|Year : 2017 | Volume
| Issue : 5 | Page : 5-8
|Date of Web Publication||8-Nov-2017|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Symposia. Indian J Soc Psychiatry 2017;33, Suppl S1:5-8
R. Tamanna*, S. Kedia1, P. Sharma*
*Department of Clinical Psychology, Dr. Ram Manohar Lohia Hospital, New Delhi, 1Amity Institute of Human Behavior and Allied Sciences, Amity University, Noida, Uttar Pradesh, India. E-mail: [email protected]
Cultural Barriers to Psychotherapy: It is an ongoing challenge for mental health professionals to reach out to people from different cultures. Culture-related barriers may act as major source of bias leading to problems in therapy initiation, continuation and its success. Client's cultural norms may be misinterpreted as symptoms of a disorder. Several culture-bound syndromes may be misunderstood. Cultural barriers may stem from differences between client and therapist cultures in the form of individualism versus collectivism, differences in verbal, emotional and behavioral expressions, preferred therapeutic approaches and views regarding mind-body separation. Further, there are several groups that are least likely to access psychotherapy. Opening up and talking about their problems may not be permissible or encouraged in several cultures. Many cultures also depend on drawing strength from their participation in the community and may look at dealing with difficult situations as the best way to develop resilience. Different beliefs about the origin of mental illness may also lead to the individual not opting for psychotherapy. This symposium elaborates on the cultural barriers one may face in psychotherapy. Both therapist and client related variables will be discussed.
Cross-Cultural Psychotherapy: Cross-cultural psychotherapy incorporates the client's cultural background as an important part of assessing and treating mental illness. Individuals and families with culturally diverse backgrounds often find community support to be lacking which exacerbates mental health conditions. Cultural and religious beliefs are invaluable to developing successful coping strategies. Cross-cultural therapy requires the therapist to be culturally aware and in touch with his/her own biases about minority patients and be comfortable about these. Non-familiarity with cultural norms will influence therapist's judgment as well as assessment. And therefore, cultural competence is a prerequisite for a cross-cultural therapist. It is imperative that the therapist encourages an open and honest dialogue about race and ethnicity and its impact on current issues. Use of imagery and metaphor can be made as they provide a universal language and bridge across cultural divides. The therapist must be sensitive to circumstances that may require referral to same-culture therapist.
Ethical Issues in Cross-Cultural Psychotherapy: How we think about culture in psychotherapy is important. The complexity and fluidity of cultural identity in society urges the therapist to avoid stereotyping and to recognize the uniqueness of each individual. It is critical for the therapist to be aware of his/her own values as they are constantly being communicated to the clients. The ethical principle of autonomy and self-determination should be followed which refers to respecting the dignity and worth of each person, their culture and context. Cultural relativism posits that all cultures are equally valuable. Post-modern lens believes in the existence of multiple realities, discourses and ways of understanding the world. Another ethical issue is the individualistic bias in ethical codes and practices as compared to the values and behaviors derived from a collective culture. Developing cultural competence is prerequisite to becoming a cross-cultural therapist. This involves being aware of one's own values, developing knowledge and practicing skills. Ethical cross-cultural psychotherapy is about respect and understanding. The therapist should be open to clients' internal worlds.
Keywords: Cross-cultural, psychotherapy, ethical issues
Tele-Psychiatry Activities at the Telemedicine Centre, Nimhans, Bengaluru
C. Naveen Kumar, N. Manjunatha, K. Kulkarni
Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India. E-mail: [email protected]
Various Models, Opportunities and Challenges during the Evolution of Tele-p sychiatric Activities at NIMHANS: It has been envisioned that in a resource-poor country such as India, telepsychiatry could be utilized as a model to provide specialized mental healthcare services. Various models of service-delivery with different costings have been studied and compared and telepsychiatry as a service has been found to be economical and feasible in a community setting. The telepsychiatry services have great potential for development. However, challenges in terms of connectivity, unavailability of essential drugs and most importantly, lack of workforce remain.
Report of KSWAN Tele-Psychiatric Consultations to Outpatients of District Hospitals of Karnataka from its Inception: Using the services of the Karnataka State Wide Area Network (KSWAN), tele-psychiatric consultations have been performed by various departments with the outpatient departments of district hospitals in the state of Karnataka. In the last six years, around 1000 tele-consultations for patients have taken place and patients have been diagnosed and provided appropriate treatment advice based on the same.
A Report of Tele-Psychiatric Consultations for the Inpatients of Nirashritara Parihara Kendra, Bengaluru: 114 inpatients from among the residents of the Nirashritara Parihara Kendra in Bengaluru have been receiving telepsychiatry follow-ups using online consultations with the community mental health team since 2013 until 2016 and have received a mean of 8 follow-ups with a mean interval of 1.5 months between follow-ups. The most common diagnosis was psychosis and the most commonly prescribed medication was risperidone. Around 80% of the patients have received IQ assessments after which several diagnoses have been revised.
