Pathways to mental health consultations: A study from a tertiary care setting in India.

BACKGROUND: Research indicates that help seeking for mental health is low and often delayed. Understanding pathways to care is crucial to facilitate mental health referrals and reduce the time to consultation. METHODS: In the present study, 63 individuals were assessed on illness severity, attitudes towards help-seeking and pathways-to-care. RESULTS: Multiple pathways for therapy were noted, a delayed-pathway, two-step referral pathway and a direct-pathway. Most prominent pathway was the delayed-pathway. The direct-pathway had least treatment delay, contributed by timely recognition of symptoms by the patient. As first point of contact, patients preferred psychiatrists and popularly sought information about treatment via media. CONCLUSIONS: There are multiple pathways to consultations, often leading to treatment delay in care received. Timely recognition of symptoms was associated a direct pathway and the least delay. These findings have implications for strengthening routes to mental health specialists at early stages and increasing awareness about treatment available.

Men with and without Alcohol Dependence: A Comparative Study of Triguna, Nonattachment, Personality and Subjective Well-Being.

Context: Indian models of personality are seldom explored in relation to alcohol dependence. Triguna is an Indian model of personality originating from the Sankhya philosophy, whereby three gunas, Sattva, Rajas and Tamas describe personality features. Additionally, the trait of Non attachment which is a concept discussed extensively in Bhagavad Gita is also studied along with Triguna. Aims: The current study discusses these concepts and attempts to explore their relationship with personality and subjective well-being, among men with and without alcohol dependence. Subjects and Methods: A cross-sectional survey method was adopted, with a sample of 84 men from the community without alcohol dependence, screened through alcohol use disorders identification test and 30 men diagnosed with alcohol dependence. Informed consent was obtained from all the participants. Statistical Analysis Used: The data were analyzed using descriptive statistics, independent sample t-test, and Mann-Whitney U-test. Results: Men without alcohol dependence scored significantly higher on variables such as Sattva, extraversion and conscientiousness, positive affect, and life satisfaction, than men in the clinical group. Men who were diagnosed with alcohol dependence, scored significantly higher on Tamas, neuroticism, and negative affect. Conclusions: This novel understanding of the personality structure of patients with alcohol dependence from the Triguna perspective may be helpful in the development of indigenous psychological interventions for alcohol dependence.

Illness perceptions and health beliefs in persons with common mental disorders.

INTRODUCTION: Help seeking is crucial in the context of illness management and care. Various psychological factors impact this process of help-seeking. In this background, the present study explored illness perceptions, attitudes to help-seeking, work and social adjustment in addition to clinical correlates, in a sample of 63 treatment seeking individuals. METHODS: The study adopted a cross-sectional single group design. Participants were assessed on the Brief Illness Perception Questionnaire, Attitudes Toward Seeking Professional Psychological Help Scale, General Self-efficacy Scale, Internalized Stigma and Work and Social Adjustment Scale. RESULTS: Majority had illness duration of about 6 years and had delayed seeking treatment for about one and half years. Participants reported higher emotional reactions to illness, concerns regarding effectiveness of treatment and understanding and meaning about illness on the BIPQ. Illness perceptions were significantly correlated with work and social adjustment and attitudes toward seeking professional psychological help. General self- efficacy and internalized stigma emerged as predictors of overall work and social adjustment. CONCLUSIONS: The study has implications for interventions that need to target beliefs about illness in order to maximize help-seeking and reduce treatment gap.

Sexual dysfunction in men on buprenorphine - naloxone-based substitution therapy.

BACKGROUND: The literature on sexual dysfunction in patients on buprenorphine-naloxone (BNX) substitution is limited. MATERIALS AND METHODS: This research aimed to study the prevalence and correlates of sexual dysfunction in men on BNX substitution therapy. We recruited consecutive forty men from BNX clinic, who had received BNX for at least 6 months, who were free from any recent illicit drug use (confirmed by urine chromatographic immune assay), and who were either married or had a stable sexual partner. Men with other psychiatric and substance use disorders (except tobacco) were excluded from the study. Data for the control group were obtained from a published study (with similar selection criteria) from our center. We assessed sexual dysfunction with two cross-culturally validated instruments: Arizona Sexual Experience Scale (ASEX) and International Index of Erectile Function. RESULTS: The sample had a mean age of 31.6 (±8) years; the mean duration of BNX treatment was 9 (±4.2) months and the mean BNX dose was 4.5 (±1.6) mg. ASEX showed the prevalence of sexual dysfunction to be 40%. The IIEF demonstrated intercourse dissatisfaction (95%) and hypoactive sexual desire (92.5%) as almost universal, while 77.5% of the participants reported erectile dysfunction. In comparison to the published data, these figures were significantly more than among the controls. We found no correlation of sexual dysfunction with marital status, age, duration or dose of BNX, duration of illicit opioid use, the severity of opioid dependence, and tobacco dependence. CONCLUSION: All men on BNX maintenance therapy must be screened for sexual dysfunction. With the rapid scaling up of office-based BNX substitution, assessment and management of sexual dysfunction ought to be incorporated in the training curriculum.

The experiential impact of isolation and quarantine on patients during the initial phase of the COVID-19 pandemic in India.

