Assessing catatonia using four different instruments: Inter-rater reliability and prevalence in inpatient clinical population.

BACKGROUND AND AIMS: The present study aimed to assess inter-rater reliability and prevalence of catatonia according to four diagnostic methods: Bush Francis Catatonia Rating Scale (BFCRS) both screening and complete scale, Braunig's Catatonia Rating Scale (CRS), ICD 10 and DSM5. METHODS: For inter-rater reliability, different raters evaluated patients using the definitions provides by the four scales: BFCRS Screen and Total, CRS, ICD10 and DSM5. Kippendorff'α was used to compute the inter-rater reliability. Concordance between different systems was assessed using spearman correlation. Prevalence of catatonia was studied using the four definitions in a clinical sample of consecutive adult admissions in a psychiatry ward of a tertiary care hospital. RESULTS: The inter-rater reliability was found to be good for BFCRS Total (α=0.779), moderate for DSM5 and BFCRS screen (α=0.575 and α=0.514 respectively) and low for CRS and ICD10 (α=0.111 and α=0.018 respectively). BFCRS Total and DSM5 definitions of catatonia had highest concordance (rs=0.892 p<0.001). In the prevalence sample of consecutive hospital admissions, the prevalence was found to be highest with the definitions of BFCRS Screen and ICD 10 (10.3%, confidence intervals [CI] 3.9% to 16.7%), followed by BFCRS Total and DSM5 definitions 6.9%, CI 1.6% to 12.2%) and while CRS yielded the lowest prevalence rate (3.4%, CI 0% to 7.2%). CONCLUSION: Different methods used to determine catatonia in the clinical sample yield different prevalence of this condition.

How do repeat suicide attempters differ from first timers? An exploratory record based analysis.

BACKGROUND: Evidence indicates that repeat suicide attempters, as a group, may differ from 1(st) time attempters. The identification of repeat attempters is a powerful but underutilized clinical variable. AIMS: In this research, we aimed to compare individuals with lifetime histories of multiple attempts with 1(st) time attempters to identify factors predictive of repeat attempts. SETTING AND DESIGN: This was a retrospective record based study carried out at a teaching cum Tertiary Care Hospital in South India. METHODS: Relevant data was extracted from the clinical records of 1(st) time attempters (n = 362) and repeat attempters (n = 61) presenting to a single Tertiary Care Center over a 4½ year period. They were compared on various sociodemographic and clinical parameters. The clinical measures included Presumptive Stressful Life Events Scale, Beck Hopelessness Scale, Coping Strategies Inventory - Short Form, and the Global Assessment of Functioning Scale. STATISTICAL ANALYSIS USED: First time attempters and repeaters were compared using appropriate inferential statistics. Logistic regression was used to identify independent predictors of repeat attempts. RESULTS: The two groups did not significantly differ on sociodemographic characteristics. Repeat attempters were more likely to have given prior hints about their act (χ(2) = 4.500, P = 0.034). In the final regression model, beck hopelessness score emerged as a significant predictor of repeat suicide attempts (odds ratio = 1.064, P = 0.020). CONCLUSION: Among suicide attempters presenting to the hospital, the presence of hopelessness is a predictor of repeat suicide attempts, independent of clinical depression. This highlights the importance of considering hopelessness in the assessment of suicidality with a view to minimize the risk of future attempts.

Do Personality Traits Such as Impulsivity and Hostility-Aggressiveness Predict Severity of Intent in Attempted Suicide? Findings From a Record Based Study in South India.

BACKGROUND: Little is known about the association of personality traits with intent in attempted suicide. AIMS: Our objectives were to assess the levels of selected personality factors among suicide attempters and to examine their association with suicide intent. MATERIALS AND METHODS: A chart review of 156 consecutive suicide attempters was carried out. All participants were administered the Beck Suicide Intent Scale, Barratt Impulsivity Scale-11, Buss-Perry Aggression Questionnaire, and Past Feelings and Acts of Violence Scale to assess suicide intent, trait impulsivity, hostility-aggression, and violence, respectively. Pearson's product moment correlation was the used as the test of association. Stepwise linear regression was used to identify predictors of suicide intent. RESULTS: Suicide intent was significantly correlated with verbal aggression (Pearson r = 0.90, P = 0.030), hostility (Pearson r = 0.316, P < 0.001), and nonplanning impulsivity (r = -0.174, P = 0.049). High hostility and low motor impulsivity emerged as significant predictors of suicide intent. CONCLUSION: Personality traits such as hostility and to an extent, impulsivity are accurate predictors of intentionality in attempted suicide. Clinicians should focus on these personality attributes during a routine evaluation of suicide attempters. They can also be considered as potential targets for suicide prevention programs.

Olanzapine-induced tender pitting pre-tibial edema.

Antipsychotic-induced edema is uncommonly encountered in clinical practice. We report a case of tender pitting pre-tibial edema with olanzapine in a woman with no medical comorbidities. The peculiar distribution of edema resulted in diagnostic confusion necessitating specific investigations. Eventually, the edema resolved following complete stoppage of the drug, but caused distress to the patient and the caregiver.