Integrated brief tobacco and alcohol cessation intervention in a primary health-care setting in Karnataka.

BACKGROUND: Tobacco and alcohol use are important preventable risk factors for noncommunicable diseases and need to be addressed in primary health care. OBJECTIVES: To find the effectiveness of Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST)-based brief intervention for alcohol and tobacco in a primary health-care setting in Karnataka. METHODS: This study was conducted in 2012 where one primary health center (PHC) in Karnataka was an intervention site and other the control site. One hundred patients each in both control and intervention PHCs took part in the study. In the control PHC, patients were administered the ASSIST questionnaire and given an information pamphlet on tobacco- and alcohol-related harm. In the intervention PHC, ASSIST-based brief intervention was provided for both tobacco and alcohol cessation. At the 3rd month, ASSIST questionnaire was re-administered to record their follow-up score. Chi-square test, paired t-test, and independent sample t-test were used for statistical analysis. RESULTS: Following the initial assessment and intervention, there was statistically significant reduction in mean ASSIST scores for tobacco in both the PHCs. For alcohol, though there was reduction in scores in both PHCs, it was statistically significant only in intervention PHC. There was also a significant reduction in the number of heavy alcohol users in the intervention PHC following assessment and intervention. CONCLUSIONS: This study shows that with minimal intervention, there is reduction in the degree of both tobacco and alcohol use and calls for wider and stringent research on the same topic.

Empowering adolescents with life skills education in schools - School mental health program: Does it work?

AIM: Mental Health Promotion among adolescents in schools using life skills education (LSE) and teachers as life skill educators is a novel idea. Implementation and impact of the NIMHANS model of life skills education program studied. MATERIALS AND METHODS: The impact of the program is evaluated at the end of 1 year in 605 adolescents from two secondary schools in comparison to 423 age, sex, socioeconomic status-matched adolescents from nearby schools not in the program. RESULTS: The adolescents in the program had significantly better self-esteem (P=0.002), perceived adequate coping (P=0.000), better adjustment generally (P=0.000), specifically with teachers (P=0.000), in school (P=0.001), and prosocial behavior (P=0.001). There was no difference between the two groups in psychopathology (P - and adjustment at home and with peers (P=0.088 and 0.921). Randomly selected 100 life skill educator-teachers also perceived positive changes in the students in the program in class room behavior and interaction. LSE integrated into the school mental health program using available resources of schools and teachers is seen as an effective way of empowering adolescents.

The course of bipolar disorder in rural India.

AIM: To examine the naturalistic course of bipolar disorder in a rural, community-based, partially treated cohort. METHODS: All patients diagnosed with bipolar disorder during an epidemiological survey (n=34) in a rural area in India were followed longitudinally using standardized instruments, and the life-chart method used to examine their course. RESULTS: Seven (26%) of the 27 patients evaluated directly had not received any treatment whatsoever. Four patients (15%) had experienced rapid-cycling at some time; patients without rapid-cycling had experienced a mean 0.22 episodes/year. Episodes of mania accounted for 72% of all episodes. None of the variables examined appeared to predict the total number of episodes experienced by individual patients, although rapid-cycling occurred significantly more often if the patients had not received any psychopharmacological treatment. CONCLUSIONS: A mania-predominant course was observed in this small cohort, similar to reports from other developing countries.

Community outreach for untreated schizophrenia in rural India: a follow-up study of symptoms, disability, family burden and costs.

BACKGROUND: In resource-poor countries, there remains an alarming treatment gap for people with schizophrenia, particularly those living in rural areas. Decentralization of mental health services, including community-based outreach programmes, represents one obvious strategy for bringing appropriate care to these communities. This study set out to assess the costs and effects of such a programme in rural Karnataka in India. METHOD: Eight rural communities were visited by an outreach team, who identified cases of drug-naive or currently untreated schizophrenia. Recruited cases were provided with appropriate psychotropic medication and psychosocial support, and after obtaining informed consent were assessed every 3 months over one and a half years on symptomatology, disability, family burden, resource use and costs. A repeated-measures analysis was carried out to test for significant change in these outcome measures over this period. RESULTS: A total of 100 cases of untreated schizophrenia were recruited, of whom 28% had never received antipsychotic medication and the remaining 72% had not been on medication for the past 6 months. Summary scores for psychotic symptoms, disability and family burden were all reduced significantly, with particular improvement observed at the first follow-up assessment. Increases in treatment and community outreach costs over the follow-up period were accompanied by reductions in the costs of informal-care sector visits and family care-giving time. CONCLUSIONS: Efforts to organize community-based care such as outreach services for people with schizophrenia living in more remote areas of resource-constrained countries can bring substantial benefits to patients and families alike.

Non-compliance with treatment in patients suffering from schizophrenia: a study to evaluate possible contributing factors.

BACKGROUND: Various factors have been associated with non-compliance with treatment in schizophrenia. The aim of this study was to examine this association using standardised measures. METHOD: Compliance was determined and socio-demographic and illness variables recorded. Insight, subjective response to medication and relative's knowledge and attitude about schizophrenia were measured. RESULTS: Non-compliant patients were younger, had shorter durations of illness, had an episodic course of illness, reported side-effects less frequently, made incorrect attributions to current positive symptoms more frequently and had a more negative subjective response to medication. Key relatives of non-compliant patients were more often employed. CONCLUSIONS: Patients need to experience for themselves the merits of taking medication before accepting the need to take them long-term. Psychoeducational and cognitive-behavioral interventions need to be targeted at changing attributions to current positive symptoms. The presence of a key person in the community is crucial to improve compliance.

Development of case vignettes to assess the mental health training of primary care medical officers.

This article reports the development of case vignettes as a method of assessing the short-term in-service training of primary care medical officers in mental health care. A pool of 18 case vignettes representing common psychiatric problems and a standard response sheet were written first. This was mailed to 45 psychiatrists for their comments. Based on the comments received from 21 psychiatrists, 2 sets of questionnaires with 7 vignettes in each set were developed. When administered to a group of 32 medical officers, this method of assessment was found to be sensitive in detecting gain in knowledge and skills following training. Further, performance on case vignettes was found to correlate positively with clinical skills when actual cases were given for assessment.