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 Table of Contents    
ORAL PAPERS FINAL  
Year : 2019  |  Volume : 61  |  Issue : 9  |  Page : 452-520
Oral Papers Final



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Date of Web Publication15-Jan-2019
 

How to cite this article:
. Oral Papers Final. Indian J Psychiatry 2019;61, Suppl S3:452-520

How to cite this URL:
. Oral Papers Final. Indian J Psychiatry [serial online] 2019 [cited 2019 Apr 22];61, Suppl S3:452-520. Available from: http://www.indianjpsychiatry.org/text.asp?2019/61/9/452/250218




1. TITLE:‘Mental Health For All’ by ‘Mental Health By All’

AUTHOR:R. Srinivasa Murthy, Professor of Psychiatry(Retd), NIMHANS, Bangalore.

Care of persons identified as suffering from mental disorders, over the course of human history, has been an evolving process. In the last century, mental health care has shifted from Institutions like mental hospitals, to general hospitals, to clinics and the most recent development is the community care. The new focus of PEOPLE as the focus of care and empowerment is a paradigm shift. Prof. Wig started the general hospital psychiatric unit in 1968 at Lucknow. He was a person ahead of his time. More than three decades back he expressed the then radical view, “Mental health is too important to be limited to mental health professionals”. This vision of mental health implies that, (i)mental health is a subject of interest to all people, all aspects of society, (ii)wide range of interventions are needed for mental health of the society, and (iii) all people in the society could be part of the mental health movement.

Current understanding of causation and interventions for most of the mental disorders allows for active involvement of people. Such an involvement will not only provide services but minimise stigma of mental illnesses and mental health care. However, this requires the creation of self-care skills that are suitable for use by different population groups, with differing education, economic status, religion and community life. We all will do well to follow his broader approach to mental health.

2. TITLE: AN ALTERNATIVE MODEL TO COMBAT MENTAL ILLNESS: A COLLABORATIVE APPROACH

AUTHOR: Dr Mohan Reddy M, Professor and HOD, Sri Devaraj Urs Medical College

In low and middle class countries like India a well-structured, cost effective mental health program becomes the need of the hour. The burden posed by mental disorders along with other chronic illness like tuberculosis and AIDS is adding up day by day with the aging of population, urbanization and globalization. Mental health disorders affect 6 to 7 % of the whole population according to World Bank report 1993. Disability adjusted life year loss due to psychiatric diseases is much higher than diarrhea, malaria, tuberculosis, worm infestations if taken individually. Around 12 % of global burden of disease is due to mental health diseases (world health report 2011). The above statistics clearly show the necessity of an effective mental health program to make up a healthy India.

Hence, we would like to propose a model of a collaborative health program along with two other well established health programs of India i.e; NACP and RNTCP. In this model a single health worker will be trained in diagnosing the most prevalent mental health problems in the society along with tuberculosis and AIDS. The health worker can be a medical or a non-medical person who is interested in community health service will be trained in such a way that he/she will be capable to diagnose mental health diseases This model being cost effective can be used as an alternative for the present National Mental Health Program which is presently facing lack of man power and financial aid. A collaborative approach is much needed in this point of time to reduce the global health burden caused by mental health diseases. This program is designed in order to fight against mental health illness as a community rather than a single individual facing it.

3. TITLE:PSYCHIATRIC DISORDERS PRESENTING WITH GASTROINTESTINAL SYMPTOMS

AUTHOR:Dr. Teli Vijay Arvind, Dr. Anu Karthika, Dr. Yogesh Motwani, Dr. Krishna Prakash, Dr. Shobha Nair, Dr. Aditi Chaudhari, Dr. Kaustubh Mazumdar,Registrar Bhabha Atomic Research Centre Hospital Mumbai

Following are 3 cases who presented to Department. of Surgery with unremitting gastrointestinal complaints which were actually atypical presentation of psychiatric disorders.

Case 1 : 53 year old male was not getting relieved of his complaints of constipation, incomplete evacuation of bowel, burning and pain in perianal area of 4 yrs duration, which gradually progressed to severely impair his socio-occupational functioning. On psychiatric evaluation, he was found to have obsession of doubt and contamination, with severe washing and cleaning compulsion. Diagnosis of Obsessive Compulsive disorder with poor insight was made. His gastrointestinal symptoms completely remitted on treatment with T. Fluvoxamine and atypical antipsychotics.

Case 2 : 70 year old lady had history of repeated visits to casualty and admission under surgery for recurrent episodes of vomiting and at times for complaint of severe constipation and requests for enema since 2 yrs. Following normal investigations, she was referred to psychiatry. On assessment she had episodes of binge eating, induced vomiting and laxative abuse with weight loss of 10 kg. Diagnosis of Late onset Unspecified Eating Disorder was made and she responded remarkably to T. Sertraline and T. Olanzapine.

Case 3 : 64year old male made repeated visits to surgery department for chronic constipation and decreased food intake with progressive weight loss over 4 yrs. On evaluation he had fixed belief that his intestines are blocked and food can’t pass through it therefore he is having constipation and can’t eat further. He was severely distressed that it was fatal condition and he could survive only if his intestine were surgically opened. There was no evidence of depression. On evaluation diagnosis of Delusional disorder (Cotard’s Syndrome type 1) was made. He partially responded to antipsychotics.

Keywords - Gastrointestinal symptoms, Late onset eating disorder, Cotard’s Syndrome

4. TITLE:Cancer and Emotional Health- Personal Observations

AUTHOR: R. Srinivasa Murthy,, Professor of Psychiatry(Retd) Bangalore.

Cancer always disrupts the lives of those diagnosed with cancer and their families.

There is evidence of more than double the prevalence rate of emotional health problems in those diagnosed with cancer. There is strong evidence that providing emotional support not only decreases distress, improves quality of life and better survival.

The presentation will cover the following aspects of cancer and emotional health:

  1. Personal experiences as a caner survivor;
  2. Experience of providing emotional health care in a cancer hospital;
  3. Experiences of using information technology- blogpost and whatsapp group to continue to support cancer survivors.
  4. Implications of cancer care for mental health and destigmatisation of mental health care.


Findings ways to make emotional health care an integral part of cancer are can have benefits to persons living with a diagnosis of cancer, their families and for the advancement of acceptance of mental health in the community.

5.TITLE: Assessment of the impact of disability on Quality of Life and Coping in patients suffering from Allergic Rhinosinusitis.

AUTHOR: Dr Himanshu Sharma,, Professor & Head,Dept of Psychiatry,Pramukh Swami Medical College, KARAMSAD,ANAND, GUJARAT

Background- Allergic Rhinosinusitis (AR) is very common especially in western India and is quite disabling. A majority of the patients with AR have underlying chronic rhinosinusitis and nasal polyp. Both these in turn lead to further impairment in Quality of life (QOL). The present study was planned keeping in mind that assessment of disability and its impact on QOL would help us to take psychosocial measures along with the primary drug treatment. Faulty coping like escape and avoidance can lead to increased morbidity. Further, this can be altered with specifically targeted psychotherapy.

Objective: (a) To study to the impact of disability in the patients suffering with Allergic Rhinosinusitis (b) To study the Quality of life (QOL) of these patients.(c)To study mechanism of coping in such patients.

Material and method:

The study was conducted in the ENT OPD of the Shree Krishna Hospital, Karamsad over the period of 6 months. Patients of both genders with age more than 18 years and without any significant co-morbidity were included in this study. Rhinosinusitis Disability Index(RSDI) for assessing disability, SF-36 survey for assessing Quality of Life and Coping Strategies Inventory- Short-Form (CSI-SF) for assessing coping strategy were used.

Result: There was significant impact of disability on quality of life (general health and health change) among patients. (P =0.505, P=0.370). The quality of life was influenced with general health and health change more in urban patients with greater distress. There was significant relationship between engagement and disengagement based coping style (r = 0.701) and conversely, social functioning and engagement based coping style had a negative co relationship (-0.210).

Conclusion: Psychosocial measures may be useful to increase life quality in Allergic Rhinosinusitis patients.

Keywords -Allergic rhinosinusitis, disability, quality of life, coping strategies.

6.TITLE:CANCER SURVIVORS: Some thoughts on PSYCHO-ONCOLOGY

AUTHOR:PROF. ABDULLAH AL MAMUN HUSSAIN,MBBS M. Phil Ph.D FCPS,Professor,Department of Psychiatry,Rajshahi Medical College, Rajshahi, Bangladesh

Background / Introduction:

The meaning of cancer, to most of us is usually that of possible death, with pain, possible disability or disfigurement from treatment, loss of independence and self esteem. Over the past decades, increasing attention has been given to the psychiatric aspect of comorbid disorders and psychosocial problems of cancer. The field has evoled to the point that it is a recognized subspecialty of oncology and consultation liaison psychiatry. Today, psycho-oncology seeks to study both the impact of cancer on psychosocial functioning and the role that psychological and behavioral variables may play in cancer risk and survival. It is observed that half of all cancer patients met criteria for diagnosis of adjustment disorder, depressive disorder or delirium. So management of psychiatric morbidity, is very must related to the clinical care of patients and families, which in the broadest sense, deals with their quality of life. Hopefully, this review would focus on major psychiatric and psychological dimension of cancer.

Methodology:

The relevant literatures were searched using the term ‘cancer’, psycho-oncology’ and ‘psychiatric aspects of cancer’, in psych INFO, pub MED and Google scholars. The results and observations after necessary evaluation were considered in the presentation.

Results:

The review noted a number of psychiatric comorbidity with psychological problems among the cancer survivors.

Conclusion:

The diagnosis of cancer for most people results in a predictable psychological pattern of distress over several weeks. So along with the treatment of cancer, psychiatric evaluation of such patients would bring qualitative support in their lifestyle, behaviors and psychosocial factors.

7.TITLE:DEPRESSION AND SUICIDAL IDEATION IN HIV (HUMAN IMMUNODEFICIENCY VIRUS) POSITIVE PATIENTS

AUTHORS: Dr. A.S. Srivastava, Dr. Raj Kumar, Dr. Madhukar Rai. Professor & Head, Deptt. of Psychiatry, IMS, BHU, Varanasi. IMS, BHU, Varanasi.

Introduction - HIV infection and psychiatric disorders have a complex relationship and offer a challenge to clinicians in issues of differential diagnosis and management. Understanding co-morbid depression is of clinical importance. It has been associated with poor adherence and compliance to anti-retroviral therapy(ART) and increased overall HIV related mortality. Methodology - HIV positive patients attending ART clinic of S.S. Hospital, IMS, BHU were randomly screened for psychiatric morbidity. 100 HIV positive patients fulfilling inclusion and exclusion criteria were included in the study. Their detail psychiatric evaluation was done to find out associated psychiatric morbidity. Details will be discussed during presentation. Result - Out of 100 HIV positive patients, 40 patients (40%) fulfilled the criteria for Depressive episode. 12 patients (12%) expressed suicidal ideation. No. of females having suicidal ideation was greater than no. of males. Conclusion - The high prevalence of depressive disorder alongwith suicidal ideation in some of the HIV positive patients necessitates the detail psychiatric evaluaton for their comprehensive management and better outcome. Key - words : HIV, Depression, Suicide

8.TITLE:Polysomnographic Predictors of Response to Milnacipran in Depression

AUTHORS:Lavania S.,Pattojoshi A, Nizamie, S. Haque, Das, B., Professor, FH Medical College, Agra

OBJECTIVE : Milnacipran has shown clinical improvement in patients of depression which was accompanied by an improvement of disturbed sleep parameters with regard to increased total sleep time, increase in sleep efficiency. In this study, the authors sought to study and compare the polysomnographic predictors of Milnacipran on sleep architecture and its response in drug naïve/free patients with depression.

METHOD: In this study, patients (N= 15) with ICD-10 clinical diagnosis of unipolar depression(N=7) or recurrent depressive disorder(N=8) and normal controls (N= 15) were enrolled. Three consecutive night PSG were done for patients and two consecutive nights for control, and the first night was used as an adaptation night while the second night was used for recording and scoring for sleep parameters. After two consecutive night PSG recording patients were administered 25mg of milnacipran 4 hour prior to PSG recording on day 3. One week after starting milnacipran at a dose of 25mg BD, the dose of milnacipran was be hiked to 50mg twice daily. Patients were assessed with Hamilton depression rating scale (HAM-D)* and Hamilton anxiety rating scale (HAM-A)** and WHO QOL- BREF*** (Field trial version) at four and eight weeks after starting milnacipran.

RESULTS: Of the 15 patients who completed the study 13 were responders to a 8 weeks trial of milnacipran in a fixed dosage schedule. Analysis of the sleep parameters at baseline and 4 hours after milnacipran treatment revealed significant increase in REM latency from a mean value of 72.03 minutes to 103.73 minutes (p=0.000). Post medication analysis of the stage 2 sleep power spectral values shows an increase in power in the delta region in the left frontal region(p=.010); left parietal region (p=.033); and left temporal region(p=.018). Post medication analysis of the REM sleep power spectral values revealed an increase in the left parietal delta band (p=.043); left parietal theta; right parietal delta band (p=.037); and left temporal theta band (p=.043). Of the 15 patients who completed the study, 13 were responders to 8 weeks trial of milnacipran in a fixed dosage schedule. Significant changes were found in terms of improvement in both HAM-D as well as HAM-A scores post treatment with very good effect size (For HAM-A; Pillai”s trace F-265.8, Effect size-0.978). Significant changes were also found in all the four domains of WHO-QOL-BREF.

CONCLUSIONS: The present study revealed that an increase in REM latency, and increased hyperactivation of cortical areas like left frontal, parietal and temporal as shown by increase in power spectral values, may predict acute antidepressant effect of Milnacipran.

REFERENCES:

*Hamilton, M. (1960) A rating scale for depression. Journal of Neurology, Neurosurgery in Psychiatry, 23, 56.

** Hamilton, M. (1959) The assessment of anxiety scales by rating. British Journal of Psychology, 32, 50.

*** Saxena,H., Carlson,D., Billington,R. and Orley.J.(2001). The WHO Quality of

Life Assessment Instrument (WHOQOL-BREF). Importance of its items for cross-cultural research. Quality of life research, 10 (8), 711-731.

Candidate Co-guide Guide

9.TITLE:BEYOND MC’NAGHTEN: PERSPECTIVES ON CRIMINAL LAW RELATING TO INSANITY

AUTHOR-Dr. Amitabh S Saxena, Professor and Head of Department, Air Force Hospital, Kanpur Cantt

To establish the defence of insanity, it must be clearly proved that at the time of committing the crime, the person was so insane as not to know the nature and quality of the act he was doing, or if he did know it, he did not know that what he was doing was wrong. Section 84 of the Indian Penal Code, 1860 relates to an act of a person of unsound mind. The section uses the term unsoundness of mind, rather than insanity. The test of wrongfulness of the act is in the alleged criminal’s ability to distinguish between right and wrong, not in the abstract or in general, but in regard to the particular act committed. The definition of insanity has undergone many changes in the past two centuries, since it was first used in the case of Mc’Naghten. The evolution of laws relating to insanity in India, England and the United States of America with relevant case laws is discussed.

Keywords: Criminal Act, Insanity, Mental Illness

10.TITLE:An insight into mental health status of medical undergraduate students by global mental health assessment tool

Authors: Shivangi Sharma, Kopal Sharma, Ritesh Kumar Chandel, Meenu Saharan, Lokendra Sharma, I D Gupta, PROFESSOR SMS MEDICAL COLLEGE JAIPUR

Introduction: The Global Mental Health Assessment Tool (GMHAT) is a computerized clinical assessment tool which is used to evaluate and screen mental health problems in primary care.

Material and Methods : It was a cross sectional observational study, done with second MBBS students of SMS Medical College. All the students who gave their written consent were recruited after explaining them the purpose of this study. The data was collected using a pre-structured proforma.

Aims and objectives : To screen the hidden cases of mental disturbances present among MBBS students and to improve the metal health of medical students by appropriate interventions.

Statistical Analysis : Outcome variable in the study was expressed as proportion and percentages. Significance of difference in proportion was inferred by Chi-square Test of significance. Significance of difference in mean scores was inferred by unpaired student t-Test of significance. For significance P- value equal to or less than 0.05 was considered as significant.

Results : Depression was also found significantly more in students of urban background than in students from rural background. Likewise depression was also found significantly more in students having family history of mental problem.

Conclusion : Psycho morbidity among MBBS students is a frequently unrecognized matter. We found that mental health issues affect a significant proportion of medical undergraduate students. So by appropriate and planned interventions mental health of medical students can be improved.

11.TITLE:Randomised control trial to evaluate the role of Dexmedetomidine premedication & Ketamine- Propofol combination on seizure time, hemodynamic responses and patient’s satisfaction in electroconvulsive therapy.

AUTHORS:Dr. Prashasti Saxena1, Postgraduate Trainee (JR III) Dr. Gyanendra Kumar2, Dr Rupesh Kumar3, Dr Chavi Sethi4 Dr. Amit Kumar Gupta5,

1. Post Graduate Trainee, Department of Anaesthesia, M.L.B. Medical College, Jhansi

2. Prof and HOD, Department of Psychiatry, M.L.B. Medical College, Jhansi

3. Prof and HOD, Department of Anaesthesia, M.L.B. Medical College, Jhansi

4. Lecturer, Department of Anaesthesia, M.L.B. Medical College, Jhansi

5. Senior Resident, Department of Psychiatry, M.L.B. Medical College, Jhansi

Introduction : Electroconvulsive Therapy is associated with hyper dynamic response which can lead to cardiac dysrhythmias, myocardial ischemia or infarction. Dexmedetomidine is alpha2 agonist with anxiolytic, sedative, sympatholytic and analgesic effects which can attenuate the hyperdynamic response and also reduce post ictal agitation in patients.

Aim and objective: The aim of this study is to compare the effect of Dexmedetomidine on agitation, satisfaction, seizure duration, and patients hemodynamic after ECT.

Methods: 200 patients were randomly allocated into 2 groups of 100 each (n=100). Patients in group I received Dexmedetomidine(0.5µg/kg) infusion premedication with Ketamine-Propofol (10mg/kg each, 1:1 combination) and in group II - normal saline infusion prior to Ketamine-Propofol (10mg/kg each 1:1). Patients undergo ECT using Ketamine-Propofol according to randomly allocated groups and pre and post ECT agitation and depression scores were calculated and compared.

Results : Out of 80 cases (group I- 40, group II- 40), best results regarding hemodynamic stability (Mean pulse rate p value 0.0001, Mean Arterial Pressure p value 0.0001), effective seizure duration (p value 0.0001) and patients satisfaction score (p value 0.00224) were achieved in group I which is significant.

Conclusion : Dexmedetomidine was effective on satisfaction of patients who were candidate for ECT. Our study shows better outcome in haemodynamic, effective seizure duration and patients’ satisfaction. More research on both biological and clinical predictors is needed to further evaluate the position of Dexmedetomidine infusion before ECT in treatment protocols.

Key Words : Dexmedetomidine, Ketamine, Propofol, hemodynamic stability.

12.TITLE: A study on prevalence of enabling among wives and mothers of adult male alcoholics

AUTHORS:Dr. Shruthi K., 1st year MD psychiatry, Dr. C. Jayakrishnaveni, Dr. P. Poorna Chandrika

BACKGROUND

Alcoholism is one of the major public health problems in our society. Most of the affected individuals are males in the middle age-group who neglect their social responsibilities. Similarly, women of such male alcoholics are also mentally affected. Women living with such males in most scenario stop resisting alcoholism and start believing alcoholism need not be totally stopped. They become victimized for such enabling and codependence. Thus, the present study has been planned with an objective to analyze enabling and its relation with care giver burden and satisfaction with life among females who live with alcoholics.

MATERIALS AND METHODS

A cross-sectional descriptive study was conducted for 2 months with the study participants being wives and mothers of 60 alcohol dependent males diagnosed using ICD-10 from 20-45 years age-group attending the OPD or admitted in the wards of the Institute of Mental Health. Wives and mothers of male alcoholics with dependence and withdrawal states with other substance use (nicotine excluded) were interviewed for basic details and given a semi-structured schedule and scales to assess general mental health, caregiver burden, satisfaction with life and enabling. The level of enabling and the reasons cited for the same was compared among female caregivers with regard to their age, relationship with patient, educational and socioeconomic status.

RESULTS

The study so far conducted shows increased enabling and co-dependence among mothers and wives with low educational status. The most common reason for enabling has been attributed to social causes. Enabling behaviour shows varied correlation with life satisfaction and caregiver burden.

CONCLUSION

In conclusion, addressing enabling and co-dependence to the caregivers has a strong role to prevent relapse among male alcoholics. It can be a part of the health education which is offered to the caregivers routinely.

KEYWORDS: Enabling, Alcoholism, Co-dependence

13.TITLE: - Parenting stress and behavioural problems among mothers of cerebral palsy and Autistic children

AUTHORS: SURJEET SAHOO, PROFESSOR, IMS & SUM HOSPITAL

INTRODUCTION: - Cerebral palsy (CP) and Autistic spectrum disorder (ASD) are the most complex childhood developmental disabilities. Parenting a child with ASD and CP is a very much stressful experience and can disturb the whole family life resulting in economic, social, physical and psychological problems. Recent studies suggest that childhood problematic behaviour of ASD and CP children may be a cause for mother’s stress and vice versa.

AIMS & OBJECTIVES:-

  1. To compare the parenting stress psychological distress (in terms of anxiety and depression) between mothers of ASD children and CP children
  2. To correlate child behaviour to parental stress of mothers of ASD children and CP children.


METHODS:-

Design: - Observational case control study

Participants: - mothers of ASD &CP children

Number of participants: - Among 60 participants, 28 CP and 32 ASD mothers.

Tools / Instruments used: - Perceived Stress Scale, Hamilton Anxiety Rating Scale, Hamilton Depression Scale, Care giver Burden Scale and Child Behaviour Check list.

DATA ANALYSIS: - Mann Whitney U test to compare parenting stress and psychological distress (in terms of anxiety and depression) between mothers of ASD children and CP children and Pearson Correlation Coefficient of two tailed tests is implemented to exclude the relationship between child behaviour to parental stress and psychological distress.

RESULTS:-The parenting stress and anxiety of mothers of children with ASD have more than the mother of children with CP (p<0.05). Child behaviour problems is positively associated with parental stress of mothers (r=0.353, p=0.05).

CONCLUSION: - Parenting stress of mother of ASD children is higher than mother of CP children and stress of mother is a cause for problematic child behaviour of ASD & CP children.

Keywords: parenting stress, behavioural problem, autistic child, cerebral palsy child

14.TITLE: Management of Substance Use – Public Health Strategies

AUTHOR: Rakesh Lal, Professor, All India Institute of Medical Sciences

The ultimate goal is to make treatment Available, accessible, affordable and acceptable. When we have this final goal in mind, we need good epidemiological information, knowledge of burden and treatment gap.

One needs to focus on the whole population including children, adolescents and the elderly. Women need special attention and the marginalized groups like the patients with co-morbidity, homeless, sex workers and prison population also should be looked after.

One needs to develop a program of capacity building and formulate policies and guidelines on how to approach such patients.

Finally one needs to take care of human rights, dignity and formulate minimum standards of care.

15.TITLE: Sexual Dysfunction in Substance Abuse and Dependence : A cross sectional survey

AUTHOR: Dr. Mona Srivastava, Professor, Department of Psychiatry,IMS, BHU

Mr. Saurav Kumar, MPhil,PhD scholar, Department of Psychiatry,IMS, BHU

Registration No. 315 IPS No. LF 13159

Introduction – Use of tobacco, alcohol, and illicit drugs is increasing due to their pleasurable effects and peer pressure. But substance abuse has a deteriorating effect on sexual well being of an individual. The aim of this survey was to assess the sexual dysfunction in substance abuse and dependence patients

Methodology – 100 male subjects in the age group of 21 – 50 years, who presented in the de-addiction clinic were included in the study. Sexual dysfunction questionnaire and self structured proforma containing socio-demographic details and pattern of substance abuse was used to assess sexual dysfunction in patients with substance abuse and dependence.

Result – The prevalence of erectile dysfunction, anorgasmia, and dissatisfaction was statistically more in patients with substance abuse history of more than 10 years. (p<0.05). Low sexual desire was statistically more prevalent in alcoholics than tobacco abusers. Alcohol and opioid abusers were at least 4 times more susceptible to sexual dysfunction than tobacco abusers. (p<0.05)

Conclusion - Substance abuse is associated with sexual dysfunction. The clinicians should be aware about this association as sexual dysfunction in patients with substance abuse may lead to poor treatment compliance and relapse.

Key words : sexual dysfunction, substance abuse, alcohol, opioids, tobacco

16.TITLE:THE ISSUES OF WOMEN MENTAL HEALTH: Overrated or Unrecognized Discourse?

AUTHOR:PROF. ABDULLAH AL MAMUN HUSSAIN,

MBBS M. Phil Ph.D FCPS, Professor, Department of Psychiatry, Rajshahi Medical College, Rajshahi, Bangladesh

BACK GROUND / INTRODUCTION:

The increasing recognition of the need to address women’s mental health issues as separate from men is much evidenced by the numerous centres specifically catering to women all round the world. In research publications, gender differences of psychiatric disorders have long been recognized: prevalence rate in women exceed those of men for a number of disorders. The morbidity and mortality associated with maternal mental illness is of significance as it can result in complicated mother- infant attachment. Evidence suggests that women’s mental health includes a wide spectrum of conditions, spanning not just the few prenatal psychiatric disorder, but also many a socio-cultural issues, that causes perennial sufferings. Keeping all these factors in mind, it indeed, becomes a more important domain to address such issues in the perspective of reproductive psychiatry & public psychiatry as well as.

METHODOLOGY:

It is a review paper. Using the key words, viz ‘Women Mental Health’, ‘Mental Health Issues’ and ‘Reproductive psychiatry’, the documents were searched in pub MED, psych INFO, Google scholar and relevant web-sites. Finally it was analyzed and noted for presentation.

REULTS:

This brief paper would address the issues of women’s mental health, highlighting effective strategies for prevention of mental disorders and reduction of risk factors.

CONCLUSION:

As the current focus on women’s mental health issues is gaining speed and credence, it is very much important to develop appropriate public health strategies for addressing mental health issues among women of reproductive age.

17.TITLE:Midlife Health of HIV Positive Unlicensed Sexproviders of Wardha District: Appraisal of Brainstorms and Catastrophe Living to Create a Roadmap for Purposeful, Compassionate and Dignified Life

AUTHOR: Dr. Rajesh Kumar Jha, Professor of Pharmacology Jawaharlal Nehru Medical College, D.M.I.M.S. (D.U.) Sawangi (M), Wardha, Maharashtra, India

Background and Rationale: HIV positive menopausal sex providers suffer from hormonal changes, intense fear of uncertain future and multi dimensional psychogens. Due to these three domains, there are alterations in attitude, behavior and quality of life of this quadrant of emotionally ill treated women fraternity.

Methodology : This interventional study was carried out between 1st April 2016 to 31st July

2018 in Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha on 238 HIV positive menopausal sex providers belonging to 4 talukas of Wardha district with the help of 2 licensed social workers and 1 licensed clinical psychologist after the approval of institutional ethics committee. The stress levels of participants were measured by using stress scale inventory (SSI) before initiation of remedial counseling. Remedial counseling was conducted by clinical psychologist of the institute.2 to 5 sessions were provided to participants depending upon severity of problem and compatibility of participants. After counseling, modulation in stress levels of participants was measured by SSI.

Observation and Results : The stress level before remedial counseling was High in 40.64% (Group A), Moderate in 43.24% (Group B) and Low in 16.12% (Group C) of participants. After counseling, participants in Group A were 02.04%, Group B 47.48% and Group C 49.46%.

Conclusion : Remedial counseling, if provided at proper time, in adequate manner for required duration along with antiretroviral and hormonal therapy can reduce stress level of HIV positive menopausal sex providers and contribute to better quality of life. Problems are like a huge sack of cotton…heavy for those who only observe, criticize and argue… but light for those who analyze, discuss and handle…

Keywords: Midlife Health, HIV Positive, Unlicensed Sexproviders

18. TITLE:Body Dysmorphic Disorder: New Insights From a Scottish Plastic Surgery

AUTHOR: Hosakere Aditya, Consultant Liaison Psychiatrist and Clinical Director, NHS Lothian NHS Lothian

Service Introduction There have been significant advances in the nosology and management of body dysmorphic disorder, in common with other Obsessive Compulsive and Related Disorders (OCRD). However, the overwhelming majority of these advances have been based on experience from psychiatric clinical settings. Our experience over the last decade in a dedicated aesthetic surgery service has revealed that patients who seek surgery are different to those who present in psychiatric settings. They also require a different management approach. Methods We reviewed our database of over 6000 patients referred to the Lothian plastic surgery service in the last decade. Particular emphasis was placed on patients whose requests for surgery were declined on psychiatric grounds. Emerging themes of presentation, psychopathology, including phenomenology, were analysed. Results Patients referred for aesthetic surgery to our service and are found to have a body dysmorphic disorder seem different to patients described in the literature. They present with a spectrum of body dissatisfaction, and seem less likely to have any insight into their condition. They are difficult to engage in psychological / psychiatric treatment. Conclusion Patients with body dysmorphic spectrum disorders presenting to a plastic surgical service seem materially different to those described in the literature as presenting to psychiatric services. Our findings may inform future research into the nosology of this disorder, and to find ways to help alleviate the suffering of this difficult-to-help group of individuals. Key words: Body dysmorphic disorder, BDD, OCRD

19.TITLE:Recent understanding in bipolar depression: an update

AUTHOR: Rudraprosad Chakraborty, Consultant Psychiatrist, Manobikshan, Berhampore, Murshidabad, West bengal

Recent evidence suggests bipolar depression may be more prevalent than it was earlier thought. Despite being associated with significant morbidity and mortality, we still have several unanswered questions. This paper will try to understand the recent advances in understanding in clinical presentation and management options available in bipolar depression.

20.TITLE: Risk assessment and parental attitude among adolescents attempting self-harm in Kolar

AUTHOR: Dr. Mona Nongmeikapam, Associate Professor Sri Devraj Urs Medical College Kolar

Introduction- As per World Health Organisation (WHO), individuals between the age of 10 and 19 years are referred to as adolescents. This is the most tumultuous and vulnerable age group. Several factors including lack of a good support system, emotional states and day-to-day perceived conflicts have been identified to lead to self-injurious behaviour in these young persons1,2. More than 30% of interviewed teens had suicidal ideations and studies indicate a rise in the trend of suicidal behaviour in this age group over the recent years3,4. Early identification of such behaviour or impulses by the paediatrician is imperative in prevention of this leading, largely preventable cause of mortality in this age group5.

Objectives-

  1. To assess the suicidal risk in adolescents reporting with self-harm behaviour to the Paediatric department of Sri Devraj Urs Medical College, Kolar
  2. To analyse the correlation of socio-demographic variables and parental attitude on the outcome.


Materials and methods-

  1. Design of study –cross sectional
  2. Total number of study subjects- 100
  3. Mode of selection of subjects- Convenience sampling
  4. Inclusion criteria: 10-18 years, willing for interview and written informed consent
  5. Exclusion criteria: severe comorbidity or on life-support


For the purpose of our study an adolescent is taken as a child between the age group of 10 to 18 years. One hundred adolescents admitted in Paediatric Ward/ ICU with self-harm will be interviewed using our predesigned proforma and the SAD PERSON questionnaire6. The parent/ care-giver of the child will be interviewed using the Parent Interview Schedule (PIS)7. The data thus collected will be coded into excel database and categorical data will be presented. Quantitative data will be presented by mean and standard deviation. Chi Square test, Fischer’s exact test will be used as the test of significance P value < 0.05 will be considered as statistically significant.

References-

  1. Mahajan M. Suicidal tendencies amongst adolescents. Volume V, Issue II, February 2016. IJLTEMAS. ISSN 2278 – 2540 www.ijltemas.in. Page 61.
  2. Nagendra K, Sanjay D, Gouli C. Prevalence and association of depression and suicidal tendency among adolescent students. IJBAR(2012)03(09)
  3. Thakur D, Gupta A, Thakur A, Mazta SR, Sharma D. Prevalence and predictors of suicidal ideations among school going adolescents in a hilly state of India. IndPsychiatry J 2015;24:140-3.
  4. Kumar S, Verma K, Bhattacharya S. Trends in rates and methods of suicide in India. Egyptian Journal of Forensic Sciences (2013)3,75-80
  5. Dilillo D, Mauri S, Mantegazza C. Suicide in pediatrics: epidemiology, risk factors, warning signs and the role of the pediatrician in detecting them. Italian Journal of Pediatrics. 201541:49
  6. Campbell W.H. Revised ‘SAD PERSONS’ helps assess suicide risk. Current Psychiatry. 2004 March;3(3):102-102
  7. https://www.sickkids.ca/pdfs/Research/Schachar%20Lab/64076-Administration_Guidelines_PICS6.pdf


21. Title:Attitude towards suicide prevention among Accredited Social Health Activists (ASHAs): A study from rural part of Karnataka

Authors:

1. Dr. Anil Kumar B.N., Associate Professor, Department of Psychiatry, Shridevi Institute of Medical Sciences and Research Hospital, Tumkur.

2. Dr. Sushma Rayappa, Senior Resident, Mysore Medical College, Mysore.


Background: Preventing suicide depends upon the health professionals’ knowledge regarding suicide, ability to make accurate suicide risk assessments, attitude toward suicide attempters and skills to manage suicidal risk.

Aim and Objective: This study was aimed to assess the attitude of Accredited Social Health Activists towards suicide prevention.

Materials and Methods: 500 Accredited Social Health Activists were recruited from 10 taluks of Tumkur district, Karnataka. Attitude towards suicide prevention scale was administered. Study design was cross-sectional.

Results: All of them were females with mean age of 34.9 years (SD= ± 5.46). Majority of them (97.2 %) were studied above secondary education (8th class onwards). 80.4 % of them had working experience of more than 3 years as health professionals. None of them had previous exposure to suicide prevention programs or workshops. Nearly half of the subjects had negative attitude towards working with suicidal patients. 40% of them expressed they are not comfortable in assessing person for suicide risk and 51% considered working with suicidal patients is not rewarding. 45% ASHAs considered suicide prevention is not their responsibility and 49% were of the opinion that little an individual can do to prevent it since unemployment and poverty are the main causes of suicide.

Discussion and Conclusion: Nearly half of the ASHAs have negative attitude towards suicide prevention. Hence, there is strong need to organize more educational and training programs on suicide prevention so that these grass root health professionals could be more equipped and trained to manage these suicidal patients.

Key words: Attitude, Accredited Social Health Activists, suicide prevention

Author for correspondence Dr. Anil Kumar B.N.

Associate Professor, Department of Psychiatry, Shridevi Institute of Medical Sciences and Research Hospital, NH 4, Sira Road, Tumur- 572106

Mob: 9731915464

22.TITLE:KNOWLEDGE AND ATTITUDE TOWARDS LGBTQUA COMMUNITY-A COMPARATIVE ANALYSIS

AUTHORS: Himanshu Sareen, M.D. Psychiatry, Associate Professor & Head, Department of Psychiatry, PIMS Medical College & Hospital, Jalandhar

Manik Inder Singh Sethi, M.B.B.S, Junior Resident, Department of Psychiatry, PIMS Medical College & Hospital, Jalandhar

Keywords: LGBTQA, homosexuality, Attitude, Knowledge

Background

LGBTQA community has been on the receiving end of discrimination since time memorial. As Doctors are required to undertake the Hippocrates oath, and treat all patients equally, it is of importance to know, what attitudes do young doctors and medical students have toward this minority. Moreover, this subject is of utmost importance now since the honorable Supreme court of India has scrapped the section 377 which made any homosexual activity illegal.

Methodology

After IEC approval and written informed consent, a cross-sectional study was conducted on a purposive sample of undergraduate medical students and interns studying in a medical college and an engineering college. The Questionnaire was distributed online and the results were computed and analyzed using appropriate statistical measures.

Results

Engineering students had inadequate knowledge about homosexuality, although they endorsed a neutral stance in so far as their attitude towards homosexuals is concerned. Medical Students had more positive attitudes towards homosexuals. Knowledge emerged as the most significant predictor of attitude; those having higher knowledge had more positive attitudes.

Conclusion

Although in comparison the medical Students showed better knowledge and thus more positive attitudes, but the fact still remains that this level of knowledge isn’t sufficient to treat the patients without prejudice. Enhancing knowledge of students by incorporation of homosexuality related health issues in the curriculum could help reduce prejudice towards the sexual minorities and thus positively impact their future clinical practice.

23.TITLE:Approaches and implementations of child and adolescent health care progrmme in children with intellectual disability at community and specialized centre, under NHM scheme at Varanasi

AUTHOR :J S Yadav, Shrivastava A S, associate professor Institute of medical sciences, BHU Varanasi

Background; Centre of excellence in child and adolescent health, started functioning at BHU Varanasi since 6 month, we running OPD and simultaneously initiated mental health services at community level in same group. We observed that there were many factors affected in functioning of delivery in services

Objective;

1. Identify the factors of helping or hindering in implementation of health care progrmme in children and adolescent with intellectual disability at community and specialized level.

Method; medical health professions including doctors, social workers, nurses working in this programme running specialized OPD on specific days at excellence centre BHU, Varanasi and to visit schools, villages and primary referral centre within 50 km. They used to target a specified area and after short sensitization they fixed the detail programme where a specialized team worked on a specific day. We collect the information with help of Semi-structured interviews Performa, assessment tools and scales. The probable facilitator and hindering factors were also assessed on another structured proforma, the detail analysis done applying spss version 18.0

Result ; 1900 children attended child and adolescent OPD and 6000 chidren were sensitized for different mental health related issues during 3 month duration. Out of those 40% in OPD and 2% at outreach has low IQ problem. 62% children with intellectual disability have associated psychiatric problems, including 12% depression, 18% stress, 17 % ADHD and 20% behavioural related problems. In outreach programme 98% children and 92% teachers have given response of feedback proforma and two percentages have academic difficulty, and 1% have other psychiatric problems. There were several factors like easy accessibility, highly specialized health team, small target plan, good networking and working in school were helping, while long distance, poor fund, poor team performance were hindering factors.

Conclusion; Higher numbers of children with intellectual disability brought in OPD for their associated psychiatric problems and factors like helping and hindering took major role in implementation of services.

24.TITLE: Depression in HIV infected patients

AUTHOR: Dr Vishal Akula, Associate professor Osmania medical college, Hyderabad

BACKGROUND

Depression is the most commonly reported psychiatric disorder in HIV-infected patients. Depression is commonly underdiagnosed and consequently untreated by general physicians, it can lead to poor adherence to ART treatment failure. Depression has long been recognized as a predictor of negative clinical outcomes in HIV-infected patients, such as reducing medication adherence, quality of life, and treatment outcome, and possibly worsening the progression of the illness and increasing mortality.

Material and Methods: The study was undertaken at ART clinic of Government medical college and hospital Nizamabad, Telangana, India. Sample size 120 participants were selected. socio demographic details were completed by interviewing each participant separately using pretested questionnaire. The socioeconomic status of respondents was assessed using modified Kuppuswamy scale. Hamilton depression rating scale was used to measure depression.

Results : The prevalence of depression in patients with HIV under ART was 52.85%. The prevalence of depression increased with the severity of symptoms. The unemployed, uneducated, unmarried, belonging to joint families, having no or low family income, migrants, having indifferent or poor relationship with spouse, poor social support and had visited commercial sex workers had a greater prevalence of depression.

conclusion

Depression is a highly prevalent disorder in the study subjects. Based on these findings, it is recommended that a comprehensive psychiatric treatment strategy should be initiated using a psychopharmacological and psychotherapeutic intervention to reduce morbidity and mortality in affected patients.

Key words : HIV infected patients, ART, Depression,

25.TITLE:NEUROSYPHILIS: the master of disguises!

AUTHOR: Dr. Mona Nongmeikapam, Associate Professor, Sri Devraj Urs Medical College Kolar

BACKGROUND:

Neurosyphilis is a central nervous system disorder caused by the bacterium Treponema pallidum. Symptoms manifestations may vary widely from patient to patient, leading to it being often wrongly diagnosed and managed.

CASE PRESENTATION:

We present a case of a 45-year-old resident of Chittoor, a small village in Andhra Pradesh, India treated as Paranoid Schizophrenia for the past 3 years, presenting with grandiose delusions, poor sleep for about a period of a month and urinary and faecal incontinence since a week. Diagnostic testing revealed neurosyphilis. The patient showed dramatic improvement with with penicillin injections and symptomatic management with antipsychotics and sedatives.

CONCLUSION:

Any unusual atypical presentation of acute psychotic symptoms should be treated with a high level of suspicion for Neurosyphilis or any other organicity, especially in the absence of any significant past or family history.

KEYWORDS:

Neurosyphilis; psychiatric manifestations; misdiagnosis

26.TITLE:Relationship of Self-efficacy, Perseverative thinking, life contentment and family function in attempted suicide.

AUTHOR: Dr Dushad Ram, Associate Professor of Psychiatry JSS Medical College, Mysore.

Abstract:

Background: Impaired Self-efficacy, family dysfunction, Perseverative thinking and life dissatisfaction may predispose to suicidal behavior.

Aims: This study was conducted to know the levels and relationships of Self-efficacy, family function, life contentment and Perseverative thinking in attempted suicide.

Methods: In this cross sectional study, 328 subjects with attempted suicide were consecutively recruited and assessed with Socio-demographic and Clinical proforma, Family Assessment Device (FAD), Satisfaction with Life Scale (SLS) Perseverative Thinking Questionnaire (PTQ), and Life Skills Profile (LSP) after obtaining informed consent.

Results: linear regression analysis revealed a statistically significant positive association of LSP with PTQ (p=.001) and FAD score (p=.004), but negative association with SLS score (p=.004).

Conclusion : Better life skills are positively associated with higher life satisfaction, family function and low repetitive thinking and may have protective role against suicidal behaviour.

Keywords: Life Skills, Family Dysfunction, Repetitive Negative Thinking, Life Satisfaction, Attempted Suicide.

27.TITLE-To study the impact of implementation of Mental Health Care Act 2017 on the admission profile of patients involuntarily admitted at a tertiary care Psychiatry Nursing Home.

AUTHOR: Prof (Dr) Asif Iqbal Ahmed, Chief Psychiatry PsyCare NeuroPsychiatry Care New Delhi

Background -

Mental health care act 2017 has been implemented in the country since May 29th 2018. Though, there are certain new additions in this act) that are welcome such as the Insurance cover, there are apprehensions that the stringent provisions for involuntary admissions and complex alien concepts such as Nominated Reoresentatives and Advance Sirectives will hamper the treatment provided to such patients

Aim and objective -

To review whether there is any significant change in number and reason of admission in involuntary admissions under the respctive sections of Mental Health Act 1987 and MHCA 2017.

STUDY DESIGN -

It is a retrospective, longitudinal observational study conducted in tertiary private psychiatry hospital.

Comparison is done between patient population admitted in five months in 2018 following implementation of MHCA 2017 with patient population admitted in same calendar months in the year 2017

RESULTS-

Though the number of admissions did not vary significantly, the diagnoses of the patients admitted showed a changed pattern. The number of patients admitted for Drug Dependence showed a substantial decrease.

CONCLUSIONS

There is no significant difference in the total number of admissions and involuntary/ high support need admissions following implementation of the act, apparently there is reduction in the number of admissions of patients with substance abuse. This study shows need for further research to find causes for drop in admissions and make appropriate changes

28.TITLE : PREDICTORS OF PSYCHIATRIC CO-MORBIDITY IN PATIENTS OF MIGRAINE

AUTHOR: Dr Santosh Kumar,

Designation : Associate Professor, Department Of Psychiatry, Rohilkhand Medical College & Hospital, Bareilly, Uttar Pradesh

Introduction / background : Migraine is a primary headache condition commonly linked with wide range of psychiatric manifestations like mood disorders, anxiety disorders, sleep disorders, etc. Various patient related socio-demographic and clinical factors have been found to be linked with clinical presentation, course and outcome of migraine. The present study aims to assess such factors in predicting psychiatric co-morbidities in patients of migraine.

Material & Methods: It was a hospital based cross-sectional study conducted at a tertiary care centre of western Uttar Pradesh. All cases of migraine that are referred from medicine and attending psychiatric OPD were included that meet the inclusion and exclusion criteria. After taking informed consent, we applied semi structured self-prepared Performa for socio-demographic variables. The psychiatric co-morbidity was assessed using ICD-10 symptom checklist for mental disorders. Data analysis was done IBM SPSS version 22 for Window 8.1. Binary logistic regression was performed to assess various patient related factors predicting psychiatric co-morbidity in migraine.

Results: Total Patients recruited were 146 Out of which 70.5% of the patients had psychiatric co-morbidity. Strong predictor of psychiatric co-morbidity in the patients of migraine wherein the middle socio-economic status recorded an odds ratio of 4.503 (p=. 029, 95% C.I.: lower= 1.165, upper= 17.408) while the lower socio-economic status had an odds ratio of 16.072 (p=. 001, 95% C.I.: lower= 2.921, upper= 88.426). Another statistically significant odds ratio of 4.211(p=.005, 95% C.I.: lower= 1.555, upper= 11.408) was there of aura with migraine and it indicated that the patients who had a diagnosis of ‘migraine with aura’ were over 4 times more likely to have psychiatric co-morbidity than those patients who had a diagnosis of migraine without aura.

Conclusion: Psychiatric disorders can be risk factors for both the onset and chronicity of primary headache and can affect both their course as well as outcome.

29.TITLE:A Study of Socio demographic and clinical profile of psychiatric patients attending Family and Community Counseling OPD in Department of Psychiatry IMS BHU Varanasi.

AUTHORS :DR SANJAY GUPTA* DR. ACHYUT KUMAR PANDEY*, Dr PANKAJ GUPTA***DR. RAGHUNATH PRASADVERMA****DR. VINOD VERMA**** PROFESSOR**ASSOCIATEPROFESSOR***ASSISTANT PROFESSOR ****JUNIOR RESIDENT, DEPARTMENT OF PSYCHIATRY IMS BHU VARANASI

OBJECTIVE: Study of Socio demographic and clinical profile of patients attending of Family and Community Counseling OPD.

MATERIAL AND METHOD : 100 patients of any psychiatric illness, both male and female, majority of age group 15-50 years without any medical illness were randomly selected from the patients who were attending Family and Community Counseling OPD in The Department of Psychiatry IMS BHU. Clinical interview was taken after written informed consent for socio-demographic as well as clinical profile. Diagnosis was made as per ICD-10 criteria. Ongoing stressor assessment was done by clinical interview as well as by application of SSDQ. Simple statistical analysis consisting of chi-square χ2 test, ANOVA test, p value for significance and Pearson correlation test are applied.

RESULTS &DISCUSSION : Out of 100 patients, 50% belonged to age group 14-23years,66% female,94%Hindu, 68% belonged to rural back ground,60%were unmarried, 60% belonged to middle socio economic status,58%were student,38%were completed up to 12th standard,92%patients had any kind of ongoing stress load.36% had depressive epsode,16% with recurrent depressive disorder,14% with dissociative disorder,12 with adjustment disorder,10%suffered with OCD,.4%psychosis,4%phobic anxiety and 4% with other anxiety disorder.

CONCLUSION: Stressors may play important role in precipitating and perpetuating psychiatric illnesses indiscriminate to diagnosis. These stressors need to be evaluated properly. SSDQ is an important tool to estimate stress qualitatively as well as quantitatively.

30.TITLE:The important role of Belief–Wish–Emotion Triads in the psychopathology and treatment of Mental Disorders

AUTHOR: Dr. Shrirang Bakhle, Director. Dr. Bakhle Clinic, Chembur, Mumbai

Introduction Many beliefs have emotions linked to them. Such Emotional Beliefs invariably have attached wishes forming Belief–Wish–Emotion Triads. For example, consider following BWE Triad: Belief: “It is terrible if people laugh at my mistake.” Wish: “Intense wish to avoid situations that may lead to people laughing at me.” Emotion: “Intense sadness if people laugh at me.” These three parts closely interact with one another. Such triads are at core of psychopathology in many disorders (from depression, addictions, phobias to PTSD). These dysfunction triads are related to aetiological factors on one hand and clinical manifestations on the other. Modification of one or more of these three, lead to changes in other parts of the triad. Thus, they become important targets for treatment (psychotherapy and pharmacotherapy).

Methodology

Identifying irrational beliefs and related hyper-intense or hypo-intense wishes and emotions is an important part of evaluation of patients. Understanding their relationship with each other and with various aetiological factors and clinical manifestations is important.

In most patients, the main dysfunctions are increased intensities of emotions, wishes and the related beliefs. Hence, reducing the intensities is therapeutic. For example, changing intensity from, “It is terrible if people laugh at me” to “It is uncomfortable but OK even if people laugh at me” is the goal of therapy.

The paper explores many such Triads in numerous Mental Disorders.

Results

Such identified Triads become precise targets of treatments. Clinicians can choose suitable interventions – psychotherapeutic techniques or pharmacotherapy – that can solve the dysfunctions optimally and synergistically.

Conclusions Belief-Wish-Emotion Triads describe the core of psychopathology of most Mental Disorders. This framework can become a systematic and comprehensive framework for evaluation and treatment of many disorders.

Keywords Beliefs, wishes, emotion, triads, psychopathology

31.TITLE:A PECULIAR CHALLENGING CASE OF SCHIZOPHRENIA PRESENTING WITH DISSOCIATION TO A TERTIARY CENTRE

AUTHOR:Dr Amitabh Saha,Assoc Professor,Dept of Psychiatry,AFMC, Pune

Dissociative state in a setting of an acute psychotic state can be very challenging to the physician. It not only allows the physician to address the treatment challenges of schizophrenia and its entire gamut of rehabilitation and cognitive behavioral therapy but also the doctor is required to address the issues of dissociative states.

Depersonalization is state of unreality which at times is infrequently encountered in patients with schizophrenia. Although it is extremely hard to elicit these symptoms readily in a functional case of schizophrenia, especially when they present in an acute setting, it nevertheless presents a persistent challenge to the treating physician to address all the problems not only related to schizophrenia management but also he would need to address the symptomatology of depersonalization in such cases.

32.TITLE:PERSONALITY PROFILE AND SEVERITY OF ALCOHOL USE IN PATIENTS WITH ALCOHOL DEPENDENCE SYNDROME: A CROSS-SECTIONAL STUDY FROM CENTRE

AUTHOR: Dr. Sachin Ratan Gedam, Associate Professor, Department of Psychiatry, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra

Introduction: Alcohol dependence is most prevalent disorder and major public health problem all over the world. Non-adaptive personality traits may influence pathogenesis, clinical course, treatment outcome and relapse in alcohol dependence syndrome (ADS). Aim: To assess the personality traits of alcohol dependent individuals, to determine its association with severity of alcohol use and to find factors influencing severity. Methodology: Total 100 patients of ADS were selected from psychiatry unit of Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe) Wardha, Maharashtra. Data was collected through socio-demographic proforma, severity of alcohol dependence questionnaire and 16 PF inventory. Results: Most of the patients scored high on personality traits such as warmth (56%), dominance (67%), social boldness (56%), sensitivity (70%), vigilance (77%), openness to change (65%) and perfectionism (52%) while they scored low on factors liveliness (35%) and privateness (50%). Prevalence of ADS severity was found to be 10% (mild), 38% (moderate) and 52% (severe) respectively. Factors such as emotional stability (0.026) and vigilance (0.019) were found to be significantly associated with severity of ADS. On other hand, factors emotional stability and perfectionism were found to predict severity on multivariate analysis. Conclusion: This study suggests that personality factors influences the severity of alcohol use and might be associated with poor treatment outcome. Hence, personality traits need to be addressed by clinicians during management to improve outcome.

