Pulmonary Function, Mental and Physical Health in Recovered COVID-19 Patients Requiring Invasive Versus Non-invasive Oxygen Therapy: A Prospective Follow-Up Study Post-ICU Discharge.

Background Survivors of COVID-19 pneumonia may have residual lung injury and poor physical and mental health even after discharge. We hypothesized that COVID-19 severe acute respiratory distress syndrome (ARDS) patients needing mechanical ventilation may be at a greater risk of deterioration in pulmonary function, mental health, and quality of life (QOL). This study analyses the differences in pulmonary function, mental health, and QOL after recovery, in patients having received non-invasive oxygen therapy versus invasive mechanical ventilation during ICU stay. Methods Patients aged >18 years, who had completed 3 months post ICU discharge, with moderate to severe COVID-19 ARDS, were consecutively enrolled from May 1 to July 31, 2021. Patients were allocated into Group A - having required high flow nasal cannula (HFNC)/non-invasive ventilation (NIV) and Group B - having received invasive mechanical ventilation. Pulmonary function tests, 6-minute walk test (6-MWT), and health-related quality of life were compared. Results Of the 145 eligible patients, 31 were lost to follow-up and 21 died. Seventy-four patients were allocated into Groups A (57 patients) and B (17 patients). In Group A, abnormal forced expiratory volume in first second (FEV1), forced vital capacity (FVC), forced expiratory flow in mid-half of FVC (FEF25-75), and peak expiratory flow rate (PEFR) values were obtained in 27 (47.37%), 43 (75.44%), 11 (19.3%), and 25 (43.86%) patients, and in Group B, in 13 (76.47%), 17 (100%), 1 (5.88%), and 8 (47%) patients, respectively. No patient had abnormal FEV1/FVC. All Group B patients had a restrictive pattern in spirometry as compared to 77% in Group A. Group B had a lower arterial partial pressure of oxygen (PaO2) (p=0.0019), % predicted FVC (p<0.0001), % predicted FEV1 (p=0.001), and 6-MWT distance (p<0.001). The physical component score in the short-form survey 12 questionnaire was higher in group A, p<0.001, whereas the mental component score was comparable. Conclusions Patients requiring invasive mechanical ventilation (MV) have a greater risk of impaired pulmonary function and reduced QOL post-ICU discharge. This warrants a greater need for following these patients for better rehabilitation.

ECT in the Postpartum Period: A Retrospective Case Series from a Tertiary Health Care Center in India.

OBJECTIVE: To evaluate the clinical profile and effectiveness of ECT in females with postpartum onset psychiatric syndromes or worsening of psychiatric disorder during the postpartum period. MATERIALS AND METHODS: A retrospective chart review was carried out to identify females who had received ECT during their postpartum period from January2004 to April 2017. RESULTS: During the study period, 13 females in their postpartum period received ECT, which accounted for 2.24% of the total females (n = 578) who had received ECT and 1% of total patients who were administered ECT during this period. The most common clinical diagnosis was postpartum depression (n = 7; 53.86%). Three (23.1%) patients were diagnosed with bipolar disorder and had experienced a relapse during the postpartum period. Two (15.4%) patients were diagnosed with schizophrenia and 1 (7.7%) patient was diagnosed with postpartum psychosis/acute and transient psychotic disorder. ECT was considered as a treatment of choice in 9 (69.2%) patients. All the patients with depression or mania achieved clinical remission, and patients with psychotic disorders also had significant reduction in their symptoms. Cognitive complaints were reported by 4 (30.8%) patients, and aches and pains after ECT were reported by 7 (53.8%). CONCLUSION: ECT is a safe and effective treatment option in postpartum onset psychiatric syndromes or patients experiencing relapse or exacerbation of severe mental disorders during the postpartum period and is associated with a very good response rate with minimal or no complications.

The Prevalence of Psychiatric Comorbidity in Patients with Prurigo Nodularis.

