Mudasir Firdosi | King's College London (original) (raw)

Papers by Mudasir Firdosi

Research paper thumbnail of Editorial: Prolonged grief disorder: vulnerability and resilience

Frontiers in psychiatry, Feb 27, 2024

Research paper thumbnail of Socio-demographic Correlates of Substance Use Disorder in Patients Seeking De-addiction Services in Kashmir India-a Cross Sectional Study

European Psychiatry, Mar 1, 2015

Background: Kashmir valley is thought to be one of the hardest hit places with drug use and the s... more Background: Kashmir valley is thought to be one of the hardest hit places with drug use and the scenario worsened by the prevailing turmoil. The present study was undertaken to find the epidemiological profile and pattern of drug use in patients seeking treatment at De-addiction Centres in Srinagar India. Methods: The present cross sectional study, was conducted at two Drug De-addiction and treatment Centers in Srinagar. Total of 125 Substance Use Disorder Patients were interviewed by using pretested semi-structured proforma, emphasizing on socio-demographic profile and reasons for starting use of substance. Results: Majority (50.4%) of patients belonged to young and productive age group. Most of the patients started taking substances in the age group of 10-19 years and more so in case of nicotine (76.8%), volatile substances (76.9%) and cannabis (70.5%). Besides nicotine (89.6%), the most common substances used were cannabis (48.8%), codeine (48%), propoxyphene (37.6%), alcohol (36.8%) and benzodiazepines (36%). Peer pressure was the most common (72.8%) reason for starting the use of substance. Conclusion: There is need for further studies to find the community prevalence of drug use. The service provision is very limited restricted to the capital city and none in the rural areas. There is a worrying trend of early age of initiation with adverse consequences including dropping out of school. The control of prescription drug use is another major issue which needs to be addressed. It is also worrying that female drug users are not able to seek help due to lack of appropriate facilities.

Research paper thumbnail of Acute Psychotic Presentation in Syphilis - the Great Imitator is Back

Psychiatria Danubina, Jun 25, 2021

Research paper thumbnail of Effect of Vitamin D Supplementation on Outcomes in People With Early Psychosis

JAMA network open, Dec 28, 2021

Research paper thumbnail of Clinical correlates of vitamin D deficiency in established psychosis

BMC Psychiatry, Mar 22, 2016

Background: Suboptimal vitamin D levels have been identified in populations with psychotic disord... more Background: Suboptimal vitamin D levels have been identified in populations with psychotic disorders. We sought to explore the relationship between vitamin D deficiency, clinical characteristics and cardiovascular disease risk factors among people with established psychosis. Methods: Vitamin D levels were measured in 324 community dwelling individuals in England with established psychotic disorders, along with measures of mental health, cardiovascular risk and lifestyle choices. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D (25-OHD) levels below 10 ng/ml (equivalent to <25 nmol/L) and "sufficient" Vitamin D as above 30 ng/ml (>50 nmol/L). Results: The mean 25-OHD serum level was 12.4 (SD 7.3) ng/ml, (range 4.0-51.7 ng/ml). Forty nine percent (n = 158) were vitamin D deficient, with only 14 % (n = 45) meeting criteria for sufficiency. Accounting for age, gender, ethnicity and season of sampling, serum 25-OHD levels were negatively correlated with waist circumference (r = −0.220, p < 0.002), triglycerides (r = −0.160, p = 0.024), total cholesterol (r = −0.144, p = 0.043), fasting glucose (r = −0.191, p = 0.007), HbA1c (r = −0.183, p = 0.01), and serum CRP levels (r = −0.211, p = 0.003) and were linked to the presence of metabolic syndrome. Conclusions: This is the largest cross sectional study of serum 25-OHD levels in community dwelling individuals with established psychosis, indicating a high level of vitamin D deficiency. Lower vitamin D levels are associated with increased cardiovascular disease risk factors and in particular metabolic syndrome. Further research is needed to define appropriate protocols for vitamin D testing and supplementation in practice to see if this can improve cardiovascular disease risk. Trial registration: ISRCTN number is ISRCTN58667926 Date of registration: 23/04/2010

