ABSTRACT
Background: Rates of undiagnosed and untreated medical illnesses are higher in individuals with severe mental illness, compared to the general population. These comorbid medical illnesses result in poorer outcomes, greater severity of symptoms, increased incidence of non-compliance, increased length of stay, increased mortality and healthcare costs. There is a paucity of literature concerning the prevalence of physical illnesses in psychiatric patients from India. Objective: To study the nature and prevalence of physical illnesses in psychiatry inpatients in a tertiary care psychiatry setup. Materials and methods: Consecutively admitted inpatients from the psychiatry ward of a tertiary care centre were recruited for study for six months duration. Detailed general physical examination, systemic examination, and various laboratory investigations were done. Referrals were sought from the respective medical or surgical departments for evaluation. Diagnosis of physical illnesses was validated by the consultant physician. The data were compiled on semi-structured proforma and analysed by using descriptive statistical methods. Results: Seventy per cent patients were found to have associated physical illnesses. Metabolic disorders were present among 28.9% patients followed by endocrinal (25.6%), haematological (18.3%), gastrointestinal (15%), cardiovascular (12.2%), neurological (9.4%), and stomatognathic disorders (8.3%). Conclusion: Index study reports a high prevalence of medical comorbidity in the psychiatric inpatients. There is an urgent need for further research and sensitisation of mental health professionals about recognising the medical comorbidities and their prompt treatment via liaison with physicians and other medical staff.
ABSTRACT
Aim: Clinical assessment of the autonomic nervous system in Diabetes mellitus (DM) and its correlation with glycemic control. STUDY DESIGN: Cross sectional study of 50 adult diabetes patients. Materials and Methods: Fifty patients with DM who were on regular treatment with either insulin and/or oral hypoglycemic agents were studied. Cardiovascular autonomic neuropathy (CAN) score was calculated using the clinical test variables. Results: Of the 50 patients 30 had no CAN, 10 had early CAN and 10 had severe CAN. The mean of CAN score increased with duration of diabetes. The mean HbA 1C was 7.73. The mean CAN score was higher in patients who had complication of diabetes as compared to patients without complications. The heart rate variability with respiration was found to be 15.84 ± 7.02/min. The mean valsalva ratio was 1.31 ± 0.23. The mean drop in BP on standing was 7.30 ± 7.24 mmHg. The mean 30:15 ratio was 1.06 ± 0.04. The mean rise in diastolic BP on sustained hand grip was 16.04 ± 4.11 mmHg. Conclusions: The prevalence of autonomic neuropathy in DM as assessed by CAN score was 40%. The CAN score did not correlate with the duration of DM. The HbA 1C had a significant correlation with the severity of autonomic neuropathy. Occurrence of CAN correlated with the presence of peripheral neuropathy but not with the presence of retinopathy or nephropathy. All individual tests in the battery of CAN score were significantly associated with the presence of autonomic neuropathy, except 30:15 ratio.
ABSTRACT
OBJECTIVE: Genetic counseling for individuals undergoing presymptomatic testing is lacking in India although testing is easily available. This has an impact on family members of Huntington's disease (HD), an autosomal dominant disease, wherein the age at onset of symptoms varies. AIM: We examine if attitudes differ towards presymptomatic testing for HD amongst HD family members, physicians and laypersons. MATERIALS AND METHODS: A modified questionnaire enquiring about opinions on various personal, family, social and future health care with regards to presymptomatic testing of HD was designed. A physician explained briefly about HD and presymptomatic testing of HD and recorded responses of unaffected family members of HD (n=25) and laypersons (n=50). Medical doctors (n=50) answered the questionnaire based on their knowledge of HD. RESULTS: HD family members, Medical doctors and laypersons were similar in their opinion to undergo the testing. Majority (60%) of HD family members did not wish to communicate test results with their friends when compared to the other two groups. Medical doctors and HD family members were more concerned about certainty of developing disease when the test results are positive. Majority (80%) of Medical doctors and less than half in the other groups felt that their decision to have a child would strongly depend on test results. Large proportion (80%) of HD family members did not wish to report their test results to their employers. CONCLUSIONS: Individuals with knowledge about HD and the test differ in their decision of sharing test results and reproductive choices.