K. Jagadheesan

Incidence of Catatonia in Children and Adolescents in a Paediatric Psychiatric Clinic

Objective: To investigate the incidence and phenomenology of catatonia in a child and adolescent population. Method: Children and adolescents who had attended a paediatric psychiatric outpatient clinic between April and July 2001 were examined for catatonic signs with a formal catatonia rating scale, and patients who had at least two catatonic signs were included. Results: Eleven patients met the criteria (5.5% of the entire sample and 17.7% of the patients with affective and nonaffective psychotic disorder); of them eight had an affective disorder and three a nonaffective disorder. The mean catatonic scores were significantly high for males and patients with mental retardation. Conclusion: This study shows that catatonia occurs in children and adolescents. Further studies are essential to clarify the distribution of catatonia across various diagnoses and the outcome of paediatric catatonia.

Subcortical functioning in obsessive-compulsive disorder: an exploratory EEG coherence study.

Background. Given the paucity of quantitative EEG studies using coherence measures to understand the electrophysiological functional integrity of sub-cortical structures in obsessive-compulsive disorder, the current study was carried out. Methods. We obtained EEG coherence values for 20 adult OCD patients (10 males; 10 females) and 19 appropriately matched healthy controls across delta (0.5–3.5 Hz), theta (4–7.5 Hz), alpha (8–12 Hz), beta1 (12.5–20 Hz) and beta2 (20.5–30 Hz) bands. As coherence between distant brain regions reflects physiological activities at sub-cortical neural networks, we chose EEG channels at four distant brain regions – anterior interhemispheric, posterior interhemispheric, fronto-temporal and fronto-occipital. Results. In comparison to controls we found significant increase of theta band EEG coherence in the fronto-occipital region in OCD patients (P = 0.045) which did not correlate significantly with either medication status or disease severity. Conclusion. This EEG coherence study that suggests hyperactivity at subcortical circuitry in OCD patients is in agreement with existing neuro-imaging findings. Furthermore, this finding provides external validity for sub-cortical dysfunction hypothesis of OCD.

Risk factors and outcome of mood disorders in epilepsy: a case-control study

BACKGROUND This case-control study investigated both the risk factors and outcome of mood disorders in epilepsy. METHODS For this study, 44 patients with both epilepsy and a mood disorder (study group) were compared with 44 randomly selected patients of epilepsy without a mood disorder (control group). Psychiatric diagnosis was made as per ICD-10 Diagnostic Criteria for Research (ICD-10 DCR). International classification for seizure types (1981) was used for classification of seizure types. RESULTS Of the patients in the study group, a majority were educated up to at least primary level, had later onset of seizures, longer duration of epilepsy and cluster attacks. The outcome of mood disorders in epilepsy was found good in most. CONCLUSIONS Educated patients who develop epilepsy at a later age and patients with poorly controlled epilepsy are more likely to experience mood disorders. In most patients with epilepsy, mood disorders remit completely; notably, in some patients affective symptoms resolve spontaneously.

Psychopathological Dimensions in Childhood and Adolescent Psychoses: A Confirmatory Factor Analytical Study

The present study explored psychopathological dimensions in psychoses of children and adolescents and the distribution of demographic and clinical variables across different psychopathological domains. This study included 101 consecutive patients aged 6–18 years who had a DSM-IV psychotic disorder (schizophrenia and related disorders or mood disorders). Exclusion criteria included presence of organicity, substance use disorders, and any other childhood disorder. Psychopathology was assessed with Scales for Assessment of Positive and Negative Symptoms. Analysis revealed a four-factor model comprising primary negative, secondary negative, manic and paranoid factors. Patients were regrouped into one of the four factors based on their symptomatology. Patients in these four groups differed in education and age of onset and duration of illness. This study confirmed the existence of a factor structure in psychoses of children and adolescents.

Risperidone-induced galactorrhoea: a case series.

We previously proposed a regime to discontinue paroxetine that, even though helpful in diminishing syndrome incidence, did not prove as successful as we had expected (2). More recently, we have tried other strategies that proved more effective, although still not always successful. Therefore, we feel that an even slower dosage reduction should be attempted. If we are to achieve this in countries such as Spain, where only 20mg tablets are available, manufacturers must produce new forms properly grooved to allow smaller dosages.

Acute onset of schizophrenia following autocastration.

1. La londe JK, Hud son JI, Gi gante RA, Pope HG Jr. Ca na dian and Ameri can psy chia trists’ at ti tudes to ward dis so cia tive dis or ders di ag no ses. Can J Psy chia try 2001;46:407–12. 2. Pope HG Jr, Oliva PS, Hud son JI, Bod kin JA, Gru ber AJ. At ti tudes to wards DSMIV dis so cia tive dis or ders di ag no ses among boardcertified Ameri can psy chia trists. Am J Psy chia try 1999;156:321–3. 3. Pope HG Jr, Oliva PS, Hud son JI, Bod kin JA, Gru ber AJ. Psy chia trists’ at ti tudes to wards dis so cia tive dis or ders. Am J Psy chia try 2000;157:1181–2.

Delusional hermaphroditism: a rare variant of delusional misidentification syndrome.

Since the historical contribution of Capgras and Reboul-Lachaux, several researchers began exploring various dimensions of the fascinating phenomena of delusional misidentification syndromes. Recently, Mulholland and O’Hara have reported a new variant of delusional misidentification syndromes named ‘delusional hermaphroditism’. In this study, we report another case of this rare entity.

Acute Antimanic Efficacy and Safety of Intravenous Valproate Loading Therapy: An Open-Label Study

This open-label study investigated whether acute antimanic effects and safety of intravenous valproate loading therapy is superior to oral valproate loading. Eighteen patients with DSM-IV diagnosis of either bipolar affective disorder or schizomania who met the study criteria were recruited (9 in the intravenous and 9 in the oral valproate group). Psychopathology was assessed with the scale for manic and mixed states on days 0 and 4. A checklist was used for the assessment of side effects. The results showed about 36% reduction in total mean manic scores with intravenous valproate loading; however, statistically, the degree of reduction in manic scores was comparable between the groups. A nonsignificant increase in the rate of adverse events was noted in the intravenous group. Despite its limitations, this study suggests that acute antimanic effects of both intravenous and oral valproate loading are comparable.