Journal Articles
2023 Volume 6 Issue 2
2023 Volume 6 Issue 1
2022 Volume 5 Issue 2
Mohammad Tariqul Alam
Coronavirus disease 2019, known as COVID-19, caused by the SARS-CoV-2 virus, is a highly contagious respiratory disease was first identified in Wuhan, China, in December 2019 and has become a major public health concern in Bangladesh. Health care workers (HCWs) are indispensable part of the battle against this deadly virus. There is evidence that their wellbeing has been compromised during this pandemic and they are exhibiting higher rates of mental disorders than general population and normal time. Multisectoral and integrated strategies are required to ensure their wellbeing.
Declaration of interest: None
Copyright and usage: ©Archives of NIMH 2022
Saifun Nahar, Bidhan Ranjan Roy Podder, Mohammad Delowar Hossain, Mohammad Tariqul Alam
Abstract
Background: The National Institute of Mental Health (NIMH) is a 200-bed tertiary psychiatric hospital located in Sher-E-Bangla Nagar, Dhaka, Bangladesh. It has been maintaining a computer database to keep records of the indoor patients since 2020, based on which this study was carried out.
Objectives: To explore the proportion of patients with psychiatric disorders of inpatient departments of NIMH, with different clinical diagnosis according to ICD-10-4-digit code and the socio-demographic and other relevant profile of those patients.
Methods: It was a retrospective medical record review conducted utilizing the computer database containing the data regarding clinical diagnosis and other relevant variables of the indoor patients of the NIMH, which were plotted there by the assigned office staff on a weekly basis, over the period from January 2021 to December 2021, from the records of the structured indoor patient data sheet, that was prepared by the teachers of NIMH. The data sheet was filled out daily before each patient’s discharge by the duty doctors of the respective departments. Patients were diagnosed according to the ICD-10 4-digit code by the Professors, Associate Professors and Assistant Professors of the respective departments.
Results: In this study, the recorded data of 797 patients were analysed. Among them, (51.4%) of the patients were male and (48.6%) female. The patients’ Mean age (±SD) was 28.6±12.16 years. Thirty-five types of different clinical diagnoses were found. Schizophrenia (39%) and bipolar affective disorder (29.4%) were the most common diagnoses.
Conclusions: Findings of this study will act as an eye-opener for psychiatrists regarding a wide range of psychiatric diagnoses and future research.
Declaration of interest: None
Copyright and usage: ©Archives of NIMH 2022
Keywords: ICD-10 4-digit code, Psychiatric disorders, NIMH, Indoor patient data sheet, computer database.
M A Mohit Kamal, Muhammad Zillur Rahman Khan, Nasim Jahan, Mahbub Mayukh Rishad, Mohammad Muntasir Maruf
Abstract
Background: People with obsessive compulsive disorder (OCD) are likely to be more susceptible to the mental health impact of COVID-19.
Objective:We aimed to investigate the socio-demographic and other factors of OCD and relation of its occurrence with COVID-19.
Methods: This was a cross-sectional study carried out among the persons diagnosed as a case of OCD by a psychiatrist according to Diagnostic and Statistical Manual of Mental Disorders, version 5 (DSM-5) and attended at private chambers of psychiatrists during April 2022 – June, 2022. All the persons diagnosed with OCD, irrespective of gender and aged more than 18 years, were approached for the research. After having their consent, sociodemographic and other information were collected through face-to-face interview of the respondents. Completed data of 153 respondents were analyzed using Statistical Package for Social Sciences (SPSS), version 25. Ethical issues were addressed properly throughout the study.
Results: Mean age of the respondents were 29.3±12 years. More than half (54.9%) of the respondents were unmarried. About one-fifth (18.3%) of the respondents suffered from OCD symptoms for the first time after COVID pandemic occurred in Bangladesh. Among the respondents diagnosed as OCD prior to pandemic, more than one-third (36.8%) had treatment for the disorder. About one-fourth (23.5%) had family history of OCD. One-fifth (20.3%) had history of substance abuse. Suicidal attempt was reported by 19% of respondents. More than half (54.9%) had co-morbid physical illness.
Conclusion: A significant proportion of persons with OCD experienced their symptoms first time during COVID outbreak.
Declaration of interest: None
Copyright and usage: ©Archives of NIMH 2022
Keywords:OCD, COVID-19, sociodemographic factors.
A S M Kowser, Munira Parveen, Mohammed Ali Chowdhury, Mohammad Taslim Uddin
Abstract
Background: Behavioral and mental disorders accounted 12% of global burden of disease (GBD). Treatments for all these disorders are as available as efficacious. However, these disorders are remarkably undertreated worldwide.
Objectives: To find out the pattern of psychiatric morbidity of patients attending at the psychiatry outpatient department.
Methods: This was a cross sectional study carried out in the Department of Psychiatry at Combined Military Hospital (CMH), Chattogram from January 2022 to June 2022. For this purpose, 1297 respondents attending in psychiatry outpatient department of CMH Chattogram were enrolled in the study by using convenient sampling technique. Psychiatric diagnoses of the patients were assigned by the consultant psychiatrist as per Diagnostic and Statistical Manual of Mental Disorders-5 (DSM)-5 criteria. Structured questionnaire was used to collect socio-demographic data. Statistical analyses were carried out by using the Statistical Package for Social Sciences version 23.0 for Windows (SPSS Inc., Chicago, Illinois, USA). The quantitative observations were indicated by frequencies and percentages. Ethical issues were maintained all through the study.
Results: The most common psychiatric morbidity among the respondents was depressive disorder (36.9%) followed by anxiety disorders (19.8%), obsessive-compulsive & related disorder (16.3%) and somatic symptom and related disorder (11.3%). The results showed that majority (26.6%) were from the age group of 31-40 years with female preponderance (59.1%). More than half of the patients were referred from different branches of Medicine (65%). Referral from Internal Medicine was 25.2%, Cardiology 13%, Gastroenterology 12.3%, Nephrology 10.6% and Physical Medicine 3.3%, respectively. The rest were from branches of Dermatology and Venereology, Surgery, Orthopaedics, Paediatrics and Gynaecology and Obstetrics.
Conclusions: Neurotic cases were predominant in psychiatric outpatient department. Referrals patients of psychiatric disorders came mainly from Medicine and allied branches. Results of thisstudy may help in the planning for better mental health service integrated with primary healthcare system of our country.
Declaration of interest: None
Copyright and usage: © Archives of NIMH 2022
Keywords: CMH; Global burden of disease (GBD); psychiatric referral; sociodemographic characteristics; DSM-5; DALY.
Mahfuza Yasmin, Abdullah Al Mamun, Afroza Rahman Lopa, A. K. M. Khaleequzzaman, Sharmin Sultana, S. M. Sazzadul Karim
Abstract
Background: A significant number of patients are referred in Forensic Psychiatry Department for civil and criminal law related reasons. Knowing their reasons for referral can help in improving service delivery.
Objectives: To estimate the proportion of different psychiatric disorders along with reasons for referrals in persons attending the Forensic Psychiatry Department of National Institute of Mental Health, Dhaka.
Methods: A cross-sectional study was conducted in National Institute of Mental Health, Dhaka in between July 2017 and December 2018. By convenient sampling technique 127 participants aged 18 and more were enrolled in the study. Sociodemographic data and reasons for referrals were collected and psychiatric disorders were diagnosed according to International Classification of Diseases (ICD) 10th edition.
Results: Of the total 127 participants, 80 (63%) were civilians seeking forensic psychiatry services; common reasons were psychiatric assessment followed by getting certificate (20.5%), getting fitness certificate (15.7%), eligibility for getting pension (11.8%) and treatment for psychiatric disorders (11%). Of the 47 (37%) participants who had criminal charges against them were referred for getting court report (20.5%), psychiatric treatment (11%), fitness to plead (3.1%) for both court report and treatment (2.4%). In the study population, schizophrenia was the most common diagnosis (34.6%), followed by bipolar affective disorders (18.1%) and mental retardation (15%). About 5.5% of the referred participants had no psychiatric disorders.
Conclusions: Nine out of ten patients referred to Forensic Psychiatry Department received a psychiatric diagnosis.
Declaration of interest: None
Copyright and usage: ©Archives of NIMH 2022
Keywords: Psychiatric disorder, forensic psychiatry department, Bangladesh
Saifun Nahar
Abstract
Background:The use of psychotropic medicines is stigmatized, which makes it difficult for the clinicians to treat children and adolescents in a suitable and efficient manner.
Objectives: To find out parents’ attitudes, knowledge and beliefs about the use and adverse effects of psychotropic medication on child and adolescents with psychiatric disorders.
Methods: A cross-sectional descriptive study was conducted from January 2018 to December 2019, in a private chamber of a psychiatrist, Bangladesh among 80 parents of children and adolescents with psychiatric disorders whose minimum level of education was up to secondary level were selected purposively. A structured, self-administered questionnaire in English for socio-demographic variables and items related to parents attitudes, knowledge and beliefs about the use and adverse effects of psychotropic medications was applied. Data were collected by face-to-face interview.
Results:80 parents with children and adolescents with psychiatric disorders participated in the study. Mean (+SD) age of the parents were 34.4(+ 8.44) years. Among the respondents 25% preferred use of medicines, 62.5% preferred medicine use as last alternative, 31.25% knows that psychiatrists unnecessarily use high doses of medicines, 60% believed that psychotropics might have brain damaging effects, 62.50% believed that psychotropics might cause dependence, 7.50% believed that psychotropics might cause damage to physical health, 15% believed that psychotropics might affect learning abilities and 41.20% knows that psychotropic drugs are dangerous.
Conclusions:Parents must be educated about the potential risks and benefits of psychotropic medications on children and adolescents in order to reduce the stigma associated with this.
Declaration of interest: None
Copyright and usage: ©Archives of NIMH 2022
Keywords: Parental attitude, knowledge, belief, psychotropic medications, children and adolescents.
Anupam Das, Choity Malakar
Abstract
Background: Sexual dysfunctions is commonly experienced as having a devastating effect on familial, vocational, psychological, or social lives of sufferers. Irrespective of high prevalence of sexual dysfunction; only little number of patients seeks psychiatric consultation. Some patients are ambivalent over getting professional help because of attached social stigma that leads to delayed or negating consultation. However, there is a paucity of studies investigating the prevalence of PSD, particularly in Indian context.
Objectives: To determine the prevalence and pattern of sexual dysfunctions.
Materials and Methods: This was a cross-sectional analytical study carried in the Outpatient Department of Psychiatry, Khwaja Yunus Ali Medical College, Sirajgonj from October 2019 to September 2020. Data were collected from face-to-face interview; a semi structured questionnaire was used.After collection, all data were checked thoroughly for consistency and completeness. Data were cleaned, edited and verified daily to exclude any error or inconsistency before coding and entering them into a database. Statistical analysis was performed using compatible computer software.
Results: This study observed erectile dysfunction (31%), premature ejaculation (25%), dhat syndrome (18%), and erectile dysfunction with premature ejaculation (17%) as the common sexual dysfunctions.
Conclusions: This study shows the common sexual dysfunctions were erectile dysfunction (ED), premature ejaculation (PME), dhat syndrome (DS) and ED with PME.
Declaration of interest: None
Copyright and usage: ©Archives of NIMH 2022
Keywords: Sexual dysfunction, male patients, tertiary hospital, Bangladesh.
Sadia Afrin Shampa, Helal Uddin Ahmed, Ahsan Aziz Sarkar
Abstract
Background: Telemedicine has been gaining worldwide popularity lately. Bangladesh is also a part of this venture. Effective service planning depends on knowing the trends of service use.
Objective: To identify the trends in using telepsychiatry service at a tertiary level psychiatric hospital.
Methods: This was a retrospective study in which data were collected from telepsychiatry service patient records of a tertiary psychiatric hospital. In between 2018 and 2021, 270 patients took the service. All were included and the record contained their name, age, gender, diagnosis and treatment.
Results: Mean age of the patients was 31.6±14.5 years with a range between 4 and 75 years andaround 50% of the patients were in the 20-40 years age group. Male patients constituted 46.5% of the sample. Majority of the patients took services for neurotic, stress related and somatoform disorders. Sertraline and benzodiazepine were found to be most commonly used medication.
Conclusions: The study showed that majority taking telepsychiatry care were having neurotic or stress related and somatoform disorders. Pharmacotherapy was the main way of treating patients.
Declaration of interest: None
Copyright and usage: ©Archives of NIMH 2022
Keywords:Telepsychiatry, tertiary hospital, Bangladesh.
