Search

Introduction: Deliberate self-harm, including suicide attempt, is a potentially self- injurious behaviour, for which there is proof, that the individual, either implicitly or explicitly, has intention of self-killing. Aims: To assess the lethality of the deliberate self-harm attempts; also, to assess the risk of death and likelihood of rescue, of the attempts and to nd out if there is an association between such morbidities, and the lethality of attempt and likelihood of rescue. Material And Methods: This cross-sectional, descriptive and analytical, quantitative, hospital-based study was conducted at KPC Medical College and Hospital, Kolkata. 182 patients of deliberate self-harm, who fullled the inclusion and exclusion criteria, were randomly selected by computer using a predetermined random number generated from computer. Result: The method of DSH attempt in male & female sexes. It is seen that in the 'cutting' method, 54.4% are males; in ingestion of oral agents, majority (62.2%) are females; in the hanging/ asphyxiation' method, 51.4% are males. Conclusion: The study found that, majority of the DSH attempters were females, young (median age being in the early 30s), Hindu, educated up to class 10, housewives followed by employed subjects, and married. Majority of the patients did not have a past history, or a family history of DSH attempt. The method of DSH attempt used by majority was ingestion of oral agents, followed by cutting, followed by hanging

The investigators assessed the prevalence of Postpartum Depression (PPD), its clinical features and relationship of PPD with socio-demographical and obstetrical factors. The samples were selected from the OPD and IPD, of a Medical college in Kolkata.. Observational study was performed on 500(N=500) postpartum mothers who were selected by using Simple Random Sampling Technique within the six weeks of postpartum period. Data were collected by using the Structured Questionnaire for background information, Edinburgh Postnatal Depression Scale (Bengali Version of EPDS) for postpartum depression. Data analysis was performed using Descriptive Statistics, Chi-square, Logistic Regression and Decision Tree. A total of 112 (Prevalence Rate 22.4%) postpartum mothers had PPD. Stepwise logistic regression model correctly classied 92.2% of women who developed PPD. Using logistic regression model, postpartum depression is best predicted by: No. of Postpartum days p< 0.001***, Age of the mother p

One hundred and sixty-three aphasia patients underwent initial language examination during the first week following stroke and 90–100 days post-stroke. Demographic factors (age, gender, and number ...

Introduction: In the year 2020, the functioning of the world changed in a big way. For a large part of the year, the world stayed locked indoor, due to the novel Coronavirus Disease -2019 (COVID-19). The need for Information Technology (IT) has reached a new height, and this is certain to persist. Though the IT professionals were mostly working indoors in 'work from home' mode, work pressure and boredom increased according to few studies. Work from home also has different set of employees’ expectations and organisational responsibilities. Aim: To assess the psychiatric morbidity working experience and related perspectives of the new normal, as perceived by IT professionals. Materials and Methods: This cross-sectional survey was conducted in Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, West Bengal, India, between May 2020 and August 2020. A Google form-based survey was done which aimed to reach throughout the country. Consent was included as the first question of the form. An ethical clearance was taken from Institutional Ethical Committee of IPGME&R, Kolkata in convenience sampling of IT professionals. For the survey, a semistructured questionnaire was developed and Brief Resilience Coping Scale (BRCS), Ten Items Personality Inventory (TIPI), and K6 psychiatric morbidity screener were used to measure the psychiatric morbidity. Snow ball sampling methods was used to get the sample through free sharing of google forms over the internet. Relevant statistical tests were used to analyse the data, where p

Wilson’s disease is a rare autosomal recessive disorder of copper metabolism that causes an impairment of cellular copper transport. An individual’s inability to excrete excess copper in bile leads to accumulation of copper in organs like the brain, liver and cornea. It can manifest with symptoms of hepatic impairment and liver failure. It can also present with neurological symptoms like rigidity, gait disturbances, dystonia, dysarthria and chorea. Frequently certain psychiatric manifestations have been reported like mood changes, personality changes, cognitive impairment, phobias, psychosis, anxiety, impulsive and compulsive behaviours . It’s rare for a Wilsons Disease patient to present with only Obsessive Compulsive Disorder (OCD). In the present case report, a 15-yearold male presented in the Outpatient Department with complaints of repetitive intrusive thoughts that he was unable to voluntarily control and compulsions of washing and preoccupation with checking and symmetrical organising with a deteriorating scholastic performance. The only positive findings were Kayser-Fleischer rings, low serum ceruloplasmin and mild cerebellar atrophy. The patient started showing symptomatic improvement with pharmacological treatment comprising of zinc, D-penicillamine, and fluoxetine and diet modification.

