Untreated Psychiatric Illness Research Articles

Post-COVID condition: a focus on psychiatric symptoms and diagnoses in patients with cognitive complaints.

Cognitive and psychiatric symptoms are frequently reported after SARS-CoV-2 infection, but their interplay has been only partially explored. We investigated frequency and severity of psychiatric symptoms in patients with persistent cognitive complaints after COVID-19. We conducted a cross-sectional study. Neurologists assessed 101 patients reporting cognitive symptoms after COVID-19. Patients were invited to fill a screening battery with self-reported psychometric scales (Depression Anxiety Stress Scales-21, Impact of Event Scale-Revised, Insomnia Severity Index). Patients scoring above validated cut-offs in ≥1 scale were referred to psychiatrists who administered the Mini-International Neuropsychiatric Interview (M.I.N.I.), Hamilton Anxiety (HAM-A), and Hamilton Depression (HAM-D) rating scales and asked to complete the Personality Inventory for DSM-5-Brief Form (PID-5-BF). Out of the 57 referred patients, 38 (64.4%) accepted to undergo the psychiatric examination. Among these, 18 (47.4%) were diagnosed with adjustment disorder (23.7%), anxiety disorder (10.5%), major depressive disorder (7.9%), and post-traumatic stress disorder (2.6%). Pharmacologic treatment before post-COVID condition (present in 12 patients, 31.6%) was associated with a score above cut-off on the HAM-A and HAM-D scales. A longer duration of untreated psychiatric illness after COVID-19 was associated with worse scores on the same scales. Patients with a higher PID-5-BF total score had a higher probability of receiving a psychiatric diagnosis. Almost half of patients with post-COVID-19 conditions reporting cognitive symptoms were found to suffer from a psychiatric condition after psychiatric evaluation. The application of a psychiatric screening in a population suffering from long-term effects of COVID-19 can lead to early diagnosis and timely treatment.

Special Report: Women’s Reproductive Mental Health—A Clinical Framework

Special Report: Women’s Reproductive Mental Health—A Clinical Framework

A Retrospective Observational Study of Psychosocial Determinants and Psychiatric Diagnoses of Mass Shooters in the United States.

Our aim was to better understand the underlying psychiatric, psychosocial, and psychodynamic aspects of mass shootings in the United States (US). The Mother Jones database of 115 mass shootings from 1982-20119 was used to study retrospectively 55 shooters in the US. After developing a psychiatric-assessment questionnaire, psychiatric researchers gathered multiple psychosocial factors and determined diagnoses and treatment by evaluating the clinical evidence obtained by interviewing forensic psychiatrists, who had assessed the assailant, and/or by reviewing psychiatric evaluations conducted during the judicial proceedings. All 35 surviving-assailant cases were selected. Additionally, 20 cases where the assailant died at the time of the shootings were randomly selected from the remaining 80 cases. The majority of assailants (87.5%) had misdiagnosed and incorrectly treated or undiagnosed and untreated psychiatric illness. Most of the assailants also experienced profound estrangement not only from families, friends, and classmates but most importantly from themselves. Being marginalized and interpersonally shunned rendered them more vulnerable to their untreated psychiatric illness and to radicalization online, which fostered their violence. While there are complex reasons that a person is misdiagnosed or not diagnosed, there remains a vital need to decrease the stigma of mental illness to enable those with severe psychiatric illness to be more respected, less marginalized, and encouraged to receive effective psychotherapeutic and pharmacologic treatments.

A Retrospective Observational Study of Psychosocial Determinants and Psychiatric Diagnoses of Mass Shooters in the United States.

Our aim was to better understand the underlying psychiatric, psychosocial, and psychodynamic aspects of mass shootings in the United States (US). The Mother Jones database of 115 mass shootings from 1982-2019 was used to study retrospectively 55 shooters in the US. After developing a psychiatric-assessment questionnaire, psychiatric researchers gathered multiple psychosocial factors and determined diagnoses and treatment by evaluating the clinical evidence obtained by interviewing forensic psychiatrists, who had assessed the assailant, and/or by reviewing psychiatric evaluations conducted during the judicial proceedings. All 35 surviving-assailant cases were selected. Additionally, 20 cases where the assailant died at the time of the shootings were randomly selected from the remaining 80 cases. The majority of assailants (87.5%) had misdiagnosed and incorrectly treated or undiagnosed and untreated psychiatric illness. Most of the assailants also experienced profound estrangement not only from families, friends, and classmates but most importantly from themselves. Being marginalized and interpersonally shunned rendered them more vulnerable to their untreated psychiatric illness and to radicalization online, which fostered their violence. While there are complex reasons that a person is misdiagnosed or not diagnosed, there remains a vital need to decrease the stigma of mental illness to enable those with severe psychiatric illness to be more respected, less marginalized, and encouraged to receive effective psychotherapeutic and pharmacologic treatments.

