EASTERN JOURNAL OF PSYCHIATRY.pmd

124 Pages·2010·0.86 MB·English

EASTERN JOURNAL OF
PSYCHIATRY
OFFICIAL PUBLICATION OF THE INDIAN
PSYCHIATRIC SOCIETY: EASTERN ZONE
ISSN-0974-1313 Volume 13 Number 1&2 February- August 2010 ISSN (Online) 0976 – 0334
Journal Advisory Committee Eastern Journal of Psychiatry is the official
Chairperson publication of Indian Psychiatric Society –
Dr. Dipesh Bhagabati Eastern Zonal Branch. Eastern Journal of
Members Psychiatry publishes original work in all fields
Dr. Jiban Chakraborty (Tripura) of Psychiatry. All correspondence including
Dr. P.K. Mahapatra (Orissa) manuscripts for publication should be sent to the
Dr. Prabir Paul (West Bengal) Honorary Editor, Eastern Journal of Psychiatry,
Dr. Vinay Kumar (Bihar) L.G.B. Regional Institute of Mental Health,
Tezpur, Assam, 784001, E-mail:
Journal Committee
[email protected]
Chairperson
Dr. Kangkan Pathak
The material published in the Eastern Journal of
Psychiatry does not necessarily reflect the views
Members
of the Editor or the Indian Psychiatric Society –
Dr. P.K. Singh (Bihar)
Eastern Zonal Branch. The publisher is not
Dr. S. Akhtar ( Jharkhand)
responsible for any error or omission of fact.
Dr. S. K. Das ( Orissa)
Dr. Gautam Saha (West Bengal)
The appearance of advertisements or product
Ex-officio Members information in the Journal does not constitute
Dr. R. R. Ghosh Roy an endorsement or approval by the Journal and/
Dr. C. L. Narayan or its publisher of the quality or value of the said
product or of claims made for it by its
Editorial Board manufacturer.
Editor
Dr. Kangkan Pathak Published by
Associate Professor of Psychiatry Editor, Indian Psychiatric Society, Eastern Zonal
L.G.B.R.I.M.H. Branch
Tezpur, Assam, 784001
Assistant Editor Printed at
Dr. Sarada Prasanna Swain (Orissa) —————————
Members
Distinguished Past Editors
Dr. Kamal Narayan Kalita (Assam)
Dr. S. Akhtar: 1998-2000
Dr. N. M. Rath (Orissa)
Dr. V.K.Sinha: 2001-2002
Dr. Sanjiba Dutta (Sikkim)
Dr. Vinay Kumar: 2003-2005
Dr. Dhrubajyoti Chetia (Tripura)
Dr. Gajendra Singh (Manipur)
Online at: www.indianpsychiatryez.org
Dr. Dhrubajyoti Bhuyan (Assam)
Dr. Arabinda Brahma (West Bengal)
EASTERN JOURNAL OF
PSYCHIATRY
OFFICIAL PUBLICATION OF THE INDIAN
PSYCHIATRIC SOCIETY: EASTERN ZONE
ISSN-0974-1313 Volume 13 Number 1&2 February- August 2010 ISSN (Online) 0976 – 0334
CONTENTS
Future of District Mental Health Programme : Kangkan Pathak
ORIGINAL ARTICLES
Insight into Schizophrenia: A comparative study between : S. Das , D. Bhagabati , U. Talukdar
patients and family members
Association of Anxiety and Depression in Postpartum Pe- : K N Kalita, H R Phookun, G C Das
riod: a Hospital Based Evaluative Study
A comparative study of thyroid hormone levels among the : S. G. Singh, S. Debbarma, N.Heramani
normal healthy persons, Depression and Schizophrenia Singh, Th. Bihari Singh, R.K.Lenin,
K.Shantibala Devi
An explorative study on Biomedical Waste Management in : J.Hazarika, A C Sarmah, M.Das
a Psychiatric Hospital of India
Efficacy of Psychosocial Intervention on Patients with : Shweta, K. S. Senger , A. R. Singh, M. Dutta
Schizophrenia
Visuospatial Working Memory Deficits in Patient with : K. Bala, M. Jahan, S. Sarkhel, A. Bakhla
Schizophrenia
A study of level of Depression, Anxiety and life satisfaction in : R. Kumar, D. K. Kenswar
acute and chronic schizophrenia
Psychopathology among primary caregivers of major psy- : S. K. Nayak, S. Kumari, M. Jahan,
chiatric patients A. R. Singh
A Comparative Study of Neuro-Cognitive Impairment in : N. A. Khan, A. Kanchan, A. Singh,
Elderly Patients with Schizophrenia and Elderly Normals K.S. Sengar, A.K. Nag
REVIEW ARTICLES
Legislation, Society and Substance Use - impact of NDPS Act,
1985 : M. Aggarwal, Umamaheswari V, D. Basu
Polypharmacy in clinical psychiatry-a brief review : G. P. Singh
Treatment Resistant Depression : M. Hembram, S. Chaudhury
Socio-Economic and Cultural Aspects of Suicide : Arabinda Brahma
VIEW POINT
Mindfulness and Mental Health : K. Nath Dwivedi
Era of Evidence Based Medicine: Is clinical expertise outdated : Y.P.S. Balhara, S. N. Deshpande
CURRENT THEME
: C.L. Narayan, Rajiv Jaiswal, Deepshikha
Towards A New Mental Health Act
CASE REPORT
Cerebral metastasis masquerading as late onset depression- A : S. G. Singh, N.H. Singh, L. Nelson, N. B.
