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Pandey A, Joseph R, Arumugham SS, Thirthalli J. Erroneous conclusions about the long-term cognitive effects of electroconvulsive therapy. Psychiatry Res 2024; 335:115864. [PMID: 38547602 DOI: 10.1016/j.psychres.2024.115864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 03/16/2024] [Indexed: 04/14/2024]
Affiliation(s)
- Abhinav Pandey
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | - Rini Joseph
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
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Uppinkudru C, Pathak H, Kumar K R, S B, Bagali K, Pantoji M, Ezhumalai N, Parlikar R, Shah V, Balachander S, Sreeraj VS, Mehta UM, Sinha P, Arumugham SS, Venkatasubramanian G, Thirthalli J. Development, validation and clinical utility of short-term adverse-effects of electroconvulsive therapy (SAVE) checklist. Psychiatry Res 2024; 335:115839. [PMID: 38503006 DOI: 10.1016/j.psychres.2024.115839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/27/2024] [Accepted: 03/03/2024] [Indexed: 03/21/2024]
Abstract
Electroconvulsive therapy (ECT) is one of the most effective treatments in psychiatry. However, it has many cognitive and non-cognitive adverse effects (AEs). There are lacunae in the literature on systematic assessment of non-cognitive AEs. There is a need for a standard, comprehensive and specific clinical tool to evaluate this. Hence, a checklist of short-term AEs of ECT (SAVE) with a 2-phase assessment was developed. Content validation was done using 15 experts' ratings and predefined content validity ratio and index (CVR and CVI) in a two-stage modified Delphi method. The checklist had a good CVR and CVI with a final tool of 39 items. The tool was sensitive and identified the non-cognitive AEs after ECT. Cardiovascular and musculoskeletal systems displayed the highest incidence. Many participants exhibited delayed recovery in orientation, gait, and stance, highlighting a necessity for meticulous monitoring. SAVE is the first standardised tool to assess short-term ECT-related AEs systematically. This checklist likely identifies clinically significant incidences of adverse effects. Its regular use may enhance the safety of ECT and patient comfort by supporting early identification and intervention for AEs. However, given the transient nature of AEs, further studies are needed to determine their predictive validity for long-term consequences.
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Affiliation(s)
- Chithra Uppinkudru
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Harsh Pathak
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Raj Kumar K
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Bridgit S
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Kiran Bagali
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Makarand Pantoji
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Nathiya Ezhumalai
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Rujuta Parlikar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Vyoma Shah
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Srinivas Balachander
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India.
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Preeti Sinha
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka India
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3
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Gangadhar BN, Sreeraj VS, Sinha P, Thirthalli J. Standards for medical devices: Electroconvulsive therapy machine. Asian J Psychiatr 2024; 93:103938. [PMID: 38335891 DOI: 10.1016/j.ajp.2024.103938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/31/2024] [Indexed: 02/12/2024]
Abstract
The manuscript calls for establishing a standard for electroconvulsive devices by manufacturers for better regulation in India. This is most relevant in the context of two recent developments, (a) Notification of medical devices rules, 2017 with classification of ECT as Class C and (b) Recent change in classification of ECT devices by US-FDA in 2018. The establishment of standards would help in upregulating the standard of ECT devices as well as ECT practices.
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Affiliation(s)
- Bangalore N Gangadhar
- National Institute of Mental Health and NeuroSciences (NIMHANS), President, National Medical Commission, Pocket-14, Sector 8, Dwaraka Phase-1, New Delhi 110077, India
| | - Vanteemar S Sreeraj
- Clinical Research Centre for Neuromodulation in Psychiatry, Department of Psychiatry, National Institute of Mental Health and NeuroSciences (NIMHANS), Bengaluru 560029, Karnataka, India
| | - Preeti Sinha
- Department of Psychiatry, National Institute of Mental Health and NeuroSciences (NIMHANS), Bengaluru 560029, Karnataka, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and NeuroSciences (NIMHANS), Bengaluru 560029, Karnataka, India.
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Mehta UM, Ithal D, Roy N, Shekhar S, Govindaraj R, Ramachandraiah CT, Bolo NR, Bharath RD, Thirthalli J, Venkatasubramanian G, Gangadhar BN, Keshavan MS. Posterior Cerebellar Resting-State Functional Hypoconnectivity: A Neural Marker of Schizophrenia Across Different Stages of Treatment Response. Biol Psychiatry 2024:S0006-3223(24)00076-3. [PMID: 38336217 DOI: 10.1016/j.biopsych.2024.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 01/11/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Identifying stable and consistent resting-state functional connectivity patterns across illness trajectories has the potential to be considered fundamental to the pathophysiology of schizophrenia. We aimed to identify consistent resting-state functional connectivity patterns across heterogeneous schizophrenia groups defined based on treatment response. METHODS In phase 1, we used a cross-sectional case-control design to characterize and compare stable independent component networks from resting-state functional magnetic resonance imaging scans of antipsychotic-naïve participants with first-episode schizophrenia (n = 54) and healthy participants (n = 43); we also examined associations with symptoms, cognition, and disability. In phase 2, we examined the stability (and replicability) of our phase 1 results in 4 groups (N = 105) representing a cross-sequential gradation of schizophrenia based on treatment response: risperidone responders, clozapine responders, clozapine nonresponders, and clozapine nonresponders following electroconvulsive therapy. Hypothesis-free whole-brain within- and between-network connectivity were examined. RESULTS Phase 1 identified posterior and anterior cerebellar hypoconnectivity and limbic hyperconnectivity in schizophrenia at a familywise error rate-corrected cluster significance threshold of p < .01. These network aberrations had unique associations with positive symptoms, cognition, and disability. During phase 2, we replicated the phase 1 results while comparing each of the 4 schizophrenia groups to the healthy participants. The participants in 2 longitudinal subdatasets did not demonstrate a significant change in these network aberrations following risperidone or electroconvulsive therapy. Posterior cerebellar hypoconnectivity (with thalamus and cingulate) emerged as the most consistent finding; it was replicated across different stages of treatment response (Cohen's d range -0.95 to -1.44), reproduced using different preprocessing techniques, and not confounded by educational attainment. CONCLUSIONS Posterior cerebellar-thalamo-cingulate hypoconnectivity is a consistent and stable state-independent neural marker of schizophrenia.
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Affiliation(s)
- Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bangalore, India.
| | - Dhruva Ithal
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Neelabja Roy
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Shreshth Shekhar
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Ramajayam Govindaraj
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bangalore, India
| | | | - Nicolas R Bolo
- Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Harvard Medical School, Boston, Massachusetts
| | - Rose Dawn Bharath
- Department of Neuroimaging & Interventional Radiology, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bangalore, India
| | | | - Bangalore N Gangadhar
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Matcheri S Keshavan
- Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Harvard Medical School, Boston, Massachusetts
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Mohanty K, Gandhi S, Krishna Prasad M, John AP, Bhaskarapillai B, Malo P, Thirthalli J. Effectiveness of lifestyle intervention on prevention/management of antipsychotic-induced weight gain among persons with severe mental illness: A systematic review and meta-analysis. J Health Psychol 2024:13591053241227384. [PMID: 38251661 DOI: 10.1177/13591053241227384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
Individualized lifestyle interventions using motivational interviewing (MI) approach are recommended for persons with severe mental illness (SMI) for effective weight management. The aim of this meta-analysis was to assess the effectiveness of various lifestyle interventions that addressed obesity among persons with SMI. Twelve RCTs were assessed by individual reviewers using revised cochrane risk-of-bias tool (RoB 2). The standardized mean difference (SMD) was calculated with a 95% CI. The age of participants was between 18 and 70 years. Waist circumference showed an SMD of -0.09 (-0.22, 0.03), weight -0.03 (-0.10, 0.15) and BMI -0.07 (-0.07, 0.22). The findings in this meta-analysis revealed that though lifestyle interventions were statistically insignificant in reducing antipsychotic induced weight gain among persons with SMI, they show changes in intervention group. Psychosocial management along with lifestyle interventions, and MI are effective in the management of antipsychotic induced weight gain.
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Arumugham SS, Thirthalli J, Reddy YCJ. Is ECT effective in treatment-refractory OCD? Concerns with the data and analysis of a recently published randomized-controlled trial. J Affect Disord 2024; 344:617-618. [PMID: 37863365 DOI: 10.1016/j.jad.2023.10.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 10/04/2023] [Accepted: 10/08/2023] [Indexed: 10/22/2023]
Affiliation(s)
- Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India.
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India
| | - Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, India
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Vranda MN, Ranjith PJ, Aadi S, Gunasekaran DM, Thirthalli J, Naveen Kumar C, Thirumoorthy A, Vasanthra CR, Amaresha AC. Predictors of long-stay in a tertiary care psychiatry hospital in India. Int J Soc Psychiatry 2023; 69:1979-1985. [PMID: 37403413 DOI: 10.1177/00207640231183916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
BACKGROUND Many psychiatric patients continue to stay for longer duration in psychiatric institutions. Community reintegration and rehabilitation of such patients needs to be explored to ensure appropriate bed occupancy rates and access to in-patient care for newer patients in need of the same. OBJECTIVES The aim is to identify the risk and protective factors leading to long-term admission of mentally ill patients in tertiary care hospital. METHODOLOGY A cross-sectional study was conducted with all patients in the long-stay ward between May 2018 and February 2023. A retrospective chart review followed by cross sectional assessment of risks and disability was carried out with all the patients living in a long-stay psychiatric ward (N = 101) at a tertiary hospital in Bangalore, India, between May 2018 and February 2023. RESULTS The hospital's average length of stay (LOS) was 5.70 ± 8.30 years. The risk and protective factors for LOS in psychiatric hospitals were analyzed using the Poisson Regression model. The results revealed that the male gender, diagnosis of schizophrenia or psychosis, clinicians' knowledge of family information, good clinical improvement, and higher participation in ward activities are the protective factors for a shorter hospital stay. While higher age, family history of mental illness, being married and employed, absence of children, and/or having family members rarely visiting the patient at the hospital were some factors that increased the risk of LOS. CONCLUSION This study highlighted the importance of possible LOS predictors in the tertiary care psychiatric hospital. The multi-disciplinary team may utilize risk and protective factors for delayed LOS to introduce comprehensive psychosocial interventions and policies that reduce the risk of delays or length of stay in mental health hospitals.
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Affiliation(s)
- Mysore Narasimha Vranda
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Prabhu James Ranjith
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Shivaleela Aadi
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Durai Murukan Gunasekaran
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Ammapattian Thirumoorthy
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Cicil Radhakrishnan Vasanthra
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Uppinkudru C, Sreeraj VS, Arumugham SS, Praharaj SK, Goyal N, Sinha P, Thirthalli J. Is ECT better than clozapine for treatment-resistant schizophrenia? Asian J Psychiatr 2023; 90:103798. [PMID: 37871364 DOI: 10.1016/j.ajp.2023.103798] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/17/2023] [Accepted: 10/10/2023] [Indexed: 10/25/2023]
Affiliation(s)
- Chithra Uppinkudru
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Shyam Sunder Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Samir K Praharaj
- Department of Psychiatry, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576104, India
| | | | - Preeti Sinha
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India.
