Yoga-based intervention in patients with somatoform disorders: an open label trial

Somatoform disorders are common mental disorders associated with impaired functioning and increased utilization of health resources. Yoga-based interventions have been used successfully for anxiety, depression, and chronic pain conditions. However, literature on the use of yoga in treatment of somatoform disorders is minimal. The current study assessed the effect of a specific yoga-based intervention in patients with somatoform disorders. Consenting patients meeting ICD-10 criteria for somatoform disorders were offered a specific yoga module (1 h per day) as a treatment. Assessments including Visual Analogue Scale (VAS), Brief Pain Inventory (BPI), and others were carried out at baseline and after 2, 6, and 12 weeks. Sixty-four subjects were included in the study and 34 completed 12 weeks follow-up. Significant improvement was noted in pain severity from baseline to 12 weeks after regular yoga sessions. The mean VAS score dropped from 7.24 to 2.88. Worst and average pain score in the last 24 h on BPI dropped from 7.71 to 3.26 and from 6.12 to 2.0,7 respectively. Results of the study suggest that yoga-based intervention can be one of the non-pharmacological treatment options in somatoform disorders. These preliminary findings need replication in larger controlled studies.

Yoga intervention and functional pain syndromes: a selective review

The definition of functional pain syndromes is varied across literature. No effort has been made to see all functional pain disorder groups under broad nomenclature which would exclude conditions for which pathophysiology is strongly known. Since these disorders are commonly treated with alternative treatment modalities and impose significant burden on health utilization, an effort to look into studies on yoga-based interventions on 'functional pain syndromes' (FPS) was made. This study defined FPS as 'Chronic relapsing remitting pain conditions, the origin of which is difficult to trace with no definite physical pathology on clinical suspicion or available laboratory measures and are valid based on subjective pain reporting, associated distress and socio-occupational dysfunction'. Chronic headache, neck pain, back pain, fibromyalgia, pelvic pain, Irritable Bowel Syndrome, Chronic Fatigue Syndrome, and somatoform pain disorders were included for this review. The review found four meta-analyses on the selected topic both indicating modest efficacy and benefit of yoga in these disorders. Future efforts should be directed to do a large meta-analysis of functional pain syndromes.

What is in a name? Causative explanatory models of postpartum psychosis among patients and caregivers in India

BACKGROUND

Explanatory models (EMs) influence decision-making related to treatment and compliance. There is little knowledge about belief systems related to postpartum psychosis in different cultures.

AIMS

To study EMs of illness among women with postpartum psychosis and their family members in India.

METHOD

A total of 123 women with postpartum psychosis and their caregivers were assessed to understand their beliefs regarding causes of postpartum psychosis using Short Explanatory Model Interview (SEMI). Local names were listed and emerging themes were analysed.

RESULTS

Respondents often held more than one EM and only one-third held a biomedical EM. Other common models included stressors unique to childbirth, marital stress and supernatural causes. Local names reflected the underlying models.

CONCLUSION

Non-biomedical EMs are common in women with postpartum psychosis. Cultural and social factors unique to childbirth appear to influence these models. There is a need to enhance awareness and knowledge about this serious disorder in the community.

Antipsychotics in pregnancy and lactation

Research on psychotropic medications during pregnancy and lactation is limited as often involves complex ethical issues. Information on safety of psychotropic drugs during these critical phases is either inconclusive or undetermined. Many women with severe mental illness have unplanned pregnancies and require antipsychotic medication during pregnancy and lactation. Multiple issues have to be considered while choosing safe treatments for pregnant and lactating women and the best approach is to individualize the treatment. Medication should be guided primarily by its safety data and by the psychiatric history of the patient. Important issues to be kept in mind include pre-pregnancy counseling for all women, including planning pregnancies; folate supplementation, discussion with patient and family regarding options, and active liaison with obstetricians, ultrasonologists and pediatricians. Whenever possible, non-pharmacological approaches should be used in addition.

The establishment of a mother-baby inpatient psychiatry unit in India: Adaptation of a Western model to meet local cultural and resource needs

BACKGROUND

Several Western countries have established mother-baby psychiatric units for women with mental illness in the postpartum; similar facilities are however not available in most low and medium income countries owing to the high costs of such units and the need for specially trained personnel.

MATERIALS AND METHODS

The first dedicated inpatient mother-baby unit (MBU) was started in Bengaluru, India, in 2009 at the National Institute of Mental Health and Neurosciences in response to the growing needs of mothers with severe mental illness and their infants. We describe the unique challenges faced in the unit, characteristics of this patient population and clinical outcomes.