Singh, K.S. Devi, L. R. Singh
case report
: Chris Nicholson
BOOK REVIEW
Kangkan Pathak
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Future of District Mental Health Programme
Kangkan Pathak
L.G. B. Regional Institute of Mental Health, Tezpur, Assam, 784001
BACKGROUND
India is the first developing country to formulate the postgraduate level, strengthening the Central and State
National Mental health Programme (NMHP) based Mental Health Authorities with a permanent secretariat,
on the principle of decentralized and deprofessionalised IEC Activities and Research & Training in the field of
mental health care1. The approach was to integrate community mental health, substance abuse and child/
mental health with general health services, also referred adolescent psychiatric clinics for improving service
to as community psychiatry initiative2. A model delivery delivery4.
of community based mental health care at the level of
But 10th plan could not meet the objectives of NMHP
district was evolved and field tested in Bellary district
which necessitated adoption of revised national mental
of Karnataka by NIMHANS during 1986-1995. The
health programme in 11th Plan. During the 11th Five Year
Central Government launched the District Mental
Plan, it has been proposed to decentralize the programme
Health Program (DMHP) as a 100% centrally
and synchronize with National Rural Health Mission for
sponsored scheme for first five years, at the national
optimizing the results. The main components of NMHP
level during the 9th Plan as pilot project. It was
that have been proposed are 5, 6:
launched in 1996-1997 in four districts, one each in
Andhra Pradesh, Assam, Rajasthan, and Tamil Nadu, • To establish Centres of Excellence in Mental
with a grant assistance of 22.5 lakhs each. DMHP was Health by upgrading and strengthening of
implemented in 27 Districts across 22 states/UTs in identified existing mental hospitals for
the 9th Plan. The DMHP was extended to 7 districts addressing acute manpower shortage.
in 1997-1998, five districts in 1998 and six districts in • To provide impetus for development of
1999-2000. During the Tenth Five Year Plan, the Manpower in Mental Health
DMHP was extended to 127 districts in the country3.
• Spill over of 10th Plan schemes for
During the 10th Five Year Plan, NMHP was restrategized modernization of state run mental hospitals and
and it became from single pronged to multi-pronged upgradation of psychiatric wings of medical
programme for effective reach and impact on mental colleges/general hospitals.
illnesses. DMHP was redesigned around a nodal • District Mental Health Programme with added
institution, usually the zonal medical college. The thrust components of Life Skills training and
areas were to expand DMHP to 100 districts all over the counseling in schools, counseling service in
country, modernization of mental hospitals in order to colleges, work place stress management and
modify their present custodial role, upgradation of suicide prevention services.
