A cross-sectional study of insight and family accommodation in pediatric obsessive-compulsive disorder

BACKGROUND: Factors predicting treatment outcome in pediatric patients with obsessive-compulsive disorder (OCD) include disease severity, functional impairment, comorbid disorders, insight, and family accommodation (FA). Treatment of pediatric OCD is often only partly successful as some of these predictors are not targeted with conventional therapy. Among these, insight and FA were identified to be modifiable predictors of special relevance to pediatric OCD. Despite their clinical relevance, insight and FA remain understudied in youth with OCD. This study examined the clinical correlates of insight and FA and determined whether FA mediates the relationship between symptom severity and functional impairment in pediatric OCD. METHODS: This was a cross-sectional, outpatient study. Thirty-five treatment-naive children and adolescentswith DSM-IV diagnosis of OCD (mean age: 13.11 ± 3.16; 54.3% males) were included. Standard questionnaires were administered for assessing the study variables. Insight and comorbidities were assessed based on clinician’s interview. Subjects were categorized as belonging to a high insight or a low insight group, and the differences between these two groups were analyzed using ANOVA. Pearson’s correlation coefficients were calculated for the remaining variables of interest. Mediation analysis was carried out using structural equation modeling. RESULTS: Relative to those in the high insight group, subjects in the low insight group were younger, had more severe disease and symptoms, and were accommodated to a greater extent by their families. In addition, comorbid depression was more frequent in subjects belonging to the low insight group. Family accommodation was positively related to disease severity, symptom severity, and functional impairment. Family accommodation totally mediated the relationship between symptom severity and functional impairment. CONCLUSIONS: Results support the differences in the diagnostic criteria between adult and pediatric patients with OCD with respect to the requirement of insight. Subjects with low insight displayed clinical characteristics of increased severity compared with their high insight counterparts, suggesting that subjects with low insight may require multimodal approach to treatment. Family accommodation was found to mediate the relationship between symptom severity and functional impairment; the use of family-based approaches to cognitive behavioral therapy, with one of the aims of reducing/mitigating FA, may provide better treatment outcomes in pediatric OCD

Bupropion for the treatment of fluoxetine non-responsive trichotillomania: a case report

<p>Abstract</p> <p>Introduction</p> <p>Trichotillomania, classified as an impulse control disorder in the <it>Diagnostic and Statistical Manual of Mental Disorders</it>, is characterized by the recurrent pulling out of one's hair, resulting in noticeable hair loss. The condition has a varied etiology. Specific serotonin reuptake inhibitors are considered the treatment of choice; however some patients fail to respond to this class of drugs. A few older reports suggest possible benefit from treatment with bupropion.</p> <p>Case presentation</p> <p>A 23-year-old Asian woman with fluoxetine non- responsive trichotillomania was treated with sustained release bupropion (up to 450 mg/day) and cognitive behavior therapy. She demonstrated clinically significant improvement on the Clinical Global Impression - Improvement scale by week 13. The improvement persisted throughout the 12-month follow-up period.</p> <p>Conclusions</p> <p>The present case report may be of interest to psychiatrists and dermatologists. Apart from the serotonergic pathway, others, such as the mesolimbic pathway, also appear to be involved in the causation of trichotillomania. Bupropion may be considered as an alternative pharmacological treatment for patients who do not respond to specific serotonin reuptake inhibitors. However, this initial finding needs to be confirmed by well designed double-blind placebo controlled trials.</p

Standards of care for obsessive–compulsive disorder centres

In recent years, many assessment and care units for obsessive–compulsive disorder (OCD) have been set up in order to detect, diagnose and to properly manage this complex disorder, but there is no consensus regarding the key functions that these units should perform. The International College of Obsessive- Compulsive Spectrum Disorders (ICOCS) together with the Obsessive Compulsive and Related Disorders Network (OCRN) of the European College of Neuropsychopharmacology (ECNP) and the Anxiety and Obsessive Compulsive Disorders Section of the World Psychiaric Association (WPA) has developed a stand- ards of care programme for OCD centres. The goals of this collaborative initiative are promoting basic standards, improving the quality of clinical care and enhance the validity and reliability of research results provided by different facilities and countries

Delirious Mania: Can We Get Away with This Concept? A Case Report and Review of the Literature

