A Diffusion Tensor Imaging Study Using a Voxel-Based Analysis, Region-of-Interest Method to Analyze White Matter Abnormalities in First-Episode, Treatment-Naïve Major Depressive Disorder.

This study used fractional anisotropy (FA), a measure of diffusion tensor imaging, to analyze white matter abnormalities in 15 first-episode treatment-naïve patients with major depressive disorder (MDD) and 15 controls matched for age. An automated voxel-based analysis and a region-of-interest (ROI) method with 3T magnetic resonance imaging were used. Compared with controls, FA values were lower in the left superior longitudinal fasciculus, the left prefrontal cortex, and the left parietal region in patients with MDD. In addition, the ROI method revealed significantly lower FA values in the right hippocampus. Voxel-based analysis, a faster technique, complements the ROI method, which highlights FA values as potential biomarkers in early MDD.

Effect of milnacipran on brain­derived neurotrophic factor and oxidative stress biomarkers in patients of major depressive disorder.

Emerging hypotheses in the pathophysiology of major depressive disorder (MDD) suggest important role of neurotrophic factors and oxidative stress. This study assessed the effect of milnacipran (a dual serotonin­noradrenaline reuptake inhibitor) on brain­derived neurotrophic factor (BDNF) and oxidative stress biomarkers i.e., malondialdehyde (MDA), glutathione­s­ transferase (GST) and glutathione reductase (GR) in patients of MDD. Thirty patients (aged 18 to 60 years) with MDD diagnosed by DSM­IV criteria, with Hamilton Depression Rating scale (HAM­D) score ≥ 14 were included in the study. Patients were given milnacipran in the doses of 50­100 mg once daily. Patients were followed up for 12 weeks. HAM­D score at the start of treatment was 17.8±1.7 which significantly reduced to 8.9±3.1 at 12 weeks of treatment. In responders, the plasma BDNF levels increased significantly at 12 weeks post treatment. There was no significant change in the pre­ and post­treatment values of oxidative stress parameters (MDA, GST and GR) after 12 week treatment. Milnacipran is effective and well tolerated in MDD patients, and its therapeutic response is associated with an increase in plasma BDNF levels. However, milnacipran did not affect oxidative stress biomarkers.

Psychiatric and cognitive correlates of quality of life among persons with primary brain tumors.

BACKGROUND: Quality of life (QoL) in primary brain tumour (PBT) is often the main outcome measure in an otherwise incurable disease. The impact of psychiatric, cognitive correlates on quality of life in primary brain tumours is less well studied. AIMS AND OBJECTIVES: The primary objective was to find out the association of psychiatric morbidity, cognitive functions with quality of life in patients with primary brain tumours. The secondary objective was to study whether any association exists with tumour grading, laterality, location and psychiatric morbidity. MATERIALS AND METHODS: 100 consecutive patients of PBT were screened in the Neuro-behavioural Clinic. Age, gender matched 52 healthy subjects were taken for comparison. Quality of life (qol) measure (EORTC), Hospital Anxiety Depression Scale (HADS), GHQ (12 item) and Mini Mental State Examination (MMSE) were administered. RESULTS: 52 PBT cases were included, out of which 17.30% had Organic Anxiety Disorder (F06.4), 23.07% had Organic Mood disorder (F06.3%).Statistically significant association was found in EORTC qol scores and anxiety scores (p 0.001), depressive scores (p 0.029), psychiatric morbidity (p0.000) .Significant association with tumour laterality, depression scores (p0.041) was found. PBT patients had poor quality of life as compared to matched healthy volunteers (p <0.001). Significant negative correlation between EORTC B-20, cognitive scores using Spearman's Rho (p0.005; r - 0.385), implying more symptoms with poor cognitive function scores. Psychiatric morbidity, cognitive dysfunction, poor qol were noted, though no association with tumour grading, location. CONCLUSION: Regular assessments, early intervention will help in improving quality of life in PBT.

