Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore s34

SYNOPSIS

Rajiv Gandhi University of Health Sciences , Karnataka Bengaluru

‘‘ FREQUENCY AND NATURE OF PSYCHOTIC SYMPTOMS IN BIPOLAR AFFECTIVE DISORDERS ’’

Name of the candidate : Dr. CHARAN TEJA KOGANTI

Guide : Dr. P.JOHN MATHAI

Course and Subject : M.D. (PSYCHIATRY)

Department of Psychiatry Father Muller Medical College Kankanady, Mangalore- 575002 AUGUST-2013 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE.

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

Dr. CHARAN TEJA KOGANTI 1 Name of the Candidate DEPARTMENT OF PSYCHIATRY And address FATHER MULLER MEDICAL COLLEGE , KANKANADY, (In Block letters) MANGALORE -575 002

2. Name of Institution FR. MULLER MEDICAL COLLEGE KANKANADY, MANGALORE – 575 002

3. Course of study and Subject M.D. PSYCHIATRY

4. Date of admission to Course 27 MAY 2013

5. TITLE OF THE TOPIC

“FREQUENCY AND NATURE OF PSYCHOTIC SYMPTOMS IN BIPOLAR AFFECTIVE DISORDERS ” 6 BRIEF RESUME OF THE INTENDED WORK :

6.1 NEED FOR STUDY:

Psychotic symptoms are common in mood disorders.1-8 It can occur in Bipolar Disorder, Manic episode, Depressive Episode and Recurrent Depressive Disorder. The terms psychotic mania and psychotic depression have been used with different connotations ever since Kraepelin. More than fifty percent of patients with mania have psychotic symptoms. A recent investigation reports that 68% of adult patients with bipolar disorder in their manic phase have psychotic symptoms. The grandiose delusions are the most frequent psychotic symptom.7 In a retrospective study of elderly patients with mood disorders in NIMHANS the investigators report that 50% of patients with mania and 35.8% of patients with depression have psychotic symptoms.8 Most studies report that 16-54 % of patients with depressive disorder have psychotic symptoms.1,2 Delusions occur without hallucinations in 50-66 % of such patients whereas hallucinations unaccompanied by delusions occur only in 3-25% of patients. Hallucinations occur more frequently than delusions in younger patients and in patients with bipolar psychotic depression.9,10 Auditory, visual, olfactory and tactile hallucinations are equally frequent in mood disorders.1 There are only a few specific investigations on the frequency and nature of the psychotic symptoms in mood disorders. Most of the reports are based on incidental results of investigations evaluating the efficacy of treatment and prognosis of different subtypes of mood disorders. There are only a very few published studies from India on this subject.

REVIEW OF LITERATURE : Psychotic symptoms in mania and mixed episodes are typically mood congruent. Delusions of grandeur such as having exceptional mental and physical fitness and talent, immense wealth, aristocratic ancestry, noble origin, divine origin, other grandiose identity, delusions of assistance, delusions of reference and delusions of persecution. The patient can have visual or auditory hallucinations congruent with their euphoric mood and inflated and grandiose self-image. Like in depressive disorder mood incongruent delusions and first rank symptoms of Schneider occur in mania and mixed episodes.3 In depressive disorder with psychotic symptoms the negative thinking acquires delusional proportion and is maintained with absolute conviction. According to Schneider, delusional thinking in 7. MATERIALS AND METHODS : 7.1 Source of Data : depression derives from our four basic insecurities regarding Thehealth, study financial will be carried status, outmoral in the worth department and relationship of psychiatry to others.of Father MullerThus Medical delusions College, of ill Mangalore health, delusions from October of nihilism, 2013 to delusionsApril 2016. of worthlessness, delusions of poverty, delusions of sinfulness, 7.2 Methodsdelusions of of guilt,Collection delusions of data of incompetence, : delusions of infidelity, delusions of reference and delusions of persecution PATIENTScharacteristically: tend to manifest in depressive disorders. A substantialAll adult inpatients minority in of psychiatry patients with department depressive of Father disorder Muller can Medicalhave Collegefleeting with or a persistent ICD-10-DCR auditory (International and visual classification hallucinations of disease, with 10th revision,extremely Diagnosticunpleasant Criteriacontent along for Research)the lines of diagnosistheir delusions. of moodAll disorderssuch psychotic without experiences co morbid psychiatric are genuine disorders affective will delusions constitute and the populationhallucinations for and the they present are mood investigation. congruent. Hundred Sometimes consecutive mood patientsincongruent with delusionsnew mood and episode(mania/hypomania/mixed) hallucinations (MIPS) and Schneider’s will form 3 thefirst sample. rank symptoms (FRS) do occur in depressive disorder.