BACKGROUND: Most countries around the world have been affected by the COVID-19 pandemic. Although there are quantitative studies on the effects of the COVID-19 pandemic on health-care professionals and other population groups, there are few studies that have evaluated the experiences of patients in the initial phases of the pandemic. AIM: This study aims to conduct a qualitative study assessing the experiences of the patients in isolation and quarantine in the initial stage of the COVID-19 pandemic. METHODOLOGY: The present study was a qualitative study through telephonic interviews with patients in isolation and quarantine due to COVID-19 from April 4 to 12, 2020. Patients in isolation had confirmed COVID-19 and were mandatorily admitted in specially designated COVID hospitals. Patients in quarantine were suspected to have COVID-19 due to symptoms or contact with confirmed patients with COVID-19. RESULTS: The experiences could be classified as having psychological impact, interpersonal impact, social impact, behavioral changes and impact on occupational aspects. The experience was predominantly unpleasant and characterized by anxiety, stigma, ostracization, guilt, and worry about the future. CONCLUSION: The experiences of the individuals in both the groups emphasize the importance of addressing psychological stressors. It could be concluded that individuals and their families would accordingly benefit from effective interventions to deal with the negative experiences they have been through due to the present pandemic.

Effectiveness of Mindfulness-based Cognitive Therapy in Patients with Bipolar Affective Disorder: A Case Series.

The present investigation was undertaken to examine the effects of mindfulness-based cognitive therapy (MBCT) on interepisodic symptoms, emotional regulation, and quality of life in patients with bipolar affective disorder (BPAD) in remission. The sample for the study comprised a total of five patients with the diagnosis of BPAD in partial or complete remission. Each patient was screened to fit the inclusion and exclusion criteria and later assessed on the Beck Depressive Inventory I, Beck Anxiety Inventory, Difficulties in Emotion Regulation Scale, Acceptance and Action Questionnaire-II, and The World Health Organization Quality of Life Assessment-BREF. Following preassessments, patients underwent 8-10 weeks of MBCT. A single case design with pre- and post-intervention assessment was adopted to evaluate the changes. Improvement was observed in all five cases on the outcome variables. The details of the results are discussed in the context of the available literature. Implications, limitations, and ideas for future investigations are also discussed.

Combining Metacognitive Strategies with Traditional Cognitive Behavior Therapy in Generalized Anxiety Disorder: A Case Illustration.

CONTEXT: Generalized anxiety disorder (GAD) is a challenging clinical condition to manage. Recent psychological models of GAD emphasis on the need to focus on metacognitive processes in addition to symptom reduction. AIMS: We examined the application of metacognitive strategies in addition to conventional cognitive behaviour therapy (CBT) techniques in an adult patient with GAD. SETTINGS AND DESIGNS: Asingle case design with pre- and post-assessments on clinician-rated scales was adopted. MATERIALS AND METHODS: Twelve weekly sessions of therapy were conducted on an outpatient basis. Assessments were carried out on clinical global impressions scales, Hamilton's anxiety rating scale at pre- and post-therapy points. STATISTICAL ANALYSIS: Pre- and post-therapy changes were examined using the method of clinical significance. RESULTS: A combination of traditional CBT with MCT was effective in addressing anxiety and worry in this patient with GAD. The case illustrates the feasibility of matching therapeutic strategies to patient's symptom list and demonstrates a blend of metacognitive strategies and conventional CBT strategies. CONCLUSIONS: In clinical practice, matching strategies to patient's problem list is important to be an effective approach.

Effectiveness of Metacognitive Therapy in Patients with Social Anxiety Disorder: A Pilot Investigation.

Metacognitive therapy (MCT) is a recent psychological intervention for emotional disorders. Its efficacy in social anxiety disorder (SAD) is yet to be established. AIMS: We examined the effectiveness of an MCT in patients with SAD. A two group case-control design with baseline, post, and 3 months follow-up was adopted. The control group received training in applied relaxation (AR). Four patients with Diagnostic and Statistical Manual-IV diagnosis of social anxiety were sequentially allotted to receive either MCT or AR. Patients were assessed on postevent processing (PEP), social anxiety, depression, and fear on negative evaluation. Clinical significance was calculated. MCT was more effective than AR in reducing social avoidance, PEP, and self-consciousness. While overall both interventions were effective in reducing social anxiety, MCT was marginally more effective. MCT may be a promising therapeutic approach in the management of SAD.

Mindfulness-based cognitive therapy in patients with late-life depression: A case series.

Depression is the most common mental illness in the elderly, and cost-effective treatments are required. Therefore, this study is aimed at evaluating the effectiveness of a mindfulness-based cognitive therapy (MBCT) on depressive symptoms, mindfulness skills, acceptance, and quality of life across four domains in patients with late-onset depression. A single case design with pre- and post-assessment was adopted. Five patients meeting the specified inclusion and exclusion criteria were recruited for the study and assessed on the behavioral analysis pro forma, geriatric depression scale, Hamilton depression rating scale, Kentucky inventory of mindfulness skills, Acceptance and Action Questionnaire II, The World Health Organization quality of life Assessment Brief version (WHOQO-L-BREF). The therapeutic program consisted of education regarding the nature of depression, training in formal and informal mindfulness meditation, and cognitive restructuring. A total of 8 sessions over 8 weeks were conducted for each patient. The results of this study indicate clinically significant improvement in the severity of depression, mindfulness skills, acceptance, and overall quality of life in all 5 patients. Eight-week MBCT program has led to reduction in depression and increased mindfulness skills, acceptance, and overall quality of life in patients with late-life depression.