Somatic multicomorbidity and disability in patients with psychiatric disorders in comparison to the general population: a quasi-epidemiological investigation in 54,826 subjects from 40 countries (COMET-G study).

BACKGROUND: The prevalence of medical illnesses is high among patients with psychiatric disorders. The current study aimed to investigate multi-comorbidity in patients with psychiatric disorders in comparison to the general population. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of mental disorders. METHODS: The sample included 54,826 subjects (64.73% females; 34.15% males; 1.11% nonbinary gender) from 40 countries (COMET-G study). The analysis was based on the registration of previous history that could serve as a fair approximation for the lifetime prevalence of various medical conditions. RESULTS: About 24.5% reported a history of somatic and 26.14% of mental disorders. Mental disorders were by far the most prevalent group of medical conditions. Comorbidity of any somatic with any mental disorder was reported by 8.21%. One-third to almost two-thirds of somatic patients were also suffering from a mental disorder depending on the severity and multicomorbidity. Bipolar and psychotic patients and to a lesser extent depressives, manifested an earlier (15-20 years) manifestation of somatic multicomorbidity, severe disability, and probably earlier death. The overwhelming majority of patients with mental disorders were not receiving treatment or were being treated in a way that was not recommended. Antipsychotics and antidepressants were not related to the development of metabolic syndrome. CONCLUSIONS: The finding that one-third to almost two-thirds of somatic patients also suffered from a mental disorder strongly suggests that psychiatry is the field with the most trans-specialty and interdisciplinary value and application points to the importance of teaching psychiatry and mental health in medical schools and also to the need for more technocratically oriented training of psychiatric residents.

The interface of psychiatry and COVID-19: Challenges for management of psychiatric patients.

COVID-19 is a viral infection that has multisystemic physical and psychological complications. The following paper looks at the various challenges seen while treating psychiatric patients during the COVID pandemic. There is a need for physician to be aware of the drug interactions between psychiatric medications and the medications used routinely in the management of COVID. There is also the concern of psychiatric side effects of medications used to manage COVID and medical complications caused by some side effects of psychiatric drugs. The telepsychiatry and telemedicine paradigm has made it mandatory for physicians to be vigilant of the same.

Sleep hygiene and diabetes: Suggestions for primary care.

Sleep problems are common in chronic disorders like diabetes and are the result of poor diet and unhealthy lifestyles. Comprehensive management of diabetes entails lifestyle management and restoration of good habits. Sleep hygiene maintenance helps persons living with diabetes enjoy a better quality of life by restoring normal sleep patterns and thereby improving glycaemic control.

Telepsychiatry and Telepsychotherapy: Critical Issues Faced by Indian Patients and Psychiatrists.

Telepsychiatry and telepsychotherapy are new treatment modalities that have been used more than ever during the COVID-19 pandemic. There are many challenges that are faced with the use of this modality for both patients and psychiatrists alike. There are critical issues faced with regard to the development of rapport, managing the entire teleconsultation set up, privacy and issues related to fees, issues related to prescribing and monitoring, and issues while handling emergencies. The challenges faced are discussed and some solutions if possible are laid out.

Comorbid Neurocognitive Impairment in Patients with Epilepsy

Background: Epilepsy is a common chronic non-communicable neurological disorder in which the brain function is impaired. Cognitive function is more frequently impaired in people with epilepsy than in the general population. The neurocognitive outcome of epilepsy in children and adults is vital for social prognosis and quality of life assessment. Cognitive changes in epilepsy have multifactorial etiology, including the epilepsy itself, age at onset, duration of epilepsy, treatment of epilepsy, reaction to epilepsy and any associated brain dysfunction and /or damage. This study was conducted to check association of neurocognitive impairment with the socio-demographic factors and disease associated factors in patients with epilepsy. Methodology: This study was a single centre cross-sectional study in which 96 patients were included. Severity of neurocognitive impairment was measured by Addenbrookes’ Cognitive Examination- R (ACE- R) score. Results: Out of 96 patients, neurocognitive impairment was seen in 23 (23.95%) patients. Conclusions: This study shows that neurocognitive impairment was found to be more when the age at onset of epilepsy was less, when the duration of the illness was more and when frequency of seizure was higher. Conclusion: Neurocognitive impairment is noted in patients with epilepsy and must be treated in the long- term management of epilepsy

Ethics of electronic tagging of dementia patients

Dementia is one of the most common neuropsychiatric disorders seen in old age with accompanying memory loss, aggressive behaviour, sleep problems and wandering behaviour with confusion. Many patients with dementia may be all alone at home with a domestic help and no family caregiver for most of the day and may sometimes wander off from their homes. Hence, dementia care programmes insist that an identity card with the patient’s key details be worn, in case the patient wanders away and is unable to return home or inform people about the location of their home.

