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A study of personality profile and psychiatric morbidity in people living with HIV/AIDS.

INTRODUCTION: India's HIV/AIDS prevalence is second in the world only to South Africa. Most of the HIV infections in India are due to sexual transmission (84-86%). In the north east, however, injectable drug use is the main mode of transmission.

Psychological and psychiatric issues associated with HIV infection have received considerable attention in the last decade. The relationship between HIV-AIDS and psychiatric disorders is well recognized to be both uni and bi-directional, and influenced by a variety of factors like stigma & discrimination, educational level, concurrent substance abuse, family support, neurocognitive disturbances, opportunistic infections and medication side effects, treatment adherence and course of HIV infection. (1) The introduction of highly active antiretroviral therapy (HAART) has transformed the HIV infection from a quickly fatal to a chronic disease is another contributing variable. (2) There are several ways in which HIV infection and psychiatric disorders are linked:

1. HIV infection owing to its malignant course and the associated stigma often results in emotional reaction of a serious nature among those infected.

2. The HIV has direct effect on the brain that may lead to neurocognitive disturbance and psychosis.

3. Opportunistic neurological and systemic infections and their treatment may lead to neuropsychiatric problems.

4. Some of the drugs used in HAART are known to be associated with psychiatric side effects.

5. Persons with severe mental illness are known to be vulnerable to HIV infection and there are special management concerns in this population.

6. Substance abuse and HIV are linked in direct ways (Intravenous drug use IVDU) and in indirect ways by their influence on sexual behavior.

7. Treatment adherence and course of illness have been found to be influenced by emotional factors and substance use.

A person may react to a HIV positive test with a syndrome similar to PTSD, (3) (or) may have severe distress on hearing about the HIV positive status. During asymptomatic period adjustment disorder, depression, substance use disorder and personality problems are common. During symptomatic period, (4,5) Depression, (6,7) and organic brain syndrome are common problems.

Factors prone for the development of psychiatric disorders have been studied:

1. HIV related factors--Psychiatric disorders are more likely to occur at two high risk periods the one immediately within 6 months after disclosure of HIV positive status & other at the onset of physical complications of AIDS. (5)

2. Socio demographic factors-older individuals may be at higher risk of HIV Dementia/minor cognitive disorder. Substance users have poor psychological status, coping skills, social and family problems even prior to acquiring infection. (8)

3. Personality factors--aspects of individuals personality such as sensation seeking, compulsivity, less effective coping skills leads to high risk sexual behavior. Some studies show that persons with antisocial personality disorder & borderline disorder are at high risk of acquiring HIV infection (Golding et al., (9) Perkin et al., (10)).

4. Past psychiatric history-presence of psychiatric morbidity in the past favors emergence of psychiatric problems. Association between previous psychiatric diagnoses and present psychiatric problem in HIV positive patients has been noticed by catalan et al. (11)

5. Social support-Inadequate social support like lack of support from family, friends, social isolation leads to high prevalence of psychiatric disorders (kelly et al., (12) 1998).

6. Life events-loss of spouse, survivors guilt, health deterioration, loss of job and financial problems are fuel for the development of psychiatric problems in vulnerable population (Cohen et al., (13) sherr et al., (14) fishman et al. (15)

In previous meta analytical studies, prevalence rates of 20-50% depressive symptoms, 4-23% for major depressive disorder (MDD), up to 13% for dysthymia and 2-40% substance abuse/dependence, (16-18) were reported HIV studies from the US have reported annual prevalence of 47.9% for psychiatric disorders MDD in 36%, Dysthymia in 26.5%, generalized anxiety disorder in 15.8% panic attacks in 10.5% substance abuse in 21% and dual diagnosis in 8% subjects. (19,20)

While in Indian scenario, Jacob (21) reported 26.1% of the HIV infected individuals having psychiatric morbidity. Falstic, (22) Seth (23) also reported high prevalence in their research. But studies by Atkinson et al. (24) 1988, Williams et al (25) 1988 did not find any significance between HIV positive and negative groups with respect to the prevalence of psychiatric morbidity.

Eysenck (1947) (26) defined personality as "sum total of the actual (or) potential behavior patterns of the organism as determined by heredity and environment. He included four main sectors of behavior patterns:

1. Cognitive sector (Intelligence) 3. Effective sector (Temperament).

2. Conative sector (Character) 4. Somatic sector (Constitution).

Eysenck describe extraversion as impulsive behavior with social tendencies, craves for excitement.

Neuroticism refers to general emotional over responsiveness, liability to breakdown under stress, instability, in adaptability, weak dependable attitude narrow interest.

In a study of Mohan and Bedi, (27) results indicate that no differences were found on extraversion in both HIV positive and negative people. HIV positive males scored higher than females in neuroticism.

The existing psychiatric research on HIV-AIDS in India has focused mostly on co-prevalence of intravenous drug abuse and, to a lesser extent on psychiatric morbidity. (28,29) With this background, the present study attempted to assess the personality profile and psychiatric morbidity in HIV positive outpatients.

