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Biomedical subjects

Prabha S Chandra

Publications and source records attributed to Prabha S Chandra.

At least 19 recordsLinked to original sources
PubMed2007

Prevalence of HIV, Hepatitis B, syphilis, and chlamydia among adults seeking treatment for a mental disorder in southern India.

This study estimated the prevalence, and identified the correlates, of HIV, chlamydia, syphilis, and Hepatitis B among patients seeking treatment for a mental disorder in India. Patients (n = 948) submitted a blood sample for serologic testing and participated in a brief interview. Lifetime prevalence rates were nearly 2% for HIV, 10% for chlamydia, 3% for Hepatitis B, and 3% for syphilis; 15% of patients had evidence of at least one infection. Bivariate associations between infection status and patient characteristics, including age, gender, psychiatric diagnosis, did not reveal any consistent risk profile. Instead, behavioral characteristics (i.e., multiple partners, exchanging sex for money, and engagement in anal sex) were associated with infection status. Recommendations for the sexual health care of psychiatric patients in India are provided.

Adolescent↗
PubMed2006

Intimate partner violence and sexual coercion among pregnant women in India: relationship with depression and post-traumatic stress disorder.

BACKGROUND: Intimate partner violence (IPV) is prevalent in most parts of the world. It is also prevalent during pregnancy. METHODS: This study assessed the prevalence of IPV during pregnancy and evaluated its relationship with mental health outcomes, including depression and post-traumatic stress disorder (PTSD). Pregnant women (n=203) attending an antenatal clinic in a public hospital in Bangalore were assessed for presence of IPV as well as depressive, somatic, PTSD symptoms and life satisfaction. RESULTS: Self-reported physical violence in the last year was reported by 14% of women, psychological abuse by 15%, and sexual coercion by 9%. One-half of these women reported ongoing abuse during pregnancy. Depression, somatic, and PTSD symptoms were higher in those with a history of abuse or sexual coercion, and life satisfaction was poorer in those with any form of violence. Among those reporting a history of sexual coercion, severity of violence was related to increased psychiatric morbidity. Alcohol abuse in the spouse was a predictor of the presence and severity of abuse. LIMITATIONS: The study was conducted in a single clinic in southern India which is a large country with very diversified populations. CONCLUSION: The experience of intimate partner violence and its mental health consequences are quite prevalent in India which is a culture where gender disparities are normative and pregnancy is a particularly vulnerable period.

Adolescent↗
PubMed2006

Quality of life in HIV subtype C infection among asymptomatic subjects and its association with CD4 counts and viral loads--a study from South India.

OBJECTIVE: To study the association between quality of life (QOL) domains and biological markers of disease progression of HIV infection, i.e. viral load (VL) and CD4 counts among asymptomatic subjects with HIV subtype C infection in South India. DESIGN: Quality of life was measured using the locally validated version of the WHOQOL HIV-BREF. The subjects were neurologically asymptomatic, non psychiatrically ill HIV infected men and women participating in a cohort study. RESULTS: The results indicated mixed findings, with some QOL dimensions being associated with high VLs and low CD4 counts while several others did not show any associations. Significant associations were seen between low CD4 counts and the psychological and social relationships domain, with lower mean scores in these domains being reported by subjects having CD4 counts <200/mm. However, there were no significant differences between the CD4 subgroups for the domains related to physical health, level of independence, environment, and spirituality domains. Significant lower mean QOL scores were found in the highest VL subgroup compared to other groups for the following WHOQOL HIV-BREF domains: physical, psychological, level of independence, and environmental. CONCLUSIONS: In this sample of HAART naïve asymptomatic HIV infected subjects, some QOL dimensions were associated with the biological markers of disease progression i.e. VL and CD4 counts, while several were not. The associations were significant only in the high VL and low CD4 groups.

Adult↗
PubMed2006

Atypical antipsychotic-induced akathisia with depression: therapeutic role of mirtazapine.

OBJECTIVE: To investigate the efficacy of mirtazapine in treating akathisia caused by risperidone and olanzapine, as well as its use in alleviating comorbid depressive disorder. CASE SUMMARIES: Five patients with diagnoses varying from schizophrenia, delusional disorder, and bipolar disorder developed akathisia while on treatment with olanzapine and risperidone. The likelihood that risperidone and olanzapine had induced akathisia in all patients was rated probable according to the Naranjo probability scale. Four of these patients were also found to be depressed. The akathisia was successfully treated with mirtazapine, and 3 of the 4 depressed patients improved with mirtazapine treatment. Use of mirtazapine did not result in any adverse effect. DISCUSSION: Mirtazapine is a potent antagonist of central alpha(2) auto- and hetero-adrenergic receptors, as well as an antagonist of 5-HT(2A/2C), 5-HT(3), and histaminergic H(1) postsynaptic receptors. The efficacy of mirtazapine in treatment of akathisia may result from its antagonist property at the H(1) receptors and its dopaminergic activity in frontal cortex. The use of mirtazapine offers advantages over other anti-akathisia drugs in its better adverse effect profile, as well as its ability to treat coexisting depression. CONCLUSIONS: Mirtazapine is efficacious in treating atypical antipsychotic-induced akathisia. It may be a good option, particularly in patients with coexisting depression.

