Primary Psychiatric Illness Research Articles

Psychiatric Etiologies and Approaches in Altered Mental Status Presentations: Insights from Consultation Liaison Psychiatry.

Consultation liaison psychiatrists are frequently asked to evaluate patients with altered mental status (AMS). Psychiatrists have unique perspectives and approaches to care for confused patients, particularly optimizing facilitation of care and maintaining vigilance for diagnostic overshadowing. Psychiatrists also offer expertise in primary psychiatric illnesses that can overlap with AMS, and the most common etiology of AMS is delirium. In this article, we provide a consultation liaison psychiatrist perspective on AMS and related psychiatric conditions in addition to delirium. Manic and psychotic episodes have primary and secondary etiologies, with some symptoms that can overlap with delirium. Catatonia, neuroleptic malignant syndrome, and serotonin syndrome are potentially fatal emergencies, and require prompt index of suspicion to optimize clinical outcomes. Trauma sequelae, functional neurologic disorders, and dissociative disorders can present as puzzling cases that require psychiatric facilitation of care. Additionally, AMS is sometimes due to substance intoxication and withdrawal in the hospital. A nonstigmatizing approach to evaluation and management of delirium and AMS can ensure optimal patient care experiences and outcomes.

Case Report and Literature review. Neuropsychiatry Manifestation of Frontal Lobe Neoplasm- Meningioma. Prevalence, Presentation and Pathogenesis

IntroductionMeningiomas are the most frequent primary brain tumor. Although most Meningiomas are benign, their location in the central nervous system can predict symptomatology which could result in significant morbidity and mortality. However, due to the slow-growing nature, meningiomas are usually asymptomatic, and diagnosis is often made incidentally on neuroimaging or at an autopsy. The incidence rate is 1.2-fold higher in Black Americans than White Americans. Neuropsychiatry manifestation might be only initial presentation; thus, psychiatrists are often the first to see these patients, and the correct diagnosis may be made only when the tumor has grown to a considerable size and begun to displace the brain.ObjectivesThe aim of this study is to understand the biological basis of psychiatry symptoms in patients with Frontal Lobe meningiomas.MethodsA review of literature and individual patient data analysis was conducted. The literature review was conducted on PubMed, Medline, MeSH, Google Scholar, and mount Sinai’s levy Library using the key words; meningioma, meningioma with psychiatric symptoms, psychosis, depression, neuropsychiatry manifestation of meningiomas.ResultsThe review revealed that 88% of brain tumors and psychiatric symptoms are located in the frontal region. Meningiomas accounts for 13%-26% of intracranial tumors. There is a reported low incidence due to its slow growing nature and are usually asymptomatic. Incidence of meningiomas is predominant in females, and is attributed to hormonal factors, this is associated with estrogen and progestogen cycles. Reports shows that smoking has been linked to increase risk of meningiomas in men. Frontal lobe meningiomas may present with only psychological symptoms that resemble depression, anxiety states, hypomania and schizophrenia. Personality and mental status changes are also noted in Frontal lobe tumors. Left sided lesions are associated with inhibition of motor activity, impairment in motor and initiative aspect of speech, diminished generalization ability and general inertia of mental process.Conclusions Given the absence of frank neurological symptoms, to help localize the lesion, most meningiomas are missed due to diagnostic overshadowing of the primary psychiatric illness. Peritumoral edema indicates the underlying mechanism and location of the lesion predicts symptomatology. Like our patient who is an 81-year-old male with no past psychiatry history, presenting to our comprehensive psychiatry emergency program with psychiatric manifestation as the initial presentation and subsequently with MRI suggestive of Right Frontal extra-axial meningioma. This study shows that primitive frontal lobe tumors are likely to be misdiagnosed as patients with such tumors are often referred first to psychiatrist. High index of suspicious is needed.Disclosure of InterestNone Declared

Psychocutaneous Disorders in Paediatric Population: A Cross-Sectional Observational Study in a Tertiary Care Centre in Eastern India

