Morvan's syndrome Presenting with Psychiatric Manifestations - A Case Report and Review of the Literature.

The term "la chorιe fibrillare" was used by the French physician Augustine Marie Morvan to describe a syndrome showing hyperactivity features involving the central, autonomic, and peripheral nervous system. The central hyperactivity symptoms are confusion, behavioral problems, hallucinations, myoclonus, and insomnia; the autonomic hyperactivity symptoms are hyperhidrosis and variations in blood pressure; and peripheral hyperexcitability is characterized by painful cramps, myokymia, and neuromyotonia. Here, we present a case that has typical features of Morvan's syndrome and provides a brief description based on available literature.

Olanzapine has better efficacy compared to risperidone for treatment of negative symptoms in schizophrenia.

OBJECTIVE: The safety and efficacy profile of risperidone and olanzapine were compared in a double-blind trial that used doses widely accepted in clinical practice. METHODS: Subjects (n = 71) who met Diagnostic and Statistical Manual of Mental Disorders-IV criteria for schizophrenia were randomly assigned to receive 2-8 mg/day of risperidone (mean modal dose = 5.5 mg/day) or 5-20 mg/day of olanzapine (mean modal dose = 14.4 mg/day) for 1 year. RESULTS: The two study groups were similar at baseline in all aspects. Seventy-four percent of the participants completed the trial, with no between-differences in the proportion of dropouts. Olanzapine group showed significantly greater improvement in negative symptoms in assessments at 3rd, 6th, 9th, and 12th months (P = 0.05, 0.00, 0.00, and 0.00, respectively). Clinical global impression of severity (CGI-S) scores were consistently lower in the olanzapine group at 3rd, 6th, and 9th months (P = 0.01, 0.03, and 0.05, respectively) as measured by positive and negative symptom scale (PANSS). Total scores on PANSS, positive symptoms, general psychopathology, and CGI improvement showed comparable improvement at 3rd, 6th, 9th, and 12th months of follow-up (all subjects, including dropouts). Severity of extrapyramidal symptoms was low in both groups, with no between-group differences. Mean change in body weight, fasting blood sugar, and fasting cholesterol was comparable in both groups. Risperidone group had significant hyperprolactinemia after one year (P = 0.03). CONCLUSIONS: Both treatments were well-tolerated and efficacious. Greater reductions in severity of the illness and negative symptoms were seen with olanzapine consistently through 1 year. The frequency and severity of extrapyramidal symptoms were negligible and similar in the two treatment groups. Weight gain, hyperlipidemia, and hyperglycemia were comparable in both groups. Risperidone produced significant hyperprolactinemia.

Risk factors for suicide in elderly in comparison to younger age groups.

BACKGROUND: The elderly population has a significant risk of suicide when compared to any other age group. Despite this, suicide among the aged receives scant attention. Hence, identification of suicide risk factors specific to this population will help in the development of suitable prevention strategies for this group. AIMS: Comparison of risk factors for attempting the suicide in the elderly versus younger suicide attempters. MATERIALS AND METHODS: A total 1159 suicide attempters attended the suicide prevention clinic of IQRAA International Hospital and Research Centre. They were evaluated using a specially designed psycho-sociodemographic proforma. The group was divided into those above 65 years (elderly) and those below 65 years (younger) and all the risk factors were compared between these two groups. RESULTS: Most suicide attempters in the elderly category were found to be married, less educated, unemployed and hailed from a rural background and joint families. They had a higher rate of family history of psychiatric illness, past psychiatric illness, concurrent medical illness and history of medical contact in the three months prior to the attempt. A significant number in the elderly group had attempted suicide more than a week after a stressor. CONCLUSION: The results from this study suggests that in suicide attempters from Indian geriatric population, co-morbid physical illness, mental illness (particularly depression) and family burden of psychiatric illness are important predictors in comparison to younger populations. Also, these attempters had contact with a medical professional in the three months prior to the attempt. Specific preventive interventions need to be tailored for this population to reduce the risk of suicide rather than adopting generalized suicide prevention strategies.

Impact of vocational rehabilitation on social functioning, cognitive functioning, and psychopathology in patients with chronic schizophrenia.

AIM: To assess the impact of vocational rehabilitation on psychopathology, social functioning and cognitive functioning in schizophrenia MATERIALS AND METHODS: 34 patients with DSM IV diagnosis of chronic schizophrenia were compared 40 patients with same diagnosis but not attending vocational rehabilitation using PANSS, SCARF social functioning Index and MMSE. RESULTS AND DISCUSSION: Basic psycho-socio-demographic data were comparable in both groups except more hospitalization in the no rehabilitation group. Comparison of social functioning, cognitive functioning and psychopathology showed significant improvement in rehabilitated patients. Cognitive functioning had positive correlation with occupational role in the rehabilitated group and negative correlation in the rehabilitated group. Social functioning had negative correlation with positive and negative symptoms, general psychopathology and total PANSS score and cognitive symptoms in patients without rehabilitation. CONCLUSION: The present concludes that there is a definite limitation in the domains of social functioning, cognitive functioning and psychopathology in chronic schizophrenia patients who had no rehabilitation. However vocational rehabilitation significantly improves these limitations, which in turn help these patients to integrate into the society so as to function efficiently in their roles as parents, home makers and social beings.

Melatonin in schizophrenic outpatients with insomnia: a double-blind, placebo-controlled study.

