Pratap Sharan - Academia.edu (original) (raw)

Papers by Pratap Sharan

Psychiatric Services, 2001

The British Journal of Psychiatry, 2006

Epidemiological studies demonstrate that child and adolescent mental health problems are very com... more Epidemiological studies demonstrate that child and adolescent mental health problems are very common, distressing, disabling and persistent. Children and adolescents ’ mental illnesses differ in terms of psychopathological patterns, comorbidities and response to treatment in many ways from those of adults; hence specific training and interventions are required for managing them properly. However, the WHO Atlas on Child and Adolescent Mental Health Resources has documented an almost total failure of countries, especially low-income countries, in providing adequate policy, training and services for child and adolescent mental health.1 Geographic and economic barriers (the majority of relevant professionals are concentrated in large cities either at university centers or inside the private system) further render access to the limited services difficult. In a low-income country like India, where just about 100-125 psychiatrists are devoting time specifically to child and adolescent ment...

Children and adolescents constitute a large proportion of the population in India (about 40 % of ... more Children and adolescents constitute a large proportion of the population in India (about 40 % of the population is below 16 years of age). Estimates, worldwide, indicate that 10%-20% of children and adolescents develop psychiatric disorders; and approximately 5%-12 % suffer from functionally impairing conditions.1,2 However, for most young people, mental health and substance abuse problems are either unrecognized or inadequately treated. Even in high-income countries, only about 20 % of emotionally disturbed children and adolescents receive mental health care and only a small fraction of them are managed by child and adolescent psychiatrists.3 Without intervention, child and adolescent psychiatric disorders frequently continue into adulthood with significant costs (distress, dysfunction, economic and social) to individuals, families and the society. Early identification and treatment of children with mental health problems has the potential to reduce the burden of mental illness and...

Estimates indicate that 10%-20 % of children and adolescents develop psychiatric disorders; and a... more Estimates indicate that 10%-20 % of children and adolescents develop psychiatric disorders; and approximately 5%-12 % suffer from functionally impairing conditions.1,2 However, for most young people, mental health and substance abuse problems are either unrecognized or inadequately treated. Even in high-income countries, only about 20 % of emotionally disturbed children and adolescents receive some kind of mental health care and only a small fraction of them receive evaluation and treatment by child and adolescent psychiatrists.3 In low- and middle-income LAMI countries, attention on child and adolescent mental health workforce has been lacking. There is a dearth of sub/super-specialists in child and adolescent mental health. Children and adolescents needing mental health care are mostly attended by general physicians (e.g. those with Bachelor of Medicine and Bachelor of Surgery degree), family physicians, pediatricians, and mental health professionals; who usually lack specific tra...

Mental retardation or intellectual disability is a problem of great importance for public health,... more Mental retardation or intellectual disability is a problem of great importance for public health, education, employment and human rights.1 Persons with conditions causing cognitive disabilities are frequently the most vulnerable group of the society and, on many occasions, encounter stigma, are exposed to human rights violations and deprived of minimum services and dignity.2-4 They are often unable to access basic health and educational services, and are excluded from ordinary social relations. Caregivers as well as people with conditions causing cognitive disabilities are aware of the stigma of their disability and its social consequences. They attempt to hide the disability as a way of avoiding stigmatization.2-4 The terms used to describe individual differences in cognitive abilities have often become controversial due to the association of such terms with issues related to stigma, prejudice, and social discrimination. The ICD-10 and DSM-IV-TR use the term mental retardation to d...

Globally substance abuse is a major public health and social concern. With changes in lifestyle, ... more Globally substance abuse is a major public health and social concern. With changes in lifestyle, globalisation in substance marketing, the erosion of powers of censure that have existed in traditional societies, and an increased acceptance of such substances it is clear that their use is growing in low- and middle-income (LAMI) countries, particularly in the children, adolescents and the youth. In 2002, the use of alcohol and illicit drugs was estimated to contribute 4 % of the disease burden in the 15–29 years age group in LAMI countries.1 Also, problems associated with use, e.g. deaths and the spread of infectious disease are on the rise.2,3 In addition to acute effects and disorders, substance use in children and adolescents can harm the healthy development of the body, brain, and behaviour.4 There is thus an obvious need to target adolescents in order to reverse this trend. Preventive efforts in adolescence will have the additional spin-off of reduction in substance use in adult...

