Rakesh Kumar Chadda

Help Seeking Behaviour of Psychiatric Patients Before Seeking Care At a Mental Hospital

BACKGROUND A wide range of professionals including psychiatrists, psychologists, general physicians, faith-healers and religious healers cater to the needs of mentally ill patients. Psychiatric facilities are available at general hospitals, office based practice and mental hospitals. Psychiatrists are preferred the least due to stigma. The present work reports on treatment options used by a group of psychiatric patients before visiting a mental hospital. AIM To study the help seeking behaviour of patients visiting a mental hospital. METHOD Patients attending psychiatric outpatient service at a mental hospital were asked specifically about various treatment facilities utilized by them before coming to the hospital and the reasons thereof. RESULTS A wide range of services was used by the subjects varying from professional care to faith healers. Trust, easy availability and accessibility, recommendations by the significant others and belief in supernatural causation of illness were the important reasons for choosing a particular facility. Thus sociocultural factors appeared to influence the help seeking behaviour. CONCLUSION A substantial number of patients suffering from severe mental disorders seek non-professional care. There is a need of studies in community to assess the help seeking behaviour of psychiatric patients and factors associated with it.

Caregiver burden and coping: a prospective study of relationship between burden and coping in caregivers of patients with schizophrenia and bipolar affective disorder.

IntroductionCaregivers of patients of schizophrenia and bipolar affective disorder (BAD) experience considerable burden while caring their patients. They develop different coping strategies to deal with this burden. Longitudinal studies are required to assess the relationship between caregiver burden and coping.AimThe present study was conducted to assess relationship between burden and coping in caregivers of clinically stable patients with schizophrenia and BAD.MethodOne hundred patients each of schizophrenia and BAD attending a psychiatric outpatient setting and their caregivers were followed up for a period of 6 months. Burden and coping strategies were assessed in the caregivers at baseline, and after 3 and 6 months using the Burden Assessment Schedule (BAS) and Ways of Coping Checklist - Hindi Adaptation (WCC - HA).ResultsBurden remained stable over 6 months and was comparable in the two groups of caregivers. Caregivers from both the groups were found to use problem focused coping strategies more often than seek social support and avoidance strategies. Scores on avoidance type of coping showed a positive correlation with the total burden scores and a number of burden factors.ConclusionCaregivers of patients of schizophrenia and BAD face similar levels of burden and use similar types of coping methods to deal with it. Relationship between caregiver burden and coping is quite complex.

Indian family systems, collectivistic society and psychotherapy

Indian society is collectivistic and promotes social cohesion and interdependence. The traditional Indian joint family, which follows the same principles of collectivism, has proved itself to be an excellent resource for the care of the mentally ill. However, the society is changing with one of the most significant alterations being the disintegration of the joint family and the rise of nuclear and extended family system. Although even in todays changed scenario, the family forms a resource for mental health that the country cannot neglect, yet utilization of family in management of mental disorders is minimal. Family focused psychotherapeutic interventions might be the right tool for greater involvement of families in management of their mentally ill and it may pave the path for a deeper community focused treatment in mental disorders. This paper elaborates the features of Indian family systems in the light of the Asian collectivistic culture that are pertinent in psychotherapy. Authors evaluate the scope and effectiveness of family focused psychotherapy for mental disorders in India, and debate the issues and concerns faced in the practice of family therapy in India.

A study of negative symptoms in schizophrenia and depression

Abstract The Scale for the Assessment of Negative Symptoms (SANS) was administered to 59 patients satisfying Research Diagnostic Criteria (RDC) for the diagnosis of definite schizophrenia and an equal number of patients satisfying Research Diagnostic Criteria (RDC) for the diagnosis of major depressive disorder. As compared to schizophrenic patients, depressives obtained significantly higher scores on ratings of subjective complaints, total score, global ratings, and various items of all subscales. Schizophrenic patients were noted to have significantly higher scores on global rating of alogia, poor eye contact, inappropriate affect, and blocking. When the same scale was applied to a group of 12 “negative schiozphrenics” also satisfying RDC for the diagnosis of schizophrenia and the ratings compared with depressed patients group, these differences disappeared to a great extent. The results of the study suggest that the SANS can also be used for the assessment of behavioral changes in depression.

Metabolic syndrome in schizophrenia: Differences between antipsychotic-naïve and treated patients

Metabolic syndrome (MetS) has been recognized as a risk factor for cardiovascular morbidity and mortality in general population and in patients with severe mental illnesses like schizophrenia. This paper reviews studies on MetS in schizophrenia and related psychotic disorders, and assesses the contribution of antipsychotics toward the development of MetS. Databases of Medline (PubMed), PsycINFO, and Scopus were searched for MetS, psychotic disorders, and antipsychotic drugs from inception till present. Prevalence of MetS in patients with schizophrenia was found to be ranging from 3.3% to 68.0%. Prevalence in antipsychotic-naïve and antipsychotic-treated patients ranged between 3.3-26.0% and 32.0-68.0% respectively, and was higher in younger patients, female gender and Hispanics, and lower in African-Americans and Orientals. Prevalence of metabolic abnormalities was higher in patients receiving second generation antipsychotics (SGAs), especially with clozapine, olanzapine, and risperidone, as compared to first generation antipsychotics (FGAs). Antipsychotic-induced changes on metabolic indices became evident after 2 weeks and reached maximum at 3 months of treatment. There is a need to sensitize the mental health professionals at all levels about the need of screening and monitoring for MetS in patients receiving antipsychotics.

Augmentation effect of repetitive transcranial magnetic stimulation over the supplementary motor cortex in treatment refractory patients with obsessive compulsive disorder.

