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   Table of Contents - Current issue
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October-December 2018
Volume 60 | Issue 4
Page Nos. 375-516

Online since Wednesday, November 28, 2018

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EDITORIAL  

Closing treatment gap of mental disorders in India: Opportunity in new competency-based Medical Council of India curriculum Highly accessed article p. 375
Om Prakash Singh
DOI:10.4103/psychiatry.IndianJPsychiatry_458_18  
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PRESIDENTIAL ADDRESS Top

Saving the sweet bird of youth p. 377
Ajit V Bhide
DOI:10.4103/psychiatry.IndianJPsychiatry_424_18  
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REVIEW ARTICLES Top

The role of online social networking on deliberate self-harm and suicidality in adolescents: A systematized review of literature p. 384
Aksha M Memon, Shiva G Sharma, Satyajit S Mohite, Shailesh Jain
DOI:10.4103/psychiatry.IndianJPsychiatry_414_17  
Social media use by minors has significantly increased and has been linked to depression and suicidality. Simultaneously, age-adjusted suicide rates have steadily increased over the past decade in the United States with suicide being the second most common cause of death in youth. Hence, the increase in suicide rate parallels the simultaneous increase in social media use. In addition, the rate of nonsuicidal self-injury ranges between 14% and 21% among young people. Evidence suggests that self-harming youth is more active on online social networks than youth who do not engage in self-harm behavior. The role of online social networking on deliberates self-harm and suicidality in adolescents with a focus on negative influence was assessed by conducting a systematized literature review. A literature search on “PubMed” and “Ovid Medline” using a combination of MeSH terms yielded nine articles for data extraction satisfying predefined inclusion/exclusion criteria. It was found that social networking websites are utilized by suicidal and self-harming youth as a medium to communicate with and to seek social support from other users. Online social networking also leads to increased exposure to and engagement in self-harm behavior due to users receiving negative messages promoting self-harm, emulating self-injurious behavior of others, and adopting self-harm practices from shared videos. Greater time spent on social networking websites led to higher psychological distress, an unmet need for mental health support, poor self-rated mental health, and increased suicidal ideation. In conclusion, greater time spent on online social networking promotes self-harm behavior and suicidal ideation in vulnerable adolescents.
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Exploring the associations of herpes simplex virus infection and cognitive dysfunction in schizophrenia: Studies in India p. 393
Smita Neelkanth Deshpande, Vishwajit Laxmikant Nimgaonkar
DOI:10.4103/psychiatry.IndianJPsychiatry_381_18  
Background: Cognitive dysfunctions being core features of schizophrenia (SZ), cause disability, increase burden and are refractory to treatment. Viral infections are not risk factors for SZ, but growing evidence indicates infection with some neurotropic viruses, particularly Herpes simplex virus type 1 (HSV -1) as a risk factor for cognitive dysfunction. Studies in India: Three research studies in India are described. In the first, participants were evaluated for HSV-1 infection and cognitive functions (cases 198 and controls 100). In the second, patients and normal nonpsychotic control individuals were examined at baseline and followed up over 1–3 years (cases 138 and controls 88). In the third, a randomized, double-blind placebo-controlled antipsychotic adjunctive trial was conducted to examine the effect of anti-viral drug valacyclovir over 16 weeks on cognitive functioning (valacyclovir 30; placebo 32, treatment for 16 weeks). Results of Indian Studies: Cross-sectional study: HSV-1 infection was associated with modest dysfunction, especially on attention (accuracy) and spatial processing (speed). Longitudinal Study: HSV-1 seropositive participants had lower scores at baseline on 6/16 measures, regardless of SZ diagnoses. At follow-up, there was a significant decline in HSV-1-positive participants for abstraction and mental flexibility and emotion discrimination. Randomized Controlled Trial: Significantly, greater improvement in accuracy index of emotion discrimination in the valacyclovir-treated versus placebo sample was found. Conclusions: Indian studies are consistent with a causative role for HSV-1 in cognitive dysfunction regardless of SZ diagnosis; more rigorous studies of the causal hypothesis are needed, particularly larger randomized controlled trials.
