Severity and Dimensions of Obsessive-Compulsive Disorder and Family Accommodation: OCD severity and Family Accommodation

Background and Objectives: Family accommodation (FA) refers to ways in which family members assistthe patient in the performance of rituals, compulsions, avoidance of anxiety provoking situations, ormodification of daily routines to assist a relative with obsessive-compulsive disorder. The purpose of thisstudy was to study the association between the family accommodation and dimensions of obsessivecompulsive disorder (OCD).Methods: The study was included 45patients and their family members, Yale brown Obsessive-Compulsivescale (YBOCS) was used to assess the severity of OCD in patients and Dimensional Yale brown ObsessiveCompulsive scale (DYBOCS) was used to identify the severity of different dimensions in OCD patientsfamily members were assessed on Family Accommodation Scale for Obsessive–Compulsive Disorder – SelfRated version (FAS-SR) for understanding accommodation level in family. A Pearson’s correlationcoefficient was used to evaluate the association between variables.Results: FA was found to be highly present in the family of patients with OCD. On the DYBOCS we foundthe dimension of cleaning and washing were prevalent and highly correlated with FA.Conclusion: The findings suggested that the family accommodation is very common in families of OCDpatients and strongly associated with symptom severity of few specific dimensions.

A Randomised Placebo Controlled Trial of Herbal Medicine (Sugaradik) in the Treatment of Type 2 Diabetes.

To evaluate the safety and effectiveness of polyherbal powder (Sugaradik) in achieving glycaemic control in newly diagnosed type 2 diabetics. Methods: It was a randomised double blind placebo controlled study. Eighty newly diagnosed patients of type 2 diabetes were selected after meeting inclusion and exclusion criteria. Patients were randomly divided into two groups. One group received drug and other group received placebo bearing a distinctive code number. Anthropometric parameters and HbA1c were performed initially as well as after three months of treatment period. Fasting blood sugar and blood pressure were recorded weekly. Student’s ‘t’ test was applied as statistical tool. Results: After three months of treatment of polyherbal powder (Sugaradik) there was a significant improvement in systolic blood pressure (136.05±3.30 to 126.42±1.51 mmHg) and fasting blood sugar (233.03±8.81 to 136.16±4.96 mg/dl; p less than 0.001). There was a significant reduction in HbA1c (8.39±0.30 to 6.37±0.10 percent; p less than 0.001). No adverse effects were observed in this trial. Conclusion: Polyherbal preparation of ten classic herbs appears to be effective in controlling glycemia. Sugaradik seems to be a safe drug and an effective oral agent in the management of type 2 diabetes.

A Comparative Study of Phenomenology, Psychiatric Co-Morbidities and Global Functioning of People with ADHD from Childhood to Adulthood.

Introduction: Although previously thought to remit largely in adolescence, a growing literature supports the persistence of the disorder and/or associated impairment into adulthood. Studies in India are lacking on ADMD. Aims and Objectives: To compare the phenomenology of ADHD in childhood, adolescence and adulthood, to compare the psychiatric co-morbidities with ADHD in childhood, adolescence and adulthood, to compare the global functioning of subjects with ADHD in childhood, adolescence and adulthood. Methods: A statistical comparison was made between studies done in dept. of psychiatry, CSMMU UP, Lucknow on childhood, adolescent and adult ADHD for its various aspects. Conclusions: Hyperactivity-impulsivity decreases as subjects with ADHD grow up and inattention symptoms become more impairing, ADHD is highly co-morbid across all age groups but the nature of co-morbidities change, functioning of subjects with ADHD improve as they grow older.

A Comparative Study of Social, Adaptive, Relational and Global Functioning of Adolescents with OCD and ADHD.

Aim – Attention Deficit Hyperactivity Disorder (ADHD) and Obsessive Compulsive Disorder (OCD) are one of the most common childhood and adolescent neuropsychiatric disorders. Adolescents with these disorders experience difficulties and impairments in various domains of life. However studies on functional impairments in adolescents with these disorders are lacking in India. This study was conducted with the aim to study and compare the functional impairments of Indian adolescents suffering with these disorders. Methods – 57 adolescents (36 having ADHD and 21 having OCD) between the age group 13 years to less than 18 years were recruited during the study period. HONOSCA, VABSII and C-GAS were applied to study the social, relational, emotional, adaptive and global functioning of these adolescents. The two groups were compared with each other using appropriate statistical methods. Result – Adolescents with ADHD had significantly greater impairments in the areas of ‘disruptive, antisocial and aggressive behavior’, ‘peer relationships’ and ‘self care and independence’ whereas adolescents with OCD had significantly greater impairments in the areas of ‘emotional and related problems’ and ‘poor school attendance’. Significantly greater number of adolescents with ADHD were below average in their functioning in the ‘receptive’ (77.8%) and ‘written’ (75%) subdomain and overall in the ‘communication’ domain (63.9%) as compared to the adolescents having OCD. Adolescents with ADHD were more impaired in their global functioning as compared to adolescents with OCD. Conclusion - There are important differences in the various correlates of functioning between the two groups of adolescents. The present findings have implications in the planning for treatment intervention in these adolescents to make them more cost effective and efficient.

