RESUMEN
BACKGROUND: Resistance to recommended medications has been an issue in dealing with a number of psychiatric ailments, and it is showing up as an ongoing challenge for contemporary mental health experts. Resistant psychiatric disorders not only increase the morbidity of patients suffering from such severe conditions but also intensify the problems of their caretakers. This has vigorously started to cause the costs to increase for healthcare services. Thanks to electroconvulsive therapy (ECT), we now have an effective method that is proving to be a fruitful final course of action in this micro-epidemic of resistant psychiatric diseases. However, the medical literature of case reports or studies in this niche is scarce. Also, no such comprehensive study has been carried out in the Southeast Asian region to date for the assessment of the effectiveness of electroconvulsive therapy in patients with medication-resistant psychiatric disorders. AIM: To assess the effectiveness of ECT in medication-resistant psychiatric patients at the post-ECT course, three-month follow-up, and six-month follow-up. MATERIALS AND METHODS: The study was a prospective and interventional study (without controls) conducted in the Institute of Mental Health and Neurosciences (IMHANS), Srinagar, India. Fifty-six patients with pharmacotherapy-resistant psychiatric disorders were included in the study. The patients were assessed at the end of the ECT course, at the three-month follow-up, and at the six-month follow-up by the Clinical Global Impression (CGI), Montgomery Asberg Depression Rating Scale (MADRS), Young Manic Rating Scale (YMRS) and the Yale-Brown Obsessive Compulsive Scale (YBOCS). Improvement was defined with the help of the CGI subscale by comparing the position of the patient at admission to the projected condition with ECT. STATISTICAL ANALYSIS: Analysis of Variance (ANOVA) was used for analysis of the quantitative data. For the pair-wise comparison of the groups, the post hoc tests were used. Pearson's chi-square test was used for analysis of qualitative data. A p-value of < 0.05 was considered to be statistically significant, and all the data analysis was done using SPSS Version 20.0. RESULTS: The CGI scale revealed that statistically significant improvement occurred in patients at the end of ECT course, at the three-month follow-up as well as at the six-month follow-up. CONCLUSION: ECT should be used for the treatment of pharmacotherapy-resistant psychiatric patients and the benefits can be seen even six months after an ECT course completion. Further work in this field should focus on educating the general public about the usefulness of ECT in the treatment of resistant mental illnesses. The myths related to the so-called psychiatric assault from ECT should be removed.
RESUMEN
BACKGROUND: The progress that man has made in all domains of life, during all these years of reign over the earth, is utterly remarkable. However, it always came at a price. Each epoch of progress has seen human beings inflicted with trauma and cynical consequences. During the last two decades, Kashmiri (Indian) people have experienced continuous violence, a reign of terror, and political turmoil. Each of these disastrous events has contributed to the increase in psychiatric disorders in this part of the world, especially major depressive disorders. We can observe that besides the environmental influences, gene polymorphism also plays a crucial role in the development of depressive disorders. The role of Tryptophan Hydroxylase 1 (TPH1) gene is implicated in various psychiatric disorders, including depression. However, no study has investigated TPH1 A779C gene polymorphism in depressive disorders in a distressed society like Kashmir (India). AIMS: To study TPH1 A779C single nucleotide polymorphism in depressive disorders in Kashmiri (Indian) population. MATERIALS AND METHODS: Two hundred and forty patients diagnosed with depressive disorder, and 160 unrelated healthy volunteers (control), were studied in a case-control study design. Polymorphism was determined using polymerase chain reaction (PCR) and agarose gel electrophoresis, after digestion with HAP II enzyme. Genotypes and allele frequencies were compared using Chi-square tests, Fisher's exact test, odds ratio, 95% confidence interval (C.I.) and a p-value of <0.05 was considered to be statistically significant. RESULTS: The mean age ± standard deviation (SD) of depression and control group was 32.02±10.99 and 31.75±9.93, respectively (p= 0.512). It was found that the patients from depression group had AA genotype (51.7%) in comparison to control group (17.5%) and these results were statistically significant (p≤0.0001). Calculation of allelic frequency revealed a stronger association of A allele with depression group (70.83%) than with the control group (41.25%), and it was also found to be statistically significant (p≤0.0001) with C.I. of 3.459 (1.909-6.266). CONCLUSION: TPH1 A779C A gene was found to be associated with a major depressive disorder (MDD) in Kashmiri (Indian) population. There were high HAM-A as well as HAM-D scores in depressive patients of Kashmir (India).
