ABSTRACTS OF THE 26TH NATIONAL CONFERENCE OF IASP, BHUBANESHWAR
Year : 2019 | Volume
: 35 | Issue : 4 | Page : 259--282
|How to cite this article:|
. Symposia.Indian J Soc Psychiatry 2019;35:259-282
|How to cite this URL:|
. Symposia. Indian J Soc Psychiatry [serial online] 2019 [cited 2021 Aug 5 ];35:259-282
Available from: https://www.indjsp.org/text.asp?2019/35/4/259/271109
S 1: Assessment and management of childhood sexual abuse
Prahbhjot Malhi, Bhavneet Bharti
Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India. E-mail: [email protected]
To know about the prevalence of CSA in India To understand the difference between normative and abnormal sexual behaviors in young children To learn about evaluation and management techniques of CSA.
Topics and Speakers
Introduction to childhood sexual abuse (CSA): Dr. Prahbhjot Malhi.
Assessment of CSA: Dr. Prahbhjot Malhi.
Management of CSA and Protection of Children from Sexual Offences (POCSO) Act: Dr Bhavneet Bharti.
The symposium is designed to enhance skills and expertise of psychiatrists and other child care service providers on recognizing the physical and behavioral signs, diagnosing and management of childhood sexual abuse cases. Sessions will be interactive and clinical cases managed by the presenters in their clinical practice will be presented. Topics covered will include defining child sexual abuse, short and long-term impact of early abuse, learning to differentiate between normative and abnormal sexual behavior in children, use of screening tools and projective techniques to assess and diagnose. Management of children using therapies such as Trauma Based Relational Intervention (TBRI) will also be discussed. The symposium will conclude with a discussion about Mandatory reporting under the Protection of Children from Sexual Offences (POCSO) Act.
Introduction to Childhood Sexual Abuse: Sexual abuse is any sexual contact between a child and an adult, or using a child for sexual purposes. It's often done by someone the child knows and trusts. Prevalence of CSA in India is rampant and in a national level survey conducted in all the states of India the overall prevalence was reported to be 53% (53% boys; 47% girls). Nearly one-fourth (22%) of the cases were for severe sexual abuse (sexual assault, making child fondle private parts, making child exhibit self, photographed in nude). One-third (31%) cases were of mild sexual abuse (forcible kissing, rubbing private parts on child, exposure to pornographic materials). Majority of the children did not report the matter to anyone. CSA is shrouded in secrecy and spreading awareness among mental health workers is important given the short and long term consequences of CSA.
Assessment of Childhood Sexual Abuse: The presentation will highlight use of screening tools and projective techniques to assess and diagnose children who present with acute behavioral symptoms. The childhood sexual abuse inventory is the most commonly used and it provides several sub domain scores and a sexual abuse score. The participants will be taught how to use and score it.
Management of Childhood Sexual Abuse and Protection of Children from Sexual Offences Act: Children who face abuse, neglect and trauma often experience psychological, behavioral, and academic issues. Trust-Based Relational Intervention (TBRI) is a therapeutic model that trains caregivers to provide effective support and treatment for at-risk children. TBRI has been applied in orphanages, residential treatment facilities, clinics, and schools. The presentation will highlight how the 3 principles of TBRI including Empowerment (attention to physical needs), Connection (attention to attachment needs) and Correction (attention to behavioral needs) were applied to cases of CSA who presented to the department of pediatrics at PGIMER, Chandigarh. The talk will conclude with the importance of mandatory reporting of CSA under the Protection of Children from Sexual Offences (POCSO) Act.
Irish L, Kobayashi I, Delahanty DL. Long-term physical health consequences of childhood sexual abuse: A meta-analytic review. J Pediatr Psychol 2010;35:450-61. Krishnakumar P, Satheesan K, Geeta MG, Sureshkumar K. Prevalence and spectrum of sexual abuse among adolescents in Kerala, South India. Indian J Pediatr 2014;81:770-4. Singhi P, Saini AG, Malhi P. Child maltreatment in India. Paediatr Int Child Health 2013;33:292-300. Purvis KB, Cross DR, Dansereau DF, Parris SR. Trust-based relational intervention (TBRI): A systemic approach to complex developmental trauma. Child Youth Serv 2013;34:360-86.
S 2: Digital psychiatry: Can it increase the reach of psychiatry?
Vikas Menon, S. K. Kar1, Naresh Nebhinani2, Suravi Patra3
Department of Psychiatry, JIPMER, Puducherry,1?Department of Psychiatry, KGMU, Lucknow, Uttar Pradesh,2Department of Psychiatry, AIIMS, Jodhpur, Rajasthan,3Department of Psychiatry, AIIMS, Bhubaneswar, Odisha, India. E-mail: [email protected]
Topics and Speakers
Digital interventions for caregiver population: Vikas Menon.
Online Psychotherapy: Evidences so far: S. K. Kar.
Challenges with online consultation in psychiatry: .NareshNebhinani.
Apps for self-assessment and monitoring in psychiatry: Relevance: Dr.Suravi Patra.
The utility of digitalization in psychiatric care Feasibility and challenges of online therapeutic interventions in psychiatry.
Over past few decades, digitalization became a trend across the globe. Digitalization involved all sectors including entertainment, education, journalism, finance, transport, defence as well as health. Digitalization attempted to connect various sectors of the world in one thread. Due to digitalization, information reaches every corner of the world within fraction of time. Digitalization has brought revolution in medicine in terms of education and learning, investigation, consultation and intervention. Digitalization has brought services to the doorstep of people, who were deprived of consultation and care due to scarcity of manpower. This symposium attempts to focus on impact of digitalization in psychiatric care. The speakers, will be highlighting on impact of digitalization on different dimensions of mental health care.
Digital Interventions for Caregivers: A substantial proportion of people worldwide are in the business of informal (unpaid) caregiving to people with mental illness (PMI). As we continue to devise better and safer treatments for PMI, it is equally important to recognize the growing needs and demands of informal caregivers (family and friends), whose unpaid efforts contribute substantially to the economy and society. Consequently, caregiving has rightly been viewed as a public health priority. As the health and well-being of caregivers is directly linked to their caregiving abilities, a range of health interventions have been piloted and tested for their effects on physical and mental health of caregivers. Digital interventions, aimed at promoting caregiver knowledge and coping strategies, offer the dual advantage of being resource effective and less stigmatizing. This segment of the symposium will provide an overview of digital interventions for caregivers of PMI such as mobile apps, web-based psychoeducation, e-bulletins and online self-help groups. It is hoped that a better understanding of these will spur further research in this area to develop locally relevant interventions that will have good acceptance, optimal engagement and, eventually, better caregiver outcomes.
Online Psychotherapy: Evidences so far: There is gross scarcity of human resources in mental health care in majority of the developing countries and undeveloped countries, which adversely affect the mental health delivery. Over past few decades, digitalization has taken a pivotal role in revolutionizing medicine. Due to scarcity of manpower in mental health, a large section of the society is deprived from mental health care. Psychotherapy, which is a highly effective and essential treatment modality in management of psychiatric disorders; however it needs a lot of expertise. Hence, the paucity of experts can be tackled by adopting online mode for delivering psychotherapy. It has found to be an effective mode to delivery psychotherapy. The presentation will focus on evidences of online psychotherapy.
Challenges with Online Consultation in Psychiatry: In addition to ease of online consultation, there are several challenges with online mental health treatment. Specific concerns are related to confidentiality, professional training, licensure issues, availability of appropriate communication devices, internet access and speed. Liability concerns also exists with regard to the client safety especially in case of sole online delivery of mental health treatment without any face to face contact session for persons with self-harm ideas or attempts. Sometime 'clients' misinformation' also causes issues when clients provide false information due to lack of face-to-face sessions and lack of family or key informants. Unsupervised chat room and unregulated online forums also increase the risk for vulnerable individuals. Other challenges are related to obtaining informed consent, boundary regulation, comprehensive evaluation, timely referral, appropriate selection (of therapist and clients) and proper termination of therapy, along with patients' mental health literacy, health professionals' technological literacy, and integration with other modalities of mental health treatment. Clinicians should stay abreast of current trends, challenges, and possible solutions for technology related issues in digital psychiatry.
Relevance of Apps for Self-Assessment and Monitoring in Psychiatry: The advent of digital technology has made delivery of mental healthcare possible in all places and times by overcoming geographical, time-zone and organizational barriers. It has made patients more active participants their mental healthcare. Apps are software designed for a particular purpose and optimized to run on mobile devices. Many wellness and health apps are publicly available designed to deliver heath related evaluations, monitoring and interventions. There are apps for suicide prevention bipolar disorder, major depressive disorder and tobacco cessation. Few app-based interventions have been developed for delivery of mental healthcare to children and adolescents. Though acceptable, these apps are yet to be ascertained for safety, efficacy and tolerability. App-based mental healthcare delivery is in infancy and much work needs to be done before these can be adapted in routine service-delivery as evidence- based approaches. This symposium would discuss about apps available for mental healthcare delivery, barriers in implementation and suggestions for way ahead.
Keywords: Digitalization, mental health, tele-consultation, telemedicine
Paul PK, Chatterjee D, Ghosh M. Medical information science: Emerging domain of information science and technology (IST) for sophisticated health & medical infrastructure building-an overview. Int Sci J Sport Sci 2012;1:97. Wells M, Mitchell KJ, Finkelhor D, Becker-Blease KA. Online mental health treatment: Concerns and considerations. Cyberpsychol Behav 2007;10:453-9.
S 3: Specific learning disabilities: Assessment, intervention and challenges
Samita Sharma, Manju Mohanty, Adarsh Kohli1
Departments of Neurosurgery and1Psychiatry, PGIMER, Chandigarh, India. E-mail: [email protected]
Topics and Speakers
Identification and Assessment of Specific Learning Disabilities – Ms. Samita Sharma.
Intervention strategies in Specific Learning Disabilities – Dr. Manju Mohanty.
Issues and challenges in Specific Learning Disabilities - Dr. Adarsh Kohli.
Identifying, screening and assessing Specific Learning Disabilities Remediation and intervention strategies for helping children with Specific Learning Disabilities (SLDs) Use of latest technologies and digital applications in intervention of SLDs Throwing light on the various issues and challenges faced by psychologists and psychiatrists while dealing with the cases of SLDs Discussing various issues pertaining to assessment, certification, government policies, relaxation by education boards, stigma, parental perceptions, lack of special educators etc.
Specific learning disability is a developmental disorder which causes impairment in reading, writing, spellings and arithmetic skills. It affects about 5%–17% of school-going children. If remains unrecognized, it results in poor academic performance, failure and dropping out of school. These children are more likely to develop low self-esteem, anxiety, depression and becoming withdrawn or aggressive. They are also at risk to be indulging in anti-social activities. Hence it is essential to identify these children, make an accurate diagnosis and plan appropriate management. Comprehensive assessment is the key to accurate diagnosis. It requires a detailed assessment of reading, writing, spelling, mathematics, comprehension skills, neuropsychological functioning and behavioral problems. Selection of appropriate tests becomes a challenge in the face of varied socio-economic status, medium of instructions and languages. Management involves treatment of any emotional and behavioral problems and planning individualized remedial strategies incorporating the strengths and deficits of these children. Awareness should be created for setting up of resource rooms, employing special educators and use of latest technologies and digital applications to facilitate learning in schools. Besides these, the issues pertinent to assessment, concept, labelling, certification, knowledge, attitude, and perception of teachers and parents needs special attention. In the present symposium an attempt will be made to impart knowledge about assessment and intervention and also will highlight the challenges faced.
Identification and Assessment of Specific Learning Disabilities: The first presenter will introduce the topic, will elaborate on how to identify and screen students in the classroom. Detailed assessment for establishing the diagnosis will be explained. It shall include assessing areas like reading, writing, comprehension, mathematics and neuropsychological functions.
Intervention Strategies in Specific Learning Disabilities: The second presenter will talk about the various remediation techniques and intervention strategies that can be adopted by the teachers and parents to help the child overcome the learning difficulties. Use of latest technology and digital applications in improving the learning skills of children with SLDs will also be discussed.
Issues and Challenges in Specific Learning Disabilities: The third presenter will throw light on the various challenges faced at different levels while dealing with SLDs. Problems faced while dealing with these children and their parents, dilemma while issuing certificates will be discussed. Various issues related to assessment, certification, government policies, relaxation by education boards, stigma, parental perceptions, lack of special educators etc. will be highlighted.
Keywords: Applications, assessment, disability, issues, learning, technology
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington D.C.: American Psychiatric Association; 1994. Karande S, Bhosrekar K, Kulkarni M, Thakker A. Health-related quality of life of children with newly diagnosed specific learning disability. J Trop Pediatr 2009;55:160-9. Bradford J. Using Multisensory Teaching Methods. Dyslexia Online Magazine; 2000. Available from: http://www.dyslexiaparent.com/mag30.html. [Last accessed on 2006 Apr 25]. Ahmad FK. Assistive provisions for the education of students with learning disabilities in Delhi schools. Indian J Fundam Appl Life Sci 2015;2:9-16.
