Catatonia and multiple pressure ulcers: A rare complication in psychiatric setting

The incidence of pressure ulcers in patients with psychiatric illness, especially with catatonia might be more than what is reported in the literature. We report a case of catatonia secondary to severe depression presenting with multiple pressure ulcers. Single case report — description and management. An 18 yrs old boy reported with a continuous course illness characterized by features of catatonia secondary to severe depression with multiple pressure ulcers over sacrum and heels. Ulcers were effectively managed by a multidisciplinary team of physiatrist, psychiatrist, and rehabilitation nurses. Immobility, reduced nocturnal movements, increased skin fragility, and poor nutrition contribute to the development of the pressure ulcer in bed-bound psychiatric patients. Efforts should be directed toward the prevention of pressure ulcers in these patients to reduce additional morbidity

Urodynamic profile in myelopathies: A follow-up study

Aims: To study the significance of filling cystometry in assessment and management of neurogenic bladder in myelopathies and correlate neurological recovery and bladder management in the follow up. Study Design: Retrospective analysis of reports of filling cystometry in patients with traumatic and non-traumatic myelopathy. Setting: Neuro-rehabilitation unit of a tertiary care university hospital. Methods: The study was carried out between September 2005 and June 2006 and included all subjects with myelopathy who underwent filling cystometry. ASIA impairment scale was used to assess neurological status during admission as well as in the follow up. Bladder management was advised based on the cystometric findings. Neurological recovery and mode of bladder management were correlated during the follow up after a minimum of 6 months. Results: Fifty-two subjects (38 males, 14 females), mean age 33.26 ± 14.66 years (10-80) underwent filling cystometry. Twenty patients had cervical, 24 had thoracic and 8 had lumbar myelopathy. Cystometric findings were overactive detrusor observed in 43 patients, (21 had detrusor sphincter dyssynergia (DSD), 22 without DSD) and areflexic/underactive detrusor in 9. Post-void residual (>15% of voided urine) was significant in 27 patients. Twenty-three patients (44%) reported for follow up (16 males, 7 females) after a mean duration of 9.04 ± 2.44 months (6-15 months). Neurological recovery was seen in 61% cases, while 1 patient showed deterioration. Only 26% patients reported change in bladder management during follow up. Correlation between neurological recovery and bladder management was found to be insignificant ( P > 0.05) using spearman correlation co-efficient. Conclusions: Filling cystometry is valuable for assessment and management of neurogenic bladder after myelopathy. No significant relationship was observed between neurological recovery and neurogenic bladder management in the follow up in the present study

Post-stroke depression: Prevalence and relationship with disability in chronic stroke survivors

Objectives: To evaluate (1) the prevalence of operationally defined depressive disorder (ICD-10) in chronic stroke subjects and (2) the relationship of post-stroke depression (PSD) with disability. Design: Cross-sectional, descriptive study. Setting: Neurological rehabilitation unit of a tertiary care university research center. Materials and Methods: Participants were those with first episode of supratentorial stroke of more than 3 months′ duration with impaired balance and gait who had been referred for rehabilitation. Data were collected on demographic data, stroke data (side and type of lesion and post-stroke duration), cognition (mini mental state examination), depressive ideation (Hamilton Depression Rating Scale - HRDS), impairment (Scandinavian Stroke Scale), balance (Berg Balance Scale), ambulatory status (Functional Ambulation Category), walking ability (speed), and independence in activities of daily living (Barthel Index). Statistical analysis was done using SPSS 13.0. We carried out the chi-square test for ordinal variables and the independent t test for continuous variables. Results: Fifty-one patients (M:F: 41:10) of mean age 46.06 ± 11.19 years and mean post-stroke duration of 467.33 ± 436.39 days) were included in the study. Eighteen of the 51 participants (35.29%) met the criteria for depression. Demographic variables like male gender, being married, living in a nuclear family, urban background, and higher HRDS score were significantly correlated with PSD (P < 0.05). Depression was related to functional disability after stroke but to a statistically insignificant level (P > 0.05) and was unrelated to lesion-related parameters. Conclusion: Depression occurs in one-third of chronic stroke survivors and is prevalent in subjects referred for rehabilitation. PSD is related primarily to demographic variables and only to a lesser extent to functional disability following stroke

Urodynamics post stroke in patients with urinary incontinence: Is there correlation between bladder type and site of lesion?

