Marriage and other psychological stressors in the causation of psychiatric disorder

The aim of this study was to compare the specific psychiatric diagnosis, frequency, and types of stressors, and the level of awareness about marriage law between married (cases; n=80) and unmarried girls (control; n=80) with one or more psychiatric disorders below the age of 18 years. The psychiatric diseases were diagnosed according to Axis One of ICD-10 clinical diagnoses of multi-axial classification of childhood and adolescent psychiatric disorder. Psychosocial stressors were considered on the basis of Axis Five of this classification. Of the cases, major depressive disorder was the highest (n=47) and next was a dissociative (conversion) disorder (n=24). Among the controls, generalized anxiety disorder (n=31) was the most prevalent followed by obsessive-compulsive disorder (n=17). The difference was highly significant (p>0.001). The cases reported a significant excess of psychosocial stressors than that of the controls to the onset of the psychiatric disorder. All the cases had associated stressors. In contrast, 77 out of 80 control patients had stressors. Marriage itself played as a stressor in the 78 cases. Beside this, other highly frequent stressors were marital discord followed by drop out from study and trouble with in-laws. Among the controls, the highest reported stressor was increased academic workload and next two commonest stressors were poor academic performance and discord with peers. Interestingly, 52.5% of the cases were having knowledge about the law on the age of marriage and that was 32.5% among the controls. It was significant that most of the girls breached their continuity of education after marriage (p>0.001). In conclusion, psychosocial stressors including marriage have a causal relationship with depressive and conversion disorder.

A neuroimaging study in childhood autism

Background: Childhood autism is now widely viewed as being of developmental neurological origin. Abnormality in neuroimaging is reported in autism.Objectives: To delineate the proportion of structural magnetic resonance imaging (MRI) and electro encephalography (EEG) abnormality among the children with Autism and to assess any association of MRI and EEG changes with co morbid mental illness.Methods: It was a cross sectional descriptive study done at a child and adolescent consultation centre, Dhaka. The study was Carried out from January 2009 to December 2009. Both boys and girls were included in the study. A total of 42 children with childhood autism aged between two and 12 years partici­pated in this study. Diagnosis of autism was based on ICD-10(DCR) criteria. Results: Abnormalities were found to be 35.7% in MRI and 42.9% in EEG. EEG abnormalities were found in the form of defuse slow waves activities, generalized faster activities, epileptogenic discharge and mixed discharge. The abnormalities in MRI was found in the form of diffuse cortical atrophic changes, focal cortical atrophy in frontal and temporal cortex with widening of major sulci, prominent ventricles, periventricular degeneration and abnormal basal ganglia. EEG changes were significantly associated with increased number of co-morbid illness (mental retardation, epilepsy and others). Conclusion: A number of abnom1alities that observed in the present study indicative of relations between structural and physiological dysfunctions and childhood autism. Further exploratory and in-depth researches are certainly required in this field. Intervention of autism needs to address co morbidities for better outcome

Adaptation, linguistic and clinimetric validation of the Bangla version of Zarit Burden Interview

The aim of this study was to develop a culturally adapted and validated Bangla version of Zarit Burden Interview  (ZBI-B) questionnaire for use in Bangla speaking caregiver of patient with dementia. This study was conducted on 100 caregivers related to consecutively attending outpatients with a previously established primary diagnosis of dementia, according to DSM-IV criteria. Validity and reliability were evaluated by comparing with the caregiver burden inventory (CBI). An exploratory factor analysis with the principle component with varimax rotation was used to detect the factorial structure in observed measurements. To attain the best-fitting structure and the correct number of factors, the following criteria were used: Eigen values >1.0, factor loadings >0.30. The Cronbachs alpha value was 0.847 for test and 0.839 retest. The intra-class correlation for the test-retest reliability was 0.89. The ZBI score was highly correlated with the CBI score (Pearsons correlation coefficient, r=0.909, P=.001). From the exploratory factor analysis six factors comprising 20 items were extracted with Eigen values higher than 1.00 accounting for 69% of the total item variance. In conclusion, ZBI-B is valid, reliable and useful for use in clinical contexts and in future studies that could lead to a better understanding of caregiver burden in dementia

