Kar, Nilamadhab
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Biography
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 Clozapine monitoring in clinical practice: beyond the mandatory requirement(Korean College of Neuropsychopharmacology, 2016-11) Kar, Nilamadhab; Barreto, Socorro; Chandavarkar, Rahul; Black Country Partnership NHS Foundation Trust, Wolverhampton, United Kingdom; North Staffordshire Combined Healthcare NHS Trust, Stoke-on-Trent, United Kingdom.Clozapine is effective in treatment resistant schizophrenia; however, it is underutilised probably because of its side effects. The side effects are also the potential reasons for clozapine discontinuation. A mandatory requirement for its use is regular monitoring of white blood cell count and absolute neutrophil count. However there are many side effects that need monitoring in clinical practice considering their seriousness. This article tries to summarise the clinical concerns surrounding the serious side effects of clozapine some of which are associated with fatalities and presents a comprehensive way to monitor patients on clozapine in clinical practice. It emphasizes the need to broaden the monitoring beyond the mandatory investigations. This may help in improving the safety in clinical practice and increasing clinician confidence for greater and appropriate use of this effective intervention.Publication Scale for assessment of lethality of suicide attempt(Medknow Publications, 2014-10) Kar, Nilamadhab; Arun, Mohanram; Mohanty, Manoj K; Bastia, Binaya K; Department of Psychiatry, Black Country Partnership NHS Foundation Trust, Wolverhampton, United Kingdom; Department of Forensic Medicine and Toxicology, JSS Medical College, Mysore, India; Department of Forensic Medicine and Toxicology, Kasturba Medical College, Manipal, Karnataka, India; Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India; SBKS Medical Institute and Research Centre, Vadodara, Gujarat, India.Background: Lethality of suicidal attempt provides useful information regarding the behavior. There is a perceived need for a clinically useful scale that can be easily adapted to various methods and circumstances of attempt. Aims: The study intended to develop and test utility of a scale for measuring lethality that can reflect overall clinical observation taking into account various indicators of lethality and which can be used across clinical scenarios involving different methods. Settings and design: Cross-sectional study in a hospital. Materials and methods: The scale for assessment of lethality of suicide attempt (SALSA) has two components: The first component has four items indicating seriousness of the attempt and its likely consequences and the second component is the global impression of lethality. All the items are scored from 1 to 5, higher scores suggestive of increased lethality. SALSA was used to evaluate lethality of 82 consecutive suicide attempters; and it was compared with lethality of suicide attempt rating scale (LSARS) and risk-rescue rating scale. Statistical analysis: Chi-square, t-test, analysis of variance, Cronbach's alpha, binary logistic regression. Result: There was significant correlation of SALSA score with that of LSARS (r: 0.89) and risk score of risk-rescue rating (r: 0.93, P < 0.001); and negative correlation with rescue score (r: -0.569; P < 0.001). Internal consistency reliability of SALSA was high (Cronbach's alpha: 0.94). Lethality scores of SALSA differentiated known groups with different lethality, e.g. deceased and survived; attempters with different levels of medical intervention: In-patient only, intensive care, ventilator support. SALSA score significantly predicted the lethal outcome (odds ratio: 3.2, confidence interval: 1.12-8.98). Conclusion: SALSA is a useful instrument for assessment of lethality of suicidal behaviors during clinical evaluations considering the ease of administration, its ability to differentiate clinical groups with known variations of lethality and clinical outcomes.Publication Factors associated with suicides in Wolverhampton: relevance of local audits exploring preventability(SAGE Publications, 2016-07-10) Kar, Nilamadhab; Black Country Partnership NHS Foundation Trust, UK;; ; ; Kar, NilamadhabSuicide rates and associated risk factors are known to change over time. The periodic evaluation of suicides in a particular locality may identify specific issues that may help in prevention efforts. The profile of 146 consecutive cases with suicide, open and narrative verdicts between January 2004 and July 2011 in Wolverhampton was studied in order to explore associated factors. Specific information about methods, mental health issues and stressors was collected. There was considerable variation in suicides in different wards of the city, with higher occurrences in inner-city areas. Male suicides were three times more common, and they were significantly younger than in female suicides. Common methods were hanging (52.7%) and poisoning (21.9%) involving a wide range of drugs. Life events were reported in 52.1% suicides, most frequently relational problems (28.1%), followed by physical illness and bereavement. Mental-health factors were associated with 63.0% of suicides, predominantly depression (45.9%) and alcohol and drug abuse (6.8%). The majority of the suicide victims (63.0%) were not in contact with mental-health services, including: most men (68.8%), young suicides up to age 34 (78.6%), the elderly (69.2%) and Asians (70.0%). A considerable proportion of these suicides had mental-health issues, mainly depression (42.4%) and alcohol or drug abuse (6.5%). Significantly more of them (69.6% vs. 22.2%) had stressors compared with suicides known to mental-health services. The findings of