Significant Psychiatric Morbidity Research Articles

Prevalence of Psychiatric Morbidity, Physical Illness, and Coping Strategies in Residents at Old Age Homes: A Cross-Sectional Study

Abstract Background: Older adults living in long-term care facilities, such as old age homes, often face a range of physical and mental health challenges that can significantly impact their overall well-being. Objectives: This study investigated the prevalence of psychiatric morbidity, physical illness, and coping strategies in old age home residents in Visakhapatnam, India. Methods: A cross-sectional study recruited 300 consenting residents. Standardized tools, namely the Mini-Mental Status Examination (MMSE), the six-item version of Goldberg's General Health Questionnaire (GHQ-6), and the Mini International Neuropsychiatric Interview (MINI) for diagnosing psychiatric disorders as per DSM-V criteria, were used to assess mental health. The Coping Checklist by Kiran Rao was also used. Results: Significant psychiatric morbidity was found in 15.33% of residents, with depression being the most prevalent disorder. Females, widowed individuals, those from urban backgrounds, and residents of nuclear families were more likely to report depressive symptoms. Physical illness was identified in 70% of the participants. Conclusion: This study highlights a considerable burden of psychiatric illness and physical health problems among residents of old age homes. Furthermore, it suggests that specific demographic factors are associated with an increased risk of depression. These findings emphasize the need for comprehensive mental and physical healthcare services within old age homes, with tailored interventions for vulnerable populations.

Stress and Common Dermatological Disorders: The Psychophysiological Dermatoses

Abstract Primary dermatological disorders which are frequently exacerbated by stress and whose course is affected by the psychological state of the patient are called psychophysiologic or psychosomatic diseases. Psychosocial stress plays a major role in the onset and/or aggravation of these skin diseases. A close relationship between the skin and the mind mediated via hormones and neurotransmitters and altered cutaneous permeability barrier homeostasis by psychological stress constitute the basic psychopathology. The common skin conditions precipitated/aggravated by stress include psoriasis, vitiligo, atopic dermatitis, acne vulgaris, alopecia areata, urticaria, lichen planus, prurigo, seborrheic dermatitis, and hyperhidrosis. These cutaneous diseases often have a chronic, unpredictable course with multiple remissions and relapses leading to significant psychiatric morbidity, and disease-related stress further acts as an aggravating factor for the cutaneous disease leading to a vicious cycle. Increased awareness about these psychophysiologic diseases among dermatologists has helped to incorporate psychotherapeutic treatment in the form of psychotropic drugs and nonpharmacological interventions in the management of these patients. A multidisciplinary approach consisting of dermatologists along with psychiatrists and psychologists in a liaison framework has proven useful for these patients.

Prevalence of Psychiatric Morbidity and Stress Burden among Patients with Limb Fracture.

To assess the prevalence of psychiatric morbidity and stress burden among the patients with limb fractures and compare them with age and gender matched control group. The cross-sectional study was conducted on 25 patients each of lower and upper limb fractures, presenting 2 weeks or more after the fracture to orthopedics OPD of Dayanand Medical College and Hospital. Psychiatric manifestations and stress burden were assessed using Mini International Neuropsychiatric Interview (M.I.N.I.), perceived stress scale (PSS), and impact of event scale-revised (IES-R) on the patients. It was compared to an equal number of age and gender matched normal control group. Majority of the patients with limb fractures were male (70%). The upper limb fracture was in age group of 18-30 years (52%), and those with lower limb fracture were >50 years of age (48%). Most common psychiatric morbidity seen in patients was major depressive disorder (52%) which was statistically significant in comparison with control group. The impact of trauma on patients resulted in avoidance and hyperarousal symptoms significantly in lower limb fracture patients than upper limb ones (P < 0.05). The long bone injuries in patient cause significant psychiatric morbidity which increases the stress burden in such patients due to immobility and pain.

Clinical features and outcomes of adult idiopathic megarectum.

