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|Year : 2011
: 53 | Issue : 5 | Page
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|Date of Web Publication||3-Apr-2012|
|How to cite this article:|
. Award Papers. Indian J Psychiatry 2011;53, Suppl S1:4-7
| Marfatia Award|| |
Development and validation of the domestic violence questionnaire in married women aged 18-55 years
Indu P.V., Ramadevi S., Vidhukumar K., Anil Kumar T.V., Subha N.
Background : Income partner violence against women is seen in all cultures. It has wide-ranging effects on the physical and psychological health of women. In the local language, available questionnaires are either too exhaustive or inadequate to assess domestic violence comprehensively.
Objective : To develop a Domestic Violence Questionnaire in Malayalam and validate it for married women aged 18 to 55 years in the local population.
Study design : Descriptive study - validation of questionnaire.
Materials and Methods : A 29 - item questionnaire to identify domestic violence over the past one year, along with another item (not included in the total score) to assess the subjective perception of the participant, was developed by selecting items from two other questionnaires and expert opinion. Item reduction was done after pilot testing. Then this 25 item questionnaire was administered to 276 married women aged 18 to 55 years. Reliability and validity were assessed. Factor analysis was done for item reduction. Wrong - loading, poor - loading and cross - loading items were removed from the questionnaire. Taking the subjective perception of the participant as the gold standard, an receiver operating characteristic curve curve was drawn and cut-off score fixed as 5.
Results : The final questionnaire had 20 items - 12 items for psychological and 7 items for physical violence. Internal consistency reliability was 0.92. Sensitivity was 89.5% and specificity 87.2%.
Conclusion : The domestic violence questionnaire in Malayalam has adequate psychometric properties to identify intimate partner violence against women in the local population.
Four-year follow-up of schizoprenia in a rural community: Good outcome and public health implications course of schizophrenia in rural India
Naveen Kumar C., Thirthalli Jagadisha, Suresh Kudumallige K., Venkatesh Basappa K., Arunachala Udupi, Kishorekumar Kengeri V., Subhakrishna Doddaballapura K., Gangadhar Bangalore N.
National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
Background : All districts are expected to be covered under the district mental health programme according to the National Mental Health Programme. Primary health care personnel will be trained to identify and treat psychiatric patients. With regard to severe mental disorders, this may translate into antipsychotic treatment only. It is important to study the impact of such a programme on course and outcome of schizophrenia.
Aims : To study the course and outcome (particularly in terms of disability) of schizophrenia patients identified and initiated on treatment over a four-year period.
Settings and Design : Naturalistic follow-up in rural community.
Materials and Methods : 244 patients identified as part of a community interventionl programme who had completed a minimum of 3 years since recruitment were followed up. 201 of these could be assessed after an average of about 4 years follow-up. Their course and outcomes were assessed using standardized tools.
Statistical analysis : Descriptive statistics was used to describe the data. Analysis of variance and McNemar's test were used to compare the different outcome and adherence groups.
Results and Conclusions : About 70% had satisfactory outcome (42.3% best outcome and 27.4% intermediate outcome). Treatment adherence had a significant role in reducing disability. Treatment with antipsychotics alone can potentially reduce disability in schizophrenia but, the need for psychosocial interventions cannot be undermined.
Psychological distress in survivors of farmers' suicides: A cross sectional comparative study from central part of rural India
Prakash B. Behere, Manik C. Bhise
Departments of Psychiatry and Drug de-addiction Center, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra.
Background : In recent years farmer's suicides are a growing cause of concern in India. Survivors of suicide are known to suffer from psychological distress and are at increased risk of psychiatric morbidity and mortality. There is an urgent need to evaluate and address the psychological needs of survivors.
Objectives : To measure the psychological distress in survivors of farmers' suicide and its relationship with various variables.
Materials and Methods : A cross sectional comparative study was conducted with 98 survivors of farmers' suicide and 98 controls using SRQ-20.
Results : Study has shown that survivors of farmers' suicide have significant high psychological distress as compared to controls (P<0.001). Females are more likely to suffer from psychological distress than males (P<0.001). Prevalence of psychological distress was highest among surviving spouses (85.1%) and parents (66.7%). About one third of survivors had thoughts of committing suicide over past month which was statistically significant as compared to controls (P<0.005). No difference was noted in psychological distress between those who received and did not receive government help.
