Medicine and Health Sciences Commons^™

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 …

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 : 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

European Society For The History Of The Human Sciences (Eshhs), Conference 2014, Oulu (Finland), Paper: “Dangerous Passions. The Construction And Cultural And Social Impact Of The ‘Psychiatric’ Framework Of The Passions In France (1790-1830)”, July 22-25 (23th), 2014., Marco Solinas

Marco Solinas

Numerous excellent works have been written on the formation process of ‘psychiatry’ and its concomitant impact on society and culture at the end of the eighteenth century and in the first three decades of the nineteenth century, in particular with regard to France. From Gladys Swain to Dora Weiner, from Jacques Postel to Jan Goldstein, from Jackie Pigeaud to Juan Rigoli, the issue has been analysed in depth and from a variety of different perspectives. However, despite constantly and inevitably resurfacing in these studies, no particular attention has been paid to the passions and emotions drawn up by nascent psychiatry. …

Newcastle And Northumbria Universities, Conference “Fashionable Diseases. Medicine, Literature And Culture, Ca. 1660-1832", Paper: “On The End Of Fashionable Melancholy”, July 3-5 (4th), 2014., Marco Solinas

Marco Solinas

The paper analyze the crucial moment of rupture in the history of the definitions, descriptions and classifications of melancholy within the ambit of medicine that occurred between the end of the Eighteenth- and beginning of the Nineteenth-century, in particular in France. That is the point at which Philippe Pinel, absorbing the contributions of Seventeenth-century British psychiatry, proceeded to abandon both the humoral doctrine and the old Renaissance conception of the dual character – melancholy as a psycho-physiological illness and as a literary and philosophical mood. Pinel now locates melancholy only among forms of mental alienation. I will proceed with the …

Student Safety And Patient Violence: The Basic Facts, Kevin J. Black

Kevin J. Black, MD

A New Brief Scale To Assess Suicidality: Scale For Impact Of Suicidality-Management, Assessment And Planning Of Care (Sis-Map- Brief Scanner), Amresh Srivastava, Megan Johnston, Miky Kaushal, Robbie Campbell, Charles Nelson

Amresh Srivastava

Purpose: In this study we examine merit of a short version (Brief Interview Screener (SIS-MAP-scn )of a previously developed and validated 108 item scale, known as ‘ Scale for Impact of Suicidality-Management, Assessment and Planning of Care ( SIS MAP), for rapid assessment in challenging clinical settings e.g. primary care and emergency room. Background: Generally suicide risk is assessed clinically and structured assessments optimize the direction for decision-making across various settings e.g. inpatient care, emergency rooms and crisis centers. We believe that measures with accurate and valid information should be based upon multifactorial risk-constituent domains, e.g. biological, social, psychological, environmental …

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 …

Dsm V: Hope Or Hype?, Amresh Srivastava

Amresh Srivastava

DSM V: HOPE OR HYPE?

Amresh Shrivastava,

MD,MPM,MRCPsych,FRCPC

Associate professor of Psychiatry

Western University

London, Ontario

Since more than 50 years psychiatric diagnostic is being developed by a number of organisations. As research has advanced in understanding mental illnesses,need for a common language has been felt in order to provide best possible care to our patients.

The process of psychiatric diagnosis has evolved significantly. WHO as well APA both have made significant advances in developing diagnostic systems. DSM 5 recently approved by board of trustees by Americal psychiatric Association is scheduled to be released on 18th of May. This document …

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 …

Baseline Serum Prolactin In Drug-Naive, Firstepisode Schizophrenia And Outcome At Five Years: Is It A Predictive Factor?, Amresh Srivastava, Megan Johnston, Yves Bureau, Nilesh Shah

Amresh Srivastava

Objective: Serum prolactin is influenced by antipsychotic use but its relationships with psychopathology and general functioning are not clear. This study aimed to assess these relationships. Design: Serum prolactin levels were measured in patients with schizophrenia before being treated with antipsychotics and at various follow-up points. Setting: The study was conducted in a nongovernmental psychiatric treatment center in Mumbai, India. Participants: The participants included 30 male and 30 female drug-naïve patients with schizophrenia and 31 control participants. Measurements: The severity of psychopathology at baseline, three weeks, six weeks, and five years following treatment was assessed using a modified Brief Psychiatric …

