Nidhi Chauhan

Prevalence of metabolic syndrome in patients with schizophrenia in India

Prevalence of metabolic syndrome (MS) was estimated in 227 patients with schizophrenia. A total of 43.6% of patients fulfilled International Diabetes Federation (IDF) criteria and 44.5% met modified National Cholesterol Education Program Adult Treatment Panel-III (NCEP ATP- III) criteria of MS. Increased waist circumference was the most common abnormality (64.8%) and high glucose level was the least common (15.9%). In regression analysis, age more than 35 years (OR-3.37), female gender (odds ratios (OR-1.81)), urban locality (OR-2.08), being employed (OR-2.12) and BMI more than 25 (OR-5.64) emerged as significant predictors of MS.

Indian Psychiatric Society multicentric study on assessment of health-care needs of patients with severe mental illnesses.

Aim: To assess the health-care needs of the patients with severe mental disorders. Materials and Methods: Patients with the diagnosis of a severe mental disorder (schizophrenia and related psychotic disorders, bipolar disorder, recurrent depressive disorder, major depressive disorder and obsessive compulsive disorder) were assessed using Camberwell Assessment of Need-Research version (CAN-R) Scale and indigenously designed Supplementary Needs Assessment Scale (SNAS). Results: The study included 1494 patients recruited from 15 centers. The most common diagnostic group was that of affective disorders (55.3%), followed by psychotic disorders (37.6%). The mean number of total needs as perceived by the patients was 7.6 on the CAN-R. About two-third of the needs as assessed on CAN-R were met, and one-third were unmet. On CAN-R, main domains of needs as reported by patients were those of money, welfare benefits, transport, information about the illness and treatment, relief of psychological distress, company, household skills and intimate relationships. On SNAS, the mean number of total needs as perceived by the patients was 7.6 of which 4.1 were met needs. The most common domains of needs as assessed on SNAS were those of financial help, medical reimbursement, psychoeducation, free treatment, certification of mental illness, flexible work/job timings, addressing the caregiver stress and legal aid. Conclusion: About two-third of the needs, of the patients with severe mental disorders are met as assessed using CAN-R. However, higher percentages of unmet needs are identified on SNAS. In view of the commonly reported needs, a change in the orientation of services offered to people with mental disorders is very much called for. At the government level, desired policies must be formulated to support the patients with mental disorders.

Prevalence of metabolic syndrome in bipolar disorder: an exploratory study from North India.

PURPOSE To study the prevalence of metabolic syndrome in patients with bipolar disorder. MATERIAL AND METHOD By using purposive random sampling 200 patients with bipolar disorder receiving treatment were evaluated for presence of metabolic syndrome using International Diabetes Federation (IDF) and modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) criteria. RESULTS Eighty patients fulfilled IDF criteria and 82 patients met NCEP ATP-III criteria for metabolic syndrome. There was significant concordance between these two criteria sets for metabolic syndrome (Kappa value 0.979, p<0.015). Among the individual parameters studied--increased waist circumference (70.1%) was the most common abnormality, followed by increased blood pressure (44.5%) and increased triglycerides levels (42%). Compared to patients without metabolic syndrome, patients with metabolic syndrome had significantly higher body mass index and higher percentage of them (74.4% vs 51.7%) were more than 35 years of age. Logistic regression analysis revealed that these two variables significantly predicted metabolic syndrome. CONCLUSION Findings of the present study suggest that abdominal obesity is the most common abnormality and metabolic syndrome is best predicted in patients with bipolar disorder by higher age and higher body mass index.

