Mental Health Programme in India: Has the tide really turned?

Mental disorders in India form a major public health concern and the efforts to tackle these dates back to four decades, by way of the National Mental Health Programme (NMHP) and its operational arm, the District Mental Health Programme (DMHP). Although the progress of NMHP (and DMHP) was relatively slower till recently, the last 4-5 years have seen rapid strides with several initiatives, including (i) expansion of DMHPs to 90 per cent of the total districts of the country, (ii) the National Mental Health Policy and (iii) strengthening the Mental Health Legislation by way of providing explicit provisions for rights of persons with mental illnesses. Among others, factors responsible for this accelerated growth include the easily accessible digital technology as well as judicial activism. Federal and State cooperation is another notable feature of this expansion. In this review, the authors summarize the available information on the evolution of implementation and research aspects related to India’s NMHP over the years and provide a case for the positive turn of events witnessed in the recent years. However, the authors caution that these are still baby steps and much more remains to be done.

Effect of photoperiod and temperature on testicular regression in Channa punctatus.

In Channa punctatus testicular regression commonly observed during spawning and postspawing phases of reproductive cycle. In the present study, testicular regression was frequently noticed in fish maintained under both long photoperiod-warm temperature (LD 16 : 8-300C) and short photoperiod-warm temperature (LD 8 : 16-30oC) regimes. Testicular regression was characterized by distortion of cellular boundary of lobules and formation of collagenous capsules containing degenerating germ cells, blood cells and colloidal mass within the lobules. The magnitude of testicular regression was more in fish exposed to short photoperiod regime (R-73.33%, SP-41.67%) than long photoperiod regime (R-50.83%, SP-19.16%) and control group (R-20.83%, SP-16.67%) in both resting (R) and spawning (SP) phases. Further, the frequency of testicular regression during resting phase was 73.33% (short photoperiod), 50.83% (long photoperiod) and 20.83% (control) whereas during spawning phase was 41.67% (short photoperiod) 19.16% (long photoperiod) and 16.67% (control). In the present study, occurrence of more testicular regression during resting phase than spawning phase may be due to change in the endogenous condition of the fish.

Psychological problems and quality of life in children with thalassemia.

OBJECTIVE: The study is aimed to assess psychological problems and quality of life (QOL) in children with thalassemia. METHODS: Thirty-nine children (8-16 yr) with transfusion dependent thalassemia attending day care services for blood transfusion were assessed for psychological problems using the Childhood Psychopathology Measurement Schedule and QOL was assessed using the EQ-5D. RESULTS: Forty-four percent of the children had psychological problems and 74% had a poor QOL. Anxiety-related symptoms (67%), emotional problems, particularly depression (62%) and conduct problems (49%) were the main findings. The children were most likely to report impaired QOL due to severe difficulties in pain/discomfort (64%) dimension, followed by depression and mobility problems of equal severity (33%). The side effects of chelation were an independent predictor of psychological problems and impaired QOL. Also psychological problems were a significant predictor of impaired QOL. CONCLUSION: The recognition and management of the psychological problems that accompany chronic physical illnesses including thalassemia would optimize treatment outcomes and QOL.

Osmotic adjustment increases water uptake, remobilization of assimilates and maintains photosynthesis in chickpea under drought.

Eight chickpea advanced breeding lines (ABLs) and their parents were evaluated for osmotic adjustment (OA), leaf carbohydrates and gas exchange under dryland field . These (ABLs) were derived from crosses between CTS 60543 x Kaniva and Tyson x Kaniva. Mean leaf water potential (LWP) fell down from -1.00 MPa at pre-stress level to about -2.25 MPa during terminal stress. Relative water content (RWC) showed periodic changes with alternate decrease or increase at certain interval, which also influenced the values of OA (low or high) in number of genotypes e.g. Kaniva, CTS 60543, Tyson and M 75. Significant variation in OA ranging 0.45 to 0.88 MPa was observed at high level of stress at -2.5 MPa. However, none of the genotypes showed stability of OA over the period of stress. Leaf starch declined even at mild stress (LWP, -1.6 MPa) resulting in an increase in hexose sugars and activation state of sucrose-phosphate synthase (SPS) that led to accumulation of sucrose. Both photosynthesis (Pmax) and transpiration decreased concurrently in two chickpea lines M 129 and Tyson with increasing water stress. However, rate of decline in the photosynthesis slowed down even drought was further intensified. The observed periodic changes in OA, RWC and photosynthesis appeared to be associated with drought-induced changes in SPS and carbohydrates which modify water uptake of the leaves.

Schizencephaly associated with bipolar affective disorder.

Schizencephaly is a rare congenital anomaly of the brain, characterized by formation of abnormal unilateral or bilateral clefts in the cerebral hemispheres. It often manifests with partial seizures, mental retardation and hemiparesis. Only two cases of schizencephaly associated with psychosis have been reported in the literature. A patient of schizencephaly, who had bipolar affective disorder is described. It has been compared with the earlier two reported cases of schizencephaly associated with pyschosis.

Depression in medical disorders.

This review highlights the occurrence of depressive disorders in medically ill patients. It discusses the difficulties in diagnosing depression in the medically ill due to the vegetative symptoms of depression which are also a feature of many medical diseases. Depression in the medically ill may be due to the disease itself, its psychological reaction, due to complications because of metabolic or other disturbances, or due to the medications for the treatment of the disease. The role of active consultation liaison between medical specialists and mental health professionals will help provide total care to the medically ill.

Emphysematous pyelonephritis: a rare presentation.

Emphysematous pyelonephritis is a rare life threatening infection in diabetes characterised by suppurative infection of renal parenchyma and perirenal tissues. It usually presents with fever, nausea, vomiting, abdominal pain, shock, lethargy, and confusion. Diabetic ketoacidosis is an uncommon presentation. In the present case, an elderly female presented with abdominal pain, fever, vomiting, and altered sensorium. She was diagnosed to have diabetic ketoacidosis with metabolic encephalopathy with right emphysematous pyelonephritis. She had an excellent response to medical treatment alone and was later discharged on oral hypoglycaemic agents.

Psychiatric symptoms in patients with non-organic chronic intractable pain.

Patients (200) with chronic intractable pain were evaluated to identify various psychiatric symptoms. Identifiable psychiatric illness, commonest being neurotic depression and anxiety states, was found in 72 per cent patients. The common symptoms reported on the present state examination (PSE) were worrying (77%), depression (40%), loss of interest (31.5%), hopelessness (16.5%), loss of weight (18%), and suicidal ideas (8%) and irritability (41.5%). Two thirds of patients had both anxiety and depression.