Nilamadhab Kar

• MD, DPM, DNB, FRCPsych
• Consultant at Black Country Healthcare NHS Foundation Trust, Wolverhampton

We intended to assess stress, anxiety, depression and coping strategies during COVID-19 pandemic. Through an online survey, we used primary care posttraumatic stress disorder (PTSD) screen for DSM 5 (PC-PTSD-5), Generalised Anxiety Disorder (GAD)-7 and Patient Health Questionnaire (PHQ)-9, along with coping methods. Of the respondents (n=733), a co...

Objectives We studied posttraumatic stress symptoms (PTSS) and disorder (PTSD), associated factors, and quality of life (QOL) of a group of passengers ( n = 58) affected by the 2023 Odisha train accident, comparing it with health professionals ( n = 42) such as doctors and nurses who treated them, and individuals from the local community ( n = 65)....

Background Although personality disorders (PD) are known risk factors for suicide attempts, studies on personality dimension are scarce, which may provide further insights for interventions. Methods The relationship between personality dimension, lethality, intent, and quality of life (QOL) was studied in suicide attempters with or without PD. We...

Health and happiness influence each other. However, the relationship is quite complex, as a healthy person may be unhappy, and a seriously ill patient may experience happiness. Physical and mental health, and illness-related variables impact upon happiness, though it may be more pronounced by mental illnesses. Positive emotions, resilience, sex and...

Context background: Hyperthyroidism has a major impact on mental health. Aims: We intended to determine the magnitude of the unmet need for mental health support in patients with hyperthyroidism attending an endocrinology clinic. Settings and design: General Hospital Endocrine Department, Prospective Study. Methods and material: In a natural...

Euthanasia and assisted suicide in their various forms remain a heated and polarising debate. There is global variance in the legalisation of forms of assisted dying; with it being legalized in some form in some countries, and staunchly prohibited in others. As legal status varies from country to country, so do religious and social views; within so...

Background: Rail and road accidents are common in India and are extremely stressful life events. Many accident survivors develop stress-related mental health problems but do not get psychotherapeutic support. We intended to analyse the needs and types of techniques for the psychotherapeutic support of the survivors of the 2023 train accident in Odi...

Dementia is a growing concern in India, requiring urgent attention due to the enormous need for care and support. There are various dementia risk factors that can be identified and dealt with effectively. Some of them have higher relevance in the Indian context, such as illiteracy, road traffic accidents associated with traumatic brain injury, poll...

Background/Objectives: Despite an improved knowledgebase, effective intervention, and guidelines, many patients with depression do not receive adequate treatment and treatment discontinuation and non-response are common. It was intended to explore the challenges clinicians face while managing depression in their clinical practice and their suggesti...

Purpose : The COVID-19 pandemic affected the ability of healthcare institutions to deliver quality services. Demand for specific resources, freedom to choose hospitals or doctors, restricted information, and the virulence of the disease caused disruption. The SERVQUAL, as a quality measure in a pandemic disruption, was perceived as debatable in a c...

Background/Objectives: Despite improved knowledgebase, effective intervention, and guidelines, many patients with depression do not get adequate treatment; and treatment discontinuation and nonresponse are common. It was intended to explore the challenges clinicians face while managing depression in their clinical practice and their suggestions for...

The 2023 Odisha train accident in India is one of the deadliest train accidents in recent history, which is expected to have a massive psychological impact on the survivors and their families. Despite train accidents being common, there is an apparent lack of a process to support the psychosocial needs of the survivors. This narrative review highli...

Children and adolescents are more vulnerable to disaster-related trauma. The specific aim of this paper was to review the coping strategies used by children and adolescents in the aftermath of disasters. The relationship of coping methods with psychological consequences were also explored, along with the effectiveness of specific strategies in deal...

BACKGROUND Electroconvulsive therapy (ECT) is a safe and effective treatment in psychiatry, but its use is decreasing. AIM It was intended to evaluate the attitude and knowledge among psychiatric trainees and psychiatrists and any change following a training session on ECT. MATERIALS AND METHODS A survey was conducted in a teaching psychiatric ho...

