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Purpose: Gall bladder cancer (GBC) is one of the commonest and deadliest cancers of Northern and Eastern India. The absence of a population-based cancer registry in Uttar Pradesh and Bihar has resulted in a lack of statistical information even though data from several hospital-based registries suggests that incidence rates of GBC may be one of the highest in the world. We present the four-year data on GBC from our tertiary-level multispeciality hospital. Materials & Methods: This is a retrospective and analytical study. All patients of histopathologically proven GBC over four years were included and geographic, demographic and clinical data was collected and presented. Follow up, where available, was used to assess survival at 12 months and factors affecting it. Results: A total of 245 patients with GBC were diagnosed during the study period of which more than two-thirds were women. The majority of cases at our hospital were from the state of Uttar Pradesh with the highest number coming from the Eastern districts closer to the river Ganga and its tributaries. 26.5% of cases were early stage and surgically resectable, 19.6% were locally advanced and unresectable while 53.9% were metastatic at presentation. Age, stage and radical surgery as treatment had a significant association with survival at 12 months. Conclusion: GBC has an extremely high incidence in the Northern plains of India. There is a high suspicion of its association with increasing pollution of the major rivers of the region. Early detection is crucial as definitive surgery is the only curative option with any significant improvement of survival.

Byline: Swarndeep. Singh, Raman. Deep Pregnancy in women with bipolar disorder (BD) can be considered a high-risk pregnancy in view of several clinical and pharmacotherapeutic considerations. Pharmacological treatment during pregnancy [...]

Background & objectives: Cingulum bundle (CB) is frequently implicated in schizophrenia; however, its role in specific symptoms of schizophrenia such as auditory verbal hallucinations (AVHs) is less explored. Few studies have reported association between reduced integrity of CB and severity of AVH. Using a symptom-based approach, this diffusion tensor imaging (DTI) tractographic study was aimed to assess and compare the integrity of CB in schizophrenia with AVH, schizophrenia without AVH and healthy controls. Methods: A total of 92 right-handed adult individuals (aged 18-50 yr) were recruited across three study groups. Those with Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) diagnosis of schizophrenia with AVH (group I; n=30) were compared to those with DSM-5 schizophrenia without lifetime AVH (group II; n=32) and healthy controls (group III; n=30; screened using Mini International Neuropsychiatric Interview version-7.0.0. and negative family history). Clinical assessments (groups I and II) included scale for assessment of positive symptoms, scale for assessment of negative symptoms, clinical global impression-schizophrenia and psychotic symptom rating scale. All participants underwent DTI, and quantitative tract-based measurements of fractional anisotropy (FA) were obtained for images using DTI studio version-3.0. Results: All groups were comparable for age, gender, education and severity of illness. Group I had significantly lower FA values in the cingulate gyrus (CG) part of the left CB compared to groups II and III. No significant difference was found between groups II and III. Interpretation & conclusions: The findings of this study suggest that the disruption in the left CB appears to be specific for AVH-positive schizophrenia. The finding is, however, preliminary subject to replication in future studies. Further investigations are needed to understand its relevance in the context of AVH-positive schizophrenia. [ABSTRACT FROM AUTHOR]

Background: Relatively limited literature is available on lethality assessment for suicide attempts in affective disorders from the Indian subcontinent. Aims: To assess the lethality and its clinical correlates in lifetime suicide attempters with mood disorders. Methods: A total of 100 lifetime suicide attempters, aged ≥18 years, with a DSM-5 diagnosis of bipolar disorder (BD) or major depressive disorder—recurrent (MDD-R) were recruited. Current euthymia was ascertained (Hamilton Depression Rating Scale (HAM-D) ≤7; Young Mania Rating Scale (YMRS) ≤4). Assessments were conducted using clinical pro forma, Risk–Rescue Rating Scale (RRRS), Columbia Suicide Severity Rating Scale (C-SSRS) and Barratt's Impulsiveness Scale (BIS). Results: Average age of the sample was 36.32 ± 11.76 years (48% males, 52% females). The mean duration of affective illness was 10.59 ± 8.32 years. Risk–rescue scores for lethality were significantly higher in males (vs females), bipolar disorder (vs unipolar), multiple attempters (vs single) and planned (vs unplanned) attempters. Risk–rescue score also showed a significant positive correlation with lifetime total and depressive episodes, and intensity of ideations, and a significant negative correlation with BIS—attention impulsiveness. Regression analysis [F (3,96) = 12.196, P < 0.001, adjusted R2 = 0.253] found that lifetime lithium prescription, intensity of suicidal ideations and attention impulsiveness explained 25.3% variance in lethality. Conclusion: Absence of lifetime lithium, higher intensity of suicidal ideations and lower attentional impulsiveness predicted higher lethality of suicide attempts. Lethality of suicide attempts was found to be associated with a multitude of clinical factors, notably male gender, bipolarity, multiple attempts, planned attempts and number of total and depressive episodes. Assessment of lethality and its correlates can help to plan strategies towards risk prevention in mood disorders. [ABSTRACT FROM AUTHOR]

