Assessment of various cognitive domains in patient with obsessive-compulsive disorder

Background: OCD is often chronic disorder and causes impairment of functional efficiency. Various researchers have found that cognitive dysfunction frequently present even when mild symptoms are present. This study aimed to investigate various domains of cognitive function in patients with OCD using cross sectional design. In this study we have tried to find out the various domains of cognitive function in OCD and their relation with clinical severities. We also compared the cognitive function of patients with OCD and their control. Methods: Total 60 subjects (30 in case group and 30 in control group) were taken for study. The study subjects (OCD group) were taken from psychiatric OPD and control group from general populations. The subjects of both the groups were screened as per inclusion and exclusion criteria and the Y-BOCS, ACE –III scales were applied. Results: In the case group, 96.70% had a normal ACE-III score and 3.30% had an inconclusive score, while in the control group 100% had a normal score at ACE-III scale, on further scoring. 60% patients have moderate and 33.3% have severe score in the YBOCS scale. We have found the significant decline in total mean ACE-III scores between case and control group (p value 0.000) and decline in memory domain with severity of illness was also significant (p value 0.037). Conclusions: Decline in cognition domain of memory in patient with OCD, was significant in comparison to control group.

Predictors of Aggressive Behaviours in Drug De-Addiction Centre.

Aim: Associations have been reported between aggression and psychoactive substance use. This study aimed to assess the prevalence and nature of aggressive incidents and to examine the factors associated with aggression in patients in a drug de-addiction unit. Method: Forms of aggression and their severity were assessed based on questions of Overt Aggression Scale (OAS). Data were collected from inpatients about the nature of their aggressive incident during a 12-month period. The characteristics of those patients involved in aggressive incidents were compared with those of others who had not been aggressive. Results: Fifty out of 83 patients admitted during this period were involved in some form of aggressive behaviour. Pattern of aggressive behaviour exhibited by patients were in the form of verbal aggression 60.24% (N=50); Object aggression 28.9% (N=24); Aggression toward other 32.53% (N=27) and Aggression toward self 2.41% (N=2). There were high correlations of one form of aggression in presence of other forms. Most common diagnosis was alcohol dependence. On the whole aggression was found to be higher in the alcohol withdrawal with delirium group. While all other forms of violence showed increase with past histories, statistical significance was there only in aggression towards others (p=0.043). Aggressive behaviours generally reported less in voluntarily admitted patients. Comparison of aggressive behaviour in relation to family type, locality, religion, family history of violence did not yield any significant variation. Conclusion: Like weather forecasting, predictions of future violence will not always be correct. However, in order to prevent aggressive incidents, present study revealed that particular attention and increase support required in patients living in the nuclear family, unwilling for admission, past history of aggressive incidents and diagnoses of alcohol withdrawal. Verbal aggression could be considered as strong predictor for other type of assault.

Evaluation of EEG in Child Guidance Clinic.

Background: Electroencephalographic (EEG) abnormalities occur in patients with various idiopathic psychiatric disorders. Among the psychiatric patients, children have shown more EEG abnormalities as compared to the adult cases. The present study therefore examined the pattern of EEG abnormalities in children’s attending child guidance clinic of psychiatry department. Method: Electrodes were positioned according to the 10 – 20 system, using a common reference electrode. EEG recordings from 138 hospitalized psychiatric patients were graded blind to diagnosis and treatment for type of EEG abnormalities. Types of clinical diagnosis were evaluated for association with pattern EEG abnormalities. Results: EEG abnormalities occurred in 53.62% (N = 74) subjects, whereas 46.38% (N = 64) showed no abnormality in EEG record. Generalized abnormalities was observed in 37.84% (N = 28) subjects. EEG abnormality in clinically diagnosed epilepsy were commonest 64.62% (N = 42), followed by dissociative (conversion) vs. epilepsy 62.5% (N = 5), pervasive developmental disorder (PDD) 56.67% (N = 17), and mental retardation with epilepsy 28.57% (N = 10). Conclusions: EEG abnormality risk varied widely among children’s with different diagnoses referred/attending Child Guidance Clinic of psychiatry department. Risk was particularly high in clinically diagnosed epilepsy.

Non Cerebral Activity in Patients of Schizophrenia: EEG Study.

