Showing papers in "Indian Journal of Psychiatry in 2000"

Epidemiological Findings on Prevalence of Mental Disorders in India

Abstract: Fifteen epidemiological studies on psychiatric morbidity in India have been analysed. National all-India prevalence rates for all mental disorders' and five specific disorders have been worked out The national prevalence rates for 'all mental disorders' arrived at are 70.5 (rural), 73 (urban) and 73 (rural + urban) per 1000 population. Prevalence of schizophrenia is 2.5/1000 and this seems to be the only disorder whose prevalence is consistent across cultures and over time. Rates for depression, anxiety neurosis, hysteria and mental retardation are provided. Urban morbidity in India is 3.5 percent higher than the rural rate, but rural-urban differences are not consistent for different disease categories. In Hindi speaking north India, mental morbidity amongst factory workers is two and half times that of the non-industrial urban inhabitants and five times the rural morbidity. The present data are expected to serve as baseline rates for mental health planners and for psychiatrists interested in epidemiological studies.

Attempted suicide in ludhiana.

Abstract: This study assesses the various socio-demographic correlates, the method adopted and the psychiatric disorders in patients with attempted suicide. Out of 208 cases presented to the hospital, one hundred individuals with suicide attempt were included in the present study. They were evaluated for socio-demographic profile and psychiatric illness on the basis of ICD-10 criteria. Analysis of the results showed that single males outnumbered single females, whereas married females outnumbered married males in suicidal attempt. The prevalence of suicidal attempt was high among males with psychiatric illness, whereas more female suicide attempters were without psychiatric illness. The most common psychiatric illnesses were found to be mood disorders (35%) and adjustment disorders (13%) as per the ICD-10 criteria. Family type, economic status and education levels appears to be playing non significant role in suicide attempt in this part of the country Marital status and psychiatric illnesses are playing important role in suicide attempt. Other demographic variables, though, were statistically non significant, but, below 30 years of age group, low socio-economic status, low education and nuclear families were found to be more vulnerable factors for suicide.

A double-blind, placebo-controlled evaluation of the anxiolytic efficacy ff an ethanolic extract of withania somnifera.

Abstract: A double-blind, placebo-controlled study was conducted to evaluate the efficacy an ethanolic extract of Aswagandha (Withania somnifera), in patients with ICD-10 anxiety disorders. The sample comprised 39 subjects, of whom 20 received the drug and 19 received placebo. The two groups were sociodemographically and clinically similar at baseline. At 2 and 6 weeks follow-up, data from approximately 85% of patients in each group were available for analysis. Statistical trends favouring the drug were observed at both time points. At 6 weeks, significantly more patients met a priori response criteria in the drug group (88.2%) as compared with the placebo group (50%). The drug was well-tolerated and did not occasion more adverse effects than did placebo. It is concluded that this ethanolic extract of Withania somnifera has useful anxiolytic potential and merits further investigation.

Organic catatonia: a review.

Abstract: Catatonia is a clinical syndrome associated with a wide variety of psychiatric, medical and neurological disorders. Despite several reports in the literature of a wide range of medical and neurological diseases causing catatonia, there has been a tendency to consider catatonia as purely psychiatric disorder. The review attempts to look at the concept of organic catatonia from a historical viewpoint, including its place in the psychiatric classification, discusses the various etiological causes of organic catatonia, and them goes through some important management issues in organic catatonia. The review suggests that organic catatonic disorder must be first considered in every patient with catatonic signs, particularly in a patient with new onset catatonia.

Mental hospitals in India.

Abstract: This review traces the history of the mental hospital movement, initially on the world stage, and later in India, in relation to advances in psychiatric care. Mental hospitals have played a significant role in the evolution of psychiatry to its present status. The earliest hospital in India were established during the British colonial rule. They served as a means to isolate mentally ill persons from the societal mainstream and provide treatments that were in vogue at the time. Following India's independence, there has been a trend towards establishing general hospital psychiatry units and deinstitutionalization, while at the same time improving conditions in the existing mental hospitals. Since 1947, a series of workshops of superintendents was conducted to review the prevailing situations in mental hospitals and to propose recommendations to improve the same. Implementation of the Mental Health Act, 1987, and governmental focus upon mental hospital reform have paved way for a more specific and futuristic role for mental hospitals in planning psychiatric services for the new millenium, especially for severe mental illnesses.

