Asian Journal of Psychiatry - Articles in Press

Barriers to discharge of patients from a government-run day-care psychiatric rehabilitation center in India - Corrected Proof

2012-02-20

Abstract: Objective: Many psychiatric patients undergoing vocational training do not achieve successful transition to regular work. In this study, we evaluated the barriers for discharge from day care center to actual work place.Materials and methods: In a cross-sectional study at a government-run day-care center at National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, we studied 76 patients who were undergoing vocational training for more than 1 year. We did a semi-structured interview with patients, their family members, and instructors of various occupational sections. We used a questionnaire of 17 different barriers to assess the obstacles in their discharge from day-care center to actual work place.Results: The majority of them had a diagnosis of mental retardation (n=47) followed by schizophrenia (n=29), and bipolar disorder (n=9). The mean (SD) age and duration of illness was 33.6 (9.7) years and 12.5 (9.3) years, respectively. Patients had more than one diagnosis. The median duration of stay in day-care center was 5.9 years. Doubts regarding performance at a new work place (n=60), fear of performance at new work place (n=65), and the fear of transition to regular work (n=64) were the most common barriers reported by patients, their family members and instructors of various occupational sections, respectively.Discussion: Educating patients and their family members, gradual exposure to new working environment, and increased community level vocational opportunities may potentially overcome above barriers. Getting them to the actual job early in their course of treatment will improve their adjustment to a new work place and overall outcome.

Applying mobile technologies to mental health service delivery in South Asia - Corrected Proof

Neil Krishan Aggarwal — 2012-02-06

Highlights: ► There is a shortage of mental health professionals in South Asia. ► There is high penetration of mobile phones throughout South Asia. ► Research can elucidate whether mobile phones can be used for mental health applications.Abstract: Mobile phones have increasingly assumed an important role in the treatment of mental disorders in high-income countries. This paper considers such possibilities in the South Asian context. First, a brief review of mobile phone use in mental disorders is provided. Next, data on the market penetration and dissemination of mobile phones in South Asia is presented. Finally, common barriers to treatment for mental disorders in South Asia are evaluated against solutions that could be derived from mobile technologies. Though not without their risks, mobile phones have the potential to increase engagement, treatment, and retention of South Asian patients with mental disorders in unprecedented ways.

Brain stimulation therapies for psychiatric disorders: The first decade of the new millennium—A review - Corrected Proof

Anand K. Pandurangi, Catherine Fernicola-Bledowski, Josef Bledowski — 2012-01-24

Abstract: Three new brain stimulation therapies have emerged in the last decade for clinical use in psychiatric disorders. Combined with electroconvulsive therapy (ECT), these therapies offer much hope to patients with medication refractory depression, obsessive–compulsive disorder and auditory hallucinations of schizophrenia. In this article we briefly review the history, development and evidence for each of the four stimulation therapies and describe the current state-of-the-art. Neuromodulation is considered as a possible common mechanism mediating the effects of these therapies. Finally, empirical guidelines are suggested for the practicing psychiatrist for the optimal utilization of stimulation therapies. It is concluded that with increasing technological sophistication, research on optimal protocols and emergence of newer modalities of stimulation, the future holds much promise for neuromodulatory therapies in psychiatric disorders.

A comparison between acupuncture versus zolpidem in the treatment of primary insomnia - Corrected Proof

Jung-Hung Tu, Wei-Ching Chung, Chun-Yuh Yang, Dong-Sheng Tzeng — 2012-01-24

Highlights: ► Acupuncture might be effective as Zolpidem for the treatment of primary insomnia. ► Female, older and higher educational level predict better outcome by acupuncture. ► No difference in follow up study of PSGI score between acupuncture and zolpidem group.Abstract: Background: To determine the relative efficacy of acupuncture and zolpidem in the treatment of primary insomnia, we administered a sleep quality scale to thirty-three patients with primary insomnia randomly chosen to receive one of the two therapies at a psychosomatic clinic.Methods: A study in the psychosomatic clinic at a teaching hospital in southern Taiwan from November 2007 to November 2008. The 19 patients in acupuncture group underwent one acupuncture session a week. The 14 patients in the control group took zolpidem 1# (10mg) every night. Members of both groups returned to our clinic once a week for four weeks. The main outcome measure was the Pittsburgh Sleep Quality Index (PSQI).Results: Both groups were found to have improved significantly. Using generalized estimating equation analysis to test the variance with group and time as factors, we found both groups improved over time at a similar rate (p=0.79). In regression analysis, setting the fourth total PSQI score to zero, the baseline PSQI score was 4.13 (p<0.001), the second score 1.32 (p=0.005), and the third 1.49 (p=0.03); men had a higher PSQI score 1.56 than women (p=0.02); the increasing age of one year would have lower PSQI score 0.08 (p<0.001) and increasing educational level of one year which would decrease PSQI score 0.25 (p=0.007).Conclusions: Acupuncture might be used as an alternative strategy compared to zolpidem for the treatment of primary insomnia.

