Musical Hallucinations In An Alcohol Withdrawal State

Objective: We report a rare case of musical hallucination in a male who had a history of alcohol consumption for 25 years. Methods: We present a 47-year-male with a history of alcohol consumption since 25 years presented with fearfulness, hearing voices and decreased sleep for 8 days. The last drink was 12 days prior to presentation. Results: The patient was diagnosed to have alcohol withdrawal syndrome and had musical hallucination whereby he heard voices reading a poem in a rhyming manner. These voices threatened him in these musical rhyming ways that they would make him go mad, would not allow him to sleep and would kill him and his family members. Conclusion: Musical hallucination has heterogeneous clinical and pathophysiological etiology, and has been reported in the elderly and in those with hearing impairment, central nervous system disorders and psychiatric disorders. Musical hallucination is very rare in alcohol withdrawal syndrome. The treatment of musical hallucination includes carbamazepine, clomipramine and Electroconvulsive therapy (ECT).

Electroencephalographic Abnormality And Clinical Response In Patients With First - Episode Schizophrenia Treated With Clozapine

Objective: Clozapine is seen as a gold standard for treatment refractory schizophrenia; however, it is not recommended for the treatment of first-episode psychosis mainly due to concerns of severe side effects. An indicator for response holds tremendous clinical value to select patients who can benefit from clozapine, safely. EEG abnormality has been reported to be one such parameter, yet the definite conclusion of the nature of EEG changes and its predictive value remains undetermined. The present study was undertaken to examine electroencephalographic (EEG) abnormalities and clinical response subsequent to clozapine therapy in schizophrenia. Methods: A total of 80 first-episode patients were recruited for a 12 week study, from a tertiary care centre in Mumbai, India. First episode was defined as an illness of less than 2 years duration and first hospitalization since illness. EEG abnormalities, psychopathology, and positive and negative symptoms were examined at baseline and again after 12 weeks of clozapine treatment. Results: There were some types of EEG abnormalities found in pretreatment state in at least two-thirds of patients. The number of patients showing EEG abnormality at the end of the 12 weeks of treatment increased significantly, which included theta (θ) frequency, slow waves, and sharp waves. Symptomatically, significant improvement was seen in both positive as well as negative symptoms scores. However, there was no significant correlation between EEG changes and clinical outcome. Conclusion: There was significant abnormality in the number of patients exhibiting EEG abnormalities. Baseline pretreatment EEG abnormalities were present in a considerable number of patients, and these EEG abnormalities did not significantly correlate with clinical improvement, except suggesting a trend towards such correlation.

Escitalopram and Mirtazapine for the treatment of depression in HIV Patients: A randomized controlled open label trial

The objective of this study was to compare the safety and efficacy of mirtazapine and escitalopram in HIV patients for the treatment of depression. Methods: In this trial, 70 adult HIV patients with major depression were randomized and assigned to receive 8 weeks of daily open label mirtazapine (5-30mg) or escitalopram (7.5-20 mg). The primary outcome variables were endpoint response in Hamilton Rating Scale for Depression (HAM-D) score and change of HAM-D score from baseline to endpoint. Patients having improvement of > 50% on the HAM-D total scores during treatment were considered to have responded. A final 17-item HAM-D total score of 8 or less defined remission. Results: The response rate was 91.4 % (32/35) in Mirtazapine group and 85.7 % (30/35) in Escitalopram group (p= 0.71). The remission rate was more in escitalopram group (48.6 %, 17/35) compared to Mirtazapine group (34.3 %, 12/35); however it was not statistically significant (Chi square (1, N = 70) = 2.1, p = 0.22). After controlling for baseline score, the median HAMD score at 8 weeks was significantly lower in the Mirtazapine group (Median (Mdn)=4, Interquartile range (IQR)= 11) compared to Escitalopram group (Mdn=13, IQR= 12) (p < 0.001). The number of adverse events reported was more in Escitalopram group (110) than Mirtazapine group (85); however this was not statistically significant (p= 0.34). Conclusions: Both these drugs are useful in the management of depression in HIV patients and need further study.

