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Aim: This study aimed to evaluate the disability and its correlates in persons with Bipolar Disorder during the remission phase. Materials and Methods: As part of the multicentric study, 773 patients with bipolar disorder, currently in clinical remission, were evaluated for disability on the Indian Disability Assessment Evaluation Scale. Results: About one-fifth of the participants had some level of disability in the domain of self-care, one-third had some level of disability in the interpersonal domain, one-fourth had some level of disability in communication and understanding, and a maximum proportion (43.7%) had some disability in the domain of work. Overall, about one-fifth (18.4%) were considered to have a benchmark disability (i.e., disability >40%). In terms of correlates, those with a disability had a short duration of current remission, a higher number of manic and mixed episodes, a higher mean number of total episodes, spent more time in the episodes, had lower severity of the depressive episodes, higher residual depressive and manic symptoms, had overall higher manic affective morbidity, had a higher level of cognitive deficits, and had poorer insight. Conclusion: A significant proportion of patients with bipolar disorder have disability in work domain, and the presence of residual symptoms of either polarity are associated with higher level of disability.
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Background: There are limited number of studies evaluating insight among patients with bipolar disorder (BD). Aim: This study aimed to examine insight and its correlates in BD using the data from the multicenter BD course and outcome study from India (BiD-CoIN). The additional aim was to evaluate the insight in patients with BD using different scales and understand the correlates of insight. Materials and Methods: 773 BD patients presently in clinical remission were evaluated on the Insight Scale for Affective Disorders (ISAD), insight items of the Hamilton Depression Rating Scale (HDRS), and the Young Mania Rating Scale (YMRS). Results: The assessment scales influenced the prevalence of poor insight. Poorer insight irrespective of the assessment scale was consistently associated with higher residual depressive and manic symptoms, and a higher level of cognitive impairment and disability. Poor insight as assessed by ISAD was associated with a higher number of episodes in the lifetime, shorter duration of current remission, a higher number of depressive episodes, a higher amount of time spent in depressive episodes, higher depressive affective morbidity, a higher number of manic episodes, and higher residual depressive and manic symptoms. Conclusion: Poor insight in BD is consistently associated with higher residual depressive and manic symptoms and a higher level of cognitive impairment and disability. However, in terms of course variables, the correlates vary depending on the assessment method.
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Background: Delirium is an acute confusional state characterized by changes in the mental status, level of consciousness, impaired cognition, and inattention. It can develop within hours or days. Cortisol release from the hypothalamic-pituitary-adrenal axis (HPA) is vital for the host survival in stress. Biomarkers are used as an indicator of pathogenic processes or to assess the responses to a therapeutic intervention. To improve delirium recognition and care, investigators have identified possible biomarkers that may help in diagnosing individuals with delirium, assessing the severity of delirium. Cortisol has been suggested as biomarker for the diagnosis of delirium. Aims and Objectives: To evaluate and compare levels of serum cortisol in patients with alcohol withdrawal delirium with delirium due to other disorders. Materials and Methods: It was a cross-sectional prospective observational study. A total of 30 patients in Group A and 32 in Group B were included. The participants were evaluated based on delirium rating scale (DRS). Results: It was seen that in alcohol withdrawal delirium group, there was significant positive correlation between DRS score and serum cortisol level, i.e., with increase in DRS score, there was increase in serum cortisol levels and vice versa. Conclusion: Serum cortisol levels are associated and directly correlate with the occurrence and severity of delirium. Further studies are needed to elucidate the implications of this association for diagnosis and treatment.
