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|Year : 2011
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. Posters. Indian J Psychiatry 2011;53:73-109
MB 12 injections in children with autism spectrum disorders (ASD): A prospective open study
Deepak Gupta, Soumini Menon
Centre for Child & Adolescent Wellbeing, New Delhi, India
Background and Objectives: Current upcoming research now explains autism spectrum disorders (ASD) as a biochemical and neurological problem that alters the way the brain and body develop, and eventually results in the social, behavioural, and communication problems. Biomedical intervention addresses these ecological and biochemical issues, leading to an improvement in the psychophysical symptoms that are representative of ASD. One of the biomedical interventions includes giving MB12 injections to the child. These MB12 injections target the methylation defects present in children with autism. Since every cell in the body expresses the folate/methionine cycle, defects in transmethylation can affect vital biochemical reactions at many places in the intermediary metabolism. Thus, suggesting that methylation capacity and antioxidant potential can be increased with obvious clinical benefits in children with ASD. As of now Methyl-B12 injections are being used as a treatment modality for ASD in United States and in many other countries as well. As per Dr. Neubrander's protocol, the dose for approximately 85% children is 64.5mcg/kg every three days (stock concentration is 25 mg/ml). To the best of our knowledge, ours is the first documented open and long term prospective trial using M-B12 injections on Indian children with ASD.
Materials and Methods: Over the last 18 months (February 2009-July 10) after parental consent, 25 children with ASD were introduced to MB12 injections (available to Indian parents via Akhil Autism Foundation (AAF), New Jersey and Dr. Karima Hirani, USA). No changes were made to any other variables in the treatment plan for initial 6 weeks and ongoing therapies were kept in place. The clinical responsiveness was carefully evaluated by both the parents at home and by the clinician, by using Autism Treatment Evaluation Checklist (ATEC) and clinical evaluation.
Result: After a careful analysis of the scores obtained on ATEC, we found that in approx. Seventy percent of the cases a mild to moderate progress could be noted. The scores revealed that maximum changes were seen in the child's speech and communication; and sociability. Overall improvement was observed in eye contact, speech, communication skills, sensory and cognitive awareness.
Conclusion: While formal tests and randomized trials are still in the early stages, parents can try this promising MB12 therapy for children with plausible methylation defect in ASD, under their doctor's close supervision and guidance.
A study of stress, quality of life and psychiatric morbidities in police personnel
Santanu Ghosh, P.K. Chaudhury, R.U. Zaman
Assam Medical College & Hospital, Dibrugarh, Assam, India
Introduction: Policing is a psychologically stressful work environment filled with danger, high demands, and equivocalness in work, encounters human misery and death exposure.
Aims: To assess perceived stress by police personnel, correlation between stress & quality of life among Constables & Officers, psychiatric morbidities in the study groups.
Methodology: Community study done in police stations of Dibrugarh District, Samples recruited from among the police personnel of different rank of Assam Police by Systemic random sampling. Sample Size : Group A (83) and Group B (33). Inclusion criteria : Policeman in service e"3 years, age e"21 years, with minimum primary school educated. Exclusion criteria : who is unable to comprehend study questionnaire, on leave, exclusively doing clerical job, who are found inebriated. Self-reported questionnaire evaluated.
Tools: Police specific Stress Questionnaire, measures of chronic job stressors, WHO QOL-BREF , General health questionnaire-30, Mini International neuropsychiatric interview (Version 5).
Results and Conclusion: 1/4 th of constables have significantly stressed and 2/3 rd of officers are significantly stressed. Positive linear relationship exists between age and stress in both the groups. Tenure of work has positive linear relationship only in officers. Officers are more stressed than constables. Bellow secondary constables are more stressed and Graduate officers are more stressed. No relationship exists between education and stress level. Mean score of neglected family life, job boredom, and quantitative work overload score is more in officers group and noxious physical environment, communication quality and praise is more in constables. The general health questionnaire-30 score does not cross the threshold in either group. Diagnostic evaluation by M.I.N.I could not be performed. In quality of life, the mean score of all the domains is higher than officers.
HIV phobia: An issue of concern
Fortis Hospital, New Delhi, India
Aims and Objectives:
• To understand the profile of patients presenting with HIV Phobia
• To understand the associated/underlying factors contributing to the problem.
• To gain insights into the treatment paradigm and course
• To highlight the need for and aid in the process of sensitive handling of sex education and preventive psychiatry
Methodology: Information was derived from case histories, mental state examination, management reviews and course of illness observed in patients suffering from HIV phobia (fear of contracting HIV infection, despite negative test results) and presenting to the Psychiatric Clinic.
Results and Conclusion: Out of the fifteen cases with 'HIV phobia' observed over the last 4 yrs, all were males in the age range of 25-40 yrs except for one in his early sixties. Over 2/3 rd were computer professionals and some were property dealers. Net surfing was reported by majority. The onset of the problem was reported mostly following a protected sexual contact (one off, approached with mixed feelings, at times peer pressure) with a FCSW while on a trip out of town and away from family. Few reported the fear following blood donation/injury/giving blood for testing. The clinical profile was reflective of hypochondriacal thought process and obsessive compulsive symptoms. Somatic symptoms of anxiety and depression further contributed to the doubts of having contracted HIV. The patients received medication (SSRI, Clomipramine, SNRI) and Psychotherapy (Cognitive behaviour therapy, insight oriented psychotherapy), sensitively handled sex education and counseling w.r.t promotion of healthy life styles. All the patients showed significant improvement within 3 months with treatment with some relapses under stress. The study highlights the need to address the issue of healthy lifestyle and moral based sex education amongst the young in a sensitive and sensible manner.
Depot antipsychotics: Patient profile and satisfaction with a manchester-based service
Parveen Sharma, J.S. Bamrah
Aims: To share our findings on how depot clinics operate in Manchester, UK, and the level of satisfaction in the service amongst patients.
Objectives: To look at the patient profile of all patients who attend the 'North' Manchester depot clinic. To randomly ascertain the levels of patient satisfaction across the depot clinics that operate in Manchester.
Methodology: Raw data for 2009, was readily available for patients attending the North clinic. All paper and electronic records were studied, and patients' prescription records were also matched for each record entry. A patient satisfaction questionnaire was devised. This was handed to a random selection of some of the 489 patients attending the depot clinics. All patients attending the clinic on a particular day were surveyed.
Results: A total of 143 patients records were screened for the first part of the audit. Males outnumbered females in a ration of 2 : 1, with a mean age of 47.5 and 48 years respectively. 85% of patients had a diagnosis of schizophrenia and allied disorders. Almost 50% of patients were prescribed Flupenthixol decanoate, Review of depot prescriptions by psychiatrists was unsatisfactory. The patient questionnaire demonstrated a high level of acceptance for depots amongst the 140 patients who attended the clinics. Ninety six percent of patients had been given sufficient information on the depot and, most patients were given an alternative (90%). However 11% of patients preferred to have the injection in their home setting.
Conclusion: Depot clinics are an effective way to deliver patient-centred care and the levels of satisfaction amongst patients are high. The clinics provide a one-stop service for giving patients information about the injections, monitoring them for side effects, and social networking. However there is scope to refine the clinics further by conducting additional assessments such as blood tests and weight monitoring.
Level of awareness towards mental retardation
Institute of Mental Health and Hospital, Agra, Uttar Pradesh, India
Mental retardation is defined as the lack of achievement of an appropriate degree of mental development in relation to age. It is determined by a low level of intellectual of abilities, which is manifested by inadequate development of thinking, limited learning ability and poor social adaptation to common living conditions. The present study proposes to assess the misinformation and misconceptions amongst the people towards mental retardation. The findings of the study will help to make a comprehensive programme to aware the community towards misconception and to rehabilitation. The sample consists of 200 subjects (100 from rural background and 100 from urban background) purposively selected from the Agra city and adjacent areas. NIMH-GEM Questionnaire (2000) was used to measure the misinformation and misconception for mental retardation. The findings of the study and its relevance are discussed.
The issue related to psychiatric illness and educative role of television: Are we moving ahead?
Jayprakash R. Ravan, Pragya Das 1
CMC Vellore, 1 Freelance Writer and Journalist
Background: Television plays an essential role in the public perception of mental illness.
Objective: The aim of the observational study is to find out the percentage of broadcasting space and time of popular television channels regarding common mental illness for the year of 2009-10. The other objective is to critically analyze the appropriateness of these programme in impacting and disseminating just information.
Methods and Methodology: All the serials broadcasted throughout the day were screened. The total number of Hindi serials broadcasted in a year and percentage of serials dealing which health related issues were calculated. The trained psychiatrist critically analyzed the appropriateness the content, characterization and educative values in the public health domain.
Results: 7.5% (3) out of 40 television serial in all the popular channels like Star Plus, Sony entertainment, Zee TV deal with mental health issues. The semi-structure questionnaires showed 90% lacked appropriateness, educative values and knowledge to public. Aapki Antara, a TV serial by Drishtant production is based on autism.
Conclusion: Authors recommends more time and space allocation for psycho-social issues relating to health in general and mental illness in particular. These programme need to undergo sensitive pre-broadcasting evaluations by senior clinicians and human right activists to provide educative value for the public.
A case of bipolar disorder with hyerammonemia due to valproate and hyponatremia due to carbamazepine
Ajeesh P.R., Vidhukumar, Anil Prabhakaran
Medical College Trivandrum, Kerala, India
Introduction: Valproate induced hyperammonemia and carbamazepine induced SIADH are well studied entities. We report a patient who has history of complex partial seizures with secondary generalization since childhood. Developed bipolar disorder during adolescence and had hyperammonemic encephalopathy 6 weeks following valproate initiation. Had hyponatraemia due to carbamazepine.Later responded with lithium and olanzapine.
Case report: A 16-year-old boy had history of neonatal hypoglycemia, septicemia, seizures and prolonged intensive care treatment. He developed left focal motor seizures with secondary generalizations since 5 years of age. He is also having hypothyroidism on thyroxine supplementation for 5 years. He had dyslexia and below average level of functioning. He developed depressive episode on March 2010 following stressor lasting 3 weeks followed by manic episode for which valproate was initiated and increased to a dose of 2000 mg. After 2 weeks he developed disoriented behavior and incontinence of urine, suspecting toxicity, valproate was stopped Arterial ammonia was found to be 150 mmol/l. He got better within 3 days and serum ammonia came down to 35 mmol/l after 10 days, For symptom control carbamazepine was increased from 400 mg to 800 mg/day and started olanzapine 20 mg/day. Serum sodium initially normal was found to be persistently low below 125 meq/l and diagnosis of SIADH due to carbamazepine was made supported by low urine sodium which got corrected by reducing the dose to 400 mg as before. For behavior control lithium 900 mg/day (serum level 0.7 meq/l) was initiated. YMRS was-46/60 became 22/60 after 14 days.
Discussion: Valproate induced hyperamonaemic encephalopathy 1,2 and Carbamazepine induced SIADH 3 are well studied entities. Our case, however, is unique because both these conditions occurring in succession becomes a challenge in treating a bipolar patient . We also suspects an undiagnosed urea cycle disorder valproate can induce hyperammonaemia in patients with underlying urea cycle disorder 4 .
Psychological androgyny: Does it have psychoprotective attributes?
Jyoti Prakash, H.R.A. Prabhu, Kalpana Srivastava, P.S. Bhat,
AFMC, Pune, Maharashtra, India
Introduction: Psychologically androgynous individual is a female or male who has a high degree of both feminine (expressive) and masculine (instrumental) traits. Androgynous men and women have been found to be more flexible and mentally healthy than either masculine or feminine individuals. A masculine or androgynous gender role may be more desirable in academic and work settings because of their demands for action and assertiveness. In present day world when omen are equally involved in work as well as domestic front and involved in the dual role of father and mother, as in long distance relationship, is the attribute more effective.
Methodology: An extensive search of related articles was done and findings were analyzed.
Result: It was seen that there has been an increase acceptance and of promotion of androgynous individual off late. They have been found to have better coping ability and mental health. Various psychosocial variables determined the androgyny of the individuals.
Conclusion: Psychological androgyny was found to have psycho protective attributes.
Acute disseminated encephalomyelitis masquerading as dissociative disorder
Jyoti Prakash, H.R.A. Prabhu, Kalpana Srivastava, P.S. Bhat,
AFMC, Pune, Maharashtra, India
Diagnostic dilemmas have always been matters of challenge as well as interest in the field of medical science. Varied presentations of disorders are becoming more of a norm than exception and the psychiatric presentation of the medical disorder had always been vexing. Acute disseminated encephalomyelitis (ADEM), an uncommon inflammatory demyelinating disease of the central nervous system, often presents with various combinations of motor, sensory, visual, gait, and memory disturbances. ADEM at times may present as psychiatric disorders primarily as confusion or psychosis and rarely as Dissociative disorder. One of such rare presentation is brought here for the clinical interest. The case has its salience in nature of presentation and the way high index of suspicion led to early diagnosis and remediation.
Charles-bonnet syndrome: A case report
Pankaj Kumar, Anurag Jhanjee, M.S. Bhatia, Deepika Verma 1 , Shruti Srivastava , Vivek Kumar 2
UCMS Delhi, 1 MBBS, Navodya Medical College, Raichur, 2 Safdarjang Hospital, New Delhi, India
Charles-Bonnet syndrome (CBS) occurs after the loss of vision or a decrease in visual ability and is characterized by visual hallucinations with insight and preserved cognitive status. The case is a 38-year-old female referred to the psychiatry outpatients department of University College of Medical Sciences & associated Guru Tegh Bahadur Hospital, Delhi for depressive complaints. She lost her vision due to optic atrophy following multiple surgeries for hypophyseal macroadenoma and visual hallucinations developed afterwards. She was started on quetiapine 300 mg/day and the hallucinations disappeared on the tenth day, her vision gradually changed into sparkling lights and simple figures at the 6th-month follow-up. CBS symptoms should be screened actively in patients with visual loss and physicians should be educated about diagnosing CBS. Novel antipsychotics, quetiapine, seem to be effective alternatives for the treatment of CBS. The details of the case will be presented during poster presentation at ANCIPS, 2011.
The gender clinic: Clients and WPATH *Standard of care (*the world professional association for transgender health)
Mrinmay Das, Lynda Quick
Devon Partnership NHS Trust (UK)
The Gender Clinic (Gender and Sexual Medicine Clinic, St. Michaels, Newton Abbot Hospital (Old Site), Which offers Treatment for Transexual and other disorders of Gender identity disorders, is one of the very few specialist centers in UK, has become quite popular to warrant an audit to examine its compliance with International Guidelines (WPATH- popularly known as Harry Benjamin International Gender Dysphoria Association, HBIGDA). In this Naturalistic Retrospective Study, data were collected from the Clinic files of patients managed under this Consultant Psychiatrist over a period of 15 months (April 2009 - July 2010) using an purpose developed audit tool with the help of audit department. Data presented keeping the WPATH Standard of Care (SOC) guidelines as comparator. Main highlights have been that most of the clients (52 out of 54) were diagnosed transexuals using ICD-10 (WHO) criteria, all of them were primary transsexuals, majority of them were male to female transexuals (39 M2F & 13 F2M, 2 Androgynae), Comorbid Diagnoses (Both Physical and Psychiatry) were made in 7 cases. All diagnosed cases were receiving treatment following 'Triadic Therapy Model' (real life experience (RLE)-supervised, trans hormone treatment and gender reassignment surgery (GSR). This audit confirms the broad adherence to guidelines, however few issues like 'formal consent form signing', waiting too long (upto 3 years) before being put on hormones are needed to be addressed.
Referral patterns to a psychiatric unit in a tertiary care general hospital
Madhusudan, Abhinit Kumar, Rajesh Rastogi, Pankaj Verma
VMMC & Safdarjung Hospital New Delhi, India
Objective: The aim of the study was to describe the referral pattern of Inpatients of various departments to the psychiatric unit at a tertiary care general hospital.
Methodology: All references made to the psychiatric unit from various departments of a tertiary care general hospital over a period of three months were analyzed over a variety of parameters.
Results: Total 192 referrals were received by psychiatric unit over a period of three months, with male- female ratio almost equal, average age 29.86 yrs. Maximum references were from medicine dept (53%), followed by burns and plastic (13%). Suicide risk assessment after Para-suicidal behavior was the commonest reason (40%) followed by referrals made for altered behavior and sensorium (28%) and pseudoneurological symptoms (7%). Deliberate self-harm impulsive type and delirium were the most common conditions found. In more than 50% cases examination findings did not match the reason for referral, past psychiatric history was found in 15.5% cases while in 28% cases the referral was done prematurely without proper investigation of an organic brain syndrome.
Conclusion: This study shows the importance of a psychiatric unit sitting in general hospital setup, considerable variation was found between various departments in referral rates, importance of psychiatric co-morbidity is highlighted as considerable no of patients were found to have past h/o psychiatric illness, finally there is a need to sensitize clinicians regarding organic brain syndromes.
Community outreach programme for providing mental health care to all
Lt. Col. H.K. Bedi
92 Base Hospital, Indian Army
Aims and Objectives:
1. Increase awareness about mental illness.
2. Give information regarding treatment modalities, to make treatment user friendly.
3. Focus on all levels of prevention ,so that community resources are used more efficiently.
4. Rehabilitation of mentally ill, decreasing burden of care.
5. Improve health professional skills.
1. "Well Being Camp" held in Jabalpur for ten days.
2. Personnel educated about issues in mental illnesses.
• Bilingual Posters
• LCD presentations
• Counseling facilities
• Interviews with treated personnel, now leading a successful life.
• Complementary therapies;
• Bilingual self-help cards, distributed so that individuals could use them to curb impulses.
- Art of living
• Camp attended by 1860 personnel, 20 doctors, 10 Psychiatrists
• 42 cases of mental illnesses detected.
Discussion: Mental illness has always mystified mankind. Mentally ill were initially considered as evil. As time passed, mental illness was considered as deviant behaviors and the mentally ill were put in jails. In modern era, shift has been from evil to ill and people were put in asylums, which however became places of human exploitation. It is the attitude of mentally ill being " beyond help" and "out of sight-out of mind", that even though one in four people will experience mental illness at some point in their lives and even though effective and affordable treatment is available, it is not being used. However during the 10 day camp, 42 personnel came out on their own to seek help.
Conclusion: 42 new cases of mental illnesses in a 10 days camp, with individuals volunteering for help, is in itself a feat, which reveals that steps taken in the right direction are extremely effective.
Gender identity disorder: A case report
Supriya Agarwal, D.K. Sharma 1 , Ashok Sharma 2 , D.K.Vijayvergia
Government Medical College, Dadabari, Kota, Rajasthan
Background: Gender Identity Disorder-Transsexualism (ICD coding 64.0 ) is a disorder where there is a desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with own biological sex and a strong desire to get the sex changed. It is a rare disorder with a prevalence of 1 in 30,000 in men and 1 in 100000 in females.
Objective: To present a case of Gender Identity Disorder-Transsexualism.
Case: A 22 yrs male first presented himself to a Urology Clinic and requested the urologist 2 for surgical change of his sex. He was then referred to the psychiatrist 1 . Case was evaluated in detail and it was found that for last 5 years he felt like dressing himself as a female. Although he felt comfortable in company of girls but he never had any heterosexual desire for them. During night hours when he was alone he used to wear women clothes like Salwar Kurta and women undergarments as night wears and felt very gratified. He also disclosed that before coming for consultation with us he took estrogen tablet for at least 1year regularly on advice of a quack to enhance his breast development & very sparse facial & pubic hair. He firmly stressed that his present sex gave him persistent feeling of discomfort and incompleteness, that's why he wished for surgical correction of his sex. On examination he was a true male, genotypic ally & phenotypically. The case was presented & discussed in a case conference. On the basis of history, physical examination, investigations & MSE we found him to be a case of Gender Identity Disorder- Transsexualism.
Conclusion: Very few cases of Gender Identity Disorder- Transsexualism have been reported in India especially those who first consulted a urologist.
A case report on ADHD with multiple co-morbidities
Sujit Kumar Kar, Sameer Belvi Mangalwedhe, Bhupendra Singh, Vivek Agarwal
C.S.M. Medical University, Lucknow, Uttar Pradesh, India
Introduction: Attention deficit/hyperactivity disorder is one of the commonly encountered psychiatric disorders in children. It is associated with significant impairment in functioning. Many co-morbid psychiatric disorders are found with attention deficit/hyperactivity disorder. Various studies indicate it to be between 60 to 80%. Presence of co-morbidities add to the management problems.
Case History: A 15 year old adolescent male was hospitalised with chief complaints of stubbornness, un-socialised behaviour and disturbed sleep for 10 years, hyperactivity and inattention for 8 years and repetitive behaviour for 4 years. Assessment on K-sads fulfilled the criteria for ADHD-CT, oppositional defiant disorder, conduct disorder, and obsessive compulsive disorder. IQ assessment revealed a functional IQ of 75 (low average intelligence). Patient's father was having anankastic triats. Patient's investigations were within normal limits. After complete assessment a final diagnosis of attention deficit/hyperactivity disorder-combined type with conduct disorder with obsessive compulsive disorder as per DSM IV-TR with low average intelligence was made. There were many difficulties in the management of the patient. He was treated with methyl-phenidate, SSRI (sertraline) and antipsychotic (risperidone). Non-pharmacological management (behaviour therapy) was also employed. The patient was hospitalised for 6 weeks, he was discharged with significant improvement. The details of clinical presentation and management issues were discussed in the case report.
Acute myopia and secondary angle closure glaucoma: A rare complication of topiramate medication in psychiatric practice
Jyoti Prakash, H.R.A. Prabhu, Kalpana Srivastava, P.S. Bhat,
AFMC, Pune, Maharashtra, India
Instructions: Topiramate is a sulfamate used commonly for epilepsy and migraine. Various other uses of topiramate include management of peripheral neuropathies and radiculopathies, idiopathic intracranial hypertension, adjunctive therapy in alcohol dependence and nicotine cessation. One of the rare but severe adverse ocular side effect seen in patients treated with topiramate is acute myopia with secondary closed-angle glaucoma. Literature documents around 115 case reports of ocular side effects, 86 cases of secondary angle closure glaucoma, and seven cases of permanent visual loss reported with Topiramate usage. Topiramate is a recent addition to the list of drugs that can precipitate acute angle closure glaucoma. Although the mechanism for this side effect is unknown, it may partly be due to its weak carbonic anhydrase inhibitor activity or a prostaglandin mediated effect. One of such rare case is being reported where an early detection and prompt management led to prevention of any significant ocular disability.
Comparison of alcoholics and depressives on personality and family functioning
Jaspreet Kaur, V.V. Upmanyu, Anuradha Bhandari, B.S. Chavan
GMCH, Chandigarh, India
Introduction: Personality and temperament may contribute to depression. Personality has also been found to be an important variable in alcoholics. Persons who are dependent on alcohol may suffer from a variety of personality traits which might predispose them to the disease.
Aim: To compare alcohol users and depressives on personality and family functioning.
Materials and Methods: The study was conducted at the Psychiatry Outpatient Department of Government Medical College and Hospital, Sector 32, Chandigarh. Sample (N=100 males in each group) comprised of patients who were diagnosed with Depressive Disorder (first episode depression) and Alcohol Dependence as per ICD-10 criteria. Patients in both the groups were compared on personality and family functioning.
Analyses: Data was analyzed by computing mean scores and t-test.
Results: Significant differences were found between two groups on extroversion, psychoticism, role, communication and leadership. Implications of the findings in management will be discussed later.
A study of relapse related factors in men with opioid dependence
Sinha A.S., Kadam M.S., Matcheswalla Y.A., Haridas R.M.
JJ Hospital and Grant Medical College, Mumbai, India
Background: Relapses are frequent in opioid dependence and interaction of multiple causes is seen.
Aims and Objectives: (1) To study relapse related factors in opioid dependence (2) To study correlates of Duration of Abstinence.
Materials and Methods: Thirty men seeking treatment for relapse and diagnosed with Opioid Dependence as per the DSM-IV TR were assessed with a semistructured questionnaire for substance history and relapse related factors. Drug Avoidance and Self-efficacy Scale (DASES), Brief Substance Craving Scale (BSCS), Affect Balance Scale (ABS) and Family Emotional Involvement and Criticism Scale (FEICS) were used.
Results: Mood state was the most commonly cited reason for relapse. A short duration of abstinence prior to current relapse was associated with single status, nuclear family, poor self-efficacy, greater perceived criticism and a short total indoor stay. Frequent relapses were associated frequent hospitalizations, family history of substance use disorders, craving, positive affective state and family emotional involvement.
Conclusion: Relapse is a multifactorial phenomenon.Improving the self-efficacy and affect during abstinence will help in reducing relapse.
A study of brief psychosocial intervention in key relatives of schizophrenics
Rajneesh Kumar, Anil Nischal, J.K. Trivedi, P.K. Dalal, P.K. Sinha
C.S.M. Medical University, Uttar Pradesh, Lucknow, India
Aims and Objectives: This study aimed to assess the efficacy of a brief psychosocial intervention in key relatives of schizophrenics on the burden of care and quality of life of key relatives and it's effect on psychopathology and quality of life of their patients.
Methodology: Sixty six patients of schizophrenia diagnosed on ICD-10 and their key relatives were included in the study. The patients were assessed on positive and negative syndrome scale (PANSS) and quality of life scale (WHOQOL-BREF) and the key relatives were assessed on burden assessment schedule (BAS) and quality of life scale (WHOQOL-100). Thirty three patients and their key relatives were allocated to each intervention and control group.
Results: There was statistically significant reductions in bas scores and improvement in QOL scores of key relatives in favor of intervention group. Statistically significant improvement in QOL scores of patients was observed in favor of intervention group but reduction in PANSS scores revealed no statistically significant difference between the two groups.
Conclusion: A brief psychosocial intervention in key relatives of schizophrenics significantly reduces the burden of care enhances quality of life of key relatives. This intervention also improves the quality of life of patients but has no significant effect on psychopathology of the patients of schizophrenia.
Pallavi A. Joshi
JNMC, Wardha, Maharashtra, India
Backround: Creutzfeldt-Jakob disease is a rapidly progressive spongiform neuro-degenerative disorder caused by prion proteins. The case rate is approximately 1 per million with an average age of onset of 60.7 years. The latency period can last years, but time from onset of symptoms to death is typically less than an year. 85% percent of cases are sporadic, while direct infectious transmission and familial mutations account for the remaining cases. Commonly presenting as a rapidly progressive dementia and myoclonus. Behavioral changes seen in 30-55% of cases. Initial presentation as depression is unusual .we present this case to share one of such rare presentation of this rare disorder.