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Jasti N, Gowrapura Halappa N, Bhargav H, Varambally S, Thirthalli J. Need for Systematic Development and Validation of Yoga Modules in Yoga Research. Ann Neurosci 2023; 30:277-278. [PMID: 38020400 PMCID: PMC10662272 DOI: 10.1177/09727531231192753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Affiliation(s)
- Nishitha Jasti
- Department of Integrative Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Naveen Gowrapura Halappa
- School of Public Health and School of Buddhist Studies, Philosophy and Comparative Religions, Nalanda University, Rajgir, Bihar, India
| | - Hemant Bhargav
- Department of Integrative Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Shivarama Varambally
- Department of Integrative Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Vaithialingam B, Bansal S, Muthuchellappan R, Thirthalli J, Chakrabarti D, Venkatapura RJ. Comparison of hands-free Trans-nasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) with conventional facemask ventilation technique for oxygenation in patients undergoing electroconvulsive therapy - A cross over study. Asian J Psychiatr 2023; 88:103734. [PMID: 37619421 DOI: 10.1016/j.ajp.2023.103734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/03/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVES Modified ECT is routinely conducted using face mask (FM) and bag ventilation technique. Trans-nasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) is a novel hands-free insufflation technique that provides oxygenation and prolongs apnoea time. There is limited literature comparing the two techniques. Primary objective of this study was to compare oxygen desaturation between THRIVE and FM techniques during ECT while secondary objective was to compare hemodynamics and complications. METHODS Patients aged 18-50 years undergoing 3rd-5th ECT treatments were enrolled. First ECT was with FM technique followed by THRIVE (with LUBO collar) in the next ECT. Except for the oxygenation technique, the protocol for ECT administration was similar with both techniques. SpO2 values were recorded every minute for 10 min while hemodynamic parameters were measured at 2 min and 5 min following administration of electrical stimulus. Any drop in SpO2 below 92 % was considered as a desaturation event. RESULTS A total of 201 patients underwent ECTs, one each with FM and THRIVE technique. Median age of patients was 28 years. There was no difference in SpO2 between the techniques (main effect P = 0.324, interaction P = 0.14). Only one patient had desaturation with THRIVE requiring intervention with FM. None of the patients had any airway complications in terms of nasal injury, hoarseness, or pneumothorax with THRIVE. CONCLUSION THRIVE is a safe alternative option for hands-free oxygenation while administering ECT. However, considering patient safety, an anaesthesiologist competent in airway management must be readily available.
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Affiliation(s)
| | - Sonia Bansal
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Hosur Road, Bengaluru, 560029, India
| | - Radhakrishnan Muthuchellappan
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Hosur Road, Bengaluru, 560029, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Hosur Road, Bengaluru 560029, India
| | - Dhritiman Chakrabarti
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Hosur Road, Bengaluru, 560029, India
| | - Ramesh J Venkatapura
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Hosur Road, Bengaluru, 560029, India.
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Kelkar RS, Currey D, Nagendra S, Mehta UM, Sreeraj VS, Torous J, Thirthalli J. Utility of Smartphone-Based Digital Phenotyping Biomarkers in Assessing Treatment Response to Transcranial Magnetic Stimulation in Depression: Proof-of-Concept Study. JMIR Form Res 2023; 7:e40197. [PMID: 37656496 PMCID: PMC10504622 DOI: 10.2196/40197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/01/2023] [Accepted: 07/20/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Identifying biomarkers of response to transcranial magnetic stimulation (TMS) in treatment-resistant depression is a priority for personalizing care. Clinical and neurobiological determinants of treatment response to TMS, while promising, have limited scalability. Therefore, evaluating novel, technologically driven, and potentially scalable biomarkers, such as digital phenotyping, is necessary. OBJECTIVE This study aimed to examine the potential of smartphone-based digital phenotyping and its feasibility as a predictive biomarker of treatment response to TMS in depression. METHODS We assessed the feasibility of digital phenotyping by examining the adherence and retention rates. We used smartphone data from passive sensors as well as active symptom surveys to determine treatment response in a naturalistic course of TMS treatment for treatment-resistant depression. We applied a scikit-learn logistic regression model (l1 ratio=0.5; 2-fold cross-validation) using both active and passive data. We analyzed related variance metrics throughout the entire treatment duration and on a weekly basis to predict responders and nonresponders to TMS, defined as ≥50% reduction in clinician-rated symptom severity from baseline. RESULTS The adherence rate was 89.47%, and the retention rate was 73%. The area under the curve for correct classification of TMS response ranged from 0.59 (passive data alone) to 0.911 (both passive and active data) for data collected throughout the treatment course. Importantly, a model using the average of all features (passive and active) for the first week had an area under the curve of 0.7375 in predicting responder status at the end of the treatment. CONCLUSIONS The results of our study suggest that it is feasible to use digital phenotyping data to assess response to TMS in depression. Early changes in digital phenotyping biomarkers, such as predicting response from the first week of data, as shown in our results, may also help guide the treatment course.
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Affiliation(s)
| | - Danielle Currey
- Beth Israel Deaconess Medical Center, Boston, MA, United States
| | | | | | | | - John Torous
- Beth Israel Deaconess Medical Center, Boston, MA, United States
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Sudarshan S, Mehrotra S, Thirthalli J. Integrating Internet-Based Self-Care Program with Face-to-Face Therapy for Depression: Observations and Emergent Insights. Indian J Psychol Med 2023; 45:415-419. [PMID: 37483566 PMCID: PMC10357908 DOI: 10.1177/02537176221137300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Affiliation(s)
- Sindhuja Sudarshan
- Dept. of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS) Bengaluru, Karnataka, India
| | - Seema Mehrotra
- Dept. of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS) Bengaluru, Karnataka, India
| | - Jagadisha Thirthalli
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS) Bengaluru, Karnataka, India
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Ravindran S, Jadhav P, Philip S, Basavarajappa C, Kumar CN, Thirthalli J, Sivakumar T. Cutoff for Benchmark Disability Using World Health Organization Disability Assessment Schedule 2.0: A Community-Based Cross-Sectional Study from Rural South India. Indian J Psychol Med 2023; 45:397-404. [PMID: 37483576 PMCID: PMC10357917 DOI: 10.1177/02537176221124177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Background India uses the Indian Disability Evaluation and Assessment Scale (IDEAS) for quantifying disability due to mental illness. The cutoff score for benchmark disability is 7. India has adopted International Classification of Functioning and Health (ICF) and thereby is a signatory to use World Health Organization Disability Assessment Schedule (WHODAS). Cutoff for benchmark disability in WHODAS in a community-based sample is lacking. Methods The study was conducted in Jagaluru Taluk, Davanagere District, Karnataka. It is a part of an ongoing research funded by Indian Council of Medical Research. Frequency, percentages, mean, standard deviations, mode, median, Receiver Operating Characteristic Curve were used in analyzing the data. Results The study included 184 persons with severe mental illness with mean age of 47 and average duration of illness (DOI) of 11 years. They had mild disability (5.99) in IDEAS. The corresponding cutoff score in WHODAS, as compared to IDEAS, when the influence of DOI is removed was 24. Conclusions A shift from IDEAS to WHODAS is feasible. With the undue influence of DOI removed, both hospital and community-based samples show the score of 24 as cutoff.
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Affiliation(s)
- Swati Ravindran
- Dept. of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
- *Swati Ravindran and Prabhu Jadhav are joint first authors
| | - Prabhu Jadhav
- Dept. of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
- *Swati Ravindran and Prabhu Jadhav are joint first authors
| | - Sharad Philip
- Dept. of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Chethan Basavarajappa
- Dept. of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | | | - Jagadisha Thirthalli
- Dept. of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Thanapal Sivakumar
- Dept. of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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14
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Gangadhar B, Kumar CN, Sadh K, Manjunatha N, Math SB, Kalaivanan RC, Rao GN, Parthasarathy R, Chand PK, Chandra PS, Thirthalli J, Murthy P, Varghese M, Mathur A, Bairy BK, Kishore C, Gowda GS, Basvaraju V, Harihara SN, Isaac MK, Chaturvedi S. Mental Health Programme in India: Has the tide really turned? Indian J Med Res 2023; 157:387-394. [PMID: 37955215 PMCID: PMC10443714 DOI: 10.4103/ijmr.ijmr_2217_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Indexed: 11/14/2023] Open
Abstract
Mental disorders in India form a major public health concern and the efforts to tackle these dates back to four decades, by way of the National Mental Health Programme (NMHP) and its operational arm, the District Mental Health Programme (DMHP). Although the progress of NMHP (and DMHP) was relatively slower till recently, the last 4-5 years have seen rapid strides with several initiatives, including (i) expansion of DMHPs to 90 per cent of the total districts of the country, (ii) the National Mental Health Policy and (iii) strengthening the Mental Health Legislation by way of providing explicit provisions for rights of persons with mental illnesses. Among others, factors responsible for this accelerated growth include the easily accessible digital technology as well as judicial activism. Federal and State cooperation is another notable feature of this expansion. In this review, the authors summarize the available information on the evolution of implementation and research aspects related to India's NMHP over the years and provide a case for the positive turn of events witnessed in the recent years. However, the authors caution that these are still baby steps and much more remains to be done.
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Affiliation(s)
- B.N. Gangadhar
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | | | - Kamaldeep Sadh
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Rakesh Chander Kalaivanan
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Girish N. Rao
- Department of Epidemiology, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Rajani Parthasarathy
- Department of Health & Family Welfare, Government of Karnataka, Bengaluru, Karnataka, India
| | - Prabhat K. Chand
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Prabha S. Chandra
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Alok Mathur
- General of Health Services, Ministry of Health & Family Welfare, Government of India, New Delhi, India
| | - Bhavya K. Bairy
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Chethana Kishore
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Guru S. Gowda
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | - Vinay Basvaraju
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
| | | | - Mohan K. Isaac
- Department of Psychiatry, University of Western Australia, Perth, Australia
| | - S.K. Chaturvedi
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, Karnataka, India
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15
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Singh O, Ameen S, Andrade C, Avula VCR, Basu D, Bhandari SS, Bhatia MS, Brahma A, Das S, Deb KS, Desousa A, Ghosh P, Goyal N, Grover S, Gupta N, Harbishettar V, Kar SK, Kumar V, Vijayanthi IP, Lakdawala B, Mahapatra S, Mehta V, Menon V, Mishra KK, Nebhinani N, Praharaj SK, Prakash J, Puli SK, Raju NN, Rao TSS, Rathi L, Reddy YJ, Sagar R, Sarkar S, Sarkhel S, Siddiqui MA, Singh V, Shah ND, Singh P, Durairaj S, Subramanyam AA, Thirthalli J, Tripathi A, Vaishnav M, Venkatasubramanian G. A consensus statement from editors of psychiatry journals published in India. Indian J Psychiatry 2023; 65:493-497. [PMID: 37397846 PMCID: PMC10309269 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_331_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 05/06/2023] [Accepted: 05/07/2023] [Indexed: 07/04/2023] Open
Affiliation(s)
| | - Shahul Ameen
- Editor, Indian Journal of Psychological Medicine
| | | | | | - Debasish Basu
- Editor, World Social Psychiatry & Advisor, Indian Journal of Social Psychiatry
| | | | | | | | - Shyamanta Das
- Editor-in-Chief, Open Journal of Psychiatry & Allied Sciences
| | | | - Avinash Desousa
- Editor, Annals of Indian Psychiatry & Indian Journal of Mental Health
| | - Prosenjit Ghosh
- Editor, Indian Journal of Private Psychiatry & Assistant Editor, Indian Journal of Social Psychiatry
| | - Nishant Goyal
- Editor, Eastern Journal of Psychiatry & Associate Editor Journal of Indian Association for Child and Adolescent Mental Health
| | - Sandeep Grover
- Associate Editor, Indian Journal of Psychiatry & Editor of Journal of SAARC Psychiatric Federation, Journal of Geriatric Mental Health, Journal of Mental Health Human Behaviour
| | - Nitin Gupta
- Editor, Indian Journal of Social Psychiatry & Journal of Indian Association for Child and Adolescent Mental Health; Co-Editor, World Social Psychiatry
| | - Vijay Harbishettar
- Assistant Editor, Indian Journal of Psychiatry & Editor, Journal of Psychiatry Spectrum
| | - Sujita K Kar
- Associate Editor, Indian Journal of Behavioural Sciences & Deputy Editor, Indian Journal of Clinical Psychiatry
| | | | | | | | | | - Varun Mehta
- Associate Editor, Indian Journal of Psychiatry
| | - Vikas Menon
- Deputy Editor, Indian Journal of Psychiatry, Chief Associate Editor, Indian Journal of Psychological Medicine, Associate Editor, Archives of Biological Psychiatry
| | - K K Mishra
- Immediate Past-Treasurer, Indian Psychiatric Society
| | - Naresh Nebhinani
- Former Editor, Journal of Indian Association for Child and Adolescent Mental Health
| | - Samir K Praharaj
- Chief Associate Editor, Indian Journal of Psychological Medicine
| | | | | | - N N Raju
- Immediate Past-President, Indian Psychiatric Society
| | - T S S Rao
- Editor, Journal of Psychosexual Health
| | | | | | - Rajesh Sagar
- Chairman, Journal Committee, Indian Psychiatric Society
| | - Siddharth Sarkar
- Assistant Editor, Indian Journal of Psychiatry & Deputy Editor, Indian Journal of Social Psychiatry
| | - Sujit Sarkhel
- Associate Editor, Indian Journal of Psychiatry & Editor of Bengal Journal of Psychiatry
| | | | - Vipul Singh
- Editor, Indian Journal of Clinical Psychiatry
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16
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Kelkar RS, Sreeraj VS, Mehta UM, Patwardhan AA, Thirthalli J, Blumberger DM. Generalized seizure induced by continuous theta-burst stimulation (cTBS) in a patient with bipolar depression: A case report. Brain Stimul 2023; 16:693-694. [PMID: 37068732 PMCID: PMC7614549 DOI: 10.1016/j.brs.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/17/2023] [Accepted: 04/15/2023] [Indexed: 04/19/2023] Open
Affiliation(s)
- Radhika Suneel Kelkar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, 560029, India.
| | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, 560029, India
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, 560029, India
| | - Ameya A Patwardhan
- Neurology division, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, 560029, India
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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17
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Shamanna V, Mehta UM, Naik S, Basavaraju R, Thirthalli J. Corrigendum to "A transdiagnostic investigation into the relationship between mirror neuron system activity, echo-phenomena, and theory of mind in major psychoses" Asian J. Psychiatry 82 (2023) 103504. Asian J Psychiatr 2023; 85:103602. [PMID: 37119683 DOI: 10.1016/j.ajp.2023.103602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- Varsha Shamanna
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India.
| | - Shalini Naik
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Rakshathi Basavaraju
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
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18
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Ibrahim FA, Mehta UM, Thekkumkara SN, Rakesh KR, Swetha G, Kumar CN, Kumar KJ, Narayana A, Ravisundar S, Satyanarayana P, Thirthalli J. Multivariate associations between cognition and neighborhood geospatial characteristics in schizophrenia. Asian J Psychiatr 2023; 84:103593. [PMID: 37084467 DOI: 10.1016/j.ajp.2023.103593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 04/06/2023] [Accepted: 04/14/2023] [Indexed: 04/23/2023]
Abstract
Cognitive impairment contributes to functional impairment in schizophrenia. Yet, little is known about how environmental characteristics are related to cognition in schizophrenia. By examining how cognition and the environment are intertwined, it may be possible to identify modifiable risk and protective factors that can improve cognitive outcomes in schizophrenia. We aimed to identify multivariate associations between cognition and three geospatial characteristics (built-space density, habitable green spaces, and public spaces for social interaction) within one's immediate neighborhood among individuals with schizophrenia. We recruited participants with schizophrenia from three sites - an urban metropolitan and two towns in southern India. We administered standard cognitive assessments and performed a principal axis factoring to identify episodic memory, cognitive control, and social inference-making factors for use in further analyses. We estimated geospatial characteristics of an individual's neighborhood, i.e., up to 1 km2 around the residence, by sourcing data from Google Earth. We performed unconditional and conditional (to examine the effect of clinical covariates) canonical correlation analyses to understand the multivariate relationship between cognition and geospatial characteristics. We analyzed data from 208 participants; the first canonical cognitive variate (higher social inference-making and poorer cognitive control) shared 24% of the variance (r = 0.49; P < 0.001) with the first geospatial variate (lower built density and poorer access to public spaces). Years of education, age at onset, and place of residence significantly modulated this relationship. We observe differential associations of the built environment with social and non-social cognition in schizophrenia, and highlight the clinical and demographic characteristics that shape these associations.
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Affiliation(s)
- Ferose Azeez Ibrahim
- Department of Psychiatry National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India.
| | - Sreekanth N Thekkumkara
- Department of Psychiatry National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - K R Rakesh
- Department of Psychiatry National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - G Swetha
- Department of Psychiatry National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - C Naveen Kumar
- Department of Psychiatry National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Keshav J Kumar
- Clinical Psychology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | | | | | | | - Jagadisha Thirthalli
- Department of Psychiatry National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
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19
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Sachdeva A, Mehta UM, Thirthalli J. A pilot-study to examine motor cortical plasticity as a neuro-marker of antipsychotic treatment response in schizophrenia. Asian J Psychiatr 2023; 82:103515. [PMID: 36812761 DOI: 10.1016/j.ajp.2023.103515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 02/13/2023]
Abstract
In a pilot study on 15 untreated first-episode schizophrenia participants, we examined how pre-treatment motor cortical plasticity - the brain's ability to change in response to an external perturbation - induced with intermittent theta burst stimulation, predicted prospectively ascertained (in 4-to-6 weeks) response to antipsychotic medications. We observed that participants with cortical plasticity in the opposite direction (possibly compensatory) had significantly greater improvements in their positive symptoms. This association persisted after correcting for multiple comparisons and controlling for potential confounders via linear regression. Inter-individual variability in cortical plasticity is a potential predictive biomarker in schizophrenia requiring further investigation and replication.
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Affiliation(s)
- Aishwarya Sachdeva
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 560029, India
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 560029, India.
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 560029, India
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20
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Shamanna V, Mehta UM, Naik SS, Basavaraju R, Thirthalli J. Transdiagnostic investigation into the relationship between mirror neuron system activity, echo-phenomena, and theory of mind in major psychoses. Asian J Psychiatr 2023; 82:103504. [PMID: 36801552 DOI: 10.1016/j.ajp.2023.103504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/02/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023]
Abstract
The association between social cognition and putative mirror neuron system (MNS)-activity in major psychoses might be contingent upon frontal dysregulation. We used a transdiagnostic ecological approach to enrich a specific behavioral phenotype (echophenomena or hyper-imitative states) across clinical diagnoses (mania and schizophrenia) to compare behavioral and physiological markers of social cognition and frontal disinhibition. We examined 114 participants with schizophrenia (N = 53) and mania (N = 61) for the presence and severity of echo-phenomena (echopraxia, incidental, and induced echolalia) using an ecological paradigm to simulate real-life social communication. Symptom severity, frontal release reflexes, and theory of mind performance were also assessed. In a proportion of these participants with (N = 20) and without (N = 20) echo-phenomena, we compared motor resonance (motor evoked potential facilitation during action observation compared to static image viewing) and cortical silent period (CSP) as putative markers of MNS-activity and frontal disinhibition, respectively, using Transcranial Magnetic Stimulation. While the prevalence of echo-phenomena was similar between mania and schizophrenia, incidental echolalia was more severe in mania. Participants with echo-phenomena (compared to those without) had significantly greater motor resonance with singlepulse (not with paired-pulse) stimuli, poorer theory of mind scores, higher frontal release reflexes but similar CSP, and greater symptom severity. None of these parameters significantly differed between participants with mania and schizophrenia. We observed relatively better phenotypic and neurophysiological characterization of major psychoses by categorizing participants based on the presence of echophenomena than clinical diagnoses. Higher putative MNS-activity was associated with poorer theory of mind in a hyper-imitative behavioral state.
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Affiliation(s)
- Varsha Shamanna
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India.
| | - Shalini S Naik
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Rakshathi Basavaraju
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
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21
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Sivakumar T, Basavarajappa C, Philip M, Kumar CN, Thirthalli J, Parthasarathy R. Impact of incentivizing ASHAs on the outcome of persons with severe mental illness in a rural South Indian community amidst the COVID-19 pandemic. Asian J Psychiatr 2023; 80:103388. [PMID: 36495728 PMCID: PMC9722235 DOI: 10.1016/j.ajp.2022.103388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/03/2022] [Accepted: 09/12/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND & OBJECTIVES Task shifting has been recommended as a strategy to reach out to persons with mental illness and bridge the treatment gap. There is a need to explore task-shifting using existing health staff like Accredited Social Health Activists (ASHAs). We examined the impact of incentivizing ASHAs on the outcome of persons with severe mental illness (SMI) amidst the pandemic. METHODS One hundred eighty-four adults with SMI from Jagaluru taluk were enrolled and followed up for a year. They were assessed for disability, work performance, internalized stigma, and illness severity at baseline, six months, and 12 months follow-up. ASHA workers were incentivized to ensure follow-up consultations, address concerns regarding illness/ medication side effects and monitor medication adherence. RESULTS Out of the 184 recruited patients, 7 died (non-COVID-19 causes), 22 stopped treatment and did not report for follow-up consultations, 11 shifted to treatment from other centers, and in 1 case, there was a change in diagnosis. 143 (78%) patients with SMI completed the study amidst the COVID-19 pandemic. At one year follow-up, there was a significant reduction in disability, illness severity, self-stigma, and improved work performance. CONCLUSION Incentivization of ASHAs helped ensure continuity of care to persons with SMI despite lockdowns and COVID-19 exigencies. It is feasible to involve ASHAs in the treatment of persons with SMI.
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Affiliation(s)
- Thanapal Sivakumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India.
| | - Chethan Basavarajappa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India
| | - Mariamma Philip
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India
| | - C Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India
| | - Rajani Parthasarathy
- Department of Health and Family Welfare, Government of Karnataka, Bengaluru 560009, India
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22
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Cohen A, Naslund JA, Chang S, Nagendra S, Bhan A, Rozatkar A, Thirthalli J, Bondre A, Tugnawat D, Reddy PV, Dutt S, Choudhary S, Chand PK, Patel V, Keshavan M, Joshi D, Mehta UM, Torous J. Relapse prediction in schizophrenia with smartphone digital phenotyping during COVID-19: a prospective, three-site, two-country, longitudinal study. Schizophrenia (Heidelb) 2023; 9:6. [PMID: 36707524 PMCID: PMC9880926 DOI: 10.1038/s41537-023-00332-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/13/2023] [Indexed: 01/28/2023]
Abstract
Smartphone technology provides us with a more convenient and less intrusive method of detecting changes in behavior and symptoms that typically precede schizophrenia relapse. To take advantage of the aforementioned, this study examines the feasibility of predicting schizophrenia relapse by identifying statistically significant anomalies in patient data gathered through mindLAMP, an open-source smartphone app. Participants, recruited in Boston, MA in the United States, and Bangalore and Bhopal in India, were invited to use mindLAMP for up to a year. The passive data (geolocation, accelerometer, and screen state), active data (surveys), and data quality metrics collected by the app were then retroactively fed into a relapse prediction model that utilizes anomaly detection. Overall, anomalies were 2.12 times more frequent in the month preceding a relapse and 2.78 times more frequent in the month preceding and following a relapse compared to intervals without relapses. The anomaly detection model incorporating passive data proved a better predictor of relapse than a naive model utilizing only survey data. These results demonstrate that relapse prediction models utilizing patient data gathered by a smartphone app can warn the clinician and patient of a potential schizophrenia relapse.
