Clinical profile of obsessive-compulsive disorder in children.

Introduction: Most studies on obsessive-compulsive disorder (OCD) among children and adolescents pertain to adolescents and Indian data on childhood-onset OCD are scant. Objective: To evaluate the clinical profile of OCD among children and adolescents with onset before the age of 12 years. Methods: Children and adolescents who attended the outpatient clinic with a clinical diagnosis of OCD were included in the study. Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) was used to assess the phenomenology and severity of OCD. The diagnoses of OCD and comorbid disorders were based on DSM5 diagnostic criteria. Children with the onset of symptoms before the age of 12 years were analyzed. Results: Among the 46 children with OCD, 31 (16 boys and 15 girls) had onset before the age of 12 years. The youngest child was 6 years old and in 29% of children, OCD symptoms began before the age of 8 years. Family history of OCD, other mental illnesses, and tics disorder was present in 48.4%, 29%, and 12.9% of children, respectively. Comorbid tics disorder was present in 12 (38.6%) children and 1 (3%) child each had depression and conduct disorder. Common obsessions and compulsions were obsessions of contamination (77.4%) and washing and cleaning compulsions (87.1%). Miscellaneous obsessions and compulsions occurred in 25.8% and 77.4% of children, respectively. Conclusion: OCD is not uncommon in young children. The present study provides preliminary data on childhood-onset OCD among children and adolescents and points to the need for larger community-based studies.

Early Social Experience and Digital-Media Exposure in Children with Autism Spectrum Disorder.

OBJECTIVE: To study the early social experience and digital media exposure in children with autism spectrum disorder (ASD) in comparison with typically developed children. METHODS: Details of digital-media exposure and early social experience in 65 children with ASD were compared with those in a control group of equal number of typically developed children, matched for age and gender. Prenatal and perinatal factors were also studied. The diagnosis of ASD was based on the International Clinical Epidemiology Network (INCLEN) diagnostic tool and Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) diagnostic criteria. Variables which were biologically relevant and has a P value of < 0.05 in the univariate analysis were analyzed by logistic regression to obtain the adjusted effect measures. RESULTS: Children with ASD were exposed to digital media at an earlier age and spent significantly more time with digital media and less time with their mothers, compared to typically developed children. Exposure to digital media before 21 mo was associated with risk of ASD and the risk increased when mothers spent less than 6.5 h per day with the baby. Family history of epilepsy and developmental delay, maternal stress during the antenatal period, and absence of exclusive breastfeeding during the first 6 mo were significantly more in children with ASD. CONCLUSION: There are significant differences in the early life social experience and digital-media exposure in children with ASD compared to typically developed counterparts. Given the reported rise in prevalence of ASD, these findings stress the need for further prospective studies to explore these potentially modifiable risk factors.

Factors Associated With Mortality in Toxic Encephalopathy Due to Shigellosis in Children.

OBJECTIVE: To study the clinical characteristics and factors associated with mortality among children with Shigella encephalopathy. METHODS: The data collection was done prospectively from January, 2018 to May, 2019 with retrospective data from June, 2016 to December, 2017. The study cohort consisted of 58 children <12 years of age with Shigella encephalopathy admitted to the pediatric intensive care unit. Shigella encephalopathy was confirmed if culture or real time polymerase chain reaction (PCR) of a stool sample or rectal swab was positive, with temporal association of diarrhea with seizures, altered sensorium or both. Association of mortality with risk factors was tested using chi square test, and the strength of association was estimated in terms of relative risk (RR) and 95% CI. RESULTS: Seizures and altered sensorium were the predominant neurological symptoms. Shock occurred in 32 (55%) children, while blood in stools was a feature in only 6 (10%) children. S. sonnei was the commonest species identified on stool culture (19;33%). On univariate analysis, prolonged seizures, shock, prolonged altered sensorium, multi-organ dysfunction, lymphocytopenia at admission and need for mechanical ventilation were significantly associated with mortality. On multivariate regression, delayed presentation (presentation to the hospital 48 hours after the onset of symptoms) and prolonged altered sensorium (>12 hours) were found to be independently associated with mortality. CONCLUSION: Recognition of factors associated with mortality in Shigella encephalopathy may assist in better monitoring of sicker children and improved outcomes.

Cognitive Functions and Psychological Problems in Children with Sickle Cell Anemia.

OBJECTIVE: To study the cognitive functions and psychological problems in children with Sickle cell anemia (SCA). METHODS: Children with SCA were compared with an age, sex- and community- matched control group of children with no SCA. Malins Intelligence Scale for Indian children, modified PGI memory scale, and Childhood Psychopathology Measurement Schedule were used to assess cognitive functions and psychological problems. RESULTS: Verbal quotient, performance quotient and intelligence quotient in SCA group were 77, 81, 78, respectively versus 92, 95, 93, respectively in non-SCA group (P <0.001). Borderline intellectual functioning and mild mental retardation were more common in SCA (70< and 16<, respectively). Children with SCA had impaired attention, concentration and working memory and more behavior problems compared to children without SCA. CONCLUSION: Cognitive functions are impaired in children with SCA and they have more psychological problems. Facilities for early identification and remediation of psychological and intellectual problems should be incorporated with health care services for children with sickle cell anemia.

Autonomic dysreflexia in acute disseminated encephalomyelitis.

Autonomic dysreflexia occurs in patients with spinal cord injury, and is characterized by unbalanced sympathetic discharge, precipitated by noxious stimuli from a site below the spinal cord lesion. An 11-year-old boy with acute disseminated encephalomyelitis and spinal cord involvement manifested episodes of intense flushing and sweating, confined to the head and neck region, and associated with hypertension and tachycardia. His signs improved after changing a partly blocked bladder catheter. The clinical features suggested autonomic dysreflexia. Early recognition of autonomic dysreflexia is important because removal of the trigger precipitating the event may be life-saving.