Major Depressive Disorder: Part-I: Personality and Phenomenology.

Objectives: To study the phenomenological variations in context of personality psychopathology in Major Depressive Disorder patients. Methods:36 indoor patients of psychiatry ward of tertiary level service out of total 168 admitted patients from Ist January 2008 to 31st Dec. 2008 diagnosed as Major Depressive Disorder (as per DSMIV TR) . Socio-demographic data on a self-designed Performa, Montgomery Asberg’s Depression Rating Scale (MADRS), Hamilton Anxiety rating scale (HARS)and Presumptive Stressful Life Event Scale(PSLE) were applied to these patients and they were observed every alternate day till discharge. International Personality Disorder Examination (IPDE) was applied on their third follow-up visit, which ranged from 6 to8 weeks. Results: Sociodemographic variables by enlarge didn’t make a difference in MADRS score. MADRS score was significantly higher with increasing episodes of illness. Personality disorder patients had significantly higher MADRS score than Double traits (t=3.47, df=27, p<0.01) and Single trait (t=4.056, df=23, p<0.001) personality psychopathology. Higher level of depression in Personality disorder patients in all components of depression like sadness, reduced sleep pessimistic and suicidal thought etc were reported. Presence of stress with personality psychopathology added greater severity to depression. Conclusion: Our study brings out constitutional vulnerability with adverse environmental conditions were associated with higher level of psychopathology.

Major Depressive Disorder: Part-II -Comorbid Anxiety Disorders.

Objective: To demonstrate that Anxiety Disorder comorbidity is reflection of underlying common risk factors (Anxiety proneness) in Major Depressive Disorder patients and may not be a separate disorder. We hypothesized that “Anxious personality traits or disorders under stress take the form of state that is Anxiety Disorders”. Methods:36 indoor patients of psychiatry ward of tertiary level services, out of total 168 admitted patients from Ist January 2008 to 31st Dec. 2008 diagnosed as Major Depressive Disorder (as per DSMIV TR). Socio-demographic data on a self-designed Performa, Montgomery Asberg’s Depression Rating Scale (MADRS), Hamilton Anxiety rating scale (HARS) and Presumptive Stressful Life Event Scale (PSLE) were applied to these patients and they were observed every alternate day till discharge. International Personality Disorder Examination (IPDE) was applied on their third follow-up visit, which ranged from 6 to8 weeks. Results: High level of co-existence of Anxiety disorder 29(80.5%) in the study sample, 11 patients (30.55%) of Major Depressive Disorder had personality disorder level of psychopathology and 18(50%) patient of Major Depressive Disorder had double or more personality traits psychopathology and there were 7(19.45%) patients of Major Depressive Disorder had only single trait personality psychopathology. Conclusion: This work support the gene environmental diathesis where vulnerable person under stress develop Axis I disorder which are considered currently as co morbid disorders.

Co-Morbidity of Personality Disorders and its Impact on Phenomenology and Treatment Response in Bipolar Disorder Patients.

Aim:To study the comorbidity of personality disorders and its impact on phenomenology and treatment response in bipolar patients. Methods:40 indoor patients of psychiatry ward of P.B.M. General Hospital out of total 437 admitted patients diagnosed as Bipolar Disorder – Manic or Mixed were randomly selected. Young’s Mania Rating Scale (YMRS), Montogomery Asberg Depression Rating Scale (MADRS) and Presumptive Stressful Life Event Scale (PSLE) were applied to these patients and they were observed every alternate day till discharge.. International Personality Disorder Examination (IPDE) was applied on their first follow-up visit after recovery. Since the major aim was to observe the routine response pattern of phenomenology in Bipolar I patients and considering wide variabilities in treatment strategies of clinicians, we decided to consider the naturalistic method, the response to the best treatment considered by the treating physician Results : Borderline disorder level personality psychopathology was noticed in 32.5% of the whole sample .Anxious and Impulsive traits came a close second with 30% of the sample demonstrating the combined trait. Anxious disorder was seen in 3 patients that is 7.5% of the sample and Anxious, Impulsive and Anti-social traits were seen in 3 patients (7.5%).5 patients (12.5%) demonstrated anxious traits,3 patients (7.5 %)had impulsive traits and 1 patient had histrionic traits. Hospital stay of patients with Borderline personality disorder versus others with trait level psychopathology was significantly higher. (t=9.40, d.f. =38, p<0.000) Electro- Convulsive Therapy was administered to a significantly higher number of patients with personality disorder level psychopathology than to trait level personality psychopathology (X2=6.856, d.f.=1, p<0.01). Borderline Disorder patients had significantly higher YMRS score than single (t=3.348, d.f.=20, p< 0.001) and double trait t=3.58, d.f.=26, p<0.001) patients.

Bipolar Disorder - Mixed States: A Diagnostic Dilemma (Part-I).

There is a large difference in classifying Mixed States according to the prevailing standardized classifications because of the differential focus of the various criteria in identifying Mixed States. Aims: To assign the Mania With Depressive symptoms patients in different groups and to compare the phenomenology, personality profiles and psychiatric co-morbidities of these various groups so generated. Material and Methods: 64 patients were randomly selected from the 214 Bipolar Disorder – Current episode Manic (as per DSM IV TR9) patients admitted in Psychiatry ward of P.B.M. General Hospital,Bikaner from 1st Jan 2007 to 31st Dec. 2007. After recording socio-demographic data on a self-designed Performa, Young’s Mania Rating Scale (YMRS)and Montgomery Asberg Depression Rating Scale (MADRS) were administered on day 1,3,5,7 and 9 till discharge.32 patients were assigned to Mania with Depressive Symptoms on displaying 1 or more depressive symptom, excluding decreased sleep.32 patients were assigned to Pure Mania group who displayed no Depressive symptoms. Results: 30 patients(94%) could be assigned to Mixed states according to Vienna Criteria,25(78%) could reach the diagnosis of Mixed States as per Cincinnati criteria, another 17(53%) were assigned to Mixed States as per Pisa San Diego Criteria.ICD-10 could identify 5 patients(16%) and DSM IV TR appeared to identify the least that is 3 patients(9%) Conclusion: Concept of MS couldn’t be better explained with these existing criteria because some patients meeting one criterion are not meeting others.