Medicine and Health Sciences Commons^™

Targets Of Therapeutic Intervention For Prevention Of Repeated Hospitalization: Need For Developing ‘Personalised Care Model’, Amresh Srivastava

Amresh Srivastava

Targets of therapeutic intervention for prevention of repeated hospitalization: need for developing ‘personalised care model’

Amresh Srivastava1, Coralee Belmont 2, Miky Kaushal 3, Avinash DeSouza 4 Robbie Campbell 5 and Larry Stitt 6 1. Associate Professor of Psychiatry, The Western University, Associate Scientist, and Lawson Health research Institute. Consultant psychiatrist Adult Ambulatory and Psychosis Program. Parkwood Institute Wellington Road. London. ON, N6C 0A7 2. Psychiatric Social worker southwest forensic mental health. St. Thomas 3. Research Fellow, Regional mental health St. Thomas 4. Research Fellow, LTMG Medical College and mental Health Resource Foundation, Mumbai, India 5. Emeritus Professor of Psychiatry. The …

Targets Of Therapeutic Intervention For Prevention Of Repeated Hospitalization: Need For Developing ‘Personalised Care Model’, Amresh Srivastava

Amresh Srivastava

Amresh Srivastava1, Coralee Belmont 2, Miky Kaushal 3, Avinash DeSouza 4 Robbie Campbell 5 and Larry Stitt 6 1. Associate Professor of Psychiatry, The Western University, Associate Scientist, and Lawson Health research Institute. Consultant psychiatrist Adult Ambulatory and Psychosis Program. Parkwood Institute Wellington Road. London. ON, N6C 0A7 2. Psychiatric Social worker southwest forensic mental health. St. Thomas 3. Research Fellow, Regional mental health St. Thomas 4. Research Fellow, LTMG Medical College and mental Health Resource Foundation, Mumbai, India 5. Emeritus Professor of Psychiatry. The Schulich School of medicine and dentistry. 6. Consultant, Statistical services, London. ON Canada Background Strategies …

Positive Psychiatry, Amresh Srivastava

Amresh Srivastava

Revolutionary advances in understanding mental disorders and in providing novel treatments have enhanced the expectations of patients and relatives. There is a growing demand on newer research in providing interventions that allow patients to live a normal life. Of late, concept of the illness itself has undergone significant change. It is now proposed that expected outcome from treatment of mental disorder is to achieve a state of ‚ ‘wellness.’ Positive psychiatry is a newer branch of psychological medicine that seeks to promote understanding of wellness and examines its application in intervention and prevention of mental disorders. The concept of positive …

Behavioural Charactertics Of Patients Vulnerable For Repeated Hospitalisation, Amresh Srivastava, Coralee Berlmont, Miky Kaushal, Avinash Desouza, Robbie Campbell, Larry Stitt

Amresh Srivastava

Background

Re-hospitalization which takes place in about 30 to 50% postdischarge patienst, leads to poor outcome, increased rate of mortality and consumes more than 2/3 of budgetary allocations. Inability to identify vulnerable candidates for repeated admissions limits our options for strategic treatment.

Methods

In this prospective study conducted at Regional Mental Health Care ( Presently Parkwood Institute) 101 patienst ( 51 feamles, mean age 43 years), were examined using standard psychometric tools on parameters of clinical, psychopathological, suicide behaviour and resiliency for their risk and preventive characerstics.

Results

We assessed 101 subjects (51 females) with mean age of 42 years. …

Should Suicide Behaviour Be An Outcome Parameter For Mental Disorder, Amresh Srivastava

Amresh Srivastava

Suicide and mental illness are closely related to each other. A high number of people who commit suicide suffer from a mental illness, and a high number of mentally ill patients exhibit suicide behavior. Suicide behavior is a significant aspect of mental illness. It is consistently observed throughout the course of illness, seen in the prodromal stage, during acute phase of remission, in residual phase and whenever illness relapses. A number of times, mental disorder improves but suicide behavior persists. 10-15% patients attempt suicide in the initial phase of an illness. More than half of the patients get hospitalized due …