Opioid Use Consequences, Governmental Strategies, and Alternative Pain Control Techniques Following Total Hip Arthroplasties.

Over the last several decades, rates of opioid use and associated problems have dramatically increased in the United States leading to laws limiting prescription duration for acute pain management. As a result, orthopedic surgeons who perform total hip arthroplasty (THA), a procedure that often leads to significant postoperative pain, have been faced with substantial challenges to adequately mitigate patient pain while also reducing opioid intake. Current strategies include identifying and correcting modifiable risk factors associated with postoperative opioid use such as preoperative opioid use, alcohol and tobacco abuse, and untreated psychiatric illness. Additionally, recent evidence has emerged in the form of Enhanced Recovery After Surgery (ERAS) protocols suggesting that a multidisciplinary focus on patient factors perioperatively can lead to reduced postoperative opioid administration and decreased hospital stays. A cornerstone of ERAS protocols includes multimodal pain regimens with opioid rescue only as needed, which often includes multiple systemic pain therapies such as acetaminophen, gabapentin, non-steroidal anti-inflammatory drugs, as well as targeted pain therapies that include epidural catheters and ultrasound-guided nerve blocks. Many hospital systems and states have also implemented opioid prescribing limitations with mixed success. As the opioid epidemic continues in the United States, while contributing to poor outcomes following elective surgeries, further research is warranted to identify multidisciplinary strategies that mitigate opioid use while also allowing for adequate pain control and rehabilitation.

Antidepressants Are the Most Commonly Discontinued Psychotherapeutic Medications in Pregnancy.

Psychiatric illnesses are common during the perinatal period. The use of antipsychotic medication during pregnancy has increased over the past two decades. In many instances, clinicians agree that untreated psychiatric illness during the perinatal period is more dangerous than the risks imposed by continuing psychotherapeutic medication. We describe patterns of psychotherapeutic medication continuation and discontinuation during pregnancy in a large U.S. We assessed the relationship between the demographic and clinical characteristics of women who continued or discontinued psychotherapeutic medications-antidepressants, anxiolytics/sedatives, anticonvulsants, antipsychotics, mood stabilizers, and stimulants-during pregnancy. This study used data from 2008 to 2015 from the Medical Expenditure Panel Survey. We used t tests and Medical Expenditure Panel Survey Household Component longitudinal sampling weights in the analysis of this data. There were few significant differences noted in clinical and demographic characteristics between women who continued and discontinued medications during pregnancy. Those who continued were less likely to be employed (46.95% of continuers were employed vs. 80.55% of discontinuers; p=.0053). Women taking antipsychotics were more likely to continue medications during pregnancy (64.60% continually used antipsychotics vs. 35.40% discontinued antipsychotics; p=.008), whereas women taking antidepressants were more likely to discontinue their use (19.62% continually used antidepressants vs. 80.38% discontinued antidepressants; p=.032). For each medication category, women resumed medication after pregnancy. Antidepressants are the most commonly discontinued psychotherapeutic medication during pregnancy. We recommend further research examining factors that may influence this observed difference.

Ethical considerations in the treatment of chronic psychosis in a periviable pregnancy

