Psoriasis is a psychocutaneous disorder whose prognosis is affected by psychological factors. Despite the psychological impact of the disease, only 33

A 48 year dark skinned North Indian male presented first time to our outpatient with history of bilateral visual decline of 3 weeks duration with associated features of headache, myalgia and rhinitus of 4 weeks duration. A detailed examination confirmed bilateral active anterior granulomatous uveitis with bilateral disc oedema with serous retinal detachment. Multimodal imaging examination was carried out with nideks mirante. Diagnosis in favour of vogt koyanagi harada disease was confirmed. The posterior segment was assessed for various changes in acute and remission phase of vogt koyanagi harada disease with fundus fluorescein angiography, fundus autoflourescence, retroillumination and optical coherence tomography. Thickness and structural change related to central macula thickness, retinal pigment epithelium and choroid were assessed pre and post treatment with additional support of optical coherence tomography and retroillumination. Both these techniques were able to document a greater value change pre and post treatment in these structures. Hence we conclude the need to include these techniques in retinal pigment epithelium and choroidal assessment in vogt koyanagi harada disease.

Objective: COPD often exists with comorbidities that may have a significant impact on prognosis. Patients with COPD are predisposed to both cognitive and psychiatric disorders. Anxiety and depression are common and important comorbidities in patients with chronic obstructive pulmonary disease (COPD). Regarding this, there is a lack of data from state of Himachal Pradesh. Methods: Our study was a cross-sectional study wherein 100 patients who attended the Pulmonary Medicine outpatient clinic of IGMC, Shimla were recruited. Patients were evaluated using tools International Classification of Disease, 10threvision, MINI 6.0, Addenbrooke's Cognitive Examination, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale. Results: About two-third (62%) of the patients were found to have psychiatric co-morbidities. The most common psychiatric co-morbidity was found to be mixed anxiety and depression in 20% of the patients followed by unspecified anxiety disorder in 12% of the patients,9% of the patients were diagnosed with dementia while 6% were found to have a major depressive disorder. As per our observation, the severity of anxiety and depressive symptoms as per the HARS scale and HAMD scales, respectively, increased as the severity of the disease increased. Conclusion: The present study shows that about two third (62%) of the patients were found to have psychiatric co-morbidities. Psychiatric comorbidities have a significant impact on quality of life, exacerbation frequency and survival. Another multicentre large observational study can be planned in the future to overcome the above problems.

Background: Acute and transient psychotic disorders (ATPDs) have benign course and takes place in the existence of noticeable and exceptionally traumatic stressors (direct temporal association between stressors and occurrence of ATPD) which necessitate clinical investigations. Stressors are also known to affect phenomenology and its content. Aims and Objectives: This study aims to study the socio-demographic characteristics, clinical variables, the role of stressors and phenomenology in ATPDs patients. Methodology: It is a cross-sectional and observational study. This study was done on 150 patients diagnosed on the basis of International Classification of Disease-10 diagnosis criteria of ATPDs after getting an informed consent from them. Patients’ information was recorded on socio-demographic and clinical profile sheet. Thereafter, Presumptive Stressful Life Event Scale and Positive and Negative Syndrome Scale (PANSS) scales were applied to assess the stressors and phenomenology, respectively. Results: Most of the patients were female and were between 15 and 35 years of age. Mean age of patients was 32.45 (standard deviation = 11.25) years. Majority of the patients were educated, married, and unemployed. A large amount of the patients belong to nuclear family and were resident of rural areas. Most of the patients presented within 2 weeks of the onset of the illness without any past or family psychiatric history. In 75% patients, stressors precede the onset of the illness. The average value of PANSS was higher in female. Sleep disturbances, delusions, hallucinations, poor rapport, lack of insight, and concrete thinking were the most commonly observed phenomenology in these patients. Conclusions: Maximum patients who developed the illness had psychological stressor/s in the past year (mainly before 2 weeks) of the onset of the illness. It helps to consider the person’s life events as a trigger for illness and make decisions regarding treatment accordingly.

