Ritu Nehra

Caregiver-coping in bipolar disorder and schizophrenia--a re-examination.

BackgroundThe caregiving experience has been extensively investigated in some chronic/severe mental illnesses such as schizophrenia. These studies have suggested that illness variables and situational/personal characteristics of caregivers have a significant influence on how caregivers cope with mental illness. However, other similar conditions, e. g. bipolar affective disorder (BPAD), have been relatively neglected in this regard. This study attempted to compare caregiver-coping in BPAD and schizophrenia and to explore the determinants of such coping.MethodIllness variables and coping, burden, appraisal, perceived support, and neuroticism among caregivers were examined in 50 patients each of BPAD and schizophrenia and their caregivers.ResultsHigh levels of patient-dysfunction and caregiver-burden, low awareness of illness and low perceived control over patient’s behaviour were characteristic of both BPAD and schizophrenia, with no significant differences between the two groups on these parameters. Coping patterns were also quite alike, though caregivers of patients with schizophrenia were using some emotion-focused strategies significantly more often. Caregiver’s gender, patient-dysfunction and caregiver-neuroticism had a significant influence on coping patterns, but explained only a small proportion of the variance in use of different coping strategies.ConclusionsCoping and other elements of the caregiving experience in BPAD are no different from schizophrenia. The relationship between caregiver-coping and its determinants appears to be a complex one. More methodologically sound and culturally relevant investigations are required to understand this intricate area, with the hope that a better understanding will help the cause of both patients and their caregivers.

Relationship of caregiver burden with coping strategies, social support, psychological morbidity, and quality of life in the caregivers of schizophrenia

AIM To evaluate the relationship of caregiver burden as assessed by using Hindi Involvement Evaluation Questionnaire (IEQ) with coping strategies, social support, psychological morbidity, and quality of life of caregivers of patients with schizophrenia. Additionally, the relationship of caregiver-burden with sociodemographic variables, and clinical variables, including severity of psychopathology and level of functioning of patients, was studied. METHODOLOGY The study included 100 patients with schizophrenia and their caregivers recruited by purposive random sampling. RESULTS Among the four domains of IEQ, highest number of correlations emerged with tension domain. Tension domain had positive correlation with the caregiver being single, time spent in caregiving per day, and use of avoidance, collusion, and coercion as coping strategies. Additionally, tension domain was associated with poor quality of life in all the domains of WHO-QOL Bref and was associated with higher psychological morbidity. Worrying urging-I domain of IEQ correlated with frequency of visits, higher use of problem focused coping and poor physical health as per the WHO-QOL Bref. Worrying urging-II domain of IEQ had positive correlation with higher level of positive symptoms, lower level of functioning of the patient, younger age of caregiver, caregiver being unmarried, and higher use problem focused and seeking social support as coping strategies. Supervision domain of IEQ correlated positively with lower income, being an unmarried caregiver, from an urban locality and non-nuclear family. Supervision domain was associated with poor physical health as assessed by WHO-QOL Bref. CONCLUSION Caregiving burden, especially tension is associated with use of maladaptive coping strategies, poor quality of life and higher level of psychological morbidity in caregivers.

Positive aspects of caregiving in schizophrenia: A review.

Schizophrenia is a severe mental illness which is associated with significant consequences for both the patients and their relatives. Due to chronicity of the illness, the relatives of patients of schizophrenia have to bear the main brunt of the illness. Studies across the world have evaluated various aspects of caregiving and caregivers such as burden, coping, quality of life, social support, expressed emotions, and psychological morbidity. In general the research has looked at caregiving as a negative phenomenon, however, now it is increasingly recognised that caregiving is not only associated with negative consequences only, also experience subjective gains and satisfaction. This review focus on the conceptual issues, instruments available to assess the positive aspects of caregiving and the various correlates of positive aspects of caregiving reported in relation to schizophrenia. The positive aspect of caregiving has been variously measured as positive caregiving experience, caregiving satisfaction, caregiving gains and finding meaning through caregiving scale and positive aspects of caregiving experience. Studies suggests that caregivers of patients with schizophrenia and psychotic disorders experience caregiving gains (in the form of becoming more sensitive to persons with disabilities, clarity about their priorities in life and a greater sense of inner strength), experience good aspects of relationship with the patient, do have personal positive experiences. Some of the studies suggest that those who experience greater negative caregiving experience also do experience positive caregiving experience.

Relationship of quality of life with coping and burden in primary caregivers of patients with schizophrenia

Background: Very few studies have evaluated the quality of life (QOL) of caregivers of schizophrenia patients. The aim of this paper is to study the QOL, including the spirituality, religiousness and personal beliefs (SRPB) facets, of primary caregivers of patients with schizophrenia using the WHOQOL-BREF and WHOQOL-SRPB scales. Additionally an attempt was made to study the relationship between QOL with coping and burden in caregivers. Method: One hundred primary caregivers of patients with schizophrenia completed the WHOQOL-BREF and WHOQOL-SRPB scales. They were also assessed on the Family Burden Interview Schedule and Coping Checklist. Results: There were no significant associations of clinical variables and perceived burden with any of the WHOQOL-BREF domains and various WHOQOL-SRPB facets. There was a significant positive correlation between WHOQOL-BREF and various facets of WHOQOL-SRPB. There was a significant negative correlation between coercion as a coping strategy and the spiritual strength facet of WHOQOL-SRPB. Seeking social support as a coping strategy had a negative correlation with all domains of WHOQOL-BREF, whereas avoidance and use of problem-focused coping had no correlation with any of the domains of WHOQOL-BREF. Collusion as a coping skill had a negative correlation with the domains of physical health, social relationships and environment and the total WHOQOL-BREF score. Coercion as a coping strategy had a negative correlation with the general health and environment domains of WHOQOL-BREF. Conclusions: Findings of the present study suggest that there is a positive correlation between WHOQOL-BREF domains and WHOQOL-SRPB facets, which indicates that SRPB forms an integral component of the concept of QOL. Further, the QOL of caregivers is influenced by the coping skills used to deal with stress arising due to a patient’s illness.