Background: Treatment of psychotic disorders in pregnancy is often ethically and clinically challenging, especially when psychotic symptoms impair decision-making capacity. There are several competing ethical obligations to consider: the ethical obligation to maternal autonomy, the maternal and fetal beneficence-based obligations to treat peripartum psychosis, and the fetal beneficence-based obligation to minimize teratogenic exposure. Objective: This article outlines an ethical framework for clinical decision-making for the management of chronic psychosis in pregnancy, with an emphasis on special considerations in the previable and periviable period. Case Presentation: A 31-year-old gravida 2, para 1 with intrauterine pregnancy at 12 weeks and 4 days gestation was brought to the emergency department by her husband seven months after delivering her first child, due to sudden onset of behavioral changes that included self-isolation, not eating, and not taking care of her child. Her past medical history included hypothyroidism and inflammatory bowel disease, but no prior psychiatric illness. After being admitted to the psychiatric hospital, she continued to have poor oral intake and weight loss despite initial inpatient treatment with antipsychotics, levothyroxine, and discontinuation of corticosteroids. Her pregnancy was also complicated by the diagnosis of multiple fetal anomalies at 20 weeks gestation, when the fetus was periviable. Conclusions: For previable or periviable pregnancies, the patient and/or surrogate should decide whether to pursue prenatal genetic screening and invasive diagnostic testing, as well as whether to continue or terminate the pregnancy. When the choice is made to continue the pregnancy, initiation of long-term psychiatric treatment (including medications with potential adverse fetal effects) should be based on shared decision-making between the physician and the patient and/or surrogate. Although some pharmacologic interventions may have potential adverse effects on the developing fetus, the use of psychotropic medications can be ethically justified, even if the patient herself does not have the capacity to consent and requires a surrogate, when the goal is to restore maternal autonomy and minimize the risks of maternal and fetal harm from untreated psychiatric illness.

Management of Psychiatric Disorders during the Perinatal Period.

Management of Psychiatric Disorders during the Perinatal Period.

A Retrospective Observational Study of Psychosocial Determinants and Psychiatric Diagnoses of Mass Shooters in the United States.

Our aim was to better understand the underlying psychiatric, psychosocial, and psychodynamic aspects of mass shootings in the United States (US). The Mother Jones database of 115 mass shootings from 1982-2019 was used to study retrospectively 55 shooters in the US. After developing a psychiatric-assessment questionnaire, psychiatric researchers gathered multiple psychosocial factors and determined diagnoses and treatment by evaluating the clinical evidence obtained by interviewing forensic psychiatrists, who had assessed the assailant, and/or by reviewing psychiatric evaluations conducted during the judicial proceedings. All 35 surviving-assailant cases were selected. Additionally, 20 cases where the assailant died at the time of the shootings were randomly selected from the remaining 80 cases. The majority of assailants (87.5%) had misdiagnosed and incorrectly treated or undiagnosed and untreated psychiatric illness. Most of the assailants also experienced profound estrangement not only from families, friends, and classmates but most importantly from themselves. Being marginalized and interpersonally shunned rendered them more vulnerable to their untreated psychiatric illness and to radicalization online, which fostered their violence. While there are complex reasons that a person is misdiagnosed or not diagnosed, there remains a vital need to decrease the stigma of mental illness to enable those with severe psychiatric illness to be more respected, less marginalized, and encouraged to receive effective psychotherapeutic and pharmacologic treatments.

Pathways to Psychiatry Care among Children with Mental Health Problems

Many children with mental health problems in Egypt, as in many other countries, do not receive the help they need. Investigating the pathways of care is crucial for the early detection and treatment of these children. This study examined referral patterns and the duration of untreated psychiatric illness of 350 children attending two urban clinical settings in Egypt. Diagnoses were made using the Kiddie Schedule for Affective Disorder and Schizophrenia for School-aged children present and lifetime (K-SADS-PL), Child behavior checklist (CBCL,) and the Stanford-Binet Intelligence Scale. For 46.3%, the most distressing symptom was behavioral problems. A delay in seeking psychiatric help was found. positive family history, and lower socioeconomic class were associated with delays in psychiatric consultation. For 39.7% of patients, the first contact was with a psychiatrist. Most children were referred by relatives. Awareness programs are needed to increase knowledge about and to decrease the duration of untreated illness.

SSRI use during pregnancy and risk for postpartum haemorrhage: a national register‐based cohort study in Sweden

