A cross-sectional study of factors associated with anti-depressant medication adherence in women attending an out patient psychiatry department

Introduction: Treatment adherence and illness may not be related only by the severity of the illness but by so many other factors which impact on seeking and continuing treatment; yet severity of the illness will be one of the major factors influencing treatment adherence. Methods: Female patients attending the psychiatric OPD, diagnosed with depression as per ICD-10 guidelines and provided informed consent participated in this questionnaire-based study. A total of 135 patients who attended the OPD in 9 months were assessed for the severity of depression and medication adherence by administering scales to assess the severity of depression and medication adherence was assessed by questioning about the drug taking and hospital attending behaviour. Out of this, thirty-one were attending for the first episode and hence were excluded from the analysis. Results: Out of the 104 female patients diagnosed with depression of more than one episode, 44 (42.3%) had mild depression, 52 (50%) had moderate depression and 8 (7.7%) had severe depression. Twenty-nine women (27.9%) were on medications and 75 (72.1%) women were not taking their medications. While greater proportion of women with mild depression were adherent to medication (51.7%), more women with moderate depression didn’t adhere to medication (54.7%), even though such difference was statistically not significant. Older age, having a paid work and married status were significantly associated with medication (antidepressants) adherence. Conclusions: Our results indicate that medication adherence is associated with factors other than severity of depression. Work and marital status played a significant role in determining the adherence to antidepressant medications among women.

Mania in an individual with Systemic Lupus Erythematosus – A case report

Neuropsychiatric manifestations are common and occur in around 14-80% of patients with SLE. No particular neurologic or psychiatric manifestation is characteristic of SLE and the form and pattern of neuropsychiatric symptoms vary significantly. The American College of Rheumatology (ACR) Nomenclature provides case definition for 19 neuropsychiatric syndromes seen in SLE. However, these case definitions were not found to be effective in differentiating neuropsychiatric SLE (NPSLE) patients from those with neuropsychiatric manifestations not associated with SLE.Here we present a case of mania in a patient with SLE and discuss the differential diagnosis of neuropsychiatric manifestations of SLE and primary mood disorder. Symptoms of neuropsychiatric SLE vary significantly and psychiatric disturbances in a patient with SLE is a diagnosis of exclusion where other possibilities have to be considered including an independent comorbid psychiatric disorder. This case highlights the difficulty in the diagnostic process and the need for more studies on the differences between primary psychiatric disorders and neuropsychiatric SLE.

Common sleep disorders in women

Sleep disturbances contribute to a high frequency of mental health and cardiovascular diseases with significant gender differences. Women have a higher incidence than men of insomnia and are more likely than men to complain of insomnia, headache, irritability, and fatigue than the ‘‘typical’’ symptoms of loud snoring and apneas during sleep. Reproductive hormones play an important role in sleep in women. In the premenopausal age these hormones have a protective effect on sleep apnea while on pregnancy there is a higher prevalence of sleep apnea and restless legs syndrome. Cardiovascular mortality is high in women with obstructive sleep apnea and continuous positive airway pressure therapy improves outcomes in most cases of obstructive sleep apnea. The epidemiology, risk factors, diagnostic criteria, and therapies for the three most common sleep disorders (insomnia, obstructive sleep apnea, and restless leg syndrome), along with effects of menopause, pregnancy, and social factors on sleep in women, are key considerations for clinicians caring for female patients across the adult life span.

Psychological Morbidity Among Post-COVID-19 Patients: A Cross-sectional Study from Chennai, South India

