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. 2019 Jan;61(Suppl 3):S440–S451.

WORKSHOPS

PMCID: PMC6366283
Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W01 Title: Brief Interventions in Medically Unexplained Symptoms (MUS): Principles and practical applications

Vikas Menon 1, Sujit Kumar Kar 1, Samir Kumar Praharaj 2, Susanta Kumar Padhy 3, Sujit Kar 5, Vikas Menon 6, Vikas 7, SK Praharaj 7, SK Padhy 8

The term “Medically unexplained symptoms” (MUS) in its broadest sense, refers to occurrence of symptoms for which there is no adequate medical explanation or demonstrable tissue pathology. They present to specialties across the board and consume limited heath care resources, often with little tangible benefits. There is an emerging consensus that cognitive behaviour therapy (CBT) and self-help strategies are effective in managing MUS though there is poorer understanding about the theoretical underpinnings of the same. The workshop will begin by briefly covering the rationale for a CBT model of MUS. This will be followed by illustrative case conceptualizations explaining the predisposing, precipitating and perpetuating factors that combine to generate an autopoietic cycle of symptom maintenance in MUS. As detailed psychological interventions are expensive, time consuming and often unavailable due to the requirement of a professional therapist, there is a need to look at brief interventions or self-help techniques that can be administered by the primary care physician or patient respectively. These techniques stem from the premise that we all have mind/body links which we can activate to help ourselves. To achieve this, the workshop will have an interactive session with sample case vignettes and brief interventions together with a simulated patient demonstration. In the last segment, brief interventions for MUS presentations in children will also be discussed. The workshop will enable clinicians and practitioners to develop a good understanding of the theoretical basis and practical application of brief interventions that can be used as the first stage in a stepped care model to optimize the management of MUS.

Keywords: medically unexplained symptoms; somatoform disorder; somatization; psychotherapy; cognitive behaviour therapy

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W02 Autism in the elderly: The importance of recognition and appropriate interventions

Shabbir Amanullah, K S Shivakumar, P Krishna

Introduction:

Autism spectrum disorders are a group of neurodevelopmental syndrome that are of early onset. It is thought to have prevalence across age groups of about 1% but with increasing recognition of its existence in adulthood as well. This point is important given the lack of recognition of the importance of continuation of treatment in childhood cases to adulthood. While ADHD has gained much importance and treatments that are specific to adult ADHD being developed, its recognition in the elderly is poor. Autism in the elderly has become an important area given the significant suffering they endure with onset of dementia amongst other conditions in old age. There is research to show that there are aspects of the individuals functioning that one needs to keep in mind during evaluations but also recognise the dearth of literature in the area (1)

Diagnosing in adulthood has finally become recognised as an important clinical step primarily due to the increasing awareness of autism in certain areas of the world. The broadening of diagnostic criteria, and the introduction of concept of autism spectrum has certainly helped as well. The concept of “a lost generation of people” previously excluded from appropriate treatment has this taken root (2).

This diagnosis in the elderly is however not without difficulties given the lack of corroborating evidence and a limited number of tools available. The use of pharmacological agents is an area that is poorly researched and hence much of the interventions use data from studies in child and adolescent groups (3)

AIMS

The workshop aims to

  1. Raise the awareness levels of autism in the elderly

  2. Review existing research.

  3. To highlight common clinical presentations and symptoms

  4. Out line the treatments intervention

METHODS:

An extensive review of research and the authors experience with dealing with autism in the elderly served as the framework around which the workshop is based. The workshop focuses on the major clinical features and common mistakes made in both recognition and diagnosis. The prevalence od conditions like dementia were used to help in guiding the process of evaluating comorbidities (4)

It is know that making a diagnosis of autism spectrum disorder in adults can be challenging for a variety of reasons including, the lack of a detailed developmental history), history of how the individual acquired camouflaging strategies and a history of concurrent disorders. The range of conditions is extensive and one needs to be aware of the various issues that may arise from an existing neurodevelopmental disorder and may indeed mask the underlying condition.

RESULTS:

The primary aim of the clinician should be to address co-morbidity with the existence of depression, psychosis, personality disorder and substance abuse being particularly important. ADHD plays an important part and may need to be addressed but so too emergent conditions like dementia

Treatment facilities may need to address design, spacing and noise levels along with gender specific needs and appropriate pharmacological interventions.

REFERENCES:

  • 1.Bennett M. ”What is Life Like in the Twilight Years?” A Letter About the Scant Amount of Literature on the Elderly with Autism Spectrum Disorders. J Autism Dev Disord. 2016 May;46(5):1883–4. doi: 10.1007/s10803-016-2710-z. [DOI] [PubMed] [Google Scholar]
  • 2.Lai MC1, Baron-Cohen S2. Identifying the lost generation of adults with autism spectrum conditions. Lancet Psychiatry. 2015 Nov;2(11):1013–27. doi: 10.1016/S2215-0366(15)00277-1. [DOI] [PubMed] [Google Scholar]
  • 3.Ji N1, Findling RL. An update on pharmacotherapy for autism spectrum disorder in children and adolescents. Curr Opin Psychiatry. 2015 Mar;28(2):91–101. doi: 10.1097/YCO.0000000000000132. [DOI] [PubMed] [Google Scholar]
  • 4.Shahin Shooshtari, Patricia Joan Martens, Charles A. Burchill2, Natalia Dik2, Saba Naghipur3. Prevalence of Depression and Dementia among Adults with Developmental Disabilities in Manitoba, Canada. Int J Family Med. 2011. 2011:319574. doi: 10.1155/2011/319574. [DOI] [PMC free article] [PubMed] [Google Scholar]
Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W03 Workshop: The Global Mental Health Assessment Tool- GMHAT/PC

Vimal Kumar Sharma 1, Krishna Sowmya, Prakash Behere, Pradeep Sharma, Gagandeep Singh, Vishal Sah, John Copeland

The Global Mental Health Assessment Tool: Training the trainers

Sharma and Copeland developed computer assisted clinical interview, the Global Mental Health Assessment Tool GMHAT/PC to assist general practitioners and front line health professionals to make a quick, convenient, and comprehensive, standardised mental health assessment. A health professional by using GMHAT/PC, in about fifteen minutes, covers worries; anxiety and panic attacks; concentration; depressed mood, including suicidal risk; sleep; appetite; eating disorders; hypochondriasis; obsessions and compulsions; phobia; mania/hypomania; psychotic symptoms; disorientation; memory impairment; alcohol misuse; drug misuse; personality problems and stressors. It gives computer assisted diagnosis, symptom ratings a summary letter as well as treatment guidelines. Its use by health professionals may help in detecting and managing mental disorders in primary care and general health settings more effectively. The GMHAT/PC has also been used in the general health setting including in elderly population, cardiac patients (UK), as a pilot project for district mental health program in Rajasthan, In multiple settings in Maharashtra and Karnataka. The reliability and validity studies’ findings will be shared in the workshop.

The training workshop intended to train the trainers so that they can support and train health professionals for its routine use in their clinical practice.

The work shop will be interactive with practical demonstration of the use of GMHAT.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W04 IMPLEMENTING MHA 2017: A SYSTEMS APPROACH

Manoj Therayil Kumar 1, Vasudevan Namboodiri 2, Aloka Joy 3, Sebind Kumar 4

Outline

The new Mental Healthcare Act is likely to radically reshape the practice and delivery of mental health services in India. Service providers need to ensure that they have robust systems in place to ensure its implementation. The act would alter the nature of decision making process in clinical interactions. Apprehensions are plenty about resource implications and the role of various professionals.

