Ruchita Shah

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.

Inhalant Abuse: A Clinic-Based Study

Background: There are very few studies reporting inhalant abuse/dependence from India. Materials and Methods: Consecutive treatment seeking inhalant abuse cases (n = 21) were studied for the sociodemographic and clinical profile by using a semi-structured interview schedule. Results: A typical case profile was: unmarried male (100%), mean age 19 years, government school background (76%), unemployed (43%) or student (38%), urban nuclear family (86%), middle socioeconomic status (76%), and poor social support (62%); inhalant dependence (81%), inhalants being the only substance of abuse (33%) and of first or second preference (76%). Duration of inhalant use ranged 6-60 (mean 16) months. All subjects abused typewriter erasing fluid by sniffing (67%), huffing (19%) or bagging (14%). Initiation was out of curiosity (62%), under peer pressure (24%), or as a substitute (14%). Craving was more common (90%) than withdrawal (57%). Almost half of the cases (48%) had a family history for substance dependence. All cases were impaired, more so in family and educational/occupational domains. Conclusions: The results depict that easy availability, cheap price, faster onset of action, and a regular high makes inhalant a substance of abuse especially among the urban youth.

Distress due to delirium experience

BACKGROUND Very few studies have evaluated the level of distress due to the experience of delirium in patients who have recovered from delirium. METHODOLOGY Fifty-three patients were rated on Delirium Rating Scale-Revised-98 at baseline and were again evaluated on Delirium Experience Questionnaire after recovery for level of distress due to the experience of delirium. RESULTS The mean age of patients was 45.58 (S.D. 19.06) years. Only 15 patients (28.3%) remembered themselves to be confused and rest had no recollection of the same. Those who could remember their experience had moderate (n = 4; 26.7%), severe (n = 6; 40.0%) and very severe (n = 5; 33.3%) level of distress. Of those who could not remember their delirium experience, most of them had moderate (n = 17; 44.7%) to severe (n = 10; 26.3%) distress. Those who remembered their experience in general described it as a state of fearfulness (n = 8), anxiety (n = 4) confusion and feeling strange (n = 7). Other experiences which were recollected were those of visual hallucinations and illusions. CONCLUSION Overall experience of delirium is distressing for the patients. Most of the patients (those who remembered or who were not able to remember) experienced at least moderate level of distress.

Telepsychiatry: Promise, Potential, and Challenges

Despite the high prevalence and potentially disabling consequences of mental disorders, specialized mental health services are extremely deficient, leading to the so-called ‘Mental Health Gap’. Moreover, the services are concentrated in the urban areas, further worsening the rural-urban and tertiary primary care divide. Strengthening of and expanding the existing human resources and infrastructure, and integrating mental health into primary care appear to be the two major solutions. However, both the strategies are riddled with logistic difficulties and have a long gestation period. In such a scenario, telepsychiatry or e-mental health, defined as the use of information and communication technology to provide or support psychiatric services across distances, appears to be a promising answer. Due to its enormous potential, a review of the existing literature becomes imperative. An extensive search of literature was carried out and has been presented to delineate the modes of communication, acceptability and satisfaction, reliability, outcomes, cost-effectiveness, and legal and ethical challenges related to telepsychiatry. Telepsychiatry has been applied for direct patient care (diagnosis and management), consultation, and training, education, and research purposes. Both real-time, live interaction (synchronous) and store–forward (asynchronous) types of technologies have been used for these purposes. A growing amount of literature shows that training, supervision, and consultation by specialists to primary care physicians through telepsychiatry has several advantages. In this background, we have further focused on the models of telepsychiatry best suited for India, considering that mental health care can be integrated into primary care and taken to the doorstep of patients in the community.

Women and mental health in India: an overview

Gender is a critical determinant of mental health and mental illness. The patterns of psychological distress and psychiatric disorder among women are different from those seen among men. Women have a higher mean level of internalizing disorders while men show a higher mean level of externalizing disorders. Gender differences occur particularly in the rates of common mental disorders wherein women predominate. Differences between genders have been reported in the age of onset of symptoms, clinical features, frequency of psychotic symptoms, course, social adjustment, and long-term outcome of severe mental disorders. Women who abuse alcohol or drugs are more likely to attribute their drinking to a traumatic event or a stressor and are more likely to have been sexually or physically abused than other women. Girls from nuclear families and women married at a very young age are at a higher risk for attempted suicide and self-harm. Social factors and gender specific factors determine the prevalence and course of mental disorders in female sufferers. Low attendance in hospital settings is partly explained by the lack of availability of resources for women. Around two-thirds of married women in India were victims of domestic violence. Concerted efforts at social, political, economic, and legal levels can bring change in the lives of Indian women and contribute to the improvement of the mental health of these women.

