Affective Disorder Patients Research Articles

Burden and Expressed Emotion in Caregivers of Bipolar Affective Disorder-Mania: A Cross-Sectional Study

There is a paucity of literature on caregiver burden and expressed emotion among persons with bipolar affective disorder and its correlates in Indian settings. Data was collected from outpatient department of psychiatry, Institute of Mental Health and Hospital, Agra, regarding socio-demographic characteristics (e.g. age, gender, domicile), followed by Burden Assessment Scale (BAS), Family emotional involvement and criticism scale, and young mania rating scale from patients of bipolar affective disorder in manic episode and their caregivers. Descriptive statistics like mean, standard deviation and unpaired “t” test was applied for continuous data and Chi square for categorical data. Spearman correlation was used to find the correlation. The mean age of patients with mania and their caregivers were 35.9 (SD = 9.8) and 43.5 (SD = 12.9) respectively. The mean total BAS score was 76.7 (12.3), which reflect a significant amount of caregiver burden. Age of the caregivers was positively correlated with total BAS scale respectively. Marital status of caregivers was negatively correlated with external support (− 0.6, p < 0.05). Education of caregivers was negatively correlated with Physical and mental (− 0.5, p < 0.05) and other relation (− 0.5, p < 0.05). Occupation of the caregivers was positively related to taking responsibility (0.5, p < 0.05). The presence of significant amount of burden of care and expressed emotion in patients with bipolar affective disorder in manic episode point out to the need for psychosocial support to the family.

Assessment of Psychosocial Aspects in the Parents of Schizophrenia and Bipolar Affective Disorder Patients

Background: Schizophrenia as well as bipolar affective disorder both are disabling illnesses, as such the patient requires much care and attention. This places a considerable degree of burden on the caregivers. Aim: Many studies undertaken in India have measured the burden experienced by the caregivers in schizophrenia and bipolar affective disorder separately. Thus the aim of the present study is to assess and compare the quality of life and depression in the parents (as caregivers) of schizophrenia and bipolar affective disorder. Sample: The sample was consisting of 30 parents of schizophrenic patients, 30 parents of patients with bipolar affective disorder and 30 parents of normal control subjects were selected with the help of purposive sampling method. Parents of both genders were included in the study. Tools: Tools used were GHQ 12, WHO Quality of Life and BDI. Result and Conclusion: The findings of the present study indicate that parents of schizophrenia patients and BPAD patients showed poor quality of life as well as depressive symptoms in comparison to parents of normal control subjects. Parents of schizophrenia patients as well as parents of bipolar affective disorder patients exhibited.

Influence of CRHR1 Polymorphisms and Childhood Abuse on Suicide Attempts in Affective Disorders: A GxE Approach.

Background: Previous studies have shown that the hypothalamus-pituitary-adrenal-axis (HPA-axis) is closely involved in the development of affective disorders. Given that early life events are also linked to dysregulation of the same system, there might be an association between childhood adversities and suicidal behavior in affective disorders, moderated by HPA-axis genes. We aimed to investigate a potential association between childhood trauma and previous suicide attempts in affective disorder patients, moderated by variants of the corticotropin-releasing hormone receptor 1 (CRHR1) gene.Methods: The current pilot study is part of an ongoing study on suicidal behavior in affective disorders (VieSAD). Two hundred fifty eight Caucasian affective disorder patients were assessed at the Department of Psychiatry and Psychotherapy of the Medical University Vienna and the Karl Landsteiner University for Health and Science. An assemblage of psychiatric interviews was performed (e.g., SCAN, HAMD, SBQ-R, CTQ) and DNA samples of peripheral blood cells were genotyped with TaqMan® SNP Genotyping Assays (rs7209436, rs4792887, rs110402, rs242924, and rs242939).Results: Neither genetic, nor haplotypic associations between CRHR1 polymorphisms and previous suicide attempts could be established for the present sample. Using a binary logistic regression model, significant gene-environment-interactions were found for the single nucleotide polymorphisms (SNPs) rs7209436 and rs110402, reflecting the impact of childhood trauma and CRHR1 polymorphisms on previous suicide attempts.Limitations: A larger sample size will be required to ultimately elucidate the link between childhood trauma and the HPA axis in suicidal behavior.Conclusion: This pilot study presents promising gene-environment-interaction findings in affective disorder patients with a history of suicide attempts.

