Kerala Journal of Psychiatry

1-2

Authors: K Ravikumar

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10-17

Authors: AP Megha, James TA, John M, Saibunnisa B K, Praveenlal K

Background: Delusional disorder presents with a stable and well-defined delusional system. Many are unwilling to accept that they have a mental disorder or that they require psychiatric treatment. The condition responds to treatment in most cases. This study aims to assess the clinical profile, treatment pattern and response to it, frequency of follow-up and current status of patients previously diagnosed as delusional disorder. Method: The case records of all patients who had come to Psychiatry OPD for 3 years with a diagnosis of delusional disorder according to ICD 10 criteria were taken and data collected. 48 patients were enrolled in the study. The current status was assessed from relatives through telephone calls. Results: The sample consisted more of males; the majority were married. The most common delusion was infidelity (72.9%) followed by persecution (22.9%). Co-morbidity was present in 43.8% of subjects. The best response was with risperidone. At follow up, all were reported to be doing a job or engaging in household work and the majority maintaining improvement. Eight had delusions and six were troublesome. Less than half of the responders were continuing their treatment. Conclusion: Male preponderance and married status were noticeable. The delusion of infidelity was the most common. The delusional disorder has much co-morbidity. Non-compliance with treatment is common. But the level of functioning is found to be reasonably fair irrespective of the treatment status.

23-25

Authors: Indu NV, Pavankumar G

Catatonia was first described by Kahlbaum as a disorder of movement and speech. Kraeplin grouped catatonia along with other sub types of schizophrenia. In ICD-10 catatonia is mentioned as sub type of schizophrenia. DSM-5 gives independent status to catatonia. Catatonia may be caused by many medical conditions, but in psychiatry it is associated more with mood disorders and schizophrenia. There are certain conditions with recurrent catatonia like the periodic catatonia. We present the case of a 35 years old south Indian woman who has recurrent catatonia for the past 15 years. She was diagnosed with catatonic schizophrenia initially, treated with adequate trials of different antipsychotics, mood stabilisers and benzodiazepines with poor response. For the past 6 years she is being given maintenance ECT to which she is showing good response. Electroconvulsive therapy is effective in the treatment of recurrent catatonia and can be maintained. But there are issues like increased tolerance to ECT in due course.

30-37

Authors: Varghese J J, Thomas S P, Kallivayalil R A

Tuberous sclerosis (TS) is an autosomal dominant, neurocutaneous disorder. Mutations of TSC1 and TSC2 genes which lead to the mechanistic target of rapamycin (mTOR) pathway dysregulation have been identified. In addition to the neurological and neuropsychiatric manifestations, the disease can have many other systemic manifestations affecting skin, kidneys, lungs, heart and eyes. The psychiatric manifestations can be broadly considered under neurodevelopmental, behavioural, intellectual, and psycho ocial symptoms. The diagnosis is often confirmed after a detailed evaluation. Treatment options include symptomatic management, prevention of loss of function of the affected organs and the etiological approach through mTOR inhibitors. Researches are being conducted using mTOR inhibitors like Rapamycin, everolimus and sirolimus on this regard. A case of organic delusional disorder with paranoid schizophrenia like symptomatology in a patient with TS is also described at the end.

46-50

Authors: Samir Kumar Praharaj, Shahul Ameen 46-50

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54-56

Authors: Badr Ratnakaran

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