RESUMEN
BACKGROUND: A gradual increase in the longevity due to advancement of treatment modalities and a subsequent surge in elderly population in India have led to a growing curiosity in the geriatric age group with Alzheimer's disease (AD). Behavioral and psychological symptoms of dementia (BPSD) represent epiphenomena of AD. However, no comprehensive study has been carried out in South East Asia (Kashmir, India), to assess the behavioral and psychological symptoms in subtypes of AD. OBJECTIVES: The purpose of this study was to assess BPSD in early-onset Alzheimer's disease (EOAD) and late-onset Alzheimer's disease (LOAD). MATERIAL AND METHODS: The study was conducted in the Memory clinic of the postgraduate department of psychiatry, Government Medical College, Kashmir, India from January 2012 to March 2014. The diagnosis of AD patients was done according to NINCDS-ADRDA criteria. A total of 80 patients of AD were screened (40 with age of onset less than 65, and 40 with age of onset greater than 64). Neuropsychiatric inventory (NPI) was the instrument used for evaluating symptoms of BPSD. The data was analyzed using paired t-test. RESULTS: The mean age of presentation of EOAD and LOAD was 63.10 years and 84.28 years, respectively, and the difference between the two was found to be statistically significant. The LOAD group had significantly higher symptom severity for delusions, agitation, anxiety, disinhibition, and nighttime behavioral disturbances (NBD) than the EOAD group (p ≤.0001). CONCLUSION: The behavioral and psychological symptoms are significantly severe in late onset subtype compared to the early onset subtype of Alzheimer's disease in the Kashmiri (Indian) population.
RESUMEN
Post-traumatic stress disorder (PTSD) occurs due to traumatic events. The last two decades have seen various traumatic events in Kashmiri population, which has led to psychological impact on all population, especially children. PTSD is one of the psychiatric disorders occurring after witnessing of traumatic events. A review of literature regarding PTSD in children of Kashmir (India) has been done to assess the prevalence, causes, neurobiology, risk factors and psychiatric co morbidity associated with it.
RESUMEN
Neuropsychiatric systemic lupus erythematous (SLE) encompasses various psychiatric and neurological manifestations that develop in SLE patients, secondary to involvement of central nervous system. Neuropsychiatric SLE, presenting as catatonia is very uncommon, and treatment of this condition is not well defined. Previously the role of benzodiazepines, immunosuppression, plasma exchange, and electroconvulsive therapy (ECT) has been described in its management. Here we describe a case of neuropsychiatric lupus presenting as catatonia that did not respond to benzodiazepines or immunosuppression. The symptoms of catatonia showed improvement with ECT. Furthermore, we have discussed the pathology of the disorder and the role of ECT in the treatment of cases of catatonia associated with SLE, who do not respond to benzodiazepines.
RESUMEN
Human beings are social species which require safe and secure social surroundings to survive. Satisfying social relationships are essential for mental and physical well beings. Impaired social relationship can lead to loneliness. Since the time of dawn, loneliness is perceived as a global human phenomenon. Loneliness can lead to various psychiatric disorders like depression, alcohol abuse, child abuse, sleep problems, personality disorders and Alzheimer's disease. It also leads to various physical disorders like diabetes, autoimmune disorders like rheumatoid arthritis, lupus and cardiovascular diseases like coronary heart disease, hypertension (HTN), obesity, physiological aging, cancer, poor hearing and poor health. Left untended, loneliness can have serious consequences for mental and physical health of people. Therefore it is important to intervene at the right time to prevent loneliness, so that physical and mental health of patients is maintained.