Are pregnant women also vulnerable to domestic violence? A community based enquiry for prevalence and predictors of domestic violence among pregnant women.

AIM: To generate local evidence to fill up the knowledge gap about the domestic violence faced by the antenatal females. OBJECTIVES: To screen for domestic violence in antenatal females. To explore association, if any, with socio-demographic and pregnancy related attributes among antenatal females of an urbanized village of Delhi. MATERIALS AND METHODS: Socio demographic details and pregnancy related attributes and HITS (Hurt, Insult, Threaten, Scream) questionnaire for screening domestic violence was used on 165 pregnant females in a community based setting. RESULTS: 23% of pregnant women were screened positive for domestic violence. Physical hurt was present among 60% of victims of domestic violence. The predictors for domestic violence among pregnant women as derived from logistic regression were - educational status of head of the family/husband, substance abuse by husband and history of previous abortions. CONCLUSION AND RECOMMENDATIONS: More emphasis should be given on well being of the pregnant women who are victims of domestic violence. The policy makers and program managers should integrate social welfare schemes with the RCH program and all levels of health care functionaries should be sensitized about dealing with victims of domestic violence. Laws should be implemented effectively against perpetrators of domestic violence and more importantly females should be made aware of such laws and should be motivated to report it to the legal authorities and not to take up violence for granted.

Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing: response to antiepileptic dual therapy.

Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) is included among trigeminal autonomic cephalalgias in the International Classification of Headache Disorders-2. Available literature suggests that it responds to anticonvulsants, particularly lamotrigine. However, management of partial responders is difficult and antiepileptic duo-therapy may be an answer to it. Nonetheless, to our knowledge, anticonvulsant combination has never been tried in partial responders to monotherapy. We are presenting a case of SUNCT that had overlapping symptoms with Short-lasting Unilateral Neuralgiform headache attacks with cranial Autonomic features and responded well only to the combination of lamotrigine with carbamazepine. However, lamotrigine had to be stopped as patient developed leucopenia and it resulted in partial recurrence of symptoms.

Adjustment to acquired vision loss in adults presenting for visual disability certification.

CONTEXT: Rehabilitation of the visually disabled depends on how they adjust to loss; understanding contributing factors may help in effective rehabilitation. AIM: The aim of this study is to assess adjustment to acquired vision loss in adults. SETTINGS AND DESIGN: This observational study, conducted in the Department of Ophthalmology at a tertiary-level teaching hospital, included thirty persons (25-65 years) with <6/60 in the better eye, and vision loss since ≥6-months. MATERIALS AND METHODS: Age, gender, rural/urban residence, education, current occupation, binocular distance vision, adjustment (Acceptance and Self-Worth Adjustment Scale), depression (Center for Epidemiologic Studies-Depression Scale), social support (Duke Social Support and Stress Scale), and personality (10-item Personality Inventory scale) was recorded. STATISTICAL ANALYSIS: To determine their effect on adjustment, Student's t-test was used for categorical variables, Pearson's correlation for age, and Spearman's correlation for depression, personality trait and social support and stress. RESULTS: Of 30 persons recruited, 24 were men (80%); 24 lived in urban areas (80%); 9 were employed (30%); and 14 (46.6%) had studied < Class 3. Adjustment was low (range: 33%-60%; mean: 43.6 ± 5.73). Reported support was low (median: 27.2; interquartile range [IQR]: 18.1-36.3); reported stress was low (median: 0.09; IQR: 0-18.1). Predominant personality traits (max score 14) were "Agreeableness" (average 12.0 ± 1.68) and "Conscientiousness" (average 11.3 ± 2.12). Emotional stability (average 9.2 ± 2.53) was less prominent. Depression score ranged from 17 to 50 (average 31.6 ± 6.01). The factors studied did not influence adjustment. CONCLUSIONS: Although adjustment did not vary with factors studied, all patients were depressed. Since perceived support and emotional stability was low, attention could be directed to support networks. Training patients in handling emotions, and training family members to respond to emotional needs of persons with visual disability, might contribute to reducing stress and depression.