The prevalence of intellectual disability is an estimated to be 1-4%. Etiological factors such as... more The prevalence of intellectual disability is an estimated to be 1-4%. Etiological factors such as malnutrition, lack of perinatal care, and exposure to toxic and infectious agents, which are more common in low- and middle-income (LAMI) countries, possibly contribute to a higher prevalence of intellectual disabilities in these countries.1-5 People with intellectual disabilities have a greater risk of experiencing physical and mental health problems and are vulnerable to chronic disease at an earlier age.2,6 While the disease burden due to intellectual disabilities has not been estimated, it is known that 1% of the global burden of diseases is due to lead exposure derived intellectual disability and cardiovascular diseases alone.7 In addition, persons with intellectual disabilities are frequently the most vulnerable group of the society and, on many occasions, are exposed to human rights violations and deprived of minimum services and dignity. They are often unable to access basic hea...

Personality disorders (PDs) arise from core psychopathology of interpersonal relationships and un... more Personality disorders (PDs) arise from core psychopathology of interpersonal relationships and understanding of self and others.1 The distorted representations of self and others, as well as unhealthy relationships that characterize persons with various PDs, indicate the possibility that persons with PDs have insecure attachment. Attachment John Bowlby postulated that human beings are under pressures of natural selection to evolve behavioural patterns since early in life, such as proximity seeking, smiling, and clinging, that evoke reciprocal caretaking behaviour in adults, such as touching, holding, and soothing.2-4 These behaviours promote the development of an enduring, emotional tone between infant and caregiver, which constitutes attachment. From these parental responses, the infant develops internal models of the self and others that function as templates for later relationships and beliefs including expectations of acceptance and rejection. A secure attachment should engender...

attention to autistic disorders.1 Autism is a serious, lifelong developmental disability characte... more attention to autistic disorders.1 Autism is a serious, lifelong developmental disability characterized by significant impairments in reciprocal social interactions and communication skills, as well as a restricted/repetitive pattern of interests and/or behaviors. During the 1960s, it was generally assumed that autism was a rare seriously handicapping disorder, usually associated with intellectual disability and constituted a condition that was qualitatively distinct from variations in social and communicative competence within the normal range.1-3 Both genetic and epidemiological research findings have forced a change in concept as a result of the evidence that autistic like abnormalities are common and often occur in individuals with normal intelligence, particularly in first degree relatives of individuals with autism.3 The heritability or underlying genetic liability of autism spectrum disorder is about 90 %- the highest figure among all multi-factorial child psychiatric disorder...

Richard Horton, the editor of Lancet states that the open access movement is about a historic rea... more Richard Horton, the editor of Lancet states that the open access movement is about a historic realignment of power in scientific and medical publishing.1 Open access literature is digital, online, free of charge and free of copyright and licensing restrictions. Such literature is available for free on the public internet, permitting users to read, download, copy, distribute, print, search or link to full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose without financial, legal or technical barriers other than those inseparable from gaining access to the internet. The only role for copyright in this domain, is to give authors control over the integrity of their work and the right to be properly acknowledged and cited.2 The debate At the heart of the debate on open access to scientific literature is the premise that scientific and technical information is an archetypal global public good which should be freely av...

Inadequate attention has been paid to public health issues related to violence and mental illness... more Inadequate attention has been paid to public health issues related to violence and mental illness in most developing societies. The burden: Mentally ill patients have a slightly higher propensity for violence compared to people in general. On the other hand, violent victimization of mentally ill patients is also common. The resources: Most countries do not have in place the system required to reduce the impact of violence by and on mentally ill. Suggestions: For effective management of violence in relation to mental illness there is a need to focus on mental health services (including training and collaborative mechanisms) in both criminal justice system and community treatment. Some innovations in the field like police-based specialized mental health response, mental health courts, involuntary out-patient commitment, and psychiatric security review boards are described. Finally, there is a need for considerable public education to increase informed opinion and reduce stigma in rela...

