Mental health and well-being in children and adolescents.

The guideline discusses the various milestones in typical neurodevelopment and the various checkpoints where atypical development can be picked up. There is also a remarkable influence of epigenetics and parenting on child development and well - being. It is also essential to establish effective communication to facilitate healthy child development. Well being in children is largely impacted by schooling, curricular design, inclusivity, teacher training and awareness of newer developments, parent teacher interaction. A clinician must also be well acquainted with the National Education Program and its impact. A healthy environment, exercise, adequate nutrition, microplastics on children and adolescents, global warming are key factors in the development of children. It is indispensable for clinicians to approach well- being in a scientific way and get a clear understanding of the laws and policies for child welfare and protection.

Epileptic Encephalopathy and Autism: A Complex Interplay.

Drug-resistant epileptic encephalopathy such as Dravet syndrome presents with autistic symptoms. Three cases with autism spectrum disorder with comorbid Dravet syndrome were assessed. All the cases presented with onset of seizures before a year and with autistic features. The patients responded to a combination of antiepileptic drugs (AEDs), resulting in reduced frequency of seizures and behavioral issues. Contrary to the belief that both epilepsy and use of AEDs have adverse impact on the cognition of children with an early onset of epilepsy, we found improvement in the symptoms of our patients who presented with autism and epilepsy. Primary treatment approaches such as occupational therapy, special education, speech therapy, and behavioral therapy; effective diagnosis of comorbidities such as epilepsy; and aggressive treatment might help with behavioral improvement. Early diagnosis followed by treatment with AEDs can improve seizures, electroencephalography abnormalities, and behavioral problems.

Psychiatric aspects of Parkinson's disease.

Parkinson's disease (PD) is essentially characterized by the motor symptoms in the form of resting tremor, rigidity and bradykinesia. However, over the years it has been recognized that motor symptoms are just the "tip of the iceberg" of clinical manifestations of PD. Besides motor symptoms, PD characterized by many non-motor symptoms, which include cognitive decline, psychiatric disturbances (depression, psychosis and impulse control), sleep difficulties, autonomic failures (gastrointestinal, cardiovascular, urinary, thermoregulation) and pain syndrome. This review evaluates the various aspects of psychiatric disorders including cognitive decline and sleep disturbances in patients with PD. The prevalence rate of various psychiatric disorders is high in patients with PD. In terms of risk factors, various demographic, clinical and treatment-related variables have been shown to be associated with higher risk of development of psychiatric morbidity. Evidence also suggests that the presence of psychiatric morbidity is associated with poorer outcome. Randomized controlled trials, evaluating the various pharmacological and non-pharmacological treatments for management of psychiatric morbidity in patients with PD are meager. Available evidence suggests that tricyclic antidepressants like desipramine and nortriptyline are efficacious for management of depression. Among the antipsychotics, clozapine is considered to be the best choice for management of psychosis in patients with PD. Among the various cognitive enhancers, evidence suggest efficacy of rivastigmine in management of dementia in patients with PD. To conclude, this review suggests that psychiatric morbidity is highly prevalent in patients with PD. Hence, a multidisciplinary approach must be followed to improve the overall outcome of PD. Further studies are required to evaluate the efficacy of various other measures for management of psychiatric morbidity in patients with PD.

Comparative study of cost of care of outpatients with bipolar disorder and schizophrenia.

