Manjeet Singh Bhatia

Delusional parasitosis : A clinical profile

Objective: Delusional parasitosis is a form of monohypochondriacal psychosis, a condition sometimes encountered in psychiatric or primary care practice. The outcome of this condition is not well known. Method: In the present study, a series of fifty-two consecutive cases of delusional parasitosis is reported. Results: A majority of cases (92%) had insidious onset. The duration of symptoms in all but two cases was six months or more. Twenty-six cases presented with a delusion of infestation by insects over the body and twenty-three cases with a delusion of insects crawling over the scalp. Three cases had associated diabetes mellitus, five cases had leprosy, five cases dementia, four cases had depression, and three cases presented with trichotillomania. Pimozide was used in forty-six cases, amitriptyline and fluoxetine in three cases each. Twenty-eight cases (54%) showed complete remission while receiving pharmacotherapy, eighteen cases showed partial improvement, and six cases did not respond to treatment. Conclusion: Further studies are warranted to study the treatment and outcome of this important psychiatric disorder.

Pseudoseizures in Children: A Profile of 50 Cases:

In contrast to adulthood hysterical disorders, childhood hysteria has not been accorded due recognition. Pseudoseizures are paroxysmal alterations in behavior that resemble epileptic seizures but are without any underlying organic cause. There is paucity of literature on pseudoseizures in children. In the present descriptive study of 2 years’ duration, a series of consecutively seen 50 children with pseudoseizures is reported. After detailed history from parents, various socio-demographic and clinical variables were noted. Of 110 children seen with conversion disorder, 50 had pseudoseizures (45.5%). The average age was 8.2 years in boys and 9.4 years in girls. There were 28 girls (56.0%) and 22 boys (44.0%), and the majority of patients had the pseudoseizures for 1 to 3 months. When the mode of referral was studied, 52% were referred from pediatric outpatient department and the majority were referred to rule out comorbid psychiatric disorder. The fits mimicking generalized tonic-clonic seizures were most common and the duration of fits ranged from 10 to 35 minutes. The most common frequency of fits was 5 to 6 per week. The average duration of symptoms was 2.6 months in boys and 3.2 months in girls. Only 14 patients (28%) gave the history of having seen the fits in a relative or schoolmate. School phobia and the fear of examinations were the most common precipitating factors. Separation anxiety disorder, school phobia, and mood disorders were common comorbid diagnoses. The patients were put on appropriate drug treatment and/or psychotherapy for 3 months. Of 50 cases, 36 (72.0%) remitted, 10 (20.0%) showed a decrease in frequency of pseudoseizures, and 4 (8.0%) did not improve. With correct diagnosis and treatment, the children with pseudoseizures have a good outcome.

Psychosocial Profile of Suicide Ideators, Attempters and Completers in India

The study aims to determine the psychological profile of suicide ideators, attemp ters and completers in a tertiary care teaching hospital. A total of 260 suicidal ideators, 58 attempters and 55 completers were studied. The majority of ideators, attempters and completers were 26-35 years of age, males (except attempters who were predominantly females), married, literate up to high school, employed (ideators) or housewives (attempters and completers). The suicide ideators, attempters and completers who had a past history of attempt were 6.9%, 24.1 % and 18.2% respectively. Family history of attempted suicide or completed suicide was also common among patients suffering from depression. In suicidal ideators, mixed anxiety and depressive disorder was the most common psychiatric diagnosis followed by major depression and schizophrenia. Among suicide attempters, adjustment disorder with depression was the most common diagnosis. The most common method of suicide attempt was organophosphorus compound intake whereas in suicide completers, the most common method in use was hanging. The patients with suicidal ideation or attempt need careful evaluation, early intervention and long term follow up.

Relationship of possible stress-related biochemical markers to oxidative/antioxidative status in obsessive-compulsive disorder.

