Depression and diabetes: impact of antidepressant medications on glycaemic control.

INTRODUCTION: One of the consistent findings among various studies on diabetes has been the prevalence of depression with or without comorbid anxiety among patients of Diabetes Mellitus. Also, numerous other studies have pointed to the negative bearing of the same on blood sugar levels among patients. However there is a lack of data on the outcome of treatment with anti-depressants on the blood glucose level. Considering the ever increasing population of diabetics in our country and the significant causal relationship established by current literature, this study was undertaken. AIMS AND OBJECTIVES: To study prevalence of depression and anxiety in patients of Type 2 Diabetes Mellitus with an increase in blood glucose levels. To study the socio-demographic profile and role of stressors in patients of Type 2 Diabetes Mellitus. To study the effects of management of depression and anxiety on blood glucose levels in patients of Type 2 Diabetes Mellitus. SAMPLE SIZE: 100 Consecutive 100 patients diagnosed with Type 2 Diabetes Mellitus(DM) fulfilling the inclusion and exclusion criteria were included in the study. Ethics committee approval was taken for the study.The sociodemographic details of the patients were collected using a specially designed semi-structured proforma. Patients were evaluated for psychiatric disorders using DSM IV TR criteria for diagnosis and Montgomery Asberg Depression Rating Scale (MADRS) and Hamilton Anxiety Rating Scale(HAM-A) were used thereafter to assess the severity of depression and anxiety, respectively. Patients detected with depression and / or anxiety were started on T. Escitalopram (10 mg); keeping the management of DM unchanged. Patients were reviewed after 6 weeks from date of initial assessment and blood glucose levels were repeated. Data thus collected was analysed using SPSS Software. RESULTS: The prevalence of depression with/without anxiety in the study was 39%. Among depressed patients stressors were found in 84% of patients with social and interpersonal stressors as the more prevalent types. The socio-economic profile showed a female preponderance, lower to middle socioeconomic and educational status and majority were married. 47% of the patients started on T. Escitalopram showed lower fasting and post-lunch blood sugar values on follow up, which was clinically and statistically significant.

Evaluation of efficacy and tolerability of dothiepin hydrochloride in the management of major depression in patients suffering from rheumatoid arthritis.

Several studies have shown that 20 to 66.2% of patients with rheumatoid arthritis have associated psychiatric comorbidity especially depression. Dothiepin hydrochloride is a well-established and effective antidepressant in patients with depressive symptoms of varying severity and co-existing anxiety. To document the efficacy and tolerability of dothiepin hydrochloride in the management of major depressive disorder (MDD) in rheumatoid arthritis patients a phase IV, open, single arm, prospective study was initiated with dothiepin hydrochloride in the dose of 75 mg/day, duration of therapy was 6 weeks. Twenty-five rheumatoid arthritis patients suffering from co-morbid MDD completed the 6-week dothiepin hydrochoride treatment and were considered for final analysis. There was significant reduction (p < 0.05) in mean HAM-D scores at week 2 (13.92 +/- 5.45), week 4 (9.28 +/- 4.13) and week 6 (5.72 +/- 3.26) compared to baseline (21.64 +/- 5.93). There was significant reduction (p < 0.05) in mean HAM-A scores at week 2 (6.52 +/- 3.34), week 4 (4.0 +/- 2.25) and week 6 (2.76 +/- 1.59) compared to baseline (10.68 +/- 3.68). The global impression of efficacy at the end of 6 weeks of dothiepin hydrochloride treatment was rated by the clinician (psychiatrist) as marked and moderate improvement in 20 (80%) and 5 patients (20%) respectively. Only 2 patients reported dry mouth as an adverse event in the study. The overall assessment of tolerability at the end of 6 weeks of dothiepin hydrochloride treatment was rated by the clinician (psychiatrist) as good and fair in 19 (76%) and 6 patients (24%) respectively. Dothiepin hydrochloride was found to be an effective and well-tolerated drug in the management of MDD and anxiety in patients suffering from rheumatoid arthritis.

Psychopathology in children of schizophrenics.

The higher prevalence of schizophrenia in children of schizophrenics than in the general population has generated an interest in pinpointing those behaviors that may precede the disorder and serve as an index of vulnerability to the disorder. Signs of neurobehavioral dysfunction in areas of neurocognitive functioning and social behavior have been found in school-age children of schizophrenic parents. This study assessed the neurobehavioral functioning, social behavior, cognitive functioning, attention and intelligence in children with a schizophrenic parent and compared the same parameters with children of mentally healthy parents. The children aged 12-15 years, were assessed with a battery of neurobehavioral tests. The children with a schizophrenic parent performed more poorly on the tests as compared to the children of mentally healthy parents. The children with a schizophrenic parent were seen to have more behavioral problems, especially withdrawn behavior and more social problems when compared to the other children in the study. Poor attention, disordered thoughts and lower intelligence were also observed to be more in the children of the schizophrenic parent.