Case description: Sixty five years old male patient, married, businessman came to our opd with history of sadness of mood, decreased sleep and appetite, decreased concentration, lethargy and easy fatigability since 15-20 days after the stressors of major loss in the business and was facing major health problems of wife also. Patient had no major medical or surgical history in the past. The diagnosis of major depressive disorder was kept and patient was started on t. Sertraline 50 mg NS on out patient basis with weekly follow up. After 7 days there was no improvement in mood and relatives reported him to be more withdrawn and he had forgotten his way to his house 2-3 times. The treatment was continued for one more week. In this week's time, patient was observed to wear his clothes improperly with improper buttoning of shirt and zipping of trousers.
Patient once met with the accident while driving as he put his foot on the accelerator instead of break. On next follow up, he was not cooperative, did not convey mood, affect was restricted, had poverty of speech. Further mental status examination was not possible. In addition he was having myoclonus of upper right limb. We admitted the patient in view of rapidly progressive cognitive decline & myoclonus. His eeg showed spike and wave complexes once every 1 to 1.5 seconds. Total protein in cerebrospinal fluid study was found to be raised. Magnetic resonance imaging brain showed signal hyperintensity in the caudate nucleus and putamen on diffusion-weighted and flair, suggestive of cortical variant of Creutzfeldt-Jakob disease or Creutzfeldt-Jakob disease (CJD) the diagnosis of sporadic CJD was confirmed.
Conclusion: This case emphasizes the need to consider organic encephalopathy or CJD in the differential diagnosis of an elderly patient with new onset depression particularly if cognitive function quickly declines and psychiatric symptoms fail to respond to therapy.
Vocational rehabilitation in schizophrenia
Dharmendra Singh, Parmanand Kulhara, Arvind Kumar Jain
PGIMER, Chandigarh, India
Introduction: A case of an adult presenting with difficult to treat chronic paranoid schizophrenia was treated with pharmacotherapy intensively but his further course, outcome and rehabilitation after discharge is significantly influenced by residual symptoms (cognitive, negative, positive and depressive), social, cultural and economic conditions leading to non compliance with pharmacotherapy, continuing critical comments from family members resulting in no gainful employment, irregular follow up and relapse; was finally put on a rehabilitation programme with limited resources of developing society resulting in respite to family, gainful employement and better quality of life inspite of residual symptoms and deficits arising out of these.
Materials and Methods: A 46-year-old separated literate male from urban background was hospitalized with difficult to treat chronic paranoid schizophrenia with severe dysfunction and suicidal ideations. In addition to residual psychotic symptoms poor family environment and lack of psychosocial support was leading to poor quality of life. A plan for rehabilitation was successfully executed with limited community sources.
Results and Discussion: Index case highlights the very basic real life problem of chronic difficult to treat schizophrenics, with no community and state support in a developing country like ours where if the primary source of support i.e. Family is weak (due to change in family structure, poverty and due to burden of disease itself in an otherwise apparently stable family); this can be a graveyard for both family and patient. So, for comprehensive management of the disorder with deep rooted inadvertent psychosocial implications state sponsored community based rehabilitation measures form equally important alternative inspite of best available medical treatments.
Successful use of risperidone in a woman with hypersexual behaviour
Kedar Tilwe, Divya Pal, Manpreet Virk, Pratibha Rao, S. Kale
Ranchi X-ray Clinic, Ranchi, Jharkhand, India
Sexual disorders have oft been neglected in psychiatry, especially those pertaining to females. Hypersexual behavior has been documented in females, although as a rare entity. We present an interesting case of a 35 year old female with hypersexual behavior resulting in a dyadic crisis and marital disharmony. The patient and her spouse had consulted in our department for increased sexual urges leading to perilous high risk behavior and consequent marital discord. A detailed history with emphasis on sexual history was noted. Mental status examination revealed no affective, obsessive or psychotic pathology. The presence of physical and gynaecological disorders was ruled out. After an initial unsuccessful trial of Benzodiazepines the patient was treated with Tab. Risperidone 1 mg. Over 3 weeks the patient showed response; reporting decreased sexual urges. Cessation of medications by the patient led to an exacerbation. Reinstatement of treatment with Tab. Risperidone 2 mg resulted in symptom resolution and improvement in marital.
Conclusion: Benzodiazepines and Tramadol have been used in Persistent Genital Arousal Syndrome. However, the use of Risperidone to treat female hypersexuality has not been reported so far and this finding merits further research.
An unusual case of lithium induced reversible renal damage
Divya Pal, Kedar Tilwe, Manpreet Virk, Pratibha Bezwada, Martin, S. Kale
Ranchi X-ray Clinic, Ranchi, Jharkhand, India
Introduction/Materials and Methods: Even though lithium has been implicated in both functional and structural changes in the kidney, the reversibility of these changes has always been questionable. We report an interesting case of a 45 year old male patient diagnosed as bipolar affective disorder being treated with Tab. Lithium who presented with renal impairment. The patient was on Tab. Lithium 1200 mg/day since 8 years. He presented to us with the chief complaints of hallucination, imbalance, agitation, slurred speech and swelling over the both lower limbs. Investigations revealed raised Serum Lithium levels. Renal function tests showed raised levels of urea and creatinine. A urine analysis further showed abnormalities in protein and renal function tests. A kidney biopsy was done and it revealed mesangio proliferative glomerulonephritis. Tab. Lithium was stopped and the patient was shifted to Tab. Valproate. A regular monitoring was kept on parameters which gradually improved over the period of time. Regular monthly monitoring of his renal parameters showed improvement and over months the investigations of renal function reverted to normal.
Conclusion: (1) Lithium induced renal damage could be reversible. (2) Regular monitoring of renal function along with the serum Lithium levels is recommended to detect renal impairment in its nascent stage so that preventive and remedial measures can be initiated at the earliest.
Carbamazepine induced hyperammonemia and asterixis a case report and review of literature
Hemendra Singh, Girish N. Babu, Senthil Redi, Prabha S. Chandra
NIMHANS, Bangalore, India
Hyperammonemia with asterixis is not a common side effect reported with Carbamazepine. We report a case of carbamazepine induced hyperammonemia with asterixis and review the available literature. 30 years old lady with bipolar disorder developed jerks in both upper limb with asterixis and impaired sensorium within 2 week of therapeutic dose of carbamazepine. Patient's liver function test, complete haemogram, serum electrolytes, CT-brain, ECG, VDRL, HIV, urine for abnormal metabolites were found to be within normal limits. Patient's serum ammonia level was found to be high 119U mol/L (reference value : 11-35 Umol/L). Hence carbamazepine has been tapered and stopped (600 mg to zero). Patient's serum ammonia level has been reduced to 47 Umol/L (upper normal limit) after stoppage of carbamazepine. Her jerks in upper limbs with asterixis has been reduced and patient regained her sensorium. Patient was not having any comorbid hepatic dysfunction or any other medication known to cause hyperammonemia. We will review the literature of carbamazepine induced hyperammonemia.
Biological correlates of mental disorders psychiatric symptomatology, scholastics and phenytoin: A case report
Achyut Kumar Pandey, Sanjay Gupta
UP RIMS & R, Etawah
Aims and Objectives: Phenytoin is a commonly used antiepileptic medication because of its easy accessibility as well as affordability. However, scientific literature shows various types of Neuropsychiatric adverse effects of phenytoin. Previous researches have suggested that phenytoin might be more deleterious to function in higher cognitive tasks than carbamazepine or sodium valproate. We report a case illustrating how the hazardous cognitive effects of chronic phenytoin administration (in the form of scholastic deterioration) transformed into mood and behavioural changes and even suicidality.
Methodology: The patient's detailed history was taken and then physical examination and mental state examination was done. Apart from routine urine and blood investigations his serum phenytoin and serum folic acid was also done. In follow up, his physical examination, mental state examination and serum phenytoin were repeated.
Results: The patient's serum phenytoin was quite high and the patient was showing toxicity symptoms in the form of mood, behavior and cognitive symptoms. The symptoms were attributable to phenytoin toxicity which responded by reducing the dose of phenytoin (also serum phenytoin) and the addition of folic acid within twelve weeks. While the mood and behavior symptoms recovered early, the cognitive symptoms responded slowly.
Conclusions: We propose that the patients on long term phenytoin therapy should be rule out for the possibility of build-up which could have harmful cognitive effects and could impair person's functioning both occupational and scholastic performance especially in children which, if undetected, may lead to further harmful psychological sequelae like depression and hopelessness and even suicide. So we recommend that the estimation of serum phenytoin concentration and serum folic acid level is invaluable in cases of chronic phenytoin use.
A case of dementia due to hypoglycemia
Col. N.L. Dinker
Military Hospital, Ahmedabad, Gujarat, India
A 52 years old patient was admitted on 20 December 2007 as he was unable to perform his official duties properly (signed at the places other than the signature block, committed many mistakes in official correspondences), becoming irritable when corrected and social withdrawal. His daughter gave history of (1) Chronic Calcific Pancreatitis (OPTD) with secondary Diabetes Mellitus since 1998 (2) Hypoglycemic Encephalopathy in August 2007 due to over dosages of Injection Insulin Mixtard (30/70). The review in October 2007, revealed memory impairment, avoidance of tasks requiring mental effort, detachment from surroundings. Physical examination revealed raised BP (150-170/80-100 mm of Hg) and constructional apraxia. Mental status examination revealed him passively co-operative, irritable, suspicious, inattentive, guarded, increased reaction time, psychomotor retardation, slurred, slow, monotonous but relevant and coherent speech, flat/apathetic affect, emotional lability, impoverished but goal directed thinking, impaired abstract thinking, distractibility, impaired recent and remote memory, disorientation to time, clear sensorium, impaired intelligence (acalculia, impaired associative functioning and Mini Mental State Examination (MMSE) score 15-20, lack of insight and impaired judgment. The relevant investigations revealed raised blood sugar levels (F-100 mg/ dl and PP-254 mg/dl on 12 January 2008 and F-204 mg/dl and PP-420mg/dl on 22 January 2008), curvilinear calcification in arch of aorta on X-Ray chest PA view, portal cavernoma and splenomegaly on USG abdomen, central pontine mylinolysis and mild cerebral atrophy on MRI Brain, hypometabolic regions in left frontal and right occipital lobe on SPECT brain and moderate impairment in executive functions, memory and visuo-spatial functions on psychometry (WCST and PGI battery of brain dysfunction). He was managed for Dementia (due to hypoglycemia) with Tab Donepezil (5 mg) 1-0-1, Tab Risperidone (1 mg) 1 HS, Tab Atorvastatin (10 mg) 1 HS, Tab Enalapril (5 mg) 1 OD, Tab Disprin ½ OD PC, Injection Insulin Mixtard (30/70) 14-14-12 units, 1800 Kcal Diabetic diet. His memory impairment deteriorated further and became bed ridden. His hygiene and personal care for daily basic needs had to be looked after by staff and his family members.
Aim of presentation: To highlight the fact that timely management of a correctible illness like diabetes can prevent the development of serious organic mental disorder and course and prognosis of both primary and secondary illnesses.
Comorbid anorexia nervosa and schizophrenia in a male patient
Anurag Jhanjee, Pankaj Kumar, M.S. Bhatia, Deepika Verma 1 , Shruti Srivastava
UCMS Delhi, 1 MBBS, Navodya Medical College, Raichur, Karnataka, India
Anorexia nervosa is a rare psychiatric disorder and epidemiological studies have shown a female to male ratio of 10 : 1, suggesting it is a disorder predominantly seen among females. The prevalence of anorexia nervosa comorbid with other psychiatric disorders has been reported to be quite high. Whereas depression and anxiety disorders are the most common comorbid diagnoses in anorexic patients, the dual-diagnosis of anorexia and schizophrenia is a relatively rare condition. Based generally on the observations from single case reports or case series, several explanations have been made about the co-occurrence of anorexia and schizophrenia. Herein, we present a male patient who developed schizophrenia after an anorexic period of 4 years that began when he was 14 years old with the decision to lose weight, which then progressed to a pattern of disordered eating and body image. This case is rare because the patient is male and has a comorbid diagnosis of anorexia nervosa and schizophrenia. To the best of our knowledge, there is only one previous case report in the literature describing a male anorexic patient with comorbid schizophrenia. The details of the case will be presented during poster presentation at ANCIPS, 2011.
Metformin in treatment of antipsychotic related metabolic complications: A retrospective chart review
Rishikesh V. Behere, Gayatri Saraf, Naren P. Rao, Ganesan Venkatasubramanian, Shivarama Varambally, P.T. Sivakumar, B.N. Gangadhar
NIMHANS, Bangalore, India
Aims and Objectives: Metabolic side effects due to atypical antipsychotics in people with schizophrenia, have long been the matter of considerable concern and debate. These side effects which include weight gain, dyslipidemia, metabolic syndrome and impaired glucose can sometimes be so troublesome that one begins to question whether the treatment is worse than the disease. Interventions for the same are less known and lesser studied and practiced. Metformin has been shown in some studies to have a positive impact on reversing some side effects, however the existing literature is sparse and studies from India are lacking. Considering this void, we did a retrospective chart review of patients attending the metabolic clinic in psychiatry at NIMHANS, Bangalore and have been on treatment with metformin for antipsychotic related metabolic adverse effects.
Methodology: A retrospective chart review was performed from medical records of patients attending metabolic clinic in psychiatry at NIMHANS, Bangalore and have been on treatment with metformin and life style modifications for antipsychotic related metabolic adverse effects. Baseline and follow up parameters of weight, Body Mass Index (BMI) and waist circumference were compared using paired samples 't' test.
Results: Data from 25 patients was analyzed who were on mean metformin dose of 1128.6±317.6 mg/day for a mean duration of 15.6±10.4 months. There was a significant improvement in all 3 parameters of weight, BMI and waist circumference (P<0.01) observed on follow up.
Conclusion: Metformin with life style modifications can be a useful intervention for antipsychotic related metabolic complications.
A study on neuro-cognitive function in recovered patients of acute psychosis
Sujit Kumar Kar, J.K. Trivedi, P.K. Dalal, P.K.Sinha, Maya Bajpai
CSMMU, Lucknow, Uttar Pradesh, India
Background: Acute psychosis is one of the common psychotic illnesses described as "acute and transient psychotic disorder" in ICD-10 and "brief psychotic disorder" in DSM-IV-TR. Onset is usually abrupt to acute and the illness subsides between 1 to 3 months. Complete recovery usually occurs. Cognition is expected to return to premorbid level with recovery.
Aim of the study: To study the neuro-cognitive function of patients of acute psychosis after complete recovery.
Materials and Methods: A total of 180 patients initially diagnosed to be suffering from acute psychosis as per the criteria of ICD-10-DCR, 1993 were screened and kept in follow up for 3 months. Cognitive assessment of 20 patients satisfying selection criteria were done on WCST, CPT and SWM after full recovery from acute psychosis and compared with healthy controls.
Result: There was significant improvement in performance in Wisconsin Card Sorting Test, Continuous Performance Test, and Spatial Working Memory test following recovery from acute psychosis. Cognitive parameters of the patient group were compared with that of healthy controls and there was no statistically difference between the two groups.
Conclusion: With complete recovery from acute psychosis, there occurs improvement in cognitive functions almost to the premorbid level. Executive functions, working memory, attention and concentration return back to normal level.
A case report on ADHD with multiple co-morbidities
Sujit Kumar Kar, Sameer Belvi Mangalwedhe, Bhupendra Singh, Vivek Agarwal
C.S.M.M.U, Lucknow, Uttar Pradesh, India
Introduction: Attention deficit/hyperactivity disorder is one of the commonly encountered psychiatric disorders in children. It is associated with significant impairment in functioning. Many co-morbid psychiatric disorders are found with attention deficit/hyperactivity disorder. Various studies indicate it to be between 60% to 80%. Presence of co-morbidities adds to the management problems.
Case history: A 15 year old male was hospitalised with chief complaints of stubbornness and un-socialised behaviour, disturbed sleep for 10 years, hyperactivity and inattention for 8 years and repetitive behaviour for 4 years. Assessment on k-SADS revealed criteria for ADHD-CT, oppositional defiant disorder, conduct disorder, and obsessive compulsive disorder. IQ assessment revealed a functional IQ of 75 (low average intelligence). Patient's father was having anankastic triats. Patient's investigations were within normal limits. After complete assessment a final diagnosis of attention deficit/hyperactivity disorder-combined type with conduct disorder with obsessive complusive disorder as per DSM IV-TR with low average intelligence was made. There were many difficulties in the management of the patient. He was treated with methyl-phenidate, SSRI (Sertraline) and antipsychotic (Risperidone). Non-pharmacological management (behaviour therapy) was also employed. The patient was hospitalised for 6 weeks, he was discharged with significant improvement. The details of clinical presentation and management issues were discussed in the case report.
Factors associated with wellbeing in spouses of chronic schizophrenic patients
Sudhir Kumar, Sandhyarani Mohanty
Institute of Mental Health and Hospital, Agra, Uttar Pradesh, India
In married schizophrenics, mostly spouses function as primary caregivers. The studies on spousal burden revealed a very high level of burden in the spouses of chronic schizophrenic patients. The basis of family reaction to their relative's schizophrenia-associated symptoms often rooted in how the family interpret these symptoms. Families often attribute these negative symptoms to their ill relative's personality and perceived character flaws, unaware that these negative symptoms are characteristic symptoms of schizophrenia. Additionally, parents, spouses, and siblings are often unable to deal with their own individual or family developmental needs because the focus is so often on the relative with schizophrenia and sequelae of the illness which compromises wellbeing of the family members. This study specifically explored demographic and clinical factors associated with wellbeing in spouses of chronic schizophrenic patients. The sample consisted of 82 spouses of chronic schizophrenic patients drawn from Institute of Mental Health and Hospital, Agra. The information such as age, gender, education, domicile, duration of illness etc. were recorded on a specifically designed proforma. Indian Disability Evaluation and Assessment Scale (IDEAS) was also administered to quantify the extent of disability. Detailed results will be presented.
Contribution of paid work assignments in work behaviour of hospitalized chronic schizophrenic patients
Sudhir Kumar, Sanjay Kumar, Sandhyarani Mohanty
Institute of Mental Health and Hospital, Agra, Uttar Pradesh, India
Background: Work activity not only provides financial support to patients but it also brings normalizing experience and allowing them to participate in society. Paid Work has been found to be very important and potential treatment component in management of patients with schizophrenia. Last few decades, work rehabilitation has assumed increasing importance as part of the array of services available for patients with schizophrenia.
Aims and Objectives: Main aim of study was to study Contribution of Paid Work Assignments in Work Behaviour of Hospitalized Chronic Schizophrenic Patients.
Materials and Methods: 100 schizophrenic patients were allocated to two groups : (a) Paid group=50, (b) Not-paid group=50 recruited form inpatient population of Institute of Mental Health and Hospital Agra, as per ICD-10 (DCR) criteria. The patients were engaged in paid work for a period of two months. Work Behavior Inventory was administered on the patients on baseline and four subsequent occasions.
Activity levels and cognitive functioning in an elderly community sample
Sudhir Kumar, S. Mohanty
Institute of Mental Health and Hospital, Agra, Uttar Pradesh, India
There is a widespread belief, particularly among elderly people, that activity prevents cognitive decline in old age and protects against the onset of dementia. This view is reflected in the philosophy that mental activity is crucial in preventing cognitive impairment. The importance of an active l.
A comparative study of cognitive insight in schizophrenia
Sudhir Kumar, O.P. Gangil, S. Mohanty
Institute of Mental Health and Hospital, Agra, Uttar Pradesh, India
Beck Cognitive Insight Scale (BCIS) has been designed for assessment of self-reflection on patients' anomalous experiences and interpretations of own beliefs. The scale has been developed and validated for patients with schizophrenia. An increasing number of studies have used the Beck Cognitive Insight Scale to understand the reasoning of individuals with psychotic disorders. Less is known, however, about "normal" levels of insight and how non-psychiatric individuals compare to those with psychosis. In this study, we compared the cognitive insight in two groups of schizophrenia based on Global Assessment of Functioning Scale (GAF) scores with the level of cognitive insight in family members of schizophrenic patients. 60 persons with schizophrenia were allocated to two groups (a) Group-A : with GAF Scores of 70 or above (n=30); (b) Group-B : with GAF scores of 30 or less (n=30) and a Control Group (n=30). Beck Cognitive Insight Scale was individually administered on each participant. In addition to Beck Cognitive Insight Scale; Scale for Unawareness of Mental Disorder (SUMD) was also administered to patient groups for exploration of association between BCIS and SUMD.
Raheel Mushtaq, Chinmay Barhale, Shriniwas Gupta,
Nilesh Naphade, M.S.V.K. Raju
Bharati Hospital, Pune, Maharashtra, India
A 34 year old male, brought for psychiatric consultation for talking excessively, suspiciousness, difficulty in finding his way and total neglect of work of 6 months duration. 15 years ago, he had generalised tonic clonic seizures which continued to occur 2-3 times in a year inspite of regular antiepileptic treatment. However, he could clear his 12 th standard in first attempt and experienced no difficulty at work till 6 months ago. Neuropsychiatric evaluation revealed that he was fully conscious and had no motor/sensory deficit. He had choreoform movements of both upper limbs, verbal perseveration, constructional apraxia, mild dysarthria and ideational apraxia and chorea, delusion of control and persecution, arguing voices, formication and gross functional impairment. Only a few cases of Fahr's disease are reported from this country. Findings of comprehensive neuro-psychiatric evaluation have not been reported so far. He would ask questions to be repeated frequently. His new learning was grossly impaired. MMSE was 18. He displayed poverty of thought along with delusions of persecution and delusion of control. He heard voices continuously talking about him in derogatory terms. He also felt ants crawling over his back and lower limbs. He did not appear concerned about all these abnormal experiences. Routine blood and biochemical parameters were within normal limits. Serum calcium, serum phosphate, parathormone levels were normal. Binet Kamat test IQ - 34, Bender Gestalt Test revised- 34 percentile. CT scan head revealed bilateral basal ganglia calcification. However, CT scan head of both parents were normal. He was treated with olanzapine 10mg per day and carbamazepine 600 mg per day. Psychotic symptoms and seizures abated within two weeks. Followed up regularly. At the end of three months, he continued to remain withdrawn and neglecting work. His cognitive status continued to remain significantly impaired. A case of FAHR's disease presented with generalised tonic-clonic seizures, intellectual decline, impaired new learning, constructional lifestyle has also received support within the scientific community. The present study investigated the role of activity on cognitive performance in a small community sample of elderly subjects. The primary aim was to determine whether differences in cognitive performance could be accounted for by activity. Instrumental Activities of Daily Living Scale (Lawton and Brody, 1969) was administered on a community sample of 100 elderly persons of 65 years and above to assess current level of functioning in various domains of activities of daily living. For assessment of Cognitive Functions following three subtests - Set Test; Standard Ten Tests; and Nahor and Benson Scale; of PGI Battery of Mental Efficiency (Kohili et al. 1996) were administered. The sample was split into two groups based upon the median score on Instrumental Activities of Daily Living Scale. The comparisons through independent sample t-test revealed significant group differences. The better cognitive functions were present in the group having higher scores than the median; which suggest that the activity level may be a significant protective factor against cognitive decline.
Traumatic experience, feverish preoccupation and subsequent antibiotic dependence - A case report
Senjam Gojendra Singh, N. Heramani Singh, R.K. Lenin Singh, T.H. Bihari Singh, K. Romeo Singh, L. Nelson
Regional Institute of Medical Sciences (RIMS),Manipur, India
The case report describes the relationship between stress and subsequent development of Obsessive Compulsive Disorder (OCD) and dependence to antibiotics. The patient is a 39 yrs old widow who suffered a major depressive disorder and later typhoid fever after her husband's death. Following the treatment of fever, the obsessive thoughts of feverish feeling without subsequent rise of temperature emerged. She continued taking repeatedly higher strengths of newer groups of injectable antibiotics to reduce her obsessive thoughts and anxiety for past 4 yrs. Later, she fulfilled the ICD-10 diagnostic criteria of dependence.
Short term course and outcome of women presenting with postpartum psychosis
Sugnyani Devi, Malvika Ravi, Kaushik G., Girish Babu N., Geetha Desai, Harish T., Prabha S. Chandra
NIMHANS, Bangalore, India
Background: Puerperal psychosis occurs majorly within 2 weeks after delivery. The illness may affect not only the mother, but also the infant and disrupt the mother - infant bonding. Prospective studies on women with severe mental illness have shown higher incidence of infanticidal ideation (Chandra et al., 2002). While treatment response may be favourable as far as clinical symptoms are considered, the impairment of maternal-infant bond may persist in the form of bonding disorders. A persistently impaired mother- infant bond might also be a more sensitive indicator of residual illness.
Aim: To evaluate the short term course and outcome of women presenting with postpartum psychosis and to assess the mother-infant interaction and bonding.
Methodology: Fifty five post-partum women diagnosed to have post-partum psychosis consecutively attending the weekly perinatal clinic at National Institute of Mental Health and Neurosciences, from 2006 to 2010 were prospectively followed up over 6 months to 1 year. Relevant sociodemographic and clinical variables including obstetrics variables, treatment, Brief psychiatric rating scale (BPRS) scores, as well as Global assessment of functioning (GAF) scores, as also Post -Partum Bonding Instrument and scores from a scale prepared to objectively rate emotional care, instrumental care and safety issues in post-partum women were collected and analyzed.
Results: Mean age of the women was 24 and 12 (23%) women had onset of episode within 1 month of post partum.
• 16 (51%) women had a BPRS score of 24, and 18 (54%) women had GAF score of above 70% during the last visit. • Mother infant bonding will be analysed during the final presentation. Further results and conclusions will be presented in the final presentation.
Add on topiramate for antipsychotic induced weight gain
Naren Rao, Venkatasubramanian G., Sridhar S, Behere R.V., Varambally S., Gangadhar B.N.
NIMHANS , Bangalore, India
Background: Weight gain and consequent metabolic and cardiovascular complications is a major concern with long term use of second-generation antipsychotic. SGAs are associated with obesity, hyperglycemia, and insulin resistance, all of which may contribute to diabetes and cardiovascular disease. Often, dietary and lifestyle changes may not be feasible or sufficient in decreasing this weight gain. Topiramate, an anticonvulsant drug is associated with reduction in appetite and weight loss through its action on Central Nervous System. Topiramate acts as antagonist at AMPA/kainite subtype of the glutamate receptor and has mood stabilizing property. A few studies have examined the effect of topiramate add on treatment for antipsychotic induced weight gain and reported positive findings, but expressed concerns about worsening of schizophrenia. However, reports from Indian subcontinent are sparse. Thus, we aimed to study the effect of add on Topiramate for treatment of antipsychotic induced weight gain.
