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Kar, Nilamadhab
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Prof Nilamadhab Kar is actively involved in mental health research along with clinical work. His research interests include stress-related mental disorders specifically posttraumatic stress disorder, suicide prevention, and clinical psychopharmacology. He has also conducted epidemiological work on mental health consequences following disasters. He is engaged in public education programmes in mental health. He has more than 300 scientific publications including articles, book chapters, and medical textbooks. His recent research highlights include unmet mental health needs of the survivors of disasters, validation of the quality of life scales in different languages to be used in psychiatric settings, the influence of lifestyle on metabolic syndrome in psychiatric patients, and mental health concerns of hyperthyroidism. Besides scientific articles, he also writes newspaper columns on mental health for public education. He is the editor of the Journal of Geriatric Care and Research and is on the editorial board of a few medical and literary journals. He is engaged in various charitable works through the Geriatric Care and Research Organisation (GeriCaRe), which has received a national award from the Government of India. He is associated with the Quality of Life Research and Development Foundation and the Institute of Insight supporting health research and public education.
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Publication Metadata only Translation and linguistic validation of Recovering Quality of Life (ReQoL) scale in Telugu: for use in mental health services(Wolters Kluwer, 2022) Satapathy, Ramanand; Madhavilatha, Kalla; Annapurna, Nimidithalli; Satapathy, Supriya; Prajwala, Mukkala; Kar, NilamadhabBackground: There is a dearth of scales in the Telugu language for assessing quality of life in persons with mental illness. Aim: It was intended to translate and linguistically validate Recovering Quality of Life 10 item version (ReQoL-10) in Telugu, a south Indian language; and to explore its acceptability among psychiatric patients. Methods: Translation of ReQoL-10 to Telugu was carried out by forward and backward translation, reconciliation, pilot testing and proofreading. Pilot testing involved psychiatric patients attending Government Hospital for Mental Care, Visakhapatnam. Results: The process of translation met with linguistic issues that were highlighted by the patients. These were addressed by modification based on patient’s observations. A second pilot-testing was done to ensure the scale is easily comprehensible by the patients, specifically by those at a lower educational level. The participating patient population (n=20) with a mean age 33.5 ± 8.4 years, was diverse in their psychiatric diagnoses which included depression, mania, schizophrenia and obsessive compulsive disorder. Conclusion: ReQoL-10 in Telugu is a linguistically acceptable scale and can be used to assess the quality of life in individuals with mental illness.Publication Open Access Personality dimension, suicidal intent, and lethality: a cross-sectional study of suicide attempters with or without personality disorders(Sage, 2024-11) Kar, Nilamadhab; Swain, Sarada; Sahoo, SaritaBackground: Although personality disorders (PD) are known risk factors for suicide attempts, studies on personality dimension are scarce, which may provide further insights for interventions. Methods: The relationship between personality dimension, lethality, intent, and quality of life (QOL) was studied in suicide attempters with or without PD. We used the international personality disorder examination (IPDE) dimensional score, the scale for assessment of lethality of suicide attempt (SALSA), suicide intent scale (SIS), and WHOQOL-BREF QOL scale, to assess a sample of suicide attempters admitted to a general hospital. Results: PD was present in 43.2% and 57.9% of them had more than one PD. Comparison of attempters with or without PD suggested that the lethality of attempts and QOL were comparable, whereas self-reported suicide intent was significantly low in patients with PD. A higher proportion of PD patients reported relational problems as the reason for the attempt. The personality dimensional score was significantly higher for female attempters from urban backgrounds than for those with previous attempt histories. It was negatively correlated with the lethality of attempts and suicide intent.Publication Open Access Profile, referral pathways and re-attendance of psychiatric patients attending the emergency department: focus on suicidality and self-harm(Cambridge University Press, 2021-06-18) Pandian, Haridha; Kar, NilamadhabAims