Introduction: Neurological soft signs (NSS) are delicate neurological abnormalities that comprise... more Introduction: Neurological soft signs (NSS) are delicate neurological abnormalities that comprise deficits in motor coordination, problems with the sequencing of complex motor acts, and sensory integration difficulties. These are nonspecific with no specific localization in the brain. NSS are found in many patients with Schizophrenia. Cognitive dysfunctions are also present in more than two-thirds of patients with Schizophrenia. This study aims at assessing the NSS and its association with cognitive impairment in patients with Schizophrenia. Methods: A total of 100 Schizophrenia patients were included in the study. The Heidelberg scale was used for assessing the NSS. The Montreal Cognitive Assessment Scale (MoCA) for cognitive impairment, the Positive and Negative Syndrome Scale (PANSS) for Schizophrenia, and the Brief Psychiatric Rating Scale (BPRS) were used to assess the severity. Statistical analysis was performed by Pearson's Chi-square test, Kruskal-Wallis test, Wilcoxon rank tests and Spearman rank correlation along with mean and standard deviation. Results: NSS were present in 68% (N=68) of the patients with motor coordination being maximally affected. Cognitive impairment was found in 73% (N=73) of patients with a MoCA score <26. Patients with predominant negative symptoms had higher NSS scores and lower MoCA scores. A "statistically significant" correlation was observed between cognitive impairment and NSS. Most patients with NSS and impaired cognition were in the "markedly ill" category of BPRS. Conclusion: A significant association was observed between cognitive deficits, negative symptoms, and NSS in Schizophrenia. NSS and cognitive dysfunctions are integral parts of Schizophrenia symptom domains and need to be assessed as the negative symptoms and severity of illness are associated with NSS, especially problems with motor coordination and cognitive dysfunctions.
Background: Self-stigma occurs when a person accepts the negative attitude towards them, then int... more Background: Self-stigma occurs when a person accepts the negative attitude towards them, then internalize and apply belief to themselves. Self-esteem is individual's subjective evaluation of their own worth. Self-stigma and self-esteem affects a person's perception about themselves and the society surrounding them which plays an important role in treatment. It is most commonly affected in people diagnosed with psychiatric disorders. Aim: The aim was to study self-stigma and self-esteem in patients with anxiety and depression. Materials and Methods: After permission from Institutional ethics committee, semi-structured proforma, Internalized Stigma of Mental Illness Inventory-9 and Rosenberg's Self Esteem Scale was used to assess 50 consecutive participants diagnosed with anxiety and depression according to DSM-5 criteria. Participants satisfying the inclusion and exclusion criteria were included in the study. The data collected was tabulated and analysed statistically and results and conclusions were drawn by using chi-square test, a p-value of <0.05 was considered significant. Results: Mean age of participants was 38.88 years with 64% females, majority being married, predominantly from urban background having education of at least secondary school certificate.19 participants were diagnosed with anxiety while 31 had depression.56% of the participants had high selfstigma and 54% participants had low self-esteem. There wasn't any significant difference in percentages of high self-stigma and low self-esteem when compared between anxiety disorders and in depression. There were no significant socio-demographic or clinical correlates relating to self-stigma and self-esteem according to this study. Conclusion: It was observed that both high self-stigma and low self-esteem was significantly high in psychiatric patients. It was seen that low self-esteem was associated with high self-stigma and high selfesteem was associated with low self-stigma. Hence, steps must be taken to psycho-educate the patient and their family members in order to reduce self-stigma and help in increasing their self-esteem. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Background: Mood disorder is one of the common causes, for which psychiatric consultations are so... more Background: Mood disorder is one of the common causes, for which psychiatric consultations are sought. A better understanding of the factors that lead to repeated admissions, increased relapse rates, and concurrent substance dependence is necessary for the development of interventions that may reduce the likelihood of adverse effects in patient with bipolar I disorder. Aims and Objectives: The aims of this study were as follows: (1) To study the correlation between the reasons for relapse and substance use with various sociodemographic factors in patients having bipolar I disorders and (2) to find out the correlation between reasons for relapse, substance use, and severity of illness. Materials and Methods: This was a cross-sectional single interview study, in which 67 consecutive patients having bipolar I disorder and admitted in psychiatry ward were admitted on the basis of a pre-defined inclusion and exclusion criteria. The details about psychiatric, relapse-related symptoms, substance use-related symptoms, as well as other aspects of clinical profile were taken. Results: Out of 67 patients, 51 (76.1%) were male and 16 (23.8%) were female. Mean age of the participants was 30.43 years (S.D.=9.05). Sleep disturbance was seen in all patients (67) and was also the most common symptom. It was followed by psychomotor disturbances in 60 (89.5%) of the patients. Among 67 patients included in the study, substance use was seen among 28 (41.7%) of the patients. Substance use was significantly associated with age of the patients and occupation (P=0.03 each). The age group of more than 30 years (57.7%) had significantly higher substance use compared to those <30 years (31.7%). Conclusion: Concurrent substance use is associated with increased risk of relapse and readmissions in cases of patients with bipolar I disorders. A thorough history is necessary to rule out substance use in these cases.