Keywords: personality, alcoholism, personality inventory, co-morbidity, cross-sectional study

33.TITLE: “A correlation study on visual motor perception of Prefrontal Cortex and severity of Schizophrenia”

AUTHORS:Akashdeep Ghosal*, Divya Chauhan, Kavita Nagpal, Rupali Shivalkar

Shanti Home Advanced Deaddiction,Mental Health Clinic and Psytchiatric Rehabilitation Center

Keywords: Schizophrenia, Neuropsychology, Visual Motor Functioning

Schizophrenia has been often linked to dysfunction in Pre frontal Cortex, which effects planning, organization and regulation of visual motor functioning (Lazak, 1993). Many previous studies have focused on dysfunction in attention, memory, and executive functioning, but less work has been done on visual motor perception (Butler PD, 2008). Kohs Block and Pass Along both assess planning, organizing and regulation of visual motor functioning. In this study 15 diagnosed Schizophrenic patients having total duration of 5+ years of persistent positive symptoms were assessed using appropriate statistical measure to study the correlation between severity of Schizophrenia symptoms using PANSS Scale, duration of illness and age with Kohs Block and Pass Along.

34.TITLE: Cholesterol Levels and Suicidal Behavior: A Case Control Study in a Tertiary Care Rural Health Centre in Central India

AUTHOR: Nikhil Goel, Assistant Professor, Shaheed Hasan Khan Mewati Govt Medical College, Nuh, Haryana

Background : In modern psychiatry, there is a movement to understand mental health, not solely based on behaviors and subjective report, but also based on objective markers of illness. Several studies have focused on a relationship between serum cholesterol levels and aggressive behaviors including suicide.

Aim : To identify a potential link between cholesterol and suicidal behavior.

Material and methods : 150 patients with psychiatry diagnosis were divided into three equal groups (50 each): those who had a recent suicidal attempt, those who had suicidal ideations but no attempts and those with psychiatry diagnosis but no suicidal ideations and attempts. Blood sample for total cholesterol level was on IPD or OPD basis. The study was started after taking approval from institute ethical committee. Analysis was done using Chi square test.

Observations and Results : It was found that maximum patients who attempted suicide belonged to major depression and schizophrenia followed by substance dependence and bipolar affective disorder (BPAD) with major depression and there was statistical difference in cholesterol levels of patients with suicide attempt, with suicidal ideations and control group. 42% and 44% of major depression and schizophrenia cases respectively had low total serum cholesterol levels (below 160 mg %).

Conclusion : There is a potential link between serum total cholesterol levels and suicidal behavior. Taking the literature as a whole there is substantial evidence that low cholesterol levels are found in suicidal behaviors of various psychiatric illnesses especially major depressive disorder, schizophrenia, substance dependence and bipolar depressive disorder.

Keywords: Suicide, depression, schizophrenia, cholesterol, alcohol use

35.TITLE:A NATURALISTIC PROSPECTIVE STUDY OF LITHIUM AND SODIUM VALPROATE IN MANIC AND MIXED STATES

Author: Dr. Jishnu Bhattacharya, Consultant Psychiatrist, Suri Superspeciality Hospital, Birbhum, WB

Objectives: Lithium is still recommended as a first choice treatment for acute bipolar mania especially in pure euphoric mania of mild to moderate severity and if there is association of any suicidal attempts. But in clinical practice its use has been going down because of management issues for its narrow therapeutic index. International Guidelines suggests combining lithium with a second mood stabilizer (anticonvulsants or atypical antipsychotic) for treatment of mixed states – rapid cycling and severe forms of mania with atypical features – considered to be poorly responsive to lithium alone. Till date, however this specific associations of lithium and valproate on the basis of different clinical presentations have been poorly investigated in clinical trials. In this study tried to evaluate the modalities of use of lithium in a naturalistic setting of manic and mixed bipolar patients and to check the effects of valproate combination on the clinical course. Methods: 75 Bipolar I patients in a manic (14.7%) or mixed (85.3%) phase, treated with lithium alone or in association with valproate, were recruited at Psychiatry OPD, Suri Superspeciality Hospital, Birbhum, West Bengal and followed up in a naturalistic trial for an average period of six months diagnosis was confirmed using SCID-I. All subjects underwent with two standardized evaluation of clinical course and assessed by the CGI-BP, at baseline and serum lithium levels. Variables concerning clinical features and course of episodes were analyzed by comparison between the two treatment groups – LITHILUM MONOTHERAPY VERSUS LITHIUM + VALPROATE. Results: The group of subjects treatment with the combination of lithium and valproate (n=41, 54.7%) was mainly of main and higher percentage of rapid cyclers and increase severity of psychotic symptoms. These two groups did not differ in other demographic and other clinical features analyzed. Patients treatment with lithium + valproate had a higher remission rate at end point than subjects treated with lithium monotherapy. Conclusion: Prospective data on the clinical course have shown that the combination of lithium with valproate – associated with increased better improvement of specific symptomatological dimensions, which are poorly responsive group lithium monotherapy.

Key words: Lithium, Valproate, Mania, Mixed state, Bipolar disorder

36.TITLE: An Unusual Presentation of Anorexia Nervosa as Cardiac Failure in an Adolescent Girl

AUTHOR: Dr Namitha M Das, Specialist

Aster Medcity,Kochi,Kerala

A fifteen year old Xth std girl,who was apparently well functioning,presented with complaints of pedal edema and tiredness of 2 weeks duration. She also had progressive loss of weight and secondary amenorrhea for past four months. On examination,she was poorly built and nourished [ Height-157cm(15th centile), Weight-37kg(5th centile), BMI-15.04 ]. Skin was dry and scaly with gross proximal muscle wasting. She had a pulse rate of 44/min and BP-70/46mmHg. ECG revealed sinus bradycardia and ST-T wave changes. In view of hypotension,she was shifted to Pediatric ICU and was started on ionotropic support. ECHO showed poor LV function with EF:35-40%. She underwent temporarycardiac pacing in view of persistent bradycardia,while coronary angiogram revealed normal coronaries. She had severe electrolyte abnormalities with hypocalcemia(S. Ca-7.9mg/dl), hypomagnesemia (S. Mg-1.4mg/dl), hypophosphatemia(S.PO4-2.1mg/dl) and low vitamin D3 level (<7.5nmol/L),which was gradually corrected with supplementation. Pediatric neurology, endocrine, gynaecology consultations were carried out in view of muscle wasting,electrolyte abnormalities and amenorrhea respectively- concluded malnutrition as a probability. Pediatric gastro evaluation ruled out malabsorption syndrome. Infectious etiology for malnutrition was ruled out with relevant viral markers and other blood investigations. On further probing,there was history suggestive of deliberate food restriction and hence psychiatrist was called in. She met the DSM5 diagnostic criteria for Anorexia Nervosa Restricting type, Severe as she had intense fear of gaining weight,disturbance in perception of body weight that led to gross restriction of food intake. She also met the diagnostic criteria of comorbid Major Depressive Disorder. She was started on fluoxetine upto 20mg per day along with Cognitive Behavioral Therapy and necessary diet charting. At the end of 6 months of treatment and follow up,she is in remission,attained a body weight of 48 kg, (BMI-19.5). All systemic complications recovered completely. She resumed menstruation and reached complete functional level with an above average academics.

37. TITLE: EFFECT OF PARENTAL PSYCHIATRIC ILLNESS ON THEIR CHILDREN

AUTHORS: Dr Shaily Mina, Assistant Professor, Department of Psychiatry, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi

INTRODUCTION

Significantly higher rate of psychopathology is observed in children whose parents (either) have psychiatric illness in comparison to the general community (25-50% v/s 20%). PPI (Parental psychiatric illness) has significant long term consequences on child’s development -general health, cognitive stimulation, social, emotional and behavioural maturity.

Various factors are responsible for the overall outcome of the PPI on their children- genetics, type of parenting, frequent familial discord, socio economic stress, severity, chronicity and the timing of the parental psychiatric illness, child’s developmental age, coping style of each individual, understanding regarding the parental illness. Child characteristics act as an add-on factor with mutual influence between parental mental illness and child functioning.10 The child temperament, gender, maladjustment to the circumstances, low intelligence, and poor social skills can modify the overall influence of the PPI.

METHODOLOGY

The purpose of the present study is to evaluate the impact of parental psychiatric illness on their children by reviewing the selective literature.

RESULT

Large argument is in the favour that mental illness early in life (especially mother) has more detrimental effect on children. Researchers have also observed some peculiar behaviour in PPI children who has no clue regarding the parent’s illness- experience more fear (regarding parent’s bizarre symptoms, their future and fear of having similar illness), uncertainty, confusion, self-blaming.

CONCLUSION

Existing preventive measures for the children of parents suffering from psychiatric illness needs upgradation. Early identification of the needs of the children of PPI should be initiated along with the treatment of their parents. Schools have also started taking initiative in early assessment by evaluation of the children with psychiatrist/psychologist

KEY WORDS: Parental Psychiatric illness, Children, Impact

38.TITLE: Home based care in Psychiatry-an NGO experience

AUTHOR: BINDU MENON, CONSULTANT, MEHAC FOUNDATION

Introduction

While palliative care settings regularly provide care at their homes for their patients facing end of life issues psychiatry has not ventured much into this domain.

Most community models of psychiatry still continue to be clinic models. This necessarily means that a large number of patients who due to either lack of insight or requisite social support will not get the care that they need.

Material and methodology-

Our NGO Mehac foundation works closely with palliative care organisations at the panchayat level as well as those in the voluntary sector to provide home based care to patients. This has gone a long way in decreasing the gaps in providing primary psycho-social and psychiatric help to both palliative care patients as well as the mentally ill in the community. We have at present

500 patients in 9 clinics spread over 5 districts of Kerala. Of this 228 patients are seen only at their homes because they are either unable or unable to come to our clinics which are also run in parallel. Of these a majority are those with chronic mental illness.

Though there are logistic,financial and other constraints,we have been able to make a difference in many lives which would have otherwise not been impacted. Clubbing our services with palliative care also goes a long way in reducing the stigma associated with the illness which usually prevents many persons from accessing mental health services.

Conclusion-Home based psychiatric care is an additional resource in ensuring that the gaps in providing mental health care are thoroughly filled. It has more acceptability among patients and go a long way in reducing stigma.it might be a model worth replication for CMHP.

39.TITLE: A pilot project on Comparative study of patients recieving treatment in tertiary care hospital & Primaryhealth center

Authors: Dr. C. Guru Prasad *, Dr Chandrashekar H,*,Mr. Vishwaanath ** Assistant Professor

Bangalore Medical College & Research Institute

Key Words- Treatment, Primaryhealth center

OBJECTIVES: 1) To compare the effectiveness of treatment given at PHCs versus Tertiary care Hospital

2) To assess subject satisfaction regarding care

METHODOLOGY: Its 1year cross-sectional study enrolled of 101 cases were selected from 7 PHC’s were running Manochaitanya Tuesday clinics launched by the Govt of Karnataka in 2016. 107 controls were selected from Tertiary care Hospital. After 3 follow ups all the subjects were assessed with their informed consent clinically by psychiatrist using ICD-10 & collected data with semi structured proforma, IDEAS,GAF,PSQ-18 instruments.

RESULTS: Mean age of cases 44.58± 14.69 controls 44.08±14.81(p>0.05) independent-t test with majority of women.

  1. Cases 3.23±2.42 n controls 2.38±1.94 Global score of IDEAS (p<0.05) mannwhitney -u test
  2. Major mental illness were 48.96% in cases as compared to controls 23.36%.
  3. Minor mental illness were 76.63% in Controls as compared to cases 52.94%
  4. Alcohol dependence syndrome is 6.54% in controls as compared to 3.92% in cases.
  5. GAF score majority were 91-100(52.8%) among 110 subjects 72 were controls n 38 were cases
  6. PSQ-18 in cases 83.07±8.72 and control 75.27±9.51 independent -t test (p<0.05)


DISCUSSIONS: There is higher global disability scores IDEAS in PHC’s than Tertiary care hospital due to more of major mental illness in PHC’s.

  1. Alcohol Dependence Syndrome is more in tertiary care hospital than PHC’s.
  2. The Global Assessment of Functionings scores are higher in Tertiary care hospital than PHC’s due to more of minor mental illness.
  3. The Patient Satisfaction Questionnaire scores higher in PHC’s than tertiary care Hospital


CONCLUSION - The patients recieving treatment is more satisfactory in PHC’s than compared to tertiary care hospital. Majority of women were catered.

40.TITLE:Assessment of Psychological Morbidity among First Year Medical Students

AUTHOR:MANMEET SINGH, ASSISTANT PROFESSOR, ACHARYA SHRI CHANDER COLLEGE OF MEDICAL SCIENCES & HOSPITAL, JAMMU

Abstract

Background : Medical Curriculum is highly stressful. Stepping into a new environment, huge course syllabus which has to be mastered in a short period of time besides continuous assessments, examinations and other social and personal issues makes a newly joined medical student prone to develop negative emotional

symptoms.

Objective : This study is an attempt to assess the level of depression, anxiety and stress among first year medical students.

Materials and Methods : A cross sectional study was conducted on 97 first year medical students of ASCOMS, Jammu, Jammu & Kashmir, India. Depression, anxiety and stress was assessed by administering a self reporting DASS-42 questionnaire. Statistical analysis- SPSS version 16 was used for statistical analysis and Pearson Chi-square was applied for statistical significance.

Results : There was significant level of depression, anxiety and stress among first year medical students. The mean depression, anxiety and stress score was 1.31±1.38, 1.71±1.3 and 1.08±1.41 respectively. The prevalence of depression was 58.76%, anxiety was 69.07% % and stress was 54.63%. The incidence of

depression and anxiety was highest which showed statistical significance (p<0.05) and females were affected more than males.

Conclusion : A significant proportion of first year medical students are affected with depression, anxiety and stress. The impact of negative emotional symptoms and the relevant contributing factors have to be understood. Early and timely intervention should be done addressing the negative psychological states.

Keywords: Stress, Anxiety, Depression.

41.TITLE:PSYCHOLOGICAL WELL BEING,WORKPLACE STRESS AND JOB SATISFACTION IN DIFFERENT HEALTH CARE PROFESSIONALS OF REGIONAL TEACHING HOSPITAL IN NORTH KARNATAKA(VIJAYAPUR)

AUTHOR: Dr Srikanth D M, ASSISTANT PROFESSOR, DEPARTMENT OF PSYCHIATRY,SHRI B M PATIL MEDICAL COLLEGE, VIJAYAPUR,KARNATAKA,

OBJECTIVE: To explore the psychological well being, workplace stress, job satisfaction among different health care professionals in a regional teaching hospital of North Karnataka.

DESIGN : CROSS SECTIONAL STUDY

SETTINGS: HOSPITAL BASED SURVEY

PARTICIPANTS: A total of 554 employees working in a teaching hospital were recruited with a response rate of 77%. The participants included 111 doctors,221 nurses,95 administrative staffs and medical technicians.

PRIMARY AND SECONDARY OUTCOMES MEASURES: Demographic data included gender, age,level of educations, marital status, working hours, work shifts were obtained. DASS 21, Workplace stress scale and job satisfaction scale was applied to assess the depression, anxiety, stress and job satisfaction at work.

RESULTS: Among the three professionals employed, the prevalence of high work related stress from highest to lowest was nurses(79.6%),doctors(72.1%), administrative staff and medical technicians(45.9%). Job satisfaction was high among administrative and medical technicians (64.21%) followed by nurses(39.3%) and doctors(29.7%). Anxiety was highly prevalent among nurses (31.6%) compared to doctors(21.6%) and other staffs (18.9%).

Conclusion : These findings may contribute to development of feasible strategies to reduce the stress which results in burnout among health care professionals, currently plaguing most hospitals.

Keywords: Healthcare professionals, Workplace stress, Job satisfaction

42.TITLE:A study of pattern of psychiatric referrals in a rural tertiary health care centre

AUTHOR: Dr. Anantprakash S. Saraf, Assistant Professor, MGIMS Sevagram Wardha

Introduction:

Consultation liaison psychiatry (CLP) deals with the evaluation and management of psychiatric symptoms in the patients referred from non-psychiatric units of the hospital. We studied the profile of patients referred and patterns of referral to CLP services.

Material and methods:

Patients referred to the department of psychiatry from various clinical departments in a rural tertiary health care centre were included in the study after informed consent. Socio-demographic, clinical and referral profile data was collected and analysed using descriptive statistics.

Results:

Patients with age ranging from 5 years to 80 years were referred, with mean age of 36 years. Majority of the patients were male (59 %), married (60 %), and belonged to rural (72%) background, living in a nuclear family (69.5%). Education level was below 10th grade in 62 % and almost half (47.5 %) of them were pursuing farming. Most of the referrals were from IPD (75.5 %); with medicine department referrals comprising 81 % of total. Poisoning due to Self-Harm attempts (40 %) was the single most common reason for referral, followed by medically unexplained physical symptoms (12.5 %), deaddiction (11.5 %), altered sensorium (9.5%) and irrelevant talk with abnormal behaviour (9.5 %). Most common psychiatric diagnoses were depression (14 %), Adjustment disorder (12.5 %), Acute stress reaction (12.5 %), delirium (10 %) and somatic symptom disorders (5.5 %). Most (62.5 %) of them didn’t turn up for follow up visit.

Conclusion: The rate of psychiatric referrals is low as compared to the prevalence of psychiatric problems patients visiting non-psychiatric units. Provision of a dedicated CL service, adequate psychiatric training of non-psychiatric health professionals are a few steps that might solve the problem.Key words: Consultation, Liaison, referral, co-morbidity

43. TITLE:Referral patterns, patient profiles and approaches to treatment in a psycho oncology clinic at a tertiary care hospital: A retrospective file review

AUTHOR: Amrtavarshini.R, Assistant professor,KMC, MANIPAL

Introduction:

Cancer is a common cause of morbidity and mortality worldwide, causing 8 million deaths worldwide, 70,000 of which is from India. The psychological burden in cancer is enormous. There are many factors that contribute to this: the illness itself, its prognosis, adverse effects of medical, surgical and radiation interventions, the financial burden of cancer treatment with added loss of productivity, caregiver burn out and stigma of cancers.

The psycho oncology clinic has been functional at KMC, Manipal since 2 to 3 decades, which runs based on referral from the various departments offering oncology services, so this study shall help enhance our clinical practices.

Materials and Methods:

A review of psycho oncology clinic records and MRD files shall be done and the following data shall be collected from the time period 2015 – 2018:

· Referral patterns: parent department and reason for referral, type of care, time frame of referral and type of cancers being referred for care.

· Clinical profiles of patients: sociodemographic data, oncological diagnoses, reason for referral and psychiatric diagnosis, other comorbidities, treatment history.

Results and Conclusion:

Shall be discussed during presentation.

44.TITLE:Correlation between Depression and Glycemic Control in Patients with Diabetes Mellitus: A Cross-Sectional Study in a Clinical Setting in India

AUTHOR: Ranjitkumar Pindikura, assistant professor, narayana medical college and hospital

Background: Diabetes mellitus is a medical disorder running a chronic course and often co-morbid with depressive disorders. Many physicians do not consider the presence of depressive symptoms per se to be adequate reason for further workup unless they are severe (e.g. suicidal thoughts).

Objectives: We aimed to assess depression in adult patients suffering from diabetes mellitus, to study the socio-demographic data associated with depression in patients suffering from diabetes mellitus, and to assess glycemic control in patients with and without co-morbid depression suffering from diabetes mellitus.

Methods: This is a cross-sectional hospital-based study. The sample of the study comprised 100 outpatients with diabetes mellitus of either type-1 or type-2. After a semi-structured clinical interview, all patients were administered with the Mini-International

Neuropsychiatric Interview (M.I.N.I.) and Becks depression inventory-II. The Chi-square test was utilized for testing the association between variables. To examine the difference between the two or three variables, the Mann-Whitney U test and the Kruskal-Wallis test were used.

Results: Among the individuals recruited for the study, 72% had depression and 28% were not affected by depression. The results showed there was a positive correlation between glycemic control, the presence of complications, the type, and duration of diabetes mellitus and depression.

Conclusions: The results clearly indicated a high rate of occurrence of depression in diabetes mellitus. Patients with a long duration of diabetes mellitus, poor glycemic control, and the presence of complications of diabetes mellitus were more likely to be severely depressed.

Keywords: Depression, Complications of Diabetes Mellitus, Poor Glycemic Control

45.TITLE: Psycho-pulmonology: an observational study to screen psychiatric comorbidities in respiratory disorders

AUTHOR: Dr. Roshan Sutar, Assistant Professor, ALL INDIA INSTITUTE OF MEDICAL SCIENCES, BHOPAL

Background: It is well known that psychiatric disorders often coexist with acute as well as chronic respiratory disorders. Since respiratory disorders are one of the largest reasons for poor health in developing countries, the impact of concurrent psychiatric disorders is multi-fold bringing down the quality of life. Very few studies have explored the relationship between respiratory and psychiatric disorders in India. Purpose of this exploratory study is to find and treat psychiatric comorbidities associated with respiratory disorders and highlight the need for active liaison psychiatry services in India.

  1. Methodology: This is a cross sectional study where 100 outpatient subjects attending tertiary respiratory hospital from August 2015 to March 2016 were selected through simple random sampling by psychiatrists and screened through semi-structured proforma, NIMHANS Psychiatry screening tool and mental status examination. Statistical analyses were done by frequency calculation.
  2. Results: It was found that 29% of subjects had comorbid psychiatric disorders among which nearly half of them required Psychopharmacological interventions while 13% required referral to higher centres. Tuberculosis was a most common diagnosis (46%) in subjects attending the respiratory clinic services while depressive, anxiety and insomnia related disorders were most common psychiatric concern (22%) in this study taking into account the high comorbid substance use on the background (38%).
  3. Conclusion: Psychiatric disorders are frequent and important causes of increased morbidity in respiratory disorders leading to poor adherence to treatment. Frequent relapses in both respiratory and psychiatric disorders are well known, making it a vicious cycle that compromises quality of life of patient and caregivers. Since this population requires active liaison with the psychiatrist, it would be beneficial to routinely screen them for psychiatric disorders. This brings us to develop screening tools for pulmonologist to detect psychiatric morbidity and to develop effective consultation-liaison psychiatry services across the country.


46.TITLE: FIGHTING THE GREATEST OPPONENT

AUTHOR:Dr Samyak Tiwari, Consultant Psychiatrist, LUCKNOW

The word Ego often brings to our mind……………. Some arrogant or dominating attitude.

If this fact of Human nature is rightly understood, then a lot many human mind complexities can be decoded.

Ego is nothing but giving undue importance to one self on persistent basis at the cost of relationship, health, finances and peace of mind……………………. But this brings out a very basic point to the forefront………………………..is anything worth important, that human peace of mind, can be traded for it

But isn’t this very process of giving importance, the major cause of major mental disharmonies.

This undue importance to anything in life is nothing but highly pumped up EGO.

It is an internal opponent that the must recognize and demolished before it destroys us.

Key words: Human nature, mental disharmonies.

47.TITLE: model for mental healthcare in mass gathering scenario

AUTHOR: dr shahbaz ali khan, Assistant Professsor, command hospital kolkata

Background: mental health in Mass Gatherings like the Hajj pilgrimage, Amarnath yatra, Kumbh etc. is different from individual or community psychiatry. A unique combination of physical, physiological, spiritual and psychological factors makes such a scenario a very unique and stressful milieu. We studied the emergence of psychopathology and it’s determinants, in this adverse environment in such a mass gathering situation, in Indian pilgrims on Haj 2016, one of the greatest mass gathering in the world.

Materials and methods - A descriptive study analyzing the mental morbidity in 1.36 lakh Indian pilgrims during haj 2016, using SPSS 19.

Results – 182 patients reported psychological problems. 22 patients (12%) required admission. 12 (6.8%) pilgrims reported a past h/o of a mental illness. 165 (93.2%) of these were new onset symptoms with no relevant past history. Stress related illnesses were predominant as expected (45.7%), followed by Psychosis (9.8%), Insomnia (7.3%) and mood disorders (5.6%). Most common symptoms recorded were apprehension (45%), sleep (55%), anxiety (41%) and fear of being lost (27%). Psychotropic were prescribed for 46%. There were no mortality and no deliberate self harm/suicide. None of the patients had to be sent back to India

Conclusion – Cumulative stress causes full spectrum of mental decompensation and prompt healing is aided by simple non pharmacological measures including social support and counseling in compatible sociolinguistic milieu.

Key message – There is significant mental morbidity in mass gathering situations and mental health professionals need to be an integral part of healthcare planning in such mass gathering scenarios in India and elsewhere in the world.

Key words – mass gathering, Haj 2016, mental morbidity, stress

48.TITLE: Undergraduate medical students and psychiatry. A qualitative attitude analysis from a teaching hospital in South India.

AUTHOR: Sreeja Sahadevan, Assistant Professor, MOSC Medical College

Abstract:

Background : Undergraduate medical students’ attitude towards psychiatric illness and treatment is crucial in building a positive approach towards psychiatry among the medical fraternity.

Aim: To study the attitude towards psychiatric illness, treatment and psychiatry as a speciality medicine among undergraduate medical students. Secondary objective is to plan an intervention to build a positive attitude towards psychiatry.

Methodology : This qualitative study was done in a teaching hospital in South India. Focused group discussions as well as in-depth interviews were conducted with the students. Content analysis was performed for determining the direct and latent themes to develop a model.

Results : The study included 92 students in the 4th semester of MBBS course, who finished their initial speciality clinical postings in general medicine, surgery, obstetrics and paediatrics. The major themes identified were classified under illness aetiology related, stigma related, impact from movies and media related and treatment related. Most of the students believed that psychiatric illness was caused by the adverse environmental factors, no major role for medication in treatment, all psychiatric emergencies were treated by ECTs as depicted in movies and once a person is ill, then he would suffer it lifelong. Many of the students did not consider psychiatry as a core medical speciality. Most of the students expressed their fear to interview psychiatric patients in the ward and did not prefer to take up psychiatry as their profession.

Conclusion: Psychiatry faculties in medical colleges should be sensitised with the attitude of medical students. Faculty should take up the role to facilitate a positive attitude through interesting and novel teaching techniques, involving in the mainstream of medical education and being good role models.

Key words: medical students, psychiatry, stigma, attitude

49.TITLE:A study of emotional intelligence, perceived stress and coping in final year medical undergraduates

AUTHOR: Dr. Amit Nagdiv, A.P., Assistant Professor, Dept of Psychiatry, JNMC, DMIMS

Sawangi (Meghe), Wardha, Maharashtra

Background/Introduction: The term “emotional intelligence” (EI) describes the “ability to monitor one’s own and others’ feelings and emotions, to discriminate between them and to use the information to guide one’s thinking and actions. It helps people to cope better. This study was conducted to study emotional intelligence, perceived stress and coping in final year medical undergraduates.

Methodology/ Materials and Methods: This was a cross sectional type of study conducted on Final year undergraduate medical students in a medical college in Maharashtra. A self-designed proforma was used to elicit socio-demographic data. The Emotional Intelligence Scale, Perceived Stress Scale (PSS), GHQ 30, Ways to coping questionnaire were used to evaluate emotional intelligence, perceived stress, general health, ways of coping and socio demographic characteristics and correlation was assessed between all these components. Analysis was done using SPSS version 21 software. Pearson’s correlation and t test were used. P value < 0.05 was taken as significant.

Result: The mean EI score was 118 and the most used coping mechanism was planful problem solving. Negative Correlation was seen between Emotional intelligence and perceived stress scores (r = -0.3635, p = 0.000026). Positive correlation (r= 0.3647, p=4.5E-05) was present between emotional intelligence and planful problem solving. Also, negative correlation (r = -0.8589, p=0.00001) was seen between emotional intelligence and escape avoidance. There was a negative correlation seen between emotional intelligence scores and scores obtained on GHQ-30(r= -0.52, p = <0.00001).

Conclusion: Emotional intelligence had a negative correlation with perceived stress, mental stress, maladaptive coping behaviour (escape avoidance) and a positive correlation with adaptive coping style (planful problem solving). Higher emotional intelligence is associated with better quality of health.

Key Words: Emotional Intelligence, Stress, Coping,

50.TITLE:Prevalence of co-morbid psychiatric morbidity among elderly individuals with Dementia

AUTHOR: Dr Mitesh Kumar, Assistant Professor, Kalpana Chawla Government Medical College

Background : People with dementia have high prevalence of comorbid psychiatric disorders. Comorbid conditions are associated with greater cognitive and functional declines, extended hospital stays and increased healthcare costs. Improved knowledge of the comorbidities would facilitate the design of preventive strategies, and early diagnosis and treatment of those disorders that are not designated as primary condition.

Methodology : It was a retrospective, descriptive study. Case record files of patients who were aged 60 or more and who were attending a “Geriatric Mental Health Clinic” of a teaching institute between 01/07/2015 to 31/12/2017 were retrieved and analysed. Patients who had been diagnosed as Dementia by consultant in charge of the clinic as per WHO ICD 10, were inducted in the study. Information was gathered from the case record files of these patients and analysed by two psychiatrists by using the coding plan for socio-demographic, clinical and follow up outcome variables. Patients who had visited the clinic only once and whose evaluation had not been completed were not included in the study. The study was approved by institutional ethical committee and confidentiality of patients was maintained.

Results : Mean (SD) age of 81 patients with dementia was 71.80 (±8.534) years and mean HMSE score was 15.35 (±6.081). Out of 81 patients, 55 (67.9%) had Psychiatric comorbidity. Depression (23.5%) was most prevalent psychiatric comorbidity, followed by delirium (12.3%), anxiety (11.1%), sleeping disorder (9.9%), psychosis (8.6%) and substance use disorder (2.5%). 49 (60.5%) patients were receiving psychotropic other than cognitive enhancers, antipsychotics (28.4%) being most common. Past history of psychiatric illness was significantly higher (p value = 0.006) in dementia patients with psychiatric comorbidity.

Conclusion : Psychiatric comorbidity is highly prevalent in patients with dementia and clinicians should be vigilant to identify them for early diagnosis and treatment.

51.TITLE:”What do I do!”: perceptions and challenges of general physicians while treating patients with dementia

A Qualitative study in eastern India

AUTHOR:Dr Debanjan Banerjeea, Dr Mayank Raib

National Institute of Mental Health and Neurosciences (NIMHANS),

bRegional Institute of Medical Sciences (RIMS), Imphal

Introduction

The world is ageing exponentially due to increased life-expectancy. Along with it, the incidence of dementia is also on the rise. The specialised health-care resources are scarce for a developing nation like India to provide quality care to the rapidly increasing number of these patients. Here comes the important role of general physicians (GP): mostly the first contact in dementia care. While research on aspects of this illness is plenty, there is dearth in studies involving the experiences of GPs in dealing with patients of dementia.

Method:

Qualitative methodology with constructivist paradigm was used. In-depth one-to-one interviews were conducted with 20 GPs who consented to be a part of the study. The interviews were audio-recorded and transcribed. Subsequently thematic analysis with focussed coding was done to analyse the data.

Results:

The predominant themes that they perceived were lack of confidence to treat, avoidance of cases with likely diagnosis of dementia, excessive use of antipsychotics and benzodiazepines and premature referrals. The challenges faced were interaction with the caregivers, breaking the diagnosis, feeling the ‘need of’ excessive investigations and behavioural management. Interestingly the overarching themes were high retention rate of patients with GPs, good compliance to medication and significant burn out of the physicians themselves.

Conclusions:

General physicians can be instrumental in the pathways to care for patients with dementia. This study showed that avoidance to face the ‘diagnosis’ and excessive reliance on pharmacotherapy often create barrier for the care of these patients. Still however the retention rate was high, which can be harnessed positively. Service provisions for adequate training of GPs and regular monitoring can go a long way in relieving their own burden and ensuring quality care for patients and families with dementia.

Keywords: dementia, general physicians, qualitative, perceptions

52.TITLE:Study of Relation between Self-reflection, Insight, Attitude towards Life and Self-stigma associated with Help Seeking Behaviour amongst Resident Doctors in a Tertiary Care Centre

AUTHOR: Dr. Krishna Patel, Assistant Professor, C. U. Shah Medical College and Hospital

BACKGROUND:

Stigma associated with mental illness does not seem to plague only general population at large, but it also affects the medical fraternity. On face value the degree of stigma seems to be strongly associated with self reflection capacity and attitude towards life of a person. Resident doctors predict the future of health sector. And they are at a level in their life where self reflection and correct attitude towards life is developing at a very fast rate and have a possibility to reach its peak. So this study is specifically planned to be conducted with the resident doctors.

AIMS:

To study the self-stigma associated with psychological help seeking behavior and its relationship with self-reflection capacity, insight and attitude towards life amongst resident doctors in a tertiary care centre

MATERIALS AND METHODS:

Study was conducted in C. U. Shah Medical College and Hospital. After taking written informed consent and Institute Ethical Committee permission data collected from resident doctors through socio-demographic data sheet, Self-Stigma of Seeking Help Scale, Self-Reflection and Insight Scale and Life Attitude Scale was analyzed using SPSS version 16.

RESULTS:

Amongst 81 resident doctors self stigma associated with seeking psychological help was at medium (60.5%) and low (39.5%) level and it had strong negative association with both global scores 1) life attitude global score (χ2=4.364,γ=-0.449,P</=0.05) and 2) global score of self-reflection and insight scale(χ2=12.656,γ=-0.692,P</=0.05).

ONCLUSION:

Measures that help in developing more positive attitude towards life and which increases the self reflection capacity and develop insight in an individual can lower the levels of self stigma associated with seeking psychological help.

KEY WORDS: Self-Stigma, Self-reflection, Insight, Life Attitude, Resident Doctors

54.TITLE:A STUDY OF SOCIODEMOGRAPHIC AND CLINICAL PROFILE OF ADMITTED PATIENT LEAVING AGAINST MEDICAL ADVICE FROM PSYCHIATRY WARD OF A TEACHING HOSPITAL.

AUTHOR- Dr Jayanta Kurmi, Post Graduate Student of Psychiatry, Silchar Medical College & Hospital

Abstract:Introduction – Leaving against medical advice in which a patient chooses to leave the hospital before the treating physician recommends discharge. Leaving the hospital against physician’s advice may result into inadequate treatment, relapse and prolonged duration of treatment.. Hospital discharge against medical advice may represent a failure of medical care. Aim & Objectives - The aim of this study is to assess the prevalence, reason of LAMA, socio-demographic variables and clinical profile of such patients. Methods - Retrospectively data will be obtained from indoor register of Psychiatry Department, Silchar Medical College &Hospital and those patients who have left against medical advice (LAMA) in last 18 months from January 2017 up to June 2018 will be selected for the study. ICD-10 criteria will be used for the diagnosis purpose. Results - Detailed results and discussion will be done after obtaining the data and analyzing them using appropriate tools. Discussion – Results will be discussed critically in light of available findings of such patients from previous research and any new findings will be highlighted.

Keywords – Left against medical advice, Psychiatric inpatients, Discharge against medical advice, Poor compliance, Sociodemographic profile.

1 – Life Fellow of IPS LF16161

* - Presenting Author, Post Graduate Student.

55. TITLE:Effect of Internalized Stigma and Mental Well-being on Adherence to Medication in patients suffering from Psychiatric Illness in a Tertiary Care Centre

AUTHOR: Dr. Krishna Patel, Assistant Professor, C. U. Shah Medical College and Hospital

BACKGROUND:

Outcome of patients suffering from mental illness largely depends on their adherence to the medication which is very difficult to achieve. Amongst multiple factors, internalized stigma related to mental illness that they suffer and their own personal well being seems to play a major role in maintaining adherence to the medications. This particular study aims at studying the effect of these two factors on adherence to medication.

AIMS:

To study the level of medication adherence and its relationship with internalized stigma as well as mental well-being amongst follow up patients

MATERIALS AND METHODS:

After taking written informed consent and Institute Ethical Committee permission data collected from follow up patients on treatment since atleast 2 months and attending the outpatient department of psychiatry in C. U. Shah Medical College and Hospital through Structured Proforma: Participant’s Profile, Morisky Green Levine Scale (MGVS), Internalized Stigma of Mental Illness Inventory (ISMI), Mental Health Inventory (MHI) was analyzed using SPSS version 16.

RESULTS:

Amongst 89 follow up patients medication adherence was medium (67.5%) and low (32.5%) level and it had strong negative association with global scores of ISMI (χ2=7.6, γ=-0.78,P</=0.05) and personal distress score of MHI(χ2=13.72,γ=-0.63,P</=0.05). Medication adherence level had strong positive association with personal wellbeing score of MHI (χ2=8.36,γ=0.68,P</=0.05).

CONCLUSION:

Measures that help in reducing internalized stigma levels and personal distress as well as those helping in increasing personal wellbeing level can help in improving the adherence to medications in patients suffering from mental illness.

KEY WORDS: Medication adherence, Internalized stigma, Mental wellbeing

56.TITLE:Internet addiction and quality of sleep in the under-graduate students of a university in southern India.

AUTHORS : 1st author: Dr Manoj Shettar,2nd author: Dr Ravichandra Karkal,3rd author: Dr Anil Kakunje,4th author: Dr Rohan Mendonsa,5th author: Dr V V Mohan Chandran,6th author: Dr Abhay Matkar, Assistant Professor SDMCMSH Hubballi

Background/ Introduction: Internet usage has become an integral part of everyday life. People who use internet excessively experience a number of functional impairments like marital or family strife, job loss or decreased job productivity, and legal difficulties or school failure. Recent research has shown that excessive use of Internet can result in addictive behaviour in some individuals.

Aim: To assess internet use in the students of Yenepoya University and to evaluate its association with sleep, effects on quality of sleep.

Methodology/ Materials and Methods: A cross-sectional study was done to evaluate 158 students of Yenepoya University using Internet Addiction Test (IAT) and Pittsburgh Sleep Quality Index (PSQI). Descriptive statistics were applied. Pearson’s bivariate correlation was done to see relationship between severity of Internet addiction and the sleep quality.

Results: Among 158 participants 76 (48.1%) were males, 82(51.9%) were females. 152 (96.2%) were single, 6 (3.8%) were married. 154 (97.5%) were from nuclear family, 3 (1.9%) were from joint family, 1 (0.6% were from extended family. 68 (43.0%) had no internet addiction, 61 (38.6%) had mild addiction, 27 (17.1%) had moderate addiction, 2 (1.3%) had severe addition of internet. Among the participants 40 (25.3%) reported of poor sleep quality. A positive correlation was seen between IAT scores and PSQI scores (r: 0.185, p&lt;0.005). A Pearson correlation coefficient of 0.185 indicates a small to moderate effect size.

Conclusion: Research exploring internet addiction and its impact on physical and psychological parameters are still in infant stage. Usage of internet can result in addictive behaviours in certain individuals. Sleep is one of the factors that are influenced by the addiction to internet. Internet addiction is associated with poor sleep quality.

Keywords: Internet addiction, sleep quality, social networking site.

57.TITLE:BRAIN ON FIRE

AUTHORS:9Dr Mehak Pahwa(garg), consultant neuropsychiatrist- Institute of Neurosciences-Kolkata,Dr Vishal Gaikwad, consultant neurologist- INK)

INTRODUCTION : Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disease with variable clinical presentation, and involves new-onset acute psychotic symptoms which can be commonly mistaken with primary psychiatric disorder.

CASE DESCRIPTION: 22 yr old female presented to psychiatry opd with history of abnormal behaviour which had started after she was sexually abused, as per the patient. There was catatonic posturing and history of 2 GTCS since 2 months. She was on 3 antipsychotics and was not improving thus was referred for tertiary care. On examination she had a blank look, following commands intermittently, maintaining postures. All basic blood parameters, MRI brain with contrast, EEG, CSF were normal. However Serum and CSF NMDAR antibody tested strongly positive and she was started on steroids and IVIg. On further investigation, a teratoma was discovered in left ovary, which was resected and she completely recovered.

Discussion: There is a need to screen for autoimmune causes in patients with atypical psychosis. Also we feel the need for growth of neuropsychiatry collaboration for prompt diagnosis and appropriate management of such cases.

58.TITLE: Psychiatric Co-morbidity in Patients With COPD - A Hospital Based Study

AUTHOR: DR BHASKAR MARA, ASSISTANT PROFESSOR, S. NIJALINGAPPA MEDICAL COLLEGE

AIM: To know the presence of psychiatric co-morbidities in patients with respiratory disorders.

Background and objectives: Chronic respiratory conditions like chronic obstructive pulmonary disorder (COPD), asthma have a significant health as well as economical implication. Prevalence of COPD is 5.0% among Indian males and approximately 3.2% among Indian females over 35 years of age. It’s estimated that by 2020 COPD will be the third leading cause of death worldwide. The association between COPD and depression and anxiety appears to be multifactorial and bi-directional. The quality of life of a chronically ill COPD patient may be complicated by a concurrent depressive disorder, which may bring the patient into a vicious cycle.

Prevalence of anxiety disorders may be around 20% and depression may range from 10-50%. It has been found that untreated mental illness acts a risk factor for poor outcome of the medical illness. Increased study in this aspect is therefore necessary to diagnose and treat such illness.

Methods : The design and nature of the clinical study was explained to the patients. Informed consent was obtained from each participant included in the study. All patients were first examined by consultant pulmonologist to confirm COPD, asthma, bronchitis and post tuberculosis sequel using Global initiative for obstructive lung diseases (GOLD) criteria Pulmonary function test (PFT) Global initiative for asthma (GINA) criteria Investigator collected socio-demographic details like education, occupation, socio economic status, history of substance use, etc. using a structured proforma. The psychiatric morbidities were screened using Mini-Plus scale and appropriate scales were used for further evaluation. Results were tabulated. The findings were statistically evaluated using appropriate statistical tests.

RESULTS AND CONCLUSION: Will be discussed at the time of presentation.

KEY WORDS: COPD, QUALITY OF LIFE, PSYCHIATRIC COMORBIDITY

59.TITLE : A study of psychiatric morbidity in psoriasis.

AUTHOR:VINOD A Assistant Professor, S N medical college, Bagalkot

Background and objectives: Psoriasis being a chronic relapsing skin condition is often found difficult to manage. Psychological factors might be playing a role in frequent relapses. Very few studies are from India. Present study was planned to know the Psychiatric disorders in patients suffering from psoriasis, their demographic profile and also to know associated psychosocial actors.

Methods : 100 consecutive patients diagnosed as having psoriasis by Consultant Dermatologist in Dermatology OPD of the SN medical college were evaluated using Psoriasis Area and Severity Index (PASI). Sociodemographic, clinical and psychological factors were studied by using a semi structured proforma. Psychiatric morbidity was assessed by structured MINI-PLUS. Each patient was also evaluated by a consultant psychiatrist.

Results : Data were analyzed using Open EPI for Windows. 61% of patients with psoriasis were found to have psychiatric co-morbidity. Major Depressive disorder (21%), Adjustment disorder with depressed mood (12%) and Adjustment disorder with anxiety (10%), Nicotine dependence (7%), Dysthymia (6%), Alcohol dependence (4%) and Social Phobia (1%) were found in the sample. Males (Х2=7.63, p<0.01), 30-39 years age group (Χ2=11.19, p<0.05), Homemakers (Х2=11.86, p<0.01) had more psychiatric morbidity. PASI was higher (t=3.73, p<0.01) in those having psychiatric morbidity. Lesion in exposed skin (82%), disgust towards skin appearance (78%) and stigma (57%) were the major stressors found in the patients with psoriasis. Psychiatric morbidity was significantly more among those who had Loneliness, Marital stress, Isolation and Disgust towards skin appearance (Х2 =4.81, 20.96, 4.18 and 17.37 respectively)

Conclusion : High amount of psychiatric co-morbidity was present in psoriasis. This study also revealed that there is a strong association of various psychosocial stress factors like Loneliness, Marital stress, Isolation and Disgust towards skin appearance with psychiatric co-morbidity.

Key words : Psoriasis, PASI, MINI-PLUS

60. TITLE:Clinical profile of Clozapine responders and non-responders from a rehabilitation setting – a retrospective file based study

AUTHOR: Rajeshkrishna Bhandary P, Asst. Professor

Co Authors: Dr. Suma Udupa, Dr. PSVN Sharma

Affiliation: Department of Psychiatry, KMC, Manipal

Background: Treatment resistant schizophrenia is a common occurrence in rehabilitation setting. Previous studies have shown resistance rates in such setting to go up to 70%. Clozapine, often given as the first choice in treatment resistance is known to lead to response in not more than 40-50% of such cases. While factors related to risk of treatment resistance are available, the research so far on factors contributing to clozapine resistance have remained inconclusive. The current study explores for the same in a rehabilitation setting which ensures good compliance and adequate monitoring for safety and trial with maximum tolerated dose.

Methodology: Files of patients admitted in a rehabilitation setting in coastal Karnataka will be reviewed. Patients diagnosed with Schizophrenia or schizoaffective disorder who were/are on clozapine will be included in the study. Based on the discontinuation of Clozapine or addition of any augmenting agent, they will be classified as known responders. Clinical profile of the patients will be collected from the records and details pertaining to their gender, onset of illness, prominent symptoms, PANSS and its subdomain score at start of clozapine, comorbidities etc., will be collected and compared with those who have responded to clozapine.

Results and Conclusions will be discussed in the Conference.

Implications: The findings from the study are likely to help in identifying any key factors that could influence Clozapine response and non-response and help facilitate decision making about the need to start early augmentation.

61.TITLE:”Study of aggression in patients with schizophrenia admitted in psychiatry ward”

AUTHOR: DR. PRITAM CHANDAK, CONSULTANT CHILD & ADOLESCENT PSYCHIATRIST, PRIVATE PRACTICE NAGPUR

Introduction: Aggression is an important reason for psychiatric referral. Schizophrenia is one of the common disorder wherein many individuals report behavioural disturbances in the form of aggression of various types and extent. Studying the association between aggression and schizophrenia would definitely help us to plan treatment in a better way and help the caregivers for better management and recovery.

Materials& Methods :It was a cross-sectional, single interview study. 80 consecutive patients with schizophrenia, were enrolled in the study. After written informed consent each participant (and/or carer) was individually interviewed along a special proforma prepared for the study which contained details about psychiatric and aggressive complaints as well as other aspects of clinical profile. Brief Psychiatry Rating Scale (BPRS), Positive and Negative Syndrome Scale (PANSS) and Overt Aggression Scale (OAS) were administered and statistical analysis was done.

Results :Mean age of the participants was 33 years, majority being male, educated, employed, married, living in urban areas and belonging to higher socio-economic group. Presence of aggression was noted in 43.75% (N=35) of the study population. Verbal and physical aggression was reported by all of them. Majority of them had active, direct, focused, continuous and unprovoked aggression directed at others, with more frequency towards known than unknown people. In this study population male gender, lower socio economic status, non compliance to the treatment and past history of deliberate self harm attempt in the participants had a significant influence on the presence of aggression. The mean of total overt aggression score for all the participants was 5.15 (SD = 4.63).

Conclusion: Detailed assessments of patients with schizophrenia should be carried out to evaluate aggressive and other behavioral disturbances which can help in planning treatment early, so as to reduce the burden on patient and carer.

62.TITLE: A Case study:Neuropsychological aspects of an adult male with Organic Personality Disorder and Cannabis dependence syndrome

Authors- 1. Akanksha Agarwal, DM Senior Resident in Geriatric Psychiatry

2. Dr. Shweta Singh 7355796343 9557565222 akanksha20132992@gmail.com

Introduction:- Organic Personality Disorder is characterized by significant changes in the personality of the individual in terms of affect, behavior and cognition due to an organic basis. Cannabis dependence syndrome may cause significant changes in personality and behavior of an individual. The present paper investigates about the neuropsychological aspects by assessment of a middle aged male with Organic personality disorder and Cannabis dependence syndrome.

Methods:- CT scan head report revealed hypodense area seen in the left temporal region suggestive of gliosis with fracture of left temporal bone with diffuse cerebral atrophy. The neuropsychological assessment was done by using standardized tools viz. NIMHANS neuropsychological battery and PGI- BBD. The areas investigated were Intellectual Functioning, Attention, Memory Functioning, Executive Functioning, Perceptuo-motor abilities and changes in personality and behavior.

Results:- Significant deficits were found in attention and concentration, immediate recall, delayed recall, verbal retention for similar pair, visual retention, mental speed and executive functioning and changes and personality and behavior. An involvement of left frontal-temporal lobes was found.

Conclusion:- The case study gives insight into the neuropsychological aspects of organic personality disorder with cannabis dependence syndrome involving left frontal temporal lobe and has implication for the multi dimensional management of this condition.

Keywords:- Organic personality disorder, Cannabis dependence syndrome and Neuropsychological assessment

63.TITLE:STRESS LEVELS IN DIFFERENT HEALTH PROFFESSIONS AND ITS CO-RELATION WITH COPING STRATEGIES USED

AUTHORS: Dr. Shalini Bijali, DNB (Post Diploma) Resident, Institute of Mental Health, Amritsar, Pujab.

Dr. Ranjit Kumar, Assistant Professor of Pharmacology, Raipur Institute of Medical Sciences, Raipur.

Dr. Vikalp Wasnik, Assistant Professor of psychiatry, Raipur Institute of Medical Sciences, Raipur.

ABSTRACT

BACKGROUND: It has been seen that the professions involving rapid decision-making skills and decisions that affect the lives of other persons are amongst the most stressful once. The present study deals with one of such professions i.e. healthcare professionals and their daily stressful life. Stress may be a cumulative factor for physical or psychological reaction or in extreme cases a psychosomatic disease. These stress levels also depends on the various coping strategies used during acute stress.

AIM: To evaluate the level of stress in healthcare professionals and correlate it with the coping strategies used by them to overcome stressful situations or events in a tertiary care Indian hospital.

METHORD: 20 volunteers each consisting of nursing staff, residents and consultants were taken after explaining the purpose of the study and taking proper written consent. They were evaluated for the level of stress by using Perceived stress score test(PSS10). Coping strategies used by them during stressful situation retrospectively were assessed by Coping Strategies for Stressful Events (CSSE). Participants were asked to fill the questionnaire honestly and fully. Confidentiality of their responses was ensured.

RESULTS: To be discussed at the time of presentation.

Key words- Perceived stress, Coping Strategies.

64.TITLE:A Pilot study of Self Reported Hypersexual Behaviours in India.

AUTHOR: Mehak Nagpal, Specialist, ESIC Hospital, NEW DELHI

Objectives: To screen for sexual compulsion and psychiatric comorbidity in persons presenting with self reported concerns of excessive sexual behaviours.

Materials & Methods : A cross-sectional, pilot study carried out in 100 sexually active men and women presenting with self/partner reported hypersexual concerns to the Psycho-sexual Clinic, Dept. of Psychiatry, ESIC Hospital New Delhi. Approval was taken from the Institutional Ethics Committee, written informed consent obtained from all participants aged 18–45 years who were sexually active since past 1year. 86 men and 14 women were studied over a period of 2 years using semi-structured demographic proforma and clinical history (including details of time and money spent on pursuing sexual behaviours). Sexual Compulsivity Scale (SCS) and MINI were used by the psychiatrist. Appropriate statistical analysis done using SPSS 21.

Results: Pornography use was the most frequently reported specifier in men (n=81), followed by phone sex (n=70) and visiting massage parlours for sexual favours (n=60) Partnered sexual activity was more common amongst women as compared to men. However, the most common hypersexual behaviour in women was also masturbation (n=12) and porn watching (n=9). 55% (n = 55) of the entire sample (49 men and 7 women) met the criteria for sexual addiction according to SCS; out of which 47% had cybersex addiction. Significant association was seen between distress related to sexual behaviours and scoring above the cutoff on SCS (p=0.01). Gender was significantly related to the mean score (p=0.03). Women also reported clinical depression, anxiety more than men (p<.05) but not substance use disorders which was higher among men.

