Deepak Ghormode

Do patients of delirium have catatonic features? An exploratory study

The aim of this study was to determine the prevalence of catatonic symptoms, as per the Bush Francis Catatonia Rating Scale (BFCRS), in patients with delirium and to evaluate the prevalence of catatonia as defined by the Bush Francis Catatonia Screening Instrument and DSM‐5 criteria in patients with delirium.

Metabolic syndrome in antipsychotic naïve patients diagnosed with schizophrenia.

Aim: The article aims to study the prevalence of metabolic syndrome (MS) and subthreshold MS in antipsychotic naïve patients with schizophrenia.

Clinicians’ versus caregivers’ ratings of burden in patients with schizophrenia and bipolar disorder

Background: Only a few studies have evaluated the similarities and differences between clinicians’ and caregivers’ rating of burden of caring for a person with chronic mental illness. Aim: To compare clinician-rated and caregiver-rated burden in a population of patients with either schizophrenia or bipolar disorder, using two different scales to measure caregiver burden. Methodology: Caregivers of patients with schizophrenia (n = 65) or bipolar disorder (n = 57) completed the Hindi version of the Involvement Evaluation Questionnaire (Hindi-IEQ) by themselves. Clinicians rated the burden on the Family Burden Interview Schedule (FBI) based on semi-structured interview with the same caregivers. Results: Both total objective and subjective burden on the FBI (clinician ratings) demonstrated significant positive correlations with the total Hindi-IEQ (caregiver ratings) scores. Most areas of burden on the FBI correlated positively with the tension and the worrying-urging II subscales, as well as the total Hindi-IEQ scores. According to clinicians, a significantly higher percentage of caregivers of patients with schizophrenia were experiencing a moderate to severe degree of subjective burden; objective burden in this group was also significantly higher in the domains of effect on the mental health of caregivers. Contrastingly, caregivers of patients with bipolar disorder judged burden to be higher in this group than schizophrenia. Conclusions: There were many areas of agreement as well as some significant discrepancies between clinicians’ and caregivers’ assessment of burden in this population of patients. This suggests that a comprehensive evaluation of burden should include assessments by both clinicians and caregivers of patients.

Catatonia in inpatients with psychiatric disorders: A comparison of schizophrenia and mood disorders

This study aimed to evaluate the symptom threshold for making the diagnosis of catatonia. Further the objectives were to (1) to study the factor solution of Bush Francis Catatonia Rating Scale (BFCRS); (2) To compare the prevalence and symptom profile of catatonia in patients with psychotic and mood disorders among patients admitted to the psychiatry inpatient of a general hospital psychiatric unit. 201 patients were screened for presence of catatonia by using BFCRS. By using cluster analysis, discriminant analysis, ROC curve, sensitivity and specificity analysis, data suggested that a threshold of 3 symptoms was able to correctly categorize 89.4% of patients with catatonia and 100% of patients without catatonia. Prevalence of catatonia was 9.45%. There was no difference in the prevalence rate and symptom profile of catatonia between those with schizophrenia and mood disorders (i.e., unipolar depression and bipolar affective disorder). Factor analysis of the data yielded 2 factor solutions, i.e., retarded and excited catatonia. To conclude this study suggests that presence of 3 symptoms for making the diagnosis of catatonia can correctly distinguish patients with and without catatonia. This is compatible with the recommendations of DSM-5. Prevalence of catatonia is almost equal in patients with schizophrenia and mood disorders.

Experience in Delirium: Is It Distressing?

A total of 203 consecutive patients were assessed on a delirium experience questionnaire 24 hours after recovery from delirium. One third (35%) of the patients could recollect their experiences during the delirium, and the majority (86%) of them were distressed by these experiences. The level of distress was moderate in most of the subjects (52.5%). Fear and visual hallucination were the most common distressing themes recollected. When the patients who could recall their experience of delirium were compared with those who could not recall, the authors noted that recall of delirium experience was associated with a higher prevalence of perceptual disturbances and language disturbances and a higher severity of delirium.

Dependence on supratherapeutic doses of modafinil: a case report.