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ORIGINAL ARTICLES Top

Diagnostic algorithm of down syndrome by minor physical anomaly p. 398
Ranjan Bhattacharyya, Debasish Sanyal, Sumita Bhattacharyya
DOI:10.4103/psychiatry.IndianJPsychiatry_401_17  
Background: Down syndrome, most common chromosomal abnormality leading to intellectual disability is being diagnosed by Karyotyping. Due to cost constraints, parents couldn't afford to do Karyotyping which causes delay in individual and family interventions. Introduction: Down syndrome has characteristic morphological features. The minor physical anomaly (MPA) are insults which occur in utero during embryonic development mostly in first and early second trimester and persists throughout life. Material and Methods: 70 karyotyping confirmed cases of Down syndrome (DS), 70 other causes of intellectual disabilities (Other ID) and 70 age matched normal children and adolescents (Average) have been incorporated in the study. The Modified Waldrop's scale (Ismail's 41 item scale) have been applied. Demographic comparison and Decision tree algorithm approach have been analysed by SPSS 25 version. Results and Discussion: The paternal age of childbirth, maternal age of childbirth, maternal age of marriage (P < 0.001), income (P = 0.026) variables are statistically significant in Down's syndrome group in comparison to other two groups whereas age and birth order are not statistically significant. DS group has more MPA (m = 17.04, SD = 5.462), than other ID (m = 5.93, SD = 2.628) and Average group (m = 1.59, SD = 1.378). Big sandal gap, high arched palate and epicanthus are most common three minor anomalies found in Down syndrome. Region wise scoring shows high significance (P < 0.001) in Global head, eyes, ears, mouth, hands and feet in Down syndrome group. The four anomalies; epicanthus, telecanthus, high-arched palate, and curved fifth finger) thus can be grouped as differentiating anomalies. When clinodactyly (item 27) and high arched palate (item 21) are present together or epicanthus (item 08) and telecanthus (item 09) present together sensitivity of diagnosing the case as Down syndrome is 0.945 with negative predictive value 0.979. Conclusion: The simian crease which is being considered as common physical anomaly is not specific for Down syndrome. The large scale study is required to extrapolate the above findings but surely it opens new avenue of research.
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Biological rhythm impairment in bipolar disorder: A state or trait marker? p. 404
Pooja Patnaik Kuppili, Vikas Menon, Vigneshvar Chandrasekaran, Karthick Navin
DOI:10.4103/psychiatry.IndianJPsychiatry_110_18  
Context: There is limited research on biological rhythms in bipolar disorder (BD) from the Indian setting despite its intricate relationship with metabolic syndrome (MS) and functioning. Aims: The study aimed to assess “trait marker” status of biological rhythms as well as correlates of biological rhythm impairment in euthymic BD. Setting and Design: Cross-sectional observational study over 6 months was carried out in hospital setting. Materials and Methods: Biological Rhythms Interview of Assessment in Neuropsychiatry Questionnaire (BRIAN) and Functioning Assessment Short Test (FAST) were used to assess biological rhythms and functioning, respectively. MS was diagnosed as per modified National Cholesterol Education Program– Adult Treatment Panel III. Depressive symptoms were assessed by the Hamilton Depression Rating Scale (HDRS). Euthymia was defined as symptomatic remission for at least 8 weeks. Ethical approval was taken. Results: Fifty cases of euthymic BD and fifty apparently healthy controls were recruited. Total as well as certain domain-specific BRIAN and FAST scores were significantly higher in cases compared to controls. A significant positive correlation was found between the total BRIAN score with HDRS as well as FAST score. No correlation was obtained between biological rhythms and metabolic parameters. Conclusions: Our results support the hypothesis that biological rhythm impairment is a trait marker in patients with BD. The study supports the need for management of subsyndromal depressive symptoms even in inter-episodic period.
