Prevalence and clinical correlates of psychiatric morbidity among caregivers of patients attending a psychiatric hospital in North India

Background: Consequent to the high prevalence of psychiatric disorders in present day world, their caregivers form an important group in the public health. Research on the physical and psychological well-being of caregivers is being carried worldwide with varied results. Psychological health of these caregivers is usually ignored both by these persons themselves and the health-care providers. The objective of the study was to screen for psychiatric morbidity among caregivers of patients attending a psychiatric hospital in North India, and to study the clinical correlates of the same.Methods: A total of 205 patients and their caregivers were consecutively recruited over a one month period. Sociodemographic and clinical information of patients was obtained either from the hospital records or from the caregiver. Scoring of the patient’s global assessment of functioning (GAF) was done by clinicians. The caregivers were administered a sociodemographic questionnaire, general health questionnaire (GHQ-12) and Zarit Burden interview. The presence of psychiatric morbidity was confirmed by a consultant psychiatrist.Results: Among the caregivers, 32.2% had GHQ scores of 3 and above. Majority of caregivers in this study were females (59.0%) while as majority of the patients were males (61.9%). Factors associated with psychiatric morbidity among caregivers include the high level of subjective burden of care, low level of functioning, and comorbid medical and psychiatric conditions.Conclusions: The study reveals a high level of psychiatric morbidity among the caregivers of patients with mental health problems

Effect of ketamine infusion in treatment resistant depression and in depressive patients with active suicidal ideations: a study from North India

Background: Treatment resistant depression can be a life-threatening condition as it leads to an increase of suicide attempts by two to three folds. It has been estimated that nearly 1 million people die due to suicide every year, and more than two-third of these cases occur when the person is undergoing a major depressive episode. Ketamine is an NMDA receptor antagonist, an anesthetic agent that is short acting and has recently been used as an antidepressant and anti-suicidal agent. It has been seen that a single intravenous infusion of ketamine at a lower dose. i.e., subanesthetic dose of 0.5 mg/kg over a period of 40 minutes produces antidepressant effect which lasts for about a week and various studies have proved that repeated infusions of ketamine can prolong the duration of the antidepressant response. Methods: It was an observational/descriptive study done in the ketamine clinic/ECT suite of institute of mental health and neurosciences Kashmir (an associate hospital of government medical college Srinagar) which runs once a week. In this study, patients satisfying the criteria of TRD and depressive patients with active suicidal ideations, visiting the ketamine clinic who had given a valid informed consent for ketamine infusion enrolled and observed for ketamine efficacy by using specific scales. The study done over a period of 18 months from January 2020 till July 2021. Results: The response rate of ketamine in our study for treatment resistant depression was 70.27%. The response rate of ketamine for suicidality in our study was 63.16%. Our study showed a rapid onset of action for ketamine, two hours after ketamine infusion. Conclusions: A significant fraction of patients suffering from major depressive disorder do not respond to antidepressants and have a poor psychosocial functioning and an increased risk of suicide attempts making their condition life threatening. These patients therefore require special attention to address their underlying condition as well as suicidality to improve their outcome. In this context we studied the role of intravenous ketamine infusion in these patients in improving the psychosocial outcome as well as preventing the suicidal ideation.

Knowledge and attitude of patients and their relatives towards electro-convulsive therapy: a study from a tertiary care centre in Northern India

Background: Electro-convulsive therapy (ECT) has been effective in various psychiatric disorders and is life-saving in some conditions. Despite its effectiveness and lack of serious side-effects, its use is restricted due to negative attitude of patients and their relatives towards ECT. The objective of the study was to study the attitude of patients and their attendants towards ECT. Also, we studied their knowledge regarding ECT prior to the administration of ECT.Methods: A 16 item questionnaire was formulated to be used for assessing the attitude and knowledge about ECT and was administered after translating it into Urdu language for better understanding. Patients planned for ECT were administered the questionnaire after taking consent. A total of 60 patients and 60 attendants were taken up for the study.Results: About 60-70% of patients gave correct (right) responses to questions like ECT being life-saving procedure, need of investigations before ECT and other questions like question numbers 1,5,6,7,11,14,15. There was little knowledge regarding other areas like use of ECT in pregnant females and elderly (question numbers 2, 4, 10, 12). The patients as well as their attendants did not differ significantly in the responses given to the queries. Maximum number of patients received knowledge regarding ECT from doctors; few had attained it from other sources like internet.Conclusions: The study is a preliminary one and emphasizes the need for better standardized questionnaire for proper assessment. It also gives us an insight into lack of knowledge among patients and their attendants regarding ECT

Socio-demographic and Clinical Profile of Substance Abusers Attending a Regional Drug De-addiction Centre in Chronic Conflict Area: Kashmir, India