Quetiapine: Relatively Safe in Overdose?

Compared to other antipsychotics quetiapine has been reported to be relatively safer in overdose. We report a case with paranoid schizophrenia who attempted suicide with 1400 mg of quetiapine and manifested drowsiness, supraventricular tachycardia (167/minute) and minimal ST depression in leads V1 to V6 on ECG; all other physiological parameters were normal. Gastric lavage, lorazepam 2mg i/v to control agitation, and 14-hour observation in emergency ended in she being sent home. Subsequently she was successfully managed with ECTs, and quetiapine 600mg and risperidone 6mg daily. This report tends to support the literature suggesting quetiapine as a relatively-safer-in-overdose antipsychotic, and preferable in medication-overdose-suicidal-risk cases.

Delirium‐Related Distress in Caregivers: A Study From a Tertiary Care Centre in India

PURPOSE To study the caregivers distress with symptoms of delirium. DESIGN AND METHODS Consenting adult caregivers (>18 years of age) of patients with delirium were evaluated for the distress due to symptoms of delirium. RESULTS The study included 72 primary caregivers of patients with delirium. Symptoms of delirium that led to severe or very severe distress in more than two thirds of the caregivers included decreased sleep, increased motor activity, attempts to remove intravenous lines, tubings, etc., and attempts to get out of bed when they were actually required to lie down. CONCLUSIONS Overall experience of delirium was very distressing for the caregivers.

Electroconvulsive therapy for lycanthropy and Cotard syndrome: a case report.

We present a case of psychotic depression presenting with lycanthropy (being converted to a pig) and Cotard syndrome simultaneously and treated with electroconvulsive therapy. A 37-year-old female patient developed psychotic depression after a stressor (a possibility of having a malignancy). As her depression worsened, she developed delusional belief of self being metamorphosed to a pig and her children also being metamorphosed into pig. In addition, she had the delusional belief that her own body and body of her children was rotting away. She was treated with electroconvulsive therapy along with venlafaxine and olanzapine, with which she improved completely.

Acute akathisia with quetiapine: A case report and review of literature

Quetiapine is an atypical antipsychotic which has been shown to have greater relative affinity for 5-HT2A receptors than for D2 receptors, due to which it is thought to lead to lower incidence of extrapyramidal symptoms (EPS). However, over the years literature in the form of case reports have accumulated which shows that quetiapine can lead to akathisia, especially in subjects prone to develop EPS. In this study, we report the case of a 22-year-old female who developed akathisia with quetiapine 150 mg/day, which subsided with reduction in dose. We have also reviewed the existing literature with respect to akathisia with quetiapine.

A Novel Screening and Diagnostic Tool for Child and Adolescent Psychiatric Disorders for Telepsychiatry.

Background: A diagnostic tool designed as part of a telepsychiatry application for diagnosis and management of child and adolescent psychiatric disorders in India was developed considering the paucity of trained child psychiatrists and mental health professionals in India. Materials and Methods: The diagnostic tool consisted of screening and 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) criteria-based diagnostic algorithms for 18 psychiatric disorders seen in childhood and adolescence. Accuracy of diagnoses and feasibility of use of the tool was examined by comparing it with detailed semi-structured clinical evaluations by a qualified psychiatrist with 50 psychiatric patients (children and adolescents). Statistical Analysis: Descriptive analyses and paired t-tests were conducted to compare the mean number of diagnosis generated by the two interviews. Sensitivity, specificity, positive and negative predictive values were computed for the screening and the diagnostic sub-modules of the tool, compared to the clinical diagnoses. Kappa coefficients were computed to assess agreement between the diagnoses generated by the diagnostic sub-module and the clinical diagnoses. Results: The screening sub-module had high sensitivity, high specificity and negative predictive values for all disorders. For the diagnostic sub-module, there was moderate (kappa-0.4–0.6) to substantial agreement (kappa > 0.6) for all the disorders, (except psychosis) and high sensitivity (barring a few disorders) and specificity for almost all the disorders. Positive predictive values were found to be acceptable to high for most disorders, with consistently high negative predictive values. Conclusion: The new tool was found to be comprehensive, reasonably short and feasible. Results showed acceptable level of accuracy in diagnosis generated by the tool.