Methodology: We examined the charts of all patients registered in specialty metabolic clinic in the past 12 months. Those in whom topiramate was initiated as add on treatment for antipsychotic induced weight gain were included in the study.
Results: Eight patients were on treatment with add on topiramate (four each with Schizophrenia and Bipolar Affective Disorder). Patients had a mean weight loss of 1. 35 kg over eight weeks. Importantly, no patient had worsening of psychosis or other serious side effects. There was no change in Clinical Global Impression - Severity.
Conclusion: In conclusion, our study indicates that Topiramate is a useful add on treatment option for antipsychotic induced weight gain.
Prescription pattern in stable bipolar patients
Mansi Somaiya, Sandeep Grover, Subho Chakrabarti, Alakananda Dutt, Munish Aggarwal, Ajit Avasthi, Parmanand Kulhara
PGIMER, Chandigarh, India
Background: Bipolar disorder is a severe mental disorder, in which psycho-pharmacological agents play an important role in management. There is lack of data from India, with respect to the prescription patterns in bipolar disorder patients.
Aim of the study: To study the prescription patterns in stable bipolar disorder patients.
Methodology: Prescription pattern of 203 bipolar patients attending the psychiatry outpatient was prospectively collected.
Results: About two third of the patients were male, married, Hindu by religion and from urban families. About half of them belonged to nuclear families and were employed. Most commonly prescribed psychotropic agent was lithium (N=100), followed by olanzapine (n=70), valproate (n=67), risperidone (N=30) and carbamazepine and other mood stabilizers (N=20). About one-fifth were receiving antidepressants (n=39) and non-psychotropic medications (n=40). About one-third of the subjects were receiving only 1 psychotropic agent and two-third were receiving 2 or more psychotropic agents. One fourth (N=51) of patients were receiving lithium and an antipsychotic agent and 35 patients received sodium valproate and an antipsychotic agent. 6 patients received combination of lithium and sodium valproate and all of them also received an antipsychotic agent in addition to 2 mood stabilizers.
Conclusion: A large number of the bipolar subjects receive more than one psychotropic agent.
The relationship between autism and parenting stress
Kumar Gaurav, Mili Jaswal
Lady Hardinge Medical College, New Delhi, India
Objective: To assess the level of parenting stress and associated factors of stress in parents having autistic children.
Materials and Methods: The sample included 80parents (40 fathers, 40 mothers) of 40 children with diagnosis of autism. Stress in parents was measured through parental stress scale (PSS). Parents respondents for children reported their recent feelings about their life sacrifices to care for their child, difficulty caring for their child, frustration with their child's actions, and anger toward their child. Responses were compiled in the Parental stress Scale.
Results: PSS score of fathers was 45.55±8.12 and mothers 52.23±8.40 (P 0.01). Score for parents of children 4-9 years age was 52.23±6.88 and for parents of children 10-18 years age 46.23±11.16 (P 0.01). Score for parents of boys was 45.32 ± 7.40 and for parents of girls 49.44±8.29 (P 0.01).
Conclusion: There was significant stress in parents of autistic children. Mothers experienced more stress than fathers. The level of stress was different in parents with the increasing age of the children. The implication is that mothers of children with autism are more prone to experience stress, thus requiring special attention from mental health professionals.
Catatonic schizophrenia presenting as catatonic stupor with good response to maintenance ECT: A case report
Malvika Ravi,. Girish N. Babu, Prabha S. Chandra
NIMHANS, Bangalore, India
Background: Periodic catatonia is an illness characterized by repeated catatonic phases with remissions to an interval state. We report a case of catatonic schizophrenia presenting as catatonic stupor with good response to maintenance ECT.
Case Report: 30 years old female presented with recurrent episodes of catatonia with catatonic stupor over 10 years, around 20 in number. Initial episodes were marked by intervening periods of mutism, posturing for upto 1 year at a time. Patient was investigated for organic origin of illness, hypothyroidism was detected in interval; patient did not continue treatment for the same.
Treatment: All episodes responded poorly for oral medications, including anti-depressants, anti-psychotics, lorazepam, thyroxine supplements, while acute episodes responded to ECTs, though there was incomplete recovery. Maintenance ECT was considered and monthly ECTs were given. With maintenance ECTs, patient's episodes of catatonic stupor improved rapidly, with improved inter-episodic functioning, improvement with smaller number of ECTs and there was reduced number of episodes.
Myths, beliefs and perceptions about mental disorders and health seeking behavior among mentally ill and normal population in Delhi
Jugal Kishore, R.C. Jiloha, G.K. Ingle, Avni Gupta,
Department of Community Medicine, Mualana Azad Medical College,
New Delhi, India
Aims and Objectives: To compare the perceptions, myths and beliefs about mental disorders and health seeking behavior among mentally ill and normal population in Delhi.
Methodology: A cross sectional comparative study was carried out with a sample of 198 mentally ill from OPD of tertiary care hospital and 180 normal subjects each from urban and rural communities of Delhi. A validated questionnaire was used to collect the information on various myths and misconceptions and their health seeking behavior. Statistically analysis was carried out using computer software package Epi-info. Difference in two proportions was accepted significant if error was less than 5% using chi-square.
Results: Mentally ill subjects were significantly more in numbers than normal subjects (67.9% vs 37.7%) who were against the marriage of their close one with subject who had recovered from mental illness. As compared to mentally ill subjects, significantly more normal subjects believed that mental illness was due to socioeconomic status, imbalance of neurotransmitter and air pollution. They felt less comfortable with mentally ill subject while talking. Significantly more mentally ill subjects considered mental illness is due to punishment of past sin, however, they had less adverse attitude towards psychiatry and psychiatrist than normal subjects and preferred to go to a psychiatrist in case of panic attack and uncontrolled behavior. Significantly, more number of normal subjects had myths and considered importance of religious leaders in their important works.
Conclusion: This study concluded that the myths and misconceptions are prevalent significantly more in general population than mentally ill subjects. This indicates that the interaction with psychiatrists removed many misconceptions among patients and such interactions through public awareness programs need to be further strengthened to change their attitude toward mental disorders so that health seeking behavior can be improved.
Escitalopram induced myoclonus: A case report
Girish Babu N., Senthil Reddi, Prabha S. Chandra
National Institute of Mental Health and Neurosciences, #2, 1 Cross, Someshwara Nagar, Jayanagar 1 Block, Bangalore, India
Background: Myoclonic jerks occurring independent of serotonine syndrome has been reported with use of sertraline. We report a case of Escitalopram induced myoclonus. Case report : Mrs X 45 female presented with symptoms of sadness, crying spells, anhedonia for 3 months. Patient was started on Escitalopram 5 mg increased to 15 mg, following which patient developed myoclonus involving upper limbs. CT scan brain and EEG were normal. Patient was started with clonazepam and Escitalopram was cross tapered with mirtazapine. Myoclonus subsided and did not relapse with discontinuation of clonazepam.
Magico-religious beliefs of patients with schizophrenia
Natasha Kate, Parmanand Kulhara, Sandeep Grover, Ritu Nehra
PGIMER, Chandigarh, India
Background: Culture influences the manifestations, treatment seeking and treatment adherence in subjects with mental disorders. The influence of culture on mental disorders can be evaluated as "magico-religious beliefs" held by persons in a particular culture with respect to causation and manifestations of mental disorders.
Aim and Objective: To study the "magico-religious beliefs" held by subjects with schizophrenia with respect to causation and management of mental disorders.
Methodology: For the study a self rated questionnaire was developed in Hindi. Patients with schizophrenia were approached for the consent.
Results: Seventy three patients returned the completed proforma. The mean age of the patients was 31.65 years and that of caregivers was 47.15 years. Most of the patients belonged to Hindu religion (79.5%) and came from rural (58.9%) non-nuclear families (58.9%). The mean duration of illness at the time of assessment was 6.80 years and mean duration of medical treatment was 5.67 years. The mean Global Assessment of Functioning Scale (GAF) score for the study sample was 49.41, indicating that subjects had fair level of residual psychopathology. About 60% of the patients admitted that people in their culture believe in sorcery and other magico-religious beliefs. About one fourth to half of the patients believed in ghosts/evil spirit (26%) and spirit intrusion (28.8%) and sorcery (46.6%). With respect to etiology, two-third of the subjects with schizophrenia believed that mental illness can occur either due to sorcery, ghosts/evil spirit, spirit intrusion, wrath of divine powers, planetary/astrological influences, dissatisfied or evil spirits and bad deeds of the past. About 40% of the subjects attributed mental disorders to more than one of these causes. About half of the patients (46.6%) believed that only performance of religious rituals was sufficient to improve their mental status. Only very few patients (9.6%) believed that magico-religious rituals were sufficient to improve their mental status but about one fourth (24.7%) admitted that during the recent episode either they or their caregivers performed magico-religious rituals in the hope of improvement in their mental status. About two-third (63%) also admitted that religious rituals were performed during the most recent episode.
Conclusions: Majority of the patients with schizophrenia attribute the symptoms of mental disorders to magico-religious beliefs.
To compare personality characteristics of persons dependent on opiates using multiphasic personality questionnaire
Archana Sharma, V.V. Upmanyu, Anuradha Bhandari,
GMCH, Chandigarh, India
Introduction: Substance misuse is a known phenomenon and relapse is a core issue in the management of patients dependent on opioids.
Aim: In the present study, we compared various personality factors in two groups of patients dependent on opioids i.e. relapsed and abstinent.
Materials and Methods: Patients attending de addiction clinic of Department of Psychiatry, Government Medical College and Hospital, Sector 32- Chandigarh were taken. The sample comprised of 140 male patients with ICD-10 diagnosis of opioid dependence either who had been treated or were under treatment for their substance dependence at least for the last 6 months. Equal number of patients comprised of Relapse and Abstinent Group (n=70 each).Both groups were administered the MPQ in a single, cross-sectional assessment.
Analyses: Appropriate descriptive statistics and t test was applied.
Results: Relapse prone patients with opioid dependence scored higher on all the factors of Multiphasic Personality Questionnaire. Further implications of these findings will be discussed.
Is "Kahlbaum syndrome" disappeared or underdiagnosed? - Reexamining the nosology of catatonia
Narayan R. Mutalik, Naren P. Rao, Vishal Kasal,
Ganesan Venkatasubramanian, Rishikesh V. Behere,
Shivarama Varambally, Bangalore N. Gangadhar
National Institute of Mental Health and Neurosciences, Bangalore, India
Introduction: Kahlbaum described catatonia as a syndrome with characteristic motor and mood symptoms. However, later catatonia was identified with motor features alone and was associated with schizophrenia while a few proposed for "third psychosis". In contemporary classification, the nosological position of catatonia is not clear, which can have significant impact on management. Thus we aimed to study the phenomenology of catatonia and its relation to contemporary psychiatric disorders.
Methodology: We reviewed the charts of patients with catatonia admitted in last two year to Psychiatric Intensive care unit of National Institute of Mental Health and NeuroSciences (NIMHANS), Bangalore for whom Bush-Francis-Catatonia-Rating-Scale was available (N=44) and clinical details were noted.
Results: Mutism is present in 97.7% followed by withdrawal (93.2%), stupor (79.5 %), staring (75%) and posturing (72.7%). Least common were combativeness (0%), verbigeration (2.3%), ECHO phenomenon (2.3%), perseveration (2.3%), waxy flexibility (9.1%). Interestingly, those who did not respond to Lorazepam differed from those who responded in presence of waxy flexibility (P=0.05) i.e. presence of waxy flexibility predicted poorer response. At the time of admission, 23 (29.9%) cases were diagnosed as Catatonia -cause not known, but the proportion decreased to 4 (5.2%) during follow up. 8 (32.5%) were rediagnosed as mood disorder and 6 (22.1%) as acute Psychosis. Only 4 (17%) were rediagnosed as schizophrenia.
Conclusion: Our data suggests that catatonia is a syndrome of varied manifestation and is possibly related to both affective and nonaffective psychosis. A novel finding is the association between presence of waxy flexibility and poorer response to Lorazepam can have potential clinical utility and needs further examination.
Deep brain stimulation in treatment resistent obsessive compulsive disorder
Chandra Shekhar Gupta, Tripathi A., Gupta A., Jha S.K., Sharma P.
VIMHANS, New Delhi, India
Aims and Objectives: To introduce Deep Brain Stimulation (DBS) as a new modality of surgical intervention in treatment resistant Obsessive Compulsive Disorder (OCD). Obsessive-compulsive disorder is a common psychiatric diagnosis, affecting approximately 1-3% of people worldwide, For initial treatment of OCD, the American Psychiatric Association recommends cognitive behavioral therapy (CBT), pharmacotherapy with SSRIs, or a combination of the two. For patients who do not respond to monotherapy, the next step is either switching medications, augmenting with another medications, or adding CBT if not already initiated. Approximately 20-40% of patients have worsening of symptoms despite conventional treatment. Surgery is an option for patients who experience severe and incapacitating symptoms in spite of multiple medication trials and /or medication and CBT. DBS is a surgical treatment involving the implantation of a medical device, which sends electrical impulses to specific parts of the brain. DBS in select brain regions has provided remarkable therapeutic benefits for otherwise treatment-resistant movement and affective disorders such as chronic pain. Parkinson's disease, tremor and dystonia. The Food and Drug Administration (FDA) approved DBS as a treatment for treatment resistant OCD in February 2009.
Methodology: DBS in treatment resistant OCD involve white matter stimulation in the internal capsule. The bilateral electrodes traverse the white matter with the tip in nucleus accumbens.
Result: Stimulation of electrode resulted in dramatic improvement of obsessive-compulsive symptomatology (based on Y-BOCS and GAF scores) in the first patient who underwent DBS treatment at VIMHANS, New Delhi.
Conclusion: DBS is a surgical intervention that does not involve destruction of brain tissue and must be considered prio to other surgical intervention which causes brain destruction. However, the limiting factor could be the cost of treatment.
Amisulpride in atypical depression - A case report (Psychopharmcology, depression)
Naren P. Rao, Agarwal S.M., Venkatasubramanian G,
Behere R.V., Varambally S., Sivakumar P.T., Gangadhar B.N.
NIMHANS, Bangalore, India.
Introduction: Amisulpride has recently been discovered to be a 5-HT7A antagonist and postulated to have antidepressant property independent of the dopamine receptor. The efficacy of Amisulpride has been documented in many forms of mood disorder. Its role in atypical depression, however, had not been reported.
Case Report: Miss P, 23 years of age, presented with one and half year history of sadness of mood, crying spells, academic decline and one suicidal attempt. Personal history of 4 months of amenorrhea due to an ovarian cyst was present. There was family history of alcohol dependence and nicotine dependence, diabetes and suicide. Emotional reactivity, hypersomnia, hyperphagia with carbohydrate craving, multiple bodily aches and anxiety symptoms were seen. She had failed adequate trials of Fluvoxamine, Buproprion and Fluvoxamine and shown short lasting response to ECTs. Her Body Mass Index (BMI) was 28.1 kg/m2. Psychomotor retardation, depressive cognition and suicidal ideation were noticed. All biochemical, hematological and hormonal investigations were normal. She was diagnosed with Atypical Depression-severe deperession without psychotic symptoms. She showed short lasting improvement with Escitalopram, Prothiaden, Chromium Picolinate and Sodium Valproate. She was then put on Amisulpride for the last one and half years and is maintaining improvement.
Discussion: The index patient had failed adequate trials of multiple antidepressants. Her remarkable response to Amisulpride and her maintaining well for a long duration only on low doses of the drug deserves attention. There is a considerable amount of evidence supporting a role for the 5-HT7 receptor in depression 6 . Whether Amisulpride at low dose exerts a selective action on the same, or whether the dopaminergic antagonism has role to play, is not known. The efficacy of Amisulpride in atypical depression and the mechanism behind such action need to be studied systematically.
Pseudoneurotic schizophrenia - A case report
Gopalkumar Rakesh, Krishna Prasad M., Geetha Desai,
Mathew Varghese, Srikaa Bharath
NIMHANS, Bangalore, India
The term Pseudoneurotic schizophrenia was coined in 1940 by Hoch and Polatin to describe individuals who presented with neurotic symptoms prior to onset of psychotic symptoms. It encompassed pan - anxiety, pan - neurosis and chaotic sexuality. In the article published by Hoch and Polatin in 1949 they wrote that in establishing the diagnosis of the pseudoneurotic form of schizophrenia, it will be necessary to demonstrate the presence of the basic mechanisms of schizophrenia. These basic mechanisms differ qualitatively and quantitatively from mechanisms seen in the true psychoneuroses. They also described some of these patients to have micro - psychotic episodes, thought magic and catathymic thinking. Here we report the case of a 23 years old gentleman who presented with some of these features and was finally given the diagnostic rubric of pseudoneurotic schizophrenia after serial mental state examinations. This was correlated with the findings of diagnositc psychometry.
Reexamination of patient's understanding of informed consent after one year
D.M. Dhavale, Swati Kandam
Poona Hospital & Research Centre, Pune, Maharashtra, India
Aims and Objective: Informed Consent, a mainstay of ethical clinical trials, is the process by which potential research subjects (patients) are asked to decide whether to participate in research. Subject's understanding of informed consent was re-examined after 1 year in a clinical trial of 2 years duration, the assumption being majority may not be able to relate important aspects of the trial.
Methodology: The subjects were tested on a 5-point scale which included questions pertaining to the study drug, likely risks etc. after 1 year trial duration was completed.
Results: Out of a total of 12 subjects enrolled for the trial 11 were available for the study after 1 year. After testing on a 5-point scale majority were unable to relate important aspects of the trial.
Conclusion: Informed Consent process and documents need to be better in trials of long duration, it might be advisable to reconsent patients, thus strengthening their understanding of the trial process.
Case report: Ophisthoclomus - A rare sign of lithium
V.G. Watve, D.M. Dhavale,. Sudhir Kothari
Poona Hospital & Research Centre, Pune, Maharashtra, India
A 57 year old female, housewife, living in rural area, was brought with symptoms of delirium and abnormal movements of 3 days duration. She was a known case of Bipolar Disorder of 15 years duration and she was receiving Lithium 800 mg/d, Quetiapine 50 mg/d and Clonazepam 0.5 mg/d. She was admitted to ICU for investigation and treatment. On neurological examination she was found to be exhibiting bilateral nystagmus - Opisthoclonus - a rare sign of Lithium Toxicity. Serum Lithium was found to be 3.78 mmol/L. This paper will discuss opisthoclonus in detail and further progress of this patient, who was treated successfully.
Psychological profile of patients on haemodialysis
Alhad Pawar, D. Bhattacharya, M. Diwakar, S. Chandrasekhar
Base Hospital, Delhi Cantt, New Delh, India
Objective: To assess the psychological profile of haemodialysis patients by studying depression and intelligence in these patients.
Materials and Methods: Thirty patients of End Stage Renal Disease on haemodialysis were studied. The patients were on haemodialysis for atleast six months. Depression was assessed by the Beck Depression Inventory (BDI) and Intelligence by using Weschler Adult Performance Intelligence Scale (Indian version).
Results: Sixty percent of the patients were depressed as assessed by BDI score >17. The average BDI score was 22.03. Cognitive affective BDI score was 15. Cognitive affective symptoms were more common than somatic affective ones. Symptoms such as Punishment feelings, crying, self-criticalness, indecisiveness, past failure and worthlessness were common. Among the somatic symptoms loss energy was a common symptom. Suicidal ideation was not seen in any patient. 22 patients had an average IQ on the WAPIS with 8 patients showing borderline retardation. The BDI score of the patients prior to renal transplant did not correlate with the performance IQ. There was a significant correlation with the picture completion subtest of the WAPIS.
Delirium as a psychiatric co-morbidity in critically ill
Abhinav Kumar, Isha Sharma, Vishal Sinha
S.N. Medical College, Agra, Uttar Pradesh, India
Aims and Objectives: To find out delirium as a psychiatric co-morbidity in patients admitted to other specialties in a tertiary care hospital in north India.
Methodology: Data of all the patients admitted to other specialty due to some medical illness for whom bedside psychiatric referral was sought during an eight months period lasting February to September '10 were analyzed. Patients were segregated on the basis of psychiatric diagnosis based on ICD-10. Proportion of patients receiving the diagnosis of delirium was calculated.
Result: Delirium was the major psychiatric co-morbidity in patients admitted to other specialties for some medical illness. 68% of all the patients with psychiatric co-morbidities were diagnosed as having delirium.
Conclusion: Excited delirium is often misdiagnosed as psychotic illness in patients admitted to other specialties, especially due to its high incidence among hospitalized patients and unawareness of treating physicians with its clinical features. Early diagnosis and proper management of delirium can minimize this therapeutic misadventure.
Expectations of patients and their caregivers seeking psychiatric consultation
Shaily Mina, Arunlata Agarwal, R.C. Jiloha, Sanjay Agrawal
Department of Psychiatry, G.B. Pant Hospital, New Delhi, India
Aims and Objectives: To study the expectations of patients and their caregivers presenting to psychiatry Out Patient Department (OPD) of a tertiary care referral hospital in Delhi.
Materials and Methods: Two hundred new patients and their caregivers consenting to be included in this cross sectional observational study were consecutively recruited from the OPD of Psychiatry at G.B. Pant Hospital (GBPH), a tertiary care referral hospital affiliated to Maulana Azad Medical College, New Delhi. Their help seeking behavior(s) since onset leading up to index consultation at GBPH, including their expectation (explicit and implicit) were elicited and documented on a Semi Structured Proforma. The results have been tabulated in terms of percentages.
Results: Patients and caregivers were clustered between 16-35 years of age. Approximately half of the patients had contacted a physician as the first source of help. Patients/ caregivers presenting with more psychological symptoms were having more uncommon and unmet expectations compared to those with biological symptoms. Patients gave social problems a higher priority, while caregivers gave to supernatural causes. Both groups considered illness to be more severe compared to objective assessment. More than half of the patients and caregivers were unaware about psychiatry referral. Severity of illness was directly proportional to medicine prescription expectation. 46% had only psychiatric illness, 45% had comorbid medical and psychiatric illness and 9% had only medical illness. Patients with psychiatric diagnosis expected more of social support and counseling besides free medication compared to those who came with only medical illness. Patients with somatic complaints wanted more prescription of medications, social support, and investigations.
Conclusion: Patients and their caregivers who were informed about psychiatric referral had more specific and due expectations. It was also seen that patients and their caregivers perceived their illness to be of much severe intensity with what was found objectively leading to undue expectations.
Coronary heart disease risk in in-patients with severe mental illness
Naresh Nebhinani, Sandeep Grover, Subho Chakrabarti,
Ajit Avasthi, Debasish Basu, Parmanand Kulhara
PGIMER, Chandigarh, India
Background: Persons with Severe mental disorders have increased death rates, with standardized mortality ratios up to three times higher than for the general population. While most of the earlier studies report elevated risks for suicide and accidental death, more recent work suggests that some much premature mortality may be due to cardiovascular disease. There is no information about cardiovascular risk (CVR) in terms of coronary heart disease (CHD) and cardiovascular mortality risk (CMR) in patients with severe mental disorder in Indian setting.
Aim and Objective: To assess 10 years Coronary Heart Disease risk in in-patients with severe mental illness.
Materials and Methods: Prospective, cross-sectional study of 95 inpatients with severe mental illness. CHD risk was assessed by Framingham (10-year all CHD events) function & SCORE (Systematic Coronary Risk Evaluation- 10 year cardiovascular mortality risk).
Results: The study sample included 60 males and 35 females. The overall 10-year risk of CHD (Framingham) was 3.12±0.53 (3.9±0.61 in males & 1.8±0.31 in females) and cardiovascular mortality risk (SCORE) was 1.42±1.14 (1.47±1.2 in males & 1.34±1.06 in females). Very high/ high CHD risk (Score of e"10 as per Framingham) was found in 9.5% patients (13.3% males vs 2.8% females) and high cardiovascular mortality risk (SCORE score of e"5) was in 5.3% subjects (6.7% males vs 2.8% females). Compared to the other gender, males had significantly higher frequency of smoking and females had higher frequency of low HDL levels. There was no significant difference between the 2 genders on other cardiovascular risk factors.
Conclusion: Cardiovascular risk is high in patients with severe mental illness, especially in males, hence they should be carefully monitored for risk factors, especially cigarette smoking.
Psychosocial profile of HIV positive subjects
Naresh Nebhinani, S.K. Mattoo, Ajay Wanchu
PGIMER, Chandigarh, India
Aim: To assess psychosocial profile of HIV positive subjects & to compare it with that of Rheumatoid Arthritis (RA) subjects.
Material and Methods: The study had a cross-sectional design with purposive sample of two patient groups consisting of HIV infected subjects not receiving antiretroviral medication (N=100), and RA subjects not receiving steroids or disease modifying antirheumatic drugs (N=40). The consenting subjects were administered Social Support Questionnaire (SSQ), Coping Strategy Check List, World Health Organization Quality of Life- HIV BREF (WHOQOL-BREF in RA group), Mini Mental State Examination (MMSE), General Health Questionnaire-12 items (GHQ-12).
Results: Following variables were significantly different in HIV and RA group respectively : age at diagnosis of HIV/RA (32.53±07.75 vs 36.60±10.06 years, P=0.011), total duration of illness (months) (12.95±20.68 vs 83.37±70.47, P<0.001), GHQ total (28.31±4.98 vs 30.15±4.35, P=0.043), denial coping skill (77.06 vs 54.10, P=0.002), and the presence of psychiatric illness (45% vs 60%, P=0.021). MMSE correlated negatively with gender, occupation, marital status, religion, and locality, and positively with education and income. Coping strategy denial score correlated positively with education and negatively with occupation, internalization score correlated positively with gender and negatively with locality, and emotional outlet score correlated positively with gender, occupation, marital status and negatively with age. SSQ total score correlated positively with denial and internalization. Coping skill internalization and emotional outlet correlated negatively with all domains and total score of Quality of life (QOL). Relationship between demographic features and QOL was also seen.
Conclusions: No significant correlation was found between QOL and social support. QOL was better in single, males, with higher education and high income group. QOL was negatively correlated with internalization & emotional outlet coping skills.
Family burden in subjects with substance dependence
S.K. Mattoo, Naresh Nebhinani, Anil Kumar B.N., Debasish Basu
PGIMER, Chandigarh, India
Aim: To study the family burden in subjects with substance dependence.
Materials and Method: A cross-sectional study was conducted with ICD-10 diagnosed substance dependence subjects and their caregivers attending the Drug De-addiction and Treatment Centre, PGIMER, Chandigarh. In all, 120 subjects (N=40 each for alcohol, opioid, and alcohol+opioid dependence subgroups) were enrolled after taking written informed consent. The family burden perceived by caregivers was assessed using Family Burden Interview Schedule (Hindi version).