METHODS:

Location, Ethical clearance, Design:

PLHIV attending the ART center, Mahatma Gandhi Memorial Government Hospital (MGMGH) attached to KAPV Govt Medical College, Tiruchirapalli were subjected for study

With ethical clearance, this time bound study involved cross sectional observation, a purposive sampling procedure, and onetime assessment of each subject.

SUBJECT: The subjects were, persons of >18 years of age group, with confirmed HIV test positivity and on ART as per the WHO criteria and National guideline irrespective of ART regimen, duration of illness or treatment, clinical staging or CD4 count, irrespective of gender and their educational status.

Patients with severe physical illness, cognitive impairment, less than age 18 were excluded from the study.

Informed consent was obtained from all patients.

Measures: Demographic proforma was used to record name, age, sex, marital status, living status, area of living and religious status.

Kuppusamy's socio economic status scale was applied to all subjects.

Cinical Profoma: Developed for the study, clinical proforma was used to collect the illness related details for the HIV group, HIV Staging, CD4 Count were taken into account. All individuals were assessed carefully using ICD-10 diagnostic criteria to assess the psychiatric morbidity.

Eysenck personality questionnaire--Revised:

This form is a 90 item Yes/No Questionnaire out of which 21 items for assessing Extraversion, 23 items for assessing Neuroticism, 25 items for assessing Psychotic dimensions, 22 items constituting the Lie scale.

Procedure: The consenting subjects meeting the inclusion and exclusion criteria were administered the demographic proforma, clinical proforma, Kuppusamy's Socio economic status scale, ICD-10 diagnostic criteria, Eysenck's personality Questionnaire--Revised. On average, 60-75 minutes was required for administering all instruments.

Statistical Analyses: Descriptive statistical data were analyzed by Percentage, Mean and Standard deviation. Results were analyzed using Chi-square test and correlations were made with Karl-Pearson test.

RESULTS: In the total study population (n=50), Male constitutes 19(38%), Female constitutes 29(58%), Transgender constitutes 2(4%). 94% of them were above the age of 25. (Table-1)

This study group showed 24% (n =12) of psychiatric disorders of which males had 10% (n=5) and females had 14% (n=7). Psychiatric morbidity was absent in 28% of males (n=14), 44% females (n=22), and in transgender (n=2). Patients below the age of 25 were not having any psychiatric morbidity. Patients above the age of 45 had 57% of psychiatric morbidity. All the patients with psychiatric morbidity were from lower socioeconomic status in which upper lower socioeconomic status constitutes 83.37%. Married individuals constitutes 83.3% of persons with psychiatric morbidity remaining 16.7% was contributed by widows. Unmarried persons didn't show psychiatric morbidity. 66.6% patients from nuclear family found to have psychiatric morbidity. With respect to family setup, 30% of the patients from nuclear family exhibited psychiatric morbidity and 16.6% of patients from joint family exhibited psychiatric morbidity. In the study 25% Hindus & 20% of Christians were found to have psychiatric morbidity. 19.4% rural population and 35.7% of urban population exhibited psychiatric morbidity. (Table-2)

14% of study population had mood disorder which is constitutes 58% of psychiatric morbidity (n=7) among the mood disorders, 42.8% (n=3) diagnosed to have depressive illness & 42.8% (n=3) diagnosed to have dysthymia 14.2% had bipolar illness. Depressive disorder was seen only in female patients. Among male patients with psychiatric disorder 10.5% of males found to have mood disorders, 10.52% of male patients exhibited substance dependence. (table-3)

21% of stage I HIV illness patient had psychiatric morbidity which constitutes 83% (n=10) of patients with psychiatric morbidity. 50% of stage II HIV illness & 100% stage III HIV illness expressed psychiatric morbidity which is statistically significant. (Table-4)

In relation to personality profile and psychiatric morbidity the extraversion group, ambiverts showed more psychiatric morbidity (75%). Among neurotics, highly neurotic sub group had high psychiatric morbidity (91.6%). Non organic insomnia is seen in patient with high neurotic no psychotic traits. Substance use disorder and delusional disorder were noted in patients with high neurotic and psychotic personality profile. (Table-5)

In the personality profile of neuroticism dimension, among male (n=19). 47% (n=9) were highly neurotics (n=9) 10.5% (n=2) are emotionally well balanced. In females (n=29), 31% (n=9) were highly neurotics and 27.5% (n=8) were emotionally well balanced. Patients in the age of 26-35yrs, 63.6% constitutes of emotionally well balanced traits 68.7% (n=13) of males showed ambivert traits (n=13) & 10.5% (n=2) males showed extravert personality traits. (Table-6)

Among extravert dimension, 62% of females (n=18) were ambiverts & 20.7% (n=6) highly extravert Patients in the age group between 26-35 contributed 44% of introverts and patients in the age group of 36-45 constituted 50% of highly neurotic & 48.50% ambivert personality profile. (Table-7)

In the psychotic personality dimension, 84.7% (n=16%) males showed psychotic traits 62%(n=18) females showed psychotic traits (n=18) 50% transgender showed psychotic traits. 76.4% patients in the age group 26-35 showed psychotic traits. (Table-8)

No significant correlation found between personality profile of the individuals and their age and sex. Likewise no significant correlation found between personality profile of the individuals and their psychiatric morbidity. (Table-9)

DISCUSSION: In this study, females were in high proportion compared to males. 94% of the study population was above the age of twenty five. 47% (n=9) patients of males are above the age of 40, 65% (n=19) of females are in age of 26-40.

