- Email: [email protected]
S22-01 Meditation as Medication
Oral presentations / Asian Journal of Psychiatry 4S1 (2011) S1–S39
Symposium S21. Improving Mental health in Low Income Countries S21-01 Developing Mental Health Services Where There Is No Psychiatrist – The Cook Island Story M. Taikoko. Te Kainga Mental Health Trust, Rarotonga, Cook Islands The Te Kainga Mental Health and Family Services NGO was formed in 2001 to help provide mental health services for the 20,000 people of the 15 inhabited islands in Cook Islands as there was none/ Despite many efforts the country never had a psychiatrist and the NGO was the only mental health provider along with its predecessor the Richmond Fellowship of New Zealand. The Richmond Fellowship counseling Centre closed its activities in 2006 and the Te Kainga has provided all mental health services since then with Mrs Mereana and a doctort with a few months experience in mental health. The Te Kainga with the Registered Mental Nurse went on to train volunteers and nurses in 10 of the 15 populated island and have held over 25 courses with the help of an AA member from Ireland and a visiting psychiatrist In 2005 the Ministry of Health promised training for the doctor a ward for acute mental admissions and the first ever budget for mental health in Cook Is. These never materialised. Te Kainga undaunted and using its own resources started a Day Centre in 2010 the first of its kind in the low income countries of the pacific with no backing! The day centre now cares for 20 members with psychogeriatric, epileptic and mental health problems and has innovated ways of raising resources to run the programme. The Ministry of health supports the centre by providing salaries of 2 nursing staff to run two busy clinics twice a week and services in the prison. Counselling and AA groups are also held in the centre. This paper will discuss what can and is being done by an NGO in mental health in a country which has no psychiatrist. S21-03 Improving Mental Health in Low Income Countries – Practical Issues M. Parameshvara Deva. Fiji School of Medicine, Fiji National University, Suva, Fiji Despite many attempts to highlight the plight of mentally ill in low income countries and dire warnings that mental illnesses will be among the biggest burden of disease by 2020 services for the mentally ill in these same countries are woefully inadequate. Human resources for 15 countries in the Pacific with 7 million people total just 13 psychiatrists. Nearby Australia and New Zealand enjoy the services of well over 4000 psychiatrists for 25 million people. Besides the lack of trained mental health staff, there are problems of poor distribution and in at least 5 Pacific countries there is no psychiatrist and only a few nurses with some training. Availability of facilities is so limited that it is common for patients with acute mental illnesses to be kept in police cells or chained in villages. Despite these constraints, there are general nurses in all populated islands and they can easily be trained to provide basic mental health services if simple guidelines and permission are given. NGOs can also play important roles in caring for the mentally ill through community based rehabilitation services. The examples of Fiji and Cook islands in turning around neglect in mental health services are highlighted in this paper.
S21
S21-04 Community Psychiatry Services in a Developing Country like Sri Lanka J. Mendis. Director of Institute of Psychiatry, Angoda Teaching Hospital, Sri Lanka The array of community mental health services in Sri Lanka vary since the time of mental health services primarily based on mental hospitals and asylums (In Colombo, Angoda) in early nineteenth century to date. In 1938 the first out-patient clinic and in 1943 the first neuropsychiatry clinic was established in General Hospital, Colombo. In 1966 it was recommended the training of all public health personnel for CMHS. In 1968 and 1969 several University Units started to address CMHS. Several non-governmental organizations also involved in the development of CMHS. Since 1998 the CMHS delivered in the primary care setting under the central leadership of a Consultant Psychiatrist, via specially trained Diploma Trainees and Medical Officers of Mental Health. Community Support Officers were trained following the Tsunami in 2004. CSOs were utilized in the management of mental health issues in the war affected areas of the country and Internally Displaced Persons. In 2010 Community Psychiatry Nursing programs were commenced. There is long journey ahead for community mental health in Sri Lanka. Urgent attention is needed in many areas if we are to realistically move towards the ambitious goals set by the National Mental Health Policy of Sri Lanka 2005–2015. i. Training of mental health professionals in community psychiatry ii. Development of infrastructure needed for CMHS iii. Consumer empowerment iv. Changing the existing legislature v. Proper leadership for CMHS vi. To ensure compliance with treatment of individuals living in the community vii. Rehabilitating long-stay mental hospital patients in the community viii. Implementing anti-stigma programmes for communities ix. Initiating population-based effective preventive interventions x. Ensuring full participation and integration of people with mental disorders within the community. To implement these effective interventions, governments need to establish clear policies articulating these measures and then developing systematic plans with dedicated budget and agreed timelines. The ultimate aim is