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ORIGINAL ARTICLE
Year : 2006  |  Volume : 51  |  Issue : 1  |  Page : 23-25
Psychiatric morbidity and pattern of dysfunctions in patients with leprosy


1 Department of Psychiatry, University College of Medical Sciences & G.T.B. Hospital, Dilshad Garden, Delhi, India
2 Department of Dermatology, University College of Medical Sciences & G.T.B. Hospital, Dilshad Garden, Delhi, India

Correspondence Address:
M S Bhatia
D-1, Naraina Vihar, New Delhi-110 028
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.25183

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  Abstract 

BACKGROUND: Leprosy, being a chronic infectious disease with profound social stigma, remains associated with high psychological mortidity. PURPOSES: To find out the pattern of psychiatric morbidity in leprosy patients and the relationship of various factors with the morbidity. METHODS: Ninty patients attending leprosy clinic were randomly chosen for the study group alongwith 40 patients suffering from acute skin problem other than leprosy as control group. The socio-demographic data were recorded in semi-structural proforma; all patients were given Goldbery Health Questioneaire (GHQ). Patients having GHQ score >2 was assessed by Disability Assessent Questionaire (DAQ). The psychiatric diagnoses was made according to ICD-10 by W ho0 and physical deformity by W ho 0 Disability Scale. FINDINGS: The mean GHQ score of the study grant was 3.44 and that of control group was 1.62. The mean DAQ score was 45.13. Psychiatric disorder was seen in 44.4% and 7.5% of study group and control group respectively. The psychiatric illness was generalised anoxidy disorder (GAD) (27.8%). CONCLUSIONS: Leprosis highly associated with psychiatric mobidity. LIMITATIONS: The findings can not be generalised due to small sample size and clinic-based data.


Keywords: Leprosy, Psychiatric morbidity, Psychiatric dysfunction


How to cite this article:
Bhatia M S, Chandra R, Bhattacharya S N, Imran M. Psychiatric morbidity and pattern of dysfunctions in patients with leprosy. Indian J Dermatol 2006;51:23-5

How to cite this URL:
Bhatia M S, Chandra R, Bhattacharya S N, Imran M. Psychiatric morbidity and pattern of dysfunctions in patients with leprosy. Indian J Dermatol [serial online] 2006 [cited 2019 Oct 15];51:23-5. Available from: http://www.e-ijd.org/text.asp?2006/51/1/23/25183



  Introduction Top


Leprosy is a major public health problem in India and accounts for one third of leprosy cases in the world and has by far the greatest number of cases among individual country.[1],[2]

The psychological reactions are well known in various physical illnesses, which may be either the part of physical illness due to biochemical changes or merely a reaction to physical disabilities or suffering. The psychological reactions to a particular illness depends upon various factors like susceptibility of the individual, type of illness, seriousness and chronicity of the illness and also the social stigma attached to a particular illness.

Leprosy is a chronic infectious disease of the skin associated with the high physical and psychological morbidity and social stigma. In two studies from northern India,[3],[4] the prevalence of psychiatric morbidity had been reported to be as high as 56-78%.

The present study was carried out with the aims to find out the pattern of psychiatric morbidity in leprosy patients and the relationship of various factors with psychiatric morbidity.


  Materials and Methods Top


The present study was conducted on the outdoor patients attending Leprosy Clinic in the department of dermatology of University College of Medical Sciences and Guru Teg Bahadur Hospital (a tetiary care teaching hospital with 900 indoor patients and catering about 5,000 outdoor patients daily) in the capital of India. The hospital runs a Leprosy Clinic under the National Leprosy Control Programme. The Leprosy clinic is managed by two dermatologists. 0The psychological evaluation of the patients included in the study was done by a psychiatrist.