Nusrat Mujtaba Maty, Md. Shahidul Islam, Md. Rashed Khan
Abstract
Blepharospasm is an abnormal uncontrolled contraction of eyelid muscles and can beapresenting motor symptoms of conversion disorder. Here is a case about 40 years old Muslim housewife from rural background presenting with the complaints of difficulty in opening eyes for 6 months and pseudo-seizures for 2 months. Her symptoms could not be explained by any known medical conditions. Both psychological and pharmacological intervention was given for the management of the patient.
Declaration of interest: None
Copyright and usage: ©Archives of NIMH 2022
Keywords:Blepharospasm; conversion disorder; rare disorders.
2022 Volume 5 Issue 1
Niaz Mohammad Khan
Abstract
Autism spectrum disorder (ASD) is a category of neurodevelopmental disorders the prevalence of which has increased over time. Since 2008 the United Nations has started celebrating 2nd April as the world autism awareness day each year to raise awareness. As like the previous years, in 2022 world autism awareness day has been observed worldwide. This year’s theme was “Inclusive Quality Education for All”. It was observed through various activities home and abroad. The government of Bangladesh is giving priority to Autism and Neurodevelopmental Disorders in many areas like protection of rights, inclusiveness, service and education.
Declaration of interest: None
Copyright and usage: ©Archives of NIMH 2022
Rifat Binte Radwan, Chiro Islam Mallik, Mohammad S I Mullick
Abstract
Background: As part of continuity, prevalence of autism spectrum disorder (ASD) is nearly the same as children and is associated with other comorbid psychiatric disorders that have substantial impact on their life and complex the intervention.
Objectives: This study was aimed to examine psychiatric co-morbidity in referred adult ASD patients compared to non-ASD psychiatric patients.
Methods: In total, 36 adult ASD patients from a psychiatric consultation center in Dhaka city were included in the study consecutively who were referred for psychiatric consultation during the period of 2019. Equal number of age and sex-matched non-ASD psychiatric patients were selected for comparison. Socio-demographic information and clinical assessment-based DSM-5 diagnosis of the cases was made.
Results: Patients’ age ranged from 18-41 years with the mean of 26.72±6.5 years. Male-female ratio was 1.6:1. Mean number of psychiatric disorders was 1.92 in patients with ASD and 1.67 in patients without ASD and the difference was significant (P= 0.04). Most three frequent co-morbidities among ASD patients were obsessive-compulsive disorder (27.8%), Major Depressive Disorder (25%) and Specific Phobia (19.4%). All these disorders were significantly higher in ASD patients than in non- ASD psychiatric patients. Conversely, major depressive disorder (30.6%) bipolar disorder (19.4%), schizophrenia, generalized anxiety disorder and substance-related disorder (13.9% each) were higher among non-ASD patients.
Conclusions: Subsequent broad-based studies using extensive measures of psychopathology are required to confirm these preliminary findings. Greater understanding of the presence of other psychiatric disorders in ASD patients will turn this awareness into action.
Declaration of interest: None
Copyright and usage: ©Archives of NIMH 2022
Keywords: ASD, Adults, Psychiatric Comorbidity
Rubina Hossain, Mohammad Tariqul Alam, Ahsan Aziz Sarkar, Hasinatul Zannat, Afroza Rahman Lopa
Abstract
Background: Intellectual Disability (ID) is a life-long disability which has a major impact on the lives of the children who suffer and their caregivers. Caring for those who are intellectually disabled is often itself stressful as care-giving affects several aspects of caregiver’s life negatively including poor physical and emotional state. Caregivers experience depression, burden, lack of social support and coping resources than non-caregivers. However, little attention is given to the health of the caregivers or families of these children.
Objectives: To find out the level of burden experienced by the caregivers and study their sociodemographic profiles.
Methods: A descriptive, cross-sectional study was conducted among the caregivers of intellectually disabled children attending the child guidance clinic in the outpatient department of National Institute of Mental Health (NIMH), Sher-e-Bangla Nagar, Dhaka. The Bangla version of the Zarit Burden Interview (ZBI-B) scale was applied to measure the level of burden experienced by the caregivers of the intellectually disabled children whose diagnoses were already confirmed by a psychiatrist using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). A semi-structured questionnaire was used to find out the sociodemographic variables. Data analysis was done by Statistical Package for Social Sciences (SPSS) version 24.0. Ethical clearance was taken from the authority of NIMH, Dhaka.
Results: The level of burden measured using the ZBI-B scale among the 66 caregivers of the intellectually disabled children, found that 41 (62.1%) of the respondents experienced severe burden and 25 (37.9%) experienced moderate to severe burden. Among them, 50% were in the age group of 31-40 years, 83.3% were females who were mostly mothers of the children (80.3%), 16.7% of the respondents were fathers and 3% were siblings of the intellectually disabled. The respondents attending the outpatient department of NIMH were mostly from urban residence (72.2%) and more than half of them were unemployed or housewives (59.1%). It was also found that with increasing age, level of burden increased and caregivers living in joint families experienced comparatively, less burden. Only 6 (9.1%) of the respondents admitted to have respite care provision, while the remaining 60 (90.9%) respondents did not have any respite care.
Conclusions: All caregivers experience burden taking care of intellectually disabled children. Therefore, education about the child’s condition, encouragement, family support, counselling services, regular screening of mothers should also be included in the protocol for management of ID. Community based approaches will help in reaching people who are not even aware of hospital settings for the intellectually disabled children.
Declaration of interest: None
Copyright and usage: ©Archives of NIMH 2022
Keywords: Caregiver burden; intellectually disabled children; tertiary care hospital.
Md. Raihan Siddique, Sultana Algin, Afroza Akter, Sadia Afrin, Taslima Yasmeen Chowdhury, Ashek Ullah
Abstract
Background: Suicide is highly prevalent in patients with obsessive-compulsive disorder (OCD) and an estimated 6 to 51.7% patients attempt suicide. Early determination of risk factors can provide an opportunity for prevention and intervention.
Objectives: To estimate the prevalence of suicidal ideation in OCD patients and assess association between sociodemographic factors and presence of suicidal ideation.
Methods: A cross-sectional study was conducted in OCD clinic, Outpatient and Inpatient settings at the Department of Psychiatry in Bangabandhu Sheikh Mujib Medical University (BSMMU) in between 2019 to 2021. By convenient sampling technique 60 OCD patients were enrolled in the study. They were interviewed using a semi-structured sociodemographic questionnaire along with Bangla version of the Modified Scale for Suicidal Ideation (MSSI).
Results: Out of the total 60 patients, 18 (30%) reported to have suicidal ideation in the last two days before interview. Suicidal ideation was more common among females (p=0.018). Across age groups, educational statuses, occupational statuses, family types, marital statuses, residences, family history of mental illness and substance use pattern, presence or absence of suicidal ideations didn’t vary.
Conclusions: One-third of OCD patients reported suicidal ideations. Female gender appeared as a risk factor.
Declaration of interest: None
Copyright and usage: ©Archives of NIMH 2022
Keywords: Obsessive-compulsive disorder, OCD, suicidal ideation
Nazia Afrin Siddiqui, Md. Shahadat Hossain, Taslima Afroz, Md.Hafizur Rahman
Abstract
Background: Chronic kidney disease (CKD) is an important contributor to global disease burden and presence of anxiety in CKD is associated with poor quality of life and increased mortality. The relationship of anxiety symptoms with kidney function and sociodemographic factors remains poorly investigated.
Objectives: To assess the relationship between anxiety with socio-demographic factors as well as some clinical biomarkers in patients with CKD.
Methods: A cross-sectional study was conducted in Nephrology Department of a medical college hospital in 2021. By convenient sampling technique 103 CKD patients of stages 3-5D were enrolled in the study. Sociodemographic and clinical data including CRP, hemoglobin, serum albumin, serum iPTH, blood urea was recorded from patients’ clinical notes and interview. CKD staging done by KDIGO 2012 criteria. Severity of anxiety symptoms was assessed by the Generalized Anxiety Disorder Scale-7 (GAD-7).
Results: Among the patients 53 (51.5%) were in CKD stage of 3-5 and 50 (48.5%) were receiving hemodialysis. A significant number of patients (28.1%) had shown moderate to severe anxiety. CKD patients’ age showed negative correlation with anxiety score (r=-0.400, p=0.000). No significant correlation was found between GAD-7 score and urea reduction ratio, serum creatinine level, eGFR, hsCRP, blood hemoglobin and serum parathyroid hormone level.
Conclusions: Anxiety symptoms are highly prevalent in CKD patients. However no significant association with sociodemographic factors or biochemical parameters were observed.
Declaration of interest: None
Copyright and usage: ©Archives of NIMH 2022
Keywords: Chronic kidney disease; anxiety; hemodialysis, GAD-7.
A S M Kowser, Munira Parveen, Md Azizul Islam, Md Shamim Reza
Abstract
Background: Prisoners have high levels of mental illness and drug or alcohol dependence. Prison environment is highly stressful and often predisposes the prisoners to develop mental disorders which go undetected and untreated.
Objectives: To find out the prevalence of psychiatric morbidity among prisoners as well as to bring out some socioeconomic & demographic parameter in relation to psychiatric morbidity.
Methods: It was a cross-sectional study conducted in Dhaka central jail, Keraniganj. The duration of study was six months starting from 01 May 2018 to 31 October 2018 All Bangladeshi male prisoners who were 18 years above and willing to participate were included in the study. Informed written consents from the respondents were taken. Those who were refused to give consent and with severe cognitive impairment were excluded. Ethical issues were maintained all through the study. 438 prisoners were randomly selected out of which 276 cases were identified as having psychiatric morbidity as well as screening of common psychiatric disorders by using General health questionnaire-12 item (GHQ-12). Socio-demographic data were collected by face-to-face interview using semi structured questionnaire, Psychiatric diagnoses were assigned by Consultant Psychiatrist according to Diagnostic and Statistical manual of Mental Disorders version 5 (DSM-5). Statistical analyses were carried out by using the Statistical Package for Social Sciences version 23.0 for Windows (SPSS Inc., Chicago, Illinois, USA). The mean values were calculated for continuous variables. The quantitative observations were indicated by frequencies and percentages.
Results: The age ranges of the prisoners were from 19-65 years having the mean age 32.5±9.3. Two third (63.0%) prisoners had psychiatric disorders, came from rural background (60.5%), most of the prisoners were from low economic group (50.4%) and charged with drug related offences (60.14%).
Conclusions: Psychiatric morbidity among the prisoners is very common. It is evident that high rate of mental health problems exists in prisons like substance related disorder, anxiety disorder, adjustment disorder, anti-social personality disorder, depressive disorder, schizophrenia. To improve overall health care service for the prisoners; psychiatric evaluation and treatment remains a fundamental element. Proper diagnosis and timely intervention of the mental health problems including substance related disorders may help in the reduction of occurrence or repetition of some offences.
Declaration of interest: None.
Copyright and usage: Archives of NIMH 2022
Keywords: Prisoners, Morbidity, General health questionnaire-12 item (GHQ-12), Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5)
Munira Parveen, Arman Ibne Haq, A S M Kowser, M M Jalal Uddin
Abstract
Background: Depression is the most common form of mental disorder in Bangladesh.
Objectives: To determine sociodemographic characteristics of depressive patients attending medical outpatient Department of Combined Military Hospital Dhaka Cantonment, Bangladesh.
Methods: It was a cross-sectional study conducted in the Internal Medicine Outpatient Department of CMH, Dhaka. Considering the inclusion and exclusion criteria, 444 samples were selected purposefully who were 18 years and above, irrespective of sex. The duration of study was six months starting from September 2018 to February 2019. Socio-demographic data were collected by face-to-face interview using semi structured questionnaire. Patient Health Questionnaire-9 (PHQ-9) score ≥5 (Five or more) was applied to screen out the positive cases. Data analysis was done by Statistical Package for Social Sciences (SPSS) version 22.
Results: Overall prevalence of depression in the study was (21.8%). Prevalence of depression was higher among young age groups of 18-40 years (75.2%). Majority of respondents were females (57.7%), came from rural background (71.1%) and achieved education level up to primary (38.1%). This study also found that majority of the participants (43.3%) were unemployed (i.e., housewife), (53.6%) other than married (i.e., single, widow, separated, divorce) who were from low-income group (42.3%).
Conclusion: More than one-fifth of the participants showed depression among medical outpatients.
Declaration of interest: None.
Copyright and usage: ©Archives of NIMH 2022
Keywords: Depression, Combined Military Hospital (CMH), DSM-5.
