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 Table of Contents    
KC DUBE AWARDS  
Year : 2020  |  Volume : 62  |  Issue : 7  |  Page : 17-22
KC Dube Award



Click here for correspondence address and email

Date of Web Publication14-Jan-2020
 

How to cite this article:
. KC Dube Award. Indian J Psychiatry 2020;62, Suppl S1:17-22

How to cite this URL:
. KC Dube Award. Indian J Psychiatry [serial online] 2020 [cited 2020 Jan 20];62, Suppl S1:17-22. Available from: http://www.indianjpsychiatry.org/text.asp?2020/62/7/17/275929





   Psychosis Unmasked By Gaming- A case series Top


Ajita Nayek, Amey Angane, Amit Mane

Department of Psychiatry Seth GS Medical College and KEM Hospital, Mumbai

Introduction:

Internet gaming use has grown exponentially in recent years, but there has been little systematic research to understand how this phenomenon may relate to mental illness particularly psychosis. It is found that gaming addiction has been associated with stress and neurotic disorders but there is a dearth of literature regarding its association with psychosis. We came across 3 patients of psychosis with internet gaming addiction. It is not sure whether gaming addiction is a preceding sign (prodromal) before the onset of psychosis or excessive gaming leads to psychotic like experiences (PLEs) and eventually to formal psychosis.

Case Presentations:

We present a case series of three adolescent males with more than one year of online gaming addiction, MMORPGs (PUBG), who eventually developed psychotic symptoms (delusions, hallucinations) which required hospitalization. All of them were successfully treated with antipsychotics and electroconvulsive therapy.

Conclusion:

Internet technology has changed our daily lives dramatically and altered the way we communicate as well. As internet games, MMORPGs (massive multiplayer online role playing games (mainly PUBG) are becoming more popular, users are connected more tightly to the internet and their time spent with others in the real world continues to decrease. Young males often isolate themselves from the social community in order to engage in online gaming. It leads to social withdrawal, sensory deprivation then to PLEs which eventually leads to a psychotic breakdown. Mental health providers should be aware about the threat the internet gaming addiction provides to mental health, and whether it is preceding sign or cause of the psychosis, both should be treated.


   Early adversity, HPA axis dysfunction, SLC6A4 methylation and ADHD in children of alcoholics Top


Anurag Timothy, PhD

Abstract:

Background: Children of alcoholics (COA) face high early adversity with vulnerability to psychiatric disorders in later life. These children have also been shown to have HPA axis impairment. Attention Deficit and Hyperactivity Disorder (ADHD) has been shown to be associated both with hypercortisolism and hypocortisolism. We studied the association of early adversity with cortisol reactivity, gene methylation and ADHD in a sample of COAs and matched controls.

Methods: We examined children of alcoholics (N=50) and matched healthy controls (N=50) for exposure to early adversity. Cortisol reactivity was tested using Trier Social stress test for children (TSST-C). The children were screened for ADHD with or without disruptive behavior disorder (DBD). CpG methylation at specific CpG sites in SLC6A4 gene was ascertained in salivary DNA.

Results: COA had higher prevalence of ADHD (44% vs 22% in controls) Children with ADHD had higher levels of adversity (<0.001) and lower cortisol reactivity (p<0.001) compared to those without ADHD. Children with ADHD and comorbid DBD had higher adversity and lower cortisol reactivity than those without. SLC6A4 methylation (p>0.44) (p<0.05) did not differ between the two groups. A binary logistic regression revealed that with early adversity, cortisol output and SLC6A4 methylation scores are predictors of ADHD. A mediational analysis revealed that reduced cortisol reactivity as well as increased SLC6A4 CpG methylation are mediational factors between early adversity and ADHD.

Conclusion: Our study provides further evidence that children with ADHD have higher early adversity and reduced cortisol reactivity. Cortisol reactivity is further blunted in children with ADHD and comorbid DBD. Cortisol reactivity and SLC6A4 methylation are mediating factors between early adversity and behavioural dysregulation in high risk children.