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Affiliation(s)
- Asher Cohen
- grid.38142.3c000000041936754XDivision of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
| | - John A. Naslund
- grid.38142.3c000000041936754XDepartment of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
| | - Sarah Chang
- grid.38142.3c000000041936754XDivision of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
| | - Srilakshmi Nagendra
- grid.416861.c0000 0001 1516 2246Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | | | - Abhijit Rozatkar
- grid.464753.70000 0004 4660 3923Department of Psychiatry, AIIMS Bhopal, All India Institute of Medical Sciences Bhopal, Bhopal, India
| | - Jagadisha Thirthalli
- grid.416861.c0000 0001 1516 2246Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | | | | | - Preethi V. Reddy
- grid.416861.c0000 0001 1516 2246Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | - Siddharth Dutt
- grid.416861.c0000 0001 1516 2246Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | - Soumya Choudhary
- grid.416861.c0000 0001 1516 2246Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | - Prabhat Kumar Chand
- grid.416861.c0000 0001 1516 2246Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | - Vikram Patel
- grid.38142.3c000000041936754XDepartment of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
| | - Matcheri Keshavan
- grid.38142.3c000000041936754XDivision of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
| | - Devayani Joshi
- grid.38142.3c000000041936754XDivision of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
| | - Urvakhsh Meherwan Mehta
- grid.416861.c0000 0001 1516 2246Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | - John Torous
- grid.38142.3c000000041936754XDivision of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
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23
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Nirisha PL, Malathesh BC, Kulal N, Harshithaa NR, Ibrahim FA, Suhas S, Manjunatha N, Kumar CN, Parthasarathy R, Manjappa AA, Thirthalli J, Chand PK, Arora S, Math SB. Impact of Technology Driven Mental Health Task-shifting for Accredited Social Health Activists (ASHAs): Results from a Randomised Controlled Trial of Two Methods of Training. Community Ment Health J 2023; 59:175-184. [PMID: 35779139 PMCID: PMC10290774 DOI: 10.1007/s10597-022-00996-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/11/2022] [Indexed: 01/07/2023]
Abstract
Mental health task shifting is a potential way to address the burgeoning treatment gap for mental illness. Easily available and accessible digital technology can be utilised to continuously engage grassroot level health workers (for example, Accredited Social Health Activists (ASHAs). However, the impact of such a strategy is not yet systematically evaluated. In this randomised controlled trial, longitudinal hybrid training of ASHAs [1 day in-person classroom training and seven online sessions (ECHO model), aimed to screen and refer to commonly prevalent mental health issues in communities] was compared with traditional one-day in-person classroom training. ASHAs (n = 75) from six Primary Health Centres in Ramanagara district, Karnataka, India were randomized into study (SG-ASHAs) and control (CG-ASHAs) groups. After excluding drop-outs, 26 ASHAs in each group were included in the final analysis of the scores on their Knowledge, attitude, and practices (KAP) in mental health. Two house-to-house surveys were conducted by both groups to identify and refer possible cases. The number of screen positives (potential persons with mental illnesses) and the KAP scores formed the outcome measures. Online sessions for SG-ASHAs were completed over 18 months, the COVID-19 pandemic being the main disruptor. SG-ASHAs identified significantly higher number of persons with potential alcohol use disorders [n = 873 (83%); p ≤ 0.001] and common mental disorders [n = 96(4%); p = 0.018], while CG-ASHAs identified significantly higher number of those with potential severe mental disorders [n = 61(61.61%); p ≤ 0.001]. As regards KAP, after controlling for baseline scores, the time effect in RMANOVA favoured SG-ASHAs. Mean total KAP score increased from 16.76 to18.57 (p < 0·01) in SG-ASHAs and from 18.65 to 18.84 (p = 0.76) in CG-ASHAs. However, the Time-group interaction effect did not favour either (F = 0.105; p = 0.748). Compared to traditional training, mentoring ASHAs for extended periods is more impactful. Easily accessible digital technology makes the latter feasible. Scaling up such initiatives carry the potential to considerably improve treatment access for those in need.
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Affiliation(s)
- P Lakshmi Nirisha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Barikar C Malathesh
- Department of Psychiatry, All India Institute of Medical Sciences, Bibinagar, India
| | - Nithesh Kulal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Nisha R Harshithaa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | - Satish Suhas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - N Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | | | - Adarsha Alur Manjappa
- DMHP Psychiatrist, Department of Health and Family Welfare, Government of Karnataka Office of the District Health Officer, Ramanagara District, Ramanagara, Karnataka, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Prabhat Kumar Chand
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Sanjeev Arora
- University of New Mexico Health Sciences Center, Albuquerque, USA
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
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Bondre AP, Shrivastava R, Raghuram H, Tugnawat D, Khan A, Gupta S, Kumar M, Mehta UM, Keshavan M, Lakhtakia T, Chand PK, Thirthalli J, Patel V, Torous J, Rozatkar AR, Naslund JA, Bhan A. A qualitative exploration of perceived needs and barriers of individuals with schizophrenia, caregivers and clinicians in using mental health applications in Madhya Pradesh, India. SSM Ment Health 2022; 2:100063. [PMID: 36688236 PMCID: PMC9792372 DOI: 10.1016/j.ssmmh.2022.100063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/27/2021] [Accepted: 01/26/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction About 3.5 million people are living with schizophrenia in India, with most failing to receive minimally adequate care. Digital mental health applications could potentially decrease this treatment gap; however, these applications should be tailored to meet the needs and overcoming barriers of its end-users to ensure their adoption and sustained usage. Few studies in India have explored the perspectives of target stakeholders to understand how digital tools could be viable for supporting care. Therefore, this study explores the perceived needs and barriers of patients with schizophrenia, caregivers and clinicians in using digital mental health applications. Methods Focus group discussions (FGDs) were conducted with patients having schizophrenia attending outpatient clinics at a government tertiary hospital, and their caregivers, and mental health clinicians in Bhopal, Madhya Pradesh, India. FGDs were audio-recorded and coded. Framework analysis was employed to guide the analysis, involving deductive and inductive generation of themes, data triangulation and comparison of perspectives between participant groups. Results Six FGDs were conducted with individuals with schizophrenia (n = 11), their caregivers (n = 14), and mental health clinicians (n = 19). Four a priori themes were established: a) Prior experiences with health applications; b) Content of a mental health application; c) Involvement of caregivers in mental health application usage and d) Supporting doctors' work through mental health applications. Additionally, two themes were generated inductively: a) Qualities of a mental health application and b) Data privacy and confidentiality. Conclusion Exploration of stakeholder perspectives on the content, features, and uses of mental health applications is crucial to yield initial insights about the use of these digital programs in India. This study generated a multitude of suggestions on app functionality and components, which can guide ongoing efforts to develop and deliver digital mental health applications for patients living with schizophrenia in low-resource settings, with limited access to mental health services.
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Affiliation(s)
- Ameya P. Bondre
- Sangath, 120 Deepak Society, Chuna Bhatti, Bhopal, Madhya Pradesh, 462016, India,Corresponding author. 120 Deepak Society: Chuna Bhatti, Bhopal, Madhya Pradesh, 462016, India.
| | - Ritu Shrivastava
- Sangath, 120 Deepak Society, Chuna Bhatti, Bhopal, Madhya Pradesh, 462016, India
| | | | - Deepak Tugnawat
- Sangath, 120 Deepak Society, Chuna Bhatti, Bhopal, Madhya Pradesh, 462016, India
| | - Azaz Khan
- Sangath, 120 Deepak Society, Chuna Bhatti, Bhopal, Madhya Pradesh, 462016, India
| | - Snehil Gupta
- All India Institute of Medical Sciences (AIIMS), Saket Nagar, Bagh Swaniya, Bhopal, Madhya Pradesh, 462020, India
| | - Mohit Kumar
- All India Institute of Medical Sciences (AIIMS), Saket Nagar, Bagh Swaniya, Bhopal, Madhya Pradesh, 462020, India
| | - Urvakhsh Meherwan Mehta
- National Institute of Mental Health and Neurosciences, Hosur Road, Lakkasandra, Wilson Garden, Bengaluru, Karnataka, 560029, India
| | - Matcheri Keshavan
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center (BIDMC), 330 Brookline Ave, Boston, MA, 02215, United States
| | - Tanvi Lakhtakia
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center (BIDMC), 330 Brookline Ave, Boston, MA, 02215, United States
| | - Prabhat Kumar Chand
- National Institute of Mental Health and Neurosciences, Hosur Road, Lakkasandra, Wilson Garden, Bengaluru, Karnataka, 560029, India
| | - Jagadisha Thirthalli
- National Institute of Mental Health and Neurosciences, Hosur Road, Lakkasandra, Wilson Garden, Bengaluru, Karnataka, 560029, India
| | - Vikram Patel
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, United States
| | - John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center (BIDMC), 330 Brookline Ave, Boston, MA, 02215, United States
| | - Abhijit R. Rozatkar
- All India Institute of Medical Sciences (AIIMS), Saket Nagar, Bagh Swaniya, Bhopal, Madhya Pradesh, 462020, India
| | - John A. Naslund
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, United States
| | - Anant Bhan
- Sangath, 120 Deepak Society, Chuna Bhatti, Bhopal, Madhya Pradesh, 462016, India
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25
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Chithra U, Samantaray S, Kumar V, K R, Maity K, E N, Akhtar KJ, Parlikar R, Bagali KB, Sreeraj VS, Shreekantiah U, Purohith AN, Shenoy S, Praharaj SK, Goyal N, Mehta UM, Venkatasubramanian G, Thirthalli J. Add-on accelerated continuous theta burst stimulation (a-cTBS) over the left temporoparietal junction for the management of persistent auditory hallucinations in schizophrenia: A case series. Brain Stimul 2022; 15:1511-1512. [PMID: 36410627 DOI: 10.1016/j.brs.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/04/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Uppinkudru Chithra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka State, India
| | - Subham Samantaray
- Central Institute of Psychiatry (CIP), Ranchi, 834006, Jharkhand State, India
| | - Vikas Kumar
- Central Institute of Psychiatry (CIP), Ranchi, 834006, Jharkhand State, India
| | - Rajkumar K
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka State, India
| | - Ketaki Maity
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka State, India
| | - Nathiya E
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka State, India
| | - Khalid Jiya Akhtar
- Central Institute of Psychiatry (CIP), Ranchi, 834006, Jharkhand State, India
| | - Rujuta Parlikar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka State, India
| | - Kiran Basawaraj Bagali
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka State, India
| | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka State, India.
| | - Umesh Shreekantiah
- Central Institute of Psychiatry (CIP), Ranchi, 834006, Jharkhand State, India
| | - Abhiram Narasimhan Purohith
- Department of Psychiatry, Kasturba Medical College (KMC), Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Udupi, 576104, Karnataka, India
| | - Sonia Shenoy
- Department of Psychiatry, Kasturba Medical College (KMC), Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Udupi, 576104, Karnataka, India
| | - Samir Kumar Praharaj
- Department of Psychiatry, Kasturba Medical College (KMC), Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Udupi, 576104, Karnataka, India
| | - Nishant Goyal
- Central Institute of Psychiatry (CIP), Ranchi, 834006, Jharkhand State, India
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka State, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka State, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, Karnataka State, India
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26
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Mehta UM, Basavaraju R, Ramesh A, Kesavan M, Thirthalli J. Motor Resonance During Action Observation and Its Relevance to Virtual Clinical Consultations: Observational Study Using Transcranial Magnetic Stimulation. JMIR Ment Health 2022; 9:e40652. [PMID: 36269658 PMCID: PMC9636526 DOI: 10.2196/40652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/09/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Virtual clinical interactions have increased tremendously since the onset of the COVID-19 pandemic. While they certainly have their advantages, there also exist potential limitations, for example, in establishing a therapeutic alliance, discussing complex clinical scenarios, etc. This may be due to possible disruptions in the accurate activation of the human mirror neuron system (MNS), a posited physiological template for effective social communication. OBJECTIVE This study aimed to compare motor resonance, a putative marker of MNS activity, estimated using transcranial magnetic stimulation (TMS) elicited while viewing virtual (video-based) and actual or real (enacted by a person) actions in healthy individuals. We hypothesized that motor resonance will be greater during real compared to virtual action observation. METHODS We compared motor resonance or motor-evoked potential (MEP) facilitation during the observation of virtual (presented via videos) and real (enacted in person) actions, relative to static image observation in healthy individuals using TMS. The MEP recordings were obtained by 2 single-pulse (neuronal membrane excitability-driven) TMS paradigms of different intensities and 2 paired-pulse (cortical gamma-aminobutyric acid-interneuron-driven) TMS paradigms. RESULTS This study comprised 64 participants. Using the repeated measures ANOVA, we observed a significant time effect for MEP facilitation from static to virtual and real observation states when recorded using 3 of the 4 TMS paradigms. Post hoc pairwise comparisons with Benjamini-Hochberg false discovery rate correction revealed significant MEP facilitation in both virtual and real observation states relative to static image observation; however, we also observed a significant time effect between the 2 action observation states (real > virtual) with 2 of the 4 TMS paradigms. CONCLUSIONS Our results indicate that visual cues expressed via both virtual (video) or real (in person) modes elicit physiological responses within the putative MNS, but this effect is more pronounced for actions presented in person. This has relevance to the appropriate implementation of digital health solutions, especially those pertaining to mental health.
