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ABSTRACT  
Year : 2014  |  Volume : 56  |  Issue : 5  |  Page : 63-96
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Date of Web Publication14-Jan-2014
 

How to cite this article:
. Free Papers (Posters). Indian J Psychiatry 2014;56, Suppl S1:63-96

How to cite this URL:
. Free Papers (Posters). Indian J Psychiatry [serial online] 2014 [cited 2019 Jun 17];56, Suppl S1:63-96. Available from: http://www.indianjpsychiatry.org/text.asp?2014/56/5/63/124975


Insight in obsessive compulsive disorder: Concordance amongst various measurements

Abhishek Ghosh, Sandeep Grover, Siddharth Sarkar, Natasha Kate, Ajit Avasthi, Savita Malhotra

Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Aims and Objectives : The objective of this study was to compare the concordance amongst three different measurements for assessing insight in patients with obsessive compulsive disorder (OCD) and to explore the relationships between insight and clinical variables.

Materials and Methods: One hundred and twenty-five subjects diagnosed with OCD were assessed for the measurement of insight with Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) insight criterion, Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and Brown Assessment of Beliefs Scale (BABS). The fourth question of Y-BOCS (resistance to obsessions) was taken as proxy measure of insight. In addition to Y-BOCS, Global Obsessive-Compulsive Symptom Severity Scale was applied to determine the clinical severity of OCD. Hamilton Depression Rating Scale (HDRS) was used to find out severity of depressive symptoms.

Results: Correlation coefficients indicated high concordance between insight as measured by Y-BOCS and BABS. The insight criterion of DSM-IV-TR had good concordance with BABS, but not with Y-BOCS. When the relationship of insight as assessed by different methods with other variables was assessed, it was seen that patients with poorer insight as per Y-BOCS had higher severity of OCD and depression, but insight assessed by other measures had no correlation with severity and comorbid depression.

Conclusions: Dimensional measurement of insight in patients with OCD may be more useful.

Comparison of familism in caregivers of patients with psychotic and affective disorders

Aditya Hegde, Subho Chakrabarti, Sandeep Grover

Department of Psychiatry, PGIMER, Chandigarh. E-mail: drsandeepg2002@yahoo.com

Background: Familism, the precedence given to family needs over needs of the individual, has been suggested as an important variable influencing caregiving in persons with mental illness.

Aim: To assess and compare familism in primary caregivers of patients with psychotic and affective disorders.

Materials and Methods: Thirty-two caregivers of patients with psychotic disorders and 39 caregivers of patients with affective disorders were evaluated on the Familism Scale (Sabogal et al., 1987). Patients in both the groups were matched on gender, age, marital status, education, occupation, religion, type of family, and level of functioning (as assessed by using Global Assessment of Functioning Scale). Caregivers were matched on gender, age, marital status, education, and occupation.

Results: A significantly greater number of patients in the affective disorder group came from a rural background (P-value 0.022). A significantly larger number of patients in the psychotic disorder group were unmarried (P-value 0.001). With respect to familism, the two groups did not differ significantly on the scores obtained on the three subscales or the total score on the Familism Scale.

Conclusions: The type of psychiatric disorder does not influence the precedence given to family needs over needs of the individual.

A study on oxidative stress in patients of major depressive disorder

Aditya Somani, PK Dalal, Madhu Dikshit, SM Natu, JK Trivedi, Bandna Gupta

King George's Medical University, Lucknow, Uttar Pradesh, India

Background : Dysregulations of oxidative and nitrosativepathway, inflammatory pathway, 3 and hypothalamic-pituitary-adrenal (HPA) axis have been associated with major depressive disorder (MDD).

Aims:

  1. To assess and compare levels of neuronal nitric oxide synthase (nNOS), nitrite levels, reactive oxygen species (ROS),andmyeloperoxidase (MPO) in polymorphonuclear leukocytes (PMNs), plasma nitrite level, and serum cortisol in drug naive patients (in current episode) of MDD; their first degree relatives and healthy controls.
  2. To study the relation between clinical profiles of these patients with above parameters.


Materials and Methods:

  • Drug naive patients of MDD diagnosed as per Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision(DSM-IV-TR), one of their healthy first degree relatives and healthy controls were selected.
  • Patients were assessed on Hamilton Rating Scales for Depression (HAM-D) and Global Assessment of Functioning (GAF). Relatives and controls were screened with General Health Questionnaire12-item (GHQ-12).
  • Physical illnesses were ruled out.
  • Investigations were carried out in neutrophils, plasma, and serum.


Results:

  • Study showed increased levels of ROSand serum cortisol, and decreased level of plasma nitrite in patients of MDD compared to controls.
  • Cortisol was increased in relatives of patients.
  • Levels of nNOS, neutrophil nitrite, and MPOwere not altered.
  • Significant correlation was not found between any of the investigational parameters and clinical profile.


Discussions:

  • Increased ROS generation and decreased plasma nitrite indicate altered functioning of oxidative and nitrosative pathway in patients of MDD.
  • Nitric oxide pathway is not contributing to oxidative stress in given set of patients.
  • Normal expression of MPOcould be due to raised cortisol in given set of patients.


Conclusions:

  • Plasma nitrite and serum cortisol could be useful peripheral biomarkers of depression.
  • Alternative sources of oxidative stress need to be explored.


Effect of resilience on internet use: A study on medical undergraduates

Amrita Chakraborti, Prasenjit Ray, Mehboob Ul Islam, Asim Kumar Mallick

Department of Psychiatry, Burdwan Medical College, Burdwan, West Bengal, India

Aims : Internet addiction is yet to be recognized as a diagnostic entity, but growing concern is being observed in Asian countries. Studies conducted in Indian city recognizes a large number of youth at risk of developing pathological internet use (Yadav, 2012). Correlates for these maladaptive digital preoccupation has been loneliness, stress, depression, lack of self-esteem, and poor resilience (Goel, 2013; Nalwa, 2003). Internet use is often increased in stressful life situation as it helps in mood regulation and social compensation, thereby temporarily reducing stress and anxiety, but research found individual resilience protects against pathological internet use (Leung, 2007; Li, 2010). Under this background, this study was undertaken with the aim of exploring the internet use pattern and possible relationship with their resilience level in medical undergraduates.

Materials and Methods: Semistructured questionnaire consisting of demographic profile, details of internet use, motives for internet use, and overall satisfaction with this media. Other scales that were used were: Internet addiction test questionnaire by Young, Resilience Scale by Wagnild and Young (1987), Student Stress Scale by Insel and Roth (1991).

Study sample (N = 100), representing both genders, is being taken from undergraduates of a medical college of West Bengal.

Results and Conclusions: As this is an ongoing research, results would be shared at the time of presentation.

Phenomenology of alcohol-induced psychosis: A retrospective study

Ankit H Moga, Ravindra Munoli, Samir Kumar Praharaj, Sreejayan K

Department of Psychiatry, Kasturba Medical College, Manipal University, Manipal, Karnataka, India

Background : Alcohol-induced psychosis is a cluster of psychotic phenomena that occurs during or immediately after alcohol use. Alcohol-induced psychosis is now seen to be a distinct entity, and separate from alcohol related delirium (delirium tremens) and schizophrenia; though many authors in the past have tried to attach it to one of the two groups.

Aim: To compare sociodemographic and clinical differences between alcohol-dependent patients with and without alcohol-induced psychosis admitted at tertiary care center.

Materials and Methods: After ethics committee approval, case records of all inpatients diagnosed as alcohol-induced psychosis and patients diagnosed with alcohol dependence syndrome without psychosis from January 2003 to December 2012 will be evaluated. Semistructured pro forma, specially designed for the study will be used to collect details regarding sociodemographic and psychopathology. Study period is August 2013-November 2013.

Results and Analysis: Results and discussion will be presented at conference.

Quetiapine-induced exfoliative dermatitis: A rare complication

Rath A, Panse S, Netto IS, Pawar AV

Department of Psychiatry, Sassoon General Hospital, Pune, Maharashtra, India

Background : Quetiapine is an atypical antipsychotic drug, useful in the treatment of the behavioral and psychological symptoms of dementia (BPSD). It can cause dermatological adverse effects like pruritus, pigmentation, acne, fixed drug eruptions, and photosensitivity. Very rarely it can cause psoriasis and exfoliative dermatitis, which may lead to serious life-threatening medical emergencies.

Case Report: An elderly male was brought by his relatives with a history of cognitive decline, disturbed activities of daily living (ADL), and BPSD in the form of psychotic behavior. He had no past or family history of psychiatric illness.

Mental Status Examination: His affect was perplexed, he had delusions of persecution, impaired recent, remote memory, and impaired judgment. Mini-Mental Status Examination (MMSE) score was 7/27 and Brief Psychiatric Rating Scale (BPRS) score was 84/126. He received tab. quetiapine (25 mg/day) in view of his psychotic behavior and developed exfoliative dermatitis (erythematous rash with skin exfoliation over his trunk, back, and extensor aspects of arms and legs, covering >90% of body surface), within 5 days of starting tab. quetiapine. After tab. quetiapine was stopped, the rash resolved within 7 days of treatment with intravenous steroids and antibiotics.

Diagnosis: Dementia in Alzheimer's disease (ICD code: F00) with quetiapine-induced exfoliative dermatitis

Conclusions: Quetiapine rarely causes exfoliative dermatitis. This adverse cutaneous reaction requires careful monitoring, prompt withdrawal of the drug, and concurrent treatment by the dermatological and neuropsychiatric departments.

A comparative study of alexithymia between neurotic patients and caregivers

Apala, Rohit Verma

Department of Psychiatry, Lady Hardinge Medical College, New Delhi, India

Aims and Objectives : To study and compare alexithymia traits among neurotic patients and their caregivers.

Materials and Methods: This cross-sectional, pilot study was carried out at an outpatient setting in the Department of Psychiatry of a tertiary care multispecialty hospital in New Delhi. Thirty consecutive neurotic patients and their caregivers were assessed using Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7) scale, and Toronto Alexithymia Scale (TAS-20) after taking informed consent. The data was imputed and analyzed using Statistical Package for Social Sciences (SPSS) ver 17.0.

Results: The mean age of patient and caregiver groups was comparable (36.57 ± 10.7 vs 35.37 ± 9.4 years) with no significant difference on sociodemographic parameters. The mean duration of illness in patient population was 57.33 ± 75.7 months. Patient group had significantly higher scores of total TAS and also on factorial parameters of difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking (P < 0.000). There was no gender difference for total TAS scores in patients as well as caregivers (P = 0.18 and P = 0.75, respectively). Total PHQ-9 and GAD-7 scores were significantly correlated to TAS scores (total and 3 factors) in both the groups.

Conclusions: Alexithymia is more common in neurotic patients as compared to their caregivers. Besides, it was closely related to the slightest presence of neurotic symptoms in the caregivers despite being free of a diagnosable illness suggesting that alexithymia may be an illness governing factor by itself. However, further research is required to evaluate whether it can be used as an illness modifiable factor for better management of neurotic disorders in future.

Migration and mental health: A comparative study of migrant versus non-migrant persons

Arvind Jinger, Vijay Choudhary, Pradeep Sharma, Gunjan, Bhakti Murkey

Department of Psychiatry, Sawai Man Singh Medical College, Jaipur, Rajasthan, India

Aim : The present study was aimed at investigating biopsychosocial aspect in migrant and non-migrant perosns It was hypothesized that migrant people were significantly more submissive, socially inferior, and shameful as compared to their non-migrant counterparts.

Materials and Methods: A sample of 35 migrants and same number of non-migrant people were selected by employing suitable inclusion and exclusion criteria from Jaipur city. The Submissive Behavior Scale, Social Comparison Rating Scale, Other as Shamer Scale (OAS), and Beck's Depression Inventory were used in this study. Stastical analysis was done by using suitable statistics.

Results and Conclusions: Analysis of results of this study has proved that the hypothesis formulated and sociocultural explanation of finding has been discussed. It was found that migrant people were significantly more submissive, socially inferior, and shy as compared to their non-migrant counterparts.

Prevalence of internet addiction among medical students in both UG and PG

Asgar Alam, Sivachidambaram, Srinivasagopalan, Zubaida Sultana, Shailaja

No.7/8 SRIJI MANOR , 72/73 maddox street, Choolai, Chennai.

Aim : To determine the extent of internet addiction among medical students undergraduate (UG) and postgraduate (PG)

Materials and Methods: Assessment tools used:

  1. Semistructured pro forma
  2. Internet Addiction Test (IAT)
  3. Socio-demographic performa
  4. Young's criteria for internet addiction based on pathological gambling in Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV).
  5. Informed consent


All modes of use of internet are included (like mobiles, tablets, laptops, and PC's).

Results and Conclusions: Will be discussed at the conference.

A rare case of disulfiram-induced peripheral neuropathy

Avik Kumar Layek, Sudipta Ghosh, Sikha Mukhopadhyay, Partha Sarathi Biswas

Institute of Psychiatry, Kolkata, West Bengal, India

Aim : Disulfiram is a drug, widely used for alcohol dependence treatment since 1951 after having Food and Drug Administration (FDA) approval. Though well tolerated, as per Western literature, rarely patients (one in 15,000) may develop peripheral neuropathy, often misdiagnosed as alcoholic neuropathy. However, search in Indian studies yield no result. Here, we wish to present a case of disulfiram-induced acute and rapidly progressing motor-sensory type of axonal neuropathy, and how we managed it.

Materials and Methods: Adequate history including alcohol intake; previous neurological functioning; relevant past, family, and personal history was obtained before initiation of disulfiram. Serial neuropsychological and hematological examinations were undergone during detoxification, treatment, and subsequent development of neuropathy and its management. Neuroimaging and electrophysiological studies were also done to establish the diagnosis and exclude other possibilities.

Results: A male patient of 38 years with alcohol dependence developed rapidly progressing acute distal sensorimotor neuropathy after being abstinent and on disulfiram (500 mg/day) for 5 months. Initially started with mild tingling and numbness in soles, which within 15 days progressed upwards causing lower limb distal segment weakness, numbness, burning, and pain in soles; making him unable to stand on his own without support. The hematological, biochemical, and magnetic resonance imaging (MRI) reports were normal, but nerve conduction studies showed axonal type of neuropathy. With cessation of disulfiram beforehand and administration of gabapentin, he made gradual recovery over next 3 months, and could walk alone with few residual symptoms.

Conclusions: Quick recognition of symptoms, a suspecting mind, and prompt withdrawal of disulfiram with regular review and reassurance of possible reversibility yielded better result than symptomatic management of this debilitating and rapidly progressing neuropathy.

Cross-sectional assessment of empathy among medical undergraduates

BO Susmita, R Shashikumar, RC Das, PS Bhat, K Srivastava, J Prakash.

Department of Psychiatry, Golden Jubilee Block, Armed Forces Medical College, Pune, Maharashtra, India

Introduction : Empathy is essentially a desirable quality among clinicians and can be developed during medical education. Studies from outside India have shown that higher empathy is related to better competency, and choice of specialty may be related to empathy levels in them. While some western studies found significant fall in empathy levels when they progressed from non-clinical to clinical training years, findings from Asian counties have been varied. Gender differences in empathy levels also vary among different countries. Since, many of such factors differ in India; therefore, there is a need to understand empathy and its correlates among medical students in India.

Materials and Methods: A cross-sectional study was undertaken in a large medical college among the undergraduates of first, third, fifth, seventh, and ninth terms to measure their empathy levels. The evaluation was done using the Jefferson Scale of Physician's Empathy-student version.

Results: The study revealed highest empathy at entry level and a significant fall by seventh term (P = 0.002). Women had significantly higher empathy levels than men (P = 0.012) across all terms. The variance in empathy scores according to the specialty chosen is not statistically significant (P = 0.2468).

Conclusions: The progressive decline in empathy levels with years in medical college here is seen much later than in western studies. Women are more empathetic than men. The relation of mean empathy scores and choice of specialty is inconclusive and at variance from other studies.

Associations between life events and the suicide intent of first episode of deliberate self-harm

Bhagwat Rajput, Late. Col Rajesh Goger, D. Bhattacharya, NC Shekhar, M Diwakar

Aims and Objectives:

  1. To determine the associations between life events in 12 months preceding an episode of deliberate self-harm (DSH)
  2. To determine severity of suicide intent for first DSH attempt
  3. Preventive and social intervention methods to prevent further acts of DSH in at risk population.


Materials and Methods: Necessary clearance from hospital ethical committee and informed consent was taken. Consecutive 100 patients who have attempted DSH for the first time and healthy relatives as control. Place: Tertiary care hospital, New Delhi Source of data: Psychiatry outpatient department (OPD), psychiatry ward, and other wards. Inclusion criteria: Informed consent age³ 15 years: Attempted DSH for the first time only (in past 6 months). Exclusion criteria: Prior history of DSH and mental retardation. Scales used: 1. Pierce's Suicidal Intent Scale: Completed after DSH attempts; scores included (circumstance + self report + medical risk) total score 0-21; low intent 0-3; medium 4-10; and severe >10. 2. Presumptive stressful life event scale (Singh et al., 1984): Contains stressful life events items standardized on Indian population. Stressful life within 12 months of DSH attempt; score ‛1' and ‛2' for 1 or 2 stressful life events. Any event happens twice or more in the preceding 1 year; a score of ‛1' is given.

Results and Conclusions: The associations between life events in the 12 months preceding an episode of DSH and the suicide intent of this episode were compared in individuals for whom the index episode was their first with healthy controls. The Pierce's scale scored distribution as low, medium, high, and very high risk. In these cases, majority of them scored medium risk on the scale (26.4%), followed by high risk (18.3%) and low risk (4.1%). P-value is < 0.01, which is statistically significant. The distribution pattern of amount of stress in study group, the life event has classified into zero event to four event; and majority of the cases have two events (21.5%), followed by three events (10.5%), four events (7%), and single event (2%). P-value is < 0.01, which is statistically significant.

Results indicated a significant interaction between independent life events and the prediction of suicide intent.

The results provide preliminary evidence to suggest the presence of a suicidal process, in which the impact of negative life events on suicide intent is significant.

Catatonia in childhood and adolescent - Modified ECT and the Mental Health Care Bill

Bhavuk Garg, Manish Borasi, Deepak Kumar


Department of Psychiatry, Institute of Human Behaviour and Allied Sciences, Dilshad Garden, New Delhi, India

Aim : To present a case series of children and adolescents with catatonia and the treatment modality used.

Introduction: Catatonia occurs in children and adolescents with affective, psychotic, autistic, developmental, drug-induced, and medical disorders. Benzodiazepines and electroconvulsive therapy (ECT), the treatments that have historically proven to be effective in adults with catatonia, also improve catatonia in children and adolescents. The use of electroconvulsive therapy in children and adolescents require careful consideration of the fundamental tenets of medical ethics: Autonomy, beneficence, non-malfeicence, and justice.

Materials and Methods: Study was conducted using chart review of children and adolescents (age < 18 years) diagnosed with catatonia admitted in child ward of a tertiary care academic neuropsychiatric institute. The underlying etiology, presentation, and treatment modality used were analyzed. The main modalities used were parenteral benzodiazepine and modified ECT data was tabulated in descriptive manner.

Results: Parenteral benzodiazepine was not enough to manage catatonia in children and adolescents. Modified ECT was required to manage children and adolescents after failing a benzodiazepine trial.

Conclusions: With the proposed Mental Health Care Bill prohibiting modified ECT in children, the case series presented raises a question in the management algorithm for childhood catatonia after prohibition of modified ECT in children and adolescents.

Self-mutilation as a presenting feature of complicated alcohol withdrawal

Bichitra Nanda Patra, Akhilesh Sharma, Aseem Mehra, Shubhmohan Singh

Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Introduction : Self-mutilation has been defined as a deliberate self-injury to body tissue without the intent to die. There has been an association between substance abuse and self-mutilation. Alcoholic hallucinosis is usually in auditory modality and regarded as harmless. But patients can indulge in self-harm behavior when the hallucinosis is commanding type.

Aim: To present a case in which the patient inflicted multiple stab injury to his own abdomen in response to alcoholic hallucinosis and discuss its clinical implications.

Materials and Methods: The patient was diagnosed and prompt treatment was introduced at the earliest.

Result: The proper and timely intervention of the patient produced a good recovery.

Conclusions: The history of substance abuse should be explored for in cases presenting with self-mutilation. This will enable timely intervention for substance abuse to take place.

Acute coronary artery disease during opioid withdrawal

Bichitra Nanda Patra, Santhosh Kumar, Uma Maheswari V, Shubh Mohan Singh

Department of Psychiatry, Drug De-addiction and Treatment Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Introduction : Myocardial insufficiency and subsequent infarction, endocarditis, and myocarditis are known to be associated with overdose of various substances of abuse. However, during the substance withdrawal phase, it is rarely reported.

Aim: To present a case of coronary artery disease (unstable angina) during the phase of opioid withdrawal.

Materials and Methods: The patient was diagnosed and prompt treatment was introduced as soon as possible.

Result: The proper and timely intervention of the patient produced improvement in unstable angina.

Conclusion: The physical complications during the substance withdrawal phase should be remembered, so that timely intervention can be done for the same.

Free legal aid clinic services - A boon for caregivers of persons with mental illness

C Ramasubramanian, M Kannan, M Ramu, KSP Janardhan Babu, R Rajkumari

M. S. Chellamuthu Trust and Research Foundation, Madurai, Tamil Nadu, India

MS Chellamuthu Trust and Research Foundation is a registered, nonprofit, secular organization founded in the year 1992, with a mission to enhance the quality of life of the persons with mental disabilities and facilitate their reintegration with the environment of their choice. Trust has a wide range of activities, which include treatment, psychosocial rehabilitation, vocational training, and placement. These activities help the persons with mental disabilities to recover and reintegrate with the mainstream of the community.

As a part of rehabilitation services, the trust motivated the caregivers of mentally disabled to involve themselves in the treatment process, and they have formed a family fellowship namely "SUBITCHAM" and initiated "NAMBIKKAI"(Hope), a self help group by the families of the mentally disabled. Our Trust has been working for the mentally disabled since 1992, whose families are facing several legal issues such as availing guardianship, family pension benefit to the mentally disabled, different issues related to property, and institutional care for destitute and wandering persons with mental illness in which, mental health professionals are not able to meet out. Finally came to the conclusion that without judicial support the above mentioned issues could not be addressed and resolved.

Aim: In order to study the services of the legal aid clinic, established in the year April 2012, supported by State Legal Services Authority, Chennai, an attempt has been made to study and understand the type of services that are availed by the caregivers of the persons with mental disabilities; thereby strengthening their family support.

Materials and Methods: A panel of advocates deputed by the district legal aid clinic is visiting twice a week to the tTrust, and addressing the grievances of the persons with mental illness; and if possible, make endeavor to resolve the disputes or refer to the cases to the District Legal Services Authority.

Findings: The various services provided by the legal aid clinic, the problem faced by these families while obtaining the services, the changes in the socioeconomic conditions after getting the services future plan, etc., are discussed at length in this paper. Finally the application of holistic approaches and the role of the judiciary for persons with mental disability are also discussed.

Acute and transient psychosis - Course and outcome

Charanpreet Singh, Ajay Kohli, Ma Siddiqui, Anju Agarwal, Kunwar Vaibhav

ERA's Lucknow Medical College, Sarfarazganj, Lucknow, Uttar Pradesh, India

Due to brief nature of acute and transient psychosis, it never comes to the attention of mental health services; as a result of which data on their epidemiology is limited, more so in developing countries such as India. The present study was conducted with the aims and objectives to assess the sociodemographic variables, prognostic factors, course, outcome, and duration of untreated psychosis (DUP) in patients presenting with a recent onset psychosis.

Materials and Methods: A cross-sectional, observational study is being conducted in Psychiatry Department, Era's Lucknow Medical College and Hospital (ELMC and H), Lucknow; with sample of 50 patients between 16 and 45 years of age coming to outpatient department (OPD) as a case of minimally or untreated first episode recent onset non-affective psychosis with a reliable informant. The patients are being evaluated at 3 months interval. This will be done over the period of 1 year with a minimum four follow-ups. Assessment is being done using the standardized tools in the form of Positive and Negative Syndrome Scale (PANSS), Hamilton Rating Scale for Depression (HAM-D), Young Mania Rating Scale (YMRS), and Clinical Global Impression (CGI) Scale. The appropriate statistical tests will be applied for analysis.

Association of Big Five personality with perceived stress in medical postgraduates: A cross-sectional study

Donthu Raj Kiran, Parameshwaram Soumya, KR Syam, Pai Keshava, Thunga Ravish

Dept. of Psychiatry, Kasturba Medical College Hospital, Attavar, Mangalore

Introduction : Medical postgraduates are exposed to heavy workloads and stress. There are studies which found some correlation between personality and stress levels.But there are only few studies correlating Big Five personality traits and stress between different medical fields. This study tries to examine whether there is a difference between personality traits and stress between different medical fields.

Aims and Objectives: This study is done with the aim of looking if a correlation exists between Big Five personality traits and perceived stress among medical postgraduates in various branches. Our study is being done with the objective of assessing the personality traits of postgraduates in various branches of medicine; and to compare the Big Five personality traits and the stress levels of the postgraduates.

Materials and Methods: We are doing a cross-sectional study at Kasturba Medical College, Mangalore, taking medical postgraduates of all branches of Kasturba Medical College, Mangalore. All the postgraduates are given Big Five Inventory (BFI) 44 (John, 1991) and Perceived Stress Scale (PSS) 14(Cohen, 1983), which are self-rated scales. The sociodemographic factors will be collected to look for their impact on perceived stress levels in postgraduates.

Results and Conclusions: As it is an ongoing study; the results, discussion, and conclusions will be presented later.

