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2. Specific Phobias

Author

Burkauskas, Julius, primary, Fineberg, Naomi A., additional, Enara, Arun, additional, Cirnigliaro, Giovanna, additional, and Drummond, Lynne M., additional

Published
2024
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3. Feasibility, acceptability and practicality of transcranial stimulation in obsessive compulsive symptoms (FEATSOCS): A randomised controlled crossover trial

Author

Fineberg, Naomi A., Cinosi, Eduardo, Smith, Megan V.A., Busby, Amanda D., Wellsted, David, Huneke, Nathan T.M., Garg, Kabir, Aslan, Ibrahim H., Enara, Arun, Garner, Matthew, Gordon, Robert, Hall, Natalie, Meron, Daniel, Robbins, Trevor W., Wyatt, Solange, Pellegrini, Luca, and Baldwin, David S.

Published
2023
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6. Feasibility and acceptability of transcranial stimulation in obsessive–compulsive symptoms (FEATSOCS): study protocol for a randomised controlled trial of transcranial direct current stimulation (tDCS) in obsessive–compulsive disorder (OCD)

Author

Cinosi, Eduardo, Adam, David, Aslan, Ibrahim, Baldwin, David, Chillingsworth, Kieran, Enara, Arun, Gale, Tim, Garg, Kabir, Garner, Matthew, Gordon, Robert, Hall, Natalie, Huneke, Nathan T. M., Kucukterzi-Ali, Sonay, McCarthy, Joanne, Meron, Daniel, Monji-Patel, Deela, Mooney, Roisin, Robbins, Trevor, Smith, Megan, Sireau, Nick, Wellsted, David, Wyatt, Solange, and Fineberg, Naomi A.

Published
2021
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23. Psychiatrist in Court: Indian Scenario

Author

Basavaraju, Vinay, primary, Enara, Arun, additional, Gowda, Guru S., additional, Harihara, Shashidhara Nagabhushana, additional, Manjunatha, Narayana, additional, Kumar, Channaveerachari Naveen, additional, and Math, Suresh Bada, additional

Published
2019
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32. Is it the right time to implement Community Treatment Order in India?

Author

Gowda, Guru, Enara, Arun, Raveesh, Bevinahalli, and Gowda, Mahesh

Subjects
*MENTAL illness treatment, *CAREGIVERS, *CONTINUUM of care, *DRUGS, *HOMELESSNESS, *PATIENT compliance, *SOCIAL stigma, *SUICIDE, *VIOLENCE, *PATIENTS' rights, *DISEASE relapse, *DISCHARGE planning, *BURDEN of care
Abstract

India enacted the Mental Healthcare Act, 2017 (MHCA 2017) on April 7, 2017 to align and harmonize with United Nations Convention on Persons with Disabilities and the principles of prioritizing human rights protection. While MHCA 2017 is oriented toward the rights of the patients, the rights of the family members and professionals delivering treatment, care, and support to persons with severe mental disorder (SMD) often suffer. MHCA 2017 mandates discharge planning in consultation with the patients for admitted patients and makes the service providers responsible for ensuring continuity of care in the community. The concerns surrounding the chances of relapse and recurrence when a person with a SMD stops medications continue to remain largely unaddressed. The rights-based MHCA 2017 makes it difficult for the prevailing practices of surreptitious treatment by the family/caregiver and proxy consultations on behalf of the patients. This will, in turn, lead to increased chances of relapse, risk of violence, homelessness, stigma, and suicide in persons with SMDs in the community, largely due to noncompliance to treatment. This will also result in increased caregiver burden and burnouts and may also cause disruptions in the family and the community. To strike a balance over the current MHCA 2017, there is a need to amend or bring-forth a new law rooted in the principles of community treatment order. [ABSTRACT FROM AUTHOR]

Published
2019
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33. Sale of medicines by Registered Medical Practitioners at their clinics: Legal and ethical issues.

Author

Math, Suresh, Manjunatha, Narayana, Kumar, Channaveerachari, Gowda, Guru, Philip, Sharad, Enara, Arun, and Gowda, Mahesh

Subjects
DRUGSTORE laws, HOSPITAL pharmacies, AUTONOMY (Psychology), BENEVOLENCE, MEDICAL care, MEDICAL quality control, MEDICAL ethics, MEDICAL practice, MEDICAL societies, LAW
Abstract

In India, manufacturing, storing, transportation, distribution, and dispensing of drugs are licensed and regulated under the drugs and cosmetic act, 1940; Indian Medical Council Act, 1956; the Pharmacy Act, 1948; and the Narcotic Drugs and Psychotropic Substances Act, 1985. Prescribing and dispensing medicines at the same time to their patients by registered medical practitioners (RMPs) is a well-known practice in all systems of medicine across the country. Further, the kind of branded medicines a patient gets from the clinics will come wrapped in a huge profit margin for RMPs, and this has been an alternative source of income to them. Dispensing and selling of medicines by RMPs at their clinics to their patients may represent a significant potential conflict of interest with the medical ethical principles, namely autonomy, beneficence, and non-maleficence and it raises various ethical and legal challenges. This article focuses on the ethical and legal issues of this practice and emphasizes the need for a proactive and dynamic approach to meet the rising demand for quality healthcare in India. [ABSTRACT FROM AUTHOR]

Published
2019
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35. The enigma of demonetization and the unexplored consequences.