Idiopathic megarectum is characterized by abnormal, pronounced rectal dilatation in the absence of identifiable organic pathology. Idiopathic megarectum is uncommon and under-recognized. This study aims to describe the clinical features and management of idiopathic megarectum. A retrospective review was undertaken on patients diagnosed with idiopathic megarectum with or without idiopathic megacolon over a 14-year period until 2021. Patients were identified from the hospital's International Classification of Diseases codes, and pre-existing clinic patient databases. Patient demographics, disease characteristics, healthcare utilization and treatment history data were collected. Eight patients with idiopathic megarectum were identified; half of the patients were female, with the median age of symptom onset being 14 years (interquartile range [IQR] 9-24). The median rectal diameter measured was 11.5 cm (IQR 9.4-12.1). The most common presenting symptom was constipation, bloating and faecal incontinence. All patients required prior sustained periods of regular phosphate enemas and 88% were using ongoing oral aperients. Concomitant anxiety and or depression were found in 63% of patients and 25% were diagnosed with an intellectual disability. Healthcare utilization was high with a median of three emergency department presentations or ward admissions related to idiopathic megarectum per patient over the follow-up period; 38% of patients required surgical intervention during the period of follow-up. Idiopathic megarectum is uncommon and associated with significant physical and psychiatric morbidity and high healthcare utilization.

Psychiatric Morbidity among Patients Living with Cancer in a Nigerian Oncology Centre

Introduction: Cancer is a leading cause of mortality worldwide and is associated with a wide range of psychiatric morbidities. The study aimed at determining the profile of psychiatric morbidity among cancer patients. Methods: In this descriptive study, 130 patients with different types of cancer were selected by systematic random selection and were interviewed. Information on sociodemographic characteristics, medical comorbidity, duration of the cancer, and duration of treatment was obtained. Psychological distress was assessed using the GHQ-12. The MINI was used to establish the presence or absence of any psychiatric diagnosis, Information on the receipt of formal psychiatric treatment was also obtained. Associated factors and predictors of “any mental disorder” (AMD) were determined. Statistical analysis was carried out using SPSS 20.0 Results: Prevalence of psychological distress was 63.8%, adjustment disorder 20.0%, anxiety disorder 29.2%, major depression 36.2%, delirium 6.9%, psychosis 2.3%, mania 0.8%, 12-month alcohol use disorder 3.8%, 12-month tobacco use disorder 0.8%, 12-month opioid use disorder 1.6%, 12-month cannabis use disorder 0.8%. In all, 66.9% had Any Mental Health Problems. The most common medical comorbidity was hypertension (36.2%) and diabetes (23.1%). Predictors of AMD were long duration of cancer OR = 6.27, 95% CI (1.22-12.1), duration of cancer treatment above 6 months OR = 5.04, 95% CI (1.97-12.92); and the presence of any medical comorbidity OR = 2.53, 95% CI (1.04-6.19). Conclusion: Cancer is associated with significant psychiatric morbidity, necessitating a collaborative Consultation-Liaison Psychiatric Service in cancer care.

Psychogenic non-epileptic seizures in youth: Individual and family psychiatric characteristics.

Youth with psychogenic non-epileptic seizures (PNES) are an understudied group associated with significant medical and psychiatric morbidity. Several studies have examined characteristics associated with youth's development of this disorder, though the exploration of family factors including psychiatric illness, has been lacking. This study sought to establish the need for a more comprehensive future study. A retrospective chart review was conducted on patients who had been admitted and diagnosed with PNES at the epilepsy monitoring unit at Children's Hospitals and Clinics of Minnesota. A total of 62 patients were included. All patients were evaluated by an epileptologist and psychologist during their diagnostic admission. "Spells" in question were captured via video EEG monitoring. PNES youth and family risk factors were assessed. Mean age of PNES symptom onset was 13.9 years. Patients (73%) were diagnosed within 6 months of onset of symptoms. Histories of other impairing somatic complaints were present in the youth (54%), with 67% having prior psychiatric diagnoses. Experiencing suicidal ideation or thoughts of self-harm occurred in 47% of this sample. Family members were unaware of the history of these symptoms with 12% of the parent's reporting awareness. Family history of psychiatric disorders (first-degree relatives of patient) was present in 54% of the sample, with anxiety, depression and conversion disorder being the most commonly endorsed diagnoses. Youth with PNES present with comorbid psychiatric disorders, though prior assessment and treatment for these disorders was not common. Youth with PNES have history of suicidal ideation and thoughts of self-harm, though parental awareness of these co-occurring symptoms is limited. Family risk factors, such as history of psychiatric disorder in first degree relatives, was high. The impact of these family risk factors is understudied and should be further evaluated to better understand the impact on development and maintenance of this disorder in youth.

