Psychiatric Morbidity in Elderly Patients attending OPD of Lumbini Medical College and Teaching Hospital

INTRODUCTION: Geriatric psychiatry patients are increasing but enough work has not been done in this area of Nepal. We conducted this study to find out the prevalence of different psychiatric morbidities in elderly population and to find out if there are any age and gender specific differences. MATERIAL AND METHODS: Medical records of psychiatric patients above 65 years of age visiting outpatient department of Lumbini Medical College and Teaching Hospitalfrom April 1, 2018 to March 31, 2019 were reviewed. Risks of having different psychiatric disorders was estimated using odds ratio. RESULTS: A total of 300 cases were enrolled in the study. Mean age of the study group was 71.49(SD=6.99). There were more females. Depressive disorderwas the most common diagnosis followed by somatoform disorder, anxiety disorder, dementia and others. Depressive disorder was higher in females and in younger subgroup of the elderly patient.The risk of having dementia was higher in older group. CONCLUSION: Depressive disorder was the most common psychiatric disorderfollowed by somatoform disorder in elderly patients above 65 years of age. Male patients were more likely to suffer psychiatric disorder as compared to females in this age.

Reversible splenial lesion syndrome with mental disorders as only manifestation

Background Reversible splenial lesion syndrome (RESLES) was reported to be associated with variable entities. However, much less is known about the cases in which the mental disorders act as the only manifestation. Method Total ten patients of RESLES were obtained in this retrospective study from Shenzhen Kangning Hospital. T1-fluid attenuated inversion recovery (T1-FLAIR), T2-weighted images, T2-FLAIR, diffusion-weighted images and apparent diffusion coefficient map were performed on all the patients. Clinical manifestations, laboratory examination results, magnetic resonance imaging (MRI) findings, treatments and outcomes were analyzed. Result All patients showed different mental disorders as the only manifestation. There were two cases of alcohol abuse, one of Asperger’s syndrome with malnutrition, one of infection and one of invasive pituitary adenoma. The other cases were diagnosis as major depressive disorder, dissociative and conversion disorders, undifferentiated somatoform disorder, unspecified psychosis and bipolar disorder, respectively. Three patients were completely recovered while the clinical symptoms of rest seven patients partially recovered at the follow-up three months later. Oval-shaped lesion centered on the splenial of corpus callosum (SCC) was observed in all patients using MRI. The lesions of SCC of all patients were completely resolved within five weeks. Conclusions We found that RESLES might only showed mental symptoms. On the one hand, for the patients with acute mental disorders, clinicians should be alert to the possibility of RESLES caused by physical disease. On the other hand, we suggest that mental disorder might be a precipitating factor of RESLES.

A STUDY OF PROFILE OF PATIENTS REFERRED TO PSYCHIATRY DEPARTMENT FROM OTHERS DEPARTMENTS

Introduction: The aim is to study the Profile of patients referred to Psychiatry department in a Medical College & Hospital in Rajasthan. Material and Methods: A study of 100 subsequent patients was conducted in psychiatry department, Diagnosis was made by psychiatrists based on ICD-10 guidelines. Data was analyzed using appropriate statistical techniques. Results: 18.00% of patients were diagnosed as Mixed anxiety & depression followed by depressive disorder 23.00%. Somatoform disorder and acute stress reaction adds 5% each. 3.00% diagnosed as psychosexual disorder followed by nil psychiatric diagnosis 2%, schizophrenia and organic psychosis/delirium 1% each. Conclusion: Psychiatric co-morbidity may present in acute & chronic physical illness. The C-L psychiatry would play a major role in the management of psychiatric co-morbidity. The General medicine was the main department for referring patients. Keywords: Psychiatry references from medical& surgical departments, Consultation Liaison Psychiatry.

A Case of Recurrent Acute Abdomen in a Young Lady Masquerading as Somatoform Disorder

Acute intermittent porphyria (AIP) is a rare autosomal dominant hereditary metabolic disorder having protean manifestations. It usually presents with short duration of gastrointestinal symptoms followed by rapidly progressivefulminant neurological syndrome. It is a neurological emergency and mimics many other psychiatric and medical disorders and can be fatal if it remains undiagnosed and untreated. Further, specifictreatment in the form of Heme arginate is not universally available and very costly, so high clinical suspicion and early diagnosis and management of acute attack and prevention of further attacks are very important. Here, we report a 23 years old married female nurse presenting with recurrent acute abdomen requiring frequent hospital admissions along with convulsion during her last attack. The presence of porphyrins in urine confirms the diagnosis of AIP.