RESUMEN
BACKGROUND: Delirium or acute confusional state is an acute neuropsychiatric syndrome, with varied cognitive dysfunctions. However, no comprehensive studies about this common condition have been carried out in India. OBJECTIVES: To assess cognitive dysfunctions in hypoactive and hyperactive delirium. MATERIALS AND METHODS: Forty cases of delirium including hypoactive and hyperactive delirium and 40 other patients (neuropsychiatric patients) were studied as controls. Cognitive status estimation test, mini mental state examination and memorial delirium assessment scale were administered to each patient. All assessments were carried out three times in 24 hour cycle of day and night. The data was analysed using two sample independent t-test. RESULTS: The mean age (standard deviation) of study and control group was 27.85 (13.73) and 33.10 (11.26) years respectively. 70% patients had hyperactive delirium while 30% were having hypoactive delirium. Hypoactive delirium had more cognitive impairment compared to hyperactive delirium (p=0.001). The difference between highest and lowest score of MMSE in both types of delirium (day to night) was found to be statically significant (p=0.001). CONCLUSION: The fluctuation in intensity of cognitive symptoms varies from day to night in both types of delirium, but more in hypoactive delirium and wider fluctuation in cognitive dysfunctions was noted in delirium cases with psychosis.
RESUMEN
Dissociative identity disorder (DID) is one of the most fascinating disorders in psychiatry. The arduous search to reveal the obscurity of this disorder has led to colossal research in this area over the years. Although drug-assisted interviews are not widely used, they may be beneficial for some patients that do not respond to conventional treatments such as supportive psychotherapy or psychopharmacotherapy. Drug-assisted interviews facilitate recall of memories in promoting integration of dissociative information. We report a case of a 16-year-old female with dissociative identity disorder (DID) that was treated with lorazepam-assisted interview and there was rapid improvement in symptoms after the interview.
RESUMEN
BACKGROUND: The gene of tryptophan hydroxylase is widely recognized as a major candidate gene in many psychiatric disorders. However, no study has been done which investigates tryptophan hydroxylase 2 gene polymorphism in anxiety and depressive disorders in Kashmiri population (India). OBJECTIVES: To study tryptophan hydroxylase 2 (TPH2) C 11993 A gene polymorphism in anxiety and depressive disorders. METHOD: Sixty patients of depression disorder, 60 patients of anxiety disorder and 40 unrelated healthy volunteers (control) were studied in a case control design. Polymorphism was determined using polymerase chain reaction (PCR) and agarose gel electrophoresis after digestion with HAP II enzyme. Genotypes and allele frequencies were compared using Chi-square tests, Fischer's exact test, odds ratio, 95% confidence interval (C.I) and p-value of <0.05 was considered to be statistical significant. RESULTS: The mean age ± SD of anxiety, depression and control group was 32.73±10.99, 32.20±10 and 29.75±10.12 respectively and the difference was found to be statistically non significant (p=0.349).The mean HAM-A (Hamilton rating scale for anxiety) score and HAM-D (Hamilton rating scale for depression) score was high in both groups (anxiety and depression) and found to be statistically significant (p=0.001).Depression group had AA genotype (55.2%) than control (37.5%) and was found to be statistically non significant (p=0.890).Comparison of allelic frequency revealed no association of A allele in anxiety group (76.67%) compared with control (75.5%) and was found to be statistically non significant (p= 0.866), OR 1.09 (0.56-2.11). CONCLUSION: TPH2C 11993 A gene was not found to be associated with major depressive disorder (MDD) and anxiety disorder in Kashmiri population.
