Psychosocial Correlates of the Experience of Caregiving Among Caregivers of Patients With Schizophrenia.

BACKGROUND: Family caregivers provide essential support to their loved ones with schizophrenia with profound outcomes for themselves. The caregiver burden fails to consider the entire caregiving experience, which also incorporates positive aspects of caring. Many potentially significant variables are associated with this. AIM: To examine the correlates of the experience of caregiving in caregivers of patients with schizophrenia. The specific objectives were to examine the socio-demographic variables of the patients and caregivers, clinical variables of the patient, caregivers' knowledge of illness, caregivers' perspectives of family functioning, caregiver coping, their social support, psychological distress, quality of life, and their spirituality, religiosity and personal beliefs and the associations of these variables with the caregivers' experience of caregiving. METHODS: This cross-sectional observational study was conducted between August 2018 and January 2021 at All India Institute of Medical Sciences, New Delhi, India. One hundred and fifty-eight dyads of patients with schizophrenia and their family caregivers were recruited using purposive sampling. Experience of Caregiving Inventory was used to evaluate the caregiving experience. The caregivers were also assessed on socio-demographics, knowledge of illness, family functioning, coping, social support, general mental health, quality of life, and spiritual, religious, and personal beliefs. Patient socio-demographics and clinical variables were also assessed. RESULTS: A negative experience of caregiving was reported by caregivers of patients who had higher positive or negative symptoms of schizophrenia. Impaired Communication, Roles, Affective Responsiveness, Affective Involvement, and General Functioning aspects of family functioning were associated with a negative experience of caregiving. Denial/blame and seeking social support as coping were also associated with a negative experience of caregiving. A negative experience of caregiving was significantly positively correlated with greater psychological distress and poorer quality of life. Greater inner peace was associated with a less negative experience of caregiving. Spiritual strength was associated with a more positive experience of caregiving. Knowledge of mental illness and caregiver social support were not significantly associated with the experience of caregiving. CONCLUSION: Experience of caregiving is a relevant construct, the understanding of which can help inform caregiver-directed interventions in the future. Specifically, family-based interventions, which include ameliorating patient symptomatology, improving the family environment, strengthening caregivers' coping strategies, attending to caregiver distress, and encouraging spirituality among caregivers, may lead to a less negative and more positive experience of caregiving; and a better quality of life for caregivers.

Changes in Psychosocial Variables Among Caregivers of Patients With Schizophrenia: A Short-Term Follow-Up Study.

BACKGROUND AND AIMS: Caring for a person with schizophrenia entails considerable effort. The caregiving experience while caring for a person with schizophrenia has been described as both stressful and enriching. The literature on changes in caregiving experience with time has been fairly limited. The present analysis looks at the change in the caregiving experience of caregivers of patients with schizophrenia. METHOD: This study had a sample of 50 caregivers of patients with schizophrenia who were followed up after a period of 6 to 10 months. Caregiving experience, knowledge of the mental illness, family functioning, coping, social support, psychological distress, quality of life, and spiritual, religious, and personal beliefs were assessed at the two time points. RESULTS: Among the negative caregiving experiences, caregivers' need for back-up and patient dependency reduced significantly at follow-up as compared to baseline, though total negative or positive experiences of caregiving did not show a significant difference. Knowledge about mental illness did not significantly increase at follow-up, though issues related to poor communication and affective involvement in family functioning reduced over the period of time. Coping and social support remained largely the same, while psychological distress was reduced. All domains of quality of life improved over the follow-up period, while the hope, optimism, and inner peace aspects of spiritual, religious, and personal beliefs improved with time. CONCLUSION: Some aspects of caregiving experiences may change with time. As caregivers become more adjusted to caregiving roles, their distress may reduce, and their quality of life may improve.

Pattern of adult psychiatric emergencies at a tertiary care center before and after the onset of the COVID-19 pandemic.