Abc Of Severe Mental Illnesses, Amresh Srivastava

Amresh Srivastava

Amresh Srivastava MD,MRCPsych,FRCPC Associate Professore of Psychiatry Western University London.ON Severe Mental Illnesses: Training and Education - About 4% patients in the community suffer from severe mental illness and about 16% from ‘any mental disorder’ Maximum financial and human resource allocations for mental health is consumed in managing severe mental disorders, leaving very little for treatment of early phase of illness and for developing preventive program. All of us, psychiatrists, family physicians, other mental health professionals like, nurse, psychologists, socal workers, occupational therapists, counsellors, and members of advocacy groups and mental health organisations, face the challenge for managing patients who …

Identification Of Risk Factors For Suicide Amongst Psychiatric Patients: Can Structured Measurement Tools Be More Specific?, Amresh Shrivastava, Robbie Campbell, Megan Johnston, Coralee Berlmont, Miky Kaushal, Avinash Desousa, Larry Stitt, Charles Nelson

Amresh Srivastava

Background One of the main challenges in suicide prevention is that it cannot be predicted. Significant number of patients attempt suicide while being under psychiatric treatment. Lethality and intent of each risk factor varies and remains inconsistent. Though structured instruments have also been useful with limited success search for newer methods remains an urgent clinical need. We believe risk is multifactorial and a scale based upon fundamental domains of biological, psychological, social, environmental, spiritual and clinical origin can elucidate more specific factors. Scale for impact of suicidality- Management, Assessment & Planning of care-brief screener (SISMAP-bcs) is 23 item scale which …

The Flip-Side To Readmission: Focused After-Care, Amresh Srivastava

Amresh Srivastava

paper 1. Suicidality in hospitalized early psychosis patients at time of discharge

The purpose of this study was to investigate the presence and nature of suicidal risk among early psychosis patients at the time of discharge from hospital. Is it only related to the involvement of a suicidal attempt at admission? Thirty such patients, who were admitted after a suicide attempt were compared with 30 patients similarly diagnosed, but admitted for clinical reasons not involving a suicide attempt. Dependent measures of psychopathology, adjustment and suicidality were used. It was found that the two groups did not differ in suicidality, which …

Resilience: A Psychobiological Construct For Pathway Of Suicidality, Amresh Srivastava, Corelee Berlmont, Miky Kaushal, Avinash Desouza, Robbie Campbell, Larry Stitt

Amresh Srivastava

Absttract: Background and objective Resilience which is a neurobiological and behavioral construct may modulate psychopathological trajectory as a ‘final common pathway’ for suicide behavior. Since it allows people to adapt to adversity and bounce back to normalcy, treatments based upon modifcation of resilience may be a possibility. Objective of this prospective, cross-sectional study was to examine association of resilience and suicidality in individuals with psychiatric disorders attending Regional RMHC, St. Thomas and London. Method We measured level of resilience by using Connor-Davidson scale (CD-RISC, cut-off 60), suicidality by Scale for Impact of Suicidality Management, Assessment and Planning of Care brief …

Resilience : An Independent Psychobiological Mental Health Construct (Guest Editorial), Amresh Srivastava

Amresh Srivastava

Survival against trauma is a unique characteristic of all human beings. While a number of factors contribute in building this capacity, resilience appears to be the most important one. Interest in studying resilience arises from number of areas which are of utmost clinical significance such as such as exploring the possibility of at-risk individuals who developing a mental illness]. Resilience is a human capacity to adapt swiftly and successfully to stressful or traumatic events and revert back to a positive state. It is commonly conceptualized as the ability to thrive despite experiencing adversity

Closing Treatment Gaps In Management Of Suicide Behaviour: New Understanding- New Hope, Amresh Srivastava

Amresh Srivastava

TBC

.General Practitioners Training: ( Second) A Strategic Response To Treatment Gaps For, Amresh Srivastava

