A cross sectional study on prevalence and pattern of personality disorders in psychiatric inpatients of a tertiary care hospital

Background: Co-occurrence of personality disorders with other psychiatric disorders has also been well documented by many researchers in the past. Diagnosing co occurring personality disorders in psychiatric patients with is of strong clinical significance, considering their association with the duration, recurrence, and outcome of these disorders. They also can have wide range of other adverse health outcomes. However, most of the existing literature regarding the studies related to personality disorders (PDs) in India is confined to community and mental hospitals. Aim: To study the prevalence and factors affecting personality disorders in a general hospital psychiatry unit. Materials and methods: The study was a cross sectional study conducted in a psychiatric unit of a tertiary care teaching hospital in south India. ICD-10, Mini International Neuropsychiatric Interview (MINI) and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental DisordersIV Personality Disorders (SCID-II) were used. Results: A total of 116 participants were included in the study. Majority of the participants were between 26 to 45 years of age. The prevalence of personality disorder was 21.55% (95%CI 14.07 to 29.03) among the study population. The most common type of personality disorder was avoidance (7.7%), followed Maanasa T J, Sivabackiya C, Srinivasan B, Shajahan Ismail, Sabari Sridhar OT, Kailash S. A cross sectional study on prevalence and pattern of personality disorders in psychiatric inpatients of a tertiary care hospital. IAIM, 2016; 3(5): 94-100. Page 95 by anti social (5.17%) and borderline (3.45%) personality disorders. Highest proportion of PD was seen in people with major depressive disorder (35.7%), followed by people with multiple psychiatric illness (31.6%) and Psychotic disorders/mood disorders with psychosis (18.9%). Conclusion: The proportion of personality disorders was highest in 26 to 35 year age group, was higher in males, compared to females. People who studied up to primary school had higher proportion of PD, compared to other educational categories. The proportion was higher in people belonging to higher socio economic strata, people who are separated and people from nuclear family.

Estimate of Genetic Variability and Heritability in Some Exotic Germplasm Lines in Kharif Rice (Oryza Sativa L.).

The high genotypic coefficient of variation, high heritability with high genetic advance as percent of mean was observed for grain yield per plant, total tillers per plant, productive tillers per plant and grains per panicle, whereas days to initiation of flowering, days to 50 % flowering and days to maturity had high heritability with low genetic adavance as per cent of mean.

Profile of Children with Poor School Performance in Mumbai.

We report on the etiology of poor school performance (PSP) in children assessed at a learning disability clinic in western India over 12 months. Specific learning disabilities (dyslexia, dysgraphia and dyscalculia) were the commonest cause of PSP (72.76%), followed by borderline intellectual functioning (8.94%), language barrier (8.54%), and mental retardation (4.88%).

Attention deficit hyperactivity disorder--a review for family physicians.

Attention deficit hyperactivity disorder (ADHD) is a chronic behavioral disorder characterized by persistent hyperactivity, impulsivity, and inattention that impairs educational achievement and/or social functioning. Its diagnosis is made by ascertaining whether the child's specific behaviors meet the diagnostic and statistical manual of mental disorders-IV-revised criteria. Its etiology is still unclear but recent studies suggest that genetics plays a major role in conferring susceptibility. Comorbidity with psychiatric disorders such as anxiety disorder, depression, oppositional defiant disorder and conduct disorder; and with specific learning disability is not uncommon. Although medication works well in most cases of ADHD, optimal treatment requires integrated medical and behavioral treatment. Methylphenidate (MPH) and atomoxetine are the two drugs being currently prescribed and their efficacy in decreasing the symptoms of ADHD is well documented. Pyschoeducational interventions in school can help increase the successful functioning of affected children and improve their academic performance. Almost half of affected children continue to show significant symptoms of the disorder into adolescence and young adulthood. The family physician can play an important role in detecting this condition early, coordinating its assessment and treatment, counseling the parents and classroom teacher, and monitoring the child's academic and psychosocial progress on a long-term basis.

Multiple giant congenital melanocytic nevi with central nervous system melanosis.

A case of multiple giant congenital melanocytic naevi in whom central nervous system melanosis was detected at 6 weeks of age is described. The infant was asymptomatic, but presence of risk factors such as multiple naevi, giant naevi and naevi on scalp and posterior axial location prompted a magnetic resonance imaging study of the brain. To our knowledge, neurocutaneous melanosis at such a young age has not been reported in Indian literature.

An unusual presentation of scurvy following head injury.

We report an unusual clinical presentation of scurvy in a one and half year old child. The child presented with abrupt onset of peri-orbital ecchymoses and scalp hemorrhage following head injury. The child also had a history of temper tantrums and head banging. Our case did not have any of the typical clinical features of scurvy. The diagnosis was eventually confirmed radiologically and by observing a dramatic response to vitamin C therapy. It is important to remember that scurvy can present atypically i.e. without bleeding gums, painful limbs, pseudo-paralysis or scorbutic rosary. Scurvy should be kept as a differential diagnosis in a young child presenting with bleeding manifestations. Taking a detailed dietary history is of utmost importance in pediatric practice.