A gap exists in published data on psychiatric emergencies presenting to Indian centers over the entire pandemic. We assessed 2,048 consecutive adult psychiatric emergencies for the period April 2019-September 2021 to compare 18 months following the onset of the pandemic, with the pre pandemic year as the control. Mean age was 33.8 ± 13.6 years, with 55% females. The proportion with ICD-10 schizophrenia and related psychotic disorders (18.9% vs 15.3%; P = 0.031), mood disorders (21.8% vs 18.1%; P = 0.038), and personality disorders (3.8% vs 2%; P = 0.018) showed a significant increase during a pandemic, while those with no diagnosable illness reduced (28.6% vs 34.3%; P = 0.006). Suicidality was the reason for referral in 43%, comparable to pre pandemic year. Those with stay ≥24 hours increased (14% vs 11%; P = 0.034). Benzodiazepines remained the commonly prescribed medication, but a notable rise was seen in mood stabilizer prescriptions.

Challenges for setting up psychiatric services in a trauma centre in India.

Psychiatric sequelae may occur following traumatic injury irrespective of whether an insult has been caused to the brain. A range of psychiatric illnesses have been either causative of or associated with road traffic accidents and traumatic injuries, including depression, anxiety, post-traumatic stress disorder, substance use disorder and attention-deficit hyperactivity disorder. Despite literature on such associations, psychiatric intervention in the treatment of patients following traumatic injury is limited. The authors share their experience of challenges in addressing mental health problems in a tertiary care trauma centre located in North India. Steps in overcoming those challenges included: developing a semi-structured form to be completed for referrals and consultations, a psychiatrist attending weekly rounds with the surgeons, and initiating a psychiatry out-patient clinic for patients discharged from the trauma centre. It may be worthwhile in the future to set up a trauma psychiatry unit at the centre, involving a clinical psychologist, a psychiatric social worker and an occupational therapist for the comprehensive care of patients.

Somatic symptoms in schizophrenia: Association with socio-demographic and clinical characteristics, disability and quality of life.

Background and Aims: There is lack of research on somatic symptoms in schizophrenia. We aimed at finding prevalence and types of somatic symptoms in patients with schizophrenia and assessed their association with socio-demographic and clinical characteristics. Methods: We assessed somatic symptoms using Patient Health Questionnaire-15 (PHQ-15) in 93 patients with schizophrenia diagnosed on ICD10-DCR. Scale for Assessment of Positive Symptoms and Scale for Assessment of Negative Symptoms, WHO Disability Assessment Schedule 2.0, WHO Quality of Life (BREF) Hindi version and Liverpool University Neuroleptic Side-Effect Rating Scale were used to assess psychopathology, disability, quality of life and side effects. Results: Significant somatic symptoms (n ≥5 on PHQ-15) were present in 62 (67.7%) patients with schizophrenia. Forty three (69.4%) had mild (n = 5-9 on PHQ-15), 17 (27.4%) had moderate (n = 10-14 on PHQ-15), and only 2 (3.2%) had severe (n = ≥15 on PHQ -15) somatic symptoms. Mean somatic symptoms score on PHQ-15 was 7.28 (± 3.83); 96.8% reported feeling tired, 76.3% had constipation or diarrhoea, 67.7% trouble in sleeping, 61.3% nausea or indigestion, 52.7% back pain and 51.6% headache. Patients with somatic symptoms were older in age, had longer duration of illness and treatment, and had more negative symptoms. They had higher disability and poor quality of life especially in physical domain. Conclusion: Somatic symptoms are common in patients with schizophrenia and are associated with chronicity, refractoriness and negative symptoms, significant disability and poor quality of life. Thus during routine clinical practice, somatic symptoms should be assessed and managed in these patients.

A Prospective Three-Months Naturalistic Follow-Up Study of Outcomes of Patients with Opioid Dependence Discharged on Buprenorphine or Oral Naltrexone.

