ABSTRACT
Background: Possession disorders are commonly reported, especially from third world countries, like India, Far East, African and South American countries. Despite the various fast paced technological advances, possession disorder is still prevalent in various rural pockets of India. As an extension of the ongoing WHO ECA study in the department an attempt was made to look at the presentation and prevalence of this rather culturally variable and versatile disorder. Aims: To study the prevalence of ICD-10-RDC diagnosable possession disorder in the revenue district of Chittoor, India. Methods: Probability sampling design (probability proportional to Size) was employed in this study, which was based on the guidelines adopted in the ongoing WHO Longitudinal Epidemiological study on mental disorders in the department of psychiatry, SVRR Hospital, Tirupati, India. After an inquiry method utilizing the key informants in the locality the cases were identified. Then the subjects and the families were interviewed using ICD10 RDC criteria for diagnosing Possession disorder. Prevalence rates were calculated as per the data available and an attempt was made to compare the data available in the department. Results: 364 cases were diagnosed based on the methodology of inquiry of key personnel in the community. A prevalence rate of 0.048 % that is 48 per 100,000 populations is identified. But S.V.R.R.Government General Hospital Psychiatry unit being the only tertiary care facility in this area, should have treated 200 cases in a district having five million populations. During the same period census showed only four case of possession disorder out of fifty five conversion disorder patients which was a small fraction. The reason for the above finding could be that many of these cases were utilizing alternate medical or socio cultural interventions. Conclusion: Prevalence of possession disorder is still high in the rural areas and public need proper education regarding the nature and management of possession disorder. Key message: Only a tip of iceberg is being treated by the psychiatrist, despite the high prevalence of possession disorder in rural India.
ABSTRACT
Background: Post Stroke depression (PSD) is considered as a frequent neuropsychiatric consequence of stroke. Approximately one third of stroke survivors experience major depression. This condition can have adverse effects on cognitive function, functional recovery and survival. Aim: The current study examined prevalence of depression in post stroke survivors, its relation with site of lesion, laterality and. sociodemographic factors. Method: After obtaining consent, selected sample of post stroke survivors were diagnosed as post stroke depression based on ICD10 diagnostic criteria. Depression was quantified using HDRS and MADRS before discharge, at the end of first month and three months. Socio demographic profile was obtained. Statistical analysis was done using SPSS. Results: 32 patients of mean age (46.25yrs) and post stroke duration (2 weeks – 3 months) were included in the study. Twenty of thirty two post stroke survivors( 62.5%) met the criteria for depression at the time of discharge i.e. 2 weeks post stroke period, prevalence of PSD was 19 (59.37%) during 2nd assessment and 13(48.15%) during 3rd assessment. PSD was significantly associated with right sided lesions (p value = 0.013). In patients with left sided lesion, it is most commonly seen with sub cortical (p value = 0.003). Middle age was significantly associated with PSD (p value = 0.03). Female sex was associated with PSD in left sided lesions (p value = 0.02). No significant difference was found between first, second and third assessment of HAMD, MADRSS scores in depressed patients. No change in depression scores was found in both left and right sides at all assessments. Conclusion: This study emphasizes the need for early detection of depression in post stroke survivors. PSD is related to laterality of lesion, middle aged group and female sex. PSD is maintained at 3 months follow up. These results highlight the need to investigate, diagnose and treat post stroke depression.