Bhat BA, Hussain A, Dar MA, Dar SA, Jabeen N, Rasool S, and Shafi S
Indian Journal Of Psychological Medicine [Indian J Psychol Med] 2018 Jul-Aug; Vol. 40 (4), pp. 349-355.
Background: Psychiatric disorders are ubiquitous and affect not only adults but also children and adolescents. The age factor plays an important role in the pattern of these psychiatric disorders. The objective of our study was to find the pattern of psychiatric morbidity in children and adolescents at the child and adolescent outpatient service of a tertiary care hospital. Materials and Methods: A semi-structured questionnaire was used to record the sociodemographic status. The state of mental health and psychiatric morbidity was assessed after a thorough clinical assessment. Intelligence quotient was assessed by a clinical psychologist as and when needed. All the diagnoses were made on the basis of Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision criteria. Results: A total of 529 patients were included. Most patients belonged to the age group of 6-16 years (70.5%). Boys (67.9%) outnumbered girls. Most of the patients were from rural background (56.7%) and from nuclear families (53%). Attention-deficit hyperactivity disorder (31%) and mental retardation (29%) were the most frequent diagnoses, followed by pervasive developmental disorders (10%). Comorbidity was present in about 18% of our patients. Conclusion: The child psychiatry is gaining acceptance, and children and adolescents with minor mental health issues are being identified and referred for specialized services.
Indian Journal Of Psychological Medicine [Indian J Psychol Med] 2018 Mar-Apr; Vol. 40 (2), pp. 121-128.
Background: Preliminary studies suggest a multidimensional relationship of mood pathology with endocrine disturbances. Studies have found an increased risk of mood disorders in polycystic ovary syndrome (PCOS), and conversely, many of the medications commonly used in the treatment of bipolar affective disorder (BPAD) can have deleterious effects on blood levels of reproductive hormones and consequently on the hypothalamic-pituitary-gonadal (HPG) axis and reproductive function. Furthermore, there is evidence of reproductive dysfunction in women with BPAD before treatment. Objectives: To assess the comorbidity of PCOS in patients of BPAD and to study risk factors associated with this comorbidity. Materials and Methods: Two hundred female patients with the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition diagnosis of BPAD, between ages of 15 and 45 years, were evaluated by an endocrinologist. Patients reporting menstrual disturbances or having any stigmata of PCOS were further subjected to hormonal analysis, which included luteinizing hormone, follicle-stimulating hormone, prolactin, and testosterone, in the early follicular phase of menstrual cycle. Diagnosis of PCOS was made as per the NIH criteria. Results: Of 200 patients, 46 (23%) were diagnosed as having PCOS. Forty-five percent (n = 90) reported menstrual disturbances while 27% (n = 54) had polycystic ovaries on ultrasonography. 19.2% of the patients diagnosed as PCOS had a history of valproate intake while 27.90% patients had no such history (P = 0.15). No significant difference (P = 0.07) was found in the prevalence of PCOS among various drug groups (including group on multiple mood stabilizers). Conclusion: A higher prevalence of PCOS is seen in BPAD, irrespective of pharmacotherapy, suggesting a common link between the disorders which might be in the form of disturbance in HPG axis.
Hussain A, Mir TH, Dar MA, Naqashbandi JI, Hussain T, Bashir A, Shah MS, Mushtaq R, and Saleem B
Indian Journal Of Psychological Medicine [Indian J Psychol Med] 2015 Oct-Dec; Vol. 37 (4), pp. 456-9.
Neuropsychiatric systemic lupus erythematous (SLE) encompasses various psychiatric and neurological manifestations that develop in SLE patients, secondary to involvement of central nervous system. Neuropsychiatric SLE, presenting as catatonia is very uncommon, and treatment of this condition is not well defined. Previously the role of benzodiazepines, immunosuppression, plasma exchange, and electroconvulsive therapy (ECT) has been described in its management. Here we describe a case of neuropsychiatric lupus presenting as catatonia that did not respond to benzodiazepines or immunosuppression. The symptoms of catatonia showed improvement with ECT. Furthermore, we have discussed the pathology of the disorder and the role of ECT in the treatment of cases of catatonia associated with SLE, who do not respond to benzodiazepines.
