Neurocognitive Profile in Indian Individuals Genetically at Risk of Schizophrenia.

BACKGROUND: Cognitive deficits have been noted in patients of schizophrenia in remission, as well as in first-degree relatives. This study aims to evaluate the neurocognitive performance in unaffected first-degree relatives of patients of schizophrenia in comparison with healthy controls, as well as patients of schizophrenia in remission. METHODS: It was a 1-year case-control study by purposive sampling. Patients with a diagnosis of schizophrenia, first-degree relatives of patients of schizophrenia, and controls from nongenetic relatives of patients were recruited as per inclusion and exclusion criteria. Samples were matched for age and educational status. The General Health Questionnaire 28 (GHQ-28) screened them and they were checked for remission by Positive and Negative Syndrome Scale (PANSS) and then subjected to various instruments for assessment of neurocognition, standardized for the Indian population. To remove the effect of symptoms as confounding factors, PANSS score of <3 for each individual item was set as the criterion for remission. Intelligence quotient (IQ) was screened in all participants to exclude mental retardation. Statistical analysis used was the analysis of variance (ANOVA) with post hoc Fisher's least significant difference (LSD). RESULTS: Significant neurocognitive impairments were detected in the patients and first-degree relatives when compared with the control subjects. The most common impairment in the patient group was in speed of processing, and among unaffected first-degree relatives, it was in the working memory. CONCLUSION: Indian individuals genetically at risk of schizophrenia showed significant neurocognitive impairments in all domains compared with controls.

Effectiveness of Psychological Intervention by Videoconference for Family Members with Depression of Farmers Who Have Committed Suicide.

BACKGROUND: In India two thirds of the population is directly or indirectly dependent on agriculture. The suicide rate for farmers throughout the world is higher than the non-farming population with India being no exception. Family members of the household where a member has committed suicide are at an increased risk for depression, anxiety and suicide. There is a paucity of trained counsellors in India, while there is sufficient research showing counselling and therapy through videoconferencing is just as effective as in-person therapy. It is however, not commonly practiced in India, especially in rural settings. We propose to evaluate psychiatric morbidity and assess feasibility and effectiveness of videoconferencing for family members of farmers who had committed suicide. OBJECTIVES: The objective is to evaluate family members of farmers who have committed suicide for psychiatric morbidity and psychosocial risk factors. We aim to identify depression, anxiety and suicidal risk in family members and then administer psychological intervention through video-conferencing for depression to study its effectiveness in the cohort. METHODOLOGY: The data on completed farmer suicide would be collected from district authorities and police departments. Home visit would be made by research staff to assess the risk factors for the farmers who completed suicide. Family members would be screened for anxiety and depression and severity of depression and suicidal ideas would be rated. The family members having mild to moderate depression would be randomised and CBT based psychological intervention (5 sessions) over three months would be given by trained psychologist through videoconferencing. The outcome would be measured at the end of six months. CONCLUSIONS: Psychological interventions through video-conference might be beneficial in the treatment of mild to moderate depression in family members of the farmers who have committed suicide.

Blue Whale Challenge: Perceptions of First Responders in Medical Profession.

CONTEXT: Blue Whale Challenge is a phenomenon which gained its early foothold on the internet chatboards. It is a dare-based harmful game which has a list of fifty tasks which you perform culminating in one's death on the final task. The fatalities caused by individuals playing this game have been reported first in Russia and followed by at least twenty countries reporting it, including India. AIMS: This study was conducted to assess perceptions and knowhow of the first responders in medical profession about online challenges. SETTINGS AND DESIGN: This was a cross-sectional descriptive study. SUBJECTS AND METHODS: Fifty-four medical professionals who practice either psychiatry, clinical psychology, or pediatrics were interviewed using a semi-structured open-ended survey was administered and data were obtained. STATISTICAL ANALYSIS USED: Descriptive statistics was used. RESULTS: Thirty-five (65%) of the total participants have heard about the Blue Whale Challenge but lacked further knowledge about the game. Ten percent of total participants knew about other internet challenges. Only 26% of total participants were largely aware about the details and harmful nature of the game. Only 12 (22%) participants knew the signs to identify the children playing this game. None of the practitioners reported of having encountered any parent or child enquiring or reporting this in their practice at the time of conducting the survey. CONCLUSIONS: The medical fraternity is lagging behind in updating themselves of the online phenomena which are important for the better outcome of children presenting with participation in online challenges. The nature of the game has been discussed, and guidelines for identifying vulnerable population have been put forward.

Psychological Dissection of Patients Having Dissociative Disorder: A Cross-sectional Study.