S 4: Internet based interventions in tobacco cessation
Sonali Jhanjee, Gaurishankar Kaloiya, Dheeraj Kattula
National Drug Dependence and Treatment Centre, All India Institute of Medical Sciences, New Delhi, India. E-mail: [email protected]
Titles of Sub-Topics
Sonali Jhanjee: Scope and rationale of internet based tobacco cessation interventions.
Gaurishankar Kaloiya: Components of internet based intervention.
Dheeraj Kattula: Effectiveness of internet based tobacco cessation.
To gain conceptual knowledge of the innovative internet based interventions in tobacco cessation To learn about the effectiveness of such interventions and compare them with established tobacco cessation treatments.
Tobacco use is a global pandemic and the largest cause of preventable death worldwide. It is predicted that tobacco use will be responsible for more than 8 million deaths worldwide per year by 2030 if effective interventions are not implemented. An innovative way to tackle the global burden of smoking could be to increase the accessibility of cessation programs across all tobacco users. A broad internet base of users confers an advantage and has the advantage of making cessation interventions more accessible and cost effective. Internet-based interventions that include text messages, email messages or a combination of the two have been shown to help adults quit smoking. Among others components may include high- versus low-depth tailored success story, outcome expectation, and efficacy expectation messages. A Cochrane review of 67 RCTs from trials in adults suggests that interactive and tailored Internet-based intervention are moderately more effective than controls at six months or longer. However some of the studies were at high risk of bias, and for most outcomes the quality of evidence was moderate or low. The review did not find evidence that these interventions were better than other active smoking treatments. The evidence base of internet based interventions in youth needs to be expanded. Further high-quality research may be needed to inform the effectiveness internet-based intervention.
Scope and Rationale of Internet Based Tobacco Cessation Interventions: Tobacco use is a global pandemic and the largest cause of preventable death worldwide. It is predicted that tobacco use will be responsible for more than 8 million deaths worldwide per year by 2030 if effective interventions are not implemented. An innovative way to tackle the global burden of smoking could be to increase the accessibility of cessation programs across all tobacco users. A broad internet base of users confers an advantage and has the advantage of making cessation interventions more accessible and cost effective as compared to face to face interventions. Internet-based interventions that include text messages, email messages or a combination of the two have been shown to help adults quit smoking. Internet-based interventions van be extended to include pharmacotherapies such as nicotine replacement therapy (NRT).
Components of Internet Based Intervention: Components of internet based interventions may vary widely in terms of basic components add on treatment elements like pharmacotherapy and the extent of individual tailoring. Internet-based tobacco cessation interventions provide information, techniques of quitting, or behavioral support to assist tobacco users who want to quit. Such interventions include websites, computer programs, or other electronic aids. Among others components may include high- versus low-depth tailored success story, outcome expectation, and efficacy expectation messages. Interventions may rely solely on internet technology or include components such as in-person counseling, pharmacotherapy (e.g., nicotine replacement therapy (NRT)), remote counseling, or text messaging.
Effectiveness of Internet Based Tobacco Cessation: Evidence in adults suggests that interactive and tailored Internet-based interventions may be slightly more effective than usual care or printed self-help at six months or longer. These interventions delivered with additional behavioural support were more effective than non-active controls but were not better than active smoking cessation treatments even with additional behavioural support. Most of the studies were done on adults so it is unclear if these can be similarly effective in adolescents. There remains a requirement for higher-quality studies, adequately powered and reporting bioverified smoking cessation, with at least six months follow-up. More trials aimed at younger smokers (i.e. 25 years and younger) and studies done in LMIC nations are needed to bridge the knowledge gap about the effectiveness of Internet interventions.
Keywords: Addiction, internet based intervention, tobacco cessation
Taylor GM, Dalili MN, Semwal M, Civljak M, Sheikh A, Car J. Internet-based interventions for smoking cessation. Cochrane Database Syst Rev 2017;9:CD007078. Chen YF, Madan J, Welton N, Yahaya I, Aveyard P, Bauld L, et al. Effectiveness and cost-effectiveness of computer and other electronic aids for smoking cessation: A systematic review and network meta-analysis. Health Technol Assess 2012;16:1-205, iii-v.
S 5: Physicians' burnout: Do we need to think about it now?
Aseem Mehra, Swapnajeet Sahoo, Sandeep Grover
Department of Psychiatry, PGIMER, Chandigarh, India. E-mail: [email protected]
Topics and Speakers
How common it is and what is the concept of burnout: Speaker: Dr. Aseem Mehra.
What causes it and what are the outcomes: Speaker: Dr. Swapnajeet Sahoo.
What can be done: Speaker: Prof. Sandeep Grover.
Concept of burnout among physicians Assessment and management strategies.
There is a growing evidence of increased prevalence of psychological problems (stress, depression, anxiety, and substance abuse) and feelings of burnout among medical professionals all over the world and this has been shown to be associated with lapses in patient care. Various factors such as increased patient load, low doctor-patient ratio, poor communication skills, long duty hours etc. among medical professionals have been proved to be associated with burnout among medical professionals across all streams. At present there is abundant literature to suggest burnout in doctors lead to a wide range of psychological problems (stress reactivity, poor sleep quality, fatigue, anxiety, depression, more prone to substance abuse/use, suicide), behavioral problems (such as poor anger control, more prone to internet addiction and other forms of behavioral addiction) and treatment errors. Several barriers exist for seeking help related to burnout and mental health issues. In this symposium, we will be focusing on these three areas related to burnout among medical professionals and how mental health professionals can help their colleagues or themselves from being burnout.
How Common is It and Concept: Multiple studies have shown that one-third of physicians experience burnout at several points throughout their careers. It is suggested that burnout begins to cultivate its seeds during the medical schooldays, continues throughout the residency period, and finally matures in the daily life of practicing physicians. Studies suggest that the prevalence of burnout among residents varies from 50% to 76%, depending on the specialty. It has been found that burnout is more often seen in trauma surgeons, urologists, otolaryngologists, emergency physicians/surgeons, vascular and general surgeons, and young professionals having children.
What Causes It and what are the Outcomes: Factors associated with burnout include working for more than 60 h/week and having more on-call duties per week (>2 nights/week) are consistently reported. Existing literature on the psychological problems faced by medical practitioners is limited to few nationwide surveys and some specific hospital surveys reporting about 27% of the sampled physicians scored in the clinical range of depression, increased incidence of severe psychological distress along with a 2-fold increased incidence of suicidal ideations in physicians compared with the general population. Indian studies have reported that about one-third of the resident doctors experience stress. Medical professionals get prone to addiction to various substances and develop substance-use disorders.
What Can be Done? There are several issues related to assessment and evaluation of burnout among medical professionals, main barriers being stigma, confidentiality issues, lack of awareness, and fear of unwanted intervention to be the major barriers for seeking help related to mental health issues. Handling stress, promoting and practicing positive mental health, yogic relaxation exercises and multiple paradigms have been explored and have been found to be beneficial in management of burnout issues in physicians.
Keywords: Burnout, mental health of physicians, physicians
Romani M, Ashkar K. Burnout among physicians. Libyan J Med 2014;9:23556. Shanafelt TD. Enhancing meaning in work: A prescription for preventing physician burnout and promoting patient-centered care. JAMA 2009;302:1338-40. Saini NK, Agrawal S, Bhasin SK, Bhatia MS, Sharma AK. Prevalence of stress among resident doctors working in medical colleges of Delhi. Indian J Public Health 2010;54:219-23. Menon V, Sarkar S, Kumar S. Barriers to healthcare seeking among medical students: A cross sectional study from South India. Postgrad Med J 2015;91:477-82. Grover S, Sahoo S, Bhalla A, Avasthi A. Psychological problems and burnout among medical professionals of a tertiary care hospital of North India: A cross-sectional study. Indian J Psychiatry 2018;60:175-88.
S 6: Internet addiction: Current understanding and management
Manoj Kumar Sahoo, Harshita Biswas, Nidhi Chauhan1
Department of Psychiatry, Tata Main Hospital, Jamshedpur, Jharkhand,1Department of Psychiatry, GMCH, Chandigarh, India. E-mail: [email protected]
Topics and Speakers
Dr Nidhi Chauhan: Understanding internet addiction, internet gaming disorder, other associated terminology & concepts, the DSM 5 criteria & epidemiology.
Ms Harshita Biswas: Aetiology related to internet addiction and assessment tools.
Dr Manoj Sahoo: Management of internet addiction & comorbidities.
Better understanding and management of patients with internet addiction.
Although the term Internet addiction was given by Goldberg in 1996, the psychologist Young K., (1998) is credited with the first published case report on Problematic internet use (PIU). Several studies attributed impulsivity as a central feature of PIU and so close to pathological gambling. Various models are proposed to explain PIU as a behavioural addiction. The models will be discussed in the presentation. Several scales that are used to assess internet addiction will be discussed. Various psychotherapies have been found effective in the management of Internet addiction, the various forms of psychotherapy along with pharmacological management will be discussed in this presentation.
Understanding Internet Addiction, Internet Gaming Disorder, Other Associated Terminology and Concepts, the DSM 5 Criteria and Epidemiology: Although the term Internet addiction was given by Goldberg in 1996, the psychologist Young is credited with the first published case report on Problematic internet use (PIU). Problematic internet use (PIU), has been variously described in literature as “internet addiction” and “pathological internet use' in which an individual's inability to control his or her internet use causes marked distress and/or functional impairment. PIU has several potential dangers associated with it. The epidemiology will be discussed in detail.
Aetiology Related to Internet Addiction and Assessment Tools: Several studies attributed impulsivity as a central feature of PIU and so close to pathological gambling. Various models are proposed to explain PIU as a behavioural addiction. Cognitive behavioural model, by Davis, neuropsychological model, neurobiological model, Compensation theory & Situational factors will be discussed. Several scales, internet Addiction test, diagnostic interview of internet addiction for adolescents etc will be discussed.
Management of Internet Addiction and Comorbidities: Various psychotherapy has been found to be effective in treating internet addiction. Cognitive–behavioural therapy, family therapy and other psychotherapies will be discussed. Pharmacological options for treating internet addiction will also be discussed. Excessive use of the internet can become associated with various psychiatric disorders, so the comorbid conditions and its management will be discussed.
Keywords: Internet addiction, internet gaming disorder, problematic Internet use, psychotherapy
Young KS, Internet addiction: The emergence of a new clinical disorder. Cyberpsychol Behav 1998;1:237-44. Davis RA. A cognitive-behavioral model of pathological internet use. Comput Hum Behav 2001;17:187-95. Tao R, Huang X, Wang J, Zhang H, Zhang Y, Li M. Proposed diagnostic criteria for internet addiction. Addiction 2010;105:556-64. Ko CH, Yen JY, Chen CC, Chen SH, Yen CF. Proposed diagnostic criteria of internet addiction for adolescents. J Nerv Ment Dis 2005;193:728-33. Goldsmith TD, Shapira N. Problematic internet use. Clin Man Impulse Control Disord 2006:291-308.
S 7: Nimhans digital academy: Expanding access to effective care in mental health and substance abuse
Prabhat Kumar Chand, Karishma, Aurobind
NIMHANS, Bengaluru, Karnataka, India. E-mail: [email protected]
Titles and Speakers
NIMHANS Digital Academy: Evolution and Scope: Prabhat.
VKN Addiction ECHO: Ms. Karishma.
Evaluation and Outcome: Mr. Aurobind.
Application of Digital Technology to empower Primary health providers inevidence-based practices for mental health and substance use management Development of Community of Practice by using ECHO model.
Recent National Mental Health Survey 2016 reported a treatment gap of >85%.This demands an urgent need to build sufficient capacity and capabilities, especially in rural and underserved areas. For a country like India, with ubiquitous smartphone and cost-effective 4G, Digital platforms can be used to exponentially increase the skilled human resources. Since 2014, NIMHANS in collaboration with Project ECHO (Extension of Community Mental Health), UNMUSA has been involved in training, telementoring, and handholding by using the HUB and SPOKES model by using simple smartphone-based digital technology. This has helped to build skilled capacity in addiction at the beginning and later to mental health also across the country as well as for the states of Chhattisgarh, Bihar, Uttarakhand, Karnataka, and Odisha. NIMHANS Digital Academy (NDA),inaugurated by Honourable Minister for Health and Family Welfare, has helped to consolidate and expand the tele-activities initiated at NIMHANS throughout the country. Since the past 4 years of this technology-enabled learning and capacity building, more than >6000 health providers could be connected and >2L lives have been touched in the area of mental health and addictive disorders. In last one year, >4000 health providers expressed interest in this digital accreditation programme for doctors, psychologists, Social workers and Nurses and >400 already accredited with Diploma in Community Mental health. Innovating pedagogy to tele-mentor Primary health care professionals to provide quality care for mental health and substance abuse in the remotest parts of India by leveraging technology as a tool to bridge two major gaps between professionals & evidence based practices; and underserved individuals & quality care. Between January to July 2019, Foundation of Addiction Management ECHO program was held for 133 primary health care providers (PCPs). This program consisted of 28 weekly Hub and Spokes tele-ECHO clinics and 108anonymized cases discussed by the spokes with the Hub Multidisciplinary specialists team. The case discussion was followed by a brief didactic from experts. The Hub team facilitated the peer-led discussion with the objective of learning the best practices in Addiction management. At the end of six months, 95% reported increased understanding in the areas of withdrawal management, brief counseling and prescribing anti-craving drugs. The PCPs reported seeing >20000 patients with substance use infographic.