Indian Psychiatric Society multicentric study on assessment of health-care needs of patients with severe mental illnesses as perceived by their family caregivers and health-care providers

Aim: To study the health-care needs of the patients with severe mental disorders as perceived by their family caregivers and the treating psychiatrists. Materials and Methods: Caregivers of patients with severe mental disorders and their treating psychiatrists were assessed using Camberwell Assessment of Need-Research Version (CAN-R) scale and indigenously designed Supplementary Assessment of Needs Scale (SNAS). Results: The study included 1494 patients recruited from 15 centers. The mean needs as per the CAN-R, perceived by the caregivers were 7.8 and treating psychiatrists were 8.1. About one-third of needs were unmet. On SNAS, both caregivers and treating psychiatrists reported a mean of 7.9 needs, of which more than half were unmet as per the caregivers. As per the treating psychiatrists, 45.5% of the needs as assessed on SNAS were unmet. There was a high level of correlation between needs perceived by the patients, caregivers and the treating psychiatrists. On CAN-R, main domains of needs as reported by the caregivers were those of money, relief of psychological distress, information about the illness and treatment, welfare benefits, transport, company and food. As per the treating psychiatrists, the most common total needs identified were those of relief of psychological distress, welfare benefits, information about the illness and treatment, money, transport, company self-care and physical health. The most common domains of needs as assessed on SNAS as per the caregivers were those of free treatment, medical reimbursement, psychoeducation, financial help, social support, insurance, more time from the clinicians and travel concession. The treating psychiatrists identified dealing with caregivers stress as the most common need. Conclusions: According to the family caregivers and treating psychiatrists, about one-third of the needs of the patients as assessed using CAN-R and about half of the needs as assessed using SNAS are unmet.

Adolescent-parent conflict in the age of social media: Case reports from India

Social media activities have gained popularity amongst children and adolescents as a means of communication; giving them the opportunity for independence and social development as well as rendering them vulnerable to negative influences. In traditionally collectivistic societies like India, moving rapidly towards modernisation, not only is there a divide between parents and adolescents over the endorsement of these sites, but also regarding value systems related to autonomy and dating that are facilitated by such activities. We present cases of two adolescent girls to highlight adolescent parent conflict that arises in the age of social media in a cultural context. Further, the cases underscore that value systems and culture play an important role in resolution of such conflict.

Somatoform pain disorder presenting as “Atypical facial pain:” A rare presentation in a 13-year-old

Children and adolescents often present to physicians and pediatricians with a range of medically unexplained symptoms, most common being headache, abdominal, and bone pains. These symptoms can be a manifestation of underlying depressive, anxiety or somatoform disorders, and sometimes the only symptom. Hence, it is important to recognize and manage these symptoms. Atypical facial pain (AFP) or atypical trigeminal neuralgia that has variably been described to be of psychological origin is considered to be rare in children. We describe the case of a 13-year-old adolescent girl who presented with AFP, who was finally diagnosed to have a somatoform disorder. We discuss the characteristics of AFP in the index case that justify the diagnosis. We also attempt to describe psychosocial factors related to such a presentation.

Valproate-induced hyperammonemic encephalopathy in an elderly patient with bipolar disorder

Hyperammonemia is a rare side effect of valproate, diagnosis of which requires a high level of clinical suspicion. We describe a case of 57-year-old man, suffering from bipolar affective disorder, who had multiple physical comorbidities (diabetes mellitus, benign prostatic hyperplasia, hydroureteronephrosis, and chronic kidney disease) and was on sodium valproate 1500 mg/day along with risperidone 6 mg/day, who developed delirium when the dose of sodium valproate was increased from 1500 mg/day to 2000 mg/day. In view of use of high doses of valproate, hyperammonemia was suspected, and on investigations, patient was found to have high ammonia levels (159 μmol/l). He was managed conservatively with stoppage of valproate and syrup lactulose. To conclude this case depicts that use of high doses of valproate can lead to hyperammonemia, especially among those with chronic medical illnesses.