The Impact of COMT and Childhood Maltreatment on Suicidal Behaviour in Affective Disorders

The inconsistent findings on the association between COMT (catecholamine-O-methyl-transferase) and suicidal behaviour gave reason to choose a clear phenotype description of suicidal behaviour and take childhood maltreatment as environmental factor into account. The aim of this candidate-gene-association study was to eliminate heterogeneity within the sample by only recruiting affective disorder patients and find associations between COMT polymorphisms and defined suicidal phenotypes. In a sample of 258 affective disorder patients a detailed clinical assessment (e.g. CTQ, SCAN, HAMD, SBQ-R, VI-SURIAS, LPC) was performed. DNA of peripheral blood samples was genotyped using TaqMan® SNP Genotyping Assays. We observed that the haplotype GAT of rs737865, rs6269, rs4633 is significantly associated with suicide attempt (p = 0.003 [pcorr = 0.021]), and that there is a tendency towards self-harming behaviour (p = 0.02 [pcorr = 0.08]) and also NSSI (p = 0.03 [pcorr = 0.08]), though the p values did not resist multiple testing correction. The same effect we observed with the 4-marker slide window haplotype, GATA of rs737865, rs6269, rs4633, rs4680 (p = 0.009 [pcorr = 0.045]). The findings support an association between the COMT gene and suicidal behaviour phenotypes with and without childhood maltreatment as environmental factor.

Assessing Caregiver Burden in Caregivers of Patients with Schizophrenia and Bipolar Affective Disorder in Kathmandu Medical College.

Schizophrenia and bipolar affective disorder are chronic psychiatric illness that requires long term care. This study tends to measure psychological burden and factors associated with it among caregivers of these two illnesses. This is a cross- sectional study that included participants by purposive sampling method. Self designed performa was used to collect the socio-demographic details of the caregivers. Modified caregiver strain index was used to assess the overall stress. Beck`s depression inventory and Beck`s anxiety inventory was used to assess depression and anxiety respectively. Hundred caregivers, 50 each of schizophrenia and bipolar affective disorder were enrolled. Seventy-two percent of caregivers were found to have higher level of stress. Twenty-five percent had depression and 29% anxiety related problems. Stress was found to be significantly associated with being in debt, longer duration of illness, education level, marital status, subjective feeling of psychological stress and self- acknowledgement of need of professional help. Caregivers of both group experienced similar level of stress. Psychological burden is seen to be high in caregivers of patients of Schizophrenia and Bipolar Affective Disorder.

Disability in bipolar affective disorder patients in relation to the duration of illness and current affective state

Background: Bipolar affective disorder (BPAD) is an episodic illness in which episodes of depression/Mania/Mixed/Hypomania occur. BPAD has been found to be associated with the following types of disability: increased suicidal behavior, higher unemployment, higher dependence on public assistance, lower annual income, and increased work absenteeism owing to illness, decreased work productivity, poorer overall functioning, lower quality of life, and decreased lifespan. The two affective disorders, major depressive disorder, and bipolar disorders were associated with the large decrements in functioning. Bipolar disorder was particularly strongly associated with having missed time at work. Depressive disorders have been associated with a larger number of disability days and poorer role functioning than several common general medical diseases – arthritis, hypertension, and diabetes. Aims: This study aims to study the disability in bipolar patients in relation to the duration of their illness and current effective state. Methodology: Clinical and sociodemographic details of patients and caregivers were collected using a semi-structured pro forma. Indian Disability Evaluation and Assessment Scale is used to assess patients' disability. The diagnosis of BPAD is made in accordance with the International Classification of Disease-10 criteria. Results: Severe disability is seen where the duration of illness is Conclusions: Severe disability is seen where the duration of illness is

Comparison of the burdens of caregivers of patient with bipolar disorder-I and schizophrenia patient