Study of anxiety symptoms in patients of multi-drug resistant (MDR) tuberculosis

Deepanjali Deshmukh, Abhijeet Faye, Sushil Gawande, Rahul Tadke, Sudhir Bhave, Vivek Kirpekar, BO Tayade

Department of Psychiatry, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Hingna Road, Nagpur, Maharashtra, India

Introduction: Tuberculosis (TB) is a chronic infectious multisystemic disease caused by Mycobacterium tuberculosis and is one of the leading causes of mortality worldwide. Multidrug resistant tuberculosis (MDR TB) () refers to strains of Mycobacterium tuberculosis that are resistant to at least isoniazid (INH) and rifampicin, the two most powerful antituberculosis agents.

TB itself being a chronic medical condition, psychiatric comorbidities are common, and in case of MDR TB, both baseline psychiatric disorders and development of psychiatric complications related to antituberculosis drugs and psychosocial factors require aggressive management, as it may affect the compliance and overall prognosis of MDR TB.

Aims and Objectives: To assess the anxiety and other psychiatric symptoms in patients of MDR TB.

Materials and Methods: Forty consecutive patients of 18 years of age or older, with diagnosis of MDR TB will be included in the study. Each patient will be individually interviewed after their consent, by using a semistructured pro forma including demographic profile, and details about TB (history, course, etc.) and its treatment with any relevant psychiatric history. Hamilton Anxiety Rating Scale will be administered to assess anxiety and Brief Psychiatric Rating Scale to find other psychiatric symptoms in these patients. Data thus collected will be tabulated and analyzed statistically.

Result and Conclusion: Will be discussed depending on the findings.

Visual hallucinations in the elderly; a diagnostic dilemma?

Deepika Verma, Aneek Saha, Sameer G, Saldanha D, Bhattacharya L

Padmashree Dr DY Patil Medical College, Pimpri, Pune, Maharashtra, India

Background: Presence of florid visual hallucinations in an elderly patient should indicate underlying organic brain syndrome or an early dementia however with no history suggestive of decline in social and occupational functioning; preceding it becomes a diagnostic dilemma.

Aim: To report a case of mild cognitive impairment with multi-infarcts in brain parenchyma.

Case: A 71-year-old woman was brought by her husband with complaints of seeing various Gods and Goddesses, except the one in whom she has belief, not sleeping or taking care of self, and often complaining of headache of 3 month's duration. She was often found talking to herself, and when asked, she stated that she sees female goddesses and want to communicate with them. There was no past history of psychiatric or medical illness. A detailed general and systemic examination showed mild cognitive impairment (mini-mental state examination (MMSE) 25) and frank visual hallucinations. A magnetic resonance imaging (MRI) brain revealed small subacute/old lacunar infarcts in the white matter, ischemic changes in pons, basal ganglia, and centrum semiovale; with marked cerebral atrophy which was age-related. There was no indication of hypertension. Bender-Gestalt test (BGT) showed gross scoring errors showing cognitive brain dysfunction.

Treatment and Outcome: Patient was treated with antipsychotic drugs in low doses (olanzapine 5 mg and donepezil 11.5 mg) and multivitamin supplements containing 1,500 mcg of methylcobalamin, with which she recovered. Follow-up showed good outcome.

Conclusion: In elderly patients when confronted with perceptual disturbances, organic causes take precedence; and hence, early diagnosis to rule out organic brain dysfunction ensures faster recovery.

Review of inpatient admissions in a general hospital's psychiatry ward for 1 year period

Divya Gopal Mukherjee, Saikat Mitra

Department of Psychiatry, Radh Govinda Kar Medical College and Hospital, Khudiram Bose Sarani, Kolkata, West Bengal, India

One hundred and ten admissions in a general hospital's psychiatry unit within a time period of 1 year (2012-2013) were reviewed to assess the major causes for admission in the psychiatry indoor ward, along with their respective outcomes at discharge. The sociodemographic characteristics and their relationship with the diagnostic category, and the outcome measures were analyzed. The necessity of inpatient admissions, and its relevance considering bed occupancy in a tertiary care center among psychiatric disorders will be discussed at length in the presentation.

A study of relaxation therapy in generalized anxiety disorder

Diwakar Sharma, Anil Nischal, Bandna Gupta, Manu Agarwal, Shweta Singh, Pooja Mahour

Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India

Aim: The aim of the study was to study the effectiveness of an "add-on relaxation therapy module" in the management of generalized anxiety disorder (GAD).

Materials and Methods: The study sample included patients of GAD attending adult psychiatry outpatient department (OPD). They were randomly allocated to study and control group. The study group was trained and practiced in the add-on relaxation therapy module developed by the study team, along with pharmacological treatment as usual; while control group received only pharmacotherapy as usual. They were assessed on Hamilton Anxiety Rating Scale (HAM-A) and GAD Severity Scale (GADSS) before intervention; and at all four follow-up visits made every fortnightly. The clinical improvement in the study group and control group were compared using appropriate statistical measures.

Results: Across the follow-up visits, patients in study group showed significantly more improvement in several domains of HAM-A (fears, insomnia, depressed mood, autonomic symptoms, and behavior in interview) and GADSS (distress due to worrying, distress due to associated symptoms, impairment in work, and social functioning), as well as their total scores.

Conclusion: In this study it was found that add-on relaxation therapy was more efficacious in the treatment of GAD in comparison to pharmacotherapy alone.

Association of big five personality with perceived stress in medical postgraduates: A cross-sectional study

Donthu Raj Kiran, Parameshwaram Soumya, KR Syam,

Pai Keshava, Thunga Ravish


Introduction : Medical postgraduates are exposed to heavy workloads and stress. There are studieswhich found some correlation between personality and stress levels. But there are only few studiescorrelating Big Five personality traits and stress between different medical fields. This study tries toexamine whether there is a difference between personality traits and stress between different medicalfields.

Aims and Objectives: This study is done with the aim of looking if a correlation exists between BigFive personality traits and perceived stress among medical postgraduates in various branches. Ourstudy is being done with the objective of assessing the personality traits of postgraduates in variousbranches of medicine; and to compare the Big Five personality traits and the stress levels of the postgraduates.

Materials and Methods: We are doing a cross-sectional study done at Kasturba Medical College,Mangalore taking medical postgraduates of all branches of Kasturba Medical College, Mangalore. Allthe postgraduates are given Big Five Inventory 44 (John, 1991) and Perceived Stress Scale14(Cohen, 1983), which are self-rated scales. The sociodemographic factors will be collected to lookfor their impact on perceived stress levels in postgraduates.

Results and Conclusions: As it is an ongoing study the results, discussion, and conclusions will bepresented later.

Topical niacin flush response in psychiatric disorders

Era Sharma, MSVK Raju, Ashish Debsikdar, Nilesh Naphade, Jyoti Shetty

Background : Psychiatry as a branch of medicine has progressed leaps and bounds in the past century. However, the psychiatrists often find themselves in a rather vexing situation as they are obliged to rely exclusively on symptom categories to identify the psychiatric disorders. There are no tests to confirm or disconfirm a psychiatric disorder. Niacin, a water-soluble vitamin produces flush reaction on oral consumption and topical application. Topical niacin was first applied by Ward et al., and the induced skin flush response was found to be significantly reduced in schizophrenic patients. This was attributed to the prostaglandin deficiency. The blunted or unobservable flush response to niacin has not been explored in case of other psychiatric disorders.

Aim: To study topical niacin flush response (TNFR) in persons suffering from psychiatric disorders.

Objectives: To measure the TNFR in persons with various psychiatric disorders and healthy controls and draw conclusion regarding suitability of TNFR as a diagnostic tool.

Materials and Methods: The study was carried out at a large tertiary hospital. Hundred cases; each of schizophrenia, mood disorders, substance use, and anxiety disorders; patients with general medical conditions and normal healthy controls were included. Niacin prepared in solutions of 0.1 and 0.01 M, was applied topically. Local erythema was then scored on a 0-3 scale, with 0 and 1 considered as negative.

Result: Fifty-five percent of schizophrenic patients had a negative TNFR, compared to 36.9%of mood and 26.4% of control. The result was statistically significant (P < 0.005). Further, the TNFR was attenuated in psychotic patients compared to nonpsychotic and the result was statistically significant (P < 0.001).

Conclusion: It appears that TNFR may be a simple biomarker test to identify cases of schizophrenia, and functional psychosis in the wide array of psychiatric disorders.

Effect of cognitive behavior therapy for problematic internet usage

G S Ajay Krishna, Madhavi Kodali, P Krishnamohan , P Sivashankar

Dr. Pinnamaneni Institute of Medical Sciences and Research Foundation, Gannavaram, Vijayawada, Andhra Pradesh, India

Background : Excessive and potential misuse of the internet among students is observed to have an adverse affect on their psychological well-being. Limited data is available on the efficacy of cognitive behavior therapy (CBT) as treatment for internet addiction.

Aims and Objectives: The aim of the present study was to evaluate the therapeutic effectiveness of CBT for problematic internet usage.

Materials and Methods: A total of 60 college students, who met criteria for internet problem users based on Internet Addiction Test (IAT) were recruited for the study. The sample was divided randomly into an active treatment group (n = 30) and a clinical control group (n = 30). The CBT combines individual and group interventions with a total duration of 4 months. Internet use, time management, and comorbid mental symptoms were assessed for both groups at baseline and immediately after the intervention.

Results: Will be discussed at the time of presentation.

Conclusion: Will be presented later.

A unique case of addiction to trifluoperazine and trihexyphenidyl and a systematic review of similar case reports

Gulbahar Singh Sidhu, Deepali Gul, Ranjive Mahajan

73-B, Gurjaipal Nagar, Jalandhar, Punjab 144001

Aims and Objectives : The case report aims to study in detail the unique case of addiction to a combination of antipsychotic drug, trifluoperazine and trihexyphenidyl. The paper also aims to undertake a thorough review of similar case reports both in India, and in the rest of theworld in the past.

Materials and Methods: The information about this particular case was obtained from the series of clinical interviews carried out during the course of four hospitalizations of this patient, andon the basis of information recorded in the indoor files of the patient.

Results and Conclusions: A review of the information obtained about the a forementioned patientconfirms that he fulfilled the criteria for substance dependence. A thorough review of similar cases from around the world would be presented at the conference.

Exploration of psychological distress among caregivers in ayurvedic treatment setting

HK Gupta, Manoj, GV Ramana

Research officer (Psychiatry), Advanced centre for Ayurveda in Mental Health and Neurosciences, Central Council for Research in Ayurveda and Siddha, National Institute of Mental Health and Neurosciences Campus, Hosur Road, Bangalore, Karnataka, India

Aim : Exploration of psychological distress among caregivers in Ayurvedic treatment setting.

Materials and Methods: Caregiving for a sick family member has been shown to compromise levels of subjective wellbeing. It manifests as caregiver's burden due to alterations in caregivers' emotional and physical health, which can occur when care demands outweigh the available resources. The aim of the present work is to explore the psychological distress as well as smoking among caregiver of psychiatric inpatient at Ayurvedic center. The General Health Questionnaire (GHQ)-5 and Fagerstrom Test of Nicotine Dependence were administered on 40 caregivers.

Results and Conclusions: Results indicate the high use of smoking on Fagerstrom Test of Nicotine Dependence as well as presence of psychological distress. The relationship has also been seen between psychological distress and use of smoking as coping behaviors to overcome the distress. It has implications for assessment of psychological variables among caregivers and development of module for promotion of positive mental health among caregivers.

Case Report - Leukodystrophy

Himani Kulkarni, Vidyadhar Watve, D. M. Dhavale,

Sudhir Kothari


Poona Hospital and Research Centre, Pune, Maharashtra, India

A 20-year-old female patient, born of a consanguineous marriage, presented with sudden onset of behavioral disturbances, psychotic features, and catatonic features like posturing and urinary incontinence. Total duration of symptoms was about 1 month and there were no precipitating factors.

A differential diagnosis of brief psychotic disorder was made.

In view of sudden onset, loss of balance, urinary incontinence, and neurological opinion was sought. Examination revealed dysarthria, brisk tendon reflexes, nasal twang, grade III power in upper limbs (UL), and lower limbs (LL). Routine workup revealed anemia (hemoglobin (Hb) 8.2), cerebrospinal fluid (CSF) was within normal limits (WNL). Magnetic resonance imaging (MRI) brain showed extensive confluent white matter lesions suggestive of (s/o) leukodystrophy.

Management: Conservative and symptomatic treatment was given. Patient was given olanzapine for behavior control.

Discussion: Leukodystrophy is a group of disorders with degeneration of white matter and developmental abnormalities of myelin.

Conclusion: This case is being presented in view of its uncommon occurrence, and presentation with psychiatric manifestations.

A cross-sectional study of physical comorbidity in psychiatric inpatients

Igam Bagra, RC Jiloha, NImmi Jose, Rashmi Prakash, Aparna Das

Dept. of Psychiatry, Maulana Azad Medical College, New Delhi

Aims and Objectives : To study the prevalence of physical comorbidity in patients with psychiatric illness.

Materials and Methods: This cross-sectional study will be conducted on psychiatric inpatients, within a fixed time frame, with the aim to see the prevalence of physical comorbidity in patients with psychiatric illness. Patients of ages <18 years and patient, not consenting were excluded from the study. The psychiatric diagnosed as per International Classification of Diseases, 10 th revision (ICD-10). Complete blood counts, including hemoglobin, total leukocyte count, erythrocyte sedimentation rate (ESR), blood sugar fasting and postprandial, liver function test, kidney function test, thyroid profile test, electrocardiography (ECG), weight, height, and waist circumference will be measured.

Results and Conclusions: The data will be analyzed using suitable statistical tools. The results will be discussed later at the time of presentation.

A case of concomitant rash and agranulocytosis on carbamazepine in a patient with bipolar mood disorder

Jagad Amish Harish, Donae George, Saumil Dholakia,

Nanma Livingstone


Department of Psychiatry unit 2, Christian Medical College, Vellore, Tamil Nadu, India

Background : The collective incidence of thrombocytopenia, agranulocytosis, and aplastic anemia, associated with carbamazepine ranges from 1 to 2%. The incidence of carbamazepine associated rash is around 3%. 2 Pharmacoepidemiological studies have shown severe blood dyscrasias to be a rare phenomenon with carbamazepine. 3 Case reports of concomitant rash and severe agranulocytosis on treatment with carbamazepine are even rarer. 4

Case Report: We report a case of a 23-year-old married female, admitted with the second episode mania with psychosis. The 20 th day after initiating carbamazepine therapy on a dose of 600 mg/day, she developed a maculopapular rash with pruritis all over the body. Blood investigation on the 3 rd day after the rash revealed that her total count was 1800/mm 3 with 10% neutrophils, 5% eosinophils, 17% lymphocytes, 17% monocytes, and 3.49 lakh platelets. A diagnosis of carbamazepine-induced rash and agranulocytosis was made and carbamazepine was stopped. She required aggressive treatment with granulocyte colony stimulating factor (G-CSF) and antibiotics for complete recovery.

Discussion: This case supports the fact that a patient who develops a rash on carbamazepine needs extensive and more vigilant monitoring for blood dyscrasias.

Conclusion: This case supports the earlier findings of rash and agranulocytosis associated with carbamazepine. Vigilant monitoring and high index of suspicion will help to prevent fatal outcomes in such cases. This case also points towards the need of further research on association of blood dyscrasias and rash.

Relationship of depression, anxiety, coping, social support, and pain intensity in patients with back pain

Jaspreet Kaur, Adarsh Kohli, Saravdeep Singh,

Mandeep S Dhillon


Department of Physical and Rehabilitation Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Introduction : Back pain is a symptom that cannot be validated by an external standard. It is a disorder with many possible etiologies, occurring in many groups of the population, and with many definitions. Back pain is a common problem with a prevalence ranging from 8 to 56%. Since past few years, growing body of research has documented the importance of psychological antecedents and consequences in back pain patients. Psychological factors have been found to play an important role in the occurrence and recovery from back pain.

Aim: The aim of the present study was to examine the relationship between anxiety, depression, coping, social support, and pain intensity in patients with back pain.

Materials and Methods: The sample comprised of 100 patients with back pain coming for follow-up to Department of Orthopedics, Post Graduate Institute of Medical Education and Research, Chandigarh. Sample included both male and female patients in the age range of 16-50 years. Patients were assessed using semistructured pro forma, Hamilton Rating Scale for Depression , Hamilton Anxiety Rating Scale, Coping Checklist, Social Support Questionnaire, and Numeric Pain Rating Scale.

Results: Results and implications will be discussed.

Are there body mass index differences between autistic children and other normally developing children in South India?

Jibi Achamma Jacob, Sherab Tsheringla, Satya Raj

Department of Psychiatry, Christian Medical College, Bagayam, Vellore, Tamil Nadu, India

Introduction : Physical development has been reported to be affected in autism spectrum disorders (ASD). There is little data from India about the body mass indexes (BMIs) of children suffering from ASD.

Aims and Objectives: The study aims to collect and compare data on the BMI of children less than 18 years of age with ASD with normative population data.Materials and Methods: A retrospective chart review of all cases of ASD over the last 5 years presenting to a tertiary care hospital, Autism Clinic of the Child and Adolescent Psychiatry Unit and Facility for Children with Neurodevelopmental Disorders, Christian Medical College (CMC), Vellore. All available data on height and weight recorded in the charts at the time of index visit to the center will be used to calculate BMI. Demographic and treatment related variables prior to the index visit will also be noted.

Results and Analysis: The data will be analyzed using descriptive statistics and mean and standard deviations for variations from normative population data will be reported. Univariate and multivariate regression analysis will also be done for analyzing predictive factors for BMI among autistic children.

Conclusion: The study is under progress and the details of the study will be presented at the conference.

Study of thyroid dysfunction in depression

Jyoti Jagtap, Vaibhav Srivastav, Bindoo Jadhav, H. S. Dhavale

Department of Psychiatry, K. J. Somaiya Medical College, Hospital and Research Centre, Sion, Mumbai, Maharashtra, India

Introduction : The relation between thyroid function and depression has long been recognized. Patients with thyroid disorders are more prone to develop depressive symptoms, and conversely depression may be accompanied by various subtle thyroid abnormalities.Traditionally, the most commonly documented abnormalities are elevated thyroxine (T4) levels, low triiodothyronine (T3), elevated reverse T3 (rT3), a b7 mmlunted thyroid-stimulating hormone (TSH) response to thyrotropin-releasing hormone (TRH), positive antithyroid antibodies, and elevated cerebrospinal fluid (CSF) TRH concentrations.

Also, a number of clinical studies have suggested a therapeutic role for thyroid hormone comedication in patients with depression, who are biochemically euthyroid. Keeping this background in mind, this study was undertaken.

Aims and Objectives:

  1. To study prevalence of thyroid dysfunction in depression.
  2. To study type of thyroid dysfunction associated with depression.


Materials and Methods:

  • Fifty consecutive new patients presenting to psychiatric outpatient department (OPD) and diagnosed as having major depressive disorder (MDD) using Diagnostic and Statistical Manual of Mental Disorders, 4 th edition, text revision (DSM-IV-TR) included.
  • Sociodemographic data collected using specially designed semistructured proforma.
  • Montgomery-Asberg Depression Rating Scale applied to assess severity of depression.
  • Thyroid functions assessed by serum T3, T4, and TSH levels.


Data thus collected to be pooled and subjected to statistical analysis.

Results and Discussion:

To be discussed in view of available literature.

Correlation of clock drawing test in prediction of therapeutic outcome in cognitive and negative symptoms domain among psychotic patients

Khairkar Praveen, Ransing Ramdas, Sarkar Dipayan, Mishra Kshirod

Department of Psychiatry, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India

Background : Cognitive and negative symptoms of schizophrenia are difficult to diagnose and often associated with poor outcome if not treated. Neuroanatomical correlations of them closely simulate what we get in a clock drawing test.

Aim: The study aimed to analyze and compare different errors in clock drawing test among patients of negative symptom psychotic disorder, and to study therapeutic response of antipsychotic.

Materials and Methods: The study was short-term, prospective, observational type; enrolling 30 conventionally treated patients of negative symptom psychotic disorder after obtaining approval from Institutional Review Board (IRB). All the 30 patients formally underwent Sunderland and colleagues' method for evaluation of clock drawing test at baseline, and again after 4-6 weeks of treatment with antipsychotics. Therapeutic response was measured with the help of Brief Psychiatric Rating Scale, Positive and Negative Syndrome Scale (PANSS), clock drawing test, and Mini-mental status examination (MMSE).

Results: The mean age of the patients were 39.94 years (standard deviation (SD ±9.27)). Fifty-eight percent of our patients belonged to paranoid schizophrenia subtype, followed by undifferentiated and residual type (26%) each. Most common patterns noted among them were conceptual deficits (29.79%) followed by perseveration (19.15%), and planning deficits (19.15%). The least common patterns were graphical difficulties and stimulus bound response. Severity of negative symptoms and cognitive symptoms is inversely correlated with improvement in errors of clock drawing.

Conclusion: The study implicates the utility and interesting analogy between impaired clockdrawing and two major domains of psychotic disorder in their understanding and signal their presence and proximity or response to therapeutic strategies for treating clinicians.

Attachment styles, negative emotions, and cognitive emotion regulation in persons with schizophrenia and their offspring

K. Rai, Sandhyarani Mohanty, Rakesh Kumar, Sudhir Kumar

Institute of Mental Health and Hospital, Agra, Uttar Pradesh, India

It is postulated that attachment theory could enhance our knowledge and understanding of psychotic phenomenology. Attachment is a deep and enduring emotional bond that connects one person to another across time and space. Attachment does not have to be reciprocal; one person may have an attachment with an individual which is not shared. There are four styles of attachment: secure, anxious-preoccupied, dismissive-avoidant, and fearful-avoidant. Insecure attachment styles are differentially associated with the severity of psychopathological symptoms and emotional distress in schizophrenia. The present study would aim at exploring attachment styles of schizophrenic and their adult offspring and how it affects negative emotions including the cognitive coping used by this population. This would be a cross-sectional study conducted at Institute of Mental Health and Hospital, Agra. Twenty schizophrenic persons and 20 offsprings would be drawn from the persons presenting at the institute. Attachment Style Questionnaire, Depression Anxiety and Stress Scale (DASS), and Cognitive Emotion Regulation Questionnaire (CERQ) would be used for data collection. The results will be presented.

Does tobacco use decrease psychiatric morbidity in alcohol dependents?

Karthick Subramanian, Shivanand Kattimani, Balaji Bharadwaj, Parthasarathy Ramamourthy

Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research Dhanvantari Nagar, Pondicherry, India

Aims : We hypothesized that in our sample of persons who sought treatment from deaddiction services, those who are concurrently using alcohol and nicotine in dependent pattern are less likely to have either substance-induced or independent psychiatric disorders.

Materials and Methods: Deaddiction clinic is a specialty clinic run by the Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Puducherry. The clinic receives referrals from within and outside the hospital. Sociodemographic and clinical data were collected using structured pro forma. International Classification of Diseases, 10 th revision (ICD-10) Clinical Descriptions and Diagnostic Guidelines (CDDG) was used to diagnose substance use disorders. Alcohol-dependent patients with and without nicotine dependence were compared with respect to comorbid psychiatric illness (including alcohol-related and independent disorders).

Materials and Methods: Persons with alcohol problems were referred to psychiatry. Department of Psychiatry at JIPMER, Puducherry, runs deaddiction services. These were predominantly referred for substance use problems. After physical and psychiatric assessment, diagnoses were made using ICD-10, chapter V. Clinic maintains detailed structured pro forma for such persons. We analyzed such persons that were seen during. We classified them into two groups: Those who were dependent only on alcohol and those who were dependent on both alcohol and nicotine. We compared these two groups for identified psychiatric disorders currently (including delirium tremens) or in the past.

Results: One hundred and twenty-two persons were assessed between January 2012 and August 2013. Twenty had only alcohol dependents, and 102 had both alcohol and nicotine dependence. Among psychiatric disorders, delirium tremens, and delusions of infidelity were commonly observed. However, there was no difference in the presence of psychiatric morbidity (lifetime) between the two groups (n = 7 vs = 33, chi-square (degrees of freedom (df)) = 0.053 (1), P = 0.818).

Conclusion: In this explorative study, we found that there was no significant difference in the occurrence of psychiatric morbidity in alcohol dependent persons compared to those who are concurrently dependent on alcohol and nicotine. This preliminary study suggests nicotine use neither protects nor predisposes to psychiatric illness in those who are using alcohol in dependent pattern.

Dhat Syndrome in a male pseudohermaphrodite (46XY, DSD)

Kate N Parkar SR, Kulkarni P

Department of Psychiatry, King Edward Memorial Hospital, Acharya Donde Marg, Parel, Mumbai, Maharashtra, India

Aim : Dhat syndrome is by preoccupation with loss of semen, which is considered to be a precious secretion of the body. Dhat syndrome has been mostly reported in males, with few such descriptions in females, and none in those with ambiguous gender. We present a case of male pseudohermaphroditism, who presented with symptoms of Dhat syndrome, and discuss the sociological and psychological issues associated with the same.

Case: A 18-year-old, male pseudohermaphrodite (46XY, disorders of sex development (DSD)), who was raised as female was referred for psychiatric evaluation prior to sex reassignment surgery. Patient reported that he was maintaining well prior to puberty and was raised as a female. However, after puberty he started feeling attracted towards females and with sexual arousal would have passage of 'whitish fluid' from the region of the urethra and rudimentary penis. Over next few years, he began experiencing weakness, loss of appetite, easy fatigability, poor concentration, along with sadness, loss of interest in previously pleasurable activities, and preoccupation of loss of bodily vigor. He attributed all his psychological and physical symptoms to this discharge at the time of sexual arousal. Due to social stigma, he initially did not seek treatment. Later, he visited physicians and on examination was found to have ambiguous genitalia, and on genetic evaluation was found to be genetically male. In view of being genetically male and having sexual attraction for females, he was advised sex reassignment surgery. In view of the symptomatology and associated beliefs, he was diagnosed with Dhat syndrome along with mixed anxiety depressive disorder. He was managed with sex education and antidepressant medication.