2021 Volume 4 Issue 2
Mohammad Tariqul Alam
Abstract
Clinical guidelines have been developed and practiced for decades in many developed countries. The potential benefit of using guidelines is to improve the overall health outcome by providing a more consistent care to patients, improving their quality of life and reduce overall mortality and morbidity. The healthcare professionals also benefit from it by taking quality clinical decisions, especially when in doubt about how to proceed to reassure them about the appropriateness of their treatment approach. The healthcare organizations and government bodies also find clinical guidelines to be effective by providing standardized care and optimizing value for money. However, there are certain limitations in guidelines too, especially when they are flawed due to lack of proper scientific evidence, misleading or influenced by the opinions and experiences of the group developing the guideline. However, with sufficient resources, expert clinicians, systematic review of evidence and group process leaders, a flexible guideline that will be valid and usable can be developed.
Declaration of interest: None
Copyright and usage: © Archives of NIMH 2021
Md. Sultan-E-Monzur, Zubair Mahmood Kamal
Abstract
Background: Increased availability of internet services and COVID-19 pandemic have produced a burst in online learning activities. Undergraduate medical students who are the future physicians are core of any health system and their training is traditionally given in face-to-face learning format. Exploring the pros and cons of online learning for undergraduate medical students will help in designing effective teaching and learning approaches.
Objectives: Exploring the perception of teachers and students regarding advantages and limitations of online learning and forming a list of recommendations for increasing effectiveness.
Methods: This narrative review was conducted with available literatures after meticulous search in Medline, Google, Google Scholar and PubMed with the searching keywords. No time limit was instituted. We also searched literatures for the explorations of the perception of teachers and students regarding the advantages and disadvantages of online medical classes during the COVID pandemic.
Results: One of the biggest difficulties for online learning is lack of access to internet and related technologies specially in underdeveloped and developing countries. Feelings of isolation may engross learners. We found that there are advantages like elimination of the cost points of student transportation, student meals and accommodation.
Conclusions: It is not possible for us to avoid this unwanted but very real situations and have to have cope with this practical issue and also should continue the study procedures, there is a need to train faculty on the use of online modalities and developing lesson plan with reduced cognitive load and increased interactivities.
Declaration of interest: None
Copyright and usage: ©Archives of NIMH 2021
Keywords: COVID-19; online classes; e-learning; merits and demerits.
Bidhan Ranjan Roy Podder, Mohammad Muntasir Maruf Shahana Parveen, Zinat De Laila, Niaz Mohammad Khan, Farzana Rahman, Zubair Mahmood Kamal
Abstract
Background: Apart from being suffered from the coronavirus disease 2019 (COVID-19) itself, this pandemic has been associated with mental health challenges related to the fear of being affected with the virus, relative insufficiency of the healthcare system and the mitigating measures.
Objectives: We aimed to assess the types of psychiatric disorders among the individuals who faced consequences of COVID-19 and attended at the outpatient department of National Institute of Mental Health (NIMH).
Methods: This was a cross-sectional study carried out during September, 2020–December, 2020. Individuals whose psychiatric symptoms were noticed for the first time after 8 March, 2020, were included in the study. Convenient sampling technique was applied. Data were collected through face-to-face interview using a semi-structured questionnaire. The psychiatric diagnoses were assigned by psychiatrists according to Diagnostic and Statistical Manual of Mental Disorders, version 5 (DSM-5). Completed data of 288 respondents were analyzed using Statistical Package for Social Sciences (SPSS), version 16.
Results: Among the respondents, 3.5% suffered COVID-19, 27.1% was affected by COVID-19 related financial or job loss. Relatives of 4.9% respondents were affected and 1.7% died due to COVID-19. Among the respondents directly or indirectly affected by COVID-19, 33.3% had COVID related anxiety. Majority of the respondents suffered from schizophrenia and spectrum disorder (27.4%) followed by bipolar and related disorder (22.9%), somatic symptom and related disorders (13.2%), anxiety disorders (10.8%) and depressive disorders (10.8%). The proportion of anxiety disorders and depressive disorders was more among the respondents who had COVID-19 related anxiety than the respondents having no anxiety related to COVID-19 (18.8% vs. 6.8% and 12.5% vs. 9.9% respectively).
Conclusions: The most common psychiatric diagnosis among the outpatients in NIMH during COVID-19 pandemic was schizophrenia spectrum and other psychotics disorders. The pattern of psychiatric disorders presented at outpatients of NIMH during COVID situation is not very different from the pre-pandemic era.
Declaration of interest: None
Copyright and usage: ©Archives of NIMH 2021
Keywords: COVID-19; psychiatric disorders, outdoor patients.
Mortoza Hassan, Jasmin Akhtar, Nazia Afrin Siddiqui
Abstract
Background: The possible influence of pathogenesis of schizophrenia of an immunological process resulting in inflammation has long been neglected, although inflammatory processes have been implicated in etiology of schizophrenia. If inflammation is a factor in schizophrenia, then it presents a target for potential treatment.
Objectives: To estimate the C-reactive protein (CRP) levels in patients with schizophrenia attending the hospital and evaluate its association with different demographic and clinical factors.
Methods: It was a cross-sectional observational study conducted at National Institute of Mental Health (NIMH), Dhaka in 2019. A total 48 patients of schizophrenia were enrolled for the study and following enrollment data on sociodemographic and other relevant variables were collected by a semi-structured questionnaire. CRP levels were estimated in NIMH laboratory. Then CRP levels were interpreted and compared with different variables.
Results: Most of the respondents (66.7%) had normal level (<6.00mg/L) of C reactive protein. However, in 16 patients CRP level was more than 6.00 mg/L. Percent wise it was 33.3%. The mean CRP levels of 48 participants was 7.70 mg/L, 95% CI [5.42, 9.99]. The association of gender of the respondents and CRP level (p=0.414), family history of psychiatric illness and CRP level (p=0.001), previous treatment history and CRP level (p=0.117), drug non-compliance and CRP levels (p=0.036) and duration of illness difference between elevated and non-elevated CRP (t= 4.44, p=0.001) were assessed in the study.
Conclusions: CRP and its blood levels have been found higher amongst schizophrenic patients, which suggested a role of inflammation in the pathogenesis of schizophrenia. Further studies are needed to better understand if CRP may be considered a biomarker in schizophrenia.
Declaration of interest: None
Copyright and usage: ©Archives of NIMH 2021
Keywords: C-reactive protein; schizophrenia patients; tertiary care hospital.
Mohammad Haris Uddin, Golam Mawla Chowdhury, Forkan Ahmmad, Bishwanath Kundu
Abstract
Background: Brain changes, circulatory and electrolyte imbalances are the main complications of transurethral resection of the prostate (TURP) surgery, known as transurethral resection (TUR) syndrome which is the result of excessive absorption of irrigating fluid. For this surgical procedure 1.5% glycine and 5% glucose are commonly used as irrigants.
Objectives: To observe the changes in the serum electrolytes and occurrence of the transurethral resection syndrome (TUR) with 1.5% glycine and 5% glucose as irrigant.
Methods: Between June 2008 and May 2010, 120 patients were included in a prospective randomized comparative trial comparing 1.5% glycine with 5% glucose irrigation fluids. We measured blood loss, fluid absorption, biochemistry including serum electrolytes, RBS and peri-operative symptoms. Blood samples were taken before and immediately and 24 h after TURP. Irrigating fluid absorption during TURP was measured by serum sodium level. Operative details were recorded, including the type of anaesthesia (with or with no sedation), resection time and weight of resected tissue. Peri-operative symptoms were documented prospectively. TUR syndrome was defined as a serum sodium level of ≤ 125 mmol/L with two or more associated symptoms or signs of TUR syndrome.
Results: Two (1.67%) patients had TUR syndrome; all two were irrigated with glycine, although this difference was not statistically significant (p=0.10). There was no difference between the groups in levels of sodium, potassium, urea, creatinine or peri-operative blood loss.
Conclusions: Both irrigants were associated with low perioperative morbidity including TUR syndrome. Except for the transient postoperative hyperglycemia in glucose group, both irrigants are nearly equivalent and safe.
Declaration of interest: None
Copyright and usage: ©Archives of NIMH 2021
Keywords: TUR syndrome; TURP, 1.5% glycine; 5% glucose; irrigation fluids.
Nazia Afrin Siddiqui, Babrul Alam, Mohammad Afjal Hossain, Md. Ashraful Alam, S M Nafeez Imtiaz, Md. Raquib Morshed
Abstract
Background: In adults with chronic kidney disease (CKD), depression is highly prevalent and associated with poor quality of life and increased mortality. The relationship of depressive symptoms with kidney function and sociodemographic factors remains poorly investigated.
Objectives: To assess the relationship between depression with socio-demographic factors as well as some inflammatory biomarkers in patients with CKD.
Methods: A cross-sectional study was conducted in Nephrology Department of a non-government hospital in 2021. By convenient sampling technique 103 CKD patients of stages 3-5D were enrolled in the study. Sociodemographic and clinical data including CRP, hemoglobin, serum albumin, serum iPTH, blood urea was recorded from patients’ clinical notes and interview. CKD staging done by KDIGO 2012 criteria. Severity of depressive symptoms was assessed by Patient Health Questionnaire-9 (PHQ-9).
Results: Among the patients 53 (51.5%) were in CKD stage of 3-5 and 50 (48.5%) were receiving hemodialysis. A significant number of patients (35%) had moderately severe to severe depression severity. Those with education level below SSC, rural residents, monthly expenditure below 10 thousand and above 31 thousand BDT, businessmen and dependent on other’s income showed higher depression levels. There were positive correlations between age (r=0.34, p=0.000), serum creatinine level (r=0.64, p=0.000), serum parathyroid hormone level (r=0.52, p=0.000) and depression severity; and negative correlations between urea reduction rate (r= -0.80, p=0.001), serum albumin (r= -0.71, p=0.000) and hemoglobin levels (r= -0.71, p=0.000) with depression severity.
Conclusions: Depressive symptoms are highly prevalent in CKD patients and several biochemical parameters correlates with depression severity.
Declaration of interest: None
Copyright and usage: ©Archives of NIMH 2021
Keywords: Chronic kidney disease; depression; hemodialysis, end stage renal failure.
Shahina Akther, Shaheen Islam, Md. Reza-A-Rabby
Abstract
Background: Patients with cancer often face psychological issues. Some nations have incorporated psychological assessments into cancer care; however, Bangladesh has minimal exposure of the discipline.
Objectives: To examine the prevalence and associated factors of anxiety and depression among cancer patients attending in a private referral hospital in Bangladesh.
Methods: The Hospital Anxiety and Depression Scale (HADS) tool was used to evaluate cancer patients by a cross-sectional study design. Eighty patients were recruited using a purposive sampling strategy. Descriptive statistics and chi-square tests were used to investigate the association of variables with anxiety and depression.
Results: The majority of cancer patients had moderate to severe depression (56.2%) and moderate to severe anxiety (42.5%). Anxiety was associated with marital status (p=0.020), financial state of the patient (p=0.003).
Conclusions: The prevalence of anxiety and depression among cancer patients was high, indicating the necessity of screening and counselling for anxiety and depression in cancer patients to help them cope with and influence their mental well-being.
Declaration of interest: None
Copyright and usage: ©Archives of NIMH 2021
Keywords: Cancer; depression; anxiety.
M Shafiul Azam, Ahmed Riad Chowdhury, Ramendra Kumar Singha Royle, Md. Abdul Motin, Md. Mejbaul khan Forhad, Suchitra Talukdar, Mohammad Tariqul Alam
Abstract
Background: Substance use disorders (SUDs) constitute a major public health problem and are associated with extensive psychiatric comorbidity. Clinical studies have demonstrated a high prevalence of personality disorders (PDs) in SUD patients which leads to poor psychosocial functioning and unfavorable clinical outcome.
Objectives: The study was aimed to assess PD in patients with SUD.
Methods: This was a cross-sectional descriptive study carried out in the Department of Psychiatry, Sylhet MAG Osmani Medical College during the period from 1st September 2017 to 31st August 2019. Purposive sample was taken and SUD diagnosis was made by Consultant Psychiatrists according to DSM-IV criteria. Sociodemographic variables were collected in a predesigned semi-structured questionnaire and Structured Clinical Interview for Diagnosis (SCID-II) was applied for screening of PD. Data analysis was performed using SPSS version 22.
Results: Among the 168 SUD patients, 50.6% had PD. Majority of the participants had cluster B PD that comprised of 39.3% of the patients. Most frequently diagnosed type of PD was antisocial PD (20.8%), followed by borderline PD (13.1%) and each of the rest of the PDs were less than 5%. Regarding association of sociodemographic variable and PDs, occupational status (p=0.027) and age at initiation of substance use (p=0.001) had significant association with PD.
Conclusions: This study revealed significantly high frequency of PD among SUD patients. It is important to assess PDs among all SUD patients in order to design more effective management of this underemphasized problem and improve the treatment outcome.
