Family History Of Psychiatric Illness Research Articles

The Challenge of Managing Patients Suffering from TBI: The Utility of Multiparametric MRI

Traumatic brain injury (TBI) is a complex phenomenon affecting multiple areas of the brain in multiple ways. Both right and left hemispheres are affected as well as supratentorial and infratentorial compartments. These multifocal injuries are caused by many factors including acute mechanical injury, focal intracranial hemorrhage, blunt and rotational forces, epidural and subdural hematoma, hypoxemia, hypotension, edema, axonal damage, neuronal death, gliosis and blood brain barrier disruption. Clinicians and patients benefit by precise information about the neuroanatomical areas that are affected macroscopically, microscopically and biochemically in an individual patient.Standard imaging studies are frequently negative or grossly underestimate the severity of TBI and may exacerbate and prolong patient suffering with an imaging result of "no significant abnormality". Specifically, sophisticated imaging tools have been developed which reveal significant damage to the brain structure including atrophy, MRI spectroscopy showing variations in neuronal metabolite N-acetyl-aspartate, elevations of membrane related Choline, and the glial metabolite myo-inositol is often observed to be increased post injury. In addition, susceptibility weighted imaging (SWI) has been shown to be more reliable for detecting microbleeds versus calcifications.We have selected two TBI patients with diffuse traumatic brain injury.The first patient is a 43-year-old male who suffered severe traumatic brain injury from a motorcycle accident in 2016. Following the accident, the patient was diagnosed with seizures, major depression, and intermittent explosive disorder.He has attempted suicide and has neurobehavioraldisinhibition including severe anger, agitation and irritability.He denies psychiatric history prior to TBI and has negative family history.Following the TBI, he became physically aggressive and assaultive in public with minimal provocation.He denies symptoms of thought disorder and mania. He is negative for symptoms ofcognitive decline or encephalopathy.The second patient is a 49-year-old male who suffered at least 3 concussive blasts in the Army and a parachute injury.Following the last accident, the patient was diagnosed with major depressive disorder, panic disorder, PTSD and generalized anxiety disorder.He denies any psychiatric history prior to TBI including negative family history of psychiatric illness. In addition, he now suffers from nervousness, irritability, anger, emotional lability and concurrent concentration issues, problems completing tasks and alterations in memory.Both patients underwent 1.5T multiparametric MRI using standard T2, FLAIR, DWI and T1 sequences, and specialized sequences including susceptibility weighted (SWAN/SWI), 3D FLAIR, single voxel MRI spectroscopy (MRS), diffusion tensor imaging (DTI), arterial spin labeling perfusion (ASL) and volumetric MRI (NeuroQuant).Importantly, this exam can be performed in 30-45 minutes and requires no injections other than gadolinium in some patients. We will discuss the insights derived from the MRI which detail the injured areas, validate the severity of the brain damage, and provide insight into the psychological, motivational and physical disabilities that afflict these patients. It is our expectation that this kind of imaging study will grow in value as we link specific patterns of injury to specific symptoms and syndromes resulting in more targeted therapies in the future.

Depression and anxiety among diabetics in primary care : a cross-sectional study

IntroductionDiabetes mellitus is one of the most frequent chronic diseases in Tunisia. Individuals with diabetes mellitus may have concurrent mental health disorders and are shown to have poorer disease outcomes.ObjectivesThe aim of this study was to determine the prevalence of depression and anxiety in diabetics attending the primary care setting.MethodsThis was a cross-sectional survey carried out over two months and including diabetic patients followed up at the consultation for chronic diseases at the primary care center of Hiboun, in Mahdia, Tunisia. The validated Hosiptal Anxiety and Depression scale (HAD) questionnaire was used as a screening tool for the symptoms of depression and anxiety.ResultsA total of 64 patients (24 men and 40 women) was enrolled. The average age was 54.5 ± 7.2 years. The mean duration of diabetes was 8.2 ± 2.3 years. The average HbA1c level was 9.1%.Over 48% of patients were overweight. The prevalence of Depression and anxiety among patients with diabetes from our study was 29.6% and 40.6%, respectively. Depression was found to be significantly associated with marital status of widowed, HbA1c level of more than 8.5%, and a family history of psychiatric illness. anxiety was significantly associated with females, unmployement and HbA1c level of more than 8.5%.ConclusionsScreening of high risk Type II diabetics for depression and anxiety symptoms in the primary care setting is recommended at regular intervals.