Poverty and Mental Health of Children and Adolescents Pratap Sharan, MD, PhD Address for Correspo... more Poverty and Mental Health of Children and Adolescents Pratap Sharan, MD, PhD Address for Correspondence: Professor Pratap Sharan, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi-110029. Email: pratapsharan@gmail.com ___________________________________________________________________________________________ The bidirectional relationship between poor mental health and the experience of poverty and deprivation has been established in adults. Poverty can lead to distress or act as a risk factor for mental illnesses like anxiety and depression. On the other hand, mental disorders also cause an enormous financial burden on individuals, their families and society. Owing to the vulnerable and dependent position of children and adolescents, social determinants are likely to play a still greater role in their development and mental health. There are multiple approaches to measuring poverty. Gordon et al used the measures of deprivation of basic needs, availabilit...

Personality disorders (PDs) arise from core psychopathology of interpersonal relationships and un... more Personality disorders (PDs) arise from core psychopathology of interpersonal relationships and understanding of self and others. 1 The distorted representations of self and others, as well as unhealthy relationships that characterize persons with various PDs, indicate the possibility that persons with PDs have insecure attachment. Attachment John Bowlby postulated that human beings are under pressures of natural selection to evolve behavioural patterns since early in life, such as proximity seeking, smiling, and clinging, that evoke reciprocal caretaking behaviour in adults, such as touching, holding, and soothing. 2-4 These behaviours promote the development of an enduring, emotional tone between infant and caregiver, which constitutes attachment. From these parental responses, the infant develops internal models of the self and others that function as templates for later relationships and beliefs including expectations of acceptance and rejection. A secure attachment should engender a positive, coherent, and consistent self-image combined with a sense of trust on others and a positive expectation of acceptance and response. The empirical assessment of patterns of attachment behaviours began with Ainsworth and colleagues' typology of infant attachment behaviours toward their mothers when under stress. 5 Under this typology, there were three organizations: secure, avoidant, and ambivalent attachment. The 'avoidant' typology is seen in children whose caregivers are consistently inaccessible or rejecting. These children tend to develop a strategy of minimizing the output of attachment behaviors, and appear to have little need for the attachment figure and show little overt distress, although they are angered and made anxious by rejection. Children of inconsistently available caretakers develop a strategy of maximizing attachment behaviors, because they are fearful of the caregiver's potential inaccessibility. Efforts by the caregiver to soothe these 'ambivalent' children are not always welcomed. In high-risk or psychiatric samples, a fourth behavioural pattern of attachment labelled 'disorganized/disoriented' was described by Main and Solomon. 6 These children have no coherent strategy to respond to separation or reunion. Lyons-Ruth and Jacobvitz distinguished normal processes of separation-individuation in early development from the disorganized conflict behaviours displayed toward attachment figures by toddlers at risk for later psychopathology. 7 They argued that these toddlers are never able to integrate positive and negative aspects of self and object representations and to internalize images of mother for object constancy. Although Bowlby was primarily interested in young children, he maintained that the core functions of the attachment system continue throughout the life span. Longitudinal studies have reported a remarkable stability of attachment classification although this stability is open to revision by later life experiences. 8-10 The adult strategies of attachment parallel to infant strategies were described by Main and Goldwyn. 11 Flexible and coherent discourse

Over the years it has become apparent that mental health disorders constitute a significant publi... more Over the years it has become apparent that mental health disorders constitute a significant public health problem. The World Health Organisation (WHO) in its World Health Report of 2001 drew attention to the fact that all over the world nearly 10% of total adult population, that is more than 450 million people worldwide, suffer from a mental or a behavioural disorder. Not only are mental health disorders very common, they are also associated with a variety of functional impairments, emotional distress, social disruptions and physical health problems. The same WHO report found that four mental disorders were among the ten leading causes of disability among people all over the world, and that one in four families suffered from the burden of caring for a mentally ill member. Despite the immense size of the problem, resources allocated for treatment and prevention of these disorders are usually inadequate, particularly in low-income countries such as India. With a population of over one...

