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    EP 1: Coping Sty...
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    EP 4: A Case Rep...
    EP 5: A Study To...
    EP 6: A Study To...
    EP 7: Brief educ...
    EP 8: A case ser...
    EP 9: Case repor...
    EP 10: Rubinstei...
    EP 11: Quality o...
    EP 12: Intellect...
    EP 13: Cannabis ...
    EP 14: A study o...
    EP 15: Developme...
    EP 16: Unfolding...
    EP 17: The Clock...
    EP 18: Case Stud...
    EP 19: A Study O...
    EP 20: Unusual P...
    EP 21: Plasma Va...
    EP 22: Mental ca...
    EP 23: Haloperid...
    EP 24: Tapentado...
    EP 25: Prospecti...
    EP 26: A rare ca...
    EP 27: Comparati...
    EP 28: Faith Hea...
    EP 29: Abstract ...
    EP 30: Topic: No...
    EP 31: A Clinica...
    EP 32: Mitochond...
    EP 33: Associati...
    EP 34: A Case of...
    EP 35: School Re...
    EP 36: Maintenan...
    EP 37: Internet ...
    EP 38: THE Role ...
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    EP 41: Epidemiol...
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    EP 43: Myxedema ...
    EP 44: Psychiatr...
    EP 45: Case Repo...
    EP 46: Depressio...
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 Table of Contents    
E-POSTERS 23RD JAN 2020  
Year : 2020  |  Volume : 62  |  Issue : 7  |  Page : 123-136
E-Posters 23rd Jan 2020



Click here for correspondence address and email

Date of Web Publication14-Jan-2020
 

How to cite this article:
. E-Posters 23rd Jan 2020. Indian J Psychiatry 2020;62, Suppl S1:123-36

How to cite this URL:
. E-Posters 23rd Jan 2020. Indian J Psychiatry [serial online] 2020 [cited 2020 Aug 9];62, Suppl S1:123-36. Available from: http://www.indianjpsychiatry.org/text.asp?2020/62/7/123/275926





   EP 1: Coping Styles and Life Satisfaction in Palliative Care Top


Presenter: Col (Dr) Vinay Singh Chauhan, Assoc Prof Psychiatry, AFMC, Pune

Co-author : Sqn Ldr (Dr) Rajat Garg, Gd Spl Psychiatry, AFCME, Delhi

Background: Patients in palliative care suffer variously due to underassessment of needs and suboptimal intervention, coupled with lack of access to palliative care. This study attempts to identify effective coping strategies which lead to life satisfaction, among those afflicted with terminal cancer.

Materials and Methods: This observational, cross-sectional study was carried out among terminally-ill cancer patients undergoing palliative care. Cancer patients receiving palliative care who give consent and were aged 18 years or older were included in the study. Those with cognitive deficits, delirium, or psychosis were excluded from the study. COPE scale, Temporal Satisfaction with Life Scale, and sociodemographic Performa were administered and analyzed. Pearson's r correlation coefficient test and multiple linear regression analyses were used to evaluate correlation and effect of coping strategies on life satisfaction.

Results: Religious coping was the most frequently used coping strategy by patients, followed by acceptance. Females showed higher problem-focused coping, whereas males had higher emotion-focused and avoidant coping strategies. Females manifested more religious coping. Males showed more acceptance of their illness. Those without a partner had significantly higher emotion-focused coping strategies and higher religious coping. Income, social support, and problem-oriented coping were positively related to quality of life. Life satisfaction showed significant negative correlation with denial, substance use, and venting utilized as coping methods.

Conclusion: Problem-focused coping (religious coping and acceptance) was found to be more effective than other methods. Patients in palliative care could be instructed for the use of problem-focused coping. Such training might enhance their life satisfaction, helping them experience greater control over the course of illness.


   EP 2: Lithium induced nephropathy with evidence– A Case Report Top


Preferred type of presentation - Poster

Presenting author; Dr. Dayananda Sagar. L (Junior resident)

Co-Authors; Dr. Madhusudan.S MBBS, MD (Assistant professor)

Dr. H.Chandrashekhar MD (Professor and HOD)

Introduction

Lithium has been used for treatment of mood disorders as early as 1940s. Lithium has a very narrow therapeutic index, so monitoring the drug levels is of vital importance. Lithium is excreted in the kidney, with a vast majority of patients doing well on longterm lithium prophylaxis. Lithium nephrotoxicity has been extensively studied in the recent times. Long-term lithium administration in humans may lead to chronic tubulointerstitial nephritis, progression to end-stage renal disease (ESRD) has been rarely reported. This is one such case of lithium induced nephropathy

Case description

Mr. M, a 42 year old male from a rural low socioeconomic status, a known case of Bipolar disorder since last 13 years with 3 episodes of mania during the course, on regular treatment and follow up with Lithium 900mg per day prophylaxis.

He presented with acute onset of pedal oedema , periorbital puffiness, recently diagnosed malignant hypertension, anemia with decreased urine output.

His biochemical investigations were deranged with elevated urea, creatinine and TSH with albuminuria. Microscopy of renal biopsy revealed severe chronic interstitial nephritic changes, hypertensive changes in glomeruli and blood vessels, secondary focal segmental glomerular sclerosis.

Patient was managed under nephrology unit along with liason psychiatry was lithium stopped and diuretics, antihypertensives, thyroxine supplements were given. Patient vaccinated for capsulated organisms. Patient improved over 2 weeks of I.P care.

Unique about the case: Lithium induced end stage renal disease, Microscopic changes with histopathology images of the patient will be discussed

Keywords; lithium nephropathy, interstitial nephritis,


   EP 3: Restless Legs Syndrome in Chronic Liver Disease – Prevalence, Severity and its Impact on Mood and Sleep. Top


Akash kumar1, Ravi Gupta1,2

1 Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh

2 Sleep clinic, All India Institute of Medical Sciences, Rishikesh

Abstract

Background and aims – Restless legs syndrome(RLS) is a sensorimotor disorder that often has a profound impact on sleep and mood. Prior studies have reported higher prevalence of RLS in patients with chronic liver disease than in general population. Our aim was to find out prevalence and correlates of RLS in chronic liver disease and to assess the severity of RLS and its impact on sleep and mood.

Methods – Study included 75 adult patients with CLD coming to outdoor and indoor department of Gastroenterology of tertiary care center. Subjects were screened by detailed clinical interview to establish presence of RLS. Severity of RLS was assessed by international Restless legs syndrome study group rating scale (IRLS). Impact of RLS on mood and sleep were assessed by Public health questionnaire (PHQ9) and Pittsburg sleep quality index (PSQI) respectively.

The results of study and conclusions we drew will be discussed in the poster.


   EP 4: A Case Report Of Mania Following Dengue Haemorrhagic Fever. Top


Case Summary:

Dengue fever, also known as Break Bone fever, is a mosquito borne infection that causes a severe flu like illness. Psychiatric morbidity during acute dengue infection been rarely reported with no systemic studies on pattern of psychiatric sequelae followed by Dengue.

We report an 18 years old male who presented with increased energy; decreased sleep; expansile mood; aggression; without significant family or past history of psychiatric illness and diagnosed as first episode mania developed after acute dengue infection which was successfully treated.

Keywords - Dengue infection ; Mania.

During last few years, there has been increasing report of dengue fever with unusual manifestations primarily with neurological symptoms. Psychiatric morbidity during acute dengue infection has rarely been reported with previous literature showing similar types of presentation with limited case reports and case series. We are reporting this case to further throw light on this presentation in the form of psychiatric sequelae or precipitating illness.

[TAG:2]EP 5: A Study To Assess The Prevalence Of Depression And Anxiety Among Alcohol Use Disorder [/TAG:2]

Aim: Alcohol is the leading substance among the abused substances which is legitimate to use and causes significant burden than any other substances. Globally, alcohol consumption has escalated in recent decades, with all or most of that increase in developing countries. The present study was aimed to estimate the prevalence of depression and anxiety among individuals with alcohol use disorder in a tertiary care hospital .

Methodology: A cross sectional based study . 40 Subjects were recruited in the study after the approval from the institutional ethics committee. After obtaining the informed consent sociodemographic profile was collected using a Semi structured Proforma . Screening for alcohol consumption was done using CAGE questionnaire and Alcohol Use Disorder Identification Test (AUDIT) . Patients were then screened for the presence of Depression and Anxiety and severity of Depression was rated based on the Hamilton Depression Rating Scale (HAM D) and Hamilton Anxiety Rating Scale respectively .The results were analysed using appropriate statistical methods.

Results & Discussion : Evaluation of the study population revealed that 80 % had depressive symptoms . The mean HAM D score was 13.7 ± 6.35 in the study population . The mean HAM-D score for participants with psychosocial stressors was 17.4 which was significantly higher (P-value= 0.004) compared to participants without psychosocial stressors whose mean score was 11.52. Entire study population had symptoms of anxiety however the severity varied . 70% of them showed symptoms of mild anxiety while17.5% showed symptoms of mild to moderate anxiety . The mean HAM A score was 13.43 ± 9.03 in the study population.

Conclusion : This study demonstrates the risk of depression and anxiety disorder to be significantly high in the adult population with Alcohol use disorder. When alcoholism and psychiatric disorder co-exist patients are more likely to have difficulty in maintaining abstinence and to avail mental health services. Meticulous evaluation of psychiatric complaints in alcoholic patients is important to reduce illness severity in these individuals and to improve their quality of life .


   EP 6: A Study To Assess The Prevalence Of Depression Among Elderly In An Old Age Home. Top


BACKGROUND: There has been a two fold increase in the older population since 1980 and the numbers have been growing faster in developing countries. This is due to a decline in fertility rates and increase in life expectancy. There is not only an increase in physical burden but also psychological issues in the elderly. Rapid urbanization and a change in family structure causing decreased support for the aged lead to the emergence of old age homes, adjustment to which adds additional psychological burden.

AIMS: To assess the prevalence of depression in elderly in an old age home.

