Evaluation of Psychiatric Morbidity in COVID-19-Positive Inpatients Referred to Consultation Liaison Psychiatry in a Tertiary Care Hospital.

BACKGROUND: The COVID-19 pandemic has led to the risk of common mental illnesses. Consultation liaison psychiatry has been one of the most requested services in the face of this pandemic. We aimed to assess (a) the prevalence of psychiatric illness, (b) different types of psychiatric diagnoses, (c) presenting complaints, (d) reasons for psychiatric referrals, and (e) psychiatric intervention done on COVID-19 positive inpatients referred to consultation liaison psychiatry at tertiary care hospital. METHOD: This was a retrospective study of data collected from April 1, 2020, to September 15, 2020. Total 300 patients were referred and diagnosed with clinical interview and Diagnostic and Statistical Manual for Mental Disorder Fifth Edition criteria. Analysis was done using chi-square test, Kruskal-Wallis test, and fisher exact test. RESULTS: Out of 300 patients, 26.7% had no psychiatric illness. Adjustment disorder was the commonest psychiatric diagnosis (43%), followed by delirium (10%). Statistically significant differences were found for parameters like Indian Council of Medical Research Category 4 of the patient, (hospitalized severe acute respiratory infection) (P value < 0.001), medical comorbidity (P value = 0.023), and past history of psychiatric consultation (Fisher exact test statistic value <0.001). Behavioral problem (27.6%) was the commonest reason for psychiatric referral. Worrying thoughts (23.3%) was the most frequent complaint. A total of 192 (64.3%) patients were offered pharmacotherapy. CONCLUSIONS: Psychiatric morbidity was quite high (73.3%) among them and adjustment disorder was the commonest (43%) psychiatric diagnosis followed by delirium (10%). Pharmacotherapy was prescribed to 64.3% patients and psychosocial management was offered to most of the referred patients.

Study of screening of mental health status of coronavirus disease-19 confirmed noncritical patients admitted at a tertiary care hospital and a coronavirus disease care center in Ahmedabad.

BACKGROUND: Despite coronavirus disease-19 (COVID-19) being a major health crisis in the current times, only a few studies have addressed its potential direct effect on mental health, especially among COVID-19 patients. AIMS: This study was conducted to assess the mental health of COVID-19 patients. MATERIALS AND METHODS: In cross sectional study, mental health status of 301 symptomatic and 200 asymptomatic COVID-19 participants was assessed using the General Health Questionnaire-28. RESULTS: Around 8.78% COVID-19 patients were found to be psychologically distressed that was predominantly higher among symptomatic COVID-19 patients. Risk of psychological distress was significantly higher in females, living in nuclear families and having a history of addiction. CONCLUSIONS: COVID-19 patients suffer from psychological distress, which needs to be addressed to cope well with this pandemic situation.

Sensitising intern doctors to ethical issues in a doctor-patient relationship.

There is a felt need in India to influence the ethical behaviour of doctors by giving students formal education in ethics in medical colleges. Since internship is the interface between learning and independent practice, it is important to sensitise intern doctors to ethical issues in a doctor-patient relationship at this stage.

A case of mixed type of paroxysmal dyskinesia: is there an overlap between two clinical categories of paroxysmal dyskinesia?

We report a sporadic case of paroxysmal dyskinesia of predominantly choreic and ballistic movements of 10 years duration in a 22-year-old male. The movement starts after exercise for certain period. However, for the next 5-15 min, the movements are triggered by sudden voluntary activity. These dyskinesias persist for about 10-30 s after sudden voluntary activity. Patient has to be immobile once symptoms start after the exercise to prevent the kinesigenic involuntary movements. Involuntary movements could be induced in the lower limbs, upper limbs, facial and jaw muscle by local exercise. Overtime symptoms occurred with minimal exercise. Secondary dyskinesia was ruled out by investigations. Patient responded well to Carbamazepine, relapsed when stopped taking it.

Cluster headache responsive to indomethacin: Case reports and a critical review of the literature.

