Psychiatry and Psychology Commons^™

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 …

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

Socio Cultural Risk Factors And Suicide Prevention, Amresh Srivastava

Amresh Srivastava

Society at large, particularly in the developing countries has been undergoing rapid socio-economic changes. There are newer risk factors for mental disorders playing a crucial role in pathogenesis e.g. economic transition and social inequalities. Students suicide and farmers’s have been of particular concern.Newer challenges need befitting responses, which are seldom sufficiently available in any society. Most conspicuous barrier to identify and treat mental disorders is human resources, which is not only dismal but also unequally distributed amongst different geographical and social strata of society. Globalization has changed the agenda for mental health. It’s now demonstrated that people immigrate, they share …

First Episode Is The Best Episode: Lessons And Limitations In Duration Of Untreated Psychosis (Dup) And Outcome In Schizophrenia, Amresh Srivastava, Larry Stitt, Meghana Thakar, Gurusamy Chinnasamy, Nilesh Shah

Amresh Srivastava

Background: Early intervention in psychosis is an opportunity. Research ahs shown that if any thing community members can do to prevent psychosis is to report early. This has opened newer vistas for understanding the complexity of brain and behaviour in schizophrenia. At the same time it has raised the bar of expectations regarding its correlation to outcome. It finally narrows down to meaningful public campaign for awareness, which will decide success of research to clinics in schizophrenia management. Duration of untreated psychosis (DUP) has emerged as a reliable predictor of outcome and provides credence to development of early intervention services. …

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 …

Risk, Vulnerability And Resilience: An Epigenetic Trajectory Of Psychiatric Disorders, Amresh Srivastava

Amresh Srivastava

Biopsychosocial model is generally widely accepted for pathogenesis of mental disorder, recent research shows a different concept. . Social, cultural, environmental factors possibly interact in a complex way to give rise to behavioral symptoms in a particular disorder. Such factors are considered 'risk factors'. but their discrete role in causation of illness is less clear. Two main factors appear to play important role which may partially explain this process. 1. risk-vulnerability and stress diathesis model and the 2. Gene-environment interaction. Both may be operating simultaneously. Our understanding of psychosocial risk factors has been changing in recent years. Psychosocial risk can …

Risk, Vulnerability And Resilience: An Epigenetic Trajectory Of Psychiatric Disorders, Amresh Srivastava

Amresh Srivastava

ABSTRACT: Risk, Vulnerability and Resilience: An epigenetic trajectory of psychiatric disorders Amresh Shrivastava. Biopsychosocial model is generally widely accepted for pathogenesis of mental disorder, recent research shows a different concept. . Social, cultural, environmental factors possibly interact in a complex way to give rise to behavioral symptoms in a particular disorder. Such factors are considered 'risk factors'. but their discrete role in causation of illness is less clear. Two main factors appear to play important role which may partially explain this process. 1. risk-vulnerability and stress diathesis model and the 2. Gene-environment interaction. Both may be operating simultaneously. Our understanding …

Need For Newer Experiments In Strengthening Education And Training Human Resource Development For Suicide Prevention, Amresh Srivastava

Amresh Srivastava

Suicide is a global public health problem and one of the leading causes of premature death for all ages. Studies show that only 25% suicide has been within health care system, we have no information about the rest 75%. To bring more people at risk for suicide is an urgent requirement which makes a strong argument education and awareness.The WHO acknowledged that suicide prevention requires intervention from outside the health sector and calls for an innovative, comprehensive multi-sectorial approach, including both health and non-health sectors, e.g. education, labor, police, justice, religion, law, politics, the media. . Early identification of at-risk …

Education And Training For Human Resource Development For Suicide Prevention' In Low And Middle Income Countries, Amresh Srivastava

Amresh Srivastava

Developing countries have more than two-thirds share of suicide in the world with dismal numbers of trained professionals. WHO data shows that more than 90% suicide occurs in the mentally ill individuals. Lack of effective manpower continues to be one of the three main barriers for prevention of suicide world over, particularly in developing countries, followed only by stigma and non-availability of care. Therefore training and education, especially for people, like teachers and health workers, who are in direct contact with vulnerable groups, can help increase identification of individuals with related problems, offer support, and make a referral. Though the …

A Study Of Resilience Amongst People Who Lost Their Relatives In Natural Calamity: Uttarakhand In Northern India., Amresh Srivastava, Chetan Lokhande, Nilesh Mohite, Avinash Desouza, Nilesh Shah

Amresh Srivastava

Background

Natural disasters can be a devastating experience for anyone. Mental disorders are common amongst survivors of natural disasters. Resilience is a significant factor that helps these survivors overcome this traumatic episode. In this study, we attempt to examine whether the level of resilience differs with nature of loss, in this case a natural calamity.

