Maternal mental health and its determinants during COVID-19, experience from Kashmir, Northern India.

Background: Since the start of the pandemic due to coronavirus 2019, stresses and anxiety have increased in all age-groups. We aimed to study the common mental disorders in pregnant and lactating females and study their fears and copings during the pandemic. Materials and Methods: Purposive sampling was employed in our study. We included all pregnant and lactating females who consented to participate in the study. A total of 95 females were included in our study. We used a semi-structured questionnaire with questions regarding socio-demographic variables and questions related to apprehensions due to COVID-19, belonging to high-risk group, and structured instruments like Edinburgh Postnatal Depression Scale, Hamilton Anxiety Rating Scale, Yale-Brown Obsessive Compulsive Scale. Results: The mean age of our study population was 30.8 ± 3.67 years. The majority of our patients were married (93) and homemakers (61) and studied up to 12th grade. Among our patients, 33 tested positive for COVID-19 and 12 patients were hospitalized for COVID-19-related symptoms. Thirty-nine females were pregnant and 56 were lactating. Preexisting medical illness was seen in 23, and psychiatric illness was already present in 19 patients. Major depression was seen in 43% of females, mild anxiety symptoms in 69%, severe anxiety in 8%, mild obsessive compulsive disorder in 16%, and moderate in 10% of cases. Conclusion: In our cases, anxiety and depression were seen in increased prevalence as compared to pre-pandemic levels. Being hospitalized for COVID-19 symptoms, social isolation and apprehensions regarding the baby increased the risk of depression.

Neurobrucellosis Presenting as Acute Psychosis.

A 45-year-old female without any past or family history of psychiatric illness presented to the emergency department with complaints of abnormal behavior, irrelevant talking, restlessness, episodic crying, and decreased sleep of 2-day duration. On detailed interview, the attendants gave a history of an intermittent headache of 6-month duration and hearing impairment of 4-month duration. On investigation, her cerebrospinal fluid was reactive, and brucella titers were positive. She received appropriate treatment for 6 months and a short course of antipsychotics. Her symptoms settled, but she had persistent hearing loss. Psychosis as well as hearing loss is a very rare presentation of brucellosis. The case highlights the importance of considering neurobrucellosis as a differential diagnosis in patients with any unexplained neuropsychiatric symptoms such as acute psychosis or hearing loss.

Nonalcoholic Wernicke's Encephalopathy: A Retrospective Study from a Tertiary Care Center in Northern India.

OBJECTIVE: The objective of this study was to describe the demographic features, clinical presentation, and management and outcome of fifty cases of nonalcoholic Wernicke's encephalopathy from a tertiary care hospital of a region with reported incidence of thiamine deficiency disorders. MATERIALS AND METHODS: In a retrospective study, fifty adult cases of Wernicke's encephalopathy were analyzed. The diagnosis of Wernicke's encephalopathy was made according to the European federation of neurological societies guidelines 2010. Response to thiamine replacement and associated brain magnetic resonance imaging (MRI) findings were also considered as supportive evidence. RESULTS: The mean age of patients was 50.38 years with 20 males and 30 females. The most common clinical manifestations were alteration in sensorium in 30 (60%), ataxia in 18 (36%), memory impairment in 15 (30%), nystagmus in 35 (70%), ophthalmoparesis in 11 (22%), and seizures in 4 (8%). A total of 42 patients had a history of recurrent vomiting. All patients had polished rice as their staple diet. Thirty-five patients had associated polyneuropathy and 15 had a gastrointestinal disorder. Twenty patients underwent MRI which showed both typical and atypical lesions. Majority of patients showed partial or complete response to intravenous thiamine. On discharge, the most common residual symptoms were lower limb weakness, ataxia, and memory impairment. CONCLUSION: The study shows high incidence of nonalcoholic Wernicke's encephalopathy in the region with predominant causative factor being a thiamine deficient diet. Recurrent vomiting can be a prominent early symptom of thiamine deficiency and its recognition can help in the early diagnosis of Wernicke's encephalopathy and related thiamine deficiency disorders. Thiamine fortification of food should be done in areas with reported incidence of thiamine deficiency disorders.

Psychiatric Co-morbidity in Patients With Irritable Bowel Syndrome at a Tertiary Care Center in Northern India.

BACKGROUND/AIMS: Irritable bowel syndrome (IBS) is a chronic psycho-physiological disorder. It is considered to be the most common functional gastrointestinal disorder, and about 50-90% of IBS patients have associated psychiatric co-morbidity. We aimed to study psychiatric co-morbidities in patients with IBS visiting a tertiary care center. METHODS: This was a cross-sectional case-control study conducted over a duration of one and a half years from January 2014 to July 2015. Patients were selected from the out-patient department of gastroenterology. About 160 patients with IBS who fulfilled the inclusion criteria and who gave written informed consent were selected as study cases. The healthy attendants of cases were selected as controls. A total of 200 controls were selected. Rome-III criteria were used to diagnose IBS. For diagnosing psychiatric disorders, we used the Mini International Neuropsychiatric Interview Schedule Plus. RESULTS: Mean age of our cases and controls was 39.7 ± 11.4 and 37.7 ± 9.6 years, respectively. Females outnumbered males in our cases as well as their controls by a ratio of 2:1 approximately. Psychiatric disorders were seen in 84.4% of IBS patients as compared to 41.5% in controls. Major psychiatric disorders seen in our patients were generalized anxiety disorders (30.0%) and depression (28.0%). CONCLUSIONS: The majority of patients with IBS who present to a tertiary care center have co-morbid psychiatric disorders. We need to screen these patients for such co-morbidities and develop a holistic approach for better outcome in such cases.

Obsessive Compulsive Disorder Presenting as Neurological Emergency.

Chronic epilepsy is leading to behavioral changes including obsessive-compulsive symptoms has been well-studied and shown to be about 22%, but the converse has not been reported. Here, we present a case discussion of a 45-year-old female, who presented with recurrent seizures with hyponatremia, which latter was ascribed to her undiagnosed obsessive compulsive disorder (OCD). This patient later did well on anti-obsessional treatment without any antiepileptic. This embarks the need for detailed psychiatric evaluation for patients in emergency care settings and gives a rare presentation of OCD.