S 8: Involvement of accredited social health activists workers in community based rehabilitation for persons with severe mental illness and as gatekeepers for suicide prevention
T. Sivakumar, M. Krishna Prasad
Department of Psychiatry, Psychiatric Rehabilitation Services, NIMHANS, Bengaluru, Karnataka, India. E-mail: HYPERLINK “mailto:[email protected]” [email protected]
Topics and Speakers
Involvement of ASHA workers in community based rehabilitation for persons with severe mental illness: Practical experience from Jagaluru taluk in Karnataka (Dr T Sivakumar) 20 minutes Gatekeepers for suicide prevention: Can ASHA workers play a crucial role? Dr Krishna Prasad M (20 minutes).
Understand role of ASHA workers in National Health Mission Involvement of ASHA workers in mental health: Opportunities and challenges Practical experience of working with ASHA workers at Jagaluru taluk, Karnataka Involvement of ASHA workers as gatekeepers for suicide prevention.
One of the grand challenges in mental health is to “provide effective and affordable community-based care and rehabilitation” and “develop effective treatments for use by non-specialists, including lay health workers with minimal training”. A rural community based rehabilitation (CBR) project is being run at Jagaluru Taluk over last 5 years in partnership with Government (NIMHANS, Government of Karnataka), NGO (Association of People with disability, Chittasanjeevini charitable trust and The Live Love Laugh Foundation), corporates (Infosys which funds CSCT) and local community to deliver community based rehabilitation for persons with mental illness in the taluk.
In India, Accredited Social Health Activists (ASHAs) are literate female health workers selected from the local community. They are honorary volunteers and are financially compensated (ranging from Indian Rupee 1 – 5000) depending on the task. ASHAs play an important role in maternal and child health. ASHAs are trusted as source of health information and referral in their communities. They form the backbone of public health system. There is limited literature on their involvement in mental health programmes. To scale up mental health services in resource constrained settings, there is a need to train ASHAs about mental illness. In the symposium, we shall share practical experience of involving ASHA workers in community based rehabilitation of persons with severe mental illness at Jagaluru taluk (Davanagere district, Karnataka) and deliberate on involving them as gatekeepers for suicide prevention in rural communities.
1.Involvement of ASHA Workers in Community based Rehabilitation for Persons with Severe Mental Illness: Practical Experience from Jagaluru Taluk in Karnataka: Dr Sivakumar T
In the presentation, we will share practical experience of involving ASHA workers in community based rehabilitation of persons with severe mental illness at Jagaluru taluk. The ground realities, issues to be considered and way forward will be discussed.
2.Gatekeepers for Suicide Prevention: Can ASHA Workers Play a Crucial Role? Dr Krishna Prasad M
In the presentation we will share the experience of involving ASHA workers as Gatekeepers for suicide prevention in the community drawing from the Sikkim-NIMHANS SPAN project. The practical opportunities and challenges in this process will be shared and discussed.
Keywords: Accredited social health activist workers, community based rehabilitation, gatekeepers, rural, severe mental illness, suicide prevention
S 9: Sex in mind: Dealing with young people
S. K. Kar, Deblina Roy, Saumya Ranjan Mishra, Adarsh Tripathi
Department of Psychiatry, KGMU, Lucknow, John Snow International, Bhubaneswar, Odisha, India. E-mail: [email protected]
Topics and Speakers
Cross-cultural variations in sexuality: S. K. Kar,
Sexuality in young people: issues and conflicts: Deblina Roy.
Demographics and clinical presentation of sexual difficulties in Youths: Saumya Ranjan Mishra.
Principles and practices in sexual health: Adarsh Tripathi.
To make the audience familiar with common sexual difficulties in Indian context To focus on the Indianized approach to sexual health.
Sexuality colours the whole life of a person, it is an detachable part of the personality. Thus the development of sexuality is influenced by the social structures and beliefs in their immediate community. India, world's 2nd largest populated country, with the largest number of youth population also has unique patterns of sexual health and illnesses. There is essentially a difference between the western countries perspectives of sexual health and demand of sexual health care in India. There sexual health concerns in India are more related to culture bound syndromes like Dhat Syndrome, erectile dysfunction and masturbation guilt etcetera (Singh et al., 2018). There are demographic differences as well compared to the western countries. The main consumer of health care services related to sexual health in India is the youth. There is difference in the socio- demographic variables regarding the Initiation of sexual activities and the understanding of their requirement are key points for mental health professionals to cater to their needs. The sociocultural construct of India demands mental health professionals to bring about culturally competent and individualized sexual health services to suit their needs in the best possible ways.
Cross-cultural Variations in Sexuality: Sexuality is an important domain of life. Relevance of sexuality is not limited to reproduction; it is an essential determinant of recreation as well as developing and retaining a relationship. Globally, there are gross variations in the culture. Culture influences sexuality significantly. There are differences in the perception and expression of sexuality, globally. Cultural evolution and transformation is not happening in equal pace in every corner of the world, which might be responsible for variations in sexuality. The scientific literature that is commonly referred to, for clinical practice in sexual medicine is mostly developed by the western world, which focuses more on the western culture. The typical Indian patients with sexual difficulties with significant cultural myths related to sexuality need to be understood in the light of Indian context. This presentation will focus on differences in the concepts of sexuality between western model and Indian model.
Sexuality in Young People: Issues and Conflicts: India Has the highest amount of young people in the world (world population report, 2019) and majority of them are adolescents. Initiation of sexual behaviour has been found to be majorly linked to their age. From the beginning of adolescence people start exploring their sexual behaviours and then they encounter various developmental changes in their bodies. Indian Society is largely conservative about sexuality so the most common sources of information are peer group, movies, videos and currently internet. This exposes them to non-expert knowledge and high risk sexual behaviours. This developing sexuality puts them at a risk for HIV and Sexually transmitted diseases (Sujita Kumar Kar, Choudhury, & Singh, 2015). The temperament of the individual also decides their ability to portray themselves sexually. Introverts usually are less confident in approaching, there may be contributing anxiety, and predetermined social construct towards sexual activities, and this contributes to the development of sexual maladjustments in their lives.
Demographics and Clinical Presentation of Sexual Difficulties in Youths: Sexual health has been a less researched area in the Indian public health context, few studies have dealt with the estimation of the prevalence of sexual disorders (Singh et al., 2018). According to a recent study in rural population, 81% of men had reported some sexual health concern, almost 65% had reported semen related anxiety (Dhat Syndrome). 20% reported that they had libido issues and almost 20% also had masturbation related guilt feelings. The main medical conditions associated were reported to be Diabetes, substance use, and hypertension. Another study reported that a mong the rural Indian population the common to go for treatment are Hakims (traditional healers) often there is reluctance to report sexual health problems (Thangadurai P, Gopalakrishnan R, Kuruvilla A, Jacob KS, Abraham VJ, Prasad J, 2014). The main factors identified regarding sexual problems was high levels of stress, financial distress, substance use ,clinical and subclinical levels of depression and anxiety, most of their sexual problems could be solved by the treatment of their underlying disease conditions.
Principles and Practices in Sexual Health: Sexual health is one of the of important aspects of health. Sexual relationship building starts developing from young adolescence and continues to grow and develop throughout the life. The Indian culture is a conservative culture, where there are a lot of taboos and reservations about even asking regarding sexual problems. This creates a challenge for treatment of such conditions. Indian researches need to be conducted to regarding treatment designs suited to Indian contexts (Singh et al., 2018). The treatment challenges commonly faced in India are due to the widespread misinformation prevalent regarding sexual problems often they have been found to worsen the associated comorbidities and facilitate cognitive distortions among patients. These issues need to be addressed with practices rooted in evidence tailored to Indian needs.
Burke L, Nic Gabhainn S, Kelly C. Socio-demographic, health and lifestyle factors influencing age of sexual initiation among adolescents. Int J Environ Res Public Health 2018;15. pii: E1851. Kar Sujita K, Tripathi A. Positive sexual development. In: Shackelford TK, Weekes-Shackelford VA, editors. Encyclopedia of Evolutionary Psychological Science. 2018. p. 1-3. Binnie J. Globalization, sexuality. In: The Blackwell Encyclopedia of Sociology. 2007. Guilamo-Ramos V, Soletti AB, Burnette D, Sharma S, Leavitt S, McCarthy K. Parent-adolescent communication about sex in rural India: U.S.-India collaboration to prevent adolescent HIV. Qual Health Res 2012;22:788-800.
S 10: Addressing violence in the perinatal period: Emphasis on intimate partner violence and obstetric violence
Madhuri H. Nanjundaswamy, Shubhangi Dere1, S. Lakshmi
Department of Psychiatry, NIMHANS, Bengaluru, Karnataka,1Department of Psychiatry, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India. E-mail: [email protected]
Topics and Speakers
Assessment of Intimate partner violence in the perinatal period- Madhuri H N.
Management of Intimate partner violence in the perinatal period- Shubhangi Dere.
Obstetric violence - impact on maternal mental health – Lakshmi S.
To understand IPV in perinatal mental health settings; its impact on mother and foetus /child, risk factors, assessment of IPV, barriers in assessment and screening tools Prevention, intervention and safety planning in women with IPV during the perinatal period. Focus on LIVES approach and legal implications Obstetric violence - impact on maternal mental health, assessment and prevention.
Background: Intimate partner violence (IPV) is a global public health and human rights problem that causes physical, sexual and psychological harm. The highest prevalence is during reproductive years. There can be maternal and foetal effects due to the impact of IPV. It may contribute to serious pregnancy complications, unintended pregnancy, sexually transmitted infections, psychological distress in pregnancy and postpartum, poor mother-baby bonding and poor overall development in the child. In limited research describing the effectiveness of the intervention strategies in IPV, few described are home visitation programs, supportive counselling, empowerment counselling, LIVES approach etc.) There might be various legal implications in this context. Obstetric trauma is one of the main predictors of traumatic childbirth experience in women and many times goes unidentified. The extreme consequences of this denial of access to good quality medical care and inhumane treatment are psychological problems like postnatal PTSD and depression, refusal to attend hospital-based care, avoidance of subsequent pregnancies, poor mother-infant bonding and in some cases death due to neglect ., The sessions will focus on addressing the topics in detail with the presentation of relevant data. Case-based presentations and audio-visual aid are planned.
Assessment of Intimate Partner Violence in the Perinatal Period: The prevalence of P IPV in developing countries is very high. In India, IPV during pregnancy is 13% - 28% (Peedicayil et al., 2004; Khosla et al., 2005). The WHO has used an ecological framework which highlights that IPV results from the interaction of many factors at four levels: individual, relationship, community, and societal level. There can be maternal and foetal effects due to the impact of IPV. There can be a wide range of physical health sequelae, high rates of psychiatric illness -depression 40 %, PTSD 19-84%, substance use disorders, suicidal risk. The foetal effects like low birth weight, preterm birth, neonatal mortality has been noticed. Considering this high prevalence and the serious impact of IPV, it becomes very necessary to assess and intervene with women who are experiencing IPV.
Management of Intimate Partner Violence in Perinatal Period: Antenatal care presents a unique window of opportunity for the reproductive health care workers who can foster trusting relationships with pregnant women, thereby increasing the likelihood of IPV detection and reducing its negative consequences. Importantly, for many women, pregnancy is the only time they maintain regular contact with health care providers (at least 8 visits in the perinatal period) further highlighting the need to form a trusting patient-provider relationship. Sensitisation among the health care providers for screening for IPV in the prenatal period is essential. Nevertheless, just screening and identification of IPV is not useful if one is not aware of the interventions to carry on with the suffering woman. A lot remains unclear about which interventions should be adopted due to lack of awareness and training on the basic interventions and legal implications with IPV. In limited research describing the effectiveness of the intervention strategies in IPV, few described are home visitation programs, supportive counselling, empowerment counselling, LIVES approach etc.). There is a need to develop a support system focused on several levels simultaneously (individual, relations, community, and society). Intervening in a single risk factor may be unsuccessful because other risk factors may persist as barriers to the desired change. “Universal screening” or “routine enquiry” (i.e. asking all women at all health-care encounters) about IPV is not recommended. However, the WHO guidelines identify ANC as a setting where routine enquiry could be implemented if providers are well trained on a first-line response and minimum requirements are met.