INCLUSION CRITERIA:  Male and female adult patients with ICD-10-DCR (International classification of disease, 10th revision, Diagnostic Criteria for OBJECTIVES OF THE STUDY : Research) diagnosis of bipolar affective disorders, current [1]. To episodeevaluate - themania/hypomania/mixed, frequency and nature of psychotic symptoms in bipolar Patients affective with disorders. age between 18-64 years, [2]. ToPatients study the with relationships comorbid medical between disorders, psychotic symptoms and sociodemographic and clinical variables in patients with bipolar affective Patients disorders. with comorbid tobacco use.

EXCLUSION CRITERIA:  Patients with comorbid psychiatric disorders,  Patients with comorbid substance use other than tobacco,  Patients with age below 18 and above 64,  Patients with Schizoaffective episodes,  Patients with Bipolar affective disorder, current episode depression.

TOOLS FOR ASSESSMENT: 1. Mini Plus, 2. Scale for Assessment of Positive Symptoms. (SAPS), 3. Mellor’s Checklist of First Rank Symptoms of Schneider (FRSS), 4. Young Mania Rating Scale (YMRS), 5. Global Assessment Scale (GAS). 8. LIST OF REFERENCES: 1. Dubovsky SL, Thomas M. Psychotic Depression: Advances in conceptualization and treatment . Hospital Community Psychiatry. 1992; 43(12): 1189-1198. 2. Dubovsky SL, Davies R, Dubovsky AND. Mood Disorders. In APA Text Book of Clinical Psychiatry. Edition 4. Edited by Hales RE, Yudofsky SC. Panther Publishers Private Limited. Bangalore. 2003:439-542. 3. Akiskal HS. Mood Disorders. In Comprehensive Text Book Of Psychiatry.Edition 8. Edited by. Sadock BJ, Sadock VA. Lippincott Williams and Wilkins. New York. 2005: 1611-1652. 4. Kempf L, Hussain N, Potash JB. Mood disorder with psychotic features, schizoaffective disorder, and schizophrenia with mood features: trouble at the borders . International Review of Psychiatry. 2005; 17(1) : 9-19 . 5. Benazzi F . The continuum hypothesis of mood disorders. Journal of Clinical Psychiatry. 2007 ;68(11):1673-1681. 6. Meyer F, Meyer TD . The misdiagnosis of bipolar disorder as a psychotic disorder: some of its causes and their influence on therapy. Journal of affective disorders. 2009; 112(1-3): 174-183. 7. Cansuo C, Bossie C, Zhu Y etal. Psychotic Symptoms in Patients with Bipolar Mania. Journal of Affective Disorders. 2009;111(2): 164-169. 8. Prakash O, Kumar CN, Sivakumar PT et al. Clinical Presentations of Mania compared to Depression. Data from a Geriatric Clinic in India. International Psychogeriatrics. 2009; 21(4): 764-767. 9. Chambers WI, Puig Antich J, Tabrizi MA etal. Psychotic Symptoms in prepubertal major depressive disorder. Archives of General Psychiatry. 1982; 39: 921-927. 10. Goodwin FK, Jamison KR. Manic Depressive Illness. Oxford University Press. New York. 1991. 9. Signature of Candidate

10. Remarks of Guide

11. Name and Designation of DR.P. JOHN MANTHAI (in Block letters) PROFESSOR & HOD DEPARTMENT OF PSYCHIATRY 11.1 Guide FATHER MULLER MEDICAL COLLEGE , MANGALORE - 575002

11.2 Signature

11.3 Co-Guide (if any )

11.4 Signature

11.5 Head of Department DR.JOHN MATHAI PROFESSOR & HOD DEPARTMENT OF PSYCHIATRY FATHER MULLER MEDICAL COLLEGE MANGALORE – 575002. 11.6 Signature