KS Shaji | Kerala University Of Health Sciences (original) (raw)
Papers by KS Shaji
Wellcome Open Research
Background: In community settings, neuropsychological assessment is the most commonly employed me... more Background: In community settings, neuropsychological assessment is the most commonly employed method for early recognition of dementia. However, little is known about the experience and perspectives of older adults when they undertake neuropsychological assessments in low-and middle-income countries (LMICs), including India. Methods: We conducted semi-structured interviews for 11 individuals (aged between 64 and 88 years) who had undergone cognitive assessment in the CST International (Cognitive Stimulation Therapy- International) study and were free from dementia. The transcripts were analysed manually utilising Interpretative Phenomenological Analysis to develop key themes. Results: When data were analysed three superordinate themes (experiences related to the process, content and outcomes) each with a set of subordinate themes emerged. Conclusions: This study highlights the need for a thorough planning of pre-assessment briefing for equipping participants with adequate infor...
JMIR Research Protocols
Background The southern India state of Kerala has among the highest proportion of older adults in... more Background The southern India state of Kerala has among the highest proportion of older adults in its population in the country. An increase in chronic age-related diseases such as dementia is expected in the older Kerala population. Identifying older individuals early in the course of cognitive decline offers the best hope of introducing preventive measures early and planning management. However, the epidemiology and pathogenesis of predementia syndromes at the early stages of cognitive decline in older adults are not well established in India. Objective The Kerala Einstein Study (KES) is a community-based cohort study that was established in 2008 and is based in the Kozhikode district in Kerala state. KES aims to establish risk factors and brain substrates of motoric cognitive risk syndrome (MCR), a predementia syndrome characterized by the presence of slow gait and subjective cognitive concerns in individuals without dementia or disability. This protocol describes the study desig...
The Lancet, 2020
The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based... more The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3•5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers.
BMJ Open, 2019
IntroductionIn low/middle-income countries (LMICs), the prevalence of people diagnosed with demen... more IntroductionIn low/middle-income countries (LMICs), the prevalence of people diagnosed with dementia is expected to increase substantially and treatment options are limited, with acetylcholinesterase inhibitors not used as frequently as in high-income countries (HICs). Cognitive stimulation therapy (CST) is a group-based, brief, non-pharmacological intervention for people with dementia that significantly improves cognition and quality of life in clinical trials and is cost-effective in HIC. However, its implementation in other countries is less researched. This protocol describes CST-International; an implementation research study of CST. The aim of this research is to develop, test, refine and disseminate implementation strategies for CST for people with mild to moderate dementia in three LMICs: Brazil (upper middle-income), India (lower middle-income) and Tanzania (low-income).Methods and analysisFour overlapping phases: (1) exploration of barriers to implementation in each countr...
Indian Journal of Psychological Medicine, 2021
significant cognitive impairment. Dementia is the main cause of cognitive impairment among people... more significant cognitive impairment. Dementia is the main cause of cognitive impairment among people aged 65 years and over. The prevalence of dementia increases with age. It is essential to differentiate dementia from other clinical states like mild cognitive impairment (MCI) and other prevalent mental health conditions like depression. Dementia is a clinical syndrome that many diseases can cause. The onset and progression vary depending on the etiology, but onset is usually insidious with slow progression. Dementia often remains a hidden problem, more so in societies with low public awareness about dementia. Often, people with mild to moderate dementia do not get identified. Clinical recognition of dementia is easier in the clinical setting when its severity is moderate or severe. However, the diagnosis can be challenging in the case of MCI and mild dementia. As dementia impacts the individual's mental capacity, a thorough understanding of the implications of such impairments is necessary to clarify the issues related to the application of the current Indian laws.