However, it remains undetermined if the level of resilience has any relation with the nature of trauma.

Resilience is one attribute that helps an individual recovers from a disastrous event It is a dynamic process, enabling an individual to successfully adapt to severe adversities. It …

What Prevents Re-Hospitalization? The Patents Of Psychopathology: Patient-Centric Management Of Psychopathology, Amresh Srivastava

Amresh Srivastava

What prevents re-hospitalization? The patents or psychopathology: Patient-centric management of psychopathology

Authors: Amresh Shrivastava, Coralee Belmont, Miky Kaushal, Avinash DeSouza, and Robble Campbell

Background Re-hospitalization is one of the priority areas of research. About 30 – 50% patients are re-hospitalized within one year of discharge. Inability to identify vulnerable candidates for repeated admissions limits our options for strategic treatment. Hospitalization occurs despite best possible community care. It is likely that untreated clinical or psychopathological may be responsible for re-admission which have not been addressed. Early initiation of effective post discharge treatment, prior to discharge may offer good benefit however indicators …

Global Mental Challenges: Response To Local Needs, Amresh Srivastava

Amresh Srivastava

Global mental Challenges: Response to local needs 1Amresh Shrivastava Running Title: Mental health: beyond Geo-political Boundaries 1Department of Psychiatry, Elgin Early Intervention Program for Psychosis, The University of Western Ontario, Ontario, Canada, and Mental Health Resource Foundation, Mumbai, Maharashtra, India, e-mail: dr.amresh@gmail.com.

The health of the people determines athe health of a society and a country. Reference to ‘health’, more often than not, directs one’s thinking towards physical health, without realizing that physical health is inseparable from mental health. Physical disorders co-exist with mental disorders and mental disorders are a significant risk factor for physical illnesses. The WHO agenda on …

Burden Of Stigma On Mentally Ill And Social Exclusion, Amresh Srivastava

Amresh Srivastava

Stigma of mental illness causes great burden on the patients and their families. It leads to discrimination, social exclusion and personal isolation. It occurs across all social, economic, and cultural class and geographical regions. As one of the greatest barrier to treatment and outcome, it is a potential clinical risk which leads to suicide, violence, physical impairment, physical illnesses, unemployment, and economic deprivation. People having mental illness suffer prejudice due to stigma. Anti-stigma measure is focussed on public health. Answer to stigma lies in personalised interventions. We carried out systematic studies to understand patient and family’s perception, and proposed clinical …

Risk Level And Range Of Suicidality Amongst Non-Attempting Early Psychosis Patients., Amresh Srivastava, Megan Johnston, Charles Nelson, Robboe Campbell

Amresh Srivastava

Purpose: Patients who are not admitted with a suicide attempt also kill themselves in post discharge period. The purpose of the study was to examine suicide risk of those patients who are not admitted due to a suicide attempt. Methods: Sixty inpatients with early psychosis were assessed in a naturalistic cross-sectional, cohort study. Standard tools for measurement of psychopathology were used. Range of suicidality and its severity was studied using a locally developed suicide assessment instrument, Scale for Impact of Suicidality-Management, Assessment and Planning of Care (SIS-MAP). Results: Out of 60 patients, 32-showed severe suicidality and 28-showed low suicidality. Characteristics …

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 …

Training And Education For Suicide Prevention (Human Resource Development) In Lmic, Amresh Srivastava

Amresh Srivastava

Video

Description of the project: Background: Suicide is an international public health issue. Barriers to suicide prevention include lack of resources, access to care, lack of human resources (services and mental health care professionals),) stigma, lack of awareness and cultural and geographical factors. Most important amongst these barriers is lack of manpower for setting up services for identification, intervention and prevention of suicide. In most of the places either professional are not available or available professions lack the skills to identify and manage suicidal patients. Suicide is one of the leading causes of premature death worldwide and claims the lives …

