Burden and depression in primary caregivers of persons with visual impairment.

Context: Caregivers who assist persons with visual impairment often neglect their needs, resulting in burden and depression. Rehabilitation efforts, directed to the disabled, seldom target the caregiver. Aim: To assess burden and depression in persons caring for blind individuals. Settings and Design: This was a cross-sectional study carried out in the outpatient department of a tertiary‑level teaching hospital in New Delhi. Materials and Methods: Institutional Ethical Board approval was obtained and written informed consent too was obtained from the participants involved in this study. Persons with best‑corrected vision <20/200 in the better eye, and their primary caregivers, were recruited. We recorded demography, other illness/disability, household income, relationship with disabled person, and caregiver burden (Caregiver Burden Scale) and depression (Centre for Epidemiologic Studies Depression Scale). Statistical Analysis: Statistical analysis was carried out using SPSS version 20 (Released 2011. Armonk, NY: IBM Corp.); range, average, and standard deviation were determined for age, burden, and depression. The association between burden and depression was determined using Pearson’s correlation; the relationship between degree of disability and caregiver burden and depression was determined using unpaired t‑test; using multiple linear regression, factors were found to be statistically significant; significance was taken at P < 0.05. Results: Twenty‑seven (53.0%) men and 24 (47.0%) women had visual impairment. Most caregivers (n = 40; 81.6%) were first‑degree relatives or a spouse; 32 (65%) had schooling <5 years; and 29 (59%) were unemployed. Depression ranged from 21 to 52 (average 43.2 ± 5.71); it correlated with degree of disability (P = 0.012), household income (r = −0.320; P = 0.025), and burden (r = 0.616; P < 0.001). Burden ranged from 30 to 73 (average 54.5 ± 6.73) and correlated with degree of disability (P = 0.006). On multiple linear regression, burden predicted depression (r = 0.557; P < 0.001). Conclusions: Caregivers merit community support, financial benefit, interventions to diagnose and treat depression, and training in coping. Centers that provide disability certification could offer counseling.

Stress, Anxiety, and Depression among Call Handlers Employed in International Call Centers in the National Capital Region of Delhi.

Background: Call handlers employed in call centers repeatedly undergo stress in their day-to-day lives and this can have deleterious effects on their health. Objectives: The objectives were to study the levels of stress, anxiety, and depression, and their predictors among call handlers employed in international call centers in the National Capital Region (NCR) of Delhi. Materials and Methods: A cross-sectional questionnaire-based survey was conducted among 375 call handlers aged 18-39 years. Depression Anxiety Stress Scale- 42 (DASS-42) was used to measure stress, anxiety, and depression along with a pretested sociodemographic questionnaire. Univariate analysis was done to fi nd out the association of stress, anxiety, and depression with various factors. Variables with P < 0.25 were included in multiple logistic regression and three models were developed each for stress, anxiety, and depression. Results: The prevalence of stress, anxiety, and depression among call handlers was 46.7%, 57.1%, and 62.9% respectively. Abnormal sleep quality, prolonged travel time, and lack of relaxation facilities at the offi ce were predictors of stress and depression. The presence of physical ailments, the absence of hobbies, temporary/part-time employment, and traveling long-distance to offi ce were signifi cant predictors of anxiety among call handlers. Conclusion: Call handlers face a high burden of stress, anxiety, and depression. Public health specialists need to pay adequate attention to their health problems.

Current Scenario of Psychiatric Diagnosis in a Tertiary Care Teaching Hospital.

Background: There is a need to evaluate the pattern of current psychiatric diagnosis in our country with the emergence of DSM-5 and ICD-11. Methods: All consecutive cases visiting a tertiary care teaching hospital in the age group of 10-80 years during November 2011 to February 2012 were recruited for the purpose of the study. Psychiatric diagnosis was made by qualified psychiatrists using semi-structured Performa as per ICD-10 Criteria. Analysis of data was done by using descriptive and inferential statistics. Results: Out of 1000 patients, 54.5 % patients are in the age group of 20-40 years with male to female ratio of 3:2 and married to unmarried ratio of 4:3. 18% patients suffered from psychosis, 6.8 % substance dependence, 3.6 % organic disorders, 12.6 % depression, 20.8 % anxiety disorders, 9.1 % bipolar disorder, 13.9 % psychosexual disorders, neurological disorders 4.6 %, and 9.2% having other psychiatric diagnosis. Conclusions: There is a need to evaluate patients visiting every psychiatric outpatient’s clinic so that changing trends in psychiatric problems, co-morbidities, prescribing patterns in view of the current diagnostic systems and treatment guidelines can be updated with special reference to Indian population.

Recurrent headache in indian adolescents.