Selective serotonin reuptake inhibitors (SSRIs) can cause the syndrome of inappropriate antidiure... more Selective serotonin reuptake inhibitors (SSRIs) can cause the syndrome of inappropriate antidiuretic hormone secretion (SIADH). SIADH is associated with hyponatraemia without oedema. We report the case of a patient who developed acute-onset hyponatraemia that progressed rapidly to serious neurological dysfunction shortly after the introduction of citalopram. All SSRIs including citalopram should be used with care in the elderly. The water and electrolyte balance should be monitored carefully during SSRI therapy.
Zenodo (CERN European Organization for Nuclear Research), Apr 29, 2023
Background: After the Covid-19 outbreak, school going children have been advised to stay at home ... more Background: After the Covid-19 outbreak, school going children have been advised to stay at home due to which children and their parents have had to greatly rely on internet for learning. Due to increased stay indoors, children are being more drawn towards screens to keep themselves occupied. Increased screen-time in children is leading to more problematic internet use. There is little research regarding the study of problematic internet use during COVID-19 in India. Therefore, this study was conducted. Primary objective: To study the problematic internet use among children of age group 6-16 years during covid-19 pandemic. Materials and Methods: After the permission from the Institutional Ethics Committee, 53 parents of school going children of age group 6-16 years in urban population, satisfying the inclusion and exclusion criteria participated in the study. Informed consents were obtained. Each individual was interviewed along with the semi-structured proforma and then administered scale for internet use. (Young's Internet Addiction test). Results: Information about 53 children was obtained through parents' interview. Out of 53 children 15 (28.3%) were in age group of 6-10 years, 34 (64.2%) were in age group of 11-15 years, 4 (7.5 %) were above the age of 15 years. The mean age in children was 11.57 ± 2.65 years. In this study, 17 (32%) children showed problematic internet use according to Young's Internet addiction scale. Conclusions: A significant number of children showed problematic internet use during covid-19 pandemic.
Phenomenology of alcohol dependence and assessment of motivation in male alcoholics in India
PANACEA JOURNAL OF MEDICAL SCIENCES, 2014
Alcohol dependence is a major public health problem with motivation as a most important factor in... more Alcohol dependence is a major public health problem with motivation as a most important factor influencing patients to seek treatment and change the drinking behavior. Clinicians need to assess the motivation to plan separate strategies to handle the unmotivated patients. This study was planned to study the phenomenology of alcohol dependence, and assess the motivation in male alcoholics.After obtaining the informed consent, 100 consecutive subjects fulfilling the selection criteria were interviewed using self-prepared semi-structured proforma and URICA scale (University of Rhode Island Change Assessment scale). Motivation reassessment was done after 1.5 months. Mean age of the participants was 42.64years. Majority were married and from rural or suburban region. Majority was consuming alcohol for more than 10years and was brought for treatment by their relatives. Main reason for seeking treatment was medical illness related to alcohol. Mean scores for motivation and readiness to change were increased on reassessment after 1.5months of treatment compared to baseline. Those with onset before 25years of age, even with higher motivation at baseline were less compliant subsequently.This study highlights the importance of motivation assessment in all the patients of alcohol dependence.Age of onset should be considered while formulating treatment plan as those with onset younger age may not be compliant.
Clozapine-induced bicytopenia: An unusual side effect
Indian Journal of Pharmacology, 2018
Agranulocytosis is a rare documented side effect of clozapine which can be associated with grave ... more Agranulocytosis is a rare documented side effect of clozapine which can be associated with grave consequences. When it is associated with other blood dyscrasia, prognosis worsens further. In literature, there are very few cases of pancytopenia and bicytopenia caused by clozapine. We present a case of bicytopenia (reduced white and red blood cells' counts) caused by clozapine within a month of therapy and complicated by a Klebsiella pneumoniae infection. Patient improved in 3 weeks after stopping clozapine along with medical management in the Intensive Care Unit. Such side effects, though rare, can be life threatening and warrants intermittent complete blood monitoring besides regular assessment of granulocytes and neutrophils when any patient is prescribed clozapine.
