Indian Journal of Community Medicine
31,
No. 1 (2006-01 - 2006-03)
Hospital Based Study on Psychoses in
Mangalore
A. Barua, H. Shankar, A. Jain, V.K. Bhat, N. U. Kiran, S. Jayarama
Department of Community Medicine, Kasturba Medical College, Mangalore
Introduction
Schizophrenia and related psychoses are
severe mental disorders, which usually start in
adolescence or early adult life, and often
become chronic and disabling. They are
considered a major public health problem in
many parts of the world, representing a heavy
burden both for the families of affected
individuals as well as national health systems.
These are group of chronic debilitating
psychiatric illness, characterized by loss of
touch with reality and disorders of thought,
behavior, appearance and speech1.
While psychiatric disorders in total have a
worldwide prevalence of 32.5%, schizophrenia
has a prevalence of 1.5% (worldwide). The
prevalence of schizophrenia in India is about
1%, this may be due to diagnostic drawbacks
rather than decreased number of cases2. The
etiological factors involved in the pathogenesis
of the disease include genetic predisposition
(60% concordance rates in monozygotic twins),
family environment (presence of stressors and
disease among other family members), viral
infection (inconclusive proof), cerebral
infections and neurotransmitter disturbances2-4.
This study was conducted with on objective to
study the socio-demographic characteristics of
the patients suffering from schizophrenia and
related psychoses in a Mangalore hospital.
Material and Methods
Vol.
Kasturba Medical College Hospital, Attavar is a
tertiary care level private institute, situated at
the centre of port town of Mangalore in
Dakshina Kannada District of Karnataka state in
India. The migratory population from Tamil
Nadu and Kerala also often utilize the health
care facilities of this hospital. This is a
Retrospective study design based on Case
Series Analysis. All in-patients admitted to
Department of Psychiatry during March 1999
and December 2000, constituted a sample size
of 98.
Data was collected by using a structured
proforma after scrutinizing from case files from
Medical Records Department. The data
collected was tabulated and analyzed using the
statistical package of SPSS (Statistical Package
for Social Sciences) Version 7.5.
Results and Discussion
None of the patients were found to be below 16
yrs. of age. Majority (85.7%) were in the age of
16-55 years. This observation is in concordance
with the figures quoted by others, who
observed in their studies that 90% of
schizophrenics belonged to the age group of 15
and 54 years3,4. Incidence of schizophrenia
was highest for men between 15 and 24 years
and for women the peak appeared between 25
and 34 years3,4. We also observed that females
were more affected than males (65.4%) in the
age group of 16-25 years and more than 65
years (83.3%). The distribution of cases
remained almost equal for both sexes in other
age groups.
Majority of the patients were Hindus (68.4%).
Most of them (85.7%) hailed from Karnataka.
14.3% came from Kerala for treatments of their
mental disorders. 58.2% individuals were
married and majority were females (57.4%).
Among female patients, 24.1% were unmarried
and only 12.2% were either widow, separated
or divorced.
More than half (53.0%) of the unemployed and
housewives were affected with schizophrenia
and related psychoses. Among the unemployed
group, 10.2% were students. Occupational
status remained unknown in 14.3% cases. We
observed that mental illnesses were common
in working class of society (32.7%).
In this study, only 16.3% patients belonged to
below poverty level. But since this hospital was
a tertiary care level private Institute, majority
of the in-patients were above poverty level and
could afford the treatment cost. While majority
(88.8%) of the patients were literates, but the
illiterates and those with lower level of
education, together constituted 50.0% of these
cases. It is a well-documented fact that
schizophrenia is more prevalent among the
lower socio-economic classes and in people
with low level of education3.
Majority, 58.2% of the patients were living with
their spouse, 31.6% living only with their
children and relatives and only 10.2% were
living alone. In 85.7% of cases, one of the 1st
degree relatives in the family had suffered from
some confirmed psychiatric illness in the past
among a total of 21.4% patients who gave a
positive family history of psychiatric illness.
Only 5.1% patients had a positive family
history of suicide or suicidal attempts. 11.2% of
schizophrenics in our study had made an
attempt at suicide. The risk of suicide in
individuals with schizophrenia has been
reported to range from (2-13)%3. Among the
stressors, marital disturbances were a
precipitating factor for 23.5% cases of
schizophrenia and related psychoses. This was
found to be the most important stressor in this
study. History of death in the family within the
last 12 months was positive in 17.3% cases.
Family disputes accounted for 15.3% and
Personal problems, including intra and
interpersonal conflicts acted as a precipitating
factor for in 9.2% of the cases. Here, on patient
was subjected to more than one stressor. No
specific references are given to numbers but
importance is given to family environment
marital disturbances and problems in
professional life as possible stressors for
schizophrenia3,4.
References
1.Braff L. Schizophrenic Disorders. In: Anthony
et. al. (editors) Harrison’s Principles of Internal
Medicine. New Delhi: McGraw Hill; 1998; P.
2415.
2.Carpenter WT, Buchana RW. Schizophrenia
Introduction and Overview. In: Kaplan Hl,
Sadock BJ (editors). Comprehensive Text Book
of Psychiatry. Philadelphia: Williams & Wilkins;
1995; 889-90.
3.Africa B, Schwartz RS. Schizophrenic
Disorders. In: Howard H Goldman (editor).
Review of General Psychiatry. New York
Appleton & Lange; 1995, 22.
4.Kasyc M, Norquist GS. Schizophrenia-
Epidemiology, In: Kaplan Hl,Sadock BJ, editors.
Comprehensive Text Book of Psychiatry.
Philadelphia: Williams & Wilkins: 1995; P. 908.