INTRODUCTION: Response to indomethacin is an essential feature for the diagnosis of both paroxysmal hemicrania (PH) and hemicrania continua (HC). Cluster headache (CH) is widely considered to be a disease unresponsive to indomethacin. CASE REPORTS: We report four patients with CH who responded to indomethacin. Two patients, who were refractory to the usual therapy for CH, fulfilled the criteria for chronic CH. Conversely, two patients had a history of episodic CH and showed response to both indomethacin and the usual therapy for CH. LITERATURE REVIEW: We also reviewed the literature for the presence of indomethacin response in patients with CH. We noted a large number of cases labeled as CH by the authors which showed a response to indomethacin. DISCUSSION: Many cases of definite or possible CH were wrongly labeled as PH because of patients' responding to indomethacin. CONCLUSION: The response to indomethacin in patients with CH may not be as immediate as in other indomethacin-responsive headaches, and many patients may need larger doses.

The prevalence of headache may be related with the latitude: a possible role of Vitamin D insufficiency?

According to recent observations, there is worldwide vitamin D insufficiency (VDI) in various populations. A number of observations suggest a link between low serum levels of vitamin D and higher incidence of chronic pain. A few case reports have shown a beneficial effect of vitamin D therapy in patients with headache disorders. Serum vitamin D level shows a strong correlation with the latitude. Here, we review the literature to delineate a relation of prevalence rate of headaches with the latitude. We noted a significant relation between the prevalence of both tension-type headache and migraine with the latitude. There was a tendency for headache prevalence to increase with increasing latitude. The relation was more obvious for the lifetime prevalence for both migraine and tension-type headache. One year prevalence for migraine was also higher at higher latitude. There were limited studies on the seasonal variation of headache disorders. However, available data indicate increased frequency of headache attacks in autumn-winter and least attacks in summer. This profile of headache matches with the seasonal variations of serum vitamin D levels. The presence of vitamin D receptor, 1alpha-hydroxylase and vitamin D-binding protein in the hypothalamus further suggest a role of vitamin D deficiency in the generation of head pain.

Restless legs syndrome with carbamazepine-induced osteomalacia: causal or casual association.

Restless legs syndrome (RLS) is a sensorimotor sleep-related disorder which can be idiopathic or secondary. Secondary RLS is associated with a variety of conditions. Here we report a 16-year-old girl with RLS secondary to vitamin D deficiency (VDD) caused by chronic administration of carbamazepine. We also speculate on the possible mechanisms for the development of RLS in patient with VDD.

Post-infectious new daily persistent headache may respond to intravenous methylprednisolone.

New daily persistent headache (NDPH) is a subtype of chronic daily headache (CDH) that starts acutely and continues as a daily headache from the onset.It is considered as one of the most treatment refractory of all headache syndromes. The pathophysiology is largely unknown. Viral infections, extracranial surgery, and stressful life events are considered as triggers for the onset of NDPH. A few patients may have the onset of their symptoms during an infection. Here we report nine patients with NDPH like headache. All of them had a history suggestive of extracranial infections a few weeks prior to the onset of headache. All patients received intravenous methylprednisolone (IV MPS) for 5 days. Intravenous MPS was followed by Oral steroids for 2-3 weeks in six patients.The relief of headache started between the second and fifth days of infusion in all patients. The steady improvement in headache continued and seven patients experienced almost complete improvement within 2 weeks. Two other patients showed complete improvement between 6 and 8 weeks after initiation of IV MPS therapy. We conclude that NDPH-like headache may occur as a post infectious process following a recent infection. We also speculate on the possible mechanisms of headache in our patients.

Unnecessary extractions in patients with hemicrania continua: case reports and implication for dentistry.

Headache and facial pain are both very high in the general population. Headache has been identified as one of the associated conditions in patients with chronic orofacial pain. The interrelation between the two has not been explored in the literature. Patients with facial pain often initially seek the care of a dentist. Misdiagnosis and multiple failed treatments (including invasive procedures) are very common in this population. This case report describes four patients whose condition fulfilled the International Headache Society's criteria for hemicrania continua but whose teeth were extracted because their pain was suspected to be of odontogenic origin. Each patient's records and the literature were reviewed for possible reasons for the unnecessary extractions. The findings suggest that initial treatment with drugs specific for primary headache disorders should be instituted before subjecting patients to invasive procedures.