BACKGROUND: Prurigo nodularis (PN) is a chronic, recalcitrant itchy dermatosis. It is supposed to be associated with psychological factors, but research in this area is scarce. OBJECTIVES: To study the prevalence and determinants of psychiatric morbidity, and the phenomenology of itch in PN. MATERIALS AND METHODS: This study was carried out in the outpatient service of the Department of Dermatology. Purposive sampling was used to recruit 50 patients each with PN, chronic urticaria (CU), and vitiligo (V). A one-time cross-sectional assessment was carried out on the participants. Psychiatric morbidity was assessed using Mini-International Neuropsychiatric Interview and Patient Health Questionnaire-9. RESULTS: The three groups were comparable on socio-demographic parameters. The prevalence of any psychiatric disorder (current or lifetime) was 48%, 42%, and 58% in the PN, CU, and V groups, respectively (P = 0.27). LIMITATIONS: The limitations of this study include the small sample size and the purposive, non-blind nature of assessments. CONCLUSION: Our study suggests that there is significant psychiatric morbidity in PN which is comparable to that seen in CU and V.

Psychosexual disorders and dermatologists.

Sexual problems that are psychological in origin, rather than physiological, are called psychosexual disorders. Multiple factors, such as general health of the patient, chronic illnesses, psychiatric/psychological disorders, and socio-cultural factors, alone or in combination can be attributed to the development of psychosexual dysfunctions. The symptoms of these disorders vary for each individual and differ with gender. These disorders may be categorized as sexual dysfunction, paraphilias, and gender identity disorders. Dermatologists are sometimes consulted for sexual dysfunctions in their routine practice by the patients visiting sexually transmitted infections (STI) clinics because a majority of the patients believe that these problems are caused by dysfunctions in the sex organs, and because people are hesitant to go to sexuality clinics and psychiatrists for such problems. Sometimes these patients are referred from other specialties such as urology or gynecology; most often, we attempt to search for STIs or other dermatoses on the genitalia and refer them back. We often underestimate the prevalence of sexual concerns of the patients or feel uncomfortable discussing matters of sexuality with them. Dermatologists should understand basic sexual medicine and ask patients for sexual problems. They should be trained to manage such patients accordingly. In this review, we will be focusing on sexual dysfunctions, their etiopathogenesis, and management from a dermatologist's perspective.

Psychiatric morbidity in patients with psoriasis.

Psoriasis is a common skin disorder that is associated with impairments in quality of life (QOL) and psychological distress. In this study, we investigated the prevalence and determinants of psychiatric morbidity (ie, psychiatric disorders) in 104 patients with chronic plaque psoriasis who presented to the Departments of Dermatology, Venereology, and Leprology at a tertiary-level teaching hospital in North India. A 2-stage, cross-sectional study using standardized self-assessment questionnaires assessing psoriasis severity and QOL were administered followed by an evaluation conducted by a psychiatrist. Our findings suggest a need for effective screening for psychiatric disorders in psoriasis patients, greater sensitivity among dermatologists to the association of impairments in QOL and psychiatric morbidity with this condition, and collaboration with mental health professionals to ensure better treatment outcomes in psoriasis patients.

A patient with Tramadol dependence and predictable provoked epileptic seizures.

Tramadol is an atypical, centrally acting synthetic analgesic with propensity for provoked seizures as well as abuse potential. The index case of Tramadol dependence discussed in this case report developed multiple epileptic seizures with high doses of Tramadol, used as a sexual enhancer by him, and later he learned to prevent the seizures by self-medicating with Alprazolam. The authors further emphasize on the regulation of Tramadol prescription.

Tramadol dependence: a case series from India.

Tramadol is an atypical, centrally acting, synthetic analgesic, acting through opioid and non-opioid systems. We present a series of seven cases, all men, who sought treatment at our centre for tramadol-dependence. The majority were using other opioids at some point in their lives. Their tramadol use had begun with a prescription of tramadol for opioid detoxification, for headache and body pains, and as an alternative to injectable opioids. The doses of tramadol used varied from 50 to 1500 mg per day. All subjects reported an experience of euphoria with tramadol use. Four patients were put on naltrexone, but had poor compliance. This case series underscores the need for caution, while using tramadol in substance-dependent patients.

Prevalence and correlates of epileptic seizure in substance-abusing subjects.

