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Showing papers in "Indian Journal of Psychological Medicine in 2020"


Journal ArticleDOI
TL;DR: This work states that research is of value only when the findings from a sample can be generalized to a meaningful population and when the sample is contaminated by respondents with biases, findings from online surveys cannot be generalized and may therefore mislead.
Abstract: Online surveys are growing in popularity, perhaps because they are an easy, convenient, and inexpensive means of data collection. Online surveys commonly suffer from two serious methodological limitations: the population to which they are distributed cannot be described, and respondents with biases may select themselves into the sample. Research is of value only when the findings from a sample can be generalized to a meaningful population. When the population addressed by the survey cannot be described, and when the sample is contaminated by respondents with biases, findings from online surveys cannot be generalized and may therefore mislead.

165 citations


Journal ArticleDOI
TL;DR: The prevalence of stress, depressive, and anxiety symptoms among HCPs in India during the pandemic is comparable with other countries.
Abstract: Background:The coronavirus disease 2019 (COVID-19) pandemic has caused great financial and psychological havoc. Healthcare professionals (HCPs) are among the many groups of people who are in the fr...

143 citations


Journal ArticleDOI
TL;DR: In this paper, Durkheim describes a society of saints, a perfect cloister of exemplary individuals, where crimes or deviance, properly so-called, will be unknown; but faults which appear venial to the layman, will there create the same scandal that the ordinary offense does in ordinary consciousnesses.
Abstract: 382 Imagine a society of saints, a perfect cloister of exemplary individuals. Crimes or deviance, properly so-called, will there be unknown; but faults, which appear venial to the layman, will there create the same scandal that the ordinary offense does in ordinary consciousnesses. If then, this society has the power to judge and punish, it will define these acts as criminal (or deviant) and will treat them as such.” —Émile Durkheim, Rules of Sociological Methods, 1895, p. 123 1

98 citations


Journal ArticleDOI
TL;DR: Practical guidance is provided on matters such as identifying the need for the survey; defining the target population; preparing the questions that address knowledge, attitudes, and practice; preparing options for the answers to the items in the questionnaire; deciding how to score the instrument and analyze the results; and validating the instrument.
Abstract: Knowledge, attitude, and practice (KAP) surveys are popular in health care because they provide useful information and appear easy to design and execute. There are subtleties, however, in such surveys that early career researchers need to be aware of. This article does not provide a detailed review of the subject, nor does it address theory; rather, it provides practical guidance on matters such as identifying the need for the survey; defining the target population; preparing the questions that address knowledge, attitudes, and practice; preparing options for the answers to the items in the questionnaire; deciding how to score the instrument and analyze the results; and validating the instrument. Specific examples are presented to help readers understand and apply the guidance in various contexts.

71 citations


Journal ArticleDOI
TL;DR: Enriching depression treatment trials with subjects having concurrent vitamin D deficiency appears to be a potential step forward in identifying subgroups who may maximally benefit from this approach, but the evidence is not strong enough to recommend universal supplementation in depression.
Abstract: Background: Growing evidence points to the role of vitamin D in the pathobiology and treatment of depression. However, the evidence is inconsistent in many aspects. The objectives of this narrative review were to evaluate the state of the evidence, synthesize the knowledge gaps, and formulate recommendations for more enhanced research in this growing area. Methods: Electronic searches of MEDLINE via PubMed, Cochrane Library, and Google Scholar databases were carried out from inception till February 2019 to identify relevant English language peer-reviewed articles. Abstracts generated were systematically screened for eligibility. Included articles were grouped under three broad themes: The association between vitamin D and depression, its biological underpinnings, and trials evaluating the efficacy of vitamin D supplementation in depression. Relevant data were extracted as per a structured proforma. Results: A total of 61 articles were included in the present review. Overall findings were that there is a relationship between vitamin D and depression, though the directionality of this association remains unclear. The association appears to be driven by the homeostatic, trophic, and immunomodulatory effects of vitamin D. Evidence from supplementation trials suggest a more robust therapeutic effect on subjects with major depression and concurrent vitamin D deficiency. Conclusion: Serum vitamin D levels inversely correlate with clinical depression, but the evidence is not strong enough to recommend universal supplementation in depression. Enriching depression treatment trials with subjects having concurrent vitamin D deficiency appears to be a potential step forward in identifying subgroups who may maximally benefit from this approach.

