Treatment compliance and noncompliance in psychoses.

BACKGROUND: Compliance or noncompliance with treatment significantly influences course and outcome of psychiatric disorders. While noncompliance has been extensively researched, compliance has received less attention. The current study was conducted to elicit reasons for compliance and noncompliance in patients having psychoses attending psychiatric clinics. MATERIALS AND METHODS: A total of 196 compliant and 150 noncompliant patients were interviewed using self-designed tools to elicit sociodemographic data, details of illness, and treatment. Factors contributing to compliance and noncompliance were grouped under illness-related, clinician-related, medication-related, family-related, and economic-related domains and compared. RESULTS: Compliance was significantly more in females and middle- and high-socioeconomic status patients. They had less substance use, high physical comorbidity, high attendance in the outpatient department, and better remission. Clinician-related, family-related, and medication-related domains were contributing more to compliance whereas illness-related and economic-related domains seemed to have more bearing on noncompliance. CONCLUSIONS: Compliance and noncompliance are determined multidimensionally. Domains related to clinician, family, and medications have to be reinforced to enhance compliance. Illness-related and economic domains have to be resolved to reduce noncompliance.

Suicide due to sulfuric acid ingestion in a case of major depressive disorder.

A case of Sulphuric acid ingestion with an intention to commit suicide in a patient of Major Depressive Disorder which resulted in death is reported. Aspects of this mode of suicide and legal issues concerning suicide in mentally ill patient have been discussed.

Comorbidity of psychiatric and personality disorders in first suicide attempters: a case-control study.

OBJECTIVES: Comorbid psychiatric and personality disorders in suicide attempters pose greater estimated risk of suicide than psychiatric disorders alone. The current study aimed to evaluate prevalence and pattern of psychiatric and/or personality morbidity and comorbidity in first-time suicide attempters in comparison to the age and sex matched community sample. METHODS: Socio-demographic variables, family background, psychiatric morbidity and comorbidity in survivors of first suicide attempt were compared to age and sex matched community controls. Structured (Mini International Neuropsychiatric Interview plus) and semi-structured (International Personality Disorder Examination) clinical interviews were utilized to evaluate for axis-I and axis-II (personality) diagnosis. Risk-rescue rating was administered to assess medical seriousness of suicide attempt. RESULTS: Individuals who made a first suicide attempt showed significantly lower educational achievement (P<0.0001; OR 1.56; 95% CI 0.89-2.74), but no significant difference in other socio-demographic variables compared to the controls. Cases had high family history of psychiatric illnesses (31% vs. 7%; P<0.0001; OR 5.97; 95% CI 2.48-14.35); high prevalence of psychiatric disorders (89% vs. 25%; P<0.0001; OR 24.27 95% CI 11.21-52.57), personality disorders (52% vs. 24%; P<0.0001; OR 3.43; 95% CI 1.88-6.28), comorbidity of psychiatric and personality disorders (51.6% vs. 19.5%; P=0.022; OR 3.01; 95% CI 1.14-7.92), and high overall prevalence of any axis-I and/or axis-II (personality) morbidity (93% vs. 41%; P<0.0001; OR 19.12; 95% CI 8.05-45.43), compared to controls. CONCLUSION: Survivors of first suicide attempt are at nineteen times increased odds of having psychiatric morbidity and/or comorbidity, especially with personality disorders. Personality evaluation and management in such individuals may result in better comprehensive approach to health care.

Comorbidity of psychiatric and personality disorders in first suicide attempters.