Background: Persons with disability (PwD) are entitled to certain benefits from the State on grounds of being disabled. With the recent enactment of the Rights of PwD Act, 2016, and increased efforts to provide assistance to persons with certifiable disabilities, data pertaining to disability requests can be useful to understand the way in which services are utilized. Materials and Methods: This study is an audit of the disability certificates issued to all subjects with age ≥18 years between 2016 and 2019 at a tertiary care general hospital psychiatry unit, and discusses the pattern and profile of the certificates. Results: A total of 356 patients were issued disability certificates (2016-2019). The mean age of the subjects was 32.8 (±11.2) years and about 30% of them were females. Intellectual disability (58.3%) was the most common diagnosis, followed by schizophrenia and related disorders (31%), while all other disorders constituted a smaller proportion (11%) of the sample. About 60% of the subjects had moderate disability, 37.4% had severe disability, and 1.7% had profound disability. Conclusion: A large majority of the certificates were issued to subjects with intellectual disability. Patients with severe mental illnesses are probably not accessing the disability benefits optimally. This audit also points to under-representation of women as well as an overall underutilization of services by individuals with mental disability. [ABSTRACT FROM AUTHOR]

Background: Gaps in lithium-related knowledge among bipolar disorder (BD) patients on lithium prophylaxis may pose safety concerns and could adversely influence attitudes to lithium. Objective: To assess the lithium-related knowledge and attitudes among patients with BD. Materials and Methods: This was a cross-sectional, observational study assessing euthymic, adult outpatients with BD on lithium prophylaxis (≥1 year) using a semi-structured pro forma, lithium questionnaire for knowledge, lithium attitude questionnaire (LAQ), and medication adherence rating scale (MARS). Results: Descriptive analysis revealed several deficits in knowledge, including lack of critical safety information or need for periodic blood tests. Lower knowledge group had significantly more negative attitudes. Favorable attitude toward lithium (lower LAQ score) was significantly associated with the number of psychiatric follow-ups in the last year and MARS score. Conclusion: There were critical deficits in lithium-related knowledge among the patients. Lower lithium knowledge was associated with negative lithium attitudes. Educative interventions should be delivered periodically to regular lithium users. [ABSTRACT FROM AUTHOR]

The article discusses auditory hallucinations (AHs) persist in a subset of chronic psychotic patients in spite of treatment. Topics include the phenomenology of auditory verbal hallucinations has conceptualized on three dimensions including a perceptual dimension , a cognitive dimension, and an emotional dimension; and AHs have one of the common psychiatric symptoms occurring across a range of disorders, in schizophrenia.

Background. Sparse data are available on service utilization, pattern and profile of mental and behavioural emergencies in India. We explored the pattern and clinical profile of consecutively referred psychiatric emergencies at a premier tertiary healthcare centre in India. Methods. We reviewed the consecutive referrals for acute mental and behavioural problems made by the emergency department and recorded in an emergency psychiatry register between January 2015 and January 2016. Results. Over a 13-month period, 666 patients were assessed; of whom 473 (71%) had no prior/known psychiatric history and 84 (12.6%) had a comorbid medical condition. Nearly one-third of patients had potential legal issues associated with their emergency. The most common reasons for presentation were: an attempt at self-harm (130; 19.5%), aggression/agitation (122; 18.3%) and psychoactive substance use-related problems (69; 10.3%). Schizophrenia and other psychotic disorders (89; 13.4%) and mood disorders (87; 13.1%) formed the 2 most common diagnostic groups seen in emergency. Most commonly prescribed medications were benzodiazepines (296; 44.4%) followed by antipsychotics (187; 28.1%) and antidepressants (90; 13.5%). Notably, 11% of patients (76) were advised immediate admission under psychiatry, half of whom could be admitted directly from the emergency. Conclusion. Our findings suggest that there is a need to optimize emergency mental healthcare and develop service delivery models for common psychiatric emergencies in India. [ABSTRACT FROM AUTHOR]