In patients with psychiatric morbidity, 57% were above the age of 45. There is no gender difference among patients exhibiting psychiatric disorders. The prevalence of psychiatric morbidity 24% was comparable to meta-analysis study done by Ciesla J A, et al. (16,18)

In this study depressive disorder constitutes 6% which is lesser than the finding noted in the study of Nebhinani, et al., (30) but comparable to meta-analysis study done by Ciesla JA, et al., (16,17)

Substance use disorder found in 4% of the study population which is contrary to the study finding of Nebhinani, et al., (30) (75%).

The studies from the US. (14,15) have reported an annual prevalence of 47.9% for psychiatric disorders including MDD in 36% was not in concurrence with this study finding. While in Indian scenario, Jacob, (24) reported 26.1% of the HIV infected individuals having Psychiatric morbidity. Deshpande, (31) et al reported 34% prevalence of Psychiatric morbidity among medical inpatients in an Indian hospital which is similar to our study findings.

Majority of studies in India have reported higher rates of depression among women compared to men (Chandra PS et al., (32)) which is consistent with our finding.

The study (31) conducted at tertiary care center of south India found no relation between stage of illness and depression which is contrary to these study findings which reveals statistically significant relationship between stage of illness and depression

The study done by Cohen M et al., (13) Aswal Siddharth et al., (33) showed patients with high viral load (CD4<500) had significantly higher scores of depression compared to patients with higher CD4 count, is similar to our study finding.

The Study done by Vidhu Mohan et al., (27) showed males with high neuroticism which is contrary to our study finding of equal expression of high neurotic states.

Psychiatric morbidity is found in 28.5% of patients with psychotic traits, 33.3% of ambivert traits, and 52.89% of high neurotic traits. 33.3% of patient with introvert personality traits exhibited psychiatric morbidity.

Patients with high extravert type & emotionally well balanced personality profile showed no psychiatric morbidity.

High prevalence of psychiatric morbidity in HIV infected persons highlights with public health needs and awareness among professionals to develop comprehensive diagnostic and treatment formulations including regular psychiatric evaluation for successful treatment outcome in difficult patients.

DOI: 10.14260/jemds/2015/1792

REFERENCES:

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(2.) Owe--Larsson B, Sall L, Salamon E, Allgulander C. HIV infection and psychiatric illness. Afr J Psychiatry 2009; 12: 115-28.

(3.) Martinez A, Israleski D, Walker C. post-traumatic stress disorders in women attending human immunodeficiency virus our patient clinics. AIDS patient care STDS 2002; 16: 283-91.

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(7.) Dilley, J.W, Ochitill H. N., Perl, M. B. et al (1985).Findings in psychiatric consultation in patients with acquired immunodeficiency syndrome. American Journal of Psychiatry, 142, PP. 82-86.

(8.) Gala, C,. Pergami, A, Catalan, J, Ricci O, M, Durbano, G, Musicco, M, Baldeweg, T and Invemizzi, G (1992). Risk of deliberate self-harm and factors associated with suicidal behavior among asymptomatic individuals with HIV Infection, Actapsychiatricascandinavia, 86, I, PP 70-75.

(9.) Golding, M & Perkings, D.O (1996) personality disorder in HIV infection. International Review of Psychiatry, 8, PP.253-258.

(10.) Perkins, D.O., Davidson, E.J., et al (1993). Personality disorder in patients infects with HIV. American Journal of Psychiatry 150, PP. 309-315.

(11.) Catalan, J, Klimes, I, Bond, A, Day, Garrod, A and Rizza, C(1992). The psychosocial impact of HIV infection in men with Haemophilia. Journal of psychosomatic research 36, PP.409-416.

(12.) Kelly, B.B., Raphael, A.M. et al (1998). Suicidal ideation, suicide attempts and HIV infection psychosomatics, 39, PP. 405-415.

(13.) Cohen MA, Alfonso CA. Psychiatric manifestations of the HIV epidemic. AIDS Reader 1994; 4: 97-106.

(14.) Sherr, L (1995). Suicide and AIDS; lesson form a case note audit in London, AIDS Care, 7 Psychiatry 145, PP.765.

(15.) Fishman, B, M Perry, S., Jacobsberg, L, and Francis, A, (1989) psychological factors predicting distress after HIV testing. Fifth international conference of AIDS, Montreal, Canada.

