Factors Associated with Family Retention or Involvement in Treatment of Persons with Severe Mental Illness: A Scoping Review.

Objective: A scoping review was conducted to detect the factors that affect family retention (FR) or involvement (FI) in the treatment of persons with severe mental illness (PwSMI) and to understand the gaps in this research area. Design: We included studies that described factors associated with FR/FI in the treatment of persons with PwSMI. English language articles available in full text, published until June 2022, were included. The literature search was carried out in four major electronic databases, such as PubMed, Scopus, ProQuest, and EBSCOhost, for 6 months from January 2022 to June 2022, which yielded 5442 articles, of which six (four primary studies and two secondary studies) were considered for the final scoping review as per the inclusion criteria. Results: Five major categories of factors were identified: (a) family level, (b) professional level, (c) mental health system level, (d) related to characteristics of the patient and illness, and (e) related to the external environment. Most studies described barriers to FI, while only a few elaborated on facilitators for FI/FR. Systemic and family-level factors were the major contributors to the barrier to FI and FR in the treatment of people with PwSMI. Conclusion: There is a dearth of literature in the field of FR/FI in the treatment of people with schizophrenia. More research is required so that holistic interventions can be designed and provided.

Prevalence of Psychiatric Disorders in Chhattisgarh: Findings from National Mental Health Survey.

Background: Psychiatric disorders are among the leading contributors to disability in India and worldwide. The pattern, prevalence, and distribution of psychiatric disorders in the country and its regions need to be assessed to facilitate early diagnosis and treatment. No study on the epidemiology of psychiatric disorders has been conducted in the Chhattisgarh state. This paper, as part of the National Mental Health Survey (NMHS), discusses the prevalence and pattern of psychiatric disorders in Chhattisgarh state. Methods: A stratified random cluster sampling technique and random selection based on probability proportional to size (PPS) at each stage were adopted. Participants were from three selected districts of Chhattisgarh, such as Janjgir-Champa, Kabirdham, and Raipur. Adults (aged ≥18 years) residing in selected households were interviewed using Mini International Neuropsychiatric Interview (version 6.0), the Fagerstrom test for nicotine dependence, the WHO-SEARO screening questionnaire for generalized tonic-clonic seizures, and screening tools for intellectual disability and autism spectrum disorders. Results: A total of 2841 individuals were interviewed. The state's lifetime and current prevalence of psychiatric disorders for adults were 14.06% [95% confidence interval (CI) = 13.83-14.29] and 11.66% (95% CI = 11.45-11.87), respectively. Prevalence of substance use disorders, tobacco use disorders, schizophrenia and related disorders, and mood disorders was 32.4% (95% CI = 32.09-32.71), 29.86% (95% CI = 29.56-30.16), 0.8% (95% CI = 0.75-0.86), and 4.44% (95% CI = 4.31-4.58), respectively. High risk for suicide was detected in 0.28% (95% CI = 0.25-0.31). Psychiatric disorders were twice more common in males than in females. Conclusions: The study gives authentic data on the prevalence of psychiatric disorders in Chhattisgarh. This shall pave the way for policymakers and planners to design state-specific plans for dealing with mental disorders and related issues.

Occupational factors associated with long-term abstinence among persons treated for alcohol dependence: A follow-up study.

Background: Several studies have examined the occupational factors associated with alcohol use and dependence. However, there are very few studies that investigated the role of occupational factors associated with long-term abstinence among persons treated for alcohol dependence in India. Aim: To examine the occupational factors associated with long-term abstinence among persons treated for alcohol dependence. Methods: Sixty in-patients treated for alcohol dependence were selected using inclusion criteria from the Government-run de-addiction center, tertiary care teaching hospital, Bangalore. All patients were followed up periodically for 1 year. The semi-structured interview schedule was used for collecting data on occupational factors associated with long-term abstinence. Descriptive statistics, Chi-square test, and Fisher exact test were used for data analysis. Results: There was a positive trend showing self-employed (pf = 1.74, P = 0.45), having skilled work (pf = 1.52, P = 0.72), regular pattern of employment (pf = 1.21, P =.60), monthly mode of income (pf = 1.43, P =.76) were factors associated with abstinence. Among eight occupational variables, employment status (x 2 = 4.0, P =.04) and having well-defined working hours ((pf = 6.18, P =.04) were significantly associated with long-term abstinence among persons treated for alcohol dependence. Conclusion: Occupational factors seem to influence the outcome in alcohol dependence and appropriate vocational interventions would be effective in promoting long-term abstinence.

