How Stigma and Discrimination are Perceived by Rural or Urban Patients Suffering from Schizophrenia? An Exploratory Cross – Sectional Study fromWestern India

Background: Stigma is conceptualized as an attribute which is deeply discrediting and makes the person carrying it different from other and of a less desirable kind. Current study aimed to describe the nature and direction of experienced stigma; and discrimination reported by people with schizophrenia. Methods: One hundred and fifty patients diagnosed with Schizophrenia were selected from the Out Patient service of Psychiatry Department of a medical college general hospital. The experiences of stigma and discrimination were assessed using a semi-structured instrument developed by national working group for India by the world psychiatric association steering committee. Results: Differences were seen between rural and urban respondents. Patients from rural background more often reported these experiences: society treats differently, ridiculing by others, offensive comments, hiding from relatives, rejecting attitude of peoples around, attribution of supernatural cause as most common source of stigma, social exploitation, not fully accepted in the family, pushed into unacceptable social situation and sexual harassment. Reported narratives provided the direct view of these patients. Conclusions: Stigma experience is pervasive: it deeply affects the social, occupational and emotional wellbeing of patients with schizophrenia and should be included in clinical management. Effective anti-stigma intervention should target on improving attitudes and the condition for social integration in the community, empowering people with schizophrenia to challenge self-stigmatization and discrimination behavior towards them.

Nursing Teachers’ Attitude Towards Suicide Prevention- A Study From Gujarat.

Background: Suicide is a global health problem and the second leading cause of death in 15-29 years of age. There were reports of nursing students committing suicide in Gujarat. As nursing teachers are the important gatekeepers, it was essential to study their attitude towards suicide prevention. Methodology: A questionaire containing 20 statements, derived from the Attitude towards suicide prevention scale and from the Suicide opinion questionnaire, to be marked as ‘agree’, ‘disagree’ or ‘uncertain’ was administered to 80 nursing teachers from Gujarat. This was followed by an interactive session on suicide prevention. Results: Most of the nursing teachers felt that suicide prevention was their responsibility, that a large proportion of suicides was preventable, most suicides were impulsive and that suicide in the young was particularly puzzling. However, nearly 80 % felt that those who are serious about committing suicide usually don’t tell anyone. Around one-fifth felt there was no way of knowing who was going to commit suicide and they were not comfortable in assessing suicide risk. Conclusion: The overall attitude of the nursing teachers towards suicide prevention was positive. However more educational and skill-based training programmes are required to better equip the nursing teachers for suicide prevention.

Major Depression: A Short Term Naturalistic Study in Outpatients.

Background: Surprisingly data regarding naturalistic or observational studies carried out in India to study Major Depressive Disorder in patients seeking outpatient treatment is almost non-existing. So this study was conducted to study the presentation and baseline characteristics of Major Depressive Disorder in Indian outpatients and the subsequent treatment and outcome after a three month follow up. Methodology: Patients seeking outpatient treatment were recruited after diagnosing an episode of Major Depressive Disorder through a clinical interview for DSM IV TR. Sociodemographic and clinical characteristics were recorded at the time of recruitment and follow up evaluations done for 3 months. All the patients were given outpatient treatment best suited to the patient profile. Results :.More than 90% patients reported one or more somatic symptoms spontaneously on presentation . Barely half of the patients out of 119 recruited completed three month follow up. 50 (81%) patients out of 62 who received adequate treatment met recovery criteria at the end of three months. Initial depression severity and receiving regular adequate antidepressant therapy was found to be associated with recovery. While sociodemographic variables were not found to significantly affect treatment outcome or compliance. Conclusion : Somatic presentation of depression is quite common in Indian patients .The high noncompliance indicate the need for strategies to be made to improve compliance and the good response to treatment found in naturalistic conditions in this study calls for more such studies to be done for better understanding of predictors of outcome in naturalistic conditions in India.

An open-label multicentric study of the tolerability and response to escitalopram treatment in Indian patients with major depressive disorder.

To evaluate the tolerability and response to escitalopram in Indian patients with major depression, over an 8-week open-label multicentric study was carried out among 18-65 years old Indian patients suffering from DSM IV major depressive disorder with Montgomery-Asberg depression rating scale (MADRS) total score> or =22. Patients received a fixed dose of escitalopram 10 mg daily for 2 weeks, followed by flexible dose of 10 to 20 mg daily for 6 weeks. Patients were evaluated for depression and rated on MADRS score and clinical global impressions-severity (CGI-S) and--improvement (CGI-I) scores. They were monitored for treatment-emergent adverse effects. A total of 119 patients were enrolled and 103 completed the trial. There was a decrease from baseline in the MADRS total score after one week of treatment continuing until 8 weeks. By week 8, 76.9% patients had responded to treatment (> or =50% or more reduction of MADRS total score). A similar pattern of improvement to that seen with the MADRS total score was seen with CGI-S and CGI-I scores. Escitalopram was well tolerated, with only 2 patients (1.7%) withdrawing from the study due to adverse events. There were no serious adverse events.

Epilepsy and teachers: a survey.

Teachers in five primary schools were surveyed for their knowledge and attitudes about epilepsy. An analysis of 113 teacher responses revealed knowledge deficits, especially regarding the prevalence of epilepsy, the future of children with the disorder and E.E.G. as an aid to diagnosis. Misconceptions regarding first aid were also common. More than two-thirds of the teachers believed that children with epilepsy have academic problems more often, although about half of the respondents were in favour of normal schools for such children. Most respondents recommended a teacher's career for these children in future but considered that of a bus driver, as unsuitable. Few teachers had attended any educational programme on epilepsy. Only about one-fifth of the teachers were confident in dealing with an epiletic child. Communication about epilepsy among the teachers, parents and doctors was virtually non-existent.