(16.) Ciesla JA, Roberts JE. Meta-analysis of the relationship between HIV infection and risk for depressive disorders. Am J Psychiatry 2001; 158: 725-30.

(17.) Ickovics JR, Hamburger ME, Vlahov D, Schoenbaum EE, Schuman P, Boland RJ, et al, Mortality, CD4, cell count decline, and depressive symptoms among HIV-seropositive women: longitudinal analysis from the HIV Epidemiology Research Study: JAMA 2001; 285: 1466-74.

(18.) Kilbourne AM, Justice A. C, Rabeneck L., Rodriguez-Barradas M, Weissman S. General medical and psychiatric comorbidity among HIV infected veterans in the post-HAART era. J ClinEpidemiol 2001; 54(suppll): S22-8.

(19.) Bing EG, Burnam MA, Longshore D, Fleishman JA, Sherbourne CD, London AS, et al. Psychiatric disorders & drug use among human immunodeficiency virus--infected adults in the US. Arch Gen Psychiatry 2001; 58: 721-8.

(20.) Pence BW, Miller WC, Whetten K, Eron JJ, Gaynes BN. Prevalence of DSM-IV-defined mood, anxiety & substance use disorders in an HIV clinic in the southeastern united states J Acquired Immune Deficiency Syndrome 2006; 42: 298-306.

(21.) Jacob K.S, John JK, Verghese A, et al. The fear of AIDS: psychiatric symptom or syndrome? AIDS CARE 1: 35-38.

(22.) Falstich, M (1987). Psychiatric aspects of AIDS. A American journal of psychiatry, 144, PP, 551556.

(23.) Seth, R, Granville--Grossman, K, Goldmier, G. et al (1991). Psychiatric illness in patients with HIV infection and AIDS, British journal of psychiatry, 159, PP.347-350.

(24.) Atkinson JH, Grant I, Kennedy CL. Prevalence of psychiatric disorders among men infected with human immunodeficiency virus. Arch Gen Psychiatry 1988; 45: 859-864.

(25.) Williams, J.B.W., Rabkin, J.G., Remein, R.H., et al (1991). Multi-disciplinary baseline assessment of homosexual men with and without human immunodeficiency infection. Arch.Gen Psychiatry, 48, 124-130.

(26.) Eysenck, H.J (1947). Dimensions of Personality, London, England; Routledge & Kegan Paul.

(27.) Mohan V, Bedi S. Extraversion, Neuroticism, Anger and Self Esteem of HIV positive Youth, The Journal of Behavioral Science, 2010 vol5, No1, 60-74.

(28.) Chadra PS, Ravi V, Desai A. Anxiety and depression among HIV-infected heterosexuals--A report from India. J. Psychosom Res 1998; 45: 401-9.

(29.) Satishchandra P, Nalini A, Gourie-Devi M, Khanna N, Santosh V, Ravi V. Profile of nuerologic disorders associated with HIV/AIDS from Bangalore, south India (1989-1996) Indian J Med Res 2000; 111: 14-23.

(30.) Naresh Nebhinani, Surendra K. Mattoo, Ajay Wanchu. Psychiatric morbidity in HIV-positive subjects: A study from India. Journal of Psychosomatic Research 70(2011)449-454

(31.) Deshpande, S.N., Sundaram K.R, Wig N.N (1989). Psychiatric disorders among medical inpatients in an Indian Hospital, British journal of psychiatry, 154, PP. 504-506.

(32.) Chandra PS. Sexual Control and awareness of STDs among HIV infected women. Proceedings of the III Asia and Pacific Conference on Social Science and Medicine. Lynne Hunle, editor. February, 1996; Edith Cowon University, Perth, Australia.

(33.) Aswal Siddharth, Agarwal Prem, Gupta LN, Verma KK, Singhal Ashok, Satya Prakash, Vikram, Mitesh. Psychiatric Disorders in HIV Infected Patients, DELHI PSYCHIATRY JOURNAL Vol. 14 No.2.

A. Niranjana Devi [1], R. Muralitharan [2], R. Sharmila [3]

AUTHORS:

[1.] A. Niranjana Devi

[2.] R. Muralitharan

[3.] R. Sharmila

PARTICULARS OF CONTRIBUTORS:

[1.] Professor, Department of Psychiatry, MGMGH/KAPV Govt. Medical College, Tiruchirappalli.

[2.] Associate Professor, Department of Psychiatry, MGMGH/KAPV Govt. Medical College, Tiruchirappalli.

[3.] ART Medical Officer, Department of Psychiatry, MGMGH/KAPV Govt. Medical College, Tiruchirappalli.

FINANCIAL OR OTHER COMPETING INTERESTS: None

NAME ADDRESS EMAIL ID OF THE CORRESPONDING AUTHOR:

Dr. A. Niranjana Devi, Professor of Psychiatry, M.G.M. Government Hospital, Tiruchirapalli-620017, Tamilnadu.