Coronavirus Disease 2019 (COVID-19) infection or Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, is associated with various psychiatric consequences, which are because of various types of stressors, may be fear of infection or social isolation, hospitalization, death and so on. In the present case report, a 44-year-old female with a history of pentazocine addiction and no known history of previous psychiatric illness was admitted to the Emergency Ward with vacant, withdrawn look, unnatural fixed posture, mutism, refusal to eat. These symptoms developed after discharge from another hospital where she was treated for COVID-19 induced severe pneumonia (resolving). The very next day, the patient demonstrated excessive talkativeness and jovial mood with echolalia. The patient was treated symptomatically and recovered without the use of any antipsychotics. This report highlights the probability of the mania like symptoms being linked to COVID-19 (SARS-CoV-2 infection) highlighting the need for assessment of various psychiatric manifestations during COVID-19 infection.

Background : Dementia is one of the leading cause of disability in geriatric population . Dementia is associated with a reduced Quality of Life (QoL) the cause of which is multifactorial .Qol is a very important outcome measure of management in persons with dementia . The objectives of this study were t Objectives : o determine the clinico social prole in the geriatric population under study and to nd out the quality of life and its correlates in the persons with dementia under study Material & Method: Observational, descriptive study with cross-sectional design. The study was done in 432 geriatric population (>60 years) in the Rural Field Practice Area of a urban Medical College , Kolkata and in the Old Age Home and day Care Centers of a leading Geriatric NGO in Kolkata ., Kolkata. 441 (51%) of the study population were male and 423 (49%) were female. In persons wit Results: h dementia age of the person was negatively co-related with the Cornel Brown score. Per capita income was positively co-related with the Cornel Brown score. Number of care givers was positively co-related with the Cornel Brown score. Cornel Brown score was higher in the persons with dementia who have a family history of dementia. Cornel Brown score was signicantly higher among the female and the difference was statistically signicant. Conclusion: InGeriatricPersons with dementia quality of life is to be assessed properly and efforts are taken to be taken measures so that their quality of life can be better.

Background: Several studies have shown a relationship between depression and low levels of Vitamin D in the body. At the same time, somatisation is found to be a significant complaint in many patients of depression. Whether somatisation has any relationship with the low levels of Vitamin D, needs further research. Aims: To compare the prevalence of Vitamin D deficiency between depressed and non depressed subjects, and see if somatic presentation of depression has any correlate with Vitamin D deficiency. Design: Observational, cross-sectional, hospital- based study. Materials & Methods: The study was conducted in the Department of Psychiatry, in a Private Hospital. Diagnosed MDD patients consenting to participate in the study, & sex matched controls, comprising of close family members of patients were selected. Detailed assessment of depression symptomatology was done. Assessment of somatization was done using Bradford Somatic Inventory. Blood samples were collected for routine tests and Vitamin D (total) estimation. Results: In the group of MDD patients, the mean age of females is 52 years, & mean age of males is 50 years. In the MDD group, the mean Vitamin D level is 17.12; in the control group, the mean Vitamin D level is 22.19. The difference is statistically significant. Among MDD patients, 70% had deficiency of Vitamin D. In the Severe somatic symptom category, 68.3% had deficiency of Vitamin D; in the Mild somatic symptom category, 66.7% had deficiency of Vitamin D. The difference is not statistically significant. Conclusion: Depression patients have significantly higher proportion of Vitamin D deficiency cases. Depressed patients with higher number of somatic symptoms have lower vitamin D level, but the difference is not significant.