RESUMEN
OBJECTIVE: To estimate the Prevalence of post-traumatic stress disorders (PTSD) among adults in field practise areas of Government Medical College, Srinagar, India. METHODOLOGY: The present study was cross-sectional in nature and was conducted in field practice areas of Government Medical College Srinagar. Three blocks of field practise areas of Government Medical College, Srinagar comprising of various villages were selected. Further 10 per cent of these villages were selected by the method of randomization sampling and then 10 per cent of household were taken again by systemic random sampling. In the selected household all adult population (18 years and above) were selected and screened by using General health questionnaires(GHQ). The patients who screened positive for PTSD (post-traumatic stress Disorders) were assessed and diagnosed. From the line listing the positive cases, the prevalence rates were calculated. RESULTS: Of the total 3400 subjects (age≥18 years), the prevalence of posttraumatic stress disorders among general population was found to be 3.76%. Prevalence was found to be more in females (Chi-square test=2.086, p>0.05 (Insignificant). Most of cases were found to be in the age group 0-40 years. Most of the cases were unmarried, illiterate and belong to lower socioeconomic class. Death of near one comprised the major traumatic event. Acute onset Posttraumatic stress disorder was the commonest type, previous history of psychiatric illness was found in 12 % of patients and drug abuse was present in 22.6%. CONCLUSION: Our findings clearly indicates that posttraumatic stress disorders (PTSD) is a prevalent disorder in the developing world, especially in disaster prone regions and in areas of political unrest. Resilience to various traumatic events in Kashmir has developed over the years and this might explains the lower prevalence of Post-traumatic disorder (PTSD) in our study.
RESUMEN
Anorexia nervosa presenting as Wernicke-Korsakoff syndrome is rare. The causes of Wernicke-Korsakoff syndrome are multiple like alcohol abuse, thyrotoxicosis, haemodialysis, severe malnutrition because of gastric carcinoma and pyloric obstruction, hyperemesis gravidarum, and prolonged parenteral feeding. We report a case of anorexia nervosa, who presented with Wernicke's encephalopathy and progressed to Korsakoff's syndrome. Knowledge, awareness, and early intervention of anorexia nervosa by mental health professionals can prevent development of Wernicke-Korsakoff syndrome.
RESUMEN
BACKGROUND: 5HTTLPR polymorphism (5- Hydroxy tryptamine transporter linked promoter region polymorphism) is the most widely studied genetic variant in psychiatry. The present study is a modest effort at ascertaining the role of 5HT transporter linked promoter region polymorphism (5HTTLPR) in anxiety and depressive disorders in Kashmir (India).The aim of this study was to examine 5-Hydroxy tryptamine transporter (5HTT) gene promoter region polymorphism in anxiety and depressive disorders. METHODS: Thirty patients with unipolar depressive disorders, 30 patients with anxiety disorders and 40 healthy volunteers (controls) were studied on a case control design, using polymerase chain reaction (PCR) and agarose gel electrophoresis after digestion with endonuclease enzyme. Genotypes and allele frequencies were compared using chi square tests, and p value of < 0.05 was considered as statistically significant. RESULTS: The mean (±sd) HAM-A (Hamilton rating scale for anxiety) scores for anxiety and depressive groups were 28.2±5.14 and 17±5.61, respectively (P < 0.001). The mean (±sd) HAM-D (Hamilton rating scale for depression) scores for depressive and anxiety groups were 25±5.58 and 15±6.13, respectively. (p< 0.001). The frequency of S allele was significantly high (83.3% vs 60%) in the group with anxiety (p< 0.05) compared to the control group (p> 0.05). CONCLUSION: The genetic studies are still evolving as pathogenesis of anxiety and depressive disorders and involve the interaction of environmental factors with various genes. Genetic variation in different populations and hence different environments is important for elucidation of the mechanisms of these disorders. However, the study concludes that the locus under study is not shared between the two disorders.
RESUMEN
Fahr's disease (FD) is a rare neuropsychiatric disease consisting of bilateral basal ganglia calcification with neurological, cognitive, and psychiatric manifestations. We report here a sporadic case of FDs with its neuropsychology.