Resilience and its relationship with disability in persons with bipolar disorder and schizophrenia: A comparative study.

Background: Resilience is the capacity to bounce back from adversity. Severe mental illnesses are associated with poor and heterogeneous functional outcomes. Symptom remission is inadequate to achieve patient-oriented outcome, and positive psychopathology constructs like resilience have emerged as possible mediators. An exploration of resilience and its association with functional outcomes can drive therapeutic endeavors. Aim: To assess and compare the influence of resilience on disability among patients diagnosed and treated for bipolar disorder and schizophrenia in a tertiary care facility. Methods: Study design - Hospital-based, cross-sectional, comparative design; study population - patients of bipolar disorder and schizophrenia with 2-5 years illness and Clinical Global Impression - Severity (CGI-S) <4; sampling procedure - consecutive sampling; sample size - 30 patients each; scales used - Connor-Davidson Resilience Scale (CD-RISC), Indian Disability Evaluation and Assessment Scale (IDEAS), and CGI-S; patients were evaluated with IDEAS, and 15 persons with and without a significant disability were recruited in each group of schizophrenia and bipolar disorder. Results: The mean CD-RISC 25 score for persons with schizophrenia was 73.60 ± 13.87, whereas that for persons with bipolar disorder was 78.10 ± 15.26. For schizophrenia, only CDRISC-25 scores are statistically significant (t = -2.582, P = 0.018) for predicting IDEAS global disability. For bipolar disorder, CDRISC-25 scores (t = -2.977, P = 0.008) and CGI-severity scores (t = 3.135, P = 0.005) are statistically significant for predicting IDEAS global disability. Conclusion: When disability is factored in, resilience is comparable in persons with schizophrenia and bipolar disorder. Resilience independently predicts disability in both groups. However, the type of disorder does not significantly affect the relationship between resilience and disability. Irrespective of diagnosis, higher resilience is associated with lower disability.

Leptin levels in alcohol dependent patients and their relationship with withdrawal and craving.

OBJECTIVE: Association between leptin plasma levels and alcohol craving has been seen previously. This study aims to research this correlation in a different population while comparing this correlation with respect to hyper-excitable state of alcohol withdrawal. METHODS: 25 patients of alcohol dependence were assessed for withdrawal symptoms and craving for alcohol. Leptin levels were measured on 1st day, @ the end of 1st week, @ the end of 3rd week of stopping alcohol. Withdrawal was assessed using CIWA-A at day 1 and day 7, craving was assessed using PENN's scale of craving at week 1 and week 3. Control group consisted of 15 first degree relatives. RESULTS: Leptin levels [t (38) = 2.95, p = 0.005] was significantly higher in alcohol dependent patients. Levels had no significant correlation with alcohol withdrawal scores [Leptin/BMI and CIWA Ar: r = 0.18, p = 0.40 on day 1] but had positive correlation with craving scores [Leptin/BMI and PACS: r = 0.684, p = 0.001]. CONCLUSION: This study shows that leptin, known for balancing the energy homeostasis of body, also seem to play a role in pathways of drug dependence and craving. This relation is independent of stress hormone axis.

Disability associated with mental disorders.

BACKGROUND: Disability associated with mental illness is a major contributor to the global burden of disease. The present study looks at some aspects of disability associated with 7 psychiatric disorders: schizophrenia, bipolar affective disorder, anxiety disorders, depression, obsessive-compulsive disorder, dementia, and mental and behavioural disorders due to the use of alcohol. AIMS: (i) To evaluate the nature and quantity of disabilities in the study groups; (ii) to compare the degree of disability with the severity of the disorder; (iii) to compare disability among various disorders; and (iv) to study the longitudinal stability of disability in the disease groups. METHODS: A total of 228 patients attending the OPD, Department of Psychiatry, Assam Medical College, Dibrugarh, between July 2003 and June 2004, who were diagnosed as per ICD-10 guidelines and SCAN, were included in the study. Severity was assessed by the application of some commonly used rating scales for each specific disorder. The level of disability was assessed by using the Indian Disability Evaluation and Assessment Scale (IDEAS). Patients were followed up at 6 and 12 months. Statistical analysis was done on SPSS version 10. RESULTS: All the 7 disorders under study are associated with significant disability; schizophrenia being maximally disabling. Disability associated with alcohol use disorder and anxiety is comparable to disability on account of OCD. Over a period of 12 months, disability due to depression, alcohol use disorder and anxiety tend to remain significant.