Ajit Avasthi

Psychoeducational intervention for caregivers of Indian patients with schizophrenia: a randomised‐controlled trial

Objective:  There are hardly any randomised‐controlled trials of structured family interventions for schizophrenia from India. This study attempted to evaluate the impact of a structured psychoeducational intervention for schizophrenia, compared with standard out‐patient treatment, on various patient‐ and caregiver‐related parameters.

PSYCHOSOCIAL IMPACT OF OBSESSIVE-COMPULSIVE DISORDER ON PATIENTS AND THEIR CAREGIVERS: A COMPARATIVE STUDY WITH DEPRESSIVE DISORDER

Background: Little empirical research has been done to assess the impact of obsessive-compulsive disorder (OCD) on patients and their caregivers. Objective: To assess the psychosocial impact of OCD on patients and their caregivers and compare it with depressed controls. Method: Thirty two patients with OCD and their caregivers and 30 patients of depression and their caregivers were assessed on sociodemographic and clinical variables and the following scales: World Health Organization Quality of Life Questionnaire-BREF version (WHOQOL-BREF); Schedule for Assessment of Psychiatric Disability; Family Burden Interview Schedule; and Family Accommodation Scale. Yale Brown Obsessive-Compulsive Disorder Scale (YBOCS) and Hamilton Depression Rating Scale (HDRS) were applied to rate the severity of obsessive-compulsive and depressive symptoms. Results: Patients with OCD had the lowest scores in the psychological health domain of the WHOQOL-BREF. They were also disabled due to their illness with maximum disability being experienced in the overall behaviour domain. Caregivers of OCD patients experienced burden in several areas and had to accommodate to the patient’s behaviour. Patients with OCD had a better quality of life (QOL) and were less disabled compared with depressed patients, but their caregivers were more burdened and had to accommodate to a greater degree in comparison to caregivers of depressed patients. The OCD patients’ QOL and disability scores and their caregivers’ burden and accommodation scores correlated significantly with several sociodemographic, clinical and psychological variables. Conclusion: OCD patients, when compared with depressed subjects, have a better QOL and are less disabled, but their caregivers are more burdened and have to accommodate more.

Cost of care of schizophrenia: a study of Indian out-patient attenders.

Objective:  To assess the cost of care of Indian out‐patients with schizophrenia.

Magico-religious beliefs in schizophrenia: a study from north India.

Psychiatric disorders in India are often attributed to influence of supernatural phenomena, and many patients are subjected to various kinds of ‘magico-religious’ treatments. We studied 40 cases of schizophrenia and ascertained magico-religious beliefs held by their key relatives. The effects of such magico-religious beliefs on psychopathology and treatment-seeking behaviour were explored. The sample were schizophrenia patients diagnosed according to ICD-10 of the World Health Organisation. Psychopathology was assessed on the 9th version of the Present State Examination (PSE-9). Supernatural Attitude Questionnaire was administered to the key relatives of the patients to ascertain their beliefs about various supernatural phenomena and magico-religious treatments. It was observed that the majority of the patients had undergone magico-religious treatment (n = 23). Nearly 74% of the patients who had symptoms coloured by cultural influences such as delusional explanation in terms of paranormal phenomena had undergone magico-religious treatment. It was also seen that though many relatives denied personal conviction in such magico-religious beliefs, yet they sought some kind of magico-religious treatment for the patients. The prevalence of culturally influenced delusions as defined by the PSE-9 was very low. Belief in supernatural influences is common in patients’ relatives from urban background and with adequate education, and treatment based upon such beliefs is sought to a considerable extent in such cases. Local and community belief in such phenomena appeared to be a factor in influencing the decision to seek magico-religious treatment.

Seasonality and affective disorders: a report from North India

Case records of the patients with major affective disorders (ICD-10 criteria), seen over a 5 year period in a busy clinic in North India were examined for Seasonal Affective Disorder (SAD) as per DSM-III-R criteria. In addition, seasonality of episodes of all affective disorders was also studied. Around 5.67% of the cases (n=44) retrospectively met the DSM-III-R criteria of SAD and predominant pattern was that of summer depression (n=18). There was also a consistent pattern of seasonal mania either in conjunction with seasonal depression (n=18) or in form of seasonal recurrent mania (n=11). None of the cases of depression showed any atypical vegetative features. In cases not meeting criteria for SAD (n=731), there was a trend for peaks for depressive episodes in winter followed by a smaller peak in summer months while manic episodes had peaks towards rainy and winter months. As compared to seasonal patterns of affective disorders in temperate zones, there was a general trend for opposite patterns of seasonality in SAD as well as in non-SAD. The findings are discussed in context of the climatic conditions of North India.

Prevalence and clinical profile of delirium: a study from a tertiary-care hospital in north India

BACKGROUND There is scarcity of data from the Indian subcontinent in terms of rates of psychiatric referrals and prevalence of delirium in the medico-surgical setting. AIM The present research aimed to study the rates of psychiatric referrals, clinical profile and treatment of delirium in a tertiary-care hospital. METHODS The referral register in the department of psychiatry (which records all referrals to the Consultation-Liaison Psychiatry Team) was used to obtain data of all referred patients who had been diagnosed to have delirium while they were admitted in the Nehru Hospital, Postgraduate Institute of Medical Education and Research, Chandigarh, during the period 2000-2005. RESULTS Over 6 years, 3092 patients/referrals were received from different wards and included 1050 who were diagnosed as having delirium. The psychiatric referral rate ranged from 0.92% to 1.56% (mean=1.3%) per year; delirium formed the largest diagnostic category (30.77% to 38.95% of all referred cases). The prevalence of delirium in all inpatients ranged from 0.28% to 0.53% (mean=0.44%), with prevalence being higher in the elderly. In 80% of the cases, the referral was for abnormal behavior or patients noncooperation for treatment. Most of the cases improved with treatment. CONCLUSIONS Delirium forms the largest diagnostic category in psychiatry referrals and improves with treatment.

