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|Year : 2011
: 53 | Issue : 5 | Page
|Symposia / Workshops
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|Date of Web Publication||3-Apr-2012|
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. Symposia / Workshops. Indian J Psychiatry 2011;53, Suppl S1:10-26
School mental health program in Indian scenario
Col. R.C. Das, Kalpana Srivastava, Jitender Nagpal 1 ,
Savita Malhotra 2
Armed Forces Medical College, Pune, 1 Institute of Child Development and Adolescent Health and Division of Mental Health In Life Skill, New Delhi, 3 PGIMER, Chandigarh, India
School mental health program in India has been given due emphasis recently. There is a pressing need to increase awareness about Mental health needs of children with the skill empowerment and general improvement in augmenting mental health delivery system. Children less than 15 years of age constitute approximately one third of the world's population and between 5-15% are afflicted by persistent socially handicapping mental disorders. Eighty percent of the world's children live in developing countries, where mental health services are meager or non-existent. This has been duly acknowledged by Government of India and substantial amount has been allocated for school mental health In 11th Five year Plan. General health and education policies such as the National Policy for Children (1974), National Policy on Education (1986), National Policy for Mental Handicap (1988). The Integrated Child Development Scheme (1989) (NIPCCD) laid the foundation for proper psychological, physical and social development of the child to reduce the incidence of school drop outs, mortality, morbidity and malnutrition. Sporadic work has been done in this area by various mental health centres, however the increase in awareness and enhancing the capability to identify the mental health problems is the need of the day. Despite these efforts, from a national perspective it can be stated that the child mental health services have not been spread out uniformly. In Indian scenario various studies have quoted wide variation in prevalence rate of psychiatric morbidity among school children ranging from 15 to 35% across the various studies. The model of knowledge empowerment and sensitization about the mental health needs of children in Indian context should include Parents, teachers, peer groups and society at large. There is need for greater integration of the health, education and welfare sectors to augment awareness and develop policy in the field of school mental health. The symposium is planned to address overview of the issue, experiences of two different centres, Pune and Delhi, and concerns about formulating the policy.
1. Overview of School Mental Health: Indian Scenario - Col. R.C. Das
2. School Mental Health Program Pune experience - Dr. Kalpana Srivastava
3. Expression 2009, Delhi Experience - Dr. Jitender Nagpal
4. Future Directions - Dr. Savita Malhotra
New frontiers in substance abuse pharmacotherapy
Debasish Basu, Vivek Benegal 1 , Suresh Kumar 2 , Atul Ambekar 3
PGIMER, Chandigarh, 1 NIMHANS, Bangalore, 2 ICMR National Institute of Epidemiology, Chennai, 3 AIIMS, New Delhi, India
The last few years have seen considerable advances in the pharmacological treatment of substance use disorders. Newer pharmacotherapies are changing the landscape of the traditional treatment paradigms, following important leads from newer understanding of the neurobiology of addiction. However, there is an urgent need to shift through available evidence in order to familiarize the practitioner with the promises and limits of these new agents. This symposium focuses on New Frontiers in Substance Abuse Pharmacotherapy.
1. Use of baclofen in addictive disorders (Dr. Vivek Benegal, NIMHANS, Bangalore)
2. Buprenorphine/naloxone combination and other substitution therapies for opioid use disorders (Dr. M. Suresh Kumar, ICMR National Institute of Epidemiology, Chennai)
3. Varenicline in Nicotine Dependence (Dr. Atul Ambekar, AIIMS, New Delhi)
4. Pharmacological treatment of cocaine and other stimulant use disorders (Dr. Debasish Basu, PGIMER, Chandigarh).
Role and responsibilities of institutions in providing mental health care to the community
Shridhar Sharma, S. Haque Nizamie 1 , E. Borde 1 , Rajesh Rastogi 2
NAMS and IHBAS, Delhi, 1 Central Institute of Psychiatry, Ranchi, 2 Safdarjung Hospital, New Delhi, India
The burden of mental illness could be estimated from the Report of National Commission on Macroeconomics and Health of 2005 which reported prevalence of 'serious' mental illness in the Indian population to be at least 6.5%, which by rough estimate would include 71 million people. The nature of the impact produced by mental illness to the individual and society is also far more widespread and consequential than many of the medical illnesses. Mental illness results in more disability adjusted life years lost than some of the very common diagnoses in India, including Tuberculosis and HIV. Mental health care is a part but not apart from total health care program. The rising consciousness of the need for the development of adequate and appropriate mental health care programs, its integration with health has been equally well reflected in the recent policies of WHO and national Governments in developing countries including India. Consequently various strategies have been suggested for improving and extending mental health care in developing countries with limited resources. India has taken a lead in this direction and has developed a well delineated National Health and Mental Health Program.
There have been continuing efforts on the part of the government for streamlining and modernization mental hospitals to transform them from the custodial mode to tertiary care centers of excellence with a dynamic social orientation for providing leadership to research and development in the field of community mental health apart from providing basic clinical services. Research and training aimed at building up an extensive database of epidemiological information relating to mental disorders and their course/outcome, therapeutic needs of the community, development of better and more cost-effective intervention models, promotion of inter-sectoral research and provision of necessary inputs/conceptual framework for health and policy planning has been an integral part of functioning of major institutes and psychiatric units at general hospitals. As a part of this strategy, there is an optimal mix of services at different levels in an environment of public, private sector mix. Mental health care delivery system has made steady progress after independence. From a handful of centers, today there are over 100 centers providing services and training mental health professionals. Keeping in pace with the development in various domains of psychiatry in the world, there has been a surge in the field of service provision as more and more institutions have started outpatient services and emergency psychiatric services, community care and rehabilitation of chronic mental illness has been addressed and research and manpower training is undergoing a paradigmatic shift finding a common ground for both biological and psychosocial aspects of various psychiatric disorders. In the present symposium each speaker will attempt to explain the role and responsibility of different institutions in providing mental health care to the community and how this strategy has been implemented.
1. Overview of Health Strategy in Providing Mental Health Care - Prof. Shridhar Sharma
2. Role of National Institute like C.I.P. in both developing Man Power development in Mental Health and effective services - Dr. S. Haque Nizamie
3. Experience about the role of Private Psychiatric Institute like Davis Institute of Psychiatry, with over 50 years experience - Dr. E. Borde
4. Role of Psychiatric units in major General Hospital at Safdarjung in Delhi and how it has been integrated with the total health care system - Dr. Rajesh Rastogi
Good psychiatric practice in private setup
N.M. Patil, Abhay Matakar 1 , G. Swaminath 2
Jawaharlal Nehru Medical College, Belgaum, Karnataka, 1 SDM College of Medical Sciences, Dharwad, Karnataka, 2 Ambedkar Medical College Bangalore, India
Objectives : Defining Good Psychiatric Practice, identification of important components of Good Psychiatric Practice, identifying barriers to good psychiatric practice, and suggesting ways to overcome the barriers. Good and acceptable clinical practice is expected from every psychiatrist. Good Psychiatric Practice (GPP) should be the basis of practice in a private set up. A large number of psychiatrists have started practicing Psychiatry in private set up and significant number of them own Psychiatric Nursing Homes. Mental Health Act (MHA) 1987 has helped make private psychiatric practice legal and accountable. GPP must conform to various rules and regulations framed by competent authorities. GPP should follow Evidence Based Guidelines and must avoid idiosyncratic personal practicing trends. A true GPP will address legal, administrative, ethical and clinical considerations in letter and spirit. Legal considerations of GPP will include norms and regulations to be followed while establishing a psychiatric nursing home, admission and discharge of patients as per the legal requirements of MHA. GPP will have to give adequate importance ethical consideration like informed Consent by the patient. If patient is deemed incompetent then having informed consent from a competent proxy will be essential. Treatment involving electro convulsive therapy and consent required is a delicate area where proper balance will be required. Confidentiality and restraint will be other major areas of interest.
Formal and informal discussions with colleagues in private practice about expected legal, administrative, ethical and clinical requirements of GPP revealed that ground realities are different and do not confirm to the expected standards. Many private practitioners find it difficult to confirm to the expected norms of practice because of socio-cultural, geographical and economic factors. Many difficulties expressed appear to be genuine. Some difficulties are beyond the scope of individual practitioner's control. These barriers and suggestions to cross them to practice GPP will be discussed. It is expected that the deliberations will help improve private psychiatric practice in India.
1. Introduction, need, basics and legal / administrative aspects - Dr. N.M. Patil
2. Clinical aspects, possible barriers and solutions - Dr. Abhay Matkar
3. Ethical aspects, taking practice to a higher level - Dr. Swaminath G.
Mild cognitive impairment: Resolving the dilemma
M. Thirunavukarasu, K.S. Shaji 1 , Alka Subramanyam 2 ,
Charles Pinto 2
SRM Medical College and Research Institute, Kattankulathur, Kanchipuram, 1 GMC, Thrissur, 2 T.N. Medical College and BYL Nair Hospital, Mumbai, India
Objectives : To provide those attending the concept of Mild Cognitive Impairment (MCI) and its evolution into an entity. Recent classifications and diagnostic criteria have pushed it into the forefront for an increasing need for identifying the syndrome so as to prevent the oncoming risk of Dementia. Proposed therapies will further help professionals to deal with it effectively and resolve the dilemma. As public awareness of dementias increases, more people are asking for advice and help about memory problems. Between 25 and 60% of the elderly people complain of some kind of memory difficulty. The field of aging and dementia is focusing on the characterization of the earliest stages of cognitive changes of normal aging and Alzheimer's disease known as MCI. Prevalence of MCI varies between 3-17%. It has been recommended that patient with mild cognitive impairment should be identified and monitored due to an increased risk for subsequent dementia. Functional and morphological imaging methods, like biological markers could, in the future, make it possible to clarify the different aetio-pathogenic factors. Drug Therapies with ongoing trials are being targeted towards delaying or modifying progression of MCI to dementia and improving cognitive function.
1. Introduction and concept - Dr. M. Thirunavukarasu
2. Clinical types and diagnosis - Dr. K.S. Shaji
3. Assessment, tests and imaging - Dr. Alka Subramanyam
4. Therapy and outcome of MCI - Dr. Charles Pinto
Cerebrovascular disease, cognition and mood: Exploring the interface
E.S. Krishnamoorthy, Albert Hofman 1
The Voluntary Health Services- Multispecialty Hospital and Research Institute, Chennai, India, 1 Erasmus Medical Center, Netherland
Objectives : To outline the public health impact and clinical management of cerebrovascular disease. Cerebrovascular disease is recognized by Word Health Organisation as a killer disease with significant public health implications. In the past decades, cerebrovascular accidents (strokes), were the focus, and post-stroke cognition and behavior of the subject were of considerable study. In the last decade, thanks to expanding community based research including brain imaging, the true burden of cerebrovascular disease in community living elderly populations has become apparent. Together with this has emerged a body of literature examining vascular cognitive impairment and vascular depression which have considerable impact on the practice of psychiatry in the elderly. In this symposium we will explore cerebrovascular disease and its impact on the mind and brain.
1. The global burden of cerebrovascular disease and the public health implications thereof - Dr. Albert Hofman
2. The syndromes of vascular cognitive impairment and vascular depression - Dr. Ennapadam S. Krishnamoorthy
Evidence informed health care: Pitfalls and strategies to overcome them
Prathap Tharyan, S. Mohan Raj 1
CMC, Vellore, 1 Consultant psychiatrist, Chennai, India
Objective : To introduce the audience to the bias that creeps into published literature and discusses strategies to overcome them. The first lecture will focus on the bias that is incorporated into published medical literature at various levels. The bias can be at the level of (a) Asking the research question, (b) Design and conduct of the study (sample size, choice of comparator, Inclusion and exclusion criteria, Scales used, Definition of outcome randomization and allocation concealment), (c) Analysis of data and in (d) Dissemination of information. In addition, the phenomenon of ghost writing, which is becoming more prevalent, would also be highlighted. The second lecture will focus on preventive and remedial actions for the above pitfalls. These measures can be taken at the level of researchers, their institutions, journals, sponsors and regulatory agencies. Trial guidelines and regulatory measures implemented would be highlighted. Clinicians need to be aware of Evidence Informed Healthcare to avoid falling prey to biased evidence. Resources available for clinicians to improve their awareness will be highlighted.