   To end or not to end, is the question!”: Content analysis of suicide-notes and thematic analysis of interviews, a Qualitative study in elderly suicide survivors Top


Debanjan Banerjee, Department of Psychiatry, NIMHANS

Background

India stands out as the 'suicide-capital of South-east Asia' with increasing suicide rates every year. Elderly population is twice more likely to act out on their suicidal ideations with multiple other vulnerabilities. As suicide attempts are much more than the completed suicides, it is fundamental to study the experiences of suicide survivors for prevention.

Objective:

To understand the perspectives, unmet needs and protective factors in the elderly who have survived a suicide attempt.

Method:

Qualitative methodology was used with constructivist paradigm. Between 2014 to 2017, all elderly (age > 60 years) who attempted suicide in our institute by any means (not just self-harm) with an intention of dying, but survived the attempt, were enrolled with consent (M:40, F:11). Their suicide notes (if present) were obtained with permission and in-depth one-to-one interviews were conducted with them once they were medically and psychiatrically stable. The interviews were audio-recorded and transcribed verbatim. Thematic analysis of the interviews and content analysis of the suicide notes were done, based on Charmaz's grounded theory approach.

Results and Discussion:

Hanging and self-poisoning/medicating were the prominent methods. The suicide notes revealed themes of self-guilt and blame, apology, bereavement, hopelessness and advice/prayers for loved ones. Their unmet needs were mainly lack of audience, increased social demands, lack of awareness about mental-health resources, loneliness, somatic complaints and loss of self-autonomy. Complaints about cognitive decline and significant stigma about the 'act of suicide' were predominant post-survival. Almost all of them visited at least one medical practitioner within two weeks prior to the attempt, which was alarming.

Conclusion:

There is significant dearth of data on suicide-survivors, more so in elderly where the risk is double. Our study showed that awareness and structured assessment of the risk, early identification of cognitive complaints and decreasing stigma can be fundamental in reducing geriatric deaths due to suicide. All classes of physicians need to be sensitive and aware about the same. Mixed method studies are further warranted.


   Profile of patients referred to Emergency Psychiatry Services at a Tertiary Care hospital in North India Top


Authors: Devakshi Dua*, Sandeep Grover, Subho Chakrabarti, Swapnajeet Sahoo, Ajit Avasthi

Post Graduate Institute of Medical Education and Research, Chandigarh

Abstract:

Background: In India, very few centres have Psychiatry emergency services. Psychiatric services are provided as per the consultation model. However, over the years, a need for having psychiatric emergency services has been suggested. The Department of Psychiatry developed the psychiatry emergency services since 2010, following a liaison model in which the psychiatry team is a part of other emergency services. However, little is known about patient population seeking emergency services. Objectives: To assess the demographic and clinical profile of patients assessed by the Emergency Psychiatry Services at a tertiary care centre in North India. Materials and Methods: Using a retrospective study design, data of patients assessed by the Emergency Psychiatry services was reviewed and analyzed. Results: A total of 5010 patients were seen during the period of January 2014 to June 2019. A nearly equal gender distribution was seen. Mean age of sample was 38.40 (SD:16.57) years, with 14.15% of patients aged 60 or more. More than 30% of the patients did not have any medical diagnosis and were primarily referred for psychiatric illness. In nearly one-fourth of patients, evaluation was asked for abnormal behavior and in one-fifth (20%) of patients, for treatment of new symptoms. Psychiatric diagnoses included delirium, severe depressive episode, substance dependence, dissociative disorders and catatonia. Pharmacotherapy was instituted in majority of patients. Nearly three-fourths improved by time of discharge. Conclusions: A large number of patients require psychiatric services in emergency setup. The patient profile suggests there is a need to develop liaison model across the country.

Title: Gender and Opioid Use Disorders: Comparative Analysis using Propensity Score Matching.

Authors:

Diptadhi Mukherjee, Lekhansh Shukla, Prabhat Chand, Pratima Murthy

Department of Psychiatry, NIMHANS

Objectives: To examine differences in 1) sociodemographic and clinical; 2) long-term pharmacological treatment and 3) outcome following a treatment episode between male and female Opioid Use Disorder (OUD) patients.

