Therapeutic efficacy of combination therapy of L-Methylfolate and Escitalopram in depression

Objective: To evaluate the efficacy of L-Methylfolate in combination with Escitalopram compared to Escitalopram monotherapy in depression

Study Design: Randomized controlled trial

Place and Duration of Study: Armed Forces Institute of Mental Health [AFIMH] Rawalpindi, six months, from Jan 2015 to Jun 2015

Material and Methods: A total of 260 patients having a primary diagnosis of Major Depression with a score of more than 14 on the HAM-D [Hamilton rating scale for depression] scale were selected in this Randomized Controlled Trial. These patients were divided into two groups. Group A received Escitalopram 10mg with a placebo whereas group B received Escitalopram 10mg with L-Methylfolate in a dose of 15mg. Both were reassessed after one month and HAM-D scores were measured again

Results: Out of the total 260 patients, response was present in 184 [70.8%] and 76 [29.2%] did not respond to the treatment. Out of 130 patients that were treated with SSRI alone, 82 [63.1%] showed response to treatment while 48 [36.9%] did not respsond. Out of 130 patients that were treated with Escitalopram and L-Methylfolate, 102 [78.5%] showed response to treatment while 28 [21.5%] did not respond. The p-value with a confidence interval of 95% was found to be 0.006 showing that the difference in the two treatments was statistically significant

Conclusion: We concluded that a combination of SSRI and L-Methyfolate in depression may prove to be more effective than Escitalopram monotherapy

Mode of presentation of patients of dissociative [conversion] disorder at the armed forces institute of mental health

To determine the mode of presentation of dissociative disorders presenting at Armed Forces Institute of Mental Health. Cross sectional study. The study was conducted at the Armed Forces Institute of Mental Health [AFIMH] Rawalpindi from 1[st] June 2013 to 31[st] August 2013. Fifty four patients of dissociative disorders were included in the study by using consecutive non-probability sampling. Category of presentation of dissociative disorders in the participants was determined by the primary mode of presentation and by using international classification of diseases [ICD]-10 diagnostic guidelines. The commonest type of presentation of dissociative disorders was mutism [40.7%], possession state [18.5%], pseudo fits [12.9%] followed by paraparesis [9.2%]. Predominantly the patients presented with mutism [dissociative motor disorder]

Anxiety, depression in patients receiving chemotherapy for solid tumors

To determine the frequency of anxiety and depression in patients undergoing chemotherapy for solid tumors using Hospital Anxiety Depression Scale [HADS]. Cross sectional descriptive study. Out-patient department of Armed Forces Institute of Mental Health, Rawalpindi from June 2011 to December 2011. Consecutive non probability sampling technique was used to select patients of age [25-70 years], male or female, who had received atleast 03 cycles of chemotherapy for solid tumors. Those with history of prior psychiatric illness, current use of psychotropic medication or psychoactive substance use, and any major bereavement in past one year were excluded from the study. After taking informed consent, relevant socio- demographic data was collected and HADS was administered. HADS-A cut off score of 7 was taken as significant anxiety while a HADS-D cut off score of 7 was taken as significant depression. The total number of participants was 209. The mean age of patients was 42.9 years, with 55.5% males and 44.5% females. Overall 33/209 [15.8%] patients had anxiety while 56/209 [26.8%] were found to have depression. there was a higher frequency of anxiety and depression in younger patients [less than age 40 years], females, patients who were single or divorced, and patients receiving chemotherapy for pancreatic carcinoma. Patients undergoing chemotherapy suffer from considerable levels of anxiety and depression, thus highlighting the need for specialized interventions

Global assessment of functioning of patients with schizophrenia a cross-sectional study

To assess psychological, social and occupational functioning of patients after seven years of diagnosis of schizophrenia using Global Assessment of Functioning [GAF] scale [DSM-IV Axis-V]. A cross sectional study. Department of Psychiatry, Military Hospital Rawalpindi from October 2007 to October 2008. This study included 30 patients who were retired military personnel invalided out of service with diagnosis of Schizophrenia between 1[st] Jan 2000 to 31[st] Dec 2001. After recording demographic data, patients underwent psychometric evaluation seven years after the diagnosis in 2007 and 2008 respectively for assessment of their psychological, social and occupational functioning using Global Assessment of Functioning [GAF] Scale [DSM - IV Axis V]. All subjects were male. Majority of the patients i.e. 14 [46.7%] patients had mild to moderate symptoms of the disease [GAF score 41 - 80]. Those having high income, employed and living in cities were associated with better global functioning. Schizophrenia continues to be a chronic disabling severe mental illness with deterioration in all aspects of functioning of patients