1. Why should we be skeptical about published evidence? - Dr. S. Mohan Raj
2. Strategies to overcome the pitfalls in Evidence Informed Healthcare - Dr. Prathap Tharyan
Magnitude and management of disability in community
Bir Singh Chavan, Priti Arun, Rachna Bhargava
Government Medical College and Hospital, Chandigarh, India
Objectives : To study the magnitude of disability in community; difficulties in receiving benefits under PWD Act by persons with disabilities; and possible approaches that can be used to reach out to persons with disabilities and overcoming difficulties faced by them. Around 10 per cent of the world's population live with a disability and eighty per cent of persons with disabilities live in developing countries. With the increasing prevalence and understanding of its impact on quality of life, attempts in relation to protection of rights and discrimination resulted in implementation of Persons with Disability Act. In the symposium, we would like to present the (a) current facilities that are made available for the disabled and a critical appraisal of the same; (b) community survey being carried out in Chandigarh to assess the awareness among the masses and the extent to which the facilities are being availed; (c) Camp approach that is being used to identify and confirm the prevalence of disability as well as to ensure that the public is able to avail the facilities provided by the government.
1. The extent of disability in the community - Dr. Priti Arun
2. Problems faced the persons with disability in availing the benefits - Dr. Rachna Bhargava
3. The possible alternatives by overcoming the barriers to reach out to persons with disability - Dr. B.S. Chavan
Prescription errors in psychiatry
M.S. Bhatia, Shruti Srivastava, Anurag Jhanjee, Pankaj Kumar, S.K. Verma
University College of Medical Sciences (U.C.M.S) and Guru Tegh Bahadur Hospital, Dilshad Garden, Delhi, India
Though Prescription errors have far reaching clinical implications, they have not received due attention in medicine in general and in psychiatry in particular. Kessler (1993) first introduced MEDWATCH in 1993 and indicated a need for a national reporting system of prescription errors in psychiatry. Only adverse events related to a psychotropic drug are being reported and that only in selected cases. Prescription error is the most common and preventable cause of patient injury.
Prescription error is defined as 'the failure of a planned action to be completed as intended or the use of wrong plan to achieve an aim'. In other words, errors can arise in planning action or in executing them. This includes giving the wrong drug or dose, by wrong route, to the wrong patient or at the wrong time. Out of all, 1% are fatal, 12% life-threatening and 28% are preventable. The errors are related to missing dose (53%), dosage error (15%), frequency error (8%) and route error (5%). The exact incidence of medication errors in psychiatry causing permanent disability or death is not known. The actual rate of negligence claims on psychiatry is unknown. There is a growing need to study the prescription errors- their incidence, causes, types, fatality, methods for prevention and medico legal aspects. The proposed symposium will attempt to discuss the relevant aspects of prescription errors- risk factors, types, causes, legal aspects and prevention in clinical psychiatric practice.
1. Introduction and Risk Factors - Dr. M.S. Bhatia
2. Types - Dr. Shruti Srivastava
3. Causes - Dr. Anurag Jhanjee
4. Prevention in Clinical Psychiatric Practice - Dr. Pankaj Kumar
5. Legal Aspects - Dr. S.K. Verma
Models of sensitising primary care physicians to mental health care
Rakesh K. Chadda, R.C. Jiloha 1 , Rajiv Gupta 2
AIIMS, Delhi, 1 G.B. Pant, New Delhi, 2 PGIMS, Rohtak, Haryana, India
Objectives : To discuss the different training modules for sensitizing the primary care physicians to the mental health problems. India with its population of more than 1 billion has nearly 100 million people suffering from mental and neurological problems, who require professional help at any point of time. The mental health resources are very low, compared to the high income countries, comprising just 0.25 psychiatric beds per 10,000 population, 0.2 psychiatrists, 0.03 clinical psychologists, 0.05 psychiatric nurses and 0.03 social workers per 100,000 of the population. Thus there is a gross disparity between resources and needs. The country trains 230 psychiatrists every year, but many of them relocate to the high income countries for greener pastures. The available mental health resources are grossly inadequate to handle the enormous mental health morbidity in the population. The primary care physicians including the general practitioners are likely to be the first contact for various mental health problems. It is vital to sensitize the primary care physicians to various mental health problems so as they are able to identify them in their patients. Patients with common mental disorders like depression or anxiety disorders can be easily managed at primary care level, while those with severe mental disorders can be referred to a psychiatrist. A number of training modules in mental health care for primary care doctors have been developed in the country following the introduction of National Mental Health Programme in 1982. The symposium will discuss the different modules which have been used for training of primary care doctors in mental health care. The presenters will be discussing their experiences with different modules in training of the primary care doctors in mental health.
1. Overview - Dr. R.K. Chadda
2. Experiences with DMHP module - Dr. Rajiv Gupta
3. Experiences with once a week module - Dr .R.C. Jiloha
4. Workshop module - Dr. R.K. Chadda
Continuing professional development for psychiatrists: A UK and Indian perspective
Praveen Sharma, J.S. Bamrah 1 , Sandeep Grover 2 ,
Parmanand Kulhara 2
University of Manchester, UK, 1 Royal College of Psychiatrist, London, 2 PGIMER, Chandigarh, India
Objectives : To highlight the importance of Continuing Professional Development for senior psychiatrists and to discuss Royal College's policy on Continuing Professional Development (CPD) and explore its applicability to psychiatrists in India. CPD is the process of self directed life- long learning and assessment that enables psychiatrists to acquire new knowledge and skills as well as maintain and improve standards across all areas of their practice. However, it is important that the process is structured, transparent and addresses quality assurance to be of any significance to the clinical practice of psychiatrists. This symposium provides an account of the standardized practice across UK and its governance arrangements by the Royal College of Psychiatrists. We aim to highlight the strengths and weaknesses of the policy and the processes that can be put into place to facilitate participation by majority of psychiatrists. We will demonstrate how CPD works at an individual level, how it impacts on training needs of established psychiatrists, and how records are maintained. We will also elicit what the prevailing practice is for CPD/continuing medical education in India and compare this with the UK system. The symposium aims to increase the awareness and knowledge of a structured approach to CPD by practicing psychiatrists. Finally we will have an inter-active session on how the RCPsych model might be applied to psychiatry in India.
1. Introduction: - Dr. P. Kulhara
2. The Royal College of Psychiatrists' CPD Policy and its applicability to psychiatry in India -Dr. J.S. Bamrah
3. An Indian Perspective on CPD - Dr. Sandeep Grover
4. An individual perspective of CPD in the UK - Dr. Parveen Sharma
Family mental health: Transforming future therapeutics
Madhao Gajananrao Raje, Sudhir Bhave 1 , Vivek Kirpekar 1
Consultant Psychiatrist, Nagpur, 1 NKP SIMS, Nagpur, India
Objective : To cater mental health to masses and to make psychiatry a house-hold name. Focus of mental health care has always been negative emotional state. Let's focus on positive psychology to increase acceptance. Because troubled person wants not only relief from mental suffering but also wants to lead a life of meaning and purpose. And purposeful life without mentally healthy family i.e. dysfunctional family is a distant dream. Dysfunctional family experiences vicious cycle of continuous conflicts, disrupting family mental health. Let's discuss clinical picture, etiology, scales to identify, and effects of dysfunctional family. Dysfunctional family can be transformed by (i) Family Therapy (ii) Training about How to Think, (iii) Positive Psychotherapy (iv) Spiritual Psychotherapy. Family therapy focuses on well-being which is over and above the absence of depression, anxiety and anger. Family therapy may alleviate, prevent deleterious effects of rearing on Hippocampus. Training sessions of family therapy, team building, goal-setting, etc. facilitate transformation. Training dysfunctional family to think is regarded as therapeutic measure. Because thinking positive will facilitate creation of skills and resources essential for family's mental health (Fredrickson). Teaching transactional analysis, cognition building, pro-active behavior, developing social maturity (Robert Kegan's theory), will sure train one to healthy thinking. Robert Kegan emphasizes that social immaturity is impediment to mental health. Psychotherapy should be initiated in all dysfunctional families, as recovery rate was found 85% when clubbed with pharmacotherapy. Positive emotions promote psychological resilience, positive emotional granularity which takes psychiatry furthest. Positive Psychotherapy focuses on pleasant, engaged and meaningful life (Seligman 2002). Spiritual psychotherapy changes brain. So practice of Meditation, Integrated Body-Mind Therapy, Yog-Nidra, spiritually augmented CBT transforms bio-social structure. Thus attained family mental health will build in-roads of psychiatry to common man's heart/kitchen.
1. Positive psychotherapy and spiritual psychotherapy - Dr. Madhao Gajananrao Raje
2. Introduction of subjects of symposium - Dr. Sudhir Bhave,
3. Family therapy and training to think - Dr. Vivek Kirpekar
First episode psychosis and early intervention
B.N. Gangadhar, M.S. Keshavan 1 , Savitha V. Eranti 2 ,
Dinesh Kumar 3 , Vinod Srihari 4 , Jagadisha Thirthalli, R. Thara 5
NIMHANS, Bangalore, 1 Wayne State University School of Medicine, Detroit, USA, 2 Institute of Psychiatry, London, UK, 3 Joint EIP Lead for London Region, EIP and ECT Lead, Essex, UK, 4 Yale University School of Medicine, Connecticut, USA, 5 SCARF, Chennai, India
Objectives : To discuss issues related to first episode psychosis/ schizophrenia including duration of untreated psychosis. To discuss services provided for this group of patients focusing on Early Intervention (EI) service model. First episode psychosis is a critical period for intervention. The average duration of untreated psychosis is about two years. The highest mortality and morbidity is present in the first few years of psychosis. Standard mental health care has not provided the input required to reduce duration of untreated psychosis and improve recovery related outcomes. Early Intervention service model has shown to be clinically effective in first episode psychosis. It has also shown to produce recovery related outcomes, including better quality of life, education and employment status, compared to standard care in patients with first episode psychosis. Early Intervention service model is also cost-effective. The talks in this symposium will focus on Early Intervention and Early detection service models for psychosis. Research evidence available to date will be presented. Experience of early intervention from the United Kingdom and United States will be discussed. The implications of long duration of untreated psychosis in the Indian population and implementing EI models in India will be discussed.
1. Rationale for early intervention - Dr. Matcheri S. Keshavan
2. Overview of results of early intervention programmes - Dr. Saviatha Eranti
3. Feasibility and preliminary results of Early Intervention in the US Public Sector: The STEP Project - Dr. Vinod Srihari
4. Early intervention experience in the UK - Dr. Dinesh Kumar
5. EI (Early Intervention) or IE (Intervention for everyone)? An Indian Perspective of EI - Dr. Jagadisha Thirthalli
6. Early intervention in India: The way ahead - Dr. R. Thara
Can a mental health professional prevent suicide?
Sagar Lavania, Debjani Bandopadhyay 1 , Amil H. Khan 2
S.N. Medical College, Agra, 1 Manasiji, Burdwan, 2 BRD Medical College, Gorakhpur, India
The first act of suicide probably occurred before the beginning of written records. In 2002, an estimated 877,000 lives were lost worldwide through suicide, representing 1.5% of the global burden of disease. Suicide must first be predicted, to prevent it. Clinicians have been trained to identify patients who have the risk factors associated with completed suicide. But they cannot know which patients will eventually die, or use this information to save them. The inability to predict suicide in individual patients raises doubt about our capacity to prevent it. Studies of the potential anti-suicidal properties of putative mood-stabilizing convulsants are considerably less abundant than those involving lithium, with still fewer reports involving controlled or randomized study designs. Meta-analytic studies show that there is reduction in suicidal ideation with the use of antidepressant as compared to placebo. Electro convulsive therapy is recommended as an initial treatment for suicidal depression. Promising results in reducing repetition of suicidal behavior and improving treatment adherence exist for cognitive therapy, problem-solving therapy, intensive care plus outreach, and interpersonal psychotherapy, compared with standard aftercare. Other useful method includes restricting access to means, education of professionals and media coverage. With multiple numbers of preventing techniques currently available it becomes difficult which one to choose for a particular patient. As in any other field of research, demonstrating a causal relationship between interventions and outcomes requires prospective data in randomized, controlled trials. Clinicians must therefore await research that could lead to more accurate prediction as well as to evidence-based programs of suicide prevention. We need not abandon, however, current efforts at predicting and preventing suicide in the patients we treat.
