Subho Chakrabarti

Extent and determinants of burden among families of patients with affective disorders

The burden of care experienced by family members of 90 patients with major affective disorder was evaluated. The extent of burden in these families was considerable. The burden was significantly more among families of bipolar patients than those of major depression. Prolonged illness and high levels of dysfunction among patients correlated consistently with severity of burden. Severity of illness, higher age of the patient and number of episodes of the illness also influenced the extent of burden. Variables such as gender of the patient, religion, education, occupation, family type and size and the locus of control of both patients and relatives did not influence the extent of burden significantly. These results have substantial implications for the planning of intervention strategies.

Comparative efficacy study of haloperidol, olanzapine and risperidone in delirium

OBJECTIVE The objective of the study was to assess the efficacy and safety of second-generation antipsychotics olanzapine and risperidone vs. haloperidol in patients of delirium admitted to medical and surgical wards. METHODS Prospective follow-up single-blind randomized controlled trials were performed. Consecutive patients with delirium referred to the consultation-liaison psychiatry team were eligible for the study. The study sample comprised 64 patients, with 20 subjects in the haloperidol group, 21 subjects in the risperidone group and 23 subjects in the olanzapine group. A flexible dose regimen (haloperidol -0.25 to 10 mg; risperidone -0.25 to 4 mg; olanzapine -1.25 to 20 mg) was used. Delirium Rating Scale-Revised-98 (DRS-R98) was used as the primary efficacy measure, and mini mental status examination (MMSE) was used as a secondary efficacy measure. RESULTS There was no significant difference in mean baseline DRS-R98 severity scores and MMSE scores between the three groups. However, there were a significant reduction in DRS-R98 severity scores and a significant improvement in MMSE scores over the period of 6 days, but there was no difference between the three groups. Four patients in the haloperidol group, six subjects in the risperidone group and two subjects in the olanzapine group experienced some side effects. CONCLUSIONS Risperidone and olanzapine are as efficacious as haloperidol in the treatment of delirium.

CULTURE AND SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS

The comparative study of schizophrenia and related disorders across cultures has come a long way since Kraepelin advocated its cause, following his trip to Java at the beginning of the last century. The principal development since then has been the burgeoning of interest in the field, culminating in innovative and ambitious international collaborative research by the WHO. Despite reservations about covert ideology or about the more overt methodologic difficulties, the balance of evidence from these and similar studies suggests that: It is feasible to conduct such research despite the numerous hazards. There is a certain uniformity to the way schizophrenia presents globally; there are equally significant cultural differences. The outcome of schizophrenia appears to be better in developing, than developed cultures; reasons for this are far from clear, nevertheless, it can be safely assumed that culturally-determined processes, whether social or environmental, are partly responsible. Overall, the study of schizophrenia in different cultures has proved useful in establishing the pancultural and the culture-specific properties of this and related disorders.

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.

Psychoeducational intervention for caregivers of Indian patients with schizophrenia: a randomised‐controlled trial

Objective:  There are hardly any randomised‐controlled trials of structured family interventions for schizophrenia from India. This study attempted to evaluate the impact of a structured psychoeducational intervention for schizophrenia, compared with standard out‐patient treatment, on various patient‐ and caregiver‐related parameters.

Cost of care of schizophrenia: a study of Indian out-patient attenders.

Objective:  To assess the cost of care of Indian out‐patients with schizophrenia.

The pattern of burden in families of neurotic patients.

SummaryThe pattern of burden in 90 families with a neurotic patient, 30 each with dysthymia, generalized anxiety disorder and obsessive compulsive disorder was evaluated in this study. Burden was chiefly felt in four principal areas; financial burden, disruption of family routine, disruption of family leisure and family interactions. This pattern was similar among the three study groups. Analysis of problems perceived as burdensome demonstrated an increased concern among relatives regarding routine household matters, restricted leisure and ill effects of the patients illness on the family atmosphere. Burden was significantly greater in cases of married patients, married relatives, housewives and employed patients. Such data, it is hoped, will help provide guidelines along which an enquiry into different aspects of burden can be conducted.

