Substance abuse as a way of life in marginalized gender identity disorder: a case report with review of Indian literature.

Persons suffering from gender identity disorder (GID) are often severely marginalized in India and mostly live outside the society as a part of a minority community called the Hijras. Although substance abuse is considered a way of life in them, such patients rarely seek treatment because of the stigma and fear of discrimination. We report a case of GID presenting to tertiary care centre for treatment of multiple substance use dependence (SUD). The case is the first to highlight the use and dependence of multiple substances in the Hijra community of India. Further, the case emphasizes that SUD treatment might be a worthwhile intervention to bring such marginalized population under treatment, when further complicated issues on gender identity can be addressed.

Mental health problems following the 2005 earthquake in Kashmir: findings of community-run clinics.

INTRODUCTION: Events such as earthquakes are followed by significant psychiatric morbidity due to the enormous damage caused to life, health, property, and other resources in the affected area. In October 2005, a devastating earthquake occurred in Kashmir in India. A team of mental health professionals visited the earthquake stricken area to provide mental health services five weeks after of the event. METHODS: The team conducted clinics at > 30 sites in different villages in the area. This paper describes the mental health problems encountered in those communities. RESULTS: All patients seen in the clinics had their houses destroyed by the earthquake. Nearly one-fourth had suffered serious physical injuries and 12% had lost one of their family members. Common psychiatric diagnoses included adjustment disorders (39.6%), depressive episode (22.6%), and other stress disorders (21.8%). Only 10 (3.3%) patients were found to suffer from posttraumatic stress disorder (PTSD), though PTSD-like symptoms were reported by more than two-thirds of the patients. CONCLUSIONS: Adjustment disorders, depression, other stress reactions, and PTSD-like symptoms were the common mental health problems five to six weeks following an earthquake.