Risperidone-induced anaemia.

Risperidone is an atypical antipsychotic drug, which is used in schizophrenia and also to treat excitation and aggression in patients with delirium. Risperidone has a low risk of haematotoxicity because of its different chemical and pharmacological profile compared to other drugs such as clozapine. Haematological abnormalities have life-threatening complications, especially neutropenia, leucopenia and agranulocytosis, but their effect on erythrocytes in adults is less well known. We highlight the effect of risperidone on erythrocytes and the mechanism that leads to anaemia. To the best of our knowledge, this is the only report of 2 patients showing combinations of mechanisms leading to risperidone-induced anaemia.

Mental health status of healthcare providers during the Covid-19 pandemic: A cross-sectional study across India.

Background From the beginning of the Covid-19 pandemic, studies have observed an increased prevalence of psychological symptoms in the general population and healthcare providers. We studied the prevalence of psychological symptoms among the latter. Methods We did this study using a self-administered questionnaire among healthcare providers across India who were involved in caring/treating patients. The questionnaire collected information on demographics, Depression, Anxiety and Stress Scales (DASS-21) and semi-structured questions related to the Covid-19 pandemic. Results A total of 612 healthcare providers participated in the study; 254 were doctors of various specialties and 358 were nursing care-providers. According to the DASS-21 assessment, the prevalence of depression was 12.4%, anxiety was 19.1% and stress was 10.8%. The prevalence of psychological problems was more among nursing staff compared to doctors (depression risk ratio [RR] 2.4, anxiety RR 1.73 and stress RR 2.93) and they were equal among both genders (depression RR 1.05, anxiety RR 1.06 and stress RR 1.21). Conclusions Our study shows that there is a higher prevalence of depression, anxiety and stress among healthcare providers, particularly among nursing care-providers. We suggest psychological interventions to nursing care-providers and also those who are vulnerable among doctors, to improve their mental health status.

Assessing caregiving burden among primary caregivers in a medical intensive care unit setup: Cross-sectional study.

OBJECTIVE: Caregiver burden in caring patients in intensive care unit (ICU) settings are stressful and challenging place. Caregivers also play very important role in doctor-patient relationship. In India, there is a skewed trend in doctor-patient relationship. Without addressing caregiver's psychological issues, we may not able to deliver good medical services. "Caregiver burden in primary caregivers of patients admitted to medical ICU (MICU) was measured. METHODOLOGY: Its cross-section observational study. We collected the information from total of 100 caregivers whose patient got admitted to MICU. We took only one caregiver. We administered socio-demographic data, Zarit Caregiver Burden Interview (ZBI) for assessing burden in caregivers. RESULTS: The mean age of the caregivers was 38 years with 66% males were being primary caregivers and mean age of education was 8.61 years. The mean duration of patient stay in hospital was 4.67 days with range of 4-18 days. Mean duration of illness in patient was 466 days with range of 4 days to 10 years. Mean score caregivers burden as per ZBI was 5.10 with range of 0-25. Thirty-five percentage of caregiver were felt caregiving was the burden. Correlation analysis shows ZBI negative relationship with caregivers' age and education and patients total duration of illness. There was a positive co-relationship with the duration of ICU admission. CONCLUSION: Higher burden was observed in caregivers and caregivers felt more burden if patients stays longer duration in ICU. More research is needed in this area.

Co-relationship between sexual dysfunction and high-risk sexual behavior in patients receiving buprenorphine and naltrexone maintenance therapy for opioid dependence.

INTRODUCTION: People suffering from substance dependence suffer from various sexual dysfunctions and are at risk for indulging in various high-risk sexual behaviors and thus are vulnerable to acquire various infections such as HIV/AIDS and other sexually transmitted infections. AIM: The aim of the study was to evaluate the correlation between sexual dysfunction and high-risk sexual behavior in opioid-dependent men receiving buprenorphine and naltrexone maintenance therapy. MATERIALS AND METHODS: Semi-structured questionnaire, brief male sexual functioning inventory and HIV-risk taking behavior scale was administered to a sample of 60 sexually active men, receiving buprenorphine (n = 30) and naltrexone (n = 30) maintenance therapy for opioid dependence. RESULTS: The main outcomes are correlation between severity of sexual dysfunction and HIV-risk taking behavior. The study results showed 83% of the men on buprenorphine and 90% on naltrexone reported at least one of the sexual dysfunction symptoms. There was a negative correlation between sexual dysfunction and HIV-risk taking behavior that suggest severe the dysfunction, higher the risk taking behavior. Significant correlation was present with overall sexual dysfunction and HIV-risk taking behavior (P = 0.028 and in naltrexone receiving group premature ejaculation versus HIV-risk taking behavior however, (P = 0.022, P < 0.05) there were no significant differences among both the groups except above findings. CONCLUSION: Conclusion was treatment is associated with sexual dysfunctions and HIV-risk taking behavior, which has clinical implication. Future research should explore this further using biochemical analyses.