67 citations


Journal ArticleDOI
TL;DR: In Asian patients with average metabolism, the dose needed for clinical response may range between 150 mg/day for female non-smokers to 300 mg/ day for male smokers, which may help personalize dosing in clozapine poor metabolizer (PMs) and ultrarapid metabolizers (UMs).
Abstract: Since 1997, studies have found that Asians need lower clozapine doses than Caucasians. Caucasians with average clozapine metabolism may need from 300 to 600 mg/day to reach the therapeutic range (350 ng/ml). Thus, serum clozapine concentration-to-dose (C/D) ratios typically range between 0.60 (male smokers) and 1.20 (female non-smokers). A 2019 systematic review of clozapine levels demonstrated weighted mean C/D ratios of 1.57 in 876 East Asians and 1.07 in 1147 Caucasians (P < .001). In Asian countries, average clozapine doses are lower than 300 mg/day. After sex and smoking stratification in 5 Asian samples with clozapine concentrations, the clozapine dose required to reach 350 ng/ml in female non-smokers ranged from 145 to 189 mg/day and in male smokers, from 259 to 294 mg/day. Thus, in Asian patients with average metabolism (with no inducers other than smoking, with no inhibitors, and in the absence of extreme obesity), the dose needed for clinical response may range between 150 mg/day for female non-smokers to 300 mg/day for male smokers. Clozapine levels may help personalize dosing in clozapine poor metabolizers (PMs) and ultrarapid metabolizers (UMs). Asian PMs may need very low doses (50-150 mg/day) to obtain therapeutic concentrations. About 10% (range 2-13%) of Asians are genetic PM cases. Other PMs are patients taking CYP1A2 inhibitors such as fluvoxamine, oral contraceptives, and valproate. Temporary clozapine PM status may occur during severe systemic infections/inflammations with fever and C-reactive protein (CRP) elevations. Asian UMs include patients taking potent inducers such as phenytoin, and rarely, valproate.

50 citations


Journal ArticleDOI
TL;DR: In this paper, the authors discuss sample size and how it relates to matters such as ethics, statistical power, the primary and secondary hypotheses in a study, and findings from larger vs. smaller samples.
Abstract: The sample size for a study needs to be estimated at the time the study is proposed; too large a sample is unnecessary and unethical, and too small a sample is unscientific and also unethical. The necessary sample size can be calculated, using statistical software, based on certain assumptions. If no assumptions can be made, then an arbitrary sample size is set for a pilot study. This article discusses sample size and how it relates to matters such as ethics, statistical power, the primary and secondary hypotheses in a study, and findings from larger vs. smaller samples.

49 citations


Journal ArticleDOI
TL;DR: The need for future research to develop and validate comprehensive psychometric tools to assess COVID-19-associated mental health problems is highlighted, in view of the vulnerable nature of healthcare professionals for developing mental health concerns in the course of providing services for COVID -19-affected individuals.
Abstract: Background:The coronavirus disease (COVID-19) pandemic, associated with the economic consequences of non-pharmaceutical interventions such as lockdown, has led to mental health consequences among p...

