DOI: https://dx.doi.org/10.18203/2349-3933.ijam20222113
Published: 2022-08-24

Clinical perspectives on the management of common psychiatric disorders in India

M. S. Reddy, E. Mohandas, Mrugesh Vaishnav, Philip John, Suresh Kumar, Uttam Garg, Bharat Shah, Jayanta Das

Abstract


Psychiatric disorders are common health problems in patients of all age groups, under-diagnosis and under-treatment of these disorders can result in disability and serious complications. With an objective of creating a comprehensive evidence-based consensus on common mental health disorders and their management in the Indian setting, 10 expert groups meetings involving 98 psychiatrists across India were conducted in the month of May 2020. Clinical insights related to burden, signs and symptoms, diagnosis and management were summarized based on the discussions during these meetings. Experts agreed that depressive disorders and anxiety disorders represent two important psychiatric disorders in India. Selective serotonin reuptake inhibitors (SSRIs) are commonly used for the treatment of depression. Benzodiazepines are effective for the treatment of comorbid anxiety in patients with depression, but their long-term use causes adverse events such as dependence and withdrawal reaction. Obsessive compulsive disorder (OCD), bipolar disorder, substance use especially alcohol withdrawal syndrome, and sleep disorders are other common psychiatric disorders found among Indian patients. Lithium and valproate represent the commonly used and effective pharmacological treatments for bipolar disorder. SSRIs are preferred drugs in the treatment of OCD, whereas benzodiazepines such as chlordiazepoxide and diazepam represent important pharmacological treatment options for alcohol withdrawal. Early identification and timely and effective treatment of psychiatric disorders is important for prevention of complications. Treatment should be individualized based on efficacy, tolerability profile of the medicine, risk of drug interactions, and cost. This consensus may be useful to psychiatrists and general practitioners treating common psychiatric conditions in Indian patients.


Keywords


Alcohol withdrawal syndrome, Anxiety, Bipolar disorder, Depression, Obsessive compulsive disorder

Full Text:

PDF

References


India state-level disease burden initiative mental disorders collaborators. The burden of mental disorders across the states of India: the global burden of disease study 1990-2017. Lancet Psychiat. 2020;7: 148-61.

Math SB, Srinibasaraju R. Indian psychiatric epidemiological studies: Learning from the past. Indian J Psychiat. 2010;52:S95-103.

Dutta S, Kar N, Thirthalli J, Nair S. Prevalence and risk factors of psychiatric disorders in an industrial population in India. Indian J Psychiat. 2007;49:103-8.

Bhalla A, Dutta S, Chakrabarti A. A profile of substance abusers using the emergency services in a tertiary care hospital in Sikkim. Indian J Psychiat. 2006;48:243-7.

Murthy P, Manjunatha N, Subodh BN, Chand PK, Benegal V. Substance use and addiction research in India. Indian J Psychiat. 2010;52(1):S189-99.

Bhaskar S, Hemavathy D, Prasad S. Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities. J Family Med Prim Care. 2016;5:780-4.

Manuel CM, Rao PP, Rebello P, Safeekh AT, Mathai PJ. Medical comorbidity in in-patients with psychiatric disorder. Muller J Med Sci Res. 2013;4: 12-7.

Bobo MV. The diagnosis and management of bipolar I and II disorders: Clinical practice update. Mayo Clin Proc. 2017;92:1532-51.

Holder SD. Psychotic and bipolar disorders: bipolar disorder. FP Essent. 2017;455:30-5.

McCormick U, Murray B, McNew B. Diagnosis and treatment of patients with bipolar disorder: A review for advanced practice nurses. J Am Assoc Nurse Pract. 2015;27:530-42.

Hilty DM, Leamon MH, Lim RF, Kelly RH, Hales RE. A review of bipolar disorder in adults. Psychiatry. 2006;3(9):43-55.