Objective. To analyze the epidemiology and characteristics of primary recurrent headaches in Indian adolescents. Methods. This cross sectional study was conducted in three urban public schools. Adolescents of 9th to 12th grades were included and they were given a questionnaire in their classrooms in the presence of at least one of the authors, who assisted them in filling it. They were asked to provide responses based on most severe recurrent headache they had experienced rather than the more frequent one. Diagnosis was based upon the information contained in questionnaire, however, where it was inadequate, those subjects were approached telephonically. Statistical analysis was done with the help of SPSS v. 11.0. Descriptive analysis, Chi-Square test, Fisher’s Exact test, and independent sample‘t’ test were run. Results. We studied 2235 adolescents (boys: girls 1.6:1). 57.5% adolescents reported recurrent headaches in past one year. Migraine was the most prevalent (17.2%) headache followed by unspecified (14.9%) and tension type headache (11%). Family history of headache was more common in adolescents with headache (p < 0.001) compared to those without headache. Average age of headache onset was 11.33 yr (10.72 yr in girls vs. 11.75 years in boys; p < 0.001). 37.1% adolescents complained of progression of headache since its onset. A significantly higher proportion of girls suffered headache (p=0.018), particularly migraine, than boys. However, other characteristics of headache were not dependent upon gender. Headache was more prevalent in higher grades. Conclusion. Primary recurrent headaches are prevalent in Indian adolescents and migraine is comparatively the most prevalent type of headache. Female gender and increasing age is associated with higher chances to have headache, particularly migraine. It progresses in approximately one third of sufferers and aura increases the chances of worsening of headache.

Sleep patterns of urban school-going adolescents.

OBJECTIVE: To analyze the variance in sleep habits of adolescents of different high school Grades in urban India. DESIGN: Cross-sectional questionnaire-based study. SETTING: Community based school survey in an urban setting. SUBJECTS: School going adolescents from 9th to 12th Grades. METHODS: A total of 1,920 adolescents aged 12-18 years were included. The questionnaire contained questions related to sleep habits. Each question was explained to the participants and their responses were noted. Outcome parameters were total sleep time in a day, time to go to bed and wake up-time, sleep latency, nocturnal awakenings (duration, frequency per night and nights per week), wake-time after sleep onset, wake time after sleep offset, sleep efficiency, quality of sleep, daytime napping (duration and frequency), and sleepiness during the day. RESULTS: Mean age of the adolescents included in this study was 15.1 years and mean total sleep time was 7.8 hr/day. Adolescents of higher Grades had lesser total sleep time (9th=8 hours; 10th=7.7 hours; 11th=7.9 hours; 12th=7.6 hours; P=0.001), and more frequent nocturnal awakenings (9th=35.9%; 10th=44.7%; 11th=40.3%; 12th=28.3%; P=0.001). Daytime leg pain ( 9th=14.4%; 10th=18.4%; 11th=6.1%; 12th= 21.8%; P=0.01), daytime napping (9th=47.6%; 10th=50.4%; 11th=61.8%; 12th=69.8%; P=0.001), and daytime sleepiness (9th=37.2%; 10th=39.1%; 11th=39.7%; 12th=54.2%; P=0.001) increased progressively among higher Grades. Adolescents in higher Grades were more prone to not follow their weekly schedule on week-ends (P= 0.001). Sleep debt of approximately one hour per day was seen in all adolescents, and progressed with higher Grades. CONCLUSION: Adolescents of higher Grades had lesser sleep time, and frequent awakenings; suffered daytime leg pain, and felt sleepy during the day. These factors suggest increasing sleep deprivation among higher Graders.

Delusional Parasitosis.

A patient with delusional parasitosis, who responded to amisulpride is described.

Amisulpride: a Brief Review.

Amisulpride, belonging to second generation antipsychotics, is a substituted benzamide derivative indicated for the treatment of acute and chronic schizophrenia with prominent positive and/or negative symptoms. Amisulpride has high affinity for the dopamine D2/D3 receptors. It inhibits dopamine transmission by blocking postsynaptic D2/D3 receptors in the limbic system, which is predicative of potent antipsychotic activity. The elimination half-life is 12 hours. Metabolism is limited with most of the drug excreted unchanged in the feces (64%). Clinical studies have supported that Amisulpride (400-1200mg/day) is at least as effective as Haloperidol and Risperidone and more effective than flupenthixol in acute exacerbation. In the treatment of patients with predominantly negative symptoms, Amisulpride was more effective than placebo. Recently some studies have shown it to be having efficacy in dysthymia also. Its favorable characteristics also include low incidence of EPSE and weight gain, however, it has a high incidence of prolactin elevation.