Background: The COVID-19 pandemic is a global health threat and is by far the largest outbreak of atypical pneumonia, since the SARS outbreak in 2003. A range of psychiatric morbidities such as persistent depression, anxiety, panic attacks, delirium and suicidality were observed in the post infectious state across the world. Hence, the aim of the study was to understand the psychological status of the patients affected by COVID during their post-COVID follow-up period and to examine the socio-demographic and clinical factors associated with high psychological morbidity. Materials and Methods: A cross sectional study conducted in the post-COVID follow up clinic, at a tertiary care hospital between the months of August - November 2020, using a semi structured proforma and rating scales such as Patient Health Questionnaire-9 (PHQ-9), Hospital Anxiety and Depression Scale (HADS) and Insomnia Severity Index (ISI) for depression, anxiety and insomnia, respectively. Results: The study results indicate that the prevalence of depression and anxiety among post-COVID-19 patients was 21.9% and 11.9%, respectively. Insomnia was observed among 21.7%Among various sociodemographic and clinical variables examined, it was observed that female gender, patients with ongoing stressors and patients with post-COVID-19 persistent physical symptoms were found to be associated with greater depression and anxiety among the study population. Conclusions: Persistent physical symptoms and ongoing life stressors are found to be associated with depression and anxiety among post-COVID-19 patients. Hence, periodic screening for individuals with persisting physical symptoms and care for the vulnerable population such as those with ongoing stressors will provide a significant advantage in the follow up of the mental health of the patients affected with COVID-19.

Coping strategies among medical professionals during COVID-19 outbreak

BACKGROUND: COVID -19 pandemic is a very stressful situation for doctors, who face the risk of infection in daily life. Coping is the process by which a person deals with stressful situations or demands. Identifying the coping strategies of our medical professionals will help us to understand their coping styles and to deliver effective interventions to enhance their mental well-being. METHODS: An online survey form with socio-demographic profile and BRIEF COPE tool for assessing different coping strategies was sent to interns, residents, and teaching faculty. The coping strategies were divided into emotion-based, problem-based, and dysfunctional coping, and spearman's correlation was done to determine any correlation between sociodemographic variables and the coping strategies. RESULTS: A total of 84 valid and complete responses were included in the study. There is a variable distribution of mean scores for problem-focused, emotion-focused, and dysfunctional strategies. Age and marital status had a positive correlation with problem-focused and emotion-focused strategies meaning that older adults and married people used these strategies predominantly. Higher designation used problem-focused coping predominantly. Dysfunctional coping strategies had no correlation with any of the sociodemographic variables. CONCLUSION: Sociodemographic factors affecting the coping mechanisms in medical professionals differ from those of the general population seen in previous studies. Within the group of medical professionals, those with higher age, higher designation and married had predominantly adaptive strategies. Interventions targetting maladaptive components of emotion-focused strategies and dysfunctional strategies should be aimed at a younger age group, unmarried people, interns, and residents among the medical professionals to better cope with this COVID scenario.

Psychological Morbidity Among Post-COVID-19 Patients: A Cross-sectional Study from Chennai, South India

Background: The COVID-19 pandemic is a global health threat and is by far the largest outbreak of atypical pneumonia, since the SARS outbreak in 2003. A range of psychiatric morbidities such as persistent depression, anxiety, panic attacks, delirium and suicidality were observed in the post infectious state across the world. Hence, the aim of the study was to understand the psychological status of the patients affected by COVID during their post-COVID follow-up period and to examine the socio-demographic and clinical factors associated with high psychological morbidity. Materials and Methods: A cross sectional study conducted in the post-COVID follow up clinic, at a tertiary care hospital between the months of August - November 2020, using a semi structured proforma and rating scales such as Patient Health Questionnaire-9 (PHQ-9), Hospital Anxiety and Depression Scale (HADS) and Insomnia Severity Index (ISI) for depression, anxiety and insomnia, respectively. Results: The study results indicate that the prevalence of depression and anxiety among post-COVID-19 patients was 21.9% and 11.9%, respectively. Insomnia was observed among 21.7%Among various sociodemographic and clinical variables examined, it was observed that female gender, patients with ongoing stressors and patients with post-COVID-19 persistent physical symptoms were found to be associated with greater depression and anxiety among the study population. Conclusions: Persistent physical symptoms and ongoing life stressors are found to be associated with depression and anxiety among post-COVID-19 patients. Hence, periodic screening for individuals with persisting physical symptoms and care for the vulnerable population such as those with ongoing stressors will provide a significant advantage in the follow up of the mental health of the patients affected with COVID-19.