Objective Post-stroke depression (PSD) is a disabling entity among stroke survivors (SS). Longitudinal studies on PSD, essential to determine its prognosis, are lacking from developing countries. This prospective study was undertaken to assess the prevalence, natural history, and correlates of depression among SS in an Indian community. Methods From a community based stroke registry, SS were assessed annually for cognition, disability, and depression using Bengali validated scales. PSD was diagnosed if score on geriatric depression scale was greater than or equal to 21. Complex sample strategy was considered when calculating prevalence of post stroke depression. An age- and sex-matched case–control study was undertaken to determine the odds of depression in SS. Results Prevalence of PSD was 36.98% (95% confidence interval [CI]: 31.89%–42.06%) among 241 patients assessed at baseline. About 17% developed depression annually and a similar proportion had spontaneous improvement. Peak rate of PSD was beyond 3 months and continued up to 18 months after stroke. Compared to the non-depressed group, PSD subjects were significantly older, had higher age at first stroke, less education, lower socioeconomic status, and greater cognitive impairment and disability. Education had a protective role. Mortality in PSD was nearly twice that in non-depressed patients, though not significant statistically (hazard ratio: 1.84; 95% CI: 0.90–3.77). Compared with controls, odds ratio of PSD was 19.95 (95% CI: 10.09–39.47). Conclusions Approximately one-third of SS develop PSD, similar to developed countries. Prevalence remains stable annually. Delayed peak of PSD suggested later realization of underlying disability. Predictors of PSD have been described and higher literacy was protective in this study.

Background: Down syndrome, most common chromosomal abnormality leading to intellectual disability is being diagnosed by Karyotyping. Due to cost constraints, parents couldn’t afford to do Karyotyping which causes delay in individual and family interventions. Introduction: Down syndrome has characteristic morphological features. The minor physical anomaly (MPA) are insults which occur in utero during embryonic development mostly in first and early second trimester and persists throughout life. Material and Methods: 70 karyotyping confirmed cases of Down syndrome (DS), 70 other causes of intellectual disabilities (Other ID) and 70 age matched normal children and adolescents (Average) have been incorporated in the study. The Modified Waldrop's scale (Ismail's 41 item scale) have been applied. Demographic comparison and Decision tree algorithm approach have been analysed by SPSS 25 version. Results and Discussion: The paternal age of childbirth, maternal age of childbirth, maternal age of marriage (P < 0.001), income (P = 0.026) variables are statistically significant in Down's syndrome group in comparison to other two groups whereas age and birth order are not statistically significant. DS group has more MPA (m = 17.04, SD = 5.462), than other ID (m = 5.93, SD = 2.628) and Average group (m = 1.59, SD = 1.378). Big sandal gap, high arched palate and epicanthus are most common three minor anomalies found in Down syndrome. Region wise scoring shows high significance (P < 0.001) in Global head, eyes, ears, mouth, hands and feet in Down syndrome group. The four anomalies; epicanthus, telecanthus, high-arched palate, and curved fifth finger) thus can be grouped as differentiating anomalies. When clinodactyly (item 27) and high arched palate (item 21) are present together or epicanthus (item 08) and telecanthus (item 09) present together sensitivity of diagnosing the case as Down syndrome is 0.945 with negative predictive value 0.979. Conclusion: The simian crease which is being considered as common physical anomaly is not specific for Down syndrome. The large scale study is required to extrapolate the above findings but surely it opens new avenue of research.

Background: Lack of insight or awareness of illness is most frequently observed in patients with schizophrenia, and it influences treatment compliance. It has been hypothesized that the frontal dysfunction may explain poor insight in schizophrenia. Aim: The purposes of the study were to assess the degree of insight in schizophrenia and to examine the association, if any, between the degree of insight and executive functions in patients with schizophrenia. Materials and Methods: In this pre-post study, 30 patients of both sexes diagnosed to have schizophrenia were assessed with the Scale to Assess Unawareness of Mental Disorder and Wisconsin Card Sorting Test (WCST). They were assessed once at the time of admission and then at the time of their discharge. Results: The study revealed that 70% of the subjects possessed poor awareness of mental disorder. There was significant improvement of insight over time. The degree of insight was significantly associated with the performance on WCST 2 nd assessment. WCST scores were able to explain 42% of the variance in insight. Conclusion: Majority of schizophrenic patients possess poor insight. This poor insight is significantly associated with poor executive function. Hence poor insight may have a cognitive etiology.

