Impact of psychiatric comorbidity on quality of life and activities of daily living among patients suffering from chronic kidney disease undergoing hemodialysis

Introduction

Chronic Kidney Disease (CKD) is a debilitating illness that impairs an individual's physical and social functioning and ultimately affects the quality of life (QOL).

Aim

To determine the impact of psychiatric comorbidity on QOL and activities of daily living in individuals suffering from CKD undergoing hemodialysis.

Materials and Methods

Fifty subjects suffering from CKD undergoing hemodialysis were consequently enrolled in the department of medicine. Institutional ethics committee permission was obtained before the start of the study. The interview was conducted only after the hemodialysis procedure. Consent was obtained and socio-demographic details were noted in the socio-demographic proforma. Schedule for Clinical Assessment in Neuropsychiatry (SCAN) was used to assess psychiatric comorbidity. QOL was assessed on Short Form-36 (SF-36). Katz Index of Independence of Activities of Daily Living scale (KADL) was used to assess the activities of living of such individuals.

Results

46% (n = 23) of subjects suffering from CKD had psychiatric co-morbidity. The most common psychiatric disorder observed was moderate depressive disorder (14%, n = 7) followed by adjustment disorder (12%, n = 6). QOL on SF-36 in all eight domains was low compared to the general population. There was a high statistically significant negative impact of psychiatric comorbidity on QOL on eight domains of SF-36 and activities of daily living. (P = 0.001).

Conclusion

Psychiatric co-morbidity is common in CKD patients on hemodialysis. Quality of life is lower compared to the general population. There is a negative impact of psychiatric co-morbidity on quality of life and activities of daily living.

Internet gaming and related psychotic disorder: An emerging phenomenon

Internet addiction has recently been suggested as a possible diagnostic entity in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and incorporated in the International Classification of Diseases 11th Revision (ICD-11) as a gaming disorder, predominantly, online or offline. Mostly, psychotic phenomena have been described by either alcohol or opioid withdrawal, but there is a paucity of literature on Internet-related psychosis. We report two cases from Northern India of sudden onset of psychosis due to Internet addiction. The contents of hallucinations and delusions reflected themes of Internet gaming. Psychosis as a specifier for Internet gaming disorder (IGD) is not defined in DSM-5, whereas it should be considered as one of the presentations of Internet addiction.

Psychiatric morbidity among patients suffering from Vitiligo

Background

Vitiligo is a chronic acquired, stigmatizing disease characterized by discoloration of skin and mucous membranes. Patients suffering from this condition suffer from a lack of confidence and psychological stress.

Aim

To assess depression, anxiety, and social anxiety among patients suffering from vitiligo.

Material and Method

This hospital-based cross-sectional, observational, descriptive study was carried out in a tertiary care center on 100 patients suffering from vitiligo, who were consecutively enrolled after informed consent from the outpatient department (OPD) of the dermatology department. Permission was obtained from the institutional ethics committee Diagnosis of vitiligo was made by two consultants from the department of dermatology. Sociodemographic variables were recorded in the sociodemographic form. The General Health Questionnaire-12 (GHQ-12) was applied to all 100 patients. Patients who scored >3 on GHQ-12 were further subjected to the Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), and Social Interaction Anxiety Scale. Results were statistically analyzed on SPSS-22.0 (IBM, Armonk, USA).