the study highlighted risk factors that may help prioritising intervention initiatives. It appears that local suicide audits may complement national information on suicide in designing appropriate local suicide-prevention strategies.Publication Depression in youth exposed to disasters, terrorism and political violence(Springer, 2019-07-04) Kar, Nilamadhab; Black Country Partnership NHS Foundation Trust;; ; ;Purpose of review: This paper reviews recent research on the depression in young people following exposure to catastrophic stresses such as disasters, terrorism and political violence. Recent findings: Depression is one of the commonest outcomes following mass trauma, for all ages including children and adolescents. Recent articles continue to report high prevalence of depression which often continues for years. It is often comorbid with other psychiatric disorders, especially PTSD. Post-traumatic depression in children and adolescence affects purpose of life, impairs scholastic achievements, increases suicidality and has extensive comorbidity. Besides the trauma, individual constructs, personality factors, social support, exposure to other traumatic events are some of the predicting factors. Biological and genetic basis of post-traumatic depression has been reported. Studies suggest some benefit to psychotherapeutic interventions such as trauma-focussed cognitive behavioural therapy and web-based therapy. A considerable proportion of youths develop depression following mass traumatic events. More research is required regarding the effectiveness of interventions in this population.Publication Validation of the EuroQol five-dimensions - three-level quality of life instrument in a classical Indian language (Odia) and its use to assess quality of life and health status of cancer patients in eastern India(Medknow Publications, 2015-09) Tripathy, Swagata; Hansda, Upendra; Seth, Newfight; Rath, Satyajit; Rao, P B; Mishra, T S; Subba, S H; Das, Rekha; Nayak, Sukdev; Kar, NilamadhabBackground and objectives: The EuroQol five-dimensions - 3-level (EQ5D) is a versatile quality of life (QOL) instrument with five dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and a visual analog scale. It can be used to calculate quality-adjusted life years. We aimed to evaluate the validity, reliability, and responsiveness of an Odia version of EQ5D and to study the QOL of cancer patients in our part of the country as cancer treatment in India still focuses largely on longevity due to scarcity of resources. Materials and methods: The EQ5D tool was translated into Odia language in collaboration with the EQ group. This tool and the World Health Organization-5 (WHO-5) questionnaires were administered to 155 surgical outpatients and 150 cancer patients in two hospitals of Eastern India. The convergent and discriminant validities (construct validity), concurrent validity, reliability (test-retest method of administering the tool to a part of the population after 7-14 days), and the internal consistency (Cronbach's alpha) were measured using preestablished hypotheses. The data from the cancer patients were analyzed separately. Results: The QOL worsened with age and was worse in cancer patients proved that the tool had good construct validity. The Anxiety Depression dimension had good correlation with all the dimensions WHO-5 (rho > 0.4) indicating a good concurrent validity. Internal consistency and reliability of the tool were good (Cronbach's alpha > 0.7). Cancer patients had a poor QOL (mean EQ5D index 0.37SD 0.4) with male patients, patients with Grade II cancer or referred for pain care services and those with living spouses reporting worse QOL. Conclusions: The Odia version of the EQ5D has good reliability and validity for the measurement of health status in cancer and outpatient department patients. Cancer patients in this part of the country have a poor QOL and may need a closer look at pain management and improved societal support systems.Publication Awareness of fitness to drive guidance amongst doctors in Black Country Healthcare NHS Foundation Trust : a survey(Cambridge University Press, 2023-07) Sundhar, Reka; Chandra, Pallavi; Fraser, Alastair; Kar, NilamadhabAims: Psychiatric patients have a higher risk of road traffic accidents than others. The Driver and Vehicle Licensing Agency (DVLA) has provided guidance on different psychiatric conditions and medication that would impact driving. The General Medical Council and Royal College of Psychiatrists advice doctors to notify the DVLA when patients unfit to drive fail to inform the DVLA themselves. In this context, it was aimed to study the awareness of doctors regarding DVLA guidance and its use in their clinical practice. Methods: We conducted a survey about doctors’ awareness of guidance on Fitness to Drive via an online questionnaire. Likert type scoring ranging from strongly agree to strongly disagree was used to assess the (i) awareness of DVLA guidance for psychiatric patients, (ii) confidence in advising patients, (iii) feeling it is a job requirement to advise patients on driving; and (iv) checking the driving status and if patients have informed DVLA where necessary. This included questions on years of experience in medicine, current grade and subspecialty of Psychiatry. Results: The sample consisted of 78 doctors, from various grades from Foundation Year 1 trainees to Consultants; working in different Subspecialties in Psychiatry. There were 36 trainees, 12 middle grades, 28 consultants and 2 ‘other’ doctors. The average year of experience of the responding doctors was 14.2±11.0 years with a range of 1-38 years. Majority (62.8%) of doctors responded that they are aware of the DVLA guidance for psychiatric patients; however 47.5% reported