Ajay Kumar Bakhla

Internal consistency and factor structure of 12-item general health questionnaire in visually impaired students

Background: As there are no instruments to measure psychological wellness or distress in visually impaired students, we studied internal consistency and factor structure of GHQ-12 in visually impaired children. Materials and Methods: Internal consistency analysis (Cronbachs alpha and item total correlation) and exploratory factor analysis (principal component analysis) were carried out to identify factor structure of 12-item general health questionnaire (GHQ-12). Results: All items of GHQ-12 were significantly associated with each other and the Cronbachs alpha coefficient for the scale was 0.7. On analysis of principal component, three-factor solution was found that accounted for 47.92% of the total variance. The factors included, ‘general well-being’, ‘depression’ and ‘cognitive’, with Cronbachs alpha coefficients being 0.70, 0.59, and 0.34, respectively. Conclusion: Our study findings suggest GHQ-12 is a reliable with adequate internal consistency scale and multidimensional factor structure in visually impaired students.

Anxiety in school students: Role of parenting and gender

Background: The prevalence of anxiety is high in school going children; however pattern of parenting and gender of the child are important factors for the development of anxiety. Gender role and parenting patterns are important construct that vary across different sociocultural setting hence are important to be studied in Indian context. Materials and Methods: In a cross sectional study all students of both sexes studying in class VIII, were assessed using the Spence anxiety scale (children version). Results: The sample consisted of 146 (55% male and 45% female) with a mean age of 12.71 years. A total of 16 (11%) students scored above cutoff for high anxiety, the mean scores across gender shows that female students scored significantly higher in total and all sub types of anxiety. Most of the students perceived their parents ‘Democratic’ and other two authoritarian and permissive type of parenting were almost equal. There was significantly higher anxiety among the students who perceived their parents as authoritarian. Conclusions: The prevalence of high anxiety was 11% in class VIII students. High anxiety in students was significantly associated with female gender and authoritarian parenting pattern as perceived by the children.

Multiple self-inserted pins and nails in pericardium in a patient of schizophrenia: Case report and review.

This report is the case of multiple self-inserted pins and nails in chest and pericardial cavity in a young male suffering from schizophrenia. This act of self-mutilation was done to get relief from burning sensation in chest and palpitations. Review of the relevant literature revealed that self-inflicted intra-cardiac needle injuries occur mainly in young and middle-aged adults suffering from psychiatric disorders, commonly depression, schizophrenia, and substance use disorders. In one-fourth of the patients, it is due to deliberate self-harm. About 70% use a single needle but 30% may use multiple needles. Second attempts are rare. Majority of the patients (85%) are managed by surgery and recover from the injury. The condition has a low mortality rate of 5%.

Cycloserine induced mania

We report a 21-year-old male who developed manic symptoms after addition of second line anti-tuberculosis treatment for his multidrug resistant tuberculosis. We identified cycloserine as offending drug; and discuss the management and possible neurobiological mechanisms as etiological explanation and implications of manic switch caused by cycloserine.

Etiologic and Cognitive Differences in Hyperactive and Hypoactive Delirium.

OBJECTIVE To assess the differing patterns of cognitive impairment in the hyperactive and hypoactive subtypes of delirium and test the hypothesis that cognitive disturbances are high in patients with hypoactive delirium. METHOD The study was conducted in a general hospital in Pune, India from 2007 to 2009 and included 80 patients with delirium (DSM-IV-TR criteria). A detailed sociodemographic profile was obtained for each patient, and their cognitive function was assessed with the Mini-Mental State Examination (MMSE) and Memorial Delirium Assessment Scale (MDAS). Patients were classified as hyperactive or hypoactive using the MDAS. RESULTS Of the 80 patients, 70% (n = 56) were identified as hyperactive, with a mean ± SD age of 33.42 ± 7.37 years, and 30% (n = 24) as hypoactive, with a mean ± SD age of 34.62 ± 6.64 years. Alcohol and other substance use disorders were the most frequent diagnosis associated with the hyperactive subtype, whereas other psychiatric disorders such as schizophrenia and mood disorders, infection, and chronic medical conditions were associated with the hypoactive subtype. Cognitive impairments were significantly high in the hypoactive subtype, as found in various cognitive domains of the MMSE and MDAS (P = .000). CONCLUSIONS The hyperactive and hypoactive subtypes of delirium appear to be etiologically associated with a different diagnostic group. Severe cognitive impairment was associated with the hypoactive subtype.

Seasonal obsessive-compulsive disorder

A case of obsessive-compulsive disorder (OCD) with seasonal variation in symptoms of 10-years duration is reported because of its rarity. The phenomenology of the observed disorder was obsessions related to dirt and contamination resulting in washing compulsions with onset in October and complete resolution in April-May every year. The patient responded to phototherapy along with exposure and response prevention therapy and pharmacotherapy.

A suspected case of olanzapine induced hyponatremia

Here we report a case of a 63-year-old male diagnosed with recurrent depressive disorder and current episode of severe depression with psychotic symptoms, developed hyponatremia soon after addition of olanzapine and increasing the dose of escitalopram. A possible causality association was established with olanzapine, and the possible etiological reasons of this clinically significant risk were discussed.