A male patient presented with tricyclic induced hypomania after treatment for chronic depression.... more A male patient presented with tricyclic induced hypomania after treatment for chronic depression. On follow up the patient deteriorated towards dementia with multifocal leucoencephalopathy. The possible role of brain lesions in the causation of affective syndromes and the neurobiological hypothesis of bipolar syndromes are discussed. The authors propose that chronic depression should be thoroughly investigated for a probable Axis III diagnosis.
Journal of Child and Adolescent Psychiatric Nursing, 2006
PROBLEM: Program evaluation of the effectiveness of two continuing nursing education programs (CN... more PROBLEM: Program evaluation of the effectiveness of two continuing nursing education programs (CNE) in child psychiatry in India. METHODS: Pre-and postevaluation of a total of 51 nurses attending a 10-day CNE program, using a 30-item (six-domain) questionnaire according to CNE topics in child psychiatry. FINDINGS: The CNE program resulted in significant increase in the total scores as well as scores in several sub-domains in the field of child psychiatry. CONCLUSIONS: In a country that does not offer degree programs that integrate psychiatric nursing into the curriculum, CNE programs are an important educational option for nurses. The CNE program offered in this study, comprising lectures, discussion, interactive sessions, and case demonstrations totaling 60 hr across 10 days, was effective in improving the level of knowledge of nurses. It was equally beneficial for senior as well as less experienced nurses.
Divorce rate in India are one of the lowest in the world, but it is increasing progressively. Men... more Divorce rate in India are one of the lowest in the world, but it is increasing progressively. Mental illness in one of the spouses are often alleged to be the ground of dissolution of marriages. There is increasing cases of such kind in the family courts. The law of the land pertaining to divorce on the ground of insanity, specially Hindu Marriage Act, 1955 has been discussed. Annulment of marriage due to absence of competency at the time of marriage and consent are important issue. Mental health professional may be called to authenticate the certificate issued by him and may be examined and cross examined as expert witness. An effort has been made to acquaint the mental health professional of the legal proceedings followed by the court in such cases and the role of mental health professional with reference to preparing reports has been delineated. Finally, court judgments which is often cited in such cases has been included and recent judgments in the Supreme court of India and var...
Methods: In the first part of the study, a cross-sectional sample of 130 patients on steady doses... more Methods: In the first part of the study, a cross-sectional sample of 130 patients on steady doses of antipsychotics was evaluated for the presence of prehypertension, hypertension and metabolic changes. In the second part, newly diagnosed patients with first-episode schizophrenia, randomized in a double blind trial to be treated with antipsychotic medication—olanzapine, risperidone, or haloperidol—and matched healthy controls were followed for 6 weeks. Body mass index (BMI), blood sugar, blood pressure changes and lipid profile changes were monitored and repeated after 6 weeks.
Akathisia, a distressing adverse reaction, is usually underdiagnosed or misdiagnosed in patients,... more Akathisia, a distressing adverse reaction, is usually underdiagnosed or misdiagnosed in patients, who are treated with selective serotonin reuptake inhibitors (SSRIs). Escitalopram-induced akathisia is rarely reported in the literature. We report a case of severe akathisia leading to a suicide attempt in a 25-year-old male induced by 5 mg of escitalopram, that remitted completely after discontinuation of escitalopram and did not reappear later. Patient and their caretakers should be warned of symptoms of akathisia even when a very low dose of SSRI is prescribed.
Mc'Naughten Rule is die commonest formulation for plea of insanity in most countries. Althoug... more Mc'Naughten Rule is die commonest formulation for plea of insanity in most countries. Although assessment of the mental state at the time of offence is difficult, few instruments have been devised for this purpose. In the USA, efforts are being made to abolish the insanity defense and in the United Kingdom, amendments in the provisions of insanity defense have been proposed. The authors have stressed the need for some changes in the relevant sections of Indian Penal Code to increase the credibility of Psychiatric testimony in such cases.
