Sexual performances after mild and moderate head injury in Indian adult males: An institutional experience.

Background: Traumatic brain injury (TBI) is one of the most common causes of morbidity and mortality worldwide than any other injuries. Disorders in sexual functions constitute one of the most prevalent and least discussed problems following head injury, which need to be studied in detail. Objective: To find out the intensity of sexual dysfunction following head injury in Indian adult males. Methods and materials: Prospective cohort study was conducted among 75 adult Indian males with mild and moderate head injury with Glasgow Outcome Scale (GOS) 4 or 5. Arizona sexual experience (ASEX) scale was used to evaluate sexual changes in these male patients following TBI. Results: Most of the patients experienced satisfactory sexual changes (P < 0.0001) in terms of sex drive, sexual arousal, erection, ease of orgasm and orgasm satisfaction. Most of the patients (77.3%) showed a total individual score of ≤18 on ASEX scale. A score of <5 on any one item on ASEX scale was seen in majority (80%) of the patients. In our study, sexual changes experienced following TBI were significantly (P < 0.0001) of mild severity as compared with moderate and severe sexual disability. Type of head injury was not associated with significant (P > 0.05) sexual changes experienced following TBI. Conclusions: In this study, some patients experienced mild sexual disability. Addressing those sexual issues, sexual education and rehabilitation programmes following head injury should be an integral part of follow-up care in such patients.

Sexual dysfunction in men on buprenorphine - naloxone-based substitution therapy.

BACKGROUND: The literature on sexual dysfunction in patients on buprenorphine-naloxone (BNX) substitution is limited. MATERIALS AND METHODS: This research aimed to study the prevalence and correlates of sexual dysfunction in men on BNX substitution therapy. We recruited consecutive forty men from BNX clinic, who had received BNX for at least 6 months, who were free from any recent illicit drug use (confirmed by urine chromatographic immune assay), and who were either married or had a stable sexual partner. Men with other psychiatric and substance use disorders (except tobacco) were excluded from the study. Data for the control group were obtained from a published study (with similar selection criteria) from our center. We assessed sexual dysfunction with two cross-culturally validated instruments: Arizona Sexual Experience Scale (ASEX) and International Index of Erectile Function. RESULTS: The sample had a mean age of 31.6 (±8) years; the mean duration of BNX treatment was 9 (±4.2) months and the mean BNX dose was 4.5 (±1.6) mg. ASEX showed the prevalence of sexual dysfunction to be 40%. The IIEF demonstrated intercourse dissatisfaction (95%) and hypoactive sexual desire (92.5%) as almost universal, while 77.5% of the participants reported erectile dysfunction. In comparison to the published data, these figures were significantly more than among the controls. We found no correlation of sexual dysfunction with marital status, age, duration or dose of BNX, duration of illicit opioid use, the severity of opioid dependence, and tobacco dependence. CONCLUSION: All men on BNX maintenance therapy must be screened for sexual dysfunction. With the rapid scaling up of office-based BNX substitution, assessment and management of sexual dysfunction ought to be incorporated in the training curriculum.

Electroconvulsive Therapy among Elderly patients: A study from Tertiary care centre in north India.

OBJECTIVE: This retrospective study aimed to evaluate the effectiveness and safety of ECT among elderly patients receiving electroconvulsive therapy (ECT). METHODS: During the study period of January 2008 to May 2017, 151 patients aged ≥60 years received ECT and they formed the study sample. Data on patients aged 19 to 59 years for the period of 3 years (2014-2016) was also extracted for comparison purposes. RESULTS: The mean age of the elderly subjects was 65.8 years. In contrast to the young patients, elderly patients who received ECT more often had diagnosis of affective disorder, especially unipolar depression. Compared to young patients, elderly patients had higher prevalence of physical comorbidity with one third having more than one physical illness. The most common reason for use of ECT among elderly was poor response to medications (62.3%), followed by requirement of early response (49.6%). Four-fifth (80.8%) of the elderly patients showed ≥50% reduction in the symptoms with ECT. In terms of side effects, acute blood pressure changes were seen in 40.3% of patients during the ECT procedure and about half of the patients reported cognitive disturbances. CONCLUSION: Present study suggests that ECT can be safely used among elderly patients, especially those with depressive disorders, not responding to medications.

Clinic-based Group Multi-professional Education Causes Significant Decline in Psoriasis Severity: A Randomized Open Label Pilot Study.

BACKGROUND: The evidence for efficacy of psychoeducational interventions in psoriasis is not well researched. OBJECTIVE: The objective of this study was to assess the benefits of a group, multi-professional, psychoeducational training in psoriasis. MATERIALS AND METHODS: Adults with moderate-to-severe psoriasis were randomized into psychoeducational intervention plus treatment (intervention arm [IA]) and treatment as usual alone (control arm [CA]) groups using random number tables. The primary efficacy measures were mean changes in Psoriasis Area Severity Index (PASI) and Dermatology Life Quality Index (DLQI) at 6months from the end of intervention. The secondary efficacy measures were the mean changes in the WHO-5 well-being index (WHO-5) and the subsets of the patient health questionnaire (PHQ), namely, PHQ-9, generalized anxiety disorder (GAD)-7, andPHQ-15. Datawere analyzed by intention-to-treat analysis. RESULTS: One-hundred and three participants were randomized into IA (n = 54) and CA (n = 49). The prevalence of psychiatric disorders in the entire population was 26.2% and was similar in both groups. Following intervention, there was statistically significant improvement in the mean scores in PASI, DLQI, and WHO-5 in the IA unlike that seen in the CA. There was statistically significant improvement in PHQ-9 scores in IA and CA. The scores on PHQ-15 and GAD-7 did not show any change. Intergroup comparisons showed that PASI was reduced significantly in IA as compared to CA. More participants in CA dropped out of the study than in the IA. LIMITATIONS: Modest sample size and lack of blinding of the participants and the administrators were the limitations of this study. CONCLUSION: Group psychoeducational intervention resulted in overall improvement in both clinical and psychological outcome measures in psoriasis patients.

A Case of Schizophrenia Like Psychosis Due to Fahr's Disease.

Fahr's disease (FD) is a rare idiopathic degenerative neurological disorder, which can be present in different heterogeneous manifestations and characterized by bilateral symmetrical cerebral calcification. We present a case of a 55-year-old male who presented with the psychotic feature, bilateral tremors of hand and bilateral symmetrical calcification of basal ganglia. Hence our case suggests that psychiatrists should evaluate the cases of psychosis thoroughly when the age of presentation is atypical, and they should consider the diagnosis of FD when psychosis presents with motor abnormalities.