Social Psychiatry

The concept of "Stalking" and its relevance to the existing phenomena of internet and social media Abhijit R Rozatkar, Nitin Gupta Indian Journal of Social Psychiatry 2019 35(1):1-3

Social psychiatry in India: Current changes and challenges Rajiv Gupta Indian Journal of Social Psychiatry 2019 35(1):4-9

Effect of marriage on pre-existing psychoses Prakash B Behere Indian Journal of Social Psychiatry 2019 35(1):10-12 The relationship between marriage and mental illness is very complicated, and this issue commonly arises in psychotic illnesses. Psychosis is usually diagnosed at late adolescent and early adulthood. Being a disease of the age at which decision of marriage is taken, the question of whether to marry or not and whether marriage will lead to improvement or deterioration in psychoses is equally faced by patients, their family members, and treating psychiatrists. Mental disorders and problems in marriage are closely linked although there is a controversy about the sequence. In India, marriages are usually arranged by parents and are influenced by a number of factors such as astrological compatibility, caste regulation, geographic proximity, and expectations of dowry. We have worked for two decades in this area. The work summarizes as “Effect of marriage on clinical outcome of persons with bipolar affective disorder: A case–control study.” Married persons had experienced more episodes of illness and for longer duration. Males are more prone for illness than females in both groups (married and never married). Marriage did not influence the severity of illness in persons with bipolar affective disorder. The effects of marriage on women with schizophrenia are as follows: This study concluded that most of the patients and relatives were of the opinion that marriage can cure mental illness. Child birth was found to be a protective factor for decreasing separation in cases. Severity of mental illness was slightly higher in cases than comparison group. It was observed that with increasing severity of illness marital adjustment deteriorates with antagonistic interaction among members.

Substance use disorders: Need for public health initiatives Rakesh Kumar Chadda Indian Journal of Social Psychiatry 2019 35(1):13-18 Substance use disorders (SUDs) are associated with substantial contribution to the global burden of disease due to high prevalence, early age of onset, and chronic course. The associated physical health complications such as HIV, hepatitis B and C, and opportunist infections, stigma, myths and misconceptions, and a huge treatment gap further increase the problem. Thus, there is a strong need to take public health initiatives. Conventionally, common substances of abuse include licit substances such as tobacco and alcohol and illicit substances such as opioids, cannabis products, cocaine, barbiturates, amphetamines, and prescription drugs. The new psychoactive substances have brought a new challenge. Conventionally, the three approaches of supply reduction, demand reduction and harm reduction have been used to deal with the problem of SUDs. Preventive strategies encompassing primary, secondary, and tertiary methods need to be formally planned to meet this massive challenge. Creating awareness about the problem in the community and targeting myths and misconceptions are important to reduce the treatment gap. There is need to ensure availability and accessibility of affordable and acceptable treatment facilities, provide evidence-based treatment, and ensure ethical standards in care including coordination between health, social, and legal agencies. Relapse prevention and rehabilitation also need to be an important component of the public health policy. A well-planned public health approach involving all stakeholders is likely to be the most appropriate method to deal with the challenges imposed by the SUDs.

Therapeutic relationship: Riding on a bumpy road and steering through to the destination Abhishek Ghosh Indian Journal of Social Psychiatry 2019 35(1):19-23 Therapeutic relationship runs a dynamic course; it usually grows and intensifies with time, but there could be unforeseeable twists and disruptions. The course, to no small extent, is contributed by the therapist's dispositions and expertise on a particular theoretical orientation. Expertise is dependent on experience, level, and quality of training. Disruptions, although unwanted, give an opportunity to reflect upon the shortcomings and are an impetus for a course correction, which more often than not gives a desirable result. In this case discussion, I shall describe the highs and lows in a therapeutic relationship. After the initial euphoria, the therapist's inexperience, limited skills, and a wrong decision would contribute to significant disruption. However, the therapist's awareness of his/her limitations, a motivation to learn, and active help from mentors and colleagues would provide momentum in the second half of the therapy, which finally would see the daylight of success.

Comparative survey of factors associated with illness-related knowledge among patients with severe mental illness and their caregivers Snehil Gupta, Mamta Sood, Rohit Verma, Jawahar Singh Indian Journal of Social Psychiatry 2019 35(1):24-31 Background: Knowledge about the illness and treatment is important for treatment adherence and positive outcomes in patients with severe mental illnesses (SMIs) and their caregivers. The current study aimed at comparing the knowledge of the patients with SMI and their caregivers, and its relationship with their sociodemographic characteristics. Methodology: A cross-sectional, observational study conducted in the outpatient department of a tertiary care general hospital and comprised 50 dyads of patients with SMIs and their caregivers. Information was collected by a semi-structured questionnaire. Comparison of knowledge between groups was performed using the Chi-square test, and the relationship of knowledge with their sociodemographic variables was analyzed using logistic regression test. Results: There was a lack of knowledge among participating dyads for most of the illness- and treatment-related variables. A significant difference was observed between the two groups in regard to their knowledge about the name of the illness, how medical comorbidity and comorbid substance use affect psychiatric illness, brand name of the medicine, adverse effect, duration of treatment, role of investigation in diagnosis and treatment, and psychosocial rehabilitation (P < 0.001). The difference in knowledge was also observed regarding the formulation of medicine other than tablets and mechanism of its action (P < 0.05). Dyads with higher socioeconomic status had more knowledge about some but not all aspects of their illness. Conclusion: The patients and their caregivers lacked knowledge about many important illnesses-related variables. It is important to psychoeducate in routine clinical practice.

