Delusional Parasitosis: An Analysis of 177 Cases from a Tertiary General Hospital.

Introduction: Delusional parasitosis (DP) is a form ofmonohypochondriacalpsychosis characterized by a feelingthat there are parasites crawling beneath the skin and is seen inrarely in psychiatric or primary carepractice. The disorder haspoor prognosis with a varied course and multiple relapses. Thepresent paper reports an analysis of 177 cases of delusionalparasitosis seen in a tertiary general hospital over the last 11years.Material and methods: The present study is an analysis of177 cases of DP that presented to the psychiatry departmentof a tertiary general hospital over the past 11 years and thedata has been analyzed using a semi-structured proforma anddescriptive statistics.Results: The mean age of the sample was 34.6 ± 21.3 yearsand the mean age of onset of the disorder was 28.3 ± 17.1years. The mean duration of illness of the sample was 3.9 ±10.3 years. 103 (58.19%) had a magnetic resonance imagingof the brain done which was within normal limits. 56(31.63%) patients had repeated neuroimaging investigationslike EEG, MRI and CT Scans done which were also all withinnormal limits. Most patients were treated with Risperidoneand Aripiprazole while few were treated with Pimozide,Haloperidol and Amisulpride. 43 (24.29%) patients received acourse of electroconvulsive therapy (ECT) as well in additionto medications.Conclusion: DP though rare is seen in clinical practice andfurther longitudinal studies are needed to establish withgreater certainty facts about the course and prognosis of thedisorder

Can perineal tear be predicted by severity of striae gravidarum score?

Background: The objective of this study was to wether perineal tear predicted by scoring of severity of striae gravidarum. The objective of this study was to predict perineal tear by simple non-invasive method and help to prevent maternal morbidity.Methods: Three hundred ninety four patients delivered normally were included in this study. Striae gravidarum score was assessed using the Atwal numerical scoring system. The association was examined between striae and perineal tear as the outcome measure, defined by tears or laceration, and the total striae scores (TSS) was obtained.Results: In present study population mean age was 25.16 years ranging from 16-40 , mean gravidity was 2.16 ranging from 1 -8 ,average baby birth weight was 2.713 kg ranging from  1.62-4.58 The only predictors of perineal tears that were found to be statistically significant in our study were severity of striae gravidarum and episiotomy given or not. In patients with moderate to severe striae there was tear in 90 patients as compared to 29 patients with no or mild striae. 224 patients belonging to no or mild striae group delivered without any perineal tear whereas 51 patients in moderate to severe striae group delivered without tear. Out of these 51 patients 5 were given episiotomy. 2 patients who were given episiotomy had perineal tear as compared to 117 patients who were not given episiotomy. This shows that patients who had an episiotomy were less likely to have perineal tear in most cases.Conclusions: This study demonstrates a significant relation between severity of striae gravidarum and perineal tear. The findings suggest that striae gravidarum assessment may be used in the clinical setting even by paramedical staff as a simple and noninvasive tool to better define women at risk for perineal tear.

Serum magnesium level in eclampsia at tertiary care center, Gujarat, India

Background: Magnesium may be physiologically important in blood pressure regulation whereas changes in magnesium levels could contribute to the patho-etiology of hypertension. The objective of the present study was to study the level and effect of magnesium in eclamptic pregnant women.Methods: This cross-sectional study was conducted among 50 clinically diagnosed women with eclampsia in their third trimester of pregnancy. Inclusion criteria for the study was; females with singleton pregnancy, all in the third trimester which were diagnosed to have PIH based on the development of hypertension for the first time, proteinuria with or without edema, with no history of previous urinary tract troubles and no evidence of UTI. The concentration of total serum magnesium was measured by atomic absorption spectroscopy.Results: Mean age, mean gestational age, mean total hospital stays, mean BMI, mean systolic BP and diastolic BP was 24.3 years with 5.1 SD, 36.4 week with 3.3 SD, 7.8 days with 2.4 SD, 28.9 wt/ht2 with 4.8 SD, 146.5 mmHg with 14.7 SD and 95.9 mmHg with 11.2 SD respectively. Mean magnesium level was 1.9 mmol/L with 2.2 SD.Conclusions: Hypomagnesemia is present in eclamptic pregnant women. In developing countries like India, sufficient dietary supplementation should be given above the recommended dietary allowances in pregnancy at least in susceptible pregnant women.