Indian Journal of Psychiatry, 1998

Aim To study the profile of psychiatric disorders in medical-surgical inpatients so that subpopul... more Aim To study the profile of psychiatric disorders in medical-surgical inpatients so that subpopulations with particular mental health care needs could be identified. Findings: a retrospective analysis of 1245 referrals seen over seven years showed that psychiatric profiles in referrals from different sub-populations divided according to age, gender, source of referral and medical-surgical diagnosis, were quite dissimilar. It was felt that non-recognition of specific needs of these client groups had led to low referral rates (0.65%), and to referral practices wherein the needs of the consultee (referral for disturbed behaviour) and the consultant (management by pharmacologic agents) and certain social biases (low referrals for suicide attempts) had taken precedence over the requirements of optimal management of the cases. Implications : Financial and manpower constraints limit the advocacy for a superspecialist orientation, as a policy in India. It is recommended that while continuin...

The National medical journal of India, 2007

IMSEAR Digital Repository, ...

The challenge of producing a classificatory system that is truly representative of different regi... more The challenge of producing a classificatory system that is truly representative of different regions and cultural variations is difficult. This can be conceptualized as an ongoing process, achievable by constant commitment in this regard from various stakeholders over successive generations of the classificatory systems. The objective of this article is to conduct a qualitative review of the process and outcome of the efforts that resulted in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders becoming a global classification. The ICD-11 represents an important, albeit iterative, advance in the classification of mental, behavioural and neurodevelopmental disorders. Significant changes have been incorporated in this regard, such as the introduction of new, culturally-relevant categories, modifications of the diagnostic guidelines, based on culturally informed data and the incorporation of culture-related features for specific disorders. Notwithstanding, ...

Psychiatric Services, 2001

The British Journal of Psychiatry, 2006

Epidemiological studies demonstrate that child and adolescent mental health problems are very com... more Epidemiological studies demonstrate that child and adolescent mental health problems are very common, distressing, disabling and persistent. Children and adolescents ’ mental illnesses differ in terms of psychopathological patterns, comorbidities and response to treatment in many ways from those of adults; hence specific training and interventions are required for managing them properly. However, the WHO Atlas on Child and Adolescent Mental Health Resources has documented an almost total failure of countries, especially low-income countries, in providing adequate policy, training and services for child and adolescent mental health.1 Geographic and economic barriers (the majority of relevant professionals are concentrated in large cities either at university centers or inside the private system) further render access to the limited services difficult. In a low-income country like India, where just about 100-125 psychiatrists are devoting time specifically to child and adolescent ment...

Children and adolescents constitute a large proportion of the population in India (about 40 % of ... more Children and adolescents constitute a large proportion of the population in India (about 40 % of the population is below 16 years of age). Estimates, worldwide, indicate that 10%-20% of children and adolescents develop psychiatric disorders; and approximately 5%-12 % suffer from functionally impairing conditions.1,2 However, for most young people, mental health and substance abuse problems are either unrecognized or inadequately treated. Even in high-income countries, only about 20 % of emotionally disturbed children and adolescents receive mental health care and only a small fraction of them are managed by child and adolescent psychiatrists.3 Without intervention, child and adolescent psychiatric disorders frequently continue into adulthood with significant costs (distress, dysfunction, economic and social) to individuals, families and the society. Early identification and treatment of children with mental health problems has the potential to reduce the burden of mental illness and...

