Effect of Alcohol Dependency on Spouse

Effect of alcohol Dependency on Spousepsychiatric illnesses argon increasingly known to be common in the recent decades and affects oer 25% of people at some point in a adults at any point in time, and at to the lowest degree one affected individual living in one every(prenominal) four families(1).Alcohol dependence syndrome is the maladaptive patters of alcohol intake with whollyowance craving, loss of control, and withdrawal symptoms (3).Bipolar affective pain is episodic in nature with manic or hypomanic or depressive or mixed symptoms occur. Patients divulge fluctuating sourness of any of these symptoms interspersed with a symptom free (euthymics 2) or subsyndromal periods.Cwvently the prevalence of bipolar affective disorder (BPAD) is around 0.4-0.5%with an 1 family prevalence of 0.5to 1.4% and a carriage-time prevalence of about 2.6 to 7.8% (4).The life-time prevalence of bipolar disorder is about 20.8 per 1000 population in India (6 ) and that of alcohol use ranges from 1.15% to upto 50% in general (8, 9).Burden Definition (10) PlattStigmatization, chronic emotional and economic magnetic core from caring are endured by the families of individuals with psychiatric illness. The illness encroachmention on the primary caregivers leisure time activities cast and social relationships. These deficits evoke different chemical reactions infifferent or expressed emotional reaction towards the patients, and a sense of insufficiency and help littleness in themselves, all of which impact on the progression and prognosis of the patients illness (1). requireTo compare the family effect, the quality of life and psychiatric morbidity between female spouses of patients with alcohol dependence syndrome, patients with schizophrenia, and patients with bipolar affective disorderOBJECTIVESTo find the family buck and quality of life in female spouses of patients with alcohol dependence, schizophrenia and bipolar affective disorderTo evaluate the prevalence o f psychiatric morbidity in female spouses of patients of these three aggroupsTo study the association between symptom clumsiness in patients, perceived apathy, world-shattering life events and family weight down, and the quality of life and psychiatric morbidity in female spouses in these groupsTo compare psychiatric morbidity, family effect of care and quality of life in female spouses between all patient groups.MATERIALS AND METHODSThe sample is drawn from male patients with female spouses attending the outpatient psychiatry department at this hospital.DesignCross partal, comparative study, including 64 patients with alcohol dependence, 64 patients with schizophrenia, and 64 patients with bipolar affective disorder, and their female spouses.With consecutive sampling from Outpatient department, a total of 192 patients with their spouses are taken up for the study.Duration and period of Study- 4 monthsInclusion criteriamale patients with equal to or more than than 10 grade d uration of alcohol dependence or schizophrenia or bipolar affective disorder, satisfying the criteria for the corresponding DSM IV-TR diagnosespatients with onset of psychiatric symptoms/disorder aft(prenominal) marriagefemale spouses who provide care for the patientsparticipa nts should be not less than 60 years of ageparticipants to be willing to provide sure consent for the interview and discernmentpatients willing to allow spouse to be assessedExclusion criteriathose who did not give their consentrefusal to allow spouse to be evaluatedpatients and/or their spouses with any chronic general medical illnessspouses with a history of substance abuse, suicide or previous history of psychiatric symptoms and interventionspouses with a family history of psychiatric illnessspouses associate to the patients by consanguinityInstruments used A semistructured profoma to collect the sociodemographic details, family history details and a semistructured clinical profileInternational Classifi cation of Diseases ICD-10Shortform Alcohol dependance entropy Questionnaire SADDQClinical Global Impressions CGI-BP bipolar andCGI-SCH schizophrenia, severeness dental platesPresumptive stressful life events baptistry PSLESApathy inventory caregiver versionBurden sagaciousness Scale BASCaregiver Reaction Assessment -Selfesteem, High life-esteem -positive caregiving, Burnout -Negative Caregiving subscales CRASH-BOUNCE chronicleWHO fiber Of Life WHOQOL BREF-1General Health Questionnaire command post-12MINI plus 5.0.0 v miniskirt International Neuropsychiatric Interview plusBeck Depression Inventory BDI infirmary Anxiety and Depression Scale anxiety HADS-ACGI-BPBipolar disorder is a cyclic and polymorphic distemper. Patients whitethorn show manic, hipomanic, depressive or mixed symptoms, and they may be in partial or complete remission. For this reason, the assessment of the course, severity and takings of the disorder is very complex. Most of the available psychometric t ools pass water been designed for the assessment of acute episodes of specific polarity.The CGI-BP-M, a user-friendly scale for the assessment of manic, hypomanic, depressive or mixed symptoms, and long-term outcome of bipolar disorder, is a useful tool for the assessment of the efficacy of several treatments.CGI-SAmongst the nigh widely used of extant brief