Conclusion: The SCS can be used clinically as a screening tool for problematic sexual behaviours which is a neglected area in the changing Indian social milieu.

65.TITLE:Sexual dysfunction in patients of bipolar disorder receiving Valproate monotherapy

AUTHOR-abbas mehdi, assistant professor, career institute of medical sciences

Background: There is scarcity of data on the prevalence of sexual dysfunction among patients with bipolar disorder receiving Valproate.

Aim of the study: To assess the prevalence of sexual dysfunction among patients with bipolar disorder receiving stable doses of valproate and to study the correlates of sexual dysfunction. Materials and Methods: 63 stable patients with a diagnosis of bipolar disorder receiving Valproate monotherapy were evaluated on Arizona Sexual Experience Scale, Brief Adherence Rating Scale, Hamilton depression rating scale, Young mania rating scale and clinical global impression scale.

Results: The mean age of study sample was 38.84 years (SD: 12.49). The mean Hamilton Depression Rating Scale score was 0.95 (SD, 1.45) and the mean Young Mania Rating Scale score was 0.48 (SD, 1.13) and the mean Global Assessment for Functioning scale score was 88.94 (SD, 7.77). The mean duration of Valproate use was approximately 46.67 (SD, 45.44) months, and the mean dose of Valproate was 799.5 (SD, 251.4) mg/d. Out of 63 patients, 18 (28.6%) had sexual dysfunction. Those with sexual dysfunction had longer duration of illness (P=0.002), higher HDRS score (P=0.012), higher ASEX score (P=0.000).

Conclusion: Present study suggests that approximately one fourth of the patients receiving valproate experience sexual dysfunction.

Key words: Valproate, sexual dysfunction, treatment adherence

66. Title: Evaluation of sexual dysfunction in patients with severe mental illness: a cross-sectional study from a tertiary care center in Chattisgarh

Authors: Deepak Ghormode, Pramod Gupta, Devendra Ratnani, Jitender Aneja*, Assistant Professor, All India Institute of Medical Sciences Jodhpur

Background : Sexual dysfunctions (SD) are common and lead to lot of psychological distress and impair quality of life. However, little attention has been paid to explore sexual dysfunction in severe mental illnesses (SMI).

Aim of this study: To explore the occurrence of SD and resultant impact on the quality of life in persons suffering from schizophrenia, bipolar disorder, depression and compare it with healthy controls.

Methodology: In this cross-sectional study, 79 patients and 50 healthy controls underwent evaluation for SD on Arizona Sexual Experience Scale and their quality of life was measured using WHOQOL BREF. Chi-square test was used for the categorical variables while comparison of continuous variables was done by t-test with post-hoc corrections.

Results : Mean age of the patient group was more than the controls (34.02 vs 26.98 years; p- <0.001), however, mean education was significantly higher for the former group (11.84 vs 10.18 years; p- 0.005). Anti-depressant medications were the most frequently prescribed medications (62.02%) and nearly two-thirds of patients received at least 2 types of psychotropic medications. Significant difference was observed for various items of ASEX as well as total scores between the patients and controls. Compared to healthy controls, patients with depression had significantly higher rates of SD in the domain of obtaining penile erection, ability to reach orgasm and satisfaction from orgasm. Patients with schizophrenia had higher rates of problems in achieving arousal, penile erection and satisfaction from orgasm while those with bipolar disorder only differed significantly on the domain of ability to reach orgasm. However, patients fared better than the patients on various domains of QOL (except social domain).

Conclusion: A significant number of patients with severe mental illness suffer from SD. Hence, it should be made a routine practice to evaluate and address the problem of SDs in patients with SMI.

Keywords: Sexual dysfunction, Schizophrenia, Bipolar Disorder, Depression, Quality of Life

67.TITLE:Sleep Walking and Sleep Related Eating Disorder Associated with Atypical Antipsychotic Medications: Case Series and Review of the Literature

AUTHOR:Amit Chopra, Assistant Professor, Allegheny Health Network, Pittsburgh

Background: Parasomnias are a group of disorders that are characterized by abnormal behavioral, experiential or physiological events that occur in association with sleep, specific sleep stages, or sleep-wake transitions. Sleep walking (SW) is a parasomnia behaviors characterized by repetitious occurrence of ambulation while sleeping after a partial arousal during stage N3 sleep in the first half of sleep period. Sleep related eating (SRE) is one of the complex behaviors that may accompany sleep walking. SRE is characterized by recurrent episodes of involuntary eating and drinking that occur during partial arousal from NREM sleep.

Methods: A Case series and review of the literature. We conducted an online database search (Ovid, MEDLINE, EMBASE, EBSCO, CINAHL) from years April 1996-March 2017 for English language case reports and series on SW and SRE associated with atypical antipsychotic use.

Results: There were total seventeen cases (n=17) of SRE due to atypical antipsychotics. The mean age of the sample was 48.12 years (SD = 14.365) with a male predominance (64.7%; n=11). Demographic distribution of the sample is mentioned in Table 1. Majority of the atypical antipsychotic-induced sleep walking (SW) episodes were associated with quetiapine use (58.8%; n = 10), followed by olanzapine use (35.3%;n= 6), and ziprasidone use (7.9%;n= 1). Remission from SW/SRE was noted in all cases with measures including dosage reduction, discontinuation of medication, switching to an alternate antipsychotic medication, and use of continuous positive airway pressure (CPAP) therapy for treatment of comorbid obstrucive sleep apnea (OSA).

Conclusions: Sleep walking (SW) with sleep related eating (SRE) can be an infrequent side effect associated with atypical antipsychotic medication use. Therefore, patients taking atypical antipsychotics and reporting weight gain should be enquired about symptoms of SW and SRE. Sleep evaluation is helpful to rule out comorbid primary sleep disorders including obstructive sleep apnea and restless legs syndrome. Discontinuation of the causative atypical antipsychotic medication often leads to complete resolution of parasomnia behaviors.

68.TITLE: Influence of Personality on Academic Stress among First Year MBBS Students in Medical College, Kolar- A Cross Sectional Study.

AUTHOR:Dr. Ruth Sneha Chandrakumar, Assistant Professor, Sri Devaraj URS Medical College

Background : The milieu of medical education has always been regarded as a stressful setting to students. Stress during medical school can lead to problems later in professional life compromising patient care. Maladaptive personality traits like neuroticism are related with increased exposure to stressful life events and likely to make individuals susceptible in experiencing negative emotion and frustration.

Methodology : This descriptive cross sectional study was carried out among the first year medical undergraduates at Sri Devraj URS Medical College, Tamaka, Kolar. Data was collected using the Eyesenck’s Personality Questionnaire to assess the personality dimensions and Medical Student Stress Questionnaire to assess the levels of academic stress. The data was analyzed using the SPSS version-20.

Results : Out of the 144 students who returned the filled up questionnaires, 89 were females, 55 were males.19% had no stress, 43% had moderate stress and 38% had severe stress. Female students had more stress than the male students and this difference was statistically significant (p=0.004). The most common stressors identified in our study were feeling tired after a tight schedule from 8:30am to 4:30pm and difficulty in covering portions daily. The least common stressor was failure in the first sessional examination. 13.31% scored high on neuroticism which had a negative impact on the academic performance. There was a positive relationship between those who scored high on extraversion (11.92%) and their academic performance.

Conclusion: Early identification of the stressors can help prevent future illness among medical students. Understanding how personality dimensions affect the academic performance could help to provide a more conducive learning environment and make the teaching process effective both for the teachers as well as the students.

69. Title: Empathy in doctors and its association with job stress, satisfaction and burnout

AUTHOR-Dr. Abhinav Chichra, Assistant Professor, Christian Medical College, Vellore

Keywords: Empathy, stress, burnout, satisfaction

Background

Empathy is widely recognized as a desirable trait in doctors and is often described as an essential attribute of a ‘good doctor’.

Burnout is commonly defined as “a psychological response to chronic interpersonal job stressors, characterized by overwhelming exhaustion, feelings of cynicism and detachment from the job”. The medical profession is considered to be at particular risk of this syndrome. It has been shown to be associated with multiple negative outcomes at both the organizational and the individual level.

The association between empathy and the burnout syndrome is unclear, with contradictory findings in several studies. There is a paucity of data in this area, in the Indian setting.

Methodology

This study was a cross-sectional observational study, using standardized self-administered questionnaires, done among consultants in a large tertiary care hospital in India. Consenting clinicians completed questionnaires to assess levels of job stress, satisfaction, burnout and empathy. The instruments used were the Consultants Job Stress and Satisfaction Questionnaire, Maslach Burnout Inventory and Jefferson Scale for Physician Empathy. Descriptive and bivariate statistical analysis was used to test for significant associations.

Results

There were 232 respondents to the study. There was no significant difference in levels of empathy by age, gender, type of work or designation. Higher levels of empathy had a highly significant association with higher scores on the Emotional Exhaustion (p value=0.008) and lower scores on the Personal Achievement domains (p value= 0.0001) of the Maslach Burnout Inventory. No significant association was seen between extent of job satisfaction and levels of empathy.

Discussion

Though an objectively desirable trait, higher levels of empathy may contribute to higher levels of burnout in doctors. This has implications on any interventions focussing on preventing burnout in doctors.

70. TITLE:Perceived work stress among nonmedical hospital employees at a tertiary care teaching public sector hospital: An exploratory study.

AUTHOR:LAXMITEJ WUNDAVALLI, Assistant Professor, NEIGRIHMS

Introduction: Stress among healthcare workers, such as doctors and nurses, is well documented. However, the extent of stress among the non medical hospital employees is not extensively studied. The purpose of this study was to measure the extent of perceived work stress among various cadres of non medical staff working in a tertiary care public sector teaching institute.

Methods: The study comprised the non medical staff working in the hospital (n=706). 20 different categories of cadre were included in the study. The HSE Management Standards Tool was used to gauge the responses of the employees to work stressors along with a few questions on socio demographic characteristics. The mean score of each sub scale was compared with the organisational averages based on data constituted from 136 organisations by the Health and Safety Executive, UK. Results: The response rate was 82 per cent. The highest mean scores were observed in the domains: role (4.58+/-0.61), peer support (4.11+/-0.78), relationships (4.05+/-0.84) and manager’s support (3.98+/-0.77). The lowest scores were obtained in the domains: control (2.89+/-0.96), change (3.83+/-0.99), and demands (3.54 +/- 0.72). The major stressor was control which required urgent action (<20th percentile). The scores on each domain were compared with the domain scores of nursing staff.

Discussion: Overall, except for the domain ‘control’, the rest of the domain scores were above the 80th percentile compared to the benchmark scores. As expected, the lowest scores are in the domain ‘control’ as most of the employees are the lowest in the cadre hierarchy. There is a significantly higher stress among nurses compared to the non medical staff. The results indicate that the mental health of the non medical employees with respect to work is substantially good.

Key words: Stress, Non Medical Staff, HSE Management Standards Indicator Tool

71.TITLE:A Study of stress loading and outcome in psychiatric patients attending Family and Community Counseling OPD in the Department of Psychiatry IMS BHU Varanasi.

AUTHOR- ACHYUT KUMAR PANDEY, ASSOCIATE PROFESSOR, Dr PANKAJ GUPTA***DR. RAGHUNATH PRASADVERMA****DR. VINOD VERMA**** ASSOCIATE PROFESSOR Department of Psychiatry IMS BHU Varanasi

OBJECTIVE: This study was conducted to find out stress loading and outcome of counseling in the patients attending Family and Community Counseling OPD IMS BHU Varanasi..

MATERIAL AND METHOD : 100 patients of any psychiatric illness, both male and female without any medical illness were randomly selected from the patients who were attending family and community counseling out door in department psychiatry IMS BHU.

Patients were interviewed after written informed consent for sociodemographic and clinical profile. Diagnosis was made as per ICD-10 criteria. Ongoing stressor assessment was done by clinical interview as well as by application of SSDQ. Counseling of the patients was done multiple sessions and their stresses were mapped after each counseling sessions.. Sample analyzed with help of SPSS version 16.

RESULTS & DISCUSSION : Out of 100 patients, 92% patients had any kind of ongoing stress loading as per clinical interview. 34%had family conflict,20% had social problem, 10% had relationship issue, 8% had education problem., 6% had each of financial, adjustment and physical issue. As per SSDQ 50% had significant stress in 2 domens,30% had stress in more than 3 domens and 13% had stress in single domen of life on SSDQ. After 2-3 counseling sessions stresses were reduced to 50 % in statistically significant no of patients.

CONCLUSION:. Family and Community Counseling is an effective method to combat stresses. SSDQ is an important tool for mapping stress in follow up to assess the effect of counseling qualitatively as well as quantitatively.

KEY WORDS : Outcome, Family counseling, SSDQ

72.TITLE: Gender Differences Amongst Individuals with Opioid Dependence Syndrome and Its Treatment Outcome: A Retrospective propensity score matched cohort study

AUTHOR:Dr Diptadhi Mukherjee, DM Resident in Addiction Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS)

Background : Gender affects the preferred drug, clinical course, treatment seeking and outcome of Opioid use disorder. There is a paucity of studies exploring salient differences between male opioid users who seek addiction treatment.

Methodology : We identified all opioid users who presented to addiction treatment services between 2014-2017 using NIMHANS electronic database. Following this, 31 female opioid dependence cases (as per ICD-10) were matched to 69 male cases using propensity score matching algorithm. These matched samples are then compared using multivariate statistics to explore significant differences. Statistical analyses are done in R core software, optmatch & MatchIt packages are used for matching.

Results : For the full sample, mean age at 1st contact is 35.8 years. Majority of the subjects are married (67%), literate, belonging from above poverty line (90%). 52% are hailing from Karnataka state. Time taken for development of dependence form 1st use was less in female compared to male (0.33 vs 1.76 years). Comorbid personality disorders are comparatively more prevalent in the female group. Diagnosed pain disorders are almost a unique feature of the female group (p < 0.0001). Co-morbid substance abuse/dependence was significantly more in male opioid users. Majority of female opioid users initiated use secondary to pain-related sufferings in contrast to recreational purpose in males. Majority of females used Tramadol as principle opioid of abuse. Whereas, codeine had been used almost exclusively by male opioid users. Female addicts use injectable opioid significantly more compared to males. Buprenorphine maintenance therapy significantly improved short-term treatment outcomes (>3 months treatment retention and abstinence) compared to other modes of maintenance treatment (p=0.001) in the full sample. Female patients were more likely to achieve abstinence as compared to males (p = 0.031).

Conclusion : Female Opioid users have a unique clinical profile. They respond to treatment especially to buprenorphine better than males.

Keywords : Gender, Opioid dependence, Buprenorphine

73.TITLE: Early indicators of neurometabolic recovery in brains of abstinent alcoholics

Authors: PA Khadse1, B Holla1,SM Agarwal1, RD Bharath2, G Venkatasubramanian1,V Benegal1

Affiliation :

1 Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India

2 Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India

Background : Chronic use of alcohol leads to various structural, metabolic and functional deficits in dependent alcoholics. Although these deficits often cause an alcoholic to relapse again and again over his lifetime they may still be reversible to varying degrees during the periods of abstinence. Previous spectroscopic research has identified few indicators of cerebral regeneration in abstinent alcoholics. In current study we aimed at finding the early indicators of neurometabolic recovery within two weeks of abstinence.

Method: The study began after obtaining formal approval from the institute ethics committee. Twenty right handed, male patients with alcohol dependence syndrome were recruited from inpatient department of the Centre for Addiction Medicine at NIMHANS. An informed written consent was obtained from all the participants. They received detoxification with benzodiazepines which was followed by a drug washout period of three days. A magnetic resononance spectroscopy (MRS) scan was performed in a 3T machine. Two separate voxels were placed in bilateral anterior cingulate cortices (ACC) to measure the level of glutamate activity. Peaks of various brain metabolites were studied at the baseline and after two weeks of abstinence. During these two weeks all the patient received treatment with acamprosate.

Results: Based on previous literature the peaks of N-acetyl aspartate, glutamate, glutamine and choline associated compounds were studied. A significant reduction of glutamate (Glu) (t =2.95; p=0.011) and Glutamate-Glutamine (Glx) (t=2.18;p=0.047) peaks were observed at the right ACC after two weeks of abstinence. Reduction of Glx peak at left ACC was significantly positively correlated with subjective craving measurements.

Conclusion: Chronic alcohol use is known to cause an up-regulation of glutamatergic neurotransmission leading to a hyper-glutamatergic state during alcohol withdrawal. The reversal of this hyper-glutamatergic state starts occurring early in the recovering brains of abstinent alcoholics. Role of anti-glutamatergic action of acamprosate in this regards needs further exploration.

74.TITLE:The prevalence of psychiatric comorbidities and relapses in males treated for alcohol dependence syndrome -Prospective study from tertiary deaddiction care unit in Kerala, India

AUTHOR:Dr. Sheena. G. Soman, Consultant Psychiatrist, Mental Health Centre Thiruvananthapuram

Kerala has high percapita consumption of alcohol among the other Indian states. Objectives:Prevalence of psychiatric comorbidities in alcohol dependence syndrome and association of severity of alcohol dependence, personality dimensions, motivation and short delay relapses Methods: A prospective study in 91 male alcoholic patients for 2 months. Results:Two groups not relapsed (NR= 48) and Relapsed (R= 43) were comparable in age, SADQ severity score, average units of alcohol consumption and years of alcohol use. Average consumption was 17 units /day (500ml spirits), age of onset before 25yrs 87%, mean age 40 and severe alcohol dependence was in 57% of study population. Comorbid Nicotine use was 80.2% and in equal numbers in the relapsers and non relapsers group Conclusions: Bipolar disorder was the most prevalent (19.8%) in the study population. About 53.8% had Alcohol dependence as the primary diagnosis with no associated psychiatric comorbidities. Anxiety disorders(12%) and personality disorders(19.7%) were found more in the Relapsers group. Anxiety symptoms seemed to be a risk factor for relapsing compared to other comorbidities in bivariate analysis (pearson chi square 5.998, p=0.014). Psychoticism among relapsers were high (Pearson chi square 4.901,p value 0.027 OR-3.782,95% CI 1.103-12.958). Comorbidities were not statistically significant in multivariate (Pearson chi square 1.765,p=0.184,OR-1.755,95% CI. 763-4.037) Severity of alcohol dependence in relapsers was not significant (Pearson Chi square. 650, p=.722). Motivation levels of 62.8% of relapsers were low, 32.6% medium and only 4.7% reported high motivation (Pearson Chi-Square 11.846, P= 0.003). Poor motivation proved to be a risk factor for future relapse(P=0.008, 95% CI 1.266-4.648, SE.332).

75.TITLE: Stress and Quality of Life of parents having children with Autism Spectrum Disorder: A Gender Perspective

AUTHOR: Prashant Srivastava1, Vani Narula2, Savita Chahal3

1 Ph.D Scholar, Department of Social Work, Jamia Millia Islamia, New Delhi and Psychiatric Social Worker, Department of Psychiatry, Kalpana Chawla Government Medical College, Karnal, Haryana

2Associate Professor, Department of Social Work, Jamia Millia Islamia, New Delhi

3Assistant Professor and Head, Department of Psychiatry, Kalpana Chawla Government Medical College, Karnal, Haryana

Parenting, a wonderful and rewarding experience, is sometime accompanied by high levels of stress, because of the difficulties, frustrations, and challenges that parents face in everyday life. The coming of a child with autism brings unexpected demands and challenges to parents, for which they are often not prepared. Having a child with autism has life changing implications and long-lasting effects on the entire family. Many aspects of family life and dynamics are adversely affected and on the other hand a few aspects get strengthened. Parents of children with autism experience heightened anxiety, overburden and marginalization in society, sense of self blame, tiredness or exhaustion and poor quality of life. Aims & Objectives: To assess and compare the Stress and Quality of Life of parents having children with Autism Spectrum Disorder: A Gender perspective. Method: 100 parents (50 father & 50 mother respondents) have been included purposively in the study. Semi- Structured Socio Demographic datasheet was used to collect the relevant socio demographic information followed by Parental Stress Index and WHOQOL Bref. Data collected was analyzed using Statistical Package for Social Sciences (SPSS- 20 version). Result and Conclusion: Results suggests that mothers having children with autism spectrum disorder found high stress and low quality of life than its male (father) counterparts.

Keywords: Parenting, Stress, Quality of Life and Autism.

76.TITLE:Successful Management of a case of Protracted Delirium Tremens

AUTHOR: Preethy Kathiresan, Senior Resident, AIIMS, DTDC

Ravindra Rao, Shubham Narnoli, Gagan Hans, Pratap Sharan

Introduction

Delirium tremens (DT) usually begins on the third day of alcohol reduction or abstinence and can last for up to a week. However, in around five to ten percent of cases of DT, it can last longer than one week. The standard treatment of DT is benzodiazepines. Studies show that in some cases, DT do not respond even to high doses of benzodiazepines leading to an entity called as refractory DT. In such cases, existing literature supports the use of barbiturates. However, barbiturates can cause respiratory depression, and such patients have to be managed in an Intensive Care Unit setting. We present a case of refractory DT whom we could manage without resorting to use of barbiturates.

Case summary

A 22-year old married male was admitted in an inpatient facility of a drug dependence treatment unit for management of alcohol dependence syndrome due to his inability to abstain on an outpatient basis. He was started on oral lorazepam for withdrawal management; however, he developed DT on second day of admission. The dose of lorazepam was gradually increased with which there was a partial improvement in his symptoms. However, delirium did not resolve completely. We increased the dose of lorazepam upto 58 milligram per day, despite which the symptoms continued. As patient also had sleep disturbance, to ensure sufficient sleep, tablet trazadone was initiated in dose of 50 milligram per day, which also led to complete resolution of his symptoms of DT by day 18 of abstinence.

Conclusion

Our case had both protracted and refractory DT. The patient did not have any comorbid conditions which are often reported with protracted DT. The patient could be successfully managed in an inpatient setting without requiring admission to an ICU. This case adds to the limited literature on protracted and refractory DT in alcohol dependent patients.

Key words: Delirium tremens (DT); Protracted DT; Refractory DT; Trazodone

77.TITLE:Clozapine in clinical profile – An Observational study in a tertiary care centre in India

AUTHOR:Dr Kusumamala N, Specialty Medical Officer

Dr Sushma Sonawane, Dr Nilesh Shah,Lokmanya Tilak Municipal Medical College & Hospital, Mumbai,E-mail id: kusumamalan@gmail.com

Background: Clozapine being one of the most effective anti psychotic drug used in varied conditions is often considered as a double edged sword owing to its deadly side effects. Lack of Indian study on the clinical profile on this in the recent years urged us to take up this study in a tertiary centre like ours.

Aims: To assess the diagnoses in which clozapine is used, the reason for initiation, the doses in which the drug was started and maintained also its side effect profile & efficacy.

Material & methods: This study is a Retrospective observational study done by convenient sampling using a semi structured questionnaire over 1 year.

Results: Majority of patients (70%) who were on clozapine suffered from schizophrenia & related disorders followed by Bipolar mood disorder (13%). Diabetes was the most common co-morbid medical condition followed by hypertension. patients with MR with behavioral issues had been on clozapine for the longest followed by schizophrenia and related disorders. More than half (53.7%) of the study population had to be started on clozapine in view of treatment resistance. Around 10% of patients were started on clozapine for suicidality. Majority of the patients (n=136) had a mean starting dose of about 25mg of clozapine. Most patients (n=45) were maintained at 100mg. More than 85% of the study population had perceived improvement of grade 2 and above on CGI improvement scale. Most common side effect was sedation which was seen in less than 30% of the study population.

Conclusions: the present study concludes that clozapine is as effective as the literature attests however the odds of the grave side effects are considerably low and this is keeping the clinicians from prescribing clozapine hence keeping the patients away from the full benefits of the drug.

Key words: clozapine, treatment resistance, tardive dyskinesia, suicidality, diabetes

78.TITLE: PREVALENCE OF SUBSTANCE ABUSE IN PATIENTS OF SCHIZOPHRENIA

AUTHOR:Dr Parisha Kelkar,Resident, Department of psychiatry,Jawaharlal Nehru Medical College, Wardha,Kelkarparisha25@gmail.com9422865577

INTRODUCTION: Substance abuse is a common comorbidity in patients of Schizophrenia. Link between the use of substances and development of psychosis is demonstrated by high prevalence of substance abuse in schizophrenia. Substance use disorders and their effects on course of schizophrenia have made identification and treatment of schizophrenic patients a high priority. This study aims to investigate the prevalence of substance abuse, preferred types of substances of abuse and its association with sociodemographic characteristics and clinical features of schizophrenia.

MATERIALS AND METHODS: It is an observational cross sectional study conducted at Jawaharlal Nehru Medical College, Wardha. Sample size of 100 patients was taken. The participants were assessed by proforma containing sociodemographic details, questionnaires PANSS, AUDIT, Fagerstrom, DAST-10. Patients with substance abuse were compared with patients without substance abuse on demographic and disease related characteristics. Categorical data was analyzed by Chi- Square test and quantitative data was analyzed by t-test.

RESULTS: 48% patients of schizophrenia had substance abuse. Smokeless tobacco was found to be the most commonly abused (42%) by patients of Schizophrenia. Substance use was more common in males than females. Smokeless tobacco was the only substance abuse in females (18%). Substance use was more common in patients belonging to lower socioeconomic status and those having family history of psychiatric illness and substance abuse. Schizophrenic patients with substance abuse had more PANSS positive score than those without substance use.

CONCLUSION: Substance abuse is a significant comorbidity in patients of schizophrenia in India.

KEYWORDS: Schizophrenia, Alcohol abuse, Comorbidity

79.TITLE:Internet Use and Addiction among Medical Students in Tertiary care Teaching hospital in South India

AUTHOR:Subahani Shaik, Assistant Professor, Narayana Medical College and Hospital

E Ananda Reddy, Ch Lakshmi Rajesh, V V Sehamma.

Abstract:

Objectives: To measure the prevalence of internet use and addiction among the Medical students of Narayana Medical College and Hospital and determine its association with gender, Academic Performance and Students health.

Methods : A cross sectional Study was conducted, during August 2018 to February 2019 in the Narayana Medical college and Hospital, Nellore Andhrapradesh using the Internet Addiction Test (IAT) questionnaire. The questionnaire was distributed by simple random methods to medical students in the Para and clinical phase, (2nd, 3rd and 4th -years). The sample size was 216 students. SPSS was used for statistical analysis Chi-Square test was used to determine whether there is a significant relationship between the use of internet and gender, academic Performance, and students’ health.

Results :

The response rate was 95.37%. 121 (58.74%) were males, and 85 (41.26%) were females. It was found that 12.4% were addict to the use of the internet and 57.9% had the possibility of being an addict. Females were more frequent users of the internet than males (p=0.006). 63.10% of students were affected in their academic performance. 71.84% of students lost their sleep due to late night log-ins and hence, this affects the early attendance to their morning activities. 59.70% of the respondents expressed feeling depressed, moody, or nervous when they were off-line.

Conclusion : Internet Addiction among medical students at Narayan Medical College Hospital was found to be very high. This ultimately affects their academic performance and psychological well-being. Suitable interventional and preventive measures are needed to encourage the proper use of the internet to protect the mental and physical health of the students.

Keywords: ; Internet use; Medical Students, South India, Medical College.

80.TITLE:Caregiver Burden and Resilience in Family members of Alcohol dependence patients : A study in rural south India

AUTHOR- Keya Das,Assistant Professor PESIMSR Kuppam

Chaitra.M, Ravikumar.S

Introduction : General population surveys in India have reported a prevalence of alcohol use ranging from 1.15% to 50%. Alcohol Dependence in Partners increased the risk for mental health disorders above and beyond significant socio-demographic risk factors, with an associated population attributable fraction of 17.5%. Families with Substance dependent patients face stigmatization, long term economical and emotional burden of taking care of the patient. Resilience is crucial for families in coping with extreme stress and trauma related to living with people with significant interpersonal, familial, marital, social, and occupational dysfunction. Our study aimed to assess Caregiver Burden in Families with Alcohol Dependence and co-relate it with Resilience.

Method: 101 patients diagnosed as Alcohol Dependence Syndrome as per ICD 10, with their Caregivers were consecutively recruited for the study over 1 year, from the Psychiatry OPD at a Tertiary Care teaching Hospital in South India. Family Burden Scale(BFSC), SADQ and Brief Resilience scale was applied on the Caregivers following Consent. Approval was taken from Ethical committee. Statistical analysis was done using SPSS 16.

Results: Out of 101 Caregivers, 61 experienced Moderate burden and 26 severe to very severe Burden on BFSC. Co-relation with Severity of Alcohol Dependence(SADQ) found 61 caregivers with Moderate Burden to have 27 family members with moderate Dependence and 28 High Dependence,(p=0.001). Majority (57) scored low. ie. <2.5 on Brief Resilience scale and co-relation with Severity of ADS (SADQ) revealed Poor Scores of BRS being significantly co-related to Moderate Dependence (27) and High Dependence(28) with p=0.042.

Conclusion: Caregivers of Alcohol Dependence patients are burdened with a positive relation to Severity Of Alcohol Dependence, and Resilience in Caregivers is poorer in those with Moderate to High Dependence.

Burden, Resilience, Alcohol dependence

81.TITLE:Anxiety in pregnancy – A cross sectional study on women attending antenatal check up in a tertiary care hospital in India

AUTHOR:Dr Krithishree S.S1, Dr Bindhu Bhaskaran2, Dr Ashraf Ali A2,Consultant psychiatrist, KMC Hospital, Mangalore,Kerala Institute of Medical Sciences, Trivandrum

BACKGROUND AND OBJECTIVES:

Pregnancy is one of the life changing events in a woman’s life and anxiety level of women associated with pregnancy often goes unnoticed. As clinicians even we do not address these issues.

Anxiety in antenatal period has a direct impact on the overall mental and physical wellbeing of the mother. Anxiety is considered to be a risk factor for many physical illnesses. It affects the physical heath of the mother and hence the growing fetus.

If anxiety in the antenatal period is identified then we can minimize the poor pregnancy outcome. In this intent, the current study attempts to study the prevalence of anxiety level in pregnancy by using Hamilton Anxiety Rating Scale (HAM-A).

METHODOLOGY:

The sample consists of 75 antenatal mothers. All the study subject were medically stable, cognitively intact and were co-operative. Subjects were assessed using Hamilton Anxiety Rating Scale for the anxiety symptoms. Descriptive statistics were used for data analysis.

RESULTS:

In our study, on HAM-A scale 73.33% were found to have mild anxiety symptoms, 14.67% had moderate amount of anxiety symptoms and 9.33%of antenatal mothers had severe amount of anxiety symptoms. The common symptoms were fears, insomnia, depressed mood, GI symptoms and tension.

CONCLUSION:

Mild anxiety symptoms were commonly prevalent among the pregnant females. On a universally used anxiety screening tool about 97.33% of antenatal mothers were found to have anxiety symptoms in which 24% had moderate to severe degree. Screening instruments are useful but a structured diagnostic clinical interview is essential to confirm the diagnosis before treatment intervention.

82.TITLE:Correlation of Social cognition and aggression in children and adolescents with ADHD

AUTHOR:Dr Bikram Kumar Dutta, SR, CHILD & ADOLESCENT PSYCHIATRY DEPT,NIMHANS

Background :- Adequate social functioning and healthy peer relationships are considered primary conditions for children’s primal development, and having healthy satisfying relationships in future. There is ample evidence that in children and adolescents with ADHD, symptoms interfere and reduce the quality of social, academic and occupational functioning. The term social functioning encompasses social skills and interactions, social cognition and behaviours displayed by the individual, which can affect adaptation in school, home and community environments. The present study attempted to find correlation of ADHD with social cognition deficits and its role in aggression and other areas of dys-functioning. Material and Methods :- the main objectives of this study was to study the various presentations of ADHD, and its correlation with social cognition especially ‘theory of mind’ construct, and to understand the impact of aggression, if present on social functioning in children with ADHD. About 20 subjects between the ages of 8 and 16 years of age were administered ADHD Rating Scale 5 (Home Version), Children’s Aggression Scale, Strength and Difficulties Questionnaire (SDQ), Children Global Assessment Scale (CGAS) and SOCRATIS Theory of Mind (TOM) tasks. Results :- It has been observed that in first and second order theory of mind tasks, scores progressively declined as the ratings on ADHD increased (p=0.01, 95% CI 0.81-0.151), especially hyperactivity symptoms (ADHD HI scores, p=0.004, 95% CI 0.83-0.235), also as externalising symptoms rise as per SDQ ratings (p=0.16, 95% CI 0.69-0.141). However, TOM tasks showed gradual improvements with corresponding age of the participants. Conclusions :- Poor social cognition in children and adolescents with ADHD leads to impaired social and adaptive functioning. Social cognitive remediation programs including learning strategies and positive appraisals may help to benefit these patient

Keywords - ADHD, social cognition, theory of mind tasks

83.TITLE:PREVALENCE OF ANXIETY AND DEPRESSION IN NEWLY DIAGNOSED PATIENTS WITH TYPE 2 DIABETES AND HYPERTENSION IN AN INDUSTRIAL CITY OF EASTERN INDIA

Author: Dr. Prabhat Kumar, SR DEPUTY DIRECTOR M&HS & Dr. Subodh Kumar

Affiliation: Dept. of Psychiatry, Bokaro General Hospital, Bokaro Steel City, Jharkhand (India).

Introduction: Though there is bidirectional relationship between psyche and soma, psychiatric comorbidity with chronic physical illnesses has remained less attended and, rather, neglected in India.

Aims: The present study intends to estimate the prevalence of anxiety and depression in patients with diabetes and hypertension in a sample of industrial population of Bokaro Steel City. Methods: Recently diagnosed (< 6 months duration) 123 diabetic patients, 151 patients with hypertension, and 160 unrelated healthy controls, aged 25-50 years, were randomly recruited from the medical OPD of the Bokaro General Hospital, Bokaro Steel City, after taking informed written consent during Oct. 2017-Aug. 2018. Patients of both groups included in the study were interviewed clinically and examined on the Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale. Healthy control subjects were assessed on the General Health Questionnaire-12.

Results: Diabetic patients had significantly more depression (20.32% vs. 10.62%), anxiety (24.39% vs. 14.37%) and comorbid depression and anxiety (17.89% vs. 8.75%) as compared to healthy controls. Patients with hypertension also showed more depression (21.19% vs. 10.62%), anxiety (27.15% vs. 14.37%) and comorbid depression and anxiety (19.20 vs. 8.75%) compared to the healthy controls. Findings will be discussed in detail at the time of presentation.

Conclusion: Prevalence of depression and anxiety is found significantly more in the newly diagnosed patients with diabetes and hypertension as compared to the healthy controls. Anxiety and depression are supposed to be risk factors for diabetes and hypertension and therefore has large-scale clinical implications.

Keywords: Prevalence, depression, anxiety, diabetes, hypertension.

84.TITLE:STUDY OF VITAMIN D DEFICIENCY IN DEPRESSION PATIENTS-IS IT THE REASON FOR HIGH RATES OF SOMATIC PRESENTATION OF DEPRESSION?

AUTHORS: 1) DEBASISH SANYAL,M.D,, ASSOCIATE PRODFESSOR, DEPTARTMENT OF PSYCHIATRY, KPC MEDICAL COLLEGE,JADAVPUR, WEST BENGAL, INDIA.E-mail-dsanyal99@hotmail.com, 2) BHASKAR MUKHERJEE, M.D.,R.M.O. cum CLINICAL TUTOR, DEPARTMENT OF PSYCHIATRY, MALDAH MEDICAL COLLEGE, WEST BENGAL. E-Mail- dr.bhaskar.mukherjee78@gmail.com

AIMS AND HYPOTHESIS--- to compare prevalence of vitamin D deficiency between depressed and non depressed subjects and see if somatic presentation of depression has any correlate with vitamin D deficiency. Observational cross-sectional study planned.

BACKGROUND- - Reports suggest high prevalence of vitamin D deficiency which might cause physical symptoms and illnesses like pain. Depression is speculated to be dependent on vitamin D status because the vitamin D receptor (VDR) is widely distributed in the human brain including areas that are assumed to be involved in the pathophysiology of depression.

Aims --- to compare prevalence of vitamin D deficiency between depressed and non depressed subjects and see if somatic presentation of depression has any correlate with vitamin D deficiency.

METHODS- --60 diagnosed MDD patients consenting to participate in the study from a large private hospital selected provided they were non-smoker,18-65 years, free from chronic illness(like hepatic, renal, dermatological disorders), and not taking antidepressant. Pregnant women were excluded. Control (60 subjects) comprised of close family members of patients. FSC (functional somatic complaints) was assessed using local language version of Bradford Somatic Inventory (BSI), while severity of depression was assessed using HDRS-17. Based on the total score, FSCs are categorized into 3 grades (a score >40 is considered to be the ‘high’ range, 26-40 ‘middle’ range, and 0-25 ‘low’ range). Control comprised of close family members of patients. Blood samples were collected for routine tests and Vitamin D (total) estimation(Deficiency <20ng/ml; insufficiency between 20-30ng/ml and sufficient when >30ng/ml).

RESULTS-Study consisted of 60 subjects in both groups, Rate of vitamin D status (deficiency:insufficiency:sufficiency) was 70:30.0::0.0% in depressed, which significantly worse compared to control subjects(55%:25:20%). Patients with higher BSI scores (i.e. more somatisation) showed non-significantly lower vitamin D level. These results were more prominent for female subjects.

CONCLUSIONS -Vitamin D deficiency is more common in depression subjects, which might thus need to be looked for and treated. However, no significant link between somatisation and vitamin D deficiency could be established.

KEY WORDS ---- depression, vitamin D deficiency, somatic symptoms

85. Title: A comparative study of depression, anxiety, stress and coping strategies in primary caregivers of patients with Obsessive compulsive disorder and Depression.

Authors:

Dr. Sachin C. Lohar (Presenting Author), Junior resident,, Dept. of Psychiatry,, Seth G.S. Medical college & K.E.M. Hospital, Mumbai,Contact: 9730767013

Dr. Shubhangi R. Parkar Professor & Head,Dept. of Psychiatry,Seth G.S. Medical college & K.E.M. Hospital, Mumbai.

Introduction:

Obsessive compulsive disorder (OCD) is the fourth most frequent psychiatric condition. OCD affects not only the person with OCD but those around them. Western studies reported poorer mental health and a significantly greater reliance on maladaptive coping strategies in caregivers. Depression also is one of the most common and debilitating mental disorder. This study was conducted to compare depression, anxiety, stress and coping strategies in primary caregivers of patients with OCD and Depression.

Methods:

It was a cross-sectional observational study. 30 primary caregivers of OCD and depression each were selected by convenient random sampling. After taking informed consent subjects were assessed on Depression, anxiety, stress scale (DASS 21) and Coping Strategy Inventory- Short Form (CSI-SF).

Results:

Amongst primary caregivers of OCD, Depression was seen in 56.66%, Anxiety in 36.66 % and Stress in 50 % of caregivers. Amongst primary caregivers of Depression, it was seen in 46.66%, 33.33% and 26.66% respectively. DASS scores in caregivers were positively correlated with patients YBOCS/HAMD scores(r=0.61/0.67). Problem focused engagement copings were more commonly seen in caregivers having low DASS scores. Emotion focused copings were positively correlated with Depression in caregivers (r=0.63).

Conclusion:

Our study showed comparatively more Depression, Anxiety, Stress in primary caregivers of patients with OCD than Depression. Study also highlighted need of psychoeducation for improving coping strategies.

Keywords: OCD, Depression, caregivers, coping

86.TITLE: “A Study Of Religious Attitude And Its Association With Depression, Anxiety Disorder And Quality Of Life Among Undergraduate Medical Students”

AUTHORS:Dr. Hiren P. Mor,Resident Doctor, Department of Psychiatry, Government Medical College & Sir. Takhtasinhji Hospital, Bhavnagar.

Co- Author:

1. Dr. Ashok U. Vala, Associate Professor, Department of Psychiatry,

Government Medical College, Bhavnagar – 364001.

2. Dr. Bharat N. Panchal, Professor and Head, Department of psychiatry,

Sir Takhtasinhji General Hospital & Govt. Medical College, Bhavnagar-364001.

3. Dr. Imran J. Ratnani, Senior Resident, Department of Psychiatry,

Government Medical College, Bhavnagar – 364001.

4. Dr. Sneha Vadher, 2nd year Resident, Department of Psychiatry,

Government Medical College, Bhavnagar – 364001.

5. Dr. Aayushi Shah, 1st year Resident, Department of Psychiatry,

Government Medical College, Bhavnagar – 364001

Address: Room NO-133, Department of Psychiatry, Government Medical College and Sir Takhtasinhji General Hospital, Bhavnagar, Gujarat, India

Phone numbers: 07567047272/09428232666

Fax numbers: 91-278-2422011

E-mail address: hirenmor127@gmail.com

Introduction: There has been increasing interest in effect of religious belief and activity on mental health, particularly in regard to depression

Aims and Objective : We studied association of religious attitude with severity of depression, anxiety disorders and quality of life.

Methods: This was an observational, single centered, cross sectional, questionnaire based study of 115 undergraduate medical students. Every participant assessed for demographic details, Duke University Religion Index (DUREL), Religious/Spiritual Coping Scale (RCOPE), Hospital Anxiety Depression Scale(HADS), The World Health Organization Quality Of Life (WHOQOL-BREF) for religious activity, positive and negative coping, anxiety and depression and Quality of Life assessment respectively.

Results: We found a significant association for depression with money spent on religious activity(p=0.0031) and negative religious coping(0.040). Participants having anxiety and depression have poor quality of life in all domain of WHOQOL-BREF(p<0.001). Sores of negative religious coping is correlated with severity of anxiety(r=0.0125, p=0.0317) and depression(r=0.250, p=0.007)

Conclusion: Spending money on religious activity and having negative coping are associated with depression. Anxiety and depression are associated with poor quality of life

87. Title: - A study of Resilience, coping strategies & personality profile in people attempting suicide, referred to a tertiary care hospital

Authors:Dr Tanvi Vaidya (Presenting Author), Resident Doctor, Dept of Psychiatry, Seth GSMC and KEM hospital, Parel Mumbai

Dr Shubhangi R Parkar, Prof and HOD, Dept of Psychiatry, Seth GSMC and KEM hospital,Parel Mumbai

Introduction: In psychiatry, suicide is an emergency and often a mirror to an underlying psychopathology. Recently, there has been growing interest in the concept of “resilience to suicidality”. Resilience is a protective factor which prevents suicidal ideations from turning into a suicide attempt. Similarly implementing effective coping strategies is vital especially in the presence of risk factors of suicide. In research certain personality types are identified to have a greater propensity to attempt suicide.

Method : Patients with suicide attempt following up for psychiatric evaluation were included in study by convenient random sampling. Patients were divided into 2 groups with Group A with no previous attempts & group B consisting of patients with previous history of suicide attempts. Patients were assessed on Brief Resilience scale, coping strategy inventory and Big five inventory.

Results : The association between multiple suicide attempts and low Resilience score was statistically significant. (p=0.0391). Coping strategy inventory indicated 76.9% of those in Group B have emotional focussed disengagement and 30.7% have problem focussed disengagement. Most common coping strategy used in the group A is problem focussed engagement (53.84%) and Emotional focussed disengagement (23.07%). High Neuroticism score was seen in Group B (38.46%) whereas high conscientiousness was seen in Group A (30.76%.)

Conclusion: The above results show significantly low resilience, high neuroticism score and emotional focussed disengagement with multiple suicide attempts. High resilience, high conscientiousness and problem focussed engagement was seen in patients with no previous suicide attempts.

88.TITLE:Comparative study of sexual dysfunction between alcohol and opioid dependence patient in a tertiary care center in western Rajasthan.

AUTHOR:Dr. Ashok Chaudhary, Resident Doctor, Govt Medical College

Abstract: Chronic and persistent alcohol and opioid use is known to induce sexual dysfunction, which causes marked distress and impaired sexual life, like premature ejaculation, low sexual desire and erectile dysfunction, decreased sexual desire.

Keywords: Alcohol dependence, sexual dysfunction

Aim and objective: We attempted to assess the prevalence of sexual dysfunction in patient of alcohol & opioid dependence.

Materials and Methods: One hundred consecutive male subjects who attend deaddiction center with diagnosis of alcohol dependence and opium dependence syndrome, were assessed for sexual dysfunction using a sexual dysfunction checklist, constructed using items from the Diagnostic Criteria for Research (ICD-10) for sexual dysfunction. Two groups, one from opium dependence, 2nd from alcohol dependence were made, each group had 50 patients. By using SPSS a comparative study was done.

Results: will be discussed at the time of presentation.

89.TITLE:Psychiatric morbidity in postpartum women: A study at Tertiary care hospital in North India.

AUTHOR:SUNIL KUMAR, RESIDENT DOCTOR, JAWAHAR LAL NEHRU MEDICAL COLLEGE

BACKGROUND Post partum period is associated with several physiological and mental changes, psychiatric morbidity during this period are also common, affecting about 1-2 women per 1000 women.there was paucity of research in this geographic area regarding post partum psychiatric morbidities. Aim of this study was to assess post partum psychiatric morbidity at tertiary care hospital.

METHODOLOGY Cross sectional observational study carried out at tertiary care hospital consisting of 200 study subjects and assessment was done using MINI (Mini International Neuropsychiatric Inventory) and Depression, Anxiety and Stress Scale - 21 Items (DASS-21).subjects were between 20-40 years of age and attended hospital for their first follow up after child birth.

RESULTS The Psychiatric morbidity was present in 92 (46%) of study subjects. most common psychiatric disorder found in study was post partum blues (n=55, 27.5%) subjects followed by post partum depression (n=30, 15%) subjects. Post partum Psychosis, obsessive compulsive disorder, phobia were different psychiatric illness that were found in study sample.no case of mania, substance use disorder, PTSD was found in study.statsistically significant association was found between psychiatric illness and bad obstetric history (p value <0.05).

CONCLUSIONS The study reveals that psychiatric co-morbidity is very common in the postpartum period and can be detected as early as first week after delivery. Cases of OCD and social phobia was also found in post partum period.in order to generalize findings one needs larger sample with prospective assessment.

KEYWORDS Post partum, post partum depression, phobia, psychiatric morbidity, Post partum blues.

90. TITLE:A PRELIMINARY STUDY OF CONSULTATION LIAISON (CL) PSYCHIATRY IN AN INDUSTRIAL HOSPITAL

AUTHOR:ARNAB BHATTACHARYA, SPECIALIST (PSYCHIATRY)

TATA MOTORS HOSPITAL

CONTEXT - The general hospital psychiatry unit offers an opportunity to study the various interdepartmental case referrals made to a Psychiatrist.

AIM- This study tried to look into the age-sex distribution and psychiatric diagnoses of the patients referred to Psychiatry, in an industrial hospital in Eastern India.

SETTING -The study center is a 404 bedded secondary level hospital in Jharkhand.

SAMPLE & METHOD -The sample included 337 patients, both inpatient and opd cases over a period of six months.

RESULTS -A majority of the subjects were male (59.35%) while females made up 40.65% of the cases. Age wise, 51 (16.91%) subjects belonged to the pediatric group, 183 (54.30%) belonged to the adult group and 97 (28.78%) subjects were from geriatric category. The maximum referrals were from departments of Medicine (67.06%), Pediatrics (15.13%) and Surgery (3.56%). The most common diagnoses noted were Somatization disorder (18.9%), Organic psychiatric disorders (12.7%) and unipolar depression (10.39%). CONCLUSION -The above findings give an insight into the prospect of a much needed independent CL psychiatry unit in our center.

KEYWORDS – Consultation-liaison, General hospital psychiatry unit, industrial psychiatry.

91.TITLE:”A STUDY OF DISABILITY AND FAMILY BURDEN IN PATIENTS WITH OBSESSIVE-COMPULSIVE DISORDER”

AUTHOR:RAJMAL MEENA, Senior Resident Doctor, R.V.R.S. Medical College

Background:- Obsessive Compulsive Disorder (OCD) is a disorder characterized by recurrent persistent ideas, thoughts or impulses that are experienced as intrusive and cause marked distress and / or anxiety (obsessions), and or / repetitive behaviors aimed at reduction of distress or anxiety (compulsions). The lifetime prevalence of OCD is estimated to be around 2% to 3%. The mean age of onset is ~20 years. OCD patients report general impairment in their functioning. They also suffer from disability in several areas, particularly in self-care, occupational, interpersonal activities, communication and understanding, emotional and social functioning.

Materials and Methods:- The study was conducted in Department of Psychiatry of New Hospital Medical College, attached to Govt. Medical College, Kota (Raj.). A total of 50 consecutive patients diagnosed as suffering from Obsessive Compulsive Disorder as per International Classification of Diseases-10 criteria were assessed along with socio- demographic profile, Yale Brown Obsessive Compulsive Scale (Y-BOCS), Indian Disability Evaluation & Assessment Scale (IDEAS).

Results & conclusion:- The study group mainly concisted of young married males(74%), residing in urban area(68%), literate(88%), self employed(43%) and belonged to middle socioeconomic class(88%). Their main obsession was contamination (46%) and main compulsion was of cleaning (46%). Severity was of moderate level in maximum patients (42%). On IDEAS Scale most patients had mild disability with work domain most affected (score: 1.10 +/- 0.89) followed by the doamin of communication and understanding. Family burden was mainly in disruption of routine/ family activities (52%), disruption of family interaction (46%) and disruption of family leisure overall (44%).

Key Words:- OCD, Disability, Family burden.

92.TITLE: A queer case of penile ulcer in Psychiatry OPD

AUTHOR:Dr Sumanta Dawn*, Senior Resident, Malda Medical College and Hospital

Theme : Anxiety disorders and OCD

Abstract :

Mr. AB, 14-year-old, Hindu Male was suffering from penile ulcer, referred to Psychiatry OPD from the Department of Dermatology. It was evident from clinical history that the patient was having obsessive doubt regarding his penis being erect all the time. At the beginning the problem was amenable to reassurance. In due course, being obsessed with the same thought he compulsively pressed his penis between his legs. The patient was diagnosed to have Obsessive Compulsive Disorder (OCD) and treated for the same. After successful treatment for 4 months, his obsessive doubt has gone and so was the penile ulcer.

Keyword : Penile Ulcer; OCD; Obsessive Doubts

93.TITLE:BODY FOCUSSED REPETITIVE BEHAVIOURS IN SCHOOL GOING CHILDREN AND ADOLESCENTS AND ITS RELATIONSHIP WITH STATE-TRAIT ANXIETY AND LIFE EVENTS

AUTHOR:Swati Sailly1, Senior Resident, Central Institute of Psychiatry

Roshan V. Khanande2, Sanjay Kumar Munda3

Introduction: Body-focused repetitive behaviours (BFRBs) refers to a group of problematic, destructive and apparently non-functional behaviours directed towards one’s own body (Hensen, 1990). The key factor underlying BFRBs is difficulty resisting the urge or impulse to perform certain behaviour and performing which causes a degree of relief. BFRBs and its relationship with anxiety and stress are well known and if state trait anxiety that define different aspects of anxiety in a subject and life events that determines stressfulness could be a reason behind BFRB’s it would be worth studying the relationship between BFRBs, state-trait anxiety and significant life events.

Materials and Methods: The study was conducted amongst 978 students from class 5th -10th. Students reported ‘yes‘on modified habit questionnaire were rated on ‘GHQ-12’ to measure current mental health. Students were assessed as per the bi-modal scoring system and those scoring cut-off score of 4 or more than 4 were excluded from the study. The 21 students were left which were further assessed on STAIC and life event scale for Indian population. The results obtained was analyzed by using the computer software program, Statistical Package for Social Sciences-version 24.0 (SPSS-24.0) for Windows.

