RESUMEN
BACKGROUND: Our aim was to investigate the influence of depressive symptoms on the clinical presentation of Persistent Delusional Disorder (PDD). METHODS: We have previously conducted a retrospective review of patients diagnosed with PDD (nâ¯=â¯455). We divided this sample into two groups according to the presence or absence of co-morbid depressive symptoms - a subsample of PDD with depressive co-morbidity (PDDâ¯+â¯D; nâ¯=â¯187) and a subsample of PDD without depressive co-morbidity (PDD only; nâ¯=â¯268). RESULTS: PDDâ¯+â¯D group had a significantly younger age at onset of PDD. The PDDâ¯+â¯D group received significantly more antidepressants but had similar response and adherence rates. CONCLUSIONS: The presence of depressive symptoms in 41% of the study population did not appear to influence the clinical presentation or response to treatment.
Asunto(s)
Depresión/fisiopatología , Esquizofrenia Paranoide/fisiopatología , Adulto , Comorbilidad , Depresión/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Esquizofrenia Paranoide/epidemiología , Adulto JovenRESUMEN
There is a dearth of prospective trials studying treatment response in Persistent Delusional Disorder (PDD) to guide clinical practice. Available retrospective data indicate good response to second-generation antipsychotics (SGAs). We selected the data of patients prescribed either olanzapine or risperidone from a retrospective chart review of PDD (n=455) at our centre. We compared the two groups olanzapine (n =86) versus risperidone (n =280) on dose, drug adherence, response and adverse effects. The two groups were comparable on socio-demographic and clinical characteristics of PDD. There was no statistically significant difference between the two groups on adherence (>80%) and response to treatment (>52% good response). Olanzapine was effective at lower mean chlorpromazine equivalents than risperidone. Logistic regression analysis identified shorter mean duration of illness, good adherence and absence of substance dependence as predictors of good response to both drugs. Our study indicates that acute PDD responds well to treatment with both risperidone and olanzapine, provided adherence can be ensured. In the absence of specific treatment guidelines and randomized controlled trials for PDD, our analysis reaffirms the efficacy of SGAs.
Asunto(s)
Antipsicóticos/uso terapéutico , Benzodiazepinas/uso terapéutico , Risperidona/uso terapéutico , Esquizofrenia Paranoide/tratamiento farmacológico , Adulto , Clorpromazina/uso terapéutico , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Olanzapina , Estudios Prospectivos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: Despite its long history as a psychiatric diagnosis, little is known about the sociodemographic and clinical profile of persistent delusional disorder (PDD) or its subtypes, treatment response, and outcomes, particularly in India. We examined the clinical characteristics and course of PDD in patients presenting to a tertiary neuropsychiatry center in India. METHOD: A retrospective chart review of patients diagnosed with PDD (ICD-10) between January 2000 and May 2014 was conducted. Sociodemographic and clinical data including age at onset, total duration of the illness, clinical symptoms and treatment, hospitalizations, occupational functioning, and follow-up were extracted from the files. The study was approved by the institute ethics committee. RESULTS: The sample (N = 455) consisted of 236 men and 219 women. The mean age at onset was 32.36 ± 10.47 years. The most common delusion was infidelity (n = 203, 44.6%) followed by persecution (n = 149, 32.7%). Hallucinations were present in 78 (17.1%), depressive symptoms in 187 (41.1%), and comorbid substance dependence in 61 (13.4%) subjects; 141 subjects (31.0%) had a family history of mental illness. Follow-up data were available for 308 subjects, of whom 285 (92.5%) reported good compliance with medication. Of the subjects, 163 (52.9%) showed a good response to treatment. The diagnosis of PDD remained unchanged in 274 of 308 subjects (88.9%). CONCLUSION: In our center, PDD appears to be uncommon and has a near-equal gender representation. Infidelity was the most common delusion, which is in contrast to the reported literature. The diagnosis of PDD appears to be stable with good response to atypical antipsychotics if compliance can be ensured.