The Relationship between Eating Disorders and the Narrative Self: An Intimate Partner Violence Comparison

Eating disorders (EDs) are associated with significant psychiatric and medical morbidity and carry unique challenges for treatment providers. An ED can become powerful to the point that it controls every aspect of the individual, and these patterns of control can be seen as similar to interactions observed within an intimate partner violence (IPV) relationship. This paper examines the literature on EDs and IPV and attempts to answer two research questions: (1) Does the ED–narrative self relationship share similarities to the victim–perpetrator relationship in IPV relationships? (2) Do individuals living with an ED report themes related to IPV in their discussion of the recovery process? Utilising a phenomenological analysis, online data from individuals living with an ED are analysed. The researchers find three themes and 10 subthemes that reveal similarities between EDs and the narrative self and the perpetrator and victim in IPV relationships. Clinical implications and future research recommendations are discussed.

Stuck in a Moment: Tonic Immobility Predicts Poor Quality of Life in Treated PTSD Patients.

Posttraumatic stress disorder (PTSD) is a prevalent and disabling multisystem disorder, with significant physical and psychiatric morbidity and poor quality of life (QOL). Although peritraumatic reactions - tonic immobility and dissociation - are established predictors of PTSD severity and development, there is a dearth of investigation assessing the impact of peritraumatic reactions on QOL of PTSD patients. Quality of life has become increasingly important in health care and research as a reliable outcome measure. It comprises psychological, physical, social and environmental domains, providing important information about the impact of diseases on patient's life. This study aims to investigate the impact of peritraumatic tonic immobility and peritraumatic dissociation on QOL of PTSD civilian outpatients. It is a cross-sectional study of 50 victims of urban violence with current PTSD, recruited in a specialized outpatient clinic. Instruments used were: Structured Clinical Interview IV, Peritraumatic Dissociative Experiences Questionnaire, Tonic Immobility Scale and WHOQOL-BREF (psychological, physical, social and environmental domains). Linear regression models were fitted to evaluate the impact of peritraumatic reactions - tonic immobility and dissociation - on WHOQOL-BREF scores. We controlled for sex as potential confounding. The severity of peritraumatic tonic immobility negatively impacted on psychological and environment domains of quality of life. For each additional point on the Tonic Immobility Scale, there was a decreased of 0.8 points on the scores of these domains of WHOQOL-BREF. Neither the peritraumatic reactions showed effects on physical nor social domains. Possible limitations of this study include cross-sectional design, relatively small sample size of tertiary center outpatients and recall bias. Peritraumatic tonic immobility is related to poor quality of life, adding new insights about the relationship between this immobility reaction and PTSD.