Sis-Map; Suicide Risk Assessment Scale, Amresh Srivastava

Amresh Srivastava

This is a New Scale for Assessment of suicide risk to evaluate clients referals and disposition. This Copy Right to Amresh Shrivastava and Chrles Nelson

“Attenuated Psychotic Symptoms Syndrome” As A Risk Syndrome Of Psychosis, Diagnosis In Dsm-V: The Debate, Amresh Shrivastava, P. D. Mcgorry, Ming Tsuang, Scott W. Woods, Barbara A. Cornblatt, Cheryl Corcoran, William Carpenter

Amresh Srivastava

Schizophrenia is a common disorder, affecting approximately 1 out of every 100 people, with a typical onset during adolescence and early adulthood. The personal and societal costs of schizophrenia are extremely high. Prevention of schizophrenia, would offer substantial benefits to patients, their family members, and the community at large. The prodromal phase of schizophrenia has been recognized since the 19th century. At-risk individuals for psychosis and schizophrenia are the subjects who can provide information for intervention prior to development of frank psychosis. This approach is currently being investigated. The question remains, however, whether it can be a diagnostic category by …

Predictors Of Long-Term Outcome Of First-Episode Schizophrenia: A Ten-Year Follow-Up Study, Amresh Shrivastava, Nilesh Shah, Megan Johnston, Larry Stitt, Meghana Thakar

Amresh Srivastava

Objective: Schizophrenia is a severe mental disorder for which final outcomes continue to be unfavorable. The main objectives of this research were to examine and determine the baseline predictors of outcome status of first-episode schizophrenia in a long-term follow-up of ten years and of recovery ten years later.

Materials and Methods: The study was carried out in a non-governmental, psychiatric hospital and participants consisted of patients available for assessment ten years following their initial diagnosis. Outcome was assessed on clinical and social parameters. Clinical measures of outcome included psychopathology, hospitalization, and suicidality. Social parameters included quality of life functioning, employability, …

Should “Risk Syndrome For Psychosis” Be Included As A Diagnosis In Dsm-V?, Amresh Shrivastava

Amresh Srivastava

No abstract provided.

Effects Of Duration Of Untreated Psychosis On Long-Term Outcome Of People Hospitalized With First Episode Schizophrenia, Amresh Shrivastava, Nilesh Shah, Megan Johnston, Larry Stitt, Meghana Thakar, Gurusamy Chinnasamy

Amresh Srivastava

Duration of untreated psychosis (DUP) has emerged as a reliable predictor of outcome but continues to remain under scientific scrutiny. The present study examines the effect of differential periods of DUP on long-term outcome of first episode schizophrenia at Mumbai, India. This research was a prospective, 10-year follow-up naturalistic study. Hospitalized patients of first episode schizophrenia were selected and followed up. Results showed that the mean DUP was higher for a group which showed clinical recovery on Clinical Global Impression Scale [14.0 months (SD=8.0) in recovered and 10.8 months (SD=5.7) in non-recovered group (P=0.091)]. DUP was not found to be …

Cognitive Neurosciences: A New Paradigm In Management And Outcome Of Schizophrenia, Amresh K. Shrivastava, Megan E. Johnston

Amresh Srivastava

No abstract provided.

Predictors And Characteristics Of Response And Nonresponse: A Ten Year Follow-Up Of First Episode Schizophrenia In Mumbai, Amresh Shrivastava, Nilesh Shah, Megan Johnston, Larry Stitt, Meghana Thakar, Gurusamy Chinnasamy

Amresh Srivastava

▪ It is not clearly known what predicts good long-term outcome in first episode schizophrenia and what the characteristics are that differentiate patients who do and do not show good response ▪ We attempted to find the characteristics and predictors of good out-come for patients who presented with severe psychopathology and were hospitalized in their first episode psychosis in a tertiary psychiatric hospital in the city of Mumbai ▪ 101 patients of first episode schizophrenia were assessed at hospitalization, and reassessed at ten years ▪ The data was analyzed on 13 outcome parameters for predictors and characteristics of good outcome, …

