A Rare Presentation of Psychotic Depression with Suicidality in a Case of Papillon-Lefèvre Syndrome.

Papillon-Lefèvre syndrome (PLS) is an autosomal recessive disorder that presents with palmoplantar hyperkeratosis and childhood-onset progressive loss of all dentition. Mental retardation is the only neurodevelopmental disorder reported with this condition till date. We report the first ever case in the literature of PLS presenting with psychotic depression and suicidal intention. A 40-year-old, never married, unemployed woman presented for psychiatric consultation and was given an International Classification of Diseases version 10 diagnosis of severe depression with psychotic symptoms. Physical examination warranted dermatological and dental evaluation before electroconvulsive therapy (ECT) could be administered. She was diagnosed with PLS and pseudoainhum by the skin and dental specialists. Karyotyping study was normal, and histopathology of the palmar tissue showed hyperkeratinization. She was treated with ECT, duloxetine and olanzapine, and she achieved full remission of her depression. She was prescribed oral retinoids and emollients for the skin disorder, and there was a good improvement. The dental prosthesis was fixed, and she was able to eat and feel better than before. Early diagnosis of this condition and rehabilitation would be important in improving wellbeing.

Profile of Young Suicide Attempt Survivors in a Tertiary Care Hospital in Puducherry.

CONTEXT: Puducherry has the highest suicide prevalence rate in India by 2014, predominantly among the 14-30 years age group. AIMS: The aim of the present study is to study the characteristics of adolescent and youth suicide attempters in Puducherry and measure the suicide intent. SETTINGS AND DESIGN: An observational study of 6 months duration was conducted in the Department of Psychiatry, at Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India. MATERIALS AND METHODS: Modified version of World Health Organizations SUicide PREvention Multisite Intervention Study on Suicidal questionnaire was used to collect sociodemographic data and Beck's suicide intent scale was used to measure the suicide intent scores. International Classification of Diseases-10 was used for diagnosis. STATISTICAL ANALYSIS: Statistical Package for the Social Sciences version 13 was used for descriptive analysis and correlation statistics. P value was set as <0.05. RESULTS: Of 56 eligible participants, 40 formed the sample, their mean age was 18. 13 (±2.50), more females (1.1:1), rural, literate, lower socioeconomic status (67.5%), mostly single (90%), living in nuclear (95%), and Hindu (87.5%). One hundred percent had psychosocial stressors before suicide attempt. Acute stress disorder/adjustment disorder was the most common diagnosis. Emotionally unstable and anankastic personality traits were seen in 12%. Pesticide ingestion (45%) was the most common suicide method. Sixty percent attempted suicide within <30 min of suicidal contemplation. Statistical associations were found between the alleged purpose, seriousness, attitude toward living/dying, conception about medical rescuability, and the overall suicide intent. CONCLUSIONS: Adolescent and youth suicide attempts occur due to psychosocial stressors rather than due to the past or on-going mental health disorders with above personality traits suggest poor coping skills and resilience taken to deal with stressful situations by younger people.

Antiretroviral treatment induced catatonia in 16-year-old boy.

We present a 16-year-old boy, who had presented to us with catatonic features of mutism, withdrawal, passive negativism, grimacing, gesturing, echopraxia, and excitement of 5 days duration while taking antiretroviral therapy (ART) for a period of 2 years. He had history of birth asphyxia and acquired HIV infection from his father when the same syringe and needle was used on both of them in a medical setting where the father and son had consulted for treatment of pyrexia of unknown origin. He was the eldest of a three children family in which the biologic father had acquired HIV through extramarital sexual contact with HIV-infected sex workers but was unaware of his HIV positive status till our patient, the 16-year-old was admitted and treated for pulmonary tuberculosis at 14 years of age. The boy's mother had only acquired HIV after having three children with the HIV-positive husband, thus leaving the other two children HIV negative. The catatonia completely resolved within 2 days after the ART was withheld, and risperidone 1 mg twice a day was prescribed. This case highlights the risks of ART and breach of universal precautions.

Assessing knowledge of primary school teachers on specific learning disabilities in two schools in India.