METHODS: The study was conducted in 40 inmates aged >60 years in an old age home in south India. The socio-demographic details were collected using a semi-structured proforma. General health questionnaire (GHQ- 12) was administered to assess psychological distress. Presence of depression was assessed by administering Geriatric Depression Scale (GDS - 15). Appropriate statistical analysis was done, the results were obtained.

RESULTS: Depression was found in 37.5% of the study population. There is a higher prevalence of depression seen in 7th and 8th decade who are widowed, belonging to lower middle socioeconomic status with presence of chronic illnesses and there is not much difference in gender, though not statistically significant. Among chronic illnesses, depression was seen more in hypertensives (84.6%) followed by diabetics (46.1%), the former being statistically significant.

CONCLUSION: Persons in old age homes have more risk of developing depression due to not only physical but also social factors. Special care should be given to address their medical needs, providing them with nutritional food and various recreational activities and improve their family ties thereby improving their quality of life.


   EP 7: Brief educational intervention for medical students for suicide prevention and management of suicide attempters Top


Presenting author: Mamta1

Co-author: Naresh2

1College of Nursing, 2Department of Psychiatry

All India Institute of Medical Sciences, Jodhpur, Rajasthan, India-342005

Correspondence: mamta_rajput45@yahoo.co.in

Background: Medical students are future physicians and their attitudes towards suicide prevention and suicide attempters impact upon the quality of care and outcome of patient management.

Aims: This study was aimed to assess the effectiveness of brief educational intervention for medical students for suicide prevention and management of suicide attempters.

Methods: Prospective study was conducted in AIIMS Jodhpur. 195 medical students were recruited through total enumeration method. Attitude towards suicide prevention scale was administered before and after three hours training on management of suicide attempters and strategies for suicide prevention.

Results: Ten out of fourteen attitudinal statements were significantly more favorable after imparting brief training on suicide prevention and management of suicide attempters. They reported lesser resentment, more responsible efforts, with greater competence and positive expectation with working for suicidal patients. They agreed for need of multidisciplinary efforts for effective suicide prevention. After intervention, they considered revelation of suicidal ideas were for help, not for attention seeking attitude and instead of considering suicidal communications as individual's choice, they agreed for substantial preventability of suicide with comprehensive management. Their misconceptions were resolved to a greater extent.

Discussion: Brief educational intervention was found effective in improving their attitudes on suicide prevention. Medical curriculum should incorporate regular educational programs suicide prevention and comprehensive assessment, and management of suicide attempter.

Key words: Medical students, brief training, educational intervention, self-harm, suicide, suicide prevention


   EP 8: A case series of compulsive insertions: Freudian relevance Top


AUTHORS: Dr Rishi Raj Mohammed1, Dr P. Kishan2

CO-AUTHORS: Dr P. Sai Krishna3, Dr Sphurti Pusukuri1

Abstract:

Background:

Obsessive-Compulsive Disorder (OCD) is characterised by the presence of obsessions and/or compulsions. Obsessions are intrusive and unwanted repetitive thoughts, urges, or impulses that often lead to a marked increase in anxiety or distress. Compulsions are repeated behaviours or mental acts that are done in response to obsessions, or in a rigid rule-bound way. According to Sigmund Freud's stages of psychosexual development, OCD is conceptualized as fixation to the anal stage of development causing oral/anal gratification. Here we present a series of OCD cases presenting with primary complaint of compulsive insertion.

Case 1: A case of oral compulsive insertion

Case 2: A case of vaginal compulsive insertion

Case 3: A case of anal compulsive insertion


   EP 9: Case reports of Trichotillomania with Trichobezoar and Schizophrenia with Phytobezoar Top


Dr Shalini Thodupunuri1, Dr P.Kishan2, Dr P. Sai Krishna3,

Dr Vishnu Vardhan M4

Background:

Trichotillomania(hair pulling disorder) is defined as the irresistible urge to pull out the hair, accompanied by a sense of relief after the hair has been plucked .It is included under obsessive compulsive and related disorders(DSM 5-312.39). Hair pulling may occur in any region of the body in which hair grows but most common sites are the scalp, eyebrows and eyelids. It is estimated that 1-2% of adults and adolescents suffer from trichotillomania.

Schizophrenia is a psychotic disorder with chronic and relapsing course with frequent medical and psychiatric comorbidities. Obsessive compulsive symptoms in schizophrenia have varied presentations such as contamination, sexual, religious or somatic themes with or with out accompanying compulsions like checking, hoarding ,repeating or arranging.

Case 1: Trichotillomania with Trichobezoar.

Case 2: Schizophrenia with Phytobezoar.


   EP 10: Rubinstein Taybi Syndrome: A Case Report Top


Dr Angshuman Kalita1, Dr Pranjal Jyoti Chakravarty2,

Dr Bikram Sutradhar3

Background:

Rubinstein-Taybi syndrome (RTS) or Broad Thumb Hallux syndrome was originally described by Michail et al. in 1957. In 1963, American physician Jack Herbert Rubinstein and Iranian-American Physician Hooshang Taybi had reported a thorough study of seven children of similar symptoms which later was named as Rubinstein-Taybi syndrome. It consists of a group of congenital anomalies consisting of short, broad thumbs and great toes, psychomotor retardation, high arched palates, and histories of recurrent respiratory infections and particular facial abnormalities. It is one of the classical recurrent pattern multiple congenital anomaly syndromes.

It is an extremely rare (1:300,000 up to 1:1,000,000), AD inheritance which occurs when a mutation of CREB binding protein (CBP) causes genetic defect related to chormosome16. The mutations in the CBP gene are responsible for RTS as well as the t (8; 16) associated acute myeloid leukemia

Case:

A 16 years old male who did not attend school at all, presented with increased anger, decreased sleep, physically abusive, wandering behavior for a total duration of 4years, increased for 3months, with history of delayed developmental milestones. Patient is the third child of his parents out of a non-consanguineous marriage, born by spontaneous vaginal delivery at home, cried immediately after birth, history suggestive of macrocephaly at the time of birth, with delay in all developmental milestones, sitting without support at 1 year, walking at 3 years of age, control over bowel at 12 years of age.

Currently, the patient stays at home. He does simple household tasks, cuts grass for cattle. But someone has to ask him to do the activities. He is able to do self-care activities by himself. He does not know how to read and write and do simple calculations.

On examination, the patient has a low hairline, low set ears, large thumbs and great toes, webs over feet.

On mental status examination, the patient is alert and conscious. Rapport not established, eye contact not maintained. Silly smiling was present throughout the interview. His speech is relevant, incoherent at times and his affect is irritable at times. The Patient had difficulty in comprehending the questions throughout the interview.

On Seguin form Board test (SFBT) - Patient does not have the concept of shapes, difficulty in comprehending instructions, stopped doing in between.

Vineland Social Maturity Scale (VSMS) - Social age found to be 7 years. The calculated SQ is 47, indicating a moderate level of retardation in socio-adaptive functioning.

Discussion:

In this case report the patient presented with the above-mentioned symptoms with characteristic morphological findings like a low set ear, low hairline, webbed toes, large thumb and great toe on VSMS indicative of a moderate level of socio-adaptive functioning.

Nayak et al. reported a case of 31 years old unmarried male presented with worsening behavioral problems for 2 months, with predominant symptoms of suspiciousness, delusion of reference and persecution, 2nd person auditory hallucination, his intelligence quotient is 60, his physical anomalies are spiky hair, bushy eyebrows, prominent supraorbital ridges, low set ears, long eyelashes, prominent nose, open mouth, carries in teeth talon cusps, broad thumbs and toes, cervical hyperkyphosis and scoliosis. Patient was assessed with MINI English version 6.0.0 and was diagnosed lifetime psychotic disorder. [3]

A case report by Cardona T. and Kline A. found with painful toenail, broad hallux, anti-mongoloid slant of eyes, heavy eyebrows, low set ears and beaked nose, plantar cleft to the plantar first inter-space, hyper-extensible joint with mental retardation. [1]

Case Report by¨unevveroglu and Akg¨o found that 7-year-old girl accompanied by parents with a complaint of caries and bleeding of the gingiva. She is the second child of a remote consanguineous couple short stature with broad thumbs, mental retardation, down the slant of the palpebral fissures, strabismus and simple ear. The nose has a beaked appearance, broad fleshy bridge, deviated septum, and short low columella and she had cardiac abnormalities. Intra-oral findings were high-arched and cleft palate, a small mouth and malocclusion. [2]

In a review and meta-analysis of 732 cases by Cantani and Gagliesi found the most evident symptoms are the thumbs and first toes with broad terminal phalanges (99%). The trunk presents many anomalies too, as spina bifida, scoliosis, kyphosis, lordosis, hypotonia, lax ligaments and above all stiff gait (83.8%).In adults were noted head circumference under 50th percentile (95%) or microcephaly. Mental, motor, language and social retardation are one of the most common symptoms in RTS; it is present in 98.5% of the patients and IQ is often under 50 (87%). [5]

Based on clinical examination and psychological assessment which is supported by case reports as mentioned reported case is diagnosed as Rubenstein Taybi syndrome.

Conclusion:

Most of the patients with mental retardation get under-diagnosed because of inability on the part of the clinician to detect some subtle morphological features, non-availability of genetic testing, non-affordability on the part of attendants. Therefore, while evaluating such cases we should focus on morphological features of some common syndromes which present as intellectual disability with a behavioral abnormality.


   EP 11: Quality of life in epilepsy patients receiving anti-epileptic drugs: A cross sectional study from a north Indian tertiary care center. Top


Dr Shobhit Kumar Prasad1

Co-authors: Dr Ravi Parkash 1, Dr Priti Singh2, Dr Rajiv Gupta3

Introduction: There is impairment in the Quality of Life (QOL) among Epilepsy patients receiving medications, posing a bigger challenge than the clinical severity. Systematic studies on QOL in epilepsy from developing countries are sparse.

OBJECTIVES: To determine the level of health-related Quality of Life in patients of

Epilepsy.

