Sociodemographic and clinical profile of patients receiving disability certificates for psychiatric disorders: An Indian Psychiatric Society Multicentric study.

Aim: To study the sociodemographic and clinical profile of subjects receiving disability certificates (DCs) issued for psychiatric disorders across multiple centres in India. Materials and Methods: Eleven centres, including ten government and one non-governmental organization spread across the country, participated in the study. Data on the sociodemographic and clinical profiles of patients who were issued DC in the calendar year 2019 were collected on a proforma designed for the study. Results: Overall, 2018 patients were issued DC for various psychiatric disorders across 11 centres in 2019. The number of certificates issued across different centres varied from 34 to 622. In terms of diagnostic profile, intellectual disability accounted for most of the certificates issued. In terms of psychiatric diagnosis, schizophrenia was the most common psychiatric diagnosis, followed by bipolar disorder, for which a DC was issued. When the diagnosis was considered, centre wise, intellectual disability (6 centres), mental illness (MI; 4 centres), and autism and specific learning disability (1 centre) accounted for the most DCs issued. Schizophrenia (9 centres), bipolar affective disorder (1 centre), and dementia (1 centre) were the most common MI for which DC was issued. Across centres, more than two-thirds of DC were issued to males. Conclusion: There is a wide variation in the number and clinical profile of DC issued across centres.

Cortical source localization during facial emotion recognition in bipolar mania: An ERP study.

Facial emotion recognition has enormous value for humans in social cognition and thereby day to day functioning. Disturbances in the processing of emotional cues are seen in all the three phases of bipolar disorder and have been proposed as an etiology in the development of bipolar disorder. 30 consented patients with bipolar mania with psychotic symptoms and 30 age and sex matched healthy controls were taken for the study. Facial emotion ecognition task containing four basic emotions namely happy, sad, anger and fear were used. Sixty four (64) channel ERP recordings were done for all the subjects. Source localization was done using sLORETA selecting the window for late positive potentials (LPP). Statistically significant and reduced cortical sources were noted in the right insula (p = 0.004) at the peak of LPP during response to anger facial emotions in bipolar mania patients. Hypoactivation of right insular cortex during response to anger emotion may be due to the aberrant activation and possible failure of interoceptive prediction system during acute manic phase are discussed.

Body-focused repetitive behaviors in school-going children and adolescents and its relationship with state-trait anxiety and life events.

BACKGROUND: Body-focused repetitive behaviors (BFRBs) are nonfunctional self-injurious behaviors. BFRBs fall under obsessive-compulsive and related disorders (OCRDs) and co-occur with anxiety disorders. AIM: The current study plans to assess the presence of BFRBs in schoolchildren and adolescents and find its relationship with state-trait anxiety and significant life events. MATERIALS AND METHODS: The study identified twenty-one students with BFRBs using the Modified Habit Questionnaire. Along with the 21 matched healthy controls, both the groups were evaluated on the State-Trait Anxiety Inventory for Children (STAIC) and Life Event Scale for Indian Children (LESIC). RESULTS: The study group scored significantly high on STAIC state score (P = 0.004), trait score (P = 0.014), and total score (P = 0.020). On five life events, the study group reported significantly high on stress. CONCLUSION: The study reports the presence of BFRBs in schoolchildren; state-trait anxiety and significant life events have a significant association with BFRBs.

Absconding During Inpatient Care from a Tertiary Psychiatric Hospital: A Comparative Study.

BACKGROUND: Absconding from psychiatric hospitals is of great concern for patients and caregivers. Absconding affects not only the treatment and safety of these patients but also patient's caregivers and the community. Further investigation is needed to examine the pattern of this event and the characteristics of patients who abscond. Hence, our study was aimed to examine the sociodemographic and clinical profiles of inpatients who absconded from a psychiatric hospital in five years and to compare them with matched controls. METHODS: A retrospective chart review of inpatients who absconded and matched control inpatients during the specified period of five years from January 2014 to December 2018 was done at a psychiatric hospital. Each control was matched with a corresponding absconding case on the following order: (a) admission ward, (b) admission period, (c) diagnosis, and (d) age. Results: Among 20,052 adult admissions during the specified period, 38 patients absconded, with a rate of 1.8 per 1,000 admissions. Most of them were male, from a younger age group, diagnosed with schizophrenia or mood disorder, and having comorbid substance use disorder, irritable affect, impaired judgment, and absent insight. Most of the events occurred within the first two weeks of admission. About 11% of them had a history of prior absconding from the hospital. CONCLUSION: Knowledge about the associated sociodemographic and clinical profile would help clinicians and mental health care professionals to prevent absconding. Further risk assessment using a patient's profile would help to reduce absconding events from psychiatric hospitals in the future.