Psychiatry wings of Govt. Medical Colleges/General • Research in mental health
Hospitals and enhancing the psychiatry content of the • IEC activities to remove stigma attached to
medical curriculum at the undergraduate as well as
mental illnesses
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12E3-4M56a7il8: [email protected]
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• Monitoring at Central/State/District level to DMHP districts (as control). The DMHP beneficiary
facilitate implementation of various Districts were chosen proportionately from 9th and the
components of NMHP and evaluation 10th Plan period. The following are the main findings of
the evaluation:
DISTRICT MENTAL HEALTH PROGRAMME3
The Objectives of DMHP are: “One third of the districts under the 9th plan have
1. To provide sustainable basic mental health services utilized over 99%, one third has utilized 63-91%, and
to the community and to integrate these services rests have utilized 37-47% of the total amount they
with other health services; have received. This is mainly due to administrative
2. Early detection and treatment of patients within delay, difficulty in recruiting and retaining qualified
the community itself; mental health professional, low utilization in training
3. To see that patients and their relatives do not have and IEC components. In Case of the 10th plan districts,
to travel long distances to go to hospitals or most of the districts had received only the 1st
nursing homes in the cities; installment under DMHP. Of the grant received one
4. To take pressure off the mental hospitals; third have utilized more than 90%, half of the districts
5. To reduce the stigma attached towards mental illness spent 51-87% and rests of the districts the programme
through change of attitude and public education; has recently started….. Most of the districts had not
6. To treat and rehabilitate mental patients discharged utilized the full amount for training due to delay in
from the mental hospitals within the community implementation. …..The expenditure on ... training and
IEC components which requires a lot of ground work,
The strategies for achieving these objectives are: i. Training
coordination and networking in the community is
programmes of all workers in the mental health team at
below par in most of the districts. This is mainly due
the identified Nodal Institute in the State. ii. Public
to lack of organizational skills in the DMHP team,
education in the mental health to increase awareness and
low community participation in the programme and
reduce stigma. iii. OPD and indoor services for early
lack of coordination with the district health system
detection and treatment. iv. Providing valuable data and
which comes under a different department. …..
experience at the level of community to the state and
Regarding availability of drugs, only 25% of the
Centre for future planning, improvement in service and
districts reported that there has been a regular inflow
research.
of drugs. …. This is because of lack of dedicated drug
For DMHP funds are provided by the Govt. of India to procuring mechanism for DMHP and financial
the state governments and the nodal institutes to meet the authority to the nodal centre. …. About 61% of the
expenditure on staff, equipments, vehicles, medicine, beneficiaries accessed the district hospital as their first
stationary, contingencies, training, etc. for initial 5 years point of contact. The percentage of patients accessing
and thereafter they should manage themselves. CHCs (12.7%) and PHCs (11.5%) were found to be
low”.
Evaluation of DMHP 7
NORTH EASTERN EXPERIENCE
During 2008-2009 evaluation of DMHP covering 20 of
the 127 districts was carried out by Indian Council of Mere allocation of fund has nothing to do with the
Marketing Research (ICMR), New Delhi to assess the successful implementation of any programme. Now
functioning of DMHP objectively and critically and to we have enough evidence from the ongoing DMHPs.
suggest future expansion of the scheme along with We were part of the recent inspection of the Districts
improvement in implementation if any, based upon the under District Mental Health Programmes (DMHP) by
evaluation. ICMR, a division of Planman Consulting Central Mental Health institutions. What we have seen in
(India) Pvt. Ltd. visited 20 DMHP districts and 5 Non- the DMHPs in the north eastern states is not at all
encouraging. The scenario is not different from other states for northeastern states, Institute of Mental Health and
also as seen in the evaluation by ICMR. Neurosciences, Pune for Western states, CIP, Ranchi and
RINPAS for eastern states. It seems there is no
The training of all categories of personnel is emphasized
coordination among the Centre, the State Nodal officers
in DMHP to face the challenge of shortage of
and the identified institutes. Because of which even the
professional manpower. But many districts could not
paramedical personnel were sent to NIMHANS,
train even 50% of the medical officers in the district.
Bangalore for training at a huge cost.
The figure is 34.3% in Goalpara, 15.8% in Tinsukia ,
The objectives of the programme are not achieved till today
26.1% in Nalbari, 39.7% in Marigaon in Assam, 0% in
after lapse of more than one decade. This indicates that
East Siang, 0.70% in Papumpare (Naharlagun) of
there is a poor commitment of the government,
Arunachal Pradesh. Surprisingly, Papumpare district
psychiatrists, and community at large. The programme
where DMHP started in 1998-99 trained just a single
has given more emphasis on the curative services to the
medical officer under DMHP out of 142 medical officers
mental disorders and preventive measures are largely
at a cost of several lakh of rupees. He was sent to
ignored8. It is beyond doubt that more public awareness
NIMHANS for one year period but he is also no more
programmes are required. A huge amount of money was
associated with the programme. For paramedical staff the
earmarked for IEC activities to increase public awareness
scenario is worse.
