Dr Austin Fernandes, one of the five psychiatrists at the hospital who joined in December 2014, said that 80-90% of the depression and psychosis cases seen in TB patients were drug induced.
Asia's largest tuberculosis (TB) hospital, in Sewri, was infamous for patient suicides but the appointment of full-time psychiatrists seems to have finally broken that trend, at least as per the hospital's records.
"There was a time when there was a suicide every month. We tried our best to step up security but, each time, the patients came up with innovative ways. But things have changed after we appointed full-time psychiatrists for our patients," said Dr Rajendra Nanavre, medical superintendent, Sewri TB hospital.
Dr Austin Fernandes, one of the five psychiatrists at the hospital who joined in December 2014, said that 80-90% of the depression and psychosis cases seen in TB patients were drug induced. "Since depression and psychosis were side-effects of the drugs given for treatment, it was a challenge to ensure that the patients continue with the treatment as well as control the side-effects via other psychiatry medicines," said Fernandes.
The second-line drug cyclocerine is known to induce psychosis in patients.
The psychiatrists now see 210 patients in the hospital's outdoor patients unit every week, apart from 30-40 patients admitted at the hospital. "For patients who are admitted in the hospital, we have trained nurses and doctors to intimate us if they see any abnormal behaviour or the slightest of sleep disturbances in them, after which we immediately start our intervention," said Dr Rohann Bokdawala, a psychiatrist working with Fernandes.
All the outdoor patients, especially multi-drug resistant (MDR) TB patients, undergo psychiatric screening. "Before starting on MDR TB treatment, patients undergo psychological tests for clinical intervention. We ask them about their sleep pattern, mood anxiety, past psychiatry episodes, etc. This helps us identify any psychological problems at the earliest," said Dr Prathamesh Kulkarni, another psychiatrist attached with the hospital.
Citing one of the many examples where the psychiatrists have succeeded in averting an untoward incident, Fernandes said, "A month ago, we had a 40-year-old MDR TB patient who was schizophrenic. He was a threat to himself and others as well. We gave him injectable anti-psychotic medicines. He calmed down and now he is doing fine and we have even been able to discharge him.".
The hospital has also started yoga, meditation and vocational training sessions to keep the patients occupied.
Welcoming the change at the Sewri TB hospital, Dr Harish Shetty, a psychiatrist at Dr LH Hirnandani Hospital, said: "The disease itself emotionally breaks a patient. The long treatment duration adds to their woes. The side-effects of the drugs cannot be ignored and many patients leave the treatment mid-way because of the side effects. Social stigma, loss of work, etc add up to their problem. Timely counselling and psychiatric intervention can help save lives and ensure adherence to the treatment. In fact, every TB patient should undergo compulsory psychological intervention."
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