RESULTS

Two hundred and thirty-seven mother-infant pairs were admitted from July 2009 to September 2013. Bipolar disorder and acute polymorphic psychosis were the most frequent primary diagnosis (36% and 34.5%). Fifteen percent of the women had catatonic symptoms. Suicide risk was present in 36 (17%) mothers and risk to the infant by mothers in 32 (16%). Mother-infant bonding problems were seen in 98 (41%) mothers and total breastfeeding disruption in 87 (36.7%) mothers. Eighty-seven infants (37%) needed an emergency pediatric referral. Ongoing domestic violence was reported by 42 (18%). The majority of the mother infant dyads stayed for <4 weeks and were noted to have improved at discharge. However, 12 (6%) mothers had readmissions during the study period of 4 years. Disrupted breastfeeding was restituted in 75 of 87 (86%), mother infant dyads and mother infant bonding were normal in all except ten mothers at discharge.

CONCLUSIONS

Starting an MBU in a low resource setting is feasible and is associated with good clinical outcomes. Addressing risks, poor infant health, breastfeeding disruption, mother infant bonding and ongoing domestic violence are the challenges during the process.

Consumer perspectives on the concept of recovery in schizophrenia: A systematic review

Subjective descriptions of recovery from schizophrenia may be different from clinical recovery measures. The aim of the review was to identify the consumer perspectives of recovery from schizophrenia. Twenty-five studies within the period of 2000-2013, including qualitative and quantitative studies were reviewed by using different search strategies. An integrated method was used and the findings were coded and related themes were identified under five areas, namely, process orientation, self orientation, family orientation, social orientation, and illness orientation. Recovery was considered as both process and outcome. Patient or client-based definitions of recovery mainly involved factors related to personal wellbeing and social inclusion, that were seemingly distant from the clinical recovery measures. Incorporating consumer descriptions of recovery in recovery oriented services can increase the outcome of the services.

The Question is the Answer: concerns and queries raised by patients and caregivers referred to rehabilitation services

BACKGROUND

The philosophy of recovery emphasises consumer participation and engagement in developing effective rehabilitation services. Assessment of consumer perspectives and concerns lies at the heart of responsive and relevant rehabilitation frameworks.

AIM

The study aimed to document and examine patient and caregiver queries, at their first contact with Rehabilitation Services.

METHODS

The sample consisted of 124 consecutive inpatients and their accompanying caregiver/s, referred to Psychiatric Rehabilitation Services, within a tertiary care psychiatric hospital in India. The data were collected using the semi-structured Inpatient Intake proforma during the intake session. The spontaneous queries raised by patients and/or caregivers were documented and content analysis identified themes, separately for patients and caregivers.

RESULTS

The results indicated both similarities and differences in the frequency of themes that emerged from questions asked by patients and their caregivers. Two prominent themes centered on specific queries about rehabilitation services and the treatment and prognosis of the psychiatric illness.

CONCLUSIONS

The findings have implications for training, practice and research in the field of psychosocial rehabilitation. Recommendations are made for training and practice frameworks to facilitate consumer-service provider communication towards the development of responsive recovery-oriented services.

On somatic symptoms measurement: the scale for assessment of somatic symptoms revisited

BACKGROUND

Scale for assessment of somatic symptoms (SASS) has been widely used for assessing somatic complaints since many years. With impending changes in the classificatory system on somatoform disorders, we re- assessed the test-retest reliability and inter-rater reliability of SASS.

MATERIALS AND METHODS

SASS was administered twice with a gap of 24 h on 20 subjects for test retest reliability. Two clinicians assessed inter-rater reliability on 20 subjects. Kendall tau B and Cronbach's alpha were calculated from the data.

RESULTS

All of the items except burning sensation, weakness of mind and trembling had strong correlation with values >±0.40 on both test retest and inter-rater reliability; burning sensation and trembling were not reported by any subject. On inter-rater reliability the items constipation, diarrhea, lack of libido weren't scored by any subjects. Cronbach's alpha for test retest was 0.982 and 0.840 indicating good internal consistency.

CONCLUSION

Majority of the symptoms in SASS had high correlation in both test retest reliability as well as inter-rater reliability, however few items needs revision.

Postpartum psychosis in a woman with Graves' disease: a case report

OBJECTIVE

Thyroid dysfunction is common during pregnancy and the postpartum period and is known to cause psychiatric disturbances. A woman with Graves' disease and psychosis in the postpartum period is described.

METHODS

A 22-year-old woman with Graves' disease developed fluctuating orientation, catatonia, delusions of persecution and auditory hallucinations 3 days following childbirth.

RESULTS

The report discusses the clinical presentation. Treatment of both conditions led to the resolution of symptoms.

CONCLUSION

Graves' disease with postpartum psychosis may present with delirium, catatonia and prominent auditory hallucinations and responds well to a combination of psychotropic and antithyroid drugs. Thyroid dysfunction should be assessed for and managed adequately in postpartum psychosis.

