Prevalence of Psychiatric Comorbidity among Patients of Type 2 Diabetes Mellitus in a Hilly State of North India.

BACKGROUND: Psychiatric comorbidity with diabetes mellitus is common. Comorbidity of diabetes and psychiatric disorders can present in different patterns, which are associated with impaired quality of life, increased cost of care, poor treatment adherence, poor glycaemia control and increased emergency room visits. The present study was planned to assess the psychiatric comorbidity in type 2 diabetic patients at tertiary care hospital in a hilly state of North India. OBJECTIVES: To study the prevalence of psychiatric comorbidity among patients of type 2 diabetes mellitus and to study the association between psychiatric comorbidity, sociodemographic and clinical variables in such patients. MATERIALS AND METHODS: A cross-sectional study was conducted after enrolling the eligible diabetic patients attending outpatient department services of medicine department, Indira Gandhi Medical College, Shimla. The Brief Illness Perception Questionnaire was used to assess the cognitive and emotional aspects of illness, Hamilton Depression Rating Scale for assessment of depression, Hamilton Anxiety Rating Scale for assessing severity of anxiety and Mini-International Neuropsychiatric Interview 6.0 for screening all major Axis I disorders. RESULTS: Out of 320 patients of type 2 diabetes mellitus screened, 202 eligible patients were enrolled. Depression was the most common psychiatric comorbid illness present in (41.9%) patients. Depression was slightly higher in female patients and persons aged >50 years. Greater prevalence of depressive episodes was there in people with longer duration of diabetes. CONCLUSION: There were a significant percentage of diabetic patients having psychiatric illnesses. Their attitude towards these comorbidities may be changed by psychiatric counselling at regular intervals.

Opium Withdrawal Delirium: Two Case Reports.

Two patients with opium dependence developed delirium during abstinence. The delirium resolved completely within 48-58 hours of appropriate treatment. Caution needs to be exercised during opioid detoxification in timely detecting and treating potentially life-threatening condition like delirium.

Scrub typhus with visual hallucinations.

The occurrence of psychiatric symptoms in scrub typhus is not commonly reported in literature. We present a case of scrub typhus with visual hallucinations.

Topiramate induced pruritus in a patient with alcohol dependence.

Topiramate is an antiepileptic medication frequently used for the management of alcohol dependence and in other psychiatric disorders. Though cutaneous side effects are known to occur with it, isolated pure pruritus is rarely reported with topiramate in the literature. We wish to report a case of pruritus associated with topiramate use in a male with alcohol dependence syndrome.

Behavioural and emotional problems in school going adolescents.

BACKGROUND: Adolescents are highly vulnerable to psychiatric disorders. This study aimed to explore the prevalence and patterns of behavioural and emotional problems in adolescents. It was also aimed to explore associations between socioenvironmental stressors and maladaptive outcomes. METHOD: A school based cross-sectional study was conducted between January and July 2008. A stratified random sampling was done. 1150 adolescents in 12 to 18 year age group in grades 7 to 12 in 10 co-educational schools (government run and private) were the subjects of the study. Behavioural and emotional problems were assessed using Youth Self-Report (2001) questionnaire. Family stressors were assessed using a pre-tested 23 item questionnaire. Univariate and multivariate analysis were performed. Multiple logistic regression analysis was also done. RESULTS: Prevalence of behavioural and emotional problems in adolescents was found to be 30%, with girls exceeding boys in all age groups. Internalizing syndrome was the most common (28.6%) psychiatric problem. On stepwise regression analysis, a perceived lack of emotional proximity to mother had the highest odds (3.489) followed by addiction in father (2.642) and marital discord in parents (1.402). Type of school, type of family, socioeconomic status, relationship with father, mother&s employment and educational status were not found to be significantly associated CONCLUSION: An alarming number of our adolescents suffer from emotional and behavioural problems which have their roots in the family environment. These data suggest urgency in establishing a school based mental health service.

Delirium associated with olanzapine therapy in an elderly male with bipolar affective disorder.