Adult↗
PubMed2005

Screening for sexually transmitted infections at a DeAddictions service in south India.

OBJECTIVES: To estimate the lifetime prevalence of four sexually transmitted infections (STIs) and to identify correlates of these infections among patients seeking care for a substance use disorder at a specialized DeAddictions Unit in southern India. METHODS: Consecutive inpatients (n=361; 98% male; M age=36.7 years) admitted to DeAddictions Unit of the National Institute of Mental Health and Neuro Sciences in Bangalore, India, participated in a structured interview to obtain demographic, psychiatric, sexual behavior, and substance use data; each patient also provided a blood sample for serologic testing for HIV, chlamydia, syphilis, and hepatitis B. RESULTS: One-quarter of all patients tested positive for at least one STI. Lifetime seroprevalence rates were 12.9% for syphilis, 10.3% for chlamydia, 3.1% for hepatitis B, and 1.1% for HIV. Analyses did not reveal any consistent pattern of associations between STI status and sociodemographic, psychiatric, and sexual behavioral characteristics. CONCLUSIONS: All patients should receive a comprehensive sexual assessment during standard care; for those patients who report risky sexual practices, we recommend voluntary counseling and testing for STIs. Although we do not recommend universal testing for STIs at this time, this should be revisited based upon national surveillance data.

Adult↗
PubMed2005

Prevalence and correlates of tobacco use and nicotine dependence among psychiatric patients in India.

Tobacco use among psychiatric patients in developing countries has not been well-investigated. To address this issue, we screened consecutive admissions to a major psychiatric hospital in southern India, and assessed the prevalence and correlates of tobacco use and nicotine dependence. Patients (n=988) provided information about their use of tobacco products, and participated in an interview that included the Fagerström Test for Nicotine Dependence as well as measures of other substance use. Three hundred and fifty-one patients (36%) reported current tobacco use, with 227 (65% of all users) reporting moderate to severe nicotine dependence. Current tobacco use as well as nicotine dependence were associated with male gender, a diagnosis of bipolar disorder, and risk of other substance use problems. The cultural context of these findings, and the implications for tobacco control among psychiatric patients, are discussed.

Adolescent↗
PubMed2005

HIV & psychiatric disorders.

HIV infection and psychiatric disorders have a complex relationship. Being HIV infected could result in psychiatric disorders as a psychological consequence of the infection or because of the effect of the HIV virus on the brain. Disorders may be as varied as depression, post-traumatic stress disorders, AIDS phobias, grief and the whole gamut of cognitive disorders. In addition, several psychiatric conditions may predispose individuals to acquiring HIV infection as a consequence of their influence on behaviour. There is also strong evidence of the relationship of substance use disorders and severe mental illnesses with HIV infection. HIV related psychiatric disorders also offer a challenge to clinicians in issues of differential diagnosis and management. Majority of the work in India has focused on substance use and HIV, and to a lesser extent on the psychiatric effects of HIV infection. Given the magnitude of the problem in the country and the multiple physical and psychological stressors that persons with HIV face in India, more research is needed.

Anti-HIV Agents↗
PubMed2003

Prevalence and correlates of areca nut use among psychiatric patients in India.

OBJECTIVES: To estimate the prevalence and identify the correlates of areca nut use among men and women being treated for a major psychiatric disorder in India. METHODS: Inpatients (N=988) admitted to the adult psychiatry department of the National Institute of Mental Health and Neuro Sciences in India were interviewed regarding their use of the areca nut, tobacco, alcohol, and other drugs. Medical records were reviewed to obtain psychiatric diagnosis and history. RESULTS: About 24% of the sample reported recent areca nut use, and 10% reported severe use suggesting dependence. Common reasons for use include to improve mood (31% of users), socialization (31%), digestion (22%), or performance (7%) and to decrease aches and pains (6%). Predictors of current areca nut use included less education, diagnosis of bipolar disorder, and current tobacco use. Predictors of severe use were older age, female gender, less education, and current tobacco use. CONCLUSION: Areca nut use occurs commonly among Indian psychiatric patients, and deserves further investigation.

Adult↗
PubMed2003

Relationship of psychological morbidity and quality of life to illness-related disclosure among HIV-infected persons.

OBJECTIVE: The aim of this study was to examine the relationship between HIV-related disclosure and quality of life, anxiety and depression among HIV-infected subjects in South India. METHODOLOGY: 68 subjects (35 men and 33 women) were assessed for quality of life and psychological morbidity using WHOQOL-BREF and the Hospital Anxiety and Depression Scale (HADS). Details of disclosure were collected using a semistructured interview. RESULTS: Certain disclosure-related variables appear to relate significantly with quality of life among HIV-infected persons. A positive outcome related to disclosure and extent to which a subject felt the need to disclose were significantly associated with higher scores on the total quality of life measure and in the social and environmental domains of the WHOQOL-BREF. No relationship was found between disclosure-related variables and psychological morbidity or other domains of quality of life. The type of disclosure (voluntary/without consent) did not appear to influence quality of life in this sample. CONCLUSION: Disclosure-related variables may have an important influence on QOL in the context of HIV infection in India.