Psychogenic Belching: A Case Report

Persistent psychogenic belching is a condition where supragastric belching occurs repeatedly in relation to apsychological stressor. Treatment involves trials of multiple medications with identification and/orelimination of the stressor. We present herewith the case of a female patient with persistent psychogenicbelching that responded well to a combination of medications.

Clozapine response and pre-treatment EEG-is there some kind of relationship.

BACKGROUND: Clozapine has been used widely in the management of treatment-resistant schizophrenia. The present study aims at determining whether pre-treatment electroencephalography (EEG) abnormalities would serve as a marker for response to clozapine treatment. SUBJECTS AND METHODS: This was a cross-sectional study done in a tertiary care center in Mumbai where patients diagnosed with schizophrenia using DSM-IV criteria and resistant schizophrenia using Kane criteria were assessed using EEG prior to starting clozapine treatment. They were rated for symptomatic improvement using the Positive and Negative Syndrome Scale (PANSS) along with Clinical Global Improvement for Severity (CGI-S). The results were statistically analysed and presented. RESULTS: 55 out of the 80 patients in the study showed baseline EEG abnormalities. The mean duration of illness in the patients were 2.65 years. Slow wave and background EEG abnormalities were common in pre-treatment EEG. 36.4% patients in the study showed clinical response. Patients with negative symptoms and baseline EEG abnormalities showed better response. CONCLUSIONS: The study was circumscribed and had many limitations due to a small sample size. The relation between pre-treatment EEG abnormalities and clozapine response could not be statistically correlated and it could not be ascertained to be a marker for response to clozapine therapy.

Repetitive Transcranial Magnetic Stimulation (rTMS) in the Management of Alcohol Dependence and other Substance Abuse Disorders - Emerging Data and Clinical Relevance.

Repetitive transcranial magnetic stimulation (rTMS) has been used widely in various psychiatric disorders like depression and schizophrenia. There have been some reports of its usefulness in alcohol dependence and substance use disorders. The present paper reviews the studies done using rTMS in substance use disorders including alcohol and nicotine dependence. Various studies done have been reviewed including the proposed mechanisms of action are outlined with the future research needs and need for further clinical data.

Effect of Nicotine Dependence on Cognition and Quality of Life in Patients Suffering from Schizophrenia

Introduction: The purpose of the present study was to examine the impact of nicotine dependence oncognition and quality of life in patients suffering from schizophrenia. The research was carried out to see ifthere is any significant difference between the cognition and quality of life among patients withschizophrenia having nicotine dependence in comparison to the no nicotine consumption group.Methodology: This study was carried out using the survey method. There were total 69 participants, allwere males and the age ranged from 20 to 50 years. The participants were the outpatients visiting thegovernment hospitals in Mumbai for their follow-ups to the psychiatrists. The data was collected from theparticipants after their consent was received. The screening for severity was done and only patients ratedwith moderate disturbances on the Positive and Negative Syndrome Scale (PANSS) were considered forfurther administration of tests. The two scales Montreal Cognitive Assessment Test (MoCA) andWHOQOL-Bref (Hindi) were used for measuring cognition and quality of life respectively. The obtainedscores were analyzed using two simple independent samples t-test.Results: The results showed significant difference between the scores of cognition and quality of life amongstthe two groups. The study was found to be in line with the previous researches. The results indicated thatcognition was significantly higher in the nicotine dependent group whereas the psychological domain ofquality of life was significantly higher for the no nicotine consumption group.Conclusion: The findings indicate the group of patients with schizophrenia having nicotine dependence wasfound to have significantly higher cognition but lower perceived quality of life in psychological domain,whereas the other group of patients who did not consume nicotine showed significantly higher perceivedquality of life but lower cognitive functioning. Overall the obtained statistical analysis revealed significantdifference between the cognition and quality of life amongst nicotine dependent group and no nicotineconsumption group.

