As a pilot project, Indian Psychiatric Society conducted the first multicentric study involving diverse settings from teaching institutions in public and private sectors and even privately run psychiatric clinics.
Aim of the Study:
To study the typology of functional somatic complaints (FSC) in patients with first episode depression.
Materials and Methods:
A total of 741 patients from 16 centers across the country participated in the study. They were assessed on Bradford Somatic Symptom inventory for FSC, Beck Depression Inventory for severity of depression, and Comprehensive Psychopathological Rating Scale- anxiety index (CPRS-AI) for anxiety symptoms.
The mean age of the study sample was 38.23 years (SD-11.52). There was equal gender distribution (male - 49.8% vs. females 50.2%). Majority of the patients were married (74.5%), Hindus (57%), and from nuclear family (68.2%). A little over half of the patients were from urban background (52.9%). The mean duration of illness at the time of assessment was 25.55 months. Most of the patients (77%) had more than 10 FSCs, with 39.7% having more than 20 FSCs as assessed on Bradford Somatic Inventory. The more common FSC as assessed on Bradford Somatic Inventory were lack of energy (weakness) much of the time (76.2%), severe headache (74%) and feeling tired when not working (71%), pain in legs (64%), aware of palpitations (59.5%), head feeling heavy (59.4%), aches and pains all over the body (55.5%), mouth or throat getting dry (55.2%), pain or tension in neck and shoulder (54%), head feeling hot or burning (54%), and darkness or mist in front of the eyes (49.1%). The prevalence and typology of FSCs is to a certain extent influenced by the sociodemographic variables and severity of depression.
Functional somatic symptoms are highly prevalent in Indian depressed patients and hence deserve more attention while diagnosing depression in Indian setting.
Depression; Functional somatic complaints; India
There are very few studies from India which have evaluated the prescription pattern for antidepressants by psychiatrists for treatment of depression.
To study the psychotropic prescription patterns of patients with first episode depression from diverse settings including teaching institutions in public and private sectors and even privately run psychiatric clinics.
Materials and Methods:
Prescription data of 706 patients with first episode depression, who participated in the IPS multicentric study, were evaluated.
Escitalopram was the most commonly prescribed antidepressant, comprising 40% of the total prescriptions. This was followed by sertraline (17.6%) and fluoxetine (16.3%). In total, selective serotonin reuptake inhibitors (SSRIs) formed 79.2% of all the prescriptions. Tricyclic antidepressants formed a small part (15.15%) of total prescriptions, with imipramine being the most commonly used tricyclic antidepressant. Serotonin-norepinephrine reuptake inhibitors (venlafaxine, desvenlafaxine and duloxetine) were prescribed to 11.3% of patients with equal share of venlafaxine and duloxetine. About one-sixth (N=104; 14.7%) of the patients were prescribed more than one antidepressant. Nearly three-fourth of the patients (N=523; 74.1%) were prescribed a benzodiazepine, with clonazepam being the most preferred agent, prescribed to nearly half of the participants (49%) and formed nearly two-third of the total benzodiazepine prescriptions (346 out of 523).
Escitalopram is the most commonly prescribed antidepressant and SSRIs are the most commonly prescribed class of antidepressants. Poly pharmacy in the form of concomitant use of two antidepressants is practiced infrequently. However, benzodiazepines are used quite frequently as the co-prescription.
Antidepressants; depression; prescriptions
The objective of this paper is to provide a review on the psychiatric comorbidity research in India based on the data published in the last six decades. The comorbidity data world over reflects that it is a much more common phenomenon than observed in routine clinical practice. In India, research into this domain of psychiatry has been limited, with comorbidity reported to be as high as 60%. In the few publications in this area, most of the authors have looked into substance related comorbidity. Small numbers of studies have looked into comorbid conditions in child psychiatry, especially mental retardation and very few studies have looked at other comorbidities. The landmarks in the studies in the area of psychiatric comorbidity have been highlighted in this review article.
Comorbidity; India; last six decades; Psychiatry
Nephropathy is an important and a frequent complication of long-term type II diabetic nephropathy. Strong evidence exists that genetic predisposition plays a major role in the development of diabetic nephropathy. Recent studies have implicated association between angiotensin converting enzyme (ACE) insertion/deletion (I/D) gene polymorphism and nephropathy. The deletion gene polymorphism of ACE gene has been shown to be associated with increased activity of this enzyme. This study examines the association of ACE I/D polymorphism with type II diabetes without nephropathy in 30 patients and type II diabetes with nephropathy in 30 patients. The results of the study suggest the association between the DD polymorphism and type II diabetes with nephropathy.
Angiotensin converting enzyme gene polymorphism; nephropathy; type II diabetes mellitus
The present study was carried out on the hospitalized geriatric general medical patients with the aim to identify the possible risk factors associated with delirium in the elderly. The assessment of the patients was carried out using Mini Mental Status Examination (MMSE), Delirium Symptom Interview (DSI), Delirium Rating Scale (DRS) and ICD-10 Diagnostic Criteria for Research for delirium Details of medical records were collected. An overall rate of delirium of 27% was found in the 100 patients who constituted the sample. Pre-existing cognitive deficits, neurological illnesses, urinary tract infections, visual impairment, hearing impairment, current proteinuria, leukocytosis, raised blood ammonia, hyponatremia and potassium level disturbances were the risk factors identified.
Delirium; elderly; genatric; risk factor
The present study was carried out on the hospitalised geriatric general medical patients. The assessment of the patients was carried out within 24 hours of admission and on every fourth day thereafter using Mini Mental Status Examination (MMSE), Confusion Assessment Method (CAM), Delirium Symptom Interview (DSI) and ICD-10-Diagnostic Criteria of Research for delirium. An overall rate of delirium of 27% was found in the 100 patients who constituted the sample. 19% was the rate of ‘prevalent’ delirium and 8% was the rate of ‘incident’ delirium. It is observed that the CAM is a useful screening method with high sensitivity for diagnosis of delirium at the bedside.