Barriers to Disclosure of Intimate Partner Violence among Female Patients Availing Services at Tertiary Care Psychiatric Hospitals: A Qualitative Study.

BACKGROUND: Intimate partner violence (IPV)/domestic violence is one of the significant public health problems, but little is known about the barriers to disclosure in tertiary care psychiatric settings. METHODOLOGY: One hundred women seeking inpatient or outpatient services at a tertiary care psychiatric setting were recruited for study using purposive sampling. A semi-structured interview was administered to collect the information from women with mental illness experiencing IPV to know about their help-seeking behaviors, reasons for disclosure/nondisclosure of IPV, perceived feelings experienced after reporting IPV, and help received from the mental health professionals (MHPs) following the disclosure of violence. RESULTS: The data revealed that at the patient level, majority of the women chose to conceal their abuse from the mental health-care professionals, fearing retaliation from their partners if they get to know about the disclosure of violence. At the professional level, lack of privacy was another important barrier for nondisclosure where women reported that MHPs discussed the abuse in the presence of their violent partners. CONCLUSION: The findings of the study brought out the need for mandatory screening of violence and designing tailor-made multicomponent interventions for mental health care professionals at psychiatric setting in India.

Group interventions.

Over the past four decades, psychiatric social workers have been conducting group interventions for persons with substance use disorders at NIMHANS. In this article, the authors highlight the brief history of group therapy, differences between group therapy and group work, and purpose and indicators of group therapy. This article sheds light on practical aspects of conducting group interventions for persons with substance use disorders and skills required by the group therapist for conducting the same andbenefits of attending group interventions. Research studies carried out at NIMHANS on group intervention for persons with substance use disorders, assessing group processes, dynamics and outcome of group interventions have been highlighted as well.

Do stress and support matter for caring? The role of perceived stress and social support on expressed emotion of carers of persons with first episode psychosis.

BACKGROUND: Caring for a person with first episode psychosis (FEP) is a challenging and distressing task for the carers. The carers' stress in the early stage of psychosis can increase their expressed emotion (EE) while social support is hypothesized to decrease EE. However, the influence of stress and social support on carers' EE is not well understood in FEP. AIM: To examine how the stress and social support shape expressed emotion in the carers of FEP. METHODS: Seventy one carers of the patients with non-affective FEP were recruited from the inpatient psychiatry ward of a tertiary mental health care center in South India. The family questionnaire, perceived stress scale and multidimensional scale of perceived social support were used to measure their EE, stress and social support respectively. RESULTS: Carers experienced high level of perceived stress, EE and poor social support. Perceived stress significantly increased EE (ß=0.834; p<0.001) and social support did not significantly influence EE (ß=-0.065; p>0.05). Perceived stress predicted 76 percent of the variance on EE (Adjusted R2=0.761). CONCLUSION: The results emphasize high level of stress and EE in carers of patients with FEP that implies the need for appropriate psychosocial interventions to manage their stress.

Association of hyponatremia with in-hospital outcomes in infective endocarditis: A 5-year review from an Indian Intensive Care Unit.