Discussion: Dhat syndrome is a culture-bound syndrome that has traditionally and almost exclusively been described in males. However, given sociocultural beliefs, other sexes are possibly also at risk for developing this disorder.

Norfloxacin-induced hallucinations in an alcohol-dependent patient: A case report from a tertiary hospital setup

Keahava Pai, Donthu Raj Kiran, Soumya P

Dept. of Psychiatry, Kasturba Medical College Hospital, Attavar, Mangalore

Introduction : Norfloxacin belongs to 4-fluoroquinolone group of antibiotics. It is active against gram positive and gram negative organisms. Rarely, hallucinations, delirium, and seizures have occurred. In the past, few cases have been reported with hallucination as rare side effect after norfloxacin was given.

Materials and Methods: Naranjo algorithm for adverse drug reaction casualty assessment gave a score of 5, suggesting that the adverse drug reaction was probably related to the administration of norfloxacin.

Conclusion: This is a rare case report of norfloxacin-induced hallucinations. When we looked at the literature, there is limited literature on this and we propose that more observation and research may be required in this direction while treating patients with alcohol dependence syndrome. A close watch might help us to find out if there is any association between alcohol withdrawal and drug-induced hallucinosis.

Methamphetamine (Wyoming (WY) tablets) dependence: A case report

Khangembam Robindro Singh, Munnawar Sameer Hussain, Mhetre Bhushan B, RK Lenin Singh

Department of Psychiatry, Regional Institute of Medical Sciences, Imphal, Manipur, India

Introduction : Methamphetamine is chemically related to amphetamine; but, at comparable doses, the effects are much more potent, long-lasting, and more harmful to the cardiovascular and central nervous system. There has been increasing incidence of addiction to amphetamine-type stimulants (ATS) among young people in our country; particularly in northeast India. Ephedrine and pseudoephedrine, the precursors of ATS are smuggled from India across Myanmar to southeast Asian regions, and the finished product, that is, ATS (commonly known as Wyoming (WY)/Yaba) reaches markets in east Asian countries; it comes to India as well. Yaba, the Thai word for "crazy medicine", is synthetically produced pill that contains methamphetamine (25-35 mg) and caffeine (45-65 mg).

Case Presentation: We report a 40-year-old male, presented at the Department of Psychiatry, Regional Institute of Medical Sciences (RIMS), Imphal with history of chasing WY tablets three to five times daily for 4 years. He presented with complaints of restlessness, sleep disturbance, loss of appetite, loss of body weight, body ache, vomiting, and general weakness following withdrawal of WY of about 20 days. He was thinly built, poorly nourished with anxious affect, and depressed mood. Investigations were within normal range except liver function tests. He was hospitalized and managed symptomatically and then followed-up regularly.

Conclusion: Methamphetamine offers a relatively prolonged high compared to other ATS, and younger users constitute a greater proportion of methamphetamine addicts. The local scenario in Manipur warrants an urgent attention for clinicians, researchers, and law-enforcers to address this emerging epidemic of WY addiction.

Assessment of subjective well-being in indoor psychiatric patients attending recreational activities

Kishor Jadhavar, Abhijeet Faye, Sushil Gawande, Rahul Tadke, Sudhir Bhave, Vivek Kirpekar

Department of Psychiatry, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Hingna Road, Nagpur, Maharashtra, India

Introduction : Well-being is a degree of 'fit' between individual's perceptions of their objective situations and their needs, aspirations, and values. Involvement with variety of recreational activities can help individuals with mental illness and lead more active and healthier life. Studies have identified consistent link between subjective measures of leisure and global subjective well-being.

Aims: To assess subjective well-being in patients admitted in psychiatry ward. To assess the effect of recreational activities on subjective well-being.

Materials and Methods: Forty indoor psychiatric patients above 18 years of age, who are able to participate in recreational activities will be selected after taking consent. Patients will be divided into two random groups of 20 each- Group A and Group B. Group A will undergo recreational activities and Group B won't. After obtaining sociodemographic profile, World Health Organization (WHO) 5 well-being index will be administered in both the groups initially, and after 1 week. Data will be collected, tabulated, and analyzed statistically.

Results and Conclusions: Depending on the findings, two groups will be compared for the effect of recreational activities on subjective well-being and conclusions will be discussed.

Postictal psychosis and frontal lobe pathology: A case report

Kishore Dudani

Department of Psychiatry, Psychiatric Centre, Sawai Man Singh Medical College and Attached Hospitals, Jaipur, Rajasthan, India

Psychiatric disturbances in epilepsy, primarily psychosis, and personality disorders, have been said to be more common in patients with complex partial seizures, most of whom have a temporal focus, compared to those with generalized seizures; though many other studies have failed to find a difference. Nevertheless, 60-76% of adults with epilepsy, regardless of seizure type, have a temporal focus. Studies on laterality suggest an association of a left side focus with psychosis. Ictal or subictal epileptiform activity may promote behavioral changes, which may occur not only with temporal lobe seizures, but also with those that originate in frontal lobes. The present case report describes first time presentation of (postictal) psychosis in a patient with long standing epilepsy associated with frontal lobe pathology. Postictal psychosis generally lasts for 24-72 h to remit spontaneously or with use of low dose psychotropic medication.

Mr H, 45year-old male, farmer by profession, presented with 1 day history of unusual behavior in form of paranoia, agitation, irritable and impulsive behavior, sudden mood swings, and impaired biological functions, following an episode of generalized tonic-clonic seizure.

Detailed history revealed similar epileptic episodes with variable frequency since last 12 years with irregular treatment in form of anticonvulsants taken with poor compliance. There was no past history of similar or any other episode with prolonged behavioral manifestations. Prescriptions available were of most recently sought treatment in form of tab. phenytoin 300 mg, and tab. phenobarbitone 30 mg, which the patient had left for 7-8 days preceding above mentioned episode. There was no family history of epilepsy or any psychiatric illness.

Brain imaging revealed an old healed lesion in left frontal lobe, while electroencephalography (EEG) demonstrated diffuse spike and wave discharges. Other blood investigations came within normal limits.

During admission, he was prescribed tab. olanzapine 10 mg in divided doses along with tab. clobazam 10 mg at night. Tab. carbamazepine 600 mg was started for management of epilepsy after taking consultation with neurologist. Complete remission was achieved within next 2 days, after which olanzapine was tapered off and patient was discharged on continuing antiepileptics.

Pathway to care in dissociative disorder

Kunwar Vaibhav, Ajay Kohli, MA Siddiqui, Anju Agarwal, Charanpreet Singh

Era Medical College, Sarfarazganj, Lucknow, Uttar Pradesh, India
"Pathways to care" is defined as the sequence of contacts with individuals and organizations, initiated by distressed person's efforts and those of his or her significant others, to seek appropriate help.There is also paucity of such study in the Asian subcontinent, particularly in India, where dissociative disorders are often considered to be associated with bad demons, spirit possessions, and other supernatural events.

Aims and Objectives:

1. To assess the pathways of care in patients of dissociative disorders.

2. To explore various myths/beliefs acting as barrier in pathway of care in these patients.

3. To explore various methods used by healthcare providers for curing the patients in initial pathway of care.

4. To find out the reasons for selection of different care mechanisms.

Materials and Methods: Patients were selected using the International Classification of Diseases, 10 th revision (ICD-10), and exclusion and inclusion criteria was applied, to those fulfilling the criteria semistructured pro forma deduced from World Health Organization (WHO), Gater et al., were applied assessing for different variables (sociodemographic profile, help seeking behavior, care providers contacted, and reasons for delay in help seeking behavior).

Results: Maximum number of patients (n = 26; 39.4%) were between 21 and 30 years of age. Maximum patients (93.9%) were females. Majority of patients were unmarried (56.1%) and from Muslim ethnicity (59.1%), belonged to rural domicile (78.8%). Majority were illiterate or educated up to primary level only. Maximum number of subjects (n = 25; 37.9%) had familial/marital issues as the stress factor. Stupor was the most common disorder (n = 41; 62.1%), followed by dissociative convulsion. Majority of patients (n = 44; 66.7%) had contacted more than one careprovider before reaching to study center. Maximum number of patients (n = 29; 43.9%) had contacted the faith healers, while psychiatrist had the shortest span as a service provider.

Petrol inhalant use disorder in child: A case report

Mukimulhasan Saiyad, Vinod Darji

F/8, Royal Akbar Residency, Opp. Lal Plaza,Sarkhej Road, Ahmedabad

There is less literature as compared to western countries regarding inhalant use in children in India.

Aim: To report a case of petrol inhalant use disorder in child.

Materials and Methods: Case report from a patient of outpatient department (OPD).

Results and Conclusion: Patient presents with symptoms of petrol inhalation use as well as attention deficit hyperactive disorder (ADHD). Case report done to highlight factors affecting such symptoms in childhood and to point out areas of future research in such conditions.

Schizophrenia in a case of corpus callosum agenesis

Madalsa A, Saldanha D, Madhav G, Sameer G, Bhattacharya L

Padmashree Dr DY Patil Medical College, Pimpri, Pune, Maharashtra, India

Background: There are very few case reports of schizophrenia with corpus callosum agenesis till date and most of these reports have been during 1970s. Association between developmental defects of corpus callosum and major psychiatric disorders has been documented.

Aim: To report a case of schizophrenia in a case of corpus callosum agenesis.

Case: A 45-year-old male was admitted with complaints from his wife of unknown fear, muttering to self, hearing voices, suspecting her of infidelity, reduced sleep (used to be awake to keep a watch over her), and appetite of 1 year duration increased over a month. Early developmental history could not be obtained. However, his marital harmony was disturbed due to his illness. General and systemic examination revealed no neurological abnormality. Psychiatric examination revealed active features of paranoid schizophrenia. An magnetic resonance imaging (MRI) scan showed corpus callosum agenesis with no other abnormality.

Treatment and Outcome: Patient was treated with antipsychotic drugs. Follow-up showed no residual symptoms of schizophrenia.

Discussion: Corpus callosum agenesis occurs as a developmental abnormality, and is normally discovered during early childhood. It probably occurs in as many as 1 in 4,000 births. Usually detected by virtue of symptoms attributable to seizures, mental retardation, or hydrocephalus, sometimes discovered only at postmortem or on imaging. Intrauterine hyperglycinemia and exposure to infections and toxins have been attributed as likely causes. A genetic cause could account in 10-15% of cases.

Conclusion: It is difficult to draw conclusions since the prevalence of callosal anomalies in the general population is uncertain.

The status of 'mind' in today's psychiatry: Has 'mind' become redundant due to advancing knowledge of neurobiology?

Shrirang Bakhle

#6, Om Niwas, 11th Road, Chembur, Mumbai

Background: The term 'mind' is used often in psychiatry. For example, psychiatrists have to certify that a person has a sound 'mind'. The word 'mental' means "related to mind; related to disorders, or illnesses of the mind". But according to biological psychiatry, 'mental illness is disease of the brain'. So are 'mental' disorders, disorders of mind, and/or brain? Can psychiatry do away with the mind?

Aim: The present study aims to understand perceptions of psychiatrists about these fundamental issues in psychiatry: What is mind? What is the best method of studying the mind of patients? What is the difference between psychiatry and neurology, if both study brain, is 'mind' the different?

Materials and Methods: A questionnaire to assess the perceptions of psychiatrists about these issues was presented to qualified psychiatrists and psychiatry residents. The replies were analyzed to understand the opinion trends and to see if there was a consensus about these topics.

Results: There is clear consensus that psychiatry and 'mental' disorders are concerned with 'mind'. However, there is a complete lack of consensus about nature of mind and related topics. There is consensus that 'mental' disorders are not disorders of just brain, and that diagnostic criteria of 'mental' disorders cannot be defined in terms of brain markers.

Conclusions: 'Mind' is an important part of psychiatry. However, considering the lack of consensus about the nature of mind and related topics today, there is an urgent need to debate and evolve consensus about these vital topics in psychiatry.

Lurasidone - A double blind trial in bipolar depression

Manjiri Dixit, Dattatreya Dhavale

Poona Hospital and Research Centre, Pune, Maharashtra, India

Aims and Objectives: To assess the efficacy and safety of lurasidone vs placebo, in addition to mood stabilizer in bipolar I patients with current major depressive episode.

Materials and Methods: Patients of bipolar I disorder experiencing a major depressive episode were recruited in the study as per eligibility criteria. Patients were receiving lithium or divalproex in therapeutic doses and confirmed by erum lithium or valproate levels. Patients were randomized to receive lurasidone 40-120 mg daily or placebo, and were assessed on Montgomery-Asberg Depression Rating Scale (MADRS), Clinical Global Impression (CGI), and other scales at regular intervals, for a total duration of 6 weeks. Those patients completing 6 weeks had further option of continuation in a 24 weeks open label study. In case of switch to mania, patient was to be terminated from study.

Results: Poona Hospital was one of the sites participating in this multicentric trial in which, globally more than 300 patients of bipolar depression were recruited. We will report the results for our site for this 6 week acute treatment period.

Conclusions: Lurasidone was a safe and effective drug in the acute treatment of bipolar depression in addition to mood stabilizer.US Food and Drug Administration (FDA) has recently approved lurasidone for the treatment of bipolar depression.

Dance therapy in chronic mental illness

Manjiri Parikshit Gokhale

#11/302, Vipulgiri Siddachal Phase II, Near Vasant Vihar, Pokhran, Thane, Maharastra,

Aims: The present study is an attempt to find the utility of dance(based on Indian classical style of Bharatanatyam) as an adjunct to regular treatment approaches for individuals with chronic mental illness. This is part of a larger longitudinal study in which pre-post analyses will be done for the various deficit areas.

Materials and Methods: Having identified the variables along which the patients would be assessed for pre-post intervention, abaseline analysis of the following parameters was done. Tools used for the same are written in brackets.

Motor skills: Gross (Tinetti Assessment Tool)

Motor skills: Fine (Peg-Board)

Affect (PANAS; Watson et al., 1988)

Self-efficacy (GSE; Schwarzer and Jerusalem, 1995)

Sample: Fifteen patients in partial remission of schizophrenia attending support group at Institute for Psychological Health (IPH) were assessed.

Procedure: The above patients were assessed along the 4parameters defined above.These measurements were used as the baseline for the longitudinal study.

Results: Demographic details of the group are given below:

Mean age: 38.2 years

10 females, 5 males

Mean duration of illness: 13 years

Mean duration of treatment: 11 years

The baseline scores of the four deficit areas were compared across gender, age, chronicity, and duration of medication.

Conclusion: The results show that patients with chronic schizophrenia would require tailored interventions based on the differences in their baseline scores.

Memory impairment 1 year after traumatic brain injury: A retrospective study

Manju Mohanty, S K Gupta, Rajesh Chhabra, S N Mathuriya,

H S Sodhi


Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Introduction: Memory impairment is the most marked and persistent sequel of traumatic brain injury (TBI), often persisting beyond the period of immediate recovery. Memory deficits have been reported to occur in 69-80% of individuals. In 36% of people with severe TBI, these memory impairments were permanent. Longitudinal studies do not demonstrate significant decrease in complaints of memory deficits. Memory deficits can profoundly impact a person's day-to-day functioning, often preventing them from returning to work, or impacting their capacity to engage in independent living. Memory impairment has been linked to increased disability and reduced quality of life in a number of populations.

Aim: To study the pattern of memory impairment in patients with TBI.

Materials and Methods: The files of all patients referred for assessment of memory functions following TBI were reviewed. Sixty patients in the age range of 18-62 years, who have been administered PGI Memory Scale were selected. The patients with a prior history of TBI, chronic medical illness, psychiatric disorder, and neurological disorders were excluded.

Results: There were 53 males and 7 females. Majority was below the age of 40 years and had moderate to severe TBI. The most common mode of injury was road traffic accident. Preliminary analysis showed injury severity and older age to be associated with memory impairment.

Conclusions: Significant domain specific memory impairments were observed which will be discussed.

To assess the stress and coping strategies among medical college students

Matilda Kamalini Arthur, Sivachidambaram, Srinivasagopalan, Zubaida Sultana, Shailaja

Meenakshi Medical College and Research Institute, Enathur, Kanchipuram, Tamil Nadu, India

Medical profession is not spared from stress. The pressure to excel and obtain the degree is highest. Home sickness, improper food habits, continuous studies, and competition with fellow students add to the stress.

Aim: To understand the stress and coping methods among undergraduate and postgraduate medical college students of Meenakshi Medical College and Research Institute, Enathur, Kanchipuram.

Materials and Methods: Questionnaires:

  1. Semistructured pro forma consisting of the sociodemographic data
  2. COPE inventory
  3. Perceived Stress Scale


Results and Conclusions: Will be discussed at the conference.

Mediation Therapy: An Indian perspective

Mohan Raju S, Neetu Rana, Anisha Shah

Department of Clinical Psychology, National Institute of Mental Health and Neurosciences. Bangalore, Karnataka, India

Many times, couple therapists are both the first to learn that a couple may separate and the last to see them in the same consultation room, still relating to each other and the same professional before theadversarial system takes over. If it appears to court that there exist elements of settlement, judge would refer such case for mediation. Mediation is an alternate dispute resolution method contemplated undercivil procedure enacted by parliament. Unlike litigation, mediation creates a positive negotiation environment in which anxiety is significantly reduced and is replaced by a healthy concern for the issues which confront both parties, and for the decisions which each must make. Marital mediation is goal and task oriented, time limited, and practical. Mediation offers a structure for having the difficult conversation about whether and how a couple might be willing to reconcile. The goal of marital mediation is to strengthen an existing relationship byaddressing areas of conflict, whether financial and budgeting, or agreeing upon parental and householdresponsibilities.

Enough commonality exists between systemic couple therapies and mediation. Both are brief and intensive, problem oriented, and focus on directives rather than on interpretations. However, mediation significantly differs from therapy in many ways too. In mediation, parties may not be able to agree on the actual problem to discuss, the exact nature of the disagreements, or even what is wrong and who has the problem. Three such cases were seen in the Family Psychiatry Unit in National Institute of Mental Health and Neurosciences (NIMHANS). The presentation shall highlight the similarities and differences between mediation and couple therapy. Case discussions shall be provided to illustrate the mediation process- therapeutic techniques applied, challenges in the process, and outcome oftherapy.

Neuropsychiatric manifestations of moyamoya disease in a 38-year-old lady - A case report

Munaf B Nandyal, Susmita, Prabhakar, Noel Joseph

Department of Psychiatry Unit 2, P.G. Registrar, Christian Medical College, Bagayam, Vellore, Tamil Nadu, India

Background: Moyamoya disease (MMD) is a rare cerebral vasculopathy with limited information on the associated cognitive and emotional sequealae. It is characterized by progressive stenosis of the terminal portion of the internal carotid artery and its main branches. It is known to present with cognitive and behavioral symptoms with peaks at 5 and 40 years of age. 1 The incidence of MMD is high in east Asia, and familial forms account for about 15% of patients with this disease. 2 MMD may mimic the signs and symptoms of other neurological or psychiatric disorders, thereby complicating diagnosis and management. 3

Case Report: We present the case of a 38-year-old female, who presented with 5 months history of cognitive deficits, behavioral disinhibition, irritability, and agitation. Magnetic resonance imaging (MRI) of brain revealed markedly abnormal appearance in the anterior cerebral circulation with extensive periventricular collateral vasculature involvement consistent with MMD. Neuropsychological assessment data revealed deficits in memory, recognition, and verbal fluency. Her behavioral symptoms improved with tab. haloperidol 2.5 mg twice daily, and after neurological workup she received tab. aspirin 75 mg per day for risk reduction.

Discussion: This case underlines the importance of considering MMD in the differential diagnosis of patients with cognitive deficits, and atypical behavioral symptoms in psychiatric setting.

Conclusion: This case report depicts rare presentation of a rare neurological condition, which can go unnoticed in a busy outpatient department (OPD). Further research is needed to understand the neuropsychological sequealae of MMD.

Delusional Procreation Syndrome: In Perspective of Hinduism

N Manjunatha, R Shankar, S Dhananjaya, Santosh K Chaturvedi

Department of Psychiatry, Employees' State Insurance Post-Graduate Institute of Medical Science and Research, Bangalore, Karnataka, India

The delusional procreation syndrome (DPS) is a recent concept in psychopathology described from India that involves procreation of human beings. It consists of sequential delusions in every stage of procreation such as having spouse/partner, getting pregnant, having delivered a child (labor and childbirth), becoming parents/grandparents, and so on. It has been described in self-reference as well as in proxy dimension.

Aims: In this background, authors aim to discuss the possible origin of delusions of DPS from the ancient Hindu mythology point of view.

Materials and Methods: Review of published DPS articles and Hinduism literature.

Results and Conclusions: The sociodemographic details of patients mentioned in published articles from authors are reviewed. Majority of reported cases belong to Hindu religion, and reported in never married/separated/widow patients except delusion of polygamy in married women (incidentally her father-in-law had two wives). In Hinduism literature, human life is believed to comprise four consecutive stages (Chaturashrama) called as "Ashrama system" described in Manusmriti, and later classical Sanskrit literatures. This consists of consecutive fourstages: Brahmacharya, Grihastha, Vanaprastha, and Sannyasa. As Hindus believes, this Ashrama system lead to a fulfillment of the four goals of life (purushartha) namely, Dharma (righteousness- religious principles), Artha (wealth), Kama (pleasure), and Moksha (liberation). The goal of each stage is fulfillment of specific goals of life. Authors attempt to correlate grihasthaashrama and goals of life in origin of delusions of DPS. Further research is required in correlating ashrama system of Hinduism with DPS.

The roles of primary level health workers in delivering rural mental healthcare in India

Nadja van Ginneken, Meera SM, Sarah Ghani, Anusha Raja, Vikram Patel

London School of Hygiene and Tropical Medicine, Keppel St, London SW14 7HT, UK

Introduction: Despite economic advances, India does not meet the basic health and mental health requirements of many poorer people. Several studies suggest that using primary health workers (PHWs)-primary care doctors/nurses/social workers and lay health workers-are effective in reducing the treatment gap.

Aims: To assess the acceptability and feasibility of using and scaling up PHWs in rural mental healthcare.

Objectives: To describe current delivery models Mental health care in Inida through task-sharing with PHWs, and outline the issues of acceptability and feasibility for scaling-up these models.

Materials and Methods: We visited and interviewed 241 PHWs, supervisors/specialists, and program founders within 37 government and nongovernmental projects across 12 states, chosen to represent 23 models of PHW delivery. We explored health worker roles, perceptions, and program characteristics. This data was triangulated with project documents and published literature.

Results: Lay health workers identified, referred patients to the primary care doctor (government settings) or psychiatric teams (NGOs), and followed-up. Primary care doctors in government program were not a resource for NGOs. Mental health roles of generalist social workers and nurses were generally poorly developed. Government PHWs were poorly motivated and under-confident, consequent to poor remuneration, inadequate training/support, excessive administrative roles, and community prejudice.

Programs with adequate mental specialist support were more motivating and acceptable to PHWs, and most functional organization (seen among NGOs or public-private partnerships).

Conclusion: For PHWs to be feasible, sustainable, acceptable, and for scaling-up, the current government strategy of PHW training could be rethought to ensure quality training and supervision with more specialist involvement, better access to funding and better centralized as well as local leadership should be thought of.

Cross-sectional assessment of phantom limb pain

Nagendra Katuwal, R. Shashikumar, Sonam Tobgay, P. S. Bhat, R. C. Das

Department of Psychiatry, Golden Jubilee Block, Armed Forces Medical College, Pune, Maharashtra, India

Aim: To evaluate the cause, frequency, and nature of phantom limb pain in amputees.

Materials and Methods:
A single cross-sectional study was carried out at the Artificial Limb Centre, Pune, among admitted amputees with phantom limb pain during 1 year period. Amputees with phantom limb pain and ability to communicate in Hindi/English and above 15 years of age were included in the study. Subjects below 15 years of age and above 75 years of age with traumatic brain injury were excluded from the study. Subjects were selected by simple randomization study.

In the present study, all subjects were interviewed and assessed using the questionnaires (Visual Analogue Scale (VAS), and Short-Form McGill Pain Questionnaire (SF-MPQ)) after 4 and 8 weeks of assessing their level of pain and number of PLP episodes. The data so generated was analyzed using appropriate statistical tests.

Results: The study showed that significant number of subjects revealed cause of amputation was road traffic accidents (80%) and frost bite (17%). Stabbing, throbbing, and sharp and hot burning were the types of pain manifested by majority of subjects. Majority of subjects (90.5%) located pain in the remaining stump and lower part remaining stump. Phantom limb pain appeared immediately in 25%, and within few days in 45% of amputees. These and other findings are discussed in the paper.

Conclusion: Phantom limb pain was found in about 78% of amputees. For majority of them, it arose within few days of amputation.

Periodic catatonia in a 16-year-old boy on maintenance lorazepam: Diagnostic and treatment issues of periodic catatonia, a brief review and a case report

M. S. Narendra Kumar, R. Rajagopal, B. N. Raveesh

Department of Psychiatry, Mysore Medical College and Research Institute, Krishna Rajendra Hospital, Mysore, Karnataka, India

Introduction: Catatonia is well described with either schizophrenia or an organic illness. Periodic catatonia is a fascinating, but still an underrecognized clinical entity. Limited information is available regarding the epidemiology of periodic catatonia and its diagnosis and treatment aspects.