Cognitive functions in bipolar affective disorder and schizophrenia: Comparison

Aims:  Earlier comparisons of cognitive impairment among patients with bipolar disorder and schizophrenia have found a largely similar profile of deficits, but results have varied between studies. This prompted the current attempt at another such comparison.

Education Effects on the International HIV Dementia Scale

Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/ AIDS) within the Indian subcontinent continues to spread. Although the primary clade of HIV in India differs from that of most Western countries, recent evidence suggests that the Indian clade (Clade C) also impacts neurocognitive functioning. India also has extremely high illiteracy rates that may confound detection of neurocognitive impairment, since many assessments to detect such impairment are heavily influenced by formal schooling. Among those with HIV/AIDS who have had limited educational opportunities and who are in the early stage of infection, the confounding effects of education on tests for neurocognitive impairment may be particularly salient. We therefore tested influence of HIV serostatus and education on a commonly used tool to screen for cognitive impairment, the International HIV Dementia Scale (IHDS), among Indian men and women in the catchment area of the Post Graduate Institute of Medical Education and Research (PGIMER) located in Chandigarh, India. Adjusted analyses showed that from a sample of 295 HIV-positive and HIV-negative individuals, only education was significantly associated with performance on the IHDS. HIV-negative and HIV-positive individuals, who were in the early stages of infection, performed similarly. Further development of this test to account for the effects of education on cut-off scores used to indicate possible dementia are needed, particularly for use in resource-limited settings such as India where low levels of education are widespread.

Supernatural beliefs, aetiological models and help seeking behaviour in patients with schizophrenia

Background: Few studies have evaluated the supernatural beliefs of patients with schizophrenia. This study aimed to study the personal beliefs, aetiological models and help seeking behaviour of patients with schizophrenia using a self-rated questionnaire. Materials and Methods: Seventy three patients returned the completed supernatural Attitude questionnaire. Results: 62% of patients admitted that people in their community believed in sorcery and other magico-religious phenomena. One fourth to half of patients believed in ghosts/evil spirit (26%), spirit intrusion (28.8%) and sorcery (46.6%). Two-third patients believed that mental illness can occur either due to sorcery, ghosts/evil spirit, spirit intrusion, divine wrath, planetary/astrological influences, dissatisfied or evil spirits and bad deeds of the past. 40% of the subjects attributed mental disorders to more than one of these beliefs. About half of the patients (46.6%) believed that only performance of prayers was sufficient to improve their mental status. Few patients (9.6%) believed that magico-religious rituals were sufficient to improve their mental illness but about one-fourth (24.7%) admitted that during recent episode either they or their caregivers performed magico-religious rituals. Conclusion: Supernatural beliefs are common in patients with schizophrenia and many of them attribute the symptoms of mental disorders to these beliefs.

Neuro-cognitive functioning in unaffected siblings of patients with bipolar disorder: Comparison with bipolar patients and healthy controls.

Aim: Neurocognitive tests can provide reliable endophenotypes for bipolar disorder (BD). The aim of this study was to compare the neurocognitive functioning of unaffected siblings of patients of bipolar affective disorder (BPAD) with that of patients with BD and a group of healthy controls. Materials and Methods: A total of 20 unaffected siblings of patients with BD-I, 20 patients of BD-I who were currently in remission and a group of 20 healthy control subjects were assessed for neurocognitive functions using Wisconsin Card Sorting Test, Brief Visuospatial Memory Test-Revised, Hopkins Verbal Learning Test-Revised and Wechsler Adult Intelligence Scale Digit Symbol Test. Results: Compared to healthy controls, unaffected siblings of patients with BD performed poorly on tests of verbal learning, but no significant differences were seen between the two groups for executive functions, visual learning and psychomotor speed, concentration and graphomotor abilities. Compared to unaffected siblings, patients with BD performed poorly on the tests of executive functions, visual memory, verbal memory, psychomotor speed, concentration, and graphomotor abilities. Conclusion: Verbal memory can serve as an endophenotype of bipolar disorder.

Enhancing HIV medication adherence in India.

Background: This pilot study evaluated an intervention designed to enhance adherence among those new to antiretroviral therapy. Methods: Participants (n = 80) were recruited from a hospital clinic in Chandigarh, India, and randomized to a 3-month group intervention or individual enhanced standard of care followed by crossover of condition and assessed over 6 months. Adherence was measured by prescription refill, pill count, and self-report. Results: At baseline, 56% of group condition (immediate intervention) and 54% of individual condition (delayed intervention) participants were nonadherent by pill count and 23% of group and 26% of individual condition participants self-reported skipping medication at least once over the last 3 months. From the postintervention to long-term follow-up, adherence in the group condition (immediate intervention) improved in comparison with adherence in the individual condition (delayed intervention; χ2 = 5.67, P = .02). Conclusions: Results support the use of interventions early in treatment to provide information and social support to establish long-term healthy adherence behaviors.

Neuropsychological test performance among healthy persons in northern India: development of normative data

Accurate identification of neurocognitive impairment associated with HIV infection (and other CNS-involved conditions) is dependent upon utilization of appropriate normative neuropsychological test performance data from healthy individuals with a similar background, culture, and characteristics of the target individual or group to be tested. In India, regional differences in language, culture, and availability of resources can significantly affect performance on neuropsychological testing. This study developed age- and education-adjusted normative data for commonly used neuropsychological test scores for use in northern India.