Minor physical anomalies in unipolar depression

Introduction: Minor physical anomalies (MPA), are mild errors of the morphogenesis, having prenatal origin and may bear major information for diagnostic and prognostic purposes. The notion that early brain insults predispose to depression is supported by findings that some patients with the disorder exhibit morphologic evidence of subtle developmental abnormalities. Aim: The aim is to study MPA in depression. Objectives: (1) To study the association of MPA in depression, if any. (2) To study the most common MPA in depression. Materials and Methods: The study was conducted on 60 patients suffering from depression attending outpatient services and 60 healthy controls. Patients were evaluated for MPA using the Waldrop and Halverson Scale. Data were tabulated and analyzed using unpaired t-test. Results: The scores in the study group are significant than the control group suggesting an association between MPA and depression. The score of anomalies in the head, ear, and in the study group was significant. Correlation between age of onset and MPA was negative which suggests that as age increases the frequency of MPA decreases. More physical anomalies were found in the patient with a positive family history of psychiatric illness than the control group. Conclusion: A few number of studies have stressed on the need to screen and identify the link between MPA with underlying etiopathogenetic mechanisms in depression. Therefore, this is one of the few studies where a physical endophenotypic marker was evaluated helping to support the neurodevelopmental hypothesis of depression.

Suicidal ideation in schizophrenia: A cross-sectional study in a tertiary mental hospital in North-East India.

Introduction:Suicide is a leading cause of mortality in schizophrenia. The study attempts to find an association of suicidal ideation, a less studied entity than suicide attempt, with various sociodemographic and clinical profiles in patients with schizophrenia.Materials and Methods:It is a cross-sectional study involving 140 patients diagnosed as schizophrenia. Sociodemographic and clinical profiles were collected using a semi-structured proforma. Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, InterSePT Scale for Suicidal Thinking, and Drug Attitude Inventory-10 were applied to assess psychopathology, depressive symptoms, suicidal ideas, and attitude toward psychotropics, respectively. The analysis was done using appropriate statistics.Results:Majority of the study sample were Hindus, male, unmarried, literate, unemployed, and belonging from lower socioeconomic class. About 25.7% attempted suicide earlier and 29.3% currently have suicidal ideation. A previous suicide attempt, family history of psychiatric illness and that of suicide and comorbid substance use, significantly predicted (p < 0.05) a current suicidal ideation. Ideation has also been found to be significantly correlated to comorbid depression and the positive, negative, emotional, and excitement domains of schizophrenic psychopathology.Conclusion:The current study shows suicidal ideations in schizophrenia patients to be significantly related to schizophrenic psychopathology and comorbid depression, thus calling for a holistic management in preventing a fatal outcome.

First-rank symptoms in Bipolar disorder: A case report.

Despite their description as characteristic symptoms of schizophrenia, first-rank symptoms (FRS) are also seen in other conditions.[1] The prevalence of FRS was 70% in schizophrenia, 29% in psychotic bipolar disorder, and 18% in psychotic depression.[2] Manic hyperactivity may at times be confused with psychotic agitation and excitement. Amidst debate on the diagnostic utility of FRS, they continue to be relevant from prognostication and treatment planning point of view.[3] The presence of FRS in bipolar affective disorder (BPAD) may be predictor of poor short-term outcome and decompensating the course of illness.[4] BPAD patients with mania or mixed episodes are more likely to be females. Younger patients had a higher prevalence of FRS.[5] The presence of FRS in psychiatric illness is associated with poor long-term residential status and poorer psychosocial functioning.[6] We present a case of bipolar affective disorder who at presentation had florid psychotic symptoms with FRS. A 19-year-old female, BA LLB student, with no family history of psychiatric illness, premorbidly stable extrovert with past history of an insidious onset gradually progressive persistent and pervasive depressed mood, loss of interest and enjoyment, reduced concentration and attention, reduced self-esteem and self-confidence, disturbed sleep and diminished appetite in September 2019 remitted gradually without treatment over 3–4 months. She manifested in November 2020 with acute onset and progressive elevated and expansive mood, increased physical restlessness, and over-talkativeness. She was suspicious as she was unable to upload video on Instagram and believed that unknown people are jealous of her celebrity status and has hacking her mobile and network. General physical and systemic examinations were within normal limits. Mental status examination revealed her to be well-groomed, wearing colorful clothes with matching mask, and nail polish. She entered the chamber without seeking permission with air of confidence around her. She briskly shook the hand with examiner and sat on chair without asking as if in casual conversation. She was suspicious that the wall clock had monitoring device and there was someone behind the curtain. She was easily distractible by people entering the room. She was over-familiar, jocular, distractible, and had increased motor activity. She had elated affect, flight of ideas, delusion of grandiosity and persecution, intermittent auditory hallucination giving a running commentary on her action, ill sustained concentration, impaired judgment and insight, and decreased need for sleep and increased energy. Her hematological, biochemical parameters (including thyroid profile), and NCCT head were within normal limits. Young Mania Rating Scale score was 32/60, suggestive of moderate mania. Rorschach psychodiagnostic test revealed an increased number of responses, decreased initial and total reaction time, high number of color, sexual, and movement responses. New and additional responses in inquiry were suggestive of mania. She was provisionally diagnosed as a case of bipolar affective disorder, current episode manic with psychotic symptoms. She was started on tablet risperidone 2 mg/day and tablet lithium 900 mg/day. Psychoeducation about the illness and relapse prevention was taught to which she responded well. Schizophrenia is often difficult to diagnose, and it is important not to give a label of Schizophrenia to those who do not suffer from it.[7] In the index case, there was a diagnostic dilemma in view of the initial presentation with widespread persecutory delusions obscuring the disturbance of affect. The presence of FRS further complicated the clinical picture. However, history suggestive of a depressive episode which remitted without medications over 4 months compelled us to consider a diagnosis of BPAD with psychotic symptoms as more likely. She responded well to antipsychotic and mood stabilizer and supportive psychotherapy with improvement in mood, social and academic functioning. The index case underscores the importance of being aware of overlapping nature of symptoms in various psychiatric disorders, the need for close serial monitoring of patients for evolution of new symptoms of changing psychopathology and the utility of Rorschach psychodiagnostic test in difficult cases. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