Journal of Affective Disorders, 2011
ABSTRACT Depressive disorders are estimated to occur in nearly half of HIV-infected individuals w... more ABSTRACT Depressive disorders are estimated to occur in nearly half of HIV-infected individuals worldwide. To examine the prevalence and cardinal demographic, psychosocial and clinical features associated with having any depressive disorder, sub-clinical depression, current and lifetime depressive disorders among patients with human immunodeficiency virus (HIV) in southern Uganda. Five hundred HIV+ individuals were screened for depression using a 20 item self-reporting questionnaire (SRQ-20) and evaluated with the mini neuropsychiatric interview(MINI) that assessed current and lifetime depressive disorders. The prevalence estimates of any depressive disorder, subclinical depression, both current and lifetime major depression, and bipolar depression were 46.4%, 17.8%, 25% and 3.6% respectively. In comparison to non-depressed patients, those with sub-clinical depression were less likely to have high levels of self-efficacy, more likely to be using ART for less than one year, have advanced HIV disease and current alcohol use disorders (AUD's). Those with both current and lifetime depressive disorders were less likely to be 85% adherent to antiretroviral therapy (ART), have social support and high levels of self-efficacy, more likely to have tuberculosis and past manic episodes. Those with only lifetime depressive disorders were more likely to have current AUD's and past manic episodes. Information concerning exposures and outcomes was collected simultaneously, thus causal relationships are difficult to establish. Sub-clinical depression, major depression and bipolar depression are widespread among HIV patients receiving ART. Integration of mental health services into HIV Care is desperately needed.
Indian Journal of Psychological Medicine, 1999
The importance of user participatory approach for successful implementation of developmental prog... more The importance of user participatory approach for successful implementation of developmental programmes h a s been widely appreciated in many areas of social development including health care. In this context, we report on a user group meeting conducted by a General Hospital Psychiatry Unit of a Teaching Hospital in Kerala. All inpatients who utllised the services of this administrative framework of a medical model. unlike the previous strategy of segregation in asylums.
Kerala Medical Journal, 2015
Background: During old age, various health problems adversely affect an individual’s life and put... more Background: During old age, various health problems adversely affect an individual’s life and put the public health system in strain. Aims: To estimate self reported chronic health problems of the elderly in a rural population in Kerala and to find out whether there are any gender related differences in these. Subjects and Methods: A community-based, house to house survey of elderly persons (aged over 60 years) in a village in the field area of a teaching hospital was carried out. Information on their self reported medical problems (Help for Activities of daily life -ADL, Behaviour problems, Hearing and vision impairment, Incontinence ,Vertigo Stroke, Falls, sadness, Alcohol use ,Pan chewing ,smoking) were collected.Results were analyzed in terms of proportions and percentages. Associations were explored with odds ratio (OR) and 95% confidence intervals (CIs). Results: Elderly persons constituted 13.03 % [2728 /20,942] of the entire population. Data was obtained from 99.41% (2712/27...
Bulletin of The World Health Organization, 1999
Indian Journal of Psychological Medicine, 2019
Use of antipsychotics in pregnancy is based on a risk-benefit analysis. Clozapine is generally us... more Use of antipsychotics in pregnancy is based on a risk-benefit analysis. Clozapine is generally used in treatment-resistant schizophrenia, and it is often less used in pregnancy. Safety of clozapine is not well studied in pregnant women. We report a case where a woman on clozapine along with folic acid supplementation gave birth to an infant with neural tube defect (NTD). Clozapine readily crosses the placenta and is found in amniotic fluid and fetal blood. [1] A few case reports and case series have reported macrocephaly, floppy infant syndrome, cardiac arrhythmias, and neonatal seizure as teratogenic effects of clozapine. [2,3] We report a rare case where an NTD was detected in a newborn exposed to clozapine during the antenatal period.
Indian Journal of Psychological Medicine, 1991
Patients 111eeli1lg DSM 111-R criteria for Delusional Disorder (DD) were studicd by the analysis ... more Patients 111eeli1lg DSM 111-R criteria for Delusional Disorder (DD) were studicd by the analysis ofcase records. Frequency of DDal~lo~lgall cases offunctio!lal psychosis was found lo be 1.52%. Thcse patients had a later age of onset and were predo~nineotly ~uales when colllpnred to that reported for schizophrenia and i~cute ps'choscs. Pcrsccutory, somatic.ond jealous were the 111ost frequent subtypes. Sonlhticsubtype had an early'onset of illness when co~llpared to other subtypes.