Workshop methods

The workshop will utilise a mixture of problem based and principle based approaches to highlight the clinical practice implications. Clinical scenarios would help the participants to see the application of the act in practice. Central tenants of this act have been in practice in UK for many years and experience of authors in its application would help participants gain insight in to possibilities and problems.

Audience will have opportunity to familiarise with all the relevant forms (reports, records, and notification),that emerge from the act. Measures and methods to enhance compliance at MHE level and individual level would be demonstrated.

Outcomes

The participants would gain practical understanding on how to use the act in daily clinical practice. Authors would demonstrate various resources being made available to implement this act.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W05 Emotion Focused Therapy: An Orientation for Practice in India

Anisha Shah 1, Shweta Singh 2

Background: All emotions, whether pleasant or unpleasant, have unique neurochemical and physiological basis and each one aids us in our survival. They inform us about our needs, help us in information- processing, prioritizing goals, decision making and also in motivating us for goal directed behaviour.

Contrary to an earlier view that emotions are post-cognitive, recent research in neuroscience suggests that emotions are prerequisite to many cognitive processes. Changsing experiences of emotions from maladaptive to adaptive further leads to change in modes of cognitive processing, which is the primary goal of Emotion Focused Therapy (EFT).

Objective: To orient participants to EFT for the management of emotional disorders in the context of psychotherapy practice in India.

Methods : The workshop will include presentations, interactive discussions, role playing and use of demonstration videos by the two presenters.

The first presenter will introduce EFT to the participants. EFT is a renowned third-wave process-experiential approach to psychotherapy and focuses on helping clients to explore and modify emotional experiences called ‘emotion schemes’. It was developed by Greenberg and his colleagues out of empirical studies on the processes of emotional change. Currently, it is an established evidence-based approach for treating depression, interpersonal problems, abuse, trauma, eating disorders and anxiety disorders. Recent empirical research shows EFT to be more effective than CBT in reducing interpersonal distress, promoting more change in symptoms and preventing relapse.

The second presenter will elaborate on integration of Emotion- Focused Therapy in psychotherapy. Usefulness of concepts like primary emotions of anxiety, sadness, anger, and shame will be elaborated. How can these primary emotions be healthy and adaptive for a patient? These aspects will be described during the program along with distinct formulations for emotional dynamics of adults and couples, and therapists’ goals for patient’s emotions.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W06 RUNNING AN EFECTIVE SCHOOL MENTAL HEALTH PROGRAMME

Avinash De Sousa 1, Kersi Chavda, Rashmin Cholera

This workshop is aimed at educating and empowering psychiatrists to run effective school mental health programmes in a given school in their city or area. The three speakers shall cover different facets of school mental health and how to go about managing the same in school settings. The workshop aims to empower psychiatrist to develop their own school mental health modules and conduct the same in different schools across various settings where they may work.

Dr Kersi Chavda – Critical challenges for school mental health

This part of the workshop shall deal with the various challenges that a school psychiatrist may encounter when working in the area of school mental health. The speaker presents an overview of these problem based on his experience of working for over 3 decades in a school setting.

Dr. Avinash De Sousa – Unique and Novel Interventions in school mental health

This part of the workshop shall look at certain novel and unique interventions that may be carried out in school settings with the aim to promote mental health in addition to the routine medical based and counseling interventions. Examples and utility as well as efficacy of various interventions are discussed

Dr. Rashmin Cholera – Handling aggressive behavior in school settings

This part of the workshop shall look at the various interventions in school and classroom settings that may be used in the management of aggressive behaviors seen by children and adolescents. Both medical and non medical approaches are discussed.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W07 Prescription writing- Look before the Leap

Rajesh Dhume 1, Vihang Vahia, Monali Dehspande, Ambrish Dharmadhikari

Prescription writing is an art, which should be learned and practiced by each and every clinician. In current era of psychopharmacology, it is important to practice prescription writing correctly. Errors occur when planned actions failed to achieve desired outcome. Various international bodies like World health organization, American psychiatry association, and British national formulary have their own guidelines for writing a prescription. Many other guidelines do suggest about pharmacodynamics and pharmacokinetics which needs consideration while writing drug prescription. Recently guidelines in India got updated regarding branded drugs verses generic drugs, which did not receive widespread acceptance in practice given the difficulties inherent in the circumstances. However, we often observe slips and lapses in patient care due to error in writing prescription and writing unethical prescriptions. Many hospital audits across globe reports poor compliance to guidelines of prescription writing. Hence there is dire need to educate clinician about prescription writing. It’s time that we collectively need to act and minimize mistakes and unethical practices in prescription writing. In era, where doctor patient relationship has shifted to consumer provider law framework, mental health practitioners need to take extra care. In the time, where doctors are not perceived in their best of image, we can’t afford to have fall in standard of patient care due to lapses and slips in prescription writing. Hence there is need for uniformity, strict adherence to guidelines and use of technology in prescription writing to improve quality. In mental health, many strategies can be administered. Education, audit of hospital prescription and active feedback to practicing clinician, multidisciplinary working, support at government level, patient safety culture are few steps leading to minimize errors in prescription writing. At the same time, in depth knowledge and emphasis should be given on understanding basics of pharmacodynamics and pharmacokinetics of psychotropic medications from post graduate levels.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W08 Title: Psychotherapy skills: Theory to practice

Naveen Grover 1

Workshop description: Psychotherapy is based on psychological theories. There is vast literature available to explain these psychological theories. One can get lost into the elaborate details provided for the practice of psychotherapy by these theories. Based on the wisdom of practitioners, it has been realized that theories of psychotherapy may seem very far off from each other on paper, but in clinical practice they are very close to each other. The focus of the present workshop is to bring up common psychological principles across theories for its clinical application in psychotherapy practice. For example, the meaning and application of - respect your clients, empathize with your clients, do not jump the gun etc will be discussed. In the facilitator’s personal experience, it has been observed that it is easier to learn what not to do in therapy than what to do in therapy. Thus, special emphasis will be given to ‘what not to do in psychotherapy’ related to sitting arrangement, personal appearance, work place setting, asking questions, giving suggestions, verbal output etc.

Key words: Psychotherapy; empathy; CBT; clinical intervention

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W09 A workshop on Community Psychiatry in India and United Kingdom - A Trichy (India) and Kent (UK) Experience

Soundararajan Munuswamy 1, Mallika Sundaram 2, N Solayappan 3, Sudha Soundararajan 4

The Community psychiatry is the branch of psychiatry which deals with the detection, prevention and treatment of mental disorders in a designated geographical area with emphasis on environmental factors. The workshop attempts to compare the practice of community psychiatry in two designated geographical areas namely, Trichy in India and Kent in United Kingdom.

Trichy is a district in the state of Tamil Nadu, India. It has population of 2,722,290 and spans around 4,404 square kilometers. District Mental Health Program (DMHP) is a pilot program of five years duration sponsored by Ministry of Health & Family Welfare, Government of India implemented at the Trichy district from 1997. The DMHP has three components namely mental health care, training, and information, education and communication activities (IEC activities). Creating the infrastructure, manpower recruitment, conducting training program for various medical, paramedical, and non -medical personnel, rendering psychiatric health care services by satellite mental health clinics and strengthening the existing psychiatric ward at Govt. hospital Trichy are some of the components of DMHP.