COVID-19 presenting with catatonia.

Infection with SARS-CoV-2 has resulted in a global pandemic, with predominant respiratory symptoms. High rates of anxiety, depression, and Post traumatic stress disorder (PTSD) have been the usual psychiatric presentation in people with COVID-19.[12] Neurologic sequelae has also reported.[34] Catatonia has been associated with various psychiatric disorders and medical conditions, including infections, metabolic, autoimmune, inflammatory, and substances, including antipsychotics, immunosuppressants, antibiotics, and recreational drugs.[5] This case highlights a rare neuropsychiatric presentation of COVID-19. A 28-year-old COVID-19–positive female with no past or family history of psychiatric illness presented with sudden onset of over talkativeness, muttering to self, disturbed sleep, for the past 3 weeks with reduced speech output, reduced oral intake, and poor self-care for 1 week. The patient was talking excessively, was irritable, and remained awake throughout the night, pacing around. She remained inattentive, barely did any of the chores, and was not looking after her children properly. Her spouse noticed her muttering to self and seemed fearful; on asking, the patient said that she was hearing voices but did not elaborate. Her self-care and appetite were poor. After admission to a private psychiatry hospital, she stopped talking completely and acted exactly opposite of what was being told. The patient kept doing repeated activities, without any apparent reason and refused to accept food or water, so Ryle's tube was inserted. She was diagnosed as a case of acute psychosis and was treated with oral and injectable antipsychotics. The patient showed 10% improvement; however, as she tested positive for COVID-19, she was referred to a dedicated COVID hospital, for both psychiatric and COVID-19 management. There was no history of head injury, convulsion, substance use, fluctuating consciousness, or any known medical comorbidity. On Mental status Examination (MSE), she was unkempt, conscious, uncooperative, and noncommunicative. She had catatonic features in the form of stupor, mutism, stereotypy, negativism, withdrawal, and ambivalence. Her affect was flat and nonreactive. No hallucinatory behavior was noted. Social judgment and insight were lacking. Bush Francis Catatonia Rating Scale score was 16 (suggestive of moderate catatonia). Her physical examination and baseline laboratory investigations, chest X-ray, and computed tomography brain did not reveal any abnormality. With a diagnosis of “catatonia due to another medical condition,” lorazepam challenge test was done, to which her catatonic features responded well. Intravenous (IV) lorazepam was continued, with routine COVID-19 protocol, IV fluids, and Ryle's tube (RT) feeding. Her catatonic features subsided gradually, and the patient was discharged on day 8 with 90% remission, on tablet lorazepam 1 mg BD, and on tablet olanzapine 5 mg HS along with routine COVID management and strict home isolation for 14 days. COVID-19 presenting in the form of catatonia is not a common finding. However, as quoted by Caan et al., “catatonia can be associated with acute COVID-19. They have also highlighted the importance of considering a diagnosis of catatonia in medically hospitalized patients who display altered mental status and motor abnormalities.”[6] Emerging evidence supports the association between acute COVID-19 infection and neuropsychiatric complications.[7] Exposure to proinflammatory cytokines has been associated with alterations in GABAergic and dopaminergic modulation of the corticobasal ganglia–thalamocortical circuit.[8] An immune response to infection, psychological trauma, and socioeconomic stressors are found to be other contributing factors.[910] COVID-19 is likely to have an effect on other organ systems in the human body, apart from the respiratory system, both in short and long term. Neuropsychiatric aspects of COVID-19 should be considered while treating the patients. Conversely, comorbid diagnosis of COVID-19 should be investigated in patients presenting with acute-onset behavioral disturbances. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Delusional parasitosis after sexual abuse.