Indian Journal of Psychiatry, 1995
Parkinsonism and tardive dyskinesia can coexist in patients taking antipsychotic drugs. Persisten... more Parkinsonism and tardive dyskinesia can coexist in patients taking antipsychotic drugs. Persistence of both parkinsonism and tardive dyskinesia during a two year follow up period after discontinuation of antipsychotic drugs is reported. Etiological significance of antipsychotic treatment is discussed.
Indian Journal of Psychiatry, 2001
Kerala state branch of IPS sought suggestions from the public regarding the state policy on menta... more Kerala state branch of IPS sought suggestions from the public regarding the state policy on mental health. The letters received from the people were analysed and most suggestions were found to be useful. Suggestions made by the people and the psychiatrists were similar in content. This observation highlights the usefulness of 'user-provider collaboration' in mental health planning. Both user as well as the 'providers' need to be consulted in order to establish user-friendly mental health services.
Indian Journal of Psychiatry, 1989
57% of a group of 35 patients treated with Lithium Carbonate at dosages predicted by the nomogram... more 57% of a group of 35 patients treated with Lithium Carbonate at dosages predicted by the nomogram suggested by Cooper et al (1973) failed to reach therapeutic levels of serum lithium. This finding casts serious doubts on the usefulness of the claim by Cooper et al (1973 & 1976) that 24 hour serum lithium level after a test dose of 600 mg. lithium can predict the daily lithium dose.
International Psychiatry, Oct 1, 2006
According to the 2001 census, India is home to more than 76 million people aged 60 years and over... more According to the 2001 census, India is home to more than 76 million people aged 60 years and over. This age-group, currently only 7.4% of the population, is expected to grow dramatically in the coming few decades. Analysis of the census data shows substantial variation in the rate of demographic ageing across India: at present, 10.5% of Kerala's population is older than 60 years, while in Dadra and Nagarhaveli this proportion is only 4%. Regions with more favourable health indicators seem to be ageing faster and the demand for specialist services will soon be evident in such places. There is a growing realisation that the care of older people with disabilities makes enormous demands on their carers. Terms such as 'dementia' and 'Alzheimer's disease' are now better understood. This was not the case when the Alzheimer's and Related Disorders Society of India (ARDSI) initiated awareness programmes. However, dementia remains a largely hidden problem in those ...
Twenty four schizophrenic patients who met DSM-III criteria, 28 of their nonschizophrenic first d... more Twenty four schizophrenic patients who met DSM-III criteria, 28 of their nonschizophrenic first degree relatives and a group of 28 normal controls who did not have anv personal or family liistory of major psychiatric illness were assessed by the same investigator for the presence of abnormalities on clinical neurological examination. Patients had significantly greater neurological impairment (p<.00l) than the normal control group. Nonschizophrenic first degree relatives of patients also had greater impairment (p<.05) when compared to the matched control group. Significant excess of neurological abnormalities seen in schizophrenic patients and their close relatives suggest that neurological factors are important in the development of schizophrenia. It was also found that thoie who had luwei education had more neurological abnormalities. The implications of these observations are discussed. Neurological basis for the syndrome now referred to as schizophrenia had been proposed so...
Health care of older people is related to their socio-cultural milieu. Families continue to be th... more Health care of older people is related to their socio-cultural milieu. Families continue to be the major support for older people. However, social changes and consequent reduction in the availability of informal care resources like the traditional family, are putting pressure on home-based care in India. The treatment gap for geriatric mental health problems is huge. Dementia and depression are the two major mental health problems in the later years of life. Screening for cognitive impairment is difficult in these settings as illiteracy influences the individual's performance on cognitive tests. The tests standardized elsewhere usually discriminate against illiterate people from rural societies, as they tend to perform poorly on these. Trained health workers can identify dementia cases in the community and support home-based care. Primary care doctors will have to be trained in identifying and managing depression and dementia. Provision of support to families and development of ...
