Rama Malhotra

Psychiatric morbidity in vitiligo: prevalence and correlates in India

Background Vitiligo, a common pigmentary disorder, is recognized to be associated with a high psychiatric morbidity, yet compared to other dermatological disorders like leprosy, psoriasis, etc., it has not been subjected to detailed evaluation of its psychological consequences. The data from the developing countries on this aspect in particular is meager.

Psychiatric morbidity in vitiligo and psoriasis: a comparative study from India.

In a tertiary‐care teaching hospital in India, dermatology outpatients with vitiligo (N=113) and psoriasis (N=103) were studied for psychiatric morbidity. The two groups were similar with regard to education, locality, religion, and attitude to appearance (ATT). Psoriasis cases were older, more often male, and more often married. The General Health Questionnaire (GHQ) assessed psychiatric morbidity rates at 33.63% and 24.7% for vitiligo and psoriasis, respectively. The ICD‐10 psychiatric diagnoses in GHQ positive cases were: adjustment disorder (56% vs 62%), depressive episode (22% vs 29%) and dysthymia (9% vs 4%) in vitiligo and psoriasis, respectively. The Comprehensive Psychopathological Rating Scale (CPRS) assessed that depression, anxiety, and total psychopathology levels were similar in the two GHQ positive subgroups. Significant correlations were noted between psychopathology (GHQ, CRPS), dysfunction as per Dysfunction Analysis Questionnaire (DAQ), and behavior change as per Impact of Skin Disease Scale (IMPACT), and all were more prominent in vitiligo.

Relationship between spirituality/religiousness and coping in patients with residual schizophrenia

PurposeTo measure spirituality/religiousness and its relation to coping skills in patients with residual schizophrenia.MethodsUsing a cross-sectional design, 103 persons with residual schizophrenia were assessed on Positive and Negative Syndrome Scale [PANSS] and Ways of Coping Checklist [WCC] to assess the repertoire of coping skills and WHO Quality of Life-Spirituality, Religiousness and Personal Belief scale [WHOQOL-SRPB] to assess religiousness and spirituality.ResultsPositive reappraisal as a coping strategy had significant positive correlation with all the facets of WHOQOL-SRPB and SRPB total domain scores. The coping subscales of accepting responsibility, planful problem solving, distancing, confrontive coping, and self-controlling also had significant positive correlations with different facets of WHOQOL-SRPB and total SRPB domain score. Seeking social support and escape-avoidance as coping mechanisms had no correlations with any of the WHOQOL-SRPB facets.ConclusionsA sound spiritual, religious, or personal belief system is associated with active and adaptive coping skills in subjects with residual schizophrenia. Understanding and assessing the spirituality and religiousness of subjects with schizophrenia can help in better management of the disorder.

Do the various categories of somatoform disorders differ from each other in symptom profile and psychological correlates.

Background: In routine clinical practice, the subcategories of various somatoform disorders are rarely used by the primary care physicians and there is lack of data to suggest any difference in the clinical manifestations of these subcategories. Aim: To compare the symptom profile, anxiety, depression, alexithymia, somato-sensory amplification and hypochondriasis of patients with persistent somatoform pain disorder with other subtypes of somatoform disorder. Method: A total of 119 patients diagnosed with somatoform disorders according to the International Classification of Diseases–10th Revision (ICD-10) were evaluated for prevalence of somatic symptoms, anxiety, depression, alexithymia, hypochondriacal worry and somato-sensory amplification. Results: No significant differences were found in the prevalence of various somatic complaints between those with persistent somatoform pain disorder group and those diagnosed with other somatoform disorders. Co-morbid anxiety and depression were seen in two-thirds of the patients, but again there was no difference in the prevalence of the same between the two groups. Similarly, no significant differences were found on alexithymia, hypochondriasis and somato-sensory amplification scales between the persistent somatoform pain disorder group and the group with other somatoform disorders. Conclusion: There are no significant differences between the various subcategories of somatoform disorders with regard to the prevalence of somatic symptoms, anxiety or depression and psychological correlates of alexithymia, hypochondriasis and somato-sensory amplification.