Results: On assessing the individual Body Focussed Repetitive Behaviours, children and adolescents with hair pulling have elevated STAIC trait score as compared to children and adolescents without hair pulling. On assessing the individual Body Focussed Repetitive Behaviours, children and adolescents with nail biting have elevated life event severity score as compared to children and adolescents without nail biting.

Conclusion: Body Focussed Repetitive Behaviours are common in normal population of school going children and adolescent. Presence of BFRBs among them may be attributed to increased levels of anxiety and various life events occurring in their life. Their behavior can have serious physical and psychological consequences in their life.

Keywords : Body Focussed Repetitive Behaviours, STAIC, Life events.

1- Senior Resident, Central Institute of Psychiatry

2- Asst Prof, Central Institute of Psychiatry

3- Asst Prof, Central Institute of Psychiatry

94.TITLE:”NEURAL CORRELATE OF EMOTION RECOGNITION IN BIPOLAR DISORDER AND SCHIZOPHRENIA: A COMPARATIVE STUDY”

AUTHOR:Dr. Sudip Kumar Sinha, SENIOR RESIDENT, CENTRAL INSTITUTE OF PSYCHIATRY

Background: Patients with bipolar disorder and schizophrenia both exhibit consistent deficit in facial emotion recognition in acute phase of illness as well as during symptomatic recovery. Bodily expressions also influence processing of facial expressions. When face and body convey conflicting emotional information (incongruent), judgment of facial expression is hampered. However, Compared to facial emotions, body language has been under-researched. Till date, there has been no systematic investigation into how facial expressions and emotional body language interact in human observers, and the underlying neural mechanisms are also unknown.

Methods: 30 psychotic bipolar mania patients, 30 schizophrenia patients and 30 matched controls were recruited in the study. Controls were age, sex and education matched with the patient groups. 64 channel Event-related potential (ERP) recording was done while the subjects were performing on the Facial Emotion Recognition Task and Facial and Bodily Emotion Recognition Task. Late positive component (LPC) latency and amplitude were marked. Statistical analysis was done using SPSS 23.0.

Results: Both Facial emotion recognition and facial and bodily emotion recognition were impaired in psychotic bipolar mania and schizophrenia patients than normal control group. LPC latency was more in schizophrenia patients than normal controls and psychotic bipolar mania patients remained in between. Reduced LPC amplitude was also seen for specific emotions in psychotic bipolar mania and schizophrenia patients than normal controls.

Conclusion: Emotion recognition was impaired both in bipolar disorder and schizophrenia and neural correlates of emotion recognition such as LPC can be regarded as an endophenotype for both schizophrenia and bipolar disorder.

Key words: ERP, LPC, Emotion, Bipolar, Schizophrenia.

95.TITLE: Prevalence of Alcohol use and binge drinking in urban female students attending women college

AUTHOR: Dr Abhinav Tewari, Senior Resident

Co-authors: Prof Sonali Jhanjee*, Prof Anju Dhawan*, Dr Rachana Bhargava*, Dr Neelam Kalia**,Department of Psychiatry and NDDTC, AIIMS, New Delhi – 110029,Kamla Nehru College, New Delhi

Background/Introduction: College students are associated with increased experimentation of psychoactive substances such as alcohol use. Binge drinking is associated with increased risk of injury and death. Female users have been associated with accelerated progression of alcoholism (Telescoping). The national data shows increasing prevalence of alcohol use among females of ages 15-24. The current study aims to add to the sparse evidence on prevalence of alcohol use in college going female students.

Methodology: This cross-sectional study was carried out among female undergraduate students of an urban women college using stratified cluster random sampling. A semi-structured questionnaire and WHO student drug use questionnaire were used. Descriptive statistics was done to calculate prevalence of alcohol use.

Results: A total of 586 students across 1st, 2nd and 3rd years of undergraduate courses participated in the study. Ever use, Past 12-month use and last 30-days use of alcohol was reported by 49.7%, 37.9% and 17.9% participants respectively. Use among 1st year students were highest across all patterns of use. Alcohol use in binge pattern was reported by 28.2% of ever users, 34.7% of past 12-month users and 44.8% of past 30-days users.

Conclusion: Our study reported higher prevalence of alcohol use compared to nationally representative data for 15-24 years age group, indicating that alcohol use among females is on the rise. Highest use among 1st year students and higher rates of binge consumption among current users indicate that further efforts are needed to understand the factors related to alcohol use in this population.

Keywords: Alcohol, college students, female

96.TITLE:a study of psychiatric co-morbidities, clinical presentations and quality of life in females with non pathological vaginal discharge

AUTHOR:Thamke Snehal Vijay, Senior resident, BARCH, Mumbai

Introduction: Nearly one third of all healthy life lost among adult women is because of reproductive health problems. Gynecological disorders have a substantial impact on female reproductive ability and mental health ability.

Aims and objectives: To assess psychiatric co-morbidities, various clinical presentations and quality of life in females with non pathological vaginal discharge.

Methodology: It is a cross sectional study, all the subjects were recruited from the gynecology clinic coming with the complain of vaginal discharge. After ensuring the vaginal discharge to be non pathological, socio-demographic data from 100 such females was recorded. Psychiatric co-morbidities, clinical presentations and quality of life was then assessed by applying Scale for Assessment of Female Dhat syndrome (SAFeD); Depression, Anxiety and Stress Scale (DASS 21) and WHOQOL-BREF. Data were analyzed using appropriate statistics.

Results: The assessed females had somatoform symptoms(80%), symptoms of anxiety(56%), stress(54%) and depression(12%). And they presented clinically with the complaints of disturbed appetite and weight(91%), physical weakness(87%), body pain and other physical symptoms (80%), headache(79%), psychological symptoms(77%), sexual problems(62%) and genito-urinary problems(61%). Also, depression, anxiety and stress significantly increased with the increase in duration, frequency and quantity of white discharge (p<0.001). Quality of life was significantly poor in physical health, psychological and social-relationship domains(p<0.001).

Conclusion: Clinical picture is similar to those of the Dhat syndrome in males. So female Dhat syndrome can also be recognized as an important entity and a culture bound syndrome. Dhat syndrome being a culture related neurosis mainly in the Indian subcontinent, needs to be considered as a specific, distinct disorder, and further research is required to develop culture specific treatment modalities for the same.

Key words: Women mental health, vaginal discharge, female dhat syndrome

97.TITLE:A STUDY OF PATHWAYS TO SEX REASSIGNMENT, PSYCHIATRIC COMORBIDITIES, DISCRIMINATION AND QUALITY OF LIFE AMONG TRANSSEXUALS

AUTHOR:Madhumitha N S, SENIOR RESIDENT

Prashanth N R, H Chandrashekar

Background:

Transsexual is the state of one’s gender identity which does not match with ones assigned sex. Recent estimates suggest that there are at least 490,000 transsexuals in India. Depression and anxiety disorders are quite high in prevalence among this population. Apart from poor sexual health, this patient cohort experiences perceived and internalized stigma, isolation, discrimination, and victimization that predisposes them to mental health issues.

Materials and methods : This hospital based study assessed transsexuals, sample size being 30. Participants were assessed for relevant demographic and clinical information. Quality of life was assessed with WHO QOL BREF scale. Discrimination and Stigma Scale (DISC-12) was used to estimate discrimination faced in various areas of life. MINI plus scale was applied to identify any psychiatric comorbidity.

Results : All participants fulfilled criteria for transsexualism according to ICD 10. Majority of the study population were poorly educated, belonged to low socioeconomic strata. They resorted to begging and sex work for their livelihood. Majority of them had faced discrimination in areas of housing, public transport, social life and employment. QOL domain score for physical health(64), psychological(73), social relationships(83) and environment(71) and mean of all domains was 73. Substance use disorders were high among them and had a higher prevalence of psychiatric comorbidities depression and anxiety.

Conclusion : There was a predictable pattern of development of gender identity disturbances and how they ended up with sex reassignment. Transsexuals face lot of difficulties both pre and post-surgery states. They suffer from higher rates of depression, suicide, anxiety and substance use disorders compared to general population.

Keywords : transsexuals, discrimination, sex reassignment

98. Title: Disability and stigma among patients with substance use disorder: A pilot study

Presenting Author: Vaibhav Patil, Senior Research officer, AIIMS New Delhi

Co-authors: Bichitra N. Patra, Yatan P.S. Balhara, Sudhir K. Khandelwal

Corresponding author: Name Bichitra N. Patra Email: patrab.aiims@gmail.com

Objective :To study the disability and the stigma experienced by the patients with substance use disorders attending the outpatient clinic of a tertiary care centre

Material and methods: 50 patients with diagnosis of substance use disorders(SUD) were recruited by non-random, non-stratified sampling method. Patients of either sex with age range of 18 to 65 meeting diagnosis of SUD as per ICD-10 were included in the study. Urine screening for substance use was done using cassette tests. All participants were assessed using semi structured study performa, discrimination and stigma scale and WHO disability assessment schedule 2.0. Means and standard deviations were calculated for continuous variables and frequencies and percentages were calculated for discontinuous variables. Level of statistical significance was accepted at p < 0.05.

Results:Out of the 50 subjects with SUD, 18 (36%) are the only earning members of the family and 22 (44%) are the head of the family. There was significant positive correlation between unfair treatment subscale of stigma and disability (p=0.00) in subjects with SUDs. There was significant positive correlation between age and duration of substance use (p=0.00), negative correlation between number of years of education and unfair treatment subscale of stigma (p=0.003) and negative correlation between number of years of education and disability (p=0.00).

Conclusion: There is significant disability and stigma is the patients suffering from substance use disorders. High stigma is associated with long duration and lesser in educated people.

Key words: disability, stigma, substance use disorders

99.TITLE: DEPRESSION IN LONG TERM SPINAL CORD INJURY

AUTHOR:Dr (Colonel) Harpreet Singh, Senior Advisor (Psychiatry)

Command Hospital, Pune

Key Words: Depression, long term, spinal injury

Introduction: Depressive symptoms are extremely common after spinal cord injuries, and many studies have reported that almost all patients with traumatic paraplegia or quadriplegia experience depression at some time during the course of their illness. However most studies do not distinguish between depressive disorders and sub-syndromal depressive symptoms.

Aim: to study the prevalence and nature of depressive disorders in patients with long term spinal cord injury:

Material and methods: In this study 50 cases of traumatic paraplegia/quadriplegia were assessed for depression using clinical interview and ICD-10 Diagnostic Criteria. The duration of injury in all cases was more than 3 years and all were staying in a long term rehabilitation centre for disabled soldiers. All patients were also administered the Beck’s Depressive Inventory (BDI) for quantification of depressive symptomatology.

Results: Five patients (10%) met the criteria Depressive Episode and two (4%) met the criteria for dysthymia. Twenty seven patients had depressive symptoms which were not sufficient to meet the criteria for a depressive disorder. There was no significant difference between tetraplegics and quadriplegics with regard to prevalence of a depressive disorder or the severity of symptoms. Presence of family support was a strong protective factor against depression.

101.TITLE:Knowledge, attitude and clinical practices of Pediatricians towards medical issues in children and adolescents with autism spectrum disorder – a survey

Authors- Dr. Chandrashekar M (PG student), Dr. Shankar K (AP), Dr. Chandrashekar H (Head of the department) -Bangalore medical college and research institute

Background

Many children and adolescents with a diagnosis of autism spectrum disorder have co- morbid health problems. Autism spectrum disorder is now recognized as a systemic disorder with multiple medical issues which are even recognized to be causative for many manifestations of autism spectrum disorder. Thus, pediatricians need to be aware of these manifestations for appropriate management. This survey was undertaken to assess the background knowledge, clinical practices of pediatricians towards these medical issues in autism spectrum disorder.

Methodology

This was an online survey which was sent to hundred pediatricians from primary and tertiary care background through e mail. A questionnaire was prepared for the survey which included questions on recognition, assessment and management practices of medical issues in children with ASD. Tabulations were done and documented.

Results

Though most pediatricians saw children with ASD, their understanding of medical issues in children of ASD was grossly inadequate. Most pediatricians dismissed medical issues as behavioural in nature.

Conclusion

Pediatricians need to be sensitized about common medical issues associated with autism as it would pave the way for better clinical management of children with autism.

Keywords: autism spectrum disorder, pediatricians, medical issues.

102.TITLE:A STUDY ON NONSUICIDAL SELF- INJURY IN SCHIZOPHRENIA

AUTHOR:Dr. Ramya. V, Post graduate in psychiatry

Dr. Jagadeesan M S Dr. Poorna chandrika

Institute of Mental Health, Chennai,ramyavenkat92@gmail.com

Background

Schizophrenia is a major mental illness affecting general population. Suicide is the most common cause of premature mortality in schizophrenia, with a lifetime risk ranging from 4.9% to 10%. Many sub lethal attempts of NSSI are also made by schizophrenia patients that are found to be an important independent risk factor for suicide. Occurrence of an episode of NSSI predicts the higher chances of future suicide in an individual. Several studies have been done to examine the prevalence and risk factors for suicide or suicidal behavior in schizophrenia. These studies have focused almost exclusively on risk factors for suicide, and separate discussion of risk factors for NSSI is absent or very limited. Hence this study is been conducted to estimate the prevalence of NSSI and its risk factors in patients of schizophrenia.

Methodology

This is a cross sectional study including 100 consecutive patients diagnosed to have schizophrenia based on ICD-10 diagnostic criteria, attending outpatient department of Institute of Mental Health.

Tools being used are semi structured socio demographic proforma and deliberate self harm inventory questionnaire

Results and conclusion of this study will be discussed at the conference as the study is currently underway.

Keywords

NSSI, suicide, self harm, schizophrenia

103.TITLE: Frequency of comorbid anxiety among patients with cervical radiculopathy

AUTHOR(s): Dr. Jonathan L1, Post graduate, Father Muller Medical College Hospital

Dr. Supriya Hegde2

Affiliation: PG Resident1,Professor 2, Department of Psychiatry, Father Muller Medical College, Mangalore, Karnataka, India,Email ID: jontysaba@gmail.com Mobile number: +91 9008127372,Category:Free paper

Background- The term cervical radiculopathy (CR)describes the group of clinical symptomsand signsrelated to any dysfunction ofthe cervical spinal nerve root due topathological changes. The present study focuses on comorbid anxiety among patient with cervical radiculopathy.

Objective- To examine the frequency of comorbid anxiety among cervical radiculopathy patients.

Methodology - It is crosses sectional study involving 64 subjects from the age group 20-60, diagnosed with CR, consenting for the study. Diagnosis of CR was done by neurologist/orthopaedican. Screening for anxiety symptoms was done using HAM-A, disability due to CR was assessed using NDI. All the following patients were excluded i.e. patients with comorbid lumbar radiculopathy, with chronic debilitating illness, with past history psychiatric illness except nicotine dependence syndrome, with significant cognitive deficit, patient who underwent cervical spine surgery within the last 6 months or patients with cervical myelopathy without any radicular involvement, patient who had underlying pathologies like cancer currently under treatment, diabetes mellitus or inflammatory joint disease such as rheumatoid arthritis. Data analysis was done using frequency, percentage, Mean, Standard Deviation and chi-square test.

Results- 64 subjects are taken for the study. It’s an ongoing study the results will be updated soon.(Results will be discussed)

Conclusion: - Will be discussed once results are ready.

Key words Cervical radiculopathy, comorbid anxiety, HAM -A- Hamilton Anxiety rating scale, NDI- neck disability index.

104.TITLE:EFFICACY OF ETIZOLAM IN REDUCING PROCEDURAL ANXIETY IN PEOPLE UNDERGOING MRI – A CASE CONTROL STUDY

AUTHOR:Dr.K. Chaitanya Laxmi Reddy, Post Graduate

SVS Medical College

INTRODUCTION

Patients undergoing MRI often experience anxiety prior to & during the procedure leading to early termination of the scan. MRI related anxiety results from limitation of movements, noise generated by the device and fear of being enclosed. Anxiety is known to increase the respiratory rate, peristalsis and fluid flow, thereby affecting the image quality. Prevalence of MRI related anxiety ranges from 27 – 51% as per various studies. Etizolam - GABA-A receptor agonist, preferred over benzodiazepines due to its short duration of action (half life = 3-4 hrs) and less sedation - popular as day time anxiolytic. This study aimed at finding effectiveness of etizolam in reducing procedural anxiety related to MRI.

METHODOLOGY

Interventional case control study wherein 30 cases & 30 controls aged 18-65yrs undergoing their first MRI were randomized into the above groups. It was conducted in tertiary care teaching hospital. Prior written informed consent was taken. Controls were explained about the MRI procedure, cases were additionally given tablet etizolam 0.5mg, 45-120 minutes before MRI. The anxiety levels in both the groups before & during MRI were recorded on visual analog scale for anxiety. Results were obtained using Mann Whitney U test.

RESULTS

Anxiety was present in 20% of controls & 56.7% of cases before MRI, 13% of the controls during MRI. None of the cases were anxious during MRI. Anxiety scores decreased in 16.7% of controls, 56.7 % of cases & increased in 10 % of controls. P value for this change was 0.008 indicating that the reduction of anxiety with etizolam was statistically significant.

CONCLUSION

Administration of 0.5 mg etizolam 45 minutes before MRI results in significant reduction in anxiety. Etizolam is an easy & practical option for reducing procedural anxiety.

105.TITLE:Mental illness and sleep quality: a cross-sectional study of psychiatric out-patients attending a tertiary level mental health care facility in Punjab, India.

AUTHOR:GARGI MONDAL, PDF in OCD

NIMHANS

Background: Poor sleep quality is frequently found in patients with psychiatric illness which may be detrimental for their prognosis.

Aim: To investigate the self-reported quality of sleep in a population of psychiatric out-patients and to compare the different components of sleep quality among the different groups of psychiatric patients.

Material and methods: Five hundred adult patients, randomly selected using purposive and systematic sampling from a tertiary level mental health care facility were evaluated for their sleep quality using the Pittsburgh Sleep Quality Index (PSQI). Mini International Neuropsychiatric Interview (MINI) was used to determine their psychiatric diagnosis.

Results: Poor sleep quality was found in 78.4% of the population. Significant difference was noted among the different psychiatric groups when the global as well as the component scores of the PSQI were compared.

Conclusion: This is a study to find out the sleep quality in a large population of psychiatric out-patients. Our study emphasizes the importance of determining the sleep quality to improve the prognosis of the patients.

Keywords: sleep quality; psychiatric population; Schizophrenia; Mood disorders; Anxiety disorder; OCD.

106.TITLE:OUTCOME OF A “MODIFIED BRIEF INTERVENTION” PROGRAM DELIVERED AT WORK PLACE FOR A POPULATION WITH HAZARDOUS ALCOHOL USE

AUTHOR:Lt Col (Dr) Sojan Baby, MD, PHD.

Command Hospital, Southern Command

Introduction:

At the population level, screening and brief intervention is the most cost effective method to reduce the burden of disease due to hazardous alcohol use. In delivering brief intervention at individual level, trained manpower as well as time is limiting factors. Hence, a study was undertaken to assess the outcome of a “modified brief intervention” program delivered at workplace in a group setting for soldiers identified with hazardous alcohol use pattern, as a secondary prevention measure.

Materials and methods

Study was a pre and post intervention study without control group. Following an education lecture conducted by a mental health team comprising of a psychiatrist at various unit locations, soldiers were screened using WHO ASSIST questionnaire, V3.0 version. Ninety soldiers screened positive for hazardous alcohol use were given “modified brief intervention” in a group setting at their workplace which consisted of two semi-structured sessions of one hour duration each. The sessions were spaced in a month. First session was based on motivation enhancement measures along with gathering of current alcohol use details and second session on relapse prevention. Three months later, outcomes were assessed with a semi-structured questionnaire and reapplication of ASSIST. Appropriate statistical tests from R-software, R-Commander were applied to analyze results.

Results:

No significant difficulty was experienced in conducting the interventions. Fifty (55.6%) soldiers stayed alcohol abstinent following second session and another 22(24.44%) had reduced both the quantity and frequency of use. Paired t-tests revealed statistically significant reduction in all outcome parameters (ASSIST scores, usual dose, maximum dose and number of days of use in month). 80(88.89%) soldiers reported the program to be effective and needed one. Only three months of observation is a limitation.

Conclusion:

The study provides an efficient secondary prevention model with less man power and time requirement to reduce hazardous drinking at population level.

Keywords:

Hazardous Alcohol Use, Brief Intervention, ASSIST, Secondary prevention

107.TITLE: TreadWill: an online treatment for depressive symptoms.

AUTBHOR:Rithwik J. Cherian, PhD student

IIT KANPUR

Background: Despite the availability of evidence-based treatments, depression is the leading cause of disability worldwide. The accessibility to evidence-based treatments is limited by the dearth of mental health professionals, social stigma, distance, and cost barriers leading to a treatment gap of 85.2%. Delivering online automated intervention has the potential to bridge this treatment gap.

We have developed an online, automated, and freely-accessible tool, TreadWill, to help users learn Cognitive Behavioral Therapy (CBT) and apply the techniques on themselves. TreadWill educates the user about CBT based on the user’s dysfunctional profile. To increase user engagement, it includes games and social networking features.

Methods: A 3-armed online randomized controlled trial with 600 participants distributed across experimental, active control, and wait-list groups in a 1:1:1 ratio is underway to test the efficacy of TreadWill. The experimental group participants have access to a full-featured TreadWill. The active control group participants have access to a feature-limited version wherein the same CBT content is presented in a plain-text format. The wait-list group participants are put on a wait-list for six weeks. The severity of the depressive symptoms, as measured by Patient Health Questionnaire-9 at baseline, post-treatment, and at 90-day follow-up, is used to assess the effectiveness of TreadWill.

Results: Currently, 400 participants have been recruited, and the feedback of the participants indicates that TreadWill has positively affected their lives. Further, they also found the interactive features useful.

Conclusion: Preliminary findings from our study provide evidence that computerized CBT is acceptable to users. We are currently including more features in TreadWill and upgrading the existing features based on user feedback. We are also including a clinician-portal through which clinicians can track the progress of their patients within TreadWill.

Keywords: CBT, CCBT, online, personalization, RCT

108.TITLE: Relationship of Internet Addiction, Selfie Behaviour, Facebook Addiction with Psychological Well Being and Social Desirability

AUTHOR:Dr. Adarsh Kohli, PhD Student

PGIMER

Internet addiction disorder (IAD), also known as pathological internet use, refers to excessive internet use that interferes with our daily life. It ruins lives by causing neurological complications, psychological disturbances, and social problems. The aim of the study is to identify the relationship of internet addiction, selfie behavior, facebook addiction with psychological wellbeing and social desirability. Fifty college going and professionals working in private or government offices both males and females in the age range of 18-35 years were recruited using purposive sampling technique. Young’s Internet Addiction Scale (Kimberly,1998), Ryff’s Psychological Well Being Scale (Ryff,1995), Social Desirability Scale (Crowne & Marlowe, 1960), Bergen’s Facebook Addiction Scale (Bergen,2015) and Selfitis Behavior Scale (Balkrishna & Griffths, 2018). Results were analyzed to find the difference in terms of sociodemographic variables like gender and education. Descriptive-analytic correlation suggests that there are significant differences in terms of gender and profession. Social desirability and selfie behaviour had a strong positive relationship with internet addiction.

Keywords – selfie, internet, addiction, social desirability, well being, facebook

109.TITLE:Efficacy of Meta-Cognitive Therapy on Adolescents with Social Anxiety Disorder

AUTHOR:Dr. Deoshree Akhouri*, Maria Madiha**

1) *Assistant Professor in Clinical Psychology, Department of Psychiatry, Jawaharlal Nehru Medical College & Hospital, Aligarh Muslim University, India

2) **PhD Scholar (Clinical Psychology), Department of Psychiatry, Jawaharlal Nehru Medical College& Hospital, Aligarh Muslim University, India (Presenter)


3) Introduction: According to National Institute of Mental Health, about 9.1% adolescents have social anxiety disorder and 1.3% has severe impairment. Studies indicate that adolescents with social anxiety disorder have reduced quality of life and low self-esteem. Various psychotherapies attempts to cure social anxiety disorder. Meta-cognitive therapy is one such technique that proves to be effective in the treatment of social anxiety disorder. The present study is done to see the effect of meta-cognitive therapy on adolescents of social anxiety disorder.

4) Aim: To study the efficacy of meta-cognitive therapy on adolescent with social anxiety disorder.

5) Objectives: To assess severity of social anxiety disorder. To assess and compare the effect of meta-cognitive therapy intervention on social anxiety disorder. To see the effect of meta-cognitive therapy on quality of life and self-esteem.

6) Tools Used: Self prepared socio-demographic and clinical data sheet, Social Anxiety Scale for Adolescents, WHO Quality of Life, Rosenberg Self-Esteem Scale and Meta-Cognitive Awareness Inventory.

7) Result: The result of present study indicates that meta-cognitive therapy is an effective non-pharmacological approach in curing social anxiety disorder when combined with pharmacological treatment.

8) Conclusion: It could be concluded that meta-cognitive therapy is an effective approach in the treatment of social anxiety disorder.

Keywords: Meta-cognitive therapy; obsessive-compulsive disorder; adolescents; exposure-response prevention

110.TITLE: Genetic and Epigenetic study in Opioid dependence patients

AUTHOR:Singh R, Singh D, Pandit MA, Sarkar S, Gupta R, Balhara YPS, Jain R, Sharma A

AUTHOR-Renu Singh, PhD

All India Institute Of Medical Sciences, New delhi

INTRODUCTION:

Drug Dependence, a neuropsychiatric condition results from complex interaction between genes and environment. Single Nucleotide Polymorphisms (SNPs) in neurotransmitter pathway genes and epigenetic modifications such as methylation and histone acetylation play an important role in drug abuse and dependence. The present study reports on SNP and methylation status in patients with opioid dependence (OD).

Methodology

A total of 100 OD males recruited from National Drug Dependence Treatment Centre (NDDTC) formed the cases and 100 male volunteers from the hospital staff and residents formed the controls. Subjects were interviewed using a semi-structured questionnaire and WHO ASSIST and five ml peripheral blood drawn. Genetic markers Stin2 VNTR and OPRM1 (A118G) of serotonin and opioid pathways were analysed and methylation status of OPRM1 assessed in all the subjects. Statistical analysis was done using SPSS v20.0.

RESULTS

Mean age of the patients was 33.17±8.25 and age of onset of opioid use was 25.07±7.89 years. Alleles of Stin2 VNTR (12/12 repeat) was observed in 52% cases and 48% controls while the 10/10 repeat allele was significantly higher in cases (24%) compared to controls (8%) (p=0.008). The OPRM1 (A118G) SNP showed similar frequency with GG genotype in 11% cases and 14% controls and AA genotype in 41% cases and 40% controls (p=0.642). Correlation with opioid use suggested the AG/GG genotypes to be risk factors for OD. OPRM1 promoter methylation was seen in 26 % controls and 6% cases showing the cases to be hypomethylated compared to controls cases (p=0.002).

Conclusion : The present study shows that the Stin2 VNTR allele might influence opioid intake. Similarly, difference in OPRM1promoter methylation observed may influence dependence due to change in gene expression.

Keywords : Opioid dependence, methylation, serotonin, polymorphisms

111.TITLE: A study to assess disability,quality of life & family burden in BPAD-1 patients under remission on regular follow-up.

AUTHORS: Dr. Ankit Pandey, 3rd year PG, Department of psychiatry, NMCH, Nellore

Aim/Objective: To study disability, quality of life & family burden in BPAD-1 patient under remission.

Background : BPAD is one of the most complex psychiatric conditions characterized by recurrent mood episodes and longitudinally varied course. It affects at least 1% of the population and according to the World Health Organization (WHO).

BPAD is the sixth leading cause of disability among illnesses worldwide. The classical concept suggests favorable functional adaptation between episodes, with a marked decrease in acute morbidity with effective mood-stabilizing treatment.

However, a number of recent studies have indicated that several patients with BPAD continue to display functional impairment even in absence of syndromal/symptomatic criteria.

Materials & Methodology : Type of study: Cross-sectional study.

Sample: 100(Diagnosed with BPAD under remission).

Approval from ethical committee obtained.

Informed consent taken.

Scales used: HDRS-17, YMRS, WHO Quality of life scale-BREF, IDEAS(Indian disability evaluation assessment scale & BAS(Burden assessment schedule).

112.TITLE:A STUDY ON THE SOCIODEMOGRAPHIC PROFILE, FAMILY STRUCTURE AND PSYCHIATRIC MORBIDITY IN THE INMATES OF A CHILDREN’S HOME.

AUTHOR:Dr AKSHATHA J K, POST GRADUATE

KARNATAKA INSTITUTE OF MEDICAL SCIENCES

KEYWORDS:Child Psychiatry, Children’s home

BACKGROUND

Most residents of the children’s homes are young adolescents showing raised levels of social and emotional problems and dysfunctional coping strategies. They are likely to have experienced abuse and/or neglect and have been in previous failed placements. The juvenile justice system is marked by a significantly higher volume of youth and families with comorbid medical, psychiatric, substance abuse disorders, multiple family and psychosocial adversities. The screening for psychological problems of the inmates in such institutes should occur at the earliest as better mental health care for the youth supports the goal of rehabilitation.

METHODOLOGY

It is a cross sectional study done over a period of one year on the male inmates of Balakara Balamandira, Hubli under the Integrated Child Protection Services. The inmates aged 8-16 years were interviewed using a self-structured proforma and KSADS-PL to assess the sociodemographic profile, family structure and psychiatric morbidity. Additional information was obtained from the staff of the children’s home.

RESULTS

Out of 121 children, 114 met the inclusion-exclusion criteria of which 76.3% were from rural areas, 78% Hindus and 100% belonged to lower socioeconomic status. 28.07% children were raised by single parents, 6.1% in step-families and there was death of one or both parents in 32.4%, parental marital discord in 37.7% and substance use in 50.8% cases. Psychiatric disorders were diagnosed in 28.07% children, the most common being ADHD (19.2%), followed by Oppositional Defiant disorder (12.2%), Conduct disorder (9.6%) and Depression (3.5%). 15.7% children had ever tried any substance.

CONCLUSION

Institutionalised children coming from dysfunctional families and lower economic strata are at a higher risk of psychiatric illnesses and need to be screened at the earliest for a productive adulthood.

113.TITLE: JOINT ATTENTION, LANGUAGE, SOCIAL RESPONSIVENESS, BEHAVIOUR FOLLOWING 8 WEEKS OF LEVO-CARNOSINE IN CHILDREN WITH AUTISM SPECTRUM DISORDER.

AUTHOR:Dr. Kanmani V. K,POST-GRADUATE, Professor- Dr. Poorna chandrika Assistant Professor –Dr. Siva lingam, Dr. Vimal Doshi

BACKGROUND

L Carnosine is a dipeptide amino acid containing B-Alanine and L-Histidine. Few studies have shown that children with autism spectrum disorder who take Carnosine supplementation have improvement in their behaviour, language, communication, socialization, object recognition within two to eight weeks. This study aims to assess the changes in children with autism spectrum disorder after 8 weeks of levo-carnosine supplementation in comparison with placebo.

MATERIALS AND METHODS:

  • 100 Children with Autism spectrum disorder attending child guidance clinic at Institute of Child Health, MMC, Chennai satisfying selection criteria and whose parents give consent are Randomized and one group of children are supplemented with L-CARNOSINE and the other group with placebo and are assessed using the following scales at 0, 4 & 8 weeks
  • SCALES: Vineland Social maturity scale, Childhood Autism Rating scale, Childhood Behaviour Check list, Social Responsiveness scale, Receptive Expressive Emergent Language scale, Short sensory profile, Early social communication scale.


RESULTS:

Results needs to be evaluated, probable results affirmed with there are some improvement in some domains after 8 weeks of L-carnosine therapy.

CONCLUSION:

There is no specific treatment for Autism Spectrum Disorder. Hence it will be of great significance levo –carnosine supplementation has significant improvement in joint attention, language, behavior, social responsiveness in children with autism spectrum disorders.

114.TITLE:EXPLORING DEPRESSION AND SUICIDE IN PSORIASIS

AUTHOR:Dr.ROSE MONICA, Post graduate

Dr. POORNA CHANDRIKA ; Dr DHANALAKSHMI

INSTITUTE OF MENTAL HEALTH, MADRAS MEDICAL COLLEGE, CHENNAI

Psoriasis, a psychosomatic disorder, is a classic example of mental – physical comorbidity.

Patients with chronic illness suffer more from major depressive disorder or subsyndromal depression, which is hardly recognised. When depression is not addressed, it leads to poor quality of life and affects the individual’s skin condition too, leading to severe exacerbation of skin lesion.

Approximately 30 – 40% of patients seeking medical treatment for their skin conditions, often have an underlying psychological problem or psychiatric illness that causes or exacerbates the skin disorder. In psoriasis, the prevalence of depression is significantly much higher than that compared to the general population. We might attribute the association between mood disorders and psoriasis to shame, social anxiety or skin lesion related embarrassment.

So in order to assess the psychiatric morbidity and its influence on individual’s life, we undertook this study to determine the prevalence of depression and suicide. An attempt was made to study the association between psychological variables (depression and suicide) with quality of life and the severity of psoriasis.

Keywords – psoriasis, depression, suicide

115.TITLE:KNOWLEDGE ATTITDUE PRACTICE ABOUT MENTAL ILLNESS AMONG STAFF NURSES AND HEALTH ATTENDANTS IN PSYCHIATRIC INSTITUTE

AUTHOR:Dr. Munivel, Post graduate and Dr. Aravindan, Dr. Poorna Chandrika,

Institute of Mental Health, Chennai.

INTRODUCTION:

Stigmatizing attitudes towards mental illness is also common among all classes of people. Stigma and discrimination associated with mental illness of staffs who is taking care of psychiatric patients result in the underuse of mental health services. Many studies have been conducted on knowledge, attitude and practice about mental illness among staffs in General hospital settings only. None of the studies were conducted in a mental health institute and asylum. This study therefore aimed to determine the knowledge of and attitude towards mental illness among institutional staffs and this information will be useful in service delivery on mental health issues.

MATERIALS & METHODS:

A Cross-sectional study is done among Staff Nurses and Health attendants working in IMH at Institute of Mental Health Chennai. Sociodemographic data are collected with a proforma. NIMHANS Structured questionnaire consist of to assess level of knowledge, attitude and practice towards mental illness(40 items) will be distributed to all participants and collected at the same day by the researcher.

RESULTS AND CONCLUSION:

Since this is an ongoing study, results will be presented at the time of presentation.

Keywords: Knowledge, Attitude, Practice, Service providers, institute, asylum

116.TITLE:STUDY OF KNOWLEDGE, PERCEPTIONS AND ATTITUDE OF NURSES WORKING IN MENTAL HEALTH FACILITY ABOUT ALCOHOL USE AND ALCOHOLICS

AUTHOR: Dr. Madhur M Rathi (1), Dr. Aditya Kashyap(2), Dr. Mayurnath Reddy(3)

(1) Post graduate in MD Psychiatry, (2) Post graduate in MD Psychiatry, (3) Professor, Dept. of Psychiatry, Institute of Mental Health.

Introduction:

Alcohol is one of the most widely used drug substances in the world. Alcohol use and binge drinking is a major public health problem due to lack of knowledge regarding its ill effects. Most of the problems can be minimized, if not completely prevented by making the public aware of the complications related to alcoholism. Nurses working in mental health practice are an important resource for the detection and management of alcoholic patients and other patients in whom alcohol abuse is a common comorbity. However, there are not many indian studies about their knowledge, perceptions and attitudes towards alcohol use and alcoholics.

Materials and Methods:

A cross-sectional study was done at Institute of Mental Health, Erragadda, Hyderabad through a self-administered proforma after the approval of institutional ethics committee. The proforma contained informed consent and socio-demographic profile of the study subjects followed by a pretested questionnaire – “Seaman Mannello Nurses’ Attitudes toward Alcoholism Scale” which analyses the knowledge, perceptions and attitudes about the alcoholics and alcoholism.

Participants included 100 nurses working at Institute of Mental Health, Erragadda, Hyderabad who were selected by simple random sampling technique. Out of the nurses available at the time of the data collection, those willing to participate in the study were included after obtaining prior permission from the concerned authority.

A descriptive, analytical and inferential analysis of the study variables was carried out using SPSS v2.0

Results: Will be discussed at conference.

Conclusion: Will be discussed at conference.

Keywords: Nurses, Alcohol, Attitude, Mental Health, Knowledge

Details for Correspondence: Dr. Madhur M Rathi

Postgraduate, Institute of Mental Health,

Erragadda, Hyderabad, Telangana – 500018

dr.maddy.rathi@gmail.com

117.TITLE:Association of Stressful Life Events In the onset of illness in Acute and Transient Psychosis (ATP), First Episode Schizophrenia and Affective Psychosis.

AUTHOR:Dr.M. Gangadhararao1, Dr.P. Padma2, Dr.P. Himakar 3, Dr.S. Radharani4

  1. Second year post graduate
  2. Associate Professor
  3. Professor and HOD
  4. Professor and Superintendent, Government Hospital for Mental Care


Department of Psychiatry, Andhra Medical College, Visakhapatnam

INTRODUCTION : Stressful life events are considered as one of the etiological factors triggering the onset of psychotic disorder. This study examines the role of stressful life events preceding the onset of ATP, first episode schizophrenia and affective psychosis.

AIM : To assess the Association of Stressful Life Events In the onset of illness in ATP, First Episode Schizophrenia and Affective Psychosis.

METHODOLOGY:

Study Design : A cross-sectional comparative study.

Study Setting: Government Hospital for Mental Care (GHMC), Visakhapatnam.

Study Population: Patients attending to Government hospital for mental care, Visakhapatnam.

Sample Size: A study sample consisting of 72 patients of which 24 patients had a diagnosis of ATP, 24 patients had diagnosis of first episode schizophrenia and 24 patients had diagnosis of affective psychosis.

Study tools : ICD-10 Diagnostic criteria for research, Presumptive Stressful Life events Scale (PSLES), Expanded-Brief Psychiatric Rating Scale (BPRS).

RESULTS: 45.83% (n=33) of total sample has incidence of stressful life events before the onset of psychotic disorder. Among these patients with stressful life events 42.4% had a diagnosis of ATP, 30.3% had diagnosis of schizophrenia and 27.3% had diagnosis of affective psychosis.

CONCLUSION : Our study showed significant percentage of patients in all the three groups had stressful life events preceding the onset of illness. So there is a clear need to develop preventive strategies and early intervention in management of psychosocial stressors.

KEYWORDS : Stressful life events, Acute and Transient Psychosis, First Episode, Schizophrenia, Affective Psychosis.

118. TITLE: JOINT ATTENTION, LANGUAGE, SOCIAL RESPONSIVENESS, BEHAVIOUR FOLLOWING 8 WEEKS OF LEVO-CARNOSINE IN CHILDREN WITH AUTISM SPECTRUM DISORDER.

AUTHOR:Dr. Kanmani V. K,Post –graduate, Professor- Dr. Poorna chandrika Assistant Professor –Dr. Siva lingam, Dr. Vimal Doshi

BACKGROUND

L Carnosine is a dipeptide amino acid containing B-Alanine and L-Histidine. Few studies have shown that children with autism spectrum disorder who take Carnosine supplementation have improvement in their behaviour, language, communication, socialization, object recognition within two to eight weeks. This study aims to assess the changes in children with autism spectrum disorder after 8 weeks of levo-carnosine supplementation in comparison with placebo.

MATERIALS AND METHODS:

  • 100 Children with Autism spectrum disorder attending child guidance clinic at Institute of Child Health, MMC, Chennai satisfying selection criteria and whose parents give consent are Randomized and one group of children are supplemented with L-CARNOSINE and the other group with placebo and are assessed using the following scales at 0, 4 & 8 weeks
  • SCALES: Vineland Social maturity scale, Childhood Autism Rating scale, Childhood Behaviour Check list, Social Responsiveness scale, Receptive Expressive Emergent Language scale, Short sensory profile, Early social communication scale.


RESULTS:

Results needs to be evaluated, probable results affirmed with there are some improvement in some domains after 8 weeks of L-carnosine therapy.

CONCLUSION:

There is no specific treatment for Autism Spectrum Disorder. Hence it will be of great significance levo –carnosine supplementation has significant improvement in joint attention, language, behavior, social responsiveness in children with autism spectrum disorders.

KEYWORDS - L-carnosine, autism spectrum disorder, joint attention.

119.TITLE: Study of Insomnia severity and suicidal ideation in patients with mental illness.

FIRST AUTHOR: Dr. SIVA ANOOP YELLA,POST GRADUATE, MD PSYCHIATRY

OSMANIA MEDICAL COLLEGE,INSTITUTE OF MENTAL HEALTH

SECOND AUTHOR : DR.GIREESH KUMAR

ASSOCIATE PROFESSOR

KAKATHIYA MEDICAL COLLEGE

THIRD AUTHOR : DR.UMASHANKAR

PROFESSOR,MD PSYCHIATRY

INSTITUTE OF MENTAL HEALTH

PRESENTING AUTHOR: DR.SIVA ANOOP YELLA

Introduction: Patients with mental illness suffering from insomnia are at increased risk for experiencing suicidal ideation. Insomnia severity would be indirectly associated with suicide-related outcomes through psychiatric symptoms. Hence treating insomnia may prevent suicidality.

Methodology: 60 Patients attending out-patient and inpatient department of tertiary care hospital are selected. Socio-Demographic data of the patients are taken and Insomnia Severity index and Modified Scale for Suicidal Ideation are administered. Severity of Insomnia is co-related with the suicidal ideation and the extent of risk of suicidality is compared with insomnia severity.

Results: Positive co-relation is found between insomina severity and suicidal ideation.

Conclusion: The higher the severity of insomnia, the higher the risk of suicidality in mental illness patients.

Keywords: Insomnia, suicide, mental illness, Insomnia severity index, Suicidal ideation.

120.TITLE:PREVALENCE OF FEMALE SEXUAL DYSFUNCTION- A CROSS SECTIONAL STUDY.

AUTHOR: DR.KANMANI.V.K, POST GRADUATE,

INSTITUTE OF MENTAL HEALTH

INTRODUCTION: Sexual function is an essential component of life. For this reason, sexual dysfunction can have a negative impact on the wellbeing of an individual. Female sexual dysfunction is understudied in our country. FSD is often assessed in people with ill health, sexual dysfunction is an illness of its own entity and is also prevalent in non-patient populations. Hence, this study focuses on assessing the prevalence of sexual dysfunction in females.

METHODOLOGY: This is cross sectional study of 100 females, who will be given questionnaire - Female sexual function index, a multidimensional self-report instrument for identifying domains of sexual functioning. Proper sociodemographic profile and detailed sexual history has been assessed properly.

RESULTS: Since this is on going study, results need to be evaluated.

CONCLUSIONS: Sexual problems are widespread in society and are influenced by both health-related and psychosocial factors. The etiology may be individual or social factors. Differing patterns of sexual dysfunction were observed across sex, age, and demographic groups, highlighting the need for further research on etiologic mechanisms. With the strong association between sexual dysfunction and impaired quality of life, this problem warrants recognition as a significant public health concern.

Key words: female sexual dysfunction.

121.TITLE:”TOLERABILITY AND EFFICACY OF ELECTROCONVULSIVE THERAPY IN OLDER PATIENTS WITH SEVERE MENTAL ILLNESS”

Authors

1. Dr. Kavyashree K, Post Graduate in Psychiatry, SDM College of Medical Sciences, Dharwad.

1. Dr Girish Babu N, Associate Professor in Psychiatry, Department of Psychiatry, SDMCMS&H, Dharwad.

2. Dr Abhay Matkar, Professor & Head, Department of Psychiatry, SDMCMS&H, Dharwad.


Background:

Electro-convulsive Therapy (ECT) is used for severe and treatment resistant psychiatric disorders, is most effective and rapid treatment available, even in elderly who have poor tolerability or poor response to pharmacotherapy. We conducted a study to look for tolerability and efficacy of ECT in older patients with severe mental illness.

Methodology:

The study was an observational study conducted in SDMCMSH, Dharwad with a sample of 12 patients with severe mental illness in older patients. All were screened with MINI International Neuropsychiatric Interview(Version.5.0) and diagnosis was made using ICD-10 and were applied HMSE, GAF, HAM-D, YMRS, PANSS scales to assess severity before initiating course of ECT. Patients were followed up after completion of course of ECT and during follow up after 1 month.

Results:

Out of a sample size of 12, 6 were male and 6 females. Mean age was 60.9 with SD 5.68. 5 patients had Major Depressive disorders, 5 were diagnosed Bipolar Affective disorder and 2 with Paranoid schizophrenia. Median use of ECTs were 4 (variance = 3.7), while 2 patients discontinued ECT. No worsening of cognitive dysfunction was seen. Clinical response as per the rating scales and Global assessment of Functioning, improved.

Discussion and Conclusion:

Modified ECT in older population with severe mental illness was safe and effective. Evaluation of comorbid medical illness and appropriate monitoring is necessary for the use of MECT.

Keywords: Electro-convulsive Therapy, older patients, severe mental illness

122.TITLE: Internalizing and Externalizing Disorders in Alcohol Dependence Syndrome and its clinical correlates

AUTHOR: Swapna S, Post graduate

Chettinad Hospital & Research Institute

Background :

Alcohol dependence syndrome is a cluster of physiological, behavioural, and cognitive phenomena in which the use of a substance or a class of substances takes on a much higher priority for a given individual than other behaviors that once had greater value

Externalizing Disorders includes attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder, and antisocial personality disorder, borderline personality Disorder, narcissistic personality disorder, and paranoid personality disorder. Externalizing patients with AUDs, have high relapse rates. Treatment for persons with AUDs may need to include interventions designed to address these.

Internalizing Disorders includes major depression and Anxiety Spectrum of Disorders such as generalized anxiety disorder, panic disorder, agoraphobia, social phobia, animal phobia, situational phobia. Internalizing disorders sometimes precede and may contribute to the development of substance-use disorders. Specific treatment improves the treatment outcome of these patients.

Purpose of the study:

Previous studies have assessed the relationship between Personality traits with substance use disorders but the correlates of externalizing and internalizing Disorders in Alcohol dependence Syndrome and its clinical parameters hasn’t been explored in south of India.

Aims : To assess the comorbid Internalizing and Externalizing disorders in Alcohol Dependence Syndrome and to assess the sociodemographic and clinical parameters of patients with Internalizing and Externalizing comorbidity in Alcohol Dependence Syndrome.

Materials & Methods : All the cases of alcohol dependence syndrome in the 5-year period between 2013-2017 registered in the Department of Psychiatry, CHRI would be taken up for the study and analyzed for the personality profile and the clinical parameters of Alcohol Dependence Syndrome. The outcomes will be compared by Chi-Square Test.

Results :

Results are being analyzed in detail and will be presented in the conference.

Conclusion:

Diagnosing the internalizing and eternalizing personality profile and treating it can help in the outcome of Alcohol Dependence syndrome.

Keywords:

Externalizing, Internalizing, Alcohol Dependence syndrome.

123.TITLE:Quality of Life, Disability & Burden of Care in Caregivers Life in Long-term Outcome Pathways of Alcohol Dependence

AUTHOR:Pradyumna Cherukumudi, post graduate

kamineni institute of medical sciences and Praveen khairkar.

Background: Literature is replete with hundreds of studies on QOL & Burden of care concerned with alcohol use disorder, however long-term outcome pathways of alcoholics usually follows 3 courses, viz in complete remission, with physical complications & the last active alcoholics. Authors aimed to study a holistic view of QoL, General disability & burden of care in the nodal caregivers of this large group from south India.

Methods : This study has been conducted in tertiary care teaching hospital which has reputed DDTC center from south India for a period of 18 months. We used qualitative observational, non-interventional single time assessment study design. For screening a large sample of about 625 caregivers whose patients were admitted & seeking treatment with effect from 2017 to till date. Standardized psychometric tools for assessing QOL, general disability& burden of care were used in nodal caregivers aged 18 to 60 years by avoiding confounding bias.

Results: We screened 625 caregivers of alcoholic patients admitted and treated in our DDTC center over last 5 years. 291(46.5%) active alcoholics whereas 84 (13.4%) families were in remission. The mean age of the caregiver was 42.9+5.5 yrs. 84.1% of our nodal caregiver were spouses of the patient. 80.8% showed moderate to severe burden and 6.6% had shown mild to moderate burden, while 12.5% had no burden. QoL in caregivers were significantly (p<0.05) affected in psychological and social domains.

Conclusion: This study demonstrates the differential pathways for caregiver burden, QoL &disability in caregivers of large group of patients. Appropriate family, social, & government directed programs should be advocated for caring the distinctive needs of these caregivers.

Keywords: Caregiver, Alcohol dependence disorder, QoL, Burden of care.

124.TITLE:”PREVALENCE OF ABNORMALITIES IN BLOOD INDICES IN ALCOHOL USE DISORDER PATIENTS – A HOSPITAL STUDY

AUTHOR :DR. Y. RUFUS EPHRAIM ”, POST GRADUATE

S.V.S. MEDICAL COLLEGE

ABSTRACT

Alcohol has numerous effects on the various types of the blood cells and its function in body. Alcohol abuse causes numerous complications and deficiency causing suppression of the marrow leading to altered blood cell indices and the cytology.

AIM

Association between the haematological profile and the alcohol consumption.

MATERIAL AND METHODS

It is an analytical observational study conducted at department of Psychiatry, SVS Medical College for two months. 40 males aged between 18-65yrs diagnosed with alcohol use disorder and 40 age and sex matched healthy controls were selected consecutively after taking consent. The study was conducted with prior clearance letter from the institutional ethics committee. The haematological parameters were measured in both the groups.

Statistics: Data was presented as mean ± SD, parametric variables are analysed using t-test, ANOVA test and Bonferroni Posthoc analysis for mean difference and other demographic details are presented.

125.TITLE:A STUDY OF NEUROLOGICAL SOFT SIGNS AND ITS CORRELATES IN PEOPLE WITH ALCOHOL DEPENDENCE AND ITS COMPARISON WITH THEIR FIRST-DEGREE RELATIVES AND HEALTHY CONTROLS

AUTHOR: K. S. HEGDE MEDICAL ACADEMY, Post Graduate

K. S. HEGDE MEDICAL ACADEMY

BACKGROUND: Two of the five leading causes of disease burden found universally are related to tobacco and alcohol abuse. Neurological complications are commonly seen in patients with alcohol dependence and are related to the vulnerability of certain brain regions. These neurological abnormalities can be assessed by neurological examination. Apart from these neurological abnormalities, there are soft signs which have been seen in patients with psychiatric disorders. These neurological soft signs have been established as an endophenotype in illnesses such as schizophrenia and bipolar disorder. However, whether NSS in Alcohol Dependence Syndrome are present as an endophenotype or as a result of the illness characteristic is yet to be investigated. OBJECTIVE:

· To assess Neurological Soft Signs (NSS) in alcohol-dependent individuals

· To compare them with their first-degree relatives and healthy controls

METHODOLOGY:

A total of 30 cases diagnosed with Alcohol Dependence Syndrome along with 30 of their first-degree relatives and 30 healthy controls between the age of 18- 45 years were assessed using the M.I.N.I. 6.0, the Severity of Alcohol Dependence Questionnaire and the Neurological Evaluation Scale.

