Antiparkinsonian prescription and extrapyramidal symptoms.
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Antiparkinson Agents↗
Biomedical subjects
P Kulhara
Publications and source records attributed to P Kulhara.
Cost of care of schizophrenia: a study of Indian out-patient attenders.
OBJECTIVE: To assess the cost of care of Indian out-patients with schizophrenia. METHOD: Cost of illness in 50 out-patients with schizophrenia was assessed over a 6-month period together with structured assessments of psychopathology and disability, and compared with 50 out-patients with diabetes mellitus. RESULTS: Total annual costs of care of schizophrenia were 274 US dollars; these were not significantly different from diabetes mellitus. Indirect costs (63%) were higher than direct costs. Drug costs were high. The main brunt of financial burden was borne by the family. Total treatment costs in schizophrenia were significantly higher in those who were unemployed, those who visited the hospital more often, and were more severely ill and disabled. CONCLUSION: Schizophrenia is an expensive illness to treat even in developing countries. Costs of care are similar to those of chronic physical illness, such as diabetes mellitus. Costs are higher in severely ill and disabled patients.
Adult↗
Cost of ambulatory care of diabetes mellitus: a study from north India.
BACKGROUND: Diabetes mellitus is a chronic and potentially disabling disease that represents an important public health and clinical concern because of the economic burden it imposes on the person, family, and society. Despite this, data regarding cost of care of diabetes mellitus from developing countries are scarce. This study aimed to assess the cost of care of Indian patients with diabetes mellitus. METHODS: Cost of illness in 50 outpatients with diabetes mellitus (diagnosed according to WHO criteria, Expert Committee, 1997) was assessed over a six month period using a specially designed questionnaire, together with structured assessments of disability. RESULTS: Total annual cost of care was 14 508 rupees (263.78 euros). The largest proportion of the total cost was made up of direct costs (68%), followed by indirect costs (28.76%) and provider's costs (2.8%). Drug costs were high. Total treatment cost was significantly higher in those who were more educated, those who visited the hospital more often, and those receiving a greater number of drugs. CONCLUSION: From this study it can be concluded that diabetes mellitus is an expensive illness to treat even in developing countries. The main brunt of financial burden is borne by the family. Any efforts at cost reduction should, therefore, have the family as its focus, and relieving the family of this financial burden needs to be prioritised.
Adult↗
Limitations of rapid tranquillisation trial.
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Antipsychotic Agents↗
Seasonality and affective disorders: a report from North India.
Case records of the patients with major affective disorders (ICD-10 criteria), seen over a 5 year period in a busy clinic in North India were examined for Seasonal Affective Disorder (SAD) as per DSM-III-R criteria. In addition, seasonality of episodes of all affective disorders was also studied. Around 5.67% of the cases (n=44) retrospectively met the DSM-III-R criteria of SAD and predominant pattern was that of summer depression (n=18). There was also a consistent pattern of seasonal mania either in conjunction with seasonal depression (n=18) or in form of seasonal recurrent mania (n=11). None of the cases of depression showed any atypical vegetative features. In cases not meeting criteria for SAD (n=731), there was a trend for peaks for depressive episodes in winter followed by a smaller peak in summer months while manic episodes had peaks towards rainy and winter months. As compared to seasonal patterns of affective disorders in temperate zones, there was a general trend for opposite patterns of seasonality in SAD as well as in non-SAD. The findings are discussed in context of the climatic conditions of North India.
Adult↗
Culture and schizophrenia and other psychotic disorders.
The comparative study of schizophrenia and related disorders across cultures has come a long way since Kraepelin advocated its cause, following his trip to Java at the beginning of the last century. The principal development since then has been the burgeoning of interest in the field, culminating in innovative and ambitious international collaborative research by the WHO. Despite reservations about covert ideology or about the more overt methodologic difficulties, the balance of evidence from these and similar studies suggests that: It is feasible to conduct such research despite the numerous hazards. There is a certain uniformity to the way schizophrenia presents globally; there are equally significant cultural differences. The outcome of schizophrenia appears to be better in developing, than developed cultures; reasons for this are far from clear, nevertheless, it can be safely assumed that culturally-determined processes, whether social or environmental, are partly responsible. Overall, the study of schizophrenia in different cultures has proved useful in establishing the pancultural and the culture-specific properties of this and related disorders.
Cross-Cultural Comparison↗
Thyroid functions in lithium-treated psychiatric patients: a cross-sectional study.
