Association of serotonin transporter (SLC6A4) & receptor (5HTR1A, 5HTR2A) polymorphisms with response to treatment with escitalopram in patients with major depressive disorder : A preliminary study.

Background & objectives: Genetic factors have potential of predicting response to antidepressants in patients with major depressive disorder (MDD). In this study, an attempt was made to find an association between response to escitalopram in patients with MDD, and serotonin transporter (SLC6A4) and receptor (5HTR1A, 5HTR2A) polymorphisms. Methods: Fifty five patients diagnosed as suffering from MDD, were selected for the study. The patients were treated with escitalopram over a period of 6-8 wk. Severity of depression, response to treatment and side effects were assessed using standardised instruments. Genetic variations from HTR1A (rs6295), HTR2A (rs6311 and rs6313) and SLC6A4 (44 base-pair insertion/deletion at 5-HTTLPR) were genotyped. The genetic data of the responders and non-responders were compared to assess the role of genetic variants in therapeutic outcome. Results: Thirty six (65.5%) patients responded to treatment, and 19 (34.5%) had complete remission. No association was observed for genotype and allelic frequencies of single nucleotide polymorphisms (SNPs) among remitter/non-remitter and responder/non-responder groups, and six most common side-effects, except memory loss which was significantly associated with rs6311 (p=0.03). Interpretation & conclusions: No significant association was found between the SNPs analysed and response to escitalopram in patients with MDD though a significant association was seen between the side effect of memory loss and rs6311. Studies with larger sample are required to find out genetic basis of antidepressant response in Indian patients.

Changing trends of services used as first contact by patients with mental health problems.

Background. In the past, traditional faith healers and practitioners of alternative medicine have often been reported to be the first source of contact for Indian patients with mental health problems. However, over the past few decades, this trend seems to be changing. Method. Using a semi-structured questionnaire, we assessed 200 new patients at a psychiatric outpatient service in a general hospital for the first service contact used by them for their mental health problems. Results. Psychiatrists, non-psychiatric physicians, traditional faith healers and practitioners of alternative medicine were the first service contact for 91 (45.5%), 88 (44%), 16 (8%) and 5 (2.5%) patients, respectively. Patients suffering from severe mental illnesses were more likely to choose a psychiatrist as the first contact, whereas those with neurotic, stress-related and organic mental disorders contacted a non-psychiatric physician. Conclusion. In the current scenario, psychiatrists and nonpsychiatric physicians serve as the first service contact for most patients with mental health problems in India, though traditional faith healers and practitioners of alternative medicine are contacted by a minority.

Rehabilitation need assessment of severely Mentally ill and effect of Intervention.

To study the rehabilitation needs of severely mentally ill person and to ascertain the efficacy of intervention strategies to meet out these needs, a group of 50 severely mentally ill persons, 25 each in experimental and control group as per proposed inclusion and exclusion criteria were selected from indoor and out patient clinic of IHBAS as sample of the study. Intervention package used in the study included psycho-education, activity scheduling and social skill training. To see the effect of intervention parameters used were symptom reduction, disability remediation, subjective wellbeing and dysfunction in social, family, personal, vocational and cognitive areas. Rehabilitation need assessment schedule, Mini Mental Status Examination, Positive and Negative symptom scale, Disability Assessment Schedule, Subjective well being Inventory and Dysfunctional Analysis Questionnaire were administered to collect desired data twice in the pre and post intervention phases. Pre assessment followed intervention sessions conducted for the experimental group for eight weeks duration. During this period control group subjects were waitlisted for this intervention. Results indicated that intervention is effective in symptom reduction, disability remediation, improving subjective well being and functioning in personal, social, family and cognitive areas.

Assessment of hospital services by consumers: a study from a psychiatric setting.

The present study revealed perception of forty-five patients and fifty nine family members selected from the outpatinet deptt. of a Psychiatric hospital. A semi-structured questionnaire was used. The issues like efficiency, punctuality, behaviour of doctors and other staff, waiting time, supply of draugs and diet and cleanliness of the hospital etc were enquired. More than ninety % of the patients and their escorts appreciated the services provided. Most of them (75-80%) was satisfied with supply of drugs, quality of diet, clinical care and cleanliness of the hospital. Measures for improvement were also suggested.

Neurocysticercosis presenting as psychiatric illness.

Neurocysticercosis is a common neuroparasitosis. Presentation with psychiatric symptoms is uncommon in neurocysticercosis. The present paper describes a patient who presented with mutism, neglect of personal care and incontinence in a psychiatric setting and investigations revealed diagnosis of neurocysticercosis. The case report highlights the possible misdiagnoses of a case of neurocysticercosis as psychiatric illness and mutism as an uncommon presentation of neurocysticercosis.

Psychiatry in non-psychiatric setting--a comparative study of physicians and surgeons.

The paper reports awareness of a group of physicians and surgeons about psychiatric disorders in clinical practice and their attitudes towards psychiatric referral. The study was carried out in a teaching general hospital. Sample consisted of 60 faculty members and senior residents belonging to various clinical disciplines. A 14-item structured questionnaire was used for assessment. The data were compared across the specialists from medical and surgical specialities. The main findings included underestimation of psychiatric morbidity by all the clinicians and a general reluctance to refer patients to a psychiatrist for varied reasons. However, most doctors considered psychiatric referral as useful. No major differences were noticed between surgeons and physicians regarding their attitudes and awareness about psychiatry. There is a need to increase the awareness of non-psychiatric clinicians about psychiatric disorders and to develop consultation-liaison psychiatric units and expand undergraduate medical education programmes in psychiatry in the developing countries.

Psychiatric morbidity in preschool children--a clinic based study.

Psychiatric morbidity patterns in preschool children attending a general hospital psychiatric clinic were studied. No psychiatric problem was detected in 48% of the sample, epilepsy being the diagnosis in more than half of these children. Common psychiatric problems were mental retardation (27%), breath-holding spells (11%) and hyperkinetic syndrome (7%). Emotional and behavioral problems, and habit disorders, which are quite common in this age group, were poorly represented in the clinic sample. It appears that mental retardation and epilepsy are the only two main disorders usually perceived by Indian parents as psychiatric problems in preschool age group.

Pattern of psychiatric morbidity in children attending a general psychiatric unit.

Patterns of psychiatric morbidity were studied retrospectively in children who attended the psychiatric outpatient clinic of a general hospital over a period of two years (January 1991-December 1992). Three hundred and eighty six children attended the clinic during this period. Twenty three percent of the children were diagnosed as mental retardation, whereas epilepsy was the diagnosis in 21% cases. A formal psychiatric diagnosis could be made only in less than half of the cases. The findings are discussed in terms of public awareness about child psychiatric disorders.