Trust and expectation on psychiatrist and its correlation with satisfaction and adherence in patients with mental illness

Background Trust and expectation are important aspect of doctor patient relationship and its role in patient’s satisfaction and medication adherence is unclear. Objective To study the levels of trust and expectation on psychiatrist and its relationship with patient’s satisfaction and treatment adherence. Methods One hundred and twenty three consecutive outpatients were recruited on follow-up if they satisfied the selection criteria. They were assessed with socio-demographic and clinical proforma designed for this study, Patient Trust Scale, Patient Satisfaction Survey, Patient Expectations Questionnaire and Medication Adherence Rating Scale. Results There was a high mean score on trust scale (Mean 38.9, SD 8.5) and expectation questionnaire (Mean 13.5, SD 3.3). On Kruskal-Wallis H test significant group differences were observed in nuclear vs joint family type (c2 = 18.496, h2 = .151, df = 1, Sig. = .000) and knowledge of treatment option (medication only vs medication + psychotherapy) treatment option (c2 = 18.100, h2 = .148, df = 2, Sig. = .000) and occupational status (employed vs unemployed) (c2 = 3.165, h2 =.029, df = 1, Sig. = .056) on the score of PTS. Similar differences were also observed in method of treatment sought before (no treatment vs allopathic) (c2 = .065, h2 = .065, df = 3, Sig. = .005), knowledge about treatment option (medication only vs medication + psychotherapy) (c2 = .026, h2 = .161, df = 2, Sig. = .000) and occupation (employed vs unemployed) (c2 = .061, h2 = .061, df = 1, Sig. = .006) on the score of PEQ. On regression analysis (R2 = .723, F = 156.46, p = .000) value of the score on patient satisfaction was statistically significant as predicted by score on measure of expectation (beta = -0.095, t = -1.966, p = 0.052) and trust (beta = .842, t = 17.504, p = .000). Discussion Levels of patients trust and expectation on physician varies with knowledge about treatment option & occupational status, and significantly associated with levels of satisfaction

Liraglutide-Induced Depression with Suicidality in an Obese Adult: A Case Report

Obesity is a major health issue worldwide. Treating adults with obesity often involves lifestyle and diet changes and sometimes medication. Liraglutide is a drug that is being closely studied for treating obesity. However, the potential side effects of liraglutide, particularly its impact on mood and the development of depression, may be of concern. Given the frequent co-occurrence of obesity and depression, it is important to understand how obesity treatments like liraglutide might affect a person’s mood. A 47-year-old schoolteacher with no personal or family history of mental illness or chronic physical condition sought help for his steadily increasing weight. Despite having a sedentary job and reporting no major stress or substance use, he did not attempt to change his diet or activity level, occasionally experiencing sleep difficulties. He was overweight, with a body mass index of 42. The patient was diagnosed with adult obesity and prescribed liraglutide, diet changes, and exercise. Initially, he lost weight, but he also developed depressive symptoms, including fatigue, loss of interest, sleep disturbances, and suicidal ideation. Following cessation of liraglutide treatment, his depression symptoms got better, but his weight slightly increased. This case sheds light on the possible link between liraglutide and depression in managing obesity. It is crucial for healthcare providers to be aware of potential mental health side effects of obesity drugs like liraglutide. Although the exact reasons behind these mood changes are not fully understood, this case emphasizes the need for careful observation and decision-making in treatment. Understanding these issues can help balance the benefits and risks of liraglutide and ensure better care and treatment options for people with obesity

Treatment burden, not health risk attitude associated with adherence in patients with mental illness in South India

Background: Attitude towards health risks and treatment burden may mediate treatment adherence in therapeutic care. There is a paucity of study examining the levels and relationships of these variables in patients with mental illness. Objective: This study was conducted to know the relationships of health risk attitude & treatment burden and medication adherence in patients with mental illness. Settings and design: Cross-sectional, Hospital-based study. Methods and material: One hundred seventy consecutive participants in remission of mental illness were recruited. The patient\u27s details were assessed with Sociodemographic proforma while attitude towards health risk was assessed with Health-Risk Attitude Scale (HRAS). To evaluate the burden of treatment, the Treatment Burden Questionnaire (TBQ) was used while medication adherence was rated with the Medication Adherence Rating Scale (MARS). Statistical analysis used: Descriptive statistics, KruskaleWallis H, Linear regression analysis. Results: Mean score on MARS was 4.9 (SD ± 1.7) while HRAS and TBQ were 62.2 (SD ± 8.6) and 44.2 (SD ± 23). On linear regression analysis scores of TBQ were statistically significant positively linked to HRAS score (R2 ¼ .35, df ¼ 1, F ¼ 94.2, p ¼ 0.001), While Scores on MARS were statistically significant negatively linked TBQ and HRAS score (R2 ¼ .53, df ¼ 2, F ¼ 97.1, p ¼ 001). Conclusions: Health risk aversion and treatment burden may upraise in mentally ill, and linked to poor medication adherence