Estimates indicate that 10%-20 % of children and adolescents develop psychiatric disorders; and a... more Estimates indicate that 10%-20 % of children and adolescents develop psychiatric disorders; and approximately 5%-12 % suffer from functionally impairing conditions.1,2 However, for most young people, mental health and substance abuse problems are either unrecognized or inadequately treated. Even in high-income countries, only about 20 % of emotionally disturbed children and adolescents receive some kind of mental health care and only a small fraction of them receive evaluation and treatment by child and adolescent psychiatrists.3 In low- and middle-income LAMI countries, attention on child and adolescent mental health workforce has been lacking. There is a dearth of sub/super-specialists in child and adolescent mental health. Children and adolescents needing mental health care are mostly attended by general physicians (e.g. those with Bachelor of Medicine and Bachelor of Surgery degree), family physicians, pediatricians, and mental health professionals; who usually lack specific tra...

Mental retardation or intellectual disability is a problem of great importance for public health,... more Mental retardation or intellectual disability is a problem of great importance for public health, education, employment and human rights.1 Persons with conditions causing cognitive disabilities are frequently the most vulnerable group of the society and, on many occasions, encounter stigma, are exposed to human rights violations and deprived of minimum services and dignity.2-4 They are often unable to access basic health and educational services, and are excluded from ordinary social relations. Caregivers as well as people with conditions causing cognitive disabilities are aware of the stigma of their disability and its social consequences. They attempt to hide the disability as a way of avoiding stigmatization.2-4 The terms used to describe individual differences in cognitive abilities have often become controversial due to the association of such terms with issues related to stigma, prejudice, and social discrimination. The ICD-10 and DSM-IV-TR use the term mental retardation to d...

Globally substance abuse is a major public health and social concern. With changes in lifestyle, ... more Globally substance abuse is a major public health and social concern. With changes in lifestyle, globalisation in substance marketing, the erosion of powers of censure that have existed in traditional societies, and an increased acceptance of such substances it is clear that their use is growing in low- and middle-income (LAMI) countries, particularly in the children, adolescents and the youth. In 2002, the use of alcohol and illicit drugs was estimated to contribute 4 % of the disease burden in the 15–29 years age group in LAMI countries.1 Also, problems associated with use, e.g. deaths and the spread of infectious disease are on the rise.2,3 In addition to acute effects and disorders, substance use in children and adolescents can harm the healthy development of the body, brain, and behaviour.4 There is thus an obvious need to target adolescents in order to reverse this trend. Preventive efforts in adolescence will have the additional spin-off of reduction in substance use in adult...

The prevalence of intellectual disability is an estimated to be 1-4%. Etiological factors such as... more The prevalence of intellectual disability is an estimated to be 1-4%. Etiological factors such as malnutrition, lack of perinatal care, and exposure to toxic and infectious agents, which are more common in low- and middle-income (LAMI) countries, possibly contribute to a higher prevalence of intellectual disabilities in these countries.1-5 People with intellectual disabilities have a greater risk of experiencing physical and mental health problems and are vulnerable to chronic disease at an earlier age.2,6 While the disease burden due to intellectual disabilities has not been estimated, it is known that 1% of the global burden of diseases is due to lead exposure derived intellectual disability and cardiovascular diseases alone.7 In addition, persons with intellectual disabilities are frequently the most vulnerable group of the society and, on many occasions, are exposed to human rights violations and deprived of minimum services and dignity. They are often unable to access basic hea...

Personality disorders (PDs) arise from core psychopathology of interpersonal relationships and un... more Personality disorders (PDs) arise from core psychopathology of interpersonal relationships and understanding of self and others.1 The distorted representations of self and others, as well as unhealthy relationships that characterize persons with various PDs, indicate the possibility that persons with PDs have insecure attachment. Attachment John Bowlby postulated that human beings are under pressures of natural selection to evolve behavioural patterns since early in life, such as proximity seeking, smiling, and clinging, that evoke reciprocal caretaking behaviour in adults, such as touching, holding, and soothing.2-4 These behaviours promote the development of an enduring, emotional tone between infant and caregiver, which constitutes attachment. From these parental responses, the infant develops internal models of the self and others that function as templates for later relationships and beliefs including expectations of acceptance and rejection. A secure attachment should engender...

