Pathways to the first contact with mental health services among patients with schizophrenia: A cross-sectional observational study

Background

Schizophrenia is a mental illness with a profound impact on patient and their caregivers. There is increasing evidence that delay in the commencement of treatment following the onset of illness may be related to the pathways; patients navigate before accessing mental health services.

Aim

The aim of this study is to assess the pathways of care to the first contact with mental health services among patients with schizophrenia.

Methods

A total of 150 diagnosed schizophrenia patients aged 12-60 years were recruited as per inclusion and exclusion criteria. The sociodemographic details were gathered using semistructured sociodemographic data sheets; semistructured pathways to care questionnaire and positive and negative syndrome scale for schizophrenia were administered.

Results

The most common first pathway to care was faith healers. The education of the head of family, socioeconomic status, rural background, and occupational status of patients have a significant impact on the first pathway of psychiatric care. The findings suggest that while planning mental health services, emphasis should be made on collaboration between psychiatric and nonpsychiatric services.

Conclusion

The pathways patient choose depend on a number of factors like their socio-cultural background, belief about the supernatural causation of psychiatric illness, stigma associated with psychiatric illness, lack of knowledge about the mental illness, and influence of close family relatives on the choice of treatment.

Does psychiatry rotation in undergraduate curriculum bring about a change in the attitude of medical student toward concept and practice of psychiatry: A comparative analysis

OBJECTIVE

To assess the attitude of MBBS student toward concept and practice of psychiatry between groups of students exposed to psychiatry rotation versus those not yet exposed to.

MATERIALS AND METHODS

A cross-sectional analytical study was carried out. Anonymity and confidentiality of the respondent was emphasized. Attitude was measured with 30-item "attitude toward psychiatry" scale.

RESULTS

Attitude toward psychiatry was found to be better in groups of medical students exposed to 2 weeks clinical rotation in psychiatry. However, the same reached statistical significance in only 36.7% of the questions.

CONCLUSION

Clinical rotation in Psychiatry in undergraduate has a favorable effect on the attitude of medical students toward concept and practice of psychiatry. Better curriculum and more hours in psychiatry may yield better gain.

Self-harm by severe glossal injury in schizophrenia

Self-mutilation, the deliberate destruction occurs in a variety of psychiatric disorders.Many methods of self-destructive behavior have been described in literature. Patients of schizophrenia are known to attempt self-harm due to command hallucination, catatonic excitement or because of associated depression, however severe glossal injury by biting has not been reported so far.Authors report case of self-harm of glossal injury by biting in schizophrenia. Treatment and management issues are discussed.

Dysphagia due to tardive dyskinesia

Tardive dyskinesia (TD), neuroleptic-induced delayed onset movement disorder, remains an enigmatic phenomenon and a therapeutic challenge. Only a few cases of dysphagia also have been reported in world literature and to the best knowledge of the authors no case of TD manifesting as isolated dysphagia has been reported so far from India. We report a case of TD consequent to prolonged exposure to typical neuroleptics, manifesting as isolated dysphagia who responded well to a combination of Quetiapine, Donepezil and Vit E.

Switching to quetiapine for risperidone-induced amenorrhea: Report of two cases

Almost all the antipsychotics can cause hyperprolactinemia-related side-effects like amenorrhea. Quetiapine has been reported to have minimal propensity to cause hyperprolactinemia. We report here two cases of risperidone-induced amenorrhea, who resumed their normal cycle on switching over the medication to quetiapine.

Partial Kluver-Bucy syndrome as a delayed manifestation of head injury

After traumatic brain injury (TBI), the most disabling problems are generally related to neuropsychiatric sequelae, including personality change and cognitive impairment, rather than neurophysical sequelae. Kluver-Bucy syndrome (KBS) is a rare neurobehavioral condition, first described in 1937 as an experimental neurobehavioral syndrome in monkeys with bitemporal brain lesions. The syndrome in man was subsequently observed to be transient or permanent in a variety of neurodegenerative disorders and after traumatic, nontraumatic and infectious brain injury. However, partial KBS may occur in the absence of the classic bilateral temporal lesion, though rare. Pharmacological treatment of post-TBI neuropsychiatric sequelae consists of symptomatic, functional and hypothetical approaches. Specific pharmacological treatment consists of antipsychotics, anti-kindling anticonvulsants or a combination thereof. A case of partial KBS presenting as delayed manifestation of traumatic brain injury that improved with carbamazapine and antipsychotics is presented.

Study of Behaviour Problems in a Paediatric Outpatient Department

BACKGROUND

Behaviour problems in children still needs precise definition, explicit criterion and assessment on multiple paradigms.

METHODS

Fifty children of the age group 6-14 years, from paediatric outpatient department, selected after randomisation were assessed for behaviour problems with the child behaviour checklist. The data collected was analysed using appropriate statistical tests.

RESULTS

40% children were above cutoff score. Mean child behaviour check list (CBCL) score was 40.6. Total of 72% children were from armed forces background of whom 9% were siblings of officers. 30.6% children from the armed forces background were above the cutoff score. There was no significant difference in the behaviour problems between different age groups and sex. There was no significant difference in behaviour problems between children of officers, other ranks or various income groups. Female children had behaviour problems like "too concerned with neatness or cleanliness", "feels has to be perfect" and "argues a lot" where as male children had behaviour problems like "Does not feel guilty after misbehaving", "argues a lot" and "restless".

CONCLUSION

Behaviour problems in the subjects were externalizing ones. No specific trend was found in children of defence personnel vis-a-vis children of civilian population.

Venlafaxine induced hypertension:a case report

Venlafaxine is a newly introduced antidepressant that is clinically different from other antidepressants, possesses a slightly different mechanism of action and may have unique efficacy properties and a faster onset of action. A case of venlafaxine induced severe hypertension is reported to highlight the need for caution while using this drug.