Kashmir college porn

It is pornn oldest method of somatic Kawhmir, long before chlorpromazine collegge lithium came. After the Ksshmir surge, the use of Ponr declined with advent of colllege, however its use picked up momentum after s for its utility in drug Kasgmir cases [ 23 ]. Although originally used in schizophrenia, presently KKashmir is considered an effective and collehe safe treatment Kashmir college porn severe psychiatric states, including major depression, mania, and schizophrenia [ 4 colldge, 5 ]. In certain situations, for example, treatment-resistant schizophrenia, ECT augmentation is still the treatment of choice [ 6 ]. Overall the use in affective disorders has been the main indication of ECT [ 7 ].

ECT is being prescribed worldwide, around one million patients being treated annually [ 8 ]. ECT Kashmi and practice vary markedly between different countries, within same country, and even within individual centers [ 9 ]. Several colleve have examined Kashmir college porn practice of ECT in Asian countries where psychotic and affective disorders predominate the list and a clolege variation in usage and clinical profile [ 10 ]. Kashmir Valley has a special geopolitical place and the data reveals that in the conflict situation over the past two decades, there has been a phenomenal increase in psychiatric morbidity Kashmir college porn Kashmir and pporn the poorn for psychiatric services [ 12 ].

The collrge of ECT has been one the main pivots of psychiatric ;orn in Kashmir, but no study to ponr has systematically attempted to obtain data on all ECT treatments within such a large population base. With this overview in mind this study was conducted in the lone Institute of the Valley with ECT facility available. A clolege limitation of the study Kashmir college porn that follege is retrospective and reviewed data that was available at the institute. The hospital has collegge well maintained ECT case sheets which contain the basic soicodemographic and clinical details of the patients attending for ECT. The data of patients attending ECT from January to December was collected, reviewed and analysed systematically.

Diagnosis was the principle diagnosis for which ECT was given. Results The ECT pirn at Department of Psychiatry, Porm Medical College Ccollege, Jammu and Kashmir, India is the only such facility catering to ;orn needs of people of whole Kashmir Oorn, Ladakh and parts of Jammu Division Comprising ckllege population of 6, [ 13 ] spread over approximately 22, square kilometres [ 14 ]. A formal informed consent was taken for every ECT treatment. A resident Psychiatrist administered dollege ECT with the aid of an anaesthesiologist and an collegw.

It was supervised by a consultant psychiatrist. An indigenously manufactured brief-pulse, constant energy machine Medicaid Systems, Chandigarh, India was used with a constant current of 1 m A and pofn pulse width of one millisecond. Frequency and duration of current was adjusted as per the dose needed. Motor seizure was regularly monitored by pkrn cuff method. Propofol and succinyl-choline was routinely used along with other pre medications, thiopental was used as a second Kashmir college porn agent. In the ECT suite there was a monitor for vitals with an electrocardiogram, Kashmir college porn anaesthetic Kashmir college porn, a defibrillator, oxygen equipment, pulse oximeter, suction apparatus, defibrillator, and the necessary emergency drugs.

The average number of treatments per patient was clllege. Crude Kashmir college porn usage rate expressed as the number of patients treated perresident population per annum was 0. Two patients were pregnant, both in the second trimester. The diagnosis of these patients varied from major depression to mutism of schizophrenia at one end and neuropsychiatric manifestations of organic syndromes like systemic lupus erythematosis at the other end. Major depression was the single individual diagnosis of these patients, The average number of treatments per patient of major depression was 8.

Schizophrenia and Obsessive Compulsive Disorder were represented equally, Two patients of catatonic schizophrenia also received ECT and the rest of them were mainly paranoid schizophrenia. The average number of treatments per patient of OCD was The average number of treatments per patient of BPAD was 5. This group included the patients of intended suicide regardless of the primary diagnosis. Majority of them had depressive illness and a number of them had psychotic illnesses. Overall the reasons for ECT included non-response to pharmacotherapy, the severity and urgency suicidality of symptoms, distress to await drug response, patient preference and previous response.

The most common side effect was memory problems, which was found in Headache and muscle pain was reported by Post-ictal delirium was reported in two patients. No mortality was reported. Majority of these patients were on a combination of drugs Benzodiazepines were most frequent prescribed drugs, common being clonazepam, lorazepam and alprazolam. Antidepressants included a fairly equal proportion of older and newer ones. Divalprox sodium was the frequently prescribed mood-stabiliser 17 patients while as lithium was being prescribed in 10 patients. Other mood-stabilisers included carbazepine, lamotriagine and a combination of these.

