Raheel Mushtaq

Relationship between loneliness, psychiatric disorders and physical health ? A review on the psychological aspects of loneliness.

Human beings are social species which require safe and secure social surroundings to survive. Satisfying social relationships are essential for mental and physical well beings. Impaired social relationship can lead to loneliness. Since the time of dawn, loneliness is perceived as a global human phenomenon. Loneliness can lead to various psychiatric disorders like depression, alcohol abuse, child abuse, sleep problems, personality disorders and Alzheimers disease. It also leads to various physical disorders like diabetes, autoimmune disorders like rheumatoid arthritis, lupus and cardiovascular diseases like coronary heart disease, hypertension (HTN), obesity, physiological aging, cancer, poor hearing and poor health. Left untended, loneliness can have serious consequences for mental and physical health of people. Therefore it is important to intervene at the right time to prevent loneliness, so that physical and mental health of patients is maintained.

Therapeutic and Diagnostic Applications of Nanotechnology inDermatology and Cosmetics

Nanoscience is the branch of science pertaining to the study of minute particles on an atomic or molecular scale, whose size is measured in nanometers. A nanometer represents one billionth of a meter (i.e., 10-9 m). Nanotechnology is an emerging branch of engineering that involves the use of particles on a nanoscale (1-100 nm). Thus, the application of nanotechnology in the field of dermatology is the Nanodermatology. Nanodermatology represents one of the most emerging fields for which an increasing interest is rising among scientists as well as pharmaceutical companies. Nanotechnology has revolutionized the treatment of several skin diseases. It is effective in targeted delivery of active medicaments and cosmetic ingredients. The skin forms the first point of contact for a diverse number of nanomaterials. Nanomedicine in dermatology has opened a new era in the diagnosis and treatment of various skin disorders. Possible applications of nanotechnology in dermatology and cosmetics include sunscreens, moisturizers, anti-aging formulations, phototherapy, ani-sepsis, vaccines, skin cancers, hair and nail care, etc. In this review after an introduction of nanotechnology, author has described various types of nanoparticles followed by various possible indications of nanotechnology in dermatology and cosmetics. An account on safety of nanoparticles has also been added to the review.

Comparison of Cognitive Symptoms in Subtypes of AlzheimerâÂÂs disease (AD)-astudy from South East Asia (Kashmir, India)

Background: The heralding of baby boomers and a subsequent surge in elderly population, has led to immense research in unravelling the mysteries in the geriatric age group with Alzheimer’s disease (AD). Alzheimer’s disease (AD) is a neurodegenerative disorder with varied cognitive dysfunctions. However no comprehensive study has been carried out in South East Asia (Kashmir, India) to investigate cognitive symptoms in subtypes of AD. Objectives: To assess cognitive symptoms in subtypes of AD in Kashmiri (Indian) population. Material and Methods: The study was conducted in Memory Clinic of Postgraduate Department of Psychiatry, Government Medical College, Kashmir (India) from January 2012 to March 2014. The diagnosis of AD patients was done according to NINCDS-ADRDA criteria .A total of 80 patients of AD were screened (40 with age of onset less than 65 and 40 with age of onset greater than 64) .Patients with age of onset less than 65 were called as Early Onset Alzheimer’s disease (EAD) and patients with age onset greater than 65 were called as Late onset Alzheimer’s disease (LOAD). MMSE (Mini Mental State Examination), CDR (Clinical Dementia Rating) and various other neuropsychological tests like verbal digit span, verbal fluency, the 15-item Mini- Boston Naming Test (Mini BNT),10- item Auditory Verbal Learning Test, Constructions, calculations, and similarities from the Neurobehavioral Cognitive Status Examination were assessed in all the patients. The data was analysed using paired t test. Results: The mean age of EAD and LOAD was 63.10 and 84.28 respectively. There was significant difference in MMSE of both of the groups and was found to be statistically significant (P<0.05).Patients in the EAD group performed better than the LOAD group on all the tests of motor-execution (P<0.05). LOAD group had lower mean score of verbal fluency compared to EAD group. Conclusion: Wider dysfunctions in cognitive symptoms were present in LOAD compared to EAD.

