Treatment of substance use disorders through the government health facilities: Developments in the “Drug De-addiction Programme” of Ministry of Health and Family Welfare, Government of India
Abstract:
Substance use disorder (SUD) is a major problem worldwide, including in India, and contributes significantly to morbidity and mortality. The Ministry of Social Justice and Empowerment, Government of India, addresses the prevention and rehabilitation aspect of substance use through the establishment of “rehabilitation centers”...
Substance use disorder (SUD) is a major problem worldwide, including in India, and contributes significantly to morbidity and mortality. The Ministry of Social Justice and Empowerment, Government of India, addresses the prevention and rehabilitation aspect of substance use through the establishment of “rehabilitation centers” run by nongovernmental organizations. The Drug De-addiction Programme (DDAP) was initiated in 1988 under the Ministry of Health and Family Welfare, Government of India, and was mandated with provision of treatment for SUDs. Through the DDAP, de-addiction centers (DACs) have been established in government hospitals by providing a one-time financial grant by the central government, with the recurring expenses to be borne by the state governments. In addition, some premier institutions as well as DACs from Northeastern region are provided annual recurring grants for their functioning. Capacity building has been a major focus area of DDAP in which nonspecialist medical officers working in government hospitals have been trained, and various training materials have been developed. Another major area of work is the development of “drug abuse monitoring system” to track the pattern of drug use and profile among individuals seeking treatment in the DACs. Monitoring and evaluation exercises carried out show that the existing model of inpatient treatment and of shared responsibility between central and state governments is partially successful. The establishment of drug treatment clinics on pilot basis with a focus on outpatient treatment and direct support from the DDAP for staff as well as for medicines is showing encouraging results.
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471 Citations
The limbic system.
Abstract:
Byline: V. RajMohan, E. Mohandas "The hypothalamus, the anterior thalamic nucleus, the cingulate gyrus, the hippocampus and their interconnections, constitute a harmonious mechanism which may elaborate the functions of central emotion as well as participate in the emotional expression." James Papez, 1937 The limbic system con...
Byline: V. RajMohan, E. Mohandas "The hypothalamus, the anterior thalamic nucleus, the cingulate gyrus, the hippocampus and their interconnections, constitute a harmonious mechanism which may elaborate the functions of central emotion as well as participate in the emotional expression." James Papez, 1937 The limbic system consists of the phylogenetically old limbic lobe and other subcortical structures and their connections. Although not empirically proven, the limbic system is a functional concept which may be employed to explain various brain functions.[sup] [1] History Paul Pierre Broca in 1878 spoke of ' le grand lobe limbique' or the great limbic lobe and applied the term "limbic" (from the Latin limbus for border) to the curved rim of the cortex which incudes the cingulate and the parahippocampal gyri. However, its putative role in emotion was elaborated by the American physician, James Papez in 1937 in the seminal paper titled 'A proposed mechanism of emotion'. This anatomical model is referred to as the Papez circuit.[sup] [2] Yakovlev in 1948 proposed Yakovlev's circuit in the control of emotion involving the orbitofrontal, insular and anterior temporal lobe cortex, the amygdala and the dorsomedial nucleus of thalamus.[sup] [3] In 1952, Paul D. MacLean coined the term "limbic system" to describe Broca's limbic lobe and related subcortical nuclei as the collective neural substrate for emotion.[sup] [1] MacLean was also instrumental in proposing and defining the Triune concept of the brain. MacLean's evolutionary "Triune brain theory" proposed that the human brain was in reality three brains in one: the R-complex (reptilian complex), the limbic system and the neocortex.[sup] [4] The concept of the limbic system has since been further expanded and developed by Nauta, Heimer and others. Components of the Limbic System There is no universal agreement on the total list of structures, which comprise the limbic system. The brain regions that constitute the limbic system are: *Limbic cortex i. Cingulate gyrus ii. Parahippocampal gyrus *Hippocampal formation i. The dentate gyrus ii. Hippocampus iii. Subicular Complex *Amygdala *Septal area *Hypothalamus These structures form a complex network for controlling emotion.[sup] [5] Limbic lobe The limbic lobe situated at the inferomedial aspect of the[sup] cerebral hemispheres, consists of two concentric gyri surrounding[sup] the corpus callosum. Broca proposed that the larger outer gyrus[sup] be named[sup] " limbic gyrus" and the smaller inner one "the intralimbic gyrus".[sup] The limbic gyrus (limbic lobe) consists of the[sup] isthmus of the cingulate gyrus, the parahippocampal gyrus (both of which are continuous via a bundle of white matter called "cingulum") and the subcallosal area.[sup] [6] The cingulate gyrus (Latin = Belt ridge) dorsal to the corpus callosum is heavily interconnected with the association areas of the cerebral cortex. The parahippocampal gyrus in the medial temporal lobe contains several distinct regions, the most important being the entorhinal cortex (ERC). The ERC funnels highly processed cortical information to the hippocampal formation and serves as its major output pathway.[sup] [5] The hippocampal formation Hippocampal formation in the temporal lobe has three distinct zones: *The dentate gyrus *The hippocampus proper *The subiculum Embryologically, the hippocampal formation is an extension of the medial edge of the temporal lobe. The entire hippocampal formation has a length of about 5 cm from its anterior end at the amygdala to its tapering posterior end near the splenium of the corpus callosum.[sup] [5] Dentate gyrus The dentate gyrus is composed of three layers: an outer acellular molecular layer, a granular middle layer and an inner polymorphic layer. …
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340 Citations
National mental health survey of India 2015–2016
Abstract:
Byline: R. Murthy During the past few months, mental health has received public and media attention in an unprecedented manner. This was related to the release of the report of the National Mental Health Survey (NMHS).[sup][1] [INLINE:1] Media referred to the findings of the report as follows: “India needs to talk about menta...