Kent is a county in South East England with a population of 1,700,000 and it covers 1,450 sq miles. Mental health care for Kent is provided by Kent and Medway NHS and Social Care Partnership Trust. It employs 3,318 staff and 228 seconded staff who are located in 66 buildings on 33 sites. There are eight localities. Mental health services are predominantly provided around key urban centres including Maidstone, Medway and Canterbury. A range of services are provided in community locations, reflecting the urban and rural mix of the area. In a year approximately 50,000 people are offered services involving half a million contact.

The principle author of the workshop played a pivotal role in planning and implementation of DMHP at Trichy, India. Later in the year 2004 he moved to United Kingdom to join the Kent and Medway NHS and Social Care Partnership Trust as a consultant psychiatrist in a community mental health centre. He with three of his colleagues shares the experience and highlights the various features of practice of community psychiatry in India and United Kingdom.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W10 Intervention Strategy for Amennorhoea, Galactorrhoea, osteopenia and Sexual dysfunction caused by Antipsychotic induced Hyperprolactinemia.

Jaya Prakash Russell Ravan 1, Jigyansa Ipsita Pattnaik 2, Santanu Nath 3, Sumit Kumar 4

Introduction: Antipsychotic induced hyperprolactinemia and its related morbidity is a neglected area in clinical practice as well as in research. This secondary hyperprolactinemia may lead to menstrual irregularities in females, disturbed sexual functioning and reduced bone mineral density. (Sauer and Howard, 2002).

Clozapine, Quetiapine and Olanzapine are usually not associated with persistent hyperprolactinemia but may cause transient and mild prolactin elevation. In many studies, Risperidone, Amisulpride and other typical antipsychotics have been known to have high propensity to cause hyperprolactinemia leading to above mentioned secondary complications by various mechanism under neuro endocrine axis.

In this context, the workshop will help the participant to update their knowledge regarding the prevalence of these conditions and possible mechanisms involved. It will focus on early identification of these clinical entities and guideline based intervention strategies to approach the secondary complications.

Proposal:

  1. Antipsychotic induced Hyper-prolactinemia - Mechanism, Consequences, Assessment- Dr Santanu Nath, AIIMS Bhubaneswar

  2. Hyperprolactinemia induced galactorrhea and menstrual irregularities - Can we relieve the distress?- Dr Jigyansa Ipsita, AIIMS Bhubaneswar

  3. Hyperprolactinemia induced osteopenia - Do we need to worry about a fracture? - Dr Jaya Prakash Russell Ravan, KIMS Bhubaneswar

  4. Hyperprolactinemia induced Sexual Dysfunction - Identification and Management- Dr Sumit Kumar, KIMS Bhubaneswar

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W11 “Workshop on emotional insight into anger management in clinical practice and personal life”

Kuldip Kumar 1, Rahul Saha 2, Satyam Sharma 3

Background: Anger is not a natural reaction to any chaotic situation but a chosen response. Anger is not a solution but an obstacle in peace and harmony. Anger has both healthy and unhealthy impact, not only upon the one who shows the aggression but instead it also has an impact on the one who becomes the victim of it. Frustration, Provocation, Exposure to Media Violence, Personal causes generates aggression. However, brain also has vital role in anger, the amygdala being the main organ responsible for regulating our perceptions and reactions to aggression, and the release of neurotransmitters related to aggression. The prefrontal cortex also has an additional role as a control center for aggression. When it is highly activated one can control aggressive impulses easily. Hormones, especially the male sex hormone testosterone is also associated with increased aggression.

Methodology:

The workshop will give a detailed account of anticipants of emotional insight in aggression and the neurobiology behind it. Role plays will be carried out to teach the audience how to develop an emotional insight in certain specific situations which can lead to aggression. The workshop will also include interactive sessions between the speakers and audience.

Conclusion:

Resolving aggressive feelings by being hostile to others will not work, nor will other approaches that amplify aggression. Hence it becomes crucial to understand the effect of emotional insight in aggression and develop insight in our emotion. This workshop is intended to facilitate the participants to consciously be aware of healthy emotional insight for day to day of handling of aggression and anger.

Key words: Aggression, emotional insight, understanding

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W 12 workshop on Tele-psychiatry

K Ashok Reddy 1, Vadlamani Naresh 2, K P Jayaprakashan 3, Chaitnya Joysula 4, Anay Shukla 5

Our Team members jointly would like to present a W 31 workshop on Tele-psychiatry during the ANCIPS 2019 @ Lucknow

Workshop is titled as “Practical Demonstration of Tele psychiatry” Team of workshop presenters and their role will be:

1. Dr. K. Ashok Reddy, Moderator of the program and will present practical demo of Tele-Psychiatry linking with a clinic in Hyderabad.using voice input, Professor & HoD, Dept. of Psychiatry, SVS Medical College, Mahabubnagar, & Past President of IPS-SZB 2. Dr. Vadlamani Naresh, Director of Columbus Hospital, Secunderabad & Hony.. Secretary of IPS-SZB,; will present about “ Pros and Cons of Tele-Psychiatry” 3. Dr. K. P. Jayaprakashan, Assoc. Professor of Psychiatry, Govt. Medical College,Thiruvananthapuram will share his experiences in Tele-Psychiatry.. 4. Mr. Chaitnya Joysula, Managing Director, Talkadoc. will clarify technical doubts from audience 5. Mr. Anay Shukla, Attorney, Nishit Desai Associates, Mumbai, will clarify the legal questions from Audience through Telepsychiatry

Kindly provide 1 hour slot during the conference or during the Pre-conference sessions. This workshop will stimulate and encourage the psychiatrists to use Tele-psychiatry which in turn benefits our patients by adding convenience and reducing the the cost of psychiatric services.

Looking forward for positive response from your side. Please feel free to call me on 9391041531 for any clarifications

Thanking you sir, Yours truly Dr.K. Ashok Reddy Past President of IPS-SZB Hyderabad

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W13 Workshop on Use of Electroencephalography (EEG) in Psychiatric practice

Vidya KL 1, Nishant Goyal 2, Umesh S 3

EEG is one of the frequently done investigations in patients with mental illness especially when presentations are atypical and where there is need for evaluation of organic etiology. It is a cost effective tool, which gives valuable insights in evaluating puzzling cases. Though the utility of EEG in psychiatry is unquestionable, the training one gets during the psychiatry residency in India is minimal and is majorly confined to the tertiary care institutions. Therefore, even on establishing an EEG system, reporting is depended on liaising neurologists. Many a times even translating and utilizing the reports of EEG for benefit of patients becomes challenging. Terminologies like sensitivity, time constant, montage and various filters at the beginning of EEG graph make it difficult to comprehend, unless trained. Moreover, now EEG is not confined to spontaneous wave patterns of the brain; ADC (analogue to digital converter) with the aid of computers demonstrates evoked and event-related potentials and to investigate the wealth of frequencies that constitute the EEG. Advanced high resolution EEG research is throwing light on the grey area of etiology of various psychiatric disorders. So this workshop will explore from basic tenets of EEG, setting up of EEG lab, use of EEG in psychiatric services to advanced high resolution EEG that is being used in psychiatric research using illustrations and virtual graphs. The team intents to focus on setting the parameters for clinical EEG record, reading of normal as well as abnormal EEGs, we come across in day today clinical settings.

