Clinical value of the cultural formulation interview in Pune, India.

CONTEXT: Development of the cultural formulation interview (CFI) in DSM-5 required validation for cross-cultural and global use. AIMS: To assess the overall value (OV) of CFI in the domains of feasibility, acceptability, and utility from the vantage points of clinician-interviewers, patients and accompanying relatives. SETTINGS AND DESIGN: We conducted cross-sectional semi-structured debriefing interviews in a psychiatric outpatient clinic of a general hospital. MATERIALS AND METHODS: We debriefed 36 patients, 12 relatives and eight interviewing clinicians following the audio-recorded CFI. We transformed their Likert scale responses into ordinal values - positive for agreement and negative for disagreement (range +2 to -2). STATISTICAL ANALYSIS: We compared mean ratings of patients, relatives and clinician-interviewers using nonparametric tests. Clinician-wise grouping of patients enabled assessment of clinician effects, inasmuch as patients were randomly interviewed by eight clinicians. We assessed the influence of the presence of relatives, clinical diagnosis and interview characteristics by comparing means. Patient and clinician background characteristics were also compared. RESULTS: Patients, relatives and clinicians rated the CFI positively with few differences among them. Patients with serious mental disorders gave lower ratings. Rating of OV was lower for patients and clinicians when relatives were present. Clinician effects were minimal. Clinicians experienced with culturally diverse patients rated the CFI more positively. Narratives clarified the rationale for ratings. CONCLUSIONS: Though developed for the American DSM-5, the CFI was valued by clinicians, patients and relatives in out-patient psychiatric assessment in urban Pune, India. Though relatives may add information and other value, their presence in the interview may impose additional demands on clinicians. Our findings contribute to cross-cultural evaluation of the CFI.

Prolactin and smoking status in antipsychotic-treated patients.

Studies investigating the relationship between cigarette smoking and prolactin secretion in the general population have yielded inconsistent results. Many antipsychotic drugs increase prolactin secretion, but there are no published studies that have investigated the relationship between smoking and prolactinaemia in antipsychotic-treated patients. We obtained prolactin levels from 228 antipsychotic-treated patients in secondary care mental health services and investigated the relationship between prolactinaemia and cigarette smoking. Twenty-three percent (n = 52) of patients had hyperprolactinaemia. Patients prescribed typical or a combination of typical and atypical antipsychotics had a significantly higher prevalence of hyperprolactinaemia and higher mean prolactin concentration. Both current and ex-cigarette smokers had significantly lower mean prolactin levels and a lower prevalence of hyperprolactinaemia, but after controlling for potentially confounding variables, only current smoking status was a significant predictor of lower prolactin levels (OR 2.3, 95% CI 1.2 to 4.7, p = 0.002). In this preliminary, cross-sectional study, there was a robust statistical relationship between cigarette smoking and prolactinaemia. The mechanism(s) underpinning this association needs further investigation.