Contours of Positive Mental Health: An Exploratory Delphi Study from India.

The need to broaden attention from a narrow focus on mental illness and pathology to investing in understanding and enhancing positive mental health is well recognized. The bulk of research on positive mental health tends to be largely based onwestern developed nationconceptualizations. This highlights the need to examine the construct of positive mental health in diverse socio-cultural contexts. Present study aimed at exploring indicators and dimensions of positive mental health in Indian adults. A two-step Delphi technique, involving a vignette- based tool was used for facilitating a contextualised understanding of indicators of positive mental health. The sample consisted of a panel of 35 experts from different regions of India, majority of whom had >10 years of professional experience. Using a bottom-up approach, content analysis of the emergent data in terms of responses of experts to 10 vignettes resulted in identification and operationalisation of 33 indicators which could be grouped under 13 dimensions. Comparisons with popular well-being frameworks indicated that eight of these could be considered newer dimensions. Though the remaining dimensions significantly overlapped with existing dimensions of well-being in the western literature; finer differences in their meanings and constituents were observed. Finding have implications for further research.

Mental health literacy in family caregivers: A comparative analysis.

The present study was undertaken to examine the current level of mental health literacy in family caregivers and to compare the changes over a 23-year period between 1993 and 2016. The current sample consisted of 60 family caregivers of patients with major mental illness from the in-patient and out-patient departments of NIMHANS, assessed on the Orientation towards Mental Illness Scale (OMI). This was compared with data of 80 family caregivers from previous study done in 1993. Family caregivers in the current study showed a significant positive trend on comparison with the previous study. However, area of abnormal behaviour shows a worsening of negative attitudes. Hopelessness and hypo-functioning, relating to the factor of after-effects of mental illness show no significant difference. While knowledge about mental illnesses can be improved by providing information, this does not automatically translate to integration of the mentally ill in society. Current initiatives need to be matched with specific and sustained efforts to reduce stigma associated with mental illness which have persisted unchanged.

Ethical dilemmas experienced by clinical psychology trainee therapists.

Ethical dilemmas are inevitable during psychotherapeutic interactions, and these complexities and challenges may be magnified during the training phase. The experience of ethical dilemmas in the arena of therapy and the methods of resolving these dilemmas were examined among 35 clinical psychologists in training, through an anonymous and confidential online survey. The trainees' responses to four open-ended questions on any one ethical dilemma encountered during therapy were analysed, using thematic content analysis. The results highlighted that the salient ethical dilemmas related to confidentiality and boundary issues. The trainees also raised ethical questions regarding therapist competence, the beneficence and non-maleficence of therapeutic actions, and client autonomy. Fifty-seven per cent of the trainees reported that the dilemmas were resolved adequately, the prominent methods of resolution being supervision or consultation and guidance from professional ethical guidelines. The trainees felt that the professional codes had certain limitations as far as the effective resolution of ethical dilemmas was concerned. The findings indicate the need to strengthen training and supervision methodologies and professional ethics codes for psychotherapists and counsellors in India.

Cognitive deficits and its relation with psychopathology and global functioning in first episode schizophrenia.

AIM: The aim was to examine the cognitive deficits profile in first episode schizophrenia patients as well as examine the correlation between cognitive deficits, psychopathology and global functioning. Better understanding of these various facets of this debilitating illness is imperative in planning treatment, thereby limiting decline in global functioning. METHODS: Forty-nine schizophrenia patients with illness duration less than two years comprised the sample. A comprehensive battery of neuropsychological tests, the Positive and Negative Syndrome Scale and WHO Disability Assessment schedule were administered to assess cognitive functions, psychopathology and global functioning respectively. RESULTS: Cognitive deficit quotient for each patient was calculated. In this cohort 16.3% of patients had less than 25% of cognitive deficits, 38.8% had 25-50% of cognitive deficits, 36.7% had 50-75% of cognitive deficits and 8.2% of patients had more than 75% cognitive deficits. More than 50% of the patients in the present cohort showed deficits in the domains of attention, executive functions and learning and memory. Psychopathology significantly correlated with global functioning. Negative symptoms significantly correlated with cognitive functions of motor speed, attention and executive functions. Step wise linear regression analysis showed that duration of illness, attention (sustained attention), executive function (response inhibition), negative and positive psychopathology predicted level of global functioning at varied levels. CONCLUSIONS: Cognitive deficits in multiple domains were observed in the present cohort. Attention and executive functions predicted global functioning. There is a need for longitudinal studies with larger sample to examine the course of the cognitive deficits with progress in illness.

Addition of home-based cognitive retraining to treatment as usual in first episode schizophrenia patients: a randomized controlled study.

OBJECTIVE: We examined the effectiveness of a 2-month-long home-based cognitive retraining program together with treatment as usual (TAU; psychoeducation and drug therapy) on neuropsychological functions, psychopathology, and global functioning in patients with first episode schizophrenia (FES) as well as on psychological health and perception of level of family distress in their caregivers. MATERIALS AND METHODS: Forty-five FES patients were randomly assigned to either treatment group receiving home-based cognitive retraining along with TAU (n=22) or to control group receiving TAU alone (n=23). Patients and caregivers received psychoeducation. Patients and one of their caregivers were assessed for the above parameters at baseline, post-assessment (2 months) and at 6-months follow-up assessment. RESULTS: Of the 45 patients recruited, 12 in the treatment group and 11 in the control group completed post-intervention and follow-up assessments. Addition of home-based cognitive retraining along with TAU led to significant improvement in neuropsychological functions of divided attention, concept formation and set-shifting ability, and planning. Effect sizes were large, although the sample size was small. CONCLUSIONS: Home-based cognitive retraining program has shown promise. However, further studies examining this program on a larger cohort with rigorous design involving independent raters are suggested.

Online infidelity: The new challenge to marriages.

Increased usage of the Internet has given rise to a new challenge to marriages: That of online infidelity, which is perceived to be as traumatic as actual infidelity. This article highlights the negative impact of online infidelity on marital relationship and its detrimental effect on the mental health of the offended spouse using a case vignette. The article discusses the importance of marital therapy in dealing with the factors contributing to online infidelity and in rebuilding marital trust.