Methods: Data of OUD patients who received treatment between 01.01.14 and 31.12.18 was collected from case files, toxicology investigations and telephonic follow-ups. A 2:1 (males:female) nearest neighbour matching based on propensity scores was used to obtain a balanced sample for outcome analysis. Survival analysis for time to relapse was used to model treatment outcome. Effect of gender on the outcome was analysed using Cox Proportional Hazards. The final model with minimum AIC value was selected using best subset selection algorithm.

Results: A total of 332 patients (31 females and 301 males) with OUD received treatment during the study period. On average female patients were older (33 years vs 28 years; p = 0.008), more likely to be living with a partner (71% vs 35%, p < 0.001) but less educated than males. Females reported first use of opioids (26 vs 21years; p = 0.002) and onset of dependence (27 vs 22 years; p =0.003) at a later age as compared to males. Injection drug use (58% vs 33%; p =0.009) and use of prescription opioids (90% vs 61%; p =0.001) was more common in females than males. Despite having higher comorbidity of personality disorder (26% vs 6%; p = 0.001) and chronic pain disorder (32% vs 3%; p < 0.001), females have a lower chance of relapse as compared to males (HR = 2.3; 95% CI =1.05 – 5.05; p = 0.038) following a treatment episode.

Discussion and Conclusion: Despite having risk factors associated with a poor outcome like personality disorder, injection drug use and chronic pain disorder; females have a better outcome if they receive long term pharmacotherapy for OUD.


   Impact of a digitally driven and module based Primary Care Psychiatry Program for Uttarakhand State Top


Erika Pahuja1*, Kumar Thamaraiselvan Santhosh1, Fareeduzzafar2, Narayana Manjunatha1, C Naveen Kumar1, Ravi Gupta3, Suresh Bada Math3

1-Dept of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru

2-Assistant Director, Directorate Health and Family Welfare, Dehradun

3-Additional Professor, Dept of Psychiatry, All India Institute of Medical Sciences, Rishikesh

Introduction: Current prevalence of psychiatric disorders in the community is 10.6%. Primary care doctors (PCDs) are most often the first contact for patients with common psychiatric disorders, but majority of them are ill-equipped to handle the same leading to symptomatic treatment. Hence, an innovative digitally-driven and module based 1-year primary care psychiatry program (PCPP) was designed and implemented exclusively for practising PCDs of Uttarakhand.

AIM: To assess the impact of this digitally-driven one-year PCPP on the general practice of PCDs of Uttarakhand.

Methods: Ten PCDs were trained in curriculum module “Clinical Schedule for Primary Care Psychiatry” (CSP) which is a validated concise guideline for screening, classification, diagnosis, treatment, follow up & referrals. They underwent 4 clinical modules of training spanning 1-year: 1. Onsite 10-days training (basic module); 2. Three online modules (with nil or minimal disruption in their regular practice)- 2 sessions of Telepsychiatric On-Consultation Training (Tele-OCT), 25 Collaborative Video Consultations, and, weekly videoconference-based Continuing Skill Development. Additionally, each PCD underwent 10 criteria-based formative assessments; two were self-reports of weekly patients' audit (to calculate proportion of psychiatric consultations in general consultations) and quarterly Tele-OCT evaluation sessions (to assess skill transfer/retention).

Results and discussion: As a result of PCPP, 11.09% (2182 psychiatric patients out of 19670 out-patients) of PCDs' total consultations turned out to have psychiatric disorders, which would have been otherwise missed. Average scores obtained in 1st and 2nd Tele-OCT skill evaluations (similar to clinical exam, but in their real time consultations) were 70.33% and 76.33% respectively suggestive of adequate skill transfer/retention at 6 & 9 months after the course started .

Conclusion: One-year PCPP is shown to be effective in acquiring psychiatry knowledge, skills, retention of skills and also translated in providing psychiatric care in general practice with a positive impact on delivery of primary mental health care services.

Key words: Primary care, psychiatry, mental health, doctors, physicians, digital, online.

Early brief integrated intervention for minimizing harm of alcohol consumption among adolescents: an innovative study.

