Psychiatric Outpatient Department Research Articles

A Study on Spectrum of Clinical Variables on the Patients Attending Psychiatry Outpatient Department in a Tertiary Care Hospital

Objectives The objective of the study is to determine the spectrum of clinical variables of the patients attending psychiatry OPD in a tertiary care hospital and to determine the association of those variables with various sociodemographic factors.The study was conducted in the psychiatric Out-patient Department(OPD) of a tertiary care hospital Barak Valley region in the Northeastern part of India. Material and Methods Retrospective observational study where we assessed 1827 consecutive patients asking for psychiatric services, attending psychiatry OPD of Silchar Medical College & Hospital in the one-year period. Out of a total of 1827 cases, 1200 cases were enrolled for the study, meeting the study criteria. Data regarding sociodemographic profile, duration of illness, and provisional diagnosis were also collected, and self-design proforma was used. For socioeconomic class Modified Kuppuswamy Scale is used. The patients were diagnosed and classified on the basis of ICD-10 Criteria by consultant psychiatrists. The patient’s complete profile and data were presented in tables with the use of Microsoft excel. The data obtained was entered and analyzed by using SPSS Version 21. Any case attending psychiatry opd with psychiatric problems and who were provided psychiatric services. Results Out of a total of 1200 patients, most patients were in the age group of 21–40 years, followed by 41– 60 years. The mean age is 34.5. Majority of them were male (59.4%) belonged to Hindu religion (56.08%),were married (44.41%),and educated upto primary school level (26.75%), living in nuclear family (64%), belonged to lower class socioeconomic status (33.5%). It was seen that the majority of the patients (31.25%) belonged to the ICD-10 category of F20-F29, and Schizophrenia (F20) was the most common diagnosis (21.75%). The majority of patients in diagnostic categories of F10-F19, F20-F29, F30-F39, F40-F48, G43, and G44, were in age group 21–40 years, while among MR and G40 were of age < 20 years. Looking at the individual diagnostic category, we found that the majority of the cases belonging to the categories of F10-F19 (19.49%), F20-F29 (35.20%), F30-F39 (14.02%), G40 (3.16%), G44 (14%), and others (2.24%) were males. while majority of cases having the diagnosis of F40-F48 (30.8%), MR (13.96%) and G43 (5.54%) were females. Conclusion This study has reflected the pattern of clinical variables of the patients attending the tertiary care center. It has helped us to understand the nature and extent of psychiatric disease burden in the community with an aim to facilitate designing and planning for providing better mental health care to the community as a whole.

The Impact of Ramadan Fasting on Sleep and Treatment Compliance in Psychiatric Patients: A Survey Study.

Background: During Ramadan, fasting is a duty for all healthy adult Muslims. During this month, there is a major and abrupt break in chrono-biological rhythms, sleep duration and timing, and the activity/rest cycle.
 Aims: This study aims to explore the impact of the month of Ramadan, with its various biological, behavioral, and social repercussions, on mental health in Tunisian psychiatric patients who may or may not be fasting.
 Objective: To determine the impact of the month of Ramadan on sleep and treatment compliance in psychiatric patients.
 Methods: This was a survey study of all patients under follow-up at the Monastir psychiatric outpatient department for mental disorders, with two measurements during and after the month of Ramadan in 2019 (i.e., from May 05 to June 04, 2019, the number of hours of fasting in Tunisia was between 15h 43 min and 16 h 36 min). The data was analyzed in 2020.
 Results: After studying 107 survey responses twice, during and after Ramadan, this study shows that sleep quality was significantly impaired during Ramadan for both fasters and non-fasters. There was also a significant difference between Ramadan and post-Ramadan in terms of treatment compliance; hence, adherence to treatment in the study population depended on the Ramadan effect and not the Fasting effect.
 Conclusion: This study showed that sleep quality assessed by the ISI insomnia scale was significantly impaired during the month of Ramadan for both fasting and non-fasting subjects. Also, adherence to treatment in the study population depended on the Ramadan effect and not the fasting effect.