RESULTS: The results showed that the total Neurological Evaluation Scale (NES) scores were statistically significant in the patients in comparison to the first-degree relatives and controls. However, there was no statistical significance seen between the total NES scores of the first-degree relatives and controls. CONCLUSION: The difference between the three groups thus can be partly attributed to the presence of the illness characteristics as a significant difference is seen between the patients and the controls and also between the patients and their first-degree relatives but not between the first-degree relatives and controls. Thus, on the basis of our study, NSS in Alcohol Dependence Syndrome cannot be regarded as a true endophenotype.

126.TITLE: STUDY OF SEXUAL DYSFUNCTION, MARITAL SATISFACTION & QUALITY OF LIFE IN FEMALE DEPRESSIVE PATIENTS IN REMISSION ON SSRIs

AUTHOR: Dr. Penubarthi Sravanthi, POST GRADUATE

CHETTINAD HOSPITAL AND RESEARCH INSTITUTE

Background :

Depression is a common mental health problem with antidepressants as the major treatment. Sexual dysfunction is a potential side effect of antidepressants, more common with Serotonin reuptake inhibitors (SSRI) (25-73%) which include diminished libido, anorgasmia, vaginal xerosis and decreased tactile sensitivity in the genital region. This affects the patient’s quality of life (QOL) and can lead to marital dissatisfaction. Poor marital harmony and QOL per se are risk factors for developing depression and increase the chance of poor compliance to medications.

Aims : To study the prevalence of sexual dysfunction and correlation between marital satisfaction and quality of life with sexual dysfunction in married female depressive patients during remission on SSRI.

Materials & Methods : This was an analytical cross-sectional study, conducted in the Department of Psychiatry, CHRI. 116 participants among which, 58 patients aged 18-45 years, with depression, in remission, on treatment with SSRI mono therapy for a duration of at least 6 weeks were included in the study, with age and sex matched comparative group. Socio-demographic profile was assessed through semi-structured proforma. Hamilton Depression Rating Scale was used to assess the severity of depression, Female Sexual Functional Index to assess the sexual dysfunction, Couple Satisfaction Index to assess marital satisfaction and World Health Organization QOL Scale-BREF scale to measure QOL. Data obtained were tabulated and analyzed using the SPSS software.

Results : Majority of participants in patient group exhibit high rates of sexual dysfunction, marital dissatisfaction and poor QOL when compared to normal population. Results are being analyzed in detail and will be presented in the conference.

Conclusion:

Sexual dysfunction in female depressive patients is under-recognized, which may further impair marital satisfaction & QOL. Hence, proper screening to detect sexual dysfunction in females on SSRIs is necessary to improve QOL.

Keywords:

Sexual dysfunction, Remission, SSRI, Quality of Life

127.TITLE:PREVALENCE AND SEVERITY OF DEPRESSION IN INFERTILE WOMEN ATTENDING TERTIARY CARE HOSPITAL

AUTHORS: DR.P.S. MURTHY, DR.N.KAVITHAPRASANNA, post graduate

Santhiram medical college

Background : Infertility is a stressful experience for many couples. Depression is considered as one of the main psychological disorders associated with infertility and it may significantly affect the life of infertile women, their treatment, and follow-up. Mild and moderate depression associated with dull mood and decreased interest in pleasurable activities is common in infertile women. As the duration of infertility increases, it progresses to severe depression and suicidal attempts due to decreasing hope.

Objectives of study

To study the prevalence of depression and severity of depression in infertile women.

Design : This is a cross sectional study

Materials and methods

· Data collected from 100 infertile women attending outpatient department of tertiary care hospital, Nandyal.

· Initially by a personal interview, psychiatric diagnosis was made according to ICD-10 criteria.

· Then the Beck Depression Inventory is applied to estimate the severity of depression

Results: Out of 100 subjects participated in the study, 81% of the women found to have depression. 31% of the patients in this study had moderate depression, whereas mild and severe depression was seen in 27% and 23% of the patients respectively. Severity of depression was found to be increasing with duration of infertility, rural background, lower education, failed attempts.

Conclusion : Depression can itself increase the problem of infertility. Our study points at the necessity of specific psychological interventions for women struggling with infertility, to help them manage potential mental health problems and meet their reproductive goals. The higher prevalence of depression in the study also emphasizes the importance of liaison with the department of obstetrics and gynecology and fertility medicine for better outcome in these women.

128.TITLE:Gender difference in deliberate self harm among Indian urban school going population.

AUTHOR:Tomar AS1, Sinha VK2 1. MD (Post Diploma) Resident Department of Psychiatry, School of Medical Sciences and Research. 2. Director Professor of Psychiatry, Central Institute of Psychiatry, Kanke Ranchi.

Background: Deliberate Self Harm (DSH) is Defined as, an act with non-fatal outcome, in which an individual deliberately initiates a non-habitual behavior that, without intervention from others, will cause self harm, or deliberately ingest a substance in excess of the prescribed or generally recognized therapeutic dosage, and which aimed at realizing changes which the subject desired via the actual or expected physical consequences. Several studies have found higher rates of self harm in individuals from younger generation. The current study aimed at studying gender difference in school going children of urban area. Method: 215 students were recruited from urban school between age of 11-17 yrs of both sexes studying in class 6th -12th Std. consent from guardian and teacher was taken prior to the study. Children with severe neurological impairment were excluded. Deliberate self harm inventory questionnaire (DSHIQ) and K-SADS was administered. SPSS 16 was used for analysis. Result: DSH was found to be more prevalent in Males 59 (70%) as compared with Females 25 (30%) between age group of 11-17 years. Most common methods used were, scratching body till bleeding occurs, cutting wrist, banging head, preventing wounds from healing etc. Conclusion: Deliberate Self Harm was found to be more prevalent in Indian urban school going population. Keywords: DSH, K-SADS, DSHIQ.

129.TITLE:A case of Compulsive Masturbation treated with Aripiprazole

AUTHOR:Manosij Maity*; Alok Pratap**, *Junior Resident; ** Assistant Professor

Central Institute of Psychiatry

Introduction

Repetitive thoughts with pleasurable and ego-syntonic content may, under certain conditions, be perceived as intrusive and distressing and cause impairments in functioning. Compulsive sexual behavior (CSB) is a disorder featuring repetitive, intrusive and distressing sexual thoughts, urges and behaviours that negatively affect many aspects of an individual’s life.

Aim

We describe a case of Compulsive masturbation with Bipolar affective disorder unspecified admitted in Central Institute of Psychiatry with the aim to describe the phenomenon and treatment response with Aripiprazole.

Methods

A 20-year-old Hindu male was admitted in Central Institute of Psychiatry with Excessive masturbation, Repeated flashing of obscene images in mind, Frequent mood fluctuations, Muttering to self and Frequent Aggressive outbursts. Initially the masturbation was pleasurable to the subject and ego syntonic. But gradually it started becoming intrusive and unwanted and got coupled with flashes of obscene images of homosexual content in his mind. A diagnosis of Excessive Sexual Drive (Compulsive Masturbation) according to ICD 10 along with Bipolar Affective disorder unspecified was made and he was started on Sodium Valproate up to 1200 mg and Aripiprazole up to 15 mg.

Results

The subject showed considerable improvement in all fronts and the frequency of Masturbation as well as repeated flashing of images and mood fluctuations.

Conclusion

Compulsive sexual behaviour as a Nosological entity has been described mostly in the context of Paraphilia related disorder, but yet has received no separate diagnosis in ICD or DSM. It has no established treatment regime, although as observed in our case there are reports of improvement in Aripiprazole as well as SSRI’s.

130.TITLE: A study to assess risk of Relapse in patients with Alcohol Dependence Syndrome in a tertiary care hospital.

AUTHOR:Dr. Divya R 1, MD PSYCHIATRY POSTGRADUATE, INSTITUTE OF MENTAL HEALTH

Dr. Divija Bunga 2 Dr. Phanikanth.K

INTRODUCTION:- Substance abuse causes acute and chronic physical, psychological and social effects in varying amounts along with serious social problems in the form of crime, unemployment, family dysfunction and disproportionate use of medical care. Relapse refers to return to abusing the substance regularly after a certain period of abstinence. Identifying those at risk for early relapse helps in taking adequate relapse prevention measures.

AIM: To identify the risk of relapse and to find the association between the risk of relapse and sociodemographic variables in such patients.

METHODOLOGY :- A cross sectional study conducted at tertiary care hospital at Hyderabad. Subjects who fulfill the inclusion and exclusion criteria will be taken after an oral informed consent.

INCLUSION CRITERIA :-

  1. Who gave consent for the study.
  2. 18-65 years.
  3. Who are diagnosed with alcohol dependence syndrome according to ICD-10.


EXCLUSION CRITERIA :-

  1. Those who didn’t give consent.
  2. With other co-morbid medical disorders.
  3. With other comorbid substance abuse except tobacco.


TOOLS USED :-

  1. A semi-structured intake proforma.
  2. Clinical Institute of Withdrawal Assessment Alcohol–revised (CIWA–Ar).
  3. Alcohol Use Disorder Identification Test (AUDIT).
  4. Advanced Warning of Relapse (AWARE) scale.
  5. ICD- 10


SAMPLING TECHNIQUE:- Convenience sampling, 50 subjects

STATISTICAL ANALYSIS:- SPSS software

RESULTS AND CONCLUSION:- Will be discussed at the time of presentation.

Key words:- Alcohol Dependence Syndrome, Relapse, CIWA–Ar, AWARE scale.

131. TITLE : A study to assess the disability impact on parents of children with Intellectual disability.

AUTHOR:DR.DIVIJA BUNGA, MD PSYCHIATRY

INSTITUTE OF MENTAL HEALTH

INTRODUCTION:- Intellectual disability is a highly prevalent and disabling condition. In India prevalence varies from 0.22 % (ICMR, 1983) to 32.7% (Shalini,1982) per thousand population. Depending on the severity of their disability they are more and more dependent on their caregivers. Family members particularly parents are more affected by the condition. There is need to find out how disability due to intellectual disability is affecting parents of such persons in order to help those who are having negative impact and to find out how they are positively affected so that others can be helped in the same manner.

AIM OF THE STUDY :- To know the disability impact and the type of impact of having a mentally retarded child, on the parents.

METHODOLOGY :- A cross sectional study done at child psychiatry outpatient department(OPD) of tertiary care hospital in September 2018. Subjects who fulfill the inclusion and exclusion criteria will be taken after an oral informed consent.

INCLUSION CRITERIA :-

4) Who gave consent for study.

5) Children brought to OPD with history of delayed milestones, behavioural issues etc.

EXCLUSION CRITERIA :-

4) Who didn’t give consent.

5) Parents diagnosed with mental illnesses prior to the birth of disabled child.

TOOLS :-

6) A semi-structured intake proforma.

7) ICD-10.

8) Modified NIMH disability impact scale.

9) Developmental Screening Test (D.S.T).

SAMPLING TECHNIQUE :- Purposive sampling.

STATISTICAL ANALYSIS :- SPSS software

RESULTS AND CONCLUSION :- Will be discussed at the time of presentation.

Key words :- Intellectual disability, Disability impact, Modified NIMH disability impact scale.

Developmental Screening Test (D.S.T).

132.TITLE:Prevalence of depression and anxiety in the elderly patients admitted in Regional Geriatric Centre, Gauhati Medical College & Hospital

AUTHOR:Dr. H.R. Phookun, Dr. S. Mazumdar, MD Psychiatry

Tezpur Medical College

Keyword – depression, anxiety

Introduction- Old age is not a disease. It is a phase of the life cycle characterized by its own developmental issues long with loss of physical agility and mental acuity, loved ones and status and power. The psychiatric morbidity in elderly is one of the less focussed area in our country and it remains undetected and therefore remains untreated. Many a times the symptoms seen in elderly individual are given less importance and thought to be a part of normal ageing.

Aims- To assess the prevalence of depression and anxiety in elderly patients and to assess the association of socio-demographic variables in these patients.

Methodology- The study was carried out in 85 patients admitted in the Regional Geriatric Centre, GMCH. Psychiatric diagnosis was made using ICD-10 and a semi-structured interview was done to assess the socio-demographic variables.

Results- The study results showed the prevalence of psychiatric morbidity in 40 patients (47.05%) out of 85. Among these, depression was seen in 16 and anxiety disorder in 5. Depression was seen more in female, widow, Hindu, from rural background, unemployed. More patients were in the age group of 70-79 years, male, married, Hindu, unemployed, in joint family and from rural background.

Conclusion- The study results show that depression and anxiety is prevalent in geriatric age group and different socio-demographic variables are associated with depression and anxiety in elderly people.

133.TITLE: Study of Depression in Epileptic patients and aspects of its phenomenology

AUTHOR :Dr. mithlesh khinchi, MD Psychiatry

government medical college kota

AIMS & OBJECTIVE: Depression is the most frequent psychiatric comorbidity in epilepsy but most of time it remain unrecognized and untreated. The aim of our study is to assess the frequency and some aspects of the phenomenology of interictal depression in a random sample of adult patients with idiopatic epilepsy

METHODS & MATERIALS: We examined 130 epileptic patients, aged 18-60 years, 78 males and 52 females, for the presence of interictal depressive disorder. All subjects underwent clinical psychiatric examination, including evaluation on Hamilton Depression Rating Scale (HAM-D17). A questionnaire for socio demographic Performa, clinical profile sheet and seizure-related variables was also completed.

RESULT & CONCLUSION: Depression (clinically presented according to ICD-10 diagnostic criteria) affected 26.92% of all evaluated patients. Based on HAM-D-17 scores depression was defined as mild – 74.28% of all depressed patients, moderate - 20% and severe – 5.71%. Atypical presentation of interictal depressive disorder was frequent. Depression has a effect on one’s family, social and psychological functioning, even more than the actual seizure frequency and severity.

Keywords: Epilepsy, Depression, Phenomenology

134.TITLE :Wilsons disease – Challenges in management of psychiatric symptoms

AUTHOR- Varshitha, MD Psychiatry

Sydney Moirangthem, Evan, T Navya Spurthi NIMHANS Bengaluru

Wilsons disease is an inherited autosomal recessive disease caused by mutation in gene ATP7B located in chromosome 13 leading to impairment in copper metabolism resulting in copper toxicity. Approximately Wilson disease affects 1 in 30,000 to 40,000 individuals. The presentation is usually neurologic or hepatic, seen in 40% of patients and about 15% of patients presented with psychiatric manifestation and vast range of psychiatric symptoms has been described that it has been great masquerader. Psychiatric manifestation may be due to because of tissue damage caused by copper accumulation, but might be consequence of real co morbidity with affective disorder principally BPAD which might co segregate with mutation causing wilsons disease in closed community with high consanguinity. We Present a 19year old gentleman diagnosed with Wilson disease 4years back presenting with wide range of psychiatric manifestation over a period of 1year who had initially presented with depression with psychotic symptoms, then in catatonia, currently in mania. This case illustrates the challenges in management of psychiatric symptoms in a person with wilsons disease,the various factors influencing the management of patient.

Key words – Wilson disease, neuropsychiatric manifestation, management of affective symptoms in Wilson, drug interactions

135.TITLE: Role of addiction specialists in prevention of Opioid Overdose deaths

AUTHOR:Dr Jaswinder Singh Gandhi,MD

Amrit foundation

Recently there has been epidemic of Opioid Use Disorders in certain parts of world and hence the mortality associated with Opioid overdose. Different studies show that Opioid overdose is generally witnessed, death takes a while and is generally due to respiratory failure

Addiction is a chronic relapsing disorder where even a recovering patient can relapse anytime and die of Opioid overdose. Considering the fact that a large number of OUD patients come to addiction specialist for treatment, these physicians can play a major role in reducing the mortality of OUD by educating the patients and their Significant Others against Opioid overdose and prescribing Naloxone to them in addition to other addiction medicines. They can keep Naloxone at a safe place and use it in case they witness an Opioid overdose and save a life.

Naloxone a pure Opioid antagonist is very safe, reliable, cheap, easily available and fast acting drug. Naloxone causes reversal of sedation and respiratory depression associated with Opioid Overdose within minutes and it has no side effect of its own even in higher doses. Recently newer preparation of Naloxone in form of Nasal Spray (Narcan) has been approved by FDA to prevent overdose deaths

In some developed countries Naloxone Dispensing program is being practiced widely and they have been able to minimize the mortality associated with Opioid overdose. Also there is Good Samaritan law being implemented in these countries where even a layman can give Naloxone in case of witnessed Opioid overdose. Unfortunately in certain parts of world including India there is yet no hold of OEND even in tertiary health care centres

As an addiction specialist certified by ISAM, in last four years I have been able to save 14 patients in emergency with Naloxone who were brought to me with Opioid overdose respiratory depression

136.TITLE: In Person v/s computerized counselling with a multilingual interactive software in SUD

AUTHOR: Dr Jaswinder Singh Gandhi, MD

Amrit foundation

Medication Assisted Treatment with Substitution Therapy (Buprenorphine, Methadone) or Antagonist Therapy (Naltrexone) is safe and effective and it is associated decrease in morbidity and mortality associated with Opioid Use disorders. Results are better when patients receive Psychosocial counseling along with MAT. Various studies show results are even better with more intensive counseling.

We present two groups of patients. First group of 30 patients using illicit Opioids were detoxified by intensive outpatient regime and they continued with Oral Naltrexone as MAT. Patients received person to person counselling for relapse prevention during weekly clinic visit for first three months and after that every fortnight for next three month.

Second group of 30 patients using illicit opioids were detoxified and continued with Naltrexone like first group. This group received relapse prevention counseling by a free Interactive Software, weekly for first three months and every fortnight for next three month.

In first group after three months 20 patients tested negative and 2 tested positive for illicit opioid in urine and continued with MAT and 8 relapsed back and stopped MAT. After Six month 16 (54 %) tested negative and 1 positive and continued with MAT and 13 patients relapsed back to illicit opioids.

Second group after three months 19 tested negative and 1 positives continued with MAT and 10 relapsed back. After six months 15(50 %) tested negative 1 positive continued with treatment and 14 patients relapsed back.

Result of Interactive computerized counseling is comparable to in person counseling. This is especially significant for Primary care centers which offer MAT but have minimum resources for in person counseling.

137.TITLE:EMOTIONAL INTELLIGENCE AND EMPATHY AMONG MEDICAL UNDERGRADUATES, INTERNS, POSTGRADUATES AND MEDICAL PRACTITIONERS

AUTHOR-Lakshmi Shodhana kasam,MBBS(MD), Mamata medical college

Raghuram Macharapu,2 Pramod KR Mallepalli,3 Ravulapati Sateesh.4

INTRODUCTION: Emotional Intelligence (EI) impacts many different aspects of daily life such as the way one behaves and interacts with others. Empathy, one of the five elements of emotional intelligence is considered to be the most important psychosocial factor in patient care. Thus an assessment of EI and empathy would probably help us determine factors to help guide healthcare professionals toward better patient-centred care, along with the ability to handle the profession-associated stress.

AIMS AND OBJECTIVES: The aim of this study is to assess emotional intelligence and empathy among medical students and professionals and its relation with personal and social factors

MATERIALS AND METHODS: This is a cross-sectional study that is conducted with a sample that consists of 200 participants in Mamata Medical College, Khammam, Telangana during a period of six months (2018).A semi structured pro forma is used to collect socio-demographic profile and Emotional Quotient Self-Assessment Checklist by Sterrett is used to measure emotional intelligence and empathy.

RESULTS: Higher EI and empathy has a direct co-relation with good sleep, recreational activities, regular exercise, less work hours and good interpersonal relationships.

CONCLUSIONS: This study provides an insight that appropriate amount of work hours, adequate sleep, good relations with colleagues and superiors must be promoted as they relate to higher EI and help provide better healthcare.

KEY WORDS: Emotional intelligence, Empathy, Medical professionals, Emotional Quotient Self-Assessment.

138.TITLE:Mobile Phones Usage and its association with Stress, Anxiety and Depression among Adolescents.

AUTHOR:Sri Divya Reddy Kandhi, MBBS (MD)

MAMATA MEDICAL COLLEGE

INTRODUCTION: The use of mobile phones has become so much integrated in our lives that they seem to be indispensable and problematic at times. Addiction to smart phone usage is a common worldwide problem especially among adolescents, which might negatively affect their wellbeing.

OBJECTIVE : The aim of this study is to assess the excessive mobile phone usage and its effects on stress, anxiety and depression among adolescents.

MATERIALS AND METHODS : The present study is conducted among students in Khammam and consists of 100 adolescents within the age group 12-19 yrs during a period of 6 months (2018). The study is conducted using Smart phone addiction scale (33 item scale) & DASS-42 (Depression, Anxiety & Stress Scale).

RESULTS: The prevalence and the factors with smart phone addiction and anxiety, depression and stress are associated with each other. Higher scores indicated higher levels of addiction and its relation with stress, anxiety and depression.

CONCLUSION: Adolescents should use mobile phones appropriately to avoid further impairment of mental health. Hence, the reasonable mobile phone usage is advised.

KEY WORDS: Mobile phone usage, Stress, Anxiety, Depression, Adolescents.

139.TITLE:Mass Media Exposure and Eating Pathology among Female Medical Students

AUTHOR:Kavya Sri K1 MBBS (MD), MAMATA MEDICAL COLLEGE

Raghuram Macharapu 2, Pramod KR Mallipalli3, Ravulapati Sateesh Babu4

ABSTRACT

Background: Social network media exposure conceivably influences behaviour and body image, through imitation and social learning. Indirect media exposure such as the proliferation of media exposure in an individual’s social network – is also associated with eating disorders.

Aims and Objectives: To test the mass media exposure both individual (direct) and social network (indirect) and it’s correlation to eating pathology in female medical students.

Materials and Methods: The total sample consists of 200 female participants who are pursuing their under-graduation in Mamata Medical College, Khammam, Telangana. The samples are drawn using convenience sampling method. Eating disorder Examination questionnaire(EDE-Q) and sociocultural attitudes towards appearance questionnaire-3 (SATAQ-3), were the tools used.

Results: Mass media exposures, both the direct and indirect were associated with eating pathology. This result was similar when eating pathology was functionalized as either a continuous or a categorical dependent variable. Subsequent analyses pointed to individual media influence as an important explanatory variable in this association.

Conclusions: Mass media exposure was associated with eating pathology in this study sample, independent of direct media exposure and other cultural exposures.

Key words: Mass media exposure, eating pathology, eating disorder examination Questionnaire (EDE-Q).

140.TITLE:COMPARATIVE STUDY OF COPING IN PATIENTS WITH EATING DISORDERS

AUTHOR: DR. PAWAR VINITA BHAUSING, M. D. PSYCHIATRY

SETH G.S. MEDICAL COLLEGE AND K.E.M. HOSPITAL

ABSTRACT:

Background: Eating disorders are complex medical and psychiatric illnesses with serious consequences on health, productivity, and relationships. Dis-engagement coping strategies during stress may predispose to eating disorders while engagement strategies may have positive outcomes.

Objectives: To find the prevalence of eating disorders and difference in psychopathology on subscales. To assess various coping mechanisms used by individuals with and without eating disorders.

Methodology: 120 subjects between the age group of 18-25 were assessed for eating disorders using the Eating Disorder Examination–Questionnaire (EDE-Q) and for coping strategies using Coping Strategies Inventory-Short Form (CSI-SF).

Statistics: Unpaired t-test and ANOVA were used to compare global and subscale scores on EDE-Q and CSI-SF among cases and controls

Results: Our analysis showed the prevalence of eating disorder in the age group 18-25 years to be 27.5%. On studying the domains related to eating disorder mean scores on shape concern and weight concern were found to be higher in females.

The use of dis-engagement coping strategies is found to be greater in subjects diagnosed with eating disorders (29% vs 18%) which implies they seek to limit exposure to noxious stimuli, often producing desirable short-term effects, but leading to longer-term problems, including depressive symptoms.

At the same time engagement strategies were found to be used more by controls (82% vs 71%) implying they involve in approach-related actions that result in confronting stressors, often viewed as a crucial factor in limiting the long-term sequelae of stressors.

Conclusions: Our study concludes that eating disorders have significantly high prevalence in the young population. Also teaching and strengthening problem-focused engagement coping mechanisms in young population can have a better outcome in eating disorders.

141.TITLE:Improving detection and treatment of mental disorders in community settings: development, validation and evaluation of Community Informant Detection Tool in Nepal

AUTHOR:Nagendra P Luitel1 Head of Research

Brandon A Kohrt2 Mark JD Jordans 3

1 Research Department, Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal

2 Department of Psychiatry, George Washington University

3 Center for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK

Background: Accurate detection of persons in need of mental healthcare is crucial to reduce the treatment gap between psychiatric burden and service use in low- and middle-income countries. Community case finding by lay community workers particularly in resource poor countries could be advantageous. The aim of this study was to develop, validate and evaluate the accuracy and effectiveness of a community-based proactive case-finding strategy called Community Informant Detection Tool (CIDT).

Methodology: The CIDT was developed following several steps including prioritization of symptoms, and assessing applicability and feasibility. Validation was conducted by using Composite International Diagnostic Interview (CIDI) as a gold standard with 195 adults screened with CIDT. The CIDT was evaluated with 509 community residents identified as potentially having MNS problems through the CIDT procedure three weeks after detection.

Results: The CIDT comprises of contextualized vignettes using local idioms of prioritized symptoms with illustrations. The CIDT has a positive predictive value of 0.64 and a negative predictive value of 0.93. The probable positive cases identified through CIDT are encouraged to visit the health facility, where diagnosis and treatment is available. Of the total 509, 67% accessed health care facility as a result of the CIDT procedure. Among the group that accessed health care, 77% were diagnosed having mental disorders and started treatment by primary health care workers.

Conclusion: The CIDT can be used by lay community members with low literacy levels. It holds potential psychometric properties to increase detection and care utilization of mental disorders in settings with limited treatment engagement.

142.TITLE:Relationship between Stigma, Self-Esteem and Quality of Life in euthymic patients of Bipolar Disorder- a cross sectional study

AUTHOR: Arun Kumar Dwivedi, DOCTOR

Base Hospital Delhi Cantt

Background. Despite good therapeutic outcomes, Bipolar Affective Disorder or Bipolar Disorder (BD) is associated with stigma at large. Available literature suggests that low self-esteem and high stigma contributes to a poor quality of life in patients of Bipolar Affective Disorders and that stigma by itself leads to low self-esteem. Current study aimed to examine this association in the Indian context, by comparing these parameters in patients of BD with controls.

Methods. Sixty two adults with BD (as per ICD-10 criteria) in remission, were selected for the study. Stigma, Self-esteem and Quality of Life were assessed using Internalization of Stigma of Mental Illness (ISMI) scale, Rosenberg Self-esteem Rating Scale and WHO QOL BREF respectively. Results were analyzed using Student’s t-test, Pearson’s correlation coefficients and multiple regression model in SPSS-20.

Results. Thirty two percent of patients did not experience stigma (ISMI total score <2.00). Mean total ISMI score for patients was 2.33 (mild stigma). Compared to controls, patients had lower self-esteem (mean 12.63) and lower scores on WHOQOL-BREF. Self-esteem scores were significantly associated with all domains of WHO QOL BREF while ISMI total scores were not. Further, self-esteem was not found to be associated with stigma scores.

Conclusion. Patients of Bipolar disorder in remission have low self-esteem, experience mild stigma and have a low quality of life. Lower self-esteem was strongly related to lower quality of life while stigma was not. Also, stigma was not associated with self-esteem. Measures to improve self-esteem may benefit patients of Bipolar disorder in the long run.

Keywords

Stigma, Self-esteem, Quality of Life, Bipolar Affective Disorder, Euthymic

143.TITLE: Age at First Drink and Severity of Alcohol Dependence

AUTHOR: Arun Kumar Dwivedi, Doctor

Base Hospital Delhi Cantt

Background: Early Age at First Drink (AFD) has been linked to early onset and increased severity of Alcohol Dependence in various studies. Few Indian studies on AFD have shown a negative correlation between age at first drink and severity of Alcohol Dependence. Our study aimed to explore this relationship in patients of Alcohol Dependence Syndrome (ADS) diagnosed using ICD-10 criteria.

Material and Methods: One hundred and fifty one consecutive patients freshly diagnosed with ADS were included in the study, which was conducted at the psychiatry unit of a tertiary care, multi-specialty hospital. Addiction Severity Index (ASI) was used to assess severity of Alcohol Dependence.

Results: Mean age at first drink was 24.85 years (range – 13 to 40 years). Mean ASI score was 36.07 (range– 21 to 57). The study yielded a weak negative correlation (ρ=−0.105) between AFD and ASI, which was statistically not significant.

Conclusions: Our finding is contrary to what has been reported worldwide and in previous Indian studies. Delayed initiation of alcohol use amongst those enrolling in the Indian armed forces and early detection of Alcohol Dependence within the military environment are possible explanations.

144.TITLE: Factors associated with medication adherence in patients with schizophrenia and their correlation with insight and therapeutic alliance – A cross-sectional study.

AUTHOR: Dr. Darshan Dharaiya,Doctor

GOVT MEDICAL COLLEGE,SURAT

Introduction: Schizophrenia is a chronic mental illness with variable course and prognosis. Taking regular medication has definitely a good outcome than not taking medication. But poor insight, a side effect of medication and other socio-demographic factors are some of the factors responsible for medication non-adherence and violence and emergency hospital admission. This study aims to find out the relationship between medication adherence, insight and physician alliance (the relationship between doctor and patient) and demographic factors.

Methodology: Patients diagnosed with schizophrenia according to DSM-V who are on medication for minimum 6 months with no admission or discontinuation of treatment within 6 months and have no associated medical comorbidity or substance use will be selected during routine out-patients hours for first 10 patients per day who fulfil the criteria and agree to take part in the study will be included during 1 month’s duration. After explaining the study and taking informed consent, Birchwood insight scale, Medication adherence scale and Working alliance inventory scales be applied along with demographic details and treatment details.

Result and Discussion Will be discussed at the time of the conference as the study is still undergoing.

Keywords: schizophrenia, insight, adherence.

145. TITLE:To study oral glucose tolerance test in drug naïve schizophrenic patients.

AUTHOR: Dr Richa choudhary1 (PG Resident)

MGM Medical College

OBJECTIVE:To study the association of impaired glucose tolerance with drug naïve schizophrenic patients compared with the healthy controls.

METHOD: 120 Study sample was taken with 60 cases and 60 control. Sociodemographic details were collected using semi structured data entry proforma. Clinical assessement of cases was done with Positive And Negative Syndrome Scale. Assessment of oral glucose tolerance test was done with glucometer using capillary blood at our hospital setting.

RESULTS:On studying oral glucose tolerance test in 60 cases and 60 controls we found that maximum cases were of >37 age group, were male, married, hindu, illiterate, semiskilled by occupation, had no income, lived in nuclear family and rural locality, had negative family history of psychiatric illness had normal BMI. whereas maximum controls were of 28-32 age group, were male, single, hindu, graduate by education, professionals by occupation, had no income, lived in nuclear family in urban locality, had negative family history of psychiatric illness had normal BMI. PANSS scale was applied Mean positive, negative and general psychopathology score were 11.27,14.68,22.11 respectively. Mean fasting and 2hr blood sugar among cases and control were 81.28±15.90 & 116.08±25.77 and 83.18±12.12. & 115.76±20.20 respectively. Prevalence of impaired oral glucose tolerance test among cases and control was 15% and 3.3% respectively

CONCLUSION: Cases with cigarette smoking were comparatively higher to contols, Statistical significant result was found. Oral glucose tolerance test was significantly impaired in cases as compared to controls. We also find significant correlation between cigarette smoking and impaired oral glucose tolerance test

146.TITLE:Perceived expressed emotions in Bipolar Disorder: Role in Relapse and Intervention

AUTHORS:Alisha Arora*, CLINICAL PSYCHOLOGIST

Palak Maheshwari, Kavita Nagpal, Rupali Shivalkar, Manish Kansal,Shanti Home Advanced Deaddiction, Mental Health Clinic and Psychiatric Rehabilitation Centre

Expressed emotions is a widespread known factor of significance in symptomatic course of many mental illnesses. Negative family dynamics has persistently been found to be related to the onset and reoccurrence of symptoms in psychiatric disorders. However, little work is available in regard to the expressed emotions in family as perceived by a patient with bipolar affective disorder, and how it might be one of the factors behind the episodes of the illness. In the present study, 35 patients diagnosed with Bipolar Affective Disorder, and having history of last episode in past 3 months, completed the Level of Expressed Emotion (LEE) scale – Client Version. The family members were also asked to write down a paragraph on their person affected with illness, focusing on their view about him. The study aimed at understanding expressed emotions as perceived and whether it may have relation to the relapse of symptoms. Information about client’s perceived dynamics will also facilitate in better planning for family intervention.

Key Words: Expressed emotions, Relapse, Level of expressed emotion, Perceived expressed emotions, Bipolar disorder

147.TITLE:Internet Use during the Premenstrual period and its correlation with Depression and Anxiety among college students

AUTHOR:Deepali Bansal, 3RD YEAR RESIDENT MD PSYCHIATRY

Rajesh Raman,Department 0f Psychiatry, JSS Medical College And Hospital, JSS University, Mysore, Karnataka

BACKGROUND:

Mood and behavioral changes are observed during the premenstrual period in as many as 80% of women, and Internet Use Disorder is a ‘real’ threat in the vulnerable age group of college-going women. Depression is twice more common in women compared to men. There is a dearth of studies in Indian context exploring the correlates of internet addiction. This study explores the possibility of increased internet use during premenstrual period and its correlation with depression and anxiety.

METHODOLOGY:

This is a cross-sectional study, 500 girl students of various colleges of Mysore, Karnataka were visited in colleges and assessed with sociodemographic proforma, and scales to assess PMS, Depression, Anxiety and Internet Addiction. Data obtained was analyzed using SPSS-20, descriptive and inferential statistics.

RESULTS:

Detailed results will be discussed at the time of presentation

CONCLUSION:

There is a dire need for systematic research in the area of internet addiction and its possible correlates.

KEYWORDS: Internet Addiction, Premenstrual, Depression, students

148.TITLE:A STUDY EVALUATING STATUS OF ANXIETY AND DEPRESSION AMONGST PRIMARY CAREGIVERS OF CHILDREN WITH ATTENTION DEFICIT HYPERACTIVITY DISORDER

Authors: Aditi Agrawal1, G.D. Koolwal2, Sanjay Gehlot2

1 3rd year Resident Doctor, Department of Psychiatry, Dr. S.N. Medical College, Jodhpur

2 Senior Professor, Department of Psychiatry, Dr. S.N. Medical College, Jodhpur

Background

Attention-deficit hyperactivity disorder (ADHD) is one of the most common neuropsychiatric condition affecting children across the world. Being a parent to an ADHD child is a challenging and sometimes frustrating task as children impose increased caretaking demands. Parents’ mental health can be adversely affected, thus displaying higher levels of depression and anxiety. It is indeed important that we attempt to understand ADHD, interrelationships among causal and controllability attributions and provide balanced and supportive benefits to meet the needs of affected children and their families; hence this study has been planned.

Aim

To assess the severity of anxiety and depression among primary caregivers of children with ADHD and its comparison with controls.

Methodology

This was a cross-sectional study conducted at MDM Hospital, a tertiary care centre associated with Dr. S.N. Medical College, Jodhpur (Rajasthan). Fifty parents of children diagnosed with ADHD, fulfilling the inclusion and exclusion criteria were taken as cases. Fifty suitably matched parents attending the OPD for treatment of their children with minor medical condition comprised the control group. Sociodemographic data of the parents of study group were obtained in a specially designed proforma and Hamilton Rating Scale for Anxiety (HAM-A) and Beck’s Depression Inventory (BDI) were used. Obtained data were analysed using appropriate statistics.

Results

Results will be discussed at the time of presentation.

Keywords: Anxiety, Attention-deficit hyperactivity disorder, Caregiver, Depression

149.TITLE:Marital satisfaction among spouses of men with alcohol dependence

Authors- Dr Gaurav dhanda,Resident Doctor, Dept. Of Psychiatry, JLN Medical College Ajmer, India

Dr Mahendra Jain, Head & Professor, Dept. Of Psychiatry, JLN Medical College Ajmer, India

Dr. Charan Singh Jilowa, Assistant Professor, Dept. Of Psychiatry, JLN Medical College Ajmer, India

Dr Parth Singh Meena, Assistant Professor, Dept. Of Psychiatry, JLN Medical College Ajmer, India

Dr Jitender arora,Resident Doctor, Dept. Of Psychiatry, JLN Medical College Ajmer, India

Context:

Alcoholism is considered as an ongoing stressor for family members as well. Spouses of alcoholics are known to be exposed to high rates of domestic violence, which could be physical, verbal or sexual. Low martial satisfaction, are the other major issues among the spouses.

Aims:

  1. To examine the severity of alcohol dependence.
  2. To assess the degree of marital satisfaction among wives of patients with alcohol dependence.


Settings and Design :

Cross-sectional, single assessment study conducted at a tertiary care centre.

Subjects and Methods:

Participants consisted of group of men-those with AD(Alcohol Dependence) as per ICD10 criteria [AD group n=70] and there wifes. Participants were individually administered sociodemographic proforma, MINI, CIWA- Ar, SADQ and MAT scales. Standard descriptive statistics (mean, percentage), Chi-square test and independent sample t-test were applied.

Results:

A total of 70 participants couples formed the study sample. Mean SADQ score was 29.7(+/-10.28), and 37(52.85%) patients had an SADQ score of more than 30 indicating severeAD,25(35.71%) patients have SADQ between 16-30, 8(11.42%) patients have SADQ score below 16. On comparison between marital satisfaction and severity alcohol dependent, sever the alcohol dependent higher the marital dissatisfaction.. Mean MAT score is 76.81(+/-21.96), 31(44.2%) wives are very dissatisfied, 15(21.4%) are dissatisfied, 19(27.4%) are average, 5(7.1%) are satisfied, no one is unusually satisfied.

Conclusion and limitations-

Marital satisfaction negatively correlated with the severity of alcohol dependence in men, satisfaction being lower as severity of dependence increases. The major limitation of the study is that the sample was selected from patients who sought help at a general hospital., the findings may not be generalized to patients with similar problems in the community or who seek help in other kinds of settings.

150.TITLE:Study of association between altered lipid profile and suicide attempt among schizophrenia patients

AUTHOR:Dr Jitender Arora, 3RD YEAR PG RESIDENT

Dr Mahendra Jain, Dr Charan Singh, Dr Gaurav Dhanda

JLN MEDICAL COLLEGE

Background - In people with schizophrenia there is approximately 4–5%, lifetime suicide mortality which is higher than in the general population. There are very little studies regarding is the biology of suicide with schizophrenia. The aim of the present study was to investigate a possible correlation between alteration in lipid profile and suicidal behavior in schizophrenic patients.

Methods - An assay of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), and triglycerides (TG) has been done for 30 schizophrenic patients with and without suicide attempts and 30 healthy controls. Psychopathology was assessed with the Positive and Negative Symptom Scale for Schizophrenia (PANSS),, CGI (Clinical Global Impression) which allows assessment of the severity, the therapeutic index, and improvise patients under treatment and CALGAGARY (Depression Scale For Schizophrenia).

Results- There were significantly higher levels of TC and LDL-c levels in schizophrenic patients compared to controls. In schizophrenic patients with suicide attempt TC was significantly lower as compared to those without suicide attempt. Depending on the duration of suicide attempt, TC was significantly lower in patients with recent suicide attempt as compared to those with lifetime suicide attempt and without suicide attempt (p < 0.001), and there was no significant differences between TG, LDL-c, and HDL-c were noted.

Conclusions- The results of above study shows that TC levels in schizophrenic patients after a recent suicide attempt are significantly lower as compared in patients without suicide attempt and with lifetime suicide attempts.

Keywords: Cholesterol, Lipids, Schizophrenia, Suicide

151.TITLE:STUDY ON LEVEL OF INSIGHT IN PATIENTS WITH OBSESSIVE COMPULSIVE DISORDER

Presenting Author: Evelyn John, Junior resident, Department of Psychiatry, Amala Institute of Medical Sciences, Thrissur. Email: johnevelyn192@gmail.com

Co- Author:

1. Sreekumar D Professor,HOD, Department of Psychiatry, Amala Institute of Medical Sciences, Thrissur. Email : sreekumardamod@gmail.com.

2. Anisha Nakulan, Assistant Professor, Department of Psychiatry, Amala Institute of Medical Sciences, Thrissur. Email: anisha_nakulan@rediffmail.com


Introduction

The historical definition of Obsessive Compulsive Disorder (OCD) required that the patient recognize the irrational and illogical nature of their obsessions and compulsions. Early descriptions nevertheless remarked that not all of them constantly show such a clear recognition and suggested that there may simply be a difference of degree between obsessions, overvalued ideas, and delusions1. Insight is a multidimensional and complex phenomenon, which involves motivational, cognitive and perceptive processes. It is now recognized that insight may lie on a continuum of full awareness of senselessness or absurdity at one end to a total lack of any such awareness at the other end.

Objectives

To study level of insight in a clinical sample of patients with OCD.

Materials and methods :

Our sample consisted of 112 consecutive patients between the age of 15 -50 years diagnosed clinically as OCD. Subjects were interviewed using socio demographic proforma, Yales Browns Obsessive Compulsive Scale, and Brown’s assessment of belief’s scale.

Result

Prevalence of poor insight was found to be 31.3% in our study. Result showed poor insight for religious obsessions. (p< 0.01) and good insight in contamination obsession /cleaning compulsions (p<0.01). Patients with poor insight had earlier age-at-onset, longer duration of illness, more number of symptoms, more severe illness (p<0.01) Poor insight was also associated with unemployment, poor social support. (p value 0.01).

Discussion: The study reports that poor insight is relatively common in OCD. This was in accordance with various studies which reported prevalence of poor insight to be 15-36%2. Cross-sectional studies have associated poor insight in patients with obsessive–compulsive disorder (OCD) with increased OCD symptom severity, earlier age of onset, co morbid depression, and poor treatment response3,4. Level of insight plays an important part in the identification and treatment plan for people with obsessive and compulsive disorder.

Key words : OCD, insight

  1. Kozak MJ, Foa EB. Obsessions, overvalued ideas, and delusions in obsessive-compulsive disorder. Behaviour Research and Therapy. 1994 Mar 1;32(3):343-53.
  2. Insel TR, Akiskal HS. Obsessive-compulsive disorder with psychotic features: A phenomenologic analysis. The American journal of psychiatry. 1986 Dec.
  3. Catapano F, Perris F, Fabrazzo M, Cioffi V, Giacco D, De Santis V, Maj M. Obsessive–compulsive disorder with poor insight: a three-year prospective study. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2010 Mar 17;34(2):323-30.
  4. Matsunaga H, Maebayashi K, Hayashida K, Okino K, Matsui T, Iketani T, Kiriike N, Stein DJ. Symptom structure in Japanese patients with obsessive-compulsive disorder. American Journal of Psychiatry. 2008 Feb;165(2):251-3.


152.TITLE:Standardization of a Indian, computerized, colour-comic based ‘Irony comprehension’ task

AUTHOR:Sai Krishna Tikka*, Avinash Shukla, Purushotham A, Lokesh Kumar Singh

Department of Psychiatry, All India Institute of Medical Sciences, Raipur

Background:

Studies exploring irony comprehension (IC) have used tasks that significantly vary. The number of stories vary from 1 to 120; median being 16. While majority of them used sentence based stimuli, a few of them have image and video based stimuli. While neuroimaging studies have computerized presentation mode, all other studies have presented stimuli in a manual mode, which eludes accuracy of measures like reaction times. Majority of the studies have task stimuli in English and are conducted on native English speaking populations. With only one available Indian validated task, which has only 2 sentence-based stories that are presented manually, we aimed to validate a computerized, Hindi, colour-comic image based IC task consisting of 15 stories.

Methods:

Task is presented as a computerized experiment using OpenSesame® software to 135 consenting healthy participants. Additionally, a sentence based, manually presented task also will be undertaken along with theory of mind (ToM) tasks of the Social Cognition Rating Tools in Indian Setting (SOCRATIS). Content Validity (evaluation by experts, whether each story represents IC assessment, Indian-ness, emotional valency of targets and response), criterion validity (correlation with ToM scores), concurrent validity (correlation with sentence based task), external reliability (test-retest reliability) and internal reliability (split half reliability) will be examined.

Results and Conclusions:

To be presented during the conference

Keywords: Irony comprehension; Indian; Computerized; Validity; Reliability.

153.TITLE:EMOTIONAL INTELLIGENCE AND COPING STARATEGIES IN LATE ADOLESCENCE PRESENTING WITH DELIBERATE SELF HARM

AUTHOR: sarmistha priyadarshani

MKCG.MEDICAL COLLEGE

INTRODUCTION: Deliberate self harm is highly prevalent in adolescents and the incidence is increasing by the day. It is a behavioural problem with significant clinical public health importance. Emotional intelligence is the ability of an individual to understand ones own and others emotions and feelings, distinguish between them and use this knowledge in decision making process and actions. EI might be linked to DSH.

OBJECTIVES: To study EI and coping strategies in the adolescents in the age grp 16 to 19 yrs who present with DSH.

METHODS: the patients coming with DSH in the age froup of 16 to 19 yrs were taken up for study. Self injurious behavior was assessed with self harm inventory and socio demographic data was taken. EI was measured and its role in DSH was assessed by means of central tendancy and dispersion Rrelative importance of different coping strategies was assessed. Association between EI and coping strategies was determined.

RESULTS: EI and four areas defining EI for 30nsubjects in our study falls in the description of poor EI. Maladaptive coping styles were more commonly used. It was found that as total EI and intra personal management component of EI increase, there was significant increase in use of adaptive coping stategies.

CONCLUSIONS: study concludes the role of low emotional intelligence in adolescents who self harm and maladaptive coping styles seem to mediate the role between low emotional intelligence and self harm.

154. TITLE: Inhalant use beginning before 5 years of age: Insights from 2 cases from north India

Authors: Jyoti Singh, SENIOR RESIDENT

Akhilesh Sharma, Ruchita Shah, Sandeep Grover, Rahul Chakravarty, Venkatesh Raju V, Satwinder Saini

Background: Those with childhood behavioral disorders such as hyperkinetic conduct disorder are at an increased risk of developing substance use disorders including that of inhalants in their adolescence. Volatile solvent use has mainly been reported in older children and adolescents. There are very few cases reporting inhalant use in children less than 10 years.

Aim: To present two cases of inhalant use beginning around 4-5 years of age and discuss the same.

Methods and results: Case 1: 7 years old male child (who presented at age 5 and then dropped out to again seek treatment at age 7) with history of symptoms of hyperactivity and inattention evident by 3 years of age, with conduct symptoms by age 4 also had history of preoccupation and demands for different types of volatile products like repellent, deodorant, and sprays. Child would spray the aerosols, bring the nozzle near his nose and protest when stopped. Parental psycho-education and behavioral management is the mainstay of management. Case 2: 11 years old male child with history of sub-average intellectual functioning with emotional and conduct symptoms presented with history of inhaling shoe polish, burnt match sticks, incense sticks, and sucking pen refills from around 4-5 years of age. Child was guarded about these behaviors. Psychotherapy and behavioral management have been planned. Both children belonged to middle socio-economic status with family history of alcohol dependence in Case 2.

Conclusion: Inhalant use is being increasingly recognized in adolescents; but one should be alert while assessing the younger children, especially those with childhood behavioral and emotional disorders so that early intervention can be planned.

Key words: Volatile solvent, Hyperkinetic conduct disorder, inhalant, behavioral disorders

155. Title: Pattern and prevalence of mental and behavioral disorder due to Opioid use : A hospital based study.

Presenter: Gyanendra Raghuvanshi (PG JR-2)

Author: Dr. Pradeep Kumar (Professor & Head, Department of Psychiatry, Shyam Shah Medical College, Rewa MP)

Introduction: In Recent changing world the prevalence of substance use sharply increasing and with time this pattern of substance use is also changing. Different psychoactive substance has different medical and social consequences for subjects. Recent National household survey (NHS) data reveals that alcohol (21.4%) was the primary substance used (apart from tobacco) followed by cannabis (3.0%) and Opioids (0.7%). Prevalence of Opioid use is two times higher than prevalence in Asia and within country the pocket of high Opioid use was found especially in Indo-Pak and Indo –Nepal border States. The eastern part of Madhya Pradesh is landlocked and far away from international borders still more number of patients availing the services of hospital for Opioid de-addiction and related consequences. This study intended to study the clinical variables and pattern of Opioid use among patients attending de-addiction services in the hospital.

Aims & Objectives:

  1. To study the hospital based prevalence of mental and behavioral disorder due to Opioid use.
  2. To study socio-demographic and clinical variables associated with substance use disorder.


Methodology: Data collected from out patients & in patients sections of department of neuropsychiatry & mental health GMH & SGMH, Rewa. Purposive sampling methods used, all the subjects attending department for de-addiction services recruited from Jan 2018 to Dec 2018 for the study and clinical and socio-demographic details entered in semi structured data after informed consent from patients.

Statistical analysis: The results will be subjected to statistical analysis using appropriate tests to achieve significance of clinical variables (p=<0.05)

Result and discussion: The data analysis will be done by using SPSS v21 with appropriate statistical analysis.

156.TITLE - Comparisons of Psychiatric Advance Directives (PADs) made by Patients’ and their caregivers

AUTHORS- Guru S Gowda*, Santhosh Kumar, Channaveerachari Naveen Kumar, Suresh Bada Math

Affiliation - Department of Psychiatry, National Institute of Mental Health And Neuro Sciences, Bengaluru – 29

Place of Work - Department of Psychiatry, National Institute of Mental Health And Neuro Sciences, Bengaluru – 29

All authors are members of Indian Psychiatric Society

Correspondence and Presenting Author*

Dr Guru S Gowda

Assistant Professor under Mental Health Care Management System

Department of Psychiatry

National Institute of Mental Health and Neurosciences, Hosur Road,

Bengaluru - 560029

Mobile No - +91-99-017-58577;

E-Mail - drgsgowda@gmail.com, drguru05@gmail.com

Objectives - Advance directives are documents stating treatment preferences in case of future lack of decision-making capacity. In India, as in many other countries, legislators advocate Psychiatric Advance Directives (PADs), while evidence on its use is limited. This study compared the contents of PADs made by patients with their caregivers.

Methods - We conducted a hospital-based descriptive study in Bengaluru, India. A total of 200 patients and their caregivers were included in the study. Patients and their caregivers were asked to make PAD using Bangalore Advance Directive Interview (BADI) after informed written consent.

Results - The mean age of the patients was 33.9 years compared to the mean age of the caregivers 43.8 years. Males outnumber females in both patients (54.4%) and caregivers (60.5%). Both the patient and their caregivers had the capacity to make a voluntary, valid and competent PAD. The significantly higher proportion of caregivers opted for inpatients care (63%) and treatment from a psychiatrist (95%). On contrary, a significantly higher proportion of patients (57.4%) have opted for outpatient care. There was no significance found in the choosing treatment options like psychotherapy, non-allopathic treatment and faith healers between them.

Conclusions - Patients and caregivers were able to make voluntary valid PADs. The findings of the study suggest that patient illness and severity may have a significant impact on patients’ advance directives rather than their capacity. Further structured studies in this area will help us to understand the patient’s perspective on PADs.

Key Words Psychiatric Advance Directives;Comparison;Patients;Care Givers;India.

157.TITLE:Prevalence of serum peripheral autoimmune markers and its association with gastrointestinal symptoms and symptomatology in autism spectrum disorder (ASD).

AUTHOR: Divya Kumari Sherigar, post graduate student

Bangalore medical college and research institute

Background / Introduction :

ASD is now being recognised as a whole body disorder with many of the manifestations being understood as a result of a complex systemic process. ASD children are believed to have high titres of various autoantibodies which may be pathogenic. Literature has also focused on “leaky gut” in ASD which increases vulnerability to these antibodies. There is only a single published study which has documented increased prevalence of anti-ds-DNA and anti-nucleosome antibody.

