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Background: Generalized anxiety disorder is commonly underdiagnosed and undertreated in medical settings. Aim: The objectives of this study were to determine the prevalence and correlates of generalized anxiety disorder among patients presenting to medicine outpatient department in a tertiary care centre. Materials and Methods: A cross-sectional observational study was conducted among the patients visiting the outpatient department of General Medicine in a tertiary care teaching hospital. Sociodemographic and clinical parameters were collected using a structured pro forma. All patients were administered Generalized Anxiety Disorder-7 (GAD-7) to screen for the presence of generalized anxiety disorder. Patients who score 10 or more underwent a semi-structured evaluation using a generalized anxiety disorder module of Structured Clinical Interview for DSM-IV Axis I disorders. Results: Two hundred and fifty patients were recruited for the study. The mean age of the participants was 40.66 ± 12.8 years. More than one-fourth of them had diabetes mellitus and about one-fifth of the participants had systemic hypertension and hypothyroidism. Thirty five (14%) participants screened positive on GAD-7 scale. On detailed evaluation using SCID-I, 19 (7.6%) participants were confirmed to have a generalized anxiety disorder. Female gender was associated with the presence of GAD. Conclusion: One in thirteen patients presenting to the medicine outpatient department were found to have generalized anxiety disorder. Female patients had a greater prevalence of generalized anxiety disorder compared to male patients.
ABSTRACT
Medication nonadherence (MNA) poses a significant challenge in the management of major psychiatric disorders. The present study was undertaken to determine the prevalence of MNA among patients with psychiatric disorders in India and to identify the factors associated with MNA. The following databases were searched systematically: PubMed, Directory of Open Access Journals, and Google scholar. Articles originating from India published in peer reviewed English language journals before May 15, 2021 reporting the prevalence of MNA and associated factors among patients with psychiatric disorders were retrieved and the relevant data were abstracted. The pooled prevalence of MNA was calculated using the inverse variance method. Factors associated with MNA were synthesized and described. A total of 42 studies (pooled N = 6,268) were included in the systematic review. Among these, 32 studies (pooled N = 4,964) reported the prevalence of MNA and hence were eligible for meta analysis. The pooled prevalence of MNA was 0.44 (95% confidence interval [CI] 0.37-0.52). The pooled prevalence of MNA for psychotic disorders, bipolar disorders, and depressive disorders were 0.37 (95% CI, 0.28-0.46), 0.47 (95% CI, 0.23-0.72), and 0.70 (95% CI 0.60-0.78), respectively. Negative attitude toward medications, polypharmacy, greater severity of illness, lack of insight, and cost of medications were associated with MNA. Quality appraisal of the included studies revealed that most studies did not categorize and address nonresponders and did not provide any information on nonresponders. To conclude, about half of the patients with psychiatric disorders in India are nonadherent to their psychotropic medications. Evidence based interventions to improve medication adherence in these patients need to be developed and implemented proactively keeping in mind the factors associated with MNA.
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Background: Globally, about half the patients with alcohol dependence syndrome have a comorbid personality disorder (PD). Indian studies that have explored this are sparse. Objectives: The present study was conducted to estimate the prevalence of personality disorders in individuals with alcohol dependence syndrome undergoing inpatient treatment and to determine the sociodemographic and clinical correlates of PDs in these patients. Methods: This cross-sectional observational study was conducted among the inpatients of the psychiatry department in a tertiary care teaching hospital. Adult male patients with DSM-IV TR diagnosis of alcohol dependence were evaluated for the presence of PDs using Structured Clinical Interview for DSM IV Axis II Personality disorders. The severity of alcohol dependence was assessed using the Severity of Alcohol Dependence Questionnaire. Results: One hundred male inpatients with alcohol dependence syndrome were recruited. Of them, 48 (48%) participants had at least one PD with a 95% confidence interval of 0.38-0.58. Antisocial and avoidant PDs were found in 26 (26%) and 13 (13%) patients, respectively. The mean age at first drink was lower in participants with PD when compared to those without any PD (18.13 ± 4.46 vs. 20.79 ± 4.61 years, respectively). Also, the amount of alcohol consumption per day was significantly higher in those with PD when compared to those without any PD (15.9 ± 6.81 vs. 13.17 ± 4.34 units per day). Conclusion: About half of males with alcohol dependence syndrome undergoing inpatient treatment had at least one PD. Antisocial and avoidant PDs were the most common PDs in this population. Individuals with comorbid PD had a lower age at first drink and higher daily alcohol consumption.
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Background: Despite the availability of several pharmacological and nonpharmacological treatments, a significant proportion of patients with alcohol dependence relapse to alcohol use after treatment. The objectives of this study were to determine the 6-month course and outcome in treatment-seeking individuals with alcohol dependence syndrome and to determine the sociodemographic and clinical correlates of the outcome in these patients. Materials and Methods: A longitudinal observational study was conducted in treatment-seeking male patients with alcohol dependence syndrome. Baseline sociodemographic and clinical details were gathered using a structured pro forma. The patients were followed up at 2 weeks, 1 month, 3 months, and 6 months. During the follow-up evaluation, abstinence status, number of abstinent days, and number of heavy drinking days were noted. Logistic regression was conducted to evaluate the factors associated with abstinence at 6 months. Results: Ninety-four patients were recruited for the study. The mean age of the participants was 43.98 years (standard deviation (SD) 10.68). Two patients were lost to follow-up. At the end of 2 weeks, 74 (80.43%) out of 92 participants remained abstinent. At the end of 1 month and 3 months, 59 (64.13%) and 38 (41.3%) participants of 92 were abstinent, respectively. At the end of 6 months, 26 (30.23%) of 86 patients were abstinent. Among those who were not abstinent at 6 months, the mean number of abstinent days was 113 (SD 51.62) days and the mean number of heavy drinking days was 56 (SD 51.62) days. Outpatients were found to have 2.91 times higher odds of remaining abstinent at 6 months when compared to inpatients. Conclusion: Nearly one-third of treatment-seeking patients with alcohol dependence syndrome remained abstinent at the end of 6 months. The locus of treatment was associated with abstinence at 6 months.