Results

Of all the patients, 55% (n = 55) had a GHQ score >3 (i.e., Psychiatric morbidity was present in 55% of patients.). Out of 50 patients in the age group of 18-25 years, 41 patients in the age groups of 26-35 years, and 9 patients in the age groups of 36-45 years, 22 (44%), 17 (42.1%), and 6 patients had psychiatric morbidity, respectively. Of the total number of patients, 46% had depression according to the HAM-D scale. Of all the patients, 18% had mild, 22% had moderate, and 6% had severe depression. Age-wise analysis showed that out of 50 patients in the age group of 18-25 years, 41 patients in the age group of 26-35 years, and 9 patients in the age group of 36-45 years, 22 (44%), 20 (48.7%), and 4 patients had depression, respectively. Of the patients who had depression, 39% were male and 58% were female. On HAM-A, 47% of the patients had anxiety; 33% had mild, 12% had moderate, and 2% had severe anxiety. Age-wise analysis showed that out of 50 patients in the age group of 18-25, 41 patients in the age group of 26-35 years, and 9 patients in the age group of 36-45 years, 20 (40%), 23 (56.1%), and 3 patients had anxiety, respectively. On SIAS, 36% of the patients had social anxiety. Out of 50 patients in the age group of 18-25 years, 41 patients in the age group of 26-35 years, and 9 patients in the age group of 36-45 years, 23 (46%), 9 (7.8%) and 4 patients had social anxiety, respectively. According to gender-wise distribution, 17% of male and 63% of female patients had social anxiety.

Conclusion

A high prevalence of anxiety, depression, and social anxiety has been observed in this present study. Therefore, importance should be given to psychiatric evaluation of such patients and, if required, necessary interventions should be undertaken to improve their quality of life.

The attitude of medical undergraduate students from North India toward transgender and change thereafter by educational intervention

Background

There is a widespread gap among medical professionals about transgender, and it needs to be addressed through proper educational intervention to inculcate positive attitudes toward transgender people.

Aim

This study aimed to assess the attitude of medical undergraduate students toward transgender and change thereafter by educational intervention.

Materials and Methods

A total of 169 final-year undergraduate students (aged 22-25 years; 50.3% males; all having heterosexual orientation) were assessed for their attitudes toward transgender people using the Genderism and Transphobia Scale (GTS) and Attitude toward Transgender Individuals Scale (ATTIS). Subsequently, an educational intervention was conducted. The attitude scores were again evaluated immediately and after one month of post-intervention. A paired t-test, independent-samples t-test, and analysis of variance (ANOVA) were used to compare the data.

Results

Mean ATTIS and GTS scores before intervention were 67.02 ± 9.20 and 80.84 ± 26.07, respectively. After the educational intervention, these scores were 79.27 ± 7.18 and 63.20 ± 12.11, respectively, thus showing a significant change in both scores. The change in GTS score was significantly higher in males than in females (P < 0.001) and in urban than in rural residents (P = 0.017). No significant association of demographic factors was observed concerning the change in ATTIS scores. On evaluating the recall value, no significant decline in GTS or ATTIS scores was observed following a one month of interval.

Conclusion

There is a need to positively reinforce these changes brought about by educational intervention in the attitude of undergraduate medical students toward transgender people. Such cognitive gains are achievable in developing a humanistic society.

Psychiatric morbidity in family members of alcohol dependence patients

BACKGROUND

There is a paucity of Indian studies assessing psychiatric morbidity among family members of subjects with alcohol use disorder.

AIM

To study psychiatric morbidity in wives/life partners and children of alcohol-dependent patients.

MATERIALS AND METHODS

Fifty consecutive index patients diagnosed to be alcohol dependent according to the International Classification of Diseases-10 classification of mental and behavioral disorders diagnostic criterion for research reporting to psychiatry department were taken. The study was conducted on family members of alcohol-dependent patients who were enrolled in the study as subjects. These included both their children and spouses and they were evaluated for any psychopathology using M. I. N. I. AND M. I. N. I.-KID scales.

RESULTS

Out of 50 spouses and 67 children enrolled in the study group. Sixty-eight percent had psychiatric morbidity in spouses which include 34% had major depressive episodes. Spouses living in the nuclear family and illiterate had more psychiatric morbidity. Total psychiatric morbidity in children above 18 years was 56.25%, maximum being in alcohol and substance dependence. Total psychiatric morbidity in children between 6 years and 18 years was 31.37%, maximum being in generalized anxiety disorder (11.76%).

CONCLUSION

Spouses of subjects with alcohol dependence have a high prevalence of psychiatric morbidity. Spouses living in the nuclear family had a more major depressive episode and generalized anxiety disorder. Psychiatric morbidity was more in illiterate spouses. Psychiatric morbidity was also high in children. Female children between 6 years and 18 years had more generalized anxiety disorder than males.

