Initiating tobacco cessation services in India: Challenges and opportunities.

Background: Tobacco use contributes significantly to the diseases burden in India. Very few tobacco users spontaneously quit. Therefore, beginning 2002, a network of 19 tobacco cessation clinics (TCCs) was set up over a period of time to study the feasibility of establishing tobacco cessation services. Methods: Review of the process and operational aspects of setting up TCCs was carried out by evaluation of the records of TCCs in India. Baseline and follow-up information was recorded on a pre-designed form. Results: During a five-year period, 34 741 subjects attended the TCCs. Baseline information was recorded in 23 320 cases. The clients were predominantly (92.5%) above 20 years, married (74.1%) and males (92.2%). All of them received simple tips for quitting tobacco; 68.9% received behavioural counselling for relapse prevention and 31% were prescribed adjunct medication. At six-week follow-up, 3255 (14%) of the tobacco users had quit and 5187 (22%) had reduced tobacco use by more than 50%. Data for three, three-monthly follow-ups was available for 12 813 patients. In this group, 26% had either quit or significantly reduced tobacco use at first follow-up (three-months), 21% at the second (six-months) and 18% at the third follow-up (nine-months) had done so. Conclusions: It is feasible to set up effective tobacco cessation clinics in developing countries. Integration of these services into the health care delivery system still remains a challenge.

Growing up with the families of β-thalassaemia major using an accelerated longitudinal design.

Background & objectives: It is difficult for a single investigator to study the psychosocial changes that occur over the life span of an individual affected with a chronic illness like β-thalassaemia major. Therefore, a developmental epidemiological perspective is required to understand the chain of events and problems of psychological nature. We aimed to construct the picture of developmental epidemiology for psychosocial aspects in families of β-thalassaemia major patients attending a tertiary care hospital in north India. Methods: The accelerated longitudinal design was used. The sample consisted of 100 children with β-thalassaemia and their 150 parents, both groups were subdivided further so that each group represented the continuum of longitudinal course. The sampling was done for a period of 16 months from January 2004 to April 2005. Results: Overall 54 per cent of children had significant psychopathology. Within the parents groups, 10 per cent had adjustment disorder, 33.3 per cent depressive disorder, and 10 per cent had anxiety disorder and 11 per cent somatoform disorder; 95 per cent of the parents of newly diagnosed children expressed feeling of dazed and shock, fear of death, hopelessness, separation anxiety and problems with their memory and concentration. There was significant difference only in the domain of psychological health in all the three groups of parents with respect to the quality of life. Among children, quality of life improved with their progression of illness. Growing up with β-thalassaemic family was analyzed. Interpretation & conclusions: The developmental epidemiological perspective was constructed in β -thalassaemic children and their family using an accelerated longitudinal design. Such a design can test the hypothesized aetiological or developmental function of a targeted risk factor within a developmental path and may be used in studying the psychological impact of even other chronic illnesses over the life span of an individual for conceptual and holistic understanding.

Informed consent & ethical issues in paediatric psychopharmacology.

Issues relating to informed consent and ethics in paediatric psychopharmacology limit research in this population. Children vary in their levels of cognitive development, and presence of psychiatric disorder may further impair their ability to give informed consent. In decisional impairment subjects, various methods used for consent are assent/dissent; inclusion of advance directives; and/or alternative decision-makers. India is emerging as a new market for clinical trials in recent years. Moreover, in India the sociocultural realities are different from those in the western countries making it necessary for professionals to be cautious in conducting drug trials. In this review, issues regarding informed consent in children and adolescent with psychiatric diagnosis are discussed for information, discussion and debate by professionals, parents, society and legal experts to create awareness and to facilitate development of guidelines that are appropriate and applicable to the Indian system.

Trichotillomania in children.

In this paper, we describe the sociodemographic profile, clinical characteristics and treatment outcome of 20 children with trichotillomania. These children presented to the Child Adolescent Psychiatry Clinic over a period of 6 years, with a prevalence of 1.24% . Most subjects were females (85%), hindu by religion (65%), and belonged to urban nuclear family (70%). The mean age at first presentation was 10.1 yr (SD = 4.4). Comorbid psychiatric illness and family history of psychiatric disorders was present in 40% and 20% cases, respectively. Nearly two-third of these had associated impulse; 75% denied resistance to pluck. Children who continued treatment, showed improvement.

Understanding childhood depression.

Major depressive disorder in children is a severe and a chronically disabling disorder. This population appears to be a special group in terms of consequences of poor psychosocial and academic outcome and increased risk of substance abuse, and suicide. Studies have revealed several major findings in genetic, familial, psychological, and biological aspects of such depression, some of which have explored into the issue of its relationship with adult depression. Considerable advances have been made now in the area of childhood depression providing a better understanding of its nature. We review literature available on historical aspect, epidemiology, clinical characteristics, and aetiology of childhood depression.

Prevalence of psychiatric disorders in school children in Chandigarh, India.

BACKGROUND & OBJECTIVES: Population studies on the prevalence of psychiatric disorders among children and adolescents in different countries of the world, have reported varying rates of disorders. There are very few studies in India and these vary widely in methodology and reported rates of disorders. The main objective of this research was to study the extent and nature of psychiatric disorders in school children in a defined geographical area and to study their psychosocial correlates. METHODS: School children, aged 4-11 yr, in the city of Chandigarh, were studied using multi-stage random sampling, and multi-informant assessment procedure. Teachers assessment on Rutter-B Scale (Stage I) was followed by parent interview (Stage II) for all children on the Childhood Psychopathology Measurement Schedule which is an Indian adaptation of Achenbach's Childhood Behaviour Checklist (CBCL). Children scoring above the cut-off at Stage I and/or Stage II were assessed clinically by two psychiatrists (Stage III) who interviewed parents as well as the child taking detailed clinical history and mental state examination including IQ assessment. RESULTS: 6.33 per cent of the children studied (n = 963) were found to have psychiatric disorders on ICD-10 criteria. Teacher's estimation of the prevalence rates was higher, i.e., 10.17 per cent as compared to parent's estimate i.e., 7.48 per cent. The most prevalent disorder was enuresis. INTERPRETATION & CONCLUSION: This study provides data for comparative epidemiology and highlights issues relating to cultural context of disorders in child psychiatric epidemiology.

Psychological consequences of chronic physical illnesses in children and adolescents.

Chronic illnesses in children and adolescents have devastating influence on them and their families. The patients have to cope up with illness, medication and it's influence on their development. Consequently a large number of them have emotional disorders which influence the course and outcome of physical disorder. In recent few years, research has shifted its focus from merely figuring out the prevalence of the emotional disorders to understanding the adjustment to chronic illness under defined theoretical constructs. Apart from temperamental variation, family burden and functioning have been identified as factors operating in determining adjustment. Distress experienced by the family and disturbed family functioning directly influences the emotional outcome in physically disordered children. Comprehensive coordinated care services are required for integration of these patients into the community.