In the present cross-sectional study, thyroid functions (viz. thyroid radioiodine uptake [RAIU] and serum T3, T4, and thyroid-stimulating hormone [TSH]) were evaluated in 24 healthy controls and 132 outdoor affective disorder patients. Eleven of these patients were to receive lithium (Li) and the remaining 121 patients were at different stages of Li treatment ranging from 0.7 to 240 mo. RAIU was found to increase significantly throughout the Li therapy and was associated with the corresponding rise in TSH levels. In totality, Li treatment induced subclinical hypothyroidism in 51/132 (39%) of patients. However, 8/51 patients who belonged to known iodine-deficient belt had abnormally high TSH (range 15.2-76.0 microIU/mL), low T4 (5.3+/-2.5 microg/dL), and normal T3 and at least 4 of these 8 patients were clinically hypothyroid. T4 levels declined significantly (p < 0.05) with Li treatment ranging from 61 to 240 mo as compared to the corresponding values in the pre-Li group. The T3/T4 ratio was found to be significantly higher with Li treatment ranging from 0.7 to 6 mo in comparison with the pre-Li group and this value returned to base levels after long-term Li therapy. High T3 and T4 were observed in 13% and 12% of the patients, respectively, as compared to the corresponding control values.
Adolescent↗
Rapid cycling affective disorder: a descriptive study from North India.
A series of 33 (4.29%) cases of rapid cycling affective disorder (RCAD ICD-10-DCR) out of a pool of 770 consecutive cases of ICD-10 affective disorder (AD) was collected over a period of 5 years. All cases of RCAD belonged to bipolar affective disorder. RCAD when compared with non-rapid cycling bipolar affective disorder (BPAD) revealed a significantly longer mean duration of illness, greater number of total episodes, greater number of hospitalizations and stronger family loading of bipolar affective disorder. These findings implicate RCAD as a severe form of bipolar affective disorder.
Adult↗
Lithium prophylaxis of recurrent bipolar affective disorder: long-term outcome and its psychosocial correlates.
BACKGROUND: Discrepancy between efficacy of prophylactic lithium and its effectiveness in ordinary clinical practice necessitates long-term follow-up data from specialised lithium clinics. Also, role of psychosocial factors in influencing the outcome is unclear. METHODS: One hundred and eighteen patients of bipolar affective disorder attending a lithium clinic were followed-up for approximately 11 years (range 2-27 years). Demographic and clinical data, measures of social support and psychosocial stress were obtained at the intake in 1989-1990. Study design combined retrospective chart-review (till the time of intake) with prospective follow-up till July 1995. RESULTS: On lithium, the patients had a mean of 0.43 relapses per year (manic, 0.26; depressive, 0.17) which was significantly less (p < 0.01) than the pre-lithium episode frequency. The figure for entirely relapse-free patients was 24%, and 62% had relapses up to one episode per year (median = 0.3 per year). Fifty-eight (49%) patients were good responders to lithium (relapses < or = 0.30 per year). In comparison to good responders, partial/poor responders had a significantly greater number of pre-lithium depressive episodes, poor lithium compliance, more psychosocial stress and lower social support at intake. These variables correlated well with relapses and explained 32% of the variance of the data. CONCLUSIONS: Lithium had a definite prophylactic effect on long-term outcome. Social support and stressful life events are significant correlates of response to lithium. CLINICAL IMPLICATIONS: Lithium prophylaxis of bipolar affective disorders seems justified though psychosocial factors appear to modulate its effectiveness. LIMITATIONS: Other psychotropic medications were used during relapse and the assessment of psychosocial factors was cross-sectional.
Adolescent↗
Family burden of caring for people with mental illness.
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Caregivers↗
A psychosocial study of 'self-immolation' in India.
The phenomenon of self-immolation was studied in 22 young people, mostly students, who had indulged in this act to protest against the decision of the Government of India to enlarge the scope of reservations in jobs and educational institutions. Within a short span of time of arriving at one of the two treatment centres after attempting self-immolation, the subjects were interviewed and assessed on a semi-structured interview schedule to elicit sociodemographic and attitudinal data. The subjects were also rated on the Brief Psychiatric Rating Scale, Pierce's Suicide Intent Scale, the Superego Paranoia Depression Scale, the Hostility and Direction of Hostility Questionnaire, the PGI Locus of Control Scale and the Alienation Scale. All subjects except one were free of manifest psychopathology. The group as a whole had a high score on Pierce's Suicide Intent Scale and displayed internal locus of control orientation. Most were ambitious, aggressive, hostile and felt alienated. The absence of manifest psychopathology sets this group apart from cases of deliberate self-harm arising in the context of psychiatric morbidity. Thwarted ambitions, a sense of alienation and intropunitive hostility can lead to protest which at times becomes altruistic and results in self-immolation.
Adolescent↗
Quality of life in schizophrenia and dysthymia.