Objective: This study aimed to compare the burden of caregivers of patients with bipolar disorder and schizo-phrenia, and its relationship with sociodemographic variables of the subjects and clinical features of the disorders. Methods: Sixty-two schizophrenia and 62 bipolar affective disorder-I patients with their caregivers who consulted Uludag University Medical Faculty outpatient clinic of Department of Psychiatry were enrolled to the study. Patients with schizophrenia were assessed on Positive and Negative Syndrome Scale, patients with bipolar affective disorder-I were assessed on Hamilton Depression Rating Scale (HDRS) and Young Mania Rat¬ing Scale. Global Assessment of Functioning (GAF) Scale, sociodemographic and Clinical Characteristics Data Form were applied to each patient. Caregivers of the patients were assessed on HDRS, Hamilton Anxiety Rating Scale (HARS), Zarit Caregiver Burden Scale (ZCBS) and Socio-demographic Characteristics Data Form. Results: It is found that the scores of ZCBS for schizophrenia patients’ caregivers were significantly higher than those bipolar affective disorder patients’ caregivers. Scores of HDRS and HARS were significantly correlated with the score of ZCBS in both care-giver groups. Conclusion: Caregivers of schizophrenia patients are more likely to be affected negatively than those of bipolar affective disorder patients, therefore psychological support should be considered for caregivers.

Burden and Expressed Emotion in Caregivers of Schizophrenia and Bipolar Affective Disorder Patients: A Comparative Study

Background: Caregiver burden and expressed emotion have been studied in patients with schizophrenia but literature is less regarding these in bipolar affective disorder (BPAD). No study could be found which compared the caregiver burden and expressed emotion in these two patient groups. Hence, the study is conducted to investigate and compare the caregiver burden and expressed emotion in caregivers of patients with schizophrenia and BPAD. Materials and Methods: Data were collected from outpatient department of psychiatry, Institute of Mental Health and Hospital, Agra regarding sociodemographic characteristics (e.g., age, gender, domicile), followed by burden assessment schedule, family emotional involvement and criticism scale, positive and negative syndrome scale, Young mania rating scale, and hamilton depression rating scale (HDRS) from patients of schizophrenia and BPAD and their caregivers. Descriptive statistics such as mean and standard deviation (SD) and unpaired t test were applied for continuous data and chi square for categorical data. Spearman correlation was used to find correlation. Results: No statistically significant difference between the sociodemographic variable of either patient of schizophrenia and bipolar disorder or their caregivers was observed. Significantly higher total burden (P = 0.01) with mean value of 82.8 (SD = 8.8) in caregivers of patients with schizophrenia compared to BPAD with mean value of 76.7 (SD = 12.3) was noted. Emotional over-involvement was significantly more in patients with BPAD compared to patients with schizophrenia (P = 0.0007). Spearman correlation shows positive correlation among age of caregivers, education, and burden of care in both the groups (P

Standards of Lithium Treatment Monitoring In a Teaching Hospital in South India among Bipolar Affective Disorder

Background: Lithium is a commonly used drug with a narrow therapeutic index, it has significant adverse effects on kidney and thyroid, and is life threatening during intoxication. Maudsley guidelines on managing bipolar affective disorder patients (BPAD) with lithium recommends checking weight at baseline and every 3rd month, serum lithium after 7th day thereafter 3 months once, renal function test and serum thyroid stimulating hormone (TSH) at baseline and 6 months once. Aim: To evaluate whether Pre-Lithium workup and monitoring is done in Bipolar affective disorder (BPAD) patients initiated on Lithium as per Maudsley prescribing guidelines in psychiatry. Method: Retrospective audit conducted in a tertiary care hospital on lithium monitoring in BPAD patients treated with lithium atleast for six months compared against Maudsley prescribing guidelines. Results: Among medical records of 114 bipolar patients fulfilling study criteria, weight and serum lithium at baseline was checked in 100% of patients; serum creatinine and TSH at baseline along with lithium at 3rd month was done in 83.3%, 78.9% and 68.4% of patients respectively. Maudsley guidelines for serum creatinine, TSH and lithium level at 6th month were met only in 43.8%, 43.8% and 72.8% of patients respectively. Conclusion: The quality of lithium monitoring in bipolar patients falls well short of accepted standards; Hence addressing the issues in monitoring and following a standard protocol can improve the effectiveness of treatment and quality of life of patients.

