Academic journal article Indian Journal of Psychiatry

A Follow-Up Study of Patients with Dhat Syndrome: Treatment Pattern, Outcome, and Reasons for Dropout from Treatment

Academic journal article Indian Journal of Psychiatry

A Follow-Up Study of Patients with Dhat Syndrome: Treatment Pattern, Outcome, and Reasons for Dropout from Treatment

Article excerpt

Byline: Sandeep. Grover, Sunil. Gupta, Ajit. Avasthi

Aim: The aim of this study was to evaluate the treatment pattern and satisfaction with treatment provided to patients with Dhat syndrome. It was also aimed to study the follow-up rates and reasons for dropping out of treatment in patients with Dhat syndrome. Materials and Methods: Sixty-four subjects diagnosed with Dhat syndrome were prospectively contacted to evaluate treatment satisfaction and reason for dropout after 6 months of baseline evaluation. Sociodemographic, clinical details were recorded at initial intake and Sex Knowledge and Attitude Questionnaire was applied. After 6 months, information on treatment received, number of follow-up visits to the clinic and the outcome were extracted from the treatment records. Treatment satisfaction using Patient Satisfaction Questionnaire and reasons for dropping out from treatment were assessed by a telephonic interview. Results: Twenty-three patients were categorized as treatment completers, 14 as early drop-outs and 27 as late drop-out. The mean (standard deviation) number of visits over the period of 6 months was 3.81 (3.06). The outcome at 6 months was no change in 45.3%, improved in 32.8% and recovered in 21.9%. Higher proportion of treatment completers (52.2%) sought psychiatric help on their own compared to those who dropped out early from the treatment (7.1%). Treatment completers had better knowledge, and more positive attitude toward sex compared to late drop-out group. 34.4%of the subjects were fully satisfied with the various components of treatment. Level of satisfaction was highest for treatment completers. The most common reasons given by those who dropped out early were "not able to spare time for consultation" (21.4%) and "not prescribed medications" (21.4%). The most common reason given by those belonging to "late drop-out" group was 'no improvement with treatment in symptoms of Dhat syndrome (40.7%). Conclusions: Patients with Dhat syndrome frequently drop-out of the treatment network. There is a need to reorganize the services for these patients and understand their expectations from the treatment so as to provide better care.

INTRODUCTION

"Dhat syndrome" is a culture-bound syndrome, characterized by the presence of somatic, anxiety, depressive and sexual symptoms, all of which are attributed to loss of semen. [sup][1] Although a number of studies from India [sup][2],[3],[4],[5],[6],[7] and other countries [sup][8],[9],[10],[11],[12] have described the clinical features of Dhat syndrome, little information is available about their treatment outcome. Available data suggests high drop-out rates. [sup][3],[13] Singh (1985) [sup][13] studied 50 patients presenting with male potency disorders of whom 40% patients fulfilled diagnosis of Dhat syndrome alone, and another 22% had Dhat syndrome with impotence. They reported that about two-third of the patients did not attend the clinic after the initial visit. Authors hypothesized that dissatisfaction with the explanation of disease provided to them could account for such early drop-out from the clinic. Bhatia and Malik [sup][7] examined 48 consecutive male patients of potency disorders, of whom two-third also had Dhat syndrome with or without impotency and/or premature ejaculation. In terms of treatment given the authors divided the study group into four sub-groups (anti-anxiety drug, anti-depressant, placebo, and psychotherapy) and reported best response in those receiving anti-anxiety or anti-depressant drugs while those receiving psychotherapy showed minimal response. In another study involving 50 patients, Behere and Natraj [sup][5] treated patients with Dhat syndrome with psychoeducation and minor tranquilizers and by the end of 1-year reported about two-third of them to have recovered from their symptoms. In another small sample of subjects ( n = 30), Dhikav et al . [sup][14] reported usefulness of selective serotonin reuptake inhibitors and regular counseling in patients of Dhat syndrome with comorbid depression. …

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