Background: Bridging the alarming treatment gap for mental disorders in India requires a monumental effort from all stakeholders. Harnessing digital technology is one of the potential ways to leapfrog many known barriers for capacity building. Aim and Context: The ongoing Virtual Knowledge Network (VKN)–National Institute of Mental Health and Neurosciences (NIMHANS)–Extension of Community Health Outcomes (ECHO) (VKN–NIMHANS–ECHO: hub and spokes model) model for skilled capacity building is a collaborative effort between NIMHANS and the University of New Mexico Health Sciences Centre, USA. This article aims to summarize the methodology of two randomized controlled trials funded by the Indian Council of Medical Research (ICMR) designed to evaluate the effectiveness of the VKN–NIMHANS–ECHO model of training as compared to training as usual (TAU). Methods: Both RCTs were conducted in Karnataka, a southern Indian state in which the DMHP operates in all districts. We compared the impact of the following two models of capacity building for the DMHP workforce (a) the VKN–NIMHANS–ECHO model and (b) the traditional method. We use the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) statement to describe the methods of these two trials. Trial 1 is to evaluate the “Effectiveness of addition of Virtual-NIMHANS–ECHO tele-mentoring model for skilled capacity building in providing quality care in alcohol use disorders by the existing staff of DMHP districts of Karnataka.” Hub for trial 1 was set up at NIMHANS and the spokes were psychiatrists and other mental health professionals headquartered in the district level office. Trial 2 assesses the implementation and evaluation of the NIMHANS–ECHO blended training program for the DMHP workforce in a rural south-Indian district of Karnataka state. The hub for trial 2 was set up in the district headquarter of Ramanagaram. Hub specialists are DMHP psychiatrists, whereas spokes are the non-doctor workforce (including auxiliary nurse midwives [ANMs] and accredited social health activists [ASHA] workers) medical officers of primary health centers. The location of the HubHub differs in these two studies. Both trials are funded by the ICMR, Government of India Discussion: Both these trials, though conceptually similar, have some operational differences which have been highlighted. If demonstrated to be effective, this model of telementoring can be generalized and widely merged into the Indian health care system, thus aiding in reducing the treatment gap for patients unable to access care.

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Background Semantic dementia (SD) is a variant of primary progressive aphasia (PPA) which is characterised by impaired confrontation naming, single word comprehension and object recognition with preserved fluency and syntax. Similar to many other neurodegenerative dementias, there is currently no effective treatment for semantic dementia. Neuromodulatory interventions like transcranial direct current stimulation(tDCS) and repetitive transcranial magnetic stimulation(rTMS) along with language training is emerging as a potential treatment strategy for Primary progressive aphasia. Aim: Four patients with semantic dementia were administered concomitant online language training with tDCS to study the feasibility and clinical outcome. Method Four patients (2 males) aged between 50‐63 years, diagnosed with semantic dementia after a comprehensive clinical assessment and Addenbrooke’s cognitive examination and Clinical Dementia Rating(CDR) scale by an experienced geriatric Psychiatrist were included in the case series. Detailed assessment of neurolinguistic skills was done using Western Aphasia Battery (WAB‐Kannada/Hindi) before and after 5‐days of tDCS by qualified speech pathologist. Daily tDCS sessions were delivered using 2mA current with anode over the left dorsolateral prefrontal cortex and cathode over right supraorbital area for 30 minutes, except one female patient with moderate dementia who received 2 session daily at an interval of 3 hours. Online cognitive‐linguistic intervention was provided by the speech pathologist during tDCS sessions. Adverse effects were monitored using structured questionnaire. Result Three Patients had mild dementia and one had moderate dementia as per CDR. tDCS was tolerated well except for burning sensation in two sessions in one patient and all were able to attend the linguistic training. All subjects improved in the domains of Spontaneous speech, Auditory verbal comprehension, repetition and naming on the WAB. Conclusion tDCS can be a potential therapeutic modality in semantic dementia. Randomized Sham Controlled Clinical trials are required to establish the efficacy of tDCS and language training in the treatment of semantic dementia.

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