|Year : 2019 | Volume
| Issue : 4 | Page : 256-257
|Date of Web Publication||15-Nov-2019|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Invited Lectures. Indian J Soc Psychiatry 2019;35:256-7
| Remove, rename or retain schizophrenia|| |
Department of Psychiatry (Retd), PGIMER, Chandigarh, India.
Kraepelin conceptualized “dementia praecox”as a severe mental disorder with onset in young age, progressive chronic course with eventual terminal defect state. Bleuler coined the term “schizophrenia” which replaced “dementia praecox” though its core remained as a chronic progressive mental disorder without any prospect of complete recovery. Since then, the term “schizophrenia”has been under criticism for being pejorative and stigmatizing term. The diagnostic uncertainty as well as lack of validity of diagnosis of schizophrenia have added to growing dissatisfaction with this term. A movement to abolish the term schizophrenia has gained momentum backed by social activists, anti-psychiatry diaspora and caregivers. Mental health professionals in many countries have also debated the issue of replacing schizophrenia with a more congenial term. Some countries viz. Japan have taken a lead to replace the term schizophrenia with some other term that is less offensive and more meaningful connotation and have shown benefits of such renaming. The presentation discusses a variety of issues related with this and the author is of the view that removing or renaming schizophrenia has considerable difficulties.
| Digital technology: Will it revolutionize mental health care|| |
Sudhir K. Khandelwal1,2
1Department of Psychiatry and Chief NDDTC, AIIMS (Retd),2Holy Family Hospital, New Delhi, India. E-mail: email@example.com
India has been going through a major transition seen in various walks of life; be it population demography, people's aspirations, economic and financial power at the national and individual levels, social indices, science and technology, and health including mental health indices. Two characteristics that define India of current times are the 'millennials' and 'digital technology'. Let us try to understand what exactly these two terms mean, and how they will influence mental health of our society, and how social psychiatry will play a major part in mental health care reaching all sections of the society.
India's demography has been playing a major role over last two decades in shaping India's status of a fast growing economy, and its likelihood of becoming a major superpower by 2030 or so. Nearly 45 percent of our population constitutes adult work force, and it will continue like this for next few decades. It is in this context that we should understand what defines millennial.
Similar to Millennial, Generation X, and the Baby Boomers have been in use for quite sometime to define populations. Broadly, Baby Boomers are considered those who were born between 1946-1964 and are now in the age varying 54-72 years old (it mostly applies to USA and Europe); Generation X are considered to be born between 1965-1980 and are approximately 38-53 years old; while Millennials are born between 1981-1996 and are in age group of 22-37 years. The term Millennials is usually considered to apply to individuals who reached adulthood around the turn of the 21st century.
Millennials grew up in an electronics-filled and increasingly online and socially networked world. They are the generation that has received the most marketing attention. As the most ethnically diverse generation, Millennials tend to be tolerant of difference. Having been raised under the mantra “follow your dreams” and being told they were special, they tend to be confident. While largely a positive trait, the millennial generation's confidence has been argued to spill over into the realms of entitlement and narcissism (https://whatis.techtarget.com/definition/millennials-millennial-generation).The Millennials may not share the same socio-culture values as their parents and grandparents did.
Millennials in India are growing in an era, where India has made rapid strides in the fields of industrialization, economy, and science and technology. Its GDP has been growing relentlessly, and it has already overtaken economy of many nations. It is believed in next one or two decades, it will rank among the top economic powers of the world. It is a nuclear power, has sent its space ships to the Moon and the Mars. Mobile and internet facilities are now available even in remote areas of the country. Its scientists, engineers, and doctors are in great demand all over the world. Yet, India's major social and health statistics, though improving, are still in deplorable stage. The same is true for the mental health problems, and their care at the community and national levels.