Research paper thumbnail of Length of stay in a home treatment team

British Journal of Psychiatry Open, Jun 1, 2021

data on array-genotyped participants with their specific phenotypic information. Prior to analysi... more data on array-genotyped participants with their specific phenotypic information. Prior to analysis, CNV selection led to the exclusion of any CNV with less than 5 hits in the UK Biobank population. Incidence of each phenotype was based on selfreported diagnoses, questionnaires or hospital ICD-10 diagnoses, with a minimum of 500 cases. Both binary logistic and linear regression were used to assess the incidence of these phenotypes in relation to the CNVs, adjusted for age, sex, and ethnicity as potential cofounders. Result. Overall, 12/13 CNVs were nominally associated with at least one phenotype, including 114/168 possible associations and 54 undetectable associations as not every CNV carrier displayed one of the chosen phenotypes. 41 associations were statistically significant (p < 0.05) and 13 survived Bonferroni Correction (p < 2.98 × 10-4). All significant associations met the expected change except 15q11.2 deletion and any CNV carrier status which showed a decrease in likelihood of addiction. Conclusion. These findings suggest schizophrenia-associated CNV can affect range of psychiatric phenotypes. By building on existing reports, understanding the widespread effects of CNVs in the aetiology and pathogenicty of psychiatric disorders may overtime aid in strengthening our search for more targetted, effective treatments. Many thanks to Professor George Kirov for supervising and supporting this project.

Research paper thumbnail of Facilitated early discharge in Wandsworth

British Journal of Psychiatry Open, Jun 1, 2021

Objective. We report a case of a 58-year-old gentleman who was hospitalised intermittently for on... more Objective. We report a case of a 58-year-old gentleman who was hospitalised intermittently for one year due to treatment resistant schizophrenia. Prior to hospitalisation he had been prescribed standard antipsychotics for decades without full resolution of positive psychotic symptoms. During his final admission lasting six months he was guarded, suspicious, irritable, constantly paced the corridor and displayed thought block and paranoid persecutory delusions. He would not enter the assessment room or allow any blood or ECG monitoring, however, he was compliant with oral medication. He was successfully treated with high dose olanzapine (40mg/day) and was discharged to the community. The aim of this study is to bring awareness and add to the body of evidence for the use of high-dose olanzapine in patients with treatment resistant schizophrenia in whom a trial of clozapine is not possible. Case report. The patient gave written consent for this case report to be written and presented. An extensive literature review was performed and key papers were identified. Discussion focuses on the key areas in the literature. Discussion. This case demonstrates that high-dose olanzapine can be used effectively as an alternative to clozapine in treatment resistant schizophrenia. Conclusion. This case highlights the need for further evaluation of high-dose olanzapine as an alternative to clozapine in patients with treatment-resistant schizophrenia.

Research paper thumbnail of Neuroleptic malignant syndrome: a guide for psychiatrists

BJPsych Advances, Oct 23, 2020

Research paper thumbnail of Royal College examination fees surplus

Research paper thumbnail of Mental health law in India: origins and proposed reforms

BJPsych. International, 2016

Although mental health legislation has existed in India since the mid-19th century, it has gone t... more Although mental health legislation has existed in India since the mid-19th century, it has gone through various changes over the years and the Mental Health Care Bill 2013 has generated a lot of debate and criticism. Despite its shortcomings, the general expectation is that this bill will usher in a new era of proper care and allow people with mental disorders to lead a dignified life.

Research paper thumbnail of Psychological distress in Kashmiri diaspora due to total communication blockade in Kashmir

On 5th August 2019, India imposed a complete communication blockade in Kashmir including telephon... more On 5th August 2019, India imposed a complete communication blockade in Kashmir including telephones, mobiles, and Internet services. Kashmiris living across the world were unable to communicate with families back in Kashmir. We conducted an online study using the HADS (Hospital anxiety and Depression) rating scale to measure the psychological distress in Kashmiri diaspora due to communication blackout and conflict in their country of origin. An online survey questionnaire using the HADS rating scale was circulated to consenting Kashmiri participants over 18 years of age using social networks. A total of 465 responses were anonymously received over 4 weeks. The results show very high scores for both anxiety and depressive symptoms across the whole sample. The results on the anxiety sub-scale showed 89% of the sample scoring above the cut off for “caseness” or “abnormal”. The scores on the depression subscale showed that 88% of the sample fell within the abnormal range. The consequenc...

