Schizophrenic patients who were never treated--a study in an Indian urban community

BACKGROUND

A significant number of patients with severe psychiatric disorders remain untreated in the community although health services are available. The factors related to non-treatment are not well understood.

METHOD

A door-to-door survey was conducted on an Indian urban population of 100,000 using standardized screening and clinical instruments as a part of a larger epidemiological study. Treatment status was determined from multiple sources of information.

RESULTS

Nearly one-third of 261 schizophrenia patients were found never to have received treatment. They were older in age and ill for a longer duration than those who had been treated and were more symptomatic and severely disabled. They were more often uneducated and divorced and lived with larger extended/joint families. This last factor was considered as being the important factor in determining whether the patient received treatment.

CONCLUSION

The larger extended/joint family, which was able to compensate and cope with the dysfunctional member, seemed to be the crucial factor related to non-treatment of the schizophrenic patient.

Prevalence of dementia in a rural setting: A report from India

A study to estimate the prevalence of dementia in a rural population was conducted in a community located on the outskirts of Madras city in South India. Seven hundred and fifty elderly 60 years of age and older, selected using the cluster sampling technique, were interviewed using the Geriatric Mental State schedule (GMS). The prevalence of dementia was 3.5%, the percentage increasing with age. These rural prevalence estimates were higher than in urban settings (WHO multicentre study on cognitive impairment and dementia in developed and developing countries, unpublished) and male/female differences were negligible. The difficulties associated with the use of the GMS in a non-literature rural population are discussed. The implications of these findings for India's growing elderly population are highlighted.

Ten-year course of schizophrenia--the Madras longitudinal study

Ninety first-episode patients fulfilling ICD-9 criteria for schizophrenia were followed up prospectively for 10 years. Complete assessments were possible on 76. The pattern of illness was good in 67% of the cases, and the commonest patterns was one with recurrent episodes. Predictors of poor course and longer time spent in psychosis were identified. All positive and negative symptoms showed a steep decline at the end of 10 years. The results are discussed in the context of longitudinal research on the course of schizophrenia in developing countries.

Age estimation in the elderly: relevance to geriatric research in developing countries

The accurate estimation of age is an important area in geriatric research. The lack of suitable records in developing countries coupled with illiteracy makes this process difficult. Fifty patients were studied in order to assess their age by means of a checklist which contained significant personal and historical events. The average patient was found to under-report his age by three years.

Incidence of schizophrenia in an urban community in madras

The incidence rate of an illness is a vital epidemiological measure for investigating etiology. Incidence estimates of schizophrenia from different parts of the world have shown variations, due to differences in the diagnostic criteria, measurement techniques and operational definitions used. In contrast to the prevalence studies in India, incidence surveys haw been sparse and the rates obtained relatively higher as compared to the west. As part of an ICMR Longitudinal Study of Functional Psychoses in an urban community in Madras, the incidence of schizophrenia was estimated in the slums. The case finding methods included a door to door survey and a leakage study. Cases defined using standardized diagnostic criteria, were identified using IPSS and PSE. The incidence rate was 0.21/1,000 by the community survey and 0.41/1,000 by the leakage study. This paper describes the study and discusses its relevance in India.

Gender differences in schizophrenia. Results of a follow-up study from India

As part of the study on 'Factors affecting the course and outcome of schizophrenia' at Madras, India, 96 schizophrenic patients who fulfilled Feighner's criteria were followed up closely. Of these, 67 patients who completed 5 years of follow-up were studied with respect to gender differences in sociodemographic and clinical variables at inclusion and follow-up, course of illness and outcome. Women were found to have a better outcome. The various factors contributing to this are discussed in the context of the Indian setting.

A study of sample attrition in follow up of schizophrenia

This paper examines attrition in a sample of 96 schizophrenic patients followed up prospectively for a period of four years. The characteristics of 25 patients who were totally lost for the study are discussed. Among those followed up, two groups were identified based on regularity of attendance to the OPD. It was found that it was primarily the clinical course which determined regularity, most of those who were irregular having a more favourable course and outcome. The importance of studying sample attrition in long term follow up of schizophrenic patients is stressed especially with reference to the continued use of psychiatric facilities.

Factors affecting relapse in schizophrenia

96 first episode schizophrenic patients were included for a prospective follow-up study on factors affecting course and outcome of schizophrenia. Feighner's diagnostic criteria were used for inclusion and a yearly assessment was made using the Present State Examination and the Personal and Psychiatric History Schedule. At the end of 3 years, 64 patients had been followed up. Of these, 38 patients had one or more relapses. A comparison of the relapsing group with the non-relapsers revealed certain variables to be significantly associated with relapses. Some of these were regularity of follow-up, presence of affective symptoms and self-neglect and lack of social contacts. The importance of recognising these factors in order to prevent relapses in schizophrenia is discussed.