Impact of Pharmacist-Psychiatrist Collaborative Patient Education on Medication Adherence and Quality of Life (QOL) of Bipolar Affective Disorder (BPAD) Patients.

Background: Bipolar Affective Disorder (BPAD) is one of the leading causes of disability globally. Medication non-adherence and low quality of life (QOL) are the major challenges associated with the treatment of BPAD patients.Objective: Aim of this study was to assess the impact of pharmacist–psychiatrist collaborative patient education on medication adherence and QOL of BPAD patients.Methodology: A prospective randomized control study was conducted in the psychiatry outpatient department in a tertiary care setting. The eligible patients were enrolled and randomized into test (collaborative care) and control (usual care) groups. Patient education was provided by pharmacists to the test group patients, along with the usual care provided to all the patients. Patients were followed for three follow-ups of nearly 1 month intervals. Medication adherence and QOL were assessed by Medication Adherence Rating Scale and WHOQOL-BREF questionnaire, respectively. T-test was used and P-values < 0.05 were considered statistically significant.Results: Out of 75 patients enrolled, 73 patients were followed for all the three follow-ups and completed the study. Thirty-eight patients belonged to test and 35 were in control group. The mean age of patients was 34.21 ± 10.91 years. Forty-eight (65.75%) patients belonged to age group of 18–39 years. There were 41 males (56.16%) and 32 female patients (43.83%) in the study. Mean improvement in medication adherence and QOL of the test and control groups were found to be 2.06 ± 0.15 (<0.001) and 13.8 ± 10.5 (<0.05), respectively.Conclusion: This study concluded that pharmacist–psychiatrist collaborative patient education can significantly improve the medication adherence and QOL of the BPAD patients. Statistically significant results indicating improved patient care and outcomes were possible when pharmacists worked as a team with psychiatrists.

Investigation of candidate genes reveals significant statistical epistasis between DISC1 and TPH2 in Bulgarian affective disorder patients

ABSTRACTThe aim of the present study was to search for joint influence of variants in affective disorder (AD) candidate genes by investigating statistical epistasis. Overall 24 single nucleotide polymorphisms (SNPs) in 9 AD candidate genes were analysed in 304 AD cases (270 bipolar disorder (BD) type I; 29 BD type II; 5 schizoaffective disorder bipolar type, 110 major depressive disorder) and 205 healthy prescreened controls. The results demonstrated statistical epistasis between variants in DISC1, TPH2, CRH, CLOCK, BDNF, ANK3 and SLC6A4. Multiple interactions involving TPH2, both protective and increasing the AD risk, were detected. Protective epistasis surviving Bonferroni correction was observed between DISC1 and TPH2, justifying further analysis, given their role in neurogenesis and synaptic plasticity and serotonin biosynthesis.

P 156 Correlation of regional brain volume and affective disorders 7T MRI based structural analysis of human hypothalami with anxiety symptoms

Objectives Essential features of the hypothalamus play a constitutive role in the depressive symptomatology and the anxiety generating stress response system. The involvement of the structure in the pathophysiology of affective disorders is undisputed. Only a few studies dealt with the association of anxiety symptoms in psychiatric disorders and the hypothalamus volume, tested via a lower resolution MRI ( Goldstein et al., 2007 , Terlevic et al., 2013 , Cheng et al., 2015 ). Yet their results remained contradictory. This substantiated our interest to verify the correlation of the hypothalamus volume and the anxiety score of affective disorder patients, hypothesizing a negative correlation. Method 61 patients, aged 20–62 years and suffering from major depressive or bipolar disorders participated in the study. The method of Schindler et al. (2013) was used to perform the hypothalamus volumetry. The anxiety score was calculated with items from the Inventory of Depressive Symptomatology (IDS) according to the factor analysis of Rush et al. (1996) . Results Kendall’s correlation shows a significant moderate correlation between the left hypothalamus volume and the anxiety score of patients with a medicated major unipolar depression ( τ b = 0.391 , p = 0,019). For patients with unmedicated major depressive or bipolar disorder the effect was not significant. Conclusions To our knowledge, this is the first study exploring a positive correlation of an anxiety score and the hypothalamus-volume, investigated with high-resolution 7T images, in affective disorders. The formerly presumed negative correlation between hypothalamus and anxiety score was refuted. However due to the contradictory state of research we could only put forward a weak hypothesis. In light of these results, future studies would have to review the correlation with an extended sample, an own factor analysis and a more precise anxiety scale.