Keywords: Online consultation, telemedicine, telepsychiatry
Medico-Psychosocial Aspects in Homosexuality
Kamala Deka, S. Ghosh1, B. S. Das1, D. Bhuyan1, D. Chetia2
Department of Psychiatry, Jorahat Medical College, Jorahat, 1Department of Psychiatry, Assam Medical College, Dibrugarh, 2LGB Regional Institute of Mental Health, Tezpur, Assam, India. E-mail: [email protected]
Gender and sexual orientation are important dimensions of everyday life in every individual's life and is presently gaining focus in the research area too. Sexual orientation is referred as a person's erotic and emotional orientation towards members of their own or other gender. Individuals who consider themselves as gay or lesbians have a sexual orientation towards members of their own gender. Even thou the origin of homosexuality have been a subject of debate yet the term 'homosexuality first appeared in 1869 in a treatise by Benkert (under the pseudo name Kertbeny). During the mid-20th century, Alfred Kinsey in his research on sexuality conceptualized a one-dimensional scale to assess sexual orientation. In this scale a seven point continuum ranges from heterosexual (0) to exclusively homosexual (6). Various studies reveal presence of stereotyping, prejudice and discrimination among the homosexual population. With regard to the mental health issues among homosexual population, research findings reveal experiencing of more mental health issues as compared to straight individuals. These issues may be related to discrimination, stress of concealing one's sexual orientation and is not restricted to one cause. Presently various researches are on-going in the area of gender and sexuality and this symposium will focus on their quality of life and their perception towards their sexuality.
Keywords: homosexuality, gender, sexual orientation, medico-legal aspects
Emergence of Psychiatry as a Science of Mind
S. Talukdar*, S. Bhandari*, S. Mandal1, M. Hazarika*, B. Das*, S. Das*
Guwahati Medical College, Guwahati, 1AIIMS, Raipur, Chhattisgarh, India. E-mail: [email protected]
Aim: Understanding the social and biological origins of psychiatry.
Introduction: Psychiatry has come a long way since it's psychodynamic roots. Now we know it's biological underpinnings and are now trying to define the full extent of that underpinnings.
Main Findings: During 18th - 19th century when there were many schools of thought regarding mental illness, Griesinger asserted the primacy of brain over mind for psychopathology. In the later part of 19th century use of hydrotherapy, opiates, blood letting were the treatment options, followed by agents like quinine, bromides, barbiturates, chloral hydrates. Kraeplin's recognition of 'dementia praecox' gave the idea that different forms of mental disorder, has it's own diathesis and etiology. Hereditary relationships in epilepsy, dementia praecox, manic depressive insanity were thought to share a common recessive transmission. In early 1900's physical therapies like insulin coma therapy, prefrontal lobotomy, chemical/ electro convulsive therapy were tried. Next breakthrough was the discovery of phenothiazines in the 1950's followed by imipramine, reserpine, clozapine, SSRI's. By the end of 20th century, neuroimaging findings detected structural abnormalities in papez circuit, temporal lobes along with the structure and function of several neurotransmitters.
Discussion: The biological concept of psychiatry has existed since the early days of establishment of psychiatry as a medical specialty. Our pure socio-psycho-phenomenological system of diagnosis in psychiatry has produced a system of disorders which has many overlapping symptoms with each other and has no longitudinal stability as a disease. Now with the help of biomarkers and biological root findings we are once again trying to finally resolve this conundrum.
Keywords: Psychiatry, science, mind
Placement of Persons With Mental Illness: Opportunities and Challenges
B. S. Chavan, S. Tyagi, N. Gupta
Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India. E-mail: [email protected]
Although we don't have any data from India regarding percentage of persons with mental illness who employment of persons with mental illness, the data going to be very disappointing. Since the illness start very early, large number of persons fails to acquire job related vocational and educational skills. Further, seeking and maintaining a job also requires social, personal and managerial skills, there are very high chances that despite having adequate qualifications, less number of persons with mental illness will be able to seek and maintain competitive jobs. In addition to social, cognitive and vocational deficits due to major mental illness, stigma associated with mental illness further hamper the chances of getting a job in open market. Unlike the developed counties, where there is focused attention on deficits through psychosocial intervention, majority of mental health facilities in India provide only acute care and rehabilitation and placement is left to the family. Recently, Govt of India has introduced certain schemes to support persons with disability. Department of Psychiatry, Govt Medical College Chandigarh has developed a placement model as a part of its Disability Assessment, rehabilitation and Triage (DART) services. The details will be highlighted in the symposium.
