Soumya Basu

The autism spectrum disorder ‘epidemic’: Need for biopsychosocial formulation

In DSM-IV autism spectrum disorder (ASD) was defined as a cluster of lifelong neurodevelopmental disorders consisting of autistic disorder, Asperger’s syndrome and pervasive developmental disorder not otherwise specified (PDD-NOS). ASDs can be disabling disorders and warrant multi-faceted assessments and interventions that are often required in some form across the lifespan. The prevalence of ASDs has climbed dramatically in recent years and an over-diagnosis ‘epidemic’ has been suggested (Frances and Batstra, 2013). Partly to reduce over-diagnosis, ASDs have been consolidated in DSM-5, such that the subtypes are no longer used but all are referred to as ASD and severity is specified. ASD in DSM-5 is characterised by deficits in social communication and social interaction plus restricted repetitive behaviours, interests and activities (RRBs). Subjects without RRBs can be given a new DSM-5 diagnosis: social communication disorder. However, the DSM-5 field trials suggest most individuals currently diagnosed with ASDs will still have ASD under the new criteria. This allayed the fears of some advocacy groups. We argue that there is an overdiagnosis ‘epidemic’ of ASDs, particularly in the paediatric population, and doubt that DSM-5 criteria will minimize this. The underlying drivers of this and similar over-diagnostic ‘epidemics’ is a combination of the descriptive symptom-focused and context-deficient nosology inherent in the DSM model combined with needs for services and other psychosocial gains associated with the use of diagnostic labels. A false ASD diagnosis can provide practical benefits such as financial and educational assistance, but it comes with side effects that may take years to be fully apparent.

Risperidone-induced galactorrhoea: a case series.

We previously proposed a regime to discontinue paroxetine that, even though helpful in diminishing syndrome incidence, did not prove as successful as we had expected (2). More recently, we have tried other strategies that proved more effective, although still not always successful. Therefore, we feel that an even slower dosage reduction should be attempted. If we are to achieve this in countries such as Spain, where only 20mg tablets are available, manufacturers must produce new forms properly grooved to allow smaller dosages.

Euthanasia: An Indian perspective

In our society, the palliative care and quality of life issues in patients with terminal illnesses like advanced cancer and AIDS have become an important concern for clinicians. Parallel to this concern has arisen another controversial issue-euthanasia or “mercy –killing” of terminally ill patients. Proponents of physician-assisted suicide (PAS) feel that an individuals right to autonomy automatically entitles him to choose a painless death. The opponents feel that a physicians role in the death of an individual violates the central tenet of the medical profession. Moreover, undiagnosed depression and possibility of social ‘coercion’ in people asking for euthanasia put a further question mark on the ethical principles underlying such an act. These concerns have led to strict guidelines for implementing PAS. Assessment of the mental state of the person consenting to PAS becomes mandatory and here, the role of the psychiatrist becomes pivotal. Although considered illegal in our country, PAS has several advocates in the form of voluntary organizations like “death with dignity” foundation. This has got a fillip in the recent Honourable Supreme Court Judgment in the Aruna Shaunbag case. What remains to be seen is how long it takes before this sensitive issue rattles the Indian legislature.

Convulsions in the treatment of obsessive-compulsive disorder.

Obsessive–compulsive disorder (OCD) and epilepsy tend to share a close association. However, the exact relationship between OCD symptoms and epileptic convulsions is not well known. A case of OCD who improved remarkably following drug-induced seizures is described, implicating a role for convulsion as an alternative therapeutic modality in OCD.