Relationship between illness disability in patients with first-episode schizophrenia with caregivers' perception of their needs Ragul Ganesh, Rohit Verma, Rachna Bhargava, Mamta Sood Indian Journal of Social Psychiatry 2019 35(1):32-39 Introduction: The humanistic burden of schizophrenia is levied mostly upon the families in India which act as the primary source of caregiving. Studies have found that symptomatic patients with schizophrenia suffer from significant disability compared to those patients with minimal symptoms. Studies have reported positive correlation between patient's disability and higher number of needs perceived by caregivers of schizophrenia. There has been no evaluation of this aspect in first-episode schizophrenia (FES). Objective: The objective of this study was to evaluate the disability in patients with FES and find the relationship with the caregivers' perception of their needs. Methodology: This cross-sectional study included symptomatic patients with FES (Group 1; n = 30) along with their caregivers and patients with FES having minimal or no symptoms (Group 2; n = 30) along with their caregivers. The assessment was done using the World Health Organization Disability Assessment Schedule 2.0 for patients and Camberwell Assessment of Need-Short Appraisal Schedule for caregivers. The correlation was done among the level of disability in patients, patients' needs as perceived by their caregivers, sociodemographic, and clinical variables. Multiple regression analysis was done with needs as the dependent variable and other variables as independent predictors. Results: Among the patients with FES, Group 1 had higher disability scores than the Group 2 (t = 23.22, P < 0.01). Total needs of the patients as perceived by their caregivers were similar in both the groups. The unmet needs were more for Group 1 as compared to Group 2 (t = 16.45, P < 0.01). The former had more met needs compared to the latter (t = −13.23, P < 0.01). Disability in patients was positively correlated to illness duration (r = 0.65), unmet needs (r = 0.96), and total needs (r = 0.71). Sociodemographic parameters are not related to illness-related disability or caregivers' perception of the needs. Patients' disability, alogia, and asociality were the significant positive predictors of the unmet needs as perceived by caregivers in Group 1. Conclusion: Symptomatic patients with FES have more disability and more unmet patients' needs as perceived by their caregivers as compared to FES with minimal or no symptoms.

Psychometric properties of the Hindi-translated version of the "Assessment of Recovery Capital" scale at a tertiary level de-addiction center in North India Aniruddha Basu, Surendra Kumar Mattoo, Debasish Basu, BN Subodh, Suresh Kumar Sharma, Fazl E Roub Indian Journal of Social Psychiatry 2019 35(1):40-46 Background/Objectives: The concept of “recovery capital” with regard to substance use draws upon the personal, social, cultural, and human resources in an individual to undergo recovery. However, lack of any structured instrument for its assessment in the local context necessitated the translation of the English self-assessment version of “Assessment of Recovery Capital” (ARC) scale to Hindi and the study of its psychometric properties. Methodology: In a cross-sectional study at a tertiary-level de-addiction center in Northwestern India, in the initial phase, forward translation to Hindi followed by expert panel back-translation, pretesting and cognitive interviewing were done. Thereafter, it was administered on 200 respondents of whom 100 were active alcohol-dependent or other illicit/pharmaceutical opioid-dependent users and another 100 dependent respondents were abstinent from such substances for the last 1 year. Results: Cognitive interviewing determined its face validity, whereas principal component analysis established a single-factor structure. It was shown to have good internal consistency (Cronbach's alpha = 0.86) and test-retest reliability (rho = 0.93, P < 0.001). Concurrent validity was established by comparing with the World Health Organization quality of life-BREF (P < 0.01), whereas predictive validity by significant area under the curve value of 82% and optimum cutoff of 41.5 (sensitivity: 81%, specificity: 71%) in the receiver operator characteristic curve. Divergent validity was established by lack of any significant positive correlation with the Addiction Severity Index (version 5.0). Conclusion: Hindi ARC has acceptable psychometric properties as a monitoring instrument for “recovery-oriented” de-addiction services. However, this needs to be studied in different settings with different substances longitudinally for its final validation.

Trajectory of perinatal mental health in India GT Harsha, Mithun Sadashiva Acharya Indian Journal of Social Psychiatry 2019 35(1):47-54 The global burden of psychiatric disorders in women is on the rise, especially in the perinatal period. Despite this, the recognition of the need and delivery of health care in women of reproductive age group is scarce and still met by unscientific treatment modalities. Such a scenario is luring in India as well. We have focused on discussing the impact of culture on the treatment practices, different challenges faced, nosological status, and management principles of different perinatal psychiatric disorders. We mainly employed the Google Scholar search engine to look into articles of all sorts (review articles, case reports, expert opinions, newspaper extracts, and Indian government websites) and reviewed them. We also acknowledged the information extracted from these articles which were highly valuable and enlightening. The perspective of the health-care delivery in the perinatal group of population has been changing over the years, but still there is lot to change. A holistic, scientific, evidence-based approach is a definite need toward attaining this goal.

Perinatal (Mother-infant) psychiatry in India: Now is the right time to talk Balaji Bharadwaj Indian Journal of Social Psychiatry 2019 35(1):55-56