Gender Differences in Clinical Characteristics and Comorbidities in Bipolar Disorder: a Study from South India.

The clinical features and course of bipolar disorder differ between women and men; however, studies are limited in Indian population. The objective of this study was to identify gender differences in patients with bipolar disorder. This was a cross-sectional, hospital-based observational study conducted over a period of 25 months. The sample consisted of 110 males and 90 females with a diagnosis of bipolar disorder according to ICD-10 Diagnostic Criteria for Research. Socio-demographic and clinical details were collected using semi-structured proforma. All patients were evaluated on Mini International Neuropsychiatric Interview Plus, Presumptive Stressful Life Events Scale and Clinical Global Impression. Sample consisted of 55% men and 45% women. The total number of episodes was similar between genders, however, the number of manic episodes (p = 0.004) was significantly more in males and the number of depressive (p = 0.003) and mixed episodes (p = 0.018) were significantly more in females. Majority of males had first episode of mania, whereas, first episode in females were mostly depressive (p < 0.001). Comorbid physical disorders were seen in 61.1% females and 40% males. Bipolar disorder subtype, episode types and number varied across gender. Co-morbid hypothyroidism, migraine, and obesity are seen more often in women and substance use was higher in men.

Prevalence and Factors Associated With Clozapine-Related Constipation: An Observational Study.

BACKGROUND: Despite being a very effective treatment for resistant schizophrenia and bipolar disorder, use of clozapine is limited by adverse effects. Constipation is a common but potentially life-threatening adverse effect of clozapine that is understudied. The objective was to study the prevalence and factors associated with constipation in those receiving clozapine compared with control subjects. METHODS: Fifty patients in age group of 18 to 55 years receiving clozapine were compared with 50 patients in the same age group receiving medications other than clozapine. Presence of constipation was ascertained using the World Gastroenterology Organization Practice Guidelines definition. The severity of constipation was assessed using Constipation Assessment Scale and Bristol Stool Form Scale, and anticholinergic burden was assessed using Anticholinergic Burden Scale. RESULTS: Among clozapine-treated patients, 28 (56%) had constipation as compared with 11 (22%) in the control subjects (P < 0.001); the odds of developing constipation was 4.5 (95% confidence interval, 1.9-10.8). Kaplan-Meier survival analysis showed median time to onset of constipation in clozapine-treated patients was 60 days (SE, 13.1 days; 95% confidence interval, 34.3-85.7 days) and median dose of clozapine was 300 mg/d (interquartile range, 312 mg/d). Clozapine group had high Constipation Assessment Scale scores (P = 0.005, Cohen d = 1.17) and higher prevalence of types 1 and 2 Bristol stool types (Fisher exact P = 0.005, Cramer V = 0.59). CONCLUSIONS: Constipation was prevalent in more than half of patients receiving clozapine, which was severe and took longer time for recovery. Limitations include using a hospital-based sample and that dietary habits and lifestyle factors were not studied.

Follow-Up Study on the Effect of Cognitive Behaviour Therapy on Haemodialysis Adherence: A randomised controlled trial.

OBJECTIVES: Patients with chronic kidney disease (CKD) undergoing haemodialysis often experience a myriad of psychosocial problems, resulting in poor adherence to their therapeutic regimen. This study aimed to examine the effect of cognitive behaviour therapy (CBT) on dialysis, fluid, drug and diet adherence among a previously reported sample of CKD patients undergoing haemodialysis. METHODS: A randomised controlled trial was conducted between January 2013 to Febrary 2014 on a random selection of 67 CKD patients attending a tertiary multispecialty hospital in India. The experimental group (n = 33) was exposed to CBT, whereas the control group (n = 34) received non-directive counselling. A haemodialysis adherence scale was developed and used to assess adherence to the treatment regimen. The effect size was calculated using Cohen's d statistics. RESULTS: At six months, mean reductions from baseline were observed in the experimental group in terms of interdialytic weight gain (-1.23 kg; effect size: 0.57), systolic blood pressure (-22.18 mmHg; effect size: 0.71) and diastolic blood pressure (-10.06 mmHg; effect size: 0.72), whereas mean increases were noted in haemoglobin (+0.75 g/dL; effect size: 0.31) and adherence to dialysis (+0.94; effect size: 0.51), fluids (+16.34; effect size: 2.30), diet (+61.19; effect size: 4.75) and drugs (+10.73; effect size: 1.3). Differences from baseline were significantly higher in the experimental group compared to the control group (P = 0.001 each). CONCLUSION: These results show that CBT is more effective than non-directive counselling for improving therapeutic adherence and physiological, clinical parameters among CKD patients undergoing haemodialysis.

Do Life Events and Social Support Vary across Depressive Disorders?

BACKGROUND: Social support and life events moderate the expression of depression though studies have shown contradictory results. The objective was to study the stressful life events and perceived social support in patients with adjustment disorder, first-episode depression, and recurrent depressive disorder (RDD). SUBJECTS AND METHODS: One hundred and forty-six patients aged 18-60 years with adjustment disorder, first-episode depression, or RDD according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision were evaluated using the presumptive stressful life events scale and Multidimensional Scale of Perceived Social Support. RESULTS: There was no difference in mean number of total life events and subgroups as well as perceived stress score in the past 1 year between the groups. There was no difference in the perceived social support scale total score, as well as from family and friends, across the three groups. However, the mean perceived social support from significant others in those with RDD was lower as compared to those with adjustment disorder. CONCLUSION: Stressful life events do not differ in adjustment disorder, first-episode depression, and RDD. Furthermore, the perceived social support was similar across the three groups, except for perceived social support from significant others, which was less in those with RDD.

Cognitive Behaviour Therapy for Anxiety and Depression among People Undergoing Haemodialysis: A Randomized Control Trial.

INTRODUCTION: Chronic Kidney Disease (CKD) is becoming a major public health problem worldwide. The very diagnosis of CKD brings a plethora of psychological problems that adds to the agony of the debilitating illness. Financial difficulties apart from the excruciating physical burden of the disease, owing to series of psychosocial issues. Anxiety and depression are two major concerns that to be managed effectively to sustain the life of people undergoing Haemodialysis. AIM: The study aimed at finding the effect of Cognitive Behaviour Therapy (CBT) on anxiety and depression among people undergoing haemodialysis. MATERIALS AND METHODS: An experimental approach with Randomized controlled trial design was adopted for the study. The instruments used for data collection were Background Proforma and Hospital Anxiety and Depression Scale (HADS). A total of 150 subjects undergoing haemodialysis in a tertiary care hospital of South Karnataka were screened for inclusion and exclusion criteria and 80 participants were recruited for the study. Through computerized block randomization 40 each were allotted to experimental and control groups whereas 33 and 34 respectively in both the groups completed the study. CBT, a structured individual therapy of cognitive, behavioural and didactic techniques, with 10 weekly sessions each was administered to the experimental group. Non-directed counseling, a psychological intervention with ten weekly sessions of individual counseling was given to the control group. RESULTS: The findings of the study revealed that there was a significant reduction of mean anxiety (F=76.739, p=0.001) and depression (F=57.326, p= 0.001) in the experimental group when compared with the control group. CONCLUSION: Researchers concluded that CBT can be effectively utilized for people undergoing haemodialysis in order to obtain control over their negative thoughts thereby reducing anxiety and depression.