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Aim: This study aimed to evaluate the prevalence of subjective cognitive complaints and their association with clinical variables, insight, and disability. Methodology: Seven hundred and seventy-three subjects with bipolar disorder (BD), recruited across 14 centers, currently in the euthymic phase were cross-sectionally evaluated on Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA). Results: The mean total COBRA score was 9.79 (SD: 6.99), and 322 (41.7%) of the participants were found to have subjective cognitive complaints when the cut-off of >10 was used. Compared to those without cognitive complaints, those with cognitive complaints more often had depression as the first episode in their lifetime, had a higher prevalence of alcohol dependence, a higher number of depressive episodes (first five years of illness, lifetime, and per year of illness), a higher number of manic episodes in the first five years of illness, more often had depressive or indeterminate predominant polarity, lower prevalence of at least one-lifetime episode with psychotic symptoms, higher severity of residual symptoms, spent more time in the episodes in the lifetime, had poorer insight and higher disability. Conclusion: The present study suggests subjective complaints complaints are associated with more severe illness, higher levels of residual symptoms, poor insight, and higher disability.
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Background: One of the commonest and most frequently said, quoted and understood by even the least educated elements of our society is the neurological symptom of headache. The commonly diagnosed and studied headaches are Migraine and Tension type headache [TTH]. Headache has the power to reduce the very essence of a peaceful life and produce a disability in a person. Aims and Objectives: The aim of our study is to approach the subject with view of correlation of quality of sleep with the disability associated with migraine and compare it to TTH. Materials and Methods: For the same a cross-sectional study design was adopted and a consecutive sampling procedure was adopted. The sample was subjected to basic socio-demography, VAS, PSQI and HDI. Statistical analysis was done on the collected data. Results: Based on scales the results were evaluated using appropriate statistical methods. It was observed that there was a higher female preponderance in both migraine and TTH, there was severe disability associated and both headaches cause poor sleep quality. Conclusion: The current study concludes that headache is a debilitating illness which causes significant disability to a person.
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Trastornos Migrañosos , Cefalea de Tipo Tensional , Femenino , Humanos , Cefalea de Tipo Tensional/complicaciones , Cefalea de Tipo Tensional/epidemiología , Calidad del Sueño , Estudios Transversales , Cefalea , Trastornos Migrañosos/complicaciones , Trastornos Migrañosos/epidemiologíaRESUMEN
AIM: To evaluate the risk factors associated with lifetime suicide attempts in bipolar disorder (BD) patients. METHODOLOGY: 773 BD patients with a duration of illness of at least ten years, currently in clinical remission, were evaluated for suicidal attempts in their lifetime. Those with and without lifetime suicide attempt(s) were compared for various demographic and clinical risk factors. RESULTS: 242 (31.3%) patients had a history of at least one lifetime suicide attempt. Compared to those without lifetime suicide attempts, those with suicidal attempts were less educated, were more often females, spent more time in episodes, and had a significantly more number of total episodes (in the lifetime, first five years of illness, and per year of illness), had significantly more number of total depressive episodes (in the lifetime, first five years of illness, and per year of illness), spent more time in depressive episodes, had more severe depressive episodes, more often had depression as the first episode in the lifetime, spent more time in mania/hypomania/mixed episodes, had higher residual depressive and manic symptoms, more often had rapid cycling affective disorder pattern in the lifetime, use of cannabis in dependence pattern, had poorer insight into their illness and had a higher level of disability (especially in three out of the four domains of Indian disability evaluation assessment scale). CONCLUSIONS: About one-third of the patients with BD have at least one-lifetime suicidal attempt, and those with suicide attempts usually have a poorer course of illness.
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Trastorno Bipolar , Trastorno Depresivo , Femenino , Humanos , Trastorno Bipolar/epidemiología , Trastorno Bipolar/diagnóstico , Intento de Suicidio/psicología , Trastorno Depresivo/complicaciones , Factores de Riesgo , ManíaRESUMEN
Aim: To evaluate the prevalence of substance use disorder (SUD) and its association with the course and outcome of bipolar disorder (BD). Materials and Methods: A total of 773 patients with BD were recruited from 14 centers in different parts of India, and they were evaluated for the prevalence of comorbid substance dependence, course and outcome, subjective cognitive functioning, and disability. Results: About one-fourth (22.9%) of the participants had one or more substance dependence. In terms of specific substance of abuse, 136 (17.6%) had nicotine dependence, 80 (10.3%) patients had alcohol dependence, 13 (1.7%) had cannabis dependence, and nine (1.2%) had opioid dependence. Compared to those without comorbid substance dependence, those with a dual diagnosis (i.e., using at least one substance in a dependent pattern) were less educated, more often males, more often currently single, more often employed, had a lower number of depressive episodes per year of illness, had a higher number of manic and mixed episodes per year of illness in the first 5 years of illness, had a higher level of disability, and more often had a history of hospitalization and a history of receiving electroconvulsive therapy (ECT); also, a higher proportion of them had manic predominant polarity, more often had recurrent mania course, and were more often receiving a combination of lithium and valproate. Conclusion: About one-fourth of BD patients have comorbid SUDs, and presence of SUD has a negative impact on the course and outcome of BD.
