Psychosocial correlates of medication adherence in patients with depressive illness.

INTRODUCTION: Nonadherence to medication is common in depressive illness and the same may lead to increased risk of relapse, morbidity, burden of care, and avoidable health cost. Factors which may cause nonadherence are multiple. METHODOLOGY: A study was undertaken to appreciate the role of various psychosocial factors in adherence to various antidepressant medication in the patients of depressive disorder. One hundred and fifty patients after due consent were subjected to medico-psychosocial-structured per forma, Beck's Depression Inventory, The Belief About Medicines Questionnaire, and the Morisky Medication Adherence Scale. RESULTS: Nonadherence to antidepressant medication in our study was 73.33%. Characteristics of the disease, disease therapies, patient-associated aspects including beliefs, and social and economic support did affect medication adherence. CONCLUSION: Nonadherence to medication was common in patients with depressive illness. Finding emphasizes the need to sensitize the patients about the importance of proper adherence.

Absolute Abstinence as a Treatment Outcome in Servicemen with Alcohol Dependence: A Retrospective Cohort Study.

Background: Within India's military medical framework, alcohol dependence syndrome (ADS) is deemed a treatable medical illness incompatible with military service, and complete abstinence is the only acceptable successful treatment outcome. Objective: This study was designed to identify factors which were able to differentiate treatment outcomes of abstinence and relapse among ADS patients in a military framework. Method: Recognizing personal incentives to misrepresent alcohol consumption, abstinence, and relapse outcomes were established using official reports from a patient's parent unit, in combination with biochemical parameters and clinical examination. Patients serially admitted for ADS treatment or follow-up review were surveyed, and their socio-demographic and alcohol consumption profiles, coping styles, life events and specific relapse precipitants were recorded and compared as contributory variables in a cognitive-behavioral model of ADS. From this survey of 140 patients, membership to abstainer or relapser groups was then predicted using a discriminant analysis. Results: 34% of patients achieved early absolute abstinence. No baseline socio-demographic or drinking profile distinctions existed between abstainers and relapsers. Differences were forthcoming on coping styles, life-event, and relapse-precipitant exposure measures. Stepwise discriminant analysis produced a final equation comprising 10 independent variables (including two positive life event measures), which predicted an abstinence/relapse outcome with an 86% and 79% hit-rate (original and cross-validated). Conclusion: Using prevailing cognitive-behavioral constructs, early absolute abstinence emerged as an actionable objective and an achievable goal without any contributory socio-demographic predilections. This preliminary evaluation suggests it is a tenable and realistic target of current ADS treatment programs.

Psychological morbidity in soldiers after spinal cord injury.

BACKGROUND: Spinal cord injury (SCI) patients usually experience multiple and ongoing, neurological, and other medical problems with significant damage to the social and psychological well-being of themselves and their families. MATERIALS AND METHODS: Soldiers with SCI transferred to the regional centre after suitable stabilization of their fractures and general physical condition were included in the study. The baseline assessment included a diagnostic interview and review of case notes for a comprehensive, multi-axial diagnosis. The participants were assessed using the Barthel's Index, the Hospital Anxiety and Depression Scale, the General Health Questionnaire, Quality of life (QOL) Index, AFMC stressful life event Scale, and the Social Support Survey with the current defense or coping style also being recorded. Similar assessments were repeated at 1 month, 6 months, and at 1 year after intake. RESULTS: It was noticed that the mean scores on the Hospital Anxiety and Depression Scale were below the cut-off point for diagnosable disorder, or in the mild end of the spectrum. However, the measures of psychological distress and QOL showed significantly high mean scores. Anxiety Scores showed little variation over time initially, and none of the mean differences (t values) reached statistical significance. However, when the scores of intake and those at 6 months are compared, there was a statistically significant improvement. Depression scores, on the other hand, showed a steady improvement with each assessment. General lack of well-being and psychological distress along with poor QOL remained high throughout the period of assessment with little variation over time .These morbidity measures could not be accounted for by variations in stressful life-event scores or by variations in degree of disability. Although the negative correlation between anxiety and depression scores and those on the QOL index approached conventional levels of significance, there was little correlation overall between morbidity measures and the putative modifying variables at any stage of assessment. CONCLUSIONS: Although psychological symptoms of depressive and anxious spectrum was virtually universal, psychiatric illness at syndromal intensity warranting a formal psychiatric referral and management was rare in patients with SCI in the 1st year. The general well-being and QOL were expectedly dismal throughout. Expected correlations between the measures of social support and degree of disability with the measures of anxiety, depression, subjective distress, and QOL were not demonstrated .There is a need to look beyond these and explore factors such as lack of information, physical morbidity, quality of social support, and dependence for the activities of daily living to evolve a nuanced approach toward the challenge that these clientele represent.