achieving a comprehensive array of recovery-oriented mental health and chemical dependency services throughout the whole country. Symposium S22. Meditation as Medication S22-01 Meditation as Medication A.K. Sharma, S.D. Sharma, M. Sharma. Cultural Psychiatry, Mind Vision, New Delhi, India Meditation is a word, which is loosely used for diverse processes. Thus, thinking, contemplation, chanting of a mantra, fixing attention on an object, objective visualization of events, part of a life style, have all been included under the rubric of the word. It has been found that Meditation produces certain psychophysiological, socio-cultural and spiritual changes. These include lowering of triglyceride levels in the body, achievement of lower stable heart rate, lowering of blood pressure, stable G.S.R., improved rhythm and more delta and alpha rhythms on EEG, fewer psychosomatic symptom and fewer use of prescription and nonprescription medication, better productivity at work, less man days
S22
Oral presentations / Asian Journal of Psychiatry 4S1 (2011) S1–S39
loss and scores on interpersonal relations and self actualization. Meditation has been found to be useful in the treatment and prevention of illnesses like Hypertension, Heart disease, Strokes, Migraine, Tension Headache, Autoimmune diseases like Diabetes and Arthritis, Obsession, Anxiety and Depression. It is probably most useful in reducing so called problems of living in so-called normal people. There are increasing numbers of psychotropic medication available now for different illnesses, the medical costs have also been rising and so have been malpractice suits for side effects etc. It is also found that relapse rates after stoppage of medication for Anxiety/Depression may be as high as 80–90%. It would be worthwhile to incorporate systems like Meditation, which in our culture are already acceptable as complimentary to psychophysiological forms of treatment. It may not only reduce costs and burden of disease on society but also lead to holistic treatment as well as growth of the individual. Symposium S23. Empathy: Contemporary Perspectives S23-01 Empathy: Contemporary Perspectives R. Nagpal. Consultant Psychiatrist, Manobal Klinik, New Delhi, India Overview: The question of other minds is an old one; the psychobiology of empathy however, is a new field of investigation. The lack of ability to empathise is the central construct of many psychiatric conditions. Empathy is affected by neurodevelopment, brain pathology and psychiatric illness. Empathy is both a state and a trait characteristic. There is an increasing interest in theories which integrate behavioural, affective, and cognitive elements of empathy. The capacity to empathise involves shared affective neuronal networks. The absence of empathy in certain neurological and psychiatric disorders, including autism and antisocial personality disorder, provides valuable clues about the relevant neurocircuitry. Convergent evidence, providing the framework for a cognitive-affective neuroscience of empathy will be presented. S23-02 Neural Correlates of Empathy E. Mohandas. Department of Psychiatry, Elite Mission Hospital, Kerala, India Empathy, a multilevel construct, involves simulation of emotional state followed by cognitive evaluation. Emotional empathy is facilitated by neuronal networks engaging fronto-parietal mirror neuron system, limbic and par limbic areas. Cognitive empathy recruits prefrontal areas in addition to certain areas representing mirror neuron system. An overview of the recent research findings is presented. S23-03 Empathy in Geriatric Population: Clinical Perspective V.G. Jhanwar. Indian Association for Geriatric Mental Health, India Patients suffering dementia infer emotions as accurately as the healthy elderly, provided the emotions are displayed unambiguously and consistently. When the displayed emotions became more variable and ambiguous, performance in dementia becomes impaired relative to healthy elderly participants. It is suggested that non-social cognitive processes affected in dementia may be an important factor in drawing inferences about other people’s feelings. A set of attributes are identified for empathy and these would be considered in relation to clinical practice in elderly mental health. Examples of care would be discussed to show how emotive empathy
can be employed to give an improved direction to care of dementia clients. The concept is reviewed in relation to the particular needs of caring for dementia. It is suggested that it should be included in mental health training. It is suggested that e motive empathy has a vital part to play in the delivery of care for the elderly mentally ill. S23-04 Autism & Empathy: Converging Evidence A.K. Mital. Rajiv Gandhi Medical College, Kalwa, India There is now an organized body of ongoing research on the interface between autism and empathy. Research suggests that 85% of ASD individuals have alexithymia. The lack of empathetic attunement inherent to alexithymic states may reduce quality and satisfaction of relationships. Further, autistic children who demonstrate a lack of theory of mind (cognitive empathy) lack theory of mind ToM) for self as well as for others. Another significant finding (unreplicated) is that relative to typically developing children, high-functioning children with autism showed reduced mirror neuron activity in the brain’s inferior frontal gyrus while imitating and observing emotional expressions. It is suggested that autistic individuals have less ability to ascertain others’ feelings, but demonstrate equal empathy when they