Indian Journal of Psychiatry, 2009
Dementia is fast emerging as a huge public health challenge in the developing world. We need to p... more Dementia is fast emerging as a huge public health challenge in the developing world. We need to prepare ourselves to face this crisis. We must know more about various aspects of dementia and its management. Better understanding of dementia in developing countries is also ...
Indian Journal of Psychiatry, 2009
Byline: K. Shaji Demographic aging is a global phenomenon with differential impact on world regio... more Byline: K. Shaji Demographic aging is a global phenomenon with differential impact on world regions. It began early in developed countries and progressed over longer period of time. They had more time to develop services. Regions like Asia, Latin America and Africa are now witnessing rapid demographic aging. The developing countries in this region will have comparatively little time to develop services. It is this unprecedented pace of demographic aging which makes it such a huge public health challenge for the region. Though the biological phenomenon of aging is universal, the daily life of an older person varies considerably according to social, economic, and cultural contexts. Aging and health has many socio-cultural determinants. Social status and available social support for older people vary in different cultures. In many developing countries, older persons are accorded great respect, both within the families and in society. But the traditionally strong social support systems ...
The Lancet Global Health
Summary Background A systematic understanding of the burden of neurological disorders at the subn... more Summary Background A systematic understanding of the burden of neurological disorders at the subnational level is not readily available for India. We present a comprehensive analysis of the disease burden and trends of neurological disorders at the state level in India. Methods Using all accessible data from multiple sources, we estimated the prevalence or incidence and disability-adjusted life-years (DALYs) for neurological disorders from 1990 to 2019 for all states of India as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. We assessed the contribution of each neurological disorder to deaths and DALYs in India in 2019, their trends in prevalence or incidence and DALY rates over time, and heterogeneity between the states of India. We also assessed the Pearson correlation coefficient between Socio-demographic Index (SDI) of the states and the prevalence or incidence and DALY rates of each neurological disorder. Additionally, we estimated the contribution of known risk factors to DALYs from neurological disorders. We calculated 95% uncertainty intervals (UIs) for the mean estimates. Findings The contribution of non-communicable neurological disorders to total DALYs in India doubled from 4·0% (95% UI 3·2–5·0) in 1990 to 8·2% (6·6–10·2) in 2019, and the contribution of injury-related neurological disorders increased from 0·2% (0·2–0·3) to 0·6% (0·5–0·7). Conversely, the contribution of communicable neurological disorders decreased from 4·1% (3·5–4·8) to 1·1% (0·9–1·5) during the same period. In 2019, the largest contributors to the total neurological disorder DALYs in India were stroke (37·9% [29·9–46·1]), headache disorders (17·5% [3·6–32·5]), epilepsy (11·3% [9·0–14·3]), cerebral palsy (5·7% [4·2–7·7]), and encephalitis (5·3% [3·7–8·9]). The crude DALY rate of several neurological disorders had considerable heterogeneity between the states in 2019, with the highest variation for tetanus (93·2 times), meningitis (8·3 times), and stroke (5·5 times). SDI of the states had a moderate significant negative correlation with communicable neurological disorder DALY rate and a moderate significant positive correlation with injury-related neurological disorder DALY rate in 2019. For most of the non-communicable neurological disorders, there was an increase in prevalence or incidence from 1990 to 2019. Substantial decreases were evident in the incidence and DALY rates of communicable neurological disorders during the same period. Migraine and multiple sclerosis were more prevalent among females than males and traumatic brain injuries were more common among males than females in 2019. Communicable diseases contributed to the majority of total neurological disorder DALYs in children younger than 5 years, and non-communicable neurological disorders were the highest contributor in all other age groups. In 2019, the leading risk factors contributing to DALYs due to non-communicable neurological disorders in India included high systolic blood pressure, air pollution, dietary risks, high fasting plasma glucose, and high body-mass index. For communicable disorders, the identified risk factors with modest contributions to DALYs were low birthweight and short gestation and air pollution. Interpretation The increasing contribution of non-communicable and injury-related neurological disorders to the overall disease burden in India, and the substantial state-level variation in the burden of many neurological disorders highlight the need for state-specific health system responses to address the gaps in neurology services related to awareness, early identification, treatment, and rehabilitation. Funding Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.
