Prevalence of Mood and Anxiety Disorders in Opioid Addicts.

Introduction: Substance use disorders and mood and anxiety disorders are widespread among the general population. Methods: This study assessed the rate of current mood disorders and anxiety disorders in outdoor opioid addicts. The data were collected from five hundred opioiddependent patients who were seeking treatment from outdoor dept. of civil hospital, Gurdaspur. The Research version of structured clinical interview for DSM-IV Axis I Disorders was used. Results: The majority (23%) were self employed and 20% were unemployed. 25% had education till the level of high school, 15% were illiterate. 326(65.2%) subjects were diagnosed as having mood disorders, of those 274 (29%) had substance induced depression, 41 (8.2%) had major depression, 5 (1%) had dysthymia, 5 (1%) bipolar mood disorder type I, and 2 (0.4%) were diagnosed as having bipolar mood disorder type II. 138 (27.6%) subjects were diagnosed as having substance-induced anxiety disorders, and 88 (17.6%) as having generalized anxiety disorder. Of the participants 218 (43.6%) reported more than 5 years use of opioid abuse. Conclusions: Due to high rates of mood disorders in opioid-dependent subjects, psychiatric treatment services should be open and accessible to the patients, especially those who voluntarily seek help and treatment to reduce the rate of mood disorders and reduce relapse of substance abuse also.

A Case Control Study to Assess the Comorbidity of Depression and Migraine.

Background — Migraine is a common neurological disorder affecting around 18% of females and 6% of males. The present study was undertaken to identify and assess the impact of coexisting depression in diagnosed cases of migraine. Material and Methods — A hospital based case control study was conducted on 450 patients suffering from migraine of all ages and both sexes attending psychiatry OPD at civil hospital, Gurdaspur in Punjab. International headache society criteria for the diagnosis of migraine and 21- item Hamilton rating scale for depression was used. Migraine with depression (MWD) cases were compared with migraine without depression as controls (MC). Duration and frequency of migraine, comorbidity with depression was measured. Results — Out of 450 patients, 200 were MWD and 200 were MC patients. Among MWD and MC, females were common: 73% (146) and 75% (150) respectively. Of the females having MWD, 50% (73) belonged to age group 31-40 years as compared to females with MC where 58% (87) were from age group 21-30 years. Among the males, maximum number of patients belonged to age group 20-30 years for MWD and MC i.e 48% ( 26 ) and 57% (29) respectively. 50% of MWD reported having migraine attacks for five years or more years, whereas only 16% of MC had the similar duration (P value<0.01). 80% of (n=160) of MWD reported maximum disability during the headache as compared to 64% (n=128) of MC. 70% (140) of MWD had an average frequency of 4 or more attacks per month compared to 45% (90) of MC having one episode per month or less. Conclusion — Patients suffering from migraine with long history and high frequency might benefit from psychiatric evaluation and addition of antidepressants for their treatment.

Attitudes of Family Members Towards Mentally Handicapped Children and Family Burden.

Background — The burden associated with rearing such mentally handicapped children usually affects whole of atmosphere of home including routine family life, emotional aspects and financial resources of family. The present study has been undertaken with the aim of determining the attitudes of family members towards a mentally handicapped child in their family and it has been assessed whether such children are considered as burden to their families. Material and Methods — The study was carried out in psychiatry OPD of the civil hospital, Gurdaspur in Punjab. Parents of children suffering from mental handicap who came for getting mental disability certificate for their children were included in the study. Total 200 families of mentally handicapped children were included in age group of upto 16 years of age. They were interviewed using a questionnaire based on ‘ Questionnaire on Resources and stress ‘scale to measure burden in their families. During the interview, an attempt was made to have both the parents present. Results — Basic psychometric properties of the questionnaire were sound. Findings revealed that mean burden was minimal to moderate in all the 200 families. The intelligence quotient was between 36 and 51 in 120 children, 70 children had IQ between 20 and 35, 10 children had IQ below 20. The education of parents was upto 5th standard in 100 children, upto 8th standard in 80 children, upto12th standard in 15 children and upto graduation in 5 children. 80% of families belonged to poor socioeconomic status. 10% of families belonged to middle class background. Conclusion — Our findings support the fact that children suffering from mental handicap are considered as burden by their family members. Negative parental attitude leads to rejecting attitude towards mentally retarded children. This adversely affects the interaction within the family and also with outsiders. Such children should be offered support by family members to enable them to cope with stressful situations and in their rehabilitation. There is a need for implementation of family based schemes for such disabled children.