Conclusions : Survivors of farmers' suicide have significantly high psychological distress. Surviving spouses and parents are most vulnerable. A high proportion of survivors have suicide ideation. Mere financial help is not effective. Special efforts are needed to provide mental health services to survivors of farmers' suicide.
| Bhagwat Award|| |
Comparative study of the experience of caregiving in bipolar affective disorder and schizophrenia experience of caregiving
Department of Psychiatry, PGIMER, Chandigarh, India
Background : Schizophrenia and bipolar disorder are disabling illnesses which also place considerable degree of burden on the caregivers. Many studies from India have tried to measure the burden of care in schizophrenia and some studies have made an attempt to measure the burden experienced by the caregivers of bipolar disorder. Few studies have compared the 2 disorders.
Experience of caregiving is a broader concept which takes into consideration both the negative and positive appraisal of the caregiving. However, no study from India has compared the experience of caregiving in schizophrenia and bipolar disorder.
Aim of the study : To study the experience of caregiving in a group of caregivers of bipolar patients and compare the same with schizophrenia.
Materials and Methods : 90 patients each with a diagnosis of bipolar affective disorder (BPAD) and schizophrenia were selected for the present study. Patients were assessed on hamilton depression rating scale, young's mania rating scale and positive and negative symptoms scale depending upon their diagnosis and thereafter were assessed on Global assessment of functioning scale. Caregivers of the patients were assessed on General health questionnaire and Experience of caregiving Inventory (ECI).
Results : Maximum ECI score negative score was seen in the domain of handling "difficult behaviour" in both the groups. Overall compared to caregivers of the patients with bipolar disorder, caregivers of patients with schizophrenia had more positive and negative appraisal of caregiving experience while caring for their ill relatives. The difference reached significant levels for all domains and total scores except the "effects on family", "good aspects of relationship" and total positive experience sub scores. There was a significant positive correlations between the negative and positive caregiving experience scores for both schizophrenia and the bipolar group.
Conclusion : The caregivers of both schizophrenia and bipolar disorders appraise the caregiving negatively and at the same time appraise some positive aspects of it. Caregivers of schizophrenia appraise caregiving more negatively than those of BPAD patients
Dorsolateral prefrontal lobe volume and neurological soft signs as predictors of clinical, social and functional outcome in schizophrenia a longitudinal study
Rishikesh V. Behere
Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
Schizophrenia is a disorder with variable outcome and the ability to predict the outcome has important clinical utility. Neurological soft signs and dorsolateral prefrontal cortex volumes have been described as trait markers for schizophrenia and their relation to long term outcome in schizophrenia has not been well studied. The aim of this study was to examine the correlation between baseline dorsolateral prefrontal lobe (DLPFL) volume and neurological soft sign (NSS) scores to clinical and functional outcome variables in a cohort of schizophrenia patients who were antipsychotic naive at baseline. Fourteen antipsychotic naive schizophrenia patients whose baseline MRI scans, NSS scores and Positive and Negative Syndrome Rating Scale (PANSS). scores (assessed in drug naive state) were available were reevaluated after a mean follow up period of 74.2+24.2 months. The clinical outcome variables measured was PANSS. The social and functional outcome was assessed comprehensively by the Social Functional Outcome Scale and the Strauss Carpenter outcome scale. The DLPFL, volume was measured from the baseline scans using the region of interest method. Statistical analysis was done using the paired samples 't' test and the Pearson's correlation coefficients. The results showed that smaller left DLPFL volume and greater primitive reflexes at baseline predicted greater negative symptoms and poorer functional outcome on follow up. This study also demonstrates the clinical utility of NSS as a simple bedside tool in assessing schizophrenia patients.
Psychopathology, coping mechanism, quality of life in parents of children diagnosed with autistic disorder
Suresh Patil, Suyog Jaiswal
Department of Psychiatry, T.N.M.C. & Nair Hospital, Mumbai, India
Objective : To evaluate psychopathology, coping mechanisms and quality of life in parents of children with autism.