The gender difference in OCD was studied in 52 patients attending the psychiatric OPD and it was ... more The gender difference in OCD was studied in 52 patients attending the psychiatric OPD and it was found that 35 (67.30%) patients were males compared to 17 (32.70%) females, which constituted 0.72 % and 1.03% of the male and female patients attending the OPD during the study period, respectively. Hence, inspite of the male preponderance in the study sample, it might not reflect the true prevalence of the disorder in the community.The age of onset for males was lower than that for females, but it did not reach statistical significance. The mean duration of illness for the entire sample was 7.48±7.66 years. The mean duration was found to be significantly longer for females compared to males. The females had higher obsessive, compulsive and total scores on YBOCS indicating a more severe psychopathology. All female patients had compulsions compared to 25.71 % males who had no compulsions. Females had increased frequency of obsessive rumination with obsessions of dirt and contamination al...
Background: Antipsychotic-induced weight gain is one of the most distressing adverse effects bein... more Background: Antipsychotic-induced weight gain is one of the most distressing adverse effects being observed in recent times. Most studies have been limited by several confounders. Aim: To evaluate the predictors of antipsychotic-induced weight gain in drug-naive patients with first-episode psychosis treated with olanzapine, risperidone, or haloperidol and compare them with a healthy matched control group. Methods: Newly diagnosed patients with first-episode schizophrenia treated with antipsychotic medication-olanzapine, risperidone, or haloperidol-and matched healthy controls were followed for 6 weeks. Body mass index (BMI), waist circumference, and weight changes and proportions of subjects with more than 7% weight gain were calculated. The predictors of weight gain were explored. Results: Ninety-nine patients with first-episode schizophrenia and 51 healthy controls were examined. Waist circumference (r = j0.25; P < 0.01) and weight (r = j0.24; P < 0.01) at baseline in addition to the disease process (P < 0.001) as well as antipsychotic use (P < 0.001) were associated with greater increases in weight and BMI. Olanzapine (77%) had greater clinically significant weight gain as compared with risperidone (63%) and haloperidol (22%). Lower BMI at baseline and a diagnosis of undifferentiated schizophrenia were associated with antipsychotic-induced weight gain. Conclusions: The results confirm clinically significant and substantial weight gain induced by antipsychotic treatment in drugnaive patients with first-episode schizophrenia and identify several risk factors for weight gain such as lower BMI scores, use of olanzapine, and a diagnosis of undifferentiated schizophrenia.
Conclusion: Therefore we assume that CNVs do not play a significant role for juvenile periodic ca... more Conclusion: Therefore we assume that CNVs do not play a significant role for juvenile periodic catatonia, and challenge earlier reports on a genetic relationship of autism and juvenile schizophrenia.
Oculogyric crisis (OGC) is an acute dystonia which can occur after initiation of antipsychotic tr... more Oculogyric crisis (OGC) is an acute dystonia which can occur after initiation of antipsychotic treatment. Stereotypic paroxysmal psychiatric symptoms have been described along with OGC that resolve spontaneously when the later remits. We report a case of tardive OGC associated with zuclopenthixol in which there were associated paroxysmal auditory pseudohallucinations.
The number of electrical injuries are rising in proportion to the increased use of electricity in... more The number of electrical injuries are rising in proportion to the increased use of electricity in both domestic and industrial sectors. There are multiple ways in which electricity can cause tissue damage, which can be due to direct effects, electroporation and thermal effects. However, these mechanisms fail to explain the enigmatous occurrences of diffuse and delayed neurological and psychological manifestations, especially those remote to the theoretical current pathway and in absence of any gross neurological abnormalities. Immediate neuropsychological sequelae have been well reported in the literature in the form of transient anxiety, emotional instability and memory disturbances. Among psychiatric manifestations, neurotic disorders like post-traumatic stress disorder, conversion and adjustment disorders have been appreciated many a times as a frequent accompaniment of these injuries. Occasional reports of occurrence of mania have also been recorded. This study reports a case of schizophrenia like illness following a low voltage electrical injury. A discussion regarding the ways in which electrical injury and schizophrenia like illness could be related has been put forth. A brief review of the literature regarding the occurrence of psychiatric disorders in such injuries is also presented.