Not limited to the millennials, the Indian population now nurtures dreams of a better life, and has become more aspirational. It desires opportunities and services in improving its quality of life. Indian population is now becoming adapt in using modern means of telecommunication, internet services, social networking platforms, and is not scared of digital technology. These applications have helped people to remain contacted, and also to use them to ease their daily problems. Digital technology enables immense amounts of information to be compressed on small storage devices that can be easily preserved and transported. Digitization also quickens data transmission speeds. Digital technology has transformed how people communicate, learn, and work.Lately, digital technology has been finding greater application in the field of health and mental health also.
We all are aware of the revolution that technology has brought in medical sciences to improve our diagnostic research abilities in health in last few decades. Digital revolution has already changed our lives in ways that are difficult to comprehend. Intelligent processes create a virtuous cycle of constant improvement fed by continuous feedback. An intelligent process is studded with sensors that monitor every move and feed those observations into sophisticated models that allow people and software to make real-time adjustments and decisions. Digital technologies make it possible to identify opportunities for adaptation, analyze the factors of disease and health and then adapt faster and more efficiently in a way that is beneficial for the humans. It is amazing to realise the ease with which smart phones and internet have penetrated our personal and social lives even in low and middle income countries. Social networking and connectivity have already become part of our daily lives. Though concerns have been raised about problems like internet or cyber addiction, yet, digital revolution has opened new vistas to find solutions to many of health challenges. Terms like mHealth or eHealth are already now a common parlance of our language. Digital health care is now fast becoming a reality, not by desktops or laptops alone, but by all kinds of mobile devices like smart phones, notebooks etc.
Earlier experiences with use of information technology in health care including mental health care have been the use of websites, and webpages to provide information to general public about disorders and their availability of treatments. Soon, IT had been used to conduct online surveys. However, major breakthrough has come in form of assessment and interventions through the use of digital technology. It is now estimated that more that 75,000 articles have already been published in conventional journals or online journals. There are now dedicated journals on the subject. It is further estimated that nearly 32,000 mobile apps are now available for host of disorders.
However, the application of digital technology in delivering the mental health care has been relatively a new discovery. Some of common mHealth uses have been like to deliver services outside the clinic; to make assessments; advise on medicine adherence; to give timely advice on medicine, diet and exercises by prompting behavior towards desirable behaviours. It is estimated that such measures significantly reduce health delivery costs, improve administrative efficiency, and aid in research.
The use of physical exercises and fitness programmes have long been advocated in comprehensive management of common as well as severe mental health disorders. Thus, programmes like behavioural activation, activity scheduling, relaxation exercises, and biofeedback, preventing misinterpretation of normal physiological responses are now available as part of mHealth in smart phones or other hand-held devices.
Digital programmes have also been available now for assessment and screening procedures. For example, depression-screening instruments like PHQ-9, SAD, and PUSH-D are now available and used online. The alcohol web portal, developed by the National Drug Dependence Treatment Centre, AIIMS, New Delhi (www.alcoholwebindia.in) is a professionally managed web portal to provide information on alcohol, alcohol use, assessment, programme and policy. It also provides an online test to determine one's alcohol use.
Lately, a number of online interventions are also available, like, computer based psychotherapeutic modules, eCBT, IT aided relapse prevention programmes in schizophrenia, use of virtual reality for management of common mental disorders, or as an intervention in certain psychotic manifestations like delusions or hallucinations. Avatar Therapy is a new approach to the treatment of auditory hallucinations (hearing voices). Computer avatars are first designed by patients to give a form to the voices they hear and then therapists to encourage patients to oppose the voices so that the voices gradually come under the patient's control.
It can be safely concluded that in view of ballooning costs of health care, cost-effective interventions are the need of the hour. Digital technology has the potential of delivering health care at patient's doorstep. It is a boon in terms of cost and ease of delivery. More innovative tools and apps are required that are simple, but effective, and can be delivered on a broader scale. Some challenges, however, are anticipated. There may be some reluctance on part of clients as well as therapists, who may find adapting to new systems and technology a bit frightening. Therapists may be concerned about the security of their data and privacy breach. But these are not insurmountable. It is possible to apply checks and balances to overcome these concerns.
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