The number of patients presenting to Emergency Departments (EDs) in the UK with acute psychiatric issues is a major concern. This project aimed to explore the outcome of patients assessed by Mental Health Liaison Services (MHLS) in a large district general hospital ED in the UK, with a focus on patients with self-harm or suicidality. Method Data were extracted from electronic patient records on 100 consecutive attendees to MHLS in July 2020. Data were collected on demographics, index of multiple deprivation (IMD) by postcode, time and reason for attendance, known ICD-10 diagnoses, self-harm history, alcohol/substance misuse at time of presentation, recent psychosocial stressors and outcome of MHLS assessment. Assessments by MHLS in the preceding 12 months and reattendance to the service within 3 months following this assessment were also recorded. Result The sample included 44 male and 56 female patients, with a mean age of 35.3 years. 80.0% of patients were Caucasian. 67.0% lived in areas classed within the top 30% most deprived in the country, whilst 2.0% had no fixed abode. The majority (79.0%) of patients self-presented; outside of normal working hours (70.0%). The most common reasons for attendance were thoughts/intent of self-harm/suicide (50.0%), overdose (29.0%) and self-harm by laceration (7.0%). The majority (73.0%) of patients had a known psychiatric diagnosis, with the most frequent being depressive disorder (36.0%) and emotionally unstable personality disorder (15.0%). Almost half (48.0%) had a history of self-harm, and 40.0% were under the influence of alcohol/illicit substances upon presentation to ED. The most common psychosocial triggers were conflict with partner (26.0%) and stress due to the COVID-19 pandemic (19.0%). Following assessment, 24.0% of patients were discharged to their General Practitioner, 18.0% to the community mental health team; and 17.0% to the Crisis & Home Treatment Team. A minority (13.0%) were admitted to a psychiatric hospital (10.0% informally, 3.0% under the Mental Health Act 1983). Approximately one in five (21.0%) patients re-attended to MHLS within 3 months. Out of 37 patients that had previously been assessed by MHLS in the preceding 12 months; 37.8% were reassessed within 3 months (p < 0.01). Conclusion In the studied sample, most (90%) of psychiatric patients attended ED for self-harm or suicide, and a significant proportion had repeat attendance. Socioeconomic deprivation, substance misuse, relationship difficulties and stress due to the COVID-19 pandemic were major issues, alongside diagnosed depression and personality disorder. Focussed support for these issues may decrease ED attendance due to self-harm/suicidality.Publication Metadata only ICU memories and patient outcomes in a low middle-income country: a longitudinal cohort study(Lippincott, Williams & Wilkins, 2021-10-01) Tripathy, Swagata; Kar, Nilamadhab; Acharya, Swati P; Singh, Santosh KumarOBJECTIVES: To study memories of ICU following discharge, their associations, and impact on mental health and quality of life in a low- and middle-income country. DESIGN: Prospective observational cohort; data on memories (pain, fear, nightmare, factual), clinical and demographic variables, anxiety-depression, posttraumatic stress symptoms, and quality of life were collected 0, 7, 14, 30, 90, and 180 days post discharge. Home visits for assessment minimized loss to follow-up. Linear mixed-models and regression analyses were used to estimate adjusted effects of memories controlling for age, sex, time, and severity of illness. SETTING: Twenty-five bedded ICU of a tertiary care center in East India. PATIENTS: Adult ICU survivors between January 2017 and July 2018 able to communicate their memories. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: Final sample consisted of 322 patients who completed 180 days follow-up. Pain, fear, factual, and nightmare memories dropped from 85%, 56%, 55%, and 45% at discharge to less than or equal to 5% at 180 days. Patients with gaps in ICU memory had worse anxiety-depression, posttraumatic stress symptoms, and quality of life at all follow-up points. Sedation (odds ratio, 0.54; CI, 0.4–0.7), steroids (odds ratio, 0.47; CI, 0.3–0.8), benzodiazepines (odds ratio, 1.74; CI, 1–3.04), and mechanical ventilation (odds ratio, 0.43; CI, 0.2–0.8) were independently associated with gaps in memory. Non-ICU factor such as substance addiction (odds ratio, 5.38; CI, 2–14) was associated with memories affecting mental health and quality of life. CONCLUSIONS: Gaps in memory and various memory types were common after ICU admission, whose prevalence waned over time. Compared with nightmares and fearful memories, gaps in memories were most strongly associated with poor mental