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ABSTRACT: OBJECTIVE. To study the prevalence and type of functional somatic complaints in patients with first-episode depression. METHODS. A total of 164 patients attending the outpatient department of a general hospital psychiatric unit were evaluated using the Patient Health Questionnaire-15 (PHQ-15) and Hamilton Depression Rating Scale (HDRS). RESULTS. More than half of the sample were male (n = 85; 52%) and most of the subjects were married (n = 128; 78%). The mean (standard deviation) HDRS score was 19.9 (5.4). All patients had at least 1 functional somatic complaint, and that the mean (range) number of functional somatic complaints per patient on the PHQ-15 was 8 (1-15). The most common functional somatic complaints included feeling tired or having little energy (93%); trouble sleeping (80%); nausea, gas and indigestion (68%); headache (68%); pain in arms, legs, or joints (66%); and feeling the heart racing (65%). Total PHQ-15 scores indicated the presence of moderate-to-severe severity of functional somatic complaints. Back pain, as well as pain in arms, legs, or joints, were found to be more common in females. The number and severity of functional somatic complaints did not differ significantly in relation to other socio-demographics (locality, marital status, age, education, income) and clinical variables (duration, physical co-morbidity, and atypical features). CONCLUSIONS. Functional somatic complaints are quite prevalent in subjects with first-episode depression. Hence, clinicians should routinely evaluate patients with depression for these symptoms.
East Asian archives of psychiatry : official journal of the Hong Kong College of Psychiatrists = Dong Ya jing shen ke xue zhi : Xianggang jing shen ke yi xue yuan qi kan. 12/2012; 22(4):146-53.
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ABSTRACT: OBJECTIVE. To develop an instrument (Scale for Positive Aspects of Caregiving Experience [SPACE]) that evaluates positive caregiving experience and assess its psychometric properties. METHODS. Available scales which assess some aspects of positive caregiving experience were reviewed and a 50-item questionnaire with a 5-point rating was constructed. In all, 203 primary caregivers of patients with severe mental disorders were asked to complete the questionnaire. Internal consistency, test-retest reliability, cross-language reliability, split-half reliability, and face validity were evaluated. Principal component factor analysis was run to assess the factorial validity of the scale. RESULTS. The scale developed as part of the study was found to have good internal consistency, test-retest reliability, cross-language reliability, split-half reliability, and face validity. Principal component factor analysis yielded a 4-factor structure, which also had good test-retest reliability and cross-language reliability. There was a strong correlation between the 4 factors obtained. CONCLUSION. The SPACE developed as part of this study has good psychometric properties.
East Asian archives of psychiatry : official journal of the Hong Kong College of Psychiatrists = Dong Ya jing shen ke xue zhi : Xianggang jing shen ke yi xue yuan qi kan. 06/2012; 22(2):62-9.
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ABSTRACT: The Involvement Evaluation Questionnaire (IEQ) is a comprehensive, conceptually valid and reliable means of assessing caregiver burden. However, its psychometric properties have rarely been examined in non-European settings. The aim of the present study was to evaluate the psychometric properties of an Indian translation of the IEQ (Hindi-IEQ).
The European Union (English) version of IEQ was translated into Hindi and reviewed by a group of experts and caregivers for translation accuracy, cultural appropriateness, and for relevance and acceptability of items and constructs. The Hindi-IEQ was then administered to 162 primary caregivers of patients with severe mental illnesses. Eighteen caregivers completed both the English and Hindi versions to check the level of agreement between them. Another 27 completed the Hindi-IEQ twice, a week apart, to evaluate its test-retest reliability. Factor structure of the Hindi-IEQ was examined using an exploratory, principal components and factor analysis.
Pearson's correlation coefficients were significant for 24 items, while intraclass correlation coefficients were significant for 28 of the 31 items (P < 0.05), indicating a satisfactory level of agreement between the Hindi and English versions. Test-retest reliability for all items of the Hindi-IEQ was adequate, with kappa values ranging from 0.46 to 0.95 and intraclass correlation coefficients from 0.76 to 1.00. Internal consistency (Cronbach's alpha = 0.89) and the split-half reliability (Spearman-Brown coefficient = 0.68) of the Hindi-IEQ were also satisfactory. However, several differences were noted in the factor structure and distribution of scores of the Hindi-IEQ, which were quite unlike that of the European Union version.
The similarities and differences between the 2 versions of the IEQ indicated that sociocultural factors could influence assessment of caregiver burden across different cultures.
East Asian archives of psychiatry : official journal of the Hong Kong College of Psychiatrists = Dong Ya jing shen ke xue zhi : Xianggang jing shen ke yi xue yuan qi kan. 12/2011; 21(4):142-51.