Research paper thumbnail of Acute psychotic presentation in neurosyphilis

Research paper thumbnail of Depression around the World

Research paper thumbnail of Kashmir Floods-Then and Now

Kashmir valley is famous for its beautiful landscapes; its majestic mountains, rivers that snake ... more Kashmir valley is famous for its beautiful landscapes; its majestic mountains, rivers that snake through this landscape, lakes which are homes in themselves and the lush green floating paddy fields. Kashmir is also equally known for its disasters, both natural and man-made. From the perpetual conflict situation to earthquakes, snowstorms and floods, there are hardly any disasters left, it has not seen. In the September of 2014 Kashmir valley witnessed the worst ever floods of last 100 years. The floods were so sudden and severe that for a few days there was no government in power, as everyone including the then Chief Minister of the state was trapped. All means of communication including the mobile networks went dead. Even the emergency numbers and wireless system of the security machinery could not stand the assault. The sudden drowning of the capital city led to the total collapse of the state administration. It was not that there were not enough warning signs-the incessant rains in upper reaches for days, the hiccups of the meteorological department to offer any proper forecast and advice and finally the failure of the Irrigation and Flood control department to manage the situation, lead to utter devastation. Even on the day when the Srinagar city lost its defences to the rising waters and the banks of river Jhelum breached, the administration kept reassuring the inhabitants that there was nothing to worry about. By this time, the south of the valley was already under water for days and it did not take long for north Kashmir to submerge. The worst hit areas included Srinagar, Anantnag, Kulgam, Pulwama, Shopian and Bandipore in the Kashmir province. Some areas of the Jammu province were also hit by heavy rains and consequent floods especially Poonch and Rajouri. Millions of people were trapped, displaced, unsafe, and worst of all at the mercy of the missing administration. People volunteered, innovated and used whatever means they could, to help and save each other. Srinagar, a city of million people slipped under water and even those high up in the corridors of power, were not able to get any help. Many people were rescued by their distant relatives, coming down from far off villages, days after they found themselves trapped under the rooftops, living on dry rice and whatever they were able to stock, in that moment of chaos. Panic gripped the inhabitants of the valley and their relatives and loved ones living outside Kashmir. The situation was made worse by the lack of communication and the abundance of rumours, as there were hardly any credible sources of information. The water reached up to 18 feet in some areas, flooding the 2 nd floors of the houses and drowning and washing away essentials, valuables, cherished memories – anything that stood in its path. There was social media frenzy, rumours, and a severe criticism of both the state and the central government, for not doing enough to save and help the people in time. Kashmir being a conflict zone, the outcry was worse. Even though the Army and National Disaster Rescue Force (NDRF) claimed to be helping people, there was a severe disquiet from various quarters. Allegations of favouritism and selective rescue and relief were hard to ignore. There was a total lack of coordination between agencies claiming to be working in the rescue operations. Even the Chief Minister went on record in the Supreme Court that the situation was under control and no further help was required in terms of boats and other essentials.

Research paper thumbnail of Psychiatric Comorbidity in Patients Suffering from Post Traumatic Stress Disorder in Kashmir Valley Doctor of Medicine Department of Psychiatry Government Medical College Srinagar, Kashmir

Research paper thumbnail of Effect of Vitamin D Supplementation on Outcomes in People With Early Psychosis

JAMA Network Open, 2021

IMPORTANCE People with psychotic disorders have an increased risk of vitamin D deficiency, which ... more IMPORTANCE People with psychotic disorders have an increased risk of vitamin D deficiency, which is evident during first-episode psychosis (FEP) and associated with unfavorable mental and physical health outcomes. OBJECTIVE To examine whether vitamin D supplementation contributes to improved clinical outcomes in FEP. DESIGN, SETTING, AND PARTICIPANTS This multisite, double-blind, placebo-controlled, parallelgroup randomized clinical trial from the UK examined adults 18 to 65 years of age within 3 years of a first presentation with a functional psychotic disorder who had no contraindication to vitamin D supplementation. A total of 2136 patients were assessed for eligibility, 835 were approached, 686

Research paper thumbnail of Neuroleptic malignant syndrome: a guide for psychiatrists

BJPsych Advances, 2020

SUMMARY Neuroleptic malignant syndrome (NMS) is a rare and potentially fatal adverse reaction to ... more SUMMARY Neuroleptic malignant syndrome (NMS) is a rare and potentially fatal adverse reaction to drugs. In psychiatric practice, it is mainly associated with antipsychotics. The classic presentation is that of hyperpyrexia, muscle rigidity, mental state changes and autonomic instability. Subtle forms are difficult to recognise owing to symptom overlap with other conditions. This article discusses the clinical presentation of the syndrome, its differential diagnosis and use of supportive care, medication and electroconvulsive therapy in its treatment. It also explores prevention of NMS and reinstatement of treatment after an episode. It is stressed that all but the mildest forms of NMS should be considered a medical emergency that is properly managed in an acute hospital.

