RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES, KARNATAKA

Annexure-1

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

Name of the candidate
Address / Dr Arudhra Gopalakrishnan
Gardenia 003, Golden blossoms,
Kadugodi Main Road
Bangalore 67.
Name of the institution / MVJMedicalCollege & ResearchHospital
Course of study and subject / MD PSYCHIATRY
Date of admission to course / May 2010
Title of the topic / A STUDY OF CAREGIVERS’ BURDENAMONG PATIENTS USING PSYCHIATRIC SERVICES IN A RURAL GENERALHOSPITAL.
6 / Brief resume of the intended work:
6.1NEED FOR THE STUDY:
“Burden of care” is defined as “the presence of problems, difficulties or adverse events which affect the life (lives) of the psychiatric patients’ significant others (e.g. Members of the household and/or the family)(1) . Burden of care has two components namely subjective and objective burden as proposed by Hoenig and Hamilton(2)
Objective burden includes measurable effects such as economic burden, caregivers’ loss of work, social and leisure activities, household disruptions such as child care, restrictions on relationships within and outside the family etc.
Subjective burden is mainly thepsychological sufferings of the caregivers themselves and is experienced by them such as depression, hatred, uncertainty, guilt, shame, embarrassment etc.
In India, families remain the major ingredient in determining better outcome measures such as ensuring patient compliance, fewer relapses, better acceptance and integration within the family and within the community at large. Positive care giving appraisals equate with better outcomes and vice versa.
Unlike the West, familyis the key resource in the care of patients with psychiatric illness. Families assume the role of primary care giver for a few reasons. First, it is because of the Indian tradition of interdependence and concern for the near and dear in adversities. Owing to dearth of mental health professionals and the poor infrastructure to provide “community care” in India, more emphasis is placed on the family’s role in the care of the patient.Thus having an adequate family support is the need of not only the patient but the clinicians and health administrators.(1) Thus it becomes very important to address care giver needs to ensure adequate family support especially in the Indian context.
This study is based on the fact that different psychiatric illnesses have varied impact on the caregiver burden. The findings of this study will help us in better management of patients and efficient redressal of caregivers’ burden in a rural context.
6.2REVIEW OF LITERATURE:
Review of available literature shows that there is significant burden among caregivers of patients with different psychiatric illnesses.
Recently, Dr Ajit Avasthi in his presidential address to the Indian Psychiatric Society (IPS) has outlined the importance of caregiver burden and family as a potent therapeutic force in the outcome of psychiatric illness with specific reference to India.
In a prospective study done in USA on care givers of patients with bipolar disorder, it was found that episodes of depression in the patient were associated with greater degree of subjective and objective stress among the care givers.(3)
In an unpublished thesis by Kiran CN submitted to Post Graduate Institute (PGIMER), Chandigarh on burden and coping in caregivers of patients with alcohol and opioid dependence, it has been found that the caregiver burden is comparable to that in schizophrenia.(4)
Studies in India have shown that the burden of care in schizophrenia iseither similar to or more than that found in chronic physical disorders.(5,6)
6.3OBJECTIVES OF THE STUDY:
To identify significant association between socio demographic characteristics, family background, duration of illness and caregiver burden amongst patients with Mood disorders or Alcohol dependence syndrome attending the psychiatric department at
M V J Medical college and research hospital, Hosakote, Bangalore.
7 / Material and methods
7.1 SOURCE OF DATA:
This is a descriptive cross-sectional study conducted in M V J Medical College and ResearchHospital. This general hospital caters mainly to the rural population from Hosakote and neighboring districts.
7.2 METHOD OF COLLECTION OF DATA(INCLUDING SAMPLING PROCEDURE IF ANY):
For the purpose of the study,caregivers of patients with a diagnosis of mood disorder or alcohol dependence as seeking psychiatric services at MVJ Medical college and Research hospitalwill beincluded in the study. A written informed consent will be taken from the patient and the primary caregivers.
The information obtained will be compiled in a specially designed Proforma. All will
be assessed in detail using standardised structured psychological instruments meant for the study. All patients/caregivers to be enrolled in the study will be discussed with a qualified Psychiatrist in thedepartment.The total number of subjects is to be kept at a minimum of 60 subjects with at least 30 in each group.
SCALES TO BE ADMINISTERED:
  1. Socio demographic proforma
  2. Mini International Neuropsychiatry Interview (MINI)
  3. Burden assessment schedule of SCARF(Schizophrenia Research Foundation )
  4. Clinical Global Impression( CGI) scale to assess severity of illness
STATISTICS:
Statistical analysis of the data will be done on the SPSS (statistical package for social science software). Descriptive statistics and statistical tests such as independent t-testwill be applied to analyse the relationship between burden in caregivers of patients with mood disorder and alcohol dependence and various independent variables.
INCLUSION CRITERIA:
  1. Patients above 16 years of age
  2. Psychiatric illness of at least 6 months duration with a diagnosis of either a mood disorder (F30- F39) or alcohol dependence syndrome( F10) according to ICD-10 criteria
  3. Primary care giver above the age of 18 and who meet at least 3 of the criteria of Perlick and Pollard:
i)Is a parent, spouse or spouse equivalent
ii)Has most frequent contact with the patient
iii)Helps to support the patient financially
iv)Has most frequently been collateral in patients’ treatment
v)Is contacted by treatment staff in case of emergency
  1. All patients/caregivers who give written informed consent.
EXCLUSION CRITERIA:
  1. Patients with mental retardation, pervasive developmental disorder
  2. Patients with organic mental disorder
  3. Patients with other concurrent substance dependence apart from nicotine
  4. Patients/caregivers unwilling to be part of study.
  5. Caregivers with sensory disability such as hearing impairment, blindness
  6. Psychiatric illness in the caregivers prior to the onset of illness in the patient under study
  7. Families with any other member in the family with serious physical and psychiatric illness
7.3 Does the study require any investigation or interventions to be conducted on patients or other humans or animal.
None required
7.4 Has ethical clearance been obtained from your institution in case of 7.3
Yes
8 / LIST OF REFERENCES:
  1. Avasthi A. Preserve and strenghten family to promote mental health. Indian J Psychiarty 2010;52:113-26.
  1. Hoenig J, Hamilton MW. The schizophrenic patient in the community and his effect on the household. Int J Soc Psychiatry 1966;12:165-76.
  1. Ostacher MJ, Neirenberg AA, Isoifescu DV et al. Correlates of subjective and objective burden among caregivers of patients with bipolar disorder. Acta psyhiatr scand 2008:118:49-56.
  1. Kiran CN. Burden and coping in caregivers of men with alcohol and opioid dependence. Unpublished thesis submitted to PGIMER, Chandigarh, 2004.
  1. Gautam S, Nijhawan. Burden on families of schizophrenic and chronic lung disease patients. Indian J Psychiatry 1984; 26:156-59.
  1. Sreeja I, Gupta S, Rakesh L, SinghMB. Comparison of burden between family caregivers of patients having schizophrenia and epilepsy. Internet J Epidemiol 2009; 6:2.