Prevalence and pattern of substance abuse at bandardewa, a border area of assam and arunachal pradesh.

Abstract: A total of 312 persons aged 10 years and above were interviewed to collect information about their habits of taking tobacco, alcohol and other substances. The study reveals that 40.4% of the respondents used tobacco irrespective of their using pattern, with significant difference between sexes (p<0.001). Among tobacco users 58.2% were only tobacco chewers. 26.3% were smokers and 15% of them were practicing both the modes. 61.4% among housewives were tobacco users. Prevalence of alcohol use was 36.5% among the respondents. Alcohol use among males (39.5%) was slightly higher than females (32.6%). A significant association of alcohol users (p<0.01) was observed with level of educational status. 3.4% of the study population were found to be habituated with substance abuse other than tobacco and alcohol. Percentage of injecting drug users was found to be 1.28%. A very small number (0.64%) was also found to be addicted to petrol inhalation.

A study of psychosocial and clinical factors associated with adolescent suicide attempts.

Abstract: There is a good deal of research showing that suicide attempts increase markedly during adolescence. This study aims at studying the demographic and clinical variables of adolescent suicide attempters and comparing certain potential risk factors between adolescent and adult suicide attempters. It was found that adolescents in our study sample differ significantly from adults in the levels of depression, hopelessness, lethality of attempt and stressful life events. These findings are important in the practical management of adolescent suicide attempters.

Musculoskeletal morbidity with unmodified ect may be less than earlier believed.

Abstract: Official guidelines for the practice of electroconvulsive therapy (ECT) recommend routine seizure modification to minimize musculoskeletal complications; nevertheless, unmodified ECT continues to be administered in India. We therefore assessed musculoskeletal morbidity with unmodified ECT with particular reference to the development of vertebral fractures and backache X-rays of the thoracolumbar spine were routinely obtained before and after a course of 6 ECTs in 50 consecutive schizophrenic patients receiving unmodified sinusoidal wave treatment.Backache was reported by 52% of patients; the symptom was severe in 14%. Severe backache developed early during the ECT course and was commoner in older patients. Gender, height and weight did not predict either presence or severity of backache. One patient experienced a vertebral fracture which was not considered serious this contrasts with the 20-40% incidence of adverse orthopedic events described with unmodified ECT in early studies. There were no other untoward events. It is concluded that, with specific reference to Indian patients, musculoskeletal morbidity with unmodified ECT may be less than earlier believed Risks with modified vs unmodified ECT therefore need to be systematically reassessed, and decision-making processes may need to be reformulated taking individual situations into account. The findings, conclusions and recommendations of this study carry much medicolegal significance for practitioners of ECT in India.

Insight and Psychopathology in Schizophrenia

Abstract: Among a group of patients with schizophrenia, severity of psychopathology was significantly correlated with dimensional measures of awareness of the abnormal experiences whereas a similar relationship with global measures of insight could not be demonstrated. The awareness of the abnormal nature of individual items of psychopathology does not necessarily overlap with insight as measured by awareness of the concept or consequences of mental illness or the need for treatment.

A decade with the mental health act, 1987

Abstract: The Mental Health Act, 1987 came into force in 1993. Mental Health Authorities that were created by this Act are useful, but the present situation of not having Government Mental Hospitals under the scrutiny of these authorities is a shortcoming. The high capital needed for upgradation of Government mental hospitals; is likely to be found, only with the intervention of Mental Health Authorities Creation of a funding agency of Government of India is also needed Denying profoundly retarded persons access to a psychiatric hospital is a hard situation. Psychiatric patients in general hospitals' having to face the hassles of mental hospital admission is against the spirit of the act and needs to be remedied Courts' directly determining the presence of psychiatric illness in persons is not serving the end of justice. They should do this on the basis of evidence Several avoidable hardships that may be caused by having the act in the present form has to be corrected This could be done by amendment of the act in certain cases by approaching the High Court in certain others and by thoughtfully framing the State Mental Health Rules in a quite a few other situations. The success of Mental Health Act, 1987 is in its effectiveness to ensure basic human rights of mental patients. A set of Mental Health Rules, that incorporates adequate provisions to protect human rights of patients, in all respects, can go a long way to strengthen the Mental Health Act.

