Prevalence of metabolic syndrome and its clinical correlates among patients with bipolar disorder.

OBJECTIVE: To assess the prevalence of metabolic syndrome (MetS) in patients with bipolar disorder (BD) and examine the clinical correlates of MetS. METHODS: Sixty-seven patients with BD were evaluated for presence for MetS. The consensus definition was used to define MetS. The clinical variables were recorded on the basis of information provided by the patients, accompanying caregivers and review of treatment records. The symptoms severity of present depressive and manic episode was assessed by using Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS) respectively. RESULTS: The prevalence of MetS was 53.7%. Patients with MetS were older than the patients with BD alone (P=0.001). Increased waist circumference was the most common abnormal parameter (74.6%) followed by low high density lipoprotein (HDL) (71.6%) and raised triglycerides (64.2%). High blood pressures were recorded in 35.8% with high fasting blood glucose levels were seen in 33.3%. MetS was associated with greater number of life time episodes (p=0.010), longer duration of illness (p=0.010), greater numbers of lifetime depressive episodes (p<0.001). Substance use (alcohol and nicotine) associated with significantly higher prevalence of high blood pressure among MetS patients (p<0.001) while abnormal triglyceride level shown associated with substance use (p=0.010). Age of the patients, number of lifetime depressive episodes and use of Olanzapine were found to predictive of the development of MetS. CONCLUSIONS: Patients with BD have high prevalence of MetS and its presence correlates with clinical variables.

Perceived mental health related stigma, gender, and depressive symptom severity in a psychiatric facility in South India.

BACKGROUND: Few studies exist on the topic of gender associated with depression and mental health-related stigma coming out of non-Western countries such as India. We aimed to add to the literature by assessing these relationships among adults seeking psychiatric services in India. METHODS: Participants were 60 individuals seeking care at a psychiatric clinic in Bangalore, India. The majority of participants were female with a mean age of 36 years (SD=9.75). RESULTS: Contrary to our prediction, there were no significant differences between men (M=28.96; SD=9.85) and women (M=33.03; SD=12.08) on depression severity, t(58)=1.42, p=.16. Yet, women (M=10.09, SD=8.23) reported significantly more perceived stigma than men (M=5.79, SD=5.86), t(58)=2.30, p=.02. CONCLUSION: While men and women seeking psychiatric services at the psychiatric clinic in India report similar levels of depression severity, women reported more perceived mental illness stigma. Having experienced regular forms of discrimination associated with female status in India, it may be the case that women are more attuned to other forms of stigma, such as mental health stigma investigated in the present study. Given the detrimental impact of stigma on treatment adherence and engagement in care, additional research is needed support this work, including research on interventions to reduce stigma and improve engagement in care.

Temporal patterns of change in panic disorder during cognitive behaviour therapy: an Indian study.

BACKGROUND: CBT has been proven to be effective in the treatment of panic disorder; however, attempts to study the process of change are limited. AIM: The study evaluated the temporal patterns of change in the panic symptoms, cognitions, behaviours, and anxiety sensitivity in subjects with panic disorder being treated with CBT. METHOD: Thirty subjects with panic disorder were allocated to two groups: Cognitive Behaviour Therapy (CBT, n = 15) and Behaviour Therapy (BT, n = 15). Assessments were carried out weekly for five consecutive weeks using the Semi-Structured Interview Schedule, the Anxiety Sensitivity Index, the Agoraphobic Cognitions Questionnaire, and the Texas Panic Attack Record Form. The CBT group received comprehensive CBT and the BT group received psycho-education and Applied Relaxation. RESULTS: Following intervention the change was continuous and gradual on all the variables in the CBT group and the scores reduced to a functional range after 4-5 weeks of therapy. Such a change was not evident in the BT group. Significant change was evident in cognitive domains following the introduction of the exposure and cognitive restructuring within the CBT group. Both cognitive and behavioural techniques contributed to the overall change. CONCLUSION: CBT had an impact on the cognitive domains and significant changes were evident corresponding to the addition of cognitive restructuring and exposure techniques in the 3rd to 5th week. Both cognitive and behavioural components are therefore crucial for overall improvement to occur.

Psychiatric morbidity and marital satisfaction among spouses of men with alcohol dependence.

