Drugs used in the treatment of childhood psychiatric disorders.
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Biomedical subjects
Publications and source records attributed to M S Bhatia.
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In a prospective study, 144 consecutive indoor cases of puerperal psychosis were assessed. Their mean age was 24.6 years. A past and a family history of psychosis was present in 12 cases each. According to RDC criteria, a majority of the patients had unspecified functional psychosis. A majority of the cases developed psychosis after the birth of a first child. Puerperal psychosis showed a positive correlation with the birth of a female child. Most of these cases developed psychiatric illness in the first 2 weeks after delivery. When the prevalence of symptoms in the study group was compared with the age- and disease-matched nonpuerperal controls, several differences were statistically significant.
Of a total of 800 children (aged 3-12 years) attending a pediatric outpatient department, 182 (22.8%) were found to be having temper tantrums (mean age, 4.7 years). Temper tantrums were found to be most common at 3-5 years (75.3%), less common at 6-8 years (20.8%), and least common at 9-12 years (3.9%). Children aged 3-5 years were more likely to be of a lower social class (p less than 0.01), whereas in other age groups (6-8 years and 9-12 years) children were more likely to be of an upper social class. Boys dominated the study significantly: the ratio of boys to girls was 3.1:1. Boys having temper tantrums were more likely to be of an upper social class (p less than 0.001) compared with girls, who tended to be of a lower social class (p less than .01). Children showed a higher incidence of history of postnatal trauma and seizure disorder compared with the control group (p less than 0.05). Parental overprotection and marital discord were found to be stress factors in a significantly higher number of boys than girls (p less than 0.01); parental negligence was a significant stress factor for girls (p less than 0.01). Associated behavioral problems, such as thumb sucking, enuresis, tics, head banging, sleep disturbances, and hyperkinesis were found to be significantly higher among children with tantrums.
Capgras syndrome in a patient with migraine is reported. It is difficult to establish whether this association, which has only been reported once before, had aetiological significance or was coincidental. Investigating all cases of Capgras syndrome for organic pathology by MRI is suggested.
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Of 50 preschool children having breath holding spells (M:F::3:1) (BHS), 80.0% were less than 18 months of age (mean age 16 +/- 5 mo). More children came from a lower social class (70.0%) and a nuclear family (64.0%). Seventy four per cent cases had onset of BHS within 12 months of age (mean 9.6 mo) and the commonest frequency was 1 to 3 spells per week (56.0%). Cyanosis and tonic-clonic spasms were seen in 96.0 and 84.0% cases, respectively. Anger and frustration were the common triggering factors in 90.0% cases. No ante-, peri- and postnatal factors were significantly associated with the study group as compared to the control cases. The mean scores on Behaviour Screening Questionnaire measuring child's habits related to feeding, toilet and sleep were not significantly different in the study and control groups but the difference was significant (p less than 0.05) for behaviour measuring child's social habits. Parental attitudes, measured on Attitude Screening Questionnaires, were also not significantly different in the study and control groups. Mean hemoglobin and percentage transferrin saturation were significantly lower in the study group as compared to the controls (p less than 0.001). There was a significant decrease in severity and frequency of spells with oral iron therapy.
Of 400 children over the age of four years, 82 (20.5%) were found to be enuretics. Enuresis was found to be statistically higher (p less than 0.001) in lower social class and between the age group 3 to 5 years. Enuresis was found to be significantly more among boys as compared to girls (p less than 0.001). Various stress factors (e.g. negligence, overprotection, strictness of parents etc) and other associated habit disorders (e.g. fear reactions, nailbiting, temper-tantrums etc) were significantly higher (p less than 0.001) in enuretics as compared to control group. The group who was put on combined drug (imipramine) and psychological treatment showed a better long term response than the patients who were put only on drug or psychological treatment (p less than 0.001).
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In a prospective study of 80 new female patients with acute psychiatric disorders (40 each with schizophrenia and major affective disorder), elevated (P less than 0.001) serum concentrations of IgG and IgA were found in comparison to healthy control groups matched for age and sex. In schizophrenic patients the mean levels of IgG (1682.76 mg/dl) and IgA (321.12 mg/dl) were found to be significantly more as compared to those in the control group (IgG-1213.18 mg/dl and IgA - 210.14 mg/dl). Patients with paranoid schizophrenia had significantly high mean serum levels of IgG (1896.86 mg/dl) and IgA (376.16 mg/dl) in comparison to other subtypes of schizophrenia (i.e., catatonic, disorganized and undifferentiated). Mean serum concentrations of IgG and IgA in major affective disorder - mania (IgG 1526.36 mg/dl and IgA 382.16 mg/dl) and major depressive episode (IgG 2008.12 mg/dl and IgA 536.72 mg/dl) were found to be significantly higher as compared to those in the control group (IgG-920.21 mg/dl and IgA - 232.12 mg/dl).
Fifty patients of myocardial infarction and 50 normal controls were studied to find out the relationship of Type A behaviour and stressful life events with myocardial infarction and its sequelae. Type A behaviour was detected in 72 per cent of patients as compared to 16 per cent in control group. Among the different components of Type A behaviour, Factor S (measuring speed and impatience) was found to be significantly higher in the study group. Patients with myocardial infarction also scored significantly high on mean frequency and stress scores on total life events as well as on various subgroups of life events. The mean anxiety and depression scores (as measured on Hamilton's anxiety rating scale and Beck's depression inventory respectively) in patients also showed statistically significant improvement with the passage of time.
48 consecutive male patients of potency disorders were examined and classified as 'Dhat' syndrome, impotence or premature ejaculation. The age range of these cases was found as 20-38 years (mean 23.5 +/- 3.3 years) while age of onset was 16-24 years (mean 20.6 +/- 4.5 years). Majority of cases were unmarried (54.2%) and educated 5th class or above (79.1%). 31 cases (64.6%) had Dhat syndrome with or without impotency and/or premature ejaculation while 7 cases (14.6%) had only premature ejaculation and 10 cases (20.8%) only impotence. The cases with 'Dhat' syndrome or with impotence scored maximally on neuroticism and depression scales. Neurotic depression was the commonest associated psychiatric illness (39.5%) followed by anxiety neurosis (20.8%) while 31.3% did not have any possible diagnosis. The common presenting symptoms of 'Dhat' syndrome include weakness (70.8%), fatigue (68.7%), palpitations (68.7%), sleeplessness (62.4%) etc. Among the four groups on the basis of type of treatment (antianxiety drug, antidepressant, placebo, psychotherapy), the best response was seen in those receiving antianxiety or antidepressant drugs while those receiving psychotherapy showed minimal response. 7 cases (14.6%) dropped out of treatment and the maximum dropout (40.6%) was seen in psychotherapy group.
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