Understanding needs of stakeholders and outcomes desired from a home-based intervention program for “difficult to treat” schizophrenia and related disorders : a qualitative study

Background: We aimed to understand the needs of service users – families and patients with schizophrenia and related disorders, and mental health professionals (MHPs) and expectations from a home-based psychosocial intervention program in Indian setting. Materials and Methods: We conducted four focus group discussions (FGDs) with families, patients with schizophrenia and related disorders and MHPs. Two FGDs were conducted with families and one each with the patients and MHPs. Participants in families and MHP group were asked about their primary concerns in caring for the patients, perceived needs of patients and the areas that can be targeted through a home-based psychosocial intervention program. All FGDs were audio-recorded and verbatim transcribed. Content analysis of the data was done to obtain a final list of needs and expected outcomes from a psychosocial intervention supported by families. Results: Six key priority needs were identified for intervention: medication adherence, activities of daily living, promoting physical health, engagement in meaningful work, building of social and support networks and information about all aspects of illness. Priority outcomes identified by MHPs were mostly clinical like symptom reduction, fewer rehospitalisation while families and patients focused more on psychosocial outcomes, such as improvement of wellbeing, having relationships, engagement in meaningful activities, better organization of the day, increased self-respect, reduced stress, lesser interference, and critical comments. All groups suggested that book or mobile app or video could be used. Conclusion: This qualitative study shows that while both clinicians and service users consider recovery from schizophrenia and related disorders to be important, they differ on what they prioritise

Liberalization, globalization and the dynamics of democracy in India

In the closing decades of the twentieth century there has been an almost complete intellectual triumph of the twin principles of marketization (understood here as referring to the liberalization of domestic markets and freer international mobility of goods, services, financial capital and perhaps, more arguably, labour) and democratization . A paradigm shift of this extent and magnitude would not have occurred in the absence of some broad consensus among policymakers and (sections of) intellectuals around the globe on the desirability of such a change. There seems to be a two-fold causal nexus between marketization and democracy. The first is more direct, stemming from the fact of both systems sharing certain values and attitudes in common. But there is also a second more indirect chain from marketization to democracy, which is predicated via three sub-chains (i) from marketization to growth, (ii) from growth to overall material development welfare and (iii) from material development to social welfare and democracy. We examine each of these sub-links in detail with a view to obtaining a greater understanding of the hypothesized role of free markets in promoting democracies. In the later part of the paper we examine the socio-economic outcomes governing the quality of democracy in a specifically Indian context

Mental health services in disaster-affected population in low-resource settings

The paper discusses planning mental health services in disaster-affected population in low-resource settings. Disasters, both natural and artificial, are not uncommon in the modern world. Mental health problems are common in a disaster-affected population. Disaster often traumatizes and devastates the affected population badly, also damaging the available resources. Planning mental health services include assessing the needs, accessibility of the area, available resources and their mobilization, and coordination with the local authorities and policymakers. Mental health professionals need to take a prompt initiative and leadership role. The author discusses his own experience in planning such a service in Kashmir in November 2005 following a massive earthquake which affected the state on October 8, 2005. Role of the National Disaster Management Authority of India in the management of disasters is also briefly discussed

Preventive psychiatry: Current status in contemporary psychiatry

Preventive psychiatry is one of the most ignored subdiscipline of psychiatry, which has got important role to play in the contemporary psychiatry. Mental disorders are very common with lifetime prevalence of about 25%, and tend to be chronic. Due to the stigma associated with mental disorders, lack of awareness, and also lack of adequate mental health resources, nearly 60%–80% of the persons suffering from mental disorders do not access mental health care services. Mental and substance use disorders have been identified as one of the major contributors to the disease-related burden and disability-adjusted life years. In this background, preventive psychiatry has an important role to play in public health sector. Since etiology of most of the mental disorders is not known, it is not possible to follow here the standard model of primary, secondary, and tertiary prevention of public health. A concept of universal, selective, and indicated prevention has been proposed in primary prevention. Preventive approaches in psychiatry focus on evidence-based risk and protective factors, promoting quality of life, reducing stressors, and improving resilience. Such interventions, when planned targeting at specific mental disorders, have a potential to prevent mental disorders. Thus, preventive psychiatry has a crucial role to play in mental health, considering the high prevalence of mental disorders, the associated disability and burden, and a great drain on human resources

Substance use disorders: Need for public health initiatives

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

Attitude toward antipsychotics and its correlation with psychopathology and insight in patients with schizophrenia

Background: Attitude to antipsychotics is likely to affect adherence to treatment and hence the outcome in schizophrenia. Methods: The present study was conducted to assess the attitude to antipsychotics and its correlates in patients with schizophrenia. Attitude to antipsychotics, insight, and psychopathology were assessed in 331 patients with schizophrenia using standardized measures. Results: Most patients showed a positive attitude toward antipsychotics. A negative correlation was observed between attitude and severity of psychopathology, whereas a positive attitude was seen between insight and attitude. Conclusion: The study emphasizes the need for psychoeducation at improving insight in patients with schizophrenia so as to enhance treatment adherence and outcome