Overview and emerging trends

Effectiveness of a new low-cost psychosocial rehabilitative model to reduce burden of disease among persons with severe mental illness: An interventional follow-up study

CONTEXT

Mental health disorders are an important factor contributing to the global burden to disease. Less than 1% of the health budgets in 62% of developing nations and 16% of developed nations are spent on mental health services. The availability of mental health rehabilitative services remains minimal.

AIMS

This study aims to find the effectiveness of a new low-cost psychosocial rehabilitation model.

SETTING AND DESIGN

The study was conducted at a rehabilitation center. An interventional follow-up study was designed.

MATERIALS AND METHODS

A new low-cost psychosocial rehabilitative model was employed for 6 months for persons residing at a rehabilitation center. The World Health Organization Quality of Life (WHOQOL-BREF) instrument, WHO Disability Assessment Schedule (WHODAS) 2.0, and WHO (Five) Well-Being Index would be scored before and after the intervention.

STATISTICAL ANALYSIS

The differences between the scores were analyzed using paired t-test or Wilcoxon signed rank test, whichever is applicable. P < 0.05 was taken as statistically significant.

RESULTS

Sample size was 110. 29.1% were rehabilitated and 68.2% remained at the rehabilitation center at 6 months. The pre- and post-test scores using the new model showed improvement in the scores. The mean scores for WHO-BREF, WHO-5 score, WHODAS-2 score were 73.2, 51.14, and 20.34, respectively. On follow-up, the scores improved to 82.6, 67.09, and 15.96, respectively.

CONCLUSIONS

The low-cost psychosocial rehabilitative model was found to be effective. This could serve as a model not only for other similar centers in India and but also for other low- and middle-income group countries.

Comparative study of cost of care of outpatients with bipolar disorder and schizophrenia

AIM

To assess and compare the average annual the cost of illness of outpatients with bipolar disorder and schizophrenia.

METHODS

Cost of illness in 75 out-patients with bipolar disorder and 53 out-patients with schizophrenia was assessed over a 9-month period by using bottom-up approach. The cost of 9 months was annualized by dividing the 9 months cost by 3 and then multiplying the obtained figure with 4.

RESULTS

Total average annual costs of care of bipolar disorder was Indian rupees 32,759 (US $ 655.18) and that of schizophrenia was Indian rupees 48,059 (US $ 961.18) and there was no significant difference between the two groups. In both the groups, indirect costs (bipolar disorder-64.0%; Schizophrenia-77.6%) were higher than direct costs (bipolar disorder-36%; Schizophrenia-22.4%). Cost of medications was high. Patient and their families bore the main brunt of financial burden (95.4-96% of the total cost). In Bipolar disorder total treatment costs were significantly higher in those who had lower level of functioning. In bipolar disorder group number of visits to the hospital correlated with total cost, indirect cost and provider's cost, whereas in schizophrenia group total number of visits correlated with provider's cost only. Only a small proportion (13.7%) of the total cost of bipolar disorder was predicted by presence or absence of alcohol dependence and number of visits. In the schizophrenia group, only positive symptom score as per the rating on PANSS appeared as a significant predictor of total cost, explaining 15.6% of the total cost.

CONCLUSION

Costs for outpatients with bipolar disorder are similar to the cost of outpatients with schizophrenia. Costs are higher in patients of bipolar disorder with lower level of functioning. Findings of the study suggests that reducing the number of visits to the hospital by providing care at the doorsteps, focusing on reduction of substance use and improving the level of functioning of the patients can reduce the cost of care of bipolar disorder.

Early intervention in psychotic disorders: Challenges and relevance in the Indian context

Over the last two decades, there has been an increasing interest in the concept of early intervention (EI) in psychotic disorders, notably schizophrenia. Several lines of research underlie this emerging paradigm shift: (a) an increasingly well-established association between the duration of prolonged untreated illness and poor outcome; (b) evidence of progressive neurobiological changes in the early course of schizophrenia both in the pre-psychotic and psychotic phases, as evidenced by brain imaging studies in schizophrenia; and (c) emerging data, albeit preliminary, suggesting the efficacy and effectiveness of EI programs in improving the outcome in these patients. Mental health service systems across the globe, including Asian countries, have been incorporating specialized early intervention programs. However, literature on EI in the Indian setting is relatively sparse. In this article, we will review the rationale and approaches to EI and the application of these approaches to the Indian context, in light of the available literature. We also examine the constraints in the implementation of EI. Controlled data are needed to evaluate EI and the roadblocks to them, in order to implement EI in the resource-strapped mental health service settings in India.