Keywords: Placement, persons, mental illness, opportunities, challenges
Depression and Alcohol Use Disorder: Addressing the Complex Interface
Rakesh Lal, Yatan Pal Singh Balhara, Gauri Shankar Kaloiya, Siddharth Sarkar
Department of Psychiatry, NDDTC, AIIMS, New Delhi, India. E-mail: [email protected]
Depression is quite often comorbid with alcohol use disorder. Depression and alcohol use disorder occur together more often than expected by chance. Depression and alcohol use disorder seem to predispose to each other, and influence the course and prognosis of the other condition. The presentation of such cases may be marred by diagnostic difficulties. Management of patients with co-occurring depression and alcohol use disorder presents several unique challenges in-terms of the provision of treatment services, the focus of care, and the pharmacological and non-pharmacological options that are available for treatment. This symposium aims to present the issues related to the co-occurrence of depression and alcohol use disorder. The first speaker, Prof Rakesh Lal would provide a broad overview of co-occurrence of depression and alcohol use disorder and present some salient findings of epidemiological data. The second speaker, Dr. Yatan Pal Singh Balhara would present the etiological underpinnings of the co-occurrence of depression and alcohol use disorder both in terms of current neurobiological and psychosocial understanding. He would also highlight the longitudinal course of patients with this co-occurrence. Dr Siddharth Sarkar would present the management challenges and the pharmacological options of treatment of patients with comorbid depression and alcohol use disorder. Dr Gauri Shankar would discuss the psychosocial management of patients with this comorbidity.
Keywords: Depression, alcohol, interface
Swavlamban Health Insurance Scheme for Persons With Disabilities: The first Health Insurance Scheme to Cover Persons With Mental Illness: NIMHANS Experience
S. Thanapal, C. Naveen Kumar, M. Sood1
Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, 1Department of Psychiatry, AIIMS, New Delhi, India. E-mail: [email protected]
According to World Health Organization (WHO), 50% of Persons with disabilities (PwD) cannot afford health care. They are 50% more likely to suffer catastrophic health expenditure. Health insurance schemes are particularly useful in preventing catastrophic health expenditure and resultant 'poverty trap'. Insurance is a contract between the insurance company and the policy holder, in which an individual or entity receives financial protecting or reimbursement against loss from an insurance company. Health insurance is one type of insurance. Health Insurance works on the principle of 'risk pooling'. It balances cost across a large, random sample of individuals.
Ministry of social justice and empowerment, Government of India has launched 'Swavlamban health insurance scheme for persons with disabilities' with New India Assurance Company limited (Fully owned by Government of India), on 2nd October 2015. The scheme covers persons disabled with mental illness and offers a family floater health cover of rupees 2 lakhs per annum for an affordable premium of Rs 366 (including GST) to be paid by PwD.
Enrollment camps for swavlamban health insurance scheme are being coordinated on third Saturday of every month since May 2016 in Information centre for persons with disabilities, NIMHANS. In the symposium, we shall discuss the details of the scheme, process of setting up the monthly enrollment camps, profile of beneficiaries, challenges, opportunities and way forward.
Keywords: Health insurance, mental illness, enrolment
Bio-Psycho-Social Interventions for Patients With first Episode Psychoses in Low Resource Settings
M. Sood, R. K. Chadda, R. Verma, K. Sinha Deb
Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India. E-mail: [email protected]
The psychotic disorders are one of the leading causes of disability globally. Patients with first episode psychosis (FEP) who receive early intervention have better chances of recovery (40%) in comparison to persons with chronic illness. Most of the psychotic disorders have onset between ages 15–17 years; this affects acquiring of age specific skills for education, vocation, relationships and marriage. In response to new adverse situation in form of psychotic disorder in their loved ones, caregivers experience distress, anxiety, financial hardships and sometimes depression. Besides caring for sick relative, they have to take care of other family members and have to maintain wellbeing of the family. Persons with FEP and their families also face issues of stigma, worries and uncertainty about the future.
In low source settings, evidence based pharmacological treatment for FEP is possible due to availability of almost all types of psychotropic drugs. However, provision of evidence based psychosocial interventions, most of which have been tested in high resource settings, is difficult because of lack of mental health manpower, material and infrastructure resources. This affects accessibility and availability of evidence-based bio-psycho-social treatment for FEP. Cultural factors also play a role in the presentation, help seeking, compliance with treatment and recovery. In most of the low resource countries, due to cultural expectations and lack of resources, most of the patients with FEP stay with their families who bear the burden for caring of their loved ones. Therefore, the interventions for patients with FEP should also focus on empowering the families with knowledge about illness and treatment, stress management and enhanced coping.
In this symposium, culture informed bio-psycho-social interventions for patients with FEP will be discussed.
Keywords: Bio-psychosocial interventions, FEP, low resource settings
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