Disulfiram-induced reversible hypertension: a prospective case series and review of the literature.

Disulfiram (DSF) is one of the recommended aids in the management of selected patients with alcohol dependence. Hypertension (HTN) as an adverse effect of DSF therapy is less understood. In our prospective case series of 7 subjects with co-morbid alcohol and nicotine dependence, a temporal, dose-dependent, and reversible grade 1-3 HTN within 1-6 weeks of initiation of DSF therapy (125-500 mg/day) with no other detectable causes of HTN was noted. Challenges and strategies surrounding diagnosis and treatment along with mean change and percentage rise in blood pressure are described. Literature review and clinical description of case series may suggest neurobiological role in its causation. HTN may be a clinically significant, dose-dependent, and reversible adverse effect of DSF therapy, especially in co-morbid alcohol and nicotine-dependent patients. Awareness amongst clinicians may render better health care delivery to subjects with alcohol dependence.

Catatonia: Etiopathological diagnoses and treatment response in a tertiary care setting: A clinical study.

AIM: Catatonia is caused by a variety of psychiatric and organic conditions. The onset, clinical profile, and response to treatment may vary depending on the underlying cause. The study is an attempt to explore clinical profile, possible etiological correlates with neurotic/psychotic spectrum illnesses, and response to treatment and outcome in patients of catatonia. MATERIALS AND METHODS: Retrospective chart analysis by using semistructured data sheet for the analysis of sociodemographic data, clinical profile, precipitating event, and response to treatment in patients with catatonic symptoms admitted to IHBAS (Institute of Human Behaviour and Allied Sciences, New Delhi, India) from January 2009 to December 2010 was undertaken. RESULTS: Catatonia was commonly observed in patients with the following profile - late twenties, female, Hindu religion, urban background, and housewives. Psychotic spectrum disorder (57%, N=35) was the most commonly entertained diagnosis and affective disorder (18%, N=11) being the second common. Thirty four percent of the subjects responded to lorazepam treatment and rest required modified electroconvulsive therapy (MECT). CONCLUSION: Catatonia is more likely to be associated with Schizophrenia and Other Psychotic Disorders in Indian settings. Majority of patients responded to therapy either by lorazepam alone or to its augmentation with modified ECT. The study being a retrospective one, the sample being representative of the treatment seeking group only, and unavailability of the follow up data were the limitations of the study.

Chronoscopic reading in whole body reaction times in detecting cognitive dysfunction in metabolic syndrome: a case control study.

BACKGROUND: The metabolic syndrome, a clustering of several commonly occurring disorders that include abdominal obesity, hypertriglyceridemia, low high-density lipoprotein level, hypertension, and hyperglycemia, has been specifically investigated as a risk factor for cognitive decline in elderly individuals. The metabolic syndrome may be a risk factor for cognitive decline because it summarizes the joint effects of these risk factors. It is known that difference between simple and choice reaction time (RT) implies time required for cognition. Though delayed choice RTs indicate involvement of cognition, they cannot quantify how much time is required for cognition. In whole body simple reaction time (WBSRT), RT is split into two chronoscopic readings: C1 and C2. C1 measures time required for central processing which requires cognition and C2 measures total RT. C2-C1 measures time required for peripheral motor response. We hypothesized that whole body choice RT chronoscopic reading 1 (WBCRTC1) will be delayed in metabolic syndrome and WBCRTC1 will have predictive value in detecting cognitive dysfunction. SETTINGS AND DESIGN: Hospital-based cross-sectional case-control study. MATERIALS AND METHODS: Study was conducted on 120 subjects using visual and WBSRT having criteria of age (40-60 years) and metabolic syndrome, compared with equal number of age- and sex-matched controls. Statistical analysis was done by independent t-test and duration of metabolic syndrome was correlated with cognition times (WBCRTC1) using Pearson's correlation. Predictive value of WBCRTC1 was calculated using receiver operating characteristic curve. RESULTS: Delayed visual simple RT, visual choice RT, WBSRT, and whole body choice RT (WBCRT) observed among subjects metabolic syndrome when compared with controls. Choice RTs were more delayed compared to simple RTs. WBCRTC1 (608.8 ± 132 ms) was more delayed than WBSRTC1 (424.05 ± 89.9 ms) among metabolic syndrome indicating cognitive dysfunction. Unfortunately, there was no significant correlation between duration of metabolic syndrome with cognition. The best cut-off value for WBCRTC1, when predicting cognitive dysfunction in metabolic syndrome was 542.5 ms (sensitivity 36.7% and specificity 31.6%). CONCLUSIONS: WBCRTC1 can be used as a tool to detect cognitive dysfunction.