Obstetric Violence: Impact on Maternal Mental Health: Childbirth has been reported to be traumatic by almost 1/3rd of women. Apart from the physical pain, the woman has to endure during labour, the professional services offered to her during the process can sometimes add to the trauma if adequate care is not given. Obstetric violence rates are reported to be as high as 70-90% across countries including India. Various forms of obstetric violence such as abuse, neglect, lack of privacy and non-consented services have been described. Such trauma inflicted to a woman during labour can not only cause her psychological distress but can also impair mother-fetal bonding, avoidance of subsequent pregnancies and maternal mortality in rare cases. A study done in our centre among women in the postpartum period reveals OV up to 70 % and its associated with significant psychological distress like PTSD and depression.
Keywords: Intimate partner violence, obstetric violence, perinatal period
Van Parys AS, Verhamme A, Temmerman M, Verstraelen H. Intimate partner violence and pregnancy: A systematic review of interventions. PLoS One 2014;9:e85084. Stewart DE, Vigod SN, MacMillan HL, Chandra PS, Han A, Rondon MB, et al. Current reports on perinatal intimate partner violence. Curr Psychiatry Rep 2017;19:26. Fairbrother N, Woody SR. Fear of childbirth and obstetrical events as predictors of postnatal symptoms of depression and post-traumatic stress disorder. J Psychosom Obstet Gynaecol 2007;28:239-42. Bhattacharya S. Silent voices: Institutional disrespect and abuse during delivery among women of Varanasi district, Northern India. 2018:1-8. Stewart DE, Chandra PS. WPA international competency-based curriculum for mental health providers on intimate partner violence and sexual violence against women. World Psychiatry 2017;16:223-4. Bowser D, Hill MP. Exploring Evidence for Disrespect and Abuse in Facility-Based Childbirth Report of a Landscape Analysis; 2010. WHO Reproductive Health Library. WHO Recommendation on the Method for Clinical Diagnosis of Intimate Partner Violence in Pregnancy. Geneva: World Health Organization, the WHO Reproductive Health Library; 2016.
S 11: Role of family therapy in substance use disorder
Gauri Shanker Kaloiya, Rachana Bhargava,
B. N. Subodh, Aniruddha Basu1
Department of Psychiatry, AIIMS, New Delhi,1Department of Psychiatry, AIIMS, Rishikesh, Uttarakhand, India.
E-mail: [email protected]
Topics and Speakers
Introduction and Overview: Gauri ShankerKaloiya.
Details of Assessment: Rachana Bhargava.
Evidence base of efficacy Subodh BN.
Conclusion and future directions: Aniruddha Basu.
Principles of assessment of family therapy Evidence base: comparison with other modes Future directions.
Family therapy is one of the most effective among the psychotherapies for management of substance use disorders. It is particularly effective for adolescents and in the Indian context where family is an integral part of ones' life. Different schools of thought for example structural model, systemic model have tried to influence family therapy. Family therapy in general requires detailed assessment of the family structure, communication patterns in the specific socio-cultural milieu. Among the different types of family therapy, multidimensional family therapy has one of the best evidence of efficacy. Alcohol use disorders have been most researched – though there is evidence in all substance use disorders. Also the different modes of therapies needs to be modified in view of different cultural milieu. A recent attempt by UNODC in this context in appreciable. However, such cultural adaptation needs to be tested and validated in different cultures for its maximum efficacy.
Introduction and Overview: The different schools and application in substance use disorders will be discussed. Details of Assessment – Detailed modes of assessment and principles ranging from coercive techniques to systemic modality will be discussed.
Evidence Base of Efficacy: Most evidence is or multidimensional therapy in adolescents though more research is needed.
Conclusion and Future Directions: cultural adaptation and need for innovation in different cultures is required.
Keywords: Culture, family, substance use
Kumpfer KL, Alvarado R. Family-strengthening approaches for the prevention of youth problem behaviors. Am Psychol 2003;58:457-65. Liddle HA, Dakof GA, Parker K, Diamond GS, Barrett K, Tejeda M. Multidimensional family therapy for adolescent drug abuse: Results of a randomized clinical trial. Am J Drug Alcohol Abuse 2001;27:651-88.
S 12: Domestic violence and mental health in digital age
Gagan Hans, Vaibhav Patil, Ragul Ganesh
Department of Psychiatry, AIIMS, New Delhi, India. E-mail: [email protected]
Topics and Speakers
Cyber Violence: A changing paradigm of Domestic Violence and Mental Health: Gagan Hans.
Impact of cyber violence on children and adolescents: Vaibhav Patil.
Effective legislation, Care givers response and support for victims of Online abuse: Ragul Ganesh.
Discussion of newer challenges in domestic violence and its impact on the mental health of the victims especially women and children.
The world in which domestic abuse is perpetrated is changing, but domestic abuse persists at worrying levels. Perpetrators of domestic abuse now routinely use technology and social media to control and instil fear in those they victimise. The online world is frequently used as a vehicle for coercive control, giving perpetrators more opportunities to monitor, humiliate, threaten and abuse. This puts the vulnerable population especially women and children at risk of developing significant mental health problems. In addition, today's children and adolescents are immersed in both traditional and new forms of digital media. Risks of such media include negative health effects on sleep, attention, and learning; a higher incidence of obesity and depression; exposure to inaccurate, inappropriate, or unsafe content and contacts; and compromised privacy and confidentiality. Online abuse must be recognised by the Government, judiciary and all relevant agencies as a harmful form of domestic abuse and violence against females and children. The crime must be sanctioned robustly, without blaming victims. Policies, strategies, training and awareness-raising on domestic abuse and coercive control by Government, statutory agencies and support services – including specialist domestic abuse services – must routinely cover the nature and impact of online abuse, and highlight the extent of the overlap between offline and online forms of the crime. Specialist services and practitioners have a critical role in supporting victims, raising awareness and gathering evidence and expertise, preventing further harm, and supporting long-term safety and recovery – both on and offline.
Cyber Violence: A Changing Paradigm of Domestic Violence and Mental Health: The world in which domestic abuse is perpetrated is changing, but domestic abuse persists at worrying levels. Perpetrators of domestic abuse now routinely use technology and social media to control and instil fear in those they victimise. The online world is frequently used as a vehicle for coercive control, giving perpetrators more opportunities to monitor, humiliate, threaten and abuse. Online abuse must be recognised by the Government, judiciary and all relevant agencies as a harmful form of domestic abuse and violence against women and girls. The crime must be sanctioned robustly, without blaming victims.
Impact of Cyber Violence on Children and Adolescents: Today's children and adolescents are immersed in both traditional and new forms of digital media. Over the past decade, the use of digital media, including interactive and social media, has grown, and research evidence suggests that these newer media offer both benefits and risks to the health of children and teenagers. Risks of such media include negative health effects on sleep, attention, and learning; a higher incidence of obesity and depression; exposure to inaccurate, inappropriate, or unsafe content and contacts; and compromised privacy and confidentiality.
Effective Legislation, Care Givers Response and Support for Victims of Online Abuse: Policies, strategies, training and awareness-raising on domestic abuse and coercive control by Government, statutory agencies and support services – including specialist domestic abuse services – must routinely cover the nature and impact of online abuse, and highlight the extent of the overlap between offline and online forms of the crime. Staying safe online can be difficult, and is particularly challenging for women vulnerable as a result of domestic abuse and coercive control. Specialist services and practitioners have a critical role in supporting victims, raising awareness and gathering evidence and expertise, preventing further harm, and supporting long-term safety and recovery – both on and offline.
Keywords: Cyber violence, mental health, online abuse
Women's Aid, Tackling Domestic Violence in a Digital Age, A Recommendations Report on Online Abuse by the All-Party Parliamentary Group on Domestic Violence (Bristol: 2017). Available from: http://1q7dqy2unor827bqjls0c4rn-wpengine.netdna-ssl.com. Reid Chassiakos YL, Radesky J, Christakis D, Moreno MA, Cross C; Council on Communications and Media. Children and adolescents and digital media. Pediatrics 2016;138. pii: e20162593.
S 13: Suicide among health care providers
Karobi Das, Sunita Sharma
National Institute of Nursing Education, PGIMER, Chandigarh, India. E-mail: [email protected]
Topics and Speakers
Suicide among health care providers: Karobi Das.
Measures for Suicide Prevention among health care providers: Sunita Sharma.
To assess the stressors among the health care professionals To be able to overcome their stress and difficult situations in their professional life through remedial measures.
Suicide is currently a major public health issue. Every 40 seconds a person commits suicide somewhere in the world. Although the physical health of the health care providers is better than average, they are at significantly higher risk of mental illness and suicide than the general population. The risk factors could be long hours of work, access to dangerous means and toxic work place culture. The problem is magnified as medical practitioners may be reluctant to seek help for their own mental health issues.
Suicide among Health Care Providers: Suicide is currently a major public health issue. Every 40 seconds a person commits suicide somewhere in the world. Although the physical health of the health care providers is better than average, they are at significantly higher risk of mental illness and suicide than the general population. The risk factors could be long hours of work, access to dangerous means and toxic work place culture. The problem is magnified as medical practitioners may be reluctant to seek help for their own mental health issues. Measures for Suicide Prevention among Health Care Providers: The symposium will not only seek to discuss the growing menace of suicide among doctors, nurses and other health care providers but also offer preventive measures, which could help to mitigate this problem. Identification of mental health problems and offering emotional support through counseling, yoga, meditation etc. will help them out to bounce back to take up professional responsibilities.
Keywords: Health care professionals, remedial measures, stress, suicide
Bailey E, Robinson J, McGorry P. Depression and suicide among medical practitioners in Australia. Intern Med J 2018;48:254-8. Petrie K, Crawford J, Baker STE, Dean K, Robinson J, Veness BG, et al. Interventions to reduce symptoms of common mental disorders and suicidal ideation in physicians: A systematic review and meta-analysis. Lancet Psychiatry 2019;6:225-34. Davidson JE, Proudfoot J, Lee K, et al. Nurse suicide in the United States: Analysis of the centre for disease control 2014 national violent death reporting system data set. Arch Psychiatr Nurs 2019. [In press].
S 14: Digital media and self harm in adolescents: Clinical scenarios and management
Suravi Patra, Sujit Kumar Kar1, Swapnajeet Sahoo2
AIIMS, Bhubaneswar, Odisha,1KGMU, Lucknow, Uttar Pradesh,2PGIMER Chandigarh, India. E-mail: [email protected]
Topics and Speakers
Digital media & Self-Harm in adolescents - Is there a link?: Speaker: Suravi Patra.
Management perspectives: Speaker: Sujit Kumar Kar.
Can Digital media help in Suicide Prevention in adolescents?: Speaker: Swapnajeet Sahoo.
Link between digital media use and self-harm in adolescents, how to manage, possible role of digital media in suicide prevention.
The recent years have seen the upsurge of social media and digital media use among the adolescents. It is now well-evident that digital media can act as a double-edge sword in causing various psychological stress as well as being used as a platform to promote awareness and reducing psychological problems. Self-harm behaviours have been well-associated with digital media use among adolescents. There can be a host of factors ranging from cyber-bullying, peer relationship, social modeling, impulsivity, novelty seeking etc. At the same time, various psychological interventions have been designed to help the adolescents through digital media to prevent self-harm and discuss their psychological problems in an online platform. The symposium will focus upon establishing the link between digital media and self-harm among adolescents, how to approach and handle a adolescent with self-harm attempt and suggest possible ways in which digital media can be helpful in preventing self-harm.
Digital Media and Self-Harm in Adolescents: Is there a Link? Globally 13-18% of adolescents engage in DSH behaviours by way of cutting, scratching, hitting self, biting, consuming overdose of medications. These behaviours are more of manifestation of communication of pain and distress rather than a cry for help. Varying reasons of DSH have been cited in literature ranging from depression to Manchausen By Internet. Media presentation of this behaviour is taking the form of a menace as it is inciting other adolescents. There is a need to better understand this phenomenon for the psychiatrist of the digital age to be able to help society at large.
Management Perspectives: Growing evidences support the possible links between self-harm behaviour of adolescents with digital media. There are ample of literature which guides the management of self-harm in adolescents; however, there is paucity of guidelines which can direct the clinician in managing self-harm behaviour in the context of digital media use. The presentation will focus on goals of management in digital self-harm with evidence supports.
Can Digital Media Help in Suicide Prevention in Adolescents? Social media platforms are commonly used for the expression of suicidal thoughts and feelings, particularly by adolescents. However, digital media can be used as a medium to promote awareness among the adolescents and to develop preventive strategies to avoid self-harm. Social media platforms can reach large numbers of otherwise hard-to-engage individuals, may allow others to intervene following an expression of suicidal ideation online, and provide an anonymous, accessible and non-judgmental forum for sharing experiences. Various psychological interventions have been developed in western countries using digital media platform to help self-harm victims. However, there are also various challenges to meet in order to develop digital media as a suicide prevention tool.