are aware of others’ states of mind. A common source of confusion in analyzing the interactions between empathy and autism spectrum disorders (ASD) is that the apparent lack of empathy may mask emotional oversensitivity to the feelings of others. People with ASDs may suppress their emotional facility in order to avoid painful feedback. Research also shows that people with autism are actually rather good at recognition and imitation if the action they perceive is one that has meaning and significance for their brains. As regards the failure of empathetic response, it would appear that at least some people with autism are oversensitive to the feelings of others rather than immune to them, but cannot handle the painful feed-back that this initiates in the body, and have therefore learnt to suppress this facility. These and other pertinent issues will be discussed. Symposium S24. Lifestyle, Self-Help & Complementary Medicines in Mood Disorders S24-01 Exercise and its Use in Major Depression N. Singh. Aged Care, Royal Prince Alfred and Balmain Hospitals, Balmain, NSW, Australia Background and aim: The evidence for the use of exercise as an antidepressant is currently not well known or widely clinically applied. This presentation will review the evidence and rationale for the use of exercise as an antidepressant and will explore some of the common misconceptions regarding the use of exercise and its mechanism of action. Methods: In DSM1V diagnosed major depression there are close to twenty randomized controlled trials demonstrating that exercise is an effective antidepressant of rough equivalence to standard medication therapy and psychotherapy, with good compliance and minimal side effects. Both aerobic and weight training are effective. There is evidence in both young and old cohorts with major depression. It appears to be effective in a group or in an individual setting both supervised and unsupervised. Relatively high intensities appear to be most effective with lower intensities achieving placebo like responses. Evidence of long term efficacy is limited but supportive of exercise as a treatment. Evidence for use in combination treatments suggest no additional improvement in depression but may treat side effects of standard medications such as poor balance and body composition change and co-morbidity associated with depression.
Symposium S21. Improving Mental health in Low Income Countries S21-01 Developing Mental Health Services Where There Is No Psychiatrist – The Cook Island Story M. Taikoko. Te Kainga Mental Health Trust, Rarotonga, Cook Islands The Te Kainga Mental Health and Family Services NGO was formed in 2001 to help provide mental health services for the 20,000 people of the 15 inhabited islands in Cook Islands as there was none/ Despite many efforts the country never had a psychiatrist and the NGO was the only mental health provider along with its predecessor the Richmond Fellowship of New Zealand. The Richmond Fellowship counseling Centre closed its activities in 2006 and the Te Kainga has provided all mental health services since then with Mrs Mereana and a doctort with a few months experience in mental health. The Te Kainga with the Registered Mental Nurse went on to train volunteers and nurses in 10 of the 15 populated island and have held over 25 courses with the help of an AA member from Ireland and a visiting psychiatrist In 2005 the Ministry of Health promised training for the doctor a ward for acute mental admissions and the first ever budget for mental health in Cook Is. These never materialised. Te Kainga undaunted and using its own resources started a Day Centre in 2010 the first of its kind in the low income countries of the pacific with no backing! The day centre now cares for 20 members with psychogeriatric, epileptic and mental health problems and has innovated ways of raising resources to run the programme. The Ministry of health supports the centre by providing salaries of 2 nursing staff to run two busy clinics twice a week and services in the prison. Counselling and AA groups are also held in the centre. This paper will discuss what can and is being done by an NGO in mental health in a country which has no psychiatrist. S21-03 Improving Mental Health in Low Income Countries – Practical Issues M. Parameshvara Deva. Fiji School of Medicine, Fiji National University, Suva, Fiji Despite many attempts to highlight the plight of mentally ill in low income countries and dire warnings that mental illnesses will be among the biggest burden of disease by 2020 services for the mentally ill in these same countries are woefully inadequate. Human resources for 15 countries in the Pacific with 7 million people total just 13 psychiatrists. Nearby Australia and New Zealand enjoy the services of well over 4000 psychiatrists for 25 million people. Besides the lack of trained mental health staff, there are problems of poor distribution and in at least 5 Pacific countries there is no psychiatrist and only a few nurses with some training. Availability of facilities is so limited that it is common for patients with acute mental illnesses to be kept in police cells or chained in villages. Despite these constraints, there are general nurses in all populated islands and they can easily be trained to provide basic mental health services if simple guidelines and permission are given. NGOs can also play important roles in caring for the mentally ill through community based rehabilitation services. The examples of Fiji and Cook islands in turning around neglect in mental health services are highlighted in this paper.