35 citations


Journal ArticleDOI
TL;DR: Burnout is highly prevalent among Indian HCPs, with close to one-fourth of them suffering from burnout, and a number of personal and professional factors are associated with burnout.
Abstract: Background: With increasing workload and dismal working conditions, healthcare professionals (HCPs) in India often suffer from burnout. Understanding the extent of these problems and the contributing factors is necessary to build a healthy workforce capable of serving the society. The purpose of this study was to systematically review and analyze: 1) the prevalence of burnout among HCPs in India and 2) the factors associated with burnout in this population. Methods: A systematic search of MEDLINE and EMBASE, from the inception of these databases to October 2019, was conducted using keywords. The search results were screened to identify studies evaluating burnout among HCPs in India using a standard burnout tool. Using a random effect model, the pooled prevalence of burnout was estimated using Maslach Burnout Inventory (MBI) in three domains: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Risk factors for burnout were assessed qualitatively. Results: A total of 15 studies assessing burnout in 3845 Indian HCPs were identified. The pooled prevalence of burnout was 24% in the EE domain, 27% in the DP domain, and 23% in the PA domain. Younger age, female gender, unmarried status, and difficult working conditions were associated with increased risk of burnout. Conclusion: Burnout is highly prevalent among Indian HCPs, with close to one-fourth of them suffering from burnout. A number of personal and professional factors are associated with burnout, and these should be considered while developing solutions to tackle burnout.

30 citations


Journal ArticleDOI
TL;DR: A high burden of perceived stress exists in residents of a low-income urban population in India and low socioeconomic status and a white-collar occupation were found to be associated with increased perceived stress.
Abstract: Background: Increasing stress has been recognized as a major public health problem in the developing world accelerated by an ongoing demographic, economic, and sociocultural transition. Our study objectives were to validate a Hindi version of the 10-item Perceived Stress Scale (PSS-10) and to also assess the extent of perceived stress and its correlates among an adult population in an urban area of Delhi. Methodology: A community-based cross-sectional study was conducted in an urban resettlement colony of Delhi among 480 adult subjects aged 25--65 years, during the period from January to December 2015. The PSS-10 was translated into Hindi and validated in the study population. Data was analyzed using IBM SPSS Version 25. Results: A total of 243 (50.6%) men and 237 (49.4%) women were enrolled. The scale had an acceptable level of internal consistency (Cronbach's alpha = 0.731). A principal component analysis was run on the PSS-10 data, based on which a three-component structure was accepted, which explained 61% of the total variance. The mean PSS score was 19.25 (SD = 4.50) years. Perceived stress was highest in the 35--50 age group. On multivariate analysis, low socioeconomic status and a white-collar occupation were found to be associated with increased perceived stress (P

30 citations


Journal ArticleDOI
TL;DR: Empirical epidemics have a profound impact on psychological well-being of HCWs, and there is a pressing need to address the issue of the psychological health of this vulnerable group.
Abstract: Background:Health care workers (HCWs) constitute a vulnerable group in terms of physical, mental, and emotional health setbacks during an epidemic. An in-depth understanding of the effects of epide...


Journal ArticleDOI
TL;DR: Given that the standard error is not presented for other parameters, such as difference between means or proportions, and difference between proportions, it is suggested that presentation of SEM values can be done away with, altogether.
Abstract: Many authors are unsure of whether to present the mean along with the standard deviation (SD) or along with the standard error of the mean (SEM). The SD is a descriptive statistic that estimates the scatter of values around the sample mean; hence, the SD describes the sample. In contrast, the SEM is an estimate of how close the sample mean is to the population mean; it is an intermediate term in the calculation of the 95% confidence interval around the mean, and (where applicable) statistical significance; the SEM does not describe the sample. Therefore, the mean should always be accompanied by the SD when describing the sample. There are many reasons why the SEM continues to be reported, and it is argued that none of these is justifiable. In fact, presentation of SEMs may mislead readers into believing that the sample data are more precise than they actually are. Given that the standard error is not presented for other parameters, such as difference between means or proportions, and difference between proportions, it is suggested that presentation of SEM values can be done away with, altogether.

Journal ArticleDOI
TL;DR: The study revealed a high prevalence of anxiety and depressive symptoms among armed forces doctors in India during the COVID-19 pandemic and the main contributing factors are female gender, young age group, non-clinical specialties, and having a doctoral degree.
Abstract: Background:A pandemic poses a significant challenge to the healthcare staff and infrastructure. We studied the prevalence of anxiety and depressive symptoms among armed forces doctors in India duri...

