Efficacy of cognitive behavioral therapy with paroxetine and paroxetine only for social anxiety disorder: A behavioral, placebo-controlled study.

BACKGROUND: Individually, cognitive behavior therapy (CBT) and paroxetine (PX) are considered as frontline treatments for social anxiety disorder (SAD). However, the possibility of combined interventions of these might be more helpful than either intervention alone has met with mixed reviews. Hence, the goal of the current study was to examine whether combining CBT + PX would be superior to PX alone in the treatment of SAD in various stages of treatment. METHODOLOGY: The present study is a single-center, rater-blind, behavioral placebo (Bh. PBO)-controlled study. Sixty-seven participants were prospectively observed in two groups, one receiving CBT + PX and PX + Bh. PBO for 24 weeks. The Social Interaction Anxiety Scale (SIAS) was measured at pre, post (12 weeks), end of booster (24 weeks), and 2-month follow-up (32 weeks) stage. The SIAS was measured at pre, post (12 weeks), end of booster (24 weeks), and 2-month follow-up (32 weeks) stage. RESULTS: Both treatment groups have significant difference in the mean scores of SIAS in posttreatment, booster, and follow-up stages from their respective mean scores at prestage. Mann-Whitney U-test found no significant differences in the mean scores of SIAS between CBT + PX and PX + Bh. PBO at posttreatment and booster phase, whereas a statistically significance difference (P = 0.03) was found in 2-month follow-up stages. Both treatment groups have large effect size in posttreatment and end of booster phase. At 2-month follow-up stage, a large effect size of 1.11 was found in CBT + PX group as compared to medium size of 0.6 in PX + Bh. PBO group. CONCLUSIONS: Combined treatment of CBT + PX provided no advantage over PX + Bh. PBO in acute stages of treatment, but the former have significantly better maintenance of treatment gains in 2-month follow-ups than the latter.

The Phenomenology and Treatment Response in Catatonia: A Hospital Based Descriptive Study.

BACKGROUND: Literatures regarding clinical symptomatology and treatment response of catatonia are very few. OBJECTIVE: To assess onset, clinical profile, diagnostic break up, treatment response and outcome in patients diagnosed as Catatonia, reported to a tertiary care hospital. METHODS: The present study was a cross-sectional descriptive study conducted in indoor of Mental Health Institute (Centre of Excellence), S.C.B. Medical College, between March 2015 to March 2016. A total of 34 patients were included in the study who reported at outdoor department of Mental Health Institute with catatonic symptoms. All patients admitted in inpatient department were routinely assessed through a detailed semi-structured interview. The diagnosis of catatonia was made if the patients present with three or more symptoms out of twelve symptoms fulfilling the criteria of DSM-5. All the patients were assessed through Bush-Francis Catatonia Rating Scale. They were initially given parental lorazepam at the doses ranging from 4-12 mg per day as per requirement. Patients who did not respond to lorazepam trial were given ECT. RESULTS: The patients were predominantly presented with retarded symptoms of catatonia such as staring, mutism, withdrawal, posturing and negativism. Schizophrenia and other psychotic spectrum disorders were more commonly presented as catatonia as compared to mood disorders. Younger age group patients were mainly responded to lorazepam only, whereas older age group patients responded to both ECT and lorazepam. CONCLUSION: This study has came out with very important insights in the age of incidence, phenomenology, clinical profile, source of referral, diagnostic break up and treatment response with lorazepam and ECT in catatonic patients following mental disorder.

The Influence of Psychosocial Dysfunctions in Chronic Schizophrenia Patients in Remission: A Hospital-Based Study.

BACKGROUND: Psychosocial dysfunctions in the various psychosocial areas in chronic schizophrenic patients predict the long-term course, outcome, and quality of life of these patients, which always varies with years of treatment. OBJECTIVE: To know the influence and compare the level of psychosocial dysfunctions and severity of disability burden in chronic schizophrenic patients who are in remission with duration of 5 and 20 years. MATERIALS AND METHODS: The sample was collected from the OPD of Mental Health Institute (COE), S.C.B. Medical College, Cuttack, Odisha, India. This study is a cross-sectional study. A total of 120 remitted schizophrenic patients (60 patients of each group with duration of 5 and 20 years), who fulfilled Nancy Andreasen criteria for Remission were selected for the study. Regional language of dysfunction analysis questionnaire (DAQ) was used to assess the level of psychosocial dysfunctions in personal, familial, social, vocational, and cognitive areas of each patient. RESULTS: Qualitative data were analyzed using Chi-square and quantitative data were analyzed using t-test and correlation as a test of significance. Statistically significant differences (P < 0.05) were found in all five domains of DAQ between two groups. Statistically significant difference (P < 0.05) was found between the two groups with respect to severity of the disability. CONCLUSION: This study confirms that there are definite and substantial psychosocial dysfunctions in personal, familial, social, vocational, and cognitive spheres with the advancement of the duration of illness in chronic schizophrenic patients.