E-mail: niranjana.danikrish@gmail.com

Date of Submission: 18/08/2015.

Date of Peer Review: 19/08/2015.

Date of Acceptance: 31/08/2015.

Date of Publishing: 03/09/2015.
Table 1: Socio Demographic Profile

Sl.                                Total
No.
                              (n=50)   -100%

1              Age
           Below 25yrs          3      6.00%
           26 to 35yrs          17     34.00%
           36 to 45yrs          23     46.00%
          46yrs & above         7      14.00%

2              Sex
              Male              19     38.00%
             Female             29     58.00%
           Transgender          2      4.00%

3           Education
           Illiterate           11     22.00%
         Primary school         13     26.00%
          Middle school         14     28.00%
           High school          9      18.00%
             Diploma            2      4.00%
             UG & PG            1      2.00%

4          Occupation
           unemployed           11     22.00%
        Unskilled worker        11     22.00%
       Semi-skilled worker      19     38.00%
         Skilled worker         8      16.00%
         Semi-profession        1      2.00%

5            Income
          Below Rs.1600         5      10.00%
         Rs.1601 to 4809        30     60.00%
         Rs.4810 to 8009        12     24.00%
        Rs.8010 to 12019        3      6.00%

6     Socio economic status
       Middle\lower middle      3      6.00%
        Lower\upper lower       38     76.00%
              Lower             9      18.00%

7        Marital status
             Married            39     78.00%
            Unmarried           4      8.00%
              Widow             7      14.00%

8         Living status
         Nuclear family
          Joint family          24     48.00%

9        Area of living
              Rural
              Urban             14     28.00%

10          Religion
              Hindu             43     86.00%
             Muslim             2      4.00%
            Christian           5      10.00%

                                    Total
S.NO
                               (n=12)   -100%
1               Age
            Below 25yrs         Nil     0.00%
            26 to 35yrs          4      33.33%
            36 to 45yrs          5      41.65%
           46yrs & above         3      25.00%

2               Sex
               Male              5      41.65%
              Female             7      58.33%
           Transgender          Nil     0.00%

3            Education
            Illiterate           3      25.00%
          Primary school         6      50.00%
           Middle school         3      25.00%
            High school         Nil     0.00%
              Diploma           Nil     0.00%
              UG & PG           Nil     0.00%

4           Occupation
            unemployed           1      8.33%
         Unskilled worker        3      25.00%
        Semi-skilled worker      7      58.33%
          Skilled worker         1      8.33%
          Semi-profession       Nil     0.00%

5             Income
           Below Rs.1600        Nil     0.00%
          Rs.1601 to 4809        10     83.33%
          Rs.4810 to 8009        1      8.33%
         Rs.8010 to 12019        1      8.33%

6      Socio economic status
        Middle\lower middle     Nil     0.00%
         Lower\upper lower       10     83.33%
               Lower             2      16.67%

7         Marital status
              Married            10     83.33%
             Unmarried          Nil     0.00%
               Widow             2      16.67%

8          Living status
          Nuclear family         8      66.67%
           Joint family          4      33.33%

9         Area of living
               Rural             7      58.33%
               Urban             5      41.65%

10           Religion
               Hindu             11     91.67%
              Muslim            Nil     0.00%
             Christian           1      8.33%

Table 3

                                  DEMOGRAPHIC PROFILE OF PATIENTS
                                     WITH PSYCHIATRIC MORBILITY

                                     NA       Depressive   Dysthymia
                                               episode
                                               moderate

                                   (n=38)       (n=3)        (n=3)
                                   -100%       -(100%)      -(100%)

Age        Below 25yrs            3(7.9%)        Nil          Nil
           26 to 35yrs           13(34.20%)   2(66.70%)    1(33.30%)
           36 to 45yrs           18(47.40%)      Nil       2(66.70%)
           46yrs & above         4(100.50%)   1(33.30%)       Nil

Sex        Male                  14(36.80%)      Nil       1(33.30%)
           Female                22(57.90%)    3(100%)     2(66.70%)
           Transgender            2(5.30%)       Nil          Nil

Socio      Middle\lower middle    3(7.90%)       Nil          Nil
economic   Lower\upper  lower    28(73.70%)   2(66.70%)     3(100%)
           Lower                 7(18.40%)    1(33.30%)       Nil

Marital    Married               29(76.30%)    3(100%)      3(100%)
           Unmarried             4(10.50%)       Nil          Nil
           Widow                 5(13.20%)       Nil          Nil

Type of    Nuclear family        18(47.40%)   2(66.70%)     3(100%)
           Joint family          20(52.60%)   1(33.30%)       Nil

Area of    Rural                 29(76.30%)   2(66.70%)    2(66.70%)
           Urban                 9(23.70%)    1(33.30%)    1(33.30%)

Religion   Hindu                 32(84.20%)    3(100%)     2(66.70%)
           Muslim                 2(5.20%)       Nil          Nil
           Christian             4(10.50%)       Nil       1(33.30%)