Wellcome Open Research
Background: In community settings, neuropsychological assessment is the most commonly employed me... more Background: In community settings, neuropsychological assessment is the most commonly employed method for early recognition of dementia. However, little is known about the experience and perspectives of older adults when they undertake neuropsychological assessments in low-and middle-income countries (LMICs), including India. Methods: We conducted semi-structured interviews for 11 individuals (aged between 64 and 88 years) who had undergone cognitive assessment in the CST International (Cognitive Stimulation Therapy- International) study and were free from dementia. The transcripts were analysed manually utilising Interpretative Phenomenological Analysis to develop key themes. Results: When data were analysed three superordinate themes (experiences related to the process, content and outcomes) each with a set of subordinate themes emerged. Conclusions: This study highlights the need for a thorough planning of pre-assessment briefing for equipping participants with adequate infor...
JMIR Research Protocols
Background The southern India state of Kerala has among the highest proportion of older adults in... more Background The southern India state of Kerala has among the highest proportion of older adults in its population in the country. An increase in chronic age-related diseases such as dementia is expected in the older Kerala population. Identifying older individuals early in the course of cognitive decline offers the best hope of introducing preventive measures early and planning management. However, the epidemiology and pathogenesis of predementia syndromes at the early stages of cognitive decline in older adults are not well established in India. Objective The Kerala Einstein Study (KES) is a community-based cohort study that was established in 2008 and is based in the Kozhikode district in Kerala state. KES aims to establish risk factors and brain substrates of motoric cognitive risk syndrome (MCR), a predementia syndrome characterized by the presence of slow gait and subjective cognitive concerns in individuals without dementia or disability. This protocol describes the study desig...
The Lancet, 2020
The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based... more The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3•5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers.
BMJ Open, 2019
IntroductionIn low/middle-income countries (LMICs), the prevalence of people diagnosed with demen... more IntroductionIn low/middle-income countries (LMICs), the prevalence of people diagnosed with dementia is expected to increase substantially and treatment options are limited, with acetylcholinesterase inhibitors not used as frequently as in high-income countries (HICs). Cognitive stimulation therapy (CST) is a group-based, brief, non-pharmacological intervention for people with dementia that significantly improves cognition and quality of life in clinical trials and is cost-effective in HIC. However, its implementation in other countries is less researched. This protocol describes CST-International; an implementation research study of CST. The aim of this research is to develop, test, refine and disseminate implementation strategies for CST for people with mild to moderate dementia in three LMICs: Brazil (upper middle-income), India (lower middle-income) and Tanzania (low-income).Methods and analysisFour overlapping phases: (1) exploration of barriers to implementation in each countr...
Indian Journal of Psychological Medicine, 2021
significant cognitive impairment. Dementia is the main cause of cognitive impairment among people... more significant cognitive impairment. Dementia is the main cause of cognitive impairment among people aged 65 years and over. The prevalence of dementia increases with age. It is essential to differentiate dementia from other clinical states like mild cognitive impairment (MCI) and other prevalent mental health conditions like depression. Dementia is a clinical syndrome that many diseases can cause. The onset and progression vary depending on the etiology, but onset is usually insidious with slow progression. Dementia often remains a hidden problem, more so in societies with low public awareness about dementia. Often, people with mild to moderate dementia do not get identified. Clinical recognition of dementia is easier in the clinical setting when its severity is moderate or severe. However, the diagnosis can be challenging in the case of MCI and mild dementia. As dementia impacts the individual's mental capacity, a thorough understanding of the implications of such impairments is necessary to clarify the issues related to the application of the current Indian laws.