about mental illness. Here also the programme failed
The basic tenet of DMHP was decentralization i.e.
abysmally in some districts. A classic example is this. In a
appropriate mental health service should be made available
district where large majority of the people are illiterate,
at the doorstep of the people. It should be accessible at
pamphlets in English were printed as part of IEC activities.
the sub-centre and village level. But in reality it is far from
The argument given was that there are many dialects in
truth even in those districts which have completed 5 year
that particular state so it is not possible to publish IEC
term of central assistance and was taken over by state
materials in each and every dialect. But the distribution
government. The skeleton service of mental health care is
of materials in English to this group of people is unlikely
restricted to district hospital only. The non-psychiatrist
to serve any purpose. Moreover, as part of IEC activities,
medical officers are hardly involved in the implementation
Mental Health Act, 1987 was also printed. This must have
of the programme. The minimum training of the health
cost several thousands of rupees at the minimum if not in
workers that is supposed to provide comprehensive health
lakh. This is sheer wastage of public money. This is
care at the most peripheral level did not materialise in
because MHA- 1987 is freely available in the market with
most of the districts. Even the trained mental health
nominal price. Moreover this Act is hardly of use for the
professionals are transferred from the DMHP to other
laymen. So, huge stock of copies of MHA-1987 is lying
posts in state health services. In another case several lakh
in the office of the nodal officer. It is not very difficult to
of rupees were shown to be spent in training but there is
guess whose interest is served by such action.
no record of the name of paramedical staff/ health worker
According to the operational guideline9, states are required
who were trained under DMHP, duration of training,
to submit proposals under various schemes of the
method of selection, their current place of posting, how
programme. Based upon these proposals from the states
they have contributed to DMHP after the training etc.
funds are released to the State Health Society for
According to norms DMHP team should be trained at
implementation as per the scheme guidelines. State nodal
the nearest training institute. But some of the nodal
officer for NMHP will represent the programme in the
officers are ignorant about the training institutes which are
State Health Society and get the grant released for various
region wise identified for this purpose. There was no
districts and institutions as per the scheme/guidelines. This
communication from the ministry also. The identified
norm is also not followed by various state Governments.
centres are NIMHANS, Bangalore for southern states,
Some state government took several years after the 1st
IHBAS, Delhi for northern states, LGBRIMH, Tezpur
installment from the Central government to appoint the
state nodal officer. Obviously, there is long delay in nodal officer or DMHP team but by the member secretary
initiating the programme for which the utilization certificate of State Mental Health Authority working in a diffferent
could not be provided within the stipulated time. As a district. So, managing the programme from headquarter
sequale of this, the programme did not receive the of a different district becomes an obstacle for successful
successive installments and the programme had to be implementation of the programme.
withdrawn. There is an example of having practically two
As per the scheme for strengthening the psychiatric
State nodal officers, one, a senior official from state health
wings of general hospitals and medical col1eges in
service, for those districts which already completed five
the Government sector under revised NMHP, a one-
years term and are taken over by state government and
time grant of Rs.50 lakhs for upgradation of
the other, a psychiatrist for those districts which are getting
infrastructure and equipment was received by many
central grants and yet to complete five years . There is no
districts hospitals which are nodal centers for DMHP.
coordination between the two nodal officers. Neither the
The grant covers:
DMHP psychiatrists, nor the joint director of Health
1. Construction of new ward.
services of the districts were ever taken into confidence
2. Repair of existing ward.
for the financial matter by the concerned official of the
3. Procurement of items like cots and tables.
directorate of health services of the state. In the district
4. Equipment for psychiatric use such as modified ECTs
level there was no documents related to financial matter
for monitoring. There is an allegation that there is frequent The in-patient ward of a district hospital was renovated
change of officers in the centre who look after this several times with these central grants. But even after
programme, because of which there is delay in issuing expenditure of such a heavy amount the in-patient ward
is found to be in poor shape. The small cubicle like set
subsequent installment even after submitting utilization
up is not suitable for hospitalization for psychiatric
certificate repeatedly.
patients. The dilapidated floor and dirty wall is tell-
Another matter of concern in many DMHP is lack of
tale evidence of utter neglect and mismanagement.