<b>Objective:</b> Assessment of bladder by urodynamic study (UDS) in patients with urinary incontinence following stroke, and correlation with site of lesion.<b> Study Design and Setting:</b> Retrospective cross-sectional study in the neurological rehabilitation unit of a tertiary care institute.<b> Materials and Methods:</b> Forty patients (22 males) with arterial or venous, ischemic or hemorrhagic stroke, with urinary incontinence in the acute phase following the event, underwent UDS. Seventeen patients had right hemiplegia, 18 had left hemiplegia, and five had posterior circulation stroke with brainstem/cerebellar features. Bladder type was correlated with age, side, and site of lesion.<b> Results: </b> The mean age was 46.80 &#x00B1; 16.65 years (range: 18-80 years). Thirty-six patients had arterial stroke and four had cortical venous thrombosis. UDS was performed after a mean of 28.32 &#x00B1; 10.27 days (range: 8-53 days) after the stroke. All but one patient had neurogenic bladder dysfunction, with 36 patients (90&#x0025;) having overactive detrusor (OD) and three having underactive/areflexic detrusor. Among the 36 patients with OD, 25 patients (62.5&#x0025;) had OD without detrusor-sphincter dyssynergy (DSD) and 11 (27.5&#x0025;) had OD with DSD. Bladder management was advised based on the UDS findings. No significant correlation (<i> P </i> &gt; 0.05) was found between type of bladder and age or side and site of lesion. <b> Conclusions: </b> UDS is a useful tool to assess and manage the bladder following stroke with urinary incontinence. In this study, no significant correlation was found between UDS findings and site of lesion

A case of Fregoli syndrome and Erotomania associated with anemia

Although anemia due to the cobalamin deficiency has been described as a cause of a wide range of psychiatric disorders, the role of iron deficiency anemia in psychiatric disorders remains unexplored. We report a rare case of simultaneous presence of simultaneous presence of Fregoli syndrome with Erotomania which occuring in the context of iron and cobalamin deficiency anemia. The index patient improved after correction of anemia. But what is notable is that the patient continues to be free from psychotic symptoms even after 4 months of discharge. This case report shows a rare combination of two different delusional disorders that might be associated with anemia. This stresses the importance of doing a complete hematological work up in patients with psychiatric disorders

Quality of life and psychological problems in patients undergoing neurological rehabilitation

Aim: To assess the quality of life (QoL) and prevalence of psychological problems (PP) in patients with neurological illness, and their correlation with functional abilities. Materials and Methods: Prospective cross-sectional study conducted in the neurological rehabilitation unit of tertiary research hospital in 30 consecutive hospitalized patients (21 men), age 16-55 years (34.63&#x00B1;11.87). Outcome Measure: WHOQoL-BREF was used to assess QoL. The prevalence of PP was recorded using Hospital Anxiety Depression Scale (HADS) and General Health Questionnaire (GHQ-12). QoL and HADS scores were correlated with functional abilities using mean Barthel Index (BI) Score. Results: The duration of illness was three to 30 months (10.63&#x00B1;7.83) and their primary diagnoses were stroke 12, traumatic spinal cord injury seven and non-traumatic spinal cord lesion 11. Twenty-two patients qualified for GHQ-12 caseness, with 15 patients having distress (score &#8805;15) and seven having severe problem and psychological distress (score&#8805;20). Twenty five patients had abnormal anxiety and 17 had abnormal depression on HADS (abnormal = 8-21), with moderate to severe anxiety and depression (scores&#8805;11) in nine and three patients respectively. The mean WHOQoL-BREF transformed scores (on WHOQoL 0-100 scale) were (38.83&#x00B1;8.02), (50.76&#x00B1;9.79), (48.53&#x00B1;18.46) and (49.13&#x00B1;10.63) in physical, psychological, social, and environmental domains respectively. The social domain of QoL had significant correlation ( P &#60; .05) with functional abilities. Conclusion: Patients with neurological disorders requiring inpatient rehabilitation have impaired QoL that affects all domains of life. There is high prevalence of psychological problems, including anxiety and depression. The social domain of QoL adversely affected functional abilities, but the correlation between PP and functional abilities was insignificant