Research paper thumbnail of Socio-demographic Profile and Psychiatric Comorbidity in Patients with a Diagnosis of Post Traumatic Stress Disorder – A study from Kashmir Valley

Acta Medica International, 2016

Objective: Kashmir valley has witnessed an armed conflict from last three decades, with one of th... more Objective: Kashmir valley has witnessed an armed conflict from last three decades, with one of the studies suggesting the prevalence of trauma exposure of 58.69% in the general population and 15.9% prevalence of Post-traumatic stress disorder (PTSD). The current study was undertaken to explore the socio demographic profile and psychiatric comorbidity in treatment seeking PTSD patients. Methods: This cross-sectional study was conducted at Government Psychiatric Diseases Hospital Srinagar, Kashmir from January 2006 to January 2007. A total of 100 PTSD patients were interviewed and screened for psychiatric comorbidity using DSM-IV diagnostic criteria and their socio demographic details were recorded using a proforma. Results: Most of the patients in our study had multiple comorbidities. Apart from depression and anxiety disorders, somatisation and peri-traumatic dissociation was highly comorbid. Conclusion: Post-Traumatic Stress Disorder is a complex diagnosis with commonly associated psychiatric comorbidity. The high comorbidity in our study sample could be due to repeated exposure to trauma, cultural expression of distress and the ongoing conflict situation which makes the recovery difficult. Recognizing the comorbidities early on may help to achieve an optimal treatment outcome. Finally, the lack of appropriate service provision results in increased morbidity and probable chronicity of the symptoms.

Research paper thumbnail of Clinical correlates of vitamin D deficiency in established psychosis

BMC Psychiatry, 2016

Background: Suboptimal vitamin D levels have been identified in populations with psychotic disord... more Background: Suboptimal vitamin D levels have been identified in populations with psychotic disorders. We sought to explore the relationship between vitamin D deficiency, clinical characteristics and cardiovascular disease risk factors among people with established psychosis. Methods: Vitamin D levels were measured in 324 community dwelling individuals in England with established psychotic disorders, along with measures of mental health, cardiovascular risk and lifestyle choices. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D (25-OHD) levels below 10 ng/ml (equivalent to <25 nmol/L) and "sufficient" Vitamin D as above 30 ng/ml (>50 nmol/L). Results: The mean 25-OHD serum level was 12.4 (SD 7.3) ng/ml, (range 4.0-51.7 ng/ml). Forty nine percent (n = 158) were vitamin D deficient, with only 14 % (n = 45) meeting criteria for sufficiency. Accounting for age, gender, ethnicity and season of sampling, serum 25-OHD levels were negatively correlated with waist circumference (r = −0.220, p < 0.002), triglycerides (r = −0.160, p = 0.024), total cholesterol (r = −0.144, p = 0.043), fasting glucose (r = −0.191, p = 0.007), HbA1c (r = −0.183, p = 0.01), and serum CRP levels (r = −0.211, p = 0.003) and were linked to the presence of metabolic syndrome. Conclusions: This is the largest cross sectional study of serum 25-OHD levels in community dwelling individuals with established psychosis, indicating a high level of vitamin D deficiency. Lower vitamin D levels are associated with increased cardiovascular disease risk factors and in particular metabolic syndrome. Further research is needed to define appropriate protocols for vitamin D testing and supplementation in practice to see if this can improve cardiovascular disease risk. Trial registration: ISRCTN number is ISRCTN58667926 Date of registration: 23/04/2010

Research paper thumbnail of Socio-demographic Correlates of Substance Use Disorder in Patients Seeking De-addiction Services in Kashmir India-a Cross Sectional Study

European Psychiatry, 2015

Background: Kashmir valley is thought to be one of the hardest hit places with drug use and the s... more Background: Kashmir valley is thought to be one of the hardest hit places with drug use and the scenario worsened by the prevailing turmoil. The present study was undertaken to find the epidemiological profile and pattern of drug use in patients seeking treatment at De-addiction Centres in Srinagar India. Methods: The present cross sectional study, was conducted at two Drug De-addiction and treatment Centers in Srinagar. Total of 125 Substance Use Disorder Patients were interviewed by using pretested semi-structured proforma, emphasizing on socio-demographic profile and reasons for starting use of substance. Results: Majority (50.4%) of patients belonged to young and productive age group. Most of the patients started taking substances in the age group of 10-19 years and more so in case of nicotine (76.8%), volatile substances (76.9%) and cannabis (70.5%). Besides nicotine (89.6%), the most common substances used were cannabis (48.8%), codeine (48%), propoxyphene (37.6%), alcohol (36.8%) and benzodiazepines (36%). Peer pressure was the most common (72.8%) reason for starting the use of substance. Conclusion: There is need for further studies to find the community prevalence of drug use. The service provision is very limited restricted to the capital city and none in the rural areas. There is a worrying trend of early age of initiation with adverse consequences including dropping out of school. The control of prescription drug use is another major issue which needs to be addressed. It is also worrying that female drug users are not able to seek help due to lack of appropriate facilities.