BACKGROUND: Evaluation of fund of knowledge about SLD among kindergarten and primary school teachers is essential to avoid misdiagnosis of SLD and to plan for specific teacher education to enable early identification of SLD among children. AIM: To assess the knowledge of learning disability among primary school teachers in India and to investigate its psychometric properties. MATERIALS AND METHODS: An observational study was carried out 34 primary school teachers from 2 different schools in Puducherry town agreed to participate in this study with informed consent. We used a multiple choice questionnaire format with a total of 50 questions, 5 choices for each question and a total score of 50. The study was held at the schools where these teachers were employed using pen and paper testing method and data were entered into the computer for statistical analysis. STATISTICAL ANALYSIS: Total scores on the questionnaire of all teachers were calculated. Content validity, reliability coefficient, discrimination factor, and facility factor were analyzed using SPSS software. RESULTS: 29% of the questions were correctly answered by all 34 teachers. The mean total score for this sample was 14.50 ± 9 and total item score for the 50 items was 9.90 ± 4. Cronbach's (α) reliability was 0.89. Overall discrimination index was + 0.2 and facility factor analysis score was 0.26. CONCLUSIONS: Validation of this new screening questionnaire was successful in Indian setting. It has to be used in other settings to extrapolate our findings.

Depression associated with dysembryoblastic neuroepithelial tumor.

Dysembryoblastic neuroepithelial tumor (DNET), a benign, rare tumor of the brain, commonly presents with generalized or partial epilepsy, post-epilepsy sequelae of psychotic, depressive or anxiety symptoms or disorders, or is usually asymptomatic. We report the first case in scientific literature of temporal lobe DNET presenting with only major depressive disorder, without epilepsy. A 24-year-old single male, presented with pervasive sadness, easy fatigability, loss of interest in his daily activities, decreasing appetite associated with poor of quality sleep, poor attention and concentration, pessimism about the future, and headaches. He was diagnosed with severe depression, without psychotic symptoms. Magnetic resonance imaging of the brain showed a lobulated hyperintense temporal lobe mass of 2.7 × 2.2 mm in the hippocampus region suggestive of a DNET. Electroencephalography, thyroid function tests, blood sugar, and electrocardiogram were normal. The depression responded well to tablet Escitalopram 10 mg once daily initially, with no adverse effects reported.

Validation of Tamil Version of Cranley's 24-Item Maternal-Fetal Attachment Scale in Indian Pregnant Women.

BACKGROUND: Maternal-fetal attachment has not been formally studied among pregnant Indian women using Cranley's 24-item maternal-fetal attachment scale. OBJECTIVE: The purpose of this study was to validate the Cranley's 24-item maternal-fetal attachment scale (MFAS-24). METHODS: Consecutive pregnant Indian women of all trimesters were studied in Pondicherry, India. STATISTICAL ANALYSIS: The mean, standard deviation (SD), Cronbach's alpha, content validity index (CVI), correlation coefficient, and simple correlation analyses were calculated. RESULTS: 230 pregnant women of various sociodemographic, religious and educational background formed the sample. Mean age of sample was 23 (SD ± 3) years, mean MFAS scores was 87.4 (SD ± 10), mean GHQ scores was 14 (SD ± 1.2), and mean gestational age was 27.2 (SD ± 7) weeks. Cronbach's reliability alpha of MFAS was high (0.71). There was no correlation between MFAS scores and gestational age or the pregnancy trimester. CVI of the scale, for the Tamil version was 0.72 and for the English version was 0.78. CONCLUSIONS: This study shows applicability of MFAS-24 in Indian settings also for measuring maternal-fetal attachment.

Repetitive Transcranial Magnetic Stimulation in the Treatment of depression: A Randomized, Double-blind, Placebo-controlled Trial.

