No abstract

BackgroundA gradual increase in the longevity due to advancement of treatment modalities and a subsequent surge in elderly population in India have led to a growing curiosity in the geriatric age group with Alzheimer’s disease (AD). Behavioral and psychological symptoms of dementia (BPSD) represent epiphenomena of AD. However, no comprehensive study has been carried out in South East Asia (Kashmir, India), to assess the behavioral and psychological symptoms in subtypes of AD.ObjectivesThe purpose of this study was to assess BPSD in early-onset Alzheimer’s disease (EOAD) and late-onset Alzheimer’s disease (LOAD).Material and MethodsThe study was conducted in the Memory clinic of the postgraduate department of psychiatry, Government Medical College, Kashmir, India from January 2012 to March 2014. The diagnosis of AD patients was done according to NINCDS-ADRDA criteria. A total of 80 patients of AD were screened (40 with age of onset less than 65, and 40 with age of onset greater than 64). Neuropsychiatric inventory (NPI) was the instrument used for evaluating symptoms of BPSD. The data was analyzed using paired t-test.ResultsThe mean age of presentation of EOAD and LOAD was 63.10 years and 84.28 years, respectively, and the difference between the two was found to be statistically significant. The LOAD group had significantly higher symptom severity for delusions, agitation, anxiety, disinhibition, and nighttime behavioral disturbances (NBD) than the EOAD group (p ≤.0001).ConclusionThe behavioral and psychological symptoms are significantly severe in late onset subtype compared to the early onset subtype of Alzheimer’s disease in the Kashmiri (Indian) population.

Our findings clearly indicates that posttraumatic stress disorders (PTSD) is a prevalent disorder in the developing world, especially in disaster prone regions and in areas of political unrest. Resilience to various traumatic events in Kashmir has developed over the years and this might explains the lower prevalence of Post-traumatic disorder (PTSD) in our study.

BackgroundResistance to recommended medications has been an issue in dealing with a number of psychiatric ailments, and it is showing up as an ongoing challenge for contemporary mental health experts. Resistant psychiatric disorders not only increase the morbidity of patients suffering from such severe conditions but also intensify the problems of their caretakers. This has vigorously started to cause the costs to increase for healthcare services. Thanks to electroconvulsive therapy (ECT), we now have an effective method that is proving to be a fruitful final course of action in this micro-epidemic of resistant psychiatric diseases. However, the medical literature of case reports or studies in this niche is scarce. Also, no such comprehensive study has been carried out in the Southeast Asian region to date for the assessment of the effectiveness of electroconvulsive therapy in patients with medication-resistant psychiatric disorders.AimTo assess the effectiveness of ECT in medication-resistant psychiatric patients at the post-ECT course, three-month follow-up, and six-month follow-up.Materials and methodsThe study was a prospective and interventional study (without controls) conducted in the Institute of Mental Health and Neurosciences (IMHANS), Srinagar, India. Fifty-six patients with pharmacotherapy-resistant psychiatric disorders were included in the study. The patients were assessed at the end of the ECT course, at the three-month follow-up, and at the six-month follow-up by the Clinical Global Impression (CGI), Montgomery Asberg Depression Rating Scale (MADRS), Young Manic Rating Scale (YMRS) and the Yale-Brown Obsessive Compulsive Scale (YBOCS). Improvement was defined with the help of the CGI subscale by comparing the position of the patient at admission to the projected condition with ECT.Statistical analysisAnalysis of Variance (ANOVA) was used for analysis of the quantitative data. For the pair-wise comparison of the groups, the post hoc tests were used. Pearson’s chi-square test was used for analysis of qualitative data. A p-value of < 0.05 was considered to be statistically significant, and all the data analysis was done using SPSS Version 20.0.ResultsThe CGI scale revealed that statistically significant improvement occurred in patients at the end of ECT course, at the three-month follow-up as well as at the six-month follow-up.ConclusionECT should be used for the treatment of pharmacotherapy-resistant psychiatric patients and the benefits can be seen even six months after an ECT course completion. Further work in this field should focus on educating the general public about the usefulness of ECT in the treatment of resistant mental illnesses. The myths related to the so-called psychiatric assault from ECT should be removed.

No abstract