A comparative study of quality of life and disability among schizophrenia and obsessive-compulsive disorder patients in remission.

BACKGROUND: Persons with long-term psychiatric disorders have greater deficits in living skills as well as greater problems in employment and relationship to their social environment. Thus, chronic psychiatric illnesses have psychosocial consequences such as disability and impaired quality of life (QOL) due to their symptomatology and chronic course. OBJECTIVES: Assessment and comparison of disability and QOL of patients suffering from schizophrenia and obsessive-compulsive disorder (OCD) in remission phase. MATERIALS AND METHODS: A cross-sectional study carried out in the psychiatry outpatient Department of Mental Health Institute, S.C.B. Medical College and Neuropsychiatric Consultation Centre, Cuttack. The study sample consisted of fifty cases of each groups (schizophrenia and OCD), which included both males and females. All of them were assessed through the World Health Organization-QOL BREF and Indian Disability Evaluation and Assessment Scale. RESULTS: Results revealed that schizophrenics have poor QOL and greater disability burden than patients of OCD. CONCLUSION: These psychiatric illnesses, i.e. schizophrenia and OCD, affect all areas of daily functioning leading to greater disability, and thus increasing the burden on the family, imposing greater challenges for the rehabilitation of these patients and their inclusion in the mainstream of the family and society.

Neuropsychological functioning in Wernicke's encephalopathy.

CONTEXT: Wernicke's encephalopathy (WE) is caused by thiamine (Vitamin B1) deficiency and most commonly found in chronic alcoholism and malnutrition. Clinically, the key features are mental status disturbances (global confusion), oculomotor abnormalities, and gait disturbances (ataxia). Apart from these clinical features, we can find deficits in neuropsychological functioning in patients with WE, which is more prominent after the improvement in the physical conditions. Neuropsychological functioning includes both basic cognitive processes (i.e., attention-concentration) as well as higher order cognitive processes (i.e., memory, executive functioning, reasoning), which is much vital for the maintenance of quality of life of an individual. However, unfortunately, in most of the cases, neuropsychological functioning is ignored by the clinicians. MATERIALS AND METHODS: In this study four case reports of WE have been presented. The patients were taken from the outdoor department of Mental Health Institute, S.C.B. Medical College, Cuttack, Odisha. Neuropsychological functioning was measured by administration of PGIBBD and Quality of Life was measured by WHO-QOL BREF Odia Version. DISCUSSION: As described in the literature, among the three cardinal signs (global confusion, ataxia, and ocular sings), the first two were present in all cases, but nystagmus was present in only two cases. Memory dysfunction was so disabling that the persons were unable to maintain a good Quality of Life and occupational impairment was prominent. There are disturbances in recent, remote memory, immediate recall, delayed recall, and attention and concentration, ultimately creating both physical and mental disability. PGI-BBD findings also suggest the overall impairment in neuropsychological functioning other than memory, that is, executive functioning, visual acuity, and depth perception. Findings of WHO-QOL BREF suggest the impairment of four domains of QOL in all the cases, but the severity level varies from person to person. CONCLUSION: Like the three cardinal features, neuropsychological dysfunction in WE should be given importance, which is a most vital component for the maintenance of QOL. As a result, the disability produced by this condition can be well managed.

Pattern of psychotropic prescription in a tertiary care center: a critical analysis.

OBJECTIVES: To study the prescription pattern of psychotropic drugs in a Tertiary Care Hospital in Eastern India with special reference to polypharmacy. MATERIALS AND METHODS: A total of 411 patients were included in the study through systematic sampling. Patients were diagnosed by a Consultant Psychiatrist before inclusion in the study using a semi-structured interview schedule based on the International Classification of Disease (ICD), classification of mental and behavioral disorders, 10th version). The most recently prescribed psychopharmacological medication of those patients was studied. A checklist to assess the pattern of prescription and evaluate reasons of polypharmacy was filled up by the prescribing consultant. RESULTS: About 76.6% of the patients received polypharmacy in the index study. Males were more exposed to polypharmacy compared to women (80.93% vs. 70.85%). Gender and diagnosis had a predictive value with regard to the polypharmacy. Polypharmacy was more common in organic mental disorders (F0), psychoactive substance abuse disorders (F1), psychotic disorders (F2), mood disorders (F3) and in childhood, and adolescent mental disorders (F9). Most frequently, antipsychotic drugs were prescribed followed by tranquilizers/hypnotics and anticholinergics. Antidepressants (35.13%) were more commonly prescribed as monotherapy. Anticholinergics (100%) and tranquilizers/hypnotics (96.7%) were the drugs more commonly used in combination with other psychotropics. The three most common reasons for prescribing polypharmacy were augmentation (43.8%) of primary drug followed by its use to prevent adverse effects of primary drug (39.6%) and to treat comorbidity (34.9%). CONCLUSIONS: Polypharmacy is a common practice despite the research based guidelines suggest otherwise. More vigorous research is needed to address this sensitive issue.