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5-HTTLPR and MTHFR 677C>T polymorphisms and response to yoga-based lifestyle intervention in major depressive disorder: A randomized active-controlled trial p. 410
Madhuri R Tolahunase, Rajesh Sagar, Rima Dada
DOI:10.4103/psychiatry.IndianJPsychiatry_398_17  
Background: There is growing evidence suggesting that both genetic and environmental factors modulate treatment outcome in, a highly heterogeneous, major depressive disorder (MDD). 5-HTTLPR variant of the serotonin transporter gene (SLC6A4) and MTHFR 677C>T polymorphisms have been linked to the pathogenesis of MDD, and antidepressant treatment response. The evidence is lacking on the clinical utility of yoga in patients with MDD who have 5-HTTLPR and MTHFR 677C>T polymorphisms and less likely to respond to medications (SSRIs). Aims: We aimed to examine the impact of YBLI in those who have susceptible 5-HTTLPR and MTHFR 677C>T polymorphisms and are less likely to drug therapy with SSRIs. Settings and Design: In a 12 week randomized active-controlled trial, MDD patients (n = 178) were randomized to receive YBLI or drug therapy. Methods: Genotyping was conducted using PCR-based methods. The clinical remission was defined as BDI-II score ≤ 9. Statistical Analysis Used: An intent-to-treat analysis was performed, and the association of genotype with treatment remission consisted of the logistic regression model. A P value of <0.05 was considered statistically significant. Results: Multivariate logistic regression models for remission including either 5-HTTLPR or MTHFR 677C>T genotypes showed statistically significant odds of remission in YOGA arm vs. DRUG arm. Neither 5-HTTLPR nor MTHFR 677C>T genotype showed any influence on remission to YBLI (P = 0.73 and P = 0.64, respectively). Further analysis showed childhood adversity interact with 5-HTTLPR and MTHFR 677C>T polymorphisms to decrease treatment response in DRUG treatment arm, but not in YOGA arm. Conclusions: YBLI provides MDD remission in those who have susceptible 5-HTTLPR and MTHFR 677C>T polymorphisms and are resistant to SSRIs treatment. YBLI may be therapeutic for MDD independent of heterogeneity in its etiopathogenesis.
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Consultation-liaison psychiatric service utilization by suicide attempters p. 427
Uzma Hashim, Ravi S Kumar, Mariamma Philip
DOI:10.4103/psychiatry.IndianJPsychiatry_471_17  
Context: There is sparse Indian literature on consultation-liaison psychiatric (CLP) service utilization by suicide attempters who generally present first to the accident and emergency departments and are seen by the psychiatrist only after the initial stabilization. Aims: The aim of the study is to study the psychiatric referral, review, and psychopharmacological intervention rates among suicide attempters and to study factors associated with psychiatric referral. Settings and Design: Retrospective, medicolegal case register-based, explorative analysis of suicide attempters presents to a rural tertiary care hospital in south India. Subjects and Methods: Eight hundred and twenty-nine medicolegal case files of individuals whose diagnosis was recorded as either suicidal attempt, deliberate or intentional self-harm, and poisoning or hanging were analyzed for different variables. Statistical Analysis Used: Descriptive frequencies, Pearson's Chi-square and logistic regression analysis to know the association of psychiatric referral with different variables, were performed using the Statistical Package for the Social Sciences, version 16. Results: A little more than half of the suspected suicide attempters (51.4%) were referred for psychiatric review, and majority of those referred (93.7%) were reviewed by the psychiatrist. Psychiatric referral was significantly associated with a relatively younger age, positive past and family history of suicidal behavior, mode of attempt (pesticide poisoning and attempted hanging were more likely to be referred), and a longer duration of hospitalization. Conclusions: The low referral rate but an overwhelming review rate among those referred shows that probably referrer factors are responsible for this and so CLP for suicide attempters needs to be strengthened by sensitizing the referring doctors on the importance of the psychiatric referral and the need to avoid discharge within the first 24 h.
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Eating disorders: Prevalence in the student population of Mysore, South India p. 433
N Nivedita, G Sreenivasa, TS Sathyanarayana Rao, S Suttur Malini
DOI:10.4103/psychiatry.IndianJPsychiatry_97_16  
Background: Eating disorders (ED), once known to be a rarity are now commonplace all over the world. However, studies on ED in the Indian population are still very rare to come across. Aim: We made an attempt to study the prevalence of ED in the student population of Mysore, South India. Materials and Methods: A total of 1600 students aged 15–25 years and residing in Mysore were surveyed using two standardized questionnaires. Among the 417 students who scored higher in the questionnaires, 35 students were recruited as participants. Another 35 students with low scores were considered controls. A series of anthropometric measurements were conducted along with the establishment of a register on their well-being and family history. Hemoglobin (Hb) content was measured using a Hb test kit from Beacon Diagnostics Pvt., Ltd., India. Statistical analyses were performed using SPSS version 14.01 software utilizing analysis of variance tool. Results: It was found that 26.06% of participants were prone to ED due to their abnormal eating attitudes. We also observed significant differences between the controls and participants in relation to various parameters such as weight, waist and hip circumferences, body mass index, basal metabolic rate, fat percentage. Hb content was normal in both controls and participants. The establishment of the register also revealed that the onset of menstruation differed significantly between the controls and participants. Conclusions: We arrived at the conclusion that ED are definitely prevailing among the students of Karnataka and have a profound effect on the mental and physical health of the students with eating discrepancies.
