Study of Determinants of Somatoform Disorders in Children.

INTRODUCTION: Somatoform disorders constitute a group of illnesses that present with predominant physical symptoms for which there is no demonstrable etiology, and psychological factors are implicated in initiating, exacerbating, and maintaining the disorder. AIM AND OBJECTIVES:  The aim of this study was to study a host of factors, namely, the I.Q. of children, scholastic performance in the last three years, the past history of medical illness, psychiatric disorders in the family, and life stress in the last year, and to compare these factors with those in matched control subjects. This study looked at the effects of somatoform disorders on children's I.Q., scholastic performance in the previous three years, a history of medical illness, psychiatric disorders in the family, and life stress in the previous year. MATERIALS AND METHODS: In this case-control study, a sample was selected from the child guidance clinic of the psychiatry outpatient department (OPD) of the University Hospital, Banaras Hindu University, Varanasi, India. The time period of study was from January 2011 to June 2012. All the patients who presented to the child guidance clinic of the psychiatry OPD with one or more somatic symptoms as among their chief complaints were screened. All subjects fulfilling the selection criteria were recruited into the study. An I.Q. test was administered to the children, and the raw score for the verbal and performance tests was calculated. Children above the age of 16 years were assessed with the Wechsler Adult Performance Intelligence Scale. RESULTS: One hundred fifteen cases that fulfilled the selection criteria were studied. About 14.6% (N = 11) of the patients had a history of significant physical illness as opposed to 12.5% (N = 5) in healthy controls. The scholastic performance in the last three years of the patients group was poorer than that of the control group. The mean number of stressful life events in the patients group was 5.95±1.77 (range: 1-10), and in the control group, it was 1.25±0.43 (range: 1-3). CONCLUSION:  Compared to controls, patients had a significantly lower I.Q. and poorer scholastic performance in the last three years, a more frequent past history of medical illness, and a greater frequency of life stress in the areas of studies, health, family-related issues, and interpersonal issues.

COVID-19 pandemic hype: Losers and gainers.

BACKGROUND: Ever since the COVID-19 pandemic was declared by the WHO as a Global Public Health Emergency the COVID-19 pandemic has been hyped by the media. AIM: To review the literature on COVID-19 pandemic hype, losers and gainers. Method: Literature on COVID-19 pandemic hype, January to August 2020, was retrieved from pubmed, google scholar and news media, and reviewed. RESULTS: The COVID-19 Pandemic has been hyped directly by highly disturbing messages from the WHO, news of famous people getting infected and dying because of the coronavirus, and highlighted news in media. Indirect hype has been by fake news and verambitious attempt to contain the virus. There have been many losers and gainers of the corona hype. CONCLUSION: The COVID-19 pandemic hype has caused huge loss to the world community, but substantial gains are also being witnessed. Media coverage should be balanced. Intensive public awareness programs coupled with best possible medical treatment to symptomatic cases are recommended.

A community engaged primary healthcare strategy to address rural school student inequities: a descriptive paper.

AIM: This descriptive paper aims to describe the design and implementation of a community engaged primary healthcare strategy in rural Australia, the Primary Healthcare Registered Nurse: Schools-Based strategy. This strategy seeks to address the health, education and social inequities confronting children and adolescents through community engaged service provision and nursing practice. BACKGROUND: There have been increasing calls for primary healthcare approaches to address rural health inequities, including contextualised healthcare, enhanced healthcare access, community engagement in needs and solutions identification and local-level collaborations. However, rural healthcare can be poorly aligned to community contexts and needs and be firmly entrenched in health systems, marginalising community participation. METHODS: This strategy has been designed to enhance nursing service and practice responsiveness to the rural context, primary healthcare principles, and community experiences and expectations of healthcare. The strategy is underpinned by a cross-sector collaboration between a local health district, school education and a university department of rural health. A research framework is being developed to explore strategy impacts for service recipients, cross-sector systems, and the establishment and maintenance of a primary healthcare nursing workforce. FINDINGS: Although in the early stages of implementation, key learnings have been acquired and strategic, relationship, resource and workforce gains achieved.

Demand, End-Uses, and Conservation of Alpine Medicinal Plant Neopicrorhiza scrophulariiflora (Pennell) D. Y. Hong in Central Himalaya.