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ABSTRACT: The overall outcome of men with erectile dysfunction (ED) depends a lot on participation in treatment of their partners/spouses. However, psychosexual functioning of partners/spouses has received scant attention.
To study the psychosexual functioning of spouses of men with nonorganic ED in terms of their sexual satisfaction, psychological problems, marital adjustment, quality of life, and level of dysfunction.
The main outcome measures for the partners of men with ED were symptom questionnaire, marital questionnaire (KDS-15 marital questionnaire), sexuality scale, quality of life enjoyment and satisfaction questionnaire, dyadic adjustment scale, and dysfunction analysis questionnaire.
Spouses of men with ED (n=50) and spouses of men without any psychosexual dysfunction (n=50) were compared for sexual and marital function, quality of life, and dyadic adjustment. The psychological impact was assessed by symptom questionnaire.
Spouses of men with ED have significantly lower levels of marital and sexual satisfaction and higher levels of psychiatric symptoms than controls. Furthermore, the spouses of men with nonorganic ED also report poor quality of life in most domains of life and had higher level of dysfunction.
Our findings support the Western data with regard to the psychosexual functioning of spouses/partners of men with ED and suggest that spouses/partners of men with ED should also be assessed thoroughly.
Journal of Sexual Medicine 11/2010; 7(11):3666-74. · 3.55 Impact Factor
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ABSTRACT: Introduction. The overall outcome of men with erectile dysfunction (ED) depends a lot on participation in treatment of their partners/spouses. However, psychosexual functioning of partners/spouses has received scant attention.Aim. To study the psychosexual functioning of spouses of men with nonorganic ED in terms of their sexual satisfaction, psychological problems, marital adjustment, quality of life, and level of dysfunction.Main Outcome Measures. The main outcome measures for the partners of men with ED were symptom questionnaire, marital questionnaire (KDS-15 marital questionnaire), sexuality scale, quality of life enjoyment and satisfaction questionnaire, dyadic adjustment scale, and dysfunction analysis questionnaire.Method. Spouses of men with ED (n = 50) and spouses of men without any psychosexual dysfunction (n = 50) were compared for sexual and marital function, quality of life, and dyadic adjustment. The psychological impact was assessed by symptom questionnaire.Results. Spouses of men with ED have significantly lower levels of marital and sexual satisfaction and higher levels of psychiatric symptoms than controls. Furthermore, the spouses of men with nonorganic ED also report poor quality of life in most domains of life and had higher level of dysfunction.Conclusion. Our findings support the Western data with regard to the psychosexual functioning of spouses/partners of men with ED and suggest that spouses/partners of men with ED should also be assessed thoroughly. Avasthi A, Grover S, Kaur R, Prakash O, and Kulhara P. Impact of nonorganic erectile dysfunction on spouses: A study from India. J Sex Med 2010;7:3666–3674.
Journal of Sexual Medicine 10/2010; 7(11):3666 - 3674. · 3.55 Impact Factor
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ABSTRACT: There are hardly any randomised-controlled trials of structured family interventions for schizophrenia from India. This study attempted to evaluate the impact of a structured psychoeducational intervention for schizophrenia, compared with standard out-patient treatment, on various patient- and caregiver-related parameters.
Seventy-six patients with DSM-IV schizophrenia and their caregivers were randomly allocated to receive either a structured psychoeducational intervention (n = 38) consisting of monthly sessions for 9 months or 'routine' out-patient care (n = 38) for the same duration. Psychopathology was assessed on monthly basis. Disability levels, caregiver-burden, caregiver-coping, caregiver-support and caregiver-satisfaction were evaluated at baseline and upon completion.
Structured psychoeducational intervention was significantly better than routine out-patient care on several indices including psychopathology, disability, caregiver-support and caregiver-satisfaction. The psychoeducational intervention package used was simple, feasible and not costly.
Structured psychoeducational intervention is a viable option for treatment of schizophrenia even in developing countries like India.
Acta Psychiatrica Scandinavica 12/2008; 119(6):472-83. · 4.22 Impact Factor
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ABSTRACT: There are significant gaps in the scientific literature concerning female sexual behavior and attitudes surrounding sexuality, which have definitive implications on public health and clinical work.
To study the sexual behavior of young married Indian women.
The study group comprised 100 consecutive women attending the Department of Pediatrics for the care of noncritical children in a multispecialty, tertiary care teaching hospital setting in North India. Current levels of sexual functioning and satisfaction were assessed by using the Brief Index of Sexual Functioning for Women (BISF-W). All participants were also administered a translated and culturally adapted instrument called Sex Knowledge and Attitude Questionnaire-II (SKAQ-II).