Using social media and apps to enhance religiosity amongst Christian youth

Social Media is a term that is so often used in our daily conversations. Whether we like it or not, it hasbecome an inevitable part of our life and it is going to stay that way in the time to come. Its rapid growthand acceptability has greatly influenced human behaviour, lifestyle and thinking. Regardless of age,gender, status and geographical location, people actively get involved in different social networking sites.The speed, cost and reach captivate the users to spend more time on the social media. Whether socialmedia is good or evil will depend on the nature of its use. This article throws some light on the increaseduse of social media among Christian youth, the role it plays in uniting Christian communities and itsgrowing impact on the administering of sacraments and the conducting of church activities. Akin togeneral population, many church leaders like Pope, Cardinals, Bishops and Priests are part of the socialmedia like Facebook, Twitter, Instagram, etc. Some of them use it extensively to spread the Good Newsand to share their messages and ideas across larger population.

Psychogenic Hiccups – a case report

Hiccups are a common occurrence which may be many a time organic in nature. We present herewith thecase of a 20 year old girl that presented with hiccups of a psychogenic in nature. The patient’s case isdiscussed as the patient responded to a combination of medical and psychological interventions.

Episodic Psychotic Behavior: a case report

Episodic psychotic behaviour is a rare condition where the patient presents with psychotic behaviour inepisodes where the symptoms remit totally in between. We describe herewith a case of a lady thatpresented with episodic psychotic behaviour and that responded to treatment in our department.

Neurocognitive impairment secondary to herpes simplex encephalitis improved with inject cerebrolysin

Herpes simplex encephalitis (HSE) is an acute illness that causes both general and focal signs of cerebraldysfunction We present herewith the case of a 33 years old female who presented with neurocognitiveimpairment that was secondary to the herpes simplex encephalitis. The patient’s case is discussed as thepatient bettered with the administration of injection cerebrolysin along with psychopharmacotherapy andcognitive exercises.

A study of Neurological Soft Signs and Minor Physical Anomalies in children of parents with Schizophrenia and those without Schizophrenia

Introduction: ‘Neurological soft signs (NSS)’ and ‘Minor physical anomalies (MPA)’ represent two quitedistinct markers of risk for schizophrenia that stem from genetic factors and have been studied over thepast 3 decades. The aim of the current study was to assess Neurological soft signs (NSS) and Minorphysical anomalies (MPA) in children of patients suffering from schizophrenia and compare the same tochildren having parents without any psychiatric disorders.Methodology: The study was a cross sectional study at a Private tertiary care psychiatric hospital in urbanset up. The data was collected over a period of 1 year during June 2016- June 2017. The subjects of thisstudy were children of parents suffering from schizophrenia and children of parents without anypsychiatric disorder. The control group was made up of 40 children of the same age group with parentshaving no psychiatric disorders. Following the collection of sociodemographic details using a semistructured proforma, children in both groups were assessed using the Physical and Neurological Soft signScale (PANESS) while MPAs were assessed using the Waldrop scale. The data collected was statisticallyanalyzed.Results: There was no statistically significant correlation between demographic factors like gender, age,birth order, educational status or type of delivery with neurological soft signs and minor physicalanomalies. It was found that the study group had higher score for incoordination of gait and balance;higher score for slowness in performing patterned speed of movements which included toe heel alteration,hand supination and pronation, finger succession as compared to control group along with higher scoresfor involuntary movements, excess dysrhythmia score and overflow score including mirror movements inindex group than controls. There was no statistically significant difference in lateral preference patterns ormix handedness of cases and controls. Among Minor physical anomalies, the study group also had moreanomalies in mouth like high-steeped palate and tongue anomaly, curved 5th finger of hands and big gapbetween first and second toe (sandal gap).Conclusion: NSS and MPA are important variables and biomarkers that may be assessed in patients withschizophrenia and their offspirngs.

A Study on Quality of Life and Self Esteem in children and adolescents with Strabismus

Background/Context: Strabismus is a condition that results in loss of self esteem and affects quality of lifedue to the changes it may cause in facial appearance and other factors. There is a dearth of Indian literatureon children and adolescents with strabismus. The current study analyzed self esteem and quality of life inchildren and adolescents with strabismus.Methods: Children and adolescents between 6-17 years attending the ophthalmology out-patient departmentof a tertiary general hospital and their normal siblings were identified and assessed after parental consentusing a semi-structured proforma and the KINDL questionnaire. The results were statistically analyzed andpresented.Results: 35 children and adolescents with strabismus were compared to 38 siblings who were the controls.It was seen that children and adolescents with strabismus scored lower on family and social contacts qualityof life scores on all subscales of the KINDL questionnaire. However, self-esteem did not differ across bothgroups.Conclusion: Further larger studies in diverse populations are needed to corroborate the effects of strabismuson self esteem and quality of life.