Keywords: Adolescents, digital media, digital self-harm, self-harm, suicide
Robinson J, Hill NT, Thorn P, Battersby R, Teh Z, Reavley NJ, et al. The #chatsafe project. Developing guidelines to help young people communicate safely about suicide on social media: A Delphi study. PLoS One 2018;13:e0206584. Jacob N, Scourfield J, Evans R. Suicide prevention via the internet: A descriptive review. Crisis 2014;35:261-7. Patchin JW, Hinduja S. Digital self-harm among adolescents. J Adolesc Health 2017;61:761-6.
S 15: Suicidal behavior in current scenario
Bichitra Nanda Patra, Rohit Verma, Siddharth Sarkar, Vaibhav Patil
Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India. E-mail: [email protected]
Topics and Speakers
Suicidal behavior in adolescent population: Bichitra Nanda Patra.
Suicide in psychosis: Rohit Verma.
Suicides and substance use disorders: An interface: Siddharth Sarkar.
Suicide preventive measures: Indian context: Vaibhab Patil.
To discuss the magnitude and risk factors of suicide in psychosis, substance use disorder and adolescent population To discuss various measures to prevent the suicidal behavior in above population groups.
Suicide is an important public health concern. It has been estimated that there are more than one lakh suicidal deaths in India in a year. The numbers of suicide attempts are far more than the number of actual suicidal death. The causes and risk factors for suicidal attempts vary across the age group and across illness profiles. This symposium discusses the suicidal behavior in terms of the magnitude and vulnerability factors, and the measures that can be taken to reduce the overall extent of suicidal behavior. The general introduction of the terminology and epidemiology of suicidal behavior would be followed by specific risk groups and risk factors. The suicidal behavior among child and adolescent population would be discussed, laying emphasis on the community impact of such a behavior in terms of morbidity, health-care aspects and mortality. The characteristics of suicidal behavior among patients with severe mental illnesses would be discussed subsequently, along with the management approaches. Thereafter, the role of substance use and substance use disorders in the suicidal behavior would be discussed, along with the measures that can be taken to reduce the influence of substances on suicidal attempts. Finally, the possibility of suicide prevention programme, its components and roll out processes and the possible outcome measures would be discussed.
Suicidal Behavior in Adolescent Population: As per the UNICEF 2011, the adolescent population in India constitutes a quarter of the country's population which is approximately 243 million which in turn constituted 20% of the world's 1.2 billion adolescents. They are at the crossroads between losing out on the potential of a generation or nurturing them to transform the society. Most mental disorders begin during youth i.e. between 12-24 years of age. Poor mental health is strongly related to lower educational achievements, substance abuse, violence, and self-harm. Suicide is the second leading cause of death for adolescents 15 to 19 years old. A 15-year-old individual in India had a cumulative risk of about 1·3% of dying before the age of 80 years by suicide. Deliberate self harm which is an important risk factors for suicide can start as early as 11 years of age. Some of the risk factors associated with suicidal behavior in this age group are depression, hopelessness, dysfunctional families, substance abuse, school failure and harassment. In recent years due to technological revolution there is easy access of young people to internet, social media through smart phones which exposes them to violent and sexual content which also causes peer pressure affecting their mental health. As adolescents are at a distinct phase of development, the findings from young adults can't be extrapolated to adolescents. In the presentation we will discuss issues specific to the adolescent suicidal behaviours.
Suicide in Psychosis: Psychosis is characterized by distorted thinking and perception and tends to run a chronic course. Individuals with psychosis experience personal distress and socio-occupational dysfunction and reduced life expectancy as a group. studies report that male gender and being unmarried are associated with an increased risk of suicide among individuals with schizophrenia. The presence of depression is also attributed with an increased risk of suicidality. An association between insight into the illness, a consequent feeling of hopelessness, and increased risk of suicide has also been a consistent finding. In contrast the role of schizophrenia subtype in suicidal risk remains controversial. The impact of specific pharmacological agents and non-pharmacological interventions on the suicidal behaviour of individuals with psychosis is yet to be fully explored by robust research.
Suicides and Substance Use Disorders: An Interface: Substance use disorders have been found to be associated with self-harm behavior and suicides. Though many substances have been associated, much literature has accrued on alcohol as a proximate antecedent to self-harm attempt and completed suicides. It has been speculated that alcohol lead to disinhibition which results in the individual unable to control the act of self-harm. Additionally, substance use disorders may impair the judgement and lead to occurrence of self-harming behaviour. Substance use disorders are themselves associated with other mental health conditions like depression and different life stressors, which may increase the likelihood of suicides. This part of the symposium would focus upon the link of suicides and self-harming behaviours with substance use and their disorders. The presentation would also deal with the considerations for managing suicidal behavior in patients who have substance use disorders.
Suicide Preventive Measures: Indian Context: Suicide is a major public and mental health problem in India. As per WHO, current rate of suicide in India is 16.3 per 1, 00,000 population as compared to 10.6 global average. India's share to global suicide deaths is high and increasing in recent years. Suicide being a preventable cause of death, there is need to implement effective suicide prevents measure to reduce it. There are two approaches to prevent suicide, mainly individual based approaches (treatment of mental illness, counselling etc.) and population based approaches (means restriction, education of the public, telephone helplines etc.). Clinicians should search for evidence based suicide prevention interventions and their effectiveness for practice. The presentation would highlight important suicide preventive measures in Indian context.
Keywords: Adolescents, alcohol, prevention, schizophrenia, self harm
Banwari GH, Vankar GK, Parikh MN. Comparison of suicide attempts in schizophrenia and major depressive disorder: An exploratory study. Asia Pac Psychiatry 2013;5:309-15. Bohnert KM, Ilgen MA, Louzon S, McCarthy JF, Katz IR. Substance use disorders and the risk of suicide mortality among men and women in the US Veterans Health Administration. Addiction 2017;112:1193-201. Jakhar K, Beniwal RP, Bhatia T, Deshpande SN. Self-harm and suicide attempts in schizophrenia. Asian J Psychiatr 2017;30:102-6. Kleiman EM, Glenn CR, Liu RT. Real-time monitoring of suicide risk among adolescents: Potential barriers, possible solutions, and future directions. J Clin Child Adolesc Psychol 2019:1-3. Shain B; Committee on Adolescence. Suicide and suicide attempts in adolescents. Pediatrics 2016;138. pii: e20161420. Too LS, Spittal MJ, Bugeja L, Reifels L, Butterworth P, Pirkis J, et al. The association between mental disorders and suicide: A systematic review and meta-analysis of record linkage studies. J Affect Disord 2019;259:302-13. World Health Organization. World Health Statistics Data Visualizations Dashboard: Suicide. World Health Organization; 2017.
S 16: Medical termination of pregnancy beyond 20 weeks: Deliberations for a social psychiatrist in modern times
Susanta Padhy, Ruchita Shah1, Akhilesh1
Department of Psychiatry, AIIMS, Bhubaneswar, Odisha,1Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India. E-mail: [email protected]
Topics and Speakers
Context and need to appraise ourselves: Susanta Padhy.
MTP beyond 20 weeks in case of a rape survivor (including POCSO cases: Ruchita Shah.
MTP beyond 20 weeks in case of fetal anomaly: Akhilesh.
Key Learning Objectives
At the end of the symposium the participants would be
Aware of the current MTP Act and its caveats (from perspective of a psychiatrist) Cognizant of Court-directed permanent medical boards for the purpose of MTP beyond 20 weeks and guidelines given by the Government of India. Aware of the role of a psychiatrist in following cases-
MTP beyond 20 weeks in case of a rape survivor (including POCSO cases) MTP beyond 20 weeks in case of fetal anomaly Discussion of legal and ethical dilemmas.
The MTP Act, 1971 states that pregnancy may be terminated “where the length of the pregnancy exceeds twelve weeks but does not exceed twenty weeks, if not less than two registered medical practitioner are of opinion, formed in good faith, that – (i) The continuance of the pregnancy would involve a risk to the life of the pregnant woman or of grave injury to her physical or mental health; or (ii) There is a substantial risk that if the child were born, it would suffer from such physical or mental abnormalities to be seriously handicapped.” However, there is no provision for MTP beyond 20 weeks in the Act in its current form. There are two distinct scenarios wherein a woman (or guardian in case of a minor) approaches the Courts to allow MTP beyond 20 weeks. The first is in case of pregnancy as a result of rape and second is when prenatal investigations reveal serious fetal anomalies and the woman requests MTP. The Courts have directed constitution of Permanent Medical Boards for this purpose; a psychiatrist is a member of the Board. This symposium aims to describe and discuss legal and ethical aspects while performing duties as part of the Medical Board in both the scenarios.
Context and Need to Appraise Ourselves: Permanent Medical Boards have been constituted to assist the Courts for petitions seeking MTP beyond 20 weeks. Psychiatrists are an integral part of such Medical Boards. The Boards are required to assess the status of the mother and fetus and give its recommendations to the Hon'ble Court for or against MTP in the said case. The context and need of appraising ourselves with the guidelines and legal process shall be discussed.
Medical Termination of Pregnancy beyond 20 Weeks in Case of a Rape Survivor (Including POCSO Cases): In case of rape survivors, a majority of cases that are referred for MTP beyond 20 weeks are those of minors. Mental state of the rape survivor needs to be assessed and in conjunction with the physical status of the pregnant woman and the fetal condition, recommendations are to be given. The risks involved in termination of pregnancy and delivery (if the pregnancy was continued) have to be examined by a medical board. In this presentation, case vignettes shall be presented to discuss assessment process, legal and ethical dilemmas, and practical problems in undertaking assessments.
Medical Termination of Pregnancy beyond 20 Weeks in Case of Fetal Anomaly: In case of fetal anomalies which may be incompatible with life or may result in serious disability, a petitioner (pregnant woman) may approach the Court to allow termination of pregnancy. Risks involved in continuation vis-avis termination of pregnancy have to be examined. In this presentation, the role of a psychiatrist will be discussed with help of case vignettes. Ethical dilemmas shall be highlighted.
S 17: Community based rehabilitation for the elderly with mental illness in urban region: Need, challenges and a proposed model
Subhash Das, Shubh Mohan Singh1, Shikha Tyagi
Government Medical College and Hospital,1Post Graduate Institute of Medical Education and Research, Chandigarh, India. E-mail: [email protected]
Topics and Speakers
Need for community-based rehabilitation of the elderly with mentalillness: Subhash Das.
Challenges of community-based rehabilitation in the elderlywith mental illness: Shubh Mohan Singh.
Community Based Rehabilitation in urban region: a proposed model: Shikha Tyagi.
The symposium will help in understanding the rehabilitation of elderly with mental illness in an urban setting.
The National Mental Health Survey 2015-16 showed that the prevalence of mental morbidity was more in the age group of 40-49 years (life-time: 18.36% and current: 14.48%) and in those above 60 years it was 15.11% life-time and 12.90 % current respectively. The survey was carried out in 12 states and when we look at the findings of these 12 states including that of Punjab. It was seen that the mental morbidity was highest in the elderly above 60 years in the state of Punjab, which was higher than that of the National figure. In Chandigarh, which is also the joint capital of Haryana and Punjab, the situation is likely to be similar. Depression and cognitive impairment like dementia are often present in the elderly. Rehabilitation needs of the elderly with mental illness are likely to be different from that of the younger ones and to rehabilitate such people requires involvement of multi discipilinary professionals like psychiatrists, psychologists, psychiatric social worker, occupational therapists, dietician and so on and also keeping the caregivers in the loop while formulating rehabilitation plan. Through this symposium the speakers would like to deliberate on the community based rehabilitation of the elderly in an urban setting and discuss the challenges of rehabilitation ofurban elderly with mental illness and would also try to propose a model in an urban scenario.
Need for Community Based Rehabilitation of the Elderly with Mental Illness: Elderly with mental illness have rehabilitative needs which are likely to be different from the younger persons with mental illness. In rapidly changing family dynamics in the urban region there is a need to have a look at the community based rehabilitation for those elderly with mental illness given the fact that many of them might have degenerative conditions like dementia. This part of the symposium thus tries to focus on the rehabilitative needs of the elderly with mentalillness in an urban setting, especially in the context of crumbling support system.
Challenges of Community Based Rehabilitation in the Elderly with Mental Illness: With the problem of migration of the younger population espcially in urban places like Chandigarh, there is bound to be a large number of elderly who are alone or have their elderly spouse. The magnamity of the problem increases many fold in the lonely elderly with mental illness given the fact that many of them are also likely to have co-morbid physical illness. This part of the symposium will thus try to have an overview of the challenges to community based rehabilitation in urban setting for the elderly with mental illness.