IntroductionKnowledge about how patients perceive mental illness and how it possibly influences help seeking behaviour is important in development of proper plan for mental health reform.ObjectiveThis study planned to study disease related perception, first help seeking behaviour and stigma among schizophrenia patients admitted at a hospital.Aims(1) To know about patient's view regarding the problems; (2) attempt to predict help seeking behaviour.MethodsFifty-one patients suffering from schizophrenia according to DSM-5 and fit to be interviewed were assessed using EMIC (Explanatory Model Interview Catalogue) to get emic (insider or person's own cultural) perspective of disease related perception, help seeking behaviour and stigma.ResultsTerms used to describe their illness included “depression” (21.6%), “mental” (17.6%) “matha kharap” (9.8%). Most common perceived cause was stress (25.5%) and sorcery (23.5). Mental health specialist was visited by 27.5% Faith healer consultation was high (29.4%). Stigma score was higher with marriage related issues and social isolation. Using exhaustive CHAID analysis, it was found that patients with negative themes as disease name like “matha kharap” (loosely meaning crazy) are more likely to visit faith healers, while patients naming the condition with some medical related term like depression were more likely to visit mental health specialist.ConclusionClearly perception of patients regarding mental illness and its causation varies greatly from the way psychiatrists’ viewpoint and this perception is likely to influence help seeking behaviour. Understanding these issues is likely to enable better patient awareness and proper formulation of plans to address mental health issues.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionHamilton Depression Rating Scale (HAMD) remains the most widely used outcome measure though many consider the scale to have many defects.ObjectivesTo use IRT analysis to identify HDRS items which are problematic in terms of IRT parameters, thus suggest changes to the scale.MethodsPatients attending psychiatric OPD meeting DSM-5 criteria for unipolar depression were selected for the study. Patients were between 18-65 years of age, had no major medical problems and were not on any medicines at present. 17 item HDRS was administered using the anchors developed by William Guy as part of the ECDEU NIMH Collaborative Study To determine the relationship between scores on the individual HAMD items and overall depressive severity in an outpatient population Option Characteristic Curve (OCC) which is a graphical representation of the probability of endorsing the different options for a given item across the range of depressive severity) and Item Characteristic Curve (ICC) which is a graphical representation of the mean item score (expected value) and confidence interval as a function of depressive severity was used.ResultsResults showed that Items Depressed Mood, Work and Activities show good relationship between item responses and overall depressive severity. Items Hypochondriasis, somatic symptoms general and retardation appeared to be more problematic with regard to their ability to discriminate over the full range of depression severity.ConclusionsFurther studies are needed to critically review one of the most commonly used scale for one of the commonest malady of humans.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionVitamin D receptor (VDR) is widely distributed in the human brain including areas that are assumed to be involved in the pathophysiology of depression. Vitamin D deficiency may cause physical symptoms like pain.ObjectivesSee if somatic presentation of depression has any correlate with vitamin D deficiency.AimsTo compare prevalence of vitamin D deficiency between depressed and non-depressed subjects and see if somatic presentation of depression has any correlate with vitamin D deficiency.MethodsSixty diagnosed MDD patients consenting to participate in the study from a large private hospital selected, provided they were non-smoker, 18–65 years, free from chronic illness and not taking anti-depressant control (60 subjects) comprised of close family members of patients. FSC (functional somatic complaints) was assessed using local language version of Bradford Somatic Inventory (BSI), while severity of depression was assessed using HDRS-17. Based on the total score, FSCs are categorized into 3 grades ((>40 ‘high, 26–40 ‘middle, and 0–25‘low’ range).ResultsVitamin D status (deficiency: insufficiency: sufficiency) was 70: 30.0: 0.0% in depressed, which significantly worse compared to control subjects (55%: 25: 20%). Patients with higher BSI scores (i.e. more somatisation) showed non-significantly lower vitamin D level. These results were more prominent for female subjects.ConclusionsVitamin D deficiency is more common in depression subjects, which might thus need to be looked for and treated. However, no significant link between somatisation and vitamin D deficiency could be established.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Health-related quality of life (QOL) has become a high priority of long-term management of HIV-infected individuals. The newly diagnosed HIV cases were assessed to obtain sociodemographic and clinical findings. Eyesenk Personality Questionnaire (EPQ), World Health Organization Quality of Life Brief (WHOQOL-BREF) for HIV-infected patients, and Beck Depression Inventory (BDI) were used to get data regarding personality traits, QOL, and depression scores. A total of 175 patients were included in the study, 128 (73.1%) men and 47 (26.9%) women. Overall 56% of patients screened positive for depression. Presence of depression and high neuroticism score in the personality profile of HIV-infected patients are significantly associated with poorer QOL. High neuroticism score was a strong predictor of poorer QOL in psychological and spiritual domain. Management of HIV-infected patients therefore needs to address these psychological issues.

