Adarsh Kohli

Incidence of childhood psychiatric disorders in India

Background: Studies on incidence of childhood mental disorders are extremely rare globally and there are none from India. Incidence studies though more difficult and time consuming, provide invaluable information on the pattern and causes of occurrence of mental disorders allowing opportunity for early intervention and primary prevention. Aim: This study aimed at estimating the incidence of psychiatric disorders in school children. Materials and Methods: A representative sample of school children was assessed through a two stage evaluation process involving teachers rating (N=963) and parent rating (N=873). Children who scored below the cut-off for psychiatric disorder (N=727) on both the screening instruments were re-contacted six years later. 186 children and their families were personally available for reevaluation. All the children and their parents were re-assessed on Parent Interview Schedule; Strengths and Difficulties Questionnaire: and detailed clinical assessment by a psychiatrist. Psychiatric diagnosis was made as per ICD 10 criteria. Data on children who were found to have psychiatric disorder were compared with those who did not have psychiatric disorders. Results: 20 children out of 186 followed up had psychiatric disorder giving the annual incidence rate of 18/1000/yr. Children who had disorder at follow-up did not differ from those who did not on age, gender and psychological (temperament, parental handling, life stress and IQ) parameters at baseline. Discussion: Incidence figures cannot be compared due to lack of any comparable studies. Factors associated with occurrence of new cases of psychiatric disorder and implications for future studies are discussed.

Auditory P300 Event-Related Potentials and Neurocognitive Functions in Opioid Dependent Men and Their Brothers

Event-related-potentials (especially P300) and cognitive functioning as potential endophenotypes have not been studied in opioid dependence. We compared auditory P300 and cognitive functions in opioid-dependent men, their brothers and normal controls in an exploratory study with a view to find shared genetic factors in the development of opioid dependence. Twenty abstinent opioid-dependent males, their brothers and twenty matched controls were administered Wisconsin card sorting test (WCST), digit span test, trail making test-B, and auditory event-related potentials (P300) from an oddball task were recorded. The opioid dependent group performed the worst, the brothers group was intermediate, and the control group performed the best on tests of WCST, digit span and trail making test-B. The opioid dependent group had the smallest amplitudes and longest latencies of P300, and was followed by the brothers group who had an intermediate position and the control group who had the largest amplitudes and the shortest latencies. P300 and executive neurocognitive functions can be considered endophenotypes for the genetic study of vulnerability to opioid dependence. These are reflective of executive dysfunction and disrupted behavioral inhibition and the intermediate position of brothers suggests a common genetic substrate as a component of the etiology.

Wisconsin Card Sorting Test: Normative data and experience

Background: The Wisconsin Card Sorting Test (WCST) has been increasingly employed as a clinical neuropsychological instrument. However, in India the use of WCST is still in a relatively preliminary stage. Aim: To analyse the utility of WCST in the Indian population. Methods: Fifty-three subjects in the age group of 20–50 years, comprising both men and women, were recruited for the study. The normality was established by administering the General Health Questionnaire as a screening instrument to evaluate their health status. The WCST was administered and the norms for various dimensions were established; these were compared with those of normal healthy individuals from the West as per the WCST manual. Results and conclusion: The significance of differences and the experience of administration have been described. The present study found highly significant differences between the means on almost all WCST scores among the Western and the Indian sample, except for the number of correct responses.

Specific learning disabilities in children: deficits and neuropsychological profile.

The public is gradually becoming aware of specific learning disabilities (SLDs), which are very often the cause of academic difficulties. The aim of the study was to assess the SLDs in the clinic population at the Child and Adolescent Psychiatry Clinic at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh using the National Institute of Mental Health and Neurosciences SLD index and subsequently to assess the childrens neuropsychological functions using a battery of tests. Thirty-five children in the age range of 7–14 years (both boys and girls) were recruited as the cohort, diagnosed clinically and assessed using the battery of tests for SLDs and neuropsychological tests consisting of the PGIMER memory scale for children, the Wisconsin card sorting test, the Bender visuo-motor gestalt test and Malins intelligence scale for Indian children. The study revealed deficits in language and writing skills and impairments in specific areas of memory, executive functions and perceptuo-motor tasks. Identification of SLDs is useful in drawing up a treatment plan specific for a particular child.