Childhood adversity in a youth psychiatric population: prevalence and associated mental health problems

ABSTRACT Background: Childhood adversity can have lasting negative effects on physical and mental health. This study contributes to the existing literature by describing the prevalence rates and mental health outcomes related to adverse childhood experiences (ACEs) among adolescents registered for mental health care. Methods: Participants in this cross-sectional study were youths (aged 12–18 years) who were referred to outpatient psychiatric departments in the Netherlands. Demographic information was collected from the medical records. The Child Trauma Screening Questionnaire (CTSQ) was used to examine the presence of ACEs and posttraumatic stress symptoms (PTSS). To assess mental health problems, we used the Dutch translation of the Youth Self Report. Descriptive statistics and frequencies were used to calculate prevalence rates across the various ACEs domains. ANOVA and chi-square tests were used to explore the relationship between ACEs and mental health. Results: Of the 1373 participants, 69.1% reported having experienced at least one ACE and 17.1% indicated exposure to four or more ACEs in their lives. Although there was substantial overlap among all ACE categories, the most frequently reported were bullying (49.2%), emotional abuse (17.8%), physical abuse (12.2%), and sexual abuse (10.1%). Female adolescents (72.7%) reported significantly more ACEs than their male counterparts (27.0%). Furthermore, a higher number of ACEs was associated with significantly more self-reported general mental health problems, an elevated prevalence of both mood and post-traumatic stress disorders, and a greater presence of two or more co-existing psychiatric diagnoses (comorbid psychiatric classification). Conclusions: This cross-sectional study on childhood adversity and its association with mental health showed that ACEs are highly prevalent in youth registered for mental health care. This study provides support for a graded and cumulative relationship between childhood adversity and mental health problems.

Sleep quality of adult psychiatric outpatients at Chris Hani Baragwanath Academic Hospital.

Sleep disorders are increasingly prevalent among the general population and individuals with mental disorders. However, little research has focused on the sleep quality of psychiatric patients beyond depression, despite its relevance in diagnostic criteria. This study aimed to assess overall sleep quality in psychiatric outpatients and to assess for an association with socio-demographic variables. This study took place at the adult psychiatric outpatient department of Chris Hani Baragwanath Academic Hospital. A cross-sectional study design was employed to evaluate overall sleep quality using the self-administered Pittsburgh Sleep Quality Index (PSQI), a validated tool. The PSQI yields a global score ranging from 0 to 21, with scores of 5 or greater indicating poor sleep quality. Eligibility was determined through structured clinical interviews and data obtained from participant records. Poor sleep quality was found in 50% of participants. Sleep quality did not differ significantly based on sex or age. Subscale analysis revealed reduced sleep duration and efficiency, nocturnal disturbances and daytime dysfunction. Additionally, 38% of participants required pharmacological intervention for sleep issues, despite lacking a diagnosis of primary or comorbid sleep disorders. Half of the psychiatric outpatients experienced poor sleep quality, irrespective of socio-demographic factors, psychiatric diagnosis, symptom remission or medication type. This study highlights the importance of addressing sleep disturbances as comorbid conditions in psychiatric patients. Comprehensive evaluation and management of sleep quality can lead to improved patient outcomes and quality of life.

Prevalence of smoking among psychiatric patients in outpatient department of tertiary care centre: A descriptive cross-sectional study