The objective of the study was to determine the safety profile of lurasidone and olanzapine in the treatment of schizophrenia. All consecutive patients of schizophrenia attending the Psychiatry outpatient department of IGMC, Shimla (Approval no. HFW(MC-II)B(12)ETHICS/2020/3930) were screened for enrolment in the study of 1 year duration (March 2019–Feb 2020). The patients enrolled (100 patients) were divided into two treatment groups (50 in each group), Group A (lurasidone) and Group B (olanzapine). During the follow-up period, investigations such as lipid profile, fasting blood sugar, ECG, blood pressure, and body weight were noted to assess the safety profile of the drug. Results showed that the mean systolic blood pressure at baseline in the olanzapine group was 125.12 ± 8.37 and the mean age was 33.50 ± 11.35 at the first follow-up, which was done at 2–4 weeks, while the same for the lurasidone group was 31.71 ± 10.44 at 2–4 weeks. The mean serum HDL level at baseline in the olanzapine group was 43.38 ± 1.28 while 39.46 ± 1.12 at first follow-up; however, it was 49.64 ± 1.29 at baseline and 45.19 ± 1.22 at first follow-up for the lurasidone group; this exhibited a p value of < 0.001 which was highly significant. The mean age for the olanzapine group was 33.24 ± 11.00 at the second follow-up which was done at 8 weeks, while the same for the lurasidone group was 31.91 ± 10.60 at 8 weeks. It can be concluded from the study that lurasidone is more preferable than olanzapine for the treatment of schizophrenia, depending on the patient's financial situation, tolerance level, and accessibility.

We report a case of 11 year old young girl referred with complaint of right sided photophobia and pain following faucet induced trauma to left eye 3 months ago, followed by loss of sight in left eye. Patient presented to us with prepthisical left eye and anterior segment uveitis in right eye. Fundus picture revealed cream colour white nodules confirmed as Dalen Fuchs on fundus fluorescein angiography and presence of hypereflective lesions placed at level of retinal pigment epithelium with disruption of the inner and outer segment (IS/OS) junction on spectral domain optical coherence tomography. Ultrasonogram-B-scan confirmed closed funnel retinal detachment in traumatized left eye and increased choroidal thickness in sympathizing right eye. She underwent orbital computerized axial tomography scan to rule out intraocular foreign body. She was diagnosed as a case of delayed sympathetic ophthalmia. Subsequently she was put on intensive topical with oral steroids and immunesuppressive therapy constituted with oral azathioprine and methotrexate continued for one year and tapered on resolution of presenting signs. At final follow up sympathizing eye was quiescent and sympathetic eye was prepthisical. Sympathetic ophthalmia needs to be distinguished from other ocular auto-immune disorder such as Vogt Koyanagi Harada disease and Acute Multifocal Pigment Placoid Epitheliopathy to which it bears striking resemblance. As these disorders have variable response to treatment with widely differing outcome one must keep that in view while managing them. It is important to remember as the treatment is prolonged recurrences and patient drop outs are commonly noted.

Background: Consultation-liaison (CL) psychiatry is a young and upcoming subspeciality of psychiatry involving application of skills and knowledge of mental health professionals for evaluation and treatment of emotional and behavioural problems in patients with medical, surgical and other problems. Aim: This study aimed to evaluate the reason for referrals and diagnostic concordance amongst referring consultant and the CL psychiatrist. Materials and Methods: A descriptive cross-sectional study was conducted over a period of one year and a total of 786 inpatient referrals were assessed for reason of referral and diagnostic concordance in terms of reason of referral and psychiatric diagnosis made by the CL psychiatrist. Results: In 43.66% cases, specific psychiatric diagnosis/symptoms were mentioned by the referring consultant; commonly including substance dependence (19.60%), anxiety (9.16%), depression (6.49%). Delirium was the most common diagnosis made by the CL psychiatrist (22.65%) followed by anxiety disorder (15.90%), alcohol dependence (15.78%) and depressive disorder (14.50%). Diagnostic concordance between the referring consultant and CL psychiatrist was slight (K < 0.2) for delirium, fair for depressive disorder (K = 0.26), substantial for symptoms suggestive of anxiety disorder (K = 0.61) and substance use disorder (K = 0.70) and almost perfect agreement was seen for intentional self-harm (K=0.89). Conclusions: The present study suggests that the most common primary psychiatry diagnosis was delirium, followed by anxiety disorder. The overall diagnostic concordance was poor for delirium, fair for depressive disorder, substantial for anxiety symptoms and substance use disorder, and excellent for intentional self-harm.