Journal of Affective Disorders, 2011
ABSTRACT Depressive disorders are estimated to occur in nearly half of HIV-infected individuals w... more ABSTRACT Depressive disorders are estimated to occur in nearly half of HIV-infected individuals worldwide. To examine the prevalence and cardinal demographic, psychosocial and clinical features associated with having any depressive disorder, sub-clinical depression, current and lifetime depressive disorders among patients with human immunodeficiency virus (HIV) in southern Uganda. Five hundred HIV+ individuals were screened for depression using a 20 item self-reporting questionnaire (SRQ-20) and evaluated with the mini neuropsychiatric interview(MINI) that assessed current and lifetime depressive disorders. The prevalence estimates of any depressive disorder, subclinical depression, both current and lifetime major depression, and bipolar depression were 46.4%, 17.8%, 25% and 3.6% respectively. In comparison to non-depressed patients, those with sub-clinical depression were less likely to have high levels of self-efficacy, more likely to be using ART for less than one year, have advanced HIV disease and current alcohol use disorders (AUD's). Those with both current and lifetime depressive disorders were less likely to be 85% adherent to antiretroviral therapy (ART), have social support and high levels of self-efficacy, more likely to have tuberculosis and past manic episodes. Those with only lifetime depressive disorders were more likely to have current AUD's and past manic episodes. Information concerning exposures and outcomes was collected simultaneously, thus causal relationships are difficult to establish. Sub-clinical depression, major depression and bipolar depression are widespread among HIV patients receiving ART. Integration of mental health services into HIV Care is desperately needed.
Indian Journal of Psychological Medicine, 1999
The importance of user participatory approach for successful implementation of developmental prog... more The importance of user participatory approach for successful implementation of developmental programmes h a s been widely appreciated in many areas of social development including health care. In this context, we report on a user group meeting conducted by a General Hospital Psychiatry Unit of a Teaching Hospital in Kerala. All inpatients who utllised the services of this administrative framework of a medical model. unlike the previous strategy of segregation in asylums.
Kerala Medical Journal, 2015
Background: During old age, various health problems adversely affect an individual’s life and put... more Background: During old age, various health problems adversely affect an individual’s life and put the public health system in strain. Aims: To estimate self reported chronic health problems of the elderly in a rural population in Kerala and to find out whether there are any gender related differences in these. Subjects and Methods: A community-based, house to house survey of elderly persons (aged over 60 years) in a village in the field area of a teaching hospital was carried out. Information on their self reported medical problems (Help for Activities of daily life -ADL, Behaviour problems, Hearing and vision impairment, Incontinence ,Vertigo Stroke, Falls, sadness, Alcohol use ,Pan chewing ,smoking) were collected.Results were analyzed in terms of proportions and percentages. Associations were explored with odds ratio (OR) and 95% confidence intervals (CIs). Results: Elderly persons constituted 13.03 % [2728 /20,942] of the entire population. Data was obtained from 99.41% (2712/27...
Bulletin of The World Health Organization, 1999
Indian Journal of Psychological Medicine, 2019
Use of antipsychotics in pregnancy is based on a risk-benefit analysis. Clozapine is generally us... more Use of antipsychotics in pregnancy is based on a risk-benefit analysis. Clozapine is generally used in treatment-resistant schizophrenia, and it is often less used in pregnancy. Safety of clozapine is not well studied in pregnant women. We report a case where a woman on clozapine along with folic acid supplementation gave birth to an infant with neural tube defect (NTD). Clozapine readily crosses the placenta and is found in amniotic fluid and fetal blood. [1] A few case reports and case series have reported macrocephaly, floppy infant syndrome, cardiac arrhythmias, and neonatal seizure as teratogenic effects of clozapine. [2,3] We report a rare case where an NTD was detected in a newborn exposed to clozapine during the antenatal period.
Indian Journal of Psychological Medicine, 1991
Patients 111eeli1lg DSM 111-R criteria for Delusional Disorder (DD) were studicd by the analysis ... more Patients 111eeli1lg DSM 111-R criteria for Delusional Disorder (DD) were studicd by the analysis ofcase records. Frequency of DDal~lo~lgall cases offunctio!lal psychosis was found lo be 1.52%. Thcse patients had a later age of onset and were predo~nineotly ~uales when colllpnred to that reported for schizophrenia and i~cute ps'choscs. Pcrsccutory, somatic.ond jealous were the 111ost frequent subtypes. Sonlhticsubtype had an early'onset of illness when co~llpared to other subtypes.