1. Can psychopharmacology prevent suicide? - Dr. Sagar Lavania
2. Can Psychotherapy Prevent suicide? - Dr. Debjani Bandopadhyay
3. Miscellaneous issues about suicide prevention - Dr. Amil Hyat Khan
Newer challenges in dementia
Atul Prasad, Anu Kant Mittal 1 , Sumant Singh 2 , Rajesh Nagpal 3 , Venugopal Jhanwar 4
Fortis Hospital, Delhi, 1 Rajiv Gandhi Medical College, Thane, 2 Consultant Neurologist, New Delhi, 3 Consultant Psychiatrist Manobal Clinik, New Delhi, 4 Consultant Psychiatrist, Deva Hospital, Varanasi, India
As our population ages, increasing numbers of patients are presenting with dementia. Diagnosis may be very straightforward, in some but a majority of them are evident diagnosed only when too late as the differential diagnosis of dementia may be less clear. Diagnostically challenging cases tend to appear in the setting of dementias that present without distinctive neurologic signs or evidence of medical or neurologic disease, such as Alzheimer's disease or the fronto-temporal dementias. A similar diagnostic challenge is seen in dementias that present with neurologic signs but without obvious significant medical disorders, such as the parkinsonian dementias or the vascular dementias. In recent years, the presentations of these dementias have become more sharply drawn on the basis of consensus reviews of clinic-pathologic correlations. Because each of these disorders has unique treatment and management strategies, the ability of clinicians to differentiate among these syndromes has become critically important. The recent advances in our Neuro-radiological and functional Imaging have led to opening of newer techniques and findings in this direction. The concept of dementia has evolved from the rather vague or nonspecific "organic brain syndrome" to a more precise picture of a syndrome complex encompassing a number of distinctive disease entities, each with its own specific set of treatment implications. As we plan to discuss, although a large proportion of the dementias affect memory early and prominently, this is not the case for all dementias., there are a number of dementias that initially affect functions generally attributed to frontal lobe systems, such as behavioral inhibition, judgment, and social conduct. Memory impairment may be quite minimal in these patients. Most current drug therapeutic approaches to Alzheimer's dementia are aimed either at elevation of the transient levels of acetylcholine in the brain or at direct enhancement of nicotinic receptor activation by the application of cholinesterase inhibitors or nicotinic agonists, respectively. There are newer options, involving novel classes of nicotinic ligands, which potentiate the response of nicotinic receptors to acetylcholine by acting from an allosteric site, to other modalities and targets. The mechanism of action and the structure-function relationship of these potential drugs will be discussed.
1. Advances in the Neurological Perspectives in Alzheimer's Dementia - Dr. Sumant Singh
2. Newer concepts in the Psychiatric Perspectives in Alzheimer's Dementia - Dr. Rajesh Nagpal
3. Newer challenges in the Management of Alzheimer's Dementia - Dr. Venugopal Jhanwar
Road rage: Dimensions, correlates and management
Sameer Malhotra, Lt. Col. Jyoti Prakash 1 , Rajiv Sharma 2
Fortis Hospital, New Delhi, 1 AFMC, Pune, 2 Janakpuri, Delhi, India
Objectives : To understand the epidemiology and dimensions of road rage, to understand the Psycho-bio-social correlates of road rage, and to understand and discuss the management issues in road rage that can help in addressing the underlying needs. With increasing and diverse vehicular traffic on road, increasing life stress and competition, there is a killer let loose on the road. It does not have a human form but it influences many of them to commit these crimes. This killer is "road rage". Road rage can be of many forms- an impulsive trying to overtake, angry young man honking from behind or a drunken in his disinhibited best. Psychology of road rage may attribute it to the ascribing vehicle as a personal space and its encroachment an insult or a displaced anger of the residues of marital discord; the fact remains that road rage is morbid. There is a growing need to understand its psychological dimension and psychosocial consequences. This symposium shall focus on various salient and relevant aspects of road rage for effective prevention and remediation. Safe driving requires driving skills, focused attention, calm mind, good roads, regulation and management of traffic.
1. What Is Road Rage-Introduction, Epidemiology and Dimensions - Dr. (Lt. Col.) Jyoti Prakash
2. Psycho-bio-social Correlates And Consequences of Road Rage - Dr. Rajiv Sharma
3. Management issues in Road Rage - Dr. Sameer Malhotra
The dementia India report 2010 - The time for action
Mathew Varghese, K.S. Shaji 1 , Srikala Bharath, Charles Pinto 2
NIMHANS, Bangalore, 1 Medical College, Thrissur, 2 BYL Nair Hospital and TN Medical College, Mumbai, India
Objectives : To make participants aware of the magnitude of the problem of dementia in India and the public health strategies for early detection, treatment, rehabilitation and prevention. The Dementia India Report was published by the ARDSI and released in New Delhi on the occasion of World Alzheimer's Day, 21st September 2010. The report focused on a description of dementia and the prevalence of dementia in our country in general and in each of the states in India. The report also made projections of the estimates of dementia for the next 20 to 50 years and the impact of these numbers on the individual, family and society costs. The report estimated the number of persons with dementia as 3.7 million in 2010 and that this number would double in the next 20 years. States like Delhi, Jharkhand, Bihar would show a 200% increase in number of persons with dementia in 20 years while many other states would have a 100% increase. The societal costs in 2010 was estimated as 14,700 crores and set to triple in the next 20 years. The main carers are family members and they need support and training to deal with this problem. The report also gave an overview of the services available in the country and made suggestions for different models of care and training for family members, professionals and other caregivers who look after persons with dementia. Finally the report made recommendations for the future course of action to remedy the gap in treatment. In this symposium the speakers would discuss the impact of the report. Some of the challenges faced by mental health professionals, policy makers and the government in the implementation of the report would be discussed. The recommendations of the report with the public health strategies for primary, secondary and tertiary prevention would be discussed.
1. Introduction and methodology of the Dementia India report - Dr. Mathew Varghese
2. Prevalence of dementia in India and future projections - Dr. K.S. Shaji
3. Impact of dementia and Costs in India - Dr. Srikala Bharath
4. Services for persons with dementia - Dr. Charles Pinto
5. Recommendations/action for a National Dementia Strategy - Dr. Mathew Varghese
Grey areas in psychiatry
Captain S. Goyal, Lt. Col. Divinakumar 1 , Lt. Col. Arun Sen 2 , Kalpana Srivastava 3 , Lt. Col. Jyoti Prakash 3
INHS Asvini, Mumbai, 1 CHSC Pune, 2 Military Hospital, Gawahati,
3 AFMC, Pune
Though Psychiatry has advanced through ages, there are still various lacunae which threaten the very existence of psychiatry as a healing and helping science. Like yesteryears custody and coercion still remains a continued concern for the healers and healed. Practice of involuntary treatment of the patient still exists as chemical and mechanical restraints. Resorting to covert medication on one hand brings ethics into question but on the other hand may be the only answer to the agony of psychotically ill or burdened caregiver. Lack of scientific evidence on one hand may make one look at this science as synthesis of hypothesis, but on the other hand significant therapeutic outcome make one construe the same as the need of the hour. Should we treat these aggrieved with strict confidentiality to prevent them from social ridicule or must we inform the society of them suffering from mental illness to prevent any untoward incidence, which might occur due to defect of their reason. Due deliberation is required to analyze these grey areas critically to bring out a balanced reasonable option of action to the fore.
1. Involuntary treatment - Surgeon Captain S. Goyal
2. Covert Medication - Lt. Col. Divinakumar
3. Constraints - Lt. Col. Arun Sen
4. Lack of Confirmatory Diagnostic Tests - Mrs. Kalpana Srivastava
5. Confidentiality vs Social Responsibility - Lt. Col. Jyoti Prakash
Repetitive transcranial magnetic stimulations (rTMS): Current understanding and clinical applications in psychiatry
S.K. Khandelwal, Nand Kumar, Achal Srivastava
AIIMS, New Delhi, India
Repetitive Transcranial magnetic stimulations (rTMS) is Non-invasive, painless method of repetitive brain stimulation in which magnetic fields are used to induce electrical currents in the specific area of cerebral cortex, thereby depolarizing underlying neurons. The lasting clinical effectiveness of the rTMS is hypothesized to be due to repetitive pulses used by the recently developed magnetic brain stimulators. The lasting effects considered to be depend on changes in the efficiency of synaptic connections in the cortex. The rTMS has generated much interest as a potential therapeutic intervention in a wide range of neurological and psychiatric conditions after its introduction in 1985 as a new treatment option for neuro- psychiatric conditions and subsequently approval by food & drug administration (FDA) in December 2008 for treatment of Depressive disorder. After the FDA approval, rTMS device is marketed for clinical use in Depressive disorder extensively in India and abroad. Current literature reflects that rTMS has been tested as a treatment tool for various neurological and psychiatric disorders including migraines, strokes, Parkinson's disease, dystonia, tinnitus, depression and auditory hallucinations. In India there is recent surge in the use of rTMS by Psychiatrist for several neuropsychiatric conditions. Considering the increasing use of the device it is imperative to apprise clinician about the various aspect of the rTMS device including its clinical applicability through this symposium. At the end of the symposium the participant will be able to appreciate the applicability of rTMS in various psychiatric conditions and safety of the device for the clinician and patients undergoing interventions.
1. Newer neurobiological intervention in Psychiatry: an overview - Dr. S.K. Khandelwal
2. Neurobiological basis of rTMS in Psychiatry - Dr. Achal Srivastava
3. Current clinical application of rTMS in Psychiatry: Evidence base - Dr. Nand Kumar
Consultation liaison psychiatry
R.K. Brahma, Arabinda Brahma, D.G. Mukherjee 1
UNM Clinic and Research Institute, Kolkata, 1 R.G. Kar M.C., Kolkata, India
The model of Clinical Consultation-Liaison Psychiatry services for out-patient general hospitals was developed in the decade after the end of the World War II over fifty years ago. The model was conceptualized to provide knowledgeable clinical experts to care for patients with dual medical-psychiatric diagnoses and to train non-psychiatric clinicians how to manage the behavioral disorders of medical patients. There remains vast number of patients suffering conjoint medical -psychiatric disorders who are usually not being treated appropriately with integrated quality medical-psychiatric care. Patients with combined medical and psychiatric illnesses, usually receive discontinuous care, poor care or more often than not, no well coordinated conjoint medical-psychiatric care at all. To look back into our limitations and future directions for evolving an improved model of Consultation- Liaison psychiatry for general hospital settings, the necessary requirements and perspectives willbe discussed. Patient care, liaison education and research, opportunities and pitfalls, will be considered in detail for refinement and developing an integrated better model. Though two-thirds of patients who are high users of medical care in the general medical setting have a psychiatric disturbance, only a small subset of them is currently being adequately identified. Recent advances in medical sciences and changes in health policy are now shifting patient care from hospitals into the community. These changes challenge the traditional model of Consultation-Liaison (C-L) psychiatry as an inpatient clinical specialty and demand a shift away from the inpatient focus and toward outpatient and primary care services. An effective collaboration between the primary care physician and C-L psychiatrist offers a further extension of outpatients C-L services. To bridge the gap between the hospital services and primary care, the C-L psychiatrist should spend time in the primary care clinic. Consultation in this environment is familiar and convenient for the patient and reduces the stigma of attending a separate mental health clinic. This service necessitates psychiatrists spending time traveling, which may be solved by offering a limited service to primary care, focusing mainly on joint assessment of especially problematic cases. Instead of entering into the merits and demerits of the definitions of liaison - consultation psychiatry propounded by various authors, I have said my idea of it and how I proceeded with establishing a brand new way of delivering a psychiatric service in the teeth of chaos, confusion and hostility towards psychiatry reflecting these on psychiatric patients as well. I threw a challenge that I can address any and all of the grievances of my colleagues provided they were prepared to heed psychiatry at par with other branches of medicine and try to understand the reasons which were militating against the delivery of a satisfactory service comparable to other disciplines. This talk will be giving the details of how an idea bloomed in reality, into a well respected and acclaimed liaison - consultation service in place of chaos and confusion and misunderstandings.
