Lifestyle related factors & impact of metabolic syndrome on quality of life, level of functioning & self-esteem in patients with bipolar disorder & schizophrenia.

Background & objectives: Though studies have reported high prevalence rates of metabolic syndrome among patients with bipolar disorder (BPAD) and schizophrenia, there is lack of data on the impact of the same on the patients’ life. This study was aimed to assess the lifestyle related factors associated with metabolic syndrome (MetS) and to study the impact of MetS on functioning and quality of life (QOL) in patients with BPAD and schizophrenia. Methods: A total of 102 patients with BPAD and 72 patients with schizophrenia attending the output unit of a tertiary care hospital in north India were evaluated for MetS. These patients were assessed on Health Promoting Lifestyle Profile scale II (HPLP II), World Health Organization QOL -Bref Version (WHOQOL-Bref), Impact of Weight on Quality of Life- Lite version (IWOQOL -Lite), Body weight, Image and Self-esteem Evaluation questionnaire (BWISE), Obesity-related Problem scale (OP scale) and Global Assessment of Functioning (GAF) scale. Results: MetS was associated with lower scores on domains of health responsibility and nutrition habit domain on HPLP-II scale in both groups, and additionally on physical activity and stress management domain in BPAD group. On WHOQOL-Bref, MetS was associated with lower scores on the domains of physical and psychological health in both groups. On IWQOL–Lite, scores on personal distress and self esteem domains were higher in those with obesity in both groups and also on physical activity domain in schizophrenia group. Those with MetS had lower level of functioning as measured by GAF in schizophrenia group. Fulfillment of higher number of criteria of MetS correlated with poorer quality of life and higher problems in both groups. Interpretation & conclusions: Many modifiable lifestyle factors increase the risk of MetS. MetS was found to be associated with poorer QOL in patients with BPAD and schizophrenia; in addition, obesity led to poor self-esteem and excessive personal distress.

Internal consistency & validity of Indian Disability Evaluation and Assessment Scale (IDEAS) in patients with schizophrenia.

Background & objectives: The Indian Disability Evaluation and Assessment Scale (IDEAS) has been recommended for assessment and certification of disability by the Government of India (GOI). However, the psychometric properties of IDEAS as adopted by GOI remain understudied. Our aim, thus, was to study the internal consistency and validity of IDEAS in patients with schizophrenia. Methods: A total of 103 consenting patients with residual schizophrenia were assessed for disability, quality of life (QOL) and psychopathology using the IDEAS, WHO QOL-100 and Positive and Negative symptom scale (PANSS) respectively. Internal consistency was calculated using Cronbach’s alpha. For construct validity, relations between IDEAS, and psychopathology and QOL were studied. Results: The inter-item correlations for IDEAS were significant with a Cronbach’s alpha of 0.721. All item scores other than score on communication and understanding; total and global IDEAS scores correlated significantly with the positive, negative and general sub-scales, and total PANSS scores. Communication and understanding was significantly related to negative sub-scale score only. Total and global disability scores correlated negatively with all the domains of WHOQOL-100 (ρ<0.01). The individual IDEAS item scores correlated negatively with various WHOQOL-100 domains (ρ< 0.01). Interpretation & conclusions: This study findings showed that the GOI-modified IDEAS had good internal consistency and construct validity as tested in patients with residual schizophrenia. Similar studies need to be done with other groups of patients.

Family burden with substance dependence: a study from India.

Background & objectives: A substance dependent person in the family affects almost all aspects of family life. This leads to problems, difficulties or adverse events which impact the lives of family members and causes enormous burden on family caregivers. The present study aimed to assess the pattern of burden borne by the family caregivers of men with alcohol and opioid dependence. Methods: A cross-sectional study was conducted with ICD-10 diagnosed substance dependence subjects and their family caregivers attending a de-addiction centre at a multispecialty teaching hospital in north India. Family Burden Interview Schedule was used to assess the pattern of burden borne by the family caregivers of 120 men with alcohol and/or opioid dependence. Results: Compared to opioid and alcohol+opioid dependence groups, more often the alcohol dependence group was older, married, currently working, having a higher income and with the wife as a caregiver. Family burden was moderate or severe in 95-100 per cent cases in all three groups and more for ‘disruption of family routine’, ‘financial burden’, ‘disruption of family interactions’ and ‘disruption of family leisure’. Family burden was associated with low income and rural location. It was associated neither with age, education or duration of dependence of the patients, nor with family size, type of caregiver or caregiver’s education and occupation. Interpretation & conclusions: Almost all (95-100%) caregivers reported a moderate or severe burden, which indicates the gravity of the situation and the need for further work in this area.

Changing pattern of substance abuse in patients attending a de-addiction centre in north India (1978-2008).