Hyponatremia is commonly noted with cardiovascular disorders, but its role in infective endocarditis (IE) is limited to being a marker of increased morbidity in IE patients with intravenous drug use. This was a 5-year retrospective review from an Indian Intensive Care Unit (ICU). Patients >18 years with IE and available serum sodium levels were included in the study. Pediatric and pregnant patients were excluded from the study. Hyponatremia was defined as admission sodium <135 mmol/L. Detailed data were abstracted from the medical records. Primary outcomes were need for invasive mechanical ventilation, ICU length of stay, and in-hospital mortality. Secondary outcomes included development of acute kidney injury, acute decompensated heart failure (ADHF), acute respiratory distress syndrome, stroke, and severe sepsis in the ICU. Two-tailed P < 0.05 was considered statistically significant. Between January 2010 and December 2014, 96 patients with IE were admitted to the ICU with 85 (88.5%) (median age 46 [34.5-55] years, 51 [60.0%] males) meeting our inclusion criteria. The comorbidities, echocardiographic, and microbiological characteristics were comparable between patients with hyponatremia (56; 65.9%) and eunatremia (29; 34.1%). Median sodium in the hyponatremic cohort was 131 mmol/L (127.25-133) compared to the eunatremic cohort 137 mmol/L (135-139) (P < 0.001). The primary outcomes were not different between the two groups. Hyponatremia was associated more commonly with ADHF (12 [21.4%] vs. 0; P = 0.007) during the ICU stay. Hyponatremia is commonly seen in IE patients and is not associated with worse hospital outcomes. ADHF was seen more commonly in the hyponatremic patients in comparison to those with eunatremia.

Discrimination against differently abled children among rural communities in India: Need for action.

BACKGROUND: Persons with disabilities comprise at least 4 to 8 percent of the Indian population. Children with disabilities in India are subject to multiple deprivations and limited opportunities in several dimensions of their lives. Their families and caregivers also go through lot of stress and challenges in having a person with disability at home which ultimately leads to grave discriminatory practices towards these children. MATERIALS AND METHODS: The article attempts to analyze and describe the common discriminatory grounds that children with disabilities commonly face from their immediate families and from the larger community through analyzing the filed visit reports of the Basic Needs India Staff providing on job training (handholding support) for the community based rehabilitation workers. RESULTS: The case studies describes the various ugly forms of the discriminatory practices seen in the community towards differently abled children, same been categorized as denial of disability, physical restraints, social boycott, denial of property rights, decreased marital life prospects due to disabled member in family, implications on sexuality of people with disability, women with disability, discrepancies in state welfare programs, and problems in measuring disabilities. CONCLUSION: During the last two decades, there has been a growing realization that institutional care for the disabled is not entirely suitable for their individual needs, dignity and independence. A movement towards community based rehabilitation has picked up pace and contribute toward greater independence and self sustainability of the disabled.

Needs of siblings of persons with psychosis: a systematic descriptive review.

Research on caregivers of psychosis has predominantly focused on parents and spouses. Issues related to siblings of persons with psychosis (SOPP) are yet to be evaluated comprehensively. Like parents and spouses, SOPP also share the caregiver burden and have their own issues and needs. This systematic descriptive review aims to identify the types of needs of SOPP in the published literature and gives implications for further practice and research. The primary data search was carried out with predefined protocol in PubMed database and an additional hand search was done in EBSCOhost, ProQuest, Scopus, and PsychINFO. All the searches yielded a total of 862 titles. After screening for necessary inclusion criteria, seven studies were included in the final review. The results are discussed under six major themes that emerged from this review. Six out of seven studies highlighted the need for information on siblings' illness and participation in caregiver support group. Other important needs were illness management or rehabilitation needs; help in managing their own psychosocial issues; treatment related informational needs; and inclusion in treatment process. The socio-demographic details of these studies showed that majority of the participants were female siblings of Caucasian or white British ethnicity and from developed countries. SOPP predominantly have specific needs such as informational and support group needs, which are different in the priority of other primary caregiver needs. Paucity of literature from developing countries and the limitations of the existing studies warrant further systematic research.

Leptospirosis and dengue fever: a predictive model for early differentiation based on clinical and biochemical parameters.