Assessing abnormal illness behavior in post-stroke patients: a preliminary report

BACKGROUND

Abnormal illness behavior (AIB) can contribute poor functioning in an individual along with significant increase in health care utilization. It has been studied in various disorders. This study examined the feasibility of assessing abnormal illness behavior in individuals with stroke who were undergoing treatment in a psychiatric and neurological rehabilitation center.

MATERIALS AND METHODS

Subjects who were admitted to the department of psychiatric and neurological rehabilitation ward for post-stroke rehabilitation treatment were assessed using screening version of Illness Behavior Questionnaire (SIBQ).

RESULTS

The total number of subjects who were screened was eight. The mean score of SIBQ was 6.125 ± 1.35. With the cut off score of 7, five subjects had abnormal illness behavior.

CONCLUSIONS

The above study highlights that it is feasible to screen individuals with stroke undergoing rehabilitation for possibility of abnormal illness behavior.

Medication Adherence, Work Performance and Self-Esteem among Psychiatric Patients Attending Psychosocial Rehabilitation Services at Bangalore, India

CONTEXT

Work benefits mental health in innumerable ways. Vocational rehabilitation can enhance self-esteem. Medication adherence can improve work performance and thereby the individuals' self-esteem.

AIM

To test the hypothesis that there would be a significant correlation between medication adherence, work performance and self-esteem.

SETTING AND DESIGN

A quantitative, descriptive correlational research design was adopted to invite patients attending psychiatric rehabilitation services to participate in the research.

MATERIAL AND METHODS

Data was collected from a convenience sample of 60 subjects using the 'Medication Adherence Rating scale', 'Griffiths work behaviour scale' and the 'Rosenberg's Self-esteem scale'.

STATISTICAL ANALYSIS USED

Analysis was done using spss18 with descriptive statistics, Pearsons correlation coefficient and multiple regression analysis.

RESULTS

There were 36 males and 24 females who participated in this study. The subjects had good mean medication adherence of 8.4 ± 1.5 with median of 9.00, high mean self-esteem of 17.65 ± 2.97 with median of 18.0 and good mean work performance of 88.62 ± 22.56 with median of 93.0. Although weak and not significant, there was a positive correlation (r = 0.22, P = 0.103) between medication adherence and work performance; positive correlation between (r = 0.25, P = 0.067) medication adherence and self-esteem; positive correlation between (r = 0.136, P = 0.299) work performance and self-esteem. Multiple regression analysis showed no significant predictors for medication adherence, work performance and self-esteem among patients with psychiatric illness.

CONCLUSIONS

Medication monitoring and strengthening of work habit can improve self-esteem thereby, strengthening hope of recovery from illness.

Does pain behavior influence assessment of pain severity?

CONTEXT

Nurses are involved in assessment of pain in most clinical settings. Pain continues to be underestimated and undertreated.

MATERIALS AND METHODS

This study assessed the rating of pain severity by nurses who observed the two case scenarios using role plays. The data were computed and frequency distribution was derived.

RESULTS

Majority of the nurses underrated the pain and based their ratings on various factors.

CONCLUSIONS

It is important to increase the awareness among nurses about comprehensive assessment of pain for better management.

A Study on First Intake Assessments of In-patient Referrals to Psychiatric Rehabilitation Services

BACKGROUND

Psychiatric rehabilitation is an important component in mental health services. The rehabilitation needs of patients with mental illness have been highlighted in various studies. The studies on in-patient referrals to rehabilitation services however are sparse. This study describes the clinical and demographic details and the reasons for referrals to rehabilitation services during the in-patients stay.

MATERIALS AND METHODS

A semi-structured pro forma was used for the assessment of in-patients referred for the psychiatric rehabilitation services. The pro forma included socio-demographic details such as background, family resources, illness related details such as symptom status, risk assessment, medication details. The total number of referrals for a period of 5 months was collected and coded.

RESULTS

The total number of referrals for a period of 5 months was 216 and there were 197 forms available for the study. The mean age of the sample was 31.48 ± 10.46 years. Vocational rehabilitation was the commonest reason for referral to the in-patient services. Severe mental disorders were the most common diagnosis of patients refereed to the services.

CONCLUSIONS

Patients with severe mental illness were most often referred to the in-patient services. This indicates that we need include to rehabilitation in the management plan at the earliest. Vocational rehabilitation is the most common reason for referrals and there is a need to develop services to cater to these needs.

Prevalence and risk factors associated with tardive dyskinesia among Indian patients with schizophrenia

BACKGROUND

Tardive dyskinesia (TD) is one of the most distressing side effects of antipsychotic treatment. As prevalence studies of TD in Asian population are scarce, a cross-sectional study was performed to assess the frequency of TD in Indian patients with schizophrenia and risk factors of TD.

METHOD

Cross-sectional study of 160 Indian patients fulfilling the DSM-IV TR criteria for schizophrenia and who received antipsychotics for at least one year, were examined with two validated scales for TD. Logistic regression analyses were used to examine the relationship between TD and clinical risk factors.