Background: The first laboratory-confirmed case of the novel coronavirus (COVID-19) was reported ... more Background: The first laboratory-confirmed case of the novel coronavirus (COVID-19) was reported in India on 30 January 2020. Since then, there has been exponential growth in cases, with India now ranking second in the global burden of COVID-19. The novel coronavirus disease (COVID-19) is the greatest burden faced by the healthcare system at present. A major part of this burden is being tackled by the resident doctors working in various teaching hospitals all over the world.This study is aimed at assessment of psychological symptoms in resident doctors posted in COVID 19 wards with respect age, gender and speciality department to which they belong. Materials and Methods: After the permission from Institutional ethics Committee, about 75 resident doctors from various specialty departments posted in COVID-19 wards were taken for study. Each participant after informed consent has been individually interviewed telephonically along with the special semi-structured proforma prepared for the study. Clinical data was collected. After application of rating scales HAM-A & HAM-D to each individual, result are obtained. Results: The survey is completed with total 75 resident doctors working in COVID 19 wards in NKPSIMS & LMH, Nagpur. Out of total n= 75, 44 were males (58.66%), and 31 were females (41.33%). The mean age of participants being = 26.82(±SD=2) years and total 7 days of duty done in COVID-19 wards. 75(100%) resident doctors reported anxiety symptoms and 20(26.66%) resident doctors reported mild depressive symptoms. 73 (97.33%) resident doctors had mild severity of anxiety and 2(2.66%) had moderate severity of anxiety. Resident doctors belonging to various speciality departments showed differing severity of symptoms with Obstetrics and Gynaecology department having maximum instance of anxiety and depressive features and Respiratory medicine and Orthopaedics having least instance of anxiety and depressive features. Conclusion: Resident doctors working in COVID-19 wards are susceptible for anxiety, depressive symptoms and insomnia. Mild form of both anxiety and depression are both prevalent. Psychological symptoms are strongly correlated with female gender as compared to male gender. Type of specialty department also affects the tendency to develop psychological symptoms in resident doctors posted in COVID19 wards. Age or past history of psychiatric illness is not found to be significantly associated with either anxiety or depression. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Association between personality factors and early employment of mothers in medical undergraduates
Annals of Indian psychiatry, 2019
Background: Personality of an individual can be influenced by a variety of factors, including par... more Background: Personality of an individual can be influenced by a variety of factors, including parenting and mother–child interactions in childhood. Reduced time spent with mother due to early employment of mother can affect the personality development in a positive or negative way. Personality, in turn, can influence academic performance, learning, and coping in Bachelor of Medicine, Bachelor of Surgery (MBBS) students. This study aims at exploring the association of mother's employment in the initial period of life and personality traits in MBBS students. Methods: This was a cross-sectional study conducted in a tertiary care center. Consecutively selected 200 MBBS students of all the academic years were interviewed using a semi-structured pro forma and big five inventory scale. Data were statistically analyzed using mean, standard deviation, Chi-square test, and other tests. A P < 0.05 was considered statistically significant. Results: Mothers of 21% of the students worked during pregnancy, and mothers of 33% of the students started working within the first 6 months of delivery. Significantly, high score of extraversion, agreeableness, and openness was found in students whose mothers started working within the first 6 months of delivery. No significant correlation was found between early employment of mother and scores of neuroticism and conscientiousness. Neuroticism score was higher in final MBBS students, students living away from home, and those staying in nuclear families. Conclusion: Early employment in mother was associated with high extraversion, agreeableness, and openness in MBBS students.
Aims: To assess the role of progressive muscle relaxation in the management of hyperemesis gravid... more Aims: To assess the role of progressive muscle relaxation in the management of hyperemesis gravidarum. Methods: This is a prospective, randomized, observer blind and comparative study. Around 30 pregnant women admitted for the treatment of hyperemesis gravidarum were enrolled and randomized into experimental and control groups. Each group was of 15 patients. Experimental group patients received pharmacotherapy with daily progressive muscle relaxation for 2 weeks, while patients in control group received only pharmacotherapy. Results: (1) Significantly high number of patients required three or more drugs in control group as compared to experimental group, (2) experimental group patients achieved complete response within 2.73 days ± SD, while control group patients achieved complete response within 4 days ± SD, (3) none of the patients in experimental group had recurrence within 2 weeks of observation period, while 13% patients in control group had recurrence after complete response, (4) on clinical global improvement scale, patients in experimental group achieved better improvement. Conclusions: Progressive muscle relaxation is effective in hyperemesis gravidarum and when combined with antiemetics, it reduces the number of antiemetics required to treat hyperemesis gravidarum. Patients also show early response to treatment, less recurrence and better improvement when combined with antiemetics.
Therapeutic Advances in Psychopharmacology, Oct 24, 2011
Objectives: To study the effect of escitalopram and fluoxetine on coagulation profile in patients... more Objectives: To study the effect of escitalopram and fluoxetine on coagulation profile in patients with major depression. Method: This was a prospective, open-label, single-centre study in 40 patients diagnosed with major depressive disorder. The patients were diagnosed using Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria. Twenty patients receiving escitalopram 10 mg per day and 20 patients receiving fluoxetine 20 mg per day participated in the study and were followed up for 3 months. Coagulation parameters-bleeding time, clotting time, platelet count, prothrombin time and partial thromboplastin kaolin time-were evaluated at baseline and after 3 months. Results: At the end of 3 months, a significant increase in bleeding time was seen in patients receiving fluoxetine, but within the normal range. No rise was seen in the group given escitalopram. Conclusion: In patients with depression, fluoxetine increases bleeding time whereas escitalopram has no effect on coagulation profile. However, both the drugs can be used safely for long-term treatment.
deposits accumulate, including progressive deterioration of mental function, loss of previous mot... more deposits accumulate, including progressive deterioration of mental function, loss of previous motor development, spastic paralysis, and athetosis. In addition, optic atrophy may occur. The disease usually manifests itself in the 3 rd to 5 th decade of life, but may appear in childhood or later in life. [8] Neuropsychiatric symptoms can be the first or the most prominent manifestations ranging from mild difficulty in concentration, memory changes in personality, behavior, frank psychosis and dementia. [9] About 40% of patients with basal ganglia calcification (BGC) may present initially with psychiatric features. [10] Cognitive, psychotic, and mood disorders are common. Symptoms may change over time. More extensive calcification and subarachnoid space dilatation are known to correlate with the presence of psychiatric manifestations. [10] Currently, there is no cure for Fahr's syndrome, nor a standard course of treatment. The available treatment is
Lurasidone-induced anemia: Is there a need for hematological monitoring?
