Contextualizing mental health: gendered experiences in a Mumbai slum

Urban mental health programmes in developing countries remain in their infancy. To serve low-income communities, research needs to consider the impact of common life experience in slums, including poverty, bad living conditions, unemployment, and crowding. Our study in the Malavani slum of Mumbai examines afflictions of the city affecting the emotional well-being and mental health of women and men with respect to gender. This is a topic for which mental health studies have been lacking, and for which psychiatric assumptions based on middle-class clinical experience may be most tenuous. This study employs ethnographic methods to show how environmental and social contexts interact in shaping local experience with reference to common mental health problems. Focusing on the social and environmental context of the mental health of communities, rather than psychiatric disorders affecting individuals, findings are broadly applicable and sorely needed to guide the development of locally appropriate community mental health programmes. Identified afflictions affecting mental health include not only access to health care, but also sanitation, addictions, criminality, domestic violence, and the so-called bar-girl culture. Although effective clinical interventions are required for mental health services to treat psychiatric disorders, they cannot directly affect the conditions of urban slums that impair mental health

Explaining Suicide in an Urban Slum of Mumbai, India

Background: Health demographic mortality studies use verbal autopsies to identify suicide as a cause of death. Psychological autopsies focus almost exclusively on associated high-risk psychiatric disorders. New approaches considering contextual factors are needed for preventing suicide and promoting mental health. Aims: This study examined explanations of suicide reported by surviving family members or close friends with reference to social, cultural, and environmental conditions as well as the challenges of life in the Malavani slum of Mumbai. Methods: An EMIC (Explanatory Model Interview Catalog) interview based on a cultural epidemiological framework considered underlying problems, perceived causes, and sociocultural contexts. It was administered to survivors of 76 people who had died by suicide (56.6% women). Results: Accounts of underlying problems typically referred to various aspects of tension (73.7%). Perceived causes often identified multiple factors. The sociocultural contexts of suicide included the victimization of women, the personal and social impact of problem drinking, marital problems, physical health problems, mental tension, possession and sorcery. Women were particularly vulnerable to the impact of problem drinking by a spouse or father. Conclusions: This study demonstrates the value of an approach to sociocultural autopsy examining local contexts and explanations of suicide. Findings highlight needs for both mental health services and culturally sensitive social interventions

Facets of clinical stigma after attempted suicide in Mumbai, India

Community stigma studies may neglect clinically relevant experience and views of stigma that are important features of mental health problems. After attempting suicide, patients in a hospital emergency ward in Mumbai, India, were assessed for stigma referring to underlying prior problems motivating their deliberate self-harm (DSH) event, the DSH event itself and serious mental illness generally based on both anticipated community views and distinctive personal views. In this cultural epidemiological study of 196 patients, assessment items and four corresponding indexes were analysed and compared on a four-point scale, 0 to 3, for prominence of indicated stigma. Narratives from patients with high, low and discordant levels of stigma for prior problems and DSH events were analysed and compared. Disclosure, critical opinions of others and problems to marry were greater concerns for DSH events than prior problems. Problem drinking, unemployment, and sexual or financial victimization were common features of prior problems. Impulsivity of the DSH event and externalizing blame were features of lower levels of stigma. Ideas about most people's views of serious mental illness were regarded as more stigmatizing than patients' prior problems and DSH event; patients' personal views of serious mental illness were least stigmatizing. Findings suggest linking suicidality and stigmatized mental illness may discourage help seeking. Suicide prevention strategies should therefore emphasize available help needed for severe stress instead of equating suicidality and mental illness. Findings also indicate the relevance of assessing clinical stigma in a cultural formulation and the value of integrated qualitative and quantitative stigma research methods

Soft neurological signs and cognitive function in obsessive-compulsive disorder patients

Objective: Modern research on obsessive-compulsive disorder (OCD) indicates that the primary cause of OCD, which was earlier explained only on basis of psychoanalytical theories, is biological. Our study attempts to investigate the neurobiological signs in form of soft neurological signs and cognitive function in OCD. Methods: A cross sectional study was conducted at psychiatric facility of Seth G.S. Medical College and KEM Hospital. Materials and Method: 50 OCD patients and age- and education-matched controls were selected for the study. Established instruments were used to assess the neurological soft signs (NSS) and the cognitive deficits. Results: OCD patients had significant more NSS in tests for motor coordination, sensory integration, complex motor tasks, hard signs, and right/left and spatial orientation. Cognitive deficits in the domains of visuospatial ability, executive function, attention, and working memory were significantly more in OCD patients compared to controls. Conclusion: Our study highlights the role of biological factors in form of soft neurological signs and cognitive dysfunction in the development of the OCD

