Mohan Isaac

Publications (15)25.31 Total impact

• Article: Addressing alcohol addiction: lessons from a hospital based audit.

  Prabhat Chand, C K Naveen, Pratima Murthy, Mohan Isaac
  The Indian journal of medical research 02/2013; 137(2):394-6. · 1.84 Impact Factor
• Article: Current status of behavioral medicine research and practice in developing countries.

  Mohan Isaac, Prabhat Chand, Pratima Murthy
  Current opinion in psychiatry 03/2011; 24(2):134-8. · 3.57 Impact Factor
• Article: Service utilization in a tertiary psychiatric care setting in South India.

  Prabhat Chand, Pratima Murthy, Vikram Arunachalam, C Naveen Kumar, Mohan Isaac
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  ABSTRACT: To carry out an audit reviewing the utilization of psychiatric services and types of disorders presenting to a tertiary care psychiatry hospital in a developing Asian country. Consecutive adult patients who came for detailed consultation in 1 year were included in this study. A senior consultant psychiatrist reconfirmed the diagnosis in each patient who underwent detailed psychiatric evaluation. Psychiatric evaluation consists of clinical history from the patients and the relatives and a mental state examination. Data was obtained from the detailed work up evaluation psychiatry records of these patients. Mood disorder was the most common diagnosis followed by substance use disorders and psychotic disorders (ICD 10). There is a substantial delay of more than 2-5 years for seeking treatment in most disorders including schizophrenia. More than 80% of the population directly seeks treatment at this tertiary hospital. Sixty-four percent of the patients came for at least one follow up. The result suggests the urgent need for strengthening community care in India and similar low and middle-income countries for early and optimal treatment.
  Asian journal of psychiatry. 12/2010; 3(4):222-6.
• Article: Behavioural interventions to reduce the risk of physical illness in persons living with mental illness.

  Vivien Kemp, Ann Bates, Mohan Isaac
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  ABSTRACT: It is beyond dispute that people living with mental illness suffer a disproportionate disease burden when compared with people in the general population. This review considers the efficacy and effectiveness of lifestyle behavioural interventions at service delivery level as a strategy to reduce the risk factors that contribute to somatic disease comorbidity. As many factors contribute to the very poor physical health of people living with mental illness and as there are no 'quick fix' remedies, strategies to improve physical health need to be sustainable on a system-wide basis. Most studies of behavioural interventions at best report modest success during the period of the intervention. However, even limited success can significantly reduce the likelihood of physical comorbidities developing. Unfortunately, the evidence suggests that any gains during the intervention are mostly lost over time. The implication is that interventions need to be sustainable over the long-term. When planning behavioural interventions, consideration ought to be given to extending them over a period of years not weeks or months. Approaches that include additional on-going support beyond the intervention period itself promote a greater likelihood of maintaining the improved physical health of the target population.
  Current opinion in psychiatry 04/2009; 22(2):194-9. · 3.57 Impact Factor
• Article: Role of behavioural and social sciences in medical education.

  Mohan Isaac, Winfried Rief
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  ABSTRACT: It is widely accepted that behavioural and social sciences (BSS) should become an integral component of medical training. This review looks at the extent to which BSS are included in medical curricula and how well they are taught in medical schools across the world. Published literature on the role of BSS in medical training is scanty and largely from developed countries. Although the need for including BSS in medical education was recognized more than 30 years ago, only little progress has been made in improving the quality and quantity of behavioural sciences' teaching in medical schools, even in developed countries. Numerous barriers that impede better integration have been identified. There are no uniform guidelines, well established curricula, training modules or materials. There is also a severe shortage of adequately qualified and experienced teachers. Although the role and significance of BSS in medical education and practice is no longer disputed, the teaching of BSS is still highly problematic all over the world. Concerted efforts by medical educators at various levels are needed to improve the quality and quantity of BSS in medical training.
  Current opinion in psychiatry 04/2009; 22(2):184-7. · 3.57 Impact Factor
• Article: Research, empiricism and clinical practice in low-income countries.

  Mohan Isaac, Prabhat Chand, Pratima Murthy
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  ABSTRACT: Mental health problems are relevant for every country. They are particularly important for low-income countries which face a high burden of illness due to infectious disease, greater socio-economic disparities, and have limited resources for mental health care. There is a great mismatch in the areas of mental health research, practice, policy and services in comparison to developed countries. There have been a few studies that have investigated major mental health problems prevailing in these countries but missed out significant health problems. Studies have tended to be more donor driven and conducted in tertiary centres. The low priority accorded to mental health by the policy makers, scarcity of human resources, lack of culture-specific study instruments, lack of support from scientific journals have been some of the impediments to mental health research in these countries. In addition, lack of community participation and absence of sound mental health policies have deprived the vast majority of the benefit of modern psychiatric treatments. Recently, with increase in collaboration in research, availability of treatment including low-priced psychotropics, and a growing emphasis on the need for mental health policy in some low-income countries, the bleak scenario is expected to change.
  International Review of Psychiatry 11/2007; 19(5):559-71. · 1.80 Impact Factor
• Article: Cannabis-related psychosis: Presentation and effect of abstinence.

