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Bipolar disorder in the International Classification of Diseases-Eleventh version:A review of the changes,their basis,and usefulness

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World Journal of Psychiatry 2022年第12期12卷 1335-1355页

作者： subho chakrabarti Department of Psychiatry Postgraduate Institute of Medical Education and Research(PGIMER)Chandigarh 160012UTIndia

The World Health Organization’s 11^(th)revision of the International Classification of Diseases(ICD-11)including the chapter on mental disorders has come into effect this *** review focuses on the“Bipolar or Related Disorders”section of the ICD-11 *** describes the benchmarks for the new version,particularly the foremost principle of clinical *** alterations made to the diagnosis of bipolar disorder(BD)are evaluated on their scientific basis and clinical *** change in the diagnostic requirements for manic and hypomanic episodes has been much *** the current criteria have achieved an optimum balance between sensitivity and specificity is still not *** ICD-11 definition of depressive episodes is substantially different,but the lack of empirical support for the changes has meant that the reliability and utility of bipolar depression are relatively *** the Diagnostic and Statistical Manual of Mental Disorders,5th edition(DSM-5),the ICD-11 has retained the category of mixed *** the concept of mixed episodes in the ICD-11 is not perfect,it appears to be more inclusive than the DSM-5 ***,there are some uncertainties about the guidelines for the subtypes of BD and cyclothymic *** initial results on the reliability and clinical utility of BD are promising,but the newly created diagnostic categories also appear to have some *** further improvement and research are needed,the focus should now be on facing the challenges of implementation,dissemination,and education and training in the use of these guidelines.

关键词： ICD-11 guidelines Bipolar disorder Utility Reliability

Digital psychiatry in low-and-middle-income countries:New developments and the way forward

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World Journal of Psychiatry 2024年第3期14卷 350-361页

作者： subho chakrabarti Department of Psychiatry Postgraduate Institute of Medical Education and ResearchChandigarh 160012UTIndia

Low-and middle-income countries(LMICs)bear the greater share of the global mental health burden but are ill-equipped to deal with it because of severe resource constraints leading to a large treatment *** remote provision of mental health services by digital means can effectively augment conventional services in LMICs to reduce the treatment *** psychiatry in LMICs has always lagged behind high-income countries,but there have been encouraging developments in the last *** is increasing research on the efficacy of digital psychiatric ***,the evidence is not adequate to conclude that digital psychiatric interventions are invariably effective in LMICs.A striking development has been the rise in mobile and smartphone ownership in LMICs,which has driven the increasing use of mobile technologies to deliver mental health *** innovative use of mobile technologies has been to optimize task-shifting,which involves delivering mental healthcare services in community settings using non-specialist health *** evidence from LMICs shows that it is possible to use digital tools to train non-specialist workers effectively and ensure that the psychosocial interventions they deliver are *** these promising developments,many barriers such as service costs,underdeveloped infrastructure,lack of trained professionals,and significant disparities in access to digital services impede the progress of digital psychiatry in *** overcome these barriers,digital psychiatric services in LMICs should address contextual factors influencing the delivery of digital services,ensure collaboration between different stakeholders,and focus on reducing the digital divide.

关键词： Digital psychiatry Low-and middle-income countries Developments Mental health

Treatment alliance and adherence in bipolar disorder

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World Journal of Psychiatry 2018年第5期8卷 114-124页

作者： subho chakrabarti Department of Psychiatry Postgraduate Institute of Medical Education and Research (PGIMER)

