ABSTRACTS FOR SYMPOSIA

Indo-UK Collaboration – the way forward

In April 2022, a team of mental health professionals from the UK visited India following a specific invitation from leading medical colleges and hospitals to discuss formal opportunities to work constructively with one another. For our part, within Psychiatry, we had a plan to look at how the UK healthcare system could create opportunities for collaboration, research, exchange and clear discussion and debate around opportunities and challenges. Starting with a pilot involving 2 NHS organisations, our Indo-UK initiative has now grown to over 20 organisations across England and Wales. At the time of the presentation, our UK counterparts plan to complete 5 trips to India with the purpose of strengthening ties around sharing knowledge, research, and collaborative working.

Developing the framework for a long-term sustainable partnership (20 minutes)

Dr Aamer Sajjad

Consultant Psychiatrist and Medical Director NAViGO Health and Social Care CiC, UK

Clinical research in India and the UK: recent advances (20 minutes)

Dr Samir Kumar Praharaj

Professor and Head, Department of Psychiatry Kasturba Medical College, Manipal, India

The UK-India partnership in mental health: strengths and challenges (20 minutes)

Mike Reeve

Deputy Chief Executive

NAViGO Health and Social Care CiC, UK

Expert panel discussion on Indo-UK Collaboration – the way forward (30 minutes)

Dr Samir Kumar Praharaj

Professor and Head, Department of Psychiatry Kasturba Medical College, Manipal, India

Dr Baxi Sinha

Consultant Psychiatrist and Deputy Medical Director Tees, Esk & Wear Valleys NHS Foundation Trust, UK

Simon Beeton

Chief Executive Officer

NAViGO Health and Social Care CiC, UK

Dr Aamer Sajjad

Consultant Psychiatrist and Medical Director NAViGO Health and Social Care CiC, UK

Dr Kwame Opoku-Fofie

Consultant Psychiatrist and Medical Director Humber Teaching NHS Foundation Trust, UK

Dr Graeme Tosh

Consultant Psychiatrist and Medical Director

Rotherham Doncaster and South Humber NHS Foundation Trust, UK

Dr Johann Philip

Kochi/ UK

Our team from the UK (Specialist Adult ADHD) would like to run a symposium on Adult ADHD - diagnosis, differential diagnosis comorbidities and management.

The prevalence of ADHD in adults is estimated to be 2 to 4% (as per WHO). Only a very small proportion of patients with this condition are diagnosed and treated, and often ADHD is misdiagnosed as BPAD or EUPD.

ADHD is one of the most treatable mental health disorders with effect size in the region of 0.6 to 0.9.

Reference Leucht, Hierl and Kissling 2012. https://psycnet.apa.org/record/2012-19376-005

ADHD is increasingly seen as a primary disorder which when left untreated considerably increases the risk of secondary mental health problems like anxiety/depression but also alcohol/substance misuse. There is also significant overlap between ADHD and other neurodevelopmental conditions like dyslexia and autism.

Impact of untreated ADHD on the individual/family/society is far reaching

– negative impact on education/employment/higher rates of criminality, substance use disorders, secondary mental health problems, suicides, road traffic accidents, marital breakdowns, teenage pregnancies etc.

Below is a journal article published by us on ADHD being a ‘missed’ diagnosis and a commonly ‘misdiagnosed’ condition, and some other links related to the author.

https://www.cambridge.org/core/journals/bjpsych-advances/article/ misdiagnosis-and-missed-diagnosis-of-adult-attentiondeficit-hyperactivity- disorder/FF6646643B2BC02FFE7D20BBB4967950

https://www.adhdfoundation.org.uk/wp-content/uploads/2022/06/ Takeda_ADHD-in-the-CJS-Roundtable-Report_Final.pdf Debert et al

Prevalence of ADHD in nonpsychotic adult psychiatric care (ADPSYC): A multinational cross-sectional study in Europe https://pubmed.ncbi.nlm.nih.gov/26462666/

Symposium Proposal

Substance use disorders and the family: Looking at the horizons

Siddharth Sarkar, Yesh Chandra Singh, Gauri Shanker Kaloiya

Department of Psychiatry and NDDTC, AIIMS, New Delhi

Substance use often affect the family members of the individual with substance use disorder. Caregiver burden has been well described issue among the individuals with substance use disorders. Additionally, the reactions of family members towards the user has the potential to perpetuate the substance use disorder, or reduce it. In collectivistic societies like ours, families have a considerable role in shaping the attitudes and behaviours of individuals. Families (and extended families) sometimes resort to extreme measures for cessation of substance use. Nonetheless, their efforts are quite important in ensuring success of the therapeutic interventions. There are some positive aspects of caregiving of individuals with substance use disorders, which are being recognized of late.

This symposium will discuss the interaction of families and substance use disorders. The first speaker will highlight the different aspects of the interaction of the family and substance use, including effect on the family members, rates of psychiatric illnesses among family members of individuals with substance use disorders, and the manner in which family can be used as a strength in the therapeutic processes. The second speaker would present the findings of a randomized controlled trial which delivered contextually relevant 3-session brief family intervention among family members of patients with opioid use disorders. The third speaker would explain the genesis and journey of a family empowerment clinic that focuses on the distress of family members of patients with substance use disorders, and would present the experiential account of the therapeutic interventions that have been feasible.

Symposium

Internet Gaming Disorder – from Neurobiological Underpinnings to Treatment Strategies

Behavioural Addictions (BA) has increasingly become a major public mental health concern, with its high prevalence and associated disability. Despite this, there is little clarity in the neurobiological underpinnings of BA. A better understanding will improve conceptual clarity and facilitate effective treatment.

This symposium examines the findings of a study which has explored neurocognitive underpinnings of Internet gaming disorder, by comparing the neurocognitive performance pertaining to reward and compulsivity paradigm using neuropsychological measures, neurohemodynamic (fMRI) and gray matter (sMRI) differences with the comparative groups those with obsessive compulsive disorder (OCD) and healthy controls.

Approximately 30 subjects with IGD, OCD and HC were compared and our study finding suggests that there are overlaps between the compulsivity circuits between subjects with IGD and OCD. Both groups differed in impulsivity scores (higher impulsivity in IGD). These findings suggest that IGD (& other behavioural addiction) may need to conceptualized as a combination of impulsivity and compulsivity dysfunctions, rather than the classical description of it being related to ‘substance addictions.

The symposium will explore the public health importance of BA, the current neurobiological conceptualisations and how this should refine management strategies encompassing both pharmacological and non-pharmacological approaches.

PSYCHOTHERAPY AND PSYCHOTROPIC DRUG TREATMENT: NEUROBIOLOGICAL AND PSYCHODYNAMIC PERSPECTIVES

This symposium addresses certain neurobiological findings involved in the healing of the mind by psychotherapeutic, yogic, meditative practices and the importance of psychodynamic factors in improving psychotropic drug treatment outcomes.

1. Neurobiology of Psychotherapy and Healing: East-West Integration Presenter: Shree Vinekar, MD Starting in the brain research-rich 1990s, Dr. Vinekar explores merging findings correlating neuroscience and mind, both for positive psychiatry and understanding psychopathology. Psychotherapy and yoga wield transformative power, reshaping cognition and brain through gene and synaptic changes. Mind-brain dichotomy should not persist in the mind of the therapist. Psychoanalysis, yogic practices and meditation impact brain function. Technological limitations remain and hinder full grasp of neurobiological mechanisms in psychotropic medication treatment as well as the healing processes in the mind. The integrated framework as presented also aligns with epigenetic research, hinting at evolutionary theory and Lamarckian role in human evolution.

2. Psychodynamic Factors in Psychotropic Prescribing Presenter: Sudhakar Madakasira, MD Recognizing that medical noncompliance and patient resistance are frequent in medical and psychiatric practices and utilizing case vignettes, Dr. Madakasira examines often-forgotten psychodynamic factors in ever-increasing psychotropic prescribing. Positive transference may underlie a placebo response to a medication. When symptoms serve as a defense mechanism, patients are likely to resist medication effects. Nonadherence to treatment may occur in patients with attachment issues that make it difficult for them to trust anyone. Understanding psychodynamic factors such as transference, attachment and countertransference can help improve therapeutic alliance, treatment decisions and patient outcomes.

Empowering Individuals with Mental Disorders Through Employment: Paving the Path to Recovery

Schizophrenia Research Foundation and Chennai Psychiatric Society

In this symposium, the presenters will delve into the transformative journey of empowering individuals with mental disorders by gainful employment through Individualised placement and support through the model of supported employment within the Indian context. Here, the presenters will share their experience of this journey to provide a holistic perspective on the intersection of mental health and employment.

Title 1: SCARF-CPS supported Employment Project: Conceptualization, Collaboration and Importance

Speaker: Dr Siva Ilango, President, Chennai Psychiatric Society

In this inaugural segment, Dr Siva Ilango, President of the Chennai Psychiatric Society, helps us to understand the origins of this visionary approach and the commencement of our transformative journey towards empowering individuals with mental disorders through employment. This presentation will provide a comprehensive exploration of the strategic and financial underpinnings that have underlined this innovative project. He will also talk on how collaboration is the crux and the importance of the project in the current social milieu.

Tile 2: SCARF-CPS Supported Employment Model: Bridging the Gap

Speaker: Dr Mangala, Consultant Psychiatrist, Schizophrenia Research Foundation

In this talk, Dr Mangala will delve into SCARF’s prior experience in aiding individuals with mental illness in securing employment and the evolution of the SCARF-CPS Supported Employment Model. This session will shed light on the various positive outcomes that employment has on individuals with mental illness. Discover how this innovative model has played a pivotal role in bridging the divide between mental health and employment, providing individuals with a meaningful route to recovery and self-sufficiency.

Title 3: Uncovering the Ground Realities: Research, Challenges and Triumphs

Speaker: Mr. Aravind Guru, Clinical Psychologist and Research Assistant, Schizophrenia Research Foundation

During this presentation, Mr Aravind dive deep into the ground realities in the implementation of the SCARF-CPS model within the job market. This session will address the pragmatic challenges, including job acquisition, job suitability, discrepancies between the patient’s current functional capacity and job expectations, factors influencing job sustainability, and external environmental factors. We will also explore our strategies for addressing these challenges and successfully placing patients in suitable employment. Additionally, we will highlight the significance of educating new employers about mental illness and how to support employees facing such challenges.

Title 4: Employer Perspectives: Enabling Change in Organizations

Speaker: Magic Bus

Our symposium concludes with a thought-provoking session where an enlightened employer shares their perspectives and experiences of employing individuals with mental disorders within their company or organization. Provides insights into the transformative impact on both employees and employers and understands the value of fostering inclusive workplaces.

Abstract for Symposium: Delivery of Community Mental Services in India: An experience of ‘reaching the unreached’ from the state of Haryana

jagritipsyc07@gmail.com

Highlighting the magnitude of problem and need of intervention at the community level in Indian perspective

Jagriti Yadav, Senior Resident IMH, UHS, Rohtak

A reflection on statistics of mental health problems across lifespan is pertinent for resource development at the community level. The needs are affected by various neurobiological, environmental and socio-cultural factors especially in Psychiatry which demand careful consideration. We will be highlighting the problem statement with respect to need of community psychiatry services in India.

An experience of delivering community mental health services in rural areas of Haryana

Sunila Rathee, Associate Professor SDDTC, IMH, UHS, Rohtak

The majority of mental health service centres are limited to urban areas in the state of Haryana.

This consequentially limits the accessibility and availability of services for rural population. We developed a model of care for the rural community which will be comprehensively discussed. Subsequently, the observations by our team and un-recognised concerns in the rural communities will be put forward.

Addressing the challenges and future prospects of Community Psychiatry in India

Avni Gupta, Senior Resident

Dr. BSA Hospital and Medical College Govt. of NCT, Rohini, New Delhi

The challenges faced in community based interventions in India shall be highlighted. Further, a dual perspective of community care in the western world and India shall be provided in order to device a conceptual framework for community service delivery in future.

Insulin Resistance and metabolic derangements in children with Autism- Are we looking at a distinct phenotype?

Speaker 1: Dr Shankar K, Associate Professor, Dept of Psychiatry, Bangalore Medical College & Research Institute, Bangalore.

Autism spectrum disorder is a heterogenous condition with various phenotypically distinct subtypes. Metabolic derangements are prominent in a subset of individuals, the biological basis of which is being studied in recent years.

Evidence points to role of low-grade inflammation and oxidative damage as key abnormalities. Markers of mitochondrial dysfunction such as elevated lactate, reduced carnitine and altered metabolism of branch chain amino acids may underlie these abnormalities. These may contribute to both peripheral and central insulin resistance.

Speaker 2: Dr Pranjal Sharma R, Psychiatrist, Bangalore.

Mitochondrial dysfunction and central insulin resistance has been correlated with greater severity of ASD symptoms, poorer cognitive function and higher burden of EEG abnormalities and seizures.

Speaker 3: Dr Shubhashree L, Psychiatrist, Bangalore.

Obesity, hypoglycaemia and hyperphagia are associated with insulin resistance and may be inherent to this subtype of ASD. These are also known to contribute to premature mortality. Contribution of the wide use of antipsychotics in this population on metabolic abnormalities also needs to be disentangled.

Concluding Remarks: Dr Shankar K

Describing this phenotype will have immense clinical value with possible implications on recognition, prevention, and management.

• It may warrant higher forms of evaluation for abnormal metabolites and genetic abnormalities

• It may require closer scrutiny of metabolic derangements and judicious use of antipsychotics

• It may elucidate role of metabolic interventions in the form of special diets etc.

Relevant data from the study on a cohort of children with ASD will be presented at the symposium.

We acknowledge Mrs. Jayashree Ramesh, Director, ASHA School for Autism, Basaveshwarnagar, Bangalore and other school staff for supporting us in conducting this study.

Corresponding Author: Dr Shankar K, Associate Professor, Dept of Psychiatry, Bangalore Medical College & Research Institute, Bangalore. Phone: 9844546083. Email: shankarkjs@gmail.com

Symposium on Regression Analysis in Mental Health Research

Prof. B. Das, Hariom Pachori, Dr. Avinash Sharma

Regression plays a pivotal role in mental health research. In this symposium we will discuss the basics of commonly used Regression Methods (Parametric & Non- Parametric Regression) in mental health research. We would try to answer all the below mentioned questions through examples in the symposium.

1. What is Regression?

2. What is Parametric & Non- Parametric Regression?

3. Why Regression is important in Mental Health Research?

4. What are the landmark studies in Mental Health Research using Regression?

5. What are the statistical issues in Regression? Mental Health Research, Regression

Titles of presentation:

1. Regression: An Overview : Prof. Basudeb Das

2. Regression in Mental Health Research: Some Landmark Studies: Dr. Avinash Sharma

3. Parametric & Non- Parametric Regression: Statistical Issues: Hariom Pachori

Details of speakers:

1. Prof. Basudeb Das, Director & Director Professor of Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi-834006.

2. Mr. Hariom Pachori, Statistician, Central Institute of Psychiatry, Kanke, Ranchi- 834006.

3. Dr. Avinash Sharma, Associate Professor of Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi-834006.

Exploring the Intersection of Literature and Mental Health

Chairperson: Dr Vinay Kumar Co-Chair: Dr Ruma Bhattacharya Speakers:

Dr Ajith Bhide, Dr Anand Nadkarni, Dr Raghuram TM and Dr K S Shubrata*

Mental Health & Literature Task Force, Indian Psychiatric Society

*Corresponding presenter: shubrataks@gmail.com Phone number: 9448149927

This symposium would highlight the profound connections between literature and Mental Health which enrich our understanding of the human psyche and the role of literature in both exploring and healing it.

1. Literature as Sublimation: Dr K S Shubrata

   Literature serves as a powerful tool for sublimation, enabling individuals to channel their innermost thoughts, desires, and emotions into creative expression. This process not only offers catharsis for the writer but also invites readers to engage with and reflect upon their own subconscious desires and struggles.

2. Depiction of Mental Illness in Narrative Fiction: Dr Anand Nadkarni

   Narrative fiction has long been a platform for the nuanced portrayal of mental illness. Through characters and their experiences, authors shed light on the complexities of various psychological conditions. These narratives not only raise awareness but also reduce stigma, fostering empathy and understanding among readers.

3. Psychological Pathology Among Famous Literary Figures: Dr Ajith Bhide

   Numerous famous literary figures have grappled with psychological pathology, which often finds its way into their work. Exploring the lives of such writers reveals the intricate interplay between mental health struggles and artistic genius.

4. Poetry as Therapy: Dr Raghuram TN

   Poetry transcends mere words; it is a form of therapy for both poets and readers. Through the concise and evocative nature of poetry, individuals can articulate their emotions, find solace, and gain clarity. This therapeutic aspect of poetry is harnessed in creative writing workshops, bibliotherapy, and expressive arts therapies, offering healing and self-discovery to those who engage with it.

Non pharmacological approach in BPSD and its caregiver’s issues in a current treatment scenario.

Background and Objectives: To provide an overview of non-pharmacological interventions and care giver’s issues for behavioural and psychological symptoms in dementia (BPSD).

Results: Nonpharmacological practices to address BPSDs include sensory practices (aromatherapy, massage, multi-sensory stimulation, bright light therapy), psychosocial practices (validation therapy, reminiscence therapy, music therapy, pet therapy, meaningful activities), and structured care protocols (bathing, mouth care). Most practices are acceptable, have no harmful effects, and require minimal to moderate investment.

Discussion and Implications: Nonpharmacological practices are person-centered, and their selection can be informed by considering the cause and meaning of the individual’s behavioural and psychological symptoms. Family caregivers and paid care providers can implement evidence-based practices in home or residential care settings, although some practices require the development of more specific protocols if they are to become widely used in an efficacious manner. Care givers are base of this treatment. They become burnout and stressed in long run. They also need special care. The recent search of systematic and other literature is reviewed. Each practice was also reviewed to determine acceptability, harmful effects, elements of effectiveness, and level of investment required, based on time needed for training/implementation, specialized care provider requirements, and equipment/capital requirements.

Keywords: Behavioural and psychological symptoms of dementia (BPSD), Nonpharmacological.

Intimacy Matters--- Managing Sexual Problems: Abstract for Symposium for ANCIPS 24

•1.Dr Sona Kakar MD

• Psychiatrist and psychotherapist

• Talk Time Clinic Hyderabad

• drsonakakar@gmail.com

• 2.Dr TSS Rao MD

• Psychiatrist and Sexologist

• Professor Dept. of Psychiatry JSS Medical College Mysuru

• tssrao19@gmail.com

• It is well known that the adult relationships are based on the template of the relationship a person has with the primary caregiver(Bowlby). Any rupture to that relationship or attachment trauma can set off a series of responses very well studied and observed by Mary Ainsworth in her strange situation experiments.

• She observed three responses ranging from a secure attachment pattern to an insecure attachment style. These patterns are reflected in the patients adult life. An insecure attachment style may often affect intimacy both emotional as well as physical, both of which can contribute to psychological symptoms.

• In this symposium we want to highlight the importance of relational patterns and their effect on intimacy and sexual life of an individual and the psychopathology that follows due to a primary disturbance in intimacy in relationships

• The aim of the symposium is to highlight the importance of treating the relational patterns and intimacy issues as an important adjunct to managing sexual psychopathology

Abstract For Symposium: Is suicide a mental health, public health or societal problem?

Dr. Aditi Gupta¹, Dr. Arka Adhvaryu²

1.Junior Resident RG KAR Medical College, Kolkata, West Bengal

2.Senior Resident RG KAR Medical College, Kolkata, West Bengal

Suicide is a fatal act that represents self-planned and deliberate termination of one’s life. According to WHO more than 8,00,000 people die by suicide every year. It is the second leading cause of death among 15–29-year- olds. Global suicide mortality rate amounts to 1.4% of all deaths worldwide.

India’s annual death rate is 10.6 per 100,000.

Previously, psychological autopsies have shown that the majority of suicide victims had a mental illness. This number may be at least 90%,

according to a recent statistic. Most commonly suicide is associated with Depression (20%), Schizophrenia (10%), bipolar disorder (15-20%), Alcohol dependence (15%), antisocial personality disorder (5%).

Despite a large rise in drugs prescribed and ongoing treatment for at-risk patients, suicide rates remain high, hence an alternative perspective posits suicide as a multidimensional public and mental health issue, having complex interactions with the economic, social, cultural, psychological and biological realms of individual and collective existence.

The external social world affects individual well-being and psychache, indicating the social foundations of suicide. The external social world is complex and multilayered, with network structures and shared cultures that influence individual group members through their social identities and social emotions, hence suicide is more of a societal problem rather than just a mental disorder.

The present discourse on suicide has suppressed important discussion by portraying it as a public health and mental health issue that can be treated with pharmacological interventions. We need to abandon this narrow perspective and adopt a more holistic approach towards the same.

Emerging paradigms of suicide risk assessment: Validity, utility, and future directions

Vikas Menon*, Rajeev Ranjan, Debadatta Mohapatra

*Professor, Dept of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry. Email: drvmenon@gmail.com

Associate Professor, Dept of Psychiatry, All India Institute of Medical Science (AIIMS), Patna Assistant Professor, Dept of Psychiatry, All India Institute of Medical Science (AIIMS), Bhubaneswar

Current suicide risk assessment models suffer from two main drawbacks. First is their reliance on long-term risk factors, such as lifetime suicidal ideation (SI) to formulate and predict near-term risk of suicide, an approach for which little supporting evidence exists. Second, perhaps more important, is their reliance on overtly expressed suicide ideation (SI). This is problematic because expressions of SI are often ephemeral, fluctuating, and unreliable. There is a need for refined risk assessment models that can identify individuals at increased near-term risk of suicide regardless of overtly expressed SI. The present symposium will provide an overview of two emerging suicide risk assessment paradigms that seek to fill this literature gap: the Suicide Crisis Syndrome (SCS) and the Acute Suicidal Affective Disturbance (ASAD). The SCS represents an acute, pre-suicidal mental state characterized by affective and cognitive disturbances and is under evaluation for inclusion in subsequent iterations of the Diagnostic and Statistical Manual of Mental Disorders. Likewise, Acute Suicidal Affective Disturbance (ASAD) is a newly proposed diagnostic entity that characterizes rapid increase in suicidal intent and affective, cognitive, and behavioral disturbances such as self-alienation, social alienation, irritability, agitation, and insomnia. We will discuss the validity, clinical utility, and correlates of the SCS for which there is recent evidence from the Indian setting. Finally, we will discuss future research directions in this area that will enable us to leverage SCS best to identify those at risk of suicide among the general population and key diagnostic subgroups.

Proposed topics and order of speakers:

1. Burden of suicide and need for efficient suicide risk assessment models - RR

2. Overview of two pre-suicidal constructs: the Suicide Crisis Syndrome and the Acute Suicidal Affective Disturbance – DM

3. The Suicide Crisis Syndrome: Validity, clinical utility, and way forward – VM

Symposium title: Statistics Demystified

• 1)Basics of descriptive statistics: Dr. Diya P Albert

  The speaker will be describing the various types and levels of variables, the statistical measures used in descriptive statistics and ways of presenting the same.

• 2)Principles of inferential statistics: Dr. Vidhukumar K

  The speaker will be describing how the statistical methods help in deciding the summary estimates of the sample are not random findings. The hypothetical chain of normal distribution, standard normal distribution, sampling distribution, sampling distribution of means and standard sampling distribution of means will be explained. How this progression helps in hypothesis testing and confidence estimation, irrespective of the statistical tests used will be explained as well.

• 3)Statistical testing : Dr. Deenu Chacko

  The speaker will be explaining about the various statistical tests used to test the significance, commonly used parametric and nonparametric tests and the significance of p value. The speaker will be also commenting on when, how and what to communicate to a statistician while doing research.

ADDICTION: LESSONS LEARNT FROM AROUND THE WORLD

It is estimated that 275 million people used illicit drugs, such as cannabis, amphetamines, opioids, and cocaine, in 2016, translating into an annual prevalence of 5.6%. Cannabis is the most used with 192 million users.

31 million people who use drugs suffer from drug use disorders. Almost 11 million people inject drugs, of which 1.3 million are living with HIV, 5.5 million with hepatitis C, and 1 million with both HIV and hepatitis C worldwide.

The case studies of countries that have implemented out-of-the-box ideas will be discussed including the example of Uruguay, the Netherlands, and Portugal among others.

In Uruguay, the civil-military dictatorship passed “Decree Law 14294” in 1974 wherein all citizens were allowed to have a minimum quantity of illicit substances intended solely for personal use. The country has gone on to enact a series of groundbreaking laws which have decriminalized addiction and have actually resulted in lower incidence of drug crimes, as well as, drug overdose.

Similar examples from the Netherlands, Portugal, and other countries will be presented.

The lessons which are of importance to our country will be presented and discussed.

