Mixed Anxiety-depressive Disorder Research Articles

Prevalence, Symptom Profiles, and Correlates of Mixed Anxiety-Depression in Male and Female Autistic Youth.

Relatively little attention has been given to mixed anxiety and depression in autistic youth, particularly how this differs between males and females. This study investigated sex-based differences in the prevalence and correlates of mixed anxiety and depression in a sample of 51 autistic males (M age = 10.16 yr, SD = 2.81 yr, and range = 6 yr to 17 yr) and 51 autistic females (M age = - 10.07 yr, SD = 2.76 yr, and range = 6 yr to 17 yr), matched for age, IQ, and autism severity. Self-reports on generalised anxiety disorder and major depressive disorder, morning salivary cortisol, ADOS-2 scores, and WASI-II full-scale scores were collected from these autistic youth, and data on the ASD-related symptoms of these youth were collected from their parents. The data were analysed for total anxiety-depression score levels, for the underlying components of this scale, and for the individual items used in the scale. The results indicate no significant sex differences for the prevalence of mixed anxiety and depression total scores or the underlying components of anxiety and depression or for the individual items of the mixed anxiety-depression scale. There were sex differences in the significant correlates of mixed anxiety and depression: morning cortisol and ASD-related difficulties in social interaction for females, and ASD-related behaviour for males. Males' feelings of being restless or edgy were correlated with their social interaction and repetitive and restricted behaviour. Females' difficulties in social interaction were correlated with their concerns about their abilities and their sleeping problems. Females' sleeping problems, their tendency to talk about dying, and feeling worthless, were correlated with their morning cortisol. These findings suggest that, while mixed anxiety and depression is experienced similarly by autistic males and females at the global, component, and individual item levels, specific aspects of the symptomatology of mixed anxiety and depression are differently associated with aspects of their ASD-related symptomatology and their levels of chronic physiological stress for males and females.

Multimodal Ayurveda and Yoga intervention in mixed depressive and anxiety disorder: A case report

Mental health disorders represent a significant global health challenge, affecting individuals across age groups, cultures, and socioeconomic backgrounds. This case report illustrates the integration of Ayurveda intervention and cognitive therapy module in the management of Mixed Anxiety Depressive disorder in 40-year-old male police personnel. The patient presented with symptoms of stress, anxiety, and depression attributed to his demanding work schedule and law-enforcement responsibilities. Ayurvedic interventions, including Jatamansi and Brahma rasayana, Yoga in the form of Naadi shuddhi pranayama, and personalized diet and lifestyle modifications, were given for three months with three months follow-up to address the patient’s symptoms comprehensively. General health questionnaire 12, 36-Item Short Form Health Survey questionnaire (SF-36) scale, Depression, anxiety, and stress scale - 21, World Health Organization quality of life brief version were used to assess the benefit of therapy. Significant improvements were observed in the patient’s sleep quality, stress levels, and overall mental well-being over the course of treatment. This case report highlights the efficacy of the multi-modal approach in promoting mental health and resilience in high-stress occupations, emphasizing the value of holistic healing modalities in addressing complex mental health concerns.

Influence of Education on Dental Anxiety and Fear in Mental Disorders after Viewing a Molar Extraction in Three Types of Mental Disorder Compared to Persons with No Mental Disorder.

Objective: The goal of this study is to validate the psychometric properties of the Modified Dental Anxiety Scale (MDAS) and the Dental Fear Scale (DFS) at three different times: seven days before, immediately after, and seven days after watching a video of surgical extraction of a lower third molar in a sample with four strata: anxiety disorder, adjustment disorder, mixed anxiety-depressive disorder, and no mental disorder ages 18-70 in a psychiatric clinic in Malaga. Methods: The Research Ethics Committee of the Virgen Macarena-Virgen del Rocío Hospitals approved the study. After being interviewed by a psychiatrist and subsequently completing the Hamilton Rating Scales for Anxiety and Depression, the participants were divided into 4 strata (60 persons in each). The influence of education level was then analyzed. Results: The scales demonstrated good psychometric properties, with higher MDAS and DFS scores for lower levels of education and mixed anxiety-depressive disorder. Conclusions: Patients who show higher levels of dental anxiety and dental fear will be those with lower education levels, as well as those who suffer from mixed anxiety-depressive disorder.