having confidence to advise patients on DVLA guidelines. Considerable proportions (79.5%) of doctors felt that as psychiatrists, it was their job to give advice on driving; but only 50% said they check the driving status and whether patients have informed the DVLA when necessary as part of routine practice. When using the Likert scale, comparing to other subspecialties, General Adult Psychiatrists responded that they check driving status less routinely (p<0.05), however there was no difference in other areas evaluated. Trainees’ responses indicated less awareness (p<0.001), confidence (p<0.001), and checking of driving related issues routinely in clinical practice (p<0.005). Conclusion: The survey results suggest variation in awareness of Fitness to drive guidance for psychiatric patients and their use in routine clinical practice amongst doctors. While trainees would need more information and training to increase their confidence, there is a need for all psychiatrists to use the guidelines in regular clinical practice.Publication Suicide by psychiatric patients: nature of risk, risk categorisation and preventability(SAGE Publications, 2019-08-03) Kar, Nilamadhab; Prasad, Tulika; Department of Psychiatry, Black Country Partnership NHS Foundation Trust, Steps to Health, UK; Department of Psychiatry, Black Country Partnership NHS Foundation Trust, Penn Hospital, UK.This study considers risk factors associated with suicide by psychiatric patients, the perceived risk at last contact and risk categorisation and reflects upon the potential for prevention. Information regarding 63 consecutive suicides known to mental health services in Wolverhampton, UK, over a 15-year period was collected as part of an audit using a semi-structured questionnaire covering sociodemographic and clinical risk factors, along with information about preventability. A complex mixture of historical, enduring and current risk factors was observed. In addition to common risk factors, a considerable proportion had histories of multiple co-morbid psychiatric (52.5%) and physical diagnoses (27.6%) and psychiatric admission (70.5%). Common suicide methods included hanging (36.5%) and poisoning (36.5%). Most suicides occurred in the post-discharge months up to around two years (75.8%). Although a range of psychopathologies and suicidal cognitions were observed at the last clinical contact, the immediate suicide risk was considered low (46.2%) or not present (38.5%) in the majority of cases. Clinicians suggested various factors that could have made suicides less likely. Clinical assessment can identify risk factors, but categorisation may not be indicative of the outcome. A focus on modifiable factors, with support for psychosocial and clinical issues, may assist with prevention.Publication Rabies may mimic acute psychiatric illness : clinical suspicion is the key(Wiley, 2018-05) Holikati, Prabhakar; Kar, NilamadhabRabies is still common in many parts of the world, including India. It is diagnosed primarily on the basis of clinical symptoms and signs; and the diagnosis is easily considered with a corroborative history of animal bite. However, its presentation may mimic acute psychiatric illness, which may delay the diagnosis. We present here a case where the diagnosis of rabies was overshadowed by possibilities of complicated alcohol withdrawal symptoms and highlight the need to ask for history of animal bite in acute psychiatric presentations, especially in countries where rabies is still common.Publication Changing patient profile in a psychiatric hospital during COVID pandemic : a comparison with pre-COVID state(Cambridge, 2022-06-20) Kar, Nilamadhab; Jiwanmall, StephenAims 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 Sociodemographic correlates of unipolar major depression among the Chinese elderly in Klang Valley, Malaysia: an epidemiological study(Hindawi, 2014-12-02) Verma, Rohit Kumar; Min, Tan Hui; Chakravarthy, Srikumar; Barua, Ankur; Kar, Nilamadhab; Department of Pharmacy Practice, School of Pharmacy, International Medical University, Bukit Jalil, 57000 Kuala Lumpur, Malaysia; Department of Pathology, School of Medicine, International Medical University, Bukit Jalil, 57000 Kuala Lumpur, Malaysia; Department of Community Medicine, School of Medicine, International Medical University, Bukit Jalil, 57000 Kuala Lumpur, Malaysia; Department of Psychiatry, Black Country Partnership NHS Foundation Trust, Wolverhampton WV10 9TH, UK.Background: Depression, as one of the most disabling diseases around the world, had caught the global concern with its rising prevalence rate. There is a growing need of detecting depression, particularly in the old age population which is often left being overlooked. Methods: We conducted a cross-sectional community-based study which included 150 Chinese elderly aged 60 and above within Klang Valley area. We obtained the sociodemographic profiles and assessed the status of well-being, depression, and cognitive function of the participants with the help of instruments: WHO Five-Item Well-Being Index, Major (ICD-10) Depression Inventory, and 6-Item Cognitive Impairment Test. Results: We found that the prevalence of depression among the Chinese elderly within Klang Valley region was 10.7%. With multiple logistic regression, decision to consult doctor on depressed mood or memory problem and presence of cognitive impairment were shown to be significantly associated with unipolar major depression, whereas wellbeing status was also found to be statistically correlated with depression in univariate analysis. Conclusion: The prevalence of unipolar depression among Chinese elderly within Klang Valley, Malaysia presented that there was an increased trend compared to the previous studies.