Phenomenology and Severity of Symptoms in OCD Patients After COVID 19: A Cohort Study

Background: COVID 19 pandemic and the associated restrictions can have significant impact on patients with pre-existing mental disorders. Fear of getting infected and excessive focus on contamination can worsen in patients with OCD. Methodology: Thirty patients with OCD attending Chengalpattu Medical College Hospital were evaluated for OCD symptom severity using Y-BOCS severity scores in June and July 2020 and that was compared with their scores five months prior (pre covid) Results: Majority of the study population (53%) had no changes in symptom severity after the onset of COVID19 pandemic. Twenty seven percent (27%) had a decrease in symptom severity while only 20% had increase in severity. Conclusion: Our study results indicate that there were no significant changes in OCD symptom severity after the onset of COVID 19 pandemic.

Coping strategies among medical professionals during COVID-19 outbreak

BACKGROUND: COVID -19 pandemic is a very stressful situation for doctors, who face the risk of infection in daily life. Coping is the process by which a person deals with stressful situations or demands. Identifying the coping strategies of our medical professionals will help us to understand their coping styles and to deliver effective interventions to enhance their mental well-being. METHODS: An online survey form with socio-demographic profile and BRIEF COPE tool for assessing different coping strategies was sent to interns, residents, and teaching faculty. The coping strategies were divided into emotion-based, problem-based, and dysfunctional coping, and spearman's correlation was done to determine any correlation between sociodemographic variables and the coping strategies. RESULTS: A total of 84 valid and complete responses were included in the study. There is a variable distribution of mean scores for problem-focused, emotion-focused, and dysfunctional strategies. Age and marital status had a positive correlation with problem-focused and emotion-focused strategies meaning that older adults and married people used these strategies predominantly. Higher designation used problem-focused coping predominantly. Dysfunctional coping strategies had no correlation with any of the sociodemographic variables. CONCLUSION: Sociodemographic factors affecting the coping mechanisms in medical professionals differ from those of the general population seen in previous studies. Within the group of medical professionals, those with higher age, higher designation and married had predominantly adaptive strategies. Interventions targetting maladaptive components of emotion-focused strategies and dysfunctional strategies should be aimed at a younger age group, unmarried people, interns, and residents among the medical professionals to better cope with this COVID scenario.

Prevalence of Physical comorbidities among Long-Term Psychiatric Inpatients: A Single Centre Study from South India

Background: Physical comorbidities are the most common causes of early mortality among patients with mental disorders. Prevention and early treatment of physical comorbidities would lead to better outcomes. Hence, the aim to the study was to estimate the prevalence of physical health disorders present as comorbidities among long-term stay psychiatric inpatients and to compare the difference in the physical comorbidities among male and female patients. Materials and Methods: The study was conducted at Institute of Mental Health, Madras Medical College, Chennai. It was a descriptive study combining data from clinical files and nursing records related to the physical health of the long-term inpatients. The clinical records of long-term inpatients, defined as the duration of stay in the care facility for more than 5 continuous years between 1stJanuary and 30thJune, 2019 were assessed. Results: The estimated prevalence was74.2% (95% CI: 69.5-78.6) for at least one physical disorder comorbidity and 38.8% (95% CI: 33.8-43.9) had more than one physical comorbidities. Female in-patients have 2.7 times higher risk than males to have diabetes mellitus, hypertension and thyroid disorders. They also have 0.92 times higher risk than males to have anaemia. Conclusion: There is a high prevalence of physical comorbidities among long term psychiatric inpatients. Systems for the early detection and better clinical management of these physical comorbidities are essential in any long-term psychiatric facility.

Predictors of Access to Mental Health Care Services Among Persons with Severe Mental Disorders: A Community-Based Study from Rural South India

Background: Various factors are associated with access to care among patients with severe mental disorders (SMD). The aim of this study was to identify the predictors of access to care among patients with SMD in rural south India. Methods: The study was conducted in Pudukkottai district of Tamil Nadu, India. After screening and confirmation of SMD by community level workers and trained mental health workers, participants were classified as those who have at some time sought treatment and those who have never accessed mental health care services. Results: Among 422 participants with SMD, 74% had at some point in time accessed mental health care services. Logistic regression showed education asthe predictor of access to mental health care services among patients with severe mental disorders. Conclusion: Improving education and awareness on the mental illness and its treatment options will help the patients with mental illness to seek care early leading to favorable outcomes.