While longevity is increasing in general, factors that can prolong the life of older adults constitute an area to explore. At the same time, it is not just adding years to life, but having increased periods of disability-free life, with increased productivity and functioning. Many factors influence remaining life expectancy at the age of 60 which c...

Background: Information about the anxiety and depression of students in rural areas of India is scant. We evaluated stress, coping strategies, quality of life (QOL), and well-being of students along with the dimensional and categorical distribution of anxiety and depression in a cross-sectional study in a rural college. Materials and Methods: It...

Background Caring for patients with severe mental illness could be stressful. Information regarding the burden and quality of life (QOL) of the family caregivers of patients with bipolar affective disorder (BD) is scant from India. It was intended to study the burden and QOL of the caregivers of patients with BD and their association with sociodemo...

Introduction The Crisis and Home Treatment Teams (CRHT) in psychiatry manages patients with risk to self and others in the community. The number of patents under CRHT who attempt or die of suicide is high in the UK (Hunt et al BJPsych Bull. 2016;40:172-4). The CRHT is an option to help support patients in managing their risk using various intervent...

Amidst the COVID-19 pandemic, educators and students endured a tumultuous two-year period marked by hasty tech integration, unprepared academic stakeholders, limited screen space, and a lack of control over educational processes. The return to offline classes and campus life was anticipated as a stress relief for higher education, but students had...

Background Mindfulness-based interventions are increasing in clinical and nonclinical populations. It is important to have a culturally validated instrument to measure the construct. Aims We intended to evaluate the Mindful Attention Awareness Scale (MAAS) in an Indian sample, for its reliability and dimensionality along with any differences among...

It is about healthcare needs in patients with dementia in long stay care homes.

BACKGROUND Discharge summaries are valuable clinical documents providing information not only about the acute presentation and progression but also suggestions for future management to maintain the continuity of care. This is important in multidisciplinary, multiagency mental healthcare. AIM It was intended to evaluate the discharge summaries for...

BACKGROUND Patients with severe mental illness have an increased risk for cardiometabolic diseases. Cardiometabolic risk screening is suggested at admission to psychiatric hospitals to identify and intervene; however, usually, these are not adequately undertaken. AIM In a quality improvement project, we aimed to find out the usefulness of having a...

Aims Psychiatric illnesses are common in the perinatal period and many women are treated with psychotropic medications. Prescribing psychotropic medications often raises concern among patients and clinicians, because of a lack of information and no license to prescribe during pregnancy. This project aimed to evaluate the interventions offered in a...

Aims Pro re nata (PRN) medications are commonly prescribed for psychiatric patients on admission, often at maximum daily dose (MaxD). We intended to evaluate prescribing patterns for PRN medications, their MaxD, and rationale, specifically in the first seven days in the hospital, along with any concerns of associated physical illnesses. Methods Al...

Aims Crisis Resolution Home Treatment Team (CRHT) provides short-term treatment for psychiatric patients in the place of residence, dealing with mental health crises, risks, deterioration, and preventing hospital admissions. This team works round the clock, seven days a week. This study aimed to analyze the clinical outcomes of the service provided...

Aims Many antipsychotics are known to adversely affect prolactin levels causing hyperprolactinemia. National Institute for Health and Care Excellence (NICE) guidelines have suggested monitoring of prolactin levels. It specifies that prolactin should be checked 6 months after starting treatment, then every 12 months; and to ask about symptoms of rai...

Data was collected from 52 patients over the age of 18, including old-age psychiatric patients. Four patients were excluded due to them being admitted for less than 7 days, and 10 patients were excluded due to missing data, thus 38 patients' data was used for the purpose of this service evaluation. A larger proportion of patients were prescribed pr...

A large proportion of the general population in the highly populous South Asian region has mental health problems. There are many challenges for their care, such as lack of resources, inadequate mental healthcare workforce, uneven distribution of professional input, large underserved areas, poor affordability, stigma, etc. There are examples of goo...

Background: Maternal mental health may influence the nutritional status of their children. It was intended to assess the mental health status of the mothers of children admitted to a nutrition rehabilitation center. We specifically explored the relationship between maternal mental health and malnutrition of the child; to observe any change of mater...

