Psychosomatic disorders in developing countries: current issues and future challenges

Reliability and Validity of the Urdu Version of Psychosomatic Symptoms Scale in Pakistani Patients

The current study was aimed to assess the reliability and validity of the Urdu version of the Psychosomatic Symptoms Scale (PSSS) in Pakistani patients. The PSSS is time-saving and easy to administer. The field experts drafted the translated version of PSSS. The Urdu version of PSSS, Patient Health Questionnaire- 9 (PHQ-9), and Symptom Checklist-90 (SCL-90) Urdu version were used for assessment. The translation procedure was comprised of three steps, namely forward translation, back translation, and expert panel discussion. A sample of 982 (men = 50.5% and women = 49.5%) was collected with a convenient sample technique from a general hospital and private clinic. The Cronbach’s alpha for PSSS was 0.974. The confirmatory factor analysis (CFA) revealed that all the items factor loading of PSSS were more than 0.35, the root mean square error of approximation (RMSEA) was = 0.062, the standardized root mean residual (SRMR) was = 0.043, and the comparative fit index (CFI) was = 0.97 with 90% CI. The results also showed that women (M = 72.08, SD = 6.79) are more likely to have psychosomatic symptoms than men (M = 51.21, SD = 13.36) on P < 0.001. The PSSS Urdu version is proven to be a useful and reliable instrument for screening, monitoring, and assessing Pakistani patients’ psychosomatics symptoms.

Challenges of Establishing a de novo Consultation-Liaison Psychiatry Service in a Tertiary Hospital: Practical considerations and challenges

Consultation-liaison psychiatry (CLP), also known as psychosomatic medicine, is a subspecialty of psychiatry that focuses on the care of patients with mental health disorders and general medical/surgical conditions. Integrating CLP services facilitates diagnosis and management of patients with complex comorbidities. This article aimed to report the practical considerations and challenges associated with establishing a de novo CLP service in a tertiary hospital in the Gulf region. This includes discussing the rationale and clinical and educational benefits as well as the resources required for establishing a CLP service.

Frequency of use of the International Classification of Diseases ICD-10 diagnostic categories for mental and behavioural disorders across world regions

AIMS

The study aimed to examine variations in the use of International Classification of Diseases, Tenth Edition (ICD-10) diagnostic categories for mental and behavioural disorders across countries, regions and income levels using data from the online World Psychiatric Association (WPA)-World Health Organization (WHO) Global Survey that examined the attitudes of psychiatrists towards the classification of mental disorders.

METHODS

A survey was sent to 46 psychiatric societies which are members of WPA. A total of 4887 psychiatrists participated in the survey, which asked about their use of classification, their preferred system and the categories that were used most frequently.

RESULTS

The majority (70.1%) of participating psychiatrists (out of 4887 psychiatrists) reported using the ICD-10 the most and using at least one diagnostic category once a week. Nine out of 44 diagnostic categories were considerably variable in terms of frequency of use across countries. These were: emotionally unstable personality disorder, borderline type; dissociative (conversion) disorder; somatoform disorders; obsessive-compulsive disorder (OCD); mental and behavioural disorders due to the use of alcohol; adjustment disorder; mental and behavioural disorders due to the use of cannabinoids; dementia in Alzheimer's disease; and acute and transient psychotic disorder. The frequency of use for these nine categories was examined across WHO regions and income levels. The most striking differences across WHO regions were found for five out of these nine categories. For dissociative (conversion) disorder, use was highest for the WHO Eastern Mediterranean Region (EMRO) and non-existent for the WHO African Region. For mental and behavioural disorders due to the use of alcohol, use was lowest for EMRO. For mental and behavioural disorders due to the use of cannabinoids, use was lowest for the WHO European Region and the WHO Western Pacific Region. For OCD and somatoform disorders, use was lowest for EMRO and the WHO Southeast Asian Region. Differences in the frequency of use across income levels were statistically significant for all categories except for mental and behavioural disorders due to the use of alcohol. The most striking variations were found for acute and transient psychotic disorder, which was reported to be more commonly used among psychiatrists from countries with lower income levels.

CONCLUSIONS

The differences in frequency of use reported in the current study show that cross-cultural variations in psychiatric practice exist. However, whether these differences are due to the variations in prevalence, treatment-seeking behaviour and other factors, such as psychiatrist and patient characteristics as a result of culture, cannot be determined based on the findings of the study. Further research is needed to examine whether these variations are culturally determined and how that would affect the cross-cultural applicability of ICD-10 diagnostic categories.

Psychiatric and medical disorders in the after math of the uttarakhand disaster: assessment, approach, and future challenges

PURPOSE

To present the descriptive data on the frequency of medical and psychiatric morbidity and also to discuss various pertinent issues relevant to the disaster management, the future challenges and psychosocial needs of the 2013 floods in Uttarakhand, India.