Free radicals have been found to play an important role in obsessive-compulsive disorder (OCD). So, we measured the oxidative/antioxidative status of OCD patients, and assessed its use as a biological marker. The study was carried out on 20 healthy and 20 OCD subjects, aged between 20 and 40 years. Biochemical parameters of all subjects were assessed and compared. A significant difference in superoxide dismutase (SOD) levels was observed between the OCD and control groups (p < 0.05); malondialdehyde (MDA) levels were also significantly higher in OCD subjects (p < 0.05). Our study found an overall oxidative imbalance in OCD, leaning towards the antioxidant side in sufferers (specifically towards SOD). SOD has a protective role in overcoming oxidative stress; therefore, oxidative stress could have a pathophysiological role in OCD. Therapy specifically targeting MDA production will have a beneficial effect in overcoming the oxidative stress, anxiety and affective disorder which may be associated with OCD.

Suicide Notes: Psychological and Clinical Profile

Objective: Suicide is one of the leading causes of mortality in developing as well as developed countries. Psychological autopsy is supplementary to medical autopsy in finding out the correct cause of death. Suicide notes form an important component of psychological autopsy. Method: In the present study, psychosocial and clinical profile of 40 suicide note writers is present. The contents of suicide notes were also analysed. Results: A majority of suicide note writers were to 21 to 30 years of age (55%) and were males (65%). Home was the most common place for committing suicide (80%) and hanging was the most common method. All suicide notes were handwritten and a last wish was mentioned in 30%. Suicide note was most commonly addressed to a sibling (20%). Disturbed love affair and financial problems were the common reasons mentioned in suicide notes. Hopelessness and depression was the most common diagnosis in 52.5% cases. Conclusion: More studies are warranted to detect and analyze the suicide notes so that they not only help in confirming cause of death as suicide but also help in suicide prevention programs.

Health-Related Quality of Life in Patients with Trachomatous Trichiasis or Entropion

Purpose: To determine the health-related quality of life in patients with trachomatous trichiasis or entropion, before and after intervention. Methods: A prospective, case-control, interventional study. Health-related quality of life was evaluated in 60 patients with trachomatous trichiasis or entropion, before and after intervention, and 60 age- and gender-matched controls without trichiasis or entropion, using the WHOQOL-Bref questionnaire. Thirty patients and controls had vision < 6/18, while 30 had vision ≥ 6/18 in the better eye. The WHOQOL-Bref assesses four domains of quality of life: physical health (1), psychological health (2), social relationships (3), and environment (4). Domain scores of patients and controls and of patients before and after intervention were compared using Students t-test. Patient characteristics were correlated with domain scores using Pearsons correlation. Results: Quality of life was poorer than that of controls in domains 1 and 2 for patients with vision < 6/18 in the better eye (p < 0.001, p = 0.001, respectively), and in domains 1, 2 and 4 for patients with vision ≥ 6/18 (p < 0.001, p < 0.001, p = 0.01, respectively). Scores improved after intervention in all domains except domain 3, even though vision did not improve. Conclusions: Patients with trachomatous trichiasis or entropion suffer in the physical, psychological and environmental domains of health-related quality of life even when vision is normal. Timely intervention is essential not only to prevent corneal blindness but also to reduce the suffering caused by the non-visual symptoms. Future studies must identify barriers to therapeutic intervention, and attempts should be directed at overcoming them so as to reduce the non-blinding burden of trachoma.

Post Partum Psychosis: a Clinical Study

In this study of 192 cases of post partum psychosis, the mean age of cases was 24.2 years. A past history of post partum psychosis was present in 16 cases (8.3%). As per the RDC categories, a majority of patients had unspecified functional psychosis and developed psychosis after the birth of first child. There was a positive correlation between the birth of female child and psychosis. The majority of cases developed psychosis within first 2 weeks after delivery. There were several other statistically significant differences when these cases were compared with non-puerperal, disease-matched controls.

Pica responding to SSRI: An OCD spectrum disorder?