Prevalence and Sociodemographic Profile of Lithium-induced Cutaneous Side Effects in Bipolar Affective Disorder Patients: A 1-year Prospective Observational Study in South India.

Objectives:Objective in our study is i) To assess the prevalence and sociodemographic profile of cutaneous side effects in bipolar affective disorder patients (BPAD) on lithium. ii) To assess the course of pre-existing skin reactions, when patient is initiated on lithium therapy.Methods:Lithium induced cutaneous side effects were assessed at baseline and monthly for 6 months followed by every 2 months over a year. Dermatologist opinion obtained to diagnose and treat for each patient who developed cutaneous side effects. Data were analyzed in percentage.Results:The prevalence of lithium induced cutaneous side effects in our study is 38.46%. On analyzing the individual subtype of cutaneous lesions, acneiform eruption and hairfall were most common. The cutaneous adverse reactions on lithium are more common in early adulthood than in the late adulthood and geriatric age group and among the subtypes of skin lesion acneiform eruptions are more common among males than in females. On analyzing the course of pre-existing lesions, severe alopecia developed with pre-existing systemic lupus erythematosis.Conclusion:These novel finding indicate that prevalence of lithium induced cutaneous side effects continues to be high. Hence, clinician should educate the patients before initiating lithium to improve attrition rate.

Sensory profiles as potential mediators of the association between hypomania and hopelessness in 488 major affective outpatients

IntroductionExtreme sensory processing patterns may contribute to the pathophysiology of major affective disorders. We aimed to examine whether significant correlations exist between sensory profiles, hypomania, self-reported depression, and hopelessness and whether sensory profiles may be potential mediators of the association between hypomania and depression/hopelessness. MethodsThe sample consisted of 488 euthymic affective disorder patients of which 283 diagnosed with unipolar and 162 with bipolar disorder with an age ranging from 18 to 65 years (mean = 47.82 ± 11.67). ResultsLower registration of sensory input and sensory sensitivity significantly correlated with elevated self-reported depression, hopelessness, and irritable/risk-taking hypomania while sensation seeking and avoiding significantly correlated with elevated depression and hopelessness but not with irritable/risk-taking hypomania. Moreover, individuals with lower ability to register sensory input and higher hypomania showed higher self-reported depression than those with good registration of sensory information. According to SEM analyses, there was both a direct/indirect effect of irritable/risk-taking on depression-hopelessness with the mediation model explaining 48% of the variance in depression-hopelessness. LimitationsThe relatively small sample size and the cross-sectional nature of the study design do not allow the generalization of the main findings. ConclusionLow registration was associated with enhanced depressed mood and hopelessness while sensory seeking may be considered a resilient factor.

Schizophrenia or Atypical Lupus Erythematosus with Predominant Psychiatric Manifestations over 25 Years: Case Analysis and Review