RESULTS

The frequency of probable TD in the total sample was 26.4%. The logistic regression yielded significant odds ratios between TD and age, intermittent treatment, and total cumulative antipsychotic dose. The difference of TD between SGA and FGA disappeared after adjusting for important co-variables in regression analysis.

CONCLUSION

Indian patients with schizophrenia and long-term antipsychotic treatment have a high risk of TD, and TD is associated with older age, intermittent antipsychotic treatment, and a high total cumulative antipsychotic dose. Our study findings suggest that there is no significant difference between SGAs with regards to the risk of causing TD as compared to FGAs.

A comparative study of psychopathology, symptom severity, and short-term outcome of postpartum and nonpostpartum mania

OBJECTIVES

Most studies acknowledge that postpartum psychosis is a variant of bipolar disorder with certain unique clinical features. There have been several descriptions of similarities and differences between postpartum psychosis and postpartum mania to support this conclusion. However, not many studies have compared postpartum-onset and nonpostpartum-onset mania. This study compared short-term outcome, clinical features, and severity of symptoms between these two groups.

METHODS

Two groups of women (n = 30 each) matching the study criteria were recruited from psychiatric inpatient units in India during the period from April 2007 to August 2008. They had been systematically assessed for psychiatric symptoms and symptom severity using the Comprehensive Psychopathology Rating Scale (CPRS), Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), and Global Assessment of Functioning Scale (GAF). To evaluate short-term outcome, all assessments were conducted within a week of admission and were repeated at six weeks.

RESULTS

Women with postpartum-onset mania had higher scores on the HDRS, indicating more depressive symptoms. The score on the anxiety factor of the HDRS was also higher in the postpartum group. Based on CPRS ratings, perplexity, muscle tension, worrying, inner tension, lability of mood, lassitude, and disorientation were more common in the postpartum group, while typical manic symptoms were more common in the nonpostpartum group. Duration of hospital stay and short-term outcome were, however, similar in the two groups.

CONCLUSIONS

Symptoms of depression and anxiety are more common and more severe in mania of postpartum onset and typical manic symptoms are fewer. However, six-week outcomes appear similar to those of nonpostpartum mania.

Therapist concerns and process issues in grappling with functional autobiographical amnesia

Dissociative amnesia is relatively rare form of the dissociative disorder. This paper aims at describing the salient features of a case of functional autobiographical amnesia in a young adult and the approach adopted in the psychological management of this case. The case highlights concerns of the therapist at various stages of the therapy process.

Pain with no cause! Nurses' perception

CONTEXT

Nurses are called upon to assess chronic pain in health settings and their perceptions about chronic pain are likely to influence the pain assessment and pain relief.

SETTINGS AND DESIGN

This survey as a part of chronic pain education workshop was conducted at National Institute of Mental Health and Neurosciences, Bangalore, India, by pain education group. Here we present the observations collected during the workshop on chronic pain held for nurses.

MATERIALS AND METHODS

A semiqualitative method was used to survey the perceptions about chronic pain among nurses. The survey form consisted of 28 statements about chronic pain with options of agree and disagree to be marked prepared by the pain education group.

STATISTICAL ANALYSIS USED

The data were computed and frequency distribution of different statements was derived.

RESULTS

The total number of participants was 44. Two-thirds of the nurses had good knowledge about pain behaviors. About 70% of the nurses reported that severity of pain to be assessed by observing patient's behavior and felt that if a house wife complains of pain it is to avoid work. Only 11% of the nurses provided correct responses related to discussion on pain being psychological; 90% had poor knowledge about pain communication on pain to be treated only for the underlying cause.

CONCLUSIONS

These observations highlight the fact that inadequacies in knowledge about chronic pain exist among nurses; the main areas include pain communication and pain treatments. It is important to include proper pain curriculum and training for chronic pain assessment and management.

Measurement and assessment of somatic symptoms

Somatic symptoms are common presentations in health settings. They can manifest as symptoms of another underlying mental disorder or be termed as medically unexplained. When they are medically unexplained they are invariably subsumed under the diagnostic categories of somatoform disorders. They are associated with interference in functioning, poor quality of life and are burdensome on health resources. The measurement of these symptoms is essential for understanding the individual and planning treatment. There are various instruments that have somatic symptoms measurement in their items. The tools have included somatic symptoms measurement in measuring general psychopathology, somatic symptoms as part of anxiety and depression, somatic symptoms specifically, and as a screening instrument for somatoform disorders. The advantages and disadvantages of common measures have been discussed. It appears that no one measure fulfils the essential criteria of an ideal measure for somatic symptoms. The measures of somatic symptoms should also be culturally sensitive and serve diagnostic, prognostic and heuristic purposes. These aspects are highlighted in the review.