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Affiliation(s)
- Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Rakshathi Basavaraju
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Abhishek Ramesh
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Muralidharan Kesavan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
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27
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Sukumaran SK, Paul P, Guttal V, Holla B, Vemula A, Bhatt H, Bisht P, Mathew K, Nadella RK, Varghese AM, K V, Purushottam M, Jain S, Sud R, Viswanath B, Viswanath B, Rao NP, Narayanaswamy JC, Sivakumar PT, Kandasamy A, Kesavan M, Mehta UM, Venkatasubramanian G, John JP, Purushottam M, Mukherjee O, Mehta B, Kandavel T, Binukumar B, Saini J, Jayarajan D, Shyamsundar A, Moirangthem S, Vijay Kumar KG, Mahadevan J, Holla B, Thirthalli J, Chandra PS, Gangadhar BN, Murthy P, Panicker MM, Bhalla US, Chattarji S, Benegal V, Varghese M, Reddy JYC, Padinjat R, Rao M, Jain S. Abnormalities in migration of neural precursor cells in familial bipolar disorder. Dis Model Mech 2022; 15:277960. [PMID: 36239094 PMCID: PMC9612872 DOI: 10.1242/dmm.049526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 09/20/2022] [Indexed: 11/21/2022] Open
Abstract
Cellular migration is a ubiquitous feature that brings brain cells into appropriate spatial relationships over time; and it helps in the formation of a functional brain. We studied the migration patterns of induced pluripotent stem cell-derived neural precursor cells (NPCs) from individuals with familial bipolar disorder (BD) in comparison with healthy controls. The BD patients also had morphological brain abnormalities evident on magnetic resonance imaging. Time-lapse analysis of migrating cells was performed, through which we were able to identify several parameters that were abnormal in cellular migration, including the speed and directionality of NPCs. We also performed transcriptomic analysis to probe the mechanisms behind the aberrant cellular phenotype identified. Our analysis showed the downregulation of a network of genes, centering on EGF/ERBB proteins. The present findings indicate that collective, systemic dysregulation may produce the aberrant cellular phenotype, which could contribute to the functional and structural changes in the brain reported for bipolar disorder. This article has an associated First Person interview with the first author of the paper.
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Affiliation(s)
- Salil K Sukumaran
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Pradip Paul
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Vishwesha Guttal
- Centre for Ecological Sciences, Indian Institute of Science, Bangalore, India.,Centre for Biosystems and Bioengineering, Indian Institute of Science, Bangalore, India
| | - Bharath Holla
- Dept. of Integrative Medicine, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Alekhya Vemula
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Harsimar Bhatt
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Piyush Bisht
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Kezia Mathew
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Ravi K Nadella
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Anu Mary Varghese
- Dept. of Neurophysiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Vijayalakshmi K
- Dept. of Neurophysiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Meera Purushottam
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Sanjeev Jain
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Reeteka Sud
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Biju Viswanath
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Biju Viswanath
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - Naren P Rao
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | | | | | - Arun Kandasamy
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | | | | | | | - John P John
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - Meera Purushottam
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - Odity Mukherjee
- Institute for Stem Cell Biology and Regenerative Medicine (InStem), India
| | - Bhupesh Mehta
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | | | - B Binukumar
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - Jitender Saini
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - Deepak Jayarajan
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - A Shyamsundar
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | | | - K G Vijay Kumar
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - Jayant Mahadevan
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - Bharath Holla
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | | | - Prabha S Chandra
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | | | - Pratima Murthy
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | | | | | - Sumantra Chattarji
- Institute for Stem Cell Biology and Regenerative Medicine (InStem), India
| | - Vivek Benegal
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | - Mathew Varghese
- National Institute of Mental Health and Neurosciences (NIMHANS), India
| | | | | | - Mahendra Rao
- Institute for Stem Cell Biology and Regenerative Medicine (InStem), India
| | - Sanjeev Jain
- National Institute of Mental Health and Neurosciences (NIMHANS), India
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28
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Arumugham SS, Praharaj SK, Shreekantiah U, Sreeraj VS, Roy C, Shenoy S, Purohith AN, Chithra U, Bagali KB, Venkataramaiah S, Nanjundaiah GKK, Thennarasu K, Kumar CN, Goyal N, Das B, Mehta UM, Muralidharan K, Venkatasubramanian G, Sinha P, Thirthalli J. Clinical efficacy and neurobiological correlates of electroconvulsive therapy in patients with clozapine-resistant/intolerant schizophrenia: study protocol of multi-site parallel arm double-blind randomized sham-controlled study. Wellcome Open Res 2022; 7:212. [PMID: 37953926 PMCID: PMC10636350 DOI: 10.12688/wellcomeopenres.18028.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 11/14/2023] Open
Abstract
Background: A substantial proportion of patients with treatment resistant schizophrenia do not respond well or partially to clozapine, with a subset that does not tolerate an adequate trial of clozapine. Electroconvulsive therapy (ECT) is regarded as one of the augmenting options, but there is a lack of high-quality evidence for this practice. This protocol describes a double-blind randomised sham-controlled modified-ECT trial to evaluate its efficacy in patients with clozapine resistant/intolerant schizophrenia. The study also involves multimodal investigations to identify the response predictors and the mechanistic basis of modified ECT in this population. Methods: One hundred consenting schizophrenia patients with resistance/intolerance to clozapine referred by clinicians for ECT would be randomly assigned to receive true ECT or sham ECT at three study centers. Sham ECT would mimic all the procedures of modified ECT including anaesthesia and muscle relaxation, except the electrical stimulation. After a blinded course, non-responders to sham ECT would be offered open-label true ECT. Clinical assessments, neurocognitive assessments and multimodal investigations (magnetic resonance imaging [MRI], electroencephalography, heart rate variability, investigative transcranial magnetic stimulation-transcranial direct current stimulation, gene polymorphism) would be conducted at baseline and repeated after the end of the trial, as well as open-label ECT course. The trial would evaluate the improvement in positive symptoms (scale for assessment of positive symptoms) of schizophrenia as the primary outcome measure with prediction of this change by resting-state functional-MRI based brain-connectivity as the second primary objective. Registration: Clinical Trial Registry of India (Reg no: CTRI/2021/05/033775) on 24 th May 2021.
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Affiliation(s)
- Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Samir K. Praharaj
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | | | - Vanteemar S. Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Chandramouli Roy
- Central Institute of Psychiatry, Ranchi, Jharkhand, 834006, India
| | - Sonia Shenoy
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Abhiram Narasimhan Purohith
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Uppinkudru Chithra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Kiran Basawaraj Bagali
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Sudhir Venkataramaiah
- Department of Neuroanaesthsia and Neuro Critical Care, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, 560029, India
| | - Gopala Krishna Kadarapura Nanjundaiah
- Department of Neuroanaesthsia and Neuro Critical Care, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, 560029, India
| | - Kandavel Thennarasu
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, 560029, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Nishant Goyal
- Central Institute of Psychiatry, Ranchi, Jharkhand, 834006, India
| | - Basudeb Das
- Central Institute of Psychiatry, Ranchi, Jharkhand, 834006, India
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Kesavan Muralidharan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Preeti Sinha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, Bengaluru, Karnataka, India, 560029, India
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29
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Sudheer N, Kumar V, Bhide SR, Naik SS, Baliga S, Varambally S, Thirthalli J, Gangadhar BN. Can yoga practise prevent electro-convulsive therapy induced neurocognitive deficits? - Findings from a pilot randomised controlled trial. Asian J Psychiatr 2022; 76:103244. [PMID: 36037698 DOI: 10.1016/j.ajp.2022.103244] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 07/21/2022] [Accepted: 08/12/2022] [Indexed: 11/02/2022]
Abstract
Despite decades of experience with ECT, no single agent has emerged as a suitable strategy to mitigate the associated neuro-cognitive deficits. In this first of its kind pilot randomised controlled trial, we sought to demonstrate the effect of yoga on neurocognitive deficits. We found a favourable effect of Yoga in the domain of verbal fluency, however our study did not reveal significant differences in other cognitive domains. Future studies could look to build on this study while addressing the limitations cited.
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Affiliation(s)
- Nivedita Sudheer
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India; NIMHANS Integrated Centre for Yoga, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Vijay Kumar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India.
| | - Shree Raksha Bhide
- NIMHANS Integrated Centre for Yoga, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Shalini S Naik
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Sachin Baliga
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Shivarama Varambally
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Bangalore N Gangadhar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
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Sinha P, Shreekantiah U, Goyal N, Sreeraj VS, Arumugham SS, Samantaray S, Jammigumpula A, Nanjundaiah GKK, Venkataramaiah S, Thennarasu K, Roy C, Purohith AN, Shenoy S, Kumar CN, Shivakumar V, Udupa K, Muralidharan K, Venkatasubramanian G, Thirthalli J, Praharaj SK, Mehta UM. Study protocol for evaluating the clinical efficacy and neurobiological correlates of sequential treatment with tDCS primed iTBS and ECT in treatment-resistant depression. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.18192.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Treatment-resistant depression is a burdensome condition. Intermittent theta burst stimulation (iTBS) of the left dorsolateral prefrontal cortex is considered a treatment option in early course of resistance with a proportion of such patients responding to it. Preliminary evidence suggests a role of priming iTBS stimulation with preconditioning using cathodal transcranial direct current stimulation (tDCS). This protocol describes a double-blind randomized sham-controlled study to evaluate the clinical efficacy and tolerability of tDCS-primed iTBS in the treatment of resistant depression. Non-responders to this trial will be offered open-label electroconvulsive therapy. All participants will undergo neurobiological investigations that will enable the identification of potential response predictors and mechanisms. Methods: Three hundred and fifty consenting patients with treatment resistant depression will be randomly assigned to receive 20–30 daily sessions of true-tDCS or sham-tDCS primed iTBS over left dorsolateral prefrontal cortex at three study centers. After this blinded sham-controlled trial, non-responders to the intervention will be offered open-label true ECT. Clinical assessments, neurocognitive assessments and multimodal investigations (magnetic resonance imaging, electroencephalography, heart rate variability, investigative transcranial magnetic stimulation-transcranial direct current stimulation, gene polymorphisms) will be conducted at baseline and repeated after the end of the trial, as well as open-label ECT course. The trial will evaluate the improvement in depressive symptoms (Hamilton depression rating scale) between the two groups as the primary outcome measure.
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Arumugham SS, Praharaj SK, Shreekantiah U, Sreeraj VS, Roy C, Shenoy S, Purohith AN, Chithra U, Bagali KB, Venkataramaiah S, Nanjundaiah GKK, Thennarasu K, Kumar CN, Goyal N, Das B, Mehta UM, Muralidharan K, Venkatasubramanian G, Sinha P, Thirthalli J. Clinical efficacy and neurobiological correlates of electroconvulsive therapy in patients with clozapine-resistant/intolerant schizophrenia: study protocol of multi-site parallel arm double-blind randomized sham-controlled study. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.18028.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: A substantial proportion of patients with treatment resistant schizophrenia do not respond well or partially to clozapine, with a subset that does not tolerate an adequate trial of clozapine. Electroconvulsive therapy (ECT) is regarded as one of the augmenting options, but there is a lack of high-quality evidence for this practice. This protocol describes a double-blind randomised sham-controlled modified-ECT trial to evaluate its efficacy in patients with clozapine resistant/intolerant schizophrenia. The study also involves multimodal investigations to identify the response predictors and the mechanistic basis of modified ECT in this population. Methods: One hundred consenting schizophrenia patients with resistance/intolerance to clozapine referred by clinicians for ECT would be randomly assigned to receive true ECT or sham ECT at three study centers. Sham ECT would mimic all the procedures of modified ECT including anaesthesia and muscle relaxation, except the electrical stimulation. After a blinded course, non-responders to sham ECT would be offered open-label true ECT. Clinical assessments, neurocognitive assessments and multimodal investigations (magnetic resonance imaging [MRI], electroencephalography, heart rate variability, investigative transcranial magnetic stimulation-transcranial direct current stimulation, gene polymorphism) would be conducted at baseline and repeated after the end of the trial, as well as open-label ECT course. The trial would evaluate the improvement in positive symptoms (scale for assessment of positive symptoms) of schizophrenia as the primary outcome measure with prediction of this change by resting-state functional-MRI based brain-connectivity as the second primary objective. Registration: Clinical Trial Registry of India (Reg no: CTRI/2021/05/033775) on 24th May 2021.