Results: Compared to opioid and alcohol + opioids subgroups, the alcohol subgroup was older (mean 44.7 vs 28.12 and 32.15 years; P<0.05), mostly married (95% vs 47.5 and 62.5%), currently working (82.5% vs 47.5% and 37.5%), and with caregiver as wife (77.5%, vs 27.5 and 42.5%) (all P<0.01). In alcohol, opioids and alcohol+opioids subgroups the global objective and subjective burden were similar. In terms of detailed profile the objective burden score was similar for total score, and the domains of financial, family routine, family interaction, and mental health of family members. However across alcohol, opioids and alcohol+opioids subgroups significant differences (P<0.05) were seen for family leisure (2.52, 2.82 and 3.42), and physical health of family members (0.42, 0.25, and 0.7) domains of objective burden score.
Conclusion: Caregivers of subjects with substance dependence report high prevalence of moderate and severe burden. This points to the need for further work in this area.
Stigma in HIV positive subjects
Naresh Nebhinani, S.K. Mattoo, Ajay Wanchu
PGIMER, Chandigarh, India
Aim: To study stigma and related issues in HIV positive subjects.
Materials and Methods: The study had a cross-sectional design with purposive sample of 100 HIV positive subjects not receiving antiretroviral therapy, attending Immunology outpatient clinic of PGIMER, Chandigarh. The subjects, recruited after a written informed consent, were given the self-administered 'Tanzania Stigma Indicator and Community Endline - Individual Questionnaire'.
Results: A typical subject was middle aged (25-44 years), male (59 vs 40 females), educated below matric (63 vs 39 matric or above), village dweller (61 vs 39 urban/town dweller). Only 35 subjects knew the difference between HIV and AIDS. Unprotected sex, sharing injections and blood transfusions were reported spontaneously as source of HIV transmission by 79, 67, and 56 subjects respectively. About 80% of subjects reported no fear in touching HIV positive subjects or their objects. To avoid injections, to be faithful to one uninfected partner, to avoid blood transfusions, to use condoms, and to avoid sharing razors/blades were reported spontaneously as ways to protect one-self from getting HIV infection by 40, 39, 37, 36, and 26 subjects respectively. Only 24 subjects were aware of antiretroviral therapy. Nearly half of the subjects blamed themselves for contracting HIV infection. 38 subjects reported that people do behave differently with HIV positive subjects. 98 subjects had disclosed their HIV status to others (73 to family or relatives). In correlational analysis : age was correlated negatively with stigma; education was correlated positively with knowledge about illness; rural locality correlated negatively with stigma; and duration of HIV infection correlated negatively with misconceptions and blame.
Conclusions: Knowledge of HIV/AIDS was limited, so measures to enhance awareness & knowledge about HIV/AIDS are strongly needed to overcome misconception and stigma.
A study of socio-demographic characteristics and clinical diagnosis among catatonic patients presenting to a tertiary care mental health institute
Santosh Ramdurg, Santosh Kumar, Nand Kishore, Vijender Singh, Deepak Kumar, N.G. Desai
IHBAS, New Delhi, India
Introduction: Catatonia is a distinct motor syndrome associated with a variety of psychiatric, neurological and other systemic disorders. It may occur in a variety of psychiatric disorders ranging from Schizophrenia to affective disorders and from Mental Retardation to Autistic Spectrum disorders. Prevalence of catatonia varies from 7 to 38% and its prompt identification and treatment is crucial.
Aim and Objectives: To assess the socio-demographic characteristics and clinical diagnosis among catatonic patients presenting to a tertiary care mental health institute.
Methodology: A retrospective chart review of catatonia patients admitted in the psychiatry wards of IHBAS which is a tertiary care centre and teaching institute. A period sample of patients admitted in psychiatry wards of the institute between January 2009 and September 10 were included in the study. Socio-demographic and clinical data of the patients were recorded on a semi-structured proforma especially designed for the study. Appropriate statistical tests were applied to analyse the findings of the study.
Prevalence of emotional, conduct and peer problems among children with attention deficit hyperactivity disorder in clinic referred cases
Ashish Kumar Mittal, Goyal S., Sagar R., Mehta M.
SGT Medical College, Hospital and Research Institute, Gurgaon, India
Introduction: Attention-deficit-hyperactivity disorder (ADHD) is one of the most common childhood psychiatric disorder. It affects 3% to 5% in children according to the DSM-IV and has been associated with a variety of comorbid mental illnesses and functional impairments, largely in clinical samples.
Aims and Objectives: Assessment of emotional, conduct and peer problems among cases of ADHD.
Methodology: The study was carried out at child and adolescent psychiatry clinic of tertiary care centre. Parents of 6-15 year old patients suffering from ADHD (diagnosed as per DSM-IVTR) were informed regarding the study and their consent was taken. After that socio demographic profile of patients was noticed and patients were assessed by means of Strength and difficulty questionnaire (SDQ). Mentally retarded patients were excluded from study and total 41 patients studied.
Result: More than 50% of Children with ADHD were having emotional, conduct and peer problems.
Conclusion: Emotional, conduct and peer problems are common in patients with ADHD and should be monitored during treatment.
Experiencing stigma: Nepalese perspectives
Shailendra Raj Adhikari
Chitwan School of Medical Sciences, Nepal
Aims and Objectives: Experiencing stigma by patients with mental illness in their day to day lives has substantial importance in treatment, compliance and quality of life. The objective of this study was to find out experiences/ perceptions and coping of stigma among patients with mental illness.
Methods: This is a retrospective, cross sectional study of patients admitted in psychiatry ward. Patients were assessed using self-report questionnaire which focused on beliefs about discrimination against mental illness, rejection experiences, and ways of coping with stigma. Patient's socio demographic profiles were also assessed.
Results: Fifty three patients completed questionnaire concerning various constructs of stigma. There were 29 male patients and 24 female patients. Majority (N=45; 84.9%) were of Hindu religion but there were mixed numbers regarding caste. Most of the patients were aware of the stigma associated with mental illness. There were experiences of rejection by family members and colleagues (N=23; 43.4%) and health care professionals (N=16; 30.2%). There were strong perceptions of stigmatization felt by patients in different social circumstances. Though maintaining secrecy and avoidance/withdrawal of stigma provoking scenario were not experienced much, there was a strong sense of advocacy whenever there was any negative view of mental illness. Some of the questionnaire items in "perception", "rejection" and "coping" showed statistical significance (P=0.001). Conclusions: People with mental illness experience stigma during their course of illness and treatment and it is an important determinant for the relapse of symptoms and non-compliance to treatment. Despite experiencing stigma, patients were generally treated fairly by other people. Patients develop various mechanisms to cope with stigma, mostly secrecy and avoidance. Advocacy and anti-stigma campaign along with positive attitudes of health professionals play important role in decreasing stigmatizing experiences in patients.
Adolescence communication: Experiences from Nepal
Shailendra Raj Adhikari
Chitwan School of Medical Sciences, Nepal
Aims and Objectives: Communication is a vehicle of social interaction- the process of transmitting feelings, ideas, facts, beliefs and attitudes. Communication problems between parents and teenagers have become significant obstructers to smooth family functioning leading to communication gaps between them.
Materials and Methods: This is a descriptive study done at one of the school in Kathmandu Metropolitan city and it was a single stage study. Every section of the class of the selected school was visited to explain the students about semi-structured Proforma and Parent-adolescence Communication Scale (PACS) developed by Barnes and Olson.
Results: Total of 150 students from class 7 to class 10 participated in the study. Total students were 104. Males 45 and females 59. Majority of students were in age of 15 years and 16 years respectively. Highest number of students came from broken family and nuclear family both in males and females. Majority of students belonged to birth orders of first, second and third. Of adolescent communication (mother) or AC-M questions, ACM-6, ACM-13, ACM-14, ACM-17, ACM-18, ACM-19 and ACM-20 showed high positive score of statistical significance. Of the adolescent communication (child) or AC-C questions, ACC-7, ACC-8 and ACC-9 of open communication sub-scale and ACC-11, ACC-12, ACC-13, ACC-14, ACC-17, ACC-18, ACC-19, ACC-20 of problem communication sub-scale showed statistically significant score.
Conclusions: This study has found both mothers and adolescents reporting problems in communication with high scores in both mother and child. Problems in communication plays very critical role because many adolescence issues such as academic, biological changes and sexuality are not discussed if communication is not open or if there are problems in communication. Parents should frequently communicate sexual issues especially with young adolescents. Not only openness in communication but also solving problems during communication is important so that adolescence can pass through this turbulent transition.
A study of non violence attitude in juvenile deliquent children
Samiksha Kaur, Jai Singh Yadav
Department of Psychiatry, Banaras Hindu University, Varanasi, Uttar Pradesh, India
Aim: To assess the attitude about non- violence.
To assess the causes of delinquent children
Introduction: Juvenile delinquency is the legal term for behavior of children and adolescents that in adults would be judged criminal under law. Theft is the most common offense by children; more serious property crimes and rape are most frequently committed in later youth. The causes of such behavior, like those of crime in general, are found in a complex of psychological, social, and economic factors. Clinical studies have uncovered emotional maladjustments, usually arising from disorganized family situations, in many delinquents.
Materials and Methods: Thirty five subjects were taken for the study from the observation home (Bal Sampresan Grih) Ramnagar Varanasi. The age group of was 15 to 22 years. The mean age of subjects was 18.5 years. All subjects were male and non convicted. Tools - Dr. Y.K. Nagle non violence attitude scale was used. This scale was reliable and valid. The number of items in the scale was 75. Scoring was positive and negative warded. Procedure- subjects were taken individually first, demographic details were written. Then apply the questionnaire in the group.
Result: The result showed that low socioeconomic status, low education of parents and child, low occupation, neglection, separated or single parents, death of both parents was responsible for developing criminal behavior. The 2 nd aim result showed that the age group of 15-16 were higher involved in the crime and 85% children were involved in major crime. But this attitude of non violence scale was average. It means they were motivated to the environmental factors and problems of life.
Conclusion: The study shows that poor socioeconomic status, low education, lot of siblings was responsible for crime, but attitude of delinquent children were average.
The clinical profile of a panic attack in India - Busting the myth of "low blood pressure"
Gulbahar S. Sidhu, Deepali Gul
Doaba Hospital Pvt Ltd, Jalandhar, Punjab, India
Aims and Objectives: The study is aimed at delineating the unique clinical profile of patients presenting with a panic attack in our region i.e. North India so that greater number of patients are identified and treated earlier.
Methodology: Fifty out-patients presenting to a multi-speciality hospital with chief complaint of "low blood pressure" or any other symptom suggestive of a panic attack, will be included in the study. These patients will be administered Sheehan's patient-rated anxiety scale and Presumptive stressful life events scale. Patients will also be asked to describe their symptoms on a sheet of plain paper in the language of their choice.
Nicotine dependence and motivation for smoking cessation in psychiatric inpatients
Sri Hari Charan, Samrat Kar, Deepthi Singh, Sateesh Babu,
C.M. Pavan Kumar Reddy
Mamata General Hospital, Khammam, Andhra Pradesh, India
Background: Cigarette smoking is the leading preventable cause of death and disease in India and is disproportionately more frequent among psychiatric patients.
Aim and Objective: To evaluate smoking prevalence, nicotine dependence, and motivation for smoking cessation in psychiatric inpatients.
Methodology: Sixty inpatients aged 18 years or older admitted in psychiatry inpatient ward at the Mamata General Hospital, Khammam, Andhra Pradesh are assessed using the Fagerstrom Test for Nicotine Dependence (FTND), the Readiness to Quit Ladder, and the Decisional Balance for Cigarette Smoking, Responses were analyzed.
Construction of the intervention package for improving the prosocial behavior among school going children
Rashmi Sanadhya, D.K. Sharma, C.S. Sushil, Surila Agrawal
Government Medical College, Kota , Rajasthan, India
In common usage the term prosocial usually refers to behavior carried out to the benefit of others without anticipation of rewards from the external sources. The present study deals with an attempt to develop a package for increasing prosocial behavior among children. A package of 20 stories depicting model prosocial behavior by audio-visual presentation before the children has been developed. Each story in the package is followed by 20-22 questions for cognitive restructuring. The package was administered to a sample of 50 boys and 50 girls of 6 th , 7 th , 8 th grade student on a specially designed proforma and score of altruism was recorded by using Altruism Scale by Rai and Singh before and after the intervention through the package of 20 stories. The 't' test was applied to find out significance between the mean altruism scores of the group of boys and girls before and after administration of the package.
Parental satisfaction assessment for treatment in ADHD patient with or without conducts symptoms
Shrigopal Goyal, Mittal A.K., Sagar R., Mehta M.
All India Institute of Medical Sciences, New Delhi, India
Introduction: Attention-deficit-hyperactivity disorder (ADHD) is one of the most common childhood psychiatric disorders. There are numerous Co-morbid disorders associated with ADHD including anxiety and mood disorders but conduct symptoms are frequently associated with ADHD. Parents feel more dissatisfied from treatment, if conduct symptoms and ADHD present together.
Aims and Objectives: Parental satisfaction assessment for treatment in ADHD patients with or without
Materials and Methods: The study was carried out at the outdoor setting at all India institute of medical sciences (AIIMS) New Delhi and 20 ADHD patients were included in study. Parents of 6-12 years old patients suffering from ADHD (Diagnosed as per ICD-10 DCR) were informed regarding the study and after taking informed consent, patients were assessed for conduct symptoms using ICD 10 DCR criteria. Patients started on treatment and parental satisfaction for treatment were assessed after 1 month of treatment by using visual analogue scale.
Results: Parental satisfaction for treatment was more in ADHD patients without conduct symptoms.
The role of low-dose pramipexole augmenatation in the treatment of treatment-resistant bipolar depression: A report of two cases
Anurag Jhanjee, Pankaj Kumar, M.S. Bhatia, Deepika Verma 1
UCMS Delhi, 1 MBBS, Navodya Medical College, Raichur, Karnataka, India
A significant proportion of depressed bipolar patients fail to respond to the treatment strategies. Novel therapeutics for bipolar depression are needed. Preliminary studies suggest that pramipexole a dopaminergic agent that has been used in the treatment of Parkinson's disease and restless leg syndrome may have antidepressant properties in unipolar and bipolar depressed patients as well as neurotrophic properties. The optimal antidepressant daily dose of pramipexole is not known. It has been suggested to be used between 0.125 to 9.0 mg/day. In double blind placebo controlled bipolar depression treatment studies, the average daily dose of pramipexole was 1.7 mg. Manic switches have been reported with depressive subjects and with subjects without any mental disorders.We report two cases of treatment resistant bipolar depression. Despite different treatment strategies and treatment adherence, the patients did not give optimal response to the treatments and continue to experience depressive relapses. They have been treated with low dose (0.5-0.75 mg/day) pramipexole augmentation successfully. The severity and the duration of the depressive episodes were decreased. No serious adverse event has been reported with pramipexole during the maintenance treatment. The details of the case will be presented during poster presentation at ANCIPS, 2011.
Prevalence of childhood depression in school going children of age group 8-14 years: A school based study
Anuradha Pareekh, Ashok Singhal
SP Medical College, Bikaner, Rajasthan, India
Background: There are limited data available on child mental health especially on depression in our country.
Aim: To study the prevalence of childhood depression in school going children of age group 8-14 years.
Materials and Methods: All the children of age group 8-14 from Army school, Bikaner will be screened on Depression Self Rating Scale for children (DSRS) (Birleson, et. al. 1987). The student who score 15 or more on DSRS will be given a probable diagnosis of depression. These students will be assessed by senior psychiatrist and final diagnosis will be given according to ICD-10.
Result: The data's collected from school children will be analyzed and presented in academic session at the time of conference.
Aggression under restraint
Prachi Sukumar Chivate, Maithili S. Kadam,
Yusuf A. Matcheswalla, Rohit M. Haridas
Department of Psychiatry, Sir J.J.Group of Hospitals & Grant Medical College, Mumbai, India
Background: Aggression is common in psychiatric inpatients and is associated with psychopathology. Limit settings and use of restraints may worsen aggression.Involuntary admission status and locked ward patients are seen to be more aggressive.
Aims: To study the correlates of aggression with psychopathology and use of restraints.
Setting and Design: Longitudinal study was conducted in a locked ward of a tertiary GHPU.
Materials and Methods: 36 Consecutive patients were admitted in the month of June 2009 enrolled. MOAS was used to assess the aggression and psychopathology was assessed with BPRS and SAPS on admission and about two weeks after admission.
Statistical Analysis: Statistical analysis was conducted with SPSS-10 software package for windows. Correlation was done using Pearson's Rank correlation coefficient.Two tailed p values were obtained for all statistical analysis with P=<0.05 considered as statistically significant.
Results: Majority of patients had psychiatric diagnosis most common being schizophrenia (77.77%). BPRS, SAPS and OAS scores decreased significantly on second week from baseline. MOAS scores were positively associated with BPRS, SAPS. Both aggression and psychopathology decreased two weeks after admission.Verbal aggression correlated with activation subscale of BPRS and bizarre behaviour subscale of SAPS. Unusual thought content, hostility/suspiciousness and mania subscales of BPRS correlated positively with aggression towards objects and others. Hallucinations and formal thought disorder correlated positively with aggression towards objects and others. Bizarred behaviour subscale of SAPS was associated verbal aggression.
Conclusion: Use of restraints and injectables were positively correlated with aggression thus contributing to aggression even after controlling for psychopathology and other factors.
Olanzapine in the management of anorexia nervosa : A case report
(Col.) P.K. Pardal, Raaj Konwar
Anorexia nervosa is a common eating disorder in the western world. However, it is rare in developing countries like India. There is paucity of studies from India on the management of this disorder. Despite a host of management options, both psychotherapeutic and pharmacological, none have been found to be universally effective. Small open-label studies suggest that low doses of atypical antipsychotics such as olanzapine and quetiapine may help. We present a case of anorexia nervosa in a young girl who was initially treated with nutritional supplementation, psychotherapy and fluoxetine with only marginal improverment. Fluoxetine was then substituted with olanzapine with marked improvement in her condition.
Comparison of anxiety and depression level between Indian and foreign students staying in hostels of Delhi university
Tarun Yadav, Dinesh Kataria, Elham Najafpour, Vida Namdari, Tarun Yadav, Indiver Kalra
Department of Psychology, Lady Hardinge Medical College, University of Delhi, Delhi, India
Aims and Objectives: To compare level of anxiety and depression between Indian and foreign students staying in hostels of Delhi University.
Methodology: A self rated Primary Care Evaluation of Mental Disorders Patient Health Questionnaire (PRIME-MD, PHQ) was used to assess the levels of anxiety and depressive symptoms in students staying in hostels of Delhi University. The sample was divided into two groups of Indian and foreign female students of Delhi University. Each group containing 34 and 36 students respectively and data regarding their depression and anxiety level were collected using the above mentioned scale. The data was later analyzed using SPSS 17 version.
Results: The findings revealed that the anxiety levels of Indian students are significantly higher and levels of depression were lower but not significant statistically as compared to foreign students.
Conclusion: Indian student group had higher anxiety level statistically as compared to foreign group. Level of depressive symptoms was low in Indian group but it was not significant statistically. Supportive psychotherapy and counseling facility should be provided to students staying in the university hostels.
Comprehensive study of adolescent sexuality and impact of media among school students : Indian scenario
Adolescence is a very exciting phase of life fraught with many challenges as increasingly more of them are initiating sexual activity at an early age. Understanding them is important in helping our adolescents grow up healthy. Therefore, a study was conducted in two co-education schools.
Aims: To elicit information from adolescents of co-education schools on matters related to pubescence, sexuality and their knowledge in this regard. To study the impact of media on adolescent sexuality.
Settings and Design: Study subjects involved students from class IX to XII in two co-education schools. Consent of school administration and parents was taken to administer the questionnaire to their wards.
Materials and Methods: A total of 586 out of 1580 students completed a self reporting questionnaire on matters related to sexuality.
Statistical analysis used: EpiInfo6 Software.
Results: The incidence of having sexual contact was 30.08 % for boys and 17.18 % for girls. 6.31% boys and 1.31% girls had reported having had experienced sexual intercourse. Friends constitute the main sexual partner for both boys and girls. Sexual abuse has been reported by both girls and boys. These and other findings are discussed.
Conclusions: Adolescent school students are involved in sexual activity but lack adequate knowledge in this regard. Students, teachers and parents need to be educated about how to handle adolescents in matters related to sex. Media has an impact on adolescent sexual activity.
Personality disorders in alcohol dependence
Subodh Kumar, S. Chaudhury, Jayati Simlai
RINPAS Kanke, Ranchi, India
Aims and Objectives: The present study aimed to describe the frequency and profile of personality disorders related to alcohol dependence, and to compare them with non-addictive disorders and with normal population.
Methodology: In this cross-sectional study, using the International Personality Disorder Examination, 91 consecutively recruited alcohol-dependent patients admitted to a de-addiction unit were compared with 91 subjects from the general population chosen to match the patient samples for age, gender and socioeconomic level.
Results and Conclusion: Personality disorders were seen in 48% of the patients with alcohol dependence syndrome and 7% of the general population.
Neuroleptic malignant syndrome and psychosis - clinical dilemma: A case report
Abhishek Kapoor, Ajeet Sidana, Abhijit Rozatkar, B.S.Chavan
Government Medical College & Hospital, Chandigarh, India
Aim and Objective: The authors report a case of Neuroleptic Malignant Syndrome (NMS) with the use of anti-pyschotics and mood stabilizers. The psychopathology disappeared with the discontinuation of all psychotropic medicines and patient is maintaining well for last 5 months on mood stabilizer.
Materials and Methods: Case report.
Result: A 31 year old male with 6 years history of Bipolar affective disorder with incomplete inter-episodic recovery presented with increased activity, irritability, big talks, increased appetite, decreased sleep and odd behaviour for last 6 months along with hyper religiosity for last 6 years. Patient was admitted in psychiatry ward and received Tab Divalproex sodium 2000 mg/day, Tab Lithium 1200 mg/day and Tab Haloperidol 40 mg/day over a period of one and half month. However, patient did not show any signs of improvement in affective as well as in psychotic symptoms. Then, Tab haloperidol was stopped and Tab Clozapine 25 mg was started. Next day patient developed fever, muscular rigidity, increased autonomic activity with S. CPK (MM) was 9149. He was diagnosed as case of NMS and treated in emergency medicine service for one week. During this period, all psychotropic medications were discontinued. Post recovery from NMS, unexpectedly, patient did not show any psychopathology. Moreover, he did not develop any symptoms during one week observation in psychiatry ward despite not being on any psychotropic medication. His score on Young Mania Rating Scale was 6/60. Considering the past history of similar episodes, patient was discharged on Tab Divalproex sodium 750 mg/day. After discharge for last 5 months, patient continues to be euthymic and is on same dose of valproate.
Mortality in medico-surgical inpatients with delirium
Ruchita Shah, Sandeep Grover, Natasha Kate, S.K. Mattoo,
Subho Chakrabarti, Savita Malhotra
PGIMER, Chandigarh, India
Background: Data from the West suggest that delirium is associated with high rate of mortalitycompared to matched controls.
Aim: To study the mortality rate of patients of delirium during their hospital stay.
Methodology: All the patients referred to Psychiatry Consultation-Liaison team of the Department of Psychiatry at Postgraduate Institute of Medical Education and Research, Chandigarh during the period of January-June, 2010 were followed up during their hospital stay for their outcome.
Results: During the study period 527 referrals were received from various medicosurgical wards, of which 236 (45%) were diagnosed as having delirium. The mean age of the patients with delirium was 46.53 (±18.61) years and most of the subjects were male (N=161, 67.9%). Of the 236 patients diagnosed as having delirium, 35 (14.83%) patients died. This mortality rate was significantly higher compared to subjects diagnosed with other psychiatric disorders (4.43%; 11 deaths out of 248) or who had no psychiatric diagnosis (no death in 43 subjects diagnosed as nil psychiatry). There was no difference in the mortality rate in the delirium group between males and females, those aged more than equal to 65 years and those aged less than 65 years of age and those admitted to medical or surgical speciality wards. The mortality rate in patients diagnosed as delirium was also higher than the overall hospital mortality rate (6.8%; 2119 deaths out of 31190 admissions).
Conclusions: Delirium during the inpatient stay is associated with high mortality rate.
Perception of stress and coping stratergies amongst 1 st year medical undergraduates
Chetan D. Vispute, Kranti Kadam, S.R. Parkar
Seth G.S.M.C. & KEM Hospital Mumbai, India
Aims and Objective: To study perception of stress amongst 1 st year medical undergraduates and to evaluate various coping strategies used by students.
Introduction: Stress is individual's owns experience. Generally it depends on the environment and psychological perspective of a person. Stress also depends on profession of a person. Training in medical education itself is an example how stress affects human being. The pressure of academic performance, adjustment to new social environment of medical college, peer adjustment staying away from family precipitates as stress among under graduate medical students.
Methodology: Data was collected on guided questionnaire research from 120 1st year medical under graduate students of Seth G. S. Medical College and K E M Hospital. This data was analysed on MAXQDA programme for qualitative research and results will be discussed in poster presentation.
Restless legs syndrome in opioid dependent patients
Debasish Basu, Abhishek Ghosh, Anant Kumar Verma,
PGIMER, Chandigarh, India
Aim: To present three cases of Restless Legs Syndrome (RLS) in opioid dependent patients. Although frequently under-diagnosed, several epidemiological studies have estimated the prevalence of RLS in western countries at 4-10% of the general population. Its diagnosis is usually made on a clinical basis, according to the criteria established by the International RLS Study Group. There are case reports of transient RLS in opiate withdrawal.
Methodology: We present three cases of patients undergoing treatment at our centre for opioid (dextropropoxyphene, DPP) dependence and were incidentally detected to have RLS. RLS was clinically suspected on history and confirmed by neurologic consultation. All three met the RLS diagnostic criteria.
Results: All three were young males using DPP as their primary substance. Two patients had DPP related seizure and then developed RLS during opioid withdrawal, but their RLS persisted even after the remission of other opioid withdrawal symptoms. Investigations including thyroid function test, haemogram and serum ferritin were normal in all of them. The cases responded well to treatment with ropinirole.
Conclusion: There might be an association between opioid dependence and RLS, which merits further large scale and well-designed studies. Patients withdrawing from opioids with persistent sleep disturbance should be screened for RLS before prolonging hypnotic prescriptions. The putative aetiological link between the two conditions and its management implications are discussed.
Association between schizophrenia and unconjugated bilirubin
Rajiv, Radhakrishnan, Milanduth Kanigere, Jayakumar Menon, Sam Calvin, Annuncia Janish, Srinivasan K.