Byline: R. Murthy During the past few months, mental health has received public and media attention in an unprecedented manner. This was related to the release of the report of the National Mental Health Survey (NMHS).[sup][1] [INLINE:1] Media referred to the findings of the report as follows: “India needs to talk about mental illness;”[sup][2] “Every sixth Indian needs mental health help;”[sup][3] “8% of people in Karnataka have mental illness;”[sup][4] “Mental problems more in 30–49 age group or over 60; low income linked to occurrence of mental disorders;”[sup][5] and “urban areas to be most affected”[sup][2] were some of the headlines in the mass media. The NMHS [sup][1] will be a milestone in understanding the epidemiology of mental disorders in the country. It is against this importance of the survey, the current commentary places the survey in the historical context, describes the methodology of the survey, salient findings and discusses the implications of the survey. Psychiatric epidemiology has been an area of great interest among all the leading psychiatrists. The other similar area of interest is the psychiatric classifications. In both these fields, there are more “failures” than successes in the past 60 years. There have been great times and not so great times in the Indian psychiatric epidemiology. It has been well reviewed.[sup][6],[7] One of the first studies, a massive plan by Govindaswamy as quoted by [sup][6],[7] in the 1[sup]st year of the All India Institute of Mental Health, Bengaluru, was so ambitious in identifying the causative factors that it did not get off the planning stage. The next major, a milestone, was the Agra study.[sup][8] This study is significant for the size of the studied population (nearly 30,000 in one study center, as compared to 30,000 + in the National Mental Health survey (NMHS), which is in the focus of the current review) and the identification of factors contributing to mental disorders (rural–urban differences, migrancy, etc.). There were a number of small size studies in the 1960s and 1970s. The most important of these was the “The Great Universe of Kota”[sup][9] considered later. There was a recognition for the need for a large-scale multicentered epidemiological study in 1976 and the Indian Council of Medical Research Department of Science and Technology (DST) project came up.[sup][7] This was a four-centered epidemiological project in Bengaluru, Baroda, Calcutta, and Patiala. Initially, the study aimed to “estimate the prevalence of psychiatric morbidity at different selected centers and investigate the sociodemographic correlates.” However, midway in the project, the objective was shifted to an interventional study, “develop and evaluate methods designed to reach, and offer services to the sick population.”[sup][7] There was a lull in general population, psychiatric epidemiological studies till the early 2000. The next major multicentered study using the World Mental Health Survey (WMHS) occurred in the beginning of the current century. It has had challenges is clear from the fact that it is being published only after 12 years of completion of the study (published in the current issue).[sup][10] The background is important to understand as the NMHS is the most expensive (around Rs. 5 crores), and most ambitious general population epidemiological study undertaken in the country to date. For this reason, it is important to understand the findings in detail and draw lessons for the future. As a scientific discipline, epidemiology has an important place in health sciences. It was Morris who described the seven purposes of epidemiology. These are: (i) understanding the magnitude of the mental disorders; (ii) the causative factors; (iii) calculating the morbid risk; (iv) monitoring the historical trends; (v) completion of clinical picture; (vi) identification of new syndromes; and (vii) treatment utilization in the community. …
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310 Citations
Indian family systems, collectivistic society and psychotherapy.
