Background:With a rapidly increasing population of older aged people, epidemiological data regarding the prevalence of mental and physical illnesses are urgently required for proper health planning. However, there is a scarcity of such data from India.Aims:To study the frequency and pattern of psychiatric morbidity present and the association of physical illness with psychiatric morbidity in an elderly urban population.Settings and Design:Cross-sectional, epidemiological study.Materials and Methods:All the consenting elderly persons in a municipal ward division (n=202) were enrolled after surveying a total adult population of 7239 people. A door to door survey was undertaken where the participants were interviewed and physically examined. General Health Questionnaire-12, Mini Mental State Examination, CAGE Questionnaire and Geriatric Depression Scale were used in the interview apart from consulting the available documents. Other family members were also interviewed to verify the information.Statistical Analysis:Chi-square test with Yates correction.Results:Psychiatric illnesses were detected in 26.7% while physical illnesses were present in 69.8% of the population surveyed. Predominant psychiatric diagnoses were depressive disorders, dementia, generalized anxiety disorder, alcohol dependence and bipolar disorder. The most common physical illness was visual impairment, followed by cardiovascular disease, rheumatic illnesses, pulmonary illnesses, hearing impairment, genitourinary diseases and neurological disorders. Presence of dementia was associated with increased age, single/widowed/separated status, nuclear family, economic dependence, low education, cardiovascular disorders, rheumatic disorders and neurological disorders. Depression was associated with female sex, single/widowed/separated status, staying in nuclear families, economic dependence on others and co-morbid physical illnesses, specifically cardiovascular disorders and visual impairment.Conclusions:This study presented a higher rate of dementia and old age depression. The interesting association with several sociodemographic factors as well as physical illnesses may have important implications for health planning.

Chromosome 22q11.2 deletion syndrome (22q11DS) is the most common microdeletion syndrome in humans. It is typified by highly variable symptoms, which might be explained by epigenetic regulation of genes in the interval. Using computational algorithms, our laboratory previously predicted that DiGeorge critical region 6 (DGCR6), which lies within the deletion interval, is imprinted in humans. Expression and epigenetic regulation of this gene have not, however, been examined in 22q11DS subjects. The purpose of this study was to determine if the expression levels of DGCR6 and its duplicate copy DGCR6L in 22q11DS subjects are associated with the parent-of-origin of the deletion and childhood psychopathologies. Our investigation showed no evidence of parent-of-origin-related differences in expression of both DGCR6 and DGCR6L. However, we found that the variability in DGCR6 expression was significantly greater in 22q11DS children than in age and gender-matched control individuals. Children with 22q11DS who had anxiety disorders had significantly lower DGCR6 expression, especially in subjects with the deletion on the maternal chromosome, despite the lack of imprinting. Our findings indicate that epigenetic mechanisms other than imprinting contribute to the dysregulation of these genes and the associated childhood psychopathologies observed in individuals with 22q11DS. Further studies are now needed to test the usefulness of DGCR6 and DGCR6L expression and alterations in the epigenome at these loci in predicting childhood anxiety and associated adult-onset pathologies in 22q11DS subjects.

The aim of the present study was to compare a cohort of schizophrenia patients with substance use disorder (SUD) with a similar cohort of schizophrenia patients without SUD with regard to sociodemographic variables, clinical variables, psychopathology, anxiety symptoms, depressive symptoms, treatment outcome, and side effect profile of drugs. A total of 143 consecutive inpatients with ICD-10 DCR diagnosis of schizophrenia were included after obtaining informed consent. Patients were evaluated by a semistructured data sheet and Maudsley Addiction Profile. They were then rated by Positive and Negative Symptoms Scale, Calgary Depression Scale, Hamilton Anxiety Rating Scale, and Brief Psychiatric Rating Scale at presentation, three weeks, and six weeks. At three weeks and six weeks, they were also evaluated by UKU Side Effect Rating Scale. Substance abuse was detected in 63.6% schizophrenia patients. Nicotine was the commonest substance followed by cannabis and alcohol. Substance users had longer untreated illness and more depressive symptoms at presentation and six-week follow-up. Dual diagnosis patients had difficulty in abstraction at three and six weeks but not at presentation. Schizophrenia patients with SUD had more depressive symptoms. SUD appeared to mask abstraction difficulties at presentation. Schizophrenia patients with SUD should be carefully assessed for presence of depression.