Quality of life (QOL) was assessed in three groups of patients, consisting of 30 schizophrenic patients with duration of illness <2 years, 30 schizophrenic patients with duration of illness > or = 2 years and 30 dysthymic patients. The diagnoses were made according to ICD-10. Two scales of quality of life were used, one of which was specific for schizophrenia, while the other was generic for all patients. On inter-group comparison the two schizophrenia groups did not show significant differences in quality of life, but on comparing schizophrenic and dysthymic patients, significant differences emerged. Dysthymic patients were significantly less satisfied than schizophrenic patients with duration of illness <2 years in the domain of physical health. In the domains of satisfaction with medication and leisure-time activities, both schizophrenic groups were significantly more satisfied than the dysthymic group. Comparison of the quality of life ratings of our patients with those of a well-known study from Sweden revealed some significant differences which relate to the domains of work, contacts, inner experience and leisure-time activities. Cultural factors are invoked to account for these differences. The need for refinement of assessment of quality of life in multi-racial and multi-ethnic contexts is stressed.
Activities of Daily Living↗
Subsyndromes of chronic schizophrenia: a phenomenological study.
Statistical grouping of clinical symptoms and signs is one method of classifying schizophrenia. This study attempted to find factors of symptoms generated through clinical ratings on three scales, namely the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS) and the Comprehensive Psychopathological Rating Scale (CPRS) in a sample of 80 stable chronic schizophrenics diagnosed by DSM-III-R. It was found that the positive-negative dichotomy could not be replicated. Inappropriate affect was found to be a clear misfit in the cluster of negative symptoms. Inclusion of CPRS led to the generation of a factor loading high on depressive and asthenic items, and this could be clearly distinguished from the factor of negative symptoms. This factor had not hitherto been identified.
Activities of Daily Living↗
Psychosexual dysfunction in Indian male patients: revisited after seven years.
Short-term (1 year) outcome of 66 male patients with psychosexual dysfunction was studied in the context of patients' sociodemographic and clinical characteristics. A combination of erectile dysfunction and premature ejaculation was the most common diagnosis. Long-term (7 years) outcome of this cohort was evaluated in relation to short-term outcome. Improvement in the short-term indicated favorable long-term outcome. Initial dropout was associated with chronic and continuous sexual dysfunctioning.
Adolescent↗
Outcome of schizophrenia: some transcultural observations with particular reference to developing countries.
The present paper provides a description of data based and methodologically sound studies of outcome of schizophrenia from developing and non-Western countries and compares the results. Major studies reviewed include the 2- and 5-year follow-up of the cohort of the International Pilot Study of Schizophrenia, the patients of the World Health Organization Collaborative Study on the Determinants of Outcome of Severe Mental Disorders, a few Indian studies including the study sponsored by the Indian Council of Medical Research and some studies from Colombia and South-East Asia. The studies are compared in terms of the quality of methodology and the rate of attrition. Although the outcome criteria of these studies are not similar, it is obvious that the outcome of schizophrenia in developing countries is generally more favourable. The reasons for this are far from clear. Research concerning the issues pertaining to better outcome of schizophrenia in developing countries in the context of socio-cultural differences in woefully lacking. This is an area that deserves research attention.
Cross-Cultural Comparison↗
Combined chlorpromazine and electroconvulsive therapy in mania.
We report the efficacy of combined chlorpromazine and electroconvulsive therapy (ECT) in the treatment of mania. Two groups of 15 manic patients received eight ECT sessions either actual or simulated, in a double-blind, controlled study. All patients also received 600 mg of chlorpromazine daily until the sixth session. Results indicate that the group receiving the combination of chlorpromazine and ECT did significantly better than the other group.
Adult↗
The pattern of burden in families of neurotic patients.
The pattern of burden in 90 families with a neurotic patient, 30 each with dysthymia, generalized anxiety disorder and obsessive compulsive disorder was evaluated in this study. Burden was chiefly felt in four principal areas; financial burden, disruption of family routine, disruption of family leisure and family interactions. This pattern was similar among the three study groups. Analysis of problems perceived as burdensome demonstrated an increased concern among relatives regarding routine household matters, restricted leisure and ill effects of the patient's illness on the family atmosphere. Burden was significantly greater in cases of married patients, married relatives, housewives and employed patients. Such data, it is hoped, will help provide guidelines along which an enquiry into different aspects of burden can be conducted.
Adolescent↗
Post-psychotic depression in schizophrenia.
Post-psychotic depression (PPD) is defined as the development of depression during the phase of remission of schizophrenia. Two groups of DSM-III-R schizophrenics, one with PPD and the other without PPD (30 subjects in each group) were compared. Significantly more patients in PPD group belonged to nuclear families, had longer duration of psychotic phase of the illness, were hospitalised more frequently and had more sadness and anxiety-somatisation during florid illness phase. The PPD group also had more past history of depression. Although PPD patients had better premorbid personal-social adjustment in comparison with non-PPD group, they perceived themselves to be lacking in social support and had experienced more stressful life events. For patients in the PPD group, stepwise multiple regression analysis revealed age of onset, sadness during florid psychotic state, premorbid adjustment, social support and life events as significant determinants of severity of depression in the post-psychotic phase.
Adult↗