We observed a case over 25 years of relapsing–remitting schizophrenic spectrum disorder, varying regarding the main symptomatology between more depressive or more schizoaffective or rather typical schizophrenic syndrome. Diseased phases were repeatedly accompanied by minor skin lesions, which were initially classified as mixed tissue disorder. Psychotic phases were waxing–waning over years. During one later relapse, skin involvement was severe, classified to likely represent an allergic reaction to psychopharmaca; this generalized exanthema remitted rapidly with cortisone treatment and azathioprine. Under continued azathioprine and low dose neuroleptics, the patient remitted completely, appearing psychiatrically healthy for 16 years. When azathioprine was set off due to pregnancy, an extraordinary severe relapse of schizophrenia like psychosis accompanied by most severe skin lesions developed within a few weeks, then requiring 2 years of psychiatric inpatient treatment. Finally, a diagnosis of systemic lupus erythematodes plus neuropsychiatric lupus was made. A single CSF sample in 2013 showed suspicious biomarkers, matching with CSF cytokine profiling in schizophrenic and affective spectrum disorder patients and indicated mild neuroinflammation. Complex immune suppressive treatment was reinitiated short after relapse, but was only partially successful. However, surprisingly the psychosis and skin lesions remitted (in parallel) when belimumab was given (add-on). The very details of this complicated, long-term disease course are discussed also with regard to general ideas, in particular with respect to the question if this case of seemingly comorbid schizophrenia with minor autoimmunity signs represented a case of one emerging autoimmune disorder with variant manifestations systemically and within the CNS, though atypically with predominant appearance as a schizophrenia spectrum disorder.

Smooth pursuit eye movements in psychiatric inpatients

IntroductionEye movements are used in several studies as a biomarker in order to evaluate cortical alterations in psychiatric disorders. Pursuit eye movements’ deficits were found both in schizophrenia and in affective disorder patients. Nevertheless, these findings are still controversial.ObjectivesSet up a system to record and evaluate the eye movements in psychiatric patients.AimsTo verify the applicability of a smooth pursuit task in a sample of psychiatric inpatients and to prove its efficiency in discriminating patient and control group performance.MethodsA sample of psychiatric inpatients was tested at psychiatric service of diagnosis and care of AUSL Romagna-Cesena. Eye movement measures were collected at a sampling rate of 60 Hz using the eye tribe tracker, a bar plugged into a PC, placed below the screen and containing both webcam and infrared illumination. Subjects underwent to a smooth pursuit eye movement task. They had to visually follow a white dot target moving horizontally on a black background with a sinusoidal velocity. At the end of the task, a chart of the eye movements done is shown on the screen. Data are off-line analyzed to calculate several eye movement parameters: gain, eye movement delay with respect to the movement of the target, maximum speed and number of saccades exhibited during pursuit.ResultsPatients compared to controls showed higher delay and lower gain values.ConclusionsFindings confirm the adequacy of this method in order to detect eye movement differences between psychiatric patients and controls in a smooth pursuit task.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Incidence of Hepatitis B and C Infections in Patients of Mental Disorders

Ojective: It is estimated that Hepatitis B (HBV) and Hepatitis C (HCV) diseases have high morbidity, affecting more than 400 million people in the world. Turkey is considered as a semi-pandemic region for these infections. Methods: In this study, our aim is to determine the seroprevalance of HBV and HCV in psychiatric hospitalized patients which is thought to be the risk group and to support the literature in terms of protective precautions in the progressed stages. Our study was performed between February-2014 and January 2015 in Diyarbakir Selahaddin Eyyubi State Hospital psychiatry clinic. The patient’s files were investigated retrospectively, the results of serological tests (HBsAg, AntiHBS and AntiHCV) and socio-demographical data (age, sex, diagnoses and living areas) were used. Results: HBSAg positivity was 1.7% in schizophrenia patients, 0,8% in bipolar affective disorder patients, 0.4% in retarded patients and 0,3% in depression patients. A statistically significant relationship was found between schizophrenia and HBSAg. Conclusion: Similar precautions against viral hepatitis with high transmission rates should be applied in the chronic, disabled psychiatric patients just like the normal population. Active immunization will be useful in the schizophrenia group patients having relatively more risk. Extensive studies should be performed to obtain detailed and accurate data.

Evaluation of Oxidative Status in Patients Treated with Electroconvulsive Therapy.