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Development of a scale for identifying autism spectrum disorder during early childhood p. 438
M Thomas Kishore, Desh Keerti Menon, Bhaskarpillai Binukumar
DOI:10.4103/psychiatry.IndianJPsychiatry_49_18  
Context: Assessment forms an important part of the early intervention in autism spectrum disorders (ASD). However, there is not much choice with regard to tools and methods for early identification and assessment of ASD. Aims: The aim is to develop a scale for identifying ASD during infancy and early childhood by mapping empirically supported skill behaviors and excess behaviors. Settings and Design: The study was conducted in community-based organisations and the local communities. Moreover, it employed a post facto research design, with survey method. Materials and Methods: Following the standard procedures to pool items and standardization, a scale was developed and administered to three groups of children (N = 190) including children with autism (n = 100), global developmental delay suggestive of mental retardation (n = 40) and neurotypicals (n = 50) in the age range of 1.5–6 years. The ICD-10 Classification of Mental and Behaviooural Disorders and Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) were the gold standards to diagnose ASD. Statistical Analysis Used: Descriptive statistics (frequency, percentages, median, and quartile deviation), Pearson's correlation, Cronbach's α, factor analysis, and binary logistic regression analysis with receiver operating characteristic curve were performed. Results: The new scale also demonstrated a high diagnostic efficiency by yielding a hit rate of 0.89, specificity of 0.90, and sensitivity of 0.88. Conclusions: The new scale can be used for early identification of ASD in the Indian population, though further validation with large population is required.
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Evaluation of psychiatry training in India: A survey of young psychiatrists under the aegis of research, education, and training foundation of Indian Psychiatric Society p. 445
Sandeep Grover, Swapnajeet Sahoo, Balachander Srinivas, Adarsh Tripathi, Ajit Avasthi
DOI:10.4103/psychiatry.IndianJPsychiatry_334_18  
Aim: The aim of this study is to assess the perception of the young psychiatrists (aged ≤45 years) about their training received during the postgraduate training period. Methodology: An online E-mail survey using Survey Monkey electronic platform evaluated the perception of 451 psychiatrists about their own perception of training received during the postgraduation period. Results: About two-third (n = 308; 68.3%) of the respondents reported that their overall training was 'good' or 'very good'. However, training was rated as poor/very poor in subspecialties of child and adolescent psychiatry and geriatric psychiatry by 26.2% and 26.9% of the participants, respectively. Exposure/training was rated as “poor/very poor” by more than one-fifth of the participants in areas of repetitive transcranial magnetic stimulation and deep brain stimulation (69.9%), rehabilitation psychiatry (47%), forensic psychiatry (45.5%), psychodynamics (40.5%), neuroimaging (38.1%), psychotherapy (34.8%), orientation to private practice (26.9%), statistics (34.1%), writing skills (24.4%), ethical principles of research (23.5%), women mental health (23.3%), psychosexual medicine (22.7%), and research methodology (21.5%). Regarding academic activities involving writing skills, although majority (72.5%) of the participants reported being involved in writing case reports and half (50.3%) reported involvement in writing original articles, but exposure to writing other types of article was quite low. Training in different types psychotherapies in the form of adequate exposure, carrying out and supervision to different types of psychotherapy was inadequate/low for psychodynamic psychotherapies, rational emotive therapy, dialectical behavior therapy, eclectic psychotherapy, and other kind of therapies. A high proportion of respondents reported having good competence in the administration of modified electroconvulsive therapy and making presentation in academic fora just after passing degree from their institutes and at the time of survey (current competence). When comparisons were done between the different groups of institutes, significant difference was noted across all aspects of training. Conclusions: The present survey reflects that there is a variation in the psychiatry training in India. Accordingly, it can be said that there is a need to develop a model for competency-based training program at the level of the Indian Psychiatric Society in consonance with training regulatory bodies like the Medical Council of India, which can be implemented across the country to harmonize the training.
