Factors responsible for delay in treatment seeking in patients with psychosis: A qualitative study

INTRODUCTION

Patients with psychosis often seek treatment at a later date after the onset of illness. There are a multitude of factors behind the treatment delay in these patients, reduction of this delay will help in better prognosis of these patients.

MATERIALS AND METHODS

A cross sectional study was conducted to understand the various reasons responsible for treatment delay in patients with psychosis. 25 subjects were selected by purposive sampling and their family members were interviewed. Qualitative analysis was carried out to identify various factors.

RESULTS

Reasons for treatment delay were at several levels like illness related, patient related, treatment related, family related factors. However the most common themes among these were unawareness of illness, explanatory models of illness, stigma, financial constraints. Other themes like relation of symptoms with premorbid personality, life events, absence of paternal support were also unfolded in the current study.

CONCLUSIONS

There is significant delay between onset of psychosis and treatment seeking. Several factors are responsible for treatment delay in patients with psychotic illness. However they vary depending upon the socio-cultural background of the patient and their family members. Hence the interventions devised towards reducing the delay should be individualised.

Specific binding of parathyroid hormone to living osteoclasts

We show that osteoclasts bind parathyroid hormone (PTH) in a manner that displays the properties of receptor-dependent hormone binding, that is, saturability, time dependence, temperature dependence, and hormone specificity. Osteoclasts were isolated from the endosteum of 2 to 3 week chick tibiae and maintained in culture for 4-6 days. Bovine PTH-(1-84) was biotinylated with N-hydroxysuccinimidobiotin. Biotinyl-PTH (btPTH, 10(-5)-10(-11) M) was added to the cultured osteoclasts for 2-20 minutes. After rinsing away unbound btPTH, fluorescein isothiocyanate-labeled avidin (FITC-avidin) at a concentration of 66 micrograms/ml was applied. Receptor binding characteristics were assessed: (1) saturation occurred at around 10(-6) M btPTH; (2) competition of excess unlabeled PTH was found, namely, a 10-fold excess abolished fluorescence; (3) specificity was shown by adding other polypeptide hormones (insulin, glucagon, and calcitonin) in 10- to 100-fold excess--no effect on PTH binding was observed; and (4) affinity of btPTH for its binding site was indicated by half-maximal binding approximately equal to 10(-7) M for both osteoclasts and osteoblasts. Biotin (10(-5) M) or FITC-avidin (66 micrograms/ml) alone did not cause fluorescence. The time course of btPTH on the cell exterior was short: at 2 and 5 minutes dots of fluorescence were randomly dispersed over the cell surface, by 10 minutes most of the fluorescence was clustered in one region of the membrane, and by 20 minutes most of the hormone was no longer present on the surface of the cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Detection of experimental Chlamydia trachomatis eye infection in conjunctival smears and in tissue culture by use of fluorescein-conjugated monoclonal antibody

The immunofluorescent staining of conjunctival cytology smears with an antichlamydial monoclonal antibody is a new method for the detection of chlamydial eye infection. Using a monkey model of chlamydial eye infection, we compared the monoclonal antibody staining cytology with the established methods of Giemsa-stained cytology and chlamydial culture with cycloheximide-treated McCoy cells. Compared with either culture or monoclonal antibody-stained cytology, Giemsa cytology had a low sensitivity (30 and 24%, respectively) but was highly specific (100% in each case). Compared with culture, monoclonal antibody-stained cytology was highly sensitive (94%) but appeared to lack specificity (70%). However, examination of the changes in identification rates with time suggested that monoclonal antibody-stained cytology may be even more sensitive than culture and detect lower levels of infection. This study showed that monoclonal antibody-stained cytology of conjunctival smears might be a rapid, efficient, and inexpensive method of diagnosing ocular chlamydial infection.