INTRODUCTION: Blood borne viral infections (hepatitis C, hepatitis B, human immune deficiency virus), constitute a significant public health concern among patients with opioid dependence, especially among intravenous drug users (IDU). AIM: To measure the prevalence of hepatitis C among patients with intravenous opioid dependence, visiting de-addiction clinic, in a tertiary care hospital in the state of Himachal Pradesh. MATERIAL AND METHOD: A cross-sectional study was conducted between January 2021 and June 2021 at de-addiction clinic, department of Psychiatry, IGMC, Shimla. Socio-demographic and clinical profiles of patients with diagnosis of opioid dependence was entered in a pre-structured performa. All these patients were investigated for HCV antibody using ELISA (enzyme linked immunoassay) test. RESULTS: The study sample comprised of 200 male patients, and majority were between age 21-40 years (96.5%), from nuclear families (57%), urban background (56.5%). One fourth (25.5%) reported suicidal ideation/attempt. Intravenous mode of drug use (IDU) was reported by 121 (60.5%) patients, and majority were from nuclear families (64.46%), urban background (49.59%), and 30.58% reported suicidal ideation/attempt. 29 patients (23.97%) tested positive for hepatitis C infection. CONCLUSION: There is high rate of hepatitis C infection among patients with opioid (intravenous) dependence, at our de-addiction clinic. Future studies with large sample size exploring the high risk behaviour practices and studies with longitudinal design to assess treatment retention, are needed.

Background: Multi morbidity is a growing concern for healthcare systems, with many countries experiencing demographic transition to older population profiles. Hemodialysis has been shown to have an adverse impact on the emotional status of patients with end-stage renal disease (ESRD). Common associated psychological problems include depression, anxiety, fatigue, decreased quality of life, and an increased risk for suicide. Chronic kidney disease (CKD) is common but often considered in isolation. The extent and prognostic significance of its co-morbidities is not well understood. This cross-sectional study aims to psychiatric assessment of ESRD patients on dialysis. Results: Two hundred fifty people were included, Cases were selected during the study period from April 2021 till July 2022. A semi-structured interview, clinical psychiatric assessment is done to measure psychiatric disorders. Conclusions: Incidence of psychiatric illness among end-stage renal disease patients on hemodialysis is high. The most prevalent psychiatric disorders among these patients are depression and anxiety disorders. Key words: Hemodialysis, Psychiatric comorbidity, Quality of life

Introduction: The corona virus disease (COVID)-19 is a severe acute respiratory syndrome (SARS-CoV-2) which is posing a great threat to mankind and has been associated with a high risk of opportunistic fungi infection presenting as rhino-orbital-cerebral-mucormycosis. We report a rare and never reported case of unilateral optic neuritis with contralateral central retinal artery (CRA) and central retinal vein (CRV) occlusion in a patient of post-COVID-19 rhino-orbital-cerebral-mucormycosis. Case Report: A 45-year-old diabetic, Indian gentleman reported to our clinic in Dehradun, Uttarakhand, India with complaints of bilateral diminution of vision in right eye (RE) five days and left eye (LE) five weeks duration. He provided recent history of COVID-19 infection for which he was hospitalized and treated. Fundus examination confirmed optic neuritis in right eye and a combined established central retinal artery and vein occlusion in left eye. Fundus fluorescein angiography, visual evoked potential, and magnetic resonance imaging (MRI) were crucial in clinching the diagnosis. Conclusion: Rhino-orbital-cerebral-mucormycosis invades tissue through multiple routes. However, it is extremely rare to see a combination of angioinvasion leading to visual loss in one eye and perineural spread leading to optic neuritis and visual loss in the contralateral eye. Clinicians must be aware of such rare presentations which could serve as benchmark in diagnosis and treatment.

