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As per the Global Burden of Disease survey, in India, developmental disabilities are projected to affect more than 11 million children in the age group of less than 5 years. The highest percentage of persons with disability is in the age group of 10–19 years, amounting to 17% of the disabled population, and around 1.2% are disabled in the age group of 0–6 years. Research based evidence has reported that intervention provided at the early stages of development has been proven to be highly effective in addressing developmental challenges of children with special needs and improving their quality of life. This perspective has been written to highlight the importance of mental health professionals at a multidisciplinary integrated early intervention and rehabilitation centre for children with special needs in the country. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has been associated with multiple psychiatric problems in the general population as well as in those admitted with the infection. Studies done so far have mainly focused on the general population. It is important to address the needs and gaps in mental and psychological aspect of health of patients admitted with the infection to improve their overall prognosis. This study was undertaken with the aim to study the pattern of psychiatric referrals of hospitalized COVID-19 patients and to find out if there is any association between their socio-demographics, severity of COVID-19 infection, inflammatory markers, and co-morbidities. Materials and Methods: A descriptive, retrospective chart analysis of the record of 160 psychiatry referrals for COVID-19 patients seen by the on-call psychiatrist from May 2020 to October 2020 in a tertiary care hospital was undertaken. Sociodemographic data, severity of COVID-19 infection, blood investigation reports, psychiatric symptoms, diagnosis and management were recorded, tabulated, and analyzed using SPSS 20. Results: Referrals were more for individuals having moderate-to-severe COVID-19 infection, in elderly patients and in males. The most common reason for referral was disorientation (27.5%) and insomnia (27.5%), followed by the patient having a preexisting psychiatric illness (15%). The most common psychiatric diagnosis was delirium secondary to general medical condition, (28%), followed by anxiety and depressive spectrum disorders (23.75%). 32.5% of the patients referred had a past history of psychiatric illness, the most common being substance use disorder, followed by major depressive disorder and mixed anxiety depression. With the increase in the age of the individuals, the number of referrals for males was significantly more as compared to females (P = 0.00). No statistically significant association was found between age (P = 0.83), gender (P = 0.99), and psychiatric diagnosis. No significant association was found between the severity of COVID-19 and psychiatric diagnosis (P = 0.69). Conclusion: It is essential to screen for psychiatric disorders in patients admitted for COVID, as it goes a long way in reducing the overall morbidity and improves patient cooperation for various procedures which could be life-saving. [ABSTRACT FROM AUTHOR]

Introduction: Coagulopathies are rare side effects with psychotropics and are thus frequently overlooked while prescribing. Selective serotonin reuptake inhibitors are more commonly associated with deranged bleeding parameters, the most frequent being decreased platelet aggregability and activity, and the prolongation of bleeding time. Thrombocytopenia as a side effect of valproate administration often goes unnoticed, and olanzapine has been associated with a higher risk of venous thromboembolism. The aim of our study was to determine what percentage of patients on psychotropics develop changes in bleeding parameters, and whether these changes are significant enough to warrant routine monitoring of these parameters. Material and methods: This was a prospective observational, single-center study which included 100 patients newly started on psychotropics. Those on medications affecting bleeding parameters or having an acute illness like sepsis were excluded. Patients were only on a single psychotropic agent, and their bleeding parameters — prothrombin time, international normalized ratio (INR), bleeding time, clotting time (CT) and platelet count — were assessed at baseline and after 15 and 30 days. Results: Mean values of prothrombin time (PT), INR, bleeding time and CT increased over time while the mean value of platelet count showed a decreasing trend but no clinical manifestations were noted. Olanzapine was the only drug causing a reduction of PT, INR and CT and valproate was the only drug affecting platelet count. Paroxetine affected the bleeding parameters the most among the antidepressants. Sertraline, fluoxetine, amitriptyline and haloperidol were the other drugs affecting various bleeding parameters, though the effects were less compared to the other drugs in the study. Conclusions: Routine monitoring of bleeding parameters in patients receiving psychotropics is not warranted, but caution must be taken while prescribing these drugs, especially in groups such as patients with known blood dyscrasias or peri-operative patients. [ABSTRACT FROM AUTHOR]

Kartagener’s syndrome is a rare genetic disorder of primary ciliary dyskinesia characterized by the triad of bronchiectasis, sinusitis, and situs inversus. There is limited data on the role of Kartagener’s syndrome leading to psychotic manifestations. We would like to discuss the case of a 26-year-old male, who presented to us with psychotic symptoms of 4-year duration. Upon detailed physical examination and pertinent investigations, he was diagnosed to be having Kartagener’s syndrome. He was treated with antipsychotics and benzodiazepines. This case highlights the importance of a thorough physical examination and eliciting medical history, as it may lead to the finding of various syndromes that have been said to be associated with schizophrenia, thereby contributing to its genetic hypothesis. The neurological, biochemical, and structural malformations seen in Kartagener’s syndrome may also lead to psychotic manifestations. They could be genetically linked to loci contributing to an increased risk of psychosis. [ABSTRACT FROM AUTHOR]

Depression in men and women presents differently and there are various factors governing this. This article aims to elucidate these differences so that the management approach can be adopted as required and the morbidity be reduced. [ABSTRACT FROM AUTHOR]

Managing a severe treatment-resistant psychiatric illness in the context of pregnancy has always been a challenge for psychiatrists, especially with a comorbid medical illness. We present a case of an elderly primigravida having schizophrenia of 22 years, with high-risk pregnancy, who suffered from an acute psychotic exacerbation during pregnancy. She was managed with clozapine, aripiprazole, and amisulpiride, after a failed trial of olanzapine and electroconvulsive therapy. This case highlights the challenges in managing an elderly primigravida with comorbid gestational diabetes mellitus and fibroid who required prolonged hospitalization throughout her pregnancy. A strong liaison with an obstetrician goes a long way in ensuring smooth management. [ABSTRACT FROM AUTHOR]

Suicide is a global phenomenon that claims a person's life every 40 s. The suicide-mortality rate in India is higher than the worldwide average for health care professionals (HCP). The treatment gap for mental health care is alarming, more than 80% in India which has improved compared to a decade. Among the methods chosen by HCPs for dying by suicide, violent suicide methods are more common. Hanging is the most common means, followed by lethal injection and jumping from a building. Among the medical students and professionals in India, academic stress is the leading cause of suicides, followed by mental illness and harassment. Stressfully long working hours, starvation for long hours, inadequate diet, sleep deprivation, inadequate rest, high levels of personal expectations, knowledge of lethal suicide methods, easy access to potentially fatal drugs, apathy, and fearlessness towards death are some of the contributing factors. Primary preventive measures to minimize suicides in HCPs would be to conduct stress-management workshops at an institutional level, routine mental health check-ups in healthcare institutions, mental-health screening for students enrolling into healthcare courses, and prompt referrals to mental healthcare facilities. In addition, telehealth services or mental health services for medical professionals of India are the need of the hour. [ABSTRACT FROM AUTHOR]