Atypical antipsychotic medications are commonly used to treat symptoms of delirium. Olanzapine has been successfully used in the treatment of delirium. However, there have been few case reports of delirium associated with olanzapine. We hereby report a case of delirium associated with olanzapine therapy. Possible risk factors and underlying pathogenesis is discussed.

Mutism as the presenting symptom: three case reports and selective review of literature.

Mutism, defined as an inability or unwillingness to speak, resulting in an absence or marked paucity of verbal output, is a common clinical symptom seen in psychiatric as well as neurology outpatient department. It rarely presents as an isolated disability and often occurs in association with other disturbances in behavior, thought processes, affect, or level of consciousness. It is often a focus of clinical attention, both for the physician and the relatives. Mutism occurs in a number of conditions, both functional and organic, and a proper diagnosis is important for the management. We hereby present three cases, who presented with mutism as the presenting symptom and the differential diagnosis and management issues related to these cases are discussed. The authors also selectively reviewed the literature on mutism, including psychiatric, neurologic, toxic-metabolic, and drug-induced causes.

First episode mania at 75 years of age.

Late onset psychiatric disorders are often associated with organic factors, either medical or neurological. Mania occurring for the first time in the elderly population is rarely reported. We hereby report a patient with first episode mania who was investigated in detail, but no organic factors were found. He was diagnosed as first episode mania and was managed with divalproex and olanzapine.

Hypomania induced by escitalopram: 2 case reports.

Two cases, one of recurrent depression and another of major depressive disorder with hypertension switched to hypomania while on escitalopram. Both patients achieved remission with atypical antipsychotics and divalproex. The implications of diagnosis and treatment are discussed.

Obsessive compulsive disorder with pervasive avoidance.

Obsessive compulsive disorder (OCD) is a common disorder, but some of its atypical presentations are uncommon and difficult to diagnose. We report one such case which on initial presentation appeared to be psychotic protocol but after detailed workup was diagnosed as OCD with marked avoidance symptoms.

A probable association of acute dystonia with gemifloxacin administration.

Gemifloxacin is a recently introduced fluoroquinolone antibiotic frequently used for its broad spectrum and once-daily dosing. Fluoroquinolones are associated with various neuropsychiatric side effects, such as seizures, insomnia, confusion, lightheadedness, psychosis, paranoia and hallucinations. We report a case of a 36-year-old woman given gemifloxacin for an upper respiratory tract infection who developed acute dystonia on the third day following therapy initiation. The clinical implications are discussed.

Clinical profile of pediatric somatoform disorders.

OBJECTIVES: To study the prevalence, pattern, clinical and socio-demographic characteristics of somatoform disorders in children. METHODS: From Aug 2004 to July 2005, children up to 18 years with unexplained physical symptoms were evaluated prospectively using DSM-IV criteria. Detailed evaluation followed for those meeting criteria. RESULTS: The prevalence of Somatoform disorders was 0.59% and 0.78% among out-door and in-door patients respectively. Among 124 children (40 boys and 84 girls) meeting criteria, conversion disorder was the commonest (57.3%), followed by undifferentiated somatoform disorder (25.2%). Girls were significantly more represented among conversion disorder patients compared to other groups of somatoform disorders (78.9 vs. 52.8 %, P=0.002). In conversion disorder, 2/3rd patients presented within 3 months, whereas in other somatoform disorders, 2/3rd patients presented within 3 months after symptoms. Fainting attacks (52.1%) and ataxia (43.7%) in conversion disorder and pain abdomen (52.8%) and headache (52.8%) in other somatoform disorders, were the commonest symptoms. Stressors were identified in 73.4% and acute precipitating stressors were present in 14.4% children. Boys had significantly higher rates of poor inter-personal relations and communication problems within the family (72.5% vs. 41.7%, P=0.001), while girls had significantly higher rates of conflicts with the parents and other family members (21.4% vs. 5%, P=0.02). CONCLUSION: Somatoform disorders, particularly conversion disorder is commoner in girls. Important stressors are poor inter-personal relations and communication problems within the family in boys, and conflicts with family members among girls.