Msvk Raju

Effect of Short-term Psychiatric Intervention in Amputees

A total of 40 patients with limb amputations were included in the present study aimed at evaluating the psychological status of amputees. All patients filled a specially designed proforma and the following psychological questionnaires: General Health Questionnaire, Carroll Rating Scale for Depression, State-Trait Anxiety Inventory, Michigan Alcoholism Screening Test and Disability Assessment Questionnaire. Analysis of the results showed that 29 (72.5%) of the amputees had psychiatric disorders and this number had reduced to 20 (50%) after therapy. The difference was statistically significant. Psychiatric treatment also resulted in a statistically significant reduction in level of depression as measured by Carroll Rating scale for Depression. The amputees had the highest score on vocational subscale of Dysfunction Analysis Questionnaire. Short term psychiatric treatment was found to be very useful in treating psychiatric morbidity and depression in amputees.

Effect of short-term Psychiatric Intervention in Cancer Patients

A total of 50 patients undergoing cancer treatment at Malignant Disease Treatment Centre were included in the present study aimed at evaluating the psychological status of cancer patients. All patients filled a specially designed proforma and the following psychological questionnaires : General Health Questionnaire, Carroll Rating Scale for Depression, State-Trait Anxiety Inventory, PGI General Well-being Scale and Quality of Life Scale. Analysis of the results showed that 22 (44%) of the cancer patients had psychiatric disorders and this number had reduced to 12 (24%) after therapy. The difference was statistically significant. Psychiatric treatment also resulted in a statistically significant reduction in level of depression as measured by Carroll Rating Scale for depression. Short term psychiatric treatment was found to be very useful in treating psychiatric morbidity and depression in cancer patients.

TRENDS AND ISSUES IN RELATION TO ALCOHOL DEPENDENCE IN THE ARMED FORCES

Alcohol dependence syndrome has an estimated prevalence of 1533% of all psychiatric hospitalizations in a year. There is an increasing trend in incidence among JCOs/ORs. The index of admission was highest in Armoured Corps, Mechanized Infantry and Army Medical Corps (AMC). Generally a service personnel becomes dependent at 35 years of age after about 11 years of drinking. The average consumption of alcohol dependent individuals was 6-7 pegs/day. A family history of alcohol abuse/dependence was found in 31 % cases. Alcoholics had high anxiety, depression, extroversion, neuroticism and psychopathic deviate traits. Alcoholism was associated with significantly low self esteem. Significantly more alcoholics were alexithymic as compared to non-alcoholics. The γ glutamyl transferase (GGT) and mean corpuscular volume (MCV) were found to be useful diagnostic aids for alcoholism. Almost a third of alcoholics have potentially serious physical problems, 20% suffer from various degrees of psychotic phenomena, 40-55% have significant marital, occupational and disciplinary problems, while 3-6.93% attempted deliberate self-harm. Despite wide variations in mode of disposal, after diagnosis only a small percentage of alcoholics remain in service beyond three years. There is need for concerted investigations into the precipitating and perpetuating factors, co-morbidity, the process of change towards betterment and the long-term outcome of alcoholism in service personnel.

Accelerated antidepressant response to lithium augmentation of imipramine

Background: Treatment of depressive episode often poses a challenge. Although there are numerous medicines available for its treatment but they all have a lag period of 2–3 weeks before they start showing their result. Aim: The aim of the present study was to test the hypothesis that an initial lithium-tricyclic antidepressant (TCA) combination has a quicker and better antidepressant effect than standard TCA treatment in unipolar depression. Materials and Methods: Twenty unipolar depressed inpatients under lithium-TCA treatment were compared with twenty patients with similar diagnosis treated with TCA-placebo combination. The duration of the study was 4 weeks under double-blind conditions. Results: Initial lithium-TCA treatment reduced depressive symptoms significantly more than TCA alone. The difference was evident from 1st week onward and persisted at 4 weeks. Conclusion: Lithium augmentation of TCA at the outset offers a strategy to reduce the lag period of antidepressant action. The choice can be made for those patients who are likely to benefit from long-term prophylaxis.

Lump in a Lactating Breast

The occurrence of a lump in a lactating breast is due to lactational galactocele or a mammary fistula discharging into a chronic subareolar abscess. The occurrence of a lump in an infertile, nulliparous lady on antipsychotic drugs with milky discharge from the nipple and raised serum proclactin is rare. The histopathological report of infiltrating ductal carcinoma suggests that carcinoma should be considered in the differential diagnosis of a lump in a lactating breast. Hyperprolactinemia can result from the administration of certain antipsychotic (viz. chlorpromazine, haloperidol) and it may accompany other endocrine disorders such as hypothyroidism [1].

Case ReportAbdominal Cocoon

Introduction The abdominal cocoon is a rare entity, characterised by a total or partial encasement of the small bowel by thick fibrotic membrane. 35 cases have been reported since it was first described by Foo et al [1]. It occurs primarily in females. Preoperative diagnosis is a matter of challenge and usually made at laparotomy. We report a patient with acute intestinal obstruction and abdominal cocoon which was diagnosed perioperatively.

PERSONALITY FACTOR CORRELATES OF GROWTH HORMONE AND HYPOTHERMIC RESPONSE TO BUSPIRONE CHALLENGE IN SUICIDAL SOLDIERS

The biological underpinnings of suicidal behaviour and possible rational pharmacotherapy of persons exhibiting such behaviour is the focus of this study. The study was conducted on 25 male Armed Forces personnel who attempted suicide and 25 matched healthy controls. Hypothermic and Growth Hormone response to Buspirone challenge was measured serially. 11 cases of attempted suicide had subsensitive postsynaptic 5 HT-1A receptors as indicated by blunted Growth Hormone response, while in other suicidal soldiers hypothermic response was markedly blunted indicating subsensitive presynaptic 5HT-IA receptors in the latter. Personality factor assessment carried out by 16 personality factor test, indicated overt extraversion marks for subsensitive postsynaptic 5 HT-IA receptors, while overt intraversion marks for subsensitive presynaptic 5 HT-IA receptors, in suicidal soldiers. In the light of the above, therapeutic options of Serotonin reuptake inhibition, agonist load at presynaptic 5 HT-IA and reciprocal stimulation of postsynatpic 5 HT-IA receptors for prevention of future attempts and completed suicides is discussed.

KLEINE – LEVIN SYNDROME (A Case Report)

A 30 year old male soldier suffered from five episodes of hypersomnia. Each episode was associated with megaphagia, mental confusion, irritability, coenesthopathic hallucinations and sexual disinhibition. The average duration of each episode was ten weeks with symptomfree intervals ranging from two weeks to one year. The patient responded well to treatment with carbamazepine and fenfluramine.