ABSTRACT FOR SYMPOSIUM TO BE PRESENTED AT ANCIPS 2024 MHCA TASK FORCE: MHCA 2017 experiences in different settings from India

Proposal - Chairperson,MHCA TASK FORCE ,Dr Savita Malhotra

Need for Mental Health Legislation

MHCA 17 has not been implemented across India even after five years of its existence. Further, instead of improving the mental health care in the country, MHCA 17 is hindering the right to mental health care in the process of protecting the rights during treatment. Ever since the notification of MHCA in 2017, there have been considerable debate and discussion among psychiatrists, raising issues about the feasibility, appropriateness, and usefulness of the various provisions of the Act in real life situations. There has been tremendous discontent and unhappiness. Basically the need for a separate Act for mental health care is questionable. The Act envisages integration of mental health care with physical health care at all levels. There are no separate Acts for other medical specialties even though all patients have and are granted protection of their rights during treatment. Mental illness is no different from physical illness. Separate laws for persons with mental illness or separate registration of mental health establishments is stigmatizing. This thought has been expressed by many psychiatrists in the country. Setting up of mental asylums of psychiatric hospitals in faraway places, to protect the society has been a legacy of the past when there were no treatments for mental illness. With advancement of science and medical knowledge, treatment of most mental illnesses is possible and effective. Also, the persons with mental illness are taken care in community and in their homes. Only a small proportion of severely mentally ill who may have lost insight or judgement or capacity to take decisions about themselves, living with their families or otherwise those who are homeless, wanderers or destitute, require the protection of the state against violation of their human rights. Treatment of all other types or grades of mental illness can very much remain as simple and accessible as treatment of any physical illness.

Dr Shrut i Srivastava, Professor(Psychiatry),UCMS & GTB Hospital Delhi-Member, MHCA TASK FORCE

Mental Health Care in General Hospital settings

General Hospital Psychiatry Units are primarily set up to eliminate stigma and provide access to mental health services in the similar manner as physical illnesses. GHPUs deal with common mental disorders, consultation liaison psychiatry practises, deaddiction services, stress related disorders , other various mental health problems /disorders. Budget as well as the facilities(infrastructure), manpower, resource allocation of running mental health services at GHPUs are far less as compared to the Psychiatric hospitals at the Centrally run institutes. The provisions of advance directive, nominated representative, capacity assessment and the stringent admission provisions, regular updates to MHRBs and SMHA in day to day functioning will lead to too many administrative hassles. Mental health professionals provide services in good faith just as any other medical professionals.

Medical boards are constituted similar to physical illnesses and patient suggestion, complaint box as well as grievance redressal work in the similar way as for other physical diseases. Efforts should be to provide better mental services for intervention, rehabilitation, community based approaches without any stigma, ease of access, with less paper work, with emphasis on the fulfilment of the rights of persons with mental illness. By the MHCA definition and Chapter V Section 18(6) cited above, all general health care establishments will qualify to be mental health establishments. The Act does not recognise the fact that mental illnesses and physical illnesses frequently cooccur. The Act treats mental illness in isolation and makes no provision for integrated care which is currently provided in general hospital psychiatry units, medical colleges, district hospitals and multi-specialty corporate hospitals. All these cannot be termed as mental health establishments. It is therefore advisable to exclude general hospital psychiatry units, medical colleges, district hospitals and multi-specialty corporate hospitals from definition of Mental Health Establishments, suggestion supported by the survey finding of the Task Force.

Dr Jayaprakashan K P: Co-Chairperson, MHCA TASK FORCE

Implementation of MHCA in India

State Mental Health Authorities (SMHA) in various states across India are in different stages of implementation. Central Mental Health Authority (CMHA) has been constituted by Central Government as well as central rules have been laid down, notified. The websites of SMHA, CMHA require regular updating. The description of the functioning of SMHA, CMHA with state-wise data will be presented throughout India. MHCA Task Force strongly suggests to allocate funds, training of all relevant persons including law enforcement official, mental health professional and other health professional, about the provisions and implementation of the Act. A major suggestion of the Task Force supported by survey of practising psychiatrists asks that the composition of SMHA needs review, there ought to be greater representation (at least 50% of total number of members) and greater role for psychiatrists in decision making in SMHA, as they are the subject experts and have the primary duty to treat mental illness.

Dr Mahesh R Gowda: EC Co-Ordinator, MHCA TASK FORCE

MHCA and Psychiatric care in Private Set up

Over 60% of mental health care in the country is provided by and in the private sector. Difficulties in complying with the requirements of MHCA is forcing the psychiatrists in private sector to close down their inpatient services. This is causing a huge setback to patients with mental illness as the number of psychiatric beds in government sector are highly insufficient to meet the need. Psychiatric services running in private sector require regular licencing, face audits and monitoring, submit regular information to Mental Health Review Boards and so on. The role of families and caregivers in present MHCA 2017 is compromised. In India, most burden of care of mentally ill is shouldered by the family. There is no mention of rights of caregivers, family members who bear the brunt of patients who refuse treatment. India is a developing country where families play a pivotal role in taking care of persons with mental illness. The Act needs to be modified making MHCA 2017 culturally sensitive, not following western models solely. Penalties described in the act on practising psychiatrists are very steep and unfair. The practising psychiatrists are working in the best interests of the patient care and services are being rendered by them in good faith. MHRB, has not started functioning in most states. Most psychiatrists in India feel that there is no need for MHRB or a judicial body monitoring the treatment and discharge of patients. It could be a hospital board or a medical board instead. As per the Act, it is obligatory for the government to provide access to mental health care to all citizens across the board as a statutory right. In reality, nothing much has been done to augment services, manpower or infra structure. By one estimate, it will cost over Rs 94,000 crore. As against this, govt‘s annual budget on mental health care is miniscule.

PHENOMENOLOGY- THE ART OF PSYCHIATRY FAST DISAPPEARING

Phenomenology is one of the basics we are taught during Psychiatry post graduate training.

Understanding the psychic phenomena, their form and content, using the various interviewing skills is an essential part of the training. But the text book sources of Phenomenology are often in German, meanings lost in translation, certain words having no substitute in other regional languages and many text books have newer editions which are far from satisfactory. The old school teachers who taught phenomenology are fast dwindling in numbers and are often mocked at by the new genre of biological psychiatrists. In the midst of fascinating functional genomics, connectomics and the r-DOC, will the phenomenologists survive? The points for and against the scope of this intriguing , yet largely subjective experiences is being discussed in our symposium.

VIOLENCE AND AGGRESSION- THE RESIDENT EVIL AND HOW TO DEAL WITH IT

Aggression and violence are omnipresent in Psychiatry, we are never far from its risk. Recent times have shown many cases of violence directed against treating personnel, some of them shocking us.

Aggression and violence are symptoms of several underlying disorders ranging from organic to severe mental illnesses like Schizophrenia and mania, to substance intoxication and withdrawal and even personality disorders. Violence risk assessment is an essential skill to be mastered during psychiatry training. So also the comprehensive management protocol for violence, which needs a team of adequately trained personnel.

In this symposium, we deal with the biology and psychology of violence, the various risk assessment tools and protocols and the pharmacological and non pharmacological management of violence.

DISABILITY EVALUATION IN PSYCHIATRY- PAST, PRESENT AND FUTURE

Disability evaluation has always been a difficult construct to conquer in Psychiatry. We have moved forwards from the PWD act of 1995 to the newer RPWD of 2016, there have been an elaboration on the list of conditions listed for disability. There are major changes in areas like hematology conditions, locomotor disability etc. mental behaviour, mental illness block still has a non specific diagnosis which needs a lot more clarity. The conditions under this block is still unclear, though the intellectual disability section has elaborated realistically in tune with the changing times. The assessment tool in Psychiatry is IDEAS still, its inadequacy in conditions like TBI etc is being debated a lot.

This symposium is looking into the evolution of disability evaluation in Psychiatry till present times, the current scenario with RPWD 2016 and its many pros and cons, and the future of this difficult construct, the possibility of tools better than IDEAS.

Use of Maintenance Electroconvulsive Therapy in Psychiatric Disorders

INTRODUCTION:

Continuation ECTs (C-ECT) refers to ECTs administered within 6 months of remission, while treatments beyond 6 months are considered maintenance (M- ECT). Continuation and maintenance electroconvulsive therapy (ECT) can be used to reduce the risk for relapse and recurrence of illness in patients who fare poorly with standard medication regimens. There is decreased chance for symptom relapse in major psychiatric disorders when continuation or maintenance (M-ECT) ECT is combined with psychotropics.

CASE PRESENTATIONS:

This is a single-centre, retrospective review of patients diagnosed with major psychiatric disorders (as per International Classification of Diseases, 11th edition) who are receiving M-ECT in Department of Psychiatry, B.J. Government Medical College and Sassoon Hospital, Pune. We included 8 patients- 3 males and 5 females in this study. There was a reduction in hospitalizations for acute exacerbation and significant improvement in the patients’ overall functioning on standardized scales without significant adverse effects.

DISCUSSION:

Relapse rates after discontinuation of ECT are very high. Maintenance ECT is an underused treatment option that can substantially reduce risks of relapse in patients with major depressive disorder, bipolar disorder and schizophrenia as well. Despite the potential value of these ECT schedules, both are relatively neglected in clinical practice.

2nd National Innovative Collaborative Symposium on Expanding Horizons in Poetry and Psychiatry by The Poets of Psychiatry Group

Background: The Poets of Psychiatry Group is a collaborative group of Psychiatrists who write Poetry for Psychiatry and Mental Health Awareness. It is currently having 70 Psychiatrists members across India and abroad. It is founded by Dr Darpan Kaur.

Aims and Objectives:

To conduct the 2nd National Innovative Collaborative Symposium on Expanding Horizons in Poetry and Psychiatry by The Poets of Psychiatry Group

Methods:

The symposium was planned over online meetings and discussions of The Poets of Psychiatry Group. The members collaborated with each other online to finalise the theme, speakers and subtopics. It is planned on innovative, creative and novel areas of Poetry and Psychiatry. The symposium shall highlight interesting aspects of Founders Perspective, Neuroscience, Psychology, Sociology, Psychotherapy and Community mental health awareness in relevance to Poetry and Psychiatry

Speakers and Topics:

Dr Darpan Kaur: Founder’s Perspective Dr Deepali Gul: Neuroscience of Poetry

Dr Neha Sharma: Interface of Psychology, Sociology and Poetry

Dr Manpreet Singh Virk: Applications of Poetry to Clinical Psychiatry Practice Dr Tushar Jagawat: Poetry for Mental Health and Community Awareness

Conclusion: The symposium shall conclude on discussions followed by Q and A session.

Symposium: Assessment and Management of Depression Among Elderly

Speakers: Sandeep Grover¹, Abdul Maajid², PT Siva Kumar³

• 1-PGIMER, Chandigarh
• 2-SKIMS, Srinagar
• 3-NIMHANS, Bengaluru

Depression is one of the commonest psychiatric disorder among the elderly. Compared to adult patient, elderly with depression, more often present with the somatic symptoms. Due to change in physiological reserve, the recommendations for use of antidepressants among the adults can not be directly translated into the geriatric practice. In elderly patients with severe depression, Electroconvulsive therapy is a safe and effective treatment modality. In this symposium:

Dr P T Siva Kumar will discuss the issues pertaining to the clinical presentation of depression among the elderly and how does the clinical presentation differ from that of adults.

Dr Abdul Maajid will discuss the issues involved in selection of various antidepressants among the elderly. The presentation will also focus on the available evidence base for the various antidepressants among the elderly

Dr Sandee Grover will discuss the issues involved in the use of electroconvulsive therapy and the available evidence for use of ECT among the elderly.

Mental health of older adults in the context of climate change in India

Kanya Nesbeth¹, Rajdip Barman², Badr Ratnakaran³

¹Howard University Hospital,²Genesis Health System,³Carilion Clinic-Virginia Tech Carilion School of Medicine

India is ranked seventh among the nations susceptible to the consequences of climate change. Daily average temperature and air pollution have also increased in India, and extreme weather- related events, including heat waves, are becoming more frequent. Climate change can have a significant impact on the physical and mental health of older adults. It can contribute to cognitive dysfunction and depression in older adults along with causing new onset of mental illness like phobias and anxiety related to climate-change related events. As the population of older adults is increasing in India, it is crucial to address the current and future consequences of climate change on older adults’ mental health. In our symposium, we will focus on the importance of climate’s influence on older adults’ mental health and the risk factors that contribute to the vulnerability of older adults to climate-change-related events. The influence of ambient changes in temperature and air pollution on depression and cognition of older adults will be highlighted during our symposium. Various psychopharmacological challenges related to climate change, including adverse effects of psychotropic medications including body temperature regulations will be described during our session. We will recommend various strategies to mitigate the risks to mental health caused by climate change in older adults.

Abstract for symposium: Mental Health in the Indian Navy: A Hub and Spoke Model

The Indian Navy is the maritime force of the Indian Armed Forces and is the seventh largest navy in the world. For the Indian Navy to be operationally ready, it is of utmost importance that every sailor is in the prime of health, both physically as well as mentally. With this view, the latest mental health model in the Indian Navy aims to increase the awareness about mental health issues among the various stake holders, which would ultimately lead to early identification of vulnerable individual and persons with mental illness thus ensuring timely intervention. With an ultimate goal of mental wellness among all, the current strategy is a hub and spoke model, wherein the psychiatrist is at the hub, coordinating the various mental health related activities, and the spokes are formed by various medical and non-medical personnel in the community, who liaise with the psychiatrist in carrying out the various mental health related activities in the community, and facilitate intervention by psychiatrist when deemed necessary. The current mental health model also envisions to run training programs for personnel based on the core idea of ‘train the trainers’ to increase the involvement of the community and to augment the mental health resilience of the naval personnel. This symposium aims to enlighten the audience regarding the existing mental health model in the Indian Navy and compare the same with the international scenarios.

Adolescence crisis vs Adolescence depression: Different approaches

Dr Bikram Kr Dutta, Dr Puneet Khanna, Dr Arun Yadav

Historically, there has always been debate over the intensity and frequency with which adolescent turmoil occurs and the extent to which it should be considered normative across epochs and cultures. They have been regarded by society with deep misgivings as potentially disruptive and subversive, not only difficult to handle, but threatening to undermine society’s strictures regarding sex, aggression, and respect for elders. Anna Freud noted that “the upholding of a steady equilibrium during the adolescent process is in itself abnormal”.

Parenting becomes challenging and stressful, as adults and adolescents appear to live in separate, if overlapping, realities, often viewing the same events quite differently. However, all is not gloom, and despite relatively high conflict, parents and adolescents tend to report that overall their relationships are good, that they share a wide range of core values, and retain considerable amount of mutual affection and attachment.

Although only a fraction of adolescents develop full blown depression, however, these period sees increase in emotional lability, depressed mood, and negative emotions. They also report substantial increase in the number of negative life events, and it gets difficult to ascertain whether this reflects more stressful environment, greater sensitivity to events, or shifts in the types of situations that precipitate negative emotion.

Points for discussion:-

• (a)Role of Indian parents in adolescence crisis/adolescent depression
• (b)Role of media – games adolescents play
• (c)Approaches to adolescence crisis and adolescence depression

Wellbeing and sustainability of the psychiatry workforce- a collaborative approach to a global challenge

Suggested speakers: Anis Ahmed, Ananta Dave, Subodh Dave Chair: Manoj Kumar.

The last few years in the wake of the Covid-19 pandemic have highlighted the increased demand for mental health services across all societies as never before, coupled with the increasing stress, burnout and mental illness experienced by healthcare professionals including psychiatrists. The sobering statistics about medic suicides which show a climbing trend, also drive home the importance of focussing on the mental health and wellbeing of doctors.

There are ethical, effectiveness and economic arguments to be made for prioritising the mental health of doctors as it is not possible to deliver the services that are needed without a workforce which is healthy, looked after and motivated to work.

Presenting a South Asian and British perspective on an organisational focus on mental health and wellbeing of doctors, a group of psychiatry leaders will explore and present an approach based on the following themes, using policy, data, narratives and examples of good practice:

Psychiatrists as leaders: With experience of identifying, diagnosing and treating mental illness, psychiatrist should take the initiative in advocating equally for their colleagues across the medical profession as they do for their patients to combat the stigma, silence and secrecy around mental illness and suicide in doctors.

Developing and delivering services for staff: working with multi-disciplinary colleagues like psychologists, occupational health professionals and nurses, this will ensure that a range of services at the right level of need will be available in a timely, sensitive manner for colleagues

Working with charities and voluntary organisations: using examples and initiatives like micro- volunteering, memorial tree planting, doctor 1in4 from the UK and Asian countries where volunteering, creative activities, and getting involved with charities working for doctors’ mental health and wellbeing can make a positive difference to mental well being

A preventative public health approach: Talking about the pact between society and the medical profession about expectations from doctors, challenging the superhuman culture in medicine, preparing College and University students for life as a doctor and supporting them right from the start of their medical career.

A collaborative approach: How the RCPsych, and Psychiatric societies from each country can work together

We hope the session will provoke, inspire and move all of us to bring about a tangible shift in the way we support one another to prioritise the mental well being of doctors. We cannot afford to lose any more to mental illness and suicide.

ANCIPS

RCPsych Submission Contact: agnes.raboczki@rcpsych.ac.uk

September 2023

Nurturing Resilience: Prioritising trainee well-being amidst shifting landscapes in psychiatry

Speakers: Dr Manoj Kumar, Dr Fabida Aria, Professor Mohammed Al-Uzri, Dr Chathurie Suraweera

In the ever-evolving landscape of modern medicine, with the addition of a global pandemic, the role of psychiatrists has become increasingly vital. The journey to becoming a psychiatrist is a transformative one, filled with opportunities for growth and challenges that test one’s resilience.

Consequently, the Royal College of Psychiatrists (RCPsych) recognises the paramount importance of trainee well-being in this dynamic environment.

This session will delve into the multifaceted aspects of trainee well-being, focusing on the unique challenges faced by those on the path to becoming psychiatrists. Our esteemed panel of experts will explore the various dimensions of this critical issue, highlighting strategies and resources available to address them effectively from both a British and South Asian perspective.

The discussion will encompass the following key themes:

1. Navigating a Changing Medical System: As the healthcare landscape evolves, trainees encounter new models of care, technological advancements, and evolving patient demographics. Understanding how to adapt and thrive within this shifting system is crucial for trainee well-being.

2. Balancing Clinical Demands: Trainees often grapple with demanding clinical schedules, intricate patient cases, and the emotional toll of treating individuals with mental health disorders. We will explore methods for maintaining a healthy work-life balance and building resilience in the face of these challenges.

3. Mentorship and Support Networks: Building a strong support network is essential for trainees. The session will emphasise the role of mentorship, peer support, and organisational resources in nurturing trainee well-being. It will also bring in the wider dimension of trainees migrating to other countries to gain experience and the support they’ll need adapting to new cultures.

4. Self-Care and Resilience Building: Participants will gain insights into practical self-care techniques and resilience-building strategies to help trainees manage stress, prevent burnout, and maintain their passion for psychiatry.

5. Advocacy and Policy Initiatives: We will also discuss the importance of advocacy in addressing systemic issues that impact trainee well-being, including workload, stigma, and access to mental health services.

Through a collaborative and insightful discussion, this session aims to inspire, empower, and equip trainees with the tools they need to thrive on their journey to becoming psychiatrists.

Understanding LGBTQ and Mental Health in India

In the period of only two decades, there has been dramatic emergence of public and scientific awareness of LGBTQ lives and issues. Although the decriminalization of homosexuality opened doors to acceptance of LGBTQ individuals in India, researches have shown that the community members face more mental health issues than heterosexuals. The stigma, prejudice, discrimination they face for being different drive them to the mental health issues like substance use disorders, affective disorders and suicidal thoughts. The repercussions of disclosure such as rejection and bullying at school, home and society; limited access to employment and social functions; loss of employment; denial of rights and all-encompassing social stigma have a great impact on their quality of life.

The recent judgement and the legislations has been a welcome step to increase the sense of respect for the transgender community. Transgender Persons (Protection of Rights) Act, 2019 aims to end discrimination against transgender persons in accessing education, employment and healthcare. The National Council for Transgender Persons has been constituted to advise the Central Government on the formulation and evaluation of policies, programmes, legislation and projects for the welfare of the transgender community.

The mental illnesses and challenges that India’s LGBTQ people face need comprehensive and long-term solutions that make queer mental health a priority and address community needs. As medical specialists, we can play a role in recognizing the individual and the specific needs of this group, while providing advocacy when possible, to close the health gap.

Schizophrenia and Bipolar disorder in patients with type-1 diabetes mellitus- neurobiological overlap

Presenters:

Dr Mamidipalli Sai Spoorthy, Assistant Professor, AIIMS, Bibinagar, Hyderabad Dr Sai Krishna Tikka, Associate Professor, AIIMS, Bibinagar, Hyderabad

Dr Devika Kosana, Assistant Professor, ESIC Medical college and Hospital, Sanath nagar, Hyderabad

Symposium Abstract

Schizophrenia and bipolar disorders, both severe mental illnesses, are now being hypothesized as neuroinflammatory or broadly neuro-immunological disorders. The neuro-immunological damage in schizophrenia and bipolar disorders is associated with an altered innate immunity, which is characteristic of autoimmune disorders like type-1 diabetes mellitus (T1DM). Intriguingly, autoimmune disorders, in general, have been shown to increase the risk of these disorders. Recently, meta-analytic studies have found that prevalence of every mental disorder, in particular depression, was greater in patients with T1DM.

Type 1 Diabetes is a lifelong autoimmune disease characterized by insulin deficiency and resultant hyperglycemia. It constitutes around 10% of all diagnosed cases of diabetes and its incidence is on the rise across the globe. Self-management is the cornerstone of diabetes care and involves calculation and administration of insulin, monitoring blood glucose levels, estimated carbohydrate intake and consideration of other factors such as physical activity levels. The burden of self-management is psychologically demanding. Patients with Schizophrenia and Bipolar disorder may have poor treatment adherence due to the underlying illness. Hence, we need to understand in detail about the association between these disorders.

Existing literature suggests controversial results with few showing inverse correlation between IDDM and Schizophrenia/Bipolar disorders and others showing positive correlation. We will try to summarize the findings of the existing literature about prevalence of Schizophrenia and bipolar disorder in T1DM patients and further pave way for better understanding of biological relationship between both types of disorders.

RAYS OF HOPE IN PSYCHIATRIC CARE: TMS, MATs and PHPs

The aim of this symposium is to present on some new developments in psychiatric treatment, particularly Transcranial Magnetic Stimulation (TMS) in psychiatric and neurological disorders, Monoclonal Antibody Therapies (MATs) targeting amyloid beta protein in Alzheimer’s dementia, and Partial Hospitalization Programs (PHPs) that bridge the gap between inpatient and outpatient care.

Transcranial Magnetic Stimulation: Amit Mohan, MD

TMS is a non-invasive neurostimulation technique that uses magnetic fields to stimulate specific areas of the brain. The current status, future and potential applications will be discussed as to: Depression, OCD, Neurorehabilitation, Pain Management, Cognitive Enhancement, ADHD, and Dementias. While TMS shows great promise in neuropsychiatric illnesses, there are still challenges to overcome, including refining treatment protocols, ensuring safety, and expanding accessibility.

Monoclonal Antibody Therapy in Alzheimer’s Dementia: Badr Ratnakaran, MBBS

Anticholinesterases and NMDA antagonists have long been used to improve cognitive outcomes in dementia. Newer agents that target amyloid beta protein, including Aducanumab and Lecanumab, are now available for treating mild cognitive impairment and Alzheimer’s disease. This marks a new era in therapies that address the underlying pathogenesis of Alzheimer’s dementia, Frontotemporal dementia and Lewy body dementia.

Partial Hospital Programs in Psychiatric Care: Sudhakar Madakasira, MD

PHPs provide transition between ever shortening inpatient hospitalization and delay-ridden outpatient care by providing intense therapies and close medication monitoring to further stabilize patients. PHPs can be as effective as inpatient treatment in all but most severely ill patients and are more cost-effective.

Abstract for Symposium on “Clinical dilemmas in Mental Capacity Act provisions as per MHCA 2017- a first hand experience”

Dr Ankit Daral, Specialist, Indira Gandhi Hospital, Dwarka, Delhi

Mental health Capacity is a concept originated from western literature. The primary reason for its introduction is to safeguard the interests of the patients who lack capacity to make their decisions with regard to their treatment decision making. The concept of admission with high support needs was introduced for individuals who lack capacity. Western nations that adopted the measure developed practise guidelines, semi-structured tools, utilised case vignettes , facilitated discussions, incorporated changes in their act from time to time. Evidence based on published literature from western countries also discusses the difficulties in clinical assessment tools. Capacity assessments share different experiences in different nations for different mental conditions, with unanimous voice of developing standardized tools for its assessment. The most widely utilised tool is the MacArthur Competence Assessment tool for treatment. This tool is based on the semi-structured interview and assesses understanding ,appreciation, reasoning ability, treatment choice of the mental disorder. The usage of existing tools , assessments and their limitations shall be discussed.

Dr Manjeet Singh Bhatia, Director Professor & Head, Department of Psychiatry, UCMS & GTB Hospital, Delhi

MHCA 2017, India states that determination of mental illness needs to be made as per the latest edition of International Classification of Disease of the World Health Organisation, Chapter II,MHCA 2017. MHCA 2017 further states that every person, including a person with mental illness has the capacity to make decisions regarding mental health care or treatment, information being provided in simple language. Even if others considers the patient decision making as wrong, still will not be considered to lack capacity. Expert guidelines on Capacity assessment were developed in order to assess capacity as per MHCA,2017 constituted by the central government. The discussion on mental capacity takes into account the advance directive, nominated representative as per MHCA 2017.