Delirium; elderly; geriatric; epidemiology
In a naturalistic longitudinal design 133 consecutive inpatients with alcohol dependence syndrome were followed up for one year following discharge from the hospital. 59 patients (group 1) paid follow up visit at regular intervals whereas 28 subjects (group 2)never returned despite three consecutive postal intimations. Rest of the patient were irregular in follow up. The individuals in group 1 were compared with those in group 2 on various sociodemographic and clinical variables with the aim of delineating the characteristics that could define the alcoholics who dropped out following discharge. It was found that such patient were relatively younger with lower level of education, less frequently married, had earlier onset of problem drinking with poor social support and higher rates of mental problems. It was concluded that post discharge attrition of alcoholics could be a social as well as a clinical problem in any setting rendering long treatment for alcoholism.
alcohol dependence; treatment dropout; long term follow up.
Mania in HIV infected individuals is an uncommon clinical presentation. It can, however, complicate any stage of the HIV infection. We herewith report a set of three case reports of patients with HIV infection who developed manic episodes. The cases highlight some aspects of the plausible relationship between HIV infection and mania. HIV infection could be revealed by manic episode, it could itself also be associated with increased cycling in bipolar patients. Mania could be secondary to HIV or zidovudine therapy (though the etiological role of the latter is as yet unclear). Mania could also occur as a reaction to awareness to having HIV infection. These relationships are important for both the physician and the psychiatrist as they have important therapeutic and prognostic implications.
Mania; HIV; AIDS; zidovudine
The diagnosis of dementia in Alzheimer's disease on clinical grounds is made by exclusion of other etiologies. The differential diagnoses of other subtypes considered along with dementia of Alzheimer's disease and the clinical process involved were studied in a tertiary level health care set up. Out of 39 patients with dementia admitted over 12 years it was found that a differential diagnoses of other subtype were considered along with dementia of Alzheimer's disease in 13 cases, while 15 cases had no such association. Most frequently associated category was vascular dementia in 30.8%. The clinical difficulties in differentiating dementia in Alzheimer's disease are discussed.
Alzheimer; dementia; diagnoses
Carisoprodol is a centrally acting skeletal muscle relaxant whose active metabolite is meprobamate. There have been few reports of carisoprodol abuse from India. This is a report of a case with carisoprodol dependence. The patient also had poly substance abuse of alcohol, nicotine, benzodiazepine and dextropropoxyphene. Although no specific withdrawal syndrome could be identified, the patient had symptoms of anxiety, insomnia, restlessness and craving. Clinicians must be aware of the dependence potential of carisoprodol and need to be cautious in its prescription, especially in view of its free availability in the Indian market.
Carisoprodol; dependence; poly-substance abuse
An attempt is made in this communication to report a better way of preparing guggulu – containing pills. This technique improves the disintegration time of the preparation, thus enhancing its therapeutic value.
The author renders here an English translation to Lehdhyaya of the Kasyapa-samhita, Suthrasthana, 1-6.
This paper deals with the various aspects of commonly used flavouring agents for the preparation of medicaments.
The research work done on different species of the genus Mimosa have been reviewed with special reference to Chemistry, Biochemistry and Biological activities.
The quantitative estimation of various metallic constituents of Trivanga Bhasma, an important Ayurvedic drug, has been carried out which provided interesting results.
In this paper the author probes the identity of Candranandana a well known author and commentator of various works in Ayurvedic literature by interpreting the classical texts.
This translation of Haramekhala – tantra of the author is based on Banaras Hindu University manuscript which seems to be a novel one. The manuscript runs into 133 stanzas in all in the form of dialogue between lord Siva and goddess Parvati. This is only the first chapter (of the great work) dealing with medicine. From stanza 109 onwards some magic spells are described and as such those have not been included in this translation.
Tantra and Ayurveda are interrelated, particularly during medieval period, Tantra had great impact on the theory and practice of Ayurveda. Hitherto this aspect of history is not sufficiently explored. In this paper, influence of Tantra on Sarngadhara, a representative author of the medieval period, has been vividly brought out.
The word ‘Sarkara’ is used to denote several meanings. That it also denotes a plant is a little known fact. This hitherto hidden fact has been brought to light with support of relevant references. The description of the plant themeda arundinacea (Roxb.) Ridley is also given.
Treatment discontinuation has been noted as a problem with psychiatric patients. This would equally be the case when long term measures for the rehabilitation of the mentally ill are concerned. In this study of patients who discontinued psychiatric day hospitalisation, it was found that over 90 % had dropped out in the first month of treatment. Schizophrenics, Manic Depressives, Epileptics and others contributed to the largest extent to this group whereas Mental Retardates discontinued less often. The discontinued patients either had better prognostic factors and maintained well subsequently (usually Manic Depressives) or relapsed soon after (usually Schizophrenics). The implications of the findings are discussed whilst comparing the discontinuers with those continuing day hospitalisation.
A begger's colony where a neuropsychiatric extension clinic is being run by NIMHANS, Bangalore, was selected for this study wherein 78 neuropsychiatrically ill inmates and 85 well ones were examined and diagnosed as per I.C.D.-9 and followed up on treatment. A period prevalence of 131.09/1000 serious neuropsychiatric morbidity was found with psychoses, mental retardation and epilepsy being more frequent than in general population studies. Findings in this study, point towards a need for reaching neuropsychiatric care to this section of society, and also confirm the association of certain social factors with serious morbidity.