Knowledge and Attitudes Towards Clinical Depression among Community Medical Providers in Gujarat, India.

There is limited data on how community medical providers in India attempt to diagnose and treat depression, as well as on their general knowledge of and attitudes toward depression. A cross-sectional survey was conducted assessing knowledge and views of clinical depression with 80 non-psychiatric physicians and physician trainees recruited from community clinics and hospitals in Gujarat, India. Interviews were also held with 29 of the physicians to assess what they do in their own practices in regards to detection of and treatment of clinical depression. Although subjects showed a generally good basic understanding of the definition of clinical depression and its treatment, their responses reflected the presence of some negative and/or stigmatized attitudes toward clinical depression. Our findings raise the question of possible stigma among physicians themselves and underscore the importance of combatting physicians' stigma against and increasing awareness of how to detect and treat clinical depression.

Opinions Regarding Benzodiazepine Teaching and Prescribing Among Trainees in Psychiatry.

OBJECTIVES: Benzodiazepines are widely prescribed for a variety of symptoms and illnesses. There has been limited investigation on the training psychiatry residents receive regarding benzodiazepine prescribing. This study surveyed US psychiatric trainees about their didactic and clinical experience with benzodiazepines, investigating how experience with benzodiazepines may shape trainees' opinions and likelihood to prescribe. METHODS: The 14-question online survey was distributed to residents and fellows at US training programs through an invitation from their training directors. RESULTS: Of 466 programs contacted, with an estimated 1345 trainees, a total of 97 programs (20.8%) and 424 trainees (31.5%) responded. The analyses focused only on the 342 general psychiatry trainees who responded. Most trainees reported having formal didactics on benzodiazepines, and earlier training was correlated with higher trainee quality of instruction assessments (p < 0.01). Most trainees rated their instructors as Above or Well Above Average. Trainees cited the observation and opinion of supervisors as the two most important factors affecting likelihood of future benzodiazepine prescribing. Trainees commonly reported pressure from patients to prescribe benzodiazepines but were split on perceived pressure from supervisors about prescribing and whether a bias exists against prescribing at their program or in general. CONCLUSION: The survey indicated that psychiatry trainees generally feel adequately trained through didactic and clinical experience with benzodiazepines. Trainees perceived pressure by patients to prescribe benzodiazepines, but generally felt comfortable in managing benzodiazepine usage. Psychiatry attendings' opinions on benzodiazepines most impacted trainees. Influences on trainees' prescribing patterns are important variables that can impact future benzodiazepine prescribing.

Assessing obesity and other related health problems of mentally ill Hispanic patients in an urban outpatient setting.

OBJECTIVE: This paper describes the role of an agency Clinical Director in developing a project to assess and begin to address obesity-related health problems of patients treated in a community-based mental health clinic in New York City. After a five year review of outpatient deaths revealed a high rate of deaths from cardiovascular and diabetes-related issues, the Clinical Director assembled a group of clinicians, researchers, and administrative staff to design a pilot project to assess health and nutrition status of primarily Hispanic day treatment patients with severe and persistent mental illness. METHOD: About 69 of the 105 patients at the clinic were assessed by chart review, interview about nutritional habits and medical care, and somatic measurements for blood pressure, weight, girth, body mass index (BMI), glucose and lipid levels. RESULTS: Patients were predominantly between the ages of 25 and 64 years, 51% were female, and 78% were Hispanic. Around 57% were diagnosed with schizophrenia-spectrum disorders, 86% were receiving antipsychotic medications, and 25% were on two or more antipsychotics. Only 11% of the women and 41% of the men had normal weight. A total of 29% of the women and 18% of the men were overweight (BMI = 25-29.9); and an additional 60% of the women and 41% of the men were obese (BMI > or = 30). Atypical antipsychotic treatment was significantly associated with obesity (BMI > or = 30) (chi sq = 5.5, df = 1, P < 0.025). Using American Heart Association criteria, waist measurements showed significant abdominal obesity among female patients. Blood pressure was elevated in 77% of the patients: 45% were pre-hypertensive with BP 120-139/80-89 and 32% were hypertensive with BP > or = 140/90. About 53% had elevated random blood glucoses (>110 mg/dl). On the positive side, patients generally had had recent medical follow-up, and most had adequate cooking facilities. CONCLUSIONS: This project revealed that these predominantly Hispanic, severely mentally ill individuals were at high risk for cardiac illness, highlighting the need for developing culturally-sensitive interventions in urban outpatient psychiatric settings. Findings were disseminated in educational presentations and clinical discussions, and have mobilized an institutional effort to significantly improve medical monitoring for these patients.