Volume 3, Issue 1, Winter and Spring 2020
2020, Volume 3, Issue 1, Pages 1-8
As part of the intention to document the recent and current history of psychiatry, I was asked to present memories of my involvement in psychiatry over the past 50 years. Reviewers suggested that I should start this personal history of psychiatry with a summary of my curriculum vitae because this will make it easier to place the events I describe into their historical context. Here it goes, then.
2020, Volume 3, Issue 1, Pages 9-16
Medical education curricula, from around the world, have often neglected psychiatry as a subject of importance in undergraduate medical training.
In India, the scenario has not been different from the rest of the world. The National Mental Health Survey done in India, recently, estimates a treatment gap of around 80–85% for various mental illnesses. This provides a strong case to strengthen the undergraduate psychiatry curricula since it would help tackle the treatment gap of common mental disorders in the community.
Further, a strong educational foundation with meaningful inclusion of mental health and well-being, will also make the trainee aware of their own mental well-being and better help seeking behaviour in the medical student. In this article, we look to review the evolution of undergraduate medical education in India.
A Novel Attention Bias Modification Single Session Training Improves Eye Gaze Behaviour in Social Anxiety Disorder: A Pilot Study
2020, Volume 3, Issue 1, Pages 17-27
Attention bias modification (ABM) can reduce anxiety and attentional bias towards threatening stimuli, but evidence of its usefulness as a potential intervention for socially anxious individuals has been mixed. Eye contact avoidance, a maladaptive attentional strategy in social anxiety disorder (SAD), has yet to be targeted by ABM research.
This study sought to establish whether a new ABM training paradigm could increase attentional deployment towards eyes and what effect this would have on social and gaze-related anxiety.
Participants (n = 23) recruited through adverts calling for people who felt anxious in social situations completed either a novel ABM training task designed to induce attentional bias towards images of eyes over images of noses, or control training. Data on response times (RTs), accuracy of responses, gaze behaviour (using an eye tracker) and scores on clinical measures of social and gaze-related anxiety were collected before and after both training tasks.
ABM training produced a greater number of initial saccades towards eye images than did the control task, indicating an induced shift in early attentional deployment. ABM training was also associated with a marginal increase in fixation durations on eye images. No effect was observed on RTs or social and gaze-related anxiety.
Our results indicate that ABM can alter the gaze behaviour of socially anxious individuals. They also highlight the importance of eye tracking to ABM research, because it was more sensitive than analyses of RTs to changes in early attentional deployment.
2020, Volume 3, Issue 1, Pages 28-50
The objective of this research is to explore how Pakistani community perceive their mental health problems by systematically reviewing the scientific literature published on major databases. The findings expectedly will be useful for general public, for clinicians and for the researchers.
The methodology of this systematic literature search involved identifying and critically appraising studies that attempted to explore how Pakistani community perceives and understands its mental health problems. We carried out literature search on some major databases including PubMed, Cochrane database of systematic reviews and Google Scholar. We followed selection criteria where researchers aimed to find perceptions and understandings of Pakistani participants regarding their mental health by adopting scientific methodologies. The extraction of data was carried out after reading the selected papers and organising the findings under specific categories, in the form of a table. Data analysis was based on the information gathered from these studies.
The results suggest that Pakistani community exhibits negligible to little understanding regarding their psychological experiences and emotional processes as separate identifiable entities. Nonetheless, multiple parallel sociocultural concepts such as religion or faith driven practices and mythical or supernatural understandings are highlighted by this research. These are accepted and practiced in order to address mental health problems.
It appears that Pakistani community has limited understanding and scarce vocabulary to describe their inner psychological and emotional experiences. However, in order to address the mental health issues, the community exhibits a variety of responses and reactions that are driven from several unique social, cultural and religious factors. Whether these are general perceptions or causations or protective factors towards illness or possible treatment options, they all are approached and addressed with some unique understandings and perceptions that are specific to this community.
2020, Volume 3, Issue 1, Pages 51-63
There is evidence of a progressive increase in the number of Randomized Controlled Trials (RCTs) in the area of psychiatry. However, some areas of psychiatry receive more attention from researchers potentially to the detriment of others.
Aiming to investigate main gaps for RCTs in psychiatry, the present bibliometric study analysed the bi-annual and five-year rates of RCTs in the main database of medical studies (Pubmed) over the 1999–2018 period (n = 3,449). This analysis was carried out using the ICD-10 mental and behavioural chapter. ICD-10, was the edition of the manual used throughout the above period.
Overall, after 16 years of considerable increase in the bi-annual absolute number of RCTs, there has been a slowdown in the last 4 years, similar to other medical areas. Affective, organic and psychotic disorders, and depression, schizophrenia and dementia were the top studied groups and disorders respectively – ahead of other groups/diagnoses. For substance use disorders, there has been a decrease of RCT in the last 5 years, in line with the fall of alcohol use disorder in the ranking of most studied disorders. Delirium and mild cognitive disorder are both ascending in this ranking. Personality disorders and mental retardation stand out as the least studied groups over the whole assessment period.