Delusional parasitosis (DP), also known as delusional infestation, monosymptomatic hypochondriacal psychosis, or Ekbom's syndrome, is a rare primary psychiatric disorder.[1] It is characterized by patients' fixed belief that their skin and body and rarely also their close personal environment are infested by small, vivid, or less frequently inanimate pathogens, although there is no medical or microbiological evidence for this.[2] Most, but not all, patients blame the pathogens for causing various tactile sensations and itching. It has most frequently been reported in women, the sixth decade of the person's life. There are some case reports of the condition as an initial syndrome of neurodegenerative diseases, such as dementia, multiple system atrophy, cerebral infarction, severe heart disease, diabetes mellitus, and other severe systemic disorders.[3] Proper diagnosis and treatment of such patients will lead to better functioning and quality of life.[4] Studies indicate that following sexual abuse, the subjects may develop anxiety disorders, depression, eating disorders, PTSD, and sleep disorders and may attempt suicide.[5] A case of DP after sexual abuse is reported because of its rarity. 45 year old female, came to the outpatient department with complaints of being eaten up by insects from inside her body, itching, worrying thoughts that she would die because of the insects, and disturbed sleep for the past 3 years. She revealed a history of alleged rape by a local goon 10 years ago. She initially believed that she may have contacted HIV following the sexual assault, due to which she is having the sensations but it was ruled out. Later gradually she began to believe that she is harboring insects within her, which are eating her from the inside. She has never seen the insects, but she referred to the black dots on her skin as holes created by the insects. No past history of any mental or physical disorder was noted. No history suggestive of intellectual disabilities was noted. No history of any substance use or family history of psychiatric illness was noted. She was successfully treated with tablet trifluoperazine of 20 mg and tablet trihexyphenidyl of 4 mg along with regular counseling. Patients with DP are on average in the older age group often with comorbid disorders, but our patient was only 45 years old and had no comorbid disorders.[3] Approximately 80% of individuals with DP have a history of having concomitant mental disorders. Depression (74%) was the most frequent concomitant mental disease, followed by drug addiction (24%) and anxiety (24%), as also observed in our patient. Patients are frequently disturbed, and their illness takes over their life, causing personal and professional relationships to suffer. Some people manage to maintain a high level of productivity at work, while their personal lives are overrun by illusions. Many of the patients have done a lot of researches on the parasites they think are infecting them.[6] Patients may claim being exposed to a filthy environment or having a sexual interaction as the source of the infection, which was elaborated by the patient.[7] After therapy with conventional antipsychotics, the majority of studies reported aggregate partial and complete remission rates of 60%–100%. After 3–6 weeks, antipsychotic medication had an effect on delusional parasitosis.[8] Reassurance that there is no evidence of organic disease seldom brings solace to the patient. Patients frequently see several doctors in search of someone who will believe them and cure their illness. Establishing a favorable physician–patient connection is critical as is emphasizing the need of a comprehensive assessment and care plan that addresses all elements of the condition, including medication to relieve symptoms.[6] Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Prevalence and Risk Factors of Depression among Adult Type 2 Diabetic Patients at Al-Jemaih Diabetic Center, Dongola, Northern State, Sudan, 2019

Background: Type 2 diabetes and depression are common diseases with bidirectional associations. Depression in diabetics leads to poor adherence to diet and medication, poor glycemic control, reduced quality of life, and increased diabetes-related healthcare expenditure. This study aimed at evaluating diabetic patients with depression to improve the quality of care delivered. Materials and Methods: An institution-based cross-sectional study was conducted among adult type 2 diabetics at Al-Jemaih Diabetic Center, Dongola, in July–December 2019A standardized pretested questionnaire was used to collect data, and the depression subscale of the Patient Health Questionnaire was used to diagnose depression. Chi-square test and logistic regression were used to analyze the data using the Statistical Package for Social Sciences version 25.0. Results: Out of the 407 participants, 282 (69.3%) were females, and more than half were aged between 40 and 59 years. The prevalence of depression among type 2 diabetic patients was 35.6%, ranging from mild (24.3%) to moderate (7.4%), moderately severe (2.2%), and severe depression (1.7%). The risk factors associated with depression in type 2 diabetes were: combining antidiabetic therapy, long duration of diabetes, family history of psychiatric illness, diabetes-related complications, poor glycemic control, and lack of regular exercise. Conclusion: More than a third of type 2 diabetics have depression. Screening diabetic patients for depression, establishing a psychiatric unit at the diabetic center, and community-based studies are recommended.&#x0D; Key words: diabetes mellitus, depression, Dongola, Northern State

