Cr Chandrashekar

Family burden, quality of life and disability in obsessive compulsive disorder: An Indian perspective

BACKGROUND Obsessive compulsive disorder (OCD) is a psychiatric disorder that often tends to run a chronic course. The lifetime prevalence of OCD is around 1-3%, which is twice as prevalent as schizophrenia and bipolar disorder. AIM To asses the family burden, quality of life (QoL) and disability in patients suffering from at least moderately ill OCD and then to compare them with schizophrenia patients of comparable severity. SETTINGS AND DESIGN We recruited 70 consecutive subjects (OCD=35, schizophrenia=35) who met study criteria between March 2005 and March 2006 from the psychiatric services of the National Institute of Mental Health and Neuro Sciences, Bangalore, India. MATERIALS AND METHODS The severity of illness was rated using the Clinical Global Impression-Severity (CGI-S). Instruments used in the current study were the Family Burden Schedule, the World Health Organization (WHO) QoL (Bref) and the WHO - Disability Assessment Schedule (DAS). STATISTICAL ANALYSIS The Fishers exact test/chi-square test was used to compare categorical variables and the independent sample t test was used to analyze continuous variables. Analysis of covariance (ANCOVA) was used to compare the groups after controlling for potential confounding variables. Pearsons correlation was used for correlation analysis. RESULTS Overall family burden, financial burden and disruption of family routines were significantly higher in schizophrenia patients compared to OCD although the groups did not differ with respect to other domains of family burden. On the WHO QoL, OCD patients were comparable to schizophrenia patients with respect to the psychological and social domains. On the WHO - DAS, both the groups were similar in all the domains except getting around. CONCLUSION Severe OCD is associated with significant disability, poor QoL and high family burden, often comparable to schizophrenia. Therefore, there is an urgent need to increase the sensitivity among healthcare professionals to recognize and treat OCD.

Cognitive endophenotypes in OCD: a study of unaffected siblings of probands with familial OCD.

BACKGROUND Impairments in executive functions and non-verbal memory are considered potential endophenotype markers of obsessive-compulsive disorder (OCD). For the neuropsychological deficits to be considered endophenotypes, they should be demonstrable in unaffected family members. AIM To compare the neuropsychological performance in unaffected siblings of probands with familial OCD with that of individually matched healthy controls. METHODS Twenty-five unaffected siblings of OCD probands with familial OCD, and 25 individually matched healthy controls were assessed with tests of attention, executive function, memory and intelligence. RESULTS Unaffected siblings showed significant deficits in tests of decision making and behavioural reversal i.e., the Iowa Gambling Task (IGT) and the Delayed Alternation Test (DAT) respectively, but performed adequately in other tests. CONCLUSIONS Our study suggests that the deficits in decision making and behavioural reversal could be potential endophenotypes in OCD. These deficits are consistent with the proposed neurobiological model of OCD involving the orbitofrontal cortex. Future studies could couple cognitive and imaging strategies to identify neurocognitive endophenotypes in homogenous samples of OCD.

Psychosomatic disorders in developing countries: current issues and future challenges.

Purpose of review This paper focuses on understanding of the concept, recent advances, and challenges to be faced in the field of psychosomatic disorders by the developing countries. Recent findings Changing health scenario in developing countries has led to imminent epidemic of noncommunicable diseases along with the unmet agenda of controlling infectious diseases. Psychosomatic medicine has a role to play in curtailing the upcoming epidemic. Research studies on psychosomatic disorders from developing countries are very few. Most of the publications are in nonpsychiatric medical journals covering explorative to intervention studies. Traditional, complementary, and alternative medicines such as ayurveda are already playing their role in the area of psychosomatic disorders in developing countries. Summary The role and responsibility of the psychiatrist is changing from treating major mental disorders to preventing and treating psychosomatic disorders. In this regard, developing countries have to meet various challenges such as development of manpower, training of medical and paramedical staff, funding resources for clinical practice and research, coordinating with complementary and alternative medicines, and networking with policy makers in combating the imminent epidemic.

