Stress and Coping Styles in Mothers of Children with Autism Spectrum Disorder.

BACKGROUND: Children with autism spectrum disorder (ASD) require well-balanced care and a comprehensive therapeutic approach. Mental health problems often go unnoticed in mothers of children with ASD due to the focus on training for the children. The presence of stress and depressive symptoms in mothers can interfere with the quality of care and therapy given to the child. The present study aimed to assess the quality of life, coping styles, and symptoms of depression, anxiety, and stress in mothers of children with ASD. METHODS: This study recruited thirty mothers of children with ASD, to whom Depression, Anxiety and Stress Scale (DASS 21), WHO Quality of Life Scale (WHOQOL-BREF), and COPE Inventory were administered. RESULTS: Results indicated the presence of depressive and anxiety symptoms and impaired quality of life among the mothers. Despite this, they exhibited positive coping styles. CONCLUSION: As part of a comprehensive intervention for children with ASD, there is also a need to address the psychological distress and coping styles of mothers.

Study of Risk Factors Associated with Suicide Attempt in Patients with Bipolar Disorder Type I.

Background Suicide is the leading contributor to mortality in bipolar disorder (BD). A history of suicidal attempt is a robust predictive marker for future suicide attempts. Personality profiles and coping strategies are the areas of contemporary research in bipolar suicides apart from clinical and demographic risk factors. However, similar research in developing countries is rarer. Objectives The present study aimed to identify the risk factors associated with suicidal attempts in BD type I (BD-I). Materials and Methods Patients with BD-I currently in clinical remission ( N = 102) were recruited. Sociodemographic details and the clinical data were collected using a semistructured pro forma. The psychiatric diagnoses were confirmed using the Mini-International Neuropsychiatric Interview 5.0. The National Institute of Mental Health-Life Chart Methodology Clinician Retrospective Chart was used to chart the illness course. Presumptive Stressful Life Events Scale, Coping Strategies Inventory Short Form, Buss-Perry aggression questionnaire, Past Feelings and Acts of Violence, and Barratt Impulsivity scale were used to assess the patient's stress scores, coping skills, aggression, violence, and impulsivity, respectively. Statistical Analysis Descriptive statistics were used for demographic details and characteristics of the illness course. Binary logistic regression analyses were performed to identify the predictors for lifetime suicide attempt in BD-I. Results A total of 102 patients (males = 49 and females = 53) with BD-I were included. Thirty-seven subjects (36.3%) had a history of suicide attempt. The illness course in suicide attempters more frequently had an index episode of depression, was encumbered with frequent mood episodes, especially in depression, and had a higher propensity for psychiatric comorbidities. On binary logistic regression analysis, the odds ratios (ORs) for predicting a suicide attempt were highest for positive family history of suicide (OR: 13.65, 95% confidence interval [CI]: 1.28-145.38, p = 0.030), followed by the presence of an index depressive episode (OR: 6.88, 95% CI: 1.70-27.91, p = 0.007), and lower scores on problem-focused disengagement (OR: 0.72, 95% CI: 0.56-0.92, p = 0.009). Conclusion BD-I patients with lifetime suicide attempt differ from non-attempters on various course-related and temperamental factors. However, an index episode depression, family history of suicide, and lower problem-focused engagement can predict lifetime suicide attempt in patients with BD-I.

Therapeutic effects of mobile-based text message reminders for medication adherence in bipolar I disorder: Are they maintained after intervention cessation?

Mobile phone short messaging service (SMS) reminders may be a low-cost method for promoting medication adherence. Our objective was to determine whether text SMS reminders improve medication adherence in patients with bipolar I disorder even after discontinuation of the intervention. Participants were stable adult bipolar I disorder outpatients on maintenance medication who were randomized to receive treatment as usual (TAU; n = 70) or TAU plus twice-weekly medication reminders by SMS (n = 62) for 3 months. Rater-blinded assessments of medication adherence, treatment attitudes, and quality of life (QoL) were obtained at baseline, at the 3-month intervention endpoint, and at a 3-month post-intervention follow up during which both groups received TAU. Intent-to-treat analyses were conducted on the full randomized sample. The clinical trial protocol was registered with the Clinical Trials Registry of India (CTRI) (CTRI/2016/07/007101). The SMS intervention improved medication adherence and attitudes towards medication at the end of the treatment phase; these benefits were maintained for medication adherence but not for attitudes towards medication at the end of the follow-up phase. The SMS intervention did not improve QoL outcomes. These findings indicate that biweekly SMS reminders improve medication adherence and the benefits persist for at least 3 months after the SMS reminders are discontinued. The SMS reminders do not affect attitudes towards treatment or QoL.

Sickness Behavior and Seasonal Affective Disorder: An Immunological Perspective of Depression.