An outbreak of leptospirosis in Mumbai.

Following prolonged water logging due to heavy rainfall in Mumbai during July 2000, a total of 102 patients clinically suspected of leptospirosis were admitted in our hospital. Blood samples were examined for the presence of leptospires by dark ground microscopy (DGM) and IgM antibodies were detected by ELISA. Out of 102 blood samples, 37 were positive by ELISA giving a positivity rate of 36.27%. Of these, only 24 were positive by DGM. Out of the positive cases, 37.83% had respiratory symptoms, 32.43% each had jaundice and conjunctival suffusion and 16.21% had renal involvement. Mortality amongst the positive cases was 10.81%. Apart from hepatic and renal involvement, respiratory symptoms due to leptospirosis are on the rise.

Approach to learning disability.

Learning disabilities (LD) is one of the important causes of poor academic performance in school going children. Learning disabilities are developmental disorders that usually manifest during the period of normal education. These disabilities create a significant gap between the true potential and day to day performance of an individual. Dyslexia, dysgraphia and dyscalculia denote the problem related to reading, writing and mathematics. Perinatal problems are certain neurological conditions, known to be associated with LD; however, genetic predisposition seems to be the most probable etiological factors. Evaluation of a child suspected to be having LD consists of medical examination, vision and hearing test analysis of school performance. The psycho-behaviour assessment and education testing are essential in the process of diagnosis. The experienced persons in the field of LD should interpret the results of such tests. With Individualized Remedial Education Plan (IEP) most children learn to cope up with disability and may get integrated in a regular steam.

Hepatic hydatid cyst rupturing into sub-diaphragmatic space and pericardial cavity.

A ten-year-old male child presented with a large hepatic hydatid cyst which ruptured into the sub-diaphragmatic space and pericardial cavity, giving rise to a pericardial effusion. This communication between the hydatid cyst and the pericardium was documented on computerised tomographic scan of the chest and abdomen. The cyst was aspirated carefully and then enucleated. There was an associated right-sided reactionary pleural effusion. The pericardial effusion and pleural effusion resolved on albendazole therapy and did not require surgical intervention.

Cerebellar atrophy in an epileptic child: is it due to phenytoin?

A four and half year old epileptic child on phenytoin therapy since one year presented with signs of cerebellar dysfunction. Serum phenytoin level was high (33 mcg/ml) and computerised tomographic scan of the brain showed severe generalised cerebellar atrophy. The cerebellar signs represented drug over dosage and toxicity and persisted long after omission of phenytoin.

Sacral chordoma--a case report.

Chordoma, a rare malignant tumour of early adulthood, rarely presents in children. We report such a case of rare malignant tumour which was diagnosed in the first decade of life.

Ciprofloxacin use: acute arthropathy and long-term follow up.

OBJECTIVE: To assess whether children treated with ciprofloxacin in 1990 had developed any permanent joint damage. DESIGN: Retrospective questionnaire-based follow-up study. SETTING: Adverse Drug Reaction (ADR) Monitoring Center in Mumbai. SUBJECTS: 3341 children treated with ciprofloxacin in 1990, including 7 who had developed a ciprofloxacin-related acute arthropathy. METHODS: A questionnaire was sent in January 1995 to 147 pediatricians who had reported to us children in whom ciprofloxacin was prescribed in 1990. The information sought for included the number of children who had followed-up beyond 2 years and details of any joint-related complaints noted in them on long-term follow-up. RESULTS: Long-term follow-up was reported in 582 of these 3341 children. No joint-related complaints had developed in 581 children, either as an acute ADR in 1990 or as a delayed ADR during a minimum follow-up period of 2 years. Long-term follow-up was available in only 1 of the 7 children in whom a ciprofloxacin-related acute arthropathy had developed in 1990, and this child was now asymptomatic. New information was received about 13 children treated with ciprofloxacin during 1991-1994 who had developed a ciprofloxacin-related acute arthropathy. In the total 20 children, aged 2-12 years, reported to us for acute ADR, the arthropathy (joint pains, restriction of joint movements and/or swelling of joint) had developed on day 1 to 8 of ciprofloxacin therapy, and in 18 the acute arthropathy had resolved within 1 day to 4 weeks of either discontinuing or completing ciprofloxacin therapy. Outcome in the remaining 2 children was not available. CONCLUSIONS: Ciprofloxacin use can cause an acute reversible arthropathy, but in this study there is no evidence that its use can cause a delayed arthropathy or any permanent joint damage.

Three sibs with mild variety of osteopetrosis.

We report three sibs with mild autosomal recessive variety of osteopetrosis. The prominent clinical features were short stature, malocclusion of teeth, hepatosplenomegaly and a typical facial appearance. The only atypical features were microcephaly, a normal upper segment to lower segment ratio and a normal arm span.