Personality disorders and its association with anxiety and depression among patients of severe acne: A cross-sectional study from Eastern India.

BACKGROUND: In many patients, emotional stress may exacerbate acne. Psychological problems such as social phobias, low self-esteem, or depression may also occur as a result of acne. The presence of acne may have some negative effect on the quality of life, self-esteem, and mood of the affected patients. While some studies have been undertaken about anxiety, depression, and personality patterns in patients with acne, only a few studies have been done to identify specific personality disorders in patients with acne. Furthermore, there is a dearth of data regarding the effect of personality disorder on the psychological states of the patients which prompted us to undertake the present study. METHODOLOGY: This was a descriptive cross-sectional study, undertaken in a Tertiary Care Teaching Hospital in Eastern India. Consecutive patients suffering from severe (Grade 3 and 4) acne, attending the Dermatology Outpatient Department, aged above 18 years were included to the study. RESULTS: A total of 65 patients were evaluated with a mean age of 26 years. Personality disorder was present in 29.2% of patients. The diagnosed personality disorders were obsessive compulsive personality disorder (n = 9, 13.8%), anxious (avoidant) personality disorder (n = 6, 9.2%), and borderline personality disorder (n = 2, 3%), mixed personality disorder (n = 2, 3%). All patients with personality disorder had some psychiatric comorbidity. Patients having personality disorder had higher number of anxiety and depressive disorders which were also statistically significant. CONCLUSION: The present study highlights that personality disorders and other psychiatric comorbidities are common in the setting of severe acne.

Prevalence of Depression in Patients with Type II Diabetes Mellitus and its Impact on Quality of Life.

BACKGROUND: Diabetes mellitus (DM) is a frequently encountered chronic metabolic disease with various complications throughout its course, which causes severe restriction and disability in an individual's life. It has been well documented that the incidence of depression is higher in diabetic patients and co-morbid depression causes further deterioration in the quality of life in diabetic patients. AIMS: To study the prevalence of depression and its impact on quality of life in patients with type II DM. SETTINGS AND DESIGN: Single centre, cross-sectional, single interview. MATERIALS AND METHODS: Total 195 type II DM patients are included in this study. To diagnose Depressive Episode Structured Clinical Interview for DSM IV Axis-1 Disorders, Research Version patient edition was applied. All patients were evaluated with a semi-structured socio-demographic proforma to assess socio-demographic characteristics, Hamilton Rating Scale for Depression (HAM-D) and Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) SF (Short Form) to measure the quality of life. RESULTS: Among them, 46.15% (N=90; males: 41, females: 49) met the DSM-IV diagnostic criteria for major depressive episodes. Among the depressed group, majority were (36.7%) moderately depressed. QLESQ-SF total and each item scores were significantly lower in the depressed group than in the non-depressed group. Both the HAM-D scores and HbA1c level have significant negative correlations with QLESQ-SF total scores. CONCLUSION: Our study demonstrates that the presence of depression in type II DM further deteriorates the quality of life of the patients. Therefore, treating depression would have a beneficial effect on the quality of life.

Assessing perceived stress in medical personnel: in search of an appropriate scale for the bengali population.

BACKGROUND: The occurrence of stress and stress related anxiety and depression in medical personnel are being increasingly reported in literature. The perceived stress scale (PSS) is the most widely used psychological instrument for measuring the perception of stress. It is needed to assess perceived stress in our population using appropriately translated version of PSS. The objectives of study were to prepare a Bengali version of PSS-10 and to establish its psychometric properties in the study population. MATERIALS AND METHODS: The study was conducted in a teaching hospital among medical students and interns (N=37). The translated Bengali version and the original English version of PSS-10 were separately handed over to the individual subjects. The scores were compared across different subgroups and psychometric properties of the translated version were assessed using SPSS 16. RESULTS: Internal consistency of PSS English (α=0.79) and Bengali (α=0.80) was satisfactory. Intra-rater reliability was adequate (κ>0.5) for most of the items, but showed an inadequate value (κ<0.5) for four items on the scale. After deleting these four items from the Bengali version, a new six-item PSS in Bengali was derived that showed good internal consistency (α=0.699). CONCLUSION: This new version needs to be validated in a larger study population. Perceived stress score using PSS-10 was considerably high in our study population, although there was no significant difference between the subgroups (male/female, intern/student).

Rapid response with ketamine on suicidal cognition in resistant depression.

CONTEXT: Suicidal ideation in depressed patients is a serious and emergent condition that requires urgent intervention. Intravenous ketamine, an N-methyl-D-aspartate (NMDA) antagonist, has shown rapid antidepressant effects, making it a potentially attractive candidate for depressed patients with suicidal risk. AIMS: In India few studies have corroborated such findings; the present study aimed to assess the effectiveness and sustainability of antisuicidal effects of ketamine in subjects with resistant depression. SETTINGS AND DESIGN: Single-center, prospective, 4 weeks, open-label, single-arm pilot study. MATERIALS AND METHODS: Twenty-seven subjects with DSM-IV major depression (treatment resistant) were recruited. The subjects were assessed on Scale for Suicidal Ideation (SSI), 17-item Hamilton Depression Rating Scale (HDRS). After a 2-week drug-free period, subjects were given a single intravenous infusion of ketamine hydrochloride (0.5 mg/kg) and were rated at baseline and at 40, 80, 120, and 230 minutes and 1 and 2 days postinfusion. RESULTS: The ketamine infusion was effective in reducing the SSI and HDRS scores, the change remained significant from minute 40 to 230 at each time point. CONCLUSIONS: The real strength of this study rests in documenting the rapid albeit short-lasting effect of ketamine on suicidal ideation in depressed patients.