Amresh Srivastava

General practitioners training: a strategic response to treatment gaps for suicide behaviour Amresh Shrivastava • Suicide is an international public heath problem, which impacts the most vulnerable of the world’s populations. • About one million people commit suicide and 10-20 times of these attempt it every year across the glob. • More than 90000 adolescents commit suicide every year while rate of attempted suicide every year. • .It is also among the top 20 leading causes of death, which is projected to contribute more than 2% to the global burden of disease by the year 2020 globally for all ages. …

General Practitioners Training: A Strategic Response To Treatment Gaps For Suicide Prevention, Amresh Srivastava

Amresh Srivastava

General practitioners training: a strategic response to treatment gaps for suicide behaviour Amresh Shrivastava • Suicide is an international public heath problem, which impacts the most vulnerable of the world’s populations. • About one million people commit suicide and 10-20 times of these attempt it every year across the glob. • More than 90000 adolescents commit suicide every year while rate of attempted suicide every year. • .It is also among the top 20 leading causes of death, which is projected to contribute more than 2% to the global burden of disease by the year 2020 globally for all ages. …

Early Identification Of Eating Disorder, Amresh Srivastava

Amresh Srivastava

Robbie Campbell MD FRCPC, Jill Mustin-Powell RN, Megan Johnston PhD, Miky Kaushal MD, Larry Stitt MSc, Amresh Srivastava MRCPsych FRCPC Purpose: Comorbidity of eating disorders and its behavioral traits are common amongst psychiatric patients. Eating disorders are often missed or misdiagnosed which leads to poorer clinical outcome and low functioning, though it is a treatable condition. Patients with eating disorders also tend to have severe psychopathology, which increases risk of suicide, duration of hospitalization and polypharmacy. The present study examines the presence of comorbid eating disorders and their behavioral symptoms in hospitalized adult psychiatric patients. Methods: The study was carried …

A Naturalistic Study Of Screening For Eating Disorder Amongst Psychiatric Patients, Amresh Srivastava, Miky Kaushal, Megan Johnston, Robbie Campbell

Amresh Srivastava

No abstract provided.

Eating Disorders Remain Undetected In Psychiatric Hospitalization: Study Of Electronic Chart Review Of 8000 Patients, Amresh Srivastava, Miky Kaushal, Megan Johnston, Robbie Campbell

Amresh Srivastava

No abstract provided.

Eating Disorders Remain Undetected In Psychiatric Hospitalization: Study Of Electronic Chart Review Of 8000 Patients, Amresh Srivastava, Miky Kaushal, Megan Johnston, Robbie Campbell

Amresh Srivastava

No abstract provided.

Screening For Eating Disorder Amongst Psychiatric Patients, Amresh Srivastava, Miky Kaushal, Megan Johnston, Robbie Campbell

Amresh Srivastava

No abstract provided.

Quantification Of Stigma For Clinical Assessment In Psychiatric Practice’ - A Paradigm Shift In Anti-Stigma Intervention: Using Newly Developed Scale (Stigma Quantification Scale ‘Sqs’)., Amresh Srivastava

Amresh Srivastava

Purpose: Objective of the project was to develop a quantification tool for measurement of stigma in clinical practice for the purpose of identifying patients who have suffered severe stigma with the hopes of identifying and treating stigma related issues. Methods: Our tool which includes 49 items, quantifies four domains of stigma: (1) Personal; (2) Family; (3) Social; and (4) Illness. In addition, the items are distributed into three subscales: (a) self-experience; (b) illness related consequences; and (c) coping strategies. Results: In this pilot study conducted in India, we present the scale details and results. We found that as age increased …

Dimensions Of Suicidality: Analyzing The Domains Of The Sis-Map Suicide Risk Assessment Instrument And The Development Of A Brief Screener, Megan Johnston, Charles Nelson, Amresh Shrivastava