Opposing white matter microstructure abnormalities in 22q11.2 deletion and duplication carriers

Deletions and duplications at the 22q11.2 locus are associated with significant neurodevelopmental and psychiatric morbidity. Previous diffusion-weighted magnetic resonance imaging (MRI) studies in 22q11.2 deletion carriers (22q-del) found nonspecific white matter (WM) abnormalities, characterized by higher fractional anisotropy. Here, utilizing novel imaging and processing methods that allow separation of signal contribution from different tissue properties, we investigate whether higher anisotropy is driven by (1) extracellular changes, (2) selective degeneration of secondary fibers, or (3) volumetric differences. We further, for the first time, investigate WM microstructure in 22q11.2 duplication carriers (22q-dup). Multi-shell diffusion-weighted images were acquired from 26 22q-del, 19 22q-dup, and 18 healthy individuals (HC). Images were fitted with the free-water model to estimate anisotropy following extracellular free-water elimination and with the novel BedpostX model to estimate fractional volumes of primary and secondary fiber populations. Outcome measures were compared between groups, with and without correction for WM and cerebrospinal fluid (CSF) volumes. In 22q-del, anisotropy following free-water elimination remained significantly higher compared with controls. BedpostX did not identify selective secondary fiber degeneration. Higher anisotropy diminished when correcting for the higher CSF and lower WM volumes. In contrast, 22q-dup had lower anisotropy and greater extracellular space than HC, not influenced by macrostructural volumes. Our findings demonstrate opposing effects of reciprocal 22q11.2 copy-number variation on WM, which may arise from distinct pathologies. In 22q-del, microstructural abnormalities may be secondary to enlarged CSF space and more densely packed WM. In 22q-dup, we see evidence for demyelination similar to what is commonly observed in neuropsychiatric disorders.

Aftermath of anti-police protests in Nigeria: Burden and predictors of psychiatric morbidity among protesters and non-protesters.

Anti-police (#EndSARS) protests took place in October 2020 across several Nigerian cities, resulting in deaths, injuries and loss of property, but the psychological sequelae of these protests have not been studied. In a cross-sectional online survey, we collected data on psychiatric morbidity and potential risk factors from 426 Nigerian social media users, who self-identified as participants or non-participants in a recent anti-police protest. We found elevated rates of psychiatric morbidity, with worse outcomes for protesters compared to non-protesters (psychological distress [44.2% vs 29.8%], depression [26.0% vs 14.9%], anxiety [51.0% vs 29.8%], post-traumatic stress disorder [7.4% vs 1.8%], current substance use [11.2% vs 4.5%] and suicidal ideation [7.1% vs 4.4%], respectively). After adjusting for the effects of COVID-19 pandemic and previous mental health diagnosis, the predictors of poor mental health among non-protesters were being unmarried (odds ratio = 7.4, p = 0.01) and low resilience (odds ratio range = 4.1-5.4, p < 0.03) while for the protesters, the predictors were low resilience (odds ratio range = 2.9-4.7, p < 0.01), being from Northern Nigeria (odds ratio = 4.7, p < 0.01) or residing in Northern Nigeria (odds ratio = 2.8, p = 0.03), being under-/unemployed (odds ratio range = 2.1-2.5, p < 0.04), holding the view that the protest was caused by the state of the economy (odds ratio = 2.0, p = 0.01), belief that the protest had a direct negative impact on the protester (odds ratio = 2.3, p = 0.04) and willingness to participate in future protests (odds ratio = 4.13, p = 0.02). We conclude that participating in the #EndSARS protest was associated with significant psychiatric morbidity. There is need to recognise and address the mental health sequelae of collective actions, and invest in programmes that build resilience and address socio-political determinants of mental health, especially with a focus on youth.

Evaluation of Psychiatric Disorders in Spouse of Patients with Alcohol Dependence Syndrome

