Association between bipolar affective disorder and thyroid dysfunction.

BACKGROUND: Bipolar affective disorder may be associated with alterations in thyroid function. A comprehensive thyroid assessment is important for assessing clinical and sub-clinical imbalances linked to a variety of mood disorders like bipolar affective disorder. AIM: To find out the association between bipolar affective disorder and thyroid dysfunction. MATERIALS AND METHOD: The present cross-sectional study was conducted at Government District Wenlock Hospital, Mangalore (GDWH), India. A total of 50 newly diagnosed bipolar affective disorder patients and 50 age and sex matched controls without bipolar affective disorder as confirmed by the application of Bipolar Spectrum Diagnostic Scale were included in the study. Thyroid function was assessed among the patients and control group to study the association between bipolar affective disorder and thyroid dysfunction. Odds ratio was calculated to find out the strength of association between thyroid gland dysfunction and bipolar affective disorder. RESULTS: The mean Bipolar Spectrum Diagnostic Scale score among patients diagnosed with bipolar affective disorder was 20.84 and that of the control group was 1.98. The proportion of thyroid dysfunction among bipolar affective disorder patients and among control group was 14% and 6% respectively. The odds ratio was calculated to be 2.55. Mean T3 values were higher in the bipolar affective disorder patients than the control group and this association was found to be statistically significant (p=0.031). Mean T4 and TSH values were higher among the bipolar affective disorder patients but did not show any significant differences when compared with the control group. CONCLUSION: The present study concludes that a statistically significant association exists between elevated T3 hormone and bipolar affective disorder and observes that the patients with bipolar affective disorder are 2.55 times more commonly associated with thyroid dysfunction.

Post-stroke depression and lesion location: A hospital based cross-sectional study.

BACKGROUND: Depression is a common neuro-psychiatric consequence of stroke, affecting approximately 40% of the patients. Many studies show that in addition to the psychosocial stress, neurobiological factors such as site of infarct and brain atrophy may also be related to Post Stroke Depression (PSD). There are conflicting results in this area of research and paucity of such data in Indian literature. Thus the aim of this study is to weigh the importance of lesion location in PSD. MATERIALS AND METHODS: Sixty two subjects with their first ever stroke were interviewed using a semi-structured proforma and PSD diagnosed using MINI Plus interview. Scales of Beck Depression Inventory and Montgomery Asberg Depression Rating Scale were used to assess severity of depression. Mini mental state examination was used to assess cognitive impairment and Barthel Index to measure Activities of Daily Living. Neuro-imaging provided information on site and side of lesion. Collected data was analysed using SPSS version 15.0. RESULTS: PSD was diagnosed in 28 subjects, amongst who 19 had left sided lesions. Left sided cortical infarcts and sub cortical infarcts showed statistically significant association with PSD. CONCLUSION: Results are in keeping with previous landmark studies. Differences in emotional reactions depending on hemisphere and site of the infarct as shown in this study suggest organic biological basis for post stroke depression. Understanding the etiological basis would allow clinicians to monitor patients at risk of developing PSD, enabling early detection and treatment thus improving their quality of life and rehabilitation.

Trends of utilization of government disability benefits among chronic mentally ill.

BACKGROUND: Mentally retarded and chronic mentally ill are being certified using IQ Assessment and Indian Disability Evaluation and Assessment Scale (IDEAS). They have been granted various benefits including monthly pension, from Ministry of Social Welfare, Government of India. The monthly pension appears to be the strongest reason for seeking certification and applying for government benefits. The caregivers appear to have only partial information and awareness about the remaining schemes. OBJECTIVE: The study aims to assess the severity of disability in the mentally retarded and mentally ill who are certified for disability benefits, as well as to assess the trends of utilization of disability benefits over a 3 year period. MATERIALS AND METHODS: This was a retrospective, file review based study of certificates of patients certified for mental disability in the period of January 2006 to December 2008. Certificates of a total of 1794 mentally retarded and 285 mentally ill were reviewed. The data regarding utilization of disability benefits was assessed. RESULTS: Patients from rural areas did not avail any benefits other than the disability pension. Among Mentally Ill, Schizophrenia accounted for highest certifications. Males had higher disability compared to females, and Dementia showed highest disability as per IDEAS. CONCLUSION: Though initial hurdles due to disability measurement have been crossed, disability benefits are still elusive to the vast majority of the disabled. Proper awareness and education will help in reducing the stigma and in the effective utilization of benefits.