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COVERING LETTER To, Hatta Sidi , MBBS MMed DipSHC. Editor, ASEAN Journal of Psychiatry Professor of Psychiatry, Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Center (UKMC) 56000 Cheras, Kuala Lumpur, Malaysia. Sub: Submission of Manuscript for publication Dear Sir, We intend to publish an article entitled [A CLINICAL STUDY OF
SUBSYNDROMAL
ANXIETY SYMPTOMS IN CHILDREN AND ADOLESCENTS FROM INDIAN CHILD AND ADOLESCENT CLINIC ]
A NORTH
” in your esteemed journal as a
research article. On behalf of all the contributors I will act and guarantor and will correspond with the journal from this point onward. Prior publication - NIL Support -
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Role of Funding Source- NIL Conflicts of interest - NIL
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Permissions -
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Contributors- NIL We also agree to provide post-publication update on the article-
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We have done sufficient work in the field to justify authorship for this article-
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Acknowledgements- NIL We hereby transfer, assign, or otherwise convey all copyright ownership, including any and all rights incidental thereto, exclusively to the journal, in the event that such work is published by the journal. Thanking you, Yours’ sincerely, 1.DR SATYAKAM MOHAPATRA 2.DR VIVEK AGARWAL3. DR. PRAVAT SITHOLEY4. DR AMIT ARYACorresponding contributor: DR SATYAKAM MOHAPATRA, MD Senior resident Mental health institute S.C.B. medical college Cuttack
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Odisha, India, 753007 E mail id-
[email protected] Mobile no- +918895293997
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ACKNOWLEDGEMENT A CLINICAL STUDY OF SUBSYNDROMAL ANXIETY SYMPTOMS IN CHILDREN AND ADOLESCENTS FROM
A NORTH INDIAN CHILD AND ADOLESCENT
CLINIC we certify that we have participated sufficiently in the intellectual content, conception and design of this work or the analysis and interpretation of the data (when applicable), as well as the writing of the manuscript, to take public responsibility for it and have agreed to have our name listed as a contributor. We believe the manuscript represents valid work. Neither this manuscript nor one with substantially similar content under our authorship has been published or is being considered for publication elsewhere, except as described in the covering letter. We certify that all the data collected during the study is presented in this manuscript and no data from the study has been or will be published separately. We attest that, if requested by the editors, we will provide the data/information or will cooperate fully in obtaining and providing the data/information on which the manuscript is based, for examination by the editors or their assignees. We also certify that we have taken all necessary permissions from our institution and/or department for conducting and publishing the present work. Financial interests, direct or indirect, that exist or may be perceived to exist for individual contributors in connection with the content of this paper have been disclosed in the cover letter. Sources of outside support of the project are named in the cover letter. We hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership, including any and all rights incidental thereto, exclusively to the Journal, in the event that such work is published by the Journal. The Journal shall own the work, including 1) copyright; 2) the right to
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grant permission to republish the article in whole or in part, with or without fee; 3) the right to produce preprints or reprints and translate into languages other than English for sale or free distribution; and 4) the right to republish the work in a collection of articles in any other mechanical or electronic format. We give the rights to the corresponding author to make necessary changes as per the request of the journal, do the rest of the correspondence on our behalf and he will act as the guarantor for the manuscript on our behalf. All persons who have made substantial contributions to the work reported in the manuscript, but who are not contributors, are named in the Acknowledgment and have given me/us their written permission to be named. We
do not include an Acknowledgment that means we have not received
substantial contributions from non-contributors and no contributor has been omitted. NAMES 1.DR. SATYAKAM MOHAPATRA 2.DR. VIVEK AGARWAL3. DR. PRAVAT SITHOLEY4. DR. Amit Arya-
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A CLINICAL STUDY OF SUBSYNDROMAL ANXIETY SYMPTOMS IN CHILDREN AND ADOLESCENTS FROM
A NORTH INDIAN CHILD AND ADOLESCENT
CLINIC AUTHORS 1.DR. SATYAKAM MOHAPATRA, MD Department of psychiatry King George’s Medical University Lucknow Uttar pradesh India Present address- DR. SATYAKAM MOHAPATRA Senior resident Mental health institute S.C.B. medical college Cuttack Odisha, India 753007
