A study of phenomenology, psychiatric co-morbidities, social and adaptive functioning in children and adolescents with OCD.

OBJECTIVE: To study the phenomenology, social, adaptive and global functioning of children and adolescents with OCD. BACKGROUND: Studies have shown varying prevalence of paediatric OCD ranging from 1% to 4%. Childhood-onset OCD have some important differences in sex distribution, presentation, co-morbidities and insight. MATERIALS AND METHODS: 25 subjects (6 to ≤18 years) with a DSM-IV-TR diagnosis of OCD were included in this study. Subjects were evaluated using K-SADS-PL, Children's Y-BOCS, HoNOSCA, C-GAS and VABS-II. RESULTS: The mean age of the sample was 14.9±2.2 years. Obsession of contamination was commonest (68%) followed by aggressive obsession (60%); commonest compulsions were washing and cleaning (72%) followed by checking (56%). Most distressing obsessions were obsession of doubt about their decision (28%), having horrible thoughts about their family being hurt (20%) and thought that something terrible is going to happen and it will be their fault (16%). Most subjects rate spending far too much time in washing hands (60%) as most distressing compulsion, followed by rewriting and checking compulsions (both 12%). 76% subjects have co-morbid psychiatric diagnosis. Anxiety disorders (24%), depression (16%), and dissociative disorder (16%) were common co-morbidities. Mean C-GAS score of the sample was 53.2±9.9. 44% of subjects had below average adaptive functioning. CONCLUSIONS: The study shows that, most frequent obsessions and compulsions may be different from most distressing ones and this finding might have clinical implication. Most of the children and adolescent with OCD have co-morbidities. Children also had problems in adaptive functioning.

A clinical study of anxiety disorders in children and adolescents from North Indian children and adolescents clinic.

BACKGROUND AND OBJECTIVES: Anxiety disorders are the most common group of psychiatric disorders in children and adolescents. But few studies on specific anxiety disorders in children and adolescents are available in India. Therefore, this study was planned to identify anxiety disorders in children and adolescents in an Indian psychiatry outpatient setting and elicit its phenomenology and co-morbidities. METHODS: 1465 persons were screened using screen for child anxiety related emotional disorders (SCARED) scale. The screen positive patients were assessed and diagnosis of anxiety disorders was established according to DSM-IV-TR. Detailed assessment of the phenomenology of anxiety disorders was done by K-SADS-PL. RESULTS: 42 (2.86%) patients had different anxiety disorders. Out of which 16 (38.1%) patients had obsessive compulsive disorder, 10 (23.81%) patients with specific phobias, 6 (14.29%) patients with generalized anxiety disorder, 4 (9.52%) patients with social anxiety disorder and 3 (7.14%) patients each with separation anxiety disorder and panic disorder. Co-morbidities were found in 54% of patients with anxiety disorders. Dissociative disorder, specific phobias and social anxiety disorder were the common co-morbidities. INTERPRETATION AND CONCLUSION: Anxiety disorders are less commonly found in clinic settings (2.86%). No case of posttraumatic stress disorder or acute stress reaction was found in this study.

Pediatric anxiety disorders.

Anxiety disorders are the most common group of psychiatric disorders in children and adolescents. Anxiety disorders in children and adolescents can be chronic and disabling, and they can increase the risk of comorbid disorders. Anxiety is associated with substantial negative effects on children's social, emotional and academic success. Identifying and treating children and adolescents with anxiety disorders would reduce the burden of this disorder and may help in better management of the co-morbid conditions in these patients.

Indian mental concepts on children and adolescents.

Ancient Indian mental concepts of children and adolescents are very similar to the contemporary modern concepts. The ancient concepts were based on a very positive regard for the children's development, education and future independence, adult role and contribution to society. Children were wanted and considered precious. The children were categorized in to 4 different varnas based on their intelligence, abilities, merit and aptitude and educated accordingly, away from their home, at Gurukuls. They had universal right to education. Girls received attention equal to boys. The boys were expected to earn their livelihood, while the girls were expected to be homemakers. Graduation of the young person at the end of education and return to home marked the emancipation from adolescence. Children's physical and mental health and its disorders were given due attention. Aetiology and treatment of physical and mental disorders was in accordance with the overall scientific development of those times.

Comorbidity of attention-deficit/hyperactivity disorder and bipolar disorder in North Indian clinic children and adolescents.