Indian Journal of Psychiatry, 1995
Parkinsonism and tardive dyskinesia can coexist in patients taking antipsychotic drugs. Persisten... more Parkinsonism and tardive dyskinesia can coexist in patients taking antipsychotic drugs. Persistence of both parkinsonism and tardive dyskinesia during a two year follow up period after discontinuation of antipsychotic drugs is reported. Etiological significance of antipsychotic treatment is discussed.
Indian Journal of Psychiatry, 2001
Kerala state branch of IPS sought suggestions from the public regarding the state policy on menta... more Kerala state branch of IPS sought suggestions from the public regarding the state policy on mental health. The letters received from the people were analysed and most suggestions were found to be useful. Suggestions made by the people and the psychiatrists were similar in content. This observation highlights the usefulness of 'user-provider collaboration' in mental health planning. Both user as well as the 'providers' need to be consulted in order to establish user-friendly mental health services.
Indian Journal of Psychiatry, 1989
57% of a group of 35 patients treated with Lithium Carbonate at dosages predicted by the nomogram... more 57% of a group of 35 patients treated with Lithium Carbonate at dosages predicted by the nomogram suggested by Cooper et al (1973) failed to reach therapeutic levels of serum lithium. This finding casts serious doubts on the usefulness of the claim by Cooper et al (1973 & 1976) that 24 hour serum lithium level after a test dose of 600 mg. lithium can predict the daily lithium dose.
International Psychiatry, Oct 1, 2006
According to the 2001 census, India is home to more than 76 million people aged 60 years and over... more According to the 2001 census, India is home to more than 76 million people aged 60 years and over. This age-group, currently only 7.4% of the population, is expected to grow dramatically in the coming few decades. Analysis of the census data shows substantial variation in the rate of demographic ageing across India: at present, 10.5% of Kerala's population is older than 60 years, while in Dadra and Nagarhaveli this proportion is only 4%. Regions with more favourable health indicators seem to be ageing faster and the demand for specialist services will soon be evident in such places. There is a growing realisation that the care of older people with disabilities makes enormous demands on their carers. Terms such as 'dementia' and 'Alzheimer's disease' are now better understood. This was not the case when the Alzheimer's and Related Disorders Society of India (ARDSI) initiated awareness programmes. However, dementia remains a largely hidden problem in those ...
Twenty four schizophrenic patients who met DSM-III criteria, 28 of their nonschizophrenic first d... more Twenty four schizophrenic patients who met DSM-III criteria, 28 of their nonschizophrenic first degree relatives and a group of 28 normal controls who did not have anv personal or family liistory of major psychiatric illness were assessed by the same investigator for the presence of abnormalities on clinical neurological examination. Patients had significantly greater neurological impairment (p<.00l) than the normal control group. Nonschizophrenic first degree relatives of patients also had greater impairment (p<.05) when compared to the matched control group. Significant excess of neurological abnormalities seen in schizophrenic patients and their close relatives suggest that neurological factors are important in the development of schizophrenia. It was also found that thoie who had luwei education had more neurological abnormalities. The implications of these observations are discussed. Neurological basis for the syndrome now referred to as schizophrenia had been proposed so...
Health care of older people is related to their socio-cultural milieu. Families continue to be th... more Health care of older people is related to their socio-cultural milieu. Families continue to be the major support for older people. However, social changes and consequent reduction in the availability of informal care resources like the traditional family, are putting pressure on home-based care in India. The treatment gap for geriatric mental health problems is huge. Dementia and depression are the two major mental health problems in the later years of life. Screening for cognitive impairment is difficult in these settings as illiteracy influences the individual's performance on cognitive tests. The tests standardized elsewhere usually discriminate against illiterate people from rural societies, as they tend to perform poorly on these. Trained health workers can identify dementia cases in the community and support home-based care. Primary care doctors will have to be trained in identifying and managing depression and dementia. Provision of support to families and development of ...
Indian Journal of Psychiatry, 2009
Dementia is fast emerging as a huge public health challenge in the developing world. We need to p... more Dementia is fast emerging as a huge public health challenge in the developing world. We need to prepare ourselves to face this crisis. We must know more about various aspects of dementia and its management. Better understanding of dementia in developing countries is also ...