Neopicrorhiza scrophulariiflora (Pennell) D. Y. Hong of Scrophulariaceae family (hereinafter referred to as Neopicrorhiza) has medicinally important rhizomes with high levels of trade. What factors drive demand for Neopicrorhiza in Central Himalaya is unknown. In this context, a nationwide comprehensive survey was conducted from September 2016 to March 2017 to assess demand, end-uses, and conservation of dry Neopicrorhiza rhizomes in Nepal. A total of 2313 herbal products were surveyed for Neopicrorhiza as an ingredient in 38 retailer shops. Processing industries of Neopicrorhiza in Nepal were interviewed using structured questionnaire. There were 23 herbal industries manufacturing 45 types of ayurvedic medicines as end-products containing Neopicrorhiza. The volume and value of annual demand for dry rhizomes of Neopicrorhiza in Nepal were found as 6076 kg and NRs 8573236 (USD 83235.30), respectively, in 2015/016 with average 264.17 kg/industry and NRs 1410.87 (USD 13.69) per kg. The major uses of ayurvedic medicines containing Neopicrorhiza were to treat a number of disease categories: cardiovascular system/liver (17), cardiovascular system/blood (6), nervous system (6), dermatological system (4), musculoskeletal system (3), digestive system (2), respiratory system (2), genitourinal system (4), and others (1). Despite changing legal regulation, trade and consumption of Neopicrorhiza exist in Nepal. It can be concluded that domestic consumption is not the major cause of resource depletion of Neopicrorhiza in Nepal.

Patterns of change: The dynamics of medicinal plant trade in far-western Nepal.

ETHNOPHARMACOLOGICAL RELEVANCE: Combined quantitative and qualitative environmental product trade studies, undertaken in the same location over time, are instrumental in identifying plant species with commercial demand and explaining what drives temporal changes. Yet such dynamic studies are rare, including for Himalayan medicinal plants that have been large-scale traded for millennia. AIM OF THE STUDY: To (i) investigate changes in medicinal plant trade in the past 17 years, and (ii) identify the main factors driving changes, using a study of Darchula District in far-western Nepal. MATERIALS AND METHODS: Medicinal plant production network data were collected from March to August 2016, for the fiscal year 2014-15, for Darchula District in far-western Nepal through 167 quantitative (58 harvesters, 38 sub-local traders, 25 local traders, 25 central wholesalers, and 21 regional wholesalers), 61 qualitative (15 sub-local traders, 19 local traders, 15 central wholesalers, and 12 regional wholesalers) interviews, and four focus group discussions. Results were compared to previously unpublished similar data for Darchula District for the year 1997-98, using quantitative and qualitative interviews with 10 local traders, 20 central wholesalers, and 53 regional wholesalers. Data analysis was guided by an analytical framework derived from Global Production Network theory. Quantitative data were used to estimate changes in 12 indicators while the qualitative information allowed identification of the factors driving observed changes in the indicators. RESULTS: The volume of medicinal plants traded from Darchula District in the fiscal year 2014-15 was 401 t with a harvester value of USD 5.5 million, representing a 2.3 fold increase in volume and 17.2 fold increase in value compared to 1997-98. Trade in the two observation years comprised 30 air-dried plant products (from 28 identified species as well as lichens and a mineral substance); 12 products were traded in both periods, while seven disappeared, and 11 new products entered the trade. The number of traders increased from 10 to 63, mainly due to the emergence of a single high value product yarsagumba (Ophiocordyceps sinensis), a fungus-caterpillar complex which alone contributed 85% of total trade value. Over the observed time period, harvesters and traders increased their margins at the cost of central wholesalers, indicating that market changes favoured lower tier actors, eroding the previously identified passive central wholesaler oligopsony in Nepal. Important drivers of market changes are: (i) rising incomes in China and India, expressed through demand for new products and increasing per unit prices for a range of products, (ii) expanding infrastructure (roads and telecommunications) towards and into harvesting sites, reducing transport costs and increasing market efficiency, and (iii) government interventions, causing disappearance of some species from trade. These market changes also led to increased cultivation at lower altitudes, and a sharp increase in the number of processor industries in Nepal. CONCLUSION: Trade in medicinal plant products in far-western Nepal in the past two decades has increased substantially, doubling in volume and increasing 17 fold in value. There is a backbone of constantly traded species but also species that disappear from trade and new species that enter. Changes favour harvesters and traders at the benefit of central wholesalers whose previous passive oligopsony is disappearing. The three main drivers of change are rising incomes in China and India, expanding infrastructure, and government interventions in Nepal. Commercial medicinal plant resources are a substantial asset that appears to offer opportunities for economic development in far-western Nepal. The trade, however, may pose sustainability threats that are best understood by combining species-level biophysical, trade, and consumer studies.

Postpartum psychiatric disorders: Early diagnosis and management.

Postpartum period is demanding period characterized by overwhelming biological, physical, social, and emotional changes. It requires significant personal and interpersonal adaptation, especially in case of primigravida. Pregnant women and their families have lots of aspirations from the postpartum period, which is colored by the joyful arrival of a new baby. Unfortunately, women in the postpartum period can be vulnerable to a range of psychiatric disorders like postpartum blues, depression, and psychosis. Perinatal mental illness is largely under-diagnosed and can have far reaching ramifications for both the mother and the infant. Early screening, diagnosis, and management are very important and must be considered as mandatory part of postpartum care.