Community Based Rehabilitation in Urban Region: A Proposed Model: In Chandigarh, the department of Psychiatry, GMCH has started its rehabilitation facility for persons with mental illness some few years back and only recently has also developed a model for rehabilitation of those with mental illness in the community. This part of the symposium will thus try to see whether a similar model can also be proposed for the elderly with mental illness.
Keywords: Elderly, mental illness, rehabilitation, urban
Gururaj G, Varghese M, Benegal V, Rao GN, Pathak K, Singh LK, et al. National Mental Health Survey of India, 2015-2016: Prevalence, Patterns and Outcomes. NIMHANS Publication No. 129. Bengaluru: National Institute of Mental Health and Neuro Sciences; 2016. Chavan BS, Das S, Garg R, Puri S, Banavaram AA. Prevalence of mental disorders in Punjab: Findings from National Mental Health Survey. Indian J Psychiatry 2018;60:121-6. Nair SS, Raghunath P, Nair SS. Prevalence of psychiatric disorders among the rural geriatric population: A pilot study in Karnataka, India. Cent Asian J Glob Health 2015;4:138. Tiwari SC, Sonal A. Clinical practice guidelines for addressing the rehabilitation needs of elderly in the Indian context. Indian J Psychiatry 2018;60:S410-S425.
S 18: Warwick India Canada NIHR Psychosis Research Group at All India Institute of Medical Sciences Centre: Strengthening Management Protocols for Psychoses in India
R. K. Chadda, Mamta Sood, Vaibha Patil, Tulika Shukla, Mona R. Sharma, Jasmine Bhogal, Rekha Patel, Dhriti Ratra
Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India. E-mail: [email protected]
Topics and Speakers
Management of Psychoses in low resource settings: An Over view: RK Chadda.
NIHR Global Health Research Group on Psychosis Outcomes: Protocol based assessment and management of First Episode Psychosis (AIIMS Centre): Vaibhav Patil, Tulika Shukla and DhritiRatra.
Development of a Home Based Psycho-Social Care Model for 'Difficult to Treat' Patients with Schizophrenia and related disorders: Mona R Sharma, Rekha Patel.
Economic costs of Psychoses: Jasmine Bhogal.
Learnings from the WIC: Mamta Sood.
The aim of this symposium is to disseminate learnings about assessment and management protocols for first episode psychoses and established psychoses and costs involved in the care.
Psychotic disorders are severe mental disorders and cause significant disability and burden. The majority of persons impacted by psychotic disorders reside in low-middle income countries (LMIC) e.g. in India recently conducted National Mental Health Survey, prevalence of these disorders is reported to be 0.4% (~5-6 million persons); the rates are 3 times higher (1.3%) in 13-17 years olds. There is huge mental health gap of about ~ 75% (NMHS, 2016) due to low mental health resources; comprising of just 0.25 psychiatric beds per 10,000 population, 0.2 psychiatrists, 0.03 clinical psychologists, 0.05 psychiatric nurses, and 0.03 social workers per 100,000 of the population (WHO, 2005). In this symposium we discuss findings from NIHR Global Health Research Group on Psychosis Outcomes that comprises of the Warwick-India-Canada (WIC) Network comprising of Warwick University, UK; McGill University, Canada and All India Institute of Medical Sciences (AIIMS), New Delhi in North India and Schizophrenia Research Foundation (SCARF) in South India.
Management of Psychoses in Low Resource Settings: An Over View: In India, most patients with psychotic disorders access general hospitals for care. They receive treatment on outpatient basis, follow-up care and need-based short hospitalization. Most of the patients stay at home with families in the community and depend on families for psychosocial care. Families take up these roles often with a lack of relevant skills and knowledge regarding how to deal with the illness. It is possible to implement evidence-based pharmacological treatment due to availability of all kinds of antipsychotics in the market e.g. 4 mg risperidone tablet for a month would only cost INR 250 (3 £). However, psychosocial interventions (crucial for recovery) are rarely applied due to lack of resources for the same. Pharmacological treatment, though leads to amelioration of positive symptoms, has a limited impact on factors responsible for poor recovery and functioning.
NIHR Global Health Research Group on Psychosis Outcomes: Protocol Based Assessment and Management of First Episode Psychosis (All India Institute of Medical Sciences Centre): Patients with first episode psychoses (FEP) have better chances of recovery in comparison to persons with chronic illness due to intervention early in the course of illness. The implementation of early treatment for first-episode and untreated psychosis is key to reducing the burden of disability due to psychotic disorders. We looked at the duration of untreated psychosis in FEP patients attending clinical services, components of delay/barriers in help seeking that contribute to long duration of untreated psychosis in these patients and pathways to care and help-seeking, short and medium-term outcomes and correlates of such outcomes in these patients.
Development of a Home Based Psycho-Social Care Model for 'Difficult to Treat' Patients with Schizophrenia and Related Disorders: Schizophrenia is leads to high individual disability and burden on caregivers and society. About half of patients with schizophrenia do not show satisfactory improvement and failure to respond to treatment in schizophrenia has been described as 'difficult-to-treat' or 'treatment resistance'. We aimed to develop a standard home-based psycho-social care programme for continuity of care from hospital to home, co-ordinated between families, patients and mental health professionals for 'difficult to treat' patients with schizophrenia and related disorders. The proposal aims to find affordable and sustainable solutions for psychosocial care incorporating locally available resources and strengths i.e. the family caregivers and extensive telecom network and phones.
Economic Costs of Psychoses: A developing country like India faces the problem of inadequate resources to treat mental health problems. The total expenditure on health as a percentage of gross domestic product is 1.15%. & the mental health budget is less than 1% of the India's total health budget. Nearly 67.78 % of total health expenditure is sourced by the households through out of pocket payments,while the world average is just 18.2%. This high levels of 'out of pocket' expenditures can further increase the incidence of poverty and make families face catastrophe. There is a lack of information on the cost of psychosis which is an impediment to the evidence-based planning for the best utilization of limited resources. Hence, the proposal aims to bridge this gap in evidence by determining cost of illness to help us in understanding the nature of economic burden and assist in the direction of future policy-making.
Learnings from the Warwick-India-Canada: In the WIC project, we have worked on both FEP and established refractory psychoses. We have been able to develop assessment and management protocols for FEP, establish pathways to care and determine determinants of DUP. For patients with established psychoses, we have developed Sakshamprogramme both booklet based and mobile app based for use in both families and patients.
Keywords: Difficult to treat, psychoses, Saksham
Chadda RK. Caring for the family caregivers of persons with mental illness. Indian J Psychiatry 2014;56:221-7. Chadda RK, Singh TB, Ganguly KK. Caregiver burden and coping: A prospective study of relationship between burden and coping in caregivers of patients with schizophrenia and bipolar affective disorder. Soc Psychiatry Psychiatr Epidemiol 2007;42:923-30. Sood M, Chadda RK. Psychosocial rehabilitation for severe mental illnesses in general hospital psychiatric settings in South Asia. BJPsych Int 2015;12:47-8. Sood M, Chadda RK, Sinha Deb K, Bhad R, Mahapatra A, Verma R, et al. Scope of mobile phones in mental health care in low resource settings mobile phones in mental health care in low resource settings. J Mob Technol Med 2016;5:33-7.
S 19: Rehabilitation of special populations in addiction psychiatry
Biswadip Chatterjee1, Piyali Mandal1, Ravindra Rao1, Dheeraj Kattula1,2
1National Drug Dependence and Treatment Centre, All India Institute of Medical Sciences, New Delhi,2Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India. E-mail: [email protected]
Titles and Speakers
Introduction and rehabilitation in adolescents – Biswadip Chatterjee.
Rehabilitation in women- Piyali Mandal.
Rehabilitation in elderly-Dheeraj Kattula.
Rehabilitation in community – Ravindra Rao.
The importance of rehabilitation for successful substance abuse treatment in special populations Provision of extra-treatment needs for special population OST as an essential means of recovery in opioid users.
Till date the focus of successful treatment of substance use was confined to abstinence from psychoactive substances. However, it is known that improvement in condition of life is one of the best predictors of successful substance use treatment. Thus, rehabilitation is an essential goal of substance use treatment. These issues are further complicated in special populations like the adolescents, women and the elderly. The importance of screening for vocational history and potential, assessment of interest, work temperament, skills, functional capacities and limitations, general aptitude and readiness for work is highlighted. Further, interventions to boost recovery and help in employment and financial independence would be discussed. These interventions can be done in various settings be it in community clinic, the outpatient care or in the patient units. The symposium would address these issues from literature and experiences from India.
Introduction and Rehabilitation in Adolescents: There are many definitions of rehabilitation in addiction psychiatry. The concept is complex and is evolving. SAMHSA simply defines rehabilitation as a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. It is recognized this occurs in different domains like in health where it is about overcoming or managing one's disease(s) or symptoms and making informed, healthy choices that support physical and emotional well-being, home where it is about having a stable and safe place to live, purpose of life meaning conducting daily activities and having the independence, income, and resources to participate in society and community which is related to having relationships and social networks that provide support, friendship, love, and hope. The conceptual boundaries would be discussed in the session. The session would also cover special issues with regards to rehabilitation of adolescents.
Rehabilitation in Women: Women face unique problem of telescoping with complications due to drug use occurring early. Rehabilitation is challenging with issues like pregnancy, childcare, medical and psychiatric comorbidities, stigma and loss of social supports. These issues will be discussed.
Rehabilitation in Elderly: The older adults have high comorbidity with physical illnesses, economic deprivation, unemployment, abandonment, loneliness and psych comorbidity including declining cognitive functioning. Challenges involved in handling these in rehabilitation will be discussed.
Rehabilitation in Community: The interventions in clinic and in community can be quite different despite being geared to aid the patient on path to recovery. This is due to patient, illness, treatment and community characteristics. The interventions in community not only focus on the individual but also develop a milieu for the patient to fit in. This implies working with NGOs, family members, community leaders, recovered substance users to help the recovering patients. The session would discuss practical steps in practice of addiction psychiatry in community. The role of opioid substitution therapy in recovery will be addressed and experience from a methadone clinic, hotspots and mobile van clinic will be shared.
Keywords: Addiction, rehabilitation, special population
White WL. Addiction recovery: Its definition and conceptual boundaries. J Subst Abuse Treat 2007;33:229-41. Bhugra D, Fiorillo A, Volpe U. Psychiatry in Practice: Education, Experience, and Expertise. Oxford University Press, Year: 2016. Giesbrecht N, Haydon E. Community-based interventions and alcohol, tobacco and other drugs: Foci, outcomes and implications. Drug Alcohol Rev 2006;25:633-46. Miller SC, Fiellin DA, Rosenthal RN. The ASAM Principles of Addiction Medicine. 6th ed. Lippincott Williams & Wilkins (LWW); 2018.
S 20: Socio-cultural dimensions of dissociative disorder
Biswa Ranjan Mishra, Shree Mishra, Rajeev Ranjan1, Santanu Nath
Department of Psychiatry, AIIMS, Bhubaneswar, Odisha,1Department of Psychiatry, AIIMS, Patna, Bihar, India. E-mail: [email protected]
Topics and Speakers
Cultural influences on etiogenesis of dissociative disorders: Biswa Ranjan Mishra Gender differences in dissociative disorders: Shree Mishra Dissociative symptoms in children: Rajeev Ranjan Sociocultural role in treatment of Dissociation: Santanu Nath.
This symposium will enrich us with understanding dissociative disorders from a socioculturalperspective. At the end of the symposium the audience is expected to learn to manage theirclients suffering from dissociative disorder after understanding from which socio-cultural milieu theybelong from and how to manage the symptoms from a socio-cultural perspective.
Dissociative disorder, otherwise known as conversion disorder is a neurosis characterized byvaried pseudo-neurological symptoms ranging from convulsive motor movements, frankunconsciousness to loss of motor and sensory functions. Society and culture, including its variouspractices within it has been found to colour the expression and manifestation of dissociativepresentation and these has been found within cultures and also across continents. One prominentfactor that shapes the symptoms is gender. There has been prominent shewing towards the fairergender both in the prevalence as well the presentation. A holistic knowledge of dissociative disorderfrom a socio-cultural perspective is important so as to tailor proper and adequate management. The current symposium will try to bring out the relevance of socio-cultural milieu in symptom manifestation of dissociative disorder which will be helpful in handling such patients. Cultural Influences on Etiogenesis of Dissociative Disorders: This section will deal with the etiopathogenesis of dissociative disorders and the intimaterole of culture with its varied practices and nuances in the pathogenesis of the disorder. This will alsoentail a detailed discussion on the folk practices, mass dissociation etc.
Gender Differences in Dissociative Disorders: This section will deal with the subtle differences that gender plays in both the etiopathogenesis andthe clinical manifestation of the disorder. The discussion will be made on real life case vignettes fromcases which are seen by the authors in their practice.
Dissociative Symptoms in Children: This section will deal with the childhood presentations of dissociative disorder and the cultural, educational, learning and behavioural factors responsible for such manifestation. It will also entail a discussion on the management in children as a whole.
