Girish N. Babu

Prevalence and correlates of suicidality among Indian women with post-partum psychosis in an inpatient setting

Objective: The aims of the present study were twofold: first, to determine the prevalence of suicidal ideation and suicide attempts among women inpatients with post-partum-onset psychosis; and second, to describe the clinical, childbirth-related and demographic correlates of suicidal ideation in this group. Method: A total of 82 post-partum women consecutively admitted to the psychiatric unit of the National Institute of Mental Health and Neurosciences, India during 18 months were assessed using the Comprehensive Psychopathology Rating Scale (CPRS) for psychopathology and suicidality. Results: Thirty-one women (38%) reported suicidal ideation, of whom 15 (18%) had attempted suicide in the current episode. Suicidal ideation and suicide attempts were more frequent in women with depression, an insidious onset of the current illness and those with higher scores on the depressive dimension. On logistic regression analysis, however, only higher scores on the depressive symptom dimension of CPRS, irrespective of diagnosis, emerged as significant (p<0.001). Suicidal ideation was also significantly associated with ideas of harm to the infant (p<0.05). Conclusions: There is a high prevalence of suicidal ideation and suicide attempts in this group of patients. Depressive symptoms in post-partum psychosis appear to be the most important risk factor predicting suicidal ideation and attempts.

Chitrachanchala (Pictures of unstable mind): Mental health themes in Kannada cinema

Regional movies in India play an important role in portraying mental illness and also depict awareness and attitudes of society towards people with mental health problems. Kannada (the language spoken by 50 million people from the state of Karnataka in South India) cinema has produced a range of movies depicting conditions ranging from psychosis to personality disorders. However, the descriptions of mental illness in several of these movies is vague and often stigmatizing. Some landmark films have involved psychiatrists in producing and directing the movies, including helping with the story line, which have added value to these films. Despite Karnataka being home to some of the important psychiatrists in the country and to some of the most famous and advanced mental health training and treatment centres, depictions of treatment and the portrayal of psychiatrists continues to be caricatured. As is true of many parts of India, treatment methods are often magico-religious, which is what Kannada cinema also reflects.

Antipsychotics in pregnancy and lactation

Research on psychotropic medications during pregnancy and lactation is limited as often involves complex ethical issues. Information on safety of psychotropic drugs during these critical phases is either inconclusive or undetermined. Many women with severe mental illness have unplanned pregnancies and require antipsychotic medication during pregnancy and lactation. Multiple issues have to be considered while choosing safe treatments for pregnant and lactating women and the best approach is to individualize the treatment. Medication should be guided primarily by its safety data and by the psychiatric history of the patient. Important issues to be kept in mind include pre-pregnancy counseling for all women, including planning pregnancies; folate supplementation, discussion with patient and family regarding options, and active liaison with obstetricians, ultrasonologists and pediatricians. Whenever possible, non-pharmacological approaches should be used in addition.

Unplanned pregnancies leading to psychotropic exposure in women with mental illness - Findings from a perinatal psychiatry clinic.

Objective: The aims of this study were (a) to describe the sociodemographic and clinical profile of women with unplanned pregnancies and consequent exposure to psychotropic drugs, (b) to describe the nature and timing of psychotropic exposure during pregnancy among these women, and (c) to examine the outcome of decisions related to pregnancy following consultation at a perinatal psychiatric service. Materials and Methods: Women attending the perinatal psychiatry services referred for accidental exposure to psychotropics were assessed by structured interviews for the following details: sociodemographic details, clinical details, psychotropic drug use, advice given in the clinic, and outcome related to this advice. Results: Fifty-three women were referred for counseling related to unplanned pregnancies and consequential psychotropic exposure. Forty-two women (79%) sought consultation in the first trimester. More than a third of the women, 19 (36%), were taking more than one psychotropic medication during the first consultation. Only 11 (20%) women had received any form of prepregnancy counseling prior to becoming pregnant. Of the 37 women who came for follow-up in the clinic, 35 (94%) of them continued the pregnancy. Conclusions: Unplanned pregnancies in women with mental illness are common and result in exposure to multiple psychotropic medications during the first trimester. Majority of women did not report of having prepregnancy counseling and which needs to be an integral part of treatment and education.

Consultation-liaison approach for the management of psychiatric manifestations in Parkinson's disease and related disorders: A report from Neuropsychiatric Hospital, India

Background: Non-motor psychiatric manifestations of Parkinsons disease have been increasingly noted to contribute to morbidity and mortality. Materials and Methods: We studied the psychiatric manifestations among inpatients with Parkinsons disease and other movement disorders by examining the referrals (N = 127) to consultation-liaison psychiatry services from neurology/neurosurgery between July 2009 and April 2010 using structured clinical proforma. Results: Parkinsons disease and other movement disorders was the most common neurological diagnosis (19%). The most common reason for referral was depression (38%) followed by behavioral problems (33%). Post-assessment, depression rates were higher (54%) and behavioral manifestations were diagnosed as sleep problems (13%), organic psychiatric syndrome (13%), psychosis (8%), anxiety and obsessive compulsive disorder (8%), nil psychiatry (4%). Conclusion: Psychiatric comorbidity is high among in-patients with movement disorders and affective changes are common. Timely assessment using structured clinical proforma would help in enhanced detection of depression in patients with movement disorders.

More Questions Than Answers! Clinical Dilemmas in Psychopharmacology in Pregnancy and Lactation

Women in childbearing age frequently suffer from mental illness. Maternal psychiatric disorders may have a devastating impact on the fetus and the newborn. Thus treating or preventing relapse of these disorders during pregnancy and puerperium is a clinical and ethical duty with the necessity to avoid or minimize fetal or neonatal drug exposure. Though there are many guidelines and comprehensive reviews regarding drug safety in pregnancy and lactation, the application of these recommendations into clinical practice appears to be complex. Hence, we present some clinical questions with answers considering the available literature on safety of psychotropics in pregnancy and lactation.

Formulation and Evaluation of Eszopiclone Film Coated Immediate Release Tablets by Direct Compression Method

Eszopiclone is a class of drug with hypnotic effect and mainly used in the treatment of Insomnia. The main objective of the present study was to develop a pharmaceutically equivalent, stable, cost effective and quality improved formulation of immediate release tablets of Eszopiclone using different concentration of disintegrants and diluents mainly MCC. Pre formulation studies were performed prior to formulation. The tablets were compressed using lactose monohydrate, microcrystalline cellulose, colloidal silicon dioxide, croscarmellose sodium, anhydrous dibasic calcium phosphate, magnesium stearate and opadry blue (white for 2mg) was used for coating the tablets. The tablets were formulated by direct compression method. And prior to the formulation, the pre formulation parameters analysed are bulk density, tapped density, compressibility index, Hausners ratio, angle of repose and post compression characteristics like thickness, hardness, friability, disintegration time, drug release and assay. The stability studies were carried out for the reproducible batch F010 (3mg), F009 (1mg) and F010 (2mg) for three months. The results of the present study showed that among all the formulations, F008 for 3mg, F009 for 1mg and F010 for 2mg was better in all terms of pre formulation and post compression parameters and showed comparably a good dissolution profile like that of the marketed product, LUNESTA ®.