Depression in children and adolescents.

Childhood depression accounts for a substantial proportion of cases in child psychiatric clinics. Depression is more common in boys than girls in school age children and it becomes reverse during adolescents. The childhood depression can be wholly chemical, wholly due to psychological factors of a combination of both. The causes of depression can be discussed under three headings--genetic factors, biological factors and social factors. Some children display the classical symptoms of sadness, anxiety, restlessness, eating and sleeping problems while others present with physical problems like aches and pains which do not respond to treatment. Diagnosis depends on interview or questionnaire instruments to screen populations and some biological procedures to determine neuro-endocrine and other physical dysfunctions. Treatment consists of pharmacological treatment and psychological treatment. Tricyclic antidepressants, serotonin specific reuptake inhibitors and electroconvulsive therapy constitute pharmacological part of the treatment, whereas supportive, insight oriented, play, behaviour, family therapies and cognitive psychotherapy constitute psychological part.

Child psychiatry in Bombay: the school mental health clinic.

The school mental health clinic is an unusual amalgamation of the mental health and education sectors in Bombay. It aims to detect emotional problems in schoolchildren, increase mental health awareness in teachers and other professionals and determine any risk or causal factors in schoolchildren suffering from mental health problems. It also offers cross-cultural research opportunities.

Stressful life-events, anxiety, depression and coping in patients of irritable bowel syndrome.

UNLABELLED: A lot of research has pointed to a complex interaction between stressful life events, psychiatric morbidity and the irritable bowel syndrome (IBS). AIM: The present study aimed to determine the: stressful life-events in patients with irritable bowel syndrome patients in comparison to normal controls; effect of these events in causing clinically significant anxiety and depression; and the effect of psychopathology i.e. anxiety and depression on coping skills in these patients. METHODOLOGY: Thirty patients with irritable bowel syndrome were compared with thirty matched normal controls, on the presumptive stressful life events scale and the mechanisms of coping scale. Further, among the irritable bowel syndrome patient group, the anxious and depressed subgroups were separated from the non-anxious and non-depressed subgroups using the hospital anxiety and depression scale. Positive and negative coping mechanisms between these subgroups were compared. RESULTS: Significantly higher stress scores were found in the irritable bowel syndrome patient group than normal controls. Not all, but slightly more than fifty percent of irritable bowel syndrome had definite and clinically significant anxiety and/or depression. Those IBS patients with either definite depression tended to use predominantly negative coping styles as compared to those IBS patients without anxiety or depression. CONCLUSION: Stressful life-event scores are significantly higher in IBS patients than in normal controls. Although not all of these patients have anxiety and/or depression, a significant number of patients show evidence of the same. Presence or absence of anxiety and/or depression influences how the patient with IBS copes with illness. Therefore, though further studies on the issue are required, we suggested that, as a supplement to medical management, recognition and treatment of anxiety and depression in this subgroup of IBS patients with psychotropic drugs and cognitive therapy for gaining more positive coping skills, may require special attention in the management of irritable bowel syndrome.

Psychosocial profile of juvenile diabetes.

A study of the complex relationships between the patient characteristics, family and environmental influences, physician's behaviour and the demands of the disease with its management in Juvenile Diabetics was taken up at a general hospital.90 subjects were selected for the study and grouped into three. Group A consisted of 30 Juvenile Diabetics, Group B of 30 Adult Diabetics and Group C of 30 Normal healthy adolescents. The impact of the illness was measured on the Diabetes Impact Measurement Scale (DIMS), the behavioural deviations and the parental attitudes towards child rearing on the Fallstrom's Questionnaire (FQ) and the family environment on the Family Climate Scale (FCS). Psychiatric morbidity was assessed using DSM-IV criteria. Group A & B were compared on the DIMS and Group A & C on FQ & FCS.Adult diabetics had a greater impact of diabetes. Juvenile diabetics had significantly higher frequency of behavioural deviations as compared to controls. Also there was a higher number of responses on questions indicating an overprotecting attitude amongst parents of juvenile diabetics. There was an increased incidence of psychiatric morbidity in juvenile diabetics as compared to normal adolescents irrespective of the family environment. The results are discussed in relation to current literature.