Difficulties encountered in day to day clinical decision making and how to overcome when implementing the guidance document in Indian context shall be discussed sharing own expertise in forensic psychiatry.

Dr Shruti Srivastava, Professor, Department of Psychiatry, UCMS & GTB Hospital, Delhi

Case based scenario of how the patient suffering from severe mental illness, coming to Psychiatry Outpatient Clinic improved in capacity to take treatment decisions over a period of weeks shall be highlighted. Another case scenario is a patient with substance intoxication willing to be admitted, receiving inpatient treatment. Clinical dilemma whether to admit as a voluntary or involuntary with high support needs shall be discussed and how the capacity assessment varies on an hourly basis. Third case scenario is of a patient of Dementia which poses a clinical challenge, more so if gets superimposed with delirium. Wandering, homeless, severe mental illness patient’s case based scenario preferring General Hospital Psychiatry Unit , refusing indoor admission with empathy ,rapport building , respecting patient autonomy shall be highlighted

Dr Pooja Yadav, Senior Resident, Department of Psychiatry, UCMS & GTB Hospital, Delhi

The capacity assessment in person with mental illness can lead to major shift in attitude of professionals during admission and treatment in Mental Health Establishment. A retrospective chart review for Capacity assessments in inpatient sample from a General Hospital Psychiatry Unit utilising MHCA 2017 compliant forms shall be presented. Published studies are using MacCAT-T which is a copyrighted scale and is not developed according to Indian scenario. Capacity assessment was carried out using expert committee guidelines laid down method. Capacity assessments carried out varied between the experienced psychiatrists within the same inpatient facility that required deliberations to reach final consensus , time of assessments, patient preference factors, clinical diagnosis, modality of treatment. 75% of participants were found to have an intact capacity to consent which is justified by available data from several countries which suggest that 22-75% of patients have intact capacity to consent for treatment.

SYMPOSIUM TITLE:

Persons, Places, Pandemics, and Nations: Clinically Unraveling the Effects of Trauma and Disaster in Our Globalized World

DURATION:

1 hour

Trauma is often thought to be an individual experience with lasting negative effects on a person’s health and wellbeing. However, trauma can be more fully understood at a multilevel interface, which includes trauma at an individual and at various group levels (E.g.- family, community, society, ancestry). In our increasingly globalized world, natural and human-caused disaster (E.g., earthquakes, wildfires, climate change, terrorism, war) can present as mass trauma influencing the emotional, cognitive, and physical medical wellbeing of communities, cities, states/provinces, and nations. We will explore the mechanisms by which adverse childhood experiences (ACEs) and large-scale disaster exert their negative impacts. In understanding the effects on brain, body, and behavior we will then look to individual and community-based solutions.

Groundbreaking scientific research is uncovering the dynamics of individual and group-based trauma and disaster. This symposium will make this advanced scientific research on the individual and group biologic and social relationships of trauma, disaster, and post- traumatic/post-disaster growth and resilience understandable and clinically applicable. The goal is to empower providers to utilize solutions that enhance resilience, promote post-traumatic growth, and move us in the direction of improved health outcomes.

LEARNING OBJECTIVES:

1. Define stress, injury, trauma, crisis, disaster, and post-traumatic growth.

2. Identify and understand the mechanisms by which Adverse Childhood Experiences (ACEs) exert longer term negative impacts.

3. Understand elements of medical disaster response and Disaster Psychiatry.

4. Explain biologic and social influences and outcomes in individual, family, micro community, and macro community-based trauma.

5. Identify individual and community-based solutions toward transforming trauma and disaster toward post-traumatic growth and reducing morbidity of ACEs.

SESSION OUTLINE:

Discuss injury, trauma, crisis, and disaster.

Overview of the adverse childhood experiences study design and findings. Physical health and aging impacts of early childhood adversity.

Mental health correlates of childhood trauma.

Overview of trauma & disaster and post-traumatic growth as clinical constructs for evaluating and treating patients.

Public health and community-based solutions to reduce the morbidities of ACEs.

Understanding how clinical and community interventions can promote resilience and post- traumatic growth.

REFERENCES

1. Berry, K., & Danquah, A. (2015). Attachment-informed therapy for adults: Towards a unifying perspective on practice. Psychology and Psychotherapy: Theory, Research and Practice,89(1), 15-32. doi:10.1111/papt.12063

2. Bierer, L.M., Bader, H.N., Yehuda, R., et al. Intergenerational Effects of Maternal Holocaust Exposure on FKBP5 Methylation. American Journal of Psychiatry. 2020; 177(8), 744-53. doi:10.1176/appi.ajp.2019.19060618

3. Higgins, E., & George, M. (2019). The neuroscience of clinical psychiatry (3rd ed.). Philadelphia, PA: Wolters Kluwer.

4. Houtepen, L. C., Vinkers, C. H., Carrillo-Roa, T., Hiemstra, M., Lier, P. A., Meeus, W., .. . Boks, M. P. (2016). Genome-wide DNA methylation levels and altered cortisol stress reactivity following childhood trauma in humans. Nature Communications,7(1). doi:10.1038/ncomms10967

5. Meichenbaum, D. (n.d.). THE-EMERGING-NEUROBIOLOGY-OF-RESILIENCE- June-2015.pdf. Retrieved from https://melissainstitute.org/

6. Resilience. (n.d.). Retrieved from https://www.apa.org/topics/resilience

7. Russo, S. J., Murrough, J. W., Han, M.-H., Charney, D. S., & Nestler, E. J. (2012). Neurobiology of resilience. Nature Neuroscience, 15(11), 1475–1484. doi: 10.1038/nn.3234

8. Walker FR, Pfingst K, Carnevali L, Sgoifo A, Nalivaiko E. In the search for integrative biomarker of resilience to psychological stress. Neurosci Biobehav Rev. 2017 Mar;74(Pt B):310-320. doi: 10.1016/j.neubiorev.2016.05.003. Epub 2016 May 11. PMID: 27179452.

9. Walker, P., 2013. Complex PTSD: Surviving to Thriving. New York, NY: Azure Coyote.

10. What is Epigenetics? (2020, August 03). Retrieved from https://www.cdc.gov/genomics/disease/epigenetics.htm

11. Yehuda R, Daskalakis NP, Bierer LM, Bader HN, Klengel T, Holsboer F, Binder EB. Holocaust Exposure Induced Intergenerational Effects on FKBP5 Methylation. Biol Psychiatry. 2016 Sep 1;80(5):372-80. doi: 10.1016/j.biopsych.2015.08.005. Epub 2015 Aug 12. PMID: 26410355.

12. Zhang, T., & Meaney, M. J. (2010). Epigenetics and the Environmental Regulation of the Genome and Its Function. Annual Review of Psychology,61(1), 439-466. doi:10.1146/annurev.psych.60.110707.163625

ANCIPS 2024- SYMPOSIUM: Alarming suicide Rate in India “Action Required to Create Hope”- A Need of the

Hour.

Dr Abhinit Kumar¹ , Dr Kunal Kumar², Dr Nikhil Nayar³, Dr.Shailendra Kumar Mishra⁴ ,Dr.Praneta Swarup⁵,Dr.Siddharth Bhargava⁶,Dr.Parika Kochhar⁷

1-Professor, Department of Psychiatry, School of Medical Sciences and Research, Sharda Hospital, Greater Noida, U.P

2-Professor & Head, Department of Psychiatry, School of Medical Sciences and Research, Sharda Hospital, Greater Noida, U.P

3-Assistant Professor, Department of Psychiatry, School of Medical Sciences and Research, Sharda Hospital, Greater Noida, U.P

4-Assistant Professor,Department of Psychiatry,Govt. Medical College,Banda, U.P 5- Assistant Professor, Department of Pediatrics, School of Medical Sciences and

Research, Sharda Hospital, Greater Noida, U.P

6-Post Graduate-3, Department of Psychiatry, School of Medical Sciences and Research, Sharda Hospital, Greater Noida, U.P

7-Post graduate-3, Department of Psychiatry, School of Medical Sciences and Research, Sharda Hospital, Greater Noida, U.P

Corresponding author: Dr Abhinit Kumar, drverma10@gmail.com, 9555212899

Suicide is an escalating global public health crisis, claiming more than half a million lives annually and casting an enduring shadow of despair over countless more. The profound social, emotional, and economic repercussions of suicide r?v?rb?rat? through families and communities, demanding our unwavering attention and collective resolve.

“Creating Hope through Action” stands as the triennial clarion call for World Suicide Prevention Day (WSPD) from 2021-2023. It serves as an unyielding reminder that an alternative to suicide exists, one that we can foster through d?lib?rat? and compassionate actions. This theme carries the profound message that hope, however exlusive, remains within reach, and that we stand united in our commitment to offer unwavering support to those in distress.

The theme underscores our shared responsibility to signal to individuals navigating the treacherous terrain of suicidal thoughts that a lifeline of hope is extended to them. It reaffirms that our actions, whether grand or small, possess the transformative power to infuse hope into the hearts of those grappling with despair.

In the Indian context, where suicide rates are alarming, it is our solemn duty as mental health professionals, educators, policymakers, and advocates to heed this call to action. By synergizing our efforts, we can crate hope through action, break down the barriers that entrap vulnerable individuals, and collectively work towards a future where despair is replaced with replaced, and lives are preserved.

ABSTARCT FOR SYMPOSIUM: Impact on cognition seen in patients undergoing treatment for opioid dependence

Proposed Speakers :

Dr. Himanshu Sareen (M.D.), Head of department and Professor , Department of Psychiatry , Punjab Institute of Medical Sciences , Jalandhar , Punjab

Dr. Arshdeep Kaur (M.D.) , Senior Resident , Department of Psychiatry , Punjab Institute of Medical Sciences , Jalandhar, Punjab

Dr. Mrinmai Pevekar (D.P.M. ), DNB Resident , Department of Psychiatry , Punjab Institute of Medical Sciences , Jalandhar , Punjab

Opioids have been known in various forms. It is available naturally, in semi- synthetic form and in synthetic derivatives for pain control. But also used in dependence pattern for their euphoric effects. The current prevalence of Opioid use in India is 2.1%, which is thrice the global average. It is reported that heroin use is 1.14%, other pharmacological opioids is 0.96% and opium use is 0.52%.It is known that Opioid dependence affects patient physically by developing withdrawal symptoms and craving on stopping Opioid usage and affects patients socio-occupational and cognitive functioning. Cognitive functioning consists of domains like attention, concentration, working memory and verbal memory. Effects on cognition due to opioid use are overlooked in literature so we want to draw attention to this important theme.

The first speaker would discuss various cognitive domains and how they can be tested in clinical setting.

The second speaker would discuss the correlation of cognition and opioid dependence.

The third speaker would discuss the findings of a study conducted in Punjab , where there is rise is opioid dependence every year, and its impact on cognition.

Do we know enough? Case for enhancing original research in Indian military psychiatry

Introduction: Military psychiatry has contributed tremendously to the growth of psychiatry as a medical field in India. A military psychiatrist must develop expertise needed to work with a clientele with unique mental health needs. A soldier and his family are faced with stressors of nature which are different form that seen in civilian life. Tremendous effort has been made by past and present generation of military psychiatrists to understand these needs and ways to address them.

However, with a rapidly changing landscape of military conflict, vast societal change, technological advances, virtual reality and artificial intelligence there is a need to update what we know about the soldier and his family. This shall put military psychiatry in good stead while delivering contemporary quality mental health care.

Aim: This symposium intends to highlight the need for enhanced original research in military psychiatry as well as generate ideas for future research in Indian military psychiatry.

Proposal: Three speakers will deliberate upon the topic broadly covering the aspects as -

• a)Speaker 1: Current state of research in Military Psychiatry
• b)Speaker 2: Present data generated by interaction with military psychiatrists relating to possible avenues of research, opportunities, expected difficulties and ways to overcome these.
• c)Speaker 3: The way forward

Abstract Proposal ANCIPS2024

Upskill Social Media Influencing & e-Mental Health Promotion: A Symposium-cum-Workshop

Dr Kashypi Garg¹, Dr N G Nihal^², Dr Rohan Jain^³, Dr Samiksha Sahu⁴

This symposium-cum-workshop delves into the intricate relationship between social media & mental well-being, exploring its potential benefits & challenges in a succinct manner.

Social media platforms like Facebook, Instagram, WhatsApp & X have become integral to our lives, offering opportunities for human connection, bolstering self-esteem & nurturing a sense of belonging. With >2.1 billion daily users, they have an unprecedented reach.

Advancements in technology & changing dynamics have transformed social media into a potent tool for disseminating knowledge, particularly on mental health. It excels in delivering online courses & activities, rivaling face-to-face interactions. This shift began with Facebook’s emergence in 2004, with 83% of 18-29 year olds now actively using social networking sites.

This symposium highlights the cost-effective potential of social media for promoting mental health awareness, fostering healthy lifestyles & need for tailored health promotion reaching diverse demographics. However, it’s crucial to acknowledge that unchecked use can contribute to stress, unhealthy comparisons & heightened isolation.

In conclusion, social media holds a pivotal role in mental health promotion. This symposium aims to explore its potential while promoting responsible & mindful consumption, recognizing its transformative impact on mental well-being.

Covering these frontiers:

• Negative Impacts of Social Media Use

• Why Social Media Influencing by Psychiatrist?

• e-Mental Health Promotion & Awareness - Current & Future scope

• How to upskill Social Media Influencing?

¹Assistant Professor, S.N. Medical College, Agra

²Consultant Psychiatrist, Kausalya Counselling Center, Visakhapatnam

³Consultant Psychiatrist, Ekta Hospital, Patiala

⁴Assistant Professor, Gandhi Medical College, Bhopal & Consultant Psychiatrist at Bhopal Neuropsychiatric Clinic & Diagnostic Centre

Symposium: Risking It All: Exploring the correlation between Pathological Gambling and Fantasy Sports Addiction

Dr. (Maj) Arka Adhvaryu (Retd)¹, Maj (Dr.) Markanday Sharma², & Surg Cdr (Dr.) Amit Chail ³

1Senior Resident, Dept of Psychiatry, RG Kar Medical College, Kolkata (West Bengal) 2Graded Specialist, Dept of Psychiatry, Military Hospital, Jhansi (Uttar Pradesh) 3Classified Specialist, Dept of Psychiatry, Command Hospital (WC), Chandigarh

Pathological gambling and fantasy sports addiction are two separate but linked disorders that have received a lot of attention in recent years. While excessive gambling has long been recognised as a psychiatric disorder, fantasy sports addiction is a relatively new concept. Pathological gambling refers to a persistent and uncontrollable urge to gamble despite negative consequences. Fantasy sports addiction is characterised by excessive participation in fantasy sports leagues and contests. Participants construct virtual teams of real-life athletes and receive points based on their performance in live sporting events. Although fantasy sports began as a leisure hobby, they have turned into a possible cause of addiction for certain people. Factors like as the availability of games on a continuous basis, monetary incentives, social pressure, and the immersive nature of the activity all contribute to the development of addiction- like behaviours. Identifying potential risk factors for pathological gambling and fantasy sports addiction can help with targeted preventative efforts. Understanding these risk factors can aid in early detection and intervention measures to reduce the harmful consequences of addictive behaviours.

The increasing popularity of gambling platforms such as Dream11, My11circle etc games raises the question of whether they are gateways for internet gambling because they can entail money transactions yet are now categorized as “games of skill.” Fantasy sports interact with gaming and gambling concepts. Pathological gambling and fantasy sports addiction are significant public health issues that require more attention and research. This symposium presents a thorough overview of these occurrences, emphasizing their key characteristics, prevalence rates, psychological mechanisms, and risk factors. A better knowledge of pathological gambling and fantasy sports addiction can help to design evidence-based prevention, intervention, and treatment strategies to effectively address these addictive behaviours.

Adolescents’ Mental Health in Service Setup: Challenges and Opportunities.

Mental health is important aspect of health. Often neglected adolescents’ mental health is an area which needs attention. Adolescents’ mental health issues involve developmental challenges to disorders like depression, anxiety and psychosis. Adolescent substance use another area of concern. children and adolescents in services set up have peculiar environmental challenges characterised by frequent transfers, absence of parent for long duration, and cultural variations. The environment also provides opportunities which might be additional to their counterparts. These challenges and opportunities affect mental health of adolescents. Studies find different prevalent rates of mental illnesses among these children compared to their civilian counterparts. Thus, this symposium plans to discuss mental health issues of this specific population.

Speakers:

1. Lt Col (Prof) Bikram Kumar Dutta, MD, DM (Child & Adol Psychiatry), Corresponding speaker

2. Lt Col (Dr) Virendra Vikram Singh, MD, DM (Addiction Psychiatry)

3. Lt Col (Dr) Puneet Khanna, MD, DM (Child & Adol Psychiatry)

4. Maj (Dr) Tanmay Agrawal, DNB (Psychiatry)

Affiliation:

Base Hospital Delhi Cantt, Delhi 110010

ANCIPS 2024- SYMPOSIUM: Alarming suicide Rate in India “Action Required to Create Hope”- A Need of the Hour.

Dr Abhinit Kumar1 , Dr Kunal Kumar2, Dr Nikhil Nayar3, Dr.Shailendra Kumar Mishra4 ,Dr.Praneta Swarup5,Dr.Siddharth Bhargava6,Dr.Parika Kochhar7

1-Professor, Department of Psychiatry, School of Medical Sciences and Research, Sharda Hospital, Greater Noida, U.P

2-Professor & Head, Department of Psychiatry, School of Medical Sciences and Research, Sharda Hospital, Greater Noida, U.P

3-Assistant Professor, Department of Psychiatry, School of Medical Sciences and Research, Sharda Hospital, Greater Noida, U.P

4-Assistant Professor,Department of Psychiatry,Govt. Medical College,Banda, U.P 5- Assistant Professor, Department of Psychiatry, School of Medical Sciences and

Research, Sharda Hospital, Greater Noida, U.P

6-Post Graduate-3, Department of Psychiatry, School of Medical Sciences and Research, Sharda Hospital, Greater Noida, U.P

7-Post graduate-3, Department of Psychiatry, School of Medical Sciences and Research, Sharda Hospital, Greater Noida, U.P

Corresponding author: Dr Abhinit Kumar, drverma10@gmail.com, 9555212899

Suicide is an escalating global public health crisis, claiming more than half a million lives annually and casting an enduring shadow of despair over countless more. The profound social, emotional, and economic repercussions of suicide reverberate through families and communities, demanding our unwavering attention and collective resolve.

“Creating Hope through Action” stands as the triennial clarion call for World Suicide Prevention Day (WSPD) from 2021-2023. It serves as an unyielding reminder that an alternative to suicide exists, one that we can foster through deliberate and compassionate actions. This theme carries the profound message that hope, however elusive, remains within reach, and that we stand united in our commitment to offer unwavering support to those in distress.

The theme underscores our shared responsibility to signal to individuals navigating the treacherous terrain of suicidal thoughts that a lifeline of hope is extended to them. It reaffirms that our actions, whether grand or small, possess the transformative power to infuse hope into the hearts of those grappling with despair.

In the Indian context, where suicide rates are alarming, it is our solemn duty as mental health professionals, educators, policymakers, and advocates to heed this call to action. By synergizing our efforts, we can crate hope through action, break down the barriers that entrap vulnerable individuals, and collectively work towards a future where despair is replaced with resilience, and lives are preserved.

Proposal for Symposium: Theme: Gender and Mental Health: Current perspectives and understandings in transgender mental health and well-being

Transgender and gender non-conforming (TGNC) individuals are at a high risk of adverse mental health outcomes due to a variety of factors not limited to minority stress and/or discrimination. They show a higher prevalence of mental health problems, such as depression, suicidality, anxiety, substance use disorders, and stress-related issues, and greater disparities in psychological wellbeing. Despite this, there is a little representation of inclusive mental health services for this sizeable population group. Literature suggests TGNC adults encounter formidable barriers to health care, including access to quality therapeutic interventions. Major barriers include personal concerns, involving fear of being pathologized or stereotyped/marginalised and an objection to common therapeutic practices, incompetent mental health professionals, affordability factors. Thus, there is a need to integrate multi- level, social-psychological interventions with psychoeducation to reduce cultural stereotypes at community as well as healthcare delivery level. Advocating legislations for rights of TGNC people, transgender-inclusive health-care services, political will for funding to create special care programmes and promoting quality gender-affirming health care services seems to be the way forward.

Thus, considering above aspects, this symposium on transgender mental health and well-being is proposed and intend to cover following aspects:

• Overview: Introduction- Global Health Burden & Needs of Transgender Population: Medical Comorbidities, Psychosocial Issues & Psychiatric Comorbidities

• Risk, Resilience Factors and Barriers to Mental Health Care faced by TGNC people

• Clinical Care Perspective

• - Gender-Affirming Healthcare: Role of Mental Health Professionals

• - Gender-Affirming Hormonal Therapy and Surgical Interventions

• Current Legislations related to Rights of Transgender Person in India

• Improving Transgender Mental Health: Research Gaps, Challenges & Way Forward

Speakers:

1. Dr. Sujita Kumar Kar, Additional Professor, King George’s Medical University (KGMU), Lucknow

2. Dr. Romil Saini, Assistant Professor, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGI), Lucknow

3. Dr. Ashish Pakhre, Assistant Professor, AIIMS, Bhopal

4. Dr. Abhishek Chakladar, Assistant Professor, Varun Arjun Medical College & Rohilkhand Hospital, Shahjahanpur, Uttar Pradesh

Abstract for Symposium: Clozapine Resistance Schizophrenia: Concept, Assessment and Management

Gopika Jagota, Sandeep Grover

Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh

Correspondence: drsandeepg2002@gmail.com

Around 30% of the patients suffering from schizophrenia do not respond to two adequate trials of antipsychotics and are considered to have Treatment Resistant Schizophrenia (TRS). Despite clozapine monotherapy in adequate doses and duration, around 30-70% of patients with TRS do not respond to clozapine and are known as “Ultra resistant schizophrenia”, “Super refractory”, “Clozapine non responders” or “Clozapine Resistant Schizophrenia” (CRS). Till recently, there was lack of definition of CRS. There is limited evidence-based data for making recommendations for management of CRS. Hence, certain consensus-based recommendations are made. In this symposium, the presenters will discuss the current concept of CRS, available evidence base and the consensus recommendations for management of CRS.

Dr Gopika Jagota will discuss the current concept of CRS, along with the assessment required prior to considering an augmentation treatment for clozapine.

Dr Sandeep Grover, will discuss the currently available evidence base, consensus recommendations and how to implement the augmentation treatment strategies.

Bipolar Disorder: a search for neurodevelopmental markers and their translational implications at a tertiary care center in South India.

Background:

The course of bipolar disorder (BD) in the Indian subcontinent is markedly different from what is reported in the west, with a predominantly manic onset, preponderance of manic episodes and relatively lower incidence of depressive episodes. Given this background, we conducted a series of experiments which examined biological markers for BD, their potential as neurodevelopmental and endophenotype markers as well as markers for staging in BD, and we discuss the findings here in terms of early identification and identification of those at risk for BD, along with their translational implications.

Nandhini P B (aberrant neurodevelopmental markers and adverse child hood experiences)

Aberrant neurodevelopment markers have been documented severe mental disorders, including BD. In a series of studies, we have examined the occurrence of neurological soft signs and minor physical anomalies in BD compared to healthy controls. In addition, these have been examined in subjects at risk for BD to understand their endophenotype potential. Adverse childhood experiences including childhood physical, emotional and sexual abuse as well as adverse environmental influences like intimate partner violence are reported more often in BD and could have a bearing on the onset and course of BD. We discuss the findings of a structured assessment of childhood adversity and IPV on the development of BD.

Muralidharan Kesavan (endophenotyes using TMS)

There is a need to study biological risk markers for BD, which may be present early or even before the onset of BD, which could help favorably modify the course of the disorder and limit disability. This lecture gives an overview of investigations in individuals very early in the course of the disorder (BD I- FEM in remission) and in individuals who are yet to develop this disorder (matched healthy individuals with family history of BD I) as compared to healthy subjects (no personal or family history of psychiatric disorders). The endophenotype potential of investigative transcranial magnetic stimulation (TMS) using single and paired pulse TMS, the role of mirror neuron activity and theory of mind functions in individuals who belong the aforementioned groups are discussed. The talk specifically focusses on the deficits in GABA- A measures of TMS including SICI as well as the GABA-B markers like LICI and CSP; in addition the changes in these measures during task observation, with and without emotional valence as well as the theory of mind functions using the SOCRATIS and TRENDS

Rashmi Arasappa (composite endophenotype)

In understanding the role of endophenotypes for BD, facial emotion recognition has been studied extensively. In a series of studies, we have examined facial emotion recognition in individuals very early in the course of the disorder (BD I- FEM in remission) and in individuals who are yet to develop this disorder (matched healthy individuals with family history of BD I) as compared to healthy subjects (no personal or family history of psychiatric disorders) using TRENDS. We also examined executive task performance in these individuals while they were undergoing a scan using functional near infra-red spectroscopy (fNIRS). Another investigation examined the role of oculomotor abnormalities in these individuals, specifically the antisaccade and smooth pursuit eye movements in these three groups. Both investigations tried to examine the possibility of a composite endophenotype for BD and the results are presented here.

