Biomedical subjects
R Raguram
Publications and source records attributed to R Raguram.
Sexual dysfunction in single males: a perspective from India.
Various personal, familial, and socio-cultural factors play a crucial role in the development of sexuality and sexual practices. They often influence the occurrence and maintenance of sexual dysfunctions. Therapies with individuals with sexual dysfunctions often emphasize the involvement of both the partners. Issues related to single males, especially in the Indian context, have not been explored. The present study is a retrospective analysis of clinical case records of single males who reported sexual dysfunctions between the years 1990 to 2000. Thirty-eight clinical case records were analyzed for the demographic details, nature of the problems, and interventions provided with the aim of exploring the reported symptomatology, precipitating and maintaining factors, prevalent beliefs about the causation of sexual dysfunction, and the outcome of interventions. The role of cultural and psychosocial issues is discussed and the need for research in this area is emphasized.
Traditional community resources for mental health: a report of temple healing from India.
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GS-02 for dysthymic disorder: results of a preliminary, open study.
In an open clinical trial, 15 patients diagnosed with DSM-IV dysthymic disorder were treated with GS-02, a herbal formulation containing extracts of four Indian herbs: Ashvatha, Kapikachu, Dhanvayasa, and Bhuriphali. Twelve patients completed the study. The medication was very well-tolerated. Among treatment completers, three (25%) patients showed no response, two (16.7%) showed partial response, and seven (58.3%) showed good response; these response rates are similar to what can be expected from an allopathic antidepressant trial. In an intent- to-treat analysis, significant improvement was observed on Hamilton depression ratings as well as on global measures. The results of this preliminary study encourage further clinical investigation of the GS-02 formulation.
Global, national, and local approaches to mental health: examples from India.
Neuropsychiatric disorders and suicide amount to 12.7% of the global burden of disease and related conditions (GBD) according to World Health Organization (WHO) estimates for 1999, and recognition of the enormous component of mental illness in the GBD has attracted unprecedented attention in the field of international health. Focusing on low- and middle-income countries with high adult mortality, this article discusses essential functions of international agencies concerned with mental health. A review of the history and development of national mental health policy in India follows, and local case studies consider the approach to planning in a rural mental health programme in West Bengal and the experience in an established urban mental health programme in a low-income community of Mumbai. Local programmes must be attentive to the needs of the communities they serve, and they require the support of global and national policy for resources and the conceptual tools to formulate strategies to meet those needs. National programmes retain major responsibilities for the health of their country's population: they are the portals through which global and local interests, ideas, and policies formally interact. International priorities should be responsive to a wide range of national interests, which in turn should be sensitive to diverse local experiences. Mental health actions thereby benefit from the synergy of informed and effective policy at each level.
Alcohol problems in a general hospital--a prevalence study.
The prevalence of problem drinking among medical and surgical in-patients in a general hospital was studied using the CAGE questionnaire. Almost a quarter (23.3%) of the in-patients had associated drinking problems which were more among medical than surgical in-patients. In a large majority of these patients, the associated problem drinking was not recognised by the treating medical professionals. Routine administration of instruments like CAGE which are brief and easy to use would contribute to the early detection and management of alcohol problems in the general hospital setting.
Stigma, depression, and somatization in South India.
OBJECTIVE: The relationships of stigma to both depression and somatization were studied in psychiatric patients in South India to test the hypothesis that stigma is positively related to depressive symptoms and negatively related to somatoform symptoms. METHOD: Illness experience, symptom prominence, and indicators of stigma for 80 psychiatric outpatients were addressed with the Explanatory Model Interview Catalogue. Stigma scores and ratings of symptom prominence were derived. The Structured Clinical Interview for DSM-III-R and the Hamilton Depression Rating Scale were administered to assess psychiatric diagnoses and symptoms of depression. Clinical narratives were analyzed to clarify the nature of relationships between stigma and symptom prominence. RESULTS: The mean stigma scores were 18.2 (SD = 13.0) for patients with somatoform disorders only, 36.0 (SD = 19.0) for patients with depressive disorders only, and 26.8 (SD = 16.0) for those with mixed depressive and somatoform disorders. The stigma scores were positively related to depressive symptoms, as indicated by Hamilton scale scores and prominence ratings for depressive symptoms, but stigma was inversely related to somatoform symptoms, as indicated by ratings of symptom prominence. Although both depressive and somatic symptoms were distressing, qualitative analysis clarified meanings of perceived stigma, showing that depressive symptoms, unlike somatic symptoms, were construed as socially disadvantageous. CONCLUSIONS: The tendency to perceive and report distress in psychological or somatic terms is influenced by various social and cultural factors, including the degree of stigma associated with particular symptoms. This study with the Explanatory Model Interview Catalogue demonstrates how quantitative and qualitative methods can be effectively combined to examine key issues in cultural psychiatry.
Cultural dimensions of psychiatric diagnosis. A comparison of DSM-III-R and illness explanatory models in south India.
BACKGROUND: Cross-cultural research to examine the cultural validity of diagnostic categories and underlying concepts requires methods that integrate epidemiological and anthropological frameworks. METHOD: The Explanatory Model Interview Catalogue (EMIC) and Structured Clinical Interview for DSM-III-R (SCID) were used to study 80 psychiatric out-patients with depressive neurosis at a clinic in south India. RESULTS: Summary kappa values of 0.75 for the EMIC and 0.68 for the SCID confirmed interrater reliability. Comparison of patient explanatory models and SCID diagnoses showed that patients emphasised somatic experience while clinicians emphasised depressive diagnoses. More than half the patients (55%) received a non-specific or dual diagnosis. CONCLUSIONS: These findings raise questions about the distinctiveness of depressive, anxiety, and somatoform (DAS) disorders for this population.
Patterns of phobic neurosis: a retrospective study.
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The neuroleptic malignant syndrome: an Indian experience.
A study was performed to investigate the clinical presentation and outcome of the neuroleptic malignant syndrome (NMS) in a large teaching psychiatric hospital in India. Thirteen cases were identified after a thorough search of intensive care unit (ICU) records during the 4-year period between 1990 and 1993. Information collected from these cases was then compared against data from a representative control group of 252 inpatients who received neuroleptics, drawn randomly from each of the 4 years of the study. Statistical comparisons were made using Student's t test, the chi-square test, and Fisher's exact test. The incidence of NMS was 1.41 per 1,000 cases treated with neuroleptics (95% confidence interval, 0.71 to 2.14 per 1,000) and the mortality from NMS was 38%. Patients who developed NMS had a significantly higher incidence of coexisting physical or neurological illness and received a higher mean neuroleptic dose. Neuroleptic loading rates were not different in the NMS and control samples. Fluphenazine decanoate was implicated as a causative factor of NMS in a significantly higher proportion of these patients. The group with a fatal outcome was significantly older and received a higher neuroleptic dose than the control group, but not compared with the group that recovered.