Dar MA, Wani RA, Rather YH, Kawoos Y, Hussain A, Margoob MA, Dar MM, and Malla AA
Indian Journal Of Psychological Medicine [Indian J Psychol Med] 2015 Oct-Dec; Vol. 37 (4), pp. 467-9.
Chronic epilepsy is leading to behavioral changes including obsessive-compulsive symptoms has been well-studied and shown to be about 22%, but the converse has not been reported. Here, we present a case discussion of a 45-year-old female, who presented with recurrent seizures with hyponatremia, which latter was ascribed to her undiagnosed obsessive compulsive disorder (OCD). This patient later did well on anti-obsessional treatment without any antiepileptic. This embarks the need for detailed psychiatric evaluation for patients in emergency care settings and gives a rare presentation of OCD.
Hussain A, Shah MS, Roub FE, Dar MA, Wani ZA, Jan MM, Wani RA, and Bhat TA
Indian Journal Of Psychological Medicine [Indian J Psychol Med] 2015 Jul-Sep; Vol. 37 (3), pp. 272-6.
Background: Many therapeutic options have been evaluated and tried for seasonal affective disorder (SAD) including bright light therapy (BLT), anti-depressants, beta-blockers and psychotherapy, but the data supporting use of mood-stabilizing agents is just handful in spite of this condition being understood most frequently to be associated with bipolar affective disorder II (BPAD II). So we planned to study role of Lamotrigine (Mood stabilizing agent) in SAD. Materials and Methods: 30 patients of SAD who were prescribed lamotrigine in addition to antidepressant medications for a minimum of 8 weeks and were assessed for severity using HAM-D were selected retrospectively from the hospital records for this study. HAM-D scores at 2, 4 and 8 weeks were compared to baseline scores. Statistics Analysis: Single tailed t-test was used to study the difference of means to assess the therapeutic response and pre/post analysis of change. Statistical significance was set at P < 0.05. Results: Though no significant difference was seen in HAM-D Scores at 2 weeks of treatment compared to baseline, but results were statistically significant at 4 and 8 weeks of treatment with lamotrigine augmentation of antidepressant medications. Conclusion: We conclude that lamotrigine augmentation was found to be effective treatment strategy for managing winter depression phase of Seasonal Affective Disorder.
Hussain A, Dar MA, Wani RA, Shah MS, Jan MM, Malik YA, Chandel RK, and Margoob MA
Indian Journal Of Psychological Medicine [Indian J Psychol Med] 2015 Apr-Jun; Vol. 37 (2), pp. 154-8.
Background: Resistance to pharmacotherapy is one of the major challenges in the management of obsessive-compulsive disorder (OCD). OCD being a quite prevalent disorder, this resistance adds to the disability. Different strategies are being employed to counter this resistance, one of them being augmentation with glutamatergic modulators. Lamotrigine is being used for same since the recent past with mixed results. Objective: The aim was to study the role of lamotrigine augmentation in serotonin reuptake inhibitor (SRI) resistant OCD patients. Methodology and Results: This study was carried by studying the case sheets of SRI resistant cases having already completed the treatment. A total of 22 cases sheets over 2 years met the study criteria with a mean age of mean age of 34.14 years. Over a period of 16 weeks, with a mean lamotrigine dose of 150 mg/day, 20 out of 22 patients had shown a significant response. The mean decrease in Yale-Brown Obsessive Compulsive Scale score was 67.23% with a baseline score of 28.87. There was a similar change on different domains of World Health Organization quality of life (P = 0.00564). Conclusion: Lamotrigine augmentation to on-going treatment with SRIs may be an effective move in case of SRI resistant OCD patients.
