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  Citation statistics : Table of Contents
   2016| April-June  | Volume 32 | Issue 2  
    Online since April 25, 2016

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Stigma associated with mental illness: Conceptual issues and focus on stigma perceived by the patients with schizophrenia and their caregivers
Aakansha Singh, Surendra K Mattoo, Sandeep Grover
April-June 2016, 32(2):134-142
Among the various psychiatric disorders, schizophrenia is considered to be associated with high level of stigma. The stigmatizing experience is not only limited to the patients but is also experienced by their close relatives. This article reviews the conceptual issues in understanding stigma, mainly in relation to schizophrenia. Further, this article reviews the existing literature in terms of extent and correlates of stigma experienced by patients with schizophrenia and their close relatives. Stigma experienced by the patients can be categorized as public stigma and personal stigma. The personal stigma is further understood as perceived stigma, experienced stigma, and self-stigma. Stigma experienced by caregivers of patients with mental illness is called associative or courtesy stigma and affiliate stigma. A number of tools have been developed for assessment of stigma among patients with mental illnesses and their close relatives. Depending on the type of instrument used to assess stigma, the prevalence of stigma among patients with schizophrenia varied from 6% to 87%. Much of the literature on stigma in the patients with schizophrenia is from developed countries. There is limited literature from India and majority from Southern and Central part of the country. Stigma associated with schizophrenia is highly prevalent across regions and varies according to different sociodemographic and clinical correlates. The experience of stigma among patients of schizophrenia is influenced by the type and severity of psychopathology, insight, coping, causal beliefs, depression, social support, self-esteem, self-efficacy, and self-directness. Stigma influences medication compliance, quality of life, and social functioning. Research is scanty with regard to stigma perceived by caregivers of patients with schizophrenia. Besides the caregiver variables, different patient variables uniquely modify the stigma experienced by the caregivers. Different interventions may reduce the stigma experienced by patients and their caregivers. Studies evaluating stigma experienced by patients with schizophrenia and their caregivers suggest that stigma is highly prevalent among patients and their relatives. Data on correlates of stigma are limited. There is a need for further research on stigma for a better understanding of the concept so as to find ways to reduce it and prevent its adverse consequences.
  11 9,109 987
Validation of hindi version of internalized stigma of mental illness scale
Aakanksha Singh, Sandeep Grover, Surendra K Mattoo
April-June 2016, 32(2):104-114
Aims: To develop a Hindi translated version of the Internalized Stigma of Mental Illness (ISMI) Scale and evaluate its psychometric properties (test–retest validity, internal consistency, split half reliability, and cross-language equivalence), convergent validity and factor structure. Methodology: The study included 161 patients with severe mental disorders. Thirty-one patients were asked to complete the Hindi version of the ISMI Scale twice within a gap of 4–7 days. Another thirty patients were asked to complete the ISMI Hindi version followed by the English version after 4–7 days. Remaining hundred patients completed the Hindi version of ISMI Scale and Explanatory Model Interview Catalog (EMIC) Stigma Scale was administered by the interviewer at the same assessment. Results: Hindi version of ISMI Scale was found to have a good internal consistency (Cronbach's alpha was 0.863), split-half reliability (Spearman–Brown coefficient-0.661; Guttmann's split-half coefficient-0.645), test–retest reliability and cross-language equivalence for all the items and various domains with almost all the correlations and intraclass coefficients significant atP≤ 0.001, and convergent validity in the form of significant correlations with EMIC Stigma Scale. Factor analysis of the scale yielded five factors, which had significant overlap with the five domains of the scale described by the developer of the scale. Conclusions: The present study suggests that Hindi version of ISMI Scale developed as a part of this study has good psychometric properties.
  10 4,269 479
Stigma in dual diagnosis: A narrative review
Yatan Pal Singh Balhara, Arpit Parmar, Siddharth Sarkar, Rohit Verma
April-June 2016, 32(2):128-133
Stigma has been described as a mark of disgrace associated with a particular person, quality, or a circumstance. Persons with either psychiatric illness or substance use disorders, their family members, caregivers, as well as health professionals engaged in the management of these persons are subject to stigma. Interestingly, there is a high prevalence of substance use disorders among persons with psychiatric disorders and vice versa. However, only a limited literature has focused on stigma in the context of co-occurrence of psychiatric disorders and substance use disorders. The current review is aimed at the presentation of various aspects of stigma in the context of dual diagnosis of psychiatric disorders and substance use disorders. Findings on the published literature on stigma in the context of psychiatric disorders and substance use disorders have been examined separately to develop an understanding into the relevance and implication of addressing stigma in the context of dual diagnosis.
