Prescription pattern of antidepressants in five tertiary care psychiatric centres of India.

Background & objectives: Limited data are available on prescription patterns of the antidepressants from India.We studied antidepressants’ prescription pattern from five geographically distant tertiary psychiatric care centers of the India. Method: In this cross-sectional study, all patients who attended outpatients department or were admitted in the psychiatry wards at Lucknow, Chandigarh, Tiruvalla, Mumbai and Guwahati on a fixed day, who were using or had been prescribed antidepressant medications, were included. The data were collected on a unified research protocol. Results: A total of 312 patients were included. Mean age was 39±14.28 yr and 149 (47.76%) were females, 277 (87.5%) were outpatients. Among the patients receiving antidepressants, 150 (48.1%) were of diagnoses other than depression. Diabetes mellitus 18 (5.78%) was the most common co-morbid medical illness. A total of 194 (62.2%) patients were using selective serotonin reuptake inhibitors (SSRIs) with escitalopram 114 (36.53%) being the most common antidepressant used. Overall, 272 (87.18%) patients were using newer antidepressants. Thirty (9.62%) were prescribed more than one antidepressant; 159 (50.96%) patients were prescribed hypnotic or sedative medications with clonazepam being the most common (n=116; 37.18%). Interpretation & conclusions: About half of the patients with diagnoses other than depression were prescribed antidepressants. SSRIs were the most common group and escitalopram was the most common medication used. Concomitant use of two antidepressants was infrequent. Hypnotic and sedatives were frequently prescribed along with antidepressants.

A Comparative Study of Body Image and Coping Style in Breast Cancer Patients.

Background: Breast cancer is one of the most common malignancies and leading cause of death in women. It not only encompasses physical but also social and psychological implications because of the importance of the breast in feminity, sexuality and motherhood. It leads to the fear of disfigurement, disability, dependence and disruption of relationships. Very few studies assessed the psychological aspect of cancer causing altered feminity and fear of death. Aims and Objectives: To assess the coping skills, death anxiety and body image in breast cancer patients, who have undergone mastectomy and who have been treated nonsurgically. Methods: 45 female in the age group of 25 years to 55 years who were aware of their diagnosis and had undergone mastectomy or treated nonsurgically between three months to twelve months at the time of inclusion were assessed on body image index, coping strategy checklist and death anxiety scale. Results and Conclusion: There were no significant differences in total coping scores between two groups but denial was used significantly higher by the patient of mastectomy group. Body image was found to be significantly better in joint family patients while patients with nuclear family had higher psychological distress. Thus types of treatment, socioeconomic and family status have important psychological implication in breast cancer patients.

A Study of Psychiatric Comorbidity in Opioid Dependence.

Aim: To assess psychiatric comorbidity in patients of opioid dependence Method: All the patients of opioid dependence attending alcohol and drug deaddiction OPD and adult psychiatry OPD on specific days, were screened. Those fulfilling the selection criteria were included in the study. A detailed evaluation was done for socio-demographic variables and history of drug using semi-structured proforma especially prepared for the study. Diagnosis of opioid dependence was made according to DSM-IV-TR criteria. The patients were seen for co-morbid psychiatric illness by applying Structured Clinical Interview for DSM-IV-TR I & II (SCID I & II). Results: Out of 25 patients 19 (76.0) were found to have comorbid psychiatric illness. Axis I and Axis II comorbidity was found in 76% and 20% of the samples, respectively. Patients of cluster B personality were dominating in the sample. Patients with more than one comorbidity accounted for 60% of the sample. Conclusion: Psychiatric comorbidity in opioid dependence are very high, other substance in particular. Number of comorbid diagnoses in a person may as high as four.

Cognitive functions in stable schizophrenia & euthymic state of bipolar disorder.

BACKGROUND & OBJECTIVE: Some cognitive deficits in schizophrenia and bipolar disorders persist after the subsidence of active symptoms. We carried out this study to assess and compare the cognitive functioning of patients with stable schizophrenia and bipolar disorder. METHODS: Fifteen each of stable maintained schizophrenic patients and euthymic bipolar-I patients attending outpatient clinic in a tertiary care psychiatric hospital in north India were included in the study as also equal number of age and education matched control subjects. Cognitive assessments were done using Wisconsin's Card Sorting Test (WCST), Spatial Working Memory Test (SWMT) and Continuous Performance Test (CPT). RESULTS: Stable schizophrenia patients performed poorly on all the neurocognitive parameters as compared to both controls and bipolar euthymic patients. Euthymic bipolar patients showed significant difference on executive functions with normal controls. Patterns of cognitive disturbances in tasks of executive function are similar in both groups but are quantitatively more marked in schizophrenia. INTERPRETATION & CONCLUSION: Our results showed that stable schizophrenia patients performed significantly worse on cognitive measures than patients of euthymic bipolar disorder which was consistent with their poorer functional outcome. The results further indicated that stable schizophrenia and euthymic bipolar disorders may be distinguished qualitatively in neuropsychological terms with different profiles of cognitive impairment.

An open-label multicentric study of the tolerability and response to escitalopram treatment in Indian patients with major depressive disorder.

To evaluate the tolerability and response to escitalopram in Indian patients with major depression, over an 8-week open-label multicentric study was carried out among 18-65 years old Indian patients suffering from DSM IV major depressive disorder with Montgomery-Asberg depression rating scale (MADRS) total score> or =22. Patients received a fixed dose of escitalopram 10 mg daily for 2 weeks, followed by flexible dose of 10 to 20 mg daily for 6 weeks. Patients were evaluated for depression and rated on MADRS score and clinical global impressions-severity (CGI-S) and--improvement (CGI-I) scores. They were monitored for treatment-emergent adverse effects. A total of 119 patients were enrolled and 103 completed the trial. There was a decrease from baseline in the MADRS total score after one week of treatment continuing until 8 weeks. By week 8, 76.9% patients had responded to treatment (> or =50% or more reduction of MADRS total score). A similar pattern of improvement to that seen with the MADRS total score was seen with CGI-S and CGI-I scores. Escitalopram was well tolerated, with only 2 patients (1.7%) withdrawing from the study due to adverse events. There were no serious adverse events.

