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FREE PAPERS  
Year : 2018  |  Volume : 60  |  Issue : 5  |  Page : 48-123
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Date of Web Publication1-Feb-2018
 

How to cite this article:
. Free Papers. Indian J Psychiatry 2018;60, Suppl S4:48-123

How to cite this URL:
. Free Papers. Indian J Psychiatry [serial online] 2018 [cited 2020 Sep 30];60, Suppl S4:48-123. Available from: http://www.indianjpsychiatry.org/text.asp?2018/60/5/48/224514




Impact of two weeks psychiatric clinical posting on Intern doctors’ Knowledge and Attitudes towards Psychiatry and Mental illnesses.

Rushiraj Joshi, Pradhyuman Chaudhary, Ritambhara Mehta

1st year resident,DPM Psychiatry, Goverment Medical College,Surat, Gujarat. 92rushirajoshi@gmail.com

Introduction: Mental Health sector is ridden with negative stigmatising attitudes, often due to lack of knowledge about mental illnesses and sufferers. Prevailing negative attitudes worldwide is the important reason, also in India, for lack of interest in the branch by medical students. Very little attention has been paid to the way attitudes of students are influenced by clinical posting in psychiatry.[1] As the intern doctors can play an important role in reduction of negative attitude and stigma amongst medical fraternity, it’s mandatory to study their knowledge and attitudes, hence the study.

Objectives: To assess change in knowledge and attitudes of intern doctors toward psychiatry and mental illnesses at start and at the end of their regular 2 weeks of psychiatry posting exposure.

Methodology: A two stage cross-sectional assessment was done using semi structured self-administered questionnaire tapping knowledge and attitudes toward psychiatry and mental illnesses, which was given to intern doctors posted from June 2016 to June 2017, at the time of joining and after 2 weeks of regular psychiatry posting during which they were taught about major psychiatric disorders and their management and they attended psychosexual counselling, alcohol group meeting and relaxation training. The scores were analysed.

Results & Conclusion: All the 93, 33 male and 60 female, overall knowledge and positive attitude toward psychiatry increases as the exposure to psychiatry increases. Interns showed significant improvement (p<0.05) in their knowledge regarding Schizophrenia, Depression, ECT and Alcohol. 37 interns have positive attitude which increased to 67 regarding recovered mentally ill can work and earn well respectively after 15 days psychiatry posting (p<0.05). Ambiguity surfaced on whether mentally ill can take their own decision or not, with 49 out of 93 disagreeing even they encountered with peer support volunteers.

Clinical outcomes in patients with drug resistant schizophrenia receiving antipsychotics other than clozapine

Abhinav Chichra, Sushmita Chandramouleeswaran, Deepa Ramaswamy

Senior Registrar, Christian Medical College, Vellore, Tamil Nadu. ab_chichra@hotmail.com

Background: Drug resistance in schizophrenia is a common problem with significant social and economic implications(1). Clozapine is considered the standard treatment for drug resistant patients by contemporary clinical guidelines(2,3), primarily based on earlier studies showing a significant advantage of clozapine in terms of efficacy(4,5). However, clozapine use has its own clinical limitations owing to side effects and stringent blood monitoring protocols, moreover newer meta-analyses and studies are challenging old assumptions about the clear superiority of clozapine in drug resistance(6,7). In a limited resource setting like India, it would be relevant to see if using a third antipsychotic apart from clozapine following failed trials of two other antipsychotics is a clinically useful option.

Methods: The study was a retrospective cohort study carried out in the Department of Psychiatry of Christian Medical College, Vellore. Adults with a diagnosis of schizophrenia (as defined in ICD-10), further characterized by drug resistance (as defined in modified Kane’s criteria) who were treated as inpatients between January and July 2016 and had received a third trial of an antipsychotic other than clozapine were identified using medical records and discharge summaries. Variables studied were socio-demographic details, details of drug used in third trial and details of prior drug trial. Proportion of patients showing improvement was calculated using rating scores available in discharge summaries. Using outpatient records; subjective clinical improvement, adherence and proportion of patients that needed another change in antipsychotic at 6 and 12 months was quantified. Variables were analyzed using Chi – square or fisher’s exact test for categorical variables and independent Sample T test, or Wilcoxin’s test for continuous variables to look for any significant associations.

Results and Discussion: Study is currently underway; results will be presented at a later date.

Pharmacovigilance in Psychiatric Outpatient department in a Tertiary Care Hospital

Abhishek Samal, Thakur Jethanand Hemnani,

Senior Resident, G.S. Medical College, Noida, Uttar Pradesh. abhibhaimbbs@gmail.com

Introduction: An adverse drug reaction (ADR) is an unwanted or harmful reaction experienced following the administration of a drug or combination of drugs under normal conditions of use and is suspected to be related to the drug. Many psychotropic drugs and others drugs used in psychiatric practice have ADR which may either be dose-dependent or idiosyncratic. One of the pressing concerns in the treatment of individuals with mental disorders, especially chronic ones, is compliance to treatment, which is largely affected by ADR among other factors. ADR monitoring and reporting to a national regulatory authority are put in place in many countries. The Pharmacovigilance Programme of India (PvPI) began in 2010 and is currently under the Indian Pharmacopoeia Commission, to which mandatory voluntary reporting of ADR is being done by all clinical and paraclinical departments of the concerned hospital.

Aim and Objectives: This study endeavours to find out the prevalence and the nature of ADR in individuals attending the psychiatric outpatient clinic of a private tertiary hospital in suburban Uttar Pradesh for four consecutive months.

Methodology: Follow-up patients attending the psychiatric outpatient for the time period of four months, who reported or were found to have ADR on interviewing, and evaluated by clinical examination were taken up for the study. The Suspected Adverse Drug Reaction Reporting Form (ADDR) for voluntary reporting of Adverse Drug Reactions by Healthcare Professionals, Version 1.2 was filled up for each patient. Clinical and sociodemographic details were obtained after informed consent was taken. Appropriate statistical analyses were done.

Results and Conclusion: The results and conclusion of the study will be presented at the conference.

Keywords: Pharmacovigilance, Adverse Drug Reaction, Side effect

A cross-sectional outpatient study of prevalence and severity of Body Dysmorphophobic Disorder in individuals with Acne – a pilot study

Abhishek Samal, Manish Kumar, Anjali Madan

Senior Resident, G.S. Medical College, Noida, Uttar Pradesh. abhibhaimbbs@gmail.com

Introduction: A significant amount of personal investment in terms of time, energy, money; mental and behavioural preoccupation, checking, and avoidance goes into the daily lives of individuals with acne, closely resembling symptoms of body dysmorphic disorder (BDD). Such individuals usually consult many doctors, seek diverse forms of treatment but do not take them sincerely, need reassurance and motivation, and usually do not visit psychiatric clinics or visit quite late. While most research in this field have directed their attention to anxiety and depressive disorders and personality factors, few have assessed the prevalence of BDD in dermatology outpatient clinics, which when undiagnosed will have an important bearing on treatment.

Aim and Objectives: This study endeavours to find out the prevalence of BDD in individuals seeking treatment for acne and to determine the relationship between the severities of acne and BDD.

Methodology: Consecutive patients attending the dermatology outpatient for acne in the time period of two months and who gave informed consent were screened using the BDD Questionnaire (BDDQ). Clinical diagnosis of BDD was made by a psychiatrist using the DSM-5 diagnostic criteria. The severities of acne and BDD were rated using the Global Acne Grading System and Body Dysmorphic Disorder Modification of the Yale-Brown Obsessive Compulsive Scale (YBOCS-BDD) respectively in those who screened positive in the BDDQ. Appropriate statistical analyses were done.

Results and Conclusion: The results and conclusion of the study will be presented at the conference.

Keywords: Acne; Body dysmorphic disorder; Dysmorphophobia.

Study of marital adjustment, mechanisms of coping and psychopathology in couples seeking divorce in India

Abhijeet Faye, Gurvinder Kalra, Alka Subramanyam, Henal Shah, Ravindra Kamath, Abhijit Pakhare

Assistant professor, NKP Salve Institute of Medical Sciences, Nagpur, Maharashtra. abhijeetfaye12@gmail.com

Background: The divorce rate in India is increasing. In some cases, divorce could result from psychopathology in one of the partners or in other cases may lead to major psychopathology. Therefore it is important to identify problems in marital adjustments. This study aims to find probable reasons for divorce, how people cope with it and whether any psychopathology is associated with it.

Material & methods: A total of 100 respondents undergoing divorce were selected consecutively after obtaining their consent. Study was conducted in Family court, Mumbai with the help of marriage counselors and participants were interviewed using a semi-structured proforma, Dyadic Adjustment Scale, Mechanisms of Coping Scale and Symptom Checklist- 90-R. Data was analyzed statistically.

Results- Around 57% of divorce cases in our study were filed by women, 31% by men and 12% by mutual understanding. The primary reason for divorce in our respondents was interpersonal problems (34%). Marital adjustment was poor in 91.6% respondents, with a minimum score for dyadic cohesion and affectional expression. Fatalism, expressive action and problem solving were the commonly used coping methods. In all, 64% had significant psychopathology with prevalence more in women than men, with depression being the most common. Poor marital adjustment and emotion-based coping were associated with higher psychopathology, whereas parental support and having children were protective factors for psychopathology. Being in a ‘Love marriage’ was associated with good marital adjustment.

Conclusion: Women outnumbered men in filing for divorce and in overall psychopathology. Inter-personal problems was most common reason for divorce whereas depression was most common psychopathology. Emotion based coping and poor marital adjustment were predisposing factors for psychopathology.

Keywords: divorce; coping; couples; marital adjustment; psychopathology; depression

The Role of Traditional Biomarkers in Patients of Alcohol Dependence – An Explorative Study

Abhilekh Das, Lakshimi Borgohain

Post Graduate Trainee (M. D. Psychiatry), Assam Medical College and Hospital, Dibrugarh, Assam. abhilekhdas336@gmail.com

Background: To treat people with alcoholism clinicians need tools that can properly assess not only the patient’s past and recent drinking activity but also any history of drinking problems in the family that they may have.

Aim and Objectives:

  1. To assess and compare levels of Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), Gamma Glutamyl Transferase (GGT) and Mean Corpuscular Volume (MCV) in patients of Alcohol Dependence with equal number of age and sex matched controls.
  2. To assess and compare levels of AST, ALT, GGT and MCV in patients of Uncomplicated Alcohol Withdrawal State with patients of Alcohol Withdrawal State with Convulsions.


Materials and Methods: This was a hospital based case control study conducted on 100 inpatients of alcohol dependence and equal number of age and sex matched controls. The biomarkers were measured on the first day of admission for all cases for the sake of uniformity. The results were analysed using SPSS Version 16.0 setting the significance threshold at p < 0.05.

Results: There was significant elevation of AST, ALT, GTT and MCV in patients of alcohol dependence when compared to controls. ALT and GGT was also significantly elevated in alcohol withdrawal cases with convulsions compared to cases with uncomplicated alcohol withdrawal.

Conclusion: AST, ALT, GGT and MCV are efficient biomarkers to screen alcoholic patients. Elevated ALT and GGT levels in alcohol withdrawal patients with convulsions indicate that it could be a risk factor for alcohol withdrawal seizures.

Keywords: Aspartate Aminotransferase, Alanine Aminotransferase, Gamma Glutamyl Transferase, Mean Corpuscular Volume.

Assessment of Neurocognitive functions in Schizophrenia and Bipolar Affective Disorder Patients: A Comparative Study

Aditi Agrawal, Nikita Dhaka, G. D. Koolwal, Sanjay Gehlot, Shreyance Jain

Resident doctor, Dr. S.N. Medical College, Jodhpur, Jaipur, Rajasthan. aditiagrawal1003@gmail.com

Background: Cognitive impairment has come to be seen as a core feature of schizophrenia and bipolar disorder which persists in remission periods and influence patients’ psychosocial outcomes. It is reliably associated with neurobiology of the disorders. Thus, cognitive perspective can provide a means to integrate the biological and behavioural aspects of these disorders. Only a few studies in India have attempted to compare neurocognitive functions in these two psychiatric illnesses.

Methodology: A cross-sectional study was done to compare the neurocognitive functions of 50 schizophrenia and 50 bipolar affective disorder patients who attended psychiatry department of M.D.M Hospital, a tertiary care centre associated with Dr. S.N. Medical College, Jodhpur (Rajasthan). Schizophrenia patients with Positive and Negative Symptom Scale score > 60, Bipolar disorder I patients with Young’s Mania Rating Scale Score > 7 and Bipolar disorder II patients with Hamilton Depression Rating Scale score > 7 were included. The PGI Battery of Brain Dysfunction was administered on subjects fulfilling inclusion and exclusion criteria to assess neurocognitive functions in domains of memory, intelligence and perceptuo-motor organisation. Data collected was analysed using SPSS software. Appropriate tests were used to compare mean scores of both groups.

Results: Lower scores for memory, verbal and performance intelligence were found in Schizophrenic patients in comparison to bipolar disorder patients with statistical significant difference (p < 0.05). The score in domain of perceptuo-motor skills of schizophrenia patients was lower than that of bipolar disorder patients; however the difference was not found statistically significant.

Conclusion: The present paper concludes that cognitive deficits represent an important target for future intervention as these impairments carry a significant functional burden.

Keywords: Schizophrenia, Bipolar disorder, Neuro Cognition.

A Study of Thyroid Dysfunction among Patients with Psychiatric Disorders: A Hospital based Cross-Sectional study

Krutika Ainapur, Shriniwas B Chaudhari, Vinod Akkasali

Post Graduate Student, S Nijalingappa Medical College, Bagalkot, Karnataka. ainapur.kruthika@gmail.com

Background: Several studies have underlined the high prevalence of psychiatric symptoms and disorders in thyroid diseases. Thyroid dysfunction has a lot of implication for prognosis and treatment response of psychiatric disorders. But the studies detecting the prevalence of thyroid dysfunction in psychiatric disorders in the Indian population are limited.

Objectives: The objective of this study is to evaluate the prevalence of abnormal thyroid hormonal status in patients with Psychiatric disorders.

Materials and methods: A descriptive study comprising of 80 subjects above the age of 20 years attending psychiatry out-patient department, S N Medical College and HSK hospital, is being done over a period of 6 months, after taking institutional ethical committee clearance.The subjects will be included in the study after being diagnosed to be suffering from a psychiatric disorder by a consultant psychiatrist based on ICD -10 criteria, who will give consent for undergoing thyroid function tests. A semi-structured proforma will be used to obtain socio-demographic data like name, age, sex, socio-economic status, education, occupation, and their thyroid function tests are will obtained and evaluated. Data will be analysed using appropriate statistical tests.

Results: Are awaited.

Study of factors effecting poor drug compliance in patients at Government hospital for mental care,Visakhapatnam

T.Akhila, K.Sarada, S.Radha Rani,

post graduate, Andhra Medical College, Visakhapatnam, Andhra Pradesh. akhilatumu9@gmail.com

Background: The term non-compliance is commonly used in regard to patient who does not take precribed medication or follow prescribed course of treatment.Poor compliance is a major obstacle in treatment of psychiatric illnesses and one of the definite reasons for relapse.

Aim: This study aims at identifying the various factors contributing to poor drug compliance in patients attenting Government hospital for mental care.

Methodology: Eighty patients with poor drug compliance and of definite psychiatric illness were randomly selected in out-patient setting. The socio-demographic details and factors effecting poor drug compliance were assessed using respective questionnaires. The questionnaire for poor drug compliance is designed taking into consideration common reasons patients report in cases of relapse due to poor drug compliance including, financial difficulties, long distance from hospital, stigma, lack of insight, lack of awareness of long term medication, side effects, care giver related problems, no improvement in symptoms and others.

Results: The most common factor effecting poor drug compliance is ‘lack of awareness of long term medication’ followed by other factors like ‘lack of insight’ and ‘care giver related problems’.

Conclusion: Addressing these factors associated with poor drug compliance decreases relapse rate and treatment cost. It also improves patient satisfaction and overall quality of life.

Key words:- non-compliance, poor compliance, relapse, psychiatric illness, medication

Somatoform and Dissociative disorders: are they clinically distinct disorders?

Alakananda Dutt, Dipanwita Sil, Dalia Bose

Consultant, AMRI Mukundapur, Kolkata, Kolkata, West Bengal. alakadutt@yahoo.com

Background: A cross sectional study was undertaken to determine the differences in clinical characteristics of patients with ICD 10 classification of Dissociative (DD) and Somatoform (SD) disorders as medically unexplained symptoms pertaining to the neurological system and the rest of the body tend to show considerable overlap in clinical practice.

Methodology: Consenting patients aged 18-60years diagnosed with SD and/or DD by the Psychiatrist using the ICD 10 in an outpatient Psychiatry clinic of a multispecialty hospital were assessed using Patient Health Questionnaire-physical symptoms (PHQ-15), Patient Health Questionnaire -depression scale (PHQ-9), Generalised Anxiety Disorder (GAD -7), Somatoform Dissociation Questionnaire (SDQ -20), SF-12v2 Health Survey, Third Edition, Questionnaire for assessment of psychological features associated with somatic complaints and Presumptive Stressful life event scale (PSLES). Patients with SD, DD and comorbid disorder (SD+DD) were compared using Multivariate Analysis of Variance with Post hoc analysis (Bonferroni) for continuous variables and Chi square test for categorical variables.

Results: Out of a total of 100 patients, 60% were diagnosed with SD, 25% with DD and 15% with comorbid disorder. Patients with DD showed a significantly higher association with younger age and female sex as compared to SD. There were no significant differences between groups in severity of somatic, depressive and anxiety symptoms, self reported life events and quality of life. The somatoform dissociation scores increased from patients with SD to DD, becoming significantly higher in the comorbid group. Significantly greater number patients with SD voiced preference towards visiting doctors in case of physical complaints, need for medical reassurance, anxiety about health, excess time spent on thinking about bodily complaints as compared to those with DD and comorbid disorders.

Conclusions: Findings suggest that patients with SD are more preoccupied and concerned about physical symptoms than those with DD.

Awareness of late life neuropsychiatric illness among caregivers of dementia

Sk Altaf Hossien, Santosh Loganathan, Meena K S

Senior Resident, Central Institute of Psychiatry, Ranchi, Jharkhand. altafhossien@gmail.com

Background: The world’s population is aging. The major part of this growth is been seen in the Low And Middle Income Countries (LAMIC). So, late life neuropsychiatric illness will demand more and more attention to deal with their effect on quality of life and productivity of elderly persons who are suffering. The data on the perception and understanding of late life neuropsychiatric illness among the caregivers in LAMIC is very less. Here we have explored the awareness of late life neuropsychiatric illness among the caregivers of dementia.

Methodology: The study has been conducted in geriatric clinic service of National institute of mental health and neurosciences (NIMHANS). It’s a cross sectional qualitative study. We interviewed the caregivers of the elderly persons with dementia about their perception and understanding of late life neuropsychiatric illness using two vignettes.

Results: Respondent could identify symptoms of dementia more frequently than depression. Whereas Dementia was considered more of an illness arising from brain, symptoms of depression were thought to be because of psychosocial stressors. Most of the respondents perceive need of medical help for symptoms of dementia, on the other hand, good family support, improving coping skills, discussion with others etc are recommended to resolve symptoms of depression.

Conclusion: Dementia caregivers have a better understanding of dementia than depression like other late life neuropsychiatric illness in terms of their cause, clinical feature and help seeking. It is possible that accompanying their ill relative to a tertiary care centre through contacting multiple health care providers improved their knowledge of dementia. There is a need to improve awareness about late life neuropsychiatric illness in the community at large to change the perspective of common people towards late life illness. That will improve help seeking and lead to a good quality of life.

A cross sectional analysis of factors affecting professional help seeking behaviour in parents of children with mental health problems in a tertiary care centre in a municipal hospital in Mumbai

Ritwick Chatterjee, Aditya Chevle, Kalpana Pawar, Natasha Kate

PG student, Nair Hospital, Bhopal, Madhya Pradesh. alwaysritwick@gmail.com

Background: A substantial number of children in India have emotional, behavioral, and developmental problems that result in significant impairment of their physical and psychological development and functioning. Only about 20% of these children receive treatment.

Aims and Objectives: To assess the factors affecting help seeking behaviour, services availed and perceived barriers towards psychiatric services by parents of children suffering from psychiatric disorders.

Methodology: 120 parents were assessed using self reported Parental Attitudes Toward Psychological Services Inventory (PATPSI), they were then assessed by a clinician with the Child and Adolescents services assessment (CASA) and a case record form for basic demography.

Results: there was a lag of 1.6 years from first symptom to presentation to a psychiatrist. 58% were seeking help from general practitioners, 34% from educators and 38% from alternative practitioners. Barriers faced by parents and impact on them correlated.

Conclusions: There is a large unmet need for early treatment of childhood psychiatric disorders

Keywords: Childhood psychiatric services, Impact, Barriers, unmet need

Prevalence, Severity of Tobacco Use and Access to Tobacco Cessation among Psychiatric In-patients.

Amol Badekar, Prabhat Kumar Chand, Pratima Murthy, Priyamvada Sharma,

Senior Resident, Smt Kashibai Navle Medical College and General Hospital, Pune, Maharashtra. amolb_22@yahoo.co.in

Introduction: Tobacco use among psychiatric patients in developing countries has not been well-investigated. Also, most physicians miss the opportunity to advise their patients on the risks of continuing tobacco use and benefits of cessation. Additional data is needed to guide tobacco control efforts among men in this vulnerable population.

Aims and objectives: To study prevalence, severity of tobacco use and access to tobacco cessation among patients admitted to the psychiatric in-patient facility of NIMHANS.

Methodology: Patients admitted to NIMHANS in-patient psychiatric services satisfying inclusion and exclusion criteria were assessed for tobacco use. Patients were assessed on Tobacco Cessation Clinic Intake Form. FTND scale for nicotine dependence. Tobacco Craving Questionnaire Short Form (TCQ-SF) scale to assess craving. Readiness to quit was tested using Reasons For Quitting Questionnaire, RFQ. CGI scale to assess the severity of illness. Any tobacco cessation specific intervention was assessed based on 5A?s semi-structured questionnaire.

Results: 34% of psychiatric inpatients use tobacco products in at least one form. There was equal association between tobacco use in any form and two main psychiatric diagnostic groups, mood disorders (33.33%) and non-affective psychotic disorders (33.64%). Patients with severe mental illness had higher reporting of tobacco use (approx. 33%) compared to common mental disorders (25.58%). Comparison of access to tobacco cessation in users of different forms of tobacco revealed that only 50% of the smokers, 33.3% of smokeless tobacco users and 36.4 % users of both forms of tobacco were asked assessed and advised about tobacco use.

Conclusion: Tobacco use in both smoking and smokeless forms is high in patients with mental illness.

Keywords: Nicotine dependence; smoking; psychiatric patients; tobacco cessation; India

“Retrospective Study Of Children And Adolescents Diagnosed With Learning Disability, Attending Psychiatric Opd.”

Ananya Dhar, Smita Panse, Jyoti Jagtap, Malathesh BC, Manjeet Santre, Ivan Stanley Netto

RESIDENT, B.J.G.M.C & Sassoon General Hospital, Pune, Maharashtra. anadhar@gmail.com

Background/Introduction: Children and adolescents with Specific Learning Disability (SLD) are those who exhibit difficulties in academic skills of reading (dyslexia), writing (dysgraphia) and arithmetic (dyscalculia) out of proportion to their intellectual capacities. The fact that SLD has been included in Rights of Persons with Disability Act 2016 highlights the growing importance of SLD and its awareness in our population.

Methodology/Material and Methods: Retrospective study of case files of children and adolescents diagnosed with SLD (DSM-5 diagnostic criteria) attending psychiatric OPD from July 2014 to June 2016 was conducted, which included semi structured proforma for socio demographic and clinical details, diagnosis, NIMHANS index for specific learning disabilities and I.Q. test findings. Data thus collected was analysed using frequency statistics.

Results: The study sample consisted of 182 diagnosed cases of Specific Learning Disability in which 79.1% were male. In all 68.7% had dysgraphia, 73% had dyslexia and 67% had dyscalculia with overlap. Mean IQ score of the sample was 99.2 (SD - 10.2). Mean IQ of those having single SLD (IQ=101.7) was significantly more than those having mixed SLD (IQ=98.2) (t = , P = 0.042). Having all the three SLD positively correlated with family history of psychiatric illness (chi square=4.45, p=0.03) and history of developmental delay (chi square=4.2, p=0.03). ADHD was the most common comorbidity.

Conclusion: SLD has a considerable impact on development, education and future life of the individual. As per our study findings, children with mixed LD have lower IQ hence require more clinical attention. Hence there is need for early detection and diagnosis so that they can avail concessions.

Keywords: Specific learning disability; children; adolescents; intelligence quotient

“A study of emotional intelligence in first year MBBS students”

Ananya Dhar, Niteen Nagnath Abhivant, Japneet Ahluwalia, Manjeet Santre, Ivan Stanley Netto

RESIDENT, B.J.G.M.C & Sassoon General Hospital, Pune, Maharashtra. anadhar@gmail.com

Background/Introduction: Emotional intelligence plays an important role in learning. In medical students this assumes a greater role as it impacts both academic performance as well as in clinical interactions with patients.

Methodology/Materials and Methods: Sociodemographic details and medical entrance examination scores were obtained of students. The Schutte Self Report Emotional Intelligence Test scale was administered to find out their emotional intelligence. Data collected was pooled and statistical analysis was done.

Results: In our study comprising of 148 first MBBS students in which majority were male(58.4%), 70.1% were staying at hostel, 55.8% were urban and majority were Hindus(86.3%). Mean Emotional Quotient (EQ) score of whole sample was 122 while mean EQ in males and females was 124 and 120.9 respectively. EQ score showed significant negative correlation (p=0.04) with medical entrance test score.

Conclusion: We found negative correlation between EQ score and medical entrance score. More studies need to be done on emotional intelligence in medical students

Keywords: emotional intelligence; medical students; medical entrance score

A Cross-Sectional Study of burden of care and quality of life(QOL) in the Caregivers of patients with Bipolar Affective Disorder(BPAD) versus Schizophrenia in a tertiary care hospital

Anant Agarwal, J.M. Wadhawan, Anita Mahajan, Arti Anand

PG student, Sir Ganga Ram Hospital, New Delhi, Delhi. anantagarwal155@gmail.com

Introduction: A Caregiver has the responsibility for meeting the physical and the psychological needs of patient with mental illness. Both patients and their caregivers suffer many adversities.

Objective: To assess and compare the burden of care and QOL in the caregivers of patients of Schizophrenia and BPAD and determine correlation of burden in caregivers with severity of illness.

Method: A one-year cross-sectional study was conducted (2016-2017). Caregivers of 50 consecutive outdoor patients each of BPAD and Schizophrenia as per ICD 10 criteria with minimum one-year duration of illness were included. Caregivers with co-morbid medical illness were excluded. The caregivers were evaluated using Burden Assessment Schedule(BAS) and WHO QOL Questionnaire Brief(WHOQOL-BREF) to determine the burden of care and QOL respectively. The severity of illness was assessed by Positive and Negative Syndrome Scale (PANSS) in Schizophrenia, and Hamilton depression rating scale (HAM-D) and Young’s mania rating scale (YMRS) in BPAD. Scores were analyzed using T-test and Pearson correlation coefficient.

Results: The caregivers were predominantly females (67%). Socio-demographic characteristics were comparable in both groups. 19 patients of Schizophrenia and 24 patients of BPAD were asymptomatic. The burden of care was significantly more in the caregivers of Schizophrenia (Mean= 74.36, SD= 15.46) compared to those of BPAD (Mean score= 68.08, SD= 19.70). Burden in caregivers of Schizophrenia showed significant positive correlation with severity of illness (p<0.00). QOL was poorer in caregivers of patients with schizophrenia (p<0.00), specifically in psychological health domain of the WHOQOL-BREF. QOL of the caregivers was negatively correlated with severity of illness of Schizophrenia (p<0.00) but not of BPAD.

Conclusion: Burden of care is significantly higher in caregivers of Schizophrenia as compared to those of BPAD. Caregivers of patients with Schizophrenia and BPAD have a poor quality of life. Caregivers should be routinely assessed for need of psychological interventions.

A study of Quality of Sleep in Psychiatric patients with significant clinical improvement

Siva Anoop Yella, M.Umashankar, M.Gireesh Kumar, B.Vijay Kumar, Divya. R

Post Graduate, Institute Of Mental Health, Hyderabad, Telangana. anoop180@gmail.com

Introduction:-Sleep disturbances have become a common co-morbid condition in psychiatric illnesses. Even after treating the immediate psychiatric symptoms ,some individuals have difficulties in sleep and their quality of sleep is altered which further effects functional disability and quality of life of the Patient. So there is a need to assess the Quality of Sleep in clinically improved psychiatric patients.

Methodology:- Clinical Global Impression–Global Improvement (CGI–I)Scale and Pittsburgh Sleep Quality index(PSQI) scale were used for the study.Patients attending Review outpatient department of Institute of Mental Health,Hyderabad were selected as subjects ,many of them being psychotic spectrum,mood disorder and alcohol dependence patients.Patients who scored <4 on CGI-I scale were taken as subjects and PSQI was calculated.Out of 70 population size,60 subjects meeting CGI-I score <4 were taken and PSQI for each subject was calculated.PSQI total</=5 indicates good sleep quality.PSQI total>/=5 indicates poor sleep quality. PSQI Mean ,Standard Deviation and Standard error mean were obtained. 95% confidence intervals were calculated. Statistical analysis using Pearson Co-relation test was done to find relation between sleep quality and medicine induced sleep.

Results:-PSQI total was </=5 in 28 patients.PSQI total was >/=5 in 32 patients.PSQI Mean was calculated to be 6.583333,Standard deviation(S.D)-3.70199976,Standard error (S.E)mean- 0.47792611.t-value-13.775,df=59,p-value less than 0.0001,which implies that test is clinically significant.95%CI-lower=5.6270054, upper=7.5396613.Pearson Co-relation Coefficient(PCC)for sleep quality and Medicine-induced sleep was found to be 0.586.

Conclusion: Out of 70 patients,60 patients scored <4 on CGI-I scale,28 patients are having good sleep quality and 32 patients are having poor sleep quality.PCC of 0.586 indicates strong positive co-relation between sleep quality and Medicine-induced sleep.Further research is needed to study co-morbid sleep disturbances in psychiatric illnesses.

Keywords: Quality of Sleep,Pittsburgh Sleep Quality Index,Clinical Global Impression-Global Improvement scale,Psychiatric patients.

Predictors of complicated withdrawal in persons with alcohol dependence syndrome

Anupama Kadajari, N. Prasanna Kumar, T.S.N. Raju, S. Radha Rani

Post graduate, Andhra Medical College, Visakhapatnam, Andhra Pradesh. anukadajari@gmail.com

Introduction: Alcohol withdrawal is a common condition in persons with alcohol dependence. The diagnosis and management of complicated withdrawal is important as it is associated with seizures and delirium tremens and also reported to have high mortality. Identification of risk factors contributing to the development of complicated withdrawal will help in preventive strategies and early management

Aim: To assess the risk factors for the development of complicated withdrawal in patients with alcohol dependence syndrome

Materials and Methods: The study subjects consists of 30 persons diagnosed with alcohol withdrawal seizures or delirium tremens and 30 persons with uncomplicated alcohol withdrawal. The sample is taken from outpatients and inpatients of Government Hospital for Mental Care, Visakhapatnam, Andhra Pradesh.

The subjects are assessed for sociodemographic profile, drinking characteristics, medical and psychiatric comorbidity.

Results, discussion and conclusion will be discussed during the conference.

Key Words: Alcohol dependence, risk factors, complicated withdrawal, uncomplicated withdrawal.

A profile of coping skills among patients with Polycystic Ovarian Syndrome

Yogesh Motwani, Kaustubh Mazumdar, Aditi Chaudhari, Pooja Mehta

Resident Doctor, Bhabha Atomic Research Centre Hospital, Mumbai, Maharashtra. anusivanna@gmail.com

Introduction: Coping skills adopted by patients suffering from chronic diseases such as Polycystic Ovarian Syndrome (PCOS) can impact the psychological well-being and health outcome. This however has not been adequately studied.

Aims and Objectives: 1. To study the type of coping skills used by the patients of PCOS. 2. To evaluate any difference in coping skills between patients with and without psychiatric co-morbidity. 3. To study any correlation with the coping skills and body-mass index.

Materials and Methods: 70 females in the reproductive age group (18-45 years) diagnosed with PCOS as per Rotterdams Criteria without any pre-existing psychiatric illness were clinically interviewed for presence of anxiety and depression. Their coping skills were assessed using Brief Cope Scale. The scores were compared using paired and unpaired t test and ANOVA and Spearman’s correlation coefficient test was used for correlations.

Results: The patients used both adaptive as well as maladaptive coping skills but the mean scores of the adaptive coping skills were higher than those of maladaptive coping. (t = 16.73 df = 69 p = 0.000). Problem focused coping was significantly higher than both emotional coping and dysfunctional coping. Homemakers had significantly lower scores on adaptive coping as compared to working women. Coping did not show any association with age, education marital status or fertility. There was no significant difference in the coping skills in patients with and without psychiatric morbidity. There was no significant correlation between coping and body-mass index.

Conclusion: Coping skills did not have a significant impact on the psychiatric morbidity or body-mass index among patient with PCOS.

Key words: PCOS, Coping skills, psychiatric morbidity, body-mass index.

Efficacy Of Adjunctive Cathodal Tdcs In Psychogenic Non-Epileptic Seizure In Children And Adolescents: A Randomized Double Blinded Sham Controlled Study

Anweshan Ghosh, Varun S. Mehta, S. K. Munda

Junior Resident, Central Institute of Psychiatry, Ranchi, Jharkhand. anweshan_quest@yahoo.com

Introduction: Psychogenic non-epileptic seizures (PNES) are a nonspecific, umbrella category that is used to collect together a range of atypical neurophysiological responses to emotional distress and physiological stressors and are currently classified as a dissociative [conversion] disorder, according to the Diagnostic Criteria for Research (DCR) of International Classification of Diseases - tenth edition (ICD-10) and as a conversion disorder according to Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). Transcranial direct current stimulation (tDCS) is a mode of neuromodulation based on the principle of delivering low intensity direct current to cortical areas either facilitating or inhibiting spontaneous neuronal activity. The present study examined response to cathodal tDCS applied at supplementary motor area in children and adolescents with PNES and aimed to establish whether tDCS was viable or not as a treatment option in the aforementioned population.

Methods: Ten children and adolescents of either sex between 8 to 17 years of age with diagnosis of dissociative [conversion] disorders as per ICD-10 will be recruited from the child guidance clinic of the institute after obtaining consent from parents and obtaining permission from the ethics Committee. The subjects will be randomly divided into two equal groups to receive active or sham treatment. All patients will be rated for psychopathology by an independent rater blind to the procedure using Psychogenic Non-epileptic Seizure scale (Cianci et al, 2011), Adolescent Dissociative Experiences Scale-II (A-DES) (Bernstein and Putnam, 1986), Children’s Depression Inventory 2 (CDI 2) (Kovacs, 1992), Hamilton Anxiety Scale (HAM-A) (Hamilton, 1959) and Clinical Global Impression – Severity of illness (CGI-S) (Guy, 1976) at baseline (within 24 hours before the first session of tDCS). Following this the patient would be given cathodal tDCS over the supplementary motor area once a day for 5 days a week for 2 consecutive weeks (a total of 10 sessions over 2 weeks) and scales would be readministered at 1 week (i.e after 5 sessions), at 2 weeks (i.e after 10 sessions), at 3 weeks (i.e 1 week after last session) and at 6 weeks (i.e 4 weeks after last session). Check list for side-effects of tDCS (Eryilmaz et al, 2014) will be applied after every session of tDCS. The results obtained will be analyzed by using the Statistical Package for Social Sciences-version 22.0 (SPSS-22.0) with different parametric and nonparametric measures being used, wherever applicable.

Results and Discussion: They would be discussed at the time of presentation.

Key words: Tdcs, Psychogenic non-epileptic seizures.

A Study Of Stigma Towards Depression And Its Correlation With Adherence To Antidepressants

Apoorva Upadhyay, Geeta Soohinda, Divyasree, Sanjiba Dutta

P G Trainee, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim. apoorvaupadhyay09@gmail.com

Introduction: Depression is a common treatable disorder, which continues to remain under detected in the primary care settings. Studies indicate that lifetime prevalence of all depressive disorders taken together is over 20%, that is one in five individuals. If current trends continue, it will become the leading cause of disease burden by the year 2030. In our society, stigma towards mental illness plays a major role in utilization of mental health services. The aim of this study is to test the level of stigma towards depression and its correlation with adherence towards antidepressants.

Materials and Methods: This is a hospital based follow up study. A total of 105 patients (Male- 41, Female- 64) suffering from moderate to severe depression who consented for the study were selected. They were followed up for next three months. Stigma towards depression was assessed by Depression stigma scale and adherence was assessed by Morisky Medication Adherence Scale. Mann Whitney U test was used to find association between stigma and adherence.

Mini tab17 software was used for statistical analysis.

Results: The mean age of study sample was 39.52 years. Mean MADRS score was 31.286(SD-5.619, CI- 30.198-32.373). Stigma [Mean personal stigma score-19.048 (SD- 6.724, CI- 17.746-20.349) and Mean perceived stigma score-26.238 (SD-6.249, CI-25.029-27.447)] towards depression was found to be strongly associated with high non-adherence rate for antidepressants.

Conclusion: One of the most important factors associated with adherence is stigma. Patients are concerned about the prejudices of those around them and often deny their disorders and delay seeking or starting adequate psychiatric care. For reducing the morbidity and burden of depression it is important to address stigma towards depression.

Keywords- Depression, Stigma, Mental health services

Metacognition in Obsessive Compulsive Disorder and Depression

M.Selvakumar, Selvamani.D, K. Ramakrishnan,

Medical Director, Appa Mental Health Facility, Tiruvannamalai, Tamilandu. appahospital@gmail.com

Background: Although Metacognition is a great leap from cognitive research in terms of phenomenology, not many studies have approached metacognition as an independent construct with metacognitive beliefs and regulatory components in comparing the Obsessions and Depressive ruminations.

Methodology: All consecutive patients of Obsessive compulsive disorder and Depression at our referral psychiatric hospital were recruited in a cross sectional comparative study by purposive sampling techniques including measures of general psychopathology, Metacognition, level of insight, and anxiety using appropriate scales.

Results: The analysis of 40 patients of Obsessive compulsive disorder and 40 patients of Depression revealed heightened Metacognitive beliefs in Both groups with no difference between the groups but Metacognitive regulation revealed greater regulatory dysfunction in the Obsessive compulsive group than Depression. Further along its subcomponents, the Need for control (NC) scored higher (uphill) in OCD group than Depression revealing greater dysfunction in OCD, While Cognitive self consciousness (CSC) Scored lower in Depression group (downhill) than OCD revealing Greater dysfunction in Depression.

Conclusion: Overall findings reveal greater implications in understanding the phenomenology of OCD and Depression which may aid in the assessment of psychopathology and diagnostic Clarification. Also it gives greater insight in to the planning of cognitive and metacognitive strategies aiming at modifying the dysfunctional Meta-regulatory process underlying OCD and Depression.

Key Words: Metacognition, Obsessions, depressive ruminations

RDD VS BPD, A Diagnostic Enigma

Nabanita Roy

2nd Year Dpm Resident, Institute Of Psychiatry, Kolkata, West Bengal. aritra_mukherji@yahoo.co.in

Presentation: A 37 yrs old Hindu married female presented with episodic low mood, anhedonia, insomnia since 2009(3 episodes so far) with median duration of 1 year; a/w incomplete inter-episode recovery characterized by sub-syndromal level of depression. Current episode lasting for 1.5 yr is a/w dissociative episodes. Parent episode started within 6 months postpartum. F/H suggestive of MDD in sibling. Premorbid personality pointed towards emotionally unstable type i.e. impulsivity, fear of rejection, emotional lability, deliberate self harm, indecisiveness, multiple affairs etc.

Examination: MSE revealed reduced psychomotor activity, delayed reaction time, depressed affect, and depressive cognition congruent to mood.

Treatment: Patient was admitted to IOP and subsequently said interventions done.

Pharmacotherapy: Patient was started with tab Escitalopram 10mg for depression and escalated to 20 mg over the next 2 weeks. Tab Quitiapine 100 mg was given considering chance of bipolarity due to its association with postpartum state. Tab Lorazepam was given as sedative. To counteract the residual symptoms Bupropion SR 150 mg was added after 3 weeks.

Psychotherapy: Patient was sent for diagnostic psychometry which revealed presence of cluster-b type of personality disorder. Targeted intervention was initiated in the form of DBT.

Follow Up: Patient was gradually improving with significant improvement of HAM-D score over 4 weeks. She was discharged afterwards with compliance training. Currently she is doing well with regular follow up.

Conclusion: Borderline personality disorder frequently coexists with other psychiatric illness; RDD is not an exception. But it complicates the clinical picture; which often mimics like BPAD. Also in this scenario, presence of post natal depression further indicates towards bipolarity; in which case addition of conventional mood stabilizer is justifiable. Early diagnosis, high degree of clinical suspicion, judicial antidepressant use under cover of mood stabilizer and early psychological intervention are prerequisite for recovery.

A Cross-Sectional Study Of Symptomatology, Quality Of Life , Sexual Dysfunction In Major Depressive Disorder In A Tertiary Care Center , Kolkata

Arnab Pathak, Md Haque Sabir Hannan, Rajarshi Neogi, Sayanti Ghosh, Uday Shankar Mondal, Ranjan Das, Taniya Kundu

Post graduate, R G Kar Medical College, Kolkata, West Bengal. arnab.pathak@gmail.com

Depressive disorders significantly impair functioning in a number of areas, including work functioning, social functioning, and health. Quality of life among depressed adults is more impaired than that of adults with diabetes, hypertension, and chronic lung disease. Adequate sexual expression is an essential part of human relationships, and may enhance quality of life. Epidemiological and clinical studies show that depression and anxiety is associated with impairments of sexual function and satisfaction.

Objective: To find the correlation between depressive symptomatology with quality of life and sexual functions in drug naïve Major Depressive Disorder patients.

Methods and Material: This study is a cross-sectional, single interview study in a tertiary care centre with a sample size of 95. Consecutive patients selected randomly aged between 18yrs to 60yrs, who are sexually active attending Psychiatry OPD, R G Kar Medical College, diagnosed as MDD with MINI 6.0 with no previous or current other axis I or II psychiatric illness, no h/o sexual dysfunction prior to depressive episode, no local genital morbidities, no other significant medical or surgical illness and giving informed consent were included in this study. A detailed history with demographic profile and physical examination is done, consultation liaison (when required), and laboratory investigations (where indicated) are performed to rule out any physical comorbidity. All the subjects diagnosed with depression were rated with BDI and BAI and are given CESD-R for depressive symptomatology. Sexual experience are assessed by Arizona Sexual Experience Scale (ASEX), the patients are evaluated by WHOQOL –BREF for quality of life. All data will be analysed by appropriate statistical methods.

Results: To be given after data collection is complete.

Conclusion: Yet to be concluded.

A study of depression and anxiety in patients with dissociative disorders in Barak valley region of Assam, India

Arnab Bhattacharya, Soumitra Ghosh, Sudeshna Das, Samir Kumar Praharaj

Specialist (Psychiatry), Tata Motors Hospital, Jamshedpur, Jharkhand. arnab2013@gmail.com

Dissociation comprises a partial or complete loss of the normal integration of the memories of the past, awareness of identity, immediate sensations and control of body movements. The present study explores depression and anxiety in patients suffering from dissociative disorders. The venue of the study was Barak Valley region of Assam and the study was conducted in Psychiatry Department of Silchar Medical College, which is a premier teaching and referral institute located in North-Eastern India. It was a cross sectional study based on a single assessment of the participants using purposive sampling. The participants of the study were 100 patients, of both sexes, aged above 18 years, having a diagnosis of a Dissociative disorder as per ICD 10 (WHO, 1992). Tools used for the study were a Proforma for socio-demographic and clinical data, Hospital Anxiety and Depression Scale (HADS), Hamilton Depression Rating Scale (HAM D) and Hamilton Anxiety Rating Scale (HAM A). Descriptive statistics were used to describe the sample in terms of socio demographic and clinical characteristics. Mann Whitney U test was used to study the relation between age and depression / anxiety and Chi square test was done to compare between the different variables under study. Findings indicate an increasing level of anxiety and depression with decreasing age of patients. Also, lower middle socio economic strata had significantly more subjects with depression with both HAMD and HADS D. The lower middle socio economic group had significantly more subjects with anxiety when assessed with HAM A and the middle socioeconomic strata had significantly more subjects with anxiety when HADS A measures were considered.

Key words: Dissociative disorder, anxiety, depression

Obsessive Compulsive Symptoms in Migraine with aura and without aura - A Comparison Study

Arpit Koolwal, G. D. Koolwal

Senior Resident, Dr. S. N. Medical College, Jodhpur, Rajasthan. arpitkoolwal1989@gmail.com

Introduction - Psychiatric symptoms, such as anxiety, depression and obsessive compulsive symptoms, are seen more in migraine patients than general population with some research suggesting higher comorbidity in migraine with aura than migraine without aura. Establishing these symptoms is important in terms of successful management. The aim of our study is to compare the levels of obsessive-compulsive symptoms between migraine with aura and migraine without aura and to detect the relationship of the levels of these disorders with duration of disease and frequency of the attacks.

Materials and Methods - In this study we aimed to study the presence of obsessive-compulsive symptoms in a sample of 30 migraine with aura patients and compare it with 30 well matched migraine without aura patients. Migraine diagnosis was made by psychiatrist trained in treating headaches and OC symptoms were evaluated by means of the Yale-Brown Obsessive Compulsive Screening Scale. 30 patients were diagnosed as per new international classification of headache disorders (ICHD-III) criteria and were selected as per inclusion and exclusion criteria after well informed written consent.

Results - Our study is currently underway and the results will be presented at the time of presentation.

Keywords: migraine with aura, migraine without aura, obsessive compulsive disorder

Evolution of Concept of Delirious Mania- A Case Report and Review of Literature

Ashay Vivek Telang, Abhilash Balakrishnan, Sundarnag Ganjekar, Geetha Desai, S.K. Chaturvedi

Pg Student, Nimhans, Banagalore -29, Karnataka. ashaytelang@gmail.com

Introduction: Delirious mania (DM) or Bell’s mania is a potentially life threatening neuropsychiatric condition in which symptoms of both mania and delirium co-exist. Though it was first described in 1800s, it has received less attention in psychiatric literature. The available literature is mainly in the form of case reports and case series. Delirious mania is often undiagnosed and has high morbidity and mortality. Here we attempt to describe the conceptual understanding of Bell’s mania and how this entity has been understood over centuries in literature along with our experience of encountering one case and the real time challenges we faced.

Method: A Case Report

Results/History: A 25year old male, from rural Bellary belonging to lower socioeconomic status with no significant family, past or personal history presented to psychiatric emergency ward at NIMHANS with sudden onset illness characterised by irrelevant talk, abnormal behaviour, fluctuating orientation, decreased attention, decreased sleep and bowel and bladder incontinence along with manic symptoms of irritability, overfamiliarity, increased psychomotor activity, dramatic talk. On examination patient had fever, tachycardia and multiple pustules over both legs with local rise of temperature and multiple abrasions over the body. All lab investigations were within normal limits except for mild leucocytosis. He was treated with high dose benzodiazepines (lorazepam 6mg/day) and risperidone (6mg/day) and valproate (500mg/day). The symptoms fluctuated and he was discharged after 2 months of IP care.

Conclusion

Delirious mania can be a potentially life threatening condition. This condition currently has no diagnostic status in classificatory systems, ICD10 or DSM5. Clinicians need to be aware of this entity as it needs high clinical suspicion to diagnose and treat at the earliest to minimise morbidity and mortality associated with the condition.

Key words: delirium, mania, delirious mania, Bell’s mania.

Prevalence and sociodemographic risk factors associated with different psychoactive substance use in psychiatric outpatients of a tertiary hospital in North India

Ashish Narvariya, Anubhuti Singh, Ravi C Sharma, Dinesh Dutt Sharma

PG student, Indira Gandhi Medical College, Shimla, Himachal Pradesh. ashishnarvariya65@gmail.com

Introduction: Prevalence and socio-demographic risk factors associated with different psychoactive substance use in psychiatric out-patients of a tertiary care hospital in north India.

Material and Methods: Retrospective evaluation of case registries of 670 substance dependence patients of all age group registering first time for treatment in the Drug Deaddiction and Treatment Centre (DDTC), I.G.M.C, Shimla from January to December 2016 was done. Statistical analysis was done using SPSS 20.

Results: Majority were males (n = 652, 97.3%). Most common substance using age group was 31-40 yrs (31.6%). Among all the substance users 43.9% were educated upto 10th or 12th standard. Substances most commonly used were tobacco (n=512,76.4%), alcohol (n= 495, 73.9%), cannabis (n= 201, 30%), opium (n= 89, 13.3%), volatile solvents (n= 34, 5.1%), and sedatives and hypnotics (n=27, 4%). 5.8% of them were currently injecting drug users and had high risk behaviors like sharing syringes and contact with commercial sex workers. 9.4% of the subjects had undergone screening for human immunodeficiency virus (HIV) and one-tenth were positive. Bipolar disorder was reported in (n=41, 6.11%), followed by Schizophrenia in (n=39, 5.8%) Depression in (n=19, 2.8%), and Somatoform disorders in (n=19, 2.8%) among all subjects. Hypertension was noted in 12.1% of the subjects and Alcoholic liver disease was diagnosed in 4.32%. 26.3% subjects had a history of previous treatment and 11.6% were prior hospitalized for deaddiction.

Conclusion: The findings of the current study suggest that the pattern and parameters associated with psychoactive substance use among those presenting to a tertiary care DDTC, needs to be prioritised within services for at-risk people in the community.

Key words: Deaddiction, Psychoactive substance use, Substance user

Prevalence of Sleep disorders in patients with Chronic Kidney Disease on Hemodialysis in a General hospital setup

Ashwini Padmashali, Girishbabu N, Abhay Matkar, Ashwini Padmashali

Senior Resident, Sdmcmsh, Dharwad, Karnataka. ashwinihp201989@gmail.com

Aims and Objectives: To determine the prevalence of sleep disorders in patients with chronic kidney disease (CKD) on hemodialysis in a general hospital setup.

Materials and Methods: It is a cross sectional study, done on the patients who presented to nephrology department of SDMCMSH, Dharwad. The patients with CKD stage 3 and above were included in this study. 105 patients of CKD on maintenance hemodialysis were interviewed for the purpose of this study. The following scales were applied – Epworth sleepiness scale (ESS) and Pittsburg sleep quality index (PSQI) to evaluate the sleep disturbance.

Results: Statistical analysis was done using Independent sample t test and chi square test.64.8% of the patients got adequate sleep and 35.3% patients had complains of reduced sleep on Epworth Sleepiness Scale. The quality of sleep assessed using Pittsburg Sleep Quality Index showed that 27.6 % of the patients had good quality sleep and 72.4% had poor sleep quality.

Discussion and Conclusions: There is high prevalence of co-morbid sleep disturbance in patients with CKD on dialysis.

It is important to screen all patients of chronic kidney disease for sleep disturbance which could help in improving the compliance towards medications and there by improve the quality of life.

Key Words: Chronic Kidney Disease, hemodialysis, compliance

“A study of symptomatic remission and its association with nicotine dependence and degree of disability in patients of Schizophrenia.”

Bhagyashree Garasia, Sushil Kherada, Nitin Aggarwal, Lalchand Bairwa, Amrit Ku. Gausai, , Sunil Sharma

Senior Resident, R.N.T. Medical College, Udaipur, Rajasthan. bhagyashree10garasia5@gmail.com

Introduction: Schizophrenia is a typically disabling disease that impact negatively on the academic, occupational, social and family functioning of the patients and become considerable cause of illness related disability. This study aimed to examine the association between remission; tobacco dependence and degree of disability in schizophrenic patients.

Methodology: A total of 318 consecutive patients of >2 years illness were recruited at psychiatry department of a tertiary care hospital. Socio-demographic,Clinical data sheet, Positive and Negative Syndrome Scale[PANSS] were applied. Remission criteria for schizophrenia by the Remission in Schizophrenia Working Group (RSWGcr),Fagerström Test for Nicotine Dependence (FTND),Indian Disability Evaluation Assessment Scale(IDEAS) were administered to assess symptomatic remission, dependence for Tobacco and degree of disability respectively.

Results: Present study showed that symptomatic remission seen in 70.8% (225) while 29.2% (93) were in non remission. Non-remission phase of schizophrenia significantly associated with high nicotine dependence including both form of tobacco use (smokers 45.40% and chewers 49%, P Value= 0.001). Besides that non-remission phase also significantly associated with high degree of disability. Greater number of non-remitted schizophrenic had moderate disability 64.5% (60) while remitted had mild disability 70.2% (158)(P= 0.000). Significantly higher PANSS score found in non-remitted than compared to remitted patients [PANSS-P 31.98(6.3) > 17.36(6.19), PANSS-N 24.37(4.2)> 17.70(4.16), PANSS-G 47.82(8.3)> 32.96(7.12) PANSS-T 104.47(15.0)> 68.08(14.53)(P=0.000)].

Conclusion: Schizophrenia is a heterogeneous disorder; it needed distinct extent of interventions for each patients. Psychosocial-intervention is needed additionally with pharmcological treatment in promoting independence, decreasing disability and enhancing quality of life in person with schizophrenia.

Keywords: Remission ,Disability,Tobacco-dependence

To study predictors for delirium tremens in patients of alcohol withdrawal syndrome

Bhavneet K Ahuja, Sanjay Jain, Vijay Choudhary

PG student, SMS Medical college and hospital jaipur, Jaipur City, Rajasthan. bhavneet.kaur39@gmail.com

Background- Alcohol Withdrawal Syndrome (AWS) is a major reason for both general inpatient and ICU admission and also complicates the hospital course of patients admitted for other reasons. The reported numbers of patients who undergo a complicated course of alcohol withdrawal vary between 5 and 20% and are dependent on several factors but it is generally accepted that withdrawal seizure (WS) or delirium tremens (DT) do occur in the range of 6–15 and 4–15%, respectively

Objective – To study predictors for delirium tremens in patients of alcohol withdrawal syndrome(AWS)

Methodology – 100 patients were taken who presented in the deaddiction ward in alcohol withdrawal state. Comprehensive assessment of alcohol use with relevant blood investigations like serum GGT, sodium, potassium, creatinine and platelet count with ethanol concentration in blood ,pulse rate and blood pressure at the time of admission were done with revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale CIWA-Ar score for severity of alcohol withdrawal syndrome were applied. Patients were observed for delirum tremens after giving standard treatment regime. The patients were divided into 2 groups one with delirium tremens and other without.

Results and Conclusion – We found significantly higher values of γGT in DT + vs. DT− patients. Rest of the result will be discussed at the time of presentation during the conference.

Key Words – Alcohol withdrawal syndrome, withdrawal seizures

Depression And Quality Of Life Among Retired Citizens

Ravi Kumar Dabbiru, Sindhuri Potluri, Sireesha S

Junior resident, Institute of mental health,Erragadda, HYDERABAD, Telangana. blitzkriegdir@gmail.com

Introduction: In Indian elderly population has increased enormously in the past 10-20yrs. The share of Indian population aging 60yrs or more has been projected to increase from 8% in 2010 to 19% in 2015. Employment is not a mere source of income, it is an important entity in personal identity construction. Even more in Indian context. Retirement is both an event and state of being, it has many consequences on different aspects of life such as finance, time, relations and also on physical and mental health. These changes are likely to affect the wellbeing of the retired person in innumerable ways.

The transition from being employed to retired is taken in a positive manner by most of the individuals but for a few it affects significantly leading to anxiety, depression, irritability and general dissatisfaction resulting in a reduction in quality of life. Prevalence of depression even though less among elderly has serious consequences. My study is done to assess the prevalence of depression and quality of life among retired citizens.

Methodology: This is a cross sectional study.

Inclusion Criteria:

  1. Those who retired from various public sector and govt. institutions and >58yrs
  2. 1-5yrs of Post retirement.
  3. Those who consented for the study.


Exclusion Criteria:

  1. Those who have serious medical problems.
  2. Those who didn’t consent for the study.


Tools Used:

  1. A Semi Structured Intake Proforma
  2. Geriatric Depression Scale (GDS)
  3. WHO QUALITY OF LIFE –OLD


SAMPLING TECHNIQUE: - convenience sampling, 100 subjects will be interviewed.

PLACE OF STUDY: - Urban (Hyderabad) community

STATISTICAL ANALYSIS: - using SPSS software

Results and Conclusion: - will be discussed at the time of presentation as we have not analyzed the data

Keywords: Depression,retired,quality of life,

A study on the attitude of undergraduate medical students towards Psychiatry”

Chaitanya Lata Singh, Prerna Balkrishen Khar, Niteen Nagnath Abhivant, Alka V Pawar

Resident, BJGMC, Pune, Pune, Maharashtra. chaitanya.singh.1989@gmail.com

Background/Introduction- Attitude towards psychiatry and to mental illness among medical undergraduate are key factors in determining the choice of psychiatry as a career and thus affecting the service provided In the field of psychiatry.

Methodology/ Materials and Methods: The study was conducted on first year medical undergraduate students of a medical college attached to a tertiary care centre. Students were given information about the nature and purpose of the study. Socio-demographic details of students were collected. Attitude Towards Psychiatry (ATP 30) questionnaire was administered. The results were tabulated and statistical analysis was done.

Results: A total of 142 students participated in study. Out of which 64 were females and 78 were males. 95% belonged to Hindu religion. Mean ATP score of total students was 84.90. Mean ATP score of females was 85.95 and males was 85.17. There was no significant association between ATP score and age, sex, religion, residence or socioeconomic status of students.

Conclusion- Overall students have negative attitude towards Psychiatry. Measures should be taken to improve it.

Keywords- attitude towards psychiatry, undergraduate students.