BACKGROUND: Patients present with dissociative disorders as a decompensation to underlying stressful situation. It is clinically important to evaluate the presence, type, and temporal relation of the stressors resulting in dissociation. Further knowing the sociodemographic and psychological profile of the dissociative patient helps in better management. MATERIALS AND METHODS: The study included 55 dissociative patients aged between 5 to 45 years. Psychiatric diagnosis was made using ICD-10 DCR. Psychosocial stressors and stressful life events were assessed using presumptive stressful life events scale/life events scale for Indian children and clinical interview. Personality and temperament traits were assessed using medico psychological questionnaire and temperament measurement schedule, respectively. Intelligence quotient (IQ) was assessed using standard progressive matrices and colored progressive matrices. Statistical analysis was done using Epi Info 7 software. RESULTS: All patients had significant psychosocial stressors preceding dissociation. Precipitating factor with temporal association was observed in only 83.64%. Family disharmony (41.82%) followed by education-related problems (29.09%) was the most common psychosocial stressors. 61.82% of the dissociative patients had psychiatric comorbidity. Mean IQ of study sample was 92.47. Dissociative children had high emotionality and energy levels but low sociability, rhythmicity, and distractibility. 50% of the adults were neurotic and had emotionally unstable personality. CONCLUSION: Dissociative disorders are commonly seen in females, adolescents, and in those from lower socioeconomic status and rural areas. They are always preceded by psychosocial stressors. Most of them have comorbid psychiatric disorders such as depression and anxiety. Neuroticism and emotionally unstable personality traits are common in adult patients while temperamental traits such as low sociability, low rhythmicity, low distractibility, high emotionality, and high energy levels are common in children.

Expressed emotions in patients with obsessive compulsive disorder: a case control study.

BACKGROUND: Expressed emotion (EE) is the attitude that the relatives show towards the illness and the person. EE is identified as a direct factor in the relapse of patients with psychological disorders. Literature on EE in anxiety disorders is limited. Role of EE in obsessive compulsive disorder (OCD) may help in better understanding of the role of social factors in OCD. AIM: To compare EE in patients with OCD and compare with controls. MATERIALS AND METHODS: The sample included 30 cases and 30 age and sex matched controls. The patients were diagnosed as having OCD using International Classification of Diseases-10 Diagnostic Criteria for Research (ICD-10 DCR) criteria. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was used to assess severity of OCD among patients. General health questionnaire (GHQ) was used to rule out any psychiatric disorder among control population. EE was assessed in cases and controls using Family Emotional Involvement and Criticism Scale (FEICS). Chi-square test and t-test were used to assess the difference between two groups. RESULTS: OCD patients in comparison controls had significantly increased total FEICS score (P = 0.001). There was an increase in both subscales of perceived criticism (PC) with P = 0.001 and emotional involvement (EI) with P = 0.001 in patients with OCD than controls. CONCLUSION: EE are significantly increased in patients with OCD. EE should be assessed regularly in patients with OCD.

Rubinstein-taybi syndrome with psychosis.

Rubinstein-Taybi syndrome (RTS) is a rare genetic disorder with characteristic physical anomalies. It is characterized by mental retardation, postnatal growth deficiency, microcephaly, specific facial characteristics, broad thumbs, and big toes. Behavioral problems are common with RTS; they include mental retardation, impulsivity, distractibility, instability of mood, stereotypes, poor coordination, atypical depression, and mania. To date, there is lack of literature on the presence of schizophrenia or non-affective psychosis with RTS. Here, we describe two cases where there is co-morbid psychosis with RTS. One case is diagnosed as paranoid schizophrenia and the other as psychosis possibly schizophrenia. Genetic analysis was not done due to unavailability. The possible etiological factors for the association of psychosis with RTS are discussed. Factors such as regulators of RNA polymerase II and hypoxia-inducible factor 1 alpha (HIF1A) may be some common etiological factors for the association of schizophrenia or non-affective psychosis and RTS. Schizophrenia / non-affective psychosis can be a comorbid psychiatric condition with RTS.

Clonazepam in the treatment of essential palatal tremors.

Essential Palatal tremor (EPT) is a rare disorder presenting as unilateral or bilateral rhythmic involuntary movements of the soft palate. There is mention of the utility of benzodiazepines like clonazepam probably because of their gamma amino butyric acid (GABA) agonistic property. But no reports are available for the same. Here we report a 30-year old married female patient who presented with the complaints of pain in the lower part of face, behind the ears, back side of neck and clicking sound in her. General physical examination (GPE) revealed symmetrical rhythmic flapping movements of the soft palate and the uvula. Central nervous system (CNS) examination did not reveal any focal deficits and Magnetic resonance imaging (MRI) of the brain was normal. She was diagnosed as having EPT and treated successfully with clonazepam.

Psychosis in patients with systemic lupus erythematosus.