Psychiatric disorders among the children of 5 to 18 years old of 'SIDR' affected areas

Background: Natural disasters give raise a significant amount of physical and mental impairment in human beings. Any sort of disaster acts as a causative and maintaining factor for any psychiatric morbidity. In November 15, 2007, the cyclone "SIDR" intensified to reach peak winds of 215 km/h (135 mph) according to the IMD, a peak of 250 km/h (155 mph) according to the JTWC. "SIDR" officially made landfall around 1700 UTC later that day, with sustained winds of 215 km/h (135 mph). As it intensified to a Category 4-equivalent cyclone and thus coastal districts of Bangladesh faced heavy rainfall as an early impact of the cyclone. The damage in Bangladesh was extensive, including tin shacks flattened, houses and schools blown away and enormous tree damage. The entire cities of Patuakhali, Barguna and Jhalokati District were hit hard by the storm surge of over 5 meters ( 16 ft). The head of the Red Crescent in Bangladesh expects the death toll to reach as high as 10,000. Over 3,000 other fishermen were reported missing on over 500 fishing boats. The "SIDR" left its strong impact on those who survived. Objectives: The Study was aimed to estimate the prevalence of psychiatric disorder among children and adolescents in the "SIDR" affected areas. Method: This was cross sectional, qualitative study done among the children and adolescent groups of 5 to 18 years old to see the effect of natural disaster on the people of southern part of Bangladesh. The whole of the children population who attended in the health camp were included in the study during the study period. Three teams have worked among the four "SIDR" affected districts. Each team consists of Psychiatrists, General Physicians, and Clinical Psychologist.Results: A total of 158 children in four defined areas revealed that the prevalence rate of psychiatric disorder was 48%.Conclusion: This type of study should be done in multi-centers in SIDR affected disti.icts of Bangladesh to find out the actual prevalence rate of child and adolescent psychiatric disorder

Adaptation, linguistic and clinimetric validation of the Bangla version of Zarit Burden Interview

The aim of this study was to develop a culturally adapted and validated Bangla version of Zarit Burden Interview  (ZBI-B) questionnaire for use in Bangla speaking caregiver of patient with dementia. This study was conducted on 100 caregivers related to consecutively attending outpatients with a previously established primary diagnosis of dementia, according to DSM-IV criteria. Validity and reliability were evaluated by comparing with the caregiver burden inventory (CBI). An exploratory factor analysis with the principle component with varimax rotation was used to detect the factorial structure in observed measurements. To attain the best-fitting structure and the correct number of factors, the following criteria were used: Eigen values >1.0, factor loadings >0.30. The Cronbachs alpha value was 0.847 for test and 0.839 retest. The intra-class correlation for the test-retest reliability was 0.89. The ZBI score was highly correlated with the CBI score (Pearsons correlation coefficient, r=0.909, P=.001). From the exploratory factor analysis six factors comprising 20 items were extracted with Eigen values higher than 1.00 accounting for 69% of the total item variance. In conclusion, ZBI-B is valid, reliable and useful for use in clinical contexts and in future studies that could lead to a better understanding of caregiver burden in dementia

Risk factors for suicide in Bangladesh: case–control psychological autopsy study

Background: Suicide is an important, understudied public health problem in Bangladesh, where risk factors for suicide have not been investigated by case–control psychological autopsy study. Aims: To identify the major risk factors for suicide in Dhaka, Bangladesh. Methods: We designed a matched case–control psychological autopsy study. We conducted a semi-structured interview with the next-of-kin of 100 individuals who died by suicide and 100 living controls, matched for age, gender and area of residence. The study was conducted from July 2019 to July 2020. Results: The odds ratios for the risk factors were 15.33 (95% CI, 4.76–49.30) for the presence of a psychiatric disorder, 17.75 (95% CI, 6.48–48.59) for life events, 65.28 (95% CI, 0.75–5644.48) for previous attempts and 12 (95% CI, 1.56–92.29) for sexual abuse. Conclusions: The presence of a psychiatric disorder, immediate life events, previous suicidal attempts and sexual abuse were found as significant risk factors for suicide in Dhaka, Bangladesh