Peno-vaginal sex continues to be considered the most desired and actually performed sexual activity for arousal and orgasm, followed by kissing and foreplay. Difficulties while performing sexual activity, in the form of physical problems, were faced by 17% of the participants. The participants displayed adequate sexual knowledge and favorable attitude towards sexuality as measured by SKAQ-II.
The present study is a preliminary effort to understand the contemporary female sexual behavior, knowledge and attitude by employing standard instruments. Still further studies are required in this area.
Indian Journal of Community Medicine 07/2008; 33(3):163-7.
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ABSTRACT: ABSTRACT Ninety-eight schizophrenic patients were studied to examine the concept of positive and negative subtyping. Using a cross-sectional phenomenological approach, the relationship of this subtyping with six definitions of schizophrenia was also investigated. The study provides support for this subtyping. Principal components analysis of the data and correlational structure of positive and negative symptom complexes lend further support to this notion.
Acta Psychiatrica Scandinavica 08/2007; 74(4):353 - 359. · 4.22 Impact Factor
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The British Journal of Psychiatry 06/2006; 188:492; author reply 492-3. · 6.62 Impact Factor
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ABSTRACT: To assess the cost of care of Indian out-patients with schizophrenia.
Cost of illness in 50 out-patients with schizophrenia was assessed over a 6-month period together with structured assessments of psychopathology and disability, and compared with 50 out-patients with diabetes mellitus.
Total annual costs of care of schizophrenia were 274 US dollars; these were not significantly different from diabetes mellitus. Indirect costs (63%) were higher than direct costs. Drug costs were high. The main brunt of financial burden was borne by the family. Total treatment costs in schizophrenia were significantly higher in those who were unemployed, those who visited the hospital more often, and were more severely ill and disabled.
Schizophrenia is an expensive illness to treat even in developing countries. Costs of care are similar to those of chronic physical illness, such as diabetes mellitus. Costs are higher in severely ill and disabled patients.
Acta Psychiatrica Scandinavica 08/2005; 112(1):54-63. · 4.22 Impact Factor
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ABSTRACT: Diabetes mellitus is a chronic and potentially disabling disease that represents an important public health and clinical concern because of the economic burden it imposes on the person, family, and society. Despite this, data regarding cost of care of diabetes mellitus from developing countries are scarce. This study aimed to assess the cost of care of Indian patients with diabetes mellitus.
Cost of illness in 50 outpatients with diabetes mellitus (diagnosed according to WHO criteria, Expert Committee, 1997) was assessed over a six month period using a specially designed questionnaire, together with structured assessments of disability.
Total annual cost of care was 14 508 rupees (263.78 euros). The largest proportion of the total cost was made up of direct costs (68%), followed by indirect costs (28.76%) and provider's costs (2.8%). Drug costs were high. Total treatment cost was significantly higher in those who were more educated, those who visited the hospital more often, and those receiving a greater number of drugs.
From this study it can be concluded that diabetes mellitus is an expensive illness to treat even in developing countries. The main brunt of financial burden is borne by the family. Any efforts at cost reduction should, therefore, have the family as its focus, and relieving the family of this financial burden needs to be prioritised.
Postgraduate medical journal 07/2005; 81(956):391-5. · 1.38 Impact Factor
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ABSTRACT: The study was aimed at estimating the joint-rater reliability and applicability of Hindi version of ICD-10 IPDE that was obtained following a standard translation protocol. The instrument was administered to 22 non-psychotic patients by two raters. The average intraclass correlation for each item (0.89), number of criteria met per disorder (0.92) and dimensional scores (0.98) was high. Kappa for definite (0.65-0.78) and probaole personality disorder (PD) (0.78-1.00) and for presence/absence of any PD (0.78) was acceptable. Overall weighted kappa was 0.81 for definite and 0.91 for probable PD. Findings suggest that ICD-10 IPDE (Hindi version) has acceptable joint- rater reliability and applicability in the North Indian Hindi speaking population.
Indian Journal of Psychiatry 10/2002; 44(4):362-4.
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Indian Journal of Psychiatry. 01/2002;
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ABSTRACT: The comparative study of schizophrenia and related disorders across cultures has come a long way since Kraepelin advocated its cause, following his trip to Java at the beginning of the last century. The principal development since then has been the burgeoning of interest in the field, culminating in innovative and ambitious international collaborative research by the WHO. Despite reservations about covert ideology or about the more overt methodologic difficulties, the balance of evidence from these and similar studies suggests that: It is feasible to conduct such research despite the numerous hazards. There is a certain uniformity to the way schizophrenia presents globally; there are equally significant cultural differences. The outcome of schizophrenia appears to be better in developing, than developed cultures; reasons for this are far from clear, nevertheless, it can be safely assumed that culturally-determined processes, whether social or environmental, are partly responsible. Overall, the study of schizophrenia in different cultures has proved useful in establishing the pancultural and the culture-specific properties of this and related disorders.