A Study Of Psychiatric Comorbidity And Coping In Patients Of Alcohol Dependence Syndrome During Their Abstinence

Challuri Prashanth, Bandela Sowmya Grace

post graduate, institute of mental health, Hyderabad, Telangana. challuri.prashanth@gmail.com

Background: Alcohol dependence has often been described as a chronic relapsing illness where continued care and support is needed. Psychiatric disorders occur in greater prevalence in these patients as compared to the general population.Various studies have found that relapse rates for addiction are alarmingly high. Hence identification of psychiatric co-morbidities and different coping mechanism is important to prevent further relapse.

Aim : To study the psychiatric co-morbidity and coping in patients of alcohol dependence syndrome during their abstinence.

Objectives:

  1. To determine the prevalence and type of psychiatric co-morbidity in alcohol dependent patients during their abstinence.
  2. To identify different coping mechanisms used by alcohol dependent patients to prevent relapse.


Methodology: A sample of 100 Alcohol Dependence Syndrome patients who are abstinent atleast for one month are taken. Semi structured proforma for socio demographic details , Mini International Neuropsychiatric Interview (MINI Plus) for evaluation of psychiatric co-morbidities and coping check list to assess individual coping styles during stressful situations will be used and data is analysed using SPSS.

Results: Will be discussed later

Conclusions: Will be discussed later

Keywords: Alcohol Dependence Syndrome , Psychiatric Co-morbidities, Coping, Abstinence

A Study Of Quality Of Life In Patient On Treatment For Vitiligo

Indukumar A, Manju Aswath, Lakshmi V.Pandit

Post Graduate, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka. changnimhans@gmail.com

Vitiligo is an acquired, multi-factorial and usually progressive disorder of melanin production. Typically asymptomatic it substantially affects the psychological wellbeing of patient due to the burden associated with the visibility of vitiligo and its consequent impact on interactions with others.

A theoretical model of quality of life as ‘the good life’ is defined as psychological well-being, perceived quality of life, behavioural competence and the ‘objective’ environment. Disease-specific quality of life scales are needed not simply for greater brevity, but to ensure sensitivity to sometimes small, but clinically significant, changes in health status and levels of disease severity.

Methodology: After institutional ethical clearance for the study, Patients seeking treatment for Vitiligo in the department of Dermatology, KIMS, Bangalore, were chosen for the study. Informed written consent was taken from patients satisfying pre formulated inclusion and exclusion criteria. Quality of Life was assessed using Vitiligo Impact scale after classifying the type of vitiligo.

Results: 101 patients were evaluated, Acro facial type (80.1%) of vitiligo was the most common subtype. Overall majority of patients (n=92) had small to moderate effect on quality of life based on VIS scores. Duration of illness in patients were categorised and compared with respective VIS mean scores i.e< 5 years duration (n=56) ,5yr-10yr(n=17) more than 10yr(n=28)were found to be statistically significant. Female Gender had statistically significant higher scores (P=0.001)..Significance were also extrapolated in subdomain scores in emotional , social avoidance domain but was not found significant in treatment and stigma domains.

Conclusions: Psychological disturbances noted more commonly when the duration of illness is less especially in females. Safety and concealing behaviours are more likely to be adopted in view of emotional factors affecting the environment. In the absence of cure, relevant supportive group-based consultations and counselling of nature of illness should also become important arms of treatment along with repigmentation strategies.

Keywords: Vitiligo, Quality of life, Safety and concealing behaviours

Intracranial Space Occupying Lesion presenting as catatonia in a patient of affective disorder with history of recurrent catatonic episodes: A case report

Arnab Datta, B. Das, Nirmalya Mukherjee

Junior Resident, Central Institute of Psychiatry, Ranchi, Jharkhand. dattacorrespondence@gmail.com

Abstract: Intracranial Space Occupying Lesions(ICSOLs) like hematomas, neoplasms, granulomas or brain abscesses can present with diverse neuropsychiatric manifestations. Subtle cognitive deficits, anxiety, affective symptoms - especially depression, personality changes and schizophrenic psychosis, most commonly hallucinations, but rarely of paranoid nature too has been associated with organic etiology. Catatonia has seen a paradigmatic shift in its etiological basis and space occupying lesion is a rare yet important cause to be investigated for, as it poses a challenge in terms of searching for early clinical indicators of organic etiology and difference in treatment outcome. Here we present a case of catatonia due to ICSOL in a patient of affective disorder with history of recurrent catatonic episodes, highlighting the importance of approaching each catatonic presentation as a syndrome with diverse possible etiology.

Keywords: Intracranial Space Occupying Lesion, catatonia, affective disorder

Facial Emotion Recognition Deficits In Schizophrenia: A Case Control Study

Devasheesh sharma, savinder singh, ishat kalra, sachdeep kaur

PG resident, Institute of mental health, Amritsar, Punjab. devash1991@gmail.com

Introduction: The face is a visible signal of the human intentions and motivations. Facial expression is a critical variable in social interaction. Diverse information can be extracted about an individual from a single glance at their face, including their identity, their emotional state, and their direction of attention.

Purpose: To study emotion recognition deficits in drug naive schizophrenia patients in comparison to normal controls. To identify any specific emotion recognition deficits and to correlate emotion recognition deficits with psychopathology.

Study design: Case control study. Methodology: 30 cases of drug naive schizophrenia who fulfilled the inclusion criteria were recruited in study. They were assessed on study proforma, emotion recognition tool (TRENDS), positive symptom (SAPS) and negative symptom (SANS) domains. Age and sex matched controls were also assessed on TRENDS.

Results: Scores on Emotion recognition task were lower and mean error scores were higher in cases significantly (p<0.0001) in comparison to controls. There was significant mislabeling of Fear (p<0.001), Sadness (p=0.001) and Anger (p<0.005) in patient group. Females scored high on recognizing non threatful emotion i.e., happy/sad/ neutral (p=0.012) and even misidentified anger /fear as non threatful stimuli (under identification errors p=0.022).Males were more likely to identify even non threatful stimuli as threat i.e., fear/anger(over identification errors p=0.004).The individual emotions which were significantly misidentified were fear (p<0.001),sadness (p=0.001) and anger (p=0.002). Significant negative correlation was found between negative symptom score and identification of threatful stimuli.

(r= -0.373 , p < 0.05).

Conclusion: Drug naive schizophrenia patients have significant emotion recognition deficits in comparison to normal population. These deficits were specifically demonstrated in identification of fear, sadness and anger. Females were better in identifying happy/sad/neutral emotions whereas males were more likely to mislabel them as fear/anger. Significant negative correlation between negative symptoms and threat identification was also found indicating that people with more negative symptoms would have significant emotion recognition deficits, which influences other social cognitive domains and functional outcome in schizophrenia.

Keywords: Facial emotion, schizophrenia

A Study Of Magnitude And Psychological Correlates Of Smartphone Use In Medical Students: A Pilot Study From India With A Novel Telemetric Approach

Devavrat Harsh, Prasad Shabiullah Syed

Assistant Professor in Psychiatry, Dr D Y Patil Medical College, Kolhapur, Maharashtra. devavrat.harshe@gmail.com

Context: Smartphone use is being investigated as a potential behavioral addiction. Most of the studies opt for a subjective questionnaire based method. This study evaluates psychological correlates of excessive smartphone use using an objective, telemetric approach.

Methods: 140 consecutive consenting undergraduate and post-graduate students using an android smartphone at a tertiary care teaching hospital were recruited by serial sampling.

They were pre-tested with the Big Five inventory, Levenson’s locus of control scale, ego resiliency scale, perceived stress scale and materialism values scale. Participant’s smartphones were installed with tracker apps, which kept track of total smartphone usage and time spent on individual apps, number of lock-unlock cycles and total screen time. Data from tracker apps were recorded after 7 days.

Results: Smartphone addiction criteria were fulfilled by 36% of participants. Smartphone addiction scale score significantly predicted time spent on smartphone in 7-day period (ß = 0.234, t=2.086, P =0.039). Predictors for time spent on social networking sites were ego resiliency (ß = 0.256, t=2.278, P=0.008), conscientiousness (ß = -0.220, t=-2.307, P=0.023), neuroticism (ß = -0.196, t=-2.037, P=0.044) and openness (ß = -0.225, t=-2.349, P=0.020).

Time spent gaming was predicted by success domain of materialism (ß = 0.265, t=2.723,

P=0.007) and shopping by ego resiliency and happiness domain of materialism.

Conclusions: Telemetric approach is a sound, objective method for evaluating smartphone use.

Psychological factors predict overall smartphone usage as well as usage on individual apps.

Smartphone addiction scale scores correlate to and predict overall smartphone usage.

Keywords: Smartphone, excessive use, telemetry, psychological, predictors

Psychosocial Disability in Migraine and Tension Type Headache: A cross sectional study.

Dhaval J Patel, Dimple Dadarwala, Ritambhara Mehta

2nd Year Resident In Psychiatry Department, Government Medical College, Surat, Gujarat. dhaval_patelx3@rediffmail.com

Introduction: Chronic headaches like migraine and tension type headache (TTH) are most commonly encountered complaints. Most of these patients report their ability to function and feeling of well-being as severely impaired. But there is paucity of studies on the disability in patients with headache especially tension type headache in India. With this background, this study was conducted with the aim to assess and compare disability, Quality of Life impairment and psychopathology in Migraine and Tension Type Headache.

Methodology: This was a cross sectional study. All the patients with presenting complaint of headache to General Hospital Psychiatry OPD of an urban city were recruited within one month. Patients with migraine and tension type headache in the age group of 18-50 years of either sex were included. Patients having secondary causes of headache like history of psychiatric illness, trauma, systemic infections, diabetes, hypertension and presence of neurological abnormalities were excluded by screening. These recruited patients were assessed using semi-structured proforma to collect socio-demographic data and headache related details. International Classification of Headache Disorder-III (ICHD-III) criteria were used to diagnose type of headache. Disability, Quality of Life and Psychopathology were assessed using Headache Disability Index (HDI), SF 36 and Hamilton Anxiety and Depression Scale respectively.

Result & Conclusion: Result & conclusions will be discussed at time of presentation as study is still going on.

Key words: Disability, QOL, Migraine, Tension Type Headache

To study the therapeutic efficacy of adjunctive Mirtazepine with SSRI in depressive episode

Gyanendra Raghuvanshi, Pradeep Kumar, Nimisha Mishra, Dheerendra Kumar Mishra,

898, S.S. Medical College Rewa, Madhya Pradesh. dheerendra9926@gmail.com

Introduction: Depressive disorder will be the leading cause of disease burden worldwide by 2030 estimated World health organization. An episode of depression leads to increased risk of absenteeism from work, decreased productivity and the treatment related costs. Depression is a common and treatable condition and antidepressants are most common prescribed psychotropic medication. Among various antidepressant SSRI is most commonly used drugs due to safety and efficacy profile of this drug. STAR* D study results at level 1 shows about one-third of the participants reached remission and about 10-15 percent more responded, but did not reach remission usually 4-6 week required to get therapeutic effects. To get earlier onset of response, rapid restoration of the biological function in depression e.g. sleep , appetite and higher remission rate various pharmacological strategy was used. Current trends shows Mirtazepine is added with SSRI even in first episode of depression to achieve above mention effects. This study intended to assess the pros and cons of adding the Mirtazepine with SSRI in depressive episode.

Aim : To study the therapeutic efficacy and safety of adjunctive Mirtazepine with SSRI in depressive episode.

Objective:

  1. To study demographic profile of patients.
  2. To study clinical profile of patients.
  3. To study the onset of antidepressant effect of prescribed medication.
  4. To study the response rate of antidepressant effect of prescribed medication.
  5. To study the side effect profile of prescribed medication.


Methodology: Study design:

An observational prospective study

Study site: Department of psychiatry out patients (OPD)

Study duration: 6weak

Study sample

Inclusion criteria:

  1. Patients had to be 18 years or older
  2. Suffer from International classification of disease-10 (ICD-10) major depressive episode
  3. Patients had to declare that they understood the goal of the study and gave their informed written consent.


Exclusion criteria.

  1. Nonstabilized somatic disease (seizures, renal, or hepatic insufficiency),
  2. History of blood dyscrasias.
  3. Known case of diabetes mellitus
  4. Known allergic reaction to Mirtazepine, Escitalopram.
  5. Current suicidal risk (according to the physician’s judgment).
  6. Pregnancy, breastfeeding, no contraception in women of reproductive age.
  7. Current depressive episode of more than 1 year’s duration or nonresponsive to 2 antidepressant treatments,
  8. Antidepressant use including monoamine oxidase inhibitor treatment during the previous 2 weeks.


Tools:

  1. International classification of disease-10 (ICD-10)
  2. Hamilton depression rating scale for depression (HAM-D 17)
  3. MADRS


Procedure:

  1. After discussion with mentor study was conceptualized and study protocol was made and approved by institutional scientific committee.
  2. Patient who were attending psychiatry OPD and diagnosed major depressive disorder (as per ICD-10)
  3. Detailed history regarding socio demography, illness and medication taken.
  4. Data was collected in the semi-structured proforma and HAM-D & MADRS scale applies to asses baseline severity of depression.
  5. Patient recruited who are receiveing antidepressant SSRI with Mirtazepine and SSRI alone as per advice of consulting psychiatrist.
  6. Patient review every week up to 6week and apply HAM-D, MADRS scale for severity of depression and asses for side effects.
  7. If patient getting serious side effect or not tolerated medication or clinical condition get worse during follow up, subjected is treated individually by treating psychiatrist and excluded from study.


Statistical analysis: Means with standard deviations and frequencies with percentages were used to summarize continuous and categorical variables, respectively. Student’s t-test (continuous variables) and Chisquare test (categorical variables) were used for comparative analyses between the genders. Repeated measures used to compare change in variable with time and Multivariate analysis of variance (MANOVA) used to asses difference between group. Statistical significance was fixed at p=0.05.

Result & Discussion: Appropriate statistical analysis was used for analysis the data using SPSSv16 and results will be discussed at the time of presentation.

Keywords: Mirtazepine, adjunct, depressive episode

A Survey On The Attitudes Of Medical Students Towards Tinder (Dating App)

Dhruv J. Parmar, Smit J. Parmar, Mansi M. Shah , Shorouq B. Motwani, Jaisukh M. Parmar, Nilesh B. Shah, Avinash De Sousa

PG student, Lokmanya Tilak Municipal Medical College and General Hospital Sion, Mumbai, Maharashtra, India. dhruvparmar316@gmail.com

Background: There has been a surge of dating apps on various online platforms; these apps serve as a medium for relationships ranging from casual friendships to short term affairs and may even foster the development of long-term relationships. The following study is a survey to assess the attitudes of UG and PG medical students towards the use of Tinder on a regular basis.

Methodology: 150 UG & 100 PG students were interviewed using a semi structured questionnaire designed to assess attitudes towards tinder. The questionnaire was specifically designed for this study and validated by three experts. Descriptive statistics was used in the assessment and the results were tabulated.

Results: Certain differences between UG and PG students were observed in the findings, statistical differences of were significance shall be evaluated, discussed and presented.

Conclusion: While this is a small circumscribed study, further large scale studies to evaluate the influence exerted by such apps are warranted.

Keywords: Dating app, tinder, attitude

Role of mobile technology in treatment of selective mutism: A case report

Diksha Sachdeva, Adarsh Kohli, Aakanksha Singh, Susanta Kumar Padhy

Play Therapist, Postgraduate Institute of Medical Education & Research, Chandigarh. dikshasachdeva2010@gmail.com

Background: Selective mutism is rare condition in children with prevalence range of 0.4% to 1.9%. In this disorder, child fails to speak in certain situations but speak normally in other situations causing interference with educational achievement and/or social communication. Treatment of selective mutism is largely non-pharmacological apart from treatment of primary psychiatric condition, if any. Selective mutism in children is under-researched, commonly misdiagnosed and inadequately treated.

Methodology: The aim of present case report was non-pharmacological treatment of selective mutism using an integrated approach. The current case report present the case of 17 years old boy admitted in Psychiatry ward, Postgraduate Institute of Medical Education & Research, Chandigarh and was diagnosed with selective mutism since 4 year of age with chief complaints of not talking to others except family members and academic difficulties. The treatment consisted of 28 sessions of eclectic approach in inpatient setting over the period of 2 months which included contingency management, systematic desensitization, mobile application (Talking Tom) and parental training. The child did not have any other psychiatric diagnosis.

Results: The child’s symptoms were significantly improved by the end of the treatment based on Selective Mutism Questionnaire (SMQ), clinical observation and parent clinical interviews. At discharge the client no longer met criteria for selective mutism.

Conclusion: This case report emphasizes the usefulness of mobile application (Talking Tom) in facilitating the outcome of standard non-pharmacological treatment.

Keywords: Selective mutism, systematic desensitization, technology, mobile application

Family Resilience and Treatment Adherence in Schizophrenia Patients with and Without Remission- A Comparative Study

Vikas Ranjan Mohanta, Dipanjan Bhattacharjee, Basudeb Das,

Assistant Professor, Central institute of Psychiatry, Ranchi, India. dipanpsw@gmail.com

Aim: To study and compare family resilience and treatment adherence in symptomatic and non symptomatic schizophrenia patients.

Background:

Schizophrenia is a serious mental illness characterized by psychotic symptoms (e.g., hallucinations, delusions), negative symptoms (e.g., anhedonia, apathy), and impaired cognitive functioning (Heaton et al., 1994). A core feature of schizophrenia symptoms tend to fluctuate over time, with periodic symptom relapses requiring temporary hospitalization for pharmacological stabilization. Cognitive impairment and negative symptoms are more stable over time and are more strongly associated with impaired functioning. The concept of family resilience extends our understanding of family functioning to situations of adversity. Family resilience involves the potential for recovery, repair, and growth in families facing serious life challenges. Improving adherence in schizophrenia may have a considerable positive impact on patients and society. This can be achieved by focusing on the identified multitude of factors driving non-adherence (Higashi et al., 2013).

Material & Methods: This study is a cross-sectional hospital based study. The total sample size of sixty (60) patients and one key caregiver of each patient will be selected by using purposive sampling technique. Measures like Socio-demographic and Clinical Data Sheet, Brief Psychiatric Rating Scale, Positive and Negative Syndrome Scale (PANSS), Family Hardiness Index (FHI) and Medication Adherence Rating Scale will be used for data collection.

Results: Results of the study will be shared at the time of presentation

Keywords: Schizophrenia, Caregivers, resilience, remission, treatment adherence

Quality Of Life And Severity Of Symptoms In Patients With Schizophrenia

Divija Bunga, C.Manoj Kumar Reddy, S.Sireesha

Postgraduate Student, Institute of Mental Health, Hyderabad, Telangana. divija.bunga@gmail.com

Introduction: Quality of life (QOL) is a sense of well-being, comprised of both subjective and objective evaluations of physical, social, and emotional well-being together with personal development and purposeful activity.Schizophrenia is a neuropsychiatric disorder associated with a wide range of symptoms including positive symptoms (i.e. hallucinations and delusions), disorganized symptoms (i.e. disorganized speech and behaviour), and negative symptoms (i.e. affective flattening, alogia, or avolition).Negative psychiatric symptoms and general psychopathology (i.e. anxiety, depression) have a significant negative relationship with QOL,while positive psychiatric symptoms have been found to have mixed relationships.schizophrenia affects multiple dimensions of functioning especially social and interpersonal relationships.The determinants of QOL for clients with schizophrenia are not well known. Multiple contributing factors, such as unemployment and deficient financial resources, residual symptoms of illness, public stigma, internalized or perceived stigma, side effects of medication and medication adherence affect QOL and may hinder recovery from illness.This study is done to assess the quality of life and its association with sociodemographic variables and severity of schizophrenia.

Methodology: A cross sectional study at review op of tertiary care hospital. Subjects who fulfill the inclusion and exclusion criteria will be taken.A written informed consent will be taken.

Inclusion Criteria:

  1. Who gave consent for the study
  2. Aged above 18yrs
  3. Who are diagnosed as having schizophrenia according to ICD10 and on maintenance treatment.


EXCLUSION CRITERIA:-

  1. Those who didn’t give consent.
  2. With other co-morbid medical disorders.


TOOLS USED:-

  1. A semi-structured intake proforma.
  2. World Health Organization Quality of Life-Bref Group(WHOQOL-BREF)
  3. Brief Psychiatric Rating Scale(BPRS)


  4. Sampling Technique:-convenience sampling, 50 subjects

    Statistical Analysis:- using SPSS software

    Results and Conclusion:-will be discussed at the time of presentation as we have not analyzed the data.

    Key words:- schizophrenia,QOL,Sociodemographic variables.

    Challenges in taking sexual history- A qualitative study of Indian postgraduate psychiatry trainees (For BPSS Award)

    Divya Hegde, Priya Sreedaran, Johnson Pradeep

    Senior Resident, St John’s Medical College, Bangalore, Karnataka. divyahegde19@gmail.com

    Context: The psychiatrist in India are often one of the primary points of help seeking for various sexual complaints and problems. Literature shows many Psychiatrists often do not take detailed sexual histories from their patients unless there is a primary sexual complaint.

    Aims:To study the difficulties experienced by postgraduate psychiatry trainees while taking sexual history as part of routine mental health evaluation in India.

    Settings: In an Indian medical college general hospital psychiatry setting.

    Methods and Materials: A qualitative study using focus group discussions and in-depth interviews with postgraduate psychiatry residents.

    Statistical analysis: Content analysis was used to identify direct and latent themes

    Results: Thematic saturation was achieved with seventeen subjects. Major themes of difficulties that emerged included trainee related factors like gender and socio-cultural background of trainee, patient related factors like age, gender and sexual orientation, setting related factors and language related difficulties.

    Conclusions: Specific and regular training in taking a sexual history is essential in addressing the difficulties faced by postgraduate psychiatry trainees in India.

    Keywords: post-graduate, psychiatry, medical education, medical graduates, sexual history.

    A study of Neurocognitive impairment, Soft neurological signs and Disability in the Euthymic patients of Bipolar Affective disorder

    Sanjay Jain, Paramjeet Singh

    Junior Resident, Dept. Of Psychiatry, SMS Medical College, Jaipur. doc.sanjay@yahoo.com

    Background: Neurocognitive deficits exist in euthymic patients with bipolar disorder, Soft neurological signs, have been observed in patients with bipolar disorder. It might be expected that soft neurological signs would be related to neurocognitive performance in bipolar disorder. Aim of the study is to measure neurocognitive function in Euthymic patients with bipolar disorder and explore link to sub-syndromal mood symptoms, soft neurological signs and social dysfunction.

    Method: Attention, memory and executive function were tested in 50 euthymic patients with bipolar disorder and 50 controls by Digit span test, Verbal learning & Memory test, Stroop color test and Trail making test. Soft neurological signs were assessed by Cambridge neurological inventory and Residual mood symptoms were assessed by using Young mania rating scale (YMRS), Hamilton depression rating scale (HAM-D) and Disability assessed by using Functioning assessment short test (FAST).

    Results: Performances on tests reflecting executive function and verbal memory were significantly poorer in the bipolar disorder group. Sub-syndromal mood symptoms produced cognitive effects, predominantly on verbal memory. Soft neurological signs, were found to be marked in Euthymic patients with bipolar disorder, some patients showed marked social disability as well.

    Conclusions: Neurocognitive dysfunction, social disability and soft neurological signs occur in Euthymic patients with bipolar disorder and may represent trait deficits.

    Key Words: Bipolar Affective disorder, Soft neurological signs, Neurocognitive, Disability

    Anxiety and its relation to suicidality in patients with depressive episode

    Satrajit Ghosal

    PGT, burdwan medical college, Kolkata, West bengal. docsatrajit91@gmail.com

    Background: Depression is a major psychiatric morbidity present worldwide. Suicidality and Anxiety are important features found in depressed patients. In STAR*D trial 46% of population were anxious depressives (Maurizio et al) having higher suicidal ideation than non anxious depressives. Study by Eric et al in AJP found 35% of old depressed patients had at least one lifetime anxiety disorder diagnosis and symptoms of anxiety were associated with greater suicidality. Comorbid anxiety was a risk factor for suicide in depressed veterans in a study by Paul et al. But still there is a dearth of studies linking anxiety symptoms and suicidality in depressed patient. So the purpose of this study will be to correlate anxiety symptoms to suicidality in patients with depressive episode.

    Materials and Method:

    Setting: BMCH PSYCHIATRY OPD

    Study design: Cross sectional study

    Subjects:

    Inclusion criteria : Age 18 to 60 years

    : Patient with proper consent

    : Meets ICD-10 (DCR) criteria for depressive episode

    Exclusion Criteria : Patient suffering from other Psychiatric Disorder

    : Having past suicidal attempts

    : Patient suffering from any medical illness or receiving any drugs

    known to predispose anxiety and suicidality.

    Sample Size: 60

    Methodology: Consecutive patients meeting the inclusion criteria will be assessed for depression and divided into 3 groups – Mild, Moderate & Severe with 20 patient in each group. The patients will be evaluated for anxiety symptoms by Anxiety State Trait Inventory and subsequently assessed for suicidality by Beck’s Suicidal Ideation Scale.

    Statistical Analysis: Regression Analysis will be used (SPSS) to correlate between Anxiety and Suicidal Score and other variables.

    Results: At this point the outcome is unclear. It is expected that the possible outcome will be increased anxiety score will result in higher suicidality.

    Conclusion: Till now only 7 patients have been assessed and no clear cut result has been found.

    Keywords: Anxiety, depression, suicidality

    Catatonia vs Malingering: Case report

    Sudheendra Huddar, Dhruva Ithal, Naren P Rao

    Junior Resident, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka. docsudhee@gmail.com

    Introduction: Catatonia-syndrome of motor, cognitive and affect disturbances-is seen in different neuropsychiatric conditions. Catatonia can present as full syndrome or at times may present with isolated symptom. The latter poses a clinical challenge and is likely misdiagnosed as malingering when presented in forensic psychiatry set up. Here,we discuss about an under trial prisoner, referred from prison for mutism who completely recovered with treatment for catatonia.

    Case Summary: Mr.A presented with complaints of mutism and decreased interaction since 1 month with history of nicotine and cannabis use in dependence pattern since >2 years but the current pattern of use was not known. There was no history of other psychotic or mood symptoms. On examination, patient could comprehend all the information but was mute. He communicated non-verbally using gestures, mental status examination did not reveal any abnormality or behavioral disturbances. His neurological examination was normal and magnetic resonance imaging of the brain did not reveal any significant brain pathology. Urine toxicology screening for substances was negative. In view of above presentation patient was admitted and was kept under close observation which revealed an instance of disorganized behavior. A provisional diagnosis of Catatonia was considered. Patient did not respond to lorazepam trial. Hence he was posted for electroconvulsive therapy(ECT). After 3 ECTs, patient was better. Later he reported of persecutory ideas. The diagnosis was revised as schizophrenia and started on antipsychotics. Patient was maintaining well during follow up after 3 Months.

    Discussion: Catatonia can be due to organic or functional causes and present in various forms, may be difficult to treat at times. In this case we have discussed about an atypical presentation with only mutism along with review about mutism.

    Keywords: Catatonia, Mutism, Malingering, Under trial prisoner.

    Internet Gaming Disorder: Investigating a Potential Psychiatric Phenomenon

    Ateeq Abu Baker Khan, Shriniwas B Chaudhari

    Post Graduate Student, S. Nijalingappa Medical College, Bagalkot, Karnataka. doctorateeqkhan@gmail.com

    Introduction: Internet gaming disorder is a pattern of excessive and prolonged internet gaming that results in a cluster of cognitive and behavioural symptoms, including progressive loss of control over gaming, tolerance, and withdrawal symptoms, analogous to the symptoms of substance use disorders. The essential feature of internet gaming disorder is persistent and recurrent participation in computer gaming causing neglect in personal, family or vocational pursuits. Dysregulated gaming is characterized by significant distress, a nuance that may discriminate passion from pathology. Internet gaming disorder has significant public health importance, and additional research may eventually lead to evidence that it has merit as an independent disorder.

    Materials and Methods: A cross-sectional study taking 325 medical undergraduate students as study participants is being done after taking institutional ethical committee clearance. Sample size was calculated using open-epi version 2. The design and nature of study is explained to participants. Each participant is subjected to a semi structured proforma for collection of socio-demographic information, Internet Gaming Disorder Test (IGD-20 Test) (Pontes et al., 2014) and Internet Gaming Disorder Scale–Short-Form (IGDS9-SF) (Pontes & Griffiths, 2015). Data will be collected and analyzed using appropriate statistical test.

    Results: Awaited

    Conclusion: Awaited

    Keywords: Cognitive, Tolerance, Dysregulated, Withdrawal

    “Hear me out”: Experiences of mothers suffering from severe mental illness with health care providers -a qualitative perspective

    Debanjan Banerjee, Geetha Desai, Prabha S Chandra,

    Senior Resident, Psychiatry, NIMHANS, Bangalore, Karnataka. dr.Djan88@gmail.com

    Background: Contrary to popular myth, majority of mentally ill women are mothers with increasing number of them seeking help. Little is known about their own experiences in this regard and the extent to which their needs are met.

    Objectives: To assess the barriers and facilitators in seeking help from mental health care providers in matters of pregnancy and parenting

    Methods: The study used qualitative design with social constructivist paradigm. A purposive sample of 30 mothers with severe mental illness was obtained. Data was collected through one-to-one in-depth semi-structured interviews. After verbatim transcription, inductive thematic analysis was used to explore transcripts.

    Results: Most women considered motherhood ‘central’ to their lives and almost all of them experienced the burden of the “dual role”. Main barriers in seeking help were stigma, treatment side-effects, wrong information and time constraints. Whereas self-advocacy, early engagement, education of women and involvement of the family with service providers were the facilitating factors. The prime expectations of the mothers as identified were early and direct communication, patient audience and basic guidance in regards to child health and parenting issues.

    Conclusion: Women who are mothers and also users of mental health services face special challenges in managing the contradictory aspects of their dual identity. Hearing their voices are essential for service provision and ensuring adequate mental health needs. Early and direct intervention along with understanding and addressing critical areas are necessary for proper care of both the mother and child.

    Keywords: Mothers, Severe mental illness, Service provision

    Quality of life of OCD patients caregiver

    Dheerendra Pratap Singh, Priyanka Sharma, Prakash Chandra,

    Post graduate resident 2 nd year, saraswathi institute of medical sciences, Hapur, Uttar Pradesh. dr.dp_singh@yahoo.com

    Introduction- OCD is known to be disabling and distressing illness characterized by obsession and compulsion. This illness not only affect the life of patient but also of caregivers, leading to the impairment in various domains of quality of life of caregivers.

    Aim & Objective- To asses the quality of life of the caregivers of OCD patients.

    Methods- The current study was carried out in the psychiatry department of saraswathi institute of medical sciences hapur with Sample size of 50 caregivers. After obtaining the consent from the family members of OCD patients they were evaluated on socio demographic proforma & WHOQLBREF. Data was then collected and was subjected to suitable statistical analysis.

    Results- Detailed table and chart will be explained during presentation.

    Conclusion- The study emphasized the need for taking care of OCD patient care giver in order to maximize the therapeutic alliance and efficiency of treatment.

    Keywords: OCD, Quality of Life, therapeutic alliance

    Acceptability and Feasibility of Tele-psychiatric “On-Consultation Training” Program for Primary Health Care Physicians

    Kiran B R, N Manjunatha, Karishma Kulkarni, C Naveen Kumar, Rajani Parthasarathy, Suresh Bada Math, Jagadisha Thirthalli

    Assistant Professor, DM-WIMS, Meppadi, Waynad,Kerala-673577, dr.kirangowda85@gmail.com

    Background: The essence of successful integration of psychiatry into the primary care is empowerment of Primary Care Physicians (PCPs). Tele-psychiatric On-Consultation Training (Tele-OCT) where specialist psychiatrists assist PCPs in managing psychiatric cases in one effort for the same. This Tele-OCT program began at Mandya district of Karnataka and recently completed 100 hours of training involving 34 PHC doctors.

    Aims: to study the acceptability and feasibility of Tele-OCT among PCPs as well as by Tele psychiatrists.

    Methods and Material: Training was conducted through video-conferencing. Routine patients attending OPDs were the recipients of care. Clinical Schedules developed by the authors was used for assisting consultation and management. Feed-back was collected in a semi-structured questionnaire from participant PCPs and Tele-psychiatrists. Mean and Standard-deviation of the feedback scores were analyzed.

    Results: Majority of the feedback scores obtained from the PCPs and also tele-psychiatrists were in favourable range suggestive of good acceptability and feasibility.

    Conclusions: Tele-OCT demonstrates that it is both acceptable and feasible both from PCPs and tele-psychiatrists. It’s potential in overcoming barriers of integrating mental health in primary care needs to be explored in larger scale.

    Key words: Telemedicine, Mental health , Primary care, Training, Feasibility and Acceptability

    Assesment Of Deliquent Behaviour And IQ Among Juvenile Offenders

    C.Manoj Kumar Reddy, K.Ananth Rupesh Reddy, M.Hrishikesh Giriprasad

    PG student, Institute of mental health, Hyderabad, Telangana. dr.manojkumarreddy@gmail.com

    Introduction:- William stern first proposed the term IQ in the form of a ratio i.e, mental age /chronological age multiplied by 100. It measures a person’s cognitive abilities in relation to their age group. IQ is an important and most ignored factor in theories of delinquent behaviour.

    Low IQ can lead to poor performance in school and also, they lack the inhibiting social factors and capacity to grasp the social values of their culture, including distinction between right and wrong. They can’t foresee the consequence of their actions. If these children are brought up in neighbourhood where delinquent examples and substance abuse are common may lead to delinquency.

    Delinquents with low IQs are more easily apprehended than other delinquents and are therefore may be disproportionately represented in samples studied.

    My study is done to assess the IQ levels of juvenile offenders and find association between delinquent behaviour and IQ.

    Methodology:-A cross sectional study at a Juvenile home. Subjects who fulfill the inclusion and exclusion criteria will be taken. A written informed assent or consent will be taken. Permission for the study obtained from concerned authorities.

    Inclusion Criteria:-

  5. Who gave consent for the study
  6. Aged below 18 yrs
  7. Who have committed a crime and are under trial or sentenced in a juvenile home


Exclusion Criteria:-

3) Those who didn’t give consent.

4) Aged above 18 yrs

Tools Used:-

4) A semi-structured intake proforma will be administered to the subjects.

5) IQ assessment done using Binet Kamath Test of Intelligence, Raven’s progressive matrices.

Sampling Technique:- convenience sampling, 30 subjects

Statistical Analysis:- using SPSS software

Results and Conclusion:- will be discussed at the time of presentation as we have not analyzed the data.

Keywords: Deliquent Behaviour, IQ, Juvenile Offenders

Depression And Marital Satisfaction Among Spouses of Alcohol Dependence Syndrome Patients

Meghamala.S.Tavaragi, Raghavendra Patil, Mahesh Desai, Arunkumar.C

Post Graduate Student, Karnataka Institute Of Medical Sciences,Hubli, Karnataka. dr.meghatavaragi@gmail.com

Introduction : Alcohol dependence not only effects the patient himself but also has maximum impact on spouses health and general well being, leading to varying severity of depression. It also exerts negative impact on marital life and thus impacts on marital satisfaction of spouses of alcohol dependent patients. Spouses play an important role in treatment of Alcohol dependence patients.

Objectives :

  1. To evaluate severity of depression using HAM-D Scale in spouses of male alcohol dependent patients admitted in KIMS Psychiatry ward, Hubballi.
  2. To assess quality of marital life in spouses of male alcohol dependent patients using Marriage Satisfaction scale
  3. To assess general well being in spouses of male alcohol dependent patients using General Well Being scale.


Methods and Methodology: 50 Spouses of alcohol dependence syndrome patients admitted in psychiatry department, KIMS Hubballi were assessed for depression and its severity using HAM-D, and marital satisfaction using Marriage Satisfaction Scale and general well being assessed by General Well Being Scale.

Results : In 50 Spouses of male alcohol dependent patients, around 46%(23) had depression on HAM-D scale and 80%(40) of the spouses showed below low positive level of well being on General well being scale and around 74%(37) showed poor satisfaction level on Marriage Satisfaction scale.

Conclusion : Spouses of alcohol dependent patients are found to be suffering from various degrees of depression, ranging from mild to very severe on HAM-D scale. Spouses have poor marital satisfaction and hence general well being is affected too. Hence there is a need to study about spouses who are the main caretakers of alcohol dependent patients and treat them at the earliest reducing morbidity among spouses.

Key Words: Spouses, Alcohol dependence syndrome Patients, depression, marital satisfaction, general Well-being

Animal Husbandry Rehabilitation Training Programme for the persons with mental illness: An innovative CBR programme

C.Ramasubramanian, Natraj Gojanur, Vikhram Ramasubramanian, M.Kannan, K.S.P.Janarthan Babu

Psychiatrist, M.S.Chellamuthu Trust, Madurai, Tamilnadu. dr.ramasubramanian@gmail.com

WORKABILITY ASIA

Background: It is well known that the treatment of psychiatric illness is not complete without appropriate rehabilitation for optimum recovery. However, in Tamilnadu, very few centres provide rehabilitation training that is customised for each patient based on the illness, family background and their needs. Common rehabilitation activities such as envelope making, phenyl and cleaning powder preparation, candle making and tailoring, only have a physical component and lack the emotional component. Such trainings may not allow them to continue these activities, since they are not desirable in the community. Therefore we need to develop meaningful rehabilitation activities, which will benefit not only the patient but also the entire family.

Aim: To portray the content of Animal Husbandry Rehabilitation Training Programme (AHRTP) and to evaluate the efficacy of this in terms of Quality of Life, self-esteem, self-confidence of recovered patients.

Methods: As part of rehabilitation initiatives, an attempt has been made to introduce the animal husbandry activities, which are popular among rural communities. A separate syllabus was prepared in consultation with Tamil Nadu Veterinary University, Chennai, and the three-month course was conducted by experts from the university for 20 recovered patients. At the end of the course, certificates were issued and one milch animal was provided to the beneficiaries on a loan basis. Further, an effort was made to measure the level of self-esteem, self-confidence and the Quality of Life, before and after the programme.

Results: The level of Quality of Life, self-esteem, self-confidence have been considerably, significantly improved after the introduction of this project.

Conclusion: It was noted that the stigma attached towards the illness was considerably reduced, the self-esteem was improved, and the overall attitude of the people in the village has changed for the better.

Keywords: Animal Husbandry, CBR, Training programme

Study to evaluate the prevalence of internet addiction and its correlation with depression , anxiety and stress among medical students of Guwahati medical college

Sanjay Kumar Singh, H.R.Phookun

Post Graduate Trainee, Gmch , Guwahati, Guwahati, Assam. dr.sanjaysingh46@gmail.com

Introduction- The use of the Internet has increased dramatically due to the development and spread of cheaper and more user-friendly computer technology and software. Despite its inherent benefits, the Internet is not without its problems,especially when its use becomes excessive. The Internet itself is mostly a harmless tool, but the overuse and incorrect use of it encourages the risk of addiction and psychiatric co-morbidity.

Aims- To assess the prevalence,pattern and factors influencing internet addiction and its correlation with depression, anxiety and stress.

Methodology- The study was carried out in 100 students of Guwahati Medical College, GMCH. IAT and DASS 21 was applied and a semi-structured interview was done to assess the socio-demographic variables.

Results- The study results showed the prevalence of internet addiction was 33% and depression was found in 58% clients and among those 16.7% having mild,38.5% having moderate, 54.5% having severe and 88.9% of the clients having extreme severe depression were having internet addiction,67% had anxiety and 46% of the participants were suffering from varying degree of stress. Most of the internet addicts were in the 24-26 years of age group though no significant relation was found between gender, domicile and educational level and internet addiction. A significant correlation was observed between internet addiction and depression (p value <0.001), anxiety (p value <0.001) and stress (p value <0.001).

Conclusion- The study results show that most of the internet addicts were in the 24-26 years of age group though no significant relation was found between gender,domicile and educational level and internet addiction. A significant correlation was observed between internet addiction and depression, anxiety and stress (p value <0.001).

Keywords: Internet addiction, depression, stress

Humanizing Mental health care- effects and acceptance of Peer support among service users in two different settings in Gujarat after Quality Rights Project

Shabina Sheth, Ritambhara Mehta, Ajay Chauhan

MD Psychiatry, Government medical college, Surat, Gujarat. dr.shabinasheth@gmail.com

Aims and Objectives: To assess the effects, benefits, acceptance of peer support among service users, dislikes and satisfaction regarding peer support and to explore needs of existing peer support groups.

Methodology: With informed valid consent from participants (20 Service users(SUs) in General Hospital Psychiatry Unit-GHPU and 20 in Hospital for Mental Health-HMH of Gujarat), a cross sectional study using semi-structured questionnaire which taps SUs’ knowledge and acquaintance with PSVs, knowledge regarding concepts of “peer support” and recovery, benefits, dislikes and suggestions about peer support. A programme satisfaction module was also administered assessing satisfaction of SUs after contact with PSVs.

Results: Service users (SUs) are facing varied mental disorders trying to combat stigma and discrimination. Though 40% of SUs of GHPU vs 5% of SUs of HMH are ever acquainted with the term ‘PSV’, all of them knew & met the persons acting as PSVs. SUs had varied understanding of Recovery but 65% of SUs from HMH think that ‘recovery’ means when patients’ staying at hospital come to an end or their relatives take them back to their home. More than half of the SUs from GHPU and HMH gained self-confidence and became more social and can share their problems with PSVs. 20-25% of SUs reported interruption by acutely ill patients and 10% SUs of both the settings got offended by the rude behaviour of PSVs. SUs of GHPU suggested that there should have structural hierarchical division of groups according to recovery stages & need of patients. Almost all SUs were satisfied with peer support and stated that they would recommend this program to other mental health consumers.

Conclusion: Peer support has great potential to prevent a helper-helpee relationship from being rigid and perpetuating the patient’s role, hence further exploration, awareness and interventions are suggested.

Keywords: Humanizing, Mental health care, Peer support

Psychiatric symptoms ingress to identification and diagnosis of Huntington’s disease. (A rare case sequence)

Samhita, Abhy Jain, Sandeep nigam, Madhukar prasad shukla

Resident, RD GMC, Ujjain, Madhya Pradesh. dr_samhita@hotmail.com

Background: Medicine in India “Charak samhita” mentioned Huntington’s disease (HD) yet its prevalence rate in India is not known. It is a progressive neurodegenerative illness that affects 2–9/100.000 of the general population.The age of onset is 35–40 yrs. HD is caused by an expanded polyglutamine stretch of huntingtin (HTT).This stretch is encoded by a trinucleotide CAG repetition in exon 1 of HTT.An expansion of > 36 repeats results in HD. This study is about a 51 years old male who came to the psychiatric out patient department with late identification of Huntington’s disease after attending various clinics for last 5yrs leading to a three generation family tree of the disease in a small village near Ujjain ,India.

Family History:

  • Patient’s father died of similar illness at age 56yrs. He had two marriages.
  • 1 brothers & 1 sister died of similar disease with mania symptoms.
  • Daughter showing similar features at age 24 yrs.
  • 3stepsisters and their family also affected.


The genetic test & diagnosis of HD was made followed by treatment.

Methodology: Patients were administered standardized neuropsychiatric inventory(MMSE,UHDRS,DSR).Patient (N=10) in the family started on treatment with regular evaluation along with counseling among successors to prevent propagation of this “family curse”.

Results: The study highlights a spectrum of psychiatric symptoms leading to disability in the course of HD along with chorea& dementia.

Conclusions: Available data suggest that there is a tendency for the affected descendant to present a larger CAG repeat expansion. Timely medical intervention and counseling has helped the affected family members and reduced propagation. The rural setup and lack of financial aid has hampered medical management and research in this sample size.

Keywords: Huntington’s disease, Psychiatric symptoms, CAG repetition

Assessment of Dreams in context to Health and Disease: Traditional Indian Understanding

Abhinav Pandey, Mona Shrivastava

Senior Resident, Ims Bhu Varanasi, Uttar Pradesh. drabhinavpandey0103@gmail.com

Background and Aims: Ayurveda is one of the most ancient prevailing medical science. Interpretation of dreams to understand one’s mind is a valid concept in modern literature has also been extensively mentioned in treatises of Ayurveda. Study of Swapna in Ayurveda can be helpful for understanding Prakriti (Personality) and prognosticating an illness. We aim to 1. Study Swapna on healthy volunteer’s to identify Prakriti and to see if there is any relation between Prakriti and Dreams. 2.To study the Auspicious and Inauspicious Swapna in persons suffering from psychiatric disorder for assessment of prognosis.

Material and Methods: Cross sectional study conducted among two study groups. Group I comprising 100 healthy volunteers assessed using Questionnaire Based on Dreams for Assessment of Prakriti (QBD-AP) and Self-report Questionnaire to Asses Prakriti (SQ-AP), as defined in Ayurveda. Group II comprised 60 patients diagnosed with a psychiatric disorder. Questionnaire Based on Dreams for A- Auspicious Dreams and B- Inauspicious Dreams (QBD-A and B) was applied. The cases were given Clinical Prognosis (CP) as good, fair and bad based on experience of the treating psychiatrist. The data was analyzed using appropriate statistical tool.

Results: No significant group differences were seen on Prakriti assessment by both methods, QBD-AP and SQ-AP(χ2=2.81, p= 0.093). No significant group differences was seen on two methods of disease prognosis based on QBD-A and B andCP (χ2= 0.667, p=0.414).

Conclusion: Concepts laid by scholars of Ayurveda 3000 years back have been validated. Prakriti assessment can be done by observing dreams in healthy persons. Furthermore, Auspicious and Inauspicious dreams can be used as prognostic marker for psychiatric disorders.

Keywords: Ayurveda, Prakriti, Dreams

A comparative study of Cognitive function, depression and anxiety in patients with Neuromyelitis optica, and Multiple Sclerosis with normal controls

Abhinav Pandey, Vinay Goyal, Rohit Bhatia, Ashima Nehra, Pratap Sharan, Ananya Mahapatra

House No. 899, Sector – 14, Indra Nagar Colony,Lucknow, Uttar Pradesh.dr.abhinavpandey@gmail.com

Background and Aims: Neuromyelitis Optica (NMO), a demyelinating illness, has been categorised as a separate disease than Multiple Sclerosis. In NMO, Brain is thought to be less extensively involved as compared to MS. However, there are only few studies assessing cognitive functions in NMO and comparing it with MS. So for a better understanding of neuropsychological profile and mental health profile of NMO this study was conducted.

Material and Methods: We studied 20 patients of NMO and compared them with 20 patients of MS and 20 Healthy Controls (HC). Assessment was carried out in single sitting using semi structured clinical sheet, MINI International Neuropsychiatric Interview (M.I.N.I), PGI Memory Scale and Controlled Oral Word Association Test taken from NIMHANS Neuropsychology Battery, Montgomery-Asberg Depression Rating Scale, and Brief Scale for Anxiety.

Results: Three groups didn’t differ in terms of age and gender. However, MS had higher educational status than NMO and HC group. Significant group differences in total duration of illness (MS>NMO) and EDSS scores (MS>NMO). Cognitive domains better in MS group compared to patients with NMO {Test Statistics (df), p}: mental balance {6.527 (2), p=0.03}, attention and concentration {3.499 (2), p=0.037}, visual retention {3.502 (2), p=0.037}, controlled oral word association test {5.003 (2), p=0.010} and overall PGIMS scores {7.492 (2), p=0.001}. NMO had better cognitive function than MS in delayed recall {7.096 (2), p=0.002}, visual recognition {6.197 (2), p=0.004}. NMO had more severe depression {13.210 (2), p=0.001} and anxiety {14.435 (2), p=0.001} as compared to MS.

Conclusions: Assessment of cognitive impairment and psychiatric comorbidity has a role in comprehensive care of NMO patients.

Keywords: NMO, MS, Cognitive Functions, Depression, Anxiety

Effect of adjunctive intermittent theta burst Repetitive trans cranial magnetic stimulation (ITBS) As a prophylactic treatment in migraine patients: A Randomized double blind sham controlled study

Amiya Krushna Sahu, Vinod Kumar Sinha, Nishant Goyal

Senior Resident, C.I.P., Ranchi, Jharkhand. draksahu81@gmail.com

Background: The dorsolateral prefrontal cortex (DLPFC), of the left (dominant) cerebral hemisphere seems to exert a bilateral control of chronic pain states like migraine. Repetitive transcranial magnetic stimulation, (rTMS) known to modulate brain excitability and modulation of neurotransmitters and endogenous opoids.

Objectives: This study was designed to assess the efficacy of adjunctive intermittent Theta Burst Stimulation (iTBS) to the left DLPFC, as a prophylactic treatment in migraine patients.

Method: The study was a randomised double blind, sham controlled experiment. Subjects with migraine were randomized to active (n=20) or sham (n=21) rTMS. The patients, received10 sessions of iTBSover the left DLPFC each comprised of 600 pulses. Patients were rated at base line and at 2 weeks, 4weeks, 6weeks and 12weeks after receiving the treatment from the headache diary and by applying Migraine Disability Assessment Scale (MIDAS).

Results: There was significant decrease in frequency; duration and severity of headache in active group than the sham group over the study period and effect was more pronounced during the initial 2 weeks. The MIDAS score reduced significantly in active group than that of sham group at 12 weeks. There were no significant adverse effects observed.

Conclusion: Compared to sham stimulation adjunctive active iTBS over the the left DLPFC was safe and effective in reducing the frequency, duration and severity of migraine headacheand in reducing migraine disability.

Keywords: Migraine, RTMS, ITBS, DLPFC

Attitude of medical interns towards Psychiatry

Amandeep Gill, GK Vankar, Nishant Ohri

Junior Resident, SAIMS, Indore, Indore, Madhya Pradesh. dramandeepgill1234@gmail.com

Aim: To assess the attitude of medical interns towards Psychiatry

Material and Methods: A hundred and fifty-three undergraduate students participated in this cross sectional, questionnaire based study. The ‘Attitude towards Psychiatry’ questionnaire (Balon et al, 1999) was filled up by the participants and was anonymously submitted at the end of their 15 days posting. The responses against each item ranged on a 5 point likart between ‘strongly agree’ and ‘strongly disagree’. The individual item-wise responses were assessed descriptively and were analyzed to see if any gender-related differences existed in their attitude.

Results: The mean age of a total of 153 students was 23.69 years, out of whom 71 (23.70 years) were girls and 82 boys (23.69 years).

The questionnaire items were divided into 5 domains: Overall merits of Psychiatry, role and function of psychiatrists, possible abuse/social criticism, career/personal rewards and academic efficacy and encouragement.

It was unanimously agreed that psychiatric research has made major strides in advancing care (98.1%) and that it is a rapidly growing frontier (96.6%) , psychiatrists in the current institution were clear, logical thinkers (92.8%) and good role models (91.5%). Students also agreed that the teaching quality in psychiatry was good (90.9%), but found psychiatrists to be too apologetic (80%). Students disagreed that psychiatry was unscientific or imprecise (99.3%) or that it is not a genuine branch of medicine (94.2%).

Responses of both, boys and girls, reflected the overall responses and no significant differences of opinion were found expect in 4 items:

The idea that psychiatrist may abuse their legal powers (90.14 % girls vs 84.14% boys agreed; X2= 7.801, p=0.020).

Attending psychiatrist made for good role models (91.5% girls vs 90.2% boys agreed; X2= 6.995, p=0.032).

Most psychiatrists are clear, logical thinkers (91.5% girls vs 91.4% boys agreed; X2= 6.194, p=0.045).

No encouragement was given towards opting psychiatry (7.04% girls vs 34.14% boys agreed; X2= 17.63, p=0.00014). Overall, 57.5% students consider opting psychiatry but are not sure and 24.2% would probably not enter it. The responses regarding opting psychiatry were similar in both sexes with no statistically significant differences.

Keywords: Medical interns

Madness in Civilization: A review of Andrew Scull’s work on the history of madness

Nishant Ohri, GK Vankar, Amandeep Gill

Junior Resident, SAIMS, Indore, Indore, Madhya Pradesh. dramandeepgill1234@gmail.com

Background/Introduction: Psychiatric disorders, especially insanity, have been documented in various cultures in texts, ancient as well as modern.

Methodology/ Materials and Methods: Madness in Civilizations is a book by Andrew scull (2015) that describes how various cultures have dealt with insanity, i.e. psychotic disorders at various phases of human history. The paper outlines the book as well as compares it with other similar books.

Results: Andrew scull, Professor of sociology and science studies has given a cultural history of madness spread over 18 chapters and 400 pages. Right from antiquity to the modern age, he describes madness, asylums, and healers in this landmark work of psychiatric history. He questions the modern developments as real revolution. He mentions that in reality, deinstitutionalization has not come on the basis of any scientific studies but due to economic forces, to begin with U.S. and later all over the world.

Conclusion: Madness in civilizations is an interesting book from social perspective, and should be on a reading list of all mental health professionals at a time when the field is predominantly biologically oriented.

Keywords: Madness in Civilization, History of madness

Impact of ‘sex-education’ classes on sex related knowledge and myths in undergraduate students

NIshant Ohri, Amandeep Gill,GK Vankar

Junior Resident, SAIMS, Indore, Indore, Madhya Pradesh. dramandeepgill1234@gmail.com

Aim: To assess the impact of ‘sex-education’ lectures on sex-related knowledge and myths among undergraduate students.

Method: A series of 9 lectures were delivered to a total of 450 students pursuing courses in Nursing and Physiotherapy. Copies of a 20 item questionnaire on sexual knowledge, involving true/false responses were distributed and anonymously collected, both before and after the lectures. The questions were in Hindi.

Results: A total of 450 and 414 students responded to pre-lecture and post-lecture questionnaires respectively. Number of female respondents were more in both cases: 313 (69.6%; N=450) and 306 (73.9%; N=414).

Age distribution in both groups was identical: pre-lecture group: 53.3% (N=240) fell in 17-19 years bracket and 46.7% (N=210) were above 20 years of age, while in the post-lecture group

The mean test score (out of 20) before the lectures was 7.88 (SD= ±3.26; N=450). After the lectures the mean score raised to 15.7 (SD= ±3.42; N=414). The difference between the scores was significant with p< 0.0001 (t=34.40; dF=862).

The mean scores of males and females before the lectures were 14.15 (SD= ±3.56) and 10.61(SD= ±4.45). The difference in scores was statistically significant p< 0.0001 (t=9.27; dF=448). But after the lectures the mean scores of male and female students were identical: 15.79and 15.66 (p= 0.734; t=0.339; dF=412).

On item-wise analysis, statistically significant improvement was seen in all 20 items after the lectures.

Keywords: Sex education, Nursing, psychotherapy

Prevalance Of Internet Addiction And Its Relationship To Anxiety And Depression In Post Graduate Medical Students.

Ambuj Kumar Pandey, Asim Kumar Mallick, Prasenjit Ray, Satrajit Ghosal

Post Graduate Trainee, Burdwan Medical College, Kancharapara, West Bengal. drambujmmch@gmail.com

Introduction: Internet use has revolutionized many areas of human life.Internet use is now in every dimension of human life comunicaation with friends and family,educational interests,business purposes,gaming and many more. Some people use internet for long periods ignoring their studies and work which leads to addiction and it is a leading problem in current scenario.Previuos studies shows impact of internet use on depression and anxiety levels.Though there are studies in the past showing prevalence of internet addiction in students there is dearth of studies in India on prevalence of internet addiction in post graduate medical students and its relationship with depression and anxiety level.The current study will explore the prevalence of internet use and its relationship with anxiety and depression level in post graduate medical students of a medical college in West Bengal.

Methodology; Study will be a cross sectional study conducted on 50 Post Graduate medical students(male; 25,female 25) of BURDWAN MEDICAL COLLEGE AND HOSPITAL,PURBA BARDHAMAN.Students will be selected randomly across various disciplines.The internet addiction will be assessed using Internet Addiction Test and anxiety wil be assessed using Becks Anxiety Inventary and depression will be assessed by Hamilton Depression Raing scale.Data will be collected and analysed using appropriate statistical tools.

Results; The study is currently ongoing and whatever data is obtained is insufficient for any statistical conclusion.

Conlusion; The present study will explore the prevalence of internet addiction in male and female post graduate medical students and it will also help in finding relationship with anxiety and depression level in them.The result of present study will pave the way for further studies in the concerned area which is a growing concern these days.

Keywords: Internet addiction, Anxiety and Depression, PG Medical Students

A study of relation of externalizing psychopathology scores and Addiction Severity scores in patients with early and late onset alcohol dependence

Anamika Das, P. K. Dalal, Sujit Kumar Kar, Pawan Kumar Gupta

Junior Resident, King George’s Medical University, Lucknow, Uttar Pradesh. dranamikadas.kgmu@gmail.com

Background: Alcohol Use Disorder (AUD) is a serious health problem over the globe. Classification of alcohol dependence has been attempted long back and one of the typologies is ‘age of onset’ with early onset being taken as onset before 25 years. Early onset AUD has more severity of illness and has higher externalizing psychopathology. The study attempted to find that whether they are related or are independent findings as literature in this area is sparse.

Aims: To study the relation of externalizing psychopathology scores and Addiction Severity scores in patients with early and late onset alcohol dependence.

Method: The study was a cross-sectional observational study. SSAGA (semi structured assessment for the genetics of alcoholism) IV was applied to find the age of onset and the population was divided into early and late onset (on the basis of 25 years). Addiction Severity Index (ASI) was applied and interviewer rating score and composite score was calculated. SSAGA IV was used to find the externalizing psychopathology scores (total score and in individual domains of conduct (CD),anti-social(ASP),oppositional defiance(ODD) and attention deficit hyperactivity disorder(ADHD)).A correlational analysis was done between the two parameters.

Results: A total of 57 patients were recruited on the study. The mean scores of the interviewer severity rating and composite rating was higher in early onset group(n=26) in all domains except medical. Early onset group (n=26) had a significantly higher externalizing psychopathology score (p<0.001).The correlation also showed a positive correlation between externalizing psychopathology score(ASP,ODD and total score) and ASI score(alcohol, employment, psychiatric scores).

Conclusion: Early onset alcohol dependence has more severe problematic use and higher externalizing psychopathology score than late onset alcohol dependence. There is a positive correlation between the two showing that with the increase in externalizing psychopathology there is an increase in the severity of addiction.