Journal ArticleDOI
TL;DR: This review discusses repurposing ketamine for potential therapeutic use and about the safety concerns related to ketamine and esketamine.
Abstract: Ketamine is a noncompetitive antagonist of the N-methyl-D-aspartate (NMDA) receptor which also interacts with various other receptors that account for its myriad actions. Originally approved as a general anesthetic, it is being explored to be repurposed for numerous other indications such as depressive disorders, suicidal ideation, substance-use disorders, anxiety disorders, chronic pain, refractory status epilepticus, and bronchial asthma exacerbations. Numerous trials are ongoing for the same. The nasal spray of esketamine, a more potent S (+) enantiomer of ketamine, has been approved by the United States Food and Drug Administration (USFDA) for treatment-resistant depression along with the oral antidepressants. However, there are concerns about its safety on long term use, given its psychedelic effects and potential abuse. In this review, we discuss repurposing ketamine for potential therapeutic use and about the safety concerns related to ketamine and esketamine.

Journal ArticleDOI
TL;DR: Following the declaration of CO VID-19 as a pandemic, people around the world easily adopted stigmatizing beliefs and behaviors towards those diagnosed with COVID-19 and their close contacts.
Abstract: panic worldwide, due to its novelty, high infectivity, and absence of effective evidence-based treatment.2,3 Faced with this blurry and uncertain situation, fear and its associated behaviors are not uncommon human reactions. The wide media coverage of the pandemic has contributed to the spread of the fear of contagion and subsequent stigmatizing behaviors.4 Following the declaration of COVID-19 as a pandemic, people around the world easily adopted stigmatizing beliefs and behaviors towards those diagnosed with COVID-19 and their close contacts and also places, people (e.g., healthcare workers [HCW]), and ethnic groups (e.g., ChiGlobal Perspective and Ways to Combat Stigma Associated with COVID-19

Journal ArticleDOI
TL;DR: Findings extend previous knowledge about the interrelationships between PIU, sleep disturbances, and mental health problems by unveiling the key role of depressive symptoms.
Abstract: Background There is a close association between problematic Internet use (PIU), sleep quality, and mental health problems. To evaluate which mental health problem is more associated with coexistence of both PIU and poor sleep quality, we hypothesized a model in which PIU influences sleep quality directly and also through the mediation of three different mental health problems. Methods A total of 402 medical students completed the Persian versions of the Internet Addiction Test, 21-item Depression Anxiety Stress Scale, and Pittsburgh Sleep Quality Index. A maximum likelihood structural equation model was used to assess the hypothesis. For assessment of the indirect effects, bootstrapping was conducted. Results PIU predicted poor sleep quality through indirect pathways by the mediation of mental health problems (P 0.05). Conclusion Findings extend our previous knowledge about the interrelationships between PIU, sleep disturbances, and mental health problems by unveiling the key role of depressive symptoms.

Journal ArticleDOI
TL;DR: The different avenues in digital innovation that is revolutionizing the practice in psychiatry like mental health applications, artificial intelligence, e-portals, and technology leveraging for building capacity are explored.
Abstract: Technology is bringing about a revolution in every field and mental health care is no exception. The ongoing COVID-19 pandemic has provided us with both a need and an opportunity to use technology as means to improve access to mental health care. Hence, it is imperative to expand and harness the tremendous potential of telepsychiatry by expanding the scope of its applications and the future possibilities. In this article, we explore the different avenues in digital innovation that is revolutionizing the practice in psychiatry like mental health applications, artificial intelligence, e-portals, and technology leveraging for building capacity. Also, we have also visualized what the future has in store for our practice of psychiatry, considering how rapid technological advances can occur and how these advances will impact us. There will be challenges on the road ahead, especially for a country like India for instance; the digital divide, lack of knowledge to utilize the available technology and the need for a quality control and regulation. However, it is safe to presume that telepsychiatry will evolve and progress beyond these roadblocks and will fulfill its role in transforming health care. Telepsychiatry will improve the health care capacity to interact with patients and family. The blurring of national and international borders will also open international opportunities to psychiatrist in India, heralding a new wave of virtual health tourism.