Preethi V Reddy (markers for staging BD)

With growing emphasis on neuroprogression and its treatment implications in BD, we sought to examine a few biological markers that could help study the staging of BD proposed by Berk et al in addition to examining its endophenotype potential in individuals very early in the course of the disorder (BD I- FEM in remission), those with established BD, in individuals who are yet to develop this disorder (matched healthy individuals with family history of BD I) as compared to healthy subjects (no personal or family history of psychiatric disorders). We examined oxidative stress markers…. Furthermore, the role of retinal vasculature as a window to the brain in BD was examined in understanding if the differences retinal vasculature in these stages could reflect brain changes and thereby neuroprogression. We also examined the role of neurocognitive functioning using the 6 core domains of cognitive functioning in trying to distinguish the four stages from each other. Neuropsychological interventions aimed at reducing cognitive deficits and enhancing functional outcomes in the Indian population are also discussed.

Symposium - Community Engagement in the Field of Mental Health

With communities forming a major buffer for persons with serious mental illnesses (SMI), involving them to spread awarenss and mitigate stigma is important.

Schizophrenia Research Foundation (India) a mental health NGO, focusses on community engagement to promote awareness about severe mental illness. The symposium will cover the recent community engagement activities that were delivered as part of a NIHR funded research project

Speaker 1: ‘Namma Area’ - A sneak peek

A social hangout space (Namma Area) for people with mental illness was established at SCARF (I) in 2022 and has been open for service users twice a week since then. The speaker will look into the journey of ‘Namma Area’.

Speaker 2: Community Engagement @ Workplace

Community engagement programs using various methods including Theatre of the Oppressed techniques focussing on employment of people with serious mental illness and on myths & misconceptions about the same were conducted by the team. The speaker will share the experience of the events done at Corporates, Colleges, Healthcare Institutions & Manufacturing Industries.

Speaker 3: Service Users & the Unchartered territory

Most community engagement programs in the field of Mental health focus on communities outside the organisation. Through art based interactive plays, service users and caregivers at the outpatient clinic of SCARF are encouraged to think about and discuss elements of mental healthcare and treatment that are seldom addressed.

Speaker 4: The way ‘WE’ see it

The global trend of service user involvement in their care, research and advocacy has taken the field by storm. In this part of the symposium a Person with lived experience will share their journey of being involved in the community engagement activities.

CHALLENGES IN IN-PATIENT CARE OF CHILD PSYCHIATRIC EMERGENCIES

Lead presenter: Dr Varghese P Punnoose (Professor and Head, Department of Psychiatry, Government Medical College, Kottayam, Kerala )

Co-presenters:Dr Geethu Roy, Dr Anju Ashok, Dr Meera S, Dr Abraham Jerome (Senior Residents)

India has more than 400 million children and adolescents i.e. approximately 40% of the population of India. The recent national mental health survey reported a prevalence of 7.3% of morbidity among adolescents. There is no national data on the prevalence of psychiatric emergencies. Overall, there is a trend for increased utilization of psychiatry emergency services by children and adolescents.

A psychiatric emergency is an acute disturbance of either behaviour, thought, or mood of a person and has the potential for a negative impact. Literature reports that the most frequent emergencies are suicidal behaviour, depression, aggressiveness, substance abuse, and violence-related situations.

MHCA 2017 regarding minors is more elaborate on inpatient admission procedures and treatments such as the use of electroconvulsive therapy. A novel aspect of the legislation is mandating nonseparation of infant and toddlers from mothers getting treatment for mental illness unless there is any risk posed to the child. Another positive move is the decriminalization of suicidal behaviours.

Despite these facts the knowledge and skill in these areas available to the medical professionals to whom these problems present first are very limited. Large treatment deficits in child and adolescent mental health (CAMH) care exist. Lack of trained mental health professionals has been an important barrier to establish mental health services in child and adolescent mental health care.The knowledge, attitude and practise base needed to address these clinical problems need to be disseminated.

Introduction by Chairperson & Overview of child psychiatry emergencies: - Dr Varghese P Punnoose (10mts)

IP care of children and challenges (8mts) Dr Geethu Roy

Legal issues related to IP care in Child and Adolescents (8mts) Dr Anju Ashok Experience from general hospital setting (8mts)Dr Meera S

Opportunities and way ahead: (10mts)Dr Abraham Jerome

Arts for awareness ! - Psychoeducation through Creative Art forms

Pavitra KS, Vinay Kumar, Suddhendu Chakraborty,Abhiruchi Chatterjee, Sayandeep Ghosh Estimated Duration: 1 hour

*Keywords* : Psychoeducation, Creativity

*Introduction:*

Psychoeducation is an essential part while initiating any psychiatric management.The aim of psychoeducation is to enhance knowledge and insight of the patient as well as their caregivers regarding the mental illness.Literature reveals a long standing trauma and shame related to mental illness.Incorporating Creative Arts in psychoeducation can develop Compassion, Courage and Community participation.Mental health awareness again remains an important tool in early recognition as well as prevention of mental illnesses.This Symposium will try to highlight the role of different Creative Forms like Dance and Movement,Drama, Visual Arts, Poetry and Music in promoting Psychoeducation amongst the general public as well as PWMI and their caregivers.The symposium will also emphasise on the importance of conglomeration of these art forms, their implementation in a group setting, and finally as literature supports, their overall effectiveness in the said domain.(Bowers et al 2015;Gerrity et al 2007;Vassilopoulos et al 2013; Norton et al 2013)

*1. Introductory Speech* Dr.Vinay Kumar MBBS,MD(Psychiatry) Professor and Head,Patna

President,Indian Psychiatric Society

_dr.vinaykr@gmail.com_

*2. Dance for psycho education* Dr.Pavitra KS

Prof and HOD Dept.of Psychiatry BMCH ,Chitradurga

pavitraks2011@gmail.com

*3. Psychoeducation and Psychodrama* Dr.Sayandeep Ghosh

MBBS;DPM

Consultant Psychiatrist and Freelance Columnist

_g.sayandip@gmail.com_

*4. Psychoeducation and Visual Arts* Dr.Abhiruchi Chatterjee MBBS,DNB(Psychiatry);MNAMS

Consultant Psychiatrist and Freelance illustrator

_abhiruchichatterjee@gmail.com_

*5. Incorporating Music and Poetry into Psychoeducation* Dr.Suddhendu Chakraborty

MBBS,DPM,MA(Clinical Psychology)

Consultant Psychiatrist and Freelance poet, musician and artist

_dr.suddhendu.chakraborty@gmail.com

CUTTING-EDGE ANTIDEPRESSANTS:EXPLORING NEW FRONTIERS IN DEPRESSION TREATMENT

Dr Jitendriya Biswal¹, Dr Swayanka Samantray², Dr Ahrumochan Sahoo³

1Associate prof, Department of psychiatry, IMS & SUM Hospital, Bhubaneswar

2Department of psychiatry, KIMS, Bhubaneswar

3Department of psychiatry, PRM MCH, Baripada

Depression is a severe mental health problem that affects people regardless of social status or education, is associated with changes in mood and behaviour, and can result in a suicide attempt. Therapy of depressive disorders is based mainly on drugs discovered in the 1960s and early 1970s. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are frontline pharmacological strategies for the medical treatment of depression. In addition, approved by FDA in 2019, esketamine [as nasal spray; N-methyl- D-aspartate (NMDA) receptors antagonist with additional effects on α-Amino-3-hydroxy-5- methyl-4-isoxazolepropionic acid (AMPA) receptors, hyperpolarization-activated cyclic nucleotide-gated (HCN) channels, L-type voltage-dependent calcium channel (L-VDCC), opioid receptors, and monoaminergic receptors] is an essential compound in suicide and drug resistant depression. However, the treatment of depression is burdened with severe side effects, and in many cases, it is ineffective. An equally important issue is the choice of antidepressant therapy in people with comorbid somatic diseases, for example, due to possible interactions with the patient’s other drugs. Therefore, there is a great need for new antidepressants with different mechanisms of action and the need to refine the search for new substances. The purpose of this seminar is to discuss new research directions and new trends that dominate laboratories worldwide. We have reviewed the literature to present new points on the pharmacological target of substances with antidepressant activity. In addition, we have also reviewed the nonpharmacological techniques like brain stimulation, such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) their role in depression.

Non Pharmacological Management of Autism Spectrum Disorder(ASD) in the Indian Context

• Gayathri Rajan* ¹Senior Resident DM, Department of Child and Adolescent Psychiatry, PGIMER, Chandigarh

• Tony Lazar Thomas ²Senior Resident DM, Department of Child and Adolescent Psychiatry, NIMHANS Bangalore

• Sakhardande Kasturi Atmaram ³Senior Resident DM, Department of Child and Adolescent Psychiatry, NIMHANS Bangalore

• (*Corresponding author-g3cr.89@gmail.com,9995172621, IPS-LOM/G05/22)

Gayathri - Naturalistic Developmental Behavioral Interventions in ASD

Early intensive intervention is the most scientifically supported treatment in ASD. 1:1 intervention for 25–30 hours/week to remediate deficits and challenging behaviors, that start by age 2-3years becomes a challenge in resource poor settings. Naturalistic interventions can be used to teach joint attention and other prelinguistic skills in ASD. It is cost effective & can be used in low-income countries. It improves the core deficits of ASD and when applied at very early age may alter the trajectories of ASD.

Tony- Social Skills Training for Adolescents with ASD

Adolescents with ASD face challenges in peer interaction with the same and other gender peers. Social skill deficits result in hinderance in forming deep friendships and romantic relationships.Social skill training has a pivotal role in helping these adolescents to gel with their peers. Evidence based strategies used to teach social skills for these adolescents are: modelling, reinforcement, social problem solving, behavioural rehearsal/practice, corrective feedback/coaching and peer mediated interventions.

Kasturi- Neuromodulation – Scope for treatment in ASD

Neuromodulation has emerged as a promising treatment modality for the treatment of ASD. The commonly used techniques in ASD are transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). Their utility has been reported for various dimensions of ASD such as repetitive behaviours, sociability, and cognitive/ executive functioning. Though data on safety of repetitive TMS is emerging, safety of tDCS in this population has been established . This area holds great promise for the treatment of ASD.

Declaration: DrGayathri Rajan had presented “Naturalistic Interventions in Autism” in the SIPSCON 2023, State Conference of the IPS held in Kannur in “Young Psychiatrist’s Forum”, but not in any other National Conference

India has seen a myriad of changes psychiatric care in the 75 years of its independence though much needs to be done.ANCIPS 2024 has aptly chosen the theme PSYCHIATRIC CARE-PROBLEMS,PROGRESS & PROSPECTS.

Dr Abhay Matkar, Dr N M Patil & Dr Swaminath G with over 100 years of collective practice in private sector have encountered many problems & have been able to overcome them with positive progress in our field.On this issue we would like to choose the topic as PSYCHIATRY— DOWN BUT NOT OUT AND RARING TO GO.

Dr N M Patil will speak on the problems envisaging MHCA & its constraints, poor financial allocation to mental health, poor infrastructure and reduced public awareness & participation in areas of mental health.

Dr Swaminath G will speak on the progresses made in the filed of psychiatry like GHPU, improved NGOs participation, better facilities for care, increase in the number of psychiatrists, better treatment options etc.

Dr Abhay Matkar will speak on the prospects like insurance for PWMI, newer treatment options like personalised medicine, public funded rehabilitation centres, research etc.

Neuroplasticity in Psychiatric Disorders

Brain is dynamically changing organ and is capable of learning throughout life. Neuroplasticity is ability of the central nervous system to alter its functional organization; a capacity to shape neuronal circuitry during development to change the way information is processed, and to compensate for injury. It’s a lifelong process which constitutes neurogenesis, axonal sprouting, neuron extension, synaptogenesis, alterations of dendritic function and synaptic remodelling through long term potentiation. Neuroplasticity proves that neuron and its synapses are plastic, changeable, and malleable. Forms of synaptic plasticity are short term and long term potentiation and depression, and it’s studied at molecular and cellular level.

TMS, FMRI, SPECT are modalities to evaluate neuroplasticity and are also used to study its role in Psychiatry.

Abnormal neuronal migration, genetic errors, environmental insults, abnormal synaptogenesis and apoptosis play role in neurodevelopmental and neurodegenerative disorders. Along with these theories, decreased level of GGF (Glial Growth Factor), BDNF (Brain Derived Neurotrophic Factor) is found in Schizophrenia; which reduces neuroplasticity. In Mood disorders, there is dysregulation of HPA axis causing hypercholesterolemia which is toxic to the neurons of hippocampus. Neuroplasticity plays an important role in neuronal circuitry of addiction. Patient’s pattern and duration of consumption of a substance will strengthen the synapses and accordingly will challenge the recovery of patient while getting out of substance taking behaviour.

Psychotropic medications, ECT, rTMS and psychotherapy improve neuronal plasticity by various mechanisms and importance of neuroplasticity for beneficial action of these treatment modalities is yet to be sufficiently explored.

Pocket psychiatry and changing conversations around mental health

After the COVID-19 pandemic, the use of online resources for mental health has increased. WHO recently recommended promoting self-care through electronic technologies. This has given rise to ‘pocket psychiatry.’ Social media posts on mental health have increased exponentially recently. A massive rise in mental health influencers- professionals and lay people has occurred. Over 10,000 mental health apps are available today. These changes have facilitated mental health conversations and made services more accessible. However, the unchecked growth of these online resources is concerning. Mental health-related social media posts and influencer content are mostly based on anecdotes. Analyses of these have revealed high stigma, trivialization, and misinformation levels. There are numerous reports of unqualified therapists offering online services as life coaches, listeners, meditation experts, etc. Even qualified professionals who take on roles of influencers have been found not to follow ethical guidelines. Mental health apps can provide timely, cost-effective, and accessible care. However, there are safety and confidentiality concerns. Moreover, many apps haven’t been tested for efficacy and use techniques with insufficient evidence. Many users rely on these sources before seeking their first consultation. Hence, it is imperative to have up-to-date and nuanced ethical and legal guidelines for pocket psychiatry. In this symposium, the authors will discuss aspects of pocket psychiatry, like social media conversations, the growth of mental health influencers, and the potentials and pitfalls of mental health apps. The symposium will emphasize the applications of online platforms for evidence-based mental health services.

Shaping tomorrow’s psychiatrists: Revisiting postgraduate education in India

Psychiatry postgraduate training in India has grown tremendously in the last few decades regarding the number of seats, avenues for residents, rankings of institutions, and opportunities for specialization. However, recent studies have revealed that most of the residents have poor exposure to vital areas like rehabilitation psychiatry, psychosexual medicine, forensic psychiatry, women’s mental health, and consultation-liaison psychiatry. Most of the institutions give no training in rTMS or DBS. There are lacunae in psychotherapy training and research methodology. High stress levels have been reported among residents, especially in premier institutions. Residents trained in various institutions significantly differ in their competence. Hence, postgraduate psychiatry training in India needs to be more cohesive and consistent. Guidelines for competency-based postgraduate training introduced in 2019 are promising. However, numerous practical and theoretical challenges exist, including a lack of flexible models, administrative requirements, and ambiguous conceptual frameworks. Hence, more innovative methods are needed to scale up psychiatry training. E- resources like massive open online courses (MOOCs) can be standardized, and integrated Learning Management System (LMS) can be applied. Online platforms like Psy Q, Cochrane Journal Club, and Indian Teachers of Psychiatry (ITOP) can help to connect and share ideas. AI-based methods like virtual patients, personalized assessments, virtual mentoring, and educational chatbots can augment or replace traditional systems. In this symposium, the speakers will discuss the past, present, and future of psychiatry postgraduate training in India, emphasizing the need for novel, affordable, and accessible methods to improve teaching and learning.

Is Recovery Achievable for Everyone? Understanding Treatment Outcomes for Substance Use Disorders

1. Dr Prabhoo Dayal , Additional Professor of Psychiatry , NDDTC ,AIIMS ,New Delhi. Email; prabhudayal.aiims@gmail.com

2. Dr Gauri S Kaloiya, Professor of Clinical Psychology , NDDTC ,AIIMS ,New Delhi. Email;

3. Dr Prashant Mishra, Commandant Medical Psychiatrist ,Base Hospital ,ITBP,New Delhi. Email; drprashant24@gmail.com

4. Dr S A Sabir ,Consultant Psychiatrist,New Delhi.Email: sbasir@gmail.com

Introduction: [ Presenter Prabhoo Dayal]

Substance use disorders (SUDs) affect millions of people globally, making it a significant health concern worldwide. SUD is a treatable chronic disease characterized by a problematic pattern of substance use leading to noticeable impairment or distress. Individuals with SUDs often experience significant challenges in various aspects of their lives. However, like many other chronic conditions, effective treatment options exist, offering hope for recovery. While there is no one-size-fits-all approach to treatment, it’s important to understand that recovery is attainable, and support is readily available for individuals with SUDs. This symposium aims to shed light on the potential for recovery and the various treatment outcomes of SUDs, recognizing that successful treatment goes beyond mere abstinence and encompasses other critical domains of life.

Treatment Modalities: Pharmacotherapy [Presenter SA Sabir]

This part of symposium will provide an in-depth exploration of pharmacotherapy options for substance use disorder, shedding light on the current state of treatment, emerging interventions, and the challenges that lie ahead. By integrating pharmacological approaches with other therapeutic modalities, we can offer individuals with SUD a more comprehensive and effective path to recovery.

Treatment Modalities: Psychosocial Interventions [ Presenter Gauri S Kaloiya]

This section of symposium will high light the importance of psychosocial interventions in treating substance use disorder. By exploring the diverse modalities available, we hope to provide a comprehensive understanding of how these approaches can be integrated into SUD treatment plans. Ultimately, the goal is to improve the lives of individuals struggling with addiction and increase the chances of sustained recovery.

Treatment Outcomes: [Presenter Prashant Mishra]

The journey to recovery from substance use disorders (SUDs) involves various treatments like detox, therapy, medications, counseling, and support groups. The right treatment depends on the person’s unique situation, including the substance, severity, and mental health issues. Recovery isn’t just about quitting; it should improve health, relationships, functioning, and quality of life. Focusing on these aspects helps us understand recovery better and support those with SUDs effectively. Treatment outcomes should consider the person’s overall well-being.

Conclusion: [Presenter Prabhoo Dayal]

While recovery from SUDs is possible, it is not without challenges. Relapse is a common part of the recovery process, and it should not be seen as a failure. Instead, it should be considered an opportunity for further refinement of the treatment plan. Success stories abound, illustrating the potential for individuals to regain control of their lives and achieve lasting recovery. In conclusion, recovery is possible for individuals with SUDs, and there are various treatment options available to support them on their journey. Treatment outcomes extend beyond mere abstinence, encompassing health, relationships, functionality, and overall quality of life. By addressing these domains, we can better understand the complex nature of recovery and work towards improving the lives of those affected by substance use disorders.

Thanks

ANCIPS 2024 SYMPOSIUM: Cartoon character syndrome- A new paradigm in child development

With rampant rise of internet use and exposure to smart gadgets, viewing cartoons by infants, toddlers and children have become an integral part of daily activity in every household. Not stopping only for the purpose of entertainment, nowadays cartoons have become the options to engage children when parents are busy in their own work, to pacify kids during temper tantrums and even for feeding the baby. This strategy of using cartoons by parents in child rearing has created a new paradigm shift in early childhood development. The impact of cartoons on child’s language, social, psychological, physical, and behavioral patterns has been an area of debate in recent times with its own pros and cons. Also, the data regarding the long-term influence on cultural and moral development of the child is still evolving.

In clinical practice it is now commonly observed that children are brought with complaints that they are speaking, imitating, responding, and behaving only like the cartoon characters. Though viewing cartoons has helped to improve vocabulary, grammar and reinforce certain positive behaviors to a certain extent, often there is delay noted in the acquisition of native language as well as difficulty in initiating meaningful conversations and social relations appropriate to their age. Attention, concentration, critical thinking, and other cognitive aspects can be altered according to the content watched.

In conclusion, cartoon character syndrome is now becoming a part of child development with its own risks and benefits. Appropriate measures must be considered to minimize its negative consequences.

Objectives:

• 1)To investigate the unique phenomenological manifestations of Schizo-obsessive disorder within a case series context, aiming to provide a deeper understanding of the condition’s clinical presentation and diagnostic challenges.
• 2)To discuss the key differentiating features that distinguish Schizo-obsessive Disorder, Schizophrenia with OCD, and OCD with Psychosis from each other.
• 3)To propose a diagnostic criteria for Schizo-obsessive disorder.

Brief description:

Schizo-obsessive disorder, characterized by the co-occurrence of schizophrenia and obsessive- compulsive features, remains a complex and under-explored psychiatric condition. Its phenomenology and nosology remain inadequately understood. Due to these challenges, this diagnostic category remains undefined in the international classification systems.

According to present literature following conditions are included in this category of Schizo- obsessive disorders-

• 1)OCD as a Psychotic Prodrome
• 2)Obsessive-Compulsive Symptoms in Schizophrenia
• 3)OCD in Schizotypal Personality Disorder
• 4)Antipsychotic-Induced OCD
• 5)OCD with absent Insight/delusional beliefs

All of which are different identities that needs to be distinguished from each other. Due to this overinclusion, the criteria for Schizo-obsessive disorder remains unexplained. This symposium aims to focus on symptomatology and phenomenology of Schizo-obsessive disorder and how it is different from Schizophrenia with OCD and OCD with psychosis based on case series of patients with different presentation. We will also shed a light on differing neurobiology of Schizo-obsessive disorder, Schizophrenia with OCD and OCD with psychosis. By doing so, we hope to propose clearer diagnostic criteria for Schizo-obsessive disorder, aiding clinicians in accurate differentiation and treatment planning.

SYMPOSIUM PROPOSAL: “Approach to Integrate Perinatal Mental Health (PMH) into existing Maternal Child Health (MCH) Program: Telangana model”

Speakers:

Sundarnag Ganjekar, Raveena Akkineni, Nithin Kondapuram.

Presentation 1 (12 minutes): Developing care model to integrate PMH into MCH Program.

Presentation 2 (12 minutes): System strengthening and pathways for stepped care to improve maternal mental wellbeing and facilitate screening for anxiety and depression among perinatal mothers.

Presentation 3 (12 minutes): Policy changes to bring perinatal mental health into existing maternal management information system (MIS) in the state of Telangana.

Discussion and Q & A (9 minutes)

In India, approximately one in every five women encounters stress, anxiety, and depression during both pregnancy and the postpartum period. In spite of huge burden of mental health conditions during perinatal period there is a lack of case identification. Among the health professionals there are lack of awareness about importance of mental wellbeing during perinatal period and adverse impact of mental health conditions on maternal and infant outcome. The stigma associated with mental illness is another systemic challenge. To address these issues, NIMHANS, in collaboration with the Government of Telangana and UNICEF, jointly developed a program that seamlessly integrated mental health support with maternal nutrition initiatives.

The presentation 1 on “Developing care model to integrate PMH into MCH Program” talks about the conceptualization of perinatal mental health care plan keeping in mind to increase the awareness on importance of mental wellbeing during pregnancy and postpartum among women, frontline health workers, medical officers, obstetricians, and other important stakeholders in the community. Provision of dignified respectful care to all women during pregnancy, delivery and postpartum. Early identification and interventions for risk factors for poor mental health during perinatal period and enhancing protective factors.

The presentation 2 on “System strengthening and pathways for stepped care to improve maternal mental wellbeing and facilitate screening for anxiety and depression among perinatal mothers” talks about the training of frontline workers, medical officers, obstetrician on perinatal mental health. It also deals with the protocol based stepped care approach in improving mental wellbeing, case identification, brief psychological intervention, and medical intervention.

The presentation 3 on “Policy changes to bring perinatal mental health into existing maternal management information system (MIS) in the state of Telangana” talks about systematic changes brought in the policy by the maternal health division, ministry of health and family welfare, Govt of Telangana to incorporate perinatal mental health into maternal and child health program. The mental health is integrated with Comprehensive Antenatal Care under the Ending Preventive Maternal Mortality Program.

Real-world effectiveness and utility of neuromodulation in obsessive-compulsive disorder: Experience from the OCD Clinic, NIMHANS

Shyam Sundar Arumugham, Janardhanan C Narayanaswamy, Srinivas Balachander, YC Janardhan Reddy,

OCD Clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka

Many patients with obsessive-compulsive disorder (OCD) do not respond optimally to standard first-line treatments such as pharmacotherapy and cogntive-behavioral therapy. Recent advancements in our understanding of brain networks/neurocircuitry of OCD, have stimulated hopes that neuromodulation may be a promising treatment, particularly in resistant OCD. Transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) are the two commonly used non-invasive methods, while gamma-knife surgery and deep brain stimulation (DBS) are the invasive procedures.

Several randomized-controlled trials (RCTs) of neuromodulatory treatments for OCD have shown them to be potentially useful treatment options. However, much of this evidence has significant heterogeneity, both in the techniques as well as their outcomes. Over the last decade, our usage of neuromodulation (both non-invasive and well as invasive) at the OCD Clinic, NIMHANS has grown substantially, both for clinical purposes and research. In this symposium, we aim to review the latest evidence pertaining to neuromodulation in OCD, and share our experience with each of these modalites and their outcomes at the OCD Clinic.