The association between attention-deficit/hyperactivity disorder and early-onset alcohol dependence: A retrospective study

Background: Early onset (EO) alcohol dependence (AD) has been found to represent a subtype of alcoholism with a distinct profile and prognosis compared to late onset (LO) alcohol dependence. Externalizing disorders, especially attention deficit hyperactivity disorder (ADHD) that may continue as attention deficit hyperactivity disorder, residual type (ADD, RT) in adulthood, may increase susceptibility to early-onset AD. Aims: To examine the relationship between ADHD and ADD, RT symptoms and age at onset of AD in a sample of Indian male patients. 70 male subjects with AD presenting to the De-Addiction Services of the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, were studied. The study had a retrospective design. Materials and Methods: Patients were examined for evidence of past ADHD in childhood and current ADD, RT using structured instruments. Chi-square tests and odds ratios were used to express the relative risk of association of ADHD with early- and late-onset AD. Results: Significantly more EO alcoholics (19/30, 63.3%) had a history of ADHD in childhood compared to LO alcoholics (7/28, 25%, P < 0.05) ADD, RT was also over-represented in EO probands. Conclusions: The results of this study are consistent with previous research that shows a high incidence of ADHD in early-onset alcoholics. This may have important management implications.

Creativity and mental health: A profile of writers and musicians

Creativity and its link with mental health have always been much speculated about. However there have been a handful of methodologically sound studies to clearly establish the relationship between creativity and mental health. The objective of the study therefore was to examine the psychiatric morbidity stress profile, coping skills and personality profile in creative versus non-creative populations. Forty writers, 40 musicians and 40 controls chosen after randomization, who met the inclusion and exclusion criteria constituted the sample of the study. All the subjects were administered GHQ-28; SCAN for all GHQ positives (and 10% of GHQ-ves), Perceived stress scale and coping check list and NEO-FFI. Statistical analysis was done using SPSS 11.0 version. Pearsons correlation, Chi-square and ANOVA one-way tests were used. The present study corroborated the findings of earlier studies in 70s and 80s that there was no difference between creative and non-creative groups in terms of mental illness and stress profile. The writers differed significantly from the other two groups on religious and faith domain of coping skills. The two creative groups had similar personality characteristics and scored significantly high on all dimensions compared to the non-creative group.

‘Ego-dystonicity’ in homosexuality: An Indian perspective

Background: Homosexual persons are targets of verbal and physical abuse, discrimination and face legal disadvantages in many countries, including India. These external factors could play a role in determining discomfort with their sexuality. Aims: We ascertained the association between ego-dystonicity of sexual orientation and indices of perceived acceptance, stigma and awareness of possible normative lifestyles. Methods: Fifty-one self-identified adult homosexual men were assessed using online questionnaires that covered information including their socio-demographic details; a Visual Analog Scale (VAS) that measured their degree of discomfort with their sexuality; Reactions to Homosexuality Scale, Perceived Acceptance Scale, Modified China Men Who Have Sex with Men (MSM) Stigma scale; and trait version of the Positive and Negative Affect Scale. The participants were also asked to provide a written narrative of their experiences which influenced their comfort with their sexuality. Results: Discomfort with sexuality significantly correlated with education, acceptance by friends and family, legal disadvantages, awareness and accessibility to non-heteronormative lifestyles and support systems and trait affect. Only acceptance by friends and awareness showed significance on linear regression. Qualitative analyses revealed external attributions for discomfort. Conclusions: Modifying external factors, reducing legal restrictions and improving societal acceptance and support systems could reduce ‘ego-dystonicity’. ‘Ego-dystonicity’ as a determinant for psychiatric classification and intervention needs to be reexamined.

Filicide as a part of extended suicide: An experience of psychotherapy with the survivor

The tragedy of maternal filicide and extended suicides has occurred throughout history. Maternal filicide–suicide perpetrators most often suffer from depression, suicidality, or psychosis. Interventions in such cases are not commonly reported in the psychiatric settings, and the components of psychotherapeutic approach and its efficacy are also not known. Here we present a long-term therapy carried out with a 36-year-old married lady, with the complaints of low mood, suicidal ideation, severe guilt feelings, and depressive cognitions. There was positive family history of depression, past history of dysthymia, suicidal attempt, and severe marital discord. Therapy was carried out for a period of 9 months with follow-up for 4 years and addressed existential issues and grief with the components of existential therapy, grief therapy, narratives, religious beliefs, and interpersonal acceptance. The case highlights the need for blending of multiple approaches to meet the challenges such cases can pose.