RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,
KARNATAKA
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / NAME OF CANDIDATEAND ADDRESS (IN BLOCK LETTERS) / Dr. ROOPESH GOPAL N.V.
PG IN PSYCHIATRY,
J.J.M. MEDICAL COLLEGE,
DAVANGERE-577004.
2. / NAME OF THE INSTITUTION / J.J.M. MEDICAL COLLEGE
DAVANGERE-577004,
3. / COURSE OF STUDY & SUBJECT / M.D. PSYCHIATRY
4. / DATE OF ADMISSION TO COURSE / 30th May 2009
5. / TITLE OF TOPIC / “DISABILITY AND QUALITY OF LIFE IN OBSESSIVE COMPULSIVE DISORDER AND DYSTHYMIC DISORDER – A COMPARITIVE STUDY”
6. / BRIEF RESUME OF THE INTENDED WORK:
6.1 Need for the study :
Psychiatric illnesses have psychosocial consequences like Disability and impaired Quality Of Life (QOL). Disability and Quality Of Life are interrelated. Severe psychiatric illnesses, like Schizophrenia, Bipolar Affective Disorder (BPAD), Dementia can cause severe disability and impair quality of life due to their symptomatology and chronic course. Non psychotic disorders like Alcohol Dependence Syndrome (ADS) Obsessive Compulsive Disorder (OCD) Dysthymic Disorder, Somatoform Disorder, Anxiety Disorder also can result in disability and impaired quality of life due to their symptomatology and course. Effective treatment and the issue of monetary benefit for the disabled by the Government assumes importance in this context. OCD is the only non psychotic illness for which the
Government Of India sanctions disability benefits. There is paucity of Indian literature in the assessment of disability and quality of life in non psychotic illnesses. Hence the present study is planned to assess quality of life and disability in Obsessive Compulsive Disorder and compare it with another non psychotic illness, Dysthymic Disorder.
6.2 Review of literature:
Disability :
Disability is any restriction or lack of ability (resulting from an impairment) to perform an activity in the manner or within the range considered normal. In the psychiatric context disability refers to a degree of dysfunction or inadequacy in the performance of any number of discreet social roles or functions normally expected in accordance with an individuals age sex and social position. For such a dysfunction or inadequacy to qualify as a disability there must be a demonstrable connection to an underlying impairment due to a mental disorder1.
Psychiatric illnesses result in considerable disability due to their symptomatology and chronic course. Disability is maximum in Schizophrenia and affects all areas of functioning. Dementia also results in significant disability especially in the areas of interpersonal relations and communication. About one third of patients having Major Depressive Disorder (MDD) and Bipolar Affective Disorder have severe disability. Self care and work were the dysfunctional areas in MDD while BPAD affected all areas of functioning2,3.
Non psychotic disorders such as Obsessive Compulsive Disorder, Alcohol Dependence Syndrome, Anxiety Disorders, Dysthymic Disorders also run a chronic course. It is reported that about 16 -17% OCD, ADS and Anxiety Disorders result in significant disability2. However, Olfson et al did not observe any significant disability in OCD4. Because of the conflicting reports, it is interesting to asses the extent of disability in OCD and compare it with another non psychotic illness, Dysthymic disorder.
Quality of life :
According to WHO, Quality of life is an individuals perception of their position in life in the context and value system in which they live and in relation to their goals, expectations, standards and concern5.
Quality of life is impaired in Schizophrenia and in mood disorders such as Major Depression, Dysthymia, Minor Depression and Anxiety Disorders like Generalized Anxiety Disorder, Panic Disorder and Post Traumatic Stress Disorder6,7. Dysthymia per se was associated with lesser impairment of QOL as compared to other mood disorders7. Alcohol Dependence Syndrome is associated with lower levels of quality of life as compared to general population8. OCD as a disorder has marked impact on quality of life in mental health domains (social functioning, role limitation due to emotional problems and mental health.) comparable to depressive disorders3. In OCD severity of obsessions and co morbid depression predict poor QOL9. Indian studies are lacking in this area.