Fagiolini A, Coluccia A, Maina G, Forgione RN, Goracci A, Cuomo A, et al. Diagnosis, epidemiology and management of mixed states in bipolar disorder. CNS Drugs. 2015;29(9):725-40.

Licht RW. Lithium: still a major option in the management of bipolar disorder. CNS Neurosci Ther. 2012;18:219-26.

Cipriani A, Reid K, Young AH, Macritchie K, Geddes J. Valproic acid, valproate and divalproex in the maintenance treatment of bipolar disorder. Cochrane Database Syst Rev. 2013;2013(10): CD003196.

Smith LA, Cornelius VR, Azorin JM, Perugi G, Vieta E, Young AH, et al. Valproate for the treatment of acute bipolar depression: systematic review and meta-analysis. J Affect Diord. 2010;122(1-2):1-9.

Calabrese JR, Rapport DJ, Kimmel SE, Reece B, Woyshville MJ. Rapid cycling bipolar disorder and its treatment with valproate. Can J Psychiatry. 1993; 38(2):S57-61.

Del Grande C, Muti M, Musetti L, Corsi M, Pergentini I, Turri M, et al. Lithium and valproate in manic and mixed states: a naturalistic prospective study. J Psychopathol. 2014;20:6-10.

Bowden CL, Mosolov S, Hranov L, Chen E, Habil H, Kongsakon R, et al. Efficacy of valproate versus lithium in mania or mixed mania: a randomized, open 12-week trial. Int Clin Psychopharmacol. 2010;25(2): 60-7.

Miller TH. Bipolar disorder. Prim Care. 2016;43(2): 269-84.

Quello SB, Brady KT, Sonne SC. Mood disorders and substance use disorder: A complex comorbidity. Sci Pract Perspect. 2005;3(1):13-21.

Tiller JWG. Depression and anxiety. Med J Aust. 2013; 199(S6):S28-31.

Gdanska P, Drozdowicz-Jastrzebska E, Grzechocinska B, Radziwon-Zaleska M, Węgrzyn P, Wielgoś M. Anxiety and depression in women undergoing infertility treatment. Ginekol Pol. 2017; 88(2):109-12.

Roseman A, Kovacs A. Anxiety and depression in adults with congenital heart disease: When to suspect and how to refer. Curr Cardiol Rep. 2019;21(11):145.

Sibelli A, Chalder T, Everitt H, Workman P, Windgassen S, Moss-Morris R. A systematic review with meta-analysis of the role of anxiety and depression in irritable bowel syndrome onset. Psychol Med. 2016;46(15):3065-80.

Clark DA, Beck AT. Cognitive theory and therapy of anxiety and depression: convergence with neurobiological findings. Trends Cogn Sci. 2010; 14(9):418-24.

Hu MX, Milaneschi Y, Lamers F, Nolte IM, Snieder H, Dolan CV, et al. The association of depression and anxiety with cardiac autonomic activity: The role of confounding effects of antidepressants. Depress Anxiety. 2019;36(12):1163-72.

Brambilla P, Cipriani A, Hotopf M, Barbui C. Side-effect profile of fluoxetine in comparison with other SSRIs, tricyclic and newer antidepressants: a meta-analysis of clinical trial data. Pharmacopsychiat. 2005;38(2):69-77.

Cipriani A, Ferla TL, Furukawa TA, Signoretti A, Nakagawa A, Churchill R, et al. Sertraline versus other antidepressive agents for depression. Cochrane Database Syst Rev. 2010;4:CD006117.

Culpepper L. Escitalopram: A new SSRI for the treatment of depression in primary care. Prim Care Companion J Clin Psychiat. 2002;4(6):209-14.

Jiang K, Li L, Wang X, Fang M, Shi J, Cao Q, et al. Efficacy and tolerability of escitalopram in treatment of major depressive disorder with anxiety symptoms: a 24-week, open-label, prospective study in Chinese population. Neuropsychiatr Dis Treat. 2017;13:515-26.