Successful treatment of atypical depression with amisulpride: A case report - Corrected Proof

2012-01-24

Recent reports support the role of amisulpride in treatment of mood disorders (). Though its antipsychotic effect is due to antagonism at D2 and D3 receptors () its antidepressant property could be due to 5-HT7A antagonism, independent of the dopamine receptor as shown recently (). The efficacy of amisulpride has been documented in schizophrenia with depression (), dysthymia with or without major depression (), and as an add-on agent in the treatment of bipolar affective disorder (). Its role in atypical depression, however, has not been investigated. In this context, we report successful use of amisulpride in a patient with atypical depression.

Electroconvulsive therapy (ECT) in bipolar disorder: A narrative review of literature - Corrected Proof

Jagadisha Thirthalli, M. Krishna Prasad, Bangalore N. Gangadhar — 2012-01-16

Highlights: ► ECT is often used to treat different phases of bipolar disorder in many countries. ► Bilateral ECT is as effective as pharmacotherapy in treatment of acute mania. ► Quality evidence is lacking regarding the use of ECT in refractory bipolar disorder. ► Merits and demerits of combining ECT and mood stabilizers need to be established.Abstract: In many countries including India electroconvulsive therapy (ECT) is frequently used to treat different phases of bipolar disorder. The response to ECT is impressive in mania, depression and in mixed affective states. Preliminary evidence also suggests benefit from maintenance ECT in bipolar disorder. However, most of the literature on efficacy and adverse effects comes from case series, retrospective reports and open trials – controlled trials have been few and far between. Official guidelines recommend the use of ECT only when there is a dire emergency or when all other options have been exhausted. Concurrent use of lithium and antiepileptic drugs along with ECT is common in clinical practice. While such practice appears to be largely safe, one should be mindful about dose of lithium and possible interference of antiepileptic drugs with efficacy of ECT. The use of suprathreshold bilateral ECT and bifrontal placement of electrodes may confer some advantage over other methods.

Problematic internet behaviours among university students in Sri Lanka - Corrected Proof

2012-01-09

Published literature on problematic internet use is mostly from industrialized nations. We attempted to identify the problematic internet behaviours among university students in Sri Lanka. This is the first study to assess this issue in Sri Lanka.

Combination of CBT with fluoxetine works better for obsessive–compulsive disorder - Corrected Proof

2011-12-26

Obsessive–compulsive disorder (OCD) is a common mental health problem. We conducted an open label, controlled, prospective and comparative study in the Department of Psychiatry, Bangabandhu Sheikh Mujib Medical University (BSMMU) to assess and compare the efficacy of fluoxetine and combined fluoxetine and cognitive behavioural therapy (CBT) in the treatment of OCD. The participants were diagnosed by a psychiatrist and were randomly divided into two groups, each consisting of 15 patients. We used a local instrument, Dhaka University Obsessive Compulsive Scale (DUOCS) () to measure OCD severity. The medication only group received capsule fluoxetine 20–60mg after dose titration; follow up was done weekly in the 1st and 2nd months and fortnightly during the third and fourth months. The combination group received CBT in addition to capsule fluoxetine. The CBT regimen consisted of 13 visits over 13weeks’ time and each session lasted approximately 1h. All patients were assessed at baseline and at weeks 5, 9 and 13. Twenty-six patients completed the 13-week long study. The mean age of the study population was 30.23±8.67years, analysis did not find any statistically significant mean age difference between the two groups (p=.524). The difference between mean duration of OCD in the two groups (7.53±8.11 and 9.47±5.47years, respectively) was not significant (p=.451). In the medication alone group, the means of DUOCS scores in 5th, 9th and 13th weeks were 39.21±15.21, 34.46±16.21 and 28.23±12.96, respectively. In the combination group, the means of DUOCS scores in 5th, 9th and 13th weeks were 30.64±10.98, 23.92±8.43, and 18.77±6.3, respectively. The comparisons between groups for the DUOCS scores were carried out using the ANOVA with post hoc analysis using the Bonferroni correction and independent sample t test (). The mean difference for the DUOCS score for the two groups at baseline was 9.9 (SE ±5.3; 95% CI −.94 to 20.8) which was not statistically significant. As the two groups did not differ significantly at baseline for DUOCS scores, they were comparable for the severity of illness. The mean difference at 5th week was 8.6 (SE ±5.0; 95% CI −1.7 to 18.9). This difference was also not statistically significant. The mean difference for the DUOCS for the two groups at 9th week was 10.5 (SE ±5.0; 95% CI .1–21.0; p<.05) and at 13th week it was 9.5 (SE ±3.9; 95% CI 1.2–17.7; p<.05), with the combination group having a higher reduction in scores as compared to fluoxetine alone. The mean differences between the two groups were statistically significant at the 9th and 13th weeks. This represents that combination of CBT and fluoxetine produces a greater improvement in severity of OCD as compared to fluoxetine alone.