Cross-Cultural Adaptation and Validation of an Attitude about Euthanasia Scale in Portuguese Older Adults with Mixed Anxiety-Depressive Disorder.

On 25 May 2023, the Portuguese parliament approved the decriminalisation of euthanasia for incurable illnesses. As the experiences of other countries show us, it will be a matter of time before mental disorders are addressed. Studying the phenomenon, particularly in vulnerable groups, in advance is essential for proper law drafting. Therefore, instruments that allow an objective assessment and comparison between groups must be available. This study aims to explore the validation of Faria's attitude about euthanasia scale in Portuguese older adults with mixed anxiety-depressive disorder. A sample of 114 older adults with mixed anxiety-depressive disorder collected by convenience in the Psychiatry Department of Senhora da Oliveira Hospital in Portugal was included. The pre-final version of the scale was tested in a small group with good results. The validity of the internal structure was analysed using exploratory factorial analysis. The internal consistency study verified reliability. For construct validity, we assessed the correlation with other validated scales measuring attitudes toward euthanasia, cognitive performance, personality and empathy. The attitude about euthanasia scale showed good internal consistency. One factor was retained in the principal component analysis. Significant correlations verified construct validity. The results support the scale's usefulness and validity. This study makes available a unique instrument to assess the overall tendency of the attitudes towards euthanasia from the European-Portuguese perspective, which can be used, for example, to compare Portuguese with Brazilian older adults suffering from the same disorder. Furthermore, the adapted scale paves the way for other cross-cultural translations, adaptations, validations, and comparative analyses.

Multidimensional Study of the Attitude towards Euthanasia of Older Adults with Mixed Anxiety-Depressive Disorder.

This study aims to verify if older adults with mixed anxiety-depressive disorder are more prone to euthanasia and identify factors that interfere with their satisfaction with health and capacity for well-informed decisions. The study applied a paper questionnaire composed of a sociodemographic section and a battery of scales (to assess depression, anxiety, cognitive performance, suicide risk, therapeutic adhesion, functionality, loneliness, attitude towards euthanasia, decision pattern, personality, empathy, and health status) in the Psychogeriatric Unity of Senhora da Oliveira Hospital in Portugal. The sample was collected by convenience to include patients and controls of the same age. Six months later, a reassessment was performed. Patients and controls were compared using descriptive statistics and a multiple-regression model. A total of 114 patients and 25 controls were included. Eighty-one point six percent of patients had four or fewer years of schooling. Contrary to controls, they presented mild depressive and anxiety symptoms, loneliness feelings, worse cognitive performance, a more fragile personality, higher personal distress, and a poorer health state. No statistically significant differences were found between controls and patients regarding their attitudes towards euthanasia. Patients more favourable to euthanasia had higher empathic concern, conscientiousness, and fantasy, and lower personal distress. When addressing euthanasia in these patients, it is crucial to ensure they are fully self-determinate and that all the necessary treatment and support are available. It may not be the case when the educational level is low and a mild disease persists, significantly affecting their well-being and cognitive performance.

Mixed anxiety-depressive disorder in Parkinson's disease associated with worse resting state functional response to deep brain stimulation of subthalamic nucleus

