Prevalence of anxiety and depression among the primary caregivers of patients with schizophrenia who attended Psychiatry Outpatient Department at Rajah Muthiah Medical College and Hospital, Chidambaram

Background: Schizophrenia is one of the most devastating mental disorders that impair language, thinking, perception and sense of self. Recent estimates suggest that around 1% of the adult population that is around 21 million people is suffering from this disabling disease. In India, caregiving is mainly by family members because there are limited alternatives in institutional facilities and welfare supports for those with chronic illnesses such as mental disorders. Most Indian families prefer to care for ill persons at all stages of illness. But, the changing society places significant demands on the caregivers. Aim of the study: To study the prevalence of anxiety and depression among caregivers of schizophrenia patients. To find the association between anxiety and depression of caregivers with the duration of illness, severity of illness (schizophrenia) and the years of association with the patients. Materials and methods: The study was conducted among patients of schizophrenia and their K. Arun Kumar, R. Gandhi Babu, M. Asok Kumar. Prevalence of anxiety and depression among the primary caregivers of patients with schizophrenia who attended Psychiatry Outpatient Department at Rajah Muthiah Medical College and Hospital, Chidambaram. IAIM, 2019; 6(11): 63-75. Page 64 caregivers attending Psychiatry Outpatient Department Rajah Muthiah Medical College and Hospital, Annamalai University, A hundred patients with a diagnosis of schizophrenia and their primary caregivers had been consecutively selected from Psychiatry Outpatient department, Rajah Muthiah medical college, Annamalai university in the year 2018-2019. Then the Self innovated proforma was filled and details about the patients and their caregivers were obtained. HAM-D and HAM-A scales were administered for caregivers and scored for the level of psychiatry morbidity among them. BPRS scale was administered for patient and the severity of illness was assessed. The prevalence was then compared with different variables and associations if any was found. Results: In 100 peoples, Ham- A anxiety score level was analyzed. Severe anxiety was seen in 8 persons, mild to moderate anxiety was in 9 caretakers. Mild severity was observed in 83 patients. Pearson Chi-Square=27.936**, p<0.001. Depression score was absent and less significant among 61 caretakers, mild depression was observed in 24 peoples, moderate depression in 7 caretakers, severe depression was observed in only 8 cases. Paranoid type is more which was around 64%, hebephrenic was 11 %, residual -7%, simple -7%, undifferentiated -7%, catatonia-4%. BPRS score was < 31 in 74 patients, 31-42 were 12 cases, > 43 in 14 patients. More than 10-20 years in people who were taking care of ill patients had severe anxiety when compared to 1-3 years, up to 1 year, 3-10 years. Pearson Chi-Square = 9.784, P = 0.134 which was statistically significant. Severe depression was seen in the illness of 10-20 years in (8) cases. Up to 1 Year, 1-3 Years, 3-10 Years, 10-20 Years had less incidence of severe depression. Few peoples had less depression, mild, and moderate depression. Pearson Chi-Square = 15.405, P = 0.080 which was statistically less significant. Conclusion: Psychiatric disorders were prevalent amongst caregivers who are first- degree relatives of schizophrenic probands. BPRS Score of the patient gave the best diagnostic accuracy for screening psychiatric morbidity and increased the probability of finding a psychiatric disorder in caregivers. Therefore, routine screening of caregivers will aid early diagnosis of psychiatric disorders and enable timely psychological intervention.

Evaluation of the efficacy of the continuation electroconvulsive therapy in treatment-resistant schizophrenia / Avaliação da eficácia da eletroconvulsoterapia contínua para esquizofrenia resistente ao tratamento

Background: Electroconvulsive therapy (ECT) has been reported being a safe and effective treatment in schizophrenia. However, there are a limited number of studies assessing continuation ECT utilization in patients with schizophrenia giving partial response to pharmacological treatment. Objective: The aim of this study is to evaluate the effectiveness of continuation ECT in preventing relapse in patients with treatment-resistant schizophrenia. Methods: In this retrospective analysis, schizophrenia patients (n = 73) were defined in three groups such as patients who received only AP treatment (only AP), patients who received acute ECT only during hospitalization (aECT+AP), patients who received acute ECT and continuation ECT (a-cECT+AP). Three groups were compared according to positive and negative syndrome scale (PANSS) and Brief Psychiatric Rating Scale (BPRS) scores. Results : As per comparison of only AP group, aECT+AP group and a+cECT+AP groups in terms of after discharge PANSS and after discharge BPRS scores for 1st month, 3rd month and 6th month; 3rd and 6th month’s PANSS scores of a+cECT+AP group were statistically significantly lower than other two groups. Discussion: Although this study suffers the limitations of retrospective medical chart analysis, results suggest that, in patients with a diagnosis of schizophrenia who have responded to an acute course of ECT, continuation ECT in combination with antipsychotics is more effective than antipsychotics alone in preventing relapse...