Background and Aim: Alcohol Dependence Syndrome has deleterious consequences not only on the patient with Alcohol Dependence Syndrome but also on the members of his family. The psychopathology in wives of patients with Alcohol Dependence Syndrome is a largely neglected area in psychiatric research. Aim of the present study was to evaluate the frequency and nature of psychiatric disorders in wives of patients with Alcohol Dependence Syndrome.&#x0D; Materials and Methods: A total of 177 wives, 100 wives of patients with Alcohol Dependence Syndrome and 77 wives of patients with Bipolar Affective Disorder- current episode mania were evaluated. Tools used were ICD-10 AM symptom checklist and modules for assessment of psychiatric morbidity and diagnosis was made based on The International Classification of Diseases – (Diagnostic Research Criteria DCR-10).&#x0D; Results: Psychiatric disorders are diagnosed in 75% of the wives of patients with alcohol dependence syndrome out of which 45% have dysthymia, 12% have mild depressive episode, 8% have adjustment disorder- prolonged depressive reaction, 5% have moderate depressive episode and 5% have anxiety disorder unspecified.&#x0D; Conclusion: The present study concludes that the wives of patients with Alcohol Dependence Syndrome have significant psychiatric morbidity when compared to wives of patients with Bipolar Affective Disorder-current episode mania. The most common psychiatric disorder is dysthymia.

Factors Associated with Psychiatric Morbidity, Post-Traumatic Stress Disorder and Post-Traumatic Growth in Paramedic First Responders: The Role of Core Beliefs

Introduction Paramedics are routinely exposed to traumatic events. This study describes the rates of post-traumatic stress disorder (PTSD), psychiatric morbidity and levels of post-traumatic growth (PTG) in New Zealand first responder paramedics, exploring a mix of demographic, professional, crewing status and exposure risk factors associated with these outcomes and their associations with core belief disruptions. Methods A cross-sectional study recruited paramedics (N=579) working in a first responder role. Univariate and multivariate logistic and linear regressions were conducted to identify predictors of PTSD, non-specific psychiatric morbidity and PTG in trauma-exposed participants. Results Two-thirds (66.3%) reported significant psychiatric morbidity, with volunteer paramedics being significantly less at risk when compared with professional paramedics (OR=0.52; 95% CI: 0.31-0.87; p&lt;0.01). Probable PTSD was reported by 14.6% of participants. Older age reduced the odds of this (OR=0.94; 95% CI: 0.92-0.98; p&lt;0.01) while experiencing greater disruptions in core beliefs increased the odds (OR=2.75; 95% CI: 2.00-3.77; p&lt;0.01). Being female (t=4.70; p&lt;0.01) and experiencing greater core belief disruption (t=7.54; p&lt;0.01) (adjusted R 2 =0.27) independently contributed to PTG. Conclusion Although PTSD rates were typical of first responders generally, psychiatric morbidity rates were high and may be more prevalent in professional staff. Contextual and methodological factors may have influenced these outcomes. Core belief disruptions predict both negative and positive emotional states, suggesting their important role in workplace interventions.

The psychological impact of the COVID-19 pandemic on dental healthcare professionals

Aims and Objectives: The advent of the novel coronavirus disease-2019 (COVID-19) pandemic has sparked a global crisis. Cumulatively, the modifications in patient care and financial restraints are leading to heightened levels of anxiety amongst dentists, making it imperative to comprehend the psychological health implications of the dental professionals. This study aimed to evaluate the psychological impact of the COVID-19 pandemic among Indian Dentists through an online web-based survey.Materials and Methods: The present randomized survey was designed to evaluate the anxiety levels. A total sample size of 405 was calculated. The questionnaire included demographic information and all the variables linked to probable cause of stress during clinical practices and the future prospects of the profession. The questions had to be responded on a scale of 1–10. The responses were statistically analyzed by subjecting the responses to descriptive analysis, Student’s t test, and Pearson’s chi-square tests.Results: A total of 405 responses were received. The levels of anxiety reported were high. Majority of the dentists were troubled by the thought of being in a high-risk profession and of transmitting the disease to others. Almost all questions were responded with a score of >5 on a scale of 1–10 depicting heightened anxiety levels. The fear levels were noted to be elevated in patients aged more than 35 years.Conclusion: Long-term unrecognized anxiety can predispose to significant psychiatric morbidity and fatigue. Identifying and acknowledging adverse factors in a crisis situation will facilitate early intervention to reduce and mitigate the impact of stress.