Sociocultural Role in Treatment of Dissociation: This section will deal with the management of dissociative disorder in broad and the socio-cultural role in treatment proper for dissociative disorder. It will entail an case to case based management based upon their socio-cultural milieu, their religious practices, belief systems etc thus entailing a holistic approach in management which is an important aspect of treatment more important than pharmacological management.
Keywords: Bio-psycho-social model, culture, dissociative disorder, gender, society
Bale TL, Epperson CN. Sex differences and stress across the lifespan. Nat Neurosci 2015;18:1413-20. Asadi-Pooya AA. Psychogenic nonepileptic seizures are predominantly seen in women: Potential neurobiological reasons. Neurol Sci 2016;37:851-5. Avbersek A, Sisodiya S. Does the primary literature provide support for clinical signs used to distinguish psychogenic nonepileptic seizures from epileptic seizures? J Neurol Neurosurg Psychiatry 2010;81:719-25. Benbadis SR, Allen Hauser W. An estimate of the prevalence of psychogenic non-epileptic seizures. Seizure 2000;9:280-1.
S 21:What's new in ICD-11: From conceptualization to impact in psychiatry
Jayapaprakash Russell Ravan, Jigyansa Ipsita1,
P. V. R. Pratheek
Department of Psychiatry, Kalinga Institute of Medical Sciences,1Department of Psychiatry, AIIMS, Bhubaneswar, Odisha, India. E-mail: [email protected]
ICD -11: Introduction, Conceptual differences from ICD-10 in Psychiatric Diagnoses: Pratheek PVR.
Newer diagnostic entities in ICD-11 related to psychiatry: JigyansaIpsita.
Coding and possible impact of ICD-11 at various levels – Social, Research, Day to Day practice: Jayaprakash RusellRavan.
The advance preview and understanding of ICD-11 will allow in future planning and clinical utility of the new version. Our symposium will help the participants to have insight into the process of development of ICD 11, conceptual changes of future nosological system as compared to ICD10. Other important learning objective would be to find out new diagnostic entities in the field of mental health and psychiatric illnesses. The proposed symposium would also throw light upon the possible coding system and its future implication in area of research and clinics, which might revolutionise the understanding of psychiatric disorders.
Substantial advancements in Medicine and Biological Sciences have occurred over the last few decades. In current scenario ICD-10 is gradually perceived as outdated, both clinically and from a classification point of view. The ICD is the foundation for identifying health trends and statistics worldwide, and contains around 55,000 unique codes for injuries, diseases and causes of death. It provides a common language that allows health professionals to share health information across the globe. The development of the ICD-11 over the past decade is based on the principles of clinical utility and global applicability. ICD-11 will be one of the broadly international, multilingual, multidisciplinary and participative revision process ever implemented for a classification of mental disorders. There is a felt need in the area of mental illness for crucial structural and conceptual changes. These changes are proposed and adopted through a rigorous process in psychiatric diagnosis such as neurodevelopmental disorders, neurocognitive disorders, Obssessive compulsive related disorders, PTSD. This information is intended to be useful for both clinicians and researchers in orienting themselves to the ICD-11 and in preparing for implementation in their own professional contexts.
ICD-11: Introduction, Conceptual Differences from ICD-10 in Psychiatric Diagnoses: Changes in the ICD-11 include the provision of consistent and systematically characterized information, lifespan approach, and culture-related approach for each disorder. Dimensional approaches have been incorporated into the classification, particularly for personality disorders and primary psychotic disorders, in ways that are consistent with current evidence. Here we describe major conceptual changes to the structure of the ICD-11 classification of mental disorders as compared to the ICD-10, Such as in the area of neurocognitive disorders, neurodevelopmental disorders, Anxiety/fear related disorders, OC related disorders, etc.
Newer Diagnostic Entities in ICD-11 Related to Psychiatry: To demonstrate set of new categories those have been added to the ICD-11 and present the rationale for their inclusion. Based on scientific validity, consideration of clinical utility and global applicability, a number of new disorders have been added to the ICD-11. Description of these new diagnostic entities at various levels such as Bipolar II disorder, Internet Gaming disorder, prolonged grief disorder, complex PTSD, AFRID, bodily distress disorder, etc.
Coding and Possible Impact of ICD-11 at Various Levels: Social, Research, Day to Day Practice: To bring the uniformity in the registry of mental illnesses appropriate coding is essential across counties and regions of the world. Coding pattern of various psychiatric disorders under ICD-11 is being changed. The digital version of coding tool - ICD-11 Coding Tool, Mortality and Morbidity Statistics (MMS), April 2019 will be demonstrated. The psychiatric disorders are coded from 6A00-6Z99. Some disorders such as sleep related and sexual related health problems are coded elsewhere. This new version of ICD-11 can have significant impact at various levels such as epidemiological prevalence of disorders, research on newer diagnostic entities, changes in day to day clinical practice.
Keywords: Coding, conceptual changes, ICD 10, ICD 11, new psychiatric diagnosis
Reed GM, First MB, Kogan CS, Hyman SE, Gureje O, Gaebel W, et al. Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders. World Psychiatry 2019;18:3-19. International Classification of Diseases-11, Classification of Diseases by WHO. Available from: https://www.who.int/classifications/icd/en/. International Classification of Diseases-11 Coding Tool, Mortality and Morbidity Statistics. https://icd.who.int/ct11/icd11_mms/en/release.
S 22: Violence against doctors and protection available: An update from India and Bangladesh
Tanjir Rashid Soron, TanayMaiti1, Ganesh Shankar2, Aminul Islam3
Telepsychiatry Research and Innovation Network Ltd.,3University of Liberal Arts Bangladesh, Dhaka, Bangladesh,1AIIMS, Bhubaneswar, Odisha,2Department of Psychiatry, GSVM Medical College, Kanpur, Uttar Pradesh, India. E-mail: [email protected]
Topics and Speakers
Violence in against doctors in India: TanayMaiti.
Violence in against doctors in Bangladesh: Tanjir Rashid Soron, Md. Aminul Islam.
Legal protections available for medial professionals, India and rest of the world: Ganesh Shankar.
To discuss the specific incidents and nature of violence against the psychiatrists both in India and Bangladesh To discuss possible measures and interventions, which can be implemented over the various settings in both the countries.
Media and state blames and judges the doctors' negligence or malpractice most of the time without seeking any expert opinion. There are multiple factors that provokes the violence and the doctors have the least control on these factors such as long waiting time due to long waiting time due to huge bulk of patients, lack of freely available medicine and equipment's, mental disorders of family members or accompanying persons of the patient, false perception regarding the adverse effect of administered drug, the miscommunication between doctor and patient. Whenever, we face the death of any of our close relative we go through a stages of changes in our mind. One of the important defense mechanisms of the initial stage is displacement. This is the transfer of emotion from a person, object, or situation to another source and showing valance towards the doctor may be an easy way expression of the anger and frustration. The accusation of doctors and violence in health sector is increasing including killing of doctors. However, the state and society are reluctant to find out the psychopathology of blaming doctors, reducing the violence and improving the detoriating doctor patient relation in Bangladesh. The country must create culturally appropriate and evidence based interventions to address the cases of violence against health workforce and develop adequate strategies to prevent them in the first place. The involvement of Psychiatrists and Psychologists should be encouraged in policy making to reduce the violence and the psychiatrist should give their expert opinions based on the psychopathology of violence. We also need to evaluate the role of social media and internet in spreading violence how psychiatry can make its contribution in preventing that and creating a safe online platform for all.
Violence against Doctors in Bangladesh: The people, media and society are hostile towards Health professionals in Bangladesh, very same like its neighboring country India. They consider every death results from the failure of doctors and the angry mobs are ready to punish and humiliate the poor physicians. Multiple incidents has been witnessed in Bangladesh also, which, considering its geographical width, probably no less than India both in prevalence and importance.
Violence against Doctors in India: Health care sector in India has witnessed massive change in past two decades, more so in last few years with a clear shift in the mind set of common people. Following the consumer act and tendency to seek compensation over possible medical negligence has markedly changed the healthy doctor-patient relationship. Dr. Tanay will be discussing the recent incidents including grievous injuries faced by various health professionals all over the India.
Legal Protections Available for Medial Professionals, India and Rest of the World: The changed social situation surely has led the mass protest followed by change in legislation by various local bodies keeping a similarity with other developed countries. Along with changes in legislation and policy making, better health care support and awareness generation in common mass is a mandatory part for re establishment of healthier doctor patient relationship.
Keywords: Cultural factors, doctor patient relationship, legislation, social changes
1.Jaiswal A, Bahatnagar AS. Doctor-patient relationship: A socio-legal analysis. Shodh Sanchayan 2013;4:1-8.
Hodgson K, Thomson R. What do medical students read and why? A survey of medical students in Newcastle-Upon-Tyne, England. Med Educ 2000;34:622-9. Bajpal V. The challenges confronting public hospitals in India, Their origins and possible solutions. Adv Public Health 2014:24;1-27. Paul S, Bhatia V. Doctor patient relationship: Changing scenario in India. Asian J Med Sci 2016;7.
S 23:Development of panic and anxiety national Indian questionnaire
Pratap Sharan, M. V. Ashok1, Manoj Sahu2, Shivani Purnima, Sarah Ghani1, Sowmya Murli1, Mahendra Kumar2
Department of Psychiatry, AIIMS, Delhi,1Department of Psychiatry, St John's Medical College, Bengaluru, Karnataka,2Department of Psychiatry, JNMMC, Raipur, Chhattisgarh, India. E-mail: [email protected]
Topics and Speakers
Chair: Pratap Sharan, MV Ashik, Manoj Sahu.
Basic Methodology of PANIQ study: Shivani Purnima.
Understanding the need for Culture Specific tool in Generalized anxiety disorder andPanic Disorder: Sarah Ghani.
Challenges and issues in Qualitative method: FGD and Cultural issues: SowmyaMurli.
Exploration of anxiety and panic symptoms in Chhattisgarhi dialect: MahendraKumar.
The aim of this symposium is to describe the process of development of the Panic andAnxiety National Indian Questionnaire (PANIQ) and the hurdles in the way of qualitativepilot and their possible solutions.
There is a need to study the phenomenology of anxiety disorders in non-Western culturalcontexts and to develop culturally appropriate assessment measures (e.g. including localidioms of distress, somatic expressions). Evident from a review of a recent review of Indianscales and inventories that not much work has been done in relation to clinometrics of anxietyin the Indian context.
In this symposium, the speakers will discuss the methodology in the development of thequestionnaire and the practical hurdles in the way of qualitative pilot and their possiblesolutions.
PANIQ is being developed under the agencies of ICMR over 3 phases.
Phase I: Development of the draft PANIQ.
Phase II: Assessment of reliability and validity of the PANIQ.
Phase III: Refinement of the PANIQ and development of a shorter version for use in generalhospital and primary care population. In the symposium we will cover the methodology used in the development of thequestionnaire and the hurdles in the way of qualitative pilot and their possible solutions.Through literature search, and the reviews of the Classificatory systems, Diagnostic instruments, and Dictionaries; Case files, Patient Interviews, and FGDs a total of 1817(AIIMS), 402 (JNMMC, and) 1050 (English; St John's MC) and 1405 (Kannada; St John'sMC) words/ idioms relevant to anxiety have been identified. We will discuss the journey of PANIQ so far & comment on the challenges ahead.
Challenges and Issues in Qualitative Method: Focus Group Discussions and Cultural Issues: Cultural diversity affects the way in which psychiatric illness manifest in the clinical and community settings. Understanding how to measure and assess behaviors, attitudes, health status, and utilization among diverse groups and understanding the cultural sensitivity ensures that health care and health research are more appropriate. But, there are many challenges that exist in developing a valid and reliable tool which can be acceptable in all cultural groups. The need for accurate information about the mental health problems of multicultural communities requires valid measures of mental health for use in a number of languages and cultural contexts.
Objective: To understand the challenges in qualitative methods in developing a tool forAnxiety and Panic in India.
Methodology: Focus Group Discussions (FGD)/ In-depth Interviews (IDIs) were conductedwith the stake holders (patients who had diagnosed as Anxiety and Panic under ICD 10) caregivers and professionals using semi structured interview guide.
Results: Though the FGDs and IDIs were conducted in the regional language (Kannada) mostof the terms derived from them, were in English language. Also, majority of the patients aswell as experts reported somatic symptoms as opposed to cognitive symptoms. Idiom ofdistress which was mostly expressed by patients was 'ennoondutaraagutide' which means'something is happening'.
Conclusions: Culture plays a significant role in psychiatric diagnosis. Hence, beforedevelopment of any tool it is vital to understand the culture at its grass root level and itsphenomenology.