Evaluate whether selective serotonin reuptake inhibitor (SSRI) use during pregnancy, as well as prior or current untreated psychiatric illness is associated with postpartum haemorrhage (PPH). National register-based cohort study based on data from the Swedish Pregnancy Register. Sweden, nationwide coverage. A total of 31159 pregnant women with singleton deliveries after gestational week 22+0 between January 2013 and July 2017. Pregnant women with self-reported SSRI use at any time point during pregnancy were compared with non-SSRI-treated women with prior or current psychiatric illness, as well as wiith healthy women with no psychiatric illness or reporting SSRI use. Postpartum haemorrhage defined as blood loss >1000ml during the first 2 hours postpartum reported by the delivering midwife or obstetrician. Postpartum haemorrhage prevalence was 7.0% among healthy women, 7.6% among women with prior or current psychiatric illness and 9.1% among women treated with SSRI. The unadjusted odds for PPH among women with prior or current psychiatric illness and women on SSRI treatment were increased by 9 and 34%, respectively, compared with healthy unmedicated women without a history of psychiatric illness (odds ratio [OR] 1.09, 95% CI 1.04-1.14 and OR 1.34, 95% CI 1.24-1.44, respectively). The estimates remained unchanged after adjustment for several confounders (such as maternal age, body mass index [BMI], parity, prior caesarean section, smoking, occupation and country of birth) and potential covariates (such as delivery mode, polyhydramnion, preterm delivery, labour dystocia and infant birthweight >4000g). Higher risk for PPH was observed both among women treated with SSRI during pregnancy and among women with prior or current psychiatric illness. SSRI use at any point during pregnancy and prior or current history of psychiatric illness was associated with an increased likelihood for PPH.

Preexisting illness, fetal malformation, and seizure control rates in pregnant women with epilepsy

Data from 2182 pregnancies in the Australian Register of antiepileptic drugs in pregnancy that were followed to term, with 1965 followed for another year, were analyzed to ascertain whether preexisting illness influenced i. the hazard of fetal malformations, and ii. seizure control during pregnancy. Fetal malformation occurred in 74 of the 842 pregnancies associated with preexisting illness (8.8%) and in 84 of the 1340 comparator pregnancies (6.27%), Relative Risk (R.R.) = 1.402 (95% Confidence Interval (C.I.) = 1.038, 1.893). Logistic regression showed statistically significant effects of preexisting maternal drug-treated psychiatric illness, untreated psychiatric illness, and use of citalopram, carbamazepine, valproate, and topiramate in increasing hazard of fetal malformation. Preexisting nonpsychiatric illness and other antiepileptic drugs and drugs prescribed for psychiatric illness, mainly antidepressants, had no such effect. Seizures occurred during 405 of the 842 pregnancies associated with preexisting illness, and during 593 of 1340 comparison pregnancies (48.1% v 44.3%; R.R. = 1.087; 95% C.I. = 0.991, 1.192). There were no statistically significant relationships between preexisting nonpsychiatric and psychiatric illnesses separately and seizure control during pregnancy.Thus, apart from consequences of antiepileptic drug exposure, preexisting maternal psychiatric illness, in its own right, or when treated with citalopram, appears to be associated with increased hazards of fetal malformation.

APA Releases New Statement on Perinatal Disorders

APA Releases New Statement on Perinatal Disorders

Obesity in Adolescents and Youth: The Case for and against Bariatric Surgery

Obesity in Adolescents and Youth: The Case for and against Bariatric Surgery

The Moderating Effect of Social Support in Promoting Self-care in Heart Failure Patients with Comorbid Illnesses

Introduction As the American population ages, patients with heart failure (HF) tend to have more comorbid conditions that make self-care difficult. Prior studies have shown that self-care is worse in HF patients with comorbid conditions but few have examined whether social support compensates for illness complexity. Hypothesis We hypothesized that social support would moderate the relationship between self-care and comorbidities in patients with heart failure. Methods This was a cross-sectional descriptive study of adults hospitalized for a HF exacerbation in one of two hospitals in the northeastern U.S. Adults were eligible if they spoke English, their admitting diagnosis was HF, and they verbally confirmed the diagnosis when approached. Exclusion criteria included dementia and major untreated psychiatric illness. Prior heart transplantation or ventricular assistive device implantation were excluded. All participants provided written informed consent prior to completing a demographic survey and the Self-Care of Heart Failure (SCHFI v7), which measures self-care maintenance, monitoring, and management. Each individual SCHFI scale is scored 0-100 to standardize the score. The number of comorbid conditions was measured by self-report selecting from a list of 18 different disease categories. Social support was measured with a single 4-level item - the higher the score, the better the perceived support. Multiple regression analysis was used to test the moderator effect using the Baron and Kenny method. Results The sample (n=85) was predominantly male (68%), older (62.5 ± 13.5 years), and White (64%); 33% had a high school education or less. Participants had HF for an average of 10.9 (± 12.9) years. The total number of diseases was 4.8 ± 2.2, ranging from 1-10. Self-care maintenance (mean=78.4±15.2), self-care monitoring (mean=73.1±21.1), and self-care management (mean=71.3±17.3) scores were adequate (i.e. >70). The number of comorbidities was significantly related to both self-care maintenance and monitoring (p Conclusion Self-care is better in HF patients with comorbid conditions when social support is higher. These complex patients need support from family and friends to assist with self-care.