Divisions:

  1. Basic tenets of Electroencephalography and setting up of EEG lab – basic parameters, normal rhythm, artifacts and sleep changes

  2. Use of EEG in psychiatric practice – Indications and abnormal EEG

  3. EEG in psychiatry research

Key words : EEG, Psychiatry, training

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W14 Mentalisation Based Therapy for Borderline Personality Disorder: Findings from a 12 month Group Therapy Program

Ashlesha Bagadia 1, Dharani Devi 1

Background: Psychotherapy for Borderline Personality Disorder has long been studied in western populations with very good outcomes. However there is limited evidence for newer psychotherapies and its application for this disorder, in India. Mentalisation Based Therapy, developed by psychoanalysts from UK, has shown to be beneficial in individual and group therapy format in the treatment of Borderline PD. A pilot study of a 12 month group therapy program using MBT principles was conducted for the first time in India. Findings from the pilot program will be discussed. Basic fundamentals of MBT and skills using videos and role plays will be described.

Learning objectives:

Delegates will be able to understand the basic principles of Mentalisation Based Therapy

Challenges and problems faced in setting up a group therapy program in private practice will be shared

Delegates will get an opportunity to practice role plays and take away skills that can be replicated in daily practice when working with Borderline PD.

Anthony Bateman MA FRCPsych & Peter Fonagy Ph.D. FBA (2013) Mentalization-Based Treatment, Psychoanalytic Inquiry, 33:6, 595-613, DOI: 10.1080/07351690.2013.835170

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W15 TITLE - Behavioural disturbance of stroke syndrome

Amrendra Kumar Singh 1, Pradeep Kumar 2

INTRODUCTION –

Stroke is one of the most common causes of mortality and morbidity in the world. Change of lifestyle, overwhelming stress and strains in all spheres of life, dietary habits and over competitiveness with a sustained struggle for existence have significantly increased the risk of hypertension and eventually cerebro-vascular accidents.

Since long behavioral disorders have been noticed by various clinicians and investigators as one of the most relevant disabilities of stroke syndrome. Such behavioral manifestation was merely considered a reaction to a devastating morbidity. In view of psychological reaction to any stress, disease or disability, much emphasis was give to this aspect.

However, with the advent of recent advances of technology, various non-invasive techniques like computerized tomography, MRI, PET, autoradiography of brain, various radio isotopic methods for evaluation of regional cerebral blood flow etc. Have given us a better understanding of Neuro-physiology and Neuro-psycho-pharmacology, electrophysiology, regional cerebral blood flow and overall picture of central synaptic transmission. Concentrated efforts using aforesaid technique provided us with ample evidence in favor of biological substratum of psychiatric manifestations following a stroke syndrome. As a result, there has been a resurgence of interest in proper identification of various organic psychiatric disorders, their underlying mechanism, anatomical and clinical correlations and overall management using various pharmacological agents.

It’s a general consensus that psychiatric symptoms play a pivotal role in symptoms formation and the overall disability of stroke syndrome. Very often due to superimpose of psychiatric disorders, the overall disability due to stroke syndrome per-se get exaggerated than the real magnitude of illness. It is therefore imperative to identify associated psychiatric disorders following cerebro-vascular accident more effectively and a holistic bio-psychosocial approach should be directed to achieve better result.

Keeping all these in view the present study was envisaged with the following aims and objectives.

AIM – to study post stroke psychiatric manifestations.

OBJECTIVE –

  1. To study the clinical picture and etiological factors of stroke syndrome.

  2. To evaluate the magnitude of various psychiatric disorders following stroke

  3. To study the clinical profile of psychiatric disorders following stroke syndrome.

  4. To correlate clinical phenomenology of psychiatric disorders with various clinical variables including nature & site of lesion.

METHDOLOGY -

  1. Study design – case control study

  2. Study site- Department of psychiatry SSMC REWA

  3. Study duration- 18 months

  4. Study sample- 90

Inclusion criteria

  1. Patent of stroke syndrome coming in psychiatric OPD, IPD, geriatric OPD with or without aberrant manifestation.

  2. Patient of strokes in acute phage as well as within 6 month of stroke will be included in the study.

  3. No age bar.

  4. Either sex

  5. Patient giving written informed consent

Exclusion criteria

  1. severe medical emergencies

  2. Unconsciousness and cognitive decline.

  3. Past h/o neuropsychiatric disorders.

  4. Mental retardation.

  5. Lack of consent.

Tools

  1. Psychiatric rating scales (MBPRS, HAM-D, HAM-ANXIETY, Yale’s mania rating scales), for psychosis, depression anxiety and mania respectively.

  2. Those patients fulfilling specific diagnostic categorisation on the basis of ICD-10 DCR will be subjected to quantification of the disorders using authentic rating scale.

  3. WHO- SCALE (Quality of life).

  4. NIH STROKE SCALE.

PROCEDURE –

The study will commence following the approval from department of scientific committee and institutional ethical and scientific committee.

The patients will be hospitalized whenever indicated.

  1. All the patients will be evaluated using semi structural proforma for socio-demographic and clinical variables.

  2. Detailed general and systemic examinations will be recorded and special emphasis will be given to higher functions consisting neurological and mental status examinations.

  3. Psychiatric diagnosis will be based on recent diagnostic criteria of ICD-10(DCR).

  4. INVESTIGATION: Routine baseline as well as specific investigation as given in proforma (LFT, KFT, Blood sugar, s. cholesterol)as and when indicated.

  5. NEUROIMAGING: CT/MRI will be done in each patient to determine the site of lesion and nature of stoke.

  6. Fundus will be examined in all patients.

  7. ECHO will be done whenever required.

The sample of the study will be comprising of 90 patients of stroke syndrome

Attending psychiatric OPD, IPD and geriatric OPD fulfilling selection criteria.

The final psychiatric evaluation and their respective diagnosis will be made only after a period of 3 weeks to avoid the confounding variable of acute emotional turmoil.

Assessment of pre and post stroke psychosocial variables will be done.

The opinion of medical consultation will be done whenever needed.