Novel treatments, ease of access to patient populations, and ‘clinical vogue’, seem to be more important in guiding the undertaking of RCTs than the actual need as indicated by prevalence and/or burden of disorders and public health impact. Regarding specific disorders, acute/transient psychosis; mixed anxiety and depression; adjustment disorder; dissociative and conversion disorders; somatization; hypochondria; and neurasthenia, would deserve future RCTs. Clinical researchers and editors of scientific journals should give special attention to the less studied areas and disorders, when considering conducting and publishing RCT studies, respectively.
Longitudinal study of PTSD and depression in a war-exposed sample – comorbidity increases distress and suicide risk
2020, Volume 3, Issue 1, Pages 64-71
Major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) are the most common mental disorders following traumatic experiences. The aim of this study was to investigate the extent to which PTSD and depression co-occurred in Serbian general population at baseline and 1 year after the follow-up, as well as how this co-occurrence was associated with sociodemographic factors, personal distress, suicidality and quality of life.
Subjects and methods
The sample consisted of 159 subjects, who fulfilled the IES criteria for PTSD, and were taken from a larger sample of 640 participants, which was chosen by a random walk technique in five regions of the country affected by major trauma. The assessment was carried out by the following instruments: Mini International Neuropsychiatric Interview 5 (MINI 5), Life Stressor Checklist-Revised (BSC-R), Brief Symptom Inventory (BSI), Impact of Event Scale-Revised (IES-R) and Manchester Short Assessment of Quality of Life Scale (MANSA). The follow-up study was carried out 1 year after the baseline.
In the initial phase, PTSD was found in 100 out of 159 participants (62.9%), while 81 (51%) fulfilled the diagnostic criteria for MDD. Comorbidity of PTSD and depression was identified in 65 (40.9%) subjects of the sample. After 1 year, PTSD was found in 56 (35.2%) and MDD in 73 (45.9%) participants. Comorbidity of PTSD and depression in the follow-up phase was identified in 41 (25.8%) subjects of the sample. The subjects with comorbidity had significantly higher level of post-traumatic stress symptoms, general psychological distress as well as suicide risk and lower level of quality of life than participants with either condition alone.
PTSD–depression comorbidity is a common post-traumatic condition. Complex psychopathology, severity of symptoms and their consequences, both at individual and community levels, require attention to be paid to early diagnostics and treatment of affected persons.
2020, Volume 3, Issue 1, Pages 72-82
Rhodiola rosea is an adaptogen herb from the Crassulaceae family, which has been vastly used in the Russian and Chinese medicine. The herb is used against depression, anxiety, mental and physical fatigue and to promote overall health. In this systematic review, we examined the effects of R. rosea on depression, anxiety and mood, as these are the most relevant to mental health.
Literature searches were made in PubMed using the term ‘Rhodiola rosea’. Inclusion criteria were: Randomized controlled trials using interventions of R. rosea on any type of participants, while focusing on the effects of the intervention on depression, anxiety or mood. Mixed interventions of R. rosea with other herbs were excluded. Studies not published in English or Greek were excluded.
A total of 39 randomized controlled trials were identified and their abstract was screened. After screening, a total of 17 papers were excluded because they were focusing on irrelevant outcomes. The full text of the remaining 22 papers was read and an additional 17 papers were excluded. These papers were excluded because they were eventually not focusing on our main outcome or they were using R. rosea interventions with other herbs. In the end, a total of 5 papers (n = 327 participants) were found eligible for our systematic review. In these studies, R. rosea seems to improve the symptoms of mild to moderate depression, symptoms of mild anxiety and to enhance mood. The last date of our search was October 13, 2019.
Rhodiola rosea supplementation may alleviate symptoms of mild to moderate depression and mild anxiety, while it may also enhance mood. The findings of our review are not definite due to the lack of available experimental data. Randomized controlled trials with a low risk of bias are needed to further study the herb.
Implementing a psychosocial intervention DIALOG+ for patients with psychotic disorders in low and middle income countries in South Eastern Europe: protocol for a hybrid effectiveness-implementation cluster randomized clinical trial (IMPULSE)
2020, Volume 3, Issue 1, Pages 83-96
Psychotic disorders have large treatment gap in low- and middle-income countries (LMICs) in South-Eastern Europe, where up to 45% of affected people do not receive care for their condition. This study will assess the implementation of a generic psychosocial intervention called DIALOG+ in mental health care services and its effectiveness at improving patients’ clinical and social outcomes.