Background: Comparative studies of the naturalistic course of patients of opioid dependence on naltrexone and buprenorphine are likely to be helpful for clinical decision-making. The article aimed to report on the three-months naturalistic outcomes of patients discharged on naltrexone or buprenorphine from the same center. Methods: Patients with opioid dependence who were discharged on either naltrexone (n = 86) or buprenorphine (n = 30) were followed up for three months for retention in treatment. The patients were also followed up telephonically, and the Maudsley Addiction Profile was applied. Results: The days of retention in treatment were significantly higher in the buprenorphine group (69.5 versus 48.7 days, P = 0.009). Heroin use, pharmaceutical opioid use, injection drug use, involvement in illegal activity, and percentage of contact days in conflict with friends in the last 30 days reduced over three months in both the groups, while the physical and psychological quality of life improved in both the groups. Additionally, in the naltrexone group, smoked tobacco use, cannabis use, and percentage of contact days in conflict with family within the last 30 days reduced at three months compared to baseline. Conclusion: With the possible limitations of choice of medication-assisted treatment for opioid dependence being determined by the patient, and prescribing related factors and sample size constraints, the study suggests that retention outcomes may vary between naltrexone and buprenorphine, though both medications may improve several patient-related parameters. However, a true head-to-head comparison of the outcomes of buprenorphine and naltrexone in a naturalistic setting may be difficult.

Pathways to care in first-episode psychosis in low-resource settings: Implications for policy and practice.

OBJECTIVE: Developing countries such as India face a major mental health care gap. Delayed or inadequate care can have a profound impact on treatment outcomes. We compared pathways to care in first episode psychosis (FEP) between North and South India to inform solutions to bridge the treatment gap. METHODS: Cross-sectional observation study of 'untreated' FEP patients (n = 177) visiting a psychiatry department in two sites in India (AIIMS, New Delhi and SCARF, Chennai). We compared duration of untreated psychosis (DUP), first service encounters, illness attributions and socio-demographic factors between patients from North and South India. Correlates of DUP were explored using logistic regression analysis (DUP ≥ 6 months) and generalised linear models (DUP in weeks). RESULTS: Patients in North India had experienced longer DUP than patients in South India (ß = 17.68, p < 0.05). The most common first encounter in North India was with a faith healer (45.7%), however, this contact was not significantly associated with longer DUP. Visiting a faith healer was the second most common first contact in South India (23.6%) and was significantly associated with longer DUP (Odds Ratio: 6.84; 95% Confidence Interval: 1.77, 26.49). Being in paid employment was significantly associated with shorter DUP across both sites. CONCLUSIONS: Implementing early intervention strategies in a diverse country like India requires careful attention to local population demographics; one size may not fit all. A collaborative relationship between faith healers and mental health professionals could help with educational initiatives and to provide more accessible care.

Relapse during opioid use disorder treatment: A pilot study to understand the reasons for opioid use during treatment.

Background: Opioid use is a cause of concern in many parts of the world. About 2.1% Indians use opioids. Opioids are also the most common drugs used by injection drug users in India. Despite various treatment strategies used to manage opioid use disorders (OUDs), relapse is common. A good treatment program would make efforts to address lapses and prevent relapse. Hence, there is a need to understand the factors associated with relapse in OUD. Method: One hundred and twenty patients completed a baseline assessment that included socio-demographic details and the Maudsley Addiction Profile (MAP). They were followed up for three months and assessed using telephonic interview for opioid use. All those who relapsed were assessed using the Reasons for Relapse Questionnaire (RRQ). The patients who relapsed were compared with the patients who were abstinent. Relapse was defined as any use of opioid during follow-up. Results: Forty participants relapsed during the 90 days of the study period. Relapsed patients had a greater number of conflict days with family members, used a higher amount of heroin and cannabis at baseline, were less likely to be discharged on buprenorphine, and were more likely to drop out. Participants cited mood and social reasons more often than cue/craving and unwell domains of RRQ. Conclusion: Baseline treatment and prospective factors are associated with relapse in OUD. Addressing these factors can help in reducing relapse in OUD patients.