Journal ArticleDOI
TL;DR: During the lockdown due to COVID-19, every 1 in 5 TN population had some form of stress, as measured by CPDI, and a model identified certain factors driving the stress, which would help policy framers to initiate an appropriate response.
Abstract: Background:COVID-19-driven pandemic has caused panic, fear, and stress among all strata of society. The study aimed to assess stress and the factors that influence it in a representative population...

Journal ArticleDOI
TL;DR: Police were among the first responders to the COVID-19 disaster and are popularly listed among the "corona warriors", along with health care personnel.
Abstract: I ndia reported the first case of coronavirus disease (COVID-19) on January 30, 2020 Police were among the first responders to the COVID-19 disaster and are popularly listed among the "corona warriors", along with health care personnel [Extracted from the article] Copyright of Indian Journal of Psychological Medicine is the property of Sage Publications Inc and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

Journal ArticleDOI
TL;DR: The scope of the Telemedicine practice guidelines and Telepsychiatry operational guidelines released in May, 2020 are discussed, which appear to remove barriers and promote equitable access to health care in India.
Abstract: Recent advancements in technology, access to smartphone, and gains achieved in increased internet speed and data transfer have expanded the scope of health care service delivery through the digital platforms. In India, telemedicine services remain poorly adopted and integrated due to various barriers. The important reasons are lack of legal and administrative clarity in using technology for service delivery and inertia from health service providers to adopt newer developments. However, during coronavirus disease (COVID-19) pandemic, these equations are changing. The Telemedicine practice guidelines released in March, 2020, and Telepsychiatry operational guidelines released in May, 2020, appear to remove these barriers and promote equitable access to health care. In this article, the authors discuss the scope of these guidelines.

Journal ArticleDOI
TL;DR: Univariate and multivariate analyses revealed that female gender and perceived stress were associated with burnout, and choosing medicine by one's own choice and maintaining hobbies and interests wereassociated with less chance for burnout.
Abstract: Background: Burnout among medical students is important for its prevalence, consequences, and modifiable risk factors. Although there are studies on the topic across the globe, Indian studies are few in number. A prevalence estimate of burnout and its determinants among Indian medical graduates will keep us informed about the emotional and motivational factors hindering their professional growth. Methods: From a total of 500 students spanning 5 professional years, data could be collected from 375 students. The study used a questionnaire primarily consisting of “personal burnout” domain of the Copenhagen Burnout Inventory (CBI), which is a validated instrument to assess the burnout at a cutoff score of 50. The questionnaire also included a set of potential personal correlates of burnout. In addition to summary statistics, both univariate and multivariate analyses were used for discerning the relationship of these correlates with burnout. Results: The prevalence of burnout among medical students in the college under study was 48.5% (95% confidence interval 43.4–53.7). The proportions of moderate, higher, and severe burnout were 44.8%, 3.2%, and 0.5% respectively. Univariate and multivariate analyses revealed that female gender and perceived stress were associated with burnout. Choosing medicine by one's own choice and maintaining hobbies and interests were associated with less chance for burnout. Conclusion: Burnout is a prevalent phenomenon among medical students. There are modifiable risk factors for burnout and addressing them will help in training a medical student with high motivation and professionalism.