BACKGROUND: Attempted suicide is a common clinical problem in a general hospital setting. It has a serious clinical and socio-economical impact too. AIMS: To study the psychosocial, psychiatric, and personality profile of the first suicide attempters in a general hospital. SETTINGS AND DESIGN: Cross-sectional, hospital-based, descriptive study. MATERIALS AND METHODS: All the consecutive cases of first suicide attempt (n=100) treated in a general hospital were studied to know the clinical profile. Variables related to socio-demographic characteristics, family background, suicide characteristics, psychiatric morbidity, and comorbidity were analyzed. Risk-Rescue rating was applied to know the medical seriousness of the suicide attempt. Presumptive stressful life event scale was utilized to calculate life events score. Structured clinical interview (MINI Plus) and semi-structured clinical interview (IPDE) were used for axis-I and axis-II (personality) diagnoses. The results were analyzed using appropriate statistical measures. RESULTS: Family history of psychiatric illnesses (31%) and suicide (11%) were noted. Insecticides and pesticides were the most common agents (71%) employed to attempt suicide. Interpersonal difficulties (46%) were the most frequent stressor. Overall medical seriousness of the suicide attempt was of moderate lethality. 93% of the suicide attempters had at least one axis-I and/or axis-II psychiatric disorder. Most common diagnostic categories were mood disorders, adjustment disorders, and substance-related disorders, with axis-I disorders (89%), personality disorders (52%), and comorbidity of psychiatric disorders (51.6%). CONCLUSION: Individuals who made first suicide attempt were young adults, had lower educational achievement; overall seriousness of the suicide attempt was of moderate lethality, high prevalence of psychiatric morbidity, personality disorders, and comorbidity, and had sought medical help from general practitioners.

Validity of screening tools for emotional problems in school children.

BACKGROUND: Emotional problems in school children may result in low level of scholastic performance. The recognition of these disorders needs effective screening tools. The choice lies between self assessment tools or observation based tools. Majority of studies use screening tools based on parental or teachers' observation. AIM: This study was designed to compare a self-assessment based screening tool (general health questionnaire; GHQ) with a parental observation based screening tool (CPMS-Childhood Psychopathology Measurement Schedule). MATERIALS AND METHODS: Two hundred and eighteen school children were selected through multistage random sampling. The study was conducted in three stages. In the first stage, all the students were administered six-item version of GHQ to screen for emotional problems. Raven's Progressive Matrices was administered to evaluate IQ. In the second stage, parents assessed their child's behavior using CPMS. In the third stage, all students were subjected for detailed clinical work-up. STATISTICAL ANALYSIS: Criterion validity of the tools used and their comparison. RESULT: GHQ had high sensitivity and specificity compared to CPMS in relation to clinical interview. CONCLUSION: It is found that GHQ is a better screening tool than CPMS in children aged between 13 and 14 years.

Self-injurious behavior: A clinical appraisal.

A case series of self-injurious behavior (SIB) encountered in a General Hospital setting has been described. Limitations of current definition of SIB are explained. SIB is not a single clinical entity and it occurs in various psychiatric syndromes with wide range of psychopathology. Based on clinical criteria, a classification of SIB into three groups has been proposed viz 1) Mild and isolated form, 2) Moderately severe and repetitive form, and 3) Very severe and isolated form. Psychodynamic, cognitive and neurochemical explanations of SIB have been reviewed. Frustration, aggression and impulsivity appearing in helpless situation appear to be a common script across most of these models of explanations. Severity of injury seems to be determined by severity of psychopathology. Site of injury appear to have symbolic significance for a particular patient. Understanding some of these clinicopsychopathological issues helps in management of these cases.

Ganser syndrome and lesion in the temporoparietal region.

Ganser syndrome is a rare dissociative disorder. It has been reported in association with various functional psychiatric disorders and organic states, most often in patients with head injury and stroke, especially those involving the frontal lobes. The present case of Ganser syndrome had features of hysterical dissociation but was found to have haemorrhage in the temporoparietal region of the dominant hemisphere. The complexities of Ganser syndrome in the presence of an organic lesion with an overwhelming emotional component are discussed.

Genital self-mutilation in erectile disorder.

The majority of cases of genital self-mutilation reported in the literature have been in patients with psychosis. We report an unusual case of genital self-mutilation in erectile disorder. It is suggested that genital self-mutilation may be a pathway out of diverse psychological disorders and in non-psychotic cases it could be an expression of a psychotic solution to a conflict and may be influenced by cultural factors.

Genital self-mutilation in depression: a case report.

Genital self-mutilation is a rare severe form of self-injurious behaviour usually described in psychotic disorders with delusions & hallucinations. It has been ascribed to sexual conflicts, body image distortion, internalized aggression and suicidal intent. This phenomenon has been described in schizophrenia, affective psychosis, alcohol intoxication and personality disorders. In the present case genital self-mutilation in a case of Major-Depressive Disorder in an 82 yrs old male is being reported and psychosocial factors are discussed. This case has some unusual features.