To the Editor: Modafinil is a wakefulness-promoting agent used for the treatment of various sleep disorders like narcolepsy, obstructive sleep apnea, and shift work sleep disorder. Over the years it has gained popularity among prescribers due to its wakefulness-promoting efficacy and presumably lower abuse potential and has been used in the treatment of various fatigue syndromes, treatment-resistant depression, and attention-deficit/hyperactivity disorder.1,2 There is a controversy with regard to the abuse potential of modafinil, with some authors suggesting that it has low abuse potential and others suggesting that it has psychoactive and euphoric effects and leads to alterations in mood, perception, thinking, and feelings, all of which are seen with other central nervous system stimulants.1,2 The data with regard to its use in toxic doses are also limited.3–6 In our search, we could find no report of modafinil abuse or dependence in the literature. We report a case of a patient who used modafinil in supratherapeutic doses in a pattern that conformed with drug dependence. Case report. Mr A, a 53-year-old man diagnosed with schizoaffective disorder (DSM-IV criteria) for the last 33 years along with tobacco and benzodiazepine dependence syndrome (currently abstaining), presented with a history of excessive use of modafinil. Exploration of his history revealed that, 3 years prior, he consulted a psychiatrist for symptoms of fluctuating sadness of mood, lethargy, and sedation and was started on tablet modafinil, 50 mg/d, which was later increased to 100 mg/d along with tablet sertraline, 50–100 mg/d, and tablet amisulpride, 100 mg/d. The addition of modafinil made the patient feel fresh and active, and after 4–5 months modafinil was increased to 200 mg/d at the request of the patient. Over the next year, he started self-medicating with modafinil, taking 1 or 2 tablets (100–200 mg) in the afternoon or evening to overcome his boredom and fatigue, having felt a strong desire to take the same. On days when he would not take modafinil, he had strong craving and urge to do so, felt that something was missing in his life, and became irritable, felt weak, and had difficulty in concentrating on the work at hand. Over the next year, his intake of modafinil increased to 1,500–2,000 mg/d in order to experience the desired effect; he consumed 100–200 mg every 1–4 hours. Later, due to heavy doses of modafinil, he would have slurring of speech and poor attention and concentration. He continued to take modafinil against the advice of family and treating psychiatrists and would indulge in doctor shopping if he had difficulty in getting a prescription for modafinil or procuring it. With the available information, an additional diagnosis of modafinil dependence syndrome (per DSM-IV criteria for substance dependence disorder) was considered. He was counseled to taper off the dose of modafinil and was given benzodiazepines to manage the symptoms of withdrawal. The usual recommended dosage of modafinil is 200 mg/d. The previous reports of the use of modafinil in supratherapeutic or toxic doses did not describe continuous intake of the higher doses over the period.3–6 In the case reported here, the patient took 1,500–2,000 mg of modafinil per day for about 1 year. The intake of modafinil followed the typical pattern of drug dependence, which indicates its abuse potential. To conclude, our case suggests that modafinil has abuse potential and hence it should be prescribed cautiously and clinicians should be aware of its abuse potential. There is a need for further systematic studies to evaluate its abuse and dependence potential.

A comparative study of caregivers' perceptions of health-care needs and burden of patients with bipolar affective disorder and schizophrenia.

Abstract Background: Although many studies in schizophrenia have evaluated health-care needs, there is a lack of data on the needs of patients with bipolar affective disorder (BPAD), with only occasional studies evaluating them, and no study has evaluated the relationship of health-care needs of patients with caregivers burden. Aim: To study the relationship of caregivers burden and needs of patients as perceived by caregivers of patients with BPAD and schizophrenia. Method: Caregivers of patients with BPAD and schizophrenia were assessed using the Camberwell Assessment of Needs – Research version (CAN-R) and Supplementary Needs Assessment Scale (SNAS), the Family Burden Interview schedule (FBI) and the Involvement Evaluation Questionnaire (IEQ). Results: Mean total needs of patients on CAN-R were 7.54 (SD 3.59) and 7.58 (SD 4.24) for BPAD and schizophrenia respectively. Mean total needs for SNAS were 7.24 (SD 3.67) and 7.68 (SD 5.02) for BPAD and schizophrenia groups, respectively. Total objective and subjective burden as assessed on FBI was significantly more for the schizophrenia group. Caregivers of patients with BPAD perceived significantly less disruption of routine family activities and lower impact on the mental health of others. On IEQ, the mean score on the domain of supervision was significantly higher for the BPAD group. In the schizophrenia group, positive correlations were seen between the total number of unmet and total (met and unmet) needs and certain aspects of burden, but no such correlations emerged in the BPAD group. Conclusion: There is no correlation between number of needs and burden in the BPAD group; however, in the schizophrenia group the number of needs correlated with the perceived burden. Accordingly, orienting services to address needs of patients with schizophrenia can lead to reduction in burden among caregivers.

Fahr's disease and psychiatric syndromes: A case series

Fahrs disease is characterized by basal ganglia calcification with clinical manifestations in the form of neuropsychiatric disorders, neurological symptoms, and cognitive symptoms. In this case series, we describe two cases of basal ganglia calcification, one of whom presented with psychotic symptoms and the other with mood symptoms, and discuss the literature with regard to psychiatric manifestations of basal ganglia calcification.

Pseudocyesis: A complication of antipsychotic-induced increased prolactin levels and weight gain.

Pseudocyesis or phantom pregnancy is characterized by a false belief in a non-pregnant female that she is pregnant and this belief is usually associated with bodily signs of pregnancy. In some of the patients, this belief is held with delusional conviction. In this case report, we present the case of a female patient who presented with delusional belief of being pregnant, which was associated with antipsychotic-associated increase in prolactin levels and metabolic syndrome.

Steroid induced mania in an elderly patient

In the present context, steroids are important therapeutic agents used in the management of various diseases. Existing literature suggests that various steroids are associated with psychiatric manifestations such as psychosis, depression, mania, dementia/cognitive impairment, delirium, etc. However, reports of such associations among elderly are limited. In this report, we present the case of an 80-year-old male who developed mania while taking dexamethasone and required management with olanzapine.