A cross sectional comparative study assessing the psychiatric morbidity in elderly living in old age homes and community

Background: There has been a change in socio familial scenario over a period of time in India. The elderly are being displaced from a combined family to the old age homes. There is a need to assess the psychiatric morbidity in these settings to frame policies for future. Aims and objectives: To compare socio demographic factors and psychiatric morbidity in elderly living in old age homes and community. Methodology: 50 subjects from each of old age homes and community were administered Geriatric Mental Status Questionnaire after taking informed consent. The socio demographic factors and psychiatric morbidity of the two groups were analyzed statistically. Results: Statistically significant differences were found between the two groups in socio demographic factors like age, educational status, socio economic status, marital status, having no male children and having employed children. Anxiety, moderate depression, obsessions and alcohol use were found to be higher in the community group where as mild depression; cognitive impairment and somatic dysfunction were found to be higher in old age homes, but statistically not significant, except for alcohol use. Conclusion: Elderly people in old age homes and community differed in socio demographic factors but not much in psychiatric morbidity.

A prospective study on the prevalence of post stroke depression and its relationship with lesion laterality and socio-demographic factors

Background: Post Stroke depression (PSD) is considered as a frequent neuropsychiatric consequence of stroke. Approximately one third of stroke survivors experience major depression. This condition can have adverse effects on cognitive function, functional recovery and survival. Aim: The current study examined prevalence of depression in post stroke survivors, its relation with site of lesion, laterality and. sociodemographic factors. Method: After obtaining consent, selected sample of post stroke survivors were diagnosed as post stroke depression based on ICD10 diagnostic criteria. Depression was quantified using HDRS and MADRS before discharge, at the end of first month and three months. Socio demographic profile was obtained. Statistical analysis was done using SPSS. Results: 32 patients of mean age (46.25yrs) and post stroke duration (2 weeks – 3 months) were included in the study. Twenty of thirty two post stroke survivors( 62.5%) met the criteria for depression at the time of discharge i.e. 2 weeks post stroke period, prevalence of PSD was 19 (59.37%) during 2nd assessment and 13(48.15%) during 3rd assessment. PSD was significantly associated with right sided lesions (p value = 0.013). In patients with left sided lesion, it is most commonly seen with sub cortical (p value = 0.003). Middle age was significantly associated with PSD (p value = 0.03). Female sex was associated with PSD in left sided lesions (p value = 0.02). No significant difference was found between first, second and third assessment of HAMD, MADRSS scores in depressed patients. No change in depression scores was found in both left and right sides at all assessments. Conclusion: This study emphasizes the need for early detection of depression in post stroke survivors. PSD is related to laterality of lesion, middle aged group and female sex. PSD is maintained at 3 months follow up. These results highlight the need to investigate, diagnose and treat post stroke depression.

Personality assessment of offenders and mentally ill offenders

Background: Crime is a complex psychological, sociological and situational behaviour. Personality theories provide possible insights into the psychological aspects of crime. The primary assumption behind the personality theories is that crime and delinquency are related to the presence of some personality traits. Aims: To assess the personality dimensions of offenders, mentally ill offenders and to compare them with normal control population. Methods: A semi-structured interview consisting of Socio-demographic details, Eysenck Personality Questionnaire (EPQ) and Barratt Impulsiveness Scale (BIS-11) were used to assess the personality of offenders, mentally ill offenders and normal population. Results: Offenders with and without mental illness did not differ in their personality, but both the groups differed significantly with the personality of general population. The offenders were more impulsive compared to normal population in general and offenders with mental illness were scoring high on total BIS-11 score and on non-planning impulsivity score compared to normal offenders. Conclusion: Personality traits can predict the person’s vulnerability to commit an offence.