Asunto(s)
Antipsicóticos/uso terapéutico , Relaciones Extramatrimoniales , Alucinaciones/fisiopatología , Esquizofrenia Paranoide/fisiopatología , Adulto , Femenino , Estudios de Seguimiento , Alucinaciones/tratamiento farmacológico , Alucinaciones/epidemiología , Humanos , India , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Esquizofrenia Paranoide/tratamiento farmacológico , Esquizofrenia Paranoide/epidemiología , Centros de Atención Terciaria/estadística & datos numéricos , Adulto JovenRESUMEN
The study objective was to comprehensively evaluate drug-naïve, adult patients with Obsessive Compulsive Disorder (OCD) for cortical structure abnormalities in comparison with healthy controls. In this cross-sectional study of case-control design, Magnetic Resonance Imaging (1-mm) was performed in drug-naïve OCD patients (N = 50) & age- sex-, education- and handedness-matched healthy controls (N = 40). We examined cortical volume, thickness, surface area & local Gyrification Index (LGI) through a completely automated surface-based morphometric analysis using FreeSurfer software. OCD symptoms and insight were assessed using Yale-Brown Obsessive Compulsive Symptom (Y-BOCS) check-list and severity scale. Illness severity was assessed using Clinical Global Impression Severity (CGI-S) Scale. OCD patients had significantly deficient volume, thickness and surface area of right anterior cingulate gyrus (ACG). Right lingual gyrus surface area was found to be significantly decreased in patients. Y-BOCS obsession score had significant negative correlation with left frontal pole volume. Y-BOCS compulsion score had significant negative correlations with right ACG volume and surface area and right lateral orbitofrontal cortex LGI. CGI-Severity score had significant negative correlations with right lingual gyrus volume, thickness and surface area as well as right lateral orbitofrontal area. Y-BOCS insight score showed a significant negative correlation with LGI of left medial OFC and left rostral ACG. Identification of novel deficits involving occipital brain regions and first-time observations of relevant correlations between various illness characteristics and cortical measures in OCD patients supports a network involving anterior cingulate, orbitofrontal and occipital brain regions in the pathogenesis of OCD.
Asunto(s)
Corteza Cerebral/patología , Trastorno Obsesivo Compulsivo/patología , Adulto , Estudios de Casos y Controles , Estudios Transversales , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Imagen por Resonancia Magnética , Masculino , Escalas de Valoración Psiquiátrica , Adulto JovenRESUMEN
OBJECTIVE: This study aims at identifying predictors of treatment response to lorazepam in catatonia. METHODS: The clinical charts of 107 inpatients, admitted over duration of 2 years, with a primary diagnosis of catatonia were examined for response to lorazepam trial. Trial was considered as having received 3-6 mg per day of lorazepam for at least 3 days. RESULTS: Out of these 107 patients, 99 received lorazepam and 8 received electroconvulsive therapy as the first line of management. There were 32 responders and 67 nonresponders to lorazepam. The nonresponders were characterized by rural background (85.1% vs. 62.5%, P=.01), longer duration of catatonic symptoms (108.88 vs. 25.12 days, P=.018), mutism (63.6% vs. 31.3%, P=.02) and presence of first-rank symptoms like third-person auditory discussing-type hallucinations (16.4% vs. 12.0%, P=.03) and made phenomena (7.5% vs. 0%, P=.04). The presence of waxy flexibility (12.5% vs. 4.5%, P=.03) predicted good response. CONCLUSIONS: This study identifies that longer duration of illness, presence of catatonic sign of mutism and certain specific phenomena like third-person auditory hallucinations and made phenomena predicted poor response to lorazepam in catatonia. This could provide insight into the prediction and planning of the appropriate treatment strategies in this psychiatric emergency.
Asunto(s)
Catatonia/tratamiento farmacológico , Hipnóticos y Sedantes/uso terapéutico , Lorazepam/uso terapéutico , Adolescente , Adulto , Anciano , Femenino , Predicción , Humanos , Hipnóticos y Sedantes/administración & dosificación , India , Lorazepam/administración & dosificación , Masculino , Auditoría Médica , Persona de Mediana Edad , Pronóstico , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: To identify any changes in the prevalence of bipolar disorder (BD) between 1998, 2004, and 2008. METHOD: Cross-sectional population-based surveys were conducted involving random and representative samples of South Australian adults aged ≥ 15 years. BD was assessed using the mood module of the Primary Care Evaluation of Mental Disorders instrument (PRIME-MD), a single question related to doctor-diagnosed BD and the Mood Disorder Questionnaire (MDQ), which defines bipolar spectrum disorder. RESULTS: The PRIME-MD-derived prevalence of BD increased significantly from 0.5% [95% confidence interval (CI): 0.27-0.79] in 1998 to 1.0% (95% CI: 0.61-1.31) in 2004 and 1.5% (95% CI: 1.05-1.91) in 2008, demonstrating a significant increased linear trend (χ² =13.91, df=2, p=0.002). Similarly, reported doctor-diagnosed BD increased significantly from 1.1% (95% CI: 0.75-1.51) in 1998 to 1.7% (95% CI: 1.26-2.18) in 2004 and 2.9% (95% CI: 2.28-3.48) in 2008 (Linear trend test χ²=24.55, df=2, p<0.001). The MDQ-derived diagnosis of bipolar spectrum disorder changed from 2.5% (95% CI: 1.96-3.08) in 2004 to 3.3% (95% CI: 2.66-3.94) in 2008 (χ² =3.22, df=1, p<0.10), but this difference did not attain statistical significance. Confining the analysis to those positive for BD on all three methods, there was a significant increase in the prevalence of the detection of BD using all three measures (χ² =4.43, df=1, p=0.03) between 2004 and 2008. CONCLUSIONS: There has been an increased prevalence of BD in South Australia over the last decade, but this may be related to changing diagnostic practices rather than a true increase.