Indian Journal of Pharmacology, 2019
Lurasidone is a newer drug used for treating schizophrenia and depression in bipolar disorder. Al... more Lurasidone is a newer drug used for treating schizophrenia and depression in bipolar disorder. Although comparatively safe, some side effects can occur with its use such as akathisia, extrapyramidal reaction, metabolic syndrome, and hyperprolactinemia. Blood dyscrasia with lurasidone is rarely reported in the literature except for few case reports. We present two cases of schizophrenia, treated with lurasidone developing anemia after variable period of treatment and reverting after stopping lurasidone. These cases emphasize the timely monitoring of blood parameters for prevention or early detection of anemia in patients treated with lurasidone.
Emetophobia is an intense, irrational fear of vomiting including fear of feeling nausea, seeing o... more Emetophobia is an intense, irrational fear of vomiting including fear of feeling nausea, seeing or hearing another person vomit, or seeing vomitus itself. It may occur at any age and we need to understand its symptomatology. We report a case of emetophobic child whose fear of vomiting started after an attack of acute appendicitis. In the initial stage, fear was limited to vomiting, later it became generalized to a fear of seeing the vomitus, worries that parents may suffer vomiting, fear of vomiting in public places followed by avoiding social activities. Patient improved on short course of anti-anxiety drugs and Graded Exposure Therapy.
WhatsApp use and its impact on relationships among doctors: A cross-sectional pilot study
Annals of Indian psychiatry, 2020
Background: Social media like WhatsApp is known to affect relationships of an individual, and bus... more Background: Social media like WhatsApp is known to affect relationships of an individual, and busy professionals like doctors appear no bar. The objectives of this study were to analyze the pattern of WhatsApp use in specialist-doctors and to study its effect on their relationships. Materials and Methods: This was a cross-sectional pilot study. Consecutively selected hundred married specialist doctors were assessed using self-reported validated questionnaire including questions related to demographics, WhatsApp use, and effects on relationships in a tertiary care center. Statistical analysis was performed using mean, standard deviation, t-test, and Chi-square test. A value of P < 0.05 was considered statistically significant. Results: Participants of various specialties, with a mean age of 41.5 years reported regular WhatsApp-use (89%) of mean duration 2.5 years with 19% spending >2 h/day. About 62% reported using WhatsApp during personal time, leading to reduction in time spent with spouse (37%), impairment in household responsibilities (24%), disturbances in social-activities (26%) and craving. About 36% reported negative effects on married life. 21% reported inability to spend quality-time with spouse, 24% had concern about spouse's WhatsApp-use, 25% reported reduced cohesion between them and 22% felt that excessive use can create doubts in spouse's mind. Those aged <40 years had significantly higher total duration and time spent/day on WhatsApp and reported more conflicts with spouse and reduced expression of love. Conclusion: Inappropriate WhatsApp use can affect many aspects of life of doctors including relationships though exact causal relation is not demonstrated and it should be used judiciously.
Study of anxiety in patients with moderate alopecia
Annals of Indian psychiatry, 2017
Background: Alopecia is known to have an impact on psychosocial health of an individual. Besides ... more Background: Alopecia is known to have an impact on psychosocial health of an individual. Besides depression, anxiety is commonly associated with it and can add significantly to the burden due to it. The present study was carried out in the patients attending dermatology outpatient department, which looked into anxiety symptoms and its correlations with various demographic and clinical factors. Materials and Methods: Thirty consecutive patients diagnosed with moderate alopecia not requiring any major intervention participated in the study. Each patient was individually interviewed using a semi-structured pro forma which included sociodemographic profile, clinical and psychiatric profile, and dermatological diagnosis, and rating scales of Brief Psychiatric Rating Scale (BPRS) and Hamilton Anxiety Rating Scale (HAM-A) were administered. Results and Discussion: Mean age was 30.86 years (standard deviation 11.89), 50% males and majority married with urban background. Many had complaints of uneasiness, excessive worries, and disturbed sleep. The mental status examination in the majority of them revealed anxious mood and preoccupation with worries. None of them satisfied the diagnostic criteria for any anxiety disorder as per Diagnostic and Statistical Manual of Mental Disorders-5. The mean BPRS score was 22.80 with the participants scored significantly on anxiety, tension, and somatic concern and the mean HAM-A score was 10.30 with the majority of participant had score in the range of significant anxiety. Their correlation with factors of gender, marital status, duration, and pattern of alopecia was found to be not significant. Conclusion: Although no diagnosable anxiety disorder was present in patients of moderate alopecia, majority of them had significant anxiety found during the assessment.
