The Hopkins Symptom Checklist (SCL-90-R): A Patient-Reported Outcome Measure in Parkinson’s Disease

Objective: This is the first study applying Clinimetric Patient-Reported Outcome Measures (CLIPROM) criteria to evaluate the construct validity, sensitivity, and clinical utility of the SCL-90-R in patients with Parkinson’s disease (PD). Methods: A Rasch analysis was conducted using a sample of 488 PD outpatients. Results: Testing for dimensionality revealed that less than 5% of t-tests were significant, indicating that the SCL-90-R subscales entailed the property of construct validity. As to the total score, a Person Separation Reliability Index of .96 was found. Conclusions: The SCL-90-R total score is a sensitive screening measure that can be used not only to differentiate healthy stress reactions from symptoms of psychological distress but also to detect PD patients with an increased risk for psychiatric complications. As to the subscales, the brief versions that did not include misfitting items should be used to assess the severity of specific symptoms of psychological distress affecting PD patients.

Impacted leopard tooth in thyroid gland of victim in a case of leopard attack – A case report

Attacks by wild animals on humans are not rare in India. Most of the cases are seen in rural areas and areas adjoining forest lands. The nature of the attack may be predatory or defensive. The main culprit for this is deforestation and encroachment of humans into the natural habitats of wild animals. Wild animal attacks can cause very severe injuries, including lacerations, fractures, and vascular injuries, and are often associated with high rates of mortality. Treatment depends on the type and nature of the injury. Those who survive the initial attack often succumb to infection and septicemia during the early hospital stay. Psychiatric complications are also common in survivors. We present the case of a 70-year-old man, who was attacked by a leopard. He sustained a few lacerated bite injuries to the neck and was treated at North Bengal Medical College and Hospital. A computed tomography scan of the neck revealed a tooth of the animal impacted in the thyroid gland of the patient. The patient is currently receiving treatment for deranged thyroid function, and awaiting normalization of the same, to get anesthetic fitness for surgical removal of the tooth. Treating surgeons must be well aware of the patterns of injuries and their treatment in cases of animal attack injuries. In-depth clinical and radiological investigations are of utmost importance to find out occult injuries that may become life-threatening. A standardized treatment protocol needs to be developed for the treatment of wild animal attack victims. There is a need to extend health care into the remote areas of the nation, for early treatment of such cases.

The Effect of Anti-anxiety Medications on the Clinical Symptoms of Anal Fissure: A Randomized Clinical Trial

Background: Fissure is a common chronic anorectal disease that causes symptoms such as pain, burning, bleeding, and psychiatric problems. One of the psychiatric complications is anxiety, which might be an etiologic factor or secondary to the disease. Materials and Methods: A total of 160 patients with anal fissure were randomly divided into two groups (80 patients treated with anti-anxiety medications along with standard anal fissure treatment and 80 patients with standard anal fissure treatment alone) after obtaining patient consent and demographic data. Then, the symptoms have recorded after treatment. Results: The results of our study indicated that the administration of anti-anxiety medications in patients with anal fissures relieved pain and anxiety scores among all patients. The anti-anxiety medications were more effective on patients younger than 40 years, men with less than two weeks duration of illness, and baseline anxiety greater than 26. Conclusion: A high prevalence of anal fissures affects the quality of life of patients. Besides the lack of effective treatment that shortens the pain and recovers patients faster, anti-anxiety medications such as benzodiazepines can use along with standard anal fissure treatment to reduce pain and anxiety in patients with acute anal fissure.

Green tea might be effective in alleviating COVID-19 associated psychiatric complications: preliminary results from a pilot randomized controlled trial

