Pub Date : 2020-11-30DOI: 10.30834/kjp.33.2.2020.218
Sukesh, Indu V. Nair
Background: In India, due to various factors, mentally ill often turn to a variety of carers for treatment. It results in a longer duration of untreated illness (DUI) with poor long term prognosis. Studies on pathways to care, seek to find out predictors of mentally ill person’s help-seeking behaviour. There is a dearth of literature in this subject in Kerala setting. Methods: Cross-sectional study was conducted on 250 consecutive first-time outpatients. The diagnosis was made according to DSM 5. A pilot-tested, semi-structured proforma was used for socio-demographic details and Encounter form by WHO for pathways to care. The analysis was done using Epi Info software. Results and discussion: Four gateways to care identified: Psychiatrist- 71.2%, faith healers – 14.8%, non-psychiatrist modern medicine doctors- 9.2%, alternate systems of medicine- 4.8%. Median DUI was seven months. Faith healers as first carers were more in BPL compared to APL families (p=0.004). Substance use disorders had longer median DUI than psychotic and anxiety disorders and mental retardation. Major neurocognitive disorder had more delays than the schizophrenia spectrum and other psychotic disorders and mental retardation (p=0.000). Among first carers, longer DUI was with faith healers and alternate systems of medicine when compared to psychiatrists. (p=0.000). Those from higher socioeconomic status and a diagnosis of substance use disorder more often have a psychiatrist as the first carer. Being male was associated with lengthier pathways. Conclusion: Faith healers & alternate systems of medicine practitioners form the first portal of psychiatric care for a small yet significant proportion of the patients. Reduction in DUI in case of psychiatric disorders needs attention to this aspect also.
{"title":"Pathways to care and duration of untreated illness in patients attending a state psychiatric hospital","authors":"Sukesh, Indu V. Nair","doi":"10.30834/kjp.33.2.2020.218","DOIUrl":"https://doi.org/10.30834/kjp.33.2.2020.218","url":null,"abstract":"Background: In India, due to various factors, mentally ill often turn to a variety of carers for treatment. It results in a longer duration of untreated illness (DUI) with poor long term prognosis. Studies on pathways to care, seek to find out predictors of mentally ill person’s help-seeking behaviour. There is a dearth of literature in this subject in Kerala setting. Methods: Cross-sectional study was conducted on 250 consecutive first-time outpatients. The diagnosis was made according to DSM 5. A pilot-tested, semi-structured proforma was used for socio-demographic details and Encounter form by WHO for pathways to care. The analysis was done using Epi Info software. Results and discussion: Four gateways to care identified: Psychiatrist- 71.2%, faith healers – 14.8%, non-psychiatrist modern medicine doctors- 9.2%, alternate systems of medicine- 4.8%. Median DUI was seven months. Faith healers as first carers were more in BPL compared to APL families (p=0.004). Substance use disorders had longer median DUI than psychotic and anxiety disorders and mental retardation. Major neurocognitive disorder had more delays than the schizophrenia spectrum and other psychotic disorders and mental retardation (p=0.000). Among first carers, longer DUI was with faith healers and alternate systems of medicine when compared to psychiatrists. (p=0.000). Those from higher socioeconomic status and a diagnosis of substance use disorder more often have a psychiatrist as the first carer. Being male was associated with lengthier pathways. Conclusion: Faith healers & alternate systems of medicine practitioners form the first portal of psychiatric care for a small yet significant proportion of the patients. Reduction in DUI in case of psychiatric disorders needs attention to this aspect also.","PeriodicalId":31047,"journal":{"name":"Kerala Journal of Psychiatry","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48065305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-31DOI: 10.30834/kjp.33.2.2020.210
Sivasubramoney Krishnan, K. Lekshmy, P. Anil, B. Sandhya, Kumari Jayageetha
Background: Stress has been proven to be hazardous, resulting in significant physical, emotional, social and cognitive disturbances which are unpleasant. Police officers have elevated rates of cardiovascular diseases, sleep disorders, anxiety disorders, depression and PRSD. Kerala Police has implemented several programs for management of stress among its members. Mindfulness-Based Interventions (MBIs) have been shown to enhance emotional intelligence, reduce negative emotions and health outcomes in police officers. Objective: The objective of the current study is to study the effectiveness of an MBI in reducing the negative emotions among police officers Methods: The present study is an observational study which attempts to assess and compare the subjectively reported emotion and Mindfulness level among police personnel before and six weeks after attending the Mindful Life Management (MLM) workshop. Results: Results of the present study suggests a statistically significant association between subjective emotional experience and the MBIs. Five Facet Mindfulness Questionnaire (FFMQ) scores also were found to be significant statistically. FFMQ scores before and after the MLM workshop were found to be statistically significant. Conclusion: Results of the present study points to the fact that MLM can be thought of as a method of intervention to manage emotional turmoil among police personnel of our state. The relationship between the change in emotion and change in FFMQ score has to be further explored with adequate sample size. This ongoing study comparing the stress and emotional levels of the police force in the State of Kerala before and after MLM course will help to strengthen further the effects of MBIs in recognizing their emotional state.