Background: Even though psychiatric illness is a risk factor of smoking tobacco; only few studies have been conducted to estimate the prevalence of smoking among that patient group in Nepal. Our study aims to determine the prevalence of smoking among psychiatric patients in the outpatient department of tertiary care centre. Material and Method: A descriptive cross-sectional study was conducted in the psychiatric outpatient department of a tertiary care centre from 27th March to 27th May, 2022 following ethical approval from the Institutional Review Committee (Reference number: 577/078-079). A convenience sampling technique was used to include 398 patients, who were assessed for tobacco use behaviour using a semi-structured questionnaire and nicotine dependence using the Fagerstrom Test for Nicotine Dependence instrument. Data was collected using the “KoBo toolbox” Android mobile application and analysed using Microsoft Excel, Statistical Package for Social Sciences version 25.0, and R Studio. Point estimates and 95% confidence intervals were calculated. Results: The prevalence of current smokers was 104 (26.13%) (21.88-30.74 at 95%CI). The prevalence of past smokers was 48 (12.06%) (9.03-15.67 at 95% CI). Nicotine dependence was present in 75(72.12%) of the 104 current smokers and 40 (83.33%) among 48 past smokers. Conclusion: Our study found a lower prevalence of smoking among participants compared to other similar studies conducted at the national level.

Perception of marital rape among married women attending psychiatric outpatient department in RIMS, Imphal

ABSTRACT Background: The definition of rape in Section 375 of the Indian Penal Code includes all forms of sexual assault involving nonconsensual intercourse with a woman. However, Section 375 exempts unwilling sexual intercourse between a husband and a wife over 15 years of age from the definition of “rape” and thus immunizes such acts from prosecution. Marriage is thus considered a continuous, unwavering consent for sexual intercourse as per current laws in the country. This is quite removed from most other countries where marital rape is a recognized crime. India is among only 36 countries that still do not consider marital rape as sexual assault. Literature on marital rape suggests both physical and psychological negative impacts on women facing this predicament. However, marital rape remains one of the most neglected kinds of sexual violence against women, both in society and available literature around the world. Materials and Methods: This was a cross-sectional study undertaken in the Department of Psychiatry, rims, Imphal. The study period was for 1 year. Semi-structured pro forma will be used to record patient data. Perception of marital rape will be assessed using an examiner-administered semi-structured pro forma which was first validated using on initial 30 samples under the scrutiny of two experienced researchers in this field. Due consent will be taken and confidentiality assured. Patient data were evaluated using SPSS version 21; Chi-square test and t-test will be used to find correlations between different variables. Results: A total of 129 women participated in the study. The majority of the participants (79%) had an average perception of marital rape, 10% had a high perception of marital rape, whereas 11% had a low perception of marital rape. Only 19 (15%) reported having experienced marital rape themselves. Nearly 98% of the participants agreed that marital rape will have a negative psychological impact on the women who are victims of it. Among the sociodemographic variables, only religion had a meaningful correlation with the perception of marital rape among the participants, where Hindu women were found to have a higher perception compared to the rest. Conclusions: The study aimed to find the perception of marital rape among women attending the psychiatric outpatient department in a tertiary hospital in Imphal, Manipur. The study showed that the majority of the participants had fair knowledge about marital rape and its psychological impact on the women who might be victims of it. However, only a minority of the participants reported facing marital rape themselves.

Neuroleptic malignant syndrome susceptibility during extreme heat waves: A case report on a patient with schizophrenia

This case report presents the clinical course of a 33-year-old male with a long-standing history of schizophrenia who presented to the psychiatric outpatient department. The patient exhibited symptoms including fever, confusion, rigidity, slurred speech, and generalized body swelling, prompting immediate admission for thorough evaluation and management. In response to the high fever and unclear etiology, our investigation broadened to consider the possible influence of heat wave exposure. The medical team took a comprehensive approach, suspending all current antipsychotic medications and implementing treatment modifications, fluid therapy, and symptomatic relief measures. The patient's condition improved significantly, leading to discharge after a nine-day hospitalization with a well-structured follow-up plan. This case highlights the importance of considering exposure to heat waves that can potentially increase susceptibility to adverse reactions to medications, including antipsychotics, thereby potentially elevating the risk of developing neuroleptic malignant syndrome (NMS) and also shows further need to explore the relationship between heat waves, antipsychotic medication, and the development of neuroleptic malignant syndrome.

Multimorbidity clusters and associated health care cost among patients attending psychiatric clinics in Odisha, India.