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Diabetes is a multi-faceted syndrome on which the brain is an etiopathogenetic factor, as well as a target organ for damage. Drugs which act on the brain, such as bromocriptine and antipsychotic drugs, are known to influence glycaemic control. This article describes lemborexant, a dual oxexin receptor antagonist (DORA), and hypothesizes that it may be used as an adjuvant in difficult-to-control diabetes. Its utility should be explored in persons with insomnia and high fasting glucose, unregulated appetite, and diabetes distress.
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Antipsicóticos , Diabetes Mellitus , Trastornos del Inicio y del Mantenimiento del Sueño , Humanos , Antagonistas de los Receptores de Orexina , Bromocriptina , Trastornos del Inicio y del Mantenimiento del Sueño/tratamiento farmacológico , Adyuvantes Inmunológicos , GlucosaRESUMEN
Background: The impairment due to the psychiatric disorders makes the sufferer unable to become independent, therefore require long term support and care by their relatives. About 32% of years lived with disability (YLD) and about 13% of disability adjusted life-years (DALYs) is found in mental illness. Aims and Objectives: The aims were to study the socio-demographic profile, the caregiver burden and quality of life of the caregivers of the patients with different psychiatric illness. Also, to compare the burden and quality of life among caregivers of different psychiatric groups. Materials and Methods: It is a cross sectional study in which 120 caregivers of patients with psychiatric illnesses were included; divided into four groups (30 each): Anxiety, psychotic, mood and substance use disorders. After the consent, Zarit burden interview, socio demographic profile and quality of life -10 scales were used to assess the objectives. Results: The results revealed that maximum caregivers were males, and spouses in relation with the patient. Most of them were married and educated. Maximum had mild to moderate level of burden (49.1%), followed by moderate to severe level of burden in about 22.5% caregivers. Significant association was seen with the burden level. But no significant association was seen with the quality of life. Conclusion: Caregivers of the psychiatric patients have to suffer a lot and may land up into the psychiatric symptoms themselves.
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AIM: Most of the available data on the prevalence and impact of psychotic symptoms on the course of bipolar disorder (BD) is from Western countries. We aimed to study the prevalence of at least one psychotic episode in the lifetime in patients with BD and its association with the long-term course and outcome. METHODOLOGY: 773 patients recruited as part of the Bipolar Disorder Course and Outcome study from India (BiD-CoIN study) were divided into 2 groups, based on the presence or absence of at least one psychotic episode in the lifetime. RESULTS: 326 (42.2%) patients had at least one psychotic episode in their lifetime. At least one psychotic episode in the lifetime was associated with overall more severe illness in terms of lower age of onset, a higher number of episodes in the first 5 years of illness; higher rates of BD-II, a higher rate of lifetime history of at least 1 suicide attempt, lifetime history of hospitalization, history of receiving Electroconvulsive Therapy, and a higher prescription rates of antipsychotics. However, presence of psychotics symptoms was associated with better cognitive functioning. CONCLUSIONS: Our findings suggest that the presence of psychotic symptoms during episodes in patients with BD is associated with poorer course of BD.