A study of prevalence and comorbidity of depression in alcohol dependence

Abstract: Depressive symptoms are wide spread in alcohol abusing patients of all ages and are much more common than diagnosable depressive disorder. Studies have reported that depression diagnosed in the current episode of alcoholism remits after two weeks of abstinence and detoxification from alcohol. Despite the high prevalence of depression in alcohol dependent individuals, the nature of the relationship between depressive disorder and alcohol abuse have been difficult to define. The present work was undertaken with the aim to study the prevalence and comorbidity of major depression in alcohol dependence. The sample comprised of 34 (32 males and 2 females) DSM-IV alcohol dependent patients admitted in the Psychiatry ward of T.U. Teaching Hospital, Kathmandu during one year study period. Diagnosis of major depressive episode was made according to DSMIV criteria. Severity of dependence on alcohol was assessed with the Severity of Alcohol Dependence Questionnaire and severity of depressive symptoms was rated on Hamilton Rating Scale for Depression. Repeat assessment was done on day 14. A high prevalence of major depression (41.7%) was found for the episode of drinking which led to hospitalization. However, within a few days of detoxification from alcohol, only few of them had depressive symptoms amounting to major depression (17.64%). There was no significant correlation between severity of alcohol dependence and depression. The findings suggest that the nature of depression found in those patients with alcohol dependence needs further exploration. It appears that clinicians exercise appropriate judgement in not prescribing antidepressant treatments for symptoms which may change within days, providing that alcohol is not consumed.

P 300 event related potential in depression

Abstract: P300 component of the event related potential (ERP) provides one neurophysiological index of cognitive dysfunction in depression. Forty subjects fulfilling DSM-III criteria for depression were compared to 40 age and sex matched normal controls. The P300 was recorded using the auditory odd-ball paradigm. Depressives had a significantly prolonged P300 latency and reduced P300 amplitude as compared to the controls. The P300 latency showed a significant positive correlation with age of the patient and severity of depression while P300 amplitude showed a significant negative correlation with age. The clinical subcategory of depression, duration of illness and sex did not show any relationship with P300 abnormality. Twelve out of 40 depressives (30%) had an abnormal P300. The mean Hamilton Rating Scale for Depression (HRSD) score was significantly high in those with an abnormal P300.

A study of thyroid hormones (t(3), t(4) & tsh) in patients of depression.

Abstract: In this study, 32 unmedicated patients of unipolar depression were included and blood samples were analysed for T(3), T(4) and TSH. These were compared with age and sex matched controls. Subnormal T(3) and T(4) levels in 90.6% and 9.3% respectively and an increase of TSH levels in 18.7% of the total patients was observed in this study. The patients were classified into mild, moderate and severe grade of depression as per DSM-IV criteria. Of the mild 66.6%, 93.3% of moderate and all of the severe grade depression patients had low T(3) levels.Of the moderately depressed patients 13.3% and 9.0% of severe depression patients had low T(4) levels. TSH was increased than normal in 54.5% of the patients and all these patients were of severe grade. ANOVA with multiple comparison testing shows significant decrease in levels of T(3) (F(2.29) >3.33) and significant increase in TSH levels (F(2.29) >3.33) at 5% level of significance amongst mild, moderate and severe grade of depression patients. This study suggests a subclinical hypothyroidism in most of the patients which could lead to nonresponsiveness to the conventional antidepressant therapy. Therefore, evaluation of thyroid status prior to antidepressant therapy and subsequent thyroid hormone substitution in subclinical hypothyroid patients is suggested.

Psychiatric referrals in multispeciality hospital.

Abstract: K.L.E.S. hospital is a new multispecialty referral hospital attached to J.N. Medical College, Belgaum. All psychiatric referrals numbering 338 over a period from 1.7.1996 to 30.6.1997 were retrospectively studied. Socio-demographic data, source and reason for referral, diagnosis and treatment advised were noted. More than two-third of the referrals were male patients and belonged to the productive age group of 16 years to 45 years. 83.17% of the patients were referred from general medicine, medicine allied and medical superspeclality departments. Unexplained physical symptoms was the commonest reason for referral (64.44%). The commonest psychiatric diagnosis was neurotic, stress related, somatoform disorders (45.54%). Next common diagnosis was mood disorders (20 92%). Need for more dialogue and interaction between the referring doctor and the psychiatric team member is strongly felt.

