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is an urgent need for first-aid measures and to impart relevant skills to the parents but the pathways to these are not described clearly. Could we have role-play models, documentaries, pamphlet distribution, and healthcare information in the media to highlight the issue? There is also an urgent need to discard the old traditional, social and religious views. The problem must be tackled effectively and lessons may be learnt from developed countries. Overall, this is an interesting topic, which generates much debate. The authors and the Editor should try to highlight such articles and I would sincerely applaud their sincere efforts. SRIJIT DAS Department of Anatomy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia Correspondence: Dr. Srijit Das, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia. E-mail:
[email protected]
REFERENCES 1. Bavdekar SB, Ghule R, Jadhav S. Healthcareseeking behavior after seizures in children. Indian
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BENIGN PROSTATIC HYPERPLASIA: IS IT A GROWING PUBLIC HEALTH CONCERN FOR INDIA? Sir, BPH is the most common urological problem of ageing men, manifested as severe obstruction in urinary flow with discomfort and pain. BPH is a complex disease from the etiological and pathogenesis point of view.[1] A recent AUA guideline (2003) suggests an increase in the incidence of BPH worldwide and predicts by the age of 60 years, more than 50% of men will have microscopic evidence of the disease and by the age of 85 years, as many as 90% of men will be affected.[2] Worldwide investigations for incidence of BPH are scanty and at times difficult to compare due to uneven definition of BPH based on different clinical parameters. There is also great geographical disparity in prevalence and degree of severity of symptoms of BPH. Benign enlargement of the prostate gland is reported to be most common in blacks, Caucasians, and Jews, but less frequent in males from the Far East.
J Med Sci 2008;62:331-5. 2. Pal DK, Chaudhury G. Preliminary validation of a parental adjustment measure for use with families of disabled children in rural India. Child Care Health Dev 1998;24:315-24. 3. Pal DK, Chaudhury G, Das T, Sengupta S. Predictors of parental adjustment to children’s epilepsy in rural India. Child Care Health Dev 2002;28:295-300. 4. Pal DK. Epilepsy control in the twenty-first century: Hidden impact on children and families. Child Care Health Dev 2003;29:233-6. 5. Chiou HH, Hsieh LP. Parenting stress in parents of children with epilepsy and asthma. Child Neurol 2008;23:301-6.
Asian, particularly vegetarian, men consume low-fat, high-fiber diets rich in weak dietary phytoestrogens, which have been proposed as chemopreventive agents. But the very few studies conducted on BPH patients from India suggest BPH as the most common pathological condition with an incidence of 92.97% (n = 185) [3] and (93.3% (n = 200).[4] Though not well performed epidemiological investigations, these data along with clinicians’ practical evidence indicate substantial need for a survey of the incidence of BPH in India. Interestingly, the Indian J Med Sci, Vol. 62, No. 9, September 2008
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Prime Minister of India was reported in the 16 September 2007 issue of The Times of India to have undergone surgical treatment for benign enlargement of the prostate gland at the All India Institute of Medical Sciences. However, the actual current incidence of BPH will require valid scientific evidence from pooled data, and India as a whole lacks a large-scale screening database of patients diagnosed for any prostatic disease. The recent increase in the BPH rate in several industrialized countries should inspire Indian urologists to more elaborate effort to investigate symptoms and risk factors of BPH. Further, public health perspective research with factual data collected through national and regional centers to assess future trends in BPH incidence rates and defining ethnic characteristics, as also case-control studies, must be strongly encouraged to identify risk factors for the Indian population. HEMANT KUMAR BID, RITURAJ KONWAR, VISHWAJEET SINGH1 Endocrinology Division, Central Drug Research Institute, Lucknow,1Chatrapati Sahuji Maharaj Medical University (CSMMU), Lucknow, India Correspondence: Dr. Vishwajeet Singh, Department of Urology, Chatrapati Sahuji Maharaj Medical University (CSMMU), Lucknow-226003, India. E-mail:
[email protected]
REFERENCES 1. Konwar R, Chattopadhyay N, Bid HK. Genetic polymorphism and pathogenesis of benign prostatic hyperplasia. BJI Int 2008;102: 536-44. 2. AUA Practice Guidelines Committee. AUA guideline on management of benign prostatic hyperplasia, Chapter 1: Diagnosis and treatment. Indian J Med Sci, Vol. 62, No. 9, September 2008
J Urol 2003;170:530-47. 3. Mittal BV, Amin MB, Kinare SG. Spectrum of histological lesions in 185 consecutive prostatic specimens. J Postgrad Med 1989;35:157-61. 4. Mathur SK, Gupta S, Marwah N, Narula A, Singh S, Arora B. Significance of mucin stain in differentiating benign and malignant lesions of prostate. Indian J Pathol Microbiol 2003;46:593-5.