ObjectiveElectroconvulsive therapy (ECT) is used in the treatment of many psychiatric diseases and this therapy may be effective on antioxidant defence system. In this study, we aimed to evaluate the effects of ECT on oxidative stress.MethodsFourteen major depression, 11 schizophrenia and 8 bipolar affective disorder patients diagnosed and received ECT treatment, and 37 healthy volunteers enrolled in the study. ECT was applied to all patients. Before ECT, after the first and last ECTs, serum samples were obtained. Serum total antioxidant status (TAS), total oxidant status (TOS), and calculated oxidative stress index (OSI) were measured in patients before and after ECTs.ResultsTOS values before ECT were higher in major depression (p=0.005) and schizophrenia (p=0.001) groups compared to the control group. TAS values were lower in major depression (p=0.0001), schizophrenia (p=0.004), bipolar affective disorder (p=0.004) groups compared to the controls. Also OSI values were higher in major depression (p=0.0001), schizophrenia (p=0.001), bipolar affective disorder (p=0.009) groups compared to healthy group. After the last ECT, TOS values were significantly lower compared to TOS values before ECT in major depression (p=0.004) and schizophrenia patients (p=0.004). TAS values after the first ECT were higher compared to values before ECT in major depression patients (p=0.004). After last ECT, OSI values were significantly lower compared to before ECT in schizophrenia patients (p=0.006).ConclusionAs a result, it can be said that ECT did not increase oxidative stress. However, further studies with more patients are needed.

Adverse Drug Events in Patients with Mental Disorder in an Ambulatory Setting.

Background:Although adverse drug events (ADEs) among inpatients occur frequently and are widely studied, few data are available on ADEs among outpatients with mental disorders.Aims:To determine the rates, types, and severity of ADEs in patients with mental disorder.Materials and Methods:Cross-sectional survey of patients with mental disorder attending outpatient department. Data were collected over a period of 6 months.Results:A total of 400 patients (217 schizophrenia patients, 127 bipolar affective disorder patients, and 56 patients of depression) with a mean age of 32.1 ± 9.7(±standard deviation) participated in the study. Patients suffering from schizophrenia and all nonadherent patients reported significantly more ADEs (P < 0.05). Out of 343 patients (86%) who reported at least one ADE, majority (87%) reported central nervous system ADEs followed by weight gain (48%), gastro-intestinal (28%), skin (4%), cardiovascular (1%), and sexual dysfunctions (0.3%). Out of 673 ADEs reported, sedation (41%) and weight gain (25%) were reported most commonly. Most ADEs reported (76%) were mild; however, there were no life-threatening, fatal, or serious ADEs. The medication classes most frequently involved in ADEs were antipsychotics (72%) followed by sedatives (44%), antimanic drugs (32%), and antidepressants (27%). Patients on atypical antipsychotic drugs reported significantly more body weight gain (P < 0.05). More than three drugs were prescribed in 49% of patients who reported ADEs.Conclusion:The study data indicate high prevalence of ADEs in the outpatients on psychotropic medications.

Association of executive dysfunctions and symptoms in a sample of bipolar affective disorder patients

Background Executive functions are defined as the higher-level cognitive functions that are necessary to plan and execute goal-directed behaviors and may include cognitive flexibility, creativity, planning ability, abstract thinking, concept formation, and response inhibition. Recently, it has been shown that those with schizophrenia, as well as those with bipolar disorder, exhibit deficits in executive functions relative to controls. Executive function capability is an important predictor of the treatment, prognosis, and functional outcomes of these disorders.Patients and methods This cross-sectional study was carried out in Suez Canal University Outpatient Psychiatric Clinic. It included 60 patients with bipolar disorder type 1 (male and female). All studied patients were subjected to assessment of the manic symptoms using the total scores of Young’s Mania Rating Scale and the depressive symptoms using the total scores of the Hamilton Depression Rating scale by researcher. Assessment of cognitive functions was carried out by an expert psychologist using the Wechsler Adult intelligence Scale, Wechsler Memory Scale-III-Revised Hayling Sentence Completion Test, Trail Making Test, and the Wisconsin Card-Sorting Test.Result The results showed worsening in the executive function associated with manic than with depressive symptoms.Conclusion Manic symptoms had a significant effect on cognitive functions.