Aicardi syndrome (AS), identified first by Jean Aicardi in 1965 (1), is a rare genetic disorder c... more Aicardi syndrome (AS), identified first by Jean Aicardi in 1965 (1), is a rare genetic disorder characterized by infantile spasm (IS), corpus callosal agenesis and chorioretinal lacunae (CRL) (2). This is an X
A male patient presented with tricyclic induced hypomania after treatment for chronic depression.... more A male patient presented with tricyclic induced hypomania after treatment for chronic depression. On follow up the patient deteriorated towards dementia with multifocal leucoencephalopathy. The possible role of brain lesions in the causation of affective syndromes and the neurobiological hypothesis of bipolar syndromes are discussed. The authors propose that chronic depression should be thoroughly investigated for a probable Axis III diagnosis.
There are clearly documented evidence concerning violence by the mentally ill. The violence may b... more There are clearly documented evidence concerning violence by the mentally ill. The violence may be committed on the basis of delusional beliefs or exacerbation of symptomatology. Family members have been the object of violence in more than 50% of the cases.It is not surprising, therefore, that patients are brought restrained to the psychiatric treatment units. This study was thus conducted to find out whether the perceived aggression by the guardians was the same as the manifest aggression by the patient.53 consecutive, drug free, psychotic patients attending the C.I.P. O.P.D. for the first time were rated on Social Dysfunction and Aggression Scale (SDAS- 9) to measure quantum of aggression and the Brief Psychiatric Rating Scale (BPRS) to assess the psychopathology. The patients were diagnosed using the criteria laid down in ICD X.BPRS score was significantly higher in schizophrenics as compared to other diagnoses (one way ANOVA, p=0.005). Although there was no difference in the agg...
A male patient presented with tricyclic induced hypomania after treatment for chronic depression.... more A male patient presented with tricyclic induced hypomania after treatment for chronic depression. On follow up the patient deteriorated towards dementia with multifocal leucoencephalopathy. The possible role of brain lesions in the causation of affective syndromes and the neurobiological hypothesis of bipolar syndromes are discussed. The authors propose that chronic depression should be thoroughly investigated for a probable Axis III diagnosis.
Journal of Child and Adolescent Psychiatric Nursing, 2006
PROBLEM: Program evaluation of the effectiveness of two continuing nursing education programs (CN... more PROBLEM: Program evaluation of the effectiveness of two continuing nursing education programs (CNE) in child psychiatry in India. METHODS: Pre-and postevaluation of a total of 51 nurses attending a 10-day CNE program, using a 30-item (six-domain) questionnaire according to CNE topics in child psychiatry. FINDINGS: The CNE program resulted in significant increase in the total scores as well as scores in several sub-domains in the field of child psychiatry. CONCLUSIONS: In a country that does not offer degree programs that integrate psychiatric nursing into the curriculum, CNE programs are an important educational option for nurses. The CNE program offered in this study, comprising lectures, discussion, interactive sessions, and case demonstrations totaling 60 hr across 10 days, was effective in improving the level of knowledge of nurses. It was equally beneficial for senior as well as less experienced nurses.
Divorce rate in India are one of the lowest in the world, but it is increasing progressively. Men... more Divorce rate in India are one of the lowest in the world, but it is increasing progressively. Mental illness in one of the spouses are often alleged to be the ground of dissolution of marriages. There is increasing cases of such kind in the family courts. The law of the land pertaining to divorce on the ground of insanity, specially Hindu Marriage Act, 1955 has been discussed. Annulment of marriage due to absence of competency at the time of marriage and consent are important issue. Mental health professional may be called to authenticate the certificate issued by him and may be examined and cross examined as expert witness. An effort has been made to acquaint the mental health professional of the legal proceedings followed by the court in such cases and the role of mental health professional with reference to preparing reports has been delineated. Finally, court judgments which is often cited in such cases has been included and recent judgments in the Supreme court of India and var...