Abstract Introduction: Psychocutaneous disorders in children have been a gray zone in dermatology practice. It can be secondary to some primary dermatological disorder or can be a presentation of underlying primary psychiatric illness. There is a paucity of data regarding the occurrence of these disorders in the pediatric population. The present study was carried out to assess the proportion of primary psychiatric dermatoses in the pediatric population seeking dermatological care. Materials and Methods: This was a hospital-based cross-sectional observational study done over 6 months. All consecutive children <14 years old presenting with primary psychiatric disorders (PPDs) to the dermatology outpatient department were recruited in the study. Results: PPDs were found in 0.41% of the pediatric patients attending the outpatient department. Dermatitis artefacta was the most common PPD in our study (47.05%). Other less frequently observed PPDs were trichotillomania, lip-licking dermatitis, and nail-biting. Underlying psychiatric illness was found in 41.17% of affected children. Conclusion: Primary psychiatric dermatoses in children could go undiagnosed because of its rarity but early diagnosis is essential as it can be an early sign or a harbinger of underlying severe psychiatric illness.

Psychodermatology: practical aspects of diagnosing autodestructive dermatoses on the example of our own clinical observations

The study of the features of the relationship between the mental state of the patient and skin pathological processes at the present stage is especially relevant. This is due not only to an increase in the prevalence of psycho-dermatological comorbidity, but also to the pathogenetic features of the formation of the clinical picture of this pathology, which make it difficult to diagnose. Skin lesions can either be a consequence of a primary psychiatric illness or induce the development of concomitant psychosocial illnesses. At the same time, mental disorders masked by skin manifestations combine, as a rule, skin lesions due to self-harm. Their clinical picture can mimic the symptoms of a number of nosologies, including not only dermatological pathology, but also systemic diseases with skin manifestations. The artificiality of rashes may not always be obvious, which often leads to the erroneous involvement of doctors of various specialties in the diagnostic search and prolongs the time for making the correct diagnosis. The article presents our own clinical observations of patients with autodestructive dermatosis, in which the verification of the diagnosis was accompanied by diagnostic errors, which caused pronounced destructive changes. In the analysis of the above clinical observations, attention is focused on the features of the skin pathological process, aspects of differential diagnosis, as well as insufficient awareness of primary health care professionals about this problem. Increased awareness of doctors of related specialties can contribute to clinical alertness, reduce the time of diagnosis and timely start of therapy for these patients by a psychiatrist, which will reduce the risk of an increase in the severity of the disease and social exclusion of patients.

A CASE REPORT ON FOCAL IMPAIRED SEIZURE ASSOCIATED WITH INTERMITTENT PSYCHOTIC DISORDER

Introduction: Focal impaired seizure is an Complex partial seizures (CPS), where focal (start in one region of the brain) and are accompanied with impairments in consciousness. The majority of them start in the temporal region and have automatisms, an aura, and reduced consciousness. The most typical incorrect diagnosis for CPS that develop in the temporal region is primary psychiatric illness. Case report: A23-year-old male patient arrived with brief episodes of hallucinations, violent behaviour, and altered levels of awareness. According to ICD10 criteria, he was diagnosed with acute and transitory psychotic illness, and he was treated with injectable haloperidol 10mg BID, then oral olanzapine 10mg. Both the electroencephalogram and the brain's computed tomography were normal. He returned to the outpatient clinic after 15 days and complained of aggressive behaviour and sensory misinterpretations. It was advised to do a video electroencephalogram, however owing to nancial limitations, this was not done. Despite the lack of EEG data, the diagnosis was changed and he was put on oral carbamazepine due to a strong clinical suspicion of complex partial seizures. Antiepileptic treatment went well for him, and the symptom remission has held. Conclusion: Persons who appear with psychosis require a thorough diagnostic analysis to rule out any other options.

Autoimmune Encephalitis: A Physician's Guide to the Clinical Spectrum Diagnosis and Management.