  Vani Kulhalli, Mohan Isaac, Pratima Murthy
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  ABSTRACT: The correlation between cannabis and negative mental health outcomes has been unequivocally established. Nevertheless, there is still a great need to research different dimensions of cannabis-related disorders, among which the study of cannabis-related psychosis is very important. There is a dearth of research regarding phenomenology and effect of abstinence, particularly from India. This study attempts to research the clinical presentation of cannabis-related psychosis and effect of abstinence. The aim of the present study was to document the clinical presentation of cannabis-related psychosis at presentation and after 7 days' abstinence from cannabis. Subjects with psychosis following cannabis use without any other prior or concurrent psychiatric disorder presenting to the outpatient department of a large tertiary care hospital were consecutively recruited for study. They were observed in a drug-free, protected environment for 7 days, during which clinical features were recorded using the Brief Psychiatric Rating Scale (BPRS). Twenty male subjects were recruited and phenomenology was evaluated on the BPRS. Items with highest frequencies were unusual thought content (100%), excitement (75%), grandiosity (75%), hallucinatory behavior (70%) and uncooperativeness (65%). The least common symptoms were anxiety (5%), guilt feeling (5%), depressive mood (10%), motor retardation (10%) and blunted affect (30%). Nine subjects (45%) presented with cognitive dysfunction. Affective psychosis was the predominant diagnosis. At the end of 1 week of abstinence from cannabis, there was a significant decrease in scores. Significant improvement was observed in cognitive dysfunction, conceptual disorganization, grandiosity, tension, hostility, hallucinatory behavior and excitement. Cannabis-related psychosis presented with a predominantly affective psychosis and prominent thought disorder, excitement and violence. All subjects showed improvement in symptoms with abstinence from cannabis. A small heterogeneous sample and short duration of observation were the important limitations of this study.
  Indian Journal of Psychiatry 10/2007; 49(4):256-61.
• Article: Schizophrenia outcome measures in the wider international community.

  Mohan Isaac, Prabhat Chand, Pratima Murthy
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  ABSTRACT: Outcome of schizophrenia has been described as favourable in low- and middle-income countries. Recently, researchers have questioned these findings. To examine the outcome studies carried out in different countries specifically looking at those from low- and middle-income countries. Long-term course and outcome studies in schizophrenia were reviewed. A wide variety of outcome measures are used. The most frequent are clinical symptoms, hospitalisation and mortality (direct indicators), and social/occupational functioning, marriage, social support and burden of care (indirect indicators). Areas such as cognitive function, duration of untreated psychosis, quality of life and effect of medication have not been widely studied in low- and middle-income countries. The outcome of schizophrenia appears to be better in low- and middle-income countries. A host of sociocultural factors have been cited as contributing to this but future research should aim to understand this better outcome. There is a need for more culture-specific instruments to measure outcomes.
  The British journal of psychiatry. Supplement 09/2007; 50:s71-7.
• Article: Are somatoform disorders 'mental disorders'? A contribution to the current debate.

  Winfried Rief, Mohan Isaac
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  ABSTRACT: During the last 2 years, a debate has started over whether the somatoform symptoms/medically unexplained symptoms are wrongly placed under the category of mental disorders (section F in International classification of diseases-10 and in Diagnostic and statistical manual for mental disorders-IV). Most experts on medically unexplained symptoms agree that there is a substantial need for revision of the diagnoses of somatoform disorders. While some authors suggest moving the somatoform disorders from axis I to axis III, others suggest improving the classification of these syndromes on axis I, such as by using empirically derived criteria and by introducing psychological descriptors which justify the categorization as a mental disorder. In contrast to the situation when the last version of Diagnostic and statistical manual for mental disorders was published, new empirical data has shown some psychological and behavioural characteristics of patients with somatoform symptoms. These and other empirically founded approaches can be landmarks for the revision of this section in Diagnostic and statistical manual for mental disorders-V and International classification of diseases-11. The classification of somatoform disorders as 'mental disorders' could be justified if empirically founded psychological and behavioural characteristics are included into the classification process. Attention focusing, symptom catastrophizing, and symptom expectation are outlined as possible examples of involved psychological processes.
  Current Opinion in Psychiatry 04/2007; 20(2):143-6. · 3.05 Impact Factor
• Article: Proposal to the Indian Psychiatric Society for adopting a specialty section on addiction medicine (alcohol and other substance abuse)

  Vivek Benegal, Alok Bajpai, Debasish Basu, Neelam Bohra, Sudipto Chatterji, R Galgali, D Goel, Mohan Isaac, Venugopal Jhanwar, Rajkumar Lenin, [......], Rajesh Nagpal, S Nambi, C Subramaniam, Shubhangi Parkar, Prasad Rao, M Reddy, Alok Sarin, T Sudhakar, B Tripathi, Matthew Varghese
  Indian Journal of Psychiatry 01/2007;
• Article: Towards better understanding and management of somatoform disorders.