The clinician patient relationship lies at the core of psychiatric practice and delivery of mental health care services. The concept of treatment alliance in psychiatry has its origins in psychotherapy, but has also been influenced by several other constructs such as patientcentred care(PCC) and shared decision-making(SDM). Similarly, there has been a shift in conceptualization of treatment-adherence in psychiatric disorders including bipolar disorder(BD) from illness-centred and clinician-centred approaches to patient-centred ones. Moreover, the traditional compliance based models are being replaced by those based on concordance between clinicians and patients. Newer theories of adherence in BD place considerable emphasis on patient related factors and the clinician patient alliance is considered to be one of the principal determinants of treatment-adherence in BD. Likewise, current notions of treatment alliance in BD also stress the importance of equal and collaborative relationships, sensitivity to patients' viewpoints, sharing of knowledge, and mutual responsibility and agreement regarding decisions related to treatment. Accumulated evidence from quantitative research, descriptive accounts, qualitative studies and trials of psychosocial interventions indicates that efficacious treatment alliances have a positive influence on adherence in BD. Then again, research on the alliance-adherence link in BD lags behind the existing literature on the subject in other medical and psychiatric conditions in terms of the size and quality of the evidence, the consistency of its findings and clarity about underlying processes mediating this link. Nevertheless, the elements of an effective alliance which could have a positive impact on adherence in BD are reasonably clear and include PCC, collaborative relationships, SDM, open communication, trust, support, and stability and continuity of the relationship. Therefore, clinicians involved in the care of BD would do well to follow

关键词： Treatment Alliance Adherence Bipolar disorder Components Mediators

Clozapine resistant schizophrenia:Newer avenues of management

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World Journal of Psychiatry 2021年第8期11卷 429-448页

作者： subho chakrabarti Department of Psychiatry Postgraduate Institute of Medical Education and ResearchChandigarh 160012India

About 40%-70%of the patients with treatment-resistant schizophrenia have a poor response to adequate treatment with *** impact of clozapineresistant schizophrenia(CRS)is even greater than that of treatment resistance in terms of severe and persistent symptoms,relapses and hospitalizations,poorer quality of life,and healthcare *** serious consequences often compel clinicians to try different augmentation strategies to enhance the inadequate clozapine response in ***,a large body of evidence has shown that antipsychotics,antidepressants,mood stabilizers,electroconvulsive therapy,and cognitive-behavioural therapy are mostly ineffective in augmenting clozapine *** beneficial effects of augmentation have been found,they are usually small and of doubtful clinical significance or based on low-quality ***,newer treatment approaches that go beyond the evidence are *** options proposed include developing a clinical consensus about the augmentation strategies that are most likely to be effective and using them sequentially in patients with ***,newer approaches such as augmentation with long-acting antipsychotic injections or multi-component psychosocial interventions could be ***,perhaps the most effective way to deal with CRS would be to optimize clozapine treatment,which might prevent clozapine resistance from *** dosing,adequate treatment durations,management of side effects and non-adherence,collaboration with patients and caregivers,and addressing clinician barriers to clozapine use are the principal ways of ensuring optimal clozapine *** present,these three options could the best way to manage CRS until research provides more firm directions about the effective options for augmenting clozapine response.

关键词： Clozapine-resistance Augmentation Medications Electroconvulsive therapy Psychosocial treatments Schizophrenia

Psychotic symptoms in bipolar disorder and their impact on the illness:A systematic review

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World Journal of Psychiatry 2022年第9期12卷 1204-1232页

作者： subho chakrabarti Navdeep Singh Department of Psychiatry Postgraduate Institute of Medical Education and ResearchChandigarh 160012UTIndia

BACKGROUND Lifetime psychotic symptoms are present in over half of the patients with bipolar disorder(BD)and can have an adverse effect on its course,outcome,and ***,despite a considerable amount of research,the impact of psychotic symptoms on BD remains unclear,and there are very few systematic reviews on the *** To examine the extent of psychotic symptoms in BD and their impact on several aspects of the *** The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were *** electronic literature search of six English-language databases and a manual search was undertaken to identify published articles on psychotic symptoms in BD from January 1940 to December *** of the relevant Medical Subject Headings terms were used to search for these *** were selected after a screening phase,followed by a review of the full texts of the *** of the methodological quality of the studies and the risk of bias was conducted using standard *** This systematic review included 339 studies of patients with *** psychosis was found in more than a half to two-thirds of the patients,while current psychosis was found in a little less than half of *** were more common than hallucinations in all phases of *** a third of the patients reported first-rank symptoms or mood-incongruent psychotic symptoms,particularly during manic *** symptoms were more frequent in bipolar type I compared to bipolar type II disorder and in mania or mixed episodes compared to bipolar *** psychotic symptoms were not more severe in BD,the severity of the illness in psychotic BD was consistently *** was usually associated with poor insight and a higher frequency of agitation,anxiety,and hostility but not with psychiatric *** was consistently linked with increased rates and the duration of hospitalizations,switching amo

