Comparison of psychiatric co-morbidity in patients with psychogenic non-epileptic seizures and epilepsy at a tertiary care hospital in Kashmir

Background: objective of the study was to describe and compare frequency of psychiatric disorders in two groups of patients, one with psychogenic non-epileptic seizures (PNESs) and other with epilepsy.Methods: We studied 64 patients in which 32 belonged to the group with PNESs and 32 belonged to group with Epilepsy, admitted in a video-EEG unit of tertiary care hospital in Kashmir in order to confirm epileptic diagnosis. This study was conducted from March 2019 to August 2019 in neurology department and the patients underwent neurological evaluation, inter ictal EEG, MRI, neuropsychological assessment and psychiatric diagnosis codified in DSM-5.Results: Depression was found to be the most common diagnosis in the group with epilepsy-40% versus 15.75% of those with PNES, while as personality disorder (21.88%) was the common psychiatric disorder in group with PNES. Anxiety disorder was found to be the second leading psychiatric disorder and was almost common in both the groups, 13.33% in group with epilepsy and 18.75% in the group with PNES. It was also cited that Psychotic disorder (13.33%) was found only in the group with Epilepsy, while Personality disorder and PTSD was found only in the group with PNES. Bipolar disorder was more prevalent in group with epilepsy (13.33%) than in the group with PNES (3.13%). Somatic symptom disorder, dissociation and obsessive-compulsive disorder (OCD) was also found in both the groups.Conclusions: Psychiatric disorder is more common in PNES than in epilepsy

Clinical and demographic profile of patients treated with electro convulsive therapy from a tertiary care psychiatry hospital in North India

Background: Electro-convulsive therapy (ECT) refers to the electrical stimulation of the brain to produce seizures for therapeutic purpose. This study was undertaken with the aim of exploring the clinical and demographic profile of patients treated with ECT from a tertiary care psychiatry hospital in north India.Methods: It was a retrospective descriptive study of patients who were treated with ECT after admission in the inpatient psychiatry unit of Institute of mental health and neurosciences Kashmir during a period of one year (March 2017 to February 2018).Results: A total of 70 patients received ECT during the course of one year. About 72.85% of the patients belonged to 20-39 years age group. Female patients constituted more than half of the subjects (55.71%). Review of diagnostic profile showed that majority of patients receiving ECT were suffering from Schizophrenia (35.71%), followed by bipolar affective disorder (28.57%), depressive disorder (28.57%), schizoaffective disorder (4.28%) and substance induced mood/psychotic disorders (2.85%). A significant majority of subjects (57.13%) received about 7-9 ECT sessions. No any major complications were noted during ECT treatment.Conclusions: This study suggests that ECT, use as a treatment modality is common in adults between 20 to 39 years of age and females with Schizophrenia being the most common indications

Effect of ketamine infusion in treatment resistant depression and in depressive patients with active suicidal ideations: a study from North India

Background: Treatment resistant depression can be a life-threatening condition as it leads to an increase of suicide attempts by two to three folds. It has been estimated that nearly 1 million people die due to suicide every year, and more than two-third of these cases occur when the person is undergoing a major depressive episode. Ketamine is an NMDA receptor antagonist, an anesthetic agent that is short acting and has recently been used as an antidepressant and anti-suicidal agent. It has been seen that a single intravenous infusion of ketamine at a lower dose. i.e., subanesthetic dose of 0.5 mg/kg over a period of 40 minutes produces antidepressant effect which lasts for about a week and various studies have proved that repeated infusions of ketamine can prolong the duration of the antidepressant response. Methods: It was an observational/descriptive study done in the ketamine clinic/ECT suite of institute of mental health and neurosciences Kashmir (an associate hospital of government medical college Srinagar) which runs once a week. In this study, patients satisfying the criteria of TRD and depressive patients with active suicidal ideations, visiting the ketamine clinic who had given a valid informed consent for ketamine infusion enrolled and observed for ketamine efficacy by using specific scales. The study done over a period of 18 months from January 2020 till July 2021. Results: The response rate of ketamine in our study for treatment resistant depression was 70.27%. The response rate of ketamine for suicidality in our study was 63.16%. Our study showed a rapid onset of action for ketamine, two hours after ketamine infusion. Conclusions: A significant fraction of patients suffering from major depressive disorder do not respond to antidepressants and have a poor psychosocial functioning and an increased risk of suicide attempts making their condition life threatening. These patients therefore require special attention to address their underlying condition as well as suicidality to improve their outcome. In this context we studied the role of intravenous ketamine infusion in these patients in improving the psychosocial outcome as well as preventing the suicidal ideation.

