Importance of 1H-MR spectroscopy of the brain to identify the minimal hepatic encephalopathy in different patients with liver cirrhosis: A prospective study.

Objectives: Liver cirrhosis patients commonly progress to minimal hepatic encephalopathy (MHE) with cognitive impairment and raised blood ammonia and proinflammatory cytokines levels. This study aims to identify the subjects of MHE in patients with liver cirrhosis by hydrogen 1 magnetic resonance (1H-MR) spectroscopy of the brain, serum proinflammatory cytokines, and neuropsychiatric tests. Materials and Methods: This prospective was carried out on 100 patients of liver cirrhosis without overt hepatic encephalopathy (HE) and compared with 100 healthy controls in a tertiary care hospital in Northeast India between September 2017 and October 2019. The psychometric hepatic encephalopathy score (PHES) neuropsychological tests, cranial MRIwith 1H-MR spectroscopy, and estimation of serum interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were done. The PHES scores and serum proinflammatory markers levels were correlated with the conventional and 1H-MR spectroscopy findings of the brain. Results: The mean PHES score in the case group was -7.58±3.43 (standard deviation [SD]) and the control group was -3.41 ± 3.87 (SD). Patients with Child-Pugh class A (n = 8) had a PHES score of -8.7 ± 2.5 (SD), class B (n = 42) -7.62 ± 3.7 (SD), and class C (n = 50) had a score of -7.36 ± 3.3 (SD). The mean value of IL-6 and TNF-α in the case group was 219 ± 180 (SD) pg/mL and 99 ± 118 (SD) pg/mL and the control group was 67.4 ± 77 (SD) pg/mL and 57.5 ± 76 (SD) pg/mL. Globus pallidus T1-weighted hyperintensities on the visibility scale with a visibility score of 0 were observed in 39 cases, a score of 1 in 38 cases, and a score of 2 in 23 cases. Increased glutamate/glutamine/creatine (Glx/Cr) ratio was identified in the case group on MR spectroscopy as compared to the control (0.95 ± 0.24 vs. 0.31 ± 0.19, P < 0.0005), a decrease of myoinositol/creatine (mI/Cr) ratio (0.11 ± 0.13 vs. 0.30 ± 0.12, P < 0.0005), and increase choline/creatine (Cho/Cr) ratio (0.69 ± 0.26 vs. 0.61 ± 0.20, P < 0.0005). There was a statistically significant difference in Glx/Cr, mI/Cr and Cho/Cr ratio between the case and control groups with P < 0.0005. Conclusion: Predicting the development of MHE in established cases of liver cirrhosis using non-invasive modalities like PHES, IL-6, TNF-α levels, and 1H-MR spectroscopy plays an important role in further progression to overt HE and coma.

Psychiatric Morbidities and Their Impact on Quality of Life in Patients With Psoriasis.

Background Psychiatric morbidities, which are commonly seen in psoriasis patients, are often missed or ignored leading to poor quality of life. A lack of communication between psychiatrists and dermatologists leads to ignorance of psychiatric morbidities in psoriasis patients, which can eventually take a severe form. Therefore, both groups must collaborate to provide high-quality patient care. As there is a dearth of such studies in the North-Eastern part of India, this study aimed to highlight the above-mentioned problem. Aim The aim of this study was to study psychiatric morbidities in patients with psoriasis and to compare quality of life in psoriasis patients with and without psychiatric morbidities. Methods This study was a hospital-based cross-sectional study conducted in the Dermatology Department, Assam Medical College and Hospital, Dibrugarh, Assam, India from July 2020 to July 2021. Ninety patients with psoriasis were included in the study and the diagnosis was confirmed by a consultant dermatologist, then the Mini International Neuro-psychiatric Interview Scale (M.I.N.I.; version 5.0) scale was applied to screen psychiatric morbidities. The diagnoses were confirmed using ICD-10 followed by dividing psoriasis patients into two groups, i.e. with and without psychiatric morbidities. After that the World Health Organization Quality of Life (WHOQOL) scale was applied to both groups and the domains of quality of life were compared. Results Our results showed that 61.1% of psoriatic patients had psychiatric morbidities, which is abnormally high compared to other dermatological disorders. The psychological domain of quality of life was the most affected (WHOQOL scale scoring of 38.12±6.67 vs. 48.76±6.21) in both groups of patients (i.e., with and without psychiatric morbidities), and the environmental domain was the least affected (56.67±10.65 vs. 64.67±8.18). Every domain of quality of life had a lower score in patients with psoriasis with psychiatric morbidities as compared to those without (p<0.05). Conclusion Our results of 61.1% psychiatric morbidities in psoriasis patients emphasize the need for psychiatric evaluation in every psoriasis patient. The timely intervention of psychiatric morbidity in psoriasis patients with collaboration of psychiatrists and dermatologists will surely improve the patient's condition to some extent and, thus, their quality of life.