An Analytical Approach to Estimate Prevalence of Depression from a Non-Probability Sample of College Students in Karachi Using Beck Depression Inventory

Objective: To estimate and compare the prevalence of depression among college students in Karachi. The analytical approach was aimed to minimize biases produced by profession, gender, and age of samples on the prevalence rate.Methods: A cross-sectional study design was employed. Two hundred and sixty students were chosen from January 2018 to March 2019 through a purposive non-probability sampling technique from different professional colleges in Karachi. Beck Depression Inventory, a self-report questionnaire comprising 21 items was used as a study tool. After taking informed consent, each sample was inquired about the profession, age, gender, and personal and family history of psychiatric illness. Diagnosed cases of any psychiatric illness were excluded. Samples were stratified on the basis of profession, gender, and age. A minimum sample size of 70 students was extracted from the total sample through quasi randomization. Statistical software SPSS version 16 was used for data entry, sample randomization and analyses.Results: Overall prevalence rate was 26.15%. Profession based stratification of samples showed prevalence rates of 21.81% and 29.33% in business and medical college students, respectively. Substrata of medical colleges i.e. public and private medical college students showed prevalence rates of 38.66% and 20%, respectively. Gender-based stratification showed a prevalence rate of 33.33% in female and 17.24% in male students. Age-based stratification showed a prevalence rate of 15.49% in teens (17-19 years) and 21.69% in the post-teen group (20-25 years). Independent sample t-tests showed a statistically significant difference between the strata of the profession, gender, and age and substrata of public and private medical colleges. A prevalence rate of 25.71% was estimated in quasi-randomized samples.Conclusion: Randomization, stratification and large sample sizes are employed to minimize biases in prevalence studies. The present study showed the importance of sample stratification based on age, gender, and profession in estimating the prevalence of depression. Results also showed the validity of the minimum sample size is calculated appropriately.

Psychiatry as a career: A survey of factors affecting students’ interest in Psychiatry as a career

The objectives of this study were to determine the characteristics of medical students and graduates interested in choosing psychiatry as a career and the obstacles in choosing this field of medicine. Two private and two public medical institutes were surveyed from June 2007 to August 2007. A self-administered questionnaire was distributed to third, fourth and final year students and to medical graduates doing their internship in these four medical institutes. A total of 909 medical students and graduates participated in the study. Seventeen percent of participants responded positively regarding their interest in psychiatry as a career. Significantly higher proportion belonged to private medical institutes (14% vs. 24%, P-value =0.001). There was no significant difference in reporting interest for psychiatry in regard to age, sex, year in medical school and whether or not the participant had done a psychiatry ward rotation. However significantly higher proportion of participants (22%, n=43) were reporting their interest in the field of psychiatry who had done more than a month long psychiatry ward rotation as compared to those participants (14%, n=54) with less than a month or no psychiatry rotation (P-value=0.01). More students were reporting their interest in psychiatry with a family history of psychiatric illness as compared to without family history (24% vs 16%, P-value=0.03). In conclusion, students and graduates with more than a month long rotation in psychiatry, studying in private medical colleges and with a family history of psychiatric illness were more interested in choosing psychiatry as a career.

English

BACKGROUND India has a large proportion of child and adolescent population. Psychiatric disorders are common among children and adolescents, but they are often underdiagnosed. Family environment influences psychopathology in young children. Identification of risk factors for child psychiatric disorders can lead to early identification of children at risk and facilitation of preventive interventions. METHODS The study was conducted among 103 children attending the Child Guidance Clinic (CGC) in a tertiary care institute in Kerala. A specially prepared proforma was used to obtain the sociodemographic profile and clinical variables. Global Family Environment Scale was used to assess the quality of family environment. ICD 10 classification of mental and behavioural disorders was used for making diagnosis, and Ravens Coloured Progressive Matrices was used for assessing intelligence. RESULTS Emotional disorders were seen more commonly in girls, and in older age group. Children with behavioural disorders were below average in academics and the difference between the groups was statistically significant. No statistically significant difference was found between the groups in socioeconomic status, locality, family type, family history of psychiatric illness, and in family environment. CONCLUSIONS Though there was no statistically significant difference, family history of psychiatric illness and poor and moderately unsatisfactory family environment was observed in a large proportion of children. This finding may have implication in management of childhood psychiatric disorders. KEYWORDS Family Environment, Children, Emotional Disorders, Behavioural Disorders

