Savita Malhotra

Childhood Disintegrative Disorder

Abstract. Childhood disintegrative disorder (CDD), which is classified as a sub-type of pervasive developmental disorder (PDD), has been recognised for many years. Research data on CDD, however, is sparse and it primarily describes the clinical parameters. In this research report clinical data on 12 cases of CDD and 21 cases of typical autism, seen during a specified period, are compared and critically evaluated in reference to the diagnostic criteria in ICD-10 for these disorders. While the findings support the clinical validity of CDD, these also highlight the limitations of the current criteria (ICD-10) particularly the age of onset in CDD and the conceptual confusion in labelling it as a ‘PDD’. Need for more research in the areas of the biology, course and outcome of CDD is emphasised.

An open clinical trial of buspirone in children with attention-deficit/hyperactivity disorder.

ABSTRACT Objective The efficacy of buspirone in controlling the symptoms of children with attention-deficit/hyperactivity disorder (ADHD) was examined in 12 children with ADHD. Buspirone was used solely in all the children. Method Twelve children (10 boys and 2 girls) aged between 6 and 12 years (mean age 8.2 years) with hyperkinetic disorder were studied. Standard rating scales such as the Conners Parent Abbreviated 10-Item Index (CPAI) and the Children Global Assessment Scale (CGAS) were used to collect data on the symptoms of ADHD. Visual analog scores were also obtained about the dimensions of hyperactivity, impulsivity, inattention, and disruptive behavior. All the subjects were given buspirone in the dose of 0.5 mg/kg body weight per day. The dose range of buspirone used was 15 to 30 mg/day, given in b.i.d. dosages. The subjects continued the regimen for a period of 6 weeks. The ratings were done at baseline, 1 week, 2 weeks, 4 weeks, and 6 weeks after starting buspirone. A detailed side effect checklist was administered at the same intervals. The CPAI was also repeated after 2 weeks of discontinuation of buspirone. Results When compared with baseline scores, all 12 subjects had shown significant improvement in hyperactivity, impulsivity, inattention, and disruptive behavior. The mean (SD) CPAI score improved from 24.75 (2.7) at baseline to 11.25 (2.73), and the CGAS scores improved from 36.6 (5.58) to 67.1 (7.31) during the 6-week period of the study. The only side effect reported was mild dizziness, during the first week, by two subjects. Stopping the drug at the end of the study period of 6 weeks resulted in the reemergence of the symptoms. Conclusion Buspirone showed a favorable side effect profile and significantly reduced the symptoms of ADHD. It appears equally effective in improving the varied symptoms of the disorder. These preliminary findings of apparent efficacy of buspirone for ADHD in children indicate that future controlled trials are warranted. J. Am. Acad. Child Adolesc. Psychiatry , 1998. 37(4):364–371.

Comparative study of neurological soft signs in schizophrenia with onset in childhood, adolescence and adulthood

Objective:  To compare neurological soft signs (NSS) in patients of schizophrenia with onset in childhood (COS), adolescence (AdOS) and adulthood (AOS).

Childhood disintegrative disorder

Abstract. Childhood disintegrative disorder (CDD), which is classified as a sub-type of pervasive developmental disorder (PDD), has been recognised for many years. Research data on CDD, however, is sparse and it primarily describes the clinical parameters. In this research report clinical data on 12 cases of CDD and 21 cases of typical autism, seen during a specified period, are compared and critically evaluated in reference to the diagnostic criteria in ICD-10 for these disorders. While the findings support the clinical validity of CDD, these also highlight the limitations of the current criteria (ICD-10) particularly the age of onset in CDD and the conceptual confusion in labelling it as a ‘PDD’. Need for more research in the areas of the biology, course and outcome of CDD is emphasised.

Testing the stress-vulnerability hypothesis in ICD-10-diagnosed acute and transient psychotic disorders.

Objective:  To examine if family‐history‐positive (FHP) vis‐à‐vis family‐history‐negative (FHN) probands with ICD‐10‐diagnosed acute and transient psychotic disorders (ATPD) differ significantly with respect to number of life events and cumulative stress score prior to the onset of ATPD.