Psychiatric Clinics of North America 10/2001; 24(3):449-64. · 2.13 Impact Factor
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ABSTRACT: The aim of the present study was to assess the efficacy and safety of olanzapine in the treatment of schizophrenic patients. 27 patients were randomly assigned to treatment with olanzapine or haloperidol over 12 weeks. The primary efficacy measure was the mean change from baseline to endpoint in total scores on the Brief Psychiatric Rating Scale (BPRS) and assessing treatment emergent adverse events. Secondary measures were positive symptoms, negative symptoms, general psychopathology depression, anxiety and quality of life. Compared to haloperidol, olanzapine had equal effect in improving overall psychopathology, positive symptoms, and severity of schizophrenic illness. Olanzapine showed supehor improvement on negative symptoms and secondary depressive features. Commonest side effects were weight gain, sleepiness and increased duration of sleep. Olanzapine is effective in improving overall psychopathology including positive symptoms, negative and secondary depressive features in Indian patients with schizophrenia and it is safe and well tolerated at dosage between 5 to 20 mg/day.
Indian Journal of Psychiatry 07/2001; 43(3):257-63.
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ABSTRACT: Sixty-eight bipolar patients in remission on lithium prophylaxis with adequate serum lithium levels were cross-sectionally studied to assess the relation of certain psychosocial variables (life events, social support and daily hassles) with psychopathology and psychosocial functioning. The daily hassles and number of life events were found to have significant positive correlation with Hamilton Depression Rating Scale (HDRS) scores while perceived social support score had significant negative correlation with general psychopathology score. In stepwise multiple regression analyses, psychosocial variables taken together explained 7% - 23% of variance in psychopathology and global functioning of these patients. We conclude that psychosocial variables may have a modest but significant relation with the clinical and psychosocial functioning of bipolar patients stabilized on lithium prophylaxis.
Indian Journal of Psychiatry 07/2001; 43(3):199-205.
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ABSTRACT: Case records of the patients with major affective disorders (ICD-10 criteria), seen over a 5 year period in a busy clinic in North India were examined for Seasonal Affective Disorder (SAD) as per DSM-III-R criteria. In addition, seasonality of episodes of all affective disorders was also studied. Around 5.67% of the cases (n=44) retrospectively met the DSM-III-R criteria of SAD and predominant pattern was that of summer depression (n=18). There was also a consistent pattern of seasonal mania either in conjunction with seasonal depression (n=18) or in form of seasonal recurrent mania (n=11). None of the cases of depression showed any atypical vegetative features. In cases not meeting criteria for SAD (n=731), there was a trend for peaks for depressive episodes in winter followed by a smaller peak in summer months while manic episodes had peaks towards rainy and winter months. As compared to seasonal patterns of affective disorders in temperate zones, there was a general trend for opposite patterns of seasonality in SAD as well as in non-SAD. The findings are discussed in context of the climatic conditions of North India.
Journal of Affective Disorders 06/2001; 64(2-3):145-54. · 3.52 Impact Factor
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Indian Journal of Psychiatry. 01/2001;
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ABSTRACT: In an exercise carried out to ascertain adequacy of antidepressant treatment, seventy case notes of patients of depression on continuation treatment with antidepressants were scanned. Antidepressants had been used universally. TCAs were the most commonly used drugs, although Fluoxetine had also been used quite frequently. Continuation treatment was found to be deficient in over a third (n=24; 34 %) of the cases, on either of the two parameters i. e. dose of drugs or duration of treatment. The outcome was poorer in those treated inadequately. The reasons for this 'treatment gap' need to be explored. Similar studies need to be conducted in other settings. Education of all clinicians about these central issues of antidepressant treatment is essential.
Indian Journal of Psychiatry 01/2000; 42(1):29-33.
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ABSTRACT: There is lack of consensus on the clinical variables that predict response to ECT. Identification of clinical variables could help in predicting the type of response before the start of ECT Therefore, a prospective study on 22 patients of severe depression, some of whom were drug-naive and others drug free at time of ECT was undertaken. A maximum of six ECT were administered with a prior definition of 'good response' (60% or greater reduction in Hamilton Depression Rating Scale scores) Results showed that three clinical variables could distinguish between good responders and poor responders Hence, response to ECT was associated with the duration of past depressive episodes, suicidal thoughts and somatic symptoms.
Indian Journal of Psychiatry 01/2000; 42(1):60-5.
