A study of dementia in old age homes.

BACKGROUND: By 2040, dementia is projected to rise exponentially by 300% in India. Studies addressing the need for psychiatric care in the community being few and those focusing in old age homes even fewer, a study was undertaken to study the prevalence of dementia and the association with sociodemographic factors and psychiatric morbidity. MATERIALS AND METHODS: A total of 558 elderly aged 60 years and above, residing in old age homes in Pune were studied. 179 inmates were included based on the inclusion and exclusion criteria. Those who scored a predetermined cut-off score on the screening tool were included to undergo a detailed physical and neurological examination, cognitive profile using subtests from the cognitive test (community screening instrument for Dementia of 10/66 group). RESULTS: Mean age of the sample was 75.02 years majority (39.7%) was in the 60-70 years group. Males 25.7% versus females 74.3%. The sample consisted of the following socioeconomic groups: 40.2% middle, 26.3% low middle, 24% high middle, 8.4% high income, and 1.1% in low income. 60.3% widow/widower category, 36.3% never married, 4.5% had family history of dementia. Mean scores of mini mental state examination in the overall sample was 26.02 compared to 18.02 in those cut-off point of 23. The prevalence of dementia in the sample was 22.9%. There was the high prevalence of psychiatric symptoms and psychiatric morbidity in the dementia group than the rest. Frontal lobe dysfunction and impairment of orientation with increasing severity of dementia were observed. CONCLUSIONS: Sociodemographic factors, which were considered protective against the prevalence of dementia, identified were less restriction in physical activity and having fish in the diet regularly.

Diverse psychiatric presentation associated with child sexual abuse: Case series.

Child sexual abuse (CSA) occurs when a person involves the child in sexual activities for his/her sexual gratification, commercial gain, or both. We report a series of 12 cases of CSA, who presented to the psychiatry department with diverse psychiatric presentations associated with CSA. In most of these cases, the perpetrator was unmarried and known to the child. The presentation was varied with patients being diagnosed with obsessive-compulsive disorder, schizophrenia, acute and transient psychotic disorder, dysthymic disorder, recurrent depressive disorder, acute stress reaction, conversion disorder, borderline personality disorder, and moderate depressive episode with somatic symptoms. Individual and family counseling was an important part of management of these cases along with pharmacotherapy. More vigilance about CSA and mental health in all categories of health-care personnel would help in early detection and timely management of these cases.

Blasphemous thoughts in obsessive-compulsive disorder: A case series.

Obsessive-compulsive disorders (OCDs) are one of the top 10 contributors of debilitating medical illnesses and are the fourth most common psychiatric disorder. Blasphemous thoughts, also known as scrupulosity, as an obsessional theme has piqued curiosities long before it was considered a neurosis. Such obsessions may or may not have an accompanying compulsion and comprise 5% of the patients of OCD. The case series is of three patients suffering from repetitive, intrusive, ego-dystonic, and distressing blasphemous thoughts, which are extremely distressing to them, rendering them unable to perform any other activity. The symptoms also indicate the presence of comorbid depressive and anxiety disorders, developing secondary to the blasphemous thoughts. Inadequate knowledge in this subtype of OCD mandates the need for more studying and research, especially with new texts suggesting the implementation of faith-assisted psychotherapy in addition to the conventional psychotherapy and pharmacotherapy.

Dangers of mRNA vaccines.

"Necessity is the mother of invention:" An adage was brought to life with the emergence of the mRNA vaccine against the backdrop of the foreboding and mercurial COVID-19 pandemic. Considering a negligible adverse-effect profile and a break-neck manufacturing speed, it shone bright as the ideal vaccine candidate. However, "all that glitters is not gold," as was evidenced by the significant reactogenicity, a host of multi-systemic side-effects, that are being reported by the vaccine recipients; which is palpably resulting in a shift of emotions for the vaccine, accounting for vaccine hesitancy. Anaphylaxis, antibody-dependent enhancements, and deaths, comprise the most serious side-effects, albeit occurring in sparing numbers. Storage and transportation require fastidious temperatures, rendering it substantially inaccessible to a country like India. The biggest jolt, however, was the unfolding of the biases in reporting vaccine efficacy, as only the attractively high numbers of the relatively equivocal relative risk reduction were reported while keeping at bay the meager numbers of the more forthright absolute risk reduction. Notwithstanding the fallacies, the mRNA vaccine still promises hope; and with the right precautions and finesse, can be potentiated, as "a watched pot never boils."

Memory: Neurobiological mechanisms and assessment.

Memory is the process of retaining of knowledge over a period for the function of affecting future actions. It can be divided into declarative and procedural types. The process of memory consolidation is done in the hippocampus. The long-term memories are spread among various areas of the cerebrum depending on the different perceptual properties. The process of long-term potentiation and molecular changes occurring during memory formation are discussed in detail below. The steps involved in memory formation include encoding, storage, and recall (retrieval) in that order. Amnesia is a phenomenon in which there is the problem in memory formation which can be due to trauma to the brain, certain diseases, or stressors. While the assessment of memory has greatly improved, we are only beginning to understand the underlying mechanisms.

A community-based study of prevalence and functional status of major depressive disorder in an industrial area.