Abstract:
Indian society is collectivistic and promotes social cohesion and interdependence. The traditional Indian joint family, which follows the same principles of collectivism, has proved itself to be an excellent resource for the care of the mentally ill. However, the society is changing with one of the most significant alteration...
Indian society is collectivistic and promotes social cohesion and interdependence. The traditional Indian joint family, which follows the same principles of collectivism, has proved itself to be an excellent resource for the care of the mentally ill. However, the society is changing with one of the most significant alterations being the disintegration of the joint family and the rise of nuclear and extended family system. Although even in today's changed scenario, the family forms a resource for mental health that the country cannot neglect, yet utilization of family in management of mental disorders is minimal. Family focused psychotherapeutic interventions might be the right tool for greater involvement of families in management of their mentally ill and it may pave the path for a deeper community focused treatment in mental disorders. This paper elaborates the features of Indian family systems in the light of the Asian collectivistic culture that are pertinent in psychotherapy. Authors evaluate the scope and effectiveness of family focused psychotherapy for mental disorders in India, and debate the issues and concerns faced in the practice of family therapy in India.
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307 Citations
Understanding nutrition, depression and mental illnesses.
Abstract:
Byline: T. Sathyanarayana Rao, M. Asha, B. Ramesh, K. Jagannatha Rao Introduction Few people are aware of the connection between nutrition and depression while they easily understand the connection between nutritional deficiencies and physical illness. Depression is more typically thought of as strictly biochemical-based or e...
Byline: T. Sathyanarayana Rao, M. Asha, B. Ramesh, K. Jagannatha Rao Introduction Few people are aware of the connection between nutrition and depression while they easily understand the connection between nutritional deficiencies and physical illness. Depression is more typically thought of as strictly biochemical-based or emotionally-rooted. On the contrary, nutrition can play a key role in the onset as well as severity and duration of depression. Many of the easily noticeable food patterns that precede depression are the same as those that occur during depression. These may include poor appetite, skipping meals, and a dominant desire for sweet foods.[sup] [1] Nutritional neuroscience is an emerging discipline shedding light on the fact that nutritional factors are intertwined with human cognition, behavior, and emotions. The most common mental disorders that are currently prevalent in numerous countries are depression, bipolar disorder, schizophrenia, and obsessive-compulsive disorder (OCD).[sup] [2] The dietary intake pattern of the general population in many Asian and American countries reflects that they are often deficient in many nutrients, especially essential vitamins, minerals, and omega-3 fatty acids.[sup] [3] A notable feature of the diets of patients suffering from mental disorders is the severity of deficiency in these nutrients.[sup] [3] Studies have indicated that daily supplements of vital nutrients are often effective in reducing patients' symptoms.[sup] [4] Supplements containing amino acids have also been found to reduce symptoms, as they are converted to neurotransmitters which in turn alleviate depression and other mental health problems.[sup] [4] On the basis of accumulating scientific evidence, an effective therapeutic intervention is emerging, namely nutritional supplement/treatment. These may be appropriate for controlling and to some extent, preventing depression, bipolar disorder, schizophrenia, eating disorders and anxiety disorders, attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD), autism, and addiction.[sup] [4] Most prescription drugs, including the common antidepressants lead to side effects.[sup] [4] This usually causes the patients to skip taking their medications. Such noncompliance is a common occurrence encountered by psychiatrists. An important point to remember here is that, such noncompliant patients who have mental disorders are at a higher risk for committing suicide or being institutionalized. In some cases, chronic use or higher doses may lead to drug toxicity, which may become life threatening to the patient.[sup] [4] An alternate and effective way for psychiatrists to overcome this noncompliance is to familiarize themselves about alternative or complementary nutritional therapies. Although further research needs to be carried out to determine the best recommended doses of most nutritional supplements in the cases of certain nutrients, psychiatrists can recommend doses of dietary supplements based on previous and current efficacious studies and then adjust the doses based on the results obtained by closely observing the changes in the patient.[sup] [4] When we take a close look at the diet of depressed people, an interesting observation is that their nutrition is far from adequate. They make poor food choices and selecting foods that might actually contribute to depression. Recent evidence suggests a link between low levels of serotonin and suicide.[sup] [5] It is implicated that lower levels of this neurotransmitter can, in part, lead to an overall insensitivity to future consequences, triggering risky, impulsive and aggressive behaviors which may culminate in suicide, the ultimate act of inwardly directed impulsive aggression. Depression is a disorder associated with major symptoms such as increased sadness and anxiety, loss of appetite, depressed mood, and a loss of interest in pleasurable activities. …
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307 Citations