Prevalence of Common Mental Disorders and Associated Factors among People with Glaucoma Attending Outpatient Clinic at Menelik II Referral Hospital, Addis Ababa, Ethiopia.

BackgroundThe burden of blindness from glaucoma is high. Therefore, people suffering from a serious eye disease such as glaucoma, which can lead to blindness, usually have an emotional disturbance on the patient. Untreated psychiatric illness is associated with increased morbidity and increased costs of care.ObjectiveThis study aimed to assess prevalence of common mental disorders and associated factors among people with Glaucoma attending Menelik II referral hospital, Addis Ababa, Ethiopia, 2014.MethodsInstitution based Cross-sectional study design was conducted in the Department of Ophthalmology Menelik II Referral Hospital from April 10 to May 15, 2014. 423 participants who had undergone through investigation, examination and diagnosed as patients of glaucoma were selected randomly from the glaucoma clinic. Data were collected through face to face interview using Self Reporting Questionnaire consisted of 20 items. Study subjects who scored ≥11 from SRQ-20 were considered as having common mental disorders. Bivariate and multivariable logistic regression analysis with 95% CI were done and variables with P<0.05 in the final model were identified as independent factors associated with common mental disorders.ResultsFour hundred five patients with glaucoma were included in our study with response rate of 95.7% and 64.5% were males. The average age was 59±13.37 years. Common mental disorders were observed in 23.2% of Glaucoma patients. It is quite obvious that levels of CMDs were high among patients with glaucoma. There was a significant association between age, sex, chronic physical illness, income and duration of illness at P < 0.05.Conclusion and RecommendationSymptoms of common mental disorders were the commonest comorbidities among patients with glaucoma. It will be better to assess and treat Common mental disorders as a separate illness in patients with glaucoma.

When Worlds Collide: Decision Making and Palliative Care for Patients with Mental Illness (FR478)

•Utilize an ethical framework to approach decision making for patients with mental illness who lack capacity to make medical decisions, with consideration to legal boundaries.•Discuss a practical approach to identify when concurrent mental health issues alter the course of a curable disease and hinder the delivery of life-saving treatments.•Understand when a mental illness alone can become terminal in the absence of concurrent life-threatening medical illness. Patients with mental illness have a higher incidence of comorbid medical diseases than the general population. There are considerable ethical and practical challenges in the treatment of medical disease in this patient population, particularly with regards to decision making and determining prognosis. Clinicians are often faced with decisions to limit treatment options, which can result in significant distress to the patient and care providers, both in pursuing the standard of care or in feeling forced to alter it. A multidisciplinary approach can help achieve coordinated care and informed decision making while addressing the palliative care needs of these patients. In this session, we will examine archetypal cases in which a patient’s mental illness alters the normal treatment planning for a serious medical illness and discuss the role that palliative care can play in aligning the care plan with individualized goals in this patient population. First, we will look at the ethical and legal complexities of decision making and surrogacy when a patient with mental illness lacks the capacity to make decisions regarding treatment. The second major scenario we will address pertains to when concurrent mental health issues alter the course of a curable disease. Third, we will discuss the challenges related to the approach to the patient whose mental illness becomes a terminal one, in the absence of comorbid medical illness, such as in the case of untreated psychiatric illness or delirium.

Managing Your Own Mood Lability: Use of Mood Stabilizers and Antipsychotics in Pregnancy.