St. Johns Medical College, Bangalore, New Haven, Connecticut, USA
Aim and Objectives: The association between Schizophrenia and hyperbilirubinemia has been replicated in few studies. It is however not clear if this association is related to Conjugated Bilirubin or to Unconjugated Bilirubin. The aim of the study was to examine the differential association between Total Bilirubin, Conjugated Bilirubin, Unconjugated Bilirubin and Schizophrenia.
Methodology: The study was a retrospective, case-control study conducted at a general medical hospital's psychiatric inpatient unit. The charts of inpatients from July 2009 to Sept 06 were screened in a consecutive fashion. Patients with ICD-10 diagnosis of Schizophrenia or Bipolar Disorder (control group) were included. All subjects were inpatient and were assessed by a treating team consisting of 2 psychiatrists. Patients with co-morbid psychiatric disorders (including substance use disorders) and medical diagnosis were excluded. The data was analyzed after adjusting for age, gender, antipsychotics and other medications and elevated liver enzymes.
Results: The charts of 100 patients each with Schizophrenia and Bipolar Disorder were screened. Those with substance use, raised AST and ALT, or incomplete data were excluded. The final analysis was conducted on 140 subjects. Patients with Schizophrenia had significantly higher levels of Total Bilirubin and Unconjugated Bilirubin but not Conjugated Bilirubin, compared to Bipolar Disorder. The association persisted despite controlling for age and medication. Levels of Unconjugated Bilirubin were significantly higher in males. Those with Schizophrenia had higher Unconjugated/Conjugated bilirubin ratio. The rate of hyperbilirubinemia was significantly higher in Schizophrenia compared to Bipolar Disorder.
Conclusion: Schizophrenia is associated with increased levels of unconjugated bilirubin, but not conjugated bilirubin. The relevance of unconjugated bilirubin and its enzyme Uridyl Glucuronide Transferase is reflected in dopamine metabolism, neurotoxicity and in the "hyperbilirubinemia" animal model of schizophrenia.
A case report of eight years of manic episode with two years follow up in euthymia: Is hypothyroidism to be blamed?
Sanjay Kumar Pattanayak, Raman Deep Pattanayak
V.I.M.H.A.N.S, New Delhi, India
Introduction: Although the association between depression and hypothyroidism is well-known, but the occurrence of mania in association with hypothyroidism is rarely reported. The chronic course of mania, especially lasting more than five years is also an uncommon clinical presentation and role of hypothyroidism in chronicity of mania is largely unknown. There are several diagnostic and management issues which needs attention.
Case presentation: We discuss the case of a 64 years married male with a strong positive family history and three previous manic episodes, each lasting approximately six months. After almost a decade of euthymia, patient started showing a cheerful mood, increased psychomotor activity, overfamiliarity, grandiose ideas, overspending, initiated and funded construction of temples at multiple places along with inter-personal and socio-occupational dysfunction lasting eight years. The thyroid function tests revealed moderate hypothyroidism (TSH : 10.58), for which treatment was initiated in form of 50μg/day. In addition to psychoeducation, pharmacological treatment for bipolar disorder was also initiated in view of past history and family history of multiple psychiatric disorders and a suicide. Patient improved within two months and continues to be in follow up, compliant and euthymic for past two years.
Conclusion: The chronicity of mania is a unique presentation of clinical and research interest. The role of hypothyroidism in causing and/or prolonging the manic episodes merits a detailed investigation.
Efficacy of adjunctive high frequency right parietal cortex repetitive transcranial stimulation in unipolar depression: A randomised double-blind sham-controlled study
Sandeep M., Ram, Ajay Kumar Bakhle
CIP, Ranchi, India
Aims: To identify a set of underlying symptoms that exist before the onset of psychotic mania and to provide a description of the symptoms behaviours characterizing a 12 month period preceding the occurrence of such an episode, and explore premorbid characteristics that could be either risk factors or markers of vulnerability to Bipolar affective disorder.
Objectives: To study the risk factors and the markers of vulnerability in the phenomenological manifestations (symptoms) occurring during the 12 months preceding the onset of mania and comparing it with healthy controls.
Methodology: It would be a hospital based cross sectional study where 30 patients meeting the ICD 10 DCR criteria for mania with psychotic symptoms demanding inpatient admission would be selected for the study. The subjects in the age group of 18-60 years would be selected along with 15 age and sex matched healthy controls. The subjects would then be rated on young mania rating scale to obtain a baseline score. After they attain remission the Bipolar prodromes symptom scale-retrospective patient version 1.2 (BPSS-R-Pt) would be applied to identify the prodrome in preceeding 12 months prior to illness onset. Subsequently assessment of risk factors for first episode manics would be done using the Child Developmental Risk Factor Index (CDRI). The presumptive life events scale would be used to assess life stressors occurring during the 12 months preceding the first manic episode. Assessment of markers of vulnerability to mania would be done using. The Schedule for Affective Disorders and Schizophrenia for School- Age Children-Parents and Lifetime Version-Behavioural Disorders Supplement to assess the lifetime and current diagnoses of ADHD, Oppositional reflecting a trait-based measure of unipolar and bipolar affective conditions. The Addiction Severity Index (ASI) would be used to assess the lifetime history of alcohol-and drug-related problems. The Global Assessment of Functioning Scale (GAF) would be used to estimate the highest lifetime level of functioning. The Premorbid Adjustment Scale (PAS) would be used to examine the attainment of developmental goals at each of several periods of a participant's life before the onset of the illness.
Assessment of sleep quality in post-graduate residents in a tertiary hospital and teaching institute
S. Vasantmeghna Murthy, Ajita Nayak, S.R. Parkar
Seth G.S. Medical College and K.E.M. Hospital, Mumbai, India
Introduction: Sleep is a basic necessity as known by studies and personal experience. Sleep deprivation is the commonest complaint in over-worked medical residents which can lead to disastrous consequences for everybody including the patient, who more often than not is first assessed by residents on duty. It has implications on the physical and mental well-being of those very doctors who are being trained to preserve the health of patients.
Aims and Objects: Our objective was to evaluate the sleep quality in residents in clinical and non-clinical departments of our institute, their day-time sleepiness and also satisfaction with life and the correlation between these variables.
Methodology: Hundred residents consenting to participate in this study shall be asked to fill questionnaires containing socio-demographic data and use of substance(s). The Pittsburgh Sleep Quality Index (PSQI)- a validated scale for assessment of quality of sleep shall be used. The other scales include the Epworth Sleepiness Scale (ESS) to assess day-time sleepiness, and the Satisfaction With Life scale (SWLS). Scores on Satisfaction with life will be correlated with sleep variables. Also a comparison shall be made between the findings in the clinical and non-clinical department residents.
Group therapy as a treatment model in dhat syndrome… A clinical innovation
Dheeraj Kattula, Jayprakash R. Ravan
0CMC, Vellore, India
Background: Dhat syndrome is a culture bound syndrome, which has high prevalence among the Indian young males. The main stay of intervention is psycho educative model involving the principle of cognitive therapy. There is not much of information available in the literature regarding practical ways of doing the therapy.
Objective: The aim of the open label trial is to demonstrate efficacy of group therapy in Dhat syndrome.
Methods and Methodology: Five groups (each group having 3 participants) of young men with age group 20-30 were included in the study. Their understanding and mental status was assessed by a psychiatrist. They were psycho-educated in groups regarding anatomy and physiology of male sexual function by another psychiatrist. Their improvement and understanding were assessed after the therapy by the unblended therapist.
Results: 13 out of 15 i.e. nearly 87% expressed satisfaction over the process of intervention. About 3 sessions were required for a meaningful understanding of psycho-education material and significant decrease in anxiety related to loss of semen. The two clients who did not benefit much from the group therapy interventions had co-morbidities. One had anxiety disorder with depressive symptoms and the other had Schizophrenia with residual psychosis.
Conclusion: Patients with Dhat syndrome get poor treatment in different psychiatric set ups due to time constraints, lack of expertise and negative feelings of the therapists towards this neurotic population. Our innovative model brings a ray of hope towards better professional care for young males with Dhat syndrome without co-morbid conditions.
A study of the diagnostic profile of geriatric patients in general psychiatry OPD of a tertiary care hospital
Ajish Mangot, S.R. Parkar, Jahnavi Kedare
Seth G.S.M.C & KEM Hospital, Mumbai, India
Introduction: General Hospital Psychiatry Units have a great role in looking after the elderly population, as elderly population is increasing in numbers. With an increase in the geriatric population the psychiatric disorders are also on the rise. Studies have found 20% prevalence rate of mental illnesses amongst elderly population according to a study done at KGMC Lucknow. Sood et al. found 49% of geriatric inpatients having psychiatric morbidity with depression and anxiety being the most common. In the present study the case records of geriatric patients in General Hospital Psychiatry Unit, outpatient services, of a tertiary care hospital were assessed for psychiatric disorders.
Aims: (1) To study the diagnostic profile of geriatric patients attending the General Hospital Psychiatry Unit; (2) To study their socio-demographic factors, i.e. age, gender, marital status and educational status associated with the diagnosis; (3) To study the presenting symptom profile.
Methods: (1) An audit was done of all the 285 geriatric patients i.e. above the age of 60 years attending the general psychiatry OPD of a tertiary care hospital for the first time during the period from January to December 2009. (2) Frequency distribution and Chi square test was used for analyzing the data. (3) Results will be discussed.
Apolipoprotien E4 allele frequency in late onset depression
Sivakumar P.T., Nalini Narayana Reddy, Suresh Kumar R., Srikala Bharath, Krishna Prasad, Babu Chinnamani,. Srinivas B.K., Meera Purushottam, Odity Mukherjee, Om Prakash, Sanjeev Jain, Mathew Varghese
NIMHANS, Bangalore, India
Introduction: Depression is a major psychiatric disorder in the elderly and leading cause for disability. Late onset depression (LOD) may be linked with a higher risk for dementia. The apolipoprotein E 4 allele is a genetic risk factor for Alzheimer disease. But the association between APOE 4 and LOD has been inconsistent.
Aim: was to examine the association of APOE4 allele with LOD in Indian population.
Materials and Methods: One Hundred Seven patients diagnosed with LOD (onset of depression after age 50 years) aged above 60 years were recruited from the Geriatric Clinic and Services of NIMHANS, Bangalore. Fifty seven healthy control subjects were recruited from the community. Genotyping for APOE was done using PCR-based assay. Both the groups were compared to evaluate the difference in APOE allele and genotype frequencies.
Results: The cognitive score measured with Hindi Mental State Examination (HMSE) and education was significantly lower in LOD than controls (P<0.01). APOE 4 allele frequency was significantly more in patients with LOD (14.49%) than controls (5.26%) with P value < 0.01. Odds ratio for presence of APOE 4 Genotype among LOD was 2.87, 95% C.I (1.11-7.43). The association of APOE4 allele with LOD remained significant after controlling for HMSE score by Logistic regression.
Conclusion: APOE4 allele is significantly associated with LOD in this study. APOE4 allele appears to be one of the risk factors for LOD. There is a need for evaluation of the possible higher risk for cognitive decline and Dementia in APOE4 positive patients with LOD in future studies.
Integrated psychological therapy for patients with schizophrenia: A pilot study from India
Aarati Taksal, Paulomi M. Sudhir, Keshav Kumar J, Jagadisha
NIMHANS, Bangalore, India
Aim and Objectives: The aim of the study was to evaluate the feasibility and effectiveness of the Integrated Psychological Therapy (IPT) in improving social functioning in patients with schizophrenia.
Methodology: The present study had a case study design. Two patients with a diagnosis of schizophrenia (DSM IV TR) attending the outpatient psychiatry services at NIMHANS were recruited for the study, after they provided written informed consent. Both patients were clinically stable at the time of recruitment. Pre and post assessments on measures of neurocognition, social cognition, psychopathology, and socio-occupational and role functioning were carried out. Assessment of socio- occupational and role functioning was done by an independent rater. The IPT consisted of interventions to improve cognitive functions, social perception, verbal communication and social skills in the patients. Patients received 20 individual sessions of the IPT on an outpatient basis, twice weekly for two and half months.
Results: A comparison of the pre and post assessments of both the patients indicated improvement in their executive functions, verbal learning and memory, social perception, social skills, negative symptoms, general psychopathology, socio-occupational functioning and role functioning.
Conclusion: The content and structure of the IPT can be modified to suit the needs of patients in India. The IPT has shown promising results in facilitating functional recovery for patients with schizophrenia in an Indian set up.
Twenty six year long first person account of a struggling male transsexual
Abhishek Pratap Singh, P.K. Singh
Patna Medical College, Patna, India
We are presenting here a rare case of 'Childhood Gender Identity Disorder' persisting into adulthood in a 30 year old male who has been struggling alone very hard right from his adolescent years to realign his discordant psychic sexual identity with socially more acceptable and manifest anatomical sexual identity. The travails of this vividly described painful psychosocial journey will also be highlighted. Other salient aspects of this case are its association with passive homosexual tendencies with clear predilection for paediatric age; his desire to finally attain, acquire and settle emotionally with manifest anatomical sexuality, which is less commonly seen and also substantial success obtained by him in this direction just by his personal efforts and willpower.
Brief history: "A 30 yrs old, primary level male school teacher, from conservative Hindu background presented to our OPD with chief complaint of his strong desire to get rid of his intense feeling of being a female. His earliest memory of being a female is from age four but has felt intensely distressed about it for last 11-12 yrs only. In his early childhood years, his behaviour, attire, games, pastimes and hobbies were of girls including his preferred playmates. Occasionally, he had strong desire to get rid of his male genitalia. Faced with strong family and social disapproval, he decided to acquire and settle with male identity around the age of 18-19 yrs. Thereafter he started to consciously acquire the manners, gestures, speech and gait of a manifest male behaviour. In this journey he took help of friends, books, magazines and also consulted an endocrinologist. By the time he came to our psychiatry department, he had already come substantially close to the highway to manhood and yet thought that he was very far". The story of the case will be presented in the language of the patient.
Body mass index and medical co-morbidity in psychiatric in-patients
Rohan Dilip Mendonsa, P. John Mathai
Aims and Objectives: To study the association between Body Mass Index (BMI) and significant medical disorders in a sample of psychiatric in-patients in a general hospital.
Methodology: A total of 78 psychiatric in-patients over a period of one month were recruited as subjects through consecutive sampling method after obtaining informed consent. A specially designed questionnaire was used in addition patients' case files provided useful data. Weight and height of each subject was measured and BMI was calculated.
Results: Bipolar mood disorder (30) was the most common psychiatric disorder followed by unspecified nonorganic psychosis (18), alcohol dependence syndrome (12), paranoid schizophrenia (6), delusional disorder (4), organic mental disorders (4), recurrent depressive disorder (2), and mental retardation with behavioural problems (2). Significant medical disorders were found in 18 subjects (23%). These were diabetes mellitus (10), hypertension (4), epilepsy (2), and hyperthyroidism (2). Medical comorbidity was highest among patients with bipolar disorder and alcohol dependence syndrome (both 40%) followed by schizophrenia (33%) and unspecified nonorganic psychosis (11%). Average BMI of the subjects was 21.67. Subjects with diabetes mellitus and hypertension had significantly higher BMI (Mean-25.46, SD-6.19) compared to subjects without these conditions (Mean-20.97, SD-3.93), which was statistically significant (P=0.016). However, there were no significant differences with regard to the BMI in patients with bipolar mood disorder (Mean-22.89, SD-6.21), schizophrenia (Mean-23.08, SD-3.39), unspecified nonorganic psychosis (Mean-20.83, SD-4.61) and alcohol dependence syndrome (Mean-21.70, SD-2.12).
Conclusions: Diabetes and hypertension are the most common medical disorders found in psychiatric patients. The higher BMI in psychiatric patients might predispose them to develop diabetes mellitus and hypertension. However, psychiatric conditions do not seem to have differential influence on BMI.
Case Report: Catatonia as a presenting symptom of wilsons disease
Veda N. Shetageri, G.S. Bhogale, N.M. Patil, R.B. Nayak,
JNMC, Belgaum , Karnataka, India
Introduction: Wilson's disease is an autosomal recessive disorder caused by mutations in the ATP7B gene. Clinical manifestations are caused by copper deposition in different parts of the body. Psychiatric symptoms (mood and psychotic) may be presenting symptoms in 25% patients with Wilson's disease.
Case Description: A 19 year old male patient presented with refusal to eat, disturbed sleep, maintaining posture, excitement, echopraxia, perseveration, decreased self care, minimal speech, suspiciousness that people are against him and discuss about him for 2 months duration. There was no past or family h/o mental illness. On mental status examination, patient had decreased psychomotor activity with occasional excitement, negativism, posturing, ecoprexia, perseveration and delusion of reference and persecution. General physical examination and Systemic examination were normal. He was diagnosed as catatonic schizophrenia & treated with trifluperazine and 4 ECTs. On Subsequent follow up trifluperazine dose was increased, within 4 days he presented with severe EPS and catatonic symptoms. Bush-Francis Catatonia Rating Scale score was 30 on admission. Antipsychotics were stopped, there was slow improvement in his EPS, but catatonic symptoms persisted, Quetiapine which has a low propensity for EPS was started and ECTs were continued. As he was young boy and born of 2nd degree consanguinous marriage and was sensitive for EPS we thought in terms of Wilsons disease and investigated. Investigations: Routine investigations were normal and MRI Scan of brain didn't reveal any copper deposition in basal ganglia. 24 hours urinary copper excretion was 2165 mg/lt, serum ceruloplasmin of 45 u/lt and serum copper 160 μg/dl. Slit lamp examination of the eye and X-rays of the hand were within normal limits. After starting him on zinc 50mg tid and ECTs he showed significant improvement in symptoms and was discharged.
Conclusion: Catatonia is rarely associated with Wilson's disease. Because effective treatment is available, it is important to make this diagnosis early.
Diagnostic stability of internet addiction in obsessivecompulsive disorder: Data form naturalistic one year follow-up study
Rajshekhar B. Yssr Rao, Ashok Reddy, K., Srinath G.
Introduction: A sub-set of people who use internet develop Internet Addiction (IA), which is a relatively new concept in psychiatry. Conceptually, the diagnosis is a compulsive-impulsive spectrum disorder. However there is considerable controversy whether IA is a disorder in itself qualifying for inclusion as a separate diagnostic identity in DSM-V, or whether it is a just a manifestation of an underlying. psychopathology.
Aims and Objectives: The present study systematically investigated the stability of diagnosis of IA in Obsessive-Compulsive Disorder (OCD) patients who were followed-up prospectively for 1 year.
Methodology: IA was assessed with Young's Diagnostic Questionnaire and Internet Addiction Test (Young, KS, '98') at baseline in OCD patients. Those who fulfilled the criteria for IA were then followed-up over a period of 1 year. Yale Brown Obsessive Compulsive Scale (YBOCS) was administered at various points of time to assess the severity of OCD. Different analytic methods assessed the stability of IA symptoms in this study population.
Results: Most of these patients did not maintain the criteria for IA at follow-up. Although all these patients had received treatment for OCD during the follow-up period, and had shown improvement on YBOCS score, the symptoms of IA improved with treatment for OCD, and no specific treatment was per se given for IA.
Conclusions: The frequent co-occurrence of psychiatirc disorders with problematic Internet use raises questions regarding the distinctness of IA as a diagnosable psychiatric disorder. At the most, IA appears to be a manifestation of an underlying psychological disturbance, and treatment of this disturbance appears to improve the symptoms of IA. Till further robust data become available IA should not be reified as a separate diagnosis in DSM-V.
Is it more similar than different from adult psychopharmacology?
Himanshu Sareen, J.K. Trivedi
Punjab Institute of Medical Sciences, Jalandhar, India
Despite having a large chunk of human population, Asian countries face shortage of mental health professionals. There is further shortage of doctors dealing with special groups of population like the children, the elderly and the medically ill. However, in this era of super-specializations, are the basic principles of general psychopharmacology being forgotten? Dealing with child population is different and often more difficult than adult population but are management guidelines for the two populations vastly divergent? A close look at this paints a different picture. Psychotherapies applied in adults and those in children and adolescents are disparate owing to cognitive, social, emotional, and physical immaturity in children and adolescents. But the drugs for the treatment of paediatric psychiatric disorders are mostly similar to those prescribed for adults (case in point bipolar disorders, Obsessive Compulsive Disorder (OCD), schizophrenia). Rather than focussing energy on propagating the differences in assorted subgroups of population, honing of skills regarding intricacies of psychopharmacology is required to be emphasized. Detailed history taking, careful evaluation of the patient, sound diagnostic formulation and prescribing medications which are tailor made to the patient, will all go a long way in ensuring a functional recovery of the patients irrespective of the group they belong to.
Atypical presentation of oligodendroglioma as depressive disorder
Abhinit Kumar, Pankaj Verma, Madhusudan, Rajesh Rastogi
VMMC & Safdarjung Hospital, New Delhi, India
Background: A 50 yr old male patient Mr. X, had depressive symptoms since 2½ yrs who was being treated as major depressive disorder and pseudodementia for six months, was not improving, had lost his job due to the illness, there was no focal neurological deficit or sign of raised ICT, seizure etc. Later on was found to have oligodendroglioma-low grade left temporo-parietal lobe which when removed surgically led to complete remission of depressive symptom.
Conclusion: This case report highlights the fact that brain tumors may rarely present with only psychiatric manifestations and hence such atypical presentation should be kept in mind while approaching patient with psychiatric symptoms not improving with treatment. Will be discussing the case in detail in poster.
A case of periodic hypersomnia with behavioural disturbances- Kleine Levine syndrome, treated successfully with lithium
Shankar K., Johnson Pradeep, Jessie Joseph
St. Johns Medical College, Bangalore, India
Introduction: Periodic hypersomnia with behavioural problems are usually seen secondary to epilepsy, MS, stroke, infectious encephalitis. Primary idiopathic periodic hypersomnia with behavioural disturbances, known as Kleine Levin syndrome, is a rare entity with only around 186 cases reported in literature so far. We here describe a case of idiopathic periodic hypersomnia with behavioural disturbances, diagnosed as Kliene-Levine syndrome, successfully managed with Lithium.
Case Report: MS, a 17 year old girl, from an urban background, easy temperament, stable family, presented with 2 month H/O episodes characterised by hypersomnia (13-16 hrs a day), physical aggression, depersonalisation, compulsions and abnormal sexual phenomena on waking up with complete amnesia of the episodes. Relapsing-remitting nature of the illness was seen with similar episodes being present for a month since 2 years with 4-5 such cycles observed till patient presented to us. Physical aggression was the most disabling symptom with no response observed after a trial of Methylphenidate. (40 mg/day for 8 months) with Carbamazepine (800 mg/day for 8 months). Routine EEG and MRI brain were normal. A prolonged video EEG also was not contributory. Serum T3, T4, TSH, Cortisol was normal. Overnight polysomnography showed predominant absence of slow wave sleep and increased density of Stage 1 and 2 NREM sleep. A diagnosis of Klein Levin syndrome was made and patient was started on Lithium and Methylphenidate and Carbamazepine were tapered. The aggressive outbursts reduced in intensity in a fortnight and no abnormal sexual phenomena on waking up were noted much to the relief of parents. She had a relapse of symptoms after an year which was milder and lasted for a week which remitted later. Currently, patient is symptom free on 900 mg Lithium per day.
Discussion: Treatment of KLS is currently based only on case-reports with very limited treatment options. Amphetamine improves only hypersomnia, but behavioural symptoms have not shown amelioration. Neuroleptics have also reported to be ineffective in case reports. Lithium is reported to be effective in preventing relapses. In our patient, Lithium not only was effective in preventing relapses, but also reduced aggression and behavioural problems during an episode. Lithium could thus be a good treatment option for this rare, yet devastating disorder.
Learning disability and ADHD coexisting entities in primary school children
Ranjana Kar, Malati Ghosh
National Medical College and Hospital, Kolkata, India
Clinical and psychoeducational data were analyzed for 25 children ages 5 to 10 years who were evaluated in a child diagnostic clinic. A learning disability (LD) was present in 70% of the children with attention-deficit/hyperactivity disorder (ADHD), with a learning disability in written expression two times more common (65%) than a learning disability in reading, math, or spelling. Children with LD and ADHD had more severe learning problems than children who had LD but no ADHD, and the former also had more severe attention problems than children who had ADHD but no LD. Further, children with ADHD but no LD had some degree of learning problem, and children with LD but no ADHD had some degree of attention problem. Results suggest that learning and attention problems are on a continuum, are interrelated, and usually coexist.
A case of Turner syndrome with schizophrenia
Dinesh Kataria, Kumar Gaurav, Mukesh Jha
Lady Hardinge Medical College, New Delhi, India
Both Turner syndrome and schizophrenia are relatively infrequent conditions. Consequently, individuals having both illnesses are rare. Abnormalities of sex chromosomes are associated with various forms of neuropsychiatric disorders, such as schizophrenia. Turner syndrome occurs approximately threefold more frequently in female schizophrenics compared to the general female population. We herein report a case of Turner syndrome with schizophrenia. Case S was admitted to our hospital at the age of 40 years with the chief complaints of auditory hallucination, persecutory delusion and remarkable excitement, and was thus diagnosed to have schizophrenia (paranoid type) according to DSM-IV. The patient had a short stature (148.0 cm), a webbed posterior neck, a broad chest with widely spaced nipples and a cubitus valgus. Poor development of secondary sexual characteristics and primary amenorrhea were also present. These physical findings led to a chromosomal analysis which revealed her to have karyotype 45X. Further clinical examinations for the visceral anomalies of Turner syndrome disclosed a horseshoe kidney with a partial double ureter. Antipsychotics were partially effective in treating hallucinations or delusions.
Acute pancreatitis associated with the use of sodium valproate
Santosh Kumar Sah, Dinesh Kataria, Raj Kumar Singh
Lady Hardinge Medical College, New Delhi, India
The incidence of pancreatitis following the use of drugs varies between 2-15% among the general population. Acute pancreatitis due to Sodium Valproate is a rare side effect. It may be an idiosyncratic complication unrelated to the patient's age, the duration of the treatment and the dose of the drug. One of the possible cause that triggers pancreatitis is the direct toxic effect produced by free radicals on the pancreas.
