Characteristics and correlates of poststroke depression: An Indian study.

BACKGROUND: Post stroke depression adversely affects long term outcome of stroke and increases mortality risk. Few studies have looked into the comprehensive picture of post stroke depression in past. AIM: The current study aimed to look into the phenomenology, characteristic features and various correlates of post stroke depression. METHOD: 142 consecutive stroke patients aged 60 years or above, fulfilling the inclusion criteria were assessed. Sociodemographic and clinical data were gathered using a specially designed pro-forma. Depression, apathy and psychosis were assessed by Post stroke depression rating scale, Apathy Evaluation Scale, and Brief Psychiatric Rating Scale respectively. Groups (with or without major depression) were compared using Mann-Whitney U, chi square or Fisher's exact test. One way ANOVA was conducted to see the relations of lesion location and laterality with various clinical parameters. Kaplan-Meier survival analysis was done to see the time to develop depression. The effect sizes were reported as r and partial eta squared. RESULTS: Guilt was significantly higher (p<.05) with lesions in parietal lobe and remaining of middle cerebral artery territory. Catastrophic reaction (p<.05) and emotional dyscontrol (p<.05) were higher for diffuse lesions, periventricular lesions and lesions in frontal/occipital lobe. BPRS score, but not apathy, had a significant positive correlation with depression (Pearson's r=.692). Mean time to develop depression after stroke was 28.34 (95% CI 22.37 to 34.31) months. CONCLUSIONS: Post stroke depression consists of various clinically important sub-components whose occurrence varies with different lesion locations. Post stroke depression is discriminable from apathy but is related to psychosis.

Olanzapine-induced Orthostatic Hypotension.

Olanzapine is an atypical antipsychotic which is efficacious in the treatment of schizophrenia. The adverse effect profile for olanzapine is benign except for higher rates of metabolic events. Orthostatic hypotension is less commonly reported with olanzapine as compared to first-generation and few atypical antipsychotics. We report a case where olanzapine, in a dose dependent fashion, caused transient postural hypotension.

Topical corticosteroid addiction and phobia.

Corticosteroids, one of the most widely prescribed topical drugs, have been used for about six decades till date. However, rampant misuse and abuse down the years has given the drug a bad name. Topical steroid abuse may lead to two major problems which lie at the opposing ends of the psychosomatic spectrum. Topical steroid addiction, a phenomenon that came to be recognized about a decade after the introduction of the molecule is manifested as psychological distress and rebound phenomenon on stoppage of the drug. The rebound phenomenon, which can affect various parts of the body particularly the face and the genitalia has been reported by various names in the literature. TC phobia which lies at the opposite end of the psychiatric spectrum of steroid abuse has been reported particularly among parents of atopic children. Management of both conditions is difficult and frustrating. Psychological counseling and support can be of immense help in both the conditions.

Empowerment and its associations in schizophrenia: a cross-sectional study.

Empowerment denotes a sense of personal competence which is considered an essential requisite of fair outcome in schizophrenia. The current study assessed empowerment along with other relevant variables in patients with schizophrenia and a comparison group. Hierarchical multiple linear regression analysis identified independent living skills survey score and perceived social support as predicting empowerment in patients with schizophrenia, suggesting a correlational relationship. Empowerment could be a treatment goal in schizophrenia and independent living skills as well as perceived social support could be the mediating factors.

Acute dystonia, akathisia, and parkinsonism induced by ziprasidone.

Ziprasidone is a second-generation antipsychotic with a lower propensity to cause extrapyramidal adverse effects that are seen at higher doses. We report a patient who developed acute dystonia, parkinsonism, and severe akathisia with ziprasidone 80 mg/d. These adverse effects subsided after dose reduction and specific treatment for akathisia and parkinsonism.

Metformin for olanzapine-induced weight gain: a systematic review and meta-analysis.

Olanzapine is an atypical antipsychotic that is useful in schizophrenia and bipolar affective disorder, but its use is associated with troublesome weight gain and metabolic syndrome. A variety of pharmacological agents has been studied in the efforts to reverse weight gain induced by olanzapine, but current evidence is insufficient to support any particular pharmacological approach. We conducted a systematic review and meta-analysis of randomized controlled trials of metformin for the treatment of olanzapine-induced weight gain. Systematic review of the literature revealed 12 studies that had assessed metformin for antipsychotic-induced weight gain. Of these, four studies (n= 105) met the review inclusion criteria and were included in the final analysis. Meta-analysis was performed to see the effect size of the treatment on body weight, waist circumference and body-mass index (BMI). Weighted mean difference (WMD) for body weight was 5.02 (95% CI 3.93, 6.10) kg lower with metformin as compared with placebo at 12 weeks. For waist circumference, the test for heterogeneity was significant (P= 0.00002, I(2) = 85.1%). Therefore, a random effects model was used to calculate WMD, which was 1.42 (95% CI 0.29, 3.13) cm lower with metformin as compared with placebo at 12 weeks. For BMI, WMD was 1.82 (95% CI 1.44, 2.19) kg m(-2) lower with metformin as compared with placebo at 12 weeks. Existing data suggest that short term modest weight loss is possible with metformin in patients with olanzapine-induced weight gain.

Salivary flow rate in patients with schizophrenia on clozapine.

AIMS: To assess the change in salivary flow rate in patients with schizophrenia on clozapine and whether the change in salivary flow rate was dose related. METHODS: Twenty male inpatients with a diagnosis of schizophrenia according to the International Statistical Classification of Diseases, 10th Revision diagnostic criteria for research who were started on clozapine were recruited for the study. Unstimulated salivary flow rate was assessed at baseline and then weekly for 4 weeks using cotton swab method in 17 patients. RESULTS: Repeated-measures analysis of variance showed a significant increase in salivary flow rate over time (F [2.37/37.94] = 3.134, P = 0.047, Greenhouse-Geisser correction, eta = 0.16). Also, there was a significant increase in salivary flow rate between weeks 2 and 3 (P < 0.05). There was no correlation between salivary flow rate and mean clozapine dose. CONCLUSIONS: There was a significant increase in salivary flow rate from baseline after starting clozapine, with a significant increase from the second to the third week followed by a "plateau."

[Folie á deux between two unrelated individuals]. / Akrabalik Iliskisi Olmayan Iki Insan Arasinda Paylasilmis Psikoz.

Folie à deux is a rare condition characterized by transmission of delusions from a primary patient to another individual, usually a blood relative or spouse, while living in relative isolation. We report a case of folie à deux, which resembled folie communiquée, in a 37-year-old man that acquired it from an older woman (primary patient). Although not related by blood, the patient was emotionally very close to the woman and they shared common features, including grandiose delusions about the supernatural powers of the primary patient and persecutory delusions concerning office colleagues, as the woman had, and then neighbors, fellow villagers, and even family members. Behavioral changes were observed in the secondary patient as he started wearing strange clothing and peculiar ornaments, and neglected his personal hygiene. He also started following the same rituals and routines as the primary patient, and changed his religious practices, which he had followed devoutly since adolescence. He began seeking her opinion concerning almost all decisions he had to make, including personal and professional matters. Yet, unlike the usual clinical picture, they did not live in social isolation; rather, they lived in an apartment in a well-known residential area of the city and he regularly worked at his office until the late stage of illness. Premorbidly, there were no features suggestive of dependency or low intelligence in the secondary case. After separation from the primary case, improvement was observed about 7 weeks after beginning risperidone treatment (6 mg/day).