Manju Mehta

Heart rate variability study of childhood anxiety disorders

Background: The current study aims at assessment of heart rate variability among children and adolescents with childhood anxiety disorder, using the case-control design. Materials and Methods: The study was carried out at a tertiary care multispecialty hospital. It included 34 children and adolescents with diagnosis of childhood anxiety disorder, in the age range of eight to eighteen years, and 30 age- and sex-matched healthy controls. Heart-rate variability was studied using the standard protocol. Results: Significantly reduced variability of the heart rate was observed in both the time as well as frequency domains in the disorder group as compared to the control group. These findings indicate decreases in the sympathetic and parasympathetic activity in the disorder group, thus representing diminished physiological variability at rest. Conclusions: The notion of autonomic inflexibility, as seen in the current study, has important implications for stability in biological systems. The loss of variability in the physiological systems in general, and in the cardiovascular system in particular, has an association with a number of diseases and dysfunctions.

The psychosocial impact of vitiligo in Indian patients

BACKGROUND Vitiligo has a special significance in Indian patients both because depigmentation is obvious on darker skin and the enormous stigma associated with the disease in the culture. AIMS This study was carried out to determine the beliefs about causation, aspects of the disease that cause concern, medical, and psychosocial needs of the patients, expectation from treatment and from the treating physician, and effects of disease on the patients life. METHODS Semi-structured interviews were conducted in 50 patients with vitiligo. Purposive sampling was used to select subjects for the study. Each interview was recorded on an audio-cassette and transcripts were analyzed to identify significant issues and concerns. RESULTS Patients had a range of concerns regarding their disease such as physical appearance, progression of white patches onto exposed skin and the whole body, ostracism, social restriction, dietary restrictions, difficulty in getting jobs, and they considered it to be a significant barrier to getting married. The condition was perceived to be a serious illness. Stigma and suicidal ideation was reported. While there were several misconceptions about the cause of vitiligo, most patients did not think their disease was contagious, heritable or related to leprosy. Multiple medical consultations were frequent. Complete repigmentation was strongly desired, but a lesser degree of repigmentation was acceptable if progression of disease could be arrested. The problems were perceived to be more severe in women. The disease imposed a significant financial burden. CONCLUSION Addressing psychosocial factors is an important aspect of the management of vitiligo, particularly in patients from communities where the disease is greatly stigmatizing.

Apparent male gender identity in a patient with complete androgen insensitivity syndrome.

Clinicians universally agree on female sex of rearing inpatients with complete androgen insensitivity syndrome(CAIS).Thesepatientshaveafemalephenotypethoughtheyhave an XY karyotype and testis. Long-term studies haveshown an overall patient satisfaction with the assigned fe-male sex, female gender identity, and heterosexual prefer-encesinpatientswithCAIS(Hines,Ahmed,HMazur,2005;Wisniewskietal.,2000).WereporthereacaseofCAIS(rearedasafemaleuntilage11 years)whopresentedwith a desire to live as a male at age 11 years.This 11 year, 3 month old girl was the youngest of fivesiblings (one brother and three sisters). She had undergonesurgery for bilateral inguinal swellings one year prior at alocal hospital. Testicular tissue was found on exploration.The wound was closed without any surgical manipulationand the patient was referred to the endocrine department ofthis hospital. The child was accompanied by father andbrotheratthefirstvisit.ThiswasaHindufamilythathadbeenresiding in a village in Haryana. The father, around 45 yearsof age, was a farmer. The father and brother expressed theirdesire for masculinizing genitoplasty to rear the child as amale.Theyreportedthattheyhadobservedboy-likebehaviorin the child from early childhood and the revelation of thetesticular tissue had made them all convinced about the truemale identity of the child. She had been the most aggressiveamong all the female siblings and her play preferences anddressingpatternweresimilartoherelderbrother.Thepatientreturned with her mother in the subsequent visit (1 monthlater).Motherwasahousewife.Duringthesevisits,thischildwas dressed like a boy, expressed a desire to go to a boy’sschool as a boy, and said that she preferred boy’s company.Oncarefulquestioning,motherrevealedthat,duringthebirthofthischild,bothparentshadnursedastrongdesireforaboyafter three girls were born. She had always preferred a malepattern of dressing for the child and took pleasure in seeingmale appropriate behavior in her. Examination revealed acomplete female phenotype with no development of secon-darysexualcharacters(A1B1P

Measurement properties of the Vitiligo Impact Scale-22 (VIS-22), a vitiligo-specific quality-of-life instrument

Vitiligo has a significant psychological impact which needs to be evaluated separately from the extent of depigmentation. We have developed a vitiligo‐specific quality‐of‐life (QoL) instrument, Vitiligo Impact Scale‐22 (VIS‐22) for this purpose.

Neuropsychological performance in euthymic Indian patients with bipolar disorder type I: Correlation between quality of life and global functioning

This study aims to assess the neuropsychological performance, quality of life (QoL) and global functioning in euthymic patients and healthy controls. It also explores the hypothesis that poorer cognitive performance will adversely influence the QoL of patients with bipolar disorder.