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Antipsicóticos , Trastorno Bipolar , Trastornos Psicóticos , Antipsicóticos/uso terapéutico , Trastorno Bipolar/diagnóstico , Trastorno Bipolar/epidemiología , Trastorno Bipolar/terapia , Preescolar , Humanos , Evaluación de Resultado en la Atención de Salud , Prevalencia , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/epidemiología , Trastornos Psicóticos/terapiaRESUMEN
As the world grapples with a rapidly increasing prevalence of obesity, epidemiologists, health care professionals and policy makers are working together to increase awareness about its prevention and management. However, what is also increasingly visible in a subset of not very obese individuals, is an undue concern about their weight, a condition we call Baromania. Akin to orthorexia nervosa, anorexia and bulimia. we define baromania as "a state of extreme attention towards one's own weight, accompanied by elation and excitement regarding weight loss and maintenance". This paper describes the different clinical presentations, diagnosis and management of persons with Baromania.
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Bulimia Nerviosa , Trastornos de Alimentación y de la Ingestión de Alimentos , Humanos , Obesidad/epidemiología , Pérdida de Peso , AnorexiaRESUMEN
AIM: This cross-sectional study aimed to assess the predominant polarity (PP) in patients with bipolar disorder (BD) and the factors associated with PP. METHODOLOGY: For this study, 773 participants with at least 10 years of illness, were recruited from 14 centres, were evaluated using the National Institute of Mental Health- Retrospective Life Charts to assess the course of illness and PP was determined by both Barcelona proposal and the Harvard Index. RESULTS: According to Barcelona proposal for PP, 20.6% of the patients belonged to depressive PP, 45.8% belonged to manic PP and 33.6% belonged to indeterminate polarity. According to Harvard index of PP, 31.6% of the patients belonged to depressive PP, 56.1% belonged to manic polarity and 12.3% of the patients could not be categorized into any of these categories and hence, were considered to have indeterminate polarity. Those with depressive PP were more often having BD-II, had later age of onset, spent more time in episodes, had higher residual depressive symptoms, had lower residual manic symptoms, more often had depression as the first lifetime episode, and less often had at least one psychotic episode. CONCLUSION: In the Indian subcontinent, although the prevalence of PP is influenced by the definition used, the most common PP is that of mania.
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Trastorno Bipolar , Trastornos Psicóticos , Trastorno Bipolar/diagnóstico , Trastorno Bipolar/epidemiología , Estudios Transversales , Humanos , Evaluación de Resultado en la Atención de Salud , Estudios RetrospectivosRESUMEN
AIM: To explore the prevalence of residual symptoms (both depressive and manic) and their correlates in subjects with bipolar disorder in clinical remission. METHODOLOGY: This multicentric cross-sectional study included patients in clinical remission recruited across the 14 centers. The patients were evaluated on the Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS) for the prevalence of residual symptoms. A score of ≤7 on both scales defined the presence of residual symptoms. RESULTS: Four-fifth (79.8%) of the participants had residual symptoms, with 130 (16.8%) having only residual depressive symptoms, 74 (9.6%) having only residual manic symptoms, and 413 (53.4%) having both depressive and manic residual symptoms, on HDRS and YMRS. The residual symptoms were related to the polarity of the most recent episode and the lifetime predominant polarity. Higher numbers of lifetime depressive episodes are associated with higher residual depressive symptoms, and higher numbers of lifetime manic episodes are associated with higher chances of having residual manic symptoms. CONCLUSIONS: A large proportion of patients with bipolar disorder have residual symptoms during the remission phase. Clinicians need to make efforts to identify and address the same to improve the treatment outcome.
