Telepsychiatry - From a Dream to Reality in Bangladesh

The governments of Low and Middle Income Countries are struggling with poverty, political instability, social inequality and inadequate health care facilities. Mental health services never get adequate attention to overcome all of these priority issues. These countries are stressed with a wide mental health treatment gap and there is no sign of adequate initiatives to minimise this gap. However, Information Communication Technologies (ICT) sectors show explosive growth. The landscape of ICT in the health sector is expanding every day. Most developing countries have no national mental health data base or electronic health record. With the help of ICT countries can collect real time data, and record the data from mobile devices in a cost effective manner. The problem of lack of trained mental health professionals, wide geographic area coverage and the large number of patients can be overcome by using telepsychiatry services. People can contact a psychiatrist or psychologist from their mobile phone whenever they need help. It removes the cost of travelling, the need to wait for an appointment and avoids the fear of being stigmatised as being mentally ill. Electronic algorithm based diagnostic systems provide professional expertise and can assist poorly trained personnel in primary care settings. Millions of people can be contacted at a time using Short Message Service (SMS), Interactive voice response (IVR) and video clips. This can be used to reduce the stigma and improve treatment adherence, two important obstacles in mental health service in low income counties. Social Networking Sites like Facebook have opened new horizons for understanding mental health conditions and providing interventions. Friendsourcing is interesting area to for mental health. All these aspect can transform mental health in Low and Middle Income Countries with their available resources

Telepsychiatry for Transforming Mental Health Scenario

Low and Middle Income Countries are struggling with poverty, political instability and inadequate healthcare facilities. Mental health hardly gets adequate attention and is relegated by other priority issues. The countries are stressed with a wide mental health treatment gap without any sign of adequate initiatives to minimise this gap. However, Information Communication Technologies (ICT) have shown promise in this regard. With the help ICT the problem of lack of trained mental health professionals, wide geographic area coverage and huge number of patients can be overcome. People can contact a psychiatrist or psychologist from their mobile phone whenever they need help. It removes the cost of travelling, overcomes the need to wait for an appointment and by-passes the fear of being identified as mentally ill during a visit to the psychiatrist. Millions of people can be addressed at a time using Short Message Service (SMS), Interactive voice response (IVR) and video clips. All these can  reduce the stigma of mental health and can improve treatment adherence, two important obstacles in mental health service in low income counties. Social Networking Sites like Facebook have opened new horizons for understanding mental health conditions and providing interventions. All these initiatives indicate the potential of telepsychiatry to transform the tragic mental health scenario in Low and Middle Income Countries

An mCARE Study on Patterns of Risk and Resilience for Children with ASD in Bangladesh

Community-wide lockdowns in response to COVID-19 influenced many families, but the developmental cascade for children with autism spectrum disorder (ASD) may be especially detrimental. Our objective was to evaluate behavioral patterns of risk and resilience for children with ASD across parent-report assessments before (from November 2019 to February 2020), during (March 2020 to May 2020), and after (June 2020 to November 2020) an extended COVID-19 lockdown. In 2020, our study Mobile-based care for children with ASD using remote experience sampling method (mCARE) was inactive data collection before COVID-19 emerged as a health crisis in Bangladesh. Here we deployed “Cohort Studies”, where we had in total 300 children with ASD (150 test group and 150 control group) to collect behavioral data. Our data collection continued through an extended COVID-19 lockdown and captured parent reports of 30 different behavioral parameters (e.g., self-injurious behaviors, aggression, sleep problems, daily living skills, and communication) across 150 children with ASD (test group). Based on the children’s condition, 4–6 behavioral parameters were assessed through the study. A total of 56,290 behavioral data points was collected (an average of 152.19 per week) from parent cell phones using the mCARE platform. Children and their families were exposed to an extended COVID-19 lockdown. The main outcomes used for this study were generated from parent reports child behaviors within the mCARE platform. Behaviors included of child social skills, communication use, problematic behaviors, sensory sensitivities, daily living, and play. COVID-19 lockdowns for children with autism and their families are not universally negative but supports in the areas of “Problematic Behavior” could serve to mitigate future risk

Transforming access to care for serious mental disorders in slums (the TRANSFORM Project) : rationale, design and protocol