Introduction: Neurological soft signs (NSS) are delicate neurological abnormalities that comprise... more Introduction: Neurological soft signs (NSS) are delicate neurological abnormalities that comprise deficits in motor coordination, problems with the sequencing of complex motor acts, and sensory integration difficulties. These are nonspecific with no specific localization in the brain. NSS are found in many patients with Schizophrenia. Cognitive dysfunctions are also present in more than two-thirds of patients with Schizophrenia. This study aims at assessing the NSS and its association with cognitive impairment in patients with Schizophrenia. Methods: A total of 100 Schizophrenia patients were included in the study. The Heidelberg scale was used for assessing the NSS. The Montreal Cognitive Assessment Scale (MoCA) for cognitive impairment, the Positive and Negative Syndrome Scale (PANSS) for Schizophrenia, and the Brief Psychiatric Rating Scale (BPRS) were used to assess the severity. Statistical analysis was performed by Pearson's Chi-square test, Kruskal-Wallis test, Wilcoxon rank tests and Spearman rank correlation along with mean and standard deviation. Results: NSS were present in 68% (N=68) of the patients with motor coordination being maximally affected. Cognitive impairment was found in 73% (N=73) of patients with a MoCA score <26. Patients with predominant negative symptoms had higher NSS scores and lower MoCA scores. A "statistically significant" correlation was observed between cognitive impairment and NSS. Most patients with NSS and impaired cognition were in the "markedly ill" category of BPRS. Conclusion: A significant association was observed between cognitive deficits, negative symptoms, and NSS in Schizophrenia. NSS and cognitive dysfunctions are integral parts of Schizophrenia symptom domains and need to be assessed as the negative symptoms and severity of illness are associated with NSS, especially problems with motor coordination and cognitive dysfunctions.
Background: Self-stigma occurs when a person accepts the negative attitude towards them, then int... more Background: Self-stigma occurs when a person accepts the negative attitude towards them, then internalize and apply belief to themselves. Self-esteem is individual's subjective evaluation of their own worth. Self-stigma and self-esteem affects a person's perception about themselves and the society surrounding them which plays an important role in treatment. It is most commonly affected in people diagnosed with psychiatric disorders. Aim: The aim was to study self-stigma and self-esteem in patients with anxiety and depression. Materials and Methods: After permission from Institutional ethics committee, semi-structured proforma, Internalized Stigma of Mental Illness Inventory-9 and Rosenberg's Self Esteem Scale was used to assess 50 consecutive participants diagnosed with anxiety and depression according to DSM-5 criteria. Participants satisfying the inclusion and exclusion criteria were included in the study. The data collected was tabulated and analysed statistically and results and conclusions were drawn by using chi-square test, a p-value of <0.05 was considered significant. Results: Mean age of participants was 38.88 years with 64% females, majority being married, predominantly from urban background having education of at least secondary school certificate.19 participants were diagnosed with anxiety while 31 had depression.56% of the participants had high selfstigma and 54% participants had low self-esteem. There wasn't any significant difference in percentages of high self-stigma and low self-esteem when compared between anxiety disorders and in depression. There were no significant socio-demographic or clinical correlates relating to self-stigma and self-esteem according to this study. Conclusion: It was observed that both high self-stigma and low self-esteem was significantly high in psychiatric patients. It was seen that low self-esteem was associated with high self-stigma and high selfesteem was associated with low self-stigma. Hence, steps must be taken to psycho-educate the patient and their family members in order to reduce self-stigma and help in increasing their self-esteem. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Background: Mood disorder is one of the common causes, for which psychiatric consultations are so... more Background: Mood disorder is one of the common causes, for which psychiatric consultations are sought. A better understanding of the factors that lead to repeated admissions, increased relapse rates, and concurrent substance dependence is necessary for the development of interventions that may reduce the likelihood of adverse effects in patient with bipolar I disorder. Aims and Objectives: The aims of this study were as follows: (1) To study the correlation between the reasons for relapse and substance use with various sociodemographic factors in patients having bipolar I disorders and (2) to find out the correlation between reasons for relapse, substance use, and severity of illness. Materials and Methods: This was a cross-sectional single interview study, in which 67 consecutive patients having bipolar I disorder and admitted in psychiatry ward were admitted on the basis of a pre-defined inclusion and exclusion criteria. The details about psychiatric, relapse-related symptoms, substance use-related symptoms, as well as other aspects of clinical profile were taken. Results: Out of 67 patients, 51 (76.1%) were male and 16 (23.8%) were female. Mean age of the participants was 30.43 years (S.D.=9.05). Sleep disturbance was seen in all patients (67) and was also the most common symptom. It was followed by psychomotor disturbances in 60 (89.5%) of the patients. Among 67 patients included in the study, substance use was seen among 28 (41.7%) of the patients. Substance use was significantly associated with age of the patients and occupation (P=0.03 each). The age group of more than 30 years (57.7%) had significantly higher substance use compared to those <30 years (31.7%). Conclusion: Concurrent substance use is associated with increased risk of relapse and readmissions in cases of patients with bipolar I disorders. A thorough history is necessary to rule out substance use in these cases.