Background: The menace of substance abuse is not only a socially unacceptable reality, but in its entirety is a disease and emerging as a major public health challenge. Objective: To study the socio-demographic and clinical profile of patients attending the drug de-addiction centre. Methods: A descriptive study was undertaken in a drug de-addiction centre at the Police Hospital in Srinagar, and all patients (198) who were admitted during this period were interviewed. Results: The mean (SD) age of patients was 26.8 years (SD 7.37), and over half (56%) belonged to the lower-middle social class. Poly-substance abuse was seen in 91.9%; medicinal opioids and cannabis were the most common substances abused. Most common age of initiation was 11–20 years (76.8%), with peer pressure and relief from a negative mood state being the most common reasons given for starting the drug(s). Prevalence of a co-morbid psychiatric disorder was high, on the order of 49.5%. A high rate of volatile substance use was observed among adolescents (54.5%). Conclusion: A pattern of poly-substance abuse was found to be quite common in patients, and use of volatile substances at a very young age emerged as a new trend. The dreadful repercussions of substance abuse justify the urgency to evolve a comprehensive strategy

Diabetes mellitus and impaired glucose tolerance in patients with schizophrenia, before and after antipsychotic treatment

Background: Treatment with antipsychotics increases the risk of developing diabetes in patients of schizophrenia but this diabetogenic potential of different antipsychotics seems to be different. Moreover, there may be an independent link between schizophrenia and diabetes. So we plan to study the prevalence of glucose dysregulation in patients of schizophrenia before and after treatment with various antipsychotics. Materials and Methods: Fifty patients (32 males and 18 females) diagnosed with schizophrenia were evaluated for glucose dysregulation using oral glucose tolerance test, initially (drug naive) and after antipsychotic treatment. Age- and sex-matched healthy volunteer group of 50 subjects (35 males and 15 females) was taken for comparison. Results were interpreted using American Diabetic Association criteria. Results: Though the glycemic status of the patient group was comparable with healthy controls initially but antipsychotic treatment was associated with glucose dysregulation. For first 6 weeks the antipsychotic (olanzapine, risperidone, haloperidol and aripiprazole)-induced glucose dysregulation was comparable, which was seen to be maximum with the olanzapine-treated group at the end of this study, 14 weeks. Conclusion: We conclude that antipsychotic treatment of nondiabetic drug naive schizophrenia patients was associated with adverse effects on glucose regulation. For initial 6 weeks the antipsychotic-induced glucose dysregulation was comparable, which was seen to be maximum with olanzapine at the end of study, i.e. 14 weeks. Keeping this at the back of mind we can stabilize a patient initially with a more effective drug, olanzapine, and later on shift to one with less metabolic side effects

Prevalence of psychiatric morbidity among school-going adolescents in the age group of 13–19 years

Abstract Background Adolescent mental health problems are vast and varied and early identification and intervention can be of utmost help. There is sparse data on mental health issues in the adolescent population from India in general and J&K in particular; thus, it was decided to embark on this study. Results The prevalence of various psychiatric disorders among school-going adolescents was as major depressive disorder 13.7%, obsessive compulsive disorder 4.0%, panic disorder 1.4%, self-harming behavior 2.5%, generalized anxiety disorder 2.5%, social anxiety disorder 2.2%, dysthymia 1.7%, and adjustment disorder 0.8%. There was no statistically significant difference in the overall psychiatric morbidity group among males and females (P = 0.90). However, panic disorder and borderline personality disorder as a group were more commonly found among females compared to males (P = 0.016 and 0.001 respectively). Also, 34% from urban and 28% from rural areas met the criteria for any psychiatric disorder (P = 1.38). Conclusion Children and adolescents represent a tender part of the human life cycle and they may be at a higher risk of psychiatric disorders. There is a very high prevalence of psychiatric morbidity of any kind among adolescents in Kashmir, many of which are unidentified and thus untreated. Depression is the most common psychiatric illness among adolescents with a higher prevalence in males while anxiety disorders are more common among females. There is a need for further research in this age group and teachers and parents need psycho-education for the identification of such children

Prevalence of psychiatric disorders in patients with a diagnosis of polycystic ovary syndrome in Kashmir

Background: Polycystic ovary syndrome (PCOS) is one of the common endocrine disorders and is associated with reproductive, metabolic, and psychological disturbances affecting one in five women of reproductive age group. Objective: To investigate the prevalence of psychiatric disorders among women in ambulatory treatment with a diagnosis of PCOS. Materials and Methods: One hundred and ten patients of PCOS were evaluated using Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition criteria by means of Mini International Neuropsychiatric Interview, English version 5.0.0. Diagnosis of PCOS was confirmed according to the National Institute of Health/National Institute of Child Health and Human Development, 1990 consensus conference criteria. Forty subjects without PCOS who were matched for age and body mass index were taken as a comparison group. Results: About 23% of cases had major depressive disorder as compared to 7.5% of controls, 1.8% had dysthymia, 15.45% had panic disorder compared to 5% of controls, 6.36% had obsessive compulsive disorder compared to 2.5% of controls, 8% cases had suicidality, 2.72% of cases were bipolar affective disorder, and 15.45% had generalized anxiety disorder (GAD). Conclusion: A high prevalence of mental disorders was observed, especially major depression, panic disorder, and GAD in patients with PCOS in our study. The results suggest that screening and appropriate management for psychiatric disorders should be part of the routine evaluation of these patients