BACKGROUND: Low nighttime levels of melatonin have been demonstrated in patients with insomnia, and melatonin has been shown to have hypnotic properties in some groups of such subjects. Low melatonin levels have also been observed in patients with schizophrenia; however, there is little literature on the efficacy of exogenous melatonin in treating insomnia associated with schizophrenia. METHOD: Stable DSM-IV schizophrenic outpatients (N = 40) with initial insomnia of at least 2 weeks' duration were randomly assigned to augment their current medications with either flexibly dosed melatonin (3-12 mg/night; N = 20) or placebo (N = 20). By use of a questionnaire, double-blind assessments of aspects of sleep functioning were obtained daily across the next 15 days. The study was conducted between March and December 2002. RESULTS: The modal stable dose of melatonin was 3 mg. Relative to placebo, melatonin significantly improved the quality and depth of nighttime sleep, reduced the number of nighttime awakenings, and increased the duration of sleep without producing a morning hangover (p < .05). Subjectively, melatonin also significantly reduced sleep-onset latency, heightened freshness on awakening, improved mood, and improved daytime functioning (p < .05). CONCLUSION: Melatonin may be a useful short-term hypnotic for schizophrenic patients with insomnia. Melatonin could be considered for patients in whom conventional hypnotic drug therapy or higher sedative antipsychotic drug doses may be problematic.

Family intervention therapy in alcohol dependence syndrome: One-year follow-up study.

BACKGROUND: Among the various treatment modalities, family intervention is the most notable current advance in the area of psychosocial treatment of alcoholism. AIM: To assess the impact of family intervention therapy as an adjuvant to pharmacotherapy in alcohol-dependent subjects in a case-control study design. MATERIALS AND METHODS: Thirty patients who satisfied DSM-IV Criteria for alcohol dependence syndrome were given the right package of family intervention therapy. Thirty age-, sex- and 'marital status'-matched patients who satisfied the same diagnostic criteria were given only brief supportive psychotherapy. Both groups were assessed at base line, six months and at one year using Michigan Alcohol Screening Test, Motivation Scale, Rotter's Locus of Control, Family Intervention Pattern Scale and Presumptive Stressful Events Scale. Primary efficacy variable was cumulative abstinence duration, and secondary efficacy variables were relapse rate and time to first drink. RESULTS: Family intervention therapy significantly reduced the severity of alcohol intake, improved the motivation to stop alcohol and changed the locus of control from external to internal in the study group. Control group experienced more severe stressful life events than the study group during the follow-up periods. Drop-out rate was comparable in both groups. CONCLUSION: Combining pharmacological treatment with appropriate psychosocial therapies focusing on the specific problem of the patient provides better outcome than either of these therapies given alone.

Stevens-Johnson syndrome-toxic epidermal necrolysis (SJS-TEN) overlap associated with carbamazepine use.

A benign pruritic rash occurs in 10%-15% of persons treated with carbamazepine. A small fraction of them may experience life-threatening dermatological syndromes such as exfoliative dermatitis, erythema multiforme, Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). The case of an 18-year-old female suffering from bipolar affective disorder (mania) who was being treated with carbamazepine, lithium, chlorpromazine and benzhexol is presented. After 10 days of treatment, she developed high-grade fever and mucocutaneous manifestations of SJS-TEN overlap. She was treated in hospital with systemic corticosteroids, antibiotics, intravenous fluids and other supportive measures, and recovered after 3 weeks.

Folie à deux.

Folie à deux is defined as an identical or similar mental disorder affecting two or more individuals, usually the members of a close family. Two case reports of this condition are presented with a brief review of the literature. Prompt recognition of this condition is an essential step in the management. The majority of patients with folie à deux require multiple treatments including separation, antipsychotics, individual and group psychotherapy, and family therapy.

Psychosocial dysfunction and family burden in schizophrenia and obsessive compulsive disorder.

This study aimed to assess and compare the extent and pattern of psychosocial dysfunction and family burden in schizophrenia and obsessive-compulsive disorder, and to identify interrelationships between the two variables in these two disorders. First-degree relatives/spouses of 35 schizophrenic and 30 OCD patients were interviewed using the Dysfunction Analysis Questionnaire (DAQ) and the Family Burden Interview Schedule (FBIS). Global score and scores in vocational, personal, familial and cognitive areas on the DAQ, and global score, subjective score, and scores on items such as financial burden, disruption of family-routine, disruption of family leisure and disruption of family interactions on the FBIS were significantly higher in the schizophrenic group. Dysfunction in social area was comparable in two groups. OCD group showed a significant positive correlation between dysfunction and all areas of family burden except physical and mental health. Schizophrenic group showed a significant positive correlation between dysfunction and disruption of family interaction. The implications of these findings are discussed.

An analysis of suicide attempters versus completers in kerala.

This study attempted to differentiate suicide attempters from completers based on their psycho-socio-demographic profile. Suicide attempters admitted to Govt. Medical College, Kozhikode during the period of 1st January to 31st December 2001 were evaluated using a specially designed proforma and for the same period, data of completers were collected using retrospective chart review. The parametric and non-parametric variables between these two groups were compared using appropriate statistics. Both attempters and completers in male gender were in the age of forties and females were in thirties. There was over representation of young females, married and housewives among the victims. In male and female victims, hanging was the commonest method followed by poisoning in males and self-immolation in females. Poisoning was the commonest mode in male attempters and drug over dose in females. Many of the differences in the psycho-socio-demographic profile of suicide attempters and completers reported from western countries could not be replicated in the present study. However comparison of our findings with studies from India and other developing countries shows many similarities.

Fluoxetine induced extrapyramidal symptoms : case reports.

This case report describes the induction of extrapyramidal symptoms with fluoxetine, which is reported to be a rare phenomenon. A dopamine blockade at the nigrostriatal level primarily mediated by serotonin has been proposed as the probable mechanism.