Statistical analysis

The results will be subjected to statistical analysis using student’s t-test (continuous variables) and chi-squared test (categorical variables) to achieve significant of various clinical variable(p=<0.05)

Result and discussion:

As study is going the analysis will be done using SPSS v21by appropriate statistical analysis.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W16 Children and Adolescents with their First Episode of Psychosis: Changing the Trajectory of their Illness

Kumail Hussain 1

The National Institute of Mental Health predicts that one out of 3 people will experience psychosis at some point in their lifetime. These episodes of psychosis someone may experience may be short in duration or become a permanent ongoing symptom one may have to get chronic treatment for. These psychotic disorders are associated with a high degree of personal, financial, societal and clinical burden. Most often clinicians encounter patients well into their illness for those that do make it to a clinician. About half of patients with psychosis do not seek treatment. Timely and early intervention can change the trajectories of a patient’s illness in patients with a First Episode Psychosis. True Psychosis suggestive of Schizophrenia is hard to diagnose in patients before the age of 13. About one out of two patients with Schizophrenia as an adult develop their first symptoms of psychosis during their adolescence. In this workshop, we will discuss how to identify children and adolescents with first episode of psychosis and how to differentiate normal experiences of childhood from true psychosis. We will discuss how to overcome cultural barriers for patients to get identification and treatment for patients with their first episode of psychosis particularly in India. In the last segment of the workshop, treatment strategies ranging from vitamins to psychotropic medications will be discussed for the management of first episode of psychosis.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W17 Title: ADHD parent training workshop

Chhitij Srivastava 1, Vivek Agrawal 2

Outline: ADHD is a chronic and pervasive developmental disorder that has maladaptively high levels of impulsivity, hyperactivity and inattention. It is pervasive across different settings. ADHD in young children, especially if left untreated, marks a significant risk for later development of oppositional defiant disorder (ODD), conduct disorder (CD), and more serious antisocial behavior in adolescence. It is therefore important to recognize and treat these children early. Early interventions focus more on parent training and behaviour management and less on medications. Parent training helps both in core ADHD symptoms and the ODD symptoms, therefore being of potential benefit in reducing the more serious conduct problems as the child grows up. This workshop aims to provide a practical overview on parent training for children with ADHD. The principles of parent training that will be discussed in the workshop will be helpful both in routine clinical settings of a busy psychiatrist and in focused parent training programs.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W18 Title: Social Media Tool Kit For Psychiatrists

Syeda Ruksheda 1, Anjali Chhabria 2, Satyen Sharma 3, Suresh Bada Math 4

Aim:

To orient psychiatrists to increasing importance of various social media outlets and encourage participation.

To enhance the participants’ social media literacy.

To share tips on social media language, trends and impactful use of them

To highlight legal and ethical aspects of online activity.

To equip the psychiatrists with skills for their own safety and privacy.

To caution about digital footprints and their impact on personal & professional lives.

Outline:

In 2019, it is estimated that there will be around 258.27 million social network users in India (1a). On average, 40 million Indian consumers are online. 42% are activities like news, knowledge website, research and classifieds. 83% say they find online to be a credible source of information. Among the popular social media avenues, Facebook is still the market leader for most Indians with 83.83% users, &.48% use YouTube, 4,11% are on Instagram, 2.68% on Pinterest and, 1.44% on Twitter (1b)

Patients increasingly turn to the Internet to learn about their conditions, physicians, and treatments (2)

Whether as users of data posted by others or creators of information that others can access, psychiatrists are full participants in the social media revolution, creating a complex set of practical and ethical challenges for psychiatric practice (3)

Psychiatrists and other physicians now also have a presence on the web, including in social media. This presence is complemented by patient-produced content about physicians, e.g., websites compiling patients’ reviews of their doctors (4)

Content of media postings can often be problematic when Drs share a case that might be descriptive enough that patients might be able to recognize themselves. Even when patients are not directly identified, it can raise doubts among the public about the privacy of their medical interactions, increasing their reluctance to speak frankly with their physicians.

Personal accounts or handles must be used judiciously too as on line disclosures can affect treatment. Today various schools of psychotherapy embrace different approaches to self-disclosure, almost everyone agrees that disclosures should be rare, time-limited and made only when they are likely to have a positive therapeutic impact (5)

Not only should psychiatrists be aware of the content they have posted and to whom it is available; they should routinely scan the web for information about them posted by others, which may be inaccurate or overtly malicious (1). The twenty-first century psychiatrist should be able to be a cautious but vigorous participant in the social media revolution (1).

The workshop will use presentations, oral discussions and individual and group activities as mediums of instructions.

References

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W19 Mental Health Care Act,2017: A new Era of mental health care in India

Rajesh Kumar 1, Pankaj Kumar 2, C L Narayan Gaya 3, Sanjay Kumar 4

The enactment of MHA, 1987 was a significant advancement in the treatment and care of mentally ill persons in the 20th century keeping aligned with the perspective of de-institutionalization of Mental Health care. Though, it provided the necessary legal and administrative framework for care of the mentally ill, it was deficient in the rights based perspective to treatment of mentally ill persons. Mental Health Care Act, 2017 has come into force w.e.f. 29 May,2018, which has currently been finalized proposes to bridge the chasm left behind by MHA, 1987. It defines mental illnesses clearly with a social perspective and empowers the mentally ill to make advance directives and with various rights such as right to access to mental healthcare. This act states the right to live life with dignity and no discrimination on basis of sex, religion, culture, and caste. This act empowers accessibility to mental health services for all. This right is meant to ensure that services be accessible, affordable, and of good quality. It also mandates the provision of mental health services be established and available in every district of the country.

This symposium attempts to understand the transgression from MHA, 1987 to the Mental Health care Act and what it holds for the future of mental health care in India.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W20 LAW AND PSYCHIATRY: APPROACH TO FORENSIC PSYCHIATRY: WHERE TWO ROADS MEET

Pankaj Kumar 1, C L Narayan 2, Rajesh Kumar 3, Ivan Netto 4

The fast-growing subspeciality of forensic psychiatry is stimulating and challenging. But still not much emphasis is laid on practical skill building aspects in educational curriculum of psychiatry. The broadening scope of psychiatry services does require to have optimum basic skills & knowledge regarding the various aspects of forensic psychiatry practice. The Symposium will be divided into 4 interactive sessions on following topics with relevant case discussions.

Psychiatrist as expert witness.:- Dr Pankaj Kumar, AIIMS, Patna

This session will discuss types of witnesses, honouring summons, preparing testimony, appearance in court as witness, demeanour & court room etiquettes, Role of expert witness, immunity of an expert witness along with discussion of few case examples pertaining to various situations of civil and criminal responsibility where psychiatrist as a testimony is required.

Civil Responsibility: Duty of Psychiatrist:- Dr C L Narayan, Gaya

This session will focus on evaluation and medical board experience of court referred cases at interface of law and psychiatry in civil cases e.g. marriage/ divorce, contract, adoption, fitness to take care of person and property, fitness for job, fitness for work, competence to be witness and testamentary capacity.

Confidentiality and psychiatric case records:- Dr Rajesh Kumar, IGIMS, Patna

This session will focus on confidentiality related issues pertaining to psychiatry case records. Important issues like patient’s rights of access to their own medical records, disclosure of confidential clinical information to patient, third parties and in context of civil and criminal suits. Duty of psychiatrist for disclosure of information in certain cases of public interest. Clinical, legal and ethical dilemmas in information disclosure in relation to right to information act, fudiciary relationship and mental health care bill will be discussed along with clinical case examples.

Boundary violations in Psychiatry and its Forensic implications:- Dr Ivan Netto, Pune.

This session will discuss various types of boundary violations in Psychiatry practice and its Forensic implications.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W21 Workshop – duration: One hour

Z Nadeem 1, H Aditya 2

2-Min Examination for Drug Induced Movement Disorders

The use of neuroleptic drugs has increased manifold over past couple of decades, as the therapeutic efficacy of these drugs is now well established. However, these drugs are associated with a wide range of side effects, including a variety of movement disorders. The newer antipsychotics and antidepressants gained popularity due to the initial findings that they have a lower propensity to cause acute extra pyramidal side effects and tardive dyskinesia. However, over the past several years, the incidence of drug induced movement disorders attributable to these newer molecules has increased.