This is a protocol for a multi-country, pragmatic, hybrid effectiveness–implementation, cluster-randomised, clinical trial. The trial aims to recruit 80 clinicians and 400 patients across 5 South-Eastern European LMICs: Bosnia and Herzegovina, Kosovo*, Montenegro, Republic of North Macedonia and Serbia. Clusters are clinicians working with patients with psychosis, and each clinician will deliver the intervention to five patients. After patient baseline assessments, clinicians will be randomly assigned to either the DIALOG+ intervention or treatment as usual, with an allocation ratio of 1:1. The intervention will be delivered six times over 12 months during routine clinical meetings. TThe primary outcome measure is the quality of life at 12 months [Manchester Short Assessment of Quality of Life (MANSA)]; the secondary outcomes include mental health symptoms [Brief Psychiatric Rating Scale (BPRS), Clinical Assessment Interview for Negative Symptoms (CAINS), Brief Symptom Inventory (BSI)], satisfaction with services [Client Satisfaction Questionnaire (CSQ-8)] and economic costs at 12 months [based on Client Service Receipt Inventory (CSRI), EQ-5D-5L and Recovering Quality of Life (ReQOL-10)]. The study will assess the intervention fidelity and the experience of clinicians and patients’ about implementing DIALOG+ in real-life mental health care settings. In the health economic assessment, the incremental cost-effectiveness ratio is calculated with effectiveness measured by quality-adjusted life year. Data will also be collected on sustainability and reach to inform guidelines for potentially scaling up and implementing the intervention widely. Conclusion: The study is expected to generate new scientific knowledge on the treatment of people with psychosis in health care systems with limited resources. The learning from LMICs could potentially help other countries to expand the access to care and alleviate the suffering of patients with psychosis and their families.
Trial registration: ISRCTN 11913964
Strategies for mitigating burnout among early career doctors in Nigeria: lessons learnt from the qualitative CHARTING study
2020, Volume 3, Issue 1, Pages 97-103
Early career doctors (ECDs) are faced with many challenges due to their transition from undergraduate medical/dental studentship to being postgraduate doctors and being in an early phase of their career. The specific factors that affect ECDs in their careers and endeavors at the workplace range from poor remuneration, particularly in developing countries, to psychosocial problems (such as burnout [BO] syndrome). There is a dearth of information on BO among ECDs in Nigeria. This qualitative study aims to explore the opinions of ECDs in Nigeria on the causal/predisposing factors of BO, effects of BO, and strategies for mitigating BO among ECDs in Nigeria.
Using purposive sampling method, two sessions of focus group discussions (FGDs) involving 14 ECDs (key informants) holding key leadership positions and who were delegates of other ECDs in Nigeria were conducted to explore their experiences on psychological issues among ECDs. Data collected were transcribed and analyzed thematically.
BO is an issue of serious concern among ECDs in Nigeria. The causes of BO are diverse, some of which include low staff strength, prolonged work hours, wrong counseling, lack of job description and specification, and abuse of powers by trainers. In order to mitigate the issue of BO among ECDs, the respondents recommended that work policy review, medical workforce strengthening, stakeholder dialog on ECDs’ welfare, regular psychological review of ECDs, and provision of free yearly medicals need to be looked into. Conclusion: Our findings revealed that the participants considered BO issues among ECDs to be common, and it affected their performance and the overall quality of care in Nigeria health system. Based on our findings, there is an urgent need to mitigate the problem of emotional exhaustion among ECDs in Nigeria.
Compassion-Focused Therapy (Cft) As An Intervention Against Suicidal Ideation In Newly Diagnosed People Living With Hiv/Aids (Plwha) Attending A Nigerian Maternity Teaching Hospital
2020, Volume 3, Issue 1, Pages 104-112
In Sub-Saharan Africa, Nigeria is currently home to many people living with HIV/AIDS (PLWHA), and suicidal ideation is amongst the common early problems of newly diagnosed PLWHA. This reflects the importance of including psychotherapy in HIV care. In this regard, compassion-focused therapy (CFT) is the one that has not been a point of study for reducing suicidal risks in newly diagnosed PLWHA despite the relevance of CFT to the treatment/management of persons living with self-criticism or self-harm. To bridge this gap, we examined the use of CFT as an intervention against suicidal ideation in newly diagnosed PLWHA receiving antiretroviral therapy at the Adeoyo Maternity Teaching Hospital in Ibadan, Oyo state, Nigeria.
Twenty-two participants (mean age = 40 ± 5.6 years) with less than 1-month-old clinical diagnosis of HIV who have recently thought about suicide because of the new HIV-positive diagnosis were purposively sampled and randomly assigned into the intervention and control groups. The CFT module and scale for suicide ideation were the research instruments. All data collected were analysed using SPSS (v.22.0), and statistical significance was determined at P<0.05.
The findings established that after administering CFT to the intervention group, the mean score for suicidal ideation was significantly lower in the intervention group compared with that in the control group.
The results suggest that CFT has the potential to reduce suicidal ideation in newly diagnosed PLWHA; therefore, in addition to the antiretroviral therapy, the administration of CFT should be included in the early stage of HIV care, to reduce the risk of suicide that is associated with newly living with HIV/AIDS.