{"title":"Self-reported Emotional Experience Among Police Personnel Before and After Attending a Mindfulness Based Intervention (Mindful Life Management-MLM)-an Observational Study","authors":"Sivasubramoney Krishnan, K. Lekshmy, P. Anil, B. Sandhya, Kumari Jayageetha","doi":"10.30834/kjp.33.2.2020.210","DOIUrl":"https://doi.org/10.30834/kjp.33.2.2020.210","url":null,"abstract":"Background: Stress has been proven to be hazardous, resulting in significant physical, emotional, social and cognitive disturbances which are unpleasant. Police officers have elevated rates of cardiovascular diseases, sleep disorders, anxiety disorders, depression and PRSD. Kerala Police has implemented several programs for management of stress among its members. Mindfulness-Based Interventions (MBIs) have been shown to enhance emotional intelligence, reduce negative emotions and health outcomes in police officers. Objective: The objective of the current study is to study the effectiveness of an MBI in reducing the negative emotions among police officers\u0000Methods: The present study is an observational study which attempts to assess and compare the subjectively reported emotion and Mindfulness level among police personnel before and six weeks after attending the Mindful Life Management (MLM) workshop. Results: Results of the present study suggests a statistically significant association between subjective emotional experience and the MBIs. Five Facet Mindfulness Questionnaire (FFMQ) scores also were found to be significant statistically. FFMQ scores before and after the MLM workshop were found to be statistically significant. Conclusion: Results of the present study points to the fact that MLM can be thought of as a method of intervention to manage emotional turmoil among police personnel of our state. The relationship between the change in emotion and change in FFMQ score has to be further explored with adequate sample size. This ongoing study comparing the stress and emotional levels of the police force in the State of Kerala before and after MLM course will help to strengthen further the effects of MBIs in recognizing their emotional state.","PeriodicalId":31047,"journal":{"name":"Kerala Journal of Psychiatry","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42306090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-31DOI: 10.30834/kjp.33.2.2020.215
P. Radhakrishnan, Praveeen Arathil, D. Narayanan
Background: Smokers with psychiatric disorders, most notably those with serious mental illness and substance use disorders tend to present with more severe nicotine dependence and nicotine withdrawal than smokers without these illnesses. The following study aims to explore the correlation of smoking with bipolar affective disorder Setting and design: The comparative cross-sectional study was done in Amrita Institute of Medical Sciences & Research Centre, Kochi, a 1,450-bed hospital for a period of 2 years. Methods and materials: Seventy subjects with Bipolar affective Disorder who were in remission for at least two months and Seventy subjects who were relatives of paediatric outpatients were included in the study and control group, respectively. Clinical variables were assessed, and Hamilton depression rating scale, Young mania rating scale and Fagerstorm nicotine rating scale were administered to the subjects. Results: In this study, 52.9% of subjects with bipolar disorder were found to be smokers, and 51.4% of the normal population were smokers. No significant association was observed between bipolar affective disorder, and smoking tobacco, however, a significant correlation was found between smoking status and the total number of episodes of the disorder, psychotic episodes and suicide attempts. Conclusion: There appears to be a relationship between smoking tobacco and certain clinical features of bipolar affective disorder. It is possibly a bidirectional relation between these two disorders.