Background: There are only a few effective treatment options currently available for treatment-refractory obsessive compulsive disorder (OCD). The supplementary motor area (SMA) has been reported to play an important role in the pathophysiology of OCD. Functional neuroimaging studies indicate that OCD is associated with increased activity in the SMA, caudate nucleus, and anterior cingulate gyrus. Novel treatment strategies like repetitive transcranial magnetic stimulation (rTMS) have been proposed for OCD refractory to standard treatments. These clinic-based data report on the efficacy of rTMS in medication-resistant OCD. Materials and Methods: Twelve right-handed persons with medication-resistant OCD were administered rTMS as an add-on treatment. Stimulation was given at 1 Hz for 10 seconds followed by 15 seconds pause and 100 trains of stimulus over the SMA per session for 5 days in a week. Assessments were done on yale brown obsessive compulsive scale (Y-BOCS) at baseline and at the end of rTMS intervention. Results: The subjects had a mean age of 33.17±12.74 years. Mean scores on Y-BOCS were 26.17 at baseline and 17.17 at the end of treatment, reflecting significant improvement. The subjects did not report any significant side effects except one person with known bipolar illness, who developed manic symptoms after the 3rd session of the rTMS. Conclusions: Low-frequency rTMS over the SMA appears a promising treatment strategy as an add-on treatment in treatment-refractory patients of OCD.

Caregiver Burden and Coping in Schizophrenia and Bipolar Disorder: A Qualitative Study

Caregivers of people with severe mental disorders suffer from having a considerable burden as a result of their caregiving role. They develop different kinds of coping strategies to deal with this burden. There has been a lack of qualitative studies on caregiver burden and coping, especially from non-Western populations. The present paper reports findings of a longitudinal study of burden and coping in a group of caregivers of people suffering from schizophrenia and bipolar affective disorder (BAD). Qualitative assessments were done by focus group discussions (FGDs) with the caregivers over a period of about a year. Caregivers reported burden in different areas including effects on family functioning, social isolation, financial problems, and health. They used multiple coping strategies including developing compassion in caregiving, hoping for a better future, developing faith in God, participating in religious practices, and helping others with a similar problem.

Dhat syndrome : is it a distinct clinical entity ? A study of illness behaviour characteristics

Dhat syndrome is a culture‐bound neurotic disorder seen in the Indian subcontinent. The disorder has recently been included in ICD‐10. In the present study, illness behaviour of 50 dhat syndrome patients was studied using a Hindi version of Illness Behaviour Questionnaire (IBQ) and was compared with 50 controls. Sixty‐six percent of dhat syndrome patients received unspecified diagnoses on DSM‐III‐R. Patients with dhat syndrome showed a distinct illness behaviour profile consisting of higher scores on IBQ factors of general hypochondriasis and affective discomfort and lower scores on denial compared with controls, suggesting that the disorder may be a distinct entity.

Metabolic syndrome in schizophrenia: A comparative study of antipsychotic-free/naïve and antipsychotic-treated patients from India

Introduction: In recent years, metabolic syndrome (MS) has been identified as an important health risk in patients with schizophrenia and related disorders, and has often been related to the use of second-generation antipsychotics. Objective: The present study was conducted to assess the prevalence of MS in schizophrenia and related disorders and its correlation with various demographic, clinical and treatment variables. Method: One hundred patients with schizophrenia and related disorders, 50 antipsychotic-free/naïve and 50 on antipsychotic medications for more than 3 months, attending a psychiatric outpatient setting, were assessed for various socio-demographic, clinical and metabolic parameters. Results: Subjects on treatment with antipsychotics had significantly higher mean weight, body mass index, waist circumference, calorie intake, triglycerides (TGL), very-low-density lipoproteins (VLDL), fasting blood sugar (FBS) and positive family history of diabetes mellitus compared with the antipsychotic-free/naive ones. Subjects on antipsychotics also had significantly higher prevalence of MS. A positive association of MS was observed with age, being married, higher education, executive jobs and ICD-10 diagnosis of schizophrenia, duration of illness, family history of diabetes mellitus and family history of hypertension. Conclusion: Use of antipsychotics increases the risk of developing hyperlipidemia and MS in patients of schizophrenia and related disorders, emphasizing the need for regular monitoring of various metabolic parameters in patients on antipsychotics. Clinical implications: 1) Antipsychotics are associated with increased risk of hyperlipidemia and MS; 2) regular monitoring of lipid profile and other metabolic parameters should be done in patients on antipsychotics; 3) psychiatrists need to lay emphasis on lifestyle and dietary modifications in their patients on antipsychotics.

Help-seeking behavior of patients with mental health problems visiting a tertiary care center in North India

Background: Patients with mental health problems in the nonwestern world seek help from a variety of sources, such as the family physicians, psychiatrists, psychologists, traditional faith-healers, or alternative medicine practitioners. Understanding the help-seeking behavior is important from the public health perspective. Materials and Methods: Two hundred new patients visiting a psychiatric outpatient service at a tertiary care hospital were interviewed on a semi-structured questionnaire for various services contacted by them for their mental health problems. Results: Psychiatrists were the first choice in 45% of the cases followed by nonpsychiatric physicians and religious faith healers. Important reasons to seek help from different sources included easy accessibility, belief in the system, or particular healer and good reputation. Mean duration of treatment varied from 2.35 months with the alternative system practitioners to 16.63 months with the psychiatrists. The mean expenditure per visit to a service was highest for the nonpsychiatric physician and lowest for alternative system practitioners. Conclusion: Patients with mental health problems seek help from psychiatrists, nonpsychiatric physicians, faith healers, alternative system practitioners, and traditional faith healers for multiple reasons. It is important to sensitize various nonpsychiatric physicians with early identification and optimum management of mental disorders.