German Version of the Relationship Problems Questionnaire: Effective Screening for Attachment Disorder

Introduction: Attachment disorder (AD), including reactive AD and disinhibited social engagement disorder, is a prevalent, yet underdiagnosed disorder in severely maltreated children. Because the condition is associated with significant psychiatric morbidity over the entire lifespan, a valid and economic screening tool to identify children with clinical symptoms of AD is needed to avoid unspecific or ineffective treatment. The present study aimed to assess the effectiveness and efficiency of the German version of the Relationship Problems Questionnaire (RPQ). Methods: With a total of 135 children (mean age = 7.17 years, SD = 1.40, 63% male) from both general (34 children) and high-risk populations (69 in- and outpatients, 32 foster children), we investigated the sensitivity and specificity of the RPQ. AD was diagnosed using a standardized clinical interview (K-DIPS). 35 out of 135 children fulfilled the criteria for AD. Results: The RPQ identified 74% of the children who fulfilled the criteria for AD in the standardized clinical interview. The optimal cut-off score of the RPQ for identifying AD was 4.5 with a moderate sensitivity of 0.74 and specificity of 0.68. Conclusions: The German version of the RPQ proved useful as a diagnostic indicator of clinical symptoms of AD. The tool is economic and suitable for the screening of AD in the general population as well as high-risk populations. We recommend the use of the RPQ in clinical and research settings, adding multi-method approaches after a positive screening.

Systemic Treatment of Eating Disorders

Systemic Treatment of Eating Disorders Abstract. Eating disorders (EDs) are deleterious illnesses that are associated with significant psychiatric and medical morbidity and mortality, considerable distress and impairment, marked caregiver burden, and high treatment costs. Because EDs commonly onset in adolescence and young adulthood, and with consistent evidence that early intervention results in the most promising treatment outcomes, an increasing amount of research has been devoted to the treatment of adolescent EDs. Although still less researched in adult presentations of EDs, the historical record of research on adolescent ED treatment over the last half-century principally supports family therapy. Current published clinical guidelines recommend an ED-specific family therapy as the first-line treatment of adolescents with anorexia nervosa (AN) and as a recommended treatment of adolescents with bulimia nervosa (BN). The number of treatment trials for adolescent AN has slowly grown over the last few decades and, more recently, family interventions include protocols extending to new populations and diagnoses, including BN. This narrative review summarizes existing family-based approaches to the treatment of adolescent EDs, integrating recent research findings. This article also includes discussion of methods, both current and proposed, that expand and adapt current family-based approaches in efforts to improve the breadth and scope of ED treatment in adolescence and young adulthood.

Healthcare cost reduction and psychiatric symptom improvement in posttraumatic stress disorder patients treated with intensive short-term dynamic psychotherapy

IntroductionPosttraumatic stress disorder (PTSD) is associated with significant psychiatric morbidity and high healthcare costs. ObjectiveThe aim of this pilot study was to evaluate changes in healthcare costs and general psychiatric symptom severity in patients with PTSD following intensive short-term dynamic psychotherapy (ISTDP). MethodHealthcare services cost and utilization data were compiled at intake, prior to starting ISTDP and then assessed annually for three years thereafter. Two validated self-report scales, the Brief Symptom Inventory and the Inventory of Interpersonal Problems, were administered at intake and termination. ResultsResults showed significant reductions in physician costs and physician visits at one-year post-treatment, with these persisting over the three-year follow-up period. There were also large but statistically non-significant reductions in hospital costs. At termination, self-reported psychiatric symptoms and interpersonal problems were reduced. ConclusionThese preliminary findings suggest that ISTDP may lead to healthcare cost reductions and general psychiatric symptom improvement in patients with PTSD, with healthcare utilization benefits maintained at long-term follow up. Future research directions were discussed.