Keywords: Psychopathology, Addiction severity score, alcohol dependence

A Retrospective study of sociodemographic profile and psychiatric morbidity in geriatric patients attending psy.dept. in a tertiary care hospital in a sub urban population

Ananthakrishnan V S, Srinivasa Gopalan G, Zubaida Sultana S., Shailaja B., Mithun Prasad V

Post Graduate Student, Meenakshi Medical College And Ri, Kanchipuram, Tamil Nadu. drananthakrishnan@hotmail.com

Aim- A retrospective study of sociodemographic profile and psychiatric morbidity in geriatric patients attending psychiatric department in a tertiary care hospital in a sub urban population.

Inclusion Criteria – All elderly people attending psychiatry out patient department.

Exclusion Criteria – All critically ill patients.

Methodology – After getting necessary permission , medical records of elderly people visiting psychiatry outpatient department in past 2 years.

Study proforma containing socio demographic profile, and diagnosis were filled according to ICD 10

For statistical convenience people were divided into diagnostic groups

Statistical analysis will be done using SPSS16

Results - will be discussed in the conference

Keywords: Retrospective, Sociodemographic, tertiary care hospital

Understanding ‘recovery’ in opioid dependence: A qualitative grounded theory study at a de-addiction centre at a tertiary hospital in north India

Aniruddha Basu, S K Mattoo, Debasish Basu, Subodh BN, S K Sharma

DM Senior Resident, PGIMER, Chandigarh, Chandigarh. draniruddhabasu@gmail.com

Background: All de-addiction treatments aim at abstinence in a narrow sense and ‘recovery’ in a broader sense.

Aim: Understanding ‘recovery’ in opioid dependence(OD).

Objective: To develop a conceptual framework for ‘recovery’ in OD through a qualitative approach.

Methodology: This is a cross-sectional, descriptive and qualitative (grounded theory) study. Consenting males with OD, with illicit or prescription opioids were recruited through ‘purposive’ and ‘theoretical’ sampling. Initially four focus group discussions (FGD) conducted among different stakeholders namely drug users, caregivers and treatment providers were transcribed and open-coding was done for the development of a semi-structured interview guide which helped to conduct in-depth interviews with four ‘recovered’ patients (opioid abstinent for at least one year), three opioid dependent patients (illict/pharmaceutical opioids within last one year), three care-givers and three mental health professionals of different background. Upon further axial and selective coding through constant comparative methods and memoing, a ‘theoretical saturation’ was achieved and a conceptual framework emerged.

Results: The conceptual framework consisted of ‘initiating recovery’ with the help of family support and intrinsic and motivational factors thereby navigating through the ‘barriers’ for ‘changes in recovery’ through diverse ‘means of attaining recovery’ leading to the reversible process of ‘recovery in general’ characterised by ‘complete abstinence’ with an ‘inner experience’ amidst a cultural understanding of ‘punarjanam’ or ‘rebirth’.

Discussion and Conclusion: A social constructivist approach yielded a middle-range grounded theory model of ‘recovery’ in OD in India named as the ‘Chakra Model’ which needs to be established through quantitative verification.

Conflict of Interest: Nil

Ethical Permission: Institute Ethics Committee

Keywords: Opioid Dependence, De-addiction, Teritiary Hospital in North India

A Short Term Comparative Study Of Depressive Episode In Major Depressive Disorder And Bipolar Disorder

Arijit Mondal, Sayanti Ghosh

Specialist Medical Officer (Psychiatry), Bishnupur District Hospital, Bankura, Burdwan, West Bengal. drarijitmondal2010@gmail.com

Topic: “PSYCHIATRIC DISORDER & CLINICAL ENTITIES”

Background : Distinguishing between major depressive disorder (MDD) and bipolar disorder is important because there are differences in the optimal management of these conditions. Most people with bipolar disorder experience depression rather than mania as their first episode of illness. It is clinically desirable to recognise, or at least to suspect, bipolar depression at an early stage of a bipolar illness.

Methodology : 80 cases of unipolar depression and 54 cases of bipolar depression were compared on the basis of socio-demographic profile, family history of mood disorder and clinical features using semi structured questionnaire for socio-demographic profile, validated Bengali version of Beck Depression Inventory (BDI). Both the population were longitudinally followed up for six months and they were compared regarding severity of depression and outcome following intervention using BDI and Depression Outcome Module (DOM) respectively.

Results : Bipolar depression is characterized by early age of onset, more number of previous episodes, positive family history, more severe in nature associated with prominent features of guilt feeling, self dislike, self accusation, suicidal ideas, irritability, social withdrawal, fatigability and loss of libido. Major depressive disorder shows female preponderance, more number of stressful life events before episodes. Body image change, insomnia, anorexia, weight loss, somatic pre-occupation are more in unipolar depression. At the end of six months, bipolar depression group shows more severe depression and poorer outcome compared to unipolar depression.

Conclusions : Any single characteristic or symptom is not pathognomonic of a particular disorder. All the findings of study improve our ability to suspect or detect underlying bipolarity in a subject presented with first depressive episode.

Key Words : comparative study, major depressive disorder, bipolar disorder, outcome.

Opinion about mental illness in caregivers of patients with schizophrenia attending group psychoeducation: A cross-sectional Comparative study

Avinash Shukla, Prem Lata Chawla, Kushal Jain

Senior Resident, Central Institute of Psychiatry, Rewa, Madhya Pradesh.dravinashcip@gmail.com

Background: Family interventions are adjunct psychosocial approaches rather than alternatives to drug treatments. These may have a number of different aims including: collaboration with the family members who provide care to the patient with schizophrenia; reducing the emotional stress and burden on relatives and within the family unit; enhancement of relatives’ ability to anticipate and solve problems; reducing expressions of anger and guilt by the family; maintenance of reasonable expectations for patient performance; encouragement of relatives to set and keep to appropriate limits whilst maintaining some degree of separation when needed; and attainment of desirable change in relatives’ behaviour and belief systems.

Studies indicate that caregivers are hesitant to be involved in psychoeducational program because they feel that such intervention will involve expectations for additional duties towards the patient.

Objective: The objective of present study is to compare the opinion about mental illness in caregivers of patients with schizophrenia attending family psychoeducation group and who do not attend intervention group which might play a role in service utilization by caregivers.

Methodology: This was a cross-sectional hospital based study conducted at Vidyasagar Institute of Mental Health and Neurosciences, New Delhi. A total of 120 family members were included in the study in groups of 60 each i.e. group attending family psychoeducation and group not attending family psychotherapy. Socio-demographic data was collected using a semi-structured performa. Attitude Scale for Mental Illness (ASMI) was used to assess the opinion about mental illness in both the groups. It is a modified version of Opinion about mental illness questionnaire developed by Cohen & Struening. It has been used in many studies conducted in Indian population.

Results: Will be discussed in detail at the time of presentation.

Discussion: Will be discussed at the time of presentation.

Keywords: Schizophrenia, Opinion about mental illness, Family Members, Psychoeducation

Personalized Social Media Anomaly Detection to Identify Potential Self-harm in Psychiatric Patients

Dayaprasad G Kulkarni, Chilukuri Mohan, Kishen Mehrotra, Mantosh Dewan, Seeta Ramanathan, Sushma Srinivas, Pranika Jain, Siddharta Roy Nandi

Founder and Director, Aarogya Seva Global Health Volunteer Alliance, Syracuse, New York. drdaya@aarogyaseva.org

Suicide risk is a major societal concern, with recent reports of increased attempts at self-harm by young people. Many individuals who attempt self-harm display such intent on social media postings. However, a generic analysis of all social media postings will result in a large number of false positives: what is alarming in one patient may be routinely observed with another patient, based on demographics and personal history.Our analysis is restricted to patients of psychiatrists already known to be depressive or at-risk, and we focus on identifying acute behavioral characteristics rather than generic diagnosis. Instead of attempting to diagnose whether an individual is depressed, efforts focus on finding time points at which a depressed individual displays social media behavior that should cause concern. The analysis is personalized, based on patterns identified regarding each patient’s personal behavior. Our approach relies on the application of anomaly detection algorithms [MMH] to social media data. Such an approach has previously been used successfully in financial and other applications [MM]. Reinforcement learning algorithms are built into the data analysis package, to determine non-acute behaviors of individual patients, based on which anomalous behavior can be spotted. Feedback and notes from the psychiatrist will be used to develop ground truth and data for validation. The overall model is that the psychiatrist first seeks permission of the patient to monitor the patient’s social media, after which data will be collected over time and patient-specific criteria will be developed, so that an alert is provided to the psychiatrist when needed. The psychiatrist may then explicitly request to look at the relevant data, and take further actions if needed. The psychiatrist also provides information (e.g., self-harm attempts by a patient) which help to refine the rules with time. A software application tool has been developed to facilitate data collection and deployment in multiple locations. First, a patient must provide permission to his mental health care provider to examine and act upon relevant social media posting of the patient. A data analysis engine examines various features of the postings, constructing internal models of normal behavior for the patient, along multiple dimensions. Anomaly detection rules are applied and combined [ZMM, HMM] in the background as new postings are made by the patient, with evaluation for potential anomalies by comparison with prior patient behavior. When the system judges it necessary, an alert is sent to the authorized medical provider, who can then examine the source data resulting in the alert, and take steps to monitor and assist potentially suicidal patients. Feedback regarding the patient’s status is also added to the patient’s health record when needed, permitting the automated finetuning of the data analysis package that generates alerts, which mayresult in modifying the relative importance associated with specific acute mental health indicators in that patient’s social media posts.

Keywords: Social Media, Anomaly-Detection, Potential Self-harm

Substance Use Related Mental Health Literacy among Medical and Nursing College Students

Falguni B. Patel, Nikita Chhatrola, Bhaveshkumar M. Lakdawala

2nd Year P.G. Student, AMC MET Medical College and Sheth L.G. General Hospital, Ahmedabad, Gujarat. drfalu.patel91@gmail.com

Introduction: “Mental Health Literacy” for Substance Use related disorders in college students is of great importance as adolescents are at high risk for initiating substance use and vulnerable to peer pressure and social influences. There is positive association between poor knowledge and negative attitude towards substance users.

Aim and Objective: To study the Mental Health Literacy (knowledge and attitude about substance use) in Medical and Nursing College students from Tertiary Care Hospital attached to Medical College in Gujarat.

Materials and Methods: The 2nd and 3rd year students recruited through Substance Use Disorders awareness programs in colleges. Substance Use related ‘Knowledge and Attitude Addiction Questionnaire for Adolescents’ (KAAQA),(31 items- ‘yes’ or ‘no’ response) self-reported questionnaire used prior to awareness lecture. IEC permission taken. Written Informed consent of participants taken. Analysis of the data was done by SPSS version 15 for Windows.

Results: Total sample size of study- 426. Out of which 209 were medical students and 217 nursing students. Two-thirds of students (70.9%) appreciated risk of substance use on staying with such people and even more (78.2%), agreed for higher risk of such intake if someone takes substances at home. Majority of students reported that substance abusing youths are influential (76.1%). Nursing students had low knowledge and negative attitude towards substance use and users compared to Medical students. Compared to nursing students, low self intake of substance and increase assertiveness was found in medical students.

Conclusion: Study was helpful to indentify low knowledge and negative Attitude of students towards Substance Use. It highlights the need for more awareness programs for better understanding of substance use and problems related to it and designing intervention and support programs for vulnerable students.

Key Words: Substance Use, Mental Health Literacy, Medical Students, Nursing Students

A Study Of Suicidal Tendency In Patients Of Obsessive Compulssive Disorder

Hari Nath Yadav, A.S. Srivastava

Junior Resident, Ims, Bhu, Varanasi, Uttar Pradesh, Varanasi, Uttar Pradesh. drharinath06@gmail.com

Background: There are limited data on suicidal behavior in obsessive compulsive disorder (OCD). This study was designed to assess the Suicidal Tendency in patients of Obsessive Compulsive Disorder (OCD) attending the Outdoor and Indoor services Psychiatric department of S.S. Hospital, I.MS.BHU Varanasi.

Methods: The present study was cross sectional study, conducted in department of psychiatry of S.S. Hospital, I.MS.BHU Varanasi, from January 2016 to March 2017. During this period, we took 50 patients of Obsessive Compulsive Disorder (OCD) attending both outdoor and indoor services who met the inclusion and exclusion criteria. The patients were assessed for psychiatric disorder (OCD) as per the ICD-10 criteria and severity was rated according to the rating scales used. Yale brown obsessive compulsive disorder (YBOCS) to measure severity of illness, The Hamilton Rating Scale for Depression (HAMD) measured severity of depression and Hamilton Rating Scale for Anxiety (HAMA) measured severity of anxiety and The Scale for Suicide Ideation (SSI) measured suicidal ideation.

Statistical Analysis: Mean standard deviation and t test for independent samples, Pearson’s correlation coefficient was used.

Results: 68% patients had co-morbid depression of varying intensities (moderate, severe) and 24% participants had significant anxiety and 32% of OCD patients exhibit suicidal risk.

Conclusion: Our study makes it clear that depression is a common co-morbidity with OCD. Our study also suggests that severity of illness is a risk factor for suicide. It was vital that patients of OCD undergo a detailed assessment for suicide risk and associated depression to modify and reduce the risk of suicide.

Key word: obsessive compulsive disorder, suicide, YBOCS, HAMD, SIS.

Incidence of suicidal ideations in treatment naive psychiatric patients attending a rural teaching hospital

P.Krishna Chaitanya, Datt, Praveen Khairkar, Swapna, Monalisa, Sushruth, Pratyusha

Post Graduate, Kamineni Institute of Medical Sciences, Hyderabad, Telangana. drkcpsych@gmail.com

Introduction: Suicidal ideation is a term encompassing thoughts, wishes and plans intended to result in suicide. The etiology for suicidal behavior is complex and multifactorial. It can vary from passive ideation to perfect planning of an attempt. Mental illness is known to be a big risk factor for suicide. The aim of the present study is to see the incidence of suicidal ideation in treatment naïve psychiatry patients.

Methodology: Treatment naïve adult patients attending the outpatient services of department of psychiatry at a rural teaching hospital in Nalgonda district of Telangana state, in the third quarter (July to September) of 2017, having a diagnosable psychiatric condition on ICD-10 are included in the study. The frequency of suicidal ideation across the spectrum of psychiatric diagnoses and a detailed evaluation of the suicidal profile of the patients are recorded using Modified Scale for Suicidal Ideation (MSSI).

Results: Of the 60 treatment naïve patients studied, suicidal ideation was seen in 24 patients (40%). Females were more with a ratio of 2:1. Highest incidence was in the age group of 18-40 yrs. Illiteracy (54%), unemployment (58%), rural domicile, nuclear families and middle class status showed results of significance. Among the psychiatric morbidities, suicidal ideation was highest in mood disorders (41%) followed by anxiety disorders (33%).

Conclusion: In the present study, we noted that every 2 of 5 patients visiting psychiatry outpatient has suicidal ideation showing psychiatric morbidity carrying a lifetime risk for suicidality which requires active screening and sustain vigilance from all treating clinicians. More research is required in the field of suicidology to enhance awareness and insight.

Keywords: Incidence, suicidal ideation, psychiatric morbidity, treatment naïve patients.

Caregiving Burden and its Impact in the Patients of Acute Lymphoblastic Leukaemia

Kumari Rina

Senior Resident, GIPMER, New Delhi. drkumaririna@gmail.com

Background: Caregiving is challenging and distressful, especially in malignancies, like Acute Lymphoblastic Leukaemia (ALL) due to rapid course of illness and intensive treatment protocol. There is paucity of research examining caregiver burden and its correlates in the patients of ALL.

Aim: To study the caregiver burden and its correlates among the caregivers of adolescent and adult patients of ALL.Methodology:A cross sectional design was followed. Sample was selected by purposive sampling. 60 caregivers of patients with ALL were assessed on Family Burden Interview Schedule(FBI), Caregiver Strain Index(CSI), Multi-Dimensional Aspect of Perceived Social Support Scale, Cognitive-Behavioural Avoidance Scale(CBAS), Ways of Coping Checklist(WCC) and General Health Questionnaire(GHQ-12).Results:Caregivers of patients with ALL reported high caregiver burden(FBI objective burden score -21.77;subjective burden score 1.83). Among the domains of FBI, highest burden was seen in the domain of financial burden followed by disruption of family leisure. Caregiver burden was higher among caregivers who reported lower perceived social support, who more often used avoidance and escape as coping and less often used planful problem solving. Higher caregiver burden is associated with higher psychological morbidity.Conclusion:Caregivers of patients with ALL experience high level of caregiver burden and it is associated with lower social support and use of maladaptive coping strategies.

Key Messages: Caregivers of ALL face numerous psychosocial difficulties during the course of treatment. None of the study has evaluated caregiver burden, psychological morbidity, coping and distress among caregivers of patients with ALL comprehensively. Hence, the present study was intended to fill this gap.

Key words: Acute Lymphoblastic Leukaemia, Caregivers, Burden, Strain, Coping

Polysomnographic characteristics, quality of life and psychiatric co-morbidities among recently detoxified alcohol dependent patients in comparison to healthy controls

K. K. Verma, Subhash Chandra Maharda, Shri Gopal Goyal, Girish Chandra Baniya

PG Student, Sardar Patel Medical College, Bikaber, Rajasthan. drmaharda@gmail.com

Introduction: Sleep is a complex human behavior which is affected by alcohol. Alcohol dependence may lead to changes in sleep regulation. Sleep disturbances and Psychiatric co-morbidity predicts relapse in alcohol dependence that may affect quality of life. Present study aim to evaluate sleep profile, psychiatric co-morbidities, quality of life in alcohol dependent in comparison to healthy control.

Material and methods: This was a cross sectional study, conducted at inpatient unit of department of psychiatry at tertiary care centre. The sample comprised of 25 patients of alcohol dependence and matched healthy control. Assessment were done using Pittsburg Sleep Quality Index, Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised, Mini- International Neuropsychiatric Interview -6, World Health Organization Quality of Life BREF and overnight polysomnography.

Results: Total sleep time in patient Vs control was (3.34±1.37 Vs 5.11±1:37; p<0.001).Sleep efficiency index was 48.14±20.91 Vs 77.77±10.75 (p<0.001). Apnea index, Limb movement index and Snoring Index significantly higher in patients than control group (p< 0.05). WHO QOL- BREF showed poor quality of life in patient (p<0.001). Major depressive disorder was most common psychiatric co-morbidity.

Conclusions: Alcohol dependence is associated with subjective, objective sleep disturbances, poor quality of life and higher psychiatric co-morbidities than healthy controls.

Key Word: Polysomnography; psychiatric-comorbidity; quality of life; alcohol dependence

Role of lipid in dissociative patients: A cross sectional study

Mahboobul Hasan Ansari

Senior Resident, Jnmc Aligarh, Aligarh, Up. drmha.snmc@gmail.com

Background: Low serum lipid concentrations have been found to correlate negatively in subjects with psychiatric comorbidity having self injurious behavior and borderline features in patients with dissociative disorders.

Aim: Present study aimed at exploring the relationship between serum lipid fractions, dissociative disorders, having high risk of self mutilative and violent behavior, attended at tertiary-level psychiatry care facility.

Method: This was a cross sectional study, and included 30 consenting adult patients with a diagnosis of Dissociative disorders as per ICD 10 DCR, and 30 age-sex matched healthy controls (GHQ<3). All data were collected using self-administered semi-structured proforma after obtaining written consent from the participants. Dissociative Experiences Scale-II and Hamilton depressive scale were applied on the patients. Appropriate statistical analyses were done using SPSS software.

Results and Discussion: To be presented during the conference.

Keywords: Dissociative disorders, serum cholesterol, serum lipid profile

Analysis of inpatient referrals in psychiatry: A study from a multidisciplinary set up

Mona Srivastava, Pradeep Chaurasia

Professor, Institute of medical sciences, Banaras Hindu University, Varanasi, Uttar Pradesh. drmonasrivastava@gmail.com

Background: There is a dearth of studies which have focused on consultation-liaison psychiatry in India.. Data from the previous studies have suggested that the referral rates in India are very low considering the higher psychiatric morbidity rates.

Objectives: The aim of the study is to assess the magnitude and the pattern of Psychiatric referrals and to find out the scope and difficulties of Consultation Liaisons. Materials and Methods: All inpatient referred to Psychiatry department over a period of one year (i.e. April 2016-March 2017). The data were taken and analysed in terms of socio-demographic characters, referring unit, reasons for referral and psychiatric diagnosis.

Results: A total of 191 inpatients were referred for psychiatric opinion comprising 0.40% of total indoor admission. 102 (53.4%) referrals were from Medicine and related specialities followed by Surgery and related Specialities (19.89%). The commonest reason for referrals was irrelevant talks and other Psychotic features (29.84%), followed by Deliberate Self Harm and attempted suicide (20.41%), however the most common final diagnosis was Substance Use Disorder (30.36%) followed by Mood Disorder (20.41%). Male consist of 58.11% and majority of the referred patient belongs to Middle socio-economic status.

Keywords: Psychiatry referrals, Consultation - liaison psychiatry

Psychogenic habit cough: A case report and review of literature

Mona Srivastava, Pradeep Yadav

Professor, Institute Of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh. drmonasrivastava@gmail.com

Background: Involuntary cough without an identified underlying organic reason has been given various names and recommended treatments. Current experience suggests that “habit cough” best describes this clinical entity and that various forms of suggestion therapy including hypnotic methods are the treatment of choice. Suggestion therapy is effective when it is directed at demonstrating to the patient that they have the ability to resist the urge to cough. Attempts at medical treatment or use of placebo therapy, even with the suggestion that the “medicine” will stop the cough, are generally not successful. In the absence of suggestion therapy, even when the diagnosis is correctly made, continued symptomatology for years is common. On the other hand, sustained relapse after suggestion therapy is uncommon.

Keywords: Cough • Functional disorder • Habit • Habit cough

Assessment of metabolic abnormalities in patients with Schizophrenia: A longitudinal study with Psycho-educational intervention

Navratan Suthar, Naresh Nebhinani, Swapnil Tripathi, Priyanka Purohit

Associate Professor, AIIMS, Jodhpur, Rajasthan. drnaresh_pgi@yahoo.com

Background: Metabolic syndrome (MS) in patients with schizophrenia varies from 8.9% to 68%. Recently an American group has attempted structured psychoeducational program to address metabolic abnormalities and found significant improvement over the 1,2,3, and 6 months period. It has given us impetus to assess the effect of psychoeducational intervention on metabolic syndrome in Indian patients with Schizophrenia.

Objectives: This study is aimed to assess the effect of psychoeducational intervention on metabolic abnormalities and metabolic syndrome in patients with schizophrenia.

Methodology: After the Ethics approval, 30 Clinically “Stable” patients with Schizophrenia were recruited after taking their written informed consent. All the assessments (anthropometric and metabolic), and Psycho-educational intervention (for schizophrenia, treatment and its side effects, and life style modification) were done at baseline, 2 weeks, 1 month, 3 months and 6 months.

Results: Initially 30 patients were recruited at baseline, out of them 8 patients continued follow-up for 6 months. Out of 8 patients with schizophrenia, 4 patients had MS before intervention, out of which 3 of them became MS negative and in 1 patient number of metabolic abnormalities were reduced from 4 to 3, after psycho-education intervention, at 6 month. In 3 other patient, numbers of metabolic abnormalities were also reduced.

Conclusion: Patients with schizophrenia should initially receive antipsychotics possessing lower metabolic risk along with regular monitoring and multidisciplinary approach for dietary modification, regular exercise, and smoking cessation to prevent morbidity and mortality.

Keywords: Metabolic, Schizophrenia, educational intervention

Alcohol Dependence Syndrome: One year Follow-up Study

Nirmal Lamichhane, Dev Kumar Thapa, Anil Subedi, Pujan Sharma Lamichhane

HOD, Gandaki Medical College, Pokhara, Gandaki. drnrmlam@hotmail.com

Alcohol is one of the commonest substances of abuse in most of the societies of the world. It is reported that nearly 30 percent of alcohol users develop temporary alcohol related problems and approximately 10 percent of men and 5 percent of women develop alcohol dependence syndrome (ADS) related problems. The major challenge in the treatment of patients with substance use disorders is not only to maintain the follow up but also to prevent relapse. The current study was planned to see the abstinence and relapse rate in follow up patients with Alcohol Dependence Syndrome. It is a hospital-based follow-up study. All the patients of alcohol dependence syndrome fulfilling ICD-10 criteria were included in the study.Results and discussion of the study will be presented in the conference.

Key Words: ADS, follow-up, relapse, abstinence rate

Meningomyelocele on exposure to clozapine during prenatal period

Prakruthi.N, Shaji k.s, Sumesh

Senior Resident, Medical College, Thrissur, Kerala. drprakruthi.psy@gmail.com

Introduction: Atypical antipsychotics are being increasingly used in pregnancy. However, safety of such drugs on growing fetus is not studied extensively, which may be due to ethical issues involved and lesser use of clozapine in pregnant women. We had a case where a pregnant woman on clozapine gave birth to a baby with neural tube defects.

Methods: Case study regarding detailed treatment records including compliance to medications, exposure to other medications during pregnancy was done. Follow up of the mother and the baby during perinatal period was done.

Results: During last trimester of Pregnancy, the subject developed gestational diabetes. During labour, child had shoulder dystocia and low Apgar scores. At birth, the baby had a lumbosacral swelling and diagnosed as having lumbar meningomyelocele.

Conclusion: This case suggests that in-utero exposure of clozapine may cause fetal abnormality by interfering with embryonic development. Further prospective studies are needed to establish the teratogenic effect of clozapine.

Keywords: Meningomyelocele, Prenatal period, antipsychotic

Parental Challenges in Care Seeking for Autistic Spectrum Disorders Children: A mixed method study from Bhubaneswar, Odisha

Pranab Mahapatra, Krushna Chandra Sahoo, Abhimanyu Singh Chauhan, Srinivas Nallala, Rakesh Ranjan Nanda, Sanghamitra Pati

Assistant Professor, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha. drpranab@outlook.com

Introduction: Autistic Spectrum Disorder (ASD) is the major cause of childhood disability across the globe. The onset of this disorder starts usually before 3 years. It is estimated that in India approximately 10 million children are affected with this disorder. For every child hood problem that receives a medical diagnosis, there is period of time between a parents first recognition of unusual behaviour and the eventual diagnosis. Several factors influence the initial symptoms recognition and final diagnosis. The present study was conducted to understand the early signs of ASD that parents recognize treatment seeking pathway and their experience in the overall process. It was an attempt to understand parents’ perception regarding ASD.

Methodology: A facility based cross sectional study was undertaken from May 2014 to August 2014 at four schools and centers providing therapy for ASD at Bhubaneswar, Odisha. A total 76 parents were interviewed using a semi structured questionnaire. The data was collected and analyzed using both quantitative and qualitative study techniques. The quantitative data analysis was done with SPSS 20.0 and thematic frame work approach was used for analyzing qualitative data.

Results: Majority of parents noticed social difficulties (about 46.1%) in their children as major symptoms. Maximum parents had not heard of ASD before their child was diagnosed with the disorder. After noticing the symptoms majority of the parents consulted to a pediatrician first. To confirm the diagnosis, the parents consulted many professionals. Many of them reported to have travelled across India. Maximum parents went to NIMAHANS, Bangalore a tertiary care center for diagnosis. In maximum cases, the diagnosis was confirmed by a child psychiatrist and after the diagnosis, children were referred to rehabilitation center, for different interventions. Lack of awareness, psychosocial stress and unavailability of services did play an important role in delaying the diagnosis and treatment of Autism.

Conclusion: Lack of awareness and knowledge on ASD was observed, among parents before their child had the problem. There is need for designing proper awareness programme and genuine center for treatment. On similar lines, referral and counter referral mechanism to be established to save delay in diagnosis and initiate prompt treatment in the field of ASD.

Weaved into the cultural fabric: A qualitative exploration of alcohol consumption during pregnancy among tribal women in Odisha, India.

Pranab Mahapatra, Sanghamitra Pati, Abhimanyu Singh Chauhan, Pranab Mahapatra, Devraj Hansdah, Krushna Chandra Sahoo, Sandipana Pati,

Assistant Professor, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha. drpranab@outlook.com

Background: Evidence-based research has documented the association between alcohol intake during pregnancy and increased risk of miscarriage, stillbirth and congenital birth defects. Alcohol consumption is a complex behavior having origins in social structure and cultural norms. In India, in tribal communities, alcohol misuse among women is a public health problem.

Objective : The study intended to explore the perceptions and beliefs among tribal women and community towards alcohol consumption during pregnancy.

Methods: A qualitative study was conducted in a tribal dominated district of Odisha, India. WHO AUDIT tool was used to identify the women who consumed alcohol during pregnancy. In-depth interviews were conducted with 19 eligible women and 18 family members. Additionally, two focused group discussions were held with local community leaders and health workers. The data was transcribed, systematically coded, and analyzed following the thematic framework approach.

Results: Findings suggest a complex interplay of drivers contributing to an unrestricted intake of alcohol among women during pregnancy. This could be attributed to non-existence of social monitoring, easy availability, low alcohol literacy and normative status of alcohol in the daily customs and traditions. Community perception of home-made alcohol with ‘no-ill effect’ notion is also another contributing factor.

Conclusion: The practice and perceptions of alcohol consumption among indigenous tribal women is deeply embedded in their daily rituals. Thus, to address this, a well-designed culture-based intervention encompassing alcohol researchers, mental health specialists, public health workers and anthropologists is necessary.

Key words: Alcohol misuse, culture, tradition, tribal women, pregnancy, Odisha, India.

A Study of Adherence to Medications - Comparison between OCD and Type 2 Diabetes Mellitus Patients

Preethi V. Reddy, Raghavendra Kumar K, Lavanya A, G.gopalakrishnan, P.l.Narayana,

Clinical Post Doctoral Fellow, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka. drpreethi20@gmail.com

Background: Adherence to long-term therapy for chronic illnesses has always been a problem. The consequences of poor adherence to long-term therapies are poor health outcomes which include morbidity, mortality & increased health care costs. There are a few studies which have looked at adherence among chronic medical and chronic mental disorders individually but, there are no studies that compare the two groups. In this study we compared adherence rates among the OCD and Type 2 DM patients, looked at the factors associated with non-adherence and also inter-group differences in the factors.

Methodology: A descriptive study, was done over a duration of 1 year, n=60 in each group, using consecutive sampling and minimum illness duration of 2 years. Medication Adherence Questionnaire (MAQ) used to assess rates of adherence. The multidimensional factors (as per WHO Adherence Report) associated with non-adherence assessed using a Semi-structured questionnaire, prepared in consensus with two psychiatrists and a clinical psychologist. Descriptive statistics and Chi square test used for statistical analysis.

Results: Adherence rates in our study showed no significant difference among the two groups. OCD =46.7%, DM=58.3% (p=0.201). Forgetfulness showed strongest association with non adherence (p=0.000), duration of treatment (p=0.001), drug side effects (p=0.002) were others. Inter-group comparison of the factors showed drug side effects (p=0.001) and number of medications (p=0.003) had stronger association with the OCD group.

Conclusion: In-spite of the fact that Diabetes is spared of social stigma and the awareness among people is fairly good when compared to OCD, the rates of adherence are poor and comparable to OCD. Clinical and research emphasis should be laid on the management of non-adherence and not only on developing newer pharmacological molecules and studying their efficacy because “pills work only if taken”.

Keywords: Adherence, OCD, Type 2 DM

Association Of Expressed Emotion In Caretakers With Severity of Depression In Patients Of Major Depressive Disorder

Raviraj Khadiya, Krishna Kumar Mishra, Rakesh Gandhi

Pg Student, Medical College Vadodara, Mahisagar, Gujarat. drraviraj61091@gmail.com

Introduction: Expressed emotion refers to a global index of particular emotions, attitudes and behaviours expressed by relatives (caretaker) about a family member diagnosed with psychiatric illness. Expressed Emotion is determined by five factors i.e. hostility, criticisms, emotional over involvement, positive remarks (regard), warmth.

Aims and Objectives: To study the correlation between expressed emotion in caretakers with severity of Depression in patients with Major Depressive Disorder.

Materials and Methods: This was a cross sectional study conducted on 40 patients of Major Depressive Disorder who were currently on medication, attending Psychiatry OPD of SSG hospital, Vadodara. Expressed emotion in caretakers was measured using Level of Expressed Emotion scale (LEE) and severity of Major Depressive Disorder was measured using Hamilton Rating Scale for Depression (HAM-D). Pearson correlation coefficient test was used to measure the strength of association between expressed emotion in caretakers and severity of Depression in patients with MDD with P value <0.05 taken as significant.

Results: Pearson Correlation Coefficient was found to be r = 0.7418 with p value <0.0001 for this study. Hence, correlation between expressed emotion in caretakers and severity of Depression in patient with MDD is significantly positive.

Conclusion: Expressed emotion in caretakers was associated with the severity of Depression in Major Depressive Disorder patients. Hence for every patient diagnosed with MDD, caretaker expressed emotion should be assessed and addressed which will have impact on the overall management and prognosis of the patient.

Prevalence of stress and psychiatric disorders among Post Graduate Trainee doctors

Surjya Roy, Asim Kumar Mallick

PGT, Burdwan Medical College, Kolkata, West Bengal. drroysurjya@gmail.com

Background: Stress is very much prevalent in various medical schools. This study was done to assess prevalence of stress and psychiatric disorders among Post Graduate Trainee doctors (PGT).

Methodology: 170 PGT of various clinical subjects were approached. Those, who were available at the time of data collection and gave valid, informed consent were taken up as a sample (N=126). Socio demographic datasheets were filled up first. Study tools such as Kessler psychological distress scale questionnaire (K10 scale) was used to assess stress among PGT. Then clinical interview was conducted to assess prevalence of psychiatric disorders among them following ICD-10 DCR

Result: Mean score of stress was 18.63±4.41 (K10 scale), 33.3% PGT were stressed and 16.7% PGT had psychiatric illness. Among psychiatric diseases 4% had harmful use of tobacco, 4% mild depression, 1.6% panic disorder, 4.8% mixed anxiety depression, and 1.6% mixed obsessive thoughts, 0.8% harmful use of alcohol. Maximum stress was found among Anesthesia PGT. Stress was more among female PGT, and married PGT. Age and stress were found to be positively correlated. Stress and presence of psychiatric illness was highest among 3rd year PGT.

Conclusion: Early recognition of stress and psychiatric morbidity is very much needed among PGT for early Pharmacological and non pharmacological management.

A study of patients of Alcohol withdrawal state at a tertiary care hospital

Santosh Chavan, Ivan Netto, Akash Nema, Rupali Patil

Resident, B.J.Medical college, Pune, Maharashtra. drsantosh815@gmail.com

Background: There are very few studies in the Indian setting regarding alcohol withdrawal state at tertiary care hospital. This study examined the socio-demographic factors, clinical features, treatment modalities and the association if any in patients of alcohol withdrawal state.

Methodology: A cross-sectional, descriptive study was conducted on 60 indoor patients of alcohol withdrawal state at a tertiary care hospital. The study protocol was approved by ethic committee. The patients were selected after they met inclusion and exclusion criteria. The patients and relatives were given information about nature of study. If they were willing to participate then their consent were taken in their mother tongue. The patients’ history was recorded and the Mental Status Examination was done. The Psychiatric evaluation was done using ICD-10 diagnostic criteria for research.The Modified Kuppuswamy’s socio-economic scale, the Mini International Neuropsychiatric Inventory- plus scale, CIWA scale was administered to the patients. The symptom triggered regimen was used to treat the withdrawal state. The results obtained were tabulated and statistical analysis is currently in process.

Results: The age range of the patients was 20 to 40 years and all were male. Most of the cases were of uncomplicated alcohol withdrawal state and the rest were withdrawal state with delirium or psychotic disorder. Most cases with liver disorder were treated with lorazepam and the rest with chlordiazepoxide.

Conclusion: Indoor patients with alcohol withdrawal state at tertiary care centre present mainly with uncomplicated withdrawal, delirium or psychotic disorders and are managed with lorazepam or Chlordiazepoxide and various types of psychotherapeutic interventions.

Key words: Alcohol withdrawal state, tertiary care hospital.

A study of psychological morbidities among Female Sex Workers(FSWs) rescued under Prevention of Immoral Trafficking Act (PITA) in protected environment of a Pune-based Non-Governmental Organization (NGO)

Santosh Chavan, Manjeet Santre, Gayatri Saraf, Krishna Kadam, Chaitanya Lata Singh, Nishant Das

Resident, B.J.Medical college, Pune, Maharashtra. drsantosh815@gmail.com

Background- Human trafficking is the exploitation of human beings in ways that include sexual exploitation, other forms of forced labour, through the threat or use of force, or abduction. Majority of the trafficked victims are forced into sexual exploitation. Sex work carries severe occupational risk, hazards that may be traumatic. Given the public health importance, actions almost exclusively focus on risks associated with infections like HIV, rather than on health problems in general, or mental health consequences in particular. We carried out this study focusing on overall psychological morbidities by using current diagnostic guidelines as well as structured instruments among FSWs rescued under PITA, who were in the protected environment of a Pune-based NGO, Rescue Foundation.

Methodology - This is an observational, cross-sectional, interview based study. 54 FSWs participated in the study. After obtaining necessary permissions from the NGO, written informed consent was taken from subjects and socio-demographic data was collected. Patients were interviewed by second year postgraduate residents of BJGMC, Pune and diagnosis were made using ICD-10, and wherever necessary, the diagnosis was confirmed by a consultant in Psychiatry. Structured instruments such as MINI, HAM-D, HAM-A, PCL-5 were applied. Statistical Package for Social Sciences, version 23 was used for statistical analysis.

Results – Preliminary findings suggest that the prevalence of psychiatric morbidity in FSWs is high(40%). The commonest diagnosis was substance use, followed by depression(7%) and personality disorders(7%). Detailed results will be discussed later.

Conclusion- It is essential to screen all FSWs for psychiatric morbidity and do appropriate psychiatric and psychological interventions.

Key words- Female sex worker, psychological morbidity, human trafficking

Attitudes Of Medical Students Towards Individuals With Mental Illness In Rajamahendravaram – A Cross-Sectional Study.

K. Santosh Kumar, S.V.V. Jagadeesh, M.Vijaya Gopal

Post Graduate, G.S.L Medical College, Rajahmundry, Andhra Pradesh. drsantoshkalla@gmail.com

Background: Lack of knowledge and awareness among the medical students is associated with the negative attitudes towards mental illness in the community. Discrimination is also seen along with stigma as long as such mental illness exists. Due to this stigma and discrimination, the people with mental illness face difficulties in social relationships, experience social isolation, social withdrawal, social distance, homelessness, unemployment and institutionalization.

Aim: To assess the basic knowledge in Medical students towards mental disorders and to evaluate their attitude towards people with mental disorders.

Materials and Methods: A cross-sectional study was done on medical students at GSL Medical College, Rajamahendravaram who had given consent. Along with demographic data, Belief Towards Mental Illness Scale (BMI) is used to assess the attitudes towards mental illness.

Results and Conclusion: Data was analyzed. Results were correlated which will be discussed during presentation.

Key words: Students, Attitudes, Mental Illness, Belief Towards Mental Illness Scale (BMI).

Prevalence of anxiety and mood disorders in patients with epilepsy.

Saurabh Jaiswal

Senior Resident, Central Institute of Psychiatry, Ranchi, Jharkhand. drsaurabh1987@gmail.com

Introduction: People with epilepsy are more likely than the general population to have comorbid psychiatric disorders that includes anxiety and depression. Even though psychiatric comorbidity is common in epilepsy, it is under recognized and under treated, both in specialty epilepsy centers and also in community-based services. A thorough assessment of this was sought in this study among the patients of Rohilkhand region of Uttar Pradesh (India).

Materials and Methods: A total of 100 patients with epilepsy who visited the outpatient clinic were recruited for this hospital based cross-sectional, observational study. They were assessed in detail for the presence of comorbid psychiatric disorders with the help of Structured Clinical Interview for Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders. Statistical analysis of the results were done using SPSS version 22.

Results: The frequency of co-occurrence of different types of psychiatric disorders was as follows: Mood disorders 21%, anxiety disorders 14%.

Conclusion: Psychiatric comorbidities were found to be a common problem in patients with epilepsy. The results of this study are in line with many different research works both in India and abroad. A proper address of this issue is important for management, better outcome, and policy making in patients with epilepsy.

Keywords: Epilepsy, anxiety disorder, mood disorder

Oxcarbazepine-induced Stevens Johnson syndrome: A rare case report

Saurabh Jaiswal

Senior Resident, Central Institute of Psychiatry, Ranchi, Ranchi, Jharkhand. drsaurabh1987@gmail.com

Introduction: Stevens–Johnson syndrome (SJS) is a rare immunologic reaction that may involve skin or various mucosal surfaces. There are various case reports of carbamazepine induced SJS. Although oxcarbazepine is structurally related to carbamazepine, but it has been rarely shown to induce SJS. Here we report a case with SJS, which was induced by oxcarbazepine.

Case Summary: A 15 year old unmarried female presented with complaints of episodic sudden jerky movements in right upper limb lasting for 2-10 minutes since last 9-10 months, with a frequency of 1-3 episodes per month. There were 2 episodes of associated loss of consciousness, but there was no history of frothing, tongue bite or incontinence. CT scan of brain revealed gliotic area in left posterior parietal lobe. Physical examination, electroencephalography and other blood and urine tests were grossly unremarkable. A provisional diagnosis of complex partial seizure was made and treatment was started with oxcarbazepine 150mg BD and clobazam 5mg HS for 10 days. On follow-up, patient was having complaint of over-sedation. Clobazam was discontinued and oxcarbazepine was augmented with another anti-epileptic levetiracetam 250 mg HS. After 2 days of continuing with these medications, the patient developed swelling, multiple erosions over body and crusting with erythema over lips together with difficulty in deglutition.

The patient was admitted in dermatology ward with the diagnosis of  Stevens-Johnson syndrome More Details - toxic epidermal necrolysis overlap. Oxcarbazepine was stopped but levetiracetam and clobazam were continued. For the skin lesions, the patient was treated with injection dexamethasone 4 mg OD, tablet hydroxyzine 10mg TID and topical ointments. Within 3 days of treatment, the patient had marked relief in the dermatological symptoms.

Discussion: It will be discussed at the time of presentation.

Keywords: Stevens Johnson syndrome, Oxcarbazepine, Dermatology

Psychiatric comorbidity in Caregivers of Patients with Dementia

Saurabh Jaiswal Suresh Kumar Parihar, B.S. Shekhawat, Devendra Vijayvargiya, Narendra Sindoliya, Vimal Meena, Shreyance Jain,

Senior Resident, Central Institute of Psychiatry, Ranchi, Ranchi, Jharkhand. drsaurabh1987@gmail.com

Background: Dementia is a devastating, chronic & progressive disease of brain. It not only affects the patient but also imposed significant burden on people taking care of the patient thereby affects quality of life, physical and psychological health of caregivers.

According to world Alzheimer report 2015 over 46 million people are living with dementia around the world & 4.1 million of them in India. This number is estimated to increase to 131.5 million by 2050.

Objective: The present study is designed to evaluate psychiatry comorbidity in primary caregivers of dementia patients.

Materials and Methods: 60 Primary Caregivers of dementia patients who attended Psychiatry and Neurology OPD of a tertiary care hospital were included in this study. Patients and Caregivers were evaluated by using a Semi-Structured Performa that includes socio-demographic data and other details. Cases of dementia were diagnosed by using MMSE.

General Health Questionnaire (GHQ) 12 was used for screening of cases & Back’s depression inventory was used to assess Severity of Depression and Hamilton anxiety scale was used for assessing severity of anxiety for those who screened positive in General Health Questionnaire.

Results and Conclusion: 15 patients (25%) were positive for GHQ 12. Out of which 4 patients (28%) were having severe & moderate depression each. Likewise 4 patients (28%) suffered with Moderate to Severe anxiety & 8 patients (53.3%) were with Mild to Moderate anxiety. Caregivers of dementia patients have significant psychiatric comorbidity.

Key words - Dementia, Quality of life, Caregiver burden.

Personality Disorder In Patients Attending OST Center NMCH Kota

Dr. Narendra Kumar, Dr Suresh Parihar, Dr Devendra Vijayvergiya, Dr ankita Garg, Dr Mithlesh Khinchi

PG Student, GMC Kota, Kota, Rajasthan. drsindu08@gmail.com

Introduction: The opioid dependence has significant harmful consequences for social, financial and physical domains of abuser’s life. Patient’s life goes through several serious life events, so there is high possibility of physical and mental morbidity as well as personality disorder.

Objective: To evaluate the personality disorder among opioid dependence patients.

Material and Method: 30 patients of opioid dependence attending opioid substitution therapy [OST] center or OPD Psychiatry NMCH KOTA, a tertiary care hospital are included in this study. The patients are being evaluated by using Eysenck’s Personality Inventory scale including sociodemographic data.

Results and Conclusion: Result & conclusion will be discussed at the time of presentation in the light of previous studies.

Key words – Opioid, dependence, personality.

Stressful Life Events And Anxiety Disorder: A Relationship Study

Soumen Samanta

PGT, Psychiatry, Burdwan, West Bengal. drsoumensamanta1983@gmail.com

Background: Anxiety disorders include disorders that share features of excessive fear and anxiety and related behavioral disturbances. Life-event may consist of any demarcated change in demographic, educational, employment, health, or other individual circumstances locatable to a particular point in time. The aim of this study is to assess stress and life events among patients of anxiety disorder.

Methodology: It is a cross-sectional study conducted over 161 new patients aged 18-60 years attending Psychiatry OPD and diagnosed as anxiety disorder (N=161). Patients fulfilling criteria of other psychiatric disorder & patients unwilling to participate were excluded from the study. After filling socio demographic data sheet, study tool i.e. Presumptive Stressful Life Events Scale (PSLES) was used and patients were asked to tick which life events out of 51 has occurred to them in past one year. Statistical analysis was done using standard statistical methods.

Results: Most of the study patients were from rural background (75.16%) and lower socio economic class (class IV &V) (72.67%). Majority of study patients belong to nuclear family (62.73%), Illiterate (29.81%), Bengali spoken (78.26%), Hindu (67.08%). Most of the patients (44.72%) were retired person, house wife, unemployed and students. Among study patients, according to total score obtained for each patients using PSLES, 53.4% patients had less/moderate stress, 39.1% patients had severe stress. Most frequently occurring live event is financial loss or problem (43.5%) followed by marital conflict (24.8%). There is statistically significant association (p<.05) found between life events score and five socio-demographic variables namely age, socio economic class, occupation, gender and language.

Conclusion: Majority of patients of anxiety disorder had moderate stress with financial loss or problem as most frequently occurring life event. Age, socio-economic class, education were important factors for occurrence of stressful life events.

Keywords: Anxiety disorder, Stress, Life events

Prevalence of depression in sexually transmitted disease patients in an out-patient clinic.

Snigdha reddy kota, Prasad rao G, Lokesh kumar k

Post graduate, Bhaskar Medical College, Hyderabad, Telangana. drsrkreddy2015@yahoo.com

Introduction: Sexually transmitted diseases are still highly prevalent worldwide and represent an important public health problem. Many studies state that both STI’s and depression go hand in hand. This study aims to measure the associations among sexually transmitted infection (STI) and depression. Depression when comorbid with STD, can pose a threat of reluctance among patients to get treated and this can lead to a vicious cycle. We in this paper tried to discuss the correlation between Sexually transmitted diseases & Depression.

Material & Methods:

Design – Analysis of a Cross-sectional study, no follow up was done.

Setting – Men and women aged 25- 60 years who presented in Bhaskar Medical College & Hospital STD clinic between March 2017- till date. Person to person interview was conducted using HAM – D scale (Hamilton Depression Rating Scale).

Participant’s - Population-based sample consisting of a total of 100 cases & 100 controls including both male & female of 25 - 60 years of age, who were diagnosed with sexually transmitted diseases & also who have multiple sexual partners.

Statistical Measure – SPSS - 23

Results – This study shows the significant association between depression occurring in Sexually transmitted disease patients who were not on treatment. Results would be discussed at the time of presentation.

Outcome measures – Multiple sexual partnerships in past year & positive test results for STI’S & venereal phobia.

Conclusion- Depression in STD clinic patients is associated with STD diagnosis. Identifying depression and developing strategies to intervene effectively may reduce risk behaviors and improve health outcomes.

Keywords: Depression, STI

Factors affecting duration of untreated psychosis in India & its implications

Sheena Varughese, Vidya Sathyanarayan, Johnson Pradeep, Sunita Simon Kurpad

Senior Resident, PIMS, Thiruvalla, Kerala. drsrliza@gmail.com

Background: In an effort to clarify the complex treatment delay construct, early psychosis researchers have focused on Duration of Untreated psychosis (DUP). There have been studies focused on the determinants of DUP abroad, however there are limited studies in India & scanty literature on factors affecting DUP & illness related factors.

Aims: To assess the DUP in first episode psychosis & to study the factors affecting DUP.

Methodology: The research design was descriptive & cross sectional. Data was collected through an interview using socio-demographic questionnaire, standardised tools & from current case records. MINI neuropsychiatric interview was used to generate ICD 10 diagnosis for primary psychotic illness. Positive and Negative symptom scale & Global Assessment of Functioning were used to assess severity of psychopathology & functioning. Hamilton Depression rating scale & Analysis of Delay in Accessing Psychiatric Treatment scale were used to assess the depressive symptoms & factors affecting DUP respectively.

Results: 53 patients were included in the study (41st episode & 13-relapse) & mean DUP were 38.8 & 32.7 months respectively. Gender, age, marital status, financial constraint, poor social support, poor insight & suspiciousness had a significant positive association with long DUP. Negative co-relation between DUP & treatment response within first 10 days of treatment were noted. Poor insight, socio-occupational dysfunction & poor self-care were associated with pathways to care.

Conclusion: We have found a significant positive relation between DUP, illness related & psycho-social factors. Treatment response with in 10 days stresses the importance of factors affecting DUP. It would be important to look at strategies to address these factors in an effort to reduce DUP in our community & thereby improve outcome.

Keywords: Duration of untreated psychosis, Treatment response, Illness related factors, Pathways to care.

Comparative Profile Of Atypical Antipsychotics In Patients Of Schizophrenia

Sumitabh Gupta ,Prerana Gupta, Mridul Sharma

Post Graduate Resident, Teerthanker Mahaveer Medical College, Moradabad, Uttar Pradesh. drsumit.tmu@gmail.com

Aims & Objectives: To evaluate the effectiveness of various atypical antipsychotics in psychopathology of schizophrenic patients.

Methodology: 40 patients diagnosed as per DSM 5 criteria for Schizophrenia admitted in the In-patient department of psychiatry at a tertiary care hospital participated in the study after obtaining due consent. 10 patients each were randomly assigned to treatment with the following four atypical antipsychotics: Olanzapine, Risperidone, Quetiapine and Aripiprazole. Positive and Negative Symptom Scale (PANSS) was administered on the first day of admission to assess baseline pathology followed by successive administration of PANSS at Day 7, Month 1 and Month 2 following initiation of treatment to assess the extent of improvement with various drugs. Results were tabulated using SPSS v20 and independent sample t tests were applied.

Results: Most significant improvement in psychopathology was seen in patients on treatment with Risperidone followed by Olanzapine. There was a significant difference found (p<0.05) between the PANSS score for Risperidone and Aripiprazole at 2 months.

Conclusion: This study shows similar results as demonstrated by comparable studies done in other countries. The baseline psychopathology as calculated using PANSS scores showed improvement after 2 months of antipsychotic treatment with all antipsychotics evaluated in this study.

Keywords: Schizophrenia, Positive and Negative Symptom Scale (PANSS), Risperidone, Olanzapine, Quetiapine, Aripiprazole.

Prevalence of Sexual Dysfunctions In Epilepsy Patients

Tahir Husssain Sisghar, K.K.verma, Girish Chandra Baniya, Sandeep Sharma

P.G.Resident, Dept.Of Psychiatry,S.P.M.C.Bikaner, Bikaner, Rajasthan. drtahir21@gmail.com

Introduction: Epileptic patients frequently exhibit sexual and reproduction dysfunctions.

Epileptiform discharges may disrupt the function of structures mediating sexual behavior, particularly the limbic cortex, or alter the release of hypothalamic–pituitary hormones.

Aims: The aim of this study was to evaluate the prevalence of sexual dysfunction among epileptic patients.

Methods and Meterials: This was a single centre, prospective, open label study conducted at Dept. of psychiatry, SardarPatel medical college. After taking ethical clearance from institutional ethical and review board one hundred married men between 21 and 50 years with a confirmed diagnosis of epilepsy were enrolled in this study. Patients with other neurological diseases, hypertension, cardiovascular diseases, diabetes mellitus, underlying urogenital diseases, and impaired general health status were excluded. Demographic and clinical characteristics of the disease were evaluated, and sexual function was assessed by the self-administered questionnaire of the International Index of Erectile Function-5 (IIEF-5) and Changes In Sexual Functioning Questionnaire(CSFQ-F-C). Unpaired student t test was applied to analyze data.

Results: Out of 100 patients, 45 (45%) had erectile dysfunction according to (IIEF-5) scale. Type of seizure had a significant correlation with erectile function score. Frequency of epileptic seizures (before treatment), total duration of illness and total duration of treatment and total number of anti- epileptic drugs correlated with the scores for erectile function, orgasmic function and sexual desire. Out of 100 patients 51 patients had sexual dysfunctions according to (CSFQ-F-C) scale.

Conclusion: It seems that the main aspects of sexual activity such as erectile function, orgasmic function and sexual desire are frequently impaired in epileptic patients. Our findings were also indicative of a higher risk of sexual dysfunction in patients with partial seizures.

Keywords: Seizure Disorder, Sexual Dysfunctions, Reproduction Dysfunctions

Domestic Violence and Role of Some Related Factors in Indian Urban Young Adults

T. Mitra., Kedar R. Banerjee, M. Das, J. Saha

Clinical Psychology, National Institute Of Behavioural Sciences, Kollkata, West Bengal. drtmitra@yahoo.in

Background: Domestic violence in form of physical aggression, emotional abuse, and sexual violence are becoming a serious problem in Indian urban life. In addition to physical injury, victims report greater psychological distress, suicidal thoughts, substance use and even indulgence in sexual promiscuous behaviour. This study examined several risk and protective factors for the domestic violence victimization among adolescents and young adults.

Methods: The subjects who visited the clinic at Kolkata during the period of 2010 to 2013. The resulting sample of participants (N = 180) included 142 women (78.89%) and 38 men (21.11%) with a mean age of 22.6 years (range 18–26 years). Questionnaires used for the purpose were serious violation, violence prevalence, locus of control, number of siblings, level of education and religiousness.

Results: Serious violation behaviors remained statistically significant in the multivariate model. Participants with an inner Locus of control were also significantly more likely to report those behaviours. Participants who have no siblings were more likely to report. Education level was not statistically significant. More religious people reported lesser violence.

Conclusion: Violence is a significant public health issue associated with serious issues for victims, families and children witnessing family violence. The present study identified several risk factors associated with violence among a high-risk sample of young adults as serious violence-related behaviors, inner locus of control, use of intoxicating substance and having less/no siblings emerged as significant predictors of violence. Collectively, these results suggest that interventions might focus on parental teaching about changing gender roles, causes of violence, anger, and stress reduction as one means to prevent domestic violence. Some possibilities include providing skills training for coping with stress, anger and anxiety.

Romantic Relationship Related Aggression in Adolescents

T. Mitra., Kedar R.Banerjee, M. Das, J. Saha

Clinical Psychology, National Institute of Behavioural Sciences, Kollkata, West Bengal. drtmitra@yahoo.in

Background: Romantic relationship has become a general trend in teen-age of urban areas in India. An increase of adolescent romantic relationship related tribulations are also becoming evident now-a-days in urban clinical practice in cities like Kolkata. Various dimensions as aggression, externalizing construct, peer relationship and psychosocial functioning which have been linked with such relationships and needed careful evaluation to deal with the problem. Present study investigated the relationship between romantic relationship and effect of negative peer pressure, aggression, locus of control and other constructs affecting psychosocial functioning.

Methods: Total 96 adolescent students were screened for the study who reported having romantic relationship for at least six months. The measures used were as Relational aggression questionnaire, LOC questionnaire, Beck Depression Inventory, Fear of Negative Evaluation etc. The assessments were done at baseline, after therapeutic intervention (at 8th week) and at follow-up (at 12th week).

Results: Results indicated strong relationship between relational aggression and negative peer pressure. Locus of control is found to be related and fear of negative evaluation is proportional to relational aggression. Higher hostility related to more aggressive behaviour came out as expected.

Discussion: Adolescents who are found to be exposed to high negative peer pressure were more aggressive in romantic relationship. This type of aggression leads to depressive symptoms and poor impulse control which can show improvement with therapeutic intervention. It may be important for parents, schools, and therapists who all have the potential to create opportunities for individuals during childhood and early adolescence to help equip teens with the tools necessary to deal with negative peer pressure.

Keywords: Romatic relationship, aggression, adolescents

Comparing Strengths, Difficulties and Loneliness between Socioeconomically Deprived and Advantaged Children

M. Vijay Kumar, Raghuram Macharapu, Pramod KR Mallepalli, Ravulapati Sateesh Babu,

Post graduate in Department of Psychiatry, 2nd year, Mamata medical college, Khammam, Telangana. drvijaymodala@gmail.com

Background: Children in the poorest households are three times more likely to have a mental illness than children in better-off households. Poverty can be intrinsically alienating and distressing. A summary of research reveals that child born into and growing up in poverty is more likely to be in poor health and have learning and behavioral difficulties.

Aims and Objectives: The present study is an attempt to study strengths-difficulties and experiences of loneliness in Below Poverty Line (BPL) and Above Poverty Line (APL) children and compared the same between two groups.

Materials and Methods: The total sample consisted of 120 participants (age range 10-13 years), 60 BPL and 60 Above Poverty Line (APL) children. Each group further consisted of 30 females and 30 males. The samples were drawn using convenience sampling method. Strengths and Difficulties Questionnaire (SDQ) and Loneliness and Social dissatisfaction scale were the tools used.

Results: Statistical analysis done by using descriptive and inferential statistics i.e. mean, standard deviation (SD), percentages, t-test & Pearson’s correlation. The results analysed will be presented later.