MATERIALS AND METHODS

Observation was undertaken by the disaster management team of National Institute of Mental Health and Neurosciences in the worst affected four districts of Uttarakhand. Qualified psychiatrists diagnosed the patients using the International Classification of Diseases-10 criteria. Data were collected by direct observation, interview of the survivors, group sessions, individual key-informant interview, individual session, and group interventions.

RESULTS

Patients with physical health problems formed the majority of treatment seekers (39.6%) in this report. Only about 2% had disaster induced psychiatric diagnoses. As was expected, minor mental disorders in the form of depressive disorders and anxiety disorders formed majority of the psychiatric morbidity. Substance use disorders appear to be very highly prevalent in the community; however, we were not able to assess the morbidity systematically.

CONCLUSIONS

The mental health infrastructure and manpower is abysmally inadequate. There is an urgent need to implement the National Mental Health Program to increase the mental health infrastructure and services in the four major disaster-affected districts.

[Psychosomatic Illness and Family Patterns of Children with Asthma]

INTRODUCTION

Asthma is the most prevalent chronic illness in children and has been related to psychological aspects involved in its evolution.

OBJECTIVE

To understand the types of relational patterns observed in families of children with this illness.

METHOD

Qualitative analysis through intentional sample of children between the ages of 4 to 15 years with asthma and other mixed populations.

RESULTS AND CONCLUSIONS

The analysis shows families with diffuse limits between its members, tendency towards amalgamation, high levels of anxiety, and the presence of parental and parental-offspring conflicts.

Gender differences in the psychological impact of tsunami

AIM

The aim of this observational study was to explore gender-related differences in psychiatric morbidity during the initial three months following the December 2004 earthquake and tsunami involving the Andaman and Nicobar Islands, India.

METHODS

There were 12,784 survivors sheltered across 74 relief camps with 4,684 displaced survivors in Port Blair and 8,100 non-displaced survivors in Car-Nicobar Island. All persons who accessed mental health assistance within the camps constituted the study sample. Diagnoses were made by qualified psychiatrists using the ICD-10. There were 475 patients: 188 (40%) men and 287 (60%) women.

RESULTS

There were significant gender differences in terms of displacement. There were significantly higher levels of panic disorder, unspecified anxiety disorder and somatic complaints in the displaced women while the non-displaced population showed more adjustment disorder.

CONCLUSIONS

Displacement was a significant factor in the manifestations of observed pathology. Displaced women had greater psychiatric morbidity. In addition, the fact that adjustment disorder (a self-limiting disorder form of psychopathology) was more prevalent in the non-displaced group may be a reflection of the findings of overall lesser morbidity in non-displaced women. Hence, women may have to be rehabilitated in their own habitats after major disasters.

Comparative Study of Psychiatric Morbidity among the Displaced and Non-Displaced Populations in the Andaman and Nicobar Islands following the Tsunami

Objective:

The objective of this study was to compare the psychiatric morbidity between the displaced and non-displaced populations of the Andaman and Nicobar Islands during the first three months following the 2004 earthquake and tsunami.

Methods:

The study was conducted at the 74 relief camps in the Andaman and Nicobar Islands. Port Blair had 12 camps, which provided shelter to 4,684 displaced survivors. There were 62 camps on Car-Nicobar Island, which provided shelter to approximately 8,100 survivors who continued to stay in their habitat (non-displaced population). The study sample included all of the survivors who sought mental health assistance inside the camp. A psychiatrist diagnosed the patients using the ICD-10 criteria.

Results:

Psychiatric morbidity was 5.2% in the displaced population and 2.8% in the non-displaced population. The overall psychiatric morbidity was 3.7%. The displaced survivors had significantly higher psychiatric morbidity than did the non-displaced population.The disorders included panic disorder, anxiety disorders not otherwise specified, and somatic complaints. The existence of an adjustment disorder was significantly higher in the non-displaced survivors. Depression and post-traumatic stress disorder (PTSD) were distributed equally in both groups.

Conclusions:

Psychiatric morbidity was found to be highest in the displaced population. However, the incidence of depression and PTSD were distributed equally in both groups. Involvement of community leaders and survivors in shared decision-making processes and culturally acceptable interventions improved the community participation. Cohesive community, family systems, social support, altruistic behavior of the community leaders, and religious faith and spirituality were factors that helped survivors cope during the early phase of the disaster.