There is a dearth of data on common multimorbidity clusters and the healthcare costs for individuals with mental health disorders. This study aimed to identify clinically meaningful physical-mental multimorbidity clusters, frequently occurring clusters of conditions, and healthcare utilization patterns and expenditure among patients attending a psychiatric outpatient clinic. Data were collected in the psychiatric outpatient department among patients aged 18 years and above in February-July 2019 (n = 500); follow-up data on non-communicable disease incidence were collected after 18 months. For analysis, morbidity clusters were defined using two approaches: 1) agglomerative hierarchical clustering method to identify clusters of diseases; and 2) non-hierarchical cluster k mean analysis to identify clusters of patients. Self-reported healthcare costs in these clusters were also calculated. Two disease clusters were identified: using the 1st approach were; 1) hypertension, diabetes, and mood disorder; 2) Neurotic, stress-related, and somatoform disorders, and acid peptic disease. Three clusters of patients identified using the 2nd approach were identified: 1) those with mood disorders and cardiometabolic, musculoskeletal, and thyroid diseases; 2) those with neurotic, substance use, and organic mental disorders, cancer, and epilepsy; and 3) those with Schizophrenia. Patients in Cluster 1 were taking more than six medicines and had more hospital visits. Within 18 months, 41 participants developed either one or two chronic conditions, most commonly diabetes, hypertension, or thyroid disease. Cardiometabolic diseases are most commonly clustered with mood disorders. There is a need for blood pressure and sugar measurement in psychiatric clinics and mood disorder screening in cardiac, endocrinology, and primary care clinics.

Quality of Life and Expressed Emotion in Caregivers of Patients with Psychiatric Disorders

Abstract Background Caregivers form an integral part of the psychosocial management of patients with psychiatric conditions. Caregivers of patients with major psychiatric disorders feel burdened, as these disorders are unpredictable and long lasting. The study was aimed to assess the quality of life (QOL) and expressed emotion among caregivers of patient's with psychiatric disorders. Materials and Methods A cross-sectional descriptive design was adopted for the study. The sample consisted of 300 caregivers of psychiatric patients who visited psychiatric outpatient department and inpatient department of selected hospital. The caregivers were selected by using convenient sampling technique. Baseline proforma, the World Health Organization Quality of Life Scale (WHO QOL BREF), and Family Attitude Scale were used to collect the data. Results Descriptive and inferential statistics were used to analyze the data. The analysis revealed that there was a weak negative correlation between QOL and expressed emotions. The obtained “r” value (−0.14) was statistically not significant at 0.05 level of significance. Hence, the research hypothesis was rejected and the null hypothesis was accepted. Conclusion The study concluded that there was a low negative correlation between QOL and expressed emotions. The obtained “r” value (−0.14) is statistically not significant at 0.05 level of significance. But there was association between QOL and income and occupation of the caregiver.

User-Friendly Chatbot to Mitigate the Psychological Stress of Older Adults During the COVID-19 Pandemic: Development and Usability Study.