Methods: In the first part of the study, a cross-sectional sample of 130 patients on steady doses... more Methods: In the first part of the study, a cross-sectional sample of 130 patients on steady doses of antipsychotics was evaluated for the presence of prehypertension, hypertension and metabolic changes. In the second part, newly diagnosed patients with first-episode schizophrenia, randomized in a double blind trial to be treated with antipsychotic medication—olanzapine, risperidone, or haloperidol—and matched healthy controls were followed for 6 weeks. Body mass index (BMI), blood sugar, blood pressure changes and lipid profile changes were monitored and repeated after 6 weeks.
Akathisia, a distressing adverse reaction, is usually underdiagnosed or misdiagnosed in patients,... more Akathisia, a distressing adverse reaction, is usually underdiagnosed or misdiagnosed in patients, who are treated with selective serotonin reuptake inhibitors (SSRIs). Escitalopram-induced akathisia is rarely reported in the literature. We report a case of severe akathisia leading to a suicide attempt in a 25-year-old male induced by 5 mg of escitalopram, that remitted completely after discontinuation of escitalopram and did not reappear later. Patient and their caretakers should be warned of symptoms of akathisia even when a very low dose of SSRI is prescribed.
Mc'Naughten Rule is die commonest formulation for plea of insanity in most countries. Althoug... more Mc'Naughten Rule is die commonest formulation for plea of insanity in most countries. Although assessment of the mental state at the time of offence is difficult, few instruments have been devised for this purpose. In the USA, efforts are being made to abolish the insanity defense and in the United Kingdom, amendments in the provisions of insanity defense have been proposed. The authors have stressed the need for some changes in the relevant sections of Indian Penal Code to increase the credibility of Psychiatric testimony in such cases.
The gender difference in OCD was studied in 52 patients attending the psychiatric OPD and it was ... more The gender difference in OCD was studied in 52 patients attending the psychiatric OPD and it was found that 35 (67.30%) patients were males compared to 17 (32.70%) females, which constituted 0.72 % and 1.03% of the male and female patients attending the OPD during the study period, respectively. Hence, inspite of the male preponderance in the study sample, it might not reflect the true prevalence of the disorder in the community.The age of onset for males was lower than that for females, but it did not reach statistical significance. The mean duration of illness for the entire sample was 7.48±7.66 years. The mean duration was found to be significantly longer for females compared to males. The females had higher obsessive, compulsive and total scores on YBOCS indicating a more severe psychopathology. All female patients had compulsions compared to 25.71 % males who had no compulsions. Females had increased frequency of obsessive rumination with obsessions of dirt and contamination al...
Background: Antipsychotic-induced weight gain is one of the most distressing adverse effects bein... more Background: Antipsychotic-induced weight gain is one of the most distressing adverse effects being observed in recent times. Most studies have been limited by several confounders. Aim: To evaluate the predictors of antipsychotic-induced weight gain in drug-naive patients with first-episode psychosis treated with olanzapine, risperidone, or haloperidol and compare them with a healthy matched control group. Methods: Newly diagnosed patients with first-episode schizophrenia treated with antipsychotic medication-olanzapine, risperidone, or haloperidol-and matched healthy controls were followed for 6 weeks. Body mass index (BMI), waist circumference, and weight changes and proportions of subjects with more than 7% weight gain were calculated. The predictors of weight gain were explored. Results: Ninety-nine patients with first-episode schizophrenia and 51 healthy controls were examined. Waist circumference (r = j0.25; P < 0.01) and weight (r = j0.24; P < 0.01) at baseline in addition to the disease process (P < 0.001) as well as antipsychotic use (P < 0.001) were associated with greater increases in weight and BMI. Olanzapine (77%) had greater clinically significant weight gain as compared with risperidone (63%) and haloperidol (22%). Lower BMI at baseline and a diagnosis of undifferentiated schizophrenia were associated with antipsychotic-induced weight gain. Conclusions: The results confirm clinically significant and substantial weight gain induced by antipsychotic treatment in drugnaive patients with first-episode schizophrenia and identify several risk factors for weight gain such as lower BMI scores, use of olanzapine, and a diagnosis of undifferentiated schizophrenia.