A study of prevalence of iron deficiency anaemia in infants and toddlers (6-24 months) by measuring serum ferritin levels

Background: Nutritional anemia is a worldwide problem with the highest prevalence in the developing countries. One of the most vulnerable groups is 6-24 months of age. NFHS-3 survey shows that the incidence of anemia in children aged 6-35 months is 79.2% with 72.7% in urban areas and 81.2% in rural areas. First stage of iron deficiency is depletion of iron stores, which is reflected by decreased serum ferritin levels and increased total iron binding capacity (TIBC) levels. The objective of this study was to detect presence of iron deficiency in children even before clinical appearance of anemia by measuring serum ferritin levels.Methods: The study was conducted from March 2017 to November 2017 in the Department of Pediatrics of Sir Sayajirao Gaekwad General Hospital, a tertiary level hospital and government medical college, Vadodara. A cross sectional study was done in which a total of 111 asymptomatic infants and toddlers in age group of 6-24 months presenting to well-baby clinic were enrolled randomly. Haemoglobin, RBC indices and serum ferritin levels were estimated. The children were classified into mild, moderate and severe anaemia according to their haemoglobin levels. Correlation with their serum ferritin levels was carried out by using statistical analysis.Results: Prevalence of anaemia (Hb <11gm/dl) was 84.14% in 6-12 months age group, 81.25% in 13-18 months age group and 84.61% in case of 19-24 months age group. Overall 83.78% of infants and toddlers were found to be anemic among 6-24 months age group. 55 infants (49.54%) among 111 infants had mild anaemia, 29 infants (26.12%) had moderate anaemia, 9 infants (8.1%) had severe anaemia. Majority of children (87 of 111 infants) had microcytic and hypochromic RBCs in their peripheral smear examination. 78 infants (72.07%)) had low serum Ferritin levels while only 31 infants had normal ferritin levels which is statistically significant (p=0.0084). Out of these, 4 infants had normal hemoglobin level.Conclusions: Anaemia is highly prevalent in the age group of 6 to 24 months even in otherwise healthy infants. Serum ferritin level is a good indicator of iron deficiency in children.

Benign Familial Essential Head Tremor: A Case Report

Introduction: Essential tremor is a movement disordercharacterized by tremors of the hands and head and seen in5-10% of patients above the age of 60 years.Case report: We report a case of benign essential familialhead tremor that was diagnosed when the patient was referredfor psychiatric fitness and that responded very well toPropranolol.Conclusion: It is a condition where the causative factors andthe pathophysiology are ill understood and there are no fixedneuroimaging paradigms for the disorder.

Psychogenic Belching: A Case Report

Persistent psychogenic belching is a condition where supragastric belching occurs repeatedly in relation to apsychological stressor. Treatment involves trials of multiple medications with identification and/orelimination of the stressor. We present herewith the case of a female patient with persistent psychogenicbelching that responded well to a combination of medications.

Neurocognitive impairment secondary to herpes simplex encephalitis improved with inject cerebrolysin

Herpes simplex encephalitis (HSE) is an acute illness that causes both general and focal signs of cerebraldysfunction We present herewith the case of a 33 years old female who presented with neurocognitiveimpairment that was secondary to the herpes simplex encephalitis. The patient’s case is discussed as thepatient bettered with the administration of injection cerebrolysin along with psychopharmacotherapy andcognitive exercises.