PSYCHIATRIC DISORDERS AMONG PARENTS OF CHILDREN SUFFERING FROM ACUTE LYMPHOBLASTIC LEUKEMIA

The aim of the study was to assess the frequency and likely associations of psychiatric disorders in parents of children suffering from acute lymphoblastic leukemia (ALL). One parent each of 30 consecutive ALL patients who achieved their first remission were interviewed and rated on the Comprehensive Psychopathological Rating Scale. Ratings were also made on the Hamilton Depression Rating Scale and the State Trait Anxiety Inventory. Fifty percent (n = 15) of the parents had psychiatric disorders, namely neurotic depression (n = 11, 36.7%) and adjustment disorder with depressed mood (n = 4, 13.3%). These disorders were of mild to moderate severity and were perceived to be highly treatable. Psychiatric morbidity was associated with women and unemployment. A score of 14 on the Hamilton Depression Rating Scale provided a reliable cutoff for selection of subjects for referral.

Vitiligo impact scale: An instrument to assess the psychosocial burden of vitiligo

BACKGROUND Vitiligo is a disease that significantly impairs quality of life. Previous studies have shown that vitiligo has an impact that may not correlate with the size and extent of depigmentation, indicating a need for an independent measure of the psychosocial burden. AIMS To develop a rating scale to assess the psychosocial impact of vitiligo. METHODS The study was undertaken in three broad phases: item generation, pre- and pilot testing, and test administration. Items were generated largely from a qualitative study using semi-structured interviews of patients. Face and content validity were assessed through pre- and pilot testing in 80 patients and the final version was administered to 100 patients who also received the Dermatology Life Quality Index (DLQI) and the Skindex-16. Each patient also underwent a physician global assessment (PGA) of the impact of vitiligo. Test-retest reliability was assessed in 20 patients. RESULTS Of 72 items initially generated for the scale, 27 were retained in the final version. Subjects were able to comprehend the items and took about 5-7 min to complete the instrument. The scale was internally consistent (Cronbachs α = 0.85). Scores on the scale correlated moderately well with the DLQI and the Skindex (Spearman rank correlation: 0.51 and 0.65, respectively). The scale was able to discriminate between patients having mild and those having moderate and severe impact as assessed by PGA. The test-retest reliability coefficient (Spearman rank correlation) was 0.80. CONCLUSION The Vitiligo Impact Scale appears to be a valid measure of the psychosocial impact of vitiligo and this instrument may be useful both in the clinic and in clinical trials.

PSYCHIATRIC MORBIDITY IN CHILDREN SUFFERING FROM ACUTE LYMPHOBLASTIC LEUKEMIA

The study aimed at assessing the frequency of psychiatric disorders in children with acute lymphoblastic leukemia. Thirty consecutive subjects in the age range of 6-12 years were interviewed with the help of a symptom checklist soon after they had achieved their first remission. The children were also administered the Childrens Depression Rating Scale and the State Trait Anxiety Inventory for Children. One-third (n = 10) of the subjects received a diagnosis according to the International Classification of Diseases, 9th ed. Ninety percent (n = 9) had emotional disorders. All the disorders were mild to moderate in intensity and were perceived to be easily treatable.

A Short-Term, Comprehensive, Yoga-Based Lifestyle Intervention Is Efficacious in Reducing Anxiety, Improving Subjective Well-Being and Personality

Objective: To assess the efficacy of a short-term comprehensive yoga-based lifestyle intervention in reducing anxiety, improving subjective well-being and personality. Materials and Methods: The study is a part of an ongoing larger study at a tertiary care hospital. Participants (n=90) included patients with chronic diseases attending a 10-day, yoga-based lifestyle intervention program for prevention and management of chronic diseases, and healthy controls (n=45) not attending any such intervention. Primary Outcome Measures: Change in state and trait anxiety questionnaire (STAI-Y; 40 items), subjective well-being inventory (SUBI; 40 items), and neuroticism extraversion openness to experience five factor personality inventory revised (NEO-FF PI-R; 60 items) at the end of intervention. Results: Following intervention, the STAI-Y scores reduced significantly (P<0.001) at Day 10 (66.7 ± 13.0) versus Day 1 (72.5 ± 14.7). Also, positive SUBI scores (F1– F6) improved significantly (P<0.01) at Day 10 versus Day 1. Similarly NEO-FF PI-R scores improved significantly (P<0.001) at Day 10 versus Day 1. Control group showed an increase in STAI-Y while SUBI and NEO-FF PI-R scores remained comparable at Day 10 versus Day 1. Conclusions: The observations suggest that a short-term, yoga-based lifestyle intervention may significantly reduce anxiety and improve subjective well-being and personality in patients with chronic diseases.

Randomized Controlled Trial in Advance Stage Breast Cancer Patients for the Effectiveness on Stress Marker and Pain through Sudarshan Kriya and Pranayam.

Objective: The objective of this study is to examine the effect of a cognitive, behavioral stress management module of Sudarshan Kriya (SK) and P on levels of serum cortisol and pain among the women suffering from advanced stage breast cancer. Materials and Methods: Participants (n = 147) were screened and randomized to receive standard care (n = 69) versus standard along with SK and Pranayam (P) intervention (n = 78) imparted in one 18 hrs workshop spread during 3 days. Participants were expected to practice it at home 20 min daily as adjuvant to standard pharmacological treatment for pain. Results: There was a significant difference in blood cortisol levels after 3 months of practice of SK and P. Mean blood levels in the intervention arm were 341.2 ng/ml against 549.2 ng/ml in the control arm (P ≤ 0.002). Pain perception in comparison to control arm reduced by 3 points in SK and P arm on 0-10 verbal scale of pain. Conclusion: SK and P is an effective intervention in reducing stress and pain among advance stage patients of breast cancer.