Cross-national differences in questionnaires do not necessarily reflect comparable differences in disorder prevalence.

PURPOSE: To examine whether the widely used Strengths and Difficulties Questionnaire (SDQ) can validly be used to compare the prevalence of child mental health problems cross nationally. METHODS: We used data on 29,225 5- to 16-year olds in eight population-based studies from seven countries: Bangladesh, Brazil, Britain, India, Norway, Russia and Yemen. Parents completed the SDQ in all eight studies, teachers in seven studies and youth in five studies. We used these SDQ data to calculate three different sorts of "caseness indicators" based on (1) SDQ symptoms, (2) SDQ symptoms plus impact and (3) an overall respondent judgement of 'definite' or 'severe' difficulties. Respondents also completed structured diagnostic interviews including extensive open-ended questions (the Development and Well-Being Assessment, DAWBA). Diagnostic ratings were all carried out or supervised by the DAWBA's creator, working in conjunction with experienced local professionals. RESULTS: As judged by the DAWBA, the prevalence of any mental disorder ranged from 2.2% in India to 17.1% in Russia. The nine SDQ caseness indicators (three indicators times three informants) explained 8-56% of the cross-national variation in disorder prevalence. This was insufficient to make meaningful prevalence estimates since populations with a similar measured prevalence of disorder on the DAWBA showed large variations across the various SDQ caseness indicators. CONCLUSIONS: The relationship between SDQ caseness indicators and disorder rates varies substantially between populations: cross-national differences in SDQ indicators do not necessarily reflect comparable differences in disorder rates. More generally, considerable caution is required when interpreting cross-cultural comparisons of mental health, particularly when these rely on brief questionnaires

Psychiatric Morbidity, Stressors, Impact, and Burden in Juvenile Idiopathic Arthritis

Juvenile idiopathic arthritis (JIA) is a chronic painful disorder conceivably with adverse psychological sequelae that might influence the outcome of the disease and its treatment. This study was designed to detect the presence of psychiatric disorders and associated abnormal psychosocial situations among children and adolescents with JIA and to evaluate their impact on and burden for their caregivers. Forty subjects with JIA suffering for at least one year were included in the study. Forty age- and sex-matched healthy subjects were included as controls. Clinical psychiatric assessment was carried out blindly, and psychiatric disorders and stressors on abnormal psychosocial situation were assigned on the basis of ICD-10 clinical diagnoses of multiaxial classification of child and adolescent psychiatric disorders. Chronicity, distress, social impairment, and burden for others were rated with the impact supplement of the strengths and difficulties questionnaire (SDQ). Of the 40 cases of JIA, 24 were boys and 16 were girls aged 10-18 years, with a mean age of 13.25 years. The frequency of psychiatric disorders was 35% in the JIA and 12.5% in the controlgroup (p <0.001). The long duration of illness was associated with a higher proportion of cases with psychiatric disorders. In the JIA group, the diagnoses in decreasing order were depressive disorder (15%), somatoform disorder (12.5%), adjustment disorder (5%), and mixed anxiety and depressive disorder (2.5%). Significantly higher stressors, perceived difficulties, distress, social impairment, and burden for caregivers were reported in the JIA group with psychiatric morbidity. The presence of psychiatric disorders was associated with substantial impairment of learning, peer relationship, and leisure activities. Early psychiatric intervention might increase the likelihood of satisfactory outcome of treatment in JIA