Aims and objective:

· To study the prevalence of ANA profile auto antibodies in children and adolescence with ASD and its relationship with G.I manifestations and ASD behaviours.

Materials and methodology:

· 50 children and adolescence from autism clinic of BMCRI will be recruited after consent.

· ISAA and BPI will be administered.

· G.I symptoms will be enquired with checklist.

· ANA profile will be sent for all these individuals.

· Appropriate statistical analysis will be done.

Results and conclusions:

Will be discussed in conference.

Keywords:

Autism Spectrum disorder.

Autoimmunity.

ANA profile.

158.TITLE:Introduction :Indian lunacy act had an objective of safe custody in asylums. Mental health act 1987, ushered treatment and care, for mentally ill, with licensing, minimum norms and inspection as theme. Now Mental health care act 2017 speaks about rights of the mentally ill and protection of human rights.

AUTHOR: Dr Divya Kumari Sheriga r, post graduate student

Bangalore medical college and research institute

Objective: Present study was undertaken to know the status of licensed psychiatric institution in Bangalore city. With the hypothesis that they fulfil minimum norms.

Methodology: A cross-sectional study in the city of Bangalore where 44 institutes were evaluated by qualified psychiatrist with the semi- structured proforma, collecting details of infrastructure, manpower, and other facilities as per mental health act. The data was entered in excel sheet and descriptive analysis was done.

Results: Total No Of 44 Institutions Visited, out of which 04 were Mental health Institutes, 08 were psychiatry units in general hospital, 20 de addiction centre,12 rehabilitation centre. 32 were acute centers, 12 were convalescent centers. Number of bed ranged between 10-250, with mean of 41.45 and standard deviation of 49.5751. Out of 44 institutions 26 were liscensed,26 were approved by local authority,27 had sufficient ventilation. Out of 44 institutions 29 had atleast one psychiatrist, 20 had clinical psychologist,16 had atleast one nurse,18 had atleast one social worker.

Conclusion: From our observation we found that the many of the inspected institutions didn’t fulfil the prescribed minimal norms as per the Mental Health Care Act 2017.

Authors : Dr Divya Kumari Sherigar, Dr Chandrashekar H, Dr Sneha, Dr Madhumitha

159.TITLE:A STUDY OF RELATIONSHIP BETWEEN SOCIODEMOGRAPHIC PROFILE & DURATION OF STAY WITH PSYCHIATRIC DISORDERS AMONG OLD AGE HOME INMATE

AUTHOR:Dr. Akshay Lele,

Rajeev Gandhi Medical College & C.S.M.H, Kalwa, Thane

Introduction – Ageing is a universal phenomenon & with changing social structure there is an increase of admissions of elderly to Old age homes for supervised care. Psychological distress is common in elderly both in community as well as old age homes. Here we present a study on relationship between socio-demographic profile & duration of stay with psychiatric disorders among old age home inmates.

Methodology – Out of 110 all 100 inmates who met inclusion & exclusion criteria were incorporated in study. ICD-10 Diagnostic Criteria were used to diagnose psychiatric disorders using MINI plus Neuropsychiatric Interview. Modified Kuppuswamy Scale was used for assessment of social status & MMSE was used for cognitive assessment. Data was tabulated on Excel sheet & statistical analysis was done by using Statistical Package for Social Sciences (SPSS).

Results – Among 100 inmates, 40 were suffering from psychiatric disorders spread over all age categories. Unmarried or separated inmates had more psychiatric disorders. Similarly, more psychiatric disorders were seen in inmates belonging to urban areas, having more financial dependence & increased duration of stay.

Conclusion – Many studies have been conducted on psychiatric disorders among elderly, but there are few Indian studies on elderly staying in old age homes. In our study we investigated associations between socio-demographic profile & duration of stay with psychiatric disorders. Marriage is a protective factor for many psychiatric disorders; similar finding was reproduced in our study. Interestingly, longer duration of stay & financial dependence was associated with more psychiatric disorders. Thus, there is a need to further analyse psychological adjustment of elderly staying in old age homes.

Key words – Old age home inmates, psychiatric disorders, socio-demographic profile, duration of stay

160.TITLE: TOPIC: PREVALENCE OF SUBSTANCE ABUSE IN PATIENTS OF SCHIZOPHRENIA

AUTHOR:Dr Parisha Kelkar,Resident, Department of psychiatry,Jawaharlal Nehru Medical College, Wardha, Kelkarparisha25@gmail.com9422865577

INTRODUCTION: Substance abuse is a common comorbidity in patients of Schizophrenia. Link between the use of substances and development of psychosis is demonstrated by high prevalence of substance abuse in schizophrenia. Substance use disorders and their effects on course of schizophrenia have made identification and treatment of schizophrenic patients a high priority. This study aims to investigate the prevalence of substance abuse, preferred types of substances of abuse and its association with sociodemographic characteristics and clinical features of schizophrenia.

MATERIALS AND METHODS: It is an observational cross sectional study conducted at Jawaharlal Nehru Medical College, Wardha. Sample size of 100 patients was taken. The participants were assessed by proforma containing sociodemographic details, questionnaires PANSS, AUDIT, Fagerstrom, DAST-10. Patients with substance abuse were compared with patients without substance abuse on demographic and disease related characteristics. Categorical data was analyzed by Chi- Square test and quantitative data was analyzed by t-test.

RESULTS: 48% patients of schizophrenia had substance abuse. Smokeless tobacco was found to be the most commonly abused (42%) by patients of Schizophrenia. Substance use was more common in males than females. Smokeless tobacco was the only substance abuse in females (18%). Substance use was more common in patients belonging to lower socioeconomic status and those having family history of psychiatric illness and substance abuse. Schizophrenic patients with substance abuse had more PANSS positive score than those without substance use.

CONCLUSION: Substance abuse is a significant comorbidity in patients of schizophrenia in India.

KEYWORDS: Schizophrenia, Alcohol abuse, Comorbidity

161.TITLE:Stigma related to Psychiatric disorders among Physiotherapy Students in Central India

AUTHORS:Divyani Padole,Parisha Kelkar

G.K. Vankar,Datta Meghe Institute Of Medical Sciences,

Sawangi (Meghe), Wardha,Maharashtra 442001

e-mail: diya.padole@gmail.com

Aim and objective: We explored attitude of physiotherapy students from an institute in Central india and its correlates.

Method: Physiotherapy students from a Physiotherapy College in central India participated in the study. Opening Minds Stigma Scale for Health Care Providers (OMS-HC) (Modgill, 2014); a 14 item five-point likert scale questionnaire was used as a study instrument, lower scores indicate less stigmatising attitude. The scale items are divided in three subscales, attitude of health professional students, disclosure and social distance. The comparisons were made among men and women students, as well as between those who had or did not have personal/family members psychiatric disorder and those without such history.

χ2 test and t test were used to find differences among the comparision groups.

P<0.05 was considered as statistically significant.

Result: Of the 113 respondents the vast majority were women, had mean age 20.4 years. They had more stigmatizing attitudes compared to western studies. They had total mean score 43.4 which is considerably higher. 43.3% would hide if they had mental disorder,41.6% would be reluctant to seek treatment, 38.1% would consider themselves as weak, 42.5% considered they could do nothing much for mentally, There was no gender difference overall in the attitude towards psychiatric disorders.

Conclusion: Physiotherapy students had significantly more negative attitude compared to their western counterparts which needs to be addressed.

References:

  1. Lawrie SM. Stigmatisation of psychiatric disorder. Psychiatric Bull. 1999;23:129–31.
  2. Raguram R, Weiss MG, Channabasavanna SM, Devins GM. Stigma, depression, and somatization in South India. Am J Psychiatry. 1996;153:1043–9.
  3. Charles H, Manoranjitham SD, Jacob KS. Stigma and explanatory models among people with schizophrenia and their relatives in Vellore, south India. Int J Soc Psychiatry. 2007;53:325–32
  4. Crisp AH, Gelder MG, Rix S, Meltzer HI, Rowlands OJ. Stigmatisation of people with mental illness. Br J Psychiatry. 2000;177:4–7


162.TITLE:Developing a contextualised care seeking pathway tool for psychiatric illness: Findings from the mixed method step.

AUTHOR:Sanghamitra Pati, Pranab Mahapatra (Presenting Author), Mousumi Samal, Krushna Chandra Sahoo. Kalinga Institute of Medical Sciences, Bhubaneswar

Background: Mental health is an emerging public health issue across the globe. In spite of advancing health care facilities, many patients are seeking care from multiple providers including magico-religious healers due to cultural beliefs and ignorance. There is a single tool used for the mapping of care-seeking pathway by World Health Organisations (WHO- 1987), which is not updated and context specific. Therefore, this study aims to design a psychiatric care-seeking pathway questionnaire.

Methods: Mixed methods design used in this study; the quantitative and qualitative data were collected in an iterative process; following both inductive and deductive approaches simultaneously. Total 125 structured questionnaire interviews (SQIs) and 30 in-depth interviews (IDIs) were conducted among the psychiatric patients those who were seeking care at a tertiary health care facility in Odisha, India. Descriptive statistics and content analysis used for quantitative and qualitative data analysis respectively.

Results: Four major themes emerged in this study. 1) Onset of illness and response, 2) The first point of care, 3) the next point of care and sequence change, 4) Roadblocks to care-seeking pathway. Under each theme categories and sub-categories were reconnoitered. The major categories were earliest symptom and time, source of information, first perception and reaction to illness, attribution of illness, reason behind care-seeking, first motivator to consult, first consultant, time lag in symptom appearance and help seeking, treatment history, and reason for referral/resumption/discontinuation of treatment.

Conclusion: This study suggests that an updated and context specific psychiatric care-seeking pathway tool is essential to monitor the patients and for opportune treatment. The mixed methods design is worthwhile in the trajectory of developing context specific and time relevant monitoring instrument.

Key words: Care-seeking, questionnaire, mental illness, mixed method

163.TITLE :Lithium carbonate induced Blepharospasm: A case report from North India

AUTHOR: Ajay Kumar, Institute of Mental Health and Hospital, Agra

Background: Blepharospasm is rarely reported with use of lithium. Methodology (Case report): In this case report, we present a patient of affective disorder, who presented with sustained contraction of orbicularis-oculi for 6 months, which was associated with use of lithium carbonate. Result (Case Description) : A 41 year married man, who was premorbidly well adjusted, presented with symptoms of recurrent sustained involuntary closure of both eyes. Evaluation of history revealed that he was maintaining well on Lithium 600 mg/day for a year, with serum lithium levels of 0.4mmol/L. In view of low serum levels of lithium, the dose of lithium was increased to 750 mg/day. Within a week of increasing Tab. Lithium to 750 mg/day, he developed sudden spasmodic closing of eyes, usually precipitated by blow of air and started having difficulty in riding the bike. On investigation, his serum lithium levels were found to be 0.49mmol/L. There was no evidence of any other ocular pathology and there was no associated history of fever, head injury, substance use, any other psychiatric manifestations, any other motoric symptoms and any neurological deficits. He did not respond to treatment with Tab. Trihexyphenidyl 10 m/day in divided doses and Botulinum injection. Following lack of improvement with these agents, reduction in the dose of Tab. lithium was considered, with which, within a period of 3-4 weeks, his blepharospasm showed marked improvement.

Key words: Lithium, Blepharospasm, tardive syndromes

164.TITLE:Legal entanglement among opioid dependent patients

AUTHOR:Dr Rahul Mathur, Dr Siddharth Sarkar, Dr Yatan Pal Singh Balhara

Department of Psychiatry and NDDTC, AIIMS, New Delhi

Corresponding author- Dr Rahul Mathur, E mail- jammyrahul17@gmail.com

Background and aims : Patients with opioid dependence have high rates of legal problems, often as a consequence of associated deviant behaviour and to fund the habit of substance use. This analysis presents the data of legal entanglement among patients with opioid dependence seeking treatment at a tertiary care centre.

Methods : Patients with opioid dependence seeking treatment at a tertiary care centre were assessed (n = 173). Legal entanglement was defined as either being detained by the police, being incarcerated or having a case pending. Relationship of legal entanglement with demographic and clinical variables were assessed.

Results : Legal entanglement was reported by 41 patients (23.7% of the sample) with 39 being detained, 23 having a history of incarceration and 8 having cases pending against them. Duration of opioid use disorder (p = 0.268). Having a history of injecting drug use was associated with having history of legal entanglement (p = 0.014). Legal entanglement was higher in those with higher per-capita income (p = 0.13), and those with greater number of significant abstinent attempts (p = 0.025).

Conclusion : Legal issues could be an important concern in patients with opioid dependence. Many issues may be contributory to the legal challenges faced by them. Yet, treatment providers need to be cognisant of legal issues being a potential impediment to the treatment process.

Key words: opioid dependence, legal entanglement, incarcerated

165.TITLE:Relationship between Stigma, Self-Esteem and Quality of Life in euthymic patients of Bipolar Disorder- a cross sectional study

AUTHOR: Arun Kumar Dwivedi, Base Hospital Delhi Cantt

Abstract

Background. Despite good therapeutic outcomes, Bipolar Affective Disorder or Bipolar Disorder (BD) is associated with stigma at large. Available literature suggests that low self-esteem and high stigma contributes to a poor quality of life in patients of Bipolar Affective Disorders and that stigma by itself leads to low self-esteem. Current study aimed to examine this association in the Indian context, by comparing these parameters in patients of BD with controls.

Methods. Sixty two adults with BD (as per ICD-10 criteria) in remission, were selected for the study. Stigma, Self-esteem and Quality of Life were assessed using Internalization of Stigma of Mental Illness (ISMI) scale, Rosenberg Self-esteem Rating Scale and WHO QOL BREF respectively. Results were analyzed using Student’s t-test, Pearson’s correlation coefficients and multiple regression model in SPSS-20.

Results. Thirty two percent of patients did not experience stigma (ISMI total score <2.00). Mean total ISMI score for patients was 2.33 (mild stigma). Compared to controls, patients had lower self-esteem (mean 12.63) and lower scores on WHOQOL-BREF. Self-esteem scores were significantly associated with all domains of WHO QOL BREF while ISMI total scores were not. Further, self-esteem was not found to be associated with stigma scores.

Conclusion. Patients of Bipolar disorder in remission have low self-esteem, experience mild stigma and have a low quality of life. Lower self-esteem was strongly related to lower quality of life while stigma was not. Also, stigma was not associated with self-esteem. Measures to improve self-esteem may benefit patients of Bipolar disorder in the long run.

Keywords

Stigma, Self-esteem, Quality of Life, Bipolar Affective Disorder, Euthymic

166.TITLE:Age at First Drink and Severity of Alcohol Dependence

AUTHOR: Arun Kumar Dwivedi, Base Hospital Delhi Cantt

Background: Early Age at First Drink (AFD) has been linked to early onset and increased severity of Alcohol Dependence in various studies. Few Indian studies on AFD have shown a negative correlation between age at first drink and severity of Alcohol Dependence. Our study aimed to explore this relationship in patients of Alcohol Dependence Syndrome (ADS) diagnosed using ICD-10 criteria.

Material and Methods: One hundred and fifty one consecutive patients freshly diagnosed with ADS were included in the study, which was conducted at the psychiatry unit of a tertiary care, multi-specialty hospital. Addiction Severity Index (ASI) was used to assess severity of Alcohol Dependence.

Results: Mean age at first drink was 24.85 years (range – 13 to 40 years). Mean ASI score was 36.07 (range– 21 to 57). The study yielded a weak negative correlation (ρ=−0.105) between AFD and ASI, which was statistically not significant.

Conclusions: Our finding is contrary to what has been reported worldwide and in previous Indian studies. Delayed initiation of alcohol use amongst those enrolling in the Indian armed forces and early detection of Alcohol Dependence within the military environment are possible explanations.

167.TITLE:PREVALENCE OF METABOLIC SYNDROME IN PATIENTS OF SCHIZOPHRENIA RECEIVING TREATMENT AND COMPARISON OF INDIVIDUAL COMPONENTS OF METABOLIC SYNDROME

AUTHOR : Arundhati Bhagabati1, Deepanjali Medhi2

1. PGT, Gauhati Medical College And Hospital, 2. Associate Professor, Gauhati Medical College

Introduction : Schizophrenia, a chronic mental illness is associated with a number of medical comorbidities one of which is Metabolic Syndrome. One causative factor is the use of antipsychotic medications acting on the receptors viz. H1,5HT2A, 5HT2C which are involved in regulation of food intake and sleep.

Aims : is to study the prevalence of metabolic syndrome in schizophrenic patients on treatment and to find out which of it’s components is significantly altered in them.

Method : Schizophrenia was diagnosed as per the ICD 10 and DSM 5 criteria in patients attending the outpatient and admitted in the department of the Psychiatry, GMCH. For the diagnosis of metabolic syndrome, the NCEP-ATPIII criteria was applied. The duration of the antipsychotic use was more than or equal to six months. The study design was a cross sectional study done within a period of one year.

Results: 14 out of total 50 (28%) patients receiving antipsychotic medication for a period of atleast six months was diagnosed with metabolic syndrome. Of the individual components of metabolic syndrome, waist circumference was significantly increased in this group of patients(p< 0.001)

Conclusion : The present study is in conformity with previous studies with similar results.

168.TITLE:THE TYPES OF PSYCHOSEXUAL DISORDERS AND PATTERN OF PSYCHOTROPIC PRESCRIPTIONS IN MALE PATIENTS ATTENDING PSYCHIATRY OPD IN A TERTIARY CARE HOSPITAL

AUTHOR:Jita Barauh1 Utpal Bora 21

1Department Of Psychiatry, Gauhati Medical College & Hospital, Guwahati, Assam, India

2Department Of Psychiatry, Gauhati Medical College & Hospital, Guwahati, Assam, India

BACKGROUND: Sexual dysfunction can be defined by the disturbance in the subjective sense of pleasure or desire usually associated with sex or by the objective performance. Sexual response is a psychosomatic process; and both psychological and somatic processes are usually involved in the causation of sexual dysfunction. Psychosexual disorder is not an uncommon presenting complain psychiatry out patient department. Most of the psychosexual problems are due to emotions or some socio-cultural belief systems.

AIMS AND OBJECTIVES : to assess the type of psychosexual disorders,the sociodemographic variables and its asssociaton with different types of psychosexual disorders and the pattern of prescriptions given.

MATERIALS &METHODS: Retrospective cross sectional study. Data were collected from records of the patients from out patient department of Psychiatry at Gauhati Medical College & Hospital from August 2016-July 2017. Data from records of males aged from 18 to 60 yrs diagnosed with psychosexual dysfunctions excluding any Psychiatric,medical or substance dependence disorder. 115 cases were recorded after filtering all the exclusion and inclusion criteria.

Data was analysed using Microsoft Excel Software version 2007.

RESULTS: Mean age of the cases was 28.33 years. Maximum diagnosed cases were DHAT syndrome i.e. (40%) followed by erectile dysfunction along with premature ejaculation, 23.47%,followed by erectile dysfunction alone(15 cases,13.04%),27 cases(23.4%) were a combination of erectile dysfunction & premature ejaculation.. Dhat syndropme dominated in the age group of 21-30 yrs(78.2%). Unmarried people majority had DHAT syndrome(84.7%) and married people majority had erectile dysfunction and premature ejaculation(70.3%).76% were prescribed SSRIs, (22%) with benzodiazepines, (13%) with phosphodiasterase 5 inhibitors and 12 cases(10.%) were prescribed other drugs.6.95% were counselled. SSRI was mostly prescribed(77.39%) for all types followed by benzodiazepines(20%).

CONCLUSION: This study shows that quite a big number of cases come with psychosexual disorders of which most common disorder being the Dhat syndrome and mostly SSRIs are prescribed.

Keywords: Dhat syndrome,erectile dysfunction,SSR

169.TITLE:A STUDY OF CLINICO-DEMOGRAPHIC PROFILE OF DISSOCIATIVE DISORER IN CHILDREN AND ADULT

AUTHOR:Manisha Bora1, Bobby Hmar2

1Department Of Psychiatry, Gauhati Medical College & Hospital, Guwahati, Assam, India

2Department Of Psychiatry, Gauhati Medical College & Hospital, Guwahati, Assam, India

Background: There are variations in presentations of the same psychiatric illness in children and adults. The study aims to study the clinico-demographic variables in children and adults with dissociative disorders and compare the variables between them.

Methodology: This is a cross sectional study. 62 adult patients aged 19-45 years and 38 child patients aged 6-18 years, diagnosed as dissociative disorder as per ICD-10 criteria from department of psychiatry, Gauhati Medical College & Hospital were enrolled for the study after obtaining written informed consent. The patients were interviewed using a self designed semi-structured proforma for clinico-demographic variables. Analysis of variables of both groups were done using SPSS software version 21. Student’s t-test and chi- square test were used. Result at P value <0.05 was considered statistically significant.

Results: In both adult and child group majority of patients were female (87.1% in adults and 92.1% in children). In both groups, majority had precipitating factors. The most common precipitating factor was found to be family disharmony (22.60%) in adult group and sexual abuse (23.70%) in child group. Significant difference was found on types of precipitating factor between two groups (p=0.004). Among adult group the most common presentation was dissociative convulsion (48.40%). Among child group the most common presentation was mixed dissociative disorders (36.80%). On assessment of difference of clinical subtypes of dissociative disorders between two groups, significant difference was found on the number of cases of dissociative convulsion (p=0.029) and mixed dissociative (conversion) disorders subtypes (p=0.010).

Conclusion: Significant difference was found on types of precipitating factors and dissociative subtypes between adult and child group. Further longitudinal study is required to evaluate outcome of patients of dissociative disorders.

Keywords : Precipitating Factors, Family, Sexual abuse, Subtypes, Mixed.

170.TITLE: A STUDY OF PSYCHIATRIC CO-MORBIDITY AMONG PATIENTS ON OPIOID SUBSTITUTION THERAPY ATTENDING DEPARTMENT OF PSYCHIATRY, RIMS, IMPHAL

AUTHOR: Dr.N Dhananjay Patro, POST GRADUATE TRAINEE

REGIONAL INSTITUTE OF MEDICAL SCIENCES, IMPHAL

BACKGROUND

Mood disorders particularly depression and antisocial personality disorders are the commonest psychiatric diagnoses reported in patients dependent on opioids followed by dysthymia and anxiety disorders. There are very few studies conducted on psychiatric comorbidities in patients on opioid substitution therapy. The objective of the study is to find out psychiatric comorbidity among patients who are on opioid substitution therapy.

METHODOLOGY

All 60(30 on methadone and other 30 on buprenorphine) patients with a diagnosis of opioid dependence syndrome made as per the ICD 10 diagnostic guidelines and who are under opioid substitution therapy are taken for the study. All the study participants were administered the tools meant for the purpose of the study after minimum 6 months of start of substitution therapy. The study is a Cross sectional study. Convenience sampling was done within duration from September 2016 to august 2018. The tools used are MINI PLUS ver. (5.0.0), and semi structured proforma for sociodemographic characteristics.

RESULTS

It has been seen that 6 out of 30 patient’s on methadone are having psychiatric comorbidities with major depressive episode (20%), Generalised anxiety disorder(16.75%), and suicidality (6.7%) and 18 out of 30 patients on buprenorphine are having psychiatric comorbidities with major depressive episode(43.3%), Generalised anxiety disorders(23.3%), Alcohol dependence syndrome(16.7%), and suicidality (26.7%).

CONCLUSION

In our study psychiatric comorbidities are seen in 40% of study population. The most commonly found disorders being mood disorders. The cooccurrence presents challenges for optimal patient management. Proper treatment of comorbidities can probably help to decrease the severity, duration, and complications of treatment. Hence, there is a need for screening all patients on opioid substitution therapy for psychiatric disorders.

KEYWORDS: psychiatric comorbidities, opioid substitution therapy.

171.TITLE:A study to assess effect of NMDA antagonist in depression in alcohol dependence and withdrawal

AUTHOR: Dhruv Gupta*1, Shobit Garg1, Sumit Khattri1,Department of Psychiatry, Shri Guru Ram Rai Institute of Medical & Health Sciences, Dehradun, Uttarakhand, India

Background:

Comorbid depression with alcohol dependence poses a clinical challenge, as well as predicts poor prognosis. There is growing evidence of anti- depressant effects of NMDA receptor antagonists such as memantine, as well as their use in alcohol dependence and withdrawal. Current study is designed to evaluate use of memantine in depressive symptoms in alcohol dependent patients.

Methodology:

This is a prospective study in a tertiary care hospital in Dehardun, Uttarakhand. Using block randomization, 86 alcohol dependent patients were randomized into equal groups receiving memantine or placebo, with both groups receiving benzodiazepines for withdrawal symptoms. Memantine was administered as fixed dose of 10mg twice daily and benzodiazepines given according to symptom triggered schedule. Revised Clinical Institute Withdrawal Assessment For Alcohol (CIWA-AR) and Montgomery- Asberg Depression Rating Scale (MADRS) was applied on days 1 and 14 of alcohol withdrawal. CIWA-AR and MADRS scores of the two groups were compared using Chi- square test. Pearson correlation analysis of socio- demographic variables, CIWA-AR and MADRS was also done.

Results:

Two groups did not have any significant difference in socio- demographic variables, or total dose of benzodiazepines received. There were no significant differences in CIWA-AR and MADRS scores of both groups on days 1 and 14. Significant correlation found in memantine group between CIWA-AR and MADRS on day 1.

Conclusions:

In accordance with available evidence, we could not find any significant effect of memantine on depression in alcohol dependent patients.

172.TITLE- Prevalence of Depression and its effect on Quality of life in HIV positive patients: A Cross-sectional Hospital-based study

AUTHORS: Dr. H. K. Goswami1, Post graduate trainee, Assam Medical College and Hospital, Dibrugarh

Dr. Pinky Poddar2

Affiliations:

Professor of Psychiatry, Principal cum-chief superintendent, Assam Medical College and Hospital, Dibrugarh.

Post graduate trainee, Department of Psychiatry, Assam Medical College and Hospital, Dibrugarh.

Presenting author: Dr. Pinky Poddar; 9864802915(M)

Background: The incidence of HIV is rising in Assam and as it affects the quality of life, it becomes a major concern for public health in the society. Various studies worldwide have reported depression to be highly common in HIV patients but despite this, it is widely under-diagnosed.

Aims: To evaluate the prevalence of depression in HIV positive patients and to study its effect on quality of life in these patients.

Methods: A cross-sectional study was conducted in HIV positive patients attending Antiretroviral Therapy (ART) centre, Assam Medical College and Hospital (AMCH), Dibrugarh. After approval from ethical committee and informed consent, 50 patients were screened for depression by applying prime MD scale and the diagnosis of depression was made according to ICD 10 guidelines. The severity of depression was assessed in depressed group and the quality of life was assessed using WHOQOF- BREF scale. The analysis of the observed data was done using Statistical Program for Social Sciences (SPSS) version 21.

Results: The prevalence of depression was found to be 54% in HIV patients. It was more in females and rural residents. The quality of life was low in all four domains namely physical, psychological, social relationships and environment of WHOQOL-BREF in those having depression than those who did not. The severity of depression correlated significantly in a negative manner with all the four domains of quality of life.

Conclusion: Depression is highly common in HIV patients and has a negative correlation with quality of life. Highly Active Antiretroviral Therapy (HAART) has increased the life of HIV patients. It is the need of the hour to detect depressive symptoms at the earliest in the HIV patients so that effective treatment for the same can be started thereby improving the quality of life.

Keywords: HIV, Depression, Quality of life

173.TITLE: Role of CRP as a response predictor in depression

AUTHOR: DIDAKAMIWAN KHONGLAH, POST GRADUATE TRAINEE

KOLKATA MEDICAL COLLEGE AND HOSPITAL, KOLKATA

Background : Depression is a major contributor to the overall global burden of disease. The inflammation hypothesis of depression proposes that MDD is also associated with activation of the immune system leading to increased production of proinflammatory cytokines. Not all patients show complete remission with antidepressant treatment. Personalizing treatment using biomarkers as predictors of antidepressant could decrease disability associated with depression. Based on this background and considering the lack of Indian literature in India, we have designed a prospective study to test the hypothesis that C- reactive protein predicts the response to antidepressants.

Aims : (a) To determine the correlation of levels of CRP and antidepressant response in patients with drug naïve MDD

(b) To determine whether lower levels of CRP is associated with better outcomes after antidepressant therapy

Materials and methods : We included 50 patients with drug naïve Major depressive disorder, and assessed CRP levels with MADRS scores at 0,3,6,12 weeks. Using general linear model analysis we analysed the association between CRP levels and the MADRS scores following treatment with Escitalopram.

Results : Although patients with higher baseline CRP levels were associated with decreased fall of the MADRS scores after 12 weeks of treatment, their scores were not statistically significant, however those with lower baseline CRP levels showed significant decrease of the MADRS scores after 12 weeks of treatment thereby confirming that lower CRP levels predicted better response to treatment

Conclusion : Our study suggests that the patients with higher CRP scores at baseline had poorer response to treatment as compared to those with lower levels of CRP at baseline.

KEYWORDS: major depressive disorder, c reactive protein, inflammation, predictor response

174.TITLE:PROFILE OF PATIENTS COMING ALONE TO PSYCHIATRY OUT PATIENT DEPARTMENT OF A TERTIARY CARE HOSITAL

AUTHOR: DR AMBUJ KUMAR PANDEY,DR AMITAVA DAN,DR ASIM KUMAR MALLICK,DR SATRAJIT GHOSAL, POST GRADUATE TRAINEE, BURDWAN MEDICAL COLLEGE, BURDWAN

INTRODUCTION ;MENTAL HEALTH IS A MAJOR CONCERN WORLDWIDE AND INDIA IS NOT BEHIND. THE BURDEN OF MENTAL DISORDERS LIKELY TO HAVE BEEN UNDERESTIMATED BECAUSE OF INADEQUATE APPRECIATION OF THE INTERPLAY BETWEEN MENTAL ILLNESS AND OTHER HEALTH DISORDERS.STIGMA HAS BEEN NOTED TO BE PRESENT IN HELP SEEKING IN MENTAL ILLNESS.

THE PROPORTION OF THE PATIENTS ATTENDING THE PSYCHIATRIC CONSULTATION IS LIMITED.LACK OF ADEQUATE KNOWLEDGE REGARDING MENTAL ILLNESSES AND HELP SEEKING ATTITUDES ARE COMMON REASONS FOR DELAY IN SEEKING PSYCHIATRIC CONSULTATION WHICH AFFECTS THE PROGNOSIS OF THE ILLNESS.

FAMILY HAS A SIGNIFICANT ROLE IN TREATMENT AND PROGNOSIS OF MENTAL ILLNESS OF AN INDIVIDUAL.IN DEVELOPING COUNTRIES FAMILY MEMBERS HESITATE IN BRINGING THE PATIENTS FOR PSYCHIATRIC CONSULTATION.

THERE IS DEARTH OF STUDIES REGARDING PROFILE OF PATIENTS COMING ALONE FOR PSYCHIATRIC CONSULTATION.

KEEPING IN BACKGROUND OF ABOVE A STUDY IS NEEDED TO ASSESS THE PROFILE AND DIAGNOSIS OF PATIENTS COMING ALONE TO A TERTIARY CARE HOSPITAL.

AIMS AND OBJECTIVES;

TO ASSESS THE PROFILE OF PATIENTS COMING ALONE TO PSYCHIATRY OUT PATIENT DEPARTMENT OF BURDWAN MEDICAL COLLEGE

METHODOLOGY ; STUDY WILL BE CONDUCTED FROM 1ST AUGUST 2018 TO 31ST OCTOBER 2018 AT PSYCHIATRY OUT PATIENT DEPARTMENT OF BURDWAN MEDICAL COLLEGE.ALL THE PATIENTS COMING ALONE TO THE OUT PATIENT DEPARTMENT AS NEW PATIENT WILL BE ASSESED BY SOCIODEMOGRAPHIC PROFORMA AND DIAGNOSIS WILL BE MADE.

RESULTS AND DISCUSSION; THE STUDY IS ONGOING AND WHATEVER DATA OBTAINED TILL DATE IS INSUFFICIENT TO COME TO A CONCLUSION.

175.TITLE:Study of prevalence of at-risk Internet use and correlates of Internet addiction among adolescents in a cantonment school

AUTHOR:Amit Chail, Harpreet Singh, Surinder Vashisht,Command Hospital, Southern Command, Pune

Background

There has been 1052% increase in internet use from 2000 to 2018. Exposure to Internet Addiction (IA) has been found to have detrimental effect on mental health of young people.

Most studies till date have focussed on the prevalence of Internet Addiction among college students. At-risk internet use was defined as a pattern of internet use which is currently not causing dysfunction but makes the individual vulnerable to addiction and the consequent bio-psycho-social consequences. The present study aims to study the prevalence of at-risk internet use among adolescents in a Cantonment school and correlates of Internet Addiction.

Methodology

Setting : A cantonment school in Western Maharashtra.

Study Design: Epidemiological (Cross sectional study)

Subjects: Students from age 10-19 years

Methods of data collection : Socio-demographic and correlates of internet use questionnaire and Young’s Internet Addiction test (IAT).

Statistical analysis: Chi square test, proportion

Results : Total 1325 students participated in the study. At-risk internet use was defined as scores range 40-69. 27.2% students had internet use pattern suggestive of At-risk internet use.

Biological factors which correlated significantly with higher score (> 70) on IAT scale were male gender and age more than 15 years. Social and technological factors were higher parental education levels (graduation or more), having own laptop/PC of the student, having laptop/PC in his/her own room, parental use of tobacco/alcohol.

Conclusion In our study, a substantial proportion (27.2%) of students is in the at-risk internet use range. There is a need for targeted interventions for this group. Interventions can be based on the modifiable risk factors.

Keywords: Internet addiction, At-risk internet use, adolescents, correlates of Internet addiction.

176.TITLE:NON ADHERENCE TO TREATMENT IN INDIVIDUALS WITH BIPOLAR DISORDER.

AUTHOR:Dr Arya Jith, Senior Resident, Amrita Institute of Medical Sciences

Cochin

KEY WORDS- BIPOLAR, NON ADHERENCE, MANIA.

Introduction:- Bipolar disorder is a chronic and severe mental illness present in 1-2 % of the population. Medication non adherence is often a greater problem in psychiatric disorders. Non adherence lead to various negative outcomes such as relapse, rehospitalisation and suicidality. It will alos afftect the quality of life of the patients. One of the ways to improve drug compliance is to elucidate the crucial factors responsible for poor drug compliance.

Methodology:

AIM:-To establish the prevalence of Non Adherence and to delineate the factors associated with it.

Study design:- Retrospective Chart Review Study

Study setting :Dr SMCSI Medical College which is a mutli speciality teaching hospital.

Instruments : Semistructed proforma.

Sample Size:- Assuming the alpha error at 0.5, power at 80% and considering the prevalence of non adherence to be 60 %13, with a precision of 20% the sample size estimation is 64. Therefore 64 study subjects were recruited. The formula employed was SS = Z2*(P)*(1 - P)/C2= (1.96)2x 60 (100-60)/122= 64

Statistical Analysis:- Proprotion of Non Adhereence will be expressed as percentage and frequency. The chi square and Fisher’s test were used to assess the significance of associations for categorical variables. Multivariate analysis will be performed using the logistic regression model. Variables with significance < 0.05 on univariate analysis will be employed in the multivariate model.

Results: 80-100%of the patients are adherent to medication. Most common cause is Negative aspect of patient towards drug and poor understanding about the illness by family.

Conclusion:- Our study shows that most of the patients who are non adherent because of the lack of understanding about illness and the need for prophylaxis by the patient and family.

177.TITLE:Role of Factors as Impulsivity, Depression, Obsession Compulsion on Adolescent Internet Addiction

AUTHOR:Dr. Tanmoy Mitra, Research & Clinical Coordinator, National Institute of Behavioural Sciences, Kolkata

Background: The ever-increasing internet use has become a concern for not only children or adolescents but also for adults. Though impulsivity has been studied in relation to internet addiction, the interaction of other psychological factors as depression, obsession and social anxiety has not been done extensively. This study aims to explore the relations of internet addiction to depression, impulsivity, and obsessive-compulsivity in adolescents.

Methodology: Sample of 140 high school students (male=60, female=80 : mean age=16.2±0.6) were included in this study. The questionnaire consisted of items on demographic characteristics and internet use pattern. We assessed the level of internet addiction using Young’s internet addiction scale (IAS) Barratt impulsiveness scale (BIS) and Maudsley obsessive compulsive inventory (MOCI) were also self-rated. In this study, the groups constituted upper 25% of IAS as ‘addiction group’ and lower 25% as ‘non-addiction group’.

Results: The results were as follows ; 1) Male students had significantly higher mean scores on Internet addiction scale than females and there was significantly higher rate of male students in addiction group. 2) The addiction group spent more time for internet use, especially for games than non-addiction group. 3) The addiction group showed significantly higher total scores on BDI, BIS, and MOCI than non-addiction group. 4) Significant associations have been found between the level of internet addiction and depression, impulsivity, and obsessive-compulsivity, respectively.

Conclusion: As mentioned above the factors as depression, impulsivity, and obsessive-compulsivity could be significant related elements predicting internet addiction. Among those, role of impulsivity and impulsive pattern of behaviour could be the most significant to explain internet addiction. Adolescents with high impulsivity may be vulnerable to internet addiction.

Keywords : Adolescents, Internet addiction, Impulsivity, Obsession

178.TITLE:Perceived stress, cognitive coping strategies and quality of life in mothers of children with Autism Spectrum disorder and Intellectual Disability-A Comparative Study

AUTHOR:Dr. Shravan Kumar, Senior Resident, Jawaharlal Nehru Medical College, AMU, Aligarh,ALIGARH

Introduction

Autism Spectrum Disorder (ASD) and Intellectual Disability (ID) are the most frequent psychiatric disorders of childhood. These are characterized by an increased risk for the development of parent-child relationship problems. The emotional and behavioral reactions of the mothers, having a child with a diagnosis of mental disorder are different and this depends on the emotional distress and cognitive strategies used. The aim of this study was to assess the cognitive coping strategies, perceived stress and the relationship among them and the quality of life in mothers of children with ASD compared to mothers of children with ID.

Material and methods

The study was done at a tertiary care teaching hospital. Data were collected from the Child and Adolescent Clinic of the Psychiatry OPD. 40 mothers of children with diagnosis of ASD and 40 mothers of children with diagnosis of ID were recruited for the study and evaluated further. Different psychological measurements were used in order to assess the QOL (family quality of life scale), Cognitive coping strategies (Cognitive-emotional regulation questionnaire) and perceived stress (Perceived stress scale) of the mothers. ASD and ID were diagnosed using diagnostic criteria of DSM-5.

Results

For QOL and perceives stress, we didn’t find significant differences between the two group. Adaptive coping strategies correlated with better family quality of life and that of maladaptive ones with poor family quality of life.

179.TITLE:A comparative study of Screen time, sleep duration and behavioural disturbances in urban and rural High school children

AUTHOR :Dr. Suhas Chandran, Senior Resident, St. John’s Medical College Hospital, Bangalore

Background

Sleep problems is a common yet unrecognised problem in adolescents. Environmental factors can negatively influence sleep quality and one such factor is the use of light emitting electronic devices. With the advent of multiple screen based devices there has been a decline in the sleep quantity and quality among adolescents. This is a matter of concern as increased screen viewing duration is associated with poor sleep quality, which can in turn have an adverse impact on behaviour of the children.

Aims

To study use &impact of electronic devices such as television, mobile phones, personal computers and tablets devices on sleep & behaviour in school children

Methods

120 high school students (8th – 10th std) took part in the study.60 each from an urban and rural school in Mysore district in Karnataka. The Pittsburgh sleep quality index was used to assess the overall sleep quality in the last 1 month along with the Epworth Sleepiness scale to quantify the daytime drowsiness. Behavioural disturbances of the children were assessed with the Aberrant behaviour checklist. A specific questionnaire was developed to assess demographics, medical information, Screen viewing duration & patterns on weekdays as well as weekends and finally the content of device use was also studied. Students with a history of substance use, a diagnosed sleep disorder and any psychiatric disorder diagnosable as per ICD 10 were excluded from the study.

Results

Will be discussed at the time of presentation

180.TITLE:Psychopharmacology and comorbidities associated with Tic disorders in child and adolescent psychiatry patients

AUTHOR:Utkarsh Karki, Senior Resident, National Institute of Mental Health and Neurosciences Bangalore

Background:

Tic disorders are one of the neurodevelopmental disorders seen in children in every part of the world. Considering the large and varying range of child and adolescent psychiatry patients in one of the only independent department of Child and Adolescent Psychiatry in the country there has been no studies with regard to tic disorders. No study has been done in this part of the country hence current study focuses on studying the clinical profile and psychopharmacology in child and adolescent psychiatry patients.

Objectives:

1] To study the clinical profile including comorbidities in children and adolescent diagnosed with tic disorder.

2] To study the use of psychotropic agents in the treatment of tic disorders in children and adolescents.

Methodology:

Review of files and records maintained under the Department of Child and Adolescent Psychiatry, NIMHANS. Case records related to inpatients and outpatients between 01.01.2014 to 31.12.2017 (4 years) will be identified. Data will be extracted for the purpose of this study based on a structured proforma. The proforma will consist of socio-demographic data (name, address, any other identifying details will be excluded),source of referral, duration of tics, type of tics, medications used and comorbidities, and family history.

Results:

Results will be discussed in the presentation as study is ongoing

Conclusion:

Conclusion will be discussed in the presentation as study is ongoing

181.TITLE:Socio-demographic Profile and Psychiatric Morbidity of Flood Victims in a Mental Health Camp

AUTHOR:Dr. Bilal Ahmad Bhat, senior resident, Government Medical College, Srinagar

Srinagar

Abstract

Background and objectives: Floods have potentially a negative impact, not only on the physical health but also on the mental health of the affected population. Our aim was to find the pattern of psychiatric morbidity in the flood victims who visited a mental health camp.

Methods: This was a cross sectional study, approved by Ethical Committee of government medical college, Srinagar. Written informed consent from the subjects was taken. Semi-structured questionnaire was used to record the socio-demographic status. MINI-International Neuropsychiatric Interview (MINI-Plus) was used to assess the psychiatric diagnosis.

Results: A total of 115 subjects visited the camp. Most of them belonged to 40-49 years age group (41.74%), females (66.96%) out-numbered males. Most of patients belonged to nuclear families (55.65%). 66 (57.39%) of our subjects had major depressive disorder, 14 (12.17%) had generalized anxiety disorder, 7 (6.09%) had panic disorder, 7 (6.09%) had post-traumatic stress disorder and 5 (4.35%) had adjustment disorder. 16 (13.91%) of our subjects where not found to have any psychiatric disorder.

Conclusion: Large number of people are potentially in need of psychological attention following exposure to a disaster such as floods. The people, who are at potential risk of developing psychiatric disorders such as those in poor health and those who have been relocated, may benefit from targeted mental health services following a disaster like floods. In our study, major depressive disorder was the most common disorder affecting flood victims with 57.39% of the patients suffering from it.

182.TITLE:The prevalence of internet addiction and psychiatric comorbidity in university students

AUTHORS: Mahboobul Hasan Ansari, Rakesh Kumar Gaur, Suhail Ahmed Azmi, Faisal Shaan, Ved Prakash Gupta

Corresponding Author:Dr Mahboobul Hasan Ansari, Department of Psychiatry, JN Medical College, Aligarh, India,drmha.snmc@gmail.com Ph. 919389006450, 918840819372

Background:

The excessive undisciplined use of internet by individuals has led to the emergence of the concept of internet addiction. There has been an explosive growth of internet use not only in India but also in the world in last few years. There is also growing concern about whether this is excessive and, if so, whether it amounts to an addiction. There is scarcity of studies about the prevalence of internet addiction in our country. Another reason to conduct this study is that psychological and environmental factors in the lives of students may leave them disproportionately vulnerable to Internet addiction.

Aim:

The study is design to-

  1. Estimate problematic internet use in undergraduate and post graduate university students.
  2. Correlate internet use with depression and anxiety disorders in undergraduate and post graduate university students.


Method

This is a cross sectional study, which will include all the undergraduate and post graduate students of different faculty residing in university campus. The data will be collected by using semi structured socio demographic proforma, Internet addiction test (IAT), General Health Questionnaire-12, HAM-D, HAM-A after obtaining informed written consent from the participants. Appropriate statistical analyses will be done by using SPSS software.

Results and Discussion

To be presented during the conference.

Keywords: internet addiction, depression, anxiety, university student

183.TITLE:A Multicentric Comparative Study of Quality of Life of Female ‘Primary’ Caregivers of Patients of Alcohol Dependence with Healthy Controls.

AUTHORS:Dr. SupriyaAgarwal1, Dr. Nimish Gupta2, Dr. Shreyance Jain3, Dr. B. S. Shekhawat4

1Assistant Professor, Department of Psychiatry, Subharti medical college, Meerut, U.P.

2Junior Resident, Department of Psychiatry, Subharti Medical College, Meerut, U.P.

3Senior Resident, Department of Psychiatry, Dr. S.N. Medical College, Jodhpur, Rajasthan

4Professor, Department of Psychiatry, Government Medical College, Kota, Rajasthan

Background

Alcohol dependence is well recognized as a complex biopsychosocial phenomenon, it is considered as a ‘family disease’. It has been stated that the complications of alcohol not only impairs the functional capacity of an individual but also negatively affects health of family members and caregivers. Majority of the studies, on problems associated with alcohol, have focused on the individuals consuming alcohol. There are few who have studied the problems and burden on caregivers and family members of such patients.

Aims

To determine the Quality of Life (QOL) of primary female care givers (mainly spouses) who are directly involved in care of patients with alcohol dependence and to compare it with other family members.

Method

The case control multicentric study was conducted in the Department of Psychiatry, Subharti Medical College (SMC), Meerut, Uttar Pradesh and Government Medical College, Kota, Rajasthan, India. Thirty cases and thirty controls were recruited consecutively with Primary Caregivers of patients with Alcohol Dependence taken as cases and other family members as control. A semi structured proforma was used to collect the socio – demographic profile of the cases and the Alcohol Dependence patients along with details associated with alcohol dependence and World Health Organization- Quality of Life Scale BREF (WHO – QOL (BREF)) Hindi version was used to assess the QOL of cases and controls.

Results

There was statistically significant difference between case and control group in all the domains i.e. physical, psychological, environmental & social and also in total WHO Quality Of Life (QOL) score. Thus there is poor QOL of caregivers of alcohol dependent group in comparison to control group.

Conclusions

The primary caregivers predominately the female members of the family (spouse or mother) bear the direct consequence of the Alcohol Dependence in the family.

Keywords – Quality of life, Caregiver burden, alcohol dependence.

184.TITLE:A Study on behavior of incidence of Selfitis, selfie addiction among Medical students

AUTHORS:Dr. D. Ravi Varma

Dr. K. Saradha

Dr. S. Radha Rani.

Dr. P. Himakar.

1. Postgraduate, Department of psychiatry, Andhra medical college, Visakhapatnam

2. Assistant professor, Department of psychiatry, Andhra medical college, Visakhapatnam

3. Professor, Department of psychiatry, Andhra medical college, Visakhapatnam,

4. Professor, Head of the department, Department of psychiatry, Andhra medical college,


Visakhapatnam.

INTRODUCTION:

Selfitis’ is a genuine mental condition and people who feel compelled to continually post pictures of themselves on social media.

The term was first coined in 2014 to describe obsessive selfie-taking in a spoof news story which suggested the American Psychiatric Association was considering classifying it as a disorder.

There are three levels of the disorder-

Borderline cases are people who take selfies at least three times a day, but do not post them on social media. Next is the ‘acute’ phase of the disorder where the pictures are posted. In the third ‘chronic’ stage, people feel an uncontrollable urge to take photos of one’s self round the clock, posting them more than six times a day.

Researchers found that typical ‘selfitis’ sufferers were attention seekers, often lacking in self confidence, who were hoping to boost their social standing and feel part of a group by constantly posting images of themselves

AIM: A study on behavior of incidence of Selfitis, selfie addiction among Medical students.

MATERIALS AND METHODS:

Sample size: 100 Medical students

Type of study: cross-sectional study

Sample: Medical Students from Andhra Medical College, Visakhapatnam who gave their consent to the study.

Study tools: screening questions- Selfitis Behaviour Rating Scale.

Results: Further results shall be discussed later at the time of presentation.

Key words: Selfitis. Selfie-taking. Selfitis Behavior Scale. Social media. Selfies

185.TITLE:A STUDY OF THE PREVALENCE & SEVERITY OF ANXIETY AND DEPRESSION IN TINNITUS

AUTHOR:NAVONEELA BARDHAN, SENIOR RESIDENT, K J SOMAIYA MEDICAL COLLEGE, MUMBAI

Background/Introduction: Approximately 5% of the general population is affected by tinnitus. The perceived level of distress depends upon various variables such the chronicity, loudness, fluctuating or non fluctuating nature, its tonal quality and whether the tinnitus is unilateral or bilateral. Symptoms of anxiety and depression are associated with tinnitus and are often co-morbid conditions, especially in those with severe tinnitus. Prior studies suggest that patients with tinnitus, more so in those with severe depression, perceive improvement in their tinnitus related symptoms after treatment with antidepressants such as nortriptyline or sertraline.

Objectives: This study aims to assess the levels of distress in patients suffering from tinnitus, to find the prevalence and severity of anxiety and depression in patients suffering from tinnitus.

Methodology/Materials and methods: This is a cross sectional study conducted in the Psychiatry OPD of K J Somaiya Medical College. Patients aged between 18-60 years diagnosed with tinnitus from Department of ENT are included in the study. Patients with preexisting psychiatric/neurological illness are excluded. Tinnitus Handicap Inventory is used to determine the degree of distress suffered due to tinnitus. The severity of anxiety and depression are assessed by administering Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Scale (HAM-D) respectively.

Results: The results are analyzed using appropriate statistical methods.

Conclusion: Appropriate conclusions are drawn, keeping in mind data from the previous studies.

Keywords: tinnitus, impairment, consultation-liaison, co-morbidities

186.TITLE:Prevalence of depression and Quality of life in patients attending a rural health institute of northern India

AUTHOR:Jyoti Gupta, Senior Resident, DrRPGMC Tanda, Teh kangra

Introduction: People with diabetes mellitus (DM) are at a greater risk of depression than those without DM. Depression in diabetes is mostly under-detected, under-diagnosed, and under-treated. The aim of the study was to know the presence of depression in patients with DM and examine interrelationship between socio-demographic, anthropometric, clinical profile and quality of life variables with depression in patients with DM. There is scarcity of such data from rural north India.

Materials and methods: This cross-sectional study is being conducted in a tertiary care hospital of North India. Socio-demographic, anthropometric and clinical data of 300 DM patients attending diabetic clinic of the hospital is being collected after due informed consent. Patients are applied Quality of Life Instrument for Indian Diabetes Patients (QOLID) and Patient Health Questionnaire-9 (PHQ-9). Data will be reported as the mean ± SD or percentages. Bivariate analysis will be done using Pearson product-moment correlation. All statistical analyses were carried out using Statistical Package for Social Sciences (SSPS) (Version 17.0, USA). The study is expected to be completed by end of October 2018.

Results: Study still not complete. Collected data not yet analysed.

Key Words: Diabetes, depression, quality of life

187.TITLE : Tuberculosis And Co- Morbid Depression: A Cross Sectional Study

AUTHOR:KESHAV JEE, SENIOR RESIDENT, RIMS, RANCHI, RANCHI

Background : Tuberculosis and depression are leading causes of morbidity in developing countries. A combination of the two may lead to marked impairment in quality of life and warrants early intervention and management.