The Effect of Sedation on Long-Term Psychological Impairment After Extracorporeal Life Support

This retrospective study aimed to identify the association between long-term psychological impairment and total sedation received during venovenous extracorporeal life support (VV-ECLS) for acute respiratory failure (ARF). This observational retrospective study compared characteristics between patients with and without long-term psychological morbidity at long-term follow-up after VV-ECLS for ARF. A single institutional experience in a quaternary referral academic medical center in the United States. Patients who received VV-ECLS for ARF between January 1, 2015, and April 1, 2017, were identified for selection. Presence of psychiatric morbidity (anxiety and/or depression) was determined with the Hospital Anxiety and Depression Subscale battery at long-term follow-up. No interventions were made during this retrospective observational study. A total of 42 patients (21 male, 21 female, median age 49 [interquartile range {IQR} 36-57]) completed a telephone interview a median of 14.6 (IQR 7.7-21.1) months after ECLS decannulation. Cohorts were defined as possessing any psychiatric morbidity (anxiety and/or depression) as defined by the Hospital Anxiety and Depression Subscale battery (n = 22 [52%]) versus no psychiatric morbidity (n = 20 [48%]) at long-term follow-up. Patients who had clinically significant psychiatric morbidity received a median of 15.0 (IQR 11.0-17.0) days of continuous intravenous sedation compared with patients who had no psychiatric morbidity, who received a median of 10.0 (IQR 6.5-13.5) days of intravenous sedation; (p = 0.02). This retrospective analysis identified a significant association between the presence of long-term post-VV-ECLS psychiatric symptoms and the total number of days of intravenous sedation.

Psychosocial characteristics of infertile women in a Nigerian tertiary hospital

Introduction: High premium is placed on childbirth particularly after marriage in our society. Sub-Sahara Africa is known to have the high incidence of infertility and the woman is usually blamed for the problem. Stress is known to have effect on ovulation and therefore conception thereby forming a vicious cycle. The study was to determine the psychosocial problems and psychiatric morbidity among infertile women and to determine the difference in psychosocial problems in primary and secondary infertility patients. Method: The Satisfaction with Life Scale (SWLS) questionnaire, the 12 -item General Health Questionnaire (GHQ-12) and the HADS (Hospital Anxiety and Depression Scale) were administered to 111 patients. Result: The mean age for the respondents was 33.6 ± 5.8 years. There were more cases of secondary infertility 58 (52.3%) compared to primary fertility 53 (47.7%). The study revealed a fairly high degree of psychological morbidity among the respondents, a depressive rate of 39.6%, anxiety rate of 48.6% and psychiatry morbidity of 39.6%.There was no significant difference in prevalence of these morbidity between the patients with primary and secondary infertility. Conclusion: Both primary and secondary infertility are associated with significant psychosocial and psychiatric morbidity. Psychological strain itself can also be a cause or aggravate infertility therefore psychological assessment and co-management with the psychiatrist should be encouraged.

Situating adult attention-deficit/hyperactivity disorder in the externalizing spectrum: Etiological, diagnostic, and treatment considerations.

Adult attention-deficit/hyperactivity disorder (ADHD) has a population prevalence of 5%. However, its prevalence is much higher in mental health and substance use treatment settings. It is associated with significant physical and psychiatric morbidity, as well as social, occupational, and legal consequences. Adult ADHD is considered to be a part of the externalizing spectrum with which it shares both homotypic comorbidity and heterotypic continuity across the lifespan. This is attributable to a shared genetic basis, which interacts with environmental risk factors such as nutritional deficiencies and psychosocial adversity to bring about epigenetic changes. This is seen to result in a lag in brain maturation particularly in the areas of the brain related to executive functioning (top-down regulation) such as the prefrontal and cingulate cortices. This delay when coupled with impairments in reward processing, leads to a preference for immediate small rewards and is common to externalizing disorders. Adult ADHD is increasingly understood to not merely be associated with the classically described symptoms of hyperactivity, impulsivity and inattention, but also issues with motivation, emotional recognition and regulation, excessive mind wandering, and behavioral self-regulation. These symptoms are also observed in other disorders which overlap with the externalizing spectrum such as oppositional defiant disorder, conduct disorder, antisocial and borderline personality disorder. It is therefore important to develop both broad-based and specific interventions to be able to target these deficits which can reduce the burden and improve outcomes.