The following case report describes an act of genital self mutilation. An employed, unmarried male suffering from schizophrenia paranoid type, autocastrated his genitalia during a period of illness when his psychotic symptoms were absent. Sufficient attention may not have been paid to his depressive symptomatology which may be primary as a core feature or secondary, in what can be called post-psychotic depression. The vulnerability of committing such an act increases when the person appears to be symptom-free and regaining insight. After a review of the available literature, it is considered that this case best fits the description for Klingsor Syndrome.

The prevalence of ageing population is increasing not only in developed countries but also in developing world like India. Epidemiological reports about cognitive impairment or dementia in elderly people from developing countries are scarce. To study the cognitive status of women more than 50 years of age and to study the relationship of sociodemographic factors with cognitive status of the study subjects a descriptive epidemiological, community based cross-sectional survey was done involving 179 old women of 50 years and above in the rural field practice area of All India Institute of Hygiene and Public Health, Kolkata. The data were analysed using Epi-info 6.04, software packages. The mean age of the sample was 64.0 +/- 7.6 years. In the total sample, 53 subjects (29.6%) were in 50-59 years, 83 (43.4%) in 60-69 years, 34 (19%) in 70-79 years and 9 (5%) in women who were more than 80 years old. The cognitive defect was found to be 42.4% in elderly women .The variables like age70 years, widowhood, low per capita income, economic dependence, non-support from children, not staying with own children and having no satisfaction with life, were found to be significantly associated with cognitive defect. On (stepwise) multiple regression analysis these factors together contributed to 37% of cognitive impairment among these women. Prevalence of cognitive defect of more than 40% in the elderly women of this study emphasises the need for more attention and more social security measures for this neglected group.

The following case report highlights about a Glioblastoma presenting with features of post stroke depression. The neuropsychological findings though initially was normal but on subsequent follow up showed gross abnormalities. The imaging studies revealed the tumor, involving the right parietal and temporal lobes with midline shift and high vascularity. The patient exhibited rapid downhill course and died within 4 weeks of initial presentation.

Lost circulation during drilling increases the drilling costs and also enhances possibility of stuck pipe. Generally, viscous mud pills with lost circulation materials and gels or cement plugs are placed to allow plugging of loss circulation zone. But in case of total circulation loss in conjunction with cross flow condition, even repeated LCM-mud plugs followed with cement plugs do not guarantee the durable sealing of lost zone. This paper discusses the properties, mechanism and placement technique for successful plugging off lost zone in such cases where very few lost circulation remedies were effective and more than several hundred cubic meter of drilling fluid and cement were already lost. Details development of a novel sealant system consisting of an elastomer combined with cross-linking polymers, activator and bridging agents which provided quick, reliable control of loss has been deliberated in this paper. Initial low viscosity of this sealant allow easy placement against the lost zones and then gel activated near wellbore to set and form a stiff, rubbery gel stick with formation sediments to eliminate further losses. This development offers a proven means of controlling severe circulation losses resulting from large fractures or vugular spaces. The composition can be engineered to produce durable cross-linked polymeric rigid gel across a vide range of densities 8.6-14 ppg and temperature 45120 deg C. Addition of accelerators or retarders during mixing controls setting time and eliminates risk of premature setting inside the string while pumping. Laboratory tests revealed effectiveness of this polymeric based sealant treatment and can improve stress around wellbore by forming a deformable, viscous and cohesive sealant inside a lost circulation fracture. Field application shows the restoration of well bore integrity in total loss with cross flow condition by the innovative approach of using this cross linked polymeric stiff rubbery gel in combination with high volume cement plug. This paper deals with aspect of important lessons learnt from the field application of the developed cross linked polymeric stiff rubbery gel to control total circulation losses in conjunction with cross-water flow.