BACKGROUND: Alcohol dependence has adverse health and social consequences; Alcohol related problems primarily occur within the family context and maximum impact is felt on spouses, given the intimate nature of their relationship. Spouses play an important role in treatment programs related to alcohol. There is thus a need to study psychiatric morbidity and marital satisfaction in spouses of alcohol dependent patients in order to understand and address such issues. AIMS: The aim of this study was to assess the pattern of psychiatric morbidity, marital satisfaction in spouses of men with alcohol dependence syndrome and explore the association. MATERIALS AND METHODS: For psychiatric morbidity, 60 spouses of men with alcohol dependence syndrome were evaluated. Marital satisfaction was assessed using the marital satisfaction scale. Severity of alcohol dependence in the husbands and consequences of drinking was assessed using short alcohol dependence data and drinkers inventory of consequences respectively. RESULTS: More than half of the spouses (65%) had a psychiatric disorder. Primarily mood and anxiety disorder were present. Major depressive disorder was present in 43%. Psychiatric morbidity, marital dissatisfaction in spouses and higher adverse consequences alcohol dependence in their husbands, were found to be significantly correlated with each other and their association was robust particularly when problems in the physical, interpersonal and intrapersonal domains were high. CONCLUSION: Psychological distress and psychiatric morbidity in spouses of alcohol dependent men is high, with marital satisfaction being low. Addressing these issues will be beneficial as spouses are known to play an important role in the treatment of alcohol dependence syndrome.

Gender inequality and structural violence among depressed women in South India.

PURPOSE: While exploring experiences of psychological distress among psychiatric outpatients in Southern India, we set out to further understand interpersonal and socio-cultural factors that are associated with depressive symptoms. METHODS: Using a grounded theory framework, we thematically coded narrative accounts of the women who sought treatment at the psychiatric clinic. In addition, we included author notes from participant observation and field work experiences in the South Indian psychiatric clinic. RESULTS: Of the 32 women who participated in the study, 75 % qualified for a diagnosis of a current major depressive episode. Depressive symptoms were associated with experiences of domestic violence and, in Farmer's terms, structural violence. Although only a partial response to gender-based suffering, allopathic psychiatric treatment seemed the best available means of coping with their circumstances. CONCLUSION: The paper moves beyond a medicalized model of disease and behavior to explore social and contextual factors that enabled these women to brave additional stigmas surrounding psychiatric treatment and seek a better outcome for themselves. It concludes by discussing the need for a multi-layered approach to addressing the suffering that women in South India experience.

Cognitive behavior therapy in the treatment of panic disorder.

BACKGROUND: Comprehensive cognitive behavior therapies have been proved to be more effective than behavioral interventions. However, the efficacy of CBT is not studied in the Indian context and also, the amount of change brought about by CBT is not known. AIMS: This study aims to examine the efficacy of cognitive behavioral intervention (CBI) in the treatment of panic disorder. Our specific objectives were to assess the effectiveness of CBI in reducing symptom severity as well as cognitions related to panic and panic-related behaviors. DESIGN: The study adopted a two-group comparison with pre- and postassessments design. MATERIALS AND METHODS: The sample consisted of 30 patients sequentially allotted to the CBI (n = 15) and behavioral intervention (BI, n = 15) groups. Assessment was done using a semistructured interview schedule, panic disorder severity scale, Texas panic attack record form, Anxiety Sensitivity Index, Agoraphobic cognitions questionnaire, Behavioral avoidance checklist, and Panic appraisal inventory. The CBI group was provided with comprehensive cognitive behavior therapy and the BI group with psycho-education and applied relaxation. RESULTS: CBI was found to be superior to BI in the reduction of panic symptoms, behavioral avoidance, safety behaviors, and cognitions. A large percentage of the CBI group patients met the criteria for clinically significant change with a large magnitude of change. CONCLUSION: Multicomponent CBI is superior to BI in terms of the amount of change it brings about with respect to panic symptoms, avoidance, safety behaviors, and cognitions.

Culture, somatization, and psychological distress: symptom presentation in South Indian patients from a public psychiatric hospital.

BACKGROUND: A number of clinical research studies have found evidence that patients from Western and non-Western countries express both somatic and psychological symptoms. Although somatic and psychological symptoms appear to coexist, patients may express more of one type of symptom, somatic or psychological, over the other depending upon the nature of the illness and the patients' psychosocial contexts. SAMPLING AND METHODS: The present study investigated the influence of Westernization, stigma, severity of symptoms, and other factors on the symptom presentation of 60 South Indian psychiatric patients, using both open-ended and symptom-directed interviewing methods. Symptom presentation was explored in terms of a balance of psychological and somatic symptoms. RESULTS: Participants predominantly emphasized somatic symptoms as their first spontaneously reported symptom. More Westernized participants and those with higher symptom severity scores tended to present a more psychological balance of symptoms. Participants with a greater concern about stigma tended to present a more somatic balance of symptoms. CONCLUSIONS: The findings suggest that several factors, including the Westernization that occurs in non-Western countries as a result of globalization, can impact an individual's expression of distress.

