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Comparison of Prevalence of Psychiatric Disorders Among the Adult Population in Bangladesh, Before and During the COVID-19 Lockdown
- Rifat Binte Radwan, Chiro Islam Mallik, Grace Pike
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, p. S68
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Aims
The aims were to determine and compare the prevalence of possible psychiatric disorders among Bangladeshi adults before and during lockdown. It was hypothesized that prevalence of possible psychiatric disorders would increase during the lockdown. In Bangladesh, lockdown was implemented in response to the COVID-19 pandemic resulting in conditions where those prone to developing psychiatric disorders were more vulnerable in an environment where the mental healthcare infrastructure is already lacking. Although many studies outlined the devastating impact on mental health that the lockdown measures created, this unique study specifically uses a World Health Organization developed research instrument for a lower-middle-income country.
MethodsThis was a cross-sectional, descriptive, comparative study with one stage design to determine possible psychiatric cases. Initially, 603 adults were randomly contacted using Facebook messenger & groups and email. Questionnaires including the validated Self Reporting Questionnaire (SRQ)-20 in Bangla, for screening psychopathology of the cases, and a structured questionnaire containing socio-demographic and other related variables, were inputted into Google Forms and hyperlinks were distributed. Eventually, 570 participants, from 18 to 77 years, with Internet access, who completed the questionnaires, were included in the study through purposive and consecutive sampling. The SRQ variables were divided into four categories: (1) depressive/anxious; (2) somatic symptoms; (3) reduced vital energy; and (4) depressive thoughts. Using IBM SPSS Statistics, paired sample t-tests were used during data analysis.
ResultsThe mean age of cases was 34.69 ± 13.02 years; male: female = 1.41:1. The prevalence of possible psychiatric disorders was 43.9% during lockdown compared to 23.3% before lockdown (t = 19.497, P = 0.000). Before lockdown, sex and employment status were significant factors for the SRQ positive cases. After lockdown, in the SRQ positive cases, sex, educational status, COVID-19 positive cases and death due to COVID-19 among family members were highly significant (p = 0.0001) factors. Somatic symptoms and depressive thoughts were approximately double in prevalence among the SRQ positive cases during lockdown compared to before lockdown.
ConclusionThere was a significant impact on mental health where a reduction in psychological and socioeconomic support occurred. These findings are in line with those in the literature where somatic symptoms have been identified as most commonly experienced during the pandemic. Increased depressive thoughts are associated with increased feelings of possible impending death and fear of an uncertain situation. Clearly, the mental health infrastructure of Bangladesh is in even greater need of rapid change to ensure resilience to the survivors of the lockdown.
Amblyopia: An Uncommon Presentation of Paediatric Conversion Disorder
- Chiro Islam Mallik, Mohammad Sayadul Islam Mullick
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, p. S121
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Aims
Conversion disorder is common among children and adolescents, particularly in non-Western societies like in Bangladesh. Diverse presentation of the disorder makes it difficult to diagnose which ultimately may lead to poor prognosis.
MethodsPatient X is a 10-year-old girl, a 5th grade student, hailing from a District town, Bangladesh, attending child and adolescent consultation services with the complaint of sudden loss of vision in both eyes for 3 weeks. Earlier, she underwent thorough examination and investigation and intervention by the different specialists (GP, ophthalmologist, and neurologist). At one point she was given zero power glasses. Her symptom was then fluctuating. She was not attending school as she was away for treatment purposes. X complained of not seeing lines of books when her parents tried to persuade her to do schoolwork at home. Eventually she was referred for psychiatric evaluation after no improvement. Assessment was completed and parental discord, violent act of father towards mother, overprotective as well as inconsistent parenting, attention seeking behaviour of X were identified. General and systemic examinations were normal. Her finding was inconsistent with any physical disorder. Investigation was normal. Thus, diagnosis of conversion disorder was given. General treatment (reassurance, psychoeducation, adopting daily life programme) along with specific treatment (symptom reduction by suggestion, relaxation, and family therapy) were provided. Improvement was noted during the follow-ups.
ResultsThe conversion disorder of this girl happened at her period of transition from childhood to adolescence. Psychopathology of hysteria still is not clear despite huge research efforts. Based on psychodynamic explanations, the core psychopathologies of her symptoms are primary gain - resolution of her witnessing severe parental discord that she failed to cope with happened through her presenting symptoms without awareness though later she does in awareness; secondary gain- she receives additional reinforcement in the form of extra care, parental help seeking behaviour, unnecessary interventions, demand fulfilment that mostly present in awareness. Other psychopathologies are conversion- the patient's psychological distress converted to presenting somatic symptoms through an intrapsychic process; repression-la belle indifference of the patient has developed through a process of displacing distressful experience, from awareness that gives relief to the distress.
ConclusionManifestations of conversion disorder can simply be explained as cry for help, give indication of the problem areas, help in understanding personality traits, making intervention and prevention plans. Early identification of stressors is crucial for the treatment of this disorder.
Psychiatric comorbidities with autism spectrum disorder in an adult clinic sample
- Rifat Binte Radwan, Chiro Islam Mallik
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S239
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As part of continuity, prevalence of Autism Spectrum Disorder (ASD) is nearly the same in adults as children and is associated with other comorbid psychiatric disorders that have substantial impact on their life and complex the intervention. This study aimed to examine psychiatric comorbidity in referred adult ASD patients compared to non-ASD psychiatric patients. It has been hypothesized that comorbid psychiatric disorders were higher among patients with ASD than patients without ASD.
MethodIn total, 36 adults with ASD referred in the year 2019 in a psychiatric consultation center in Dhaka city were included in the study. They were derived from the case register of the center. Similar number of age and sex-matched adult psychiatric patients without ASD were selected for comparison. All patients were referred for psychiatric consultation. Socio-demographic variables were collected from the patients’ record. Diagnosis of psychiatric disorders including ASD was made by an experienced psychiatrist. It was done clinically based on all available information, examination and relevant investigations. Diagnoses were assigned according to DSM-5. Then comparisons of psychiatric disorders were made between the two patient groups.
ResultThe cases were ranged from 18-41 years with the mean of 26.72 ± 6.5 years. Among them, 22 were male and 14 were female. Male-female ratio was 1.6:1. Most of the subjects received no education and were from middle income family with urban background. Mean number of comorbid psychiatric disorders was 1.92 in patients with ASD and 1.67 in patients without ASD and the difference was significant (P = 0.04). Most two frequent comorbidities among ASD patients were Obsessive Compulsive Disorder (27.77%) and Major Depressive Disorder(25%) followed by Specific Phobia(19.44%), Social Phobia and Intermittent Explosive Disorder(16.67%) for each, Attention Deficit Hyperactivity Disorder(13.89%) and Conduct Disorder(11.11%). All these disorders were significantly higher than patients without ASD. Conversely, Major Depressive Disorder (30.55%) was most frequent among the patients without ASD and that was even significantly higher than patients with ASD. Other frequent disorders like Bipolar Disorder, Schizophrenia, Generalized Anxiety Disorder and Substance Related Disorder were also higher among non-ASD patients.
ConclusionThis research shows that comorbid psychiatric disorders were frequently found in patients with ASD. Subsequent broad-based studies using extensive measures of psychopathology are required to confirm these preliminary findings. Greater understanding of the presence of other psychiatric disorders in ASD patients will turn this awareness into action.