Declaration of interest: None
Copyright and usage: ©Archives of NIMH 2021
Keywords: Personality disorder; substance use disorder; antisocial personality disorder; SCID-II.
Sadia Afrin Shampa, Md. Sultan-E-Monzur, Fahima Sharmin Hossain, Md. Khairul Islam, Muntasir Maruf, Mohammad Tariqul Alam
Abstract
Sheehan’s syndrome (SS) denotes to the occurrence of varying degree of hypopituitarism after childbirth. Nowadays it’s a rare cause of hypopituitarism in developed countries due to advancements in obstetric care. But the underdeveloped and developing countries still have higher number of SS due to poor healthcare services and poor obstetric management. SS may present in post-partum period or several years after delivery. Reports of SS with psychotic manifestations is rare. It’s a case report of a 36 years old woman presented with psychotic features after childbirth. She had a history of post-partum hemorrhage. Antipsychotics were applied but there was no improvement. Treatment with thyroxine and glucocorticoids resulted in complete remission and returning back to normal functioning as before.
Declaration of interest: None
Copyright and usage: ©Archives of NIMH 2021
Keywords: Sheehan’s syndrome; post-partum onset; female; rare disorders.
2021 Volume 04 Issue 01
Mohammad S I Mullick
Naturally, comorbidity exists in psychiatry and is expected in nearly half of the cases across age, gender and time. The main reasons for comorbidity are shared biological and environmental risk factors that create complex psychopathology. Low reliability and validity of some disorders as well as other artefacts can be additional reasons for increased rate of comorbid diagnosis. Despite these limitations and controversy, considering comorbidity is one of the key issues in clinical psychiatry for adequate intervention to minimize the multiplied distress and impairment.
Declaration of interest: None
Copyright and usage: © Archives of NIMH 2021
Helal Uddin Ahmed, Md. Sultan-E-Monzur, Mohammad Tariqul Alam
Background: In medical practice the knowledge of psychiatry, mental health and behavioural science are essential. For this reason, training on psychiatry for undergraduate students is very much important. But medical students have a neutral or negative attitude to psychiatry.
Objectives: To find out the reasons behind current attitude towards psychiatry and propose an action plan to make psychiatry interesting and improve teaching techniques at the undergraduate level.
Methods:This narrative review was conducted with available English language literatures after meticulous search in Medline, Psycinfo, Google, Google Scholar and PubMed with the searching keywords. No time limit was instituted. We also searched the PubMed for assessment of knowledge, skills, and attitude about undergraduate medical education.
Results: This review revealed that several factors are involved for negative attitude towards psychiatry among the undergraduate medical students. We also found, psychiatry as a career choice has been negatively regarded and not prioritized for further post-graduation. Students are not clear of the psychiatrists’ role in the multidisciplinary team in the context of patient management as well as health policy implementation.
Conclusions: The need to address psychiatry curricula and introduce novel teaching and training strategies in undergraduate medical education. Simulated and standardized patients are useful and appropriate for teaching and assessment and are well accepted at undergraduate level. Further situation analysis and research are needed regarding the implementation of different simulation technologies in psychiatry.
Declaration of interest: None.
Copyright and usage: ©Archives of NIMH 2021
Keywords: Medical education; psychiatry; Bangladesh; narrative review; undergraduate education; curriculum
Md. Anowar Hossain, Ahsan Aziz Sarkar, Fatima Zohra, Md. Mamun Al Mujahid, Md. Shohedul Alam, Afroza Rahman Lopa
Background: Dementia patients need assistance and supervision in their daily life activities and this often places a major burden on their caregivers, thereby putting the caregivers at a great risk of mental and physical health problems. Identifying the severity and factors related to caregiver burden will facilitate the care of the dementia patients.
Objectives: To assess the proportion, severity and factors associated with caregiver burden in dementia patients.
Methods:It was a cross-sectional, observational study conducted at National Institute of Mental Health (NIMH), Dhaka in 2019. Eighty caregivers of dementia patients were enrolled in this study by convenient sampling technique. Following enrollment sociodemographic and relevant data like age, sex, education, income, marital status, residence, duration of caregiving, time spent in caregiving, provision of respite care, were collected. Then Mini-Mental State Examination (MMSE) score of each patient and Zarit Burden Interview (ZBI-B) score of each caregiver were recorded. Between group comparison was done by t-test and ANOVA. Association between continuous variables was seen by Pearson’s correlation test. P values obtained from t-test, ANOVA, Pearson’s correlation tests were considered significant if p< 0.05.
Results: Overall, all of the 80 participants described different levels of burden; among them 35% reported mild to moderate, 51.2% reported moderate to severe and 13.8% reported severe burden.Caregivers’ age (r=0.118, p=0.297), sex (t=1.41, p=0.160); marital status (t= -1.41, p=0.149); educational status (F=1.13, p=0.342) of the caregivers’; number of family members in the household (r=0.134, p=0.237), relationship with the patient (F=1.12, p=0.149); duration of caregiving in year (r=0.096, p=0.397); dementia patients’ age (r=0.198, p=0.079) and dementia patients’ sex (t= -1.68, p=0.096) had no statistically significant impact on caregiver burden.
Caregivers with low family income (r= -.133, p=0.238); who were not living with the patients (t= -4.04, p<.001); who had no provision of respite care (t= -3.32, p=0.001); and who spent more time on caregiving (B=0.244, p=0.001) reported higher and statistically significant burden. Finally,with deteriorating cognitive function of the dementia patient as measured by MMSE, caregiver burden had also increased (B= -1.22, p=0.001).
Conclusions: All caregivers experienced different levels of burden while giving cares to their dementia relatives. Increased time spent in caregiving and more cognitive impairment greatly increased burden. Provision of respite care and adequate social support can reduce the burden perception of carers.
Declaration of interest: None
Copyright and usage: ©Archives of NIMH 2021
Keywords: Caregiver burden; predictors; factors; dementia patients; tertiary care hospital.
Md. Abdullah Sayed, Md. Rezaul Karim, Kowsar Ahmed, Ramendra Kumar Singha Royle, Ahmed Riad Chowdhury,Md. Mubin Uddin, Rezwana Habiba
Background:Major depressive disorder (MDD) is one of the most common psychiatric disorders. Sexual dysfunction is common in MDD, which is an important cause of poor quality of life as satisfying sexual experience is an essential part of a healthy life.
Objectives:The study was undertaken to assess the pattern and frequency of sexual dysfunctions in male MDD patients; to find out whether there is any correlation between severity of depression and sexual dysfunction; and to see the relationship between sexual dysfunction with sociodemographic variables of patients suffering from MDD.
Methods:It was a cross-sectional, observational study conducted in the Department of Psychiatry, Sylhet MAG Osmani Medical College Hospital, Sylhet during the period of September 2017 to August 2019 where 68 male MDD patients were enrolled for the study. MDD was diagnosed according to the Diagnostic and Statistical Manual for Mental Disorders, 5th Edition (DSM-5) criteria. The sociodemographic information of the patients was obtained by using a semi-structured questionnaire. Severity of depression was assessed by Bangla version of Depression Anxiety and Stress Scale (DASS-21). Arizona Sexual Experience Scale (ASEX) scale was used to assess sexual dysfunction.
Results:Majority of thepatients (70.5%) with MDD had sexual dysfunction.Low sexual drive and orgasmic difficulty were the commonly reported sexual problems (35.3%). Problem with orgasmic satisfaction was present in 33.8% patients, 23.5% had difficulty in erection and 16.2% had low arousal. In this study we found statistically significant correlation between sexual dysfunction and severity of depression and no statistically significant correlation between duration of MDD and sexual dysfunction. On the other hand, neither severity of depression nor sexual dysfunction was correlated with duration of MDD.
Conclusions: This study revealed significantly high frequency of sexual dysfunction in patients with MDD. All the domains of sexual functioning were affected. Hence, this study emphasizes the need for awareness and importance of enquiring about sexual dysfunction in MDD patients.
Declaration of interest:None
Copyright and usage: ©Archives of NIMH 2021
Mst. Shammy Akhter, Nusrat Shamima Nur, Sultana Algin, Hafizur Rahman Chowdhury, Susmita Roy, Mohammad Enayeth Karim,Sharif Ashraful Habib
Background: Pregnancy, childbirth and parenthood are major life events that have been associated with increase vulnerability for the development of obsessive-compulsive disorder (OCD).
Objectives: To explore the sociodemographic and clinical factors found in postpartum mothers with OCD.
Methods: One twenty-six mothers presenting with OCD in postpartum period, attending the EPI clinic of Bangabandhu Sheikh Mujib Medical University, Dhaka were conveniently enrolled for the study. OCD was diagnosed by using Mini International Neuropsychiatric Interview (MINI) scale-7. Sociodemographic and relevant clinical data were collected by a semi-structured questionnaire.
Result:Majority of the participants belonged to age group 21-30 years. One-fifth had family history of mental illness; almost half of the participants had past history of OCD. A significant number of participants had medical co-morbidity and majority of the participants had depressive symptoms.
Conclusions:Past history of OCD are associated with OCD symptomatology in postpartum mothers. Majority of the mothers also had depressive symptoms.
Declaration of interest:None
Copyright and usage:©Archives of NIMH
Munira Parveen, AunikaJabunnasa, Md Habibur Rahman, A S M Kowser
Background:Migraine afflicts approximately 8-10% of general population. It is associated with a considerable psychiatric morbidity.
Objectives:To explore sociodemographic characteristics and psychiatric morbidities of migraine patients.
Methods:It was a cross-sectional, observational study which was carried out in 2020 at the Department of Psychiatry and Department of Neurology of Combined Military Hospital, Dhaka, Bangladesh. By convenient sampling technique 400 migraine patients were recruited. A semi-structured questionnaire for sociodemographic and relevant information and General Health Questionnaire-12 (GHQ-12) were used for data collection. Psychiatric diagnoses were made by psychiatrists using DSM-5 criteria.
Results: Among the 400 migraine patients 148 (37%) had psychiatric comorbidity. Majority (45.9%) were diagnosed as cases of major depressive disorder followed by obsessive-compulsive disorder (37.9%), anxiety disorders (13.5%) and other psychiatric disorders (2.7%).
Conclusions: Psychiatric morbidity was highly prevalent among migraine patients and among the psychiatric disorders, mood and anxiety disorders were common.
Declaration of interest: None
Copyright and usage: Archives of NIMH 2021
Keywords: Migraine; comorbidity; sociodemographic characteristics; General Health Questionnaire.
A S M Kowser, Fatima Zohra, Munira Parveen, Md Azizul Islam, M M Jalal Uddin
Background:Depression is one of the most common forms of mental disorders. It frequently goes unrecognized and unmanaged in outpatient department.
Objectives:To determine the prevalence of depression in medicine outpatient department patients.
Methods:This cross-sectional study was conducted in the Internal Medicine Outpatient Department of Combined Military Hospital, Dhaka. Considering the inclusion and exclusion criteria 444 samples were selected purposefully who were 18 years and above. The duration of study was six months starting from September 2018 to February 2019. Sociodemographic data were collected by face-to-face interview using a semi-structured questionnaire. Patient Health Questionnaire-9 (PHQ-9) scoreof ≥5 (Five or more) was used to detect positive cases. Data analysis was done by Statistical Package for Social Sciences (SPSS) version 22.
Results:Prevalence of depression in the study was 21.8%. Majority of respondents were females (57.7%), came from rural background (71.1%), completed education level up to primary (38.1%), were unemployed (43.3%), unmarried 53.6%) and were from low-income group (42.3%).
Conclusions:More than one-fifth of the participants,seeking medical outpatient services showed sign of depression.
Declaration of interest: None.
Copyright and usage:©Archives of NIMH 2021
Keywords: Depression;prevalence;medicine outpatient department.
Shoebur Reza Choudhury, Fahmida Ferdous, Nayan Ranjan Sarker, Abdul Matin
Background:Domestic violence is increasingly cited as a risk factor for the adverse physical and mental health outcomes. It is associated with an increase of psychoactive substance use, anxiety, depression, suicidality, and post-traumatic stress disorder symptoms. It is also related with high risk of developing severe mental illness such as schizophrenia and bipolar disorder.
Objectives:To estimate the prevalence and factors associated with domestic violence among psychiatric patients.
Methods: It was a cross-sectional, descriptive study and a convenient sample of 200 married adult psychiatric patients were taken. Domestic violence was assessed by using the Bangla version of HITS (Hurt-Insult-Threaten-Scream) Scale.
Results: Out of the 200 married adult psychiatric patients, domestic violence was experienced by 21% of the patients. Among the male 13% were victims of the domestic violence and among the female it was 27.8%. Victims of the domestic violence most commonly suffered from depressive disorders (47.6 %) and trauma and stress related disorders (19%).