We describe a case of 45-year-old female suffering from chronic hepatitis B and bronchial asthma who presented with symptoms of seasonal affective disorder and sickness behavior. The case report illustrates syndromal and sub syndromal presentations of depression such as sickness behavior in support of "malaise theory of depression" from psychoneuroimmunological perspective. The current case depicts the complex interplay of inflammatory physical illness, medication and manifestations of depression in an individual case. Thus, the physicians and psychiatrists must be vigilant regarding the psychiatric manifestations of physical illness with immune-inflammatory component.

A Cross-sectional Analysis of Patterns and Predictors of Medication Adherence in Bipolar Disorder: Single Center Experience from South India.

OBJECTIVE: Our objective was to determine patterns and predictors of medication adherence in bipolar disorder. METHODS: Between August 2015 and December 2016, we recruited 160 patients with a diagnosis of bipolar disorder as per International Classification of Diseases-10: Clinical Descriptions and Diagnostic Guidelines. The diagnosis was further confirmed by using the MINI International Neuropsychiatric Inventory. All of them were currently in remission (confirmed by standard measures) and on stable dosing of medication for at least a year. Medication adherence was assessed using Tamil validated version of Morisky Medication Adherence Scale. Patients were dichotomized into low adherence (<6) and high adherence (≥6) groups and compared on various socio-demographic and clinical variables. RESULTS: Majority of the sample (n=97, 60.6%) demonstrated low adherence to treatment regimen. Being employed and having spent greater number of days in hospital were predictive of higher medication adherence (odds ratio [OR] 2.78, 95% confidence interval [CI] 1.019-7.585; and OR 1.02, 95% CI 1.003-1.037, respectively). Fewer number of lifetime depressive episodes and positive drug attitudes demonstrated trend level positive association with high medication adherence. CONCLUSION: Non-adherence to prescribed medications is a common problem in bipolar disorder. Interventions targeting vocation, medication focused psychoeducation and promotion of positive drug attitudes are likely to enhance medication adherence in this group.

Pharmacotherapy for relapse prevention of alcohol use disorder in the Indian setting: A systematic review.

Alcohol use disorders (AUDs) is an important public health concern as estimates of the prevalence of AUD range at 4%-6% in the Indian population. Currently, there is limited literature on the pharmacotherapeutic interventions for AUD in the Indian setting. It is imperative to identify the possible variations in their effects from Western studies, and hence the current review was attempted to perform a comprehensive evaluation and critical appraisal of the methodology of the evidence on pharmacological strategies of relapse prevention of AUD in the Indian setting. A total of 18 studies were included in the review. Disulfiram was the most common pharmacological agent to be studied. The initial literature before 2000 focused primarily on disulfiram, whereas the studies in the next decade compared it to acamprosate and naltrexone and emerging interest in anticraving agents such as baclofen and topiramate had been noted over the past few years. No studies were available on newer agents such as ondansetron, selective serotonin reuptake inhibitors or formulations such as depot and implants. Deterrent agents were found to be better when compared to anticraving agents in terms of abstinence and relapse, whereas the latter were more effective for control of craving. Among the pharmacological agents studied, the greatest evidence exists for disulfiram for relapse prevention which could be due to affordability of disulfiram and social support in the Indian context. The chief methodological limitations include the lack of randomized trials and objective measures for assessing abstinence.

A qualitative analysis of explanatory models in medically unexplained physical symptoms presenting to a tertiary health care psychiatric facility in South India.

BACKGROUND: Knowledge about subjective perceptions and explanatory models has the potential to inform clinical evaluation and lead to development of patient-friendly treatment models in medically unexplained physical symptoms (MUPS). AIM: To collect qualitative data about explanatory models in MUPS. METHODS: A cross-sectional observational study was done among patients with MUPS presenting over a 2-year period to a specialty psychosomatic clinic. The Short Explanatory Model of Illness interview was used to gather qualitative data about explanatory models which were subsequently recoded using standard manuals. RESULTS: A total of 123 subjects were evaluated. The nature of symptoms was most commonly reported as 'non-specific' ( n = 102, 82.9%) but of moderate to severe intensity ( n = 87, 73.8%). Getting cured or showing improvement was the most common expectation from treatment ( n = 58, 47.9%). Moderate to severe impact of symptoms was reported on work output ( n = 100, 84%), emotional life ( n = 85, 71.4%) and physical mobility ( n = 59, 49.1%). A considerable proportion was either dissatisfied ( n = 61, 50%) or frankly unhappy ( n = 38, 31.4%) with treatment received. CONCLUSION: There is a need to re-calibrate the clinical approach to people with MUPS to enhance treatment satisfaction. Our findings could assist in evolving culturally sensitive conceptualizations of illness and in developing patient-centred models for therapy in MUPS patients.