Prevalence and clinical correlates of psychiatric morbidity among caregivers of patients attending a psychiatric hospital in North India

Background: Consequent to the high prevalence of psychiatric disorders in present day world, their caregivers form an important group in the public health. Research on the physical and psychological well-being of caregivers is being carried worldwide with varied results. Psychological health of these caregivers is usually ignored both by these persons themselves and the health-care providers. The objective of the study was to screen for psychiatric morbidity among caregivers of patients attending a psychiatric hospital in North India, and to study the clinical correlates of the same.Methods: A total of 205 patients and their caregivers were consecutively recruited over a one month period. Sociodemographic and clinical information of patients was obtained either from the hospital records or from the caregiver. Scoring of the patient’s global assessment of functioning (GAF) was done by clinicians. The caregivers were administered a sociodemographic questionnaire, general health questionnaire (GHQ-12) and Zarit Burden interview. The presence of psychiatric morbidity was confirmed by a consultant psychiatrist.Results: Among the caregivers, 32.2% had GHQ scores of 3 and above. Majority of caregivers in this study were females (59.0%) while as majority of the patients were males (61.9%). Factors associated with psychiatric morbidity among caregivers include the high level of subjective burden of care, low level of functioning, and comorbid medical and psychiatric conditions.Conclusions: The study reveals a high level of psychiatric morbidity among the caregivers of patients with mental health problems

Drug treatment of SARS-Cov2: potential effects in patients with substance use disorders (SUD).

Severe acute respiratory syndrome- Coronavirus 2 (SARS-CoV2) has presented an unprecedented challenge of finding therapeutic agents. Presently hydroxychloroquine (HCQ), lopinavir-ritonavir combination (LR), remdesivir, and favipiravir are candidate medications. Patients with substance use disorder (SUD) are especially susceptible to develop COVID-19 owing to underlying comorbidities, immune-suppression, and socioeconomic circumstances of drug use [1]. Moreover, the SARS-CoV2 pandemic has met with a pre-existing epidemic of Opioid use disorders. Given the susceptibility and magnitude of both the conditions, co-occurrence seems to be commonplace. Therefore, exploring the effects of candidate medications (for SARS-CoV2) among patients with SUD warrant clinical attention...

Prevalence of psychiatric morbidity among school-going adolescents in the age group of 13–19 years

Abstract Background Adolescent mental health problems are vast and varied and early identification and intervention can be of utmost help. There is sparse data on mental health issues in the adolescent population from India in general and J&K in particular; thus, it was decided to embark on this study. Results The prevalence of various psychiatric disorders among school-going adolescents was as major depressive disorder 13.7%, obsessive compulsive disorder 4.0%, panic disorder 1.4%, self-harming behavior 2.5%, generalized anxiety disorder 2.5%, social anxiety disorder 2.2%, dysthymia 1.7%, and adjustment disorder 0.8%. There was no statistically significant difference in the overall psychiatric morbidity group among males and females (P = 0.90). However, panic disorder and borderline personality disorder as a group were more commonly found among females compared to males (P = 0.016 and 0.001 respectively). Also, 34% from urban and 28% from rural areas met the criteria for any psychiatric disorder (P = 1.38). Conclusion Children and adolescents represent a tender part of the human life cycle and they may be at a higher risk of psychiatric disorders. There is a very high prevalence of psychiatric morbidity of any kind among adolescents in Kashmir, many of which are unidentified and thus untreated. Depression is the most common psychiatric illness among adolescents with a higher prevalence in males while anxiety disorders are more common among females. There is a need for further research in this age group and teachers and parents need psycho-education for the identification of such children