attention to autistic disorders.1 Autism is a serious, lifelong developmental disability characte... more attention to autistic disorders.1 Autism is a serious, lifelong developmental disability characterized by significant impairments in reciprocal social interactions and communication skills, as well as a restricted/repetitive pattern of interests and/or behaviors. During the 1960s, it was generally assumed that autism was a rare seriously handicapping disorder, usually associated with intellectual disability and constituted a condition that was qualitatively distinct from variations in social and communicative competence within the normal range.1-3 Both genetic and epidemiological research findings have forced a change in concept as a result of the evidence that autistic like abnormalities are common and often occur in individuals with normal intelligence, particularly in first degree relatives of individuals with autism.3 The heritability or underlying genetic liability of autism spectrum disorder is about 90 %- the highest figure among all multi-factorial child psychiatric disorder...

Richard Horton, the editor of Lancet states that the open access movement is about a historic rea... more Richard Horton, the editor of Lancet states that the open access movement is about a historic realignment of power in scientific and medical publishing.1 Open access literature is digital, online, free of charge and free of copyright and licensing restrictions. Such literature is available for free on the public internet, permitting users to read, download, copy, distribute, print, search or link to full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose without financial, legal or technical barriers other than those inseparable from gaining access to the internet. The only role for copyright in this domain, is to give authors control over the integrity of their work and the right to be properly acknowledged and cited.2 The debate At the heart of the debate on open access to scientific literature is the premise that scientific and technical information is an archetypal global public good which should be freely av...

Inadequate attention has been paid to public health issues related to violence and mental illness... more Inadequate attention has been paid to public health issues related to violence and mental illness in most developing societies. The burden: Mentally ill patients have a slightly higher propensity for violence compared to people in general. On the other hand, violent victimization of mentally ill patients is also common. The resources: Most countries do not have in place the system required to reduce the impact of violence by and on mentally ill. Suggestions: For effective management of violence in relation to mental illness there is a need to focus on mental health services (including training and collaborative mechanisms) in both criminal justice system and community treatment. Some innovations in the field like police-based specialized mental health response, mental health courts, involuntary out-patient commitment, and psychiatric security review boards are described. Finally, there is a need for considerable public education to increase informed opinion and reduce stigma in rela...

Poverty and Mental Health of Children and Adolescents Pratap Sharan, MD, PhD Address for Correspo... more Poverty and Mental Health of Children and Adolescents Pratap Sharan, MD, PhD Address for Correspondence: Professor Pratap Sharan, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi-110029. Email: pratapsharan@gmail.com ___________________________________________________________________________________________ The bidirectional relationship between poor mental health and the experience of poverty and deprivation has been established in adults. Poverty can lead to distress or act as a risk factor for mental illnesses like anxiety and depression. On the other hand, mental disorders also cause an enormous financial burden on individuals, their families and society. Owing to the vulnerable and dependent position of children and adolescents, social determinants are likely to play a still greater role in their development and mental health. There are multiple approaches to measuring poverty. Gordon et al used the measures of deprivation of basic needs, availabilit...