An internal 24-hour biological clock working in tandem with external environmental cues like bright light regulates our daily rhythms specially sleep-wake cycle. In a blind individual, due to absence of external cue endogenous rhythm may take upper hand and free running of sleep-wake cycle starts without any synchronicity with day-night cycle, creating ground for sleep disorders. To evaluate the frequency of sleep disorders, 65 blind individuals without any comorbid medical or surgical problem were interviewed according to the criteria of Diagnostic and Statistical Manual of Mental Disorder-IV (DSM-IV). Simultaneously 70 persons with no visual impairment were assessed in the same manner as used for blind persons. Blind patients showed far higher presence (44.6%) of sleep problems compared to controls (15.7%), and this difference was highly significant statistically [odd's ratio (OR) = 4.32, CI 95 =1.8-10.54]. Blind patients showed far higher presence (43.1%) of DSM-IV based diagnosis compared to controls (8.6%), and this difference was highly significant statistically [OR = 8.072, CI 95 = 3.059-21.298]. Circadian sleep disorders, insomnia and hypersomnia were relatively higher in blind patients. High incidence of sleep disorders calls for development of short reliable screener for sleep disorders among blind persons and better liaison among ophthalmologists and psychiatrists for early detection of this problem.

Depression is a common mental disorder quite prevalent at the primary care level and needs proper identification and prompt treatment. Bengali adaptation and validation of such an instrument (BPHQ) is aimed to provide a sensitive screening instrument that can help primary care physicians in the identification of depression correctly and easily.

Introduction : Neurological diseases are very important causes of prolonged morbidity and disability, leading to profound financial loss. Epilepsy is one of the most important neurological disorders Healthcare seeking by epilepsy patients is quite diverse and unique. Aims and Objectives: The study was conducted among the epilepsy patients, to assess their healthcare-seeking behavior and its determinants. Materials and Methods: Three hundred and fifteen epilepsy patients, selected by systematic random sampling, in the neuromedicine outpatient department of a tertiary care hospital were interviewed with a predesigned, pretested, semi-structured proforma. Results and Conclusion: More than 90% sought healthcare just after the onset of a seizure. The majority opted for allopathic medicine and the causes for not seeking initial care from allopaths were ignorance, faith in another system, constraint of money, and so on. A significant association existed between rural residence and low social status of the patients with initial care seeking from someone other than allopaths. No association was found among sex, type of seizure, educational status of the patients, and care seeking. The mean treatment gap was 2.98 ± 10.49 months and the chief motivators were mostly the family members. Patients for anti epileptic drugs preferred neurologists in urban areas and general practitioners in rural areas. District care model of epilepsy was proposed in the recommendation.

Background: Domestic violence has serious impact on women's health and well-being. A nationwide survey conducted in India observed that 37.2% of women experienced violence after marriage. Objectives: To assess the prevalence of domestic violence among the ever married women in reproductive age group and to find out the types of domestic violence and factors associated with it. Materials and Methods: The study was a community based cross-sectional study, conducted in a slum area of Kolkata. Results and Conclusion: Overall prevalence of domestic violence was 54%, of which 41.9% suffered from both current and lifetime physical and psychological violence. Presence of property, higher per capita income and social support were protective factors against domestic violence, whereas alcohol addiction and multiple sex partners were the important contributory factors for it. The study recommended more social support, awareness and income generation for women in the slum areas.

Neuroleptic malignant syndrome is a rare and potentially serious syndrome associated with the use of many antipsychotic, antiparkinsonian, antidepressants, etc. Moreover, of the agents known to cause this entity, clozapine has been mentioned a fewer times, but desvenlafaxine has never been known to precipitate it. However in this study, we present a case of established Neuroleptic syndrome that precipitated after administration of desvenlafaxine in a patient of resistant schizophrenia who was on clozapine. The presenting case explores the possibility of the potential of desvenlafaxine in causing this rare clinical entity and also a possible idiosyncratic interaction between desvenlafaxine and clozapine, whose mechanism is yet to be known.

The following case report highlights an interesting observation of paroxetine-induced galactorrhoea at therapeutic dosage and serum prolactin values of this patient comes out to be normal. This observation merits a systematic study to find the causal relationship of this unusual phenomenon and further explanation.

Objective : The minor physical anomaly (MPA) is believed to reflect abnormal development of the CNS. The aim is to find incidence of MPA and its behavioral correlates in Down syndrome and to compare these findings with the other causes of intellectual disability and normal population. Materials and Methods : One-hundred and forty intellectually disabled people attending a tertiary care set-up and from various NGOs are included in the study. The age-matched group from normal population was also studied for comparison. MPA are assessed by using Modified Waldrop scale and behavioral abnormality by Diagnostic assessment scale for severely handicapped (DASH II scale). Results : The Down syndrome group had significantly more MPA than other two groups and most of the MPA is situated in the global head region. There is strong correlation (P < 0.001) between the various grouped items of Modified Waldrop scale. Depression subscale is correlated with anomalies in the hands (P < 0.001), feet and Waldrop total items (P < 0.005). Mania item of DASH II scale is related with anomalies around the eyes (P < 0.001). Self-injurious behavior and total Waldrop score is negatively correlated with global head. Conclusion : Down syndrome group has significantly more MPA and a pattern of correlation between MPA and behavioral abnormalities exists which necessitates a large-scale study.