MATERIALS AND METHODS: A cross-sectional, questionnaire-based study was conducted in a tertiary care center of north India. Respondents were adults aged more than 18 years with a diagnosis of epilepsy on medication. The Quality of Life was assessed using QOLIE-31.

RESULTS: A total of 50 patients with epilepsy were included in this study. The standard deviation (mean) total score of QOLIE-31 in our study was 63.5. It was noted that the total score of QOLIE-31 was significantly better in single antiepileptic drug user group than polytherapy.

CONCLUSION: Patients on monotherapy had a better QOL as compared to patients receiving polytherapy.

[TAG:2]EP 12: Intellectual Disability Disorder with skin lesions – An intresting/ rare twist [/TAG:2]

BACKGROUND: Incontinentia pigmenti (IP) is a rare X-linked dominant disorder characterized by cutaneous findings and often by abnormalities of teeth, hair, nails, eyes, musculoskeletal system, and central nervous system.

AIM : Report a case of Incontinentia pigmenti with prominent yet undetected CNS findings

16 year old male child born out of non consanguineous marriage with term normal delivery presented to the OPD for IQ assessment . Detailed history revealed multiple episodes of head ache, vomiting and loss of consciousness since child hood which was being treated symptomatically .Routine general physical examination brought to attention multiple hypo pigmented nevi on abdomen , chest , face and neck region this raised the suspicion of IP , ophthalmological evaluation revealed the presence of typical demarcation line on the fundus of left eye in temporal periphery separating vascular retina from peripheral avascular retina . CT brain did not show any significant abnormality. EEG showed generalized sharp waves suggestive of seizure disorder .IQ assessment using BKT confirmed MILD MR . His diagnosis of IP was confirmed and was started with sodium valproate

Seizure was controlled on followup

CONCLUSION: Early detection and a thorough clinical examination would have helped him through his school going age and could have made a more positive impact in his life


   EP 13: Cannabis withdrawal presenting as Schizophrenia-like acute psychosis in a young adult male: a Case Report. Top


Authors: Dr. Pritha Roy *, Sidhant Kumar Sahu**

Psychosis related to Cannabis use has been reported to be dose-dependent, with individuals using Cannabis more frequently and in larger amounts, more prone to developing psychosis; psychotic episodes occurring mostly during acute intoxication (toxic psychosis) and less commonly, during the withdrawal phase. Equivocally enough, Cannabis has been postulated to cause as well as precipitate psychosis in predisposed individuals.

Here, we present the case of a 22-year old male who has been using Cannabis for last four years; initially smoking Ganja in form of joints and later ingesting pellets of Bhang. Upon abrupt stoppage of its use five days back owing to familial pressure, he experienced symptoms of disturbed sleep, easy irritability, anger outbursts, suspiciousness towards family members and hearing voices of people talking to him and about him. There was no history of any other substance use in past or during this episode of illness. He was started on Carbamazepine 400mg/day, Risperidone 3mg/day, and Lorazepam 4mg/day (in tapering dose) & reported significant improvement at 2 weeks' follow-up. He was planned for psychoeducation and psychotherapeutic interventions in subsequent out-patient visits.

Though reported less commonly in literature, cannabis withdrawal symptoms warrant meticulous clinical attention and can affect illness course, chances of relapse, co-morbid substance use and quality of life.

[TAG:2]EP 14: A study on awareness of mental retardation among caregivers [/TAG:2]

Dr. Bvijaykumar, Dr.Sireesha,Professor, Dr.Anilraj Dv, Dr.Umashanker

Introduction: With each passing day increasing number of children are being diagnosed with mental retardation. Caregivers need to identify problem, obtain evaluation, accept situation adjust to it accordingly. they should make effective use of available abilities of MR children.

Aim: To assess the awareness of different aspects of intellectual disability [MR] among caregivers of children with mental retardation

Objectives :

1. To study socio-demographic data of study sample

2. To assess the awareness of different aspects of MR among caregivers

Size of ample: 100 cregivers. Sampling :Purposive sampling

Inclusion criteria: care givers educated upto 5th class staying with MR child for 5 years, who have given consent

Exclusion criteria : intellectual Disability in care givers ,psychiatric problems in caregivers

Methodology: Purposive sampling was done.100 caregivers who presented to the out patient and who fulfilled the inclusion criteria willing to give consent were selected for the study. sociodemographic data was taken. Awareness among caregivers were studied using NIMH GEM questionnaire.

Tools used : Semistructured intake proforma ,NIMH GEM questionnaire

Results and conclusions: SPSS soft ware is used to analyse the data. 30%OF Caregivers had misconceptions and 70% of caregivers had no misconceptions

Key words: mental retardation, Awareness of caregivers, NIMH GEM questionnaire


   EP 15: Developmental regression in children with autism based on parental reports: A cross-sectional study from eastern India Top


Jakati PK1, Naskar S1, Saha B1, Chowdhury S1

Background: Parents of children with Autism often report of loss of skills that were previously well established along with marked change in the child's temperament, in other words they present with regression. Due to limited studies from this part of the world, we aimed to explore a much neglected and yet unexplained phenomenon of developmental regression and its various clinical correlates in patients with autism.

Aims and objectives: This study tried to assess the phenomenon of developmental regression in children with autism

Methods: children <10 years of age were selected (N=100). Diagnosis confirmed by using DSM 5 criteria. Tools used: DST for assessment of cognition, CARS for assessment of severity of autism, semi structured questionnaire for sociodemographic data, developmental history and regression phenomenon.

Results and Conclusion: We found that 60.2% of the sample had history of developmental regression as per parent reports. Regression occurs mostly between 16 to 24 months. Regression can occur more than once (multiple regression) in few children with Autism. Most children with regression lose skills in more than one domain and language regression is noted earlier by parents. More than 1/3 of children who report regression have some early social changes compared to typical children. Children with regression and without regression do not differ significantly on cognitive score or Autism severity. Some parents notice infections or psycho-social factors preceding regression and lack of stimulation is one of major psycho-social factors reported as preceding factor for regression in some children of Autism.


   EP 16: Unfolding of psychopathology and its socio-occupational and legal consequences Top


Ananta Manna1, Amitava Dan2, Ashis Debnath3, Srijit Ghosh4, Anirban Mukherjee5, Sibasis Roy6, Jayita Saha7

Introduction & Objective: The importance of phenomenology in psychiatry is decreasing with the advancement of biological research, but still, it has its own importance in clinical decision making. Delusion is a common phenomenon occurs in schizophrenia with its wide variations in form and content. However, some unique content of delusion manifested with its significant clinical and legal implications was found less often in the literature record. Here is one such rare presentation.

Case description: A middle-aged male was found living with a corpse at his residence for last three years. Police rescued him from his residence and produced in the court with alleged charges u/s 176 & 269 I.P.C. The case was covered widely by both electronic and print media. He was admitted in the mental hospital for psychological assessment & management by order of honourable court. History reveals that from early childhood he had fluctuating performances in academics, odd and eccentric behaviours, disobeying of parents, poor social mingling, strong sense of superiority in various spheres of life and tendency to experiment on different ideas of self.

On mental state examination, he had delusions of grandiosity with the thought that by his extraordinary secret research activities he would survive his mother who died three years back along with features of tendency to lie, intact cognitive functions and impaired insight.

On psychometric assessment, Brief Psychiatric Rating Scale score was 64, Rorschach Ink Blot test was negative, and the Eysenck Personality Questionnaire showed low psychoticism, high neuroticism, introversion & high lie factor. MRI head and evaluation of his physical state were within normal limits. He was diagnosed as a case of Schizophrenia.

Case formulation: Since early age, the person had vulnerable personality traits. Perpetuated by other (bio-psycho-social) factors these traits were unfolded in adulthood to generate disastrous psychopathology (delusion) with its marked socio-occupational dysfunction and legal consequences.

Discussion & Conclusion  The most crucial challenge of this case was not only diagnosis and treatment but to answer the judiciaries as an expert opinion, confounded by wide media hype.

Keywords: Schizophrenia, Delusion, Judicial proceeding


   EP 17: The Clock Drawing Test: An examination of sociodemographic influences and normative data in a cognitively healthy elderly Bengali speaking population Top


Aparna Dutt1, Ranita Nandi1, Ammu Lukose2, Rahul KV3

Objectives

The Clock Drawing Test (CDT) is a widely used screening test for dementia. However, normative data is not available for the Indian population. We aimed to examine the influence of sociodemographic factors on CDT performance and accordingly establish normative data for the Bengali speaking population.

Method

110 cognitively healthy Bengali speaking individuals residing in the city of Kolkata in the age range of 50 to 80 years (mean age = 62.72 ± 9.11 years) with a minimum of Class V education (mean education = 12.06 ± 3.9 years) participated in the study. Two neuropsychologists independently rated the CDT performance according to the Addenbrooke's Cognitive Examination III (ACE III) and Rouleau scoring systems.

Results

The two CDT scoring systems correlated well with each other (Spearman's rho = .664; p <.01). Education had a significant but a weak association with the CDT performance scored by the Rouleau method (Spearman's rho = .236; p =.013). The association with gender and the CDT performance according to the Rouleau scoring system was significant but also weak. We developed normative data for the Rouleau scoring system considering education and gender.

Conclusion

The data available from the current study will prove useful for clinical and research purposes not only in the Bengali speaking population, but perhaps for the rest of India.


   EP 18: Case Study of a Patient Diagnosed with Severe Depressive Episode with Psychotic Symptoms. Top


Sqn Ldr (Dr) Rohit Ranjan Mohakud, Resident, Psychiatry, CH (EC), Kolkata, Col (Dr) Rajiv Kumar Saini, Professor and HoD, Psychiatry, CH (EC), Kolkata.

Background: Electroconvulsive Therapy is indicated in patients of severe depressive episode in whom there is a need for rapid antidepressant response and high risk of suicide.