Personality disorders (PDs) arise from core psychopathology of interpersonal relationships and un... more Personality disorders (PDs) arise from core psychopathology of interpersonal relationships and understanding of self and others. 1 The distorted representations of self and others, as well as unhealthy relationships that characterize persons with various PDs, indicate the possibility that persons with PDs have insecure attachment. Attachment John Bowlby postulated that human beings are under pressures of natural selection to evolve behavioural patterns since early in life, such as proximity seeking, smiling, and clinging, that evoke reciprocal caretaking behaviour in adults, such as touching, holding, and soothing. 2-4 These behaviours promote the development of an enduring, emotional tone between infant and caregiver, which constitutes attachment. From these parental responses, the infant develops internal models of the self and others that function as templates for later relationships and beliefs including expectations of acceptance and rejection. A secure attachment should engender a positive, coherent, and consistent self-image combined with a sense of trust on others and a positive expectation of acceptance and response. The empirical assessment of patterns of attachment behaviours began with Ainsworth and colleagues' typology of infant attachment behaviours toward their mothers when under stress. 5 Under this typology, there were three organizations: secure, avoidant, and ambivalent attachment. The 'avoidant' typology is seen in children whose caregivers are consistently inaccessible or rejecting. These children tend to develop a strategy of minimizing the output of attachment behaviors, and appear to have little need for the attachment figure and show little overt distress, although they are angered and made anxious by rejection. Children of inconsistently available caretakers develop a strategy of maximizing attachment behaviors, because they are fearful of the caregiver's potential inaccessibility. Efforts by the caregiver to soothe these 'ambivalent' children are not always welcomed. In high-risk or psychiatric samples, a fourth behavioural pattern of attachment labelled 'disorganized/disoriented' was described by Main and Solomon. 6 These children have no coherent strategy to respond to separation or reunion. Lyons-Ruth and Jacobvitz distinguished normal processes of separation-individuation in early development from the disorganized conflict behaviours displayed toward attachment figures by toddlers at risk for later psychopathology. 7 They argued that these toddlers are never able to integrate positive and negative aspects of self and object representations and to internalize images of mother for object constancy. Although Bowlby was primarily interested in young children, he maintained that the core functions of the attachment system continue throughout the life span. Longitudinal studies have reported a remarkable stability of attachment classification although this stability is open to revision by later life experiences. 8-10 The adult strategies of attachment parallel to infant strategies were described by Main and Goldwyn. 11 Flexible and coherent discourse

Over the years it has become apparent that mental health disorders constitute a significant publi... more Over the years it has become apparent that mental health disorders constitute a significant public health problem. The World Health Organisation (WHO) in its World Health Report of 2001 drew attention to the fact that all over the world nearly 10% of total adult population, that is more than 450 million people worldwide, suffer from a mental or a behavioural disorder. Not only are mental health disorders very common, they are also associated with a variety of functional impairments, emotional distress, social disruptions and physical health problems. The same WHO report found that four mental disorders were among the ten leading causes of disability among people all over the world, and that one in four families suffered from the burden of caring for a mentally ill member. Despite the immense size of the problem, resources allocated for treatment and prevention of these disorders are usually inadequate, particularly in low-income countries such as India. With a population of over one...

Indian Journal of Psychiatry, 1998

Aim To study the profile of psychiatric disorders in medical-surgical inpatients so that subpopul... more Aim To study the profile of psychiatric disorders in medical-surgical inpatients so that subpopulations with particular mental health care needs could be identified. Findings: a retrospective analysis of 1245 referrals seen over seven years showed that psychiatric profiles in referrals from different sub-populations divided according to age, gender, source of referral and medical-surgical diagnosis, were quite dissimilar. It was felt that non-recognition of specific needs of these client groups had led to low referral rates (0.65%), and to referral practices wherein the needs of the consultee (referral for disturbed behaviour) and the consultant (management by pharmacologic agents) and certain social biases (low referrals for suicide attempts) had taken precedence over the requirements of optimal management of the cases. Implications : Financial and manpower constraints limit the advocacy for a superspecialist orientation, as a policy in India. It is recommended that while continuin...

The National medical journal of India, 2007

IMSEAR Digital Repository, ...

The challenge of producing a classificatory system that is truly representative of different regi... more The challenge of producing a classificatory system that is truly representative of different regions and cultural variations is difficult. This can be conceptualized as an ongoing process, achievable by constant commitment in this regard from various stakeholders over successive generations of the classificatory systems. The objective of this article is to conduct a qualitative review of the process and outcome of the efforts that resulted in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders becoming a global classification. The ICD-11 represents an important, albeit iterative, advance in the classification of mental, behavioural and neurodevelopmental disorders. Significant changes have been incorporated in this regard, such as the introduction of new, culturally-relevant categories, modifications of the diagnostic guidelines, based on culturally informed data and the incorporation of culture-related features for specific disorders. Notwithstanding, ...

Reimagining Psychiatric Epidemiology in a Global Frame: toward a social and conceptual history, 2022