Psychiatric Morbidity in Post Traumatic Orthopedically Handicapped Patients.

Objectives: Prevalence of comorbid psychiatric disorders in trauma is high and it increases the overall management difficulty. The current study attempts to find out the prevalence of psychiatric disorders and factors affecting these disorders in post traumatic orthopedically handicapped patients. Method: This is a hospital based cross-sectional study which involves 85 post traumatic orthopedically handicapped inpatients and outpatients of orthopedics, rehabilitation unit and psychiatry. They were screened for psychiatric symptoms by SCL-90R (Symptoms Check List-90 Revised). All patients underwent detailed psychiatric assessment using ICD-10 (International Classification of Disease-10) criteria and further subjected to MADRS (Montgomery Asberg Depression Rating Scale) and HARS (Hamilton Anxiety Rating Scale) to assess severity of the symptoms. Results: 67.6% patients had psychiatric symptoms. According to ICD-10, 38% had depressive disorder of which majority have mild to moderate depressive disorder. 26.8% patients had post traumatic stress disorder, 15.5% phobic anxiety disorder, 14% adjustment disorder, 12.7% somatoform disorder and 4.2% acute stress reaction. Conclusions: The psychiatric comorbidity was observed more in temporal association to traumatic injury, was higher in intensity and severity after more severe injury. The psychiatric co-morbidity following trauma needs to be addressed while we aim for holistic treatment of a patient.

Impact of Substance Dependence on Primary Caretaker in Rural Punjab.

Objectives: The study was planned to assess the impact of substance dependence and factors affecting it on PCT (Primary Care Taker) in rural area of Punjab. Methods: This is a systematic, randomized,cross sectional study which involves 83 PCT of patients with ICD-10 diagnosis of substance dependence in village Chhajli of Punjab. Details of substance useand sociodemographic attributes of dependence patients were taken on semi-structured proforma. All PCT underwent detailed assessment using Family Burden Interview Schedule. Results: Majority of PCT (77.5 percent) was found to have moderate burden especially in financial areas, disruption of routine activities, family leisure and family interaction. Higher proportion of burden was seen in PCT of illiterate patients of reproductive age group, of lower socioeconomic status, having multiple and longer duration of substance dependence and had relapsed many times. Conclusion:Burden on PCT was observed more in temporal association to the number of substance, type and duration of dependence. The impact of substance dependence on family members must be assessed at every stage of patient treatment for better quality of life.