Case: A 21 years old, Hindu female patient having generalized epilepsy with behavioral problems, being treated with Sodium valproate with a dose of 15 mg/kg/day, administered in two divided doses, complained of acute pain abdomen localized in the epigastrium which was not alleviated by the administration of common antispasmodic and analgesics; concomitantly she had nausea and 38.5Ί C fever, for which she was hospitalized. On examination there was tenderness over upper abdomen. No masses or hepato-splenomegaly was palpable and bowel sounds were present. The remainder of the examination was normal. Surgical and medical opinion were taken. She was investigated for acute pain abdomen. On lab report nothing was abnormal except elevated level of serum amylase and lipase isoenzymes. Abdominal ultrasonography revealed mild ascites and morphologically normal pancreas. There were no peripancreatic fluid collections and no biliary dilatation. An abdominal computed axial tomography (CAT) did not show cystic or tumour lesions and confirmed enlargement of the pancreas.
Conclusion: Acute pancreatitis must always be considered while treating with Sodium valproate. Findings of pancreatic amylase and lipase isoenzymes would confirm the clinical suspicion. The suspension of the administration of valproate in patients who have acute pancreatitis is mandatory, and use of the Sodium Valproate must not be resumed once the patient has recovered.
Compliance of prescribed dextropropoxyphene in opioid dependent patients: Role of urine testing
Raka Jain, Raman Deep Pattanayak
AIIMS, New Delhi, India
Introduction: A valid assessment of drug consumption is critical for evaluating substance abuse treatment programmes and interpreting treatment outcome data. Objective assessment has become essential for such programs.
Aims and Objectives: The study aims to evaluate the compliance of prescribed dextropropoxyphene and detection of illicit drug use among opioid dependent subjects.
Materials and Methods: A total of 2122 urine samples over a period of one year were collected from patients seeking treatment at National Drug dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi. Their diagnosis, drug use history, medicines being prescribed were recorded on the drug abuse screening request forms by the clinicians and urine samples were sent to Centre's laboratory for testing. The urine samples were screened for illicit and prescription drugs by thin layer chromatography (TLC).
Results: Out of 2122 urine samples, 510 samples were found to have dextropropoxyphene prescribed for the treatment of opioid dependence. The urinalysis results revealed that 25.3% of the samples did not test positive for dextropropoxyphene and 15.5% were found to be positive for morphine, pointing to illicit opioid use. Benzodiazepines were co-prescribed with dextropropoxyphene in almost half (52.5%) of the samples, but were present in only one-third (31.7%) of samples.
Conclusions: Urinalysis plays a pivotal role in the clinical management of patients, decrease the risk of diversion and influence the policy decisions regarding dispensing of medicine at a particular facility. The study concludes that it is highly desirable to incorporate urinalysis as a routine procedure in all substance use treatment clinics, even while dispensing opioids for short-term treatment purposes. (Supported by National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India).
Management of treatment resistant schizophrenia patient with history of complex partial seizure: A case report
Maheshwar Nath Tripathi, Jai Singh Yadav, Abhishek Pathak, Uddip Talukdar
BHU, Varanasi, India
Aim and Objective: About 30-60% of schizophrenic patients do not respond adequately to antipsychotic treatment and are known as refractory schizophrenia patients. The management becomes more challenging when treatment resistance is complicated with other medical condition like seizure disorder. We report a case which highlights the management of treatment refractory schizophrenia with history of complex partial seizures.
Materials and Methods: A case of 36 years old man admitted from psychiatry OPD of a tertiary care hospital, who had over 13 years' history of schizophrenia, with occurrence of four attacks of complex partial seizure. He was resistant to high doses of typical and atypical antipsychotics and antiepileptic therapy and was troubled by marked and persistent extra-pyramidal symptoms (EPS). Refractory schizophrenia criteria were established based on Kane's studies with clozapine and modified by the International Psychopharmacology Algorithm Project (IPAP). Scales used were Brief-Psychiatric Rating Scale (BPRS) for symptoms rating, and Clinical Global Improvement (CGI) /Quality of Life Scale (QLS) for general condition.
Results: Treatment with amisulpride (800 mg/day), clozapine (300 mg/day) and sodium valproate (1000 mg/day) resulted in substantial improvements in symptom ratings (BPRS) and general condition (CGI/QLS). These improvements were reflected in enhanced social function and quality of life and good compliance during 18 months treatment.
Conclusion: Combination of amisulpride and clozapine is justified as well as valproate can be the safest and best-tolerated antiepileptic drug (AED) as reflected in this case. Although clozapine increases seizure threshold but the dose used is reasonable. This case study also highlights the fact that valproate is well tolerated with clozapine.
Prevalence of psychological problems in adolescent school students using sacks sentence completion test
Subodh Kumar, Saurabh Raj
Bokaro General Hospital, Bokaro Steel City, Jharkhand, India
Background: Adolescent school students are among the most vulnerable groups for varied psychological problems. Equipping with such a tool which has high chance of social acceptability in non- psychiatric situations and easy administration process in target groups is required to work effectively in this area of research.
Aims: The present study aims to see the prevalence of psychological problems in significant life- areas (self-concept, family, interpersonal relations and sex) of adolescent school students of an industrial town, Bokaro Steel City, using Sacks Sentence Completion Test (Sacks and Levy, 1950).
Methodology: One hundred adolescent students of both sex, aged 16-19 years, studying in class 12th in three different English medium schools of Bokaro Steel City were included in the study on the basis of random sampling. All the students were assessed on SSCT with their consent on four different times, from June to September, 2010. The obtained data are in the process of analysis.
A case of atypical tardive dyskinesia complicated with diabetes
Ganesh Shanker, Jai Singh Yadav, Maheshwar Nath Tripathi
Aims and Objective: Tardive dyskinesia most commonly occurs in patients with psychiatric conditions who are treated with antipsychotic medications for prolong period of time. We report a case of an atypical tardive dyskinesia complicated with diabetes along with psychiatric manifestation and its management.
Materials and Methods: A case of 41 year old male was admitted from psychiatry OPD with complaints of excessive sleep, laziness, decreased activities, jerky movements of the whole body and marked disturbances in his behavior. He was not following command of his relatives and he was not listening to them. He was known diabetic for more than a year. There were no features of aggressiveness, abusive language or suspiciousness towards others. Scales used were Brief-Psychiatric Rating Scale (BPRS) for symptoms rating, Clinical Global Improvement (CGI) /Quality of Life Scale (QLS) for general condition and Modified AIMS (abnormal involuntary movement scale) for movement rating.
Results: Treatment with atypical antipsychotic (Quetiapine 200 mg/day), Pregabalin 75 mg/day and Injection insulin resulted in substantial improvements in symptom ratings (BPRS), general condition (CGI/QLS) and AIMS score. These improvements were reflected in enhanced social function and quality of life and good compliance.
Conclusion: In our case report we found that the trunk movement of the patient was very prominent which came out to be an atypical and rare presentation of tardive dyskinesia, not noticed in previous studies. Second part we found that pregabalin was very effective in managing this condition.
Comparison of rapid eye movement latency between male and female major depressive patients
Ravi S. Pandey, P.S. Sajish, Bindu M. Kutty, Naveen Kumar
NIMHANS, Bangalore, India
Aims and Objective: To compare rapid eye movement (REM) latency between male and female major depressive patients.
Methodology: Patients diagnosed as major depressive disorder according to DSM IV were included in the study if they satisfied certain specific inclusion criteria. After hospitalisation, they were evaluated by structured clinical interview for DSM IV, Hamilton Rating Scale for Depression and baseline biochemical tests. Following one night of acclimatization, they were subjected to standard whole night Polysomnography using EEG, EOG and EMG. The variable considered for this study was REM latency.
Results: Among the 30 patients (M15, F15), only 27 patients (M14, F13) had REM stages. Female depressives had higher REM latency (mean+SD=129.03+51.93) than male counterparts (mean+SD=65.21+42.16) which was statistically significant (P<0.002).
Conclusion: Female depressives have longer sleep latency than male counterparts. It may be a vulnerability or state factor for depression in female.
Trichotillomania, a case report : Poster presentation
R.S. Swaroopa Chary, Samrat Kar, C.M. Pavan Kumar Reddy,
R. Sateesh Babu
Mamata General Hospital, Khammam, Andhra Pradesh, India
Trichotillomania is a chronic disorder characterized by repetitive hair pulling, driven by escalating tension and causing variable hair loss that is usually visible to others. The prevalence of trichotillomania may be under estimated because of accompanying shame and secretiveness. Childhood type of trichotillomania occurs approximately equally in boys and girls. Significant co morbidity is found between trichotillomania and OCD, affective illness, eating disorders and various personality disorders. Disturbances in mother child relationships, fear of being left alone, and recent object loss are often cited as the critical factors contributing to the condition. The present case of trichotillomania is a young female of 21 years with mental retardation. The details of the case and the psychosocial factors will be discussed in the conference.
A case of Cotard's syndrome in an elderly male with recurrent depresive disorder - A case report
Nihad A. Amanullah, Krishan S., Anil Prabhakaran
Government Medical College, Trivandrum
Background: Cotard's syndrome is a rare neuropsychiatirc syndrome originally described by and named after Dr. Jules Cotard, a French Psychiatrist as le delire des negation in 1880 in a middle aged female. This syndrome is characterized by the presence of nihilistic delusions - of being dead, not existing, putrefying, losing blood and internal organs. Jules Cotard described various degrees of severity ranging from feelings of despair and self-loathing to denial of the very existence of self. Though encountered primarily in psychiatric disorders like depression, schizophrenia and bipolar disorder, Cotard's has also been associated with structural and functional Brain dysfunction. The author seeks to increase awareness of the condition and the options of management as evidenced by literature.
Materials and Methods: Case Report: An elderly male with recurrent depressive disorder with cortard's syndrome which failed to respond with ECT, but responded to a combination of antipsychotic and antidepressants.
Result: The patient failed to respond to ECT but responded with a combination of Mirtazapine, Venlafaxine and Risperidone within 2 weeks.
Conclusion: Cotard's delusion is a spectrum of delusions seen in individuals with various psychiatric and neurological disorders. The authors would like to highlight the importance of diagnosing this rare yet historically important clinical syndrome and the various options of treatment and its prognosis.
Knowledge and attitude towards the perceived health risks of tobacco among patients with bipolar disorder and nicotine dependence
Raman Deep Pattanayak, Rajesh Sagar, R. Jain
A.I.I.M.S., New Delhi
Introduction: Nicotine dependence is frequently seen in association with bipolar disorders. The patients with bipolar disorders are at an increased risk for nicotine-related illnesses compared to general population. Yet they may not fully appreciate the health risks associated with nicotine use.
Aim: The study aims to assess the knowledge and attitude towards the health risk associated with tobacco use.
Methodology: A sample of 30 bipolar disorder patients who had a comorbid diagnosis of Nicotine dependence as per DSM-IV were included. The socio-demographic profile, clinical details and substance use history were noted. The severity of addiction was assessed using Fagerstrom test for nicotine dependence. A detailed semi-structured questionnaire was administered for assessment of intention to quit, awareness of health risks and attitude towards health warnings.
Results: Preliminary results suggest a moderate to higher level to nicotine dependence in most patients. Majority had a limited knowledge and a lax attitude towards the displayed health warnings over the tobacco product packets.
Conclusion: The assessment of patient's perceptions of health risk is an essential step before planning an intervention for this population.
Nicotine use disorders in schizophrenia - Is the symptom profile and severity of symptoms in schizophrenia related to nicotine use?
Nithya B., Shubangi R. Parker, Jahnavi S. Kedare
Flcon Castle, Lower Parel, Mumbai, India
Introduction: Several studies have shown that the rate of smoking in patients with schizophrenia is two- to four-fold the rate seen in the general population (20-35%).The reasons for the widespread smoking behaviour seen in schizophrenia are not well understood. Cigarette smoking has been reported to have beneficial effects on negative symptoms, extrapyramidal symptoms, cognitive functioning and mood symptoms. Studies have been done showing no significant differences between smoking and non-smoking groups with regard to Positive and Negative Symptom Scale. In contrast studies have demonstrated that high Positive and negative symptom scale (PANSS) total scores and positive symptoms were less frequent in mildly dependent smokers than in non-smokers or highly dependent smokers. Not many Indian studies are available on this issue.We therefore conducted the study in our institute to have a better understanding about the topic.
Aims and Objectives: (1) To study the prevalence of nicotine use disorders in patients with Schizophrenia. (2) To study the pattern of use of nicotine containing products. (3) To study the correlation between severity of nicotine use disorders and the symptom profile and severity of symptoms in schizophrenia.
Materials and Methods: A sample of 200 consecutive male patients of schizophrenia attending the psychiatric OPD in a tertiary care hospital were assessed. The diagnoses of schizophrenia was done using the DSM-IV TR criteria. They were then administered Fagerstrom Nicotine Dependence Scale (FNDS)/Fagerstrom Test of Nicotine Dependence-Smokeless Tobacco (FTND-ST), PANSS and Brief psychotic rating scale (BPRS). Data was tabulated and statistical analysis was done. Results will be discussed.
A study of parent's burden during the care of their autistic children who are service utilisers of few selected intistutions of Delhi
Sindhu Rajesh, Raminder Kalra, Shailja Singh, Minakshi Mann, K.E.S. Unni.
Methodology: A study was conducted in the city of Delhi on the parents whose children were autistic and receiving care from out- and in-door service of the Department of Psychiatry, LHMC, and also from paramedical day care facility of different Non Governmental Organisations. 50 children between 3 and 15 years diagnosed (independently by two consultant psychiatrists) to have autism or autism spectrum disorders were studied.
Aims and Objective: The aim was to assess the psychosocial burden of parents of children with autism or autism spectrum disorders using Zarit's Burden Interview Schedule.
Results: Among the parents 60% of them were of 36-45 years of age. 42% were post graduates, and 40% were graduates. 40% of mothers were house wives; 48% of the parents were with an average family monthly income of above Rs. 25,000/-; 62% belonged to nuclear family; 54% of the parents were with 2 children including the autistic child. As regards to children 48% were of the age group of 6-10 years, and among the 58% of the parents were with more than one child, 32% had their second child autistic. 46% of the children were diagnosed as autistic, between the ages of 1-3 years. 84 % were male children and 16% were female children. 60% of the parents had mild burden and 22% had moderate burden. Among the informants 74% were mothers, who experienced higher burden than the fathers. The parents with higher education and higher income had low burden, and those who belonged to nuclear family had high burden; urban residents were with low burden and those who have a family history of mental illness also had a low burden. The sex of the children did not make any significant difference in the burden of parents. There is an increased burden experienced by parents with the increasing age of their autistic child. The need to further analyse the burden of the parents as care giver to their autistic children, so that adequate intervention strategies can be streamlined with specificity is highlighted.
Prescription patterns in stable patients of unipolar depression
Shreyas Pendharkar, Alakananda Dutt, Sandeep Grover,
Subho Chakrabarti, Munish Aggarwal, Ajit Avasthi,
PGIMER, Chandigarh, India
Background: Antidepressants are one of the important treatment modality for the management of unipolar depressive disorder (first episode depression and recurrent depression). Most of the guidelines suggest use of a single antidepressant in the initial treatment with an adjunct antipsychotic when psychotic symptoms are present. However, studies suggest that when it comes to prescribing medications very few clinicians adhere to the recommendations of guidelines, in clinical practice. There is lack of data from India, with respect to prescription patterns in subjects with unipolar depression.
Aim of the study: To study the prescription patterns in the stable patients of unipolar depression.
Methodology: Data were collected prospectively from 164 patients with unipolar depression attending psychiatry outpatient clinic.
Results: Majority of the subjects were females, mean age being 43.7 years, married, Hindu by religion and from urban nuclear families. Venlafaxine (N=38; 23.17%) was the most commonly prescribed antidepressant whereas Selective Serotonin Reuptake Inhibitors (SSRIs) together formed the largest class of antidepressant prescribed (N= 0; 36.58%). Very few patients (N=5) were receiving more than one antidepressant and 13.4% of subjects were receiving a combination of an antidepressant and an antipsychotic agent. Besides antidepressants, 9 patients were on benzodiazepines.
Conclusion: Most of the patients are prescribed only 1 antidepressant for management of depression. SSRIs as a class are the most commonly prescribed antidepressants and Venlafaxine is the most commonly prescribed antidepressant agent.
Prescription patterns in stable schizophrenia subjects
Sudhir Mahajan, Munish Aggarwal, Sandeep Grover,
Subho Chakrabarti, Alakananda Dutt, Ajit Avasthi,
PGIMER, Chandigarh, India
Background: Schizophrenia is a severe mental disorder, in which antipsychotic agents form the mainstay of treatment. Most of the guidelines suggest use of a single antipsychotic in the management of schizophrenia; however, studies from the west suggest that when it comes to prescribing medication in clinical practice very few clinicians adhere to the recommendations of guidelines. There is lack of data from India, with respect to prescription patterns in schizophrenia subjects.
Aim of the study: To study the prescription pattern in stable schizophrenia subjects.
Methodology: Data were collected prospectively from 298 schizophrenia subjects attending psychiatry outpatient.
Results: Almost half of the patients were males, single and less than 30 years of age. Two-third of them were unemployed or engaged in house hold work, belonged to nuclear family from urban background and three-fourth of them were Hindu by religion. Most commonly prescribed antipsychotic agent was olanzapine (N=144) followed by risperidone (N=83) and clozapine (N=22). Other antipsychotics that were prescribed included quetiapine, aripriprazole, ziprasidone, trifluperazine, amisulpride. About 5% of the patients (N=16) received combination of antipsychotics, 15% of patients (n=44) received an antidepressant in addition to an antipsychotic agent. Among the patients who received combination of antipsychotics, 6 received an antidepressant in addition to the combination of antipsychotics. Three-fifth of the sample received only one drug, while the rest had more than one psychotropic agent.
Conclusion: Atypical antipsychotics are the most commonly prescribed drugs and more than one antipsychotic is used in a few cases only, though antipsychotic are combined with other psychotropic agents.
Tramadol dependence: Case report
Gayatri Devasthali, Debasish Basu, Gayatri Devasthali,
Munish Aggarwal, Nidhi Malhotra
PGIMER, Chandigarh, India
Background: Opioids are commonly abused drugs. Initially the opioid pain medications were marketed as drugs with low abuse potential. Later, there are reports which have shown that these drugs have abuse potential. Tramadol is not widely known as an opioid with abuse liability.
Aim: To present two cases of tramadol dependence.
Case description: First patient is a 37-year old married male who started with codeine containing cough syrup at 19 years and later experimented with dextropropoxyphene, heroin and crude opium. He came for treatment in our Centre in 2009 and was advised detoxification regime. Oral tramadol six tablets of 50 mg each (300 mg/d) was added later because of severe withdrawal symptoms. Patient dropped out of follow-up and escalated the dose of tramadol up to 30 tablets per day. After two admissions and repeated attempts on OPD basis, he was able to remain abstinent at the time of last contact. He was also dependent on alcohol. The second patient started abusing substances at 10 years of age, also initially experimented with injection pentazocine, dextropropoxyphene and then later shifted to tablet tramadol. His brother has a chemist shop and patient has access to medicinal products. He increased the dose to 10 tablets of 50 mg each per day. Patient also has alcohol dependence and a history of past episode of mania.
Conclusion: These two cases illustrate that the individuals who have dependence on multiple substances and especially on the medical products have chances of getting dependent on tramadol.
The study of psychiatric morbidity in the inmates of old age home
N.H. Vaishali, Kosgi Srinivas, Satheesh Rao
Yenepoya Medical College, Mangalore, Karnataka, India
Aims amd Objectives: To determine the frequency of psychiatric morbidity and disability and their association with various psychosocial and physical variables in the inmates of old age homes.
Materials and Methods: Study was conducted in old age home "Abhaya ashraya". Two hundred forty five patients were screened from October 05 to January 07 using short psychiatric evaluation scheduled (SPES). One hundred ten inmates scoring 4 on SPES were evaluated for sociodemographic details, physical examination, disability and Mini-International Neuropsychiatric Interview (MINI).
Results: Among Psychiatric disorders, depressive disorders were found to be 58.2% (F=64), dysthymia; 30% (F=33), psychotic disorders; 8.2% (F=9), GAD; 2.7% (F=3), dysthymia and GAD; 0.9 % (F=1). Psychotic disorders positively correlated with past history of psychiatric illness, female gender and duration of stay. Mean of Disability was found to be 1.4182 + 0.9024. Disability was positively correlated with past physical illness, respiratory diseases and visual problems and family history of physical illness.
Conclusion: The study showed that depression and dysthymia were significant morbidities among the inmates and that presence of past psychiatric illness; longer stay and female gender were the predisposing factors.
Community psychiatry mental health training of general physicians: Matching training contents to the perceived training needs
IHBAS, Delhi, India
Aims and Objectives: Contents and process of GP training programmes are mostly decided by psychiatrists and a psychiatric disorder based approach is followed in these training programmes. The present study is an exploratory study to find out - (i) Perceived mental health training needs of general practitioner (GPs) in rural India and (ii) Whether the perceived needs of GPs and their interest to learn about various mental health problems match with the contents of these training programmes.
Methodology: All of the 15 GPs practicing in a block area in Northern India were interviewed using a semi-structured interview schedule prepared for the purpose of this study. The GPs were interviewed regarding- (i) their views on clinical importance of various mental health problems in their practice, (ii) their self-reported competencies in diagnosis and treatment of mental health problems, and (iii) their perceived needs for training in various mental health problems. Two approaches were adopted to state the mental health problems the traditional psychiatric disorder based approach as followed in training programmes and an alternative approach of possible clinical presentations of patients with mental health problems in GP/PHC setting.
Results: The results are analysed to compare the GPs' responses on two approaches and to find out GPs' preferences about mental health topics in training programmes for them. The results and their implications for developing mental health training programmes for GPs were discussed.
Conclusion: Active consideration of GPs' perception about training needs and process while formulating a GP training programme in mental health can help in enhancing their participation and making the training more effective.
HIV associated dementia, a diagnostic dilemma?
Agrim Bery, Sumit B., Rujuta G., Saldanha D., Archanaj, Bhattacharya L.
Dr. D.Y. Patil Medical College, Pune, Maharashtra, India
Background: Ever since Navia et al in 1986 described a triad of clinical symptoms which were categorized as AIDS dementia complex (ADC), the occurrence of dementic symptoms in an established case of HIV were considered to be common neurologic disorder affecting 6% to 30% of all infected persons with HIV. In 1990 the WHO recommended a new diagnostic term, HIV Associated Dementia (HAD) to replace ADC.With the introduction of highly active anti-retroviral therapy (HAART) the incidence of HAD has reduced and the median survival rate from 6 months has increased considerably. The early detection of HAD in presence of behavioural abnormality poses considerable diagnostic problem.
Aim: To estimate the incidence of HAD in HIV cases in a semiurban industrial Area.
Materials and Methods: Those who registered for HIV Pre-test counselling from January 2008 to August 10 in a prestigious Medical College Hospital formed the basis of the study. They were followed till they were screened out for HIV Status and development of any Psychiatric problems in those cases who were detected to be HIV positive.
Results: A total of 6135 who were subjected to Pre-test Counselling from January 2008 to August 10 5688 (92.71%) underwent tests for HIV Status. Out of these 5297 (93.12%) were subjected to Post-test Counselling. 273 (4.80%) cases were found positive for HIV by western blot . 246 (90.10%) cases were put on HAART. One case was detected to have developed HAD stage II.
Conclusions: Although HAD is the initial AIDS defining illness in 3% of HIV +ve patients, it is a clinical dilemma in undiagnosed HIV cases in the early stages. The incidence of HAD has significantly reduced after the introduction of HAART.The HIV patients can hope for a better living with the easy availability of HAART.
Alcohol induced psychosis, Is it common?
Anuja Kelkar, Vishal P., Devjit D., Saldanha D., Archana J., Bhattacharya L. Padmashree
Dr. D.Y. Patil Medical College and Research Centre, (Deemed University), Pune, Maharashtra, India
Background: The occurrence of Psychosis on prolonged and continuous use of addictive substances is well known. However their incidence in semi urban setting in an industrial area is relatively unexplored.
Aim: To estimate the incidence of Alcohol induced Psychosis in a semiurban industrial Area.
Materials and Methods: A total of 518 consecutive psychiatric admissions from January 2009 to June 10 were identified according to International Classification of Diseases (ICD-10) for Alcohol Dependence syndrome were analysed in the present report. Demographic variables taken into account were Age, sex, economic status, age of initiation of alcohol abuse, duration of use and co morbidity. The results were analysed by SPSS.
Results: Five hundred eighteen patients were taken into study. 69 (13.32%) were Alcohol dependence Syndrome. 75.37% of Alcohol dependent cases were below the age of 40 years compared to 87.08% of non alcohol/Psy cases. 52.17% were illiterate compared to 53.45% of other Psy cases. 47.83% were either undergraduates or graduates compared to 46.45% of other cases. 59.38% of cases were earning less than Rs 3000 compared to 56.13% of other cases. Where as 40.58% had an income of Rs 3000 to 7000 compared to 43.87% of other cases. 76.81% were Alcohol dependent cases. 7.25% had co morbid Psychiatric illness. 11.59% had Alcohol with medical problems. 5.80% were Alcohol induced Psychosis. The duration of alcohol abuse varied between 2 to 25 years.
Conclusions: The onset and precipitation of Alcohol induced Psychosis depends on the duration of alcohol abuse, the amount of alcohol intake and abrupt cessation of intake.
Mega cistern magna associated with recurrent catationa: A case report
Shravani Sur, Sudhir Kumar, Ashutosh Singh
Institute of Mental Health and Hospital, Agra, Uttar Pradesh, India
We present a case of recurrent catatonia with cognitive deficits in a patient with 'mega-cisterna magna', a congenital defect within the 'Dandy-Walker Complex' continuum. The 37-year-old female had a 6 year history of recurrent catatonic symptoms of negativism, mutism, posturing and waxy flexibility despite adequate antipsychotic treatment. MRI scan revealed 'mega-cisterna magna' compressing left cerebellum. EEG revealed normal study. Thorough neuropsychological testing recorded deficits in memory, arithmetic skills and predominantly left sided sensory motor dysfunction, Patient responded dramatically with electro convulsive therapy (ECT) with resolution of catatonic symptoms within 2-3 ECTs in every episode. Symptoms reappeared within few months of stopping ECT. It is postulated that even a less extended cerebellar lesion, such as mega-cisterna magna, can be associated with psychosis, and in some cases with treatment refractoriness or cognitive dysfunction.