assessmenttools in psychiatry, the CGI is a 3-item observer-ratedscale that measures illness severity (CGIS), global receipts or change (CGIC) and healing(predicate) response.The illness severity and improvement sections of theinstrument are used more frequently than the therapeuticresponse section in both clinical and research settings.Amongst the most widely used of extant brief assessmenttools in psychiatry, the CGI is a 3-item observer-ratedscale that measures illness severity (CGIS), globalimprovement or change (CGIC) and therapeutic response.The illness severity and improvement sections of theinstrument are used more f requently than the therapeuticresponse section in both clinical and research settings.Burden Assessment entry (BAS) (104) ANNEXURE IVIt is an instrument to assess burden on caregivers of chronic mentally ill. It was substantial to assess subjective burden in Indian population, as many a(prenominal) of the burden assessment instruments developed in the west were not culturally suited to Indian population.This schedule has 40 items and 9 domains. The different domains are Spouse related, Physical and mental health, External support, Caregivers routine, Support of patient, Taking responsibility, former(a) relations, Patients, Patients behaviour and Caregivers strategy.Each of these 40 items was rated on a 3-point scale tag 1-3. The responses were not at all, to some extent and very much. Depending on the questions were framed, the responses and the score for each of those responses would vary.In this study the schedule was modified by written text 40- items into the above 9 domain s. Total score of each domain was metrical separately and at the end the total burden was calculated. This was done to lay down the domain score apart from the total score. In the spouse was replaced with every son, daughter, brother, sister, mother or father, depending of the patient to the caregiver. In the items 2 and 4, the word internal and marital was replaced by family as and when needed.The minimum total score of burden in BAS is 40 and the maximum score in 120. In this the severity of burden was categorized into 4 groups, in the following way,40-60 Minimum burden61-80 Moderate burden81-100 Severe burden101-120 Very severs burden mannerConsecutive patients attending the Psychiatry OPDs of hospitals attached to J.J.M. Medical College, diagnosed as BPAD and Alcohol dependence according to DSM IV criteria who met the inclusion criteria and did not get excluded were include in the study.Written informed consent was taken from the patients or from the caregivers depending on t heir ability to give consent, following an explanation about the nature and the pattern of the study in the language in which the patient could understand. Sociodemographic details were save on the self designed proforma.The primary family care-giver was one who met at least three of the following criteria (108).Is a spouse, parent or spouse equivalent.Has the most frequent contact with the patient.Helps to support the patients financially.Has most frequently been collateral in the patients treatment.Is contacted by treatment staff in case of emergency.Burden Assessment Scale (BAS) was administered to assess the burden on caregivers of BPAD group and ADS group. Severity of alcohol dependence was assessed using Short Alcohol Dependence Data (SADD) Questionnaire.GHQValidityDiscriminative validityThere was a non-significant trend in GHQ Total gain ground and Depression subscales gain to be higher for carers using Admiral Nurse (AN) teams vs. carers who did not(Woods et al., 2003). O n follow-up, a significant difference was set in motion on the Anxietyand Insomnia subscale, where outcome was better for the AN group. Another studyshowed that carers of dementia patients showed higher levels of distress as measuredby GHQ than carers for patients with depression (Rosenvinge et al., 1998).Furthermore, significant differences in GHQ scores have been be between carersof people with anorexia and psychosis (Treasure et al., 2001). GHQ scores have alsobeen found to differ in carers of people with a head injury according to different timeintervals post-injury. The GHQ scores were higher for carers of people with a recenthead injury, which indicates greater burden in this group ( drum sander et al., 1997).Predictive validityCoping style has been found to contri bute significantly to GHQ score variance, withemotion-focused coping being related to GHQ scores in a study by Sander et al.,(1997). Furthermore, coping accounted for more of the GHQ variance than disabilityscore s.Socio-demographic variablesGender has been found to have a significant effect on GHQ scores, but neither racenor relationship to the injured person had a significant effect (Sander et al., 1997).Dimension-specific variablesStrong positive correlations were found between the GHQ and the Relatives tenorScale (Draper et al., 1992).ResponsivenessThe GHQ-28 has been shown to be responsive to change in a study using cognitivebehavioural therapy in carers of Parkinsons disease patients. Both the Total score andthe scores for 3 of the sub-scales decreased in response to the intervention (Secker andBrown 2005). Both conventional and AN services take to lower GHQ scores overalland 2 of the 4 subscales over an 8-month period (Woods et al., 2003).