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Background: Identification of barriers to mental healthcare seeking among medical students will help organize student mental health services in medical colleges across India. This study was conducted to estimate the prevalence of depression, anxiety disorders, and suicidal behavior among medical students and to identify the potential barriers to mental healthcare seeking among them. Methods: In this cross-sectional observational study, the medical students from a medical college in South India were asked to complete a structured pro forma for sociodemographic details, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Questionnaire (GAD-7),and Suicide Behaviors Questionnaire-Revised (SBQ-R). The barriers to mental healthcare seeking were assessed using the mental health subscale of Barriers to Healthcare Seeking Questionnaire for medical students. A cut-off of 15 was used for determining the presence of depression on PHQ-9. A cut-off of 10 on GAD-7 indicated the presence of anxiety disorder, and a cut-off of 7 on SBQ-R indicated suicidal risk. Results: Out of the 425 participants, 59 (13.9%) were found to have depression (moderately severe or severe) and 86 (20.2%) were found to have anxiety disorders (moderate or severe). A total of 126 (29.6%) students were found to have a suicidal risk. Preference for informal consultations, concerns about confidentiality, and preference for self-diagnosis were the most commonly reported barriers to mental healthcare seeking. Students with psychiatric disorders perceived more barriers to mental healthcare seeking than students without psychiatric disorders. Conclusions: One-fourth of the medical students were detected to have depression and/or anxiety disorders. Establishing student mental health services, taking into account the perceived barriers, will go a long way in improving medical students' mental well-being.
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BACKGROUND: The Section 84 of the Indian Penal Code (IPC) describes how Indian courts have to deal with 'the act of an unsound person'. This study was undertaken with the objectives of estimating the success rate of insanity pleas in Indian High Courts and determining the factors associated with the outcome of such insanity pleas. MATERIALS AND METHODS: The data was collected from the websites of 23 High Courts of India using the keywords 'insanity' and 'mental illness', and the judgments delivered between 1.1.2007 and 31.08.17 were retrieved. Information regarding the nature of the crime, diagnosis provided by the psychiatrist as an expert witness, documents used to prove mental illness, and the judgment pronounced by the High Court were retrieved. RESULTS: A total of 102 cases were retrieved from 13 High Courts for which data was available. Out of the 102 cases examined, the High Court convicted the accused in 76 cases (74.50%), thereby rejecting the insanity defense. The High Court acquitted the accused under section 84 IPC in 18 cases (17.65%), thereby accepting the insanity plea raised by the accused. Chi-square tests of independence revealed that the verdict of the lower court, documentary evidence of mental illness prior to the crime, and the psychiatrist's opinion were associated with the success of insanity pleas. CONCLUSION: Insanity pleas had a success rate of about 17% in Indian High Courts in the past decade. The factors associated with success of insanity pleas provide valuable guidance to several stakeholders who are dealing with mentally ill offenders.
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BACKGROUND: In India, about 130,000 people died by suicide in the year 2015. It is important to understand the variation of suicide across different parts of India and the trend of suicide rates over the years. The objectives of this study were to determine whether suicide rates in India showed temporal variation in the last decade and to determine whether suicide rates in India showed geographical variation across different states and union territories (UTs). METHODS: Data on suicide rates for the years 2006-2015 were collected from the official publication of the National Crime Records Bureau. This study looked for time trend in suicide rates over the years. Further, the variation in suicide rates across different states/UTs in India and the factors associated with the variation were also analyzed. RESULTS: The average suicide rate in India for the years 2006-2015 was 10.9/100,000 population. Overall, there was no significant variation in the suicide rate over time in the years studied. The average suicide rate varied widely across the states and UTs, between 0.91 and 43.92 per 100,000 population. The analysis revealed a positive association between suicide rates and accident rates for the above years. In addition, for the year 2011, a positive association between suicide rate and per capita state domestic product was noted. CONCLUSION: There was no variation in the suicide rate in India over time. However, there were significant regional differences. Reporting differences and economic factors could partially explain the differences.
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Clozapine is superior to all other antipsychotics in treatment-resistant schizophrenia. However, metabolic side effects are common while treating patients with clozapine. Administering clozapine in a patient who already is diabetic involves careful weighing of risks and benefits. Here, we report our experience of starting clozapine in a known diabetic patient. Clozapine was started in a patient with treatment-resistant psychosis in view of suicidal risk. Her diabetes mellitus was under good control with oral medications. After initiation of clozapine, blood sugars increased several fold within few days. Blood glucose continued to increase even with high doses of insulin and insulin infusion. Finally, blood sugars came under control only after discontinuation of clozapine. Precautionary measures while initiating clozapine in a diabetic patient are suggested - close monitoring of blood sugar during the initial few days and intensive intervention if blood sugar levels increase. Discontinuation of clozapine should also be kept in mind as a last resort.