To safeguard the most vulnerable individuals during the COVID-19 pandemic, numerous governments enforced measures such as stay-at-home orders, social distancing, and self-isolation. These social restrictions had a particularly negative effect on older adults, as they are more vulnerable and experience increased loneliness, which has various adverse effects, including increasing the risk of mental health problems and mortality. Chatbots can potentially reduce loneliness and provide companionship during a pandemic. However, existing chatbots do not cater to the specific needs of older adult populations. We aimed to develop a user-friendly chatbot tailored to the specific needs of older adults with anxiety or depressive disorders during the COVID-19 pandemic and to examine their perspectives on mental health chatbot use. The primary research objective was to investigate whether chatbots can mitigate the psychological stress of older adults during COVID-19. Participants were older adults belonging to two age groups (≥65 years and <65 years) from a psychiatric outpatient department who had been diagnosed with depressive or anxiety disorders by certified psychiatrists according to the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) criteria. The participants were required to use mobile phones, have internet access, and possess literacy skills. The chatbot's content includes monitoring and tracking health data and providing health information. Participants had access to the chatbot for at least 4 weeks. Self-report questionnaires for loneliness, depression, and anxiety were administered before and after chatbot use. The participants also rated their attitudes toward the chatbot. A total of 35 participants (mean age 65.21, SD 7.51 years) were enrolled in the trial, comprising 74% (n=26) female and 26% (n=9) male participants. The participants demonstrated a high utilization rate during the intervention, with over 82% engaging with the chatbot daily. Loneliness significantly improved in the older group ≥65 years. This group also responded positively to the chatbot, as evidenced by changes in University of California Los Angeles Loneliness Scale scores, suggesting that this demographic can derive benefits from chatbot interaction. Conversely, the younger group, <65 years, exhibited no significant changes in loneliness after the intervention. Both the older and younger age groups provided good scores in relation to chatbot design with respect to usability (mean scores of 6.33 and 6.05, respectively) and satisfaction (mean scores of 5.33 and 5.15, respectively), rated on a 7-point Likert scale. The chatbot interface was found to be user-friendly and demonstrated promising results among participants 65 years and older who were receiving care at psychiatric outpatient clinics and experiencing relatively stable symptoms of depression and anxiety. The chatbot not only provided caring companionship but also showed the potential to alleviate loneliness during the challenging circumstances of a pandemic.

Burden on caregivers of schizophrenic patients at polyclinic outpatient psychiatric department, edward francis small teaching hospital, the gambia

Burden on caregivers of schizophrenic patients at polyclinic outpatient psychiatric department, edward francis small teaching hospital, the gambia

Multidimensional variability in ecological assessments predicts two clusters of suicidal patients

The variability of suicidal thoughts and other clinical factors during follow-up has emerged as a promising phenotype to identify vulnerable patients through Ecological Momentary Assessment (EMA). In this study, we aimed to (1) identify clusters of clinical variability, and (2) examine the features associated with high variability. We studied a set of 275 adult patients treated for a suicidal crisis in the outpatient and emergency psychiatric departments of five clinical centers across Spain and France. Data included a total of 48,489 answers to 32 EMA questions, as well as baseline and follow-up validated data from clinical assessments. A Gaussian Mixture Model (GMM) was used to cluster the patients according to EMA variability during follow-up along six clinical domains. We then used a random forest algorithm to identify the clinical features that can be used to predict the level of variability. The GMM confirmed that suicidal patients are best clustered in two groups with EMA data: low- and high-variability. The high-variability group showed more instability in all dimensions, particularly in social withdrawal, sleep measures, wish to live, and social support. Both clusters were separated by ten clinical features (AUC = 0.74), including depressive symptoms, cognitive instability, the intensity and frequency of passive suicidal ideation, and the occurrence of clinical events, such as suicide attempts or emergency visits during follow-up. Initiatives to follow up suicidal patients with ecological measures should take into account the existence of a high variability cluster, which could be identified before the follow-up begins.