Research paper thumbnail of Editorial: Prolonged grief disorder: vulnerability and resilience

Frontiers in psychiatry, Feb 27, 2024

Research paper thumbnail of Socio-demographic Correlates of Substance Use Disorder in Patients Seeking De-addiction Services in Kashmir India-a Cross Sectional Study

European Psychiatry, Mar 1, 2015

Background: Kashmir valley is thought to be one of the hardest hit places with drug use and the s... more Background: Kashmir valley is thought to be one of the hardest hit places with drug use and the scenario worsened by the prevailing turmoil. The present study was undertaken to find the epidemiological profile and pattern of drug use in patients seeking treatment at De-addiction Centres in Srinagar India. Methods: The present cross sectional study, was conducted at two Drug De-addiction and treatment Centers in Srinagar. Total of 125 Substance Use Disorder Patients were interviewed by using pretested semi-structured proforma, emphasizing on socio-demographic profile and reasons for starting use of substance. Results: Majority (50.4%) of patients belonged to young and productive age group. Most of the patients started taking substances in the age group of 10-19 years and more so in case of nicotine (76.8%), volatile substances (76.9%) and cannabis (70.5%). Besides nicotine (89.6%), the most common substances used were cannabis (48.8%), codeine (48%), propoxyphene (37.6%), alcohol (36.8%) and benzodiazepines (36%). Peer pressure was the most common (72.8%) reason for starting the use of substance. Conclusion: There is need for further studies to find the community prevalence of drug use. The service provision is very limited restricted to the capital city and none in the rural areas. There is a worrying trend of early age of initiation with adverse consequences including dropping out of school. The control of prescription drug use is another major issue which needs to be addressed. It is also worrying that female drug users are not able to seek help due to lack of appropriate facilities.

Research paper thumbnail of Acute Psychotic Presentation in Syphilis - the Great Imitator is Back

Psychiatria Danubina, Jun 25, 2021

Research paper thumbnail of Effect of Vitamin D Supplementation on Outcomes in People With Early Psychosis

JAMA network open, Dec 28, 2021

Research paper thumbnail of Clinical correlates of vitamin D deficiency in established psychosis

BMC Psychiatry, Mar 22, 2016

Background: Suboptimal vitamin D levels have been identified in populations with psychotic disord... more Background: Suboptimal vitamin D levels have been identified in populations with psychotic disorders. We sought to explore the relationship between vitamin D deficiency, clinical characteristics and cardiovascular disease risk factors among people with established psychosis. Methods: Vitamin D levels were measured in 324 community dwelling individuals in England with established psychotic disorders, along with measures of mental health, cardiovascular risk and lifestyle choices. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D (25-OHD) levels below 10 ng/ml (equivalent to <25 nmol/L) and "sufficient" Vitamin D as above 30 ng/ml (>50 nmol/L). Results: The mean 25-OHD serum level was 12.4 (SD 7.3) ng/ml, (range 4.0-51.7 ng/ml). Forty nine percent (n = 158) were vitamin D deficient, with only 14 % (n = 45) meeting criteria for sufficiency. Accounting for age, gender, ethnicity and season of sampling, serum 25-OHD levels were negatively correlated with waist circumference (r = −0.220, p < 0.002), triglycerides (r = −0.160, p = 0.024), total cholesterol (r = −0.144, p = 0.043), fasting glucose (r = −0.191, p = 0.007), HbA1c (r = −0.183, p = 0.01), and serum CRP levels (r = −0.211, p = 0.003) and were linked to the presence of metabolic syndrome. Conclusions: This is the largest cross sectional study of serum 25-OHD levels in community dwelling individuals with established psychosis, indicating a high level of vitamin D deficiency. Lower vitamin D levels are associated with increased cardiovascular disease risk factors and in particular metabolic syndrome. Further research is needed to define appropriate protocols for vitamin D testing and supplementation in practice to see if this can improve cardiovascular disease risk. Trial registration: ISRCTN number is ISRCTN58667926 Date of registration: 23/04/2010