The rapidly expanding spectrum of autoimmune encephalitis in the last fifteen years is largely due to ongoing discovery of many neuronal autoantibodies. The diagnosis of autoimmune encephalitis can be challenging due to the wide spectrum of clinical presentations, prevalence of psychiatric features that mimic primary psychiatric illnesses, frequent absence of diagnostic abnormalities on conventional brain MR-imaging, non-specific findings on EEG testing, and the lack of identified IgG class neuronal autoantibodies in blood or CSF in a subgroup of patients. Early recognition and treatment are paramount to improve outcomes and achieve complete recovery from these debilitating, occasionally life threatening, disorders. This review is aimed to provide primary care physicians and hospitalists who, together with neurologist and psychiatrists, are often the first port of call for individuals presenting with new-onset neuropsychiatric symptoms, with up-to-date data and evidence-based approach to the diagnosis and management of individuals with neuropsychiatric disorders of suspected autoimmune origin.

271 The association between primary focal hyperhidrosis and psychiatric illnesses

Primary Focal Hyperhidrosis (PFH) is a debilitating condition that causes excessive sweating and is known to be associated with a lower quality of life and psychosocial distress. However, little is known on the clinical consequences of having PFH. Therefore, the goal was to examine the association between PFH and mental health (MH) disorders. A cross-sectional study was conducted using data from the National Inpatient Sample (2004-2014), a database consisting ∼20% stratified sample of all US hospitalizations.

Case Report: Cotard's Syndrome in Anti-N-methyl D-aspartate (NMDA) Receptor (Anti-NMDAR) Encephalitis

Cotard's syndrome is uncommon psychopathology among patients with psychotic illnesses. Limited cases had been reported regarding the occurrence of this syndrome in anti-NMDAR encephalitis which itself is a relatively new disease that often presents with florid psychotic symptoms. This poses difficulties in differentiating it from a primary psychiatric illness. Late recognition of anti-NMDAR encephalitis can lead to death as it can progress to autonomic instability in its natural course of illness. We report a patient who first presented with psychotic symptoms with initial negative findings from baseline investigations. Further investigation revealed anti NMDAR antibodies in the cerebrospinal fluid. Prompt treatment was initiated and despite early poor response to the first-line treatment with the development of allergic reaction, our patient recovered completely after 1 month of hospitalization. This case report aims to highlight the importance of early detection of anti-NMDAR encephalitis and the possibility of uncommon psychopathology such as Cotard's syndrome occurring in this disease.

Are Chronic Pain Syndromes the Reason for Statin-Associated Muscle Symptoms?

Background: Statin induced myalgia is defined as muscle pain without elevation of serum creatine phosphokinase levels, and is a well-known complaint among statin users. Chronic pain syndromes affect a high percentage of the population; and it may be possible that these pain syndromes confound the reports of statin induced myalgia. We sought to compare the occurrence of chronic pain among patients on statin therapy who developed myalgia with those who did not. Methods: This study included 112 statin-treated patients, followed up at the clinic of the Lipid Center in Sheba Medical Center. Fifty-six of the subjects had a diagnosis of statin associated muscle symptoms (SAMS) and 56 did not. Verified questionnaires were used to assess the diagnoses of fibromyalgia, pain intensity, functional impairment, anxiety and depression in the study population. Results: Patients with statin myalgia were more likely to fulfil the diagnostic criteria for fibromyalgia than patients without statin myalgia (11 (19.6%) vs. zero, respectively). Patients in the SAMS group also exhibited higher levels of anxiety and depression in comparison with the control group. Female sex, higher scores on the Brief Pain Inventory pain intensity scale, and a Hamilton rating scale level indicative of an anxiety disorder were found to be significant predictors for fibromyalgia in patients suffering from statin myalgia. Conclusion: A significant percentage of patients, diagnosed with statin myalgia actually fulfilled the diagnostic criteria for fibromyalgia, depression or anxiety disorder. Detection of these patients and treatment of their primary pain disorder or psychiatric illness has the potential to prevent unnecessary cessation of effective statin therapy.

Management of Medication-Induced Psychiatric Disorders.

Management of Medication-Induced Psychiatric Disorders.