Gurvinder Pal Singh, Dept of Psychiatry, Govt Medical College, Chandigarh

Suman Gehlot, Gian Sagar Nursing College

Aims and objectives: It was to evaluate the usefulness of early brief integrated intervention in promoting the knowledge and awareness about the harmful effects of alcohol consumption in a sample of adolescents. Methodology: The research design was prospective, interventional nonrandomized control group design with two groups, one experimental group(interventional) and another control group. Ethical clearance was obtained from institutional ethical committee. Samples were selected by using nonprobability convenience sampling technique in two schools of district Patiala, Punjab. The assessment instrument used were a) semi-structured sociodemographic proforma b) alcohol use proforma, c) semi-structured interventional knowledge questionnaire, d) early brief integrated interventional manual. Early brief integrated intervention (psychological, psychoeducative, psychosocial interventions) for prevention of alcohol misuse among adolescents was provided to experimental group. Results:The target intervention population consisted of adolescents of age group (14-18) years. Nearly half of the subjects (47.5%) in experimental and more than half of subjects (57.5%) in control group had trend of alcohol consumption sometimes in family functions and social gathering. The results of the study revealed that in pre-intervention baseline assessment the adolescents were having on average level score of knowledge regarding ill effects of alcohol consumption and mean score(±S.D) was 12.43±2.645. After post intervention phase, average level of knowledge was found to be improved regarding ill effect of alcohol consumption and mean(± S.D.) knowledge level score was(19.60±2.599). Discussion: Findings of this study showed that after early brief integrated target intervention among experimental group, the knowledge level for minimizing alcohol consumption increased significantly. The participants reported abstinence from alcohol consumption in experimental group after intervention. Conclusions:The salient findings gained from this study can be utilized to develop and implement effective early brief primary prevention strategies to tackle alcohol consumption in various parts of Punjab. Further research is warranted to replicate the findings of the present study.

Key-words: Alcohol consumption, early brief integrated intervention, adolescents.


   Musical preferences of children with autism: an exploratory study Top


Lakshmi Sravanti , John Vijay Sagar Kommu

Department of Psychiatry, NIMHANS

BACKGROUND: Music therapy, as a therapeutic intervention, has been used for children with autism since 1940s.1It has been shown to reduce undesirable behaviors and improve verbal communication and social interaction.2 Music's therapeutic potential can be put to better use for children with autism and there is a need for culture-appropriate intervention modules to be devised.

AIMS & OBJECTIVES: The primary objective of this study is to explore musical preferences of children with autism in India. This study also aims to study the current practices prevalent in their households, caregivers' awareness and attitudes towards the same. It will help in assessing feasibility of interventions using music and serve as a baseline to come up with formal strategies in the future.

METHODOLOGY: Cross-sectional study of 120 subjects diagnosed with Autism. Convenience sampling was done. Child's clinical condition was assessed using INCLEN and ISAA and relevant data collected using standardized data-abstraction forms. Institutional Ethics Committee's approval was obtained for conducting the study.

RESULTS: Study is ongoing. Preliminary findings suggest that children with autism have specific musical preferences and parents have a positive attitude towards the idea of music therapy.

DISCUSSION & CONCLUSIONS: Results of our study will be compared with existing literature to come to valid conclusions. We hope that our findings will inform clinical practice in the field of autism.

Comparison of NLR and PLR as inflammatory markers in 1st episode mania and bipolar mania: A preliminary study.

Manish Kumar Goyal, Kuldeep Singh Yadav, R. K. Solanki, Dept. of Psychiatry, SMS Medical College, Jaipur

BACKGROUND: There are various factors including inflammation that have been studied in etiopathogenesis of Bipolar Disorder. NLR (Neutrophil to lymphocyte ratio) and PLR (platelet to lymphocyte ratio) are one of them. Various psychotropic medicines can affect the inflammatory state. So this study was planned to find NLR & PLR in Bipolar and psychotropic drug naïve 1st episode mania patient.

AIM AND OBJECTIVES: To study the NLR and PLR value in 1st episode and bipolar mania and to ascertain the correlation between severity of mania with NLR and PLR levels.