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Trastorno Bipolar , Trastorno Bipolar/epidemiología , Estudios Transversales , Progresión de la Enfermedad , Humanos , India/epidemiología , Evaluación de Resultado en la Atención de Salud , Escalas de Valoración PsiquiátricaRESUMEN
AIM: This study aimed to evaluate the prevalence of unipolar mania (UM) in a group of patients of bipolar disorder (BD). Additionally, effort was made to evaluate the demographic, clinical and treatment related factors, which distinguish subjects of UM from BD. METHODOLOGY: Seven hundred and seventy-three patients with BD, of at least 10 years duration, recruited from 14 General Hospital Units of tertiary care centers from India were evaluated for UM. RESULTS: The prevalence of UM, varied from 5.4% to 20.3%, depending on the definition used. With the most stringent definition of ≥4 episodes of mania and at least 5 years of follow-up, the prevalence of UM was 5.4%. Compared to patients of BD, who have episodes other than mania too, those with UM had lower proportion of patients with lifetime history of suicide attempts, spent less time in the episodes in their lifetime and had lower severity of residual depressive and manic symptoms. Further, compared to those with episodes other than mania too, those with UM had higher number of manic episodes per year of illness, had higher proportion of patients who had more than five episodes in the lifetime and had higher proportion of those with at least one episode with psychotic symptoms in the lifetime. CONCLUSION: The present study suggests that a small proportion of patients with BD have UM course and this runs a different clinical course compared to that seen in patients with traditionally recognized as BD.
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Trastorno Bipolar , Manía , Trastornos Psicóticos , Trastorno Bipolar/diagnóstico , Trastorno Bipolar/epidemiología , Humanos , India/epidemiología , Manía/diagnóstico , Manía/epidemiología , Evaluación de Resultado en la Atención de Salud , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/epidemiologíaRESUMEN
AIM: To evaluate the prescription pattern of patients with BD, currently in clinical remission. Additional aim of the study was tocompare the prescription pattern across different study centres. METHODOLOGY: Prescription of 773 patients, currently in clinical remission, recruited from the outpatient setting of 14 General Hospital Tertiary Care Units of tertiary care centres in the country were evaluated. RESULTS: Almost all (98.1 %) participants were on medications at the time of assessment. In terms of conventional mood stabilizers, those receiving valproate (44.2 %), out-numbered those receiving lithium (38.9 %). A small proportion (7.4 %) was receiving a combination of both valproate and lithium. About two-third (62.5 %) were receiving at least one antipsychotic medication, with olanzapine (31.7 %) being the most commonly prescribed antipsychotic, followed by quetiapine (11.1 %), and risperidone (9.6 %). About one-third (34.4 %) of the participants were receiving antidepressants, with sertraline (22.6 %) forming bulk of the prescription. Less than half (43.9 %) of the participants were also receiving a benzodiazepine medication at the time of assessment, with chlordiazepoxide (18 %) being the most common agent, followed by clonazepam (14.5 %). There was variation in the prescription patterns across different centres, in terms of monotherapy, polypharmacy, use of preferred conventional mood stabilizers, use of various antipsychotics and antidepressants. CONCLUSION: Besides conventional mood stabilizers, about two-third of patients with bipolar disorder received concomitant antipsychotics, one-third received concomitant antidepressants and less than half received benzodiazepines.
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Antipsicóticos , Trastorno Bipolar , Antimaníacos/uso terapéutico , Antipsicóticos/uso terapéutico , Trastorno Bipolar/tratamiento farmacológico , Humanos , India , PrescripcionesRESUMEN
OBJECTIVES: This multicentric study from India aimed to evaluate the long term course and outcome of bipolar disorder (BD). METHOD: Seven hundred and seventy-three participants diagnosed with BD, attending 14 outpatient clinic centers across the country, were evaluated using the National Institute of Mental Health- Retrospective Life Charts to assess the long term course of BD. RESULTS: The mean age of onset of the first episode of illness of the study sample was 26.3 (8.54) years, and mean duration of illness at the time of assessment was 233.05 (94.55) months. In terms of the total number of lifetime episodes, the mean number of manic episodes (mean: 3.68; SD: 4.75) exceeded the mean number of depressive episodes (mean: 3.36; SD: 5.51). The mean numbers of total lifetime episodes were 8.58 (10.6%). When the number of episodes per year was computed, the mean number of manic episodes per year exceeded that of the mean number of depressive episodes. Compared to females, a higher proportion of males had a history of comorbid substance dependence. LIMITATIONS: The course was assessed retrospectively and the study was limited to participants attending the outpatient clinics. CONCLUSIONS: The course of BD in India differs from that described from developed countries in the form of a number of manic episodes exceeding the depressive episodes.
