Cognitive and affective empathy in men with alcohol dependence: Relation with clinical profile, abstinence, and motivation.

BACKGROUND: Empathy plays a role not only in pathophysiology but also in planning management strategies for alcohol dependence; however, few studies have looked into it. No data are available regarding the variation of empathy with abstinence and motivation. Assessment based on cognitive and affective dimensions of empathy is needed. AIM: This study aimed to assess cognitive and affective empathy in men with alcohol dependence and compared it with normal controls. Association of empathy with disease-specific variables, motivation, and abstinence was also done. METHODS: This was a cross-sectional observational study conducted in the outpatient department of a tertiary care center. Sixty men with alcohol dependence and 60 healthy controls were recruited and assessed using the Basic Empathy Scale for cognitive and affective empathy. The University of Rhode Island Change Assessment Scale was used to assess motivation. Other variables were assessed using a semi-structured pro forma. Comparative analysis was done using unpaired t-test and one-way ANOVA. Correlation was done using Pearson's correlation test. RESULTS: Cases with alcohol dependence showed lower levels of cognitive, affective, and total empathy as compared to controls. Affective and total empathy were higher in abstinent men. Empathy varied across various stages of motivation, with a significant difference seen between precontemplation and action stages. Empathy correlated negatively with number of relapses and positively with family history of addiction. CONCLUSIONS: Empathy (both cognitive and affective) is significantly reduced in alcohol dependence. Higher empathy correlates with lesser relapses. Abstinence and progression in motivation cycle is associated with remission in empathic deficits.

Prescription patterns and medication adherence in preadolescent children with attention deficit hyperactivity disorder.

BACKGROUND: Nonadherence in attention deficit hyperactivity disorder (ADHD) can be as high as 80%, yet studies on adherence to medications in preadolescent children are few. Recent Indian trends in prescription patterns are lacking. AIM: The present study assesses prescription patterns and adherence to medications in preadolescent children with ADHD. MATERIALS AND METHODS: Fifty children aged 5-12 years with ADHD, who were on medications for at least 6 months, were enrolled. Their sociodemographic factors and prescription details were noted. Vanderbilt ADHD Diagnostic Parents Rating Scale and Compliance Rating Scale were administered. RESULTS: Sixty-two percent of the children had good compliance, whereas 38% showed reluctance. Adherence was better in children with shorter duration of illness, lesser severity, absence of side effects, and stimulant prescription. Non-stimulant-based combination (40%) was more common compared to stimulants (28%), with atomoxetine and risperidone being the most commonly prescribed medications. CONCLUSIONS: Adherence to medications in preadolescent children with ADHD is good. Associated factors and implications are discussed.

Gender Variability of Perceived Stress and Negative Inferential Feedback in Depression.

BACKGROUND: The role of negative inferential feedback and perceived stress in hopelessness depression is known. However, studies on their gender variability are lacking. The difference in various domains of negative inferential feedback and its impact on cognitive hopelessness, depression, and outcome of psychotherapy between men and women has been hypothesized. AIMS: This study analyzed the difference in stress levels and hopelessness in the form of negative inferential feedback in depressed men and women. METHODOLOGY: In all, 35 men and 35 women suffering from depression were recruited. They were first assessed on the Hamilton's Depression Rating Scale, and their sociodemographical details were recorded. They were then administered the Perceived Stress Scale (PSS) and the Adaptive Inferential Feedback Questionnaire. RESULTS: Perceived stress in depressed women showed a positive correlation with negative inferential feedback (r = 0.39, P = 0.04). Levels of depression were comparable in the two genders. Comparison between the two genders showed no difference in proportion across the levels of severity of depression (χ2 = 5.44, P = 0.14). Depressed women rated higher stress, mainly in the helplessness domain of the PSS (P = 0.04). Women were shown to have more negative inferential feedback and attribute their hopelessness to more stable and global causes when compared with men (P = 0.04). CONCLUSION: Depressed women perceive more stress and receive more negative feedback, than men, to negative life events. Women attribute their hopelessness to more stable and global causes when compared with men.

Risperidone as an effective choice for obsessive-compulsive symptoms and tardive dyskinesia in an Indian quadragenarian with schizo-obsessive disorder.

Tardive dyskinesia (TD) is a chronic, stigmatizing side effect of typical and atypical antipsychotics that is often debilitating for the patient and resistant to treatment. Obsessive-compulsive symptoms (OCS) may arise at any stage of schizophrenia ranging from prodrome to posttreatment and carry a poor prognosis. Management of both the conditions is a challenging and often fatiguing task for the treating physician. We report a case of schizo-obsessive disorder in an Indian quadragenarian who had developed TD with olanzapine and had failed to show improvement with clozapine and quetiapine. The patient improved dramatically with risperidone. Our findings corroborate with previous literature which has shown risperidone to be effective in treatment of TD and obsessive symptoms, possibly due to its action on the serotonergic system. The authors conclude that risperidone is an effective choice to treat TD and comorbid OCS in patients with schizophrenia.

Risk analysis of suicidal ideations and postpartum depression with antenatal alpha methyldopa use.

Out of the various risk factors for postpartum depression, use of pharmacotherapy during pregnancy is the most poorly understood. The present study aimed to establish risk of postpartum depression and suicidal ideations with antenatal use of alpha methyldopa. Out of the 100 postpartum women assessed, 77.78% of the women who were prescribed alpha methyldopa had significant postpartum depression. There was statistically significant risk of postpartum depression associated with alpha methyldopa (p = 0.026, OR = 6.45). There was no increased suicidal risk with use of alpha methyldopa in these women (p = 1.00).

School Refusal Behavior in Indian Children: Analysis of Clinical Profile, Psychopathology and Development of a Best-Fit Risk Assessment Model.

OBJECTIVES: School refusal is seen as an emergency in child psychiatry and various risk factors have been analyzed. Children who present with school refusal have been shown to have several associated psychiatric comorbidities. However, risk assessment of psychiatric comorbidities is lacking, particularly in the Indian context. The authors aimed to study the sociodemographic profile and associated psychopathology in children with school refusal. They compared the prevalence rates of psychiatric illnesses to that of the community. A best-fit model for risk assessment of psychopathology was formulated. METHODS: Past records of children aged 5-16 y, who presented with school refusal in the period from June 2013 through June 2015 to authors' Child Guidance Clinic were studied and their sociodemographic details, symptoms and diagnoses were obtained. Chi square test of proportion was used to compare the prevalence rates between the study population and community. Multinomial analysis was used to elucidate a best-fit model of risk assessment. RESULTS: School refusal was seen in 3.6% of children. 77.8% of the children had a psychiatric diagnosis, most common being depression (26.7%), followed by anxiety (17.7%). Prevalence of psychiatric disorders was significantly higher in the study population than community (p < 0.05). A best-fit model of 4 factors: academic difficulties, adjustment problems at school, behavioral problems and parental conflicts is suggested (p < 0.05). CONCLUSIONS: School refusal is associated with significant psychopathology, most commonly depression, followed by anxiety. The best-fit model for risk assessment can predict the likelihood of psychopathology and help in early diagnosis.