  3 4,820 354
Recovery among patients with severe mental illness: Factor analysis of recovery assessment scale in Indian setting
Sandeep Grover, Nandita Hazari, Neha Singla, Subho Chakrabarti, Jitender Aneja, Sunil Sharma, Ajit Avasthi
April-June 2016, 32(2):92-103
Aim: This study aimed to evaluate recovery among patients with severe mental disorders by using Recovery Assessment Scale (RAS). Additionally this study evaluated the, factor structure of RAS in the Indian setting, and assessed the correlates of recovery in severe mental illness. Methodology: Two hundred and eighty-five patients with severe mental illness (bipolar disorder-185 [BD], schizophrenia-100) currently in remission were recruited for the study. Clinical rating scales - Young Mania Rating Scale, Hamilton Depression Rating Scale, and Positive and Negative Syndrome Scale for Schizophrenia were used for assessing remission and residual symptoms. RAS was administered for recovery assessment. Results: Majority of the patients were married males belonging to urban background with no significant difference in sociodemographic profile of schizophrenia and BD groups. On factor analysis of RAS, all 41 items had loaded on one of the factors (compared to 24 items on the old factor structure). Five-factor were obtained with two factors - personal confidence and hope, goal and success orientation being similar to the old factor structure and three new factors being identified as awareness and control over the illness, seeking and relying on social support and, defeated/overcome the illness. Overall recovery measures were higher in BD group, and higher levels of residual depressive symptoms were associated with significantly lower level of recovery in BD. In the schizophrenia group, level of positive symptoms correlated negatively with goal and success orientation (as per the current analysis) and higher level of negative symptoms correlated positively with the domain of “reliance on others” as per the old factor structure. Conclusion: RAS follows a five-factor structure in Indian context, which is different than that reported in the previous study. There are few sociodemographic and clinical correlates of recovery.
  2 3,165 382
Quality of life of senior citizens: A Rural-Urban comparison
VK Usha, K Lalitha
April-June 2016, 32(2):158-163
Background: The experience of aging is unique to every individual because of the individual differences in personalities, varying social support network, and differing cultures to which one belongs. Quality of life (QOL) of senior citizens is greatly influenced by their previous lifestyle, culture, education, health care beliefs, family strengths, and integration into the communities. Aims: To assess the sociodemographic profile, QOL, and to compare the QOL of senior citizens in rural and urban areas. Methodology: Data were collected from 830 rural senior citizens and 120 urban senior citizens through multistage random sampling technique. The tools used in this study were sociodemographic data sheet and WHO QOL-BREF-26. Results: Majority of senior citizens belonged to the age group 65–75 years in rural (65.3%) and urban (65%) areas and majority were females (rural 61.4% and urban 66.7%). A major percentage (44.7%) of senior citizens in rural areas lived with their spouses and children, whereas 40% of them in urban areas lived with their children and 40% with their spouse and children. Majority of study subjects in rural (90.6%) and urban areas (97.5%) were not involved in any social activities. The senior citizens in urban areas showed better QOL than the senior citizens in rural areas. This was statistically significant in the overall perception of QOL, the overall perception of health, physical health, psychological health, and environment (P < 0.05). Conclusion: This study showed that QOL was poorer among senior citizens in rural areas. In India, the population of senior citizens is greater in rural areas where the health care facilities are minimal. Hence, policies and programs related to senior citizens should be launched in rural areas without neglecting the needs of urban senior citizens. Training of voluntary workers, health care professionals, and family members on the care of senior citizens should be implemented. QOL of senior citizens could be enhanced only with the support of family members.
  2 4,956 472
Menace of stigma in psychiatry
Sujata Sethi, Pankaj Sheoran, Suja Kurian
April-June 2016, 32(2):120-127
Despite major breakthroughs and advances in our knowledge about various psychiatric disorders, stigma toward psychiatry continues to prevail. The stigmatization of people with mental illnesses has been recognized by international agencies such as the World Health Organization and the World Psychiatric Association as an important public health and human rights problem. Individuals with mental illness are devalued and are treated unfairly by others because of their mental health condition. It is not only the general public that views psychiatry and psychiatrists negatively, but medical students, health professionals other than psychiatrists, families of patients and media also have similar views. These negative attitudes not only lead to delay in seeking professional help for the patients but also discriminate against patients and their families, and hinder in the deserved placement of patients in the society. All these further adversely affect the outcome of psychiatric disorders. This symposium addresses these issues as well as measures to combat and prevent stigmatization of patients with psychiatric disorders.
  2 3,139 258
Stigma toward psychiatric disorders: What can we do about it?
Siddharth Sarkar, Varghese P Punnoose
April-June 2016, 32(2):81-82
  1 1,917 412
From one substance dependence to another: Are gateway violations common?