S21
S21-04 Community Psychiatry Services in a Developing Country like Sri Lanka J. Mendis. Director of Institute of Psychiatry, Angoda Teaching Hospital, Sri Lanka The array of community mental health services in Sri Lanka vary since the time of mental health services primarily based on mental hospitals and asylums (In Colombo, Angoda) in early nineteenth century to date. In 1938 the first out-patient clinic and in 1943 the first neuropsychiatry clinic was established in General Hospital, Colombo. In 1966 it was recommended the training of all public health personnel for CMHS. In 1968 and 1969 several University Units started to address CMHS. Several non-governmental organizations also involved in the development of CMHS. Since 1998 the CMHS delivered in the primary care setting under the central leadership of a Consultant Psychiatrist, via specially trained Diploma Trainees and Medical Officers of Mental Health. Community Support Officers were trained following the Tsunami in 2004. CSOs were utilized in the management of mental health issues in the war affected areas of the country and Internally Displaced Persons. In 2010 Community Psychiatry Nursing programs were commenced. There is long journey ahead for community mental health in Sri Lanka. Urgent attention is needed in many areas if we are to realistically move towards the ambitious goals set by the National Mental Health Policy of Sri Lanka 2005–2015. i. Training of mental health professionals in community psychiatry ii. Development of infrastructure needed for CMHS iii. Consumer empowerment iv. Changing the existing legislature v. Proper leadership for CMHS vi. To ensure compliance with treatment of individuals living in the community vii. Rehabilitating long-stay mental hospital patients in the community viii. Implementing anti-stigma programmes for communities ix. Initiating population-based effective preventive interventions x. Ensuring full participation and integration of people with mental disorders within the community. To implement these effective interventions, governments need to establish clear policies articulating these measures and then developing systematic plans with dedicated budget and agreed timelines. The ultimate aim is achieving a comprehensive array of recovery-oriented mental health and chemical dependency services throughout the whole country. Symposium S22. Meditation as Medication S22-01 Meditation as Medication A.K. Sharma, S.D. Sharma, M. Sharma. Cultural Psychiatry, Mind Vision, New Delhi, India Meditation is a word, which is loosely used for diverse processes. Thus, thinking, contemplation, chanting of a mantra, fixing attention on an object, objective visualization of events, part of a life style, have all been included under the rubric of the word. It has been found that Meditation produces certain psychophysiological, socio-cultural and spiritual changes. These include lowering of triglyceride levels in the body, achievement of lower stable heart rate, lowering of blood pressure, stable G.S.R., improved rhythm and more delta and alpha rhythms on EEG, fewer psychosomatic symptom and fewer use of prescription and nonprescription medication, better productivity at work, less man days
S22
Oral presentations / Asian Journal of Psychiatry 4S1 (2011) S1–S39
loss and scores on interpersonal relations and self actualization. Meditation has been found to be useful in the treatment and prevention of illnesses like Hypertension, Heart disease, Strokes, Migraine, Tension Headache, Autoimmune diseases like Diabetes and Arthritis, Obsession, Anxiety and Depression. It is probably most useful in reducing so called problems of living in so-called normal people. There are increasing numbers of psychotropic medication available now for different illnesses, the medical costs have also been rising and so have been malpractice suits for side effects etc. It is also found that relapse rates after stoppage of medication for Anxiety/Depression may be as high as 80–90%. It would be worthwhile to incorporate systems like Meditation, which in our culture are already acceptable as complimentary to psychophysiological forms of treatment. It may not only reduce costs and burden of disease on society but also lead to holistic treatment as well as growth of the individual. Symposium S23. Empathy: Contemporary Perspectives S23-01 Empathy: Contemporary Perspectives R. Nagpal. Consultant Psychiatrist, Manobal Klinik, New Delhi, India Overview: The question of other minds is an old one; the psychobiology of empathy however, is a new field of investigation. The lack of ability to empathise is the central construct of many psychiatric conditions. Empathy is affected by neurodevelopment, brain pathology and psychiatric illness. Empathy is both a state and a trait characteristic. There is an increasing interest in theories which integrate behavioural, affective, and cognitive elements of empathy. The capacity to empathise involves shared affective neuronal networks. The absence of empathy in certain neurological and psychiatric disorders, including autism and antisocial