Suicide prevention strategies for general hospital and psychiatric inpatients: A narrative review Karthick Navin, Pooja Patnaik Kuppili, Vikas Menon, Shivanand Kattimani Indian Journal of Psychological Medicine 2019 41(5):403-412 Background: In-patient (IP) suicides contribute a small but significant proportion of overall suicides. Despite this, suicide prevention strategies focusing on the general hospital IP population remain relatively underresearched. This paper is intended to provide an overview of various proposed suicide prevention approaches in the general hospital, including psychiatric IP, settings, and their evidence base. Methodology: Electronic searches of MEDLINE through PubMed, ScienceDirect, and Google Scholar databases were performed to identify potentially relevant articles from inception till January 2019. The generated abstracts were systematically screened for their eligibility to be included in the review. Included articles were grouped under five broad themes: environmental modification, staff education, pharmacotherapy, psychotherapy, and brain stimulation. Data extraction was done using a structured proforma. Results: Environmental modifications and educating the health care professionals appear to be the most promising strategies to reduce suicide-related mortality among IPs. Among pharmacological methods, ketamine has shown initial promise in reducing suicidal ideations. Follow-up data are lacking for most of the described methods. Limited but positive evidence exists for cognitive therapies focusing on the immediate postadmission period and brain stimulation techniques, and it warrants further replication. Conclusion: There is a striking paucity of original research on IP suicide prevention. Given the ethical and methodological issues in carrying out studies with IP suicide as the primary outcome, there is a need to focus on intermediate suicide outcome measures, such as knowledge, attitude, and skills among staff handlers of suicidal patients.

Perspectives about Illness, Attitudes, and Caregiving Experiences among Siblings of Persons with Schizophrenia: A Qualitative Analysis Anekal C Amaresha, Ganesan Venkatasubramanian, Daliboina Muralidhar Indian Journal of Psychological Medicine 2019 41(5):413-419 Background: Siblings of persons diagnosed with schizophrenia (SPS) are one among the major sources of support for persons with schizophrenia. There is a dearth of psychosocial literature on SPS in India. This qualitative study explored the perspectives about the illness, attitudes, and caregiving experiences of SPS. Materials and Methods: Qualitative audio-recorded interviews were conducted with 15 SPS, purposively selected from a tertiary mental health hospital of Southern India. A general inductive approach was adopted to analyze the qualitative data. Results: Four broad themes were identified from qualitative data analysis. (1) SPS described several explanatory models of mental illness in terms of causal attributions and treatment care. (2) They had expressed emotion toward their ill siblings, such as criticality, hostility, and emotional over-involvement. (3) They experienced objective and subjective burden while caring for their ill sibling. In spite of all these, (4) they were part of their ill siblings' care in terms of ensuring regular follow-ups and drug adherence and supported their livelihood. They coped up with adaptive as well as maladaptive strategies. Conclusion: SPS provide significant support to their affected siblings. However, they do have non-biomedical models of mental illness and negative attitudes toward patients and experience burden. Hence, psychosocial interventions may help SPS while caregiving for their affected siblings.

Quality of life in Schizophrenia: What is important for persons with Schizophrenia in India? Sumit Durgoji, Krishna Prasad Muliyala, Deepak Jayarajan, Santosh Kumar Chaturvedi Indian Journal of Psychological Medicine 2019 41(5):420-427 Background: Quality of life (QOL) is a multidimensional construct and is increasingly recognized as an important outcome measure. Schizophrenia runs a chronic course and is a disabling mental disorder. Assessment of QOL using currently available scales for schizophrenia may not be culturally relevant. Methods: In phase one, patients with schizophrenia using psychiatric rehabilitation services, caregivers, and mental health professionals were interviewed qualitatively to identify factors that are important for QOL of patients. In phase two, 40 patients with schizophrenia were recruited consecutively from the outpatient department and asked to rate the importance/relevance of the above items for QOL on a Likert scale. Results: Themes that emerged were work, family's understanding about illness, stigma, financial issues, social life, social standing, religion and spirituality, medications, physical health, mental health and symptoms, recreation and leisure, and independent living. Work and family's understanding of illness were considered as moderately or very important by all patients in phase two. Conclusions: Work is very important for all patients with schizophrenia for their QOL. The themes derived from this study could guide the development of a scale for QOL that is relevant to the Indian context.