Case Presentation: We describe a case of a 16-year- old (now 19) boy, who had history of six episodes of recurrent catatonia over 4 years duration, who initially responded to lorazepam but had recurrence, each time thelorazepam was stopped. But, he has been maintaining remission with maintenance lorazepam at 1 mg twice daily, along with olanzapine 5 mg over the last 40 months.

Conclusions: The patient met the diagnostic criteria for periodic catatonia and has been maintaining remission for 40 months with lorazepam and olanzapine He had a period of repeated recurrences with stoppage of lorazepam, highlighting the need of a select population who need maintenance with lorazepam to maintain remission in catatonia. There was difficulty in labeling the condition with a psychiatric diagnosis according to the present existing classificatory system; emphasizing the need to frame fresh diagnostic criteria along with consensus upon the treatment guidelines for periodic catatonia in spite of the heterogeneous etiology of the periodic catatonia.

Category: Schizophrenia, other psychiatric disorders.

As a free paper or a poster category

Oculogyric crisis with clozapine: A case report

Naresh Nebhinani, Ajit Avasthi 1 , Manish Modi 1

All India Institute of Medical Science, Jodhpur, Rajasthan, 1 Postgraduate Institute of Medical Education and Research, Chandigarh, India

Background: Oculogyric crisis (OGC) is a dystonic syndrome that starts after long-term use of dopamine receptor antagonists. Atypical antipsychotics have reduced liability and clozapine has been reported effective for tardive dystonia.

Aim: To present a case with schizophrenia who developed OGC while taking clozapine.

Case Details: A 25-year-old male, postgraduate student, presented with 7 years history of suspiciousness, referential and persecutory delusion, oddities of behavior, with significant academic and functional decline over the years. He was diagnosed with schizophrenia and tried on chlorpromazine, risperidone, and quetiapine, but failed. Therefore, he was started and maintained symptomatically well on clozapine (up to 350 mg/day) since end of 2004. Later, Divalproate 750 mg was added as he had three episodes of generalized seizures.

After 3 years of clozapine therapy, he started reported ocular phenomenon (initially reduced eyeball movement, followed by gradual upward movement, and fixation of eyeball) suggestive of OGC. Several strategies (trihexyphenidyl 2 mg, promethazine 50 mg, propranolol 80 mg, and tetrabenazine 50 mg) were tried for OGC, but of no use. Later after discussing with patient and family, clozapine was tapered gradually, and substituted with quetiapine (300 mg). With this change, frequency of OGC reduced markedly but his psychotic symptoms reemerged again on clozapine 100 mg. Pros and cons of treatment plan were discussed with family. On family's apprehension for worsening, and insistence to resume clozapine and past record of improvement solely with clozapine therapy; clozapine dose was gradually hiked to 150 mg on which psychotic symptoms subsided but OGC continued, though on lesser frequency.

Successful use of valproate in Kleine-Levin syndrome: A case report

Naresh Nebhinani, Ajit Avasthi 1 , Manish Modi 1

All India Institute of Medical Science, Jodhpur, Rajasthan, 1 Postgraduate Institute of Medical Education and Research, Chandigarh, India

Background: Kleine-Levin syndrome (KLS) is a rare disorder which mainly affects adolescent men and characterized by recurrent episodes of hypersomnia, and sometime along with hyperphagia and hypersexuality. Several treatment strategies have been reported to provide variable benefit in different symptoms profile.

Aim: To present the case with recurrent episodes of hypersomnia, sexual disinhibition and low mood, who was diagnosed KLS and reported significant improvement with valproate therapy.

Case Details: A 17-year-old single male student of 12 th standard, presented with increased sleepiness, sadness, decreased appetite and interest in studies, along with touching female breast occasionally. Onset was acute, without elicitable precipitating factors, while course remained episodic on average 1-2 weeks episode/month in last 3 years.

After detailed evaluation, differential diagnosis of KLS vs recurrent depressive disorder was kept, this was later finalized to KLS. He did not show any improvement with sertraline (100 mg) and risperidone (2 mg). Lithium (900 mg) has shown significant improvement initially, but failed later. He also had three episodes of fall, unresponsiveness, and epileptiform discharge in electroencephalography (EEG) twice. Hence lithium was switched to valproate (750 mg), on which he maintained completely well for 4 years, except brief reemergence of symptoms on discontinuing valproate, which improved completely on resuming valproate therapy. Later valproate was gradually tapered and stopped on insistence of patient and family with discussing its pros and cons. Now index case is maintaining well-off valprote for last 3 years.

Autism association with vitamin d deficiency: Case report and review of literature

Nikita Rajpal, Nidhi Malhotra, Susanta K. Padhy

Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Background: There are limited data available regarding association of vitamin D and autism.

Aim: To present autism association with vitamin D deficiency: Case report and review of literature.

Case Report: The index case is a 88-months-old female child from cold hilly areas of Himachal Pradesh, born of uneventful vaginal delivery. The developmental milestones were normal till 5 months of age. She had exanthematous illness for 1 week at 5 months of age, which resolved with Ayurvedic medication. Following this, impaired social interaction, language and communication, delayed motor milestones, stereotypic movements, and hypersensitivity to noise and touch were present. She required assistance for most activities of daily living. Excessive fidgetiness, restlessness, hyperactivity, lack of persistence, and excessive temper tantrum was noticed since 3 years of age, which gradually increased. On examination, she had microcephaly, chronic malnutrition, and mental retardation. Vitamin B12 levels, urine screen for mental retardation, tandem mass spectrometry of blood, and gas chromatography-mass spectrometry of urine (to rule out organic acidemias and aminoacidopathies), serology for subacute sclerosing panencephalitis (SSPE) and magnetic resonance imaging (MRI) brain were normal. Initial abnormal electroencephalography (EEG) got normalized with 2 years treatment with valproate (no clinical evidence of seizure disorder). Vitamin D3 level was found to be 10.3 ng/dl. No other nutritional deficiency stigmata noted. Childhood autism rating scale score was 41. Her hyperactivity improved with methylphenidate. Vitamin D3 supplementation, high protein, and calorie diet and behavioral intervention instituted. We do not know the status of vitamin D3 level in mother during pregnancy. To our knowledge, no such association was reported from India. We review the association of autism spectrum disorder and vitamin D deficiency and possible mechanism.

Co-occurrence of depression in dementia in a tertiary care center

Parameshwaran Soumya, Donthu Raj Kiran, Pai Keshava, Thunga Ravish

Department of Psychiatry, Kasturba Medical College Hospital, Attavar, Mangalore, Karnataka, India

Background: Depression is common accompaniment in dementia. The prevalence of depressivesymptoms in Alzheimer's dementia clusters around 30-50%. Depression in dementia has negativeconsequences on patients and caregivers. Previous studies have supported this and recommended thatall cases of dementia should be routinely screened for depression and managed accordingly. Earlyrecognition and proper intervention for depression is therefore necessary to reduce the morbidity andmortality associated with depression in dementia and improves the patient outcomes.

Aims and Objectives: The objective of the study is to look at co-occurrence of depression with dementiaand correlating severity of depression with dementia, among the hospitalized population.

Materials and Methods: The study is an ongoing cross-sectional study being conducted at a tertiaryreferral center, Kasturba Medical College Hospital, Mangalore. Consecutive patients diagnosed withdementia has been recruited in the study since May 2013, for a period of 8 months. A battery ofassessment tools such as the Hindi Mental State Examination (HMSE) for brief screening of cognitivefunctioning, Clinical Dementia Rating (CDR) scalefor assessment of the severity of dementia, and CornellScale for Depression in Dementia (CSDD) have been used for measurement depressive symptoms in dementiain patients recruited. Pearson's correlation and Chi-square test will be used to measure therelationship between the variables.

Results and Conclusions: On completion of study, data would be subjected to statistical analysis. Results and conclusion of the study will be discussed later.

Attitude of medical students toward homosexuality

Poorav Patel, I. Chetan Chaudhar, Sweta Parikh, G. K. Vankar

Department of Psychiatry, B.J. Medical College and Civil Hospital, Asarwa, Ahmedabad, Gujarat, India

Background: Attitude of medical personnel towards gay man has raised many questions in recent time in our culture, which involves influence of religion, society, peer groups, education, media, etc. This study reflects attitude of healthcare individual towards homosexual person, their behavior, civil rights, and male toughness.

Materials and Methods: Cross-sectional survey (anonymous) among 200 medical students (undergraduates (UG) and postgraduates (PG)) of BJ Medical College, Ahmedabad. Previously, validated 20 items scale was used for this study. Collected data was analyzed using Statistical Package for Social Sciences (SPSS).

Results: Results shows statistically significant negative attitude towards homosexual person. Civil rights participants showed a positive attitude and large proportion exhibited neutral views. 59.9% students strongly agree to notion "Male homosexuality is a perversion". 48.2% participants believe that gay persons pose threat to safety of children, reflex homophobia, and indirectly suggest exclusion of homosexual persons from society.

Boys have higher score for homosexual behavior and person; whereas, girls have higher score for civil rights. PG students have low score for homosexual behavior as compared to interns and UG students. Otherwise, no significant difference was found between attitudes of students from different caste.

Conclusion: Results reflects majority of students hold negative attitude towards gay behavior in person, which adversely affects healthcare delivery towards the minor community. It recommends training and awareness beyond our conceptual and conventional education, professional teaching approach, and to develop appropriate system in future.

Comparison of patient satisfaction in psychiatric inpatient and outpatient services

Pratibha Gehlawat, Savita Kundu, Priti Singh, Rajiv Gupta

Department of Psychiatry, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana, India

Introduction: Patient satisfaction is an indicator of healthcare quality. Studies from India exploring this area are scanty and are required to improve mental health services, treatment compliance, and prognosis.

Aims: The present study aims to measure and compare patient satisfaction within psychiatric inpatient and outpatient services in Pt Bhagwat Dayal Sharma, Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, a tertiary care center of northern India.

Materials and Methods: It was a cross-sectional study design. Participants between the age 18-60 years, who gave consent were randomly selected from psychiatric inpatient (n = 30) and outpatient (n = 30) settings. The information about sociodemographic data, past psychiatric/medical history, family history, diagnosis as per International Classification of Diseases, 10 th revision was included. Satisfaction of each group was measured by Patient Satisfaction Questionnaire-18 (PSQ-18), severity of psychiatric disorder was measured using Clinical Global Impression Severity Scale, and functioning level was assessed by Global Assessment of Functioning.

Results and Conclusions: To be discussed in presentation.

Characteristics of patients attending child and adolescent psychiatry clinic at a teaching hospital: A 6-year experience

P. P. Singh, S. A. Azmi

Department of Psychiatry, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India

Aims: To study the sociodemographic and clinical profile of patients, who presented to the child and adolescent psychiatry services at a tertiary care teaching hospital over a period of 6 years.

Materials and Methods: Data was collected retrospectively from the work up files of the clients assessed in the Child and Adolescent Psychiatry Clinic during the period of January 2007-December 2012.

Results: Out of the total patients (n = 729) presenting to the clinic; most were males (n = 427; 58.57%), aged between 11 and 15 years (54.04%). The common diagnoses were epilepsy (22%), mental retardation (21%), anxiety and stress related disorders (17.83%), conversion disorder (7.3%), depression (6.17%), and hyperkinetic disorders (3.02%). Most common prescribed drugs were antiepileptic (25.81%) and second generation antipsychotics (11.22%), followed by selective serotonin reuptake inhibitors (SSRIs) (8.21%). Psychological treatment was provided to two-thirds of the patients, mostly as parental counseling and individualized therapy. Further results will be discussed at the time of presentation.

Conclusions: The Child and Adolescent Psychiatry Clinic are visited mostly by males aged 11-15 years, with nearly half the caseload consisting of epilepsy and mental retardation. Antiepileptics and newer antipsychotics were most common drugs. Psychological therapy was provided to two-thirds of the patients.

Disulfiram emergent psychosis: Is it simply an association?

C. Pradeep, Abhishek Ghosh, Debasish Basu

Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Aim: To report a case of emergence of psychotic symptoms following administration of disulfiram.

Materials and Methods: Case report of a 32-year-old male, dependent on alcohol for last 10 years, presented to an unregistered medical practitioner, who prescribed him disulfiram.

Results: Index subject was abstinent from alcohol, and after 2 weeks on regular dose of disulfiram (250 mg/day), he started to remain suspicious that someone was trying to harm him and was conspiring against his family. Also he would accuse others discussing about him with malicious intent. He would remain firm in these beliefs, and was not amenable to logical explanation. In response, he turned homebound and religious to escape, and set aside imaginary imminent danger. He continued to be fearful and seldom expressed sadness. He would have insomnia and poor self-care. The index subject did not have either perceptual or cognitive disturbances. None of the physical or psychological symptoms of withdrawal was present. Subject neither had any past nor had a family history of psychosis. Family stopped disulfiram within 5 days of the appearance of delusions. He was prescribed olanzapine. Though symptoms persisted for another 2 weeks, but the severity came down gradually. Olanzapine was discontinued over another 2 weeks. Magnetic resonance imaging (MRI) of the brain was normal. Disulfiram was never reintroduced. Psychotic symptom did not reappear subsequently.

Conclusion: Use of disulfiram might be associated with psychosis. Though the plausibility of causal link cannot be ignored, it is difficult to substantiate and would require large scale systematic investigation.

Olanzapine associated hirsutism in a patient with incidentaloma - A case report

Aditya Hegde, Susanta Kumar Padhy

Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India. h.aytida@gmail.com

Background: Among second generation antipsychotics, olanzapine is thought to have lesser propensity to elevate prolactin levels.

Aim and Objective: To present a case of a young female with pituitary incidentaloma, who developed hyperprolactinemia, hirsutism, oligomenorrhea, and galactorrhea, associated with olanzapine.

Case Presentation: A 19-year-old female presented with features suggestive of acute and transient psychotic disorder. There was history of schizophrenia in her father and uncle. Having a seizure disorder in the past, she had been on carbamazepine till 15 years of age. Hair growth on upper lip had been noticed after carbamazepine had been started, persisting till date. Olanzapine was started at 5 mg/day. Eight weeks later, she reported oligomenorrhea. Two weeks after hiking olanzapine to 20 mg/day, increased hair growth was noticed on upper lip and other parts of body. Modified Ferriman-Gallwey Score for hirsutism was 11, denoting hirsutism. Galactorrhea was observed. Consecutive prolactin levels showed hyperprolactinemia (up to 104 ng/ml). Olanzapine was stopped after 8 months of institution. One month later, menstrual periods returned to normal. Galactorrhea was not evident. Prolactin levels after stopping olanzapine were normal (10.92 ng/ml). Hirsutism persisted to same degree till 4 months of stopping olanzapine. She received no other medication during this period. Ultrasound abdomen was normal, magnetic resonance imaging (MRI) brain showed pituitary incidentaloma (6 × 8 mm). Endocrinology consultation ruled out the role of the incidentaloma, as well as other causes for hyperprolactinemia. Score of 8 on adverse drug reaction (ADR) probability scale showed high probability of the adverse effects being related to olanzapine.

Conclusion: Olanzapine has the propensity to cause hyperprolactinemia and related adverse effects. Patients who have had these effects with other drugs may be more vulnerable.

Religious beliefs, practices, and traditional healing among psychiatric patients

Ankita Shah, Rachana Pole, GK Vankar

Department of Psychiatry, Byramjee Jeejeebhoy Medical College, Civil Hospital, Ahmedabad, Gujarat, India. E-mail: ankita267@gmail.com

Context: The relation between religion and science has been largely ignored because of the disparity among those two. This study signifies the importance of personal and subjective meaning of religion in patients' mental health.

Aim: To study religious beliefs, experiences, and practices; and two important issues, that is, possession states and traditional healing practices among patients attending psychiatric outpatient department (OPD).

Materials and Methods: A series of 134 OPD patients irrespective of their diagnosis were selected and interviewed by a semistructured questionnaire. Patients' religious beliefs and practices were tabulated. Possession states and traditional healing practices were explored for all patients and their correlates examined.

Result: 97.7% patients believed in God and more than half of the patients had strong religious beliefs and practices. 57.4% patients had consulted traditional healers at least once in their course of illness. 25.37% of patients had been possessed and 76.4% among them desired that.

Conclusion: As a mental health professional, one cannot ignore patients' core beliefs and faith in religion. As well as one needs to understand and integrate traditional healing practices into mainstream.

Pagophagia in a female with recurrent depressive disorder: A case report

Aseem Mehra, Nidhi Sharma, Abhishek Ghosh, Sandeep Grover

Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India. E-mail: nidhisharmajr2@gmail.com

Background: Pagophagia is a form of the disorder involving the compulsive consumption of ice or iced drinks. It is considered to be an expression of the more general phenomenon of PICA. However, it is rarely described as a psychiatric manifestation associated with depression. Aim: To present a case of depressive disorder along with pagophagia. Case Report: A 44-year-old female presented to psychiatry outpatient services for the treatment of her recurrent depressive disorder, current episode moderate depression without somatic symptoms. History revealed that patient was suffering from depressive disorder since 11 years. Her depressive symptoms were associated with life stressors and over the last 5 years she started consuming ice to cope with her stress. According to patient whenever she would be tense or would feel low, she would have intense desire to eat ice, which she would not be able to resist and would feel better only after consumption of ice cubes or iced drinks. Initially she would consume about 250-500 g of ice per day, but gradually the quantity of consumption of ice increased to about 10-12 kg of ice cubes per day. The preoccupation with consumption of ice was to such an extent that she would spend hours in purchasing/procuring/making ice and this led to significant psychosocial dysfunction and interpersonal problems. On the basis of the available history a diagnosis of recurrent depressive disorder, current episode moderate depression without somatic symptoms and pagophagia was made and she was managed with venlafaxine and psychotherapy, with which her depressive symptoms improved. Although her pagophagia reduced, it did not subside completely. Conclusion: Patient of depressive disorder can have associated pagophagia.

Obsessive compulsive disorder manifesting as bleeding per anum in a patient with Turner syndrome

Nidhi Sharma, Abhishek Ghosh, Sandeep Grover

Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India. E-mail: ghoshabhishek12@gmail.com

Aim: To present a case of Turner syndrome with obsessive compulsive disorder (OCD) manifesting as bleeding per anum.

Materials and Methods: (Case description): A 27-year-old female diagnosed to have Turner syndrome based on primary amenorrhea, breast atrophy, short stature, and lack of any secondary sexual characters which was substantiated by karyotyping. She presented to the medical outpatient with bleeding per anum. Local examination did not reveal any evidence of hemorrhoids or fissure. On further evaluation, her excessive perianal cleaning ritual came up as the reason behind blood streaked stool. She was referred for psychiatric evaluation which revealed that since the age of 25 years she had repetitive, intrusive, anxiety provoking doubts that her perianal area was soiled with feces even after washing adequately. These were her own thoughts but she did not consider these doubts as absurd. She had to follow a specific cleaning ritual. Gradually her symptoms worsened further and additionally she started having obsessive doubts of her hands being contaminated with germs and associated repeated hand washing. Her days would be occupied to accomplish the compulsive rituals resulting in frequent absenteeism from college and impaired functionality in the household. Eventually she turned home bound. Since last few months the washing rituals increased to such an extent that she would not only wash the perianal area, but also try to clean the anal canal and in the same processes ended up injuring herself. She was diagnosed with OCD (mixed thoughts and acts) with poor insight. She was treated with sertraline 150 mg with which her Yale-Brown Obsessive Compulsive Scale rating came down from 27 at the baseline to 15 after 3 months of treatment.

Conclusion: The present case demonstrates an association of OCD and Turner syndrome and bleeding per anum as a rare presentation of OCD.

A Study of Psychiatric Morbidity in Psoriasis

Sunil Goyal, Vikas Mathur, K Srivastava, D Bhattacharya, S Grover

Background: Psoriasis is a chronic, relapsing, and disfiguring dermatological disorder with significant effect on occupational, social, and other areas of functioning. Psychosocial stress has been implicated in its onset and exacerbation.

Objectives: To study the prevalence of psychiatric morbidity in cases of psoriasis and the influence of specified demographic, psychological, social, and illness related variables.

Materials and Methods: The study was carried out at Command Hospital (SC), Pune. In this cross-sectional study, 100 consecutive cases of psoriasis were evaluated along with healthy controls matched for sociodemographic profile. The subjects were given-Sociodemographic questionnaire, clinical profile sheet, and Psoriasis Area and Severity Index (PASI). General Health Questionnaire-12 (GHQ-12) was used as a screening instrument and subsequently Hospital Anxiety and Depression Scale and Quality of Life-BREF (QOL-BREF) scale were administered. The results obtained were analyzed for evaluating the psychiatric morbidity and its various correlates.

Results: Using GHQ-12 cut-off score (≥3) for psychological distress, the overall prevalence of psychological distress was 31% in cases of psoriasis and it was significantly more in comparison to healthy controls. Statistical analysis showed statistically significant correlation of educational status with QOL and severity of skin lesions (PASI) with anxiety level. Severe skin lesions, more so on visible body parts were associated more commonly with psychological distress.

Recommendations: All patients of psoriasis should be educated about the nature of the illness and screened for psychological distress. Dermatologists and family members should be educated to recognize the symptoms early and encouraged to seek help of psychiatrist.

Characteristics of Auditory Hallucinations in Indian Patients with Schizophrenia and Bipolar Affective Disorder

Suprakash Chaudhury, Rajesh Dhakne 1

Pravara Institute of Medical Sciences, Rural Medical College and Hospital, Loni, Maharashtra, 1 National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India. E-mail: suprakashch@gmail.com

Background: Auditory verbal hallucinations are not unitary phenomenon and can be further differentiated in certain clinical characteristics viz. frequency, intensity, control, tone, distractibility, distress, and clarity. These clinical characteristics have different qualities in different psychiatric disorder.

Aim: The present study was undertaken to see in what domains these clinical characteristics differentiate in schizophrenia and bipolar affective disorder.

Materials and Methods: A total of 110 patients of schizophrenia and bipolar affective disorder each matched for age, education, socioeconomic status, marital status, and duration of illness were selected and assessed using Characteristics of Auditory Hallucination Scale.

Results: There was significant difference in characteristics of auditory hallucinations between patients of schizophrenia and bipolar affective disorder in domains of frequency, intensity, tone, self-control, clarity, distractibility, and distress. The mean for these characteristics were significantly higher in schizophrenic group as compared to bipolar group.

Conclusion: Characteristics of auditory hallucinations differ in all domains between patients with schizophrenia and bipolar affective disorder.

A case report of efficacy of vasopressin in V-2 antagonist in a case of moderate mental retardation with significant impairment of behavior with antipsychotics induced hyponatremia

Narendra A. R., Gaikwad Vijay B., Munda S. K., Khess C. R. J.

Central institute of Psychiatry, Kanke road, Ranchi, Jharkhand, India.

E-mail: niskasinha@yahoo.com

Background: Antipsychotic-induced hyponatraemia can occur in the context of 1. Water intoxication (psychogenic polydipsia) 2. Drug induced syndrome of inappropriate anti-diuretic hormone (SIADH) 3. severe hyperlipidaemia and/or hyperglycemia associated with antipsychotics leading to secondary increase in plasma volume and pseudohyponatraemia. A new class of drugs called vaptans (non-peptide arginine-vasopressin antagonists) has shown promise in the treatment of hyponatremia of varying etiology.

Case History: Index patient Mr Pintu, 44 yrs old single hindu male admitted in our hospital with a diagnosis of moderate mental retardation with significant impairment of behavior on treatment with inj zuclopenthixol depot(200mg/ ml), 1ml deep i.m every 2 weeks, tab. Na Valproate 1200mg, tab Haloperidol 30mg, tab Chloropromazine 600mg, tab trihexiphenydl 2mg, cap zinc iron and b-complex.

He had been showing consistently hyponatremia with serum sodium levels of 120-130 meq/litre from last 1 yr. A trail of restricted fluid intake added salt in diet was given considering psychogenic polydipsia to be the cause without any benefits. Subsequently the trail of newer agent is being planned with "Tolvaptan" a Vasopressin V2 receptor antagonist to start at 15mg O.D and slowly titrated upto 60mg over 2 weeks. Baseline assessment to be done with brief psychiatric rating scale, mini mental status examination along with weekly serum electrolytes and urine routine examination over a period of 4 weeks. Other investigation findings and results in the form of serum sodium levels and urine osmolality, improvement in behavior and cognitive functioning to be shared at the time of presentation.

Paroxetine-induced galactorrhea: A case report

Prannay Gulati, BS Chavan, Subhash Das

Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India. E-mail: prannaygulati28@gmail.com

Aim: To present a case of adverse drug reaction (galactorrhea) with paroxetine.

Materials and Methods: A 48-year-old female patient of obsessive compulsive disorder (OCD) was evaluated for having galactorrhea on multiple occasions while on paroxetine. Galactorrhea would subside after discontinuing paroxetine and reemerge after starting its use. Serum (S.) prolactin levels, along with other hormonal tests, magnetic resonance imaging (MRI) brain, local and systemic examination were done to rule out other causes of galactorrhea.

Results: Serum prolactin levels were found to be normal and elevated on different occasions. Finding of incidentaloma on recent MRI brain was noted. No other cause of galactorrhea except use of paroxetine was found. Naranjo algorithm score to determine the likelihood of paroxetine causing galactorrhea was in "probable" range.

Conclusions: Galactorrhea was attributed to paroxetine use.

Formulation of CLUE: The Compliance Evaluation Questionnaire (Indian Version)

Prasad G Rao, Prasad S Shetty

603, Ambar, Lok Rachana CHSL, Amar Nagar, Behind Nirmal Lifestyles, Mulund (west) Mumbai. E-mail: drprasadshetty@yahoo.in

Background: Noncompliance in psychiatry is to the extent of 60-70%. The annual risk of relapse for patients with good compliance was 35% in comparison to 75% for those with noncompliance. As of date, there are no validated compliance evaluation questionnaires for Indian patients.