Pica is a common disorder in childhood, however, in adults it is associated with mental retardation, psychosis and pregnancy. A few case reports have described it being associated with obsessive compulsive disorder in adults. We describe the case of an adult female patient who developed an impulse to ingest chalk only in stressful situations. These thoughts were ego-dystonic and kept on hammering her mind until she ate it. She was diagnosed as having Major Depressive Disorder with relational problems and pica. We prescribed her escitalopram with clonazepam and asked her to ventilate her feelings during stressful situations. Her depression improved within three weeks, with remarkable improvement in pica symptoms. We concluded that stress may induce the pica in some adults and that such feelings have impulsive/compulsive characters. In addition, appropriate management of stress may help to alleviate the symptoms of pica.

Comparison of oxidative stress among migraineurs, tension-type headache subjects, and a control group

Background: A primary headache, particularly migraine, is associated with oxidative stress during the attack. However, data regarding the interictal state in migraineurs and in those with tension-type headache (TTH) is limited. Objectives: (1) To assess the oxidative stress in migraineurs and TTH subjects in between the episodes and (2) to see if there is a difference in the degree of oxidative stress in the different subtypes of migraine and TTH. Materials and Methods: Fifty migraineurs, 50 patients with TTH, and 50 control subjects were included in this study after screening for the exclusion criteria. Diagnosis of headache was made according to the International Classification of Headache Disorders (ICHD)-2 criteria. A venous blood sample was collected from the antecubital vein at least 3 days after the last attack of headache. The sample was centrifuged immediately and the plasma was stored at –70°C. The ferric reducing activity of plasma (FRAP) and the malondialdehyde (MDA) levels were assessed using colorimetric methods. Statistical analysis was done with the help of SPSS for Windows, v 11.0. One way ANOVA with post hoc Tukey test, independent sample t test, univariate regression, and multivariate regression analysis were done as indicated. Results: Migraineurs had higher values of MDA and FRAP than the subjects in the other two groups (P<0.001). No difference was observed between the TTH group and the control group. FRAP levels were significantly higher in subjects who had mixed migraine (migraine with aura and without aura) as compared to those with only migraine without aura (mean difference 196.1; 95% CI = 27.3 to 364.9; P = 0.01). Similarly, oxidative stress was significantly higher in patients with episodic TTH as compared to those with chronic TTH (FRAP t = 3.16; P = 0.003 and MDA t = 2.75; P = 0.008). Conclusions: This study suggests that oxidative stress continues even between headache episodes in migraineurs but not in those with TTH. This could probably be consequent to the different pathophysiological mechanisms of TTH and migraine.

Prevalence of Depression in People Living with HIV/AIDS Undergoing ART and Factors Associated with it.

BACKGROUND HIV/AIDS is one of the most devastating illnesses that humans have ever faced. Depression in HIV/AIDS patients is very common but the factors affecting it are not well studied. AIMS AND OBJECTIVES HIV/AIDS though such a big public health problem worldwide, not enough data is available regarding association of HIV and Depression. Therefore this study was undertaken to evaluate the association between HIV/AIDS and depression in an Indian setting. MATERIAL AND METHODS The study was conducted in Guru Teg Bahadur Hospital and University College of Medical Sciences, Delhi. One hundred sixty patients were interviewed using a questionnaire containing factors that affect depression. CES-D (Center for Epidemiologic Studies - Depression) scale was used to measure depression. The data collected was analyzed using SPSS software. RESULTS The prevalence of depression in patients with HIV under ART was 58.75%. The prevalence of depression increased with the severity of symptoms. The unemployed, uneducated, unmarried, belonging to joint families, having no or low family income, migrants, having indifferent or poor relationship with spouse, poor social support and had visited commercial sex workers had a greater prevalence of depression. CONCLUSION The rate of depression in patients with HIV/AIDS is very high. Detecting depression early and treating it goes a long way in improving the compliance to treatment as well as quality of life.