Mobile phones as a medium of mental health care service delivery: Perspectives and barriers among patients with severe mental illness Gopika Sreejith, Vikas Menon Indian Journal of Psychological Medicine 2019 41(5):428-433 Background: The use of mobile phone technology to support various components of health care delivery (often referred to as mHealth) is on the rise. Little systematic information, however, is available on user felt needs and barriers to mHealth approaches among people with severe mental illness (SMI). Our objectives were to elicit user needs, preferences, and barriers to using mobile phones for health care service delivery among people with SMI. Materials and Methods: A cross-sectional study was carried out among 75 subjects with SMI between August 2017 and October 2017. All patients had a minimum illness duration of two years or more and a Global Assessment of Functioning score of less than 70. Information on user perspectives was elicited using a 10-item structured questionnaire, to assess mobile phone usage patterns, felt needs, barriers, and preferences, developed for use in patients with SMI. Results: Majority of the patients reported using mobile phones and were favorably disposed to mHealth approaches. Voice calls (n = 47, 62.7%) were the most preferred mode of service delivery. The most preferred service frequency was twice-weekly (n = 31, 41.3%), followed by once-weekly (n = 22, 29.3%). Majority (n = 47, 62.7%) reported no barriers to mobile phone usage, whereas 14 (18.6%) perceived a lack of necessity of mobile phones as a service delivery medium. Reminders about medication and appointments through mobile phones (n = 35, 46.6%) were the most felt needs, followed by crisis helplines (n = 27, 36.0%) and information about mental health services (n = 22, 29.3%). Conclusion: These findings support the use of mHealth approaches in resource-constrained settings and provide specific inputs to refine the modalities of mHealth service delivery.

Sexual dysfunction in drug-naïve or drug-free male patients with psychosis: Prevalence and risk factors Dhananjayan Ravichandran, Rajesh Gopalakrishnan, Anju Kuruvilla, KS Jacob Indian Journal of Psychological Medicine 2019 41(5):434-439 Background: There is a growing body of literature on the high prevalence of sexual dysfunction in patients with psychotic disorders. However, most studies have focused on medication-related sexual side effects. Material and Methods: Consecutive males with a diagnosis of acute psychosis or schizophrenia who were either drug-naïve or drug-free for six months were recruited to the study after obtaining informed consent. Sociodemographic and clinical data, psychopathology (using Positive and Negative Syndrome Scale), and sexual functioning (using The International Index of Erectile Functioning and DSM-IV TR criteria) were assessed. Bivariate and multivariate statistics were obtained. Results: One hundred males were recruited. The overall prevalence of sexual dysfunction by DSM IV-TR criteria in this population was 17%. The factors that were associated with sexual dysfunction were older age and later age of onset of illness. The rate was higher on excluding those who said that they were not sexually active (25%). Conclusions: Sexual dysfunction may be found in patients with psychotic disorders even prior to commencing antipsychotic medications. It is possible that this is contributed to by several factors including the disease process. Assessment of sexual function in these patients will help in early identification and appropriate management.

Perception about marriage among caregivers of patients with schizophrenia and bipolar disorder Pramod Kumar, Nitasha Sharma, Sandhya Ghai, Sandeep Grover Indian Journal of Psychological Medicine 2019 41(5):440-447 Background: Marriage has a complex relationship with mental illness. The marriage of a person with mental illness (PMI) is a controversial issue with varied opinions. There is a dearth of studies exploring perception about marriage among caregivers of patients with severe mental disorders. Materials and Methods: Thirty caregivers were interviewed in depth using a semi-structured interview schedule. Quantitative data were analyzed using MS Excel, while qualitative data were interpreted based on Colaizzi's framework. Results: About half (53%) of the caregivers believed that PMI should marry, and 46% of caregivers believed that marriage could worsen the mental illness of their patient. The qualitative analysis showed that factors that affect the decision among caregivers to get their mentally ill wards married include shovelling off the stigma of keeping the unmarried ward at home and to have somebody to take care of the unmarried ward after their death. Many caregivers believe that marriage and/or sexual intercourse can be a cure/treatment for various mental disorders. Conclusion: Caregivers of patients with severe mental illness have many misconceptions about the association of marriage and outcome of mental illnesses.