transparency and poor maintenance of record of There was only a single patient in the ward on the day
expenditure. There was no proper documentation of of inspection. The arrangement in the ECT room
the implementation of DMHP for the entire period in speaks volume about its utilisation. The ECT machine is
a district. One peculiar aspect of handling grants from safely kept in locker. Layer of dust accumulated over the
centre for DMHP in one state is that the fund used to Boyles’ apparatus. It seems it was never used since its
be deposited in the state exchequer for a long time. The purchase. In another district hospital, the grant received
1st installment of Rs. 26.2 lacs meant for East Siang for development of psychiatric ward was spent for
construction of office building. Equipments like modified
DMHP (located about 250 Km from the state capital)
ECT machine, Boyle’s apparatus were purchased with
was received in February, 2007. The grant was deposited
the grant but never used as there is no indoor facility. The
in state exchequer . Surprisingly it is not handed over to
erstwhile ‘Isolation ward’ was earmarked as in-patient
the concerned district till date. This has prevented the
ward for psychiatric patient. Since no patient was treated
humble beginning even after 3 years. Keeping the money
as in-patient, the existing psychiatry ward is being used
of 1st installment for more than three years is violation of
as ‘Burn Unit’. On the other hand, some DMHPs which
guidelines of the programme9. If unspent, the money should
is doing a very good job is facing problem due to lack of
have been refunded with interest. Many programmes failed
provision of in-patient ward in the district hospital. They
to spend the 1st installment even after several years. have to share beds with medicine department which
As DMHP is a district level programme, the financial creates conflicts at times.
matters should be managed at district level. In most of
In most of the districts under DMHP, the supply of
the DMHP, the people working at the district level are
psychotropic medicines is few and irregular. One DMHP
totally unaware about the fund position and its utilization.
psychiatrist commented that supply of surgical items even
There is a case where the fund is managed not by the
without indent is more regular (though often unused) than In all practicality, DMHP has become solely dependent
psychotropic medicines. The reason behind this is well on the DMHP psychiatrist in most of the districts. The
understood. There was occasion when medicine supplied medical officers who were trained under DMHP are
was much more than required and hence major part of no longer recording and reporting the number of
the consignment expired. The medicines are dispensed psychiatric cases seen by them once it is taken over by
only in the district hospital. No essential psychiatric the state governments. This is probably because of lack
medicines are made available or dispensed at primary of communication. Even many nodal officers are not
level. receiving any guideline from the centre. So, it is not
surprising to know that there is no record of how many
There is another interesting case. As per record of
medical officers who were trained under DMHP are
Ministry of Health and Family Welfare, Government
transferred to other districts or retired. No new training
of India, there is a programme under DMHP in Darrang
programme is undertaken after it was taken over by
District of Assam and Gauhati Medical College is the
state government for lack of fund. In the monthly
nodal institute. But no such programme is going on in
meeting also, record from the psychiatry department
Darrang District of Assam. Neither Principal of Gauhati
is hardly discussed.
Medical College nor the State Nodal Officer received
any grant so far for this district. This matter was already The 11th Plan has a vision of district mental health
intimated to the Government of India by the State programmes that include community mental health
Nodal Officer. But we were asked to inspect that services like life-skill training and counselling in educational
district recently by the Government of India. institutions, workplace stress management and suicide
Government of India should probe about allocation of prevention services. Most of the DMHPs of this region
fund to Darrang DMHP. If no such sanction was made, did precious little in this regard. DMHP in current form is
the money should be released immediately so that the mostly focused on pharmacological management of
nodal institute can start the programme immediately. psychosis only.
There is a goal of providing short-term training to deliver
At present the major issue of DMHPs which completed
basic mental health services to the existing health staff in
five year term is the regularisation of services of the staff
the districts by the end of the 11th Plan. This goal is unlikely
working for DMHP by the state government. They were
to be achieved in the Plan period.
given consolidated pay only without any increment or
allowances. For several years they worked without any The role of State Mental Health Authority in
pay for which many member of DMHP team already left implementation of the programme needs to be defined.
the service. They were given infrequent financial assistance In many states the state mental health authority is
in the form of lump sum amount by the state government. defunct or it is not very much sure about their roles and
But the staffs want their service to be regularised by the responsibilities. It should function as technical support
state government with pay packages at par with other team to assist the state nodal officer.
state government employee which is very much justified.
