Cognitive performance and psychosocial functioning in unaffected siblings of bipolar disorder patients in comparison with healthy controls.

We aimed to evaluate the cognitive domains for endophenotypes and their bearing on psychosocial functioning in unaffected siblings of patients with bipolar type I disorder (BD-I). We recruited unaffected siblings (n = 60) and age (±2 years), gender and education-matched healthy control subjects (n = 60) after screening with Structured clinical interview for DSM-IV-TR axis I disorders (SCID-I) - Research Version, Young Mania rating scale (YMRS), Hamilton depression rating scale (HDRS) and Family Interview for Genetic Studies scale (FIGS). Cognitive functioning was evaluated using Addenbrooke's Cognitive Examination III Revised (ACE-III R) and Trail making tests A and B, whereas psychosocial functioning was evaluated using the Social and Occupational Functioning Assessment Scale (SOFAS). The siblings had scored significantly lower in memory tasks of ACE-III R (p < 0.001) than controls, whereas other cognitive domains were comparable. Psychosocial functioning did not differ significantly between the groups. No correlation existed between cognitive performance and psychosocial functioning. Memory functions can be considered as a possible endophenotype for BD-I.

Role of stressful life events and kindling in bipolar disorder: Converging evidence from a mania-predominant illness course.

Stressful life events can precipitate relapses and recurrences in bipolar disorder. Kindling in bipolar disorder has been linked to maladaptive psychological reactivity to minor stressful life events. Systematic studies on life events and kindling are rare in bipolar disorder with a manic predominant polarity. One hundred and forty-nine remitted patients with bipolar I disorder were recruited. The National Institute of Mental Health-Life Chart Methodology was used to depict the illness course retrospectively, and the Presumptive Stressful Life Events Scale-Lifetime version was used to record the stressful life events. The role of stressful life events and the probability of kindling were assessed using appropriate statistics. There was a mania-predominant course of bipolar disorder in the sample with 55.7% (n = 83) having only recurrent mania. Family conflict and altered sleep patterns were the commonly reported stressful life events. When controlled for the severity of the stressor, the stressful life events were often associated with the initial episodes rather than the latter ones. Kindling may occur in bipolar disorder with mania as the predominant polarity. However, retrospective recall bias and hospital-based sampling limit generalizability of such observations.

DRESS syndrome: Addressing the drug hypersensitivity syndrome on combination of Sodium Valproate and Olanzapine.

A case of an adolescent with symptoms of Mania, who developed Drug Reaction with Eosinophilia and Systemic Symptom (DRESS) syndrome on exposure to combination of oral Olanzapine and Sodium Valproate is presented. We have attempted to highlight the atypical presentation of DRESS syndrome in this patient as well as management difficulties in patient who develops DRESS syndrome with the conventional psychotropic medication. Hence, it is necessary for mental health professionals to be vigilant about this life threatening drug reaction associated with high morbidity and mortality, thus ensuring prompt diagnosis and management.

Diagnostic Masking and Overshadowing in Intellectual Disability-How Structured Evaluation Helps.

PROBLEM: Comorbid psychiatric diagnoses tend to be underdiagnosed in patients with intellectual disability. Diagnosing anxiety disorders in such patients can pose challenges, in particular with regard to obsessive and compulsive disorder (OCD). METHODS: We present the case of an adolescent diagnosed with intellectual disability with poor expressive language skills who presented with nonspecific mood and behavioral symptoms, not improving with routine clinical evaluations and treatment. A structured assessment was done to decipher the psychopathology. FINDINGS: The structured evaluation was able to diagnose OCD, and the treatment response was accentuated, bringing about a significant reduction in patient and caregiver distress. Psychosocial interventions through nurses played a significant role. CONCLUSIONS: The case highlights the need for a systematic assessment of patients with intellectual disability to arrive at reliable diagnoses and to plan appropriate treatment strategies.

Temporal variations in suicide attempt rates: A hospital-based study from India.

BACKGROUND: Temporal variations of suicide attempts can help to better understand correlates of suicidal behavior. This study attempted to find the diurnal, weekly, and seasonal variations in suicide attempts at a tertiary care hospital in India. MATERIALS AND METHODS: This record-based study was conducted among patients evaluated at a crisis intervention clinic over a 4-year period at a tertiary care teaching hospital in Southern India. Patients who attempted suicide in recent past and had been medically stabilized were evaluated in this clinic. The distribution of suicide attempts across the time of the day, the day of the week, and month of the year was assessed. RESULTS: Of the 407 patients who were included in the analysis, the frequency of suicide attempts varied across time of the day (χ2 = 134.504, P < 0.001). The most common period of the day for the attempt was evenings (6 pm to 9 pm). There were no significant temporal associations between month of the year or day of the week and suicide attempts though peaks were observed for June among the months and Sundays among days of the week. CONCLUSION: Diurnal variations exist in the suicide attempts. This has implications on clinical caseloads on emergency departments, especially during the times when staffing might be sub-optimal.