Siddharth Sarkar, Naresh Nebhinani, Sunil Gupta, Preeti Parakh, Debasish Basu
April-June 2016, 32(2):171-173
Objectives: This study aimed to assess the progression from one substance dependence to another in a sample of treatment-seeking substance users. Materials and Methods: The present cross-sectional study was based on a consecutive sample of patients with substance use disorder attending a de-addiction service in North India. Information was gathered about the demographic details and substance use pattern from the patient, family members, and previous records using a structured questionnaire. Results: Two hundred seventy-three patients out of 406 consecutive participants were dependent on more than one substance of abuse (67.2% of the sample). Most of the subjects were male, married, employed, and of urban background. In this sample of 273 patients, the substance of first dependence in descending order of frequency was tobacco, opioids, alcohol, and cannabis. Of those patients who had become dependent on opioids, it was the initial substance of dependence among 51.3%. Conclusion: Initial dependence to illicit substances without progressing through “gateway” of alcohol and nicotine dependence can occur due to socio-cultural influences. Knowing the sequence of dependence to substances can help design focused preventive measures.
  1 1,485 113
Depression and coping mechanism among HIV/AIDS patients under anti-retroviral therapy
Salma Kaneez
April-June 2016, 32(2):149-153
Background: HIV infection owing to its chronic course and the associated stigma often results in emotional reactions of a serious nature among the people infected with the illness. Depression is the most common psychiatric syndrome in HIV patients found by various studies. Prevalence rate of depression reported in India among HIV sero-positive individuals is as high as 47%. Symptoms of depression may lead to nonadherence to anti-retroviral therapy (ART) and consequent poorer health. Unfortunately, more than half of the HIV-positive population that suffer from depression have not received official diagnosis of their depression. Objective: The aim of this study was to examine the level of depression and relationship between depression and coping styles among HIV-infected people. Sample: About 30 HIV/AIDS patients receiving ART were assessed for depression and coping strategies they used to deal with the illness. Measures: Beck Depression II inventory and Brief Cope Scale were used for data collection. Results and Conclusion: Findings indicate severe to extreme level of depression among people receiving medical treatment. Although women reported slightly higher level of depression than men, no significant gender difference was observed. Women preferred religion, ventilation, and support coping more than men. A significant positive correlation was observed between depression and avoidant coping (r = 0.505, P< 0.001). Results underline the need to incorporate mental health services as an integral part of HIV/AIDS routine health care.
  1 4,033 412
Psychosocial issues in an unknown mentally ill: The journey to discover professional self-actualization and more…
Shikha Tyagi
April-June 2016, 32(2):83-91
This case describes my journey with a homeless mentally ill patient who was suffering with schizophrenia, and how it taught me what chronic mental illness means and what kind of social issues are associated with mental illnesses. It has also given me new insights into the community rehabilitation of unknown mentally ill persons; which I have tried to demonstrate through my real-life experiences of working with two sisters suffering with schizophrenia.
  - 2,214 224
Workshop on management of “Difficult to Treat” serious mental illnesses using problem-based learning approach
Mamta Sood, Nitin Gupta
April-June 2016, 32(2):174-176
The patients with “difficult to treat” serious mental illnesses (SMIs) pose a significant challenge for practitioners. A workshop was conducted during Annual National Conference of Indian Association for Social Psychiatry, Kolkata, November 2013 using “problem-based learning” approach focusing on the management of “difficult to treat” SMIs. The problem was presented in the form of paper-based case vignette. This format for the workshop was reported to be useful by the participants.
  - 1,392 104
Influence of psychiatric comorbidity on the treatment process of type 2 diabetic patient
Rohit Sharma, Hetal Amin, PK Prajapati
April-June 2016, 32(2):177-178
  - 1,304 218
Screening for harmful alcohol use with the alcohol, smoking, and substance involvement screening test in clients recruited from workplace settings of a Tertiary Care Hospital of North India
Jaison Joseph, Karobi Das, Debasish Basu, Sunita Sharma
April-June 2016, 32(2):164-166
Background: World Health Organization developed the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) as the first screening test for rapidly detecting the harmful use of all major psychoactive substances. However, epidemiological research on substance use screening using ASSIST in Indian populations is limited. Aims and Objectives: To screen for harmful alcohol use in the Indian workplace settings using ASSIST. Subjects and Methods: In this cross-sectional study, 162 class C employees were randomly screened in their workplace settings from a tertiary care hospital based on the criteria of ASSIST. Results: The study found that nearly one-fourth (24.06%, n = 39) of the total participants as moderate and high-risk users of alcohol as per ASSIST scores. In addition, one-fifth (19.74%, n = 32) of the total participants used both alcohol and tobacco in moderate or high-risk manner. Conclusion: The results of the study indicate the alarming magnitude of harmful alcohol use in workplace settings and advocate that ASSIST is an important screening tool for detecting harmful substance use in this population.