Isolated sleep paralysis

Sleep paralysis (SP) is a cardinal symptom of narcolepsy. However, little is available in the literature about isolated sleep paralysis. This report discusses the case of a patient with isolated sleep paralysis who progressed from mild to severe SP over 8 years. He also restarted drinking alcohol to be able to fall asleep and allay his anxiety symptoms. The patient was taught relaxation techniques and he showed complete remission of the symptoms of SP on follow up after 8 months

A study on postgraduate medical students academic motivation and attitudes to research

Background: Medical students do postgraduation in a specific branch for a particular motive and goal in life. Due to workload, they have less desire to do research or even pursue academics. This study was undertaken to study the differences among the clinical and nonclinical postgraduate students in the intrinsic and extrinsic motivation to learning and the attitudes to research. Methods: This study was conducted in 373 postgraduate students in a tertiary care hospital after written informed consent and ethics approval. A semi-structured questionnaire, academic motivation scale, and attitudes toward research scale collected the information about aims of the study. Results: Two groups were formed depending on the disciplines being pursued by the students, namely, clinical (n = 245) and nonclinical (n = 128). The nonclinical group showed significant differences on extrinsic motivation (t = 2.886, P = 0.0004), total motivation (t = 2.92, P = 0.0024), and attitudes to research students (t = 11.14, P = 0.0001) as compared to the clinical disciplines. However, on the intrinsic motivation subscale, no significant differences were seen. Discussion: The nonclinical postgraduate students were influenced by extrinsic factors to pursue learning and gain mastery as well as to do research. Students pursuing clinical disciplines had lower scores for academic motivation as well as attitudes to research. Time constraints, lack of infrastructure, and clinical workload add to the woes of clinical students. Conclusion: The results of this study will help us in determining the ways of improving motivation of postgraduate medical students toward academics and research

Lorazepam-induced Short-term Remission of Symptoms in a Case of Paranoid Schizophrenia

Conventionally, antipsychotics are used to treat schizophrenia due to predominant dopamine antagonist activity. The use of various types of Benzodiazepines (BZDs) in the treatment of Schizophrenic symptoms like agitation and psychotic excitement in general and control of florid psychotic symptoms such as hallucinations and delusions in particular is well known. However, the use of BZDs, specifically in remission of paranoid schizophrenia, is not reported so far. Here, we are reporting a case of an elderly female patient with chronic paranoid schizophrenia showing short-term remission in paranoid symptoms with injectable lorazepam

Assessing metacognitive abilities of postgraduate medical students

Background: Metacognition is essential to successful learning, especially in the field of medicine because it enables individuals to better manage their cognitive skills and determine weaknesses that can be corrected by constructing new cognitive skills. This study was undertaken to study the difference in the metacognitive abilities toward learning in the clinical and nonclinical disciplines of medicine. Methods: Four hundred and sixty-eight residents were contacted, 442 consented, 373 completely filled pro formas were received, and two groups, namely, clinical (n = 275) and nonclinical (n = 128) were formed. Data were collected with the help of a semi-structured questionnaire and the metacognitive assessment inventory. It has two broad domains-knowledge about cognition and regulation of cognition with each having 3 and 5 subdomains, respectively. Results: The two broad domains of MAI revealed a highly significant difference with the students of nonclinical disciplines having higher knowledge about cognition (t = 1.46, P < 0.014) and regulation of cognition (t = 3.13, P < 0.0019) as compared to their clinical peers. All subdomains of knowledge about cognition showed highly significant differences. Planning and evaluation subdomains of regulation of cognition were significant in the nonclinical group. The other subdomains of information management, debugging strategies, and comprehension monitoring were not significant. Discussion: The nonclinical disciplines showed better ability for factual knowledge, use of critical thinking, knowledge about how to implement and when, and why to use learning procedures as compared to their clinical counterparts. Planning, goal setting, with an analysis of performance was also much better in the students of nonclinical disciplines. Conclusion: This study highlights the need to inculcate in medical postgraduates self-learning using their metacognitive abilities so that learning would become more focused and improvement in skills would take place