Comparative study of risperidone and haloperidol on clinical and psychosocial parameters in treatment of schizophrenia : a randomised open trial.

Abstract: The study compares the efficacy of risperidone and haloperidol in patients of schizophrenia on various clinical and psychosocial parameters.In the present open, comparative study, in patients suffering from schizophrenia (DSM-IV), 50 patients each were randomly treated with risperidone and haloperidol over a period of 1 year. The clinical improvement was judged on PANSS (Positive and Negative Symptom Scale) and CGIS (Clinical Global Impression Scale). The improvement in psychosocial functioning and other areas was judged using a five point scale (0-4). Though the improvement on PANSS was comparable in both the groups except on the general psychopathology subscale, on CGIS a better improvement profile was observed in risperidone group. In the other psychosocial areas such as social functioning, productivity and education a significantly more number of patients showed improvement in risperidone group as compared to haloperidol group. In significantly less number of patients suicidality and rehospitalization was found in risperidone group as compared to haloperidol group.

Risperidone versus haloperidol in acute and transient psychotic disorder.

Abstract: The mechanism of action of a relatively new antipsychotic drug-Risperidone differs from conventional antipsychotics like Haloperidol. We compared low dosages of Risperidone with near equivalent dosages of Haloperidol in first episode drug naive Acute and Transient Psychotic disorder. A single blind randomised four-week study protocol was employed. Highly significant and comparable efficacy as assessed by Brief Psychiatric Rating Scale and Global Assessment of Functioning Scale was seen at the end of the Study protocol in both the groups. Risperidone had significantly, an early onset of action on some of the positive as well as negative symptoms with less incidence of Extrapyramidal Symptoms in comparison to Haloperidol. We conclude that Risperidone may represent a potential useful first line agent in the treatment of Acute and Transient Psychotic Disorder.

A study of alcohol related physical diseases in general hospital patients.

Abstract: We studied the prevalence of harmful use of alcohol and alcohol related diseases in newly admitted patients in a general hospital. Two hundred and ninety seven patients were screened for alcohol use with Alcohol Use Disorders Identification Test (AUDIT). Sixty one subjects (21%) had harmful pattern of alcohol consumption. Of these twenty eight patients (9.4%) had alcohol-related diseases, while in 33 patients (11.1%) we did not find any association between alcohol use and hospital diagnoses. Physicians' referral rate for problem drinking was low. The findings indicate the need for an active consultation service to address the specific issue of harmful drinking among patients admitted in general hospitals.

Treatment setting and follow-up in alcohol dependence.

Abstract: This study aimed at evaluating patient and treatment variables influencing six month treatment outcome in alcohol dependence. 134 serially registered patients selected their treatment setting as either outpatient or inpatient. Sociodemographic variables, alcohol consumption patterns, drinking consequences were measured at intake. Following treatment, drinking patterns and consequences were re-measured at three and six months follow up in each of the groups. 86 of 134 chose the inpatient program and 48 the outpatient program. Overall, 58 maintained total abstinence, and 11 had significantly reduced alcohol consumption at six months follow up. The inpatient group did marginally better than the outpatient group. More severely dependent patients, those with greater physical and psychosocial consequences opted for an inpatient program, and did well. Less severely dependent patients did favourably with outpatient intervention alone. Improvements made within the first three months tended to influence subsequent treatment compliance The observation that less severely dependent individuals who opted for outpatient services did favourably suggests that extensive treatment may be required only for those with more severe dependence or greater psychosocial consequences. Our findings also highlight the need for developing community based low cost interventions.

Clinical variables as predictors of response to electroconvulsive therapy in endogenous depression.