Hussain A, Chandel RK, Ganie MA, Dar MA, Rather YH, Wani ZA, Shiekh JA, and Shah MS
Indian Journal Of Psychological Medicine [Indian J Psychol Med] 2015 Jan-Mar; Vol. 37 (1), pp. 66-70.
Background: Polycystic ovary syndrome (PCOS) is one of the common endocrine disorders and is associated with reproductive, metabolic, and psychological disturbances affecting one in five women of reproductive age group. Objective: To investigate the prevalence of psychiatric disorders among women in ambulatory treatment with a diagnosis of PCOS. Materials and Methods: One hundred and ten patients of PCOS were evaluated using Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition criteria by means of Mini International Neuropsychiatric Interview, English version 5.0.0. Diagnosis of PCOS was confirmed according to the National Institute of Health/National Institute of Child Health and Human Development, 1990 consensus conference criteria. Forty subjects without PCOS who were matched for age and body mass index were taken as a comparison group. Results: About 23% of cases had major depressive disorder as compared to 7.5% of controls, 1.8% had dysthymia, 15.45% had panic disorder compared to 5% of controls, 6.36% had obsessive compulsive disorder compared to 2.5% of controls, 8% cases had suicidality, 2.72% of cases were bipolar affective disorder, and 15.45% had generalized anxiety disorder (GAD). Conclusion: A high prevalence of mental disorders was observed, especially major depression, panic disorder, and GAD in patients with PCOS in our study. The results suggest that screening and appropriate management for psychiatric disorders should be part of the routine evaluation of these patients.
Indian Journal Of Psychological Medicine [Indian J Psychol Med] 2017 Sep-Oct; Vol. 39 (5), pp. 663-664.
Many accounts refer to insertion of finger into anus mostly for gratification from stimulation of prostate gland, but index case Mr. M. continued doing this to get rid of constipation that eventually led to feelings of guilt, stinky fingers, not able to defecate normally, and dysphoric emotions. Further research is needed to find out the phenomenology of this condition.
Indian Journal Of Psychological Medicine [Indian J Psychol Med] 2014 Apr; Vol. 36 (2), pp. 170-3.
Objective: The efficacy of atypical antipsychotics including olanzapine in acute treatment of manic episode has been established, whereas its role in maintenance treatment is not clear. Materials and Methods: Thirteen patients of bipolar disorder who were on regular treatment with mood stabilizer and subsequently relapsed into mania or depressive episode after discontinuation of olanzapine were studied for various socio-demographic and clinical factors using retrospective chart review. Results: There was no correlation found between the period of tapering olanzapine, time to recurrence of episode after discontinuation, and the dosage of olanzapine at the time of discontinuation. The predominant early signs of relapse after discontinuation of olanzapine included sleep disturbance (72.7%), lack of insight for change in behavior (72.7%), irritability (54.5%), and elevated mood (45.5%). Conclusion: Mood stabilizer alone as a maintenance therapy of bipolar disorder may be inadequate for long-term management. A low dose of olanzapine along with mood stabilizers might be useful for prevention of recurrence in bipolar disorder.
Indian Journal Of Psychological Medicine [Indian J Psychol Med] 2011 Jan; Vol. 33 (1), pp. 77-9.
Bezoar is a tightly packed collection of undigested material that is unable to exit the stomach. Most bezoars are of indigestible organic matter such as hair-trichobezoars; or vegetable and fruit-phytobezoars; or a combination of both. Trichobezoars commonly occur in patients with psychiatric disturbances who chew and swallow their own hair. In very rare cases, the Rapunzel syndrome hair extends through the pylorus into the small bowel causing symptom and sign of partial or complete gastric outlet obstruction. A case report of trichobezoar in the stomach causing Rapunzel syndrome in a 12-year-old female is reported.