Diagnostic Variations and Treatment Responses of Catatonic Patients in the Psychiatric In-Patient Department of a Rural Tertiary Care Centre - A Clinical Study from Eastern India.

This is a cross-sectional descriptive study done in the Psychiatric indoor of North Bengal Medical College between December 2018 to December 2019. Catatonia was diagnosed using DSM-5 criteria in the patients admitted. A total 30 patients were included in the study. The patients were assessed by Bush-Francis Catatonia Rating Scale, were given oral or parenteral lorazepam as needed and observed for 2-3 weeks. Non-responders were given modified ECT as per convention. Background diagnoses were checked by thorough history taking and investigations.RESULTSMajority of the patients were Hindu males in their twenties from rural lower-middle socio-economic families, around 20% of them having family history of affective and psychotic illnesses. They were diagnosed mostly with schizophrenia and other psychotic illnesses (53%) and mood disorders (30%). The mean BFCRS score at the time admission was 20.93 ± 6.16. The commonly found symptoms were mutism, staring, negativism, rigidity, posturing/catalepsy, mannerism, and withdrawal. It was seen that 83.33% of cases responded well to lorazepam only, whereas the rest 13.33% required ECT after non-response or partial response to lorazepam. Only one case after diagnosis with catatonia following organic condition was referred to the Medicine Department. The duration of hospital stay was found to be significantly different [F= 3.58 (>3.35)] among different diagnoses groups (mood disorders, psychotic disorders and others) when the catatonic severity, lorazepam dosage and the duration of treatment response were assessed among those groups using multiple one-way ANOVA.CONCLUSIONSThis study has yielded important findings regarding the age and socio-demographic profiles of the patients, family history of psychiatric disorders, clinical features, and significance of diagnostic variations in relation to the treatment with lorazepam and ECT in catatonic patients in the psychiatric indoor in a tertiary care rural hospital of Eastern India.

Psychiatric Co-morbidities Among Patients of Globus Hytericus Attending ENT OPD of a Tertiary Care Hospital.

Globus hystericus is a functional esophageal disorder, contributes a significant portion of ENT referral. Severe incapacitating symptoms of globus invariably compromise their quality of life which is further hampered by associated psychiatric co-morbidities. But in literature, conflicting results were reported regarding the pattern of psychiatric co-morbidities. Method: In an observational cross sectional study 53 consecutive consenting patients (N=53) of globus diagnose by criteria of R E Clouse, attending to the Department of ENT of tertiary care hospital of Eastern part of India were referred to Psychiatry OPD and screened for psychiatric comorbidities using Mini International Neuropsychiatric Interview (MINI) English Version 5.0.0 and confirmed by Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR). Result: 79.25 % (n=42) of globus patients had psychiatric co-morbidities which was significantly higher (p<0.05, odds ratio 14.02) than their relatives attending with the patients. Among the patients of globus, 32.01% (n=17) had multiple diagnoses. Major depressive disorder was found in 43.04% (n=23), obsessive compulsive personality disorder in 16.98% (n=9), undifferentiated somatoform disorder in 13.21% (n=7), generalized anxiety disorder and panic disorder with agoraphobia each in 9.43% (n=5), borderline personality disorder in 7.55% (n=4), obsessive compulsive disorder and dysthymia each in 3.77% (n=2) and hypochondriasis in 1.89% (n=1). No association was found between presence of psychiatric morbidity and socio-demographic variables of the globus patients. Conclusion: Burden of psychiatric co-morbidities among the patients of globus is quiet high. So, they should be regularly screened for psychiatric illness and an integrated treatment approach can be taken for them to get the opportunity of effective psychopharmacological and behavioral approaches.

Disability in Person with Schizophrenia: Its Correlation with Psychopathology and Socio-Demographic Profile.

Schizophrenia causes considerable functional disability. The present study was designed to assess disability in person with schizophrenia and to see its relationship with psychopathology (PANNS score), UKU side effect, duration of illness, duration of treatment, perceived social support and other socio-demographic factors . The study was done at the Institute of Post Graduate Medical Education & Research (IPGMER), Kolkata, India. For this study 100 patients with a clinical diagnosis of schizophrenia as per ICD-10 were taken. Thereafter, all patients were assessed on Positive and Negative Syndrome Scale for Schizophrenia (PANSS) for psychopathology, on Indian Disability Evaluation Assessment Schedule (IDEA) for disability, on UKU Side Effect Rating Scale for side effects of drugs and on Social Support Questionnaire (SSQ) for perceived social support. It was found that majority of the patients were having severe level of disability in global, interpersonal activity and communication & understanding area and moderate level in work and self care domains. PANSS total score had a significant (<0.035) positive correlation and SSQ total score had a significant (p<0.000) negative correlation with global disability. Age of onset, duration of illness have an effect on disability. The total score of PANSS and SSQ SERS total score emerged as the sole significant predictor of global disability. Treatment in schizophrenia should be focused on psychopathology and social support system to improve competencies in retaining an occupation, better interpersonal relationship with co-workers, and significant others.