Material and methods : This is a cross sectional study conducted among patients admitted in pulmonary ward of Anugraha Narayan Medical College & Hospital, Gaya(ANMCH) with tuberculosis during January to December 2018. Patients who consented were assessed using a socio-demographic proforma. Depression was diagnosed using ICD- 10 (International Classification of Diseases) and severity of depression assessed using Beck’s depression Inventory (BDI). Factors associated with depression reported by patients were noted. Analysis to be done using SPSS software using suitable statistical tests.

Results : Awaited

Conclusion : To be drawn

KEYWORDS : tuberculosis, depression, health burden, morbidity

188.TITLE:Clinical approach to Hyponatremia presenting with neuro-psychiatric maifestations in Consultation Liasion Practice: A Three Step Module

AUTHORS:Dr Ganta Akhila1, Dr Sucheta Chatterjee1, Dr Sivani Dua1, Dr Sandesh P1, Dr Sumit kumar,1 Dr Jigyansa Ipsita2, Dr Jayaprakash R Ravan1, Prof Dr RC Das1, Prof Dr S C Dash1, 1Kalinga Institute Of Medical Sciences & 2AIIMS, Bhubaneswar

Introduction: Hyponatremia is defined as plasma sodium concentration less than 135 mEq/L. Literature states hyponatremia occurs in 20% of in patients in a hospital. When serum sodium is below 125 mEq/L, neuro-psychiatric symptoms manifest in the form of lethargy, restlessness, disorientation, behavioral changes, confusion, irritability, seizure, psychotic and mood symptoms. This is a common encounter in consultation liaison psychiatry.

Rational Approach: This is a step-wise working approach devised for psychiatrists on the basis of a case series on 20 patients in a tertiary care hospital. Hyponatremia can be categorized into- hypervolemic, hypovolemic and euvolemic.

Step 1: “Hypervolemic Hyponatremia” is a Red flag sign. The causes include chronic liver, kidney or cardiac failure and these cases should be referred to concerned specialists.

Step 2 : “Hypovolemic hyponatremia” is usually seen in dehydrated patients presenting with vomiting, diarrhea, burns or trauma or in Aldosterone deficiency leading to loss of sodium and retention of Potassium. These cases also present with hyperkalemia and can be managed accordingly or referred to nephrologists.

Step 3: “Euvolemic hyponatremia” is the domain for psychiatrists as the most common causes include SIADH and psychogenic polydipsia. A systematic approach will include investigations like urine and serum osmolality and urine spot sodium to differentiate between both. SIADH presents with concentrated urine, no edema, increased urine osmolality, increased spot sodium and decreased serum osmolality while psychogenic polydipsia has diluted urine, decreased serum and urine osmolality and a history of excess water intake.

Cases and conclusion : We would be presenting Case Vignettes with the varied psychiatric presentations in hyponatremia and formulate a systematic step-wise approach for further management.

189.TITLE:THE PREVALENCE OF DEPRESSION AND QUALITY OF LIFE IN THE UNINFECTED SPOUSES OF HIV PATIENTS

AUTHOR: Dr. VARUN RAJAN, Senior Resident, Govt. T. D. Medical college, Alappuzha

BACKGROUND There is enormous strain on those caring for HIV, particularly the spouses of HIV patients. Relatively few studies have examined the factors associated with depression in the uninfected spouses of HIV infected persons.

This study aimed to evaluate the prevalence of depression and quality of life in the uninfected spouses of HIV patients attending ART clinic. Also, to evaluate the relationship between socio demographic variables and the depressive episode and also with the quality of life of the spouses.

METHADOLOGY Hospital based cross sectional study in the department of Psychiatry and ART clinic, Govt TD Medical College Hospital, Vandanam for a period of 1 year. 100 consecutive uninfected spouses of HIV patients attending the ART clinic were recruited. Informed consent was obtained and subjects were evaluated in detail using a specially designed proforma and DCR 10 criteria was applied to arrive at a diagnosis of depressive disorder. MADRS was applied to assess the severity of the depressive episode and the quality of life of the subjects was assessed using the WHO QoL (bref) scale. Statistical analysis was done using appropriate tests.

RESULTS The prevalence of depression in the uninfected spouses of HIV patients was found to be 58%. The quality of life of the uninfected spouses using the WHO QOL (bref) scale had a mean score of 50.88 with a SD of 7.55. The study also found a positive correlation between the depressive episode and variables like age, educational status, occupational status, socio economic status, duration of illness in the HIV infected patients and duration of the marital life. The study also found a negative correlation between severity of depressive episode and the quality of life of the uninfected spouses. These findings indicate that a better knowledge of the depressive episode in the care takers of the HIV patients will help reducing the burden the caregivers are suffering from and will help improving the overall care of the HIV patients.

CONCLUSION Majority of the uninfected spouses had a depressive episode and several factors were identified to be positively correlated with depressive episode which could be utilized in the management strategies while addressing care giver distress in HIV patients.

KEYWORDS Depression, uninfected spouses, HIV, MADRS, Quality of life.

190.TITLE:SEXUAL AWARENESS AMONG MEDICAL UNDERGRADUATE STUDENTS

AUTHORS:Gyan Nihal N1, Raghuram Macharapu2, Pramod Kumar Reddy Mallepalli3, Ravulapati Sateesh Babu4

Postgraduate TRAINEE, Mamata Medical College, Visakhapatnam

Background: Medical professionals often lack sexual awareness themselves, which impacts the information imparted to the population who seek it. This affects their ability to deal with the sexuality issues. Thus it is of paramount importance that individuals in medical profession are well informed and sexually aware.

Aims & Objectives: The objective of this study was to determine the sexual awareness among medical undergraduate students and comparing sexual awareness among gender.

Materials and Methods: This cross sectional study consisted a sample size of 200 participants who are undergraduate students in Mamata Medical College, Khammam, Telangana. The samples were drawn using convenience sampling method. Sexual Awareness Questionnaire (SAQ) was the tool used to collect data for this study.

Results: The current study suggests of less sexual awareness among medical undergraduate students.

Conclusions: Medical undergraduate students continue to have poor sexual awareness. There is a need to improve awareness and stimulate positive attitudes of students which also improves their ability to deal with patients with sexuality problems. This can be done by encouraging participation of medical undergraduate students in workshops and also be promoted by making it a part of medical curriculum.

Key words : Sexual awareness, Sexual assertiveness, Medical undergraduate students, Sexual Awareness Questionnaire (SAQ).

191.TITLE:A CROSS SECTIONAL STUDY ON ATTITUDE OF INTERNS TOWARDS MENTAL ILLNESS AND PSYCHIATRY

AUTHORS:Dr Revathy P, Dr Sabitha V,Institute of mental health, Chennai 600 010

Background

The patients with psychiatric disorders and psychiatrists are subjected to negative attitude not only by general population, these prejudices exists within medical community as well. The Internship being the final stage in undergraduate students training can have a bearing on the attitude they develop towards various specialities. This study aims to understand the attitude of interns towards psychiatric illness and their willingness to choose psychiatry as their career.

Methodology

A cross sectional study is being done among the interns from various medical colleges in Tamilnadu. ATP-30 scale to assess the attitude of interns towards psychiatrists, semi structured proforma including socio demographic details, questionnaire to assess the knowledge and perception of interns towards psychiatry would be used. Data will be analysed using appropriate statistical analysis.

Results and conclusion

As this is an ongoing study results and conclusion will be published during presentation of the paper.

Key words; attitude, medical students, psychiatry, mental illness

192.TITLE: “INTERNET USE DISORDER & INTERNET GAMING DISORDER AMONG COLLEGE STUDENTS”

AUTHOR: Dr. Mukesh BM, Postgraduate trainee, Vydehi Institute of Medical Sciences & Research Centre, Bangalore

Co-Authors: Dr. Fiaz Ahmed Sattar, Dr. Kiran Kumar K, Dr. Aruna K, Dr. Sharnita.P

Background and rationale

Internet addiction is a significant area for research in this day and age. There is an on-going debate surrounding ‘generalised internet use disorders’ versus ‘specific internet use disorders’. Studies regarding Internet gaming disorders in Indian population are scanty compared to Internet use disorder studies. There is a need to establish the prevalence rate of the above disorders and explore evidence for the specific internet addictions. It is hypothesized that there are two diverse groups of individuals; one who use the internet generally and the other who predominantly use for online gaming.

METHODOLOGY

Design : A cross sectional study.

Sample: 2nd and 3rd year engineering students (Computer Science) aged between 18 to 20

Sample Size: N= 154 (M = 78, F = 76)

Data collection by Semi structured proformas (which includes informed consent) & scales through paper & pencil method. Informed consent after signing will be retrieved first to ensure anonymity.

Tools

  1. Socio-demographic proforma
  2. Internet Addiction Test (Young)
  3. Generalized Problematic Internet use scale
  4. Gaming addiction scale
  5. Patient Health Questionnaire-9


Statistical test: ANOVA, t-test, Multiple linear regression

Results: Prevalence of Internet use disorder is 32% and Internet gaming disorder 14% respectively. Out of the 22 participants in internet gaming disorder group males are predominant (n= 17). Internet gaming disorder group had high internet use, whereas majority of the sample had high internet use but no online gaming. Hence Internet gaming is a specific addiction. Further details will be described at the time of presentation.

Conclusion: Internet use disorder is highly prevalent among young college students and measures should be undertaken to provide necessary support. It can also be concluded that the internet gaming disorder are a diverse group of individuals warranting their own diagnostic category.

Keywords: college students, Internet addiction, Internet gaming disorder,

193.TITLE:INTERNET ADDICTION AND ITS ASSOCIATION WITH PSYCHOPATHOLOGY AND QUALITY OF SLEEP AMONG MEDICAL STUDENTS

AUTHORS:DR. SHIBA.S, DR. VIVEK.N, DR. POORNA CHANDRIKA, POSTGRADUATE MADRAS MEDICAL COLLEGE Chennai

INTRODUCTION

There is a growing concern regarding the exponential increase in the use of internet among the adolescents, adversely affecting their behaviour. Hence this study was undertaken to assess the association of internet usage with quality of sleep and psychopathology among the medical college undergraduate students.

METHODS This is a short term cross-sectional study done with a total of 500 undergraduate students from Madras Medical College who were administered a set of self reporting questionnaires for evaluation.

SCALES USED: YOUNG’S INTERNET ADDICTION TEST

DASS-DEPRESSION ANXIETY STRESS SCALE

PITTSBURGH SLEEP QUALITY INDEX

RESULTS In our study 44% of students are addicted to the internet of which a higher prevalence of depression was seen among females. 40% of internet addicted students had significant sleep disturbance which is higher than the non-addicted students.

CONCLUSION This study shows a significant internet addiction among medical students and a strong impact on their psychopathology and quality of sleep.

KEYWORDS: INTERNET ADDICTION, ADOLESCENTS, MEDICAL STUDENTS, SLEEP, PSYCHOPATHOLOGY

194.TITLE:A cross sectional study on supernatural beliefs, attitude and help seeking behaviour in patients with schizophrenia seeking admission in tertiary care centre in Hyderabad.

AUTHORS::Dr arunima R1 Dr Shilpa Akkineni 2Dr Umashankar M3

1 Postgraduate In MD psychiatry 2 Postgraduate in MD psychiatry 3 Professor Dept of psychiatry, Institute of mental health

Background: Few studies has evaluated cultural supernatural belifs of patients with schizophrenia in south india This study intent to study supernatural belifs aetiological models and help seeking behaviour in schizophrenia patients

Aim: To study supernatural beliefs aetiological models and help seeking behaviour in patients with schizophrenia

Setting and design A cross sectional study conducted at institute of mental health Hyderabad 60 patients diagnosed as schizophrenia were selected for the study

Materials and methods 60patients diagnosed with sczhophrenia were selected (aged 20-60)

Supernatural attitude questionnaire was administered.

Results will be discussed at conference

Conclusions will bediscussed at conference

Details for correspondence Dr Arunima R Osmania medical college

195. TITLE:A STUDY OF PREVALENCE OF SMARTPHONE DEPENDENCE AND ITS IMPACT ON SLEEP PATTERN AMONG MEDICAL STUDENTS

Authors: Dr. Aditya Kashyap (1), Dr. Madhur M Rathi(2), Dr. Umashankar M(3)

(1) Post graduate in MD Psychiatry, (2) Post graduate in MD Psychiatry, (3) Professor, Dept. of Psychiatry, Institute of Mental Health.

Background: The smartphone is one of the biggest non-drug addictions of this century. It favours personal autonomy, provides identity and prestige, favours the establishment and maintenance of interpersonal relationships, and is a source of fun and entertainment. Data has emerged about various negative consequences of smartphone overuse. Etiology of sleep disorders is extremely complicated. One of the factors effective in the change of sleep pattern is smartphone dependence which refers to excessive or problematic use of smartphone satisfying the ICD 10 criteria for dependence syndrome.

Aim: The aim of this study is to investigate the prevalence smartphone dependence among medical students and to find its impact on their sleep pattern.

Setting&Design: Cross sectional, Observational study was conducted at a Government Medical College in Hyderabad. 100 MBBS students having personal smartphone and willing to participate were included in the study by random sampling.

Material and Methods: The subjects were asked to fill a form containing informed consent, sociodemographic profile and smartphone usage pattern after approval of the Institutional Ethical Committee. They were administered a 23 item –Mobile Phone Dependence (MPD) questionnaire designed and tested by Aggarwal et al. According to their responses, participants were divided into two groups as Dependent and Non Dependent and were administered Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI). The association between different variables and comparison were studied by using suitable statistical methods using SPSS v2.

Results: Will be discussed at conference

Conclusions: Will be discussed at conference

Keywords: Smartphone dependence, ICD 10, sleep pattern, medical students

Details for Correspondence : Dr. Aditya Kashyap

Postgraduate, Institute of Mental Health,

Erragadda, Hyderabad, Telangana – 500018

aditya.27590@gmail.com

dr.kashyap90@gmail.com

196.TITLE:Evaluating supportive psychotherapy vs life skills therapy in MDD

AUTHOR:PARUL YADAV, SENIOR RESIDENT, MRA MEDICAL COLLEGE, VARANASI

Introduction - CBT has been the most-studied psychotherapy in MDD but literature regarding efficacy of other psychotherapies are limited. In this study we compared the efficacy of both supportive psychotherapy and life skills therapy.

Methodology - All OPD patients above 18 yr and below 60 yr were screened for MDD (DSM-V) and consented eligible patients (n =60) were randomized to recieve either Supportive Psychotherapy (n =60) or the Life Skills therapy (n =60). Total 20 session of psychotherapy for 45 min-1 hour and fluoxetine upto 40 mg was given in both groups during 12 weeks of study period. The primary outcome measure was the improvement in the HAM-D scores. Secondary outcomes were post-baseline changes in QOL ratings on different domains.

Results - Total 53 patients has completed the study, three patients withdrew consent due to adrs,and four patient were lost in follow up so drop out rate was 10% and 13.33% in both groups respectively. There were no significant differences in HAM-D ratings between groups either at baseline or at any assessment point afterwards. The data shows that improvement in HAM-D scores between baseline and endpoint, was significant for both Groups (p< 0.001). At the 12 weeks, response rate was 80% Vs 83.3% and remission rate was 66.6% vs 68.33%. in both groups respectively, and groups did not differ significantly.

Conclusion- These results shows that even well designed supportive psychotherapy of short duration without much active intervention by therapist is as effective as life skills therapy in which lot of intervention and expertise required.

197.TITLE:A STUDY OF EARLY TREATMENT ADHERENCE AND IT’S RELATION TO PERCEIVED STIGMA AND MEDICATION SIDE EFFECTS IN PATIENTS WITH DEPRESSION

AUTHOR: DR APOORVA UPADHYAY, senior resident, KGMU, Lucknow

Introduction

Depression is a chronic illness and its treatment requires long-term medication. Inadequate adherence reduces the effectiveness of treatment and lead to complications or deterioration in health. Adherence for treatment is influenced by many factors such as patient and disease characteristics, illness stigma and beliefs regarding medications and its side effects. Very few Indian studies have focused on role of stigma and medication side effects in depression and its correlation with adherence to antidepressants.

Materials and methods

AIMS-

· To study adherence to medications in patients with depression.

· To study relation between medication adherence and perceived stigma.

· To study relation between medication adherence and side effects of antidepressant treatment.

Design- Hospital based follow up study. Convenient sampling used.

Sample size- 105 patients (Male- 41, Female- 64) suffering from moderate to severe depression

Place of study- Central Referral Hospital, Gangtok

Duration- Aug 2016 - Oct 2017

Follow up 3 months

Diagnosis of depression- As per ICD 10

Severity of depression- MADRS

Stigma towards depression- DEPRESSION STIGMA SCALE

Adherence towards antidepressants- Morisky Medication Adherence Scale

Side effects of antidepressants- Toronto side effects scale (TSES)

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). 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. No significant association was found between socio-demographic profiles, medication side effects and adherence to antidepressants.

Conclusion

Principal finding of this study is positive correlation between stigma and non-adherence to antidepressants. Most of the studies done on psychiatric diseases have found positive correlation between stigma and it’s association with treatment non-compliance.

198.TITLE:EFFECT OF TESTOSTERONE ON AFFECT

AUTHOR: Dr. Divya Sharma, Senior Resident,King George’s Medical University, Lucknow

BACKGROUND

Testosterone influences brain through various neurobiological processes. In melancholic depression there is hypercortisolemia (HPA axis), whereas atypical depression there is hypocortisolemia. Positive correlation has been found between evening cortisol and evening testosterone levels. Melancholic and atypical depression subtypes might not only be distinguishable by differing activity of the HPA axis but by that of the HPG axis as well. Neuroendocrine dysfunctions may play an important role in the pathogenesis of major depressive disorder (MDD). Hypogonadism has been associated with depression, and evidence suggets that testosterone secretion is impaired during depressed mood, though findings have not been replicated. However, there is a growing evidence which suggests that there may be subpopulations vulnerable to depression in which hypogonadism is a contributing factor.

AIM AND OBJECTIVES

  1. To assess symptom profile of sexual dysfunction in drug naïve MDD Patients.
  2. To determine testosterone levels in MDD Patients with and without sexual dysfunction.


MATERIALS AND METHODS

Hospital based comparative type of observational study. 80 subjects were taken using simple random technique for major depressive disorder group at α (alpha) error 0.05.

RESULTS

Sexual dysfunction was reported in 72.5% of the subjects. In males, total dysfunction was present in 69.23% of the subjects. Low desire was most frequently reported followed by difficulty in sustaining penile erection. While 75.60% females reported sexual dysfunction with low desire being the most common sexual dysfunction. Comparing data regarding serum testosterone level in both control and experimental group, it was observed that serum testosterone level was significantly lower in experimental group. Significant difference of testosterone level was found in both male and females.

CONCLUSION

Outcome of this study narrates that sexual dysfunction has a complex mechanism which includes hypothalamo-pituitary-gonadal axis. So the diagnostic workup for sexual dysfunction of an endocrine nature must therefore be comprehensive and thorough.

199.TITLE:Psycho-Socio-Demographic and Clinical Profile Of Single And Multiple Suicide Attempters In A Tertiary Care Centre – A Comparative Study

AUTHOR:Kannan Rajendran, Senior Resident,Govt T D Medical College, Alappuzha,

Introduction: Suicides are born out of an irrational desire to die and the problem that leads to suicide is almost always temporary but the suicide is permanent. Suicide can leave a lasting psychological, social and financial trauma on the family members of the victim. A better understanding of the psychosociodemographic and clinical profile of suicide attempters can help us plan, formulate and implement suicide intervention strategies that are more effective.

Materials and Methods: Among the patients attending the Dept. of Psychiatry, Govt T D Medical College Alappuzha, 75 single and 75 multiple suicide attempters who consented for the study were selected. A specially designed proforma was completed to collect the psycho-socio-demographic profile and Kuppuswamy’s Socioeconomic Scale was applied to find out the socioeconomic status of the attempters. DCR criteria of ICD-10 was used to arrive at a psychiatric diagnosis. Data were tabulated and statistically analysed.

Results: There was a preponderance to younger attempters in both our study groups. Female: male ratio was nearly equal. Family history of psychiatric illness, past history of psychiatric illness, menstrual history, taking precaution against discovery of the suicide attempt, last acts, time of suicide attempt and time lag between trigger and suicide attempt was significantly associated between the two groups. There was no significant correlation between the two groups with regard to age, marital status, socioeconomic status, religion, educational status, occupation, family structure or consanguinity.

Conclusion: Family history of psychiatric illness, past history of psychiatric illness, menstrual history, taking precaution against discovery of the suicide attempt, last acts, time of suicide attempt and time lag between trigger and suicide attempt was significantly associated between the two groups.

Keywords: suicide, single suicide attempter, multiple suicide attempter

200.TITLE: Suicidal Ideations in schizophrenia: a cross-sectional study in a tertiary mental hospital in N.E. India

AUTHOR:Santanu Nath, Senior Resident, All India Institute of Medical Sciences, Bhubaneswar,

Background:

Schizophrenia is a debilitating mental disorder with a lifetime prevalence of 0.4-1.4%. Life expectancy among the sufferers is less as compared to general population of which suicide is a major concern. Various studies have found link between suicide and the disease symptomatology. These study tries to find out the association of suicidal ideas with various socio-demographic and clinical profiles in patients suffering from schizophrenia.

Methodology:

It is a cross-sectional study on 140 schizophrenia in-patients. Socio-demographic and clinical profiles associated with the disease were collected using a semi-structured proforma. Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, InterSePT Scale for Suicidal Thinking and Drug Attitude Inventory-10 scales were applied to assess psychopathology, depressive symptoms, suicidal ideas & attitude towards psychotropics. Parametric & Non-parametric tests were applied to find out the association between suicidal ideas and various socio-demographic & clinical parameters of the disease.

Results:

Majority of the patients were hindus, male, unmarried, literate & unemployed who were suffering for 5-10 years with duration of untreated psychosis of less than a year. 25.7% attempted suicide earlier & 29.3% presently have an ideation to die. 17.9% of them have a family history of suicide. A previous attempt, family history of psychiatric illness and suicide, co-morbid substance use are the factors that significantly predicts having a suicidal ideation. Ideation has also been found to be significantly correlated to positive, negative, emotional & excitement domains of schizophrenic psychopathology. The single most important factor that is significantly correlated is the presence of depression in them.

Conclusions:

The study shows that apart from patient specific factors like family history of mental illness & suicide, substance use, past attempt to die & poorer attitude to psychotropic medications; psychopathology & depression are strongly related to suicidal ideas in schizophrenia.

Keywords : Suicidal ideation, schizophrenia, depression

201.TITLE- Meaning in Life as a Resilience factor to Suicide in Older Adults

AUTHOR:Akanksha Sonal,Senior Resident.

ABSTRACT:

Background- With increasing trends of suicidal self harm behavior in older adults, there is increasing research needed to evaluate the resilience factors (protective factors) not just the risk factors of the suicidal self harm.

Aim- The present study had examined the role of Meaning in Life as a possible resilience factor to self harm in older adults.

Methodology- It was a cross sectional study conducted at Gandhi Memorial Hospital, King George’s Medical University, Lucknow, after permission from Institutional Ethical Committee. 75 consecutive subjects with history of self directed violence reporting to the department included in the study after informed and written consent. They all were evaluated on structured per-forma for psycho-social details and suicide risk was calculated using risk rescue scale, hopelessness was evaluated on Becks Hopelessness scale, meaning of life was assessed using Stergers – Meaning in life Questionnaire and social support using Sarsons and Sarsons social support scale.

The data were recorded and analyzed using SPSS 22

Result- Out of 75 subjects enrolled, 56 were able to complete the assessment. Data was analyzed using correlation analysis with significant results were- risk of suicidal behavior increases with increasing age, physical disability, absence/searching for meaning in life (0.003) and with poor perceived social support (p=0.025). However presence of meaning in life (p=0.027) and positive sense of social support was found to have protective effect against suicidal behavior.

Conclusion - These finding suggests that with interventions targeting Meaning in Life and increasing sense of social support may be useful in attenuating risk of suicide in this very special group of society.

Key word - Meaning in life, Suicide, Older adult.

202.TITLE:A CROSS SECTIONAL STUDY OF BURN OUT AMONG DOCTORS FROM VARIOUS SPECIALITIES

AUTHORS:Dr Subashree K, Dr deepica kumar A, Dr Poornachandrika P, Postgraduate trainee, Institute of mental health, Chennai 600 010,

Background

The term ‘burn out’ explains ruining one’s health or become completely exhausted through overwork. This pervasive issue among doctors affects the health of doctors as well as their care to patients. So, as to give a detailed report on burn out, to understand it better and help doctors to overcome it. Also, the awareness and enthusiasm in doctors seeking for help to overcome their burnout also needs to be assessed. Also, there lies a curiosity to find out impact on burn out based on gender differences.

Methodology

Study setting

Reaching for doctors in both community and in medical colleges

Study design

cross sectional study

Study participants

Doctors from all specialities

Statistical analysis

Mean scores are compared by appropriate statistical tests

Results and conclusion

The critical care and OBG specialists has a probability of experiencing higher burn out. Other statistically significant data will be published during presentation of the paper. The future perspective of this paper is to find evidence-based management in burn out to help doctors have a better quality of living.

Key words; burn out, doctors, specialities / specialists

203. TITLE:Planned vs Impulsive Act of Suicide in Young Adults

AUTHORS:Dr. Shivi Kataria, post-graduate junior resident, Dept of Psychiatry, TMMC & RC, Moradabad, U.P.- 244001

Dr. Seema Singh, Associate Professor, Dept of Psychiatry, TMMC & RC, Moradabad, U.P.- 244001

Dr. S. Nagendran, Professor & HOD, Dept of Psychiatry, TMMC & RC, Moradabad, U.P- 244001

Background:

Suicide is the third-leading cause of death for 15- to 24-year-olds, according to the Center for Disease Control and Prevention (CDC), after accidents and homicide. The reasons is complex behind a teen’s suicide or attempted suicide. Although suicide is relatively rare among children, the rate of suicides and suicide attempts increases greatly during adolescence. Suicide rates differ between boys and girls. Among teenagers, suicide attempts may be associated with impulsivity, feelings of stress, self-doubt, pressure to succeed, financial uncertainty, disappointment, and loss. Girls think about and attempt suicide about twice as often as boys, and tend to attempt suicide by overdosing on drugs or cutting themselves. Yet boys die by suicide about four times as often girls, perhaps because they tend to use more lethal methods, such as firearms, hanging, or jumping from heights.

Method:

All patients coming with attempted suicide, once stable, were evaluated with Colombia-Suicide Severity Rating Scale (C-SSRS) & Barratt Impulsiveness Scale (BIS11).

Results & conclusion:

Results were made in a tabulated form comparing planned act & impulsive act by the patient. It was found that, impulsive act was more as compared to planned one’s.

Key words- suicide, impulsive acts, planned acts, rating scales

204.TITLE:PREVALENCE OF SLEEP DISORDERS AND SEVERITY OF INSOMNIA IN PSYCHIATRIC OUTPATIENTS ATTENDING GOVERNMENT HOSPITAL FOR MENTAL CARE, VISAKHAPATNAM, INDIA.

AUTHORS:Dr. D. Satya Prasanna.1, Dr. K. Sarada.2, Dr. S. Radha Rani.3, Dr. P. Himakar.4

1. Postgraduate, Department of psychiatry, Andhra medical college, Visakhapatnam

2. Assistant professor, Department of psychiatry, Andhra medical college, Visakhapatnam

3. Professor, Department of psychiatry, Andhra medical college, Visakhapatnam,

4. Professor, Head of the department, Department of psychiatry, Andhra medical college, Visakhapatnam.


INTRODUCTION:

Sleep disorders are frequently associated with psychiatric disorders and can be both cause and effect of the psychiatric disorders. Sleep disturbances are so commonly observed in the psychiatric patients that they have been incorporated in the official diagnostic criteria of some disorders. According to Previous studies, majority of the patients were found to have sleep disorders. Insomnia was noted as most common amongst them all.

AIM : To study the prevalence of sleep disorders and severity of insomnia in psychiatric outpatients.

MATERIALS AND METHODS :

Sample size : 60 patients

Type of study : cross-sectional study

Sample : patients attending out-patient department in Government hospital for mental care, Visakhapatnam who gave their consent to the study.

Study tools : screening questions-sleep history and physical, Pittsburgh sleep quality index(PSQI), Insomnia severity index(ISI)

Results: More than two thirds of the study population has some type of sleep disorders. Further results shall be discussed later at the time of presentation.

Key words : Sleep disorders, Psychiatric patients, Insomnia

205.TITLE: - De-ritis ratio, Alcohol use and Liver disease – How are they related?

AUTHORS - Dr. Pooja R Raikar1, Dr. Sudarshan C.Y.2, Dr. Shamshad Begum3

1Post-graduate student, 2Professor and HOD, 3Professor of Clinical Psychology, Department of Psychiatry, JJM Medical College, Davanagere.

Background - Alcohol consumption is considered as one of the common causes of liver disease. De-Ritis ratio- Serum aspartate aminotransferase (AST) to serum alanine aminotransferase (ALT) ratio is considered as a useful and reliable marker of liver injury due to alcohol. Relationship between De-Ritis ratio and various parameters of alcohol use have not received much attention in research.

Methodology – After obtaining informed consent and eliciting socio-demographic data, De-Ritis ratio was compared between patients having alcoholic liver disease (102) and those having non-alcoholic liver disease (58). In 48 patients having alcohol dependence syndrome, parameters of alcohol use like duration of use, quantity and duration of dependence were recorded. De-Ritis ratio was compared with the parameters of alcohol use in the dependent group. Statistical analysis was done using SPSS-Version 22.

Results - De-Ritis ratio of >2 was significantly associated with Alcoholic liver disease and <2 was significantly associated with non-alcoholic liver disease. Duration of alcohol use ranged between 6-20 yrs in 68.8% of patients. 64% of the patients consumed 120-240 grams of alcohol per day. 60% of patients were found to be dependent for 1-5 yrs. De-Ritis ratio had no significant association with the parameters of alcohol use that were studied.

Conclusion – De-Ritis ratio was associated with alcoholic liver disease and not with the duration of use, quantity of alcohol consumed and duration of dependence.

Keywords –De-Ritis ratio, Alcohol use, Liver disease

Author for correspondence- Dr. Pooja R Raikar, Kaveri hostel, JJM Medical College, Davangere-577004, Email- drpraikar@gmail.com, Phone number-8277270254

206.TITLE: CURRENT TRENDS OF PHYSICAL AND PSYCHIATRIC MORBIDITIES IN RURAL GERIATRIC SERVICES FROM SOUTH INDIA

AUTHOR:V VISHWAK REDDY SENIOR RESIDENT, KAMINENI INSTITUTE OF MEDICAL SCIENCES, NARKETPALLY

Introduction: In India, geriatric population rose to 8.6% and likely to reach a challenging figure of 14% by 2030. Several Indian studies identified various psychopathologies in geriatric group, however data is scarce among rural population for concurrent physical and psychiatric comorbidities.

Materials and Methods: It is a qualitative, naturalistic, cross-sectional study using convenient consecutive sampling in all geriatric outpatients visited/referred to psychiatric services from January 2015 to June 2016 in our rural tertiary care hospital affiliated to medical institute. We excluded all those who were hailing from urban area and clinical diagnosis were made using ICD-10 DCR criteria. Patients were screened for presence of obvious physical disorders and further assessed for their cognitive status, depression and suicidal ideation using Mini Mental Status Examination (MMSE), Geriatric Depression Scale (GDS) and Modified Scale for Suicidal Ideation (MSSI) respectively. We analysed 50 patient data for various clinical parameters using descriptive statistics of SPSS 17 version software.

Results: For about every 25 psychiatric patients, 1 was geriatric. Among 50 studied geriatrics, mean age were 65.12 years and only 16% were above 70 years. We found 46% being free from physical comorbidities while 34% had systemic hypertension, 20% had diabetes and 14% had surgical problems. Among psychiatric morbidities, dementia (20%) was more common than depression (18%) and higher odds of alcohol dependence disorders (18%). Substantial (60%) of the subjects had cognitive impairment on MMSE, 72% had depression on GDS and 12% had suicidal ideation on MSSI. There was significant (p<0.05) relationship observed between cognitive impairment and depression on GDS.

Conclusion: Geriatric patients visit to psychiatric rural services is uncommon. Dementia currently was most common reason for geriatric psychiatry in rural area than mood disorders compared to urban counterparts. Need for integrated resource allocation for rural geriatric health care is advocated.

207.TITLE:A Descriptive Study on Perceived Levels of Stress, Coping and Their Correlation in Retirees of Kashmir Valley

AUTHOR:Shabir Ahmad Dar Senior resident, Postgraduate department of psychiatry govt.medical college, srinagar

Background : Retirement is a major and fundamental life change that affects numerous areas. The transition from a life of work to one of retirement has both practical and emotional implications. Apart from physical health issues, they are more likely to suffer from mental and psychological distress.

Materials and methods : A descriptive, cross-sectional study was conducted among 100 retirees of district Srinagar from June 2015 to June 2016, using a semi-structured questionnaire. Levels of Stress and coping among retirees were assessed using the Depression Anxiety Stress Scales and Brief COPE scale.

Results: Nearly 40(40%) of cases had moderate level (10-12), 03(03%) had severe level (13-16), 04(04%) had extremely severe level (17+), and around 35(35%) had no stress (0-7). Majority of retired employees 85(85%) either used average level (57-84), or used good level (85-112) of coping with a minority 10(10%) using low level (28-56) of coping. There was a significant positive correlation between the stress and coping scores among retired employees.

Conclusion : The perceived level of stress was moderate among retired employees and the retirees used average level of coping to deal with the retirement stress. There is a need for organized family and social support to improve the physical and psychological health of retirees.

208.TITLE:COMPARISON BETWEEN DONEPEZIL 10MG AND 23MG IN PATIENTS WITH MODERATE –SEVERE ALZHEIMER’S DISEASE; SINGLE BLINDED RANDOMIZED CONTROLLED TRIAL IN TERTIARY CARE CENTRE

AUTHORS:DR PRABHU JADHAV*, DR P T SIVAKUMAR, DR PREETI SINHA, DR AJIT D Senior Resident NIMHANS BENGALURU

Abstract:

Introduction: Moderate to severe stage Alzheimer’s disease (AD) patients are having more cognitive deficits and behavioural and psychological symptoms of dementia (BPSD). Occurrence of BPSD is associated with more cognitive deficits, significant impairment in activities of daily living (ADL), lower the QOL of patient and caregiver, psychotropic prescription.

Objectives: To compare the effectiveness of Donepezil 10mg and 23mg in behavioural and psychological symptoms in patients with moderate to severe AD(primary) and effect on the caregiver burden, quality of life, functionality, cognitive deficits and adverse side effects(secondary).

Methods: Patients (n = 19)were randomly assigned to receive high-dose donepezil (23 mg once daily) or standard-dose donepezil (10 mg once daily) for total 12 weeks into two follow ups i.e. at 6th week and 12th week with the researcher as blind. BPSD was assessed by Neuropsychiatric inventory (NPI) and Behavioral pathology in Alzheimer‘s disease 84 (BEHAVE-AD).

Results: At the 1st follow up there were statistically significant results noted only in functionality (p=0.042) and behavioural symptoms assessed (0.028). during 1st & 2nd follow ups we found a similar pattern of clinical improvement in from the baseline in both 10mg &23mg groups i.e. behavioural symptoms > severity >ADL> side effects scores >cognitive deficits and also scores of caregiver burden and quality of life.

Conclusions: Though there were high attrition rates, patients on 10mg Donepezil were efficacious, better tolerable and found a pattern of higher clinical improvement in behavioural symptoms followed by quality of life, caregiver burden, functionality, severity of AD compared to 23mg group.

209.TITLE:Knowledge and attitude towards LGBT (Lesbian, Gay, Bisexual and Transgender) patients among medical undergraduates in changing contexts.

AUTHOR: Dr Suman S Rao Senior Resident, Vydehi Institute of Medical sciences, Bangalore co-Authors: Dr F.A. Sattar, Dr Kiran Kumar K, Dr T S Sathyanarayan Rao

BACKGROUND:

Medical Professionals attitude towards homosexuals, lesbian, gay, bisexual and transgender (LGBT) affects health care offered to patients with a different sexual orientation. There is paucity of studies that explores the knowledge and the attitude of Indian medical students or physicians towards LGBT community more so now in context of changing trends with respect to the landmark ruling of decriminalization of homosexuality in India. This study is aimed to evaluate medical undergraduates and intern’s knowledge about homosexuality and their attitude towards LGBT patients.

MATERIALS AND METHODS :After IEC approval and obtaining written informed consent, a cross-sectional study was conducted on medical undergraduates (3rd term to 9th term) and interns (N=350) studying at VIMS & RC (by purposive random sampling). Study tools consisted of a semi-structured proforma specially designed for this study, Knowledge was tested using the Sex Education and Knowledge about Homosexuality Questionnaire (SEKHQ). Attitude towards LGBT was assessed using revised ALTG (Attitudes towards Lesbians and Gay Men) scale and Attitudes towards Homosexuals Questionnaire (AHQ). Multiple linear regression was used to find the predictors of knowledge and attitude

RESULTS:

A pilot study data of 45 students (3rd term) [M=29 & F=16] was analysed, where 59.2% & 66.4% was the total mean score of respondents on AHQ & SEKHQ respectively. Majority respondents reported that their attitude was most influenced by family (58.4%), friends (63.5%) and media (63.0%). Females were found to have more positive attitude (57.0%) towards LGBT patients although their knowledge did not differ significantly from males.

CONCLUSION:

Medical undergraduates had inadequate knowledge about homosexuality, although they expressed a neutral stance in their attitude towards LGBT community. Enhancing the knowledge of medical undergraduates by incorporating changes in the curriculum in the era of decriminalization of section 377 is the need of the hour.

Key words: Homosexuality, Lesbian, Gay, Bisexual, Transgender and Medical undergraduates.

210.TITLE: Profile of in-patients with severe mental illness in a tertiary care hospital.

AUTHORS: Jai Singh1*, Sujit Kumar Kar2

Senior Resident1, Associate Professor2

Department of Psychiatry, King George’s Medical University, Lucknow, U.P

Introduction: Severe mental illness (SMI) often refers to schizophrenia spectrum disorders and bipolar affective disorder. Patients with SMI are vulnerable to become homeless, jobless, victims of stigma & discrimination. Many of these patients could not get the optimal premorbid level of functioning. SMI compromises the decision taking ability and causes impairment in real world functioning.

Objective: To study the profile of hospitalized patients with severe mental illnesses in a tertiary care hospital of North India.

Method: This is a retrospective chart review of hospitalized patient between August 2013 to July 2018 in department of psychiatry, King George’s Medical University, Lucknow, Uttar Pradesh. Data of patients suffering from severe mental illnesses was extracted from records of in-patient hospitalization. In this review severe mental illnesses included schizophrenia spectrum disorders (ICD -10 codes: F20, F22, F25, F28, F29) and bipolar affective disorders(ICD-10 F30,31).

Results: The study sample consisted of 129 psychiatric patients with severe mental illnesses. Study population consisted of 61.24% patients diagnosed with schizophrenia and related disorders and 38.76% with bipolar disorders. Mean age of the patients was 31.69±12.14 years and most of the patients (72.09%) were males, unemployed(38.76%), belonged to nuclear family(65.12%) and were Hindu (85.27%). Family history was negative in 78.29% patients and 40.31% were compliant to recent treatment. Psychiatric comorbidities were found in 28.68% and medical comorbidity was present in 59.74%. Tobacco use (44.19%) and cannabis use (21.71%) were present in most of severe mentally ill. Average duration of hospitalization was 23.61±14.29 days. Duration of hospitalization was found significant (p= 0.0482) higher among patients of SMI with other psychiatric comorbidities.

Conclusion: In tertiary care settings, patients with SMI found to have higher medical as well as psychiatric co-morbidities. Presence of other psychiatric co-morbidities among patients with SMI predicts longer hospitalization.

*Presenting author

211.TITLE:What percentage of papers presented during ANCIPS are finally published?

AUTHOR:Noble Dalton (Presenting Author), Sandeep Grover,Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh,Correspondence: drsandeepg2002@yahoo.com

Background: Every year the scientific sessions of ANCIPS are marked by presentation of guest/plenary sessions, symposia, workshops, free papers, posters and award sessions. The free papers, posters and award sessions are usually meant for presentation of new research which is not yet published. Hence, it is expected that these papers will be published in near future, so that the scientific literature is distributed and shared with wider audience. Aim: This paper aims to evaluate the proportion of free papers, posters and award session papers being published as full articles after ANCIPS. Methodology: For this study, all the free papers, posters and award papers presented during ANCIPS of 2012 to 2014 were listed and electronic searches were carried out to search for matching papers with same/similar title and same group of authors. These years were selected keeping in mind the usual lag period for publication of different papers. Results: A total of 1084 papers were presented during the ANCIPS in the 3 year period. Out of these 65 were award papers, 624 were free papers and 395 were posters. Majority (N=819; 74.6%) of these could be categorised as research data base presentations, this was followed by case reports/series (207; 19.2%), review of literature (N=19; 1.8%) and others (N=49; 4.5%). Out of all the award papers, 55.4% of papers were published, whereas only 31.2% of free papers were published and 21.1% of free posters were published. Out of the research data base presentations only 25.4% are published and 26.7% of case reports/series are published. Conclusion: This research suggest that majority of the papers presented during ANCIPS remain unpublished even after 5 years of making such presentations. Issues and implications of lack of publication will be discussed during the presentation.

212.TITLE:A STUDY ON THE EFFECT OF PREMENSTRUAL SYNDROME ON INTERPERSONAL RELATIONSHIPS AND QUALITY OF LIFE

AUTHOR: Dr. Taniya Kundu.1,MD Psychiatry PGT, R G Kar Medical College, Kolkata.

Keywords: premenstrual syndrome, quality of life, interpersonal problems.

INTRODUCTION:

Premenstrual Syndrome (PMS) is characterised by various psychological and physical symptoms on a continnum of severity. About 85% women experience mild symptoms, 20-25% experience moderate to severe symptoms and about 5% meet the diagnostic criteria of Premenstrual Dysphoric Disorder (PMDD). PMS often leads to worsening of daily functioning and cause problems in interpersonal relationships. In our study, we aim to find out the correlation between the severity of PMS with interpersonal problems and quality of life.

METHODOLOGY:

This is a cross-sectional single interview study among consenting medical and paramedical students, aged 18-35 years, of a tertiary care general hospital. Diagnosis of PMS was done by ICD-10 criteria (N94.3). Severity of symptoms was assessed using Premenstual Syndrome Questionnaire (PMS-Q). Interpersonal relationships were studied using Inventory of Interpersonal Problems- Short Circumplex (IIP-SC) Scale. Quality of life was assessed using World Health Organisation-Quality of Life Abbreviated (WHO-QoL BREF) Scale. Brief history was taken to rule out other major psychiatric illnesses.

RESULTS:

There is negative correlation (Pearson coefficient=-0.458,P=0.014) between WHO-QoL domain 3 (social relationships) and PMS total score. IIP-SC total score and PMS total score has strong positive correlation (Pearson’s coefficient=0.505,P=0.006).

Negative correlation between WHO QoL D3 and PMS-A (anxiety)(Pearson coefficient=-0.400,P=0.035); PMS-D (depression)(Pearson coefficient=-0.411,P=0.030); PMS-H (hormonal)(Pearson coefficient =-0.410,P=0.030) found.

Significant positive correlation between IIP-SC scale ‘Domineering’ domain with PMS-A(anxiety), C(biofunction), D(depression), H(hormonal) and Other symptoms domains; ‘Cold’ domain with PMS-C and Other Symptoms; ‘Exploitable’ and ‘Overly Nurturant’ domain with PMS-A found.

CONCLUSION:

The study suggests significant inverse relationship between Premenstrual Syndrome and social relationships. ‘Domineering’ attribute is found more commonly in Premenstrual Syndrome.

Keywords: premenstrual syndrome, quality of life, interpersonal problems.

213. TITLE:”A COMPARATIVE STUDY OF COGNITIVE IMPAIRMENT IN PATIENTS OF SCHIZOPHRENIA AND BIPOLAR AFFECTIVE DISORDER”

AUTHOR:- Dr. Mayuresh Bodliya, senior resident, jawahar lal nehru medical college, sawangi, wardha

Guide- Dr. C.S. Sushil (email- sushilcs58@gmail.com)

Background:- Neurocognitive dysfunction is believed to be a core feature of schizophrenia and is increasingly recognized as a common symptom dimension in bipolar disorder. Cognitive functioning is among the strongest predictors of outcome in patients with schizophrenia and bipolar affective disorder. The severity of the impairment in schizophrenic patients is greatest in the domains of memory, attention, working memory, problem solving, processing speed, and social cognition. Patients with bipolar disorder performed worse on executive function in the study. Patients with euthymic bipolar disorder performed worse in tests of declarative memory, poorer performance on measures of verbal learning, executive function and motor coordination.

Materials and Methods:- The study was conducted in Department of Psychiatry of New Hospital Medical College, attached to Govt. Medical College, Kota (Raj.). A total of 50 consecutive patients of Schizophrenia and 50 consecutive patients of Bipolar affective disorder (in remission phase) were diagnosed as per International Classification of Diseases-10 (ICD-10) criteria. We assessed the socio- demographic profile and performed Neuropsychological tests (Mini mental state examination (MMSE), Controlled oral word associations test (COWT) and Stroop colour test) on both Schizophrenia and Bipolar affective disorder patients.

Results:- Schizophrenia and Bipolar disorder patients were significantly impaired on different tests of executive function, verbal fluency. Patients with schizophrenia consistently performed worse than patients with bipolar disorder and differences between schizophrenia and bipolar disorder patients were significant in Controlled oral word associations test (COWT) and Stroop colour test.

Conclusion:- Patients with bipolar disorder exhibit cognitive difficulties that are very similar to schizophrenia in terms of their profile, although patients with schizophrenia may have more severe and widespread impairments.

Key Words:- Schizophrenia, Bipolar affective disorder (BPAD), Mini mental state examination (MMSE), Controlled oral word associations test (COWT) and Stroop colour test.

214.TITLE:The pattern of psychiatric comorbidities in globus: a cross sectional study from a tertiary care hospital in Kashmir, north India

AUTHOR:Dr. Shabir Ahmad Dar, senior resident postgraduate department of psychiatry govt.medical college srinagar

Background/Aims

Globus is the physical sensation of a lump in the throat presenting as difficulty in swallowing. Since there is paucity of literature regarding the psychiatric comorbidity in globus, we aimed to study the psychiatric co-morbidities in these patients visiting a tertiary care center in Kashmir.

Methods

It was a non-controlled, non-interventional, cross sectional; hospital based study carried out from August 2014 to July 2015 amongst the patients with diagnosis of globus. Patients were selected from the out-patient unit, visiting Institute of Mental Health and Neurosciences Kashmir. About 51 patients with globus who fulfilled the inclusion criteria and gave written informed consent were selected as study cases. For diagnosing psychiatric comorbidities, we used the Mini International Neuropsychiatric Interview.

Results

Mean age of our cases was 39.58 years. Females outnumbered males in cases by a ratio of 3:1 approximately. Psychiatric disorders were seen in 70.588% of globus patients. Major psychiatric disorders seen in our patients were major depressive episode (23.53%) and generalized anxiety disorders (11.76%).

Conclusions

Majority of patients with globus who present to a tertiary care center have co-morbid psychiatric disorders. We need to screen these patients for such co-morbidities and develop a holistic approach for better outcome in such cases.

Key words: Globus, Psychiatric comorbidity, Major depressive episode

215. Title: “Assessment of sexual dysfunction among psychotropic treated male patients of schizophrenia.

AUTHORS:Dr. Bhagyashree Garasia, Dr. Amrit Ku. Gausai, Dr. Sushil kherada, Dr. Suresh Gocher, Dr. Dileep Singh Verma, Senior resident, Aiims, Jodhpur

Abstract

Objectives:

The human sexual function is complex and one of the important element of quality-of-life dimension. The higher prevalence rate of sexual dysfunction is seen among patients of psychiatric disorders, particularly those treated with psychotropic medication. Schizophrenia, the condition itself and the negative impact of some antipsychotic treatments lead to sexual dysfunction. It can adversely affect treatment compliance with antipsychotic and persuade relapse, re-hospitalization, poor outcome, and high economic costs.

Methods:

This cross-sectional study was conducted in north India at the psychiatric unit of a Tertiary Care Teaching government Hospital. A total of 82 schizophrenic male patient with icd-10 diagnosis were assessed for sexual dysfunction. The Socio-demographic scale, Clinical data sheet, Positive and Negative Syndrome Scale [PANSS], Psychotropic Related Sexual Dysfunction Questionnaire (PRSexDQ) were applied.

Results:

Out of 82 schizophrenic male patients, approximately 75.6% patients complained of sexual dysfunction. On the basis of the Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ), 42.7% (35) having moderate, 28% (23) mild and 4.9% (4) having severe sexual dysfunction.

Conclusions:

Results showed that majority of patients having sexual dysfunction. So, it is important for all healthcare professionals to aware as well as motivate quality discussion about sexual symptoms on the routine basis. Enquiry about sexual symptoms prior to the prescription of antipsychotics and on follow-up would improve overall sexual dysfunction and adherence to treatment.

Keywords : Schizophrenia, Antipsychotics, Sexual dysfunction

216.TITLE:A Study on Long Acting Antipsychotic Injectable Use in Patients of Schizophrenia at a Tertiary Care Hospital in Kashmir.

AUTHORS: Dr. Waris Ahmad Zargar ; Dr. Yuman Kawoos, Dr. Haamid Ismael, Dr. Sanjeet Kaur. Senior Resident, Govt. Medical College Srinagar

Background: Main form of treatment in schizophrenia consists primarily of antipsychotics. Non-compliance is closely linked to relapse, re-hospitalization and poor outcome.LAI’s have been used to enforce adherence in patients who do not or will not take medication.

Objectives:

  1. To study clinical profile of patients put on LAI’s and to study their pattern of use in schizophrenia.
  2. To study clinical outcome and side effect profile in patients of schizophrenia receiving LAI’s.


Materials and methods:

This was observational prospective study which was conducted among the schizophrenia patients attending the Outpatient and inpatients services. 103 patients put on LAI’s were enrolled for the study. PANSS score at baseline, 8weeks and 16 weeks was taken. A score on CGI-S (Severity) was taken at baseline and 8 weeks. A score on CGI-I was taken at 8 weeks and 16 weeks. CGI-EI was calculated at 8 weeks and 16 weeks. All the reported side effects were recorded using Glasgow Antipsychotic Side effect Scale (GASS).

Observations and results:

Four LAI’s were used in our study. PANSS score at baseline was calculated and was found statistically insignificant. The four LAI’s reduced PANSS score almost equally at eight weeks (p=0.176) and sixteen weeks (p=0.529). Improvement in symptoms as measured by CGI scale at eight weeks and sixteen weeks was not much different statistically at eight weeks (p=0.418) and sixteen weeks (p=0.362).

Conclusion: LAI of FGA and SGA were equally effective in reducing symptoms. There was no superiority of one FGA-LAI over other. The side effects caused by FGA-LAI and SGA-LAI as per GASS were almost similar quantitatively.

Key Words: Long Acting Antipsychotic Injectable, Adherence, Schizophrenia.

217.TITLE:Assessing Neuroplasticity in Children with Schizophrenia with Theta Burst Transcranial Magnetic Stimulation: A Randomized Crossover controlled study.

AUTHORS:Purushotham A1, Vinod Kumar Sinha2, Nishant Goyal3

1Senior Resident, All India Institute of Medical Sciences, Raipur.