Psychological Issue in Hand Trauma

Acquired hand trauma is a significant event that often affects an individuals’ life in diverse manners. The present paper aims to review the psychological issues in hand trauma along with factors that affect recovery from the same. Method: A relevant search for literature on psychological issues in hand trauma was made across search engines like Google Scholar, Medline and Pubmed and relevant studies were selected for this review. The studies include those on symptomatology, course as well as treatment. The studies were analyzed critically along with inputs of personal clinical experience of the authors. Results: Psychological symptoms that occur after hand trauma together with the treatment methods that provide relief from psychological symptoms are discussed. Symptoms of post-traumatic stress disorder (PTSD), flashbacks, concerns with personal appearance, avoidance of reminders of the trauma and physiological arousal along with sleep issues have been discussed. The article also looks at the psychosocial effects of hand trauma including marital and sexual issues that may arise. Treatment interventions commonly used in the form of imagery and in vivo exposure with and without cognitive restructuring are explained along with psychoeducation approaches that may benefit these patients. Conclusions: It is important that surgeons and professionals dealing with hand trauma are aware of the psychological issues in hand trauma and to take appropriate steps to deal with any such problems that ensue.

open clinical study of immediate release methylphenidate [IR-MPH] versus atomoxetine [ATX] in attention deficit hyperactivity disorder

Studies that focus on treatment efficacy with an effectiveness study design provide the best evidence for the practicing clinician regarding the usefulness of treatment methods. The present study was carried out to evaluate the effectiveness and tolerability of Methylphenidate [MPH] versus Atomoxetine [ATX] in children aged 8 to 12 years with ADHD. Open label clinical study. Private psychiatric centre in Mumbai over a period of 2 years from January 2007 to January 2009. This 12 week, open-label study had 183 subjects on either MPH or ATX. Subjects were titrated to a clinically effective dose of either study medication over 4 weeks and maintained on that dose for an additional 8 weeks. The SNAP-IV parent-rating scale was the primary effective measure used in the study. Other measures used was the Conners Parent rating Scale, Parent Stress Index, IOWA Parent Rating Scale and the Clinical Global Impression Scale for severity and improvement. MPH showed statistically significant superiority to ATX based on the 18 ADHD symptoms of the SNAP-IV [p = 0.01] and severity of ADHD and ODD symptoms [p=0.008] as well as on the following secondary assessments. Parental stress too was lower in the MPH group [p = 0.007]. Both drugs were well tolerated with a similar side effect profile. The study concluded that MPH is significantly more effective than ATX in reducing ADHD symptoms based on multiple outcome measures in this study group though further studies across different populations are warranted

Metabolic syndrome and antipsychotic drugs a review

Metabolic syndrome is characterised by a constellation of obesity, dyslipidemia, insulin insensitivity, deranged glucose metabolism and hypertension. The interface between psychiatry and metabolic syndrome is of importance today due to the increasing recognition of this syndrome among patients receiving psychotropic medications. Antipsychotics and possibly other psychotropic drugs like antidepressants can induce weight gain or worsen other metabolic parameters, particularly increasing the cardiovascular risk factors. Mounting evidence has suggested decreased life expectancy in psychiatric patients by one to three decades. Changes associated with metabolic syndrome appear to play a significant role in them. This article reviews metabolic syndrome in association with psychiatric illnesses, antipsychotic treatment and recent guidelines for its detection and management

Conduct disorder: an analysis of subtypes

This study sought to identify cormorbidity, aggression, hostility and severity across the subtypes of CD based on the age of onset as per the DSM-IV criteria. Descriptive study. Place and duration of the study: This study was carried out in a private psychiatric clinic in Mumbai between January 2007 and January 2008. Referred children aged 7-16 years old were clinically assessed using clinical interviewing to determine comorbid psychiatric diagnoses. The Modified Overt Aggression Scale [MOAS], Buss Durkee Hostility Inventory [BDHI], Clinical Global Impressions Scale [CGI] and Clinical Global Assessment Scale [CGAS] were used in quantitative assessment. Parental psychiatric diagnosis was ascertained via clinical interview. Childhood onset CD was associated with greater rates of ADHD, anxiety disorders, complex cormorbidity, higher perceived hostility scores and lower rating on the CGAS scale than adolescent onset CD. Greater number of mothers in the childhood onset CD group had borderline personality disorder. Both parents across the group had high rates of major depression while fathers across both groups showed the presence of alcohol and nicotine dependence. Understanding age of onset related patterns of comorbidity and psychopathology may help therapeutic intervention in children and adolescents with CD