Reducing Treatment Delay For Early Intervention: Evaluation Of A Community Based Crisis Helpline, Amresh Srivastava

Amresh Srivastava

Background A limited number of studies have assessed the pathways to care of patients experiencing psychosis for the first time. Helpline/clinic programs may offer patients who are still functional but have potential for crisis an alternative that is free from judgment. Methods In this study we report on patient calling a round-the-clock crisis helpline for suicide prevention supported by psychiatric facilities in Mumbai, India. Chi-square and test of mean differences were used to compare outcomes between first-episode patients and those with a previous history. Results Within five years, the helpline received 15,169 calls. Of those callers, 2341 (15.4%) experienced suicidal …

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 …

Early Intervention Of Psychosis And Re! Ections For Programmes In India, Amresh Srivastava

Amresh Srivastava

Mental illness is perhaps the most common and most debilitating among non-communicable diseases. Schizophrenia, for example, normally occurs before the age of 25, affect the most productive years of life. The World Economic Forum graphically illustrates that mental illnesses will be a major contributor to the erosion of gross domestic product over the next 20 years. The developed world has established programs that have proven to be clinically and economically effective and sustainable.[1] Early intervention has played an important role in demonstrating that outcome can be improved if patients are treated in the early phase of illness. It is believed …

Suicide From A Global Perspective, Amresh Srivastava

Amresh Srivastava

This book is in 5 volumes, Hard cover and e-book, with 110 Chapters and contributions from more than 30 Countries

Amresh Shrivastava (ed), Megan Kimbrell and David Lester Handbook of Suicide From Global Perspective

Preface by Professor N. Sartorius, MD, PhD

Suicide is the cause of death for nearly one million people a year. Death by suicide is often reported as being due to other causes to avoid stigmatization and other negative consequences of suicide for the family: it can therefore be assumed that the number of people who commit suicide is much higher than this number. Attempts of suicide …

Stigma Of Mental Illness-1: Clinical Reflections, Amresh Srivastava

Amresh Srivastava

Stigma of Mental Illness-1: Clinical Reflections Amresh Shrivastava*, Megan Johnston**, Yves Bureau*** ABSTRACT Although the quality and effectiveness of mental health treatments and services have improved greatly over the past 50 years, therapeutic revolutions in psychiatry have not yet been able to reduce stigma. Stigma is a risk factor leading to negative mental health outcomes. It is responsible for treatment seeking delays and reduces the likelihood that a mentally ill patient will receive adequate care. It is evident that delay due to stigma can have devastating consequences. This review will discuss the causes and consequences of stigma related to mental …

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

Beyond Early Intervention, Amresh Srivastava

Amresh Srivastava

No abstract provided.

“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.

Should ‘Risk Syndrome Of Psychosis’ Be Included In Dsm V As A Diagnosis? A Road Towards Preventive Psychiatry”, Amresh Srivastava

Amresh Srivastava

Psychiatric diagnosis has acquired a position of a quasi-legal document for mental health services and agencies working with mental health. Its utility has gone far beyond ‘clinical diagnosis for treatment’.

The concept of risk syndrome for schizophrenia has been thoroughly researched in last ten years or so. Significant advancement has been made in phenomenology, diagnostic criteria, classification, & neurobiology. The research of prodromal or at-risk or Ultra high-risk psychosis has significantly contributed to the body of knowledge of aetio-pathogenesis of schizophrenia.

The science of risk syndrome has apparently matured and its proponents are ready for its inclusion in DSM V …

Outcome, Early Intervention & Dup: The Matrix Of Research In Early Psychosis, Amresh Srivastava, Megan Johnston

Amresh Srivastava

There has been little investigation of the relationship of DUP to other long-term outcomes such as negative symptoms and cognitive functioning neither have the possible confounds of DUP been widely investigated or controlled. It is important that there should be more thorough investigations of DUP, its correlates, and the extent to which it does mediate any advantages of earlier intervention. Shorter duration of untreated psychosis was associated with greater response to antipsychotic treatment, as measured by severity of global psychopathology, positive symptoms, negative symptoms, and functional outcomes. At the time of treatment initiation, duration of initially untreated psychosis was associated …