Indian Journal of Psychiatry, 2009
Byline: K. Shaji Demographic aging is a global phenomenon with differential impact on world regio... more Byline: K. Shaji Demographic aging is a global phenomenon with differential impact on world regions. It began early in developed countries and progressed over longer period of time. They had more time to develop services. Regions like Asia, Latin America and Africa are now witnessing rapid demographic aging. The developing countries in this region will have comparatively little time to develop services. It is this unprecedented pace of demographic aging which makes it such a huge public health challenge for the region. Though the biological phenomenon of aging is universal, the daily life of an older person varies considerably according to social, economic, and cultural contexts. Aging and health has many socio-cultural determinants. Social status and available social support for older people vary in different cultures. In many developing countries, older persons are accorded great respect, both within the families and in society. But the traditionally strong social support systems ...
The Lancet Global Health
Summary Background A systematic understanding of the burden of neurological disorders at the subn... more Summary Background A systematic understanding of the burden of neurological disorders at the subnational level is not readily available for India. We present a comprehensive analysis of the disease burden and trends of neurological disorders at the state level in India. Methods Using all accessible data from multiple sources, we estimated the prevalence or incidence and disability-adjusted life-years (DALYs) for neurological disorders from 1990 to 2019 for all states of India as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. We assessed the contribution of each neurological disorder to deaths and DALYs in India in 2019, their trends in prevalence or incidence and DALY rates over time, and heterogeneity between the states of India. We also assessed the Pearson correlation coefficient between Socio-demographic Index (SDI) of the states and the prevalence or incidence and DALY rates of each neurological disorder. Additionally, we estimated the contribution of known risk factors to DALYs from neurological disorders. We calculated 95% uncertainty intervals (UIs) for the mean estimates. Findings The contribution of non-communicable neurological disorders to total DALYs in India doubled from 4·0% (95% UI 3·2–5·0) in 1990 to 8·2% (6·6–10·2) in 2019, and the contribution of injury-related neurological disorders increased from 0·2% (0·2–0·3) to 0·6% (0·5–0·7). Conversely, the contribution of communicable neurological disorders decreased from 4·1% (3·5–4·8) to 1·1% (0·9–1·5) during the same period. In 2019, the largest contributors to the total neurological disorder DALYs in India were stroke (37·9% [29·9–46·1]), headache disorders (17·5% [3·6–32·5]), epilepsy (11·3% [9·0–14·3]), cerebral palsy (5·7% [4·2–7·7]), and encephalitis (5·3% [3·7–8·9]). The crude DALY rate of several neurological disorders had considerable heterogeneity between the states in 2019, with the highest variation for tetanus (93·2 times), meningitis (8·3 times), and stroke (5·5 times). SDI of the states had a moderate significant negative correlation with communicable neurological disorder DALY rate and a moderate significant positive correlation with injury-related neurological disorder DALY rate in 2019. For most of the non-communicable neurological disorders, there was an increase in prevalence or incidence from 1990 to 2019. Substantial decreases were evident in the incidence and DALY rates of communicable neurological disorders during the same period. Migraine and multiple sclerosis were more prevalent among females than males and traumatic brain injuries were more common among males than females in 2019. Communicable diseases contributed to the majority of total neurological disorder DALYs in children younger than 5 years, and non-communicable neurological disorders were the highest contributor in all other age groups. In 2019, the leading risk factors contributing to DALYs due to non-communicable neurological disorders in India included high systolic blood pressure, air pollution, dietary risks, high fasting plasma glucose, and high body-mass index. For communicable disorders, the identified risk factors with modest contributions to DALYs were low birthweight and short gestation and air pollution. Interpretation The increasing contribution of non-communicable and injury-related neurological disorders to the overall disease burden in India, and the substantial state-level variation in the burden of many neurological disorders highlight the need for state-specific health system responses to address the gaps in neurology services related to awareness, early identification, treatment, and rehabilitation. Funding Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.