Relationship of supernatural beliefs and first treatment contact in patients with obsessive compulsive disorder: an exploratory study from India.

BACKGROUND: The etiology of mental illness has been attributed to many different causes by people of various cultural backgrounds, including supernatural beliefs. This in turn affects the help-seeking behavior. Aim of this study was to explore the supernatural belief and pathways of care in patients with obsessive compulsive disorder (OCD) attending a tertiary care hospital located in north India. METHODOLOGY: In all, 89 consecutive patients diagnosed with OCD (according to the International Classification of Diseases-10th Revision (ICD-10)) and ≥ 15 years of age were evaluated for their supernatural belief and help seeking. RESULTS: More than half of the patients (54%) believed in supernatural causes and 57.3% attributed their illness to supernatural causes. In addition to supernatural causes, many patients also attributed their illness to stress (household/work-related stress) or chemical imbalance in the body and or mind. About two-thirds of the patients (n = 58; 65.2%) first contacted a psychiatrist for their symptoms of OCD. Those who first contacted faith healers believed in one of the supernatural causations. CONCLUSION: Patients with OCD hold multiple beliefs regarding the etiology and treatment of mental illness which can affect their pathways to care.

Comparison of symptoms of delirium across various motoric subtypes.

AIM: The aim of this study was to determine the correlation between delirium motor subtypes and other symptoms of delirium. METHODS: Three hundred and twenty-one (n = 321) consecutive patients referred to consultation-liaison psychiatry services were evaluated on Delirium Rating scale-Revised-98 version and amended Delirium Motor Symptom Scale. RESULTS: Half of the patients had hyperactive subtype (n = 161; 50.15%) delirium. One-quarter of the study sample met the criteria for mixed subtype (n = 79; 24.61%), about one-fifth of the study sample met the criteria for hypoactive delirium subtype (n = 64; 19.93%), and only very few patients (n = 17; 5.29%) did not meet the required criteria for any of these three subtypes and were categorized as 'no subtype'. When the hyperactive and hypoactive subtypes were compared, significant differences were seen in the prevalence of perceptual disturbances, delusions, lability of affect, thought process abnormality, motor agitation and motor retardation. All the symptoms were more common in the hyperactive subtype except for thought process abnormality and motor retardation. Compared to hyperactive subtype, the mixed subtype had significantly higher prevalence of thought process abnormality and motor retardation. Significant differences emerged with regard to perceptual disturbances, delusions, lability of affect and motor agitation when comparing the patients with mixed subtype with those with hypoactive subtype. All these symptoms were found to be more common in the mixed subtype. No significant differences emerged for the cognitive symptoms as assessed on Delirium Rating scale-Revised-98 across the different motoric subtypes. CONCLUSION: Different motoric subtypes of delirium differ on non-cognitive symptoms.

Clozapine associated thrombocytopenia.

Although agranulocytosis as a side effect of clozapine is well known, there is scarcity of data with regard to thrombocytopenia associated with clozapine. In this report we describe a case of clozapine induced thrombocytopenia and review the existing literature. A 22 year old female patient developed thrombocytopenia while on clozapine 187.5 mg/day for 17 weeks. Thrombocytopenia persisted for 24 weeks even after reduction in the dose of clozapine and ultimately clozapine had to be stopped, which led to resolution of thrombocytopenia. Clozapine-induced thrombocytopenia is a less well-known, but potentially serious, adverse effect that should be screened for in practice. The case highlights the fact that besides monitoring the leucocyte count, platelet count of patients receiving clozapine should also be monitored.

Carisoprodol: an underrecognized drug of abuse in north India.

BACKGROUND: There is limited literature on clinical profile of subjects abusing carisoprodol. METHODS: Our series of 34 subjects shows that a typical subject was an unmarried, unemployed, urban resident from a nuclear family set up; was a substance abuser before being introduced to carisoprodol by another substance abuser; initiated the use to get a better "kick" and after regular use reported craving and withdrawal symptoms. RESULTS: The effect of carisoprodol was dose dependent: a majority reported a feeling of general wellbeing on consuming up to three tablets; a hypomanic state with 4-10 tablets and confusion, disorientation and drowsiness with >10 tablets at a time. CONCLUSION: Thus being an underrecognized drug of abuse, carisoprodol is in need of wider awareness and regulatory measures to prevent its emergence as a greater menace in the future.