Frequency of Depression in Patients Suffering from Non-Epileptic Fits

Introduction: The most prevalent and severe type of mental disease, depression affects 60–70% of adults, primarily between the ages of 15 and 35. Not only are the patients affected by this terrible disorder, but also their care givers and families. It has long been known that depression often manifests as a variety of psychosomatic conditions, one of which is non-epileptic fits, which are typically more common in children and women than men. Therefore, the majority of patients who present to a psychiatric emergency room, outpatient department, or ward having non-epileptic fits have underlying depression. This was one of the few studies conducted on the prevalence of depression in patients experiencing non-epileptic fits in Pakistan, particularly in province, Khyber Pakhtunkhwa. Study Design and Study Area: In the psychiatry department of Khyber Teaching Hospital Peshawar, this descriptive cross-sectional study was conducted. Duration of Study: The duration of study was 06 months i.e. from 30th march, 2015 to 30th September, 2015. Materials and Methods: The study included 162 patients who presented to the hospital with non-epileptic fits and had ages ranging from 20 to 40 years. The study excluded non-consenting individuals, those with organic brain disorders, and those who had another psychiatric diagnosis already. On a proforma that was especially created, variables were recorded. The BDI depression scale was used to evaluate the depression screening process. Results: Of 193 patients, 162 met the requirements for study. The patients were estimated to have a mean age of 25.44 years, with a standard deviation of 14.25 years. Only 32 patients (20%) were female, while remaining 130 (80%) patient were male. Majority 88 (56%) individuals were uneducated. 46 people (32%) had education up to the primary level, 14 (8%) were matriculating, and 12 (4%) were graduates. 40 people (25%) were single, 94 people (58%) were wed, and 28 people (17%) were widows or widowers. 30 people (19%) were working and 132 (81%) were unemployed. 62 persons had been seeking care for more than 24 months, compared to 8 who had been doing so for less than 24 months, 20 persons for less than 18 months, 14 patients having duration of illness for less than 12 months and 12 patients of less than 6 months period of illness. Only when non-epileptic fits were linked to the depression (p value 0.004) was statistical significance observed. When depression was compared to the patient's gender, marital status, educational attainment, length of care, and occupation, there was no statistically significant difference. Conclusions: The majority of people who have non-epileptic fits also have depression. Age of onset of non-epileptic fits and depression are significantly correlated, whereas gender, educational level, marital status, occupation, length of illness, and patient's family history are not. Keyword: Psychological distress, depression, non-epileptic fits, KTH.

Organic Brain Disorders Manifesting as Psychiatric Symptoms

Abstract Organic brain disorders (OBD) may present with multiple psychiatric symptoms which may mimic as primary psychiatric disorder. We present three cases such as astrocytoma, cerebellar cyst, and hypothalamic hamartoma presented to our psychiatric outpatient department with psychotic, manic, and headache symptoms with no physical neurological signs and symptoms. Treatment resistance and relapse motivated us for seeking neuroimaging that subsequently revealed space occupying lesions. Some patients with neurologically silent OBD may present with psychiatric symptoms only. Therefore, we should consider of neuroimaging in patients with a change in mental status regardless of a lack of neurological symptoms.

Caregiver burden among caregivers of mentally ill individuals and their coping mechanisms A facility based study

Problem: Mental illnesses not only affect the individual concerned but also the caregivers. Caregiver burden is a complex phenomenon. Caregivers who perceive high level of burden are those who lack both family and social support. They require tireless endeavor, sympathy and energy. Mostly family members fail to recognize it and caregiver’s own physical, mental and social health is often ignored. Care givers adopt various coping mechanism. A Mechanism, adopted in a positive way would lessen the amount of burden.6 Mal adaptive strategy in turn would affect the well being.7The study was done to measure and analyze caregiver burden and factors associated with the burden respectively. The study was also intended to explore coping mechanisms adapted by the caregivers in response to burden perceived by them. Approach: A cross sectional analytical study was conducted among 60 caregivers of patients with mental illnesses attending psychiatric medicine outpatient department in a tertiary care hospital, at Karur(India) between July 2022 and Dec 2022. After obtaining Institutional Ethics clearance and informed consent, study tool was administered. It consisted of 4 parts. Part 1 dealt with socio-demographic details of the participants. Part 2 enquired about clinical information of care recipient. Part 3 included the Burden Assessment Schedule. Part 4 was the brief COPE assessment scale. Data entry was done in Microsoft Excel. Entered data were exported to SPSS software version 20 for analysis. Appropriate descriptive and inferential statistics were done. Independent T test, one way ANOVA, Pearson’s correlation and Chi square tests were applied. Findings: Among caregivers other than spouses, male caregivers perceive higher burden (mean score +/- SE = 28.75 +/- 2.272) than the female caregivers (mean score +/- SE = 26.25 +/- 2.192). Perceived severity of disease was higher among Care givers residing in urban area (mean score +/- SE = 8.0385 +/- 0.36577) than those residing in rural area (mean score +/- SE = 6.9118 +/- 0.28438). Among caregivers other than spouses, caregivers who had completed higher secondary schooling or diploma holders perceive higher level of burden (mean – 28.75) than those who completed primary schooling (mean – 24.75). Impact of chronic mental illness of care recipients on well being of caregivers was higher among spousal caregivers than the others. A Positive correlation existed between burden perceived among spousal caregivers and problem focused, emotional focused and adaptive coping. All these associations were statistically significant at p value 0.05, 0.01 or 0.001. Distribution of moderate to severe burden among caregivers other than spouses (52.3%) is slightly higher than that of spousal caregivers (50%) and the difference is not statistically significant (p = 0.876). Conclusion: Among various factors, gender, education, residence and chronic nature of care recipient’s mental illness were found to be significantly associated with either one or another component of burden or the whole. Mental health professionals should broaden their vision so that burden perceived by the caregivers would also be attended. Public health personnel should take measures to implement family as well as community level approach to attend caregivers along with their mentally ill care recipients.

