Prevalence of mixed features in patients with first-episode depression: An exploratory multicentric study.

Background and Aim: There is limited literature on the prevalence of mixed features in patients with depression, especially from countries in Asia. Our aim was to evaluate the prevalence of "mixed features" in patients with first-episode depression. Materials and Methods: Patients with first-episode depression were evaluated for the presence of mixed features as per the Diagnostic and Statistical Manual (DSM)-5 criteria. They were additionally evaluated on Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS). Results: About one-sixth (16%) of the patients fulfilled the DSM-5 criteria for the mixed features specifier. The most common manic/hypomanic clinical feature was increased talkativeness or pressure of speech, followed by elevated expansive mood (12.5%), and inflated self-esteem or grandiosity was the least common feature (8.7%). Those with mixed features had higher prevalence of comorbid tobacco dependence and psychotic symptoms. In terms of frequency of depressive symptoms as assessed on HDRS, compared to those without mixed features, those with mixed features had higher frequency of symptoms such as depressed mood, insomnia during early hours of morning, work and activities, agitation, gastrointestinal somatic symptoms, genital symptoms, hypochondriasis, and poorer insight. Conclusion: Mixed features specifier criteria were fulfilled by 16% patients with first-episode depression. This finding suggests that the extension of this specifier to depression can be considered as a useful step in understanding the symptom profile of patients with depression.

Prevalence of depression among middle aged women in the rural area of Kerala.

AIMS: The aim of this study was to determine the prevalence of Depression among women aged 40-60 years in the rural area of Kerala using Patient Health Questionnaire 9 (PHQ-9). SETTINGS AND DESIGN: Ambalappuzha is an area of rural background under the District of Alappuzha. The study was conducted by Preventive and Social Medicine department of Govt. T. D. Medical College, Kerala in collaboration with the department of Psychiatry with the help of Ambalappuzha health centre. METHODS AND MATERIAL: A cross-sectional survey was carried out among 594 women from 18 wards of Amabalappuzha North Panchayat using cluster sampling technique. Data on sociodemographic factors, health factors, and behavioral factors were collected from the women by investigator administered the semi-structured questionnaire. Patient Health Questionnaire9 (PHQ-9), was used for diagnosing Major Depression. RESULTS: The prevalence of Major Depression among middle aged women was 26.09% using the PHQ-9 diagnostic criteria and 24.2% using a PHQ-9 cut off score ≥ 10. With increasing age, there was an increasing trend in the prevalence of Depression up to the age of 55years followed by a small decline. A higher prevalence of Depression was observed among widows (43.37%), women not in a marital relation (41.38%), a woman with a history of postpartum Depression (OR 3.471), with peri-menopausal symptoms (40.28%, OR 2.86). CONCLUSIONS: One fourth of the women screened positive for Depression in Ambalappuzha North Panchayat (26.09%). This study highlights the need for understanding the high prevalence and myriad determinants of depression among women living in villages.

Psychiatric morbidity in the community: A population based-study from Kerala.

BACKGROUND: Estimates of psychiatric morbidity in the community will help service development. Participation of trained nonspecialist health-care providers will facilitate scaling up of services in resource-limited settings. AIMS: This study aimed to estimate the prevalence of priority mental health problems in populations served by the District Mental Health Program (DMHP). SETTINGS AND DESIGN: This is a population-based cross-sectional survey. MATERIALS AND METHODS: We did stratified cluster sampling of households in five districts of Kerala. Trained Accredited Social Health Activists (ASHAs) identified people who had symptoms suggestive of schizophrenia or bipolar disorder. Clinicians evaluated the information collected by the ASHAs and designated individuals as probable cases of psychosis or noncases. Screening instruments such as General Health Questionnaire-12, CAGE questionnaire, and Everyday Abilities Scale for India were used for identifying common mental disorders (CMDs), clinically significant alcohol-related problems, and functional impairment. RESULTS: We found 12.43% of the adult population affected by mental health conditions. We found CMD as most common with a prevalence of 9%. The prevalence of psychosis was 0.71%, clinically significant alcohol-related problems was 1.46%, and dementia and other cognitive impairments was 1.26%. We found informant-based case finding to be useful in the identification of psychosis. CONCLUSIONS: Mental health problems are common. Nonspecialist health-care providers can be trained to identify psychiatric morbidity in the community. Their participation will help in narrowing the treatment gap. Embedding operational research to DMHP will make scaling up more efficient.

Psychosis in Secondary Empty Sella Syndrome following a Russell's Viper Bite.

Hypopituitarism can present with psychiatric symptoms. We report a unique case of psychosis in clear consciousness in a case of hypopituitarism due to the secondary empty sella syndrome following a Russell's viper bite which was untreated and presented with psychotic symptoms for past 13 years following the snake bite. After the diagnosis of psychosis due to hypopituitarism was made, the patient was treated with levothyroxine and prednisolone supplements and his psychotic symptoms subsided without any psychotropic drugs. Vasculotoxic snake bites can cause hypopituitarism and can present with psychosis. Further research will be needed into the prevalence of this phenomenon.

A comparative study on psycho-socio-demographic and clinical profile of patients with bipolar versus unipolar depression.

BACKGROUND: Several studies have revealed significant differences between bipolar (BP) and unipolar depression (UP). Misdiagnosing BP depression results in suboptimal symptom resolution, induction of manic switch, mixed state, or accelerated cycling. This study compares various psycho-socio-demographic, longitudinal course, and phenomenological factors associated with BP and UP depression. MATERIALS AND METHODS: We compared 30 UP and 30 BP depression patients using a specially designed intake proforma, International Classification of Diseases-10 diagnostic criteria for research, Hamilton Rating Scale for Depression-21 (HAMD-21), Hypomania Checklist-32 Questionnaire (HCL-32), Brief psychiatric rating scale (BPRS), and Kuppuswami's socioeconomic status scale. RESULTS: BP depression group consisted of mostly males, with earlier age of onset of illness, longer illness duration, frequent episodes, hospitalizations and psychotic symptoms. The total HAM-D score and 4 HAM-D item scores-psychomotor retardation, insight, diurnal variation of symptoms and its severity, and paranoid symptoms were significantly higher in this group. Binary logistic regression identified the age of onset, the total duration of illness, frequency of affective episodes, and presence of delusions as predictors of bipolarity (odds ratio = 1.327; 1.517; 0.062; 0.137). CONCLUSIONS: Identification of clinical markers of bipolarity from large scale prospective studies is needed.

Understanding and managing somatoform disorders: Making sense of non-sense.

Somatization is a clinical and public health problem as it can lead to social dysfunction, occupational difficulties and increased healthcare use. Hence understanding somatoform disorders is of paramount importance, especially so in developing countries like India. This paper discusses the history and evolution of the concept of somatization and somatoform disorders, etiological considerations, classification, assessment, diagnosis and clinical management. Research from India, controversies and criticisms and future perspectives are mentioned. A new model to understand functional somatic symptoms, in Indian setting is also proposed.