BackgroundParkinson's disease (PD), even though generally perceived as a dominantly motor disorder, is associated with a wide range of non-motor symptoms, including mixed anxiety-depressive disorder (MADD). ObjectivesThe aim of the presented study was to determine whether deep brain stimulation (DBS) of the subthalamic nucleus (STN) brings the functional characteristics of non-motor networks closer to the condition detected in healthy population and whether pre-DBS presence of MADD in PD patients was associated with different reaction to this therapeutic modality. MethodsResting-state fMRI signature elicited by STN DBS activation and deactivation in 81 PD patients was compared against healthy controls, with the focus on measures of efficiency of information processing and localised subnetwork differences. ResultsWhile all the MRI metrics showed statistically significant differences between PD patients in DBS OFF condition and healthy controls, none were detected in such a comparison against DBS ON condition. Furthermore, in the post-DBS evaluation, PD patients with MADD in the pre-DBS stage showed no differences in depression scales compared to pre-DBS psychiatrically intact PD patients, but still exhibited lower DBS-related connectivity in a subnetwork encompassing anterior and posterior cingulate, dorsolateral prefrontal and medial temporal cortices. ConclusionsSTN DBS improved all the metrics of interest towards the healthy state, normalising the resting-state MRI signature of PD. Furthermore, pre-DBS presence of MADD, even though clinically silent at post-DBS MRI acquisition, was associated with lower DBS effect in areas highly relevant for depression. This finding points to a possibly latent nature of post-DBS MADD, calling for caution in further follow-up of these patients.

Preliminary results of “Choose Life!” - a county-wide programme for suicide prevention and mental health awareness

IntroductionSuicidality and depression awareness still remains a concern in Hungary. This programme, based on the principles of the European Union Against Depression, implemented its five steps, such as: 1. improving family doctors’ readiness to diagnose and treat depression, 2. increasing public awareness, 3. training stakeholders and community facilitators, 4. offering special help for risk groups, 5. facilitating self-help by the online tool “ifightdepression” in five of seven districts of Heves county from November 2014 until May 2016.ObjectivesWe aimed to look at some clinical outcome measures of the programme, like diagnosis density of depression in primary care before and after the intervention; diagnosis density of depression in outpatient services; suicide attempts in specialised care; and completed suicide rates.MethodsWe extracted patient turnover data from the joint database of the National Healthcare Fund and the National Directorate-General for Hospitals. Raw patient turnover data were divided by the total patient turnover in order to obtain diagnosis density. For the diagnosis of depression, we used the sum of the ICD-10 diagnoses of F32 (depressive episode) to F33 (recurrent depression) plus F4120 (mixed anxiety-depressive disorder), as family doctors tend to use these diagnoses interchangeably. For suicide attempts, we used the diagnoses X60 to X84, plus Y8700. For completed suicides we used the same diagnoses with the “deceased” flag. Diagnosis densities were compared with concurrent national data and were standardised to the long-term average. In the case of outpatient services, we only could retrieve monthly data, which we smoothed out with threemonthly moving averages.ResultsBaseline diagnosis density of depression in primary care was already 44% above the national average when the program started and after the kickoff, it shortly went up to 53,3% and remained over the baseline for as long as until 2019. Also, the recognition rates of depression with no comorbidities in primary care increased by 6%, and steadily remained over the national average until 2019. For outpatient psychiatry, there was an 8% increase in depression turnover throughout the duration of the programme. As regards to suicide attempts treated in hospital, the rates went 20% below the national averages for the duration of the programme, and mostly remained there until 2020. Fatal suicidal events accounted for five to seven deaths a year per county, therefore, simple statistical methods could not uncover significant differences.ConclusionsThese early results indicate that the programme may have been effective in terms of reinforcing the diagnostic and treatment capacities of primary care for recognising a treating depression adequately, thereby eliminating suicide risk. Further statistical exploration of the data is still needed to confirm the magnitude and the validity of these results.Disclosure of InterestNone Declared

Retrospective Chart Analysis of Psychiatry Referrals for Hospitalized COVID-19 Patients in a Dedicated COVID Hospital in a Metropolitan City in India