Selective serotonin reuptake inhibitors (SSRIs) can cause the syndrome of inappropriate antidiure... more Selective serotonin reuptake inhibitors (SSRIs) can cause the syndrome of inappropriate antidiuretic hormone secretion (SIADH). SIADH is associated with hyponatraemia without oedema. We report the case of a patient who developed acute-onset hyponatraemia that progressed rapidly to serious neurological dysfunction shortly after the introduction of citalopram. All SSRIs including citalopram should be used with care in the elderly. The water and electrolyte balance should be monitored carefully during SSRI therapy.
Zenodo (CERN European Organization for Nuclear Research), Apr 29, 2023
Background: After the Covid-19 outbreak, school going children have been advised to stay at home ... more Background: After the Covid-19 outbreak, school going children have been advised to stay at home due to which children and their parents have had to greatly rely on internet for learning. Due to increased stay indoors, children are being more drawn towards screens to keep themselves occupied. Increased screen-time in children is leading to more problematic internet use. There is little research regarding the study of problematic internet use during COVID-19 in India. Therefore, this study was conducted. Primary objective: To study the problematic internet use among children of age group 6-16 years during covid-19 pandemic. Materials and Methods: After the permission from the Institutional Ethics Committee, 53 parents of school going children of age group 6-16 years in urban population, satisfying the inclusion and exclusion criteria participated in the study. Informed consents were obtained. Each individual was interviewed along with the semi-structured proforma and then administered scale for internet use. (Young's Internet Addiction test). Results: Information about 53 children was obtained through parents' interview. Out of 53 children 15 (28.3%) were in age group of 6-10 years, 34 (64.2%) were in age group of 11-15 years, 4 (7.5 %) were above the age of 15 years. The mean age in children was 11.57 ± 2.65 years. In this study, 17 (32%) children showed problematic internet use according to Young's Internet addiction scale. Conclusions: A significant number of children showed problematic internet use during covid-19 pandemic.
Phenomenology of alcohol dependence and assessment of motivation in male alcoholics in India
PANACEA JOURNAL OF MEDICAL SCIENCES, 2014
Alcohol dependence is a major public health problem with motivation as a most important factor in... more Alcohol dependence is a major public health problem with motivation as a most important factor influencing patients to seek treatment and change the drinking behavior. Clinicians need to assess the motivation to plan separate strategies to handle the unmotivated patients. This study was planned to study the phenomenology of alcohol dependence, and assess the motivation in male alcoholics.After obtaining the informed consent, 100 consecutive subjects fulfilling the selection criteria were interviewed using self-prepared semi-structured proforma and URICA scale (University of Rhode Island Change Assessment scale). Motivation reassessment was done after 1.5 months. Mean age of the participants was 42.64years. Majority were married and from rural or suburban region. Majority was consuming alcohol for more than 10years and was brought for treatment by their relatives. Main reason for seeking treatment was medical illness related to alcohol. Mean scores for motivation and readiness to change were increased on reassessment after 1.5months of treatment compared to baseline. Those with onset before 25years of age, even with higher motivation at baseline were less compliant subsequently.This study highlights the importance of motivation assessment in all the patients of alcohol dependence.Age of onset should be considered while formulating treatment plan as those with onset younger age may not be compliant.
Clozapine-induced bicytopenia: An unusual side effect
Indian Journal of Pharmacology, 2018
Agranulocytosis is a rare documented side effect of clozapine which can be associated with grave ... more Agranulocytosis is a rare documented side effect of clozapine which can be associated with grave consequences. When it is associated with other blood dyscrasia, prognosis worsens further. In literature, there are very few cases of pancytopenia and bicytopenia caused by clozapine. We present a case of bicytopenia (reduced white and red blood cells' counts) caused by clozapine within a month of therapy and complicated by a Klebsiella pneumoniae infection. Patient improved in 3 weeks after stopping clozapine along with medical management in the Intensive Care Unit. Such side effects, though rare, can be life threatening and warrants intermittent complete blood monitoring besides regular assessment of granulocytes and neutrophils when any patient is prescribed clozapine.