9 / Signature of candidate:
10. / Remarks of the guide:
The caregivers’ burden is the much neglected aspect in the clinical set up. Such a study will draw the attention of the psychiatric team to this aspect. Of the possible primary caregivers, the blood relatives may have a genetic loading in familial psychiatric disorders and will have an added effect in the causation of the illness in the caregivers besides the stress of the burden due to the illness in their wards. Hence a careful study of the burden of the non-consanguineous caregivers like the spouse, daughters-in-law and sons-in-law will give a true picture about the caregivers’ burden.
11. / Name & designation of
11.1 Guide: Dr. K THIAGARAJAN M.D; D.P.M;
PROFESSORHOD;
DEPT.OF PSYCHIATRY,
MVJMEDICALCOLLEGE &RH
BANGALORE.
11.2 Signature:
11.3 Co-guide: Not applicable
11.4 Signature:
11.5 Head of department: Dr. K THIAGARAJAN M.D; D.P.M;
PROFESSORHOD;
DEPT.OF PSYCHIATRY,
MVJMEDICALCOLLEGE &RH
BANGALORE.
11.6 Signature:
12. / 12.1 Remarks of the chairman & principal:
12.2 Signature:

PROFORMA FOR “STUDY OF CAREGIVERS’ BURDEN AMONG PATIENTS USING PSYCHIATRIC SERVICES IN A RURAL GENERALHOSPITAL”

DETAILS OF THE PATIENT:

NAME: DATE OF ASSESSMENT:

ADDRESS: 0P NO:

IP NO:

(In case of in-patients)

PHONE NO:

AGE:

SEX: Male/ Female

AREA: Rural/ Suburban

RELIGION: Hindu/ Muslim/Christian/ Others

OCCUPATION: Unemployed/Student/House wife/Farmer/ Labourer/Business Official/ Retired / if others specify______

PSYCHIATRIC DIAGNOSES(BPAD, Depressive illness, ADS)

DURATION OF ILLNESS:

DETAILS OF CAREGIVERS:

AGE:

SEX: Male/Female

EDUCATION: Illiterate/ Lower primary/Higher primary/ high

school/PUC/Graduate/PG

MARITAL STATUS OF CAREGIVER: Single/Married/ Separated /

Divorced /Widowed/Live in

RELATIONSHIP TO PATIENT:

OCCUPATION: Unemployed/Student/House wife/Farmer/ Labourer/Business Official/ Retired / if others specify______

SOCIO ECONOMIC STATUS: Lower/Middle/Upper

FAMILY: Nuclear/Joint/Extended

ANY KNOWN PHYSICAL ILLNESS IN CAREGIVER:

BURDEN ASSESSMENT SCALE OF SCARF (Schizophrenia Research Foundation) SCORE: ______

Notes to Aru:

  1. Include references for perlick pollared’s criteria
  2. Refrences for OCD Vs Schzo, Fuctional psysh illness burden
  3. Search ofr ADS burden

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