Research paper thumbnail of Length of stay in a home treatment team

British Journal of Psychiatry Open, Jun 1, 2021

data on array-genotyped participants with their specific phenotypic information. Prior to analysi... more data on array-genotyped participants with their specific phenotypic information. Prior to analysis, CNV selection led to the exclusion of any CNV with less than 5 hits in the UK Biobank population. Incidence of each phenotype was based on selfreported diagnoses, questionnaires or hospital ICD-10 diagnoses, with a minimum of 500 cases. Both binary logistic and linear regression were used to assess the incidence of these phenotypes in relation to the CNVs, adjusted for age, sex, and ethnicity as potential cofounders. Result. Overall, 12/13 CNVs were nominally associated with at least one phenotype, including 114/168 possible associations and 54 undetectable associations as not every CNV carrier displayed one of the chosen phenotypes. 41 associations were statistically significant (p < 0.05) and 13 survived Bonferroni Correction (p < 2.98 × 10-4). All significant associations met the expected change except 15q11.2 deletion and any CNV carrier status which showed a decrease in likelihood of addiction. Conclusion. These findings suggest schizophrenia-associated CNV can affect range of psychiatric phenotypes. By building on existing reports, understanding the widespread effects of CNVs in the aetiology and pathogenicty of psychiatric disorders may overtime aid in strengthening our search for more targetted, effective treatments. Many thanks to Professor George Kirov for supervising and supporting this project.

Research paper thumbnail of Facilitated early discharge in Wandsworth

British Journal of Psychiatry Open, Jun 1, 2021

Objective. We report a case of a 58-year-old gentleman who was hospitalised intermittently for on... more Objective. We report a case of a 58-year-old gentleman who was hospitalised intermittently for one year due to treatment resistant schizophrenia. Prior to hospitalisation he had been prescribed standard antipsychotics for decades without full resolution of positive psychotic symptoms. During his final admission lasting six months he was guarded, suspicious, irritable, constantly paced the corridor and displayed thought block and paranoid persecutory delusions. He would not enter the assessment room or allow any blood or ECG monitoring, however, he was compliant with oral medication. He was successfully treated with high dose olanzapine (40mg/day) and was discharged to the community. The aim of this study is to bring awareness and add to the body of evidence for the use of high-dose olanzapine in patients with treatment resistant schizophrenia in whom a trial of clozapine is not possible. Case report. The patient gave written consent for this case report to be written and presented. An extensive literature review was performed and key papers were identified. Discussion focuses on the key areas in the literature. Discussion. This case demonstrates that high-dose olanzapine can be used effectively as an alternative to clozapine in treatment resistant schizophrenia. Conclusion. This case highlights the need for further evaluation of high-dose olanzapine as an alternative to clozapine in patients with treatment-resistant schizophrenia.

Research paper thumbnail of Neuroleptic malignant syndrome: a guide for psychiatrists

BJPsych Advances, Oct 23, 2020

Research paper thumbnail of Royal College examination fees surplus

Research paper thumbnail of Mental health law in India: origins and proposed reforms

BJPsych. International, 2016

Although mental health legislation has existed in India since the mid-19th century, it has gone t... more Although mental health legislation has existed in India since the mid-19th century, it has gone through various changes over the years and the Mental Health Care Bill 2013 has generated a lot of debate and criticism. Despite its shortcomings, the general expectation is that this bill will usher in a new era of proper care and allow people with mental disorders to lead a dignified life.

Research paper thumbnail of Psychological distress in Kashmiri diaspora due to total communication blockade in Kashmir

On 5th August 2019, India imposed a complete communication blockade in Kashmir including telephon... more On 5th August 2019, India imposed a complete communication blockade in Kashmir including telephones, mobiles, and Internet services. Kashmiris living across the world were unable to communicate with families back in Kashmir. We conducted an online study using the HADS (Hospital anxiety and Depression) rating scale to measure the psychological distress in Kashmiri diaspora due to communication blackout and conflict in their country of origin. An online survey questionnaire using the HADS rating scale was circulated to consenting Kashmiri participants over 18 years of age using social networks. A total of 465 responses were anonymously received over 4 weeks. The results show very high scores for both anxiety and depressive symptoms across the whole sample. The results on the anxiety sub-scale showed 89% of the sample scoring above the cut off for “caseness” or “abnormal”. The scores on the depression subscale showed that 88% of the sample fell within the abnormal range. The consequenc...