BACKGROUND: Depression is a significant public health issue that needs to be taken care of, as it poses a great economic burden on the society at large. Early identification and treatment of the patients will reduce mental morbidity and disability. AIM: The aim is to study the prevalence and functional status of subjects with major depressive disorder in the community. MATERIALS AND METHODS: After identification of the sample population, the sociodemographic details were recorded. Subsequently, assessment was carried out by General Health Questionnaire (GHQ), Patient Health Questionnaire-9 (PHQ-9), Functional Status Questionnaire (FSQ), and Mini Mental State examination (MMSE). RESULTS: A total of 2000 subjects were screened using the GHQ and PHQ and 544 subjects were selected. These 544 subjects were further assessed with FSQ and MMSE. Out of the 544 subjects, 65.1% had a GHQ score of <14, 22.1% had a score between 15 and 19, and 12.9% had a score of >20. The PHQ-9 score was found to be <5 in 28.9% subjects, 5-14 in 64.3% subjects, and >14 in 6.8% subjects. Majority of the sample population was in the warning zone according to the FSQ. The MMSE scores were ≥23 in 86% and ≤22 in 14% of the patients. Over 65% of the subjects were relatively mentally healthy. Out of the remaining 35%, 22% of the subjects required screening for psychiatric disorders and 13% of them did require active psychiatric intervention. CONCLUSIONS: It would be beneficial to the community if a database is created regarding the psychiatric disorders such as depression prevalent in the community and their functional status so that the effective measures can be implemented to minimize the suffering by providing effective psychiatric care at the earliest and follow them up in the long run.

Quality of life and marital adjustment in spouses of schizophrenia patients.

BACKGROUND: With the availability of potent antipsychotics, the prognosis of schizophrenia has improved. As a result, there is increasing interest in assessing the quality of life (QOL) and marital adjustment of patients with schizophrenia. However, there is a paucity of Indian data in this area. AIM: To evaluate and compare the QOL and marital adjustment in spouses of patients with schizophrenia and controls. MATERIALS AND METHODS: This cross-sectional, hospital-based study comprised of consenting female individuals of the age group of 20-40 years. The study group included 30 spouses of male patients with schizophrenia (according to ICD 10-DCR) and control group included 30 age-matched spouses of male participants without psychiatric disorders. The participants were selected from the psychiatry ward and outpatient department and neighboring areas of the Dr. D. Y. Patil Medical College, Pune, India. Only couples married for at least 5 years were included in the study. Wives with a history of any major psychiatric or major medical disorders were excluded. All the participants were evaluated with a sociodemographic data sheet, the World Health Organization QOL (WHOQOL)-BREF, and the Marital Adjustment Questionnaire. The statistical analysis was done using descriptive frequency, Chi-square, and Mann-Whitney U-test. RESULTS: Wives of patients with schizophrenia had significantly lower scores on psychological, social, and environmental domains of WHOQOL BREF and on sexual adjustment, social adjustment, emotional adjustment, and total score on the marital adjustment questionnaire as compared to the control group. CONCLUSION: Wives of patients with schizophrenia have lower QOL and marital adjustment compared to controls.

Self-injurious behavior in epilepsy.

Self-injurious behavior (SIB) can be described as an act involving self-inflicted destruction of tissue, right away or over a period of time. Patients with epilepsy have to deal with an often chronic and unpredictable disorder leading to adversity in many psychosocial variables such as employment, stigma, and overall quality of life. The above factors contribute toward SIB in these patients. Behavioral problems occurring in people with epilepsy can range from aggressiveness, mood fluctuations to SIB. We report a 23-year-old male, married, educated up to 10th standard, referred from neurology department for psychiatric evaluation. The patient had gone to neurologist with the chief complaints of generalized tonic-clonic convulsions and was hospitalized for breakthrough seizure. There was a history of indulging in episodes of self-SIB since the past 8 months. He responded satisfactorily to adjustment of antiepileptic medication along with fluoxetine and low-dose risperidone. Early identification of such behavior in epilepsy patients should be done so that a holistic management is undertaken leading to better functioning and improved quality of life.

Assessment of quality of life before and after successful percutaneous transvenous mitral commissurotomy in patients with severe mitral stenosis.

BACKGROUND: Rheumatic mitral stenosis (MS) is a significant cause of morbidity and mortality in India. Percutaneous transvenous mitral commissurotomy (PTMC) has become the procedure of choice for severe MS with pliable leaflets. Despite a wealth of literature on the technical aspects of PTMC, there is a dearth of literature addressing the impact of PTMC on the quality of life (QOL). AIM: The aim of the study is to assess the impact of PTMC on clinical status and QOL of patients with severe MS. MATERIALS AND METHODS: Twenty-five consecutive patients with severe MS undergoing PTMC were included in the study with their informed consent. All patients were subjected to routine blood tests, electrocardiogram, chest X-ray, two-dimensional and color echocardiography, treadmill test (TMT), and World Health Organization (WHO) QOL scale. The echocardiography, TMT, and WHOQOL scale were repeated after the procedure. RESULTS: The procedural success was 98%. The mean (range) mitral valve area preprocedure was 0.82 (0.59-0.92) cm2 and postprocedure was 1.61 (1.51-1.76) cm2. The difference was statistically significant (t = 5.02; P < 0.01). The mean (range) of TMT preprocedure was 4.05 (3.0-7.0) METS and postprocedure was 8.52 (6-12) METS. The difference was statistically significant (T = 3.08; P < 0.01). The mean (range) of QOL assessment pre- and post-procedure on physical domain was 8.83 (8.3-10.1) which increased to 11.11 (10-12.7); on social relationship domain from 9.17 (7.5-12.4) to 11.37 (9.4-12.0); on personal relationship from 11.6 (11-13) to 12.52 (12-13); on environment domain from 10.78 (10.2-11.7) to 11.56 (10.8-12); and on level of independence from 9.02 (8-10) to 12.29 (11.0-13.6). All the differences were statistically significant (Wilcoxon signed-rank test z = -4.376; -4.379; -4.234; -4.200; -4.375; respectively, all P < 0.001 highly significant). CONCLUSIONS: PTMC resulted in a significant improvement in the QOL of patients with severe MS. The significant improvement in QOL post-PTMC may be an indication for offering PTMC at an earlier stage to those patients whose QOL is severely compromised.