Neuropsychological assessment in obsessive-compulsive disorder

Background: Neuropsychological deficits in obsessive-compulsive disorder (OCD) have been encouraged by brain imaging studies suggesting a putative fron to- striatial biological basis of the condition. Studies of neuropsychological functions in OCD have documented deficits in several cognitive domains, particularly with regard to visuospatial abilities, executive functioning, motor speed and memory. The Aim of the present study was to assess neuropsychological profile of patients with OCD. Objectives of the study were to assess and compare the neuropsychological profile of patients with OCD and matched healthy controls. Materials and Methods: Twenty clinically stable outpatients with ICD-10 diagnosis of OCD and equal number of normal controls matched for age, education, gender and handedness were studied using a battery of neuropsychological tests. The tests consisted of verbal and performance tests of intelligence, memory, perceptual motor functions, set test and Wisconsin Card Sorting Test (WCST). Results: On perceptual-motor functions, verbal fluency, executive functions (WCST), intelligence and memory patients with OCD did not show impairments comparable to healthy controls. An attempt to correlate the test findings with the duration of illness, stability of illness and the average drug dose was made and it was found that there was no correlation between the two. Conclusion: The present study does not provide evidence for a localized neuropsychological/cognitive impairment in OCD in cases that are stable for at least three months. Absence of impairments in perceptual-motor functions, verbal fluency, executive functions (WCST), intelligence, and memory does not agree with the results of other studies using these tests.

Profile of Deficits on Assessment Battery in Children with Specific Learning Disorders

Learning disabilities affects the acquisition, organization, retention, understanding, or use of verbal or nonverbal information. They usually result from impairments in memory, attention, phonological processing, language processing, visuospatial processing, and so forth leading to inabilities in oral language like speaking and understanding the grammatical constructions, reading like phonetic knowledge and word recognition, written language like spellings and alphabet recognition, and also arithmetic like computation. The aim of the current study is to show the profile in learning disabled children. Brigance Basic Skills List and the National Institute of Mental Health and Neurosciences (NIMHANS) index of specific learning disabilities are used for the purpose. The Brigance Basic Skills List is designed to assess visuomotor skills, visual discrimination, acquisition of gross motor and fine motor skills, and acquisition of alphabets and numbers. The NIMHANS index in addition to the above also assesses the reading, writing, spellings, and arithmetic skills of the subjects and other functions like attention, memory, and perceptual motor functions of the subjects. The sample was drawn from the Child and Adolescent Psychiatric clinic of outpatient of Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India. It comprised of 20 subjects within the age range of 10 to 18 years with learning disabilities in one or more areas along with difficulties. They were all belonging to middleto upper-middle socioeconomic status and were studying in private school setup. The results show the profile of the subjects on attention in terms of distractibility and impulsiveness, the memory profile, perceptual motor functions, basic academic skills in terms of visual and auditory discrimination, concept and sequencing of letters and numbers, and the type of errors in terms of their reading, writing, spellings, and arithmetic skills.

Predictors of Pre-operative Anxiety in Indian Children

ObjectiveTo identify the predictors of pre-operative anxiety in school-going children in India.MethodsA prospective observational study was done at a tertiary care teaching hospital. Children aged 7–12 y scheduled for elective surgery and their parents were enrolled. Pre-operative anxiety in children and parents was assessed using STAI-C and STAI-P questionnaires respectively. The child’s anxiety in pre-op room, at the time of parental separation and induction of anesthesia were assessed using m-YPAS scale. Possible predictors of anxiety under ‘individual’, ‘social’ and ‘healthcare’ domains were analyzed using logistic regression. The quality of mask induction of anesthesia was assessed using Induction Compliance Checklist.ResultsSixty children completed the study successfully. Receiver operating characteristic (ROC) curve indicted mYPAS score ≥ 30 (observed score) to identify children with high anxiety as identified by STAI-C ≥37 (self-reported score). The incidence of high anxiety escalated from pre-operative time (48%) to the time of parental separation (72%) and increased further at anesthetic induction (95%). Parental anxiety (p = 0.03) and socioeconomic background (p = 0.03) were significant predictors of the child’s pre-operative anxiety. The presence of >4 people at induction (p = 0.002), but not pre-operative anxiety, was found significantly more in children with poor quality of mask induction.ConclusionsThe incidence of peri-operative anxiety in Indian children is significant. Parental anxiety and socioeconomic background were found significant predictors of high pre-operative anxiety in our set-up.