Awareness and attitude about mental illness in the rural population of India: A mixed method study.

Context: Recent systematic review and meta-analysis of public attitudes have shown that despite improvements in mental health literacy, public attitudes and desire for social distance with mental illnesses have remained stable over time. Aims: To assess the awareness and attitude of the rural community towards mental disorders using the CAMI scale. Materials and Methods: This mixed method study was conducted under the ICMR-STS grant scheme after IEC approval. It included administration of a pre-tested questionnaire adapted from CAMI scale on 196 adults aged 18-60 years from an adopted village in the field practice area of medical college along with 8 in-depth interviews of key people in the same community. Thematic analysis was done for the qualitative part whereas for the quantitative part, Pearson's correlation coefficient, independent t-test, ANOVA and Kruskall-wallis test were used. Results: Age was positively correlated with the attitude of authoritarianism, social restrictiveness, CMHI and showed a negative correlation with attitude of benevolence. Females showed higher scores for authoritarianism and social restrictiveness. There was a statistically significant difference between APL and BPL groups for authoritarianism attitude towards the mentally ill (P value = 0.02) and CMHI (P value = 0.033). It was observed that with increase in the education levels there was a rise in the mean score of the values for the attitude of benevolence but the difference wasn't statistically significant (P > 0.05). Thematic analysis of the key informant interviews suggested various perceptions of the community regarding mental illness, available options for management, current practices of the community and what can be done further to improve facilities for mental health. Conclusions: People in the community have a varied perspective to mental illnesses which has changed for the better over time but community still approaches quacks first which warrants the need for more awareness. For this, feasibility and effectiveness of increasing involvement of females from the community in health-related decisions can be explored further. We recommend further awareness generation in the younger generation with community-based research on perceptions of the community about mental health. This will provide more practical and feasible solutions to complement the national mental health program.

Vitalizing Community for Health Promotion Against Modifiable Risk Factors of Noncommunicable Diseases (V-CaN) in Rural Central India: Protocol for a Hybrid Type II Implementation Effectiveness Trial.

BACKGROUND: Low- and middle-income countries are facing the emerging burden of chronic noncommunicable diseases (NCDs). Apart from loss of human lives and premature deaths, NCDs result in huge costs for treatment to individuals and the health system. Although NCDs develop in later life, the risk factors begin at an early age. The key to the control of the global epidemic of NCDs is primary prevention based on comprehensive community-based programs. OBJECTIVE: This study aims to develop, implement, and evaluate the effect of a participatory health promotion initiative utilizing the existing mechanisms of Village Health Nutrition and Sanitation Committees (VHNSCs), women's self-help groups (SHGs), and schools on modifiable risk factors for NCDs among young people aged 10-30 years. METHODS: The proposed type II hybrid effectiveness implementation cluster randomized field trial will be conducted in the catchment area of 4 primary health centers (PHCs) in Wardha district, India, comprising 100 villages with a population of 144,000. Each PHC will be randomly allocated to one of the 3 intervention arms or the control arm. The 3-intervention arm PHCs will utilize a unique strategy with either VHNSC or SHG members or school students as change agents for health action against common modifiable NCD risk factors. This study will be implemented in 3 phases from January 2022 to December 2024. First, the preparatory phase for baseline assessments includes anthropometry, behavioral and biochemical risk factors for NCDs, and participatory development of the health promotion intervention modules. Second, the implementation phase will focus on capacity building of the change agents and implementation of the participatory health promotion initiative. The implementation will include organization of community-based events, 6-monthly participatory assessment of change, and preparation of a sustainability and exit plan toward the end of this phase. Third, the evaluation phase will consist of studying the effectiveness of each intervention strategy in the reduction of risk factor prevalence at the population level. RESULTS: We will assess 12,000 (3000 in each arm) randomly selected individuals for behavioral risk factors and 1600 (400 in each arm) individuals for biochemical risk factors during baseline as well as endline assessments. Difference in differences, ANOVA or multivariate analysis of covariance, and regression analysis will be performed to assess the effectiveness of the interventions. Qualitative methods such as focus group discussions and stories of change will be documented and analyzed using thematic framework analysis. The implementation outcomes will be reported using the PRISM (Practical Robust Implementation and Sustainability Model) RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. The results are expected to be published by mid-2025. CONCLUSIONS: This study will show the magnitude of risk factors for NCDs, its determinants, feasibility, effectiveness of community-based interventions, and health promotion models for NCD prevention. TRIAL REGISTRATION: Clinical Trials Registration India CTRI/2020/10/028700; https://ctri.nic.in/Clinicaltrials/showallp.php?mid1=47597&EncHid=&userName=V-CaN. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/42450.

Clinical features and outcomes in acute psychosis: A retrospective hospital-based study in rural patients of central India.

Background: Acute and transient psychotic disorder (ATPD) is a distinct diagnostic category (F23) in ICD-10 which includes non-schizophrenic and non-affective psychoses following a transient course. The clinical features, diagnostic stability, and epidemiology of ATPD have not been adequately explored in the developing countries. The aim was to explore the socio-demographic and clinical characteristics of ATPD as well as examine the diagnostic stability and longitudinal revisions in the diagnosis of ATPD. Material and Methods: An observational retrospective study based on 10-year OPD records of ATPD patients was conducted in a tertiary health care center after ethics committee approval. A total of 120 patient records were analyzed for socio-demographic data, clinical symptoms, mental status examination findings, diagnosis on the first visit, and subsequent revisions in the diagnosis. Results: The mean age of ATPD patients was 31.8 (±11.73) years. Delusion was the most common psychiatric symptom in ATPD patients followed by abnormal speech, hallucinations, and disorganized behavior. Antecedent psychosocial stressors were found in 44.2% cases. More than half of ATPD patients (51%) followed up after initial symptom remission and were diagnosed with chronic mental illnesses (schizophrenia or bipolar affective disorder). The ATPD patients experiencing a stressor at the onset of illness were less likely to develop chronic mental illness compared to the ones who did not have antecedent stressors. Conclusion: Irrespective of the genetic and phenomenological distinctiveness of ATPD, which has led to its inclusion as a separate diagnostic category in ICD-10, ATPD is an unstable diagnosis.

Obsessive-Compulsive Symptoms in an Adolescent Appearing after Cerebellar Vermian Mass Resection.

Obsessive compulsive symptoms have been reported in frontal lobe tumours and basal ganglia lesions. We report herewith a case of an adolescent who had a vermian cystic mass for which he underwent excision surgery. Three months postsurgery family members noticed that he started with repeated hand washing and abnormal walking pattern. Also, he developed bedwetting in sleep at night. He was given clinical diagnosis of Obsessive-Compulsive Disorder (OCD) and Nocturnal enuresis following a cerebellar mass removal which improved with fluoxetine and impiramine respectively.

Hypnic jerks possibly induced by escitalopram.

Hypnic jerks or sleep starts are benign myoclonic jerks that usually occur on falling asleep. Various factors like excessive caffeine intake, physical, and emotional stress can increase their frequency. Here we report a case of a female who suffered from hypnic jerks with use of selective serotonin reuptake inhibitor drug escitalopram and responding to treatment with clonazepam.