Byline: Anindya. Das, Urvashi. Rautela Sir, We congratulate Professor Avasthi (2011) [sup][1] on his award paper published in the Journal of Psychiatry (Vol.53, pp.111-120) for a fresh look on the importance of culture in psychiatry and its practice in India. He has pointed out the uniqueness of the discipline; the distinctiveness of psyche; the ill-fitted-ness of Western described clinical syndromes in India; cites certain biological differences implicating mental health of Indians; and discusses various other issues related to service provision and treatment. To us, the paper brings out the importance of culture in psychiatry but its arguments are weak. Such as the case for uniqueness of the discipline, Avasthi argue that similar chronic incurable physical conditions (such as diabetes) have vast differences in terms of diagnostic uniformity and treatment. Yet, we know the assumed diagnostic uniformity in chronic physical disorders often do not reflect as uniformity of practice (in diagnosis and more often in treatment) in widely different cultures, social settings, over different time periods, and in different health systems. On the other hand, expert-driven diagnostic (and management) uniformity is also a truth for psychiatric problems. Similarly, Avasthi constructs the psyche as fragmented, multifaceted due to and [sup][2] brought about by the onslaught of British colonialism. But the discipline of discursive psychology shows these processes to be universal. In fact, it particularly focuses on how identity, subjectivity, and agency are constructed within available personal, familial, social, and cultural discourse, opening up various interpretive repertoires making way for a socially emergent self. [sup][3] Thus, we see compartmentalized and often mutually contradictory ways of dealing with various social and personal situations that define self and identity. Moreover, the distinctive Indian influence on compartmentalization and contextualization is not just colonialism, traditional values, and modern ways of life but institutional structures, networks, and social movements. [sup][4] Thus, issues of social position/hierarchy, class relations, caste dimensions, religious affiliation, and the political trends of the time needs to be considered to understand the influence of culture on psyche and collective identity. On the other hand, Avasthi rightly points out the incongruence in Western diagnostic systems and ways of manifesting psychological distress, described as category fallacy. [sup][5] But it confuses us who does the author imply to wield the power to characterize problems. Kirmayer (2006) [sup][6] warns that the ways, by which psychological decompensation is defined, needs evaluation within the context of global systems of knowledge generation and power. Thus, psychiatrists talk about validating (Western) diagnostic systems. Avasthi also notes people's preference for folk medicine to be partly traditionally inspired and partly due to the lack of availability/affordability of health services. We would in addition like to impress on the cultural incongruence of mental health services as a vital reason for this. [sup][7],[8] In addition, the consideration of Indianization of psychotherapeutic practice lacks consideration for the need to understand how the culture perpetuates certain power differentials between the client and the healer (of biomedical kind or otherwise). Culturally appropriate forms of healing (e.g., faith healing, shrine healing, etc.), and their dynamics in terms of power differentials, meaning generation, family role, and manipulation of psyche need consideration for the above task. …
Background: Chronic obstructive pulmonary disease (COPD) is a disease with known systemic manifestations including psychiatric comorbidities most commonly being depression and/or anxiety. Studies regarding the association of these psychiatric comorbidities in terms of symptom scores, spirometric variables, and hospitalizations among patients of COPD are lacking, especially in India. Materials and Methods: One hundred and twenty-eight patients of COPD attending the Outpatient Department of AIIMS Rishikesh, and fulfilling inclusion criteria were screened by Hospital Anxiety and Depression Scale, and those who scored above the cutoff underwent psychiatric evaluation using the International Classification of Diseases, Tenth Edition Diagnostic Criteria for Research for confirmation of their diagnosis. All patients were then evaluated by physician-administered questionnaire for symptom scores by Modified Medical Research Council Scale (mMRC) for dyspnea, Hindi-validated Clinical COPD Questionnaire (CCQ), and for functional capacity by 6-min walk distance (6MWD) according to the American Thoracic Society Guidelines. All patients also underwent spirometric evaluation, and postbronchodilator forced expiratory volume in 1 s (FEV1), BODE index (body mass index [BMI], postbronchodilator FEV1, mMRC for dyspnea, 6MWD) and a history of hospitalization/exacerbations over the past 1 year was also obtained. Comparison of symptom scores, functional capacity in terms of 6MWD, history of exacerbations or hospitalizations over preceding 1 year and BODE index between patients of COPD with or without anxiety and/or depression was done. Results: COPD patients with comorbid anxiety and/or depression had higher dyspnea scores and CCQ scores though the proportion of current smokers, BMI, history of hospitalization over the past 1 year, FEV1, and BODE index was not statistically significant between the two groups. Conclusions: Depression is a common comorbidity and leads to higher symptom scores as well as poorer quality of life among COPD patients.
El Congreso de Auditoría Internacional tuvo como principal objetivo la difusión del trabajo efectuado por la Contraloría General de la República durante sus seis años de mandato como auditor externo de la Junta de Auditores de las Naciones Unidas. Esta labor, concluida exitosamente en julio de 2024, posibilitó la construcción de considerables aprendizajes en el ámbito de la fiscalización, el control y la colaboración internacional que se estimó útil compartir con las partes interesadas dentro del país, las que incluyen académicos, diplomáticos y profesionales del mundo de la auditoría, tanto del sector público como del ámbito privado.
In The Movement for Global Mental Health: Critical Views from South and Southeast Asia, prominent anthropologists, public health physicians, and psychiatrists respond sympathetically but critically to the Movement for Global Mental Health (MGMH). They question some of its fundamental assumptions: the idea that "mental disorders" can clearly be identified; that they are primarily of biological origin; that the world is currently facing an "epidemic" of them; that the most appropriate treatments for them normally involve psycho-pharmaceutical drugs; and that local or indigenous therapies are of little interest or importance for treating them. The contributors argue that, on the contrary, defining "mental disorders" is difficult and culturally variable; that social and biographical factors are often important causes of them; that the "epidemic" of mental disorders may be an effect of new ways of measuring them; and that the countries of South and Southeast Asia have abundant, though non-psychiatric, resources for dealing with them. In short, they advocate a thoroughgoing mental health pluralism.
This study describes two surveys of psychotropic drug prescribing patterns for long stay patients in a teaching institute at an interval of 4 years. Polypharmacy was found to be at a low key, with minimal use of anticholinergics. The chief difference between the two surveys was in the significantly more use of once a day medication in 1988 compared to two divided doses in 1984. The importance of conducting such surveys periodically as a form of self audit is discussed.
This study examined therapeutic milieu interventions on self-esteem, socio-occupational functioning, and depressive symptoms among inpatients with depressive disorders.A pretest-posttest nonequivalent control group quasi-experimental design was adopted. Sixty participants with depression who got admitted to the general hospital psychiatric ward were assigned to a control (Treatment as Usual) group and an experimental (therapeutic milieu intervention) group nonrandomly using a convenience sampling technique. We evaluated the following outcome measures: self-esteem, socio-occupational functioning, and depressive symptoms for both groups at baseline, 4th, 8th, and 12th weeks.Therapeutic milieu interventions improved self-esteem, socio-occupational functioning, and reduced depressive symptoms. The findings provided initial evidence for practice.Psychiatric nurses can implement simple, milieu therapy interventions in any setting, which will enhance the clinical outcomes and socio-occupational functioning of depressive patients.
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