Understanding suicide and its prevention in the Indian context: Mental Health Perspective

In India, suicide research has largely concentrated on the prevalence, method, psychological, and demographic risk factors. Suicide processes, paradigms, prevention strategies, and other features of suicide that are common in the West may not be applicable in India. It is vital to study potential underlying processes, various suicide prevention methods, and suicide prevention in general, as well as what more work has to be done in the Indian context. Suicide, on the other hand, is a cross-sectoral public health issue that demands collaboration across all key sectors, and its prevention should engage all stakeholders in India

A study of drug attitude and medication adherence and its relationship with the impact of illness among the mentally ill

Background: Impact of illness may vary with the medication adherence which in turn may vary with the attitude towards drugs. There is a paucity of research examining relationships between these variables. Objective: To study the levels of drug attitude, adherence and its relationship with the impact of illness. Methods: A total of 279 participants with mental illness in remission were assessed with socio-demographic and clinical proforma, scales like Hogan Drug Attitude Inventory (DAI), Impact of Illness Scale (IIS), and Morisky Medication Adherence Scale (MMAS) were used. Results: Mean score on DAI, IIS, and MMAS were 2.38 (SD = 4.6), 25.88 (SD = 6.6), and 5.04 (SD = 2.2) respectively. On linear regression analysis (R2 = .122, DF = 2, F = 17.598, p < .001) IIS Score was statistically significant but negatively associated with the score of MMAS (p < .05) and DAI (p < .05). Discussion: Impact of illness has an inverse relationship with the level of drug attitude and medication adherence. Improving drug attitude and adherence may buffer the impact of illness

Stark contrast in prevalence and correlates of mental disorder in the Arabic and Indian populations.

The Indian and Saudi Arabian (a prototypical Arab nation) national mental health surveys were compared. In comparison to Saudi Arabia, India had a 2.5-fold lower lifetime prevalence of mental illnesses, a 3.8-fold lower current prevalence, and a 7-fold lower prevalence of serious mental disorders. All mental disorders, except drug use disorder, were less common in India. Being over 40 years old and having a better education level had a greater rate of mental illness in India; conversely, being a woman increases the risk of mental illness in Saudi Arabia, particularly anxiety and eating disorders. Besides substance abuse disorders, the treatment gap for mental illnesses is larger in Saudi Arabia. Overall, the comparison suggests a contrasting difference in the prevalence of psychiatric disorders, and their demographic correlation varies between the Indian and Saudi Arabian populations. There is a need to understand as to why such discrepancies exist

The relationship of serum leptin, serum TNF-α, plasma lipids and obesity parameters in patients treated with weight neutral antidepressants

Background: Leptin and tumor necrosis factor (TNF­α) are involved in weight regulation1. Elevated lipids are frequently encountered in obese people which are helpful in the formation of atherosclerotic plaques in the coronary arteries. This study helps us to know whether weight neutral antidepressant therapy can be therapeutic option in those with obesity associated with depression.Methods: It is a Longitudinal study of sample size 72 where Patients with obesity attending to JSS hospital who are found to be depressive in both inpatients and out patients fulfilling the inclusion and exclusion criteria.Results: Our study showed mean difference value of weight, BMI and waist circumference, S. leptin, S.TNF-α, S. total cholesterol, S. LDL-C, S. VLDL-C, triglycerides of obese patients treated with lifestyle modifications, psychotherapy and weight neutral antidepressants at baseline and 3rd month was significantly decreased when compared to obese patients treated with lifestyle modifications, psychotherapy alone at baseline and 3rd month is 3.5kgs, 1.2kg/m2, 0.89cm, 9.53pg/ml, 10.86pg/ml, 22.34mg/dl, 17.94mg/dl, 4.42mg/dl, 21.78mg/dl and 1.2kgs, 0.32kg/m2, 0.02cm, 5.22pg/ml, 7.86pg/ml, 11.72mg/dl, 15.37mg/dl, 1.98mg/dl, 9.54mg/dl respectively (p=0.0001).Conclusions: Our study demonstrated a significant weight loss, and significant decrease in S. Leptin, S. TNF- α, TC, LDL-C, VLDL-C, triglycerides, when obese patients treated with lifestyle modifications, psychotherapy and weight neutral antidepressant (Desvenlafaxine)