The patients of either sex attending the Leprosy Clinic were randomly taken up as the Study Group (SG) (N=90). Those patients attending the clinic for the first time or having unreliable history, acute lepra reaction or severe illness needing hospitalization, or having concomitant severe physical disorder were excluded from the study. The attendants of the patients attending dermatology outpatient department for acute skin problems were age and sex matched and formed the Control Group (CG) (N=40). The socio-demographic data was recorded in a semi-structured proforma and all the patients in the study were administered Goldberg Health Questionnaire containing 12 items (GHQ-12) after an informed consent. Those patients having GHQ score of 2 or more were further assessed by a detailed mental status examination and Disability Assessment Questionnaire (DAQ) (by Pershad and Verma, 1985) standardized for the Indian population. DAQ measures dysfunction in five areas of activity: social (S), vocational (V), personal (P), familial (F) and cognitive (C). It is a self-administered or interviewer-administered in a structured clinical interview. There are 50 items in Hindi, ten each in five areas mentioned above. Each item is rated on a five-item scale (1-5), comparing the present level of functioning with that before the onset of illness. A score of 1 indicates functioning better than that present before the onset of illness, 2 indicates functioning no impairment and 3, 4 and 5 indicate mild, moderate and severe impairment respectively. The psychiatric diagnosis was made according to ICD-10 by WHO (1992). The patients were also physically examined and physical deformity was graded according to Who Disability Scale. The requisite investigations like hemogram, liver function tests, X-ray chest, skin biopsy from multiple sites were done wherever required. The patients' knowledge about the disease was assessed by asking two open-ended questions about the diagnosis and the duration of treatment required to be taken.


  Results Top


A total of 90 patients, consisting of 67 males (74.4%) and 23 females (25.6%) formed the study group. The age range was between 18 to 50 years (mean 30.02; SD 8.96). Majority of the patients in the were Hindus (SG 90%; CG 92.5%), literate above high school (SG 55.6%; CG 60.0%), married (SG 70.0%; CG 72.5%) and employed (SG 64.4%; CG (65.0%). Most of the cases with Leprosy had the disease for a long period (mean 2.51; SD 3.37 years). Out of 90 patients, 56 (62.22%) were aware about their illness and 49 (54.44%) were aware about the long duration of treatment required for their illness. Only 12 (13.33%) patients had moderate to severe deformity whereas rest had either no mild deformity.

The mean GHQ score of the Study Group was 3.44 (SD 4.04) with a range of 0 to 12 whereas mean GHQ score in the Control Group was 1.62 (SD 1.76) with a range of 0 to 5. The mean DAQ score was 45.13 (SD 6.29) with a range of 39.6 to 70.02. Out of 90 cases in the study group, 40 (44.4%) had a psychiatric disorder in comparison to 7.5% (3 cases) in the control group (one had mixed anxiety depressive disorder and two had generalised anxiety disorder). The predominant psychiatric illness in the study group was generalised anxiety disorder (GAD) (27.8%), followed by mixed anxiety and depressive disorder (MADD) (13.3%), psychosexual disorders (2.2%) and one case (1.1%) had delusional parasitosis [Table - 1]. The comparison of patterns of psychiatric dysfunction as on DAQ is shown in [Table - 2]. The commonest disturbance was in personal sphere, followed by vocational, social, personal and cognitive. There was no significant association between duration of leprosy and psychiatric diagnosis. The comparison between severity of deformity and psychiatric diagnosis was also not significant. The association between GHO scores and total scores of DAQ as well on its other five areas was highly significant [Table - 3].


  Discussion Top


The increased prevalence of psychiatric disorders in leprosy patients in comparison to general population has been reported in previous studies.[2],[6] The prevalence of psychiatric morbidity in leprosy has been reported as 9.9% in community-based study[6] and 10.4%[7] or 12.2%[8] in clinic-based studies but the prevalence in the present study was 44.4% (in comparison to 7.5% in the control group). The difference could be due to the population studied, the reliable instruments used for screening and the patients' correct knowledge about the diagnosis and duration of treatment required.

Against what had been reported in some previous studies,[7],[8] there was association between duration of leprosy and psychiatric disorders. Some studies [6],[7],[8],[9],[10],[11],[12],[13],[14],[15] have reported the relevance of physical deformities to the psychiatric morbidity in patients with leprosy but in the present study, no significant association was found between the severity of physical deformity and psychiatric disorders.

The various psychiatric disorders commonly reported in leprosy patients were depressive neurosis and anxiety neurosis. [6],[7],[8],[12],[13],[16],[17] In the present study, generalised anxiety disorder was the commonest psychiatric disorder followed by mixed anxiety depressive disorder. Some studies[7],[10],[18],[19] had reported the presence of excess of somatic, suicidal or paranoid cognitions but no such finding was found in the present study. There was one case of delusional parasitosis. We had previously reported[20] such an association.

The magnitude of dysfunctions in different spheres of functioning in leprosy patients had not been studied. There were dysfunctions in all reas, most common being personal one (as measured on DAQ). There was also a significant association with scores on GHQ.