Background: The servicing and framework for mental health care accessible to population have been affected during the unprecedented times of coronavirus disease (COVID-19) pandemic. The new and almost exclusive method to maintain a therapeutic alliance with these patients has been the recently evolving telepsychiatry services. Aim and Objectives: The main aim of the study was to assess and compare the mental health status of patients seeking available psychiatry facilities in pre-lockdown and post-lockdown period during COVID-19 pandemic. Methodology: This was a retrospective cross-sectional study that was conducted in a tertiary care hospital in a hilly region of North India. The registered data was analyzed between January 1, 2020 to March 21, 2020 to gather the information of patients about sociodemographic profile and clinical diagnosis on the basis of International Classification of Diseases-10. The retrieved data constituted 499 new consecutive patients during this period. Then in the post-lockdown phase after the resumption of OPD services in the institute (May 3, 2020), the data collection was initiated to collect a similar sample size of new consecutive patients (501). These data were collected over 151 days (May 3, 2020 to September 30, 2020). Results: A total number of 1000 patients were analyzed. Majority of the patients were male (66%) and within 19 to 60 years of age (85–90%). The average number of patients (3.31) seen per day was less and the average age of the patients (39.17 years, standard deviation = 14.37) was significantly higher in the post-lockdown phase. The most common diagnostic group consisted of neurotic/stress-related/somatoform disorders. As compared to the pre-lockdown period, a significantly (P < 0.001) lower number of patients diagnosed with substance use disorders and a significantly (P < 0.001) higher number of patients diagnosed with psychotic disorders along with anxiety disorders availed the available psychiatry services in the period of COVID-19 pandemic. Conclusion: Sudden cessation of the psychiatry services further precipitated the deterioration of mental health of the patients. There is an urgent demand for services to adapt to changing scenarios with emphasis on practical approaches to help the mentally ill people especially in geographically difficult hilly areas.

Introduction- Bilateral facial paralysis is a rare condition. It may manifest either simultaneous or alternating form and it represents the .3-2% patients of all cases of facial nerve palsy. Majority of these cases have some underlying medical condition. Bell’s palsy accounts for only 23% of bilateral facial paralysis. Case report-A young male patient of 18 yrs presented in ENT OPD with history of difficulty in chewing, impaired facial movements, incomplete eye closure bilaterally. Haematology, serum biochemistry, chest x-ray, MRI brain were normal. Discussion- There may be some serious underlying disease responsible for bilateral facial nerve palsy. However etiology may be congenital, traumatic, infectious, neurological, metabolic, neoplastic, toxic, vascular, and idiopathic. A complete head neck and neurological examination should be done. Conclusion- Bilateral facial palsy is a rare condition and it may present as alternative or simultaneous bilaterally. Careful history and detailed examination is to be done. Its very important to consider all the possible differential diagnosis, to perform relevant lab. And radiological Investigations to reach up to the underlying etiology. However prognosis is good.

Background and Aim: The servicing and framework for mental health care accessible to population have been affected during the unprecedented times of the coronavirus disease (COVID-19) pandemic. The new and almost exclusive method to maintain a therapeutic alliance with these patients has been the recently evolving telepsychiatry services. The main aim of the study is to assess and compare the mental health status of patients seeking psychiatry facilities in prelockdown and postlockdown period during the COVID-19 pandemic. Materials and Methods: This was a ambirespective study which was conducted in a tertiary care hospital in a hilly region of North India in which the registered data were analyzed between January 1, 2020 and March 21, 2020 (prelockdown phase) and from May 3, 2020 to September 30, 2020 (postlockdown phase, after the resumption of outpatient department services in the institute), to gather the information of patients about sociodemographic profile and clinical diagnosis on the basis of International Classification of Diseases-10. A total sample size of 1000 patients was included. Chi-square test and Student's t-test were used to compare the patient presentation before and after the lockdown periods. Results: Majority of the patients were male (66%) and within 19–60 years of age (85%–90%). The average age of the patients (39.17 years, standard deviation = 14.37) was significantly higher in postlockdown phase. As compared to prelockdown period (499 patients), a significantly (P < 0.001) lower number of patients diagnosed with substance use disorders and a significantly (P < 0.001) higher number of patients diagnosed with psychotic disorders along with anxiety disorders, availed the available psychiatry services in the period of COVID-19 pandemic (501 patients). Conclusions: Sudden cessation of the psychiatry services further precipitated the deterioration of mental health of the patients. There is an urgent demand for services to adapt to changing scenarios with emphasis on practical approaches to help the mentally ill people, especially in geographically difficult hilly areas.