1. History and Theoretical Basis of Consultation-Liaison Psychiatry - Dr. D.G. Mukherjee.
2. Consultation-Liaison Psychiatry in Primary Care - Dr. Arabinda Brahma
3. Setting up a Liaison Consultation Service in a University Hospital in London - Dr. R.K. Brahma
Fever and psychopathology
P.K. Singh, Balram Pandit 1
Patna Medical College, Patna, 1 BHU, Varanasi, India
Objectives : To focus attention on a novel observation of 'afebrile gap' intervening before the onset of psychopathology in majority of cases where fever and mental symptoms are associated; to create awareness and sensitization among psychiatrists about different patterns of association between fever and psychopathology; to discuss the aetio-pathogenic and nosological implications of such an observation. Fever is an extremely common occurrence in our part of world. Quite often it is also associated with mental symptoms. Paradoxically and unfortunately not enough attention has been focused on the patterns of association between the two. It has been my long term observation that in many such patients an afebrile gap of a few days intervenes between the termination of fever and onset of psychopathology. To quantify and validate this clinical observation, a study was carried out in the Department of Psychiatry of Patna Medical College, Patna as part of postgraduate thesis work. To our great satisfaction, it was observed that in about 70% of such cases the mental symptoms began after an afebrile gap of about 2-4 days. To the best of our knowledge such an observation has not been recorded before. The theoretical implication of such an observation is full of substantial potentials which would have bearing on our understanding of psycho-pathogenesis and our thinking about its nosological status.
1. Basic observational data of the study on association between fever psychopathology - Dr. Balram Pandit
2. Psychopathogenetic and nosological implications of the phenomena of afebrile gap - Dr. P.K. Singh
Mental health in India: Historical perspectives
Shridhar Sharma, Sanjeev Jain 1 , S. Haque Nizamie 2
NAMS and IHBAS, Delhi, 1 NIMHANS, Bangalore, 2 Central Institute of Psychiatry, Kanke, Ranchi, India
Emil Kraepelin observed that, in the first decades of the nineteenth century, many of the books dealing with psychiatric themes were written by medical doctors, such as Reil (who coined the word psychiatry), who had few contacts with mental patients or even by philosophers and theologians, and specialists appeared in so called great scientific centers 'who had decided to spend their life in the study and treatment of mental diseases'. History of psychiatry and its development as a separate profession from medicine can be traced back to thousands of years ago with numerous anecdotes and evidences. With the current trend of paradigmatic shift of the science of mental health towards a biological model a crisis has crept up in psychiatry as some neuroscientists raise doubts about the usefulness of maintaining psychiatry as a specialty in growing field of neuropsychiatry gradually amalgamating into neurosciences by virtue of neurobiological underpinnings of almost all psychiatric disorders. The roots of psychiatry as practice in India can be traced back to 1500 BC in the Atharva Veda, the most ancient authentic Indian medical cripture which describes conditions similar to schizophrenia and bipolar disorder. These texts differentiated doctors practicing magical medicine from scientific physicians and surgeons. Books by Charaka and Susrutha have vivid descriptions of schizophrenia. It states clearly that only an expert in the field of mental health should treat people with this illness. Colonial era saw development of institutions with more emphasis on custodial care which again moved forward, albeit slowly towards community care post independence. Modern psychiatry in India, in comparison with such systems, is a relatively recent introduction with subsequent development of psychiatric practices which have evolved with development of mental health institution and general hospital psychiatry. A knowledge and understanding of our history provide important reference points of understanding appropriate mental health policies, programmes and service models to deliver optimal mental healthcare to our patients. Mental health has evolved over several decades and it is important to recognize that development in the field of mental health has not occurred because of any dramatic paradigm shifts, but has been built on a cumulative body of clinical knowledge, research, foresight and experience of generations of mental health professionals, health planners and policy makers who have carved a niche for Indian Psychiatry in the changing world of medicine. Each era in the history of psychiatry has left behind important testimonials which help to understand the ever elusive areas of mind-brain dualism, developments in neuroscience, philosophical and psychological roots of mental health, paving way for further development in the ever changing science of human behaviour.
1. History of Mental Health in India: An Overview Descriptive overview of important landmarks in the development of Psychiatry as a specialty in India with special emphasis on development of mental health services - Prof. Shridhar Sharma.
2. History of Mental Health: Roots in Colonial India - The growth and paradigmatic shifts in the field of mental health under the influence of colonial culture in India - Prof. Sanjeev Jain.
3. Development of Psychiatry as a Specialty in Modern India - A detailed description of developments in the field of Psychiatry in India after independence with critical discussion of issues associated with ongoing growth of Psychiatry as a specialty - Prof. S. Haque Nizamie.
Need for intervention in domestic violence against women - Epidemiology, risk factors, consequences, psychosocial intervention and medico legal aspects
Shruti Srivastava, M.S. Bhatia, Anurag Jhanjee, Pankaj Kumar, N.K. Aggarwal
U.C.M.S. and Guru Tegh Bahadur Hospital, Delhi, India
Domestic violence against women is a serious problem in India. Overall, one third of women aged 15-49 have experienced physical violence and about 1 in 10 have experienced sexual violence. Domestic violence prevails in all sections of Indian society. Though, India being the largest democracy in the world, a significant population comprising of women still occupy a disadvantageous position. Nevertheless, this is often a neglected problem rarely being reported in health care settings. The objectives of the current symposium include clarifying the definition, epidemiology, risk factors and consequences, intervention strategies of domestic violence against women as well as the psychopathological profile of victims with special emphasis on Indian subcontinent. Innovative strategies for identification of domestic violence victims and different interventions aimed without disrupting marital harmony will be discussed. Preliminary data collected from casualty, screening outpatient clinic, antenatal clinics, wards of Guru Tegh Bahadur hospital and associated University College of Medical Sciences will be presented. Women who have been victimized find it hard to share their experiences and seek help. We often found it difficult to offer help to the victims of domestic violence, to make them recognize that this is a problem and to counsel them.
Mental Health Professionals should be alerted to this subject and prepare guidelines for the further management and treatment of abused women. Information and support for medical staff can help to identify domestic violence, and encourage communication about this problem, thereby leading to a better and more efficient use of available services and resources. Current medico-legal aspects of Domestic Violence Act, 2005 with special reference to Indian population will be discussed.
1. Definition, Epidemiology (Introduction) - Dr. M.S. Bhatia
2. Risk Factors and Our Preliminary Findings - Dr. Shruti Srivastava
3. Consequences - Dr. Anurag Jhanjee
4. Intervention Strategies - Dr. Pankaj Kumar
5. Legal Aspects - Dr. N.K. Aggarwal
Critical care in psychiatry
Debjani Bandyopadhyaya, Om Prakash Singh 1 , Gautam Saha 2
Manasij, Burdwan, 1 Burdwan Medical College, 2 Consultant Psychaitrist, Barasat, West Bengal, India
Objective : Psychiatric medications are frequently an essential component of care for critically ill patients. Their use may lead to medical complications, however, as a result of direct toxicity from psychotropic medications, drug-drug interactions, or intoxication or withdrawal states. These complications may be a nuisance (eg, dry mouth and nausea) or serious and life-threatening (eg, neuroleptic malignant syndrome (NMS) and cardiac arrhythmias). This symposium addresses the most important medical complications of psychiatric treatment, in critical care set up. The use of psychiatric medications in critically ill patients is an important component of comprehensive care. Many a times a psychiatrist is consulted by Intensive care unit (ICU) Internists for alteration in behaviour, mood, thinking and perception of reality. Because the emergence of psychiatric symptoms may be precipitated and exacerbated by various medical conditions, proper evaluation and emergency management is of utmost importance. Many psychotropic drugs are notorious for causing sudden and life threatening physical complications needing ICU management, like Neuroleptic Malignant Syndrome, Serotonin Syndrome, Electrolyte imbalance, Cardiac Arrythmias etc. Psychotropic drugs can cause toxicity, intoxication and withdrawal states, severe drug reactions like rashes, SJ Syndrome, drug interaction with several drugs used in general medical conditions etc, which need to be evaluated and managed. In this regard, it is essential to consider the potential complications of psychotropics while balancing the important role they serve in treatment of the medically ill.
1. Critical care in psychiatry set up: Psychotropic drug related complications and Physical illnesses - Dr. Debjani Bandyopadhyaya
2. Psychiatrist in Critical Care - Dr. Gautam Saha
3. Training and Infrastructure - Dr. O.P. Singh
Recent advances in the understanding of childhood bipolar disorder
D.K. Mondol, Prathama Guha, Somsubhra Chattopadhyay, Bappaditya Choudhury, Kaberi Bhattacharyya
Medical College and Hospital, Kolkata, West Bengal, India
Objective : To discuss the recent advances in phenomenology, neurobiology, cognitive deficits and management of childhood BPAD. Pediatric bipolar disorder is notoriously controversial, the debate being whether the condition can be diagnosed in prepubertal children at all. The issue at stake is whether the childhood presentation of bipolar disorder represents the same disorder as in adults. The two primary developmental differences in phenomenology that have been suggested are (a) a distinction between discrete mood episodes separated by periods of euthymia or subsyndromal symptoms in adults, in contrast to chronic symptoms and/or rapid mood cycles in youths, and (b) the characterization of pediatric mania by severe irritability instead of euphoria. The advent of safe, noninvasive techniques for studying brain function in children has made pediatric bipolar disorder the focus of pathophysiology-based research. Major findings are abnormal volume and activation of Amygdala, prefrontal cortex, nucleus accumbens and putamen. Studies focusing on ongoing changes in the developing brain, and differential activation of brain circuits during periods of euthymia and illness are likely to throw new light into the neurocircuitry of emotion processing. Trait related deficits in verbal memory and sustained attention are common in juvenile paediatric bipolar disorders (BPD). Deficits also have been reported in working memory and mathematical skills. In addition to core cognitive deficits children have difficulty adapting their behavior to changes in reward contingencies, deficits in response flexibility and difficulty in labeling facial emotions. Medication is often the first intervention in pediatric BPD. The latest recommendations in pharmacotherapy, along with the international treatment guidelines will be discussed in this section. Treatment programs include child- and family-focused cognitive-behavioral therapy (CFF-CBT), multifamily psychoeducation groups (MFPG), and family-focused psychoeducational therapy (FFT) and interpersonal social rhythm therapy (IPSRT). Increasingly, psychotherapy is focusing on the family of the afflicted child.
