Comparative Short term Efficacy and Tolerability of Methylphenidate and Atomoxetine in Attention Deficit Hyperactivity Disorder.

Objective: To compare the short term efficacy and tolerability of methylphenidate and atomoxetine in children with Attention deficit hyperactivity disorder (ADHD). Design: Open label randomized parallel group clinical trial. Setting: Child Guidance Clinic of a tertiary care hospital of Northern India from October 2010 to June 2012. Participants: 69 patients (age 6-14 y) with a diagnosis of ADHD receiving methylphenidate or atomoxetine. Intervention: Methylphenidate (0.2-1 mg/kg/d) or atomoxetine (0.5-1.2 mg/kg/d) for eight weeks. Main outcome measures: Treatment response (>25% change in baseline Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS); Vanderbilt ADHD Diagnostic Teacher Rating Scale (VADTRS); Clinical Global Impression Severity Scale (CGI-S) at eight weeks and adverse effects. Results: Treatment response was observed in 90.7% patients from methylphenidate group and 86.2% patients of atomoxetine group at an average dose of 0.45 mg/kg/d and 0.61 mg/kg/d, respectively. The patients showed comparable improvement on VADPRS (P=0.500), VADTRS (P=0.264) and CGI-S (P=0.997). Weight loss was significantly higher in methylphenidate group (-0.57±0.78 kg; P=0.001), and heart rate increase was observed at higher rate in atomoxetine group (7± 9 bpm; P=0.021). Conclusion: Methylphenidate and atomoxetine are efficacious in Indian children with ADHD at lesser doses than previously used. Their efficacy and tolerability are comparable.

Prevalence of specific developmental disorder of scholastic skill in school students in Chandigarh, India.

Background & objectives: Several studies have been conducted in India to determine the prevalence of learning disabilities in school children which has been reported to be 3-10 per cent among students population. The present study was conducted to find out prevalence of specific developmental disorder of scholastic skills in students of classes VII to XII and to find out feasibility of screening tool in Chandigarh, India. Methods: A cross-sectional study on school students was carried out in two phases. The students were drawn from classes VII to XII from 10 schools of Chandigarh, India. Details of academic performance of all the students was taken, subjectively from class teachers and objectively from the marks obtained in the last academic session. In phase I, 2402 students were assessed. In phase II, 108 students were randomly selected for evaluation for assessing sensitivity and specificity of screening proforma for teachers. A total of 124 students from phase I and all students in phase II were assessed in detail. Tests of intelligence (Malin’s Intelligence Scale for Indian Children and Standard Progressive Matrices), and NIMHANS Index for specific learning disability (SLD) battery were administered. Results: A total of 38 students were found to be having specific developmental disorder of scholastic skills in phase I, that gave a prevalence of 1.58 per cent. Majority had mixed type of errors on SLD battery. There were more boys diagnosed with specific learning disability. Teacher’s screening instrument had high sensitivity (90.385) and specificity (94.68). Interpretation & conclusions: The findings of our study conducted in community, showed that specific learning disability was not identified even till later age. The screening instrument thus could be used by teachers to suspect students with specific learning disability.

Quality of life after electroconvulsive therapy in persons with treatment resistant schizophrenia.

Background & objectives: In recent years, health-related quality of life (QOL) has been regarded as the most important dimension of outcome in schizophrenia. Recent research has shown that atypical antipsychotics improve QOL in patients with schizophrenia. Importance of electroconvulsive therapy (ECT) has been demonstrated in restoring function and health related quality of life in depressed patients. However, there are no data on patients of schizophrenia. The objective of the present study was therefore, to assess the improvement in quality of life after ECT in treatment resistant schizophrenia. Methods: Thirty consecutive patients of treatment resistant schizophrenia were given ECT sessions twice a week and assessments were made with Positive and Negative Syndrome Scale of Schizophrenia (PANSS), WHO QOL Bref, Global Assessment of Functioning Scale and Clinical Global Impressions. Results: The group improved significantly on all the domains of quality of life scale except the domain named satisfaction with social relations. There was also significant change in the total score of PANSS after 6 ECT sessions (mean at baseline = 86.7, mean after 6 ECT = 65.5, P< 0.001) as well as on different subscales of PANSS. The score on the global assessment of functioning also changed significantly (mean 26.3 at baseline to 44.5 after 6 ECT sessions). Interpretation & conclusions: The present findings showed that ECT in addition to improvement in symptomatology led to improvement in QOL in patients of treatment resistant schizophrenia.