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Trastorno Bipolar , Adulto , Trastorno Bipolar/epidemiología , Femenino , Humanos , India/epidemiología , Masculino , Evaluación de Resultado en la Atención de Salud , Estudios RetrospectivosRESUMEN
BACKGROUND: Patients with psychiatric disorders can be vulnerable to oral diseases due to the adverse effects of medications and disease per se. The aim of this study is to assess oral health status, self-perceived dental needs, and barriers to utilization of dental services along with evaluation of intervention urgency among psychiatric patients. MATERIALS AND METHODS: In this cross-sectional study, 165 individuals were examined at the psychiatric outpatient department of a tertiary care center. Clinical examination [dentition status and community periodontal index (CPI) modified] was done according to the World Health Organization Basic Oral Health Surveys, 2013. Other information was collected by direct interview and all the data were recorded on a prestructured, validated pro forma. Data were analyzed using SPSS Software. The statistical significance was determined by analysis of variance (ANOVA) and level of significance was set at P < 0.05. RESULTS: Although decayed, missing, and filled teeth (DMFT) and CPI-modified scores increased with increase in duration of illness, the difference was not statistically significant. Evaluation of self-reported attributes revealed that the majority of the individuals had reported dental pain (34.6%) as their dental problem, 39.6% visit dentist only when there is a dental problem, and 41.7% did not felt any need to visit dentist. The ANOVA of DMFT in relation to duration of illness (P > 0.062) and CPI-modified scores (P > 0.078) were not statistically significant. Although when intervention urgency was evaluated, 70.3% needed prompt treatment depending on their oral health assessment. CONCLUSION: The findings of this study suggest that oral health concerns of this marginalized section of the population are unrecognized and should be given prominence by psychiatrists.
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Psychiatry and Endocrinology share a deep rooted, multifaceted bidirectional relationship. Both have seen a surge in cases due to change in lifestyle. Time has come where these two rapidly growing fields interact and exchange knowledge leading to emergence of Psychocrinology. This communication describes the rationale behind using the term psychocrinology, and provides an overview of it's vast spectrum.
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Endocrinología , Psiquiatría , Comunicación , HumanosRESUMEN
INTRODUCTION: To mitigate the spread of the pandemic coronavirus infection (COVID-19), governments across the world have adopted "lockdowns" which have confined many individuals to their homes. This disrupts normal life routines, elements of which are important circadian cues. The pandemic is also associated with new stressors, altered roles, and uncertainties about health and economic security, which are also likely to affect sleep. The current study is an online survey of sleep experience, routines, physical activity, and symptoms of anxiety and depression, to study the alterations associated with the lockdown. MATERIALS AND METHODS: The survey was conducted in early May 2020 using a questionnaire circulated through social media platforms. Questions related to demographic characteristics, current and previous sleep schedules, routine, and working patterns. Insomnia (Insomnia Severity Index - 4), Stress (Perceived Stress Scale - 4), anxiety and depressive symptoms (Patient Health Questionnaire - 4) and physical activity (International Physical Activities Questionnaire) were assessed using standardized instruments. RESULTS: A total of 958 valid responses were received. Compared to the prelockdown period, there was a shift to a later bedtime and waking time, with a reduction in night-time sleep and an increase in day-time napping. These effects were visible across occupational groups, but mostly affected working individuals except health professionals. Sleep quality deteriorated across groups. Reductions in sleep duration were associated with depressive symptoms. CONCLUSIONS: The COVID-19 lockdown is associated with changes in sleep schedule and in the quantity and quality of night-time sleep. Although these changes are associated with elevated rates of emotional symptoms, it is unclear from these cross-sectional results, whether sleep deterioration produces psychological distress, or vice versa.