Traumatic Brain Injury in Children: The Psychological Effects of Mild Traumatic Brain Injury

ABSTRACT Concussion, or mild traumatic brain injury (mTBI), results from a force to the head and can cause acute physical, cognitive, and psychological symptoms. The majority of concussion symptoms will resolve within a month, but upward of a third of patients will have persistent, chronic symptoms. When these symptoms become chronic and persist beyond 1–3 months, this is termed post-concussion syndrome (PCS). Psychological changes associated with PCS may in part be due to a traumatic event and the injury itself and therefore post-traumatic stress reactions may contribute. In addition, alterations to daily life and alteration of lifestyle as a result of the injury can cause feelings of disconnection which in turn can feed anxiety and depression symptoms. A preinjury diagnosis or history of psychiatric or mood disorder, migraine, or family history of psychiatric illness is one the greatest risk factors for the development of PCS. It is recommended that evaluation of concussion and those with PCS take a multidisciplinary approach including evaluation by psychology, psychiatry, and/or neuropsychology. While most concussions do not require treatment, those with PCS will not likely see the resolution of their physical and psychological symptoms without intervention. Treatment is limited, but cognitive behavioral treatment has shown promise in the management of PCS symptoms. It is important to recognize the role psychology plays in the development and persistence of PCS and to recognize and seek collaborative care when treating these patients.

335 - BEHÇET DISEASE PRESENTING WITH ACUTE PSYCHOSIS

ObjectivesUsing as a starting point a clinical case, the authors performed a literature review to clarify the relationship between Behçet disease and acute psychosis.MethodsAnalysis of the patient's clinical process and brief review of the latest available literature on the subject, published in PubMed/Medline databases.ResultsMale patient, 55 years old, brought to the emergency room by fever, headache, hetero-aggressive behavior, disinhibited behavior, mood swings, euphoria, persecutory delusions and insomnia, in the last 4 days. He had no insight into his illness. There was no personal or family history of psychiatric illness and toxicological habits were irrelevant. Due to the personal history of posterior uveitis with bilateral macular edema, retinal vasculitis, genital aphthosis, papulo-vesicular lesions and recurrent bipolar aphthosis, the hypothesis of neuro-behçet was raised.ConclusionsBehçet's disease can present with neurological involvement - neuro -behçet - and can manifest itself with several psychiatric symptoms (euphoria, lack of insight, disinhibited behavior, agitation or psychomotor retardation, persecutory delusions, obsessive thoughts, anxiety, depression, insomnia or memory changes). Fever and headache usually appear in the prodromal stage and can be signs of onset or recurrence of the disease. The prevalence of neuro-behçet ranges from 2 to 50% and usually occurs 1 to 10 years after the first symptoms of the disease. Since it appears as the first manifestation of the disease in only 3% of cases, it is difficult to diagnose. The literature suggests that symptoms are generally resistant to treatment with conventional psychotropic drugs and so it is an important cause of morbidity and mortality.”

Correlations Between Family History of Psychiatric Illnesses and Outcomes of Spinal Cord Stimulation

Spinal cord stimulation (SCS) is a well-established procedure for chronic neuropathic pain. Research has established patients with personal psychiatric history do not fare as well as their correspondents following SCS surgery. We explored whether a documented psychiatric family history (PFH) correlated with worse outcomes following SCS surgery. We retrospectively reviewed our single-center, prospectively collected database of patients who received permanent SCS implants over the past eight years. Subjects were separated into those with documented PFH and those without. Subjects completed validated scales at preoperative, 6 ± 2 postoperative, and 12 ± 3 months postoperative visits. The percent change in scores from preoperative to postoperative timepoints was compared between subjects with PFH vs. controls. SCS subjects reporting a PFH demonstrated significantly worse 6-month outcomes on Pain Catastrophizing Scale-rumination subscale (p = 0.02), numeric rating scale (NRS) scores on "pain at its least" (p = 0.04) and NRS "pain right now" (p = 0.02). This group also endorsed greater disability as measured by the Oswestry Disability Index (ODI) throughout the follow-up period (p = 0.04 at 6 ± 2 months, p = 0.001 at 12 ± 3 months). Subjects with PFH may experience less improvement in disability following SCS as compared to subjects without PFH. They may take longer to achieve the same outcomes, including pain relief and decrease in pain rumination. Our findings show that improvements in the PFH cohort are equivalent to that of the no PFH cohort on all measures except ODI at 12-month follow-up. Thus obtaining a detailed PFH prior to performing SCS is important in order to implement pre-operative coping training for PFH patients, rather than exclusion from SCS.

