Psychiatric Morbidities and Their Impact on Quality of Life in Patients With Psoriasis.

Background Psychiatric morbidities, which are commonly seen in psoriasis patients, are often missed or ignored leading to poor quality of life. A lack of communication between psychiatrists and dermatologists leads to ignorance of psychiatric morbidities in psoriasis patients, which can eventually take a severe form. Therefore, both groups must collaborate to provide high-quality patient care. As there is a dearth of such studies in the North-Eastern part of India, this study aimed to highlight the above-mentioned problem. Aim The aim of this study was to study psychiatric morbidities in patients with psoriasis and to compare quality of life in psoriasis patients with and without psychiatric morbidities. Methods This study was a hospital-based cross-sectional study conducted in the Dermatology Department, Assam Medical College and Hospital, Dibrugarh, Assam, India from July 2020 to July 2021. Ninety patients with psoriasis were included in the study and the diagnosis was confirmed by a consultant dermatologist, then the Mini International Neuro-psychiatric Interview Scale (M.I.N.I.; version 5.0) scale was applied to screen psychiatric morbidities. The diagnoses were confirmed using ICD-10 followed by dividing psoriasis patients into two groups, i.e. with and without psychiatric morbidities. After that the World Health Organization Quality of Life (WHOQOL) scale was applied to both groups and the domains of quality of life were compared. Results Our results showed that 61.1% of psoriatic patients had psychiatric morbidities, which is abnormally high compared to other dermatological disorders. The psychological domain of quality of life was the most affected (WHOQOL scale scoring of 38.12±6.67 vs. 48.76±6.21) in both groups of patients (i.e., with and without psychiatric morbidities), and the environmental domain was the least affected (56.67±10.65 vs. 64.67±8.18). Every domain of quality of life had a lower score in patients with psoriasis with psychiatric morbidities as compared to those without (p<0.05). Conclusion Our results of 61.1% psychiatric morbidities in psoriasis patients emphasize the need for psychiatric evaluation in every psoriasis patient. The timely intervention of psychiatric morbidity in psoriasis patients with collaboration of psychiatrists and dermatologists will surely improve the patient's condition to some extent and, thus, their quality of life.

Cotard's Delusion and Its Relation With Different Psychiatric Diagnoses in a Tertiary Care Hospital.

Background Cotard's delusion/Cotard's syndrome is a series of delusions ranging from a false, fixed, unshakeable belief that one has lost their soul, blood, organs, and body parts to the belief that one is dead. The syndrome was initially thought to be associated with only mood disorders but later was found in other psychiatric illnesses as well. Aim The study aimed to find an association between Cotard's delusion and the psychopathology of different psychiatric diagnoses. Method The clinical study comprised seven patients presenting with symptoms of Cotard syndrome with different presentations, diagnoses, and onset and meeting inclusion criteria. The study was carried out in the Department of Psychiatry, Assam Medical College and Hospital. The patients were hospitalized and, after a detailed history, mental status examination, and laboratory investigations, were treated with pharmacological and non-pharmacological methods. A descriptive statistical analysis was done. Results Denial of the existence of body organs was the most similar complaint encountered in the cases. The duration of illness onset ranged from weeks to months. The symptoms were found to be present in different psychiatric illnesses like schizophrenia, delusional disorder, depression, and intellectual disability. The patient had responded well to pharmacological agents with the exception of three patients who were treated with electroconvulsive therapy. Conclusion The study highlights the different subtypes of Cotard's syndrome and its associated symptoms, which provides a better understanding of the condition. The case series presents a finding of a higher proportion of male patients and adolescent cases than in previous reports. The study also provides valuable insights into its heterogeneity in the diagnosis and treatment of Cotard's syndrome, which may help in the early recognition and management of this rare condition.

Parental Supervision and Its Relation With Emotional and Behavioral Problems in Secondary School Children.

Background Emotional and behavioral problems of children are a common concern for parents and mental health stakeholders alike. Poor parenting is a well-known factor associated with behavioral problems in children. There is unanimity regarding the correlation between parental supervision and emotional and behavioral problems. This present study aimed to establish a relationship between parental supervision and emotional and behavioral problems, as it could make way for further research based on the concept of parental supervision, which parents can quickly adopt as an intervention strategy for children with behavioral and emotional problems. Aim We aim to assess parental supervision and its relation with emotional and behavioral problems in secondary school children. Method This is a community-based cross-sectional observational study among 770 parents of children from schools in Dibrugarh, Assam, over a period of one year. Multistage random sampling was applied to obtain the sample size. The Strengths and Difficulties Questionnaire (SDQ) was used to assess children's emotional and behavioral problems, the Alabama Parenting Questionnaire (APQ) was used to assess parental supervision, and sociodemographic proforma was used to study various demographic variables. The observed data were analyzed using the computer program Statistical Package for the Social Sciences for Macintosh version 24.0 (IBM SPSS Statistics, Armonk, NY, USA). Results The study revealed that participants' poor supervision had a positive correlation with emotional and behavioral problems. Poor monitoring/supervision had a positive correlation with total difficulty score levels, and positive parenting practices such as involvement and positive parenting had a negative correlation with emotional and behavioral problems. There was a statistically significant association between behavioral problems and selected demographic variables such as parents' education, socioeconomic status, and family type. The study also found that there was a significant statistical association between sociodemographic variables such as age and negative parenting practices such as poor monitoring/supervision, inconsistent discipline, and corporal punishment. Conclusion It was found that factors such as inconsistent discipline and poor supervision had a significant impact on emotional and behavioral problems in children. In future monitoring research, one can adopt a constructional approach, where the goal should be to explain and distinguish good parental supervision behaviors from poor supervision. This knowledge can be used to develop good intervention strategies to halt such emotional and behavioral problems.

Life-threatening thrombocytosis following GCSF treatment in a case of clozapine-induced agranulocytosis.

Clozapine was introduced in European market in 1972 as an effective treatment for schizophrenia without extrapyramidal side effects. Within a short while, the clozapine story virtually came to a halt following detection of life-threatening neutropenia and agranulocytosis. Judicial use of granulocyte colony stimulating factor (GCSF) can be life saving with infrequent side effects in these cases. Here we are presenting a case of clozapine induced agranulocytosis managed with GCSF but had transient but life-threatening thrombocytosis, a very uncommon complication of GCSF therapy. Expression of GCSF receptors on the surface of megakaryocytic lineage is thought to be the cause of this unusual phenomenon.

A case presented with "as if" phenomenon.

A 22-year-old young male who was brought with a history of feeling of unreality, as if he himself and his surroundings had changed, since six months without any comorbid mental disorder or physical illness. Premorbidly he had some "obsessional traits". Mental state examination revealed perceptual disorder in the form of depersonalization and derealization with insight grade VI. The patient was admitted and treated with pharmacotherapy and behavior therapy (relaxation exercise).