The comparative study of quality of life among working women and homemakers taking care of psychiatric patients presenting in a tertiary care hospital, Patna

Background: In India, women are twice more likely to become caregivers than men. The quality of life (QOL) is the ability level to which an individual is healthy and able to enjoy life. Aims and Objective: To assess and compare QOL among homemaker women and working women giving care to patients suffering from psychiatric illnesses. Materials and Methods: This hospital-based, cross-sectional study was conducted on the caregivers who were recruited from out-door patient department of Psychiatry department of Patna Medical College and Hospital, Patna from January 1, 2021, to June 31, 2021. Women who were 30–55 years old, working or homemakers, and who were taking care of psychiatric patients diagnosed with Schizophrenia and Bipolar affective disorder of either sex. Caregivers were first degree relatives of patients. The estimated sample size was 140 (Group 1=70 homemaker women and Group 2=70 working women). Sociodemographic data were recorded using Sociodemographic Performa 1 and QOL was assessed using World Health Organization (WHO)-QoL-BREF. Results: WHO-QOL domain mean score for physical, psychological, social, and environmental of Group 1 was 12.42, 11.60, 12.24, 12.62 whereas 14.46, 13.28, 11.28, and 12.28 of Group 2 with statistically significant difference (P<0.05). Conclusion: In physical and psychological domain of QoL, working women scores were better than homemakers. QOL in working women caregivers was better than homemakers’ caregivers in social and environmental domains but statistically non-significant.

Comparative safety and efficacy of tibolone and escitalopram in postmenopausal women

BACKGROUND

A high prevalence of psychiatric disorders, particularly depressive and anxiety disorders among women is observed through the postmenopausal stage.

AIM

The aim of this study is to compare the safety and efficacy of tibolone (TIB) and escitalopram (ESCIT) in postmenopausal women (PMW).

MATERIALS AND METHODS

It was an interventional, open-label, hospital-based, follow-up study conducted on 60 PMW with the diagnosis of depression as per the Diagnostic and Statistical Manual of Mental Disorder-5 criteria. Patients were divided into two groups of 30 each, i.e. Group I (TIB-2.5 mg/day) and Group II (ESCIT-10-20 mg/day). The primary outcome was assessed for change in climacteric symptom scores on Greene's Climacteric Scale (GCS), severity of depression and anxiety on Hamilton Rating Scale for Depression (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A), and sexual functioning on Arizona Sexual Experience Scale (ASEX). The secondary outcome of well-being was assessed on World Health Organization Quality of life (QOL)-BREF. All the observations were carried out from baseline and at 2, 4, 8, and 12 weeks.

RESULTS

Both the groups showed significant improvement in climacteric and depressive symptoms. However, at the 8^th and 12^th weeks, mean ± standard deviation scores were significantly lower in Group I (GCS score - 24.80 ± 4.92, 20.30 ± 3.56; HAM-D score - 16.57 ± 5.83, 10.2 ± 5.67) compared to Group II (GCS score - 27.27 ± 5.83 and 23.33 ± 5.70, HAM-D score - 19.97 ± 7.98 and 16.17 ± 10.11). No significant difference between the groups was seen for anxiety on HAM-A scores. Only in Group I, there was significant improvement in ASEX scores. QoL in Group I had shown significant improvement in physical and psychological domain compared to Group II at different time interval, i.e. 4^th and 8^th week onward. In Group I, Alternative Dispute Resolution was reported to be 23.3%, whereas it was 56.7% in Group II. However, none were serious to warrant discontinuation.

CONCLUSION

TIB was better than ESCIT in improving depression, climacteric symptoms, and physical and psychological domain of QoL with an additional benefit of restoring sexual functioning.

Psychiatric morbidity in individuals with permanent orthopedic disability

BACKGROUND

Individuals with permanent orthopedic disability present with a number of physical and mental health issues. Psychiatric illnesses have been seen more frequently among people with disabilities as compared to normal population.

