Development of a Supported Education Program for Students with Severe Mental Disorders in India.

BACKGROUND: The onset of severe mental disorders (SMDs) is during adolescence or young adulthood, which affects the well-being and the educational aspirations of the students. Models of supported education practiced in the West are not culturally suitable for Indian students or the Indian education system. This study aimed to develop a Supported Education Program (SEP) for students with SMDs to help them with academic reintegration in an Indian context. METHODS AND MATERIAL: To develop the SEP, a realist review was done, followed by an in-depth interview with eight mental health professionals (MHP) and nine lecturers, using a validated interview script. After each interview, interim analysis and modifications were done to improve the rigor of the interview. After all interviews, the SEP was circulated for a second round of iteration for consensual validation by four mental health experts. The outcome of the entire process was the final version of SEP for students with SMDs. RESULTS: The final SEP had two broad themes and 18 subthemes from the qualitative thematic analysis: theme 1 included issues and strategies relevant to the client or caregivers, and theme 2 was pertinent to the education system. CONCLUSION: The SEP developed and validated for people with SMDs has distinctive components: one for the individual and caregiver and the other for the educational system.

Palliative Care in Duchenne Muscular Dystrophy: A Study on Parents' Understanding.

INTRODUCTION: Duchene muscular dystrophy (DMD) is a neuromuscular disease of childhood, which has clear progression. The international standardized care guidelines for DMD suggest that palliative care is essential for the affected children. OBJECTIVE: To explore the parent's understanding of palliative care services available for children with DMD and the challenges faced by them in utilizing the same. METHODS: A cross-sectional qualitative exploratory study was conducted among six families of boys diagnosed with DMD. A semi-structured interview guide with prompts was used to conduct in-depth interviews which lasted for an average of 1 h. Thematic analysis was done to identify the pattern or themes. RESULTS: The major themes identified were "palliative care, living with DMD, Awareness about palliative care services and challenges." Awareness about palliative care services is the dominant theme identified as influencing rest of the experiences narrated by the parents of children with DMD. DISCUSSION: Integration of palliative care services from an early stage of the illness can help the child to make transition from one stage to another stage of the illness. To ensure the utilization of the available palliative care services, there is a need to create awareness about it among the general public. CONCLUSION: Introducing the concept of palliation of symptoms and ensuring quality of life of the child with DMD by accessing the available services can aid the parents to reach out for help for their child.

COVID-19-related anxiety and concerns expressed by pregnant and postpartum women-a survey among obstetricians.

This paper from India describes anxieties that pregnant and postpartum women reported to obstetricians during the COVID-19 pandemic. Of the 118 obstetricians who responded to an online survey, most had been contacted for concerns about hospital visits (72.65%), methods of protection (60.17%), the safety of the infant (52.14%), anxieties related to social media messages (40.68%) and contracting the infection (39.83%). Obstetricians felt the need for resources such as videos, websites and counselling skills to handle COVID-related anxiety among perinatal women.

Denial of Pregnancy: Psychopathology and Clinical Management.

Denial of pregnancy (DOP) is a challenging condition with poorly understood psychopathology. DOP is reported to be associated with problems such as severe psychological conflicts, obstetric complications, risks to the newborn, and difficulties in bonding with the infant. In this paper, we present and discuss the clinical manifestations of a severe form of DOP that lasted until the time of delivery with resultant multifaceted complications. Our paper highlights the severity of psychopathology and the need for coordinated management. Descriptions from different cultural backgrounds would improve the conceptual understanding of DOP.

Barriers to academic reintegration in students with severe mental disorders: Thematic analysis.

BACKGROUND: Education provides a platform to persons to integrate into society for their livelihood. In countries like India, higher education is accorded a significant place in society and is an important pre-requisite for most professional and skilled occupations. However there are a number of illness related and psychosocial barriers to attaining educational goals, especially for persons with Severe Mental Disorders (SMDs'). The purpose of this qualitative study is to understand the bio-psychosocial barriers of students with severe mental disorders to academic reintegration. METHODS: Qualitative in-depth interviews were conducted with Mental Health Professionals (MHP's) (n = 8), Lecturers (n = 9) and Students with SMD's (n = 14). The interviews were audio recorded, transcribed and coded into themes and sub-themes separately for each group manually. Triangulation of the themes derived data collected from the three groups were subject to thematic content analysis. RESULTS: A total of five barriers (themes) to academic reintegration were derived from triangulated data: 1. Illness and its treatment-related barriers, 2. Individual related barriers, 3. Family-related barriers, 4. Academic-related barriers and 5. Social barriers. CONCLUSION: It is important for mental health professionals and researcher in the field to understand the above barriers in order to plan and implement supported education programmes effectively and enable the students to attain their post-secondary educational goals.

Intelligence and cognition in a child with high functioning autism.

Intelligence is assessed for ruling out mental retardation and to find out the relative cognitive strengths in autism. Of special interest is to know the nature of intelligence and cognition in high functioning autism. But very little is known how the assessments are carried given the deficits in communication, socialization in autism. This cross-sectional study aims to describe the nature of intelligence and cognition in a child with HFA and drawing implications for assessment in the Indian setting. Results indicate that there is no evidence for superior crystallized intelligence in HFA, though a jagged profile could be expected both across and within cognitive domains.

Mountaineering expedition by persons with intellectual disability: impact on behavior and temperament.

The recreational needs of adults with intellectual disability are the same as those of the general population. If properly planned, recreational activities can facilitate positive behavioral changes. In this context, this present study was designed to understand the effects of a mountaineering expedition on the behaviors and temperament in a group of people with intellectual disability. The study included eight men and two women with intellectual disability aged 17-38 years. After a training programme, the participants went on an 11 day expedition in the Himalayan region under the supervision of professionals and two parents. Results indicated that all of them successfully climbed mountains up to 12,000 feet, and also had specific positive behavioral changes. Details and implications are discussed in this article.

The depression - happiness scale and quality of life in patients with remitted depression.

With the aim of studying validity of Depression-Happness Scale (D-HS) in the assessment of bipolarity of affect in patients with remitted depression and its impact on quality of life, 31 patients of both genders, aged 17 to SO , fulfilling the ICD-10 criteria for recurrent deppressive disorder and bipolar affective disorder, currently severe depression and single episode severe depression were included in the study. Patients were rated on Hamilton Depression Scale (HDRS) on the third day of their admission.After treatment, when patients had remitted (either symptom free or 50% reduction in HDRS scores), D-HS and WHOBREF QOL were administered. Results indicated that the D-HS is valid measure of bipolar affect. Its correlation with final HDRS scores (r=-.356;P< 05) and overall quality of life (r=.46;P< .0l) confirm the convergent and construct validity of D-HS . Implications are discussed along with the possibility of using D-HS for clinical and research purpose.