Conclusions: The current study carried out to compare strengths, difficulties and loneliness among socioeconomically deprived and advantaged children.

Key words: BPL children, strengths-difficulties, loneliness.

Assessing the Relationship of ABO & Rh Blood Groups with Dhat Syndrome and its Psychiatric Comorbidities: A Preliminary Study

Vinay Kumar, Pravin Khairkar

Junior Resident, MGIMS Sevagram, Sevagram, Wardha, Maharastra. drvinay15@gmail.com

Background: “Dhat syndrome” is a culture bound syndrome characterized by preoccupation with semen loss and attribution of physical and psychological symptoms to the same. This study aims to examine the relationship between ABO & Rh Blood Groups in patients of Dhat Syndrome and to evaluate presence of psychiatric comorbidities in patients of Dhat Syndrome

Material and Methods: This is a Cross Sectional, Observational study done in 100 male patients visiting in out-patient department of psychiatry of Mahatma Gandhi Institute of Medical Sciences during the study period of 18 months. All new patients diagnosed with Dhat syndrome as per International Classification of Diseases 10 (ICD 10) were included in our study. The patients who did notagree to take part in the study were excluded. We investigated the blood group of all patients and psychiatric comorbidities were assessed by using Hamilton depression rating scale (HAM-D) and Hamilton rating scale for anxiety and sexual dysfunction by Arizona sexual experiences scale (ASEX). Data were analysed by using Microsoft Excel Sheet and Calculations were done.

Result: Total of 100 patients participated in the study. Out of these most common ABO Blood Group was Group B (35%) among Dhat syndrome patients, followed by Group A(33%), with Rh Positive Blood Group (93%) was more common. In our study overall 51% of patients had either comorbid psychiatric disorder and or Sexual dysfunction or both. We found 33% of patients had co-morbid psychiatric disorder and 36% of the patients had sexual dysfunction.

Conclusion: We concluded, there is no statistically significant correlation between ABO & Rh Blood Groups with Dhat Syndrome. Also, Depression is commonest psychiatric comorbidities in the patient of Dhat Syndrome.

Key Words: Dhat Syndrome, Blood Group, Psychiatric Comorbidity.

Prevalence of depression among tuberculosis patients: A study from north India

Yogesh dosodiya, Parth Singh meena, Mahendra jain, Anil Kumawat, Charan Singh jilowa,

PG Student, JLN Medical College Ajmer, Rajasthan. dryogesh.dosodiya@gmail.com

Background:- Tuberculosis is a chronic infectious disease and is one of the leading causes of mortality worldwide, if not treated properly. Symptoms of depression and anxiety have been commonly observed among patients of TB. When TB and depression coexist, the risk for developing co-morbidities increases.

Objective:- Aim of this study was to determine the risk factors and prevalence and depression among TB patients.

Method- After obtaining informed consent, a semi-structured, pre-designed questionnaire was used to assess socio- demographic profile of study subjects. Beck’s Depression Inventory was used to assess prevalence of depression. Patients who were already undergoing treatment for depression prior to onset of TB were excluded.

Results- Prevalence of depression among tuberculosis patients was found to be 50.31%. Majority (84.9%) of patients had pulmonary TB. Treatment category I was prescribed for 68% of patients. The study highlighted older age, extensive pathology, unmarried status and lack of social support as risk factors for depression in patients.

Conclusion:- Depression is highly prevalent among patients in treatment for TB, most particularly among elderly. Patients with extensive disease, from joint family and who are unmarried.

Keywords: -Depression, Tuberculosis (TB), psychiatric morbidity

Depression, Stress, Anxiety and Psychosocial Functioning in School going Adolescents

Srinivasa Sivaram Kishore D, Raghuram Macharapu, Pramod KR Mallepalli, Ravulapati Sateesh Babu

Post graduate in dept of psychiatry, 2nd yr, Mamata medical college, Khammam, Telangana. dssrkishore@gmail.com

Background: Lifetime prevalence of depression and anxiety increases from 1% of the population under age 12 years to ~17%-25% of the population by the end of adolescence. The greatest increase in new cases occur between 15-18 years. Indian empirical studies have reported a prevalence of psychiatric morbidity in the range between 14.4% and 31.7%; thus, affecting psychosocial functioning.

Aims and Objectives: The objectives of the current study were to (i) examine the psychometric properties of the DASS and SDQ on Indian adolescents, (ii) explore the role of socio- demographic variables.

Methodology: The sample comprised of 100 students from 8th, 9th and 10th standard. The participants were administered a booklet containing demographic questionnaire and psychometric scales such as DASS and Strengths and Difficulties Questionnaire (SDQ)

Results: Statistical analysis was done by using descriptive and inferential statistics i.e. mean, standard deviation (SD), percentages and correlation analysis. The results analysed will be presented later.

Conclusion: The current study is being carried out to know the symptoms of depression, stress and anxiety and their effect on psychosocial functioning.

Keywords: depression, anxiety, stress, psychosocial functioning.

A study of attitude towards medication and medical help-seeking among medical and pharmacy students

Dushad Ram, Najla Eiman

Associate Professor, JSS Medical College, Mysore, Karnataka. dushadram@hotmail.com

Background: Attitude towards medication and medical help-seeking varies among students and has a bearing on keeping optimum health. There is a paucity of studies examining these variables among medical and pharmacy students.

Aims: To know the attitude towards medication and medical help-seeking and its relationship in medical and pharmacy students.

Materials and Methods: 306 (Pharmacy =162, Medical =144) were assessed with socio-demographic and clinical proforma, Hogan Drug Attitude Inventory, and the action/intention sub-scale of Attitudes toward medical help-seeking scale.

Results: Mean score on DAI-12 score and ATMHSS were 14.02 and 26.29 respectively. Pharmacy group had statistically significantly lower score (MU=1.012, Z=-2.012, p=.044) on DAI-12. There was a statistically significant association of ATMHSS score with partial (MU=6570.500, Z=-2.425, p=.015) and good (MU=1532.000, Z=-2.686, p=.007) attitude of DAI- 12 score.

Conclusion: Pharmacy students tend to have negative attitude towards medication use as compared to medical students. There is positive association between attitude towards medication and medical help seeking.

Keywords: Attitude, Medication, Help-seeking, student

Suicide and depression literacy among health professions’ students in tertiary care centre in South India.

Dushad Ram, Suhas Chandran

Associate Professor, JSS Medical College, Mysore, Karnataka. dushadram@hotmail.com

Background: Level of suicide and depression literacy may mediate help seeking. There is paucity of research in this field. This study was undertaken to know suicide and depression literacy among health professions’ students.

Materials and Methods: Three hundred thirty nine health professions’ students were assessed with socio-demographic and clinical proforma, depression literacy scale and suicide literacy scale.

Results: There was low score on measure of Depression and suicide literacy. Paramedical have lower literacy of suicide (MU=9.44; Z=-5.39; p=.001) and depression (MU= 9.28; Z=-5.53; p=.001) than medical student. On linear regression analysis (R2=.06, F=21.66, p=0.001), there was a statistically significant association between suicide and depression literacy (p=.001)

Conclusion: Depression and suicide literacy is poor among health professions’ students, particularly paramedical student. Suicide literacy is positively associated with depression literacy. There is a need to sensitize these students about depression and suicide.

Keywords: depression literacy, suicide literacy, health professions’ students

Prevalence of Attention deficit hyperactivity disorder and it’s comorbidities.

B Suryaprabha, Sireesha, Hrishikesh giri prasad

Student, Institute of mental health, Hyderabad, Telangana. earthlyshine@gmail.com

Introduction: ADHD is one of the most common chronic behavioral disorder among children characterised by persistent hyperactivity, impulsivity and inattention. It effects multiple domains child’s life causing significant impairment which is carried forward into adolescent and adulthood Hence it is important to diagnose and treat ADHD to prevent defects in overall functioning.

It is often associated with multiple comorbiditis and optimal and timely addressal of them is also important

Objectives of the study:

  1. To study prevalence of ADHD among children aged 6-12 yrs of age.


  2. To study sociodemographic factors associated with study sample.


  3. To study comorbidities of ADHD subjects.


  4. Inclusion Criteria: Parents of ADHD subjects who have given consent.

    Exclusion Criteria: Parents who have not given consent

    Chronic physical illness

    Visual and hearing defects.

    Place of study: Tertiary hospital for women and child care Hyderabad.

    Duration of study: November- December 2017.

    Methodology: This is a cross-sectional study.

    Study involves children aged 6-11 years.

    All registered cases from psychiatric opd within this age limit are taken

    Sampling Technique: convenience sampling.

    Consent is taken and confidentiality is maintained.

    ADHD- diagnosed by DSM 5

    Separate Semi structured intake proforma for child and parent will be used to elicit birth and developmental milestones of children, history of substance abuse, educational qualifications of parents, family history of ADHD, mental illness and recent stressful life events.

    Semi structured proforma and Vanderbilt scale for assessment of comorbidities will be given to parents.

    Analysis: SPSS software version 17.

    Results & conclusion: will be discussed at time of presentation

    Key words: ADHD, Prevalence comorbidities

    Experience of Caregiving and its association with Coping Strategies in Caregivers of Obsessive Compulsive Disorder

    Erika Pahuja, Anil Nischal, Anuradha Nischal, Bandna Gupta, Adarsh Tripathi, Manu Agarwal

    Junior Resident, King George’s Medical University, Lucknow, Uttar Pradesh. erikapahuja.01@gmail.com

    Background: Experience of Caregiving represents both positive and negative appraisals of caregiving whereas burden of care represents only negative connotation. Caregiving experience may depend on various patient and caregiver related factors including caregiver’s personality and coping strategies used by them. It is well known that severe mental disorders like Obsessive Compulsive Disorder have a significant level of burden on caregivers. Experience of Caregiving has been studied in SMDs like Schizophrenia, Anorexia Nervosa, however we did not come across any study on Experience of caregiving in OCD. Hence we planned our study on the same.

    Aims: To study the experience of caregiving in caregivers of OCD and its association with coping strategies.

    Method: Sixty seven caregivers of patients of OCD were assessed on Experience of Caregiving Inventory and Cope Inventory. Association of experience of caregiving with socio-demographic variables of caregivers as well as patients and clinical variables of patients was studied. Correlation of ECI scores with coping strategies was studied.

    Result and Conclusions: Negative appraisal of caregiving was maximum in the domains of ‘Dependency’, ‘Negative Symptoms’ and ‘Need to Back up’. ‘Good Aspects of Relationship’ scored more than ‘Positive Personal Experience’ in positive appraisal of caregiving. Negative appraisal was higher in female, rural, illiterate caregivers and in caregivers of severe and extreme OCD. Male caregivers had high positive appraisal of caregiving. Instrumental social support and Emotional social support were found to influence negative appraisal of caregiving and Progressive Reinterpretation and Growth, Active Coping and Planning influenced positive appraisal of caregiving.

    Non Adherence with Pharmacotherapy Among Patients Attending Psychiatry OPD : A Study From Kashmir

    Insha Rouf

    Senior Resident, GMC Srinagar, Srinagar, Jammu and Kashmir. fazleroub@gmail.com

    Introduction: Psychiatric disorders usually require treatment for prolonged periods of time.One of the greatest challenges in treatment of these disorders is treatment non adherence as prescribed by psychiatrists. Effective strategies need to be planned out so as to understand the factors contributing to treatment non adherence and manage them properly.

    Aim: To understand major factors responsible for treatment non adherence among psychiatric patients attending OPD at a tertiary care hospital in Kashmir.

    Material and Methods: 120 consecutive non adherent patients attending psychiatry OPD at our department were evaluated. Non adherence was defined by Rosack’s criteria while as the reasons for non adherence were assessed using a checklist prepared by consultant psychiatrist.

    Results: Non compliants were more likely to be females,less educated, unmarried, unemployed, belonging to low socioeconomic status and from rural background.Side effects (19.17%) and mistrust or lack of knowledge regarding illness (18.33%) were the major contributors to non adherence.

    Conclusion: Our findings suggest that there is a need to provide adequate information regarding illness and drugs to patients and/or caregivers.

    Keywords: Compliance, Non adherence, Kashmir

    Clinical Phenomenology of OCD

    Sabreena Qadr

    Senior Resident, GMC Srinagar, Srinagar, Jammu and Kashmir fazleroub@gmail.com

    Background: Obsessive Compulsive Disorder is a chronic and disabling psychiatric disorder characterized by recurrent intrusive thoughts, images and impulses known as obsessions which are usually accompanied by repetitive acts or behaviors known as compulsions. The clinical presentation of this disorder has been found to be vary from one region to other ; being highly influenced by social, cultural and religious factors. We aimed to study the symptom pattern of the patients presenting to our institute from Muslim majority region of Kashmir valley.

    Methods: Our study was a cross sectional observational study. Obsessive Compulsive Disorder was diagnosed as per DSM IV TR criteria. A total of 156 patients were included in this study. Clinical phenomenology and severity were assessed using Yale Brown Obsessive Compulsive Check list and Scale respectively. Data analysis was done with the help of SPSS,version 20.

    Result: Contamination was the commonest obsession in 55.76% patients. Religious obsessions in 25.00%, Aggressive obsessions in 21.15%, Symmetrical obsessions 20.51%, Sexual obsessions in 16.02%, Somatic in 15.38%, miscellaneous in 32.69% patients were the other types of obsessions. Cleaning in 51.92%, Checking 32.69%, repeating 28.28%, counting in 6.41%, ordering in 4.48% and miscellaneous in 15.38% patients were the type of compulsions found in our study.

    Conclusion: Contamination was the commonest obsession while as cleaning was the commonest compulsion

    Key Words: Kashmir, Obsessive Compulsive Disorder, OCD, Phenomenology.

    Attempted suicide in young adult and adolescent patients in Kashmir

    Fazle Roub

    Senior Resident, GMC Srinagar, Srinagar, Jammu and Kashmir. fazleroub@gmail.com

    Background: Several efforts have been made in the past to study psychosocial risk factors and clinical profile associated with attempted suicide, but only few have addressed the issues of youth in a conflict area Kashmir.

    Aims: To study psychosocial risk factors and clinical profile associated with attempted suicide in young adult and adolescent patients in conflict zone-Kashmir.

    Material and Method: It was a hospital-based study in which 200 young adults and adolescent patients who were admitted following unsuccessful suicide attempts to the emergency and referred to Department of Psychiatry, Govt. Medical College, Srinagar, Jammu and Kashmir, India. Selected patients were subjected to Mini International Neuropsychiatric interview (MINI) and International Personality Disorder Examination (IPDE) for evaluation of symptoms and diagnosis. Subjects of age less than 15 years and more than 34 years have been excluded.

    Results: Majority of the suicide attempters 65% were < 24 years of age with adolescent over represented in the sample (Mean = 21.24 ± 4.66), females were 58%, low socioeconomic status (86%), oral agents (most common method) was used by 84%, 64% had expressed suicidal or death wishes before act and 72% made an impulsive attempt. Eighty-two percent of the suicide attempters were suffering from some psychiatric illness at that time. Out of which 40% had mood disorder with predominance of major depressive disorder, 15% had personality disorders, and 9% had posttraumatic stress disorder.

    Conclusion: Knowledge of clinical phenomenology may assist in identification and early intervention of youth who are at high risk. Overall, findings indicate a strong and immediate relationship between suicide attempt and psychiatry morbidity.

    Keywords: Attempted suicide, clinical phenomenology, psychosocial risk factors, young adult and adolescent patients

    A study of attitude of post graduate medical students towards psychiatry in north India

    Gaurav Dhanda, Mahendra Jain, Charan Singh Jilowa, Parth Singh Meena, Jitendra Arora, Sunil Moond

    Resident, JLN Medical College Ajmer , Rajasthan. gauravdhanda007@gmail.com

    Context: Attitude of Post graduates toward psychiatric patients is important to bridge the treatment gap due to mental illness. Psychiatry as a subject has been neglected in the undergraduates of MBBS.

    Aims: To compare the attitude of post graduate medical students at tertiary care centre toward mental illness and psychiatry.

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

    Subjects and Methods: Participants consisted of post graduate medical students, who had completed their compulsory 2 week clinical posting in psychiatry. Participants were individually administered sociodemographic proforma and attitude to psychiatry-30 (ATP-30) scale. Standard descriptive statistics (mean, percentage), Chi-square test and independent sample t-test were applied.

    Results: A total of 116 participants formed the study sample, with 64 males and 52 female. Mean ATP score was 90 for the entire sample. Mean ATP for Age<30 years, 90.35(1.171) and >30years, 91.96(1.485), for Clinical group, 90.33(11.138) and Paraclinical, 91.85(8.263), for duration of experience <5years 90.35(1.095) and>5years, 92.50(2.047), for Male 88.13 (1.403) and Female 93.83(1.208), with positive family history, 93.79(1.591) and negative family history 89.45(1.189)

    Conclusion: There was better outlook of postgraduates of non-clinical department, elderly, females and postgraduates who had more exposure to medical education (p=>0.05). Having a psychiatric patients in family enhanced the understanding and positive attitude toward psychiatric illness and psychiatry.

    A Cross-Sectional Study Of Perceived Stress, Self Esteem, Body Image Disturbance And Suicidal Intent In Patients Of Acne Vulgaris

    Geetanjali Ghorpade, Kranti Kadam, Sunanda Mahajan, Shubhangi Parkar, Amey Angane

    Second Year Resident,M.D Psychiatry, Seth G.S.Medical College And K.E.M Hospital, Mumbai, Maharashtra. geetanjalighorpade@gmail.com

    Introduction: Acne vulgaris is a common dermal disease characterized by chronic inflammation of the pilosebaceous units. A strong association is reported between the incidence of acne and elevated anger, depression, frustration, disturbed self-image, suicidal ideation, mental health problems, and social impairment among adolescents. Psychological stress has also been identified amongst factors that exacerbate acne. Acne may be associated with impairment in self esteem.

    Aims and Objectives: The purpose of the study is to assess the level of perceived stress ,self esteem, body image disturbance and suicidal intent in patients of acne vulgaris and to study the co-relation between severity of acne and perceived stress, self esteem , body image disturbance and suicidal intent.

    Materials and Methods: It is a cross-sectional observational study. Sample consisted of 72 patients with acne vulgaris. After taking informed consent subjects were assessed on Perceived Stress Scale-10 for finding out the perceived stress, Rosenberg’s Self Esteem Scale to find out the self esteem , Appearance Anxiety Inventory for body image disturbance and Columbia-Suicide Severity Rating Scale for suicidal intent

    Results: Study is still on going.

    Conclusion: Pending as the study is ongoing

    Key Words: Acne vulgaris, perceived stress, self esteem, body image disturbance, suicidal ideation

    A Study of Sociodemographic Profile and Psychiatric Comorbidities in Adolescent Patients with Deliberate Self Harm: A Chart Review

    Indu C.G, Sandeep Alex, V. Sathesh

    Junior Resident, Govt Medical College Kottayam, Kerala. geethavs4@gmail.com

    Background: Suicide is a major public health concern and WHO estimates that nearly 900,000 people worldwide die from suicide every year [1Adolescents constitute 21 per cent of the population of India.Hence study about adolescents got huge public importance.

    Aim: The aim of this study was (1)To study the sociodemographic profile of Adolescent patients with Deliberate Self Harm. (2)To study the psychiatric morbidities in them.

    Materials and Methods: This is a descriptive observational study done by chart review from July 2016 to July 2017 of adolescent patients with Deliberate Self Harm who attended Suicide prevention clinic, Department of Psychiatry at a Tertiary care center. Out of 57 adolescents attended the Suicide prevention clinic.43 were included.Sociodemographic and clinical profiles were collected using the semi-structured proforma. The assessment of Suicide intent was done by Beck’s suicide Intent Scale. Psychiatric comorbidity of these patients was assessed on Structured clinical interview for DSM-5.The data were tabulated and analysed using Descriptive statistics. Statistical Package for the social sciences(SPSS) Version 22 was used for analysis.

    Results: Females studying in Higher secondary school outnumbered the males, majority under the age group of 16 and 17 years coming from nuclear family belonging to Above poverty line group. Most of them were of low intent with mixed personality traits followed by borderline traits and with other psychiatric morbidities such as adjustment disorders,conduct disorders, ADHD, Substance use disorders and no subjects fell under the classification of Non suicidal self injury.

    Conclusion: Age group 16 and 17 were more vulnerable to deliberate self-harm and majority were females, with scolding as the main triggering factor. Majority was of low intent with borderline personality traits and adjustment disorders and no subjects involved under the classification of Non suicidal self injury.

    Key words: Adolescents, Deliberate self-harm, Descriptive study, Psychiatric morbidity

    A Study Of Prevalence Of Internet Addiction And Patterns Of Usage Among Medical Students

    Gautami Nagabhirava, S.G Gupte, Rohan Shah

    PG Student, Dr.Vasantrao Pawar Medical College,Hosptial, and Research Center, Nashik, Maharashtra. gnagabhirava@gmail.com

    Background: India now has the world’s third largest national digital population, with approximately 120 million internet users in 2011. With this increase comes a growing concern about ‘Internet Addiction” a term defined by Young as pathological compulsive internet use. This study was aimed to study the prevalence and patterns of internet addiction among medical students.

    Material and Methods: A cross sectional study will be carried out in medical students of both sexes in a medical college in the city of Nasik, Maharashtra.

    Inclusion Criteria:

    1. Medical students.
    2. Both sexes.
    3. Students aged between 17 and 25 years.
    4. History of using internet from past 1-year or more.
    5. Willing to give consent.


    Exclusion Criteria:

    1. Not willing to give valid consent.
    2. Not using internet


    Institutional Ethical Committee approval will be obtained before starting the study.

    All questionnaires will be distributed to the participants in classroom settings at a predetermined time and will be collected onsite after 30 minutes. The questionnaires will be anonymous and self-administered.

    The information will be collected by using a semi structured proforma that contains details of demographic data, purpose of using the internet (by choosing among the options such as education, online games, social networking or entertainment), gadget used to access internet (Desktop, Laptop, Mobile phone or Tablet), and the average duration of usage per day.

    Subsequently all the subjects will be assessed for internet addiction by administering Young’s Internet Addiction test.

    Results: Statistical analysis will be done using SSPE software. As this is an ongoing study, results are awaited.

    Conclusion: Results are awaited

    A Comparative Study of Deliberate Self Harm among Adolescent and Adult and their Personality and Psycho-pathological Correlates

    Narottam Halder

    MBBS,DCH,3rd Year MD PGT, Institute Of Psychiatry,Center of Excellence, IPGME&R, Kolkata , West Bengal. halder.narottam@gmail.com

    Introduction: The cost of suicide attempt or DSH is not only destruction or injurious to self-life, but it imposes mental, physical and emotional stress on the family members and friends as well. Usually, suicide attempt or DSH has no single cause. The late adolescents and early adults are likely to experience more stress and emotional turmoil as they face the threshold of adulthood. So this study was aimed to compare several associated factors among adolescents and adults in cases of patients with deliberate self harm.

    Materials and Methods: Consecutive 50 adolescent (12 to <18 years) and 50 adult (>18 to 60 years) cases were taken based on the inclusion and exclusion criteria of the study, conducted from 1st April 2016 to 31st March 2017. Socio-demographic profile, Psychiatric disorders, Severity of depression/anxiety, Suicide intent, Lethality of suicide attempt and Personality profile of each of the patient in the study population was noted. The findings and observations were noted on a pre-designed proforma and statistically analyzed by using SPSS software version 20.0 for windows 7.

    Results: In the present study several psycho-socio-demographic factors like young age, singles, females, nuclear family, Hindu, urban/semi-urban, past history of DSH and presence of some psychiatric illness (OCD, GAD, Alcohol/substances dependence/abuse) were identified as contributing factors to suicide attempt/DSH. Likewise personality traits such as neuroticism and psychoticism also contributed to suicide attempt/DSH. A significant positive relationship between these factors was also identified.

    Conclusion: Findings of the present study demand the immediate attention of mental health professionals to identify these high risk factors in susceptible individuals, so as to modify these factors to prevent them from attempting suicide/DSH.

    Keywords: Adolescents, Adults, Deliberate Self Harm

    Prevalence Of Depression And Anxiety Among Coronary Heart Disease Patients- A Study In A Tertiary Hospital

    M.Haritha Devi, Prabhu Kiran, R.Somasundarababu

    Mbbs, Asram, Eluru, Andhra Pradesh. haritha.kona4@gmail.com

    Background: Depression and anxiety could reduce the quality of life, and exacerbate physical symptoms and even mortality amongst patients with coronary heart disease. According to an estimate by the World Health Organization (WHO), by the year 2020, both coronary heart disease and depression will be the two major causes of disability- adjusted life years.

    Aim: To find the prevalence of depression and anxiety among Coronary heart disease patients.

    Materials and Methodology: Study population consists of 30 Coronary heart disease patients admitted in department of Cardiology, ASRAM college and hospital, the study is a cross sectional study and the patients will be assessed using Hospital Anxiety and Depression Scale(HADS).

    Note: Since the study is in process the results, discussions, and conclusion will be discussed during the time of final presentation of the paper.

    Keywords: Depression, Anxiety, Coronary heart disease.

    Assessment of Reassurance Seeking In Patients Of Somatoform Disorder

    Soumyabrata Hati

    M.B.B.S , M.D.(Pgt), The West Bengal University Of Health Sciences, Serampore, West Bengal. hatisoumyabrata@gmail.com

    Background: Patients with mental disorder presenting with medically unexplained symptoms (somatized mental disorder) are common in all opd. They have potentially treatable psychiatric disorders that cause, exacerbate, or maintain the physical symptom or related disability.

    Reassurance seeking scale is a vital tool for assessment in patients of somatoform disorder.

    Materials and Methods:

    Study Area: Outpatient department in Burdwan Medical College and Hospital , Burdwan.

    Study Population: New patients during the study period primarily diagnosed with somatoform disorder at Psychiatry OPD who are aged between 18-60 years and from both sex.

    Study Design: A Cross-Sectional study.

    Study Tool: Reassurance Seeking Scale[RSS]

    Statistical Analysis - SPSS, Descriptive statistics & Linear Regression.

    RESULTS: Measures of central tendency for Reassurance Seeking Scale (RSS) in Somatoform Disorder patients

    RSS DATA SCORE

    Lowest value 19

    Highest value 36

    Mean 26.5858

    Standard deviation 4.6758

    Median 26.0000

    AGE VS RSS DISTRIBUTION

    ASSOCIATION BETWEEN RSS WITH BACKGROUND CHARACTERISTICS



    Conclusion: The lowest and highest value are 19 and 36 respectively. In case of mean , standard deviation and median the score value are 26.6,4.7 & 26 respectively.

    According to age distribution, the RSS total score showed maximum population between the age group 30-50 yrs. In association with demographic profiles RSS showed significant results for education, language, occupation and sex category.

    Thus it can be concluded that somatoform disorder patients who were predominantly female, belonging to lower socio-economic class, from a rural background, Bengali speaking of age group 31-45 years were more prone to seek reassurance.

    Sexual Dysfunction With Substance Use

    Ichpreet Singh, Suprakash Chaudhury, D.Saldanha, Archana Javadekar, Samiksha Sahu, Prajakta Patkar, Saurav Kumar

    PG Student, Dr. Dy Patil Medical College and Hospital, New Delhi. ichpreetsingh_2007@yahoo.com

    Background: Alcohol associated sexual dysfunction leads to marked distress and interpersonal difficulties. There are very few Indian studies dealing with this subject. It is in this context that this study is conceptualized to unravel the magnitude of sexual dysfunction in patients suffering from alcohol dependence syndrome.

    Aim: To assess the prevalence and pattern of sexual dysfunction in a clinical sample of subjects with alcohol dependence syndrome.

    Materials and Methods: Hospital based, cross sectional study included seventy consecutive male subjects admitted to a tertiary care hospital with a diagnosis of alcohol dependence syndrome (F10.30, ICD-10 DCR criteria). Patients were assessed for sexual dysfunction using changes in sexual functioning questionnaire-14 (CSFQ-14).

    Results: Our study showed that 75.7% of our patients of alcohol dependence syndrome were suffering from sexual dysfunction including erectile dysfunction (73.5%), decreased sexual desire (50.9%) and pre mature ejaculation (37.7%).

    Conclusion: Sexual dysfunctions are common in patients with alcohol dependence. Clinicians need to thoroughly assess sexual functioning in alcoholic patients to rule out other factors leading to sexual dysfunction.

    Key words: Sexual dysfunction, alcohol dependence syndrome.

    Assessment for prevalence and pattern of depression in cancer patients

    Anil Kumar Kumawat, Parth Singh Meena, Mahendra jain, Yogesh Dosodiya, Krishan Sharma

    PG Student, JLN Medical College Ajmer, Rajasthan. imanil.kumawat@gmail.com

    Introduction: Major Depressive disorder is a major cause of concern in cancer patients. Clinical depression is a common and more often unrecognized source of psychiatric problems in cancer patients. This is an important factor leading to drop out form treatment before the start of cancer treatment. Depression also contributes to suicidal tendencies in cancer patients. Prevalence of depression varies depending upon the type and sites of cancer.

    Objective:- Aim of this study was to relate the socio-demographic profile of cancer patients with their depression levels.

    Materials and Methods: In this analysis patients who were registered and undergoing treatment for various cancers at a regional cancer centre were followed- up and evaluated of depression and its levels. The study was carried out from July 2017 to November 2017. The mini international neuropsychiatric interview (MINI) questionnaire was used for screening and processing of the symptom for depression. Hamilton’s depression rating scale (HDRS) was used for grading Patients depression.

    Results: The Results will be assessed with appropriate statistics tools and will be discussed in the case conference.

    Conclusion: Will be discussed in the case conference.

    Key words : Cancer, Depression, Hamilton depression rating scale.

    Clinical correlates of Cavum Septum Pellucidum and its prevalence in patients of Alcohol dependence: A prospective comparative CT study

    Karnik kishore, Crj Khess

    Senior resident, PMCH, Patna, Bihar. imkarnik@yahoo.co.in

    Background - Some neuroimaging studies have reported a range of functional and structural abnormalities of the limbic system in substance-dependent subjects like reduced amygdala volume immature prefrontal cortex.The role of Septum pellucidum is described as an important relay between limbic structures (hippocampus, amygdaloid complex), hypothalamic autonomic system and brain stem reticular formation. Larger CSP should be considered a developmental anomaly, contributing to neurological and psychiatric disorders.

    Aims & Objectives - To compare prevalence of CSP (normal and abnormal) between patients of alcohol dependence and matched healthy controls.

    Methodology: In this study we will try to explore the correlation of dimensions of CSP with the duration of alcohol dependence and prevalence of normal (length <6 mm) and abnormal CSP (length >6 mm), as defined by Kwon et al. (1998), Nopoulos et al (1998), Dickey et al (2007) and Choi et al (2008), in comparison to matched healthy controls using CT scan in prospective manner.

    Venue: SS Raju Center for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi.

    Study Design: Prospective comparative hospital based study.

    Sampling technique: purposive sampling technique.

    Sample size: 60 diagnosed cases of mental and behavioral disorder due to use of alcohol, dependence syndrome, active dependence according to ICD-10, DCR (WHO, 1993) and 60 healthy matched controls.

    Results And Conclusion: This study found statistically significant differences in the prevalence of CSP in cases and controls but none of the cases had abnormal dimensions of CSP (> 6 mm).This study thus concludes that the prevalence of CSP is higher in patients of alcohol dependence but it is not associated with abnormal dimensions.

    Key words – CSP, Dimensions of CSP, Alcohol dependence, CT Scan.

    Fluvoxamine Induced Subconjunctival Haemorhage: A Case Report

    Ishat Kalra, Vikrant Bajaj, Devasheesh Sharma, Trishi Sharma

    Junior Resident, Institute of Mental Health, Amritsar, Punjab. ishatkalra16@gmail.com

    Fluvoxamine is preferred for management of obsessive compulsive disorder among all SSRIs. SSRIs usually have a safe side effect profile as compared to TCAs. But in recent times alarms have been raised for their association with increased risk of bleeding. Most of the available literature shows their association with gastrointestinal bleeding. But we present a case of recurrent episodes of subconjunctival haemorrhages with fluvoxamine.

    Introduction: Fluvoxamine is 2-[[5-methoxy-1-[4-(trifluoromethyl) phenyl] pentylidene] amino] oxyethanamine. It is a newer selective Serotonin Reuptake Inhibitor (SSRI), found to be more effective than other SSRIs in the treatment of OCD. Prior to the introduction of SSRIs in the late 1980s, TCAs were the medication of choice for the treatment of major depressive disorder, panic disorder and other anxiety disorders in spite of their side effect profile. In the initial years of their use SSRIs were considered to have mild side effect profile. But in last few years, there are case reports and uncontrolled studies reporting bleeding events in the form of ecchymoses, purpura, epistaxis, and gastrointestinal bleeding. Similarly we present a case of recurrent episodes of subconjunctival haemorrhages with fluvoxamine.

    History: A 36 years old male was diagnosed with OCD and was prescribed fluvoxamine 200mg/day in divided dosages. After an initial improvement, the dose was increased to 300mg after 15 days. The patient improved significantly in four weeks time. The dose was maintained at the same levels. After 8 weeks of starting of fluvoxamine, the patient developed subconjunctival hemmorhage. The patient consulted an ophthalmologist and he was started on topical antibiotics. The haemorrhage subsided within two weeks to appear again within four weeks. The topical antibiotic was started again and haemorrhage subsided. The patient informed the treating team about these subconjunctival bleeds, the patient was interviewed and examined in detail about any other contributing cause for these bleeds. However, there was no history of any bleeding disorder, uncontrolled hypertension, trauma or recent intake of NSAIDs or antiplatelet agents. His blood counts and blood coagulation tests were within normal limits. As fluvoxamine induced bleed was a possibility, the drug was stopped and clomipramine was started. The patient maintained remission on this drug and did not get any further subconjunctival bleeds for next 8 months.

    Discussion: Fluvoxamine is commonly used in the treatment of obsessive compulsive disorder because of their efficacy and a favorable safety and tolerability profile. Side effects like sexual dysfunction, nausea, diarrhea, anxiety, insomnia, sedation, nightmares and rare instances of extra pyramidal symptoms are well known. However, episodes of bleeding have also been noticed with SSRIs and it has become a matter of avid research. There have been a few retrospective studies, in recent years, showing higher relative risk in cases as compared to controls.

    In the above case, when fluvoxamine was prescribed, recurrent subconjunctival bleeds had occurred, which subsided after stopping the drug. There was neither bleeding nor clotting disorder nor any drug interaction responsible for the causation of subconjunctival hemorrhages. Spontaneous subconjunctival haemorrhages can be considered another differential diagnosis but as the haemorrhages were temporally related to administration of fluvoxamine and did not recur after stopping the drug, fluvoxamine seems to be the likely offending agent.

    In literature different mechanisms have been proposed as responsible for SSRI induced haemorrhages. Shen et al., 1999 proposed that SSRIs acting through inhibition of nitric oxide synthase cause disturbances of regulation of platelet aggregation might mediate SSRI-induced bleeding. Hougardy et al., 2008 proposed that SSRIs act on the serotonin transporter located on the platelet cell membranes leading to depletion of serotonin in the platelets which decreases coagulation and may lead to a bleeding tendency in vulnerable individuals. Andersohn et al., 2009 opined that drug- induced immune thrombocytopenia may present another possible mechanism for bleeding in SSRI-treated patients.

    The studies and case reports in last few years have shown that the use of SSRIs is associated with increased incidence of episodes of ecchymoses, purpura, epistaxis, and gastrointestinal bleeding and SSRIs may play a causal role in it. The risk decreased to same level as controls in past users of SSRIs indicating that bleeding is likely to be associated with the drug rather than the illness it was prescribed for [Weinrieb et al 2005]. The association also holds when age, gender, and the effects of other drugs such as aspirin and NSAIDs are controlled for.

    In the index case, although no other clear cut risk factor could be detected, the temporal relationship between the onset of SSRI therapy and bleeding, more than once, is impressive. Equally impressive is the prompt resolution of the problem with discontinuation of the therapy and hence the association between SSRI therapy and subconjunctival bleed seems to be quite high. The authors however, acknowledge the limitations in establishing the causality. Also, literature mentions hematological side effects with other antidepressants including TCA’s and venlafaxine.

    Further studies are needed to investigate whether caution should also be exercised in prescribing SSRIs to those in which other risk factors for bleeding like hypertension are present. Also, as no other clear-cut risk factor could be identified in the index case, the authors wonder whether any genetic predisposition might be present as well, in certain patients. Further studies should seek to inquire this aspect as well.

    In view of these findings it is suggested that physicians be cautious in prescribing SSRIs and should seek to find out additional risk factors for bleeding episodes or past history suggestive of the same in patients who are to be prescribed SSRIs, Gastro protection (in the form of proton pump inhibitors or H2 receptor antagonists) is advised, especially when concomitantly using NSAIDS. The effects of SSRIs on bleeding are not predicted by standard blood tests but are revealed by platelet-aggregation tests. As these tests are not likely to be readily available in developing countries, the physicians in these countries should exercise even more caution in finding out other risk factors for GI bleed before prescribing SSRIs.

    Key words: Fluvoxamine, Subconjunctival Hemorrhage, NSAID

    Comparison Of Executive Functioning In Depressive Episode, Obsessive Compulsive Disorder With Depressive Episode And Obsessive Compulsive Disorder Without Depressive Episode

    Ishat Kalra, Vikrant Bajaj, Devasheesh Sharma, Trishi Sharma,

    Junior Resident, Institute of Mental Health, Amritsar, Punjab. ishatkalra16@gmail.com

    Introduction: Executive function impairment has been implicated in a wide range of neurological as well as psychiatric conditions and has been associated with problems in personal,social,familial and occupational spheres of life.The aim of this study was to assess and compare the executive functions in patients with a Depressive episode, obsessive Compulsive Disorder with depressive episode and Obsessive compulsive disorder without depressive episode.

    Materials and Methods: A total of 90 patients (30 in each category) were chosen and assessed for executive functions using neuropsychological tests like Trail making tests (Part A and Part B),The PGI memory scale, digit Span test and Wisconsin Card Sorting Test(WCST).

    Results: Results reveal a male preponderance among all the study groups. Attention and Concentration abilities as well as Short term memory was more impaired in Depressive Episode patients,however abilities for Abstract reasoning, concept formation, decision making and planning of behavior were least affected in depressive patients. Domains of visual scanning along with visuo-motor and visuo-spatial coordination and sustained attention were significantly impaired in OCD with depressive episode patients.Patients without depressive episode had least dysfunction overall.

    Conclusion: Executive function deficits on maximum domains were obtained in OCD with depressive episode followed by depressive episode and least dysfunction was seen in patients with OCD without any comorbidities

    Although the study had various strengths like inclusion of homogenous population and clear demarcation of depressive symptomatology in Ocd,but still large sample studies are required to compare these groups to generalize the results in the population

    A Study On The Personality Traits In Patients With Schizophrenia And Bipolar 1 Disorder

    A.Kiruthika, Shanthi Maheshwari, Shanthi Nambi,

    2nd year postgraduate, Madras Medical College, Chennai, Tamil nadu.itsmekiruthika@gmail.com

    Introduction: Schizophrenia and bipolar illness are major mental illnesses among all mental disorders. Personality is an important aspect because it influences course and treatment of mental illness. Limited studies are available on the personality differences among these groups.By studying these personality traits we can further look upon the relationship between various traits and course and treatment of illness.The aim of this study is to assess the personality traits in schizophrenic and bipolar patients.

    Materials and Methods: A study on a total of 120 stabilised outpatients -60 schizophrenic and 60 bipolar 1 patients from institute of mental health diagnosed as per ICD-10 criteria were assessed for personality differences based on NEO FFI scale after obtaining informed consent.Five factors-neuroticism(N), openness(O), aggreableness(A), conscientio usness(C), extraversion(E) are assessed for their individual differences in schizophrenic and bipolar 1 patients and assessed using appropriate statistical methods.

    Results and Conclusion:

    Since this is an ongoing study, results will be presented at the time of presentation.

    Key Words: personality,schizophrenia,bipolar

    Antitubercular Drug Induced Psychosis – Review and Guidelines

    Shobhit Jain, Jai Singh Yadav, Ajeet Kumar, Brij Bhan Bind, Pradeep Yadav,

    Senior Resident, Banaras Hindu University (BHU), Varanasi, Uttar Pradesh. jainshobhitji@gmail.com

    Introduction: Tuberculosis (TB) is one of the top 10 causes of death worldwide. India is one of the countries having highest TB burden. To add to the problem, multidrug-resistant and extensively drug-resistant TB is on the rise. Several antitubercular agents are used in combination to treat tuberculosis. However, these are known to precipitate adverse effects including psychotic symptoms. Thereby, treatment guidelines are required for treatment of psychosis secondary to antitubercular agents.

    Aim: To review available literature and treatment guidelines pertaining to antitubercular induced psychotic symptoms.

    Method: A search was conducted on Pubmed and Google Scholar for search terms (eg. “antitubercular agents”, “tuberculosis”, “psychotic disorders”). Relevant studies were selected for the review.

    Results: The available level of evidences are limited to mostly case reports and a few case series. Antitubercular agents like Isoniazid, Ethanbutol, Ethionamide, Cycloserine, Ciprofloxacin have been most commonly reported to cause psychotic symptoms. Strategies like stopping the precipitating agent and use of antipsychotic drugs have been mostly used for treating antitubercular induced psychotic symptoms. Specific treatment guidelines are lacking. During the presentation we will further present the stepwise treatment of antitubercular agent induced psychosis.

    Conclusion: Treatment guidelines are useful for clinicians for evidence based management. Due to lack of such guidelines, clinicians often face dilemma for treating such cases. Our proposed step-wise recommendations may be helpful for clinicians in treating psychosis secondary to antitubercular agent.

    Keywords: Antitubercular Agent, Psychotic Disorders, Tuberculosis

    Differentiating elementary auditory hallucinations from tinnitus

    Shobhit Jain, Adya Shanker Srivastava, Raghunath Prasad Verma, Vinod Verma, Amit Singh

    Senior Resident, Banaras Hindu University (BHU), Varanasi, Uttar Pradesh. jainshobhitji@gmail.com

    Introduction: Patients with psychosis often have co-morbid ear disease. Tinnitus is one of the most common presenting symptom among patients with middle ear disease, whereas, auditory hallucination is one of the most common symptom presenting symptom among patients with psychosis. Thus, it is usually challenging to differentiate between tinnitus and elementary auditory hallucinations among patients with psychosis and co-morbid ear disease. Since hallucinations and tinnitus have different origin, therefore, it is essential to differentiate the two conditions.

    Aim: We will present a challenging case of psychosis with bilateral mastoiditis, with an attempt to differentiate between elementary hallucination and tinnitus.

    Method: A 48 year married male belonging to hindu nuclear family and middle socioeconomic status, with past history of bilateral otitis media at 30 year of age, with family history of psychosis in younger brother and sister, presented with total duration of psychiatric complaints since 10 years, characterized by delusion of infidelity, reference and persecution, insomnia, and marked socio-occupational dysfunction. Since past 6 months, he developed additional symptoms delusion of grandiosity, perception of wind blowing sounds, agitation, abusiveness and sometimes aggressiveness.

    Results: On examination, sounds would increase after occluding external ear with fingers. Physical examination and electrophysiological investigations were suggestive of bilateral conductive hearing loss, more on the left side. Imaging of head showed the presence of bilateral mastoiditis. Although, treatment with risperidone and olanzapine for 3 weeks each was ineffective, however, he improved with treatment with trifluoperazine.

    Conclusion: Several differentiating features between tinnitus and hallucinations will be presented. Case highlights the underlying possibility of dopamine in perception of tinnitus and association between middle ear disease and development of psychosis. Further studies are required to understand the neurobiology of tinnitus and association between middle ear disease and psychosis.

    Keywords: Tinnitus; Hallucination; Ear Diseases; Psychotic Disorders

    Highlights Of Autism Criteria In DSM-5 And It’s Comparison With DSM IV

    Shreyance Jain, Manish Parakh, Surender Kumar

    Senior Resident, All India Institute Of Medical Sciences, Jodhpur, Rajasthan. jainshreyance@gmail.com

    Background: Substantial revisions to the DSM-IV criteria for autism spectrum disorders (ASDs) have been proposed in efforts to increase diagnostic sensitivity and specificity. The DSM5 committee has published proposed diagnostic criteria for autism spectrum disorders in 2013. We examine these criteria in detail. Although concerns have been raised about the validity and diagnostic sensitivity of the proposed DSM-5 criteria, a number of studies have emerged in support of the conceptual validity of the new criteria.

    Methodology- Autism Disorder, Asperger’s Syndrome, Childhood Disintegrative Disorder and PDD-NOS diagnostic categories included in DSM-IV-TR were gathered under the title of Autism Spectrum Disorder (ASD) in DSM-5. Three symptom domains (social, communication and repetitive behavior) become two i.e. deficit in social-communication and interaction and repetitive behaviors. Social-communication and interaction includes deficits in social-emotional reciprocity, nonverbal communicative behaviors, developing, maintaining, and understanding relationships while repetitive behaviors comprise of stereotyped or repetitive motor movements, insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behaviour, restricted, fixated interests and Hyper or hyporeactivity to sensory input. Number of symptoms streamlined from 12 to 7 by merging criteria also “severity” criteria has also been added and symptoms present in the early developmental period.

    Results : These changes in DSM-5 has received the attention for both diagnostic and research purpose. Index paper highlights the changes made in DSM5 also its comparison with DSM IV and ICD 10 for better understanding and clinical accuracy.

    Conclusion- changes made in the DSM5 criteria might be used reliably and validly in clinical practice and research.

    Keywords: AUTISM, ASD, DSM5, DSMIV

    Identifying persons with mental illness in the community by Accredited Social Health Activist (ASHA)

    James J W, Santhosh S, Dundesh Y Doddur, Manjula M, T Sivakumar, Dr Jagadisha Thirthalli, C Naveen Kumar

    PhD scholar, NIMHANS, Bangalore, Karnataka. jameypsw@gmail.com

    Background: Treatment gap for mental illness is high despite the enchantment in mental health service delivery across the country. The community based rehabilitation (CBR) for severe mental illness project has been running in collaboration with Association of People with Disability and the local health and disability welfare department of Jagalur Taluk, Davangere district, Karnataka. Accredited Social Health Activists (ASHA’s) from the initiation of the CBR program have been active in referring cases and following them up. The objective of this study is to identify persons with severe mental illness in the community using ASHA workers.

    Method: ASHA’s were trained in identification of severe and common mental illnesses and how to use symptoms tool in other. A door to door survey was planned by which the 156 ASHA workers would cover the whole Taluk which has around 1.9 lakhs population. Each ASHA worker would visit each household and administer symptoms in others to one family member.

    Results: The door to door survey covered more than 27,000 household out of which more than 300 persons with mental illness were identified and around 90 persons with intellectual disability were also identified. The identified individuals were referred to the treatment camp near to their house.

    Conclusion: Identification of mental illness in the community and providing treatment in the primary health care can bring down the treatment gap of mental illness. Early identification and treatment can bring down the chances of the person being disabled due to mental illness and can bring down the global burden of disability.

    A comparative study of cognitive functions in patients with remitted bipolar affective disorder

    Y. Jayakrishna, Sireesha Rao, Shalini Reddy, J Bhargav Reddy, Shagufta Rahman

    M.D Psychiatry, Institute Of Mental Health,Hyderabad, Rangareddy, Telangana. jayakrishnaajayanth@gmail.com

    Background: Patients with bipolar affective disorder have been shown to have persistent impairment in cognitive functions.

    Aims:
    1. To assess cognitive functions in remitted patients with BPAD
    2. To compare cognitive functions in study subjects and controls.


    Inclusion criteria: Age 18-60yrs.

    1. Study group - Diagnosed cases of remitted bipolar affective disorder as per ICD 10 CRITERIA.
    2. who have reliable informant.
    3. Who gave consent.
    4. Control group: from community with no family, past, current psychiatric disorder


    Exclusion criteria:

    1. Study groups: Psychiatric disorder other than BPAD.
    2. H/o current and past substance dependence.
    3. Who do not have major medical and neurological illness.


    Remission can be defined as bipolar affective disorder subjects with YMRS, HAM-D score of 7 for past one month cross-checked from attendants.

    Materials and Methods: Place of study: outpatient department of tertiary hospital, Hyderabad Telangana state.

    Study design: cross sectional and comparative study

    Sampling: convenient sampling.

    Size of sample: 100 (50 each from study and control group)

    Diagnosed cases of bipolar affective disorder under remission according to ICD 10, YOUNGS MANIA RATING SCALE, HAMILTON DEPRESSION SCALE, and BOWMAN GRAY NEUROPSYCHIATRIC BEDSIDE BATTERY.

    Intake proforma for noting sociodemographic factors of study and control subjects like name, gender , Education ,type of family, marital status and illness details like duration of illness , treatment , number of episodes.

    Procedure: 50 subjects each with remitted bipolar affective disorder and age and gender matched controls were subjected to neuropsychological assessment. Consent and confidentiality issues were taken care.

    Ethics committee approval was obtained from institutional Ethics Committee before carrying out the study.

    Results: It will be analysed by SPSS 22 and will be submitted soon.

    Key words: cognitive functions, bipolar affective disorders, remission.

    Characteristics of Mood disorder Patients attending Geriatric Clinic at a Tertiary Care Center in Eastern India

    Jayanath B P, Anushul Khichchy, Nishant Goyal, D. Ram

    Senior Resident, Central Institute of Psychiatry, Ranchi, Jharkhand.jayanathchandran17.jc@gmail.com

    Background: Mood disorders, both bipolar and unipolar, represent a major disease burden in later life, contributing to suffering, functional impairment, medical disability, and excess mortality.

    Aims: This study is aimed to examine the socio-demographic and clinical characteristics of elderly patients with mood disorders attending the geriatric clinic at a tertiary care center in eastern India.

    Methods: The register of geriatric clinic of Central Institute of Psychiatry, Ranchi was reviewed for data of last one year (From August 2016 to July 2017). The data derived from Case record files of patients with mood disorders attending geriatric clinic (total- 101 patients, bipolar- 57 patients, unipolar- 44 patients) would be recorded in a comprehensive specially designed socio-demographic and clinical information data sheet. Appropriate statistical methods will be applied to analyze the data.

    Results and Discussion: These would be shared at the time of presentation.

    Keywords: Mood disorders, Geriatrics, Unipolar disorder, Bipolar disorder

    A follow up study of opioid injecting drug users registered in opioid substitution therapy center- after three years

    Jai Singh, P.K. Dalal , Amit Arya, Manu Agarwal, P.K. Sinha

    Junior Resident, King George’s Medical University, Lucknow, Uttar Pradesh.jays.singh777@gmail.com

    Background: Opioid Substitution therapy has been found to be an effective harm reduction treatment strategy for opioid injecting drug users. Injecting drug use is now a global burden and India is nowhere exception to this. Current research estimates that there are between 180000 and 1.1 million users of injected drugs in the country. Various studies have been conducted to see the outcome of its effectiveness but data is lacking in Indian scenario.

    Aims: To assess the psychiatric comorbidities and functioning among opioid injecting drug user’s(IDU) after three years and to compare above variables with the baseline.

    Method: We planned to conduct a three years follow-up study on the same sample enrolled in a study titled “A clinical study of psychiatric comorbidity among injection drug user’s” during the year 2013-14 to see psychiatric comorbidity and functioning among them after three years of opioid substitution therapy. We could enrol 58 IDU clients out of 100 at baseline. SCID-I and SCID-II was used to see psychiatric comorbidities and functioning was assessed using Global Assessment of Functioning scale and Axis-iv DSM-IV TR.

    Result and Conclusions: We found total 28 deaths out of 100 IDU clients in a period of three years. Psychiatric comorbidity other than substance was reduced from 43.1% to 22.4%. Substance use was reduced from 58.6 to 53.45 IDU clients at follow-up. GAF score increased significantly and significant improvement in all parameters of Axis-iv after three years except housing and educational problems.

    Key words: Opioid Substitution therapy, Opioid injecting drug user’s, psychiatric comorbidities

    Quality Of Life In Patients With Schizophrenia

    Jibi Achamma Jacob, Anju Kuruvilla

    Assisstant Professor, CMC Vellore, Vellore, Tamil Nadu. jibiachamma@gmail.com

    Objectives: This study aims to assess the relationship between quality of life and clinical and socio- demographic characteristics in patients with schizophrenia.

    Methods: 130 consecutive patients with schizophrenia attending the outpatient clinic were recruited. The Positive and Negative Symptoms Scale (PANSS) was used to rate the severity of symptoms. The Tamil version of the World Health Organization Quality of Life-Brief (WHO QOL-BREF) was used to assess the quality of life in various domains. Sociodemographic and clinical details of patients were assessed by chart review and patient interview. Continuous variables were described using descriptive statistics, frequency distributions were obtained for categorical variables; student t -test was used to compare continuous variables between groups and Pearson’s correlation coefficient was employed to assess associations, between two continuous variables.

    Results: Quality of life, assessed by the WHO –QoL BREF, was affected in every domain. A higher quality of life score was associated with a better socioeconomic background, single status as compared to married, and absence of substance abuse. The total PANSS scores, as well as scores on the negative and general psychopathology sub-scales , correlated negatively with the WHO-QoL- BREF scores.

    Keywords: Schizophrenia, Quality of life, WHO –QoL BREF

    A 6 month follow up study regarding depression and anxiety in patients of head and neck cancer

    Jitender Arora, Mahendra Jain, Charan Singh, Parth Singh, Gaurav Dhanda, Sunil Moond

    PG Student, JLN Medical College Ajmer, Rajasthan, India. jitenderarora600@gmail.com

    Introduction: The aim of this study to assess the psychiatric morbidities in head and neck cancer patients before the start of treatment and at 3 and 6 months and to compare the health related quality of life (HRQL) between those with depressive disorders and without depressive disorders.

    Methodology : A 6 month follow up study in tertiary care center of north India. 150 newly diagnosed head and neck cancer patients were assessed with ICD 10 for psychiatric comorbidities , the HRQL was simultaneously evaluated using the quality of life questionnaire of the European Organization for Research and Treatment of Cancer with a specific module for head and neck cancer. Becks depression inventory and Hamilton Anxiety Scale were used to assess depression and anxiety respectively.

    Results: 150 patients took part in the study, anxiety rates were high (30%) before the treatment and declined to 8% and 5% after 3 and 6 months respectively. Depression had a skew pattern with 10% at pretreatment , 30% and 12% after 3 and 6 months respectively. Depression is related to loss of sense, loss of speech, low libido ,dry mouth and weight loss over time. Depression was predicted by sticky saliva and problems with social contact at 3 months and social eating at 6 months

    Conclusion: Patients of head and neck cancer experienced different changes in anxiety and depression in the first 6 months of treatment.

    Keywords: depression, anxiety, quality of life

    Depression and Quality of Life Among Patients With Neuro Cognitive Disorders

    Jithu Jacob Varghese, Prof Roy Abraham Kallivayalil

    PG Student, Pushpagiri Institute of Medical Sciences,Thiruvalla,Kerala, Thiruvalla, Kerala. jithujv@gmail.com

    Introduction: Depression is a common co-occurrence in neurocognitive disorders. Different studies gave different values regarding the prevalence of depression in dementia. WHO estimates that geriatric population will be tripled by 2050, as compard to 2000. There are very few studies in India regarding depression ,QOL & dementia. This study looks into this matter

    Objectives:
    1. Estimate prevalence of depression and assessment of quality of life among patients with mild and major neuro cognitive disorders
    2. Determine the association between severity of depression with severity of neuro cognitive disorders & its effect on QOL


    Study Design & Setting : cross sectional study conducted in Pushpagiri Medical college, Kerala

    Tools

    1. for depression -CORNELL SCALE FOR DEPRESSION IN DEMENTIA
    2. for qol -WHO-QOL(BREF)&DEMQOL
    3. for neuro cognitive disorders -a)ACE& b)MMSE


    SAMPLE SIZE- 100

    Sampling Technique & Statistical Analysis - consecutive Sampling ;data entered in MS Excel and analysed using appropriate software.

    Results: 55%of the participants had moderate dementia; 24% had severe dementia, and 21% had mild dementia. Prevalence of depression was 36%,with significant difference between, age and severity. In depressives, marital status and severity of dementia had significant association. Poor financial status & educational qualifications was seen among depressed people, but was not statistically significant. Relationship with children and poor physical conditions where found to be important predictors for QOL

    Conclusion: A large proportion of older adults with dementia were suffering from depression. Also strong association was observed between depression and QoL. These findings may suggest for a better rehabilitation strategies ,as current facilities may not provide the adequate care & Qol for dementia patients

    Keywords – Neurocognitive Disorder, Depression, Quality-Of-Life

    Cognitive and psychosocial functioning in bipolar disorder with and without psychosis

    Joan. C. Puzhakkal, Roy Abraham Kallivayalil

    PG resident, Pushpagiri Medical college, Thiruvalla, Kerala. joancpuzhakkal@yahoo.com

    Background: There is a dilemma on whether Bipolar disorder(BD) with psychosis would develop more cognitive impairment and lower psychosocial functioning than without psychosis.

    Aims:1) To fnd out whether Cognitive and psychosocial functioning is lower in BD with psychosis as compared to without psychosis. Cognitive impairment is correlated to psychosocial functioning

    Materials and methods: Study done at post graduate tertiary care centre, Kerala. Consecutive sampling done within 3 months. It was a comparative cross sectional study. Sample size was 40(20 in each group). Participants were inpatients in psychiatry ward and met DSM5 diagnostic criteria for bipolar disorder. When patients were stable, neuropsychological testing (NIMHAN’S battery; Halstead-Reitan Neuropsychological Test Battery) was scheduled. Global Assessment of Functioning scores obtained. Data collected over 3 months and analyzed using SPSS 20 package. Chi-square test and unpaired sample T-test were used wherever applicable; pearson correlation coefficient was used to find out correlation.

    Results: It was found out that age of onset of illness in patients of bipolar disorder with psychosis was earlier than without psychosis.There was significant group difference(p<0.05).There was no significant group differences in other sociodemographic variables.In trail making test A , trail making test B;digit vigilance test ,COWAT-FAS Test,logical memory,Digit symbol test ,there was no significant group differences(p value>0.05).There was significant correlation between cognitive function and functioning(GAF score).