Background. Delirious mania (DM) as a clinical entity is well described, yet is often unrecognized in clinical practice. While most often misdiagnosed as acute psychotic episodes of organic delirium, these patients meet the criteria for mania with attendant delirium and pose therapeutic challenges. In addition to the case presentation, this paper also discusses the available literature on DM. Case Presentation. A 29-year-old man with DM was treated with a combination of electroconvulsive therapy (ECT), divalproex 2000 mg/day, loxapine 100 mg/day, and lorazepam 4 mg/day. He demonstrated clinically significant improvement by day 10, which persisted through the twelve-month follow-up period. Conclusions. DM is a severe psychiatric syndrome which should be accurately diagnosed. Patients with DM should be treated aggressively, especially with ECT. Lack of recognition of DM can lead to serious morbidity or fatal outcomes. Though the concept of DM is well established, recent psychiatric literature does not make a mention of this life threatening yet treatable condition. We propose that there is a dire need to keep this concept alive

A study to assess the quality of life of undergraduate medical students

Background and aims: Although the quality of life (QoL) of medical students is a relatively well-researched topic in the West, there is a dearth of it in developing countries like India. The aim of this study was to examine the QoL of Indian undergraduate medical students and its associations with sociodemographic and other parameters. Methods: A cross-sectional study was conducted on 349 medical students in Telangana, India. Students self-reported their QoL using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) and the Short-Form Health Survey (SF-36) tools. Data were collected on the individuals’ characteristics, including the year of study, substance use, physical exercise, academic performance, and other parameters. Results: Male students scored better than females in several SF-36 domains and the WHOQOL-BREF psychological domain; females performed better in the social relationships domain (P=0.006). Students in the second and third year had higher scores compared to first-year students. Smoking was negatively associated with the physical component score (P=0.027). Alcohol consumption was related with a higher score in the psychological domain (P=0.049). Living with parents led to higher scores on the environmental domain (P=0.001) and mental component (P=0.048), but a lower score on the psychological domain compared to those living in the hostel (P=0.017). Students with better academic performance had better scores on all domains. Conclusion: This study indicates that medical students in the first year and females, in particular, have a lower QoL. Medical schools need to formulate tailor-made policies and ensure better conditions for interns, incoming students and female students in particular

Social anxiety disorder co-morbid with schizophrenia: a cross-sectional study from India

Introduction: The co-morbidity of various psychiatric disorders with schizophrenia (SZ) is increasingly being recognized, with anxiety disorders (ADs) being no exception. Among the various ADs, the co morbidity of social anxiety disorder (SAD) and SZ is not well studied. We hypothesized that the prevalence of SAD in SZ is high. Objective: We aimed to study the prevalence of SAD in patients with SZ, and to determine the associated socio-demographic and clinical correlates. Materials and methods: This was an outpatient study on consecutively sampled 64 International Diagnostic Criteria (ICD-10) diagnosed treatment-naive SZ patients, who were rated on the Positive and Negative Syndrome Scale (PANSS), the Social Interaction Anxiety Scale (SIAS), the WHO-5 Well-Being Index (WHO-5) and the Global Assessment of Functioning Scale (GAF). Results: The prevalence of SAD in or sample of SZ patients was 26.56%. Compared to the SZ without SAD group, the SZ with SAD group had a lower quality of life (QoL) and GAF scores, but, no significant difference in the PANSS ratings. Conclusions: The SAD is highly co morbid with SZ, and appears to be independent of psychosis, and is associated with lower QoL and psychosocial functioning. Future follow-up studies should evaluate whether this SAD co-morbidity has any impact on the treatment outcome of SZ

A Family Study of Consanguinity in Children with Intellectual Disabilities in Barwani, India

Background: Intellectual disability (ID) can be inherited in families through consanguineous marriage. The ID in an individual can be associated with the ID, epilepsy, and mental illness in their parents. Such connections can be seen more closely among consanguineous marriages in tribal and nontribal population in India. Objective: This study shows a few common patterns of the consanguineous relationship in the parents of children with ID in India. Materials and Methods: This is a case series research design. Extreme or deviant case sampling was applied. Data were collected in homes, camps, and clinical settings in the Barwani district of Madhya Pradesh, India. The patterns of consanguineous marriages and the relationship between children with ID and their relatives with ID, epilepsy, and mental illness were analyzed and reported with pedigree charts. Results: Multiple patterns of consanguineous marriages in tribal and nontribal populations were observed. ID was found to be associated in children with their relatives of the first, second, and third generations. Conclusion: ID may inherit in individuals from their relatives of the first, second, and third generations who have ID, epilepsy, or mental illness and married in the relationship. Appropriate knowledge, guidance, and counseling may be provided to potential couples before planning a consanguineous marriage