Introduction: To study the prevalence of anxiety and depression in stable COPD patients. Methodology: 100patients of stable COPD were assessed to look for the presence of anxiety and depression using beck anxiety inventory (BAI) and patient health questionnaire (PHQ-9). Patients already on treatment forpsychiatric illnesses were excluded from the study. Patients with total score above cut off value (BAI >7 ORPHQ-9 >4), were assessed in the psychiatry department. Quantitative data was compiled and statistical analysis was done. Results: Among study population 68% were males, 62% were in the age group of 60-80years, 83 % were ex smokers and 92 % of them were exposed to indoor air pollution (chullahs). It was found that 64 % of the study population had psychiatric morbidity out of which 42% had mixed anxiety and depressive symptoms. Psychiatric symptoms were more prevalent in female patients (97%, P value is0.003), and in patients who had more severe disease (P value is 0.04), 6 minute walk distance < 300 m (P value is 0.00001), percentage of desaturatoin> 3% after 6 M.W (P value is 0.0001) and Smoking Index >400.Smoking status and 6 minute walk distance were independently associated with the development of anxiety and depression with significant P values in stable COPD patients. Conclusion: Anxiety and depression are common psychiatric co-morbidities associated with COPD patients. Early diagnosis and proper management of COPD and timely evaluation for psychiatric illnesses is essential for the better outcomes in COPD patients.

Introduction: Cancer is a serious and potentially life-threatening illness which has an effect on physical and emotional wellbeing of patients and their families. The diagnosis of cancer in itself is a stressful event causing significant psychological distress. The aim of the present study was to find out the psychiatric co-morbidity among cancer patients and correlate the morbidity with type of cancer, its severity, treatment and other relevant variables. Methodology: It was a cross-sectional observational study. 226 consecutive patients were recruited for this study which was already diagnosed with malignancy. A detailed history from the patient and/or a reliable person who knew the patient well was taken as per pre-designed structured format. Diagnosis of psychiatric disorders was made according to ICD-10. [1] Results: The prevalence of Psychiatric co-morbidity in our study came out to be 35% with 95% Confidence Interval 29-42%. In our study we had observed that patients who were living alone had high percentage of psychiatric disorders as compared to those living with partners and this difference was found to be statistically significant. Conclusion: Significant percentage of patients with malignancy had co-morbid psychiatric illnesses. Patients with malignancy need careful assessment for the presence of psychiatric co-morbidity especially patients living without partners. Mental health professionals may be included in the treating team.

Background: The present study was done in a tertiary care centre of North India to know the profile of epilepsy. Methods: Total of 210 patients were selected during the period August, 2017 to July 2018 who attended outpatient clinic of the Department of Neurology, Indira Gandhi Medical College, Shimla, Himachal Pradesh. Detailed clinical history was taken, general physical examination, and routine blood examination were carried out. Results: Of all the cases, sex ratio (male:female) was 2.39:1. A high proportion of cases (43.3%) were from lowermiddle socio-economic group. 76.7% patients had generalized seizures. For 38.6% patients, frequency of seizures was more than 8 in the past 6 months. 71.9% of the patients were using only one anti-epileptic drug. Conclusions: Patients with seizures comprise a significant burden in inpatient department of developing countries.

Background: Cognitive impairment is a common clinical condition among elderly patients suffering with depression and has a well-known aetiology. The present study planned to determine the prevalence of cognitive impairment and depression in geriatric patients attending Psychiatric outpatient department services. Methods: The study was a prospective cross-sectional one and carried out with a sound methodology on elderly patients attending the Psychiatric OPD of Indira Gandhi Medical College, Shimla-1, Himachal Pradesh. A total of 130 patients were screened, out of which 105 patients have fulfilled the inclusion criteria and enrolled after written informed consent form. The cognitive function and depression were assessed by using standardized Mini-Mental State Examination of Folstein (MMSE) and the Geriatric Depression Scale (GDS), respectively. Results: Prevalence of cognitive impairment was found 42.9% (44.2% in women, 35.5% in men), whereas the prevalence of depression was found 48.6% (56.30%women, 41.10% men) which was statistically significant (p<0.05). Conclusions: Cognitive impairment and depression were found to be more prevalent in the females than in the males. So, it is advised that psychiatrist should provide special attention for early detection and treatment of depressive symptoms in elderly patients suffering with cognitive impairment.