Understanding intimate partner violence and its correlates.

OBJECTIVES: This study assessed intimate partner violence (IPV) and alcohol use in an urban population in Pune, India. The prevalence of IPV and alcohol use was assessed along with the correlation of IPV with alcohol and other variables. MATERIALS AND METHODS: The study was cross-sectional, questionnaire-based. The materials used were the hurt insult threaten scream (HITS) scale, the alcohol use disorders identification test, and a brief psychosocial questionnaire. Systematic random sampling was done on the target population. Regression analysis of various factors in relation to HITS score was done. RESULTS: Sample size (n) was 318 individuals. Prevalence of IPV was found to be 16% and the victims were mostly women. Prevalence of alcohol use was 44%, of which 8.9% were harmful users. No female subjects consumed alcohol, but 94% were aware of their husband's alcohol consumption. No significant correlation was found between IPV and education (P = 0.220) or income of women (P = 0.250). Alcohol consumption by males was a significant risk factor for women experiencing IPV (σ = +0.524; P< 0.001). Regression analysis also revealed that increasing marital age (P = 0.019) and financial support from in-laws (P = 0.040) were significantly protective. CONCLUSION: IPV prevalence was less than the national average for India, but the majority of victims was women. The most common type of IPV was verbal. Alcohol use prevalence was higher than the national average, but harmful use was lower. Alcohol use is a significant risk factor for IPV. Education and income of women were not significantly protective against IPV but increased age at marriage and support from in-laws were.

Scorching effects of heat on extracted teeth - A forensic view.

CONTEXT: Fire investigation is the multidisciplinary basis of the exploration, which involves investigations concerning the origin of fire, its cause as well as the identification of victims. At times, victim identification in fire disasters becomes nearly impossible owing to complete destruction of soft tissues. In such circumstances, teeth may prove to be of value since they are extremely hard. A precise understanding of physical and histological changes in teeth subjected to high temperature can provide valuable clues in fire and crime investigations, when dental evidence remains. AIM: The main aim and objective of the study was to investigate structural damage in freshly extracted teeth to heating, at different temperatures for a certain length of time in the laboratory. SETTINGS AND DESIGN: Fifty-four freshly extracted teeth of different age groups had been subjected to different temperatures for a period of 15 minutes in the laboratory furnace. Physical and microscopic findings were correlated to the temperature. MATERIALS AND METHODS: Freshly extracted 54 permanent teeth of different age groups were collected and were subjected to temperatures of 100°C, 300°C, and 600°C. Teeth were then examined for any physical changes such as change in color, texture, or morphology that occurred. Then the teeth were subjected for decalcification following which the tissues were kept for routine processing and were embedded in paraffin wax. Sections of 4 µm thickness were made and stained in hematoxylin and eosin (H and E) to correlate the microscopic findings to the temperature. STATISTICAL ANALYSIS: Physical and microscopic findings were correlated to the temperature. RESULTS: Microscopic examination revealed definite histological patterns, which were explicitly seen at a particular temperature. The samples showed cracks and charring of the tooth structure with microscopic findings such as widening of dentinal tubules and altered histological staining. CONCLUSION: Evaluation of incinerated dental remains may provide additional forensic investigative avenues in victim identification because of the consistency of morphological changes, the histological patterns at temperatures that are commonly encountered in common domestic fires.

Risk Factors for Suicide in Wives of Military Personnel.

BACKGROUND: An increasing trend in attempted and completed suicide amongst wives of serving personnel was observed. METHODS: A questionnaire designed to elicit the known risk-factors for suicide, suicide attempts and suicidal ideation by women in the Indian context was administered to 222 wives of Indian military personnel living in a garrison with their husbands. RESULT: A large number (28%) of the sample were child-less. Alcoholism in husband was reported by 22 women and domestic violence by four. Six had been bereaved in the past year. Chronic illness was reported by 10 women and psychiatric illness by four. CONCLUSION: Wives of military personnel may need targeted community interventions focusing on the risk factors for suicide.

Psychiatric Morbidity Pattern in a Child Guidance Clinic.

BACKGROUND: There is a paucity of Indian studies on psychiatric morbidity in children. Present work was undertaken in a child guidance clinic in armed forces. METHODS: Retrospective analysis of 213 patients who attended a child guidance clinic was done. RESULTS: Majority (n=138) were boys. 55.9% were referred from paediatric outpatient department while medical officers in periphery referred 38.5%. The diagnoses was mental retardation in 30.97%, behavioral and emotional disorders in 23.06% and neurotic, stress related and somatoform disorders in 15.98% cases.