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2.DR. VIVEK AGARWAL, MD Associate professor Department of psychiatry King George’s Medical University Lucknow Uttar pradesh India 3. DR. PRABHAT SITHOLEY, MD Ex- head and professor Department of psychiatry King George’s Medical University Lucknow Uttar pradesh India 4. DR. AMIT ARYA, MD Assistant professor Department of psychiatry
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King George’s Medical University Lucknow Uttar pradesh India CORESSPONDING AUTHOR DR SATYAKAM MOHAPATRA, MD Present address-Senior resident Mental health institute S.C.B. medical college Cuttack Odisha, INDIA 753007 E mail id-
[email protected] Mobile no- +918895293997
Total number of words-1037
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Number of words in the abstract- 240 Numbers of references-07 Tables- 01 Figures-nil
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A CLINICAL STUDY OF SUBSYNDROMAL ANXIETY SYMPTOMS IN CHILDREN AND ADOLESCENTS FROM
A NORTH INDIAN CHILD AND ADOLESCENT
CLINIC ABSTRACT Background & objectives: Though anxiety disorders are one of the most common group of psychiatric disorders among children and adolescents, the frequency of subsyndromal forms of anxiety in children and adolescents is unknown and under-diagnosed . No study is done in India on subsymdromal anxiety symptoms in children and adolescents. Therefore, this study was planned with the aim to identify subsymdromal anxiety symptoms in children and adolescents and elicit their phenomenology and impairment. Methods: Patients between age group 6 to 16 years attending child and adolescent psychiatry clinic were screened by Screen for child anxiety related emotional disorders (SCARED) scale. Those patients having anxiety symptoms, but not fulfilling criteria for any anxiety disorder their phenomenology was assessed by SCARED scale. Impairment due to anxiety symptoms was assessed by Children’s global assessment scale (CGAS). Results: Out of 1465 screened patients 21(1.43%) patients had anxiety symptoms. Mean age of patients with anxiety symptoms was 11.4±1.8years. Majority of patients were females patients 15(71%).
4(19.05%) patients had family history of psychiatric disorders. Mean score of anxiety
symptoms on SCARED scale was 18.24±2.51. Most of the subjects had some difficulty in functioning (Mean C-GAS score -65±3.78). Interpretation & conclusion: The significant prevalence of sub-syndromal anxiety symptoms, the significant psychosocial impairment associated with it and the possible chronicity of its
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course should make the sub-syndromal anxiety symptoms a matter for serious consideration by both clinicians and researchers. Key words- anxiety, subsyndromal , children , adolescents.
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1.Introduction The specification of diagnostic algorithms and cut off scores for different psychiatric disorders has led to the new controversy as to whether the sub-threshold/subsyndromal symptoms are a clinical problem at all, or separate phenomenon in their own right, or a minor form of major psychiatric disorder1. Though anxiety disorders are one of the most common group of psychiatric disorders among children and adolescents, the frequency of subsyndromal forms of anxiety
in children and adolescents is unknown. Unfortunately, these are often significantly
underreported and under-diagnosed and difficult to recognize. Great Smoky Mountains Study2 showed that subsyndromal anxiety symptoms in children and adolescents quadrupled the likelihood
of developing of anxiety disorders in the future. This study also revealed that
children and adolescents with subsyndromal forms of anxiety were twice as likely to have impaired functioning compared to those with no symptoms. Typically, the best predictor of later psychopathology2, including anxiety disorders , is earlier psychopathology. If symptoms of anxiety in children and adolescents are predictive of disorders and impairment, then treatment of
subsyndromal forms of anxiety in children and adolescents may be one of the few options
for reducing the chronicity of anxiety disorder.
No study is done in India on subsymdromal
anxiety symptoms in children and adolescents. Therefore this study was
planned
in a
psychiatry outpatient setting of a university department of psychiatry in northern India with the aim to identify subsymdromal anxiety symptoms in children and adolescents and elicit their phenomenology and impairment.
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2. Material and Method This cross-sectional, clinic based study was carried out at Department of Psychiatry, King Goerge’s medical university , Lucknow from August 2010 to July 2011 . The study was approved by the institutional ethics committee. Inclusion criteria were, (i) non psychotic patients between 6 to 16 years of age , (ii) availability of at least one reliable informant who may be a parent or guardian of the subject, (iii) informed consent of the parent or guardian of the patient. Exclusion criteria included, (i) patients with psychotic illness, (ii) patient with a severe physical disorder or condition requiring priority medical management, (iii) Parents or guardians not willing to give informed consent, (iv) non-availability of a reliable informant,(v) mental age