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Sivakumar T, Jadhav P, Allam A, Ramachandraiah S, Vanishree BNG, Meera J, Santhosha S, Doddur D, Janardhana AL, Basavarajappa C, Kumar CN, Thirthalli J. Continuity of Care for Persons With Serious Mental Illness in a Rural Rehabilitation Program During the COVID-19 Pandemic in India. Psychiatr Serv 2022; 73:830-833. [PMID: 34991340 DOI: 10.1176/appi.ps.202100462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The COVID-19 pandemic has posed challenges to community-based rehabilitation (CBR) for persons with mental illness, especially in resource-constrained settings. This column discusses the pandemic-related challenges faced by a rural CBR program in Jagaluru taluk (a subdistrict) in Karnataka, India. Thanks to stakeholder collaboration, task shifting with lay health workers, and implementation of telepsychiatry, the authors' clinical team could ensure uninterrupted medical care for persons with serious mental illness. Other CBR components were reduced because of pandemic-imposed resource and logistic constraints.
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Affiliation(s)
- Thanapal Sivakumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Prabhu Jadhav
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Abhishek Allam
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Sujai Ramachandraiah
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Byalya Nanje Gowda Vanishree
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Jyothi Meera
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Shivamurthy Santhosha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Dundappa Doddur
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Akkalapura Lokappa Janardhana
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Chethan Basavarajappa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
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Thirthalli J, Mehta UM, Keshav Kumar JK, Tyagi V, Sunder P, Dharmappa A, Govindaraj R, Saini J, Chaturvedi SK, Gangadhar BN. Randomized, sham-controlled trial of transcranial magnetic stimulation augmentation of cognitive remediation in schizophrenia. Schizophr Res 2022; 241:63-65. [PMID: 35086060 DOI: 10.1016/j.schres.2022.01.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 01/08/2022] [Accepted: 01/15/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India.
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | - J K Keshav Kumar
- Department of Clinical Psychology, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | - Vidhi Tyagi
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | - Poornima Sunder
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | - Arpitha Dharmappa
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | - Ramajayam Govindaraj
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | - Jitender Saini
- Department of Neuroradiology and Interventional Radiology, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | - S K Chaturvedi
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | - B N Gangadhar
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
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Basavaraju V, Murugesan M, Kumar CN, Gowda GS, Tamaraiselvan SK, Thirthalli J, Nagabhushana SH, Manjunatha N, Bada Math S, Parthasarathy R, Arunachalam V, Kumar Ks C, Am A, H C. Care at door-steps for persons with severe mental disorders: A pilot experience from Karnataka district mental health program. Int J Soc Psychiatry 2022; 68:273-280. [PMID: 33356744 DOI: 10.1177/0020764020983856] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Public funded outreach services for persons with severe mental disorders (SMDs), a norm in developed nations, is non-existent in India. We share our pilot experience with an indigenous model named 'Care at Doorsteps' (CADs) for persons with SMDs who dropped out from clinical care of District Mental Health Program (DMHP) at three sites of Karnataka, a south Indian state. AIM The objectives of this study were to identify the reasons for drop outs from routine care and to assess the burden of illness and disability after the intervention. METHODOLOGY Six-month prospective observational study on patients aged 18-60 years, diagnosed as Schizophrenia or bipolar disorder was conducted. Three home visits were made by the team and provided medications, also offered brief psychoeducation and counselling. Care-givers were interviewed to identify the reasons for drop outs and their expectations from the treating team. Patients were also assessed using the Clinical Global Impression Scale (CGI), Indian Disability Evaluation and Assessment Scale (IDEAS) and Burden Assessment Schedule (BAS) during each visit. RESULTS Ninety-six patients (50 males and 46 females) were followed up, of which 85 had a diagnosis of schizophrenia and 11 with bipolar illness. Common reasons for drop out were: single caregiver (breadwinner) unable to accompany the patient, loss of faith in medical treatment and financial constraints. Symptomatic improvement and restoration of productive work were the priority expectations. Over the course, the mean CGI-S showed significant reduction (4.81 ± 1.57, 4.46 ± 1.32 and 4.11 ± 1.39 respectively; p = 0.001). Mean score on BAS showed a significant reduction (85.76 ± 12.15, 83.46 ± 11.30, 84.27 ± 11.82; p = 0.04). Mean total IDEAS scores did not show significant change (13.27 ± 4.78, 12.82 ± 4.24, 13.17 ± 4.40; p = 0.16). CONCLUSION Meaningful assertive outreach care is feasible in India and is found to be useful for persons with SMDs by utilising the already existing public sector resources.
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Affiliation(s)
- Vinay Basavaraju
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Manisha Murugesan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | | | - Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | | | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | | | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Rajani Parthasarathy
- Department of Health and Family Welfare, Government of Karnataka, Bangalore, Karnataka, India
| | - Vikram Arunachalam
- Department of Health and Family Welfare, Government of Karnataka, Bangalore, Karnataka, India
| | - Chetan Kumar Ks
- Department of Health and Family Welfare, Government of Karnataka, Bangalore, Karnataka, India
| | - Adarsha Am
- Department of Health and Family Welfare, Government of Karnataka, Bangalore, Karnataka, India
| | - Chandrashekar H
- Department of Psychiatry, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
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Mohanty K, Prasad MK, Gandhi S, Thirthalli J. Effect of Nurse-Led Counseling on Maintenance of Healthy Lifestyle Among Outpatients Receiving Antipsychotics: Clinical Case Reports. Indian J Psychol Med 2022; 44:185-188. [PMID: 35655983 PMCID: PMC9120973 DOI: 10.1177/02537176211021283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Dinakaran D, Manjunatha N, Kumar CN, Math SB, Thirthalli J. The rationale and guiding principles to design a psychiatry curriculum for primary care doctors of India. Natl Med J India 2022; 35:32-37. [PMID: 36039625 DOI: 10.25259/nmji_289_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background Integrating psychiatric care into the general practice of primary care doctors (PCDs) is necessary to overcome the shortage of human resources to cater to the burgeoning public mental health needs of India. The traditional psychiatry curriculum is often top-down and specialist-based that contributes little in terms of skill quotient. We designed an innovative, digitally driven, distance education-based, part-time, modular-based Primary Care Psychiatry Programme (PCPP, skill-based). It is being implemented across many states of India to equip PCDs with skills to provide first-line psychiatry treatment. We discuss the rationale and guiding principles behind designing the curriculum of PCPP. Discussion There are nine guiding principles behind designing and implementing PCPP to provide pragmatic, acceptable, feasible modules of higher translational quotient (TQ) that are essential to upskill PCDs. There is a shift in training the location of PCDs in their live brief general consultations utilizing innovative telemedicine-based 'on-consultation training' (OCT) augmented with collaborative video consultations. A monolithic treatment protocol-driven, trans-diagnostic approach is used to design a concise, all-inone, point-of-care manual containing a culturally sensitive, rapid, validated screener and taxonomy, called 'Clinical Schedules for Primary Care Psychiatry'. This incorporates the PCDs' style of clinical practice that helps in picking up the most commonly prevalent adult psychiatric disorders presenting to primary care. Conclusion This PCPP curriculum contains pragmatic modules with higher TQ. This curriculum is dynamic as the learning is bi-directional. This can be used by policy-makers, innovators and academia for integration with national health programmes such as those for non-communicable diseases and reproductive and child health.
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Affiliation(s)
- Damodharan Dinakaran
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Sivakumar T, Kumar CN, Thirthalli J. Role of accredited social health activists in treatment of persons with severe mental illness in the community. Indian J Psychiatry 2022; 64:102-105. [PMID: 35400750 PMCID: PMC8992760 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_702_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/26/2021] [Accepted: 12/01/2021] [Indexed: 11/05/2022] Open
Affiliation(s)
- Thanapal Sivakumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Lakhtakia T, Bondre A, Chand PK, Chaturvedi N, Choudhary S, Currey D, Dutt S, Khan A, Kumar M, Gupta S, Nagendra S, Reddy PV, Rozatkar A, Scheuer L, Sen Y, Shrivastava R, Singh R, Thirthalli J, Tugnawat DK, Bhan A, Naslund JA, Patel V, Keshavan M, Mehta UM, Torous J. Smartphone digital phenotyping, surveys, and cognitive assessments for global mental health: Initial data and clinical correlations from an international first episode psychosis study. Digit Health 2022; 8:20552076221133758. [PMID: 36386246 PMCID: PMC9647298 DOI: 10.1177/20552076221133758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/30/2022] [Indexed: 11/11/2022] Open
Abstract
Objective To examine feasibility and acceptability of smartphone mental health app use
for symptom, cognitive, and digital phenotyping monitoring among people with
schizophrenia in India and the United States. Methods Participants in Boston, USA and Bhopal and Bangalore, India used a smartphone
app to monitor symptoms, play cognitive games, access relaxation and
psychoeducation resources and for one month, with an initial clinical and
cognitive assessment and a one-month follow-up clinical assessment.
Engagement with the app was compared between study sites, by clinical
symptom severity and by cognitive functioning. Digital phenotyping data
collection was also compared between three sites. Results By Kruskal-Wallis rank-sum test, we found no difference between app
activities completed or digital phenotyping data collected across the three
study sites. App use also did not correlate to clinical or cognitive
assessment scores. When using the app for symptom monitoring, preliminary
findings suggest app-based assessment correlate with standard cognitive and
clinical assessments. Conclusions Smartphone app for symptom monitoring and digital phenotyping for individuals
with schizophrenia appears feasible and acceptable in a global context.
Clinical utility of this app for real-time assessments is promising, but
further research is necessary to determine the long-term efficacy and
generalizability for serious mental illness.