Cotard's Delusion and Its Relation With Different Psychiatric Diagnoses in a Tertiary Care Hospital.

Background Cotard's delusion/Cotard's syndrome is a series of delusions ranging from a false, fixed, unshakeable belief that one has lost their soul, blood, organs, and body parts to the belief that one is dead. The syndrome was initially thought to be associated with only mood disorders but later was found in other psychiatric illnesses as well. Aim The study aimed to find an association between Cotard's delusion and the psychopathology of different psychiatric diagnoses. Method The clinical study comprised seven patients presenting with symptoms of Cotard syndrome with different presentations, diagnoses, and onset and meeting inclusion criteria. The study was carried out in the Department of Psychiatry, Assam Medical College and Hospital. The patients were hospitalized and, after a detailed history, mental status examination, and laboratory investigations, were treated with pharmacological and non-pharmacological methods. A descriptive statistical analysis was done. Results Denial of the existence of body organs was the most similar complaint encountered in the cases. The duration of illness onset ranged from weeks to months. The symptoms were found to be present in different psychiatric illnesses like schizophrenia, delusional disorder, depression, and intellectual disability. The patient had responded well to pharmacological agents with the exception of three patients who were treated with electroconvulsive therapy. Conclusion The study highlights the different subtypes of Cotard's syndrome and its associated symptoms, which provides a better understanding of the condition. The case series presents a finding of a higher proportion of male patients and adolescent cases than in previous reports. The study also provides valuable insights into its heterogeneity in the diagnosis and treatment of Cotard's syndrome, which may help in the early recognition and management of this rare condition.

Parental Supervision and Its Relation With Emotional and Behavioral Problems in Secondary School Children.

Background Emotional and behavioral problems of children are a common concern for parents and mental health stakeholders alike. Poor parenting is a well-known factor associated with behavioral problems in children. There is unanimity regarding the correlation between parental supervision and emotional and behavioral problems. This present study aimed to establish a relationship between parental supervision and emotional and behavioral problems, as it could make way for further research based on the concept of parental supervision, which parents can quickly adopt as an intervention strategy for children with behavioral and emotional problems. Aim We aim to assess parental supervision and its relation with emotional and behavioral problems in secondary school children. Method This is a community-based cross-sectional observational study among 770 parents of children from schools in Dibrugarh, Assam, over a period of one year. Multistage random sampling was applied to obtain the sample size. The Strengths and Difficulties Questionnaire (SDQ) was used to assess children's emotional and behavioral problems, the Alabama Parenting Questionnaire (APQ) was used to assess parental supervision, and sociodemographic proforma was used to study various demographic variables. The observed data were analyzed using the computer program Statistical Package for the Social Sciences for Macintosh version 24.0 (IBM SPSS Statistics, Armonk, NY, USA). Results The study revealed that participants' poor supervision had a positive correlation with emotional and behavioral problems. Poor monitoring/supervision had a positive correlation with total difficulty score levels, and positive parenting practices such as involvement and positive parenting had a negative correlation with emotional and behavioral problems. There was a statistically significant association between behavioral problems and selected demographic variables such as parents' education, socioeconomic status, and family type. The study also found that there was a significant statistical association between sociodemographic variables such as age and negative parenting practices such as poor monitoring/supervision, inconsistent discipline, and corporal punishment. Conclusion It was found that factors such as inconsistent discipline and poor supervision had a significant impact on emotional and behavioral problems in children. In future monitoring research, one can adopt a constructional approach, where the goal should be to explain and distinguish good parental supervision behaviors from poor supervision. This knowledge can be used to develop good intervention strategies to halt such emotional and behavioral problems.