Life-time prevalence of epileptic seizures was assessed in 626 consecutive patients treated for substance abuse. Seizures were reported in 8.63% (9.2% in alcohol abusers, 12.5% in opioid abusers). A total of 64.8% of the seizures were associated with substance use. These occurred during withdrawal in the alcohol cohort and during intoxication with dextropropoxyphene and withdrawal from heroin or poppy husk in the opioid cohort. Results indicate that seizures may be more common in older patients with longer duration of dependence among those abusing alcohol.

Unintentional rapid opioid detoxification: case report.

BACKGROUND: Naltrexone is a competitive opioid antagonist and is often used to maintain abstinence in detoxified opioid dependent patients. However, it can precipitate an accelerated withdrawal when ingested by an individual with concurrent opioid use. METHODS: We report the case of a 28 year old male with opioid dependence syndrome presenting with chaotic symptoms following ingestion of naltrexone. Symptomatology, management is described and literature in this area is reviewed. RESULTS: Accidental or surreptitious ingestion of naltrexone in a patient with concurrent opioid use can precipitate symptoms typical of opioid withdrawal in addition to other varying symptomatology. Most cases would require sedation and management of concurrent vomiting and diarrhoea. CONCLUSIONS: Clinicians, especially those providing substance abuse and emergency care, need to be aware of the possibility of an accelerated and possibly life threatening withdrawal associated with naltrexone ingestion in an incompletely detoxified patient with opioid dependence.

The P300 event-related potential and its possible role as an endophenotype for studying substance use disorders: a review.

The concept of endophenotypes has gained popularity in recent years. This is because of the potential that endophenotypes provide of measuring objective trait markers that are simpler to access and assess than complex behavioral disease phenotypes themselves. The simplicity, ease of measurement and the putative links to the etiology of the disease in the study of an endophenotype has the potential promise of unraveling the genetic basis of the disease in question. Of the various proposed endophenotypes, the P300 component of the event-related potential has been used in studies on alcoholism, schizophrenia and externalizing disorders. The current state of knowledge regarding the concept of endophenotypes, P300 and the validity of P300 as an endophenotype with special reference to substance use disorders is discussed in this review. The implications of the above are discussed.

A study in dualism: The strange case of Dr. Jekyll and Mr. Hyde.

R. L. Stevenson's novel, The Strange Case of Dr. Jekyll and Mr. Hyde is a prominent example of Victorian fiction. The names Jekyll and Hyde have become synonymous with multiple personality disorder. This article seeks to examine the novel from the view point of dualism as a system of philosophy and as a religious framework and also from the view point of Freud's structural theory of the mind.

Long-term outcome of in-patients with substance use disorders: A study from North India.

BACKGROUND: Research into substance use disorders (SUD) has been unable to unequivocally demonstrate effectiveness of treatment modalities. AIMS: The aim of the study was to study the long-term outcome after in-patient treatment in a cohort of patients admitted for SUD in a deaddiction unit of a hospital in North India. MATERIALS AND METHODS: The case notes of all in-patients with a primary diagnosis of alcohol and/or opioid dependence syndrome (F10.24 and F11.24) in the calendar year 2006 were examined. All patients without any physical or mental comorbidity other than comorbid SUD were included in the study. They were contacted telephonically or their case notes examined in September, 2007. Status regarding abstinence or relapse was determined and data was analyzed. Independent samples t-test and chi-square test were used for determining significance of difference between continuous and categorical variables respectively. Kaplan-Meier analysis was applied to find the survival times of different groups with the duration to relapse as variable of interest. Log rank test was applied to find the significance of differences in various groups. Cox's Regression analysis was applied to find the hazard ratio. RESULTS AND CONCLUSIONS: Data for 59.22% of patients included in the study were available for analysis. Mean survival time was 36.35 weeks (28.74-43.95, 95% CI) for patients across different groups, 36.71 weeks (26.24-47.18, 95% CI) for the alcohol group, 34.00 weeks (8.37-59.36, 95% CI) for natural opioids group, 37.53 weeks (26.33-48.73, 95% CI) for semi/synthetic opioids group and 17.00 weeks (3.39-30.60, 95% CI) for the mixed group. Kaplan-Meier analysis revealed that those who were following-up at time of evaluation had significantly longer durations to relapse. Deaddiction services should stress on keeping patients on follow-up as a means to better outcomes.