OBJECTIVE: This study examined comorbidity between attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder (BPD) in children attending child and adolescent psychiatry (CAP) services in a Medical University in North India. METHODS: Children attending CAP services, old or new, were assessed using unstructured clinical interview, kiddie-Schedule for Affective Disorders and Schizophrenia for School-age Children-Present and Lifetime Version (K-SADS-PL), Mental State Examination (MSE) for ADHD, Child Mania Rating Scale (CMRS) Parent Version and Children's Global Assessment Scale (C-GAS). Information was collected from both children and parents. All children were clinically evaluated, and prospectively followed up. The diagnosis was made by consensus. Subjects with DSM-IV-TR diagnosis of ADHD, BPD, and ADHD+BPD were compared with each other. Research criteria for broad phenotype BPD were applied in ADHD subjects without DSM-IV-TR diagnosis of BPD. RESULTS: 45 subjects had ADHD; 21, BPD and; 7 had lifetime DSM-IV-TR diagnosis of ADHD+BPD. 13.5% of ADHD subjects had comorbid BPD and 25% of BPD subjects had comorbid ADHD. ADHD-CT was the most common subtype of ADHD. Nearly two third of BPD subjects had their first mood episode before 13 years of age. ADHD+BPD subjects were more likely to be mentally retarded and have longer duration of mood episode compared to BPD subjects. Three subjects with DSM-IV-TR diagnosis of ADHD without BPD were additionally diagnosed with broad phenotype of BPD. CONCLUSIONS: Variable comorbidity rates of ADHD+BPD in different studies are most likely due to differences in study setting, study sample, conceptualization of BPD and assessment methods.

A preliminary study of factors affecting adherence to medication in clinic children with attention-deficit/hyperactivity disorder.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a common and chronic condition requiring long-term management. However, nonadherence to treatment and its reasons have not been studied in Indian children with ADHD. OBJECTIVE: To identify the factors affecting adherence to medication in clinic children and adolescents with ADHD. METHODS AND MATERIALS: Twenty-four children and adolescents newly diagnosed with ADHD on Kiddie schedule for affective disorders and schizophrenia - present and lifetime - were prescribed medication on an outpatient basis and followed-up to check their adherence to medication. Information regarding adherence was obtained from the parents on a proforma to assess the factors affecting the adherence to medication. RESULTS: Twenty (83.3%) subjects were nonadherent within the first month. The most common reasons as given by the parents for nonadherence to treatment were side-effects of medication in 13 (65%), lack of effectiveness of medication in 10 (50%), problems in hospital, like long waiting time and procedural delay, in 10 (50%), fear that the child will become addicted to medication in nine (45%), problems in accessing medication in eight (40%), careless attitude of caregivers in eight (40%) and high cost of medication in eight (40%). CONCLUSIONS: The rate of adherence to medication in this short-term follow-up of newly diagnosed children with ADHD was very low. Other than the commonly reported reasons in Western countries, there were some sociocultural and local reasons for nonadherence to treatment in our country. Efforts are needed to improve adherence to medication in children with ADHD.

Adult attention deficit/hyperactivity disorder: one year follow up.

BACKGROUND & OBJECTIVES: This study aimed to find out phenomenology, stability of diagnosis, comorbidities, impairments and treatment status of the adults with ADHD one year follow up as there are no such data. METHODS: 20 subjects (all males, mean age 25.1+/-6.2 yr) with adult ADHD (DSM-IV-TR) were followed up at mean 1.3+/-0.2 yr after their diagnosis. Phenomenological assessments were done using ASRS v1.1, WMH-CIDI, ADHD-RS and clinical assessment where required. Diagnoses of ADHD and comorbidities were made using DSM-IV-TR. Global functioning was also assessed using GAF. RESULTS: 19 (95%) of the 20 subjects could be followed up. All (100%) of them could again be diagnosed having ADHD according to DSM-IV-TR criteria. However, the symptoms declined in severity over a period of one year. Diagnosis of 2 (10.5%) subjects of ADHD-CT was changed to ADHD-IA. 1 (5.3%) subject each of ADHD-IA and ADHD-NOS types went into partial remission. Substance abuse was increased at the follow up from 26.3 to 47.4 per cent. Rates of the other comorbidities did not change during the follow up. Only 3 (15.8%) subjects adhered to the prescribed treatment at the follow up. Global functioning of the adherent group improved significantly at the follow up (t = 6.000, P = 0.027). INTERPRETATION & CONCLUSION: Adult ADHD has diagnostic stability at one year follow up. The adult ADHD subjects remained highly comorbid with other psychiatric disorders including increased substance abuse at the follow up. Only 10.5 per cent subjects remained in the regular follow up. The above findings suggest that the patients with adult ADHD should be properly psycho-educated and regularly followed up.

