ABSTRACT
Background: Medications are an essential treatment modality of mental disorders. There is limited scientific literature on medication non-adherence among patients in Severe Mental Disorders with respect to patient-related factors. The current study explores the factors associated with medication non-adherence in such patients. Objectives: To study the relationship between socio-demographic, clinical, treatment related factors, self-stigma, patients' & caregivers' attitude towards psychotropic medications, doctor-patient communication and medication non-adherence in patients with severe mental disorders. Methods: A cross-sectional observation study, where patients with severe mental disorders attending Psychiatry Outpatient services, and their caregivers, were recruited. Sociodemographic and clinical variables were recorded using data collection form and illness-specific severity scales. Patients were administered Medication adherence rating scale (MARS), Internalised stigma of mental illness inventory (ISMI- 9), Attitude of patients towards psychotropic medication scale and Doctor-patient communication questionnaire (DPCQ). The Attitude of caregivers towards psychotropic medication scale was administered for caregivers. Results: Among 152 patients, 58 (38.16%) patients had a diagnosis of schizophrenia, 11 (7.24%) had delusional disorder, 32 (21.05%) patients were diagnosed with bipolar disorder type 1 - mania and 19 (12.50) with bipolar disorder type 2 - depression whereas 32 (21.05%) had major depressive disorder. Majority of the patients were non-adherent to medications (88.16%). MARS score was significantly higher among patients of middle socioeconomic class (p = 0.014), urban domicile (p = 0.033) and those with higher caregivers' age (p = 0.019) . Among 79.61% of patients, ISMI-9 score was minimal to mild. Most patients (76.97%) and caregivers (83.55%) had negative attitude towards psychotropic medications. MARS score negatively correlated with BPRS (p = 0.0001*), HAM-D (p = 0.0004*), YMRS (p = 0.0007*), ISMI-9 (p ≤0.0001*) and the attitude of the caregivers towards psychotropic medicationsnegative scale scores (p = 0.003*) . MARS score positively correlated with DPCQ scores (p ≤0.0001*) . Conclusion: Medication adherence was higher among patients belonging to uppermiddle socioeconomic status, urban domicile and higher caregiver age. Higher severity of illness, self-stigma and negative attitude of patients and caregivers towards psychotropic medications were associated with lower adherence whereas better doctor-patient communication was associated with higher adherence to medications.
ABSTRACT
BACKGROUND: Functional bowel disorder (FBD) is conceptualized as a "biopsychosocial disorder." Psychological factors are important moderators of symptom severity and persistence, treatment seeking and response to treatment. We investigated psychological factors and quality of life (QOL) in patients with FBD. METHODS: Seventy patients visiting the department of medical gastroenterology diagnosed as FBD were included in the study. Severity of FBD was rated with FBD Severity Index. The Depression, Anxiety, and Stress Scale was applied and patients were divided into two groups, i.e., with moderate stress (Group A) and with severe stress (Group B). QOL in both the groups was assessed by WHOQOL-BREF Scale. Chi-square, t-test was done to compare the groups. Regression analysis was done to find predictors of poor QOL. P < 0.05 was taken as significant. RESULTS: Patients of Group B had a longer duration of illness and had higher prevalence of depressive disorder (P = 0.03) in comparison to patients in Group A, who had higher prevalence of anxiety disorders (P = 0.06). Severity of FBD was positively correlated with depression (r = 0.8; P = 0.02). Physical and psychological QOL was significantly impaired in Group B patients having depression (P = 0.02; P = 0.03). Regression analysis showed a positive trend for presence of depressive disorder (P = 0.05), anxiety disorder (P = 0.08) and severity of FBD (P = 0.09) as predictors of poor QOL. CONCLUSION: In our study, the high prevalence of stress, anxiety and depression in patients with FBD indicates the need for routine screening of such symptoms along with a collaborative and holistic treatment approach. Several etiological perspectives explaining the complex gut-brain interaction are also provided.