                                  DEMOGRAPHIC PROFILE OF PATIENTS
                                    WITH PSYCHIATRIC MORBILITY

                                  Bipolar      Non      Delusional
                                 disorder    organic     disorder
                                    in       insomnia
                                 remission

                                   (n=1)      (n=2)       (n=1)
                                  -(100%)    -(100%)     -(100%)

Age        Below 25yrs              Nil        Nil         Nil
           26 to 35yrs              Nil        Nil         Nil
           36 to 45yrs            1(100%)     1(50%)     1(100%)
           46yrs & above           Nill       1(50%)       Nil

Sex        Male                   1(100%)     1(50%)       Nil
           Female                   Nil       1(50%)     1(100%)
           Transgender              Nil        Nil         Nil

Socio      Middle\lower middle      Nil        Nil         Nil
economic   Lower\upper  lower     1(100%)    2(100%)       Nil
           Lower                    Nil        Nil       1(100%)

Marital    Married                1(100%)     1(50%)       Nil
           Unmarried                Nil        Nil         Nil
           Widow                    Nil       1(50%)     1(100%)

Type of    Nuclear family           Nil        Nil       1(100%)
           Joint family           1(100%)    2(100%)       Nil

Area of    Rural                    Nil      2(100%)     1(100%)
           Urban                  1(100%)      Nil         Nil
Religion   Hindu                  1(100%)    2(100%)     1(100%)

           Muslim                   Nil        Nil         Nil
           Christian                Nil        Nil         Nil

                                 DEMOGRAPHIC PROFILE OF PATIENTS
                                   WITH PSYCHIATRIC MORBILITY

                                  Alcohol                    Total
                                 dependence
                                 with other    Nicotine
                                 habit and    dependence
                                  impulse
                                  disorder

                                   (n=1)        (n=1)        (n=50)
                                  -(100%)      -(100%)

Age        Below 25yrs              Nil          Nil        3(6.00%)
           26 to 35yrs            1(100%)        Nil       17(34.00%)
           36 to 45yrs              Nil          Nil       23(46.10%)
           46yrs & above            Nil        1(100%)       7(14%)

Sex        Male                   1(100%)      1(100%)     19(38.00%)
           Female                   Nil          Nil       29(58.00%)
           Transgender              Nil          Nil        2(4.00%)

Socio      Middle\lower middle      Nil          Nil        3(6.00%)
economic   Lower\upper  lower     1(100%)      1(100%)     38(76.00%)
           Lower                    Nil          Nil       9(18.00%)

Marital    Married                1(100%)      1(100%)     39(78.00%)
           Unmarried                Nil          Nil         4(8%)
           Widow                    Nil          Nil         7(14%)

Type of    Nuclear family         1(100%)      1(100%)      26(52%)
           Joint family             Nil          Nil        24(48%)

Area of    Rural                    Nil          Nil        36(72%)
           Urban                  1(100%)      1(100%)      14(28%)
Religion   Hindu                  1(100%)      1(100%)      43(86%)

           Muslim                   Nil          Nil         2(4%)
           Christian                Nil          Nil         5(10%)

                                   Statistical
                                    inference

Age        Below 25yrs           [X.sup.2]=17.843
           26 to 35yrs              .659>0.05
           36 to 45yrs           Not Significant
           46yrs & above

Sex        Male                  [X.sup.2]=8.310
           Female                   .873>0.05
           Transgender           Not Significant

Socio      Middle\lower middle   [X.sup.2]=7.946
economic                              Df=14
           Lower\upper  lower       .892>0.05
           Lower                 Not Significant

Marital    Married               [X.sup.2]=11.230
           Unmarried                .668>0.05
           Widow                 Not Significant

Type of    Nuclear family        [X.sup.2]=9.374
                                    .227>0.05
           Joint family          Not Significant

Area of    Rural                 [X.sup.2]=9.317
                                    .231>0.05
           Urban                 Not Significant

Religion   Hindu                 [X.sup.2]=3.525
                                      Df=14
           Muslim                   .998>0.05
           Christian             Not Significant

Table 4

STAGING OF ILLNESS AND PSYCHIATRIC MORBIDITY

Stage                     DEPRESSIVE                BIPOLAR
of HIV           NA        DISORDER    DYSTHYMIA   DISORDER
illness

I             37(97.4%)    2(66.7%)    3(100.0%)    1(100%)
II             1(2.6%)      0(.0%)      0(.0%)      0(.0%)
III            0(.0%)      1(33.3%)     0(.0%)      0().0%
CD4 count

1<250          3(7.9%)     1(33.3%)     0(.0%)      0(.0%)
250 to        16(42.1%)    1(33.3%)     0(.0%)      0(.0%)
500 to        15(39.5%)    1(33.3%)    1(33.3%)     0(.0%)
750 to 1000    3(7.9%)      0(.0%)     1(33.3%)    1(100.0%)
Above 1000     1(2.6%)      0(.0%)     1(33.3%)     0(.0%)