Aims and Objectives: Keeping in mind this high rate of noncompliance in psychiatric disorders a 'Compliance Evaluation Questionnaire' suited to Indian patients was devised. This was based on the World Health Organization (WHO) questionnaire for compliance. The initial protocol was presented in a symposium, Annual National Conference of Indian Psychiatric Society (ANCIPS), 2013 in Bangalore.

Materials and Methods: The WHO factors would not necessarily reflect on Indian factors responsible for noncompliance. With the help of an advisory board, views of psychiatrists across the country were taken, and a questionnaire was devised. Out of the WHO factors, 10 common factors were selected. Three more factors relevant to Indian context were added; making it 13. Out of the 13, eight factors were chosen as the important ones. Subsequently, through further ad boards across the country, a questionnaire was devised with a scoring system. This questionnaire will be validated by administering it on first episode, major depressive disorder patients. Statistical analysis will be done on the scores obtained.

Results: Results will be discussed in the conference.

Amisulpiride-induced dysmegalopsia

Prerna Kukreti, Abhishek Pratap Singh, Omprakash Jhirwal

Department of Psychiatry, Institute of Human Behaviour and Allied Sciences, New Delhi, India. E-mail: dearfrien@gmail.com

Introduction: Psychedelics and hallucinogens have been known to cause sensory distortions; however, rarely they have been reported with antipsychotic usage. We hereby report first ever presentation of a rare case of amisulpiride-induced dysmegalopsia.

Case Report: Mr. D, 32-year-old male presented to psychiatry outpatient department (OPD) of a tertiary care mental health facility with subacute onset continuous illness of past 4 years duration characterized by delusion of persecution and auditory hallucination third person type. Diagnosis of paranoid schizophrenia was made. Following 8months treatment with risperidon (8 mg), patient showed near complete improvement in positive symptoms and Positive and Negative Syndrome Scale (PANSS) score decreased from baseline 45 to 37. However, patient developed persistent negative symptoms; alogia, avolition, anhedonia, and asociality. Risperidon was cross-tapered to amisulpiride. After 1 year of using 400 mg amisulpiride, patient started to show marked improvement in negative symptoms and PANSS score came down to 30. After 18 months of amisulpiride usage, patient developed dysmegalopsia. Local opthalmological examination was unremarkable and magnetic resonance imaging (MRI) brain was within normal limit. There was no history of any other medication or substance use or head injury or seizure. Amisulpiride was tapered off and patient's symptoms gradually improved in next 3 months.

Implications: Uniqueness of the study and implications for clinical practice will be discussed in detail at the time of presentation.

Study of clinical profile of mentally-ill prisoners referred to a tertiary care mental health facility

Prerna Kukreti, Amit Khanna, Abhishek Pratap Singh, Rajesh Kumar

Department of Psychiatry, Institute of Human Behaviour and Allied Sciences, New Delhi, India. E-mail: dearfrien@gmail.com

Background: Mental health of prisoners is an important matter of concern. As per UN Convention on the Rights of Persons with Disabilities (UNCRPD) , prisoners too have right for highest attainable standards of health. However, there have been huge incidences of human rights violation, especially with regard to mentally ill as mentioned in National Human Rights Commission (NHRC) 2007 study in prisons. According to Prison Statistics 2000, mentally-ill prisoners constituted 0.1% of the total prison population and 15.3% of the under trials constituted that segment of the prison population that was implicated in under the Narcotic Drugs and Psychotropic Substances Act, 1985. In India, long process of trial, poor conditions of jails, and prolonged incarceration precipitates and perpetuates mental illness including substance use disorders. Rate of suicide is also four times as compared to general population. Mentally ill prisoners often constitute the hapless sector, ignored by both the outside world and those inside. Thus, there is an urgent need to divert attention towards mental health of prisoners.

Aims and Objectives: To study clinical profile of mentally ill prisoners (under trial and convicted) referred to tertiary care psychiatry health facility.

Materials and Methods: Fifty mentally-ill prisoners were assessed for presence ofunderlying psychiatric illness. General Health Questionnaire (GHQ) 16 and Composite International Diagnostic Interview (CIDI) were applied as screening instruments and diagnosis was made as per International Classification of Diseases, 10threvision, Diagnostic Criteria for Research (ICD-10DCR). Correlation was found between nature of crime and nature of mental illness.

Results and Conclusions: It will be discussed at the time of presentation.

"Dystonia meets dissociation" - A case report from a tertiary care center in South India

R Prince, Saumil Dholakia

Department of Psychiatry, Christian Medical College (CMC), Bagayam, Vellore, Tamil Nadu, India. E-mail: princemed@gmail.com

Background: The absence of a strong etiological model has maintained psychiatry as an observable science. Hence, psychiatrists deal with illnesses, whereas a neurologist deals with disease processes. The functional vs organic dichotomy is classically represented in dissociative disorders (International Classification of Diseases, 10th revision (ICD-10)). The physician needs to make the diagnosis both tentatively and firmly, and pursue treatment with the goal of symptom remission rather than treatment of the perceived cause.

Case Report: Mrs M, a 31-year-old housewife presented to us with 3 months history of acute onset abnormal, rhythmic, nonpurposeful, jerky, involuntary, and spontaneous sideway tonic movements of the neck. They were present in standing or sitting positions and disappeared in supine position and when the head was supported with a hand. Possibility of cervical dystonia was considered and electromyography (EMG) supported the diagnosis of the disease process. However, she showed no improvement with local injections of botulinum toxin. Detailed evaluation and observation in a psychiatric care setting revealed a symbolic representation of symptom production with temporal correlation with the sudden demise of her mother, and subsequent guilt associated with it. The diagnosis was revised to dissociative motor disorder- the symptom hypothesized as a symbolic representation of an unconscious psychological conflict. The illness allowed the patient with the primary gain of keeping the conflict out of conscious awareness, and the sickness allowing her to negotiate the role of an overburdened mother, who has no one to express her distress. She markedly improved with a multidisciplinary treatment approach that combined psychotherapy, physical therapy, and occupational therapy.

Discussion: This case report highlights the multidimensional relationship between a disease, an illness, and sickness.

Conclusion: This case report reminds the physician of the erstwhile axiom to treat the patient, and not only the disease process.



Trichotillomania with antisocial personality disorder: A case report

Priti Singh, Pratibha Gehlawat, Rajiv Gupta

Department of Psychiatry, Pandit Bhagwat Dayal Sharma University of Health sciences, Rohtak, Haryana, India. E-mail: bpreetirth@yahoo.com

Trichotillomania is an impulse control disorder characterized by an urge for pulling self-hair. It may be associated with trichotillophagia. In literature, it is reported to be associated with personality disorder in few cases.

We are reporting a case of a 32-year-old male from urban background, who presented to us as trichotillomania with comorbid antisocial personality disorder.

Patient responded well to combination of selective serotonin reuptake inhibitors (SSRIs) and sodium valproate, but the personality disorder resulted in compliance issues, interpersonal, and legal problems.All these difficulties are discussed in the poster presentation.

Prevalence and correlates of substance use among college students in Kerala (The 50 college study)

Priya G Menon, TS Jaisoorya, B Sivasankaran Nair, Anjana Rani, Revamma M, Jeevan CR, KS Radhakrishnan, Vineetha Jose

Department of Psychiatry, Cochin Medical College, North Kalamassery, Ernakulam, Kerala, India. E-mail: doctorpriyamenon@gmail.com

Background: Various studies across the world have suggested a high prevalence of use of various substances among university students leading to long-standing negative consequences. There are very few studies which have looked at the pattern of substance use, and its correlates across students of different streams of study.

Aim: To study the prevalence and correlates of substance use among students pursuing higher education in the district of Ernakulam, in Kerala state.

Materials and Methods: Trained mental health professionals conducted the survey using a self-administered questionnaire. .A total of over 5,000 students from 50 colleges completed the study ensuring a minimum sample size for various courses including medicine, nursing, engineering, homeopathy, ayurveda, management, legal studies, arts, and sciences.

The questionnaire used modified World Health Organization-Alcohol, Smoking and Substance Involvement Screening Test (WHO-ASSIST) to assess substance use, Kessler's Psychological Distress Scale (K10) for psychological distress, Barkley Adult ADHD (attention deficit hyperactivity disorder) rating scale (BAARS) IV for assessing ADHD. Suicidality, sexual abuse, and gambling were assessed using structured questionnaires. Appropriate statistical techniques were used for analysis.

Results: A high prevalence of alcohol and tobacco was seen among college students with a male predominance. Substance use was correlated with higher psychological distress, higher suicidality, sexual abuse, greater ADHD scores, and poor academic performance.

Conclusion: This is one of the largest studies in our country which has replicated findings from various studies across the world. The high prevalence, significant comorbidity, and poor academic performance among college students using substances highlights the need for greater focus and a comprehensive intervention by all stakeholders.

Degree of insight in patients with bipolar affective disorder in remission - A clinical study

Priya Nayak K, Shambu Sugathan, Safeekh AT, P John Mathai

Department of Psychiatry, Father Muller Medical College, Kankanady, Mangalore, Karnataka, India. E-mail: priyanayakk@gmail.com

Aims:

  1. To evaluate the degree of insight in patients with bipolar affective disorder currently in remission.
  2. To study the degree of insight in relation to sociodemographical variables.
  3. To study the degree of insight in relation to clinical variables.


Materials and Methods:

This is an observational, cross-sectional, clinical study that is conducted in psychiatry outpatient department in Father Muller Medical College.Sample for the study consists of 50 consecutive patients with a clinical diagnosis of bipolar affective disorder in remission.The sociodemographic and clinical variables of subjects are recorded in a semistructured pro forma prepared for the clinical study. All patients are administered with socioeconomic status scale to assess socioeconomic status and Young Mania Rating Scale (YMRS) and Montgomery-Asberg Depression Rating Scale (MADRS) to assess the affective symptoms.The degree of insight in the patients is assessed using the scale to assess unawareness of mental disorder (SUMD). The level of functioning is assessed using Global Assessment of Functioning scale . Appropriate statistical analysis is used to calculate the results.

Results and Conclusion: This is an ongoing study and results and conclusion will be discussed at a later date.

A study to assess disease severity and disability of patients with schizophrenia, and bipolar affective disorder

Prodipto Dhar, Asim Kumar Mallick, Amit Bhattacharyya, Paromita Roy, Syed Naiyer Ali

Kalyani B-8/3 ,Dist:-Nadia. E-mail: pdhar2011@gmail.com

Schizophrenia and bipolar affective disorder are two such diseases that cause a lot of disability to the lives of people they affect.

Aims:

  1. Assess the severity of the disease among the two groups
  2. Assess the disability caused by the disease of the two groups
  3. Correlate the severity of the disease with the severity of disability of each groups
  4. To show which domains of Indian Disability Evaluation and Assessment Scale (IDEAS) are affected more by which disease.


Methods and Materials: Patients of schizophrenia and bipolar affective disorder, diagnosed as per International Classification of Diseases, 10th revision (ICD-10), 30 in each group, 18-60 years of age, both sexes, after obtaining written informed consent are included for the study. They were assessed by Positive and Negative Symptoms Scale for schizophrenia, Young Mania Rating Scale and Hamilton Rating Scale for Depression (HRSD) for bipolar disorder, and IDEAS for disability. Statistical analysis was done by Statistical Package for Social sciences (SPSS) version 20.

Results: On correlation study all the three components of PANSS had a positive correlation with IDEAS-GS with negative symptom score stronger (0.939, P < 0.01) than GPS score (0.852, P < 0.01) and positive symptom score (0.709, P <0.01). When correlated with the components of IDEAS, positive symptoms less significantly affects communication (r = 0.383, P < 0.05). The disease severity of the bipolar group correlated positively with IDEAS-GS (0.852, P < 0.01).When correlated with components of IDEAS, self-care was least affected (0.351, significance two-tailed 0.119).

Conclusion: As it is seen that disease severity has a positive correlation with disability, if we can reduce disease severity, we can reduce disability.

Web-Based Intervention in Psychiatry: Challenging the Didactic Perspective

Rohit Verma, Yatan Pal Singh Balhara, Samir Kumar Praharaj, Koushik Sinha Deb

Lady Hardinge Medical College, New Delhi, India.

E-mail: rohit.aiims@gmail.com

Since its commercialization in early 1990s, internet usage has been on a constant rise impacting various aspects of human life. This includes use of internet in health care service delivery. The public health impact of an intervention is a product of the program's efficacy and reach. Thus, the impact is highest when an intervention is effective and has a wide reach. Web- (internet) based health interventions (WBHIs) have a potential to reach a large section of the population. Also, WBHIs enables the end users to access large amount of information at a pace and time of their own convenience. Recent findings support use of online support groups by individuals with lower income as well. Though WBHIs have been developed for various mental health conditions, little is known regarding their effectiveness. Nonuse and dropout attrition for the most part affect their feasibility and outcome. Among the different intervention formats developed for mental health programs are self-help websites, structured computer-administered therapy with or without computer-generated feedback, and therapies involving asynchronous and synchronous text-based contact with other users (internet support groups) or with therapists, synchronous internet video conferencing, or real time computer contact with video. The current symposium will tend to highlight on the broader perspective of internet usage in mental health.

Role of auditory hallucinations in suicide among psychiatric patients with high suicidal intent

Hemendra Singh, V. Senthil Kumar Reddi, Prabha S Chandra

Department of Psychiatry, MS Ramaiah Medical College, Bangalore, Karnataka, India. E-mail: hemendradoc2010@gmail.com

Objectives: To investigate the role of auditory hallucinations in suicide among psychiatric patients with high suicidal intent.

Materials and Methods: This study was conducted at the emergency psychiatry service at National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, between June 2011 and May 2012. One hundred and twenty consecutive psychiatrically ill patients with high suicidal risk were systematically evaluated for auditory hallucinations, depression severity, hopelessness, and past attempts (both suicidal and non-suicidal self-injury (NSSI)) by Psychotic Symptom Rating Scales (PSYRATS), Beck Depression Inventory (BDI), Hopelessness Scale (BHS), and Suicidal Behavior Questionnaire (SBQ), respectively. The diagnostic breakup was: Schizophrenia spectrum disorders (SSD)-35 (29 %), affective disorders-78 (AD) (65%), and other disorders-7 (5.8%).

Results: Of the 120 patients with high suicide intent, 18 (15%) reported auditory hallucinations. Of the 12 patients (34.3%) with SSD who reported attempting suicide on account of auditory hallucinations, seven patients (58.33%) gave command hallucinations as the reason, and five patients (41.67%) distress associated with the negative content of the voices. Of the thee patients (3.8%) with AD, two patients (66.67%) gave command hallucinations as the reason, and one patient (33.33%) attributed it to distress associated with the negative content of the voices. Mean value of BDI, BHS, and Suicide Intent Scale's (SIS) total scores were higher in those reporting suicide due to distress associated with negative content of voices as compared to those who had command hallucinations.

Conclusion: More than one-third of the SSD group attributed their suicide attempt to auditory hallucinations. While not disregarding the role of hopelessness and depressive symptoms in patients with SSD, it might be clinically relevant to assess patients for auditory hallucinations while assessing suicide in these patients.

Factors affecting stress perception in the nursing profession and its impact on patient care

Rupavataram Sunita Ramam, Jyoti M Pandey

Bharti Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India. E-mail: sunitarupavataram@gmail.com

Background: The nursing staff in any hospital forms the first-line and constant-line of contact between the patients and the hospital. Although there is an on duty doctor, it is the nursing staff who receives the patient, and are the first caregivers. They also have to work in shifts managing their other obligations. In India, nursing is not considered a well-paid profession. Due to the paucity of healthcare facilities, most hospitals usually run to capacity. It is possible that in working constantly in this kind of environment, nursing staff would experience stress, which then would have a direct impact on patient care. Since, it is nurses who dispense medicines and are responsible for maintenance observations and interventions like monitoring of vitals and immediate suction, etc., costly mistakes are possible.

Objective: This study intends to explore the self-perceived stress levels of nursing staff across hospitals. This will help us understand if a problem exists, and the magnitude of the problem. It will also help us in planning relevant interventions.

Materials and Methods: Nursing staff with minimum 2 years experience will be included in the study. Informed consent will be sought from them. Perceived Stress Scale by Cohen (1994) will be used for measuring the self-perceived stress perception. At least a sample of 30 nurses will be studied. Relevant demographic data will also be collected while ensuring that the identity of the individual is not revealed.

Results and Conclusion: Data will be analyzed using suitable statistical analytical techniques to quantify the level of stress perceived and the factors impacting the same.

False diagnostic labeling not beyond the realms of possibility: A viewpoint through cinematic experience

Sabari Sridhar O T, Vidyendaran Rudhran

Department of Psychiatry, Chettinad Hospital and Research Institute, Kanchipuram, Tamil Nadu, India. E-mail: sribornagain@gmail.com

Aim and Objectives: To study how movies can create awareness about how psychiatric illness can be concoctedby misusing the knowledge of the phenomenology of psychiatric illness.

Materials and Methods: By critically appraising some recent Tamil language movies, in which the subject matter is handled by the makers of those movies.

Results and Discussion: Three Tamil language movies that were taken up for evaluation viz., "Mouna Guru,""Poraali", and "555" have shown that vested interests in collusion with mental health professionals, threatened friends, and family members of the victim distort the reality into a delusion like experience by concocting the real life situations as imaginary. They pose pertinent possibilities that with adequate knowledge about psychiatric illness, their phenomenology, and symptomatology; one can create delusions out of reality in such an authentic manner that even the victims themselves at one point in time can get confused as to whether it is their real experiences or actually delusions. This pose threatening questions of dangerous proportions that there is a chance that psychiatric illness can possibly be misused resulting in serious forensic and legal repercussion, both for the patients as well as for the mental health professionals.

Conclusion: Hence, the mental health professionals must be mindful of the consequences of their diagnosis on the patients and should arrive at the diagnosis by judicious scrutiny of information from various sources and thorough mental state examination.

Trichotillomania as comorbidtiy with other disorders: Four case reports

Sagar Karia, Avinash Desousa, Nilesh Shah

Addres s for Correspondence: Sagar Karia, A-601, Maple Heights, Ghati Pada Road, Mulund West, Mumbai, Maharashtra, India. E-mail: karia777@yahoo.com


The Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR) defines trichotillomania (TTM) as an impulse control disorder characterized by the recurrent failure to resist impulses to pull out one's own hair. Trichotillomania is a complex psychiatric disorder and occurs along with a large number of comorbidities. We report four cases of TTM:

  1. Late onset TTM.
  2. TTM with autism.
  3. Pica with TTM.
  4. TTM in case of vascular dementia.


Key words: Autism, dementia, late onset, pica, trichotillomania

Clozapine-induced akathisia: A case report

Swapnajeet Sahoo, Sandeep Grover

Department of Psychiatry, Postgraduate Institute of Medical Education.

E-mail: swapnajit.same@gmail.com

Background: Akathisia as a side effect of clozapine has rarely been reported.

Aim: To present a case of undifferentiated schizophrenia that developed akathisia while receiving clozapine, and review the literature on clozapine associated akathisia.

Case Report: A 32 year old male, who was suffering from schizophrenia presented to the outpatient clinic with symptoms of feeling restless and would have tingling sensation in his feets and hands. He would continuously feel an urge to move about and would not be able to sit at a place. Exploration of history revealed that he was suffering from a psychotic illness since last 9 years, for which he was treated with various antipsychotics like haloperidol, olanzapine, and risperidone with poor treatment response. Following this, he was started on clozapine which was gradually increased to 200 mg/day over the period of 3 weeks, with which his symptoms started improving. But by 4th week of clozapine therapy, he started feeling restless, developed tingling sensation in his feets and hands, and a continuous urge to move about. His Barnes Akathisia Rating Scale score was 7. Organic workup did not reveal any abnormality which could explain presence of akathisia, following which a possibility of clozapine associated akathisia was considered. He was started on tab. propranolol 40 mg/day and the dose of clozapine was reduced to 150 mg/day, with monitoring of psychopathology. With these measures, Barnes Akathisia Rating Scale gradually decreased from 7 to 0 within a period of 3 weeks.

Conclusion: Clozapine can rarely cause akathisia.

Comorbid OCD and ADHD: A case report

Santhosh Kumar, Sunil Gupta, Sandeep Grover

Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India. E-mail: sunilg8881@yahoo.com

Background: Studies have shown that the neurobiology of attention deficit hyperkinetic disorder (ADHD) and obsessive compulsive disorder (OCD) may be opposite with respect to the dopamine and glutaminergic activity in the prefrontal cortex, but their co-occurrence and risk of one for another is still inconclusive.

Aim: To report a case of OCD with history of ADHD.

Case Description: A 15-year-old boy, born of full-term vaginal delivery, had developmental delay and by the age of 4 years developed features of hyperactivity, inattention, impulsive behavior, and poor scholastic performance. Additionally, he developed tics at the age of 6 years. At the age of 6 years, he was diagnosed with ADHD along with comorbid tic disorder and was started on tab. methylphenidate with which his symptoms improved in 3-4 months. Tab. Methylphenidate was continued for the next 3 years, and was then tapered off. By 15 years of age, patient started to have repetitive, unwanted, intrusive, anxiety provoking thoughts of fear of harming others which were recognized as own, which he would try to resist. In response to these thoughts he would indulge in controlling compulsions, which will lead to reduction in anxiety. On the basis of available information, a diagnosis of OCD with past history of ADHD was considered and he was treated with tab. Clomipramine and behavior therapy in the form of exposure and response prevention. Patient showed significant improvement within 2 months of treatment.

Conclusion: The co-occurrence of OCD and ADHD suggests that the two disorders may be related biologically and there is a need to explore the relationship between the two disorders.

Executive functioning on the Wisconsin Card Sorting Test in generalized anxiety disorder

Saranya Dhanasekaran, JK Trivedi, Adarsh Tripathi, PK Sinha, Krishna Dutt

E-mail: saranya296@gmail.com

Aim: We examined the executive functioning on the Wisconsin Card Sorting Testin adults with generalized anxiety disorder (GAD) in comparison with age- and sex-matched healthy adults.

Materials and Methods: A total of 15 cases (diagnosed with GAD based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision(DSM-IV-TR) criteria) and 15 individuals in a comparison groupunderwent assessment of executive functions on a computerized version of WCST.

Results: On assessment of the performance on the Wisconsin Card Sorting Test, those in the GAD groupperformed significantly worse than those in the comparison group. The patient group used more number of trials administered to complete the test (P < 0.05). The patient group had a higher number of total errors (P < 0.05), percentage of perseverative errors (P < 0.05), and percentageof nonperseverative errors (P < 0.05) as compared to the control group. The number of categories completed wasalso lower among the patient group (P < 0.05).

Conclusion: GAD in adults is associated with deficits in executive functioning.Deficits in executive functioning in GAD can causeimpairments in everyday activities such as decision making, problem solving, and flexibility to respond to changing situations. Study of the effect of treatment on executive function deficits in GAD and measures to remedy them are needed.

Different facets of seizures in opioid use disorders: A series of three cases

Savita Kundu, Aniruddha Basu, Rajiv Gupta

Department of Psychiatry, Pandit Bhagwat Dayal Sharma University of Health sciences, Rohtak, Haryana, India. E-mail: kundusavita3@gmail.com

Aim, Material and Methods: Seizures are an uncommon complication in opioid use disorders unlike alcohol use disorders; so we describe a caseseries of three prototype cases illustrating the different context of seizures in association with opioid use among patients in a de-addiction center in north India.

Result: First patient who was a chronic heroin user was being detoxified on a regimen comprising of mainly non-opioid analgesics. He developed a generalized tonic-clonic seizure (GTCS) on the 3rd day of the last intake of heroine. Second patient who was also a chronic heroine user developed GTCS, while being detoxified on a regimen comprising of tramadol, a low potency opioid. The third patient was using tramadol in a very high dose- up to 2,000 mg/day and he developed seizures after starting naltrexone without adequate detoxification. The symptom profile, clinical details, and differential diagnosis will be discussed.

Conclusion: These cases will sensitize clinicians about this uncommon but life-threatening condition among opioid users and help to understand its etiology as distinct from alcohol use disorder.

Periodic catatonia: Report of two cases

Savita Kundu, Aniruddha Basu, Rajiv Gupta, Priti Singh

Department of Psychiatry, Pandit Bhagwat Dayal Sharma University of Health sciences, Rohtak, Haryana, India. E-mail: kundusavita3@gmail.com

Catatonia is a rare psychomotor syndrome, which can be associated with psychiatric illnesses such as schizophrenia (catatonic subtype) and manic-depressive disorder, as well as with neurological and medical diseases. Describing periodic catatonia as 'recurrent episodes of catatonic stupor or excitement occurring in schizophrenia', Gjessing went on to conclude that the syndrome was associated with periodic shifts in nitrogen metabolism.

We here describe two cases of periodic catatonia, one middle-aged female and another adolescent girl. The variation in clinical details, the symptom profile as well as the diagnostic confusion, will be discussed in the poster. These two cases and our clinical knowledge in relation to periodic catatonia raise an issue whether this clinical entity is part of other syndromes or need a consideration as a separate clinical entity.

The 'mirrors' in schizophrenia - Evidence for unchanging 'reflections'

Sayantanava Mitra, Haque S. Nizamie, Nishant Goyal

Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand, India.

E-mail: sayantanava@gmail.com

Background: The 'mirrorneuron system' has been implicated in automatic decoding of biological motions and the understanding of socially adaptive environmental stimuli. This system has been shown to be dysfunctional in schizophrenia and proposed to be a mediator of the psychotic manifestations.