关键词： Psychotic symptoms Bipolar disorder Extent Impact

Development of a protocol for videoconferencing-based exposure and response prevention treatment of obsessive-compulsive disorder during the COVID-19 pandemic

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World Journal of Psychiatry 2023年第2期13卷 60-74页

作者： Sanjana Kathiravan subho chakrabarti Department of Psychiatry Postgraduate Institute of Medical Education and Research(PGIMER)Chandigarh 160012India

BACKGROUND The existing literature indicates that psychotherapeutic treatment,especially exposure and response prevention(ERP)is efficacious in treating obsessivecompulsive disorder(OCD).The coronavirus disease 2019 pandemic adversely impacted many patients with OCD and disrupted their usual ***,the pandemic forced a global switch to telemental health(TMH)services to maintain the standards and continuity of ***,clinicians are increasingly using TMH-based psychotherapeutic treatments to treat ***,several challenges have made it difficult for them to implement these treatments in the changed circumstances imposed by the *** To describe the formulation,implementation,feasibility,and usefulness of videoconferencing-based ERP(VC-ERP)treatment for OCD during the coronavirus disease 2019 *** This prospective,observational study was conducted in the psychiatric unit of a multi-specialty hospital in north India over 12 mo(July 2020-June 2021).All patients with OCD were assessed using the home-based TMH services of the *** VC-ERP protocol for OCD was the outcome of weekly Zoom meetings with a group of clinicians involved in administering the *** a systematic evaluation of the available treatment options,an initial protocol for delivering VC-ERP was *** for clinicians and educational materials for patients and their families were *** protocol was implemented among patients with OCD attending the TMH services,and their progress was *** weekly meetings were used to upgrade the protocol to meet the needs of all *** and efficacy outcomes were *** All patients were diagnosed with OCD as a primary or a comorbid condition according to the International Classification of Diseases,10th version *** of 115 patients who attended the services during the study period,37 were excluded from the final *** the remaining 78 patie

关键词： Videoconferencing Exposure and response prevention Obsessive-compulsive disorder Telemedicine COVID-19

Composition of treatment alliance in bipolar disorder: A cross-sectional study of patients' perspectives

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World Journal of Psychiatry 2022年第6期12卷 814-826页

作者： Rajeet Kumar subho chakrabarti Abhishek Ghosh Department of Psychiatry Postgraduate Institute of Medical Education and ResearchChandigarh 160012India

BACKGROUND Treatment alliance has an impact on several key patient outcomes in all psychiatric disorders,including bipolar disorder(BD).It has been suggested that the construct of treatment alliance is different among patients from routine psychiatric settings compared to psychotherapeutic ***,research on the composition of treatment alliance in psychiatric disorders,such as BD,is relatively *** To determine whether a broader construct of treatment alliance was prevalent among outpatients with *** This is a cross-sectional study,conducted in the psychiatric unit of a multispecialty hospital in north India over 12 mo(September 2018 to September 2019).A consecutive sample of 160 remitted adult outpatients with BD on mood stabilizers for at least a year were *** principal instrument to assess treatment alliance was the Working Alliance Inventory-client version(WAIClient).Other potential constituents of the alliance explored were perceived trust in clinicians assessed by the Trust in Physicians(TRIP)scale,perceived support from clinicians assessed by the Psychosocial Care by Physicians(PCP)scale,and perceived treatment satisfaction assessed by the Patient Satisfaction Questionnaire(PSQ).Associations between scores on all scales were determined by correlational and multiple regression *** factor analysis of combined items of all scales was conducted using a principal components *** Scores on all the three WAI-Client subscales were significantly correlated with each other(r=0.66-0.81;P<0.0001).The total TRIP scores were associated with the total WAI-Client scores(r=0.28;P<0.01).The total TRIP scores and the total PCP scores were also significantly associated with the WAI-Client scores on the Task subscale(r=0.28-0.29;P<0.01).The total TRIP scores were significantly associated with the total PSQ scores(r=0.45;P<0.0001).Factor analysis yielded two independent and coherent factors,which explained 69%of the va