{"title":"Association of tobacco smoking with bipolar affective disorder- a comparative cross-sectional study at a tertiary care centre in south India","authors":"P. Radhakrishnan, Praveeen Arathil, D. Narayanan","doi":"10.30834/kjp.33.2.2020.215","DOIUrl":"https://doi.org/10.30834/kjp.33.2.2020.215","url":null,"abstract":"Background: Smokers with psychiatric disorders, most notably those with serious mental illness and substance use disorders tend to present with more severe nicotine dependence and nicotine withdrawal than smokers without these illnesses. The following study aims to explore the correlation of smoking with bipolar affective disorder\u0000Setting and design: The comparative cross-sectional study was done in Amrita Institute of Medical Sciences & Research Centre, Kochi, a 1,450-bed hospital for a period of 2 years.\u0000Methods and materials: Seventy subjects with Bipolar affective Disorder who were in remission for at least two months and Seventy subjects who were relatives of paediatric outpatients were included in the study and control group, respectively. Clinical variables were assessed, and Hamilton depression rating scale, Young mania rating scale and Fagerstorm nicotine rating scale were administered to the subjects.\u0000Results: In this study, 52.9% of subjects with bipolar disorder were found to be smokers, and 51.4% of the normal population were smokers. No significant association was observed between bipolar affective disorder, and smoking tobacco, however, a significant correlation was found between smoking status and the total number of episodes of the disorder, psychotic episodes and suicide attempts.\u0000Conclusion: There appears to be a relationship between smoking tobacco and certain clinical features of bipolar affective disorder. It is possibly a bidirectional relation between these two disorders.","PeriodicalId":31047,"journal":{"name":"Kerala Journal of Psychiatry","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42025579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-30DOI: 10.30834/kjp.33.2.2020.205
Chithira Thomas, G. Menon, P. Kuttichira
The novel coronavirus pandemic had caused the closure of beverage outlets in Kerala in late March 2020. There were a few suicides in the immediate period, which were highlighted in the media attributing to non-availability of alcohol. An observational study of patients admitted at the De-addiction Centre, NEST and Jubilee Mission Medical College and Research Institute was done. We recorded our observations from the closure of the beverage outlets until two weeks after. Though the government anticipated at least 100 patients, we encountered only 17. Those admitted were brought in delirium, with seizures or injuries sustained during delirium. The possible reasons behind this disparity are discussed which included the sale of illicit liquor or use of home-made preparations. The current situation arose due to a lack of planning and sudden closure of beverage outlets without warning being issued to mental health professionals. Opinions regarding steps to be taken for similar situations in the future are posited.
{"title":"Impact of COVID-19 pandemic on people with alcohol use disorder in Kerala– An observation from Thrissur district","authors":"Chithira Thomas, G. Menon, P. Kuttichira","doi":"10.30834/kjp.33.2.2020.205","DOIUrl":"https://doi.org/10.30834/kjp.33.2.2020.205","url":null,"abstract":"The novel coronavirus pandemic had caused the closure of beverage outlets in Kerala in late March 2020. There were a few suicides in the immediate period, which were highlighted in the media attributing to non-availability of alcohol. An observational study of patients admitted at the De-addiction Centre, NEST and Jubilee Mission Medical College and Research Institute was done. We recorded our observations from the closure of the beverage outlets until two weeks after. Though the government anticipated at least 100 patients, we encountered only 17. Those admitted were brought in delirium, with seizures or injuries sustained during delirium. The possible reasons behind this disparity are discussed which included the sale of illicit liquor or use of home-made preparations. The current situation arose due to a lack of planning and sudden closure of beverage outlets without warning being issued to mental health professionals. Opinions regarding steps to be taken for similar situations in the future are posited.","PeriodicalId":31047,"journal":{"name":"Kerala Journal of Psychiatry","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47947318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-03DOI: 10.30834/kjp.33.2.2020.203
Smitha Ramadas
The diagnosis and boundaries of borderline intellectual functioning (BIF) lack clarity. The nosological status in DSM 5 and ICD 10 and 11 are also dubious. The provision of 'borderline disability' of 25 % for the category of Intellectual Disability, in the RPWD (Rights of persons with disability) act, falls below the benchmark disability criteria. The Kerala State commissioner for persons with disabilities categorises those with IQ between 70 and 84, as 'borderline intelligent' and provides the benefits of scribe/interpreter to them. Can the psychiatrist certify an entity which does not exist in the current classificatory systems? The author tries to highlight the fallacies in the implementation of disability provisions in Kerala for students with BIF and provides alternative solutions vis a vis the disability plea.