Non Cerebral Activities (NCA) can mimic almost any kind of cerebral electrical activity and lead to serious misinterpretation if artefact periods remain in the recording. We focused on NCA detection in EEG of Patients with Schizophrenia. Out of 35 schizophrenia patients the presence of muscle and eye blink artefacts were higher in there percentages i.e. 86% and 92%. Fifteen patients (42.8%) reported as EEG of doubtful significance, which is higher in psychiatric patient’s then general population of epileptics.

Conversion Disorder: Socio-demographic and Psychosocial correlates of patients presenting with Nonepileptic events.

Objective: To study the socio-demographic and psychosocial correlates in patients with conversion disorder presenting with nonepileptic events and discuss its interventional implication. Material and Methods: This cross-sectional descriptive study was carried out in a tertiary care centre of eastern India from September 2008 to February 2009. 151 consecutive patients with conversion disorder satisfying the inclusion and exclusion criteria were selected. They were interviewed using semi-structured socio-demographic profile proforma, Holmes and Rahe stress scale for the exploration of psycho-social stressors. The data were entered on MS excel, analyzed by SPSS-version 16.0. Results: The psychosocial stressors were clearly identified in all patients. Almost ninety five (94.70%, n=143) out of the total 151 subjects had a history of stressors, while in the rest 4.95% no stressors could be established. The commonest stressors were Troubles with in-laws (26.49%), Death of close family member (11.92%) and Increase in argument with significant others (10.59 %). Conclusion: Significantly higher number of the patients presented with the stressor of troubles with in-laws, when assessed on the Holmes and Rahe Social Readjustment Rating Scale. Detection of exact nature of correlates has immense potential for therapeutic as well as preventive field.

Geriatric Mental Health in a Tertiary Care Centre: Socio-Demographic and Clinical variables.

Background: Nearly 50% of the aged have some physical ailment and are in need of active health care. Geriatric psychiatry is a sub-specialty of psychiatry, which deals with psychopathology occurring in the elderly and the various aetiological factors which cause the mental disorders in old age. Method: This is a descriptive study with sampling in a tertiary centre where the diagnoses were made based on the tenth edition of the International Statistical Classification of Diseases and Related Health Problems (ICD- 10) and were evaluated for sociodemographic and clinical variables as well as general medical conditions. Results: Mean age of the patients was 69.81 years, male constituted 73.58% and female 26.42%, Hindu were 56.60% and Islam 43.40%. Mean duration of stay in psychiatry ward was 5.7 days. 77.36% of patients were discharged on advice, 15.09% were transferred to another department, 1.89% absconded, 1.89% referred to another hospital and 3.77% referred to another department. 9.62% patients had general medical conditions alone and 40.38% had psychiatric disorders alone while 50% had combined psychiatric disorders with general medical conditions. 42.31% patients had organic, including symptomatic, mental disorders; 3.85% had mental and behavioural disorders due to psychoactive substance use; 26.92% had schizophrenia, schizotypal and delusional disorders; 28.85% had mood [affective] disorders; 5.77% patients had neurotic, stress-related and somatoform disorders. Conclusion: Within the limitations of nongeneralizability of findings, present study throws light in important areas of geriatric mental health including general medical conditions.

EEG Study in Excellent and Poor Achiever Students.

Objective: To assess the EEG amplitude and frequency of poor and excellent achievers. Method: The 15% highest achieving students and the 15% lowest achieving students from the three faculties were selected to be included in the study sample. EEG was carried out according to the 10–20 system, using a common reference electrode. The Bipolar recording of 10 minutes of two runs i.e. anterior, posterior and transverse has been taken into account for the analysis of data. Results: There are significant differences in the amplitudes of certain lobes of both hemispheres of poor and excellent achievers. Particularly, poor achievers have higher amplitudes. The frequency of excellent achievers of certain lobes is found to be significantly higher than those of the poor achievers. Conclusion: The relationship of amplitude and frequency with academic achievement are inconclusive, nothing can be said with confidence about the role played by the amplitude in determining the academic achievement of poor achievers. It is difficult to understand the specific roles played by the frequencies of the different lobes in determining the academic achievement of excellent achievers. Hence, further researches should be undertaken to study the cause and effect relationship between amplitude and frequency of the different lobes and academic achievements of’ students.