Case: A 40 year old male presented with insidious onset gradually progressive sadness of mood, reduced interest and enjoyment in previously pleasurable activities, feeling of low energy state and easy fatiguability, reduced sleep appetite and libido of 04 months duration. Examination revealed ill kempt person with depressed facies, reduced psychomotor activity, reduced spontaneity, prosody, rate, tone and volume of speech, depressed affect with reduced range, reactivity and control, mood congruent psychotic features in the form of hypochondriacal and nihilistic delusions, depressive cognitions of hopelessness and helplessness and repeated thoughts of suicide, impaired judgement and insight, reduced sleep, appetite, energy and libido. He was diagnosed as a case of Severe Depressive Episode with Psychotic Symptoms and managed with anti-depressants, anti-psychotics and supportive psychotherapy along with 06 sittings of ECT. He responded to the interventions which was corroborated by serial HAM-D scores. His delusions fragmented and there was improvement in mood, sleep, appetite and energy.

Conclusion: This poster focusses on an approach to a case of Severe Depressive Episode with Psychotic Symptoms and the relevance of administering ECT early in the treatment schedule.


   EP 19: A Study Of Oxytocin, Bdnf, Il-6 And Tnf-A As Trait Markers In Mania Top


Bipolar disorder is a relatively common, long-term and disabling psychiatric illness that is associated with high levels of functional impairment, morbidity, mortality and an increased risk of suicide. The defining characteristic of bipolar disorder is the appearance of episodes of mania or hypomania alternating with, or occurring concomitantly with depressive episodes. Episodes are generally separated by periods of recovery and a return to normal function but the recurrence rate is high.

Much of the interest in early studies was directed at hypothalamic-pituitary-adrenal (HPA) axis and monoaminergic neurotransmitters and later platelet, H-imipramine binding as potential biomarkers; however, the specific evidence has remained elusive. In the subsequent years, there has been a rise in the number of studies looking at the peripheral biomarkers in mood disorders. The potential advantages of this approach are its easy accessibility through vene-puncture, low-cost and potential for wider availability and amenability to large-scale studies.

Of particular interest are these three areas, namely, (i) cell growth, survival and synaptic plasticity [inclusive of brain-derived neurotrophic factor (BDNF)]; (ii) pro- and anti-inflammatory cytokines; and (iii) markers for oxidative stress and mitochondrial function.

Need for study: There have been studies about biomarkers in mood disorder, in patients in manic or depressive phases, documented in history.

However very few studies have been conducted to establish a role of biomarkers as trait markers in manic patients in remission with none performed on an Indian population.

Therefore with the emergence of potential 'trait' markers to identify the at-risk individuals, these biomarkers may play a role in primary prevention.

They may also be useful for early identification of illness relapse, perhaps even before clinical symptoms have started, helping in secondary prevention.

The discovery of biomarkers could be a promising beacon to guide novel therapies to act on the potential targets.

This study is aimed at estimating the serum levels of Oxytocin, BDNF, and Cytokines-IL6 and TNF-alpha in manic patients in remission and comparing them with their first degree relatives and matched healthy controls in an effort to assess their role as trait markers .


   EP 20: Unusual Presentation of Alcohol Withdrawal Delirium Top


Introduction:

Alcohol withdrawal delirium is associated with increased morbidity and mortality. Along with assessing the other causes of delirium, Pellagra encephalopathy (Niacin deficiency) should not be overlooked. The prevalence of pellagra may be as high as 27% in patients with alcohol dependence. Here we present the case of alcohol withdrawal delirium which did not improve even with escalating doses of Benzodiazepines.

Case Description

31-year-old, thin built male, with alcohol use for the past 15 years but in dependence for the past 6 months, presented to the outpatient department with mild tremors but no autonomic symptoms. His last drink was on the previous day. He had an episode of seizure in the OPD. The patient was admitted and started on Benzodiazepines and Thiamine. He had prolonged delirium in spite of high doses of Benzodiazepines. Radiological and biochemical evaluation ruled out metabolic and infectious causes. He was also noted to have skin lesions. In liaison with the dermatologists (the lesion was identified as Casal Necklace), pellagra was diagnosed and he was started on oral Nicotinamide. There was rapid resolution in his delirious state.

Discussion:

Prolonged delirium can pose a diagnostic challenge and it was more so in this case because of its atypical presentation (late age and shorter duration of dependence, absence of tremulousness). Along with the usual causes, pellagra encephalopathy should be considered. Oral Nicotinamide as replacement therapy (minimum 300 Niacin Equivalence) is recommended which is inexpensive and with no side effects at such doses


   EP 21: Plasma Vascular Endothelial Growth Factor Levels in Patients With Schizophrenia Top


Introduction: Vascular endothelial growth factor (VEGF) is a signal protein that stimulates both vasculogenesis and angiogenesis. Its production can be induced in various cells ranging from endothelial cells to monocytes and ending up on ones which are not receiving enough oxygen. Importantly, VEGF acts through its specific receptors expressed not solely by endothelial cells, but also by astrocytes, mature neurons, and neuronal progenitors in the adult brain, including the hippocampus). VEGF plays important roles in neuronal survival, neuroprotection, regeneration, growth, differentiation, and axonal outgrowth. VEGF has also been observed to promote neurite outgrowth. Accordingly, VEGF seems to be a critical factor in adult neurogenesis in the hippocampus. A recent imaging study with voxel-based morphometry reported that first-episode patients with schizophrenia have reduced volume in the bilateral hippocampus, parahippocampus, and superior and middle temporal gyri of the brain In line with these findings, a postmortem study showed that the proliferation of neural stem cells was diminished in the hippocampus of patients with schizophrenia.

Need for study: There are only a few studies till date which have studied the serum VEGF levels in schizophrenia. Further, the effect of treatment on serum VEGF levels has not been explored entirely. One clinical study examined serum VEGF levels in medication naïve, first-episode psychosis patients aged 15–25 years before and after a 12-week treatment with quetiapine. The current study is aimed to gain evidence regarding the neuroprotective role of VEGF and thus corroborate the findings with the previous studies. Therefore, we hypothesized that VEGF might be associated with the development of or improvement in schizophrenia as a neurotrophic factor.


   EP 22: Mental capacity assessments: Challenges in current practice and research Top


Praveen Pandey, Anil Nischal, Divya Sharma

Background: The Mental Healthcare Act(MHCA) 2017 says a capacitous patient holds the right to refuse treatment even when this might be considered wrong or harmful by the treating psychiatrist. The capacity for mental healthcare decision making is a legal construct and psychiatrists are not familiar with it.

Aims: To discuss the current challenges in mental capacity assessment in clinical practice and research

Methods: We reviewed the common methods used for assessment of mental capacity, existing guidelines for mental capacity assessment, the abilities models and the recently released mental capacity guidance document. We also present insights from a study we are finishing on mental capacity and practical problems encountered, which might be relevant to Indian scenario.

Results: Mental capacity assessments are best performed using a structured interview. There are no gold standard assessment methods recommended by any scientific or government body. However, Mac CAT(MacArthur Competence Assessment Test) is the most widely used tool in clinical research. There are differences as to what ability standards are used per the relevant jurisdiction.

Conclusion: Clinical judgement when accompanied with structured assessment tools is helpful in a holistic evaluation of mental capacity status.


   EP 23: Haloperidol induced Hepatotoxicity: A Case Report Top


Dr Satya Kumar Dutta1, Dr Pranjal Jyoti Chakravarty2, Dr Ankur Jyoti Borah

Background: Drug-induced Liver Injury(DILI) is a common drug reaction. Haloperidol has the potential to cause the extrapyramidal symptoms and also mild elevation of liver enzymes.

Aim: To report a case of hepatotoxicity associated with Haloperidol.

Method: A 45 year old male with psychotic symptoms was started on Haloperidol upto 20 mg. Symptomatic improvement of his symptoms,in third week presented with jaundice, poor appetite.On liver function test elevated AST,ALT,GGT,ALP and bilirubin were noted.Baseline LFT was normal. Following withdrawal of medications LFT returned to normal, but symptoms aggravated. As he had good response to Haloperidol and poor response to Olanzapine and Riperidone, Haloperidol was restarted increasing upto 10 mg.Towards end of 2nd week, his hepatic enzymes again started to rise and Haloperidol stopped.

Result: In drug induced liver injury (DILI) Roussel Uclaf Causality Assessment Method (RUCAM) is an assessment method that reflects the likelihood the causation of hepatic injury.In RUCAM total score came out to be 7 which suggests Haloperidol as the probable cause for deranged Liver function.

Conclusion: The appearance of constitutional symptoms such as fever, chills, yellowish urine,skin rash following Haloperidol administration should raise suspicion for possible development of hepatic dysfunction.


   EP 24: Tapentadol dependence in a young female: A case report Top


Dr Vijay Kumar Saini, Dr Pratibha Gehlawat, Dr Karandeep Paul, Dr Tanu Gupta

Background: Tapentadol is a newer synthetic opioid which is mainly used for pain management. International data infers a low risk of abuse and diversion of tapentadol. In India, Central Drug Standard Control Organisation (CDSCO) approved tapentadol immediate-release (IR) and extended-release (ER) preparations since April 2011 and December 2013 respectively. However, tapentadol is also used for deaddiction of other opioid derivatives and is available more or less over the counter.

The abuse of prescription opioid analgesics is becoming a serious public health concern. We aim to present a case of young female with tapentadol dependence.

Case: A 23year female presented to Deaddiction clinic, Department of Psychiatry, AIIMS, Jodhpur with complaints of consuming Tab. Tapentadol -ER (100 mg) 10-12 tablets/day for last 6 months in dependent pattern. Earlier, she used to consume tab. Tramadol (100 mg) 12-15 tablets/day in a dependent pattern for around 2 years. History started with smoking cigarettes (2packets/day) 6 years back followed by consumption of opioid (amal-around 100 grams /day)) for 1 year (four years ago). She conveyed that she started consuming the substances under peer pressure. There was no significant past and family history of psychiatric illness. Premorbid personality revealed histrionic and dissocial traits. She was subsequently admitted in the ward for further management. The management will be further discussed in the presentation.

Conclusion: Tapentadol have a abuse potential and presents challenges for opioid treatment services. The urgent regulatory measures are required for over the counter use of tapentadol.