Social implications in gender identity disorder - A case report
Rahul Saha, Bandana Gupta, Anil Nischal, Rajneesh Kumar
CSMMU (KGMC), Lucknow, India
Many people who suffer from gender identity disorder do not regard their own cross-gender feelings and behaviors as a disorder. People suffering from gender identity disorder often question what a "normal" gender identity or "normal" gender role is supposed to be. We are presenting hereby a case report of an adult female in Indian society and her problems. A young adult self employed female of 27 yrs age of middle socio economic status from a conservative muslim community presented to our OPD with chief complaints of wanting a sex reassignment surgery from last 4-5 years. Exploration of history revealed severe internal conflict of having a feeling of being a man from inside despite having a body structure of female from the time she remembers. She revealed that she always had boyish character from childhood, avoided wearing girl's dress or using girl's toilet. She always involved in outdoor games such as football, cricket. She had sexual interest toward a girl but never to any boy. She is now facing lot of emotional problems such as frequent mood swings and irritability which is interfering in her daily life. She denied marrying a male. She adapted to male lifestyle. She also tried for a sex reassignment surgery in a renowned plastic surgery centre. She is now more concerned about her certificates, her job prospects and problems in her social life that is going to arise after the sex change operation due to her conservative muslim background. She is now arranging financial support for her operation without any psychosocial support. This case is being reported with an intention to highlight the emotional problems suffered by a female patient of gender identity disorder due to various social implications.
Case report of atypical autism in biological siblings
Sannidhya Varma, Anubhav Rathi, Vivek Agarwal
CSMMU (KGMC), Lucknow, India
Two biological brothers, aged 7 and 10 years, presented in our department with chief complaints of delay in developmental milestones, impairment in social and language skills and stereotyped behaviour. Personal history reveals minor ailments during both pregnancies with deliveries at full term. Both the brothers had a history of delayed developmental milestones till the age of about 5 years but developmentally they acquired motor, language and communication skills according to their mental age. After the age of 5 years there was a progressive decline in the previously acquired skills along with certain behavioral abnormalities. Both the brothers show decreased emotional reciprocity, poor eye to eye contact, impairment in social interaction with peers, spontaneous seeking to share enjoyment, interests, or achievements with other people, spontaneous make believe play or social imitative play appropriate to developmental level, along with presence of stereotyped and restricted motor and verbal mannerisms. On developmental behaviour check list both the brothers satisfied the criteria for autism. However, in view of their delayed developmental milestones before the deterioration, a diagnosis of atypical autism was kept as per the diagnostic criteria of DSM-IV-TR. On psychometric tests the mental age of the two brothers came out to be about 1½ years with IQ of the elder brother in range of 15-20 and that of the younger one in range of 20-25. We hereby present report of atypical autism in two biologically related siblings. Further details of clinical presentation, management plan, course and outcome will be discussed in the report.
Biological psychiatry socio demographic and clinical profile of epileptic patients visiting a tertiary care hospital in north India
Pankaj Kumar Gupta, Brajendra Kumar, Vishal Sinha
S.N. Medical College, Agra, Uttar Pradesh, India
Aims and Objectives: A clinical Audit of epileptic patients presenting to Psychiatry department in a state medical college in north India.
Methodology: Socio-demographic variables and clinical details of all patients presenting to psychiatry OPD and receiving a diagnosis of seizure disorder over a period of one year were collected and analyzed. Information pertaining to variables set by the authors to see incidence of various type of seizures, duration of untreated period, response to different anti-epileptics and adverse effects, if any due to the prescribed drugs, time required to become seizure free etc. were sought and interpreted.
Result: Generalised Tonic Clonic Seizure (GTCS) was the most common seizure type. Majority of the patients could be stabilised on monotherapy with the most commonly prescribed drug being Carbamazepine. Presence of comorbid mental retardation rendered the management of epilepsy difficult.
Conclusions: Careful evaluation of epilepsy type and cautious selection of antiepileptic medications can help to control seizures by monotherapy only, resulting in increased cost effectiveness, compliance and decreased economic burden and side effects of polypharmacy.
Catatonia: Towards an integrated neuropsychiatric approach
Jyoti Prakash, H.R.A. Prabhu, Kalpana Srivastava, P.S. Bhat, R. Shashikumar
AFMC, Pune, Maharashtra, India
Introduction: Catatonia is an interesting yet amorphous phenomenon in psychiatry and neurology. There exist a lack of clarity on its nosological status, diagnosis, pathophysiology and management.
Methodology: An extensive review and analysis of literature was attempted via MEDLINE to understand the history and evolving concept of catatonia over time.
Result: The analysis brought out the existence of various types of catatonia, its spectrum concept, diagnostic problems, proposed mechanism of dysfunction and management methods in practice. There was also an existing neurology-psychiatry divide on this subject despite strong evidence of neurobiological dysfunction primarily because of the associated behavioural and emotional symptoms.
Conclusion: The whole gamut of catatonic symptoms does reflect the need of separate diagnostic entity for catatonia to facilitate an integrated approach.
Electroconvulsive therapy in pregnancy
Vivek Kumar, Rajesh Rastogi, Pankaj Verma
Safdarjang Hospital, New Delhi, India
Aim: A comparative review of safety of electroconvulsive therapy during pregnancy. Psychiatric illness during pregnancy often presents a clinical dilemma. Pharmacologic interventions that are usually effective for these disorders have teratogenic potential and are therefore sometimes contraindicated during pregnancy. However, for depression, mania, catatonia, and schizophrenia, an alternative treatment exists : electroconvulsive therapy (ECT), the induction of a series of generalized seizures.
Conclusions: ECT offers a valuable alternative for treating the pregnant patient suffering from depression, mania, catatonia, or schizophrenia. Pharmacological therapy for these psychiatric illnesses carries inherent risks of side effects and adverse consequences to the unborn child. An effective and relatively safe alternative for pregnant patients requiring psychiatric treatment is ECT. In addition, complications reported in pregnant patients who received ECT during pregnancy have not been conclusively associated with the treatment. Long term complication in children of mother who received ECT has not been conclusively associated with the treatment. Research conducted to date suggests that ECT is a useful resource in psychiatric treatment of the pregnant patient.
A study on relationship between perceived academic performance and mental health among college students
Fernandez, Sandhya, Isabella
Aim: The major thrust of this study was to see the relationship between perceived academic performance and aspects of mental health in college students.
Materials and Methods: Two hundred and nineteen male and female undergraduate students from the colleges in Delhi were selected through randomized sampling technique. The major instrument used in the study was a Semi Structured Interview Schedule (SSIS), the General Self Efficacy Scale (GSES), General Health Questionnaire (GHQ), Attributional Style Assessment Test-I (ASAT-I) and the Rumination Reflection Questionnaire (RRQ). A single-item measure asked students to rate their overall academic performance as : "poor," "below", average," "average," or "above average" was used in order to determine their perceived academic performance.
Result: Analysis of results reveals the majority of (78.5%) students perceiving their performance as average. SPSS computer software X was utilized in the calculation of the research data, the result of the one-way ANOVA found out there was significant difference between self efficacy and perceived academic performance (3.58688). Post hoc analysis reveals the higher the self efficacy, the higher the academic performance. There was no significant difference between perceived academic performance and rumination, attributional style and mental health. There was a significant difference between actual academic performance in class 12 and perceived academic performance.
Conclusion: The present study concludes that the self efficacy is a factor which affects academic performance. The limitations and suggestions for future research are presented in the study.
Should opioids cause impairment in psychomotor performance?
Shrigopal Goyal, Atul Ambekar
Introduction: Drug dependence is a major problem and poses a significant burden on health care globally including India. A major proportion of the subjects seeking treatment in India are dependent on opiates (Ray, 2004). Opioids have been subjected to scientific assessment in terms of their propensity to impair cognitive and psychomotor functioning. The clinical importance of such studies is that they address the hazards of engaging in certain type of activities requiring higher levels of psychomotor functioning. Opioids are one of the most widely prescribed drugs for various purposes including for analgesia and as maintenance agents for opioid dependence. Among the drugs having abuse and dependence potential, opioids are most important which are used as well as abused and also have an influence on psychomotor performance.
Aims and Objectives: To assess if opioids may cause impairment in psychomotor performance or not.
Methodology: Literature was searched on Pubmed and Medline regarding psychomotor impairment by using different key words (opioid and psychomotor impairment, opioid and cognitive impairment, buprenorphine and psychomotor impairment).
Results: Most of the studies found no or minimal effect of morphine in healthy volunteers in one or more of the following tests; maddox-wing , digit symbol substitution, coordination, auditory reaction, immediate memory, reasoning, number vigilance, word recognition (Zacny et al, 1998; Walker and Zacny, 1998; Hill and Zacny, 2000; O'Neill et al, 2000). In contrast morphine has also improved some psychomotor performances in few studies like improvement in accuracy on choice reaction time (Hanks et al, 1995 and O'Neill, et al 2000). Curran et al (2001) found psychomotor impairment by undivided dose of daily methadone treatment in heroin dependent subjects. Methadone maintenance treatment was found to give variable results. Gritz et al (1975), Darke et al (2000) and Specka et al (2000) found impairment on psychomotor functions while Gordon et al (1976) did not. Similarly Buprenorphine impaired psychomotor performance in healthy voluntaries but its effect on drug abuser and Opioid maintained subjects were inconclusive.
Conclusions: Effects of opioids on psychomotor performance was different in different type of study population and some studies reported improvement in psychomotor performance but other reported no effects or impairment in psychomotor performance.
Narcotherapy for psychogenic aphonia: Case series
Shivanand Kattimani, Suresh Chand, Ashish Kumar Mittal
JIPMER, Pondicherry, India
Aims and Objective: Aphonia due to non-organic cause is rarely discussed in standard textbooks. There are no standard treatment modalities. Voice therapy and removal of stressors are general approaches. We would like to share our experience in such cases using narcotherapy.
Methodology: Case series Case 1: An 18 yr old below average intelligent boy just before his class X exams became aphonic. Therapy didn't help him. We could not consider malingering or factitious disorder and duration under our follow up was for 4 yrs. Case 2A: 24 yr male, recently married became aphonic for one month. He responded initially to therapy, some real stressor elicited, and later he showed getting 'high' with benzodiazepine use in the therapy. Over 1.5 yr of follow up he had lost his job and wife and was looking for disability benefit for his Aphonia. Case 3: 35 yr storekeeper became aphonic for one day and stressor identified were his and his daughter's illnesses. He improved with therapy with one session and remained well under follow up. Case 4: A 18 yr old girl, became aphonic when she was about to be sent to her husband's house. Therapy had no benefit and patient dropped out. Case 5: 35 yr homemaker landed with Aphonia following some verbal threat. One session of therapy helped regain her voice but lost again with no effect of further sessions.
Results and Conclusions: Functional Aphonia can happen in person with urban background. Use of benzodiazepine and thiopentone is safe. It may help in people with short duration aphonia (less than 24 hrs). Functional Aphonia can be associated with considerable morbidity.
Influence of sleep on children's academic achievement
Rohit Sharma, R.K. Solanki, Paramjeet Singh, Suresh Gupta
S.M.S. Medical College, Jaipur, Rajasthan, India
Aim: To study influence of sleep on children's academic achievement. For a child, recognition in the family and society is influenced by his academic achievements. Child behavioral, developmental outcomes and academic achievements are influenced by numerous individual factors, family factors, and community factors. In individual factors quantity and quality of sleep is important factor influencing the behavior and academic achievement.
Materials and Methods: Four hundred school children of sixth standard were enrolled in the study. Each subject's sociodemographic data was recorded and all subjects were assessed by general class room achievement scale (GCAS) for class sixth. On basis of the scores obtained in GCAS two groups were made : group A (low achievers) and group B (high achievers). Both the groups were assessed by sleep questionnaire.
Results: average sleep of group A was (506.7 minutes) statistically (P=0.023) higher than group B(464.0 minutes). The correlation of average sleep with academic achievement was -0.315 (P=0.014). 53.3% of group A subjects had night awakening, while only 23.3% of group B had night awakening, difference being statistically significant P=0.034. 73.3% subjects of group A watch TV in bed as compared to 60% in group B and 36.7% of subjects of group A read in bed as compared to 46.7 % of group B. 23.3% of subjects of group B had computer in bedroom as compared to 10% of group A. only 46.7% of subjects of group B have TV in bedroom as compared to 56.7% of subjects of group A.
Conclusion: Both quantity and quality of sleep influences children's academic achievement. Sleep environment also contribute to academic achievement. Sleep problems should always be searched and managed in low academic achievers to optimize their achievements.
Schizophrenia schizotypy as a trait marker for schizophrenia
Rohit Sharma, R.K. Solanki, Paramjeet Singh, Suresh Gupta, Mukesh Swami
SMS Medical College, Jaipur, Rajasthan, India
Aim: To evaluate schizotypy among first degree relatives of patient with schizophrenia .
Materials and Methods: A cross sectional study was conducted on first degree relatives (n=50) of patients with schizophrenia. They were assessed with schizotypal personality questionnaire (SPQ-B) and were compared with controls (n=30).
Statistical analysis used: Statistical analysis was done with the help of software 'PASW 18'. Group comparison was done with 'independent t-test'. P value as well as effect size (Cohen's d) for difference was computed.
Results: First degree relatives scored higher on all subscales of SPQ. Difference was significant on total score, cognitive perceptual & interpersonal subscale, with large effect size (Cohen's d>0.8). Difference was insignificant on disorganization subscale.
Conclusions: Features of schizotypy may indicate a trait marker for schizophrenia.
Role of stressful life event in relation to violence against women
Arvind Jinger, Pradeep Sharma, Alok Tyagi, Anil Tambi, Gunjan
S.M.S. Medical College, Jaipur, Rajasthan, India
Background: Domestic violence is the most common form of violence against women. It affects women across the life span from sex selective abortion of female fetuses to forced suicide and abuse, and is evident, to some degree, in every society in the world. Among that Incidence of domestic violence crosses all the barriers of class, income, race, culture and religion and is a highly under reported crime. Domestic violence is one of the greatest obstacles to gender equality and securing for women their fundamental rights to equal protection under the law and the right to life and liberty. The epidemic of violence directed at women and girls constitutes a major human rights issue and a public health crisis.
Aim and Objective: The study was conducted to fulfill the following aims-to evaluate the role of stressful event in relation to violence against women.
Methadology: The present study was carried out on a sample population of 35 women consecutively attending Mahila Salah Suraksha Kendra, Violence against women counselling Center Jaipur and same number of control group vertical taken from relative of these women with suitable inclusion and exclusion criteria. The two groups were compared for their psychiatric morbidity on following measure-
• Sociodemographic Proforma and identification sheet.
• Interview schedule of violence against women.
• Presumptive stressful Life Events scale by (Gurmeet Singh et al, 1981)
Results: By using the suitable statistics the results were emerge and concluded that those women whom suffer from violence have more stressful life event (7.03+2.42) and score of ISVAW) and co relation between PSLE and ISVAW (r=0.42).
Association of depression and metabolic syndrome
Kaberi Bhattacharyya, Somsubhra Chattopadhyay
Medical College & Hospital, West Bengal
Aims and Objectives: Previous reports have suggested that depression may lead to the development of cardiovascular disease through its association with the metabolic syndrome; however, little is known about the relationship between depression and the metabolic syndrome. The aim of this study was to establish an association between depression and the metabolic syndrome in a OPD based study conducted in Department of Psychiatry and Department of Biochemistry, MCH, Kolkata.
Methods: About 100 known unipolar depression patients were selected for the above study. Known cases of diabetes and coronary heart disease will be excluded. Patients will be given Beck Depression Inventory (BDI) (Bengali version) to note severity of depression. Different components of Metabolic Syndrome will be recorded as per guideline of National Cholesterol Education Program. Fifty age, sex, obesity, medical history, life style and habit matched Controls will be taken from the care givers of our OPD patients and screened for different components of Metabolic Syndrome. Written consent will be taken from all cases and controls.
Materials: BDI (Bengali version) HDL Cholesterol Triglycerides Fasting Blood Glucose, Blood Pressure, Abdominal Circumference.
Results and Conclusions: Data was analysed statistically and no association was found.
Depression, social psychiatry pathways to care of patients with first episode depression presenting to a tertiary care hospital
Prabhakar Holikatti, Sandeep Grover, Subho Chakrabarti, Parmanand Kulhara, Vineet Kumar, Shikha Tyagi, Pritpal Singh
Background: Cultural factors play an important role in manifestation of psychiatric symptoms and help seeking.
Aim: To study the pathways to care of patients with first episode depression.
Methodology: For the study 164 patients who attended the walk-in clinic of a busy psychiatry outpatient department of a general hospital psychiatric unit were evaluated for their pathways to care before the index presentation.
Results: More than half of the sample comprised of males (N=85; 51.8%) and most of the subjects were married (N=128; 78%), came from urban background (N=89; 54.3%) and were Hindus (N=86; 52.4%). Most of the cases (N=103; 62.8%) were diagnosed to have moderate depressive episode with or without somatic symptoms and the mean Hamilton Depression Rating Scale score was 19.89 (SD-5.32; range 8-36). According to the information provided by the patients 42.68% of them contacted a general physician after the onset of their symptoms and another 40.24% contacted a psychiatrist at the first instance. However, about 17% contacted a relative/friend, chemist, Ayurvedic doctor, faith healer, registered medical practitioner or exorcist at the first place. Though, with passage of time more and more patients moved to a psychiatrist for the treatment of depression.
Conclusion: Most of the patients in this geographical area of North- West India seek help from a general physician or a psychiatrist at the first instance.
Depression prevalence and typology of functional somatic symptoms in subjects with first episode depression
Vineet Kumar, Sandeep Grover, Subho Chakrabarti, Parmanand Kulhara, Prabhakar Holikatti, Pritpal Singh, Shikha Tyagi
PGIMER, Chandigarh, India
Introduction: Depression is a common, treatable psychiatric disorder. However, many subjects with depression have predominant functional somatic symptoms and hence consult many other physicians before consulting psychiatrists.
Aim: To study the prevalence and typology of functional somatic symptoms in patients with first episode depression.
Materials and Methods: For the study 164 patients who attended the walk-in clinic of a busy psychiatry outpatient department of a general hospital psychiatric unit were evaluated on Patient Health Questionnaire-15 (PHQ-15) and Hamilton Depression Rating Scale.
Results: More than half of the sample comprised of males (N=85; 51.8%) and most of the subjects were married (N=128; 78%), came from urban background (N=89; 54.3%) and were Hindus (N=86; 52.4%). Most of the cases (N=103; 62.8%) were diagnosed to have moderate depressive episode with or without somatic symptoms and the mean Hamilton Depression Rating Scale score was 19.89 (SD-5.32; range 8-36). Except for 1 patient, all the patients had atleast 2 functional somatic symptoms and two-third of the sample had 6 or more functional somatic symptoms. The most common functional somatic symptoms as per PHQ-15 were : feeling tired or having low energy (N=152; 92.7%), trouble sleeping (N=131; 80%), nausea, gas and indigestion (N=112; 68.3%), headache (N=112; 68.3%), pain in arms, legs, or joints (N=108; 65.9%), feeling that heart is racing (N=107; 65.2%), back pain (N=90; 54.9%), constipation, loose bowels, or diarrhoea (N=85; 51.8%) and dizziness (N=82; 50%). The symptoms that were reported by less than 50% of the subjects included: shortness of breath (N=80; 48.8%), chest pain (N=63; 38.4 %), pain in stomach (N=63; 38.4 %), problem or pain during sexual intercourse (N= 39; 23.8%), problems during menstruation (N=34 females; 42.5% of total females) and fainting (N=20; 12.2%). More than one third of the females (N=34; 42.5% of total females) reported menstrual cramps or other problems during periods. However, when present, in two-third of cases feeling tried or low in energy and troubled sleeping led to a lot of botheration. In about one-third cases, when present, headache, pain in arms, legs, or joints, feeling that heart is racing and nausea, gas and indigestion led to a lot of botheration to the patients.
Conclusion: Functional somatic symptoms are quite prevalent in subjects with first episode depression. Hence, clinicians should routinely evaluate the patients of depression for these symptoms.
Psychological characteristics of school bullies: An exploratory study
Paakhi Srivastava, T.B Singh
IHBAS, Delhi, India
The present study examined the psychological characteristics of school bullies, using a cross sectional research design. This study included a total of 40 students of age group 8-11 years, in which 20 were school bullies (19 boys, 1 girl) and 20 were control participants (19 boys and 1 girl). The two groups were matched on relevant variables like age, gender and grade. The sample was drawn from two private schools of East Delhi. The study was carried out in two phases, the screening phase and the assessment phase. The screening phase included the identification of school bullies using the sociometry technique where peer and teacher nominations were taken. Developmental Psychopathology Checklist was administered to rule out any mental health problems among the study subjects. Thereafter, Children's Personality Questionnaire and Children's Apperception Test- Human Figure were used to assess the personality of study participants. Results showed that out of a total sample of 20 school bullies only one girl was identified as bully. School bullying was highest among VI grade students. Verbal form of bullying was highest compared to only physical or both these forms of bullying used together. On CPQ, statistical test of significant difference i.e. t test revealed that mean scores of school bullies were found significantly higher than control group on factors of Extraversion & Independence. The school bullies scored significantly high on tendency for aggression; warm heartedness, cooperativeness, ego strength, superego strength, impulsivity, tender mindedness and difficulty in managing balance between self expression and self control. Differences were assessed using frequency and percentages on Children's Apperception test-Human figure. School bullies in higher percentage had themes of loneliness, neglect and ignorant, punishing parents in CAT-H stories. Environment was perceived as depriving, hostile and negligent. Higher percentage of school bullies had need for abasement, autonomy and succorance compared to control group. Higher number of school bullies had dominant anxieties of loss of love, blame and punishment and conflicts were in succorance v/s n rejection, autonomy v/s n abasement, n autonomy v/s punishment. Thematic analysis revealed themes of 'absence of holding environment, 'anger and fear', 'struggles with authority', 'friendships and fighting', and 'false self-bully'. A conceptualization of probable dynamic genesis of bullying behavior has been proposed. Conclusively, a combination of both personality factors and transaction with parents at home are associated with risk factors for bullying behavior. Intervention programs aimed at reducing bullying should focus at helping the child cope up with his emotional difficulties and also to intervene and change parent child interaction.
A follow-up study to assess outcome of patients with delirium
Aarya K.R., Ruchita Shah, Sandeep Grover
PGIMER, Chandigarh, India
Background: Data from the West suggest that delirium is associated with high rate of mortality and the rate range from 6-18% (twice that of matched controls). However, the mortality rate in patients with delirium has not been studied in Indian setting.
Aim: To study the rate of mortality in subjects developing delirium in the hospital.
Methodology: Ninety-nine patients with delirium seen by the consultation-liaison team of the Department of Psychiatry at Postgraduate Institute of Medical Education and Research, Chandigarh were recruited for the study after obtaining consent from an adult caregiver. Socio-demographic and clinical details were recorded. The patients were rated on Delirium Rating Scale-Revised 98 (DRS-R98), the Delirium Motor Checklist and delirium etiology checklist.
Results: The mean age of the patients was 46.29 (±18.88) years and the mean number of years of education was 8.21 (±5.66). Most of the subjects were male (N=71, 71.7%) and had hospital emergent delirium (N=70, 70.7%). The mean duration of delirium was 4.11 (±5.66) days at the time of assessment and the mean DRS-R-98 score was 30.54 (±5.09). Of the 99 subjects assessed, 12 patients (12.1%) expired during their hospital stay. Attempt was made to contact the caregivers of the remaining 88 patient at a mean duration of about 3 months after the initial evaluation, of which 48 could be contacted. Of the 48 contacted subjects another 12 had died at the time of follow-up. On the basis of last observation carried forward, mortality rate at 3 months after developing delirium was 24.24%.
Conclusions: Delirium is associated with high mortality rate.
Depression, social psychiatry explanatory models of patients with first episode depression
Vineet Kumar, Sandeep Grover, Subho Chakrabarti, Parmanand Kulhara, Prabhakar Holikatti, Pritpal Singh, Shikha Tyagi
PGIMER, Chandigarh, India
Background: The explanatory models of psychiatric illness can influence treatment seeking, treatment adherence, and drug compliance.
Aim: To study the explanatory models for depression in patients with first episode depression.
Methodology: For the study 164 patients who attended the walk-in clinic of a busy psychiatry outpatient department of a general hospital psychiatric unit were evaluated for explanatory models of their symptoms on perceived causes subscale of Explanatory Models Interview Catalogue (EMIC).
Results: More than half of the sample comprised of males (N=85; 51.8%) and most of the subjects were married (N=128; 78%), came from urban background (N=89; 54.3%) and were Hindus (N=86; 52.4%). Most of the cases (N=103; 62.8%) were diagnosed to have moderate depressive episode with or without somatic symptoms and the mean Hamilton Depression Rating Scale score was 19.89 (SD-5.32; range 8-36). When the patients were asked to report the possible etiological cause for their symptoms of depression, about one fourth (27%) were not able to specify any cause, whereas 28.48% of cases attributed it to the psychological, 22% to social and only 7% to karma-deed-hereditary causes. However, when the patients were probed, the most common etiological attribution was that of karma-deed-hereditary (N=128; 77.57%) followed by psychological (N=113; 68.48%), weakness-nerves (N=88; 53.33%), social (N=80; 48.48%), environmental (N=32; 19.39%), others (N=31; 18.78%) and health-illness injury- medical (N=26; 15.75%) , ingestion (N=20; 12.12%), victimization (N=7; 4.12%), sexual reproductive functions (N=10; 6.1%) and traditional causes (N=1; 0.6%).
Conclusion: Most of the patients in this geographical area of North- West India attribute their depression to karma deed- hereditary causes.
Neuropsychiatric profile of patients attending medical OPD of a railway hospital
Rama Shanker, Braham Prakash, A. Govil
Northern Railways Central Hospital, New Delhi, India
Background: Railway health services provide health care to its beneficiaries free of cost at three levels. 1. Health Unit (like primary health centers), 2. Divisional hospital, 3. Central hospital-located at each Zonal head quarters. A lot of Neuropsychiatric morbidity was observed on cursory examination both in indoor and outdoor patients.
Aims and Objectives: To get the level of Neuropsychiatric morbidity in patient attending Medical OPD in a Railway general hospital.
Materials and Methods: The neuropsychiatric Impressions were made according to ICD 10 guidelines from July 2010 to December 10.
A study on psychological distress in cancer patient
Bappaditya Chowdhury, Dilip Kumar Mondal,
Medical College and Hospital, 21/5 Northern Avenue, Kolkata, India
Background: Cancer is one of the leading causes of deaths in men and women. An investigation was carried out to examine anxiety and depression in this group of patients and to investigate whether the knowledge of cancer diagnosis affects their psychological distress.
Materials and Methods: This was a cross-sectional study of anxiety and depression in patients with cancer attending to the Oncology Day Care unit at Medical College & Hospital. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). This is a widely used valid questionnaire to measure psychological distress in cancer patients. Demographic and clinical data also were collected to examine anxiety and depression in sub-group of patients especially in those who knew their cancer diagnosis and those who did not.