AIM Substance abuse is associated with mental health crises, leading to increased attendance in A and E and hospital admissions. This quality improvement project (QIP) evaluated the assessment and documentation of substance abuse of patients admitted under the crisis resolution home treatment team (CRHT) as well as any change following a teaching s...

It is well known that public knowledge about mental illnesses is not at an expected level, and misinformation and stigma continue to be commonplace. These factors have a negative impact on appropriate and timely help seeking, adherence to treatment, and consequently on the clinical outcomes. There are robust public education materials and resources...

BACKGROUND Missed appointments in mental health services have been a concern; as nonattendance may be associated with various clinical risk factors. AIMS We intended to compare the profile of nonattenders at psychiatric outpatient clinics before (in-person model) and during the COVID-19 pandemic when the services changed to remote consultations (t...

As disasters are becoming more common, there is an ever-increasing need for support from personnel working in those situations, from search and rescue to emergency health care, relief, and postdisaster short-and long-term support. Exposure to traumatic situations affects disaster responders psychologically for various reasons and to different degre...

Background Many patients attending dermatology clinics have mental health problems which may affect their well-being. Aims It was intended to study the influence of anxiety and depression on well-being and quality of life (QOL) in relation to satisfaction of dermatological care in an out-patient setting. Materials and Methods In a cross-sectional...

Most of the elderly stay at home, along with their family members. Some live alone and others in old age homes. The preference to stay in the family home is well recognised. The care of the elderly primarily involves basic care for the activities of daily life, support regarding illnesses, providing medications and other medical treatment, nursing...

Background Metabolic syndrome (MetS) is a concern in psychiatric patients. We aimed to study the influence of the modifiable lifestyle factors on MetS in adult psychiatric patients along with associated clinical factors and quality of life. Methods Factors such as diet (Healthy Eating Index), exercise, substance use, cardiovascular risk (QRISK), i...

BACKGROUND Old age is associated with a greater prevalence of worry, anxiety, and depression when compared to the younger age groups. Age-specific stressors and comorbidities accumulate and negatively impact the well-being of older adults. AIMS/OBJECTIVES In this context, we intended to study the factors influencing the happiness of older adults....

BACKGROUND Insomnia is a common condition in patients with mental illness, for which hypnotic medications are regularly prescribed. AIM It was intended to study the clinical practice of using hypnotic medications including Z-drugs for insomnia and compare it with treatment guidelines. METHODS In this clinical audit, data were collected from the c...

Quality of life (QOL) is affected by various factors including mental health. This is now commonly used in clinical assessments and as an outcome measure in research. However, there is a dearth of QOL scales in local languages in India for specific use in mental health settings. It was intended to review the translation process of the recovering QO...

The delusional belief one has died is a rare psychopathology. It has been described as a part of Cotard's syndrome and is associated with psychiatric and neurological illnesses. Here we present a case of a 97‐year‐old male patient who experienced this delusion with a background of long‐standing dementia with hearing and vision impairment. There wer...

The aim of this survey of psychiatrists from the UK and India was to compare their opinions on antipsychotic medication choice and their experiences of such medications’ effectiveness and tolerability in patients who were newly diagnosed with acute schizophrenia. Following ethical approval, a cross-sectional online survey of psychiatrists from the...

Background/Objective As the health services were reorganized during the COVID-19 restricting access to family caregivers, we explored the experience of women in the perinatal period, attending a specialist perinatal mental health service. Methods Patients ( n = 38) in the outpatient list for review were assessed over phone based on a predesigned,...

The Odisha train accident in Balasore is a catastrophic disaster affecting a large number of people. The family members of the passengers are the indirect victims of this disaster; among them, the dependent elderly relatives of the deceased or injured passengers are most affected. In the context of the massive stress on the family, the concerns of...

Introduction General trust and trust in various social institutions/agents are argued to positively influence the outcome, more so, in a crisis. Mitigating a crisis requires actions from individuals, family, friends, co-workers, various policymaking, and implementing agencies, media, and other agencies with whom people interact. In the COVID-19 sit...

Aims Mental illness is linked with a higher risk of dangerous driving; e.g. patients with neurotic disorders have 50% more accidents than controls and 10% of drivers involved in accidents have reported feeling suicidal. The Driver and Vehicle Licensing Agency (DVLA) have provided guidance related to fitness to drive for those with mental illness. I...