A Study of Emotional Intelligence Among Postgraduate Medical Students in Delhi.

CONTEXT: The importance of emotional intelligence (EI) in the successful practice of medicine has been well established. However, efforts to study the same in India, especially in doctors and medical students, are lacking. This study has measured the emotional intelligence of postgraduate medical students in Delhi and aimed to identify some of the factors affecting it. METHODS: A cross-sectional analytical study, using the Schutte's Self-Report Emotional Intelligence Test, to measure the EI of 200 postgraduate medical students of two medical colleges in Delhi. Students working in clinical specialties were selected randomly and contacted by the first author. Data was collected by a self-administered questionnaire. RESULTS: The mean scores of EI among the study participants was 124.4 with a standard deviation of 12.8. The total scores possible in the scale range from 33 to 165, with higher scores representing higher EI. The age of the participants was positively associated with emotional intelligence (r = 0.187, p = 0.008). EI was also found to decrease with the increase in total workload (p=0.013), having night duty hours (p = 0.019), and having emergency duty (p = 0.037).   Conclusions: More studies to measure the EI of doctors, the factors affecting it, and possible measures to improve it, are needed. The workload of the resident doctors needs to be assessed with appropriate changes made in the total work done and the quality of work done.

Barriers to acceptance of intervention among patients with trachomatous trichiasis or entropion presenting to a teaching hospital.

PURPOSE: To determine the barriers to therapeutic intervention in patients with trachomatous trichiasis or entropion. METHODS: Prospective study over one year in 60 patients with trachomatous trichiasis or entropion presenting to a teaching hospital. The outcome measure was reported barriers to uptake of intervention using a questionnaire. The data were analysed using chi-square and Fisher's exact tests. Patient characteristics were correlated with barriers using univariate and multivariate analysis. RESULTS: The major barriers (operative in > 60% of patients) were illiteracy (66.7%), ignorance regarding treatment (65.0%), and fear of surgery (63.3%). Duration of symptoms in 43 females and 17 males ranged from 0.5 to 240 months (mean 30.2 +/- 45.82). Females reported significantly more barriers (average 5.8 +/- 1.88) than males (average 4.6 +/- 1.97; p = 0.03). Shorter duration was significantly related to perceived expense (p = 0.008). Patients aged =55 years more often cited young children as a barrier (p = 0.02). CONCLUSIONS: Encouraging patients who have undergone intervention to share their experiences with community members, providing intervention in patients' villages, community involvement with patients who live alone and making gender-sensitive medical programmes might be useful in reducing the fear of surgery and enhancing awareness and uptake of intervention. Future studies must identify barriers in their regions so that attempts can be directed to overcoming them so as to reduce the blinding and non-blinding burden of trachoma.

Pseudoseizures in children: a profile of 50 cases.

In contrast to adulthood hysterical disorders, childhood hysteria has not been accorded due recognition. Pseudoseizures are paroxysmal alterations in behavior that resemble epileptic seizures but are without any underlying organic cause. There is paucity of literature on pseudoseizures in children. In the present descriptive study of 2 years' duration, a series of consecutively seen 50 children with pseudoseizures is reported. After detailed history from parents, various socio-demographic and clinical variables were noted. Of 110 children seen with conversion disorder, 50 had pseudoseizures (45.5%). The average age was 8.2 years in boys and 9.4 years in girls. There were 28 girls (56.0%) and 22 boys (44.0%), and the majority of patients had the pseudoseizures for 1 to 3 months. When the mode of referral was studied, 52% were referred from pediatric outpatient department and the majority were referred to rule out comorbid psychiatric disorder. The fits mimicking generalized tonic-clonic seizures were most common and the duration of fits ranged from 10 to 35 minutes. The most common frequency of fits was 5 to 6 per week. The average duration of symptoms was 2.6 months in boys and 3.2 months in girls. Only 14 patients (28%) gave the history of having seen the fits in a relative or schoolmate. School phobia and the fear of examinations were the most common precipitating factors. Separation anxiety disorder, school phobia, and mood disorders were common comorbid diagnoses. The patients were put on appropriate drug treatment and/or psychotherapy for 3 months. Of 50 cases, 36 (72.0%) remitted, 10 (20.0%) showed a decrease in frequency of pseudoseizures, and 4 (8.0%) did not improve. With correct diagnosis and treatment, the children with pseudoseizures have a good outcome.