关键词： Treatment alliance Bipolar disorder Composition Factor-analysis

Comorbidity of bipolar and anxiety disorders:An overview of trends in research

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World Journal of Psychiatry 2019年第1期9卷 7-29页

作者： Mamidipalli Sai Spoorthy subho chakrabarti Sandeep Grover Department of Psychiatry Postgraduate Institute of Medical Education and Research

Over the last three decades burgeoning research has shown that anxiety disorder comorbidity is not only highly prevalent in bipolar disorder(BD),but it also adversely impacts the course,outcome,and treatment of *** present review provides an overview of the current trends in research on comorbid anxiety and BDs based on prior reviews and meta-analyses(n=103),epidemiological surveys,and large-scale clinical *** results reiterated the fact that at least half of those with BD are likely to develop an anxiety disorder in their lifetimes and a third of them will manifest an anxiety disorder at any point of *** types of anxiety disorders were equally common in ***,there was a wide variation in rates across different sources,with most of this discrepancy being accounted for by methodological differences between *** anxiety disorders negatively impacted the presentation and course of *** unfavourable clinical profile led to poorer outcome and functioning and impeded treatment of *** the extensive body of research there was paucity of data on aetiology and treatment of anxiety disorder comorbidity in ***,the substantial burden and unique characteristics of this comorbidity has important clinical and research implications.

关键词： Comorbidity Bipolar disorder Anxiety disorders Correlates Impact Aetiology Treatment

Role of adjunctive nonpharmacological strategies for treatment of rapid-cycling bipolar disorder

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World Journal of Psychiatry 2023年第8期13卷 495-510页

作者： subho chakrabarti Amal J Jolly Pranshu Singh Nidhi Yadhav Department of Psychiatry Postgraduate Institute of Medical Education and ResearchChandigarh 160012Chandigarh UTIndia Department of Psychiatry Black Country Healthcare NHS Foundation TrustDudley DY28PSWest MidlandsUnited Kingdom Department of Psychiatry All India Institute of Medical SciencesJodhpur 342005RajasthanIndia

Rapid-cycling bipolar disorder(RCBD)is a phase of bipolar disorder defined by the presence of≥4 mood episodes in a *** is a common phenomenon characterized by greater severity,a predominance of depression,higher levels of disability,and poorer overall *** is resistant to treatment by conventional *** existing literature underlines the scarcity of evidence and the gaps in knowledge about the optimal treatment strategies for ***,most reviews have considered only pharmacological treatment options for *** the treatment-refractory nature of RCBD,nonpharmacological interventions could augment medications but have not been adequately *** review carried out an updated and comprehensive search for evidence regarding the role of nonpharmacological therapies as adjuncts to medications in *** identified 83 reviews and meta-analyses concerning the treatment of ***,we found 42 reports on adjunctive nonpharmacological treatments in *** of the evidence favoured concomitant electroconvulsive therapy as an acute and maintenance *** was preliminary evidence to suggest that chronotherapeutic treatments can provide better outcomes when combined with *** research on adjunctive psychotherapy was particularly scarce but suggested that psychoeducation,cognitive behavioural therapy,family interventions,and supportive psychotherapy may be *** overall quality of evidence was poor and suffered from several methodological *** is a need for more methodologically sound research in this area,although clinicians can use the existing evidence to select and individualize nonpharmacological treatment options for better management of *** summaries are included to highlight some of the issues concerning the implementation of adjunctive nonpharmacological treatments.

关键词： Rapid-cycling bipolar disorder Bipolar disorder Adjunctive therapy Nonpharmacological treatment