Background & objectives: The patterns of abused psychoactive substances change over time, and it is important to document such changes. The present retrospective study was carried out to document these changes in patients registered in a de-addiction centre in north India over three decades. Methods: Case notes of all patients registered in the centre from September 1978 till December 31, 2008 were reviewed. Comparisons were made among three decades (1978-1988, 1989-1998, and 1999-2008). Results: The number of registered subjects increased eight-fold over the decades, and age of the subjects presenting for the treatment decreased. The percentages of subjects presenting for the treatment with opioid dependence were 36.8 per cent (n=204), 42.9 per cent (n=809) and 53.2 per cent (n=2219), respectively for the three decades (P<0.001). The proportion of subjects using natural opioids decreased over the three decades (47.4, 26.5 and 18.3%; P<0.001), with a concomitant emergence and/or increase of newer and prescription opioids such as buprenorphine, codeine and dextropropoxyphene. Dependence on tobacco and sedative-hypnotics also increased, and inhalant abuse was reported especially in the third decade. Polysubstance dependence increased significantly over the decades (P<0.001). Interpretation & conclusions: Our results showed major shifts in the patterns of substance abuse in clinic-attending patients in north India over the three decades from 1978 till 2008. These have important implications for all the stakeholders concerned with combating the challenge of psychoactive substance abuse in our society.

Prevalence & correlates of metabolic syndrome in alcohol & opioid dependent inpatients.

Background & objectives: The research on the association of metabolic syndrome (MS) and substance abuse is scanty. The present research aimed to study the prevalence and correlates of MS among the inpatients at a Drug De-addiction Centre in north India. Methods: Consecutive male subjects (N=110) admitted to a drug de-addiction centre during July to December 2009 with a primary diagnosis of alcohol or opioid dependence were evaluated for the presence of MS as per the International Diabetes Federation (IDF) criteria. Results: The prevalence of MS was 24.6 and 29.3 per cent in alcohol and opioid dependent groups, respectively. MS showed a significant association with the age and body mass index (BMI) in the opioid dependent group. Co-morbid tobacco use was not associated with MS in either group. Interpretation & conclusions: The prevalence of MS in our sample of alcohol and opioid dependent male inpatients was greater than the prevalence of MS in general population, however it was comparable to that reported in physical and other psychiatric disorder populations. Even though the absence of any comparative study limits the generalizability of our findings, results indicate towards a need for screening of the patients with substance dependence especially for those aged above 30 years and/or having a high BMI for MS.

Prevalence of depression and its effect on disability in patients with age-related macular degeneration.

Aims: To estimate depression in patients with age-related macular degeneration (AMD) and study the relationships among depression, visual acuity, and disability. Materials and Methods: It was a cross-sectional study with consecutive sampling (n = 53) of patients with AMD aged 50 years and above attending the retina clinic of a tertiary care hospital in North India. Depression, general disability and vision-specific disability were assessed in subjects meeting selection criteria. Assessments were done using the fourth edition of Diagnostic and Statistical Manual of mental disorders (DSM- IV) Geriatric Depression Scale (GDS), Structured Clinical Interview for DSM-IV Axis -I Disorders, Clinical Version (SCID-CV), World Health Organization Disability Assessment Schedule-II (WHODAS-II) and Daily Living Tasks dependent on Vision scale (DLTV). Non-parametric correlation analyses and regression analyses were performed. Results: Out of 53 participants, 26.4% (n = 14) met DSM-IV criteria for the diagnosis of depressive disorder. Depressed patients had significantly greater levels of general and vision-specific disability than non-depressed patients. General disability was predicted better by depression and vision-specific disability than by visual acuity. Conclusion: Depression is a major concern in patients with AMD and contributes more to disability than visual impairment.

Diagnosis of common mental disorders by using PRIME-MD Patient Health Questionnaire.

BACKGROUND & OBJECTIVE: Primary care physicians in their clinical settings usually fail to diagnose common mental disorders (CMDs). Primary Care Evaluation of Mental Disorders (PRIME-MD) Patient Health Questionnaire (PHQ) has been shown to facilitate diagnosis of most CMDs seen in primary health care. Its utility in Indian setting has not been evaluated. We carried out this study in Indian setting to evaluate the extent of psychiatric morbidity as measured by PRIME-MD PHQ. METHODS: A total of 500 consenting patients attending Medical outpatient department were recruited. All subjects were first assessed by the physician for presence of any physical illness and psychiatric disorder and their socio-demographic data were collected. Subjects were asked to fill the PRIMEMD PHQ. Illiterate subjects were assisted by the research worker in filling up the questionnaire. RESULTS: At initial evaluation physicians opined that 30.4 per cent of the subjects had psychological disorder, the most common diagnostic category was of anxiety disorders (15.8%), followed by depression (6%) and somatoform disorders (5.6%). On PHQ 42 per cent subjects had at least one psychiatric diagnosis. The most common psychiatric diagnosis was panic disorder (18.4%), followed by other anxiety disorders (16.6%). On comparing the diagnosis of physicians and PHQ, out of 152 cases (30.4%) suspected to have any psychological disorder by the physicians in the initial evaluation, 105 were found to have PHQ diagnosis. Of the 348 cases in which physicians did not suspect any psychiatric diagnosis, 243 were also negative in PHQ screening. There was a significant correlation between physicians and PHQ diagnosis. INTERPRETATION & CONCLUSION: There is a high psychiatric morbidity in the general medical practice and in many cases psychiatric morbidity is either missed or is misdiagnosed and by the physicians. Our results showed that PHQ could be a valuable screening instrument for psychiatric morbidity in primary care and general medical practice.