Problems in Disposal of Long Staying Criminal Psychiatric Patients in Mental Hospital, Varanasi.

Aim – The purpose of the study was to assess, the problems in disposal of long stay criminal mental patients, from mental hospital Varanasi, despite of their improvements and types of crime. Method – In this study 202 criminal mental patients taken from the mental hospital Varanasi. Those patients were admitted between years of 1948-2002. Out of 202, 193 were male criminal patients and 9 were female. Patients were divided into two groups, convicted and nonconvicted. The patients were analysed on the basis, of duration of stay in hospital, despites of their fitness, types of crime, time of discharges and types of mental disorders. Results –The incidence of crime committed were significantly higher in male patient in the age group of (18-40) years 75%, nearly 53%, patients committed crime below 30 years and, 5% crime committed above the age of 50 years. Similar finding reported as (Gluecks 1943, Baldev et al 1970). 75% patients were suffering from Schizophrenia. 67% patients stayed in the mental hospital less than 5 years but remaining patient stayed more than 6 years. 2% patient stayed more than 45 years. Conclusion – A part of criminal patient stayed in the mental hospital because of legal, administrative, medical, and communication problems with respective jails.

Determinants of Acute Dystonia in First Episode of Psychotic Patients Treated with Haloperidol and Centbutindole.

Objectives: To assess the factors affecting of acute dystonia in first episode psychotic patients taken haloperidol and centbutindole Method and Procedure: Total 54 patients (Schizophrenia, manic, psychotic) taken for the study from the psychiatry O.P.D. K.G.M.C Lucknow. The age group of patients were between the 17 to 55 years. This study was double blind and prospective. Patients were randomly administered Holoperidol (5 mg) TDS or Centbutindole (1.5 mg) TDS. The total period of study was 2 weeks, if any abnormal movements developed during this period the criteria for acute dystonia was applied. Tools: Semi structured proforma, International Classification of Disease — 10. Diagnostic and research criteria for neuroleptic induced acute dystonia, Scale for assessment of torsion dystonia. Beck and Refaelsen Mania Rating Scale: for manic patient only, Brief Psychiatric Rating Scale: On all patients was used. Result: The results show that acute dystonia was higher among the manic patients, younger age, married, male between the age group 17-25 year and duration of illness 1-3 months. It was also higher among those patients who have psychiatric family history.

Effect of diagnostic X-rays on somatic chromosomes of occupationally exposed workers.

Investigations were carried out to estimate the level of radiation exposure effect of X-ray machines on 40 male personnel handling diagnostic X-ray machines and compared to 38 matched, unexposed, normal controls. The actual accumulated radiation doses were not disclosed. As compared to controls the exposed persons showed highly significantly increased levels (P < 0.01) of chromosome aberrations (0.68%-2.67%). Frequencies of sister chromatid exchanges (5.80-6.20) and the levels of aneuploidy (2.27-2.37) were also increased a little, but did not show statistically significant effect of exposure. Satellite associations (7.84-16.25) and mitotic index (5.14-6.07) showed a significant increase (P < 0.05) in exposed individuals. The statistically significant increase in the frequencies of chromosomal aberrations and satellite associations in X-ray personnel underscores the need of adopting measures to avoid or at least minimiZe overexposure to X-irradiation.

Genotoxic effect of ammonia exposure on workers in a fertilizer factory.

Cytogenetic investigations carried out on 22 workers exposed to ammonia in a fertilizer factory showed increased frequency of chromosome aberrations (2.00) and sister chromatid exchanges (5.21). Effect of smoking and/or drinking habits coupled with exposure to ammonia showed higher values of mitotic index, satellite associations and micronuclei in the exposed workers (6.50, 17.4 and 2.20 respectively) as compared to the controls (4.34, 8.11 and 0.14 respectively). The results indicate the genotoxic potential of ammonia gas in the ambient air of the work place.

Cutaneous leishmaniasis in domestic dogs.

Cutaneous leishmaniasis was clinically diagnosed by non-healing skin lesions present on dorsal surface of nose (Snout) and outer surface of ear and by making impression smear from lesions. One per cent Berberine sulphate inoculated intralesionally on four occasions at weekly interval was found to be highly effective against cutaneous leishmaniasis in domestic dogs.