Leptospirosis and dengue fever are increasingly seen as causes of tropical febrile illness and often are clinically indistinguishable. This two-year prospective study from a tertiary care centre comprised 200 patients including 68 men (mean 34.8 years) with dengue and 73 (mean 46.19 years) with leptospirosis. Oliguria, icterus, muscle tenderness, anaemia, leukocytopenia, thrombocytopenia, elevated erythrocyte sedimentation rate (ESR), acute renal failure (ARF) and hypoalbuminaemia appeared more commonly in leptospirosis in comparison to dengue. Eighteen per cent mortality was observed in leptospirosis compared to one per cent in dengue. ARF, hyperbilirubinaemia, acute respiratory distress syndrome (ARDS), creatine kinase (CK) elevation and thrombocytopenia were predictors of death in leptospirosis and thrombocytopenia, ARDS and ARF predictors of death in dengue. On receiver operating characteristics (ROC) analysis, leucocytosis >11000/mm(3), ESR >40 mm, serum creatinine >2 mg/dL, total serum bilirubin >2 mg/dL, CK >500 U/L and serum albumin <3 mg/dL were more likely to be an indication of leptospirosis at presentation compared to dengue.

Therapeutic efficacy of add-on yogasana intervention in stabilized outpatient schizophrenia: Randomized controlled comparison with exercise and waitlist.

BACKGROUND: Schizophrenia is a highly disabling illness. Previous studies have shown yoga to be a feasible add-on therapy in schizophrenia. AIMS: The current study aimed to test the efficacy of yoga as an add-on treatment in outpatients with schizophrenia. SETTINGS AND DESIGN: The study done at a tertiary psychiatry center used a single blind randomized controlled design with active control and waitlist groups. MATERIALS AND METHODS: Consenting patients with schizophrenia were randomized into yoga, exercise, or waitlist group. They continued to receive pharmacological therapy that was unchanged during the study. Patients in the yoga or exercise group were offered supervised daily procedures for one month. All patients were assessed by a blind rater at the start of the intervention and at the end of 4 months. RESULTS: Kendall tau, a nonparametric statistical test, showed that significantly more patients in the yoga group improved in Positive and Negative Syndrome Scale (PANSS) negative and total PANSS scores as well as social functioning scores compared with the exercise and waitlist group. Odds ratio analysis showed that the likelihood of improvement in yoga group in terms of negative symptoms was about five times greater than either the exercise or waitlist groups. CONCLUSION: In schizophrenia patients with several years of illness and on stabilized pharmacological therapy, one-month training followed by three months of home practices of yoga as an add-on treatment offered significant advantage over exercise or treatment as usual. Yoga holds promise as a complementary intervention in the management of schizophrenia.

Calcium binding properties of gamma-crystallin: calcium ion binds at the Greek key beta gamma-crystallin fold.

The beta- and gamma-crystallins are closely related lens proteins that are members of the betagamma-crystallin superfamily, which also include many non-lens members. Although beta-crystallin is known to be a calcium-binding protein, this property has not been reported in gamma-crystallin. We have studied the calcium binding properties of gamma-crystallin, and we show that it binds 4 mol eq of calcium with a dissociation constant of 90 microm. It also binds the calcium-mimic spectral probes, terbium and Stains-all. Calcium binding does not significantly influence protein secondary and tertiary structures. We present evidence that the Greek key crystallin fold is the site for calcium ion binding in gamma-crystallin. Peptides corresponding to Greek key motif of gamma-crystallin (42 residues) and their mutants were synthesized and studied for calcium binding. These peptides adopt beta-sheet conformation and form aggregates producing beta-sandwich. Our results with peptides show that, in Greek key motif, the amino acid adjacent to the conserved aromatic corner in the "a" strand and three amino acids of the "d" strand participate in calcium binding. We suggest that the betagamma superfamily represents a novel class of calcium-binding proteins with the Greek key betagamma-crystallin fold as potential calcium-binding sites. These results are of significance in understanding the mechanism of calcium homeostasis in the lens.

Neuropsychiatric morbidity in a beggars' colony.

A begger's colony where a neuropsychiatric extension clinic is being run by NIMHANS, Bangalore, was selected for this study wherein 78 neuropsychiatrically ill inmates and 85 well ones were examined and diagnosed as per I.C.D.-9 and followed up on treatment. A period prevalence of 131.09/1000 serious neuropsychiatric morbidity was found with psychoses, mental retardation and epilepsy being more frequent than in general population studies. Findings in this study, point towards a need for reaching neuropsychiatric care to this section of society, and also confirm the association of certain social factors with serious morbidity.