Objective: To describe the clinical profile and pattern of pediatric psychiatric emergency referrals at a tertiary-care center in India. Methods: Retrospective chart review of emergency psychiatry records over a 13-month period (January, 2015–January, 2016). Results: Pediatric psychiatric emergencies (n=65) (mean (SD) age, 14.2 (2.39) y) constituted 10% of all-age psychiatric emergencies. Risk of harm to self and/or others was seen in a third of patients (aggression, 18.5%; self-harm, 16.9%). Common psychiatric diagnoses were dissociative disorder (27.7%), mood disorders (9.3%) and psychotic disorders (7.7%). Compared to adult emergencies attended during same time period, pediatric group had more females (63.1% vs 47.4%; P=0.02), more patients with dissociative disorders (28.7% vs 8.2%; P<0.01) and absence of psychotropic medication prescriptions (36.9% vs 20.6%; P=0.003), while frequency of self-harm and aggression as a reason for presentation was similar to adults. Conclusion: The report helps to understand the service needs of younger age group presenting with psychiatric emergencies. [ABSTRACT FROM AUTHOR]

In this paper, we prove some fixed point results using mixed weakly monotone property and altering distance function in the setting of S-metric space. Our result generalizes the result of Lakshmikantham and Ciric [V. Lakshmikantham and L. Ciric, Coupled common fixed point theorems for nonlinear contractions in partially ordered metric spaces, Nonlinear Analysis, 70, (2009), 4341 - 4349]. [ABSTRACT FROM AUTHOR]

Patch and lymphocyte transformation testing might help to identify the drug, but neither is widely used or accepted.11,12 This article adds to the scarce reports describing psychotropic-drug-induced DRESS, along with the subsequent clinical-psychiatric management and a safe trial on quetiapine and nortriptyline. Given the severity of depressive symptoms and the caregiver's initial refusal for modified electro-convulsive therapy (MECT), nortriptyline was added cautiously and built up to 125 mg/day, over his other medications (prednisolone 40 mg, quetiapine 200 mg/day, clonazepam 1.5 mg/day, amlodipine 5 mg, telmisartan 80 mg). Dear Sir, Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a severe drug reaction characterized by mucocutaneous rash, fever, multi-organ involvement, and hematologic abnormalities.1 Incidence is about one in 1000-10,000 individuals exposed to offending drugs, with 10%-20% mortality.2 Drugs such as allopurinol, sulfasalazine, and anticonvulsants have been associated in existing reports.1,2 Very few reports, however, exist in psychiatric literature.3-6 PubMed-based MeSH search [("Drug Hypersensitivity Syndrome"[Majr]) AND "Psychotropic Drugs"[Majr]] and search terms restricted to the title/abstract returned less than 10 case reports, inclusive of cross-reference search. [Extracted from the article]

In this paper, we have given a criteria for the existence of common fixed point for pair of mappings in 2-metric spaces and establish common fixed point theorems for certain class of contractive type mappings. The results presented here, generalize some well known fixed point theorems given in the literature. [ABSTRACT FROM AUTHOR]

Background: The mitochondrial DNA (mtDNA) G10398A polymorphism has been associated with bipolar disorder (BD). It leads to an amino acid substitution within NADH dehydrogenase subunit, thereby altering the mitochondrial complex I function. This exploratory case-control study assesses the association of mtDNA G10398A with the risk of BD and its relationship to clinical variables in Indian patients., Methods: Cases met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnosis of BD-I in remission and had a family history of BD or recurrent unipolar disorder in biological relatives. The healthy controls (HC) had no known illness and were screened negative for Family Interview for Genetic Studies. Participants were assessed using Clinical Pro forma, NIMH-Life Chart Method and Alda lithium response scale. The mtDNA G10398A was assessed with real-time polymerase chain reaction using TaqMan assay., Results: A total of 82 participants were recruited across cases and controls, with 42 patients (50% with maternal history) and 40 healthy individuals with similar demographic profiles. The mean age of onset was 25.16 (standard deviation [SD] 7.6) years, with illness for 11.59 years (SD: 7.18). Allele A was found in 50% of cases compared to 32.5% HC (odds ratio = 2.08; 95% confidence interval [CI]: 0.85-5.09). Findings remain non-significant for patients with maternal mood disorders (allele A: 38.9%; 21/42). Cases with allele G had significantly higher body mass index (BMI) (P = 0.008) than those with allele A., Conclusion: The study adds information on mtDNA 10398A amongst Indian patient samples and healthy individuals. No significant group difference was found with respect to mtDNA G10398A. The positive association of allele G with higher BMI has potential clinical relevance that can be further investigated in larger samples., (Copyright © 2024 Copyright: © 2024 Nigerian Postgraduate Medical Journal.)