Social Phobia and Its Impact on Quality of Life Among Regular Undergraduate Students of Mettu University, Mettu, Ethiopia.

BackgroundSocial anxiety disorder is a serious and disabling mental health problem that begins before or during adolescence, with the potential to significantly interfere with an individual’s daily functioning and overall quality of life.ObjectiveThe aims of this study were to assess the prevalence, severity, and quality of life towards social anxiety disorder among students of Mettu University, Ethiopia.Subjects and MethodsA cross-sectional study was conducted among a stratified sample of 523 undergraduate students to identify the prevalence, correlates of social anxiety disorder, and impacts on quality life. All participants completed the Social Phobia Inventory, Liebowitz Social Anxiety Scale, and World Health Organization Quality of Life-Brief Form, Turkish Version (WHOQOL-BREF-TR). Of 523 students, 26% were screened positive for social anxiety disorder. About 69.4% and 17.4% of the students had mild and moderate symptoms of social anxiety disorder, respectively. WHOQOL BREF-TR scores showed that students with social phobia had significantly lower quality of life quality than those without social phobia. Being criticized by others or fear of parties was the most commonly feared situations. Talking to strangers was the most commonly avoided situations. Being females, current tobacco use, and family history of psychiatric illness were factors significantly associated with social phobia symptoms using logistic regression analysis.ConclusionThe current study shows high prevalence of social phobia among the university students and its significant negative effects on quality of life which require prompt identification and treatment.

Characterization of Young Children Presenting to the Emergency Department for Mental Health Complaints.

From 2011 to 2015, psychiatric emergency department visits among youth in the United States increased 28% and psychiatric visits made up 10% of all pediatric emergency department (ED) visits. Previous research has focused on adolescent mental health, with little characterization of children 10 years of age and younger with mental health complaints. The primary objective of this study was to describe these children who presented to a pediatric ED for mental health complaints in terms of demographics and psychosocial factors. One researcher reviewed medical records of children 10 years and younger who presented to the Children's of Alabama ED between January 1, 2016 and May 31, 2016 with a mental health-related chief complaint. Patient data were then categorized based on demographic information, characteristics of the ED visit, and medical and social history. Descriptive analyses were run using SAS version 9.4. In total, 222 patients 10 years and younger were seen between January 1 and May 31, 2016. This age group makes up 20% of all of the children seen in the ED for mental health-related complaints. Patients were 73% male (n = 162) and ages 3 to 10 years, with a mean age of 7.8 years. Patients were 55% white (n = 122), 42% African American (n = 94), 1% Hispanic (n = 2), and 1% other ethnicity (n = 3). Patients' insurance coverage was 76% Medicaid (n = 168), 18% private insurance (n = 39), and 6% uninsured (n = 14). Of the 219 patients treated in the ED (3 left without treatment), 45% of patients were admitted (n = 100). Univariate analyses showed increased odds of admission for children with 3 or more prior psychiatric diagnoses (odds ratio [OR] 2.33, P = 0.03), a family history of psychiatric illness (OR 2.53, P < 0.01), history of any previous psychiatric care (OR 2.61, P = 0.01), a history of trauma (OR 1.84, P = 0.03), and a chief complaint of suicidal ideation (OR 1.54, P < 0.01). Analyses showed a decreased odds of admission for children referred to the ED by their school (OR -1.12, P < 0.01). The pediatric ED sees a significant number of children ages 10 years and younger for mental health-related complaints. Nearly half of these children were admitted for psychiatric care. Several factors were found to predict admission, which reflect psychosocial influences. These psychosocial factors are important targets for intervention both in the ED and in the community.

Long-term posttraumatic stress disorder in mine workers after a coalmining disaster

Background: A coalmine disaster has occurred in Turkey on 13 May 2014, which caused the death of 301 miners. Objective: This study aimed to determine the prevalence of posttraumatic stress disorder (PTSD) symptoms and the risk factors for PTSD among mine workers, 2 years after the coalmining disaster. Methods: This was a cross-sectional survey conducted between June 2016 and July 2016 among mine workers who were the employees of either the mine where the accident occurred or three other mines in the same area. Sociodemographic data form and PTSD Symptom-Scale Self-Report (PSS-SR) were used to collect data. Results: 672 mine workers participated in the study. At the time of the accident, 23.7% (n = 159) of them were in the mine where the accident occurred. The mean score on total PSS-SR was 4.27 (SD: ±4.49). Eighteen (2.7%) participants screened positive for PTSD. Logistic regression analysis revealed the significant risk factors for PTSD are: being single/divorced/widowed, having a chronic disease, having a family history of psychiatric illness and previously experiencing traumatic events more than one. Discussion: Coalmining workers have considerably high prevalence rate of PTSD symptoms after a coalmining disaster. Assessing PTSD and associated risks is important for preventive mental health services.