Psychiatric Illness in Indian Bone Marrow Transplant Patients.

Introduction: Bone marrow transplantation is the main stay treatment for various disorders. Psychosocial morbidity associated with Bone Marrow Transplant are due to the diagnosis of a deadly disease, curative option with its associated risk of death. Several psychosocial factors influence the long-term outcome in patients.Objective: To identify Psychiatric illnesses in Indian patients undergoing hematopoietic stem cell transplantation.Materials and Methods: This cross-sectional study was conducted during the period of July 2015 to March 2017 at Institute of Haematology and Bone Marrow Transplantation, MIOT INTERNATIONAL, Chennai, India. All consecutive patients, aged 15 years and above, who fulfilled inclusion and exclusion criteria and underwent transplantation, were enrolled in this study. Psychiatric assessment comprised of a semi-structured interview based on Present Status Examination (PSE).Results: Out of 72 enrolled patients, twenty-six (36.1%) patients met the psychiatric diagnostic criteria. Adjustment disorder (43%) was more frequently encountered among the affected individuals followed by depressive illnesses (24%).Discussion:We had 36% of patients with symptoms of psychiatric illnesses. Interestingly higher percentage (54% and 41%) of psychiatric morbidity was observed in studies carried out by Leigh et al. and Sasaki respectively. Regarding diagnostic breakup among transplant patients, adjustment disorders (with symptoms of anxiety and depression) was the most frequent diagnosis (43%) in our study, which is similar to research of Sasaki.While on the other hand study done by Jenkin et al.observed higher prevalence (40%) of depression, which was the second highest psychiatric morbidity in our research. Majority of patients appeared to be mentally prepared and tolerant during transplantation and very few patients observed psychological problems. So, any sort of psychological issues encountered during transplantation has no relation with the diagnosis or the therapy per se but rather is more intricately related to the personality and personal history of the patients.Post-transplantation period seems to be highly stressful mainly due to the isolation, high vigilance, expectations, apprehension of the future and reverse barrier nursing. Therefore, most of psychiatric symptoms were observed within first week after transplantation procedure in 69% (n=18) of patients in our study. Other studies by Illescas - Rico et al. and Sasaki also noted that psychiatric disorders mainly developed after transplantation in majority of cases (68.75%). 76%(n=20) required psychotropic medicines in addition to counselling and psychotherapy Psychiatric symptoms settled in 62% (n=16) of cases during their stay in BMT unit.In this study, patients of the age group 24-45 years, were mostly affected comprising of 54% of all the individuals having psychological problems. Another study carried out by Prieto et al.on 220 patients who had recieved stem cell transplantation had however observed that younger age is one of the risk factor associated with psychiatric disorder in BMT. This clearly reflects the more stress observed in younger population secondary to transplantation. Regarding gender, it is believed that psychiatric disorders are significantly more common in females than males. However in this study, the number of males (58%) were more than the number females amongst the affected patients.There are few limitations of our study like the relatively small sample size, single centre study and limited time period. A multi-centric study is mandated to establish the findings more strongly to bring about a comprehensive care for the patients.Conclusion: Significant psychiatric morbidity (>1/3 - 36%) associated with bone marrow transplantation was observed. This study indicates the importance of psychiatric intervention during the transplant procedure as well as pre-transplant psychiatric assessment and counselling regarding transplant procedure.Keywords: Psychiatric disorder, Adjustment disorder, Hematopoietic stem cell transplantation.ReferencesAndrykowski MA.Psychological factors in bone marrow transplantation: a review and recommendation. Bone Marrow Transplant 1994; 13: 357-375,PrietoJM, BlanchJ, AtalaJ, CarrerasE, RoviraM, CireraE, et.al. Stem cell transplantation: risk factors for psychiatric morbidity. Eur J Cancer 2006; 42:514-20. DisclosuresNo relevant conflicts of interest to declare.