Assessment of Psychiatric Comorbidities and Disability in Patients with a Complaint of Headache Attending Psychiatric Outpatient Department at Tertiary Care Center

Abstract Background: Headache is one of the most common complaints seen among the patients attending the psychiatric outpatient department. Psychiatric comorbidities worsen the headache and there is a vicious cycle of headache and psychiatric symptoms, aggravating each other. This further complicates headache management so it is better to explore psychiatric symptoms whenever we come across a headache patient. Aims and Objectives: The aim and objective of the study are to assess the psychiatric comorbidities and disability among the patients complaining of headaches. Materials and Methods: This was a cross-sectional study carried out at a tertiary care center. Patients attending the outpatient department with complaints of headaches were enrolled. Psychiatric comorbidities were assessed by using patient health questionnaire-9, generalized anxiety disorder-7 scale, depression, anxiety, and stress 21 scale along with allodynia symptom checklist-12. Disability in the past 3 months was assessed by Migraine Disability Assessment Scale (MIDAS) scale. A semi-structured Performa was used to record sociodemographic details and clinical variables. Results: Majority of the patients (69%) were of the age group 20–40 years. Females (75%) predominated in the study. The average severity of headaches reported by 63% of patients was moderate over Likert’s scale. Temple area (73%) was the main location. Throbbing (81%) was the main type of headache. One-third of the patients got compelled to wake at night due to headache attacks. The main premonitory symptoms were depression, irritability, and sensitivity to sound. Other associated symptoms during headache attacks were sensitivity to sound, anxiety, and irritability. Psychological stress was the main provoking factor. The majority of patients (75%) show mild disability in the past 3 months over the MIDAS scale. 25% of the patient-reported moderate depression over the patient health questionare-9 scale. The majority of the patients (85%) reported moderate-to-severe anxiety and nearly half of the patients reported severe stress. Conclusion: Patients with headaches have high chances of associated psychiatric comorbidities that make worse outcomes of each other so it is better to do detailed psychiatric workup and treat them efficiently keeping in view of psychiatric symptoms.

Effectiveness of Caregiver Intervention for Improving Medication Adherence on Level of Medication Adherence and Attitude toward Medications among Nonadherent Patients with Mental Illness

