Shruti Srivastava

Quality of life in patients with obsessive compulsive disorder: A longitudinal study from India.

Obsessive Compulsive Disorder (OCD) is one of most frequently diagnosed psychiatric illness, tends to run a chronic course and severely affects the patients quality of life (QoL). The aim of this study was to assess QoL in patients with OCD and compare it with QoL of patients with major depressive disorder (MDD) and healthy controls. Forty-five patients with OCD, fifty patients with the diagnosis of MDD and one hundred and fifty healthy controls were evaluated using WHOQoL-BREF, Hindi version and their QoL scores were compared. Symptom severity of the OCD group was measured using Yale Brown Obsessive Compulsive Scale (YBOCS) and was charted longitudinally over a period of 6 months. The QoL of patients with OCD was found to be significantly lower in the domains of physical, psychological well-being and social domains as compared to the healthy controls. When compared with patients with MDD, the pre-treatment QoL of patients with OCD was found to be significantly higher. Six months follow up found Psychological health domains of QoL better in the MDD group than the OCD group. Between MDD and OCD groups, statistically significant differences were noted in the environment domains, though overall improvement in QoL scores was noted in both the groups in all domains. YBOCS scores significantly improved with treatment in OCD patients, as did the scores on WHOQoL-BREF. Minimal correlation was found between changes in YBOCS scores and QoL scores in OCD subjects at 6 months follow up. These findings indicate that all aspects of QoL are markedly affected in individuals with OCD, QoL scores improve with treatment and the changes in QoL scores over a period of 6 months are not necessarily correlated with corresponding changes in YBOCS scores (indicative of symptom severity in OCD subjects).

A Diffusion Tensor Imaging Study Using a Voxel-Based Analysis, Region-of-Interest Method to Analyze White Matter Abnormalities in First-Episode, Treatment-Naïve Major Depressive Disorder

This study used fractional anisotropy (FA), a measure of diffusion tensor imaging, to analyze white matter abnormalities in 15 first-episode treatment-naïve patients with major depressive disorder (MDD) and 15 controls matched for age. An automated voxel-based analysis and a region-of-interest (ROI) method with 3T magnetic resonance imaging were used. Compared with controls, FA values were lower in the left superior longitudinal fasciculus, the left prefrontal cortex, and the left parietal region in patients with MDD. In addition, the ROI method revealed significantly lower FA values in the right hippocampus. Voxel-based analysis, a faster technique, complements the ROI method, which highlights FA values as potential biomarkers in early MDD.

Delusional infestation: A clinical profile

OBJECTIVE Delusional infestation or delusional parasitosis is a form of monodelusional disorder, a condition sometimes encountered in psychiatric or primary care practice. The outcome of this condition is good when compliance can be ensured. PATIENTS AND METHODS In the present study, a series of 50 consecutive cases of delusional infestation is reported. RESULTS A majority of cases (94%) had insidious onset. The duration of symptoms in all but 3 cases was 6 months or more. Twenty-eight cases presented with a delusion of infestation by insects over the body and 20 cases with a delusion of insects crawling over the scalp. Two cases had associated diabetes mellitus, 3 cases had leprosy, 2 cases had dementia, 5 cases had depression, and 4 cases presented with trichotillomania. Among the second generation antipsychotics, risperidone was used in 12 cases, olanzapine in 9 cases, amisulpride in 7 cases, etc. Thirty-four cases (68%) showed complete remission while receiving pharmacotherapy, 13 cases showed partial improvement, and 3 cases did not respond to treatment. CONCLUSIONS The study demonstrates the utility of second generation antipsychotics in the treatment of this disorder. Further studies are warranted to study the treatment and outcome of this important psychiatric disorder.

Depression in women in Indian context.

The estimate of the global burden of disease predicts that depression will be the second-leading cause of disability worldwide by 2020. Depression is widely prevalent in women in all age groups especially in India where 1.2 billion population lives. In the current scenario of underdiagnosed, untreated cases of females suffering from depression, the hurdles faced by Indian women include inadequate number of mental health professionals, lack of awareness, stigma, disadvantaged position of women, multiple roles, increased levels of stress, and domestic violence. The literature search included an electronic database, published materials, and standard textbooks. The authors have provided a brief overview of different types of depression in females. Epidemiology, etiology, clinical presentation, and management linked to the reproductive cycle of women have been covered. Awareness through public education, early detection, organized national mental health programs, comprehensive management, with judicious utilization of the limited resources would tackle the rising number of cases of female depression, in a cost effective manner, thereby preventing suicide.