A prospective observational study of change in caregiver burden and psychological distress in caregivers of patients with alcohol dependence.

Background: Alcohol use disorder has a substantial impact on patients' caregivers, leading to burden and adverse effects on their psychological health. Currently, there is limited literature which is available to suggest whether the burden and psychological distress of the family members change when patients with alcohol dependence undergo treatment. This study aimed to longitudinally examine the change in burden, depression, anxiety, and stress experienced by caregivers of patients with alcohol dependence undergoing treatment. Subjects and Methods: This prospective observational study recruited treatment-seeking men with alcohol dependence and their caregivers as dyads. The burden, depression, anxiety, and stress of caregivers were assessed at baseline and at six weeks, using the Family Burden Interview Schedule and Depression Anxiety Stress Scale, respectively. Pre and post values were compared using paired t-test. Interaction effects of resumption of drinking were assessed using repeated measures test. Results: Of the 101 dyads recruited in the study, 60 could be followed up at six weeks. Significant decrements were seen in burden, depression, anxiety, and stress of caregivers at six weeks compared to baseline (mean 62.3%, 54.2%, 65.9%, and 53.4%, respectively, all P < 0.001). The decrement in burden and depression was lower in those caregivers where the patients had resumed alcohol use within the span of six weeks. Conclusions: Findings suggest that engagement in treatment by patients with alcohol dependence may reduce the burden and psychological distress among their caregivers, more so in situations where the patients had quit alcohol. However, the change in burden and psychological distress could be due to several other factors as well.

Internet use among persons with common mental disorders: A qualitative study.

Aims and Objectives: To assess the current patterns and experience of internet use among persons with depressive and anxiety disorders, particularly for health-related issues. Methodology: In-depth interviews were conducted with persons diagnosed with depressive and anxiety disorders (DSM-5), aged ≥18 years who could read and write in Hindi/English, using an interview guide. The interview guide contained questions related to internet use in daily life, internet use for health-related issues, and internet use for stress, and internet use for anxiety/depressive disorder. Interview data were transcribed and analyzed to identify codes and subsequently themes. Results: A total of 20 subjects; 10 each diagnosed with depressive and anxiety disorders were interviewed. About half the participants could operate internet independently, while rest required assistance. YouTube was the most common search engine used, and leisure was the most common reason for daily use. Almost all participants reported searching internet for health-related information including their psychiatric diagnosis. The most common purpose, for health in-general, was searching for alternate therapies. Most common purpose for psychiatric diagnosis was understanding the symptoms, recovery from their illness, and side effects of medicines. Highest impact as perceived by the participants was on distraction or stress reduction rather than direct impact on the illness/treatment. Conclusion: Persons with depressive and anxiety disorders use internet for distraction, communication, and seeking information about the illness and medicines.

A parent-child conjoint psychological intervention for children in maintenance phase of acute lymphoblastic leukemia: Feasibility and preliminary outcomes from a randomized control pilot trial.