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Affiliation(s)
- Tanvi Lakhtakia
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Prabhat Kumar Chand
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Soumya Choudhary
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Danielle Currey
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Siddharth Dutt
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Mohit Kumar
- Department of Psychiatry, AIIMS Bhopal, All India Institute of Medical Sciences Bhopal, Bhopal, India
| | - Snehil Gupta
- Department of Psychiatry, AIIMS Bhopal, All India Institute of Medical Sciences Bhopal, Bhopal, India
| | - Srilakshmi Nagendra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Preethi V Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Abhijit Rozatkar
- Department of Psychiatry, AIIMS Bhopal, All India Institute of Medical Sciences Bhopal, Bhopal, India
| | - Luke Scheuer
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | | | | | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | | | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Matcheri Keshavan
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Angothu H, Ajmera S, Thanapal S, Reddy K, Jagannathan A, Muliyala K, Thirthalli J. Poor enrollment of persons with disabilities in niramaya health insurance scheme over a decade under the Indian national trust. Indian J Soc Psychiatry 2022. [DOI: 10.4103/ijsp.ijsp_189_20l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kumar C, Varshney P, Malathesh B, Nirisha PL, Harshitha N, Kulal N, Gajera G, Suhas S, Rahul P, Harshitha HA, Manjunatha N, Manjappa A, Math S, Thirthalli J. Stake holder perspectives on the role of accredited social health activists (ASHAs) in Indian public mental healthcare space: A qualitative study. J Family Med Prim Care 2022; 11:7308-7315. [PMID: 36993024 PMCID: PMC10041250 DOI: 10.4103/jfmpc.jfmpc_543_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 12/24/2022] Open
Abstract
Background Community health workers such as Accredited Social Health Activists (ASHAs) are existing resources who can facilitate the bridging of the mental health treatment gap. Knowing about the perspectives of ASHAs in delivering mental health care and other professionals with experience working in the area of community mental health is imperative. Method As part of an implementation research project aimed at comparing the effectiveness of two training methods for community health workers (ASHAs), we conducted five focussed group discussions including four with ASHAs (n = 34) and one with other stakeholders (n = 10). Focussed Group Discussion (FGD) was conducted under the following themes: acceptance and feasibility of provision of mental health services from ASHA's point of view and understanding the supply and demand side opportunities and challenges. The discussion began with open-ended questions, allowing for new themes to emerge until saturation was reached. Results ASHAs were willing to incorporate mental health identification (and referral) in their regular activities without additional perceived burden. ASHAs were easily able to identify severe mental disorders (SMDs). For substance use disorders (SUDs), due to factors such as normalization of substance consumption and stigma, there was a felt difficulty in the recognition by ASHAs. ASHAs' difficulty in identifying the CMDs was because of poor awareness in both those with mental illness and ASHAs. Incentivizing the work of ASHAs was thought to yield more returns. Conclusions ASHAs have the potential to be excellent resources for easy screening, identification, and follow-up of those with mental health concerns in the community. Policies to involve them need to evolve.
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Basavaraju R, Ithal D, Thanki MV, Ramalingaiah AH, Thirthalli J, Reddy RP, Brady RO, Halko MA, Bolo NR, Keshavan MS, Pascual-Leone A, Mehta UM, Kesavan M. Intermittent theta burst stimulation of cerebellar vermis enhances fronto-cerebellar resting state functional connectivity in schizophrenia with predominant negative symptoms: A randomized controlled trial. Schizophr Res 2021; 238:108-120. [PMID: 34653740 PMCID: PMC8662658 DOI: 10.1016/j.schres.2021.10.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 10/01/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Negative symptoms of schizophrenia are substantially disabling and treatment resistant. Novel treatments like repetitive transcranial magnetic stimulation (TMS) need to be examined for the same using the experimental medicine approach that incorporates tests of mechanism of action in addition to clinical efficacy in trials. METHODS Study was a double-blind, parallel, randomized, sham-controlled trial recruiting schizophrenia with at least a moderate severity of negative symptoms. Participants were randomized to real or sham intermittent theta burst stimulation (iTBS) under MRI-guided neuro-navigation, targeting the cerebellar vermis area VII-B, at a stimulus intensity of 100% active motor threshold, two sessions/day for five days (total = 6000 pulses). Assessments were conducted at baseline (T0), day-6 (T1) and week-6 (T2) after initiation of intervention. Main outcomes were, a) Scale for the Assessment of Negative Symptoms (SANS) score (T0, T1, T2), b) fronto-cerebellar resting state functional connectivity (RSFC) (T0, T1). RESULTS Thirty participants were recruited in each arm. Negative symptoms improved in both arms (p < 0.001) but was not significantly different between the two arms (p = 0.602). RSFC significantly increased between the cerebellar vermis and the right inferior frontal gyrus (pcluster-FWER = 0.033), right pallidum (pcluster-FWER = 0.042) and right frontal pole (pcluster-FWER = 0.047) in the real arm with no change in the sham arm. CONCLUSION Cerebellar vermal iTBS engaged a target belonging to the class of cerebello-subcortical-cortical networks, implicated in negative symptoms of schizophrenia. However, this did not translate to a superior clinical efficacy. Future trials should employ enhanced midline cerebellar TMS stimulation parameters for longer durations that can potentiate and translate biological changes into clinical effects.
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Affiliation(s)
- Rakshathi Basavaraju
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Dhruva Ithal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Milind Vijay Thanki
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Arvinda Hanumanthapura Ramalingaiah
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Rajakumari P. Reddy
- Department of Clinical Psychology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Roscoe O. Brady
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Mark A. Halko
- Department of Psychiatry, McLean Hospital and Harvard Medical School, Belmont, MA, USA
| | - Nicolas R. Bolo
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Matcheri S. Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research and Center for Memory Health, Hebrew Senior Life, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA; Guttmann Brain Health Institut, Institut Guttmann, Universitat Autonoma Barcelona, Spain.
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 560029, Karnataka, India.
| | - Muralidharan Kesavan
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 560029, Karnataka, India.
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Mehta UM, Ektare A, Jakhar J, Basavaraju R, Sanjay TN, Naik SS, Syed FA, Bhargav PH, Reddy PV, Kelkar RS, Arumugham SS, Kesavan M, Thirthalli J, Gangadhar BN. A transdiagnostic evaluation of cortical inhibition in severe mental disorders using Transcranial Magnetic Stimulation. J Psychiatr Res 2021; 143:364-369. [PMID: 34571321 DOI: 10.1016/j.jpsychires.2021.09.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/16/2021] [Accepted: 09/23/2021] [Indexed: 10/20/2022]
Abstract
Multiple lines of investigations suggest the presence of cortical inhibition aberrations as central to the phenotypic manifestations of severe mental disorders. Transcranial Magnetic Stimulation (TMS) combined with electromyography can characterize these inhibitory processes in the motor cortex with satisfactory temporal precision. We examined TMS-evoked short- (SICI) and long-interval intracortical inhibition (LICI) and cortical silent period (CSP) as markers of GABAA- (SICI) and GABAB-mediated (LICI and CSP) cortical neurotransmission in symptomatic individuals with mania (n = 40), schizophrenia (n = 76), unipolar depression (n = 86), and OCD (n = 43), and compared them against similar recordings in healthy subjects (n = 125). We hypothesized transdiagnostic GABAA deficits across all the clinical groups and diagnosis-specific GABAB alterations in mania (increased) and OCD (decreased). After controlling for potential confounder variables (gender, education, benzodiazepine prescription, and motor threshold) using the ANCOVA, we observed no significant group difference in SICI (F = 1.04, P = 0.38), but a significant group effect in LICI (F = 16.29, P < 0.001) and CSP (F = 3.02, P = 0.018). Post-hoc analyses revealed that LICI was significantly reduced in OCD but increased in mania and schizophrenia with reference to the healthy group. Similarly, CSP was significantly reduced in OCD and depression groups as compared to the reference group. We observed that LICI and CSP, both followed similar descending gradients from mania through schizophrenia and depression to OCD; with significant elevation in mania, and reduction in depression and OCD, as compared to the healthy group. This pattern of GABAB-mediated cortical inhibition aberrations needs independent validation as potential state-markers of distinct clinical categories.
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Affiliation(s)
- Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India.
| | - Aboli Ektare
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Jitender Jakhar
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Rakshathi Basavaraju
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Tarasingh N Sanjay
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Shalini S Naik
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Farooq Ali Syed
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Praerna Hemant Bhargav
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Preethi V Reddy
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Radhika Suneel Kelkar
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Muralidharan Kesavan
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Bangalore N Gangadhar
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
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Agarwal V, Thirthalli J, Kumar CN, Christopher R, U Arunachal G, Reddy KS, Rawat VS, Gangadhar BN, Wood J, Nimgaonkar V. Parental consanguinity among patients with schizophrenia in a rural community of South India: A clinical and genetic investigation. Asian J Psychiatr 2021; 64:102814. [PMID: 34425412 DOI: 10.1016/j.ajp.2021.102814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/12/2021] [Accepted: 08/10/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Studies from certain regions of the world indicate that consanguineous marriages are a risk factor for the development of schizophrenia in offspring. However the evidence is inconsistent partly due to methodological limitation of which hospital based recruitment contributing to significant bias. The studies from the Indian subcontinent, is scarce, where rates of consanguinity is high. METHODS The schizophrenia patients living in a geographically defined rural south Indian community and randomly selected controls dwelling in the same community sharing sociocultural, economic and lifestyle factors were recruited. They were assessed for parental consanguinity using the clinical interviews as well as DNA-based estimates. The latter was conducted by calculating the coefficient of inbreeding 'f'. A participant was considered to have consanguineous parentage if his/her parents shared a common ancestor no more remote than a great-great-grandparent, corresponding to DNA-based estimates of 'f' ≥ 0.0156. RESULTS The rates of parental consanguinity assessed by clinical interview were comparable in both groups (Cases: 10.71 %, Controls: 7.25 %; χ2 = 0.493, p = 0.4825). However, DNA-based rates of parental consanguinity showed that 'f' was significantly higher among cases than controls (Mann-Whitney U = 11315.5; p = 0.022). Seventy-five cases (62.5 %) and 108 control participants (48.6 %) had 'f' ≥ 0.0156 (χ2 = 6.008; p = 0.014). The results were consistent across different quality control measures. CONCLUSION Schizophrenia is associated with higher parental consanguinity, suggesting a role for multiple recessive risk alleles in its etiology. Replication in future studies in diverse settings would add further strength to this.
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Affiliation(s)
- Vikas Agarwal
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences, Bengaluru, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences, Bengaluru, India.
| | | | - Rita Christopher
- Department of Neurochemistry, National Institute of Mental Health And Neuro Sciences, Bengaluru, India
| | - Gautham U Arunachal
- Department of Human Genetics, National Institute of Mental Health And Neuro Sciences, Bengaluru, India
| | - K Shanivaram Reddy
- Department of Psychiatric Social Work, National Institute of Mental Health And Neuro Sciences, Bengaluru, India
| | - Vikram Singh Rawat
- Department of Psychiatry, All India Institute of Mediacal Sciences, Rishikesh, India
| | - Bangalore N Gangadhar
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences, Bengaluru, India
| | - Joel Wood
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Hospital, Pittsburgh, USA
| | - Vishwajit Nimgaonkar
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Hospital, Pittsburgh, USA; Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
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Pahuja E, Thirthalli J, Ibrahim FA, Andrade C. Carbamazepine/oxcarbazepine and valproate have different effects on the electroconvulsive therapy seizure threshold. Psychiatry Res 2021; 304:114149. [PMID: 34384943 DOI: 10.1016/j.psychres.2021.114149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/27/2021] [Accepted: 07/31/2021] [Indexed: 11/20/2022]
Abstract
Patients receiving mood stabilizers such as valproate (VAL) and carbamazepine (CMZP)/Oxcarbazepine (OX) may be referred for electroconvulsive therapy (ECT). The relative effects of these anticonvulsants on seizure threshold and seizure duration are unknown. We extracted data for a 20-month period from the medical records of patients who received bilateral ECT while on treatment with VAL (n=102) or CMZP/OX (n=31; 20 on CMZP, 11 on oxcarbazepine). Age-matched ECT-treated anticonvulsant-free patients (n=133) formed the control group. Seizure threshold in these patients had been determined by stimulus dose titration. The effect of VAL vs CMZP/OX on seizure threshold was examined using multivariable regression with adjustment for confounders. The mean (standard deviation) seizure threshold at the first ECT was highest in the CMZP/OX group (243.9 [106.1] mC), intermediate in the VAL group (177.7 [97.0] mC), and lowest in the control group (138.7 [86.0 Mc]). The regression model explained 37.5% of the variance in seizure threshold at the first ECT. Age, use of CMZP/OX, and anticonvulsant dose were each significantly associated with higher seizure threshold. CMZP/OX was associated with a higher initial ECT seizure threshold than VAL. ECT practitioners may prefer to start with a higher initial stimulus dose in patients receiving CMZP/OX or VAL, and more so for CMZP/OX than VAL, to avoid repeated sub-convulsive stimuli being administered.