                                         ALCHOL
                                       DEPENDENCE
Stage            NON      DELUSIONAL   WITH ORTHER
of HIV         ORGANIC     DISORDER     HABIT AND
illness       INSOMNIA                   IMPULSE
                                        DISORDER

I             2(100.0%)     0(.0%0      1(100.0%)
II             0(.0%)     1(100.0%)      0(.0%)
III            0(.0%)       0(.0%)       0(.0%)
CD4 count

1<250          0(.0%)     1(100.0%)      0(.0%)
250 to        2(100.0%)     0(.0%)       0(.0%)
500 to         0(.0%)       0(.0%)       0(.0%)
750 to 1000    0(.0%)       0(.0%)      1(100.0%)
Above 1000     0(.0%)       0(.0%)       0(.0%)

Stage          NICOTINE                  STATISTICAL
of HIV        DEPENDENCE     TOTAL        INFERENCE
illness

I             1(100.0%)    47(94.0%)   [X.sup.2]=40.580
II              0(.0%)      2(4.0%)       Df=14.000
III             0(.0%)      1(2.0%0         <0.05
CD4 count                                Significant

1<250           0(.0%)     5(10.0%)    [X.sup.2]=41.057
250 to          0(.0%)     19(38.0%)        Df=28
500 to        1(100.0%)    18(36.0%)      .053>0.05
750 to 1000     0(.0%)     6(12.0%)    Not Significant
Above 1000      0(.0%)      2(4.0%)

Table 5

PERSONALITY PROFILE ANDPSYCHIATRIC MORBIDITY

EPQ               NA       DEPRESSIVE   DYSTHYMIA     BIPOLAR
psychosis                   DISORDER                  DISORDER

No            13 (34.2%)    0 (.0)%      0 (.0%)      0 (.0%)
Psychotic
traits (<5)

Psychotic     25 (65.8%)   3 (100.0%)   3 (100.0%)   1 (100.0%)
traits (>5)

EPQ EXTRA-
VERSION

Introvert     6 (15.8%)    1 (33.3%)     0 (.0%)      0 (.0%)
(<8)

Ambivert      24 (63.2%)   2 (66.7%)    3 (100.0%)   1 (100.0%)
(8to16)

High          8 (21.1%)     0 (.0%)      0 (.0%)      0 (.0%)
extravert
(17&above)

EPQ
NEUROTIC

Emotionally   11 (28.9%)    0 (.0%)      0 (.0%)      0 (.0%)
well
balanced
(Below 4)

Average       19 (50.0%)    0 (.0%)     1 (33.3%)     0 (.0%)
Neurotic
(5 to 13)

High          8 (21.1%)    3 (100.0%)   2 (66.7%)    1 (100.0%)
Neurotic
(14 &
above)

PERSONALITY PROFILE ANDPSYCHIATRIC MORBIDITY

                                           ALCHOL
                 NON                     DEPENDENCE
EPQ            ORGANIC     DELUSIONAL    WITH ORTHER
psychosis      INSOMNIA     DISORDER      HABIT AND
                                           IMPULSE
                                          DISORDER

No            2 (100.0%)     0 (.0%)       0 (.0%)
Psychotic
traits (<5)

Psychotic      0 (.0%)     1 (100.0 %)   1 (100.0%)
traits (>5)

EPQ EXTRA-
VERSION

Introvert     1 (50.0%)    1 (100.0 %)     0 (.0%)
(<8)

Ambivert       1 (5.0%)      0 (.0%)     1 (100.0%)
(8to16)

High           0 (.0%)       0 (.0%)       0 (.0%)
extravert
(17&above)

EPQ
NEUROTIC

Emotionally    0 (.0%)       0 (.0%)       0 (.0%)
well
balanced
(Below 4)

Average        0 (.0%)       0 (.0%)       0 (.0%)
Neurotic
(5 to 13)

High          2 (100.0%)   1 (100. 0%)   1 (100.0%)
Neurotic
(14 &
above)

PERSONALITY PROFILE ANDPSYCHIATRIC MORBIDITY

EPQ            NICOTINE      TOTAL        STATISTICAL
psychosis     DEPENDENCE                   INFERENCE

No             0 (.0%)     15 (30.0%)   [X.sup.2]=9.273
Psychotic                                     Df=7
traits (<5)                                .234>0.05

Psychotic     1 (100.0%)   35 (70.0%)         Not
traits (>5)                               Significant

EPQ EXTRA-
VERSION

Introvert      0 (.0%)     9 (18.0%)    [X.sup.2]=10.810
(<8)                                         Df=14
                                           .701>0.05
Ambivert      1 (100.0%)   33 (66.0%)         Not
(8to16)                                   Significant

High           0 (.0%)     8 (16.0%)
extravert
(17&above)

EPQ
NEUROTIC

Emotionally    0 (.0%)     11 (22.0%)   [X.sup.2]=20.682
well                                         Df=14
balanced                                   .110>0.05
(Below 4)                                     Not
                                          Significant
Average        0 (.0%)     20 (40.0%)
Neurotic
(5 to 13)