Neuropsychiatric manifestations in systemic lupus erythematosus (SLE) are common; however, psychosis per se is bit uncommon. They may be cognitive deficit, lupus headache, psychoses, seizures, peripheral neuropathy, and cerebrovascular events. Psychiatric symptoms in SLE can be functionally independent psychiatric disorders. It can be due to drugs (steroids) used for SLE or secondary to SLE because of its brain involvement, which is termed as neuropsychiatric systemic lupus erythematosus (NPSLE). No single clinical, laboratory, neuropsychological, and imaging test can be used to differentiate NPSLE from non-NPSLE patients with similar neuropsychiatric manifestations. Presently we are discussing about three cases of SLE with psychosis and which had different clinical presentation. The present reports also depict the approach to case differential diagnosis and management of the same.

Mania with Aarskog-Scott syndrome.

Aarskog-Scott syndrome is transmitted as an X-linked trait and affects males. We report a 10-year-old boy presenting with complaints of increased temper tantrums, demanding behavior, grandiose ideas, over familiarity, abusive assaultive behavior and tobacco abuse. On examination, patient had most of the physical characteristics of Aarskog-Scott Syndrome. He also had global developmental delay and attention deficit hyperactivity disorder. This is the first case report of Aarskog Scott syndrome combined with mania.

Mania associated with complicated hereditary spastic paraparesis.

Hereditary spastic paraparesis (HSP) is an inherited group of neurological disorders with progressive lower limb spasticity. HSP can be clinically grouped into pure and complicated forms. Pure HSP is one without any associated neurological/psychiatric comorbidity. Depression is the most common psychiatric comorbidity. Presence of mania or bipolar affective illness with HSP is a rare phenomenon. We report a case of a 17-year-old boy who presented with classical features of HSP with complaints of excessive happiness, irritability, increased self-esteem and decreased sleep since 1 month. The patient also had complex partial seizure ever since he had features of HSP. The patient's father and younger sister suffer from pure HSP. The patient was diagnosed to have first episode mania with complicated HSP. The details of treatment and possible neurobiology are discussed in this case report.

Dilemmas in private psychiatric practice.

BACKGROUND: A practicing psychiatrist faces dilemmas on a number of occasions, in deciding the best course of action he/she needs to undertake while treating a patient. At times, this choice may not be in accordance with the ethical and moral principles and may in fact appear to violate patient's autonomy and rights. AIM: To study the nature of psychiatric practice by the practicing psychiatrist in the areas of admission, discharge, consent, physical restraint, electroconvulsive therapy (ECT), certification, treatment, suicide and psychotherapy. SETTINGS AND DESIGN: Cross-sectional observational study. MATERIALS AND METHODS: Forty-eight psychiatrists gave consent to participate in the study. A special proforma was prepared, which addresses the common dilemmas in the clinical psychiatric practice. All the psychiatrists were given specially designed profoma and were requested to fill the proforma with appropriate answers. Statistical analysis was done using SPSS software. RESULTS: There were 42 male and 6 female psychiatrists. The age of the psychiatrists ranged from 28 to 65 years with a mean of 43.08 years. The mean duration of practice of these psychiatrists was 14.81±11.07 years. Question and answers related to admission, discharge, consent, physical restraint, ECT, certification, treatment, suicide and psychotherapy are discussed. CONCLUSIONS: The present standard and practice especially in private psychiatric set-up does not confirm to the rules, recommendations, and regulations suggested by Mental Health Act 1987, Mental Health Authorities and various guidelines of practice. Indian Psychiatric Society and other professional bodies need to take steps to prepare guidelines for a good psychiatric practice.

A Cross-sectional Descriptive Study of Prevalence and Nature of Psychiatric Referrals from Intensive Care Units in a Multispecialty Hospital.

CONTEXT: The prevalence of psychiatric comorbidity in general hospital range from 20% to 60%. Presence of psychiatric morbidity compounds the disability and suffering in medical patients. There is a limited literature on the prevalence of psychiatric morbidity in patients admitted in the intensive care units (ICUs). AIMS: The aim of the study was to estimate the prevalence and nature of comorbid psychiatric illness in the cases referred from ICUs. SETTINGS AND DESIGN: Cross-sectional observational study. MATERIALS AND METHODS: This study included all the consecutive patients referred from different ICUs to psychiatry department for consultation during the four-year period from January 1, 2000 to December 31, 2003, assessment was done by psychiatrist and diagnosis was made using ICD-10. STATISTICAL ANALYSIS: Descriptive statistics. RESULTS: There were 309 (1.97%) referrals from ICUs to psychiatry department during the period of study. Among the referred patients, diagnosis of organic mental disorders was the commonest psychiatric diagnosis present in 104 (33.65%) patients followed by suicidal attempt in 101 (32.69%); anxiety disorders in 40 (12.94%); depressive disorders in 21 (6.8%); Psychotic illness in 10 (3.24%); other psychiatric illnesses in 28 (9.06%); and nil psychiatric illness in 5 (1.62%) patients. CONCLUSION: Prevalence of psychiatric referrals from ICUs was low. This could be due to stigma and lack of awareness among physicians. There is increased need for recognition and treatment of comorbid psychiatric illness by the treating physicians which may help to decrease morbidity and overall cost of the treatment.