Abstract Background: Nonadherence to medication is the major challenge in treating mental illness, resulting in worsening symptoms and prolonging the course of the illness. Caregivers spend a considerable amount of time with the patients. Therefore, proper training and education for caregivers help to improve treatment outcomes. Aim: This study aims to evaluate the effectiveness of caregiver intervention for improving medication adherence (CIIMA) on level of medication adherence and attitude toward medications among nonadherent patients with mental illness. Methods: This study was an experimental study using a randomized pretest posttest control group design. The study was conducted in the psychiatric outpatient department of tertiary care hospital in the eastern India. Eighty nonadherent patients with mental illness and their primary caregivers were randomly allocated to the experimental and control group using the concealment allocation method. Patients were assessed for their level of medication adherence using medication adherence rating scale, their attitude toward medication were assessed using drug attitude inventory and reasons for medication nonadherence were assessed using the Rating of Medication Influence. CIIMA consisted of individual psycho-education, pill card monitoring, weekly telephonic and text reminders provided to the experimental group, and routine treatment was provided to the control group. The level of medication adherence and attitude toward medication were reassessed for both groups after 1 month of the initial assessment. Results: After 1 month of CIIMA, 87.2% of patients in the experimental group were adherent to medication as compared 18.4% in the control group (P &lt; 0.001), significant improvement in their attitude toward medication and treatment in the experimental group as compared to the control group (P = 0.001). Conclusion: CIIMA is an effective, low-cost, nurse-led intervention can be delivered in the inpatient and outpatient units for improving medication adherence thereby preventing future relapse of their mental illness.

Clinical Practice Guidelines for Assessment and Management of Patients with Borderline Personality Disorder.

Clinical Practice Guidelines for Assessment and Management of Patients with Borderline Personality Disorder.

A naturalistic study on side effects of selective serotonin reuptake inhibitors in psychiatric out-patient department

Introduction: &gt;Antidepressants are one of the most commonly prescribed psychotropic drugs. Six SSRIs are approved for various disorders. SSRIs have fewer side effects owing to its selective blocking the serotonin transporter. Nonetheless SSRI has several troublesome side effects, including nausea, diarrhoea, headache, dizziness, sexual side effects, tachycardia, or weight gain. Methodology: This cross-sectional comprised of 200 patients who were divided into two groups. Group 1 had participants who had received SSRI for less than 6 weeks duration and group 2 had patients who had taken SSRI for more than 6 months. Side effects of medications were recorded using UKU side effect rating scale and causality was ascertained using Naranjo adverse drug reaction probability scale. Results: Among the early side effect group consisting of 100 patients, 40% of patients reported at least one side effect. Tension/inner unrest, nausea and vomiting and orgastic dysfunction was the most common side effect reported. 30% of patients in late side effect group had at least one side effect. Orgastic dysfunction, decreased sexual desire and weight gain were the main side effects reported. All the reported side effects were probably associated due to the prescribed SSRI, as inferred from Naranjo causality scoring system. Conclusion: Escitalopram was the most commonly prescribed SSRI among all the SSRIs. Paroxetine and fluvoxamine were the least prescribed SSRIs. Sertraline was found to cause maximum side effects in the early group and fluoxetine caused the most side effects in the late group. Tension/Inner unrest was the most commonly reported side effects followed by sexual side effects.

PREVALENCE OF ORAL MUCOSAL LESIONS IN PATIENTS WITH PSYCHIATRIC DISORDERS IN A TERTIARY MEDICAL CENTER

Background: Psychological stress adversely affects the physiological effectiveness of a person to an abundant point of melancholy. Considering the high prevalence of oral health problems in psychiatric patients, the present study was conducted to assess prevalence of oral mucosal lesions in psychiatric patients attending psychiatric outpatient department (OPD) at Nobel Medical College Teaching Hospital. Methods: The descriptive cross-sectional study was conducted in Outpatient Department of psychiatry at Nobel Medical College Teaching Hospital in Biratnagar. A total number of 130 patients diagnosed with oral mucosal lesions and stress related conditions were screened. Data for this research was collected by Oral visual examination. Statistical analysis was carried out by using spss software version 21 with use of descriptive statistics like mean and percentage. Results: Majority of the participants were females constituting of 61% of the study group and male subjects with 39 % of the sample size. Major participants were of 38-48 years of range and least from 58 years and above. Schizophrenia was most prevalent psychiatric disorder. Lichen planus was mostly associated with 38% of females, while apthous ulcers were predominant in 40 % of male populations. Conclusions: Oral mucosal Lesions lessen the quality of life of patients, the role of stress and other psychogenic factors cannot be ruled out. The present study highlights the association of stress and anxiety in development of mucosal lesions in patients with psychiatric disorders.