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Innovative telementoring for addiction management for remote primary care physicians: A feasibility study p. 461
Mallikarjun Rao Sagi, G Aurobind, Prabhat Chand, A Ashfak, C Karthick, N Kubenthiran, Pratima Murthy, Miriam Komaromy, Sanjeev Arora
DOI:10.4103/psychiatry.IndianJPsychiatry_211_18  
Objective: Addiction is a growing public health problem which affects the person, the whole family, and society. The primary care physician (PCP) is often the first point of contact in the health care and can play a significant role in the early detection and intervention. It is well established that early intervention is associated with better outcomes. In the formal medical training, PCPs receive no formal training on drug addiction management. In this pilot study, we developed an innovative telementoring model and looked at feasibility as well as acceptability among remote PCPs on drug addiction management. Materials and Methods: The telementoring model consists of both synchronous and asynchronous components. The synchronous component consists of National Institute of Mental Health And Neuro Sciences (NIMHANS) academic center Hub and remote district level primary care physician Spokes, and is implemented by using low-cost multipoint videoconference based tele-ECHO (Extension for Community Healthcare Outcome) clinics. During the tele-ECHO clinics, held fortnightly, the remote PCPs used Internet-enabled smartphones to connect as well as present the patient case summaries to the multidisciplinary expert team of NIMHANS HUB. The asynchronous component consists of mobile-based ubiquitous e-learning integrated to a course completion certificate. We evaluated this innovative telementoring program on participant engagement, learning, confidence, and satisfaction. A pre-post design and e-learning assignments were used to measure the outcomes. Results: Of the proposed 21 tele-ECHO clinics, 11 were held till the end of August 2017. All the PCPs were able to virtually join at least one tele-ECHO clinic. Out of 38 participants, two participated in all the tele-ECHO clinics and 47.36% (n = 18) attended more than six (>60% of total) tele-ECHO clinics. About 76.31% (n = 29) of the PCPs presented 41 patient case summaries. Among 38 PCPs, a cumulative of 89.47% completed three e-Learning assignments. The majority of participants (80%) used smartphone with 4G connections to join the tele-ECHO clinics. There was a significant change in knowledge gained over the time duration of 1-month (3.00 ± 0.86, P < 0.001) and 3-month (3.16 ± 0.90, P < 0.001) assessments compared to the baseline (1.77 ± 1.02). About 32.25% (n = 10) reported improved confidence level in managing a case of substance use disorder on a 10-point scale. Conclusion: It has been feasible to connect an academic hub, i.e., NIMHANS to the PCPs of 36 remote districts of Bihar and conduct multipoint videoconference-based tele-ECHO clinics. The results indicate high participant retention. The learners are comfortable in adapting new technology-based learning as evidenced by high rate of e-learning assignment completion. These findings suggest that this new innovative learning model using technology can be an important modality for effective training to address management of drug addiction.
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C-reactive protein level in late-onset depression: A case–control study p. 467
Dheerendra Mishra, Ujwal Sardesai, Ramghulam Razdan
DOI:10.4103/psychiatry.IndianJPsychiatry_127_17  
Background: Late-onset depression (LOD) is less responsive to standard antidepressant medication compared to early-onset depressive disorder. A group of early-onset depressive episode is less responsive to antidepressant medication, and immune dysregulation is critically involved in it. LOD has been associated with increased vascular risk factor and atherosclerosis and immune dysregulation is critically involved in vascular disease. We hypothesized that increased inflammatory activity may be associated with late-onset depressive disorders. Aim: The aim of this study is to study the C-reactive protein (CRP) levels in LOD compared with age-matched controls and association between CRP levels and severity of depressive episode. Settings and Design: This was a case–control study at tertiary care psychiatry department. Materials and Methods: Depressed patients (as per International Classification of Disease 10 Diagnostic and Research Criteria) of age >55 years were recruited and age-matched control participant were recruited after informed consent. A complete clinical assessment, assessment of vascular risk factors, blood sample for the evaluation of serum CRP was obtained, and baseline depression severity was measured on Hamilton Depression Rating Scale (HDRS). Statistical Analysis: The quantitative and qualitative variables were described as means, standard deviation, and P value. The student's t-test for parametric data and the mann-whitney test for nonparametric data spearman correlation coefficient method were used. Results: The mean age of cases (n = 25) was 64.7 ± 5.8 years, and mean age of controls (n = 25) was 64.2 ± 3.7 years. Patients with current depressive disorders had 40% times higher levels of CRP than control. Baseline HDRS of cases was 18 ± 3. CRP level and depression severity shows strong positive (r = 0.935, P = <0.001) correlation between CRP level and depression severity. Conclusion: LOD was associated with higher level of CRP compared to age-matched nondepressed patients. Raised CRP was associated with severity of depressive episode of LOD.
