DIFFERENTIAL PATTERN OF SOCIAL COGNITION IMPAIRMENT BETWEEN RURAL AND URBAN DWELLING PATIENTS OF SCHIZOPHRENIA AND ITS FUNCTIONAL CORRELATES

BackgroundCognitive deficits (both neuro & social Cognition) play a vital role in determining functional status in schizophrenia. It has been noted that functional outcomes are relatively better in Indian rural settings. This suggests that cognition might be better in rural patients. Considering the prevailing vast cultural differences there is paucity of research which delineates the differences in social cognition and its impact on the functional outcomes between rural and urban setups. Hence, we aim to explore differential impairment in social cognition in patients with schizophrenia residing in rural versus urban settings and their impact on real-world functioning.Methods122 patients diagnosed with either schizophrenia or schizoaffective disorder from the rural taluk of Thirthahalli and Turuvekere were compared with 97 patients with similar diagnosis visiting a teaching hospital with urban residence. All the 219 patients met the standardized criteria for remission from positive and disorganized symptoms and were compared on culturally validated tests of SC—Social Cognition Rating Tool in Indian Setting (SOCRATIS) & Tool for Recognition of Emotions in Neuropsychiatric Disorders (TRENDS) to assess theory of mind, social perception and emotion recognition and NC—(attention/vigilance, speed of processing, visual and verbal learning, working memory and executive functions). Groningen Social Disabilities Schedule (GSDS) was used for the assessment of social dysfunction of the patients. Based on past factor analytical studies on these tests, social cognition dimensions were grouped into inferential social cognition which comprised of 1st order theory of mind & 2nd order theory of mind Index & socio-emotional cognition which included faux pas recognition, emotional recognition & social perception indices. These were compared using analysis of covariance after controlling for neurocognitive composite performance and other confounders Correlation between social-cognition and functioning among the two groups was assessed using Pearson correlation.ResultsPatients from rural population had significantly better inferential social cognition whereas patients form urban population had significantly better socio-emotional cognition. ANCOVA showed that even after controlling for effects of age, gender, duration of illness, family history, number of hospitalization & neuro-cognition composite scores the differences were significant. Social cognition composite score was significantly (negatively) correlated with functional disability. The socio-emotional cognition component had a stronger association (proportion of variance explained) with functioning in both rural & urban samples (r= -0.411, r= -0.403 respectively). Inferential Social cognition from both rural & urban samples (r= -0.212, r= -0.238) also has significant association with functioning but of lesser magnitude as compared to the formerDiscussionThe two distinct components of social cognition - inferential and socio-emotional- were differentially impaired among rural & urban patients. With respect to its relationship with functioning, the socio-emotional cognition had a stronger association with functioning in both the groups. The reasons for the difference need to be explored by studying the socio-cultural characteristics of rural & urban dwelling patients which can moderate their expression of social cognition. These observations are critical in understanding how our micro- and macro-level environments can influence cognitive performanc

A Community Participation Initiative During COVID-19 Pandemic:A Case Study From India

Background: A community participation initiative of stitching personal protective equipment (PPE), masks, and face shields for healthcare professionals working in the hospital during the COVID-19 pandemic was conducted using a case study design. Methods: The hospital tailoring unit was used to cater to the in-house demand for stitching safety gear kits for healthcare professionals. A transect walk was conducted to survey hospitals for selecting material for stitching the safety gears and to draw up a plan to meet future demand. The psychiatric social worker induced a community participatory initiative using the method of social work of community organization. A flyer was prepared to invite participants with prior experience in tailoring for this initiative. All participants were trained by the master trainers of the tailoring unit. The participants were also interviewed about their views on this initiative in an informal interview. Results: A total of 83 participants, including 26 individuals (8 volunteers and 18 who received an honorarium), 2 boutiques ( n = 12), and 1 government organization, participated in the activity ( n = 45). A total of 1700 complete PPE kits and 13,000 masks were stitched during this period. The participants reported that the benefit of being a part of this initiative was reduced boredom, sense of purpose and satisfaction, and improved mental health due to structured activity. Conclusions: A community participation initiative using the principles of community organization, a method of social work, can help produce desired outputs and improve the well-being of the participants

Development and validation of a peer support programme for the prisoners with mental and substance use disorders in India

BACKGROUND: The prevalence of mental health problems and substance use disorders is high in prisons. There is a need to develop effective and sustainable models in prison to address their mental health demands. AIM: The study aimed to develop and validate a peer support programme (PSP) for prisoners with common mental and substance use disorders (SUD). METHOD: The PSP was developed by reviewing the literature and expert interviews and validated by seven experts. RESULT: The expert interview brought out a total of 10 themes. The final components included in the content of the peer support interventions were information about mental health issues, identification of the cases, basic counseling skills, psycho-education, early warning signs and symptoms, managing substance use by motivational interviewing, and suicidal gatekeeping. CONCLUSION: This study describes the development of a comprehensive PSP, and it needs to be tested to examine its feasibility and effectiveness in addressing mental health problems in prison settings

Psychosocial Interventions for Prisoners with Mental and Substance Use Disorders:A Systematic Review

PURPOSE OF THE REVIEW: The prevalence of mental and substance use disorders is three to five times higher than that of the general population. Psychosocial interventions are effective in identifying and managing mental health and substance use disorders. This article aims to review the randomized control studies which have used nonpharmacological interventions alone or in combination with pharmacological interventions for managing mental and substance use disorders in prison/correctional settings. COLLECTION AND ANALYSIS OF DATA: Studies included were randomized control trials and pilot randomized studies that assessed the impact of psychosocial interventions for prisoners with mental disorders and substance use disorders. A comprehensive search for articles was done by the primary author (Sreekanth Nair Thekkumkara) in the following databases: PubMed, ProQuest, PsychArticles, and Google Scholar (search engine), for the period June 1, 2000, to December 31, 2020. RESULTS AND CONCLUSIONS: The 21 studies included in the review had a sample size of 34 to 759. The settings of all the interventions were the prison and different types of psychosocial interventions were provided across the studies. The average duration of intervention ranged between 10 min and 120 min with the frequency of one to six sessions per week for 1 to 36 months. All the 21 Randomized Control Trials (RCTs) were nonIndian studies. Overall, the results of the included studies showed significant improvement postintervention (motivational intervention, interpersonal therapy, cognitive behavior therapy, positive psychology intervention, music therapy, and acceptance and commitment therapy) on primary outcome measures such as symptom severity of depression, anxiety, and substance abuse prisoners. Positive effects were observed on secondary outcome measures such as motivation, aggression, follow up rates, and recidivism. A limited number of studies have focused on evaluating psychosocial interventions in prison settings. Most of the interventions were tested in prisoners with substance use disorder alone or in those with dual diagnoses and in high-income countries