Abstract- Poster

Background:Psychiatric manifestations are common in Wilson’s disease and may precede manifestations of hepatic and central nervous system in 20% of cases. Most of the times undetected Wilson’s disease is treated as a primary psychiatric illness. We report different psychiatric manifestations in the course of the illness of a Wilson’s disease.Case presentation:An eighteen-year-old female presented with poor oral intake, decreased speech output, weakness of all limbs, talking to self and with poor self-care. She was provisionally diagnosed with catatonic schizophrenia but didn’t respond to lorazepam and risperidone. On subsequent evaluation found to have Wilson’s disease. Upon starting D-penicillamine, patient developed Stevens Johnson syndrome. She improved with steroids and zinc acetate and maintained well since then. After 3 years, patient presented with psychotic symptoms of few days which responded well to olanzapine 2.5mg. However, 3 years later she had a depressive episode and showed good response to adding sertraline. Sertraline was stopped because of switch to manic episode. She is maintaining well with the olanzapine 10mg per day and on regular neurology follow up.Discussion:Wilson’s disease may present with catatonia, depressive symptoms, personality and behavioral changes. Persons with Wilson’s disease are more prone to adverse events of psychotropic medication. Hence medication must be used with caution. This case suggests that if any young patient presents with psychiatric symptoms not responding to medication, one should try to investigate for any underlying organic pathology especially Wilson’s disease.

Abstract- Poster

INTRODUCTION:Readmission rates are found to be an important quality marker of patient care in psychiatric hospitals. Readmission occurs earlier when the duration of the index admission is less. Vasudeva et al 2009 reported that length of initial admission is the only predictor for readmission. Schizophrenia and Bipolar Affective Disorder are the two major primary psychiatric illness that requires multiple hospital admission.AIM: To study the sociodemographic factors and clinical features of patients with schizophrenia and bipolar affective disorders who are getting readmitted, and to find out which of these factors can influence the services delivered.OBJECTIVE: 1)To study the relationship between duration of index hospital stay and readmission2)To study how medical comorbidities, substance use affects readmission MATERIALS AND METHODS: A retrospective chart analysis of case records of patients registered at Institute of Mental Health, Chennai diagnosed with Schizophrenia or Bipolar Affective Disorder during January 2018 to June 2018 was done. Those case records having follow up documentation up to a period of three years till August 2021 were chosen. The sociodemographic variables like age, gender, occupation, education and clinical parameters like diagnostic subtype, presence of substance use, duration of index hospital stay in days and number of readmissions collected. The data will be analysed using SPSS-16 softwareResults:Readmission rates are not influenced by the diagnostic subtype, presence of substance use,comorbid medical conditions and duration of hospital stay.OUTCOME MEASURES:Helps in better understanding of the illness for improvement in healthcare services and future policy making