Purpose It is argued that COVID-19 patients show various neuropsychiatric symptoms, including fatigue, depression and anxiety. On the other hand, epidemiological and experimental evidence indicated that green tea could potentially have antiviral effects and ameliorate psychiatric disorders. However, there is a lack of clinical evidence. The purpose of this study was to investigate whether drinking green tea can clinically improve psychiatric complications of COVID-19 infection. Design/methodology/approach This study included 40 patients with laboratory confirmed mild-to-moderate COVID-19 disorder in the current randomized open-label controlled trial. Patients were instructed to include three cups/day of green tea (intervention) or black tea (control) to their usual diet for four weeks immediately after diagnosis of the disease. At the study baseline and after the intervention, the enrolled patients’ fatigue, depression and anxiety were assessed by the Chalder Fatigue Scale, Beck Depression Inventory-Fast Screen and State-Trait Anxiety Inventory questionnaires. Findings A total of 19 COVID-19 cases in the intervention group (mean age = 52 years) and 14 cases (mean age = 50 years) in the control group completed the study. Analysis of covariance adjusted for baseline levels, and confounders revealed that those who consumed three cups/day of green tea compared to the patients who received black tea experienced significantly lower fatigue, depression and state and trait anxiety levels (adjusted means for fatigue = 12.3 vs 16.2 (P = 0.03), depression = 0.53 vs 1.8 (P = 0.01), 37.4 vs 45.5 (P < 0.01) and 37.9 vs 45.2 (P < 0.01)). Research limitations/implications The open-label design may bias the evaluation of the self-reported status of fatigue, depression or anxiety as the main outcomes assessed. Moreover, as this study did not include patients with severe COVID-19, this might affect the generalizability of the present results. Thus, the recommendation of daily drinking green tea may be limited to the subjects diagnosed with mild-to-moderate type of infection or those with long-term neuropsychiatric complications owing to COVID-19. Besides, considering the ethical issues, this study could not exclude the drug therapy’s confounding effects; thereby, this point should be considered when interpreting the current results. Besides, it is worth noting that Guilan province in the north of Iran is recognized as a tea (and particularly green tea) producing region; thereby, it is an available and relatively inexpensive product. Considering this issue, the recommendation to consume this medicinal plant in adjunct to the routine treatment approach among patients with mild-to-moderate COVID-19 based on its beneficial effects may be widely accepted. Practical implications Green tea consumption could be considered an option to combat COVID-19 associated psychological complications, including fatigue, depression and anxiety among patients suffering from mild-to-moderate type of this viral infection. Originality/value To the best of the authors’ knowledge, in this study, for the first time, the effects of green tea compared to black tea on COVID-19 associated fatigue, depression and anxiety status within an open-label controlled trial have been investigated.

Psychiatric Complications in Patients with COVID-19: A Narrative Review

Coronavirus disease 2019 (COVID-19) is associated with severe multiorgan clinical manifestations. Although respiratory involvement is the predominant manifestation in patients infected with COVID-19, involvement of other organs, such as the nervous system, has also been identified; which highlights the virus' ability to disrupt the organs’ function. There is ample evidence of a nervous system susceptibility to the COVID-19. In this regard, the COVID-19 pandemic effect on psychological health, including insomnia, anxiety, obsessive-compulsive disorder, and depression among health care workers and other high-risk groups has been identified. So far, many studies have examined the psychiatric manifestations in infected patients with COVID-19. Undoubtedly, awareness of these findings can help in the prevention and timely treatment of these patients. This study aimed to review the possible mechanisms of COVID-19 neuroinvasive potential, psychiatric manifestations, and the management of mental disorders in infected patients.

Emergency Department Visits and Trends Related to Cocaine, Psychostimulants, and Opioids in the United States, 2008-2018

Background Drug-related emergency department (ED) visits are escalating, especially for stimulant use (i.e., cocaine and psychostimulants such as methamphetamine). We sought to characterize rates, presentation, and management of US ED visits related to cocaine and psychostimulant use, compared to opioid use. Methods We used 2008–2018 National Hospital Ambulatory Medical Care Survey data to identify a nationally representative sample of ED visits related to cocaine and psychostimulant use, with opioids as the comparator. We excluded visits related to ≥2 of the three possible drug categories. We estimated annual rate trends using unadjusted Poisson regression; described demographics, presenting concerns, and management; and determined associations between drug-type and presenting concerns (categorized as psychiatric, neurologic, cardiopulmonary, and drug toxicity/withdrawal) using logistic regression, adjusting for age, sex, race/ethnicity, and homelessness. Results Cocaine-related ED visits did not significantly increase, while psychostimulant-related ED visits increased from 2008 to 2018 (2.2 visits per 10,000 population to 12.9 visits per 10,000 population; p < 0.001). Cocaine-related ED visits had higher usage of cardiac testing, while psychostimulant-related ED visits had higher usage of chemical restraints than opioid-related ED visits. Cocaine- and psychostimulant-related ED visits had greater odds of presenting with cardiopulmonary concerns (cocaine adjusted odds ratio [aOR] 2.95, 95% CI 1.70–5.13; psychostimulant aOR 2.46, 95% CI 1.42–4.26), while psychostimulant-related visits had greater odds of presenting with psychiatric concerns (aOR 2.69; 95% CI 1.83–3.95) and lower odds of presenting with drug toxicity/withdrawal concerns (aOR 0.47, 95%CI 0.30–0.73) compared to opioid-related ED visits. Conclusion Presentations for stimulant-related ED visits differ from opioid-related ED visits: compared to opioids, ED presentations related to cocaine and psychostimulants are less often identified as related to drug toxicity/withdrawal and more often require interventions to address acute cardiopulmonary and psychiatric complications.