Materials and Methods : 41 mothers whose children had autism were randomly selected from the outpatient department of a teaching general hospital. The parents were interviewed on a semi structured proforma and also rated on symptom check list-90-revised (SCL-90-R), Mechanisms of Coping and Quality of life scales. The data was analyzed using Pearson's correlation coefficient.
Results : The parents were seen to have high psychopathology on SCL-90-R. Depression was the subscale with the maximum elevation. The General Symptomatic Index, a measure of general distress was extremely high in about 70.7% of the mothers. Most mothers were fatalistic in their approach towards the illness. Quality of life (QOL) was poor in 39% of the mothers. Younger the mother, more the psychopathology and poorer the QOL. Illiteracy and lower education, increases depression, fatalism and worsens QOL. Joint family fosters problem solving, nuclear family have higher general psychopathology. With increase in adult members in the family, though problem solving increased, fatalism persists. Lower the socio economic status, poorer the QOL. Lower the age of child, worse the overall QOL. More the severity of autism, increase in emotional coping such as fatalism and escape avoidance.
Conclusion : autism in children affects the psychological health and quality of life of the mothers. Fatalism was associated with greater depression and thus if active coping strategies are inculcated, it may improve the ability to bear the burden of the illness without becoming themselves affected by psychiatric illnesses.
| Bombay Psychiatric Society Award|| |
Effect of clozapine on spontaneous gamma activity in schizophrenia: A prospective study
Avinash Sharma, Daya Ram
Department of Psychiatry, Central Institute of Psychiatry, Ranchi, India
Background : Electroencephalographic gamma activity derangements occur in schizophrenia. Positive symptoms are associated with increased gamma power, while negative symptoms with decreased power. Aberrant gamma activity, thought to underlie psychotic symptoms, should therefore "normalize" as a consequence of antipsychotic treatment.
Aims : To compare changes in gamma band power at baseline and after 6 weeks of clozapine treatment. Patient and Methods: The changes of gamma1 band (30.5-50 Hz) in the quantitative electroencephalography (qEEG) was recorded prospectively in 20 patients with schizophrenia (ICD-10-DCR) during clozapine treatment on two occasions - before initiation of clozapine at baseline and 6 weeks after clozapine treatment. Psychophathology was assessed using the Positive and Negative Syndrome Rating Scale (PANSS).
Results : Significant reduction in all the PANSS subscales was observed after 6 weeks of clozapine treatment. The absolute power spectrum values of the gamma1 band over the left frontal region showed a significant decrease. The correlation between improvement in positive symptoms after clozapine treatment and reduction in gamma power was not found to be statistically significant.
Conclusions : Likely mechanisms of "normalization" of aberrant gamma activity by clozapine accompanied by improvements in positive symptoms of schizophrenia are discussed. Study findings suggest that the classic dopamine hypothesis may not fully explain the improvements in positive symptoms seen with clozapine treatment.
Psychiatric morbidity among inmates of leprosy homes
K.C. Jindal, Gurvinder Pal Singh, Varinder Mohan, B.B. Mahajan
Department of Psychiatry, G.G.S. Medicall College and Hospital, Faridkot, Punjab, India
Background : Leprosy affected people are having high psychological distress and it in turn leads to psychiatric disorders. There is a paucity of literature from our country in this significant health problem.
Aim : To find the prevalence of psychiatric morbidity and its association with sociodemographic and clinical factors among the inmates of leprosy homes.
Materials and Methods : Study sample was obtained from individuals residing in two leprosy homes of Malwa belt of Punjab. In screening stage, the study subjects were administered sociodemographic proforma and general health questionnaire-12 (GHQ-12). In the confirmation stage, the study subjects were interviewed in detail and disability assessment was done using world health organization disability scale. Final psychiatric diagnosis was made as per international classification of diseases (ICD-10) criteria's. Statistical analysis was done using descriptive statistics, chi square test, analysis of variance and correlation analysis.
Results : Majority of the subjects were in the age group 41-50 years, female, married, illiterate, Hindu and were from nuclear families. 50.38% of subjects were having GHQ-12 score more than twelve. 55.6% subjects were having psychiatric disorders out of which large number of patients were diagnosed as having dysthymia. The other psychiatric disorders found in study population were moderate depressive episode, generalized anxiety disorder, mixed anxiety and depressive disorder and schizophrenia unspecified. Psychiatric morbidity was found to be significantly related to age, family status, duration of leprosy illness and presence of deformities among inmates.