BACKGROUND: The efficacy of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression has never been reported as yet in the Indian literature. AIMS: To study the efficacy of rTMS in the treatment of depression and to evaluate its safety and tolerability. SETTINGS AND DESIGN: A randomized, double-blind, sham-controlled trial was conducted at the Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore. MATERIALS AND METHODS: 23 patients with depression were randomized to receive either active (n=9) or sham (n=14) treatment with rTMS. Treatment consisted of six sessions of rTMS for 2 weeks (10 trains of pulses, intensity equal to motor threshold, 10 Hz frequency, train duration of 5 seconds, 1 minute inter-train duration). Response was assessed using Hamilton Depression Rating Scale (HDRS), Montgomery Åsberg Depression Rating Scale (MADRS) and Clinical Global Index (CGI). The safety and tolerability was assessed with side-effect checklist for electroconvulsive therapy. 50% reduction in HDRS scores from baseline was defined as treatment response. Outcome measures were analyzed by repeated measures analysis of variance. Chi-square test was used to analyze the categorical variables. RESULTS: No statistical significance was seen on the baseline socio-demographic and illness characteristics (Pearson's Chi-square=0.5). Although HDRS (sham 22.0-12.4; active 22.8-12.7) and MADRS (sham 30.7-17.3; active 31.8-16.7) scores reduced by the end of 2 weeks treatment, it was not statistically significant. One patient developed manic symptoms early in the treatment. CONCLUSIONS: Treatment with rTMS did not show improvement at the end of 2 weeks. More studies with larger sample size and with higher rTMS dosages need to be done.

Psychiatric curriculum and its impact on the attitude of Indian undergraduate medical students and interns.

CONTEXT: Psychiatry is given very less importance in the Indian undergraduate medical curriculum and this affects the attitudes of students toward psychiatry and mentally ill patients. AIM: To study the attitude of undergraduate medical students and interns toward psychiatry and mentally ill patients. MATERIALS AND METHODS: Undergraduate medical students and interns of a private medical college and research institute in South India consented to form our sample. We studied the General Health Questionnaire, overall level of satisfaction in ongoing Medical course using Visual Analog Scale, attitudes toward psychiatry scale and the attitudes toward mentally ill patient's scale of the students, with their informed consent. SPSS version 18 was used for analysis of data. RESULTS: Participation rate was 96%. Mean age of entire sample was 20.56 years. The total mean score on the General Health Questionnaire was 13.52 in first year but became worse toward internship (18.2). The level of satisfaction in the medical course dipped from 86% at baseline to 20% during internship. Equally high scores were noted in the attitude toward mentally ill scale. On the attitude toward psychiatry scale, there were more views on psychiatry as being an unscientific specialty, psychiatrists being considered poor role models, and psychiatric teaching was of low quality and psychiatry was the least preferred career choice. CONCLUSIONS: The undergraduate medical students have a very unfavorable attitude toward psychiatry and mentally ill patients.

Dandy-Walker variant associated with bipolar affective disorder.

The Dandy-Walker malformation is a congenital brain malformation, typically involving the fourth ventricle and the cerebellum. To date, the Dandy-Walker syndrome has not been described in association with bipolar disorder type I mania, and therefore we briefly report the case of a Dandy-Walker variant associated with acute mania. A 10-year-old boy was brought by his mother to the outpatient clinic of the Department of Psychiatry of a tertiary care hospital, with symptoms of mania. The MRI brain of the patient showed a posterior fossa cystic lesion, a giant cisterna magna communicating with the fourth ventricle and mild hypoplasia of the cerebellar vermis, with the rest of the structures being normal and no signs of hydrocephalus. These findings showed that the patient had a Dandy-Walker variant. He responded partially to valproate and olanzepine, which controlled the acute manic symptoms in the ward.

Entomophagy and coprophagy in undifferentiated schizophrenia.

Coprophagia or the ingestion of feces, considered to be a variant of pica, has been associated with medical disorders like seizure disorders, cerebral atrophy, and tumors and with psychiatric disorders like mental retardation, alcoholism, depression, obsessive compulsive disorder, schizophrenia, schizoaffective disorder, fetishes, delirium, and dementia. But entomophagy or the practice of eating live or dead insects as food by humans has only been reported as part of eating habits by some cultures in the world and not in association with any medical or neuropsychiatric disorders. Till date, there is no report in medical literature of entomophagy as an association with any neuropsychiatric or medical illnesses. Coprophagy and entomophagy has not been together reported as well. We describe the first ever case report of a 19-year- old male patient diagnosed with undifferentiated schizophrenia and associated with both entomophagy and coprophagy. His schizophrenic symptoms, the entomophagic, coprophagic behaviors improved with olanzapine therapy. Entomophagy and coprophagy, two very unusual human behaviors, can be seen in association with schizophrenia.