Understanding parental causal explanations and help seeking in attention-deficit/ hyperactivity disorder: perspectives from a developing Asian nation

INTRODUCTION Research on parental understanding of causation and help-seeking for ADHD comes from ethnic minorities in developed nations; research from Asia is scarce. Our purpose was to explore perceptions of Indian parents regarding causation and diagnosis of problematic childhood behaviors diagnosed as ADHD or hyperkinetic disorder, and to understand the process of decision making and help seeking using a qualitative study design. METHOD In-depth, semi-structured interviews were conducted with 52 parents (33 mothers and 19 fathers), focusing on initial emotional reactions and cognitive appraisals, decision making, parental causal explanations and perceptions regarding diagnosis and symptom labeling. RESULTS Mothers were decision makers for seeking professional help either singly or jointly in 76.1% of cases. Initial reactions ranged from those with negative valence (negative emotional reactions and cognitive appraisals) to ambi-valence (recognition of problems, but at the same time not accepting completely) and positive valence (sense of relief and hopefulness). Psycho-social explanations (63.46%) were more common than biological explanations (51.82%), with 19.23% reporting both explanations. Biological explanations included illness model (e.g. brain problem, obstetric complications), hereditary and intellectual disability. Psycho-social explanations included psychological (e.g. lack of motivation) and social (e.g. problems with disciplining at home) causations. Irrespective of initial reactions and causal explanations, a significant majority of parents were aware of the diagnosis and labeled problems as symptoms attributable to ADHD. CONCLUSION Our findings provide insights for development of culturally sensitive psycho-social interventions; from understanding of causal attributions, process of decision making and help seeking.

Symptom profile of catatonia in children and adolescents admitted to psychiatry inpatient unit

AIM To study the symptom profile of catatonia in children and adolescents. METHODOLOGY Treatment records of all the inpatients aged (≤19 years) were reviewed for the period January 2005 to January 2017. Patients with catatonia (diagnosed as having at least two symptoms as per the Bush Francis Catatonia Rating scale) were included. RESULTS During the study period, data was available for 52 children and adolescent. The mean age of the sample was 16.8 years (SD=2.0; range 9-19). Males (N=28; 53.8%) outnumbered females. The most common primary psychiatric diagnostic category was that of psychotic disorders (N=26; 78.8%). One-sixth (N=8; 15.4%) were diagnosed with organic illnesses like epilepsy and systemic lupus erythematosus. Affective disorders accounted for only one-tenth (N=5; 9.6%) of cases, with mania being more common presentation than depression. Very few patients were diagnosed with pervasive developmental disorder (N=2). The common signs and symptoms noted were mutism (90.4%) followed by immobility/stupor (75%), staring (71.2%), negativism (57.7%), rigidity (55.8%) and posturing (53.8%). The mean BFCRS score was 13.73 (SD - 7.6; range 3-20). Overall there was no significant difference in the prevalence of various signs and symptoms of catatonia between those with psychotic disorders, affective disorders and those with catatonia due to organic causes. In only half of the patients catatonia responded to lorazepam and other half required electroconvulsive therapy. CONCLUSION The most common symptoms of catatonia in children and adolescent are mutism, immobility/stupor, staring, posturing, negativism and rigidity. The most common underlying psychiatric diagnosis is that of schizophrenia.

Psychiatric manifestations of congenital rubella syndrome: A case report and review of literature

Neurodevelopmental disorders are known to have varied etiology. Among known etiologic causes, congenital rubella syndrome (CRS) is reported to be one of the infections associated with neurodevelopmental disorders. CRS has been reported to be associated with large number of psychiatric manifestation. However, data from developing countries on psychiatric manifestations of CRS are nonexistent. In this report, we present the case of a 7-year-old boy, who presented with mental retardation, atypical autism, and attention deficit hyperactivity disorder. Since birth, the child was found to have congenital cardiac defects and was found to have bilateral profound sensorineural hearing loss since the age of 6 months. Magnetic resonance imaging showed multifocal symmetrical T2/fluid attenuated inversion recovery hyperintensities in bilateral cerebral hemisphere suggestive of sequelae of congenital rubella infection.