1. Introduction - Dr. D.K. Mondol
2. Phenomenology - Dr. Prathama Guha
3. Neurobiology - Dr. Somsubhra Chattopadhyay
4. Cognitive deficits associated with pediatric BPAD - Dr. Bappaditya Choudhury
5. Management - Dr. Kaberi Bhattacharyya
Body-mind-brain-The three fold cord
Uday Chaudhuri, Abhay Dey, Abir Mukherjee 1
Vivekananda Institute of Medical Science, Kolkata, 1 Medica Super specialty Hospital, Kolkata, India
Objective : Psychiatry is an interface discipline, combining the study of Mind, Brain and Body. It's the study of the individual and social environment. Study of the Humane and scientific aspect. This Body- Mind- Brain interface symposium will provide you with an opportunity to review timely, new information in scientific field of interest as they are developing Fibromyalgia and Fibrofog: An exciting area of Interface between Body Mind and Brain will be highlighted with recent update and evidence based treatment. Treat my Brain and Mind the Body: By directional relationship of Mental Illness and Metabolic Syndrome, with contributing factors and practical management issues will be highlighted. Medicine- Psychiatry - Neurology - the three fold cord will highlight the importance of harmony of concerted clinical work in Psychiatric Training and Practice
1. Fibromyalgia and Fibrofog; Body - Mind-Interface - Dr. Abir Mukherjee
2. "Treat My Brain and Mind the Body": Mental Illness and Metabolic Syndrome - Dr. Abhay Dey
3. Medicine-Psychiatry-Neurology - the Three Fold Cord - Prof. Uday Chaudhuri
Lt. Col. Shashi Kumar, Lt. Col. V.S. Chauhan 1 ,
Lt. Col. Jyoti Prakash, Lt. Col. R. Saini 2
AFMC, Pune, 1 Command hospital, Udhampur, 2 Military Hospital, Pathankot
Whether be it "Dashratha" bringing blessed "Khir" for his three wives for procreation in "Ramayana" or "Ved Vyasa" in "Mahabharata" resorting to magical effort to bring hope to "Kuru clan", sex has been the essence of survival and the sexual dysfunction a matter of grave concern. Be it psychosexual stages of Freud, Oedipus complex, James Bond of fiction or Kamasutra of fantasy; sex pervades all aspects of the society. A skeleton hidden in closet refrained from free expression, sex has manifested as distress/deviance in various manners i.e. orientation, identity, preference or inadequacy. Sexual dysfunction still remains an enigma solved at times by few. The management of sexual disorder has also been fraught with various obstacles like building adequate therapeutic alliance, careful handling of sensitive topics, overcoming own discomfort in handling such issues, respecting confidentiality etc. The mere fact that many people still take it as "Gupt Rog" and resort to clandestine medication or occult practices indicates that we have to go a long way in removing stigma, handling psychosocial issues and effective remediation. This symposim aims at clarity in this direction and includes:
1. History of sexuality: concepts and treatment - Lt. Col. Shashi Kumar2. Causes and consequences of psychosexual dysfunction - Lt. Col. V.S. Chauhan
2. Management of psychosexual dysfunction - Lt. Col. Jyoti Prakash
3. Current concept and recent advances in difficult to treat psychosexual dysfunction- Lt. Col. R. Saini
Alcohol and the family - Recent advances
Alhad Pawar, D. Bhattacharya, M. Diwakar, S. Chandrashekhar
Army College of Medical Science, New Delhi, India
Objectives : To cover the recent advances in the alcohol dependence and its impact on the family. Adverse effects of alcohol on the family are well known. However, the family as an institution is changing rapidly in the country. More and more people are marrying late, cohabitation are becoming common and the increase in divorce rates means that there are greater proportion of single parents. The situation is further complicated by the increase in the number of women consuming alcohol. This is more common among the young and affluent generation. Alcohol abuse thus may have a greater impact on marital and family life than earlier when women generally stayed at home and family life was more stable. Intimate partner violence, comorbid psychiatric disorders in person abusing alcohol as well as psychiatric disorders in the non-abusing spouses all have a role to pay ininfluencing the family psychopathology. Does alcohol abuse in a family member influence the decision of marriage or that of becoming of a parent? What is the impact of divorce on alcohol consumption in the family members or the separating partners? Similarly the role of maternal alcohol abuse on children, and on their consuming alcohol too needs elucidation. The role of prevention of alcohol abuse through health education in children is a grey area which needs to be elaborated on. The speakers intend to focus on these and other issues relevant to the rapidly changing society in which we live.
1. Introduction - Dr. Alhad Pawar
2. Impact of alcohol on marriage - Dr. D. Bhattacharya
3. Alcohol abuse in the family-influence on children - Dr. M. Diwakar
4. who abuse alcohol - Dr. S. Chandrashekhar
HIV/AIDS and mental health
Rajesh Kumar, N.G. Desai, Vijender Singh
Institute of Human Behavior and Allied Science (IHBAS), Delhi
HIV/AIDS has become a major public health problem in India and it is estimated that close to 4- 5 millions people are already infected. Mental illnesses are frequently comorbid with HIV/AIDS. This may be because HIV infected individuals may be having pre-existing psychiatric morbidity especially in groups who are at high risk for HIV infection. Apart from syndromal psychiatric disorder, the sub-syndromal state also cause significant morbidity but have rarely been studied by researchers. HIV/AIDS and mental health issues are interrelated and it has also been establishedthat psychological symptoms have adverse psychosocial consequences when it comes to overall HIV/AIDS care. These issues also significantly influence the course and outcome of HIV/AIDS (e.g. adherence to ART, disability and quality of life).
1. Mental Health issues in HIV/AIDS - an overview - Dr. N.G.. Desai.
2. Mental health and psychosocial aspects and its implication in the management (IHBAS experiences) - Dr. Rajesh Kumar
4. Psychosocial Management Strategies - Dr. Vijender Singh
Psychosurgery in psychiatric disorders
Paresh Doshi, Sandeep Grover 1 , G. Venkatasubramanian 2 , T.S.S. Rao 3 , Sumant Khanna 4 , Y. Janardhan Reddy 2
Jaslok hospital and research center, Mumbai, 1 PGIMER, Chandigarh, 2 NIMHANS, Bangalore, 3 JSS Medical College, Mysore, 4 Senior Consultant in Psychiatry and Clinical Trials
Objective : The symposium will review the current literature on the medical treatment of Obsessive compulsive disorder (OCD) and Depression, in light of the available physiological evidence. The neuroimaging data i.e. MRI, PET scan etc., available on these disorders will also be presented. Following this the surgical option for these disorders will be discussed. This will include some lessons learnt from history, selection of the surgical target (based on the current knowledge of the neuronal circuits involved in these disorders), and different surgical therapies like deep brain stimulation, lesion and gamma knife surgery, followed by outcome analysis. The presentation will conclude by summarizing the future surgical options suitable in Indian scenario.
1. Medical Management of OCD and Depression in light of the Neurophysiological evidence - Dr. Sandeep Grover
2. Neuroimaging in OCD and Depression - Dr. G. Venkatsubramaniam
3. Surgery in intractable OCD and Depression - Dr. Paresh Doshi
4. Formation of psychosurgery guidelines in India - Dr. T.S.S. Rao, Dr. Sumant Khanna, Dr. Y. Janardhan Reddy
MCI - A new concept to predict and prevent dementia
Paramita Ray, Amitava Dan, Neelanjana Paul 1
Burdwan Medical College, Kolkata, 1 BIN, Kolkata, India
Objectives : With the scope of better health care and higher life expectancy, world population is adding more older people than young. Degenerative dementias hold the potential of an impending crisis in elderly. Mild Cognitive Impairment (MCI) is a proposed clinical entity that encompasses the clinical state between normal cognition and dementia, at which intervention can be attempted. Till now there is no consensus on clinical approach and methods of interventions for MCI. On the basis of available literature, this symposium proposes an approach a psychiatrist might follow in practice for individuals having diagnosis of MCI. MCI have received more attention than other concepts proposed to describe the tail-end of the normal cognitive range, as it has well-operationalized criteria for clinical practice and it can predict better the conversion to dementia. The initial criteria for MCI were proposed by Dr. Ronald C Petersen (1997), subsequently by the American Academy of Neurology as complaint of defective memory with abnormal memory function for age and education, maintaining normal other general cognitive functions as well as activities of daily living. What's the current incidence and prevalence of MCI? What's the outcome of MCI including annual and long term conversion rate to Alzheimer's disease or other types of dementia? No studies have validated a particular diagnostic approach. According to many physicians, the clinical evaluation of suspected MCI is almost identical to that of dementia that includes history-taking, physical examination, brief cognitive testing, and laboratory tests to look for reversible causes of memory loss. But how frequent we should call them for follow up? How frequent brief cognitive screening, neuropsychological testing or other laboratory tests to be repeated to assess for conversion to dementia? Till date there is no proven treatment. In randomized clinical trials, cholinesterase inhibitors, rofecoxib and vitamin E have failed to prevent progression of MCI to dementia in long term follow up. Evidence from population based longitudinal epidemiologic studies suggests those life style modifications (e.g. exercise and physical activity) and engaging in substitute teaching and challenging cognitive activities, particularly those involving the use of language are associated with a lower risk of dementia. So what should be a standard method of intervention?
1. Concept of MCI - Dr. Amitava Dan
2. Approach to diagnosis - Dr. Paramita Ray
3. How to intervene - Dr. Neelanjana Paul
| Special International Symposia|| |
Indian American psychiatric association symposium Improving outcomes in psychiatric disorders: Translating evidence into action
Ashwin A. Patkar, Anand K. Pandurangi 1 , Meera Narasimhan 2 , Atul R. Mahableshwarkar
Duke University Medical Center, Durham, North Carolina , 1 Virginia Commonwealth University, Richmond, Virginia, 2 University of South Carolina School of Medicine, Columbia, SC, USA
Increasing advances in understanding the etiology and treatments for psychiatric disorders have led to redefining outcomes in terms of symptoms remission and functional recovery. Over the last decade, a consensus has emerged regarding a set of evidence-based practices for psychiatric disorders that address symptom management and psychosocial functioning. Yet, studies suggest that the great majority of the population of psychiatrically ill individuals do not receive optimal care. In this symposium, we review and discuss the empirical evidence for effective treatments for schizophrenia, depressive disorders, anxiety disorders and alcohol and drug addiction. The effective treatment approaches include medication practices, psychosocial interventions, information technology, and service delivery systems. We address major barriers to access to care, engagement and retention. We also review some of the promising medications in development and likely future direction of such line of research. We conclude with recommendations for future directions and suggestions for narrowing the gap between science and practice. Ultimately, improving mental health of affected individuals will require a comprehensive strategy that would encompass cost effective medications and psychosocial interventions along with policies that promote early and easy access to care.
Improving outcomes in psychiatric disorders: Translating evidence into action - Alcohol and drug addiction
Ashwin A. Patkar
Both pharmacotherapy and behavioral treatment approaches are required to relieve the symptoms of addictive disorders and improving outcomes. Treatment providers have entered a new era of accountability with increasing demands for objective measures of effectiveness. These measures include cessation or reduction in substance use, and demonstrable improvements in functioning. Medications that target addiction phenomena, such as euphoria, withdrawal and craving, are being developed as treatments that may significantly improve clinical outcome. The development of new agents has been greatly facilitated by research, revealing the underlying neuronal mechanisms of these phenomena. Although the many types of drug use disorders have common aspects, there are also many differences that must be specifically addressed with different pharmacological strategies. In addition, all patients require a full evaluation and tailored treatment plans that take their unique set of problems into account. It is especially important to identify and stabilize co-occurring medical and psychiatric disorders in the addicted population. Currently, effective medications are available for some addictive disorders, and others will certainly be developed through continued research. This presentation will review medications that are approved to treat alcohol and drug addiction as well as medications under development. It will also highlight behavioral treatments for substance abuse that have sufficient evidence to be used in clinical practice. The presentation will address programmatic and policy related changes that can improve outcomes in addictions when combined with effective clinical approaches. When viewed in comparison with other chronic diseases, the current treatments for addiction are reasonably successful. Long-term treatment is accompanied by improvements in physical status, as well as in mental, social and occupational functions. Treatment is usually not curative. As is the case with other chronic diseases, when the treatment is ended, relapse occurs in most cases.
Improving outcomes in psychiatric disorders: Translating evidence into action - depression
Major Depression is a chronic debilitating disorder given its heterogeneity and devastating implications on morbidity and mortality. Treatment resistance continues to be a significant problem with only a third of patients experiencing complete remission following the initial antidepressant trial. Increasing advances in understanding the etiology and treatments in depression has led to redefining remission and functional recovery in terms of functional improvements, barriers to compliance and improved access to resources. Barriers to treatment in patients with depression has been an elusive pursuit that continues to grapple our field. These barriers have serious implications on subsequent relapses, increased potential for assault and dangerous behaviors, worsening of prognosis, higher economic burden and quality of life. Despite treatment advances and improved understanding of mental illness, stigma still remains a significant barrier to treatment and recovery. Remission should be the goal of treatment, since remission is associated with a much lower rate of relapse and greater improvement in psychosocial aspects of an individuals' life. The foremost step in achieving remission starts by partnering with consumers, advocacy groups to help in consensus building to destigmatize mental illness. Successive steps include accurate diagnosis of depression, appropriate matching of an antidepressant given the presenting symptoms, providing an adequate trial while monitoring clinical outcomes. Improving treatment adherence, educating the consumer that remission is the goal of therapy and working with them in a collaborative effort are key to successful long-term clinical outcomes. Identifying bio-psycho-social barriers that lead to non-adherence and enhancing compliance by adopting a comprehensive strategy that would encompass optimum choice of medication and psychosocial interventions that will significantly improve the management of depression is key to reintegration.
