ABSTRACT
Objectives: The objectives were to determine the proportion of elderly among the new psychiatry outpatient attendees, identify their sociodemographic profile and clinical presentations, and determine risk factors associated with suspected organic conditions in patients presenting with acute onset and chronic presentations. Methodology: This retrospective cross-sectional study focused on the elderly presenting with psychiatric symptoms to a psychiatric setting. The onset of symptoms at presentation was divided into acute and chronic conditions. Clinical symptom clusters and the risk factors associated with organic conditions were identified. The Chi‑square and Fisher’s exact test were used to find an association between factors and outcome (organic/functional). Results: Elderly seeking consultation constituted < 10% of total new case registration. Acute onset was seen in one-third and chronic presentation constituted nearly two-thirds of the group. The common clinical presentations with acute onset were acute psychosis, altered sensorium, and psychosis due to an organic etiology. The most common clinical presentation with chronic course was chronic psychosis. Nearly 40% had suspected organicity. Increasing age, structural abnormality in brain imaging, and the presence of stressors were risk factors for the onset of psychiatric presentation in the elderly (P = 0.001). Conclusion: Early detection of the clinical syndrome, identification of organic conditions, and appropriate and prompt referral to the general physician should be the rule for the care of the elderly presenting to a psychiatric facility.
ABSTRACT
Background: Absence of menstrual period in a woman of reproductive age group could be physiological or pathological. Ascertaining the cause for this is a common clinical scenario faced by physicians. It is also a common clinical problem in women who are on treatment with antipsychotic medication. This cross-sectional study aimed to assess the occurrence of antipsychotic induced amenorrhoea among women aged 18-45 years, attending outpatient services of a tertiary care setting, the factors associated and to assess the effective strategies of treatment.Methods: Retrospective chart review of clinical details of women in the reproductive age group who fulfilled the inclusion criteria was carried out. They were divided into two groups: Group A included 84 women with antipsychotic induced amenorrhea and Group B included 94 women on antipsychotics and had normal menstrual cycles. Various factors and strategies which worsened or alleviated the symptoms were noted.Results: Women who were less than 35 years of age, on antipsychotic treatment for more than two years duration (52;83.9%) and those who were on treatment with Risperidone (69;73.4%) were identified as having the risk of developing antipsychotic induced amenorrhoea. The strategy of switch of medication to prolactin sparing antipsychotic was more effective in regularising the menstrual cycles (43;87.8%).Conclusions: In women presenting with amenorrhoea, a possible medication induced aetiology need to be considered, especially use of antipsychotics. Further understanding of the complexities of this relationship may help to guide the assessment and proper treatment of women with antipsychotic related amenorrhoea.