Evaluation of efficacy and tolerability of dothiepin hydrochloride in the management of major depression in patients suffering from rheumatoid arthritis.

Several studies have shown that 20 to 66.2% of patients with rheumatoid arthritis have associated psychiatric comorbidity especially depression. Dothiepin hydrochloride is a well-established and effective antidepressant in patients with depressive symptoms of varying severity and co-existing anxiety. To document the efficacy and tolerability of dothiepin hydrochloride in the management of major depressive disorder (MDD) in rheumatoid arthritis patients a phase IV, open, single arm, prospective study was initiated with dothiepin hydrochloride in the dose of 75 mg/day, duration of therapy was 6 weeks. Twenty-five rheumatoid arthritis patients suffering from co-morbid MDD completed the 6-week dothiepin hydrochoride treatment and were considered for final analysis. There was significant reduction (p < 0.05) in mean HAM-D scores at week 2 (13.92 +/- 5.45), week 4 (9.28 +/- 4.13) and week 6 (5.72 +/- 3.26) compared to baseline (21.64 +/- 5.93). There was significant reduction (p < 0.05) in mean HAM-A scores at week 2 (6.52 +/- 3.34), week 4 (4.0 +/- 2.25) and week 6 (2.76 +/- 1.59) compared to baseline (10.68 +/- 3.68). The global impression of efficacy at the end of 6 weeks of dothiepin hydrochloride treatment was rated by the clinician (psychiatrist) as marked and moderate improvement in 20 (80%) and 5 patients (20%) respectively. Only 2 patients reported dry mouth as an adverse event in the study. The overall assessment of tolerability at the end of 6 weeks of dothiepin hydrochloride treatment was rated by the clinician (psychiatrist) as good and fair in 19 (76%) and 6 patients (24%) respectively. Dothiepin hydrochloride was found to be an effective and well-tolerated drug in the management of MDD and anxiety in patients suffering from rheumatoid arthritis.

Depression in children and adolescents.

Childhood depression accounts for a substantial proportion of cases in child psychiatric clinics. Depression is more common in boys than girls in school age children and it becomes reverse during adolescents. The childhood depression can be wholly chemical, wholly due to psychological factors of a combination of both. The causes of depression can be discussed under three headings--genetic factors, biological factors and social factors. Some children display the classical symptoms of sadness, anxiety, restlessness, eating and sleeping problems while others present with physical problems like aches and pains which do not respond to treatment. Diagnosis depends on interview or questionnaire instruments to screen populations and some biological procedures to determine neuro-endocrine and other physical dysfunctions. Treatment consists of pharmacological treatment and psychological treatment. Tricyclic antidepressants, serotonin specific reuptake inhibitors and electroconvulsive therapy constitute pharmacological part of the treatment, whereas supportive, insight oriented, play, behaviour, family therapies and cognitive psychotherapy constitute psychological part.

Stressful life-events, anxiety, depression and coping in patients of irritable bowel syndrome.

A lot of research has pointed to a complex interaction between stressful life events, psychiatric morbidity and the irritable bowel syndrome (IBS). AIM: The present study aimed to determine the: stressful life-events in patients with irritable bowel syndrome patients in comparison to normal controls; effect of these events in causing clinically significant anxiety and depression; and the effect of psychopathology i.e. anxiety and depression on coping skills in these patients. METHODOLOGY: Thirty patients with irritable bowel syndrome were compared with thirty matched normal controls, on the presumptive stressful life events scale and the mechanisms of coping scale. Further, among the irritable bowel syndrome patient group, the anxious and depressed subgroups were separated from the non-anxious and non-depressed subgroups using the hospital anxiety and depression scale. Positive and negative coping mechanisms between these subgroups were compared. RESULTS: Significantly higher stress scores were found in the irritable bowel syndrome patient group than normal controls. Not all, but slightly more than fifty percent of irritable bowel syndrome had definite and clinically significant anxiety and/or depression. Those IBS patients with either definite depression tended to use predominantly negative coping styles as compared to those IBS patients without anxiety or depression. CONCLUSION: Stressful life-event scores are significantly higher in IBS patients than in normal controls. Although not all of these patients have anxiety and/or depression, a significant number of patients show evidence of the same. Presence or absence of anxiety and/or depression influences how the patient with IBS copes with illness. Therefore, though further studies on the issue are required, we suggested that, as a supplement to medical management, recognition and treatment of anxiety and depression in this subgroup of IBS patients with psychotropic drugs and cognitive therapy for gaining more positive coping skills, may require special attention in the management of irritable bowel syndrome.

Psychiatric referral pattern in general hospital.

Here we have tried to analyse the psychiatric referral pattern in general hospital setting. In one year period, 20.20% of the total new cases in psychiatry O.P.D. were referred cases. Majority of the patients were referred at O.P.D. level. Males were more than females. Physicians referred maximum cases than surgeons and gynaecologist. Neurosis was the common diagnosis amongst the referred cases. As one of the senior psychiatrists has mentioned 'lack of referral's by the non-psychiatrists has been an unfortunate negative factor for the growth of psychiatry.

A preliminary study of reaction time in schizophrenics.

The aim of this study was to make a preliminary study of auditory reaction time (ART) and its significance in cases of schizophrenia. It was found that ART is significantly affected and prolonged in schizophrenia as compared to normal healthy controls (P less than 0.001) when the stimulus is presented to both ears or either car separately. Distractability was higher in schizophrenics as compared to adult controls (P less than 0.001). There was no significant difference in ART within the patient group when the stimulus was presented to the right ear or left ear (P greater than 0.05). There was no significant difference between ART of male and female schizophrenics (P greater than 0.05).