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Biomedical subjects

P Sharan

Publications and source records attributed to P Sharan.

14 recordsLinked to original sources
PubMed1999

Thyroid functions in lithium-treated psychiatric patients: a cross-sectional study.

In the present cross-sectional study, thyroid functions (viz. thyroid radioiodine uptake [RAIU] and serum T3, T4, and thyroid-stimulating hormone [TSH]) were evaluated in 24 healthy controls and 132 outdoor affective disorder patients. Eleven of these patients were to receive lithium (Li) and the remaining 121 patients were at different stages of Li treatment ranging from 0.7 to 240 mo. RAIU was found to increase significantly throughout the Li therapy and was associated with the corresponding rise in TSH levels. In totality, Li treatment induced subclinical hypothyroidism in 51/132 (39%) of patients. However, 8/51 patients who belonged to known iodine-deficient belt had abnormally high TSH (range 15.2-76.0 microIU/mL), low T4 (5.3+/-2.5 microg/dL), and normal T3 and at least 4 of these 8 patients were clinically hypothyroid. T4 levels declined significantly (p < 0.05) with Li treatment ranging from 61 to 240 mo as compared to the corresponding values in the pre-Li group. The T3/T4 ratio was found to be significantly higher with Li treatment ranging from 0.7 to 6 mo in comparison with the pre-Li group and this value returned to base levels after long-term Li therapy. High T3 and T4 were observed in 13% and 12% of the patients, respectively, as compared to the corresponding control values.

Adolescent↗
PubMed1999

Lithium prophylaxis of recurrent bipolar affective disorder: long-term outcome and its psychosocial correlates.

BACKGROUND: Discrepancy between efficacy of prophylactic lithium and its effectiveness in ordinary clinical practice necessitates long-term follow-up data from specialised lithium clinics. Also, role of psychosocial factors in influencing the outcome is unclear. METHODS: One hundred and eighteen patients of bipolar affective disorder attending a lithium clinic were followed-up for approximately 11 years (range 2-27 years). Demographic and clinical data, measures of social support and psychosocial stress were obtained at the intake in 1989-1990. Study design combined retrospective chart-review (till the time of intake) with prospective follow-up till July 1995. RESULTS: On lithium, the patients had a mean of 0.43 relapses per year (manic, 0.26; depressive, 0.17) which was significantly less (p < 0.01) than the pre-lithium episode frequency. The figure for entirely relapse-free patients was 24%, and 62% had relapses up to one episode per year (median = 0.3 per year). Fifty-eight (49%) patients were good responders to lithium (relapses < or = 0.30 per year). In comparison to good responders, partial/poor responders had a significantly greater number of pre-lithium depressive episodes, poor lithium compliance, more psychosocial stress and lower social support at intake. These variables correlated well with relapses and explained 32% of the variance of the data. CONCLUSIONS: Lithium had a definite prophylactic effect on long-term outcome. Social support and stressful life events are significant correlates of response to lithium. CLINICAL IMPLICATIONS: Lithium prophylaxis of bipolar affective disorders seems justified though psychosocial factors appear to modulate its effectiveness. LIMITATIONS: Other psychotropic medications were used during relapse and the assessment of psychosocial factors was cross-sectional.

Adolescent↗
PubMed1996

Preliminary report of psychiatric disorders in survivors of a severe earthquake.

OBJECTIVE: The authors' goal was to study psychiatric morbidity after a natural disaster in rural India. METHOD: As members of a volunteer medical team assigned to 23 households in three villages in India affected by an earthquake, the authors examined the results of semi-structured interviews used to interview all of the adults (older than 14 years) in these households (N=56). DSM-III-R diagnoses were assigned on the basis of these interviews, and non-parametric tests were applied to comparisons of subjects who were or were not given a psychiatric diagnosis. RESULTS: Thirty-three (59%) of the subjects received a psychiatric diagnosis; the most common diagnoses were posttraumatic stress disorder (13 subjects [23%]) and major depression (12 subjects [21%]). Psychiatric morbidity was associated with female sex, destruction of house, and destruction of possessions. CONCLUSIONS: Attention to the mental health needs of disaster survivors in third world countries is indicated.

Adolescent↗
PubMed1995

Eating disorders: an Indian perspective.

Anorexia nervosa and related eating disorders are rare in non-western cultures. In India the information regarding these disorders is very limited. The authors describe five cases of young women who chiefly presented with refusal to eat, persistent vomiting, marked weight loss, amenorrhea and other somatic symptoms. They did not show overactivity or disturbances in body image seen characteristically in anorexia nervosa. Though finally diagnosed and treated as cases of eating disorder, they presented considerable difficulty in diagnosis. The paper discusses the reasons for the seeming rarity of anorexia nervosa in India and sociocultural reasons for its atypical presentation.