2 Former professor of Psychiatry, Central Institute of Psychiatry, Ranchi

3Assistant Professor, Department of Psychiatry, Central Institute of Psychiatry, Ranchi

Introduction

Compromised neuroplasticity as result of altered brain activity has been found in children with schizophrenia, which can be assessed using Theta Burst Transcranial magnetic stimulation (TBS) by keeping known fact that Continuous theta burst (cTBS) and Intermittent theta burst (iTBS) has long term depression (LTD) and long term potentiation (LTP) like cortical activity.

Aim

This study was designed to evaluate neuroplasticity effect of TBS on motor cortex in Children with schizophrenia and normal controls.

Methodology

It was randomised crossover controlled hospital based study. Subjects included children with schizophrenia (n=20) and normal controls (n=20) who were randomized to receive either cTBS or iTBS after evaluation of Resting motor threshold (RMT), Activated motor Threshold (AMT), Motor evoked potentials (MEP) and subsequently subjects were crossovered to other type of Stimulation after 1 week. After each TBS sessions, MEPs are recorded at predetermined time intervals for 120 minutes. In cTBS, bursts of 3 pulses at 50 Hz at frequency of 5Hz for 40seconds and in iTBS 20cycles for 2 seconds periods of TBS were applied. The duration of suppression or facilitation of MEPs was indexed by time for MEP amplitudes to return to baseline values was considered.

Result

RMT and TBS power was higher in cases and produced comparatively lesser amplitude MEP waves than normal controls. There was LTP and LTD like activity of the MEPs following iTBS and cTBS respectively and crossover effect was not much significant in both cases and controls. Cases needed more time for MEPs to reach baseline after TBS sessions when compare to controls indicating compromised neuroplasticity.

Conclusion

This study concludes that children with schizophrenia had compromised brain plasticity when compared to normal controls, which can be modified to some extent using TBS.

Keywords Schizophrenia, cTBS, iTBS, left Motor cortex and MEP.

218.TITLE: “EFFECTS OF ELECTRODE PLACEMENT ON SYMPTOMS, MEMORY AND SUSTAINMENT OF RESULTS AFTER ELECTROCONVULSIVE THERAPY: A COMPARATIVE STUDY”

AUTHORS:Ankit Chaudhary, C.R.J Khess, K K Kshitiz1

SENIOR RESIDENT Department of Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand, India

1Department of Biochemistry, Central institute of Psychiatry, Kanke, Ranchi, Jharkhand, India

Introduction: Few treatments in modern day clinical practice are as old as Electroconvulsive Therapy (ECT). The cognitive side effects, both memory and non-memory related, rank among the strongest reasons for hostility against ECT. Although there are reassuring reports indicating the benign nature of the side effects, these criticisms have remained on the centre stage since the introduction of ECT. Various meta-analyses have also been conducted to compare the effects of unilateral and bilateral ECT. But most of these studies have been conducted on the patients having depression. So, to see the effects of UL and BL ECT on symptoms and memory in psychotic patients, and whether the effects are consistent after stopping ECT, this study was conceptualized.

Materials and Methods: 100 patients having any psychotic illness who were given ECT were recruited for the study. They were randomized into either Right Unilateral (RUL) or Bilateral (BL) group. CPRS, CGI-S, MMSE and PGI-MS were applied before ECT, after 4 sessions of ECT and 2 weeks after last session of ECT. Statistical analysis was done using SPSS 25.

Results: The results showed similar symptomatic improvement in patients receiving RUL and BL-ECT and the results persisted beyond the therapy sessions. But, in case of RUL-ECT, the cognitive side-effects and deterioration in memory functions were lesser as compared to BL-ECT. In the subsequent 2 weeks after ECT, both the groups showed significant improvement in cognitive side-effects. In this respect also, the patients receiving RUL-ECT performed better and the improvement in memory functions was better.

Conclusion: The study pointed towards a favourable outcome in case of therapeutic response with ECT without any significant difference between both the placements. After stopping the therapy, the symptoms didn’t show relapse and the improvement appeared to be stable over time. Although there was a side-effect of cognitive impairment, but it appeared to be for a short duration and it improved with time. The side-effect profile of Right Unilateral placement was lower as compared to Bilateral placement. In the post-ECT period also, the patients receiving Right Unilateral placement showed better improvement in memory functions.

Keywords : Electroconvulsive therapy, cognitive side-effects, memory.

219.TITLE:Acute and Transient Psychotic Disorders - Role of Personality and Stressful Life Events

AUTHORS:Dr. Merin Poulose, Senior Resident Government Medical College, Kottayam

BACKGROUND & OBJECTIVES :There are varying findings regarding association of stressful life events in the evolution of Acute and Transient Psychotic Disorders(ATPD). Though ‘vulnerable personality’ is a common notion,there is no mention about this in concept of ATPD in ICD 10 or ICD 11. Objective was to study whether patients with ATPD have any specific personality traits or stressful life events or both as preceding /associated factor and which is the common pattern of personality traits and to study the minimum stress

METHODS :31 consenting patients diagnosed ATPD using ICD10 were recruited. They were studied during follow up when free of psychotic symptoms. Presumptive Stressful Life Events Scale was used to measure life events& NEOFFI used to measure personality traits. The pattern of personality traits in ATPD patients was identified. The correlation of stress with relative position of the trait when compared to the scores of other traits was made. Also the stress score was compared with the mean value of each of the traits.

RESULTS AND DISCUSSION :87%reported stress while13%didnot report stress showing existence of ATPD without stressors. 43was the minimum and 80was the maximum stress score observed among those who reported stress. For majority of patients 25(80.6%),conscientiousness was standing apart as the high scoring personality domain and neuroticism was standing apart as the low scoring personality domain. The mean value of neuroticism is less(statistically significant with p value 0.000)and conscientiousness is higher(statistically significant with p value 0.000)than the mean of normal population. This finding doesnot correspond with the existing study and is the opposite of traits observed in schizophrenia patients in other studies done elsewhere. There exist a positive correlation between the stress score and relative position of neuroticism among the five traits. Also,there exist a negative correlation between the stress score and relative position of conscientiousness among the five traits.

220.TITLE:Suicide attempt during Unresponsive episode –Is it Complex Partial Seizures or Dissociative episode ? - Diagnostic Challenges

AUTHORS:Preethy Kathiresan, Surbhi Sharma, Igam Bagra, Koushik Sinha Deb, Rakesh Chadda,

Senior resident, Department of Psychiatry & NDDTC, All India Institute of Medical Sciences, New Delhi

Introduction :

Patients with Complex partial seizures are known to have increased risk for suicide. Also patients with suicidal attempts have been found to have increased risk for epilepsy. There are also some case reports of Complex partial seizures presenting with suicidal gestures – found near railway track, found with knife in hands, etc. There have been case series from India regarding dissociative amnesia, wherein patients take up a different identity or behave differently, but do not remember later. However, suicide attempts during such episodes have not been reported. Suicide attempts among dissociative disorder have usually occurred due to depressive symptoms, as a way to breakthrough prolonged episode of depersonalization or during dissociative alter in dissociative identity disorder. In this paper, we present a patient with suicide attempts during unresponsive episode in the absence of these, which presented diagnostic challenges in management.

Case Summary:

A 18 yr old female who was on treatment for Complex partial seizures presented to our OPD with H/O hanging during an unresponsive episode for which she had amnesia. She did not have any depressive symptoms. There were similar episodes in the past when patient tried to commit suicide by either jumping from the terrace or tried to strangulate her neck with dupatta, but patient would have amnesia for all these episodes. She was also found to have mixed dissociative disorder – Dissociative possession, Dissociative convulsions based on history. There was diagnostic dilemma in the index case regarding the comorbid or exclusive diagnosis of complex partial seizures and dissociative disorder as well as management issues. Following admission in ward, anticonvulsants were tapered and stopped and psychological treatment initiated following which patient showed marked improvement.

Conclusions:

Suicide happening during the dissociative episode has been rarely reported in literature and hence clinicians should be wary about organicity in such cases.

Key words : Dissociative disorder, complex partial seizures, suicide attempts

221. TITLE: A Study of depression and anxiety disorders in the patients with Rheumatoid Arthritis.

AUTHOR:Prakash Haldar1, Senior Resident ESIC, PGIMSR Medical College and Hosp. Joka. Senjam Gojendra Singh2, N Heramani Singh3

BACKGROUND: Significant evidence in the scholarly literature suggests that depression and anxiety is a common comorbidity among patients with rheumatoid arthritis. Psychiatric comorbidity especially depression and anxiety are more common in the patients with rheumatoid arthritis. This study has highlighted on the psychiatric comorbidity of depression and anxiety in the patients with rheumatoid arthritis.

OBJECTIVES: To assess depression and anxiety among patients with rheumatoid arthritis.

MATERIAL AND METHOD: A prospective study of the outdoor patients of aged 20-60 years who attended Rheumatology Department, RIMS, Imphal during the period between November 2013 to July 2016 were analyzed.

RESULT: Depression and anxiety are more common in the patients with rheumatoid arthritis. Among 680 patients 47.35%(n=322) are in age group of 41-50 yrs, female are 66.47%(n=452), Hindu are more 53.24%(n=362). In our study we found 36.18%(n=246) are having anxiety disorder where as 23.09%(n=157) are depression.

CONCLUSION: The study was carried out to assess depression and anxiety in the patients with rheumatoid arthritis.

KEY WORDS: Depression, anxiety, Rheumatoid arthritis.

Senior Resident, 2- Assistant Professor, 3- Professor and Head of Department,

Department of Psychiatry, Regional Institute of Medical Sciences (RIMS),

Imphal, Manipur, India.

Address for correspondence : prakashmed03@gmail.com, Dr. Prakash Haldar, Department of Psychiatry, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, India.

222.TITLE:Pharmacovigilance activities at Addiction Psychiatry Centre: Development and Status

AUTHOR:Naveen Dhagudu,* Anusha Eravalli, Siddharth Sarkar, Rakesh K Chadda,

Senior Resident All India Institute of Medical Sciences, New Delhi. Ghaziabad, NCR Department of Psychiatry and NDDTC, AIIMS, New Delhi

Abstract:

Background/Introduction: Continuous, spontaneous reporting of adverse drug reactions (ADRs) as part of pharmacovigilance activity in speciality health care setting is infrequent in India. Speciality based monitoring and reporting programmes aim to identify and quantify the risks associated with use of medicines which are being commonly using in that field. This may helpful in better and safe prescribing practices, and would improve the knowledge and competence of prescribers. We describe here the activities of related to pharmacovigilance at the National Drug Dependence Treatment Centre(NDDTC), Ghaziabad, which has been designated as an Adverse Drug Reaction Monitoring Centre (AMC) under the Pharmacovigilance Programme of India (PvPI).

Methodology: The centre became an AMC and started its activities in August 2016. The presentation gives a glimpse of the training activities, and the measures taken to ensure continued reporting. A snapshot of the ADRs reported in the field of addiction psychiatry is also presented.

Results: Over the course of 2 years, about 750 ADRs have been reported. The medications commonly implicated included tramadol, naltrexone and disulfiram. The challenges to continued reporting include sustaining motivation and training in reporting procedures. To make training flexible, online presentation of training has been initiated with knowledge check through a brief online questionnaire. Acknowledgements of the efforts of reporters are done through token appreciations. Active efforts from the pharmacovigilance associate have helped to sustain the reporting.

Conclusions: The NDDTC provides a unique setting of generating ADR reports with respect to substance use disorders. Concerted efforts need to continue at micro and macro levels for effective ground implementation of the Pharmacovigilance Programme of India.

223.TITLE: Tapentadol dependence: A case series

AUTHOR:PreethyKathiresan*, Ashish Pakhre, Dheeraj Kattula, Siddharth Sarkar, Senior Resident Department of Psychiatry and NDDTC, AIIMS, New Delhi, Email: princyaiims@gmail.com

Introduction: Tapentadol is a mu opioid agonist and norepinephrine reuptake inhibitor approved for treatment of moderate to severe acute and chronic pain. It has been found to have abuse liability like other opioids. Here, we present a series of three cases of tapentadol dependence which were treated at our centre.

Case summary: The cases were all male and were aged 20, 30 and 34 years respectively. Each of the case had initiated tapentadol for different reasons: one patient due to easy availability and for enjoyment, one for self medication to stop alcohol use, and the third on advice of a doctor for his abdominal pain. The patients reported more psychological withdrawal symptoms in the form of depressive symptoms, than physical withdrawal symptoms. One patient reported visual hallucinations, while another reported hypnagogic hallucinations with the use of tapentadol.

Discussion: Though tapentadol has been found to be useful in patients with chronic pain with comparatively lesser abuse liability than other opioids, caution must be exercised against unregulated use. Multipronged approach for optimally using this medication may include judicious clinical use, as well as effective regulation of diversion or abuse.

224.TITLE:Study of clinical profile, type of stressors, temperamental characteristics and impairment in children and adolescents with dissociative disorders

AUTHOR- Sumit Kumar singh, Post graduate student S.C.B medical college Cuttack

Keywords- Dissociative disorder, children and adolescents, stressors, temperament

Background- Dissociative disorders in children and adolescents are more frequent in Indian children and adolescents population as compared to western population. But there is dearth of research studies among Indian children and adolescents. We studied the clinical profile, type of associated stressors, temperamental characteristics and impairment in children and adolescents with dissociative disorders.

Materials and Methods- The study was conducted at the department of Psychiatry, SCB Medical college, Cuttack, Odisha from 1st January to 30th June of 2018. The study sample consists of consecutive new cases of dissociative disorder (as per ICD-10 diagnostic criteria) in the age group of 6 to 16 yrs. Socio-demographic variables, clinical profile and types of stressors were assessed by using self-designed proforma. Temperamental characteristics of the patients were assessed using temperament measurement schedule (TMS). Impairment due to illness was assessed by using Children’s global assessment scale(C GAS).

Results- Total 40 patients who fulfilled the diagnostic criteria for dissociative disorder as per the ICD 10 were included in the study. 50% of the patients were diagnosed as mixed dissociative disorder, 15% as dissociative convulsions and 5% as trance and possession disorder. 80% patients were in the age group of 12-16 years. Majority (55%) of patients were females. 20% of patients had history of childhood trauma. Majority of patients (75%) had extra familial stressors. 35% of patients poor scholastic performances, 35% of the patients had discord in the family. Variable functioning with sporadic difficulties was found on CGAS in most of the patients (80%).15% in approach withdrawal, activity level and rythymicity and 10% in adaptability and mood had more than average scores on temperament measurement schedule.

Conclusion- Majority of patients of our patients were mixed type of dissociative disorder, majority had extra familial stressors, impairment in functioning was detected only in dysfunctional settings of the patient and major associated temperamental characteristic features were poor adaptability, approach withdrawal and activity level.

225.TITLE: Autism Spectrum Disorders and its association with metabolic syndrome and atherogenesis – an exploratory case control study.

AUTHOR:Dr. Sneha V Post graduate student Bangalore Medical College and Research Institute Bangalore

Introduction: Autism Spectrum Disorders (ASDs) are typically associated with dyslipidemia or lipid profile abnormalities which include low serum cholesterol believed to be linked to pathogenesis of ASD. ASD has also been described as a disorder of fatty acid metabolism with disordered beta oxidation of fatty acids. However, recent studies have also documented increased rates of obesity, metabolic complications in children with ASD which probably may reflect aberrations secondary to psychotropic use.

Objectives: 1. To study the prevalence of metabolic syndrome in ASD patients.

2. To study the prevalence of behavioral abnormalities and its association with metabolic syndrome components or atherogenesis.

3. To study atherogenic serum markers in this sample.

Methodology: Thirty autism patients attending out patient department in Bangalore Medical College and Research Institute and attached hospitals were taken into study after obtaining informed consent. ASD severity was assessed using Indian Scale for Assessment of Autism, ID severity using Binet Kamat test of intelligence, behavioral problems using Behavior Problems Inventory. Details of psychotropics used was collected. Patients were assessed for metabolic syndrome using the International Diabetes Federation clinical criteria. Blood investigations – lipid profile, HbA1c, thyroid function tests, Apo B/Apo A1 ratio, hsCRP done. Data obtained entered and statistical analysis done using SPSS version 24.

Results: Results obtained after statistical analysis will be presented.

Conclusion: Results obtained will be compared with previous studies and conclusion drawn.

226.TITLE:Prevalence of serum peripheral autoimmune markers and its association with gastrointestinal symptoms and symptomatology in autism spectrum disorder (ASD).

AUTHOR:Divya Kumari Sherigar, post graduate student Bangalore medical college and research institute Bangalore

Background / Introduction :

ASD is now being recognised as a whole body disorder with many of the manifestations being understood as a result of a complex systemic process. ASD children are believed to have high titres of various autoantibodies which may be pathogenic. Literature has also focused on “leaky gut” in ASD which increases vulnerability to these antibodies. There is only a single published study which has documented increased prevalence of anti-ds-DNA and anti-nucleosome antibody.

Aims and objective:

· To study the prevalence of ANA profile auto antibodies in children and adolescence with ASD and its relationship with G.I manifestations and ASD behaviours.

Materials and methodology:

· 50 children and adolescence from autism clinic of BMCRI will be recruited after consent.

· ISAA and BPI will be administered.

· G.I symptoms will be enquired with checklist.

· ANA profile will be sent for all these individuals.

· Appropriate statistical analysis will be done.

Results and conclusions:

Will be discussed in conference.

Keywords:

Autism Spectrum disorder.

Autoimmunity.

ANA profile.

227.TITLE: Prevalance of serum pheripheral autoimmune markers and its association with gastrointestinal symptoms and symptomatology in Autism Spectrum Disorder (ASD)

AUTHOR:DR ANVITHA K Post graduate student Bangalore Medical College and Research Institute Bangalore

Background / Introduction: ASD is now being recognized as whole body disorder with many of the manifestations being understood as a result of complex systemic process. ASD children are believed to have high titres of various antibodies which may be pathogenic. Literature has also focused on “leaky gut” in ASD which increases the vulnerability to these antibodies. There is only single published study which has documented increased prevalence of Anti-ds-dna and Antinucleosome antibody.

Aims and Objective: To study the prevalence of ANA profile antibodies in children and adolescents with ASD and its relationship with gastrointestinal manifestations and ASD behaviours.

Materials and Methodology: Fifty children and adolescents from autism clinic of BMCRI will be recruited after consent. ISAA and BPI will be administered. Gastrointestinal symptoms will be enquired with a checklist. ANA profile will be sent for all these individual. Appropriate statistical analysis will be done.

Results and Conclusion: will be discussed in conference.

Key words: Autism Spectrum Disorder

Autoimmunity

ANA profile

228.TITLE: Impact of filtered selfies on mental health- Chasing Mirage

AUTHOR:- Dr. Muskaan Makkar, PGJR-2, Teerthanker Mahaveer University, Moradabad

Co-Authors: Dr. S. Nagendran, Professor & Head of Dept., Psychiatry, TMM&R

Dr. Prerana Gupta, Associate Professor Dept. of Psychiatry, TMM&RC

Dr. Sunny Dua, PGJR3, TMM&RC

Affiliation: Teerthanker Mahaveer Medical & Research Centre, Moradabad, U.P

Purpose- We live in an era of edited selfies and ever-evolving standards of beauty. The pervasiveness of these filtered images can take a toll on one’s self esteem, make one feel inadequate for not looking a certain way in the real world, and may even act as a trigger to induce anxiety, depression and may eventually lead to body dysmorphic disorder (BDD). A new phenomenon, “Snapchat dysmorphia,” has patients seeking cosmetic surgery to resemble filtered versions of themselves. These filtered selfies often present an unattainable look and are blurring the line of reality and fantasy for these patients. Filtered images are fostering a fixation on how we present, to others, to the point where it’s a mental health crisis unfolding before us. Since there is paucity of data on this topic, the current study was initiated to know the impact of this alarming trend on mental health of individuals.

Methodology- To fulfill the purpose of the study cross sectional survey has been conducted. Individuals using smartphones were randomly selected from the general population after informed consent and were then evaluated using socio demographic data sheet, self-structured questionnaire and YBOC-BDD scale. Appropriate statistical tools were applied for the study.

Result & Conclusion – On the basis of the statistical analysis we can conclude that there is positive outcome between the use of beauty apps and its adverse effect on mental health. Complete results and testing hypothesis will be presented at the time of presentation.

Keywords : Selfies, BDD, Snapchat Dysmorphia, chi-square test

229. TITLE:SERUM CALCIUM AND SERUM MAGNESIUM LEVEL IN DEPRESSION

AUTHORS: Dr. Arpita Thakur¹, Dr. Pali Rastogi², Dr. Rajeev Lohokare

1. M.D resident, M.G.M. Medical College, Indore

2. M.D, Associate professor, M.G.M. Medical College, Indore

3. M.D, Associate professor, M.G.M. Medical College, Indore

INTRODUCTION: DEPRESSION is one of the leading causes of morbidity among psychiatric illness. There are 322 million people in the world (WHO) and around 57 million people in India (18% of the global estimate) affected by depression. Various mechanism explained the role of magnesium and calcium in depression. Both magnesium and calcium regulate various neurotransmitters through NMDA receptors channel that has high permeability to Ca++, which is blocked by Mg++ Ions. In Mg++ depletion state, Calcium-calmodulin binding causes activation of the neuronal nitric oxide synthase, which catalyzes the oxidation of L-arginine and form L-citrulline and nitric oxide. An excess nitric oxide leads to generation of toxic reactive oxygen species and radicals and damaging the neurons and give rise to affective disorders like Depression.

OBJECTIVE: To study serum calcium and serum magnesium level in depression.

METHOD: Study population consists of 200 individuals, aged 15-65 years. It is a cross-sectional comparative study held in the Department of Psychiatry, MGMMC, Indore. All socio-demographic details were recorded diagnosis and severity assessed by using the ICD 10 and HAM-D. Estimated serum Mg++ and serum Ca++ level were compared between cases and control.

RESULT: Initial assessment has shown a significant difference of serum mg++ level between cases and control with no significant correlation with the socio-demographic profile. Detailed findings will be discussed at the time of presentation.

CONCLUSION: Low serum mg++ level related to depression and further study required to confirm it as a definite biomarker. Mg++ preparation adding to pharmacotherapy can be an important regimen to treat depression.

KEYWORDS: Calcium, depression, magnesium

230.TITLE: Alcohol biomarker levels among treatment seeking patients with alcohol dependence syndrome.

AUTHORS: Shobhit Jain, Rizwana Quraishi, Raka Jain Senior Resident Institute of Medical Science, Banaras Hindu University Varanasi

Introduction: Alcohol control being one of the major health challenges, however its prevention is the single greatest opportunity for preventing non-communicable disease in the world today. Often there is concern over self-reported abstinence, hence serum markers are helpful in monitoring. Due to lack of Indian data, present study aimed to assess the cut-off levels of serum alcohol biomarkers (AST, ALT, and GGT) in detection of active alcohol consumption and during the course of abstinence among Indian patients diagnosed with alcohol dependence syndrome (ADS).

Method: This is a retrospective chart review of clinical profile and serum biomarkers of 316 patients diagnosed with ADS. The study excluded the records of patients with lifetime dependence on other substance (except nicotine dependence), prior history of chronic medical condition, or ongoing treatment for any other condition.

Results: The mean age of sample was 37.6 years, with 47% having co-morbid nicotine dependence syndrome. The self-reported alcohol use was 13.6% “on the day of assessment”, 57.9% “within four weeks”, and 28.4% “more than four weeks before”. The ROC analysis of AST, ALT, and GGT levels revealed highest positive likelihood ratio for the cut-off value 101.5, 80.0, and 81.0 IU respectively. After abstinence, the ALT was earliest to return to the normal reference range followed by AST and GGT.

Conclusion: Among patients with ADS, GGT can be used for screening active alcohol consumption and monitoring prolonged abstinence, whereas the AST and ALT for monitoring recent abstinence. Although the study adds to the limited data in Indian context, future multi-centric prospective study with larger sample size is required for the findings could be generalized to other settings.

Keywords: Biomarkers; Alanine Transaminase; Aspartate Transaminase, Gamma GlutamylTransferase, Alcohol Dependence Syndrome

231.TITLE:SLEEP DISORDERS IN OPIOID DEPENDENT PATIENTS MAINTAINED ON BUPRENORPHINE

AUTHORS:Dr. R. TRIPATHI1, Dr. R. Rao2, Dr. A. Dhawan3, Dr. R. Jain4 1- Dr. R. TRIPATHI Senior resident, Department of psychiatry and National drug dependence treatment center, All India institute of medical sciences, New Delhi, India 2- Dr. R. Rao Associate professor, Department of psychiatry and National drug dependence treatment center, All India institute of medical sciences, New Delhi, India 3- Dr. A. Dhawan Professor, Department of psychiatry and National drug dependence treatment center, All India institute of medical sciences, New Delhi, India 4- Prof. R. Jain Professor, Department of psychiatry and National drug dependence treatment center, All India institute of medical sciences, New Delhi, India

Background Opioid dependent individuals frequently complain of sleep problems in withdrawal and during abstinence. Sleep disturbances is seen even among methadone maintained patients. Few such studies exist on patients maintained on buprenorphine; however, the findings are inconsistent. The aim of the present study was to assess the rates of sleep disturbances among buprenorphine-maintained opioid-dependent patients, and to delineate factors associated with sleep disturbance.

Methodology Using a cross-sectional study design, seventy-five opioid-dependent patients maintained on buprenorphine for at least six months and on same dose in past month with no other psychotropic medications were interviewed. Pittsburgh sleep quality index (PSQI) instrument was used to assess sleep pattern. Socio-demographic, concomitant drug use and treatment related variables were compared between those with and without scores of greater than five on PSQI.

Results All participants were males. Their mean age was 40.8 years (SD:13.9), while the mean duration of illicit opioid use was 13.9 years (SD:10.9). The mean duration and dose of buprenorphine treatment was 63.2 months (SD:53.1) and 10.6 mg/day (SD:4.0) respectively. Proportion of past three-month substance use was: alcohol – 36% (n=27), cannabis – 33.3% (25), and illicit opioids – 6.7% (n=5). About 48% (n=36) had PSQI scores more than 5 denoting sleep problem. High PSQI scores was significantly associated with age (p=0.03), but not with duration of illicit opioid use, treatment duration and mean buprenorphine dose.

Conclusion A sizeable proportion of opioid dependent patients on buprenorphine have sleep problems. The sleep problems seem to be independent of either their drug use status or treatment related variables.

232.TITLE: MANAGEMENT OF SUBSTANCE USE DISORDERS IN THE HEARING- IMPAIRED AND CHALLENGED PATIENT: A CASE REPORT

Author & Co-Authors : Dr. Ashish Pakhre, Dr. Richa Tripathi, Dr. Roshan Bhad

Address : Room no. 4096

4th floor, Teaching Block

Department of Psychiatry

All India Institute of Medical Sciences

New Delhi, India-110029

E-Mail : sjmc.ashish@gmail.com

Mobile No. : 9871891011

Mode of Presentation: Oral

Introduction: There is a lack of research that attempts to characterize the patterns of drug use in the hearing-impaired and their specific needs with respect to treatment, although substance-use disorders are common in this population as in the general population. We describe a case of the hearing –impaired and challenged patient and management difficulties faced by treating team.

Case Description: A thirty-six-year-old man with a history of dependence on tobacco and alcohol for duration of eighteen years presented to tertiary deaddiction centre of India for treatment. A detail assessment revealed a patient has congenital total deafness diagnosed at the age of six months and absence of speech development. His primary mode of communication was through sign language and writing. He initiated alcohol use at the age of eighteen years and developed features of dependence (tolerance, craving, use despite harm, loss of control) within six-seven years. The severity of his alcohol use and associated physical and psychosocial complications prompted his family members to seek treatment. The assessment required greater time and his brother and sister in law served as interpreter between him and the clinician. Obstacles were faced in assessment of diagnosis and communicating the laboratory result findings, treatment options and other details regarding treatment, and the treating clinician had to resort to sign language and writing for communication. Patient was started on T. Naltrexone 50 mg as an anticraving agent after management of withdrawal symptoms using benzodiazepines. In view of the patient’s fair motivation for abstinence, the option of starting a deterrent agent (T. Disulfiram 250 mg) was communicated and his consent was obtained for the same. In addition psychoeducation and relapse prevention sessions using pictures, videos and with the help of sign language interpreters were planned.

Conclusion : This case demonstrates the problems encountered in the management of substance use disorders in the hearing-impaired and challenged patient. Communicating with the patient presents several hurdles, which if not identified and resolved, will lead to people with hearing-impairment being denied the opportunity of treatment for their problems related to substance use.

Key words: Addiction; Alcohol dependence syndrome; Deafness; Hearing-impaired person; Deaf mutism

233.TITLE:Prevalence of substance use among the outpatients of a tertiary care psychiatric hospital in Amritsar: A cross-sectional study.

AUTHORS: Tathagata Mahintamani1, Savinder Singh2

1 Senior Resident, IMH Amritsar, 2 Director, IMH Amritsar.

Background: Substance use disorders are common co-morbidity among patients with mental illness. Substance may mimic, induce, aggravate, and sometimes attenuate psychiatric symptoms leading to their rampant use among psychiatric patients. Their prevalence vary across different socio-cultural groups, religions, geographical areas and psychiatric illnesses. There is scanty published data measuring the prevalence of substance use in outpatient psychiatric population in Northern India.

Aim: To measure the prevalence of substance use among psychiatric outpatients in relation to their socio-demographic and clinical variables.

Materials & methods: 300 adult patients with psychiatric diagnosis as per ICD 10 DCR, attending the OPD of Vidyasagar Institute of Mental Health, Punjab for the first time were randomly selected after taking informed consent. Patients with neurological problem, mental retardation and substance use disorder as primary diagnosis were excluded. Patients were subsequently assessed using socio demographic Proforma and Alcohol Smoking and Substance Involvement Screening Test (ASSIST) for assessment of substance use.

Data were statistically analyzed using SPSS 20 software.

Result & Conclusion: 53.7% patients used substance in their lifetime. Most of the single substance users used tobacco (21.3%) followed by, alcohol (9.3%), cannabis (3%) and opioid (1.3%). 18.3% of patients used multiple substances. Tobacco was commonest substance of initiation among multiple substance users (50.9%), followed by alcohol and cannabis. Lifetime substance intake was significantly more prevalent among: males, non-Sikhs, residents of neighboring states, patients with positive family history of SUD. Other socio-demographic and clinical variables were similar between patients with and without substance use.

Keywords: substance use disorder, prevalence, psychiatric population.

234.TITLE:Correlates of Epileptic Seizures in Patients abusing Opioids

AUTHOR:Dr. Mrinal Jha Senior Resident AIIMS RISHIKESH

Introduction: Opioid abuse is a growing public health problem in our country. While there is literature to suggest a correlation between use of opioids like Tramadol and Fentanyl, and occurrence of seizures, especially in cases of toxicity, very few studies have demonstrated a link between opioid withdrawal and seizures. In India, Khanra et al reported three cases of opioid withdrawal seizures, while Mattoo et al demonstrated that 8.5% of patient abusing opioids had a seizure assosciated with the substance use.

Methodology: Patients meeting criteria for opioid abuse or dependence with history of epileptic seizures shall be included. Patients with co-morbid use of other psychoactive substances shall not be excluded, though information regarding these substances shall also be collected. Data will be collected to describe type, duration, pattern and severity of opioid use with tools like MINI(Mini International Neuro-psychiatric Interview : Non- Alcohol Psychoactive substance Use Disorders,SODQ (Severity of Opiate Dependence Questionnaire) and COWS(Clinical Opiate Withdrawal Scale), along with description of seizures including type, frequency and phase of occurrence (intoxication/withdrawal/independent). Where available, findings of Urine Drug Screen, Neuro-imaging and EEG shall be recorded.

Results shall describe the various correlates between opioid use and occurrence of epileptic seizures in these patients.

Keywords: Opioid, Seizure, Withdrawal, Intoxication, Correlates

235.TITLE:STUDY OF COMORBIDITY AND PREVALENCE OF NICOTINE DEPENDENCE IN ALCOHOL DEPENDENCE PATIENTS

AUTHOR:DR.MEGHAMALA.S.TAVARAGI SENIOR RESIDENT,DIMHANS,DHARWAD

INTRODUCTION

Most individuals with alcohol use disorders are also dependent on nicotine, with concurrent smoking ranging from 60-95%. Co-dependent sub-population may have a higher level of nicotine dependence and report difficulty in quitting tobacco use. According to literature 80% of alcoholics smoke regularly and that majority of them die due to smoking related disorder rather than alcohol related disease. Smoking converts moderate drinking to heavy drinking more likely by decreasing the effects of alcohol intoxication and thus worsen the complications due to alcohol.

OBJECTIVES

  1. To assess severity of alcohol dependence
  2. To assess severity of nicotine dependence
  3. To study association between nicotine dependence in alcohol dependence patients


METHODS AND METHODOLOGY

60 alcohol dependence patients admitted in DIMHANS, Dharwad from Jan 1st 2018 to June 31st 2018 were taken as sample, after taking informed consent and ethical committee clearance.

Alcohol dependence syndrome diagnosis made according to ICD 10.

Severity of alcohol dependence assessed by using SADQ scale.

Nicotine dependence assessed by Fagerstrom smoking and smokeless scales.

RESULTS:

Among 60 alcohol dependence patients around 65%(39pts) had nicotine dependence. In ADS (60) pts, 56.7%(34) had severe, 30%(18) had moderate and 13.3%(8) had mild alcohol dependence. Among 65%(39) nicotine dependence patients, 53.8%(21) were smokless,18%(7) smoking and 28.2%(11) had combined nicotine dependence. Among, Smokeless(nicotine) 32pts, 62.5%(20) had severe and 37.5%(12) had moderate nicotine dependence. Among smoking(18)pts, 61%(11) had high and 39%(7) had moderate nicotine dependence.

CONCLUSION

Alcohol and tobacco together are more deleterious to health than use of only a single substance. And results suggest the nicotine and alcohol dependent patients represent a separate population requiring higher attention from the treating psychiatrist. Hence understanding the pattern of tobacco use with co-morbid alcohol use may help in planning appropriate prevention/treatment strategies.

KEYWORDS

ALCOHOL, NICOTINE, DEPENDENCE, COMORBIDITY

236.TITLE:ATTITUDE AND BEHAVIOUR TOWARDS MENTAL ILLNESS AMONG NON-PSYCHIATRIC CLINICIANS IN A TERTIARY CARE TEACHING HOSPITAL

AUTHORS:Dr. Harita Darji1, Dr. Avisha Mahla2, Dr. Rakesh Gandhi3

1. Second Year Resident Doctor, Department of Psychiatry, Medical College, Baroda

2. Third Year Resident Doctor, Department of Psychiatry, Medical College, Baroda

3. Associate Professor, Department of Psychiatry, Medical College, Baroda


Abstract

Introduction

Psychiatry as a discipline is often perceived as ‘different’ by other medical professionals as much as by a common man, may give rise to stigma towards both mental illness and mental health professionals. Therefore, it is important to know their attitude and mental health stigma related behaviour towards psychiatry as large number of people with mental illness tend to visit their primary clinician before visiting a Psychiatrist.

Aim

  1. To assess the Attitude and Behaviour towards mental illness among non-psychiatric clinicians in a tertiary care teaching hospital.
  2. To test the primary hypothesis that doctors who hold more negative attitudes towards people with mental illness will have more discriminatory behaviours.
  3. To compare the Attitude and Behaviour towards mental illness between consultants and resident doctors.


Materials and Methods

This was a cross sectional study conducted by interviewing 147 resident doctors and 53 consultants of various medical faculties of Medical College, Baroda. Their attitude was assessed by MICA (Mental Illness Clinician’s Attitude Scale) and mental health stigma related behaviour was measured by RIBS (Reported and Intended Behaviour Scale).

Results

Mean score for the overall population of MICA4 was 46+/-9 and for RIBS was 15+/-3.

There was a negative correlation found between attitude and intended behaviour towards people with mental illness indicating that negative attitude was associated with more discriminatory behaviour.

Consultants held a better attitude towards mental illness than the resident doctors with significant difference although intended behaviour towards people with mental disorder was same by both.

Conclusion From our study we can conclude that despite of having training in psychiatry during MBBS, doctors hold negative attitude towards mental illness and tend to have a discriminatory behaviour towards people with mental illness which indicates the needs for reforms in medical education so as to reduce the stigma.

237.TITLE:AN INTERESTING CASE REPORT OF MORVANS SYNDROME PRESENTING AS PERCEPTUAL ABNORMALITIES WITH BEHAVIORAL DISTURBANCE.

AUTHORS:1Dr. Sunny Dua 2Dr. Seema Singh Parmar 3Dr. Subramaiah Nagendran 4Dr.. Muskaan Makkar

1. Post-Graduate Student, Department of Psychiatry, Teerthanker Mahaveer Medical College & Research Centre, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh

(Email -sunnydua1981@gmail.com, ph. - 7351521097)

2. Associate Professor, Department of Psychiatry, Teerthanker Mahaveer Medical College & Research Centre, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh.

3. Professor and Head, Department of Psychiatry, Teerthanker Mahaveer Medical College & Research Centre, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh

4. Post-Graduate Student, Department of Psychiatry, Teerthanker Mahaveer Medical College & Research Centre, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh

ABSTRACT

Neuromyotonia is a rare neurological condition, which is characterized by peripheral nerve hyperexcitability. Morvan’s syndrome is characterised by Neuromyotonia, pain, hyperhidrosis, weight loss, severe insomnia and hallucinations, Acquired NMT is thought to be autoimmune in a high proportion of cases. It can be associated with thymoma and antibodies to voltage-gated potassium channel antibodies (VGKC) are present in a proportion of patients’ Anti-voltage-gated potassium channel antibodies (anti-VGKC) cause hyperexcitability of the peripheral nerve and central nervous system.

Autoantibodies against neuronal surface antigen are found in patients with autoimmune encephalopathies. The antibodies directed against voltage gated potassium channel (VGKC) or VGKC-associated proteins (LGI1, CASPR2, TAG/contactin-2) had been described with autoimmune limbic encephalitis, Neuromyotonia, or Morvan’s syndrome. These severe, potentially lethal syndromes can have a non-paraneoplastic or paraneoplastic etiology.

We report a case of 40 years old male patient who presented to our OPD with acute onset complaints of behavioural disturbance, visual hallucinations for the past one month along with muscular twitching’s in the whole body. Electromyography (EMG) revealed fasciculations, doublets, and triplets in bilateral gastrocnemii, biceps brachii, and quadriceps femoris and masseters. Antibody were positive for VGKC-associated protein (CASPR2). Possibility of Morvan’s syndrome was considered. The patient was managed with IV Ig. After 2 weeks of completion of immunomodulatory therapy, the patient started showing improvement with decreased muscle twitching, and improved behavioural disturbance.

KEYWORDS : Voltage gated potassium channel, Leucine rich glioma inactivated protein 1, Contactin-associated protein like 2

238.TITLE:SUICIDALITY IN PATIENTS WITH FIRST EPISODE PSYCHOSIS

Authors: Dr. Surekha.S (1), Dr. Harihar.C (2), Dr. Lokesh Kumar. K(3),Dr. Balvanth Reddy.C (4), Dr.M. Vijay Kumar (5)

(1) Post graduate in MD Psychiatry, (2) Professor, (3) Assistant Professor, (4)) Post graduate Department Of Psychiatry,(5) Assistant professor Department Of Community Medicine,Bhaskar Medical College.

Background: Suicide is an act of intentionally causing one's own death. The suicide risk in schizophrenia and other psychotic disorders is highest in the early phases of illness. Most of the studies have focused on patients on treatment rather than actual onset of psychosis.

Aim: The present study of patients with FEP aimed at exploring the prevalence and characterstics of suicidality in patients with first episode psychosis(FEP) in two time intervals 1)prior to study entry and 2) explicitly in the period of untreated psychosis.

Material&Methods: Cross sectional study was conducted at Bhaskar Medical College in Hyderabad. The study included 120 patients with FEP from Out Patient Depatment of psychiatry at Bhaskar Medical College, after the approval of the Institutional Ethical Committee. The subjects were asked to fill a form containing informed consent and sociodemographic details taken.

Inclusion criteria were age 18-65years and a FEP according to ICD-10(International Classification of Diseases-10),including schizophrenia, persistent delusional disorder, acute and transient psychotic disorders, schizoaffective disorder and unspecified nonorganic pychosis.

Exclusion criteria were history of head injury,brain damage, neurological disorder and mental retardation.

Duration of the study was December 2016 to June 2018

The data entry done by using Microsoft Excel 2010 version and analysis using EPI INFO version 7. Appropriate stastistical tests will be done wherever required.

Results: Will be discussed at conference

Conclusions: Will be discussed at conference

Keywords: First Episode Psychosis,Schizophrenia,Suicide risk,ICD-10.

Details for Correspondence : Dr. Surekha.S

Postgraduate, Bhaskar Medical College,

Hyderabad, Telangana – 500075

239.TITLE:A study of attitudes toward antipsychotic medications and factors related to drug compliance in patients with Schizophrenia from a tertiary care centre of eastern India

AUTHOR-Kirti Anurag, Bapini patra

Designations-Post graduate students

Institution -SCBMCH

Keywords- Schizophrenia, antipsychotics, attitude, compliance.

Introduction -Adherence to medication is essential for maximising the outcomes of patients with schizophrenia as the consequences of poor adherence are devastating. Adherence to treatment has a significant impact on the prognosis of schizophrenia. Good medication adherence generally contributes to an improvement in clinical outcome, which leads to a reduced rate of rehospitalisation, higher rates of employment, and improved quality of life and functioning.

Aim- The aim of the study is to find out the attitudes of patients towards antipsychotic medications and reasons for drug non-compliance in schizophrenia and its association with clinical and socio-demographic variables.

Materials and Methods - The study is conducted at department of Psychiatry, Mental health Institute, SCB Medical college, Cuttack from 1 January to 31 May of 2018. The study sample consists of consecutive follow-up patients attending the out-patient services in our hospital for schizophrenia. Various socio-demographic and clinical variables were explored to find associations with medication adherence. Positive and Negative Syndrome scale (PANSS) was used to assess the severity of the illness. Subjective reasons of medication compliance/non-compliance were assessed using 20 item Rating of Medication Influence (ROMI) scale. The attitude toward antipsychotic medication was assessed using Drug Attitude Inventory-10 (DAI-10). The data was statistically analyzed using Statistical product and service solutions (SPSS-16) version.

Results-

Mean age of compliant patients were found to be more. DAI SCORE was found to be more positive, insight into illness was higher,PANSS score was lower in compliant groups

Conclusions-

Higher the Dai score and insight into illness, lesser was the PANSS score and better was the drug compliance

240.TITLE:Study Of Executive Functioning In Patients With Alcohol Use Disorder

AUTHOR:DR. Swati Sharma post graduate student lady hardinge medical college delhi

INTRODUCTION

Alcohol is psychoactive substance with dependence producing properties most commonly abused. Alcohol impacts are determined by volume consumed, pattern of drinking, quality.

It affects executive functioning like mental flexibility, decision making, problem solving, processing speed, planning which influence environmental factors involved in management, like self-efficacy, readiness to change, treatment compliance

METHOD

25 Patients with alcohol use disorder according to DSM 5 taken. SAD Q, STROOP TEST, DIGIT SYMBOL SUBSTITUTION TEST, TRAIL MAKING TEST applied. Socio-demographic data and clinical variables are compared.

RESULT

Final rest will be declared during presentation

CONCLUSION

Executive dysfunction is seen with high intake of alcohol use.

241.TITLE: Psychobiological exploration in Natural vs Surgical Menopause

AUTHOR: Shadaan Afeen, Praveen Khairkar , post graduate student kamineni institute of medical sciences hyderabad

ABSTRACT

Background : Menopausal women report psychiatric morbidity wide the literature. However, little is known about how the progression of Natural menopause is different than Surgically induced course. The present study intends to explore the psychobiological mechanisms and clinical presentations in large group of menopausal women from South India.

Methodology : A hospital based, qualitative cohort study sample of 2 separate groups of menopausal women for a period of 18 months to identify psychiatric morbidity, menopausal symptoms and biological markers like Hemoglobin, Thyroid Stimulating Hormone, Leutinising hormone, Follicle Stimulating Hormone, and Serum Calcium in the patients of age group of 40-60yrs. Menopausal rating scale to assess for menopausal symptoms and Mini International Neuropsychiatric Interview 7.0 to diagnose for Psychiatric morbidity.

Results : We evaluated 96 menopausal women, 56 of them were with natural menopausal course while 40 were through surgically induced menopause. Mean age of our sample was 47.3. 29.16% of natural menopausal women were having psychiatric morbidity compared to 48.8% surgically induced menopause. Predominant psychiatric diagnosis were depression and anxiety disorders. On menopausal rating scale we could differentiate both the groups significantly (p<0.05). Serological biomarkers like LH, FSH, and Haemoglobin % have shown statistically significant differences (p<0.05) but not with Serum TSH and Serum Calcium levels.

Conclusion: This is to our knowledge the first psychobiological exploration of the menopausal women from India. Appropriate interventions and psychiatric referrals during menopausal phase is highlighted.

256. Title- Hs-CRP levels in patients in depression with suicidal behavior and depression without suicidal behavior.

Dr. Varchasvi Mudgal

Introduction: Hs-CRP (highly sensitive) is an acute-phase inflammatory protein synthesized by hepatic Kupffer cells signalling other body cells for destruction by the complement system and generated in response to increases in serum IL-6. We explore Hs-CRP in depression following suicidal behaviour with goal of obtaining a significant correlation between Hs-CRP and suicidality.

Objective: To study inflammatory marker Hs-CRP levels in patients with depression having suicidal behaviour (suicidal attempt or suicide ideation) and without suicidal behaviour.

Method: After applying strict inclusion and exclusion criteria participants were included. Subjects were taken from Dept of psychiatry, MGM Medical College and appropriately matched. Written informed consent was taken after explaining the objectives and procedure. The diagnosis of depression was made with ICD -10. Blood sample was collected in a clot activator tube and serum was processed with centrifuge machine and analyzed for Hs-CRP with Automated analyzer using Immunoturbidimetry. HAM-D and BECK’s Suicidal Ideation scale were used.

Results : In our study majority of the sample with suicidal attempt were males while for suicidal ideation were evenly distributed in gender. Majority were Hindu by religion, married, belonging to urban background and had low socioeconomic background. Elevated Hs-CRP levels were found in the attempt group. Rest of the results will be discussed later.

Conclusion : Elevated levels of Hs-CRP were found in patients with suicidal attempt showing an association between suicidality and inflammatory markers. Hence while dealing with depression inflammatory markers (Hs-CRP) could be an indicator for suicidality.

461. Title- basal thyroid function test in first episode of depression and healthycontrols

Dr. Beema Chauhan

Introduction: Thyroid dysfunction has commonly been seen associated with depression. The most commonly seen thyroid abnormality in the thyroid patients are raised levothyroxine (FREE T4), decreased triiodothyronine(FREE T3), and raised thyrotropin release hormone (TRH) levels, and a blunted thyroid stimulating hormone (TSH) response. Our study explores association between thyroid dysfunction and 1st episode depression.

Objective: To study thyroid hormones (TSH, FREE T3, FREE T4) in patients of first episode depression and normal healthy controls.

Method: After applying strict inclusion and exclusion criteria participants were included. Subjects were taken from Dept of psychiatry, MGM Medical College and appropriately matched. Written informed consent was taken after explaining the objectives and procedure. The diagnosis of depression was made with ICD -10. Blood sample was collected in a clot activator tube and serum was processed with centrifuge machine and estimation of serum TSH, FREE T4, FREE T3 was done by using in vitro competitive ELISA.

Results : In our study majority of the sample were females, Hindu by religion, middle aged, married, urban background and low socioeconomic background. There was found to have no significant association between basal thyroid and first episode of depression. Rest of the results will be discussed in details later.

Conclusion : No statistically significant relation was found between basal TFT and first episode of depression. This result corroborates with previous studies hence TFT in a patient of first episode depression can be excluded from baseline investigation.

462. Title- metabolic syndrome in patients with chronic schizophrenia receiving treatment and not receiving treatment

Dr. Krishna Kumar Carpenter

Introduction: Several studies suggest that patients with serious mental illness die about 20 years earlier than the general population patients of schizophrenia should be closely monitored for the metabolic syndrome and must be taken into account, while choosing various antipsychotics medications which are known to be associated with higher weight gain and metabolic abnormalities. Our study explores association between chronic schizophrenia and metabolic syndrome.

Objective: To study metabolic syndrome in patients with chronic schizophrenia receiving treatment and not receiving treatment

Method: Subjects were taken from opd of mental hospital, MGM medical college Indore fullfilling the inclusion and exclusion criteria. Written informed consent was taken after explaining the objectives and procedure of study in detail. Detailed physical examination was done to rule out any medical or neurological abnormality AND waist,arm,hip and chest circumferences, height, weight and BMI. The diagnosis of schizophrenia was made using ICD-DCR 10. Blood samples were withdrawn. Estimation of parameters of study HDL, TG, & FBS. Patients were assessed on PANSS.

Results : In our study majority of the sample males, Hindu by religion, married, belonging to urban background and had low socioeconomic background. Treatment receiving group had higher risk of metabolic syndrome. Results will be discussed in details later.

Conclusion : Patients of chronic schizophrenia had increased risk of developing metabolic syndrome irrespective of treatment. Hence regular assessment of metabolic risk factors and healthy lifestyle is advisable.

4. The impact of depression on productivity of work and earning of livelihood- Dr Manjunatha B Kondapura

The Impact of depression on productivity of work and earning of livelihood

Manjunatha B Kondapura1, N Manjunatha2, C Naveen Kumar3, Girish N Rao4, Suresh Bada Math5

1Junior Resident, 2Associate Professor of Psychiatry, 3Additional Professor of Psychiatry, 4Professor of Epidemiology, 5Professor of Psychiatry, NIMHANS, Bengaluru

1Presenting Author (manjunatk6@gmail.com) (Manjunatha B Kondapura)

Background and Objectives:

It is the quintessential step, to assess the magnitude of societal cost and economic impact of any health condition; for the proper allocation and better utilization of health resources.

The most important health condition associated with high societal cost is depression and it is the leading cause of disability worldwide. The greatest contributor to the economic impact of depression is from loss in work productivity which is measured by Absenteeism (habitual pattern of absence from work) and Presenteeism (Poor performance at work due to illness)

There is paucity of studies in India which looks upon the impact of mental illnesses on Productivity of work which costs both patient and the society significantly

Methods:

Design: cross sectional study at neuro-psychiatric hospital OPD.

Sample size: 120 people diagnosed with depression clinically and/or by DSM-5/ICD_10.

Tools:

· Loss in work productivity is assessed using “WHO Heath and Work Performance Questionnaire (HPQ)”

· Reduced earning of livelihood (loss of income) is assessed in terms of indirect cost of illness using newly designed Schedule for Assessment of Financial Burden of Illness (SAFBI).

· WHO HPQ guidelines for Calculation

Results:

· Average hours of absenteeism due to depression is 60 hours/month [expected hours/norm of work - 213 hours/ month]

· Mean value of Relative presenteeism is 0.73 [expected value/ norm – 1]

· Patient reported Average loss of earning due to depression is ?2226/month

Conclusions: Depression reduces a persons productivity of work by more than half (54%) which shows that depression has significant impact on a person/society economy

(Future directions: Monetization of loss of work productivity and interpretation of the results with appropriate statistical methods in easily understandable layman terms)

Key words: depression, work productivity, work performance, WHO HPQ, loss of earning, cost of illness



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Source of Support: None, Conflict of Interest: None


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