Conclusions:A significant number of individuals with mental illnesses suffered from the domestic violence. Screening for domestic violence and providing information about safety plans canimprove the quality of life and reduce the violence related injuries.
Declaration of interest: None
Copyright and usage: © Archives of NIMH 2021
Keywords: Domestic violence; mental health; in mental health settings; HITS.
Sadia Afrin Shampa, Niaz Mohammad Khan, Md. Sultan-E-Monzur, Rubina Hossain
Trichotillomania (TTM) or hair pulling disorder is a debilitating psychiatric condition characterized by recurrent, irresistible urge to pull out one’s own hair that leads to hair loss and marked functional impairment. This is a case report about a 21-year-old female from urban background who presented with the complaints of repeated hair pulling for last 4 years. On mental state examination, she revealed obsessive thoughts about hair pulling and compulsive act of pulling out hair from scalp region. Other medical causes of such condition were excluded. Both pharmacological and psychological intervention was given for management of the patient.
Declaration of interest: None
Copyright and usage: ©Archives of NIMH 2021
Keywords:Trichotillomania; treatment of trichotillomania; rare disorders
2020 Vol 03 Issue 02
Md. Azizul Islam
Abstract
Telepsychiatry is an innovative practice in healthcare that applies tele-medicine in the field of psychiatry1. Telepsychiatry is also called tele mental health or e-mental health. Truly speaking it’s the use of ICT to provide psychiatric service across distance. Using the Information Communication Technologies mental health professionals can render their expert service to the far reach area
Declaration of interest: None
Copyright and usage: ©Archives of NIMH 2020
Md Faruk Hossain
Abstract
Background: Insomnia is a condition of unsatisfactory quality and/or quantity of sleep, with difficulty falling asleep, remaining asleep, or waking early and being unable to return to sleep. Transient insomnia occurs at times of stress but frequently accompanies various medical and psychiatric conditions and is often associated with substance misuse. Insomnia affects one-third of adults occasionally, and 9 to 12 per cent on a chronic basis.
Objectives: To develop a better understanding of insomnia as a whole with its different sub types and various treatment modalities for effective management of cases with insomnia.
Methods: A search was carried out on the web including Google Scholar, Medline, HINARI and several other web portals for English-language articles containing the following keywords- sleep, insomnia, epidemiology of insomnia, etiology of insomnia, pathology of insomnia, presentation of insomnia and treatment of insomnia. Relevant chapters in some authoritative textbooks were also consulted.
Results: Insomnia is more common in women, the elderly, shift workers and in patients with medical and psychiatric conditions. For diagnosis of insomnia disorder, DSM-5 requires insomnia to be present for at least three nights per week for 3 months and to cause clinically significant distress or functional impairment. The insomnia should not be adequately explained by another sleep or mental disorder, and not be attributable to the effects of a substance or medical condition. Both pharmacological and non-pharmacological approaches can be used to treat insomnia. Among pharmacological agents, short and intermediate acting benzodiazepines and benzodiazepine receptor agonists are the mainstay. Non-pharmacological interventions include a range of cognitive and behavioral techniques, including sleep hygiene. Hypnotic drugs were widely prescribed in the past, but non-pharmacological approaches are now recommended as the first-line treatment.
Conclusions: Sleep disturbance is ubiquitous among general people and insomnia is the most common type of sleep disorder. An individual at any age can develop insomnia as a primary sleep disorder, as part of another mental disorder or as a complication of a medical illness. The presentation differs among patients and so does the choice of appropriate treatment modality. Nevertheless, most patients significantly benefit from therapeutic interventions.
Declaration of interest: None
Copyright and usage: ©Archives of NIMH 2020
Keywords: Insomnia; presentation of insomnia; treatment of insomnia; review article
Mohammad Tariqul Alam, Md. Faruq Alam, Ahsan Aziz Sarkar, Rubina Hossain, Surajit Kumar Talukder Md. Abdullah AI Mamun, A. D. M. Rifat Chowdhury, Mekhala Sarkar, Helal Uddin Ahmed, Mohammad Hasibur Rahman, Fatima Zohra, Farjana Akhter
Abstract
Background: Frequent comorbidity among patients with neurodevelopmental disorders impair management process. Premature mortality and disability could be reduced if there were a greater focus on comorbidity. Holistic and cost-effective services to the persons with neurodevelopmental disorders is of utmost importance.
Objectives: The objective of the study was to find out the prevalence and types of comorbidities among individuals diagnosed with neurodevelopmental disorders.
Methods: A hospital based cross-sectional study was conducted among 346 children between 10 to 18 years with neurodevelopmental disorders (NDDs) in the Child Guidance Clinic of National Institute of Mental Health, Dhaka during the period of September 2017 to June 2018. Diagnosis of neurodevelopmental disorders were done by the research psychiatrists following DSM-5 criteria. Physical comorbidities were diagnosed from history, physical examination, relevant investigations and consultation with the consultant of the respective discipline. A research psychiatrist, a statistician, medicine specialists and other specialists as required, were recruited accordingly. Coordination meetings with involvement of all were held before data collection. MS Excel 2003 and SPSS version 18 were used for data analysis.
Rest//Is: Overall 346 children were approached for interview and among them 311 respondents completed full data collection procedure. Among the respondents, 61.7% were boys and 38.3% girls. Intellectual disability was the most common type of NDDs followed by ADHD and ASD. Among children with neurodevelopmental disorders (NDDs), 32.2% had physical comorbidity. Epilepsy (14.2%) was the most common comorbid physical disorder, followed by diabetes mellitus (2.6%) and cerebral palsy. Other physical comorbidity among patients with NDDs were infectious and parasitic diseases, diseases of the thyroid gland, hypertension, obesity, diseases of the respiratory tract, diseases of the urinary tract, diseases of the skin, diseases of ear, nose and throat.
Conclusions: Treatment of coexisting physical illnesses is required for proper management of patients with neurodevelopmental disorders. Approach of integrative medicine involving pediatrics and related disciplines needs to be taken for managing such children.
Declaration of interest: Financing authority- Non-Communicable Disease Control (NCD) wing of Directorate General of Health Services, Ministry of Health & Family Welfare, Government of People’s Republic of Bangladesh; study was conducted by National Institute of Mental Health, Dhaka, Bangladesh.
Copyright and usage: Archives of NIMH 2020
Keywords: Physical comorbidity; neurodevelopmental disorders
- D. M. Rifat Chowdhury, Md. Delowar Hossain, Arman Ibne Haq, A S M Kowser, Md. Showkat Ali Khan, Munira Parveen
Abstract
Background: Obsessive-compulsive disorder (OCD) is a debilitating heterogenous psychiatric disorder which is often comorbid with other psychiatric disorders.
Objectives: To identify the psychiatric comorbidities in patients with OCD.
Methods: This cross-sectional study was based on a survey conducted on 105 DSM-5 diagnosed OCD patients. The patients were older than 18 years and enrolled from the Inpatient and Outpatient Psychiatry Departments of NIMH and BSMMU, Dhaka in between December 2018 to December 2019. Psychiatric comorbidities and OCD severity were measured by the SCID-I CV and DUOCS (Dhaka University Obsessive Compulsive Scale). Data analysis was done by SPSS 25.
Results: The study observed that 92.4% of the respondents had comorbid psychiatric disorders, with the mean DUOCS score of 42.3. A larger proportion of OCD patients had comorbidity like panic disorder, generalized anxiety disorder and hypoactive sexual desire disorder, with the figures of around 40% for each. This study also found that around one-third of OCD patients had comorbidity like social phobia, secondary insomnia, dysthymic disorder, undifferentiated somatoform disorder, agoraphobia and major depressive disorder. Fewer than 20% of the OCD patients had comorbid conditions such as hypochondriasis, tic disorder, body dysmorphic disorder, hypomania, bipolar II, non-alcohol substance use disorder, dhat syndrome, acrophobia, etc.
Conclusion: This study provides essential information about the proportion of psychiatric comorbidities in patients with OCD. It is recommended that psychiatric comorbidities should be taken into consideration while planning for OCD management.
Declaration of interest: None.
Copyright and usage: ©Archives of NIMH 2020
Md. Mamun Al Mujahid, Ahsan Aziz Sarkar, Md. Sultan-E-Monzur, Md. Anowar Hossain, Md. Shohedul Alam, A. D. M. Rifat Chowdhury
Abstract
Background: Various studies have revealed that sexual side effects are frequent in psychotic patients treated with antipsychotics. Although sexual side effects have a negative impact on adherence to treatment, information on factors associated with antipsychotic related sexual side effects are limited.
Objectives: To evaluate the factors associated with sexual side effects of antipsychotics in psychotic patients.
Methods: We employed a single center, cross-sectional, naturalistic study design to collect data from 146 patients with DSM-5 diagnosis of different psychotic disorders. In addition to assess sexual functioning by Pyschotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ-SalSex), we recorded demographic data, medication history and relevant clinical information.
Results: Among the patients, 52.1% exhibited sexual dysfunction according to the assessment with PRSexDQ. Sexual dysfunction (SD) was common in both sexes with males exhibited higher prevalence of SD (58.5%) than females (43.8%). Incidence of SD increased in male patients (χ2=3.14, p=.050), when risperidone and typical antipsychotics were used (χ2=10.5, p=.030), with higher doses (t=15.1, p=.001), as the duration of treatment (t=8.2, p=.001) and illness (t=14.7, p=.001) got longer, when age of the patients were more (t=39.5, p=.001) and when the diagnoses were schizophrenia (χ2=50.8, p=.000). Patients’ route of taking medication (χ2=0.535, p=.380) and polypharmacy of antipsychotics (χ2=0.955, p=.220) appeared to have no significant effect.
Conclusions: Sexual side effects were common in patients taking antipsychotics and antipsychotics should be carefully chosen to ensure compliance.
Declaration of interest: None
Copyright and usage: ©Archives of NIMH 2020
Keywords: Sexual side effects; sexual dysfunction; antipsychotics
Farjana Akhter, Mohammad Tariqul Alam, Mahbuba Ahmed, Borhan Uddin, Nasrin Akhter, Farjana Rahman
Abstract
Background: Sociodemographic status and utilization of diagnostic healthcare facilities are important parameters to consider to ensure equitable distribution of healthcare services.
Objectives: To assess the sociodemographic characteristics and referral pattern of the patients who have undergone CT scan at National Institute of Mental Health & Hospital (NIMH), Dhaka.
Methods: This observational study was carried out during the period of March 2019 to September 2019 and 475 clients were consecutively enrolled. Sociodemographic and relevant data were collected by a semi-structured questionnaire.
Results: Mean age of the participants was 40.3±16 years; 42.5% of them were female and 57.5% male. For majority of them requests were for the brain CT scan (47.6%) followed by CT KUB (23.8%), whole abdomen (19%) and CT urogram (9.5%). Among the referred patients, 50.1% were referred from NIMH, 42.5% were referred from NIKDU, 4.8% were directly referred from physicians and 2.5% were referred from BSMMU. Patients came from urban locality were 47.5% whereas 52.4% patients were from rural areas. Majority of the patients were married (77.4%). More than half of the patients (60%) were not involved with any sort of income generation.
Conclusions: This study depicts some of the important sociodemographic contents of the patients undergoing CT scan along with the referral pattern, which requires further research and monitoring to obtain better understanding about the current utilization pattern of CT scanning.
Declaration of interest: None
Copyright and usage: ©Archives of NIMH 2020
Keywords: CT scan; referral pattern
Atiqul Haq Mazumder, Sadya Tarannum
Abstract
Background: Substance abuse is becoming a grievous problem among young generation and it takes time and substantial amount of money for treatment of drug addiction.
Objectives: To explore the patterns of service use among substance abusers living in Dhaka city.
Methods: The study population included 36 parents and 48 recovering addicts selected from Dhaka city using a random table. Data were collected through face-to-face interview using a semi-structured questionnaire.
Results: Half of the recovering users were on their thirties or forties. Two-third of the addicts used methamphetamine. Most of them had been addicted for 6 to 20 years. Cost of counseling was within 20000 BDT for half of them and from 20001 to 40000 BDT for one-third of them. Cost for treatment was within 20001 to 40000 BDT for half of them and within 20000 BDT for one-fourth of them. It took 2 to 5 years for complete recovery for more than half of the recovery addicts.
Conclusions: Substance abusers invest considerable time and money for counseling purpose.
Declaration of interest: The work was supported by the Access to Information (a2i) innovation fund of the government of Bangladesh for the project Ashokti Mukti. The Principal author was supported by the Marie Skłodowskaja-Curie Action co-funding of regional, national, and international programs.
Copyright and usage: ©Archives of NIMH 2020.