Psychiatric diseases: Need for an increased awareness among the anesthesiologists

Psychological disorders and psychiatric diseases have been on the rise since the last three decades. An increasing number of such patients are encountered nowadays for elective or emergency surgery. A multi-array of challenges are faced while anesthetizing these patients or treating them in an intensive care unit. The problems include the deteriorated mental physiology, altered cognition and the possible drug interactions with psychotropic medications. The challenge starts from the preoperative assessment stage. Knowledge of the pharmacological profile of the various anti-psychotic drugs, their side-effects and drug interactions are of prime importance for an anesthesiologist to facilitate smooth delivery of anesthesia in such patients. It is important to formulate a clear plan to deal with any challenge in the perioperative or postoperative period. All the clinical aspects and various definitions of mental disorders in the present article have been used as per the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). We reviewed the advances in psychiatric diseases, their treatment and their implications on delivery of anesthesia.

Indian Psychiatric epidemiological studies: Learning from the past

The objective of this paper is to provide a systematic review on the epidemiology of psychiatric disorders in India based on the data published from 1960 to 2009. Extensive search of PubMed, NeuroMed, Indian Journal of Psychiatry website and MEDLARS using search terms "psychiatry" "prevalence", "community", and "epidemiology" was done along with the manual search of journals and cross-references. Retrieved articles were systematically selected using specific inclusion and exclusion criteria. Epidemiological studies report prevalence rates for psychiatric disorders varying from 9.5 to 370/1000 population in India. These varying prevalence rates of mental disorders are not only specific to Indian studies but are also seen in international studies. Despite variations in the design of studies, available data from the Indian studies suggests that about 20% of the adult population in the community is affected with one or the other psychiatric disorder. Mental healthcare priorities need to be shifted from psychotic disorders to common mental disorders and from mental hospitals to primary health centers. Increase in invisible mental problems such as suicidal attempts, aggression and violence, widespread use of substances, increasing marital discord and divorce rates emphasize on the need to prioritize and make a paradigm shift in the strategies to promote and provide appropriate mental health services in the community. Future epidemiological research need to focus on the general population from longitudinal prospective involving multi-centers with assessment of disability, co-morbidity, functioning, family burden and quality of life.

Unexplained and underpowered: the relationship between psychosomatic disorders and interpersonal abuse -- a critical review

Although it is commonly accepted that interpersonal violence (IntPV) leads to adverse health consequences, the available data are far from decisive. To test the hypothesized link, the authors devised an evidence-based strategy to determine the data quality in studies purporting to link IntPV and some medically unexplained disorders in women (irritable bowel syndrome, chronic pelvic pain, fibromyalgia/chronic fatigue, and other chronic pain syndromes). English language studies with control groups of unaffected women were assessed for the quality of their methodologies. The number of studies, together with the consistency of their findings in each domain, was collated to determine the overall weight of evidence regarding the link for each condition. The quantity and quality of research in each clinical area proved to be sparse. In general, most research was limited to small, convenience samples, with insufficient attention to the design of control groups and to sample size. The evidence currently available regarding irritable bowel syndrome, fibromyalgia/chronic fatigue, chronic pelvic pain, and other chronic pain syndromes does not allow for any firm conclusion regarding their link to IntPV. More research - paying particular regard to the methodological concerns identified here - is required in order to generate any definitive conclusions.

Psychological impact of the tsunami on children and adolescents from the andaman and nicobar islands

OBJECTIVE

The aim of this article is to present the assessment of the presentation of symptoms and psychiatric morbidity of children and adolescents from the Andaman and Nicobar islands during the first 3 months following the December 2004 earthquake and tsunami.

METHOD

According to predefined criteria, a primary survivor is one who was exposed directly to the earthquake and tsunami, a secondary survivor is one with close family and personal ties to primary survivors, and tertiary survivors are individuals from the communities beyond the impact area, a majority of which were exposed to the earthquake only. This study included 37 primary and secondary survivors (aged

RESULTS

The most common psychiatric morbidities observed among the primary and secondary survivors were adjustment disorder (N = 5, 13.5%), depression (N = 5, 13.5%), panic disorder (N = 4, 10.8%), posttraumatic stress disorder (N = 4, 10.8%), schizophrenia (N = 1, 2.7), and other disorders (N = 16, 43.2%). Subclinical syndrome was present in the majority of the primary and secondary survivors. Few tertiary survivors had subsyndromal symptoms.

CONCLUSION

Only a few of the primary and secondary survivors required intensive individual psychiatric interventions; however, a majority of the primary, secondary, and tertiary survivors required community-based group interventions. Community-based group interventions and group discussions are simple, easy to implement using local resources, and effective in all groups, and provide important components of psychosocial rehabilitation. This kind of approach should be started as early as possible, targeting all children and adolescents affected by any disaster in developing countries.

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Affiliation(s)

Suresh Bada Math Department of Psychiatry ; the Department of Clinical Psychology ; the Department of Psychiatric Social Work ; and the Department of Neurology , National Institute of Mental Health and Neurosciences , Bangalore, India
Shweta Tandon
Satish Chandra Girimaji
Vivek Benegal
Uday Kumar
Ameer Hamza
Kavita Jangam
D Nagaraja

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