Rapid and spontaneous recovery in autistic disorder.

Recovery in autistic disorder is rare. There are few reports of recovery from autistic disorder after a few years of therapeutic intervention. We report here a case of autistic disorder who recovered spontaneously without any intervention in 13 days.

An exploratory clinical study of adult attention deficit/hyperactivity disorder from India.

BACKGROUND & OBJECTIVE: Although adult attention-deficit/hyperactivity disorder (ADHD) is well recognized in western countries, there are no reports of adult ADHD from India. Therefore, this study was planned to identify ADHD in adults in an Indian psychiatry outpatient setting and elicit its phenomenology and co-morbidities. METHODS: A total of 283 adults were screened using Adult ADHD Self-Report Scale-v1.1 (ASRSV1.1) screener. Screen positives were evaluated on ASRSv1.1 symptom checklist, World Mental Health Survey Initiative Version of the World Health Organization Composite International Diagnostic Interview (WMH-CIDI) and by clinical assessments. DSM-IV-TR and Wender-Utah criteria were used for diagnosis. RESULTS: Twenty five men (mean age +/- SD, 23.4 +/- 5.6 yr) were diagnosed as having adult ADHD. The subjects' most common presentations were of losing temper and poor academic performance. The most common ADHD symptoms were difficulty in sustaining attention, easy distractibility, often losing things, and blurting out answers. A majority (80%) of the subjects had one or more psychiatric co-morbidity like oppositional defiant disorder, major depressive disorder and substance abuse/dependence. INTERPRETATION & CONCLUSION: Adult ADHD can be diagnosed in an Indian psychiatry outpatient setting. ADHD adults infrequently presented with the core symptoms of the disorder and had high psychiatric co-morbidity rates.

A preliminary open trial of olanzapine in paediatric acute and transient psychotic disorders.

BACKGROUND: Acute and transient psychotic disorders (ATPD) have been characterized by the development of florid psychotic symptoms within 2 weeks and complete remission of symptoms. Although there are no definite guidelines, these are usually treated by antipsychotic medication. AIM: This preliminary study examined the effectiveness of olanzapine in paediatric ATPD. METHODS: In this 6-week open trial of olanzapine in paediatric ATPD, the patients were rated weekly on the Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI) Scale and Dosage Record Treatment Emergent Symptom Scale (DOTES). RESULTS: Twenty-three patients (11 males, 12 females; mean age 14.0+/-1.3 years; range 11-16 years) were included in the study. The mean olanzapine dosage was 12.7+/-3.9 mg/day (range 5-20 mg/day). All the patients showed significant improvement in 6 weeks. The results showed a significant decrease (p< 0.0001) in scores of BPRS (mean at baseline 46.2+/-7.0 to 21.4+/-3.9 at week 6). Severity of illness (CGI) decreased from 4.7+/-0.8 to 1.6+/-0.9 in 6 weeks. Also, global improvement (CGI) showed marked improvement in 14 (60.9%), good improvement in 8 (34.8%) and minimal improvement in 1 (4.3%) patient. Some common side-effects were dryness of mouth (n=14, 60.9%), increase in appetite (n=12, 52%), weight gain (n=12, 52%) and drowsiness (n=8, 34.8%). No patient developed extrapyramidal symptoms. CONCLUSION: Olanzapine was safe and effective in paediatric ATPD.

Rett syndrome.

Rett syndrome is a rare, progressive, neurodevelopmental disorder that has been reported only in the girl child. We describe the case of a 6.9-year-old girl with Rett syndrome. She had normal development till the age of 2 years. However, over the next 4-5 months, she lost her acquired, purposeful hand skills; expressive and receptive language; and reciprocal social interaction; and gradually developed a broad-based gait and typical midline stereotyped hand movements (mouthing, rubbing).