[TAG:2]EP 25: Prospective memory in patients with first-episode psychosis [/TAG:2]

P.Sulakshana Rao1, 2, Madhavi Rangaswamy1,

Jonathan Evans1,3, AnirbanDutt1, 2, 4

Introduction: Individuals suffering from serious and enduring mental health problems such as psychotic disorders often have deficits in neuro-cognitive functions, including deficits in Prospective Memory (PM), which is the ability to carry out intentions after a delay. PM is important for activities of daily living, social and occupational functioning, yet relatively few studies have attempted to examine this problem in the South Asian setting, particularly in India.

Objectives & Methods: 70 healthy controls and 40 patients with first episode psychosis or established schizophrenia were assessed in Kolkata, a socio-economically diverse, multi-ethnic and multi-cultural city. A set of neuropsychological tests including Addenbrooke's cognitive examination – Bengali, Hospital Anxiety and Depression scale Digit Span, Auditory Verbal Learning Test, Brixton Spatial Anticipation Test, and the Cambridge Prospective Memory Test (CAMPROMT) were administered. In addition, PM questionnaires, the Prospective and Retrospective Memory Questionnaire (PRMQ) and Comprehensive Assessment for Prospective Memory (CAPM) were administered. Group differences were assessed using Mann-Whitney U Tests.

Results: There were no group differences for age (p=.416), gender (p=0.26) and education (p=.569) between patients and controls. However, the patients had significantly greater difficulties in cognitive functions including attention (p<0.005), learning (p<0.001), memory (p<0.001) and planning (p<0.001). Patients performed significantly poorer on the both the time based (p<0.001) and event (p<0.001) based subtest of CAMPROMPT in comparison to controls. Patients also reported significantly more problems with PM in everyday life on the PRMQ (p<0.005) and CAPM (p<0.005)

Conclusions: Cognitive deficits in domains such as attention, memory and planning for individuals with FEP/schizophrenia were evident. Difficulties were also evident in both time based and event based tasks of prospective memory. Even in the early stages of psychosis, PM deficits were prominent. Although promising, these findings would need to be replicated on a larger sample, accounting for other potential confounders, for generalisation of findings in the Indian population. Further data collection is being carried out in order to acquire more conclusive evidence.


   EP 26: A rare case of Craniopharyngioma presenting with psychosis & catatonia - A debate over the implications of the Lorazepam challenge test Top


Dr Debanjan Mandal, Christian Medical College, Vellore

Background: Craniopharyngiomas are slow growing benign tumours. Presenting primarily with psychiatric symptoms is rare. Catatonia refers to a clinical psychomotor syndrome that can present both in psychiatric and neurological disorders. A positive Lorazepam challenge test is considered to favor a psychiatric etiology.

Case: We describe a case of Craniopharyngioma in a 47-year-old gentleman, presenting with acute onset auditory hallucination, thought alienation and persecutory delusions. He was treatment naïve. Physical examination including neurological examination was unremarkable. Risperidone trial showed initial response.

Later he developed catatonia, which improved with Lorazepam challenge. Persisting ataxia and urinary incontinence warranted a neuroimaging which showed Craniopharyngioma. Liaison with neurosurgery was done. Shunting was done resulting in remission of his symptoms.

Discussion: Lorazepam challenge is not a pathognomonic test to diagnose psychiatric etiology in catatonia.There is surprising paucity of data about the predictive value of the Lorazepam challenge test; though it is commonly accepted that it is clinically useful.This case combines a rare presentation of Craniopharyngioma presenting with psychosis and catatonia, with an illustration of the shortcomings of the Lorazepam challenge test.

It also supports the need for high suspicion of organic ethology in catatonia with atypical clinical features, regardless of the results of Lorazepam challenge.


   EP 27: Comparative study of Risky Driving behaviors in Late adolescents with and without substance use Top


Dr. Kajal Taneja1 Dr. Rajiv Gupta2 Dr. Priti Singh3

Professor, Dept. of Psychiatry, Pt B.D. Sharma PGIMS, Rohtak

Background

Risky Driving behaviors among adolescents include non use of seatbelts, driving under influence of alcohol, riding with a driver who had been drinking and texting while driving co-occur with substance use. Substance use impairs driving performance in proportion to the amount consumed and contributes significantly to motor vehicle crashes.

Objectives

To study the risky driving behaviors in adolescents using substance and compare with non-substance users. To study correlation of this behavior with sensation seeking.

Methodology

Thirty late Adolescent (16-19 years) males who attended the State Drug Dependence Treatment centre, PGIMS, Rohtak for seeking treatment for substance use and age matched controls during September 2017- November 2018 were interviewed two weeks after recruitment and successful detoxification after taking written consent (in case of assent, consent of parent). Adolescents were interviewed along the Drug Abuse Monitoring proforma. Risky Driving behavior was assessed on a questionnaire based on YRBS (Youth Risk Behavior Surveillance) questionnaire. Independent t- test was used to compare the two groups. Pearson's correlation coefficient was used to study correlation.

Results

About one third of the adolescents were underage drivers (<18 years). There was a significant difference in the mean scores of risky driving behavior between adolescents with substance use and those without substance use (Mean score -14.10 (SD=4.50) vs 8.10 (SD=5.40) (p<0.001)). Significant positive correlation was found between risky driving and thrill and adventure seeking (r=0.390), experience seeking (0.304) domains of sensation seeking scale.

Conclusion

Late adolescents using substance have higher indulgence in risky driving behaviors. Those with high experience seeking and thrill and adventure seeking should be focused for preventive measures.

Keywords

Risky driving, adolescents, Substance use

[TAG:2]EP 28: Faith Healing and its Repercussions: A Case Report from Rural India [/TAG:2]

Introduction

In Indian villages, faith healers hold higher regard in society as compared to doctors. This is true with psychiatric disorders also. Many times out of societal pressure, illiterate people succumb to such practices. It may cause them physical, psychological harm or even their lives. Seeking psychiatric help is still a taboo in India. By the time a patient is brought, much damage is already done.

Case Report

A 24-year female living with parents came with complaints of aggressive behavior, abusiveness, irrelevant talk and disturbed sleep since 15 days. As per ICD-10, Acute and Transient Psychotic Disorder was diagnosed. Patient was given Olanzapine 10mg (hiked to 15mg) and Clonazepam 0.5mg (which was gradually tapered and stopped). There were excoriations and sticky discharge around her eyelids. On opening the eyes, corneal damage was visible. On detailed history taking, parents had taken her to a 'saadhu' for her psychiatric complaints, where allegedly “angara” (ash) of unknown content was put in her eyes. After ophthalmic opinion, it was reiterated twice that the prognosis was poor and that, she may never restore original eyesight. She was referred to a cornea specialist next, and was discharged free from psychiatric symptoms.

Discussion

Above case shows how superstitions can cost a person and her family, major hassles, including physician and psychiatrist fees. Hence proving, the need for awareness regarding psychiatric disorders and that they are treatable. The need to spread that psychiatry isn't a pseudoscience is the need of the hour.


   EP 29: Abstract for poster presentation at Ancips-2020 Pseudocyesis Versus Delusion of Pregnancy Top


Poonam Dhurwe, Dr. Pali Rastogi , Dr. Ramghulam Razdan

Pseudocyesis is a condition in which the patient has all signs and symptoms of pregnancy except for the confirmation of the presence of a fetus. We hereby present a case of delusion of pregnancy. The case highlights the possibility of delusion of pregnancy if a patient present with features suggestive of pseudocyesis. This would be especially true if there are no associated clearcut psychotic features.

Pseudocyesis (greek pseudçs, false + kyçsis, meaning pregnancy) is a condition in which the patient has all signs and symptoms of pregnancy except for the confirmation of the presence of a fetus. In the case of pseudocyesis, i.e., phantom pregnancy, there is abdominal distention, enlargement of the breasts, enhanced pigmentation, cessation of menses, morning sickness and vomiting, typical lordotic posture on walking, inverted umbilicus, increased appetite, and weight gain. Pseudocyesis used to be a comparatively phenomenon in the past and the ratio of false to true pregnancies was around 1:25.


   EP 30: Topic: Non Acceptance of Negative Emotions in Women with BPD—Association with Neuroactivuty of Dorsal Striatum Top


Author: Dr. JISHNU BHATTACHARYA (Psychiatrist at Suri Superspeciality hospital Birbhum West Bengal)

Abstract for poster presentation

Background: Emotional dysfunction is the main symptom of person with BORDERLINE PERSONALITY DISORDER (BPD)& is considered a consequence of Dysfunctional emotion regulation. In the present functional MRI (FMRI)Study, investigated the neural correlates of habitual emotion acceptance in individuals with BPD.

Methods: Female patient s with BPD and female healthy controls passively viewed negative and neutral movie clips of faces during fMRI. I assess the emotional acceptance by Emotion Acceptance Questionnaire (EAQ). To examine brain activation associated with habitual emotional acceptance of negative stimuli, the EAQ score was included as a regressor of interest in brain data analysis of activation intensity during negative compared with neutral movies.

Results: I include 20 women with BPD. And 20 healthy controls in my analysis. Compared with healthy controls, patients BPD showed significantly more activation in Frontostraiatal brain regions (i.e. Left Superior Frontal Gyrus, Right Caudate Nucleus) as well as in the left premikera, left precentral Gyrus, left posterior cingulate cortex and left hippocampus when confronted with negative stimuli. Patients with BPD reported decreased emotion acceptance compared with healthy controls, and habitual emotion acceptance was inversely associated with activation of Striatal areas (left Out amen and left Caudate Nucleus) in patients with BPD.

Conclusions: Data indicate that Striatal hyperactivity during the processing of negative stimuli in women with BPD is related to their decreased disposition to accept unpleasant emotional states. Thus individuals with BPD may benefit from therapy Approaches that focus on emotion acceptance in order to normalize emotional reactions.