Chronic subdural hematoma following electro convulsive therapy.

Subdural hematoma is a rare but serious complication following electroconvulsive therapy (ECT), a frequently used treatment modality in the management of various psychiatric morbidities including bipolar affective disorder (BAD). There are very few reports of intracranial bleeding following ECT in the literature. A 38-year-old female, known case of BAD for last fifteen years receiving ECT, presented with the symptoms of dysphasia, headache, left sided paresis, and sudden deterioration of sensorium. Computed tomography (CT) scan of the brain was suggestive of left-sided fronto parietal chronic subdural hematoma with midline shift that was drained successfully.

Rapid Antidepressant Response with Ketamine: Is it the Solution to Resistant Depression?

BACKGROUND: Treatment-resistant depression (TRD) is a relatively common condition, challenging the clinician. There is an urgent need to develop pharmacological treatments for TRD that exert rapid and sustained antidepressant effects. Ketamine induces a rapid antidepressant effect. AIMS: In India, very few studies have corroborated such findings, and the present study aimed to assess the effectiveness and sustainability of antidepressant effects of ketamine in subjects with TRD. MATERIALS AND METHODS: The present study was a single-center, prospective, 4-week, open-label, single-arm pilot study. Twenty-two subjects with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition major depression (treatment resistant) were recruited. After a 2-week drug-free period, subjects were given a single intravenous infusion of ketamine hydrochloride (0.5 mg/kg) and were rated at baseline and at 40, 80, 110, and 230 min and 1, 2, 3, 4, 7, and 14 days postinfusion. The main outcome measure was changes in scores on the 17-item Hamilton Depression Rating Scale (HDRS). Data were analyzed by using Freidman's analysis of variance and a post hoc test. RESULTS: The ketamine infusion was effective in reducing the HDRS scores, and the change remained significant from minute 80 to day 3 postinfusion at each time point. The change was not significant at any time after day 3. CONCLUSION: The real strength of this study rests in documenting the rapid, albeit short-lived, antidepressant effect of ketamine in TRD.

Nature of sexual dysfunctions in major depressive disorder and its impact on quality of life.

BACKGROUND: Adequate sexual expression is an essential part of many human relationships, and may enhance quality of life and provide a sense of physical, psychological, and social well-being. Epidemiological and clinical studies show that depression is associated with impairments of sexual function and satisfaction, even in untreated patients. Most antidepressant drugs have adverse effects on sexual function, but accurate identification of the incidence of treatment-emergent dysfunction has proved troublesome. However, few investigators have reported the base rate for disturbances in sexual desire, arousal, and orgasm or ejaculation in patients with major depressive disorder (MDD) prior to antidepressant treatment. The purpose of this study is to define the frequency of sexual dysfunction (SD) in 60 patients with MDD and examine the relationship between SD and quality of life enjoyment and satisfaction variables. MATERIALS AND METHODS: A consecutive series of 24 male and 36 female MDD patients diagnosed by SCID-DSM IV assessment completed a series of psychometric measures including a Sexual Function Questionnaire-Arizona Sexual Experience Scale (ASEX) which asked about change in sexual interest and function as well as quality of life of life enjoyment using QLESQ-SF. RESULTS: Over 33.33% of men and 42% of women reported decreased sexual interest. Reduced levels of arousal were more common in both men and women (8-22%) than ejaculatory or orgasm difficulties (11-16%). In women, SDs were more than males. Quality of life was more impaired in sample with SDs than those without dysfunction showing significant impact of SD on quality of life. LIMITATION AND CONCLUSION: Although limited by a relatively small sample of drug-free patients with MDD, and by the absence of a non-depressed comparison sample, these results emphasize the importance of factors beyond specific drug effects in the assessment of SD in drug naive-depressed patients.

Putative effect of alcohol on suicide attempters: an evaluative study in a tertiary medical college.

CONTEXT: Alcohol abuse is a known risk factor for suicide. Alcohol increases aggression and impulsivity, which are strongly related to suicidal behavior. Sociocultural factors influence both alcohol use and suicide rates. Studies, conducted in one population, are not applicable to other and the results cannot be generalized. AIMS: The aim was to study the putative role of alcohol in suicide cases in the rural Indian population by analysis of various sociodemographic variables. SETTINGS AND DESIGN: This was a cross-sectional study in conducted in a tertiary medical college. MATERIALS AND METHODS: Two hundred consecutive patients who survived a suicide attempt were evaluated by a psychiatrist. The data were recorded for sociodemographic variables, psychiatric disorders, suicide intent, lethality of the suicide attempt, and history of alcohol intake prior to the suicide attempt. Using alcohol intake prior to the suicide attempt as a determining dimension, various sociodemographic variables were analyzed for their statistical significance and the role of alcohol in suicide cases was assessed. RESULTS: Seventeen percent suicide attempt survivors had a history of alcohol intake prior to the suicide attempt. Fifteen percent had a history of alcohol use disorder. Alcohol use affected the suicide rate in the male population in the late twenties to mid-thirties age group, illiterate and people with high school education, semiskilled workers, shop owners, and student population. Alcohol dependence, bipolar II disorder, intermittent explosive disorder, and dysthymic disorder had higher rate of suicide attempt with the use of alcohol prior to the suicide attempt. Alcohol users attempted a more lethal suicide attempt and were found to have problems with primary support group and occupational problem as precipitating stressor for suicide attempt. CONCLUSIONS: Alcohol use increases the suicide rate, in the specific rural Indian population.