Background:Research has not adequately focused on the issue of burnout in Psychiatric nurses, despite the fact that they suffer considerable stress in their work. Till date no study has been conducted on burnout among psychiatric nurses in India. Further, there is a particular lack of research in internal variables predicting burnout in them.Aims:To determine whether there are any internal psychological factors relevant to burnout in psychiatric nurses in India.Materials and Methods:We recruited 101 psychiatric nurses scoring less than two in General Health Questionnaire, version 12 (GHQ-12) from two psychiatric hospitals after obtaining informed consent. All subjects filled up a sociodemographic data sheet along with global adjustment scale, emotional maturity scale, PGI general well-being scale, locus of control scale, and Copenhagen burnout inventory (CBI). Correlations between burnout and sociodemographic/clinical variables were done by Pearson's r or Spearman's rho. Signi ficant variables were entered in a stepwise multiple linear regression analysis with total burnout score as dependent variable.Results:Age, duration of total period of nursing, prior military training, locus of control, sense of general well-being, adjustment capabilities, and emotional maturity had significant relation with burnout. Of them, emotional maturity was the most significant protective factors against burnout along with adjustment capabilities, sense of physical well-being, and military training in decreasing significance. Together they explained 41% variation in total burnout score which is significant at <0.001 level. An internal locus of control was inversely correlated with burnout, but failed to predict it in regression analysis.Conclusion:Emotional maturity, adjustability, sense of general physical well-being as well as prior military training significantly predicted lower burnout. Of them, emotional maturity was the most important predictor. Internal locus of control was also correlated with lower burnout.

TO THE EDITOR: Atypical antipsychotics are less likely than first-generation antipsychotics to induce dystonic reactions. In particular, clozapine has rarely been reported to induce dystonic reactions 1 ; indeed, it has been reported to ameliorate dystonia. 2 Oculogyric crisis, which is a specific type of dystonic reaction, has been reported to occur during clozapine treatment 3 and upon clozapine discontinuation. 4 We report 2 episodes of oculogyric crisis.Case Report. A 37-year-old Indian man with chronic paranoid schizophrenia was admitted to a closely supervised inpatient unit, owing to severe psychotic symptoms. One year prior to admission, he had received therapy with depot fluphenazine. During the months leading up to admission, he had been treated with a combination of risperidone 8 mg/day, trifluoperazine 5 mg/day, amisulpride 200 mg/day, and trihexyphenidyl 6 mg/day orally. This antipsychotic polypharmacy regimen provided limited therapeutic benefit and induced prominent and persistent nondystonic extrapyramidal symptoms (EPS).The 3 antipsychotics were discontinued simultaneously and abruptly upon the patient's admission, but trihexyphenidyl was continued at a reduced dose of 4 mg/day. Without any washout period, clozapine was initiated at 25 mg/day and was gradually titrated upward. Within a few days, EPS resolved completely. Suddenly, 9 days later, the patient experienced a witnessed episode of oculogyric crisis (clozapine dosage 150 mg/day), which was successfully treated with 50 mg of intramuscular promethazine.Because the patient suffered from constipation, the decision was made to gradually discontinue trihexyphenidyl over a 2 week period. Within 48 hours of such discontinuation, he experienced a second episode of oculogyric crisis (on day 25 of clozapine monotherapy; clozapine dose 150 mg/day), which again responded to promethazine. In neither of these 2 oculogyric crises did immediate and follow-up clinical examinations reveal changes in the patient's mental or neurologic status. By the time the second event occurred, his psychopathology was showing moderate improvement.Discussion. It seems unlikely that these reactions were related to the residual effects of the patient's previous antipsychotic drugs. The oral medications had been discontinued 9 days prior to the first incident and 25 days prior to the second. Moreover, he had not received depot fluphenazine for more than a year. It is also unlikely that he was taking any other medications or substances during the hospitalization, given that he was under close supervision. Thus, clozapine appears to be the cause of the oculogyric crises. This viewpoint is consistent with the Naranjo probability scale, which indicates a probable relationship between the oculogyric crises and clozapine pharmacotherapy. 5 Interestingly, anticholinergic agents have been used to treat rare cases of clozapine-induced dystonic reactions, 3 but our patient experienced oculogyric crisis while receiving an anticholinergic agent. Another episode of oculogyric crisis occur...