    Conclusions: There was difference in neuropsychological testings for bipolar with psychosis and without psychosis. So we could not conclude that bipolar patients with psychosis have more cognitive impairment than those without psychosis.The cognitive impairment infuences psychosocial functioning.

    Key words: cognitive impairment,psychosocial functioning,psychosis

    Family Burden and Social Support: A Comparative Study in Schizophrenia and Mood Disorders

    Josy Thomas, Melissa Petrakis, Rosemary Sheehan

    PhD student (Social Work), Monash University, Melbourne, Australia, Caulfield East, Melbourne, VICTORIA. josy67@gmail.com

    Introduction: Caregiver burden in mental illness has been the subject of research ever since the deinstitutionalisation movement in the 1960s and 1970s. Unlike in the developed countries where community mental health programs are streamlined and have been largely successful, this movement has put enormous stress on families in non-developed countries like India, where there are no national social welfare and medical insurance schemes, and the burden of caring for patients with severe mental disorders falls largely on family members. The present study was an attempt to assess and compare patient’s severity of illness, social support perceived by both patients and their caregivers, and family burden in schizophrenia and mood disorders.

    Materials and Methods: The study was carried out at the Institute of Mental Health (IMH), Hyderabad with a capacity of 600 in-patient beds. The study adopted a quantitative descriptive study design. 54 patients with schizophrenia and 58 patients with mood disorder, and one of their key relatives were selected purposively and consecutively meeting certain inclusion and exclusion criteria. Patient’s severity of illness, social support perceived by both patients and relatives, and family burden were assessed by using standardised scales. The statistical tests used were c2 test, Pearson’s correlation co-efficient, ‘t’ test and ‘Mann-Whitney U-test’.

    Results: The patients with schizophrenia were found to be more severely ill (p<0.001) with a longer duration of illness (p<0.001) and perceived less social support (p<0.001) as compared to the patients with mood disorder. The caregivers’ perceived social support was similar in both diagnostic groups. Family burden was significantly (p<0.001) higher in the schizophrenia group. Some significant correlations have been found among socio-demographic and clinical characteristics, and the key study variables.

    Conclusion: The study findings revealed the extent of social support perceived by the caregivers was lower and similar in both diagnostic groups. Similarly, although the extent of burden was higher in schizophrenia, the pattern of burden was similar in the two diagnostic groups. These results call for interventions aimed at enhancing the social support for both patients and their caregivers. The implications of the study will be discussed.

    Keywords: severity of illness, social support, family burden, schizophrenia, mood disorder

    Families where a Parent has a Mental Illness (FaPMI) Program

    Josy Thomas

    PhD student (Social Work), Monash University, Melbourne, Australia, Caulfield East, Melbourne, VICTORIA. josy67@gmail.com

    Over a million Australian children (about 4% of Australia’s population) have at least one parent with a mental illness. Approximately 23% of children in the Victoria State live in a household where a parent has a mental illness. Approx. 35, 000 children live in about 18,500 Victorian families where a parent has a severe mental illness being assisted by specialist mental health services. Children of parents with mental illness are at greater risk of developing a mental health problem later in life. They are at the highest risk if they live with a single parent who has mental illness (Mayberry, 2005). The children may face many challenges. They are more likely to experience a range of psychological, social and financial difficulties which may threaten their development and wellbeing. Research demonstrates that parents with mental illness may be less emotionally available to their children (Reupert & Maybery, 2007), have less support from family or services (Perera et al., 2014), are more likely to experience poverty and homelessness (Reupert et al., 2012), and face discrimination and stigma, which can prevent them seeking support when needed (Hinshaw, 2005). Research also demonstrates that parents with mental illness may have difficulty responding to their child’s developmental needs due to symptoms and/or medication (Nicholson & Blanche, 1994; Brunette & Dean, 2002), and may be less likely to seek help due to a fear of losing custody of their child (Davies & Allen, 2005; Montgomery et al., 2006; Seeman, 2010).

    The Families where a Parent has a Mental Illness (FaPMI) program has been launched as a service development strategy in 2007 by the Department of Health, Government of Victoria State, Australia following increased recognition of the impact of mental illness on parents and other family members, particularly dependent children. The overall aim of the FaPMI Strategy is to reduce the impact of parental mental illness on all family members through timely, coordinated, preventative and supportive action. This, in turn, would deliver greater opportunities and more positive outcomes for all family members. The priority is on better understanding the needs of families where a parent has a mental illness and the associated risks for all family members, including children. This will be primarily achieved through service and network development. The details of the program will be discussed.

    Keywords: FaPMI, Parents with Mental illness, Families

    Study of serum testosterone and cortisol difference in male and female patients with major depressive disorder compared with healthy controls

    Mahendra kumar Sharma, Ram kumar Solanki, Kuldeep Yadav, Vikash Chandra Mishra, Ravi kumar Gupta

    PG student, SMS Medical College Jaipur, Rajasthan. jpr.mahendra@yahoo.com

    Background: There is enough evidence that both testosterone and cortisol have role in pathophysiology in major depression. in major depression. In major depression, it has been consistently shown that there is dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, as reflected by hypercortisolemia and nonsuppression of cortisol after dexamethasone administration. The hypothalamus-pituitary-adrenal (HPA) axis affects the functions of sex steroid hormones through interaction with corticotropin-releasing hormone (CRH) and gonadotropin-releasing hormone (GnRH).

    Aim &Objectives: The proposed study is to investigate differences in serum levels of testosterone and cortisol in male and female patients with major depressive disorder (MDD).

    Methods: 50 outpatients suffering with MDD and willing to participate in the study and fulfilling the inclusion and exclusion criteria were recruited. 50 healthy comparable group were also included in the study as a control. Data from MDD patients and controls were compared separately for men and women. Correlations between serum hormone levels and scores on the Hamilton Rating Scale for Depression (HAM-D) of patients were assessed by sex. Effects of various factors on testosterone and cortisol were analyzed.

    Results: In male patients with MDD, a significant negative correlation was found between testosterone levels and the “retardation” score of HAM-D. Serum testosterone was negatively associated with the number of depressive episodes in male patients with MDD. In female patients Serum cortisol levels were significantly increased compared with female controls.

    Conclusions: The negative correlation between the “retardation” score of the HAM-D and testosterone may be associated with the biological pathophysiology of male depression. Findings of serum cortisol levels in women may suggest distinct characteristics of these hormones in men and women with MDD.

    Keywords: Testosterone, Cortisol, Major Depressive Disorder

    Long term neuropsychiatric disorders of earthquake exposure

    Jai Singh Yadav, Adya shanker Srivastava, Samiksha kaur

    Associate professor, Institute of Medical Sciences, Banaras Hindu university Varanasi, Uttar Pradesh. jsypsyji@gmail.com

    An earthquake resulting from the releases of energy from the lithosphere of earth, this energy produces seismic waves. These waves travel through earth’s interior and can be recorded by seismometer. The strength, size and magnitude of the earthquake are measured using Richter scale. High intense earthquake associated with psychiatric disorders such as anxiety, mood disorders, sleep problems and post traumatic stress disorders. Apart of psychiatric disorder earthquake also causes neurological disorder like dizziness.

    The disequilibrium can be caused by exposure to aftershocks, therefore these phenomena can directly disturb the functioning of the semicircular canal system. Neuroanatomical finding revealed that vestibule-parabrachial pathway reciprocally innervated with cortical, limbic and autonomic systems of brain; these areas are responsible for disturbance in the internal ear functioning. Though the limbic area is majorly responsible, a part vestibular control is also responsible for emotion and psychological response; therefore equilibrium dysfunction can also occur through psychological stress such as anxiety. The earliest earthquake jerk on 2016-01-04 of Richter scale 6.8 shaken India, Myanmar, Bangladesh, the centre of this was part of Myanmar, it also involved the parts of Northeast India, Bihar, Uttar Pradesh, Bengal, Haryana Nepal and Himanchal Pradesh. We found the series of patients that experienced jerks of the earthquake complain of various neuropsychiatric problems like anxiety, vertigo, death feelings, depression, insomnia and headache. In our cases we have reported that all patients have various neuropsychiatric disorders like dizziness, anxiety, death anxiety, headache and they responded by 61.21% on Hamilton Anxiety Rating scale(HAM-A) and 65.96% on Death Anxiety Rating Scale with anti anxiety and antidepressant drugs within 2 weeks duration of treatment.

    Keywords: Earthquake, exposure, neuropsychiatric disorder

    A Comparative study of C-REACTIVE PROTEIN in patients with Bipolar Affective Disorders with healthy controls in a hospital based population and its correlation with the illness severity

    D. Bhagabati, Juhi Gupta

    Post graduate trainee, Gauhati Medical College, Guwahati, Assam. juhi.gupta27@gmail.com

    Introduction - Bipolar disorders are among the frequently encountered illnesses in psychiatric settings. Various studies have shown significant role of pro-inflammatory markers like IL-6, CRP, TNF-a in the causation of the disease. Increased peripheral inflammation has been associated with changes resulting in numerous symptoms of mood disorders and the symptom severity.

    Aims-

    1. Assessment and comparison of CRP levels in bipolar patients and healthy controls.
    2. Correlation of CRP levels in Bipolar Disorder with respect to severity of illness in depressive phase and manic phases of the illness.


    Method and Material-

    1. Study location : Department of Psychiatry, Gauhati Medical College and Hospital
    2. Study type : Descriptive and analytical case-control study
    3. Study population : 30 male and female bipolar patients and 30 healthy controls
    4. Period of study : August 2016 to July 2017


    Psychiatric diagnosis was made using ICD-10 classification of mental and behavioural disorders. CRP levels of all the study population were assessed. Severity of depressive and manic phases were assessed using the HDRS and YMRS scales respectively.

    Results- Bipolar patients had a higher mean CRP level than healthy controls. Mean CRP levels were higher in mania than in depression and more so in case of males than females. Significant correlation of CRP level with the symptom severity in case of mania.

    Conclusion- The current findings show that there are large group differences in CRP levels between patients with Bipolar Disorder and healthy controls. The results are consistent with the argument that Bipolar Disorder have inflammatory basis.

    Keyword- Bipolar Disorder, Inflammation, CRP level

    Prevalence of Somatic Complaints in Psychatric Patients

    Kakumanu Monalisa, Adi Pratyusha, Datt, Praveen Khairkar, Krishna Chaitanya, Swapna Pandurangi, Sushrut Patil

    PG Student, Kamineni Institue of Medical Sciences, Hyderabad, Telangana.kakumanu.monalisa@gmail.com

    Background: Somatic symptoms are seen in a variety of illnesses, both psychiatric syndromes and chronic medical illnesses. It’s known that psychological problems often appear in the garb of a wide array of somatic symptoms such as headache, etc.This may reflect an individuals inability to cope with the various issues or his basic underlying personality.The aim of the present study is to see frequency of somatic complaints among the patients attending the psychiatric out patient services and their diagnostic profile.

    Methodology: All adult patients attending the Psychiatry OPD from over 3 month period are screened and diagnosed applying the criteria of ICD-10.If the patients volunteered somatic complaints they were duely noted and various parameters such as duration and severity were noted with the help of Somatic Symptom Scale-8 and a self prepared Somatic Symptom Checklist. Remaining details such as sociodemographic features, objective data and clinical details are also recorded.

    Results: Of the 185 patients seen, 68 patients (36.75%) voluntarily complained of somatic symptoms.Out of these, 49 had Headache(72.05%) which was the most commonly complained somatic symptom followed by Generalised body pains seen in 44 patients(64.70%).The most commonly associated psychiatric diagnoses associated with are the Psychotic disorders(25 patients)(36.76%) and Mood Disorders(18 patients)(26.47%).More details will be discussed during the presentation.

    Conclusion: 36.75% of patients have somatic complaints i.e. almost 1 in 3 patients.These results correlate with the previous studies done in this area.However there is dearth of such studies, especially in the last ten years.Given the neglected nature of these symptoms more light needs to be shed about the cause and the origin as well as the burdern imposed.Even the coping mechanisms and the effective ways to deal with such issues need to be addressed.

    Key words : Somatic symptoms, psychiatric co-morbidity

    A Randomised Double Blind Placebo Control Study Of Joint Attention, Language, Social Responsiveness, Behaviour And Epileptic Discharge Following 8 Weeks Of Levo-Carnosine In Children With Autism Spectrum Disorder

    Kanmani.V.K, Suresh Kumar, Vimal doshi, Sivalingam, Shanthi Nambi

    Post Graduate, Institute Of Mental Health, Chennai, Tamilnadu. kanscute057@gmail.com

    Background: L- Carnosine, dipeptide amino acid (B-Alanine & L-Histidine) has shown improvement in Social cognition, Communication, Joint attention in children with autism spectrum disorder within 2-8 weeks.

    Aim: To study the changes in Joint attention, Language, Social responsiveness, in autistic children after 8 weeks of L-carnosine.

    Design: This study is naturalistic prospective double- blind placebo controlled trial of L-carnosine in autistic children attending child psychiatry department, Institute of Child Health, MMC, Chennai.

    Materials and Methods: All children attending department in November to December included in the study based on selection criteria. Children further randomized into placebo vs L-carnosine group. Scales measuring Social cognition, Joint attention, Language, Severity of autism with behavioral problems were administered at 0,4 and 8 weeks.

    Statistical Analysis: For continuous variables- Independent t-test, for categorical variables- Chi-square test and Pearson correlation coefficient.

    Results-

    Conclusion: Results will be presented in conference.

    Keywords- Levocarnosine, Autism Spectrum Disorder

    Role of stressful life events and kindling in bipolar disorder: Converging evidence from a mania-predominant illness course

    Karthick Subramanian, Siddharth Sarkar, Shivanand Kattimani, Ravi Philip Rajkumar, , Venkatalakshmi Penchilaiya,

    Senior Resident, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry. karthick.jipmer@gmail.com

    Stressful life events can precipitate relapses and recurrences in bipolar disorder. Kindling in bipolar disorder has been linked to maladaptive psychological reactivity to minor stressful life events. Systematic studies on life events and kindling are rare in bipolar disorder with a manic predominant polarity. One hundred and forty-nine remitted patients with bipolar I disorder were recruited. National Institute of Mental Health-Life Chart Methodology was used to retrospectively depict the illness course, and the Presumptive Stressful Life Events Scale-Lifetime version was used to record the stressful life events. The role of stressful life events and the presence of kindling were assessed using appropriate statistics. There was a mania-predominant course of bipolar disorder in the sample with 55.7% (n=83) having only recurrent mania. Family conflict and altered sleep patterns were the commonly reported stressful life events. Controlling for the severity of the stressor, the stressful life events were often associated with the initial episodes rather than the latter ones. Kindling can occur in bipolar disorder with mania as the predominant polarity. Effective strategies tackling the common stressful life events can improve the outcome of bipolar disorder. Retrospective recall bias and assessing hospital-based sample could limit the generalizability.

    Keywords: Bipolar; kindling; predominant polarity; sleep; family; India.

    Sudden Memory loss mimicking as Severe Anxiety : A rare manifestation of Transient Global Amnesia

    Archish Khivsara, Divya hegde, Sonia, Thomas Mathew

    Postgraduate-final year, St. John, Bangalore, Karnataka. khivsara.archish@gmail.com

    Background/Introduction : Transient Global amnesia(TGA) is a neurological disorder whose key defining characteristic is a temporary but almost total disruption of short term memory with a range of problems accessing older memories. TGA is often accompanied by anxiety.

    Materials and methods : A 61 year married female, a prediabetic and a k/c/o of hypertension for 30 years-on treatment, with premobidly well adjusted personality, presented with history of left sided headache, atypical in nature, holocranial for last 2-3 months, on and off (similar headache in past 5 years back; on treatment) and sudden acute memory loss for one day. Patient was not able to recall what she had for dinner previous night and where she visited in last day. She was not able to recall events of last day and reason for her current consultation and her current medications.. Patient presented with severe anxiety and stress to emergency department where after initial evaluation by Psychiatry, Patient was admitted under neurology for evaluation. Patient was investigated and found to have bilateral hippocampal changes in MRI of the brain with normal EEG. No other Psychiatric manifestations were noted.

    Results : Patient was thoroughly evaluated under Neurology and found to have no other focal deficits. Patients symptoms were suggestive of an episode of amnesia with anxiety due to stress secondary to memory loss. Patient’s was diagnosed with TGA supported by findings on imaging and dose of gabapentin was increased.

    Conclusion : We report a case of acute memory loss presenting in emergency department with sudden onset of severe anxiety. Patient usually has no neurological deficits and can recall deeply encoded facts of his or her past, such as their own name. The most important part of management after diagnosis is looking after the psychological needs of patient and his or her relatives.

    Keywords: Sudden memory loss, severe anxiety, transient global amnesia

    Smartphone based solutions for managing severe mental illnesses in low resource settings: roadblocks and opportunities

    Koushik Sinha Deb, Mamta Sood, Rakesh K Chadda, Pushpendra Singh, Rohit Verma, Saurabh Kumar, Ragul Ganesh

    Assistant Professor, All India Institute of Medical Sciences, New Delhi,Delhi.koushik.sinha.deb@gmail.com

    Background: Mobile application based delivery of psycho-social interventions may help reduce treatment gap for severe mental illnesses (SMIs) and decrease the burden on caregivers. Apps developed in high income settings show effectiveness, but suffer from lack of applicability in low resource scenarios due to difference in technology penetration, affordability and acceptance. This study aimed to understand the health technology usage, perceived needs and acceptability of app based interventions in patients of SMIs and their care-providers.

    Materials and Methods: The study was conducted in the inpatient and outpatient settings of a tertiary care center in North India. A cross-sectional survey assessed the smartphone and health app usage. Three focused group discussions evaluated needs and apprehensions in using apps in management of SMIs. Health technology acceptance was assessed by in-depth interviews in patients and their care providers after 15 days of app use.

    Results: Around 34% of the 88 patient-caregiver pairs surveyed had access to smartphones, although health app usage was low. Cost, unfamiliarity, and language were significant barriers to adoption. Actual app usage was hampered by low technology literacy.

    Conclusions: The study systematically looks into the scope, design considerations and limitations of implementing a mobile technology based intervention for low resource settings.

    Keywords: Smartphones, apps, SMI, schizophrenia, bipolar disorder, health technology

    Insulin-like growth factor-1 in first-episode schizophrenia: A cross-sectional study.

    Vemulakonda Sri Krishna Teja, Basudeb Das, Varun S. Mehta

    Junior Resident, Central Institute of Psychiatry, Ranchi, Jharkhand.krishnateja25.5@gmail.com

    Introduction: Schizophrenia is conceptualized as an illness of disturbed functional circuitry where a wide range of white matter abnormalities has been revealed including myelination defects and alterations in density, as well as morphology and gene-expression profiles of myelin-forming oligodendrocytes. There is increasing evidence that all types of glial cells, especially oligodendrocytes, are affected in schizophrenia. Previous studies have suggested that insulin-like growth factor-1 (IGF-1) is altered in schizophrenia. IGF-1 induces neuronal proliferation and differentiation. The purpose of this study is to assess the IGF-1 levels in patients with first episode schizophrenia and assess the relationship of IGF-1 levels to the symptom dimensions of schizophrenia.

    Methodology: Twenty subjects diagnosed drug naive or drug free cases of first episode schizophrenia and 20 normal controls will be chosen after obtaining their written informed consent. Patients aged 18 – 45 years of either sex with BMI 18.5 – 24.9 kg/m2 and a score less than 60 on MDRF-IDRS and normal controls with a GHQ – 12 score less than three in addition to the above criteria would be eligible for the study. The patients would be assessed on Socio- occupational functioning scale (SOFS), Calgary Depression Scale for Schizophrenia (CDSS), Positive and Negative Symptoms Scale (PANSS), Montreal cognitive assessment (MoCA). A blood sample of 5 ml will be drawn in the morning from all the subjects to assess IGF-1. All statistical analysis would be done using Statistical Package for Social Sciences (SPSS) by appropriate statistical tests. The samples for blood glucose and serum lipid profile will be analysed immediately to rule out presence of diabetes or dyslipidaemia which if present will lead to discontinuation of the patients/subjects from the study.

    Results & Discussion: They would be dealt at the time of presentation.

    Keywords: IGF-1, Schizophrenia, oligodendrocytes

    Shift Work Sleep Disorder And Fatigue In Nurses In A Tertiary Care Psychiatry Hospital , Goa

    Kshipra Naik, Shilpa Waikar

    Junior Resident, Institute of Psychiatry and Human Behaviour, Bambolim, Goa. kshipranaik@yahoo.co.uk

    Introduction: Shift workers as a result of their working patterns may experience a wide array of problems ranging from disturbance of circardian rhythm and sleep, to compromised family and social life, to impairment in mental plus physical health. Due to varied nature of work, shift patterns in psychiatric nursing staff pose a greater health challenge.

    Nursing staff in psychiatry deal with monitoring patients’ state of mind. In addition, their role demands a constant equipped state to face changing demographics, violence and many a times barriers to treatment.

    This study aims to assess shift work sleep disorder and fatigue in nurses working in a tertiary care psychiatry hospital.

    Methodology: The study is a descriptive cross sectional study carried out in the Institute of Psychiatry and Human Behaviour, Goa. All nurses were selected for the study after obtaining informed written consent. Structured psychiatric interview using standardized diagnostic tools was conducted. Tools used include demographic details, Standard Shiftwork Index Questionnaire, Epworth Sleepiness Scale, Fatigue Severity Scale, Bergian Insomnia Scale.

    Results: Results are currently being analysed to compare socio demographic variables, Work situation, General job satisfaction, Information on shifts, Personal habits, social and domestic situation, Sleep, Physical health , General health questionnaire, Injuries, Coping, and severity of fatigue.

    Keywords: Sleep disorder, fatique, nurses

    To study the electronic gadgets use and its association with behavioural problems among children and adolescents with ADHD and disruptive behaviour disorder (DBD)

    Lavkush kumar, Vivek Agarwal, Amit Arya, Pawan Kumar Gupta, Pooja Mahour

    Junior Resident, KGMU, Lucknow, Uttar Pradesh. lavkushverma05@gmail.com

    Objective: To Study the electronic gadget use and its association with behavioural problems among children and adolescent with attention deficit hyperactivity disorder (ADHD) and disruptive behavior disorder (DBD ) and compare with healthy control

    Methods: It was a cross sectional study and total 70 children were recruited in case group (31 in ADHD, 29 in DBD and 10 in ADHD+DBD sub groups ) and 40 in control group. Pattern, type, duration and purpose of gadgets use were assessed and severity of electronic gadget use was assessed by Young’s Internet addiction test and Lemmens’s Game addiction scale and association between behavioral problems and problematic Game use were assessed by Child Behavior Checklist (CBCL).

    Results: In case group 43(61.5%) and only 4(10%) children in control group were using gadgets for >4 hr duration. Among internet using children, 28(75.7%) children in case and 5(23.8%) in control group were problematic internet user (PIU). In ADHD group 9(69.3%), in DBD 13(7.5%) and in ADHD+DBD 6(85.8%) children were PIU and it was significantly higher in comorbid ADHD+DBD as compared to ADHD or DBD (p=0.0001). Problematic gadget use found significantly higher in ADHD+DBD group(80%) as compare to ADHD (22.5%) or DBD(37.9%) children. Among the cases who had problematic use for game or internet had higher scores on CBCL as compared to non-problematic user. Problem of addicted use of game and internet increased with severity of illness in domains of aggressive behavior (r=0.77, 0.84), social problems (r=0.80, 0.72), rule breaking (r=0.91, 0.96) and attention problem (r=0.67, 0.61).

    Conclusion: Among ADHD and DBD children, problematic gadget is more as compared to normal children. ADHD and DBD children have significantly higher risk for PIU/PGU.

    Keywords: ADHD, DBD, PIU, PGU

    Prevalence of Premenstrual Dysphoric Disorder in Medical and Paramedical college students

    Avisha Mahla, Pooja Thakrar, Rajat M. Oswal

    Second year Resident doctor, Medical College,Baroda, Vadodara, Gujarat. mahla.avisha@gmail.com

    Introduction: PMDD consists of a “cluster of affective, behavioural and somatic symptoms” that recurs monthly during the luteal phase of menstrual cycle. 80% of all women experience some alterations in mood, sleep or somatic symptoms during premenstrual period and around 40% of these women have mild to moderate premenstrual symptoms prompting them to seek medical advice. Most women suffering from PMDD are severely functionally impaired, so it is important to identify them so as to reduce the functional impairement and morbidity.

    Aims and Objectives: To assess the prevalence of Premenstrual Dysphoric Disorder and its association with various demographic, lifestyle and menstrual factors in college students.

    Material and Methods: This was a Prospective study conducted on students of Medical College, Nursing College and Physiotherapy College,Vadodara. Students were given a semi structured Performa along with the Premenstrual Symptom Screening Tool (PSST).Those who screened positive were informed telephonically and were interviewed individually for provisional diagnosis of PMDD based on DSM 5 criteria.Those who were provisionally diagnosed with PMDD were given the Daily Record of Severity of Problems form (DRSP-PMDD ) to be filled on a daily basis for 2 menstrual cycle for confirmation of diagnosis.

    Results: According to PSST,out of 654 participants,33 (5.04%) were diagnosed as having PMDD,99(15.13%) were having moderate/severe PMS.The prevalence of PMDD was found to be 4.43% by DRSP.Positive correlation was found between PMDD and positive family history of PMS/PMDD.

    Conclusion: From this study we can conclude that the disease is quite common and the burden of illness is high as a result of decreased productivity and effectiveness at work.

    Keywords: PMDD, PMS, Medical, Paramedical students

    The Language Of The Non-Suicidal Self Injury: The Cutting Edge In Adolescents

    Abdullah Al Mamun Hussain, Bappa Sarker

    Professor, Rajshahi Medical College, Rajshahi, Rajshahi. mamun.hussain.bd@gmail.com

    Background and Objectives: Non-suicidal self-injury (NSSI) has been included in DSM-5, as a condition requiring further study. Research has shown that NSSI principally serves an intrapersonal findings and often the adolescents engage in NSSI to cope with their negative thoughts and feelings.

    Despite its contemporary ubiquity, understudying of NSSI is nascent. Again, the specific behaviour employed as part of NSSI are often confused with suicide, and NSSI is largely devoid of suicidal intent and paradoxically, most often signals a strong desire to live.

    But the practical approaches for detecting, responding and intervening with NSSI in everyday settings of youth lag even further behind than our basic understanding of what it is and why people do it.

    This presentation hopefully, would make an overview of this issue and provides starting points for proactively addressing, detecting and responding to NSSI in adolescents.

    Materials: The relevant literatures were searched using the term ‘non-suicidal self-injury’ or ‘self-injury’, with the combination of the terms, viz. ‘treatment’ or ‘therapy in psychINFO, PubMed and Google scholar. The results and observations after necessary evaluation were considered in presentation.

    Conclusion: Although previously believed to be a characteristics of severe psycho pathology, it now appear that NSSI is associated with wide variety of externalizing and internalizing conditions. So, effective treatment is grounded in a collaborative understanding of the function of NSSI for the adolescents and we need to address the affective, psychosocial, biological and cognitive factors, appropriate for each individual, as a strategy in management.

    Keywords: NSSI, Adolescent, self-injury

    Effectiveness of Gatekeeper Training among medical professional and undergraduate students: Outcomes of the Optimizing Suicide Prevention Program.

    Rutvin Patel, Ritambhara Mehta, Kamlesh Dave, Pradhyuman Chaudhary

    3 rd year resident doctor, Government Medical College, Surat, Gujarat. mbbs.rut4@gmail.com

    Introduction: Suicide risk among Indigenous populations is a multifaceted phenomenon, influenced by biological, psychological, and social factors at the individual level, as well as cultural, political, and economic issues at the family and community level. The global prevalence of depression among medical students was recently estimated to be 28.0 % according to a meta-analysis of 77 studies. In the field of suicide prevention, the term gatekeeper refers to “individuals in a community who have face-to-face contact with large numbers of community members as part of their usual routine.” They may be trained to “identify persons at risk of suicide and refer them to treatment or supporting services as appropriate”. This study aimed to assess change or impact of training on attitudes and knowledge in Gatekeepers, which can improve detection, communication and referral of individuals at risk of suicide.

    Methodology: An evidence-based Gatekeepers’ training of two-hour duration, multi-modal and interactive session was planned for medical professionals and undergraduate students. Pre and post intervention free-recall knowledge and attitudes questions were examined. Focused groups with students enriched interpretation of quantitative results.

    Result: Undergraduate students developed more positive attitudes towards suicidal behavior whereas faculties perceived themselves more confident in their skills after training sessions (Data were analyzed by Mann Whitney U test). Overall, attitudes and skills of both students and faculties were fairly changed positively (Data were analyzed by Wilcoxon Signed Rank test).

    Conclusion: A brief, multi-modal Gatekeepers’ training is effective in promoting positive behaviors, skills and self-efficacy for suicide prevention program for at-risk population.

    Keywords: gatekeeper, suicide prevention

    Perception of Suicidal Behaviour and Help Seeking Practices among College Going Youth in Mumbai

    Meena Yerunkar, Tejas Kirtane, Shubahngi Parkar

    Post Graduate resident doctor, Seth GS medical college and KEM hospital, Mumbai, Maharashtra. meenayerunkar@gmail.com

    Introduction

    Suicide in the youth is becoming an increasingly important public health problem. Extensive literature on prevalence and methods of prevention are available, most of it being from the developed nations. It is known that suicide forms a considerable social and public problem in developing countries, but information on the same is lacking.

    Aims and objectives

    To investigate the perceptions of suicidal behaviour and help seeking practices in college going youth, so as to derive important implications that could be used for suicide prevention programmes and thus community mental health.

    Methodology

    It is a cross sectional study including 242 college students which had equal number of males and females, chosen from 6 different colleges from Mumbai. A questionnaire designed for this purpose was given to them and their responses were analyzed using frequency analysis and weighing of responses (the responses were graded by preference).

    Results

    The results showed that the respondents perceived suicide to be more common in women (59.1%) than in men (40.9%). Suicide was thought to be more common in the youth (70.7%) than in any other age group. The important life events contributing to suicide in youth were related to academic performance, financial well being and relationships with the opposite sex. Family (29%) was perceived to be the best support system followed by Friends (28%), Counsellors (15%), Girlfriend/Boyfriend (11%), Teachers (6%), Help lines, Religious preachers (4 %) and General Practitioners (3%).

    Conclusions

    The finding in relation perceived life events reflects the need to improve the coping styles and adaptive strategies among youth for suicide prevention. Developing awareness programmes for family members and friends appears to be a more economical resource for primary prevention in this target group.

    Keywords: Suicidal behavior, help seeking practices, youth

    A Study On Anxiety And Alcohol Use Among Undergraduate Medical Students

    Meesha Haorongbam, Sathyanarayana M.T, Hemanth Kumar B.G, Sowmyashree C.N, Akshatha H.S

    Post Graduate Student, Sri Siddhartha Medical College, Tumkur, Karnataka. meeshahao@gmail.com

    Background: Anxiety can significantly hamper academic performance and can also lead to substance abuse. The various causes leading to anxiety in medical students along with the multiple factors for alcohol use need to be assessed in view of rising levels of psychiatric morbidity.

    Aim: To study the relationship between anxiety and alcohol use among undergraduate medical students

    Materials and Methods: A cross sectional study was done on 428 undergraduate students in a medical college in Karnataka. They were assessed using a semi structured proforma, Hamilton Anxiety Rating Scale (HAM-A) and Alcohol Use Disorders Identification Test (AUDIT).

    Results: The mean age of the students was 20.41 with almost equal number of males and females. Majority of the students were staying in hostel with a room-mate and were from urban area. 17.1% had severe anxiety with the maximum being in 4th year. Main stressor was in academic domain with “need to do well” being the most common, closely followed by “vast amount of content to be learnt”. Majority of them (83.4%) used internet/TV/music to deal with stress. 15.7% had hazardous level of drinking while 3.7% had dependence level and had failed in atleast one academic year. This study found a significant relationship between anxiety and alcohol use.

    Conclusion: Stress and alcohol use are highly prevalent in undergraduate medical students. Anxiety and alcohol abuse was more commonly seen in the final year students. However, such students rarely seek help. Future steps should be taken up to identify such students and offer them remedies at the earliest, to prevent any further morbidity.

    Keywords: Anxiety, alcohol use, medical students

    Coping and Burnout in primary key caregivers of patients with schizophrenia and bipolar affective disorder in relapse.

    Techi Mekap, Mittu Muthu Vergese, Nishant Goyal

    PG Student, CIP, Rachi, Jharkhand. mektech1@gmail.com

    Background: Caregivers are facing problems such as stress, burden, anxiety, frustration, feeling the pressure of increased dependency and etc. Care activities for schizophrenia and bipolar affective disorder patients affect on the general and mental health of caregivers. In modern psychiatry, the pendulum has swung from biological to psychosocial factors in the study of the onset of illness. Coping strategies are the behaviors, thoughts, and emotions that the patient and primary caregivers will use to adjust to the changes that occur in their life. Burnout usually occurs when caregivers don’t get the help they need, or when they attempt to do more than they are able - emotionally, physically or financially.

    Material: To assess coping and burnout in primary key caregivers of patients with schizophrenia and bipolar affective disorder in relapse.

    Discussion: Schizophrenia and bipolar affective disorder are chronic mental illnesses, and sufferers are usually dependent on family, primary key caregivers in particular. The present study is designed to assess coping and burnout in primary key caregivers so that adequate services can be provided for them in family and community.

    Keywords: Coping, burnout, primary key caregivers, schizophrenia, bipolar affective ,disorder, relapse

    Study On Sociodemographic Profile, Stress And Sexual Satisfaction Among Spouses Of Male Patients With Dhat Syndrome Attending Opd In New Hospital Medical College Campus, Kota

    Mohammad Javed, Rajmal Meena, Suresh parihar, Devendra Vijayvargiya, Manoj dudi

    PG resident, GMC KOTA, Kota, Rajasthan. mohammadjaved874@gmail.com

    Background: Dhat syndrome is a culture-bound disorder which manifests in the form of preoccupation regarding semen loss among patients in the Indian subcontinent. It is associated with vague multiple somatic and psychological complaints such as fatigue, listlessness, loss of appetite, lack of physical strength, poor concentration and forgetfulness. It is commonly accompanied by stress and sexual satisfaction among spouses of male patients with Dhat syndrome.

    Materials and Methods: The study was carried out in the outpatient psychiatry department in new medical college hospital, Kota. A total of 30 subjects diagnosed with Dhat syndrome as per international classification of diseases-10 (ICD-10) criteria and were assessed Along With Socio-Demographic Profile, Perceived Stress Scale-10 (PSS-10) and Sexuality Scale (SS) to determine the levels of stress snd degree of sexual satisfaction.

    Results and Conclusion: Will be discussed at the time of presentation.

    Key Words:- Culture Bound Syndrome, Dhat Syndrome, Stress, Sexual Satisfaction.

    A study of quality of life, disability and coping in Dhat syndrome with and without co-morbidities

    Mohit kumar shahi, Adarsh Tripathi, Sujit kumar kar, P. K. Dalal, Anil Nischal, Shweta Singh

    Junior Resident, King George Medical University, Lucknow, Uttar Pradesh. ohitshahi.kumar57@gmail.com

    Background: Dhat syndrome is a sexual neurosis commonly reported from South-east Asia, characterized by excessive concern about harmful consequences of loss of semen. It is commonly associated with various sexual and psychiatric co-morbidities. Patients of Dhat syndrome are reported to manifest a great variety of physical, psychological and sexual symptoms, which are attributed to loss of semen. Previous studies have shown that upto two-third of cases of Dhat syndrome have psychiatric and/or/sexual co-morbidities.

    Aims & Objectives: To study quality of life, disability and coping in the patients of Dhat syndrome with or without co-morbidities and to compare these variables with healthy individuals.

    Material and Methods: The present study is a cross-sectional study done at a tertiary care centre of North India. A total of 117 patients were recruited in the study on the basis of selection criteria. Age, education and domicile matched healthy volunteers fulfilling selection criteria were included as controls. Semi-structured proforma was used to collect information about the demographical, clinical and psycho-social variables of the patients. WHOQoL-BREF, WHODAS 2.0 and Cope inventory were used to assess quality of life, disability and coping in the patient and control group respectively.

    Result: Most of patients in the study group were young adults belonging to age group 25-35(50.6%) years, unmarried(72.65%) and from rural background(72.65%). Most of patient had co-morbidities (72.65%). Among co-morbidities, psychiatric illness (58.1%) was common. Premature ejaculation (50.42%) was the commonest nonorganic sexual complaints followed by failure of genital response (46.12%). Quality of life of patients of Dhat syndrome was poorer, having more disability and using maladaptive coping strategies in compare to healthy individuals.

    Conclusion: Dhat syndrome is commonly associated with co-morbidities. Dhat syndrome per-se causes impairment in quality of life and disability.

    Keywords: Quality of Life, Disability, coping, Dhat syndrome

    Pattern of substance use among a medical college students in a metropolitan city: A cross-sectional study

    Sumit Mukherjee, Sk Ashik Uzzaman

    Junior Resident, R.G.Kar Medical College, Kolkata, West Bengal. mukherjeesumit26@gmail.com

    Background: Substance use and its associated problems are a global concern in recent time. Doctors are extremely vulnerable to substance use due to easy accessibility to the substances. Adolescence is the most critical period for substance use. Among adolescents, students are particularly vulnerable due to various reasons. Substance use assumes a special significance among medical students as they are the future medical practitioners and have a potential role in treating and counselling the patients of substance abuse disorder.

    Materials and Method: Approval from the Institutional ethics committee was obtained. Written informed consent was also taken. A structured questionnaire designed and validated in-house was administered to obtain information. Briefly, the themes under which the questions were asked included demographic details, details of the substance use and its source, attempt to quit in the past, ill-effects and legal consequences of substance use etc. The main aim of the study is simply to identify the type of substances being used, reason of use and effects in different spheres of life. 200 students were recruited from a medical college of a metropolitan city. Descriptive analysis was used for analyzing various categorical variables. Chi-square test was used to analyse the association of various categories.

    Results: Among 200 participants, 142 were male and 58 were female. It has been seen that much lesser number students from Muslim community is taking substance and the result is significant statistically (p= 0.000983). It has also seen that rising trend of substance use from first year to internee batch (p= 0.006595). Students who are staying at hostel are taking substance more (p= 0.024183).

    Conclusion: Various substances like Alcohol, Tobacco, Cannabis are being used commonly. Problem of substance abuse should be taken seriously as it may have an impact on their professional judgement and in family life.

    Key words: Adolescence, Substance

    The Efficacy Of Adjunctive Theta Burst Repetitive Transcranial Magnetic Stimulation To The Cerebellar Vermis In Negative Schizophrenia: A Randomized Double Blind Sham Controlled Study

    Narendra A R, Vinod Kumar Sinha

    Consultant, District Mental Health Programme, Mysore, Karnataka. narendra.ar.86@gmail.com

    Objectives: To assess the change in negative symptoms following cerebellar vermal intermittent theta burst repetitive transcranial magnetic stimulation in schizophrenia patients as compared to sham stimulation.

    Methodology: Forty patients of schizophrenia with prominent negative symptoms were given 10 sessions of intermittent theta burst stimulation (iTBS) by using Magstim Rapid Square @ device stimulator and butterfly shaped coils to the vermal part of cerebellum located according to the 10 - 20 international system. Patients were randomized into two groups; active group receiving iTBS and control group receiving sham rTMS. Double blinded rating was done before and after completion of 10 sessions and the final rating was done 14 days after sessions of rTMS. Patients’ antipsychotic dosages were optimized before the start of rTMS sessions and were maintained on same dosage till the end of study period. Results obtained were analyzed by using the computer software program SPSS-19.0

    Results: A repeated measure ANOVA found no significant difference regarding changes in psychopathology scores (SANS; CDSS; SAS) when the active and sham groups were compared with each other over the period of 4 weeks. No significant difference was found even in PANSS domains and total score between active and sham groups over the period of 4 weeks. Negative correlation was found between duration of illness and relative percentage change of SANS, PANSS (General psychopathology domains and Total score).

    Conclusion: Intermittent theta burst (iTBS) over cerebellar vermis does not seem to have significant effect on psychopathology in the patients of schizophrenia with negative symptoms. Further improvisation in the methodology, like larger sample size, optimizing TMS parameters, longer follow up and more precise application of rTMS to the cerebellar vermis could result in more favorable outcome.

    Keywords: Repetitive Transcranial Magnetic Stimulation (rTMS); Vermis; Cerebellum; Schizophrenia.

    Purinergic System Derangements As Diagnostic And Prognostic Marker In Bipolar Disorder

    Narveer Yadav, Vishal Sinha, Manjeet Singh, Ramashankar Maddeshiya, Rohit Singhal

    Junior Resident Iii, S.N.M.C. Agra, Uttar Pradesh. narveerisyadav@gmail.com

    Background- Bipolar disorders (BD) a disabling mental illness, affecting millions of people worldwide. Etiopathology of BD is not entirely known, various theories have been proposed as time elapsed but no one found to be definitive and conclusive. The theory that purinergic system derangements could be the underlying cause of BD has long been proposed by Kraepelin and supported by Cade. However, this concept remains untouched for decades but now has been revised in many western countries and promising results were found.

    Method – A longitudinal observational comparative study in patients of bipolar mania (BD-M) /bipolar depression (BD-D) as per ICD-10 attending psychiatry OPD (April 2016-September 2017) of a tertiary care center was planned. Sociodemographic data and biochemical parameters were collected and compared with age-sex matched healthy control. Subjects were investigated for the serum levels of UA (at the 1st day as a baseline, at the end of 1st and 4th week). The severity of the disease was assessed using YMRS and MADRS in respective groups. Collected data was analyzed using Pearson’s correlation and One-way ANOVA.

    Result – We included 53 BD-M, 24BD-D and 30 healthy controls in our study. S. UA levels were found significantly higher in BD-M (5.40±0.82) mg/dl compared to BD-D (4.08±0.48) mg/dl and control (3.15±0.51) mg/dl. YMRS scoring showed statistically significant positive association with S. UA levels (p<0.01) when assessed at baseline and follow-up.

    Conclusion: S.UA found significantly raised in both phases of BD and shows a positive correlation with the severity of BD-M.

    Key words- Bipolar Disorder, Purinergic System, Uric Acid.

    Executive dysfunctions in first episode psychosis correlates with premorbid adjustment, duration of untreated psychosis, symptom profile

    Nathalia, Sathesh V

    Consultant, Kim’s hospital, Kottayam, Kerala. nathalia.ec@gmail.com

    Background of the study: Patients with psychosis exhibit wide ranging impairments on neuropsychological tasks,compared to healthy subjects,including tasks measuring memory,attention,and executive functions.However,lack of methodological rigor prevents firm conclusions about selective deficits in a first episode of psychosis.A further delineation of dysfunctional cognitive processes would provide information about the neurobiology of the disorder and it will contribute to the rehabilitation.Abnormalities detected earlier in development are more likely to be etiological.First episode psychosis is an optimal disorder for examining the neurobiology of the illness.Since confounds such as hospitalization,long term medication,and chronicity can be avoided.

    Objectives: To study the executive functions in first episode psychosis.

    To compare these functions with those of controls

    To study the effect of illness variables on executive functions.

    To study the relationship between duration of untreated psychosis,premorbid illness factors,and clinical symptoms in patients with executive dysfunction.

    Methods: 30 first episode psychosis patients from psychiatry ward of medical college Kottayam was taken as cases.30 healthy people(matched for age,sex,educational status)were taken as controls.Both were subjected to tests of executive function under similar conditions,and the cases and controls were compared in terms of their executive functions.An intra group analysis was done among cases to see the correlation between their performance on tests of executive functioning and premorbid adjustment score,PANSS,duration of untreated psychosis.The results were tabulated and conclusions were drawn.

    Results: There was significant difference between the performance on tests of executive functions by cases and controls.There was negative correlation of duration of untreated psychosis and premorbid adjustment score with executive functions.But there was no significant association of symptom profile with executive dysfunctions.

    Interpretation and conclusion: Executive functions were found to be impaired when the premorbid adjustment score was high,and the duration of untreated psychosis was more.In patients with poorer premorbid adjustment,there was poor executive functioning,and in people with longer duration of untreated psychosis,there was poor executive functioning.Few relationships were found between clinical and neurocognitive indices,suggesting that the two domains are relatively independent.So we can conclude from the present study that longer duration of untreated psychosis had a neurotoxic effect on cases and premorbid adjustment was a marker of the neurodevelopment.

    Key words: first episode psychosis, executive dysfunction,premorbid adjustment,neurobiology.

    A Study Of Clinical And Mri Brain Correlates Of Cognitive Impairment In Post-Stroke Elderly Patients

    Nilam S. Behere, Shubhangi R. Parkar, Shilpa Sankhe

    Speciality Medical Officer, Seth G.S.M.C. and KEM Hospital, Parel, Mumbai, Maharashtra. neelamsb7@gmail.com

    Introduction: Stroke affects 15million people every year worldwide. Cognitive impairment is an important complication resulting in significant impairment in quality of life. It is important to identify its clinical and MRI brain correlates to prevent cognitive impairment and effective cognitive rehabilitation.

    Aims and Objectives: To identify pattern of cognitive impairment across its various domains in post-stroke patients and to find association of cognitive impairment with clinical parameters after stroke and changes seen on MRI brain

    Methodology: 100 elderly patients after a single stroke episode (3months or prior) were studied. Relation of clinical variables and cognitive impairment using ACE-R scale was noted. Later, a subset of 70 patients who had good pre-stroke cognitive functions and vascular risk factors was identified. Their MRI brain scans were studied and data was analyzed.

    Results and Conclusion: Prevalence of cognitive impairment was found to be 78% with highest prevalence in domain of fluency(80%), followed by memory(69%), visuo-spatial orientation(68%), attention(57%) and language(27%). Clinical correlates like duration passed since stroke episode, clinical presentation of stroke, time required for full recovery of deficit symptoms were not associated with cognitive impairment. In the subset of 70 patients, 100% of the patients showed presence of white matter hyperintensities(WMH) on MRI brain scans. General cognitive impairment as seen on total ACE-R score, was not associated with any specific locations of WMH in brain. Specific domains showing significant association included Attention and Memory with left internal capsule, Language with left internal capsule and thalamus and Visuo-spatial orientation with right and left frontal lobe and thalamus.

    Keywords: Post stroke, cognitive impairment, MRI

    Study of correlation of depression and hippocampal volume

    Nidhi Jain

    Junior Resident 2nd Year, R D Gardi Medical College, Ujjain, Madhya Pradesh. nidhijain689@gmail.com

    Introduction: Major depressive disorder is a common, severe and debilitating illness with increasing rate of morbidity and mortality. The biological model used to conceptualise the course of depression involves structural changes in hippocampus. Reduced plasticity of hippocampus has been found to be correlated to stress and depression in many studies. Depression is associated with hypercortisolaemia which down-regulates the HPA axis and damages hippocampal neurons. Executive deficits are very common in depression which strongly suggests hippocampal involvement over the course of depressive illness.

    Materials and Methods:

    Study Centre: A total of 70 Patients admitted in various specialties in R D Gardi Medical College.

    Study Design: Cross sectional Study

    Statistical Analysis: All statistical analysis will be done by SPSS 23.0. For quantitative data frequency distribution, measures of central tendency, dispersion and graphical representation will be applied. For qualitative data percentage and diagrammatic representation will be applied. For comparing various groups appropriate parametric and non-parametric test will be applied.

    Results: This is an ongoing study in which we will try to demonstrate the response of severity of depression on hippocampal volume loss as it has been observed in various studies.

    Keywords: Depression, Hippocampal volume, HPA axis

    Satisfaction With Life, Perceived Loneliness, Depression Among Adolescents – A Comparative Study Between Hostellers And Day Boarders

    Nikhil Nayar, Sagar Mudgal, Rishabh Pratap Singh Yadav, M.K. Deshpande

    Junior Resident, Department Of Psychiatry, Index Medical College, Indore, Madhya Pradesh. nikhil.nayar173@gmail.com

    Introduction: There is a common saying - “The wheel, that squeaks gets the grease”. It is a globally accepted fact that during adolescence a child goes through a lot of changes physically, emotionally and socially. These changes have a great impact on them; these can either make or break an individual. Living away from family for a specific period of time leaves some enduring experiences in the life of the students. Day scholars do have an advantage in shielding the child from the adverse effects of peer pressure and its resulting problems. Adolescents residing as day scholar or hostellers are socialized and natured in totally different situations. So it is expected that Day Scholar and Hostelers situation can affect adolescent’s emotional intelligence and various areas of adjustment. This research is an attempt to study and compare the psychological and behavioral impacts of hostel life and day boarders and help the teachers and parents of students to overcome problems they face during this period.

    Methodology: The study is conducted among the adolescents in the age group of 11-18 i.e. students from class 6 to class 12 of a school in Indore city. 40 students are hostellers and 40 students are day boarders. Scales applied are the Satisfaction with life scale- child (SWLS-C), UCLA Loneliness Scale and the Children’s Depression Rating Scale- Revised (CDRS-R).

    Statistical Tool Applied: Appropriate statistical tool applied using SPSS 22.0. Further details will be discussed at the time of presentation.

    Results and Discussion: Result will be discussed at the time of presentation.

    Keywords: Depression, adolescent, Hostellers

    Efficacy of Adjunctive low frequency (0.3 Hz) rTMS over vertex in localization related epilepsy in Children and adolescent: A Randomized double-blinded sham controlled study.

    Nirmalya Mukherjee, Vinod Kumar Sinha, Nishant Goyal

    Senior resident, Central Institute of Psychiatry, Ranchi, Jharkhand. nirmalya.ik@gmail.com

    Objectives: Low-frequency (<1Hz) rTMS decreases the excitability of the cortical areas. Mixed results noted in reducing seizure using <1Hz rTMS in adults. We evaluate the efficacy of adjunctive vertex 0.3 Hz rTMS in focal epilepsy in children and adolescents.

    Methods: 30 patients, of either sex, aged eight to eighteen years, with ≥4 paroxysms of localization related seizures in last month on continuous anti-epileptics were included and divided randomly in to active or sham group. Active group received two daily sessions (30 seconds apart) of 300 stimuli/train of rTMS (100% MT) at 0.3 Hz, over vertex for 5 days. Sham group received stimulation with same protocol except the coil being placed vertical to scalp. Seizure frequency were compared pre- vs. upto 3 months post-stimulation. EEG was recorded baseline and after last rTMS session.

    Result: No significant difference noted between two groups in seizure frequency change over time. No significant change in interictal epileptiform discharges between pre and post stimulation found.

    Conclusion: Adjunctive 0.3 Hz rTMS over vertex has no significant effect in epilepsy treatment in children and adolescent but medication interaction effect can’t be ignored. In future, localised stimulation on the affected lobe can be tried with more homogeneous sample.

    Keywords: rTMS, Epilepsy, Children, Adolescent

    Psychiatric morbidities in Transgender & Cisgender people of Imphal- A comparative study

    Niranjan Hebbar YR, RK Lenin Singh

    PGT, RIMS, imphal, manipur. niru53koppa@gmail.com

    Introduction- Psychiatric morbidities seems to be one of the biggest hurdles among transgender people. Lack of knowledge and ignorance with ever growing abuse over this population makes them vulnerable for mental instability.

    Aim- To identify and compare the psychiatric morbidities of transgender people with that of cisgender people of Imphal, Manipur.

    Methods- Between September 2015 and December 2016, a cross sectional study was conducted in the General OPD of Regional Institute of Medical Sciences, Manipur. A standardised survey questionnaire (MINI-Plus scale) was used to assess the presence of psychiatric illnesses like depression, phobia, anxiety etc.. among all adults (32) with Gender Dysphoria and a comparative group of Cisgender persons. Data obtained was tabulated and analysed using SPSS version 21. Descriptive statistics and chi square were used to analyse the data.

    Results- 56.25% of transgenders were found be suffering from at least one psychiatric diagnosis. Substance abuse was seen in 59.37% , life time alcohol abuse in 84.37%, past history of depression in 46.87% and Generalized Anxiety Disorder, PTSD in 37.5% and 9.4% of transgenders, which were significantly higher when compared to cisgender group. Suicidal risk was also significantly higher in transgender persons with 37.5% of them with previous suicidal attempts when compared to cisgender population.

    Conclusion- Transgenders have more psychiatric morbidities compared to the cisgender people. It is in line with the results of previous studies. High degree of suspicion and timely intervention for psychiatric illness should be part of care of transgender persons.

    Keywords: Transgender, Cisgender, Psychiatric morbidities

    Stress and insomnia among first year post graduate residents

    Vinyas Nisarga, Anupama M, Harish Kulkarni

    Junior Resident, JJM Medical college, Davangere, Karnataka. nisargavinyas@gmail.com

    Background of the study: Medical residency is a strenuous phase of medical education. Residents are subjected to vast academics, extended hours of duties, heavy patient load and reduced personal time. This could make them profoundly stressed. Due to their rapid shift in work schedule they are also expected to have sleep problems. This study was planned to assess the presence of stress and insomnia and the relationship amongst the first-year medical residents (post graduates).

    Methodology: A cross sectional assessment was done on the first year (post graduate) medical residents. After obtaining written consent, socio-demographic details were collected. Following scales were administered: Bergen insomnia scale for sleep related problems and Perceived stress scale for stress were administered. Statistical analysis was done using IBM SPSS version 22.

    Results: Out of 172 post graduates,112 consented and completed the study. Sample consisted of 53% of females, mean age was 26, 60% were from urban locality and 80% were unmarried. 57.1% were found to be having insomnia, 68.5% and 8.1% had moderate and high stress respectively. There was strong association between insomnia and stress which was highly significant (χ2 = 14.42, p<0.001)

    Conclusion: First year postgraduate residents were found to have high prevalence of stress and insomnia. Stress was highly co-related with insomnia.

    Keywords: Residents, Stress, Insomnia.

    Selfie taking behavior: Personality factors, Self-esteem and Interpersonal closeness in college going students in a Metropolitan city

    Nitisha Verma, Kalpana Pawar

    Speciality Medical Officer, Department of Psychiatry, TNMC, Mumbai, nitishaverma30@gmail.com

    Background: Selfie taking is an emerging trend. Studies have linked it to personality and self-esteem issues. It has recently been associated with psychopathology.

    Aim and Objectives:

    1. To study prevalence of ‘selfie taking behavior’ in college going students.
    2. To study personality factors, self-esteem and interpersonal closeness in college going students engaged in ‘selfie taking behavior’.


    Methodology: ‘Selfie taking behavior’ was defined as ‘taking of two or more selfies in a day’. 703 students from four colleges participated in this cross sectional study. They were assessed using a self-designed face validated questionnaire, Rosenberg Self-esteem scale, Ten Item Personality Inventory and Perceived Interpersonal Closeness Scale. They were divided into two groups: students with ‘selfie taking behavior’ and those without it.

    Results: Prevalence of ‘selfie taking behavior’ was 28.7%. Students involved in ‘selfie taking behavior’ tended to be extroverts. There was no significant difference on other domains. Students who had ‘selfie taking behavior’ found themselves taking selfies when they were meant to be doing something important. They were unable to decrease the frequency of their selfie taking. They also reported interference in their social and academic functioning.

    Conclusion: ‘Selfie taking behavior’ may be pathological and needs to be evaluated further.

    Keywords: Selfic, Personality, Self-esteem, college students

    A study of factors influencing the duration of stay in closed ward patients

    Bandela Sowmya Grace, Challuri.Prashanth

    Post Graduate Md Psychiatry, Institute Of Mental Health,Hyderabad, Telangana. olive7017@gmail.com

    Background: Psychiatric patients who are admitted into closed ward have frequent hospital admissions and prolonged length of hospital stay, may be due to the growing demands in health services and the limitation of resources of patients and their care takers. The present study aims at factors influencing the duration of hospital stay in these patients, with a goal of improved patient care, reduction in length of stay, and effective management of hospital resources.

    Aims and objectives:

    1. To study the mean duration of stay.
    2. To study the sociodemographic factors of the admitted patients.
    3. To study the clinical profile.


    Methodology: A total of 150 case records fulfilling criteria for study were taken. Semi -structured proforma for sociodemographic and clinical variables will be used and analysed using spss.

    Results: Mean duration of hospital stay in closed ward patients is 92.47.and the mean duration of hospital stay is 21.9 days in patients whose reception order has a clear mention of free citizen and can be handed over to family members, in comparison 38.9 days in to be produced before the court and 33.71 days in reception order having yet to be clarified.

    Conclusions: Admission into closed wards is determined by many factors ,many studies are from other countries which are not similar to our country. In addition to clinical diagnosis delay in the discharge also because of certain phrasings of reception orders.

    Keywords: Closed ward admissions ,Mean duration of stay, reception order.

    Role of Sexual Attribution and Sexual Dysfunction Among Female With Schizophrenia And Female Without Schizophrenia.

    Pallavi Abhilasha, Mrinalini Reddy

    Post graduate 2nd year, SRM medical college, Chennai, Tamil Nadu. pallaviabhilasha@yahoo.com

    Sexual functioning occurs in a woman’s life during different periods of age, and in stages such as pregnancy, parturition, breastfeeding and menopause. Additionally, women with desire disorders have anxiety issues, low self-esteem, emotional instability and neuroticism. The first-generation antipsychotics cause further deterioration in orgasmic function. Sexual disorders lead to considerable personal distress, interpersonal difficulties and mental ill health, mostly anxiety and depression. Difficulties were in the form of headache after sexual activity,difficulty reaching orgasm, painful intercourse,lack of vaginal lubrication ,vaginal tightness,bleeding after intercourse and vaginal infection. 14% subjects attributed these difficulties to their own health problems; further lack of privacy spouse’s health problems and conflict with spouse were the other cited reasons for those difficulties.

    Methodology:-

    Aim: Identify attribution and sexual dysfunction among female with schizophrenic disorder and females without schizophrenia.

    Objectives: To assess and compare the sexual functioning among female without schizophrenia and female schizophrenic patients.

    Identify and compare attributing factors of female without schizophrenia and female schizophrenic patients.

    Inclusion Criteria For Females With Schizophrenia:

    Women who are currently sexually active.

    With age between 21-45 years.

