Surendra K. Mattoo

Psychiatric morbidity in vitiligo: prevalence and correlates in India

Background Vitiligo, a common pigmentary disorder, is recognized to be associated with a high psychiatric morbidity, yet compared to other dermatological disorders like leprosy, psoriasis, etc., it has not been subjected to detailed evaluation of its psychological consequences. The data from the developing countries on this aspect in particular is meager.

Quality of life and its correlates in patients with bipolar disorder stabilized on lithium prophylaxis

Abstract  The quality of life (QOL) of 50 bipolar disorder patients in remission (stabilized on lithium prophylaxis) was assessed and compared with that of clinically stable patients with schizophrenia (n = 20) and healthy subjects (n = 20). World Health Organization Quality of Life‐Bref (WHOQOL‐BREF) and Quality of Life Enjoyment and Satisfaction Questionnaire (Q‐LES‐Q) were used to assess QOL in the three groups of subjects. The factors that contribute or influence QOL (i.e. stressful life events, social support, daily hassles) were also studied using standardized instruments in the study group. It was found that, compared to schizophrenia group, the bipolar group had significantly better QOL in all the domains of Q‐LES‐Q and the domains of general well‐being, physical health and psychological health of the WHOQOL‐Bref. The bipolar group had similar QOL scores in all other domains and higher scores in leisure time activity domain of Q‐LES‐Q, in comparison to the healthy group. The QOL in the bipolar group was better in patients who were younger and had a lesser severity of daily hassle. The present findings suggest that euthymic patients with bipolar disorder have a QOL that is comparable to that of healthy subjects. In contrast, patients with clinically stable schizophrenia have a poorer QOL. Occurrence of daily hassles contributes significantly to QOL in patients with bipolar disorder. However, the relatively limited variance explained by the independent variables included in the study, suggests the need to examine other (perhaps non‐clinical) factors that may affect QOL.

Relationship of anger and anger attacks with depression: a brief review.

AbstractAnger is a common and potentially destructive emotion that has considerable social and public health importance. The occurrence of anger, irritability and hostility in depression have been known for many years, but the prevalence, significance for treatment and prognosis and the mechanisms involved remain poorly understood. More recently, anger attacks have been proposed as a specific form of anger in depression. They are characterized by a rapid onset of intense anger and a crescendo of autonomic arousal occurring in response to trivial provocations. Though the presence or absence of hostility, anger and aggression in depression has been a matter of controversy, anger attacks have been found to occur more often in depressed patients in comparison to healthy controls. Some studies have reported that depressed patients with anger attacks differ from those without such attacks in terms of clinical profile, comorbid personality disorders and certain biological variables. Serotonergic dysfunction may characterize this distinct subtype of depression – depression with anger attacks.

Psychiatric morbidity in vitiligo and psoriasis: a comparative study from India.

In a tertiary‐care teaching hospital in India, dermatology outpatients with vitiligo (N=113) and psoriasis (N=103) were studied for psychiatric morbidity. The two groups were similar with regard to education, locality, religion, and attitude to appearance (ATT). Psoriasis cases were older, more often male, and more often married. The General Health Questionnaire (GHQ) assessed psychiatric morbidity rates at 33.63% and 24.7% for vitiligo and psoriasis, respectively. The ICD‐10 psychiatric diagnoses in GHQ positive cases were: adjustment disorder (56% vs 62%), depressive episode (22% vs 29%) and dysthymia (9% vs 4%) in vitiligo and psoriasis, respectively. The Comprehensive Psychopathological Rating Scale (CPRS) assessed that depression, anxiety, and total psychopathology levels were similar in the two GHQ positive subgroups. Significant correlations were noted between psychopathology (GHQ, CRPS), dysfunction as per Dysfunction Analysis Questionnaire (DAQ), and behavior change as per Impact of Skin Disease Scale (IMPACT), and all were more prominent in vitiligo.

Lithium prophylaxis of recurrent bipolar affective disorder: Long-term outcome and its psychosocial correlates

BACKGROUND Discrepancy between efficacy of prophylactic lithium and its effectiveness in ordinary clinical practice necessitates long-term follow-up data from specialised lithium clinics. Also, role of psychosocial factors in influencing the outcome is unclear. METHODS One hundred and eighteen patients of bipolar affective disorder attending a lithium clinic were followed-up for approximately 11 years (range 2-27 years). Demographic and clinical data, measures of social support and psychosocial stress were obtained at the intake in 1989-1990. Study design combined retrospective chart-review (till the time of intake) with prospective follow-up till July 1995. RESULTS On lithium, the patients had a mean of 0.43 relapses per year (manic, 0.26; depressive, 0.17) which was significantly less (p < 0.01) than the pre-lithium episode frequency. The figure for entirely relapse-free patients was 24%, and 62% had relapses up to one episode per year (median = 0.3 per year). Fifty-eight (49%) patients were good responders to lithium (relapses < or = 0.30 per year). In comparison to good responders, partial/poor responders had a significantly greater number of pre-lithium depressive episodes, poor lithium compliance, more psychosocial stress and lower social support at intake. These variables correlated well with relapses and explained 32% of the variance of the data. CONCLUSIONS Lithium had a definite prophylactic effect on long-term outcome. Social support and stressful life events are significant correlates of response to lithium. CLINICAL IMPLICATIONS Lithium prophylaxis of bipolar affective disorders seems justified though psychosocial factors appear to modulate its effectiveness. LIMITATIONS Other psychotropic medications were used during relapse and the assessment of psychosocial factors was cross-sectional.