METHODOLOGY: Total 120 subjects were chosen including, 40 Bipolar manic, 40 drug naïve 1st episode manic and 40 healthy controls. The severity of mania in the study group was assessed by Young Mania Rating Scale. Blood samples were collected in the morning hours in order to get blood counts. Proper statistics were applied.

RESULTS: (1) NLR value and neutrophil count in 1st episode mania and bipolar mania were significantly higher. (2) No significant difference of PLR value observed between manic and healthy controls (3) Lymphocyte counts were significantly lower in 1st episode mania than healthy control. (4) 1st episode mania patients had significantly higher NLR in comparison to bipolar mania. (5) Insignificant positive correlation found between severity of mania and NLR, PLR values.

DISCUSSION: Mania can be considered as an inflammatory state and psychotropic medicines may have anti-inflammatory effect, signified by the fact that 1st episode manic subjects have greater level of inflammation in comparison to bipolar manic subjects. As previous studies have been done on this subject but none of them delineated the presence of inflammation in drug free manic patients.

CONCLUSION: NLR may be considered as a potential marker of mania and highlights a need of anti-inflammatory agents in the treatment.


   Association of Single nucleotide polymorphisms in DNA Repair Gene (XRCC1) (Arg399Gln; rs25487) and SNAP25 (rs3746544) with Schizophrenia Top


Authors:

Dr Naresh Nebhinani

Dr Prasenjit Mitra

Dr Mukesh Swami (Presenting author)

Dr Vijay kumar Saini

Dr Praveen Sharma

Institute: Dept of Psychiatry, All India Institute of Medical Sciences (AIIMS), Jodhpur

Background

Schizophrenia is a severe disorder with varied presentation and etiology. The etio-pathogenesis of schizophrenia is complex, involving the interplay of environmental and genetic factors. Gene variants may influence diseases onset or progression. A literature review identified two polymorphisms XRCC1 rs25487 and SNAP25 rs3746544 to be potential candidate gene variations that may contribute to the diseases. Due to paucity of Indian data, their association with Schizophrenia is unknown among Indians.

Aims & Objectives

The study was planned to assess the genotype status of rs25487 and rs3746544 in patients with schizophrenia and compare them with healthy controls for any plausible association.

Methodology

150 patients of Schizophrenia and 52 healthy controls participated in the study after obtaining written informed consent. Genomic DNA was isolated using Qiagen Miniamp DNA isolation kit. Genotyping of rs25487 was done by PCR-RFLP. Genotyping of rs3746544 was done by Taqman SNP genotyping assay.

Results

The frequency distributions of the genotypes were in accordance with Hardy-Weinberg Equilibrium. For XRCC (rs25487) polymorphism, individuals carrying at least one A allele had higher risk of having schizophrenia than those with G allele. The A allele frequency was more in cases (60%), than in controls (45%) (OR = 1.8191, 95 % CI: 1.1600 - 2.8530, p value = 0.0092). For SNAP25 (rs3746544) polymorphism, individuals with at least one G allele had higher risk of having schizophrenia than those with T allele. The G allele frequency was more in cases (42%), than in controls (31%) (OR-1.6820, 95 % CI: 1.0421 -2.7150, p value = 0.0333). Presence of these polymorphisms was not associated with age of onset of schizophrenia or gender.

Conclusions

Increased frequency of A allele in XRCC (rs25487) and G allele in SNAP25 (rs3746544) is associated with schizophrenia. Further studies are needed in larger sample sets to identify implications of such association.

Title: Intimate Partner Violence on women and husband's Alcohol use: can mass media help to reduce the prevalence?

Authors: Nithin Kondapuram , Chetan Kumar K S 2

1. Consultant Psychiatrist, Aster Prime Hospitals, Hyderabad (IPS No. – LOM/N06/17)

2. Psychiatrist, DMHP, Bengaluru Urban, Bengaluru (IPS No. – LOM/C01/17)

Background:

WHO in 2014 estimated that the global prevalence of Intimate partner violence (IPV) to be 30% among ever partnered women. Strong links have been found between alcohol use and the increase occurrence and severity of intimate partner violence in many countries. Mass-media is a powerful tool which can educate people at large and reduce the prevalence of such harmful behavior and can empower people to act. Control of tobacco use among adults is one of the best examples of using mass-media as a tool to reduce the harmful behaviors.