Evaluacija grupe pacijenata obolelih od epilepsije u pogledu kvaliteta sna, umora i depresije

Introduction: The aim of this study is to investigate the relationship between clinical features, sleep quality, fatigue and mental symptoms in epileptic patients. Material and Methods: This cross-sectional study was conducted at epilepsy outpatient clinic of Bozyaka Training and Research Hospital. 81 patients who were followed up for the diagnosis of epilepsy were included in the study. The patients were administered a sociodemographic data form, Pittsburgh Sleep Quality Index, Beck Depression Inventory, Fatigue Severity Scale. Results: The median age of the patients included in the study was 37.42 (51.9%) were women and 39 (48.1%) were men with an education period of 8 years. There was no previous family history of psychiatric illness. Seizure control was achieved in 34 (42%) patients. 53 (65.4%) patients were observed for focal type, 28 (34.6%) patients were for generalized type seizures. The median duration of epilepsy was 13 years. The median Beck Depression Inventory score of the patients was 13, and the number of patients with a Beck Depression Inventory score higher than 19 was 25 (30.9%). There was mild tiredness in 47 (58%) and chronic fatigue in 16 (19.8%) patients. The median of Pittsburgh Sleep Quality Index total score was 4 and 18.5% (15) had poor sleep quality. Chronic fatigue was higher in epilepsy patients without seizure control compared to those with seizure control (p = 0.001). Conclusion: The rate of patients with moderate and severe depression is high in our study. This indicates the significance of evaluating the diagnosis of depression in epilepsy patients. In the follow-up of these patients, it is crucial to investigate the causes of fatigue and depression carefully. Especially psychiatric expert opinion and multidisciplinary follow-up should be carried out without ignoring the presence of depression.

Epidemiology of Schizophrenia in an Indian Hospital

According to WHO estimates, schizophrenia affects approximately 24 million people worldwide As epidemiological studies on schizophrenia are sparse in India, present study was undertaken to analyze the Sociodemographic profile and distribution pattern of schizophrenia in India. Demography of the patients like age, sex, family history, ICD-10 sub class, outcome as clinical status of patient at the time of discharge and length of hospital stay were also studied. Marital status and family history of psychiatric illness were also studied. Majority of the patients were males 81(58.27%) The average age was 34.4±11.9 years. Predominance of males below 40 years and females above 40 years were observed. Paranoid schizophrenia was the major subclass (63.3%). The present study revealed an increasing trend of schizophrenia among the patients admitted in a tertiary care hospital.

Attitude of Parents to Childhood Psychiatric Disorders in Nigeria

Background: Many community and hospital based studies have found high prevalence of childhood psychiatric morbidity in the community and hospital. However, it has been noticed that few children are presented to hospital by parents with complaints related to psychological or emotional disturbances. This may be due to stigma and discrimination attached to mental illness including those of children. Aim: This part of the study set out to assess the attitudes of parents to childhood psychiatric disorders. It also set out to reveal what factors were associated with attitude and predictors of positive or negative attitude. Methodology: A cross-sectional study was carried out where parents were interviewed and the sociodemographic features of the child, parents and family were elicited. The study was carried out at Murtala Muhammad Specialist, hospital, Kano, Nigeria within a three months period. The child was assessed for psychological disorder with the Reporting Questionnaire for children. Parent’s attitude was assessed with a modified community attitude towards the mentally ill scale, (CAMI). Result: A total of two hundred and three subjects (203) were involved in the study. Most (78.3%) parents had negative attitude to childhood psychiatric disorders while only (13.8%) had positive attitude. Parents who classified a child as having a psychological component to their illness were more likely to exhibit positive than negative attitude (83.3% vs. 16.7%, X2 = 22.75, d.f = 1, p = 0.0002). Those with positive attitude were more likely to be mothers than fathers (71.4% vs. 28.6%; X2 = 4.78, d.f = 1, p = 0.04). Those with a family history of psychiatric illness were more likely to exhibit positive than negative attitude. (58.3% vs 41.7%; X2 = 18.94, d.f = 1, p = 0.0003). A child’s father being of lower social class predicted positive attitude. No variable predicted negative attitude. Conclusion: Most parents had negative attitude to psychiatric disorders in children. The study advocated health education and enlightenment programmes to enhance mental health literacy for parents so that they could develop a more positive attitude to psychiatric disorders including childhood psychiatric disorders which will lead to reduction in childhood psychiatric disorders and later adversities.