Keywords: Time, cost and visits; substance abuse; health care utilization
Md Khairul Islam, Pratyay Hasan, Md. Motlabur Rahman, Tasnima Kabir, S.M. Atikur Rahman, Ponkaj Kanti Datta, Md. Manjurul Haque, Md. Harun Ur Rashid, Imtiaz Faruq, Tazdin Delwar Khan, Rifat Hossain Ratul
Abstract
Background: Depression is a common mental illness worldwide. More than 264 million people are facing its devastating consequences. It is more common among doctors than the general population. Physicians are vulnerable to depression, because of their exposure to high levels of occupational stress and work load, which plays a devastating consequence over the quality of health care systems, making more medical errors and decline their professional performance. The majority of the physicians are unaware of their mental sickness and reluctant to seek mental health treatment due to fear of social stigma and failure to find reliable and trustful health care provider. As a result, the incidence of suicidal tendency has increased among physicians. Therefore, the psychological well-being of physicians is mandatory for the general population.
Objectives: To estimate the extent of depression among doctors who responded to an online based survey and to correlate it with their demographic characteristics.
Methods: A cross-sectional study in the form of online based survey was conducted among doctors who were working in different hospitals (both government and private) in Bangladesh, from June 2019 to December 2019. A preformed questionnaire was sent to the doctors through internet with Standardized PHQ-9 inventory. Demographic characteristics of the participants were recorded as independent variables; depression scores being outcome variables. Data analysis was done via SPSS-23.
Results: During the study period 502 doctors agreed to participate and filled up the online form. Minimal depression was present in 3.1%, mild in 5.5%, moderate in 32.5%, moderately severe in 27.2% and severe depression in 31.8% of the respondent doctors. Around 39 (8.6%) had none or only mild depression. Association between sex and PHQ-9 depression stages was significant (χ²=21.30, p<0.001). Males were less likely to be depressed than females. Association with place of job, physical assault and PHQ-9 depression stages were significant but association between age categories and depression stages determined by PHQ-9 scoring was not significant. Similarly, marital status, having children and distance of work place, living with family did not show significant association with depression.
Conclusions: The prevalence of depression is high among the doctors of Bangladesh. They must be promptly screened and managed at all medical institutions.
Declaration of interest: None
Copyright and usage: ©Archives of NIMH 2020
Keywords: Health care professional; physician; developing countries; psychological stress
Shoebur Reza Choudhury, Fahmida Ferdous, Nayan Ranjan Sarker
Abstract
Background: Domestic violence represents a worldwide public health issue that can result in short and long-term physical and mental health problems. HITS (Hurt-Insult-Threaten-Scream) was designed as a short instrument to determine domestic violence.
Objectives: The objective of the study was to adapt the Bangla version of the HITS Scale.
Methods: Cultural and linguistic adaptation in Bangla was done by translation, back translation, expert committee review, pretesting and revision of the scale. Then the reliability of the Bangla version of the HITS Scale was determined by employing both the parallel form and test-retest reliability techniques along with measuring Cronbach’s alpha for internal consistency. In the parallel form reliability correlation between Bangla and English version was tested by applying the scale on 30 healthy medical professionals. The test-retest reliability of Bangla version of the HITS Scale was tested at two-week time interval. Later the Bangla version of the HITS Scale was applied to 24 participants with self-reported domestic violence and compared with the results of 30 nonclinical healthy medical professional participants.
Results: Cronbach’s alpha value found was 0.75 which indicates an acceptable level of reliability. For the parallel form reliability, i.e., correlation between Bangla and English version, the Pearson correlation coefficient found was 0.647. In the test-retest reliability score two weeks apart, in the same healthy medical professionals, correlation coefficient was 0.797. The mean HITS scores for healthy medical professionals, (n=30) and the self-identified victims of domestic abuse (n=24) were 7.30 and 14.17, respectively. The difference in these means was found to be statistically significant (t=14.4, p=.000).
Conclusions: Bangla version of the HITS Scale can be a reliable tool to study domestic violence in both male and female subjects and was able to successfully differentiate between clinical and non-clinical populations.
Declaration of interest: None
Copyright and usage: ©Archives of NIMH 2020
Keywords: Domestic violence; HITS; Bangla HITS.
Anika Ferdous, Faijul Islam, Taiyeb Ibna Zahangir
Abstract
Hematohidrosis is a mysterious and rare disorder characterized by one or more attacks of spontaneous, bloody sweating from intact surfaces of skin and/or mucous membranes. The exact explanation of this condition is not so clear, but activation of the sympathetic nervous system has been suggested. This is a case report of a 13-year-old girl with recurrent bleeding from right nostril, right ear and right eye for 1.5 months. She was depressed and had an anxious trait before these episodes. She was referred to National Institute of Mental Health as a suspected case of factitious disorder. She was worried about the significance of her symptoms, thinking she might have developed some serious illness. There was complete remission of bleeding with pharmacotherapy and psychotherapy.
Declaration of interest: None
Copyright and usage: ©Archives of NIMH 2020
Keywords: Hematohidrosis; etiology of hematohidrosis; factitious disorder
2019 Vol 02 Issue 02
Md. Golam Rabbani
Abstract
The Covid-19 pandemic has alarming implications for individual and collective health and emotional and social functioning. This pandemic has reemphasized the role of mental health care providers in delivering psychosocial support to their patients, health care providers, and the public with renewed focus on the need to remove stigma surrounding mental health.
Declaration of interest
None
Copyright and usage
© Archives of NIMH 2019.
Niaz Mohammad Khan, Muhammad Zillur Rahman Khan, Md. Khairul Bashar, M M Jalal Uddin
Abstract
Background: Cognitive deficits in schizophrenia are profound and affect most of the patients.
Objectives: To find out the recent advancement and findings related to cognitive impairment in schizophrenia.
Methods: This narrative review was conducted with available literatures after meticulous search in PubMed, PubMed Central, Google, Google Scholar with the searching keywords.
Results: The most prominent of the cognitive deficits in schizophrenia are memory, attention, working memory, problem solving, processing speed, and social cognition. These impairments exist prior to the initiation of antipsychotic treatment and are not caused by psychotic symptoms in patients who are able to complete cognitive testing, which include most patients. The various cognitive deficits in schizophrenia have all been shown to be associated with functional outcomes such as difficulty with community functioning, difficulty with instrumental and problem-solving skills, reduced success in psychosocial rehabilitation programs and the inability to maintain successful employment.
Conclusions: Cognitive deficits are better able to explain important functional outcomes, such as work performance and independent living; than positive or negative symptoms.
Declaration of interest: None
Copyright and usage: Archives of NIMH 2019
Keywords: Cognitive impairments; schizophrenia
Md. Faruq Alam, Helal Uddin Ahmed, Mohammad Tariqul Alam, Mekhala Sarkar, Avra Das Bhowmik, Romendra Kumar Singha, Muhammad Zillur Rahman Khan, Niaz Mohammad Khan, M M Jalal Uddin, Ahsan Aziz Sarkar, Md. Azizul Islam, Jhunu Shamsun Nahar, Md. Masud Rana Sarker, Syed Mahbub-E-Kibria, Md. Saleh Uddin, Md. Jamal Hossain, Shoebur Reza Chowdhury, Khaleda Khanam.
Abstract
Background: Most of the studies in different parts of the world indicate a significant portion of people suffering from mental disorders have physical comorbidities which in turn impair management process. Premature mortality and disability could be reduced if there were a greater focus on comorbidity. There is almost no nationwide data about the prevalence and pattern of the problem in Bangladesh.
Objectives: The study was conducted to investigate the prevalence and types of physical comorbidity including substance use among persons with severe mental illness (SMI).
Methods: A hospital-based cross-sectional study was conducted among 2200 samples with severe mental illness (SMI) in 2 specialized psychiatry hospitals, psychiatry department of a medical university (Bangabandhu Sheikh Mujib Medical University) and an army hospital (Combined Military Hospital), psychiatry department of 8 medical college hospitals throughout the country from September 2017 to June 2018. Persons with severe mental illness- es for 10 years and above in Inpatient Department (IPD) and Outpatient Department (OPD) of the study sites were included in the study. Severe Mental Illnesses (SMI) included major depressive disorder, schizophrenia, schizoaffective disorder, bipolar disorder and organic psychotic disorders diagnosed by research psychiatrists following Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria of diagnosis. Physical comorbidities were diagnosed by history, physical examination, relevant investigations and consultation with the consultant of the respective discipline. Pretested questionnaire for socio-demographic and clinical variables and DSM 5 for diagnosis of mental illnesses were used in the survey. Local coordinators (psychiatrists), research psychiatrists, research officers, a statistician, medicine specialists and other specialists as required were recruited from the study sites. Two coordination meetings with involvement of all were held. MS Excel 2003 and SPSS version 18 were used for data entry and data analysis respectively.
Results: Among estimated 2200 samples from different sites of the study, 1648 respondents provided complete information. Among them 93.57% were 18 years or older, 45.63% female and 54.36% male. Overall, 42.0 % of the respondents with severe mental illness (SMI) had physical comorbidity where diabetes mellitus (28.47%) was the most common comorbidity followed by hypertension (26.45%),obesity (6.06%), respiratory tract diseases (4.91%), dyslipidemia (4.04%), diseases of the thyroid gland (3.46%), diseases of the blood-mostly anemia (3.32%), urinary tract infection (2.89%), diseases of the digestive system (2.60%), diseases of the musculoskeletal system (2.45%)and ischemic heart disease (2.31%). Other physical comorbidities included infectious and parasitic diseases (2.16%), diseases of the skin (1.73%), diseases of the genitourinary system (1.44%), epilepsy (0.86%), chronic kidney disease (0.86%) and underweight (0.72%). As additional findings, 7.77% of the respondents with severe mental illness had comorbid substance related and addictive disorders. Among the abusing substances, cannabis (63.28%) was the most frequently used drug followed by amphetamine (18.75%), alcohol (14.06%) and other types of drugs (3.90%).
Conclusions: Physical comorbidities including using substances are common among patients with severe mental illness in Bangladesh which could result in adverse outcomes. Treatment of coexisting physical and mental disorders are required for proper management of patients with severe mental illnesses. Approach of integrative medicine involving different disciplines need to be taken for managing such patients.
Declaration of interest: Financing Authority-Non-Communicable Disease Control (NCDC) wing of Directorate General of Health Services (DGHS) under Ministry of Health & Family Welfare (MOH&FW), Government of People’s Republic of Bangladesh; conducted by National Institute of Mental Health, Dhaka, Bangladesh.
Copyright and usage: @Archives of NIMH 2019
keywords: Comorbidity; physical comorbidity; mental disorder
Sifat E Syed, MSI Mullick
Abstract
Background: Headache is one of the most common complaints in outpatient departments and is known to have significant impact on different areas of functioning. The co-existence of psychiatric disorders with headache is an established fact.
Objectives: This study was aimed to explore the impact of headache, estimate the psychiatric comorbidity among headache patients and to see the possible association between them.
Methods: This cross-sectional study was conducted among 51 primary headache patients at Neurology Outpatient Department of Bangabandhu Sheikh Mujib Medical University in 2015. International Classification of Head- ache Disorders (ICHD-3) and Mini International Neuropsychiatric Interview (MINI) were used as diagnostic tools. Age range was 16-65 years.
Results: 62.7% had at least one psychiatric disorder. Severe impact on educational or occupational life was reported by 43.1% patients but association was not found with having psychiatric disorder. Severe impact on family/personal life and social life was reported by 15.7% and 6% individuals and it was significantly associated with psychiatric comorbidity (p=0.02 & 0.001). There was female preponderance and all types of headache were more prevalent among women. Prevalence of headache increased with age, peaked at 26-45 years and declined after that. Tension type headache was the commonest type of headache (60.8%) and highly prevalent among all age groups.
Conclusions: This small study shows the need of larger research in this area and also points out the importance of psychiatric intervention for headache patients.
Declaration of interest: None
Copyright and usage: Archives of NIMH 2019
Keywords: Impact; headache; Bangladesh; socio-demographic
Md. Jahangir Hossain, Noor Ahmed Giasuddin
Abstract
Background: Almost all physical illnesses have some psychological component and psychiatric disorders often present with physical symptoms; so psychiatric referral is especially important for the proper management of a patient.
Objectives: The purpose of the present study was to find out the referral pattern of patients to psychiatry department from other disciplines of “Monno Medical College & Hospital” and to come to diagnoses of those referred patients.
