Neuropsychiatric Manifestations of Acute Intermittent Porphyria – A Diagnostic Dilemma

Porphyrias are a group of inherited or acquired disorders of certain enzymes in the heme bio-synthetic pathway (also called porphyrin pathway). They are broadly classified as acute (hepatic) porphyrias and cutaneous (erythropoietic) porphyrias, based on the site of the overproduction and accumulation of the porphyrins or their chemical precursors. They manifest with either neuropsychiatric complications or skin problems or occasionally both. A clinically induced and histologically identical condition is called pseudo porphyria which is characterized by normal serum and urine porphyrin levels.

Stigma, COVID-19 and mental health: where do we stand?

As the world grapples with the Covid-19 pandemic, along with the obvious health challenges, imposed restrictions and associated economic consequences, the socio-cultural aspects need to be addressed too. Though it is true that increased awareness is essential, to endure the pandemic, it is coming with other unacceptable consequences, as well. Stigma is one of them.

COVID 19 and Psychiatric Morbidity

The COVID 19 virus was first identified in Wuhan in China in 2019. It spread to the entire world subsequently and gave rise to a global pandemic. Although the virus is primarily known to cause respiratory symptoms, there are instances of gastrointestinal symptoms as well as neurological sequelae. The main route of neurotropism is ACE2 receptors expressed in neurons and neuroglia. The SARS-CoV-2, similarly to other respiratory viruses, could gain access to CNS through several routes, for example by migrating through axons of the olfactory nerve.[1]The virus infects and damages the brainstem where respiratory center is located. The inflammatory response, so commonly described in COVID 19 infections, also damages the blood brain barrier causing further destruction to central nervous system through inflammatory chemicals. These massive changes to the brain milieu may be responsible for various neuropsychiatric sequelae like delirium, dementia, stroke as well as form the organic basis of psychiatric conditions like major depressive disorder, anxiety disorder and reactive psychosis. Similarly, massive psychosocial upheavals caused by the overwhelming global pandemic including change in lifestyle and socialization, being forced to stay indoors for weeks together due to lockdowns, financial consequences of unemployment and downslide of economy have all lead to increase in anxiety, depression and even suicidality. This is bound to increase further as time passes and economy takes a further beating. Prolonged stay in intensive care units, fear of imminent death, loss of loved ones all of a sudden- all these have caused increased incidences of post traumatic stress disorder. Overall, the COVID 19 is poised to increase the burden of neuropsychiatric conditions manifold. Longitudinal studies must be undertaken to gain clarity and further understanding on the neuropsychiatric sequelae of COVID 19 and their mechanism.

Long Term Pharmacotherapy for Alcohol Use Disorder

The psychopharmacology of alcohol dependence is today poised at interesting crossroads. Three major drugs Naltrexone, Disulfiram and Acamprosate have been tried and tested in various trials and have many meta-analyses each to support them. While Naltrexone may reduce craving, Acamprosate scores on cost effectiveness worldwide with Disulfiram being an alcohol deterrent drug. Studies support, refute and criticize the use of each of these drugs. Combining one or more of them is also a trend seen. The most important factor in efficacy has been the combination of psychosocial treatment with medication. In this article, we are going to discuss about long term pharmacological management of chronic alcoholism.

Suicide and the Law: Indian Perspective

Suicide is defined as an act in which a person intentionally causes his/her own death. In India, the number of people who ended their lives by committing suicide was 131, 666[1] in 2014; 133, 623[2] in 2015; and 230, 314[3] in 2016. Attempt to die by suicide is defined as a nonfatal and self-injurious behavior with an intent to die. For every death by suicide, on an average, 25 people attempt to die by suicide.[4-6]

A ssessment of Suicide Risk : Practical Issues

Suicide is a major public health problem worldwide with complex multifactorial origins. More than 800,000 lives worldwide are lost to suicide every year, and Asia accounts for more than 60% of such deaths. India has seen a steady increase in the incidence of suicidal deaths in the last five decades.1 The estimated suicide-related death rate in India is 21/100,000, which is nearly twice the global average (11.4/100,000) and translates into more than 230,000 lives lost annually.2 Assessment of suicide risk is of utmost importance and is considered one of the key area and responsibilities of a consultant psychiatrist.

Towards a National Policy on Suicide Prevention

Suicide is a global phenomenon and occurs throughout the life span. It is recognised as a critical public health issue by the World Health Organization (WHO) in its Comprehensive Mental Health Action Plan 2013-2020.1 In the year 2016, it was estimated that globally 817000 population committed suicide. This means world wide one person commits suicide in every 40 seconds.

Non-Suicidal Self Injury: Indian Perspective

Self-injurious behavior or deliberate self-harm (DSH) in adolescents and young adults is an area of growing concern. Reports from clinics and emergency rooms are pointing to the increase in incidence. However, there are very few studies from India. Many of the people presenting with acts of self-harm do not have suicidal intent, and this has prompted the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)[1] to propose a category of Nonsuicidal Self-Injury (NSSI) as a “Condition for Further Study” to encourage further research in this area. DSM-5 Proposed Criteria for NSSI requires an individual to engage in intentional self-inflicted damage to the surface of his/her body, on 5 or more days in the last 1 year, with the expectation that the injury will lead to only mild or moderate physical harm. NSSI is defined as ‘intentional destruction of one’s body tissue without suicidal intent’.

Editorial

The theme for the World Mental Health Day this year is, “Mental Health Promotion and Suicide Prevention”. In keeping with this theme we are bringing out a special issue of our journal on Suicide Prevention. The issue comprises of articles which are of significant relevance to suicide prevention in Indian perspective. We have an article on risk assessment. Subsequent two articles are important from the perspective of our government policy on suicide prevention: One article delves into the need of a National Policy on Suicide Prevention whereas the other one deals with legal aspects of suicide in India. Finally, the concluding article deals with Non-Suicidal Self Injury from an Indian viewpoint. I sincerely hope that the readership would find it useful to broaden their knowledge regarding various aspects of suicide prevention in our country.

Behavioural Side Effects of Methyl Phenidate and Atomoxetine

Attention - Deficit Hyperactivity Disorder (ADHD) is one of the most common childhood behavioral disorders diagnosed in the psychiatry outdoor setting, affecting 5-7% of school - aged children[1]. It is a neuro - developmental disorder that runs a chronic course and causes significant impairments across various domains of day to day functioning. The symptoms of ADHD are divided into two predominant categories: inattention and hyperactivity/impulsivity. Inattention is divided intwo subtypes i.e. focused and sustained/ Executive dysfunction.