BIPOLAR AFFECTIVE DISORDER IN PARKINSON’S DISEASE: CLINICAL DILEMMAS Sir, Psychiatric disorders are a common cooccurrence in people with Parkinson’s disease (PD). [1] Psychiatric symptoms may be the direct result of PD, its co-morbid pathologies, or occur as a side effect of its pharmacotherapy. About 10% of patients on treatment for PD will experience euphoria and 1% will develop mania.[2,3] We report a case of bipolar affective illness complicated by idiopathic PD and its treatment with special reference to its response to Clozapine. The patient is a 56-year-old married lady with premorbid paranoid personality traits without family history of any neuropsychiatric illness. Her index visit was in August 2005 when she was diagnosed to have severe depression with suicidal intent, and a detailed neurological evaluation at that time did not reveal any symptoms of PD. She was treated with a course of seven bilateral brief pulse modified electro convulsive therapy and Sertraline 100 mg, and became euthymic within one month. One year later
INDIAN JOURNAL OF MEDICAL SCIENCES
she developed unilateral tremors for which neurology consultation was sought. She was diagnosed with left hemi Parkinsonism and started on Ropinarole 0.125 mg thrice daily and Trihexyphenidyl 1 mg thrice daily. Following poor response of PD symptoms, in Sep 2006 the neurologist started her on Selegiline 5 mg in the morning. Subsequently the patient was reported to be irritable, dysphoric and over-religious; these symptoms remitted on stopping Selegiline but there was inevitable worsening of motor symptoms. On restarting Selegiline she developed a full manic syndrome characterized by overactivity, over-talkativeness, irritability, hyperreligiosity and decreased sleep with grandiose delusions. Selegiline was stopped considering the possible interaction with Sertraline and as a doubtful precipitating factor for mania but other drugs were continued according to the neurologist’s advice. Treatment options for mania were discussed with the patient and caregivers, who were willing to opt for Clozapine only after a conventional trial in view of serious side effects. The patient was started on Sodium Valproate, which was increased to 1200 mg daily (serum Valproate level of 55 microgram per ml) and Olanzapine 20 mg daily. With this treatment her manic symptoms improved but she did not become euthymic. After one month there was a worsening of manic symptoms for which the patient was started on Clozapine 12.5 mg and the dose was increased to 37.5 mg daily. Valproate and Olanzapine were tapered and stopped gradually. Two weeks after starting Clozapine the patient showed significant improvement in her manic symptoms without any worsening of motor symptoms. After 3 weeks, at the time of discharge, the patient
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was euthymic without any worsening of the motor symptoms of PD. This case highlights the efficacy of Clozapine in the management of mania in PD. There is one report of two patients with longstanding idiopathic PD, without individual or family history of affective disorders, who on developing bipolar mood disorders were treated with lithium and Clozapine. Only one of them responded favorably. [4] But in our case the patient had a history of depression prior to the onset of PD and the mania responded well to a low dose of Clozapine without worsening of motor symptoms. No guidelines or strategies are available for the management of mania or bipolar illness in PD. However, guidelines are available for the prevention and management of psychosis in PD.[5] Further, the possibility of Selegiline precipitating mania in a patient who has vulnerability for a bipolar illness should not be discounted. The authors would like to stress the need for good liaison between the various specialities and for a specialist who can manage both mood and movement problems together. NAVEEN THOMAS, PRASANNA JEBARAJ, KISHOR KUMAR S. Department of Psychiatry, Christian Medical College, Vellore-632 002, Tamil Nadu, India Correspondence: Dr. Naveen Thomas, Department of Psychiatry, Christian Medical College, Vellore-632 002, Tamil Nadu, India. E-mail:
[email protected]
REFERENCES 1. Aarsland D, Larsen JP, Lim NG, Janvin C, Karlsen K, Tandberg E, et al. Range of neuropsychiatric Indian J Med Sci, Vol. 62, No. 9, September 2008
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disturbances in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry 1999;67:492-6. 2. Factor SA, Molho ES, Podskalny GD, Brown D. Parkinson’s disease: Drug-induced psychiatric states. Adv Neurol 1995;65:115-38. 3. Cummings JL. Behavioral complications of drug treatment of Parkinson’s disease. J Am Geriatr Soc 1991;39:708-16.
4. Kim E, Zwil AS, McAllister TW, Glosser DS, Stern M, Hurtig H. Treatment of organic bipolar mood disorders in Parkinson’s disease. J Neuropsychiatry Clin Neurosci 1994;6:181-4. 5. Friedman JH, Factor SA. Atypical antipsychotics in the treatment of drug-induced psychosis in Parkinson’s disease. Mov Disord 2000;15: 201-11.
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Announcement
Dr. J. C. Patel Birth Centenary Celebration Committee The year 2008 is the Birth Centenary Year of Dr. J. C. Patel. Some of his students/admirers felt that it would be a good idea to celebrate this Centenary Year by organizing CMEs, Orations/ Lectures, Conferences, etc. during the year. He was associated with many professional bodies, which meet regularly every year; during these annual meetings/conferences, a lecture/symposium, etc can be organized as a part of Centenary celebrations. We would like to form a Dr. J. C. Patel Birth Centenary Celebrations Committee. All his past students/admirers are invited to join the committee (without any financial commitment). Kindly communicate your name, designation, postal address, telephone number and E-mail ID to Dr. B. C. Mehta at Flat 504, Prachi Society, Juhu-Versova Link Road, Andheri (W), Mumbai 400 053 (
[email protected]). Indian J Med Sci, Vol. 62, No. 9, September 2008
