Prevalence of psychiatric morbidity amongst the community dwelling rural older adults in northern India.

Background & objectives: The population of elderly is growing globally and so are the physical illnesses and psychiatric morbidity. This study was planned to assess the prevalence and patterns of psychiatric morbidity amongst rural older adults in Lucknow, north India. Methods: A survey was conducted in subjects aged 60 yr and above to identify the cases of psychiatric morbidity in rural population from randomly selected two revenue blocks of Lucknow district, Uttar Pradesh, India. All subjects were screened through Hindi Mental Status Examination (HMSE) and Survey Psychiatric Assessment Schedule (SPAS) to identify for the suspected cases of cognitive and the psychiatric disorders, respectively. The subjects screened positive on HMSE and SPAS were assessed in detail on Cambridge Mental Disorder of the Elderly Examination-Revised (CAMDEX-R) and Schedule for Clinical Assessment in Neuropsychiatry (SCAN), to diagnose cognitive disorders and psychiatric disorders (other than the cognitive), respectively on the basis of International Classification of Diseases-10 (ICD-10) diagnostic guidelines. Results: The overall prevalence of psychiatric morbidity in rural older adults was found to be 23.7 per cent (95% CI=21.89-25.53). Mood (affective) disorders were the commonest (7.6%, 95% CI=6.51-8.80), followed by mild cognitive impairment (4.6%, 95% CI=3.72-5.53), mental and behavioural disorders due to substance use (4.0%, 95% CI=3.17-4.87) and dementia (2.8%) [Alzheimer’s disease (2.4%, 95% CI=1.81-3.16) and vascular (0.4%, 95% CI=0.16-0.73)]. Interpretation & conclusions: Overall prevalence of psychiatric morbidity amongst rural elderly in this study was found to be less in comparison to those reported in earlier studies from India. However, prevalence pattern of different disorders was found to be similar. Therefore, it appears that a stringent methodology, refined case criteria for diagnosis and assessment by trained professionals restrict false diagnosis.

Psychosocial Characteristics as Perceived by Families in North Indian Community.

National or Caste group characteristics typify psycho-social characteristics of that group. These typifying psycho-social characteristics, whether of individuals or of families or of small or big groups, have tremendous predictive value in determining interventional outcomes. Systematic studies to discern distinguishing features of population subgroups vis-à-vis domicile, socio economic status (SES), gender etc. practically non-existent. . Psycho-social characteristics determine behavioural expressions in day to day living. In a separate large scale study entitled “A Study of the Impact of Behavioural Interventions on Illness Breeding Behaviors” funded by World Bank through Uttar Pradesh Health System Development Project; Lucknow, 1134 families drawn on stratified random basis from rural and urban areas of Barabanki, Mujaffarnagar and Gorakhpur districts of Uttar Pradesh (Northern India) were studied along various psycho-social characteristics to study the differences, if any, between the population subgroups. The data revealed significant differences between the population sub-groups along several psychosocial characteristics. The findings are discussed.

Psychotherapeutic Approaches in the Management of Elderlies with Dementia An Overview.

The population of the world in 1995 was 5.7 billion and it is expected to reach 10.8 billion by 2050. The percentage of older people in the world population is expected to increase rapidly from 9.5 in 1995 to 20.7 in 2050 and to 30.5 in 2150. In absolute numbers, India’s elderly population is expected to increase from 76 million in 2000 to 327 million in 2050. The prevalence of psychiatric disorders in old age and burden of care will further increase as the proportion of elderly persons in the India population increases over the next 50 years. Now, attention of mental health professionals should be focused on to plan and provide better care in the management of old age psychiatric disorders. From the management point of view cognitive disorders are more challenging psychiatric disorders of the old age. Dementia is one of them. Successful management of patients with dementia requires a broad range of tasks. These tasks help to maximize the patient’s level of functioning and to assure the safety and comfort of patients and their families in the context of living with a difficult disease. The topic provides an overview of psychotherapeutic approaches and its effectiveness in the management of elderly dementia patients.

Isolated tubercular liver abscess in children treated with percutaneous isoniazid infusion.

Isolated Tubercular liver abscess is mainly reported in adult patients. We report two cases of isolated tubercular liver abscess in paediatric patients. Diagnosis was made by clinical and ultrasound guided aspiration of pus showing acid fast bacilli in one case. In second case, biopsy of the abscess wall was confirmatory. In both cases percutaneous drainage of pus and transcatheter infusion of Isoniazid was given. After two weeks of infusion no acid fast bacilli was detected and cavity size decreased. Direct infusion of anti-tubercular drugs is more efficient than systemic therapy alone. This is first of its kind in treating isolated tubercular abscess in paediatric patients. So, percutaneous infusion of anti-tubercular agents can be considered in the treatment of tubercular liver abscess.

Bilateral eventration of the diaphragm with malrotation and unilateral renal agenesis.

Bilateral eventration of the diaphragm associated with malrotation of gut and unilateral renal agenesis is a very rare entity. The authors treated a seven mth old male child who presented to them with respiratory distress and gastrointestinal problem. The child was anemic and was in type II respiratory failure. His X-ray chest showed bilateral eventration of diaphragm and ultrasonography abdomen was consistent with left renal agenesis which was confirmed by radionuclide scan. Bilateral plication of the diaphragm done with correction of malrotation which was diagnosed peroperatively. The association of these three anomalies are rare and to be kept in mind whenever treating a patient with bilateral eventration of the diaphragm.

Health Conducive Behavioural Intervention Needs of Rural and Urban Communities.

The study reports the prevalence of non-conducive behavioural practices in the area of “health care” prevalent in 1134 families of Northern India. Sample consisted of 563 families from rural and 571 families from urban area of Barabanki (Centre), Muzaffarnagar (North) & Gorakhpur (East) district of Uttar Pradesh, India. Behaviour correlates in the area of health care were mapped on a pre-prepared schedule, “Proforma for mapping of Behaviour correlates”. Percentage, hypothesis testing for difference between proportions and rank-order correlation was used for statistical analysis of data. Findings suggest that significantly more families from rural areas were involved in non-health conducive behavioral practices in all the studied constituent elements of self care except ‘carefulness about oral hygiene’. Urban families were more frequently involved in regular daily routine, carefulness about personal hygiene, appropriate use of personal & leisure time activities, elderly & child care than rural area. The study highlights the need for behavioural intervention both in urban as well as rural families in day to day living.

Tuberculosis in Transverse Testicular Ectopic testis a diagnostic dilemma: Case report.

Transverse testicular ectopia is a rare entity where one testis migrates to the other inguinal area. Genital involvement due to tuberculosis is rare in children. Tubercular involvement in transverse testicular ectopic testis has not been reported earlier. A case of tuberculosis in transverse testicular ectopic testis is reported here where the testicular mass mimicked as a tumour. Histopathological examination confirmed the diagnosis.

Bilateral adrenal abscess in a neonate.

A 23-day-old male baby with a history of perinatal hypoxia presented with refusal of feeds and abdominal distension. The child had a right-sided cystic upper abdominal mass and features of neonatal septicemia. Abdominal ultrasound (US) and contrast-enhanced CT scan showed bilateral adrenal abscesses. Laparotomy with drainage of the abscesses successfully treated the condition. The literature on the subject is reviewed.