Psychiatric morbidity among caregivers of schizophrenia&bipolar disorder and its correlates

Dr.Naresh Ninama
(3rd yr resident) Dr.Mehul Brahmbhatt Associate Professor

Introduction
The family constitute the major support system in the community care of the chronic mentally ill patient,although many family show tremendous resilience in caring for an ill relative,theire share of physical and emotional distress can not be ignored(Thara et al.,1998)Thus families are recognised as critical parteners in care of mentally ill in this era of deinstitutionalisation which can be much recognised the fact that nearly 60% of patient having major mental illness return back to live with relatives(Macmillan et al.,1986)in west,while in india most patient are cared by immediates and extended families Care taking many a times appear to be rewarding and satisfying for a caregiver.However this care giving does became hazardous if patient is suffering from chronic mental illness.which results in increase psychological distress in caregivers. PRIMARY CAREGIVER:pollak and perlick(1991)had established the method to identify primary caregiver according to this method primary caregiver is defined as a family member,friend or significant other who satisfied greatest number (>=3) of the following criteria Spouse,parent or spouse equivalent Has the most frequent contact with the patient Helps to support patient financially Has been most frequent collateral participant in patients treatment Is the person contacted by treatment staff in case of emergency

Aims and objectives

To find out the psychiatric morbidity among caregivers of severe mental disorder(here schizophrenia and bipolar disorder) To find out correlates of this morbidity like duration of illness,demographic characteristics,knowledge etc. To compare the psychiatric morbidity among caregivers of schizophrenia and bipolar disorder patients.

Materials and methods

Fifty consecutive patients and theire cxaregiver,each of schizophrenia and bipolar I disorder,manic episode diagnosed according to DSM IV (APA ,1994)criteria, attending psychiatric department civil hospital,ahmedabad formed the sample of this study Inclusion criteria: presence of primary caregivers attending hospital psychiatric diagnosis of either schizophrenia and bipolar iI mood disorder according to DSM IV criteria Exclusion criteria: Nonavailability of caregiver Bipolar I disorder most recent depress and mixed episode. Instruments: primary caregivers of schizophrenia and bipolar disorder DSM IV TR interviewed in detail by using General Health Questionnare- 28 assess for psychiatric morbidity General Health Questionnaire(GHQ-28) (Goldberg and Hillier 1979): This scale is used to detect psychiatric illness,scaled version of 28 item was developed by Gol

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patient Sex Male female Age in years Range Mean Age (years) <20 21-39 >40 Duration of illness Mean duration Comorbidity Tobacco use Schizophrenia N=50(%) N% 32(64) 18(36) Bipolar N=50(%) N% 36(72) 14(28) Test of Significance P=0.39NS

17-70 33.9
5(10) 33(66) 12(24) 8.7

16-80 32.1
11(22) 25(50) 14(28) 6.5

T=0.69 P=0.24NS

P=0.17NS

2-45years

2-30years

T=1.39 P=0.08 P=0.12NS

7(14)

17(34)

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Depressive symptoms in schizophrenia and bipolar caregivers

Depressive symptoms Worthlesness Hopelesnes Helplesnes Death wish Suicidal ideation Schizophrenia % 40 40 30 34 24 Bipolar% 48 60 60 60 58

Result and Discussion

In this study psychiatric morbidity measured with help of mean GHQ scorein caregivers of schizophrenia and bipolar disorder GHQ score of 5 or more in caregivers indicates psychiatric morbidity in caregivers.caregivers of both groups reports increase psychiatric morbidity with 84%of bipolar caregivers and 78% of schizophrenia caregivers had score of 5 or more. Numbers of studies indicate that 30-60% carers suffer significant distress as measured by General Health Questionnaire as reported by wienfield et al.,(1993)and MacGillowy et al.,(1997).caregivers of bipolar disorder patients had satisfactorily significant increased distress as compare to caregivers of schizophrenia which suggest that ,in this study manic symptoms were found to be mmore distressing than psychotic symtoms for caregivers.