Prevalence of Obsessive-Compulsive Spectrum Disorders in Obsessive-Compulsive Disorder.

INTRODUCTION: There is growing awareness of the heterogeneity of obsessive-compulsive disorder (OCD) and of the multiple systems involved in its pathogenesis. Identification of obsessive-compulsive spectrum disorders (OCSDs) may have important implications in the management and prognosis of OCD, but there is a paucity of research in the domain of identification of OCSD in probands with OCD. There are few studies that have examined OCSD in the first-degree relatives (FDR) of OCD patients, some of these were not controlled, and these studies have no final agreements over outcomes, and therefore, this area needs to be further explored. OBJECTIVES: The objective of this study was to assess the prevalence of OCSDs in OCD probands; and its relationship to sociodemographic and clinical variables, comparing each aspect by a control group of schizophrenia probands. MATERIALS AND METHODS: Sixty patients each of OCD and schizophrenia, diagnosed by the Diagnostic and Statistical Manual of Mental Disorders IV Text Revision,[1] above 18 years of age and giving informed consent, were interviewed using the Structured Clinical Interview for OCSD, Yale-Brown Obsessive-Compulsive Rating Scale, Hamilton Rating Scale for Depression, and Hamilton Rating Scale for Anxiety. RESULTS: In OCD group, 22 OCSDs were found in 11 subjects whereas in schizophrenia group, 2 OCSDs (self-injury) were found in two probands. When the two groups were compared in terms of individual OCSDs, there was no significant difference between them. However, when the comparison was made taking into account all OCSDs taken together, it was significantly higher (P = 0.016) in the OCD group compared to the schizophrenia group. CONCLUSION: OCSDs were significantly more in OCD probands as compared to schizophrenia probands. This suggests a familial aggregation of these disorders.

An Unusual Case of Delirium after Restarting Clozapine.

Clozapine is a gold standard medication and drug of choice in refractory schizophrenia. Among many of its fatal side effects, delirium is less reported and inconsistently recognized by clinicians. We here present a case of delirium which emerged during retreatment with clozapine in a patient of paranoid schizophrenia. A patient diagnosed with paranoid schizophrenia, was restarted on clozapine after he left medications and became symptomatic. He was delirious on 22nd day after clozapine was restarted. Clozapine was stopped and the patient was managed with standard treatment for delirium. After one week interval, clozapine was restarted. Delirium was not noted till 6 weeks of his hospital stay. Clozapine induced central anticholinergic toxicity or clozapine induced seizure might cause delirium in index case. Limited literature exist delirium with clozapine. Clinicians must have high index of suspicion to detect delirium during clozapine therapy. More researches should focus to explore the association between delirium and clozapine.

Sex difference in symptomatology of manic episode.

OBJECTIVE: Studies addressing sex differences in the symptoms and course of bipolar affective disorder had been investigated across different phase of bipolar affective disorder. There are few studies in manic phase that have reported inconsistent results. Therefore, we investigated sex difference in symptom presentation of manic episode. METHODS: A total of 150 male and 50 female subjects meeting criteria for manic episode according to International Statistical Classification of Diseases, 10th Revision Diagnostic Criteria for Research, giving written informed consent, were included for the study. Those with comorbid major medical or psychiatric disorders were excluded. All the patients were assessed on Scale for Manic States. RESULTS: Multivariate analysis of variance using all the items of Scale for Manic Symptoms showed significant sex difference (Pillai's Trace F(20,179) = 5.154, P < .001), with large effect size (η2 = .365). In men, there was significantly higher motor activity, psychosis, grandiosity, contact, and humor, whereas mood lability, depressed mood, guilt, suicide, anxiety, and dress scores were higher in women. Discriminant analysis showed that 84% of men and 72% of women could be correctly classified using the Scale for Manic Symptoms. Stepwise logistic regression analysis showed anxiety, guilt, and dress positively predicted female sex and the model explained 24% to 36% of variance. CONCLUSION: Symptom presentation of mania differs across sex and a predominance of anxiety and depressive symptoms was found in women, whereas increased psychomotor activity was prevalent in men.