AIM: To assess and compare the average annual the cost of illness of outpatients with bipolar disorder and schizophrenia. METHODS: Cost of illness in 75 out-patients with bipolar disorder and 53 out-patients with schizophrenia was assessed over a 9-month period by using bottom-up approach. The cost of 9 months was annualized by dividing the 9 months cost by 3 and then multiplying the obtained figure with 4. RESULTS: Total average annual costs of care of bipolar disorder was Indian rupees 32,759 (US $ 655.18) and that of schizophrenia was Indian rupees 48,059 (US $ 961.18) and there was no significant difference between the two groups. In both the groups, indirect costs (bipolar disorder-64.0%; Schizophrenia-77.6%) were higher than direct costs (bipolar disorder-36%; Schizophrenia-22.4%). Cost of medications was high. Patient and their families bore the main brunt of financial burden (95.4-96% of the total cost). In Bipolar disorder total treatment costs were significantly higher in those who had lower level of functioning. In bipolar disorder group number of visits to the hospital correlated with total cost, indirect cost and provider's cost, whereas in schizophrenia group total number of visits correlated with provider's cost only. Only a small proportion (13.7%) of the total cost of bipolar disorder was predicted by presence or absence of alcohol dependence and number of visits. In the schizophrenia group, only positive symptom score as per the rating on PANSS appeared as a significant predictor of total cost, explaining 15.6% of the total cost. CONCLUSION: Costs for outpatients with bipolar disorder are similar to the cost of outpatients with schizophrenia. Costs are higher in patients of bipolar disorder with lower level of functioning. Findings of the study suggests that reducing the number of visits to the hospital by providing care at the doorsteps, focusing on reduction of substance use and improving the level of functioning of the patients can reduce the cost of care of bipolar disorder.

Changes in cost of treating schizophrenia: comparison of two studies done a decade apart.

Objective of this study was to compare the cost of care of schizophrenia estimated in the same catchment area separated by a decade. Cost of care of schizophrenia was estimated in 50 outpatients in 2001-2002 and 53 outpatients 2010-2011 using the same methodology along with structured assessments of psychopathology. Overall cost of care of schizophrenia has doubled in the last one decade. The total direct cost of the treatment has not changed much in the monetary terms in last one decade, but total indirect cost has increased 2.35 times. In terms of proportion of cost, there was no significant change in the proportion of the provider cost, however, the proportion of indirect cost increased from 63% to 77.57% from the year 2001-2002 to the year 2010-2011. Cost of care of schizophrenia is more for those have lower level of functioning and have to visit the hospital more often. Cost of care of schizophrenia in India has doubled in the last one decade.

Electroconvulsive therapy in the presence of atrial septal defect: a case report.

There is limited literature on the use of electroconvulsive therapy in patient with congenital heart defect. We present a case of a 24-year-old woman with diagnosis of persistent delusion disorder with depression and congenital heart defect of ostium secundum type treated successfully with a course of electroconvulsive therapies.

Prevalence of metabolic syndrome in patients with schizophrenia in India.

Prevalence of metabolic syndrome (MS) was estimated in 227 patients with schizophrenia. A total of 43.6% of patients fulfilled International Diabetes Federation (IDF) criteria and 44.5% met modified National Cholesterol Education Program Adult Treatment Panel-III (NCEP ATP- III) criteria of MS. Increased waist circumference was the most common abnormality (64.8%) and high glucose level was the least common (15.9%). In regression analysis, age more than 35 years (OR-3.37), female gender (odds ratios (OR-1.81)), urban locality (OR-2.08), being employed (OR-2.12) and BMI more than 25 (OR-5.64) emerged as significant predictors of MS.

Prevalence of metabolic syndrome in bipolar disorder: an exploratory study from North India.

PURPOSE: To study the prevalence of metabolic syndrome in patients with bipolar disorder. MATERIAL AND METHOD: By using purposive random sampling 200 patients with bipolar disorder receiving treatment were evaluated for presence of metabolic syndrome using International Diabetes Federation (IDF) and modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) criteria. RESULTS: Eighty patients fulfilled IDF criteria and 82 patients met NCEP ATP-III criteria for metabolic syndrome. There was significant concordance between these two criteria sets for metabolic syndrome (Kappa value 0.979, p<0.015). Among the individual parameters studied--increased waist circumference (70.1%) was the most common abnormality, followed by increased blood pressure (44.5%) and increased triglycerides levels (42%). Compared to patients without metabolic syndrome, patients with metabolic syndrome had significantly higher body mass index and higher percentage of them (74.4% vs 51.7%) were more than 35 years of age. Logistic regression analysis revealed that these two variables significantly predicted metabolic syndrome. CONCLUSION: Findings of the present study suggest that abdominal obesity is the most common abnormality and metabolic syndrome is best predicted in patients with bipolar disorder by higher age and higher body mass index.