Attitude to Medication and Insight in Patients with Schizophrenia.

INTRODUCTION : Schizophrenia, with an approximate lifetime risk of 1 in 100, and an annual incidence of 0.5 to 5.0 per 10,000, is one of the leading causes of disability in the world. As per the assessment of leading cause of years lived with disability, worldwide statistics showed that schizophrenia ranks ninth in the order among various other disorders that causes disability to an individual. OBJECTIVES : 1. To assess the level of insight and attitude towards medication in patients with chronic Schizophrenia. 2. To determine factors associated with insight and attitude to medication in patients with chronic schizophrenia. 3. To determine the relationship between insight and attitude to medication in this group of patients with chronic schizophrenia. METHODS: A cross-sectional survey of insight into the illness and attitude towards medication of consenting patients suffering from chronic schizophrenia using the schedule for assessment of insight (SAIE) and drug attitude inventory (DAI). Clinical assessment of psychopathology using PANSS and assessment of treatment adherence using subjective (Morisky Scale) and objective (chart review) were done to supplement assessment of relation between severity of illness, insight, attitude towards medications and compliance to medications in consecutively recruited outpatients. Data was analyzed using chi square statistics for significant association with a corresponding p value of less than 0.05 suggesting statistically significant association between the variables. RESULTS: All the 101 patients suffering from chronic schizophrenia were found to be mild to moderately ill in terms of psychopathology and had good to moderate insight into their illness. Those who had good insight into their illness expectedly had a favorable attitude towards medications. The degree of psychopathology was inversely correlated with insight into the illness and compliance to medications. Compliance to medications is a larger complex construct which seems to be affected by the severity of illness; however neither good insight into the illness nor a favorable attitude towards medications seems to significantly alter the rates of compliance to treatment. CONCLUSIONS : In this study population of patients with schizophrenia who regularly attend the outpatient department, the majority were females, aged less than 35, married, unemployed, belonging to the low socio economic class, residing in the rural areas, Hindu by religion, having a continuous course of disorder with mild severity, manifesting good insight, noncompliant with medication as per the Morisky scale and compliant as per the chart review and with no physical comorbidity or substance use or family history of any psychiatric morbidity. There was significant negative correlation between the total insight score as per SAI E and the total PANSS ( p value 0.007). Majority of patients (95 %) of this study population had a favourable attitude to medication. PANSS severity and Drug attitude inventory (DAI 10) showed a negative association (p value =0.001) in that the more the psychopathology the less favourable was the attitude towards medication. According to the Morisky scale, the patients were less compliant regardless of the psychopathology as assessed by PANSS (0.046). As per the chart review however it was seen that patients with mild psychopathology were more compliant compared to those patients with moderate psychopathology. (p=0.047). PANSS score was associated with insight, attitude to medication and compliance as assessed by the different tools. However insight was not related to compliance or attitude to medication

A case of virilising steroid cell tumour of ovary

A middle aged female patient presented to our Gynaec OPD with acute onset of virilising symptoms and vague abdominal pain. The patient’s biochemical values were normal except for a raised serum testosterone level and a raised CA125 level. Ultrasound and Computed tomography revealed an ovarian mass with mild ascites that appeared to be a yellowish solid ovarian tumour on gross examination. Microscopic examination showed a neoplasm composed of medium sized cells with clear cytoplasm and some with eosinophilic granular cytoplasm. The diagnosis of Benign steroid cell tumour of ovary, not otherwise specified (NOS-type) was made. The case is presented for its rarity

Clozapine re-challenge under the cover of Filgrastim

Rechallenge with clozapine, despite a history of clozapine-induced neutropenia is considered in patients with a good response to the drug in the past, for whom no other treatments are effective, and in cases where the risks of withholding treatment are greater than the risks of rechallenge. Dyscrasias that occur during rechallenge are reportedly earlier in onset and longer lasting. Strategies advocated during rechallenge include frequent monitoring of white blood counts, the use of lithium or Granulocyte-Colony Stimulating Factors. We report a case of a patient with treatment-resistant schizophrenia who developed neutropenia with clozapine as a result of which the drug was discontinued. However poor response to other first and second-generation antipsychotic medication and the persisting risk of harm to himself and others necessitated the reconsideration of clozapine. The patient was re-challenged with clozapine under the cover of Filgrastim, a Granulocyte-Colony Stimulating Factor