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A prospective study on sexual dysfunctions in depressed males and the response to treatment p. 472
Abha Thakurdesai, Neena Sawant
DOI:10.4103/psychiatry.IndianJPsychiatry_386_17  
Background: Sexual dysfunctions are common in depression but are often underreported and the misconceptions about sexual functioning are highly prevalent. Medications used to treat depression can also cause impairments in sexual functioning. Hence, we decided to study the prevalence and types of problems in sexual functioning, sexual myths, and misconceptions in depressed males and compare it with the general population, along with the changes in depression and sexual functioning after treatment with escitalopram. Materials and Methods: A total of 56 depressed males diagnosed as per the International Classification of Diseases 10 criteria and 60 males from the general population were recruited after their informed consent. Beck Depression Inventory, the Arizona Sexual Experiences Scale, the International Index of Erectile Functioning, and a questionnaire to assess myths and misconceptions were used for assessment. The patient group was treated with escitalopram and all the above scales were re-administered after 6 weeks. Results: Most of the patients had mild-to-moderate grades of depression. Sexual dysfunctions were seen in 62.5% of the patient group. Significant differences were seen with decreased sexual desire, orgasmic problems, and overall dissatisfaction in the patient group. Depression was found to be significantly associated with sexual functioning. Myths about masturbation and penile size and shape were higher in the depressed population. After treatment with escitalopram, there was an improvement in depression and satisfaction with intercourse and overall sexual life. Conclusions: Mental health-care professionals, must inquire regarding sexual functioning sensitively, ensure that they psycho-educate those with misconceptions, and be watchful for changes in sexual functioning when they prescribe antidepressants.
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Is obstructive sleep apnea the missing link between metabolic syndrome and second-generation antipsychotics: Preliminary study p. 478
Rupali Rohatgi, Ravi Gupta, Rajat Ray, Vinita Kalra
DOI:10.4103/psychiatry.IndianJPsychiatry_105_18  
Background: Metabolic syndrome in individuals taking second-generation antipsychotics is thought to be mediated by antipsychotic-induced weight gain. However, recent literature challenges this notion, and theoretically, it may also be mediated through obstructive sleep apnea (OSA). This study explores the contribution of OSA in antipsychotic-induced metabolic syndrome. Materials and Methods: Forty-three participants suffering from schizophrenia spectrum disorder and major depressive disorder, taking second-generation antipsychotics were included in this study. Treatment history was taken in detail, and lifetime exposure to antipsychotics was converted to olanzapine-equivalent doses. Physical characteristics were noted. OSA was screened through the Hindi version of Berlin Questionnaire. Plasma glucose, serum total cholesterol, serum high-density lipoprotein, and serum triglyceride were measured after 12-h fasting. Adult treatment Panel-III criteria were used to diagnose metabolic syndrome. Results: Gender distribution was comparable in the study sample. About 27% had continuous illness, 25.6% of participants had metabolic syndrome, and 20.9% were at high risk for sleep apnea. Participants with and without metabolic syndrome were comparable with regard to demographic variables, duration of illness, and lifetime exposure to antipsychotics. Logistic regression depicted that OSA (odds ratio [OR] = 15.09), waist circumference (OR = 1.15), and fasting plasma glucose (OR = 1.21) increased the risk of metabolic syndrome. Conclusion: Results of the present study suggest that metabolic syndrome in participants taking second-generation antipsychotics is mediated through OSA.