Mental and Behavioural Disorders of Childhood and Adolescence: An Observational Study.

BACKGROUND: There is overlap of symptoms in psychiatric disorders, especially in mental and behavioural disorders of childhood and adolescence. Half of all lifetime psychiatric disorders tend to arise by age 14 years and three fourths of them arise by age 24 years. AIM: To study the various types of mental and behavioural disorders of childhood and adolescence, and to find out comorbidities within and across the types. METHODS: An observational cross-sectional study was carried out over a period of one year in the psychiatry department of a tertiary care general hospital. The psychiatric diagnoses according to the World Health Organization's (WHO) tenth revision of the International Statistical Classification of Health and Related Problems (ICD-10) were categorised into type 1 (depression, anxiety, obsessive-compulsive disorder, and somatoform disorder), type 2 (attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder), type 3 (mental retardation, developmental disorders of speech and language, and scholastic skills, and pervasive developmental disorders). Descriptive statistics was used with frequency and percentage. RESULTS: Total sample size was 137. Children and adolescents were almost equally distributed. Boys were more than girls. Type 3 disorders were maximum. Adolescents had mostly type 1 disorders. Children had mostly type 3 disorders. Girls had almost same number of type 1 and type 3 disorders. Boys had mostly type 3 disorders. Within group comorbidity was mostly with type 3 disorders. Across group comorbidity was highest in type2-type 3 disorders. CONCLUSION: Mental and behavioural disorders in childhood and adolescence do vary according to age and sex, and their recognition will help in the early diagnosis and proper management.

Baclofen Abuse due to Its Hypomanic Effect in Patients with Alcohol Dependence and Comorbid Major Depressive Disorder.

Baclofen is a gamma-aminobutyric acid type B receptor agonist used as an anti-craving agent for treatment of alcohol dependence. It has gained popularity in the recent times because it is well tolerated even in patients with hepatic impairments. Herein we are summarizing the latest literature about baclofen induced hypomania and are reporting a case of baclofen abuse because of its mood elevating property in a patient of alcohol dependence with comorbid major depressive disorder. Literature review and case study of a 36-year-old male with alcohol dependence with comorbid major depressive disorder was prescribed with tablet baclofen as an anti-craving agent along with antidepressant medicines. The patients who did not improve with conventional antidepressant therapy started feeling better in terms of his mood symptoms on taking tablet baclofen. Owing to the mood elevating property he started abusing baclofen. Despite its safety profile in hepatic impairment, one must be very cautious in prescribing baclofen because of its mood altering property which may account for its abuse potentiality.

Asenapine-Induced Acute Dystonia in an Adolescent Male.

Asenapine is a sublingually absorbed newer second-generation antipsychotic that is approved for the treatment of schizophrenia and bipolar disorder in patients, with a lower extrapyramidal adverse effect potential. We report an adolescent boy having schizophrenia who developed an acute dystonic reaction after 4 days when the dose of asenapine was increased from 10 to 15 mg per day.

Life-threatening thrombocytosis following GCSF treatment in a case of clozapine-induced agranulocytosis.

Clozapine was introduced in European market in 1972 as an effective treatment for schizophrenia without extrapyramidal side effects. Within a short while, the clozapine story virtually came to a halt following detection of life-threatening neutropenia and agranulocytosis. Judicial use of granulocyte colony stimulating factor (GCSF) can be life saving with infrequent side effects in these cases. Here we are presenting a case of clozapine induced agranulocytosis managed with GCSF but had transient but life-threatening thrombocytosis, a very uncommon complication of GCSF therapy. Expression of GCSF receptors on the surface of megakaryocytic lineage is thought to be the cause of this unusual phenomenon.

Conduct disorder-A sequelae of viral encephalitis.

An 11-year-old girl presented with a behavioural problem of 2 years' duration, which developed following an attack of viral encephalitis. Her behavioural changes had manifested as conduct disorder and were treated with pharmacotherapy as well as behavioural therapy.