REMEDIAL MEASURES
In order to make the programme successful, their
grievances must be addressed by the concerned As a remedial measure for such anomalies and for success
government. As stated in the NMHP guideline, it is of DMHP, frequent and timely monitoring is essential. In
mandatory on the part of the state government to take many cases the official who was responsible for
over the programme on completion of central assistance implementation of the programme is no longer available
for a period of five years. But the genuine grievances of due to superannuation, death or transfer. Many queries
DMHP team working in the field are not reaching the could not be clarified by the officials currently engaged
officials sitting in state capital. with the programme. There is no point of monitoring a
programme several years after it was completed. The idea
of monitoring is to find out the deficits so that timely manpower until and unless there is revision of the
corrective measures can be taken in order to make the remuneration. The DMHP psychiatrists are mostly from
programme successful. Continuous monitoring and state health cadre and therefore they are not spared from
reporting as well as regular external evaluation is other emergency duties. They do not get any incentive
also for working in DMHP. So, there is resentment and
recommended for mid-course correction. Utilisation
some of them consider it to be an extra burden. The staff
certificate should not be taken at their face value. The
of the DMHP should be exclusively engaged for
staff working in DMHP should be regularized by the State
programme related works. Training should be imparted
government and instead of consolidated pay they should
regularly to all members of the DMHP team. Refresher
be given pay and allowances at par with other employees
training and in-service training with the focus on local
of state government. The medical officers who are yet to
challenges will boost up the morale of the personnel
be trained under DMHP should be trained. There should
implementing the programme. Training the DMHP team
be thorough verification of expenditure in various heads
in organizational skills, networking and involvement of all
since inception of the programme. The programmes where
stakeholders is also important. The trained personnel
posts of supporting staff are lying vacant should be
should be retained in the district or if transferred it should
recruited immediately and sent for training for stipulated
be to other DMHP districts only. The DMHP team needs
period in the identified nodal institutes for the region. The
to be trained on Programme Management and
in-patient ward should be made functional immediately.
organizational activities7. It is recommended that in
There should be an effective and time specific monitoring
addition to diagnosis and treatment involvement of family
system. Periodic training of the health workers at primary
members and community in the treatment process should
level on priority mental disorders and their day to day
be stressed. Counseling should be an integral component
supervision, along with monthly review of the mental health
in each step. Proper mechanism should be evolved for
programme during the regular review of other health
drop out cases by ensuring availability of psychiatric social
programmes will definitely play a significant role in proper
worker and community nurse to follow up the drop out
implementation of DMHP. By this process, the mental
cases. The involvement of PRIs and local leaders can
health programme will not be seen as separate from the
make this much easier. The programme should emphasize
other health programmes. Mental health services at
on promotive and preventive aspects rather than curative
subcenter, PHC, CHC level should be strengthened so
only. So, suicide prevention, workplace stress
that the services become more accessible to the patients7.
management, school and college counseling services etc
Most of the DMHP failed to provide disability certification
should be incorporated at each level. Though there is
on a monthly basis. The involvement of Panchayat Raj
enough discussion about integration/ coordination of
institutions and voluntary organizations for community level
mental health programme with other health programme
rehabilitation of patients, including the setting up of support
like. ICDS, NRHM this is far from reality. There is urgent
to self-help groups is almost nonexistent.
need for regular inflow of medicines and availability at
Central Government in consultation with State
primary level. Drug procurement mechanism should be
Governments should ensure continuity of DMHP
streamlined to reduce delay in procurement and achieve
beyond the plan period by an undertaking to this effect
economy of scale (e.g. Tamil Nadu model) 7.
and integration of mental health services in State and
District Programme Implementation Plan (PIP). The
There should be regular review of the case Records by
fund allotment should be regular and timely. Initiation
the DMHP officer/ team for completeness of the records;
of programme should be ensured in time bound manner
correctness of the diagnosis, appropriateness of the
after the receipt of funds7. The salary of staff should
medicine used, appropriateness of the dosage of the
be revised. The salary of DMHP psychiatrist and the
medicine, follow-up records-completeness,
faculties under NMHP is so less that it is unlikely that
appropriateness of changes in the treatment, Medicine
these posts will be filled up even if there is sufficient
stock etc. The record and work of health workers should
be evaluated and their problem should be discussed. Ministry of Health and Family Welfare, New Delhi.Dtd.24
Most of the DMHP failed to initiate any programme for April 2009
support of the caregivers. Community resources like 7. Indian Council of Marketing Research, Evaluation of
District Mental health Programme-final report, 2009, New
families were not accorded due importance. Most
Delhi
important is that the nodal officer should be a psychiatrist.