Abstract Background: The COVID-19 pandemic has been associated with multiple psychiatric problems in the general population as well as in those admitted with the infection. Studies done so far have mainly focused on the general population. It is important to address the needs and gaps in mental and psychological aspect of health of patients admitted with the infection to improve their overall prognosis. This study was undertaken with the aim to study the pattern of psychiatric referrals of hospitalized COVID-19 patients and to find out if there is any association between their socio-demographics, severity of COVID-19 infection, inflammatory markers, and co-morbidities. Materials and Methods: A descriptive, retrospective chart analysis of the record of 160 psychiatry referrals for COVID-19 patients seen by the on-call psychiatrist from May 2020 to October 2020 in a tertiary care hospital was undertaken. Sociodemographic data, severity of COVID-19 infection, blood investigation reports, psychiatric symptoms, diagnosis and management were recorded, tabulated, and analyzed using SPSS 20. Results: Referrals were more for individuals having moderate-to-severe COVID-19 infection, in elderly patients and in males. The most common reason for referral was disorientation (27.5%) and insomnia (27.5%), followed by the patient having a preexisting psychiatric illness (15%). The most common psychiatric diagnosis was delirium secondary to general medical condition, (28%), followed by anxiety and depressive spectrum disorders (23.75%). 32.5% of the patients referred had a past history of psychiatric illness, the most common being substance use disorder, followed by major depressive disorder and mixed anxiety depression. With the increase in the age of the individuals, the number of referrals for males was significantly more as compared to females (P = 0.00). No statistically significant association was found between age (P = 0.83), gender (P = 0.99), and psychiatric diagnosis. No significant association was found between the severity of COVID-19 and psychiatric diagnosis (P = 0.69). Conclusion: It is essential to screen for psychiatric disorders in patients admitted for COVID, as it goes a long way in reducing the overall morbidity and improves patient cooperation for various procedures which could be life-saving.

Prevalence and coping of depression and anxiety among college students during COVID-19 lockdowns in China

BackgroundThis study sought to investigate the prevalence of anxiety, depression and mixed anxiety-depression disorder among college students during COVID-19 shelter-in-place lockdowns in China. MethodsParticipants (N = 2818) were selected from 8 provincial regions across the country in areas that were under lockdown mandates. The dependent variables were anxiety and depression. Multiple regression models were tested using anxiety and depression as the respective outcome variables, and binary logistic regression was conducted with anxiety-depression comorbidity as the dependent variable. Explanatory variables were changes in (social) media use and communication behaviors, perceived effectiveness of daily activity involvements as well as a number of demographic and environmental factors. ResultsBeing a college senior, prior anxiety/depression history, having family members and residents in neighborhood tested positive with COVID were all important predictors of elevated anxiety, depression and their comorbidity. Increased face-to-face family communication and reading more e-books were associated with reduced anxiety, depression and their comorbidity. Listening to music and playing video games were correlated with lower anxiety but not depression. ConclusionsDraconian shelter-in-place lockdowns as strictly enforced in China within a short notice could be detrimental to individual mental health and psychological well-being. Findings in this research can provide practical guidance for college counselors and health professionals in targeting particular segments of the student population in providing tailored psychological, therapeutic and material services during disruptive moments and public health crises. The central role of family communication in the emotional and social support process deserves critical contemplation.

Skin Diseases in Patients With Primary Psychiatric Conditions in Northern India: A Cross-Sectional Study.