Amresh Srivastava

This study aimed at validating the domains of suicidality assessed by the Scale for Impact of Suicidality—Management, Assessment and Planning of Care (SISMAP) and creating a brief screener based on the full scale. A total of 50 individuals with suicidal ideation were given the SIS-MAP interview. Support was found for these domains of suicide risk; in particular, the subscales of ideation and protective factors for suicide risk were highly reliable. For each domain of suicidality, items most predictive of total risk index scores were selected to create a brief screener aimed at expediting the assessment process. The screener was reliable, …

Suicidal Ideation In Callers To A Crisis Hotline In Mumbai,, Amresh Srivastava, Megan Johnston, Larry Stitt, Meghana Thanksr, Sunita Iyer, Nilesh Shah, David Lester

Amresh Srivastava

Suicidal ideation in callers to a crisis hotline in Mumbai, India Amresh K. Shrivastava1,2, Megan Johnston3, Larry Stitt4, Meghana Thakar5, Sunita Iyer6, Nilesh Shah7 and David Lester8* 1Silver Mind Hospital and Mental Health Foundation of India, (PRERANA Charitable Trust) Mumbai. 2Department of Psychiatry, University of Western Ontario, London, Canada. 3Department of Psychology, University of Toronto, 100 St. George St., Toronto, Ontario, Canada, M5S 2M2. 4Biostatistical Support Unit, Department of Epidemiology and Biostatistics, The University of Western Ontario, London, Ontario, Canada. 5Silver mind Hospital, Mumbai, Currently, Child and Adolescent Mental Health Practitioner, Lambeth CAMHS Early Intervention Team, South London and Maudsley …

Resilience, Psychopathology And Rehospitalization, Amresh Srivastava

Amresh Srivastava

Purpose: The goal of the project was to determine why patients are being hospitalized repeatedly within an acute psychiatric facility. Past studies have found repeated hospitalization leads to economic drain, disability, poor outcome, stigma and discrimination. Repeated hospitalizations are one of the main causes of disability and dysfunction amongst the mentally ill as well as consuming more than 90 % of the mental health budget. This drain deprives consumers of a major part of allocated health resources. Identifying the potential risk factors for repeated hospitalization, interrelationships between risk factors, and vulnerability will help us take the appropriate measures to prevent …

Cannabis And Psychosis: Transition To Psychosis, Amresh Srivastava, Kristen , Terpstra, Yves Bureau

Amresh Srivastava

Cannabis has been implicated as a risk factor for the development of schizophrenia, however, but the pathway of cannabis causing psychosis is not well understood. It appears that cannabis does not cause any structural changes per say but deficits in areas of the brain responsible for memory and emotion do show some changes. Recent studies suggest that cannabinoids such as CB1 have a pharmacological profile similar to that of atypical antipsychotic drugs. This mechanisms may involve dopamine, GABA, and glutamate neurotransmission; It is still not known if these changes are transitory or permanent, and whether or not they contribute to …

Measurement Of Clinical Risk Of Stigma And Discrimination Of Mental Illnesses, Amresh Srivastava, Yves Bureau, Nitika Rewari, Megan Johnston, Arman Panday, Nilesh Shah

Amresh Srivastava

Abstract

Background: Stigma and discrimination continue to be a reality in the lives of people suffering from mental illness, particularly schizophrenia, and prove to be some of the greatest barriers to access care, continue to remain under care, and regain a normal lifestyle and health. Research advances have defined stigma, assessed its implications and have even examined intervention strategies for dealing with stigma. The delay in treatment due to stigma causes potential complications like suicide, violence, harm to others and deterioration in capacity to look after one’s physical health. These are preventable clinical complications. In order to deal with the …

Transition To Psychosis In Cannabis Abusers, Amresh Srivastava

Amresh Srivastava

Transition to psychosis in Cannabis abusersSchizophrenia is a debilitating disease of major public health importance, the incidence of which shows prominent worldwide variation (up to fivefold) and is about 40% greater in men than in women. Furthermore, epidemiological studies have shown that the incidence is higher among those who grow up in urban areas and among migrants. Recent evidence indicates that, although the neurochemical origins of schizophrenia do not necessarily lie in dopamine dysregulation, this operates as the final common pathway underlying positive psychotic symptoms and may also play a role in negative and cognitive symptoms. The last few years …