ABSTRACT
BACKGROUND: A majority of mental illness start during adolescent period, and teachers can be a major resource in provision of mental health services to them. Stigma is a major barrier between persons with mental illness and opportunities to recover. MATERIALS AND METHODS: Cross-sectional analytical study was conducted to assess the stigma toward mental illness and associated factors among higher secondary school teachers in Puducherry from April 2017 to March 2018. Multistage sampling was used to select 566 teachers from 46 schools. A part of the vignette-based "Mental Health Literacy Scale" portraying depression was used to assess stigma toward mental illness. Sociodemographic and work characteristics were also obtained. Data were analyzed using SPSS v16. To identify factors associated with stigma, bivariate analysis was done using Chi-square test and multivariate analysis using logistic regression. RESULTS: Among the teachers, 72.9% and 65.7% showed overall agreement to personal and perceived stigma, respectively, toward case in vignette. Teachers in lower age group [adjusted odds ratio (AOR): 4.6 (95% confidence interval (CI): 2.54-8.33)], male gender [AOR: 2.79 (95% CI: 1.85-4.24)], working in urban [AOR: 2.8 (95% CI: 1.91-4.15)], private schools [AOR: 2.58 (95% CI: 1.77-3.77)], and less teaching experience [AOR: 3.72 (95% CI: 2.4-5.88)] had significantly higher personal stigma. Similarly, lower age group [AOR: 4.6 (95% CI: 2.54-8.33)], male gender [AOR: 2.79 (95% CI: 1.85-4.24)], working in urban [AOR: 2.8 (95% CI: 1.91-4.15)] schools, and less teaching experience [AOR: 3.72 (95% CI: 2.4-5.88)] had significantly higher perceived stigma. CONCLUSION: About 70% teachers showed overall agreement to stigma toward the depressive case vignette. The significant factors influencing stigma were identified. This can act as a baseline to implementmental health training program for teachers therefore bringing an attitudinal shift to being positive toward the psychologically disturbed.
ABSTRACT
BACKGROUND: The burden of mental disorders has been increasingly recognized and 450 million people globally are suffering from mental illness. Mental-physical comorbidity has adverse effects on the overall outcome. Research is scarce with regard to mental health screening in the context of "preventive health care" in India. Thus, the study aimed to identify the prevalence of mental illness and the effect on quality of life (QOL) among participants attending preventive health-care unit (PHCU). SETTINGS AND DESIGN: This was a cross-sectional study conducted in PHCU of a tertiary hospital in Puducherry. MATERIALS AND METHODS: All consecutive participants (>18 years) attending PHCU were included in the study. The Standard for Clinicians' Interview in Psychiatry (SCIP) screening module, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Level 1 Cross-Cutting Symptom Measure, Mini-Cog, and Quality of Life Enjoyment and Satisfaction Questionnaire were administered. Relevant diagnostic modules of SCIP were applied to participants who screened positive on SCIP. Data analysis was performed using SPSS (version 17.0). RESULTS: The mean age of participants was 43.38 ± 13.99 years. Of 203 participants enrolled, 28.1% screened positive and 26.1% were confirmed to have psychiatric disorder. About 4% screened positive for cognitive impairment. Most commonly diagnosed disorders were alcohol use disorder and major depressive disorder. The prevalence of depressive disorder was higher in patients with physical disorder. Participants with psychiatric disorder alone or with both psychiatric and physical disorders had significantly poorer QOL (F = 27.13; P < 0.001). CONCLUSION: One-fourth of the participants attending preventive health-care services were found to have psychiatric disorders. The presence of psychiatric disorder was associated with significantly poorer QOL. This highlights the importance of routine mental health screening in this setting.
ABSTRACT
BACKGROUND: Depression causes significant burden both to the individual and to society, and its treatment by antidepressants has various disadvantages. There is preliminary evidence that adds on yoga therapy improves depression by impacting the neurotransmitters involved in the regulation of mood, motivation, and pleasure. Our study aimed to find the effect of adjunctive yoga therapy on outcome of depression and comorbid anxiety. MATERIALS AND METHODS: A randomized controlled study involving patients with major depressive disorder (n = 80) were allocated to two groups, one received standard therapy (antidepressants and counseling) and the other received adjunct yoga therapy along with standard therapy. Ratings of depression and anxiety were done using Montgomery-Asberg Depression Rating Scale and Hospital Anxiety and Depression Scale at baseline, 10th and 30th day. Clinical Global Impression (CGI) Scale was applied at baseline and 30th day to view the severity of illness and clinical improvement. RESULTS: By the 30th day, individuals in the yoga group had significantly lower scores of depression, anxiety, and CGI scores, in comparison to the control group. The individuals in the yoga group had a significant fall in depression scores and significant clinical improvement, compared to the control group, from baseline to 30th day and 10th to 30th day. In addition, the individuals in the yoga group had a significant fall in anxiety scores from baseline to 10th day. CONCLUSION: Anxiety starts to improve with short-term yoga sessions, while long-term yoga therapy is likely to be beneficial in the treatment of depression.