Cases of buprenorphine abuse in India

Buprenorphine was introduced as a potent analgesic with low abuse potential. Reports of buprenorphine abuse by opiate abusers have accumulated over the years, highlighting its use as a cheap alternative to heroin. The lower potency compared with heroin is being compensated by using a cocktail of buprenorphine with benzodiazepines or cyclizine. This study of 18 cases seen over 3 years broadly confirms these findings. Four cases reported haematemesis during acute withdrawal, a symptom not reported in earlier studies.

Antecedents, concomitants and consequences of anger attacks in depression

Anger attacks are episodes of intense anger with autonomic arousal, which occur in response to often trivial provocations. This study explores some of the antecedents, concomitants, and consequences of anger attacks in patients with depression. The sample comprised three groups: depression with anger attacks (n=20), depression without anger attacks (n=20) and normal controls (n=20). Subjects were administered the Mini International Neuropsychiatric Interview, the Anger Attack Questionnaire, Irritability, the Depression Anxiety Scale, the State-Trait Anger Expression Inventory, the Psychoticism Extraversion Neuroticism Inventory, the Hassles Scale, the World Health Organization Quality of Life-BREF Version and the Dysfunctional Analysis Questionnaire. Depressed patients with anger attacks exhibited more suicide-related phenomena and dysfunction scores in comparison to depressed patients without anger attacks. Depressed patients with anger attacks also had higher scores of anxiety, irritability, trait-anger, anger-out, anger expression, psychoticism, hassles, and poor quality of life in comparison to the other two groups. In conclusion, anger attacks adversely affect the lives of depressed patients and their family members and may serve as a qualifier for partially distinct syndrome of depression.

Correlates of early- and late-onset alcohol dependence

The present study aimed at finding out demographic, clinical, personality, and behavioural correlates of age at onset of alcohol dependence. Fifty-one male patients of alcohol dependence (DSM-III-R, APA, 1987) attending the drug de-addiction clinic of a general teaching hospital in India comprised the sample. They were administered a composite socio-demographic and alcohol use proforma, modified Sensation-Seeking Scale (SSS), Multiphasic Personality Questionnaire (MPQ), and a checklist of behavioural tendencies when drinking. The early-onset alcoholics (age at onset of alcohol dependence 25 years or less) were younger. They had a larger proportion of first-degree relatives with both lifetime use and abuse/dependence of alcohol but not of other psychoactive substances. They had experienced a greater number of alcohol-related problems in the previous 1 year. They were also higher sensation seekers, higher on the Psychopathic deviate scale of MPQ, and tended to display aggression, violence, and general disinhibition when drinking. The late-onset alcoholics (age at onset of alcohol dependence more than 25 years) were anxiety-prone and guilt-ridden, and had less alcohol-related problems. The two groups were comparable on duration, frequently, and quantity of alcohol consumption. The findings are discussed in relation to some of the recently proposed typologies of alcoholism.

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.

Prevalence and clinical profile of delirium: a study from a tertiary-care hospital in north India

BACKGROUND There is scarcity of data from the Indian subcontinent in terms of rates of psychiatric referrals and prevalence of delirium in the medico-surgical setting. AIM The present research aimed to study the rates of psychiatric referrals, clinical profile and treatment of delirium in a tertiary-care hospital. METHODS The referral register in the department of psychiatry (which records all referrals to the Consultation-Liaison Psychiatry Team) was used to obtain data of all referred patients who had been diagnosed to have delirium while they were admitted in the Nehru Hospital, Postgraduate Institute of Medical Education and Research, Chandigarh, during the period 2000-2005. RESULTS Over 6 years, 3092 patients/referrals were received from different wards and included 1050 who were diagnosed as having delirium. The psychiatric referral rate ranged from 0.92% to 1.56% (mean=1.3%) per year; delirium formed the largest diagnostic category (30.77% to 38.95% of all referred cases). The prevalence of delirium in all inpatients ranged from 0.28% to 0.53% (mean=0.44%), with prevalence being higher in the elderly. In 80% of the cases, the referral was for abnormal behavior or patients noncooperation for treatment. Most of the cases improved with treatment. CONCLUSIONS Delirium forms the largest diagnostic category in psychiatry referrals and improves with treatment.