Objective: Adverse childhood experiences are linked to the development of a number of psychiatric illnesses in adulthood. Our study examined the pattern of adverse childhood experiences and their relation to the age of onset of major psychiatric conditions in individuals from families that had ⩾2 first-degree relatives with major psychiatric conditions (multiplex families), identified as part of an ongoing longitudinal study. Methods: Our sample consisted of 509 individuals from 215 families. Of these, 268 were affected, i.e., diagnosed with bipolar disorder ( n = 61), obsessive–compulsive disorder ( n = 58), schizophrenia ( n = 52), substance dependence ( n = 59) or co-occurring diagnoses ( n = 38), while 241 were at-risk first-degree relatives who were either unaffected ( n = 210) or had other depressive or anxiety disorders ( n = 31). All individuals were evaluated using the Adverse Childhood Experiences – International Questionnaire and total adverse childhood experiences exposure and severity scores were calculated. Results: It was seen that affected males, as a group, had the greatest adverse childhood experiences exposure and severity scores in our sample. A Cox mixed effects model fit by gender revealed that a higher total adverse childhood experiences severity score was associated with significantly increased risk for an earlier age of onset of psychiatric diagnoses in males. A similar model that evaluated the interaction of diagnosis revealed an earlier age of onset in obsessive–compulsive disorder and substance dependence, but not in schizophrenia and bipolar disorder. Conclusion: Our study indicates that adverse childhood experiences were associated with an earlier onset of major psychiatric conditions in men and individuals diagnosed with obsessive–compulsive disorder and substance dependence. Ongoing longitudinal assessments in first-degree relatives from these families are expected to identify mechanisms underlying this relationship.
Introduction: There is an unmet need for continuity-of-care is well known for those with severe mental disorders (SMDs) after acute care at hospitals in India. The “Sakalawara Rehabilitation Services (SRS)” functioned from March 2014 at “Sakalawara Community Mental Health Centre” (SCMHC) of “National Institute of Mental Health and Neurosciences,” Bengaluru, India in the concepts of residential care (half-way-home) with the aim to develop a replicable model. Aim: To review the inpatient records after the initial 2 years of experience in residential care at SCMHC. Methodology: Retrospective file review of inpatients at SCMHC from March 2014 to March 2016 in a semi-structured proforma designed for the study. Ethical committee of NIMHANS Bengaluru has approved the study. Results: The total number of inpatients during this period was 85. It was found that Schizophrenia spectrum disorders were the most common diagnosis among these patients. The activity of daily living and psycho-education were the most common individual interventions. The majority of families underwent structured family psycho-educational interventions. This review also demonstrated the feasibility of tele-aftercare in continuity of care after discharge of patients. Conclusion: SRS kind of residential set-up is feasible and demonstrated effectiveness in maintaining continuity of care of SMDs. There is a need for better structured and customized interventions. There is further a scope for tele (video) aftercare for those with SMDs.
Introduction:Lifetime prevalence of psychiatric disorders in India is about 14%, and the treatment gap is huge necessitating large-scale public health efforts. Manochaitanya programme (MCP), one such innovative program, was launched by the Government of Karnataka in October 2014. MCP entails provision of outpatient psychiatric care in subdistrict (Taluk) hospitals and primary health centers under a public–private (Indian Psychiatric Society-Karnataka chapter) partnership model, at least one Tuesday of every month.Aim:The aim was to do a secondary care level performance audit of MCP of initial 2½ years at all Taluka general hospitals of Karnataka.Methodology:Data on MCP were collected and tabulated from all 31 districts using a specially designed semistructured pro forma. This includes the number of self-reported psychiatric consultations in each Tuesday's clinic, number of psychiatrists, and their visit details. Prospective data were obtained from monthly reports.Results:The district coverage was 100% during initial 2½ years over this period, i.e., MCPs were successfully covered in at least one Taluka hospital in all 31 districts. A total number of estimated consultations under this initiative were 73,663 with an average of 24.1 patients per psychiatrist consultation. One hundred and eleven psychiatrists participated in a total of 3,056 visits across the state. Patient footfall increased consistently over this time period.Conclusions:Psychiatrist-based Manochaitanya programme at secondary care level at Taluk hospitals has noticed substantial benefits to patient care. There is a need for psychiatrist-based secondary care at Talukas (subdistrict) level across the country.
Women from rural areas form a unique group due to the realities of rural living. The various challenges rural women face include gender disadvantage, poverty, poor physical health, roles of caregiving, and being women farmers. Besides gender disadvantage, exposure to intimate partner violence (IPV) is also one of the main risk factors for common mental disorders (CMDs) in rural women. Suicide, depression, anxiety, perinatal disorders, somatization, and substance abuse are few of the disorders that rural women often face. Challenges preventing rural women from approaching mental healthcare include an absence of women-friendly mental healthcare services, lack of trained mental health professionals in rural areas or those who understand the unique needs of rural culture, stigma associated with help seeking, poor knowledge about treatment facilities, lack of accessibility to transport, and the high costs of mental health services. Factors that contribute to enhanced vulnerability include older age, widowhood, poverty, and living in areas of armed conflict. HIV infection and comorbid physical illnesses also add to risk. Rural women's well-being is strongly associated with their physical health, inner well-being, economic security, rural identity, household and family well-being, and community relations. Psychological therapies tailored to the needs of rural women have reported improvement in mental health. Rural women are more accepting of help from their own community-level workers and peer volunteers. Mental health delivery, therefore, has to be tailored to the norms and realities of rural women.
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