The relationship between skin diseases and psychiatric illnesses is bi-directional and is manifested as cause and effect. Psychiatric disorders such as stress, anxiety, and depression are seen to be instrumental in the development and progression of dermatological diseases on one hand, while on the other hand, cosmetic disfigurement caused by dermatological diseases is responsible for psychological distress in patients. The present study was conducted to investigate the spectrum of dermatological disorders in psychiatric patients to offer them holistic treatment andprovide them with a better quality of life. This cross-sectional, observational study wasconducted at a tertiary medical care center. A total of 170 psychiatric patients referred to the dermatology department for different dermatological manifestations were enrolled in the study. A demographic profile of the patients was done, and an association between dermatological diseases and psychiatric illnesses was done. Out of 170 study participants, 88 (51.8%) were females, and the rest (82, 48.2%) were males.A total of 13 major types of dermatological conditions were noted; among them, fungal infection (43, 25.3%) was the most common, followed by eczema (18, 10.6%), parasitic infestation (17, 10.0%), pigmentary disorder (13, 7.6%), acne (11, 6.5%), bacterial infection (11, 6.5%), pruritic disorder (11, 6.5%), hair disorder (9, 5.3%), drug reaction (9, 5.3%), papulosquamous disorder (7, 4.1%), and viral infection (6, 3.5%). Skin conditions other than the above-mentioned were present in 15 (8.8%) patients.The most common psychiatric illness in the present study was major depressive disorder (41, 24.1%), followed by generalized anxiety disorder (38, 22.4%) and psychosis not otherwise specified (34, 20.0%). Other psychiatric illnesses included in the study were bipolar affective disorder (22, 12.9%), schizophrenia (18, 10.6%), obsessive-compulsive disorder (12, 7.1%), and mixed anxiety depressive disorder (5, 2.9%). The findings of the present study depict that psychiatric patients with dermatological manifestations show a spectrum of dermatological conditions, primarily of infectious (fungal, parasitic, or viral) nature. This might be associated with a relatively poor hygienic status of psychiatric patients and thus their increased susceptibility to these disorders. Most of the time, the susceptibility to these skin conditions seemed to be opportunistic and unaffected by the type, duration, and level of control of psychiatric illness.

Features of the immuno-metabolic status in patients with mixed anxiety and depressive disord

Worldwide epidemiological data reveal extremely high prevalence of anxiety and depressive disorders, leading to loss of fitness for work and the associated increased economic burden on society. In this regard, it seems crucial to improve the efficacy of standard psychopharmacological treatment of anxiety and depression. The relevance of the study is determined by the identification of combined immune-metabolic disorders in mixed anxiety and depressive disorder.Laboratory and clinical parameters of patients with mixed anxiety-depressive disorder were assessed. It was found that symptoms of anxiety and depression were accompanied by changes in immune and metabolic status. Statistically significant correlations between symptoms of anxiety and depression, and immune-metabolic statuses were identified,which indicates the possible existence of immune-oxidative stress in patients with symptoms of anxiety and depression, and damage to all parts of the immune system: humoral, phagocytic, cytokine, free-radical oxidation, and antioxidant system dependent immunity. These findings indicate the need to take into account changes in immune and metabolic status in patients with mixed anxiety and depressive disorder and consider the possibility of adding immunocorrective drugs to the treatment regimen in order to increase the effectiveness of standard psychopharmacological therapy.

Electrodermal activity moderates the relationship between depression and suicidal ideation in a group of patients with anxiety and depressive symptoms

PurposeBeing suicide a serious global issue, it's urgent to identify the involved factors and possibly precursors. In our study, it was hypothesized that autonomic hyperactivation might have a moderating role in the relationship between symptoms of depression and suicidal ideation in a group of patients suffering from Mixed Anxiety Depressive Disorder (MADD). MethodsFifty-three outpatients diagnosed with MADD were consecutively recruited. Anxiety and depression levels were assessed through the Symptom Questionnaire whereas suicidal ideation was calculated through specific items extrapolated from the Symptom Checklist-90-R (SCL-90-R). Additionally, Electrodermal Activity (EDA) and the evaluation of Skin Conductance, Level and Response (SCL-SCR), was detected through the recording of a Psychophysiological Stress Profile (PSP). ResultsThe analyses confirmed depression as the first predictor of suicidal thoughts. Nonetheless, EDA levels recorded at baseline and under induced stress exerted a moderating effect on the relationship between thymic deflection and thoughts of death. ConclusionsEven though activation is usually considered a positive factor for clinical prognosis, our findings highlight that autonomic arousal may represent a harmful resource for patients suffering from MADD. The involvement of the psychophysiological axis can accentuate mental suffering and favor suicidal ideation. The need to consider a multidimensional assessment strongly emerged.