Coping with symptoms of relapse in schizophrenia

A pilot study is reported of 30 chronic schizophrenic patients at the psychiatric out-patient facility of Government General Hospital, Madras, India. The objectives of the study were to assess the patients' perception of prodromata of relapse and their coping mechanisms. Patients were questioned on these aspects, using a semi-structured interview guide. The study showed a high degree of perception of prodromal signs amongst the cohort. Only 4 patients were unable to perceive any prodromata of relapse. Most commonly noted prodromal symptoms were disturbed sleep and slowness and underactivity. Patients had also resorted to various coping measures such as internal dialogue and talking to a close relative or friend. The study has clearly proved that Indian schizophrenic patients are perceptive of prodromata of relapse and developed self-help methods. These methods, if properly identified, could be incorporated in psychosocial intervention programmes.

Factors associated with the course and outcome of schizophrenia in India. Results of a two-year multicentre follow-up study

The paper describes the two-year follow-up results from 323 out of 386 patients fulfilling a modified version of Feighner's criteria for diagnosis of schizophrenia, in Lucknow, Vellore, and Madras. There was remission in 66% of cases. Short duration of illness, consistent compliance with medication, positive attitudes of relatives and neighbours, absence of economic difficulties, increase in religious activities on the part of patients, a rural background, and a non-schizoid pre-morbid personality were associated with good outcome. Features of depression, dangerous behaviour, and absence of agitation were associated with poor outcome.

Alexithymic characteristics in rheumatoid arthritis: a controlled study

Forty rheumatoid arthritis (RA) patients diagnosed by rigid criteria were evaluated for alexithymic characteristics using the Beth Israel Hospital Psychosomatic Questionnaire (BIQ) and the Toronto Alexithymia Scale (TAS). 40 healthy subjects matched with RA patients on sociodemographic variables served as controls. RA patients scored significantly higher on the BIQ and TAS compared to controls. The two scales correlated in the expected direction. Using the TAS cutoff score of 74 and above, 11 RA patients (27.5%) were identified as alexithymic. RA patients with greater functional impairment showed significantly higher alexithymia scores.

Prevalence of schizophrenia in an urban community in madras

Several studies have estimated the prevalence of Schizophrenia. Widely varied rates have in part been due to methodological and diagnostic differences. This paper presents the epidemiological indices for Schizophrenia, estimated as a part of a large study of over 1,00,000 urban population for Functional Psychoses. The age corrected prevalence rate is estimated and discussed.A study of socio-demographic aspects showed the prevalence of Schizophrenia to be higher among males; in slums; in extended and joint families; in those with no schooling and in unemployed. The focus of discussion is on methodological issues of prevalence estimation and the socio-demographic aspects of Schizophrenia.

The schedule for assessment of psychiatric disability - a modification of the das-ii

Measurement of Disability is one of the off-shoot projects of the major multicentred study on 'Factors Affecting Course and Outcome of Schizophrenia' being held at Madras, Vellore and Lucknow. As part of this study, modification of the Disability Assessment Schedule (II) was carried out at the Madras centre. Certain items of the DAS were deleted and the rest were regrouped into 4 main areas of personal, social, occupational and global disability. This modified instrument called the Schedule for Assessment of Psychiatric Disability (SAPD) was administered to 30 patients each of the 3 groups of psychoses, neurotics and diabetics. It was found that the SAPD effectively discriminated the psychotic group from the other 2 groups. The authors recommend this instrument for measurement of disability in an outpatient psychiatric population.

Study of relapses in schizophrenia using the life table method

The life table has been used to study mortality and survival in a population and also the pattern of course of various chronic medical illnesses. In this study, the life table has been applied to a cohort of well defined Schizophrenic patients undergoing a long term followup. The probability of occurence of relapses, time of maximum risk for occurence of relapses are estimated using the life table technique. The life table shows a steep fall in the percentage of Non-relapsers from 85% at the end of first year to 35% at the end of the third year. Projected survival rate at the end of 5 years, using the second degree parabola curve, is only 2 % which needs to be tested by further followup.

Progressive renal damage due to lead intoxication in early life

We have evaluated the effect of an increased body lead burden in young (3 weeks old) and adult (9 weeks old) Sprague-Dawley rats. Following intraperitoneal administration of lead on two occasions, both renal blood flow and glomerular filtration rates were diminished in the young rats, but not in the adult rats. Our study lends credence to the hypothesis that age at the time of exposure is critical to the development of progressive renal damage.

Rehabilitation needs of schizophrenic patients - a preliminary report

59 Feighner positive Schizophrenics were assessed for subjective rehabilitation needs using a specially designed schedule for the purpose. It was observed that employment and vocational rehabilitation were most sought after, psychosocial rehabilitation less so, and accommodation hardly at all. Both women and men had identical needs, and the necessity for individualised package programmes was identified. The implications of the findings are discussed.

Lichen sclerosus et atrophicus in an eleven year old girl. Report of a case

An elevent year old girl who presented with constipation of two years' duration was found to have atrophy and depigmentation of the anogenital area. Results of a skin biopsy confirmed the diagnosis of lichen sclerosus et atrophicus, which is a rare disease in children. Treatment of the disease is non-specific, and it usually disappears in half of the patients around the time of menarche. Long-term follow-up of persistent anogenital lesions is necessary.

Shigella vulvovaginitis in childhood: a case report

Vulvovaginitis due to Shigella sonnei is reported in a four-year-old child.Shigella sonnei as a rare primary pathogen causing vulvovaginitis, the prolonged nature of the clinical course, and the therapeutic implications of increasing resistance to ampicillin by the organism are discussed.