Adolescent↗
PubMedDate not supplied

Coping and adaptation in acute lymphoblastic leukemia.

The coping and adaptation of 39 children (6-12 years) to Acute Lymphoblastic Leukemia was studied during the first remission with a projective technique--Children's Apperception Test (CAT-S). Seventy seven percent of the children gave adequate responses. Among these, disease awareness was present in 96%, expectation of a favourable outcome was held by 70%, though 61% evidenced emotional distress. Children's psychiatric morbidity was found to be associated with non-response to CAT-S, to anxiety related themes, and negatively with ability to maintain an expectation of a positive outcome.

Adaptation, Psychological↗
PubMedDate not supplied

Coping and adaptation in parents of children suffering from acute lymphoblastic leukemia.

The coping and adaptation of 30 parents of children suffering from A.L.L. (during first remission), was studied with the Thematic Apperception Test (TAT--Indian modification). Emotional distress was evident in the stories of 83%, only 37% maintained an expectation of a positive outcome. Parents' psychiatric morbidity was found to be associated with the gender of the parent, employment status, and on the TAT--with the expectation of an unfavourable outcome, feelings of lack of self efficacy and emotional distress. Particularly depression. A significant association between the presence of psychiatric disturbance in the children and the parents was also found.

Adaptation, Psychological↗
PubMedDate not supplied

Psychiatric disorders among parents of children suffering from acute lymphoblastic leukemia.

The aim of the study was to assess the frequency and likely associations of psychiatric disorders in parents of children suffering from acute lymphoblastic leukemia (ALL). One parent each of 30 consecutive ALL patients who achieved their first remission were interviewed and rated on the Comprehensive Psychopathological Rating Scale. Ratings were also made on the Hamilton Depression Rating Scale and the State Trait Anxiety Inventory. Fifty percent (n = 15) of the parents had psychiatric disorders, namely neurotic depression (n = 11, 36.7%) and adjustment disorder with depressed mood (n = 4, 13.3%). These disorders were of mild to moderate severity and were perceived to be highly treatable. Psychiatric morbidity was associated with women and unemployment. A score of 14 on the Hamilton Depression Rating Scale provided a reliable cutoff for selection of subjects for referral.

Adult↗
PubMedDate not supplied

Psychiatric morbidity in children suffering from acute lymphoblastic leukemia.

The study aimed at assessing the frequency of psychiatric disorders in children with acute lymphoblastic leukemia. Thirty consecutive subjects in the age range of 6-12 years were interviewed with the help of a symptom checklist soon after they had achieved their first remission. The children were also administered the Children's Depression Rating Scale and the State Trait Anxiety Inventory for Children. One-third (n = 10) of the subjects received a diagnosis according to the International Classification of Diseases, 9th ed. Ninety percent (n = 9) had emotional disorders. All the disorders were mild to moderate in intensity and were perceived to be easily treatable.

Anxiety↗
PubMedDate not supplied

Treatment-resistant depression: clinical significance, concept and management.

Depression is a common disorder which causes intense personal suffering and socio-occupational dysfunction. It also imposes a heavy economic burden on society. It has been shown that between 29% and 46% of depressed patients fail to respond adequately to antidepressant medication. Treatment-resistant depression may contribute to the morbidity and mortality associated with affective illness. When treatment resistance is suspected, the patient's history should be reevaluated particularly regarding diagnostic subtypes and comorbidity. An assessment of treatment adequacy in terms of dose, duration and compliance should also be made. Treatment strategies for treatment-resistant depression should be systematic and empirically grounded because of the risk of increased resistance and loss of time in case of a random trial-and-error approach, and the inherent risks in certain novel strategies. A stepped care approach to treatment-resistant depression involves optimization of the current drug under trial, augmentation with drugs such as lithium and triiodothyronine, and switching to other somatic therapies such as electroconvulsive therapy and monoamine inhibitors. Only if these strategies fail, should novel treatments such as the use of venlafaxine, antidepressant combinations and augmentation with sleep deprivation be considered. Experimental strategies such as the use of antiglucocorticoids and sex hormones, which carry considerable risk, should be restricted to research settings. Somatotherapy should be combined in all cases with depression-specific psychotherapy. Psychosurgery should be considered only in truly intractable cases. Rational and energetic treatment can adequately help a large majority of patients with treatment-resistant depression.

Adolescent↗