health and quality of life. Identifying patients with gaps in memories might be an objective way of planning interventions to improve their long-term outcomes.Publication Open Access Changing patient profile in a psychiatric hospital during COVID pandemic: a comparison with pre-COVID state(Cambridge University Press, 2022-06-20) Kar, Nilamadhab; Jiwanmall, Stephen A.Aims COVID-19 pandemic has a massively adverse mental health impact and people with pre-existing psychiatric illnesses are one of the most severely affected groups. We intended to study the changes in the patient profile in a psychiatric hospital during the COVID-19 pandemic, comparing it to the period just before the pandemic. Methods Consecutive patients (n = 210) admitted to psychiatric ward under one team during COVID-19 pandemic (February 2020 to January 2022) were compared with patients (n = 234) admitted in the immediate pre-pandemic period (January 2017 to January 2020). Demographic (age, gender, and ethnicity) and clinical variables (diagnosis, admission days, Mental Health Act status, risk to self and others) were collected from the electronic patient records and analysed. Results During the pandemic monthly admission rates have gone up by 38.1% over the base rate of 6.32/month. There was no difference in the mean age at admission; or the proportion of patients aged 18–40 years or above in the pre-pandemic and pandemic groups. Similarly the gender composition of patients in the two periods was comparable. Proportion of patients from Asian background increased from 7.7% to 16.8% during pandemic period (p < 0.05). The number of hospital days decreased from 31.97 ± 45.8 days in the pre-pandemic period to 22.44 ± 25.1 days during pandemic (p < 0.05). Along with increased admission rates, it suggested a rapid flow of the admission and discharge during the pandemic. Considering diagnostic composition between pre-COVID-19 and COVID-19 periods, psychotic (27.8% v 26.7%) and mood disorders (18.8% v 23.3%) were the predominant; and substance related disorders (20.5% v 16.7%) were the most common comorbidities. Risk to self was associated with 84.3% admissions during the pandemic compared to 78.6% in the pre-pandemic period; however, risk to others was noted in 13.8% v 22.2% (p < 0.01) respectively. There was no difference in proportions getting admitted under Mental Health Act or being discharged with Community Treatment Order. Interestingly, proportions of patients getting discharged under the care of Home Treatment Team decreased from 31.1% pre-pandemic to 16.5% during pandemic period (p < 0.005). Conclusion There is an increase in admission rate and decrease in the number of admission days, suggestive of increased demand of clinical resources during pandemic. This could be reflective of the stressful situation and adverse impact on mental health in the pandemic period. As the impact on mental health is expected to continue, there is a need for greater resources both in community and inpatient psychiatric services.Publication Open Access Worry and media use behavior during COVID-19 pandemic(Horizon Journals, 2022) Kar, Brajaballav; Kar, Shreyan; Kar, NilamadhabBackground: Information seeking occurs to reinforce existing information, to solve problems, construct meaning, and as a response to alienation. The continual information uncertainty related to COVID-19 pandemic impacted life, livelihood and triggered worry. Information seeking from multiple sources became necessary to allay anxiety and verify authenticity. This research investigated the various sources of information, and its influence on their level of worry.Methods: An online survey required respondents to indicate their sociodemographic details, different information sources used, awareness of rumors, the ability to check the authenticity of the information, sources, and COVID-19 related experiences. The lowest and highest for worry scale was 1—10. Results: The median worry during the period was seven, and the number of media accessed was five. Overall worry correlated significantly with other worries (personal and family health, income, job, and lack of growth). Worry differed significantly among age groups, education, occupation, and marital status but not across gender and economic status. Individuals, who self-isolated, experienced issues with rumors, feared infection and death reported significantly more worry. Awareness, fear of infection, and rumors influenced significantly more number of media use.Conclusions: The extent of worry and the number of information sources showed complex and non-linear ‘U’ shaped relationship with the lowest at six sources. The article extends the information-seeking behavior literature by indicating that the use of a higher number of media sources