Serotonin syndrome is a known entity, which occurs with multiple drugs acting on serotonergic receptors. A 73-year-old lady presented with a history of agitation, altered sensorium, and autonomic hyperactivity after starting escitalopram on therapeutic dosage for her depressive syndrome who was on selegiline for her parkinsonism. This syndrome with therapeutic dose escitalopram warrants the careful and judicious use of the drug especially with other serotonergic drugs, so that this serious medical complication can be avoided.

BACKGROUND: The behavioral phenotype in Down syndrome follows a characteristic pattern. AIMS: To find the incidence of behavioral abnormalities in Down syndrome, to compare these findings with other causes of intellectual disability and normal population and to cluster these abnormalities. SETTINGS: One hundred forty mentally challenged people attending at tertiary care set up and from various non-governmental organizations were included in the study. Patients from both rural and urban set up participated in the study. The age-matched group from normal population was also studied for comparison. DESIGN: The study design is a cross-sectional survey done independently by four observers. MATERIALS AND METHODS: A semi-structured proforma for demographic profile has been used. The behavioral abnormalities are assessed by using DASH II (Diagnostic Assessment for the Severely Handicapped second modified version) scale. STATISTICAL ANALYSIS: Demographic comparison has been done by analysis of variance. Correlation matrix has been run to identify correlation between individual items. Principal component analysis has been used for grouping the behavioral pattern. RESULTS: Behavioral abnormalities as expected are more common in people having intellectual disability than the normal population. The Down syndrome group unlike other causes of intellectual disability shows higher scores in Stereotypy. Impulse control and Mania subscales. Factor analysis yields five characteristic factor structures, namely, hyperactive-impulsive, biological functions, affective, neurotic and organic-pervasive developmental disorder clusters. CONCLUSIONS: Contrary to the conventional belief of docile-fun and music loving prototype, individuals diagnosed with Down syndrome show clusters of behavioral abnormalities and management can vary depending on these target symptoms.

Assessment of Quality of Life in Epilepsy has currently been emphasized to provide comprehensive care to patients. Aim: To develop and standardize and assess the psychometric properties of Bengali version of QOLIE-10 and to assess the relationship of quality of life with seizure variables and presence of psychiatric morbidity. Design: English QOLIE-10 was translated into Bengali by a translation committee using translation-re-translation technique. Inter-rater reliability between the English and Bengali version was assessed during initial practice session held amongst 20 bilingual patients. It was found that item 3 (related to driving) was reported to have difficulty in answering by all the patients as none drove any vehicle. Thus, this item was dropped. The inter-rater reliability of the resultant 9 item scale was found to be high (kappa = 0.9). One hundred and seven epilepsy patients attending the Epilepsy clinic were selected for the study if they met the following criteria: age> 15 years, duration of seizure> 1 year, regular intake of antiepileptic drugs, presence of informant and ability to read Bengali. For each patient, demographic and clinical data (seizure frequency, last seizure date, seizure type as per record, medicine intake history and records of past investigations such as EEG) was collected. Each patient were administered QOLIE-9 (Bengali) and SRQ-24 Bengali version to screen for psychiatric morbidity. Results: The Cronbach′s Alpha coefficient for QOLIE-9 was 0.81, which did not improve if any item was dropped. All items showed strong correlation with the total score. The instrument showed stable factor structure with three factors (Limitation, Depression, Illness effects). However, the item with regard to memory problem did not fit into any of the factors. The QOLIE-9 total showed a significant correlation with the seizure frequency (r = 0.76FNx08). SRQ positive (i.e., suspected psychiatric morbidity) cases had higher QOLIE-9 score (thus, poorer quality of life) in comparison to non-psychiatric cases. Conclusion: Bengali QOLIE-9 is a valid and reliable instrument to assess the quality of life in patients suffering from epilepsy.