Homosexual Obsessive Compulsive Disorder (HOCD): A Rare Case Report.

Homosexual Obsessive Compulsive Disorder (HOCD) is marked by excessive fear of becoming or being homosexual. The subjects often experience intrusive, unwanted mental images of homosexual behaviour. The excessive uncontrolled thoughts/doubts are very distressing and lead to compulsions in form of checking. We present a rare such case who was suffering from HOCD.

Quality of life as an outcome measure in the treatment of alcohol dependence.

BACKGROUND: Quality of life has emerged as an important treatment outcome measure for alcohol dependence whose natural course comprises of remission and relapse. MATERIALS AND METHODS: The purpose of this study was to examine the prospective change in Quality of life (QoL) in 56 patients aged 18-45 years of alcohol dependence over a three months' period and compare it with QoL of 150 age- and gender- matched healthy controls using WHOQoL-BREF. Severity of alcohol dependence and drinking parameters were assessed. RESULTS: Significant improvement in QoL of patients of alcohol dependence over three months' abstinence. The physical, psychological, social, and environment domains of QoL in alcohol dependence subjects were significantly lower before treatment initiation than the healthy controls. Alcoholic liver disease emerged as a predictor of improvement in psychological and social domains of QoL. CONCLUSION: The study confirms poor quality of life in patients of alcohol dependence before intervention. The regular follow-up with the family members in out-patient setting enables the patients achieve complete abstinence, thereby improving their quality of life.

Psychiatric morbidity in school children who suffered a stampede.

BACKGROUND: Stampede is described as a sudden movement of a mass of people in response to a particular circumstance or stimulus. Human stampedes are quite often reported from crowded places like places of worship, sporting events, political rallies, etc. There are reports of development of posttraumatic stress disorder, depressive and anxiety symptoms in children and adolescents subsequent to both natural and man-made disasters. The present tragedy struck in a Government Secondary School in Delhi on September 9, 2009. The study describes the long-term psychiatric morbidity in children following stampede. MATERIALS AND METHODS: The study was conducted by the department of psychiatry of a tertiary care hospital. A total of 38 children (all adolescent girls) were registered at the casualty of the hospital and 1 absconded, 5 were brought dead. A total of 32 children were included in the study. After first assessment in the casualty, subsequent assessments at 8 weeks and 6 months were done using semi-structured performa, GHQ and Child's reaction to traumatic event scale (CRTES-Revised). Data was analyzed using SPSS version 17. RESULTS: The age-group of the children were 12-20 years(mean 14.3), all girls, studying in grades - VII to X Eight weeks follow up GHQ score was high in 27 (87%). On CRTESQ-R scale, 22 children were in high distress group (71%). Twenty-two children had symptoms of PTSD and five were in moderate distress group. Eleven children also had a comorbid diagnosis of depressive disorder, six had phobic disorder and generalized anxiety disorder. There were statistically significant differences in mean GHQ scores at baseline and at 6 months follow up. There was also significant decrease in CRTESQ-R scale scores between baseline and 6 months. CONCLUSION: The children who were victims of stampede warrant the need for long-term intervention.

Delusional parasitosis of face in a factory worker.

Delusional parasitosis is a form of monohypochondriacal psychosis, a condition sometimes encountered in psychiatric or dermatological clinical practice. The exact etiology and outcome of this condition is not well known. A patient with delusional parasitosis of face who responded to aripiprazole is described.