Droit à mourir et suicide assisté : état des lieux et analyse critique

ObjectivesIn the context of the present re-examination of the French bioethical laws by the National Advisory Ethics Committee (“Comité consultatif national d’éthique”: CCNE), a recent survey indicated a request of the public opinion to obtain a medical aid in end of life and a so-called “assisted suicide”. This led psychiatrists to re-consider their role and deontological position which usually led them to consider a request for an assistance in suicide as – a priori – a pathological demand, occurring within a suicidal crisis. The present article intends to: 1) describe the laws and practices of countries which allow medically assisted end of life help procedures; 2) clarify the definitions of “assisted suicide”, “assistance to suicide” and “euthanasia”; 3) consider available epidemiological data and the roles given to doctors and, more specifically psychiatrists, in these procedures; 4) analyse the rationale behind these demands. These considerations should enable French psychiatrists to clarify their position when facing requests for a medical aid in dying. MethodsFour European countries (Switzerland, the Netherlands, Belgium, Luxemburg) and Oregon (the first US state to introduce legislation) were considered, since they accumulated and published a large amount of experiences and data about “assisted suicide” and medical help in dying. In total, 127 articles were selected, mainly from PubMed and Cairn databases, published between 1997 and 2020. These articles deal with legal considerations, epidemiological data, ethical and sociological considerations. ResultsLaws and practices differ notably according to the state/country. In Belgium, the Netherlands and Luxemburg, as in Oregon, the medical help in dying has been de-criminalized, as long as certain legal criteria are met. In Switzerland, where no specific law exists in the penal code, non-governmental associations have benefited from the legal vacuum and organized the practice of “assisted suicide” for “altruistic motives”. In the scientific and legal literature, the terms used to describe and define the medical help in dying upon request differ greatly. In France, the National Advisory Ethics Committee defines euthanasia (“euthanasie”), assisted suicide (“suicide assisté”) and suicide assistance (“assistance au suicide”). Available epidemiological data, whatever the country considered, indicate that requests for a medical aid in dying are expressed mainly by patients aged over 60 years and suffering from cancer. Psychiatric diseases account for only 1% to 3%. Most often, systematic assessment by a psychiatrist is neither requested nor made, when the demand does not occur during a primary psychiatric illness. In the case of an existing primary psychiatric pathology, a psychiatrist assesses the case against formal legal predefined criteria. This latter practice was only recently introduced, after some feedback and after legal actions had been brought to Court. When the underlying motivations of the request are considered, it appears that, even in the absence of an evolving psychiatric condition, several psychological or psychopathological reasons prevail such as spirituality, attachment style, social isolation, despair, depression… which should greatly benefit psychiatric exploration, investigation and expertise. ConclusionIn some countries, the request for medically assisted help in dying has become a legal and social reality. In France, where the public debate is still open, it should be emphasized that a psychiatric assessment and interview should be systematically provided to any person requesting medical assistance to die or commit suicide. It is the commitment of psychiatrists to understand the implicit demands and unexpressed motives underlying this request which have strong links with the unique life-events and emotional experiences of the person. The psychiatrist has a unique role in the contextualization of such a request.

Association between sleep health and cognitive reserve in older adults with cognitive concerns

AbstractBackgroundWe examined the association between sleep health consequences and perceived fatigability within the context of carrying out everyday activities in non‐demented older adults and investigated whether cognitive reserve (CR; individual differences in susceptibility to cognitive decline due to brain aging, pathology, or insult) moderated this relationship.MethodThis was a cross‐sectional study. We prospectively screened adults age 55‐90 years at a Memory Research Clinic. An IRB approved the study protocol, and informed consent was obtained. Patients with cognitive concerns underwent neurocognitive testing to determine cognitive status based on the ADNI criteria. Inclusion criteria: the ADNI criteria for cognitively normal or MCI. Exclusion criteria: 1) depression assessed with the Geriatric Depression Scale (GDS>5) and DSM‐5 criteria, 2) history of primary psychiatric illnesses, 3) medical conditions associated with fatigue, and 4) a history of obstructive sleep apnea diagnosed by a clinical sleep physician. Measures included the PROMIS Sleep‐related Impairment (SRI); the Neuro‐QOL Cognitive function (CogF) and Fatigue measure, which yields “fatigue symptom severity (Fat_Sx)” and “perceived fatigability (Fatiga)” subscales. CR was assessed with the CR Index questionnaire (CRIq). Linear regression models were fit to the fatigue outcomes and included the SRI, CR, and their interaction as predictors. If the interaction was significant, SRI slopes were assessed at CR=mean and mean ±1SD. All analyses were adjusted for age, sex, and education.ResultThere were 37 subjects in this study; mean age of 70.8 years (SD=9.3); 70.3% subjects were female; 86.5% white, 10.8% Hispanic, and 2.7% others. CR significantly moderated the relationship between SRI and perceived fatigability (F (1,32)=18.64, p=0.011). A higher SRI score was associated with a higher perceived fatigability severity with a low CR (CRIq mean‐1SD)=108.6; b(se)=.493(.089), p<0.001) and a mean CR (CRIq mean=128.0; b(se)=.274(.076); p=0.001), but not a high CR (CRIg mean+1SD=147.4; b(se)=0.1278; p=0.636). Moreover, higher perceived fatigability was associated with lower cognitive function (b(se)=‐.24 2(0.077), p=0.004), controlling for age, gender, and education.ConclusionPoorer cognitive function was significantly associated with greater fatigability within the context of managing everyday activities. Greater cognitive reserve may reduce the detrimental influence of poor sleep health on perceived fatigability in managing daily function during the preclinical stages of dementia.