Abstract: There is lack of consensus on the clinical variables that predict response to ECT Identification of clinical variables could help in predicting the type of response before the start of ECT Therefore, a prospective study on 22 patients of severe depression, some of whom were drug-naive and others drug free at time of ECT was undertaken A maximum of six ECT were administered with a prior definition of 'good response' (60% or greater reduction in Hamilton Depression Rating Scale scores) Results showed that three clinical variables could distinguish between good responders and poor responders Hence, response to ECT was associated with the duration of past depressive episodes, suicidal thoughts and somatic symptoms

Management of "dual diagnosis" patients : consensus, controversies and considerations.

Abstract: The term 'dual diagnosis' denotes the coexistence of substance use disorder(s) and other, non-substance-use, psychiatric disorder(s). The last two decades, and especially the 1990s, have witnessed tremendous research and clinical interest in this previously neglected area. India, however, lags behind, inspite of indications that the problem exists here too. The current approach to managing such patients is the 'integrated treatment model' in which the same clinician (or team of clinicians) provides treatment for both the disorders at the same time, treating both with equal understanding and importance. Both pharmacotherapy as well as psychosocial therapies are specifically designed keeping in mind the integrated' philosophy of treatment. The specific principles and components are described Areas of difficulty, uncertainty, and future considerations are highlighted, with a note on the Indian setting.

Expression of Suicidal Intent in Depressives

Abstract: The study was undertaken to find out correlation, if any, between severity of depression and suicidal intent communication and its relation to age, marital status, duration of iilness, previous admission in a psychiatric hospital in patients of depression diagnosed using criteria of ICD-IX category codes F31.3, F31.4, F31.5, F32 and F33. Sample consisted of 30 patients from the OPD of Agra Mansik Arogyashala. The Hamilton Rating Scale for depression was used to measure severity of depression and suicidal intent questionnaire was used to assess suicidal intent communication. A positive correlation between severity of depression, being married, being male, being employed, being ex-mental hospital patient, duration of illness being more than one month and age being less than or equal to 35 years was found. Further research in this area is required.

Relapse precipitants in opiate addiction : assessment in community treatment setting.

Abstract: Drug and alcohol dependence is a chronic relapsing disorder so that there is a need for continued care to prevent relapses. Relapse is generally understood as a return to earlier pattern of use for a drug after a period abstinence. The factors leading to relapse can be intra-psychic and interpersonal. In an attempt to understand the factors leading to first use and relapse in opioid dependence this study was conducted in a community treatment setting at the De-addiction centre of All India Institute of Medical Sciences. The sample consisted of 25 consecutive subjects with opioid dependence who had used the opioid after a period of 3 weeks of self reported abstinence in the 6 months prior to assessment. A semi-structured interview schedule was used to interview the subjects. The results showed that about 2/3rds of the sample had heroin dependence whereas the rest had buprenorphine dependence. After the first use, which occurred after a mean abstinence of 16.4 weeks. 19/25 subjects progressed to regular use (relapse) within a mean period of 8.7 days. The reasons for first use and regular use were almost the same and the common reasons were sleep disturbances, body ache and urges to take the drug. Some subjects reported sadness, family conflict and peer influences also as reasons for first as well as regular use. This preliminary study found that the factors leading to first use and regular use in our subjects are the same and that very soon after the first use the regular use ensues thus interventions that focus on preventing first use need to be emphasised.

Psychological morbidity of parents of mentally retarded children.

Abstract: The magnitude of the problem of mental retardation in our country hardly needs any exaggeration. The psychological burden that these parents carry has been varied. The present study was undertaken to delineate the psychological problems of parents of mentally retarded children and to establish whether these problems were more prevalent in the parents of mentally retarded children than in the parents of normal children. The material comprised of three groups of subjects: The first group comprised of parents of twenty students of a school for mentally handicapped children; the second group comprised of parents of ten mentally retarded children who were not institutionalised or attended any special school for mentally retarded in the past: the third group comprised of parents of twenty normal school going children. The results of the study conclusively proved that the parents of mentally retarded children had a higher prevalence of psychological morbidity than the parents of normal children. The commonest psychiatric disorder was Dysthymia followed by Generalised Anxiety Disorder and Moderate Depression.