Aims and Objectives:

To see whether interventions using mass-media can influence to reduce Intimate Partner Violence among women whose partner consumed Alcohol.

Materials and Methods:

The study used the Indian National Family Health Survey 4 (NFHS 4), a cross-sectional national survey of 699,686 ever-married women of reproductive age in India. Secondary data analysis was done on women who were administered the domestic violence module(n=83,397). Multiple Linear regression was used to identify factors associated with domestic violence, Alcohol use and use of mass-media and to see if there is a common factor.

Results and Discussion:

Results: 14.24% of women reported any intimate partner violence and the number rose to 74.53% if the partner consumed Alcohol. 92.3% of such women facing IPV never reported the incidents due to ignorance. Among them 85% of the women had access to mass-media (Television, Radio and Newspaper) with Television being watched by 66% of them.

Conclusions:

By taking Tobacco control campaign as an example, we can use the mass-media penetration among women facing IPV whose partner consumed alcohol. This can be used to empower them by educating regarding the IPV, legal aspects, and related things. We can thus motivate women having IPV to fight back, improve their quality of life and reduce mental health morbidity.


   Comparative Study Of Eating Disorders Among College Students Of Arts, Commerce And Science Top


Ajita Nayak, Prerna Keshari, Vinita Pawar

Dept of Psychiatry, KEM Hospital and Seth GS Medical College, Mumbai

Background: The stressors in college students vary depending on the branch of study. Academic demands, peer relations etc. are different in each stream. This can affect the prevalence of Eating Disorders(ED).

Objective: To compare the prevalence and the associated factors of Eating Disorders among the students belonging to different streams of education.

Methodology: 300 subjects from Arts, Science and Commerce streams (100 subjects from each stream) between the age group of 18-25 were assessed for ED using the Eating Disorder Examination–Questionnaire (EDE-Q). A semi-structured proforma was used to record stream, gender, family income and parental education.

Statistics: Fischer's exact test was used to correlate global scores on EDQ in different streams with parameters like gender, family income and parental education.

Results: The prevalence of ED in the total sample was found to be 16.7% with a higher prevalence among Commerce students(25%) as compared to Arts(15%) and Science(10%) students. However the mean scores on EDE-Q were higher among Science students.

Gender differences were studied and a significantly higher prevalence of ED among females was found in Arts and Science students.

On comparing the parental education and family income; ED was significantly more prevalent in those with higher maternal education in Science(p= 0.0094, RR=0.49, 95%CI= 0.2 to 1.1) and Arts(p= 0.044, RR=0.52, 95%CI= 0.25 to 1.1); while ED in Commerce students was significantly associated with higher family income (p= 0.0078, RR=0.69, 95%CI= 0.5 to 0.9). No significant association was found between Father's education and ED.

Conclusions: Our study concludes that ED is more prevalent among Commerce students as compared to Arts and Science students. Identifying specific high risk individuals and stressors in each branch of education can significantly decrease morbidity.

KEYWORDS: Eating disorders, associated factors.


   Study of feeling, perceived impact and coping strategies among siblings with Down's Syndrome Top


Sanjay Ghuge, Pramod Totewad, Shilpa Agarkar

Dept of Psychiatry, KEM Hospital and Seth GS Medical College, Mumbai

Introduction

Down's syndrome (DS) is a genetic disorder caused by the presence of all, or part of a third copy of chromosome 21. When a child with DS is a part of a family, his or her siblings become part of disability community. Brothers and sisters, experience a wide range of emotions, but typically the positive feelings, empathy, kindness & more warmth outweigh the negative ones. Siblings of DS cope slightly better than family members of persons with any other disabilities, a phenomenon called the “Down syndrome advantage”. Study of needs and perception of siblings with DS are very few, especially in the Indian population.

Aims & objectives

1) To study the feelings and perceived impact amongst siblings of DS.

2) To study the coping strategies amongst siblings of DS.