Journal ArticleDOI
TL;DR: The high prevalence of psychiatric disorders and the strikingly low help-seeking in perinatal women with a current psychiatric diagnosis can help in planning treatment and prevention programs for timely detection and intervention forPerinatal psychiatric disorders.
Abstract: Background: Poor mental health of the mother affects her physical health and the neonate's health and development. Studies from Southern India place different estimates of perinatal mental ill-health. Cultural variables affect health-seeking behaviour and are thus important to study in perinatal women with psychiatric morbidity. Methods: A total of 281 perinatal women were screened on Edinburgh Postnatal Depression Scale (EPDS), Perinatal Anxiety Screening Scale (PASS) and Mini International Neuropsychiatric Interview version 6.0 (MINI), assisted with a clinical interview to identify psychiatric illnesses. The cultural formulation interview (CFI) of DSM-5 was applied on perinatal women having psychiatric illnesses and their caregivers. Results: A psychiatric diagnosis was present in 10.3% of perinatal women. Depression and anxiety disorders were seen in 7.12% and 1.41%, respectively. Marital discord (P

Journal ArticleDOI
TL;DR: More than half of the FHCWs had a severe psychological impact owing to COVID-19, and the psychological impact was more in males and those who were married, and it was related to the place of posting of theFHCWs.
Abstract: Background:Frontline healthcare workers (FHCWs) are at an increased risk of contracting COVID-19. We aimed to assess the stress and psychological impact of the COVID-19 pandemic among FHCWs.Methods...

Journal ArticleDOI
TL;DR: A preanesthetic workup of a patient with adequate clarification about their doubts and fears related to anesthesia and surgery is recommended to bring down the level of anxiety.
Abstract: Background: There is a paucity of data related to anxiety levels in patients undergoing day care surgery in India.Methods: Preoperative anxiety was assessed using Amsterdam Preoperative Anxiety and Information Scale (APAIS) 1 day before surgery and on the day of surgery, and the patients were categorized as cases (APAIS score ≥13) and controls (APAIS score

Journal ArticleDOI
TL;DR: Challenges specific to older adults in the form of low digital literacy, sensory issues, and cognitive impairment can be overcome by adopting telepsychiatry services in coming years.
Abstract: Psychiatric illnesses are an important contributor of morbidity and mortality in older adults. There is increase in older adults with psychiatric disorders paralleling their growth in absolute numbers. This leads to challenges in mental health care and service delivery. Several barriers that exists in our community hinder older adults from receiving mental health care. Additionally, lack of adequate human resources in geriatric mental health care compounds the problem. Telemedicine, though not new in other fields of medicine, is relatively new in the practice of psychiatry in India. This is probably due to lack of clear guidelines and regulations regarding the same in India. There is a recent increase in teleconsultations in India similar to other developed countries due to ongoing COVID-19 pandemic. The recent telepsychiatry operational guidelines have made telepsychiatry a legitimate and official practice in India. Challenges specific to older adults in the form of low digital literacy, sensory issues, and cognitive impairment can be overcome by adopting telepsychiatry services in coming years. Concerns related to security and safety of telepsychiatry require further evaluation.

Journal ArticleDOI
TL;DR: Sexual dysfunction was more common in females with clinical depression than in those without depression, and underlines the importance of screening females with depression for FSD, for its early diagnosis and management.
Abstract: Background: There is a need to explore the sexual functioning of women with depression as one part of sexuality is that it helps in developing an intimate emotional and physical relationship with another person, and this relationship may serve as a buffer against life stresses. Our aim was to study the prevalence and types of sexual dysfunction in depressed women patients and to compare them with non-depressed women. Materials and Methods: A total of 270 participants who attended a teaching hospital were selected for the study – 135 cases and 135 controls. Sociodemographic and clinical details were collected. Mini International Neuropsychiatry Interview (M.I.N.I), Hamilton Depression Rating Scale (HAM-D), Arizona Sexual Experiences (ASEX) scale, and Female Sexual Functioning Index (FSFI) scale were used. Sexual dysfunction was assessed in both groups. Results: Among the cases, 47.40% had mild depression, 44.44% had moderate depression, and 8.15% were severely depressed. On the ASEX, 46.66% of the cases had sexual dysfunction, while it was only 8.89% among the controls. The difference in sexual dysfunction among cases and controls was statistically significant. Using the FSFI, 40% of the cases had female sexual dysfunction (FSD), and it was only 11.1% in controls. Conclusion: Sexual dysfunction was more common in females with clinical depression than in those without depression. Numerous factors can operate in the causation of FSD. This study underlines the importance of screening females with depression for FSD, for its early diagnosis and management.