Research paper thumbnail of Acute psychotic presentation in neurosyphilis

Research paper thumbnail of Depression around the World

Research paper thumbnail of Kashmir Floods-Then and Now

Kashmir valley is famous for its beautiful landscapes; its majestic mountains, rivers that snake ... more Kashmir valley is famous for its beautiful landscapes; its majestic mountains, rivers that snake through this landscape, lakes which are homes in themselves and the lush green floating paddy fields. Kashmir is also equally known for its disasters, both natural and man-made. From the perpetual conflict situation to earthquakes, snowstorms and floods, there are hardly any disasters left, it has not seen. In the September of 2014 Kashmir valley witnessed the worst ever floods of last 100 years. The floods were so sudden and severe that for a few days there was no government in power, as everyone including the then Chief Minister of the state was trapped. All means of communication including the mobile networks went dead. Even the emergency numbers and wireless system of the security machinery could not stand the assault. The sudden drowning of the capital city led to the total collapse of the state administration. It was not that there were not enough warning signs-the incessant rains in upper reaches for days, the hiccups of the meteorological department to offer any proper forecast and advice and finally the failure of the Irrigation and Flood control department to manage the situation, lead to utter devastation. Even on the day when the Srinagar city lost its defences to the rising waters and the banks of river Jhelum breached, the administration kept reassuring the inhabitants that there was nothing to worry about. By this time, the south of the valley was already under water for days and it did not take long for north Kashmir to submerge. The worst hit areas included Srinagar, Anantnag, Kulgam, Pulwama, Shopian and Bandipore in the Kashmir province. Some areas of the Jammu province were also hit by heavy rains and consequent floods especially Poonch and Rajouri. Millions of people were trapped, displaced, unsafe, and worst of all at the mercy of the missing administration. People volunteered, innovated and used whatever means they could, to help and save each other. Srinagar, a city of million people slipped under water and even those high up in the corridors of power, were not able to get any help. Many people were rescued by their distant relatives, coming down from far off villages, days after they found themselves trapped under the rooftops, living on dry rice and whatever they were able to stock, in that moment of chaos. Panic gripped the inhabitants of the valley and their relatives and loved ones living outside Kashmir. The situation was made worse by the lack of communication and the abundance of rumours, as there were hardly any credible sources of information. The water reached up to 18 feet in some areas, flooding the 2 nd floors of the houses and drowning and washing away essentials, valuables, cherished memories – anything that stood in its path. There was social media frenzy, rumours, and a severe criticism of both the state and the central government, for not doing enough to save and help the people in time. Kashmir being a conflict zone, the outcry was worse. Even though the Army and National Disaster Rescue Force (NDRF) claimed to be helping people, there was a severe disquiet from various quarters. Allegations of favouritism and selective rescue and relief were hard to ignore. There was a total lack of coordination between agencies claiming to be working in the rescue operations. Even the Chief Minister went on record in the Supreme Court that the situation was under control and no further help was required in terms of boats and other essentials.

Research paper thumbnail of Psychiatric Comorbidity in Patients Suffering from Post Traumatic Stress Disorder in Kashmir Valley Doctor of Medicine Department of Psychiatry Government Medical College Srinagar, Kashmir

Research paper thumbnail of Effect of Vitamin D Supplementation on Outcomes in People With Early Psychosis

JAMA Network Open, 2021

IMPORTANCE People with psychotic disorders have an increased risk of vitamin D deficiency, which ... more IMPORTANCE People with psychotic disorders have an increased risk of vitamin D deficiency, which is evident during first-episode psychosis (FEP) and associated with unfavorable mental and physical health outcomes. OBJECTIVE To examine whether vitamin D supplementation contributes to improved clinical outcomes in FEP. DESIGN, SETTING, AND PARTICIPANTS This multisite, double-blind, placebo-controlled, parallelgroup randomized clinical trial from the UK examined adults 18 to 65 years of age within 3 years of a first presentation with a functional psychotic disorder who had no contraindication to vitamin D supplementation. A total of 2136 patients were assessed for eligibility, 835 were approached, 686

Research paper thumbnail of Neuroleptic malignant syndrome: a guide for psychiatrists

BJPsych Advances, 2020

SUMMARY Neuroleptic malignant syndrome (NMS) is a rare and potentially fatal adverse reaction to ... more SUMMARY Neuroleptic malignant syndrome (NMS) is a rare and potentially fatal adverse reaction to drugs. In psychiatric practice, it is mainly associated with antipsychotics. The classic presentation is that of hyperpyrexia, muscle rigidity, mental state changes and autonomic instability. Subtle forms are difficult to recognise owing to symptom overlap with other conditions. This article discusses the clinical presentation of the syndrome, its differential diagnosis and use of supportive care, medication and electroconvulsive therapy in its treatment. It also explores prevention of NMS and reinstatement of treatment after an episode. It is stressed that all but the mildest forms of NMS should be considered a medical emergency that is properly managed in an acute hospital.