Do Atypical Antipsychotics Differ In Determining Long-Term Outcome Of First Episode Schizophrenia? A Naturalistic Outcome Study In India, Amresh Srivastava, Nilesh Shah, Megan Johnston, Larry Stitt, Meghana Thakar, Gurusamy Chinnasamy, Anukant Mital

Amresh Srivastava

Antipsychotic medications form the mainstream of treatment in schizophrenia. These drugs have several short term as well long term advantage. It is not known if atypical antipsychotics have the long-term effect in improving outcome and meeting expectations (1,2,3). The present study examined usage and association of antipsychotics drugs with clinical outcome a long-term naturalistic study.

Psychiatrists And Neuroscientists Of Indian Origin In Canada: Glimpses, Amresh Shrivastava, D. Natarajan

Amresh Srivastava

Psychiatrists of Indian origin are popular in Canada, being firmly rooted in the Canadian mental health system, and they have been making considerable contributions internationally. The Indian Psychiatric Society has long been collaborating with and inviting contributions from overseas Indian psychiatrists, particularly those in academics, and this collaboration has fructified well. There are several different challenges these psychiatrists have had to face in their own specialty work, with having to adjust to a new culture, new ways of living, and new ways of work. Our colleagues of Indian origin have demonstrated excellence in almost all fields of mental health and …

Initiatives In Biological Research In Indian Psychiatry, Amresh Shrivastava

Amresh Srivastava

Biological psychiatry is an exploratory science for mental health. These biological changes provide some explicit insight into the complex area of 'brain-mind and behavior'. One major achievement of research in biological field is the finding to explain how biological factors cause changes in behavior. In India, we have a clear history of initiatives in research from a biological perspective, which goes back to 1958. In the last 61 years, this field has seen significant evolution, precision and effective utilization of contemporary technological advances. It is a matter of great pride to see that in spite of difficult times in terms …

Clinical Interview For Psychiatric Assessment, Amresh Srivastava

Amresh Srivastava

No abstract provided.

Early Psychosis: A Novel Gateway For Suicide Prevention, Amresh Srivastava

Amresh Srivastava

No abstract provided.

Cannabis & Psychosis: The Interface Emerging Frontiers For Research, Amresh Shrivastava

Amresh Srivastava

INTRODUCTION: CANNABIS CONTINUES TO AFFECT MENTAL HEALTH. ITS ABUSE IS ON RISE GLOBALLY. IN CANADA A RISE BY 30% IN LAST TEN YEARS HAS BEEN OBSERVED IN HIGH SCHOOL STUDENTS. INTERRELATIONSHIP OF CANNABIS WITH PSYCHOSIS AND SCHIZOPHRENIA IS A COMPLEX ONE. CANNABIS IS HIGHLY COMORBID WITH PSYCHOSIS, & RELATED TO FUNCTIONAL DISABILITY AND OUTCOME. IT POSES SEVERAL CHALLENGES IN UNDERSTANDING CAUSAL RELATIONSHIP FOR COMORBIDITY, UNDERLYING NEUROCHEMICAL BASIS AND SPECIFICS OF SERVICE DEVELOPMENT. PREVALENCE OF CANNABIS VARIES FROM 20 TO 50% EARLY PSYCHOSIS. OBJECTIVE OF THIS PAPER IS TO REVIEW AVAILABLE LITERATURE TO IDENTIFY CHALLENGES FOR NEWER TARGETS OF RESEARCH AND …

Response, Remission & Recovery: Need To Review Outcome Measures For Schizophrenia, Amresh Shrivastava, Nilesh Shah

Amresh Srivastava

Schizophrenia is a complex neurobehavioral disorder known to be associated with poor outcome. It causes significant disability in patients and burden of care amongst relatives. Outcome in developing countries has been reported to be far better than western world, which has come into scientific scanner recently. Wide gap exists between expectations of outcome amongst patients, relatives, caregivers and professionals, which is possibly because of limitations in measurements tools. Significant number of patients remain marginalized without improvement in social & occupational functioning preventing their integration into mainstream of society despite 'clinically reported good outcome' and significant advancement in treatments. The contemporary …