Results: In all 42 patients studied, 52% did not know their cancer diagnosis. The mean anxiety score was 7.2 (SD=4.9) and for depression it was 9.2 (SD=3.5). Overall 47.2% and 57% of patients scored high on anxiety and depression. There were no significant differences between gender, educational level, marital status, cancer site and anxiety and depression scores whereas those who knew their diagnosis showed a significant higher degree of psychological distress.
Conclusion: Psychological distress was higher in those who knew their cancer diagnosis. It seems that the cultural issues and the way we provide information for cancer patients play important role in their improved or decreased psychological well-being.
Use of synthetic cannabinoids in dementia with agitation: Literature review and case studies
Introduction: Synthetic cannabinoids have been studied and utilized in the management of pain, nausea and multiple sclerosis (1-4). Clinical research with cannabinoids in the field of psychiatry has been isolated to small trials in the treatment of dementia related behavioral disturbances (5,6). This is despite the growing scientific evidence supporting the potential positive effects of synthetic cannabinoids on Alzheimer's Disease (AD) processes. A Cochrane review of cannabinoids for the treatment of dementia reported that more double blind placebo controlled trials are required to determine efficacy in this population (7). There is also a paucity of case reports in the literature describing use of these agents in clinical practice. One case report outlines a positive result with the cannabinoid receptor agonist Nabilone in a patient with Alzheimer's type dementia related agitation (8). This study reports its successful use in patients with dementia and severe agitation.
Metabolic syndrome in subjects with unipolar depression
Alakananda Dutt, Sandeep Grover, Subho Chakrabarti,
Ajit Avasthi, Parmanand Kulhara
PGIMER, Chandigarh, India
Background: Studies from west suggest that up to one third of the subjects (13.3 - 36%) with unipolar depression (First episode or recurrent depressive disorder) have metabolic syndrome (MS). However, studies from India have not evaluated the prevalence of MS in patients with unipolar depression.
Aim of the study: To study the prevalence and risk factors for MS in patients with unipolar depression.
Materials and Methods: Sociodemographic, clinical, anthropometry data and metabolic profile were collected prospectively from 164 subjects with unipolar depression attending the psychiatry outpatient. Metabolic syndrome was defined according to the International Diabetic Federation (IDF) criteria.
Results: Majority of the subjects were females, mean age being 43.7 years, married, Hindu by religion from urban nuclear families. Overall 45.1% of subjects (N=74) met the IDF criteria for metabolic syndrome. Among the various criteria of metabolic syndrome, the most commonly satisfied criterion was that of waist circumference (N=124; 75.6%), followed by triglyceride (N=78; 47.6%), high density lipoprotein (N=71; 43.3%) and the least commonly satisfied criterion was that of fasting blood sugar (N=44; 26.8%). None of the socio-demographic variable emerged as a risk factor for MS.
Conclusion: This study suggests that there is a high prevalence of MS in subjects with unipolar depression. Hence, patients with unipolar depression should routinely undergo physical evaluation (especially measurement of Waist circumference) and should be investigated from time to time to take appropriate preventive measures.
Psychiatric medication psychotropic induced anticholinergic side effects: Possible role of donepezil
Santosh Kumar, Pankaj Kumar, Santosh Ramdurg
IHBAS, New Delhi, India
Aims & Objectives: The potential therapeutic use of Donepezil in ameliorating sign and symptoms produced by anticholinergic effects of psychotropic drugs was explored through the present study.
Materials and Methods: Fifty consenting patients of non-geriatric group who experienced anticholinergic side effects after being on stable clinical course with classical psychotropics were prescribed 5 to 10 mg Donepezil. The side effect profile was monitored clinically and with UKU scale.
Results: All anticholinergic side effects studied, improved significantly with addition of Donepezil to the psychotropic regimen. Cognitive disturbances e.g. (Memory-loss) was the most common presentation of anticholinergic side-effects due to psychotropics followed by dryness of mouth, constipation, difficulty in concentration and blurred vision, in decreasing order of frequencies. Blurred vision was the symptom that disappeared completely in most of the patients. Donepezil was effective in mitigating the anticholinergic side effects of patients, irrespective of their psychotropic regimen.
Conclusion: Donepezil can prove a potential tool in armamentarium of psychiatrists in combating the intensity of emergent anticholinergic side-effect of classical psychotropic drugs in non-demented, non elderly mentally ill patients in addition to its established role in dementia.
Knowledge about child development and parenting among anganwarli worker and anganwarli helper of ICDS project in Rajasthan
Soumen Acharya, Neelam Bhatia, Dinesh Paul
National Institute of Public Cooperation & Child Development
A lecture was organised in AWTC in rajasthan on child development and upbringing. At the beginning of lecture AWW&AWH knowledge on various aspect s of child development and parenting was measured by giving them 20 items true false questionnaire each correct response carried 1 mark Among the 94 respondent 69 were AWW and 25 were AWH. The total knowledge score ranged from 10 to 18 with mean score 14.03 (SD+1.57). AWW have slightly higher mean compared to AWH (14.3 vs 13.3). On the following items correct response rate extended 90% appropriate time of weaning, age at which child is able to tell full name, age at which child learns to sit, age at which separation anxiety appears, effect of sensory stimulus on child development and effect of prematurity on development. The knowledge deficit was most marked for 5 statements (correct response rate < 50%) : appropriate age at which child should be initiated in writing, age at which bed wetting should be consider abnormal, age at which toilet training should be given, stuttering as a developmental phenomena, thumb sucking as a focus of treatment at age of six. The study shows that the knowledge imparted to the anganwari worker and the anganwari helper about child development in ICDS programmes are effective.
Psychopharmacology amantadine for olanzapine-induced weight gain: A systematic review and meta-analysis
Samir Kumar Praharaj, P.S.V.N. Sharma
Kasturba Medical College, Manipal, India
Aims and Objectives: To conduct a systematic review and meta-analysis of randomized controlled trials of amantadine for the treatment of olanzapine-induced weight gain.
Methodology: Studies will be identified using online searches of PUBMED/MEDLINE and Cochrane database (CENTRAL), supplemented with manual search of cross-references. The search will be restricted to publications in the English language. Systematic review and if possible, meta-analysis will be performed to see the effect size of the treatment on body weight, waist circumference and body mass index (BMI).
Postpartum depression and subjective well being: A comparative study of women with epidural delivery and women with painful delivery
Aswathy P.V., Biji Mathew
The aim was to study and compare the mental health of women who had undergone epidural delivery and painful delivery. The sample included 30 women from each group who were selected based on purposive sampling. The study focused on assessing the post partum depression and subjective well being of both the groups. The tools used for assessment were Edinburgh Postnatal Depression Scale (EPDS) and Subjective Well Being Inventory (SUBI). The analysis of the result indicated that postpartum depression was not diagnosed in both the groups. No significant difference was found among the two groups with respect to post partum depression although significant difference was obtained in subjective well being among both the groups. Women who underwent epidural delivery had obtained higher subjective well being score compared to painful delivery. A significant negative correlation was found between post partum depression and subjective well being in both the groups. Both the variables are also studied based on the sociodemographic details also. Post partum depression score was higher for women who belonged to the age range of 20-27, low socioeconomic status and first birth among women who underwent epidural delivery. The limitations and suggestions for future research are presented in the study.
Psychopathology in perinatally acquired clinically stable HIV infected children
Bappaditya Chowdhury, Malay Kumar Ghosal,
Medical College and Hospital, 21/5 Northern Avenue, Kolkata, India
Aims and Objective: The threat of HIV /AIDS is one of the major menace to mankind and the number of HIV-infected children has also increased in recent years. HIV infection in children has been transformed from an acute to a chronic illness after the introduction of antiretroviral therapy. Studies have reported high prevalence of psychopathology in HIV infected children but data on Indian children are very few. The study aims to assess the prevalence of psychopathology in perinatally acquired clinically stable HIV infected children. It also aims to explore the relations of psychopathology with various clinico-demographic factors.
Materials and Methods: Out of 215 HIV positive children enrolled by survey method, 153 children met our inclusion and exclusion criteria. Clinico-demographic profile collected on pretested proforma. Psychological profile was assessed using Childhood Psychopathology Measurement Scale (CPMS).
Result: In sample population (n-153), 69 (45.1%) children screened positive for presence of psychopathology. Presence of psychopathology has been found to be significantly associated with age (P<0.000001), CD4+ count (P=0.0000) caregiver in family other than mother (P<0.0015), whether mother died (P<.00001) and whether father died (P<0.00007). No significant association was found between gender, hailing background (rural or urban area), whether receiving ART or not.
Conclusion: Clinically stable HIV infected children have high Prevalence of psychopathology with significant association of various social factors. Considering better survival profile comprehensive management needs integrated therapeutic approach incorporating both medical and psychiatric services.
Evaluation of quality of life in patients of epilepsy
Shantanu Bharti, Adarsh Tripathi, Ajay Kohli, M.A. Siddiqui, Monika Srivastava
ERA'S Lucknow Medical College and Hospital, Sarfarzaganj, Hardol Road, Lucknow, India
Background: Epilepsy is a multifaceted chronic disorder which has diverse and complex effects on well being of the patient and the family. Chronic and potentially life-threatening conditions, such as epilepsy, introduce significant psychological challenges and adaptive demands. Affected individuals experience the continuing threat of unpredictable and uncontrolled seizures. Deficit in emotional, social, cognitive, reduced physical strength and complications of treatment are generally believed to introduce significant disruptions of quality of life. Indian studies to assess quality of life in epilepsy are scanty in number and content.
Aims and Objectives: The Purpose of this study is to assess the quality of life of patients of Generalized Tonic clonic epilepsy. Methodology: First two consecutive GTCS cases on three consecutive days of the week at the psychiatry OPD of Era's Lucknow Medical college and hospital, Lucknow. Who would give informed consent, above 18 years and had seizures for more than one year will form the study group. Patients of epilepsy due to secondary cause, Mental retardation, Psychiatric illnesses, Chronic medical or surgical illnesses which can affect quality of life and person's not willing to give informed consent will be excluded. Quality of life in epileptics is assessed by, QOLIE 31. QOLIE 31contains seven multi-item scales that tap the following health concepts; seizure worry, emotional wellbeing, energy/ fatigue, cognition, medication effects, social effects, and overall quality of life.
Depression and co morbid alcohol dependence - Are they different from those without co-morbidity?
Khanra Sourav, Malick A.K., Mukherjee D.G., Paul N.
Institute of Psychiatry, IPGME&R, Kolkata, India
Background: Subjects with both unipolar depression (UD) and bipolar depression (BD) are known to have increased dependence and harmful use of alcohol. Alcohol influences the course of depression through increased rates of switching, suicides and impaired socio-occupational functioning.
Objectives: This study compared sociodemographic variables, family history of mood disorder and substance use and response to treatment, in depressed male patients with alcohol dependence, and those without alcohol use.
Materials and Methods: Consecutive, consenting patients attending the outpatient department between March 2009 to August 10, with current diagnosis of depressive episode, were taken up for this study. The total 124 patients included four groups, namely, bipolar (group IA, n=30) and unipolar depression (group IB, n=32) with alcohol dependence, and bipolar (Group IIA, n=31) and unipolar depression (Group IIB, n=31) without alcohol use. Information was collected about socio-demographic variables and family history of psychiatric illnesses, especially mood and substance-use disorders. Depression was rated at baseline and at two followups after 6 and 12 weeks, using HAM-D. Appropriate statistical tests were used to compare the parameters between the different groups.
Results: The four groups showed no significant difference regarding socio-demographic variables. Acute onset and episodic course was commonest in patients with alcohol dependence (IA and IB). Positive family history of alcohol dependence (P=0.00), other psychoactive substance use (P=0.042), mood disorder (P=0.035) was significantly higher in group IA. HAM-D scores were highest in group IA and lowest in group IIB. Repeated measures test showed patients of group with alcohol dependence improved faster than those without the same.
Conclusions: Our findings suggest that depressed patients who develop alcohol dependence may represent a separate subgroup, and not just have an incidental co-morbidity.
Attribution of neuroticism and perceived control in obsessive compulsive patients
Kedar Ranjan Banerjee, Tanmoy Mitra
National Institute of Behavioural Sciences, Kolkata, India
Background: Life events are known to delineate the mental health outcome of individuals and can act as significant risk factors for psychiatric vulnerability. The role of adverse life events in psychiatric patients seems even more critical as those may impose significant escalation of neuroticism and thereby cause further complication or comorbidity. Patients with Obsessive Compulsive Disorder (OCD; DSMIV) often refer to some stressful life events in connection with initiation of the illness. Perceived control of stressful life events and locus of control are areas were OCD patients appear to exhibit marked deviation from normal individuals.
Aim: Present study was designed to assess to what extent neuroticism and perceived control of life events impinge on the psychopathology of the OCD patients in an urban hospital set up.
Materials and Methods: Total fifty-six (n=56) OCD patients who came for treatment to the OPD of Salt Lake Government Hospital at Salt Lake, Kolkata were selected for the study. Diagnosis was done (structured clinical interview and Y-BOCS) by the chief psychiatrist and demographic variables were matched as far as practicable. The test batteries used were HAMA (Hamilton, 1969), HAMD (Hamilton, 1960), Personality Questionnaires (PQ) (Eysenck & Eysenck, 1975), LOC (Velucha, 1982), Self-Esteem Inventory (Karunanidhi, 1996), Stress Questionnaires (Latha, 1997) and Modified Life Events Scale (Singh, 1989).
Results: In both studies, analysis of covariance (ANCOVA) followed by post hoc tests indicated that high OCD scores were associated with external locus of control and low perceived control over high magnitude stressful life events. Neuroticism had been related significantly (r=0.73; P=<0.05) to external locus of control. Neuroticism also significantly related (r=0.64; P=<0.05) with lower self-esteem.
Discussion: Anxiety disorders and depressive disorder are common and result in significant suffering, lost opportunity, and economic loss with a prevalence rate of approximately 5% worldwide. Some authors identified consistent symptom clusters impulses and fear of loss of control besides contamination obsessions and cleaning compulsions, sexual /religious /somatic obsessions and checking, etc. Neuroticism and intolerance of uncertainty both made significant direct contributions to the prediction of worry, and neuroticism made a significant direct contribution to the prediction of obsessive-compulsive symptoms. Present study indicates that external locus (which refers to being controlled by external factors and having lesser self-control) and having less control over negative life events both can contribute to higher obsessive-compulsive symptoms. Lesser self control in turn affects self-esteem and these patients reflect lower self-esteem. The anxiety looms as these patients perceive that they cannot control the anxiety generating events or expressions. The feature of obsession-compulsion may eventually be their behavioural means to deal with increasing stress.
A cross sectional study of treatment seeking behaviour for premenstrual dysphoric disorder in doctors and nursing staff of a tertiary care hospital
Priyanka Gautam, Dinesh Kataria, Kishore Kumar Arya
Lady Hardinge Medical College, New Delhi, India
Introduction: Premenstrual dysphoric disorder (PMDD) is a somato-psychic illness triggered by changing levels of sex steroids that accompany an ovulatory menstrual cycle. It occurs about 1 week before the onset of menses and is characterized mainly by irritability, emotional lability, headache, anxiety and depression. Somatic symptoms include edema, weight gain, breast pain, syncope and paresthesias. Approximately five percent of women have the disorder. Some patients respond to short course of SSRIs.
Aims and Objectives: The assessment of treatment seeking behavior for PMDD in doctors and nursing staff of a tertiary care hospital.
Methodology: In this study assessment of premenstrual dysphoric symptoms will be made by interviewing the female doctors and nursing staff working in Lady Hardinge Medical College and SSK Hospital by using Daily Record of Severity of Problems (DRSP). Those who will be having symptoms on the basis of scale will be further enquired about whether they are seeking any treatment advice for the same. Data generated will be assimilated using appropriate statistical analysis.
Therapeutic effect of NMDA receptor blocker "Memantine" in hepatic encephalopathy
Pradeep Kumar, Vidyanand Tripathi, M.K. Jain
S.S.M.C., Rewa, Madhya Pradesh, India
Objective: To evaluate the therapeutic efficacy of NMDA receptor blocker "Memantine" on cognitive functions and overall morbidity and mortality of patients with hepatic encephalopathy (HE).
Materials and Methods: Patients of mild to moderate hepatic encephalopathy were categorized into Memantine (n-33) and control groups (n-22). Patients of either groups were assessed by PSE index which consists of NCT-A, Mental state, Asterixis and EEG grades in current trial. Both the groups received similar standard line of treatment of hepatic encephalopathy. The Memantine group also received Memantine as an add on therapy. Liver function tests were conducted in both the groups daily. Critical and severe grade HE patients were excluded from the study.
Results: Memantine group showed significantly (P<0.05) higher improvement in PSE index when compared to control group. Mortality was significantly low (P<0.05) in Memantine group.
Conclusion: Memantine may be an important adjuvant to the management of acute HE. Its therapeutic efficacy in conjunction with mannitol in light of retarding the genesis and evolution of cerebral edema and eventually in he is discussed.
Schizophrenia prevalence of metabolic syndrome in people with schizophrenia
Lokesh Shekhawat, Manish Kandpal, R.C. Jiloha
G.B. Pant Hospital, Maulana Azad Medical College, Delhi, India
People with schizophrenia have up to 20% shorter lifespan than general population with cardiovascular disease as the leading cause of death. Currently, the compilation of established individual risk factors for cardiovascular diseases has been referred as metabolic syndrome. Although there are minor distinctions in popular international guidelines for diagnosing metabolic syndrome but all these share the common objective to evaluate for obesity, glucose dysregulation, dyslipidemia, and hypertension. Metabolic syndrome is highly prevalent with the range between 20-60% among the patients treated with second-generation antipsychotics. Olanzapine and risperidone are among the most commonly prescribed second generation antipsychotics.
Aims and Objectives: To evaluate the prevalence of metabolic syndrome in patients with schizophrenia treated with olanzapine and risperidone.
Methodology: Fifty patients with schizophrenia, diagnosed as per ICD-10 criteria, were randomly selected for assessment of metabolic syndrome as per International Diabetes Federation criteria. Patients included in the study were required to take regularly either risperidone or olanzapine at least from last 6 months.
Somatoform disorders: comparison of quality of life and disability with schizophrenia
Lokesh Shekhawat, Manish Kandpal, R.C. Jihoha
G.B. Pant Hospital, Maulana Azad Medical College, Delhi, India
Somatoform disorders gets low priority in clinical practice over psychiatrist's preoccupation with so called "serious mental illnesses" eg. Schizophrenia, while it's among the most prevalent mental disorders with its 10 to 15% presence in primary care patients and it's comparable impact that seen in depressive and anxiety disorders on quality of life and functioning which make the patients suffering from these disorder chronically disabled and dependent, needs closer attention and more extensive research to increase the understanding of these disorders and better management to reduce disability and enhance quality of life of these patients.
Aims and Objective: To study the quality of life and disability in patients with somatoform disorder and their comparison with patients with schizophrenia.
Methodology: Twenty five randomly selected female patients of age group 18-65 years with each somatoform disorder and schizophrenia (disgnosed as per ICD-10 criteria), who were under treatment from last 1 year or more, from Psychiatry OPD were assessed on WHO quality of life and WHO Disability Assessment Scale-II and were compared on both of these measures.
Socio-demographic profile and drug-seeking situation in nicotine dependence
Arun Kumar V., Shilpa Adarkar, S.R. Parkar
G.S.M.C. and KEM Hospital, Mumbai, India
Introduction: Recent research has emphasized commonalities between nicotine and other drug dependencies, but nicotine dependence differs from other drug dependencies in several ways. It has become the most prevalent, most deadly, and most costly and yet the most ignored of the substance dependencies. Tobacco use is a major cause of death from cancer, cardiovascular disease, and pulmonary disease and remains a leading cause of death. Worldwide, the prevalence of smoking is high in developed countries. Developing countries also have tobacco chewing Besides cigarette and beedi smoking. Why do people consume it? Is it for fun or as a stress buster? Is it habit or imitation?
Aims and Objectives: To assess the socio-demographic profile of nicotine users and the situations in which they consume nicotine.
Materials and Methods: This is a retrospective study of 100 nicotine consumers attending the deaddiction OPD at KEM Hospital in the year 2009 and 2010. Relevant socio demographic data was obtained using a predesigned proforma. Fagerstrom test was used to evaluate level of nicotine dependence. Inventory of Drug Taking Situations (IDTS) scale was used to understand the drug seeking situations. The results are discussed.
A study of psychiatric morbidity in burn patients
Prerna Malik, Kuldip Sharma, Avtar Singh, Rajinder Garg
Government Medical College, Patiala, Punjab, India
Out of 70 inpatients hospitalized in the Department of surgery and plastic surgery of Rajendra Hospital, Govt. Medical College, Patiala between May 07 and August 08, 48.57% patients had psychiatric morbidity as revealed on the SCL-80 scale. The morbidity was greater in shorter duration of injury, severe degree of injuries and injuries on the face and in female patients. On SCL-80 scale, 70% of the patients had anxiety and interpersonal sensitivity symptoms and 50% had depression and somatization. The quality of life was poorer in patients with psychiatric morbidity as compared to patients without psychiatric morbidity. According to ICD-1 criteria, 86.67% patients had psychiatric disorders of which commonest was depression (33.33%) followed by PTSD (26.67%), adjustment disorder (13.33%), phobic anxiety disorder (3.33%) and somatoform disorder (3.%).
Prevalence of depressive symtoms among junior residents of medical college trivandrum- A croos sectional study
U. Vivek, Ajeesh P.R., Anil Prabhakaran, Vidhu Kumar
Medical College, Trivandrum, India
Background: Doctors lead a highly stressful and busy lifestyle and among doctors residents and post graduate students have a highly stressful life due to their academic, clinical and call duty workload along with personal life problems. This can lead to depressive symptoms in many cases and may have an adverse effect on their personal and professional life with serious consequences in patient management.
Aims and Objective: The objective of the study was to study the prevalence of depressive symptoms in junior residents of medical college, Trivandrum and to find whether gender differences exist among junior residents with depressive symptoms.
Materials and Methods: 342 junior residents were evaluated by Beck Depression Inventory (BDI). A confidential questionnaire (BDI) was distributed, completed by the junior residents and collected.
Results: 342 junior residents completed the study. The ages varied from 24 to 48 years. The mean age was 28.76 years (SD, 4.12). 85.7% had an age between 24 to 30 years. Prevalence of depressive symptoms was estimated to be 24.9% (n=85), (CI 0.25 +/- 0.045) of which, 257 residents (75.1%) had minimal depressive symptoms BDI score (0-9), 69 (20.2%) had mild depressive symptoms BDI score (10- 16), 11(30-63). No gender differences were found.
Conclusions: Our results indicated that although a low percentage of Medical College, Trivandrum Junior residents were found to have significant level of depressive symptoms, this should not be underestimated, and interventions should be taken to encourage junior residents to seek help for psychiatric problems especially depression. The risk factors as well as protective ones must be identified nation-wide to promote the mental health of the junior residents.
Suicide gender differences in patients attempting suicide admitted in medical ward of a tertiary care hospital
S. Avudaiappan, S. Ilangovan, Muralitharan, Vidhu Kumar
Thanjavur Medical College, Thanjavur, India
Aims and Objectives: To identify gender Specific characteristics in patients who have attempted suicde and admitted in a medical ward of a tertiary care Hospital.
Methodology: Sixty Consecutively admitted patients sociodemographic data were obtained, assessed and screened for psychiatric illness using a detailed clinical interview and measures of suicide intent (Beck suicide intent scale) and lethality (risk - rescue rating scale) were administered.
Severity of depression and cognitive decline in old age
Navendu Gaur, Ram Kumar Solanki, Manisha Gaur
PGIMER, Chandigarh, India
Aim: As more and more data is accruing, investigators around the world have aimed to identify a pattern of interaction between education and cognition in depressed elderly population. Indian data is lacking regarding impact of depression severity on cognitive decline in the elderly. Keeping this in mind, the following study was planned with the aim to evaluate in detail the neuropsychological performance of depressed geriatric population in a psychiatric out-patient setting and to see whether depression severity has any role to play.
Materials and Method: A cross-sectional examination of 90 outpatient subjects (3 non-depressed and 60 depressed) aged 60 years and above was conducted in a psychiatric clinic of a north Indian tertiary care hospital. The diagnosis of depression was made as per ICD-10 criteria. A comprehensive neuropsychological assessment was done and appropriate statistics applied.
Results: Significant differences in performance on neurocognitive tests exist between depressed elderly and non-depressed elderly subjects and cognitive decline is directly influenced by depression severity.
Conclusion: Impairment of neurocognitive functions occurs in geriatric depressed population and its severity increases with increasing severity of depression.
Profile of obsessive compulsive disorder patients who responds to SSRI alone
Bhoomika, Preeti G., Shivani, Neha S., Jyoti M., S. Akhtar
Central Institute of Psychiatry, Ranchi, Jharkhand, India
Aim and Objective: Obsessive-compulsive disorder (OCD) is a heterogeneous disorder, characterized by the presence of upsetting, persistent worries, images or impulses. The present study aims at finding clinical correlates of the patients suffering from OCD who responds adequately to high dosage of SSRI for adequate period without any behavioural treatment as compared to those who don't.
Methodology: Sampling technique used was purposive sampling. 40 patients of OCD who attended the outpatient department of Central institute of psychiatry, Ranchi, Jharkhand, India were taken up for prospective study. The diagnosis of Obsessive-compulsive disorder was made by consensus by two psychiatrists using research diagnostic criteria of ICD-10. Clinical groups were assessed on Yale Brown Obsessive Compulsive Scale (YBOCS), Hamilton Anxiety Rating Scale (HARS) and Hamilton Depression Rating Scale (HDRS) for the severity of psychopathology. Brief Psychiatric Rating Scale (BPRS) was use to find psychotic symptoms. Socio-demographic data sheet was filled for each sample that included age, gender, education, marital status, SES and habitat. Clinical correlates consisted of premorbid personality, family history, co-morbidity, type of obsession, insight, psychotic symptoms, and depressive symptoms. They were prescribed SSRI. (Sertraline upto 250 mg/Fluoxetine 80 mg/ Fluvoxamine upto 300 mg depending on response by the treating psychiatrist) The adequate response in OCD was rated when there was 30% reduction in score in YBOC and 50% reduction and a score < 10 on HDRS.
Result: The result showed that there is a group of patients who respond to SSRI alone in higher dosage. The patients whose duration are short, who have primary obsessional ideas are more likely to respond to SSRI alone. The treatment implication of the study in the management of OCD will be discussed in the conference.
Conclusion: SSRIs pose lesser side-effects that made them the first line medication for OCD.