Materials & methods

It was a Cross-sectional Observational study. Sample consisted of 40 siblings of children with DS. After taking IEC approval and informed consent and assent, Children's coping strategies checklist revision 1 (CCSCR 1) scale and Feeling and perceived impact questionnaire were applied to find out coping strategies and feelings amongst siblings of DS.

Results

Total number of siblings were 40, 20 males and 20 females. Two age group were made, 9-11yrs and 12-13 yrs. In first group, 90% siblings were expressed 'love and proud' feelings towards their brother or sister with DS while in 2nd group 90% participant expressed 'proud' feeling of siblings with DS. Very few siblings (15%) felt embarrassed to have brother or sister with DS. Majority siblings from each age group, gender and birth order had used active coping strategies. Younger siblings used more distraction strategies than elder ones. Few siblings from each age group, gender and birth order had used Avoidant coping strategies.

Conclusion

This study creates an opportunity to have evidence-based discussions about sibling issues in DS. It provides parents, and practitioners with some understanding of the possible risk and protective factors for these siblings.

Keywords:

Down syndrome, coping strategies, Feelings.

Night hospitalization as a treatment model for patients with substance use disorders: the concept and its outcome.


   PreethyKathiresan , Biswadip Chatterjee, Ravindra Rao Top


Dept of Psychiatry, NDDTC,AIIMS, New Delhi

Background: Night hospitalization is an indigenous model developed and practiced for providing support to patients with substance use disorders who are currently unemployed with poor psychosocial support. In this model, the in-patient stay of the patients is prolonged beyond that required for medical management. The patients are given leaves in daytime to find suitable job and find an accommodation. Active support for employment like liaisoning with local recruiter, giving small sums of money to start some work is also pursued. The night stay, treatment and other basic necessities are also taken care by the treatment centre. Once the patients are employed, start getting wages and arranges for night stay elsewhere, they are shifted to out-patient care.

Objective: To assess treatment retention, abstinence status and employment status of patients who underwent night hospitalization in past 4 years

Methodology: In this retrospective study, medical records of all patients who underwent night hospitalization in last four years were assessed. Structured questionnaire was used to collect details about their socio-demographic, clinical and night hospitalization details. Treatment retention, abstinence status and current employment status were assessed as outcome parameters.

Results: A total of 30 patients with mean age of 40 years (SD:9.125) completed night hospitalization. Majority (93.3%) were dependent on opioids and 66.7% were IDUs. More than 40% were staying alone, 90% were unemployed before admission and 36.7% were indulged in illegal activities. Majority (70%) found job and 36.7% found accommodation near the centre during night hospitalization. Majority of them (80%) are retained in treatment, 69.23% continued to be employed and 62.5% are abstinent from illicit substance.

Conclusion: Night hospitalization is a low-cost, low resource intensive model for occupational rehabilitation and social reintegration of patients who suffer severe socio-occupational dysfunction because of substance use disorders.


   Lipid correlates of impulsivity in geriatric depression Top


Seshadri Sekhar Chatterjee*,

Dept of Psychiatry,Diamond Harbour Govt Medical College and Hospital

Sayantanava Mitra,

Lecturer, Dept of Psychiatry,The University of Queensland Rural Clinical School, Queensland, Australia

Background

Geriatric depression is fast increasing in proportion, and becoming a significant cause of concern for Psychiatry. Associated morbidity and mortality, mainly stemming from completed suicide are far higher in this group. It is well known that increased impulsivity is independently associated with increased suicidality; and there is some evidence of an inverse relationship between the former and serum lipid levels; at least in younger population. This study aims at exploring this relationship in a geriatric sample – given greater propensity in this age group of using lipid lowering agents for other physical ailments.

Method

Thirty-one patients with depression and age >65 years, drug-free for at-least 4-weeks, were selected according to the study criteria; and socio-demographic data, data on depression severity (HAM-D), impulsivity (BIS-11) and fasting serum lipids (enzyme assay) were obtained. The lipid profile was matched against 31 age-sex matched non-affective, nonpsychotic healthy controls. Analysis was done on SPSS.

Results

In patients, the mean HAM-D score was 17.62±3.43 and mean BIS-11 score was 67.65±3.45. Serum LDL and TC were significantly higher than the controls. TC and LDL level were negatively correlated with trait impulsivity (p<0.05), but not with depression severity (p>0.1).