The first presentation, will provide an overiew of the neurobiology of OCD, particularly focusing of brain networks/neurocircuitry which informs our approach to neuromodulation. The second presentation, will focus on non-invasive brain stimulation methods, particularly tDCS and TMS. We will share the results of our systematic review/meta-analysis of the latest evidence, and highlighting our own RCTs as well as naturalistic outcomes. The third presentation will focus on the use of psychosurgery (particularly gamma-knife) and DBS, with an overiew of the procedure, highlighting our experience and outcomes.

Keywords: obsessive-compulsive disorder, OCD, brain stimulation, neuromodulation, tDCS, TMS, DBS, psychosurgery

GENDER NONCONFORMITY: CONFUSING DIFFERENCE WITH DISEASE

Gender is defined as an achieved status as opposed to sex that is an ascribed status. The words “sex” and “gender” are often used interchangeably overlooking the underlying complexity that gender holds which is a very complex biopsychosocial phenomenon, and its fluidity, changeability, and variations are unravelling.

Transsexualism has been present since the advent of human civilization and in mythological stories across cultures like Mohini, Ardhanarishwara, Shikhandi, Brihannala, Chitrangada, Hermaphroditus yet the public understanding about Gender Diversity continues to be dismal.

Gender is assumed to be a socially defined status that is normative and must be met and when the gender expression of one is different from that of the socially expected “normal,” there is difficulty in assimilating that fact for the family and near ones leading to shock, denial, and conflicts to the extent of disowning a person. “Gender policing” leads to delay in expression of distress, psychiatric mismanagement, and high comorbidity of depression, anxiety, post- traumatic stress, self-harm, substance use and suicidality.

Being transgender is not a choice, but a state of the body and the mind. Just as we understand varied personalities, gender is also an expression of one’s self.

The social stereotypes need to be challenged with a collective responsibility from the individual, community, media, and administration. Only then we can look beyond the “medical model” of GD and improve their psychosocial outcomes.

Movement disorders and Psychiatry

Presenting author:

Dr Priyojyoti Chakma, Assistant Professor, Department of Psychiatry, AGMC & GBP Hospital Dr Arnab Deb, Senior Resident, Department of Psychiatry, AGMC & GBP Hospital

A movement disorder is a group of neurological conditions that cause abnormally increased or decreased movement.Movement disorders range from mild to severely debilitating, and many have very similar symptoms.

Abnormal movements or postures often present a diagnostic and therapeutic challenge to the psychiatrist or neurologist. The diagnosis of movement disorders in patient with psychiatric condition is a common challenge for neurologist & Psychiatrist. Traditionally a common dilemma has been distinguishing between organic & psychogenic explanation went no clear anatomical cause can be identified.

It can be classified based on the clinical presentation as hypo kinetic and hyperkinetic; based on the underlying neuroanatomical structure involved like basal ganglia, extrapyramidal tract or cerebellum and also according to the etiology like due to genetic disorders, post traumatic, vascular, toxin and medication induced or idiopathic causes.

Psychiatric disorders are common in patients with Neurologic disorders, occurring in 34% in Neurology in patients & up-to 40% of outpatients. Movement disorders associated with psychiatric conditions can be thought of as occurring in three broad categories.

• 1)As a direct result of Psychiatric conditions(Conversion disorder)
• 2)Treatment side effect (Drug induced)
• 3)Functional overlay when psychological factor exacerbate organic conditions

Some common movement disorders are Parkinsonism, tremor, akathesia, dystonia, myoclonus, tics, chorea and rare but life threatening disorder include neuroleptic malignant syndrome.

Many psychotropic medications can cause movement disorders specially antipsychotics where first generation antipsychotics are most notorious to cause them.

In the future, advances in the understanding of the patho-physiologic basis of these disorders will help reconcile the broader issue of mind brain Dualism & facilitate a unified approach to treatment.

Symposium: Revisiting Stereotactic Functional Psychosurgery in Psychiatric Disorders: Past, Present, and Future.

Presenters- Dr Sonakshi Jyrwa, Associate Professor of Psychiatry, AIIMS Nagpur Dr Varied Katiyar, Assistant Professor of Neurosurgery, AIIMS Nagpur.

Despite advances in the treatment of psychiatric diseases, 30–40% of patients will exhibit treatment resistance. After exhausting all pharmacological and psychological treatment options, very often than not, psychosurgeries are rarely advised, and likely not a part of a practicing psychiatrist’s treatment armamentarium. Psychosurgeries were only discussed for its historical significance. Psychosurgery had been a ‘controversial’ treatment for its use had been overshadowed by doubts about its effectiveness, stigma promulgated by its cinematic portrayal, inadequate reporting of outcomes, and varying ethical questions. Despite, Surgical Neuromodulation techniques e.g., Deep brain stimulation (DBS), emerging as novel effective therapeutic approach for treatment resistant psychiatric disorders, it has not yet gained widespread adoption. While, Neuromodulation, for persistent disabling neurological ailments such a Parkinson’s Disease is well-accepted by clinicians and laypersons. The prevailing stigma, absence of neurosurgical expertise and foremost, apprehensions amongst psychiatrist and mental health professionals are amongst few possible reasons.

The symposium aims to reappraise the role of stereotactic functional psychosurgeries for psychiatric ailments, especially treatment resistant psychiatric disorders. We will discuss and past, present and future directions for Functional Psychosurgeries in Clinical Psychiatry.

Symposium for ANCIPS 2024: Continuity of care from identification to integration: Implementation Models for larger Community Outreach

Introduction (Dr. Shivam Gakkhar, Senior Resident – Post Doctoral Fellow, Centre for Addiction Medicine, NIMHANS)

The mental healthcare resource distribution is inequitable in India. Availability of psychiatrists varies from 0.05 to 1.2 per lakh population which is much less than needed. The treatment gap ranges from 60-80%, highlighting the longer pathway to care, lack of availability, accessibility, and affordability of mental healthcare. This leads to higher dropout rates from treatment and poor quality of life.

Task shifting and Task sharing for Identification and Management: Decentralised approach (Dr. Gajanan Ganapati Sabhahit, Senior Resident, Goldman Sachs- NIMHANS Mental Health Program, NIMHANS)

Task shifting and sharing ensure care continuity in resource-limited countries. Capacity building of primary medical officers in transdiagnostic approach and training Community Health Workers in identification and referral through MERIT Screening tool help in enhanced case identification and management. Collaborative Video Consultations aid in delivering better care. Training community volunteers to become lay counsellors and Tele MANAS program are effective models for immediate mental health assistance.

Community Engagement models for integration: (Dr. Nikhita Kulkarni, Senior Resident, NIMHANS)

The role of caregivers in the integration of patients into society is essential. Collaborative approaches at the grassroot level ensure continuity and sustained integration process. Salient models in this regard include the Care at doorstep model, Daycare Services, technology driven models for follow-up care and Community-based rehabilitation model focusing on skill building.

Future Prospects: (Dr. Kalyani B. G., Senior Resident, NIMHANS)

The focus will be on strengthening the community services under the District Mental Health Programme (DMHP). We will speak on customised and culturally integrated models using available resources for capacity building. We will also highlight measures at the policy level, such as the Ayushman Bharat Digital Mission. The objective is to identify long-term strategies for enhancing mental well-being while supporting the integration of mental health services into general healthcare models.

ANCIPS 2024: Symposium Proposal

Proposer – Dr. Ashish Pakhre, Assistant Professor, Department of Psychiatry, AIIMS, Bhopal, India

Symposium Title: Suicide Prevention in Low- and Middle-Income Countries : Review of Interventions and Suicide Prevention Programs

Suicide and Low- and Middle-Income Counties : The risk of suicidal ideation, attempts, and deaths by suicide is high among vulnerable groups in LMICs, including women, sexual minorities, refugees, and internally displaced persons. In LMICs, particular and distinctive socio-cultural and environmental factors may raise the risk of suicidal behaviors in vulnerable groups. It is essential to assess these differential risk factors and create culturally competent and sensitive interventions and strategies in order to create comprehensive and successful suicide prevention plans.

Review of Developments in Suicide Interventions: The primary types of evidence-based suicide interventions include safety planning, brief contact, digital, psychosocial, pharmaceutical, and outreach. Utilizing registry-based data, standardizing suicide-related outcomes across trials, interventions in psychotherapy, selecting the most effective comparator interventions, and collecting data at multiple time points are all essential.

Suicide Prevention Programs and Policies : LMICs account for the majority of suicide deaths globally. There are persistent issues with the accuracy of suicide statistics in many nations. The World Health Organization’s major strategic documents, such as the Global Mental Health Action Plan, 2013-2020, the WHO report Preventing Suicide: A Global Imperative, and the United Nations Sustainable Development Goals for 2030, which include a target of reducing premature mortality from noncommunicable diseases by one-third and identify suicide mortality rate as an indicator for this target, provide the foundation for the global approach to suicide prevention.

Trauma and Psychiatry: A Lifetime Perspective

1. 1. Dr. Mahadev Singh Sen, Assistant Professor, IHBAS, Delhi (Corresponding Author: mahadevsinghsen@gmail.com, Contact: +91-9911110047)

2. 2. Dr. Nishtha Chawla, Assistant Professor, AIIMS, New Delhi

3. 3. Dr. Kamini Verma, Assistant Professor, NIMHANS, Bengaluru

4. 4. Dr. Manoj Kumar, Assistant Professor & Unit head, IHBAS, Delhi

Abstract (250 words; 10 minutes each + 5 minutes for discussion):

Trauma, in its various forms, can profoundly shape an individual’s psychiatric well-being, with implications that span childhood to late adulthood.

Speaker 1

Title: Childhood Trauma and Lifelong Consequences

There are enduring effects of childhood trauma on psychiatric health. Drawing from extensive research, he will examine how early traumatic experiences can set the stage for a range of psychiatric disorders throughout life. This session will shed light on the importance of early intervention and trauma-informed care in mitigating the long-term impact.

Speaker 2

Title: Adolescence, Trauma, and Transition to Adulthood

The pivotal juncture of adolescence and the role of trauma in shaping the transition to adulthood. This presentation will address the unique challenges faced by adolescents who have experienced trauma, emphasizing the importance of timely psychiatric support and interventions in this critical period of development.

Speaker 3

Title: Trauma in Adulthood: Resilience and Recovery

The impact of trauma in adulthood, highlighting the potential for resilience and recovery. This presentation will examine how individuals can navigate the psychiatric consequences of trauma in their adult years, offering insights into therapeutic approaches that promote mental well-being and healing.

Speaker 4

Title: Late-Life Trauma: Understanding and Addressing Psychiatric Challenges

This presentation will shed light on the often-overlooked topic of trauma in late adulthood. How late-life trauma can exacerbate existing psychiatric conditions or lead to new challenges. This session will provide guidance on tailored interventions and support for older individuals dealing with the lasting effects of trauma.

CHILD SEXUAL ABUSE IN PSYCHIATRIST PERSPECTIVE

Speakers;

1. 1. Dr. Vundi Manasa Ram, MD(PSY),PDF(CAP) Consultant and head ICGC(INDLAS CHILD GUIDANCE CLINIC), Visakhapatnam.

2. 2. Dr. Swati Mishra MD(PSY) Assistant professor MKCG medical college and Hospital Berhampur

3. 3. Dr. Sai Kiran MD(PSY) Associate Professor , Guntur medical college, Guntur

INTRODUCTION;-

The World Health Organisation has defined child sexual abuse as the involvement of a child in sexual activity as he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent, or that violates the laws or social taboos of society. It includes different sexual activities like fondling, inviting a child to touch or be touched sexually, intercourse, exhibitionism, involving a child in prostitution or pornography, or online child luring by cyber-predators.

Children who are victims of sexual abuse are found to be at an increased risk of various mental health problems. Though most of them develop alarming changes in behavior post abuse, but there is delay in identification and seeking help of psychiatric services, which can lead to deterioration in their mental and physical health . Victim-centered and trauma-focused treatment including proactive psychiatric care by a multidisciplinary team after proper and detailed evaluation has shown good results in the better development of child and also their families. This emphasises the dire need of identifying and understanding red flag signs of behavioural changes due to sexual abuse in children and the importance of psychiatric help as early as possible.

Pills for pitilessness: Pharmacotherapy of Conduct Disorders

Conduct disorders are common in clinical settings and difficult to manage. The most effective treatments are time-intensive psychosocial interventions, which can be demanding for busy clinicians who may lack the necessary time or expertise. The symposium will provide a concise overview of the pertinent neurobiology and nosology of the disorder and then present the latest evidence for various psychopharmacological agents such as antipsychotics, mood stabilizers, and antidepressants when the disorder presents in isolation or, as is often the case, comorbid with conditions such as ADHD.

Artificial Intelligence for Mental Health and Mental Illness- Past,Present and Future

The concept of digital health in mental health care integrates artificial intelligence ,big data analytic and Deep learning.

E Health has become a major topic in mental health care within the last decade. The burden of mental health/illness worldwide is increasing at an alarming rate. There is increase in incidence and prevalence of mental illness after covid-19 pandemic. There is a huge resource and treatment gap in mental health care in developing countries compared to developed countries. According to WHO, there is a 76-85% treatment gap in developing countries regarding mental disorders. AI is emerging as a viable alternative for reducing this gap and making psychiatric diagnosis and treatment accessible and affordable. Studies related to artificial intelligence and mental health are limited in India. In the last decade AI has been used for diagnosis and classification of disorders like schizophrenia,Alzheimer’s,Depression and Geriatric psychiatry. In this decade there are some more indications of AI which is still in its early stage . It is necessary to discuss the importance of AI.In this symposium we are discussing about the past,present and future of AI along with advantages and disadvantages. This symposium concludes that , What ever might be the advantages of AI , it cannot replace the human being who created it .

Symposium: Reviewing Findings of the National Mental Health Survey-1 & overview of the Preparatory Processes for NMHS-2

The two phases of the National Mental Health Survey -1 (including the Megacity survey) have identified high levels of mental health morbidity and treatment gap. The symposium will contextualise the findings of these studies in the larger framework of Mental Health Systems in the country. Further, the Department of Health & Family Welfare, Government of India has deemed it necessary to conduct a second survey -NMHS -2, to examine the mental health morbidity in all the 36 states and Union territories of India.

The major initial challenge for the NMHS-2 have been to develop a validated free to use structured instrument compatible to ICD-11 which assesses mental health disorders of public health importance. The speakers will detail the collaborative effort of the team with WHO to develop a culturally adapted instrument for the survey (Flexible Interview for ICD- 11) ensuring its appropriate local validation. Speakers will allude to development of a new disability scale for use for NMHS-2 which taps the major domains impacted across mental health disorders in community settings.

Symposium title: - Gender Dysphoria: Is Society Prepared for the Shift in perspective, as Diagnostic Guidelines and Patient Journeys Evolve?

Presenters:

1. 1. Dr Pratap Sharan, Professor, Department of Psychiatry, NDDTC, AIIMS, New Delhi

2. 2. Dr Pooja Shakya, Project Scientist (Medical), Department of Psychiatry, NDDTC, AIIMS, New Delhi

3. 3. Dr Arnab Datta, Senior Resident, Department of Psychiatry, NDDTC, AIIMS, New Delhi

4. 4. Dr Deeksha Kalra, Consultant Psychiatrist, West Delhi Psychiatry Centre, New Delhi

1. 1. Gender dysphoria: status, changes in nosology and clinician readiness

   Individuals with non-alignment of phenotypical sex and experienced gender have distress due to incongruous primary and secondary sexual characters, strong desire to acquire sexual characters of experienced gender. This distress merits clinical attention primarily to facilitate gender affirming hormonal and surgical procedures, but also to address the significant mental health needs of this vulnerable minority. The need for clinical attention has been further enshrined with the retention of the health status of ‘gender incongruence’ in the ICD-11, and devolution of ‘transsexualism’ and ‘gender identity disorder’.

2. 2. Findings from an observational study

   Mean age of onset of symptoms of gender dysphoria 9.76±2.12 years while mean age of presentation for help seeking for gender related issues was 21.28±3.68 years. 36.66% were found to have psychiatric comorbidities. FtM (birth assigned female) as compared to MtF (birth assigned male) were found to have more psychiatric comorbidities, in spite showing better parental support.

3. 3. Road to transition

   Detailed description of three interesting and clinically different cases of gender dysphoria. Challenges and upheavals faced on their disclosure of experienced gender and further journey of transition from birth assigned gender to their identified gender.

4. 4. Stigma, support, and the relevant legislations

   Due to stigma associated with mental disorders there is a constant effort to diminish the role of psychiatrists in transitioning journey of people with gender dysphoria. But considering the high intensity of marginalisation and poor acceptance in the society, people with GID require strong mental health support.

Symposium title: - Gender Dysphoria: Is Society Prepared for the Shift in perspective/mindset, as Diagnostic Guidelines and Patient Journeys Evolve?

Presenters:

1. 1. Dr Pratap Sharan, Professor, Department of Psychiatry, NDDTC, AIIMS, New Delhi

2. 2. Dr Pooja Shakya, Project Scientist (Medical), Department of Psychiatry, NDDTC, AIIMS, New Delhi

3. 3. Dr Arnab Datta, Senior Resident, Department of Psychiatry, NDDTC, AIIMS, New Delhi

4. 4. Dr Deeksha Kalra, Consultant Psychiatrist, West Delhi Psychiatry Centre, New Delhi

1. 1. Gender dysphoria: status, changes in nosology and clinician readiness

   Individuals with non-alignment of phenotypical sex and experienced gender have distress due to incongruous primary and secondary sexual characters, strong desire to acquire sexual characters of experienced gender. This distress merits clinical attention primarily to facilitate gender affirming hormonal and surgical procedures, but also to address the significant mental health needs of this vulnerable minority. The need for clinical attention has been further enshrined with the retention of the health status of ‘gender incongruence’ in the ICD-11, and devolution of ‘transsexualism’ and ‘gender identity disorder’.

2. 2. Findings from an observational study

   Mean age of onset of symptoms of gender dysphoria 9.76±2.12 years while mean age of presentation for help seeking for gender related issues was 21.28±3.68 years. 36.66% were found to have psychiatric comorbidities. FtM (birth assigned female) as compared to MtF (birth assigned male) were found to have more psychiatric comorbidities, in spite showing better parental support.

3. 3. Road to transition

   Detailed description of three interesting and clinically different cases of gender dysphoria. Challenges and upheavals faced on their disclosure of experienced gender and further journey of transition from birth assigned gender to their identified gender.

4. Stigma, support, and the relevant legislations

   Due to stigma associated with mental disorders there is a constant effort to diminish the role of psychiatrists in transitioning journey of people with gender dysphoria. But considering the high intensity of marginalisation and poor acceptance in the society, people with GID require strong mental health support.

SYMPOSIUM/WORKSHOP PROPOSAL: DIGITAL TOOLS FOR MENTAL HEALTH RESEARCH: UPSKILLING RESEARCHERS, ENABLING RESIDENTS

INTRODUCTION:

Mental health research is a rapidly evolving field, with innovative technologies playing a pivotal role in not only being the subject of research, but also being the tools for research . Artificial Intelligence (AI) has emerged as a powerful ally, facilitating data gathering, data summarization, and data analysis in ways that were previously unimaginable. This symposium aims to bring together experts in the field to explore the latest digital tools and their applications in mental health research. The symposium is specially targeted to young researchers and residents, and intends to empower them with the skills necessary to form research questions, gather and organise literature, conduct research and analyse findings using newer technologies.

OBJECTIVES:

1. a. Showcase cutting-edge AI research assistant – Dr Koushik Sinha Deb, Additional Professor, Psychiatry, AIIMS, Delhi

2. b. AI-Enabled literature search tools – Dr Vijay Krishnan, Assistant Professor, Psychiatry, AIIMS, Rishikesh

3. c. Digital tools literature organization – Dr Swati Kedia, Assistant Professor, Psychiatry, AIIMS, Delhi

4. d. Digital tools literature review – Dr Pooja Shakya, Research Associate, Psychiatry, AIIMS, Delhi

5. e. Digital data collection for research – Dr Ragul Ganesh, Assistant Professor, Psychiatry, AIIMS, Jammu

6. f. AI-Enabled data summarization – Dr Koushik Sinha Deb, Additional Professor, Psychiatry, AIIMS, Delhi

CONCLUSION:

The symposium will feature interactive discussions on various AI-enabled tools, where participants can learn, share, and collaborate. These sessions will address the practical implementation of digital tools in mental health research and clinical settings.

TeleMANAS – Serving People – Empowering Bharat

TeleMANAS is a comprehensive digital mental health care service launched by the Ministry of Health and Family Welfare in India. It is a tele-mental health initiative that aims to provide free mental health services to people across the country, especially those in remote or underserved areas. The service is available 24/7 and can be accessed by dialling the toll-free number 14416 or 1-800 891 4416. The initiative was launched on World Mental Health Day, October 10, 2022.

The service provides a range of mental health care services, including counselling, psychotherapy, and psychiatric consultations. The initiative was launched as an acknowledgement to the mental health crisis in India and aims to enable people to seek support for their mental health issues while maintaining anonymity of the callers, thereby reducing the stigma generally surrounding mental health issues. The National Institute of Mental Health and Neurosciences (NIMHANS) is a nodal centre for this initiative.

In this symposium, the presenters intend to highlight about the TeleMANAS Program, challenges, opportunities, current status and way forward for this innovative initiative.

Topic	Presenter
TeleMANAS – An overview	Dr. Channaveerachari Naveen Kumar Professor of Psychiatry, NIMHANS
Trishul Trichotomy of mental health	Dr Narayana Manjunatha Additional Professor of Psychiatry, NIMHANS
Legal challenges of Telecounselling	Dr Suresh Bada Math Professor of Psychiatry NIMHANS
MANASVITA – A key to the future	Dr Dinakaran Damodharan* Assistant Professor of Psychiatry, DPSSDM, NIMHANS

Corresponding author: Email ID- dina.nimhans@gmail.com Mob-8197311288

Positive Psychiatry: The Way Forward

Presenting Authors- Prof.Dr Sudhir Bhave, Prof.Dr Vivek Kirpekar, Prof.Dr Sushil Gawande, Dr Neha Salankar

Department of Psychiatry, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital,Nagpur

Psychiatry, traditionally, has been dealing with diagnosis and treatment of mental disorders, thus basing their objective on eradication of the negative. Lately, some thought is being given to increasing the positive attributes of a person, thus shielding him from future psychological ill-health and aiding recovery.

All the practices of psychiatry that deal with the understanding of and promotion of well- being come under an umbrella term, called positive psychiatry. The concept of positive psychiatry dates back to 1906 when William James argued for this new approach. Positive psychiatry has 4 main components: (1) positive mental health outcomes, (2) positive psychosocial characteristics and environmental factors, (3) biology of positive psychiatry constructs, and (4) positive psychiatry interventions.

Its scope is not limited to persons suffering from mental illnesses.It is especially useful for people who suffer from or are at high risk of developing mental or physical illnesses.

It will be broadly discussed under the following four heads -

1. Concept of positive psychiatry

2. Evidence of clinical utility of positive psychiatry

3. Cognitive models of positive psychiatry

4. Behavioral models of positive psychiatry.

Proposal for “paper presentation”

Gayatri Khanal, Y. Selvamani

Association of childhood socio-economic status and health with depressive symptoms among older adults in India

Background: Childhood adverse experience has been linked with poor health outcomes across the life course. Nevertheless, whether such an association or direction could be projected to older people’s life remains still unclear and needs to generate more evidences, particularly in India. Therefore, this study was conducted to examine the association of childhood socio-economic status and health with depressive symptoms.

Methods: Cross-sectional study from the first wave of the national representative survey “Longitudinal Ageing Study in India (LASI)” was used. Depressive symptoms were measured by Centre for Epidemiology Studies Depression Scale (CES-D). Multivariable regression analysis was used to examine the association between variables.

Results: Poor childhood health was significantly and positively associated with depressive symptoms (AoR: 1.372, CI: 1.09, 1.727). Likewise, respondents who were bedridden for a month during their childhood had high odds of developing depressive symptoms (AoR: 1.154 CI: 1.008, 1.322). The odds of having depressive symptoms increased significantly among the average (AoR: 1.276 CI: 1.025, 1.588) and poor childhood socioeconomic status group (AoR: 1.259 CI: 1.007, 1.573) as compared to the elite childhood socioeconomic status category.

Conclusions: Childhood socioeconomic status and health have a statistically significant role in determining the mental health in later life. Results suggest that considering childhood socioeconomic status and health is important while diagnosing depression in older population in order to identify the significant associated factors in early childhood and thus help in preventing depressive symptoms in later life.

Do we need a separate legislation for substance use treatment?

Substance use is a major problem across the globe and also in India. Bringing a patient of substance use disorder for treatment is a difficult task, as majority of them fails to recognize the problem and completely refuse for any treatment even when their family members are of different opinion. Also the legislation in India, on one hand are not supporting involuntary treatment and on other hand put treating doctors in difficult circumstances. The current symposium will highlight the various difficulties faced by users and carer due to current legislations and how a separate legislation can solve these difficulties.

MHA 2017 and substance use treatment (15mins): As per MHA 2017, every person is presumed to have capacity to make choice about his mental healthcare needs but in reality many patients with substance abuse lack such a capacity. Due to this provision of MHA 2017 it is difficult to treat patients of substance abuse involuntarily and if they are treated involuntarily, patients have dragged psychiatrist to the court causing apprehension among psychiatry fraternity. The speaker will highlight various sections of MHA 2017 relevant to substance use treatment and how they are hindrance to substance abuse treatment.