{"title":"Borderline intelligence, disability provisions and fuzzy borders","authors":"Smitha Ramadas","doi":"10.30834/kjp.33.2.2020.203","DOIUrl":"https://doi.org/10.30834/kjp.33.2.2020.203","url":null,"abstract":"The diagnosis and boundaries of borderline intellectual functioning (BIF) lack clarity. The nosological status in DSM 5 and ICD 10 and 11 are also dubious. The provision of 'borderline disability' of 25 % for the category of Intellectual Disability, in the RPWD (Rights of persons with disability) act, falls below the benchmark disability criteria. The Kerala State commissioner for persons with disabilities categorises those with IQ between 70 and 84, as 'borderline intelligent' and provides the benefits of scribe/interpreter to them. Can the psychiatrist certify an entity which does not exist in the current classificatory systems? The author tries to highlight the fallacies in the implementation of disability provisions in Kerala for students with BIF and provides alternative solutions vis a vis the disability plea.","PeriodicalId":31047,"journal":{"name":"Kerala Journal of Psychiatry","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42500916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-02DOI: 10.30834/kjp.33.2.2020.192
Joice Geo, C. Joseph, Chintu Sabu George, R. Kallivayalil
Background: Deliberate self-harm patients (DSH) with upper limb injuries are commonly admitted in the plastic surgery units. Psychiatric comorbidities are risk factors for these patients with self-inflicted injuries. A multidisciplinary team approach is needed. Methods: Patients who presented with self-inflicted upper limb injuries in the plastic surgery department were referred for psychiatric liaison services. Socio-demographic data, mode of injury, plastic surgical procedures, and psychiatry diagnosis were noted. Results and discussion: Out of 48 patients, 20 (41.6%) belong to the 21-30 age group, 30 (62.5%) were males. 43 (89.6%) patients needed major plastic surgery procedures. The major psychiatric comorbidities were depressive disorder (27.1%), adjustment disorder (16.6%), alcohol dependence syndrome (14.6%), and bipolar mood disorder (12.5%). High psychiatric morbidity among self-inflicted hand injuries suggests the need for a multidisciplinary approach and long term follow-up. Conclusion: Psychiatric liaison services are important in the treatment of self-inflicted upper limb injuries.
{"title":"Self-inflicted upper limb injuries in a tertiary care rural Plastic Surgery unit - A psychiatric evaluation","authors":"Joice Geo, C. Joseph, Chintu Sabu George, R. Kallivayalil","doi":"10.30834/kjp.33.2.2020.192","DOIUrl":"https://doi.org/10.30834/kjp.33.2.2020.192","url":null,"abstract":"Background: Deliberate self-harm patients (DSH) with upper limb injuries are commonly admitted in the plastic surgery units. Psychiatric comorbidities are risk factors for these patients with self-inflicted injuries. A multidisciplinary team approach is needed.\u0000Methods: Patients who presented with self-inflicted upper limb injuries in the plastic surgery department were referred for psychiatric liaison services. Socio-demographic data, mode of injury, plastic surgical procedures, and psychiatry diagnosis were noted.\u0000Results and discussion: Out of 48 patients, 20 (41.6%) belong to the 21-30 age group, 30 (62.5%) were males. 43 (89.6%) patients needed major plastic surgery procedures. The major psychiatric comorbidities were depressive disorder (27.1%), adjustment disorder (16.6%), alcohol dependence syndrome (14.6%), and bipolar mood disorder (12.5%). High psychiatric morbidity among self-inflicted hand injuries suggests the need for a multidisciplinary approach and long term follow-up.\u0000Conclusion: Psychiatric liaison services are important in the treatment of self-inflicted upper limb injuries.","PeriodicalId":31047,"journal":{"name":"Kerala Journal of Psychiatry","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44637059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-25DOI: 10.30834/kjp.33.2.2020.198
S. Kuriakose, Vinaychandran S, K T P Dayal Narayan, M. Ch