Psychotropic Drug Induced Metabolic Disorders.

According to a report from the Centers for Disease Control and Prevention released in April, the leading cause of death contibuting to that shortened lifespan is not the patients’ mental illness, but rather something largely preventable cardiovascular disease. Metabolic disorders are known complications of newer antipsychotics. The term Metabolic Syndrome refers to a syndrome consisting of central obesity as indicated by excessive visceral fat, plasma lipid abnormalities, glucose dysregulation, and high blood pressure. The metabolic syndrome develops gradually, different drugs have differential propensity to cause it. This is a dreadful condition as it induces medical morbidities, which may be life threatening in patients. The criteria for diagnosing the metabolic syndrome propsed by the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) are the most current and widely used but are not universally accepted. Common manifestations are dyslipidemia, hypertension, weight gain, increase in blood glucose etc. This review covers the latest available information on the drug — induced metabolic syndrome. Risk factors and mechanisms are discussed.

Disability assessment in mental illnesses using Indian Disability Evaluation Assessment Scale (IDEAS).

BACKGROUND & OBJECTIVE: Psychiatric disorders cause disability in individuals and pose significant burden on their families. In most of the cases residual disability and poor quality of life continue even after disability evaluation in patients with chronic mental illness in very important. The present study was undertaken to assess and compare the disability in patients with schizophrenia and obsessive-compulsive disorder (OCD) using Indian Disability Evaluation Assessment Scale (IDEAS). METHODS: Patients diagnosed to have schizophrenia and OCD with mild severity of illness were included in the study. Indian Disability Evaluation Assessment Scale (IDEAS) was applied. Disability was assessed in these patients on all domains of IDEAS. RESULTS: Majority of the patients with schizophrenia were from rural areas whereas most of the patients with OCD were from urban background. There was comparable disability in the patients with schizophrenia with duration of illness in the range of 2-5 yr and >5 yr. Significant disability in work and global score was seen in patients of obsessive-compulsive disorder with duration of illness >5 yr. Patients with schizophrenia had significantly higher disability in all domains than patients with OCD. INTERPRETATION & CONCLUSION: Schizophrenia causes greater disability than obsessive-compulsive disorder in patients. These illnesses affect all areas of daily functioning leading to greater disability, and thus increasing the burden on the family, pose greater challenge for the rehabilitation of patients and their inclusion in the mainstream of the family and society. Further studies on a larger sample need to be done to confirm the finding.

Suicide: an Indian perspective.

Suicide, as an issue, has attracted the attention of society since time immemorial. Its situation in India and the socio-demographic variables have been discussed along with management profile. The education of physicians and general practitioners in suicide prevention has been stressed.

Depression in general clinical practice.

Worldwide currently about 340 million people suffer from depression. If not treated, it leads to increased morbidity and mortality. Risk factors include female sex, young age, lower socio-economic study, separated or divorced, positive family history, stressful life events, certain medical illness and so on. Aetiology lies on genetic factors, biochemical abnormality and personality and environmental factors. Clinical features lie on cardinal and other common symptoms. Depression usually starts before 40 years of age, average duration of one episode being 3-9 months. Treatment consists of a variety of psychotherapeutic approaches, pharmacotherapy and electroconvulsive therapy. A clinician may start therapy with low dose SSRIs which is considered as 1st line drugs. To educate patients about anti-depressants is very important.

Prevalence of hypertension in psychiatric disorders.

OBJECTIVE: To study the prevalence of hypertension in our cases with psychiatric disorders and to study if the prevalence is higher in the cases with psychiatric disorders. METHODS: Four hundred twenty two cases with various psychiatric disorders attending the Outpatient Department of Psychiatry of our hospital were studied. Detailed clinical evaluation was done in all the cases. Blood pressure was recorded in the sitting position and mean of three readings was taken. Diagnosis and grading of hypertension was done according to the JNC V recommendations. Psychiatric disorders were diagnosed according to DSM IV criteria. RESULTS: Mean age of the cases was 36.3 years. Prevalence of hypertension in the cases was 7.1%. Prevalence in male and female cases were 7.2% and 7.0%, respectively. Prevalence of hypertension in various age groups was 20-39 years--1.48%, 40-60 years--24.4%, > 60 years--33.3%. CONCLUSION: The overall prevalence of hypertension in our cases with psychiatric disorders was 7.1% which was not higher than the reported prevalence of hypertension in our general population.

Relationship of immunoglobulins with the number & duration of schizophrenic episodes.

The relationship of serum and CSF immunoglobulins with the number and duration of schizophrenic episodes was assessed in 40 schizophrenics. The mean IgA was increased in patients having 3 or more episodes as compared with those having the first episode (P less than 0.001). IgM showed a moderate increase in patients with the second episode and those having 3 or more episodes. IgG/TP per cent (IgG/total protein %) was found to be significantly increased in CSF of patients having the first episode, as compared with those having 3 or more episodes (P less than 0.001). IgG was increased (although insignificantly) in the CSF of patients with illness of five years duration as compared to patients having illness of one year duration or for illness between 1-5 yr. IgG/TP per cent was found to be significantly increased in patients having illness for 5 or more years when compared to patients having illness for less than 1 yr (P less than 0.001) and for 1-5 yr (P less than 0.01).