Journal ArticleDOI
TL;DR: How to set up telepsychiatry services, the procedure of telePsychiatry consultation, how to record and maintain the electronic health records, the potential challenges, ethical and legal aspects concerning telepsychietry while ensuring the good practice guidelines, medical ethics, patient rights, and the minimum requirements are discussed.
Abstract: The exponential growth of technology in the past few decades has benefitted the healthcare sector. Telemedicine is a newer advancement which is making healthcare affordable and more accessible to the needy in recent times. This article discusses how to set up telepsychiatry services, the procedure of telepsychiatry consultation, how to record and maintain the electronic health records, the potential challenges, ethical and legal aspects concerning telepsychiatry while ensuring the good practice guidelines, medical ethics, patient rights, and the minimum requirements as established by the Information Technology Act and the telemedicine practice guidelines (TPG) 2020 issued by the Indian Medical Council.

Journal ArticleDOI
TL;DR: In addition to direct delivery of services, telerehabilitation can facilitate task-shifting, with mental health professionals mentoring and supervising existing human resources, such as ASHA workers, VRWs, DMHP programme staff, and others.
Abstract: The COVID-19 pandemic has interrupted the usual mechanisms of healthcare delivery and exacerbated symptoms of mental illnesses. Telemedicine has morphed from niche service to essential platform, with newly released guidelines that cover various aspects of tele-mental health delivery. Rehabilitation services, which incorporate a range of psychosocial interventions and liaison services, have been significantly impacted too. They are currently more institute-based than community-based in India. However, recent legislation has mandated that community-based rehabilitation options be available. While a large treatment gap for mental health issues has always existed, telemedicine provides an opportunity to scale services up to minimize this gap. Community-based rehabilitation can be delivered over various platforms, from text to phone to videoconferencing, and various devices. Telemedicine is cost-effective, and enables delivery of services where existing services are inadequate. The recent guidelines allow other healthcare workers to be involved in mental health service delivery. Hence, in addition to direct delivery of services, telerehabilitation can facilitate task-shifting, with mental health professionals mentoring and supervising existing human resources, such as ASHA workers, VRWs, DMHP programme staff, and others. Tele-rehabilitation also poses challenges - not all needs can be met; access and privacy can be a problem in resource-scarce settings; liaison with existing services is required; and organisations need to plan appropriately and re-allocate resources. Digital access to welfare benefits and interventions must be expanded without disadvantaging those without internet access. Yet, many rehabilitation interventions can be adapted to telemedicine platforms smoothly, and task-shifting can broaden access to care for persons with disability.

Journal ArticleDOI
TL;DR: A woman withbetes mellitus, initially admitted in the authors' COVID isolation ward and developed shortness of breath within hours of admission, with a drop in her oxygen saturation,12 for which she had to be shifted to the COVID ICU.
Abstract: betes mellitus, was initially admitted in our COVID isolation ward and developed shortness of breath within hours of admission, with a drop in her oxygen saturation,12 for which she had to be shifted to the COVID ICU. In the ICU, she was stabilized with nasal prongs and did not require ventilator support. However, she was found to be extremely anxious, was sweating despite maintaining normal oxygen saturation, and would appear worried. She was not able to sleep properly and would frequently ask “Will I be able to survive? Will I be able to meet my family again?” She would ask the HCWs to inform her if she was going to die soon, so that she can have a last-minute conversation with her husband, and would often become tearful. She would be comforted and reassured by the HCWs, which would make her feel relaxed for a few minutes. However, this would immediately be followed by re-emergence