presidential address
Presidential Address
Address delivered at the ANCIPS 2009 in Agra on 9th January 2009
The Vision:
Women' issues
Women constitute 48% of Indian population.. Although Indian history depicts equal rights for women in ancient India, the medieval period denied equal rights. Indian constitution has many provisions for the welfare of women as could be learnt from article 14 (equality), article 15 (1) (no discrimination by the State), article 16 (equality of opportunity), article 39 (equal pay), article 51 (A) (e) (dignity of women), and article 42 (maternity relief). The dowry prohibition act of 1961, National policy for the empowerment of women in 2001, and The Protection of Women from Domestic Violence Act of 2005 (which came into force in October, 2006) are geared towards the welfare of women. Despite all this, discrimination and oppression are rampant especially in rural areas. Less than 10% of households are matriarchal. It has been predicted that the growth rate of crimes against women might surpass the population growth rate by 2010. Poverty, illiteracy, malnutrition, infections and improper maternity care in rural areas might be the reason for the high rate of maternal mortality in India (second highest in the world). 21, 22
A meta-analysis of 13 epidemiological studies in different regions of India revealed an overall prevalence rate of mental disorders in women of 64.8 per 1000.8 Women are twice prone to develop depression compared to men. Poverty and malnutrition may have direct link in causing depression during pregnancy and post partum period. The hormonal milieu of female gender may render vulnerability to emotional disorders and may influence the pharmacokinetics of drugs. Woman’s mental health issues have been discussed elsewhere. 8, 21, 22
Physical illness in mentally ill
Several large studies show that psychiatric patients suffer a high rate of co-morbid medical illnesses. Co-morbid depression in medically ill is often undiagnosed and untreated leading to increased morbidity. Lack of proper training, defective perception about psychological impact on physical disorders, improper rationalization about the somatic symptoms of depression and a tunnel vision to medical pathology may culminate in the physician’s non-recognition of psychopathology. Co-morbid psychopathology may contribute to therapeutic non-adherence to medical regimen. The drug-drug interaction may pose therapeutic dilemma. 23
Let me now focus on two specific issues relevant to the Indian context- Diabetes and HIV.
With a 40 million diabetic population, India has earned the recognition as the diabetic capital of the world. The characteristics of higher glycemic response to all food items, secreting more insulin in response to glucose and the Asian Indian Phenotype (increased insulin resistance, greater abdominal adiposity, lower adiponectin and higher high sensitive C-reactive protein levels) demonstrate higher vulnerability to develop type II diabetes with a projected 70 million by 2025.24-28
Meta analysis of 42 studies has shown clinically relevant depression in 31% of diabetics. Diabetics are twice likely to have depression. Co-morbid depression may affect glycemic control and diabetes self care behavior. Depression may also add to disability and decreased QOL. Medication non-adherence can lead to increased morbidity and mortality. The relationship between depression and diabetes may be summarized as follows. 27, 28
- Depression is a risk factor in the development of Type II DM
- Depression increases the risk of CHD in established DM
- Depression is associated with hyperglycemia and other metabolic abnormalities
- Depression is associated with other physical precipitants of heart disease
- Treatment of depression may reduce the risks of DM and its complications
Around half of Indian population is adults in the sexually active age group. The National Family Health Survey conducted between 2005 and 2006 measured HIV prevalence among the general adult population of India. The revised prevalence estimate in July 2007 suggests that around 2.5 million people in India are living with HIV. The HIV prevalence in female sex workers in India is around 5%, mainly accounted by Maharashtra and Nagaland.HIV prevalence is high in intravenous drug users(IDU).The rates are as high as 64% in certain cities. Manipur ranks first with six times the prevalence of Maharashtra and 20 times as that of Tamilnadu. The concurrent hepatitis C/B, tuberculosis, anemia and cellulitis complicate the management of HIV in IDU.29-31
The psychiatric disorders in HIV may range from adjustment disorders, depression, anxiety states to AIDS dementia. Rates of depression in Indian HIV cases range from 10-40%, higher than the rate reported elsewhere. However, the rates of AIDS dementia are pretty low (1-2%).29
Research in psychiatric disorders in HIV will be an area where young researchers in psychiatry have to focus.
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