Adult intussusception: Is associated bowel gangrene common.

Introduction: Adult intussusception is a rare clinical entity in contrast to pediatric intussusception. Varied and non-specific clinical features, delayed presentation, and lack of awareness among attending surgeons to consider it as differential diagnosis complicates the clinical course of the disease. Methods: A retrospective study was conducted in a tertiary care teaching hospital in north India. Nine adult patients who presented with intussusception over a period of six years were analyzed. Their clinical profile, management and underlying pathology were studied. Results: Five out of nine patients had acute presentation while remaining four presented with subacute/chronic symptoms. Median duration of presentation was 8 days (range 2-180 days). Clinical diagnosis of intussusception was considered in only one patient. Ultrasonography clinched the diagnosis in all four patients who presented with subacute/chronic symptoms. Ileo-ileal intussusception was present in five patients, with one having associated jejunojejunal intussusception. Other four patients had ileo-colic intussusception. Seven of the 9 patients (77%) were found to have associated bowel gangrene. Resection of the bowel segment having intussusception was done in all patients. Five patients had associated benign intestinal pathology while idiopathic intussusception was present in four patients. Conclusion: The patients presented in the series are distinct from cases reported earlier in literature in term of late presentation, manifesting as acute intestinal obstruction, high frequency of associated intestinal gangrene, and absence of associated intestinal malignancy. Patients presenting with features of intestinal obstruction and abdominal lump should be subjected to urgent imaging studies to examine the possibility of intussusception. The high frequency of bowel gangrene encountered in patients of adult intussusception mandates prompt surgical intervention soon after diagnosis.

Adult attention deficit/hyperactivity disorder: One year follow up.

Background & objective: This study aimed to find out phenomenology, stability of diagnosis, comorbidities, impairments and treatment status of the adults with ADHD one year follow up as there are no such data. Methods: 20 subjects (all males, mean age 25.1±6.2 yr) with adult ADHD (DSM-IV-TR) were followed up at mean 1.3±0.2 yr after their diagnosis. Phenomenological assessments were done using ASRS v1.1, WMH-CIDI, ADHD-RS and clinical assessment where required. Diagnoses of ADHD and comorbidities were made using DSM-IV-TR. Global functioning was also assessed using GAF. Results: 19 (95%) of the 20 subjects could be followed up. All (100%) of them could again be diagnosed having ADHD according to DSM-IV-TR criteria. However, the symptoms declined in severity over a period of one year. Diagnosis of 2 (10.5%) subjects of ADHD-CT was changed to ADHD-IA. 1 (5.3%) subject each of ADHD-IA and ADHD-NOS types went into partial remission. Substance abuse was increased at the follow up from 26.3 to 47.4 per cent. Rates of the other comorbidities did not change during the follow up. Only 3 (15.8%) subjects adhered to the prescribed treatment at the follow up. Global functioning of the adherent group improved significantly at the follow up (t = 6.000, P = 0.027). Interpretation & conclusion: Adult ADHD has diagnostic stability at the one year follow up. The adult ADHD subjects remained highly comorbid with other psychiatric disorders including increased substance abuse at the follow up. Only 10.5 per cent subjects remained in the regular follow up. The above findings suggest that the patients with adult ADHD should be properly psycho-educated and regularly followed up.

An exploratory clinical study of adult attention deficit/hyperactivity disorder from India.

BACKGROUND & OBJECTIVE: Although adult attention-deficit/hyperactivity disorder (ADHD) is well recognized in western countries, there are no reports of adult ADHD from India. Therefore, this study was planned to identify ADHD in adults in an Indian psychiatry outpatient setting and elicit its phenomenology and co-morbidities. METHODS: A total of 283 adults were screened using Adult ADHD Self-Report Scale-v1.1 (ASRSV1.1) screener. Screen positives were evaluated on ASRSv1.1 symptom checklist, World Mental Health Survey Initiative Version of the World Health Organization Composite International Diagnostic Interview (WMH-CIDI) and by clinical assessments. DSM-IV-TR and Wender-Utah criteria were used for diagnosis. RESULTS: Twenty five men (mean age +/- SD, 23.4 +/- 5.6 yr) were diagnosed as having adult ADHD. The subjects' most common presentations were of losing temper and poor academic performance. The most common ADHD symptoms were difficulty in sustaining attention, easy distractibility, often losing things, and blurting out answers. A majority (80%) of the subjects had one or more psychiatric co-morbidity like oppositional defiant disorder, major depressive disorder and substance abuse/dependence. INTERPRETATION & CONCLUSION: Adult ADHD can be diagnosed in an Indian psychiatry outpatient setting. ADHD adults infrequently presented with the core symptoms of the disorder and had high psychiatric co-morbidity rates.