OBJECTIVE: To develop and test a brief Composite Intervention Module for Pre-adolescents with Acute Lymphoblastic Leukemia (CIMPALL). DESIGN: Single-center randomized controlled design. SETTING: A tertiary care center of national importance PARTICIPANTS: A total of 36 children with acute lymphoblastic leukemia in the maintenance phase of the treatment. INTERVENTION: A five-session (540 min) brief, multidomain, audiovisually aided, therapist-facilitated conjoint intervention module for children with cancer and their parents. MAIN OUTCOME MEASURES: Standardized psychological tools for children including CBCL, CPSS (Child Posttraumatic Stress Disorder Symptoms Scale), PedsQol (Pediatric Quality of Life), and NIMHANS (National Institute of Mental Health and Neurosciences) neuropsychological battery and parents including PTSD CC (Posttraumatic Stress Disorder Civilian Checklist), CHIP (Coping Health Inventory for Parents), CBS (Caregiver Burden Scale), and SRQ (Self-Reporting Questionnaire). RESULTS: A total of 36 patients were randomized to an experimental or a control group. Over 80% agreement was observed on indices of expert evaluation; 100% of participants found the sessions to be helpful, useful, appropriate in terms of time, duration, and place, and interventionist. The participation rate in the sessions was 94% and the study flow was smooth; 97.3% eligible candidates agreed to participate. Furthermore, 100% agreement on performance of activities was observed and the attrition rate was 5.26%. CONCLUSION: This pilot study presents the CIMPALL, which to the best of our knowledge is the first of its kind in India. The data suggest that the CIMPALL intervention is feasibly delivered by a clinical psychologist and that the CIMPALL intervention has an impact on important psychosocial variables for children with acute lymphoblastic leukemia and their parents.

Evaluation of Psychological Impact of COVID-19 on Health-Care Workers.

BACKGROUND: Little information is available from India about the psychological impact of COVID-19 on helath-care workers. AIM: The current study aimed to evaluate the psychological issues among the health-care workers (HCW) during the COVID-19 pandemic. MATERIALS AND METHODS: An online survey using Survey Monkey® platform was carried out to evaluate depression (using Patient Health Questionnaire-9), anxiety (using Generalized Anxiety Disorder Questionnaire-7), and other psychological issues (using a self-designed questionnaire). RESULTS: The study sample comprised 303 participants with a mean age of 41.2 (standard deviation: 11.1) years. A majority of them were male (69%) and married (79.9%). Nearly half (46.2%) of the participants had either anxiety disorder or depression or both and 12.9% of HCW had suicidal behavior. Higher level of anxiety and depression scores were associated with being female, having undergone quarantine, directly involved in the care of COVID-19 patients, and younger age (<30 years). Higher prevalence of depression and anxiety disorder was seen in younger (<30 years) age group, being a doctor (compared to paramedics). In addition, higher prevalence of depression was seen in those who were directly involved in the care of patients with COVID-19 infection. CONCLUSION: About half of the HCWs are suffering from psychiatric morbidity, specifically anxiety, in the wake of the COVID-19 pandemic. There is a need to assess all the HCWs for psychiatric morbidity and provide them with psychological support.

Warwick-India-Canada (WIC) global mental health group: rationale, design and protocol.

INTRODUCTION: The primary aim of the National Institute of Health Research-funded global health research group, Warwick-India-Canada (WIC), is to reduce the burden of psychotic disorders in India. India has a large pool of undetected and untreated patients with psychosis and a treatment gap exceeding 75%. Evidence-based packages of care have been piloted, but delivery of treatments still remains a challenge. Even when patients access treatment, there is minimal to no continuity of care. The overarching ambition of WIC programme is to improve patient outcomes through (1) developing culturally tailored clinical interventions, (2) early identification and timely treatment of individuals with mental illness and (3) improving access to care by exploiting the potential of digital technologies. METHODS AND ANALYSIS: This multicentre, multicomponent research programme, comprising five work packages and two cross-cutting themes, is being conducted at two sites in India: Schizophrenia Research Foundation, Chennai (South India) and All India Institute of Medical Sciences, New Delhi (North India). WIC will (1) develop and evaluate evidence-informed interventions for early and first-episode psychosis; (2) determine pathways of care for early psychosis; (3) investigate the efficacy and cost-effectiveness of community care models, including digital and mobile technologies; (4) develop strategies to reduce the burden of mental illnesses among youth; (5) assess the economic burden of psychosis on patients and their carers; and (6) determine the feasibility of an early intervention in psychosis programme in India. ETHICS AND DISSEMINATION: This study was approved by the University of Warwick's Biomedical and Scientific Research Ethics Committee (reference: REGO-2018-2208), Coventry, UK and research ethics committees of all participating organisations. Research findings will be disseminated through peer-reviewed scientific publications, presentations at learnt societies and visual media.

