Sailaxmi Gandhi

Consumer perspectives on the concept of recovery in schizophrenia: A systematic review

Subjective descriptions of recovery from schizophrenia may be different from clinical recovery measures. The aim of the review was to identify the consumer perspectives of recovery from schizophrenia. Twenty-five studies within the period of 2000-2013, including qualitative and quantitative studies were reviewed by using different search strategies. An integrated method was used and the findings were coded and related themes were identified under five areas, namely, process orientation, self orientation, family orientation, social orientation, and illness orientation. Recovery was considered as both process and outcome. Patient or client-based definitions of recovery mainly involved factors related to personal wellbeing and social inclusion, that were seemingly distant from the clinical recovery measures. Incorporating consumer descriptions of recovery in recovery oriented services can increase the outcome of the services.

Somatic symptoms, perceived stress and perceived job satisfaction among nurses working in an Indian psychiatric hospital

BACKGROUND High stress perception by nurses caring for psychiatric patients can lead to somatic symptoms which impact on their job satisfaction perception. OBJECTIVE To assess and correlate the level of somatic symptoms, perceived stress and perceived job satisfaction among the subjects. DESIGN The authors used a descriptive correlation design to invite 150 nurses of both genders working for more than one year with psychiatric patients. The Scale for Assessment of Somatic Symptoms (Chaturvedi et al., 1987) and a Visual Analogue Scale (VAS) for stress and job satisfaction perception were used to collect data. RESULTS The nurses (128) reported mainly pain related (4.87±2.97) somatic symptoms. Somatic symptoms positively correlated (r=0.302) with stress perception and negatively correlated (r=-0.231) with perceived job satisfaction, while perceived stress and perceived job satisfaction were negatively correlated (r=-0.460, p=0.000). CONCLUSION The results indicate a need for stress management interventions.

A Study on First Intake Assessments of In-Patient Referrals to Psychiatric Rehabilitation Services

Background: Psychiatric rehabilitation is an important component in mental health services. The rehabilitation needs of patients with mental illness have been highlighted in various studies. The studies on in-patient referrals to rehabilitation services however are sparse. This study describes the clinical and demographic details and the reasons for referrals to rehabilitation services during the in-patients stay. Materials and Methods: A semi-structured pro forma was used for the assessment of in-patients referred for the psychiatric rehabilitation services. The pro forma included socio-demographic details such as background, family resources, illness related details such as symptom status, risk assessment, medication details. The total number of referrals for a period of 5 months was collected and coded. Results: The total number of referrals for a period of 5 months was 216 and there were 197 forms available for the study. The mean age of the sample was 31.48 ± 10.46 years. Vocational rehabilitation was the commonest reason for referral to the in-patient services. Severe mental disorders were the most common diagnosis of patients refereed to the services. Conclusions: Patients with severe mental illness were most often referred to the in-patient services. This indicates that we need include to rehabilitation in the management plan at the earliest. Vocational rehabilitation is the most common reason for referrals and there is a need to develop services to cater to these needs.

Under graduate nursing students' knowledge and attitude toward people living with human immunodeficiency virus/acquired immunodeficiency syndrome

Background: Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has become one of the significant public health problems in the world. Research regarding HIV/AIDS among nursing professionals is limited from India. Aim: The aim was to assess nursing student′s knowledge and attitude toward people living with HIV/AIDS. Methods: A descriptive cross-sectional design was adopted among conveniently selected under graduate nursing students (n = 172) using self-reported questionnaires. Results: The overall mean knowledge (38.05 ± 4.91) and attitude score (51.26 ± 6.2) indicate that majority of the students have good knowledge (77.6%) and moderately favorable attitudes (67.4%) toward HIV/AIDS patients. However, statistically significant differences were observed between age (P < 0.001, P < 0.019) education (P < 0.34, P < 0.01) and experience in taking care of HIV/AIDS patients (P < 0.01, P< 0.01) with knowledge and attitude. Conclusion: Though, a majority of nursing students had adequate knowledge, few students hold discriminatory attitudes toward people with HIV/AIDS. These findings indicate that there is an urgent need to improve the level of knowledge and attitudes among nursing students toward HIV/AIDS as they have a key role in prevention, care and treatment in their future career as nurses.