Prolonged delirium secondary to hypoxic ischemic encephalopathy following complete hanging

Background: Delirium is a common disorder, and can occur in children and adults. It is short lasting, with duration ranging from hours to days. However, prolonged delirium can occur in people with brain damage. Hypoxic ischemic encephalopathy (HIE) is a condition that occurs when the entire brain is deprived of adequate oxygen supply. HIE results in neurological injury and long term dysfunction. Outcome of HIE ranges from significant changes in personality, impairment in memory, cognition and attention, to coma and vegetative states. Only a quarter of patients survive to be discharged from hospital. There are very few case reports of prolonged delirium secondary to HIE following hanging. Case description:A 27 year old Asian man with alcohol dependence syndrome developed prolonged delirium (more than two months) following HIE subsequent to hanging. Discussion:Prolonged delirium has been reported in 1/3rd cases of delirium. Risk factors for prolonged delirium are increasing age, severe delirium, increasing number of medical conditions. Prolonged delirium was found to be associated with poor functional outcome and increased mortality. Conclusion:Our case report highlights the importance of early detection and management of prolonged delirium.

A controlled study of psychopathology, life events, personality and sociodemographic factors in irritable bowel syndrome

Background: Irritable Bowel syndrome (IBS) is a common gastroenterological problem with symptoms causing a significant impact on the quality of life of patients. Psychopathology is associated in most of the cases affecting its overall prognosis. Life stressors influence significantly; either by precipitating or causing exacerbation of symptoms. IBS patients exhibit high levels of neuroticism and introversion. Dietary factors also play a role in IBS .Only few Indian studies reported these aspects in IBS. Aims: To identify the sociodemographic, dietary factors, psychopathology, life events and personality factors in irritable bowel syndrome (IBS) in the Indian context. Methods: Patients having IBS were selected for the study by purposive sampling. Normal controls without bowel symptoms were randomly selected from the population. After taking informed consent; sociodemographic data, diet details and illness details were obtained from all subjects. All the subjects were given a 30 item General Health Questionnaire (GHQ); Hamilton Anxiety Rating Scale (HARS); Hamilton Depression Rating Scale (HDRS); Eysenck Personality Inventory (EPI) and Presumptive Stressful Life Events Scale (PSLE). Parametric and non-parametric tests of comparison were employed in analysis of the data and results were interpreted. Results: IBS group scored significantly more than controls on GHQ scores, HDRS scores, Psychic and Somatic sub scores of HARS and PSLE mean stress scores. There was higher neuroticism score, especially in female patients. Family conflict; illness of family member; financial problems and change in sleeping habits were the frequently reported undesirable life event and going on a pleasure trip was the desirable event reported as stressor in these patients. Dietary sensitivities were significantly higher in patient group. Conclusions: We observed higher psychopathology scores consistent with earlier studies. In addition to undesirable stressors, going on a pilgrimage was the only desirable stressor associated with symptom exacerbation which was not reported earlier. Food sensitivities were significantly higher in IBS patients consistent with earlier studies. Key Message: We propose that psychological and dietary factors play a significant role in IBS. Hence, a multimodality treatment approach in the form of psychosocial therapy; dietary changes along with pharmacotherapy may be more effective in treatment of IBS.

Pellagra in patient with schizophrenia: a case report and review of literature

Background: Pellagra, called the disease of 4D’S- dermatitis, diarrhoea, dementia and death, is seen in patients of chronic alcohol dependence, mal absorption syndrome, and psychiatric illnesses like schizophrenia. Mostly a clinical diagnosis, its treatment includes balanced diet and niacin supplementation. There are hardly any case reports about pellagra in schizophrenia patients. Case description: A young Asian woman with complaints of abusing and assaulting, talking to self since three years and loose motions since fifteen days presented to psychiatric outpatient department with signs of dehydration, sharply defined symmetrical, desquamating rash in the neck area and in the sun exposed parts of forearms and legs with mental status examination findings of muttering to self, impaired recent and immediate memory and inability to do simple calculations. Patient showed significant improvement with supportive therapy, antipsychotics, niacin supplementation and balanced diet. Discussion: Pellagra can be seen in psychiatric illnesses like alcohol dependence syndrome, eating disorders and schizophrenia. It occurs along with other vitamin deficiencies which improve with medication and balanced diet. Conclusions: Early identification of vitamin deficiency along with proper education to patients and family regarding the need of balanced diet and adequate vitamin supplementation will prevent further complications. Thus, pellagra seen in schizophrenia patients requires medication and balanced diet.