The small smaple of the study with no control group and clinic based data were the limitations of the study. Therefore the findings can not be generalized. In conclusion, leprosy is associated with high psychiatric morbidity and there is need to involve a psychiatrist in the team working in leprosy clinics or centres.



 
  References Top

1.WHO. Technical Report Series No. 768, 1988.  Back to cited text no. 1    
2.Bharath S, Shamsundar C, Raghuram R, Subbakrishna DK. Correlates of psychiatric morbidity in patients with leprosy. Indian J Lepr, 2001; 73: 717-28.  Back to cited text no. 2    
3.Verma KK, Gautam S. Psychiatric morbidity in displaced leprosy patients. Indian J Lepr, 1994; 66: 339-43.  Back to cited text no. 3  [PUBMED]  
4.Pershad D, Verma SK, Malhotra A. Measurement of Dysfunction and Dysfunctional Analysis Questionnaire. National Psychological Corporation, Agra, 1985.  Back to cited text no. 4    
5.World Health Organization. International Classicification of Diseases 10th edition. WHO, Geneva, 1992.  Back to cited text no. 5    
6.Kumar JH, Verghese A. Psychiatric disturbances among leprosy patients. An epidemiological study. Int. J Lepr Other Mycobact Dis, 1980; 48: 431-34.  Back to cited text no. 6  [PUBMED]  
7.Behere PB. Psychological reactions to leprosy. Lepr India, 1981; 53: 266-72.  Back to cited text no. 7  [PUBMED]  
8.Bharath S, Shamsundar C, Raghuram R, Subbakrishna DK. Psychiatric morbidity in leprosy and psoriasis-a comparative study. Indian J Lepr, 1997; 69: 341-6.  Back to cited text no. 8    
9.Price JF. A study of leprosy patients with deformities and implications for treatment for all leprosy patients. Lepr Rev, 1983; 54: 129-37.  Back to cited text no. 9    
10.Ramanathan U, Srivastav I, Ramu G. Psychiatric morbidity in patients with leprosy. XII International Leprosy Proceedings, New Delhi, 1984, 810-1.  Back to cited text no. 10    
11.Kaur H, Ramesh V. Social problems in women leprosy patients-a study conducted at two urban leprosy centres in Delhi. Lepr Rev, 1980; 65: 310-75.  Back to cited text no. 11    
12.Davey TF. Psychological aspects of leprosy. Lepr. Rev, 1976; 47: 71-4.  Back to cited text no. 12  [PUBMED]  
13.Henderson AS. Psychiatric sequelae of leprosy in New South Wales. Med J Aust, 1964; 2: 632-4.  Back to cited text no. 13    
14.Mhasawade BC. Leprosy-a case for mental health care. Lepr. India, 1983; 55: 310-13.  Back to cited text no. 14  [PUBMED]  
15.Owen S, Bochner S. Social factors in the treatment of leprosy. Med J Aust, 1968; 24: 351-3.  Back to cited text no. 15    
16.Reddy VVS, Sudhakar S, Anand B. Study of psychiatric morbidity in Hansen's disease at a rehabilitation centre. Abstract in Int J Lepr 1993; 61 Suppl: 137A.  Back to cited text no. 16    
17.Llyod GG. Emotional aspects of physical illness. In: Recent Advances in Clinical Psychiatry, Vol 5, ED K Granville-Grossman. Churchill Livingstone, New York, 1985; 63-85.  Back to cited text no. 17    
18.Flynn PE, Harvey H. Invetigation of the psychological world of the Hansen's disease outpatient. Abstract in Int J Lepr, 1968; 36 Suppl: 155A.  Back to cited text no. 18    
19.Campos FJ, Castenada S, Agoita L. The mental states of leprosy patients. In: Leprosy Excepta Medica. Eds. F Latapi, A Soul, O Rodriguez, M Malcara, SG Browne. Excepta Medica, International Congress Series 466, 1980, 201.  Back to cited text no. 19    
20.Bhatia MS, Shome S, Gautam RK. Delusional parasitosis in leprosy. Lepr Rev, 1996; 67: 230.  Back to cited text no. 20    


    Tables

[Table - 1], [Table - 2], [Table - 3]

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Journal of Psychosomatic Research. 2014;
[Pubmed] | [DOI]



 

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