Asunto(s)
Trastorno Bipolar/epidemiología , Planificación en Salud Comunitaria , Adolescente , Adulto , Factores de Edad , Anciano , Análisis de Varianza , Australia/epidemiología , Trastorno Bipolar/terapia , Estudios Transversales , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Atención Primaria de Salud/métodos , Atención Primaria de Salud/estadística & datos numéricos , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: Catatonia is a syndrome characterized by concurrent motor, emotional, and behavioral symptoms. Short-term benzodiazepine administration and electroconvulsive therapy have proven to be safe and useful for treatment of this syndrome. AIMS: This study aimed to explore the evidence of effectiveness of lorazepam as a first line treatment for catatonia in a tertiary psychiatry centre in India given the lack of facilities for ECT in primary care centers of developing countries. We examined the response rate of lorazepam in Catatonia. METHODOLOGY: Clinical charts of 107 inpatients, admitted over a duration of two years, with a primary diagnosis of catatonia were examined for response with lorazepam trial. Trial was considered as having received 3-6 mg per day of lorazepam for at least 3 days. RESULTS: Among the patients who were given lorazepam treatment, 32 out of 99 (32.3%) showed response (with complete resolution of catatonic symptoms). Improvement in catatonic symptoms was seen in 68 out of 99 (68.7%) patients. CONCLUSIONS: Lorazepam is cost effective and could rapidly relieve catatonic signs, even without the use of ECT in a significant proportion of catatonic patients. Its early use can prevent disease progression and complications.
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Catatonia/tratamiento farmacológico , Catatonia/psicología , Países en Desarrollo , Lorazepam/uso terapéutico , Tiempo de Reacción/efectos de los fármacos , Adolescente , Adulto , Catatonia/epidemiología , Femenino , Humanos , India/epidemiología , Lorazepam/farmacología , Masculino , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
Comorbidity of obsessive-compulsive disorder (OCD) in bipolar disorder is well documented. However, clinical characteristics of bipolar OCD are not well studied. The objective of the present study was to compare the clinical characteristics of bipolar and nonbipolar OCD. We chose 28 subjects with bipolar-OCD comorbidity from a sample of 80 remitted bipolar subjects (bipolar OCD) attending the outpatient services of the National Institute of Mental Health and Neurosciences, Bangalore, India, over a period of 11 months. We also recruited 78 nonbipolar OCD subjects consecutively during the same period from the OCD clinic of the institute. They underwent systematic assessment using both structured and unstructured clinical interviews and corroborative information obtained from the immediate family members and the hospital clinical charts. Bipolar OCD subjects were characterized by episodic course of OCD, high family loading for mood disorders, and comorbidity with depression, social phobia, and generalized anxiety disorder. They had less severe OCD and had somewhat different symptom profile compared with nonbipolar OCD. The OCD predated bipolar disorder in 54% of the bipolar OCD subjects; and in the remaining subjects, it had an onset during the course of bipolar disorder. Most bipolar OCD subjects reported worsening of OCD in depression (n = 22, 78%) and improvement in manic/hypomanic episodes (n = 18, 64%). Our findings suggest that OCD in those with a primary diagnosis of bipolar disorder is perhaps pathophysiologically related to bipolar disorder than to OCD. This is strongly supported by the episodic course of OCD, high familial loading for mood disorders, and worsening of OCD in depression with improvement in hypomania/mania phases. There is a need for systematic exploration of the OCD-bipolar comorbidity in both OCD and bipolar samples. Family-genetic and other neurobiological research and the prospective follow-up of bipolar and nonbipolar OCD subjects would further enhance our understanding of this complex comorbidity. The cross-sectional nature of the study based on retrospective assessment of course, the small sample size and the inclusion of only remitted bipolar subjects are the limitations of this study.