Comparison of Intramuscular Olanzapine and Intramuscular Haloperidol in Treatment of Acute Agitation in Patients of Schizophrenia.

Objectives: To determine the antipsychotic efficacy and extra pyramidal safety of intramuscular olanzapine and intramuscular haloperidol during the first 24 hours of treatment of acute agitation in schizophrenia. Methods: Patients (n = 29) with schizophrenia were randomly allocated to receive one to three injections of intramuscular olanzapine (10 mg, n =14), intramuscular haloperidol (10 mg, n = 14) over a 24-hour period. Agitation was measured with the excited component of the positive and negative symptom scale (PANSS) and agitation behavior scale (ABS). Results: After the first injection, IM olanzapine was comparable to IM haloperidol for reducing mean changes in scores from baseline on excited component of PANSS at 2 hours to ( -13.08 olanzapine, -8.07 haloperidol ) and at 24 hours (-9.86 olanzapine, -8.07 haloperidol ). Mean changes in the scores of ABS scale from baseline was at 2 hours (-9.78 olanzapine, -8.54 haloperidol) and at 24 hours (-6.14 olanzapine, -6.6 haloperidol). Patients treated with IM olanzapine had significantly fewer incidence of treatment emergent Parkinsonism (0% olanzapine versus 6.66% haloperidol, p = 4.55), no patient had akathisia with olanzapine as compared to 13.33% of patients with haloperidol, p = 2.03. No patient developed acute dystonia compared to 6.66% of patients with haloperidol, p = 2.59. Conclusion: IM olanzapine was comparable to IM haloperidol in reduction of symptoms of acute agitation in schizophrenia during first 24 hours of treatment, the efficacy of both being evident within 2 hours after first injection. More Extra pyramidal symptoms were observed during treatment with IM haloperidol than with IM olanzapine.

Prevalence of Depression in Epileptic Patients.

Objectives : To determine the prevalence of depression among epileptic patients attending the outdoor patient department of Psychiatry department of G.G.S. Medical College, Faridkot. Material and Methods: Total 100 consecutive epileptic patients were included in study , these patients were screened with ICD-10 diagnostic criteria of depression and were interviewed. Demographic data that affect depression were evaluated. Results: During the study of 100 patients, prevalence of depression was 25%. Mild depression was found in 67% and moderate in 33%. No patient had severe depression . Comparing between male and female patients, there was no statistical significant diference (P>0.05). The age group that compared between age equal or less than 25 years and more than 25 years had no statistical significant difference (P>0.05). Other variables were not found to be significant risk factors of depression among epileptic patients including duration of seizures [Equal or less than 5 and more than 5 per year (P>0.05)] and number of antiepileptic drugs [monotherapy and polytherapy (P>0.05)]. Type of seizures [ Generalized tonic clonic seizures and Partial seizures had statistical significant difference ( P<0.05)]. Conclusion: Prevalence of depression among epileptic patients was 25%, divided between mild (67%) and moderate (33%) . Epileptics should be aware of this and seek prompt treatment for depression.

An Open Label Study on Amisulpride in Augmentation with Atypical Antipsychotics in Treatment Resistant Patients of Schizophrenia and Schizoaffective Disorders.

The authors report an open label study in treatment resistant patients of schizophrenia and schizoaffective disorders. The patients who were earlier being treated with atypical antipsychotics were put on combination of amisulpride and atypical antipsychotics and efficacy as well as safety of the combination was assessed. Method: A study of 6 weeks duration was conducted on 30 patients (9 women, 21 men).The mean dose of amisulpride used was from 250.00 mg/day + 91.65. SAPS, SANS, CGI-S scales were applied. 4 patients dropped out of study. 26 patients completed 6 weeks duration. Results: There was significant improvement in negative symptoms, positive symptoms, cognition especially in old chronic schizophrenics.Only two patients developed extrapyramidal symptoms.Improvement in all symptoms was remarkable. Conclusion: The combination of amisulpride with atypical antipsychotics is a promising option in patients who are resistant to treatment.