Predictors of Suicide Ideations in Adolescents

Background and Objectives: Adolescence is a crucial phase of one’s life, given the physical andpsychological changes that occur during this phase. Number of adolescent suicides are on rise and a largenumber of adolescents report higher suicidal ideations during this phase. Suicide ideation involves thoughtsand cognitions about suicidal behavior. It involves thoughts related to desire, intent or method of committingsuicide. Research on suicide ideation has established strong links between depression and hopelessness withsuicidal thoughts and tendencies. Depressed adolescents are reported to be highly vulnerable to developsuicide ideations. In addition to depression and hopelessness, familial variables like support from parentsand emotional bonding with them is detrimental to such outcomes like suicide ideation. The present studythus aims to find depression, hopelessness, emotional autonomy and hardiness as predictors of suicideideation in adolescents.Methods: A sample of 400 adolescents (242 = Females and 158 = Males) in the age group of 15 – 22 (MeanAge = 18.36 years) years was taken. Beck Depression Inventory, Beck Hopelessness Scale, Personal ViewsSurvey, Emotional Autonomy Scale and Beck Scale for Suicide Ideation were used to collect the data. Thedata so obtained for the predictor variables was first factor analysed so as to obtain independent factors.Results: Results revealed single factor with high factor loadings on all the four predictor variables. The factorscores from this factor were further used in linear regression in order to predict suicide ideation inadolescents. Regression analysis revealed that the factor was a significant predictor of suicide ideation. Theobtained results have been elucidated.Conclusion: There is a very high prevalence of depression, anxiety and stress among interns working inMaharashtra which needs to be effectively dealt with on an urgent basis. The strong association of theprevalence of psychological illnesses with many factors and stressors faced by them will help us highlightthe contributory factors and suggest strategies to deal with them effectively at a personal, institutional andnational level.

A Study on Quality of Life and Self Esteem in children and adolescents with Strabismus

Background/Context: Strabismus is a condition that results in loss of self esteem and affects quality of lifedue to the changes it may cause in facial appearance and other factors. There is a dearth of Indian literatureon children and adolescents with strabismus. The current study analyzed self esteem and quality of life inchildren and adolescents with strabismus.Methods: Children and adolescents between 6-17 years attending the ophthalmology out-patient departmentof a tertiary general hospital and their normal siblings were identified and assessed after parental consentusing a semi-structured proforma and the KINDL questionnaire. The results were statistically analyzed andpresented.Results: 35 children and adolescents with strabismus were compared to 38 siblings who were the controls.It was seen that children and adolescents with strabismus scored lower on family and social contacts qualityof life scores on all subscales of the KINDL questionnaire. However, self-esteem did not differ across bothgroups.Conclusion: Further larger studies in diverse populations are needed to corroborate the effects of strabismuson self esteem and quality of life.

Indemnity bonds for MBBS students: Need for a change of perspective

Compulsory service programmes for MBBS students have existed for many years in India and other parts of the world. Such programmes have been referred to differently as “obligatory”, “mandatory”, “requisite” and “compulsory” service. Governments look at these programmes as a means to deploy and retain the health workforce even as health professionals are lost to opportunities in other countries. Though these programmes have been successful, they have been carried out by enforcement on medical students to finish a rural bond.

Episodic Psychotic Behavior: a case report

Episodic psychotic behaviour is a rare condition where the patient presents with psychotic behaviour inepisodes where the symptoms remit totally in between. We describe herewith a case of a lady thatpresented with episodic psychotic behaviour and that responded to treatment in our department.

A Clinical Analysis of patients seen in a Geriatric Mental Health Camp organized in Mumbai

Background: Geriatric mental health is a neglected domain of mental health and many cases remainundetected in the community. Community programs have often helped to detect many cases of the elderlywith psychiatric problems and help them access care. The current paper aims to present an analysis ofpatients seen in a geriatric health camp from a psychiatric perspective.Methods: 103 elderly attended the geriatric camp and were assessed clinically for psychiatric problems. Theywere also administered the Adenbrooke’s Cognitive Examination Revised (ACE-R) Hindi version, Barthel’sIndex for Activities of Daily Living and 3.Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST). Theresults were analyzed statistically and presented.Results: The mean age of the subjects in the study was 66.05 ± 7.9 years. 83 subjects (79%) out of the 105were female. The mean BIADL score of the sample was 19.52 ± 1.9 and on the basis of scores on the ACER they were classified as having cognitive impairment (n=67) and not having cognitive impairment (n=27).The cognitively impaired group differed from the non-cognitive impairment on all subscales of the ACE-R.55 (52.4%) reported the presence of elder abuse but had taken no action against it. The BIADL scores showeda significant correlation on all aspects of ACE-R scores.Conclusions: Geriatric health camps can serve as a useful arena for the detection of geriatric mental healthproblems. Further studies in larger populations are needed to corroborate the findings seen in the geriatrichealth camp reported in this study

Prescription pattern of antidepressants in five tertiary care psychiatric centres of India.