   EP 31: A Clinical Study To Assess The Personality Profiles And Prevalence Of Personality Disorders In Patients With Substance Use Disorder Top


Introduction

It has been seen that personality of individuals has a direct relationship with their substance abuse behavior so that it influences and predisposes them into falling a prey to the vicious habit of substance abuse from which escape becomes utterly difficult. Personality disorders are commonly seen in patients with substance abuse.

AIMS AND OBJECTIVES:

· To assess the personality profile of patients with substance use disorder.

· To assess the prevalence of personality disorders in those patients.

METHODOLOGY:

STUDY PERIOD: September, 2018 to August, 2019.

STUDY TYPE: Cross-sectional Study

SAMPLE SIZE: 80

TOOLS USED:

· Semi-structured proforma for socio-demographic profile of participants.

· ICD-10.

· 16PF questionnaire (Form A).

STATISTICAL ANALYSIS: Descriptive and inferential statistics.

Ethical clearance was obtained from the Institutional Ethics Committee.

RESULTS:

In the study sample of 80 patients, more participants scored highly for Factors A, B, E, F, H, I, L, M, N, O, Q1, Q2, Q3 and Q4 whereas for Factor G, low scores were obtained. In the current study comprising of 80 patients of substance use disorder, 16 (20%) met the criteria for Dissocial personality disorder, 14 (17.5%) met the criteria for Emotionally unstable personality disorder (mostly Borderline type), 5 (6.25%) patients met the criteria for Anxious [avoidant] personality disorder and 2 (2.5%) each met the criteria for Schizoid and Anankastic personality Disorder, as per the diagnostic guidelines of ICD-10.

CONCLUSION:

The study provides an interesting insight into the personality profiles of substance use disorder patients which may be applied into creating more wholesome approaches into the treatment of such individuals.


   EP 32: Mitochondrial Dysfunction in Depression Top


Author Information: Dr. Bindu Rathod, Dr. D. Ram, Dr. Kshitij K. Kshitiz, Dr. Mahesh Kumar

Introduction: Depression is a common disease, with more than 300 million people affected by it.

Depression is a leading cause of morbidity worldwide. Many patients show poor response to conventional antidepressants. Until now the antidepressants have been developed based on monoamine theory of depression. But, latest evidence shows that mitochondrial dysfunction in various brain regions is associated with depression. Recent findings have sparked renewed appreciation for the role of mitochondria in many intracellular processes coupled to synaptic plasticity and cellular resilience. Acetyl-L-carnitine (LAC) is an endogenous short-chain acetyl ester of free carnitine that crosses the blood–brain barrier. LAC plays a central role in the transport of fatty acids into the mitochondria for beta oxidation to sustain energy metabolism in the brain and the rest of the body. LAC also facilitates elimination of oxidative products, provides acetyl groups to regulate expression of neurotrophins and glutamate genes that contain spontaneous glutamate release, and protects from excitotoxicity, therefore interacting with mechanisms that contribute to the pathophysiology of depression. ALC may promote neurogenesis in the hippocampus and prefrontal regions via upregulation of mGLU receptors caused by NF-kB p65 acetylation. ALC may also exhibit antidepressant effects via increasing neurotrophic factors including Brain Derived Neurotrophic Factor (BDNF), artemin (ARTN) and Nerve Growth Factor (NGF). Coenzyme Q10 (CoQ10) is a substance that is naturally present in the human body, with the highest levels in the heart, liver, kidneys, and pancreas. Coenzyme Q10 (CoQ10) is a strong.

antioxidant that has anti-inflammatory effects. On the inner membrane of the mitochondria, CoQ10 transfers electrons from complexes I and II to complex III which take part in the respiratory chain and ATP synthesis. CoQ10 deficiency in depression may predispose to decreased mitochondrial respiratory chain and mitochondrial dysfunctions including damage to mitochondrial DNA.

Methodology: It was a hospital based cross sectional study. The sample size consisted of 30 cases diagnosed with moderate or severe depressive episode with or without psychotic symptoms according to ICD-10 diagnostic criteria for research (DCR) and 30 healthy controls age and sex matched. Patients were rated on HAM D, PHQ-15, Beck's scale for suicidal ideation. A spot blood sample of 5ml was drawn under complete aseptic conditions from the ante-cubital vein of all the subjects in plain vials. Samples were allowed to settle down in the vial for 1 hour after which they were subjected to centrifugation for 5 minutes. Serum was then collected and stored in aliquots at

-50°C until the assay of serum acetylcarnitine and coenzyme Q-10 levels with respective ELISA kits which was done together after all the samples were collected.

Results and Discussion: To be displayed at the time of presentation.

Keywords: Depression, Acetylcarnitine, Coenzyme Q10, mitochondrial dysfunction


   EP 33: Association of Increased CRP Level in Bipolar Manic Episode”. Top


Introduction

Bipolar affective disorder (BAD) is an episodic illness of uncertain etiology in which episodes of depression/Mania/Mixed/Hypomania occur Increased levels of C-reactive protein have been associated with chronic infections and inflammatory conditions as well as with increased risk of inflammatory cardiovascular disorders.

The association between CRP levels and bipolar disorder has been the focus of only limited investigation.

Huang and Lin found that acutely manic patients had higher levels of CRP and other markers of inflammation as compared to healthy controls. In particular, previous studies suggest that bipolar disorder may be associated with immunological activation

Aim & objective

To investigate the association between serum levels of CRP and the severity of psychopathology within bipolar disorder and compared with non-psychiatric controls.

Methodology

A total of 52 patients, (age 18-55 years), recruited from OPD were included in the study.

The non-psychiatric control (N=65) group was recruited from the same geographic area as the bipolar disorder sample

Inclusion & Exclusion criteria

Age 18-55 years diagnosis of bipolar disorder confirmed by ICD-10 not currently receiving inpatient or day hospital care; absence of current substance abusers over the past one month and of any history of intravenous substance abuse; absence of mental retardation; absence of clinically significant medical disorder that would affect cognitive performance such as epilepsy, history of encephalitis or head trauma, or any other reported neurological disorder of the central nervous system that had resulted in past or current treatment

Result

The YMRS was significantly correlated with the level of CRP (F =11.7, p=.0009) but was not correlated with age at evaluation, age of onset of mood disorder, gender (all p >.05).

The CRP levels of the YMRS >6 group were also significantly greater than the levels of the control group ( p=.033, adjusted for age, gender,) while the CRP levels of the YMRS ≤6 group did not differ from that of controls ( p>.05).

YMRS >6 had a mean CRP level of 7.2 μg/ml (S.D. 9.5), while who had a YMRS ≤6 had a mean CRP level of 3.6 μg/ml (S.D. 4.9) (F =7.94, p<.006,).

Conclusion

Our results suggest that outpatients with bipolar disorder with mania symptoms have increased levels of CRP as compared to those without mania symptoms and compared to individuals without psychiatric disorders. The long-term consequences of CRP in bipolar disorder should be the subject of future studies. Such studies would better establish the role of inflammation in the development and course of manic symptoms.


   EP 34: A Case of Levosulpiride induced Galactorrhoea Top


Monal Singh1, Vijay Niranjan1, Ramghulam Razdan1

1-DEPARTMENT OF PSYCHIATRY MGM MEDICAL COLLEGE INDORE

ABSTRACT

Levosulpiride is a substituted Benzamide drug which is widely used as a prokinetic agent in general medicinal practice. It is a known antiemetic,antidyspeptic and antipsychotic drug. Common side effects include sedation,akathisia, weight gain,postural hypotension and serum prolactin elevation in some cases. It blocks Dopaminergic(D2) receptors centrally and peripherally and has 5HT4 agonistic action.

Galactorrhoea is an important adverse effect with the use of levosulpiride and its possibility is commonly overlooked by physicians and this can lead to patients' distress and has implications on treatment compliance. Hereby we report a case of levosulpiride induced galactorrhoea in a young female where it was prescribed as an antiemetic drug.


   EP 35: School Refusal – Brief Intervention in a Series of 24 Cases Top


Parul Sharma, Moushumi Purkayastha, BK Waraich, Ruchi Gupta, Sumedha Banerjee

OBJECTIVES: Children who present with the chief complaint of school refusal have a multitude of symptoms stemming from multifarious diagnosis. Many a time the reason a child is brought for evaluation is the School refusal though symptoms may have been there for some time. The aim of the study is to study the sociodemographic profile, diagnosis, any family psychiatric illness and discuss management.

METHODS- Children 5 to 16 years of age who presented with School Refusal were studied and their sociodemographic details, History elicited and Diagnosis formulated.

RESULTS- A total number of 24 patients were seen. Brief Intervention in the form of sessions of Relaxation exercises, Parent training, Cognitive Behaviour therapy, were done. Seven children had 1 session, 17 had 5-10 sessions. Family History and Diagnoses are discussed. Results of Interventions and implications are discussed.

Key Words- School refusal, Brief Intervention,

[TAG:2]EP 36: Maintenance Electroconvulsive Therapy in Clozapine Resistant Schizophrenia [/TAG:2]

Introduction

Ultra-Treatment Resistant Schizophrenia is used to designate cases showing inadequate response to adequate trial of clozapine. Though commonly found in clinical practice, there are no definitive guidelines regarding its management. This case report attempts to add information regarding the effectiveness of maintenance electroconvulsive therapy in such situations.

Case summary

A 32yr old single male presented in 2018 with complaints of hearing voices and muttering to self since 2000, obsessive thoughts of blurting out since 2006 and multiple suicidal attempts since 2004. Illness has insidious onset, continuous course deteriorating progress. The patient with increased speech productivity, obsessive fear of blurting out obscene words, grandiose delusions, and very distressing auditory hallucinations. These symptoms continued to persist on Tab. Clozapine 700 mg/day and had gastrointestinal hypomotility so dose was decreased to 500mg.The patient had several failed trials of augmentation strategies with antipsychotics and mood stabilisers. The patient was started on modified electroconvulsive therapy and after 24 treatment sessions patient was put on maintenance sessions every 2 weeks. He was also continued on Lamotrigine 200mg, Lurasidone 160 mg and Escitalopram 30mg.This treatment regime being continued for last 1 year, has shown significant improvement in his psychopathology as noted on the clinical rating scales and subjective report.