Background: Childbirth is associated with significant physiological changes as well as challenges related to psychiatric disorders. Postpartum depression (PPD) is one such condition associated with high levels of morbidity and mortality. Screening postpartum women for early identification of depression and its prompt treatment should be a crucial component of postnatal health care. Assessment of prevalence and correlates of postpartum depression hence becomes important. Methods: Cross-sectional assessment of mothers (n=250) during postnatal visits to the family planning clinics between four weeks and one year of delivery, using Edinburg Postpartum Depression Scale (EPDS), Social Support Questionnaire and a structured questionnaire for the assessment of psychosocial risk factors was carried out in a tertiary care postgraduate teaching hospital of north Kerala. Multivariate Regression Analysis was used to identify the risk factors for PPD. Results: 27.6% had postpartum depression (score of >11 in EPDS), and 18.4% had suicidal ideation. Factors associated with the presence of PPD included alcohol use of husband, marital discord, lack of family support and lack of physical help during the postnatal period. Difficulties during labour, the gender of the baby or postnatal complications did not have a significant association with PPD. Though there was a negative correlation between Social Support Scale (SSS) total score and EPDS score, it was not statistically significant. (Pearson’s co-relation coefficient= -0.084, p= 0.186). Conclusion: Prevalence of depression in postnatal women is very high. Modifiable psychosocial factors have a close association with PPD, and these are opportunities for intervention as well. Considering the morbidity and mortality linked to untreated PPD, screening of postnatal women and routine provision of therapeutic services to them is suggested.
{"title":"Postpartum depression and its association with social support: a cross sectional study at a maternity hospital in Kerala","authors":"S. Kuriakose, Vinaychandran S, K T P Dayal Narayan, M. Ch","doi":"10.30834/kjp.33.2.2020.198","DOIUrl":"https://doi.org/10.30834/kjp.33.2.2020.198","url":null,"abstract":"Background: Childbirth is associated with significant physiological changes as well as challenges related to psychiatric disorders. Postpartum depression (PPD) is one such condition associated with high levels of morbidity and mortality. Screening postpartum women for early identification of depression and its prompt treatment should be a crucial component of postnatal health care. Assessment of prevalence and correlates of postpartum depression hence becomes important. Methods: Cross-sectional assessment of mothers (n=250) during postnatal visits to the family planning clinics between four weeks and one year of delivery, using Edinburg Postpartum Depression Scale (EPDS), Social Support Questionnaire and a structured questionnaire for the assessment of psychosocial risk factors was carried out in a tertiary care postgraduate teaching hospital of north Kerala. Multivariate Regression Analysis was used to identify the risk factors for PPD. Results: 27.6% had postpartum depression (score of >11 in EPDS), and 18.4% had suicidal ideation. Factors associated with the presence of PPD included alcohol use of husband, marital discord, lack of family support and lack of physical help during the postnatal period. Difficulties during labour, the gender of the baby or postnatal complications did not have a significant association with PPD. Though there was a negative correlation between Social Support Scale (SSS) total score and EPDS score, it was not statistically significant. (Pearson’s co-relation coefficient= -0.084, p= 0.186). Conclusion: Prevalence of depression in postnatal women is very high. Modifiable psychosocial factors have a close association with PPD, and these are opportunities for intervention as well. Considering the morbidity and mortality linked to untreated PPD, screening of postnatal women and routine provision of therapeutic services to them is suggested.","PeriodicalId":31047,"journal":{"name":"Kerala Journal of Psychiatry","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46343116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-01DOI: 10.30834/kjp.33.1.2020.199
Aysha Zabin M Madathil, Anithakumari Ayirolimeethal, P. Indu
Dacrystic seizures present with sudden bursts of crying and often manifest with comorbid psychiatric symptoms. Here, we present the case of a 27-year-old female with an 11-year history of stereotyped patterns of crying spells, associated with fearfulness, suspicions, hallucinatory behaviour, recurrent suicidal gestures and impairment in functioning. She was treated mostly with antipsychotics, antidepressants and mood stabilizers (for a brief period) irregularly, without adequate improvement. She presented with catatonia, hypokalemia and aspiration pneumonia, following default of medications for one month. With appropriate treatment, her physical condition became stable, when short lasting bouts of recurrent crying spells were observed, followed by confused behaviour and sleep, along with delusions and hallucinations. Her EEG showed epileptiform discharges; brain imaging was normal. She showed good response to anticonvulsants along with antipsychotics. Such unusual presentations of epilepsy and comorbid psychiatric symptoms warrant a high index of suspicion, for proper diagnosis and management.
