A follow-up study of anxiety and depressive symptoms in irritable bowel syndrome.

Background: Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) disorder and is closely linked to stress. Psychiatric morbidities such as anxiety and depression are common in IBS. Long-term follow-up studies on anxiety and depressive symptoms in IBS and the impact of treatment are lacking in the Indian scenario. Aims: This study aimed to assess the various subtypes of IBS according to the Rome IV criteria, assess anxiety and depressive symptoms in patients with IBS at baseline and also at various phases of follow-up over one year, and see the impact of the treatment of both IBS and associated anxiety and depressive symptoms if present, in the severity of IBS and other psychiatric symptoms. Materials and Methods: Patients with IBS, aged between 18 and 65 years, were enrolled for the study. Subtypes and severity of IBS were assessed. Anxiety and depressive symptoms were assessed by the Hamilton Rating Scale for Anxiety (HAM-A) and the Hamilton Rating Scale for Depression (HAM-D), respectively. The patients were treated with conventional treatment of IBS with concomitant treatment of anxiety and depressive symptoms and were followed up for 1 year. Results: Thirty-seven patients completed a 1-year follow-up. The mean age was 38.4 ± 11.6 years. The majority were males (81%), and IBS-D (84%) was the most common subtype. Stressful life events (67.6%) and chronic stressors (64.9%) were present in the majority of the patients. The patients had moderate-to-severe anxiety at baseline (HAM-A score 27.8 ± 6.4) and moderate-to-severe depression at baseline (HAM-D score 19.7 ± 6.6). The improvement over 1 year was statistically significant (P = 0.000, two-tailed). A positive correlation between the severity score of IBS and HAM-D (r = 0.604) and HAM-A (r = 0.536) scores was present. Conclusion: There is a high prevalence of anxiety and depression in patients with IBS. With adequate treatment of both IBS and concomitant anxiety-depressive symptoms, there is a significant decrease in the severity of IBS, anxiety, and depression.

Dissociative experiences and health anxiety in panic disorder.

BACKGROUND: Dissociative experiences and health anxiety are frequently encountered in anxiety disorders and contribute to the burden of illness. AIM: The aim was to assess and compare dissociative experiences and level of health anxiety in patients with panic disorder and normal individuals. MATERIALS AND METHODS: We recruited forty eligible patients with panic disorder and forty healthy volunteers without any psychiatric diagnoses. Health anxiety was evaluated by the Short Health Anxiety Inventory and dissociative symptoms were assessed by the Dissociative Experiences Scale (DES). RESULTS: Dissociative experiences were more frequently reported by patients with panic disorder compared to normal controls, but overall mean DES scores were lower in both groups compared to previous literature. A high level of health anxiety was also seen in panic disorder compared to normal individuals. CONCLUSION: Health anxiety and dissociative experiences, especially depersonalization-derealization, are commonly encountered in panic disorder and should be actively explored to understand how they influence psychopathology and treatment outcome.

Obsessive compulsive-disorder and reproductive life events.

We explored the association between reproductive life events and the onset or exacerbation of obsessive-compulsive disorder (OCD) among women in comparison with men with OCD. We chose men because there is some evidence of increased occurrence of OCD in expectant fathers as well. We recruited 150 eligible outpatients (58 men and 92 women) with OCD, who attended a specialty OCD Clinic over a period of one year. Occurrence of any life event including reproductive life events in the year before the onset of OCD was assessed using the Interview of Recent Life Events (IRLE). Reproductive life events in the year prior to onset of OCD were overrepresented in women compared to men. Postpartum onset and worsening of OCD was reported in 14 % and 11 % of women respectively. Menarche and menopause as life events were infrequently reported (3% and 1%). Symmetry obsessions and ordering compulsions were more common in women with post-partum onset of OCD than those without. Post-partum period seems to be associated with onset and exacerbation of OCD; therefore, routine screening for OCD during this period is necessary.

Menstrual psychosis: A not so forgotten reality.

Menstrual psychosis is a rare entity, reported mostly as case studies in the medical literature. It presents with an acute onset of psychotic symptoms lasting for a short duration in a previously normal patient and occurring in rhythm with her menstrual cycle. It is usually associated with complete recovery in between episodes. This case series elaborates three case studies which have met the modern classification of this disorder and responded adequately to treatment. Reporting this series will help us to recognize and explore the role of hormonal changes related to the menstrual cycle on the mental health of women.

Bipolar disorder comorbidity in patients with a primary diagnosis of OCD.

OBJECTIVE: Bipolar disorder (BD) is considered to be a common comorbid condition in subjects with obsessive-compulsive disorder (OCD), but there is limited literature on the prevalence of BD and its clinical correlates in those with a primary diagnosis of OCD. METHODS: We studied the prevalence of BD in a sample of consecutively registered outpatients attending a specialty OCD clinic in India over a period of 13 months. One hundred and seventy-one patients with a primary diagnosis of OCD were assessed systematically using structured and semi-structured instruments. RESULTS: The prevalence of lifetime BD in OCD was 4%. The OCD + BD group had an episodic course of OCD and higher rate of lifetime suicide attempts. CONCLUSIONS: BD may not be as highly prevalent in OCD as reported in literature. Those with OCD seem to have only a marginally higher risk for developing BD than the general population. A diagnosis of BD seems to have a pathoplastic effect on the course of OCD. Patients with OCD-BD comorbidity have to be specifically assessed for suicide risk.

Complex partial status epilepticus: an unusual presentation.

Nonconvulsive status epilepticus (NCSE) is not uncommon, especially in the elderly population. It can occasionally present as confusion, personality change, coma, subtle motor activity and psychosis, thus causing diagnostic difficulties. We report an unusual case of NCSE which presented as psychosis-like episodes at regular intervals. The confirmation of diagnosis was aided by serial electroencephalography.