The management of psychiatric disorders during the perinatal period can be difficult; psychiatric decompensation during pregnancy can affect not only the mother but also the fetus and neonate. It is imperative that psychiatric providers proactively discuss pregnancy planning, and be able to thoughtfully weigh the risks of untreated psychiatric illness and psychotropic medications in pregnancy and breast-feeding. With the exception of valproate and carbamazepine, several mood stabilizers and antipsychotics can be utilized during pregnancy with minimal risk to the fetus and neonate in terms of major malformations; there is a growing body of evidence regarding the risk profile of use of these medications in pregnancy. Key Points Preconception planning is very helpful when it can be done; consider discussion and documentation of risks at time of administration of psychotropic medications for any reproductive-aged women, regardless of plans for conception. Continued psychiatric stability through the perinatal period is imperative; the risks of an untreated psychiatric disorder are just as important, if not more so important, than the risks of psychotropic medication exposure. Exposure to one psychotropic medication is safer than exposure to multiple medications. Utilize lowest effective dose of medication; most risks are not dose dependent, therefore would typically prefer higher dose of medication, rather than emergence of psychiatric symptoms, in order to avoid exposure of the fetus to both psychotropic medications and psychiatric symptoms. General recommendations are to avoid valproate and carbamazepine in reproductive-aged women. With close monitoring, lithium can be safely utilized in pregnancy. Preliminary data regarding use of atypical antipsychotics is reassuring in regards to major malformations; however, larger numbers of participants are needed to provide more complete reproductive safety data with this class. Clearly document risks of an untreated psychiatric illness as well as risks of psychotropic medication management to the mother and developing fetus/neonate.

Medication Use before, during, and after Pregnancy among Women with Eating Disorders: A Study from the Norwegian Mother and Child Cohort Study.

IntroductionLittle is known about medication use among women with eating disorders in relation to pregnancy.AimsTo explore patterns of and associations between use of psychotropic, gastrointestinal and analgesic medications and eating disorders in the period before, during and after pregnancy.MethodThis study is based on the Norwegian Mother and Child Cohort Study (MoBa). A total of 62,019 women, enrolled at approximately 17 weeks' gestation, had valid data from the Norwegian Medical Birth Registry and completed three MoBa questionnaires. The questionnaires provided diagnostic information on broadly defined anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED) and recurrent self-induced purging in the absence of binge eating (EDNOS-P), along with self-reported use of medication six months before, during, and 0–6 months after pregnancy.ResultsThe prevalence of eating disorder subtypes before and/or during pregnancy was: 0.09% AN (n = 54), 0.94% BN (n = 585), 0.10% EDNOS-P (n = 61) and 5.00% BED (n = 3104). The highest over-time prevalence of psychotropic use was within the AN (3.7–22.2%) and EDNOS-P (3.3–9.8%) groups. Compared to controls, BN was directly associated with incident use of psychotropics in pregnancy (adjusted RR: 2.25, 99% CI: 1.17–4.32). Having AN (adjusted RR: 5.11, 99% CI: 1.53–17.01) or EDNOS-P (adjusted RR: 6.77, 99% CI: 1.41–32.53) was directly associated with use of anxiolytics/sedatives postpartum. The estimates of use of analgesics (BED) and laxatives (all eating disorders subtypes) were high at all time periods investigated.ConclusionsUse of psychotropic, gastrointestinal, and analgesic medications is extensive among women with eating disorders in the period around pregnancy. Female patients with eating disorders should receive evidence-based counseling about the risk of medication exposure versus the risk of untreated psychiatric illness during pregnancy and postpartum.

Duration of untreated psychiatric illness and its correlations in patients attending a tertiary care psychiatric facility: a cross-sectional study

Introduction: Duration of untreated psychiatric illness is an important component of the final pathway to care for patients. Longer the duration of untreated illness, poorer is the prognosis. Aim: To determine the Duration of Untreated Illness (DUI) along with its correlates, to thus evaluate the pathway to care at our setup. Settings and design: A retrospective cross-sectional study including 228 patients with psychiatric illnesses done at a tertiary care general hospital with a psychiatric setup. Materials: Semi-structured proforma for socio-demographic details, psychiatric diagnosis, duration of illness and duration of untreated illness. Statistical analysis: Sociodemographic details were mainly descriptive and categories compared using Pearson’s Chi square test. Results: The mean age of patients was 36.13 years (Standard Deviation (S.D.) 15.06). The mean DUI was 57.53 months (80.21). Excluding patients with Alcohol Dependence Syndrome (ADS), mean duration of illness was 51.58 months (S.D. 75.50) and DUI was 33.77 months (S.D. 49.11). Mean duration of illness for ADS group was 176.19 months (S.D. 101.20) and DUI was 165.90 months (S.D. 103.07). There was significant association of DUI with occupation (P = .039) and residence (P = .006). While 127 (55.70%) of patients showed to a psychiatrist at first, seventy (30.7%) patients went to faith healers first. Conclusion: It took about 5 years on average to reach a psychiatric facility, which was higher in patients with ADS. Awareness regarding illness model of ADS and other psychiatric disorders along treatment availability may improve DUI and lead to better prognosis.