Methods: This descriptive cross-sectional study was performed in the department of psychiatry at a tertiary level multidisciplinary teaching hospital from June 2019 to December 2019. Patients referred from outpatient and inpatient departments of different disciplines were taken as study subjects. Psychiatric diagnoses of the patients were conferred by the consultant psychiatrist according to “The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)” diagnostic criteria. A semi-structured questionnaire was used to collect socio-demo- graphic information. The patients were analyzed based on important sociodemographic variables, source of referral, and diagnoses conferred. Ethical issues were maintained throughout the study.
Results: A total of 224 patients were referred to the Department of Psychiatry during the study period. Three fourths of the referred patients (171, 76%) were from outpatient departments of different disciplines and one fourth (53, 24%) from inpatient departments of the same. Majority of the patients were referred from the medicine and allied disciplines (194, 86.6%); the most referring departments were gastroenterology (63, 28%), medicine (51, 22%), dermatology (28, 12.5%), neuromedicine (24, 10.7%) and endocrinology (21, 9.4%) respectively. The
referrals from the departments of surgery (17, 7.6%) and gynecology (3, 1.3%) constituted a minority (20, 9%). Common psychiatric diagnoses of the referred patients were generalized anxiety disorder (72, 32%), somatic symptom disorder (44, 19.6%) and major depressive disorder (30, 13.4%).
Conclusions: Patients with psychiatric symptoms and comorbidity come to the outpatient and inpatient departments of mainly medicine and allied disciplines, other than psychiatry itself. We need to increase interaction among psychiatry and rest of the medicine allied departments to enhance overall patient management.
Declaration of interest: None
Copyright and usage: Archives of NIMH 2019
Keywords: Tertiary care hospital; Bangladesh; referral pattern; psychiatry; comorbidity.
A S M Kowser, Md. Mamun Al Mujahid, Ahsan Aziz Sarkar
Abstract
Background: Sexual performance related side effects of antipsychotic medications are important causes of non-compliance to medications.
Objectives: To estimate sexual dysfunction (SD) in patients taking antipsychotic medications.
Methods: A total of 146 participants taking antipsychotic medications attending the inpatient and outpatient units of National Institute of Mental Health (NIMH), Dhaka were recruited for the study. Bangla adapted version of Psychotropic Related Sexual Dysfunction Questionnaire (PRSexDQ) was used to determine SD along with a semi-structured questionnaire for collecting sociodemographic and relevant clinical information.
Results: Among the 146 participants, 52.1% exhibited SD and males exhibited higher prevalence of SD (58.5%) than females (43.8%). Among the sufferers, 63.2% had shown problems in all three domains of SD, that were desire, arousal and orgasm; 23.7% in desire and arousal; 5.3% in desire and orgasm; 5.3% in arousal and orgasm; and 2.6% solely in desire domain.
Conclusions: More than half of the participants showed SD and it usually affected multiple domains of sexual performance.
Declaration of interest: None
Copyright and usage: Archives of NIMH 2019
Keywords: Sexual dysfunction; antipsychotic medication
Nadia Afroz, Rubina Hossain, Shaafi Raaisul Mahmood, Mohammad Tariqul Alam
Summary
Stevens-Johnson syndrome (SJS) is an immune–complex mediated hypersensitivity reaction and has been linked as an adverse reaction to many drugs that predominantly involves the skin and the mucous membranes. In most of the cases, drugs are clearly the main causative factor. Lamotrigine, an anticonvulsant is recently being used as a mood stabilizer in many psychiatric disorders. Association between SJS and Lamotrigine is very rare in psychiatric settings in our country. A 19-year-old female with borderline personality disorder who developed Stevens- Johnson syndrome 3 weeks after starting of Lamotrigine reflects an important but rare side effect.
2019 Vol 02 Issue 01
Md Jahangir Hossain, Md Abdus Salam, Mohammad Muntasir Maruf, Noor Ahmed Giasuddin
Summary
The presence of physical illness in psychiatric patients not only creates difficulties in the diagnosis and treatment, but also complicates the course of both illnesses. The aim of this study was to find out the proportion of physical illness in patients attending the psychiatric outpatient department in Zainul Haque Sikder Women’s Medical College and Hospital. In this descriptive cross-sectional study, 345 respondents were evaluated in a period of 2 years. The respondents included in the study purposively were of ages between 18 and 60 years and fulfilled the criteria for psychiatric disorders according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR). Respondents of both sexes and from all socioeconomic and educational backgrounds were included. All the participants were subjected to assessment by history taking and examination; clinical assessment was carried out by a psychiatrist, and appropriate laboratory investigations were performed in relevant cases. This study showed that 41.74% of psychiatric patients had physical illnesses. The generalized anxiety disorder was the psychiatric group in which the highest number of physical illness was present (79.16%). Most prevalent physical condition was hypertension (1 7.6%). 37.5% of the physical illnesses were diagnosed for the first time at the time of psychiatric consultation. Physical co-morbidities are present in a substantial number of psychiatric patients. Early diagnosis and treatment of physical illnesses should be carried out to improve the physical health of psychiatric patients.
Md. Sultan-E-Monzur, Mohammad Muntasir Maruf, Susmita Roy
Summary
Presence of someone with schizophrenia in the home, especially after deinstitutionalization, can affect the work and social life of family members or the caregivers. This study was conducted to evaluate depression among caregivers of patients suffering from schizophrenia. This was a cross sectional study carried out in the department of psychiatry at North Bengal Medical College Hospital (NBMCH), Sirajganj, Bangladesh, during the period of January 2016 to June 2017 among purposively selected 50 respondents who were the primary caregivers of persons with schizophrenia attended the psychiatry outpatient department (OPD) of NBMCH. Mean age of the respondents was 38.98 (+12.42). Majority were from the age group of 41-50 years (28%) and 31-40 years (24%). Among the respondents, 58% were female and 42% male. Most of them were married (72%), Muslim (74%), completed primary level of education (32%), house wife (46%) and of rural background (70%). Among them, 44% suffered from Major Depressive Disorder. This study reflects that significantly higher rate of caregivers experienced depression. So, we should pay attention to not only the persons with schizophrenia but also those who are giving care to them.
SM Sayful Islam,MMA Shalahuddin Qusar,Md Shahidul lsIam, SM Abu Hena Mostafa Alim, Mommad Waliul Hasnat Sajib
Summary
Chronic and debilitating diseases like chronic kidney disease have numerous psychiatric consequences and strongly affect the mental health status of patients. The objectives of this study were to assess and quantify Depressive Disorders among End Stage Renal Disease (ESRD) patients, waiting for renal transplantation and 3 months after Renal Transplantation. It was a descriptive and analytical, follow up study which was conducted in the department of Psychiatry, Bangabandhu Sheikh Mujib Medical University (BSMMU) from July, 2013 to September, 2014. Cases were taken from department of Nephrology, BSMMU and Center for Kidney Diseases & Urological (CKDU) Hospital, Shyamoly, Dhaka. Adult ESRD patients waiting for Renal Transplantation of either sex were included. A total of 45 patients were taken and SCID-I CV (Clinician Version) was applied for diagnosis of Depressive Disorder. Severity was assessed by Bangla version of short-form of the Depression Anxiety Stress Scale-21(DASS-21-BV). Depressive Disorders were found among 51.1% of patients before renal transplantation and 28.9% of patients after transplantation. Severity scoring of Depression revealed, 8.7% had extremely severe, 21.7%, 39.1% and 30.4% had severe, moderate and mild level of Depression respectively before renal transplantation. After renal transplantation 13.1%, 21.7%, 21.7% of patients had severe, moderate and mild level of Depression respectively. Frequency of Depressive Disorders were significantly more before renal transplantation (y2 vaIue=4.63, p=0.03). Severity also significantly reduced 3 months after renal transplantation (y2 value=13.98, p=0.007). Depressive Disorders are highly prevalent among ESRD patients. So, strong consultation-liaison psychiatric services are needed to provide proper treatment to this group of patients.
Saifun Nahar, Md. Mazharul Shaheen, Mohammad Tariqul A/am, Mohammad Muntasir Maruf
Summary
Premature Ejaculation (PE) has been considered as the most common male sexual dysfunction having significant adverse effects on the quality of life of the men and their sexual partners. The objective of the study was to determine the proportion of PE among men attending in the sex clinic of National Institute of Mental Health (NIMH), Dhaka, Bangladesh. This was a descriptive cross-sectional study conducted from August 2017 to June 2018 among the purposively selected 280 patients. The patients were of 18 to 60 year, and sexually active during at least the past 6 months. A semi-structured self-administered questionnaire, containing socio-demographic and clinical variables and Bangla version of Premature Ejaculation and Diagnostic Tool (PEDT) were used to assess PE. Results showed that mean (+SD) age of the respondents was 38.8 (+8.44) years. 26.4% of the respondents were found to have Premature Ejaculation. Among the PE subtypes, lifelong PE, acquired PE, natural variant PE, and premature-like ejaculatory dysfunction, was 20.3%, 24.3%, 25.7% and 29.7% respectively. Presence of PE was slightly higher among the younger age (aged 20-40 years) group (51.1%) than the older age (aged 41-60 years) group (48.9%). Intra-vaginal ejaculatory latency time (IELT) of 51.1% of men was >3 minutes, 38.2% of men in the range of 2-3 minutes and that of 10.7% men was <1 minute. The high prevalence and adverse consequences illustrate the need for promoting awareness and standardized methods of PE diagnosis, assessment and treatment.
Noor Ahmed Giasuddin, Rokeya Tasnin, Mohammad Muntasir Maruf
Summary
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder with impairments in social communication and interaction, restricted interests, and repetitive behaviors. According to a recent study, ASD occurs in approximately sixteen out of every 1,000 children. Children with ASD often suffer from mental retardation, seizure disorder, and psychiatric disorders such as depression and anxiety. Early detection and intervention of this condition can significantly improve outcome, with about one third of persons with ASD achieving some degree of independent living. Current research links autism spectrum disorder to biological or neurological differences in the brain. Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET) scans show abnormalities in the structure of the brain, with significant differences within the cerebellum, including the size and number of Purkinje cells. In some families there appears to be a pattern of autism or related disabilities, which suggests there may be a genetic basis to the disorder, although at this time no one gene has been directly linked to autism. There are three large categories of treatment for this disorder: behavioral modification and communication approaches, dietary and nutritional approaches, and complementary approaches. This review paper discusses all of these broad categories and the sub-categories associated with them.
Syed Faheem Shams, Bulbul Ahmed Khan, Syeda Shara Chowdhury
Summary
Ice use is getting popular day by day in Bangladesh. This is a case report of a young lady of mid-twenties from urban background whose family complained that she used to take ice but she denied any history of substance use. On mental state examination, her mood was euthymic but there was delusion of grandiosity, delusion of control, delusion of persecution and systematized delusion. Finding of Magnetic Resonance Imaging (MRI) of brain was normal. We should check for history of ice use when a person of young or early adult age presents with the symptoms of psychosis.
2018 Volume 01 Issue 02
M M Jatal Uddin, Mohammad Tariqul Alam, Helal Uddin Ahmed, Niaz Mohammad Khan, Mahmudur Rahman, M A Hamid, Md Golam Rabbani, Zinat de Laila
Summary
Care giving and care receiving can occur at any point in the life course and is typically associated with chronic illness or disabilities which result in losses of independence and functioning. Families are an integral part of the care system for persons with a chronic mental illness such as schizophrenia. The aim of this study was to assess the characteristics of the caregivers of schizophrenia patients. This descriptive cross-sectional study was done among the caregivers of all consecutive schizophrenia patients in outpatient and inpatient department of National Institute of Mental Health (NIMH), Dhaka, Bangladesh from September 2010 to February 2011. Diagnosis of schizophrenia was done by consultant psychiatrist following DSM-IV criteria. A semi-structured questionnaire was applied to the caregivers of schizophrenia patients who fulfilled the inclusion criteria. Ethical issues were maintained accordingly. Out of 272 caregivers of schizophrenia patients most were female (86.03%), housewife (72.43%), of rural area (56.25%). Most of the respondents (80.52%) belonged to the age range of 21 to 50 years. Regarding educational status more than 43% completed secondary level. Among the caregivers 81.25% lived with non-nuclear family. Female members of the family specially mothers (45.22%) and wives 33.09%) were the highest group among the caregivers of schizophrenia patients. Significant proportions of the caregiver of schizophrenic patients were the female members of the family. Information about other characteristics of the caregivers will help further broad-based study regarding this issue and burden of the caregivers of schizophrenia patients.