Understanding the need for Culture Specific Tool in Generalized Anxiety Disorder and Panic Disorder: Cultural beliefs and the patient's experiences usually influence their narrative and it is criticalto understand the cultural context in treating patients with mental illness as the concept ofnormality differs across cultures. Cultural factors have influenced the presentation, diagnoses,and treatment of anxiety disorders in India for several centuries. Certain representation ofsymptoms are culture-specific to India. Hence, the present study was conducted to break down the different concepts of anxiety andpanic and to comprehend if and how we can make a difference in order to efficiently pick upthe culture specific differences in the expression of symptoms.
Objective: To understand the need for Culture Specific Tool in Generalized anxiety disorderand Panic Disorder.
Methodology: All available scales used to screen and diagnose Generalized anxiety disorderand Panic disorder were used.
Results: The review helped in producing for 21 domains for Anxiety such asthoughts/thinking, physical tension, etc. as well as 15 domains for Panic Disorder such asPanic attacks, thoughts, fear, etc. The review also showed that majority of the items werefocused on psychological symptoms like thoughts and worries whereas patients in Indiapresent with mostly somatic complaints.
Conclusion: The western instruments and tools used in India needs to be modifiedappropriately or new culture specific tools must be developed in order to efficiently pick upthe regional variations in the manifestation of GAD and Panic disorder.
Exploration of Anxiety and Panic in Chhattisgarhi Dialect: When exploring the Hindi dictionary it was realized that the print material is not sufficient forChhattisgarhi terms related to anxiety. Therefore, the JNMMC team conducted key informantinterviews with Chhattisgarhi language experts in Pt. RSS University and asked open endedquestions about terminology used in the language to describe anxiety and panic. The processand outcome with respect to exploration of Chhattisgarhi items will be discussed in thesymposium.
Keywords: Anxiety, anxiety disorders, cultural characteristics
Lewis-Fernández R, Hinton DE, Laria AJ, Patterson EH, Hofmann SG, Craske MG, et al. Culture and the anxiety disorders: Recommendations for DSM-V. Depress Anxiety 2010;27:212-29. Grant BF, Hasin DS, Stinson FS, Dawson DA, June Ruan W, Goldstein RB, et al. Prevalence, correlates, co-morbidity, and comparative disability of DSM-IV generalized anxiety disorder in the USA: Results from the national epidemiologic survey on alcohol and related conditions. Psychol Med 2005;35:1747-59. Lee S, Tsang A, Ruscio AM, Haro JM, Stein DJ, Alonso J, et al. Implications of modifying the duration requirement of generalized anxiety disorder in developed and developing countries. Psychol Med 2009;39:1163-76. Baxter AJ, Scott KM, Vos T, Whiteford HA. Global prevalence of anxiety disorders: A systematic review and meta-regression. Psychol Med 2013;43:897-910. Leong FT, Okazaki S, Tak J. Assessment of depression and anxiety in East Asia. Psychol Assess 2003;15:290-305. Venkatesan S. Indian scales and inventories. Indian J Psychiatry 2010;52:S378-85. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Washington, DC: American Psychiatric Association; 2013.
S 24: Portrayal of psychoactive substances in bollywood movies: A mixed-methods study
Ravindra Rao, Swati Kedia Gupta1, Udit Panda2
National Drug Dependence Treatment Centre, All India Institute of Medical Sciences,1Holy Family Hospital, New Delhi,2Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India. E-mail: [email protected]
Topics and Speakers
Substance Use and movies: Global and Indian evidence – Dr Swati Kedia Gupta.
Portrayal of psychoactive substance in Bollywood movies: study findings – Dr Udit Panda.
What do we understand from the study? – Dr Ravindra Rao.
How common is various psychoactive substances portrayed in Bollywood movies How are psychoactive substances portrayed in bollywood movies What are the trends in portrayal of psychoactive substances in Bollywood movies over last six decades.
Substance use causes not only adverse health effects, but also social and economic loss to the individual and the society. Initiation of psychoactive substances is associated with various individual and environmental factors. Studies have also assessed the role of media, especially movies, in influencing an individual's choice to consume psychoactive substances. During adolescence, exposure to psychoactive substances in popular movies is associated with higher rates of psychoactive substances use. Many studies have assessed the extent and pattern of depiction of alcohol in Hollywood movies. Most of these studies have systematically chosen top grossing movies, and assessed the proportion of time in which tobacco, alcohol or illicit substances have been portrayed. This is not the case with Indian movies. Some documents, including studies and articles in lay media, have just described depiction of psychoactive substances in Bollywood movies. However, these studies have chosen the Bollywood movies for review purposively, rather than systematically. To our best knowledge, there are no studies that have systematically assessed the extent of depiction of psychoactive substances in Bollywood movies and their trends in over several decades. The present study was planned keeping this background in mind. The symposium will present the existing literature on this topic, describe the study conducted by our team, and discuss the significance of the findings obtained.
Substance Use and Movies: Global and Indian Evidence: Substance use disorders are chronic, relapsing conditions that tend to influence all aspects of an individual's life as well as drain the social and economic resources. Major work has focused on the sociological causes of initiation and maintenance of psychoactive substance. Media can influence the behaviour of individuals, including substance use. Various theories have been postulated to understand the effect of media on an individual's behaviour. Depiction of smoking and alcohol is commonplace in media, including movies. Studies that aimed to understand the influence of movies on initiation of substance use date back to 1970s. Experimental studies have shown alcohol portrayal in movies directly influence actual alcohol intake. Cross-sectional and longitudinal association has also been seen between binge drinking in adolescents and exposure to alcohol use in movies. The Hindi film industry, also called as Bollywood, dominates the Indian film industry. The number of tickets sold in Bollywood yearly is much higher compared with Hollywood. While there are systematic studies on portrayal of substance use in Hollywood movies, there are no such systematic studies from India.
Portrayal of Psychoactive Substance in Bollywood Movies: Findings from a Mixed-Methods Study: The specific objectives of the study were: a) to quantify (by number and duration) the scenes in which various psychoactive substances is depicted in Bollywood movies; b) to conduct content analysis of the scenes in which psychoactive substances is depicted in Bollywood movies, and c) to analyse the trends over three decades in portrayal of psychoactive substances in Bollywood movies. We selected the top five grossing movies for each year of the three decades selected (1961-70; 1981-90; 2001-2010). Content analysis was conducted for each scene depicting psychoactive substances in the movie. We compared quantitative variables across the three decades to assess for any changes in the portrayal of psychoactive substances and performed qualitative content analysis for the text description of the context in which psychoactive substances was depicted in each movie. Total duration of the movies included in the analysis was about 399 hours and 32 minutes. 120 out of 150 movies (80%) depicted tobacco in some form or the other; about 53% of the total scenes involved tobacco, totalling to a time of about 19 hours. Cigarettes was the most commonly depicted form of tobacco (49%). In majority of scenes, the hero was shown using tobacco (71.3%). The frequency of portrayal of tobacco use showed a decline in the third decade (2000-2010). In case of alcohol, 135 (90%) movies contained at least one scene depicting alcohol. Alcohol scenes comprised seven percent of the total movie time. Hard liquor was the most common alcohol beverage depicted (75%, n=733). Most scenes portrayed hero (n=253, 36%) consuming alcohol. In case of other psychoactive substances 50 (33%) movies contained scenes depicting “other drug use”. About 5% (n=103) of the scenes were scenes depicting use of substances (other than tobacco and alcohol). The commonest type of drug use shown was cannabis (20%). In most scenes, the message was pro-use and the characters were shown to be happy (35%; n=19). Decade one had the least proportion of movies with drug use and decade two had the highest proportion of drug-using scenes.
What do we Understand from the Study? Few studies have analysed the manner in which psychoactive substances are depicted in Bollywood movies mainly using qualitative methods. To our best knowledge, there are no studies that have quantified to what extent psychoactive substance use is portrayed in Bollywood movies. Our study showed that majority of the movies had one or more depiction of psychoactive substance use. The most common portrayal of psychoactive substances in Bollywood is the hero consuming psychoactive substances for fun or to accentuate his 'maleness'. This depiction has the risk of young audience viewing these characters as 'super-peers' and copy the behaviour of these characters. Trend analysis also points to increasing portrayal of this pattern of some substances such as alcohol use lately. The movies of the last decade increasingly showed alcohol used during casual meeting between two characters or even between families. This is termed as 'routinised background' stereotype in movies, where non-problematic use of drugs is shown to have positive social connotations. There was also increased trend of female characters using alcohol or other psychoactive substances in movies in the latter decades, pointing to feminisation of substance use. Further studies should be conducted to assess the impact of exposure of substance use on the individuals, particularly younger population.
Keywords: Bollywood movies, psychoactive substance use, trend analysis
S 25: Psychosocial skills to cope with stigma and stress in digital age
Kanwal Preet Kochhar, Rekha Sapra1, Sudarsan Behera2, Sanimar Kochhar2
Department of Physilogy, AIIMS, Departments of1Human Development and Family Empowerment and2Psychology, Bharati College, University of Delhi, New Delhi, India
Topics and Speakers
Social responsibility of medical teachers in digital age: Kanwal Preet Kochhar.
Social and emotional learning in digital Age: Rekha Sapra.
Moderating role of emotional state and social among youth: Sudarsan Behera.
Salutogenic Aspects of destigmatization and psychoeducation in digital Age: Sanimar Kochhar.
Developing Disability Competencies Empowerment of children and adolescents by social and emotional support learning and training Fostering salutary concepts of social and emotional well being Tapping digital technology to formulate solutions for stress and stigma Rational and responsible use of digital technology.
Good health is attributable to not only favourable biological factors but also to a supportive material, social or psychological environment. A salutogenic interpretation of good health concept combines the global, external, interpersonal and personal resources of an individual, group or society. The journey through a stringent and structured system of medical education in India is stressful and demanding and much more so for those with psychiatric disabilities. Digital technology should be captured in positive ways by e-mentoring, mobile based health interventions, in a backdrop of extended digital kinships and popularity metrics. Teachers, researchers, psychologists, mental health professionals and all the stake holders can come together to make use of the available digital programs in a responsible manner. Rational use of social media can be used by educators, psychologists and researchers in an interactive manner to promote student engagement, peer collaboration.
Social Responsibility of Medical Teachers in Digital Age: Social responsibility of medical educators precludes engendering salutary concepts of physical, mental, social, emotional and spiritual well being as a duty as well as a moral responsibility towards self , students and society. Today in the digital age social needs and healthcare are in a period of rapid flux and evolution. A medical student, a young person with experience and emotions of an adolescent enters medicine after a rigorous entrance test, experiences conflicts to be a good doctor or a good human being. This is further compounded academic, financial, parental, societal and peer-enforced stress more so in the fear of missing out on social media updates. Medical educators need to consider these.
Social and Emotional Learning in Digital Age: The digital technology as a powerful influence on how and what we learn has been established by an array of researches in this domain. The core skills, which have been identified by social-emotional learning (SEL) programs focus on self-awareness, self-management, responsible decision making, social awareness and relationship skills. The umbrella term for SEL includes skills of team work, collaborative abilities, negotiation skills, critical thinking, ethical and social responsibility and effective communication to name a few. SEL is still an emerging field of enquiry and fostering and promoting it through technology has powerful implications for positive outcomes. World Economic Forum notes that both current and leading edge tools have the potential to bring social-emotional competencies to school. Digital technology is a powerful and all pervasive tool which can be used positively in classroom situations. Teachers, researchers, psychologists, mental health professionals and all the stake holders can come together to make use of the available digital programs in a positive structured manner.
Moderating Role of Emotional State and Social Support among Youth: In the present study intends to examine the moderating role of Emotional State and Perceived Social support towards the relationship between Post-traumatic Stress Disorder and Post-traumatic growth among youth in New Delhi. The total study sample of 200 participants were screened out from the total sample in New Delhi which is comprised by males and females underpinning the PTSD category. The data was collected by administering the Multidimensional perceived social support scale, 8 state questionnaire, PTDS inventory and PTG scale. The results found significant difference between male and females in emotional state, social support, PTSD and PTG along with demographic factors.
Social Stigma of Mental Illness and Salutogenic Aspects of Destigmatization and Psychoeducation in Digital Age: Sanimar Kochhar: Stigma makes individulas feel different and devalued by others. This can happen in the workplace, educational settings, health care, the criminal justice system, and even in their own family.Three out of four people with a mental illness report that they have experienced stigma. Digital technology with its wide acceptance and outreach can help by integrating stigma-coping strategies in treatment may represent a cost-effective way to reduce the risk of relapse and poor outcome occasioned by chronic exposure to stigma. In addition, significant gains in quality of life may result if all youth with mental health issues routinely receive information about stigma and are taught to use simple strategies to increase resilience vis-à-vis adverse, stigmatizing environments .The benefit of digital technology lies in ensuring privacy, reducing distractions and fostering therapeutic alliances and time, cost and effort saving strategies for better functional outcomes in morbid and premorbid states.
Keywords: Digital technology, emotional well being, medical teachers, stigma