Public Attitudes Toward Psychiatric Hospitals: A Rural-Urban Comparative Public Survey in Odisha State, India

Background: Integration of psychiatric care with public health services and offering mental health care services to patients from lower socioeconomic status remains a global challenge. Scarcity of funds and professional workforce in psychiatric hospitals contribute to this situation. However, negative attitudes in the population are also a known impediment to patients seeking mental health services. This study aimed to assess the attitudes toward psychiatric hospitals among the urban and rural population in India. Subjects and Methods: The study was carried out amongst the general population in Odisha, India. The total sample (n = 988) includes 496 respondents from an urban-setting, and 492 respondents from rural parts of the district. Participants were selected by using simple random-sampling from the Asian Institute of Public Health (AIPH) data base. A standardized seven-item questionnaire was adopted, with responses indicated on a 5-point Likert-scale. Interviews were fully structured and conducted face-to-face. Results: Level of education (B = -0.192, ss = -0.320, p < 0.000) and urban-rural comparison (B = -0.272, ss = -0.189, p < 0.000) significantly influenced attitudes toward psychiatric hospitals. Gender, age, and religious beliefs did not show any significant effect on attitudes toward psychiatric hospitals. Individuals in rural areas and those with lower education levels showed more negative attitudes toward psychiatric hospitals. Conclusion: Negative attitudes toward psychiatric hospitals from those living in rural areas as well as those with lesser education may be reflective of the lack of availability, accessibility, affordability, and credibility of such mental health services. The Mental Health Care Act in India is a progressive legislation which might improve the situation of the provided services and, consequently, reduce negative attitudes in the years to come

Unregulated Sale of Nimesulide in India

IntroductionNimesulide has been withdrawn from a number of countries. However it continues to be available over the counter in India.MethodsA survey of 1460 drug stores and 1531 families in India on their perceptions of the potential side effects of Nimesulide.Results A high proportion (78.96%) of the drug stores sold the drug without prescription from a licensed physician. More than one in four families (26.95%) preferred Nimesulide to other drugs. A relatively small proportion drug store owners and families (12.14% and 9.6% respectively) were aware of the potential adverse effects of this drug. DiscussionThere is an urgent need to tighten regulation of dangerous drugs freely available to Indian consumers. Further research to increase public awareness about drug side effects is required in order to reduce the potential for harm from under regulation

No Effect of Cathodal Transcranial Direct Current Stimulation on Fear Memory in Healthy Human Subjects

Background: Studies have demonstrated that fear memories can be modified using non-invasive methods. Recently, we demonstrated that anodal transcranial direct current stimulation (tDCS) of the right dorsolateral prefrontal cortex is capable of enhancing fear memories. Here, we examined the effects of cathodal tDCS of the right dorsolateral prefrontal cortex during fear reconsolidation in humans. Methods: Seventeen young, healthy subjects were randomly assigned to two groups, which underwent fear conditioning with mild electric stimuli paired with a visual stimulus. Twenty-four hours later, both groups were shown a reminder of the conditioned fearful stimulus. Shortly thereafter, they received either tDCS (right prefrontal—cathodal, left supraorbital—anodal) for 20 min at 1 mA, or sham stimulation. A day later, fear responses of both groups were compared. Results: On Day 3, during fear response assessment, there were no significant differences between the tDCS and sham group (p &gt; 0.05). Conclusion: We conclude that cathodal tDCS of the right dorsolateral prefrontal cortex (right prefrontal—cathodal, left supraorbital—anodal) did not influence fear memories

Modifizierung des emotionalen Gedächtnisses bei gesunden Menschen durch transkranielle Gleichstromstimulation des präfrontalen Cortex

