ABSTRACT
Background: ADHD is a heterogeneous disorder with a prevalence ranging from 4- 7%.It is associated with comorbidities like oppositional defiant disorder, conduct disorder, mood disorders, anxiety disorders, learning disability to name a few. The rate of comorbidities has ranged from 60 to 100 % in various studies. The most common comorbid disorder has been found to be oppositional defiant disorder. Combined type of ADHD was found to be the subtype associated with most comorbidity. Studies have differed in their findings regarding the influence of gender on comorbidities in ADHD. Aims: To study the rates of various comorbidities in ADHD and differences in comorbidities according to subtype of ADHD and gender. Methods: Our current study was conducted in an outpatient child psychiatry clinic. The records of children who were diagnosed as ADHD were analyzed to understand whether our data reflected the findings of international and other Indian studies. The data was analyzed with regard to the rates of various comorbidities, the difference in comorbidities according to subtype of ADHD and gender. Results: We found the overall rate of comorbidities to be 52.9%.The most common comorbidity was oppositional defiant disorder followed by anxiety disorders. The overall rate of comorbidities did not differ significantly according to gender and subtype. However when individual comorbidities were analyzed oppositional defiant disorder was significantly more in combined type, Anxiety disorders were more in inattentive type and Depression was significantly more in females. Conclusions: As a child with ADHD and comorbidities suffers from multiple handicaps it is essential to study the comorbidities in detail both crosssectionally and longitudinally to understand and treat the illness better. Considering the multiple comorbidities a child with ADHD can present with clinical management should be individualized.
ABSTRACT
Background: Mutism is a common accompaniment of catatonic schizophrenia. It responds to treatment with benzodiazepines and electro convulsive therapy. However mutism can also occur in non catatonic schizophrenia. There are very few reports of the same in literature and most show resistance to conventional treatment. The present case report deals with one such case and the challenges it poses. Case description: A young Asian man, with a diagnosis of paranoid schizophrenia presented with long standing mutism in the absence of any other catatonic features. A trial of various antipsychotics and also electroconvulsive therapy failed to show any improvement in mutism. He ultimately responded to amisulpride 800 mg/day. Discussion: Mutism though is most widely reported in catatonic schizophrenia, can also be seen in non catatonic schizophrenia. It shows poor response to conventional treatment. Conclusion: Mutism is a challenging symptom which may persist after the resolution of other psychotic symptoms and continue to hinder the patient’s social, occupational and personal life.