Sociodemographic and clinical factors associated with relapse in schizophrenia.

Abstract  The aim of the present study was to examine sociodemographic and clinical factors associated with relapse in schizophrenia. The study group consisted of a convenience sample of 40 schizophrenia patients (20 patients each in relapse and remission). Relapse and remission were defined based on clinical criteria (ICD‐10 criteria, course since last episode, and duration of remission) and psychometric criteria (scores on Socio‐Occupational Functioning Assessment Scale [SOFAS] and Positive and Negative Syndrome Scale for Schizophrenia [PANSS]). The index group was evaluated after the occurrence of current relapse but within 6 months of its onset. Sociodemographic, current psychopathology (PANSS) and functioning (SOFAS), and other (mainly retrospective) variables were assessed with a specifically designed clinical profile sheet, Schedule for Affective Disorders and Schizophrenia Lifetime version, Presumptive Stressful life Events Scale, and World Health Organization Life Chart Schedule for Assessment of Course and Outcome of Schizophrenia. Patients who had relapsed were more symptomatic and exhibited greater dysfunction in comparison to remitted patients. Relapse in schizophrenia was significantly associated with unemployment, number of psychotic episodes, side‐effects of medication, and life events score. The present findings suggest that a severe illness (no. psychotic episodes, unemployment), psychological stress and inappropriate treatment (side‐effects of medicines) may be causally related to relapse in schizophrenia. However, the possibility that these variables may be caused by relapse or may be explained by a common underlying variable needs to be assessed prospectively.

Delusional disorder: Study from North India

Abstract  The aim of the present study was to study sociodemographic profile, clinical parameters including comorbidity, usefulness of antipsychotics especially atypicals, family history, and follow‐up rates for delusional disorder. The records of all subjects who were seen in the Department of Psychiatry during a period of 10 years (i.e. 1994–2003) were reviewed. Eighty‐eight subjects fulfilling the inclusion criteria were enrolled. The sample consisted predominantly of female subjects (55.7%), most of the total subjects were married and had favorable social functioning. The most common delusion was persecutory (54.5%), followed by delusion of reference (46.6%). The majority of the subjects had a comorbid psychiatric disorder. Education was negatively correlated with age at onset and positively correlated with the number of delusions. Age at onset was negatively correlated with total number of delusions. The sociodemographic profile of delusional disorder is consistent across various cultures, has high comorbidity and, when treated appropriately, responds to various antipsychotic agents.

Comparative study of the experience of caregiving in bipolar affective disorder and schizophrenia

Background: Bipolar affective disorder and schizophrenia are disabling illnesses and place a considerable degree of burden on the caregivers. Many studies from India have measured the burden of care in schizophrenia and some studies have measured the burden experienced by the caregivers of bipolar affective disorder. Few studies have compared this variable in these disorders. Experience of caregiving is a broader concept that takes into consideration both the negative and positive appraisal of the caregiving. However, no study from India has compared the experience of caregiving in bipolar affective disorder and schizophrenia. Aim of the study: To study the experience of caregiving in a group of caregivers of bipolar patients and compare the same with caregivers of patients with schizophrenia. Method: Seventy patients with a diagnosis of bipolar affective disorder and 70 with a diagnosis of schizophrenia were selected for the present study. Patients were assessed on the Hamilton Depression Rating Scale, the Young Mania Rating Scale and the Positive and Negative Syndrome Scale depending upon their diagnosis. They were also assessed on the Global Assessment of Functioning (GAF) scale. Caregivers of the patients were assessed on the General Health Questionnaire (GHQ) and the Experience of Caregiving Inventory (ECI). Results: The maximum ECI score was seen in the domain of handling ‘difficult behaviour’ in both the groups. Compared to caregivers of patients with bipolar affective disorder, caregivers of patients with schizophrenia had overall more positive and negative appraisal of caregiving experience while caring for their ill relatives. The difference reached significant levels for all domains but for the domains of ‘effects on family’, ‘need for back-up’ and ‘good aspect of relationship’. There were significant differences too for the total positive personal experience sub-score. There was a significant positive correlation between the negative and positive caregiving experience score for both schizophrenia and bipolar groups. Conclusion: The caregivers of both bipolar affective disorder and schizophrenia appraise the caregiving negatively, while at the same time appraising some positive aspects of it. Caregivers of schizophrenia patients appraise caregiving more negatively than those of bipolar affective disorder patients.

An overview of Indian research in depression

Depression as a disorder has always been a focus of attention of researchers in India. Over the last 50-60 years, large number of studies has been published from India addressing various aspects of this commonly prevalent disorder. The various aspects studied included epidemiology, demographic and psychosocial risk factor, neurobiology, symptomatology, comorbidity, assessment and diagnosis, impact of depression, treatment related issues and prevention of depression in addition to the efficacy and tolerability of various antidepressants. Here, we review data on various aspects of depression, originating from India.