Fabbri C, Tansey KE, Perlis RH, Hauser J, Henigsberg N, Maier W, et al. Effect of cytochrome CYP2C19 metabolizing activity on antidepressant response and side effects: Meta-analysis of data from genome-wide association studies. Eur Neuropsychopharmacol. 2018;28(8):945-54.

Batelaan NM, Bosman RC, Muntingh A, Scholten WD, Huijbregts KM, van Balkomet AJLM. Risk of relapse after antidepressant discontinuation in anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder: systematic review and meta-analysis of relapse prevention trials. BMJ. 2017; 358:j3927.

Brent DA. Antidepressants and suicidality. Psychiatr Clin North Am. 2016;39(3):503-12.

Goodman WK, Grice DE, Lapidus KAB, Coffey BJ. Obsessive-compulsive disorder. Psychiatr Clin North Am 2014;37(3):257-67.

Obsessive compulsive disorder. Available at: https://www.nhp.gov.in/disease/neurological/obsessive-compulsive-disorder. Accessed on 01 March 2021.

Abramowitz JS, Taylor S and McKay D. Obsessive-compulsive disorder. Lancet. 2009;374(9688):491-9.

Sinopoli VM, Burton CL, Kronenberg S, Arnold PD. A review of the role of serotonin system genes in obsessive-compulsive disorder. Neurosci Biobehav Rev. 2017;80:372-81.

Bokor G, Anderson PD. Obsessive-compulsive disorder. J Pharm Pract 2014;27(2):116-30.

Fireman B, Koran LM, Leventhal JL, Jacobson A. The prevalence of clinically recognized obsessive-compulsive disorder in a large health maintenance organization. Am J Psychiatry. 2001;158(11):1904-10.

Fenske JN, Petersen K. Obsessive-compulsive disorder: Diagnosis and management. Am Fam Physician. 2015;92(10):896-903.

Fenske JN, Schwenk TL. Obsessive compulsive disorder: diagnosis and management. Am Fam Physician. 2009;80(3):239-45.

Skapinakis P, Caldwell DM, Hollingworth W, Bryden P, Fineberg NA, Salkovskis P, et al. Pharmacological and psychotherapeutic interventions for management of obsessive-compulsive disorder in adults: a systematic review and network meta-analysis. Lancet Psychiat. 2016;3(8):730-9.

Muncie HL Jr, Yasinian Y, Oge L. Outpatient management of alcohol withdrawal syndrome. Am Fam Physician. 2013;88(9):589-95.

Pach D, Radomska M, Groszek B, Hydzik P, Gilis-Januszewska A, Pach J. Abnormal glucose metabolism in men with alcohol withdrawal syndrome. Przegl Lek. 2014;71(9):469-74.

Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). Br J Addict. 1989;84(11): 1353-7.

Ahwazi HH, Abdijadid S. Chlordiazepoxide. Available at: https://www.ncbi.nlm.nih.gov/books/ NBK547659/. Accessed on 01 March 2021.

Elholm B, Larsen K, Hornnes N, Zierau F, Becker U. Alcohol withdrawal syndrome: symptom-triggered versus fixed-schedule treatment in an outpatient setting. Alcohol. 2011;46(3):318-23.

Ramanujam R, Padma L, Swaminath G, Thimmaiah RS. A comparative study of the clinical efficacy and safety of lorazepam and chlordiazepoxide in alcohol dependence syndrome. J Clin Diagn Res. 2015;9(3): FC10-3.

Kumar CN, Andrade C, Murthy P. A randomized, double-blind comparison of lorazepam and chlordiazepoxide in patients with uncomplicated alcohol withdrawal. J Stud Alcohol Drugs. 2009; 70(3):467-74.

Benedict NJ, Wong A, Cassidy E, Lohr BR, Pizon AF, Smithburger PL, et al. Predictors of resistant alcohol withdrawal (RAW): A retrospective case-control study. Drug Alcohol Depend. 2018;192:303-8.