Background: The first laboratory-confirmed case of the novel coronavirus (COVID-19) was reported ... more Background: The first laboratory-confirmed case of the novel coronavirus (COVID-19) was reported in India on 30 January 2020. Since then, there has been exponential growth in cases, with India now ranking second in the global burden of COVID-19. The novel coronavirus disease (COVID-19) is the greatest burden faced by the healthcare system at present. A major part of this burden is being tackled by the resident doctors working in various teaching hospitals all over the world.This study is aimed at assessment of psychological symptoms in resident doctors posted in COVID 19 wards with respect age, gender and speciality department to which they belong. Materials and Methods: After the permission from Institutional ethics Committee, about 75 resident doctors from various specialty departments posted in COVID-19 wards were taken for study. Each participant after informed consent has been individually interviewed telephonically along with the special semi-structured proforma prepared for the study. Clinical data was collected. After application of rating scales HAM-A & HAM-D to each individual, result are obtained. Results: The survey is completed with total 75 resident doctors working in COVID 19 wards in NKPSIMS & LMH, Nagpur. Out of total n= 75, 44 were males (58.66%), and 31 were females (41.33%). The mean age of participants being = 26.82(±SD=2) years and total 7 days of duty done in COVID-19 wards. 75(100%) resident doctors reported anxiety symptoms and 20(26.66%) resident doctors reported mild depressive symptoms. 73 (97.33%) resident doctors had mild severity of anxiety and 2(2.66%) had moderate severity of anxiety. Resident doctors belonging to various speciality departments showed differing severity of symptoms with Obstetrics and Gynaecology department having maximum instance of anxiety and depressive features and Respiratory medicine and Orthopaedics having least instance of anxiety and depressive features. Conclusion: Resident doctors working in COVID-19 wards are susceptible for anxiety, depressive symptoms and insomnia. Mild form of both anxiety and depression are both prevalent. Psychological symptoms are strongly correlated with female gender as compared to male gender. Type of specialty department also affects the tendency to develop psychological symptoms in resident doctors posted in COVID19 wards. Age or past history of psychiatric illness is not found to be significantly associated with either anxiety or depression. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Association between personality factors and early employment of mothers in medical undergraduates
Annals of Indian psychiatry, 2019
Background: Personality of an individual can be influenced by a variety of factors, including par... more Background: Personality of an individual can be influenced by a variety of factors, including parenting and mother–child interactions in childhood. Reduced time spent with mother due to early employment of mother can affect the personality development in a positive or negative way. Personality, in turn, can influence academic performance, learning, and coping in Bachelor of Medicine, Bachelor of Surgery (MBBS) students. This study aims at exploring the association of mother's employment in the initial period of life and personality traits in MBBS students. Methods: This was a cross-sectional study conducted in a tertiary care center. Consecutively selected 200 MBBS students of all the academic years were interviewed using a semi-structured pro forma and big five inventory scale. Data were statistically analyzed using mean, standard deviation, Chi-square test, and other tests. A P < 0.05 was considered statistically significant. Results: Mothers of 21% of the students worked during pregnancy, and mothers of 33% of the students started working within the first 6 months of delivery. Significantly, high score of extraversion, agreeableness, and openness was found in students whose mothers started working within the first 6 months of delivery. No significant correlation was found between early employment of mother and scores of neuroticism and conscientiousness. Neuroticism score was higher in final MBBS students, students living away from home, and those staying in nuclear families. Conclusion: Early employment in mother was associated with high extraversion, agreeableness, and openness in MBBS students.
Aims: To assess the role of progressive muscle relaxation in the management of hyperemesis gravid... more Aims: To assess the role of progressive muscle relaxation in the management of hyperemesis gravidarum. Methods: This is a prospective, randomized, observer blind and comparative study. Around 30 pregnant women admitted for the treatment of hyperemesis gravidarum were enrolled and randomized into experimental and control groups. Each group was of 15 patients. Experimental group patients received pharmacotherapy with daily progressive muscle relaxation for 2 weeks, while patients in control group received only pharmacotherapy. Results: (1) Significantly high number of patients required three or more drugs in control group as compared to experimental group, (2) experimental group patients achieved complete response within 2.73 days ± SD, while control group patients achieved complete response within 4 days ± SD, (3) none of the patients in experimental group had recurrence within 2 weeks of observation period, while 13% patients in control group had recurrence after complete response, (4) on clinical global improvement scale, patients in experimental group achieved better improvement. Conclusions: Progressive muscle relaxation is effective in hyperemesis gravidarum and when combined with antiemetics, it reduces the number of antiemetics required to treat hyperemesis gravidarum. Patients also show early response to treatment, less recurrence and better improvement when combined with antiemetics.
Therapeutic Advances in Psychopharmacology, Oct 24, 2011
Objectives: To study the effect of escitalopram and fluoxetine on coagulation profile in patients... more Objectives: To study the effect of escitalopram and fluoxetine on coagulation profile in patients with major depression. Method: This was a prospective, open-label, single-centre study in 40 patients diagnosed with major depressive disorder. The patients were diagnosed using Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria. Twenty patients receiving escitalopram 10 mg per day and 20 patients receiving fluoxetine 20 mg per day participated in the study and were followed up for 3 months. Coagulation parameters-bleeding time, clotting time, platelet count, prothrombin time and partial thromboplastin kaolin time-were evaluated at baseline and after 3 months. Results: At the end of 3 months, a significant increase in bleeding time was seen in patients receiving fluoxetine, but within the normal range. No rise was seen in the group given escitalopram. Conclusion: In patients with depression, fluoxetine increases bleeding time whereas escitalopram has no effect on coagulation profile. However, both the drugs can be used safely for long-term treatment.
deposits accumulate, including progressive deterioration of mental function, loss of previous mot... more deposits accumulate, including progressive deterioration of mental function, loss of previous motor development, spastic paralysis, and athetosis. In addition, optic atrophy may occur. The disease usually manifests itself in the 3 rd to 5 th decade of life, but may appear in childhood or later in life. [8] Neuropsychiatric symptoms can be the first or the most prominent manifestations ranging from mild difficulty in concentration, memory changes in personality, behavior, frank psychosis and dementia. [9] About 40% of patients with basal ganglia calcification (BGC) may present initially with psychiatric features. [10] Cognitive, psychotic, and mood disorders are common. Symptoms may change over time. More extensive calcification and subarachnoid space dilatation are known to correlate with the presence of psychiatric manifestations. [10] Currently, there is no cure for Fahr's syndrome, nor a standard course of treatment. The available treatment is
Lurasidone-induced anemia: Is there a need for hematological monitoring?