Chronic tension-type headache with vitamin D deficiency: casual or causal association?

The prevalence of tension-type headache and vitamin D deficiency are both very high in the general population. The inter-relations between the two have not been explored in the literature. We report 8 patients with chronic tension-type headache and vitamin D deficiency (osteomalacia). All the patients responded poorly to conventional therapy for tension headache. The headache and osteomalacia of each of the 8 patients responded to vitamin D and calcium supplementation. The improvement in the headache was much earlier than the improvements in the symptom complex of osteomalacia. We also speculate on the possible mechanisms for headache in the patients with vitamin D deficiency.

Migrainous vertigo responsive to intravenous methylprednisolone: case reports.

Migrainous vertigo (MV) is a newer evolving concept in which vertigo is causally related to migraine. We report 4 patients with MV. Episodes of severe MV of more than 1-day duration were successfully terminated by intravenous methylprednisolone (IV MPS) in 2 patients. Two other patients who had attacks of MV almost daily also showed complete response to IV MPS.

Coexistence of cluster headache and paroxysmal hemicrania: does it exist? A case report and literature review.

The coexistence of different types of trigeminal autonomic cephalalgias is a rare phenomenon. The two different types of headache may occur either at two different periods or simultaneously at the same time. We report a 22-year-old male who had cluster headache (CH) and chronic paroxysmal hemicrania (CPH) since the onset of symptoms. Both types of headache responded to indomethacin. Review of the literature suggests that simultaneous occurrence of CH and CPH in a patient may be both over and under reported.

Secondary hemicrania continua: Case reports and a literature review.

Hemicrania continua (HC) is an indomethacin responsive primary headache disorder. Secondary or symptomatic HC is associated with another neurological or non-neurological disease. We report three patients with secondary HC. We also review the literature to identify the clinical predictors of an underlying disease entity. Intracranial structural lesion, head and neck vessel pathology, and carcinoma lung should be suspected in every patient. The factors that may suggest a secondary pathology are: elderly age, male sex, smoking habit, constitutional symptoms, symptoms related to respiratory system, frequent and short-lived exacerbation, nocturnal exacerbation, HC evolving from remitting form, recent neck and/or head trauma, miosis, elevated ESR, and fading effect of indomethacin. We recommend MRI brain in all the patients presenting with HC or HC like headache. Angiography and CT chest are two other investigations that may be supplemented in patients with high risk for head/neck vessel pathology and carcinoma lung.

Hemicrania continua unresponsive or partially responsive to indomethacin: does it exist? A diagnostic and therapeutic dilemma.

Hemicrania continua (HC) is a primary headache disorder characterized by a continuous, unilateral headache that varies in intensity, waxing and waning without disappearing completely. Ipsilateral cranial autonomic features and response to indomethacin are essential features for the diagnosis of HC. We hereby, describe three patients with the clinical phenotypes of HC in whom response to indomethacin was either incomplete or not sustained. We also review the literature especially for the presence of indomethacin response and ipsilateral cranial autonomic features.

Is there need to search for alternatives to indomethacin for hemicrania continua? Case reports and a review.

Hemicrania continua (HC) is a daily continuous unilateral headache of moderate intensity with super imposed exacerbations of more severe pain accompanied by migrainous and cranial autonomic features. Response to indomethacin is an essential feature in the IHS diagnostic criteria. However, indomethacin is associated with a number of side effects. HC is a life long condition, and skipping of a single dose of indomethacin usually leads to reappearance of headache. Various drugs have been tried as alternatives to indomethacin in the patients intolerant to indomethacin. We report two cases of HC responsive to topiramate and review the available alternatives for the patients of HC. We also discuss the side effects of indomethacin in the various headache disorders and other painful conditions, and suggest the need for trial of other drugs for the patients of HC.