Background & objectives: Limited data are available on prescription patterns of the antidepressants from India.We studied antidepressants’ prescription pattern from five geographically distant tertiary psychiatric care centers of the India. Method: In this cross-sectional study, all patients who attended outpatients department or were admitted in the psychiatry wards at Lucknow, Chandigarh, Tiruvalla, Mumbai and Guwahati on a fixed day, who were using or had been prescribed antidepressant medications, were included. The data were collected on a unified research protocol. Results: A total of 312 patients were included. Mean age was 39±14.28 yr and 149 (47.76%) were females, 277 (87.5%) were outpatients. Among the patients receiving antidepressants, 150 (48.1%) were of diagnoses other than depression. Diabetes mellitus 18 (5.78%) was the most common co-morbid medical illness. A total of 194 (62.2%) patients were using selective serotonin reuptake inhibitors (SSRIs) with escitalopram 114 (36.53%) being the most common antidepressant used. Overall, 272 (87.18%) patients were using newer antidepressants. Thirty (9.62%) were prescribed more than one antidepressant; 159 (50.96%) patients were prescribed hypnotic or sedative medications with clonazepam being the most common (n=116; 37.18%). Interpretation & conclusions: About half of the patients with diagnoses other than depression were prescribed antidepressants. SSRIs were the most common group and escitalopram was the most common medication used. Concomitant use of two antidepressants was infrequent. Hypnotic and sedatives were frequently prescribed along with antidepressants.

Antidepressant action of ketamine anaesthesia during electroconvulsive therapy in a patient with depression

Background: Managing treatment resistant depression has been a confounding problem for psychiatrists in clinical practice. Glutamate receptor agents are being tried as the next line of antidepressants for the future. Case Description: We describe herewith a case of treatment resistant depression that received ECT with ketamine anaesthesia and showed improvement in a course of 7 ECTs. Discussion : The improvement the patient showed was remarkable and demonstrates the efficacy of ketamine in the management of depression where most drugs have not benefited the patient Conclusion : The role of ketamine in ECT anaesthesia in the management of patients with depression needs to be explored further

Strikes and Doctors- psychosocial and ethical dilemmas.

Abstract: This paper is a commentary on whether doctors have the right to strike work or not while keeping in mind, psychosocial and ethical implications of the same. Certain guidelines and criteria that may be applicable when examining doctors on strike are elucidated and discussed.

Clinical and psychoeducational profile of children with specific learning disability and co-occurring attention-deficit hyperactivity disorder.

BACKGROUND: Almost 10% of school-going children have specific learning disability (SpLD) in the form of dyslexia, dysgraphia and/or dyscalculia. Attention-deficit hyperactivity disorder (ADHD) occurs as a comorbidity in about 20% of these children. AIMS: To document the clinical profile and academic history of children with SpLD and co-occurring ADHD. SETTINGS AND DESIGN: Prospective observational study conducted in our clinic. MATERIALS AND METHODS: From August to November 2004, 50 consecutively diagnosed children (34 boys, 16 girls) were included in the study. SpLD was diagnosed on the basis of psychoeducational testing. Diagnosis of ADHD was made by DSM-IV-revised criteria. Detailed clinical and academic history and physical and neurological examination findings were noted. STATISTICAL ANALYSIS: Chi-square test or unpaired student's t-test was applied wherever applicable. RESULTS: The mean age of children was 11.4 years (+/-SD 2.5, range 7-17.1). Fifteen (30%) children had a significant perinatal history, 12 (24%) had delayed walking, 11 (22%) had delayed talking, 5 (10%) had microcephaly, 27 (54%) displayed soft neurological signs and 10 (20%) had primary nocturnal enuresis. There were no differentiating features between the two gender groups. Their academic problems were difficulties in writing (96%), inattentiveness (96%), difficulties in mathematics (74%), hyperactivity (68%) and difficulties in reading (60%). All children had poor school performance, 15 (30%) had already experienced class retention and 20 (40%) had developed aggressive or withdrawn behavior. CONCLUSION: Children with SpLD and co-occurring ADHD need to be identified at an early age to prevent poor school performance and behavioral problems.