Aims Psychiatric patients have a higher risk of road traffic accidents than others. The Driver and Vehicle Licensing Agency (DVLA) has provided guidance on different psychiatric conditions and medication that would impact driving. The General Medical Council and Royal College of Psychiatrists advice doctors to notify the DVLA when patients unfit to...

Aims Clinical research shows that compared to Caucasian patients, Asian patients appear to have a lower clozapine dose requirement for clinical efficacy. Hence, appropriate dose adjustment should be considered in Asian patients receiving maintenance clozapine therapy. Secondly, studies in the UK report that Asian patients with treatment-resistant s...

We present a case of a 27‐year‐old Caucasian male with a background of surgically corrected tetralogy of Fallot (TOF) and pulmonary valve regurgitation, who presented with psychotic symptoms. The case presented a challenge in treatment due to the patient's cardiac history and ongoing cardiac‐related health problems with prolonged QTc before initiat...

Ageing is a process and it does not start at a particular chronological age. Although most people enjoy this period of life, many still face multiple challenges related to ill health, disabilities and care related issues. Multi-morbidity is common in this age group, and the need for routine and emergency health care is more frequent. There are conc...

There is scant information on early manifestation of trauma due to catastrophic natural events and its relation with stress-related disorders. The specific objective of this study was to estimate and compare the prevalence of post-traumatic stress and depression on day 3 (D3) and week 6 (W6) following the 2018 flood in Kerala, India. In a cross-sec...

Obesity is a major public health problem worldwide. Its association with multiple physical morbidities is well known. Although there is a massive impact of obesity on mental health, these areas are not adequately highlighted. Following a comprehensive literature search, this narrative review describes the complex relationship of obesity and mental...

CONTEXT Aggressive behaviors and violence from psychiatric patients have been consistently reported. AIMS It was intended to explore the experience of mental health professionals about the aggression from the psychiatric patients. SETTINGS AND DESIGN This study was a cross-sectional survey in the community. MATERIALS AND METHODS A semi-structure...

Mental health concerns of doctors, especially psychiatrists, have not been highlighted adequately. Like other fellow clinicians, psychiatrists face considerable stress in clinical practice and a proportion of them suffer from mental health problems. However, besides low rate of help-seeking, there are concerns of the availability of services and fa...

BACKGROUND/OBJECTIVES Pregnancy and childbirth are one of the vulnerable periods in women's lives, and women with mental illness require additional support during this period. The COVID-19 pandemic along with its impact on clinical services brought challenging situations. We intended to study the experiences of women with mental illness in their pe...

CONTEXT The catastrophic stress of disasters and the associated secondary traumas lead to negative mental health outcomes in a great proportion of survivors. A range of coping strategies are used, which may have possible preventive and therapeutic effects related to posttraumatic stress-related manifestation. AIMS It is essential to learn about th...

Background: With gradually increasing older population, the profile of elderly attending psychiatric services needs exploration to inform changing service needs. Aims: Clinical characteristics of elderly attending a psychiatric outpatient department and the challenges faced by their caregivers were studied. Methods: An explorative, interview-based...

Disruption of habitual daily activities is associated with mental health issues. Social rhythm therapy encourages greater regularity of daily activities. Interventions to re-stabilise the activities have been reported to be helpful. Social rhythm therapy has been used in bipolar disorder, depression, stress related disorder including posttraumatic...

Background: Information seeking occurs to reinforce existing information, to solve problems, construct meaning, and as a response to alienation. The continual information uncertainty related to COVID-19 pandemic impacted life, livelihood and triggered worry. Information seeking from multiple sources became necessary to allay anxiety and verify auth...

Optimal time for ICU diary delivery and impact on mental health (MH), anxiety-depression, post-traumatic stress symptoms (PTSS), quality of life (QOL), and memories is unclear. We evaluated the effect of ICU diaries, dispatched at different time points, on outcomes in an Indian cohort. Design: Double-blind randomized controlled trial. Setting:...