Comparative study of neuropsychological correlates in schizophrenia with onset in childhood, adolescence and adulthood

Childhood onset schizophrenia (COS) patients have marked neuropsychological deficits in areas of attention, working memory and executive functions. Similar deficits have been found in studies on Adolescent onset (AdOS) and Adult onset schizophrenia (AOS). In this study we compared the neuropsychological profile of COS with AdOS and AOS to test the hypothesis that earlier the onset greater is the severity of illness and greater are the neuropsychological deficits. A sample of 15 patients of COS was compared with 20 patients each of AdOS and AOS group. Assessment of neuropsychological profile was done using standard neuropsychological battery for Indian population. Nahor Benson Test and Bender Visual Motor Gestalt Test were used to assess perceptuomotor functioning. COS patients showed significantly greater deficits on scales of IQ, memory and perceptuomotor skills as compared to AdOS that in turn had greater deficits than AOS. The persistence of differences across the three groups inspite of controlling for education and age suggest that these deficits may have been present even before the onset of illness and was not the result of poor academic achievements. These findings also point towards a brain damage in schizophrenia that occurs on a continuum of severity with COS being the most virulent, AOS being the least and AdOS falling in between these two extremes.

Onset of acute psychotic states in India : a study of sociodemographic, seasonal and biological factors

This is a comparative study of patients with acute‐onset, non‐affective, non‐organic, remitting psychoses and with non‐remitting or schizophrenic psychoses in India. Two groups of patients with acute remitting and non‐remitting or schizophrenic psychoses were compared with regard to the following variables: month of onset of psychosis; presence of stress, particularly fever, within 4 weeks preceding the onset of psychosis; childbirth within 12 weeks preceding the onset of psychosis; gender differences. It was found that the acute remitting psychoses showed an overrepresentation of females, a higher frequency of associated stress preceding the onset of psychosis, more often had onset during the summer months, i.e. between May and September, and had fever and childbirth preceding the onset of psychosis in a significantly higher proportion of patients, compared to acute non‐remitting psychoses or schizophrenia. The implications of the findings which point towards biological factors in the aetiology of acute remitting psychoses are discussed.

Seasonality and affective disorders: a report from North India

Case records of the patients with major affective disorders (ICD-10 criteria), seen over a 5 year period in a busy clinic in North India were examined for Seasonal Affective Disorder (SAD) as per DSM-III-R criteria. In addition, seasonality of episodes of all affective disorders was also studied. Around 5.67% of the cases (n=44) retrospectively met the DSM-III-R criteria of SAD and predominant pattern was that of summer depression (n=18). There was also a consistent pattern of seasonal mania either in conjunction with seasonal depression (n=18) or in form of seasonal recurrent mania (n=11). None of the cases of depression showed any atypical vegetative features. In cases not meeting criteria for SAD (n=731), there was a trend for peaks for depressive episodes in winter followed by a smaller peak in summer months while manic episodes had peaks towards rainy and winter months. As compared to seasonal patterns of affective disorders in temperate zones, there was a general trend for opposite patterns of seasonality in SAD as well as in non-SAD. The findings are discussed in context of the climatic conditions of North India.

Varied psychiatric manifestations of acute intermittent porphyria

Acute Intermittent Porphyria (AIP) is an autosomal dominant metabolic disorder that has various psychiatric manifestations. This is a report of a case who had six brief psychotic episodes of varying nature within a 2-month period. The psychotic manifestations included catatonic stupor, hypomania, and delirium in different episodes. The management aspects of the case have been highlighted.

Early-life mental disorders and adult household income in the World Mental Health Surveys

BACKGROUND Better information on the human capital costs of early-onset mental disorders could increase sensitivity of policy makers to the value of expanding initiatives for early detection and treatment. Data are presented on one important aspect of these costs: the associations of early-onset mental disorders with adult household income. METHODS Data come from the World Health Organization (WHO) World Mental Health Surveys in 11 high-income, five upper-middle income, and six low/lower-middle income countries. Information about 15 lifetime DSM-IV mental disorders as of age of completing education, retrospectively assessed with the WHO Composite International Diagnostic Interview, was used to predict current household income among respondents aged 18 to 64 (n = 37,741) controlling for level of education. Gross associations were decomposed to evaluate mediating effects through major components of household income. RESULTS Early-onset mental disorders are associated with significantly reduced household income in high and upper-middle income countries but not low/lower-middle income countries, with associations consistently stronger among women than men. Total associations are largely due to low personal earnings (increased unemployment, decreased earnings among the employed) and spouse earnings (decreased probabilities of marriage and, if married, spouse employment and low earnings of employed spouses). Individual-level effect sizes are equivalent to 16% to 33% of median within-country household income, and population-level effect sizes are in the range 1.0% to 1.4% of gross household income. CONCLUSIONS Early mental disorders are associated with substantial decrements in income net of education at both individual and societal levels. Policy makers should take these associations into consideration in making health care research and treatment resource allocation decisions.