5 results
Comparison of prophylactic response to lithium and valproate in patients with Early Onset Bipolar Disorder
- M. Purkayastha MUKHERJEE, G. G, P. Kandasamy, S. S, D. pandian
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S706-S707
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Introduction
The clinical presentation and the course and outcome in Early-Onset Bipolar Disorder (EOBD) patients are found to be atypical compared to adult bipolar patients. Lithium and valproate are among the first-line maintenance treatments for bipolar disorder. Because of atypical features, in many patients, valproate is preferred over lithium. However, recent studies have shown that valproate results in more neurocognitive deficits than lithium. There have been very few Indian studies that assessed the prophylactic response to mood stabilizers in patients with early-onset bipolar disorder. BDNF has an important role in neurodevelopment, and it is shown that peripheral levels of BDNF are reduced in early-onset bipolar disorder.
ObjectivesTo compare the effectiveness of lithium and valproate in attenuating manic, depressive, and mixed episodes in early-onset bipolar disorder.
MethodsThis study was an observational (cross-sectional analytical) study conducted in the Affective Disorder clinic of a tertiary care hospital. We have recruited a total of 50 adult patients with a history of early-onset, i.e., onset at <18 years of age and in remission. Patients were divided into two groups based on the mood stabilizer drug they were receiving. There were 25 patients each in the lithium and valproate group. Montreal Cognitive Assessment (MoCA) scale was applied to assess cognitive functions.
ResultsThe overall functioning was found to be significantly better in the patients receiving lithium than valproate, which was found by higher scores on the Global Assessment of Functioning (GAF) scale.We have found a statistically significant negative correlation between the number of episodes before starting a mood stabilizer and the time to recurrence after starting a mood stabilizer. However, the former cannot predict the latter. The age, educational status of the patient, total duration of illness and number of episodes before starting mood stabilizer correlated significantly with the MoCA score. Of all, the educational status could also predict the patient’s performance on the MoCA scale.
ConclusionsThere were no significant differences between lithium and valproate in attenuating further episodes, the frequency of neurocognitive deficits and other adverse effects. Both drugs were equally effective and tolerable. The severity of illness was more in valproate-treated patients, and overall functioning was better in lithium-treated patients. BDNF levels did not correlate with neurocognitive deficits significantly. Future studies comprehensively assessing neurocognitive measures with a larger sample size in the early-onset bipolar disorder population would shed more light on the role of biomarkers in cognition in subjects with early-onset bipolar disorder.
Disclosure of InterestNone Declared
Developing and testing a Video assisted brief CBT intervention for children and adolescent with anxiety disorder
- M. Purkayastha MUKHERJEE, S. T. Spalzang, P. Kandasamy, M. T, D. Pandian
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S451
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Introduction
CBT for childhood anxiety is used as the gold treatment of choice for anxiety disorders in children. Video-assisted CBT can serve as a cost and time effective intervention method in a low-resource setting.
ObjectivesTo develop, validate video-assisted CBT for children and adolescents with Anxiety disorder with secondary objective to explore feasibility of brief video assisted CBT as an additional component to treatment as usual in improving symptom severity.
MethodsStudy was divided into 2 phases. In the 1st phase videos (1 common introductory video and 2 videos each for children and adolescents,in Tamil and English) based on a validated CBT workbook was made. A second phase involving exploration of feasibility of video-based interventions along with treatment-as-usual was carried out in OPD of tertiary care hospital. Of 13 children recruited with anxiety disorder,2 were lost to follow-up. In 2nd phase, intervention delivered on OPD computer and provided to family members to watch at home through phone. Assessment of symptoms were done using SCARED, CGAS, CGI-S, VAS (parent) at baseline & 8 weeks. Written narratives were taken from participant at baseline & 8 weeks. Parent semi structured proforma was used to assess perceived benefit by parent.
ResultsIn first phase validation was obtained from 3 experts. All experts agreed or strongly agreed for videos to be appropriate for use in children and adolescents with anxiety disorder. Most frequent diagnosis was social anxiety disorder.Family history of psychiatric illness was there in 61.54% of participants. Post intervention at 8 weeks when compared to baseline found statistically significant reduction in symptom severity on SCARED, CGAS and VAS (parent) scores. In parent semi structured proforma good improvement in understanding, perceived reduction of symptom severity reported.For qualitative data, manual content analysis done with clustering of themes and sub-themes.
In theme of Treatment impact on self, codes of decreased self-esteem and overthinking generated the maximum response. In theme of impact of illness in various contexts, codes of peer relationship and academic performance generated the maximum responses. At the end of 8 weeks participants reported Relaxation techniques as most used, followed by coping skills and challenging negative thoughts with help of tension diary respectively.
In aspects of videos liked by parents, brevity and simplicity generated most responses. In aspects requiring improvement most of parents reported no improvement needed in videos.
ConclusionsThis pilot study on video based CBT can serve as a time and cost-effective treatment strategy for anxiety disorders in children and adolescents especially in low resource settings. Similar studies involving development of similar videos can be made for various mental illnesses in various vernacular languages and tested in a larger population.