is counterproductive. Understanding information exchange and information sources can help address public worryPublication Metadata only COVID-19 and the experience of mothers in perinatal psychiatry services : an explorative study in the UK(Wolters Kluwer, 2023-07) Almas, Saima; Kar, Nilamadhab; Kennedy, VanathiBackground/Objective: As the health services were reorganized during the COVID-19 restricting access to family caregivers, we explored the experience of women in the perinatal period, attending a specialist perinatal mental health service. Methods: Patients (n = 38) in the outpatient list for review were assessed over phone based on a predesigned, semi-structured questionnaire, comprising both quantitative (demographic, clinical variables) and qualitative open-ended questions regarding their experience of services during COVID-19. Results: The responses provided insight into how the pandemic affected the experience of pregnancy of mentally ill women and the impact of changes in perinatal mental health services. The main concerns centered around reduced support from close family members during the perinatal period due to the lockdown, anxiety regarding COVID transmission, absence of a supporting persons in antenatal clinics, difficulty accessing support from midwives, and health visitors as well as the use of virtual clinics for mental health consultations. Conclusions: The results suggested possible methods of improving perinatal mental health support during challenging times, which included ensuring in-person consultations, access to family even remotely, increasing accessibility through alternative means; providing and close monitoring of additional psychosocial support when needed.Publication Open Access What can we learn from the COVID pandemic about care of older adults?(GeriCare, 2021-07) Kar, NilamadhabThe elderly population has been worst hit during the COVID pandemic. Society should take this challenge to learn from the experience to improve the support services for the elderly and preparedness for pandemic. Proper planning and strategies in health, social care, and public services are requiredPublication Open Access Clinical profile and comorbidity of elderly patients presenting to a psychiatric outpatient unit of a tertiary care hospital in Odisha, India: a cross sectional study(GeriCare, 2022-11) Mahanta, Debasish; Mohanty, Nitya; Kar, Shreyan; Mohapatra, Satyakam; Kar, NilamadhabBackground: With gradually increasing older population, the profile of elderly attending psychiatric services needs exploration to inform changing service needs. Aims: Clinical characteristics of elderly attending a psychiatric outpatient department and the challenges faced by their caregivers were studied. Methods: An explorative, interview-based study. Results: The sample included 78 consecutive (49 male and 29 female) patients; between 60-80 years of age (63.7+4.7); amongst them 12.8% were widowed, and 19.2% were still working. The common diagnoses were schizophrenia and bipolar disorder at 29.5% each, and major depression and dementia 10.3% each. Comorbid physical illnesses were reported in 56%, which were mostly neurological side effects and illnesses (26.9%), hypertension (19.2%), and diabetes (15.4%). Majority (85.9%) of elderly had antipsychotic drugs and 16.4% of them had two antipsychotics. Challenges in caregiving were financial (59.0%), hampered leisure (62.8%) or family (60.3%) activities, psychological stress and mental health problems (55.1% each), and physical health problems (33.3%) and other problems (37.2%). The patients had to travel on an average of 81.9±77.9 km with an average travel time of 2.3±2.0 hours. Conclusion: Most elderly attending psychiatric outpatients had severe mental illnesses and there were major caregiving concerns which need to be addressedPublication Open Access War and older adults: consequences and challenges(GeriCaRe, 2022-05) Kar, NilamadhabThe catastrophic nature of war has deleterious impact on almost all individuals of the affected populations; amongst them older adults are known to be one of the most vulnerable groups. Along with the life changing economic and social adversities, the physical and mental health of the older adults are seriously impaired secondary to war. The consequences are immediate; but most continue long-term; in fact, experiences of the war have lifelong impact. In addition, people who are exposed to war in younger age continue to have health related morbidities in the old age. There are enormous needs for protection, support and care of older adults during and in post-war situations. While efforts should be taken to mitigate the devastating effect of the war on all, including the elderly people; it is important to prevent war at all costs