Drug-induced movement disorders or extra pyramidal symptoms as they are commonly known as, if unidentified and untreated, pose a significant burden to patients and may result in poor compliance, medication non adherence or abandonment of treatment and increase in social stigma.

Many of these movement disorders are treatable if detected early. It is important for psychiatrists to understand that DIMDs can occur acutely (i.e., hours to days after drug exposure), sub acutely (i.e., within weeks after exposure), or months to years after drug exposure. It has been observed that patients with movement disorders do not always complain about their adverse effects and sometimes, often out of shame, they try to hide their involuntary movements. Robust knowledge of DIMDs and how to examine for them in a busy psychiatric outpatient clinic will enable psychiatrists to better identify patients with DIMDs or those at risk for them and initiate appropriate treatment strategies and prevention plans.

Our training and clinical experience has taught us that it is indeed possible to do a quick physical examination to identify DIMDs effectively in less than two minutes in not so subtle cases. We would like to demonstrate how to do this quick examination in our workshop. The workshop will also briefly cover the use of specific rating instruments like AIMS and Barnes scale.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W22 WORKSHOP: AN INTRODUCTION TO HYPNOSIS IN CLINICAL SETTINGS

Kishore Dudani 1, Dharamdeep Singh 2

Hypnosis is a state of mind that facilitates it to be connected to both the inside and the outside world at same time. This state of being simultaneously related to and aware of ‘Outside’ or ‘Sensory’ and ‘Inside’ or ‘Experiential’ is called the state of Trance. American Psychological Association describes hypnosis as a cooperative interaction in which the participant responds to the suggestions of the hypnotist. Hypnosis has been clinically proven to provide medical and therapeutic benefits, most notably in the reduction of pain and anxiety.

This workshop shall include the following components; Introduction: This section shall present an overview and definition of hypnosis, mechanism of creation of hypnotic state, body changes that occur during hypnotic induction, busting myths surrounding hypnosis, Do’s & Don’ts’s and practical uses of hypnosis. Demonstration: This section shall include practical demonstration of hypnotic induction. Discussion and feedback: The final section shall focus on the discussion based on the workshop, including the queries on the same.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W23 BUILDING EMOTIONAL INTELLIGENCE IN A VIRTUAL WORLD

R Kamath, Alka A Subramanyam 1

Today’s fast paced world has become restricted to our smart-phones and online connectivity. So much so that we forget that to connect, we have to disconnect.

Emotional intelligence (EI) has been spoken about often and has garnered much importance in the 21st century. Emotional intelligence is nothing but awareness of emotions- of oneself and others in the environment; and thereby achieving control of any situation by awareness and control of one’s emotions. This leads to a win-win situation for all.

However, in today’s day and age it is important to not only recognize actual emotions in others, but also read the same through digital language or communication.

As mental health professionals it becomes imperative for us to understand emotions in our patients, other professionals and with each other, in both the physical and the virtual world. This will lead to a more beneficial doctor-patient relationship and less burn out in mental health professionals themselves.

This hands-on workshop deals with emotional intelligence through a new lens. 90 minutes, discussions, group activity and an enriched understanding of EI in today’s times.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W24 Role Of Mass Media For Awareness & Use of Technology In Public Education for Mental Health & Emotional Well-Being

Avdesh Sharma 1, Sujatha Devanathan Sharma 2

There is a growing incidence of psychological distress and mental illness across the world and also due to rapid socio-cultural and socio-political changes. Disability due to mental illness and the burden of care are further stretching the meagre resources and increasing the economic costs of healthcare in many developing countries. In such a scenario where there are both an inadequacy of mental health professionals and inaccessibility to quality care across the country it is imperative to harness the power of mass media and public education in mental health.

This workshop would focus on the role of mass media & technology in creating awareness about mental health issues and emotional well-being and disorders for early identification and to reduce the stigma of mental illness as key components in public education and health seeking behaviour. It would provide information on accessing services and basic self-care approaches for dealing with minor mental health problems. These strategies have tremendous scope to educate the public in prevention of mental illnesses and promoting mental well-being.

This workshop would specifically also focus on C4MH (Communication for Mental Health) Campaign & some landmark mass media initiative towards public education of mental illness and mental well-being in India. We would share our experiences of more than three decades of work with television, radio and print media in this area. This includes Television series ‘Mann Ki Baat, Mindwatch, Mind Your Mind and Mind Matters’ having access to millions of households. We would also share the work in print media through our weekly column series – ‘Behaviour’ and ‘Relationships’ about 110 columns over two years and now through the Internet and our future plans through mobile phone platform.

The workshop aims to look at how similar work has been happening and the need for collaborations and training to take it forward.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W25 Interphase of Mental Health AND SPIRITUALITY

Avdesh Sharma 1, Sujatha Devanathan Sharma 2

Mental health professional in varied settings today has to increasingly deal with clients who do not fall into watertight psychiatric syndromes. The needs of these large subgroups of patients are beyond what is taught as a part of psychiatric education or is traditionally practiced. The needs of the patients and their families are also beyond just symptom reduction through medication. It is also known that cultural factors especially existential issues may precipitate or modify mental illnesses. Mental health and well-being require a very different mindset (beyond just the physical medicine). This requires awareness and integration of spirituality and mental health.

It is found that a large number of the population believes in ‘Soul’, Energy, Consciousness etc. The clients may not feel comfortable with a mental health professional who can’t understand or does not wish to address their client’s religious/psycho spiritual beliefs. They may also be seeking simultaneous treatments from Ojha (faith healers), new age therapists, Astrologers or just cognitive behavioral shift through religious/spiritual beliefs.

The recent boom of ‘new age/alternative therapies’ has not only attracted those having these existential concerns but also those who have not benefited from mainstream psychiatric treatments. There is now increasing evidence of efficacy of many therapeutic techniques like Yoga, Meditation, Prayers and Spirituality based interventions. It is time to incorporate Spirituality, spiritual history taking and collaboration with Spiritualists in providing Medical Sciences and Mental Health along with other ingredients in a cultural context as a viable model, which is cost effective, locally available and acceptable to the population it caters to.

The workshop would focus on the prevalent scenario beyond the mainstream psychiatric/psychological help in an interactive way with the audience. It would look for new models, specially international collaborative context of health delivery incorporating spiritual principles in mental health, including for mental illnesses.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W26 TITLE: REFRAMING PROBLEM AND LIFE COURSE OF ADULT ADHD: FROM EVALUATION TO TREATMENT

Madhav Raje 1, K Srinivasa 2, Praveen Khairkar 3, Neha Gupta 4

CONSTRUCT OF WORKSHOP:

ADULT ADHD ONCE THOUGHT TO BE RARE AND UNDIAGNOSED IS NOW BECOMING COMMON CO-MORBID PRESENTATIONS IN UNUSUAL PRESENTATIONS IF KEENLY EVALUATED AND IDENTIFIED FOR ITS PRESENCE ESPECIALLY IN HARD TO TREAT PATIENTS. NOT MANY PSYCHIATRISTS KNOWS ABOUT ITS INTEGRATED EVALUATIVE PROCESS. ITS ASSESSMENT, LONG-TERM COURSE, UNCOMMON PRESENTATIONS, TREATMENT OUTCOME AND CHALLENGES SHALL BE DISCUSSED IN THE CURRENT WORKSHOP. FURTHER EXPERTS WOULD LIKE TO FOCUS HOW THIS DOMAIN IN WORKING OR NON-WORKING INTELLECTUALS CAN HAVE PROFOUND CONSEQUENCES FOR THEIR IMPORTANT REQUISITE OF WELL BEING. SPECIFIC PSYCHOTHERAPIES / PRINCIPLES OF MANAGEMENT SHALL BE CAREFULLY CASE BASED DISCUSSED AND INTERACTIONS WITH AUDIENCE IS SOUGHT. 8 SPECIFIC COMPLICATIONS OF ADULT ADHD AND REFRAMED STRATEGIES OF ITS MANAGEMENT WOULD BE EXCLUSIVELY DISCUSSED. HELPFUL RESOURCES, TOOLS OF EVALUATION AND MANAGEMENT WOULD BE DISTRIBUTED DURING WORKSHOP.

