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      A cross-sectional comparative study on the assessment of quality of life in psychiatric patients under remission treated with monotherapy and polypharmacy

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          Abstract

          Context:

          The concept of quality of life (QoL) is becoming an important measure of the impact of psychiatric disorders. It is natural that once patient achieves remission, QoL would improve, but very few studies are conducted under this phase. This study compares the differences in QoL in remitted patients with monotherapy and polypharmacy.

          Aims:

          The aim of this study is to compare the QoL between psychiatric patients in remission treated with monotherapy and polypharmacy.

          Settings and Design:

          It is a questionnaire based cross-sectional comparative study.

          Materials and Methods:

          This study included outpatients under remission who come for follow-up in psychiatric department. Semi-structured data collection form was used. Remission was confirmed using suitable scales, and QoL was assessed using the World Health Organization quality of life-Brief (WHOQOL-BREF) scale. Clinical Global Impression (CGI) and Global Assessment of Functioning (GAF) were applied to understand the overall improvement and functioning levels.

          Results:

          Out of the total 100 patients enrolled in the study, fifty patients were on monotherapy and fifty patients on polypharmacy. The cost of medication was comparatively high for polypharmacy (Rs. 3568.92 [±348.54]) than monotherapy (Rs. 1936.56 [±252.07]). The QoL in physical, psychological, and social domains was significantly high in patients on polypharmacy rather than monotherapy when assessed using the WHOQOL-BREF scale. Ninety-six percent of monotherapy patients had CGI scores between 1.5 and 2.4 while 74% of polypharmacy patients had scores between 1.0 and 1.5. Ninety-six percent of monotherapy patients had <80 GAF scores while 92% of polypharmacy patients had >80.

          Conclusions:

          Patients treated with polypharmacy had better QoL and also clinical improvement and functioning levels were superior.

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          Most cited references 30

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          A new depression scale designed to be sensitive to change.

          The construction of a depression rating scale designed to be particularly sensitive to treatment effects is described. Ratings of 54 English and 52 Swedish patients on a 65 item comprehensive psychopathology scale were used to identify the 17 most commonly occurring symptoms in primary depressive illness in the combined sample. Ratings on these 17 items for 64 patients participating in studies of four different antidepressant drugs were used to create a depression scale consisting of the 10 items which showed the largest changes with treatment and the highest correlation to overall change. The inner-rater reliability of the new depression scale was high. Scores on the scale correlated significantly with scores on a standard rating scale for depression, the Hamilton Rating Scale (HRS), indicating its validity as a general severity estimate. Its capacity to differentiate between responders and non-responders to antidepressant treatment was better than the HRS, indicating greater sensitivity to change. The practical and ethical implications in terms of smaller sample sizes in clinical trials are discussed.
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            A rating scale for mania: reliability, validity and sensitivity.

            An eleven item clinician-administered Mania Rating Scale (MRS) is introduced, and its reliability, validity and sensitivity are examined. There was a high correlation between the scores of two independent clinicians on both the total score (0.93) and the individual item scores (0.66 to 0.92). The MRS score correlated highly with an independent global rating, and with scores of two other mania rating scales administered concurrently. The score also correlated with the number of days of subsequent stay in hospital. It was able to differentiate statistically patients before and after two weeks of treatment and to distinguish levels of severity based on the global rating.
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              The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability.

              The Yale-Brown Obsessive Compulsive Scale was designed to remedy the problems of existing rating scales by providing a specific measure of the severity of symptoms of obsessive-compulsive disorder that is not influenced by the type of obsessions or compulsions present. The scale is a clinician-rated, 10-item scale, each item rated from 0 (no symptoms) to 4 (extreme symptoms) (total range, 0 to 40), with separate subtotals for severity of obsessions and compulsions. In a study involving four raters and 40 patients with obsessive-compulsive disorder at various stages of treatment, interrater reliability for the total Yale-Brown Scale score and each of the 10 individual items was excellent, with a high degree of internal consistency among all item scores demonstrated with Cronbach's alpha coefficient. Based on pretreatment assessment of 42 patients with obsessive-compulsive disorder, each item was frequently endorsed and measured across a range of severity. These findings suggest that the Yale-Brown Scale is a reliable instrument for measuring the severity of illness in patients with obsessive-compulsive disorder with a range of severity and types of obsessive-compulsive symptoms.
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                Author and article information

                Journal
                Indian J Psychiatry
                Indian J Psychiatry
                IJPsy
                Indian Journal of Psychiatry
                Medknow Publications & Media Pvt Ltd (India )
                0019-5545
                1998-3794
                Jul-Sep 2017
                : 59
                : 3
                : 333-340
                Affiliations
                Departments of Pharmacy Practice, SJMCP, Chitradurga, Karnataka, India
                [1 ]Department of Psychiatry, BMCH and RC, Chitradurga, Karnataka, India
                Author notes
                Address for correspondence: Dr. Benson Koshy, Methundil House, Yeroor P.O Kollam- 691 312, Kerala, India. E-mail: benzkoshy@ 123456gmail.com
                Article
                IJPsy-59-333
                10.4103/psychiatry.IndianJPsychiatry_126_16
                5659084
                Copyright: © 2017 Indian Journal of Psychiatry

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                Categories
                Original Article

                Clinical Psychology & Psychiatry

                quality of life, remission, psychiatry, monotherapy, polypharmacy

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