    Females diagnosed with schizophrenia.

    Inclusion Criteria For Females Without SchizophrenIA

    Women who are currently sexually active.

    With age between 21-45 years.

    Female without a psychiatric illness

    Exclusion Criteria For Females With Schizophrenia And Without Schiophrenia

    History of hyper tension, diabetes, cardiac problems, severe dermatological problems, terminal illnesses, epilepsy, hysterectomy, menopausal women and hormonal therapy, history of substance abuse/alcohol, head injury.

    Study Type: Cross-Sectional

    Sample Source: The study will be conducted at both inpatients and outpatients in Department of Psychiatry from SRM MCH&RC, KATTANKULATHUR

    Assessment tools- socio demographic performa female sexual Functioning Index (15 min):-Female Sexual Function Index (Rosen et al., 2000) was the only published instrument validated and normed on a sample of women with clinically diagnosed female sexual dysfunction. The FSFI has been shown to discriminate reliably between women with and without female sexual arousal disorder (FSAD) on each of six domains: desire, arousal, lubrication, orgasm, satisfaction, and pain.

    Conclusion-This study highlights the high rates of sexual dysfunction among women with schizophrenia and its relationship not just to illness and medication side effects but also to the quality of marital life. It emphasizes the need to look beyond signs and symptoms and focus on other areas that may have an important impact on the quality of life of women with schizophrenia such as sexual functioning. Future studies should try to prospectively assess change in sexual functioning after the onset of illness and initiation of treatment and should include the partner’s perspective.

    Keywords: Female, Schizophrenia, Sexual Dysfunction

    Caregiver of the Elderly Patients with Psychosis- A Comparative Study with Caregivers of Dementia

    Pallavi Sinha, Nimesh G Desai, Om Prakash, Suman Kushwaha, C B Tripathi

    Assistant Professor, North Delhi Municipal Corporation Medical College, Delhi, pallavisinha0102@gmail.com

    Introduction: Research in the field of caregiving for the geriatric population with mental health issues has been largely focused on dementia caregiving. However, elderly patients with severe mental health disorders like psychosis pose significant strain on their caregiver’s life. The index study was carried out with the objective to evaluate the caregiver burden and quality of life in elderly patients with psychosis.

    Methodology: 32 caregiver of elderly patients with psychosis were compared to 32 caregivers of patients with dementia. The caregivers of both groups were evaluated for quality of life and burden of caregiving. Patients in addition underwent cognitive screening, assessment for psychopathology. Statistical analysis using bivariate tests were performed to study the factor affecting burden and quality of life in caregivers of elderly with psychosis

    Results: The caregivers of elderly with psychosis were seen to have a significantly worse environmental domain of quality of life as compared to dementia caregivers (p=0.05). There were low scores in the other three domain of caregiver quality of life but this was not significantly different as compared to dementia caregivers. Dementia caregivers however had a higher burden of care (47.69±11.49; p<0.001). Factors associated with poor caregiver quality of life were advanced age of the patient and caregiver, caregiver burden, psychological distress and greater psychopathology in patients as shown by correlation analysis.

    Conclusions: The sphere of geriatric mental health caregiving has been largely overshadowed by dementia caregiving. However the index study shows caregivers of elderly patients with psychosis have poor quality of life. Identification of factors associated with poor caregiver quality of life can allow development of interventions that can turn caregiving into a positive action.

    Keywords: Elderly, Dementia, Psychosis

    A prospective cohort study about relationship of Sexual Dysfunction with dose and duration of Escitalopram and Paroxetine use

    Pankaj Sureka, A S Srivastava

    Assistant Professor, BHU, Varanasi, UP. pankajsureka17@gmail.com

    Background:

    1. To determine the relationship of Sexual Dysfunction (SD) with dose and duration of Escitalopram or Paroxetine.
    2. To study difference in incidence of Sexual Dysfunction in participants taking Escitalopram or Paroxetine


    Methodology: A hospital based naturalistic prospective cohort study using purposive sampling technique with time period of 12 months. Only male patients receiving either Escitalopram 10-20mg/day or Paroxetine 25-62.5 mg/day were included in the study. Participants in Escitalopram group were 83 and in Paroxetine group 47.

    Results: Majority of participants in both groups were middle aged, married, Hindu belonging to lower socio-economic status (SES) with diagnosis of depression. At end of 40 weeks those taking Escitalopram had 0.524 i.e 52.4% probability of remaining free from SD; while those taking Paroxetine had 0.498 i.e. 49.8% probability of remaining free from SD. Mean duration at which SD occurred was 30.6 weeks for Escitalopram and 28.7 weeks for Paroxetine. There was no difference in risk of developing SD on taking either Escitalopram or Paroxetine. In both groups low family income and rural residence are socio-demographic risk factors which increased risk of developing SD. Low literacy and unskilled occupation were additional risk factor for Escitalopram group but not for those on Paroxetine.

    Conclusion: Longer treatment with Escitalopram or Paroxetine increase risk of developing SD. Increasing dose of either Escitalopram or Paroxetine does not increase risk of developing SD.

    Keywords: Sexual Dysfunction, Escitalopram, Paroxetine

    Effect of adjunctive N-acetyl cysteine supplementation on symptom profile in patients of schizophrenia

    Parul Prasad, D. Ram, Nishant Goyal

    Senior Resident, Government, Lucknow, Uttar Pradesh. parulprasad88@yahoo.com

    Background: Schizophrenia is a debilitating condition that affects 1% of the population worldwide. There is now increasing evidence that a number of physiological mechanisms such as oxidative stress, one carbon metabolism and atypical immune-mediated responses exist in individuals with schizophrenia, not solely dopaminergic pathophysiology as per the dopamine (DA) hypothesis. Orally administered Nacetyl cysteine (NAC) as adjunctive treatment, which is a precursor of GSH, is a possible way to reduce the oxidative burden in patients with schizophrenia.

    Aim: To study the efficacy of adjunctive N-acetyl cysteine in patients with schizophrenia as measured by PANSS.

    Method: A prospective hospital based study in which 41 cases of schizophrenia were enrolled, who were then randomized into two groups (study group and control group) using random sampling technique using computer generated randomization table. Both the groups were receiving antipsychotic medications as per decision of the treating psychiatric units. The study group received 600 mg of NAC thrice daily in addition to the antipsychotic treatment whereas the control group received only the antipsychotic treatment. Baseline data, and data at 2weeks, 4 weeks and 6 weeks was collected for all subjects using Positive and Negative Syndrome Scale (PANSS),Clinical Global Impression (CGI) Severity (CGI-S) and Improvement (CGI-I) Scales.

    Result: The results showed that from baseline to 6 weeks, the patients with schizophrenia who received NAC had significantly greater percentage change in PANSS scores (positive, negative, general psychopathology and total scores), significantly greater improvement in CGI-S and CGI-I scores as compared to patients with schizophrenia who did not receive NAC.

    Conclusions: The findings points to an improvement in the psychopathology, as is evident by significant improvement in PANSS positive, negative, general and total scale along with improvements on CGII and CGI-S scales in patients with schizophrenia who received NAC as compared to patients with schizophrenia who did not receive NAC. Glutathione (GSH) dysregulation at the gene, protein, and functional levels has been observed in schizophrenia patients. GSH precursor NAC presumably improves symptoms in schizophrenia as was observed in our study. Keywords: N-acetyl cysteine; schizophrenia; Glutathione; Positive and Negative Syndrome Scale; Clinical Global Impression; Calgary Depression Scale for Schizophrenia.

    Keywords: N-acetyl cysteine, Schizophrenia

    The Relationship between Professional Quality of Life and General Health in a Tertiary Care Hospital

    Pavani Narukurthi, Raghuram Macharapu, Pramod KR Mallepalli, Ravulapati Sateesh Babu

    Postgraduate, Mamata General Hospital, Khammam, Telangana.pavani2019@gmail.com

    Introduction: Professional quality of life is the measure that everyone feels in relation to their work. Both the positive and negative aspects of doing a job, influence the professional quality of life. The majority of people spend more time at work than they do anywhere else, doing anything else.

    Aims and Objectives: The aim of this research is to study the relationship between professional quality of life and general health in the postgraduates of a Tertiary Care Hospital.

    Methodology: This is a cross-sectional study, which is conducted at Mamata General Hospital in Khammam, Telangana during a 6-month period (2017). The tools used are the Professional Quality of life questionnaire(ProQol) and General Health Questionnaire(GHQ).

    Results: Statistical analysis needs to be done and the results will be analysed and presented later.

    Conclusion: The current study is carried out to support the findings between the professional quality of life and general health among postgraduates in a tertiary care hospital.

    Key words: Relationship, ProQol, General Health.

    Association of caregiver burden with insight and quality of life in persons suffering from Schizophrenia and BPAD

    Kampalli S V R Naga Pavan Kumar, N Prasanna Kumar, V Padma

    Post Graduate, Andhra Medical College, Visakhapatnam, Andhra Pradesh.pavankumarkampalli@gmail.com

    Introduction: Caregivers play a pivotal role in the maintenance part of the management of psychiatric disorders. Psychiatric illnesses not only effect the patients, but also the lives of their caregivers. Caregivers experience high levels of burden while dealing with the patients’ sufferings, meeting their demands of taking care of them. Caregiving could be highly stressful.

    Insight is one of the most important aspects of the patients’ illness and plays an important role in drug compliance and thereby the maintenance of the remission.

    Quality of life of the persons with psychiatric illnesses may affect the caregivers’ suffering. As there are few studies determining the association between the insight, quality of life on caregiver burden, this study is performed to find the association between the caregiver burden and the insight and quality of life.

    Aim: To find the correlation between the caregiver burden with insight and quality of life of the patients attending the Government Hospital for Mental Care, Visakhapatnam with the experienced by their attendants.

    Materials and Methods: Sample Size: 60 patients

    Type of study: Cross-sectional study.

    Inclusion criteria: Patients diagnosed with Schizophrenia and BPAD as per ICD 10 criteria. Patients and caregivers who gave informed consent for the study.

    Exclusion Criteria: Patients who are aggressive, violent and not co-operating for the study.

    Study tools: Birchwood Insight Scale for insight, WHO-QOL BREF scale for quality of life and Burden Assessment Scale for the caregiver burden.

    Correlation statistical tests will be applied.

    Results: Results will be discussed later at the conference

    Key words: Insight, Quality of life, Caregivers, Burden.

    Physical anhedonia is neither an endophenotype nor a candidate symptom in paediatric bipolar disorder

    Pawan Arun Khadse, Vinod Kumar Sinha,

    Post Doctoral Fellow in Addiction Medicine, NIMHANS, Bangalore, Karnataka.pawankhadse@gmail.com

    Aims: Various studies have identified physical anhedonia as a potential candidate symptom and an endophenotype in schizophrenia. One study in adult bipolar disorder has failed to obtain such results. The current study was aimed at characterizing physical anhedonia in euthymic paediatric bipolar disorder patients and their relatives.

    Methods: Thirty patients fulfilling the ICD 10 diagnostic criteria for bipolar affective disorder currently in remission were recruited from the outpatient department of a tertiary care centre in India. One healthy first degree relative of each patient and thirty healthy controls were also recruited. All participants in the study were below 18 years of age and informed written consent was obtained from their parents. All participants were evaluated on Chapman’s Revised Physical Anhedonia Scale.

    Results: Among three groups mean physical anhedonia score was highest for the first degree relatives and minimum for the patient group; no significant difference was noted across the groups. When individual cases and their first degree relatives were paired together using sibling pair analysis, an intrafamilial correlation coefficient of 0.063 (p = 0.369) was obtained suggestive of absence of significant intrafamilial correlation for physical anhedonia. Further there was no significant difference in clinical characteristics of anhedonic and hedonic patients.

    Conclusions: Similar physical anhedonia scores across three groups suggest that physical anhedonia cannot be regarded as an endophenotype in paediatric bipolar disorder. Further physical anhedonia also fails to identify a homogeneous clinical or familial sub-group of paediatric bipolar patients and thus it cannot be considered as a candidate symptom.

    Keywords: Anhedonia, Pediatric, Bipolar disorder

    Innovative programme for training and mentoring of primary health care physicians in the remote areas to provide best practice in mental health: Virtual NIMHANS ECHO

    Pawan Arun Khadse, Jayakrishnan Menon, Mrunal Bandawar, C. Naveen Kumar, Prabhat Chand, Pratima Murthy, Sanjeev Arora

    Post Doctoral Fellow in Addiction Medicine, NIMHANS, Bangalore,Karnataka. pawankhadse@gmail.com

    Background: Treatment gap for mental illnesses is 75%. Innovative methods of reaching the unreached are the need of the hour. Since 2014, National Institute of Mental Health and Neurosciences (NIMHANS) in collaboration with Project ECHO (Extension for Community Healthcare Outcomes), has initiated one such program

    Aim: The aim of the NIMHANS ECHO project is to strengthen the ability of non-specialist health professionals to identify, assess and provide intervention for mental health in District Hospitals (DH) located in the community and co-manage the cases on discussion with multidisciplinary NIMHANS hub.

    Method: VKN (Virtual Knowledge Network) NIMHANS ECHO ‘hub and spokes’ model was used to train 23 medical officers working in various district hospitals in Chhattisgarh state. A brief sensitization program of 10 days was initially conducted at NIMHANS, followed by fortnightly virtual sessions through a HIPAA compliant multipoint video conferencing solution, accessed through smart phones. During these sessions, the DH physicians (spokes) presented five or six cases in a pre-designed semi-structured format and raised questions regarding diagnosis and management. The NIMHANS hub team guided the physicians in managing the cases. The case discussions would end with a “brief didactic” by a hub expert on the relevant pre-decided curriculum.

    Results: Till date, 4 virtual sessions were held in which total 15 cases were presented by the spokes for diagnostic clarifications and discussing management. Varied cases were reported out of which 6 cases were of mood disorders and 4 were of anxiety disorders. The average attendance of the participants was 73.91%.

    Conclusion: It is feasible to connect district hospitals to a tertiary care centers like NIMHANS through this programme. Pending systematic outcome assessments, this model holds promise in reducing treatment gap in the mental health.

    Keywords: Primary health care, physicians, NIMHANS ECHO

    A Study Of Prevalence Of Depression And Anxiety In Patients With Chronic Kidney Disease.

    S.Periyar Rani

    Post Graduate, Institute of Mental Health, Chennai, Tamil Nadu. periyarranimd@gmail.com

    Background: Patients with chronic kidney disease due to various reasons like the complexity, multidimensional nature of problems, long term duration of the disease, are the most difficult groups of patients often suffering from psychiatric morbidity. Depression and anxiety are the most common psychological problems in these patients.Therefore they should be carefully assessed and treated appropriately in order to improve the quality of life and wellbeing of patients.

    Aims and Objectives:

    To estimate the prevalence of anxiety and depressive disorders in patients with chronic kidney disease and to assess their quality of life.

    Materials and Methods

    A cross sectional study of 120 chronic kidney disease patients attending op/ip at department of nephrology ,Rajiv Gandhi government hospital, Chennai for 2 months duration done to estimate the prevalence of anxiety and depression after obtaining informed consent. Social demographic details collected using semi-structured proforma and the following questionnaires are applied to the patients,SCID (Structured clinical interview for DSM disorders) ,HAM-A(Hamilton anxiety rating scale), HAM-D(Hamilton rating scale for depression), SF 16(short form health survey) to assess the quality of life.

    Statistical Analysis : Results analysed using SPSS 20 package(Statistical Analysis Software)

    Results and Discussion:

    Results will be discussed at the time of presentation.

    Keywords: depression,anxiety, chronic kidney disease,End stage renal disease

    Internalized Stigma And Its Correlates Among Treatment Seeking Natural Opiates Users In India: A Cross-Sectional Observational Study

    Prashant Gupta, Udit Panda, Arpit Parmar, Roshan Bhad

    Senior Resident, AIIMS, New Delhi, pg_aiims@yahoo.co.in

    Background. Use of natural opiates is socio-culturally sanctioned and has been widely reported from India. Literature suggests that natural opiates users seems to be a unique population of opioid users with largely preserved functioning in various domains of life, despite using natural opiates for prolonged periods. However, no study has ever assessed stigma among this group of patients.

    Materials and methods. This cross-sectional observational study was performed at National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences, New Delhi, a tertiary care substance use treatment centre located in North India. A total of 117 male participants with primary natural opiates use disorder presenting at the outpatient department of NDDTC were recruited in the study after written informed consent. Information related to socio-demographics, substance use and clinical details were collected using a data collection tool developed for the study. Internalized Stigma of Mental Illness (ISMI) scale – Hindi version was used for assessing stigma.

    Results. The mean age of the participants was 44.79±11.04 years. Majority of the participants were Sikh, married, semi-skilled workers, educated up to 10 years and coming from rural background. Use of other substances (except tobacco) and other opioids was low with primary opioid of use being doda/poppy-husk for most of them. Mean total score on ISMI scale was 2.58±0.72 suggesting overall moderate levels of stigma. More than 50% of participants had reported minimal to mild internalized stigma. Age of the participants was negatively correlated with ISMI total score (and domain scores) (p<0.05). Patients with higher stigma reported higher recreational use of pharmaceutical sedatives (p<0.01).

    Conclusions. Our study suggested lesser stigma scores as measured by ISMI-Hindi among natural opiate users. This further adds to the limited literature on natural opiates users suggesting it to be a distinct subpopulation of opioid users requiring special attention.

    Key Words: Doda, Afim, Opium, Poppy husk, Stigma

    Association of glycemic control in type 1 diabetic adolescents and diabetes related distress among their parents

    Phani Ram vavila, T S N Raju, S Radha Rani

    Post Graduate, Andhra Medical College, Visakhapatnam, Andhra Pradesh. phanivavila@gmail.com

    Introduction: Parents who are primary caregivers in most cases, play a vital role in the treatment of type 1 diabetic adolescents. They have to participate in the aspects of management like blood glucose monitoring and insulin administration on a daily basis. Parents of adolescents with type 1 diabetes worry more about health of their children compared to parents of healthy adolescents. Greater child related distress is described in parents of type 1 diabetes influencing parent child relation. Clearly parenting distress is a risk factor when it comes to child’s diabetes outcome as supportive parenting and positive communication empower children in their diabetes self care.

    Aim: To find the correlation between glycemic control among type 1 diabetic adolescents and diabetes related distress among their parents in the patients and parents attending a N.G.O. camp.

    Materials and Methods: Sample Size: 42 patients

    Type of study: Cross-sectional study.

    Sample: Patients diagnosed with type 1 Diabetes and presently in the age group of 10 to 19 and their primary caregiver parent attending a NGO camp and who gave their consent to the study.

    Study tools: Diabetes distress scale for parents of teens with type 1 diabetes, HbA1c value of type 1 diabetic adolescents collected from their medical records.

    Correlation statistical tests will be applied.

    Results: Results will be discussed later at the conference

    Key words: Diabetes related distress, glycemic control, type 1 diabetes, Adolescents.

    Remembrance of Things Present: Making Peace With Dementia

    Peter Maeck

    Writer/Photographer, The Authors Guild; The Dramatists Guild, Raleigh, NC.pmaeck@gmail.com

    Background: I am an American writer/photographer. My talk celebrates my father who died of complications from Alzheimer’s Disease. I have presented it at TEDx events and the World Federation for Mental Health World Congress in Delhi, India; the Royal Australian & New Zealand College of Psychiatrists; the European Conference on Mental Health; the WPA World Congress of Psychiatry; and a plenary session at the Royal College of Psychiatrists in London. My TEDx Talk: https://www.youtube.com/watch?v=BXBNNQqE2jw. Book available on Amazon. More at: www.petermaeck.com

    Methodology: I blend prose, rhyming poetry, and photographs to convey a challenging experience with a lyrical, often humorous touch. If art can offer only symptomatic and palliative relief from the effects of Alzheimer’s Disease, that is no less than modern medicine has done to date. Ideally, art and science can work together to reduce dementia’s effects and ultimately reach a cure.

    Results: Dementia’s dark cloud is lifted by poetry, pictures, music, and love which freeze time initially then melt it, enabling a coming-together in a lyrical middle realm between what has gone before and what is yet to be.

    Conclusion: Viewed as a deterioration of the brain, Alzheimer’s is terrifying. But seen as fermentation which is not spoilage but transformation – e.g. grapes into wine; milk into cheese ¬– it can enhance the caregiver-patient relationship. Indeed, my father and I moved from a prose relationship into one of poetry which was no better or worse, just different, where we engaged more in rhyme than in reason, joining in a blessed present tense. For me it was grief’s fifth stage of acceptance, and I think for him also, as he lived his last days and died in a state of peace.

    Keywords: Alzheimer’s, Dementia, Caregivers

    A Study Of Pattern Of Referrals In Liaison Psychiatry

    Pankaj Kumar Gupta, Sally John, Sonia Mary Thomas,

    PG Student, JNMC(DMIMSs), Wardha, Maharashtra. pnkjdoctor@gmail.com

    Background: Liaison psychiatry specializes in bridging psychiatric services to other specialties. It provides the ability to acquire adequate understanding about the intricacies involved in treating patients with physical and psychiatric co-morbidities. Efficient communication between different levels of care has a great impact on quality of health care. Objectives: To assess the source of referral, reason for referral, the psychiatric diagnosis of the patients referred and the psychiatric treatment initiated by the referring team and the knowledge of the illness. Materials and method: The study was a cross sectional study conducted on the out patients and inpatients referred to the psychiatric department in a tertiary care hospital in central India. It was completed in the time period of 3 months with a sample size of 150 patients. All the referred patients were evaluated by a consultant psychiatrist and diagnosed according to ICD 10. Results:79(52.6%) patients were males and 71(47.3%) were females. The mean age was 36.01 years. A majority of the referrals were made from the department of medicine (n=76, 50.6%).The most common reason was the presence of abnormal behavior (n=37, 24.6%). The most common psychiatric diagnosis made was substance use disorders (n=51, 34%) Conclusion: There is significant gap existing in consultation liaison psychiatry. Early diagnosis and management of psychiatric disorders in patients presenting to the other departments with various physical illnesses definitely hasten recovery, reduce morbidity and improve quality of life.

    Key word-Referrals,Liaison,Psychiatry

    Biological rhythms in Bipolar Disorder: A state or trait marker?

    Pooja Patnaik Kuppili

    Senior Resident, JIPMER, Puducherry, Puducherry. poojapatnaik.aiims@gmail.com

    Background: There is limited research on biological rhythms in Bipolar Disorder (BD) from the Indian setting despite its intricate relationship with metabolic syndrome and functioning

    Aims: The study aimed to assess “trait marker” status of biological rhythms as well as correlates of biological rhythm impairment in euthymic BD.

    Settings and Design : Cross sectional observational study over six months carried out in hospital setting

    Methods and Material: Biological Rhythms Interview of Assessment in Neuropsychiatry Questionnaire (BRIAN) and Functioning Assessment Short Test (FAST) were used to assess biological rhythms and functioning respectively. Metabolic syndrome was diagnosed as per modified National Cholesterol Education Program – Adult Treatment Panel III. Depressive symptoms were assessed by Hamilton Depression Rating Scale (HDRS). Euthymia was defined as symptomatic remission for atleast eight weeks. Ethical approval was taken.

    Statistical analysis : Descriptive statistics was performed. Comparison among continuous and categorical variables were done by appropriate tests. Correlation coefficient was performed to assess strength and direction of association between the variables.

    Results : Fifty cases of euthymic BD and fifty apparently healthy controls were recruited. Total as well as certain domain specific BRIAN and FAST scores were significantly higher in cases compared to controls. A significant positive correlation was found between the total BRIAN score with HDRS as well as FAST score. No correlation was obtained between biological rhythms and metabolic parameters.

    Conclusions: Biological rhythm impairment is found to be a trait marker in patients with BD in our study. The study supports need for management of subsyndromal depressive symptoms even in interepisodic period.

    Key words: Biological rhythms, Functioning, Metabolic syndrome, Subsyndromal depression, Trait marker

    A co-relational study of Severity, Dimensions of Obsessive Compulsive Disorder and Family Accommodation

    Pooja Mahour, Pragya Verma, P K Dalal, Vivek Agrawal

    Assistant Professor cum Child psychologist, King George’s Medical University, Lucknow, Uttar Pradesh. poojapsy@gmail.com

    Objective: Family accommodation (FA) refers to ways in which family members assist the patient in the performance of rituals, compulsions, avoidance of anxiety provoking situations, or modification of daily routines to assist a relative with obsessive-compulsive disorder. The purpose of this study is to explore the association of family accommodation with severity and dimensions of obsessive compulsive disorder. Method: Though Purposive sampling N=45 Diagnosed OCD patients (DSM-IV TR) and N=45 their family members were included after fulfilling the inclusion and exclusion criteria and consented for the study, sample collected from the department of Psychiatry, KGMU, Lucknow, India. Yale brown Obsessive-Compulsive scale (YBOCS) and Dimensional Yale brown Obsessive-Compulsive scale (DYBOCS) were used to assess the severity and different dimensions of OCD patients, family members were assessed on Family Accommodation Scale for Obsessive–Compulsive Disorder –Self Rated version (FAS-SR). A Pearson’s correlation coefficient was used to evaluate the association between variables. Results: FA was moderately present in the family of patients with OCD. FA has significantly association with Obsession (r=. 413, P>.001), Compulsions (r=. 607, P>.001) and Over all OCD (r=. 597, P>.001). On DYBOCS we found the dimension of cleaning & washing (r =0.461, P>.001) and aggressive obsession (r =0.382, P>.001) were significantly correlated with FA. Conclusion: The findings suggested that the family accommodation is very common in families of OCD patients and strongly associated with symptom severity, not all but specific dimensions. Hence along with patients their family members could also be evaluated on mentioned parameters and incorporated as well in psychotherapy for OCD.

    Keywords: Family Accommodation, Obsessive–Compulsive Disorder, Predictors, Symptoms Dimensions.

    A study of the factors associated with course and outcome of early onset schizophrenia

    Prajakta S. Patkar, Suprakash Chaudhury, D. Saldanha, Archana Javadekar, Samiksha Sahu, Ichpreet Singh, Saurav Kumar

    P.G. student, Dr. D. Y. Patil Medical College and Hospital, Pune, Maharashtra. prajakta06@gmail.com

    Introduction: As neurodevelopmental disorders, schizophrenia and other psychoses usually show their first manifestations during childhood and adolescence, and 11–18% of patients experience first episode of psychosis before 18yrs. Research on Early onset schizophrenia (EOS) is limited, partly due to its low prevalence.

    Materials and methods: This prospective, longitudinal hospital based study was undertaken at Psychiatry department of Dr D.Y.Patil Medical College and hospital during September 2016 to September 2017. 50 patients diagnosed with schizophrenia according to ICD – 10 DCR with age less than 18years were enrolled after an Ethical Committee approval. Information regarding sociodemographic details, illness and treatment details was collected. PANSS scores were noted at each visit. Treatment outcome on follow up was assessed by Clinical Global Impression (CGI) Scale at 6 months and 1year.

    Results: The mean age of onset was 15 years. Around 10% were premorbidly intellectually disabled. Positive symptoms were common than negative. 40% had a positive family history of psychosis. Non-compliance and illiterate care taker were important factors in deciding outcome. Patients with insidious onset had significant degree of occupational and social impairment compared to those with acute onset. Another striking finding was the presence of sexual abuse in 20% cases.

    Conclusion: In cases of schizophrenia, premorbid intellectual disability adds to the difficulty for the psychiatrist to diagnose it, thus interfering with the outcome. The risk is directly proportional with non-compliance and educational status of the patient and family, and some association is seen with positive family history as same with adult onset schizophrenia. This is one of the few studies that shows some relation of EOS with sexual abuse prior to the onset of the disease.

    Keywords: EOS, positive and negative symptoms, treatment outcome, child sexual abuse.

    A Study of depression and anxiety disorders among alcohol dependent patients in Psychiatry department, RIMS, Imphal, Manipur.

    Prakash Haldar, Senjam Gojendra Singh, N Heramani Singh

    Senior Resident, Indian Psychiatric Society, Bongaon, West Bengal. prakashmed03@gmail.com,

    Background: Alcohol dependence is a very important public health issue in North East India, especially in Manipur. Psychiatric comorbidity especially depression and anxiety are more common among alcohol dependent patients. This study has highlighted on the psychiatric comorbidity of depression and anxiety among alcohol dependent patients.

    Objectives: To assess depression and anxiety among alcohol dependent patients .

    Material and Method: A prospective study of the outdoor and indoor patients of aged 20-60 years who attended Psychiatry Department, RIMS, Imphal during the period between November 2013 to July 2016 were analyzed.

    Result: Depression and anxiety are more common among alcohol dependent patients. Among 400 patients 56.5%(n=226) are in age group of 31-40 yrs, male are 93.5%(n=374), Christian are more 52.25%(n=209). In our study we found 32.75%(n=131) are having anxiety disorder where as 24.25%(n=97) are depression.

    Conclusion: The study was carried out to assess depression and anxiety among alcohol dependent patients.

    Key Words: Depression, anxiety, alcohol dependent.

    A Study of prevalence of psychological distress in caregivers of Schizophrenia patients.

    Prathyusha Mikkilineni , Sabari Sridhar, Srinivasan, Kailash.S, Gopalakrishnan, Shabeeba Kailash

    PG student, Chettinad Hospital and Research Institute, Padur, Tamil Nadu. prathyu16mikkilineni@gmail.com

    Introduction:

    • Caregiver is an individual who has the responsibility of meeting the physical and psychological needs of the dependent patient. A primary caregiver is the person who takes primary responsibility for someone who cannot care fully for themselves.
    • Psychiatric patients need assistance or supervision in their daily activities and this often places a major burden on their caregivers, thereby placing the caregiver at a great risk of mental and physical health problems.
    • The term “caregiver burden” is used to describe the physical, emotional and financial toll of providing care.
    • The most common mental health consequences identified are depression, anxiety and burnout which occurs when a caregiver slips beyond exhaustion or depression.
    • Most of the notable community-based studies proved that 18–47% of caregivers land in depression.


    Materials & Methods: Participants who are the primary caregivers of schizophrenia patients are included. Sociodemographic profile, burden assessment schedule (BAS) and SRQ-20 is used to measure participant’s burden and psychological distress.

    Result: Currently, the study is under progress. It is noted that there is significant psychological distress among primary caregivers of schizophrenia patients. However, the final results with statistical analysis will be presented at the time of conference.

    Keywords: Prevalence, caregivers, schizophrenia, psychological distress

    A comparative study on sexual functioning of sexually active females of depression - in remission receiving Escitalopram, sexually active drug-naive depressed females and healthy controls

    Pritha Roy, Bandna Gupta, P.K Dalal, Anil Nischal, Adarsh Tripathi

    Junior Resident, King George’s Medical University, Lucknow, Uttar Pradesh.pritha_r@yahoo.com

    Introduction: Sexual functioning is a strong determinant of quality of life. Female sexual dysfunction is widely reported due to depression (prevalence 35-50%) and is also antidepressant-induced (prevalence 10-80%)-culminating in a double-edged sword, causing drug discontinuation and relapse. Meagre systematic research exists regarding the same in Indian female population. Escitalopram is widely prescribed in depression and, hence, chosen for study.

    Objective: To assess and compare sexual functioning of (i) sexually active females of depression, currently in remission, receiving Escitalopram, (ii) sexually active depressed and (iii) healthy females.

    Method: Fifty female patients of depression, currently in remission, with self-reported normal sexual function previously and currently receiving Escitalopram for at least 3 months were selected. Fifty age group-matched females of depression with self-reported normal sexual function previously and fifty age group-matched apparently healthy females were selected. Subjects of three groups were cross-sectionally assessed on female sexual function index (FSFI) questionnaire.

    Results: Twenty-five patients on Escitalopram (50%) were found to have sexual dysfunction (FSFI score < 26.55), majority having decreased desire and arousal. Thirty patients of depression (60%) were found to have sexual dysfunction, majority of them having dysfunction in domains of arousal, desire and lubrication and most having decreased orgasm and satisfaction. Ten percent of healthy controls had sexual dysfunction. As compared to depressed subjects, lesser number of treated patients had dysfunction in domains of lubrication, orgasm, satisfaction and pain during sexual activity. Total and domain scores were not influenced by socio-demographic and clinical variables.

    Conclusions: Sexual dysfunction is quite prevalent in sexually active females receiving Escitalopram as well as those suffering from depression. All domains of sexual functioning are impaired. Healthy female subjects may lack awareness about their own sexual function.

    Keywords: Sexual functioning, depression, females, escitalopram

    Personal Social Capital and Quality of Life of Patients with Schizophrenia: A controlled study

    Nilesh Maruti Gujar, Lokesh Kumar Ranjan, Deepanjan Bhattacharjee, Basudeb Das, Narendra Kumar Singh

    Phd Scholar, Lgbrimh, Tezpur, Assam. psynilesh@gmail.com

    Background: Schizophrenia is a serious brain disorder that has been commonly understood as “one of the most disabling and baffling mental illnesses known.” Schizophrenia is a disorder with variable phenotypic expression and poorly understood, complex etiology, involving a major genetic contribution, as well as environmental factors interacting with the genetic susceptibility. Schizophrenia causes significant dysfunctions in the thinking, cognitive and perceptual processes and socio-occupational functions. Numerous epidemiological studies had shown ample evidences of the role of sociocultural and environmental factors in the incidence and course of schizophrenia1-5. In the context of schizophrenia, some researchers stated social capital as a mechanism through which the social environment influences the mental health of affected individuals6-8. Social capital is understood to be a complex, multi-dimensional concept which came into the scope of social science in last few decades6, 9. More candidly social capital can be understood as social networks and support, high levels of interpersonal relations, trust, social cohesion, community involvement, and a sense of community10. High levels of social capital are thought to be a protective factor for mental illness in general11. It is suggested that communities high in social capital are likely to promote healthy behavior and ultimate has a positive effect on mental health of the people of those communities12.

    Aim: To assess the personal social capital and quality of life of patients with schizophrenia and compare with normal controls.

    Materials and Methods: The sample consisted of 60 individuals (30 patients diagnosed with schizophrenia and 30 normal populations.) selected from the Central Institute of Psychiatry outpatient department (OPD) by using purposive sampling method. Socio-demographic and clinical details of the entire patients were assessed through socio-demographic datasheet, clinical datasheet (PANSS and GHQ-12) along with personal, social, capital Scale and the WHO Quality of Life – BREF Scale.

    Result: Significant differences observed in personal social capital and quality of life between the persons with schizophrenia and normal controls.

    Conclusion: The patients with schizophrenia have low personal social capital and quality of life.

    Keywords: Schizophrenia, personal, social, capital, quality of life.

    Personal Social Capital and Socio-occupational Functioning of Persons with Schizophrenia: A Controlled Study

    Nilesh Maruti Gujar, Deepanjan Bhattacharjee , Basudeb Das , Narendra Kumar Singh

    Phd Scholar, Lgbrimh, Tezpur, Assam. psynilesh@gmail.com

    Background: Schizophrenia is a severe, complex and debilitating psychiatric disorder occurring at a high frequency with global burden of disability, and has high societal costs. It is empirically specified that schizophrenia is one of the leading cause of disease related disability in worldwide and urbanization and migration are leading cause for high occurrence. Schizophrenia has become a global disease which is increasing disability in mental illness. Social capital is networks and connections between individuals that can provide support and resource. Individual who are excluded from accessing social capital have a higher risk of schizophrenia and may have informal social control. Social functioning of individuals with schizophrenia gets disturbed therefore improving the functioning levels is considered to be an important goal in treating schizophrenia.

    Aim: To assess and compare personal social capital and socio-occupational functioning of patients with schizophrenia and normal controls.

    Materials and Methods: The sample consisted of 60 individuals (30 patients diagnosed with schizophrenia and 30 normal population) selected from the Central Institute of Psychiatry outpatient department (OPD) by using purposive sampling method. Socio-demographic and clinical details of the entire participants were assessed through socio-demographic datasheet, clinical datasheet (PANSS and GHQ-12) along with the personal social capital Scale and socio-occupational functioning scale.

    Results: Present study shows significant difference in personal social capital and socio-occupational functioning of persons with schizophrenia and normal controls.

    Conclusion: The patients with schizophrenia hold lower personal social capital and socio-occupational functioning than normal population. Patient with schizophrenia showed reduced personal social capital which tends to lower socio-occupational functioning and vice versa.

    Key words: Schizophrenia, personal social capital, socio-occupational functioning.

    A Prospective Study Of Psychiatric Manifestations In Patients Following Traumatic Brain Injury At Kims Hospital, Hubballi

    Raghavendra Patil, Meghamala.S.Tavaragi, Arunkumar.C, Mahesh Desai

    3rd Year PG, MD Psychiatry,Kims.Hubballi, Karnataka Institute of Medical Sciences, Hubballi, Karnataka. raghavendrapatil5483@gmail.com

    Introduction: Traumatic brain injury (TBI) is a major cause of death and disability and impairs health-related quality of life, yet very few studies have addressed the relationship between TBI and novel neuropsychiatric disorders. But most of the TBI related symptoms are being managed by treating neurologist and neurosurgeons. Hence these patients end up with chronic neuropsychiatric disorders and cognitive deficits.

    Objectives: To study the prevalence of psychiatric manifestations and quality of life of patients following traumatic brain injury.

    Methodology: Study sample included the patients with traumatic brain injury(TBI) due to several mode and admitted in Neurology, Neurosurgery and Psychiatric department of KIMS Hospital, Hubballi were recruited from January 2016 to December 2016. Each patient was followed up for a minimum period of 6 months involving 2 follow-ups at 3rd and 6th month. Assessment done after Ethical committee clearance.Socio-Demographic data, TBI related factors, HMSE scale, MINI PLUS (5.0.0) and QOL BREF scale were used.

    Results: Among 110 patients, 96 patients completed all follow-ups (0, 3 & 6 months) male being 75 and female 21 and 12 patients dropped out during subsequent follow-ups including 2 deaths. Among 96 patients TBI due to RTA was 65.6%(63), self-fall 27.1%(26) and assault was 7.3%(7). Psychiatric manifestations following TBI was 39.58%(38 out of 96 pts). Commonest psychiatric illness after TBI was depression 52.6%(20) (p=0.02),followed by GAD 23.6%(9), ADS 13.2%(5), PTSD 5.3%(2), OCD 2.6%(1) and psychosis 2.6%(1). Psychological and social domains were the most affected on QOL in our study.

    Conclusion: Most common cause of TBI was road traffic accidents. Depression following TBI is most common psychiatric disorder. Psychiatric sequalae of TBI accounting for nearly 50% may frequently be overlooked, and therefore be under treated , hence require routine follow-ups with psychiatrist for treatment and rehabilitation.

    Key Words: Traumatic Brain Injury, Mini Plus, Hmse, Qol Bref, Depression

    Neurocognitive Deficits in Individuals with First-Episode Psychosis and their First-Degree Relatives

    R.Rajasekaran, S.J.Daniel, P.P.Kannan, M.Malaiappan

    PG Student, Government Kilpauk Medical College, Chennai, Tamilnadu. rajanslink@gmail.com

    Background: Neurocognitive deficits are frequently present even in individuals with first-episode of psychosis which often worsens the prognosis. The neurocognitive domains commonly implicated are speed of processing, working memory and learning, attention and executive functions. These cognitive deficits are present well before the start of psychotic episode and are hence seen as endophenotypic traits with genetic underpinnings. However, the expression of such cognitive endophenotypic traits is not well studied in first-degree relatives of individuals with first-episode psychosis. Hence, the aim of the current study is to assess neurocognitive functioning in selected domains of first-degree relatives of individuals with first-episode psychosis and to compare them with their probands.

    Materials and methods: Consecutive patients (probands) with a diagnosis of first episode schizophrenia as per DSM 5 criteria and their first degree relatives are assessed cross-sectionally for neurocognitive functions. Informed consent and Institutional Ethical Committee approval are obtained prior to the start of the study. Only individuals in the age group 16-40 years are selected for uniformity. Any individual with lifetime history of any psychiatric or medical illnesses that impair neurocognitive functions; history of head injury with loss of consciousness; mental retardation; substance abuse within past 6 months except nicotine are excluded. The performance on selected neurocognitive domains will be assessed in both the individuals with first-episode psychosis and their first-degree relatives using relevant components from the NIMHANS Neuropsychological battery.

    Results: The results of the study will be discussed in detail at the time of presentation.

    Keyword: First-episode psychosis, Neurocognition, first degree relatives

    Minor Physical Anomalies in Patients of Schizophrenia, Bipolar I Disorder and Healthy Controls- A Comparative Study

    Rajanikant Meher, Deepanjali Medhi

    Post graduate tranee, Gauhati Medical College, Guwahati, Assam. rajeshkumarmeher8@gmail.com

    Introduction: Neurodevelopmental hypothesis of schizophrenia and bipolar disorder suggests that well before the formal onset of illness symptoms, exposure to pathogenic factors disrupt the normal course of neural development. In clinical setting, presence of minor physical anomalies (MPAs) point toward the underlying aberrant neurodevelopment.

    Materials and Methods: The study sample consisted of 30 consecutively selected subjects diagnosed as having schizophrenia and 30 subjects diagnosed as having bipolar disorder type I, admitted in the Psychiatry ward of Gauhati Medical College and Hospital, Guwahati, meeting the selection criteria. The control group consisted of 30 subjects which were taken from the attendants of the patients admitted in the inpatient department of a different ward. MPAs are measured by using Waldrop minor congenital anomalies scale developed by Waldrop and Halversion and later modified by Waldrop. The difference in mean MPA scores between the groups was analysed using ANOVA.

    Results and Discussion: The mean MPA score for the schizophrenia group was 2.40±2.31 and that of control group was 0.87±1.04 and the difference was statistically highly significant (p=0.003). The mean MPA score for bipolar I disorder group was 1.37±1.65. But the difference in mean MPA score between bipolar I disorder group and control group was and the difference of mean MPA scores between schizophrenia and bipolar I disorder groups failed to reach a significant level (p>0.05).

    Conclusion: High prevalence of MPAs in schizophrenia and bipolar I disorder supports the neurodevelopmental hypothesis proposed for these illnesses. Intermediate prevalence of MPAs in bipolar I disorder suggests that this illness falls in the intermediate category in psychosis spectrum.

    Key Words: Neurodevelopmental hypothesis, schizophrenia, bipolar I disorder, minor physical anomalies.

    Study of childhood trauma and stressor in dissociative patients

    Ramashankar Maddeshiya, Vishal Sinha, Manjeet Singh, Narveer Yadav, Rohit Singhal

    Junior Resident, S.N. Medical College, Agra, Uttar Pradesh. rama12980@gmail.com

    Background: Dissociative disorders manifest as disruptions of the normal integration between memories of the past, awareness of identity, immediate sensations and control of bodily movements not explained by any physical disorder. Various studies suggest, associated stressful events and childhood stress play an important role in the causation of the dissociative disorder.

    Method: This was a cross-sectional study, performed on 141 dissociative patients consulting psychiatric OPD for the first time during June 2016 and Dec 2016. Data was collected using semi-structured proforma to assess sociodemographic characteristics, childhood trauma and stressful events in patients after obtaining written consent. Assessment tools were childhood trauma questionnaire, presumptive stressful life event scale and Dissociative experiences scale. Statistical analysis was done using SPSS software.

    Results and Discussion: Out of 141 patients with mean age, 27.38± 11.54 years majority were female (82.3%) and belonged to rural community (62.4%). Majority of patients reported childhood trauma with childhood emotional neglect being the most common (41.8%). Family conflict (22.7%) followed by broken love affair (13.5%) were commonly reported stressful situations. The mean DES score was 69.18± 3.46 and this score was positively correlated with age (p-value 0.001), duration of illness (p-value 0.001), total stress score in the last 6 months (p-value 0.001) and lifetime (p-value 0.001).

    Conclusion: Dissociative patients reported significant childhood trauma and stressful full events in their life. Severity was found proportional to the duration of illness and severity of stressful events and timely probe into these domains can help to achieve speedy recovery.

    Keywords: Dissociation, Stressor, childhood trauma

    Bedside assessment of cognitive heterogeneity with Clock Drawing Performance among Clinical Sub Types of Schizophrenia

    Ramdas Ransing, Praveen Khairkar, Dipayan Sarkar

    Assistant Professor, BKL Walawalkar Rural Medical College, Ratnagiri, Maharashtra. ramdas_ransing123@yahoo.co.in

    Introduction: Cognitive deficit is highly prevalent, variable and the core feature of schizophrenia associated with psychosocial disability. It is often overlooked by clinician because of complexity in assessment. Clock drawing test is common and widely used cognitive screening instrument to identify cognitive impairment in patients with dementia. The present study was aimed to measure the clock drawing performance among different subtypes of schizophrenia.

    Material and Methods: We examined institutionalized patients with schizophrenia (n=90) with age and sex matched controls (n=30). The patients with schizophrenia were sub grouped into paranoid (n=30), disorganised (n=30) and other group (n=30) on the basis of DSM –IV-TR criteria. The Clock drawing test (free- drawn) and Positive and negative symptoms scale (PANSS) were administered at the time of admission. One way ANOVA test was used to compare among the groups.

    Results: We observed that patients with schizophrenia (3.77±2.51) performed poorly on Clock drawing test than comparison group (8.72±1.24), [p<0.001]. There was significant difference between disorganised and paranoid types of schizophrenia on CDT score (95% CI=2.14 to 4.13, p<0.001), but not with others. The performance on CDT score was closed related with PANSS Score.

    Conclusions: Our findings suggests that clock drawing test have potential to differentiate between disorganised and paranoid types of schizophrenia and useful to measure cognitive impairment in patients with schizophrenia. It suggests the distinct involvement of hypothesized neural circuitry among subtypes of schizophrenia.

    Keywords: Clock drawing test, Schizophrenia, Cognitive Deficit

    Potential Bedside Utility of the Clock-Drawing Test in Evaluating Rapid Therapeutic Response in the Natural Course of Schizophrenia: A Preliminary Study (for Poona Psychiatrists Association Award II)

    Ramdas Sarjerao Ransing, Khairkar Praveen, Mishra Kshirod Kumar, Sakekar Gajanan

    Assistant Professor, BKL Walawalkar Rural Medical College, Ratnagiri, Maharashtra. ramdas_ransing123@yahoo.co.in

    The Clock-Drawing Test (CDT) is a brief, relatively time-efficient, easy to administer at bedside, and well-proven cognitive screening test that assesses a broad range of cognitive abilities in stroke, delirium, and dementia. However, challenges of comprehensive therapeutic outcome evaluations in schizophrenia can also be potentially overcome using CDT. The authors aimed to measure the therapeutic outcome using CDT in 101 schizophrenia patients, irrespective of their diagnostic subtypes. A repeated measures analysis of variance found that improvements on CDT and the Positive and Negative Syndrome Scale were closely correlated, reflecting critical information about therapeutic response measures in schizophrenia.

    Keywords: Bedside, clock-drawing test, schizophrenia.

    A study to find the difference of Quality of life and psychological issues between caregivers of patients with psychosis and patients with chronic kidney disease

    Ramya Rachel Jetty, Prasanna Kumar N, Suresh Kumar G

    postgraduate, Andhra Medical College, Visakhapatnam, Andhrapradesh. ramyaracheljetty@gmail.com

    Introduction: Caregiving plays an important role in supporting people with illness either acute or chronic. The burden of care can lead to breakdown among the caregivers themselves. Caregivers may experience financial burdens, difficulty handling disruptive behaviours and fluctuating emotions that cannot be controlled, a lack of time for personal enjoyment and social enagement, difficulty handling the lack of motivation found in mentally ill family members .Similarly the same is seen in the care givers of patients with chronic kidney disease patients. There are no studies comparing psychological issues in caregivers of psychotic patients and caregivers of chronic kidney disease patients.

    Aim: To assess the quality of life and psychological issues between the caregivers of patients with psychosis and caregivers of chronic kidney disease and to know the difference between those two groups.

    Methodology: A cross-sectional study with a sample of 60 caregivers of patients fulfilling the inclusion criteria are taken into study of which 30 are caregivers of psychotic patients and 30 are caregivers of chronic kidney disease patients in a teritary care hospital after obtaining permission.

    Tools: WHO-QOL BREF scale for quality of life and Depression Anxiety and Stress Scale (DAS Scale) for psychological issues.

    Results: Results will be discussed in the conference.

    Keywords: Quality of Life, Chronic kidney disease, Psychosis

    A study on prevalence of psychiatric comorbidity in patients with Rheumatoid arthiritis

    Ramya. V, Ranganathan. T

    Post graduate in psychiatry, Institute of mental health, MMC, Chennai, Tamil Nadu. ramyavenkat92@gmail.com

    Background: Rheumatoid arthritis is a chronic, progressive systemic inflammatory disease. In addition to physical disability, it also has high prevalence of psychiatric comorbidities like depression and anxiety. Psychiatric comorbidity is found to be among the most important independent predictors of work disability in RA patients. Prevalence of depression in RA ranges from 20-40%. Prevalence of anxiety ranges from 21-70%. Although there are numerous studies on the prevalence of depression and anxiety in patients with RA, they mostly do not include prevalence rate of depressive and anxiety disorders. Moreover, the data regarding prevalence of other psychiatric disorders in RA patients are limited in the literature. Hence this study is been conducted to estimate the prevalence of psychiatric comorbidities in patients of Rheumatoid arthritis.

    Methodology: This is a cross sectional study including 100 consecutive patients diagnosed to have RA according to ACR/EULAR classification criteria, attending outpatient department of rheumatology in a tertiary care hospital.

    Tools being used are semi structured sociodemographic proforma, MINI(Mini international neuropsychiatric interview) for preliminary assessment of major psychiatric disorders, Health Assessment Questionnaire(HAQ) to assess physical disability and Disease Activity Score(DAS) to assess disease activity.

    Results and conclusion: This study will be discussed at the conference as the study is currently underway.

    Key words: Psychiatric comorbidity, rheumatoid arthritis, disease activity

    Pattern of Psychiatric morbidity in Jail inmates of Himachal Pradesh.

    Anubhuti Singh, Ravi Chand Sharma, Dinesh Dutt Sharma

    Junior Resident(Iii), Indira Gandhi Medical College, Shimla, Himachal Pradesh. ranjananu26@gmail.com

    Background: A substantial burden of psychiatric morbidity exists in the prison population of India. To study the pattern of psychiatric illness in this vulnerable population poses a serious challenge to the psychiatrist.

    Materials and Method: 706 Jail inmates in 3 state prisons were assessed for psychiatric morbidity with the help of a) Socio-demographic performa b) Modified Kuppuswamy Socioeconomic scale c) MINI-6.0. SPSS 16.0 was used for statistical analysis.

    Results: 6.94 %(n=49) of the Jail inmates were suffering from Psychiatric illness excluding substance abuse.73.5 % (n=36) of the prisoners suffering from psychiatric illness had history of substance abuse prior to incarceration. Most common diagnosis was schizophrenia 16.3 %(n=8) followed by psychosis NOS (14.3%, n=7). Preexisting psychiatric illness before committing crime was detected in 40.8 %(n=20) of prisoners suffering from psychiatric illness. Among the convicted prisoners suffering from psychiatric illness 49 % (n=24) were accused under section 302. 18.4 %(n=9) of the convicted prisoners suffering from psychiatric illness happened to commit crime under delusion/hallucination. 63.3 %(n=31) showed significant improvement.

    Conclusions: Substantial amount of psychiatric morbidity was present among prisoners. Mentally ill prisoners are at high risk for repeated offence which should be a point of concern for psychiatrists as well as policy makers.

    Keywords: Prisoners, Psychiatric illness, Substance Abuse

    A study on eating behaviors and its association to body image disturbances in medical students.

    Rashmi Singh, Neena Sawant, Shubhangi Parkar

    2Nd Year PG Student, Seth .G.S.Medical College, Mumbai, Maharashtra. rashmisingh2590@gmail.com

    Background: Body image is conceived as one’s attitudinal disposition towards physical self and has always been a subject of scientific research with an emphasis on eating disorders. This study was undertaken to see the perceptions of the medical students with weight, body image and their eating behaviors.

    Material & Method: The study was conducted over a period of one month where 280 students belonging to the second and third years of the medical school were addressed in their respective classes after taking prior permission from the Dean of the institute and their respective teachers with ethics approval. Eating behaviors were assessed using the Eating Attitudes Test(EAT)and the Multidimensional Body Self Relations Questionnaire(MBSRQ) was used to assess the self attitudinal aspects of the body image construct. The MBSRQ has 7 factor subscales and 3 additional scales . 204 completely filled proformas were analysed.

    Results: Amongst the medical undergraduates 46% perceived themselves to be of normal weight and nearly 25 -28% of them felt they were underweight or overweight. Anorectic behaviors were seen in 7% of the students. A highly significant negative correlation was seen with appearance evaluation, fitness evaluation, fitness orientation, health evaluation, health orientation, body areas satisfaction .No significant association of the eating behaviors with overweight preoccupation, appearance and illness orientation was seen.

    Conclusions: There was a healthy attitude towards ensuring good health but certain eating behaviors gave way to dieting & calorie restraints. This has led to an obsession with bulk and muscle mass in boys and a waif like figure in girls amongst all college going population which could lead to a diet and health conscious society saddled with immense physical and emotional problems.

    Keywords: Eating behaviors, Body image disturbances, Medical students

    Prevalence And Determinants Of Depressive Disorder Among Women Of Rural Area

    Ravi jaiswal, Suruchi gupta, pankaj Gupta

    Junior resident, IMS BHU, Varanasi, Uttarpradesh. ravi_rash1886@yahoo.co.in

    Introduction: Depression is a significant contributor to the global burden of disease and affect people in all communities across the world. Today, depression is estimated to affect 350 million people.The World Mental Health Survey found that on an average about 1 in 20 reported having an episode of depression in previous year. The burden of depressive disorder is 50% higher among females than males and Indians are reported to be among the world’s most depressed.

    Aims & Objectives:

    1. To study the prevalence of depressive disorder among study subjects.
    2. To study the determinants of depressive disorder among study subjects.


    Material &Methods: A cross sectional study was conducted among 200 females aged 20 to 60 years in the rural area served by RHTC, Kalyanpur, Kanpur. A predesigned and pretested questionnaire was used to elicit the determinants of depressive disorder and MINI scale was used to diagnose depressive disorder. The data was analyzed using SPSS and the conclusion was drawn accordingly .

    Results: Prevalence of depressive disorder among adult women was 28.08%. Prevalence of depressive disorder was maximum 31.07% among 40-50 yrs followed by 26.90% among 30-40 yrs. About 56.4% of women were Hindu & 42.44% were Muslims and 49% women with depressive disorder belonged to OBC while 45.75% to General category which was statistically significant. Majority of study subjects having depressive disorder were either unmarried or widowed. 81% ,52% and 43% of the study subjects were illiterate, belongs to nuclear family and were housewives respectively. Around 54% suffered from physical/mental/sexual harrassment.Most (67%)of them had chronic comorbid condition.

    Conclusion: The study shows that depression was more common among adult women who were illiterate,housewives and suffered from physical/mental/sexual harrasement.

    Keywords: Depressive disorder, women, rural area

    A Comparative study of of Thyroid-Stimulating Hormone (TSH) Level in Patients of Schizophrenia and mood Disorders

    Ravi kumar gupta, vikash chandra mishra, mahendra kumar sharma

    PG student, SMS Medical College Jaipur, Rajasthan. ravigupta106@yahoo.in

    Aim: The aim of our study is to investigate difference in thyroid-stimulating hormone (TSH) level in patients with schizophrenia, unipolar depression bipolar depression and bipolar Mania.

    Method: This was a retrospective, cross-sectional, naturalistic study. Our psychiatry centre was screened for serum thyroid-stimulating hormone (TSH) level. Only the new inpatients were used for analysis. Serum level of TSH was measured in 1254 patients.

    Results:-Mean serum TSH concentration was: schizophrenia (n = 313) 1.69 lIU/mL, unipolar depression (n = 564) 1.67 lIU/mL, bipolar disorder (n = 377) 1.85 lIU/mL, bipolar depression (n = 125 2.08 lIU/mL, bipolar mania (n = 252) 1.40 lIU/mL (H = 11.56, p = 0.008). Depending on the normal rang used, the overall rate of being above or below the normal range was 7.8–22.2 % for schizophrenia, 13.8–25.9 % for unipolar depression, 10.9–27.8 % for bipolar disorder 12.4–28.7 % for bipolar depression, and 11.5–24.6 % for bipolar mania. We have also found differences in TSH levels between the age groups (B20,[20 years and B40, [40 years and B60 years and[60 years). TSH level was negatively correlated with age (r = - 0.25, p\0.002) Weak correlations with age have been found in the schizophrenia (r = - 0.22, p\0.001), unipolar depression (r = - 0.24, p\0.001), bipolar depression (r - 0.26, p = 0.002) and bipolar disorder (r = - 0.21, p = 0.004) groups.

    Conclusion:-We conclude that mood disorders (both unipolar and bipolar) may be higher prevalence of thyroid dysfunction and these two groups were differ in terms of direction and frequency of thyroid dysfunctions.

    Keywords: TSH, Schizophrenia, mood disorder

    Is Melancholic Depression Different from Non-Melancholic Depression? A 6 Months’ Prospective, Hospital Based Study

    Ravindra Munoli, Samir Kumar Praharaj, P S V N Sharma, Rajeshkrishna Bhandary P

    Assistant Professor, Kasturba Medical College, Manipal, Manipal, Karnataka. ravindra.nm@hotmail.com

    Background: Binarian model views melancholia as a distinct depressive class. Unitarian model views it as a more severe expression of depression. Pursuit of the status of melancholia has seen efforts by many since ancient times and it is still struggling to find a strong foothold as a disease.

    Objective: To study the socio-demographic, clinical and course differences between melancholic and non-melancholic depression categories.

    Method: It was a prospective, naturalistic, hospital based study of 50 in-patients diagnosed with unipolar depression in a tertiary centre. Patients were categorized into melancholia (>8) and non-melancholia using CORE questionnaire. Patients were evaluated on Hamilton depression rating Scale (HAM-D), Hamilton anxiety rating scale (HAM-A), Somatoform Symptom Checklist (SSC), CSSRS (Columbia suicide severity rating scale), Clinical Global Impression (CGI), presumptive stressful life-events scale (PSLES) at baseline and at 1st, 3rd and 6th month.