8. Srinivasa Murthy R and Wig N.N. Evaluation of the
Non Psychiatrist nodal officers overburdened with other progress in mental health in India since independence. In,
responsibilities and having no technical expertise failed to Mental Health in India (Eds) Purnima Mane and Katy
Gandevia) Tata Institute of Social Sciences, 1993; pp. 387-
give justice to their responsibilities particularly when the
405.
central guidance is inadequate.
9. http://www.mohfw.nic.in/Guidelines_NMHP_final.pdf
It was indeed a good idea to expand this programme
to each districts of the country during 11th five year
plan period. But it has not been possible due to flaws that
are discussed already. The core idea of integration with
the general health service is not implemented at the
operational level. With proper monitoring and active
involvement of all sections of people definitely DMHP
can lessen the sufferings of millions of mentally ill and their
families and promote mental health in the society.
REFERENCES
1. Government of India. National Mental Health Programme
for India. Ministry of Health and Family Welfare, New
Delhi.1982
2. Community Mental health News, District Mental health
Programme, 1988, Issue No.11 and 12, 1-16.
3. Government of India. In Annual report, National Mental
Health Programme for India. 2000 Ministry of Health and
Family Welfare, New Delhi.
4. http://nihfw.org
5. http://india.gov.in/sectors/health_family/mental_health.php
6. Government of India. Implimentation of National Mental
Health Programme during the Eleventh Five Year Plan-
approval of the manpower development component,
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Insight into Schizophrenia: A comparative study
between patients and family members
Shyamanta Das*; Dipesh Bhagabati**, Uddip Talukdar***
*Department of Psychiatry, Silchar Medical College Hospital, Silchar, Assam, ** Department of Psychiatry,
Gauhati Medical College Hospital, Assam,*** Department of Psychiatry, Himalayan Institute of Medical
Sciences, Jolly-Grant, Dehradun, Uttaranchal,
ABSTRACT
Background: Despite the recognition of the role that sociocultural factors play in the process of acquiring
insight, recent research on this issue is scare. Aim of the present study was to compare patients’ insight with
family members’ insight.
Method: 50 patients with schizophrenia (International Statistical Classification of Diseases and Related Health
Problems – Tenth Revision – ICD-10) undergoing treatment and members of their families were interviewed
using the Schedule for Assessment of Insight (SAI). It was a cross-sectional study.
Results: Family members performed better than patients in the total and partial SAI scores [total: 11 to 6.7 (p
< 0.0001); adherence: 3.84 to 2.7 (p < 0.0001); recognition of illness: 4.54 to 2.84 (p < 0.0001); relabeling of
psychotic phenomena: 2.62 to 1.16 (p < 0.0001)]. However, when the scores were correlated for each patient-
family member pair, the partial scores had positive correlations (adherence r = 0.07191; recognition of illness r
= 0.1632; relabeling of psychotic phenomena r = 0.2052).
Conclusion: There was a positive correlation between the scores of family members and patients regarding
adherence, recognition of illness and the ability to relabel psychotic phenomena as abnormal. This might be
understood as a stronger influence of sociocultural factors in these dimensions. The fact that family members
were not assessed for the presence of psychopathology is a limitation of this study.
Keywords: Schizophrenia. Awareness. Self concept. Family relations. Social environment.
INTRODUCTION
Schizophrenics (CCHS). In addition, lack of insight
Insight is ability to understand the true cause and
has been included among the 12 symptoms that have
meaning of a situation (such as a set of symptoms).
the highest power to discriminate schizophrenia from
Impaired insight is diminished ability to understand
other psychoses and depression3. It has been shown
the objective reality of a situation 1.
that patients with better insight are more likely to
A lack of insight was the most prevalent symptom of
present better adherence to treatment4, 5. Lack of
schizophrenia found in two seminal international
insight has been correlated with worse outcome6, more
studies, the International Pilot Study of Schizophrenia
admissions6, worse psychosocial functioning7, 8,
(IPSS) 2 and the Classification of Chronic Hospitalized
reduced success rates in outpatient treatment of
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123D4r5.6 S78h9y0a1m23a4n5t6a7 8D90a1s23456789012123456789012345 symptoms and the seeking of treatment10.
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12345678901234567890123456789012123456789012345 The relationship between insight and psychopathology is
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12345678901234567890123456789012123456789012345 controversial. Some authors have proposed that insight
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