Multidimensional predictors of antidepressant responses: Integrating mitochondrial, genetic, metabolic and environmental factors with clinical outcomes

Major depressive disorder (MDD) is a primary psychiatric illness worldwide; there is a dearth of new mechanistic models for the development of better therapeutic strategies. Although we continue to discover individual biological factors, a major challenge is the identification of integrated, multidimensional traits underlying the complex heterogeneity of depression and treatment outcomes. Here, we set out to ascertain the emergence of the novel mitochondrial mediator of epigenetic function acetyl-L-carnitine (LAC) in relation to previously described individual predictors of antidepressant responses to the insulin-sensitizing agent pioglitazone. Herein, we report that i) subjects with MDD and shorter leukocyte telomere length (LTL) show decreased levels of LAC, increased BMI, and a history of specific types of childhood trauma; and that ii) these multidimensional factors spanning mitochondrial metabolism, cellular aging, metabolic function, and childhood trauma provide more detailed signatures to predict longitudinal changes in depression severity in response to pioglitazone than individual factors. The findings of multidimensional signatures involved in the pathophysiology of depression and their role in predicting treatment outcomes provide a starting point for the development of a mechanistic framework linking biological networks and environmental factors to clinical outcomes in pursuit of personalized medicine strategies to effectively treat MDD.

MACHINE LEARNING TECHNIQUES BASED ON FEATURE SELECTION FOR IMPROVING AUTISM DISEASE CLASSIFICATION

Nowadays, Autism Spectrum Disorder (ASD) is one of the primary psychiatric disorders illness that rapidly increases. One of the main problems of medical diagnosis data and classification is the variance in symptoms between patients. Thus, finding the discriminative symptoms that distinguish the illness accurately is an important issue. This paper will explore various feature selection methods on four ASD datasets for extracting significant features for improving the ASD classification system. Datasets were created in 2017 and 2018 for child and adult gathered online. Several feature engineering techniques are applied to rank significant features. The correlation matrix method showed the association between features that enable us to select the highest significant features. Then each dataset split into 70% for training and 30% for test. Several machine learning classifiers are applied. After testing, the selected features achieve 100% accuracy, specificity, sensitivity, AUC, and f1 score with adaboost, linear discriminant analysis and logistic regression classifier on different size of data. I choose the adaboost model because it does the same performance with less time and less computational power in both dataset 2017 and 2018 for child and adult. Results were validated using cross-validation with 10 k-fold. The code applied in that paper in https://github.com/BasmaRG/ASD/ .

Anti-N-Methyl-D-Aspartate Receptor Encephalitis: A Detailed Review of the Different Psychiatric Presentations and Red Flags to Look for in Suspected Cases.

Anti-N-methyl-D-aspartate receptor encephalitis is a rare autoimmune disorder that involves N-methyl-D-aspartate (NMDA) receptors. It is the most common autoimmune encephalitis, and early detection and treatment are crucial for morbidity-free recovery. Distinguishing this disorder from a primary psychiatric illness is quite challenging as this disorder classically presents with psychiatric manifestations that often resemble schizophrenic psychosis. Therefore, this review intended to scope the psychiatric manifestations this disorder could present with and dissect how they differ from primary psychiatric disorders. A PubMed database search was done. The results yielded were analyzed; eventually, 50 papers were used to review the different signs and symptoms the disease can present with, including common and rare disease presentations. Diagnostic challenges and helpful clinical clues to recognize the disorder were reviewed as well.