  Aleksandar Janca, Mohan Isaac, Jane Ventouras
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  ABSTRACT: Much research has recently been conducted on somatoform disorders demonstrating their clinical importance, associated health-service burden and economic cost. These conditions are often comorbid with other mental and physical disorders and particularly prevalent in primary care and general medical settings. Although culture-specific manifestations and variations of somatization occur--it is now accepted that medically unexplained somatic symptoms are a universal phenomenon. The management of somatoform disorders is generally a complex and lengthy process; however, a number of recent studies have demonstrated the effectiveness of short-term treatments such as cognitive behaviour therapy and educational interventions. Despite advances in their understanding and treatment, debate still surrounds the conceptualization and categorization of somatoform disorders, with a number of experts proposing a complete re-evaluation and reassignment of this diagnostic classification category. The following paper represents a review of recently published literature on frequency, characteristics, conceptualization, impact and management of somatoform disorders.
  International Review of Psychiatry 03/2006; 18(1):5-12. · 1.80 Impact Factor
• Article: Dissociative and conversion disorders: defining boundaries.

  Mohan Isaac, Prabhat K Chand
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  ABSTRACT: Although dissociative disorders have been described and diagnosed for some time, their aetiology, pathogenesis, phenomenology and management continues to arouse debate. It is only in recent times that researchers have made some progress by integrating trauma related theories with more contemporary cognitive theories and neurobiology. Dissociation as a phenomenon is reported to occur in a variety of disorders. This widespread occurrence has contributed to a better understanding of dissociation. An expansion of this concept may have contributed to the loss of its original significance. Recent studies in the field of dissociation that pertain to its aetiology, pathophysiology, neurobiology and management are critically reviewed. Dissociative disorder is conceptually a difficult disorder to study. Apart from exposure to trauma, certain primary personality attributes may contribute to the propensity to develop dissociative disorder. Recent advances in functional neuroimaging facilitated by enhanced knowledge in the neural representation of body state have helped to improve our understanding of dissociation. There is confusion over the use of various terms such as sexual abuse and physical abuse in explaining causality. Current classificatory systems have not been found suitable when applied across cultures. In spite of all of these limitations, there has been recent progress toward a better understanding of dissociative disorders.
  Current Opinion in Psychiatry 02/2006; 19(1):61-6. · 3.05 Impact Factor
• Article: Somatic symptoms study: physical health of patients with mental illness

  Aleksandar Janca, Mohan Isaac, Jonathan Laugharne, Jane Ventouras
  Annals of General Psychiatry. 01/2006;
• Article: Social rituals and mental health: evaluation of the Social Rituals Interview Schedule

  Aleksandar Janca, John Owen, Victoria Burbank, Jane Ventouras, Mohan Isaac, John Cooper
  Annals of General Psychiatry. 01/2006;
• Article: Post-traumatic stress disorder and terrorism

  Alyssa Lee, Mohan Isaac, Aleksandar Janca
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  ABSTRACT: Purpose of review: Terrorist attacks are increasing in different parts of the world. The psychiatric consequences of terrorist attacks, particularly post-traumatic stress disorders, are often underrated. Recent terrorist attacks, particularly the attacks of September 11, 2001 in the USA, focused attention on post-traumatic stress disorder. This review examines the prevalence rates and characteristics of post-traumatic stress disorder after terrorist attacks. Recent findings: At least 28-35% of people exposed to a terrorist attack may develop post-traumatic stress disorder. Whereas persons directly exposed to terrorist attacks have a greater risk of developing post-traumatic stress disorder, the secondary effects of vicarious exposure on people not directly exposed are significant. Individuals with post-traumatic stress disorder have higher healthcare utilization and medication use. More than 40% of people across the USA experienced substantial symptoms of stress after the attacks of September 11, 2001. The rates of acute post-traumatic stress disorder and depression among residents of lower Manhattan, New York, were twice the baseline rate 5-8 weeks after the attacks. The presence of pre-existing stressors, levels of social support, female sex, and Hispanic ethnicity were important predictors of post-traumatic stress disorder. Disaster-related television viewing could be harmful for children. The role of psychological debriefing in the prevention of post-traumatic stress disorder is questionable. Summary: Most suffers of post-traumatic stress disorder are reluctant to see mental health professionals. Primary care physicians are best suited to identify and manage individuals with post-traumatic stress disorder. There is a need to train primary care practitioners in the identification and management of the psychiatric consequences of trauma and terrorism.
  Current Opinion in Psychiatry 10/2002; 15(6):633-637. · 3.05 Impact Factor