AIM

To study psychiatric morbidity among people with permanent orthopedic disability.

MATERIALS AND METHODS

This cross-sectional, observational, hospital-based study was conducted at the department of psychiatry of a tertiary care hospital attached to a medical college during January 01, 2018, to December 31, 2018. The study included subjects over the age of 18 years comprising two groups: Group A (n = 50) including consecutive subjects with orthopedic disability and Group B (n = 50) including normal age- and sex-matched controls. Permission was obtained from the institutional ethics committee before the start of the study. Prior informed consent was obtained from all subjects. Sociodemographic variables were recorded, and psychiatric morbidity was screened on Mini International Neuropsychiatric Interview.

RESULTS

62% (n = 31) of subjects in Group A had psychiatric morbidity as compared to Group B (22%, n = 11). Maximum psychiatric morbidity noted among subjects with disability was generalized anxiety disorder (22%, n = 11), followed by major depressive disorder (20%, n = 10) and alcohol dependence (18%, n = 9). Substance dependence was more in Group A (34%, n = 17) as compared to Group B (18%, n = 9). The most common substance dependence was for alcohol (18%, n = 9), followed by opioids (8%, n = 4) and tobacco (6%, n = 3).

CONCLUSION

Psychiatric morbidity including substance dependence is more common among people with orthopedic disability as compared to normal control subjects.

Caregiver burden among working women and homemakers taking care of psychiatric patients

BACKGROUND

Caregiver burden is defined as the physical, psychological or emotional, social, and financial problem that can be experienced by the members of family caring for impaired person. In India, women are twice more likely to become caregivers than men, despite emergence of men as caregivers.

AIM

The aim of the study is to assess burden of illness among working women and homemakers taking care of psychiatric patients.

MATERIALS AND METHODS

This hospital-based, descriptive, cross-sectional comparative study was conducted on the caregivers who were recruited from outdoor patient department of psychiatry department of a tertiary care hospital attached to a medical college. Women who were 30-45 years old, working or homemakers and who were taking care of psychiatric patients diagnosed with schizophrenia and Bipolar affective disorder (BAPD) of either sex. Caregivers were first-degree relatives of patients. Sociodemographic data were recorded using a special performa and caregiver burden was assessed using caregiver burden questionnaire.

RESULTS

Overall mean caregiver burden scores in Group 1 and Group 2 were 55.66 ± 4.09 and 58.16 ± 3.97, respectively, with statistically significant difference (P < 0.05).

CONCLUSION

Caregiver burden was more among working women compared to homemaker women.

Psychiatric comorbidity in patients undergoing hemodialysis

BACKGROUND

Patients undergoing hemodialysis are under considerable physical and mental stress. Few studies indicate an increase of psychiatric morbidity in them.

AIM

The aim is to study the prevalence of psychiatric comorbidity in patients undergoing hemodialysis.

MATERIALS AND METHODS

A total of 49 consecutive patients of chronic kidney disease undergoing hemodialysis were included in the study with their consent. The Institute Ethics Committee clearance was obtained before the start of the study. The psychiatric interview was conducted only after the dialysis procedure was over. Patients were assessed using the Schedule for Clinical Assessment in Neuropsychiatry and Hamilton rating scale for depression.

RESULTS

A total of 49 patients in the age range of 15-64 years were included in the study. Majority of the sample was males (75.5%). Out of the patients enrolled in the study group, 45% had psychiatric comorbidity which included depression (26%), adjustment disorder (12.2%), generalized anxiety disorder (2%), mixed anxiety and depression (2%), and mental and behavioral disorders due to harmful use of alcohol (2%) indicating that patients undergoing hemodialysis is more likely to have mood disorder than other psychiatric disorders.

CONCLUSION

Patients with recent-onset dialysis are more prone to psychiatric illnesses as it has a chronic debilitating course with poor outcome leading to major lifestyle changes with occupational disturbance and consequent financial implication.