Patterns of Tobacco Consumption among Indian Men with Schizophrenia Compared to Their Male Siblings

OBJECTIVE: Tobacco consumption among patients with schizophrenia has been investigated extensively in western countries, but there is a dearth of studies in India, where socio-economic and cultural variables are different. This study aims to investigate the patterns of tobacco consumption among schizophrenia patients compared with their non-psychotic siblings. METHODS: Consenting, successive male outpatients diagnosed with schizophrenia (n=100, DSM-IV criteria), and their non-psychotic brothers (n=100) were compared. Following a structured diagnostic interview, detailed information about tobacco consumption (including smokeless tobacco) was obtained using the Fagerstrom Test for Nicotine Dependence for smoked tobacco, and FTND-smokeless tobacco. The University of Pennsylvania Computerized Neurocognitive battery (CNB) was administered to a sub-group of patients (n=48). RESULTS: Schizophrenia patients initiated tobacco use at a significantly earlier age than their brothers, but there was no significant difference with regard to type, quantity or frequency of tobacco use (smoke or smokeless varieties). Patients who consumed tobacco had significantly higher positive symptom scores compared with non-users (p=0.043). There were no significant differences between nicotine dependent and non-dependent patients with regard to CNB domains except attention. CONCLUSION: Patterns of tobacco consumption were similar among schizophrenia patients and their non-psychotic brothers. Tobacco use was associated with increased positive symptom scores, but there were no significant differences in cognitive measures among nicotine dependent and non-dependent patients.

Profile difference between male and female psychiatric patients seeking certificate of disability

Neuropsychiatric disorders are one of the major contributors to the global burden of disease and disability. Issue of disability in psychiatric disorders has been studied across multiple studies in India. However, there are no reports on the profile and nature of disability among those seeking disability certificates. The current study aims at understanding the socio-clinical profile of patients seeking disability certificate in a tertiary care hospital in India. The study was carried out in the Department of Psychiatry of a tertiary care multispecialty teaching hospital. A chart review of the records of the patients referred for disability evaluation over a one year period was conducted. The disability was assessed using IDEAS. In between group comparisons were carried out for male and female subjects for different sociodemographic variables, IDEAS total score and individuals item score using independent sample t test [parametric test] and Mann Whitney-U test [non parametric test]. Additionally, Spearman's rank order correlation was calculated to establish the level of correlation between total IDEAS score and score on individual items of the scale. The subjects were diagnosed to have been suffering from mental retardation 107 [61.8%], schizophrenia 54 [31.2%], dementia 5 [2.9%], bipolar affective disorder 4 [2.3%] and obsessive compulsive disorder 3 [1.7%] as per ICD-10. Male and female subjects differed significantly on the global IDEAS score. The total score was significantly higher for male subjects compared to female subjects. The difference was statistically significant for "self care" and interpersonal activities items of the scale with male subjects having higher disability scores. The current study provides some important insights into profile of disability certificate seeking individuals in India

Differences among Men and Women with Schizophrenia: A Study of US and Indian Samples

OBJECTIVE: To test the hypothesis that similar differences in psychopathology are present across cultures among men and women with schizophrenia (SZ). METHODS: Sex based differences were tested systematically in two independent samples from the Northeastern USA and North India using the same procedures. The clinical variables were obtained from five interview instruments. RESULTS: Among the US participants, the number of significant differences exceeded chance predictions (15/240 variables significant at p<0.02, 6.25%; expected number of significant differences: 5). Similarly, a greater than expected number of variables differed significantly between men and women among the Indian subjects (13/230 differences at p<0.02, 5.65%; expected: 5). One of these variables significantly differed in both samples (lifetime abuse of cannabis). When multivariate analyses were conducted in the combined US and Indian samples sex based differences remained for only four variables: course of the illness, history of inappropriate emotions, marital status and number of children. CONCLUSION: Sex based differences in SZ/schizoaffective disorder are present in the USA and India at greater than chance probabilities. The majority of the variables differ across the samples. The biological underpinnings of these variables need further investigation.

Is Familiality Associated with Downward Occupation Drift in Schizophrenia?

OBJECTIVE: Downward occupational drift has been extensively investigated in schizophrenia. It is known that certain illness related factors, such as severity, affect drift, but the impact of familial factors has not been investigated. METHODS: Occupation drift was studied among patients with schizophrenia/schizoaffective disorder (SZ/SZA)(n=523) and 130 affected sib pairs (ASPs). Drift was analyzed in relation to familiality as well as demographic and clinical variables. For comparison one proband (one of the affected siblings) from each ASP was selected. Occupation drift was measured in relation to the most responsible job held, and with regard to head of the household (HOH) occupation status. RESULTS: There was no significant difference between single affected and ASP probands in terms of occupational drift from the most responsible job (drifted 39.2% and 38% respectively) and with regard to HOH's occupation (drifted 88% and 82.8% respectively). A significant part of the sample remained unemployed in both single affected and ASP samples. Thus, there was no significant impact of familiality on these variables. However, marital status, pattern of severity, age at onset, gender were found to be associated with downward occupation drift in single affected probands while the only significant factor in familial probands was pattern of severity of severity when measuring in terms of downward drift from most responsible job. CONCLUSION: Though there is occupation drift in schizophrenia, there is no detectable impact of familial factors. Employment is associated with severity of delete.