personality disorder, provides valuable clues about the relevant neurocircuitry. Convergent evidence, providing the framework for a cognitive-affective neuroscience of empathy will be presented. S23-02 Neural Correlates of Empathy E. Mohandas. Department of Psychiatry, Elite Mission Hospital, Kerala, India Empathy, a multilevel construct, involves simulation of emotional state followed by cognitive evaluation. Emotional empathy is facilitated by neuronal networks engaging fronto-parietal mirror neuron system, limbic and par limbic areas. Cognitive empathy recruits prefrontal areas in addition to certain areas representing mirror neuron system. An overview of the recent research findings is presented. S23-03 Empathy in Geriatric Population: Clinical Perspective V.G. Jhanwar. Indian Association for Geriatric Mental Health, India Patients suffering dementia infer emotions as accurately as the healthy elderly, provided the emotions are displayed unambiguously and consistently. When the displayed emotions became more variable and ambiguous, performance in dementia becomes impaired relative to healthy elderly participants. It is suggested that non-social cognitive processes affected in dementia may be an important factor in drawing inferences about other people’s feelings. A set of attributes are identified for empathy and these would be considered in relation to clinical practice in elderly mental health. Examples of care would be discussed to show how emotive empathy
can be employed to give an improved direction to care of dementia clients. The concept is reviewed in relation to the particular needs of caring for dementia. It is suggested that it should be included in mental health training. It is suggested that e motive empathy has a vital part to play in the delivery of care for the elderly mentally ill. S23-04 Autism & Empathy: Converging Evidence A.K. Mital. Rajiv Gandhi Medical College, Kalwa, India There is now an organized body of ongoing research on the interface between autism and empathy. Research suggests that 85% of ASD individuals have alexithymia. The lack of empathetic attunement inherent to alexithymic states may reduce quality and satisfaction of relationships. Further, autistic children who demonstrate a lack of theory of mind (cognitive empathy) lack theory of mind ToM) for self as well as for others. Another significant finding (unreplicated) is that relative to typically developing children, high-functioning children with autism showed reduced mirror neuron activity in the brain’s inferior frontal gyrus while imitating and observing emotional expressions. It is suggested that autistic individuals have less ability to ascertain others’ feelings, but demonstrate equal empathy when they are aware of others’ states of mind. A common source of confusion in analyzing the interactions between empathy and autism spectrum disorders (ASD) is that the apparent lack of empathy may mask emotional oversensitivity to the feelings of others. People with ASDs may suppress their emotional facility in order to avoid painful feedback. Research also shows that people with autism are actually rather good at recognition and imitation if the action they perceive is one that has meaning and significance for their brains. As regards the failure of empathetic response, it would appear that at least some people with autism are oversensitive to the feelings of others rather than immune to them, but cannot handle the painful feed-back that this initiates in the body, and have therefore learnt to suppress this facility. These and other pertinent issues will be discussed. Symposium S24. Lifestyle, Self-Help & Complementary Medicines in Mood Disorders S24-01 Exercise and its Use in Major Depression N. Singh. Aged Care, Royal Prince Alfred and Balmain Hospitals, Balmain, NSW, Australia Background and aim: The evidence for the use of exercise as an antidepressant is currently not well known or widely clinically applied. This presentation will review the evidence and rationale for the use of exercise as an antidepressant and will explore some of the common misconceptions regarding the use of exercise and its mechanism of action. Methods: In DSM1V diagnosed major depression there are close to twenty randomized controlled trials demonstrating that exercise is an effective antidepressant of rough equivalence to standard medication therapy and psychotherapy, with good compliance and minimal side effects. Both aerobic and weight training are effective. There is evidence in both young and old cohorts with major depression. It appears to be effective in a group or in an individual setting both supervised and unsupervised. Relatively high intensities appear to be most effective with lower intensities achieving placebo like responses. Evidence of long term efficacy is limited but supportive of exercise as a treatment. Evidence for use in combination treatments suggest no additional improvement in depression but may treat side effects of standard medications such as poor balance and body composition change and co-morbidity associated with depression.