Quality of life as an outcome measure in the treatment of alcohol dependence

Background: Quality of life has emerged as an important treatment outcome measure for alcohol dependence whose natural course comprises of remission and relapse. Materials and Methods: The purpose of this study was to examine the prospective change in Quality of life (QoL) in 56 patients aged 18-45 years of alcohol dependence over a three months’ period and compare it with QoL of 150 age- and gender- matched healthy controls using WHOQoL-BREF. Severity of alcohol dependence and drinking parameters were assessed. Results: Significant improvement in QoL of patients of alcohol dependence over three months’ abstinence. The physical, psychological, social, and environment domains of QoL in alcohol dependence subjects were significantly lower before treatment initiation than the healthy controls. Alcoholic liver disease emerged as a predictor of improvement in psychological and social domains of QoL. Conclusion: The study confirms poor quality of life in patients of alcohol dependence before intervention. The regular follow-up with the family members in out-patient setting enables the patients achieve complete abstinence, thereby improving their quality of life.

Organic Mania in Dengue

Dengue fever is considered to be one of the major health problems in south east Asia. In the recent past, epidemic outbreaks of Dengue have also been noticed in India. Initially, the neurological manifestations which were associated with Dengue received little attention, but now, there have been several reports of encephalitis and encephalopathy . However, nowhere in the literature has Dengue fever been mentioned as a cause of acute psychosis or mania. Here, we are reporting a 21-year-old male, a resident of Delhi, India who after the Dengue infection, developed an episode of classical mania.

1. An Uncommon Case of Zoophilia

Humans show a wide array of sexual preferences and behaviour. Zoophilia, or bestiality, consists of sexual intercourse by a human being with a lower animal. There is a paucity of literature on zoophilia. We describe a rare case of preferential zoophilia involving multiple animals. The perpetrator developed this habit only during episodes of depression. It is recommended that due to the apparent common occurrence of this condition, questions exploring a topic which appears to be routinely ignored should be included in the psychiatric interview.

Mania in dengue fever.

Dengue fever, also known as break bone fever, is a mosquito-borne infection that causes a severe flu-like illness. During the last few years, there had been increasing reports of dengue fever with unusual manifestations, primarily with neurological symptoms. Psychiatric morbidity during acute dengue infection has rarely been reported. There has not been any systemic study mentioning the prevalence and pattern of psychiatric sequelae. We report a 28-year-old male who after an acute dengue infection developed an episode of mania which was successfully treated.

Health-Related Quality of Life in Bipolar Disorder Patients and Their Caregivers

Introduction: The health-care implications of quality of life (QOF) in longstanding disorders such as bipolar disorder (BD) for the patients and their caregivers is significant. Objectives: This study compares QOL among BD patients, their caregivers, and healthy controls and assesses whether the level of depression correlates with the scores of QOF in BD patients. Method: We compare BD patients (n = 40), their caregivers (n = 40), and healthy controls (n = 150) on health-related QOF (HRQOL) which was assessed using the 26-item World Health Organization QOL instrument (WHOQOL-BREF, Hindi version). All BD patients were diagnosed using the Structured Clinical Interview for DSM-IV. Within the BD group, we examine the relation between HRQOL using WHOQOL BREF Hindi version and depression assessed on 17-item Hamilton Depression Rating Scale (HDRS). Results: BD patients had lower QOL on all the four domains compared to healthy controls and their caregivers. The four domains of the WHOQOL scale correlated negatively with the HDRS. Conclusions: Our findings suggest that BD depression and residual symptoms of depression are negatively correlated with QOL in BD patients. The comprehensive treatment should target in improving the QOL of both BD patients and their caregivers.

An uncommon case of hypersexual behaviour with frotteurism

Frotteurism is an aberrant behaviour wherein the person tends to rub or bring about physical contact between his genitals and an unrelated female to derive sexual pleasure. Our report describes an atypical case of hypersexual behaviour presenting in the form of masturbation with features of frotteurism and unipolar depression. The paper discusses the differential diagnosis and management of hypersexual behaviour.