Gender differences in caregiving among family - caregivers of people with mental illnesses

All over the world women are the predominant providers of informal care for family members with chronic medical conditions or disabilities, including the elderly and adults with mental illnesses. It has been suggested that there are several societal and cultural demands on women to adopt the role of a family-caregiver. Stress-coping theories propose that women are more likely to be exposed to caregiving stressors, and are likely to perceive, report and cope with these stressors differently from men. Many studies, which have examined gender differences among family-caregivers of people with mental illnesses, have concluded that women spend more time in providing care and carry out personal-care tasks more often than men. These studies have also found that women experience greater mental and physical strain, greater caregiver-burden, and higher levels of psychological distress while providing care. However, almost an equal number of studies have not found any differences between men and women on these aspects. This has led to the view that though there may be certain differences between male and female caregivers, most of these are small in magnitude and of doubtful clinical significance. Accordingly, caregiver-gender is thought to explain only a minor proportion of the variance in negative caregiving outcomes. A similar inconsistency characterizes the explanations provided for gender differences in caregiving such as role expectations, differences in stress, coping and social support, and response biases in reporting distress. Apart from the equivocal and inconsistent evidence, there are other problems in the literature on gender differences in caregiving. Most of the evidence has been derived from studies on caregivers of elderly people who either suffer from dementia or other physical conditions. Similar research on other mental illnesses such as schizophrenia or mood disorders is relatively scarce. With changing demographics and social norms men are increasingly assuming roles as caregivers. However, the experience of men while providing care has not been explored adequately. The impact of gender on caregiving outcomes may be mediated by several other variables including patient-related factors, socio-demographic variables, and effects of kinship status, culture and ethnicity, but these have seldom been considered in the research on gender differences. Finally, it is apparent that methodological variations in samples, designs and assessments between studies contribute a great deal to the observed gender differences. This review highlights all these issues and concludes that there is much need for further research in this area if the true nature of gender differences in family-caregiving of mental illnesses is to be discerned.

Electroconvulsive therapy: A review of knowledge, experience and attitudes of patients concerning the treatment

Abstract Objectives. Despite its proven efficacy and safety, electroconvulsive therapy (ECT) has a negative image and attracts widespread public criticism. In contrast, perceptions of patients who have received ECT appear to be more favourable. This review intended to encapsulate the evidence on knowledge and views concerning ECT among its recipients. Methods. Extensive electronic and manual searches were conducted to identify all relevant studies on the subject. Results. Seventyfive reports were found suitable. The evidence from these studies suggested that patients undergoing ECT were usually poorly informed about it. This was attributable to factors such as unsatisfactory pre-treatment explanations or post-ECT memory impairment. About one-third undergoing ECT reported feeling coerced to have the treatment. Fear of ECT and distressing side effects were also present in a majority. Despite these problems, a vast majority of patients perceived ECT to be helpful and had positive views regarding the treatment. Simultaneously, a sizeable proportion was quite critical, although little was known about the extent and nature of such disapproval. Conclusions. Overall, the weight of the evidence supports the notion that patients undergoing ECT are well-disposed towards it. However, much needs to be done to improve the practice of ECT and to enhance patients’ satisfaction with the experience of treatment.

Combined use of electroconvulsive therapy and antipsychotics in schizophrenia: the Indian evidence. A review and a meta-analysis.

Background: Combined use of electroconvulsive therapy (ECT) and antipsychotics in acute phases of schizophrenia remains controversial and inadequately investigated. Aim: This study tried to examine whether the ECT-antipsychotic combination was more efficacious than antipsychotic drugs used alone in the acute phase treatment of schizophrenia, by way of an open review and an exploratory meta-analysis of the Indian studies on the subject. Method: Eleven studies (n = 651) and 4 controlled trials (n = 113) were selected for the open review and the meta-analysis, respectively. For the meta-analysis, a standard &khgr;2 analysis was undertaken to check for heterogeneity. Brief Psychiatric Rating Scale scores were used to estimate treatment effects. Results: The open review suggested that the ECT-antipsychotic combination was more efficacious than antipsychotic drugs used alone in the first few weeks of treatment of schizophrenia. The meta-analysis, using the Inverse Weighted Variance Model, showed that the ECT-antipsychotic combination provides an advantage of approximately 5 Brief Psychiatric Rating Scale points over antipsychotic drugs, in the first 4 to 5 weeks of treatment of schizophrenia (mean treatment effect, 4.89; 95% confidence intervals, 0.50-9.38). Conclusions: The studies reviewed thus indicated that ECT-antipsychotic combinations might be better than antipsychotic drugs used alone in the first few weeks of treatment of schizophrenia; the main benefit seemed to be an acceleration of treatment response. Although the evidence was not conclusive because of several methodological difficulties, it does suggest that further research is required to determine the usefulness of the ECT-antipsychotic combination in the acute treatment of schizophrenia.