Marital problems among partners of patients with bipolar affective disorder Parakkal Drisya, Kavungathodi Bindumol, TK Saleem, Dayal Narayan Indian Journal of Psychological Medicine 2019 41(5):448-454 Background: Partners of patients with bipolar affective disorder (BPAD) have problems with their marital life. Identification of these problems is important to develop strategies to solve them for improving quality of life. Aims: To identify marital distress and problem areas in their marital life among the partners of patients with BPAD. Materials and Methods: A cross-sectional descriptive design was used to collect data from 125 participants, 59 males and 66 females, who were partners of patients with BPAD. The study was done in outpatient clinics of Community Mental Health Clinics of District Mental Health Program. Tools used for data collection included a semi-structured interview schedule to collect socio-personal data of partners of patients with BPAD and clinical data of the patient, Couple Satisfaction Index (CSI), and Problem Areas Questionnaire (PAQ). Purposive sampling technique was used. Results: Majority of the participants (male - 55.9%, female -54.5%) expressed marital distress on CSI. Handling family finances and career/job decisions were the most problematic areas for male participants, whereas household tasks, handling finances, and career/job decisions were the most problematic areas for female participants. Conclusion: A significant proportion of spouses of BPAD patients have marital distress in important areas of life, with a potential for long-term consequences in their lives.

Stigma and its correlates among caregivers of patients with bipolar disorder Sandeep Grover, Jitender Aneja, Nandita Hazari, Subho Chakrabarti, Ajit Avasthi Indian Journal of Psychological Medicine 2019 41(5):455-461 Background: Stigma associated with mental illness is multifaceted, and it extends to even those who take care of the afflicted persons. Research shows that stigma has maximal impact on patients who have schizophrenia and their caregivers, but information pertaining to caregivers of patients with bipolar disorder is minimal. Accordingly, this study aimed to evaluate stigma and its correlates among caregivers of patients with bipolar disorder. Methodology: This cross-sectional study conducted at a tertiary care hospital purposively enrolled 103 caregivers of patients with bipolar disorder-I. The caregivers were assessed on the stigma scale for caregivers of people with mental illness (CPMI) and the Explanatory Model Interview Catalogue (EMIC) stigma scale. Results: The majority of caregivers attributed the illness of the patient to stress (54.4%), chemical imbalance (48.5%), or heredity (29.1%), while nearly one-fourth believed it to be the will of God. The mean weighted scores on various domains of CPMI were comparable [affective domain = 2.24 (standard deviation (SD) = 0.51); cognitive domain = 2.25 (SD = 0.54) and behavioral domain = 2.23 (SD = 0.55)]. The mean score on EMIC was 28.00 (SD = 14.57). Caregivers with low income reported higher stigma in affective and cognitive domains. Also, lesser time spent with the patient correlated with higher stigma in the affective domain. Furthermore, poor functioning of the patient was associated with high caregiver stigma in cognitive and behavioral domains. Conclusion: Caregivers of patients with bipolar disorder experience significant affiliate and courtesy stigma, and higher stigma is associated with lower income of the caregivers and lesser time spent in caregiving.

Change in attitude among nursing undergraduate students following one-month exposure in a mental healthcare setting Naveen Grover, Sayma Jameel, Vishal Dhiman Indian Journal of Psychological Medicine 2019 41(5):462-465 Background: Attitude of treating professionals plays an important role in the treatment of mental illnesses. Nursing professionals are an important part of the mental health care team. As a part of their nursing coursework, nursing students are posted in a mental health setting. It is important to assess the impact of such postings on their attitudes. Materials and Methods: A total of 235 undergraduate nursing students posted in a mental healthcare setting for one month participated in the study. Their attitude towards mental illness and psychiatry was assessed before and after the posting, using Personal data sheet, Attitude Scale of Mental Illness (ASMI), and Attitude towards Psychiatry Scale (ATP). Results: At pre-assessment, the nursing students had a negative attitude on all dimensions of ASMI except benevolence, and positive attitude on all the six domains of ATP. At post-assessment, attitude improved significantly on pessimistic prediction dimension of ASMI, and they were able to maintain their positive attitude on ATP. Conclusions: One-month posting had a weak positive impact on attitude towards mental illness and no detrimental impact on attitude towards psychiatry. There is a need for better efforts to increase the impact of training on attitude towards mental illness.

Role of integrated and multidisciplinary approach in combating metabolic syndrome in patients with severe mental illness Pooja Patnaik Kuppili, Naresh Nebhinani Indian Journal of Psychological Medicine 2019 41(5):466-471