ABSTRACT
INTRODUCTION: The association between psychological factors and non-ulcer dyspepsia remains controversial. AIM: To determine the prevalence of Helicobacter pylori (HP) and Stress/Anxiety/Depression (SAD) in patients with Functional Dyspepsia (FD) and assess the outcome at three months after appropriate intervention. MATERIALS AND METHODS: This prospective non-randomized interventional study was conducted on 120 patients with FD. Initial workup included upper gastrointestinal endoscopy to confirm HP infection with either of two tests, the urease test or histopathology. Patient Health Questionnaire-9 scale (PHQ-9) was used to assess depression, General Anxiety Disorder-7 scale (GAD-7) for anxiety and Perceived Stress Scale (PSS) for stress. Patients were considered positive when they had significant scores on one or more of the questionnaires (SAD+). The subjects were then classified into four groups: Group A (positive for HP and SAD, n=35), Group B (positive for HP and negative for SAD, n=31), Group C (negative for HP and positive for SAD, n=33) and Group D (negative for HP and SAD, n=21). The groups were then treated as follows: Group A: HP eradication plus psychiatric intervention, Group B: HP eradication alone, Group C: psychiatric intervention alone and Group D: proton pump inhibitors. Modified Glasgow Dyspepsia Symptom Score (Mod. GDSS) was used to assess the severity of dyspepsia at baseline and to monitor the change in score over three months. Statistical analysis was done using the Statistical Package for the Social Sciences version 16.0. Non-parametric data like proportions of response in different groups to treatment was analysed using the Chi square test and quantitative data using ANOVA. Gender wise distribution and response to treatment was calculated using the z-test and unpaired t-test. RESULTS: Overall 120 patients were recruited across four groups. A 55% of the subjects were positive for HP and 56.7% for SAD and 29.2% for both. In all three groups with psychiatric comorbidity, females exceeded males in a proportion of 3:1. Mod. GDSS was not significantly different at baseline between HP+ and HP- patients (p=0.1278) except when HP positivity was also associated with SAD (p<0.001), whereas SAD positivity alone significantly increased the baseline Mod. GDSS (p=0.006). Mod. GDSS declined in all four groups at three months. When a fall of four or more was considered as an indicator of significant response to intervention, it was seen that overall 74.2% responded to intervention with the best response in Group B and the poorest was in Group C. CONCLUSION: There is a significant prevalence of HP and SAD in FD. Appropriate intervention is beneficial except in those who are HP negative and SAD positive. This latter group requires further investigation and or drug intervention for SAD.
ABSTRACT
BACKGROUND: Physical and mental comorbidity is common and has significant implications for overall health outcomes. Psoriasis, a psychocutaneous disorder, is a classic example of mental-physical comorbidity. AIMS: In view of the impact of socio-cultural influences on mind-body interactions and the paucity of Indian research pertaining to psychiatric morbidity in psoriatic patients, this study was undertaken to measure the prevalence of anxiety and depression in patients with psoriasis, and to correlate these with severity of psoriasis and quality of life. MATERIALS AND METHODS: This cross-sectional study was conducted on 90 consecutive patients of psoriasis, over a period of 12 months, in a tertiary care centre. The Psoriasis Area and Severity Index was used to assess severity of psoriasis. PHQ-9, GAD-7 and the Perceived Stress Scale were used to screen for depression, anxiety and perceived stress respectively. The WHOQOL-BREF was used to determine the quality of life. STATISTICS ANALYSIS: All analysis was performed using Microsoft Excel software and Statistical Package for Social Sciences. RESULTS: A total of 71 (78.9%) subjects had depression and 69 (76.7%) had anxiety. Fifty one patients had significant stress. A significant positive correlation was established between psoriasis variables (severity and duration of psoriasis) and psychological variables (depression, anxiety and stress). Severity of psoriasis had a significant negative correlation with social relationships and environmental domains of WHOQOL. Quality of life was significantly worse in patients with psoriasis with comorbid anxiety/depression. CONCLUSION: Patients with psoriasis have a clinically significant prevalence of depression, anxiety and perceived stress. This study highlights the complex relationship between psoriasis, psychiatric comorbidity and quality of life and the need to simultaneously consider dermatological and psychological factors.