NDPS act and substance use treatment (15mins): As per this act even consumption of narcotic drug is a punishable offense, so revealing this information even to the doctors can be problematic. The information from patient is obtained by psychiatrist in fiduciary capacity. So they remain in ethical dilemma to whether pass the information of narcotic drug use to police or not. Also narcotic drugs are stored and prescribed by psychiatrist for treatment but there is no provision in NDPS act which allows permissible quantity of storage and hence some psychiatrist are arrested in certain states under this act, causing apprehension among psychiatry fraternity. The speaker will discuss these issues in detail at symposium.

COTPA act and substance use treatment (10mins): As cigarette smoking is a punishable offense in public places and even in hospital, this provision of COTPA act create a difficulty in managing patients who wants to give up harder substances like alcohol, opioids and cannabis but are not motivated to give up smoking. Putting a forced treatment of smoking cessation leads to early drop out from de-addiction facility and at times leads to wrong practices of bringing substances to de-addiction facilities. The speaker will discuss short coming of this act and how it is hindrance in treatment of substance use treatment. The speaker will also discuss how a separate legislation which will be exclusively applicable to substance use treatment can overcome these challenges faced by users and carers.

Discussion: 5mins

Speaker 1. Dr.Manoj Kumar, Assistant Professor Deptt of Psychiatry IHBAS, Delhi. dmk73psy@gmail.com, 9818973700

Speaker 2. Dr.Mahadev singh Sen, Assistant Professor Deptt of Psychiatry IHBAS, Delhi

Speaker 3. Dr.Renju Sussane Baby, Assistant Professor Deptt of Psychiatry Nursing IHBAS, Delhi

Lost ,Never to be Found -----Understanding Grief

1. 1. Dr.Sonaa Kakar MBBS,MD

   (Psychiatrist and Practitioner of Short Term Psychodynamic Psychotherapy) Talk Time Clinic, Columbus Hospital Hyderabad drsonakakar@gmail.com mobile 9959403334

2. 2. Dr.Ajit Bhide MBBS, MD, HOD Department of Psychiatry, St Martha’s Hospital Bangalore drajitbhide@gmail.com

Summary

It is well known and documented that unattended emotions can manifest as psychopathological symptoms. Loss inevitabily leads to grief . The coping strategies used by an individual to loss can lead to symptoms and psychopathology. The more primitive the defenses the more the psychopathology and distress.Through the experience of affect/grief which has been avoided by a unique individual defense system , symptoms may cease.

Human tragedies continues to unfold the truth about the short and long tem impact of loss on those who lose. In order to work with patients with symptoms related to recent or earlier losses, a fair understanding of the phenomena and experience of grief will be discussed

Aims

This symposium has been conceptualized keeping in mind the learning needs of mental health professionals especially dealing with patients in regions with greater human tragedy than usual and also as an opportunity to be attentive to the connection between loss and psychopathology presenting in a regular out patient setting.

Role of Large-Scale Neurocognitive network across psychiatric disorder.

DR AAKANKSHA MALHOTRA¹, DR SOUMI GHOSH ², DR SOURAV BAG ²

¹Senior Resident, Department of Psychiatry, IHBAS, Delhi.

²Senior Resident, Department of Psychiatry, Institute of Psychiatry- Centre of Excellence, Kolkata.

Multiple psychiatric disorders share a common feature which is the presence of cognitive deficits, particularly in working memory, executive control and attribution of salience. Also, psychiatric disorders share common neurobiological correlates in the dorsolateral prefrontal cortex (dlPFC), insula, dorsal anterior cingulate (dACC), posterior cingulate cortex (PCC), parietal and temporal cortices. Since the discovery of the large-scale brain networks, we are being able to see the brain and its connections as a whole and it is evident that functionality of the brain depends on multiple areas of brain working in a synchronized way. Psychiatric disorders can also be explained to some extent in the mirror of large-scale neurocognitive network as well. This can give us a better and wholesome understanding of the psychiatric disorders in the coming time.

Psychopharmacology practices in perinatal period: Investment in mother, Dividend for children

Decision making concerning usage of Psychotropic agents in pregnant and postpartum women are often influenced by simultaneous consideration of both maternal and fetal/infant health and well-being, identified teratogenic effects of some medications, attitude of obstetricians and neonatologists towards psychotropics and family’s preference as per prevailing controversial sociocultural context. But the evidence has emerged in favor of early and effective treatment of mental illnesses during perinatal period. It is imperative to discuss evidence based use of psychotropics in this period and risk of fetal anomalies as well as childhood mental disorders in women on psychotropic as compared to their healthy cohort. It’s also essential to extend this care beyond pregnancy and postpartum symptom reduction to pre pregnancy planning, lactation care and contraceptive care planning to appropriate assessment of infants for being watchful for signs of early neurobehavioral insults

Speakers:

Principles of Rational Psychopharmacology in Perinatal period: Dr Bhavuk Garg, Associate Professor Psychiatry, LHMC, Delhi

Risk of fetal anomalies vs Maternal Pharmacological Treatment: Walking the Tight rope: Dr Prerna Kukreti, Professor Psychiatry, LHMC, Delhi

Prenatal and Postnatal counselling for mothers on Psychotropics: Dr Omsai Ramesh V, Professor Psychiatry, LHMC, Delhi

Assessment measures in Infants born to mothers on Psychotropics: Dr Nagaratna, Early Interventionist Consultant, Delhi

Perinatal Psychopharmacology, Pre pregnancy Counselling, Fetal anomalies, Infant assessment

Coordinating author: Dr Prerna Kukreti, Professor Psychiatry, Lady Hardinge Medical College, Delhi, India, dr.prernakukreti@gmail.com, 9810612578

Clozapine: Understanding its side effects and Using it for Management for Tardive Dyskinesia

Speakers: Sandeep Grover, E Mohandas

Chairperson: Ajit Avasthi

Understanding the side Effects of Clozapine: Sandeep Grover

Clozapine is associated with many troublesome side effects. Due to this clinician often refrain from using clozapine, even though indicated. On the other hand, some of the life threating side effects of clozapine are missed by the clinicians. This presentation will focus on understanding the life-threatening side effects of clozapine and how to manage the same.

Recent Trends in the pharmacotherapy of Tardive Dyskinesia: E Mohandas

Tardive Dyskinesia is a potentially disabling and permanent hyperkinetic movement disorder resulting from chronic exposure to dopamine receptor blocking agents .The pathogenetic mechanisms proposed include dopamine hypersensitivity, dysfunctional gamma-aminobutyric acidergic neurons and reactive oxygen species hypothesis. The mean prevalence of TD is estimated to be 25.3% in psychiatric patients on chronic use of antipsychotics. The propensity for some groups prone to develop tardive dyskinesia has suggested genetic links- dopamine D2 and D3 receptor genes, serotonin 2A and 2C receptor genes, vesicular monoamine transporter 2 (VMAT 2) gene, Heparan sulfate proteoglycan 2gene, FoxP1 gene and regulating synaptic membrane exocytosis 2 (RIMS2).

The pharmacological strategies suggested are reduction/stoppage of offending agent, substituting with clozapine if possible, dietary supplements like vitamin E, B6, essential fatty acids, yokukansan; drugs like melatonin,GABA agonists, amantadine and vesicular monoamine transporter inhibitors 2(VMAT-2).The current opinion recommends VMAT2 inhibitors with the best evidence, clozapine with moderate evidence and other agents with minimal evidence. The available data on VMAT-2 inhibitors is presented.

Dr E.Mohandas MD(AIIMS),Chief Consultant Psychiatrist, Sun Medical& Research Centre,Trichur,Kerala(India),680001, +919447086355 emohandas53@gmail.com

Measuring Substance Use Disorder Severity: Insights and Pragmatic Issues

Mukesh Kumar Swami, Balaji Bharadwaj, Siddharth Sarkar

Department of Psychiatry, AIIMS, Jodhpur Department of Psychiatry, JIPMER, Puducherry

Department of Psychiatry and NDDTC, AIIMS, New Delhi

Measuring a problem enables a clinician to assess the changes with time. This is applicable in the context of substance use disorders as well, which form an important part of the clinical load in routine psychiatric practice. Assessment of substance use disorder severity has the potential applicability of routine clinical care to chart the progress of patients with time. It also has the potential for use in clinical trials where the efficacy needs to be clearly documented. This symposium will discuss the measurement of severity in the context of substance use disorders. The first speaker would bring out the importance and relevance of measurement of severity in substance use disorders, the cultural-social-economic issues in severity assessment, and the clinical considerations and constraints pertaining to such assessment. The utility of assessment and the various assessment measures will also be highlighted. The second speaker would discuss the development of an Indian instrument for the assessment of substance use disorder severity. He would also present the methodology and different aspects of the scale development process followed. The third speaker would share the findings of the multi-center application of the instrument. He would discuss the severity measures assessed, the two different versions of the instrument, and the potential clinical application of this instrument. The symposium would also highlight the importance of inter- institutional efforts and research networks for enhancing the repertoire of scales and instruments that can be utilized in the local setting.

1^st Collaborative Symposium by IPS Technology and Psychiatry Specialty Section Title: Generative AI for Mental Health Professionals

Speakers:

• Dr. Mohan Sunil Kumar, Director and Chief Psychiatrist, Augmenta Health (P) Ltd. (Applications of Generative AI)

• Dr. Darpan Kaur, Professor, MGM Institute of Health Sciences, Navi Mumbai (Understanding Generative AI)

Generative Artificial Intelligence (AI) is a rapidly evolving field with the potential to revolutionize mental health care. Generative AI models can learn from large datasets of text, images, and other data to create new content, such as text, images, and code. This capability has the potential to transform the way mental health professionals diagnose, treat, and manage mental health conditions.

This symposium aims to provide mental health professionals with a comprehensive overview of generative AI, including its underlying algorithms and methodologies, its potential applications in mental health care, and ethical considerations for its implementation.

In the first talk, Dr. Darpan Kaur will introduce the fundamental concepts of generative AI and discuss its relevance and adaptability in mental health care settings. She will also highlight the challenges and opportunities associated with the use of generative AI in mental health care.

In the second talk, Dr. Mohan Sunil Kumar will explore the specific applications of generative AI in mental health care. He will discuss how generative AI can be used to augment traditional therapeutic interventions, such as CBT, and to develop novel diagnostic tools. He will also provide examples of current research and development efforts in this area.

By the end of this symposium, participants will have a nuanced understanding of the potential of generative AI to transform mental health care. They will also be equipped with the knowledge and skills to integrate generative AI ethically and effectively into their clinical practice.

Members of the IPS Technology and Psychiatry Speciality Section:

Advisor: Dr Parmod Kumar

Chairperson: Dr Mohan Sunil Kumar

Co-Chairperson: Dr Darpan Kaur

Convenor: Dr Bappaditya Chowdhury

EC Representative: Dr Sudhir Bhave

PROPOSAL FOR SYMPOSIUM: WORKPLACE MENTAL HEALTH: ASPIRATIONS CHALLENGES AND SOLUTIONS

Work is both an important resource for mental health, yet it also presents risk factors for mental illness. A roaring hike in stress related psychiatric symptoms has been noticed in employees across different sectors. However, the occupational sector is yet not well equipped to provide adequate help or directions to these affected individuals or provide suitable workplace accommodation, leading to delayed help seeking, stigmatization & alienation. Due to the lack of collaboration with occupational sector, mental health professionals face various dilemmas in evaluating and treating employees referred from industrial sector. Striking balance between patient’s right of confidentiality and disclosure to employer becomes a tough task for mental health professionals. Hence, it is an emerging need to identify the reasons for developing mental health problems at workplace, explore barriers in help seeking and ethical concerns in disclosure at workplace. At the same time, it is also prudent to identify potential areas to create a supporting environment for positive mental health promotion and early identification at workplace to be incorporated in company policies. This symposium will discuss these sensitive issues under following subheadings:

Topics and Speakers (name and designation)

Workplace stress and mental health: Dr Shiv Prasad, Professor and Head, Dept. of Psychiatry, Lady Hardinge Medical college (LHMC) Delhi

Disclosure of mental illness & workplace accommodation-Challenges for clinicians & employers: Dr Prerna Kukreti, Professor, Dept. of Psychiatry, Lady Hardinge Medical college (LHMC) Delhi

Creating supportive environment for mental health promotion at work place: Dr Dinesh Kataria, Professor, Dept. of Psychiatry, Lady Hardinge Medical college (LHMC) Delhi

Workplacemental health, Disclosure, Workplace accomodation

Coordinating author: Dr Prerna Kukreti, Professor Psychiatry, Lady Hardinge Medical College, Delhi, India, dr.prernakukreti@gmail.com, 9810612578

Development and validation of the scale to assess severity of substance use

The need for a scale for measurement of substance use severity in Indian settings was a felt need. The existing scales were designed in foreign countries and were poorly validated in our setting. Moreover, the scales were often too long or cumbersome. Hence the need for this scale development.

An initial literature search was done to identify the pre-existing scales and a pool of items were generated from it. These items were sent to the experts who were part of the validation study through online mode followed by a second in- person meeting to decide on the importance and relevance of the items. This led to a 43-item scale along with a brief 5-item scale which focused on current (last 30-days & lifetime severity). Based on initial pilot testing, two more items were dropped and the scale was reduced to 41-items and the brief version was retained at 5-items for current and lifetime ratings.

The scale was applied to all the patients who consented and participated at each of the centres. In addition, for a subset of patients, the Addiction Severity Index was applied for testing reliability, the Addiction Recovery Capital was assessed for divergent validity. For a subset of patients, the scale was applied at 1-month and 3-month follow-up to give predictive validity of the instrument. Factor analysis was done for the full version of the scale to find out the latent factors.

PROPOSAL FOR MILITARY PSYCHIATRY SYMPOSIUM – ANCIPS 2024

Models Of Mental Healthcare Delivery in the Armed Forces

1. Introduction and global perspective – Surg Cdr Priyadarshee Patra. Brief history of Mental Healthcare Delivery across the world and in India, role of Military Psychiatrists as pioneers in evolution of newer models, legal perspective in the light of MHCA 2017.

2. Different models of care existing in military psychiatry in India

   – Surg Cdr Neha Sharma. Standard of care in military GHPUs, different types of set-up in existence for Psychiatric services – conventional and non-conventional GHPU, Polyclinic, Day Care centres etc.

3. Advantages and disadvantages of these models over one another – Lt Col Madhubrata Ray. Comparison of different set-ups in terms of clinical, legal and administrative aspects.

4. Discussion and Conclusion – Lt Col SP Panda. Past, present and future of Mental Healthcare delivery in armed forces.

Moderator: Col Vinay Chauhan

Celebrity Suicide: Influence and Media reporting Topics and speakers:

An overview of suicide- with a special focus on celebrities: Dr. Devika Kosana, Assistant Professor of Psychiatry, ESIC Medical College and Hospital, Sanath Nagar, Hyderabad.

Suicide in celebrities: Dr. M. Hrishikesh Giri Prasad, Associate Professor of Psychiatry, Niloufer Hospital, Osmania Medical College, Hyderabad.

Media reporting of death of celebrity: Dr. Nithin Kondapuram, Consultant Psychiatrist, Aster Prime Hospital, Hyderabad.

Celebrities experience severe psychological stress due to paparazzi and public scrutiny, inability to accept failures, substance use etc. They are unlikely to seek timely help as a result of barriers such as isolation, mistrust and fear of losing fame, placing them at a greater risk of suicide.

Celebrity suicide influences the general population. Copycat suicides are common following the aftermath of such events increasing the need for crisis intervention in person or through suicide helplines. Younger age, females, unemployed, persons having a mental illness or precipitating life stressors were found to be more likely to commit suicide following a celebrity suicide. Increased use of social media by adolescents, and the desire to become celebrities and social influencers for quick success makes them more prone to suicide which may be a rising concern in the coming days.

High publicity, providing minute details of the suicidal act, various speculations and repeated highlighting of the news predisposes vulnerable individuals to resort to suicide as a solution to their problems. Responsible media reporting is essential to prevent a rise in suicides in the general population. Based on the recent incidents, the Press Council of India framed guidelines for media professionals that align with the WHO recommendations for reporting.

Psychiatrists have a primal role in interacting with media in these instances to provide scientific information regarding mental illnesses and reduce the associated stigma. Caution should be exercised from making unvetted statements that can adversely influence the perception of mental health among general population.

Proposal for Symposium: Addressing dropouts from psychiatric treatment in Indian setting

Objectives: To discuss the determinants of dropouts from psychiatric treatment and possible solutions to address it

Background: In addition to the huge treatment gap for psychiatric disorders, dropping out of treatment further worsens the existing problems. Dropping out is defined as an early withdrawal from the treatment without the agreement of the therapist and it ranges from 21.3% to 59.3% in different Indian studies. Various factors that influence dropout from treatment can be grossly categorized as sociodemographic factors, cultural factors, patient-related factors, illness factors, and clinician factors. Almost every type of psychiatric illness be it psychotic spectrum disorders, mood disorders, stress related disorders, or substance use disorders has been associated with dropouts. One important influencer that affects treatment decision is sociocultural understanding about the mental illness. Among sociocultural factors stigma and faith healing practices are important and dominating factors determining treatment seeking as well as adherence in Indian context. Dropout may adversely influence the course and prognosis of the underlying psychiatric illness. Hence, to improve treatment adherence, it is very important to address issues such as stigma, lack of awareness, myths, and negative attitudes toward medications via proper psychoeducation in their own local language specially during the initial visits. In order to reduce dropout rates, treatment approaches should be tailored according to patient characteristics. Also, it is important for young psychiatrists to learn building an effective patient–doctor relationship.

Description of the symposium: This symposium will be discussed under following heading:

1. Dropout: concept and relevance

2. Determinants of dropouts

3. The way forward: Addressing dropouts in the Indian setting

Key Words: Dropouts, determinants, socio-cultural factors, stigma, faith healing

Speakers:

1. Dr. Vijay Kumar Saini,

   Assistant Professor, Department of Psychiatry, AIIMS Jodhpur, India. Email ID: vsaini344@gmail.com

2. Dr. Mukesh Kumar Swami,

   Additional Professor, Department of Psychiatry, AIIMS Jodhpur, India. Email ID: mukesh.swami@gmail.com

3. Dr. Navratan Suthar,

   Associate Professor, Department of Psychiatry, AIIMS, Jodhpur, India. Email ID: navratansuthar86@gmail.com

Background:

Major depressive illness is a debilitating condition which is matter of concern worldwide affecting millions of people causing a considerable burden on health and socioeconomic status.. Pharmacotherapy modulating monoamine systems generally takes 4–12 weeks to start improvement. Recent studies are accepting the role of glutamate in depression, in particular, N– methyl-D aspartate (NMDA) receptors along with serotonin receptors. They are postulated to be involved in depression. Glutamate is the main excitatory neurotransmitter which has a role in neurodevelopment, neurocognitive (memory learning), and neurotrophic (nerve growth differentiation, maintenance) function. Racemic (R,S)-ketamine (hereafter referred to as ketamine), first synthesized in 1962, is a rapid-acting general anesthetic; it has been on the World Health Organization’s Essential Medications List since 1985

The Department of Psychiatry KMCT Medical College has been giving IV Ketamine on a Regular Basis from 2021. The cases more than 50 + will be presented (The largest sample from a teaching hospital in Kerala)

Presentation Format

Session Chair: Prof. Sushil Kakkan Opening Comments – 5 minutes

1. Ketamine in Major Depressive Disorder: The Neurobiologic Underpinning- Prof. Rajmohan Velayudhan – 15 monutes

2. Guidelines on Use of Ketamine in Major Depressive Disorder- Dr. Raiza Mohamed – 15 minutes

3. Practice Experience of Intravenous Ketamine Use in Major Depression from a Rural Medical College Setting in Kerala – Dr. Pranav Nair – 15 minutes

4. Discussion – 10 minutes

Tackling Gambling Disorder in India: Perspective of prevention, treatment and policy

Presenters:

Dr. Mohit Varshney, Associate Professor of Psychiatry, ILBS New Delhi Dr. Amit Singh, Assistant Professor of Psychiatry, KGMU Lucknow

Dr. Dheeraj Kattula, Associate Professor of Psychiatry, CMC Vellore

Dr. Arpit Parmar, Assistant Professor of Psychiatry, AIIMS Bhubaneswar

Gambling has been a popular pastime from ancient India. The rates of gambling and problem gambling are increasing across the globe. This is an important public health concern, even in India. Gambling is more common in specific vulnerable populations, such as those with substance use disorders. It is associated with numerous harms in various aspects to the person who gambles, their family members, the community, and society. Despite this, gambling has attracted limited interest among Indian mental health professionals. There is a surprising lack of scientific literature on various aspects of gambling in India. We hereby present an overview of gambling disorders from an Indian perspective. The first presenter will discuss the epidemiology of gambling in India and the world and the conceptual issues defining gambling disorder. The second presenter will discuss the various clinical aspects of gambling disorders, including comorbidities. The third presenter will discuss the various treatment modalities found to be helpful in tackling gambling-related issues in clinical practice and discuss a few case vignettes. Finally, the last presenter will discuss the policy and legal framework for tackling gambling and the need for a comprehensive public health framework.

NON-INVASIVE BRAIN STIMULATION: NOVEL SITES AND PARADIGMS

Category- SYMPOSIUM

1. Principal author: Dr. Shobit Garg : Professor, Department of Psychiatry, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand. Pin code: 248001 (shobit.garg@gmail.com) Phone number-8958534261

2. Dr. Aditi Bhatia :SR, Psychiatry, SGRRM&HS, Dehradun (aditibhatia926@gmail.com) Phone number-7409956865

3. Dr. Sarthak Bhandari :JR, Psychiatry, SGRRM&HS, Dehradun (Sarthak.bhandari1@gmail.com) Phone number-9548120655

4. Dr. Anusha Aggarwal :JR, Psychiatry, SGRRIM&HS, Dehradun (aggarwalanusha32@gmail.com) Phone number-8054671984

Correspondence:

Dr. Aditi Bhatia

Email address: aditibhatia926@gmail.com Phone no.: 7409956865

Word count-196

Non-invasive brain stimulation including Transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) has been studied as a potential treatment for several psychiatric and neurological disorder. TMS and tDCS, two noninvasive brain stimulation methods, can provide facilitation resembling long- term potentiation, however, its additive effects are uncertain. These 2 forms of stimulation can bidirectionally control the excitability of neurons in neural networks, depending on the stimulus frequency of rTMS or the polarity of electrodes positioned on the scalp in tDCS. We also intend to discuss the role of patterned TMS (e.g. theta burst stimulation) in anxiety disorders, OCD and refractory schizophrenia including novel sites of stimulation. Total duration of the symposia shall be 60 min and under the following sub-headings:

1. Overview: 12 min

   Speaker: Dr Shobit garg (Prof. Psychiatry, SGRRM&HS, Dehradun)

2. tDCS and TMS: Are they different sides of the same coin: 12 min Speaker: Dr Aditi Bhatia (SR, Psychiatry, SGRRM&HS, Dehradun)

3. tDCS and TMS: Case based scenarios: 12 min

   Speaker: Dr Anusha Aggarwal (JR, Psychiatry, SGRRM&HS, Dehradun)

4. Neurostimulation in anxiety disorders: 12 min

   Speaker: Dr Sarthak Bhandari (JR, Psychiatry, SGRRM&HS, Dehradun)

Discussion: 12 minutes

There has been an enormous amount of interest growing around biomarkers as potential tools for improving prevention, diagnosis, prognosis, drug response and drug development in psychiatric disorders over the last few years.

The identification of biomarkers in psychiatry is becoming essential to facilitate diagnosis through the developing of markers that allow to stratify groups within the syndrome, which in turn may lead to more focused treatment options. In order to throw more light on this issue, we would like to propose a symposium on Biomarkers in Psychiatry.

Presentors

Dr. Minhajzafer Nasirabadi,

President, IPSTSB, Prof and Head, Dept of Psychiatry.

Dr. V. George Reddy,

Imm Past President, IPSTSB

Consultant Psychiatrist,Healthy Brain Clinic, Hyderabad.

Dr. Pavan Kumar K, Imm Past Secretary, Prof and Head, Dept of Psychiatry, CAIMS, Karimnagar.

drrag27@gmail.com

Dr. Vishal Akula, Hon Gen Secretary,

Direct Council Member,

Professor and Head, Dept of Psychiatry, GMC Jagtial

and

Dr. Phanikanth, Hon Editor, IPSTSB Ass Professor,

IMG, OMC, Hyderabad.

There has been an enormous amount of interest growing around biomarkers as potential tools for improving prevention, diagnosis, prognosis, drug response and drug development in psychiatric disorders over the last few years.

The identification of biomarkers in psychiatry is becoming essential to facilitate diagnosis through the developing of markers that allow to stratify groups within the syndrome, which in turn may lead to more focused treatment options. In order to throw more light on this issue, we would like to propose a symposium on Biomarkers in Psychiatry.

Presentors

Dr. Minhajzafer Nasirabadi,

President, IPSTSB, Prof and Head, Dept of Psychiatry.

Dr. V. George Reddy,

Imm Past President, IPSTSB

Consultant Psychiatrist,Healthy Brain Clinic, Hyderabad.