The dynamics of psychological attributes and symptomatic comorbidity of depression in children and adolescents

PurposeThis investigation aimed to explore attribute dynamics and symptomatic comorbidity of depression with internalizing, externalizing, and other personal–contextual problems in children and adolescents from a network analysis.MethodsWe tested an attribute network of regularized partial correlations, standard and alternative centrality measures, and comorbidity bridge symptoms according to centrality bridge measures.ResultsRegularized partial correlation network and a centrality measures graph shown the prominent position of social problems and anxiety–depression. Minimum spanning tree (MST) found a hierarchical dynamics between attributes where mixed anxiety–depression was identified as the core and the other attributes were hierarchically connected to it by being positioned in six branches that are differentiated according to their theoretical contents. The most central connections are established with the attributes of their own community or theoretical groups, and 37 bridge symptoms were identified in all networks.ConclusionsA significant role of mixed anxiety depression as an activator and intermediary of psychopathologies was supported as a central attribute of internalizing problems. Aggressive behavior as part of the broad externalizing dimension was one of the constructs that most intensively activate the network, and social problems were also distinguished as a relevant factor not only in terms of connections and central attributes but also in terms of bridge symptoms and comorbidity. This framework extends to the study of symptomatic “comorbidity.”

Frequency Of Psychiatric Illnesses And Opinion/Vantage Of Patients Attending Neurology Out-Patient Department.

To determine the Frequency of psychiatric illnesses in patients with neurological conditions, and to take their opinion about psychiatric disorders. The cross-sectional study was conducted from June 1 to August 30, 2021, at the Neurology Outpatient Department of Allied Hospital, Faisalabad, Pakistan, and comprised patients of either gender aged 12-70 years from among those visiting the outpatient clinic. Data was collected through interviews and the 41-item Depression Anxiety Stress Scale. Data was analysed using SPSS 21. Of the 201 patients, 160(79.6%) were females and 41(20.4%) were males. The overall mean age was 34.5+/- 9.38 years. Primary neurological problem was headache 119(59.2%). Overall, 155(77.2%) patients met the criteria of psychiatric disorders; 55(27.4%) anxiety, 37(19.4%) had depressive disorder, 42(20.8%) mixed anxiety depressive disorder, and 19(9.5%) had other psychiatric illnesses. Also, 101(50.2%) patients lacked awareness about psychiatry illnesses, 35(17.4%) had fear of stigma, and 28(13.9%) had misconceptions. The frequency of psychiatric disorders among those visiting the neurology outpatient department was high, and was associated with negative views about such illnesses.

Utilization Study of Antidepressants in a Teaching Hospital of Sikkim and Adherence to Standard Treatment Guidelines

Aims: Depression is known to have an overarching negative impact on the quality of life of afflicted individuals. Mitigation of depression associated adverse outcomes is mostly reliant upon timely diagnosis and decisive intervention. Antidepressants and adjunct drugs constitute the pharmacological modalities for the therapy of depression, in addition to supportive non-pharmacological methods of management. This prospective cross-sectional observational study aims at analyzing the utilization of antidepressants in American Psychiatric Association (APA) categories of depression in a remote North-East Indian teaching hospital. Methods: Patients clinically diagnosed with depression based on Diagnostic and Statistical Manual of Mental Disorders (DSM) and prescribed with antidepressant medication, were included in the study. The data were analyzed based on demographic characteristics, prescribed antidepressant medication and co-prescribed adjunct drugs. Results: A total of 316 patients were included in the study. The SSRI class of antidepressants were prescribed most frequently (89%) followed by TCAs (6%) & SNRIs (4.4%). Escitalopram was the single most frequently prescribed antidepressant (51%) followed by sertraline (23%) & fluoxetine (11.4%). The SSRIs were used most frequently in bipolar disorder (94.7%), followed by depressive episode (89.2%) & mixed anxiety depressive disorder (88.2%). The utilization of SSRIs was more frequent in the ≤ 50 age group (90.3%) and in males (92.5%). Sedatives including benzodiazepines, were used in 78.8% and atypical antipsychotics in 8.9% of the patients. Conclusion: SSRIs are the most frequently used antidepressant class across all categories of depression. Benzodiazepines have been extensively co-prescribed. The pharmacotherapy of depression in this hospital conforms to currently available clinical evidence and treatment guidelines.