Metabolic syndrome among substance dependent men: A study from north India.

BACKGROUND: Substance abuse, alcohol in particular, is associated with increased risk of diabetes and metabolic syndrome (MS). The relationship between the substance abuse and MS is complex and the literature is sparse. OBJECTIVES: The present research was aimed to study the prevalence and predictors of MS among outpatients with substance dependence. MATERIALS AND METHODS: Patients with substance dependence were recruited from a deaddiction center in North India, who attended outpatient clinic from 1(st) January, 2010-31(st) December, 2010. MS was assessed using International Diabetes Federation (IDF) criteria. RESULTS: Out of 250 subjects, 34 (13.6%) of the subjects met the IDF criteria for MS and highest being in alcohol group (21.6%). The commonest abnormality was increased triglycerides (TG; 54%) and increased waist circumference (36.8%). Age, body weight, body mass index, and obesity were significant predictor of MS. CONCLUSION: MS was highest in subjects with alcohol dependence with the commonest abnormality of TG and blood pressure. Hence, routine screening is advisable in this population to address emerging MS.

Substance-induced psychotic disorders: 13-year data from a de-addiction centre and their clinical implications.

The relationship between substance use and psychotic disorder has been complex. Alcohol, cannabis, amphetamines, hallucinogens, and phencyclidine have been implicated as a causative factor for psychotic disorders. It is important to differentiate substance induced psychotic disorders (SIPDs) from primary psychotic disorders as management of the two conditions is different. There is paucity of research in the area of SIPD particularly from Asia. The present study was a retrospective study and it determines retrospectively the incidence rate and clinical characteristics of the SIPDs over a period of 13 years. The incidence of SIPDs was found to be 1.4% and all the subjects were males. In the present study, only alcohol and cannabis were implicated as causative agents for SIPDs. The most common type of psychosis was schizophrenia like psychosis, being more common in the cannabis group. The other forms of psychosis included delusional type, hallucinatory type and affective psychosis. 20% of the subjects had a change in diagnosis to either schizophrenia or affective psychosis on follow-up. The present study showed that the presentation of SIPDs is similar to the primary psychotic disorder and this has management implication.

Catatonia associated with hyponatremia treated with electroconvulsive therapy.

Catatonia has been reported to occur in various brain pathologies and systemic conditions. We present a case of catatonia associated with hyponatremia treated with a course of electroconvulsive therapy. A 48-year-old woman presented with catatonia and, upon investigation, was found to have persistent/recurrent hyponatremia. Upon investigation also, she was found to have adrenal insufficiency. Her symptoms of catatonia did not respond to correction of hyponatremia, a course of lorazepam, after which she was treated with ECT, with which her catatonia improved.

Changing pattern of substance abuse in patients attending a de-addiction centre in north India (1978-2008).

BACKGROUND & OBJECTIVES: The patterns of abused psychoactive substances change over time, and it is important to document such changes. The present retrospective study was carried out to document these changes in patients registered in a de-addiction centre in north India over three decades. METHODS: Case notes of all patients registered in the centre from September 1978 till December 31, 2008 were reviewed. Comparisons were made among three decades (1978-1988, 1989-1998, and 1999-2008). RESULTS: The number of registered subjects increased eight-fold over the decades, and age of the subjects presenting for the treatment decreased. The percentages of subjects presenting for the treatment with opioid dependence were 36.8 per cent (n=204), 42.9 per cent (n=809) and 53.2 per cent (n=2219), respectively for the three decades (P<0.001). The proportion of subjects using natural opioids decreased over the three decades (47.4, 26.5 and 18.3%; P<0.001), with a concomitant emergence and/or increase of newer and prescription opioids such as buprenorphine, codeine and dextropropoxyphene. Dependence on tobacco and sedative-hypnotics also increased, and inhalant abuse was reported especially in the third decade. Polysubstance dependence increased significantly over the decades (P<0.001). INTERPRETATION & CONCLUSIONS: Our results showed major shifts in the patterns of substance abuse in clinic-attending patients in north India over the three decades from 1978 till 2008. These have important implications for all the stakeholders concerned with combating the challenge of psychoactive substance abuse in our society.