    Results: Melancholia group had significantly higher depression scores (p=.00,Cohen’s d=1.51), higher anxiety score (p=.05,Cohen’s d=0.56), CGI scores and psychotic depression (p=.007,phi=0.38). Higher suicidal ideation was seen in melancholic group but suicidal behaviour and actual attempts did not differ. During follow ups, all sub components of melancholia namely, non-interactiveness, retardation and agitation, showed reduction in scores. Age, gender, education, life events, occupation, comorbidities did not show significant effect. By 1st month 25.8%, by 3rd month 8.33%, by 24 weeks 12.5% were melancholic.

    Conclusion: Construct and course of melancholia may be viewed as a part of depression, more in lines with severe depression. Melancholia increases the risk for suicidal ideation but not behaviour or attempts.

    Study Of Disability In Patients With Schizophrenia Attending The Outpatient Department In A General Hospital Setting

    Rakesh B, Kailash.S, Srinivasan, Sabari Sridhar, Gopalakrishnan, Shabeeba Kailash

    PG student, Chettinad Hospital and Research Institute, Kelambakkam, Tamil Nadu. rbreddy9@msn.com

    Introduction: Disability associated with mental disorders is a major contributor to global burden of disease. Schizophrenia ranks among top ten causes of disease related disability.

    Evaluating disability can help in knowing the impact of mental illnesses on different domains of patients’ life. This would help to understand and plan appropriately as far as their management and rehabilitation is concerned.

    The need for this study is to assess the level of severity and also the relationship between disability and various variables of illness.

    Methodology: Patients with schizophrenia in the age group 18-60 years were selected from those attending the OPD. Patient with organic involvement and co morbid psychiatric disorders were excluded. Semi structured interview to elicit socio demographic and illness characteristics was conducted.

    Positive and Negative Syndrome Scale (PANSS), Medication Adherence Rating Scale (MARS), Glasgow Antipsychotic Side-effect Scale (GASS) were used to assess the symptoms, treatment adherence and side effects. Indian Disability Evaluation Assessment Scale (IDEAS) was used to assess the level of disability in the patients.

    Results: The study is currently under progress. It is seen that schizophrenia affected various domains of life. It is noted that long duration of illness caused significant disability. However, the results of the study with statistical analysis will be presented and discussed at the conference.

    Keywords: PANSS, Disability, IDEAS

    Study on the association of genetic variations in serotonin pathway genes with alcohol dependence

    Renu Singh, Ranjan Gupta, Dr. Atul Ambekar, Tripti Grover, Dr. Raka Jain, Dr. Arundhati Sharma,

    PhD, All India Institute Of Medical Sciences, New Delhi, renu.singh2127@gmail.com

    Introduction: Alcohol dependence (AD) is a chronic, relapsing disorder involving complex interaction between genes and the environment. Presences of Single Nucleotide Polymorphisms (SNPs) in genes of the various neurotransmitters have been reported to play an important role in several psychopathologies including aggression, alcohol and drug abuse and dependence. This study reports on the serotonin pathway gene SNPs and their role in AD.

    Methodology: 100 alcohol dependent males from National Drug Dependence Treatment Center, AIIMS and 100 healthy males (controls) from the general population without history of substance abuse formed the study group. Subjects were interviewed using a semi-structured questionnaire and WHO ASSIST and five ml peripheral blood was drawn after taking informed consent. Two SNPs of serotonin pathway HT1B (G861C) rs6296 and HTR3B (Tyr129Ser) rs1176744 were analyzed by PCR/RFLP. Genotype frequencies were assessed and results correlated with alcohol use parameters including duration and age at onset of use, quantity consumed (gms/day) and WHO assist score along with levels of liver function enzymes like SGPT, SGOT and GGT. Statistical analysis was performed using SPSS v 21.0.

    Results: The HTR3B Tyr129Ser rs1176744 SNP showed a significantly lower frequency of wild type Tyr129 allele (0.49) in the cases compared to the controls (0.66) (p=0.04). The frequency of HT1B (G861C) rs6296 did not show significant difference between the cases and controls, but correlation with alcohol use parameters showed an association with liver function wherein individuals with CC genotype showed higher levels of liver enzyme GGT (274.57±98.37) compared to GG genotype (75.04±22.06) (p-0.03) suggesting a possibility of liver dysfunction in such individuals.

    Conclusion: The present study shows a possible association of the HTR3B Tyr129Ser rs1176744 SNP with alcohol dependence and HT1B (G861C) with liver function in AD needing validation on a larger sample size.

    Keywords: Alcohol dependence, dopamine, serotonin, polymorphisms.

    Prevalence of anxiety symptoms among newly joined medical students: A cross sectional study from North-West Rajasthan.

    Ripu Daman Singh Dhariwal, KK Verma, Shri Gopal Goyal, Girish chandra Baniya, Dewanand

    PG Resident, Dept of Psychiatry, SPMC, Bikaner, Rajasthan. ripudhariwal@gmail.com

    Background: Medical education is highly stressful. Medical students confront significant academic, psychosocial and existential stressors for coping with new college and schedule during the tough journey of becoming a physician, ; So assessment of the symptoms of anxiety among medical students are essential to take necessary steps to treat or prevent any psychiatric morbidity.

    Objective: This study is an attempt to assess the prevalence of anxiety symptoms among newly joined medical students.

    Materials and Methods: A cross sectional study was conducted on 230 newly joined medical students of Sardar Patel Medical College, Bikaner, Rajasthan, India. Anxiety symptoms were assessed by administering a self reporting Sinha’s Comprehensive Anxiety Test (SCAT). Statistical analysis- SPSS version 16 was used for statistical analysis and Pearson Chi-square was applied for statistical significance.

    Results: Most of the participants were male (59.6%), belong to upper socioeconomic class (49.1%), hindu religion (96.5%), and live in rural areas (67%) in joint family(48.7%). Mean age of participants was 18.85 ±1.39 years. There was significant level of anxiety symptoms among first year medical students. The mean anxiety score was 23.32 ± 12.57. Males and females had mean anxiety score of 21.80 ± 11.68 and 25.56 ± 13.52 respectively and females were significantly affected with anxiety symptoms as compared to males. (p=0.026)

    Conclusion: A significant proportion of first year medical students are affected with anxiety symptoms. Adequate psychological services and various relaxation techniques should be advised intermittently to manage these symptoms among medical students.

    Key-words: Anxiety, SCAT, Rajasthan

    Prevalance of adult attention-deficit hyperactivity disorder in undergraduate students of medical and allied health sciences

    Rishi Malik

    Junior Resident 2nd year, R D Gardi Medical College, Ujjain, Madhya Pradesh. rishi52@gmail.com

    Introduction: Numerous lines of epidemiological evidence reveal that prevalence rates of adult ADHD are among the highest of all psychiatric disorders. Clinical investigations indicate that adults with ADHD have patterns of psychiatric comorbidity and neurocognitive deficits similar to children, but suffer with a much broader array of functional impairments. Adult ADHD has emerged as a major public health concern in the last decade and the data on it’s prevalence in the Indian Subcontinent is relatively scarce, necessitating the need to conduct research in estimating it’s burden so that we can correctly calculate the burden of this previously undervalued and less understood disorder.

    Methodology:

    Aims & Objectives :

    1. To find out the prevalence of Adult ADHD in Undergraduate Students pursuing Medical and allied health studies.
    2. To find out the percentage of Subtype of ADHD in these students.


    Tools & Apparatus:

    1. World Health Organization Adult ADHD Self-Report Scale (ASRS)
    2. Clinical interview based on Diagnostic and Statistical Manual (DSM) 5 criteria for Adult ADHD


    Study Design

    Observational Study

    Subjects: A cumulative of 700 undergraduate students of all batches attending Medical (M.B.B.S), Nursing (B.Sc and G.N.M) and Physiotherapy (B.P.T) courses in R. D. Medical and Allied Health Sciences College.

    Statistical Analysis: Done using SPSS 23.0

    For comparing various groups appropriate parametric and non-parametric tests will be applied.

    Results: This is an ongoing study for which we estimate that the prevalence of Adult ADHD is actually more than thought of, thereby emphasizing on the morbidity due to it.

    Keywords: ADHD, ASRS

    Military Psychiatry: From Background to Frontlines

    Rajiv Saini

    COL, AFMC, PUNE, near command hopital. rks197019@gmail.com

    Last century has witnessed immense political and military turmoil and the saga is not over as yet. Significant attrition on account of mental health issues raised alarm and selection and retention of the fittest to guard national interests and honour became the theme of military psychiatry. The major hub of Psychiatry changed from Europe to America, and military psychiatry saw its origin. Psychoanalysis dominated the first part of the 20th century, and trauma related mental illnesses and their treatment, the second. The past few decades have seen rapidly shifting doctrines from therapeutics to resilience building. Military psychiatrist of the Armed Forces have been engaged in intensive programs so as to improve mental health of soldiers and their families. The session will focus on the activities being conducted across the country by Armed Forces’ Psychiatrists.

    Quality of life in patients with Multi-drug resistant Tuberculosis

    Rohan Shah, Bsv Prasad, Gautami Nagabhirava

    Post Graudate Student, Dr Vasantroa Pawar Medical College Nashik, Maharasthra. rohan22.rs@gmail.com

    Introduction : Multi-drug-resistant tuberculosis (MDR-TB) is in increasing trends nowadays, regarded as the third epidemic in the world. India has the highest burden of MDR-TB. Along with medical complication associated with MDR-TB patients additionally have to suffer from the social stigma associated with chronic illness leading to social isolation, low socioeconomic status, stress related to living with a life threatening illness, poverty, debilitation, demotivation and concomitant infection with HIV infection and anti-retroviral treatment.

    Side effects of anti- TB drugs play a very important role in mental health of these patients.

    Additionally they may have low self-confidence ,shame, limited support from family members adversely affecting their quality of life.

    Materials and Methods: Study Group consisted of 50 participants who were assessed.

    A pre-designed, pre-tested questionnaire about HRQOL using WHOQOL BREF, a 26-item scale was used to assess the Quality of life. The questionnaire has four domains i.e. physical health, psychological health, social relationships and environment.

    The overall QOL is assessed using specific questions and the mean scores for it were the average of the mean scores of the domains.

    One-way ANOVA was used for comparison between mean group scores.

    Results and conclusion- The study is still under progress and results are awaited.

    Keywords: WHOQOL BREF, HRQOL, MDR-TB

    Phantom limb syndrome- exploring psychiatric morbidity , quality of life and resilience

    Rose Monica V R, Poorna chandrika , Shanthi Namb

    PG Student, Institute of Mental Health, Chennai, Tamil Nadu. rosemonica05@gmail.com

    Introduction: Phantom limb syndrome is a condition in which patient experience sensation in a limb that does not exists. Loss of a limb disrupts integrity of body and affects the physical and psychological condition of patients who undergo amputation surgery.

    Phantom limb pain may occur in 80% of amputation patients, which leads to socio-occupational dysfunction. The impact of amputation influence their self esteem and lead to psychopathological symptoms like anxiety, depression and also impair their social functioning .Within this context , this study aims to assess patients who underwent amputation for anxiety ,depression , quality of life and their resilience(results will be presented in the conference)

    Conclusion: Phantom limb pain leads to changes in psychosocial profile which results in major impact on adherence to rehabilitation program, functional outcome and quality of life. Therefore its evaluation and treating the comorbid psychiatric condition should be part of approach for patients who underwent amputation surgery

    Keywords – phantom limb , depression , resilience

    Mental Health Problems At Work Place : Prevalance In Indian Railways

    P K Samantary, G Hariharan

    Chief Health Director, Indian Railways, Mumbai, Maharashtra. samantaraypk@gmail.com

    Psychiatric problem at work place is a concern for employer . The working atmosphere & personal work domain both are affected due to onset & ongoing psychiatric problems. In addition the family life of the employee is also affected, which leads to decrease in the productivity of the employee.

    Most common psychiatric problems encountered at work place in Indian Railways are:-

    1. GENERALSED ANXIETY DISORDERS, PANIC DISORDER & PHOBIC ANXIETY DISORDER (12-14%)
    2. PSYCHOTIC DISORDERS (2%)
    3. DEPRESSIVE DISORDERS/ M.D.P (7-8%)
    4. PERSONALITY DISORDERS (1-2%)
    5. HYPOCHONDRIASIS (0.5-1%)
    6. COMPENSATION NEUROSIS (0.25%) & MALINGERING (0.25%)
    7. FACTITIOUS DISORDERS (0.25%)


    MENTAL HEALTH SCENARIO IN WORK PLACE

    W.H.O. collaborative study on “PSYCHOLOGICAL PROBLEMS & MORBIDITY AT WORK PLACE “ across the globe , conducted over 15 countries (GERMANY, ENGLAND, U.S.A, FRANCE, INDIA, CHINA, ITALY, NETHERLAND etc,) found the prevalence of psychiatric problems are as follows:-

    1. G.A.D & PANIC (15%)
    2. DEPRESSION (8%),
    3. PSYCHOSIS (2%)
    4. Other NEUROTIC PROBLEMS (6-8%)


    are the cause of OCCUPATIONAL MORBIDITY .

    It results in high man days loss , increase no of accidents , reduced production capacity, poor quality of living, and sagging morale of work force

    Indicators of MENTAL Health Problems:-

    l Increased absenteeism

    l Mood changes

    l Increase in minor accidents

    l Fatigue or general decrease in energy

    l Sudden weight loss or gain

    l Increased blood pressure

    l Frequent stress-related illnesses

    MENTAL DISORDER “ in Employees resulting in occupational problems (Indian railways):-

    1. JOB DIS-SATISFACTION
    2. POOR CAREER adjustment
    3. VOCATIONAL MAL-ADJUSTMENT & POOR
    4. JOB PERFORMANCE
  5. MALINGERING & COMPENSATION NEUROSIS
  6. ABSCENTEEISM
  7. ACCIDENTS


OCCUPATIONAL STRESS AND PSYCHOLOGICAL PROBLEMS

  1. STRESSFUL CHANGES IN WORK :- INITIAL / MAINTAINANCE / BURN OUT STAGE
  2. LAY OFFS / PREMATURE RETIREMENT / LACK OF LEGITIMATE POWERS / HARSH HIERARCHY / UNABLE TO FULFILL CONFLICTING EXPECTATIONS.
  3. POOR WORK CHOICES AND CHANGES :-
  4. (a) LACK OF VOCATIONAL COUNSELLING (b) UN-PREPARED ENTRY TO FAMILY BUSINESS / TRADE PROFESSION
  5. OCCUPATIONAL DISTRESS: (a) DISCRIMINATION AT WORK PLACE (b) MINORITIES (c)REJECTION (d)LOW PAY, LOW SKILL JOBS


OCCUPATIONS MOST AFFECTED IN INDIAN RAILWAYS

  1. SENIOR CORPORATE EXECUTIVES
  2. GUARD /SWICHMAN/ POINTS MAN/ GANG MAN
  3. RAIL TRAFFIC CONTROLLERS
  4. DRIVERS (TRAIN )
  5. SURGEONS (NEURO / CARDIO-THORACIC / PLASTIC / GENERAL)
  6. RAILWAY POLICE OFFICERS
  7. WORK SHOP EMPLOYEES
  8. SENIOR LEVEL SUPERVISERS


Keywords: Indian Railways, OCCUPATIONAL STRESS

Prevalance Of Psychiatric Morbidity In Indian Railways

P K Samantary, G Hariharan

Chief Health Director, Indian Railways, Mumbai, Maharashtra. samantaraypk@gmail.com

INDIA RAILWAY RESEARCH ON TRAIN DRIVERS: 163 (1996- 2015) accident involved train drivers studied for the human failure & psychological reasons resulting in rail accidents: 14% suffered from Anxiety disorders, 8% suffered from Depression Syndrome & 2% from Personality Disorder(Type A , Extrovert, Depressive, Anxious ) 4-6% other psychological problems.

Interventions at the Worksite

l Primary prevention

– Health Education

– Health promotion

– Stress reduction

– REGULAR HEALTH CHECK UP

(EMPLOYEE ASSISTANCE PROGRAMMES)

l Secondary

– Pre-employment screening

– Periodic screening

– Environmental screening

l Tertiary

-Prevent complications of acute and chronic Psychiatric illnesses

-Prompt treatment of psychiatric illness such as depression,anxiety,drug addiction etc

-Psycho therapy, relaxation therapy, yoga, meditation helps in stress reduction

-Assess fitness to return to work.

Conclussion: To avoid occupational & behavioural morbidity of Employees due to mental health problems A Proper psychological screening is a must. personality should be assessed, presence of A)Anxiety, B) Depression C)Psychosis & D) Other Psychiatric Disorders should identified by suitable projective tests academic performance, previous work experience, proper medical history essential periodical medical screening is essential. pre placement vocational training, in-service reorientation training is helpful.

Quality of life, enjoyment and satisfaction in caregivers of patients with Schizophrenia

Samapti Saha Debsikdar, Nitin P. Patil, Sudhir J Gaikwad

PG Student - Md Psychiatry, Bharati Vidyapeeth Deemed University, Medical College And Hospital, Sangli, Maharashtra. samaptis40@gmail.com

Aim: A couple of decades ago, hospitals or psychiatric institutions were in charge of caring for patients with schizophrenia. However nowadays this role is performed by one or more patient’s relatives. Evidence shows that informal caregivers experience negative changes in their quality of life. The current study examined perceived burden and its influence on the Quality of life, enjoyment and satisfaction in caregivers of persons suffering from schizophrenia.

Methods: Care givers of persons suffering from schizophrenia (50 subjects) attending the outpatient department of a psychiatry in Bharati Hospital were assessed on Quality of Life, Enjoyment And Satisfaction Questionnaire(QLESQ-SF), Global Assessment Of Functioning and data were collected for the study.

Results: Over all care givers of schizophrenic patients group reported high burden and significantly reduced Quality of Life in the domains of physical health, social relationships and environment.

Conclusions: The findings from this study suggest that caregivers need social support and family intervention programs to cope with the burden of care-giving and enhance better quality of life. Decreased quality of life may be associated with caregivers burden, lack of social support, course of the disease and family relationships problems. In addition, in developing countries, quality of life is affected by caregivers economic burden. High quality research is needed in order to identify factors associated with quality of life over time and testing the efficacy of interventions aiming to improve quality of life in caregivers of patients with schizophrenia.

Keywords: QLESQ-SF, Caregiver

Brief Intervention To Reduce Substance Use In Class C Male Hospital Employees: A Randomised Controlled Trial

Sambhu Prasad, Debasish Basu, S K Mattoo, Subodh BN

Senior Resident, Pgimer,Chandigarh, Chandigarh (Ut). sambhu3011@gmail.com

Background: Substance use in workplace is linked with risk of accidents, injury, poor health, absenteeism, and negative effects on the workplace atmosphere. Existing research focuses on alcohol related harm, while workplace use of other substances has been neglected. There are no randomised controlled studies of brief interventions in Indian hospital settings.

Aim: To evaluate the efficacy of WHO ASSIST-linked Brief Intervention (ALBI) for reducing risky patterns of substance use in Class C male workers at a tertiary-care hospital in North India.

Material and methods: The study was conducted in two phases. In Phase-I a random list of 400 employees was generated from the entire pool of Class C male hospital workers. Data on the ASSIST risk categories (mild, moderate, and severe) was generated from Phase I. In Phase-II moderate and high risk subjects (‘screen-positive’ by ASSIST score) were randomised into Intervention and Control groups with 35 screen-positive subjects in each group. The Intervention group was given a structured session as per ALBI protocol, while the control group was given a 30-minute general talk on health related consequences associated with substance use. The subjects were compared on ASSIST score, WHOQOL-BREF, RCQ and Motivation to Seek Treatment? at baseline and at 3-month follow up.

Results: The percentage of ‘screen-positive’ subjects for different substances was: tobacco-28.6 %, alcohol-24 %, and cannabis-6.9 %. The inferential analysis showed that ALBI recipients had significant reduction of ASSIST scores for all risky use of substance compared to the control group (p<0.001). Changes in motivation toward action stage were documented significantly more in intervention group than in the control group. Participants receiving ALBI were significantly improved across WHOQOL-BREF parameters and more motivated to seek treatment compared to the control group.

Conclusion: The screening and ALBI were effective in: reducing substance use, increasing motivation to change and improving the QOL of the subjects at workplace setting.

Keywords: ASSIST, brief intervention, psychoactive substances, hospital employees, class C workers, screening, randomized controlled trial.

Depression, Anxiety and stress among Alcohol Dependence patients: A Control Study

Samiksha Sahu, Suprakash Chaudhury, Daniel Saldanha, Dikshita Garg

PG Student, Dr. D Y Patil Medical College, Pimpri , Pune, Maharashtra. samikshasahu111@gmail.com

Background: The evaluation of psychiatric symptoms in alcoholic patients is complicated by low mood, anxiety and other stress related complications.

Aim: Aim is to assess the relationship between depression, anxiety and stress among alcohol dependent patients.

Methods: On the basis of purposive sampling fifty male alcohol dependent persons were taken as a sample of study from the department of Psychiatry Dr DY Patil Medical College. Patients with target organ damage and comorbid psychiatric disorders were excluded. Equal number of age and sex matched control subjects with no history of substance abuse and psychiatric disorders were also included in the study. Patients were evaluated and investigated to rule out physical disorders, all the subjects gave informed consent. All subjects were assessed on socio-demographic data sheet and Depression, Anxiety and Stress scale was administered to the alcohol dependent patients after 2 weeks of abstinence in hospital.

Statistical analyses were carried out using t test, chi square test and Mann Whiney U test

Results: Patients with alcohol dependence obtained significantly higher scores on anxiety, depression and stress compared to the normal control group.

Conclusion: Alcohol dependence is associated with significantly higher levels of anxiety, depression and stress and when the comorbid conditions were addressed with psycho-pharmacotherapy patients showed better compliance and were abstinent on 1 month and 3 month follow up.

Key Words: Depression; Anxiety, Stress; Alcohol dependence

Common Sideeffects And Unknown Reasons: Do We Have An Answer?

Sandesh Pasumarthy, Sumit Kumar, Jayaprakash R Ravan, Sudipta Kumar Das, P C Chowdary

Post Graduate, Kalinga Institute of Medical Sciences, Bhubaneshwar, Odisha. sandeshpasumarthy@gmail.com

Background: The side effects (lithium induced acne, olanzapine induced pedal oedema,etc) experienced by the patients due to the psychotropic medications are commonly seen in our daily practise.Many of the patients would experience these unpleasant and embarrasing events.However,the mechanism of action of most of these side effects are poorly understood and less discussed in the popular textbooks. Hence, it is a felt need that the psychiatrist ought to understand the underlying mechanisms responsible for commonly occuring problems so that our patients are better managed

Aims & Objectives: The aim of this presentation would be to review the scientifically published articles, to discuss the pharmacokinetic and pharmacodynamic mechanisms of these adverse events and also to find the scientific ways to reduce or prevent these commonly occuring problems.

Material & Methods: We have taken information from the pubmed,medline and other journals from the period (1980 to till date). All the relevant published information is collected,the mechanism of action,neurotoxicity and other metabolic side effects are considered and analysed.

Results: Lithium induced neutrophil chemotactic hyperkeratosis being mechanism for acne ; Olanzapine and Risperidone being responsible for the pedal edema due to cyclical AMP and Ca pump induced peripheral vascular relaxations and Valproate is responsible for the alopecia through telogen effluvium phenomenon and excessive renal tubular water absoption leading to hyponatremia in patient with carbamazepine theapy are the possible scientic explanations of some of commonly occring adverse events in our mentaly ill patients.

Discussion: There are many other commonly occuring psychotropic related adverse events like Clozapine induced agranulocytosis,Risperidone induced urinary difficulties,Quetiapine induced QTc prolongation,Olanzapine induced sudden cardiac events,Topiramate induced renal stones and so on which are commonly seen in our clinical practise will be dissected out,analysed and presented.

Conclusion: There has been good amount of information in basic science research and these findings need to be understood from a clinician prospective. This in-turn will help psychiatrists to provide better drug management, lesser side effects and better quality of life.

Keywords: Side effects, Lithium

A Case Of Klein Levin Syndrome In An Adolescent Female From Rural Eastern India

Sumit kumar, Sandesh Pasumarthy , Govind Singh , Jayaprakash R Ravan, Sudipta kumar das, P C Chowdhury

Post Graduate, Kalinga Institute Of Medical Sciences, Bhubaneshwar,Odisha . sandeshpasumarthy@gmail.com

Background: Kleine–Levin syndrome (KLS) is a rare sleep disorder mainly affecting mostly teenage boys in which the main features are intermittent hypersomnolence, behavioral and cognitive disturbances, hyperphagia, and in some cases hypersexuality. Each episode is of brief duration varying from a week to 1–2 months and affected people are entirely asymptomatic between episodes. No definite cause has been identified, and no effective treatments are available even though illness is having well-defined clinical features. Multiple relapses and variable response to different psychotropics.

Aims and Objectives: To study the phenomenological difference of K L Syndrome in India as comapered to western presentation.And to study the effect of Lamotrigine as monotherapy in patients with hypersomnia, hyperphagia, mood swings and other symptoms of Klein Levin syndrome.

Case scenario: Here is a case of young female who presents with complains of hypersomnia, hyperphagia, behavioural and cognitive disturbances which was associated with hypersexuality in our cultural setting altogether different from what we usually come across western literature. This particular case had atypical presentation had consist of in hyperphagia in form Rice Flakes, disinherited with inappropriate use of phone in the absence of typical hypersexual behavior and good response to Lamotrigine.

Conclusion: the above described case report of Klein Levin syndrome gave us a better understanding regarding cultural variation of symptomatology as well as a novel way to intervene.

Keywords: Klein Levin syndrome, Sleep disorder, Lamotrigine

A Comparative Study for Assessing Memory Deficits in Patients with Alcohol Dependence Syndrome and Healthy Controls

Sanju Buragohain, Bobby Hmar

Post Graduate Trainee 3rd year, Gauhati Medical College and Hospital, Guwahati, Assam. sanjuborguhai@gmail.com

Introduction: Alcohol is a major public health concern worldwide. There is a causal relationship between harmful use of alcohol and a range of mental and behavioural disorders, other non communicable conditions as well as injuries. Chronic alcohol use is associated with a wide range of cognitive impairment especially of memory in its various domains. The purpose of this study is to assess the memory deficits in patients of alcohol dependence syndrome compared to healthy controls.

Methodology: The study sample consisted of 30 detoxified patients with alcohol dependence syndrome (ADS) admitted in drug deaddiction centre and 30 normal healthy controls comparable to age, sex and education of the alcohol dependence group. Memory with its various domains was assessed using the PGI-Memory scale at third week of deaddiction for detoxified patients and was compared to healthy controls.

Results: The mean total dysfunctional score was more for patients with ADS compared to healthy controls and was statistically significant. Moreover there is marked impairment of recent memory, attention and concentration, delayed recall, verbal retention for similar and dissimilar pairs i.e., the ability of learning simple and complex information, and visual retention compared to healthy controls.

Conclusion: This study supports the view that deficit of memory is one of the important cognitive declines among patients of chronic alcoholism. Cognitive rehabilitation at alcohol treatment entry along with pharmacological management may prevent patients from developing more serious condition like  Wernicke-Korsakoff Syndrome More Details.

Key words: cognitive impairment, memory deficits, PGI-memory scale, dysfunctional score, Wernicke-Korsakoff syndrome.

Socio-economic Pattern of Female Patients at a Private Psychiatric Consultation Centre

Shafquat Waheed, Burhan Uddin Haider, Dilwara Akhter, Mohammad Mokbul Hossain, Saiful Islam

Assistant Professor, Pabna Medical College, Pabna, Bangladesh. shaafqaat@yahoo.co.uk

Aim: To study socio-economic conditions of female psychiatric patients and their correlates in a paid psychiatric consultation centre in a district town in Bangladesh.

Background: It is generally considered that female patients are marginalized in the healthcare system in Bangladesh like all other aspects of the society due to proportionately more poverty and little education among them. Moreover, stigma about psychiatric illness and its treatment in general population bars psychiatric consultations. But no consistent data is available in Bangladeshi population.

Methods: All 593 patients attended, including repeated visits, in the calendar month of August 2017 were included in the study to look at socio-economic conditions and correlates.

Results: Among 593 patients attended the centre 327 (55.14%) were female. Among 327 female patients, 266 (81.34%) lives in rural areas. Low level of education and income was common in the rural patients.

Conclusion: Significant number of female rural population seeks psychiatric treatment even when they have to pay for it.

Keywords: Bangladesh, Female psychiatric patients

Obsessive Compulsive Symptoms In Schizophrenia-A Hospital Based Study From Northern Kerala

Shalima S, Druhin A V, Sumesh Balachandran

Junior Resident, Psychiatry, Kannur, Kerala. shalimakairali7@gmail.com

Background: The primary aim of the study was to compare the profile between patients diagnosed with Schizophrenia with and without obsessive compulsive symptoms

Materials and methods: This was a cross sectional study.Consecutive patients in the age group of 18-59 years diagnosed to have Schizophrenia, with at least 2 years of duration of illness consulting in outpatient department of psychiatry and inpatients admitted in psychiatry ward at Pariyaram Medical College were included. Clinical status of the patient is assessed using structured clinical interview for DSM IV TR(SCID), the Positive and Negative Symptom Scale(PANSS) and Yale-Brown Obsessive- Compulsive Scale(Y-BOCS) Severity and Symptom check list. Sociodemographic profile of the patients will be collected using specially designed proforma.Data analysis was done using SPSS version 20.0(chi square and t test).

Results: A total of 73 participants formed the study sample. The prevalence of obsessive compulsive symptoms in patients with schizophrenia was 34.2% .The schizophrenia with OCS were better educated,were more likely to come from a semi urban background,had alcohol dependence and longer duration of untreated illness than the group with schizophrenia alone.There is no difference in gender,family type, marital status, occupation, religion or socioeconomic status. The schizophrenia group without OCS had an excess of patients with paranoid subtype of schizophrenia.

Conclusion: The findings suggests that OCS does not exert a deleterious effect on schizophrenia.Schizophrenia patients with and without OCS have comparable profile with few exceptions.More the delay in treatment more is the likelihood of comorbidities in Schizophrenia

Keywords: Schizophrenia,Obsessive Compulsive Symptoms, northern kerala

Reduced heart rate variability in alcohol use disorder: relationship with severity of depressive symptoms in post acute alcohol withdrawal state

Shalini Singh, Rakesh Lal, Yatan Pal Singh Balhara, KK Deepak, Dinu S Chandran

Senior Resident, All India Institute of Medical Sciences, New Delhi, Delhi. shalin.achra@gmail.com

Background: Alcohol Use Disorder (AUD) and depression are both associated with autonomic dysfunction (AD). Monitoring those with AUD for indicators of AD such as reduced Heart Rate Variability (HRV) helps in detecting early asymptomatic and preclinical changes in a patient who could be at risk of developing end-organ dysfunction. There is limited research on how presence of depressive symptoms in those with AUD impacts their autonomic functioning.

Objectives: The current study aimed to measure cardiac autonomic function parameters in patients with AUD post management of acute withdrawal and to correlate them with presence and severity of co-morbid depressive symptoms, and clinical features.

Materials and methods: Cross-sectional observational study; in-patients who met selection criteria were recruited through convenience sampling. AUD diagnosis was made as per DSM-5 criteria; severity of AUD & depressive symptoms were measured using Severity of Alcohol Dependence Questionnaire (SADQ) and Hamilton Depression Rating Scale (HDRS) respectively. AD was assessed using time and frequency domain measures of short-term heart rate variability. Hierarchical regression analysis was used to control factors potentially affecting HRV. Spearman’s correlation coefficient was used to assess level of correlation between study variables. Level of statistical significance was kept at p < .05.

Results: Severity of AUD significantly correlated with reduced HRV (r= -0.310, p=0.041). Age of onset of alcohol use also showed weak correlation (r= -0.271; p=0.05) while the severity of depression did not show a significant correlation (r= 0.124; p=0.422). Hierarchical regression analysis showed that impact of confounding factors such as age, BMI, and nicotine use insignificant (R2 change= 0.079; p=0.845).

Conclusion: HRV may be an indicator of a biological mechanism that contributes to dysfunctional physiological state in those with AUD. It needs to be further explored how affective symptoms impact the impaired inhibitory mechanisms associated with low HRV in these individuals.

Keywords: AUD, HRV, SADQ

Sociodemographic Variables And Personality Disorder In Suicide Attempters In Tertiary Care Hospital.

Vishwanatha Sham Alamela, Arunkumar C, Mahesh Desai

Senior Resident, Shri B.M.Patil Medical College, Hospital And Research, Centre, Vijayapur., Vijayapur, Karnataka. shamalamela@gmail.com

Background: Suicide is the leading cause of premature death worldwide. Over 8,00,000 people die due to suicide every year. Suicide is the second leading cause of death among 15–29-years old. More than one lakh lives are lost every year to suicide in our country, with 4% to 67% of them having personality disorder. The number of suicides in India during the last decade has recorded an increase of 25.0%.

Method: A cross sectional study conducted in a tertiary care hospital. 100 cases of attempted suicide recruited for the study from the medical and psychiatry ward of the hospital. Structured proforma containing sociodemographic variables and suicide attempt data was administered. IPDE was administered to assess the personality disorders.

Result: In this study, male constituted 60% and females 40%, there was a significant association between gender and personality disorder. 23.3% male had personality disorder compared to 2.5% females. Mean age of subjects was 29.08 ± 10.49 years. Majority 49% of subjects were in the age group 21 to 30 years. There was a statistical significance found between locality and personality disorder (p=<0.01). 91.2% of rural subjects had personality disorder. In this study 3% attempted hanging, 9% took drugs and 88% took poison as a mode for suicide attempt. Over all 15% had personality disorder.

Conclusion: Most of the suicide attempters in our study had personality disorder, majority were from rural area and from lower socioeconomic status, its need to address the situation at gross root level to increase the awareness and treatment of morbidities and to prevent suicide attempts and subsequent rates of suicides in the community.

Keywords: IPDE, Personality Disorder, Suicide.

A Study Of Prevalence Of Pediatric Psycho-Cutaneous Disorders And Age Based Comparison Of Quality Of Life In Pediatric Psycho-Cutaneous Disorders With Non Psycho-Cutaneous Disorders. A Cross-Sectional Study From a North Indian Tertiary Care Center

Sheena Goyal, Khsitij Saxena, Venkat Rao Koti, Kabir Garg

Junior Resident, Era, Lucknow, Uttar Pradesh. sheenagoyal01@gmail.com

Aims and Objectives: The array of psycho-cutaneous disorders include disorders at the interface of dermatology and psychiatry. It has in-fact been seen that 30-40% patients seeking treatment for skin disorders have an underlying psychiatric or a psychological problem that either causes or exacerbates a skin complaint. The complex interrelationship between mind and skin has been investigated at both molecular and cellular levels and has been studied extensively, especially as brain, nerve, and skin are embryologically derived from the neural plate in the ectoderm. Examples of some psycho-cutaneous disorders include psoriasis, atopic dermatitis, acne and hyperhidrosis. These are in addition to primary psychiatric disorders with dermatology symptoms, such as dermatitis artifact, skin picking disorders, trichotillomania, delusional parasitosis and neurotic excoriations. The current study was done to examine and compare the prevalence of psycho-cutaneous disorders against other skin disorders in pediatric age group, and to compare the quality of life as measured by Children’s Dermatological Quality of Life Questionnaire (CDLQI).

Method: A total of 1000 cases from pediatric age group (0-12 years) were selected through stratified random sampling from patient population at the dermatology outpatient clinic from a tertiary care medical college in North India. Written informed consent was taken from the patients’ guardians and complete dermatological diagnostic workup was done along with administration of CDLQI, which had been translated and validated in local language for the purpose of this study. The sample was divided into psycho-cutaneous and non psycho-cutaneous disorders based on the classification provided in major reviews on the topic. The data was tabulated and results calculated using computer software.

Results: Among the 1000 patients enrolled 52% were male and 48% females, the patients were grouped into psycho-cutaneous and non psycho-cutaneous diagnoses as discussed above. 138 out of 1000 (13.8%) subjects had a diagnosis falling under the psycho-cutaneous category. Psoriasis (71/138, 51.4%) was the commonest psycho-cutaneous disorder presenting in our sample, followed by vitilligo, and atopic dermatitis. Of the age groups studied (neonates, infants, preschool and school age), psycho-cutaneous disorders were significantly higher in the school age group than other age groups (Χ2 =10.89, df=3, p=0.012). the presentation was also significantly more in females than males (Χ2 =14.49, df=1, p<0.001). No significant differences were found in the domicile (residential area) or religion. The psycho-cutaneous disorders had significantly higher presentation in winters when compared to other seasons (Χ2 =19.35, df=3, p<0.001). The mean CDLQI score was significantly lower in the psycho-cutaneous disorders group (11.78±4.2) than the other group (17.31±9.95) (t=-6.43, p<0.001), indicating a worse quality of life for non-psychocutaneous disorders in our sample. Similarly, mean CDLQUI score was higher in School age children was compared to toddlers.

Discussion: Psycho-cutaneous disorders were found to represent a smaller proportion of cases presenting to our center. This may be in due to our sample characteristics that included only pediatric age group while psycho-cutaneous disorders are common in the adult age group. Similarly, higher presentation in the females is similar to epidemiological studies on the disorder. The management of psycho-cutaneous disorders warrants a multi-disciplinary approach that frequently requires use of psychotropics and psycho-social management. A survey to assess the level of training regarding awareness and attitude about this condition among dermatologists revealed a clear understanding of psycho-dermatology in only 18%, and 39% expressed their interest and willingness to attend any kind of continuing medical education activity on psycho-dermatologic disorders. Epidemiological studies such as the current ones can help improve the attitude and sensitivity of clinicians towards diagnosing such disorders and managing them in collaboration with psychiatry colleagues.

Keywords: CDLQUI, Pediatric Psycho-Cutaneous Disorders

Cognitive Impairment and Depression in patients with CKD undergoing Haemodialysis

Shijo John Joseph, Samrat Singh Bhandari, Sanjiba Dutta

Post Graduate Student/Trainee, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim. shijojj90@gmail.com

Introduction: There is a dearth of literature in Cognitive Impairment and depression in patients with Chronic Kidney Disease(CKD) undergoing haemodialysis. The aims of this study were to find the prevalence of Cognitive impairment and Depression, measure the impairment of Cognitive Domains and to find out the impact of Depression on the domains.

Methodology: It was a Cross-Sectional study done in two Dialysis units in Sikkim. 50 participants fulfilling the inclusion criteria, who gave informed consent were assessed using Montreal Cognitive Assessment Scale and Patient Health Questionnaire-9. Sociodemographic and clinical variables were described using mean and standard deviation for continuous variables, while categorical variables using percentages. Shapiro-Wilk test was used to check the normality of data. Kruskal-Wallis and Mann Whitney U tests were used to find the association between categorical and quantitative variables. Spearman’s rho test was used to find the correlation between quantitative variables.

Results: The mean age of participants was 50.32 (SD= 12.41). The numbers of males and females were 33(66%) and 17(34%) respectively. The mean duration of haemodialysis was 18.8 months (SD= 15.11). Prevalence of Cognitive Impairment was 44% and that of Depression was 42%. There was a significant association between depression and various domains of Cognition except for abstraction. A negative correlation between Cognitive domains and Depression was found. Also, there was a significant association and negative correlation between duration of dialysis and Cognitive domains except abstraction. However, no significant relation was found between age and Cognitive domains. Cognitive impairment in the domain of Visuospatial Skills/Executive functioning was found to be most affected.

Conclusion: Cognitive Impairment and Depression are highly prevalent but underdiagnosed in patients with CKD undergoing haemodialysis. Further research is recommended as there is a scarcity of literature in this sphere of Consultation-Liaison Psychiatry.

Keywords: Cognitive dysfunction, Depressive disorder, Dialysis

Biopsychosocial-oriented Model of Care

Shivananda Jena, Kumari Rina

Associate Professor of Psychiatry, GIPMER, New Delhi, shiv.jena@me.com

Background: George Engel in 1977 proposed a holistic model alternative to the prevailing biomedical model which was being used by clinicians since the mid-20th century. He called it biopsychosocial (BPS) model in which biological, psychological and social factors interact in developing and progressing a disease, illness or problem. Borrel-Carrio et al. (2004) proposed a biopsychosocial-oriented clinical practice.

Outline of the workshop: Thirty participants in this workshop will be divided into 3 groups of 10 partcipants. Knowledge, attitude and skill will be taught.

Part 1 (30 min): Each group will be making a BPS formulation of a case vignette and do their presentation.

Part 2 (40 min): Each group will be making a BPS-oriented care plan of the case vignette and do their presentation.

Part 3 (20 min): The topic will be discussed and feedback will be given to each group.

Conclusion: The BPS-oriented model of care is a holistic and humane care which every clinician needs to learn and use in their clinical practice. This workshop is an attempt to teach them skills which they will use in their day to day practice.

Keywords: Bio psychosocial

Study of metabolic syndrome and it’s sociodemographic and clinical correlates in patients with schizophrenia

Shivananda Jena, Vishwanath S Lalugol

Associate Professor of Psychiatry, GIPMER, New Delhi, Delhi. shiv.jena@me.com

Introduction: Metabolic syndrome (MS) is a constellation of dyslipidemia, elevated blood pressure, impaired glucose tolerance, and central obesity. MS is of immense clinical relevance because it is associated with the development of coronary heart disease, type 2 diabetes mellitus and cerebrovascular diseases. It has been observed that people with severe mental illness such as schizophrenia are at greater risk of developing MS than people without such diagnosis.

Methodology: Aim of our study was to estimate the prevalence of MS in patients with schizophrenia and identify it’s sociodemographic and clinical correlates. A total of 100 subjects aged 18-60 years with schizophrenia, diagnosed according to DSM-5, attending the Psychiatry OPC were taken. Fasting blood samples for triglycerides, HDL, blood glucose, LDL, high sensitive CRP, fasting Insulin and total cholesterol were taken. Diagnosis of MS was made according to International Diabetic Foundation (IDF) criteria. The severity of the illness was rated using Brief Psychiatric Rating Scale (BPRS). All data were analysed with SPSS v.16 and chi-square/Fisher exact test was applied and a p-value of <0.05 was considered significant.

Results: In our study, the prevalence of MS in patients with schizophrenia was 24%. Out of various clinical and sociodemographic and clinical variables, significant association with MS was found with age group of 41-50 years, family history of psychiatric illness, divorced, sedentary lifestyle, family income below Rs.10,000 PM, low SES, olanzapine use and severe illness.

Conclusions: Every patient with schizophrenia needs to have clinical and laboratory monitoring using a standard protocol to identify emerging MS so that treatment is provided at the early stage and modifiable risk factors need to be avoided or reduced.

Keywords: metabolic syndrome, schizophrenia, MS

Clinical profile of children with Autism Spectrum Disorder in a tertiary care hospital.

Shivaji Marella, Daniel Saldanha, Suprakash Chaudhury

JRIII, Dr D Y Patil Medical College, pune, Maharashtra. shivaji.marella@gmail.com

Introduction: ASD is characterized by impairments in social communication and interaction along with restricted and repetitive patterns of behavior since early developmental period. There is less data on clinical and sociodemographic features of Indian ASD patients.

Methodology: A prospective observational cross sectional study with IEC approval was conducted. 600 consecutive patients from 2 - 12 years presenting with any psychiatric complaint received a thorough psychiatric evaluation and were screened for ASD using CARS. Those above cut-off on CARS were evaluated by experts and received a diagnosis of ASD according to DSM 5 criteria. The ASD patients were further evaluated using CBCL. Statistical Analysis was carried out using open source R software.

Results: 4.66% children had ASD all of whom had a supra-cutoff score on CARS. Average age at first symptom was 16 months. The ASD patients waited 19 months before 1st consultation. There was a Male:Female ratio of 6:1 with higher age at 1st consultation for girls. There were more MSES and HSES children. IQ of ASD patients was significantly lesser. Of 26 presenting complaints, 17 were SCI related and 9 related to RRBs. The CBCL findings conform with a previously developed autism profile. All patients fulfilled DSM 5 criteria A1, A2, A3, B1 and B4 on current status or history. Criteria B2 and B3 were fulfilled by 96%. 100% children with ASD had greater than mean HC for age and sex and 71% were higher than the 90th percentile. All patients had withdrawn/depressed problems, 96% patients had social problems, 96% patients had thought problems. 100 % patients had DSM diagnosis scale anxiety problems on CBCL.

Conclusion: ASD is commoner in boys and in MSES/HSES families. There is a delay in evaluation and diagnosis of ASD in India which may adversely affect long term functional outcome.

Keywords: Autism Spectrum Disorder, CARS

Follow Up Study Of Schizophrenia Patients With And Without Psychiatric Comorbidity

Shivani bansal, P.D. Garg, Neeru Bala

PG Student, GMC,Amritsar, Ludhiana, Punjab. shivanibansal30@gmail.com

Introduction: Schizophrenia is a heterogeneous disorder.Although it is generally accepted that psychiatric comorbidity is associated with schizophrenia the exact prevalence/epidemiology is unclear.

Aims & Objectives: 1.To study the comorbid psychiatric disorders in patients of schizophrenia and to assess its relation with sociodemographic and clinical variables

Methods: The present study was carried out on 45 patients diagnosed diagnosed as schizophrenia on the basis of ICD-10 criteria, of those patients coming in psychiatry department of Government Medical College and Hospital Amritsar from January1, 2016 to December 31 ,2016.Socio-demographic information was obtained, MINI was used to assess comorbidity and PANSS Scale was used to assess psychopathology at baseline and at 12 months.

Results:. The mean age was (32 ± 9.12 ) years. No statistically significant difference was found with and without psychiatric comorbidity with regard to sociodemographic variables except income. The rate of comorbidity was 46.67 %. The difference in mean scores of schizophrenia patients with and without comorbidity was found statistically significant in terms of PANSS-positive,PANSS–general and PANSS- total scores.On 12 months follow up patients without psychiatric comorbidity had more mean improvement in the PANSS scores than those with psychiatric comorbidity.

Conclusions: We conclude from the study that psychiatric comorbidity is highly prevalent in schizophrenia patients and it has a significant impact on disease course.

Keywords: Schizophrenia, Comorbidity,substance dependance, psychiatric

Efficacy and safety of repeated ketamine infusion in major depressive disorder with suicidal ideation.

Shri Gopal Goyal, KK Verma, Ripu Daman Singh, Girish Chandra Baniya

Assistant Professor, Department of Psychiatry (DIMHANS), PBM Hospital,S.P.M.C. Bikaner, Rajasthan. shrigopalgoyal@gmail.com

Introduction: Major depressive disorder is a serious illness. Without treatment an episode may continue with symptoms becoming increasingly more serious. Major depressive episodes may lead person to feel that life is not worth living and to commit suicide. Close to 800 000 people die due to suicide every year. So an urgent intervention is required to solve the crisis. As evident by previous studies, Ketamine infusion was known to be effective treatment in depression with suicidal ideation and repeated infusion having higher response rate than single infusion. With this rationale, we planned a study to see efficacy and safety of repeated infusion in such patients.

Methods and Materials: This was a single center, prospective, open- label study. After applying inclusion and exclusion criteria 20 patients were recruited and ketamine was infused @ 0.5mg/kg over 60 min under guidance of anaesthetist. Various scales like MADRS, CGI, SSI, BPRS and CADSS were applied to see efficacy and safety of infusion before and after every infusion and mean scores were compared with appropriate statistics.

Results: Repeated infusion of ketamine was effective in reducing the MADRS and SSI scores when compared to baseline scores. Endpoint MADRS score for all patients was 13.10 ±6.47, its difference with baseline score was found highly significant (t=15.89; p=0.001). Endpoint SSI for all patients was 0.50±1.08, its difference with baseline score found highly significant (t=25.99; p=0.001).

Conclusions: Ketamine seems to have a high potential in acutely reducing the suicidal ideation in patients with major depressive disorder.

Key words: MDD, Suicidal ideation, MADRS, Ketamine, NMDA

Unconventional Methods for Preventing Social Suicide in Teen

Shriya Shripad Ambhaikar

PG student, Dali Medical University, China, Raipur, Chhattisgarh. shriya1996@icloud.com

Suicide has a major impact on society across the world and the cases are growing in number day by day. An estimated 1 million people worldwide take their lives by suicide every year. It is estimated that global annual suicide fatalities could rise to 1.5 million by 2020. Suicide ranks among the three leading causes of death among those aged 15–44 years. Suicide attempts are up to 20 times more frequent than completed suicides. Incidence of suicide in a society depends on a range of factors. Clinical depression is an especially common cause. Depression often runs in families, suggesting that genetics can play a role, perhaps affecting chemical activity in the brain. Especially in teens, the causes for suicide include exam results, love failures, lack of patience, nuclear family culture, peer pressure, competition, lack of self-confidence and etc. Substance abuse, severe physical disease or infirmities are also recognized causes which may intensify depression, if not give rise to it. The countries of the Eastern Europe and East Asia have the highest suicide rate in the world. The region with the lowest suicide rate is Latin America. Other suicides are impulsive acts due to stress such as from financial difficulties, troubles with relationships, or from bullying. Those who have previously attempted suicide are at higher risk for future attempts. Suicide prevention efforts include limiting access to methods of suicide, such as firearms, drugs, and poisons, treating mental disorders and substance misuse, proper media reporting of suicide, and improving economic conditions. Although crisis hotlines are common, there is little evidence for their effectiveness. According to the research performed it is clear that psychological support is necessary for the depression patients. There are also cases which are not depression but just an emotional outburst called sadness. Many people consider this as a depression and then lack of self believe and confidence leads to bad consequences like suicide. In this research we tried to merge neuropsychiatry with psychoneurology. There are many therapies and healing methods which deal with the neurotransmitters along with the Indian ancient therapies which show the positive results. Along with this behavioral therapies like psychiatry first aid kit also showed outstanding results in depression patients. After going through these processes, outcomes were really positive and hence suicide could be prevented. A step by step technique and method always leads to a positive outcome.

Key words: suicide, depression, neuropsychiatry, psychoneurology, positive, results, behavioral therapy, outcome

Assessment of effect of demographic and illness factors on coping and social functioning in patients with depression and their spouses

Shruti, Dinesh Kataria, Shiv Prasad

Senior Resident, Lady Hardinge Medical College, Delhi. shruti.aggarwal49@gmail.com

Background: Depression leads to deterioration of social functioning of patients. Also, type of coping adopted by patients and their spouses determines the course and prognosis of illness. Thus, the factors affecting coping and social functioning needs evaluation

Aims: To evaluate the effects of various demographic and illness factors on patients with depression and their spouses with intra-spouse comparison.

Settings & Design: Hospital based cross sectional study.

Methods: 50 patients diagnosed with depression along with their spouses. Couples were assessed separately for coping and social functioning. Data related to various demographic and illness factors were collected and their effects on coping & social functioning assessed using appropriate statistical tools.

Statistical Analysis: t- test, Pearson’s test and ANOVA with post hoc LSD used as appropriate.

Results: Both illness severity and duration of untreated illness have significant impact over coping and social functioning of both the groups. Amongst demographic factors, family history of psychiatric illness has significant impact over coping as well as social functioning with no effect of any other demographic factor.

Conclusion: Intervention at stage of mild illness may be helpful in maintaining adaptive coping & subsequently social functioning of patients. Provision of better professional support for spouses seems to be the need of the hour.

Further studies are needed to establish better norms for DUI in depression and to assess the causes behind effects of family history on an individual’s life apart from genetic factors.

Keywords: Depression, coping, social functioning, depression severity, duration of untreated illness, family history of psychiatric illness.

Study of antenatal preparedness for motherhood and it’s association with antenatal anxiety and depression in pregnant women.

Shubhangi Sambhaji Dere, Jagdish Varotariya, Rakesh Ghildiyal, Darpan Kaur

Lecturer, MGM Medical College & Hospital, Navi Mumbai, kharghar, Maharashtra. shubhangi.dere@gmail.com

Background & Aims: Pregnancy is a normal developmental period demanding special adjustments. Psychologically, pregnancy can be associated with positive preparedness in some and fear of childbirth or doubts of mothering role in others. Anxiety and depression during pregnancy can have negative implications on it’s outcome. Current study aims to provide insight into factors influencing maternal preparedness for motherhood.

Methodology: Hundred first time pregnant women were enrolled after written informed consent and ethical approval. Pregnancy Experience Scale- Brief Version(PES-BRIEF) used to study maternal rating of uplifts and hassles specific to pregnancy indicating affective valence towards the pregnancy. Pregnancy Related Anxiety Questionnaire(PRAQ-R) helped to identify pregnancy-specific anxiety and depressive symptoms were screened using Whooley’s Questions. Data was analysed using SPSS 17.

Results: Mean age of the women was 23.1 years. More than half pregnancies were unplanned and mean duration of pregnancy was 6.8months. Positive experience was reported more than negative experience. Negative valence increased in presence of psychosocial stressors. On PRAQ-R, anxiety symptoms were reported by 52% of the patients, especially high on domain of ‘fear of giving birth’ and increased with trimester. Depressive symptoms were reported by 23% of the women.

Conclusion: Advanced gestation, presence of stressors, past psychiatric illness, ANC complications and presence of anxiety/depression influence maternal preparedness for motherhood. There is a need of sensitizing the doctors, nurses, health care workers and relatives regarding screening, referral of unmet psychological needs of pregnant women to help new mothers to adjust with their motherhood positively.

Keywords: Pregnancy, Maternal preparedness, Anxiety, Depression

The knowledge, experience and attitudes of recipients of Repetitive Transcranial Magnetic Stimulation: a study from North India

Shubh Mohan Singh, Mohit Sharma, Anisha Aggarwal, Ajit Avasthi

Associate Professor, PGIMER, Chandigarh, Punjab. shubhmohan@gmail.com

Background: Patient knowledge, experience and attitude towards a newer treatment modality are important variables that influence potential acceptability and satisfaction with the same. This is especially so with an increasing choice of treatment modalities available and greater patient participation in the treatment decision making process. The care-giver is also an important component in this decision making especially in a country such as India. In this context, repetitive transcranial magnetic stimulation (rTMS) is a relatively recent, non-invasive brain stimulation technique that has a wide variety of clinical and research applications. The aim of this study was to study the knowledge, attitude, and experience concerning repetitive transcranial magnetic stimulation among patients undergoing rTMS treatment and their relatives.

Materials and Methods: Ethical clearance was sought and received. The study was conducted in the rTMS service of the Department of Psychiatry PGIMER Chandigarh. A cross sectional study design was employed and 40 consecutive patients with their relatives were recruited after written informed consent. Socio-demographic and clinical data were recorded. Knowledge, attitude and experience of patients and their relatives was assessed using a questionnaire adapted from a similar questionnaire used earlier for electroconvulsive therapy.

Results: 20 male and female patients each were recruited. Patients mostly had adequate knowledge and favourable attitude towards rTMS. They also found the experience of rTMS treatment to be benign and not unpleasant.

Conclusion: It is likely that given proper pre-treatment assessment and education, patients would have a favourable impression of rTMS as a treatment modality.

Keywords: rTMS, North India

Assessment of coping skills in relation to recent life events in suicide or deliberate self-harm(DSH) attempters in a tertiary care hospital

Shwetali Gholap, Gayatri Saraf, Manjeet Santre, Rahul Bagle

Resident, BJMC & Sasson Hospital, pune, Maharashtra. shwetaligholap06@gmail.com

Introduction: Suicide is a major public health concern in India. Impulsive suicide attempts tend to be immediately preceded by interpersonal conflicts. This maladaptive response to conflict calls for an assessment of coping styles and stressful life events preceding the attempt.

Aim: To assess coping styles and their relationship with life events in inpatients admitted with recent suicide or DSH attempts in a tertiary care setting. Methodology: This is a cross- sectional study of 75 inpatients between 18-65 years of age referred to Psychiatry department of Sassoon General Hospital for suicide attempts from the General Medicine department. Columbia Suicide Severity Rating Scale(CSSRS) was used to quantify the severity of suicide attempts. COPE inventory was used to assess coping styles. Recent life events were evaluated using Presumptive Stressful Life Events Scale.

Results: The mean age group was 28.8±10.5 years, of which 40(53.3%) were males. The mean stress score of these respondents in the preceding one year was 198.67±66.69 and mean number of life events were 3.97±1.15 which is higher than the mean number of live events experienced by general Indian population . Most of the respondents had emotion focused coping(69.3%). 20(36.4%) stated the reason for their attempt was to get attention and to end pain. 38(50.7%) had made an attempt of moderate lethality.

Conclusion: Emotion focused coping style predominated among the respondents. The respondents had also experienced a higher number of life events in the preceding one year. This has implications for intervention among patients admitted in a general hospital setting for suicidal attempts. Brief interventions focusing on coping skills in these patients are needed.

Key Words- suicide, deliberate self-harm, coping skill

Internet Addiction and Substance Use: A Cross-sectional Study

Samant Singh, Lakhan Kataria, Dhawal Patel

Junior resident, SBKS MI & RC, Vadodara, Gujarat. smc_02@rediffmail.com

Introduction: In today’s world of information and technology, internet use as become an integral part of our lives. The impact of such rampant use of internet including social networking and other web services on the mental health of its users. The potential addictive nature of internet and associated ill-effects have now become a concern for leading researchers around the world. Here we have attempted to investigate the relationship between internet addiction and substance use amongst under-graduate students in this cross-sectional study.

Methods: A total of 1260 students of medical and dental undergraduate students were interviewed, using an anonymous structured questionnaire including details of age, gender, details of substance abuse and number of hours spent daily on internet using Young’s Addiction Scale.

Results: Out of 1260 students, 650 (52%) were males and 610 (49%) were females. The mean age of study participants was 19.06 years. Average daily time spent online was 2.10 hours (SD=2.65 hrs). Statistically significant and proportionate relation between the time spent online and substance abuse was observed (χ2 value=119.7, df=3, p<0.001 for alcohol and χ2 value=75.4, df=3, p<0.001 for tobacco).

Conclusions: Results from our study indicate a positive correlation between internet addiction and substance use.

Key Words: Substance use, undergraduate students, Internet addiction, social networking.