Alexithymia and related mental and psychosomatic disorders

Rationale. Currently, there is a growing number of mental disorders, which are infl uenced by various external and internal factors, including the presence of alexithymia. Most studies focus on the prevalence of somatic diseases among patients with alexithymia, while the prevalence of mental disorders in these patients remains insuffi ciently studied. Presumably, alexithymia can serve as a background for the development of mental disorders such as anxiety, depressive, and mixed anxiety-depressive disorders. The aim of the study is to investigate the correlation between alexithymia and mental disorders, somatic diseases, and suicidal thoughts in patients.Material and methods. A total of 184 outpatients (107 women and 77 men) with various illnesses were examined. Clinical rating was conducted using the TAS, HADS, and MADRS scales. Additionally, medical history was collected.Results. A higher incidence of mental disorders was detected in patients with alexithymia (correlation coeffi cient 0.71). Depression was most frequently observed in these patients (73.5%), followed by anxiety disorder and mixed anxietydepressive disorder (13.2%). Patients with alexithymia also had a higher incidence of psychosomatic disorders (correlation coeffi cient 0.68), with multiple psychosomatic diseases usually occurring in the same person. Moreover, a higher incidence of hypertension (47%), ischemic heart disease (25%), skin diseases such as neurodermatitis, psoriasis, atopic dermatitis, and others (59.6%), gastrointestinal diseases such as peptic ulcer and irritable bowel syndrome (28.7%), bronchial asthma (8.8%), thyrotoxicosis (0.7%), and rheumatoid arthritis (0.7%) was detected in patients with alexithymia. As the degree of alexithymia increased, suicidal thoughts were more frequent and severe (correlation coeffi cient 0.74).Conclusion. The hypothesis of the correlation between alexithymia and the development of mental and psychosomatic disorders and the appearance of suicidal thoughts has been confi rmed.

Clinical and diagnostic significance of plasminogen activator inhibitor type 1 in the early development of coronary heart disease

Aim to determine the quantitative content of the tissue plasminogen activator inhibitor type 1 (PAI-1) and to determine its relationship with risk factors for coronary artery disease.
 Material and methods. The study included 67 male and female patients (36 men and 31 women) with coronary artery disease (CAD) and stable angina classes II-IV with the presence of hypertension. The mean age of the patients was 60.20.76 years. In all patients, clinical and anamnestic data were collected during the examination. For pain assessment, we used a verbal scale. We registered the anthropometric data and body mass index. Biochemical and instrumental methods of research were used according to the standards for diagnosing CAD. We assessed the occurrence of risk factors in patients included in the study. A complex of general clinical laboratory and instrumental tests was used, as well as the method of enzyme immunoassay ELISA, which determined the level of PAI-1, platelet aggregation activity, renin, aldosterone, cortisol and endothelin.
 Results. The group of patients demonstrated a reliable elevation of PAI-1 plasma level. Compared with practically healthy people, the level of this biomarker was 1.6 times higher in patients with coronary artery disease. A significant elevation of PAI-1 level indicates an increased risk of endothelial and hemostasiological disorders in patients, which, in turn, increases the risk of thrombogenic complications. The study revealed the correlation of PAI-1 protein in CAD patients with such risk factors as mixed anxiety-depressive disorder, smoking, hypertension, obesity, and hypercholesterolemia.