Discussion

The case once again highlights the effectiveness of maintenance electroconvulsive therapy in difficult to treat cases.

Keywords: Ultra treatment resistant schizophrenia, Electroconvulsive therapy


   EP 37: Internet gaming disorder in an adolescent: A case report Top


ABSTRACT

Introduction

Internet gaming is one of the most popular sources of entertainment for people in all ages, but excess playing this game causes negative consequences including video game addiction. Internet gaming disorder (IGD) is not currently a recognized diagnosis in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5). IGD strongly resembles substance and gambling addictions. Such characteristics include tolerance, withdrawal, and social and occupational neglect. Here we report a case of a 13 -year old adolescent with IGD.

Case summary

A 13-year-old male adolescent, studying in class VII, presented with low mood, reduced interest in studies and excessive internet gaming for 1.5 years, after changing his school and being bullied in the new school. His time spent on gaming increased from 3-4 hours per day to 12-14 hours per day. He started getting irritable when phone was snatched away and starting skipping school or other daily activities. MSE revealed a depressed affect with ideas of worthlessness, helplessness and preoccupation with internet gaming. He was treated with Carbamazepine and cognitive behavioral therapy.

Discussion: This case report presented a pattern of behavior closely resembling as seen in substance and gambling addiction as they are defined in the DSM-5, such manifestation includes tolerance and withdrawal and social and occupational impairment. It is important to identify the potential comorbidities of IGD, such as social anxiety, depression and others, for better management and prognosis.

Key words: IGD, Adolescence, Addiction


   EP 38: THE Role of High Sensitive C-Reactive Protein in Depression Top


Authors: Sheetal Tripathi, Shantanu Bharti, Anju Agrawal, A.Q Jilani, Reema Sinha.

ABSTRACT:

BACKGROUND: Depression and inflammation are closely intertwined, and possibly powering each other in a bidirectional loop. Various studies have explained the role of low-grade inflammation in development of depression. Elevated C - reactive protein has observed in depression but exact association between hs-crp and depression is still unclear.

AIM: To compare the levels of high sensitive C-Reactive protein (hs-crp) in patients of depression and control group.

METHODS: The level of serum hs-crp was measured in 32 diagnosed cases of depression as per ICD-10 DCR against 32ages, sex and body weight (BMI) matched control subjects. The degree of depression in the case group was assessed by the BDI-II scale.

RESULTS: The serum levels of hsCRP were significantly higher (P < 0.05) in depression group as compared to the control group.

CONCLUSION: It can be inferred from our study that depression is associated with underlying low-grade inflammation, which might contribute to increased morbidity in patients of depression.


   EP 39: Diagnostic dilemma and management challenges in a case of chronic mania: a case report Top


Dr. Vijay Kumar Saini (Presenting author), Dr. Tushar Kanta Panda, Dr. Pankaj Mahal, Dr. Naresh Nebhinani

Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur (Rajasthan)

Background

Chronic mania is defined as presence of manic symptoms for more than two years without remission. It has diagnostic dilemma, management challenges and different psychopathological presentation.

AIM

To discuss diagnostic dilemma and management issues in a case of chronic mania.

Case Summary

A 24-years-old, separated female presented with continuous illness of 6 years characterized by aggressive and disinhibited behaviour, over familiarity, big talks, over talkativeness, decrease sleep. Mental status examination showed increased psychomotor activity, exalted affect, pressure of speech, delusion of grandiosity, delusion of persecution (may be secondary) was found. Past records were not available. As per ICD -10 nosology, differential diagnosis of Schizoaffective disorder and Mania with Psychotic symptoms were kept but after detailed assessment chronic mania was considered.

She was started on Olanzapine, which was increased to 30 mg along with Inj. Fluphenazine 25 mg due to poor compliance. Sodium valproate 1000 mg/day was added in view of predominantly manic symptoms and Olanzapine was cross tapered with Risperidone which was increased to 8 mg. Later second mood stabilizer Lithium 600 mg was added in view of minimal response. 12 sessions of modified ECT were administered. Patient was discharged after 6 weeks of admission but still she have residual symptoms.

Conclusion

Studies have reported that the incidence of chronic mania among all patients with bipolar disorders is 6-15 %. These patients have poor response to treatment, more severe symptoms, severe impairment in social, familial, interpersonal and occupational functioning as seen in our index case.


   EP 40: Clinical profile of patients admitted to acute care ward in a tertiary care psychiatric hospital Top


Dr. Divya Sekhar

Christian Medical College, Vellore

Background

Psychiatric emergency services are not well developed in India. Data is sparse about profile of mental and behavioural emergencies and service utilization, from India. The challenges faced by psychiatrists in emergency setting are distinct and can impact the quality of care for this population.

Aims and Objectives

This retrospective chart review attempted to assess the socio-demographic & clinical psychiatric profile of patients admitted to an adult acute care unit in Vellore.

Methods

Medical records of all adult patients admitted to the acute care ward between 1st July & 31st August 2019, were retrieved.

Socio-demographic & clinical details were collected using a proforma.

Data analysis was performed using SPSS version 16.0

Result

104 patients were admitted during the study period.

Mean age of the participants was 34 years (SD=11.63).

Majority were men (77.9%) and from a lower socio-economic background (54.8%).

Risk of harm to others (52.9%) was the most common indication followed by suicidal risk (40.5%). Schizophrenia (39.4%) was the most common psychiatric diagnosis.

Chemical restraints (45.2%) were more commonly used than physical restraints (18.3%).

69.2% of patients were advised inpatient care after the acute care.

Conclusion

This study adds to the existing literature on the patient profile of patients attending emergency psychiatric services.

It will help in developing efficient and cost-effective services and better service delivery models.


   EP 41: Epidemiology and clinical characteristics of Dissociative Disorder in a tertiary care Centre of North India Top


Shrestha Verma, Anmol Singh, MK Srivastava

Background

The prevalence and type of dissociative disorders is considered to vary across cultures and over time. Dissociative identity disorder is more common in western population whereas trance and possession disorder is more common in Indian population. These differences could be explained by various factors including cultural and other demographic factors.

Aims

The aim of this study was to determine the epidemiological and clinical features of patients with dissociative disorder presenting to the Psychiatry department of ABVIMS & Dr RML Hospital, New Delhi

Methods

We carried out a retrospective and descriptive study of patients presenting to the psychiatry department for dissociative disorder. The data was extracted from the medical notes (Outpatients and Inpatients). All the data was recorded by the same person. Extracted data was analyzed.

Results

The majority of the patients were followed as outpatients. Women were more represented. The majority of the patients were young. The majority of the patients had a low academic standard. A recognizable stressor was found in the most of the cases. Neurological symptoms were the most frequent. Depression and anxiety disorders were co-morbid. Certain personality traits were also associated.

Conclusion

Dissociative disorders are common in our hospital. It is worthwhile to explore why dissociative disorder is more common among these groups. Identification of at-risk groups can further help us plan preventive strategies targeted at them.

KEYWORDS

Dissociative disorder, Epidemiology, characteristics


   EP 42: Title: A Case of Young Onset Dementia Top


Authors: Dr.Krishnendu Datta, Maj Manisha Jindal, Col Rajiv Saini

Background: Alzheimer's disease is traditionally subdivided into early onset (EOAD) and late onset (LOAD). EOAD has an onset before age 65 years and accounts for 1–5% of all cases. Two main presentation types of AD are familial and sporadic.

Case Summary: 45-year-old male presented with insidious onset gradually progressive significant cognitive decline in domains of memory, executive function, & visuo-spatial function of 3 yrs duration. Examination revealed impaired higher mental functions with deficits in memory and learning, attention, aphasia, executive dysfunction and dressing apraxia. Series of hematological and biochemical investigations were done and reversible causes were ruled out. MRI Brain showed Diffuse cerebral atrophy and enlarged ventricles. PET-CT: revealed hypometabolism in posterior cingulate gyrus B/L parietal lobes, precuneus and temporal lobe. Diagnosis of Young Onset Alzheimers Dementia was made. His family members were psycho-educated about the course of illness and care of dementia patient.

Focus of my poster will be how to approach a case of young onset dementia and non-pharmacological management of Dementia.

Patient Particulars

  • 45 yrs old serving AMC/AA
  • Educated upto Class 10
  • Married
  • Resident of Sitamarhi, Bihar
  • Left handed


Reason for Referral

  • While attending COs interview parade, unable to recall names of wife and kids
  • Referred for psychiatric evaluation


Chief Complaints

  • Progressive forgetfulness of 03 yrs duration
  • Insidious onset/ gradual progression


History Of Present Illness

2016

  • Forgetting where he kept I card/keys/glasses
  • Forgot his luggage in bus while travelling
  • Often left ATM card in the machine
  • Forgetting items from grocery list


2017

  • Forgot allotted task, slow at job
  • Difficulty identifying his house
  • Signatures in bank did not tally
  • Unable to plan move for posting
  • Socially withdrawn


2018

  • Getting lost inside own house
  • Unable to handle money (unable to count)
  • Spoke less, avoided close family members
  • Unable to use public transport
  • Able to ride cycle but wife wouldn't let him


2019 (progressive decline)

  • Difficulty in dressing up
  • While watching TV during leave/ difficulty in remembering favorite channels
  • Self-care reduced
  • Forgetting names of close family members


Summary

  • 45 yr old serving well-adjusted soldier with family history of CAD in father and uterine cancer in mother
  • Presented with insidious onset gradually progressive significant cognitive decline in domains of memory, executive function, & visuo-spatial function of 3 yrs duration
  • The symptoms led to impairment in activities of daily living and occupational role
  • Without any sufficient evidence of any infectious, metabolic, vascular, traumatic or malignant cause



   EP 43: Myxedema madness Top


Dr. Meena

Introduction:

Hypothyroidism is a medical condition which is a common occurrence in many patients. The clinical features of hypothyroidism are wide, sometimes vague and hence easily overlooked. Hypothyroidism can cause neuropsychiatric manifestations like Depression, Bipolar affective disorder and psychosis. The doubt that hypothyroidism may be the cause for a mental illness requires utmost search for the details in the general health of the patient. Prompt treatment of hypothyroidism can potentially reverse the Neuro psychiatric complication. This poster presents a case of clinical hypothyroidism who presented with frank psychosis and had poor response to anti psychotics, was later identified as hypothyroid and was treated successfully with thyroid supplement.