Contexto: A eletroconvulsoterapia (ECT) tem mostrado ser um tratamento seguro e eficaz para esquizofrenia. No entanto, o número de estudos que avaliam a utilização contínua de ECT em pacientes com esquizofrenia e a resposta parcial ao tratamento farmacológico é limitado. Objetivo: O objetivo deste estudo é avaliar a eficácia da ECT de continuação na prevenção de recaída em pacientes com esquizofrenia resistente ao tratamento. Métodos: Nesta análise retrospectiva, pacientes com esquizofrenia (n = 73) foram alocados em três grupos: pacientes que receberam apenas o tratamento AP (somente AP), pacientes que receberam um curso agudo de ECT durante a hospitalização (aECT+AP) e pacientes que receberam um curso agudo de ECT durante a hospitalização e ECT de continuação (a-cECT+AP). Esses três grupos foram comparados de acordo com a pontuação atribuída na Positive and Negative Syndrome Scale (PANSS) e na Brief Psychiatric Rating Scale (BPRS). Resultados: De acordo com a comparação dos grupos, somente em AP, aECT+AP e a+cECT+AP, em termos de PANSS e BPRS, após descarga no primeiro, terceiro e sexto mês, as pontuações na PANSS no terceiro e sexto mês no grupo a+cECT+AP foram estatística e significativamente menores do que nos outros dois grupos. Conclusões: Embora este estudo mostre limitações causadas pela análise retrospectiva de prontuários, os resultados sugerem que a continuação da ECT em combinação com antipsicóticos é mais eficaz do que somente os antipsicóticos, na prevenção da recaída em pacientes com diagnóstico de esquizofrenia que responderam ao curso agudo de ECT...

Clinical Correlates and Description Profiles of Antipsychotic Polypharmacy for Patients with Schizophrenia / 신경정신의학

OBJECTIVES: Despite increasing use of antipsychotic polypharmacy (APP), few studies have investigated APP for Korean patients with schizophrenia. The aim of this study was to identify the sociodemographic and clinical correlates and recent prescription profiles of APP in schizophrenia patients. METHODS: A total of 297 schizophrenia patients were recruited and interviewed using standardized assessment instruments in Seoul National Hospital. Differences in demographic and clinical characteristics between APP and antipsychotic monopharmacy (APM) groups were analyzed. The prescriptions of psychotropic drugs were collected by a review of medical records. RESULTS: In comparison with the APM group, the APP group showed association with earlier onset, lower employment rate, and higher scores for Clinical Global Impression-Severity and Brief Psychiatric Rating Scale (BPRS) (p<0.001). In particular, the BPRS positive (p<0.001) and affective symptom scores (p<0.001) of the APP group were higher those of the APM group. The most frequent combination pattern of APP was second generation antipsychotics (SGA)+SGA, followed by SGA+first generation antipsychotics (FGA), and SGA+SGA+FGA. For antipsychotics, it was risperidone+quetiapine, followed by clozapine+risperidone, risperidone+sulpiride, and risperidone+haloperidol. CONCLUSION: The current study suggests that the usage of APP for schizophrenia could be related to symptom severity affected by positive and affective symptoms. The prescription profile reflects that the proportion of atypical antipsychotics on APP has increased.

Gradual Community-based Rehabilitation for Schizophrenia in Changping Countryside: A Comparative Study / 中国康复理论与实践

@#Objective To explore the effect of gradual community-based rehabilitation on schizophrenia in the countryside. Methods 60 rural patients with schizophrenias were randomly sampled and divided into two groups: the rehabilitation group and the control group. The patients in the rehabilitation group were intervened with comprehensive rehabilitation by specialist, while those in the control group were intervened with follow-up survey. They were assessed with the Brief Psychiatric Rating Scale (BPRS), Scale for Assessment of Negative Symptoms (SANS) and Social Disability Screening Schedule (SDSS) before and 3, 6, 9, 12, 15, 20 months after the rehabilitation. Results The differences in scores of BPRS, SDSS and SANS were more significant with the time of rehabilitation. Conclusion The outcome of the community-based rehabilitation for schizophrenias may associate with the persistence in the countryside.