Prevalence of metabolic syndrome in patients with schizophrenia in India.

Prevalence of metabolic syndrome (MS) was estimated in 227 patients with schizophrenia. A total of 43.6% of patients fulfilled International Diabetes Federation (IDF) criteria and 44.5% met modified National Cholesterol Education Program Adult Treatment Panel-III (NCEP ATP- III) criteria of MS. Increased waist circumference was the most common abnormality (64.8%) and high glucose level was the least common (15.9%). In regression analysis, age more than 35 years (OR-3.37), female gender (odds ratios (OR-1.81)), urban locality (OR-2.08), being employed (OR-2.12) and BMI more than 25 (OR-5.64) emerged as significant predictors of MS.

Comparative study of the experience of caregiving in bipolar affective disorder and schizophrenia.

BACKGROUND: Bipolar affective disorder and schizophrenia are disabling illnesses and place a considerable degree of burden on the caregivers. Many studies from India have measured the burden of care in schizophrenia and some studies have measured the burden experienced by the caregivers of bipolar affective disorder. Few studies have compared this variable in these disorders. Experience of caregiving is a broader concept that takes into consideration both the negative and positive appraisal of the caregiving. However, no study from India has compared the experience of caregiving in bipolar affective disorder and schizophrenia. AIM OF THE STUDY: To study the experience of caregiving in a group of caregivers of bipolar patients and compare the same with caregivers of patients with schizophrenia. METHOD: Seventy patients with a diagnosis of bipolar affective disorder and 70 with a diagnosis of schizophrenia were selected for the present study. Patients were assessed on the Hamilton Depression Rating Scale, the Young Mania Rating Scale and the Positive and Negative Syndrome Scale depending upon their diagnosis. They were also assessed on the Global Assessment of Functioning (GAF) scale. Caregivers of the patients were assessed on the General Health Questionnaire (GHQ) and the Experience of Caregiving Inventory (ECI). RESULTS: The maximum ECI score was seen in the domain of handling 'difficult behaviour' in both the groups. Compared to caregivers of patients with bipolar affective disorder, caregivers of patients with schizophrenia had overall more positive and negative appraisal of caregiving experience while caring for their ill relatives. The difference reached significant levels for all domains but for the domains of 'effects on family', 'need for back-up' and 'good aspect of relationship'. There were significant differences too for the total positive personal experience sub-score. There was a significant positive correlation between the negative and positive caregiving experience score for both schizophrenia and bipolar groups. CONCLUSION: The caregivers of both bipolar affective disorder and schizophrenia appraise the caregiving negatively, while at the same time appraising some positive aspects of it. Caregivers of schizophrenia patients appraise caregiving more negatively than those of bipolar affective disorder patients.

Prevalence of metabolic syndrome in bipolar disorder: an exploratory study from North India.

PURPOSE: To study the prevalence of metabolic syndrome in patients with bipolar disorder. MATERIAL AND METHOD: By using purposive random sampling 200 patients with bipolar disorder receiving treatment were evaluated for presence of metabolic syndrome using International Diabetes Federation (IDF) and modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) criteria. RESULTS: Eighty patients fulfilled IDF criteria and 82 patients met NCEP ATP-III criteria for metabolic syndrome. There was significant concordance between these two criteria sets for metabolic syndrome (Kappa value 0.979, p<0.015). Among the individual parameters studied--increased waist circumference (70.1%) was the most common abnormality, followed by increased blood pressure (44.5%) and increased triglycerides levels (42%). Compared to patients without metabolic syndrome, patients with metabolic syndrome had significantly higher body mass index and higher percentage of them (74.4% vs 51.7%) were more than 35 years of age. Logistic regression analysis revealed that these two variables significantly predicted metabolic syndrome. CONCLUSION: Findings of the present study suggest that abdominal obesity is the most common abnormality and metabolic syndrome is best predicted in patients with bipolar disorder by higher age and higher body mass index.