TITLE OF EACH SPEAKER

  1. IS THERE ANY CHANGE IN UNDERSTANDING & EVALUATION OF ADULT ONSET ADHD?

    BY:-DR. NEHA GUPTA MD.

  2. LESS COMMON PRESENTATIONS OF ADULT ADHD: CASE BASED MANAGEMENT DIFFICULTIES

    BY:- DR. MADHAV RAJE, MD, DPM

  3. ADHD AND CYBERCHONDRIASIS: DATABASE EVALUATION FROM SOUTH INDIA

    BY:-DR. K. SRINIVASA. MD

  4. LONG-TERM COURSE OF ADHD: CAN WE REPHRASE OR PREVENT THE IMPENDING PANDEMIC?

BY: DR. PRAVEEN KHAIRKAR, MD

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W27 TITLE: SELECTING PARTNER FOR MARRIAGE:

Indira Sharma 1, Vipul Singh 2

MEDICAL OR RELIGIOUS HOROSCOPE, WHICH IS MORE RELEVANT?

Aim: To deliberate on which is more important, religious horoscope or medical horoscope (medical history and risk factors) for deciding on a partner for marriage.

1. Introduction to workshop: 10 minutes

The use of religious horoscope for selecting partner for marriage has a long history, but recently medical horoscope (medical history), is assuming significance. Many diseases such as major mental illnesses, illnesses related to social drugs (alcohol, cannabis tobacco), diabetes, hypertension, eye diseases, infertility, etc have adverse effects on marriage and need consideration.

By Prof. Indira Sharma

2. Presentation of Vignettes: 30 minutes-

by Dr Indira Sharma & Dr Vipul Singh

Vignette 1: This vignette will highlight the effect schizophrenia in a woman on her marriage

Vignette 2: This vignette will highlight the effect of alcohol drinking in a man on his marriage.

Vignette 3: This vignette will highlight the effect of diabetes mellitus and hypertension in a man on his marriage.

Vignette 4: This vignette will highlight the effect of female infertility on her marriage

3. Discussion: 40 minutes

4. Conclusions: 10 minutes

By Dr Vipul Singh & Dr Indira Sharma

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W28 Performing a Peer Review: Workshop for Young Mental Health Professionals

Naresh Nebhinani 1, Rohit Verma 2, Siddharth Sarkar 2, Sujit Kar 3, Rajeev Ranjan 4, Roshan Bhad 2

Psychiatrists are increasingly requested to engage in peer review process as a part of academic commitment and involvement in the progress of science. Peer review process critically evaluates the research work conducted by another individual or group, and provides feedback for scrutiny or improvement. This workshop is aimed at mental health professionals who are engaged in or plan to engage in peer review process for academic journals. The workshop would help the residents as well since it might help them to gain understanding in making critical evaluation of scientific literature. The workshop also aims to increase reviewer’s awareness about certain guidelines for conducting peer review (like CONSORT guidelines, STROBE guidelines, PRISMA guidelines).

The workshop shall include the following several components. Introductory comments would include overview of the peer review process, need to engage in peer review, and potential benefits of being a peer reviewer. Thereafter, hands on experience of conducting a peer review would be done using a sample manuscript. The abstract and title of the article would be discussed, followed by introduction. The methodology section along with statistical tests would be discussed next. The results section would be evaluated, followed by the discussion section. Concluding remarks would include ways of organizing and presenting the peer review, and addressing the varied forms of manuscripts.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W29 COGNITIVE-BEHAVIOURAL INTERVENTIONS FOR MANAGING NICOTINE DEPENDENCE

G S Kaloiya 1

Cognitive behavioural treatment focuses mainly on learning coping and problem solving strategies for understanding and disrupting patterns of tobacco use, dealing with beliefs related tobacco use, craving, resisting social pressures to use tobacco, and managing stressful situations. The cognitive skills required for successful behaviour change include the ability to identify and self-monitor behavioural patterns, anticipate problem situations, develop and prepare plans for handling high risk situations, and remember both the plan and the need to take action in the future. Behavioural interventions typically target users’ motivation, self-efficacy, skills, and social support. Two of the most common intervention paradigms that derive from these conceptual underpinnings are motivational interviewing and skills training. Motivational enhancement helps users to remain in treatment. Skill training is used with individuals who are actively working on cessation. The core components of skills training include- identifying and coping with high-risk situations associated with tobacco use, modifying cognitive expectancies and attributions associated with tobacco use, teaching stress management skills, and modifying general lifestyle activities. The workshop will include brief description of models & components of CBT and in detail about techniques used in CB Interventions through demonstrations, role plays etc.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W30 Impact of Perinatal Mental Illness on mother & baby: working with trauma and mother infant bonding

Prabha Chandra 1, Sonia Parial 1, Darpan Kaur 1, Ashlesha Bagadia 1

Background: Incidence of mental illness in pregnancy and post partum illness is just as common in India if not more*. Emerging studies show the immediate impact of untreated illness on the infant and long term adverse effects on mother, infant and the whole family. History of trauma in the mother makes her more vulnerable to perinatal mental illness and can further lead to intergenerational trauma. Understanding the nature of adverse effects will inform clinicians in guiding their patients through better treatment outcomes.

Dr Prabha Chandra & Dr Sonia Parial: Perinatal disorders and it’s immediate and long term impact on the mother & infant.

Dr Darpan Kaur: Including infants in adult psychiatric care in India. Challenges and rewards.

Dr Ashlesha Bagadia: Working with trauma and mother infant bonding.

Learning objectives:

Learners will be able to describe the neurobiological impact of perinatal mental illness and adverse childhood experiences on the mother and infant.