Mental health issues and coping among health care workers during COVID19 pandemic: Indian perspective.

OBJECTIVES: We assessed mental health issues among Indian health care workers (HCWs) and their coping strategies during COVID 19 pandemic. METHODOLOGY: An online survey was conducted in 348 HCWs using PHQ-SADS and Brief-COPE inventory. RESULTS: Depression, anxiety and somatic symptoms were present in 54 %, 44.3 % and 54.6 % of HCWs and were more in those working in COVID19 areas. The nurses and female HCWs had more moderate to severe somatic symptoms. HCWs with moderate to severe symptoms used simultaneously both maladaptive and adaptive coping strategies. CONCLUSION: The HCWs during COVID19 pandemic have significant mental health issues and use multiple coping strategies.

Community stakeholders' perspectives on youth mental health in India: Problems, challenges and recommendations.

BACKGROUND: India has a large youth population whose mental health needs must be addressed. This includes promotion of positive mental health, with early detection and effective intervention for mental health disorders. Understanding the perspectives of community stakeholders working with youth is pivotal to this effort. Current study aimed to bring together a group of community stakeholders (eg, parents, teachers, policy makers) to understand their perspectives on youth mental health problems, challenges in provision of care, and to provide recommendations to address these concerns at national level. MATERIALS AND METHODS: The study was conducted across two sites in India: Chennai and New Delhi. Three group meetings were conducted involving 52 participants, including governmental, non-governmental and community representatives working with youth. The proceedings were manually recorded, transcribed, and analyzed using thematic analysis method. RESULTS: Many youth mental health problems were similar across the two sites. The commonest drivers of mental health problems were reported to be academic pressure, substance use and problematic internet/social media use. Stigma and lack of awareness were identified as the most important challenges acting as barriers to seeking mental health help by youth. Prioritizing youth mental health as a national programmes along with strong political will were the major recommendations suggested by the stakeholders. CONCLUSION: Initial findings suggest that prioritizing youth mental health programmes in India would be advantageous. Inclusive and collaborative approach, involving community stakeholders working with youth in providing services that promote mental health and early access to care will help in developing healthy young citizens.

Psychological impact of COVID-19 lockdown: An online survey from India.

BACKGROUND: The COVID-19 pandemic has led to a complete shut-down of the entire world and almost all the countries are presently in a "lockdown" mode. While the lockdown strategy is an essential step to curb the exponential rise of COVID-19 cases, the impact of the same on mental health is not well known. AIM: This study aimed to evaluate the psychological impact of lockdown due to COVID-19 pandemic on the general public with an objective to assess the prevalence of depression, anxiety, perceived stress, well-being, and other psychological issues. MATERIALS AND METHODS: It was an online survey conducted under the aegis of the Indian Psychiatry Society. Using the Survey Monkey platform, a survey link was circulated using the Whatsapp. The survey questionnaire included perceived stress scale, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Warwick-Edinburgh Mental Well-being Scale to assess perceived stress, anxiety, depression, and mental well-being, respectively. The survey link was circulated starting from April 6, 2020 and was closed on April 24, 2020. RESULTS: During the survey, a total of 1871 responses were collected, of which 1685 (90.05%) responses were analyzed. About two-fifth (38.2%) had anxiety and 10.5% of the participants had depression. Overall, 40.5% of the participants had either anxiety or depression. Moderate level of stress was reported by about three-fourth (74.1%) of the participants and 71.7% reported poor well-being. CONCLUSIONS: The present survey suggests that more than two-fifths of the people are experiencing common mental disorders, due to lockdown and the prevailing COVID-19 pandemic. This finding suggests that there is a need for expanding mental health services to everyone in the society during this pandemic situation.