Tryptophan Hydroxylase 2 Gene Polymorphism in Anxiety and Depressive Disorder in Kashmiri Population

BACKGROUND The gene of tryptophan hydroxylase is widely recognized as a major candidate gene in many psychiatric disorders. However, no study has been done which investigates tryptophan hydroxylase 2 gene polymorphism in anxiety and depressive disorders in Kashmiri population (India). OBJECTIVES To study tryptophan hydroxylase 2 (TPH2) C 11993 A gene polymorphism in anxiety and depressive disorders. METHOD Sixty patients of depression disorder, 60 patients of anxiety disorder and 40 unrelated healthy volunteers (control) were studied in a case control design. Polymorphism was determined using polymerase chain reaction (PCR) and agarose gel electrophoresis after digestion with HAP II enzyme. Genotypes and allele frequencies were compared using Chi-square tests, Fischers exact test, odds ratio, 95% confidence interval (C.I) and p-value of <0.05 was considered to be statistical significant. RESULTS The mean age ± SD of anxiety, depression and control group was 32.73±10.99, 32.20±10 and 29.75±10.12 respectively and the difference was found to be statistically non significant (p=0.349).The mean HAM-A (Hamilton rating scale for anxiety) score and HAM-D (Hamilton rating scale for depression) score was high in both groups (anxiety and depression) and found to be statistically significant (p=0.001).Depression group had AA genotype (55.2%) than control (37.5%) and was found to be statistically non significant (p=0.890).Comparison of allelic frequency revealed no association of A allele in anxiety group (76.67%) compared with control (75.5%) and was found to be statistically non significant (p= 0.866), OR 1.09 (0.56-2.11). CONCLUSION TPH2C 11993 A gene was not found to be associated with major depressive disorder (MDD) and anxiety disorder in Kashmiri population.

Recognizing Changes in Cognition in Sub Types of Acute Confusional State

BACKGROUND Delirium or acute confusional state is an acute neuropsychiatric syndrome, with varied cognitive dysfunctions. However, no comprehensive studies about this common condition have been carried out in India. OBJECTIVES To assess cognitive dysfunctions in hypoactive and hyperactive delirium. MATERIALS AND METHODS Forty cases of delirium including hypoactive and hyperactive delirium and 40 other patients (neuropsychiatric patients) were studied as controls. Cognitive status estimation test, mini mental state examination and memorial delirium assessment scale were administered to each patient. All assessments were carried out three times in 24 hour cycle of day and night. The data was analysed using two sample independent t-test. RESULTS The mean age (standard deviation) of study and control group was 27.85 (13.73) and 33.10 (11.26) years respectively. 70% patients had hyperactive delirium while 30% were having hypoactive delirium. Hypoactive delirium had more cognitive impairment compared to hyperactive delirium (p=0.001). The difference between highest and lowest score of MMSE in both types of delirium (day to night) was found to be statically significant (p=0.001). CONCLUSION The fluctuation in intensity of cognitive symptoms varies from day to night in both types of delirium, but more in hypoactive delirium and wider fluctuation in cognitive dysfunctions was noted in delirium cases with psychosis.

Neuropsychiatric manifestations of Fahr's disease pathogenesis and potential for treatment

Fahrs disease (FD) is a rare neuropsychiatric disease consisting of bilateral basal ganglia calcification with neurological, cognitive, and psychiatric manifestations. We report here a sporadic case of FDs with its neuropsychology.

A Comparison of the Behavioral and Psychological Symptoms of Dementia (BPSD) in Early-Onset and Late-Onset Alzheimer's Disease - A Study from South East Asia (Kashmir, India).

Background A gradual increase in the longevity due to advancement of treatment modalities and a subsequent surge in elderly population in India have led to a growing curiosity in the geriatric age group with Alzheimer’s disease (AD). Behavioral and psychological symptoms of dementia (BPSD) represent epiphenomena of AD. However, no comprehensive study has been carried out in South East Asia (Kashmir, India), to assess the behavioral and psychological symptoms in subtypes of AD. Objectives The purpose of this study was to assess BPSD in early-onset Alzheimer’s disease (EOAD) and late-onset Alzheimer’s disease (LOAD). Material and Methods The study was conducted in the Memory clinic of the postgraduate department of psychiatry, Government Medical College, Kashmir, India from January 2012 to March 2014. The diagnosis of AD patients was done according to NINCDS-ADRDA criteria. A total of 80 patients of AD were screened (40 with age of onset less than 65, and 40 with age of onset greater than 64). Neuropsychiatric inventory (NPI) was the instrument used for evaluating symptoms of BPSD. The data was analyzed using paired t-test. Results The mean age of presentation of EOAD and LOAD was 63.10 years and 84.28 years, respectively, and the difference between the two was found to be statistically significant. The LOAD group had significantly higher symptom severity for delusions, agitation, anxiety, disinhibition, and nighttime behavioral disturbances (NBD) than the EOAD group (p ≤.0001). Conclusion The behavioral and psychological symptoms are significantly severe in late onset subtype compared to the early onset subtype of Alzheimer’s disease in the Kashmiri (Indian) population.

