Translation and Psychometric Validation of Belief about Medication Questionnaire in Parents of Children with Difficult-to-Treat Nephrotic Syndrome.

Belief about Medications Questionnaire (BMQ) is a validated tool to assess the beliefs of patients about their medications. The objective was to translate the BMQ in Hindi, and to perform reliability and validity testing of Hindi version in Indian children (aged ≤ 12 y) with difficult-to-treat nephrotic syndrome (DTNS). The BMQ was first translated using the standard translation and back-translation procedure. The BMQ-Hindi was then applied to 110 children with DTNS. The Principal component analysis was performed, and Cronbach alpha (CA) was calculated. Construct validity was tested by assessing the correlation (Pearson r) between BMQ-Hindi scores and Reported Adherence to Medication (RAM-Hindi) scale. The BMQHindi displayed two-factorial (five-item each) structure similar to BMQ-English. The CA was 0.79 and 0.63 for 'necessity' and 'concerns' subscale, respectively and was comparable to BMQ-English. BMQ-Hindi is a valid and reliable tool for Indian children with DTNS to assess parental beliefs about their child's medications.

A study of emotional states in candidates undergoing the diagnostic process for COVID-19.

BACKGROUND: Waiting for results is often associated with a state of anxiety and restlessness. The current study is intended to study the emotional state of people waiting for their results after undergoing COVID-19 testing. METHODS: A descriptive study was done among 140 participants enrolled by simple random technique over a period of 1 month in May 2020. The participants who gave sample for COVID-19 were assessed for their emotional state at two stages - after giving sample and during the waiting period before telling results to them. A self-designed questionnaire focusing on the demographics and emotional state was submitted by the participants distributed to them as Google Forms. Wilcoxon signed-rank test and McNemar test were used to compare the statistical change in emotions over a period of time. RESULTS: Around 63.6% and 68.8% of the participants had neutral emotional state after giving sample and before announcement of results, respectively. The mean score of agreement with decision to test was 9 ± 1.6 and discomfort related to testing was 4.6 ± 2.6 on Likert scale of 1-10. A statistically significant difference (P = 0.01) was observed in mean response for "something can be done to help" after giving sample (1.6 ± 0.4) and before announcement of results (1.8 ± 0.3). CONCLUSIONS: Patients undergoing testing for COVID-19 undergo psychological turmoil and use various coping methods. Patients endorsed various suggestions including quicker generation of results, environmental changes and counselling services to help them cope better. Incorporating these suggestions may improve the diagnostic process in patients with COVID-19.

Effect of clozapine on psychological outcomes of caregivers of patients with treatment resistant schizophrenia.

BACKGROUND: There is limited information on caregiver outcomes of patients with treatment-resistant schizophrenia (TRS). AIM: This study aimed to evaluate the impact of short-term treatment with clozapine (i.e. 3 months) on caregiver burden, expressed emotions, caregiver abuse, and psychological morbidity among the caregivers in patients with TRS. 52 caregivers of patients with TRS were evaluated on the Family Burden Interview Schedule, Perceived Criticism Measure, Caregiver Abuse Screening Questionnaire, and General Health Questionnaire-12. RESULTS: Maximum caregiver burden was seen in the domain of disruption of routine family activities, and this was followed by the domains of disruption of family leisure, disruption of family interaction, and the effect on mental health on others. At the baseline assessment, three-fourth of the caregivers scored ≥12 on the objective burden. With 3 months of clozapine therapy, there was a significant reduction in the caregiver burden in all the domains of objective burden, subjective burden, and the global objective burden as per the clinician rating, in the expressed emotions as per both patients and the caregivers, caregiver abuse, and psychological morbidity among the caregivers. CONCLUSION: To conclude, this study suggests that caregivers of patients with TRS, experience significantly higher caregiver burden, and a large proportion of them suffer from psychological morbidity and indulge in expressed emotions and abuse of the patient. Treatment with clozapine for 3 months leads to a reduction in the caregiver burden, expressed emotions, caregiver abuse, and psychological morbidity among the caregivers.

Attitude towards and experience with clozapine of patients and their caregivers after three months of starting of clozapine.

AIM: To evaluate the patients' perceptions of clozapine and that of their family caregivers about the positive and negative effects of clozapine. METHODOLOGY: 52 patients and their family caregivers were assessed for their perception of the positive and negative effects of clozapine by using a self-designed questionnaire. RESULTS: About half (53.8%) of the patients were not distressed of frequent blood testing. At least two-thirds of the patients acknowledged a reduction in psychopathology, achieving clinical stability, improvement in the behavior of others towards them, improvement in their behavior towards others, improvement in regularity in medication intake, agreed that their clinical state will worsen if clozapine is stopped, and reported overall satisfaction/happiness with the intake of clozapine. In general, caregivers also reported similar perceptions. In terms of caregiver outcomes, about two-third to three-fourth of the caregivers reported a reduction in caregiving needs, personal caregiver distress and tension, caregiver burden and time spent in caregiving. About half of the caregivers reported a reduction in the cost of treatment, since the starting of clozapine. CONCLUSIONS: To conclude, the present study suggests that a significant proportion of patients receiving clozapine for three months and their relatives report positive perception and experience with the molecule.

Cost of the Illness of Treatment-Resistant Schizophrenia: A Mirror Image Study Comparing Clozapine With Other Antipsychotics.