Objective: The present study prospectively evaluated this system using the 'Electroenchephalogram (EEG) mu-wave (8-13 Hz) suppression' paradigm; and associated changes in psychopathology in schizophrenia patients.

Materials and Methods: Fifteen drug free/naive schizophrenia patients were recruited using purposive sampling and followed up for 8weeks. High (192-channel) resolution EEG was recorded while they watched a custom made videoclip, depicting a sociallyrelevant biological motion and white visual noise alternately; on admission (baseline), at 4and 8weeks. Simultaneous rating on Positive and Negative Syndrome Scale (PANSS) was done. The data from 24 electrodes overlying the sensorimotor cortex was analyzed using Matlab7.12 and Statistical Package for the Social Sciences (SPSS)20 . Mu-wave modulation was calculated using log of the ratio of mu power under biological motion versus noise conditions. A log ratio less than zero indicated mu suppression; equal to zero indicated lack of suppression; and a log ratio greater than zero indicated mu enhancement.

Results: Subjects showed significant changes in all PANSS sub-scores (P < 0.001) over the study duration. However, the degree of mu-wave suppression did not change significantly (P = 0.819).

Conclusion: The present study is the first-of-its-kind. It demonstrates an unchanging functioning of the neural circuit responsible for social perception in face of changing psychopathology in schizophrenia patients, suggesting that its abnormality might be a 'trait factor and might not be related to the disease 'state'.

Keywords: EEG mu-waves, mirror neurons, schizophrenia

Schizo-Obsessive Disorder-Is It A Valid Diagnosis? - A Case Report

Shabeeba Z, Reeti R, Preethi S, Srinivasa M, Mahesh R, Chandrashekar M

Department of Psychiatry, Spandana Nursing Home, Rajaji Nagar, Bangalore, Karnataka, India. E-mail: dr_shabee@yahoo.co.in, mefantasy02@gmail.com

Aims: Despite growing recognition, the context of psychotic belief within the context of obsessive compulsive disorder (OCD) is poorly understood. Differential diagnoses of psychotic and obsessive nature of symptoms in a patient include comorbid schizophrenia and OCD (schizo-obsessive), OCD with poor insight, and schizophrenia with OC symptoms. We present a case to outline a strategy for differentiating among these and for optimizing treatment.

Materials and Methods: Mr. D, a 22-year-old male had long standing (8 years) history of having fear that whenever someone sees him their personality gets inserted into his mind, and whatever he does after that is done by the acquired personality. To control this he tries to reassure himself, stiffens his muscles, and does not move to the extent that he passes urine in clothes to avoid others' personality entering him. He had self-harm attempts with multiple slash/bite marks over abdomen and forearms. He was diagnosed to have psychosis previously and had received adequate trials of antipsychotics without improvement. MSE showed that phenomenology had some obsessive quality but no insight. Psychometry revealed poor reality testing and meditational impairment with significant OCD features.

Results: A diagnosis of OCD with poor insight was made and patient improved on a combination of selective serotonin reuptake inhibitor (SSRI), low dose antipsychotic, and cognitive behavioral therapy (CBT).

Conclusion: Varied complex presentation of OC symptoms necessitates a high degree of suspicion from the clinician to make the correct diagnosis. This case report raises a discussion whether schizo-obsessive is a valid diagnosis.

A rare case of fish odor syndrome presenting as depression

Shahbaz Ali Khan Shagufta

Military Hospital Danapur Cantonment, Patna, Bihar, India.

E-mail: shahbaaz323@yahoo.com

Aims and Objective: To present and discuss a rare disorder known as "fish odor syndrome' presenting as depression.

Materials and Methods: Reporting a very interesting case of a rare disorder (about 200 cases reported worldwide)-trimethylaminurea also known as "fish odor syndrome' in a young unmarried lady. She was being treated for headache in medical outpatient department (OPD) since 3 months, unsuccesfully, and finally psychiatric referral was made. Evaluation revealed depressive symptoms of 6 months duration in the background of long standing stressor in the form of a foul odor emanating from her body resulting, over a period of time, in social withdrawal and depressive symptoms including sadness of mood, decreased interest, poor sleep and appetite, suicidal ideation as well as significant impairment of day-to-day functioning. After excluding other possibilities, a diagnosis of trimethylaminurea (fish odor syndrome) and adjustment disorder, prolonged depressive reaction, was arrived at. There appeared to be genetic loading in the father. The diagnosis was confirmed by lab investigation (urinary ratio of trimethylamine to trimethylamine oxide). The disorder is also discussed in detail.

Results: High index of suspicion, empathetic handling, psychoeducation, behavioral modifications, and cognitive counseling with a short course of antidepressants helped her improve significantly with return to almost normal functioning.

Conclusion: A rare and socially crippling medical disorder, potentially "uncurable", like the fish odor syndrome can have good results if handled empathically with psychotherapy and adequate behavioral measures. In all such cases the psychosocial consequences can be mitigated with therapy and a psychiatric referral is always indicated.

Prevalence of adult ADHD in recently diagnosed HIV males in a tertiary care center

K. Shankar, Abhinav Nahar, Y. S. Aashik, Gopal Das

Department of Psychiatry, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India. E-mail: abhinavnahar2002@gmail.com

Introduction: A majority of children with symptoms of attention deficit hyperactivity disorder (ADHD) from early childhood continue to demonstrate notable ADHD symptoms throughout life though in later life hyperactive/impulsive subtype manifests more frequently causing persistent and significant impairment among different areas of life. Impulsivity in later life has been found to predict unstable interpersonal relationships and high risk sexual behavior. There is no literature on the prevalence of adult ADHD among patients with human immunodeficiency virus (HIV) and which could pave way for further studies including planning primary prevention strategies as this is a potentially treatable condition. Aims and Objectives: To determine the prevalence of adult ADHD in recently diagnosed young male HIV patients.

  1. To determine other factors contributing to high risk sexual behavior in adult ADHD.


Materials and Methods: We recruited 100 HIV positive young adult males with less than 1 year of diagnosed HIV after informed consent. They were administered Adult ADHD Self-Report Scale (ASRS) v1.1 to screen for ADHD in adulthood. Those who scored more than cutoff were then administered the Abbreviated Conners retrospective to parent/informant and Wender-Reimherr Adult ADHD Rating Scale to confirm ADHD, The Mini-International Neuropsychiatric Interview (MINI) plus to rule out (r/o) comorbidities, mini-mental state examination (MMSE) to r/o major neurocognitive impairment, Zuckerman-Kuhlman Personality Questionnaire to screen for sensation seeking and impulsivity traits, and HIV Risk Taking Behavior Scale to assess high risk sexual behaviors.

Results: There was significantly high prevalence of adult ADHD among young males with HIV. Details will be discussed in the study.

An atypical case of Dhat syndrome: Carried to psychotic proportions

Shwetank Bansal, Deepak Moyal, Rajesh Kumar, Pankaj Kumar

Department of Psychiatry, Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi, India. E-mail: drshwetankbansal@gmail.com

Aim: The present case highlights an atypical presentation of a case of Dhat syndrome, and its management.

Materials and Methods: A young unmarried adult Hindu male presented with persistent belief that he is passing semen through urinary tract and losing his vitality for past 3 years. In order to prevent this he took various measures which included insertion of foreign bodies like plastic tacks and metal zipper into his penile urethra. On one occasion he inserted a pencil in urethra and pushed it up leading to perforation of the urinary bladder which required an emergency laparotomy. The persistent belief was associated with extreme anxiety which led to such acts. Patient had presented to us with two plastic tacks and a metal zipper lodged in his urethra.

Comorbid conditions: Use of cannabis and anabolic steroids.

Results: The patient was evaluated and after detailed assessment he was treated along the lines of psychosis not otherwise specified (NOS) with second generation antipsychotics, and showed gradual improvement in his belief. No further acts of obstructing the urethra were evidenced. Post discharge patient continued to function normally.

Conclusion: This case highlights the possibility of Dhat syndrome being carried to psychotic proportions. The diagnostic dilemma posed by the clinical presentation in itself, as well as the presence of anxiety symptoms is discussed. Finally, the management plan followed by the treating team and the patient's response to it is highlighted.

Sexual dysfunction in alcohol-dependent men taking disulfiram and baclofen pharmacoprophylaxis - A preliminary estimate

Siddharth Sarkar, Naresh Nebhinani, Sandeep Grover, Surendra K Mattoo

Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India. E-mail: sidsarkar22@gmail.com

Background: Research looking at the sexual functioning of patients receiving pharmacoprophylaxis for alcohol use disorders is sparse.

Aim: To study the prevalence of sexual dysfunction in male patients receiving baclofen or disulfiram as pharmacoprophylaxis.

Materials and Methods: Currently abstinent patients of alcohol dependence on baclofen (N = 18) or disulfiram (N = 30) who were premorbidly free from any sexual dysfunction and currently cohabiting with a stable partner were assessed on Arizona Sexual Experiences Questionnaire (ASEX).

Results: As per ASEX, 38.9% of patients on baclofen and 10% of patients on disulfiram had sexual dysfunction; however, this difference between the two treatment groups was nonsignificant. On the various domains of sexual functioning, higher proportion of patients receiving baclofen had poorer desire than those on disulfiram.

Conclusions: In alcohol-dependent males on pharmacoprophylaxis, baclofen is associated with higher level of sexual dysfunction than disulfiram.

Risk factors for delirium tremens - A retrospective study

P. Sinha, A. Garg, P. Kumar

Institute of Human Behaviour and Allied Sciences, New Delhi, India

Aims: To analyze the sociodemographic and clinical variables associated with the development of delirium tremens (DTs) in patients who were admitted to the deaddiction unit of a tertiary care hospital.

Materials and Methods: A retrospective chart review was performed within an inpatient deaddiction unit in an attempt to identify risk factors for DTs. Cases of DTs were compared to cases of patients with simple alcohol withdrawal that did not progress to DTs.

Results: Forty-two patients of DTs were compared with 46 patients of simple alcohol withdrawal. Statistical analysis of the data revealed that mean age was 46.8 years, while 100% patients were male. Significant differences were found in regard to prior histories of DTs and laboratory values at admission.

Conclusion: Development of DTs was common among patients treated for alcohol withdrawal and correlated with several readily available clinical variables.

Compulsive muttering: Is it a new phenomenology?

Sonakshi Jyrwa, Aninda Sidana, Arun Chahar, Om Prakash3

Department of Psychiatry, Institute of Human Behaviour and Allied Sciences (IHBAS), New Delhi, India. E-mail: sonakshidj@yahoo.co.in

The complexities of differentiating obsessive-compulsive symptoms from psychotic symptoms have always been a challenge in children and adolescents unlike in adults. We are reporting one of the first reports of compulsive muttering in obsessive compulsive disorder (OCD) which needs further debate. Mr. G, a 17-year-old male having no contributory past and family history of psychiatric illness presented in outpatient setting with an insidious onset and continuous illness of 1.5 years with complaints of repeated muttering to self, impaired concentration, and academic decline. Before presenting in the outpatient department (OPD), the patient had received various antipsychotics like amisulpride and clozapine from psychiatrists. Initially he was diagnosed as a case of psychosis and started on risperidone up to 4 mg with minimal improvement. But on further exploration of muttering symptom, patient reported having repeated intrusive unwanted thoughts of past events. He claimed these thoughts were his own, came against his will, and were quite distressing. Following these thoughts, he would have to mutter them. He tried to stop doing it but could not as he would feel uneasy. This led to difficulty in concentration and academic decline. Hence, the diagnosis was revised to OCD and fluoxetine was added up to 40 mg. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) dropped from 30 to 10 and patient reported subjective improvement of about 90%. Thus, the presentation of the case with self-muttering as the major symptom raised the possibility of psychosis. However, a careful analysis of the phenomenon of compulsive muttering as a part of OCD revealed its exact nature.

Minor physical anomalies: Going beyond the Waldrop scale - A cross-sectional, hospital-based study

Sreyoshi Ghosh, Samir K Praharaj, PSVN Sharma

E-mail: drghosh23@gmail.com

Aim: To evaluate the presence of minor physical anomalies (MPAs) in patients diagnosed with schizophrenia with specific focus on the phenotypic abnormalities found in specific syndromes associated with psychosis, namely velocardiofacial syndrome and Lujan-Fryns syndrome.

Objectives: To determine the presence of MPAs in a sample of patients with schizophrenia; to ascertain the relative importance of certain specific MPAs that are seen in syndromes that have an established link with psychosis; to identify if there is a particular cluster of MPAs that when viewed as a composite index has a stronger association with schizophrenia; and to determine the association, if any of specific MPAs with illness characteristics.

Materials and Methods: The study design adopted was a cross-sectional, case-control study. A sample size of 50 patients with an International Classification of Diseases, 10th revision (ICD-10) diagnosis of schizophrenia and 50 controls were included for the study using purposive sampling. A new scale was designed for the assessment of MPAs using items from the modified Waldrop scale in addition to specific dysmorphic features seen in velocardiofacial and Lujan-Fryns syndrome.

Results and Conclusions: Preliminary results reveal that the frequency of MPAs in schizophrenic patients is significantly higher than that in the general population as indicated by previous studies. Further statistical analysis is required to determine whether the dysmorphic features unique to syndromes that have a known association with psychosis are also significantly represented in our sample which would confirm the study hypothesis.

Visual hallucinations in a case of type 2 myotonic dystrophy

Srinivas Balachander, Siddharth Sarkar, Susanta Kumar Padhy

Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India. E-mail: sidsarkar22@gmail.com

Introduction: Myotonic dystrophy type 2 is a dominantly inherited, multisystem disease presenting in adulthood with prominent features of myotonia, proximal muscle weakness, and early onset cataracts. Though cognitive deficits are commonly noted, literature on psychiatric comorbidities associated with its condition is limited.

Case Description: A 62-year-old married female, well-adjusted premorbidly, since 52 years of age had insidious onset fatigability, pain and stiffness in bilateral thighs with difficulty in climbing stairs and getting up from squatting position, and grip and percussion myotonia on examination. Bilateral "christmas-tree" cataracts and diabetes mellitus were also found. Magnetic resonance imaging (MRI) showed diffuse white matter hyperintensities in the pons and right thalamus. She was diagnosed as myotonic dystrophy (type 2). Despite symptomatic treatment and physiotherapy, her symptoms progressed to speech difficulties, facial muscle weakness, and urinary incontinence. Her mother and elder sister had expired earlier due to a similar illness. Since 1 year, the patient also started complaining of seeing live snakes clearly moving about a few meters away from her, in full consciousness throughout the day wherever she went, and became fearful due to this. Two months ago-sadness of mood, anhedonia, ideas of pessimism, helplessness and wish to die, and poor sleep and appetite ensued as her daughter developed a similar illness. Her expression was noticeably blunted due to facial muscle weakness, but she broke into tears during the interview, while voicing depressive cognitions. Psychometry for organic brain syndrome (OBS) was normal. She was started on low-dose quetiapine and escitalopram, supportive sessions were taken.

Conclusions: To our knowledge, this is one of the few cases of myotonic dystrophy with hallucinations. Possible pathogenic mechanisms for the same are discussed. Various biological and psychosocial factors led to the development of depression in this patient. Difficulty in early recognition of depression in such cases and benefit of early treatment is also highlighted.

Calculating sample size - A primer for beginners

T. P. Subhalakshmi

Department of Psychiatry, Malankara Orthodox Syrian Church Medical College Hospital, Kolenchery, Ernakulam, Kerala, India.

E-mail: subhalakshmitp@yahoo.com

Everyone is expected to do research nowadays along with the clinical and teaching work. However, many are apprehensive about doing research mainly because of unfamiliarity with the concepts and the practical difficulties. Targeted primarily at 1st year postgraduate students this paper attempts to make the initiation in to the fascinating area of research interesting. The concepts of sampling, determining sample size, confidence level, confidence interval, and significance are discussed with examples taken mainly from clinical practice.

Attitude of nurses towards suicidal patients

Shubhangi Sambhaji Dere, Shaunak Ajinkya, Rakesh Ghildiyal, Darpan Kaur, Varun Ghildiyal

Mahatma Gandhi Mission Medical College and Hospital, Kamothe, Navi Mumbai, Maharashtra, India. E-mail: shubhangi.dere@gmail.com

Suicide is a tragic and potentially preventable public health problem. India is experiencing emerging socioeconomic, family, and individual crisis, due to increasing suicide rates. Health professionals like nurses may hold misconceptions about suicide that may negatively affect their approach towards such patients. As nurses are primarily involved in emergency care of suicide attempter, lack of education and training may increase their stress while handling these patients. Research in this area can increase knowledge about nurses' attitudes towards suicide. It can help in understanding and preventing suicides, and in planning educative programs to reduce stress of handling suicide patients.

Aims:

  1. To study sociodemographic details of the nurses.
  2. To study their attitude towards suicide patients.
  3. To study nurses' stress and coping in caring for a suicidal patient.


Materials and Methods: It will be a cross-sectional observational study where all students as well as registered nurses will be included after obtaining informed consent and ethics committee approval. Sociodemographic details will be studied through a self-designed pro forma. Nurses' attitude towards suicidal patients (those presenting with attempted suicide or deliberate self-harm or expressing suicidal ideations) will be studied using Attitude Towards Suicide (ATTS) Scale. Their stress and coping in caring for a suicidal patient will be assessed using a questionnaire designed by Holdsworth et al.

Results: Data obtained will be pooled, tabulated, and analyzed using appropriate statistical tests. Results will be discussed with reference to available literature.

Impact of psychiatry training on attitude of medical students towards mental illness and psychiatry

Subhash Das, Prannay Gulati, BS Chavan

Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India. E-mail: asthus10@gmail.com

Context: Attitude of fresh graduates towards psychiatric patients is important to bridge the treatment gap due to mental illness. Psychiatry as a subject has been neglected in the undergraduates of Bachelor of Medicine, Bachelor of Surgery (MBBS). Aims:

  1. To compare the attitude of medical students and interns in a medical college towards mental illness and psychiatry.
  2. To assess the impact of psychiatric training on attitude towards mentally ill person and mental illness.


Settings and Design: Cross-sectional, single assessment study conducted at a tertiary hospital.

Materials and Methods: Participants consisted of medical students of 1st and 2nd year who did not have any exposure to psychiatry and interns who had completed their compulsory 2 week clinical posting in psychiatry. Participants were individually administered sociodemographic pro forma, General Health Questionnaire-12 (GHQ-12), Opinion about Mental Illness (OMI) Scale, and Attitude to Psychiatry (ATP-29) scale.

Statistical analysis: Standard descriptive statistics (mean, percentage) and chi-square test.

Results: One hundred and thirty-five participants formed the study sample, with 48, 47, and 40 participants from 1st year, 2nd year, and interns, respectively. Mean GHQ score was 14.03 for the entire sample. There was better outlook of interns towards psychiatry and patients with mental disorders in comparison to fresh graduate students in some areas. Overall, negative attitude towards mental illness and psychiatry was reflected.

Conclusion: Exposure to psychiatry as per the current curriculum seems to have a limited influence in bringing a positive change in opinion about mental illness and psychiatry.

Attachment styles, negative emotions, and cognitive emotion regulation in persons with schizophrenia and their offspring

K. Rai, Sandhyarani Mohanty, Rakesh Kumar, Sudhir Kumar

Institute of Mental Health and Hospital, Agra, Uttar Pradesh, India.

E-mail: imhh.agra@gmail.com

It is postulated that attachment theory could enhance our knowledge and understanding of psychotic phenomenology. Attachment is a deep and enduring emotional bond that connects one person to another across time and space. Attachment does not have to be reciprocal; one person may have an attachment with an individual which is not shared. There are four styles of attachment: Secure, anxious-preoccupied, dismissive-avoidant, and fearful-avoidant. Insecure attachment styles are differentially associated with the severity of psychopathological symptoms and emotional distress in schizophrenia. The present study would aim at exploring attachment styles of schizophrenic and their adult offspring and how it affects negative emotions including the cognitive coping used by this population. This would be a cross-sectional study to be conducted at Institute of Mental Health and Hospital, Agra. Twenty Schizophrenic persons and 20 offspring would be drawn from the persons presenting at the Institute. Attachment Styles Questionnaire, Depression Anxiety and Stress Scale (DASS), and Cognitive Emotion Regulation Questionnaire (CERQ) would be used for data collection. The results will be presented.

Psychopathology and depression as predictors of cognitive insight in schizophrenia

Sudhir Kumar, Sandhyarani Mohanty, Ajai Kumar Srivastava

Institute of Mental Health and Hospital, Agra, Uttar Pradesh, India.

E-mail: imhh.agra@gmail.com

The concept of cognitive insight is being implicated in the persons with psychotic illnesses as a contributor in the maintenance of psychotic symptoms such as delusions and hallucinations. This is a little different concept in the domain of insight and shares a moderate relationship with clinical insight. Cognitive insight is based on the theoretical framework of cognitive-behavioral approaches for understanding and managing psychiatric disorders and focuses on the cognitive processes involved in correcting erroneous judgments and certainty about mistaken judgments. This study aimed at exploring relationship of psychopathology and depression with cognitive insight in persons with chronic schizophrenia. This is a cross-sectional correlational study conducted at Institute of Mental Health and Hospital, Agra. The sample consisted of 50 male patients in the age range of 20-55 years drawn from the wards of the Institute. Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia, and Beck Cognitive Insight Scales were individually administered on the patients. The detailed results will be presented.

Trihexyphenidyl dependence - A case report

Sudhir Mahajan, Debasish Basu, C. Pradeep, Sonali Mahajan

Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India. E-mail: drsudhirmahajan@yahoo.com

Background: Trihexyphenidyl (THP) is a commonly used anticholinergic drug with mild euphoriant effect.

Aim: To present a case of paranoid schizophrenia with THP dependence.

Case Details: A 42-year-old male with paranoid schizophrenia for the past 20 years was receiving inj. fluphenazine decanoate 25 mg intramuscular (IM) biweekly with significant improvement and residual symptoms being sensory distortions and fearfulness. He was prescribed THP 4 mg for extrapyramidal side effects with which he reported relief from the sensory distortions and fearfulness. Initially he would be given THP in prescribed doses only. However, later on he would take more than the prescribed doses of THP. Since around last 8 years, on attempted abstinence from THP, he would have "withdrawal symptoms" in the form of low mood, fatigue, body aches, anxiety, palpitations, and difficulty concentrating at work; which would promptly improve after taking THP. The dose of THP has also gradually increased to 24 mg/day in six divided doses. For the last 2 years, in additions he was also taking cap. tramadol in a dependent manner, average amount being 500-600 mg/day. He requested admission in our deaddiction ward for failure to abstain from THP, last intake of THP being on the day of admission (8 mg); although was abstinent from tramadol for 2 weeks before admission. After admission THP was stopped and patient had "withdrawal symptoms" which lasted for 2 weeks during which he would insist on giving him THP.

Conclusions: This patient used THP for self-medication of "positive" symptom rather than negative symptoms as reported in the literature. Also, he did not report euphoria or stimulant effect as the major motivational factor for his excessive THP use in contrast to literature.

Role of education in seeking first help for psychiatric illness

Suneet Kumar Upadhyaya

Department of Psychiatry, Gujarat Medical Education and Research Society Medical College, Patan, Gujarat, India. E-mail: dr_suneet12@yahoo.com

Aims: To assess role of education of patient and of decision maker in deciding first help for psychiatric illness.

Materials and Methods: Using convenience sampling 250 patients who had no history of earlier consultation with psychiatrist were assessed. They were classified on basis of first healer consulted. Healers were categorized as psychiatrists, faith healers, and general medical practitioners. All cases were subjected to a semistructured questionnaire for sociodemographic details including years of education. Years of education of 'decision maker' were also enquired. 'Decision maker' was the person who was the authority to decide treatment plan of the patient. In those presented self, patients themselves were considered decision maker. Means were analyzed using analysis of variance test.

Results: Mean years of education of patients in those consulting first to psychiatrist (10.142 ± 6.31), faith healer (8.107 ± 6.26), and general medical practitioner (7.897 ± 6.4) did not show significant difference (P = 0.03). Mean years of education of decision maker in psychiatrist group (11.642 ± 5.29), faith healer group (8.3571 ± 6.17), and general medical practitioner group (10.9 ± 5.08) had significant difference (P = 0.0004).

Conclusion: Compared to patient, decision maker's education status has a significant role in selection of first help for psychiatric illness patients.

Psychological correlates and psychiatric morbidity in patients with Dhat syndrome

Sunil Gupta, Sandeep Grover, Ajit Avasthi

Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India. E-mail: sunilg8881@yahoomail.com

Aim: To study the prevalence of alexithymia, somatosensory amplification, hypochondriacal attitudes and beliefs, and comorbid psychiatric disorders in patients with Dhat syndrome.

Materials and Methods: Fifty-two consecutive patients with Dhat syndrome were assessed on Toronto Alexithymia Scale (TAS-20), Somatosensory Amplification Scale (SAS), Whiteley Index for hypochondriacal attitudes and beliefs, and psychiatric comorbidity as per International Classification of Diseases, 10th revision (ICD-10).

Results: The mean age of the study sample was 28.11 years. More than half of the subjects were unmarried (59.6%), from a nuclear family setup (53.8%), and rural area (55.8%). The mean age of onset was 23.32 years (range: 11-50). On TAS-20 assessment, 30% of patients were found to have alexithymia (TAS score > 60). On SSAS , the mean score were highest on the item of 'I am quick to sense the hunger contractions in my stomach' (2.82), followed by 'I can sometimes hear my pulse or my heart beat throbbing in my ears' (2.61), and 'When someone coughs, it makes me cough too' (2.61). On Whitley Index, significantly high proportion of patients reported that they do worry a lot about their health (84.6%), thought that there was seriously something wrong with their body (88%), acknowledged that they worry more than others (78.8%), and was bothered about aches and pains (73.1). The mean Whiteley Index score was 20.01. Depression was found to be the most common comorbid psychiatric illness (21.92%), followed by anxiety spectrum disorders (15.07%), premature ejaculation (17.81%), and erectile dysfunction (9.59%).

