Indian Journal of Medical Psychiatry

Risperidone is a second generation antipsychotic reported to cause hyperprolactinemia due to its D2 receptor antagonism, which may induce amenorrhea, altered menstrual cycle, loss of libido and increase the long-term risk of osteoporosis. However, to our knowledge, all previous reports have focused on risperidone induced hyperprolactinemia.Here we are presenting a rare case report on prolactinoma caused by risperidone.

Keywords: Risperifone; Adverse Drug reaction; prolactinoma.
 

Anxiety disorders commonly co-occur in patients of schizophrenia and have signicant inuence on course and prognosis of schizophrenia. However, probably due to diagnostic and treatment hierarchical reductionism anxiety disorders have been overlooked in schizophrenia. Review of the literature reveal great differences in prevalence estimates as a result of variations in symptom descriptions and different diagnostic
instruments. There are significant differences in psychopathology of individuals with Schizophrenia with and without anxiety disorders. With regard to treatment response it is seen that subjects with Schizophrenia
and anxiety disorders respond poorly to only antipsychotics but respond better to antipsychotics plus the SSRIs. Further, the duration of illness of schizophrenia subjects with anxiety disorder is comparatively briefer.
The presence of comorbid anxiety disorder in schizophrenia patients may indicate a better prognosis. It is essential that schizophrenia patients undergo proper psychiatric screening and detailed evaluation to detect and treat comorbid anxiety disorders, since this may improve their quality of life and future prospects.

Keywords: Schizophrenia; anxiety disorders; prevalence; management.
 

Background: Psycholeptic and psychoanaleptic drugs are associated with adverse effects which can affect the patient compliance and course of treatment. Psychiatrist awareness about this can facilitate rational and safe use of these medicines. Pharmacovigilance studies for psychiatric drugs are found to be very low in our country. Objectives: To assess the types, severity, causality, preventability, predictability and management of Adverse Drug Reactions (ADRs) among Psycholeptics and Psychoanaleptics. Method: A Prospective spontaneous reporting study was carried out for 6 months in the patients of psychiatry department. The study includes the ADRs among the Psycholeptics and Psychoanaleptics in any age of either sex from in-patients. The medication charts of patients were analysed for ADRs. Results: Among the 141 admitted psychiatric patients, 35 ADRs were reported during the course of study. Risperidone and Olanzapine were the frequently used drugs having the highest number of ADRs and tremor was the commonest ADR. Number of ADRs was found to affect the neurological system. Type A reactions were found to be more in males than in females. The causality assessment was done using Naranjo scale and majority of the reports were rated as possible (85.71%). Mild and moderate reactions accounted for 31.43% and 62.86% respectively as per Hartwig scale and only 5.71% of the reactions were found to be severe. Preventability assessment using Schumock and Thornton scale showed that most of the ADRs were definitely preventable (48.57%). Conclusion: Continuously monitoring the safety profile of psychiatric drugs fosters the rational and safe use of the medicines.

Keywords: Adverse Drug Reactions; Psycholeptics; Psychoanaleptics; Antipsychotics.
 

Background: Postoperative cognitive dysfunction (POCD) is a well recognized complication following various operative procedures. The role of anesthetic agent in etiopathogenesis is still controversial. The
present study aims to describe and compare effects of general and regional anesthesia on post-operative cognitive functions among patients undergoing orthopedics surgery. Methods: A total of 80 patients aged 20-60 years, belonging to either sex, scheduled for <120 minutes duration orthopaedic surgery of lower limb, with good physical status, and with ±20% ideal weight were included. Patients unwilling for consent, past anesthetic use, cognitive impairment, sub-normal intelligence, substance use disorder, psychiatric disorder, and chronic medical condition were excluded. Patients were randomized to receive either general anesthesia (n=40) or regional anesthesia (n=40) during surgery. After routine preanesthetic examination and laboratory investigations, Hindi version of mini-mental status examination scale was applied prior to surgery and at 24h, 2weeks, and 6 weeks postoperatively. Results: The prevalence of POCD at 24 h, 2 weeks, and 6 weeks after the surgery was higher among general anesthesia group (80%, 52.5%, and 27.5% respectively) compared with regional anesthesia group (57.5%, 27.5%, and 15% respectively). When compared with regional anesthesia group, the cognitive domains related to orientation to time, place, registration, recall, and copying at 24 h and recall at 2 weeks postoperatively were significantly affected in general anesthesia group. Conclusion: Although POCD has multifactorial etiopathogenesis, the role of general anesthesia cannot be completely
refuted. Besides preoperative and intraoperative precautions, postoperative cognitive remediation techniques may be recommended. Further studies investigating effect of individual anesthetic agent in causing POCD is required.

Keywords: Anesthesia; Postoperative Complications; Cognitive Dysfunction.
 

Background: Mental health and physical health are essentially intertwined. People living with severe psychiatric disorders are at significant risk of suffering from many physical disorders. The prevalence of depression and anxiety in patients with cardiac disease is little understood. Aims & Objectives: The objective of this study was to assess depression and anxiety in cardiac patients and to determine the relationship between them. Materials and Methods: The study sample comprised of 200 outpatients following up in the cardiology outpatient department (OPD) of the Mamata General Hospital, a tertiary care hospital in Khammam, Telangana, India over a period of 1 year from March 2019 to March 2020. The samples were drawn using a convenience sampling method. Mini International Neuropsychiatric Interview (MINI), Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D) were the scales administered.
Results: Anxiety and depression were present in 51% and 30% of the sample respectively. The mean scores of depression and anxiety were significantly high in females than males significantly. Correlation between depression and anxiety showed that depression and anxiety were positively correlated (r=0.738, P=<0.001). Conclusions: Depression and anxiety are associated with cardiac disorders. There is a need to keep in mind anxiety and depression as comorbidities in cardiac patients for adequate intervention that can be incorporated in the management plan.

Keywords: Depression; anxiety; cardiac patients.
 

Introduction: The attitude of medical students towards psychiatry has been studied extensively in this developed world. The inability to attract medical students to specialize in psychiatry has always been a serious
challenge to psychiatric recruitment in developing countries like India. Aims and Objectives: To study the attitude of undergraduate medical students toward psychiatry. Materials and Methods: This is a cross-sectional study with a sample size of 200 participants who are undergraduate medical students of Mamata Medical College, Khammam, Telangana. The samples were drawn using convenience sampling method. Attitude towards Psychiatry scale (ATP) was the tool used to collect data for this study. Results: The senior students have more favorable attitude towards psychiatry than the junior students (75% vs. 45%). Only 8% second year and 12% final year students affirmatively said they wanted to become a psychiatrist, while around
70% denied psychiatry as their career option. Conclusions: The final year students displayed a more positive attitude towards psychiatry when compared to second-year students owing to the increased exposure during their clinical rotations.

Keywords: Medical College; Undergraduate; Attitude towards Psychiatry.