Posttraumatic stress disorder among patients with oral and maxillofacial trauma in a South Indian population.

AIM: To determine the incidence and severity of Post-Traumatic Stress Disorder (PTSD) in maxillofacial trauma patients and to assess the predisposing factors. METHODS AND RESULTS: Post-Traumatic Stress Disorder (PTSD) was assessed as per the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. The PTSD checklist for DSM-5 (PCL-5), was used initially to screen patients for PTSD for a provisional diagnosis. These provisionally diagnosed patients were then subjected to a structured interview by a Clinician Administered PTSD Scale for DSM-5 (CAPS-5). The PTSD status outcome of PCL-5 and CAPS-5 were correlated. PTSD was compared among patients with different types of facial fractures/injuries and also compared based on their anatomic location. The reliability of PCL-5 scale in relation to the structured CAPS-5 was assessed and the specificity was found to be 71.4%. Patients with both aesthetic and functional deformity exhibited greater severity of injury and showed higher incidence of PTSD with higher conversion rate from the 1st month to 3rd month. The frequency of PTSD in deformities with higher severity like zygomaticomaxillary complex injuries was found to be statistically significant. CONCLUSION: A high incidence of PTSD is associated with maxillofacial trauma and early detection is essential.

Nocebo effect in Dermatology.

Nocebo effect, originally denoting the negative counterpart of the placebo phenomenon, is now better defined as the occurrence of adverse effects to a therapeutic intervention because the patient expects them to develop. More commonly encountered in patients with a past negative experience, this effect stems from highly active processes in the central nervous system, mediated by specific neurotransmitters and modulated by psychological mechanisms such as expectation and conditioning. The magnitude of nocebo effect in clinical medicine is being increasingly appreciated and its relevance encompasses clinical trials as well as clinical practice. Although there is hardly any reference to the term nocebo in dermatology articles, the phenomenon is encountered routinely by dermatologists. Dermatology patients are more susceptible to nocebo responses owing to the psychological concern from visibility of skin lesions and the chronicity, unpredictable course, lack of 'permanent cure' and frequent relapses of skin disorders. While finasteride remains the prototypical drug that displays a prominent nocebo effect in dermatologic therapeutics, other drugs such as isotretinoin are also likely inducers. This peculiar phenomenon has recently been appreciated in the modulation of itch perception and in controlled drug provocation tests in patients with a history of adverse drug reactions. Considering the conflict between patients' right to information about treatment related adverse effects and the likelihood of nocebo effect stemming from information disclosure, the prospect of ethically minimizing nocebo effect remains daunting. In this article, we review the concept of nocebo effect, its postulated mechanism, relevance in clinical dermatology and techniques to prevent it from becoming a barrier to effective patient management.

Fixed-dose combinations for cough and common cold in India: an assessment of availability and rationality.

This study was conducted to determine the number and composition of the various cough and cold formulations available in the Indian market and to study their pharmacological rationale over a period of 7years. Data for the study was collected from an annual Drug Compendium entitled 'THE DRUG TODAY' of the years 2001, 2004, and 2007. Medications were assessed for total number, different formulations, and number of constituents present in each formulation, their pharmacological group and amount of each constituent per dose. Rationality of available preparations was assessed on a seven-point scoring criteria. There are over thirteen hundred drug products for cough and cold in the Indian market, which is an increase of 71.2% from the year 2001. More than 90% of the preparations were fixed-dose combinations (FDCs). Majority of the cough and cold preparations had 3-4 constituents. Many preparations contained more than one constituent of the same pharmacological group. Some preparations had constituents with opposing action. A wide variation in the amount of each constituent present per dose in different formulations was observed. The number of banned drug combinations for cough and cold showed an increase from 9 in 2001 to 27 in 2007. Rationality assessment of the FDC preparations revealed that most of the preparations were irrational and had no documented benefit in the treatment of common cold. Availability of such a large number of irrational FDCs for cough and cold requires serious review of the legal provisions in India for drug manufacturing and marketing.