Psychometric Properties of Quality of Life (QLS) Scale : A Brief Report

Abstract: Quality of life research in chronic schizophrenia has not adequately focussed upon psychometric properties of the disease specific scales (including Quality of Life Scale); especially in the cross-cultural perspective. The authors attempted to assess certain psychometric properties of the Quality of Life Scale (QLS); modified as per the Indian cultural background Fifteen patients of ICD-10 chronic schizophrenia and their key relatives were administered QLS and rated by two investigators. Patients were also administered Lehman's Quality of Life Interview-Brief Version. Correlation coefficients were high for inter-rater reliability and divergent validity and inconsistent for convergent validity. Results support the original construct of QLS and demonstrate its easy crosscultutral applicability to key relatives by clinicians.

Patterns of antidepressant prescriptions : I acute phase treatments

Abstract: Although depression is an eminently treatable condition, inadequate pharmacotherapy is far too common. Lack of uniform standards of care across different settings characterises psychiatric practice in a developing country like India. But, there have hardly been any attempts at assessing the standards of care being delivered. A case note study was carried out of patients attending a general hospital psychiatric unit with depression, over a one year period, to evaluate the nature and adequacy of antidepressant therapy. Prescribing patterns in 108 cases fulfilling the selection criteria, were examined. The sample consisted mainly of young to middle aged patients, predominantly female, with moderately severe depressive episodes. Antidepressants were prescribed universally with TCAs (mainly Imipraminc), followed by Fluoxetine being the most common drugs used. Pharmacotherapy was often found to be deficient in several areas such as, starting doses, rate of increase in dose, maximum doses used, dose titrations, duration of treatment, change of drugs, recording of side effects and compliance etc. Results regarding norms for adequate doses and periods of treatment before switching drugs, for the kind of patients included in this study, were unclear, and need to be explored further. Inadequate treatment can have a number of adverse consequences, hence some guidelines for minimum standards of care while undertaking antidepressant treatment need to be formulated for India and other developing countries, as none exist at present.

Serum prolactin level and severity of psychopathology in patients of schizophrenia.

Abstract: Serum prolactin level was measured in 20 male and 11 female drug naive patients of schizophrenia Subsequently, these patients were treated with antipsychotics and ECTs. The severity of psychopathology at the baseline rind subsquent improvement at the end of 3 weeks and 6 weeks was assessed on modifies brief psychiatric rating scale (BPRS). Contrary to the expectations, a two fold increase in serum prolactin level was observed in drug naive male and female patients of schizophrenia The difference was found to be statictically significant in males No correlation was observed between the baseline serum prolactin level and the severity of baseline psychopathology and subsequent improvement in psychopathology at the end of 3 weeks and 6 weeks From the present study it seems that baseline serum prolactine level in drug naοve patients of schizophrenia may not be a reliable indicator of psychopathology and prognosis.

Treatment of obsessive compulsive symptoms in schizophrenia with fluoxetine

Abstract: Obsessive compulsive symptoms have been reported to occur in high proportion in schizophrenia. Presence of obsessive compulsive symptoms in schizophrenia has poor prognostic significance. Because of the antiobsessional effect of the fluoxetine, present study was undertaken as preliminary investigation in cases of schizophrenia with obsessive compulsive symptoms. We conducted an open trial of 12 weeks duration in which fluoxetine was added up to 80 mg to the maintenance neuroleptic medication of outpatients of schizophrenia with obsessive compulsive symptoms diagnosed by DSM-IV criteria. Five patients showed a significant reduction in scores of Positive and Negative Syndrome Scale, Yale Brown Obsessive Compulsive Scale and Clinical Global Impression Scale. Two patients did not show any response. Fluoxetine was well tolerated by all the patients. The positive findings of this preliminary investigation supports the further investigations of fluoxetine as potential treatment in the obsessive compulsive symptoms in schizophrenia.

Wilson'S disease presenting with obsessive-compulsive disorder.

Abstract: Wilson's disease, a disorder of copper metabolism, is known to be associated with psychiatric symptoms. Psychiatrists see about 20% of these cases before they are labeled as Wilson's disease. Reports of these patients treated mistakenly as primary psychiatric illnesses exist in literature. This report thus emphasizes a thorough underpinning in this disease on the part of psychiatrists in order to arrive at the correct diagnosis at first contact. Besides this, the emergence of obsessive-compulsive symptoms in a case of Wilson's disease is described, which is a rare association. Finally, the authors discuss the role of basal ganglia in obsessive-compulsive disorder.