Frequency of psychiatric disorders in referred hospitalized patients of other medical disciplines a hospital based study

To asses the frequency of psychiatric disorders in the admitted patients of other medical disciplines at PNS Shifa Karachi. Cross sectional study. Place and duration of study: The study was conducted at PNS Shifa Karachi from April 2007 to Oct 2007. Total of 427 hospitalized patients in other medical disciplines at PNS Shifa Karachi; a tertiary care hospital, referred for psychiatric consultation in sequence were studied. The age of the patients ranged from 13 to 97 years, with the mean age being 43.22 years. Sixty four percent patients of the studied individuals were males. Forty nine percent patients were diagnosed to be suffering from Depression/Dysthymia. Twelve percent patients qualified the diagnosis of Anxiety disorder and Reaction to severe stress and adjustment disorders each. Seventeen percent patients suffered from Dementia, Delirium, Psychoactive substance abuse, Acute and transient Psychotic disorder, Schizophrenia, Bipolar affective disorder/Mood disorder and Puerperal depression. A considerable proportion of psychiatrically ill patients require psychiatric intervention either because of their primary psychiatric disorder or secondary psychological reactions to physical morbidity. Such intervention in time not only improves the quality of patient's life but also saves the heavy portion of the budget utilized for medical services in these patients later on if not diagnosed earlier

Effects of electro convulsive therapy on cognitive functions in patients of depressive episode

The objective of the study was to determine the effect of Electro Convulsive Therapy [ECT] on cognitive functions in patients of depressive episode. Design and It was an observational analytical study conducted in Departments of Psychiatry Military Hospital Rawalpindi and the Naval Hospital [PNS Shifa] Karachi. Fifty-five patients with depressive episode who were to undergo ECT treatment were included. They were administered translated versions of Mini Mental State Examination [MMSE] 24 hours before first ECT and 3 hours after first, second, fourth and sixth ECT and one month after the last ECT. Pre ECT cognitive functions were compared with those after subsequent ECTs. Data was compiled and analyzed by using Statistical Package for Social Sciences [SPSS] version 10.0 calculating mean values and p-value for determining the significance of difference which was set at 0.05. Mean age of the subjects was 29 years. Thirty-nine [71%] were males, 16 [29%] were females; 24 [44%] were taking tricyclic antidepressants as compared to 31 [56%] who were on other antidepressants. ECT had a significant effect on registration and recall of memory in the depressed patients who underwent six ECTs given by bilateral electrode placement and this persisted one-month after the last ECT. There was no significant effect of ECT on orientation, attention and concentration component of cognitive functions one month after last ECT. Language functions including comprehension and articulation remained unaffected. This study finds no persistent cognitive impairment after 30 days in patients treated with ECT, except for a decline in registration and recall aspects of short term memory

Hysteria: a symptom or a syndrome

A descriptive follow up study of 100 consecutive cases of hysterical [dissociative/ conversion] disorders was conducted from 1995-1998 at CMH Kharian to describe find out the relative frequency of hysterical disorders and other underlying conditions in the patients presenting with hysterical symptoms and also to see the long term validity of this diagnosis. The findings of this work indicated that in 40% of the cases there was either a physical or psychiatric underlying cause of these symptoms i.e. depression [40%], anxiety state [15%], adjustment disorder [17.5%], personality disorder [5%] and medical illnesses [25%]. In 60% of the cases of hysterical disorder who responded to the follow up questionnaire, the diagnosis of hysterical disorder was sustained. The prevalence of hysterical disorder was more in women, among young, undereducated and lower socio-economic groups. In majority of the patients, a psychosocial stress was identified. Convulsions, sensory loss, visual symptoms, aphonia, headache, amnesia and possession state dominated the presenting complaints. Further sound methodological studies using the structured instruments are needed to replicate these findings