Disclosure of InterestNone Declared
P03-14 - A Quasi-Experimental Controlled Intervention to Reduce Violence on an Acute Psychiatric Ward
- J. Beezhold, P. Williams, J. Taylor, A. Harris, S. Kandasamy
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- Journal:
- European Psychiatry / Volume 25 / Issue S1 / 2010
- Published online by Cambridge University Press:
- 17 April 2020, 25-E864
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Introduction
Violence and aggression are a major concern in acute inpatient psychiatric wards. Hard outcome data on the impact of service change are scarce. This poster presents the outcomes of service changes designed to improve the acute ward environment and patient experience.
Aims and objectivesTo implement changes to the delivery of acute inpatient psychiatric services and to measure the outcome of these changes in objective verifiable form.
MethodSignificant changes were introduced to an acute psychiatric inpatient service. These included introducing a dedicated inpatient psychiatrist “hospitalist”, replacing weekly ward rounds with daily multidisciplinary care and discharge planning meetings and promoting increased roles for nursing staff in decision-making and patient contact. Outcomes measured included routinely recorded incidents of violence with and without injury, use of restraint for medication and use of constant nursing observation. The control group was a similar service in the same hospital subject to the same general policies and admitting patients demographically comparable, but that did not at the time undergo the interventions implemented in the trial service. All data was recorded by staff who were unaware of this study or even that any analysis of the data would occur.
Results and conclusionsViolent incidents in the intervention ward dropped by 34% per patient (p=< 0.02) whilst increasing by 3% in the control ward; restraints decreased by 28% (p=ns) whilst increasing by 12% in the control ward; with an overall reduction in constant observation. The intervention was highly effective in reducing violent incidents.
Psychiatric intensive care units - designed for the patient ….designed for the environment
- S. Kandasamy, D. Dooldeniya, J. Beezhold, A. Prabhu, C. Heffernan
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- Journal:
- European Psychiatry / Volume 26 / Issue S2 / March 2011
- Published online by Cambridge University Press:
- 16 April 2020, p. 746
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Aims
This poster explores how Psychiatric Intensive Care Units can be designed using “green” technology in order to be environment-friendly whilst also meeting patient needs.
MethodAnalysis of the new PICU at Hellesdon Hospital, Norfolk and Waveney Mental Health NHS Foundation Trust, United Kingdom. We describe how the architecture has been adapted from the standard mental health unit model to facilitate more intensive supervision. We will also examine the building design features that have been incorporated to ensure the lowest possible carbon footprint.
ResultsRollesby Ward (PICU) at Hellesdon Hospital won the Broadland design award 2009. It is a new, purpose built, building that provides a safe, user-friendly unit with en-suite accommodation; and rooms for seclusion, therapeutic activities and one to one sessions. The use of key cards and the layout of the bedrooms and lounge areas maintain patient privacy and dignity. A number of technologies have been used to minimise the building's carbon footprint. These include maximising usage of natural light and ventilation, underground rainwater tanks for flushing toilets, photovoltaic roof panels, and ground source heat pumps. Since the PICU has opened, 62.63 mwh of energy (35.57 tons of carbon) has been saved.
ConclusionNew build psychiatric units can successfully incorporate design features that deliver a better patient and therapeutic environment whilst also minimising the consumption of energy and the size of the carbon footprint.
Inter-fraction variation in interstitial high-dose-rate brachytherapy
- Saravanan Kandasamy, K. S. Reddy, Vivekanandan Nagarajan, Parthasarathy Vedasoundaram, Gunaseelan Karunanidhi
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- Journal:
- Journal of Radiotherapy in Practice / Volume 14 / Issue 2 / June 2015
- Published online by Cambridge University Press:
- 04 February 2015, pp. 143-151
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Aim
To evaluate the inter-fraction variation in interstitial high-dose-rate (HDR) brachytherapy. To assess the positional displacement of catheters during the fractions and the resultant impact on dosimetry.
BackgroundAlthough brachytherapy continues to be a key cornerstone of cancer care, it is clear that treatment innovations are needed to build on this success and ensure that brachytherapy continues to provide quality care for patients. The dosimetric advantages offered by HDR brachytherapy to the tumour volume rely on catheter positions being accurately reproduced for all fractions of treatment.
Materials and methodsA total of 66 patients treated over a period of 22 months were considered for this study. All the patients underwent computer tomography (CT) scan and three-dimensional treatment planning was carried out. Brachytherapy treatment was delivered by the HDR afterloading system. On completing the last fraction, CT scan was repeated and treatment re-planning was done. The variation in position of the implanted applicators and their impact on dosimetric parameters were analysed using both the plans.
ResultsFor all breast-implant patients, the catheter displacement and D90 dose to clinical target volume were <3 mm and 3%, respectively. The displacement for carcinoma of the tongue, carcinoma of the buccal mucosa, carcinoma of the floor of mouth, carcinoma of the cervix, soft-tissue sarcoma and carcinoma of the lip were comparatively high.
ConclusionInter-fraction errors occur frequently in interstitial HDR brachytherapy. If no action is taken, it will result in a significant risk of geometrical miss and overdose to the organs at risk. It is not recommended to use a single plan to deliver all the fractions. Imaging is recommended before each fraction and decision on re-planning must be taken.