SARS-CoV-2 Psychiatric Sequelae: An Urgent Need of Prevention

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), responsible for COVID-19 pandemic, caused catastrophic health and social effects, but little is known about its consequences on mental health. Other viral infections have been associated with psychiatric sequelae: infection-triggered disturbing of the immune system and the stressful intensive unit care can cause psychological and psychiatric complications. Moreover, SARS-CoV-2 can potentially induce neuronal injuries, leading to neurocognitive disabilities. Previous studies during the COVID-19 pandemic reported a high occurrence rate of psychopathological and neurocognitive conditions among COVID-19 survivors, highlighting the need for screening for these impairments in order to implement early interventions and secondary prevention. However, many psychiatric disorders can take several years to develop, and it is still difficult to differentiate between factors linked to the infection itself or to the global context of the pandemic. In this review, we describe the effects of SARS-CoV-2 infection on mental health, the mechanisms involved in psychiatric and neurocognitive sequelae, and the strategies of prevention and management. More studies are needed to investigate the effects of a range of factors including clinical, sociodemographic, and inflammatory predictors. These efforts could be useful to identify high-risk individuals and inform targeted preventive actions.

Operative Therapy of Parkinson's Disease and the Role of Neurologist

Dopaminergic agents are still the mainstay of therapy in Parkinson's disease. Such dopamine replacement therapy results in a reduction in motor symptoms in the early stages of the disease. However, dopaminergic agents will cause motor (motor fluctuations and dyskinesia) and nonmotor (sensory, autonomic, and psychiatric) complications, 50% will occur after 5 years, The operative approach has been shown to be effective in improving motor symptoms in PD. Deep brain stimulation (DBS), which is the second largest finding after levodopa, is still the first choice of operative treatment for PD, however, other operative therapies such as ablative therapy (radiofrequency, stereotactic radiosurgery, focused ultrasound thermal ablation, laser interstitial thermal therapy) have almost the same effectiveness. with DBS. As primary care physicians, it is very important for neurologists to understand the role in operative therapy that is currently developing. Keywords: Parkinson's disease, surgery, neurologist, therapy.

A Retrospective Study of Symptom Profile of Psychiatric Complications in Alcohol Dependence Patients Admitted in Psychiatric Ward in Chennai

BACKGROUND Alcohol dependence is a psychiatric diagnosis in which an individual is physically or psychologically dependent on alcohol. It includes the presence of alcohol tolerance, physical dependence, and an inability to control alcohol intake. Alcohol dependence is a severe mental health problem associated with health issues, social and financial burden not only for the patient but also for the family members. The purpose of this study was to analyse the psychiatric complications in patients with alcohol dependence syndrome (ADS) admitted in psychiatry ward. METHODS A retrospective review of records of patients admitted in male psychiatry ward at a tertiary care center was done. The data was collected among 200 male patients admitted in the psychiatry ward from January 2019 to December 2019. Patient's' demographic details like their age, gender, socioeconomic status, locality, religion, marital status, and psychiatry comorbidity were noted. RESULTS Secondary data was collected from 200 patients admitted in the psychiatry ward. Percentage analysis was done. The patient's demographic details like their age, gender, socioeconomic status, locality, religion, marital status and their psychiatry complications were considered. Complications like sleep disturbances, tremors and seizures were mainly observed in this study. Major findings of the study were anxiety, depression, psychosis, cognitive impairment, cravings and relapses which were common symptoms among alcohol dependence patients admitted in psychiatric ward. CONCLUSIONS Alcohol dependence can lead to severe psychiatric disorders. Heavy consumption of alcohol can affect brain function and alter various chemical and hormonal systems in brain known to be involved in the development of many common mental disorders. The intoxicating effects which result due to intake of alcohol can result in temporary impairment of judgment and motor skills.1 Alcohol addiction can lead to development of tolerance and dependence, as well as abnormal social and occupational functioning.2 People who are married in the age group between (30 to 49) years from rural areas with low socioeconomic status are mostly found to be dependent on alcohol. KEYWORDS Alcoholism, Addiction, Behaviour, Drinking