Discussion

Our study shows that in patients with depression above 65 years, the lipid profile is significantly different from their healthy counterparts. Further, we found that a relatively lower lipid level was associated with greater trait impulsivity in the patients, indicating a possibility of deleterious effect of this relationship with attempted lipid lowering treatment. This relationship is known in the western literature; and a similar finding in an Indian population warrants significant caution in such attempts for this population.


   Late onset Delusional disorder: Finding's from a tertiary care hospital Top


Dr Shiva Shanker Reddy, Dr Krishna Prasad Muliyala, Dr PT Sivakumar, Dr Mathew Varghese

Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore

Background: Delusional Disorder is an important sub-group among late life psychotic disorders. Studies indicate a prevalence of 0.03 % in the elderly. There is paucity of literature on delusional disorder in elderly.

Objectives: To study the socio-demography, phenomenology and outcome of delusional disorder in elderly

Methodology: Case records of patients above 45 years with delusional disorder as per ICD-10 classification were reviewed. Details pertaining to sociodemography, phenomenology, comorbid psychiatric illness and stability and outcome details were reviewed and analysed.

Results: Total 68 elderly meets the criteria for delusional disorder as per ICD-10. The mean age of the patients was 53.07 (SD-6.428) with slightly more females (54.4%) than males (45.6%). Among them 50% had high school education, 52.9% had employment and were predominantly from urban, middle socio-economic strata. The mean age of onset was 45.56 (SD-10.57). In terms of delusions, persecutory (30.8%), infidelity (27.9%) and presence of both (17.6%) were the commonest. The less common were delusional parasitosis (7.3%), dysmorphophobic (5.8 %), somatic (2.9%), erotomanic (2.9%) and grandiose (2.9%). Perceptual abnormalities were found in 11.7%. Family history of psychosis was found in 11.7% and mood disorders in 5.8%. Paranoid traits were present in 5.8%. Among the 44.1% sample who had follow-up details there was a change in diagnosis in 8.8%. The commonest antipsychotic used were risperidone (30.8%) and olanzapine (22.1%).

Discussion and Conclusion: In our study we found delusional disorder in minority of those presenting with psychotic symptoms in late life. Our study is similar to other studies in terms of female predominance. The commonest delusions is persecutory which is similar to the type of delusion seen in late life. We also found stability of diagnosis in majority of patients which is in agreement with other studies. There is dearth of literature on choice of antipsychotic in elderly with delusional disorder.

Depression, Sexual Dysfunction And Medical Comorbidities In Young Adults Having Nicotine Dependence

Tamoghna Bandopadhyay, Aratrika Sen, Ranjan Bhattacharya

Dept of Psychiatry, Murshidabad Medical College and Hospital, West Bengal

BACKGROUND: Nicotine dependence, Depression, Diabetes mellitus, Hypertension and hypothyroidism are risk factors of sexual dysfunction.

AIMS & OBJECTIVES: The present study aims to find out the prevalence of sexual dysfunction and the various sexual response cycle domains in subjects with nicotine dependence with and without comorbidities.

MATERIALS & METHODS: Total 52 subjects attending the Tobacco cessation clinic were included in the study. To assess the primary outcome, Fagerstrom test for Nicotine dependence (FTND), Arizona Sexual Experiences Scale (ASEX), Hamilton's Depression Rating Scale (HAM D 17) had been administered after validation in local vernacular.

RESULTS: In the sample 32 (61.5%) were male and 20 (38.5) were female. The 17 subjects (32.7%) met the criteria of low nicotine dependence, 5 (9.6%) subjects met low to moderate, 11 subjects (21.2%) had moderate dependence and 19 (36.5%) subjects met the criteria of high nicotine dependence.

CONCLUSIONS: The Nicotine dependence is directly related to sexual dysfunction and it affects various stages of sexual response cycle. One quarter of individuals of nicotine dependence also met the threshold criteria of depression. The interventions as primary and primordial preventions with awareness building and health education may be a cost effective measure to prevent tobacco related deaths.



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