Case report:

35 years old male patient presented with a history of 10 years of waxing and waning pattern of psychotic illness. He was tried with many antipsychotics for which he had poor response. Eventually was found to have very high TSH levels and was started on thyroxine supplements. Patient gradually improved and was gradually weaned off from antipsychotics. Patient is currently asymptomatic maintaining only on thyroxine supplements for the past 6 months

Conclusion:

  • This case report demonstrates the importance of careful assessment and search for endocrine disorders in patients with unresponsive psychosis



   EP 44: Psychiatric Morbidity and Quality of Life in Patients who have undergone angioplasty in Tertiary care centre in Western Uttar Pradesh Top


Dr. Tarun Yadav, Dr. Prerana Gupta, Dr. Jigar haria

AIM:

The study aims to detect Psychiatric morbidity and Quality of Life in Post angioplasty patients.

BACKGROUND:

Cardiac Patients have increased rates of Psychiatric morbidity and unsatisfactory Quality of Life.

Subjects and Methods: Fifty Patients will be interviewed from the outpatient clinic from medicine department of Tirthankara manager medical college and research Centre.

They will be assessed using ICD 10 criteria, and the Hindi version of the World Health Organization Quality of Life Questionnaire (WHOQOL – 100)

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


   EP 45: Case Report: Oral Naltrexone induced Severe Depression with Psychotic symptoms Top


Dr Nisha (MD PSYCHIATRY 3rd YEAR, IHBAS)

Dr Shivali Aggarwal (SENIOR RESIDENT, PSYCHIATRY, IHBAS)

Dr Deepak Kumar (ASSOCIATE PROFESSOR, PSYCHIATRY, IHBAS)

Introduction:

  • Naltrexone is a non-specific competitive opioid antagonist, used for maintenance treatment in opioid, alcohol and other substance dependence including cannabis.
  • The adverse effect of naltrexone includes nausea, headache, abdominal pain, anxiety, dysphoria and insomnia.
  • We are presenting a case report of severe depressive episode with psychotic symptoms after Naltrexone use, which is rare finding.


Clinical Case:

A 16 years old boy presented with c/o craving for cannabis with h/o cannabis use in harmful pattern for 3 years, last use 3 months before admission. He had stable behaviour in ward and was highly motivated to remain abstinent, in action stage of change. He was pharmacologically started on oral Naltrexone 25mg, for craving. After 3 day's patient observed to have sudden low mood, decreased interaction, anhedonia, self-harming behaviour, ideas of hopelessness and worthlessness with auditory hallucination. The symptoms showed significant improvement after withholding Naltrexone. Patient started showing improvement over 2 days, but in view of symptom severity Cap Fluoxetine 40mg and Tab Aripiprazole 10 mg was started. Complete improvement was noticed over 2 weeks. No past or family h/o psychosis. No h/o psychosis due to any medical condition was found.

Conclusion:

A 16 years old boy presented with c/o craving for cannabis with h/o cannabis use in harmful pattern for 3 years, last use 3 months before admission. He had stable behaviour in ward and was highly motivated to remain abstinent, in action stage of change. He was pharmacologically started on oral Naltrexone 25mg, for craving. After 3 day's patient observed to have sudden low mood, decreased interaction, anhedonia, self-harming behaviour, ideas of hopelessness and worthlessness with auditory hallucination. The symptoms showed significant improvement after withholding Naltrexone. Patient started showing improvement over 2 days, but in view of symptom severity Cap Fluoxetine 40mg and Tab Aripiprazole 10 mg was started. Complete improvement was noticed over 2 weeks. No past or family h/o psychosis. No h/o psychosis due to any medical condition was found.


   EP 46: Depression as initial presentation in SLE Top


Dr.JK Ajithraa , Dr.T Kumanan , Dr.G Amutha, Dr.Prabha Samiraj

Background:

Depression is the most common mood disorder in Neuropsychiatric Systemic lupus erythematosus and its lifetime prevalence is 17 to 65%. The possible mechanisms were identified as antibody mediated, vasculopathy, cytokine-induced neurotoxicity, loss of neuroplasticity. Identification of anti-DNA antibodies is critical to diagnosis and allows to distinguish different presentations. Anti-ribosomal P antibodies is one among the antibodies associated with neuropsychiatric SLE. Although they are detected in only approximately 14% patients with SLE, the specificity is 90%.

Aim:

To report a single case of neuropsychiatric SLE which presented with depressive features and to highlight the importance of physical examination in psychiatric patients.

Methods/case description: We report a 28-year-old married female presented with initial clinical features of Major depressive disorder for 6 months along with physical examination findings of scarring alopecia and severe pallor. Later, she is diagnosed as anti-ribosomal P positive neuropsychiatric SLE with secondary autoimmune haemolytic anaemia and autoimmune thyroiditis and started on prednisone 40mg /day, Thyroxine 100mcg /day and other nutritional supplements. Mini neuropsychiatric interview was done to confirm depression and quantified with HAMD and MADRS scales. She was started on Escitalopram 10mg HS and followed up twice monthly. Her depressive symptoms remitted by 8 weeks.

Results: She scored 27 in HAMD and 32 in MADRS at initial presentation and her depressive symptoms remitted by 8 weeks with scores of 7 in HAMD and 10 in MADRS.

Conclusion: The 5-year survival rates of SLE have improved from 50% reported in 1950s to greater than 90% in 1990s, with 15-year survival rates in excess of 80% in some series. This case merits discussion for the importance of medical evaluation and meticulous physical examination of patients presenting with depression, to find the possible etiology like SLE, since early diagnosis of this primary condition improves the prognosis and long term survival.


   EP 47: Phantosmia after head injury Top


Dr. Aarti, Dr. Ashish Malik, Dr. Rajiv Gupta

Phantosmia, more commonly known as an “olfactory hallucination”, Occurs when people experience or smell scents that actually do not exist around them. Neuropsychiatric sequelae, including cognitive, behavioural, and psychiatric symptoms and signs, may be present to varying degrees following a traumatic brain injury. Olfactory functioning disturbances are common following TBI and, can have a significant impact on quality of life. Reduced appreciation of food, drink, and other smell-laden sensual experiences; loss of employment, when this depends on an intact sense of smell; and increased danger from environmental hazards (e.g., volatile agents/gas, fires, spoiled food) are among the most obvious potential consequences of post-TBI olfactory deficits. The interval between the TBI and olfactory testing ranged from 2 weeks to many years in some cases. Olfactory hallucinations have two possible causes: either an abnormal signal from the primary olfactory neurons, or signals from the peripheral olfactory or the largest pair of cranial nerves, called the trigeminal nerves, that begin a central process. We present a case of phantosmia and parosmia in 28yrs old male presented in 3months of head injury after a road traffic accident. He complaint of difficulty to eat hot food items as experiencing bad odour out of them, persistent symptoms leading to weight loss and disturbing day to day functioning. On mental status examination, perception revealed foul odour in presence of normal stimulus and even without any stimulus. He was treated with combination of antipsychotics and reported improvement after that.

Keywords: brain injury, olfaction, phantosmia, trauma


   EP 48: A case of Psychogenic vomiting Top


Dr. Pooja V

Psychogenic vomiting or also called as functional vomiting is a rare entity, it is a condition which occurs as a result of an emotional disturbance or emotional upset, presence of a psychosocial stressor, without any organic pathology. According to the Rome III criteria on functional gastroenterology disorders, 'functional vomiting' is defined as recurrent, unexplained vomiting one or more episodes per week that is not cyclical and lacks an organic basis, and does not occur within the context of self-induced, chronic cannabinoid use and absence of criteria for an eating disorder, rumination or major psychiatric disease.

This condition is easily missed by the physicians. Hence early recognition of this condition as a clear-cut disorder or as a part of other psychiatric disorder will help in appropriate management of the condition and saving resources and time.

Case Report: A 14-year-old girl, Christian by religion, studying in 9th standard presented with complaints of 2-3 episodes of vomiting everyday from the past one year. It was associated with headache and not associated with nausea. After unsuccessful medical management for the vomiting for a year, she sought out for psychiatric help. She was diagnosed with Psychogenic vomiting and was started on amitriptylline 50 mg and regular sessions of counselling was given. Her symptoms resolved gradually over a month.


   EP 49: A Study on Correlation Between Childhood Abuse and Dissociation Top


Background: Dissociation is a disruption of normal integration between memories of the past, awareness of identity and immediate sensations and control of bodily movements. Although it is a common experience, those with an actual dissociative disorder almost universally have a background of childhood trauma especially sexual and physical abuse.

Objective: The aim of this study was to examine the relationship between childhood sexual and physical abuse and dissociation in an adult population.

Methods: Study sample consisted of 70 female patients who attended the psychiatry out-patient department in Alluri sitarama raju academy of medical sciences, eluru. They completed self-report questionnaires on measures of dissociation which includes Dissociative Experience scale [DES] and Childhood trauma questionnaire (CTQ). Each subject completed a semi-structured face-to-face interview that included measures of childhood sexual abuse, childhood physical abuse on some semi-structured pro-forma. Study was done between November 2017 and September 2018.

Results: In this study it was found that dissociative disorder was most commonly seen among married(68.3%), age group of 18-29years(58.3%) and in the people who score >30(high score) in dissociative experience scale(85%). There was significant association between the incidence of dissociative disorder and those who experienced childhood physical, emotional abuse and neglect.

Conclusion: The present study adds the previous hypothesized direct effect of child sexual and physical abuse in the development of dissociative disorder.



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