Improving outcomes in psychiatric disorders: Translating evidence into action-mixed anxiety-depression disorder
Atul R. Mahableshwarkar
Anxiety and depression are distinct disorders commonly seen in clinical practice, particularly in the primary care setting. Comorbid or mixed disorders are also encountered so frequently that a diagnostic category of "mixed anxiety-depression disorder" is proposed for inclusion in the Diagnostic and Statistical Manual of Mental Disorders, fifth Edition (DSM-V). Evidence has been accumulating over the past seven to eight decades that the presence of anxiety symptoms in patients with major depressive disorder confers greater risk to outcomes. Such patients exhibit greater severity of symptoms, have more co-morbidities, suffer from more treatment related side effects, have poorer treatment response and exhibit greater suicidality and completed suicides. Higher rates of healthcare use and costs are also associated with comorbidity because these patients have more psychological, physical, and social impairment than those with either disorder alone. It is crucial for clinicians to recognize both anxiety and depression early in the clinical course and institute appropriate therapy aimed at making the patient well (ie, achieving full remission) rather than merely improving symptoms. Patients with comorbid anxiety and depression tend to discontinue treatment earlier than those with depression alone, and they may not respond as robustly to conventional treatments. The introduction of newer classes of antidepressants that exhibit both robust antidepressant and anxiolytic effects has provided the ability to treat both disorders with a single medication. The lecture will review and present the evidence supporting the worse prognosis of this group of patients with depression and anxiety and then discuss actions that can be taken based on evidence in order to achieve and maintain treatment goals which is remission.
Improving outcomes in psychiatric disorders: Translating evidence into action- schizophrenia
Anand K. Pandurangi
Introduction : It remains an open question whether the long-term outcome in schizophrenia has improved with all the treatments available to the clinician. However, symptomatic and short-term functional outcome after a psychotic episode appear to be better. First generation antipsychotics (1950-90), and second generation antipsychotics (1990-2010), combined with schizophrenia specific psychotherapies may have helped reduce the devastation caused to an individual's life by psychotic episodes. Newer knowledge, techniques, and treatments are emerging that may be translated into prevention of psychosis, prediction of response, attenuation of psychosis, better outcome for the episode, reduced disability, and improved long-term outcome for the disease.
Materials and Methods : The literature is critically reviewed for 2000-10 to summarize the most promising evidence-based developments in schizophrenia that have a bearing on episode and illness outcomes. The major findings in genetics, early identification, imaging, algorithmic treatment, long-acting injections, drugs with novel receptor actions, case management, and rehabilitation and recovery are summarized.
Results and Discussion : Several promising gene locations (6p, 11q, 22q, etc) are being actively pursued through linkage studies, genomic wide association studies and identification of copy number variants leading to a better understanding of this disease. Functional magnetic resonance imaging and diffusion tensor imaging are revealing the likely functional and structural neural circuitry of psychosis. A better definition of the psychosis-risk syndrome and hence early identification and treatment is underway. The emphasis on an algorithmic approach to pharmacotherapy including greater use of clozapine and long-acting injections is emerging to optimize outcome. Personalized medicine based on pharmaco-genomics may help fine treatment to the individual. Glutamatergic drugs are in the pipeline and likely to address refractory symptom domains. Assertive and intensive community management strategies and re-prioritized goals in rehabilitation of persons with schizophrenia are likely to change the pessimistic landscape of this complex disorders.
Bipa symposium: Undergraduate psychiatric education in the 21 st century
Subodh Dave, R.C. Jiloha 1 , J.S. Bamrah 2
Derbyshire Mental Health NHS Trust, Derby, UK, 1 G.B. Pant, New Delhi, India, 2 Royal College of Psychiatrist, London
Psychiatric morbidity is estimated to be nearly 20-25% in many international epidemiological studies. Mental illnesses account for nearly 15% of the burden of diseases in established market economies, which is more than all cancers put together. Identification of mental illnesses in primary care remains poor in both developed and developing countries. Targeting medical students to enhance the quality of psychiatric education provided in an "easy win' in terms of improving diagnosis and treatment of mental illness. At the end of symposium, delegates will get (1) an understanding of the key psychiatric competencies that all medical students need and (2) learn about recent developments in India and the UK at streaming undergraduate medical education.
1. Undergraduate psychiatric education: Fit for purpose in the 21 st Century? - Dr. Subodh Dave
2. Undergraduate Curriculum: Indian experience - Dr. R.C. Jiloha
3. Global Competencies for Tomorrow's Doctors - Dr. J.S. Bamrah
Tap symposium: Use of atypical antipsychotics in psychiatry - An update moderators
Yasin Bez 1 , Numan Konuk 2 , Ilhan Yargic 3 , Mesut Cetin 4
1. What did atypical antipsychotics bring us? - Yasin Bez
2. Atypical antipsychotics and mood disorders - Numan Konuk
3. Use of atypical antipsychotics in other areas - Ilhan Yargic
4. Second generation antipsychotics and their metabolic side effects - Mesut Cetin
| Speciality Section Symposium|| |
Alcohol policy statement of the IPS
Vivek Benegal, D. Basu 1
NIMHANS, Bangalore, 1 PGIMER, Chandigarh
Alcohol misuse is an important contributor to the cumulative health burden in India. A sizeable proportion of alcohol attributable fraction of the health burden is due to hazardous and harmful use of alcohol. Alcohol problem is multidimensional and complex. There are various facets of the problem, and there are various stake-holders with varied and at times mutually conflicting interests. Interventions and treatments have been hampered by the lack of a coherent alcohol policy; especially relating to treatment and rehabilitation and minimum guidelines of care. That space has been filled by practices prompted more by the economic pressures of state income from alcohol sales than guided by health considerations and by a profusion of care-providers with questionable, often dubious, practices. The psychiatrist fraternity of India needs to provide informed guidance to rectify this anomalous situation. The first step would be to provide a framework for policy planners and subsequently monitor its implementation. With this aim in view, we propose a Specialty Section Symposium. We will present and discuss a set of policy recommendations on behalf of the IPS, which are being drafted by the Specialty Section on Substance Use Disorders of the IPS. The draft will be first circulated via the e-ips bulletin board for comments and suggestions, as well as being subjected to the IPS executive committee to vet, before being presented for discussion. It is hoped that the final version may be placed before the annual general body for its consideration.
1. The need for an alcohol policy statement by the IPS- context, conflicts, and toward a consensus - Dr. Vivek Benegal
2. The Alcohol Policy Statement of the IPS - a living document - Dr. Debasish Basu.
The first one will cover the extent of alcohol use and various harms in India, the challenges and conflicts involved in formulation of a policy statement, and how to move towards a consensus. The second talk will present the actual policy statement and recommendations as formulated by the Specialty Section, emphasizing its sensitivity to the economic, cultural and political complexity of the Indian situation and hence the need for such a policy statement to be responsive to such contextual factors, mandating it to be a dynamic, changeable, 'living' document.
Mental health care for older adults: Where we stand and future strategies
S.C. Tiwari, K.Shaji 1 , Shiv Gautam 2 , Charles Pinto 3
CSM Medical University, Lucknow, 1 GMC, Thrissur, 2 Gautam Institute of Behavioral Sciences and Alternative Medicine, Jaipur, 3 TN Medical College and BYL Nair Hospital, Mumbai, India
With improving life expectancy at birth, there is a global rise in the population of older adults both in terms of proportion and absolute numbers. At present, there are about 515.21 million older adults in the world aged 65 years and above including 60.49 living in India. Older adults aged 60 years and above are 83.58 million in India. Epidemiological surveys across the globe have indicated steady rise in mental health problems of older adults; to the extent that there will be 43% increase in prevalence for dementia in the developed world and 218% in developing countries from year 2000 to 2025. Results from a large recent Indian council of medical research study indicate an average mental health morbidity of 20.5% in older adults in India (absolute numbers - 17.13 million) and thus there is a formidable challenge to provide mental health care to these mentally ill older adults. In European and Western countries Geriatric Psychiatry is a well defined and recognized medical discipline with dependable infrastructure and manpower. The present Indian scenario is quite dismal as the discipline is neither defined nor recognized. The proposed symposium will highlight the global and Indian demographic and mental health scenario; the service gap; the road map to develop mental health services for older adults in India; and the role of government, non government organizations and community in mental health care of older adults and future strategies.
1. The Global Demographic and Mental Health Scenario of Older Adults with special reference to India - Dr. K. Shaji
2. The Requirements and Availabilities of Mental Health Services for Older Adults in India: 'The Gap'- Dr. S.C. Tiwari
3. Role of Govt., NGO's and Community In Mental Health Care of Older Adults in India and Future Strategies - Dr. Shiv Gautam
4. Road Map to Develop Mental Health Services for Older Adults in India - Dr. Charles Pinto
Adult attention- Deficit/hyperactivity disorder
Prabhat Sitholey, Devashish Konar 1 , Vivek Agarwal
CSM University, Lucknow, 1 Consultant Psychiatrist, Burdwan, West Bengal, India
Attention-Deficit/Hyperactivity Disorder (ADHD) was considered primarily a disorder of childhood. But now it has been found to persist in to adulthood, often with serious consequences. Adult ADHD is now considered to be a valid disorder which can be treated effectively. Presentations of adults with ADHD are varied and they usually come to attention because of comorbid psychiatric disorder. In assessment it is necessary to use valid instruments like K-SADS, WMH-CIDI, ASRS v1.1-screener and Conners Adult ADHD Diagnostic Interview (CAADID). In treatment it is important to treat ADHD with either psycho-stimutants or atomoxetine. Comorbidities need to be simultaneously treated. Psycho-education and frequent follow-ups are necessary to maintain contact with the patients and ensure compliance. However, there is scarcity of information on adult ADHD from India. Most of the psychiatrists have relatively little training on the assessment and management of adult ADHD. Therefore this symposium will focus on the recognition and management of adult ADHD.
1. Introduction - Dr. Devashish Konar
2. Assessment of Adult ADHD - Dr. Vivek Agarwal
3. Management of Adult ADHD - Dr. Prabhat Sitholey
Spectrum concept in psychiatry
Lt. Col. Arun Sen, Lt. Col. (Mrs) H.S. Bedi 1 , Surg Capt. Kaushik 2 , Lt. Col. V.S. Chauhan 3
Military Hospital, Gawahati, 1 Base hospital, Srinagar, 2 INHS Asvini, Mumbai, 3 Command hospital, Udhampur
As new parts of the brain are being explored and roles of various chemicals are being evaluated for various psychiatric disorders; classification of psychiatric illness has rolled in, to be a rather dynamic process than a mere static book revelation. Simultaneously clinical research has begun to validate that a much larger group of patients demonstrate milder and/or atypical forms of same illness widely varying in frequency, intensity and forms, core features remaining the same. They would often be resistant to standard therapies, and sometimes the conditions are worsened by standard treatment vexing and confusing the clinician further. This prismatic aspect of science forces us to give due cognizance to a spectrum concept for better understanding of illnesses. Implication of the same goes a long way in treatment, prognosis and outcome. This symposia endeavor to deliberate on this conceptually stimulating and therapeutically relevant issue. It will focus on the spectrum profile of various psychiatric illnesses and simultaneously will bring out the salience and pitfall of such concept.
1. Obsessive Compulsive Spectrum Disorder - Lt. Col. Arun Sen
2. Autistic Spectrum Disorder - Lt. Col. (Mrs) H.S. Bedi
3. Bipolar spectrum disorder and others - Surg Capt. Kaushik
4. Advantages and drawbacks of spectrum concept - Lt. Col. V.S. Chauhan
Forensic psychiatry - Basics
R. Sathianathan, Sanjay Gupta 1 , Srinivasa Ragavan 2 , N.G. Desai 3 , Malaiappan, A.K. Kala 4 , Subhangi Parkar 5
Madras Medical College, Chennai, 1 Varanasi, 2 Ilinosis, USA, 3 IHBAS, Delhi, 4 Consultant Psychiatrist, Ludhiana, 5 GSMC and King Edward Memorial Hospital, Mumbai, India
Forensic Psychiatry is a sub specialty of psychiatry deals with the interface between law and psychiatry. Forensic Psychiatrist is a psychiatrist who has additional training and/or experience related to various interfaces of mental illness with the law. In US after completing psychiatry training there is a one year fell0owship following which they have to sit for a board certification examination in forensic psychiatry. In U.K. after completing psychiatry training there is a three years training course in forensic psychiatry after which they get a Certificate of completion of specialist training (CCST). In most of the countries including India there is no separate training programme for forensic psychiatry, so the present symposium aimed at improving the knowledge and skills of the psychiatrists.