Conclusion : This study highlighted that psychiatric disorders were found in large number among inmates of leprosy homes. Leprosy eradication programme must place specific emphasis on psychiatric care of these patients.
Attitude towards mental illnesses among paramedical professionals and junior doctors
Chintan K. Solanki, G.K. Vankar, M.N. Prikh
Department of Psychiatry, B.J. Medical College, Civil Hospital, Ahmedabad, Gujarat, India
Background : Attitudes of paramedical and medical professionals to psychiatric illness are important for referral and use of mental health facilities by general people. Knowledge of psychiatric disorders and experience of working with psychiatric patients may be responsible for positive attitudes.
Aim : Our aim was to assess attitude towards different mental illnesses among different paramedical professionals and to know impact of education and work experience on attitudes towards mental illnesses.
Materials and Methods : We included nursing staff, nursing students and junior doctors from our hospital and students of clinical psychology from a private deaddiction centre. Study design was cross sectional. Attitudes to Mental illness Questionnaire was used with modifications and addition of demographic details. Experience of working with psychiatric patients and of attending mental health primary care program also were included.
Results : Attitudes towards drug abuse, depression, alcohol abuse and schizophrenia were negative. Anxiety spectrum disorders, conversion and dissociative disorder showed positive attitudes. Subjects with experience of working with psychiatric patients and experience of mental health primary care showed more positive attitudes.
Conclusions : There is need of developing program containing knowledge of mental health and practical experience of psychiatric patients in curriculum of paramedical and medical profession and of restructuring present curriculum to develop positive attitudes to mental illnesses for benefit of community.
| Young Psychiatrist Award|| |
Mothers of children with developmental disabilities (an analysis of psychopathology)
Avinash De. Sousa
Visiting School Psychiatrist Mumbai, India
Background : Mixed feelings are seen in parents of children with developmental disabilities. Anxiety, depression, guilt and sorrow are rampant in their lives. Mothers undergo a lot of stress to bring up these children. The aim of this study was to compare the psychopathology in mothers of autistic chlidren with mothers of mentally retarded children.
Materials and Methods : 300 mothers each of children with mental retardation were rated on the Back Depression Scale, Toronto Alexithymia Scale, State- Trait Anxiety inventory and symptom Checklist-90 Revised. The data was tabulated and statistically analyzed.
Results : Mothers of autistic children had significantly greater depression than mothers of mentally retarded children (P=0.0481). Anxiety state and trait scores were significantly higher in these groups though psychopathological anxiety was absent (P=0.0057, P=0.0002). Mothers of mental retarded children had greater alexithymia scores and a significant majority of them had alexithymia of pathological nature (P=0.0001). They also had higher somatization scores on the symptom check list-90 (P=0.0031) while autistic mothers reflected greater anxiety (P=0.0016) and general symptomatology index scores (P=0.0021).
Conclusions : The psychopathology in mothers of children with developmental disabilities warrants attention in any program designed to treat children with autism and mental retardation.
Effects of lithium-ect combination treatment: A comparative study
Department of Psychiatry, NIMHANS, Bangalore, India
Background : Psychiatrists are often faced with the issue of combining lithium and electroconvulsive therapy (ECT). Studies of good scientific standard, examining the safety of their combination, are sparse.
Objectives : To compare patients who were on treatment with lithium on and those who were not on lithium with regard to adverse effects while receiving ECT.
Materials and Methods : Consecutive inpatients with a diagnosis of schizophrenia, non-organic (n=28) on lithium were recruited into the study. Researchers who were blind to lithium-status studied with succinyl choline, cardiovascular responses, seizure parameters, recovery from ECT and for any immediate post-ECT complications.
Results : The lithium group showed no significant difference in terms of seizure variables, apnea time, and recovery from anesthesia when compared to the non-lithium group. There was a significant difference in terms of hemodynamic response in the lithium group. Average maximum heart rate, average maximum systolic blood pressure and average maximum rate pressure product were significantly lower in patients who had combined lithium and ECT.
Conclusions : In relatively younger patients, whose serum lithium level is at the lower side of therapeutic range and those who have no high risk factors, the combination of ECT and lithium is likely to be safe. This may be therapeutically advantages in some patients.