Simplified Method for the Determination of Total Kjeldahl Nitrogen in Wastewater

The increase in total Kjeldahl nitrogen (TKN) concentrations is correlated with increases in cyanobacterial bloom biomass. Standard methods for the measurement of TKN are tedious, costly, time-consuming and involve the use of hazardous catalysts, such as mercury, high temperatures and significant amounts of toxic acids and bases. Since TKN plays a pivotal role in influencing algal blooms, there is an urgent need to develop simpler, safer and more accurate methods for the determination of TKN. The simplified TKN method (s-TKN™) developed by Hach® offers several advantages over the traditional TKN method, including eliminating the use of mercury, requiring low sample and reagent volumes and being cost-efficient and user-friendly. This communication presents preliminary results comparing the efficacy of s-TKN™ and the standard method, using commonly used primary standards and waste, estuarine and lake water matrices. For all primary standards analyzed, the s-TKN™ method exhibited good accuracy across a wide range of concentrations. The repeatability for the glycine–para-toluene sulfonic acid (Gly-PTSA) standard using the s-TKN™ method was 4.1% at the highest concentrations analyzed, with overall repeatability across concentrations comparable to the standard EPA method. For wastewater, estuarine and lake matrices, a good correlation (r2 = 0.9917) between the two methods and no statistical difference in the values (p > 0.05) were obtained between two methods. Preliminary studies indicate that the s-TKN™ method has the potential to reduce the expenditure associated with the cost of analysis and has the potential to be a safer and cheaper alternative, while providing comparable analytical results to the standard method

Simplified Method for the Determination of Total Kjeldahl Nitrogen in Wastewater

The increase in total Kjeldahl nitrogen (TKN) concentrations is correlated with increases in cyanobacterial bloom biomass. Standard methods for the measurement of TKN are tedious, costly, time-consuming and involve the use of hazardous catalysts, such as mercury, high temperatures and significant amounts of toxic acids and bases. Since TKN plays a pivotal role in influencing algal blooms, there is an urgent need to develop simpler, safer and more accurate methods for the determination of TKN. The simplified TKN method (s-TKN™) developed by Hach® offers several advantages over the traditional TKN method, including eliminating the use of mercury, requiring low sample and reagent volumes and being cost-efficient and user-friendly. This communication presents preliminary results comparing the efficacy of s-TKN™ and the standard method, using commonly used primary standards and waste, estuarine and lake water matrices. For all primary standards analyzed, the s-TKN™ method exhibited good accuracy across a wide range of concentrations. The repeatability for the glycine–para-toluene sulfonic acid (Gly-PTSA) standard using the s-TKN™ method was 4.1% at the highest concentrations analyzed, with overall repeatability across concentrations comparable to the standard EPA method. For wastewater, estuarine and lake matrices, a good correlation (r2 = 0.9917) between the two methods and no statistical difference in the values (p > 0.05) were obtained between two methods. Preliminary studies indicate that the s-TKN™ method has the potential to reduce the expenditure associated with the cost of analysis and has the potential to be a safer and cheaper alternative, while providing comparable analytical results to the standard method

Believing and acting on fake news related to natural food:the influential role of brand trust and system trust

Abstract Purpose: Fake news represents a real risk for brands, particularly for firms selling essential products, such as food items. Despite this anecdotal acknowledgement, the dynamics of the relationship between fake news and brand reputation remain under-explored. The present study addresses this gap by examining the association of consumer values (universalism and openness to change), brand trust, fake news risk and system trust in the context of natural food products. Design/methodology/approach: The study utilised a cross-sectional survey design and the mall-intercept method to collect data from 498 consumers of natural food residing in India. To test the hypotheses, which were grounded in the stimulus-organism-response (SOR) framework, the collected data were analysed using covariance-based structural equation modelling in SPSS AMOS. The conceptual model proposed universalism and openness to change as stimuli, brand trust as an internal state or organism and fake news risk — captured through the tendency of consumers to believe and act on fake news — as a response. Findings: The findings support a positive association of universalism with brand trust and a negative association with fake news risk. In comparison, openness to change has no association with either brand trust or fake news risk. Brand trust, meanwhile, is negatively related to fake news, and this association is moderated by system trust. Furthermore, brand trust partially mediates the relationship between universalism value and fake news risk. Originality/value: Notably, the present study is one of the first attempts to understand the fake news risk associated with natural food brands by utilising the SOR framework in an emerging market setting. The study provides interesting insights for policymakers, brands and consumers