High          1 (100.0%)   19 (38.0%)
Neurotic
(14 &
above)

Table 6

                                   EPQ NEUROTIC

                  Emotionally         Average             High
                 well balanced        Neurotic          Neurotic
                   (Below 4)         (5 to 13)        (14 & above)

                (n=11)   (100%)   (n=20)   (100%)   (n=19)   (100%)

Age

Below 25yrs       0       .0%       2      10.0%      1       5.3%
26 to 35yrs       7      63.6%      6      30.0%      4      21.1%
36 to 45yrs       3      27.3%      11     55.0%      9      47.4%
46yrs & above     1       9.1%      1       5.0%      5      26.3%

Sex

Male              2      18.2%      8      40.0%      9      47.4%
Female            8      72.7%      12     60.0%      9      47.4%
Transgende        1       9.1%      0       .0%       1       5.3%

                  EPQ NEUROTIC

                     Total
                                          Statistical
                (n=50)   (100%)            inference

Age

Below 25yrs       3       6.0%      [chi square]=9.687 Df=6
26 to 35yrs       17     34.0%             .138>0.05
36 to 45yrs       23     46.0%          Not Significant
46yrs & above     7      14.0%

Sex

Male              19     38.0%    [chi square]=3.981 Df=4.409>
Female            29     58.0%        0.05 Not Significant
Transgende        2       4.0%

Table 7

                                 EPQ EXTRAVERSION

                 Introvert(<8)      Ambivert       High extravert
                                    (8to16)          (17&above)

                (n=9)   (100%)   (n=33)   (100%)   (n=8)   (100%)

Age

Below 25yrs       0      .0%       2       6.1%      1     12.5%
26 to 35yrs       4     44.4%      11     33.3%      2     25.0%
36 to 45yrs       3     33.3%      16     48.5%      4     50.0%
46yrs & above     2     22.2%      4      12.1%      1     12.5%

Sex

Male              4     44.4%      13     39.4%      2     25.0%
Female            5     55.6%      18     54.5%      6     75.0%
Transgender       0      .0%       2       6.1%      0      .0%

                EPQ EXTRAVERSION

                     Total          Statistical
                                     inference
                (n=50)   (100%)

Age

Below 25yrs       3       6.0%    [X.sup.2]=2.504
26 to 35yrs       17     34.0%    Df=6.868 >0.05
36 to 45yrs       23     46.0%          Not
46yrs & above     7      14.0%      Significant

Sex

Male              19     38.0%    [X.sup.2]=1.977
Female            29     58.0%    Df=4.740 >0.05
Transgender       2       4.0%    Not Significant

Table 8

                         EPQ psychosis

                  No Psychotic       Psychotic
                  traits (<5)       traits (>5)

                (n=15)   (100%)   (n=35)   (100%)

Age

Below 25yrs       1       6.7%      2       5.7%
26 to 35yrs       4      26.7%      13     37.1%
36 to 45yrs       8      53.3%      15     42.9%
46yrs & above     2      13.3%      5      14.3%

Sex

Male              3      20.0%      16     45.7%
Female            11     73.3%      18     51.4%
Transgender       1       6.7%      1       2.9%

                 EPQ psychosis          Statistical
                                         inference
                    Total

                (n=50)   (100%)

Age

Below 25yrs       3       6.0%    [X.sup.2]=.612 Df=3.894
26 to 35yrs       17     34.0%             >0.05
36 to 45yrs       23     46.0%        Not Significant
46yrs & above     7      14.0%

Sex

Male              19     38.0%    [X.sup.2]=3.077 Df=2.215
Female            29     58.0%             >0.05
Transgender       2       4.0%        Not Significant

Table 9: Correlations

Age                     Correlation value     Statistical inference

EPQ psychosis                 .023          .875>0.05 Not Significant
EPQ NEUROTIC                  .261          .067>0.05 Not Significant
Psychiatric morbidity         .116          .422>0.05 Not Significant
n                              50                      50

Table 10

Sex                     Correlation value     Statistical inference

EPQ psychosis                 -.245         .086>0.05 Not Significant
EPQ NEUROTIC                  -.260         .068>0.05 Not Significant
Psychiatric morbidity         -.199         .166>0.05 Not Significant
n                              50                      50

Table 11: Correlations

Stage of HIV illness    Correlation value     Statistical inference

EPQ psychosis                 .155          .281>0.05 Not Significant
EPQ NEUROTIC                  .064          .661>0.05 Not Significant
Psychiatric morbidity         .142          .326>0.05 Not Significant
n                              50                      50
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Title Annotation:ORIGINAL ARTICLE
Author:Devi, A. Niranjana; Muralitharan, R.; Sharmila, R.
Publication:Journal of Evolution of Medical and Dental Sciences
Article Type:Report
Date:Sep 3, 2015
Words:5445
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