Designing A Culture, Language And Illness-Specific Self-esteem Scale In Bahasa Malaysia

Objective: Self-esteem is an important component of psychological health. In Malaysia, Rosenberg’s self-esteem scale remained the single most popular utilized scale for studying global self-esteem. This study aims to design a language, culture and illness specific self-esteem questionnaire. Methods: The study consisted of 2 phases. The first phase was to generate items for the new self-esteem questionnaire (SSES) in Bahasa Malaysia. Literature review on the concept of self- esteem and its’ content was conducted. This was followed by expert opinion from professional care-givers. The items were qualitatively validated by healthy subjects and patients with schizophrenia from the same locality, culture and language. The second phase consists of quantitative validation of the items. Items in the new scale were analyzed based on the responses from 165 stable schizophrenia outpatients. The validated Malay version of Rosenberg Self-Esteem scale (RSES) was used concurrently as a comparison. Results: The SSES displayed good internal consistency for its two domains (Cronbach’s alpha=0.88, 0.81) and test-retest reliability (ICC), ranged from 0.44 to 0.87. Its construct validity was confirmed by confirmatory factor analysis. The concurrent validity of SSES and RSES using Pearson correlation was 0.77. The Cronbach’s alpha for the validated Malay version of RSES is 0.67. Conclusion: This study presents a new self-esteem questionnaire (SSES) which has high concurrent validity with the standard RSES and confirms the reliability and validity of SSES in Malay patients with Schizophrenia.

A Validation Study of the Korean-Version of the Young Mania Rating Scale / 신경정신의학

OBJECTIVES: The reliability and validity of the Korean version of Young Mania Rating Scale (K-YMRS) were examined in the Korean patients with major psychosis. METHODS: One hundred and twenty inpatients diagnosed as major psychosis by DSM-IV criteria were assessed with both K-YMRS and expanded Brief Psychiatric Rating Scale (BPRS-E) during the first 3 days in hospital and after 4-week treatment. RESULTS: The Cronbach's alpha coefficient of K-YMRS was 0.73. The inter-rater reliabilities of total score (r=0.93, p=0.000) and individual item scores were high (r=0.65-0.96, p=0.000). The correlations of each items of K-YMRS with total score were statistically significant (r=0.35-0.78, p=0.000) except for the "insight" item. The principal component analysis for K-YMRS produced three factors;a) mood and vegetative symptoms, b) behavioral symptoms, and c) thought content and insight. The total scores of K-YMRS showed a significant correlation with the manic-excitement factor scores of BPRS-E at baseline and after 4-week treatment (r=0.82, r=0.72, respectively, p=0.000). The discriminant function analysis showed that manic (n=43) and non-manic patients (n=73) were discriminated 73.7% correctly by K-YMRS total score (p=0.01). The change of the total score of K-YMRS after 4-week treatment in manic patients was significantly greater than that in non-manic patients (p=0.000). CONCLUSIONS: K-YMRS was demonstrated to have good reliability and validity for measuring the severity of manic symptoms. It is expected that K-YMRS will be a useful tool for assessing mania symptoms in Korea.

Relationship between Clinical Symptoms and P300 in Schizophrenia / 신경정신의학

OBJECTIVE: This research was performed to evaluate the relation clinical symptoms and P300 in patients with schizophrenia. METHODS: 25 patients with schizophenia by DSM-IV in Soonchunhyang Chunan University hospital were participated. Clinical symptoms were checked by BPRS (Brief Psychiatric Rating Scale) and PANSS (Positive and Negative Syndrome Scale). Auditory event related potentials P300 components were obtained with "Oddball paradigm". RESULTS: P300 in T 3 was smaller and more delayed than T 4 in patients with schizophrenia. Especially, P300 on T 3 were correlated with BPRS scores and negative symptoms scores of PANSS, which were also correlated with P300 on Fz. CONCLUSION: The results of this study suggest that P300 on frontal and left temporal lobe reflect clinical symptoms in patients with schizophrenia.

Acupuncture Treatment for Refractory Auditory Hallucination in Schizophrenia Patients——A Report of 50 Cases / 中医杂志

Objective To observe the effect and safety of acupuncture treatment on refractory auditory hallucination in schizophrenia patients. Methods The 100 patients clinically diagnosed as refractory auditory hallucination of schizophrenia were randomized into test group and control group with 50 in each. The control group was treated with risperidone alone while the test group was treated with acupuncture on the basis of TCM syndrome differentiation in addition to risperidone. One month was one course,totally 3 courses of treatment was given. The clinical effect of both groups was observed. The effect in different courses of disease and the effect in different syndromes of the test group were compared respectively. Before and after treatment the brief psychiatric rating scale (BPRS),specific auditory hallucination scale(SAHS),and treatment emergent symptom scale (TESS) were adopted to score the patients of both groups. Results In the test group,there were 3 cases lost,the total effective rate was 72.34%; while in the control group,there was 1 case lost,the total effective rate was 38.78%,the difference being significant (P 0.05). The difference in BPRS and SHRS scores at the same period of time after 2nd and 3rd courses of treatment of the two groups was significant (P