Medicalization of Nervous and Emotional Problems

Medicalization is the process of defining non-medical problems in medical terms, usually with the implication that a medical intervention is needed. It has been criticized for re-labeling “normal” human experiences as pathological or medical conditions. Some of the driving engines of medicalization include growth of pharmaceutical industry, advertising, managed care, and biotechnology. In the last few decades, serious concerns have also been raised about medicalization of mental health issues. Diagnosis such as attention-deficit hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD) and sexual disorders are discussed in context of medicalization. Also, role of various stakeholders in dealing with medicalization are discussed. Keywords: Medicalization, mental health, attention deficit hyperactivity disorder (ADHD), medical marketing, post-traumatic stress disorder (PTSD)

Need Assessment of Consultation Liaison Psychiatry amongst the Clinical Faculty

Nearly 20-40% of patients with medico-surgical illnesses in general hospitals have a co morbid psychiatric illness or psychosocial issues, which interfere in improvement of the primary illness. It is important to assess the attitudes and awareness of non-psychiatrist clinicians about the co-existing psychiatric morbidity in their patients and their felt needs, which can help in mitigating this morbidity. The present study attempts to gauge the non-psychiatrist clinician's perception, felt needs and barriers to referral/ intervention in a tertiary care teaching hospital. A cross-sectional, descriptive, online questionnaire-based method was used. Of the 239 clinical faculty members, only 45 responded. Responses indicated that clinicians were aware of the existence and significance of psychological problems in their patients, but could do with further increased levels of awareness and more specific training in evaluation and intervention. Stigma, lack of awareness of available services, and lack of detailed understanding regarding psychological problems were the important barriers to referral/ intervention. Better teamwork, training and more manpower were the specific suggestions for improvement in the future

Pathways to care in first-episode psychosis in low-resource settings: Implications for policy and practice.

Developing countries such as India face a major mental health care gap. Delayed or inadequate care can have a profound impact on treatment outcomes. We compared pathways to care in first episode psychosis (FEP) between North and South India to inform solutions to bridge the treatment gap. Cross-sectional observation study of 'untreated' FEP patients (n = 177) visiting a psychiatry department in two sites in India (AIIMS, New Delhi and SCARF, Chennai). We compared duration of untreated psychosis (DUP), first service encounters, illness attributions and socio-demographic factors between patients from North and South India. Correlates of DUP were explored using logistic regression analysis (DUP ≥ 6 months) and generalised linear models (DUP in weeks). Patients in North India had experienced longer DUP than patients in South India (β = 17.68, p < 0.05). The most common first encounter in North India was with a faith healer (45.7%), however, this contact was not significantly associated with longer DUP. Visiting a faith healer was the second most common first contact in South India (23.6%) and was significantly associated with longer DUP (Odds Ratio: 6.84; 95% Confidence Interval: 1.77, 26.49). Being in paid employment was significantly associated with shorter DUP across both sites. Implementing early intervention strategies in a diverse country like India requires careful attention to local population demographics; one size may not fit all. A collaborative relationship between faith healers and mental health professionals could help with educational initiatives and to provide more accessible care. [Abstract copyright: Copyright © 2023. Published by Elsevier B.V.

Meeting the Challenge of COVID-19 Pandemic in Mental Health Care in a Tertiary-Care General Hospital in India

Medical profession has proved its versatility in the adoption of many strategies to deal with the impact of COVID-19. All India Institute of Medical Sciences (AIIMS), New Delhi, India is a large public funded medical school and general hospital in North India. Psychiatry department is one of the 42 departments at AIIMS. COVID-19 has impacted all the functions of the department: clinical care, teaching and training, research and other roles. In this communication, we report the strategies, simple yet effective improvisations to meet the challenges of COVID-19 so as to continue the basic functions of the discipline. This could serve as a model for continued functioning of a tertiary care teaching medical facility in a pandemic situation

Challenges for setting up psychiatric services in a trauma centre in India

Psychiatric sequelae may occur following traumatic injury irrespective of whether an insult has been caused to the brain. A range of psychiatric illnesses have been either causative of or associated with road traffic accidents and traumatic injuries, including depression, anxiety, post-traumatic stress disorder, substance use disorder and attention-deficit hyperactivity disorder. Despite literature on such associations, psychiatric intervention in the treatment of patients following traumatic injury is limited. The authors share their experience of challenges in addressing mental health problems in a tertiary care trauma centre located in North India. Steps in overcoming those challenges included: developing a semi-structured form to be completed for referrals and consultations, a psychiatrist attending weekly rounds with the surgeons, and initiating a psychiatry out-patient clinic for patients discharged from the trauma centre. It may be worthwhile in the future to set up a trauma psychiatry unit at the centre, involving a clinical psychologist, a psychiatric social worker and an occupational therapist for the comprehensive care of patients