From self-care to hospitalization: bipolar patients' health care practices in Mexico

Pathways to care and barriers in treatment among patients with Dissociative disorders

INTRODUCTION

Dissociative disorder patients often present with sudden and embarrassing symptoms, and it is difficult for the patient and care giver to understand initially, recognize the need for help and reach for appropriate treatment timely. This can result in high risk of engaging in dangerous behaviors such as self-harm and suicidal acts, impaired global functioning, and poor quality of life. Knowledge about the types of barriers which are there in treatment seeking, can help in planning strategies for their removal and to facilitate the treatment process.

METHODS

Cross-sectional study among patients (n=133) with Dissociative disorders which were recruited from January 2023 to June 2023 in a tertiary care hospital. Pathways to care and barriers in treatment for Dissociative disorders were assessed by interviewing patients using semi-structured proforma. The Dissociative Experience Scale and World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0)) were used to assess disease severity and impact of illness on various domains of life respectively. Group comparison was made to assess differences in social- clinical profile of patients choosing different modalities of treatment.

RESULTS

133 patients of Dissociative disorders with mean age 29.6±9.2, showed their first-choice of help seeking from general practitioner/ neurologist (40.6%), traditional faith healers (35.3%), psychiatrist (18.1%) and 5.2% preferred alternative treatments. This trend changed with 2nd and 3rd contact of help seeking with greater preference for psychiatrist in their 2nd (n=45, 33.8%) and 3rd (n=69, 51.8%) contact. The median duration of untreated illness was 56 weeks (IQR 24-182 weeks). Social-clinical profile of patients varied with their choice of treatment, having lower education level (P = 0.013), longer duration of untreated illness (p=0.003), more severity of symptoms (p=0.032) and greater disability scores(p=0.002) in patients whose first treatment choice was traditional faith healers. More than 70% patients faced availability barriers, stigma, unawareness about mental illness and influence of others in treatment of choice as barriers in initiating and continuing treatment.

CONCLUSION

Patients with Dissociative disorders seek treatment from a multitude of healthcare providers including traditional faith healers, general physicians, and alternative medicine practitioners before reaching psychiatrist and undergoes various barriers in treatment. There is need to implement necessary measures for sensitization and awareness about Dissociative disorders to prevent prolonged and undue delays in initiation of appropriate management.

Pathways to Care for Patients with Bipolar-I Disorder: An Exploratory Study from a Tertiary Care Centre of North India

INTRODUCTION

Understanding the pathways to psychiatric care is important from a public health perspective. Only a few Indian studies have focused on this, particularly for severe mental disorders. The present study was planned to assess it in patients with Bipolar-I disorder (BD-I).

MATERIALS AND METHODS

Sixty-four patients with DSM 5 diagnosis of BD-I and their caregivers were included. A semi-structured interview proforma was used to gather information.

RESULTS

Psychiatrists were the first care provider in 43.8% of the cases, followed by traditional faith healers (32.8%) and general physician/neurologists (17.2%). The median duration of untreated bipolar disorder (DUB) was 21 days (1 day to 152 months). Relatively long DUB (3.5 ± 3.5 years) was found for 17.2% of the sample. The median duration of the first contact with a psychiatrist was 45 days and the interval between the contact with the first care provider and a psychiatrist was 90 days (1 day to 151 months). At the time of first treatment seeking, 64% of patients and caregivers had poor awareness regarding psychiatric treatment.

CONCLUSIONS

Patients with BD-I seek help from psychiatrists, faith healers or other medical practitioners for multiple reasons. There is a need to sensitise the community and various service providers about early identification and optimum management of BD-I.

Taking or not taking medications: psychiatric treatment perceptions in patients diagnosed with bipolar disorder

WHAT IS KNOWN AND OBJECTIVE

Bipolar disorder is a common and disabling condition. Although its negative impact may be limited in some way by the use of different treatment options, lack of adherence to psychiatric treatment is still an obstacle to overcome. Because there are many factors involved in non-adherence to treatment, in this study, we sought to examine the subjective aspect of this phenomenon. We analysed perceptions of both the disease and the treatment in a group of patients with bipolar disorder.

METHODS

We incorporated a qualitative design that included 50 outpatients diagnosed with bipolar disorder type 1. Through semi-structured interviews, we explored patients' perceptions of bipolarity and psychiatric medication management.

RESULTS AND DISCUSSION

The participants reported the use of medications as one of the most troubling aspects of having bipolar disorder. The fear of becoming addicted to psychiatric drugs was repeatedly mentioned among the patients as an argument for abandoning treatment. The main expectation of treatment was to achieve stable mood, but the patients considered that drugs were not the only way to be euthymic.

WHAT IS NEW AND CONCLUSIONS

The patients expressed ambivalence between the need to take medication to remain stable and the fear of negative consequences of using psychiatric drugs. Personal beliefs and environmental influences seem to determine each individual's final choice of whether to maintain or discontinue treatment; so, in everyday clinical practice, it would be necessary to discuss perceptions of the disease with patients and their families.