Pattern of Illness in Prisoners Admitted in a Tertiary Care Hospital of South Eastern Rajasthan

The delivery of health care among prisoners is one of the most important aspects of improving human rights compliance. Estimating common healthcare problems in prisoners will be helpful in assessing their health status and recommending the rectifying steps. Therefore, knowing the types of morbidities will help us in making health policies which will be helpful in reducing the health burden in prisoners and will also help in reintegration of prisoners into mainstream society. The present study is a retrospective analysis to find out the common medical conditions in prisoners. The study was carried out by collecting data of 500 admitted prisoner in a tertiary care institute in south-east Rajasthan. The majority (95.2%) of referred prisoners were male, from age group of 30-39 years, mean age of prisoners being 39.6 years and the majority (90%) were referred from Central Jail, Kota. The majority (53.2%) of prisoners were admitted to medicine department followed by psychiatry department (26.4%). A higher prevalence of anemia and pulmonary tuberculosis was reported among prisoners. Surgical illness related to infectious etiology and poor personal hygiene was common in prisoners. Psychosis not specified (17%), schizophrenia (8%), mixed anxiety depressive disorder (8%) and substance use disorders (16%) were common psychiatric conditions. Mean duration of hospitalization was 9 days.

Ectopic parathyroid adenoma causing hyperparathyroidism-induced psychosis: A case report

Primary hyperparathyroidism is a disease with multisystemic and heterogeneous manifestations, characterized by underlying high parathormone concentrations. Despite neuropsychiatric involvement being one of the manifestations, psychosis is rare. This is the case of a 68-year-old female with a 10-day clinical course of anorexia, mutism, dysphagia, constipation, and weight loss. The patient had disorganized speech associated with paranoid delusions. Prior to this visit, the patient was recently diagnosed with a mixed anxiety-depressive disorder. For this reason, treatment with antidepressants in combination with atypical antipsychotics was administered without a satisfactory response. Neuroimaging, infectious panel, and toxicology screening showed no abnormal findings. Hypercalcemia secondary to a retropharyngeal ectopic parathyroid adenoma was the causative etiology of her primary hyperparathyroidism, and hypercalcemia treatment resolved the psychotic episode. We highlight the importance of recognizing psychosis as a possible initial presentation of hyperparathyroidism and hypercalcemia. Ruling out organic etiologies prior to diagnosing a primary cause of psychosis is crucial, as their treatment can reverse the psychotic symptoms.

Prevalence of Burnout and Psychiatric Illness among Postgraduate Trainee Doctors of a Tertiary Care Hospital

Objective: Burnout is a state of physical and emotional depletion, and it is a result of prolonged exposure to the stressful working environment. Burnout has three primary symptoms: (a) emotional exhaustion (EE) occurs due to a depletion of emotional resources, feeling no longer to give any more to their job; (b) depersonalization (DP) occurs in response to EE, making employees detached from their job and developing uncaring attitudes to their work; and (c) reduced personal accomplishment (PA) with perceiving less enjoyment from their work. Psychological distress is also higher among medical students and doctors than that in the general population. In this study, we intended to study the prevalence of burnout and various psychological problems among postgraduate trainee (PGT) doctors of a tertiary care hospital. Methods: In this cross-sectional study of one year, we recruited postgraduate training doctors whoever gave valid and informed consent. Results: We included 170 PGTs from various clinical departments at the time of our study, but 126 PGTs were included as the sample population. They were assessed for sociodemographic determinants first. Then received assessment using sociodemographic pro forma and Abbreviated Maslach Burnout Inventory and International Classification of Diseases 10 for screening psychiatric morbidity among them. Results: In this study, 31.7% of PGTs had high EE, 34.9% of them higher DP, and 30.2% of them a high burnout rate. Of them, 31.7% of PGTs had a reduced PA with a score ≤ 25 percentile. In this study, 83.3% had no psychiatric illness and 16.7% had a psychiatric disorder. Among psychiatric disorders, 4% had harmful use of tobacco, 4% had mild depression, 1.6% had panic disorder, 4.8% had mixed anxiety depression, 1.6% had obsessive-compulsive disorder, 0.8% had harmful use of alcohol. Highest EE was noted among PGTs from the Department of Anesthesiology, followed by those from the Departments of Pulmonary Medicine and then Radiotherapy. Conclusion: One-third of PGTs suffered from burnout. Psychiatric diseases were also increased with a higher burnout rate.