Author

Enara, Arun and Gowda, Mahesh

Subjects
*PUBLIC administration, *FEAR, *MENTAL illness, *PSYCHIATRIC hospitals, *SERIAL publications, *SLEEP deprivation, *TERRORISM, *COMORBIDITY, *NET losses
Abstract

An editorial is presented on the economic and the psychological impact of demonetization on the people in India. Topics include the reasons for the implementation of the demonetization including the reduction of counterfeit cash, elimination of black money and the expansion of the fiscal space of the Indian government, the stress developed within the people, and its impact on psychiatric comorbidities in patients.

Published
2018
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36. Repetitive transcranial magnetic stimulation (r-TMS) and selective serotonin reuptake inhibitor-resistance in obsessive-compulsive disorder: A meta-analysis and clinical implications

Author

Luca Pellegrini, Kabir Garg, Arun Enara, David Shimon Gottlieb, David Wellsted, Umberto Albert, Keith R. Laws, Naomi A. Fineberg, Pellegrini, Luca, Garg, Kabir, Enara, Arun, Gottlieb, David Shimon, Wellsted, David, Albert, Umberto, Laws, Keith R, and Fineberg, Naomi A

Subjects
treatment-resistance, treatment-pathway, Obsessive-Compulsive Disorder, OCD, researcher-allegiance, Transcranial Magnetic Stimulation, Psychiatry and Mental health, Clinical Psychology, Treatment Outcome, rTMS, Obsessive-compulsive disorder, Humans, Selective Serotonin Reuptake Inhibitors, Randomized Controlled Trials as Topic
Abstract

Introduction: Despite promising results from several randomized controlled trials (RCTs) and meta-analyses, the efficacy of r-TMS as a treatment for OCD remains controversial, at least in part owing to inconsistency in the trial methodologies and heterogeneity in the trial outcomes. This meta-analysis attempts to explain some of this heterogeneity by comparing the efficacy of r-TMS in patients with or without resistance to treatment with selective serotonin reuptake inhibitors (SSRI), defined using standardized criteria. Methods: We conducted a pre-registered (PROSPERO ID: 241381) systematic review and meta-analysis. English language articles reporting blinded RCTs were retrieved from searches using MEDLINE, PsycINFO, and Cochrane Library databases. Studies were subjected to subgroup analysis based on four stages of treatment resistance, defined using an adaptation of published criteria (1 = not treatment resistant, 2 = one SSRI trial failed, 3 = two SSRI trials failed, 4 = two SSRI trials failed plus one or more CBT trial failed). Meta-regression analyses investigated patient and methodological factors (age, duration of OCD, illness severity, stage of treatment-resistance, or researcher allegiance) as possible moderators of effect size. Results: Twenty-five independent comparisons (23 studies) were included. Overall, r-TMS showed a medium-sized reduction of Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores (Hedge's g: -0.47; 95%CI: - 0.67 to -0.27) with moderate heterogeneity (I2 = 39.8%). Assessment of publication bias using Trim and Fill analysis suggested a reduced effect size that remained significant (g: -0.29; 95%CI: -0.51 to -0.07). Subgroup analysis found that those studies including patients non-resistant to SSRI (stage 1) (g: -0.65; 95%CI: -1.05 to -0.25, k = 7) or with low SSRI-resistance (stage 2) (g:-0.47; 95%CI: -0.86 to -0.09, k = 6) produced statistically significant results with low heterogeneity, while studies including more highly resistant patients at stage 3 (g: -0.39; 95%CI: -0.90 to 0.11, k = 4) and stage 4 (g: -0.36; 95%CI: -0.75 to 0.03, k = 8) did not. Intriguingly, the only significant moderator of the effect size found by meta-regression was the severity of baseline depressive symptoms. All trials showed evidence of researcher allegiance in favour of the intervention and therefore caution is required in interpreting the reported effect sizes. Conclusion: This meta-analysis shows that r-TMS is an effective treatment for OCD, but largely for those not resistant to SSRI or failing to respond to only one SSRI trial. As a consequence, r-TMS may be best implemented earlier in the care pathway. These findings would have major implications for clinical service development, but further well-powered RCTs, which eliminate bias from researcher allegiance, are needed before definitive conclusions can be drawn.

Published
2022

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