{"title":"A case report of dacrystic seizures presenting with psychosis","authors":"Aysha Zabin M Madathil, Anithakumari Ayirolimeethal, P. Indu","doi":"10.30834/kjp.33.1.2020.199","DOIUrl":"https://doi.org/10.30834/kjp.33.1.2020.199","url":null,"abstract":"Dacrystic seizures present with sudden bursts of crying and often manifest with comorbid psychiatric symptoms. Here, we present the case of a 27-year-old female with an 11-year history of stereotyped patterns of crying spells, associated with fearfulness, suspicions, hallucinatory behaviour, recurrent suicidal gestures and impairment in functioning. She was treated mostly with antipsychotics, antidepressants and mood stabilizers (for a brief period) irregularly, without adequate improvement. She presented with catatonia, hypokalemia and aspiration pneumonia, following default of medications for one month. With appropriate treatment, her physical condition became stable, when short lasting bouts of recurrent crying spells were observed, followed by confused behaviour and sleep, along with delusions and hallucinations. Her EEG showed epileptiform discharges; brain imaging was normal. She showed good response to anticonvulsants along with antipsychotics. Such unusual presentations of epilepsy and comorbid psychiatric symptoms warrant a high index of suspicion, for proper diagnosis and management.","PeriodicalId":31047,"journal":{"name":"Kerala Journal of Psychiatry","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48590312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-22DOI: 10.30834/kjp.33.1.2020.193
Charanya Kaliamoorthy, M. P. Mukherjee, M. Das, Nivedhitha Selvakumar, P. Kandasamy
Multi-systemic genetic disorders are strongly associated with psychiatric illness and may require psychotropics for their management. The choice of psychotropics is primarily determined by medical comorbidities and adverse effects. A careful assessment of behavioural phenotype and metabolic monitoring for children on psychotropics should be followed to avoid adverse consequences. Hence, the need for monitoring of metabolic syndrome during routine clinical evaluation and the use of aripiprazole which demonstrated a good response with minimal adverse effects are highlighted with a description of cases of children with intellectual disability and neurodevelopmental genetic syndromes like Down Syndrome and Prader-Willi syndrome.
{"title":"Psychotropic medications and metabolic side effects in common genetic syndromes with intellectual disability-case report","authors":"Charanya Kaliamoorthy, M. P. Mukherjee, M. Das, Nivedhitha Selvakumar, P. Kandasamy","doi":"10.30834/kjp.33.1.2020.193","DOIUrl":"https://doi.org/10.30834/kjp.33.1.2020.193","url":null,"abstract":"Multi-systemic genetic disorders are strongly associated with psychiatric illness and may require psychotropics for their management. The choice of psychotropics is primarily determined by medical comorbidities and adverse effects. A careful assessment of behavioural phenotype and metabolic monitoring for children on psychotropics should be followed to avoid adverse consequences. Hence, the need for monitoring of metabolic syndrome during routine clinical evaluation and the use of aripiprazole which demonstrated a good response with minimal adverse effects are highlighted with a description of cases of children with intellectual disability and neurodevelopmental genetic syndromes like Down Syndrome and Prader-Willi syndrome.","PeriodicalId":31047,"journal":{"name":"Kerala Journal of Psychiatry","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42547198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-11DOI: 10.30834/kjp.33.1.2020.191
Hareesh Angothu
{"title":"Comments on the editorial on the Rights of Persons with Disabilities (RPWD) Act 2016 and Psychiatric Care","authors":"Hareesh Angothu","doi":"10.30834/kjp.33.1.2020.191","DOIUrl":"https://doi.org/10.30834/kjp.33.1.2020.191","url":null,"abstract":"","PeriodicalId":31047,"journal":{"name":"Kerala Journal of Psychiatry","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42711070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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