English

BACKGROUND Skin diseases and psychiatric illnesses are frequently found in the same patient. Although the psychiatric comorbidity of patients with dermatological conditions have been frequently studied, the prevalence of skin diseases in patients with primary psychiatric illnesses in India has not yet been extensively analysed. We hope to shed some light on the topic through this study and to gain insights into the co-morbidity of skin disorders in primary psychiatric outpatients. METHODS We have utilised a cross-sectional descriptive design for estimating the prevalence of skin disorders in primary psychiatric outpatients attending the outpatient department of a tertiary medical college hospital in India during the period from October 2019 to January 2020. Patients over the age of 18 years had been recruited for the study. Informed consent was obtained from all the patients. RESULTS A total of 135 patients were recruited for the study. 70 were males and 65 were females. The mean age of the participants was 38.6 years. A total of 88 patients of whom 46 were females had a co-existing dermatological condition that amounts to a prevalence rate of 65.1 %. Around 94 cutaneous manifestations were found among the 88 patients who had a dermatological disorder. CONCLUSIONS Skin disorders were highly prevalent in patients attending the psychiatric outpatient department. This points to a need for an inquiry and examination into skin related ailments in all psychiatric patients. KEYWORDS Psychodermatology, Comorbidity in Psychiatry, Skin Diseases in Psychiatry

A study of dermatological disorders with primary psychiatric illness from South India

<p><strong>Background:</strong> Dermatological disorders are frequent among patients with psychiatric illness. The interaction between skin and mind is complex. Pre-existing skin diseases may be modified in psychiatric illness due to self induced changes which may delay the diagnosis and treatment of skin diseases and result in complications. There are only few published studies about skin diseases in psychiatric patients from south India. We are undertaking this study to highlight the importance of dermatology consultation in psychiatric patients.</p><p><strong>Methods:</strong> 200 patients with primary psychiatric disorders who accepted for the study were subjected to history taking and general examination. Detailed dermatological examination was carried out by visual inspection and clinical examination.</p><p><strong>Results:</strong> Out of 200 patients, 65 were diagnosed with major depressive disorder, 42 patients were with bipolar disorder, 40 with schizophrenia, 30 with obsessive compulsion disorder, 23 with anxiety disorder. 153 (76.5%) patients had dermatological findings, in which 84 (55%) had infectious disease, 35 (22.9%) had parasitic infections, 26 (17%) had fungal infections, 15 (9.8%) had bacterial infections, 8 (5.23%) had viral infections. 56 (36.6%) had non-infectious skin findings, 22 (14.4%) had acne, 15 (9.8%) had pruritis, 12 (7.84%) had eczema, 5 (3.3%) had psoriasis and 2 (1.3%) had vitiligo. 13 (8.4%) patients had psychodermatological problems, 10 (6.53%) had neurotic excoriation, 2 (1.3%) had delusion of parasitosis and 1 (0.6%) had trichotillomania.</p><p><strong>Conclusions</strong>: This study implies that there is a definite association of dermatology and psychiatry.</p>

Prevalence and Clinical Features of Seizure Attacks in Psychiatric Wards: A Local Review

Introduction: Behavioral and cognitive dysfunction is frequently observed in patients with recurrent seizures and represents an important challenge in treating these patients. In the present assessment the incidence and clinical profile of seizure attacks have been probed among a great sample of non-western psychiatric inpatients and compared with the available data in literature regarding prevalence and other associated clinical physiognomies Methods: All inpatients that had suffered seizure attack during the last sixty-four months had been included in the present study. Clinical diagnosis, as well, was in essence based on Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Results: While epilepsy had been identified as the primary cause of seizure (82.92%), 17.64% of them had experienced their first attacks during hospitalization. Annual incidence of seizure in psychiatric iseizure; epilepsy; schizophrenia; mood disorder; neuropsychiatry.npatients, on the whole, was around 0.07%. It was almost 0.06 in identified epileptic cases and about 0.01% with respect to the first time unprovoked epileptic attack. Also, the seizure attacks were significantly more prevalent among male psychiatric inpatients than female patients. Schizophrenia and bipolar disorder were significantly more prevalent than substance abuse, schizoaffective and depression, as comorbid psychiatric disorders among patients who had suffered seizure attacks, generally, and known cases of epilepsy, particularly. Conclusion: While, etiologically, epilepsy had been identified as the primary cause of seizure in psychiatric inpatients, schizophrenia and bipolar disorder were significantly more prevalent, as comorbid psychiatric disorders, in comparison with other primary psychiatric illnesses. Male gender, as well, could be considered as a risk factor.