Relationships of academic expectation stress & self-efficacy, efficacy for self-regulated learning with academic performance during Covid pandemic

Background: Academic expectation stress & self-efficacy and efficacy for self-regulated learning may affect academic performance. The Covid pandemic has affected the physical and psychological well-being of all, including students. However, there is a paucity of studies examining these variables in college students in Saudi Arabia. Objectives: This study was conducted to explore the levels and relationships of academic expectation stress & self-efficacy, self-regulated learning, and its relationships with academic performance in college students of ---- University during the Covid pandemic. Material and Methods: A total of 302 students were recruited in this cross-sectional study. They were assessed with sociodemographic and academic proforma designed for this study, the Academic expectation stress inventory (ASE), the Academic self-efficacy scale (AES), and the efficacy of the self-regulated learning scale (SRL). Results: Results revealed that the mean score of AES, SRL, and ASE was 29.18, 35.38, and 41.11, respectively. On linear regression analysis exam score was statistically significant positively predicted by the score on SRL, and the Score of AES was statistically significantly predicted by the score of SRL (+ve) and the score of ASE (-ve). Conclusions: It may be concluded that efficacy for self-regulated learning may mediate academic performance and academic self-efficacy during the Covid pandemic. Enhancing self-regulated learning may improve academic performance during the pandemic

Impact of Baseline Characteristics on Stroke Outcomes in Pakistan: A Longitudinal Study Using the Modified Rankin Scale

Introduction. Stroke is a leading cause of disability and mortality globally, with a significant impact on healthcare systems. Various factors, including age, gender, comorbidities, and the type of stroke, influence the burden of stroke and its outcomes. The study was conducted with an objective to determine the impact of baseline characteristics on the long-term functional outcome of stroke patients. Methods. This prospective observational study was conducted between April 6, 2022 - December 31, 2023, at a tertiary hospital. The study included patients with radiologically confirmed stroke, selected through convenience sampling. Stroke patients of any gender and all age groups, with any comorbidity, were included. The Modified Rankin Scale (mRS) assessed disability on admission and three months post-stroke. Results. Of the 213 patients, 122 (57.3%) were males and the majority, 199 (93.4%) individuals, had acute ischemic stroke. The median age of the participants was 60 years (range: 13-97 years; IQR=18 years). The mRS score on admission was poor (5.0; IQR=1.0) for patients ≥ 60 years. In 74 (34.74%) participants, the left middle cerebral artery was a frequently involved site. Age of ≥ 60 years (mRS=4.0; IQR=4.0; p=0.001) and the presence of ≥ 3 comorbidities (mRS=5.0; IQR=1.0; p=0.001) were significantly associated with poor outcomes three months post-stroke. Ordinal logistic regression revealed that a mRS score of 4 (OR=14.20; 95% CI=1.70-145.25; p=0.02) and a mRS score of 5 (OR=78.84; 95% CI=9.35-820.25; p < 0.001) on admission were associated with poor outcomes. In addition, the presence of ≥ 3 comorbidities (OR=4.59; 95% CI=14.65; p < 0.01) and increasing age (OR=1.04; 95% CI=1.01-1.07; p=0.02) were predictors of poor outcomes three months post-stroke. Conclusions. The study underscores the importance of early intervention and effective management of comorbidities to improve functional outcomes in stroke patients. It highlights the need for targeted stroke care and rehabilitation strategies

Issues in acute psychosis of an illiterate hearing impaired with minimal speech output: A psychiatrist perspective

<p>Assessment and management of mental disorder among sensory impaired is challenging as there is no clear guideline. Most physicians and psychiatrists are not trained to provide competent care in such patients. This report highlights the issues and challenges that a clinician may encounter in patient with profound hearing loss and speech impairment</p