Niaz Mohammad Khan, Ahmad Seraji, Mohammad Tariqul Alam, Mohammad Muntasir Maruf, Shahriar Faruque, Md. Abdullah Al Mamun
Summary
A burn injury is a traumatic experience, with tremendous social, physical, and psychological consequences. But care and research in burn patients has focused on medical issues rather than on psychological predictors. So, this study was done to know the psychiatric consequences of burn patients. The general objective of this study was to find out the prevalence and pattern of psychiatric morbidity in burn patients in Shaheed Suhrawardy Medical College Hospital, Dhaka. It was a descriptive cross-sectional study done among thirty-two patients admitted in the burn unit of Shaheed Suhrawardy Medical College Hospital. After taking the written informed consent a semi structured questionnaire was applied to the respondents to know the socio- demographic characteristics. Screening for psychiatric illness was done by applying Bangla version of self-re- porting questionnaire (SRQ-20), which has been developed by World Health Organization (WHO) to screen for psychiatric illness. Diagnosis of psychiatric illness was confirmed by applying the Clinician Version of the Structured Clinical Interview for DSM-IV for Axis I mental disorders (SCID-CV). Data were analyzed using Statistical Packages of Social Sciences (SPSS) version 17 for windows. Most of the respondents had a diagnosis of psychiatric illness (56.3%). Among the nine positive cases four had a diagnosis of post-traumatic stress disorder; two were suffering from major depressive disorder, one from schizophrenia, one from somatoform disorder and one from adjustment disorder. Psychiatric illness is common among the burn patients. So, psychiatric aspect should be given more priority in the management of burn patients.
Fahmida Ferdous, Hariprakash Chakravarty, Mohammad Muntasir Maruf, Md. Faruq AIam, Shoebur Reza Choudhury, Mohammad Mahsukur Rahman Chisty, Khandker Parvez Ahmed, Mohit Kamal
Summary
Stroke is a common neurological disorder with high mortality and disability rates worldwide. The burden of psychiatric co-morbidity is not well documented in developing countries like Bangladesh. The objective of the study was to examine the frequency and pattern of common psychiatric disorders present in stroke survivors in a medical college hospital of Dhaka, Bangladesh. A cross-sectional study was conducted from October 2017 to April 2018 in the Neuro-science Department in Z H Sikder Women’s Medical College Hospital, Dhaka. A total of 50 patients with stroke were evaluated to study the frequency and characteristics of psychiatric morbidities. The participants were interviewed by experienced neurologists and psychiatrists. Informed consent as well as socio-demographic data was obtained and each patient was evaluated for psychiatric morbidity using the Mini International Neuropsychiatric Interview (MINI). Mean age of the respondents was 58.28 (+12.61) years, age ranging from 41 to 82 years. Out of 50 respondents, 80% were male, 44% had educational qualification below SSC, 54% had multiple risk factors of stroke. The results further showed that 20% respondents developed anxiety disorders, 70% developed major depressive disorder and 10% developed stress disorder. There is a significant burden of psychiatric co-morbidity found in stroke survivors in Bangladesh. This may go unnoticed, if not actively screened for by clinicians and could impact negatively on management outcomes if not attended appropriately.
Md Mohsin Ali Shah, Syed Reazur Rahman, S.M. Yasir Arafat
Summary
Suicide is a preventable public health problem which is under researched in Bangladesh. This review aimed to discuss the risk factors of suicide in Bangladesh based on readily available literatures. Current study was conducted with available literatures after adequate search in PubMed, PubMed Central, Google, Google Scholar, BanglaJOL with the searching keywords. Different studies revealed somewhat similar risk factors in Bangladesh. Majority of suicides were found to be linked with emotional events such as marital discord and family quarrel. Other reported risk factors were also related with strong emotions such as sexual harassment, failed in exam, not fulfilling immediate demand such as motor bike, bicycle, special dress in ceremonial occasions, special television channel watching etc., extra-marital relationship issue, early marriage, death of partner, death of children, and verbal abuse by teacher, love affair related complicacy, domestic violence, and divorce. Psychiatric illness as a risk factor of suicide is under focused and has not been considering as import- ant risk factor in the country. Risk factors of suicide in Bangladesh have been found different in regards to the other parts of the world and mostly related with emotionally charged events. Culturally appropriate prevention strategies should be considered to address the issue.
S.M. Yasir Arafat
Summary
Obsessive-compulsive disorder (OCD) is a chronic and debilitating neurotic illness; however, phenomenological aspects of childhood OCD are not extensively studied in Bangladesh. The article aimed to review symptom pattern of OCD among the children and adolescents of Bangladesh. This narrative review was conducted with available literature after meticulous search in PubMed, PubMed Central, Google, Google Scholar, BanglaJOL with the searching keywords. Prevalence of OCD among children and adolescents was found from 1.3%-2.5% with male predominance. Dirt and contamination was found as the commonest obsessions and cleaning/washing was found as the commonest compulsion among the child and adolescents of Bangladesh.
Mohammad Kafil Uddin Chowdhery, AKM Khalequzzaman, Fatema Zohra, ADM Rifat Chowdhuy, Mohammad Tariqul Alam, Mohammad Muntasir Maruf, Md. Faruq Alam, Md. Zahir Uddin
Summary
Tuberous sclerosis or Bourneville’s disease is a rare multi-system genetic disease, which is clinically characterized by classical Voget’s clinical triad such as adenoma sebaceum, low intelligence and epilepsy. It is a Mandelian monogenic disorder which is inherited as autosomal dominant fashion with prevalence rate is approximately I in 6000 live births. In this disease specific genetic abnormality causes benign tumor to grow in brain, kidneys, heart, liver, eye, lungs and skin, which gradually cause significant functional impairment of those organs either in isolation or in combination. This is a case report of 22 years old young man present with aggression with significant behavioral impairment for last 3 years who has history of epilepsy as well as multiple cutaneous manifestations such as adenoma sebaceum, Shagreen patch, peri and subungual fibroma. His IQ was extremely low measured by Wechsler Abbreviated Scale of Intelligence. According to that scale his total IQ score was 53. On systemic enquiry by both clinical and laboratory means we found that he had multiple renal cysts with chronic kidney disease. According to that finding we advised antipsychotics and referred him to National Institute of Kidney Diseases and Urology (NIKDU) for better nephrological evaluation and treatment. Two weeks later on a follow up session we found that he was quiet and calm. His aggression and violence was subsided.
2018 Vol 01 Issue 01
Ahsan Uddin Ahmed, Mohammad Muntasir Maruf, Md Harunur Rashid, Arman lbne Haq, Jotirmoy Roy
Summary
Substance abuse has become a major public health concern in Bangladesh. The present study was designed to assess the pattern of substance abuse and factors related to it among the patients attending government facilities. This was a descriptive cross-sectional study conducted during November, 2013 to April, 2014 among patients with substance use disorder. A total of 175 patients with substance use disorder (SUD) were selected using convenient sampling technique from both the inpatient and outpatient departments of Central Drug Addiction Treatment Center (CTC), Dhaka and National Institute of Mental Health (NIMH), Dhaka. Data were collected through face-to-face interview using a semi-structured questionnaire designed by the researcher containing socio-demographic and other variables. The mean age of the respondents was 29.53(+8.10) years. More than one third of the respondents (37.1%) were included in the age group of 21-30 years. More than half (54.3%) of the respondents used amphetamine (Yaba) as their main substance of abuse which was followed by cannabis (15.4%) and pethedine (9.1%). Most of the respondents (58.3%) started to use substance when they were in between 16 to 20 years of age. Majority of the abusers (72.0%) took substance through smoking. Relapse rate (86.3%) was found high. This study provides information about recent pattern of different types of substance use among the abusers receiving services from government facilities. Amphetamine was found the main substance of abuse. An alarming proportion of respondents started to use substance before or at the age of 20.
Farzana Rahman’, Murshed Baqui, Mohammad Muntasir Maruf, Zinat De Laila, Nasrin Akhter, Shahana Parveen, Wasima Rahman, Nasim Jahan
Summary
Juvenile offenders are generally vulnerable to psychiatric illness. The objectives of the study were to deter- mine the prevalence and types of psychiatric disorders among male juvenile offenders in Bangladesh. This was a cross-sectional study conducted in Juvenile Development Center (Boys’), Bangladesh. All the male offenders of 9-18 years were included in the study during January 2011 – June 2011. Total respondents were 138. Validated Bangla version of the Development and Well-Being Assessment (DAWBA) was used to deter- mine psychiatric disorders which were assigned based on ICD-10 diagnostic criteria. Information regarding socio-demography and other factors were collected through face-to-face interview using a semi-structured questionnaire and from the case-notes. Data analysis was done by SPSS for windows 15 version. The mean (+SD) age of the respondents was 14.2 (+1.7) years. Majority of them were from urban area (73.9%), were Muslims (94.2%), unmarried (97.1%), completed primary level of education (41.7%), lived in nuclear family (77.11%) having monthly family income of less than 10,000 Tk (89.1%). Most (26.8%) inmates were charged with murder. Psychiatric disorders were diagnosed in 57.2% of the respondents. Rate of emotional disorders (48.1%) was higher than behavioural disorders (38.4%). Regarding specific disorders, conduct disorder (46.8%) and major depressive disorder (43.0%) were the most common diagnoses. It can be concluded that there was considerable rate of psychiatric disorders among the male juvenile offenders in the development centre. Broad-based replication study could confirm these findings.
Helal Uddin Ahmed, MMA Shalahuddin Qusar, AFM Helal Uddin, Md. Jamal Hossan, Mohammad Tariqul Alam, M.S.I Mullick, Jhunu Shamsun Nahar, M M Jatal Uddin, Niaz Mohammad Khan, Md. Faruq Alam
Summary
Mood disorders impose a significant burden on a personal, medical and socioeconomic level of the caregivers. It is observed in our country that in almost all sort of patient with psychiatric illness including mood disorders depend on the care of their family members. The objectives of this study were to determine the level of burden of caregivers of patients with mood disorders attended in a tertiary care hospital and to identify the possible association of duration, type of mood disorders, and the socio demographic variables on the burden of caregivers. This was a cross sectional study, sample size were 95 and SCID-I applied on the subjects and they diagnosed mood disorders and caregiver‘s burden was assessed by using the Zarit Burden Interview (ZBI). It was found the positive relationship with the disease duration and caregiver burden level (p=0.000). The duration of providing care also significant (p=0.000) with the higher level of burden. Among the subjects 44.2% diagnosed Major Depressive Disorder, 43.1% Bipolar Mood Disorder (Manic), 7.4% Bipolar Mood Disorder (Depressive) and 5.3% were diagnosed Dysthymic Disorder. The caregiver from nuclear family (74.7%) felt higher degree burden than caregivers from joint family (24.3%). The family type and burden level bound significant relationship (p=0.013). Regarding the burden level 54.8% caregiver possessed severe burden, 24.2% moderate to severe burden, 18.9% mild to moderate burden and 2.1% possessed little or no burden. To provide a total care to the patients with mood disorders it is necessary to mitigate the caregiver‘s burden. For this reason clinicians need to review periodically the status of caregiver‘s burden.
Mohammad Kafil Uddin Chowdhury, Mohammad Tariqul Alam, Ahsan Aziz Sarkar, Md. Faruq Alam
Summary
Hematidrosis or hematohidrosis or hemidrosis is a very rare condition in which a human being sweats blood. Physical and psychological stresses are found to be the most frequent causes among other causes such as systemic diseases and vicarious menstruation. This is a case report of 16-year-old girl with oozing of blood from intact skin of forehead, scalp, ears, eyes and nose. Physical exertion, long journey, intense fear secondary to psychosocial stressors and academic examination were identified as precipitants in this case she was provisionally diagnosed as mixed anxiety and depressive disorder. Pharmacotherapy and psychotherapy were followed by complete remission; it is inferred from the experience that hematidrosis is a treatable condition if the underlying cause is correctly identified.
Md Ahasan Ullah, Fatima Zohra, Mekhala Sarkar, Ahsan Uddin Ahmed
Summary
In Psychiatry insight refers to the conscious awareness and understanding of one‘s own psychodynamics and symptoms of maladaptive behavior, highly important in effecting changes in the personality and behavior of a person. Impaired insight into illness is common. It has direct or indirect impacts on almost all phases of the diagnosis and treatment protocols. Not surprisingly, there is scarcity of summarized outline of evidence-based importance of insight in psychiatry. This article aimed at fulfilling this scarcity. For this purpose, thirty articles were selected through searching internet and reviewed. This article reviews recent research related to impaired insight in major mental illness and its consequences for cognitive, behavioral, legal, and treatment compliance issues affecting this population. It discusses efforts to find the neurobiological basis for lack of insight and the various structures or circuits of the brain that have been implicated in schizophrenia. In the search for a more reliable and valid measure of insight for treatment decisions, the development of various assessment instruments is summarized. Impaired insight is shown to be related to a poorer course of the illness and noncompliance with necessary treatment in schizophrenia. The implications of these findings for treatment decisions, legal interventions, and ongoing treatment monitoring are discussed.