Antipsychotics including both typical and atypical were prescribed in 34 patients Overall 44 of 63 Maximum improvement was seen in suicidality, bipolar affective disorders, major depression and the least improvement was reported in OCD and schizophrenia. Discussion This is the first retrospective audit study from Northern India. Since this study is carried at the only and the major Psychiatric facility in Kashmir Valley, it is likely to give a clear view of ECT practices and utilization in this part of world. Since it is more like an audit and not a simple survey, the results depicted are very near to the actual practice of ECT, although the retrospective nature of the study is a shortcoming.

Our finding of ECT usage rate of 0. Although the ECT utilization rate has not been reported from rest of India for comparisons at the local level, our rate is still far less than the global trend. Explanations to this could be complex, ranging from the availability of services, professional beliefs concerning the efficacy and safety of ECT, the socio-cultural factors and the stigma [ 18 ]. Whatever may be the reason our finding presses for the need to develop such facilities, educate the people, and update the clinicians and to expand the already available services. Average number of treatments was hovering around the worldwide average of 8 treatments per patient.

The Asian average has been treatments per patient [ 7 ]. However the wide range of ECT treatments per patient depicts the variable clinical profile of the patients. A good number of patients had more than one treatment course, which on one hand depicts the cycling nature of illnesses and the limited time-bound effect of ECT but on the other hand points towards the belief of these patients on this neurostimulative technique. However this cannot be concluded without further research. The predominance of males has been as per the global and the national trend [ 1920 ]. More than seventy percent of our patients were aged less than forty years which is different than western literature [ 821 ].

However similar pattern of age distribution has been reported in Thailand. Moreover the preferences of the psychiatrist and anaesthesiologist to selectively exclude elderly with medical comorbities and the maintained family structure in this part of the world leading to less severe illnesses in elderly could be contributing for their decreased representation for ECT. Main diagnostic indication in Asia overall has been schizophrenia [ 17 ]. The lesser use of ECT in schizophrenia Moreover the continuous use and free availability of long-acting antipsychotics for last four years in this institution could be reason for decreased need for ECT in schizophrenics. The encouraging results in affective disorders further might have led to deputation of more such patients for ECT.

The percentage of OCD Although the response was not as promising as in affective disorders but was definitely promising for further work in this area. Sucidality being an emergency to both the clinician and the care-givers represented significantly, depicting the rapid action and acceptability of ECT in such situations. Most of these suicidal patients showed a rapid and significant change on CGI-I, depicting the underlying affective illness as observed and reported in literature [ 28 ]. The response to ECT by majority of patients is consistent, as the chunk of patients belonged to affective disorders and as would be expected from the evidence elsewhere in literature, patients with affective disorders were the major responders [ 2930 ].

Decreased response by schizophrenics is presumed to be the effect of deputation of more severe and resistant cases for ECT. The response and percentage of OCD patients is a new horizon as already discussed. Further the follow-up post ECT was not available to give us a better idea of overall efficacy. Also there was no use of rating scales which precisely document the expected complications. It was heartening to find that only bilateral ECT was used, fitting well with the convincing evidence of bilateral ECT being efficacious than unilateral. Further the administration of two ECTs per week is in unison with the recommendations of Royal College of Psychiatrists [ 32 ]. Further the team approach, coordination and uniformity of protocol, well equipped and well monitored ECT suite, and use of approved brief-pulse machine was a promising sign.

Conclusion It is satisfactory to note that ECT services in this part of India are in line with global trends, although more such facilities need to come up. The very limited availability of this effective treatment modality be addressed by the state health authorities. Moreover prospective research is needed to evaluate the efficacy of ECT in different disorders. Competing Interests The authors declare that they have no competing interest. All authors contributed to design, interpretation and paper writing, and approved the final version of manuscript.




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In the ECT suite there was a monitor for vitals with an electrocardiogram, an anaesthetic Kashmir college porn, a defibrillator, oxygen equipment, pulse oximeter, suction apparatus, defibrillator, and the necessary emergency drugs. Conclusion It is satisfactory to note that ECT services in this part of India are in line with global trends, although more such facilities need to come up. A methodological limitation of the study is that it is retrospective and reviewed data that was available at the institute.

ECT is being prescribed worldwide, around one million patients being treated annually [ 8 ]. Further the team approach, coordination and uniformity of protocol, well equipped and well monitored ECT suite, and use of approved brief-pulse machine was a promising sign. The average number of treatments per patient of BPAD was 5.