Faith healer, Leaving against medical advice, Substance abuse
DOI: 10.5005/jp-journals-10067-0018 |
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Ghosh P, Kurmi J. Study of Sociodemographic and Clinical Profile of Admitted Patient Leaving Against Medical Advice from Psychiatry Ward of a Teaching Hospital. Ind J Priv Psychiatry 2018; 12 (2):39-45.
Introduction: Leaving against medical advice (LAMA) meaning a patient choosing to leave the hospital before the treating physician recommends discharge may result into inadequate treatment, relapse and prolonged duration of illness.
Aim and objectives: The aim of this study was to assess the prevalence, reasos for LAMA, sociodemographic variables and clinical profile of such patients.
Materials and methods: Retrospectively data were obtained from indoor register of a Psychiatry department of a teaching hospital for patients opting LAMA, during a period of 18 months from January 2017 up to June 2018. International Classification of Disease (ICD)-10 criteria was used for the diagnosis purpose.
Results: Out of 569 patients admitted during the study period total 60 patients fulfilled the criteria for LAMA. The frequency of LAMA was found to be 10.5%. LAMA was found to be more common in those below age 40 years (85%), in those from nonurban background (75%), who were educated up to high school (71%), who were suffering from neurotic, and psychotic and substance abuse disorders. The commonest reason cited for LAMA was going to faith healer and most of the LAMA occurred within first four days of hospitalization.
Conclusion: Leaving against medical advice (LAMA) is a frequent problem in psychiatric inpatients and is a matter of great concern for the treating doctors
Background: The number of continuing medical education (CME) programmes is becoming increasingly more in recent times and there were no formal reported studies among psychiatrists in India.
Objective: To find out psychiatrist's general opinion about CME.
Materials and methods: Data were collected from a representative sample of psychiatrists in active practice about CMEs attended in the last 5 years using a proforma through email and representative contacts. The general impression about CME and faculty was collected apart from personal data. The opinion regarding CME credit hours for renewal of medical council of India (MCI) registration was obtained by a question. Data were analysed using descriptive statistics and Cronbach's alpha was computed for reliability, validity and to know the data adequacy of the test to perform
Results: In all responses from 202 participants were analysed. Majority of responders were below 40 years (64%). More than half were in the profession for less than 10 years. Two-fifth conducted CME and nearly a third were office-bearers mostly in city associations. Sixty-six percent attended because of topic while 34% for faculty and 21% for MCI renewal. Thirty-six percent were either partly or fully sponsored by pharmaceutical companies. While 58% participants and 74% faculty found CME favorably, on the unfavourable side the figure were 21% and 51% respectively. More than half (55%) were against the need of CME for renewal of registration.
Conclusion: An unconditional positive regard may be good for psychiatric therapy but the same cannot be said of CME.
Krishna M Singh,
Regina R Khakha,
Roshan V Khanande
Aim: To review the place of antioxidants in the treatment of psychiatric disorders, and to weigh it against the criticism for such treatments.
Background: Oxidative stress leads to aging, and antioxidant use (naturally available in food and supplementations) is one of the dietary modality for health promotion with major benefits. Antioxidants have also been used in treatment and prevention of many medical disorders. Brain, one organ using oxygen abundantly, and for its high lipid content suffers from oxidative stress. Even postmortem studies of brains of individuals with psychiatric disorders show degenerative changes possibly due to long-term damage by oxidative stress. Hence, the use of antioxidants in treating psychiatric disorders is one of the new areas of research in psychiatry.
Review results: Many agents have been used in the treatment of psychiatric disorders. Gingko biloba, Selegiline, omega- 3-triglycerides, vitamin E, and N-acetyl cysteine have been found useful as adjuncts in the treatment of schizophrenia. Similarly, the usefulness of adjunct N-acetyl cysteine and ethyleicosapentaenoic acid (EPA) treatment in bipolar depression is reported. omega-3-triglycerides have also been used in the treatment of dementia as an adjunct with mixed results. Ubiquinol has shown promise in treating autism.
Conclusion: The results of adjunct antioxidant treatment in psychiatry have been mixed with at times conflicting results. Much research is required to establish their place as a treatment modality in psychiatry.
Clinical significance: Use of antioxidants in the treatment of psychiatric disorders, at Max, currently, is of adjunct value only; even the cost-effectiveness of such treatments has to weighed against the useful clinical utility.
Seshadri S Chatterjee,
Adesh K Agrawal
Klein Levin syndrome (KLS) is rare triad of episodic hypersomnolence, hyperphagia, and hypersexuality. Cavum verge (CV), although, mainly reported as a non-pathological, incidental, neuro-radiological abnormality by itself, may sometimes be associated with behavioral and psychiatric abnormalities. We here present a case of KLS with the magnetic resonance imaging (MRI) finding of Cavum verge. We then discuss the current literature of both the disorders and try to find some heuristic associations, if any, between the two.
Bipolar mood disorder (BPD) may manifest as the first episode of mania as early as below 6 years old. There are controversies regarding its diagnoses as because of sharing of symptoms with disruptive mood dysregulation disorder (DMDD), attention deficit hyperactivity disorder (ADHD) and conduct disorder. Hypersexuality was found to be a prominent feature in early-onset bipolar disorder (EOBD). Here is a case report of first episode mania in a child of 4.5 years old with a prominent feature of hypersexuality who responded well with valproate and risperidone.
Clozapine, an atypical antipsychotic agent commonly used for treatment-resistant schizophrenia (TRS) is well known to cause blood dyscrasias among many other common side effects like sedation, sialorrhoea, weight gain and some rare side effects such as eosinophilia. Clozapine-induced eosinophilia though rare has received extensive attention and may preclude its use in the patients who may otherwise be responding well to the treatment. Although there has been evidence in the literature highlighting the rare presentation of eosinophilia in patients receiving clozapine. Here we present a rare case of undifferentiated schizophrenia who received clozapine in the past and tolerated it well but developed transient eosinophilia on its re-introduction.
Vortioxetine is the new antidepressant on the block which has been described to have a novel mechanism of action–it directly works on multiple receptors of the neurotransmitter serotonin and it also inhibits serotonin reuptake. It has been shown to have promising antidepressant, antianxiety and pro-cognitive action especially during treatment of major depression. This article gives a brief overview of vortioxetine–its clinical use, pharmacological profile, and safety and tolerability. Most of the studies till date have found vortioxetine to be clinically efficacious, and it also improved the cognitive profile in patients with depression. It has a favorable adverse effect profile- it has been shown to be tolerated well by most subjects in clinical trials where nausea was the most frequently reported side effect, and it also showed the added advantage of comparatively less incidence of unwarranted sexual adverse effects.