Immunological abnormalities in drug naive, comorbidity free obsessive compulsive disorder
Naren P. Rao
Department of Psychiatry, NIMHANS, Bangalore, Karnataka, India
Background : Growing evidence in the last decade suggest significant role of immune alterations in pathogenesis of Obsessive compulsive disorder (OCD). Interestingly, Cytokines, result in a hyposerotonergic - hyperglutamatergic state, well known in pathogenesis of OCD. However, only few studies have examined cytokine abnormalities in OCD and result are inconsistent, possibly due to confounding effects of comorbidity and medications. For the first time, we studied immune abnormalities in Drug-naive, comorbidity-free OCD patients. Methodology : This study examined 20 comorbidity-free Diagnostic and statistical manual of mental disorders-IV-OCD patients (17-Drug-naive; 3-Drug-free) and 40 age-sex-matched healthy controls. After clinical assessments using Yale Brown Compulsive Scale (YBOCS), Hamilton anxiety rating scale (HARS), Hamilton depression Rating scale (HDRS), Clinical Global Impression (CGI), cytokines (Interleukin-2,4,6,10,17A, Tumor-necrosis-alpha, Interferon gamma) were assessed using Cytometric-Bead-Array-Cytokine-Kit (BD-Biosciences, San Jose, USA). Assessments were repeated after 12 weeks of treatment Results : At baseline, OCD patients had significantly higher levels of IL-2 (patients = 1.90+1.31; - controls = 0.82+1.11; P=0.001), IL-6 (patients = 2.01+1.54; - controls = 0.73+1.00; - P<0.001) and IL-10 (patients = 1.31+0.82; controls = 0.54+0.82; P=0.002) than controls. There was significant decrease in IL-0 levels after treatment. There was significant negative correlation between age-at-onset (18.70+7.07) and IL- 6-levels (Pearson-correlation = 0.62; P=0.003). There was a trend level negative correlation between baseline IL-2-level and follow-up-CGI-Improvement (P=0.029; Pearson's-Correlation = 0.58,). Discussion : This first time study in comorbidity free drug naive OCD suggests patients to have elevated cytokine levels than controls. Abnormalities are predominantly in T-cell mediated immune response. Presence of abnormalities in drug naive status suggests the possible role immune abnormalities in pathogenesis of OCD. Correlation between age at onset and II-6 level suggests probable differences in pathogenesis of childhood and adult OCD. Study findings have potential clinical utility in development of novel therapeutic options targeting immune system in OCD. The novel finding, correlation between IL-2 and clinical improvement, raises the possibility of immune abnormalities being potential prognostic indicator.
Culture and depression - A study of the association of depression with cultural change in havik brahmin women of south India
Pavitra K.S., Sridhara K.R.
Sridhara Neuropsychiatric Centre, Rajendra Nagar, Shimoga, Karnataka, India
Considerable attention has been given to cultural research in psychopathology. With widely prevalent cultural heterogeneity in India, the provision of appropriate clinical care depends upon understanding sub cultural differences in the experience and presentation of depression. Our study aimed at studying the prevalence of depression in women belonging to Havik Brahmin Community, elaborating the psychosocial problems, coping skills in the background of cultural changes in this particular community in the last 15 years. Two hundred Havik women randomly selected from the Havik directories, who met the eligibility criteria were interviewed with general health questionnaire 28, mini international neuropsychiatric interview plus 5.0.0 questionnaire, coping check list, semi structured questionnaires for psychosocial problems and gender disadvantage factors. The important changes noted in the last 15 years in Havik society were increase in education levels in females, laborer problem for household work increase in difficulty in getting a girl for marriage for boys residing in villages. Of the whole sample 24.5% met criteria for life time episode of major depression. Depressed women significantly had more of poor quality of marital relationship, nicotine use in spouse, domestic violence, joint family problems, and loneliness. The depressed women used significantly more of coping skills in denial/blame domain. The changes depression in particular appear to have multiple clinical implications. Hence it is important that the mental health professionals should focus on the issue of phenomenology, course and outcome of mental disorders being dependent upon multiple socio cultural factors.
Source of Support: None, Conflict of Interest: None