Transition To Psychosis In Cannabis Abusers, Amresh Srivastava

Amresh Srivastava

Transition to psychosis in Cannabis abusersSchizophrenia is a debilitating disease of major public health importance, the incidence of which shows prominent worldwide variation (up to fivefold) and is about 40% greater in men than in women. Furthermore, epidemiological studies have shown that the incidence is higher among those who grow up in urban areas and among migrants. Recent evidence indicates that, although the neurochemical origins of schizophrenia do not necessarily lie in dopamine dysregulation, this operates as the final common pathway underlying positive psychotic symptoms and may also play a role in negative and cognitive symptoms. The last few years …

Study Of Negatives Symptoms In First Episode Schizophrenia*, Vivek Bambole, Nilesh, Shah, Shushma Sonavane, Megan , Johnston, Amresh Srivastava

Amresh Srivastava

Background: Prevalence of negative symptoms in the early phase of schizophrenia remains uncertain. Ne- gative symptoms are the primary cause of long term disability and poor functional outcome. The purpose of this study is to examine the presence of negative symptoms in patients with fist episode psychosis in schizophrenia who were hospitalized. Methods: Nega- tive symptoms were measured in 72 patients present- ing with FEP using the scale for assessment of nega- tive symptoms (SANS) and ascertained diagnosis us- ing DSM-IV. Prevalence of SANS items and sub- scales were examined for both schizophrenia and bi- polar disorder. Results: This study …

Extrapyramidal Symptoms In 10 Years Of Long Term Treatment Of Schizophrenia: Independent Of Psychopathology And Outcome, Amresh Srivastava

Amresh Srivastava

Extrapyramidal Symptoms in 10 Years of Long Term Treatment of Schizophrenia: Independent of Psychopathology and Outcome Amresh Srivastava1, Megan Johnston2, Kristen Terpstra3, Larry Stitt4, Avinash De Sousa5*, Nilesh Shah6 1Department of Psychiatry, Elgin Early Intervention Program for Psychosis, The University of Western Ontario, Ontario, Canada, and Mental Health Resource Foundation, Mumbai, Maharashtra, India, 2.Department of Psychology, University of Toronto, 100 St. George St., Toronto, Ontario, Canada, M5S 3G3 Ontario, London, Ontario, Canada N6A 5C1 5Research Officer, Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai 6 Professor and Head, Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai: One of …

Symptom Overlap Between Schizophrenia And Bipolar Mood Disorder: Diagnostic Issues, Amresh Srivastava

Amresh Srivastava

Although the Kraepelinian classification paradigm is widely used, observations of overlapping boundaries between the symptoms associated with bipolar disor- der and schizophrenia are beginning to challenge this dichotomy. The objective of this research was to explore the symptoms of individuals diagnosed with schizo- phrenia and with bipolar mood disorder in order to de- termine the frequency of symptom overlap. One hun- dred patients of a psychiatry ward were divided into two main groups based on their diagnosis—schizo- phrenia or bipolar mood disorder. Chi-square analy- ses were used to determine whether the symptoms mea- sured in this study differed between individuals …

Clinical Consequences Of Stigma (Suicide, Non-Compliance And Rehospitalisation), Amresh Srivastava

Amresh Srivastava

ABSTRACT Stigma and discrimination continue to be a reality in the lives of people suffering from mental illness, particu- larly schizophrenia, and prove to be some of the greatest barriers to access care, continue to remain under care, and regain a normal lifestyle and health. Research advances have defined stigma, assessed its implications and have even examined intervention strategies for dealing with stigma. The delay in treatment due to stigma causes potential complications like suicide, violence, harm to others and deterioration in capacity to look after one’s physical health. These are preventable clinical complications. In order to deal with the …