Sexual dysfunction among male patients receiving buprenorphine and naltrexone maintenance therapy for opioid dependence.

INTRODUCTION: Opioid-dependent men suffer from sexual dysfunctions in the short and long term. The medications used for long-term pharmacotherapy of opioid dependence also affect sexual functioning, though this has been a poorly investigated area so far. AIM: To study the sexual dysfunction in opioid-dependent men receiving buprenorphine and naltrexone maintenance therapy. METHODS: A semistructured questionnaire and Brief Male Sexual Functioning Inventory (BMFSI) was administered to a sample of 60 sexually active men, receiving buprenorphine (n = 30) and naltrexone (n = 30) maintenance therapy for opioid dependence. MAIN OUTCOME MEASURES: Prevalence of premature ejaculation, erectile dysfunction, low sexual desire, weakness due to semen loss, and overall satisfaction. RESULTS: About 83% of the men on buprenorphine and 90% on naltrexone reported at least one of the sexual dysfunction symptoms. The commonly reported dysfunctions were premature ejaculation (83% in buprenorphine and 87% in naltrexone), erectile dysfunction (43% in buprenorphine and 67% in naltrexone), and loss/reduction in sexual desire (33% in buprenorphine and 47% in naltrexone). On BMSFI however, there were no significant differences among both the groups. CONCLUSIONS: Opioid dependence as well as its pharmacological treatment is associated with sexual dysfunctions, which has clinical implication. Future research should explore this further using biochemical analyses.

Sociodemographic profile, clinical factors, and mode of attempt in suicide attempters in consultation liaison psychiatry in a tertiary care center.

BACKGROUND: The objective was to study the sociodemographic data, psychiatric disorder, precipitating events, and mode of attempt in suicide attempted patients referred to consultation liaison psychiatric services. SETTINGS AND DESIGN: A prospective study of 6-month duration was done in a tertiary care center in India. MATERIALS AND METHODS: During the 6-month period all referrals were screened for the presence of suicide attempters in consultation liaison services. Those who fulfilled the criteria for suicide attempters were evaluated by using semistructured pro forma containing sociodemographic data, precipitating events, mode of attempt, and psychiatric diagnosis by using ICD-10. RESULTS: The male-to-female ratio was similar. Adult age, urban background, employed, matriculation educated were more represented in this study. More than 80% of all attempters had psychiatric disorder. Majority had a precipitating event prior to suicide attempt. The most common method of attempt was by use of corrosive. CONCLUSIONS: Majority of suicide attempter patients had mental illness. Early identification and treatment of these disorders would have prevented morbidity and mortality associated with this. There is a need of proper education of relatives about keeping corrosive and other poisonous material away from patients as it was being commonest mode of attempt.

Kleine-Levin syndrome: Etiology, diagnosis, and treatment.

Kleine-Levin syndrome (KLS) is a rare sleep disorder mainly affecting teenage boys in which the main features are intermittent hypersomnolence, behavioral and cognitive disturbances, hyperphagia, and in some cases hypersexuality. Each episode is of brief duration varying from a week to 1-2 months and affected people are entirely asymptomatic between episodes. No definite cause has been identified, and no effective treatments are available even though illness is having well-defined clinical features. Multiple relapses occur every few weeks or months, and the condition may last for a decade or more before spontaneous resolution. In this study, PubMed was searched and appropriate articles were reviewed to highlight etiology, clinical features, and management of KLS. On the basis of this knowledge, practical information is offered to help clinicians about how to investigate a case of KLS, and what are the possible treatment modalities available currently for the treatment during an episode and interepisodic period for prophylaxis. Comprehensive research into the etiology, pathophysiology, investigation, and treatments are required to aid the development of disease-specific targeted therapies.