Dr. Pavan Kumar K, Imm Past Secretary, Prof and Head, Dept of Psychiatry, CAIMS, Karimnagar.

drrag27@gmail.com

Dr. Vishal Akula, Hon Gen Secretary,

Direct Council Member,

Professor and Head, Dept of Psychiatry, GMC Jagtial

and

Dr. Phanikanth, Hon Editor, IPSTSB Ass Professor,

IMG, OMC, Hyderabad.

“Clearing the Fog: Navigating Diagnostic Complexities and Optimizing Management for Adult ADHD”

This symposium delves into the multifaceted realm of Adult Attention-Deficit/Hyperactivity Disorder (ADHD), a condition that often shrouds itself in diagnostic complexities and management challenges. With a focus on clarity and effective strategies, our symposium brings together experts, clinicians, and researchers to shed light on the intricacies of diagnosing and managing Adult ADHD. We explore the latest developments in diagnostic tools, assessment methods, and emerging research, aiming to provide attendees with practical insights into improving diagnostic accuracy and optimizing treatment protocols. Join us for a comprehensive discussion, where we aim to “clear the fog” surrounding Adult ADHD and empower professionals with the knowledge and tools to better support individuals with this condition.

Navigating the Path: Career Opportunities for Indian Psychiatrists in the UK

This research explores the career opportunities and challenges faced by Indian psychiatrists seeking to establish themselves in the United Kingdom’s healthcare system. As the demand for mental health services in the UK continues to rise, this study delves into the pathways available to Indian psychiatrists, examining factors such as training, accreditation, cultural adaptation, and the evolving landscape of mental healthcare in the UK. By analysing the experiences of Indian psychiatrists and considering the perspectives of key stakeholders, this study aims to provide valuable insights into the unique opportunities and obstacles in this career migration, contributing to the ongoing discussion on enhancing diversity in the mental health workforce.

This talk will also focus on challenges in clearing MRCPsych CASC exam and some tips to be successful

ANCIPS 2024: Proposal for Symposium: Effects of Lithium on carbohydrate metabolism and body weight

Speakers:

Topic 1: Dr Ravindra Neelakanthappa Munoli, Associate Professor

Email: ravindra.nm@manipal.edu, Mob: 9972028881 Topic 2: Dr Suma T Udupa, Assistant Professor Email: udupa.suma@manipal.edu Mob: 9901790003 Topic 3: Dr Samir Kumar Praharaj

Email: samir.kp@manipal.edu Mob: 8971026304

Department of Psychiatry, Kasturba Medical College, Manipal Manipal Academy of Higher education, Karnataka, India

Topic 1: Lithium, Insulin and Glucose tolerance

Lithium may exert insulin-like effects, increasing glucose utilization and glycogen synthesis. The lithium ion influences enzymes involved in glycolysis, gluconeogenesis and glucose uptake by the cells. Both insulin and lithium inactivate glycogen synthase kinase 3 (GSK3) and thus activate glycogen synthase. Few studies reported that lithium does not significantly affect blood glucose concentration in bipolar patients. Few studies have also shown that lithium may acutely impair insulin release.

Topic 2: Weight changes during Lithium treatment

Weight gain is a significant undesirable side-effect of long-term lithium administration which might interfere with treatment compliance. In the majority of studies, it was found that lithium prophylaxis led to weight gain in a high proportion of patients treated, with up to a quarter becoming clinically obese. The findings seem to indicate that weight gain is a direct effect of lithium treatment. However, in some studies only moderate weight gain on lithium has been reported.

Topic 3: Lithium administration in Bipolar patients with diabetes mellitus: Case Based Discussion

There are few case reports on the use of lithium in bipolar patients with pre-existing diabetes mellitus. In addition, there are also case reports describing antidiabetic effects of lithium. In studies serum lithium levels were correlated with fasting blood glucose levels, and lowering of the lithium level led to a lowering of the fasting glucose concentrations. A judicious decision is essential in these circumstances.

Psychedelic Renaissance- The road to be taken or not?

Psychedelic drugs have been used in psychiatry for decades, but their use has been limited due to their classification as Schedule I drugs. However, recent research has shown that these drugs may have therapeutic potential in treating a variety of psychiatric conditions. Psychedelic drugs such as LSD, psilocybin, MDMA, ayahuasca, DMT, and ketamine have been found to be beneficial in treating depression, anxiety, trauma, and addiction.

Psychedelic drugs are a loosely grouped class of drugs that are able to induce altered thoughts and sensory perceptions. At high doses some of them, such as LSD, can cause visual hallucinations. Psilocybin can also alter perceptions and cause hallucinations at high doses. There are likely several ways in which psychedelics can accomplish the intended result. Psychedelic therapy (sometimes referred to as psychedelic-assisted psychotherapy or PAP) is a type of psychiatric practice that involves the use of psychedelics combined with talk therapy. Clinical trials have assessed the benefits of methylenedioxymethamphetamine (MDMA), in treating depression and PTSD.

Psychedelic drugs are not without risks. They can cause adverse reactions such as anxiety or paranoia in some people. However, research has shown that when used under controlled conditions with trained professionals present, these risks can be minimized. In this symposium, the presenters intend to highlight about the Psychedelic drugs, history, mechanisms of action, current evidence and way forward.

Topic	Presenter
Psychedelics since stone age	Dr. Venakata Lakshmi Narasimha Director, Manosuraksha Foundation Bengaluru
Mechanism of “shutdown with update”	Dr Jayakrishnan Menon Consultant Psychiatrist IQRAA Hospital, Calicut
Levels of Evidence	Dr Mukku Shivashanker Reddy Assistant Professor of Psychiatry Viswabharathi Medical College, Kurnool Dr Ateev Sudhir Chandna, Senior Resident, NIMHANS, Bengaluru
The Road ahead	Dr Dinakaran Damodharan* Assistant Professor of Psychiatry, DPSSDM, NIMHANS

Corresponding author: Email ID- dina.nimhans@gmail.com Mob-8197311288

TeleMANAS – Serving People – Empowering Bharat

TeleMANAS is a comprehensive digital mental health care service launched by the Ministry of Health and Family Welfare in India. It is a tele-mental health initiative that aims to provide free mental health services to people across the country, especially those in remote or underserved areas. The service is available 24/7 and can be accessed by dialling the toll-free number 14416 or 1-800 891 4416. The initiative was launched on World Mental Health Day, October 10, 2022.

The service provides a range of mental health care services, including counselling, psychotherapy, and psychiatric consultations. The initiative was launched as an acknowledgement to the mental health crisis in India and aims to enable people to seek support for their mental health issues while maintaining anonymity of the callers, thereby reducing the stigma generally surrounding mental health issues. The National Institute of Mental Health and Neurosciences (NIMHANS) is a nodal centre for this initiative.

In this symposium, the presenters intend to highlight about the TeleMANAS Program, challenges, opportunities, current status and way forward for this innovative initiative.

Topic	Presenter
TeleMANAS – An overview	Dr. Channaveerachari Naveen Kumar Professor of Psychiatry, NIMHANS
Trishul Trichotomy of mental health	Dr Narayana Manjunatha Additional Professor of Psychiatry, NIMHANS
Legal challenges of Telecounselling	Dr Suresh Bada Math Professor of Psychiatry NIMHANS
MANASVITA – A key to the future	Dr Dinakaran Damodharan* Assistant Professor of Psychiatry, DPSSDM, NIMHANS

Corresponding author: Email ID- dina.nimhans@gmail.com Mob-8197311288

Title of the Symposium Proposal: Digital Geriatric Mental Health Care- Scope and Challenges in Indian Context

Speakers: Sivakumar PT¹, Vikas Menon², Srinandha S²

1National Institute of Mental Health and Neurosciences (NIMHANS)

2Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)

The population of older adults in increasing rapidly in India contributing to the need for developing geriatric mental health care services. The prevalence of geriatric mental health conditions like dementia, older adults with chronic severe mental illness like Schizophrenia and Bipolar disorder are increasing significantly due to population ageing. Older adults have increased vulnerability for suicide due to factors like depression, loneliness and social isolation. There is high treatment gap for geriatric mental health conditions due to several challenges in providing services for older adults with mental health conditions as well as their caregivers. Digital geriatric mental health care can help in addressing this issue and reduce treatment gap. This symposium will address the scope and challenges for the digital geriatric mental health care in Indian context.

Prof. Sivakumar PT will discuss “Digital geriatric mental health care in dementia and related cognitive disorders”.

Prof Vikas Menon will discuss “Digital geriatric mental health care for reducing loneliness, social isolation and prevention of suicide in older adults.”

Dr Srinandha Srinivasan will discuss “Digital geriatric mental health care for older adults with chronic severe mental illness.”

Symposium (type) in Child and Adolescent Psychiatry (category) presenting

EASE a pioneering state wide suicide prevention program for children in AP, India ( Emotional Assessment of Students by Educators and referral)

Aparna Vuppala MD Medical Director EASE AP, Clinical faculty UABHSOM, ACOM, VCOM schools of Medicine, Board certified child and adolescent Psychiatrist in private practice, USA

Ivatury Sarath Chandra MD Hon Gen Secretary IPSAPSB, Psychiatrist in Private Practice, Guntur, AP

The 2021 State of the World’s Children Report says that 1 in 7 youths in India, between 15-24 years, reported ‘feeling depressed’. At least 1 student dies by suicide every hour with about 28 student deaths per day in India.

There is no infrastructure with regards to child mental health in India with School Counselors to identify children needing help or Clinical Psychologists for counseling or Child Psychiatrists to refer to. The Government of AP (Andhra Pradesh) has reached out to AAPI (American Association of Physicians of Indian Origin) in 2022 to address rising rates of child suicides in the state.

The EASE program was devised after extensive research and was launched at the AAPI Global Health Summit in Jan 2023 by Health Minister of AP.

Step 1 involves training master trainers on Mental Health 101 & Emotional First Aid and QPR Progatekeeper + Instructor Training.

Step 2 involves cascade training to educators in schools to identify and refer children for counseling.

Step 3 involves QPR gatekeeper training and Peer mentor training to medical students.

Step 4 involves training mental health professionals to screen, assess, counsel, and refer to Drs. Training includes Prep for advanced training, Certified QPR + Pathfinder training, and workshop at Nimhans on counseling using CBT framework.

Step 5 involves

-training physicians who see children on QPR Training for Doctors + Continuing Medical Education modules by US based Child psychiatrists online.

-training psychiatrists to evaluate, diagnose and treat children via modules by US based Child Psychiatrists online

Mental Health issues among Migrant labourers in Kerala

Speakers: Dr Lekshmy Guptan, Dr Jaimon P M*, Dr Balmukund R

Department of Psychiatry, Government Medical College, Ernakulam, Kerala

Correspondence: Dr Jaimon P M, Assistant Professor, Department of Psychiatry, Government Medical College, Ernakulam, Kerala-683503

jaimonpm@yahoo.co.in

Migration is the movement of a person from one location to another either within the nation or between different nations. Migration includes a relatively permanent change of residence from one city or rural area to another; a move from one neighborhood to another within the same city, temporary moves for purposes such as seasonal employment or to attend school and voluntary or involuntary movements across national boundaries.

Migration in Kerala has a different picture. There was an outward flow for the past four to five decades to the Gulf countries for employment. The inward flow was slow and it was from only the neighboring states like Tamil Nadu, Karnataka and Andhra Pradesh. But, in the past two decades, the flow of immigration from the neighboring states and north-east states has increased significantly. The effect of migration on the mental health of the migrants and their family members are diverse. There are only few studies regarding the mental health of the migrant labourers in Kerala.

Standard of living and purchasing power of migrant workers are less compared to the Keralites. Cultural differences - dress, rituals, habits, -add on to the psychological issues among the migrant workers. Attitude of native people, especially at work place, is another factor. There is a need to assess the substance use among the migrants. In this context to understand the psychological problems faced by migrant labourers in Kerala is important to plan and formulate policies related to migrant workers.

Dr Lekshmy Guptan: Introduction

Dr Jaimon P M: Migration and Mental Health

Dr Balamukund R: Prevalence of mental disorders in migrant labourers Dr Lekshmy Gupthan: The way forward and conclusion

POCSO, An Act Lost in Translation: Essential raw perspectives for mental health practitioners and ideas worth sharing

Suhas Chandran ^1, Lakshmi Keerthana T ¹

1-Assistant Professor of Child and Adolescent Psychiatry

Department of Psychiatry, St. John’s Medical College, Bangalore, Karnataka, India

Preferred Presentation type- Symposium

Child sexual abuse (CSA) is widely prevalent in all societies and remains an under reported offence in India. There are enough provisions against such perpetrators in India and possibly the most important of such provisions is the Protection of Children from Sexual Offences (POCSO) Act of 2012; amended in 2019. There have been several prevalent and emergent challenges in the implementation and enforcement of the POCSO act due to poor awareness (in the community, with medical professionals as well as legal agencies), lack of adequate training and retraining of key gatekeepers and most importantly the absence of a multidimensional, multi-tier approach to the cases especially the lack of a systematic psychosocial support system. A distinct discordance is also felt between the gender-neutral tone of the act and its discharge in the community setting. The lack of follow through on rehabilitation plans for survivors and compensation remains a major concern.

This symposium delves into the challenges faced by the clinicians with the medicolegal applications of the POCSO act including an adverse impact of criminalization on rights of the adolescents, other ethical and moral challenges as well as difficulties faced by survivors and their caregivers due to an obsolete healthcare culture including that of social ostracism and re- victimization. Ways forward including clinical, institutional, legal, educational and policy reforms will be discussed.

The speakers will be utilizing data and experiential perspectives from a tertiary care centre in South India for the session. A combination of didactic presentations as well as case vignette- based discussions will be used.

“Understanding about ’Cotards Syndrome’- Symptomatology or Diagnostic entity; The past, present and future”

Dr Subramanyam M¹, Dr Vinutha R²

¹Senior Resident, Department of Psychiatry, East Point College of Medical Sciences, Bengaluru.

²Associate Professor, Department of Psychiatry, East Point College of Medical Sciences, Bengaluru.

We, the following, propose to conduct a symposium on “Understanding about ’Cotards Syndrome’- Symptomatology or Diagnostic entity; The past, present and future”, at ANCIPS 2024, Kochi, Kerala.

Cotard syndrome is an uncommon psychiatric disorder characterized by nihilistic delusions about one’s own body; with a heterogeneous presentation. Currently its not being listed as a separate diagnostic entity in DSM 5 and ICD 10 classificatory system. Whether this syndrome can be a distinct disorder or as a symptomatology of various other disorders is the topic of debate off late.

The discussion regarding this rare syndrome is limited to case reports and case series in the medical literature with only a few review articles. The understanding of this monothematic delusion in various etiopathological dimensions would help us in interpreting the interrelation of psychopathology and phenomenology in various neuropsychiatric conditions. It’s necessary to discuss the complexity of this syndrome, specific underlying mechanisms which helps for its early recognition, treatment and better prognosis.

In this symposium we plan to discuss the important aspects of this rare syndrome under following headings -

1. Complex psychopathology and underlying mechanism.

2. It’s heterogenous presentation in various diagnoses.

3. Management of Cotard syndrome.

Slaying the wait times for Seriously mentally ill patients – a model from Rural Canada

Sanjay Siddhartha, Chief of Staff, Horizon Health Network, Region 7 Miramichi, New Brunswick Canada

Assistant Professor, Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada

Canada offers universal health care to all is residents. The coverage includes managing mental health problems.

However, the wait times to see people with serious psychiatric illness would extend into several months and sometimes years.

Several reasons could be attributed to this inaccessibility to needed psychiatric services. Lack of manpower, inadequate use of the available resources, inefficient management and attraction to status quo could be some of the reasons.

In a small County of Northumberland, we developed psychiatric services over the last three decades. It provides continuum of psychiatric services from home visits to the emergency room, then inpatients and outpatient services. The waitlist is in weeks rather than in months or years. Various team members collaborate closely with one another. This model can be transposed to other regions with some success.

Abstract for Symposium: Use of Technology in ADHD:Impact on clinical, academic and social functioning Speakers:

1. Dr. Shivanand Kattimani, Child and adolescent Psychiatrist, Professor, Dept of Psychiatry, JIPMER, Puducherry-605006, India. Email: drshivanand@gmail.com, Phone: 8754970078.

2. Dr. Sowmyshree CN, Senior Resident, Dept of Child and Adolescent Psychiatry, NIMHANS, Bangalore-560078, India. Email: sowmyashree.kavadike@gmail.com, Phone:9108801971.

3. Dr. Bikram Dutta, Child and adolescent Psychiatrist, Professor (Addl), Army College of Medical Sciences, New Delhi-110010, India. Email: bikrammonu@gmail.com, Phone: 8601223999

ADHD is a neurodevelopmental disorder with significant economic and societal cost. Pharmacological and behavioral therapies have limited impact. Existing cognitive training programs have shown limited efficacy. Certain domains of ADHD can be improved through non- pharmacological interventions based on technology. There is still debate on whether use of technology has led to an increase in the prevalence of ADHD or technology can mitigate dysfunction seen in ADHD. There are technical innovations from assessing ADHD symptom severity to those help in self-management. Delivery of digital treatment interventions may increase access to treatment, reduce cost of care, and increase compliance by making the treatment enjoyable and comfortable for use in an at-home setting. Students with ADHD frequently struggle with organization and time management. Technology based tools are promising in promoting attention. They are classified as study skill apps, academic/learning apps, organization apps. Older children required technologies more focused on self-management. Whether findings extrapolate to real word scenarios is doubtful, its impact on ADHD symptoms but also on the functional impairments (e.g., academic, social) that impact these children in their day-to-day lives. Any future technological interventions aiming to facilitate self-management of ADHD should cover the following domains: positive rewarding feedback, downloadable gaming resources, personalizable and adaptable components, psychoeducation component, contextual goal setting. Parents and health professionals endorse the importance of technology. However, the need for monitoring, being practical, and tailoring to the specific needs are still the shortfalls.

Key words: ADHD, mental health, children and adolescents, health technology, functional outcome

Abstract for Symposium

COVID generation-PostCOVID-19 impact on Mental health of children and adolescents

Speakers:

• 4.Dr. Shivanand Kattimani, Child and adolescent Psychiatrist, Professor, Dept of Psychiatry, JIPMER, Puducherry-605006, India. Email: drshivanand@gmail.com, Phone: 8754970078.
• 5.Dr. Sowmyshree CN, Senior Resident, Dept of Child and Adolescent Psychiatry, NIMHANS, Bangalore-560078, India. Email: sowmyashree.kavadike@gmail.com, Phone:96110204195.
• 6.Dr. Bichitra Nanda Patra, Child and adolescent Psychiatrist, Professor (Addl), Dept of Psychiatry and NDDTC, AIIMS, New Delhi-110029, India. Email: patrab.aiims@gmail.com, Phone: 9717880196
• 7.Dr. Bikram Dutta, Child and adolescent Psychiatrist, Professor (Addl), Army College of Medical Sciences, New Delhi-110010, India. Email: bikrammonu@gmail.com, Phone: 8601223999

WHO declared COVID19 as pandemic on 11th March 2020.Children are most susceptible to stress. Direct effects of COVID19 were increased mortality and morbidity in children and in around 25% of children it was long-COVID. Children were exposed to disruption in education, restriction in physical activities, decreased opportunities for socialization in presence of fear and uncertainty and were pushed into risky lifestyle behaviors. There was disruption of health services especially in low- and middle-income countries even for children with neurodevelopmental disorders.

Post COVID children presented with internalizing and externalizing disorders higher than pre pandemic period. Pooled prevalence of depression 32%, and anxiety 32% along with increased withdrawn and aggressive behavior. Advocacy for children and adolescent welfare is required. Parental involvement is necessary and serves as protective factors. Priority for return to school with services targeting learning and services to improve their psychosocial wellbeing. Children should receive support to catch up on lost time in learning, children may require remedial education. Children and teachers need to use digital technology to improve foundational literacy and numeracy skills. Teachers have to update their teaching methods in keeping with the COVID generation having low attention span and less communication and social skills. Effort is to identify key risk factors, and effort to mitigate those risk factors and enhance protective factors. Active involvement of government and policy makers especially from low- and middle-income countries (LAMIC) is required. Enhancing health access and development of internal and external resources for coping with stress is required.

Key words: Postcovid, mental health, children and adolescents, adverse childhood experiences, resilience

Understanding nuances of Treatment gap: Concepts to practice

Background : (Dr. Hetashri B. Shah, Senior Resident, Goldman Sachs- NIMHANS Mental Health Program, NIMHANS)

The current era of multitudinous psychiatric epidemiology research has yielded a substantial unmet mental healthcare need worldwide, usually denoted as treatment gap. There still lies a discrepancy in consensus of its definition. Treatment gap, if not bridged, can have severe enduring impact on disability, mortality and gross financial determinants of the nation. Considering the huge demand to supply ratio of mental healthcare, the paradigm has shifted to sensitize national policies to functional treatment gap from apparent treatment gap.

Treatment gap and its reasons (Dr. Meena k Medikonda , Senior Resident,Goldman Sachs- NIMHANS Mental Health Program, NIMHANS)

The global treatment gap for mental illness ranges from 50% in developed countries to 80% in developing nations. As per National Mental Health survey, the treatment gap ranges between 70% to 90%. Key contributors to this gap include limited awareness, restricted access to mental healthcare, stigma, medication shortages, and inadequate psychiatric training in medical education.

Initiatives Bridging the Treatment Gap : (Dr. S.Chandana, Senior Resident,Goldman Sachs- NIMHANS Mental Health Program, NIMHANS)

Current strategies for mitigating the treatment gap involve workforce and infrastructure expansion, the establishment of digital academies dedicated to psychiatry training, and implementing innovative digital training programs to enhance mental health capacity in primary care. Further, public-private partnerships and community mental health programs are deployed to augment public awareness and access to mental health services.

Current Challenges and Future directions: (Dr Abinash Achary, Senior Resident, Goldman Sachs- NIMHANS Mental Health Program, NIMHANS)

Current challenges in reducing the treatment gap include training resistance, limited digital literacy, medication availability, and societal stigma, which persist despite improved service accessibility. A comprehensive health system response should include continuous availability of essential psychotropic medications, integrating services into general healthcare, expanding existing services like the District Mental Health Programme and promoting cost-effective interventions at primary care level.

Mental health dynamics and climate change. Presenters:

1. Dr. Suyog Vijay Jaiswal, Additional Professor in Psychiatry, AIIMS Nagpur. (Corresponding author, email suyogjaiswal@gmail.com, Phone: +91 9970850212)

2. Dr. Abhijeet D. Faye, Professor in Psychiatry, DMIMS, Nagpur

3. Dr. Nitin B. Raut, Specialist Psychiatry, LHMC, New Delhi

Climate change is the biggest threat to global health in the 21^st century. The change is well- acknowledged by the environmentalists and scientists alike. The World Health Organization (WHO) has proposed five global research priorities for protecting human health from climate change. They are risk assessment, effective interventions, guiding change in other sectors, improving decision support and cost estimations. While health indicators of climate change are globally studied and monitored, gaps exist in mental health indicators.

Climate change can lead to job loss, force people to migrate, and adversely affect social cohesion and community resources, all of which have mental health consequences. It affects mental health via direct or indirect pathways. Direct pathways are the immediate impact of extreme climate events on mental health. This ranges anywhere from reeling into traumatic experiences to extreme distress and despair. Whereas indirect pathways affect mental health through changes in social, economic and political determinants of climate change. The indirect pathways are more complex and multifactorial in origin and have not been studied in great detail.

The symposium will discuss the impact of climate change on mental health and its pathways. The risk assessment of climate change, environmental exposure, mental health outcomes, vulnerable populations and effective interventions in mental health in line with climate change and global warming will be discussed.

SYMPOSIUM: Increasing digital addiction among different age groups in India

Digital addiction is characterised by excessive or poorly controlled preoccupation, Urges ,or behaviour that lead to impairment or distress. No single behaviour pattern define digital addiction , it is the use pattern of different digital platform interferes with one’s life in any way I.e. impacting work, family life, relationship , school etc. Now in present decade due to easy availability of Internet connectivity on computer mobile tablets etc , prevalence of digital addiction is increasing in every age group starting from as young as toddler to elderly people. Internet addiction has been associated with dimensionally measured depression and indicators of Social isolation. Psychiatric comorbidity is common, Particularly mood, anxiety , impulse control and substance use disorder.

Personality disorders and even different physical illness are more in later life when having digital addiction during Childhood. According to neurobiological model of brain development , revealing neural mechanism of reward and the cognitive control system of digital addiction is the key to solving digital addiction.

Digital addiction can manifest through various signs and symptoms like preoccupation , tolerance, withdrawal, loss of control, neglecting responsibilities, neglecting personal life, physical symptoms conflict , loss of interest, impaired muscle control, mood swings etc.Since the addicted persons

Often so little motivation for a behavioural change, we consider it promising approach to treat and trained their relatives with the aim of increasing the motivation for behaviour change of the addicted person.