Social and legal aspects of marriage in women with mental illness in India.

The institution of marriage in Hindus is regulated by the prevailing social norms and the Hindu Marriage Act (HMA), 1955. Married women with mental illness are heavily discriminated. This paper examines the social and legal aspects of Hindu marriage in women with mental illness. The HMA, 1955 lays down the conditions for a Hindu marriage and also provides matrimonial reliefs: Nullity of marriage, restitution of conjugal rights, judicial separation and divorce. The application of the provisions of HMA in the setting mental illness is difficult and challenging. There is a wide gap between the legislative provisions of HMA, and societal value systems and attitudes towards marriage in Indian society. Societal norms are powerful and often override the legal provisions. The disparities are most glaring in the setting of mental illness in women. This is a reflection of social stigma for mental illness and patriarchal attitude towards women. Concerted efforts are needed to bridge the gap between the legislative provisions of HMA and societal value systems and attitudes toward marriage. Awareness programs regarding the nature and types of mental illness, advances in treatment and information about good outcome of severe mental illness will be helpful. Improvement in moral and religious values will overcome to some extent the negative attitudes and patriarchal mind set toward married women with mental illness.

Violence against women.

Violence against women (VAW) is a major public health problem in the country. The problem is grossly under-reported. A number of factors have been blamed for crimes against women. An inefficient law enforcing machinery has often been targeted for the increasing number of cases being reported. There is little recognition that psychiatric morbidity can perpetuate such crimes. Of late, there appears to a continuous increase in the number of crimes committed against women; especially the very serious ones like gang rapes. The latter have shaken the very conscience of people. Even harsher legislation does not seem to have made any effect. One wonders how this could be possible in a society heading toward high education, economic and technological development. Media has played a pivotal role by highlighting the problem to the masses. The need for the hour is for mental health professionals to take the challenge and present a comprehensive proposal for definite action to prevent all forms of VAW.

Marriage, mental illness and law.

The Special Marriage Act (SMA), 1954 and the Hindu Marriage Act (HMA), 1955 have put restrictions on the marriage of persons with mental illness, which are proving to be detrimental to patients and their families. There is an urgent need to address this problem. The deficiencies in the existing legislation have been projected and constructive suggestions have been put forward.

Hinduism, marriage and mental illness.

For Hindus, marriage is a sacrosanct union. It is also an important social institution. Marriages in India are between two families, rather two individuals, arranged marriages and dowry are customary. The society as well as the Indian legislation attempt to protect marriage. Indian society is predominantly patriarchal. There are stringent gender roles, with women having a passive role and husband an active dominating role. Marriage and motherhood are the primary status roles for women. When afflicted mental illness married women are discriminated against married men. In the setting of mental illness many of the social values take their ugly forms in the form of domestic violence, dowry harassment, abuse of dowry law, dowry death, separation, and divorce. Societal norms are powerful and often override the legislative provisions in real life situations.

Intracranial (structural) changes in obsessive- compulsive disorder: A computerized tomography scan study.

OBJECTIVE: To assess intracranial structural changes in obsessive-compulsive disorder (OCD) with CT scan. MATERIALS AND METHODS: Thirty patients of OCD between 21 and 40 years of age and fulfilling various inclusion and exclusion criteria were compared with control group. CT scans of all the patients and controls were taken and compared with regard to ventricular size, Evan's ratio and ventricular brain ratio (VBR). RESULTS: Patients of OCD were found to have greater cortical atrophy and scored significantly higher in frontal and parietal area. Only 4 patients had enlarged ventricles, and there were none with a smaller ventricle. Mean Evan's ratio of patients was lower than that of the control group but the difference was statistically nonsignificant. The mean VBR of patients was lower than that of the control group and the difference was highly significant. CONCLUSIONS: The evidence of neuro-radiological abnormalities in patients with OCD suggests that these disorders should not be considered merely functional in the traditional sense.

Training CAMHS Professionals in Developing Countries: An Indian Case Study.

This paper presents a rationale for the education of CAMHS staff and service development as a partnership between the UK and developing countries. The local context and background of child and adolescent mental health services in India are described, and the rationale for the teaching principles is outlined. The planning and delivery of the teaching, following these principles, is illustrated through a case study of work in India. The discussion focuses on what worked well, problems and difficulties faced, how these were managed, and how visitors can influence change whilst respecting the local perspective. Suggestions are made for improving future programmes so as to maximise the outcomes of such links.