Quality of life and marital adjustment in remitted psychiatric illness: an exploratory study in a rural setting.

People with mental disorders experience impaired quality of life (QOL). In India, spouses form the most important caregiver for the patient and therefore impact the patients' QOL. However, relatively little is known about marital adjustment, which can definitely influence QOL of patients with mental illness. This study intended to explore marital adjustment and QOL among remitted patients with schizophrenia (SC), depression, and bipolar disorders (BPADs) and to study differences, if any, between the groups. Using a cross-sectional design, consecutive patients (N = 150) with an ICD-10-Diagnostic Criteria for Research diagnosis of SC, depression (recurrent depressive disorder [RDD]), or BPAD, who were currently in remission, were taken up for the study and administered the WHOQOL-BREF for assessing QOL and the Marital Adjustment Inventory for assessing marital adjustment, separately for the husband and the wife. The patients with SC reported poor QOL, whereas a better QOL was seen in those with BPAD and RDD, with significant differences noted between all three groups (p < 0.001). Marital adjustment was perceived to be poor by the patients but not so by the spouses. The greatest marital dissatisfaction was reported by the patients with SC (96%). A positive correlation was observed between the patients' perception of marital adjustment and QOL (p < 0.05). Provision of mental health care should take into consideration patients' possible perception of marital maladjustment and factor these into treatment strategies.

Behavioral emergencies in India: would psychiatric emergency services help?

INTRODUCTION: Behavioral emergencies constitute an important component of emergencies worldwide. Yet, research on behavioral emergencies in India has been scarce. This article discusses the burden, types, and epidemiology of behavioral emergencies in India. METHODS: A computerized search of Medline, Psychinfo, and Cochrane from 1975 to 2009 was performed, and all articles were evaluated and collated. The results were summarized. RESULTS AND CONCLUSIONS: There is an acute need for psychiatric emergency services in India. Suicides, acute psychoses, and substance-related problems form the major portion of behavioral emergencies, while current trends show a rise in disaster- and terrorism-related emergencies.

The burden of behavioral emergencies: need for specialist emergency services.

Behavioral emergencies constitute an important component of medical emergencies. Psychiatric emergency services, which handle the bulk of behavioral emergencies, are inadequate to meet the burden. Strategies to deal with them are also hampered by the lack of adequate research and availability of data. Since behavioral emergencies may present differently in different groups, requiring differing management, consensus guidelines need to be arrived at for tackling behavioral emergencies. In addition, training professionals for psychiatric emergency services should form a part and parcel of emergency management services.

Behavioral emergencies in India: a population based epidemiological study.

INTRODUCTION: Behavioral emergencies constitute an important but neglected part of emergencies seen worldwide in both emergency departments and by emergency services. Yet research on behavioral emergencies in India has been scarce. METHOD: The study aimed to evaluate the occurrence of acute behavioral problems as an emergency attended by our emergency management service-108 services. During the period of August 1st 2007-July 31st 2008, all behavioral emergencies presenting to our emergency services in the states of Gujarat and Andhra Pradesh, which together account for more than 15% of India's population, were reviewed for data completeness and validity. Key word analysis of recorded case details was carried out to determine cause of emergency. Survival to hospital and 48-h outcome was also evaluated to study risk factors for mortality. RESULTS: A total of 40,541 cases of behavioral emergencies were recorded, in which the male:female ratio was 1.3:1. Most victims were in the 20 and 30 years (42%), from a poor socio-economic background (93%), rural area (74.3%), and backward caste (42.6%). Suicidal attempts, whether in the form of poisoning (60.5%) or otherwise (30.7%) was the most common emergency, followed by acute psychiatric causes (4%) and alcohol intoxication (3%). Victims, who met a fatal outcome, were more likely to be male (p = 0.02), having a better socio-economic condition (p < 0.001) and older (p < 0.001). CONCLUSION: Suicidal attempts, which form the largest chunk of behavioral emergencies, need to be tackled on a war-footing, given the sensitivity it deserves. Acute psychiatric emergencies, which form about 9% of all emergencies, require the emerging role of emergency psychiatric services.

Neurological emergencies in India--lessons learnt and strategies to improve outcomes.

BACKGROUND: Neurological emergencies account for between 2.6 and 14% of medical emergencies, a number that can be salvaged, if addressed in time. This study aimed to answer the questions of demand, type and outcome of neurological emergencies by conducting a retrospective analysis of neurological emergencies serviced by 108, the first professional emergency service in India. METHOD: During the period between January 1, 2007 and December 31, 2008, a total of 24,760 calls were received by 108, of which confirmed neurological emergencies (n = 14,448) were followed up and evaluated. Risk factor analysis and stratification were done with respect to survival outcome at 48/120 h. RESULTS: The subjects had a mean age of 37.4 (+/-19.5) years, were mainly male (63%) and were victims of seizures (51.5%), stroke (24%) or unconsciousness (21%). Risk stratification observed that rural area (p < 0.001), emergencies of stroke and coma (p < 0.001), age (p < 0.001), lower vital sign measurements (p < 0.001) and time to reach hospital (p = 0.05) were the main risk factors. CONCLUSION: Emergency medical systems should implement a prehospital stroke protocol including the use of vital sign monitoring, point-of-care clinical diagnostics and advance forewarning systems. Geriatric clinics attending to the elderly age group, especially located in rural areas, with better identification of stroke and coma as medical emergencies, either through neuroimaging or clinical diagnostic facilities, will definitely improve outcomes. As seizures form a large chunk of neurological emergencies, genetic testing and counseling to detect hereditary causes could identify and keep most victims on regulated treatment in order to reduce adverse outcomes.

Possible manic switch induced by combination of bupropion and electroconvulsive therapy in recurrent unipolar depression: a case series.

Although there is sufficient evidence of manic switch induced by bupropion or electroconvulsive therapy (ECT) in bipolar depression, the evidence is not robust for unipolar recurrent depression. We present two patients with unipolar recurrent depression, with no family history of bipolarity or relevant personal medical history, who switched states while on a possible combination of bupropion and ECT. We believe that a hypersensitive state caused by ECT may have been aggravated by the dopamine synergistic action of bupropion, causing the switch. As current guidelines (American Psychiatric Association versus the National Institute for Health and Clinical Excellence) give contradictory advice regarding the treatment of patients with severe depression especially about combining pharmacotherapy and ECT, such patients need to be carefully evaluated before being treated with ECT.

Attitudes of ward attendants towards mental illness: comparisons and predictors.

BACKGROUND: In India few studies exist that explore attitudes of mental health professionals, especially psychiatric ward attendants, towards psychiatric illnesses. This study aimed to explore attitudes of psychiatric ward attendants since they work closely with psychiatric patients in the hospital ward, and which may differ given their cultural and social background. METHODS: Five hundred psychiatric ward attendants were targeted and a 100 sample size chosen based on systematic random sampling. A control group from guardians attending the outpatient department of Central Institute of Psychiatry was selected using the same methods. Attitudes of both groups were assessed using Community Attitudes towards Mental Illness (CAMI) after written informed consent. RESULTS: There were no significant differences noted in Authoritarianism and Benevolence domains of CAMI. However, there were significant differences in the domains of Social Restrictiveness and Community Mental Health Ideology with psychiatric ward attendants scoring higher than the general attendants. Among the socio-demographic variables, there was significant correlation between age, duration of contact and educational background and various domains of CAMI. CONCLUSIONS: Psychiatric ward attendants had more positive attitudes than general attendants towards psychiatric illnesses. Socio-demographic variables like older age, higher education and longer duration of contact with the psychiatrically ill predicted more favourable attitudes.