Socio demographic, clinical and side effect profile of electroconvulsive therapy use among psychiatric inpatients: a cross sectional study from South East Asia - Kashmir.

Background: Electroconvulsive Therapy (ECT) is a neuromodulative technique, which is effective but underutilized for treatment of psychiatric disorders. The aim of the study was to investigate socio demographic, clinical and side effect profile of electroconvulsive therapy use among psychiatric inpatients. Methods: A cross sectional study was performed for a period of 1 year in postgraduate department of psychiatry (Institute of mental health and neurosciences Kashmir - center of excellence). Patients of pharmacotherapy resistant psychiatric disorders attending the hospital during this period were taken in study. The data was recorded in a specially designed proforma which documented the socio-demographic variables including age, sex, residence, occupation, socioeconomic status was recorded. Chi-square, Fisher exact, and t tests were used to note the statistically significant association. Results: The mean age of the study sample was 39.6 (±11.76) years. Maximum number of patients were in the age group 41-50 years i.e. 16 (28.6%), followed by 31-40 years i.e. 15 (26.8%). The mean number of ECT’s received was 8.22 (±2.073). About 29 (51.8%) patients reported body aches, 24 (42.9%) patients reported forgetfulness, 9 (16%) patients reported headache and only 1 (2%) patient reported agitation. Conclusion: The results indicate that electroconvulsive therapy is used in all psychiatric disorder with fewer side effects in pharmacotherapy resistant psychiatric disorders.

Is institutionalization a risk factor for poor oral health; a comparison of the oral status of schizophrenia and bipolar affective disorders.

Background: Oral health is an integral part of general health and psychiatric disorders lead them to change their life style and lose concern for general and oral health. In view of this, the study was planned to compare the oral health status in different types of in-patient psychiatric patients. Objective of current study was to study the oral health status in schizophrenia and bipolar affective disorders institutionalized in psychiatric hospital. Methods: 50 Psychiatric patient (43 patients suffering from schizophrenia, 7 patients of bipolar affective disorder,) and 50 unrelated healthy volunteers were taken in the study. Dental examinations were done in both groups to measure the following indices of oral health: decayed, missing, and filled teeth index (DMFT) for caries; simplified oral hygiene index (OHI-S) for oral hygiene status; and tooth wear index for the wear of teeth. For comparison analyses t test was used. Results: Mean age of the study group was 37.74 years. Mean decayed missing filled teeth index (DMFT) score for study group and control population was 8.52 ± 4.36 vs. 4.72 ± 2.74 vs. 1.81 ± 1.00 (P ≤0.0001). The mean simplified oral hygiene index (OHI-S) for study group was 3.87±1.21, while that of control was (p≤0.0001).The mean Tooth wear index (TWI) score for study group was found to be 1.62 ± 0.75 and for control group was 1.08±0.48 (P ≤0.0001). Conclusion: Oral health status is affected in psychiatric patients and improving the oral health in psychiatric patients can go long way in improving the quality and management of these patients.

Psychosocial and medical factors affecting treatment compliance in patients attending psychiatric hospital: a study from Kashmir.

Background: Compliance with medication is decisive for treatment of the psychiatric disorders and is necessary for determining the outcome and prognoses of psychiatric patients. While the causes of poor compliance are multifactorial, the psychiatrist should be aware of such factors and may be able to implement interventions to address those factors. The objective of study was to find out the various medical and social reasons affecting treatment Compliance among patients suffering from psychiatric disorders. Methods: A Cross-Sectional study from 2011 to 2012 was conducted in IMHANS (Institute of Mental Health and Neurosciences) Srinagar (J&K), a questionnaire was designed, and the questionnaire included questions on socio-demographic variables, psychiatric illnesses, and Medical and psycho-social affecting treatment compliance. A systematic selection method for choosing the respondents was opted, questionnaire was administered on 200 (n=200) patients who attended the Outpatient department during the period. Simple random sampling method was applied for selection of respondents, the first time visitors to OPD were exclude along with repetition of respondents. Results: Out of 200 respondents studied in the study 41.5 % were males and 58.5% were females. Maximum number of patients (31.5%) studied were in the age group below the 30 years. 3.5% of respondents were in the age group above 70 years. Out of total 200 respondents in the study 74 % of the respondents are in compliance with recommended medicine whereas non-compliance was found in the 26% of studied population. Complications (13.46%) ascending out by usage of psychiatric medicine can be attributed as one of the major case of treatment non-compliance in psychiatric patients, among the psychiatric patients. Accessibility of psychiatric medicine and Financial constrain was also one of the reasons behind the medicine non-compliance (7.69%). Patients with no insight to psychiatric disease also include a good percentage of (5.76 %) of medicine non- compliance. Conclusions: Non-compliance is a dominant factor which causes possibly causes readmission in psychiatric wards. Compliance in psychiatric patients in general could be enhanced and improved by adequate intervention via patient counselling and patient medicinal care and education.

Unusual foreign body insertion in rectum and vagina in schizophrenic patient.

Insertion of foreign body in to the body is rare in medical literature. Here we report a case of 21 year old female who presented to emergency with acute abdomen and on detailed evaluation turned out to be schizophrenia. Our patient had history of insertion of ball pen in rectum following command hallucination. The foreign body was later removed through laparotomy. The cause of insertion of foreign body are multiple from command hallucination, suicidal attempt, erotism to somatic delusions. Thus the clinician should always be vigilant while dealing with psychiatric patients as sometimes impacted foreign body can present as acute emergency.

Quality of life and wellbeing in patients receiving electroconvulsive therapy: a study from Kashmir.

Background: Electroconvulsive therapy (ECT) is an effective neurostimulative treatment in psychiatric disorders and is widely used throughout the world except few countries. Studies regarding quality of life and well-being in patients receiving electroconvulsive therapy have not been undertaken in our country. Objective of current study was to study the quality of life and well-being in patients receiving Electroconvulsive therapy. Methods: 50 patients who have been prescribed pharmacological drugs form the control group and 50 patients already on psychotropic medication who were prescribed electroconvulsive therapy form the case group were taken up for study. Detailed evaluations were carried out clinically and by measurement of Well-being index. Pre-treatment evaluation was carried out one day before Electroconvulsive therapy, and post treatment was carried out at 3 and 7 week. Data were evaluated by means of chi square and Repeat ANOVA, Post hoc Bonferroni correction for within group comparisons applicable. Results: Mean wellbeing index for study group is 14 which is slightly higher than control (11) (p>0.001.) Well-being index of study group is much higher than that of control group at 3 and 7 week post treatment (p>0.001). Conclusions: Sustained effect on quality of life remains in depression up to 7 weeks and in mania it responds rapidly wanes off within 7 weeks. Electroconvulsive therapy improves the quality of life in psychiatric patients.