Aims Prescribing of psychotropic medications in pregnancy is still considered a ‘grey area’ in clinical practice. National Institute for Health and Care Excellence (NICE) in the UK suggests that the decisions should be person-specific, considering the risks to both the mother and unborn child, and the patient is supported to make an informed decisi...

Aims COVID-19 pandemic has a massively adverse mental health impact and people with pre-existing psychiatric illnesses are one of the most severely affected groups. We intended to study the changes in the patient profile in a psychiatric hospital during the COVID-19 pandemic, comparing it to the period just before the pandemic. Methods Consecutive...

Aims During the COVID-19 pandemic most clinical services changed to remote consultation and management to minimise virus transmission by direct contact. As the social distancing and restrictions have eased with greater control of the pandemic, the nature of consultations is going to change. At this juncture we intended to understand the perception...

Context: The catastrophic stress of disasters and the associated secondary traumas lead to negative mental health outcomes in a great proportion of survivors. A range of coping strategies are used, which may have possible preventive and therapeutic effect related to posttraumatic stress related manifestation. Aims: It is essential to learn about th...

The catastrophic nature of war has deleterious impact on almost all individuals of the affected populations; amongst them older adults are known to be one of the most vulnerable groups. Along with the life changing economic and social adversities, the physical and mental health of the older adults are seriously impaired secondary to war. The conseq...

Background: There is a dearth of scales in the Telugu language for assessing quality of life in persons with mental illness. Aim: It was intended to translate and linguistically validate Recovering Quality of Life 10 item version (ReQoL-10) in Telugu, a south Indian language; and to explore its acceptability among psychiatric patients. Methods: Tra...

The Recovering Quality of Life (ReQoL) scale, developed in the UK is an appropriate instrument for routine clinical use in mental health services. It has been translated to many languages in India and elsewhere. The translation and linguistic validation process of the ReQoL scale to Punjabi, an Indian language spoken in many Northern states of Indi...

We intended to compare mental health concerns in patients attending a general hospital clinic with that of patients attending a psychiatric clinic during the coronavirus disease 2019 (COVID-19) pandemic. We specially wished to know about the perceived stress, worries, possibility of anxiety and depression, and the quality of life (QOL) of the patie...

Developed countries report higher ICU-related mental-health complications. The absence of non-ICU comparators limits interpretation and comparability across socioculturally diverse populations. Having found low levels of mental health complications in our ICU patients, we compared anxiety, depression, posttraumatic stress symptoms (PTSS), quality o...

There is a paucity of research on the role of COVID-19 related fear and lockdown on social anxiety disorder (SAD). In a follow-up study during post-lockdown period, we compared social anxiety of individuals with SAD who received cognitive-behavioral therapy (CBT) versus psychoeducational-supportive therapy (PST) before the COVID-19 pandemic, and th...

The Recovering Quality of Life (ReQoL) scale is a short scale for routine clinical use in mental health services. Its shorter 10-item version in English was translated and validated in Gujarati, an Indian language, spoken in the western state of Gujarat in India. The translation process involved following process: forward and back-translation, pilo...

Background: Performance of students at university level may be influenced by various factors. Aim: In a sample of business administration students, we explored personality, mental health, and life style factors associated with high and low achievers based on their examination grades (Grade A and higher vs. Grade B and lower). Methods: We studied pe...

The trait- or personality-based approach has not been able to answer some of the core questions in entrepreneurship research. The cognitive approach has gained currency over a period in an attempt to explore many key areas. As a budding research domain in the intersection of cognitive psychology and entrepreneurship, the scope and boundaries must b...

Background There is a need to study age-sensitive psychological management for improving the clinical and overall health outcome for elderly adults. Hence, we intended to evaluate the effects of selection, optimization, and compensation (SOC) model, usually studied in nonmental health settings predominantly, in managing depression and well-being of...

The elderly population has been worst hit during the COVID pandemic. Society should take this challenge to learn from the experience to improve the support services for the elderly and preparedness for pandemic. Proper planning and strategies in health, social care, and public services are required.

Background Life in college and university can be stressful. It was intended to evaluate mental health, specifically depression, anxiety, substance use, and stress among management students to explore the need for support in a campus. Methods It was a cross-sectional study in the setting of a university campus. Using a questionnaire method, student...