Conclusions: Patients with Dhat syndrome have high prevalence of alexithymia, hypochondriacal attitudes and beliefs, and somatosensory amplification.

Pattern of emergency psychiatry referrals in general hospital setup

B. Swapna, Kiran K. Kumar, Fiaz Ahmed Sattar, Niharika Singh, Malini Govindan, J. Santosh

Department of Psychiatry, Vydehi Institute of Medical Sciences and Research Center, Bangalore, Karnataka, India. E-mail: swapna199@yahoo.co.in

Aim: To study the pattern of psychiatric referrals in the general hospital setup.

Materials and Methods: This is a cross-sectional retrospective hospital-based study. The study was carried out at the Vydehi Institute of Medical Sciences and Research Center (VIMS and RC). All the cases referred from other departments, where the immediate psychiatric intervention was required were included in the study. The study period was from May 2012 to May 2013.

Results: Total of 150 cases were referred to the psychiatry department where emergency intervention of psychiatrist was required. Majority cases were male in the age group of 20-40 years. The cases were referred were for behavioral disturbances, hyperventilation, and intentional self-harm. Maximum cases were referred from department of medicine and from EMD and the common psychiatric diagnosis was delerium, alcohol intoxication, anxiety disorder, and adjustment disorder.

Conclusion: This will be discussed at the time of presentation.

Posttraumatic stress disorder in an opioid dependent male: A case report

Swapnajeet Sahoo, Nidhi Malhotra, Debasish Basu

Department of Psychiatry Postgraduate Institute of Medical Education and Research, Chandigarh, India. E-mail: swapnajit.same@gmail.com

Background: Posttraumatic stress disorder (PTSD) is a condition that develops after a distressing ordeal that involves physical harm or the threat of physical harm.

Aim: To present a case of a male with opioid dependence syndrome who developed PTSD.

Materials and Methods (Case Report): A 30-year-old married male started taking opioids in form of afeem/diphenoxylate tablets/heroin since the age of 18 years and gradually developed dependence within a period of 2 years. He had sociooccupational and family disruption due to substance abuse and so his family member admitted him forcibly in a private deaddiction center. There, he was allegedly subjected to sexual, physical, and mental harassment which he had to suffer for 4 months. He relapsed very soon after discharge. However, he began to have recurrent thoughts of being tortured in the center, would get extremely terrified with minimal stimuli, would reexperience the above mentioned events and would have nightmares of being beaten up. He started to remain aloof, would be irritable, and did not enjoy his hobbies any more. To ameliorate these symptoms, he started to chase more quantity of heroin than his previous intake which led to further disharmony in his family. He was unable to quit heroin in spite of repeated attempts and was admitted in drug deaddiction and treatment center, PGI . Diagnosis of opioid dependence with PTSD was kept. After detoxification with tramadol, supportive sessions were taken. Relaxation exercises along with biofeedback sessions were taken. Paroxetine was started and increased up to 37.5 mg/day. Relapse prevention counseling was undertaken. He improved in his symptomatology, was discharged, and maintaining abstinent presently.

Conclusion: Early detection of PTSD is very essential for its outcome and needs urgent treatment especially in substance dependent persons so as to prevent relapse.

Gender identity disorder - A diagnostic dilemma

Sweta Parikh, Bhavesh Lakdawala

E-mail: sweta5_87@yahoo.com

Introduction: Gender identity disorder (GID) is used to describe people who experience significant discontent with the sex they were assigned at birth and the gender roles associated with that sex. This case stresses the social pressures and the negligence of doctors.

Case report: Miss X, a 23-year-old patient presented to psychiatry department for certification for change of name. On detailed interview, it was obtained that patient had ambiguous genitalia at birth and the attending pediatrician negligently advised to raise the child as a female. At 4 months of age, karyotyping revealed 46XY-male. At 10 years of age, the patient underwent bilateral orchidectomy with vaginoplasty and was put on female hormone-estrogen-for development of female secondary sexual characters. However, the dressing, behavior, play, and activities were like a male child. The patient's friends too were mostly males and sexual orientation was for females. At 18 years of age when he came to know about everything, he refused further hormonal therapy and decided to create his identity as a male. Ambiguous genitalia at birth led to misidentification of gender and later to sex change operation. But the dilemma over the real sex continued among friends, family, and society; consequently causing great distress in his social functioning.

Discussion: How social pressure and negligence of doctors add distress to existing ambiguity of sexual organs will be discussed.

Keywords: Certification, gender identity disorder, negligence, social pressure

Do schizophrenia and myasthenic syndrome share a common pathway?

A. Tewari, D. Saldanha, G. Vivek, C. Bushan, O. Piush

Padmashree Dr Dnyandeo Yashwantrao Patil Medical College, Pimpri, Pune, Maharashtra, India. E-mail: saldanhavalsa@gmail.com

Background: Schizophrenia is a disorder with a lifetime prevalence of 0.6-1.5. While its etiology is multifactorial, pathophysiology involves the dopaminergic, gamma aminobutyric acid (GABA) nergic, glutaminergic, and probably alpha 7-nicotinic acetylcholine receptors (nAChRs); whereas, myasthenic syndrome is caused by mutations in the muscle nAChR that alters its properties.

Aim: To report the occurrence of schizophrenia and myasthenic syndrome in the same patient.

Case Report: A 22-year-old unmarried male accompanied by sister, a reliable informant, gave history of aimless wandering inside the house, generalized weakness, and reduced appetite following relapse of mother's mental illness. He would sit at one place with vacant looks on face, was sleepless and neglected self-care. There was no past psychiatric or history of diagnosed medical illness. However, sister reported weakness and easy fatigability with drooping eyelids noticed since his very young age. General and systemic examination revealed an alert, but noncooperative individual who was undernourished with no abnormality except for drooping eyelids, muscle wasting, and motor weakness of grade 3/5. Mental status showed active features of schizophrenia. Repeat nerve stimulation and neostigmine tests were positive. Chest computed tomography (CT) scan showed enlargement of thymus. Patient was treated with antipsychotic drugs, steroids, and pyridostigmine. He showed rapid response, when followed last he was in remission.

Discussion: This above case is unique because of the occurrence of myasthenic syndrome and schizophrenia in the same patient.

Conclusion: Although there are no reports that show a direct relationship between schizophrenia and myasthenic syndrome, it is clear that an aberration of nAChR is involved in both.

Cotard's Delusion of Walking Corpse- A Case Report

Thingbaijam Bihari Singh, Mhetre Bhushan B, Yumnam Sana Devi

Department of Psychiatry, Regional Institute of Medical Sciences, Imphal, Manipur, India. E-mail: sanayumnam_023@yahoo.in

Cotard's syndrome is a very rare neuropsychiatric condition where nihilistic delusions are core symptoms. The syndrome is frequently associated with major depressive disorder but is also seen in schizophrenia and psychoorganic syndromes. It is commonly reported to occur in late midlife with more preponderance among females. This syndrome can be presented with destructive behaviors to self and/or others. Authors report a case of a middle-aged widow, who suffered from nihilistic delusions of self-claimed death with no blood inside her body, her hands and legs as moving sticks. Patient also had odd behaviors like puncturing herself with needles and gesturing like a spirit. All these features were developed in the background of major depression. The patient's nihilistic delusions responded well to newer antipsychotics along with antidepressants.

Key words: Cotard's delusions, major depressive disorder, self-mutilation

Psychiatric morbidity in asymptomatic HIV patients

VS Chauhan

Military Hospital, Jalandhar Cantt Punjab, Jalandhar, Punjab, India.

E-mail: vinaychauhan2@gmail.com

Aim: To study psychiatric morbidity in asymptomatic human immunodeficiency virus (HIV) patients.

Objectives:
  1. Find out the prevalence of different psychiatric disorders in asymptomatic HIV patients.
  2. To identify various determinants that affects the psychiatric morbidity in asymptomatic HIV patients and assess their role.


Materials and Methods:

The study was undertaken at a large 1,200-bedded tertiary care hospital. A case-control research design was used.

Cases: All asymptomatic HIV patients who were admitted to the hospital at the time of evaluation. Inclusion Criteria: Confirmed HIV seropositivity, physically asymptomatic in stage II or II, and minimum education up to IX standard.

Exclusion criteria: Past history or presence of central nervous system (CNS) disorders, history of head injury with loss of consciousness, past history of psychiatric illness, and patients who qualify acquired immunodeficiency syndrome (AIDS) defining criteria.

Controls: An equal number of normal persons were selected as controls. The controls were comparable with the case regarding their age, education, sex, monthly income, and occupation.

Materials and Methods: Following psychiatric scales were used to assess psychiatric morbidity: General Health Questionnaire-12 item (GHQ-12), Hospital Anxiety and Depression Scale (HADS), mini-mental state examination (MMSE), and Sensation Seeking Scale. The demographic characteristics of the group were compared by the chi-square test. For comparing the scores on psychiatric rating scales the Mann-Whitney U test was used.

Results: The subjects in two groups were matched in age, sex, and education status. Risk factors for HIV in the present study were heterosexual promiscuity in 85% of the cases, while multiple injections/tattooing (3%), transfusion of unscreened blood (25%), health worker handling blood (1%), and in 9% patient denied any high-risk behavior. Asymptomatic HIV patients had statistically significant higher GHQ caseness and depression. Anxiety scores were higher in asymptomatic HIV patients. Sensation seeking trait was assessed under the four different characteristics. Thrill and adventure seeking, experience seeking, and boredom susceptibility revealed statistically significant higher scores in asymptomatic HIV patients compared to HIV seronegative controls. However, disinhibition scores did not reveal any statistically significant difference between the two groups. The difference between the two groups for alcohol dependence syndrome was statistically significant.

Conclusion: Psychiatric morbidity is higher in asymptomatic HIV patients as compared to HIV seronegative controls. High sensation seeking and substance abuse may play a vital role in engaging in high-risk behavior resulting in this dreaded illness.

Internet addiction disorder and its impact - A case report

VV Jagdeesh Settem, Samir Kumar Praharaj, PSVN Sharma

Department of Psychiatry, Kasturba Medical College, Manipal University, Manipal, Karnataka, India. E-mail: svvjagadeesh@gmail.com

Background: Internet addiction disorder (IAD) is growing both in the prevalence and the public consciousness as a potential problem, 1% in the general population and even higher in the US and Europe. Reduction in the thickness of orbitofrontal cortex and in the striatal dopamine transporter has been implicated in the pathology of both drug and behavioral addictions. IAD causes neurological complications, psychological disturbances, and social problems.

Case Report: A 20-year-old male, premorbidly well-adjusted, personal history of emotional neglect from the parents, physical abuse by the father, and mother's psychiatric illness, previously had three episodes of depression. During his third episode he was tried with paliperidone for persecutory delusion and mirtazapine; but later due to excessive drowsiness, the medication was changed to aripiprazole and escitalopram and was regularly being seen in the outpatient department (OPD) for the academic decline. His recent admission was for his excessive daytime sleep, addiction to the computer gaming, and academic irregularities. He was started with BT for computer addiction along with activity scheduling. He was tried on various antidepressants with no improvement. All medications were stopped and a sleep study with electroencephalography (EEG) monitoring was done, which showed reduced sleep efficiency and less rapid eye movement (REM) sleep. Due to severe academic dysfunction akin to his internet addiction, and irregular schooling in spite of various interventions, he had to quit the course as decided by the college staff and the parents.

Conclusion: This case report focuses on the severity of the internet addiction, gaming, and social networking and its impact on the sociooccupational functioning.

A study on relationship between somatic complaints and depression in elderly - A hospital-based study

Varsha BG, Shilpashri SK, Vinay HR, Preethi S, Srinivasa M, Mahesh R, Chandrashekar M

Department of Psychiatry, Spandana Nursing Home, Rajaji Nagar, Bangalore, Karnataka, India. varhabg9987@yahoo.co.in, drvarshabg@gmail.com

Aims: In the most recent surveys, major depressive disorder has the highest lifetime prevalence ranging from 5 to17% and an average of 12%. Depressive symptoms are present in about 15%of older community. The presenting complaints in older patients may be different because of an increased emphasis on somatic complaints. So, this study aims at studying the relationship between somatic complaints and depression in elderly.

Materials and Methods: A prospective study where consecutive 30 elderly patients meeting inclusion and exclusion criteria attending psychiatric outpatient department (OPD) of Spandana Nursing Home, Bengaluru, are taken as subjects. They are administered structured interviews assessing the presenting complaints using SCAN questionnaire for somatoform complaints and concurrently Hamilton Depression Rating Scale-7 item (HAMD-7) for depression. The correlation measures studied.

Results: Results will be discussed in details in the mail presentation.

Conclusion: Somatic complaints in depression are common among elderly, but their frequency varies depending upon how the somatization is defined and the unexplained somatic symptoms should raise the suspicion of major depressive disorder as it is often missed and should be managed accordingly.

Medical/dental resident's burnout - The present plight and the dark future

Vidhi Patel, Sandip Shah, Lakhan Kataria, Kajal Tanna

Department of Psychiatry, SBKS MI and RC, Dhiraj Hospital, Waghodia, Baroda, Gujarat, India. E-mail: drvidhi1987@gmail.com

Introduction: Due to persistent stress, burnout, and illogical working hours, it has long been acknowledged that medical students are at a greater risk for depression, anxiety, and stress, but their elevated risk for suicide is particularly alarming. Previous studies have not been able to consistently quantify or qualify that risk. Aim: To assess the:

  1. Relative extent to which burnout is prevalent among Bachelor of Medicine, Bachelor of Surgery/Bachelor of Dental Surgery's (MBBS/BDS) postgraduate residents.
  2. Depression, anxiety, and stress affects a resident doctor's life due to burnout.
  3. Suicide ideation, intent, and attempts; correlate the parameters with the work related stress.
  4. Empathy among the resident doctors and correlate with extent of burnout.


Materials and Methods: Resident doctors studying in postgraduate medical/dental course in any year/semester in medical/dental colleges were assessed using Maslach Burnout Inventory to assess the burnout, Depression Anxiety Stress Scales-21 item (DASS-21) to measure the depression, anxiety, and stress; Jefferson Empathy Scale to measure the empathy; and Suicide Behavior Questionnaire to assess the suicidal ideations.

Conclusion: We found that with increase in burnout there was a increase in depression, anxiety, and stress. Suicidality was more in residents with higher scores on burnout and DASS-21. We also found that burnout directly affects the empathy of any resident.

Relation of hopelessness and suicidal ideation with depression severity

Vijay Choudhary, Pradeep Sharma, Girish, Gunjan, Bhakti Murkey, Sunil Suthar

Sawai ManSingh Medical College, Jaipur, Rajasthan, India.

E-mail: doctor.bhaktii@gmail.com

Background: Hopelessness and suicidal ideation is common in depression, but these are moderately related to severity of depression.

Aim and Objective: To find out correlation between hopelessness, suicidal ideation, and depression severity.

Materials and Methods: The present study was carried out on 50 consecutive patients as diagnosed depression. The diagnosis was validated by the senior consultant psychiatrist by using International Classification of Diseases, 10th revision (ICD-10) criteria. Each patient also completed the Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), and the Scale for Suicide Ideation (SSI).

Statistics: The proposed study was conducted in phased manner, observing ethics of voluntary participation and informed consent of the participants were taken. Mean and standard deviation were computed.

Results: By using the suitable statistics, the results revealed that those higher levels of hopelessness have a higher level of depression and higher level of suicidal ideation. This study shows that hopelessness appears to be an important clinical marker of suicidal ideation.

Study of relationship of cognitive insight and depression in patients of schizophrenia

Vijay Choudhary, Pradeep Sharma, Gunjan, Bhakti Murkey, Sunil Suthar, Arvind

Sawai ManSingh Medical College, Jaipur, Rajasthan, India.

E-mail: doctor.bhaktii@gmail.com

Introduction: Insight in schizophrenia is a multidimensional phenomenon. Impaired insight is common in schizophrenia and is associated with poor clinical outcome. There is good evidence for an association between better cognitive insight and depressive symptoms.

Aim: To assess the correlation between cognitive insight and depression in patients of schizophrenia.

Materials and Methods: Thirty consecutive patients diagnosed with schizophrenia as per International Classification of Diseases, 10th revision (ICD-10) criteria. Calgary Depression Severity Scale (CDSS) score of greater than 5 were considered as depressed. Cognitive insight is assessed by Beck's Cognitive Insight Scale (BCIS).The statistical analysis was done by using Statistical Package for Social Sciences (SPSS) 20.

Results: We found a significant correlation between CDSS score and self-reflectiveness, and self-reflectiveness and self-certainty (R-C) index.

Discussion: Relationship between depression and cognitive insight in patients of schizophrenia aims towards developing more efficient cognitive strategies to improve overall clinical outcome in schizophrenia.

A case of genital self-mutilation

Vikash Kumar Gupta, Pankaj Kumar Sharma, T Madhusudan, R Shashikumar

Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India. E-mail: bhagal0007@gmail.com

Background: Malegenitalself-mutilation or amputationis an infrequently reported event in the general medical literature. Most of the cases have been reported either in urosurgical contexts or in sociocultural accounts. Very few reports have delineated the psychopathological aspects of genital self-mutilation and autocastration.

Aim: To highlight and discuss psychopathological aspects of genital self-mutilation and self-castration.

Materials and Methods: Here, we report a case of genital self-mutilation with partial amputation of the penis and complete excision of both testes (autocastration) preceded by an overdose of alprazolam by a patient. Anamnesis revealed insidious onset, progressive, delusions of persecution, and reference of about 6 months duration. The patient was diagnosed and treated for persistent delusional disorder (F22.0).

Conclusion: Intentional self-harm can be acomplication in delusional disorders. Such catastrophic acts of self-mutilation (including self-castration) canbe due toan underlying psychopathological process, most commonly a psychotic disorder. Awareness of this possibility will lead to proper management. In addition toprompt management of hemorrhage, urological injuries, andendocrine sequelae; a detailed psychiatric evaluation and treatment should start in earnest to reduce the risk of repetition of the act, completion of the suicidal act, and also to definitively treat the psychopathology.

Opinion and attitude of postgraduate students of media and medicine towards mental illness: A comparative study

Vinay Bansal, Hemanth B. G. Kumar, N. Keertish, M. T. Sathyanarayana, H. R. A. Prabhu

Department of Psychiatry, Sri Siddhartha Medical College and Hospital, Agalakote, Tumkur, Karnataka, India. E-mail: dr.vinaybansal86@gmail.com

Aim: Although media plays a very important role in modeling the attitude of general public towards mental illness, there are only a few studies that have focused on the attitude of media students/professionals towards mental illness. The aim of this study was to assess the opinion and attitude of postgraduate students in media towards mental illness, and to compare that with postgraduate students in medicine.

Materials and Methods: It is a cross-sectional, comparative study. Thirty-six postgraduate students of media and 41 postgraduate students in various medical disciplines constituted the sample. Self-administered semi-structured pro forma and 'Opinion about Mental Illness' (OMI) scale was used to assess the study subjects. Data obtained was analyzed using appropriate statistical methods.

Result: There was significant difference in the OMI scores of postgraduate students of media (mean = 5.66, standard deviations (SD) = 2.17) and those of postgraduate students in medical specialties (mean = 6.85, SD = 2.51).

Conclusion: Media postgraduate students were found to have a less favorable opinion towards mental illness when compared to that of postgraduate students of medical disciplines. Thus, indicating the need for steps to enhance awareness about mental health and illness among the media students.

Fluvoxamine-induced neuroleptic malignant syndrome: A case report

Vinayak Koparde, Adarsh Bellad, Sandeep Patil

Jawaharlal Nehru Medical College, Karnataka Lingayat Education Society Dr. Prabhakar Kore Hospital, Belgaum, Karnataka, India

Introduction: Neuroleptic malignant syndrome (NMS) is an uncommon but life threatening idiosyncratic drug reaction that occurs following neuroleptic drug exposure. The estimated incidence of NMS is about 0.2% and mortality rates range between 4-30% (Andreassen). The characteristic clinical features of NMS include extrapyramidal signs like rigidity, autonomic signs like hyperthermia, fluctuating blood pressure, tachycardia, tachypnea and mental status changes like confusion. Other features include raised Creatine phosphokinase (CPK) levels, leucocytosis, myoglobinuria, hypernatremia, hyperkalemia, metabolic acidosis. Death in NMS may occur due to complications involving renal, cardiovascular systems and respiratory insufficiency. NMS is also reported with agents other than classic neuroleptic drugs leading to changing concepts of NMS. NMS has been reported to occur in patients exposed to Selective Serotonin Reuptake Inhibitors (SSRI). NMS has been reported in a patient treated with Fluoxetine (Halman), Citalopram (Aydin). NMS is also reported when SSRI like Fluvoxamine is combined with a second generation antipsychotic i.e Quetiapine (Matsumoto). Combination treatment with Risperidone and Fluvoxamine is reported to cause neurotoxic syndrome in one patient (Reeves). Here we report a case of NMS with Fluvoxamine treatment alone.

Case Report: A 64 year old woman with Obsessive compulsive disorder for past 15 years, with no history of Diabetes mellitus and Hypertension was treated in past with Fluoxetine 60 mg/day and Clomipramine 25mg/day and improved. She was recently started on Fluvoxamine controlled release 50mg/ day tablet for worsening of her symptoms of OCD. Patient within 2 days of starting Fluvoxamine started complaining of severe generalized weakness, fever, excessive drowsiness. Patient when presented to us on 3rd day had fever, extremity muscle rigidity, hypertension, tachycardia, diaphoresis, decreased urine output. There was no history of taking any other medication, myoclonus, seizure, any focus of infection. Subsequently patient was admitted in ICU care. On clinical examination patient continued to have rigidity of extremities, perspiration, tachycardia, decreased urine output, fluctuating blood pressure suggestive of autonomic instability. Patient on 3rd day of admission developed disorientation to time and visual hallucinations. When investigated further patient had developed metabolic acidosis. The laboratory parameters of the patient from day of admission are given in [Table 1].



Patient's investigations on admission showed raised levels of CPK, Total leucocyte count, Urea and Creatine. Myoglobinuria was present. A diagnosis of Neuroleptic Malignant Syndrome with OCD was made and patient was admitted in Intensive Care Unit. Fluvoxamine was discontinued and she was treated with Paracetamol for fever, Intravenous fluids to maintain hydration and electrolyte balance, intravenous Sodium Bicarbonate to treat acidosis and Clonazepam 0.25 mg for complains of anxiety and insomnia. By day 7 of admission patient started showing improvement, i.e. rigidity decreased, sleep and urine output improved, there was no fever but weakness persisted. Laboratory investigations done at the time of discharge from hospital were within normal limits.

Discussion: Neuroleptic malignant syndrome and Serotonin syndrome (SS) are both serious adverse drug reactions related to exposure to psychotropics and diagnostic difficulty may arise in patients because of overlapping clinical features of these two syndromes. There are some features which distinguish NMS from SS like elevated creatine kinase, lactate dehydrogenase, aspartate transaminase, and white blood cell count. NMS is classically reported with typical antipsychotics but in recent years this concept is changing because of its association with atypical antipsychotics, SSRIs and other psychotropic medications. The majority of SSRI-related reactions appear to occur within the first month of treatment (Caley). SSRIs may cause NMS by their facilitative action on neurotransmitter serotonin along with central dopaminergic blockade (Halman). Addition of SSRI to Second Generation Antipsychotic is also reported to increase the risk of NMS by inhibiting Dopamine release by SSRIs (Stevens). Treatment of NMS whether induced by an antipsychotic or SSRI consists primarily of early recognition, discontinuation of triggering drugs, management of fluid balance, temperature reduction, and monitoring for complications. Dantrolene is indicated in more severe, prolonged, or refractory cases. Electroconvulsive therapy has been used successfully in some cases. Health care workers should be aware of SSRI induced NMS for early recognition and treatment of these patients and also to differentiate it from Serotonin Syndrome because of overlapping clinical features.

Post pyrexia psychosis: A study from tertiary care center

Vinit Yadav, Ashok Kumar Choudhary, Navandu Gaur

Department of Psychiatry, Jawaharlal Nehru Medical College, Ajmer, Rajasthan, India. E-mail: doc_vinityadav03@rediffmail.com

Aim and Objective: To find out the effect of seasonal variation and common infection on the natural history of psychiatric illness.

Materials and Methods: Retrospective chart review from 1st January 2013 was undertaken, which is to be continued till 1st December 2013.

Inclusion criteria: Patient reporting in outpatient department (OPD) with diagnostic criteria meeting International Classification of Diseases, 10th revision (ICD-10) guidelines for common psychiatric illness. Patient's age was between 18 and 60 years.

Exclusion criteria: Patient known to be suffering from chronic or debilitating illness. Data will be collected on day 0 and day 7. Statically analysis will be done using Statistical Package for Social Sciences (SPSS) version 20.

Results and Conclusion: To be discussed later.

Alcoholism: A major health problem

Vinod Kumar Shanwal

School of Humanities and Social Sciences, Gautam Buddha University, Noida, Uttar Pradesh, India.