Self-Regulation as a Predictor of Internet Addiction among College Students

Sonal Shukla , Manoj K. Pandey

Psychiatrist, Post Graduate Institute of Behavioural & Medical Sciences (PGIBAMS), Raipur, Chhattisgarh. snlshkl14@gmail.com

Background: Internet addiction has been found to be associated with impairment or difficulties in health, personal, familial and professional life of youth worldwide. Current research in this field is directed to find out the causative factors for internet addiction and its treatment. Self-regulation is conceptualized as a mechanism of controlling one’s thoughts and behaviours in persuasion of various goals in life. There seems a scant of research on the role of self-regulation in determining internet addiction among youths. This paper is aimed at to find out the predictive role of self-regulation in determining the internet addiction among college students.

Methodology: This study was conducted in a sample of 200 engineering students in Raipur (C. G.) drawn by purposive sampling method. Tools used to collect data were Online Cognition Scale (Davis, Flett & Besser, 2002) and Self-Regulation Questionnaire (Carey, Neal & Collis, 2004). Pearson’s correlation and Linear regression were opted to analyze the data.

Results: The findings of the present study revealed that there was a significant negative correlation between self-regulation and internet addiction. Further, it was found that poor self-regulation significantly predicted internet addiction.

Conclusion: The present study indicated the significance of poor self-regulation in determining internet addiction among college students. It seems worthwhile to include the psycho-social methods of management, targeted to improve self-regulation in adjunct with other treatment modes, in a holistic approach to treat individuals with internet addiction.

Key words: Self-Regulation, Internet Addiction, College Students.

A Curious Case Of Catatonia With Epilepsy In An Adolescent Girl

Soumyadeep Saha

PG, Institute of Psychiatry, IPGME&R, SSKM Hospital, Kolkata, West Bengal. soumodip1625@gmail.com

Introduction: Catatonia, a psychomotor syndrome with marked decrease in environmental reactivity which ranges from resistance to instructions {negativism); to maintaining a rigid, inappropriate or bizarre posture; to a complete lack of verbal and motor responses {mutism and stupor) including purposeless and excessive motor activity without obvious cause {catatonic excitement). Other features being stereotyped movements, staring, grimacing, and the echoing of speech. It was first described by the German psychiatrist Kahlbaum in 1874, occurring in several psychiatric and neurological disorders.

Presentation: 16 year old girl, nil contributory past, family, personal history ; well adjusted premorbid temperament presented to psychiatric emergency with C/O limb rigidity, immobility, mutism - 1.5yrs ; muttering, aggressive behavior - 1 yr, h/o disrobing herself 1 yr back. last 8 months, she developed multiple convulsions with incontinence, LOC, post-ictal confusion.

Examination: Vitals Stable.

Limb Rigidity + Hypertonia

Kirby’s examination revealed stupor, non reactive to painful stimuli, apathetic, posturing, mask facies, gagenhalten, negativism, mitgehen.

Treatment: Patient was admitted immediately & was put on I.V LORAZEPAM 10 mg in divided doses as at the time of presentation catatonic symptoms were prominent with no seizure activity (normal EEG report). Treatment continued for 7 days . Catatonic symptoms improved with decrease in BFCRS score = 16. Same treatment continued with repeated monitoring of BFCRS showing remarkable improvement of target symptoms. Patient was discharged adding Tab.Sodium Valproate 600mg daily keeping in mind H/O GTCS; with Tab. Lorazepam 6mg daily

Conclusion: Albeit rare, case reports have supported co-occurrence of catatonia with epilepsy; making clinical scenario complex & difficult to perceive. Only higher degree of clinical suspicion , routine investigation, imaging & early intervention can delineate & manage such conditions, otherwise the morbidity & mortality will hike.

Keywords: catatonia, epilepsy, BFCRS

Comparitive Study Of Neurological Soft Signs In Childhood Onset Schizophrenia And Their Healthy Siblings

SOUMYA JHANDA, SUSANTA PADHY, Ruchita shah , ADARSH KOHLI

Senior Resident, PGIMER Chandigarh,. soumyajhanda86@gmail.com

Background: Neurological soft signs (NSS) have been considered as one of the functional features and endophenotypes of schizophrenia spectrum disorders.

Objective:  To compare neurological soft signs (NSS) in subjects with Childhood Onset Schizophrenia (COS) with their healthy siblings.

Method: The study was conducted on 15 patients each with COS diagnosed as per DSM IV-TR criteria using MINI Plus, and their siblings. Sociodemograpic details and clinical profile were recorded. Psychopathology was assessed using PANSS scale. IQ was assessed using Coloured Progressive Matrices (CPM) and Standard Progressive Matrices (SPM). NSS were assessed using Neurological Evaluation Scale (NES). Handedness was evaluated using Edinburgh Handedness Inventory.

Results:  NSS were significantly more in COS (p=0.01) as compared to their siblings. Individuals with COS showed significantly higher scores on frontal lobe (fist-edge-palm test p=0.02, glabellar reflex p=0.03) and temporal lobe NSS (memory p=0.04). The NSS were more in those with lesser IQ (p=0.02) and higher Positive (p=0.02) and Negative Syndrome Scale (p=0.01) scores.

Discussion and Conclusion: This is the first study from India comparing NSS with healthy siblings. Findings indicate that earlier onset types may be more strongly associated with a generalized disruption of brain function. This supports the notion that non-suppression of primitive reflexes with cortical maturation in COS point towards disordered neurodevelopment. Neurodevelopmental abnormalities leading to NSS also lead to lower IQ and lower educational level. Hence early identification of NSS in healthy siblings may be of relevance clinically.

Keywords: NSS, COS, CPM, SPM

Depression in Principal Caregivers of Patients with Breast Cancer: A cross- sectional study from a Cancer Research Centre in South India

Sreeja Sahadevan

Assistant Professor of Psychiatry, MOSC Medical college, Kolenchery, Ernakulam, Kerala. sreejasubin@gmail.com

Background: Existing literature suggests an alarming rate of depression in cancer caregivers, which is comparable to or even higher than in patients themselves. There are no studies on depression among caregivers of breast cancer from India.

Aims: To study the prevalence and determinants of depression in caregivers of breast cancer

Methodology: This is a cross sectional study of 384 patient –caregiver dyads at a cancer research centre in South India. Based on ICD-10 depression was diagnosed and severity of depression was assessed using HAM - D. A semi-structured proforma was used to collect the clinical data under patient, caregivers and care characteristics.

Results: The prevalence of depression in caregivers was 52.5%. Spousal caregivers, those who reside with patient, those providing financial support and those with non-caring domestic responsibilities appear most vulnerable in univariate analysis. However multivariate analysis did not support the same.

Conclusion: Depression is common among caregivers of patients with breast cancer. There is a need for focused interventions for this group, which may improve the outcome of the patient as well.

Key words: Depression, caregiver, breast cancer, HAM-D, South India

Is there a link between suicide attempt and personality profile of psychiatric patients? A cross-sectional study from South India.

Sreeja Sahadevan

Assistant Professor of Psychiatry, MOSC Medical college, Kolenchery, Ernakulam, Kerala. sreejasubin@gmail.com

Background: An attempted suicide being the best predictor of suicide, interventions on attempted suicide could reasonably reduce the mortality. Personality traits have several properties that make them attractive targets for research and interventions. Factors like impulsivity, aggressiveness and virulence can lead to suicide in mentally healthy persons. So can it coexist in a person with mental illness, making them more prone to commit suicide?

Aim: To study the personality profile of suicide attempters and to compare among those with and without psychiatric illness

Methods: This cross-sectional study was done in a teaching hospital in South-India. Consecutively admitted consenting 300 patients were interviewed using MINI for a psychiatric diagnosis. Personality profile was assessed using 16 PF questionnaire, Velicer’s Revised Attitude towards Violence Scale and Barratt Impulsiveness Scale. Results were analysed using Chi square and t tests. Multiple logistic regression was used as multivariate analysis.

Results: Among 300 patients, 204(68%) patients had psychiatric diagnosis. The personality factors like reserved (c2=,4.37p= 0.037), humblenss(c2=5.15, p= 0.023),being sober(c2=8.66,p=0.003), suspiciousness (c2=15.64,p< 0.001) and imaginative (c2=5.21,p= 0.022) were significantly associated with psychiatric disorders. However the significance was lost in multivariate analysis.

Conclusion: Personality factors may worsen the suicidality of a psychiatric patient. Understanding the personality profile of attempters should help in assembling care for them rather than serving as predictors of suicide. Irrespective of the causative role, this should inform the therapist in moulding the perfect care package for the person in distress who decided to end life in desperation.

Key words: suicide, suicide attempt, personality, 16PF, psychiatric illness

Jurisdiction of Mental Health Care Bill 2016: Differentiating between Mental and Neurological disorders

Shrirang Bakhle

Director, Dr. Bakhle Clinics, Mumbai, Maharashtra. ss.bakhle@gmail.com

Introduction: The Mental Healthcare Bill 2016 is applicable to patients with Mental disorders. One related issue is that, it is not applicable to patients with Neurological disorders.

Hence, from a legal point of view, it becomes vital to know whether a person is suffering from a Mental disorder or a Neurological disorder, and whether provisions of the MHC Bill apply to a particular patient or not.

Currently, there are no inclusion / exclusion criteria to differentiate between these two groups of disorders. From a practical and clinical point of view, there are no clear criteria that guide the decision to admit a patient in Psychiatry ward or Neurology ward.

Methodology: Both, Mental disorders and Neurological disorders are disorders of the same organ – brain.

This paper discusses neuroanatomical, neurophysiological, nosological and clinical points for differentiating between Mental disorders and Neurological disorders.

The paper discusses the definition of Mental disorders as given in the MHC Bill 2016 and describes how the definition can apply to some Neurological disorders, too.

Results: It is not possible to differentiate between Mental and Neurological disorders on the basis of neuroanatomy or neurophysiology. For example, it is incorrect to say that disorders of some brain parts (e.g. amygdala) or some systems (e.g. Dopaminergic system) are Mental disorders, while disorders of other parts/systems are Neurological disorders.

The paper shows how some disorders are considered as Mental disorders by DSM 5, while ICD-10 classifies them as Neurological disorders.

Conclusion: There are no neuroanatomical, neurophysiological, clinical or nosological criteria that can differentiate between Mental and Neurological disorders. The only difference is that ‘Mental’ disorders are disorders of ‘mind’, and Neurological disorders are disorders of brain. The paper precisely describes the ontological differences between mind and brain.

Keywords: Neurological disorders, Mental Health Care Bill

Psychiatric co-morbidity in elderly patients admitted in Regional Geriatric Centre, Gauhati Medical College & Hospital

Suranjita Mazumdar, H. R. Phookun

Post graduate trainee, Gauhati Medical College, Guwahati, Assam. su4dreamz@gmail.com

Introduction - Old age is not a disease, but it is a product of ongoing process which is gradual and progressive and involve changes which may be biological, psychological or sociological nature. This group of population is at increased risk of developing both physical and psychological problems due to the age-related factors and changes in the social circumstances.

Aims- To study

  1. The prevalence of psychiatric disorders in geriatric in-patients of non-psychiatric ward.
  2. The association of socio-demographic variables with psychiatric illness.


  3. Method and material-

  4. Study location: Regional Geriatric Centre, Department of Medicine, Gauhati MedicalCollege.
  5. Study type: Hospital based observational study.
  6. Study population: 85 male and female geriatric patients attending Regional Geriatric Centre
  7. Period of study: August 2016 to July 2017


Psychiatric diagnosis was made using ICD-10 classification of mental and behavioural disorders and a semi-structured interview was done to assess the socio-demographic variables. Medical illnesses are diagnosed by the consultants of department of Medicine.

Results- Among 85 patients, 40 patients are found to be suffering psychiatric illness. Among the group of patients with psychiatric illness, depression is the most common followed by dementia and substance use disorder. Hypertension is found to be the most common medical ailment present in the study group.

Conclusion- The present study establishes the fact that psychiatric co morbidity with various medical illnesses is very common in geriatric age group. The study also emphasizes the need for early bed side evaluation of elderly patients with medical illness to rule out any psychiatric co morbidity.

Keyword- Depression, Dementia, Hypertension

Community Mental health Services in United Kingdom

Subhash Chandra Gupta

Overseas delegate, Devon Partnership NHS Trust, Paignton, Devon. subhash.gupta@nhs.net

I worked as a Consultant in Community Psychiatry at the Devon Partnership for 7 years from 2005 to 2012 and then again from August 2016 (worked in Forensic and General Psychiatry in Singapore from 2012 to 2016). This is a secondary mental health service which receives referrals from General Practitioners in the patch. I will be presenting aspects of Community Psychiatry, as practiced in United Kingdom, from my experience. This will cover issues such as assessment hub, changes in community psychiatry over the years, problems facing community psychiatry, multi-disciplinary working and structure of community services. I will also discuss the interface betweeb community psychiatry and other services, such as inpatient facilities, Eating Disorder and Personality disorder Services, Mental Health Act Assessments and Community Treatment Orders.

I will also be available to provide any further information that the attendees might want regarding the working environment and opportunities in Psychiatry in NHS.

Keywords: Community Psychiatry

Side Bias In Depression: A Study Using Dichotic Listening Measure

Subodh Kumar, Kala Nand Thakur

Clinical Psychologist, Bokaro General Hospital, Sail, Bokaro Steel City, Jharkhand. subodhkumarbgh@gmail.com

Background : Side bias, the preferential use of one of the paired organs such as hand, foot, eye, or ear while doing unilateral activities of daily life, is considered to be an important indicator of cerebral lateralization. Findings of these studies generally showed an association between anomalous (left, mixed or reduced rightward) lateral bias and depression. No Indian study has been conducted using both side bias measures and experimental dichotic listening test. It was hypothesized that depressive patients will show more anomalous pattern of side bias on different measures than normal controls.

Methodology : 30 depressive patients, 30 first degree relatives and 30 normal controls were assessed on Side Bias Questionnaire for handedness , footedness, eyedness and earedness and on the verbal dichotic listening test using 30 pairs of CV syllables.

Results and Conclusion : Patients and their first degree relatives expressed reduced rightward bias on handedness , footedness and dichotic listening test, and mixed bias on earedness in comparison to the normal controls. The observed gradient in the magnitude of left hemispheric asymmetry (right ear advantage) exhibited by the three groups on the dichotic listening test is remarkable. These findings can be used to identify the risk population of depression on the basis of behavioural predictors and thus preventing them from developing depressive symptoms in the future.

To study the pattern of sleep disturbances in patients with mood disorders and compare the perceived sleep quality with the Global PSQI score

Keywords: Indian study, side bias in depression

To study the pattern of sleep disturbances in patients with mood disorders and compare the perceived sleep quality with the Global PSQI score

Sufiyan Sirkhot, Sharmishtha Deshpande, Manasi A Aphale

PG Student, SKNMC Pune, Maharashtra. sufyan1986@gmail.com

Background: Mood disorders are characterized by a significant disturbance in a person’s persistent emotional state or mood. The two main syndromal presentations of mood disorders are depression and mania. Thus, mood disorders are classified under the broad categories of depressive disorders and bipolar disorders. Sleep disturbance is one of the main symptoms of mood disorders.

Most depressive mood changes go unnoticed by the family, friends and health professionals in the early stage. If not treated, this can result in suicide and loss of life. The topic of sleep disturbances does not have a social stigma attached to it and thus can be easily enquired about. The results thus obtained from the study will help to assess for residual symptoms of sleep disturbances in patients on medications for psychiatric disorders and compare betwwen the subjective and objective quality of sleep disturbances

Objectives:

  1. This is a descriptive observational study of sleep disturbances in patients with mood disorders.
  2. To compare the findings of the study with unipolar and bipolar mood disorders.
  3. To compare the perceived sleep quality to the Global PSQI Score


Material and Methods: Patients attending the Psychiatry OPD were the reference population. All consecutive patients with mood disorders were interviewed. Semi-structured interview was conducted which included the socio-demographic details, general history and detailed history regarding the sleep disturbances of the patient.

A questionnaire, Pittsburgh Sleep Quality Index was used which included questions about sleep disturbances, quality of sleep, nature of dreams etc.

Results: A total of 50 patients with mood disorders were assessed.29 of them Females and 21 Males.17 of them in age group 18-30 yrs, 22 in group 30-50 yrs and 11 in the group 50-70 yrs. 33 of them were diagnosed with Major depressive disorder and 17 of them with Bipolar Affective disorder.Majority of them had a general quality of sleep (score 5-7) , 17 had good quality of perceived sleep (score 8-10) whereas a minority of them had poor quality of sleep (Score <5).The global PSQI score grades had most patients (46%)with poor sleep (PSQI Score >9) with only (28%) having good quality of sleep (PSQI <=4) and the rest (26%) having general quality of sleep (PSQI 5-8)

Conclusion: Detailed analysis to be furnished at the time of presentation

Keywords: PSQI, Mood Disorder, Sleep disturbance,

The pattern of heart rate variability response to arithmetic stress in adolescent children of patients with schizophrenia – a pilot study.

Suhas Satish, T N Sathyaprabha, Shivarama Varambally, John Vijay Sagar, Anu P John, B N Gangadhar

Junior Resident in Psychiatry, NIMHANS, Bangalore, Karnataka. suhasedu@yahoo.in

Introduction: Internal homeostasis is maintained by the autonomic nervous system which can be assessed by Heart Rate Variability(HRV). There is emerging evidence that HRV may be different in first degree relatives of patients with schizophrenia, indicating a probable genetically mediated trait characteristic. The purpose of the study was to examine the pattern of HRV response to mental arithmetic stress in a cohort of siblings who are adolescent children of patients with schizophrenia.

Methodology: The study was conducted at the Autonomic laboratory in NIMHANS. Purposive sampling was done. 6 pairs of adolescent (12-18 years) siblings who were children of patients with schizophrenia were recruited for the study after consent from parents and assent from the subjects. They were subjected to a baseline, stress (mental arithmetic), and post stress HRV testing. We performed a Wilcoxon signed rank test to compare the differences the three readings, and significance was assumed at 0.05%.

Results: It was observed that there were significant differences in the values, across three frames of measurement (prior to stress, during stress and after stress) in the following domains -Total power, Standard deviation of the R-R interval(SDNN), >50ms NN segments(NN50), very low frequency(VLF), low frequency (LF), LF power. There were no significant differences observed in Heart rate(HR), mean of the R-R interval(MeanNN), HF, HF power and LF/HF ratio.

Conclusion: We observed a significant change in the slow sympathetic response(VLF) and sympathetic response(LF and LF power) after stress. We could not observe any significant change in the vagal activity(HF). However, we observed no significant change in the sympatho-vagal balance (LF/HF) despite a significant change in the sympathetic response which was in contrast to previous studies. The findings need to be replicated with larger sample size and compared to a healthy control group.

Keywords: Schizophrenia, Heart rate variability, adolescent children.

Prevalence Of Anxiety And Depression In Female Patients At Different Hormonal Phases Of Life - A Cross Sectional Study In Western U.P.

Sujit Kumar, Sandeep Choudhary, Supriya Agarwal

P G Student, Subharti Medical College, Meerut, UP. sujit.dbg@gmail.com

Introduction - Women, who constitute about half the World’s population, are now the centre of concern as far as health; especially mental health is concerned even in a developing country like India. The problems faced by the female gender associated with their social, physiological and psychological attributes, have led to an increased incidence of Common Mental Disorders (CMD’s) like Depression, Anxiety Disorders and Psychosomatic Symptoms. Unipolar Depression, which is predicted to be the second leading cause of global disability burden by 2020, is twice as common in women. Furthermore, the lifetime risk of Anxiety Disorders (e.g., Generalized Anxiety Disorder) is 2–3 times higher in females as compared to males. Postpartum Depression is seen 11% in women, which increases to 26% if only adolescent mothers are considered. This study will analyse these morbidities in relation to various hormonal phases (menarche to marriage, marriage to 1st pregnancy, pregnancy, postpartum including lactation, perimenopausal) amongst women in Western Uttar Pradesh and provide an insight into a problem which requires serious intervention and may further provide the backbone to the health care in the field of Mental Health of Women in our country.

Methodology- The study is being conducted in outpatient unit and inpatient unit of Department of Psychiatry, Subharti Medical College, Meerut. It is an Observational Cross-Sectional Study. Female patients from menarche to postmenopausal (up-to 60 years) and having willingness to participate in the study are being screened for anxiety and depression, a sample size of 50 will be obtained and scales (Hamilton Rating Scale for Depression & Hamilton Anxiety Scale) will be applied. The data will be analysed using appropriate statistical tools.

Result & Conclusion- Result and conclusion will be discussed at the time of presentation.

Key Words – Women, Anxiety, Depression, Hormonal Phases

Comparison of Self-esteem and Socio-demographic profile between Bullies and Victims in School going Adolescents

Sumanth Ediga Kornapalli, Raghuram Macharapu, Pramod KR Mallepalli, Ravulapati Sateesh Babu

M.D. 2nd year, Mamata medical college, Khammam, Telangana. sumanthek@gmail.com

Background: Bullying is intentional, repeated negative behavior by one or more persons directed against a person who can’t defend him/herself. Over all prevalence of bullying in Indian schools in previous studies is 53%.

Aims and Objectives: The present study is an attempt to assess prevalence of bullying identifying bullies and victims .Comparing socio demographic profiles and self esteem between bullies and victims.

Materials and Methods: The total sample comprised of 450 students they are administered with peer interaction in primary school questionnaire(PIPS), Copper smith self-esteem inventory, Strengths and Difficulties Questionnaire (SDQ) and Socio-demographic details like weight, academic performance are collected.

Results: Statistical analysis done by using descriptive and inferential statistics i.e. mean, standard deviation (SD), percentages, t-test. The results analysed will be presented later.

Conclusions: The current study carried out to know profiles of bullies and their victims, their likely associations. .

Key words: PIPS, self-esteem, Strengths and difficulties

Headache Masquerading As Common Psychiatric Disorders In Patients Of Low Economic Class In A Tertiary Care Setting.

Sunny Dua, Seema Singh Parmar, Shweta Chauhan

Post Graduate Resident, Teerthanker Mahaveer Medical College, Moradabad, Uttar Pradesh. sunnydua1981@gmail.com

Aims & Objectives: To evaluate the presence of various psychiatric disorders in patients reporting with headache as the only symptom.

Methodology: 200 patients with the chief complain of headache who visited the psychiatric OPD of a tertiary care were investigated. Out of them 50 who had pure psychiatric illness without any other neurological disease were investigated and their diagnosis was made. Independent sample t-tests was applied to generate results.

Results: The most common psychiatric diagnosis seen in the sample was Depression (64%) out of which 47% showed features of Depression with anxious distress. Other psychiatric disorders seen were Generalized Anxiety Disorder, Panic Attacks, Somatic Symptom Disorder and Obsessive Compulsive Disorder. For pure psychiatry related illnesses female to male ratio was 1.64.

Conclusion: The increasing frequency of psychiatric disorders among patients who only visit the doctor seeking treatment of headache shows the need for better identification of psychiatric disorders because proper diagnosis and target of psychiatric treatment shall give complete relief to the patient’s symptomatology.

Keywords: Anxiety Disorders, Depression, Headache, Panic Attacks.

Post Traumatic Stress Disorder (PTSD) in patients of burns and limb amputations.

Surabhi Mitra, Abhijeet Faye, Deepika Singh, Sushil Gawande, Rahul Tadke, Sajal Mitra, Sudhir Bhave, Dr. Vivek Kirpekar

Junior Resident, NKP-Salve Institute of Medical Sciences and Research Center, Nagpur, Maharashtra. surabhiversatile@yahoo.co.in

Introduction : Cosmetic disfigurement after amputation and burn is not uncommon. Such suffering can be traumatic with physical, social and psychological consequences. These patients are at a significant risk of developing PTSD. This study aims at finding prevalence and severity of PTSD in such patients as per various components of cosmetic disfigurement and their quality of life post burns and amputations.

Methodology/materials and methods : This is an on-going cross-sectional study in which sample collection will continue till 31st December 2017 of every consenting follow-up patient across three tertiary care hospitals in Central India. Until now 17 burn patients and 36 amputees were assessed using Clinician-administered PTSD Scale (CAPS) for (Diagnostic and Statistical Manual-5) DSM-5, American Psychiatric Association (APA) DSM-5 Severity of PTSD scale, World Health Organization Quality of Life scale (WHOQOL), DSM-5 criteria for substance use disorders, semi-structured socio-demographic proforma and brief information questionnaire for details of burn and amputations.

Results : Out of 36 amputees, 11 (30.55%) were females, 25 (69.44%) were males and out of 17 burn patients, 5 (29.41%) were females, 12 (70.58%) were males. Out of the total patients (53) more prevalence and severity of PTSD was seen in males. Severity was higher in paediatric and geriatric population, those with lesser family support, phantom limb phenomenon, upper limb amputations, no prosthesis use, greater percentage of burns specially those with facial burns and contractures, lower quality of life and no pre- or post-operative psychiatric consultation. Results will be presented after completion, applying appropriate statistical tests.

Conclusion : In these patients a proper protocol is needed to detect PTSD at its earliest stage, so that it can be effectively treated to avoid its undesirable consequences.

Keywords : PTSD, amputation, burn

Burden and coping among caregivers of children with psychological disorders

H.V.Suresh, N. Prasanna Kumar, N. Harikrishna

Postgraduate, Andhra Medical College, Visakhapatnam, Andhra Pradesh. sureshnew29@gmail.com

Introduction: Children suffer from behavioural and mental illnesses like autism, hyperkinetic disorders, learning disorders, depression, anxiety disorders, conduct disorders, substance abuse, eating disorders and psychosis. These children are very difficult to manage for both the doctors and family caregivers. They are prone to burden and psychological disorders due to the impact of caring them. In India there are less studies regarding the caregiver’s suffering.

Aim: To study the burden and coping among caregivers of children with psychological disorders

Methodology and study tools: A cross sectional study on 70 caregivers of children and adolescents with different psychological disorders including mental retardation attending the Government hospital for Mental Care, Visakhapatnam. Children and adolescents with psychological disorders attributed to underlying medical or neurological illnesses are excluded from the study. Burden assessment schedule and Cope Scale were used in the study. The differences in the scores for each individual will be compared with their sociodemographic factors as well. Data were collected via interview using semi structured questionnaires, and results were computed using appropriate statistical tests.

Results and conclusion: Results and conclusion will be discussed in the conference

Keywords: caregiver, burden, coping, children, adolescents

Role of consanguinity in mental retardation

Susmitha Gajula, O Radhika, V Padma

Post Graduate, Andhra Medical College, Visakhapatnam, Andhra Pradesh. susmitha.gajula@gmail.com

Introduction: Intellectual disability is defined as a disability characterized by significant limitations in both intellectual functioning and in adaptive behavior . Mental retardation can be caused by a range of environmental and genetic factors that lead to a combination of cognitive and social impairments .

Consanguinity among parents as a cause of mental retardation in their children is debatable . Consanguineous marriages are common in Indian culture , particularly in the southern region . The contributing factors could be customs , traditions , and beliefs , the desire to preserve family property and to maintain ties .

Aim: To find the correlation between consanguinity and mental retardation of the patients attending the Government Hospital for Mental Care, Visakhapatnam over a period of one year .

Materials and Methods: Sample Size: 421 patients

Type of study: Retrospective study.

Inclusion criteria: Patients diagnosed with mental retardation as per ICD 10 criteria .

Results: A total of 421 mentally retarded patients were studied, out of which 135 were born of consanguinous marriage and 286 were born of non consanguineous marriage . The percentage of mild, moderate, severe, and profound mental retardation in both the groups and correlation to consanguinity will be assessed and discussed later in the conference .

Key words: Consanguinity, mental retardation, South India

Hindi Adaptation and Validation of The Copenhagen Multi-Centre Psychosocial Infertility (COMPI) Coping Strategy Scale for Indian Infertile Couples

Swarnali Bose, Bharati Roy

Assistant Professor of Clinical Psychology, School of Allied Health Sciences, Manipal University, Manipal, Karnataka. swarnali.bose@rediffmail.com

Infertility is one of the major clinical and psychosocial problem faced by one in six couples in their child bearing age. Infertility is often perceived as a psycho-social stressor and couples invariably engage in a variety of coping strategies to regain control over their disturbed relationships due to infertility. The Copenhagen Multi-Centre Psychosocial Infertility (COMPI) Coping Strategy Scale is a 19 item scale for measuring infertility related coping and is categorized into four subscales:

  1. active avoidance strategies
  2. active-confronting strategies
  3. passive-avoidance strategies and
  4. meaning-based coping. It has been previously used in several infertility research in the past to assess coping in infertility owing to its good reliability and validity. Till date, there is dearth of literature focusing on coping related to infertility in India due to lack of a reliable and valid scale. Moreover, all the items of English version may not be culturally suitable for Indians. Hence there is a need for a reliable and valid Hindi scale for the assessment of coping in infertility. After obtaining permission from the original author of COMPI Coping strategy scale, the scale was translated by two independent researchers and back translated subsequently by two researchers independently. Fifty couples aged between 18-45 years with primary infertility were assessed using the back translated and modified version of Hindi COMPI coping questionnaire after taking informed consent. The translated version of the scale had a good internal consistency of 0.77. Cronbach’s alpha was also calculated for all four domains separately and it ranged from 0.73 to 0.87 across both genders. The inter-item correlation of individual items of a domain correlated with the domain scores (r>0.5) suggesting good validity measures. Hindi version of COMPI coping strategy scale is a reliable and valid scale for the assessment of coping strategies in Indian couples with infertility.


Keywords: COMPI, Hindi Version of COMPI, Infertility

The Study Of Social Engagement, Emotional Intelligence, Resilience, Self Rated Subjective Successful Aging And Health And Disability Status Amongst Socially Active Eldelry Population

Swati B. Shelke, Rashmi Satpute,

3rd Junior Resident M.D. Psychiatry, Topiwala National Medical college & B.Y.L Nair hospital, Mumbai 400008, Ahmednagar, Maharashtra. swatigsite@rediffmail.com

Background : Successful aging and self rated successful aging are viewed as multidimensional concepts. Factors like emotional intelligence, resilience and social engagement help in aging successfully.

Aims and Objectives: To assess for and correlate self-rated subjective successful aging, health and disability status, social engagement, emotional intelligence & resilience in socially active elderly population.

Materials and method: It was a cross sectional study with 160 older adults attending senior citizen groups. They were administered Cohen’s social network index, Connor Davidson Resilience scale, Schutte’s Emotional intelligence scale, Self rated successful aging scale and WHO DAS 2.0. The data was analyzed using Mann Whitney test and Pearson’s correlation coefficient in SPSS version 21.

Results: 94.4% of study population reported self rated successful aging irrespective of sociodemographic profile. Social engagement was significantly higher in <=75 years of age, working, and married than in above 75 years, retired, single. Emotional intelligence (EI) was significantly lower in retired, currently single and self rated not successfully aging. Resilience was higher in self rated successfully ageing, married and currently working study population. Health and disability status did not differ significantly in self rated successful and self rated not successful aging population.

Conclusions: Being socially active, resilient, emotionally intelligent help in successful aging and perception of successful aging.

Keywords: self rated successful aging, social engagement, resilience, emotional intelligence.

Prevalence of Anxiety, Depression and Stress among ANC Mothers in Rural setting: A Hospital Based Study

Swati Madhukar Sonawane, Rupali Rajendra Chavan, Ramdas Ransing

Clinical Psychologist, BKL Walawalkar Rural Medical College, Ratnagiri, Maharashtra. swatipsy2811@gmail.com

Background: Previous studies have reported high prevalence of depression, anxiety and stress in pregnant women. Most of the studies are conducted in developed countries and urban population. There is a paucity of research on prevalence of anxiety, depression and stress among the ANC mothers in rural setting.

Aims: To determine the prevalence of anxiety, depression and stress among the rural ANC mother attending ANC Clinic in rural setting.

Methods: All pregnant women attending tertiary care rural hospital of western India were screened by mental health professionals. Of these, Sixty five percent of eligible women were administered Depression Anxiety and Stress Scale (DASS).

Results: Sixteen percent of the ANC mothers were depressed. The prevalence of Anxiety was 33.33%, whereas Mixed Anxiety and Depression was 41.66%. Forty one percent ANC mothers reported high level of stress.

Conclusions: The higher prevalence rate of depression, anxiety and stress among the pregnant rural women suggests the need of integrated routine screening and treatment program for these illnesses.

Keywords: ANC Mother, Rural setting, DASS

A Study of Insight in Mania,Bipolar Affective Disorder

Rekha B Balakrishna, Hemapriya.M.G, Poornachandrika, Shanthi Nambi

1st year Diploma in Psychological medicine, Institute Of Mental Health, Chennai, Tamil Nadu. sweetrekha777@gmail.com

Background: Insight in Mania,despite its possible impact on both treatment compliance and outcome,the study of insight in mood disorders has recieved limited attention.In the current study,we compare insight levels during different phases(manic and remission phase) of bipolar disorder 1 and its relation to sociodemographic profiles and clinical correlates.

Aims and Objectives: To evaluate insight in bipolar disorder 1 during manic phase,compare the changes in insight in bipolar disorder1 between manic and remission phase and to determine the relation between sociodemographic profile,clinical correlates and insight

Materials and Methods: A cross sectional study of 120 bipolar disorder 1 patients in manic phase for 3 months duration has done to evaluate insight in bipolar disorder 1 during manic phase,compare the changes in insight between manic and remission phase and determine the relation between sociodemographic profiles,clinical correlates and insight in patients coming to Op/Ip at Institute of Mental Health, Chennai after obtaining consent from patient/close relatives.Sociodemographic details are collected by semi structured proforma and following three questionnaires are applied to the patients;KUPPUSWAMY SCALE,YMRS(young mania rating scale),SUMD(scale to assess unawreness of mental disorder)

Statistical Analysis: Results analysed using SPSS 20 package(statistical analysis software)

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

Keywords: Insight, BPAD, Mania

Cross Sectional study of Quality of Life in patients suffering from schizophrenia for ten or more years

Teli Vijay Arvind, Shobha Nair , Tejas Gholap, K.Mazumdar, Aditi Chaudhari

Senior resident doctor, Bhabha Atomic Research Centre Hospital, MUMBAI, Maharashtra. teli.v7@gmail.com

Background: There is a need to focus on the outcome of the schizophrenia in terms of quality of life (QOL). A systematic study of the clinical correlates of QOL could help to delineate the factors that impact it.

Aims and objectives: 1. To assess the QOL in patients suffering from Schizophrenia for ten or more years. 2. To study whether QOL varied with the socio-demographic profile of the patient. 3. To evaluate the association of symptom severity with the QOL. 4. To determine whether or not age at onset, duration of illness and duration of untreated psychosis affected QOL.

Materials and Methods: 50 patients who had been suffering from schizophrenia for ten or more years were included. The socio-demographic and illness related variables were noted. Symptomatology was assessed using the Positive and Negative Syndrome Scale (PANSS) for Schizophrenia and QOL was assessed using the World Health Organisation – Quality of Life Scale Brief Scale (WHO-QOL Bref).

Results: The scores on the domain of environmental and financial resources were significantly higher than the other domains while the social and personal relationships domain had the least score. QOL did not show any significant association with age, gender, education and occupation, age at onset of illness, duration of untreated psychosis. Unmarried patients, and those with a duration of illness more than 15 years had a lower QOL. Both positive and negative symptoms impacted QOL.

Conclusion: Marital status, duration of illness and symptomatology can influence QOL among patients suffering from schizophrenia for ten or more years.

Key Words: Schizophrenia, Ten years, QOL, Symptomatology.

Study on the genetic association of Serotonin pathway and brain derived neurotropic factor gene variants with Alcohol Dependence

Tripti Grover, Ranjan Gupta, Renu Singh, Atul Ambekar, Raka Jain, Arundhati Sharma

PG Student, All India Institute of Medical Sciences, New Delhi, tripti.grover@gmail.com

Background: The neurobiology of alcohol dependence (AD) involves alterations in neurotransmitters and the stress response. There is convincing evidence of genetic influence on vulnerability to alcohol dependence, besides the environmental factors. This study reports on the identification of serotonin pathway and Brain Derived Neurotropic Factor (BDNF) gene polymorphisms in AD.

Methodology: The single-nucleotide polymorphisms, 5-HTTLPR, HTR1B rs130058, HTR3B rs2276307 of the serotonin pathway and Val66Met (rs6265) of BDNF gene were analyzed by PCR-RFLP. The study group comprised 100 each of male AD cases (DSM IV criteria), recruited from the National Drug Dependence Treatment Center, AIIMS and individuals who did not consume alcohol as controls. All participants were interviewed using a pre-designed questionnaire and WHO ASSIST which was followed by drawing 5mL blood sample in EDTA for genetic analysis, after taking informed consent. Association of the polymorphisms with alcohol use parameters like age, age at first use, intake (g/day), ASSIST score, and liver function enzymes (SGOT, SGPT) was analyzed using SPSS v20.0.

Results: Analysis revealed no significant differences in the genotype frequency of the 5-HTTLPR in AD subjects and controls (p=0.93). The HTR1B rs130058 AA genotype was moderately higher in cases (6.9%) compared to controls (3.9%) (p=0.62). The HTR3B rs2276307 (cases: 13.0%; controls: 13.7%; p=0.957) and the BDNF gene polymorphism rs6265 (cases: 62%; controls: 65%; p=0.96) showed similar frequency in both groups. Correlation with related parameters showed that individuals with HTR1B rs130058 genotype TT started consuming alcohol at a significantly early age (p=0.03) compared to the other genotypes. The BDNF rs6265 was observed to be significantly associated with high SGOT levels (p=0.01).

Conclusion: The present findings are suggestive of a possible role of genetic variations on phenotypes like early onset of the alcohol use (rs130058; TT genotype) and SGOT levels with BDNF in the Indian male subjects.

Keywords: Alcohol dependence, serotonin, BDNF, HTR1B, HTR3B

Suicide Prevention Clinic in Emergency Departments of Tertiary Hospitals In India: Need of the Hour

Udayan Bhaumik, Hemendra Singh

Junior Resident, M S Ramaiah Medical College, Bangalore, Karnataka. udayan.bhaumik@gmail.com

Introduction: Suicide is a personal, family, and societal crisis. According to the WHO 2012 estimates, 8 lakh people globally die by suicide every year which amounts to a suicide death every 40 seconds (Mythri & Ebenezer,2016). History of suicide attempt is an important predictor of future attempts (Ribeiro et al,2015). Suicide risk assessment is an important process to be done in all cases of suicide attempters and it is beneficial if a psychiatrist is associated with each step any suicide attempter must go through for stabilisation after an attempt-through the emergency, intensive care, general ward till discharge and after that. Despite psychiatry services being present in tertiary hospitals, most suicide attempters are first seen in the Emergency Department. Suicide attempters are usually not evaluated for future risk upon arrival to these Emergency Units. These is also paucity of research on Suicide Prevention Clinic or services in Emergency Department. These issues can be addressed by having Suicide Prevention Clinic with psychiatrist attached to emergency services.

Methodology: Our study is a retrospective chart review of suicide attempters(both male and female)brought to the Emergency Unit of M S Ramaiah Medical College from 2013-2017 wherein details like age, gender urban/rural, marital status, method of suicide attempt and whether seen by psychiatrist at the Emergency will be collected. Relevant statistical analysis will be undertaken post data collection.

Results: Will be presented

Conclusions: It is important to have a Psychiatrist assess suicide risk assessment and provide intervention at each stage for suicide attempters as they are brought to the emergency till discharge. Hence there is a need for a integrated approach in the form of Suicide Prevention Clinic to be attached to Emergency Services in tertiary hospital settings.

Keywords: Suicide risk assessment, suicide prevention clinic

A Study Of The Patterns Of Psychiatric Morbidity Among The Adolescents Attending Department Of Psychiatry, Rims

Udayan Majumder, N.Heramani Singh, R.K.Lenin SIngh, Th. Bihari Singh, S.Gojendra Singh

Postgraduate Student, Psychiatry, RIMS, Imphal, Manipur. udayan586@gmail.com

Introduction: Mental health problems during adolescence are often difficult to recognize and diagnose because normal development includes periods of rapid physical, mental and emotional change. Consistently, reports stated that (16-20)% of the population of children and adolescents had some psychosocial disturbance, (4-7)% suffered significant functional impairment. Nearly 9.8 million of young Indians between 13-17 years are in need of active interventions. This hospital based study attempts to explore the morbidity load of categorized mental disorders in the adolescent group of people of this region.

Aims & Objects: To document the socio-demographic profiles & patterns of psychiatric morbidity among the adolescents 10-19 years attending Department of Psychiatry, RIMS, Imphal

Materials and methods: A cross sectional study comprising of 474 adolescents within 10-19 years of age attending our psychiatry department during 2 years of duration was done after taking institutional ethical committee clearance. A semi-structured Proforma for socio-demographic details and childhood history of the client was used. Diagnosis was done following ICD-10. Appropriate analysis was done by SPSS 21 software.

Results : Mean age of the adolescents was 16.27 years. Among them mostly were males 56.1%, majority were Hindus 62%, mostly belonged to urban areas 54.4% and staying with the family 51.3%. Most of them were undergoing secondary education 55.9% & belonged to joint families 82.9%. Among psychiatric morbidities, highest was Neurotic & stress related 41.4% followed by Psychotropic substance abuse 21.3%, mood disorders 14.8%, Schizophrenia and related disorders 12.2% & behavioral disorders of childhood was 9.3%. Among substance use pattern, opiods were mostly abused one 14.1%.

Conclusion: Despite its few limitations, we hope this study will be helpful in reflecting the psychiatric morbidity load in the adolescent group for helping them with early diagnosis and intervention.

Keywords: Psychiatric morbidity, adolescents, substance abuse, comorbidity, adolescent mental health, hospital.

Prevalence of Functional Somatic Symptoms in Drug Free Patients Suffering From Major Depressive Disorder

Urvika Parekh, Aamirkhan pathan, Rajat M Oswal

MBBS, Baroda Medical College, Gandhinagar, Gujarat. urvika7@gmail.com

Background: Functional Somatic Symptoms (FSS) are frequent among people in the community but studies on patients with depression in primary care settings show that functional somatic symptoms occurs more as a rule than an exception in two thirds or more of the depressed patients. A definite medical diagnosis that explains the symptoms is often not established, and at least one third of these symptoms lack a reasonable organic explanation. Such somatic symptoms are therefore regularly referred as “Functional”, “Atypical”, or “Somatoform”.

Aim: The aim of this study was to find out the prevalence of Functional Somatic Symptoms in patients suffering from Major Depressive Disorder.

Methods: This was a cross sectional study conducted in a hospital setting in the psychiatry out-patient department in SSG hospital, Baroda. Serial interviews were conducted and patients were diagnosed on the basis of DSM-5 criteria, FSS were assessed using PHQ 15 questionnaire.

Results: A total of 150 adult patients suffering from MDD were interviewed. The mean age of patient was about 43, Number of Female patients (57.3%) was higher than Male (42.6%). The results showed all patients had at least two FSS. Each patient reported at least two FSS. The mean of total PHQ 15 score was 9.36. The most common symptoms were trouble sleeping (94%), feeling tired or having little energy (78.6%), headache (63.3%), pain in the arms, legs, or joints (60.6%), dizziness (52.7%) and back pain (50%). Out of these, the first 2 symptoms led to maximum distress as reported by patients. Patients Age, Sex, Education level and marital status had significant correlation with FSS.

Discussion: The study concluded that Functional Somatic Symptoms are highly prevalent in patients diagnosed with Depression. These should be inquired in all patients suffering from depression.

Keywords: Functional Somatic Symptoms, Major Depressive Disorder

Prevalence Of Depression And Its Relation With Quality Of Life In Young Women

Vatsala Sharma, Geeta Soohinda, Divyasree Sreedhar, Sanjiba Dutta

PG Student, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim. vatsalasharma99@gmail.com

Introduction: The mental health issues pose major problems for college students worldwide. In accordance with the stressful life and cut throat competition, there is progressively increasing depression rates in young adults as they have to cope with the academic and social demands in preparation for professional careers. The frequent coexistence of family responsibilities with requirements of academia leads to additional challenges for female students. The purpose of this study is to examine the prevalence of depression among female students as well as to estimate its influence on quality of life (QoL).

Materials and Methods: Consent was taken from 619 female students, belonging to 18-24 years, who were pursuing MBBS, BSc Nursing and Bachelor of Physiotherapy (BPT) course. For the study, candidates were administered Patient Health Questionnaire-9 (PHQ-9) and WHO Quality of Life BREF (WHO QoL BREF) in their respective classrooms. Minitab 17 was used for statistical analysis.

Results: Depression of moderate severity onwards was found in 9.05 % of our respondents. Depression had significant association with physical (χ=23.97,SD=3.6,CI=1.9-4.5,p=0.000), psychological (χ=20.75,SD=3.5,CI=2.6-5.3, p=0.000), social relationships (χ=8.47,SD=2.3,CI=0.2-1.9, p=0.020) and environmental (χ=27.75,SD=4.4,CI=1.2-3.9, p=0.001) domains of the study population; along with impairment of overall quality of life (OR=3.48,CI=1.9-6.5,z=3.89,p=0.000) as well as overall health related quality of life (OR=2.73,CI=1.5-4.9, z=3.31, p=0.001).

Conclusion: The prevalence of depressive symptoms in young adults is alarming which further deteriorates quality of life. This emphasizes the need for preventive measures and early intervention, as well as the development of adequate and appropriate support services for this group.

Keywords: Young women- Depression- QoL

Auditory Steady- State Response in Children and Adolescents with Autism and Healthy Control: A Comparative Study

Veena Tejan, V.K Sinha, K.K. Kshitiz

Junior Resident, Cip, Ranchi, Ranchi, Jharkhand. veena.6186@gmail.com

Background: Gamma-band dysfunction in autism is seen as a potential non-invasive marker of dysfunction in the underlying circuitry, which heavily implicates GABA and glutamate neurotransmission.

Aims: To assess the auditory steady state gamma oscillatory response in children and adolescents with autism, and to compare it with healthy controls.

Methods: Eight right handed children of the age 6-12yrs with the diagnosis of autism were taken from the out patient department of child psychiatry unit of Central Institute of Psychiatry, Ranchi as subjects along with 8 right handed healthy controls of the age 6-12 yrs. Childhood Autism Rating Scale (CARS) and Indian Scale for Assessment of Autism (ISAA) were used for diagnosis and rating the severity of autism in the study group. Ten minutes of auditory steady state EEG were recorded for each participant (both the groups), while sitting, eyes closed, on a reclining chair in a light and sound attenuated room. MATLAB 7.0 version will be used for EEG analysis. Appropriate statistical methods will be applied to analyse the data.

Results and discussion: These would be shared at the time of presentation.

Keywords: Auditory steady state response, gamma oscillatory response, autism

Alexithymia And Sensation Seeking In Alcohol Dependence Syndrome

Vinayak Pathak, Suprakash Chaudhary, D Saldanha, Bhushan Chaudhary, Preethi Menon, Akanksha Gajbhiye

PG Student, D.Y. PATIL MEDICAL COLLEGE , PUNE, Maharashtra vickypathak7@gmail.com

Introduction: Alexithymia is characterized by impairments in emotional awareness and is also common among individuals with substance use disorders. Research on alexithymia suggests that it is a trait that may contribute to substance dependence. Alexithymia relates to substance use and substance use disorders, considering its potential role in the maintenance and treatment of these disorders. Several aspects of emotional dysregulation in substance users may relate to alexithymia, which is characterized by a diminished ability to identify, define, and explain one’s own emotions, as well as a tendency to externalize feelings and experiences. The scale for assessment of is - The Toronto alexithymia scale (TAS-20) which has been validated in multiple populations, including healthy individuals and those with addictive, eating, anxiety, mood, psychotic, and somatoform disorders.

Some studies indicate that in addition to alexithymia patients with substance use disorder also have sensation seeking behaviour. A number of studies have used sensation seeking to explain certain high risk behaviours.

Material and Method: This cross-sectional, hospital based study was undertaken at Psychiatry department of Dr. D.Y. PATIL medical college during September 2016 to September 2017.Inpatients with alcohol dependence syndrome diagnosed by ICD-10 DCR criteria and age and sex matched control group were included in the study after obtaining written informed consents. Institute Ethics Committee approval was obtained for the study. All subjects were assessed with sociodemographic and psychiatric porforma , Toronto Alexithymia scale (TAS-20) and The brief sensation seeking scale .

Result- Patients with alcohol dependence syndrome had higher scores of alexithymia and sensation seeking in comparison to the matched control patients.

Conclusion- In the treatment of alcohol dependence , alexithymia and sensation seeking should also be addressed.

Keywords- Alexithymia, substance use disorder, emotional dysregulation, sensation seeking.

A Study On Prevalence Of Depression And Anxiety In Patients With Chronic Liver Disease.

L.Vishalakshi, Hemapriya.M.G, Shanthi Nambi

Postgraduate, Institute of Mental Health, Chennai, Tamil Nadu. vishalaklshisowmya19@gmail.com

Background:

Chronic liver disease is the long term illness associated with multiple dimensional nature of problems. It often requires frequent hospital admissions hence more susceptible to have psychiatric comorbidity mainly anxiety and depression. Therefore they should be carefully assessed and treated appropriately in order to improve the quality of life and wellbeing of patients.

Aims and Objectives:

To estimate the prevalence of anxiety and depressive disorders in patients with chronic liver disease and to assess their quality of life.

Materials and Methods

A cross sectional study of 120 chronic liver disease patients attending op/ip at department of hepatology, Rajiv Gandhi government hospital, chennai for 2 months duration was done to estimate the prevalence of anxiety and depression after obtaining informed consent. Social demographic details were collected using semi-structured proforma and the following questionnaires are applied to the patients,SCID (Structured clinical interview for DSM disorders) ,HAM-A(Hamilton anxiety rating scale), HAM-D(Hamilton rating scale for depression), SF 16(short form health survey) to assess the quality of life.

Statistical Analysis : Results analysed using SPSS 20 package(Statistical Analysis Software)

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

Keywords: Chronic liver disease,psychiatric comorbidity

Mother-infant bonding and clinical correlates among mothers admitted to a Mother Baby Unit.

Vishwas Yadawad, Sundaranag Ganjekar, Harish Tippeswamy, Geetha Desai, Prabha S Chandra

Junior Resident, NIMHANS, Bangalore, Karnataka. vishwasyadawad99@gmail.com

Background: Clinical outcome from mother baby units across the globe have reported good outcome and reported improvements in maternal mental health, mother infant relationship and child development. However, the data is lacking form LAMI countries.

Aim: To study the clinical profile of mothers admitted at Mother Baby Unit (MBU) with postpartum onset of severe mental illness. To assess mother-infant bonding at admission and discharge.

Methodology: All mothers admitted to MBU of NIMHANS during period of March 2016 to February 2017 were recruited after obtaining informed consent. It was a prospective descriptive study and sampling method was purposive sampling. Rating of maternal behavior as objective assessment tool of maternal and infant bonding was administered at the time of admission and discharge which assess under care, affectionate behavior, significant incidents, overall assessment of safety, handling separation from baby, whether mother is separated from the baby and reason.

Result- During the study period 43 mothers were assessed. Mean age of mothers was 27.44±3.71years. 26(60.5%) mothers were from rural background. 28(65.1%) women were below poverty line. Among them 39(90.7%) were Hindus, 12(27.9%0 had completed graduation, 19(44.2%) secondary, 10(23.3%) primary and 2(4.7%) illiterates. 37(86.0%) were home makers. Mean duration of postpartum period was 12.79±6.54 weeks. Psychiatric Diagnosis was Acute psychosis 17(40%), BPAD 14(32.5%), Schizophrenia 6(14%), Depression 3(7%), Schizoaffective disorders 3(7%). Mean Total bonding score of rating of maternal behavior at admission 32.95±4.6 and discharge 20.74±3.7 (t=7.89 ; p=0.00)

Conclusion- This study demonstrated significant improvement in mother infant bonding at admission and discharge to mother baby units. Mother infant bonding is an important clinical outcome which needs attention by health professionals who are caring for women with postpartum mental illness.

Keywords: Mother infant bonding, mother baby units,maternal mental health

A study of psychopathology and its correlation with aggression among patients of schizophrenia.

Mohd, Wasim, RK Solanki, Alok Tyagi, Chitra Singh,

Resident Doctor (JR-3), S.M.S. Medical College Jaipur, makrana, Rajasthan.wasimgesawat5270@gmail.com

Background: In most of the patients of schizophrenia having active psychopathology show anger outburst. Aggression in schizophrenia was found to be correlated with psychopathology (sumit et al 2014)

Objective: The purposed study aims to explore the correlation of aggression with psychopathology among drug naïve patients of schizophrenia.

Material & Method: The study was conducted at department of psychiatry SMS Medical College Jaipur. Study group consisted of 60 patients of First episode drug naïve patients of schizophrenia those who were willing to participate and fulfilling the inclusion and exclusion criteria were recruited for the study. Informed consent was taken from patients and relatives. Patients were diagnosed according to ICD 10 and confirmed by two senior psychiatrists. All the patients were subjected to Positive And Negative Syndrome Scale (PANSS), Modified Overt Aggression Scale (MOAS) and divided into two groups on the basis of presence of aggression. Those who were showing aggression correlated with the psychopathology.

Suitable statistics applied and compared two groups with and without aggression

Result: In the study group aggression was found to be highly correlated with the positive psychopathology.

Key Words: Aggression, Schizophrenia, Psychopathology

Stigma among persons with psychotic disorders and its impact on quality of life

Sravan Yatirajula, Prasanna Kumar N, K V Rami Reddy

Post graduate, andhra medical college, Visakhapatnam, Andhra Pradesh. yatirajula.sravan@gmail.com

Introduction: Stigma acts as a major factor in persons suffering from mental illness and it has wide implications from treatment seeking to long term management.

Quality of life of the persons with psychiatric illnesses may be affected due to various reasons. There are very few studies determining the association between the stigma and the quality of life of the patient.

Aim:

  • To find the difference in stigma in persons suffering from schizophrenia and Bipolar affective disorders.
  • To find whether quality of life affected due to stigma.


Materials and Methods: Sample Size: 60 patients

Type of study: Cross-sectional study conducted at Government Hospital for Mental Care , Visakhapatnam

Inclusion criteria: Patients diagnosed with Schizophrenia and BPAD as per ICD 10 criteria, who gave informed consent for the study.

Exclusion Criteria: Patients who are diagnosed having any other co morbid medical illnesses such as HIV, Epilepsy were excluded from the study.

Study tools:

  • DISC – Discrimination and stigma scale and
  • WHO-QOL BREF scale for quality of life were applied.


Data is analyzed using relevant Correlation statistical tests.

Results: Results will be discussed later at the conference

Key words: Stigma, Quality of life.

Internet Gaming Disorder and Co-occurring Mental Disorders: A Case Series from Behavioral Addictions Clinic (BAC) , AIIMS, New Delhi

Ashish Pakhre, Satish Kumar, Jawahar Singh, Rachna Bhargava, Yatan Pal Singh Balhara

Associate Professor, AIIMS, New Delhi. ypsbalhara@gmail.com

Introduction - Internet gaming disorder (IGD) is a new psychiatric disorder currently placed in the appendix of the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5th edition. Data on the epidemiological status of Internet gaming disorder is deficient. Considering the rapid rise and excessive use of internet games, it becomes a necessity to explore this area. We report six cases from our outpatient clinic diagnosed as internet gaming disorder, highlighting the importance of new entity and need for research into this unexplored area.

Methodology – In our outpatient clinic, six cases presented with excessive internet gaming use, avoidance of other pleasurable activities, preoccupation and dysfunction in sociooccupational domains. Cases also had other comorbid psychiatric diagnosis. Detail assessment was done and treated with pharmacological interventions and Psychological therapy.

Results – All six cases fulfilled the criteria for internet gaming disorder. Internet Gaming Disorder is an important unexplored disorder in developing countries. This case series highlights the need to screen for Internet Gaming Disorder in psychiatry clinics.

Conclusions – This case series points out that there is definite need to evaluate this disorder in routine psychiatry clinics and the difficulties in the clinical course, treatment and management of such patients. Research into diagnostic status, course and treatment of internet gaming disorder has to be studied under various socio cultural norms. Such disorders show features of impulsivity and compulsivity, additional studies are required to assess the neurocognitive characteristics of such behavioral addictive disorders.

Keywords: Internet gaming disorder, behavioural addiction

Event Related Potentials In Subjects Of Cannabis Induced Psychosis ‘Schizophrenia Like’ And Cannabis Dependent Subjects Without Psychosis: A Comparative Study

Shraddha Chaudhary, C.R.J. Khess, Nishant Goyal

Senior Resident, C.I.P. Ranchi, Jharkhand. shraddhachaudharydr@gmail.com

Background: Cannabis use may have a causal association with schizophrenia resulting in information processing impairments. The literature pertaining to the effects of cannabinoids on the event related potential P300 have produced inconsistent and equivocal results. Our study aims to study P300 in subjects of cannabis induced psychosis ‘schizophrenia like’ (SCZ CDS) and cannabis dependent subjects without psychosis (CDS) and to compare with healthy controls as there is paucity of studies demonstrating the same.

Materials and Methods: The study was a hospital based cross sectional study. Twenty subjects of SCZ CDS, 20 CDS subjects without psychosis and 20 education and handedness matched normal controls were recruited. Patients were rated on PANSS, BPRS, and Severity of Dependence Scale. The 40 channel ERP recording was done while doing Continous performance test and P300 waves were generated. Chi-square tests, t-test, One way ANOVA, Post hoc tests (Bonferroni) and Pearson‘s bivariate correlation were applied for analyzing the data.

Results: P300 latency in majority of the electrodes was significantly delayed in subjects with SCZ CDS and CDS as compared to healthy controls. No significant difference was found in P300 latency between SCZ CDS and CDS. There was significant correlation between P300 latency and age of patient, PANSS positive score, severity of dependence and duration of intake of cannabis.

Conclusions: Patients taking cannabis and those who developed schizophrenia like illness after cannabis consumption showed severe deficits in cognition when compared to healthy controls. Though, SCZ CDS and CDS groups did not differ in terms of p300 latency, the right frontotemporal area deficits have shown correlation with positive symptoms of cannabis induced schizophrenia.

Keywords: Event Related Potentials, P300, Cannabis induced psychosis, Schizophrenia



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