Research paper thumbnail of Socio-demographic Profile and Psychiatric Comorbidity in Patients with a Diagnosis of Post Traumatic Stress Disorder – A study from Kashmir Valley

Acta Medica International, 2016

Objective: Kashmir valley has witnessed an armed conflict from last three decades, with one of th... more Objective: Kashmir valley has witnessed an armed conflict from last three decades, with one of the studies suggesting the prevalence of trauma exposure of 58.69% in the general population and 15.9% prevalence of Post-traumatic stress disorder (PTSD). The current study was undertaken to explore the socio demographic profile and psychiatric comorbidity in treatment seeking PTSD patients. Methods: This cross-sectional study was conducted at Government Psychiatric Diseases Hospital Srinagar, Kashmir from January 2006 to January 2007. A total of 100 PTSD patients were interviewed and screened for psychiatric comorbidity using DSM-IV diagnostic criteria and their socio demographic details were recorded using a proforma. Results: Most of the patients in our study had multiple comorbidities. Apart from depression and anxiety disorders, somatisation and peri-traumatic dissociation was highly comorbid. Conclusion: Post-Traumatic Stress Disorder is a complex diagnosis with commonly associated psychiatric comorbidity. The high comorbidity in our study sample could be due to repeated exposure to trauma, cultural expression of distress and the ongoing conflict situation which makes the recovery difficult. Recognizing the comorbidities early on may help to achieve an optimal treatment outcome. Finally, the lack of appropriate service provision results in increased morbidity and probable chronicity of the symptoms.

Research paper thumbnail of Clinical correlates of vitamin D deficiency in established psychosis

BMC Psychiatry, 2016

Background: Suboptimal vitamin D levels have been identified in populations with psychotic disord... more Background: Suboptimal vitamin D levels have been identified in populations with psychotic disorders. We sought to explore the relationship between vitamin D deficiency, clinical characteristics and cardiovascular disease risk factors among people with established psychosis. Methods: Vitamin D levels were measured in 324 community dwelling individuals in England with established psychotic disorders, along with measures of mental health, cardiovascular risk and lifestyle choices. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D (25-OHD) levels below 10 ng/ml (equivalent to <25 nmol/L) and "sufficient" Vitamin D as above 30 ng/ml (>50 nmol/L). Results: The mean 25-OHD serum level was 12.4 (SD 7.3) ng/ml, (range 4.0-51.7 ng/ml). Forty nine percent (n = 158) were vitamin D deficient, with only 14 % (n = 45) meeting criteria for sufficiency. Accounting for age, gender, ethnicity and season of sampling, serum 25-OHD levels were negatively correlated with waist circumference (r = −0.220, p < 0.002), triglycerides (r = −0.160, p = 0.024), total cholesterol (r = −0.144, p = 0.043), fasting glucose (r = −0.191, p = 0.007), HbA1c (r = −0.183, p = 0.01), and serum CRP levels (r = −0.211, p = 0.003) and were linked to the presence of metabolic syndrome. Conclusions: This is the largest cross sectional study of serum 25-OHD levels in community dwelling individuals with established psychosis, indicating a high level of vitamin D deficiency. Lower vitamin D levels are associated with increased cardiovascular disease risk factors and in particular metabolic syndrome. Further research is needed to define appropriate protocols for vitamin D testing and supplementation in practice to see if this can improve cardiovascular disease risk. Trial registration: ISRCTN number is ISRCTN58667926 Date of registration: 23/04/2010

Research paper thumbnail of Socio-demographic Correlates of Substance Use Disorder in Patients Seeking De-addiction Services in Kashmir India-a Cross Sectional Study

European Psychiatry, 2015

Background: Kashmir valley is thought to be one of the hardest hit places with drug use and the s... more Background: Kashmir valley is thought to be one of the hardest hit places with drug use and the scenario worsened by the prevailing turmoil. The present study was undertaken to find the epidemiological profile and pattern of drug use in patients seeking treatment at De-addiction Centres in Srinagar India. Methods: The present cross sectional study, was conducted at two Drug De-addiction and treatment Centers in Srinagar. Total of 125 Substance Use Disorder Patients were interviewed by using pretested semi-structured proforma, emphasizing on socio-demographic profile and reasons for starting use of substance. Results: Majority (50.4%) of patients belonged to young and productive age group. Most of the patients started taking substances in the age group of 10-19 years and more so in case of nicotine (76.8%), volatile substances (76.9%) and cannabis (70.5%). Besides nicotine (89.6%), the most common substances used were cannabis (48.8%), codeine (48%), propoxyphene (37.6%), alcohol (36.8%) and benzodiazepines (36%). Peer pressure was the most common (72.8%) reason for starting the use of substance. Conclusion: There is need for further studies to find the community prevalence of drug use. The service provision is very limited restricted to the capital city and none in the rural areas. There is a worrying trend of early age of initiation with adverse consequences including dropping out of school. The control of prescription drug use is another major issue which needs to be addressed. It is also worrying that female drug users are not able to seek help due to lack of appropriate facilities.