ABSTRACT
Background: The exact magnitude and phase of sexual function affected remains to be elucidated for most psychotropic drugs. So far little research has been done into sexual dysfunctions that develop during the use of antipsychotics. Most clinically used psychotropics cause sexual side-effects, but the nature, severity and frequency of these effects have not been systematically studied in Indian patients. Aim: To evaluate the frequency of sexual dysfunction and its impact on treatment adherence in patients with mental illness treated with various psychotropics under routine clinical conditions. Methods: We assessed the participants’ sexual functioning using Psychotropic-Related Sexual Dysfunction (PRSexDQ) is a brief and relatively nonintrusive questionnaire that has shown adequate psychometric properties in patients with mental disorder. Results: It was found that the rate of sexual dysfunction in the study group varied across the scale. However, sexual dysfunction was highest in the Antipsychotic group compared to others. Among the various domains of sexual dysfunction, decreased libido was the most common sexual dysfunction in all groups. On the PRSexDQ, all patients had sexual dysfunction on more than 1 domain (n = 20) out of 45 subjects which is higher in anti-psychotic group compared to the antidepressant group. Conclusions: In order to keep patients symptomatically stable and to help alleviate these side effects, clinicians should alter the treatment strategy, possibly by switching medications, to encourage adherence to the medication as well as optimize patients’ outcomes. Our results show that sexual dysfunction is very common in patients receiving long-term treatment with antipsychotics, and it is associated with a great impact in a substantial proportion of patients. Key message: Because psychotropic-associated sexual dysfunction is considerably underestimated by physicians, greater recognition and education are imperative when prescribing psychotropic treatment.
ABSTRACT
Background: At times, there is even a need for community involuntary treatment which may help in reducing the hospital admissions of patients with mentally illness. In India, there are very few State run psychiatric hospitals where patients get admitted and treated under section 20 of MHA 1987. There should be provisions for treating mentally ill in the community, if needed involuntarily. Detention of mentally ill for treatment during the time of florid psychosis is not a permanent solution for mental illness treatment. With the existing medicines these illnesses cannot be cured but can be controlled. So it leaves us with the option of using such detention only when no other method to treat is practicable. Such detention should best in the interest of the patient and the community. Aims: This study was an attempt to explore the practical problems in reintegrating the mentally ill back in to the community after their involuntary admission in comparison with the voluntary admission. Methods: This is a cross sectional study and data was collected from the medical records of 113 patients who were admitted in this hospital during the period of January 2010 to June 2010. Nearly 470 voluntary patients’ records were analysed during the above said period but by randomization they were limited to nearly 113 to equate with the involuntary admission. Results: Median duration of total hospitalization period in involuntary admission group of patients is 108 days with a minimum of 15 days and maximum of 460 days of admission. Median duration of involuntary stay at hospital is 91 days in some patients in whose reception orders there was a clear mention of what should be done after their treatment and recovery. In comparison to this group median duration of involuntary stay in others is 113 days as there was no clear mention in their reception orders about what should be done after their treatment and recovery. Conclusion: Most of the hospitals do not have any community social worker who can liaise with the family members to address their fears and to facilitate their early reintegration back in to home. There is a need for a review board consisting judiciary and medical personnel which can revoke the reception order at any point of time to minimize through duration of involuntary hospitalization in closed wards. Key message: Mentally ill patient rights need to be protected.