Long-term maintenance lorazepam for catatonia: a case report.

Catatonia is described as a syndrome of motor abnormality associated with the disorder of thought, behavior and emotions. Lorazepam has been shown to be useful in the short-term management of catatonia [Ungvari G.S., Kau L.S., Wai-Kwong T., Shing N.F., The pharmacological treatment of catatonia: an overview. Eur Arch Psychiatry Clin Neurosci 2001;251(suppl 1):31-34; Daniels J., Catatonia: clinical aspects and neurobiological correlates. J Neuropsychiatry Clin Neurosci 2009;21:371-380]. However, there is sparse literature with respect to patients requiring long-term maintenance lorazepam for catatonia. Manjunatha et al. [Manjunatha N., Saddichha S., Khess C.R.J., Idiopathic recurrent catatonia needs maintenance lorazepam: case report and review. Aust NZ J Psychiatry 2007;41:625-627] described a case which required long-term maintenance lorazepam for recurrent catatonia that was unresponsive to most antipsychotics. Gaind et al. [Gaind G.S., Rosebush P.I., Mazurek M.F., Lorazepam treatment of acute and chronic catatonia in two mentally retarded brothers. J Clin Psychiatry 1994;55:20-23] described the use of maintenance lorazepam in a mentally retarded boy with catatonia of 5 years' duration, which improved slowly over a period of 5 months. We present a case of recurrent catatonia, in which symptoms relapsed whenever an attempt was made to taper off lorazepam.

Experience of caregiving in schizophrenia: a study from India.

BACKGROUND: Many studies from India have evaluated the burden of schizophrenia on caregivers. Experience of caregiving, on the contrary, is a broader concept that takes into consideration both negative and positive consequences of the disorder and is influenced by factors like social support and coping of caregivers. METHODOLOGY: Fifty caregivers of patients with diagnosis of schizophrenia were assessed on Experience of Caregiving Inventory (ECI), Coping Checklist (CCL), Social Support Questionnaire (SSQ) and General Health Questionnaire-12 (GHQ-12). Patients were assessed on Positive and Negative Syndrome Scale (PANSS). RESULTS: Maximum ECI score was seen in negative domains of handling the difficult behaviour followed by negative symptoms, loss and dependency. Significant positive correlation was seen between total positive ECI score and the level of education of patients and caregivers. Regression analysis showed that use of problem-focused coping, seeking social support as a coping strategy and education of caregivers explained 30.6% of the variance of ECI positive score. CONCLUSION: The study showed that education of caregivers, coping strategies used by the caregivers and available social support influence the final appraisal of caregiving.

Research on antipsychotics in India.

Antipsychotic as a class of medications became available for treatment of various psychiatric disorders in the early 1950's. Over the last 60 years many antipsychotics have become available. In line with the west, Indian researchers have evaluated the efficacy of antipsychotics in various conditions. Additionally, researchers have also evaluated the important safety and tolerability issues. Here, we review data originating from India in the form of drug trials, effectiveness, usefulness, safety and tolerability of antipsychotics. Additionally, data with respect to other important treatment related issues is discussed.

Research on mood stabilizers in India.

Mood stabilizers have revolutionized the treatment of bipolar affective disorders. We review data originating from India in the form of efficacy, effectiveness, usefulness, safety and tolerability of mood stabilizers. Data is mainly available for the usefulness and side-effects of lithium. A few studies in recent times have evaluated the usefulness of carbamazepine, valproate, atypical antipsychotics and verapamil. Occasional studies have compared two mood stabilizers. Data for long term efficacy and safety is conspicuously lacking.

Research on antidepressants in India.

Data suggests that antidepressants are useful in the management of depressive disorders, anxiety disorders, sexual dysfunction, eating disorders, impulse control disorders, enuresis, aggression and some personality disorders. Research focusing on the usefulness of antidepressants in India has more or less followed the trends seen in the West. Most of the studies conducted in India have evaluated various antidepressants in depression. In this article, we review studies conducted in India on various antidepressants. The data suggests that antidepressants have been evaluated mainly in the acute phase treatment and rare studies have evaluated the efficacy in continuation phase treatment.