Depressive symptoms in mothers of children with cerebral palsy

To find out depression in mothers of children with cerebral palsy, exploring the various factors that affect depressive symptoms in these mothers. Cross sectional study. The study took place over a three year period between January 2006 and January 2009 in the city of Mumbai. 200 mothers of children with cerebral palsy were compared to normal controls on depression scores using the Beck Depression Inventory [BDI]. These scores were compared within the group on the basis of various maternal, child and family factors. Both groups were well matched in all respects. 71% mothers of children with cerebral palsy reported depression compared to 33% in the control group. The presence of increasing age, poor spousal support, unemployment and low education seemed to aggravate depression in these mothers. Having another child with normal development, good family support and joint families served as protective factors. Presence of epilepsy in the child, low intelligence, severity of paralysis, motor problems, feeding issues and behavioral problems along with poor toilet training worsened BDI scores in these mothers. Maternal, child and familial factors all affect depression in mothers of children. Further research shall be of help in the management of depression in such subjects

Mothers of children with developmental disabilities: an analysis of psychopathology

To compare the psychopathology in mothers of autistic children with mothers of mentally retarded children. Cross section study. This study was carried out on mothers of children studying in special schools across Mumbai, India from January 2006 to January 2009. 300 mothers each of children with mental retardation were rated on the Beck Depression Scale. Toronto Alexithymia Scale, State-Trait Anxiety Inventory and Symptom Checklist-90 Revised. The data was tabulated and statistically analysed. Mothers of autistic children had significantly greater depression than mothers of mentally retarded children [p= 0.0481]. Anxiety state and trait scores were significantly higher in these groups though psychopathological anxiety was absent [p= 0.0057, p=0.0002]. Mothers of mental retarded children had greater alexithymia scores and a significant majority of them had alexithymia of a pathological nature [p= 0.0001]. They also had higher somatization scores on the SCL-90 [p= 0.031] while autistic mothers reflected greater anxiety [p = 0.0016] and general symptomatology index scores [p = 0.0021]. The psychopathology in mothers of children with developmental disabilities warrants attention in any program designed to treat children with autism and mental retardation

Ketamine dependence: case report and review

Ketamine has been in medical circles since the past three decades but has recently emerged as a party drug and drug of abuse. The literature regarding ketamine abuse and dependence is presented and the relevant neurobiology and mechanism of addictive action is discussed. We also present a case of ketamine dependence that was admitted to our centre

Maternal, child and family factors in childhood obesity

Childhood obesity is an ever increasing problem in today's modern world. This study aimed at trying to recognize the role of maternal, child and family factors in childhood obesity. There were 2 groups in the study, the study group comprising of 80 obese primary school boys and their mothers and the control group that comprised of 80 normal weight primary school boys and their mothers. The children and mothers were assessed using a semi-structured questionnaire for collecting socio-demographic and other relevant data. Maternal mental health was assessed using the Depression Anxiety Stress Scale [DASS] and the Negative Life events scale. Parenting and family functioning was assessed using the Parenting Scale and the McMaster Family Assessment Device [FAD], respectively. Maternal depression and anxiety, laxness and verbosity in parenting styles, meal frequency, eating out, lack of play with increased television viewing was significantly more in the study group. Family functioning was affected significantly in the study group as well. Childhood obesity is intricately linked to maternal, child and family health, both physical and mental. It is therefore essential that family based interventions be sought in the long term management of childhood obesity

Types and contents of hallucinations in schizophrenia

Hallucinations are one of the commonest symptoms seen in schizophrenia. This research aimed to study the types and content analysis of various hallucinations seen in patients with schizophrenia. Cross sectional study. This study was conducted in a private psychiatric hospital in Mumbai from January 2002 to January 2007. The nature and content of hallucinations in 559 patients with schizophrenia was analyzed. The patients meeting DSM IV criteria for Schizophrenia were asked to complete a questionnaire which enquired the hallucinatory experience. The data was tabulated and the results presented. The most common type of hallucinations were of auditory nature [69.23%] and amongst that a majority of patients heard voices of an unknown person [54.52%]. Visual hallucinations were less common [8.59%] followed by the other types of hallucinations. The study was an exploratory study in a private care setting. Auditory hallucinations were the most frequent as is generally reported in literature. More than one third [37%] of those experiencing auditory hallucinations had first rank symptoms