A comparative study of psychological factors in patients with normal and abnormal angiographic findings.

Chest pain is one of the most common symptoms in psychiatric and primary care practice and a frequent reason for extensive diagnostic work-up. Despite extensive investigations no recognizable medical cause to account for these symptoms is detected in many patients with chest pain. Studies of patients with non-cardiac chest pain have revealed that many continue to report symptoms and disability despite medical reassurances.The aims of the study were to evaluate the prevalence of psychiatric morbidity, personality profile and stressors along with functional impairment in patients with chest pain and normal angiographic findings and compare the same with patients who have chest pain but abnormal angiographic findings and a diagnosis of ischemic heart disease.The study included 30 consecutive patients in each group. The scales used were SCID-I of DSM-III-R, 16-PF, semi structured questionnaire for assessment of type A behaviour, PSLES and GAF scale of DSM-III-R.Panic disorder and depression were highly prevalent in patients with atypical chest pain. These patients had lower prevalence of type A behaviour, a unique 16-PF profile, experienced more stresses at any given point in time and significant impairment in day-day and in socio-occupational functioning.

Risperidone in Indian patients with schizophrenia.

Conventional antipsychotic agents are not effective against negative symptoms of schizophrenia and are also noted for their extrapyramidal side effects. Risperidone is a noval antipsychotic agent whose dual antagonism of dopamine and serotonin receptors is believed to underlie its efficacy against negative symptoms and the low incidence of extrapyramidal side effects. An open, non-comparative study of seven weeks duration was performed to evaluate risperidone in the treatment of schizophrenia in Indian patients. Previous antipsychotic therapy was discontinued for a week before risperidone therapy was initiated. At the end of six weeks of risperidone therapy, clinical improvement (≥ 20% reduction in total score on positive and negative syndrome scale for schizophrenia (PANSS;; was shown by 128 (87.7%) of the 146 evaluable patients. Statistically significant reduction (p < 0.05) occurred in the total score of this scale and in the subscale scores for positive, negative and general psychopathology symptoms and in the clinical global impression severity score. The number of patients with adverse experiences were 108 (65.5%) at baseline and 120 (72.7%) at the end of risperidone therapy. Extrapyramidal symptoms, seen in 65 (39.4%) patients compared to 22 (13.3%) patients at baseline, were largely mild to moderate in intensity.

Psychiatric referral pattern in general hospital.

Here we have tried to analyse the psychiatric referral pattern in general hospital setting. In one year period, 20.20% of the total new cases in psychiatry O.P.D. were referred cases. Majority of the patients were referred at O.P.D. level. Males were more than females. Physicians referred maximum cases than surgeons and gynaecologist. Neurosis was the common diagnosis amongst the referred cases. As one of the senior psychiatrists has mentioned 'lack of referral's by the non-psychiatrists has been an unfortunate negative factor for the growth of psychiatry.

A preliminary study of reaction time in schizophrenics.

The aim of this study was to make a preliminary study of auditory reaction time (ART) and its significance in cases of schizophrenia. It was found that ART is significantly affected and prolonged in schizophrenia as compared to normal healthy controls (P less than 0.001) when the stimulus is presented to both ears or either car separately. Distractability was higher in schizophrenics as compared to adult controls (P less than 0.001). There was no significant difference in ART within the patient group when the stimulus was presented to the right ear or left ear (P greater than 0.05). There was no significant difference between ART of male and female schizophrenics (P greater than 0.05).

Study of correlation of intensity of symptoms with stressful life events in depressed patients.

60 patients suffering from "Depression" attending the Psychiatry outpatient clinic in a general hospital were studied.The intensity of symptoms, and life stress events for 12 months prior to episode were obtained and compared on the basis of sex of patient.The findings of the study indicate that, the depressed patients had the severity of symptomatology positively correlated with the severity of stress. Thus with the increase in stress, the severity of symptoms would be on increase.The findings also indicated the distribution of more physical and affective symptoms in depressed females and more of behavioural symptoms in depressed males.It was seen that occurrence of undesirable life events which could be specific for Indian culture were perceived more than desirable events by the sample.

Psycho Social Aspects of Venereal Disease in Fifty Young Girls.

Fifty girls aged between 14 and 20 years and suffering from Venereal Diseases have been prospectively studied and analyzed with respect to age, marital status, religion, education, economic status, occupation, neurotic traits, intelligence and personality, maturity and psychiatric illness.' the results are discussed with relevant references.