Sexual dysfunction in single males: a perspective from India.

Various personal, familial, and socio-cultural factors play a crucial role in the development of sexuality and sexual practices. They often influence the occurrence and maintenance of sexual dysfunctions. Therapies with individuals with sexual dysfunctions often emphasize the involvement of both the partners. Issues related to single males, especially in the Indian context, have not been explored. The present study is a retrospective analysis of clinical case records of single males who reported sexual dysfunctions between the years 1990 to 2000. Thirty-eight clinical case records were analyzed for the demographic details, nature of the problems, and interventions provided with the aim of exploring the reported symptomatology, precipitating and maintaining factors, prevalent beliefs about the causation of sexual dysfunction, and the outcome of interventions. The role of cultural and psychosocial issues is discussed and the need for research in this area is emphasized.

GS-02 for dysthymic disorder: results of a preliminary, open study.

In an open clinical trial, 15 patients diagnosed with DSM-IV dysthymic disorder were treated with GS-02, a herbal formulation containing extracts of four Indian herbs: Ashvatha, Kapikachu, Dhanvayasa, and Bhuriphali. Twelve patients completed the study. The medication was very well-tolerated. Among treatment completers, three (25%) patients showed no response, two (16.7%) showed partial response, and seven (58.3%) showed good response; these response rates are similar to what can be expected from an allopathic antidepressant trial. In an intent- to-treat analysis, significant improvement was observed on Hamilton depression ratings as well as on global measures. The results of this preliminary study encourage further clinical investigation of the GS-02 formulation.

Global, national, and local approaches to mental health: examples from India.

Neuropsychiatric disorders and suicide amount to 12.7% of the global burden of disease and related conditions (GBD) according to World Health Organization (WHO) estimates for 1999, and recognition of the enormous component of mental illness in the GBD has attracted unprecedented attention in the field of international health. Focusing on low- and middle-income countries with high adult mortality, this article discusses essential functions of international agencies concerned with mental health. A review of the history and development of national mental health policy in India follows, and local case studies consider the approach to planning in a rural mental health programme in West Bengal and the experience in an established urban mental health programme in a low-income community of Mumbai. Local programmes must be attentive to the needs of the communities they serve, and they require the support of global and national policy for resources and the conceptual tools to formulate strategies to meet those needs. National programmes retain major responsibilities for the health of their country's population: they are the portals through which global and local interests, ideas, and policies formally interact. International priorities should be responsive to a wide range of national interests, which in turn should be sensitive to diverse local experiences. Mental health actions thereby benefit from the synergy of informed and effective policy at each level.

Recovery and rechallenge after the neuroleptic malignant synorome.

The Neuroleptic Malignant Syndrome (NMS) can have a complicated recovery and rechallenging these patients is fraught with risks of recurrence. We examined our data from a sequential case series of NMS over a four-year period for details about treatment, complications and rechallenge. Duration of NMS when treated with one versus two dopamine agonists, and neuroleptic loading rates before NMS and on rechallenge were compared using the chi-square test with correction. Duration of NMS was found to be longer when treated with more than one agonist. The mean loading rate on rechallenge. attempted in six patients, was not found tc be statistically different from that resulting in NMS However, two patients (33%) re-challenged with high-potency neuroleptics at high loading rates experienced partial recurrence. Our findings show no advantage for treating NMS with multiple agents and emphasize the need for a cautious dosing strategy while re-challenging patients with typical neuroleptics.

A double-blind, placebo-controlled evaluation of the anxiolytic efficacy ff an ethanolic extract of withania somnifera.

A double-blind, placebo-controlled study was conducted to evaluate the efficacy an ethanolic extract of Aswagandha (Withania somnifera), in patients with ICD-10 anxiety disorders. The sample comprised 39 subjects, of whom 20 received the drug and 19 received placebo. The two groups were sociodemographically and clinically similar at baseline. At 2 and 6 weeks follow-up, data from approximately 85% of patients in each group were available for analysis. Statistical trends favouring the drug were observed at both time points. At 6 weeks, significantly more patients met a priori response criteria in the drug group (88.2%) as compared with the placebo group (50%). The drug was well-tolerated and did not occasion more adverse effects than did placebo. It is concluded that this ethanolic extract of Withania somnifera has useful anxiolytic potential and merits further investigation.