Psychosocial morbidity in Cushing disease: a study from India

The main objective of this article is to study the psychosocial profile of patients of Cushing disease (CD) in a developing country setting. Eighteen patients with CD underwent a cross-sectional assessment regarding their socio-demographic and clinical profile, life events, social support, coping, dysfunction, quality of life, and psychiatric morbidity. Twenty-two demographically group-matched healthy participants (free from psychological morbidity) acted as the control group. The CD group had predominance of females (71.5%) with mean age at onset of 20.38 (range 8–38) years, and mean duration of illness of 65.33 (range 4–260) months. Six subjects (i.e., GHQ positive group) scored positive on the General Health Questionnaire-12 giving a psychological morbidity rate of 33.33%, with one having an ICD-10 diagnosis. There was no difference between GHQ positive and GHQ negative groups on number of life events, social support, quality of life and dysfunction. However, GHQ positive group used significantly more of internalizing coping strategies. Psychological morbidity occurs in a significant percentage of patients with CD. Presence of psychological morbidity is associated with internalizing coping strategies.

Explanatory models of somatoform disorder patients attending a psychiatry outpatient clinic: A study from North India:

Background: The symptoms of somatoform disorders are very distressing to the sufferer as well as pose significant burden on the health-care delivery system. Although the nature of symptoms is physical, the underlying mechanisms are not clearly understood. Objective: The purpose of this study was to assess the explanatory models of patients with somatoform disorders presenting to a tertiary care hospital in Northern India. Method: A total of 99 consecutive adult patients (≥18 years) with diagnosis of somatoform disorders according to the International Classification of Diseases–10th Revision (ICD-10) were evaluated for their explanatory models using the causal models section of Explanatory Model Interview Catalogue (EMIC). Results: The mean age of the study sample was 36.52 years, and the mean duration of illness was 59.39 ± 57.68 months. The most common clinical diagnosis was that of persistent somatoform pain disorder. The most common explanations given belonged to the category of psychological factors (68.7%) followed by weakness (67.7%), social causes (51%) and karma–deed–heredity (53.5%) category. The mean number of etiological categories reported were 2.6 (standard deviation (SD) = 1.7). Among the various specific causes, the commonly reported explanations by one half of the sample in decreasing order were general weakness (63.6%), mind–thoughts–worry category (59.6%) and loneliness (53.5%). The mean number of specific etiologies was 4.9 (SD = 3.83). Conclusion: Most of the patients with somatoform disorder attribute their symptoms to psychological factors. It also becomes imperative to understand the physical symptoms in somatoform disorders from the sociocultural aspects of patients.

Internalized stigma experienced by patients with first-episode depression: A study from a tertiary care center

Background: Although there is abundant literature on stigma and its correlates in patients with severe mental illnesses such as schizophrenia and bipolar disorder, data on stigma experienced by patients with first-episode depression (FED) are limited. Aims and Objectives: To estimate internalized stigma perceived by patients with FED and to assess the relationship of stigma with sociodemographic and clinical variables. Methodology: This cross-sectional study included 107 patients with FED with duration of illness of at least 1 month, currently not meeting the criteria of syndromal depression (as assessed on Hamilton depression rating scale score ≤ 7). These patients were assessed on Internalized Stigma of Mental Illness Scale (ISMIS) for internalized stigma and Participation Scale for restriction of activities. Results: About two-fifths of patients (41.1%) reported stigma as per the total ISMIS score. In terms of various domains of stigma, stereotype endorsement (54.2%) was reported by the highest proportion of patients and this was followed by alienation (47.7%) and discrimination experience (38.3%). About half of the study sample (49.5%) reported restriction in participation with one-third of the sample reporting having severe or extreme restriction. Younger age, longer duration of depressive episode, and presence of comorbid physical illness were found to be strongly associated with higher level of stigma. Higher level of participation restriction was associated with higher level of stigma in the domains of alienation (P ≤ 0.001) and social withdrawal (P ≤ 0.004). Conclusions: The present study suggests that internalized stigma/self-stigma is highly prevalent among patients with FED. Accordingly, there is a need to develop stigma mitigation programs addressing these patients at the earliest to improve their treatment outcome.