Indian Journal of Pharmacology, 2019
Lurasidone is a newer drug used for treating schizophrenia and depression in bipolar disorder. Al... more Lurasidone is a newer drug used for treating schizophrenia and depression in bipolar disorder. Although comparatively safe, some side effects can occur with its use such as akathisia, extrapyramidal reaction, metabolic syndrome, and hyperprolactinemia. Blood dyscrasia with lurasidone is rarely reported in the literature except for few case reports. We present two cases of schizophrenia, treated with lurasidone developing anemia after variable period of treatment and reverting after stopping lurasidone. These cases emphasize the timely monitoring of blood parameters for prevention or early detection of anemia in patients treated with lurasidone.
Emetophobia is an intense, irrational fear of vomiting including fear of feeling nausea, seeing o... more Emetophobia is an intense, irrational fear of vomiting including fear of feeling nausea, seeing or hearing another person vomit, or seeing vomitus itself. It may occur at any age and we need to understand its symptomatology. We report a case of emetophobic child whose fear of vomiting started after an attack of acute appendicitis. In the initial stage, fear was limited to vomiting, later it became generalized to a fear of seeing the vomitus, worries that parents may suffer vomiting, fear of vomiting in public places followed by avoiding social activities. Patient improved on short course of anti-anxiety drugs and Graded Exposure Therapy.
WhatsApp use and its impact on relationships among doctors: A cross-sectional pilot study
Annals of Indian psychiatry, 2020
Background: Social media like WhatsApp is known to affect relationships of an individual, and bus... more Background: Social media like WhatsApp is known to affect relationships of an individual, and busy professionals like doctors appear no bar. The objectives of this study were to analyze the pattern of WhatsApp use in specialist-doctors and to study its effect on their relationships. Materials and Methods: This was a cross-sectional pilot study. Consecutively selected hundred married specialist doctors were assessed using self-reported validated questionnaire including questions related to demographics, WhatsApp use, and effects on relationships in a tertiary care center. Statistical analysis was performed using mean, standard deviation, t-test, and Chi-square test. A value of P < 0.05 was considered statistically significant. Results: Participants of various specialties, with a mean age of 41.5 years reported regular WhatsApp-use (89%) of mean duration 2.5 years with 19% spending >2 h/day. About 62% reported using WhatsApp during personal time, leading to reduction in time spent with spouse (37%), impairment in household responsibilities (24%), disturbances in social-activities (26%) and craving. About 36% reported negative effects on married life. 21% reported inability to spend quality-time with spouse, 24% had concern about spouse's WhatsApp-use, 25% reported reduced cohesion between them and 22% felt that excessive use can create doubts in spouse's mind. Those aged <40 years had significantly higher total duration and time spent/day on WhatsApp and reported more conflicts with spouse and reduced expression of love. Conclusion: Inappropriate WhatsApp use can affect many aspects of life of doctors including relationships though exact causal relation is not demonstrated and it should be used judiciously.
Study of anxiety in patients with moderate alopecia
Annals of Indian psychiatry, 2017
Background: Alopecia is known to have an impact on psychosocial health of an individual. Besides ... more Background: Alopecia is known to have an impact on psychosocial health of an individual. Besides depression, anxiety is commonly associated with it and can add significantly to the burden due to it. The present study was carried out in the patients attending dermatology outpatient department, which looked into anxiety symptoms and its correlations with various demographic and clinical factors. Materials and Methods: Thirty consecutive patients diagnosed with moderate alopecia not requiring any major intervention participated in the study. Each patient was individually interviewed using a semi-structured pro forma which included sociodemographic profile, clinical and psychiatric profile, and dermatological diagnosis, and rating scales of Brief Psychiatric Rating Scale (BPRS) and Hamilton Anxiety Rating Scale (HAM-A) were administered. Results and Discussion: Mean age was 30.86 years (standard deviation 11.89), 50% males and majority married with urban background. Many had complaints of uneasiness, excessive worries, and disturbed sleep. The mental status examination in the majority of them revealed anxious mood and preoccupation with worries. None of them satisfied the diagnostic criteria for any anxiety disorder as per Diagnostic and Statistical Manual of Mental Disorders-5. The mean BPRS score was 22.80 with the participants scored significantly on anxiety, tension, and somatic concern and the mean HAM-A score was 10.30 with the majority of participant had score in the range of significant anxiety. Their correlation with factors of gender, marital status, duration, and pattern of alopecia was found to be not significant. Conclusion: Although no diagnosable anxiety disorder was present in patients of moderate alopecia, majority of them had significant anxiety found during the assessment.
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