• 1)Neurobiology of digital addiction ( Dr Surabhi Sinha PGT 3^rd year JLNMCH Bhagalpur)
• 2)Clinical presentation and impact of digital addiction (Dr. Ritesh Ranjan PGT 3^rd yr, JLNMCH Bhagalpur.)
• 3)Management of digital addiction. ( Dr. Jitendra Kumar verma, PGT 3^rd yr JLNMCH Bhagalpur)

Challenges in establishing a neuropsychiatry clinic in India: Experience from AIIMS New Delhi and Newer AIIMS

Vaibhav Patil ¹,Ragul Ganesh², Jawahar Singh³

1- Assistant Professor, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi

2- Assistant Professor, Department of Psychiatry, All India Institute of Medical Sciences, Jammu 3- Assistant Professor, Department of Psychiatry, All India Institute of Medical Sciences, Bhatinda

Treatment for patients with neurological problems is frequently complicated by the presence of psychiatric disorders. Neuropsychiatric disorders reside at the interface of psychiatry and neurology, and they pose unique problems to patients, caregivers and treating team. India witnesses a rising demand for specialised neuropsychiatric clinics due to the increasing prevalence of mental health issues and neurological disorders. This surge underscores the necessity of well-equipped clinics to provide comprehensive care, addressing both neurological and psychiatric aspects. Addressing the establishment of neuropsychiatric clinics in India comes with many challenges, encompassing several aspects, including resource limitations, societal attitudes, and promoting a holistic healthcare approach. Securing the necessary funding, infrastructure, and medical equipment to establish these clinics can pose significant challenges. Ensuring equitable access to neuropsychiatric services across India’s diverse regions is a substantial challenge, especially considering disparities in healthcare infrastructure and access, particularly in rural areas. Collaboration with other medical departments is essential for providing holistic patient care, particularly for patients with comorbid conditions. Developing and implementing integrated care models that consider both neurological and psychiatric aspects of patient’s health can be complex but essential for providing comprehensive treatment. There is a need for more research specific to neuropsychiatry disorders in the Indian population. Establishments of these clinics can also serve as centres for mental health research and innovation, potentially leading to better treatment approaches and training opportunities for healthcare professionals. Each of us will share our experience of developing such services at AIIMS New Delhi and Newer AIIMS.

Corresponding Author – Dr Vaibhav Patil, Assistant Professor, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi

Symposium Abstract: Youth and its dilemma : Mental Health in the era of digitalization , artificial intelligence and climate change

Dr Astha

Senior Resident,

UCMS & GTB Hospital, Delhi

Dr Kashyapi Garg

Assistant Professor, SNMC Agra

Convener, Young Psychiatrists Subcommittee

Dr N G Nihal

Consultant Psychiatrist Kausalya Counselling Centre

Co- chairperson, Young Psychiatrists Subcommittee

Dr Shashank Bhardwaj,

Consultant Psychiatrist,

Manoved Mind Hospital & Research Centre, Patna

The neurobiological correlates in the etiology of mental illness have spread its wings. Recent advances in psychiatry have stressed upon the fact that environmental determinants along with the socio-cultural factors are equally important in preventing or contributing to mental illness. Rapid urbanization , environmental degradation , air , water and noise pollution have been strongly linked with the genesis of common mental disorders, neurodevelopmental disorders and neurocognitive disorders .The impact of climate change on mental health is being thoroughly documented .

Digitalization is a novel phenomenon that has elevated the use of information technology across various domains. Approximately 28% of India’s population uses the internet regularly, with 9% of users in cities and 26% in rural areas growing annually. Social media platforms are using AI technologies to scan posts for content suggestive of suicidal thoughts or behavior and mobile applications are being used in the treatment and prevention of substance use disorders. The ability to combine the benefits of extensive interventions with the effectiveness of evidence-based treatments is now possible because of internet- based technologies.

Apart from social isolation, internet addiction , nature deficit disorder and climate anxiety have also been reported in young generation. The GenZ and millennials are a group that is facing a dilemma of optimizing screen time or prioritizing “green time”.

This symposium would be discussed as follows: 1.Ecopsychiatry in digital era

• 2.Social Isolation and addictive behaviours affect on GenZ mental health
• 3.GenZ cruising through the digital era and their mental health over the years.
• 4.The future and past of GenZ mental health.

SUBMISSION FOR SYMPOSIUM

Presenters

1. Dr. Shipra Singh

Associate Professor (Psychiatry)

Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi Contact No.: +91-8097970246

Email: ssomvanshi27@gmail.com

2. Dr. Nitin Raut Specialist (Psychiatry)

Department of Psychiatry and drug de-addiction centre Lady Hardinge Medical College, New Delhi.

Contact No.: +91-9834206242

Email: drnitinraut@gmail.com

Patient’s Suicide and Mental Health Professionals: Perceived Impact and Prevention/Mitigation

Mental health professionals (MHPs) are in contact with patients who suffer from plethora of challenges, and some of these patients might also exhibit suicidal tendencies. Most psychiatrists experience the death of a patient by suicide at least once during their career, with many experiencing this more often. It is seen that suicide of a patient affects around 31–61% of psychiatry residents during training itself.

It is unfortunate that therapists are not always successful in preventing suicide - or even predicting it. The death of patient by suicide can have profound effects on the personal and professional life of many MHPs. Studies have differentiated such impacts on personal life and those on professional practice. This is characterized by experience of shock, grief, guilt, and anger. They also feel the anguish of losing a patient, which many describe as the most profoundly disturbing event of their professional careers. This may be further exacerbated by organizational responses, including serious incident enquiries, and the pressure of attending the court. For those suffering a severe stress reaction, retirement and change in career are often considered.

Overall, it has remained a relatively less discussed, as exemplified by the sparse literature on this topic, especially in India. The lack of formal attention given to this situation in residency training, along with lack of adequate discussion regarding this topic, makes it difficult for mental health professionals to deal with such a situation, if and when encountered.

Impact of patient’s suicide on mental health professionals: Dr. Shipra Singh, Associate Professor (Psychiatry), Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi

Dealing with patient’s suicide by mental health professionals: Dr. Nitin Raut, Specialist (Psychiatry), Department of Psychiatry and drug de-addiction centre, Lady Hardinge Medical College, New Delhi.

The importance of nurturing and developing good attitude, ethics and communication skills in MBBS students in India was recognized with the formal introduction of AETCOM modules in the MBBS curriculum in 2019. While there have been enthusiastic faculty across medical disciplines in many colleges who have embraced this plan, it has been a challenge for colleges to implement this module effectively. Preclinical, paraclinical and clinical departments generally handle different modules across the years. This raised difficulties with some departments finding it a challenge to handle the content, and others the methodology of the teaching learning. In this symposium, we discuss lessons from the experience of two medical colleges- St. John’s Medical College, Bangalore and Dr. Somervell Memorial CSI Medical College, Karakonam in delivering AETCOM to their students. While the models of delivery of AETCOM in both these centres have some differences, the commonality has been in the involvement of psychiatrists in leading the AETCOM programme. We also discuss how the particular skill sets psychiatrists possess by virtue of handling ethical dilemmas in clinical care and ensuring good communication with patients and caregivers- give a unique opportunity for enthusiastic early career, as well as senior psychiatrists to actively participate and even take the lead in the AETCOM sessions of their medical colleges. The involvement of psychiatrists facilitates unique opportunities in learning for medical students and training for faculty from other departments. Preparation for these sessions enhances our own learning in all topics from confidentiality to medical errors amongst others.

Symposium: Minds and the Machines: Promises and Perils of Artificial Intelligence in Psychiatry

Artificial intelligence (AI) has emerged as a transformative technology with the potential to revolutionize psychiatry. This abstract explores the evolving role of AI in the field, focusing on its applications in assessment, diagnosis, treatment, and personalized mental health care. AI- powered assessment tools enhance traditional psychiatric evaluations. Natural language processing and machine learning algorithms analyse large volumes of patient data, such as electronic health records and self-reported symptoms, facilitating accurate and efficient assessments. AI algorithms detect subtle patterns and markers indicative of mental disorders, aiding early detection and intervention. AI supports mental health professionals in diagnosis. Machine learning algorithms trained on extensive datasets recognize patterns and symptoms associated with various mental illnesses, improving diagnostic accuracy. AI-powered diagnostic tools demonstrate comparable performance to human experts, potentially reducing misdiagnosis rates and enhancing treatment outcomes.

AI interventions and treatments show promise. Virtual reality therapy and chatbot interventions driven by AI provide personalized mental health support, addressing the growing demand for accessible and cost-effective alternatives to traditional therapy approaches. Personalized mental health care is a key aspect of AI’s role. AI algorithms analyse individual patient data, generating personalized treatment plans considering genetic profiles, environmental influences, and treatment response patterns. This approach optimizes treatment outcomes by tailoring interventions to unique patient needs. However, ethical considerations and challenges must be addressed. Data privacy, algorithm bias, and the need for human oversight are critical factors in integrating AI into psychiatric practice.

In conclusion, AI has the potential to significantly impact psychiatry by enhancing assessment accuracy, aiding diagnosis, providing innovative interventions, and enabling personalized mental health care. By leveraging AI technologies, mental health professionals can improve clinical decision-making and deliver effective, tailored treatment options to individuals in need.

Cinema and Psychiatry: The good, the bad, and the ugly

Cinema is a powerful medium of mass communication and social change. Movies offer a quick source of entertainment to its viewers. And this source of entertainment brings with it an escape from reality for some. However, this escape comes at the cost of abandoning real for the reel. There is a wide gap between the state of the medical field in real life and its portrayal on the screen. This gap is even wider for mental illnesses and psychiatrists. This symposium explores these differences in detail while commenting upon how they impact us both, in positive as well as negative ways. It will explore the intersection of cinema and mental health and will try to shed some light on how this intersection has shaped the general public’s understanding of mental illnesses and treatment practices. It will also delve briefly into the portrayal of psychiatrists in the movies and how has it influenced their public perception.

The symposium will conclude by highlighting the role of cinema in generating public awareness regarding mental health and how this powerful tool can be utilised by psychiatrists and policymakers to penetrate the masses. The symposium will also draw some examples from the movies to make a case for influencing policies for the betterment of the field.

Problems Progress and Prospects- Child and Adolescent Clinics experiences in three different settings

Smitha CA¹,Suhas Chakraborthy ², Vidya Ganapathy³

1Govt. Medical College, Kozhikode.drsmithaca@gmail.com

2HAL, Bangalore drsuhas@gmail.com

3Manasa Clinic, Pune.vidyaganapathy@gmail.com

Keywords: Child and Adolescent Psychiatry,Treatment settings,Psychiatry clinic, Adolescent, Management.

Background: Child and adolescent mental health is an important aspect of the public mental health. Child and adolescent patient cohort attending the child guidance clinics will be different depending on the treatment setting.Responsibilities and functions of the treating psychiatrists will vary depending on the patient cohort. Speakers and Subtopics:

Smitha CA will discuss the experience of running a Child and Adolescent Psychiatry Clinic in a Govt. teaching hospital. The patient characteristics,referral patterns,stakeholder involvement,and the treatment adherence will be discussed.

Suhas Chakraborthy will talk about running a child and adolescent psychiatry clinic in an industrial hospital-A decade’s experience in dealing with various children in a metropolitan city will be shared.

Vidya Ganapathy will communicate the experience of setting up and running a private child and adolescent clinic. Experience on finding the resources to send the references will be discussed. Hopes and hurdles in the process will be analysed.

Symposium - Community Engagement (CE) with service user participation in Mental Health

R Mangala ²*, Manikandan Pari¹*, Mr Omkumar D ^3*, Syjo Davis PP^4*, Lakshmi Venkatraman^5*, Kasthuri Divya G^1*, Krishna Priya K^1*, Harini Jayaraman^1*, Padmavati R⁶*

*Schizophrenia Research Foundation (I), Chennai, Tamil Nadu – 600 110, India

1 Consultant Psychiatrist and Assistant Director (Awareness)

2 Research Assistant

3 Person with Lived Experience

4 Research Project Coordinator

5 Consultant Psychiatrist

6 Director and Consultant Psychiatrist

With communities forming a major buffer for persons with lived experiences (PwLE) of serious mental illnesses (SMI), their attitudes towards PwLE play a vital role in stigma reduction and inclusivity. It is important to explore innovative methods for CE that will go beyond improving knowledge and awareness about SMI.

Research shows that participation of PwLE plays a key role in CE. Globally, service users participate actively in care, research and advocacy.

This symposium will cover innovative CE activities of SCARF (I) involving PwLE, that were delivered as part of a NIHR funded research project.

Speaker 1: ‘Namma Area’ - A sneak peek

A social hangout space (Namma Area) for PwLE was established at SCARF (I) in 2022 and is fully managed by the service users. The speaker will look into the experiences of ‘Namma Area’.

Speaker 2: Participatory theatre @workplace

Sensitizing workforce about PwLE will help improve inclusivity at workplace. Using interactive theatre including Theatre of the Oppressed (TO) techniques, sessions were conducted in various Corporates, Colleges, Healthcare Institutions & Manufacturing Industries. The theatre group included one or more PwLE in all performances.

Speaker 3: Waiting room theatre

CE usually targets public communities. Through art based interactive plays, service users and caregivers at the outpatient clinic of SCARF are encouraged to think about and discuss elements of mental healthcare and needs that are seldom addressed. The plays are conceptualized and performed by PwLE.

Speaker 4: The way ‘WE’ see it

A PwLE who has been part of the CE activities will share their experience and personal journey of being involved in this.

Proposal/Abstract for symposium: Sexual Objectification and Mental Health Problems in Young Women

Introduction: Women encounter a spectrum of gender oppression, ranging from seemingly benign sexist jokes to severe sexual violence. What ties these disparate forms of mistreatment together is sexual objectification, a pervasive phenomenon that plays a fundamental role in perpetuating gender-based discrimination, systemic sexism, and violence against women. To comprehend its far-reaching consequences, this symposium seeks to explore the intricate relationship between sexual objectification and women’s mental health.

Sexual Objectification:

Sexual objectification involves reducing a woman to her physical attributes, severing her from her multifaceted identity. In this dehumanizing process, a woman’s worth becomes inextricably linked to her appearance and sexual desirability, rendering her an object for the consumption and gratification of others. Sexual objectification takes two main forms: interpersonal interactions and media representation. Interpersonal objectification encompasses unwanted body evaluation, including catcalling, leering, and inappropriate comments. It also extends to unwanted sexual advances, such as harassment and coercion. Media outlets perpetuate objectification through advertisements, television, movies, and pornography, constructing a relentless stream of sexually objectifying experiences. Women who experience constant objectification internalize societal judgments about their bodies. This internalization results in self-objectification, characterized by self-conscious body monitoring, body shame, and anxiety. These, in turn, can lead to depression, disordered eating, and reduced productivity.

Conclusion:

The profound link between sexual objectification and women’s mental health is undeniable. It contributes to anxiety, depression, disordered eating, and diminished productivity. A comprehensive understanding of this phenomenon is crucial for shaping policies, public health initiatives, and educational programs, ultimately enhancing the well-being of women across society.

Non Suicidal Self Injury, Suicidal Behaviour and Suicide prevention: Indian Perspective

Hemendra Singh¹, MD; Anita Gautam²,MD; Manaswi Gautam MD;³ V. Sathesh⁴ MD.

1. Assocaite Professor, Dept. of Psychiatry, M. S Ramaiah Medical College & Hospitals

2, 3. Consultant Psychiatrist, Gautam Hospital & Research Center, Jaipur, India

4. Professor and Head, Dept. of Psychiatry, Mount Zion Medical College Adoor, Pathanamthitta, Kerala

The major risk factor for suicide is mostly an untreated and frequently undiagnosed mental disorder. Each year 800,000 persons die by suicide. Every 40 seconds, 1 person dies by suicide. National suicide rate in India is 12 per 100,000 during 2021. Dr Anitha Gautam will be talking about hidden epidemiology of suicide in India. Dr.Hemendra Singh will discuss various clinical correlates of suicide attempts based on his study findings and his experience of delivering brief intervention module for suicide prevention. Dr Manaswi Gutam throws light on Non Suicidal Self- Injury (NSSI) and suicidal behaviour and various strategies for prevention of NSSI and suicidal behaviour. As history of suicide attempt is a risk factor for future suicide, it is high time that the various factors associated with suicide attempt are to be identified to prevent future suicide and also to rehabilitate them psychosocially. Dr V. Sathesh would be discussing clinical characteristics of 1300 patients with current suicide attempt and need of various preventive measures for specific population based on his study findings.

Key Words: Non –Suicidal Self Injury, Suicide attempts, Psychiatric patients, Suicide Prevention

WFMH and WPA Section on Psychiatry, Law and Ethics: Symposium “Mental Health, Human Rights and Legislation”

Speakers:

1. Prof Roy A Kallivayalil- Human rights in the practice of Psychiatry

2. Prof Sudhir Bhave – Mental health and legislation- Ethical imperatives

3. Dr CL Narayan- Mental Health Care Act, India 2017- A critical appraisal

4. Dr Sunil Mittal- Mental Health, Human Rights and Legislation- Newer perspectives-

‘Mental Health is a Universal Human Right’ is the theme for the World Mental Health Day 2023 organised under the leadership of the World Federation for Mental Health (WFMH) and WHO. The observance this year is of special significance, as the WMFH, founded in 1948 is celebrating its 75^th anniversary. 1948 also marks the adoption of the Universal Declaration of Human Rights (UDHR) on December 10 by the UN General Assembly

Mental health remains a low priority in most countries. Besides discrimination, stigma and human rights violations are rampant. The 2023 theme is a call to the governments, policy makers, administrators and all stake holders and the general public to ensure the human rights and well being of all those who suffer with mental health problems are protected and upheld.

India has enacted the Mental Health Care Act in 2017. There has been several practical obstacles in its implementation. Many have argued, the cultural ethos of our country have not been reflected in mental health care in this Act. The Act has also placed impediments in access to mental health care in a low resource country. Hence we need a critical appraisal. Human rights, ethical imperatives and newer perspectives will be discussed.

DEPARTMENT OF PSYCHIATRY INDEX MEDICAL COLLEGE, INDORE: A Symposium On “Saas-Bahu Syndrome”

DrRam Ghulam Razdan¹,Dr Ankita Shahi², Dr Tanul Jain³

Introduction: In Indian culture there are large number of age old beliefsand practices amongst which one of them is that the mother-in-law holds the extreme power and supremacy and is the dominating member in the family and household due to which the daughter-in-law is expected to be in the submissive role leading to the fight for survival in the family post marriage. Relationship plays a very important role in the life of a women to lead a successful life. And so, for achieving that better life she has to undergo through many segments of life. In order to cope this phase of women life this study emphasizes on the importance of women life when family size shrinks and she becomes the mother and daughter in law. When a woman steps in the relationshipwith in-laws, it accompanies with the difference in the environment of origin where she is brought up and now where she enters in as a daughter- in-law which opens new challenges, conflicts and adjustment problems for her which often leads to depression and anxiety and in many cases even suicide by young females. This type of phenomenon is found in Indian culture because of age long social beliefs are continuing today. These might be reason for bride burning and death of newly married women also. At present there is need of resolving this conflicting attitude between mother-in-law and daughter-n-law for happy and healthy family .

Speaker 1: Is the phenomenon of conflicts between Mother-in-law and Daughter-in-law in Indian culture, okay? Whether it could be called as “?Saas -Bahu Syndrome”

Speaker 2: Research based evidences about the Saas-Bahu Syndrome.

Speaker 3: Measures to resolve the conflicts between mother-in-law and daughter-in-law for a healthy and happy family.

1=Professor & Head; 2,3 =PG Resident: Index Medical College, Hospital and Research Centre, Indore.

Topic of the Symposium- “Navigating Bipolar Depression: Challenges, Guidelines, and Innovations in Treatment”

Sub-topics-

1. Challenges in the management of bipolar depression

2. Current guidelines in the management of bipolar depression

3. Evidence of newer molecules in the treatment

4. Evidence of neuromodulation in bipolar depression

Speakers-

1. Dr. Divya Sharma, MD. Assistant Professor in the Department of Psychiatry, SMS Medical College, Jaipur

2. Dr. Shivangini Singh, MD, Senior Resident in the Department of Psychiatry, KGMU, Lucknow

3. Dr. Mohita Joshi, MD, PDF, Senior Resident in the Department of Psychiatry, KGMU, Lucknow

4. Dr. Kritika Chawla, MD, Senior Resident in the Department of Psychiatry, KGMU, Lucknow

Bipolar depression in India has a reported prevalence of 0.3% (NMHS, 2016), highlighting the need for a nuanced understanding of its complexities. Longitudinal studies reveal a persistent challenge wherein individuals with bipolar I and II disorder grapple with significant depressive symptoms despite standard treatments. The impact of these symptoms extends beyond manic episodes, significantly impairing work, social life, and family dynamics.

Treating bipolar depression poses major clinical challenges, with a notable lack of exploration compared to unipolar depression, especially in the realm of long-term prophylaxis. Few treatments have demonstrated consistent effectiveness in acute episodes, and controversies persist around the value and risks of antidepressant drugs (Pacchiarotti et al., 2013; McGirr et al., 2016). Antidepressants’ short-term efficacy remains a subject of debate, with potential risks of clinical worsening, particularly in mixed states and rapid-cycling scenarios. Limited evidence supports the efficacy of lithium and anticonvulsants, with long-term benefits observed in lamotrigine but significant teratogenic risks associated with valproate and carbamazepine.

The scarcity of highly effective treatments underscores the need for exploration, prompting a focus on new molecules and neuromodulation options. Newer molecules encompass atypical antipsychotics, glutamate modulators, neurosteroid modulators, anti-inflammatories, mitochondrial modulators, cannabidiol (CBD), and psilocybin. Noteworthy findings include the efficacy of lumateperone and cariprazine in large-scale trials for treating bipolar depression.

Additionally, meta-analyses suggest preliminary evidence supporting the beneficial effects of Repetitive Transcranial Magnetic Stimulation (rTMS) and D-cycloserine (DCS).

While these potentially efficacious agents show promise, further study and validation are imperative. In navigating bipolar depression, the integration of challenges, existing guidelines, and innovative approaches becomes paramount to advancing effective and patient-centric strategies.

Symposium: Violence and Mental Health

Objectives: Violence in any form is a topic of grave concern all throughout the world. Some forms of violence are consistent throughout the globe, whereas some forms of violence are specific to a particular culture or community. Several studies have shown a strong correlation between violence and mental health issues in victims, offenders and community at large. And there is a dire need to scientifically analyse violence issue in victims, offenders and community from a mental health perspective. At the same time, it is also very essential to discuss all the possible interventions and rehabilitation methods for the same. Violence causes injury, death, psychological harm, mal- development, or deprivation. To address this issue and to show recent researches in these areas we have planned a symposium on this neglected and untouched subject. It becomes extremely important to analyse and discuss violence from various points of view. To make the topic palatable and cover as many sub topics as possible, the subject of “Violence and mental health” has been divided into three main perspectives on which the speakers shall speak and discuss. These are as follows:

1. Violence and Mental Health: Victim’s Perspective

2. Violence and Mental Health: Offender’s Perspective

3. Violence and Mental Health: Community Perspective

Keywords: Violence, Mental Health, Victims, Offender, Community

Dr. Bhaveshkumar M. Lakdawala: Professor and Head, Dept. of Psychiatry, Narendra Modi Medical College and Sheth L.G. General Hospital, Ahmedabad, Gujarat, India

E mail: dr_bmlakdawala@yahoo.co.in M: 9687284967

Dr. Divyank A. jajoo: 2^nd Year Resident, Dept. of Psychiatry, Narendra Modi MedicalCollege and Sheth L.G. General Hospital, Ahmedabad, Gujarat, India

E mail: divyankjajoo7@gmail.com M: 8980288385

Dr. Parag S. Shah: Professor and Head, Dept. of Psychiatry, SMIMER Medical College, Surat, Gujarat, India

E mail: drparagsshah@hotmail.com M: 9426138318

INDIAN FATHERS, FATHERHOOD: SOCIOCULTURAL PERSPECTIVES AND MENTAL WELL BEING

Dr Rama Rao

Background:Fatherhood in India, is distinct from fatherhood elsewhere as it is shaped by unique cultural and family norms, values, and ideals because of variations in social and anthropological evolution .In a society as complex and heterogeneous as India, has distinct regional, linguistic, caste, class, and regional sub identities is an ever evolving with admixture of Hindu, Christian,Persian, Moghal, Muslim,Buddhist,Jain,Sikh values and colonial influences and recent industrialized western values, globalization, industrialization,digitalization.

Aims:With recent economic and technological growth, challenges to the old masculinity and patriarchy, female employment, egalitarian relationships and lifestyle changes akin to western industrialized societies affected Indian men. Father’s investment and role in family and care of children. Fathers played a peripheral,supportive role in child rearing. As mothers are working and contributing to the family income, dads are sharing household chores and taking up parenting duties. Fathers are spending three times as much time with their children as men did two generations ago and developing a different,greater bond with children. Fathers want to be equal parents and spend more time with their kids.

Methods. The faculty of Professors Sharma,Kalliayalil,Gogineni fathers,grand fathers, experienced, scholarly will present the above sociocultural,family,aspects making use of case examples,and video clips. Engage attendees in discussion, exchanging ideas. Also will present current mental health issues that men/fathers face including domestic violence,child abuse, alcoholism,depression and other mental illnesses,sexual/arousal issues,marital problems.

Results: Attendees will learn sociocultural, evolutionary aspects of Indian fathers, fatherhood and problems, conflicts, problem ares for the “new” 21^st century father conclusion” Attendees will learn to be helpful to men.fathers and families to enjoy, enhance fatherhood.