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Affiliation(s)
- Erika Pahuja
- Ex-Senior Resident, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Jagadisha Thirthalli
- Professor, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
| | - Ferose Azeez Ibrahim
- Ex-Senior Resident, Tele-medicine Centre, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Chittaranjan Andrade
- Professor, Department of Clinical Psychopharmacology and Neurotoxicology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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Math SB, Nagendrappa S, Mukku SSR, Harshitha NR, Venu MA, Manjunatha N, Kumar CN, Sivakumar PT, Thirthalli J. Video consultations from an Indian academic hospital: First 3 years of experience from telepsychiatric after-care clinic. Natl Med J India 2021; 34:261-265. [PMID: 35593247 DOI: 10.25259/nmji_189_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background Continuity of care for psychiatric disorders by conventional in-person consultation by psychiatrists is associated with several challenges. There is a need to develop alternative models of specialist care. We studied our 3 years' experience of live video consultations (VCs) from the tele after-care clinic to patients with psychiatric disorders at an Indian academic hospital. Methods We did a file review of 669 VCs provided to 213 patients in the first 3 years (2017-2019) from the telemedicine centre of a tertiary care academic hospital. We analysed details of sociodemography, clinical profile, tele after-care consultations and outcome. Results Two hundred and thirteen patients (55% men) were enrolled for the tele after-care clinic. The mean (SD) age of the patients was 42.2 (17.29) years and a majority were educated till high school and beyond. Patients with severe and common mental disorders constituted 60.1% and 40%, respectively. Among the total 669 appointments, 542 (81%) VCs were successfully provided; of the remaining, 125 were cancelled and 2 were aborted due to a medical emergency. Medication prescriptions were unchanged in 499 and modified/totally changed in 47 VCs. Conclusion Our large study shows that telepsychiatric after-care is a useful alternative method which can supplement in-person follow-up. Barriers such as distance, cost and medical illness can be overcome using tele after-care clinics for regular follow-ups in stabilized psychiatric patients. There is a need for prospective studies, preferably, randomized controlled trials comparing effectiveness of tele after-care with in-person consultations to assess treatment outcomes.
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Affiliation(s)
- Suresh Bada Math
- Tele-Medicine Centre, Forensic Psychiatry, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru 560029, Karnataka, India
| | - Sachin Nagendrappa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru 560029, Karnataka, India
| | - Shiva Shanker Reddy Mukku
- Geriatric Clinic and Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru 560029, Karnataka, India
| | - Nisha R Harshitha
- Tele-Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru 560029, Karnataka, India
| | - Mekala A Venu
- Tele-Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru 560029, Karnataka, India
| | - Narayana Manjunatha
- Tele-Medicine Centre, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru 560029, Karnataka, India
| | - Channaveerachari Naveen Kumar
- Forensic Psychiatry, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru 560029, Karnataka, India
| | - Palanimuthu Thangaraju Sivakumar
- Geriatric Clinic and Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru 560029, Karnataka, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru 560029, Karnataka, India
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Reddy SK, Jagnnathan A, Ashraf GH, Kumar CN, Thirthalli J, Banerjee R, Muralidhar D. Barriers in Accessing Social Welfare Benefits for Families of Children With Intellectual and Developmental Disorders in Rural Karnataka: A Situation Analysis. Indian J Psychol Med 2021; 43:403-409. [PMID: 34584305 PMCID: PMC8450745 DOI: 10.1177/0253717621994706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Several government schemes exist for the welfare of families having children with intellectual and developmental disorders (IDDs) in India. However, these schemes are often not utilized. An understanding of the barriers to access these social welfare benefits, especially in rural areas of India, can aid in planning social action toward the implementation of these schemes. METHODS A situation analysis of the resources and potential barriers to access social welfare benefits for families of children with IDD was conducted in a rural community. Stakeholder interviews were conducted with families of children with IDD (n = 20), government officials responsible for implementing education at the state level (n = 5), local officials responsible for facilitating social welfare benefits (n = 5), and nongovernmental organization (NGO) working in the area of children with IDD (n = 3). Qualitative thematic analysis was used to understand the barriers to access social welfare benefits for the families of children with IDD. RESULTS Barriers encountered by families of children with IDD, local officials, and NGOs included lack of awareness about the available welfare schemes, unavailability of social welfare facilities in the local areas, lack of social auditing in the provision of social welfare schemes to the needy, and stringent process of application and regulation for financial aid under the National Trust schemes. CONCLUSION There are multiple barriers to access social welfare benefits for families having children with IDD in rural Karnataka. There is a strong need to empower families, sensitize local officials, and advocate for social policies to effectively implement National Trust schemes in rural areas of Karnataka.
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Affiliation(s)
- Shanivaram K Reddy
- Dept. of Psychiatric Social Work (Psychiatric Rehabilitation Services), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Aarti Jagnnathan
- Dept. of Psychiatric Social Work (Psychiatric Rehabilitation Services), National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Guddekoppa H Ashraf
- Mane-Manasa Project, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | | | - Jagadisha Thirthalli
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | | | - Daliboina Muralidhar
- Dept. of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Malathesh BC, Ibrahim FA, Nirisha PL, Kumar CN, Chand PK, Manjunatha N, Math SB, Thirthalli J, Manjappa AA, Parthasarathy R, Reddy S, Arora S. Embracing Technology for Capacity Building in Mental Health: New Path, Newer Challenges. Psychiatr Q 2021; 92:843-850. [PMID: 33215290 PMCID: PMC7676753 DOI: 10.1007/s11126-020-09859-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2020] [Indexed: 11/25/2022]
Abstract
Technology driven capacity building initiatives are the way to break the barrier of shortage of mental health human resources in India. This new path, while is a welcome step, comes with its own set of challenges. In one prototypic project that is being implemented in Ramanagara District of Karnataka, a south Indian state, we encountered many such issues. They ranged from issues related to availability of dedicated space to set up the hub-studio, inconsistent internet connectivity (particularly in remote areas) and inadequate digital literacy among the grassroot community health workers who hail from villages. This article summarises these challenges and ends by looking into ways and means of overcoming them.
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Affiliation(s)
- Barikar C Malathesh
- Department of Psychiatry, Community Psychiatry Unit, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, 560029, India
| | - Ferose Aziz Ibrahim
- Department of Psychiatry, Community Psychiatry Unit, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, 560029, India
| | - P Lakshmi Nirisha
- Department of Psychiatry, Community Psychiatry Unit, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, 560029, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, Community Psychiatry Unit, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, 560029, India.
| | - Prabhat Kumar Chand
- Department of Psychiatry, Community Psychiatry Unit, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, 560029, India
| | - Narayana Manjunatha
- Department of Psychiatry, Community Psychiatry Unit, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, 560029, India
| | - Suresh Bada Math
- Department of Psychiatry, Community Psychiatry Unit, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, 560029, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, Community Psychiatry Unit, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, 560029, India
| | | | | | - Shanivaram Reddy
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, 560029, India
| | - Sanjeev Arora
- The ECHO Institute, University of New Mexico, Albuquerque, NM, USA
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Venkatasubramanian G, Mehta UM, Goyal N, Praharaj SK, Umesh S, Muralidharan K, Thirthalli J. Clinical Research Center for Neuromodulation in Psychiatry: A Multi-Center Initiative to Advance Interventional Psychiatry in India. Indian J Psychiatry 2021; 63:503-505. [PMID: 34789940 PMCID: PMC8522609 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_1180_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 07/03/2021] [Indexed: 11/04/2022] Open
Abstract
This manuscript introduces a unique program titled "Clinical Research Center (CRC) for Neuromodulation in Psychiatry" supported by the prestigious CRC/Public Health Research Center Grant of the DBT Wellcome Trust India Alliance. This multi-institutional research program will be led by NIMHANS (Bengaluru) in collaboration with the Central Institute of Psychiatry (Ranchi), and Kasturba Medical College (Manipal). The goal of this CRC is in alignment with the editorial titled "Need to Develop "Interventional Psychiatry" as a subspecialty in India" published in the January 2020 issue of the Indian Journal of Psychiatry. The translational research studies and the training programs envisaged through this center will facilitate the development of cost-effective, advanced interventional psychiatry tailored to resource-limited Indian clinical settings and similar other countries as well.
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Affiliation(s)
- Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Nishant Goyal
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Samir Kumar Praharaj
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shreekantiah Umesh
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Kesavan Muralidharan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Angothu H, Philip S, Somanathan R, Reddy KS, Jayarajan D, Muliyala KP, Thirthalli J. Admission of persons with disabilities into nursing and midwifery courses: Progress made by the Indian Nursing Council. Indian J Med Ethics 2021; V:1-18. [PMID: 34018947 DOI: 10.20529/ijme.2020.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
India's Persons with Disabilities Act, 1995 (PWD Act, 1995) mandated a minimum enrollment reservation of 3% for persons with disability (PwDs) across all educational courses supported by government funding. Following this, the Indian Nursing Council (INC) issued regulations limiting such an enrollment quota to PwDs with lower limb locomotor disability ranging between 40%-50%. The Medical Council of India (MCI) also restricted admissions under the PwD category to PwDs with a lower limb locomotor disability to comply with the Act. The Rights of Persons with Disabilities (RPwD) Act, 2016, which replaced the PwD Act, 1995, raised the minimum reservation to 5% for all government-funded institutions of higher education and extended this reservation to PwDs under 21 different clinical conditions, rather than the seven conditions included under the PwD Act, 1995. Following the enactment of the RPwD Act, 2016, the MCI issued regulations that allowed PwDs with locomotor disability and those with a few other types of disabilities in the range of 40%-80%, to pursue graduate and postgraduate medical courses, while the INC has not made any changes. This article addresses the complexities of inclusion of PwDs in the healthcare workforce, offers suggestions for inclusive measures; and compares the INC admission regulation released in 2019 to the MCI 2019 admission guidelines for graduate and postgraduate medical courses.
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Affiliation(s)
- Hareesh Angothu
- Associate Professor of Psychiatry, NIMHANS, Bengaluru, 560 029 INDIA
| | - Sharad Philip
- Senior Resident in Psychiatric Rehabilitation Services, NIMHANS, Bengaluru, 560 029 INDIA
| | - Revathi Somanathan
- Doctoral Scholar in Psychiatric Rehabilitation Services, NIMHANS, Bengaluru, 560 029 INDIA
| | | | - Deepak Jayarajan
- Associate Professor of Psychiatry, NIMHANS, Bengaluru 560 029 INDIA
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Surve RM, Sinha P, Baliga SP, M R, Karan N, Jl A, Arumugham S, Thirthalli J. Electroconvulsive therapy services during COVID-19 pandemic. Asian J Psychiatr 2021; 59:102653. [PMID: 33845300 PMCID: PMC8022516 DOI: 10.1016/j.ajp.2021.102653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/05/2021] [Accepted: 04/05/2021] [Indexed: 12/14/2022]
Abstract
The COVID-19 pandemic has hit the electroconvulsive therapy (ECT) services hard worldwide as it is considered an elective procedure and hence has been given less importance. Other reasons include the risk of transmission of infections, lack of resources, and the scarcity of anesthesiologists due to their diversion to intensive care units to manage COVID-19 patients. However, ECT is an urgent and life-saving measure for patients diagnosed with depression and other severe mental illnesses who have suicidality, catatonia, or require a rapid therapeutic response. COVID-19 pandemic is a significant source of stress for individuals due to its impact on health, employment, and social support resulting in new-onset psychiatric illnesses and the worsening of a pre-existing disorder. Hence, a continuation of the ECT services during the COVID-19 pandemic is of paramount importance. In this narrative review, the authors from India have compiled the literature on the ECT practice during the COVID-19 pandemic related to the screening and testing protocol, necessity of personal protective equipment, modification in ECT Suite, electrical stmulus settings, and anesthesia technique modification. The authors have also shared their experiences with the ECT services provided at their institute during this pandemic. This description will help other institutes to manage the ECT services uninterruptedly and make ECT a safe procedure during the current pandemic.
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Affiliation(s)
- Rohini M Surve
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Preeti Sinha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
| | - Sachin P Baliga
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Radhakrishnan M
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Nupur Karan
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Anju Jl
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Shyamsundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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