  - 1,845 193
Pilot translation of the social skills improvement system questionnaire among Indian children
Sreeja De, Triptish Bhatia, Vishwajit L Nimgaonkar, Smita N Deshpande
April-June 2016, 32(2):167-170
Background: Many developmental and mental disorders significantly impair the ability of children and adolescents to successfully function in society. Among several scales evaluating social performance, the Social Skills Improvement System by Gresham and Elliot evaluates the social functioning of children from ages 3 to 18 years. It has three forms per child - to be filled in by the child himself/herself, by the parent and the teacher. Each form has 75, 79, and 83 items, respectively, assessed on a four-point system. Methodology: The present study aimed at translating and validating this scale on a small pilot sample of parents and child only (n = 21). The Cronbach alpha of the Hindi forms was estimated. Intraclass correlation between each item of the original and translated versions of the scale was examined. Results: For the parent form, Cronbach alpha was 0.9, and for the student form, it was 0.8. The maximum correlation was present in the parent form (40% of items). Self-scoring forms by children correlated 23% of the time between the Hindi and English versions. Conclusion: Significant correlation was not seen between the original and translated versions. Possible reasons are discussed.
  - 2,057 144
Characteristics of opioid drug users in an Urban Community Clinic
Sonali Jhanjee, Hem Sethi
April-June 2016, 32(2):154-157
Background: Community-based treatment program is an approach for the treatment of opioid users that aims to engage, retain, and provide treatment to some of the most marginalized and hardest to reach populations in order to reduce the harms of continued opioid use. Aims: To describe the demographic and clinical characteristics of opioid drug users from a community clinic for opioid drug users in a metropolitan city of India. Methods: Oral substitution treatment with buprenorphine for opioid-dependent drug users was being carried out through a community clinic located in an urban resettlement colony in Delhi. The information on 104 opioid users attending the clinic was gathered by self-report on the drug abuse monitoring system questionnaire and a brief semi-structured proforma. Results: Majority of opioid-dependent (mainly heroin) drug users were male (97.1%) and most were married (58.7%). Around 33% were illiterate, and a large number (42%) were presently unemployed. Heroin was the primary drug of abuse in majority of the patients (97%). The mean age of initiation of opioid use was 20.3 ± 7.3 years and mean duration of opioid use 10.8 ± 8.9 years. Around 67.3% had a history of injecting drug use, while 49% were still injecting drug in the last 1 month. The highest rates of injecting drug use were among those who were between the ages of 18 and 25 years, unmarried, having some education, employed, and living in nuclear families. The significant risk factors for injection drug user (IDU) were being unmarried (odds ratio [OR] = 3.6, confidence interval [CI] = 1.2–10.9) and having sex with sex workers (OR = 2.9, CI = 1.4–7.7). A highly significant linear relationship was found between the number of risk factors and IDU. Conclusions: Studying the characteristics of opioid drug users and injectable drug use among people who use opioids will help to define treatment and preventive interventions.
  - 1,803 127
A study of experiences of stigma and discrimination in patients with schizophrenia and bipolar mood disorder
Smruti S Karambelkar, Bharat Navinchandra Panchal, Ashok Ukabhai Vala
April-June 2016, 32(2):143-148
Objectives: To study the experiences of stigma and discrimination among Schizophrenia and bipolar mood disorder (BMD) patients and to find if any difference in them is present. Materials and Methods: 50 patients diagnosed as BMD and Schizophrenia and in remission for at least 3 months were interviewed by a semi-structured scale. The verbatim was then analyzed qualitatively. Results: Eighty-six percent (86%) patients experienced stigma. Schizophrenia and BMD patients did not differ in their experiences of stigma proving that the tag of mental illness was stigmatizing enough and had no relation to the duration or intensity of illness. The major themes emerging out of the qualitative analysis showed that most of the patients experienced stigmatizing experiences at home with family members which included shame and ridicule, belittlement of opinion. At work place, inability to hide illness lead to change of job or been considered inept to carry out responsibility. Sixty percent (60%) believed that stigma could not be eradicated. On ways to combat stigma, most patients believed that adequate rehabilitation and an assertive attitude on the part of patients was most likely to work. Conclusions: Despite having longer remissions and a milder course than Schizophrenia, BMD patients experienced as much stigma as Schizophrenia patients.
  - 3,043 262
Stigma toward psychiatric disorders - National and International perspectives
Roy Abraham Kallivayalil, Arun Enara
April-June 2016, 32(2):115-119
  - 3,719 335