Conclusion: Therefore we assume that CNVs do not play a significant role for juvenile periodic ca... more Conclusion: Therefore we assume that CNVs do not play a significant role for juvenile periodic catatonia, and challenge earlier reports on a genetic relationship of autism and juvenile schizophrenia.
Oculogyric crisis (OGC) is an acute dystonia which can occur after initiation of antipsychotic tr... more Oculogyric crisis (OGC) is an acute dystonia which can occur after initiation of antipsychotic treatment. Stereotypic paroxysmal psychiatric symptoms have been described along with OGC that resolve spontaneously when the later remits. We report a case of tardive OGC associated with zuclopenthixol in which there were associated paroxysmal auditory pseudohallucinations.
The number of electrical injuries are rising in proportion to the increased use of electricity in... more The number of electrical injuries are rising in proportion to the increased use of electricity in both domestic and industrial sectors. There are multiple ways in which electricity can cause tissue damage, which can be due to direct effects, electroporation and thermal effects. However, these mechanisms fail to explain the enigmatous occurrences of diffuse and delayed neurological and psychological manifestations, especially those remote to the theoretical current pathway and in absence of any gross neurological abnormalities. Immediate neuropsychological sequelae have been well reported in the literature in the form of transient anxiety, emotional instability and memory disturbances. Among psychiatric manifestations, neurotic disorders like post-traumatic stress disorder, conversion and adjustment disorders have been appreciated many a times as a frequent accompaniment of these injuries. Occasional reports of occurrence of mania have also been recorded. This study reports a case of schizophrenia like illness following a low voltage electrical injury. A discussion regarding the ways in which electrical injury and schizophrenia like illness could be related has been put forth. A brief review of the literature regarding the occurrence of psychiatric disorders in such injuries is also presented.
Aicardi syndrome (AS), identified first by Jean Aicardi in 1965 (1), is a rare genetic disorder c... more Aicardi syndrome (AS), identified first by Jean Aicardi in 1965 (1), is a rare genetic disorder characterized by infantile spasm (IS), corpus callosal agenesis and chorioretinal lacunae (CRL) (2). This is an X
A male patient presented with tricyclic induced hypomania after treatment for chronic depression.... more A male patient presented with tricyclic induced hypomania after treatment for chronic depression. On follow up the patient deteriorated towards dementia with multifocal leucoencephalopathy. The possible role of brain lesions in the causation of affective syndromes and the neurobiological hypothesis of bipolar syndromes are discussed. The authors propose that chronic depression should be thoroughly investigated for a probable Axis III diagnosis.
There are clearly documented evidence concerning violence by the mentally ill. The violence may b... more There are clearly documented evidence concerning violence by the mentally ill. The violence may be committed on the basis of delusional beliefs or exacerbation of symptomatology. Family members have been the object of violence in more than 50% of the cases.It is not surprising, therefore, that patients are brought restrained to the psychiatric treatment units. This study was thus conducted to find out whether the perceived aggression by the guardians was the same as the manifest aggression by the patient.53 consecutive, drug free, psychotic patients attending the C.I.P. O.P.D. for the first time were rated on Social Dysfunction and Aggression Scale (SDAS- 9) to measure quantum of aggression and the Brief Psychiatric Rating Scale (BPRS) to assess the psychopathology. The patients were diagnosed using the criteria laid down in ICD X.BPRS score was significantly higher in schizophrenics as compared to other diagnoses (one way ANOVA, p=0.005). Although there was no difference in the agg...
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