Medication adherence, work performance and self-esteem among psychiatric patients attending psychosocial rehabilitation services at Bangalore, India

Context: Work benefits mental health in innumerable ways. Vocational rehabilitation can enhance self-esteem. Medication adherence can improve work performance and thereby the individuals’ self-esteem. Aim: To test the hypothesis that there would be a significant correlation between medication adherence, work performance and self-esteem. Setting and Design: A quantitative, descriptive correlational research design was adopted to invite patients attending psychiatric rehabilitation services to participate in the research. Material and Methods: Data was collected from a convenience sample of 60 subjects using the ‘Medication Adherence Rating scale’, ‘Griffiths work behaviour scale’ and the ‘Rosenbergs Self-esteem scale’. Statistical analysis used: Analysis was done using spss18 with descriptive statistics, Pearsons correlation coefficient and multiple regression analysis. Results: There were 36 males and 24 females who participated in this study. The subjects had good mean medication adherence of 8.4 ± 1.5 with median of 9.00, high mean self-esteem of 17.65 ± 2.97 with median of 18.0 and good mean work performance of 88.62 ± 22.56 with median of 93.0. Although weak and not significant, there was a positive correlation (r = 0.22, P = 0.103) between medication adherence and work performance; positive correlation between (r = 0.25, P = 0.067) medication adherence and self–esteem; positive correlation between (r = 0.136, P = 0.299) work performance and self-esteem. Multiple regression analysis showed no significant predictors for medication adherence, work performance and self-esteem among patients with psychiatric illness. Conclusions: Medication monitoring and strengthening of work habit can improve self-esteem thereby, strengthening hope of recovery from illness.

Admission experiences of psychiatric patients in tertiary care: An implication toward Mental Health Care Bill, 2013

Background: Coercion is not uncommon phenomenon among mental health service users during their admission into psychiatric hospital. Research on perceived coercion of psychiatric patients is limited from India. Aim: To investigate perceived coercion of psychiatric patients during admission into a tertiary care psychiatric hospital. Materials and Methods: This was a cross-sectional descriptive survey carried out among randomly selected psychiatric patients (n = 205) at a tertiary care center. Data were collected through face-to-face interviews using structured questionnaire. Results: Our findings revealed that participants experienced low levels of coercion during their admission process. However, a majority of the participants were threatened with commitment (71.7%) as well as they were sad (67.8%), unpleased (69.7%), confused (73.2%), and frightened (71.2%) with regard to hospitalization into a psychiatric hospital. In addition, the participants expressed higher levels of negative pressures (mean ± standard deviation, 3.76 ± 2.12). Participants those were admitted involuntarily (P > 0.001), diagnosed to be having psychotic disorders (P > 0.003), and unmarried (P > 0.04) perceived higher levels of coercion. Conclusion: The present study showed that more formal coercion was experienced by the patients those got admitted involuntarily. On the contrary, participants with voluntary admission encountered informal coercion (negative pressures). There is an urgent need to modify the Mental Health Care (MHC) Bill so that treatment of persons with mental illness is facilitated. Family member plays an important role in providing MHC; hence, they need to be empowered.

Gender Differences in Body Mass Index, Body Weight Perception, weight satisfaction, disordered eating and Weight control strategies among Indian Medical and Nursing Undergraduates

OBJECTIVES To assess gender disparity in body weight perception, Body Mass Index (BMI), weight satisfaction and role of depression among undergraduate Medical and Nursing students. METHODS A descriptive cross sectional descriptive study was conducted in conveniently selected medical (n=241) and nursing (n=213) students of Bangalore, South India. Data was collected using self-administered SCOFF questionnaires. RESULTS Our findings revealed that men had a significantly higher BMI than women (t=5.403, p<0.001). More number of women compared to men, perceived themselves as over weight (74.8%) and not satisfied with their weight status (81.6%). More men than women scored positively for disordered eating behaviors on SCOFF (45.4% vs. 31.1%) and EAT scale (16.5% vs. 8.7%). While, 48.2% of the women practice binge eating, 41.2% of the men practice it (p<0.004); more men (47.4%) than women (25.4%) exercised for more than sixty minutes (p<0.001) to control their weight. CONCLUSIONS Findings indicate small differences between the genders that have to be taken in consideration in planning interventional programs to prevent eating disorders in this population.