PURPOSE/BACKGROUND: This study aimed to evaluate and compare the cost of illness in patients with treatment-resistant schizophrenia (TRS) during 3 months before starting clozapine and for the initial 3 months of treatment with clozapine. METHODS/PROCEDURES: Fifty-two patients with TRS were evaluated for the cost of illness (direct, indirect, and provider cost) by using a structured questionnaire for the period of 3 months before starting clozapine and then at the end of the 3 months of clozapine therapy. FINDINGS/RESULTS: Total treatment cost for the period of 3 months before starting clozapine was Indian rupees (INR) 40,372 (560.72 US dollars), and the total treatment cost for the first 3 months of clozapine therapy was INR 40,553 (563.23 US dollars). At both the assessments, indirect cost formed the main bulk of the total cost, with no significant difference in the indirect cost. The total direct treatment cost reduced from INR 13,931.6 (193.49 US dollars) to INR 8756 (121.61 US dollars), and the difference between the 2 assessments was statistically significant, with an advantage for clozapine. Overall, after starting clozapine, the total direct cost reduced from 34.5% to 21.6%, and the total indirect cost reduced from 54.3% to 40.2%. After starting clozapine, total provider cost increased from 11.2% to 38.2% of the totalcost. IMPLICATIONS/CONCLUSIONS: Treatment with clozapine is not associated with a significant increase in the overall treatment cost, in the short term. However, there is a significant reduction in direct treatment costs.

Effectiveness of clozapine on quality of life and functioning in patients with treatment-resistant schizophrenia.

BACKGROUND: Although it is well known that treatment with clozapine is associated with improvement in core symptoms of schizophrenia, little information is available about its impact on other outcome variables. Accordingly, this study aimed to evaluate the short term (3 months) effectiveness of clozapine in patients with treatment-resistant schizophrenia (TRS) in terms of quality of life, disability, and level of functioning. METHODS: This naturalistic follow-up study evaluated 52 participants at the baseline and three months (±1 week) after initiation of clozapine (prospective assessment) on Positive and Negative Syndrome Scale for schizophrenia, Calgary Depression Scale for Schizophrenia, Yale-Brown Obsessive-Compulsive Scale Checklist and Scale, Clinical Global Impression (CGI) scale, Beck Cognitive Insight Scale (BCIS), Scale to Assess Unawareness of Mental Disorders (SUMD), Social Occupational Functioning Scale - SOFS, Functioning Assessment Short Test (FAST), Indian Disability Evaluation and Assessment Scale (IDEAS), World Health Organisation Quality Of Life-BREF (WHOQOL-BREF) and Self-report Quality of Life Measure for people with schizophrenia. RESULTS: Treatment with clozapine led to significant improvement in the quality of life, functioning, and disability; reduction in psychopathology (positive, negative, general psychology, depression), the severity of illness, compulsive behavior, and improvement in insight including cognitive insight. CONCLUSIONS: Treatment with clozapine leads to improvement in core symptoms of schizophrenia and is also associated with significant improvement in the quality of life, functioning, and disability.

A Review of Models and Efficacy of Telepsychiatry for Inpatient Service Delivery: Proposing a Model for Indian Settings.

BACKGROUND: The use of telepsychiatry (TP) for inpatient service delivery is still an emerging field and there is limited literature on its practice and evidence. This review was conducted with the objectives of (a) exploring the models of TP for inpatient service delivery, (b) qualitative synthesis of the efficacy of TP in inpatient settings, and (c) proposing a best-fit model of TP-based inpatient care for Indian settings. METHODS: An electronic database search was conducted on July 22, 2020, in PubMed, Directory of Open Access Journals, and Google Scholar for relevant articles. Seventeen articles were included in the review. RESULTS: The review revealed three models for TP-based inpatient care; direct care model, teleconsultation model, and the collaborative care model. Preliminary evidence suggests that TP is cost-effective and reliable, and that patients and service providers are highly satisfied with this approach. Evidence gaps were seen for some diagnostic categories such as psychosis and for extremes of age groups. Based on the existing models, we propose an Indian model for implementing TP in inpatient settings. CONCLUSION: Promising initial results and the evidence gaps highlight the need for further research in this area.

Safety of Use of Clozapine in Patients With Schizophrenia With Comorbid Diabetes Mellitus.

PURPOSE/BACKGROUND: To evaluate the outcome of diabetes mellitus among patients of schizophrenia who had diabetes mellitus before starting clozapine. METHODS: Clozapine data were screened to detect the patients who had diabetes mellitus before starting clozapine. Those who had diabetes mellitus before starting clozapine were taken up for the study. RESULTS: Of the 468 records screened, 28 patients (5.6%) had diabetes mellitus before starting clozapine. Among the 28 patients, 15 (53.6%) were females, and 13 (46.4%) were male. In three-fourths (75%) of the patients, clozapine was started while these patients were admitted to the inpatient unit. Twenty-six patients had type 2 diabetes mellitus and 2 patients had type 1 diabetes mellitus at the time of starting clozapine. Most patients also had deranged blood glucose levels at the time of starting clozapine and required close monitoring of blood glucose levels and also starting/continuation of antidiabetic medications. None of the patients developed diabetic ketoacidosis during the initial part of the treatment. At the mean follow-up duration of 16 months, most patients were on regular follow-up for more than 1 year, and their blood glucose levels were maintained close to the reference range. Majority of these patients showed good response to clozapine. CONCLUSIONS: The present study suggests that presence of diabetes mellitus should not stop the clinicians to use clozapine among patients with schizophrenia. However, close monitoring of blood glucose levels must be done.