1. Introduction - R. Sathianathan, Sanjay Gupta, Srinivasa Raghavan
2. Criminal responsibility and competency to stand trial - Prof. Nimesh Desai
3. Human Rights of the mentally ill - Dr. M. Malaiappan
4. Civil competency (to make contract, to marry, to make medical decisions and to execute wills) - Dr. A .K. Kala
5. Risk Assessment (Dangerousness to others / self) - Dr. Subhangi Parkar
Community Psychiatry in India: From concept to reality
Harjeet Singh, Shiv Gautam 1 , Jagdish Kaur 2
CSM Medical University, Lucknow, 1 Gautam Institute of behavioral sciences and alternative Medicine, Jaipur, 2 Ministry of Health and Family Welfare
The symposium intends to emphasize the delivery of psychiatric services to the people with in their community itself. Speakers aim to discuss the merit of community psychiatry concept in reality the section affected, there are practical difficulties while its implementation and how to tackle them, so that newer strategies for mental health act can be focused.
1. Need and concept of National Mental Health Programme and new directions - Dr. Shiv Gautam.
2. Present day ground realities of National Mental Health Programme - Dr. Jagdish Kaur.
3. Operational issues of National Mental Health Programme implementation - Dr. Harjeet Singh.
Career needs of young Psychiatrists
Ravi Gupta, Anil Nischal, Samir Kumar Praharaj,
G. Venkat Subramanian
The symposium intends to bring forth the needs of trainee and young psychiatrists who have jus completed their training. The First speaker will discuss the current status of subspecialty training in India and what should be done to improve the training in various subspecialties. The second speaker will emphasize the training for delivering non-pharmacological treatments and what should be done to improve the skills. The third speaker will cover the areas to be covered in the research keeping the currently available research with respect to day to day clinical matters. The fourth speaker will cover the area of research and publication as how to groom the young psychiatrists in developing publication skills.
1. Development and training in sub-specialities - Dr. Ravi Gupta
2. Training needs for non-pharmacological treatments - Dr. Anil Nischal
3. Research: On what and how to go about - Dr. Sameer Kumar Praharaj
4. Publishing research: how to go about and the avenues - Dr. G. Venkat Subramanian
Indo Australasian psychiatry association symposium 63 rd Ancips0 , Delhi, January 2011
Indo Australasian Psychiatry Association (IAPA) was incorporated in 2003 with the membership of psychiatrists and Psychiatry Trainees in Australia and New Zealand of Indian and Indian subcontinent ancestry. IAPA has close relations with Indian Psychiatric Society from its inauguration and is a further collaborator as part of the Indo Global Psychiatric Initiative with IPS that was inaugurated at the 2010 annual national conference of indian psychiatric society (ANCIPs). IAPA has had 7 international conferences in Cultural Psychiatry and International Mental health held in Australia and New Zealand. IAPA has also participated in several ANCIP Congresses and contributed to the IAPA Symposia at the ANCIPS, IAPA submits its symposium for the 63rd ANCIPS at Delhi in January 2011 with topics that IAPA feels will be relevant to Australasian and Indian psychiatry.
Chairs: Prof Dinesh Arya Newcastle, Prof Saji Damodaran Melbourne
1. Introduction to the IAPAus and the Symposium at ANCIPS - (10 Min) Dr. Shailesh Kumar, New Zealand
2. Consumer and Career Participation - evidence from surveys and renewed directions - (20 Min) Dr. Raju Lakshmana, Austin Health Melbourne
3. Suicide and Media - Current perspectives and applications (20 Min) Dr. Neeraj Gill, Clinical Director, University of Queensland
4. Clinical Governance: Its place in Mental health Management (20 Min) Dr. Sanjib Buruah, Brisbane Queensland
5. Wrap up - Summary (5+5 min) Prof. Russell D'Souza, Prof. Dinesh Arya Australia
| Workshops|| |
Relapse prevention in schizophrenia
Shiv Gautam, Pranab Kalita 1 , Manasvi Gautam 2 , Parmanand Kulhara 3 , H.M. Gadhvi 4
Gautam Institute of behavioral sciences and alternative Medicine, Jaipur, 1 Janssen-Cilag India, Mumbai, 2 Gautam Hospital and Research center, Jaipur, 3 PGIMER, Chandigarh, India, 4 London, U.K.
Objective : To equip the participants with knowledgebase related to current issues in the diagnosis of schizophrenia, Current strategies in the management of schizophrenia, strategies of relapse prevention in schizophrenia and discussion on current assessment tools for schizophrenia. The definitions and boundaries of Schizophrenia have continued to vary over the period. At any given time, the changing concept of schizophrenia has been influenced by available diagnostic tools and treatments, related conditions from which it most needs to be distinguished. There is significant heterogeneity in the etio-pathology, symptomatology, and course of schizophrenia. It is characterized by an admixture of positive, negative, cognitive, mood, and motor symptoms whose severity varies across patients and through the course of the illness. Schizophrenia tends to be a chronic and relapsing disorder with generally incomplete remissions, variable degrees of functional impairment and social disability, frequent co-morbid substance abuse, and decreased longevity. Although schizophrenia may not represent a single disease with a unitary etiology or pathogenetic process, alternative approaches have thus far been unsuccessful in better defining this syndrome or its component entities. The nosological boundaries between schizophrenia and other psychiatric disorders remain blurred despite several changes in diagnostic criteria over the past century Boundaries remain blurred between schizophrenia on the one hand, and personality disorder, developmental disorders, mood disorders, substance-induced psychotic disorders, and other psychotic disorders. The introduction of second-generation antipsychotics and cognitive therapies for schizophrenia over the past two decades generated considerable optimism about possibilities for recovery. In taking stock of our current body of knowledge, it can be said that day-to-day management of schizophrenia appears not to have changed very much. This is despite the supposed revolutionization of treatment by the introduction of second-generation antipsychotic agents and a range of cognitive psychotherapeutic approaches over this period of time. In an effort to explore this discrepancy, our current knowledge about pharmacological, psychological, social, and other emerging treatments for schizophrenia and the current science-to-service gap in schizophrenia treatment needs to be discussed. Non-adherence with antipsychotic medication remains a persistent and challenging problem in the treatment of patients suffering from schizophrenia. Rather than reflecting an all-or nothing situation, adherence is a behavior difficult to detect, with patients being fully, partially or non-adherent. The level of partial or non-adherence in patients with schizophrenia is as high as 60%, resulting in a higher risk of relapse, re-hospitalization and suicide attempts and is a major contribution to the economic burden of schizophrenia. Factors that may affect a patient's decision to adhere to a medication regimen can be regarded as a result of the interplay between a numbers of construct factors. The need to incorporate adherence-focused psychotherapy and psycho-education into daily clinical practice and structuring pharmacotherapy to improve therapeutic compliance needs to be discussed.
1. Current issues in the diagnosis of schizophrenia - Dr Manaswi Gautam
2. Current strategies in the management of schizophrenia and current assessment tools for
3. schizophrenia - Prof. Shiv Gautam
4. Current strategies in relapse prevention in schizophrenia - Dr Pranab Kalita
The global mental health assessment tool - Primary care version
Vimal Sharma, J Copeland, Gagandeep Singh
Cheshire and Wirral Partnership NHS Foundation Trust, UK
Objectives : GMHAT/PC is a computerized clinical assessment tool developed to assess and identify a wide range of mental health problems. It generates a computer diagnosis, a symptom rating and risk assessment. The instrument has been translated into 6 different languages (including Hindi) and has led to number of publications. The published data suggests that the GMHAT/PC is an easy to administer computerized tool which can be used in primary care for the standardized assessment of mental health problems. The authors are very keen to develop this into an international instrument and test its translated version in various countries. The instrument is already being used in different countries. This workshop is aimed at providing information/training to the interested professionals so that different resource centers can be created across India. These resource centers will then act as contact/training centers with a view to use this instrument in Primary Care Centers across India.
Skill development in Psychiatric rehabilitation
V.K. Radhakrishnan, T. Murali 1
CNK Hospital Pvt. Ltd, Changanacherry, Kerala, 1 Sri Siddhartha Medical College, Tumkur, Karnatka, India
Mental health professionals especially psychiatrists who have recovery as their vision must become "teachers" not just therapists. The practice of rehabilitation is different from usual clinical practice. The practitioners may use systematic and structured educational services that go beyond discussions of problems and solutions and empower the individual with the necessary skills for social integration. The techniques of the social skills training includes, detailed evaluation, identification of the problem behaviour, motivational enhancement, cultural competence, informed and shared decision making social role modeling, specific instructions behavioral training, coaching, positive reinforcement, resource management and homework assignments. The developments of the last two decades and specifically the advance in the information technology of the current century open a new window of opportunity to make psychosocial rehabilitation a PEOPLE movement. To make the ill persons and their families the centre of the care program. In promoting recovery from psychiatric disorder such as schizophrenia Psychiatrists much teach individuals to set individual specific goals, learn the social cognitive, verbal and nonverbal communication skills required for the successful achievement of their goals, training to look after themselves in personal hygiene and social skills.
In this workshop participants must bring interesting case histories which they found to be beneficial in rehabilitation aspects of chronic diseases. This is an active-directive learning experience in which participants will 'learn by doing' and which they apply to their patients next day onwards.
Management of dementias
S. Anand, V. Sivakumar 1
Witham Court, Lincoln, 1 Beighton Hospital, Sheffield, NZ
Objectives : Workshop aimed at practicing psychiatrists to enable confidence in diagnosing various memory disorders and to effectively manage the illness. The world population is ageing and it is becoming more apparent in countries like India. Coincidentally it is further burdened with increasing prevalence of Dementias. This is further complicated by rapidly changing socioeconomic scenario. Clinicians working with older adults in their clinical practice will increasingly come across Dementias and find themselves managing these memory disorders. The speakers are practicing Old Age Psychiatrists in UK and this workshop aims to work with practicing clinicians to enable confidence in diagnosing and managing Memory Disorders. The workshop will look at epidemiology to understand the gravity of these illness prevalence, work through neuropathology, investigations, diagnosis and evidence based pharmacological and non pharmacological interventions.
Parental divorce and the stress process: Does divorce increase the risk for childhood mental disorders?
Lisa Strohschein, T.S.S. Rao 1
University of Alberta, Edmonton, Alberta, 1 J.S.S. Medical College, Mysore
Objectives : Once a rare occurrence, divorce is on the rise in India. As divorce becomes more common, psychiatrists and other mental health professionals will need empirical information about whether and how parental divorce affects children in order to provide effective services. The purpose of this paper is to give an overview of what has been learned in Canada about the association between parental divorce and childhood mental disorders such as depression, antisocial behavior and attention deficit disorder. Importantly, this paper addresses the issue of whether there is a causal relationship between parental divorce and children's risk for mental disorders.
Materials and Methods : Analysis is based on multiple waves of data from the Canadian National Longitudinal Study of Children and Youth, an ongoing survey of a nationally representative sample of Canadian children followed from birth since 1994. By prospectively tracking mental disorders in children before, during and after parental divorce and comparing their mental health status to children whose parents remain married, the author is able to address whether divorce is a cause of childhood mental disorders.
Results : Results show that some of the effects of divorce are due to selection (that childhood mental disorders are evidenced prior to divorce), but that the relationship is also causal: divorce is associated with subsequent increases in the risk for childhood mental disorders. Factors that mediate and moderate the causal association and implications for mental health professionals are discussed.
Guidelines for marriage of women with mental illness
M. Thirunavukkarasu, S. Nambi 1 , Indira Sharma 2 , Sonial Parial 3 , Shanti Nambi 4 , Prabha Chandra 5 , T.S.S. Rao 6 , P.K. Dalal 7
Consultant Psychiatrist, Anna Nagar, Chennai, 1 Consultant Psychiatrist, Chennai, 2 Institute of Medical Sciences, BHU, Varanasi, 3 Consultant Psychiatrist, Raipur, 4 Madras Medical College, Chennai, 5 NIMHANS, Bangalore, 6 JSS Medical College, Mysore, 7 CSMMU, Lucknow, India
Objective : To discuss about the problem of marriage of women with mental illness. Marriage of women with Psychiatric Illness is a clinical, social and legal problem. The relevance of having specific guidelines for the marriage of women with mental illness will be introduced. The problems faced by the girl and her family when they go for marriage of their mentally sick daughter and the boy and family when married to a woman with mental illness will be elaborated. Specific guidelines for the marriage of women with mental illness will be suggested.
