Determinants of family functioning in caregivers of persons with obsessive-compulsive disorder.

BACKGROUND: Obsessive-compulsive disorder (OCD) is known to cause significant burden to patients and their caregivers. However, there is limited data on its impact on family functioning, especially from families with an adult member having OCD. METHODS: Four hundred subjects, which included treatment-seeking adult OCD patients (n = 200) and their caregivers (n = 200) were recruited. Patients were evaluated using the Mini International Neuropsychiatric Interview (MINI) and the Yale-Brown Obsessive-Compulsive Scale (YBOCS). Caregivers were evaluated using the MINI, the Caregiver Strain Index (CSI), the Hamilton Anxiety Rating Scale (HAM-A), the Hamilton Depression Rating Scale (HAM-D), the Socio-Occupational Functioning Assessment Scale (SOFAS), the Family Accommodation Scale (FAS) and the Connor-David Resilience scale (CD-RISC) in a cross-sectional interview. Family functioning was measured using the OCD Family Functioning (OFF) Scale. Structural equation modeling (SEM) was carried out to evaluate the relationships between the patient and caregiver variables to predict family functioning. RESULTS: From the best-fitting path model, we ascertained that OCD symptoms did not have a direct relationship with family dysfunction. Their effects were in turn was mediated by family accommodation, anxiety, caregiver stress/burden and depression. "Contamination & washing" was the only significant symptom dimension within the model. Caregiver resilience was found to predict only their individual functioning, and not family functioning. LIMITATIONS: Study sample included patients from a tertiary care OCD service, only one caregiver from each patient's family was interviewed. CONCLUSIONS: Evaluating family functioning, addressing it as part of interventional modules for patients and caregivers may help improving treatment outcomes.

Needs of Persons with Neurological Disorders.

BACKGROUND: In India, many persons with neurological disorder (PwND) get discharged from several hospitals with significant unmet needs. AIM: To assess the needs of persons with neurological disorders in a tertiary care hospital, Bangalore, India. METHOD AND MATERIALS: It was a cross-sectional descriptive study where thirty PwND availing the in-patient services at NIMHANS, Bangalore were selected through purposive sampling. Camberwell Assessment of Need - Research version was used. RESULTS: Large majority (90%) of the respondents have unmet needs in daytime activities, psychological distress, information about illness and sex. Majority (70%) have unmet needs in job, self-care, medicines, mobility, child care. Half (50%) of the respondents have unmet need in accommodation, intimate and social relationships, finance. Three-fourth revealed that their need for food, safety and social welfare needs have been met. CONCLUSION: Patients from lower economic, educational status and urban domicile have more service needs. Present study attempts a systematic need assessment which has implication in addressing the unmet needs of PwND to improve their quality of life.

The Question is the Answer: concerns and queries raised by patients and caregivers referred to rehabilitation services.

BACKGROUND: The philosophy of recovery emphasises consumer participation and engagement in developing effective rehabilitation services. Assessment of consumer perspectives and concerns lies at the heart of responsive and relevant rehabilitation frameworks. AIM: The study aimed to document and examine patient and caregiver queries, at their first contact with Rehabilitation Services. METHODS: The sample consisted of 124 consecutive inpatients and their accompanying caregiver/s, referred to Psychiatric Rehabilitation Services, within a tertiary care psychiatric hospital in India. The data were collected using the semi-structured Inpatient Intake proforma during the intake session. The spontaneous queries raised by patients and/or caregivers were documented and content analysis identified themes, separately for patients and caregivers. RESULTS: The results indicated both similarities and differences in the frequency of themes that emerged from questions asked by patients and their caregivers. Two prominent themes centered on specific queries about rehabilitation services and the treatment and prognosis of the psychiatric illness. CONCLUSIONS: The findings have implications for training, practice and research in the field of psychosocial rehabilitation. Recommendations are made for training and practice frameworks to facilitate consumer-service provider communication towards the development of responsive recovery-oriented services.

Barriers to discharge of patients from a government-run day-care psychiatric rehabilitation center in India.

OBJECTIVE: Many psychiatric patients undergoing vocational training do not achieve successful transition to regular work. In this study, we evaluated the barriers for discharge from day care center to actual work place. MATERIALS AND METHODS: In a cross-sectional study at a government-run day-care center at National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, we studied 76 patients who were undergoing vocational training for more than 1 year. We did a semi-structured interview with patients, their family members, and instructors of various occupational sections. We used a questionnaire of 17 different barriers to assess the obstacles in their discharge from day-care center to actual work place. RESULTS: The majority of them had a diagnosis of mental retardation (n=47) followed by schizophrenia (n=29), and bipolar disorder (n=9). The mean (SD) age and duration of illness was 33.6 (9.7) years and 12.5 (9.3) years, respectively. Patients had more than one diagnosis. The median duration of stay in day-care center was 5.9 years. Doubts regarding performance at a new work place (n=60), fear of performance at new work place (n=65), and the fear of transition to regular work (n=64) were the most common barriers reported by patients, their family members and instructors of various occupational sections, respectively. DISCUSSION: Educating patients and their family members, gradual exposure to new working environment, and increased community level vocational opportunities may potentially overcome above barriers. Getting them to the actual job early in their course of treatment will improve their adjustment to a new work place and overall outcome.

Expressed emotion and caregiver burden in patients with schizophrenia.

BACKGROUND: Family's expressed emotion has been shown to be predictive of outcome in mental and physical illnesses in a variety of cultural settings. The relationship between caregiver burden and high level of expressed emotions has demonstrated a high level of relapse among the psychiatric patients in the West. AIM: The current study explores the relationship between caregivers' burden and level of expressed emotions by the patients with schizophrenia in Indian setting. MATERIALS AND METHODS: The sample for the study consisted of totally 70 subjects comprising 35 schizophrenic patients and 35 caregivers. The schizophrenic patients who were attending the Day Care Center run by Department of Psychiatric and Neuro Rehabilitation Unit at National Institute of Mental Health and Neuro Sciences (NIMHANS) in Bangalore, India (a tertiary care center) and their primary caregivers were included. Family emotional involvement and criticism scale and The burden assessment schedule were administered to assess the expressed emotions and caregivers' burden. Carl Pearson Correlation test used to study the relationship between the variables. RESULTS AND CONCLUSION: The study highlighted the need for addressing expressed emotion in comprehensive psychosocial intervention plan. More attention should be paid to the needs of the caregivers in order to alleviate their burden in managing mentally ill patients.

Work-Life Balance among Married Women Employees.

UNLABELLED: Family-work conflict (FWC) and work-family conflict (WFC) are more likely to exert negative influences in the family domain, resulting in lower life satisfaction and greater internal conflict within the family. Studies have identified several variables that influence the level of WFC and FWC. Variables such as the size of family, the age of children, the work hours and the level of social support impact the experience of WFC and FWC. However, these variables have been conceptualized as antecedents of WFC and FWC; it is also important to consider the consequences these variables have on psychological distress and wellbeing of the working women. AIM: to study various factors which could lead to WFC and FWC among married women employees. MATERIALS AND METHODS: The sample consisted of a total of 90 married working women of age between 20 and 50 years. WFC and FWC Scale was administered to measure WFC and FWC of working women. The obtained data were analyzed using descriptive and inferential statistics. Carl Pearson's Correlation was used to find the relationship between the different variables. FINDINGS AND CONCLUSION: The findings of the study emphasized the need to formulate guidelines for the management of WFCs at organizational level as it is related to job satisfaction and performance of the employees.