A double-blind, controlled evaluation of the efficacy and adverse effect profile of sustained-release alprazolam.

In a double-blind, prospective study, 40 patients diagnosed with DSM-IV generalized anxiety disorder and stabilized on alprazolam therapy were randomized to receive the same dose of either conventional or sustained-released alprazolam for two weeks, followed by the other formulation of alprazolam in an identical dose for a further two weeks. Conventional alprazolam was administered thrice daily while the sustained-release formulation was administered once-daily, in the morning. Thirty four patients completed the study. Recruitment into the study was associated with a significant decrease in all measures of illness severity; however, no efficacy differences between the two forms of alprazolam were observed. Adverse effects, specifically insomnia, were reported more with the sustained-release formulation. It is concluded that once-daily sustained-release alprazolam is as effective as the conventional form of the drug, and may be preferable because of a wide range of advantages; in this study, the higher incidence of adverse effects with the sustained-release drug was probably an artefact of the experimental design, which fostered a (nighttime) state of partial drug withdrawal.

The neuroleptic malignant syndrome: an Indian experience.

A study was performed to investigate the clinical presentation and outcome of the neuroleptic malignant syndrome (NMS) in a large teaching psychiatric hospital in India. Thirteen cases were identified after a thorough search of intensive care unit (ICU) records during the 4-year period between 1990 and 1993. Information collected from these cases was then compared against data from a representative control group of 252 inpatients who received neuroleptics, drawn randomly from each of the 4 years of the study. Statistical comparisons were made using Student's t test, the chi-square test, and Fisher's exact test. The incidence of NMS was 1.41 per 1,000 cases treated with neuroleptics (95% confidence interval, 0.71 to 2.14 per 1,000) and the mortality from NMS was 38%. Patients who developed NMS had a significantly higher incidence of coexisting physical or neurological illness and received a higher mean neuroleptic dose. Neuroleptic loading rates were not different in the NMS and control samples. Fluphenazine decanoate was implicated as a causative factor of NMS in a significantly higher proportion of these patients. The group with a fatal outcome was significantly older and received a higher neuroleptic dose than the control group, but not compared with the group that recovered.

Alcohol problems in a general hospital--a prevalence study.

The prevalence of problem drinking among medical and surgical in-patients in a general hospital was studied using the CAGE questionnaire. Almost a quarter (23.3%) of the in-patients had associated drinking problems which were more among medical than surgical in-patients. In a large majority of these patients, the associated problem drinking was not recognised by the treating medical professionals. Routine administration of instruments like CAGE which are brief and easy to use would contribute to the early detection and management of alcohol problems in the general hospital setting.

Stigma, depression, and somatization in South India.

OBJECTIVE: The relationships of stigma to both depression and somatization were studied in psychiatric patients in South India to test the hypothesis that stigma is positively related to depressive symptoms and negatively related to somatoform symptoms. METHOD: Illness experience, symptom prominence, and indicators of stigma for 80 psychiatric outpatients were addressed with the Explanatory Model Interview Catalogue. Stigma scores and ratings of symptom prominence were derived. The Structured Clinical Interview for DSM-III-R and the Hamilton Depression Rating Scale were administered to assess psychiatric diagnoses and symptoms of depression. Clinical narratives were analyzed to clarify the nature of relationships between stigma and symptom prominence. RESULTS: The mean stigma scores were 18.2 (SD = 13.0) for patients with somatoform disorders only, 36.0 (SD = 19.0) for patients with depressive disorders only, and 26.8 (SD = 16.0) for those with mixed depressive and somatoform disorders. The stigma scores were positively related to depressive symptoms, as indicated by Hamilton scale scores and prominence ratings for depressive symptoms, but stigma was inversely related to somatoform symptoms, as indicated by ratings of symptom prominence. Although both depressive and somatic symptoms were distressing, qualitative analysis clarified meanings of perceived stigma, showing that depressive symptoms, unlike somatic symptoms, were construed as socially disadvantageous. CONCLUSIONS: The tendency to perceive and report distress in psychological or somatic terms is influenced by various social and cultural factors, including the degree of stigma associated with particular symptoms. This study with the Explanatory Model Interview Catalogue demonstrates how quantitative and qualitative methods can be effectively combined to examine key issues in cultural psychiatry.