Adolescent↗
PubMed2003

Predictors of HIV risk among men seeking treatment for substance abuse in India.

The purpose of this study was to investigate the prevalence and correlates of HIV risk among men receiving treatment for substance abuse in India. Consecutive inpatients from the major substance abuse hospital in southern India were screened using a structured interview and standardized measures to obtain demographic, psychiatric, sexual behavior, and substance use data at the time of admission. Seventy-seven percent of the 352 men who were screened reported that they were sexually active during the past year, and 13% reported that they had engaged in sexual practices associated with greater risk. The most common risk practices in the past year included having multiple sexual partners (7%), paying for sex (5%), and having unprotected anal sex (4%). Engaging in risky sexual practices was associated with the presence of a co-occurring psychiatric disorder and higher scores on a drug abuse screening measure. Assessing HIV risk in substance abuse settings can help to identify patients who may benefit from HIV-risk reduction programs.

Adult↗
PubMed2003

HIV risk behaviour among psychiatric inpatients: results from a hospital-wide screening study in southern India.

The study was carried out to investigate the prevalence and correlates of sexual risk behaviour among psychiatric inpatients in India. Consecutive inpatients (n = 618) were assessed using a structured interview and standardized measures. Women were more likely to be sexually active (50%) than men (36%), but equally likely (6% vs 5%) to engage in risky behaviour. Common risk behaviours included having a risky partner, having multiple partners, and exchanging money for sex. Being sexually active was associated with younger age, being married, being diagnosed with a disorder other than schizophrenia, and a history of drug use problems. Engaging in risky sexual behaviour was associated with being male, using tobacco and screening positive for either drug use or alcohol problems. Screening psychiatric patients for HIV risk behaviour can identify those who may benefit from risk reduction programmes.

Adolescent↗
PubMed2003

A cry from the darkness: women with severe mental illness in India reveal their experiences with sexual coercion.

THIS STUDY used qualitative research methods to investigate the problem of sexual coercion among female psychiatric patients in India. Consecutive female admissions (n = 146) to the inpatient unit of a psychiatric hospital in southern India were screened regarding coercive sexual experiences. Women who reported coercion (n = 50; 34%) participated in a semi-structured interview to learn more about their experiences. Among these women, 24 (48%) reported that the perpetrator was their spouse, 13 (26%) identified a friend or acquaintance, and 10 (20%) identified a relative such as an uncle or cousin. Most experiences occurred in the women's homes. Thirty of the 50 coerced women (60%) reported that they had not disclosed their experience to anyone, and that they had not sought help. Women revealed a sense of helplessness, fear, and secrecy related to their experiences. The problem of sexual coercion is seldom addressed in mental health care in India; the prevalence and severity of such experiences warrant immediate clinical attention and continued research.

Adolescent↗
PubMed2003

Psychometric evaluation of the alcohol use disorders identification test and short drug abuse screening test with psychiatric patients in India.

BACKGROUND: The Alcohol Use Disorders Identification Test (AUDIT) and the short Drug Abuse Screening Test (DAST-10) are brief self-report screens for alcohol and drug problems that have not been evaluated for use with psychiatric patients in developing countries. This study was designed to evaluate the factor structure, reliability, validity, and utility of the AUDIT and the DAST-10 in an Indian psychiatric hospital. METHOD: Consecutive inpatient admissions from April to December 2001 were sampled. Patients were diagnosed with substance use disorders or psychiatric disorders according to ICD-10 criteria. All patients completed both the AUDIT and the DAST-10 during their intake evaluation. RESULTS: Of the 2286 admissions to the hospital, 1349 were enrolled in the study (30% women); 361 patients (27%) had primary substance use disorders and 988 patients (73%) had primary psychiatric disorders. Both the AUDIT and the DAST-10 were unidimensional and internally consistent. Total scores significantly differentiated the subsamples with primary substance use from those with primary psychiatric disorders (p <.0001). Using cutoff scores of >/= 8 on the AUDIT and >/= 3 on the DAST-10, only 10% (N = 100) of the psychiatric subsample exceeded either cutoff, whereas 99% (N = 358) of the addiction treatment subsample exceeded 1 or both cutoffs. Within the psychiatric subsample, 77% (N = 65) of the patients who were identified as high risk on the AUDIT did not receive an additional alcohol use disorder diagnosis at discharge, and 59% (N = 16) of those identified as high risk on the DAST-10 did not receive an additional discharge diagnosis of drug use disorder. CONCLUSION: The AUDIT and the DAST-10 demonstrate strong psychometric properties when used in an Indian psychiatric hospital. Routine use of these brief screens can facilitate detection of substance use disorders among psychiatric patients.

Adult↗