This paper introduces the TRANSFORM project, which aims to improve access to mental health services for people with serious and enduring mental disorders (SMDs – psychotic disorders and severe mood disorders, often with co-occurring substance misuse) living in urban slums in Dhaka (Bangladesh) and Ibadan (Nigeria). People living in slum communities have high rates of SMDs, limited access to mental health services and conditions of chronic hardship. Help is commonly sought from faith-based and traditional healers, but people with SMDs require medical treatment, support and follow-up. This multicentre, international mental health mixed-methods research project will (a) conduct community-based ethnographic assessment using participatory methods to explore community understandings of SMDs and help-seeking; (b) explore the role of traditional and faith-based healing for SMDs, from the perspectives of people with SMDs, caregivers, community members, healers, community health workers (CHWs) and health professionals; (c) co-design, with CHWs and healers, training packages for screening, early detection and referral to mental health services; and (d) implement and evaluate the training packages for clinical and cost-effectiveness in improving access to treatment for those with SMDs. TRANSFORM will develop and test a sustainable intervention that can be integrated into existing clinical care and inform priorities for healthcare providers and policy makers

The sun is no fun without rain : Physical environments affect how we feel about yellow across 55 countries

Across cultures, people associate colours with emotions. Here, we test the hypothesis that one driver of this cross-modal correspondence is the physical environment we live in. We focus on a prime example – the association of yellow with joy, – which conceivably arises because yellow is reminiscent of life-sustaining sunshine and pleasant weather. If so, this association should be especially strong in countries where sunny weather is a rare occurrence. We analysed yellow-joy associations of 6625 participants from 55 countries to investigate how yellow-joy associations varied geographically, climatologically, and seasonally. We assessed the distance to the equator, sunshine, precipitation, and daytime hours. Consistent with our hypotheses, participants who live further away from the equator and in rainier countries are more likely to associate yellow with joy. We did not find associations with seasonal variations. Our findings support a role for the physical environment in shaping the affective meaning of colour.Peer reviewe

Mobile Phone for Mental Health

The rapid growth of information communication technology (ICT) has brought new hope for people with mental illness who were beyond health and social service for long time. It has transformed the health service for many Low and Middle Income Countries and most of the governments are motivated to incorporate information communication technology for health sector. As the developing countries are stressed with high demand in contrast to low resources, here, mental health hardly receives adequate attention overcoming all the other priority issues. However, evidence revealed more than 75% of the affected people with mental disorders live in this region and in the least resource area about 90% of the affected people do not get their required care [1].</p

A Case Report on Management of Father Daughter Incest with Schizophrenia

Incest is a neglected and hidden public health problem. This case is about a patient who was victim of sexual abuse, suffered from schizophrenia and abused his biological daughter. He was physically and sexually abused by seniors and classmates, developed paranoid delusion and auditory hallucination. During the course of the illness, he was hospitalized several times as a case of schizophrenia and sexual dysfunction was his main concern. The patient’s illness followed a waxing and waning course. He took medication on on-and-off basis. He abused his biological daughter sexually at the later stage of the illness. Ultimately, the patient attempted suicide after an indecent sexual act with another relative and he was admitted to the hospital. He was treated with risperidone that was titrated to 10 mg per day. After continuing the medication for 2 years he regained a functioning life and remained stable with medication. This case shows the importance of exploring the sexual behavior of the patients and sharing the experience may help in the treatment of schizophrenia patients with incest

Suicide on Facebook-the tales of unnoticed departure in Bangladesh

Abstract Facebook has transformed social communication and offers the opportunity to share personal thoughts to people including suicide ideas, plans and attempts. Suicide after Facebook posts has been reported in different parts of the world and it has become a potential area of research for suicide prevention. The analysis of Facebook posts prior to suicide or Facebook live streaming may help in understanding the etiological factors, patterns of communication and possible prevention approaches for a particular community. However, there is a dearth of evidence about suicide incidents after Facebook posts and Facebook live streaming in low and middle-income countries. This study aims to explore the trends and phenomena of suicide after Facebook posts and live streaming in Bangladesh. We conducted an online search using the Google, Facebook and five daily online newspaper archives from 15th August to 15th September 2019. Two research assistants independently conducted the initial searching to find out people who committed suicide after Facebook posts or live streamed suicide in Bangladesh and documented 21 cases. After further evaluation of each of the 21 cases we confirmed 19 cases that met the selection criteria. All of them were under 35-years of age. We observed sucide after Facebook posts were more common in male(78%) e and students. Hanging was the most frequently used method of suicide followed by poisoning. Their Facebook posts and livestream videos indicated relationship problems, academic stress and mental disorders were the common stressors for their suicide. This study lays the foundation for the future researchers to work on suicidal posts on Facebook in Bangladesh and develop culture-specific, real-time suicide preventive systems using a social media platform