Einführung: Bisherige Studien haben verschiedene pharmakologische und nicht pharmakologische Interventionen untersucht, um das emotionale Gedächtnis zu beeinflussen. Die Modifizierung des emotionalen Gedächtnisses könnte wichtige therapeutische Konsequenzen haben, vor allem in Hinsicht auf die Behandlung psychiatrischer Erkrankungen. Viele Interventionen, die in Tierstudien gute Ergebnisse gezeigt haben, können aufgrund ihrer Invasivität in humanen Studien nicht durchgeführt werden. Deshalb ist es wichtig, nicht-invasive Verfahren, die nur geringe Nebenwirkungen haben und das emotionale Gedächtnis beeinflussen könnten, zu untersuchen. Methodik: Unser Ziel war es, mittels nicht-invasiver Hirnstimulation beziehungsweise Gleichstromstimulation (tDCS), diverse Gedächtnisprozesse in gesunden Probanden zu beeinflussen. TDCS beeinflusst kortikale Exzitabilität mit polaritäts-abhängigen Effekten: anodale Stimulation wirkt exzitatorisch durch neuronale Depolarisation; cathodale Stimulation wirkt inhibitorisch durch neuronale Hyperpolarisation. Wir haben zwei Studien mit reversierter Polarität durchgeführt, um die Rekonsolidierung des Angstgedächtnisses im präfrontalen Kortex zu untersuchen. In einer dritten Studie haben wir den Effekt auf anodal tDCS auf Neubewertung während der Emotionsregulation untersucht. Ergebnisse: Wir konnten zeigen, dass tDCS (rechts präfrontal: anodal, links supraorbital: cathodal) das Angstgedächtnis verstärkt, aber tDCS (rechts präfrontal: cathodal, links supraorbital: anodal) keinen Effekt auf das Angstgedächtnis hat. Die anodale Stimulation auf den präfrontalen Kortex führt zu einer Verstärkung der Neubewertung während die Emotionen hoch- und herrunterreguliert werden. Schlussfolgerung: Unsere Ergebnisse zeigen, dass anodale Stimulation auf den präfrontalen Kortex emotionales Gedächtnis und Neubewertung während Emotionsregulation beeinflusst. Allerdings hat cathodale Stimulation auf den präfrontalen Kortex keinen Effekt auf das emotionale Gedächtnis. Mehr Studien mit zusätzlichen Kontrollgruppen werden benötigt, um tDCS als effektiver Neuromodulator für das emotionale Gedächtnis zu entwickeln.Background: Various pharmacological and non-pharmacological interventions have been used to modify emotional memory. Influencing emotional memory could have important therapeutic implications in the treatment of psychiatric disorders. Many interventions that have shown promising results in animal studies cannot be used in humans because of their invasive nature. Therefore, it is critical to investigate non-invasive interventions that can safely modify emotional memory in humans with minimal side effects. Methods: We used a non-invasive form of brain stimulation, more specifically transcranial direct current stimulation (tDCS) to target different emotional memory processes in healthy human subjects. TDCS influences cortical excitability with polarity dependent effects; anodal stimulation exerts an excitatory effect through neuronal depolarization whereas cathodal tDCS exerts an inhibitory effect through hyperpolarization. We performed two studies with reversed polarity of tDCS electrodes targeting reconsolidation of fear memory in the prefrontal cortex. In a third study, we investigated the effects of excitatory tDCS targeting the prefrontal cortex on cognitive reappraisal. Results: While tDCS (right prefrontal: anodal, left supraorbital: cathodal) enhanced fear memories, tDCS (right prefrontal: cathodal, left supraorbital: anodal) did not have any effect on fear memories. Anodal tDCS of the prefrontal cortex facilitated cognitive reappraisal during emotional upregulation as well as downregulation by either increasing or decreasing emotional responsiveness. Conclusions: Our results indicate that anodal tDCS of the prefrontal cortex is effective in modifying emotional memory and modulating cognitive reappraisal. However, cathodal tDCS of the prefrontal cortex did not affect emotional memory. More studies with additional control groups are needed to develop tDCS as an effective neuromodulatory tool to consistently influence emotional memory

No Effect of Cathodal Transcranial Direct Current Stimulation on Fear Memory in Healthy Human Subjects

Background: Studies have demonstrated that fear memories can be modified using non-invasive methods. Recently, we demonstrated that anodal transcranial direct current stimulation (tDCS) of the right dorsolateral prefrontal cortex is capable of enhancing fear memories. Here, we examined the effects of cathodal tDCS of the right dorsolateral prefrontal cortex during fear reconsolidation in humans. Methods: Seventeen young, healthy subjects were randomly assigned to two groups, which underwent fear conditioning with mild electric stimuli paired with a visual stimulus. Twenty-four hours later, both groups were shown a reminder of the conditioned fearful stimulus. Shortly thereafter, they received either tDCS (right prefrontal—cathodal, left supraorbital—anodal) for 20 min at 1 mA, or sham stimulation. A day later, fear responses of both groups were compared. Results: On Day 3, during fear response assessment, there were no significant differences between the tDCS and sham group (p &gt; 0.05). Conclusion: We conclude that cathodal tDCS of the right dorsolateral prefrontal cortex (right prefrontal—cathodal, left supraorbital—anodal) did not influence fear memories

Perceived Course of Illness on the Desire for Social Distance From People Suffering From Symptoms of Schizophrenia in India

Background: Stigmatization of people with schizophrenia remains a highly relevant topic worldwide, particularly in low- and middle-income countries like India. It is crucial to identify the determinants of the desire for social distance as a proxy for discriminatory behavior in a socio-cultural context to indicate ways to reduce stigma. This study aims to explore whether the public perception of the perceived course of an illness concerning people with symptoms of schizophrenia has an impact on the desire for social distance. Subjects and Methods: Data collection took place in five cities in India. The sample (N = 447) was stratified for gender, age, and religion. Desire for social distance was sampled based on a self-reported questionnaire using unlabelled vignettes for schizophrenia. First, factor analysis was conducted to identify the main factors underlying the perception of the perceived course of the illness. Subsequently, a regression analysis was conducted to examine the impact of the perception of those prognostic factors on the desire for social distance. Results: Factor analysis revealed two independent factors of the perceived course of an illness: (1) life-long dependency on others and loss of social integration and functioning and (2) positive expectations toward treatment outcome. This second factor was significantly associated with a less desire for social distance toward persons with schizophrenia. Conclusion: The desire for social distance toward people with schizophrenia reduces with the expectation of positive treatment outcomes which underlines the need to raise public mental health awareness and provide psychoeducation for affected people and their family members in India. Help-seeking behaviors can be promoted by directing those needing treatment toward locally available, affordable and credible communitybased services rather than facility-based care. Strikingly, lifelong dependency and the inability to socially integrate do not increase the desire for social distance, reflecting the Indian nation’s socio-relational values and insufficiency of public mental health services. This indicates the suitability of systemic therapy approaches in public mental healthcare services to support the family’s involvement and family-based interventions in caregiving for mentally ill people across the lifespan