Perception of family emotional climate by family members of persons with schizophrenia

Background: There is a dearth of instruments to assess schizophrenia persons’ Family Emotional Climate (FEC). Aim: This study aims to explore the relation between family members’ personality traits and FEC. Methods: We invited a convenience sample of 50 both gender family members who were accompanying the person with schizophrenia for out-patient department (OPD) consultation to provide data on a socio-demographic proforma and the researcher prepared ‘Emotional climate assessment questionnaire – caregivers’ version’ (ECAQ-C) as well as the Eysenck personality questionnaire. Results: Caregivers’ extroversion traits (r = .427, p = .002) were positively correlated and neuroticism traits were negatively correlated (r = −.330, p = .019) with their positive perception of FEC. There was a higher perception of positive FEC (mean scores = 65.5 ± 10.5) while caregivers seemed to perceive less negative FEC (mean scores = 36.5 ± 10.2). Caregivers with education above 11th std perceived less (χ2 = 8.6, p = .013) of negative FEC. Conclusion: The findings highlight that caregivers’ personality traits seem to influence the FEC. While caregivers’ perception of FEC is positive in this study, those in the higher education group seem to have a better perception of FEC indicating that education also may influence FEC.

Services for Enhanced Recovery with Intensive and Continued Engagement (SERWICE): An outpatient psychiatric rehabilitation model from India

The long-term outcome of patients with psychiatric disorders is likely to be better with rehabilitation inputs (DeSisto et al., 1995). In India, there is paucity of psychiatric rehabilitation facilities. Formal rehabilitation settings are lacking in most teaching institutes too, and hence, postgraduate trainees in psychiatry lack training in psychiatric rehabilitation. In this context, a specialized service ‘Services for Enhanced Recovery with Intensive and Continued Engagement (SERWICE)’ was conceptualized to provide (a) an outpatient, family-assisted, comprehensive rehabilitation for patients with severe mental disorders and (b) much-needed training for trainees in psychiatric rehabilitation. SERWICE is being run at the National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore over the last 3 years. SERWICE is offered to patients [preferably those with severe mental disorders (SMD)] who have not attained satisfactory recovery with medications. All 6 adult psychiatry units of the Department of Psychiatry refer patients to SERWICE. Only such patients and families, who agree to take active role in the recovery process (i.e., more frequent follow-up visits, implementing homework assignments and consenting to be contacted by phone/email/home visits), are recruited under SERWICE. These patients are allotted to postgraduate psychiatry trainees – on an average, each trainee has about 2–4 SERWICE patients. The trainees assess patients with SERWICE proforma, which includes a comprehensive assessment of rehabilitation challenges and opportunities of the patients. Under the supervision of a consultant psychiatrist, the trainee provides individualized management, comprising of pharmacotherapy and a host of services, including psycho-education, individual psychotherapy for residual symptoms, family therapy, cognitive retraining, social skills training, training in self-help skills, study skills, behavioural modification, vocational counselling and vocational training. In most cases, a family caregiver is actively involved through the planning and implementation of the plans. Trainees proactively contact patients by phone/e-mail and coordinate multidisciplinary interventions. Follow-up

Eating Attitudes, Weight Control Behaviors, Body Image Satisfaction and Depression Level Among Indian Medical and Nursing Undergraduate Students

This was a cross sectional descriptive study carried out among Medical and Nursing students to assess the presence of eating disorders. Data was collected using self administered ‘Sick, Control, One, Fat, Food’ (SCOFF) and ‘Eating Attitudes Test (EAT-26)’ questionnaires. It was found that 34.1% and 10.4% of the participants were at high risk to suffer from eating disorders on SCOFF and EAT-26 scales. Further, age, gender and education found to have significant association on SCOFF and EAT-26 scores (p < 0.05). Thus, the findings suggest the need for effective interventions to prevent depression and eating disorders among the future health professionals.