Stress and suicidal ideas in adolescent students in Chandigarh.

Background and Objectives: School students in India have a high stress level and high rate of deliberate self-harm. The present study was conducted to find out stress, psychological health, and presence of suicidal ideas in school students and to find out any correlation between these variables. Setting and Design: Cross-sectional study conducted on school students in urban area of Chandigarh city. Materials and Methods: Data was collected on 2402 students from classes VII to XII on socio-demographic scale, 12-item general health questionnaire, Mooney problem checklist, and suicide risk eleven -a visual analogue scale. Statistical analysis used was chi square and Spearman's correlation. Results: Out of 2402 students, 1078 (45.8%) had psychological problems, half (1201 students) perceived problems in their role as students, 930 (45%) reported academic decline, 180 (8.82%) students reported that life was a burden, 122 (6%) reported suicidal ideas and 8 (0.39%) students reported suicidal attempt. There was significant correlation between student's perception of life as a burden and class they were studying, mother's working status, psychological problems and problems students experienced in relation to study, peers, future planning and with parents. Conclusions: Students with academic problems and unsupportive environment at home perceived life as a burden and had higher rates of suicidal ideations.

Attitude towards Acquired Immune Deficiency Syndrome and its determining factors: A community survey in rural and slum areas in India.

This survey was conducted to find out attitude of persons living in villages and slum areas of Chandigarh towards Acquired Immune Deficiency Syndrome and evaluate its determining factors. Methods - Households were selected from 5 villages and 5 slum areas by stratified random sampling. Trained field workers studied 2992 persons. A specially designed performa was administered to assess awareness, knowledge, and attitude about Acquired Immune Deficiency Syndrome. Result - Only 26.6% of study population had heard of Acquired Immune Deficiency Syndrome. Positive attitude towards Acquired Immune Deficiency Syndrome patients’ movement in community, work, school and continuing friendship was found. Majority knew about four major routes of transmission and basic preventive measures. A negative correlation was found between knowledge & attitude scores. On stepwise regression analysis, sex, education and marital status contributed to the variance with attitude as dependent variable. Conclusion – Majority of subjects held positive attitudes towards Acquired Immune Deficiency Syndrome. Education and marital status determined attitudes.

Trichotillomania.

Trichotillomania, though uncommon, is one of the causes of unexplained hair loss, especially in children. Three girls in the age group of 4-6 years were observed in our pediatric dermatology clinic to have trichotillomania. In one child, there was co-existent alopecia areata. All were referred to the child guidance clinic and they all showed improvement with behavior therapy. A close liasion between the dermatologist, psychiatrist and parents would go a long way in preventing this alopecia

Prevalence of psychiatric disorders in school children in Chandigarh, India.

BACKGROUND & OBJECTIVES: Population studies on the prevalence of psychiatric disorders among children and adolescents in different countries of the world, have reported varying rates of disorders. There are very few studies in India and these vary widely in methodology and reported rates of disorders. The main objective of this research was to study the extent and nature of psychiatric disorders in school children in a defined geographical area and to study their psychosocial correlates. METHODS: School children, aged 4-11 yr, in the city of Chandigarh, were studied using multi-stage random sampling, and multi-informant assessment procedure. Teachers assessment on Rutter-B Scale (Stage I) was followed by parent interview (Stage II) for all children on the Childhood Psychopathology Measurement Schedule which is an Indian adaptation of Achenbach's Childhood Behaviour Checklist (CBCL). Children scoring above the cut-off at Stage I and/or Stage II were assessed clinically by two psychiatrists (Stage III) who interviewed parents as well as the child taking detailed clinical history and mental state examination including IQ assessment. RESULTS: 6.33 per cent of the children studied (n = 963) were found to have psychiatric disorders on ICD-10 criteria. Teacher's estimation of the prevalence rates was higher, i.e., 10.17 per cent as compared to parent's estimate i.e., 7.48 per cent. The most prevalent disorder was enuresis. INTERPRETATION & CONCLUSION: This study provides data for comparative epidemiology and highlights issues relating to cultural context of disorders in child psychiatric epidemiology.