7. / MATERIALS AND METHODS:
7.1 Source of data:
Patients diagnosed as having OCD, Dysthymic Disorder attending psychiatric services at hospitals attached to JJM Medical College, Davangere.
7.2 Method of collection of data (including sampling procedure, if any):
Consecutive patients meeting the DSM-IV-TR criteria for OCD, Dysthymic Disorder will be chosen. Those who meet the inclusion criteria and do not get excluded will be part of study.
Inclusion criteria:
· Age between 18-45 years
· Both sexes
· Duration of illness 2 years.
Exclusion criteria:
· Patients having co morbid Organic Brain Syndromes, Psychosis, Bipolar Affective Disorder, Major Depressive Disorder, Alcohol and Substance dependence, Personality, disorder and Mental Retardation.
· Patients having concomitant chronic physical illness.
· Past history of psychiatric illness.
· Family history of psychiatric illness.
Sample size : Minimum of 30 patients will be taken in each group.
Assessment tools :
· Proforma to assess sociodemographic data
· Prasad’s sociodemographic status scale
· DSM-IV-TR criteria
· Yale Brown Obsessive Compulsive scale
· Hamilton depression rating scale.
· Indian Disability Evaluation and Assessment Scale. (I D E A S)
· The WHO QOL-BREF INSTRUMENT
Patients selected for the above study will be administered the above scales after obtaining informed consent.
The results will be recorded and compared using appropriate statistical methods.
7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly?
No
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Yes
8. / LIST OF REFERENCES:
1) WHO Geneva Lexicon of Psychiatric and Mental Health Terms; 2nd edn., 1994.
2) Chaudhury P K, Deka K, Chetia D. Disability associated with mental disorders. Indian J Psychiatry 2006;95-101.
3) Koran LM, Thienemann ML, Davenport R. Quality of life for patients with obsessive-compulsive disorder. Am J Psychiatry 1996;153:783-788.
4) Olfson M, Fireman B, Weissman MM, Leon AC, Sheehan DV, Kathol RG et al. Mental disorders and disability among patients in a primary care group Practice. Am J Psychiatry 1997;154(12):1734-1740.
5) Saxena S Functioning, disability and quality of life assessment in mental health Bhugra D, in Ranjith G Patel V. Hand book Of Psychiatry (A South Asian Perspective). Byword Viva Publishers. 2005;104-114.
6) Solanki RK, Singh P, Midha A, Chugh K. Schizophrenia: Impact of quality life. Indian J Psychiatry 2008;50:181-186.
7) Spitzer RL, Kroenke K, Linzer M, Hahn SR, Williams BW, deGruy FV et al. Health Related Quality Of Life In Primary care patients with mental disorders JAMA, 1995; 274:1511-1517.
8) Donovan D, Mattson ME, Cisler RA. Longbaugh R, Zweben A. Quality of life as an outcome measure in alcoholism treatment research. J Stud Alcohol Suppl;2005;15:119-39.
9) Masellis M, Rector N A, Richter M A. Quality of life in OCD: Differential Impact of Obssession, Compulsions and Depression Comorbidity. Can J Psychiatry 2003;48:72-77.
9. / Signature of Candidate
10. / Remarks of Guide / This synopsis has been prepared under my guidance. This study is clinically relevant and is feasible.
11. / Name and Designation of
(In Block Letters)
11.1 Guide
11.2 Signature
11.3 Co-Guide (If any)
11.4 Signature
11.5 Head of Department
11.6 Signature / Dr. C.Y.SUDARSHAN, M.D.(PSY)D.P.M.,
PROFESSOR,
DEPARTMENT OF PSYCHIATRY,
J.J.M MEDICAL COLLEGE,
DAVANGERE – 577004.
None
Dr. K. NAGARAJA RAO. M.D.(PSY)
PROFESSOR AND HEAD
DEPARTMENT OF PSYCHIATRY,
J.J.M. MEDICAL COLLEGE,
DAVANGERE – 577004.
12. / 12.1 Remarks of the Chairman and
Principal
12.2 Signature.