Recognizing Risk of Psychiatric Comorbidity in Headache: Looking for Symptoms of Anxiety and Depression in Headache: A Study from General Hospital in Kashmir (India)

Background: Headache is one of the most common neurological symptom that we come across, but very few well-planned studies have been conducted to know its psychiatric aspects .The aim of the study was to investigate the socio demographic profile, clinical types and psychiatric comorbidity in patients with various types of headache. Methods: We conducted a cross-sectional study for a period of one and a half years in Shri Maharaja Hari Singh hospital of Government medical college. The study was conducted in patients attending the medical outpatient department (OPD) for headache. The diagnosis of various headache disorders was established by adopting the International Headache Society criteria (2004). A total of 200 patients were screened. Psychopathology was measured using MINI International Neuropsychiatric Interview Schedule PLUS (MINI PLUS). Descriptive statistics was used to report the socio-demographic characteristics of the patients. Chi-square was used to assess association between categorical variables and a p-value of significance was set at p ≤ 0.05. Results: Among 200 patients, there were 83 (41.5%) males and 117 (58.5%) females. Their ages ranged between 18 years to 78.5 years, with mean (± SD) of 35.85 (± 9.45) years. Psychiatric morbidity in headache was 47%. The psychiatric morbidity was more in females (53%) than males (38.6%) (P-value=0.044). Psychiatric morbidity was also found more in urban (58.3%) than rural areas (42.1) (p-value= 0.036). Tension-type headache (48%) was the most predominate type of headache. Conclusion: Patients with headache had higher psychiatric morbidity. Screening patients with headache for psychiatric disorders and timely psychiatric intervention can go a long way in improving the quality of life of headache with comorbid psychiatric disorders.

An Interventional Study on the Clinical Usefulness and Outcomes of Electroconvulsive Therapy in Medication-Resistant Mental Disorders

Background Resistance to recommended medications has been an issue in dealing with a number of psychiatric ailments, and it is showing up as an ongoing challenge for contemporary mental health experts. Resistant psychiatric disorders not only increase the morbidity of patients suffering from such severe conditions but also intensify the problems of their caretakers. This has vigorously started to cause the costs to increase for healthcare services. Thanks to electroconvulsive therapy (ECT), we now have an effective method that is proving to be a fruitful final course of action in this micro-epidemic of resistant psychiatric diseases. However, the medical literature of case reports or studies in this niche is scarce. Also, no such comprehensive study has been carried out in the Southeast Asian region to date for the assessment of the effectiveness of electroconvulsive therapy in patients with medication-resistant psychiatric disorders. Aim To assess the effectiveness of ECT in medication-resistant psychiatric patients at the post-ECT course, three-month follow-up, and six-month follow-up. Materials and methods The study was a prospective and interventional study (without controls) conducted in the Institute of Mental Health and Neurosciences (IMHANS), Srinagar, India. Fifty-six patients with pharmacotherapy-resistant psychiatric disorders were included in the study. The patients were assessed at the end of the ECT course, at the three-month follow-up, and at the six-month follow-up by the Clinical Global Impression (CGI), Montgomery Asberg Depression Rating Scale (MADRS), Young Manic Rating Scale (YMRS) and the Yale-Brown Obsessive Compulsive Scale (YBOCS). Improvement was defined with the help of the CGI subscale by comparing the position of the patient at admission to the projected condition with ECT. Statistical analysis Analysis of Variance (ANOVA) was used for analysis of the quantitative data. For the pair-wise comparison of the groups, the post hoc tests were used. Pearson’s chi-square test was used for analysis of qualitative data. A p-value of < 0.05 was considered to be statistically significant, and all the data analysis was done using SPSS Version 20.0. Results The CGI scale revealed that statistically significant improvement occurred in patients at the end of ECT course, at the three-month follow-up as well as at the six-month follow-up. Conclusion ECT should be used for the treatment of pharmacotherapy-resistant psychiatric patients and the benefits can be seen even six months after an ECT course completion. Further work in this field should focus on educating the general public about the usefulness of ECT in the treatment of resistant mental illnesses. The myths related to the so-called psychiatric assault from ECT should be removed.

Systemic lupus erythematous presenting as catatonia and its response to electroconvulie therapy

Neuropsychiatric systemic lupus erythematous (SLE) encompasses various psychiatric and neurological manifestations that develop in SLE patients, secondary to involvement of central nervous system. Neuropsychiatric SLE, presenting as catatonia is very uncommon, and treatment of this condition is not well defined. Previously the role of benzodiazepines, immunosuppression, plasma exchange, and electroconvulsive therapy (ECT) has been described in its management. Here we describe a case of neuropsychiatric lupus presenting as catatonia that did not respond to benzodiazepines or immunosuppression. The symptoms of catatonia showed improvement with ECT. Furthermore, we have discussed the pathology of the disorder and the role of ECT in the treatment of cases of catatonia associated with SLE, who do not respond to benzodiazepines.