Learn skills to include infants in routine clinical practice

Learn skills to work with trauma and mother infant bonding

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W-31 WORKSHOP ON RESEARCH AND PUBLICATION BY IJP

  1. Need for such trainings and workshops- Dr Gautam Saha (15 minutes)

  2. Publication Ethics- Dr Sandeep Grover and Dr Shyamanta Das (30 minutes)

  3. How to choose a research topic? – Dr Adarsh Tripathi and Dr Darpan Kaur (30 minutes)

  4. How to write an original research paper? – Dr Neelanjana Paul and Dr Sujit Sarkhel (30 minutes)

  5. How to write a systematic review and meta-analysis?-Dr Samir Kumar Praharaj and Dr Rajsekhar Bipeta (30 minutes)

  6. How to write a narrative review?-Dr Alka Subrahmanyam and Dr Avinash DeSouza (30 minutes)

  7. How to write a case report and letter to the editor?- Dr Nitin Gupta and Dr Siddhartha Sarkar (30 minutes)

  8. How to publish in IJP?-Dr Om Prakash Singh (15 minutes)

Total Time-3½ hours

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W 32 Management of Cognitive and Behavioural Symptoms of Dementia

Velusamy Sivakumar 1

Introduction

The number of people with dementia is increasing globally. In India, it is estimated that there are more than 4 million people with Alzheimer’s and other dementias and this places India with the third highest caseload of dementia sufferers in the world after China and USA. Good dementia care should include medical, social and supportive care tailored to individual and cultural needs. Managing the cognitive and challenging behavioural and symptoms of dementia is vitally important for the patients and their care givers.

Aims and Objective of the Workshop

It is anticipated that the practising psychiatrists from all sub-specialties possess a good knowledge in recognising and assessing people with cognitive problems and formulate a management plan for their cognitive and non-cognitive symptoms of dementia. In this workshop, the authors intend to present several case studies of four major sub-types of dementia – Alzheimer’s, Vascular, Fronto-temporal and Lewy Body Dementia. The workshop will aim to encourage the participants to identify the challenges in the assessment and management of their patients.

The speaker is a senior consultant in Old Age Psychiatry in UK and has worked in the field of older people mental health and dementia for more than 20 years. He intends to take through the participants looking at the epidemiology, challenges in identifying these illnesses that is prevalent in Indian communities, work through the neuropathology, assessment and diagnosis and evidence based pharmacological and non-pharmacological interventions.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W 33- Mental Capacity Assessment: Are we ready?

Manu Agarwal 1, Vivek agarwal 2, Anil Nischal 3, Adarsh Tripathi 4

Mental capacity is a multidimensional construct that is a determinant of an individual’s ability to make autonomous decisions. Capacity to consent for treatment is the ability to accept a treatment, refuse it or select among alternatives. Mental health capacity assessments are relevant to consent for research, treatment and for advance directives. Capacity is decision and time specific. There is a conceptual overlap between mental capacity and insight but mental capacity and insight are not synonymous. Among psychiatric patients, lack of insight (the lack of awareness of illness and the need for treatment) has been reported to be the strongest predictor of incapacity.

With the introduction of Mental Healthcare Act (MHA) 2017, mental capacity is now a core part of mental health law and has various implications among persons with mental illness. As per the MHA, 2017, a person with mental illness is deemed to have capacity to make decisions regarding his mental healthcare or treatment if they have the ability to understand the relevant information to take the decision, appreciate the reasonably foreseeable consequence of that decision, communicate the said decision by means of verbal or non-verbal means. The capacity to consent as introduced is narrow and overlooks the best interest principle. There is lack of clarity on an instrument to assess capacity to consent for treatment as per Indian context. The criteria of harm to self and others is for admission but not for treatment per se.

The MacArthur Competence Assessment Tool for Treatment (MacCAT-T) is regarded as the gold standard for capacity assessment but is not validated for Indian patients. There is an urgent need to formulate and validate a capacity assessment tool for our population.

Key words: Mental capacity, Mental Healthcare Act, capacity assessment

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W 34 IPS Young Psychiatrists Subcommittee

Manaswi Gautam, Shivaji Marella, Parth Vaishnav, Pawel Singh, Shivam Sunil

fMRI is now used widely to explore the networks of the brain in both the resting state and while performing various standard or customized tasks. Studies are carried out in both healthy and psychiatrically ill persons. These studies have led to the elucidation of the resting state, wide networks of the brain along with loco-regional functional changes in the brain.

Recently the Human connectome project has provided us with a new cortical functional map extending to 180 regions per hemisphere. This gives us the opportunity to study the functional brain with far greater detail and specificity.

RTMS is used by many of the academic and some of the larger private mental health facilities in india.

RTMS as a method has not been taught to most of the young psychiatrists in India. A similar state obtains with fMRI.

This workshop will give a brief training in both these methods to the interested participants. This will ensure that a greater deal of research and clinical implications of these methods will be thought upon and brought to realization.

The extensive research, forensic and clinical implications of fMRI and rTMS will be discussed along with the methods in an interactive format.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

W 35 Title- Mental Healthcare Act, 2017 – Challenges and Opportunities

Naveen C Kumar 1, Manjunatha N 2, Mahesh Gowda 3, Suresh Bada Math 4

Mental Health Care (MHC) Act 2017 is a reality and rights based mental healthcare legislation for protecting, promoting and preventing human rights violation during health service delivery. This legislation revolves around ‘individual rights’ & ‘liberty’ and brought various revolutionary changes such as advance directive, nominated representative, capacity to consent for treatment & admission and articulating rights of persons with mental illness. Further, independent Mental health review boards and responsibilities of government are clearly emphasized. The major importance of human rights-based approach in MHCA 2017 will eventually bring in changes by making States responsible and accountable for providing care. This new legislation bring in new hopes, new challenges and new opportunities.

The objective of this workshop is to give an overview of MHC act 2017 and its upcoming issues while implementing it. The workshop brings together all mental health practitioners and legal experts, who are interested and working in the field of mental healthcare service delivery to discuss the processes underlying the legal reasoning and helping the practitioners in making clinical decision making under the legal framework.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S440–S451.

1. Workshop ANCIPS 2019: Title of Workshop: RIGHTS OF PERSONS WITH MENTAL ILLNESS: RIGHT TO ACCESS TREATMENT V. RIGHT TO REFUSE TREATMENT

India Sharma, Varghese P Punnoose, RK Solanki

Proposed by: Committee on Patients Rights, Indian Psychiatric Society

Organised by:

Organising Chairperson Indira Sharma 1

Organising Secretary: Ganesh Shanker2

  1. Professor & Head, Department of Psychiatry, Heritage Institute of Medical sciences, Varanasi, UP, India.

  2. Assistant Professor of Psychiatry, GSVM Medical College, Kanpur, UP, India.

Background: The Mental Health Care Act (MHCA) enlists 11 Rights of persons with mental illness. Some of the Rights do not seem to be in harmony with certain of the provisions of the MHCA. Eg, in patients with severe mental illness, the Right to accept treatment as well as the Right refuse treatment may sometimes have to be transferred to his Guardian / Representative, to ensure that the patient receives appropriate and timely treatment.

Aim:

To determine whether the Rights of patients enlisted in MHCA are in harmony with each other and with other provisions of the MHCA.

Layout of Workshop: Duration 1 hour

1. Introduction: 10 minutes

The rights patients shall be presented along with any conflicts amongst them or with the provisions of MHCA.

2. Presentation of Rights and discussion: 20 minutes

Rights 1-6 will be presented with remarks (Accepted/ Rejected/ Modification needed (options provided))

Suggestions and discussions from participants

Moderation by Chairperson

3. Presentation of Rights and discussion: 20 minutes

Rights 7-11 will be presented with remarks (Accepted/ Rejected/ Modification needed (options provided))

Suggestions and discussions from participants

Moderation by Co-Chairperson

4. Concluding remarks: 10 minutes

Major conclusions with regard the Rights of patients

Articles from Indian Journal of Psychiatry are provided here courtesy of Wolters Kluwer -- Medknow Publications

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