Psychopathological dimensions in childhood and adolescent psychoses: a confirmatory factor analytical study

The present study explored psychopathological dimensions in psychoses of children and adolescents and the distribution of demographic and clinical variables across different psychopathological domains. This study included 101 consecutive patients aged 6-18 years who had a DSM-IV psychotic disorder (schizophrenia and related disorders or mood disorders). Exclusion criteria included presence of organicity, substance use disorders, and any other childhood disorder. Psychopathology was assessed with Scales for Assessment of Positive and Negative Symptoms. Analysis revealed a four-factor model comprising primary negative, secondary negative, manic and paranoid factors. Patients were regrouped into one of the four factors based on their symptomatology. Patients in these four groups differed in education and age of onset and duration of illness. This study confirmed the existence of a factor structure in psychoses of children and adolescents.

Acute antimanic efficacy and safety of intravenous valproate loading therapy: an open-label study

This open-label study investigated whether acute antimanic effects and safety of intravenous valproate loading therapy is superior to oral valproate loading. Eighteen patients with DSM-IV diagnosis of either bipolar affective disorder or schizomania who met the study criteria were recruited (9 in the intravenous and 9 in the oral valproate group). Psychopathology was assessed with the scale for manic and mixed states on days 0 and 4. A checklist was used for the assessment of side effects. The results showed about 36% reduction in total mean manic scores with intravenous valproate loading; however, statistically, the degree of reduction in manic scores was comparable between the groups. A nonsignificant increase in the rate of adverse events was noted in the intravenous group. Despite its limitations, this study suggests that acute antimanic effects of both intravenous and oral valproate loading are comparable.

Incidence of catatonia in children and adolescents in a paediatric psychiatric clinic

OBJECTIVE

To investigate the incidence and phenomenology of catatonia in a child and adolescent population.

METHOD

Children and adolescents who had attended a paediatric psychiatric outpatient clinic between April and July 2001 were examined for catatonic signs with a formal catatonia rating scale, and patients who had at least two catatonic signs were included.

RESULTS

Eleven patients met the criteria (5.5% of the entire sample and 17.7% of the patients with affective and nonaffective psychotic disorder); of them eight had an affective disorder and three a nonaffective disorder. The mean catatonic scores were significantly high for males and patients with mental retardation.

CONCLUSION

This study shows that catatonia occurs in children and adolescents. Further studies are essential to clarify the distribution of catatonia across various diagnoses and the outcome of paediatric catatonia.

Risk factors and outcome of mood disorders in epilepsy: a case-control study

BACKGROUND

This case-control study investigated both the risk factors and outcome of mood disorders in epilepsy.

METHODS

For this study, 44 patients with both epilepsy and a mood disorder (study group) were compared with 44 randomly selected patients of epilepsy without a mood disorder (control group). Psychiatric diagnosis was made as per ICD-10 Diagnostic Criteria for Research (ICD-10 DCR). International classification for seizure types (1981) was used for classification of seizure types.

RESULTS

Of the patients in the study group, a majority were educated up to at least primary level, had later onset of seizures, longer duration of epilepsy and cluster attacks. The outcome of mood disorders in epilepsy was found good in most.

CONCLUSIONS

Educated patients who develop epilepsy at a later age and patients with poorly controlled epilepsy are more likely to experience mood disorders. In most patients with epilepsy, mood disorders remit completely; notably, in some patients affective symptoms resolve spontaneously.

Caregiver'S burden : a comparison between obsessive compulsive disorder and schizophrenia

The present study compared burden of care between the key relatives of patients with obsessive compulsive disorder (OCD) and schizophrenia. For this study, consecutive key relatives of patients with either OCD (n=30) or schizophrenia (n=41) were evaluated with 40-item burden assessment schedule (BAS). In comparison with schizophrenia group, caregivers in OCD group had significantly high mean scores for the domains, spouse-related factor and caregiver's strategy of BAS. The degree of burden, evidenced by mean scores, was comparable between groups for other domains of BAS. Spouses and unemployed caregivers in OCD group had significantly elevated mean total burden scores. The present findings suggest that caregiver's burden imposed by OCD is either excess or nearly comparable to that of schizophrenia.

'Internet delusion' responsive to cognitive therapy

Delusions are known to be influenced by the popular media, the sociopolitical undercurrents and also by the scientific innovations. Internet is one such modern communication tool, which can easily be incorporated into the delusional system of patients by virtue of its semblance to some psychopathological phenomena. We describe a patient with paranoid schizophrenia who developed a delusion about the Internet controlling him but showed a good response to cognitive therapy.

Intravenous valproate: a new perspective in the treatment of manic symptoms

Over the last few years, the use of valproate in psychiatry has increased considerably. With the advent of oral loading dose strategy, its role in rapid treatment of acute mania has been demonstrated. The intravenous formulation of valproate, while retaining the rapidity of action of oral loading, also avoids some of the adverse effects of the oral preparation. Moreover, reports are pouring in that intravenous valproate loading may be more efficacious than oral valproate loading in the treatment of acute mania. We report two patients whose manic symptoms showed a dramatic response to intravenous valproate without adverse effects. The pharmacology of intravenous valproate and its clinical relevance to psychiatry are discussed.

Catatonia in obsessive compulsive disorder

Catatonia occurs in a wide range of neuropsychiatric conditions. Among the psychiatric disorders, occurrence of catatonia has rarely been documented in obsessive-complsive disorder. Given the paucity of reports, we report two cases of obsessive compulsive disorder that presented as catatonia.

Delusional hermaphroditism: a rare variant of delusional misidentification syndrome

Since the historical contribution of Capgras and Reboul-Lachaux, several researchers began exploring various dimensions of the fascinating phenomena of delusional misidentification syndromes. Recently, Mulholland and O'Hara have reported a new variant of delusional misidentification syndromes named 'delusional hermaphroditism'. In this study, we report another case of this rare entity.

Electro convulsive therapy in pre-pubertal catatonia: a case study

Depression in prepubertal age group is a relatively rare condition. The presence of life threatening catatonic features call for aggressive treatment. Electro convulsive therapy (ECT) has been described to be effective in these circumstances; however, doubts have been raised about its safety profile. This present case study illustrates the efficacy and safety of ECT in prepubertal catatonia.