Smoking and Peer Preference in College Students: an exploratory study

Background: Smoking in adolescents is related to multiple factors like genetics, family variables and peerpreference and influence. The aim of the following study was to study the prevalence of smoking and age ofinitiation college students while comparing peer preferences in smoker and non-smoker college students.Methods: 100 college students were divided on the basis of current smoking status into two groups. Thesetwo groups were administered the Evers-Pasquale peer preference test and the Global Youth Tobacco Survey(GYTS). Sociodemographic variables were assessed using a semi-structured proforma. The data was thenstatistically analysed.Results: The prevalence of current smoking was 54%. Almost 44% of college students had initiated smokingat or after 16 years of age, whereas only 4% of the entire sample had initiated smoking before 10 years ofage. Close to one fifth (18.52%) of current smokers smoked daily and smoked cigarettes first in morningsuggesting dependence. Students who currently smoked were most likely to engage in any activity in thecompany of best friends, followed by cool friends (p = 0.0001).Conclusion: Smoking and peer pressure are linked and there is a need for tobacco intervention programmesto be directed at adolescent specific factors. Further research is needed to understand other factors promotingsmoking like personality factors, social influence, genetic factors etc.

A Clinical Analysis of patients seen in a Geriatric Mental Health Camp organized in Mumbai

Background: Geriatric mental health is a neglected domain of mental health and many cases remainundetected in the community. Community programs have often helped to detect many cases of the elderlywith psychiatric problems and help them access care. The current paper aims to present an analysis ofpatients seen in a geriatric health camp from a psychiatric perspective.Methods: 103 elderly attended the geriatric camp and were assessed clinically for psychiatric problems. Theywere also administered the Adenbrooke’s Cognitive Examination Revised (ACE-R) Hindi version, Barthel’sIndex for Activities of Daily Living and 3.Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST). Theresults were analyzed statistically and presented.Results: The mean age of the subjects in the study was 66.05 ± 7.9 years. 83 subjects (79%) out of the 105were female. The mean BIADL score of the sample was 19.52 ± 1.9 and on the basis of scores on the ACER they were classified as having cognitive impairment (n=67) and not having cognitive impairment (n=27).The cognitively impaired group differed from the non-cognitive impairment on all subscales of the ACE-R.55 (52.4%) reported the presence of elder abuse but had taken no action against it. The BIADL scores showeda significant correlation on all aspects of ACE-R scores.Conclusions: Geriatric health camps can serve as a useful arena for the detection of geriatric mental healthproblems. Further studies in larger populations are needed to corroborate the findings seen in the geriatrichealth camp reported in this study

A Study on Premenstrual Syndrome symptoms and their association with the Attitudes towards Menstruation in Nursing Staff

Background: Symptoms in the premenstrual period have a detrimental impact on the general health ofwomen. There is a lack of studies examining the relationship between menstrual attitudes and symptoms ofpremenstrual syndrome (PMS), especially in the Indian scenario. This study was conducted to look atcontributing factors, frequency of PMS in different age groups and the association of these symptomstowards the attitude towards menstruation in nursing staff.Methodology: The cross-sectional study involved 450 female nursing staff between 25- 50 years of age fromvarious tertiary care hospitals who were administered the Premenstrual Tension Syndrome Rating Scale(PMTS) and Menstrual Attitude Questionnaire (MAQ). The data was then statistically analyzed.Results: The prevalence of premenstrual symptoms was found to be 85.6% amongst the participants(according to the ACOG criteria), while the proportion of females suffering from PMS (according to DSMIVTR criteria) was 36.5%. On studying the association, a negatively significant correlation between scoreson PMTS and mean scores of MAQ across all age groups.Conclusion: The intensity of PMS was associated with negative menstrual attitude in our study. Furtherstudies on PMS, its frequent symptoms and relevant variables may guide psychoeducational interventionsand need to carried out in larger and diverse populations to corroborate our findings.