E-mail: dr_vinodshanwal@yahoo.co.in, vinodihbas@hotmail.com

The higher consumption of drugs is a serious concern for the stakeholders particularly in the developing countries. Alcoholism is one of the major health problems among the drug abuse, which not only affects the health of the individual but also significantly impacts on the well-being of family members including spouses and children at a large. The long-term affect of the alcoholism may be seen on the well-being of overall socioeconomic conditions of the community. It has been found that the developmental projects undertaken through different governmental policies and programs have limited impact in uplifting the socioeconomic status of the families of the alcoholics. The dynamics of development that includes the fulfillment of potentialities of an individual to contribute for improving the well-being of society is highly threatened by the negative coping strategies, which have severe disabling impact on psychosocial development. Hence, in facilitating the development of the society, removing its barriers plays pivotal role and prioritizes alcohol abuse among the underprivileged as well as poor sections of the society. Thus, there is a strong need to change the psychosocial approaches of the people who are spending most of their hard earned money in the consumption of alcohol and thereby face serious challenges in meeting regular need of their family. It is crucial time to integrate developmental programs with the community-based interventions that highlight building resiliency, healthy family environment, positive child-rearing practices, and assessing the developmental opportunities available within the vicinity. The integrated model of development discussed in the study concentrates on the individual (alcoholic) rehabilitation and also suggests some coping strategies for the family members.

The effect of the development of alcohol withdrawal on the clinical course and outcome of the patients with leptospirosis

Vishal Gandhi, Ritambhara Y. Mehta, Kamlesh R. Dave, Nilima Shah

Department of Psychiatry, Government Medical College, Surat, Gujarat, India. E-mail: vishal_1179@yahoo.com

Aims and Objectives:

  1. To find out the prevalence of alcohol dependence in the patients of leptospirosis.
  2. To compare the clinical picture of patients of leptospirosis with and without symptoms of alcohol withdrawal.


Materials and Methods: Case papers of all the patients admitted with leptospirosis were reviewed and a semistructured pro forma was filled up with demographic details, detailed history of leptospirosis and alcohol use, laboratory parameters, duration of stay, complications, treatment, and outcome. The patients were divided in two groups depending on whether or not they developed alcohol withdrawal; and the parameters were compared.

Results: There was a high prevalence of alcohol use in the patients with leptospirosis. Alcohol withdrawal syndrome ranged from mild tremors to delirium tremens. Difficult issues in the treatment of alcohol withdrawal in patients of leptospirosis were altered liver and renal functions and risk of respiratory depression, allowing only a cautious use of benzodiazepines. Often intravenous preparations were to be used as intramuscular injections were avoided due to low platelet count, increasing the risk of over sedation, aspiration, and respiratory depression. Untreated severe alcohol withdrawal would increase the risk of injury, aspiration, and disruptive behavior. This posed a clinical dilemma and adversely affected the patients with leptospirosis.

Conclusion: Alcohol withdrawal must be treated cautiously, but adequately in patients with leptospirosis. Initiating early treatment may prevent the development of delirium tremens and further complications. Taking a history of alcohol use and counseling about alcohol deaddiction, at the time of administering doxycycline prophylaxis for at risk leptospirosis population is advisable.

A randomized comparison of lorazepam and chlordiazepoxide in patients with uncomplicated alcohol withdrawal

Vishnu Gade, Pramod M Reddy, Pavan CM Kumar Reddy

Department of Psychiatry, Mamata General Hospital, Khammam, Andhra Pradesh, India. E-mail: vishnu.gade117@gmail.com

Aim: To compare the efficacy between lorazepam and chlordiazepoxide in treating patients with uncomplicated alcohol withdrawal. Assessments: 1) SADQ- Severity of Alcohol Dependence Questionnaire 2) CIWA-Ar- Clinical Institute Withdrawal Assessment for Alcohol Revised Scale.

Materials and Methods: The study will be conducted in the in patient setting in the Department of Psychiatry at Mamata General Hospital, Khammam. The sample will be approximately 100 consenting male patients in a state of moderate to severe uncomplicated alcohol withdrawal and at the time of screening they will be randomized to receive either lorazepam or chlordiazepoxide. Informed verbal consent will be taken from the patients before initiation of the study. Lorazepam will be started at a dosage of 8mg per day (in divided doses) for the first 2 days and the dose will be reduced by 2 mg every 2 days such that after 8 days of treatment the patient will be drug free. Chlordiazepoxide will be started at a dosage of 200 mg per day (in divided doses). Chlordiazepoxide dose will be reduced by 50 mg every 2 days, such that after 8 days of treatment the patient will be drug free. All routine laboratory investigations like random blood sugar (RBS), complete blood picture (CBP), renal function tests, serum electrolytes, liver function tests (LFTs), and ultrasound (USG) abdomen will be performed at the beginning of the study.

Results and Conclusions: Will be discussed at the time of the presentation as this is an ongoing study.

Indications and prescription pattern of electroconvulsive therapy -A retrospective study

V. Subbalakshmikota, Khyatiwadhwa, K. Avinash, Rishikesh V. Behere, P. S. V. N. Sharma

Department of Psychiatry, Kasturba Hospital, Manipal, Karnataka, India. E-mail: Lakshmi.kota@gmail.com

Background: Electroconvulsive therapy (ECT) is used to achieve rapid and short-term improvement of severe symptoms, when the condition is considered to be potentially life-threatening and/or after an adequate trial of other treatment options has proven ineffective. Major indications being severe depression, catatonia, and mania. Depression appears to be most common diagnosis for which ECT is prescribed worldwide. However, studies from India report schizophrenia as the most common diagnosis.

Aim: Evaluate the main indications and prescription pattern of modified ECT (MECT) in a tertiary care center.

Materials and Methods: Case records of all patients who received MECT from 2008 to 2012 will be reviewed. Semistructured pro forma will be used to collect details regarding diagnosis, indication for MECT, and psychopathology prior to receiving treatment.

Results and Analysis: Data collection will be done from September toNovember 2013. Data will be analyzed and results will be presented and discussed.

Maladaptive behaviors among drug users

J. S. Yadav, S. Kaur 1

All India Institutes of Medical Sciences, New Delhi, 1 SRLNM Hospital, Varanasi, Uttar Pradesh, India

Aim: Maladaptive behavior and anxiety was higher in drug users then control subject.

Materials and Methods: In this cross-sectional study, 200 patients of various drug users and 150 controlled subjects were taken from same community Trilokepure during year 2012-2013. They were screened on inclusion and exclusion criteria. Finally 164 patients of various drug users fulfilled the selection criteria, their diagnosis made by consultant incharge of the community clinic, and the sociodemographic data were noted. These patients were divided into different groups on the basis of types of substance use and their doses. Hamilton Anxiety Rating Scale and semistructured pro forma of maladaptive behavior was applied in both the groups. Hamilton scale divided in to 14 subparts with 70 questions. This scale was reliable and valid.

Result: All patients of drug users given 98% and control subject 100% response to 30 items of questioners. Deviation of behavior was more common among male, uneducated, low socioeconomic status, unemployed, and unmarried. Eighthy percent drug users showed maladaptive behavior patterns in social situation, while only 20% in their family environment . Higher percentage of maladaptive behavior (90%) was found in opium than tobacco users, anxiety was also higher in drug users then control.

Conclusion: Maladaptive behavior mainly occurs in anxiety provoking situations. Most of the studies reported that the patients of psychoactive substance users are more prone to develop secondary anxiety and depression. The effect of these psychoactive substances depends upon their types, dose, and duration. In this study, we find that maladaptive behavior is more prone in particular situation.

The stability of the diagnosis of psychosis NOS among adolescence with emotional and behavioral disorders in India

Yogendra Singh, Praveen Kumar, Priya Mammen, P. S. S. Russell

Department of Psychiatry, Child and Adolescent Unit, Christian Medical College, Bagayam, Vellore, Tamil Nadu, India.

E-mail: dryogendrasingh16@yahoo.com

Aim: To determine the diagnostic stability of psychosis not otherwise specified (NOS) in adolescence population with emotional and behavioral disorder attending tertiary care.

Materials and Methods: Psychiatric charts of 104 children and adolescents between 11 and 18 years of age with an index diagnosis of psychosis NOS (International Classification of Diseases, 10th revision (ICD-10) of F29) attending a child and adolescent psychiatry unit in a teaching hospital were reviewed by two qualified psychiatrists, and conflicts resolved by a consultant psychiatrist. During the available mean (standard deviation (SD)) follow-up period of 2.73 (1.84) years, any change in diagnosis as confirmed by a consultant psychiatrist was noted in a specialized pro forma. Appropriate descriptive and bivariate analyses were done.

Result: About 60% (25/42) with an index diagnosis of psychosis NOS had a change in diagnosis. The reviewed changes in the diagnosis were schizophrenia (36%), mood disorders (56%), obsessive compulsive disorder (4%), and organic brain syndrome (4%). More girls and participants in the middle adolescence had more changes in their diagnosis, but were not statistically significant.

Conclusion: Our study demonstrated that the stability of the diagnosis of psychosis NOS was only 40%, suggesting that many of those with the above diagnosis may have other illness. This study duplicates other studies in other age groups and culture.

Severe headache as a presenting complaint in sigmoid sinus thrombosis complicated by strong hysterical overlay

Pradhyuman Chaudhary, Girish Banwari

Department of Psychiatry, Sheth Vadilal Sarabhai General Hospital, Ellis Bridge, Ahmedabad, Gujarat, India. E-mail: drpradhyman@gmail.com

Objective: To emphasize that an otherwise serious as potentially fatal organic condition can present with a coexisting strong functional component through a case report.

Materials and Methods: A 30-year-old female patient presented with recurrent bouts of severe headache over the occipital region, associated with blurring of vision. Initially noncontrast computed tomography (CT) scan of brain showed normal study, but noncontrast magnetic resonance imaging (MRI) brain showed filling defect in right sigmoid sinus and MR venography confirmed right sigmoid sinus thrombosis. On starting antiplatelet drug, she did not improve and still had bouts and severe headache, although no longer associated with impaired vision. As conducted by the treating neurophysician, symptoms did not correlate with the organic brain condition. Overt and covert psychosocial stressors were found to be present in a detailed psychological exploration. Psychological intervention effectively controlled the headache.

Results and Conclusions: Hysterical features can be present and complete the clinical picture in a severe organic condition and may require active psychiatric intervention over and above medical treatment.

Key words: Functional overlay, psychiatric intervention, right sigmoid sinus thrombosis, Severe headache

Does clonidine has an abuse potential? A case report

Shruti, Vishal Dhiman, Dinesh Kataria

E-mail: shruti.aggarwal49@gmail.com

Aim: To demonstrate the abuse potential of clonidine in opioid-dependent patients.

Materials and Methods: We analyzed a case of 42-year-old male patient dependent on opioids consuming up to 24 capsules of proxyvon per day. In addition he started using clonidine 0.5 mg and clonazepam 2.5 mg per day, prescribed once, in lower doses for opioid deaddiction. He presented to us after 5 years with inability to discontinue any of the three drugs.

Results: Patient was found to develop signs and symptoms of opioid withdrawal in addition to rebound hypertension in an attempt to taper clonidine.

Conclusion: Clonidine, one of the dangerous drug, with its propensity to cause rapid hypotension as well as rebound hypertension, has a definite abuse potential and may be having dependence potential as well independent of opioid dependence. Thus, clinicians must play extra caution while prescribing such medications, especially to the patients with propensity to abuse drugs.

Frontal meningioma presenting with psychiatric symptoms

Shruti, Simmi Kumari, Dinesh Kataria

23-U.B. Jawahar Nagar, Delhi. E-mail: shruti.aggarwal49@gmail.com

Aim: To demonstrate the delay in diagnosis of patient of frontal lobe meningioma due to clinical presentation in form of psychiatric signs and symptoms.

Material and Methods: We analyzed a case of 55-year-old female who presented with history of (h/o) two seizure-like episodes 10 and 3 years back with persistent nonspecific headache in between with only symptomatic management all through followed by gradual personality changes since last 3 years with episodes of fall multiple times in a day since 2 months each preceded by abnormal tactile sensation, occurring in full consciousness with no injury sustained ever. Bilateral pedal edema, anosmia, and papilledema were the only positive findings on clinical examination.

Results: Magnetic resonance imaging (MRI) findings were suggestive of subfrontal meningioma.

Conclusion: Cases like this emphasizes the fact that psychological symptoms may be a mode of presentation of an organic pathology and a need of thorough understanding of neurology by psychiatrists.

Megalencephalic leukoencephalopathy with subcortical cysts: A case report from a rural health setting

Swetha Sheth, Sydney Moirangthem

Department of Psychiatry, National Institute of Mental Health and Neuroscience, Bangalore, Karnataka, India. E-mail: sweta.sheth86@gmail.com

Megalencephalic leukoencephalopathy with subcortical cysts (MLC) is a recently described neurogenerative disorder with an autosomal recessive inheritance, with an underlying mutation in the MLC1 gene and a more recently described mutation in GlialCAM. It presents with macrocephaly, developmental delay, ataxia, and spasticity. The disease has been found to be common in the Agarwal community in India. We describe here a patient from a non-Agarwal community who presented to our Rural Mental Health Center (RMHC) with a diagnosis of MLC and seizure disorder and the pharmacological and nonpharmacological aspects of its management. Her seizure was controlled with sodium valproate at 400 mg/day. Intelligence quotient (IQ) assessment was done which revealed profound mental retardation (IQ of 19). Behavioral interventions were taught by the psychologist (part of the treating team) to the parents to help improve the child's speech. A disability certificate was also given so that the parents would receive financial aid from the government with progressive follow-ups, improvement was noted in the child's vocabulary which was noted by the treating team and also reported by the parents. In conclusion, MLC is a complex disorder with no definitive treatment. However, a multifaceted treatment approach can be of benefit to the patients and the family.

A cross-sectional study exploring retracted literature on mental disorders

Yatan Pal Singh Balhara, Ashwani Mishra

Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. E-mail: ypsbalhara@gmail.com

Aims: Flawed medical literature can have deleterious effect on medical science. There is no published literature that has focused no retraction of articles on mental disorders. The current study was aimed to assess the retracted medical literature on mental disorders. Also, it aimed at testing the hypothesis that weak research infrastructure in certain countries and expansion of Asian science with pressure to publish might contribute to more retractions.

Materials and Methods: A bibliometric search was carried out using PubMed database. Retraction rates were calculated as number of articles retracted per 100,000 publications. The data were analyzed using Statistical Package for Social Sciences (SPSS) ver 17. In between group analysis were carried out between high-income and low- or middle-income countries (HICs and LMICs). Similarly, in between group comparisons were carried out for publications from Asian and non-Asian countries. Nonparametric test (Mann-Whitney U test) was used for this purpose. The value of statistical significance was kept at P < 0.05 (two-sided) for all the tests.

Results: The final analysis included 55 articles. Overall 0.0138% of the articles were retracted. Similarly 0.0095% of the articles on mental disorders were retracted. Of the thirty-eight articles for which the reasons of retraction could be accessed, 10 (26.31%) were retracted for fraud. A disproportionately greater proportion of published articles were retracted from LMICs as compared to the HICs. Also, a disproportionately greater proportion of published articles were retracted from Asian countries as compared to the non-Asian countries.

Conclusion: Retracted literature on mental disorders has increased over the past few years.

A study of psychiatric morbidity in recovering intensive care unit patients

Pranjalee Bhagat, Shilpa Adarkar, SR Parkar, ND Karnik

Department of Psychiatry and Department of Medicine, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, India. E-mail: pranjeebhgt@gmail.com

Introduction: Patients admitted in intensive care unit (ICU) generally have a debilitating disease. With improvement in medical facilities, ICU patient's mortality is reduced leading to increase in surviving patients. While the patient is recovering, he/she may develop some psychological symptoms like sadness of mood, anxiety, sleep disturbances, irritability, etc. Studies have shown that ICU stay can lead to psychiatric diseases of which depression, anxiety, and posttraumatic stress disorder are most common. Several risk factors for these psychiatric symptoms include pre-ICU psychiatric symptoms, female sex, younger age, education. Commonly reported ICU risk factors include poor recall of hospital stay, traumatic or delusional ICU memories, and ICU sedation and restrain, long duration mechanical ventilation, unemployment due to long stay in ICU, and post ICU cognitive impairment. Pre and post ICU impairment in physical function can also be associated. Identifying these risk factors will help us to detect patients at risk for psychiatric complications and plan further interventions. However, few studies have been done on psychiatric morbidity in recovering ICU patients; hence we decided to do this study.

Aims and Objectives:

  1. To study sociodemographic profile of patient recovering from ICU.
  2. To access psychological symptoms in recovering ICU patients.


Materials and Methods: Fifty patients recovering from ICU, who were under critical care in medical and neurological ICU and now stabilized and transferred to intermediate care of tertiary hospital, were enrolled after informed consent and institutional review board (IRB) permission. Semistructured questionnaire was administered to study sociodemographic profile of patient. Clinical diagnostic interview as administered to assess psychological symptoms. Mini-mental state examination (MMSE) was used to assess cognitive impairment.

Results and Conclusion are discussed.

Insomnia associated with restless leg syndrome

Ravi Gupta, Deepak Goel, Vivekananda Lahan, Sohaib Ahmad, Meenakshi Dhar

Department of Psychiatry and Sleep Clinic, Himalayan Institute of Medical Sciences, Swami Ramnagar, Doiwala, Dehradun, Uttarakhand, India.

E-mail: sleepdoc.ravi@gmail.com

Aims: To study the sleep problems associated with restless leg syndrome (RLS).

Materials and Methods: A total of 173 consecutive patients with the diagnosis of RLS were included in this study. There demographic profile was recorded. Detailed history regarding RLS was gathered. Information regarding sleep problems was also asked. Severity of RLS was measured. Statistical analysis including chi-square test, independent sample t-test, and Pearson's correlation was done.

Results: Sleep problem was reported in nearly 90% subjects. Gender had no effect on sleep problem in this group (P = 0.25). Initial insomnia was the most common type of sleep problem. Many of the subjects fulfilled the diagnostic criteria for other primary insomnias, for example, psychophysiological insomnia, paradoxical insomnia, etc.

Conclusion: Insomnia is a common accompaniment with RLS.

"How are you feeling today doctor?" - Mental well-being of young medical professionals: A cross-sectional analysis

Shalini Singh, Shruti Aggarwal, Suman Kumar Sinha, Dinesh Kataria

E-mail: shalin.achra@gmail.com

Aims: Mental well-being is now a focus of policy and science. This study aims at assessing the mental well-being of young medical professionals and their subjective responses to the demographic determinants of the study.

Materials and Methods: A cross-sectional study was carried out using an anonymous self-administered questionnaire based upon the mental well-being scale. The questionnaire was distributed among medical students, interns, and postgraduate students under the age of 33 years. Descriptive statistics were used to compile and present the results.

Results: The sample comprised of 234 medical professionals (14% medical students, 63% postgraduates, and 23% interns) with 63% of sample being female. The overall response rate was 97.9%. The average age of the participants was 25.3 years. According to the survey, males are significantly more calm and peaceful, energetic, full of life, optimistic, and found themselves to be more adept at completing tasks. Participants from urban background were found to be significantly more calm and peaceful than their rural counterparts. Participants older than 25 years were found to be significantly more optimistic than the younger (≤25 years) age group. Undergraduates were statistically happier than the rest of the group, while interns enjoyed their spare time the most.

Conclusion: Significant differences exist among medical students and doctors in the various indicators of mental well-being based upon gender, residence, original domicile, and professional qualifications. The cause behind these findings needs to be further investigated.

Medical/Dental resident's burnout - The present plight and the dark future

Vidhi Patel, Sandip Shah, Lakhan Kataria, Kajal Tanna

Department of Psychiatry, SBKS MI and RC, Sumandeep Vidyapeeth, Dhiraj Hospital, Waghodia, Gujarat, India. E-mail: drvidhi1987@gmail.com

Introduction: Due to persistent stress, burnout, and illogical working hours; it has long been acknowledged that medical students are at a greater risk for depression, anxiety, and stress; but their elevated risk for suicide is particularly alarming. Previous studies have not been able to consistently quantify or qualify that risk.

Aim: Assess the

  1. Relative extent to which burnout is prevalent among Bachelor of Medicine, Bachelor of Surgery (MBBS)/Bachelor of Dental Science (BDS) postgraduate residents.
  2. Depression, anxiety, and stress affects a resident doctor's life due to burnout.
  3. Suicide ideation, intent, and attempts correlate the parameters with the work-related stress.
  4. Empathy among the resident doctors correlates with extent of burnout.


Materials and Methods: Resident doctors studying in postgraduate medical/dental course in any year/semester in medical/dental college were assessed using Maslach Burnout Inventory to assess the burnout; Depression, Anxiety, and Stress (DAS)-21 to measure the depression, anxiety, and stress; Jeffersons Empathy Scale to measure the empathy; and Suicide Behavior Questionnaire to assess the suicidal ideations.

Conclusion: We found that with increase in burnout, there was an increase in depression, anxiety, and stress. Suicidality was more in residents with higher scores on burnout and DAS-21. We also found that burnout directly affects the empathy of any resident.

Functional Neuroanatomy of Insula

E Mohan Das, Rajesh Nagpal, MS Reddy

Sun Medical and Research Centre, Trichur, Kerala, India.

E-mail: emohandas53@gmail.com

Sub Topics:

Insula in Schizophrenia - Dr. Rajesh Nagpal

Insula in Bipolar Disorder - Dr. M.S. Reddy

Situated in the depth of sylvian fissure, the insular cortex has three concentrically arranged zones: Rostroventral granular zone, caudodorsal granular zone, and intermediate dysgranular zone. Broadman's areas 13-16 signify the insular cortical area. Insula may be subdivided into anterior and posterior sections based on connectivity, cytoarchitecture, and function. Anterior insular cortex in its fifth layer contains large spindle-shaped cells (von Economo neurons). The anterior insula involving the agranular region has extensive and reciprocal connections to limbic areas, higher order visual areas, olfactory areas, and posterior insula. The posterior insula representing the granular and adjacent dysgranular region has reciprocal connections with higher order visual areas, auditory processing areas, somatosensory areas, and anterior insula.

The 'salience circuit' implicated in various psychiatric disorders revolves around insula. The role of anterior insular cortex in cognitive control, perceptual decision making, self-recognition, time perception, olfaction, social emotions, auditory and language tasks, and speech and taste recognition is briefly discussed. Also discussed is the role of posterior insula in visceral, somatomotor, and pain sensation.

The functional neuroanatomy of insular cortex with functional implications will be discussed.

Treatment of Obsessive Spectrum and Anxiety Disorders

Focus on sigma receptors


Philip John, Johann Philip

Peejays @ the Neurocenter, Cochin, Kerala, India. E-mail: info@peejays.in

Psychiatry, at this juncture of its evolution, is witnessing many changing scripts. Nosological concepts, classificatory systems, and treatment strategies are undergoing changes based on accumulated clinical evidence. Translational by nature, research evidence in molecular biology is transforming the way we use psychopharmacological strategies for clinical treatment.

Exponential molecular research today has been making it possible to discover novel modes of action by psychotropic drugs. To create design molecules and amazingly, to turn 'old' drugs to 'new', with the discovery of newer targets of drug action within the neuron.

The discovery recently of sigma receptors and the action upon them by drugs like fluvoxamine and opipramol has indeed been a game changer in many ways. Foundations of neurology are shifting, with the molecular insights into both synaptic and structural plasticity of the neuron induced by these drugs. Fresh insights into the sequence of chronic antidepressant action such as neuroplasticity with structural changes in the neuron and neurogenesis, will be addressed in this presentation.

The 'sigma enigma' is examined in this lecture, with its discovery and cloning in 1996 and its role in signal transduction in the neuron. The role as 'receptor chaperone' for neuronal energy production and for intracellular protein synthesis will be alluded to. Our lecture throws light on recent molecular research on signal transduction, the processes by which long strings of chemical messages traverse from the receiving dendritic end, undergo transformation with the use of these drugs that act on sigma receptors, and then are propagated from the axon terminal to the next neuron. In turn, our presentation examines this translation of molecular research into current clinical treatment of a plethora of common psychiatric disorders.

Proposal for Sexual Medicine Specialty Symposia for ANCIPS 2014 to be held at Pune between 16 - 19th January

Normal, impulsive, obsessive, and addictive sexuality - Sexaholism: A perspective

Chairperson- Dr. V.K. Aravind, Dr. Om Prakash

Speakers - Mrugesh Vaishnav TSS Rao

Sex is a biological drive. Sexual thoughts, urges, and behaviors are part of normal sexuality which at time becomes difficult to resist, hence results into impulsive, obsessive, or addictive sexual behavior. Though there is no clear-cut demarcation between normal and abnormal sexual behavior, some of the researchers have defined total sexual outlet (TSO) to measure whether the sexuality is normal or abnormal.

The recent Diagnostic and Statistical Manual of Mental Disorders (DSM) 5 classification have classified paraphilic disorders, however highly prevalent paraphilia-related disorders like compulsive masturbation, phone sex dependence, pornography dependence, protracted promiscuity, severe sexual desire incompatibility, and sexual chat room dependence are still not separately classified as mental disorders.

Based on the current research data available, sexual compulsion can easily be fit either into obsessive compulsive spectrum or into an addiction module, but hypersexuality or sexual addiction is still considered as symptom of mental illness and not separate diagnostic entity.

A clinician may come across cases of partners complaining hyper sexuality, excessive chat room dependence, or several extramarital affairs. The clinician's dilemma is whether to label that individual into any psychiatric disorder pattern as, for example, impulsive, compulsive, or addictive. It is also difficult to decide up to which extent sexual behavior is to be considered normal. This will be discussed with anecdotal case examples about what is normal and what is abnormal sexual desire, urges, and behavior. Sex and the drive of evolution and sex and the religious quest for divine reunion will be discussed. Several examples of hypersexuality, paraphilia, paraphilia-related disorders, sexual obsession, and sexaholism and public health will also be discussed. The symposia will throw light on how these cases can be managed in routine clinical practice.

E-mail: drmrugesh@rediffmail.com

List of Poster Abstracts that will be published in the next supplement. [Additional file 1]

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