Understanding autism and autism spectrum disorders
Porpavai Kasiannan, Srinivasan 1
Melbourne, Australia, 1 Kovai Medical Centre and Hospital, Coimbatore,
Tamil Nadu, India
Objectives : This workshop will attempt to answer the most commonly asked questions about Autism and Autism spectrum disorders and also to provide information about the latest research findings and management strategies. The ultimate goal is for the participant to gain better understanding of Autism in their clinical practice. They will also gain skills in recognizing the disorder, differentiating from other psychiatric disorders in various age groups including adults. Various evidence based management strategies will be discussed. Participants will be provided with a list of resources and copies of relevant articles. Autism is a neurodevelopmental disorder that is characterized by impairments in communication, impairments in social interaction and restricted, repetitive or stereotyped patterns of behaviour, interests and/or activities. However, symptoms vary from individual to individual. Children with classical autism are usually diagnosed between the ages of 2 and four. However children and adults with atypical autism, high functioning autism and Asperger's syndrome may not be diagnosed until much later or even in adulthood. Diagnosis of autism and pervasive developmental disorders (PDDs) or autism spectrum disorders (ASDs) have increased since the disorder was first recognized. In the past decade prevalence has increased from 3 in 10,000 to 1 in 500, 1in 150, or even more in some studies. Many a time autism has been misdiagnosed as a result of which individuals with autism do not receive appropriate support.
1. Overview, Etiology, Clinical features and Diagnostic issues - Dr. Porpavai Kasiannan
2. Management of Autism Spectrum Disorders - Dr. Srinivasan
Reghuvaran Kunjukrishnan, A.G. Ahmed, Vanessa Woods 1
University of Ottawa, 1 Royal Ottawa Health Care Group, Ottawa, Ontario, Canada
Objectives : To discuss about the basic theoretical framework of forensic psychiatry, forensic mental health assessment and violence risk assessment and management. Forensic psychiatry operates at the interface of psychiatry and the law. This subspecialty applies scientific and clinical expertise to mental health issues presenting within the context of civil, criminal, correctional or legislative matters. Although well developed in the West, the practice remained rudimentary in most parts of the world. This workshop based on Canadian framework of reference, is designed for psychiatrists and other clinicians with professional accreditation who wish to have an introduction or update in the principles and practice of psychiatric assessment and treatment of individuals with mental disorders who engage in criminal and other antisocial behavior. In addition, this workshop will provide participants with an update on research related to psychiatric risk assessment and management.
Management of endocrine and neurological morbidity in schizophrenia
Jayprakash R. Ravan, Arun, Dheeraj Kattula 1 , Vivek Mathew
CMC Vellore, TN, 1 Christian fellowship hospital, Oddanchatram, Tamil Nadu, India
Objective : The aim of the workshop is to demonstrate the principles and practice of screening and intervening for metabolic syndrome, thyroid dysfunction, clinical significant hyperprolactinemia, hypertension and neuropsychiatric morbidities in strokes. The prevalence of medical morbidities is very common in patients with chronic schizophrenia. The challenge for the psychiatric community is to diagnose and provide a rational treatment for the same. There is not much of information available in the psychiatry literature regarding practical screening, diagnosing as well initiating rational treatment for the same.
Managing the monkey managerial leadership: Delegating for development
Shubhangi R. Parkar, H.R. Shah 1
G.S. Medical College and King Edward Memorial Hospital, Parel, 1 T N M C and Nair Hospital, Mumbai, India
Objectives : At the completion of the session, participants will understand dimensions of empowerment; Understand the theory behind the Situational Leadership Model-demonstrate how each of the four behavioral styles is used with direct reports, peers and students, be able to determine the competence and commitment levels of those they lead to complete work assignments; Be able to assess the risk associated with each situation, and use the appropriate leadership style for the risk; Understand the concept of managing the "monkey" and how it relates to Situational Leadership, the delegation of responsibility and the development of direct reports, students and colleagues. Today's psychiatrist, whether in institutes or in private sector works in a team. For an effective team, a good leader is important. The role of leadership has shifted dramatically as we come to more fully understand the relationship between leaders and followers. In the past, the emphasis was more on the leader as the authority person, the person who gave directions, expecting people to follow them. Today, leaders must be more of a "partner" with those they lead and empower. With educationists and physicians, this includes direct reports, mentees, students, and professional colleagues. In the working of a team, one can be saddled with many "monkeys", that is jobs and duties which one is not responsible for. It is important to learn to deal with these monkeys to be an effective leader. One simple idea can set you free: Don't take on a problem if it isn't yours! Those who accept every problem given to them by their staffs become hopeless bottlenecks. Delegation and empowerment of one's colleagues is thus an important skill that one needs in their toolkit.
This skills-based session teaches attendees how to vary their leadership style as necessary to develop followers' competence and confidence as a pathway to empowerment. When leaders know how to determine the development levels of those they lead, and then vary their style accordingly, overall performance and learning is enhanced.
Enrichment of adolescent life skills through the peer educators approach
Jitendra Nagpal, P.C. Shastri 1 , Amulya Khurana 2 , Divya S. Prasad 3 , Geetanjali Kumar 3 , Priyanka Gera 3 , Aditya Pathak 3
Institute of Child Development and Adolescent Health and Division of Mental Health In Life Skill, New Delhi, 1 Consultant Psychiatrist, Mumbai, 2 IIT, New Delhi, 3 Expressions India, New Delhi, India
Objectives : Expressions India' is a school based programme on mental health and life skills education. The objectives of the programme have been sensitization of school children and adolescence about relevant psychosocial issues, promotion of life skills and prevention of difficulties associated with behavioral and learning problems. It strives to impart knowledge to adolescents regarding problem solving techniques, decision making strategies and aspiring for peer tutoring and mentoring. Empowerment through the national peer educator task force has been a key human resource in the journey of Adolescent education by Expressions India. Adolescents contribute a demographic bonus and a window of opportunity for the overall development of a nation. Schools are one of the settings outside the home which provide children with new knowledge and skills and can foster their emotional and mental health. Children often turn to their friends or other adults whom they trust for help and that within every school an informal network exists.
Materials and Methods : Programme consists of two parts: children below 12 years and teens: 13 to 18 years. Trained adolescents in turn work as peer educators for more programs with a cascade effect. The school doctor, school teachers and counselors are trained via lectures, case vignettes and interactive sessions. Parents are also involved in many workshops. Topics include common childhood and adolescent developmental, behavioral, emotional problems, life skills, family communication, relationships, basic counseling skills. Informative material is provided on issues of substance abuse, HIV/AIDS, anger and stress management, coping with failures etc. Structured questionnaires assessing behavioral issues of students and concerns of parents and teachers are used in each workshop. The peer training approach, involves one teacher and 3-4 student representatives from each school (forming the core life skills team) at the school. They learn these skills through active learning and participation in a 6 session inter school training workshop programme. They further train their peers at school in these skills through the same process. They follow up with the main resource team for feedback, discussions and training material. It involves the process of experiential learning using 4 components: Practical activity, Feedback and reflections, Consolidation and reinforcement, and Practical applications. Each workshop is specially designed to impart a particular skill and involves all or some of the following techniques: Mini lectures, Group participation and discussions, Brainstorming, Role play, Group tasks and activities, and Puppetry.
Results : Started in July 2000 the program has so far covered 400 schools in NCR of Delhi. In over 500 workshops across the country, thousands of children, adolescents, teachers and over 300 school counselors have been sanitized in the training programs. Training modules have been specially developed for this program. This has led to the establishment of the National Peer Educator Forums (NPEF) as a movement towards the goal of adolescent well being.
Conclusion : The key to success of the model depends upon continued partnership between the school management, parents, school teachers and counselors during and after the program. Role of peer educators has been significant in maintenance of school mental health programme. Effective acquisition and application of life skills can influence the way one feels about others, ourselves and equally will influence the way we are perceived by others. It contributes to perception of self confidence. Life skills help the child through the turbulence of adolescence and help him steer clear of irresponsible decisions throughout his life. It is a paradigm of human capital through sharing of knowledge and skills.
Religion and psychotherapy
Aziz Ahmed Quadri, M.S. Reddy 1
Director Mental Health Center, Aurangabad (MS), 1 Director Asha Bipolar Clinic, Hyderabad, India
Objective : To discuss (a) Psychotherapy: insights from the Bhagavad Gita, b) Psychotherapy in light of Holy Quran. Part A: Psychotherapeutic considerations in light of Bhagavad Gita for Resolution of conflict and successful resumption of action with regards to the following: 1. The conflict and the diagnosis of the client/patient, 2. The background setting of the situation, 3. The personality and character of both the patient and the therapist, 4. The technique of therapy -Underlying psychological concepts/ principles/theories, 5. The Guru - Chela concept of psychotherapy - Dr. M.S. Reddy. Part B: 1. Brief case histories of minimum 6 cases with different psychiatric disorders (OCD, panic disorder, post traumatic stress disorder, depressive disorder, addictions, personality disorder, conduct disorder, dementia, mental retardation), 2. Cognitive restructuring of these cases in light of Holy Quran and Hadith. 3. Basic principles of Islam and different aspects of Islam which deal with psyche of a Muslims. 4. Socio-cultural context of many of the thoughts which disturb patients. 5. Interactive discussion - Dr Quadri.
Making sense of history
Alok Sarin, Anirudh Kala 1 , Sanjeev Jain 2
Sitaram Bhatia Institute, New Delhi, 1 North India Psychiatry Centre, 2 NIMHANS, Bangalore, India
The present workshop is part of fellowship work that the 1st author is pursuing at the Nehru Memorial Museum and Library, and will attempt to address these rather difficult issues. In a country, a sub-continent, and indeed, a world that is so frequently riven asunder by communal conflict, it is indeed surprising that mainstream psychiatry has largely been silent on the mental health aspects of communal conflict. Thus while sociology, psychology, literature, and the arts have explored this domain extensively, medical psychiatry has been quiet. There are clearly many possible reasons for this and an attempt to understand these should be made. To start with, psychiatry essentially is a discipline of the individual. To extrapolate from there to larger groups or communities is an exercise in speculation. Will a community behave like all its participant units, or will it gain attributes because of its collectivism? The answer obviously has to be nuanced in that some attributes will certainly remain, but not necessarily all. The next part of the answer lies in psychiatry's conceptualization of itself. So psychiatry as a medical discipline is inherently uncomfortable with the 'softer' sciences, and reluctant to incorporate them into its world view.
Eye movement desensitization and reprocessing: A promising psychotherapeutic intervention
Deepak Gupta, Parul Tank 1 , Sushma Mehrotra 2
Sir Ganga Ram Hospital, New Delhi, 1 Fortis Hospital, 2 Consultant clinical psychologist, Mumbai, India
Objectives : To present an overview of eye movement desensitization and reprocessing (EMDR), specific applications in various psychological problems and psychiatric disorders, and use of EMDR in children. EMDR is a psychotherapeutic approach to deal with patients distressed by psychological traumas (single or multiple) or suffering from phobias and fears. The goal of EMDR is to help the client learn from negative experiences, desensitize present triggers that are inappropriately distressing and incorporate templates for appropriate future action that allow the client to excel individually and within his/her interpersonal system. Through this approach the client is able to obtain the most comprehensive treatment in the shortest period of time, so that it allows the person to move forward and function normally in day to day life. Research on using EMDR with children is a promising area. Although there is vast literature supporting the use of EMDR with adults, it has been observed that it is quite effective even with children and adolescents. EMDR is quite a simple task for the child. Since the changes occur automatically, and in a non volitional manner, it makes it comparatively easier to use with children, as compared to other therapies. We have worked with children and adults with a spectrum of psychological problems and psychiatric disorders, with whom EMDR has been beneficial. The average number of sessions required was 2-4, and they continue to show improvement, even after EMDR was stopped. A note of caution is that it is important that professionals be trained to use it before they put it to practice. EMDR has a huge potential, but along with it comes the clinician's responsibility to use it wisely and ethically.
Source of Support: None, Conflict of Interest: None