ORTHOSTYLE OR MODERN NEUROSIS:

Problems of eating behavior and the desire for a healthy diet are topical issue today. The WHO claims that there are patterns of eating behavior that can be a harbinger of other mental illnesses. The purpose of the research: to study the emotional and behavioral mental manifestations in people with nervous orthorexia, to develop an algorithm for medical and psychological support, calculation of statistical data among respondents (200 people) as a percentage of "norm - orthorexia". Information and educational work on eating disorders among the population of Ukraine. Material and methods. ORTO-15 (according to the Institute of Food Sciences, University of Rome "La Sapienza") was used to detect people with orthorexia, which determines the obsession with healthy eating. Using the Minnesota Multidisciplinary Personality Questionnaire "MMPI-2", pathopsychological changes were identified, hidden individual tendencies and psychopathological experiences among a group of people with nervous orthorexia were analyzed. Socio-statistical methods were also used to analyze and compare data (age, gender, preferences, place of residence, education, physical activity). The research involved 200 respondents: 100 women and 100 men. Ukrainians from Ukraine and the diaspora were involved (87% to 13%). More than 60% of participants monitor their weight, play sports and comment on their appearance. Research findings and their discussion. Of the 200 respondents 15% with orthorexia and 15% with the borderline condition. Among men orthorexia (20%) is more common than borderline condition (16%). In women there is a reverse trend: borderline condition (14%), orthorexia - (10%). Among the identified men and women with orthorexia, a research was conducted for a detailed analysis of pathopsychological features and individual psychological trends using the MMPI-2 test: orthorexia group (women) 79% - schizophrenia, 68% - psychoasthenia, 19% - hypomania, 6% - hypochondria and psychopathy and orthorexia group (men) 81% - schizophrenia, 66% - psychoasthenia, 21% - hypomania, 8% - hypochondria and psychopathy. Conclusions. Nervous orthorexia is a modern eating disorder characterized by an obsessive desire for a healthy diet. According to a research among the Ukrainian population: young people (up to 35 years old), people with certain dietary regimes (vegans, vegetarians, pescetarians, raw eaters), people who care about their physical condition are more prone to orthorexia. There is also an association between orthorexia and age generations. Millennials and generation Z are more likely to develop this eating disorder. Also at risk are people with cycloid traits, mood swings, high anxiety and a tendency to obsessive thoughts. There is a link between orthorexia and other neurotic disorders: OCD, anxiety disorder, GAD, somatoform disorder, and variants of adult personality disorder. Eating disorders can be associated with various stressors and self-perceptions. They occur in people with low self-esteem, in people with an obsessive desire to change their own body (dysmorphomania), as a result of distorted vision of their own body. The media and society make their adjustments to beauty standards, which encourages change. According to the research, 78.4% of men and 82.3% of women want to change their appearance, which may be due to: bullying at school age for excess weight, beauty standards from TV shows, social networks and contemplation of photos with perfect figures.

Reversible Splenial Lesion Syndrome with Mental Disorders as Only Manifestation

Background Reversible splenial lesion syndrome (RESLES) was reported to be associated with variable entities. However, much less is known about the cases in which the mental disorders act as the only manifestation. Method: Total ten patients of RESLES were obtained in this retrospective study from Shenzhen Kangning Hospital. T1-fluid attenuated inversion recovery (T1-FLAIR), T2-weighted images, T2-FLAIR, diffusion-weighted images and apparent diffusion coefficient map were performed on all the patients. Clinical manifestations, laboratory examination results, magnetic resonance imaging (MRI) findings, treatments and outcomes were analyzed. Result All patients showed different mental disorders as the only manifestation. There were two cases of alcohol abuse, one of Asperger’s syndrome with malnutrition, one of infection and one of invasive pituitary adenoma. The other cases were diagnosis as major depressive disorder, dissociative and conversion disorders, undifferentiated somatoform disorder, unspecified psychosis and bipolar disorder, respectively. Three patients were completely recovered while the clinical symptoms of rest seven patients partially recovered at the follow-up three months later. Oval-shaped lesion centered on the splenial of corpus callosum (SCC) was observed in all patients using MRI. The lesions of SCC of all patients were completely resolved within five weeks. Conclusion MRI is an essential tool to identify the RESLES. For the patients with acute mental disorders, clinicians should be alert to the possibility of RESLES. Excluding other possible etiologies, we suggest that different mental disorders might be precipitating factors of RESLES.

A Case of Recurrent Acute Abdomen in a Young Lady Masquerading as Somatoform Disorder

Acute intermittent porphyria (AIP) is a rare autosomal dominant hereditary metabolic disorder having protean manifestations. It usually presents with short duration of gastrointestinal symptoms followed by rapidly progressive fulminant neurological syndrome. It is a neurological emergency and mimics many other psychiatric and medical disorders and can be fatal if it remains undiagnosed and untreated. Further, specific treatment in the form of Heme arginate is not universally available and very costly, so high clinical suspicion and early diagnosis and management of acute attack and prevention of further attacks are very important. Here, we report a 23 years old married female nurse presenting with recurrent acute abdomen requiring frequent hospital admissions along with convulsion during her last attack. The presence of porphyrins in urine confirms the diagnosis of AIP.