Thyroid Functions and Bipolar Affective Disorder

Accumulating evidence suggests that hypothalamo-pituitary-thyroid (HPT) axis dysfunction is relevant to the pathophysiology and clinical course of bipolar affective disorder. Hypothyroidism, either overt or more commonly subclinical, appears to the commonest abnormality found in bipolar disorder. The prevalence of thyroid dysfunction is also likely to be greater among patients with rapid cycling and other refractory forms of the disorder. Lithium-treatment has potent antithyroid effects and can induce hypothyroidism or exacerbate a preexisting hypothyroid state. Even minor perturbations of the HPT axis may affect the outcome of bipolar disorder, necessitating careful monitoring of thyroid functions of patients on treatment. Supplementation with high dose thyroxine can be considered in some patients with treatment-refractory bipolar disorder. Neurotransmitter, neuroimaging, and genetic studies have begun to provide clues, which could lead to an improved understanding of the thyroid-bipolar disorder connection, and more optimal ways of managing this potentially disabling condition

A Perspective on Fisheries Sector Interventions for Livelihood Promotion

The distinctive features of fisheries resources, fishers and their geographic contexts, on the one hand, and broad stylized features of the existing lacklustre performance of this sector, on the other, call for specialized and sustained efforts to promote livelihood of usually poor, backward and unorganized fisher communities, which are nevertheless and often the most intimate stakeholder of this sector and its underlying resources. To develop a perspective on intervention strategies for livelihood promotion of most intimate stakeholders – that is, the fisher folk, in a sustainable manner, this paper uses clues from recent economic theories and management tools on property rights, Coase Theorem, stakeholder cooperation and public-private-community partnership in an effort towards resolving the multi-dimensional problems of this sector. It stratifies and brings out the pros and cons of the existing fishing efforts into four categories of models – the traditional marketing model, state-led models of livelihood promotion and fisheries development (including cases of para-statal cooperatives), entrepreneur or leader-driven models, and technology-driven models, through selected illustrations from different parts of the country and covering both marine and inland (including brackish water) segments of fisheries. The paper, after identifying the major ingredients for sustainable livelihood development around fisheries, finally articulates Dr. APJ Kalam’s concept of PURA to recommend a rural entrepreneur-led hybrid model of fisheries development to solicit sustainable and growth oriented cooperation among the suppliers of land (i.e., stakeholders to fishery resources, which are available through Nature), labor (including fishers) and capital (including professionals). The ultimate goal of this paper is to derive inspiration from Coase Theorem and the Japanese model of Keiretsu to empower the producers and suppliers of fish – namely, the fisher folk and to place them at the centre stage of control of rural entrepreneur-led private organizations, wherein the fisher community will not be deemed as mere consumers or vendors of fish, but will enter as dignified co-producer partners with significant shares in residual claim and residual control in those organizations.

Preventive strategies for severe mental disorders

Since the 1990s, there has been a tremendous upsurge in research on early intervention in psychotic disorders. The neurodevelopmental hypothesis enabled the development of clinical staging models of schizophrenia, which in turn demonstrated that early intervention is possible before the onset of psychosis. Such intervention relied on early detection using prodromal vulnerability indicators and on targeted and stage-specific treatments. Initial efforts were focused on reducing the duration of untreated psychosis to improve outcome. As these efforts were not always successful, research moved on to the examination of prodromes and high-risk states. The “at-risk mental state” strategy based on principles of indicated prevention consisted of the “ultra-high risk” and the “basic symptoms” approaches. A large body of evidence indicated that about 30% of the patients who met criteria for either approach went on to develop full-blown psychosis in the next 2–3 years. Several early psychosis detection programs have been set up worldwide, and controlled trials have shown efficacy of early intervention in first-episode psychosis as well as prodromal or at-risk states. However, several issues regarding identifying and managing such patients still need to be sorted out before prevention of severe mental disorders becomes a reality

Mood disorders in the international classification of Diseases-11: Similarities and differences with the diagnostic and statistical manual of mental Disorders 5 and the international classification of Diseases-10

The revision of diagnostic requirements for mood disorders in the forthcoming International Classification of Diseases-11 (ICD-11) classification was governed by the same principles that applied to the rest of the draft. Precedence was given to clinical utility and universal applicability of the classification. Other guiding principles included ensuring scientific validity of the revision and harmonizing it with the Diagnostic and Statistical Manual of Mental Disorders-5. These fundamentals led to considerable reorganization, restructuring, and expansion of the contents of the revision including the section on mood disorders. The mood disorders section now follows a much simpler format than the ICD-10 and is expected to be easier to use. Its simplicity, notwithstanding descriptions of individual diagnostic categories in the revision are more elaborate and precise and in consonance with the current state of knowledge regarding the different mood disorders included in the section. The draft guidelines are undergoing comprehensive field testing on a very large scale across many countries including a majority from the developing world. Results up to now have been encouraging in terms of user acceptability, clinical utility, and global and cross-cultural relevance. However, one has to await the results of further testing and actual use of the final version of the ICD-11 by all stakeholders to determine if the revision indeed meets the high standards it has set for itself

A study in dualism: The strange case of Dr. Jekyll and Mr. Hyde

R. L. Stevenson's novel, The Strange Case of Dr. Jekyll and Mr. Hyde is a prominent example of Victorian fiction. The names Jekyll and Hyde have become synonymous with multiple personality disorder. This article seeks to examine the novel from the view point of dualism as a system of philosophy and as a religious framework and also from the view point of Freud's structural theory of the mind

Home-based telemental health services for Indian patients during the COVID-19 pandemic: A comparison with the pre-COVID phase

Background: Many developed countries have switched from conventional outpatient psychiatric services to tele mental health-based alternatives because of the COVID-19 pandemic. However, similar transitions might be difficult for countries like India because of a shortage of necessary resources. Therefore, the feasibility and acceptability of converting to a home-based tele mental health (HB-TMH) service during the pandemic were examined in an Indian hospital. Materials and Methods: A new and expanded version of an HB-TMH service was operated for all outpatients following the onset of the pandemic. Feasibility outcomes included operational viability, service utilization, service engagement, the need for additional in-person services, and the frequency of adverse events. Patients' and clinicians' satisfaction with different aspects of the service were evaluated using Likert-style questionnaires to ascertain acceptability. The outcomes during the prepandemic and pandemic phases were also compared. Results: The switch to HB-TMH services took 6 weeks during the pandemic. Patient numbers increased greatly following this transition. Attendance improved, the requirement for in-person services was low, and no serious adverse events were reported. However, patients' satisfaction levels were relatively low during the pandemic. Clinicians were more satisfied than the patients with HB-TMH treatment during the pandemic. Differences between them were less marked but still present before the pandemic. Pre- and postpandemic comparisons revealed that both patients and clinicians were more satisfied with all aspects of HB-TMH care before the pandemic than during it. Conclusions: Though conversion to HB-TMH services was feasible during the pandemic, such services need to be improved to enhance patient acceptability