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BRIEF COMMUNICATION Top

Prevalence and clinical correlates of depression in chronic kidney disease patients in a tertiary care hospital p. 485
Shivam Gupta, Nanasaheb Madhavrao Patil, Mallikarjun Karishetti, Bheemsain V Tekkalaki
DOI:10.4103/psychiatry.IndianJPsychiatry_272_18  
Background: Prognosis and associated complications of chronic kidney disease (CKD) may result in psychological distress and mood disorders especially depression. Prevalence and clinical correlates of depression in CKD patients in the Indian context are not well studied and established. Materials and Methods: This cross-sectional study included 84 CKD patients. The diagnosis was made based on the diagnostic and statistical manual, 4th edition criteria; psychiatric disorders were ruled out through the mini-neuropsychiatric interview. Montgomery-Asberg Depression Rating Scale was used to assess the severity of depression. Suicidal ideations were evaluated by using a modified scale of suicidal ideations. Data were analyzed using Epi Info 7 software. Results: The prevalence of major depression was 44.05%, while the prevalence of depressive symptoms was 82.14%. Age of the patients (P = 0.0065), patients on dialysis (P < 0.0001), and serum creatinine levels >5 (P = 0.0180) showed a statistically significant association with depression. The prevalence of depression was significantly associated with dialysis (P < 0.0001). The severity of depression and the severity of suicidal ideations were well correlated with each other (P < 0.0001). Conclusion: The increased prevalence of depression and suicidal ideations was observed in CKD patients. We strongly recommend initiating screening of depression in CKD patients for appropriate rehabilitation and improved the quality of life.
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VIEWPOINT Top

The possible role of the psychiatrist: The lesbian, gay, bisexual, and transgender population in India p. 489
Warren Kealy-Bateman
DOI:10.4103/psychiatry.IndianJPsychiatry_83_17  
Sweeping social change is occurring in India with regard to the proposed transgender legislation and the enshrinement of associated rights. This progressive legislative change occurs as existing Indian law is profoundly reshaped by the judiciary with regard to other members of this sexually diverse group, the lesbian, gay, bisexual, and transgender (LGBT) group. Now as a group of immense interest within high-income countries, this article through Government, legal, and medical literature, explores the possible population of interest in India, relevant law and associated health disparities. The author considers the evidence of a mental health burden, among the estimated 45.4 million LGBT people in 2011. The complex contribution of psychiatrists is noted, and a prism for care delivery is suggested. The underlying goal of lower morbidity for the entire LGBT community is through enhanced care opportunities, understanding, and reduced societal discrimination.
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MISCELLANY Top

Intimate partner violence: Wounds are deeper p. 494
P Patra, Jyoti Prakash, B Patra, Puneet Khanna
DOI:10.4103/psychiatry.IndianJPsychiatry_74_17  
Intimate partner violence claims millions of victims worldwide leading to infringement of fundamental human rights, serious physical and mental heath consequences and leading behind in its wake broken relationships and affected children. Despite its prevalence, its is not a well understood phenomenon. Through this article, we briefly review the literature on this subject; emphasizing on epidemiology and typologies of IPV, perpetuating factors and outcomes, the relevant legislations in India and the screening and intervention steps.
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CASE REPORTS Top

Parkinsonism-hyperpyrexia syndrome: A case report and review of literature p. 499
Sandeep Grover, Ashirbad Sathpathy, Sai Chaitanya Reddy, Sahil Mehta, Navneet Sharma
DOI:10.4103/psychiatry.IndianJPsychiatry_113_18  
Parkinsonism-hyperpyrexia syndrome (PHS) is a rare but potentially life-threatening complication of the management of Parkinson's disease (PD). Central hypodopaminergic state which results due to abrupt withdrawal of dopaminergic medications in patients with PD is the postulated cause. Clinical manifestations of PHS are very akin to neuroleptic malignant syndrome (NMS). Here, we report a case of a 60-year-old male with 13-year history of PD, who was on Levodopa (300 mg) + Carbidopa (75 mg). On abrupt stoppage of Levodopa (300 mg) + Carbidopa (75 mg), he presented with symptoms akin to NMS, with raised creatine kinase. As soon as the antiparkinsonian medications are reinstituted, the patient recovered completely. Literature in this area is limited to few case reports only. Existing literature recommends prompt reinstitution of antiparkinsonian medications as the mainstay of therapy for patients presenting with PHS.
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“Mind, body, and water!” – Postherpetic polydipsia masquerading as obsessive-compulsive disorder p. 504
Seshadri Sekhar Chatterjee, Sutanuka Ghosal, Soumitra Das, Guru S Gowda
DOI:10.4103/psychiatry.IndianJPsychiatry_153_18  
Polydipsia has always been an intriguing entity in clinical psychiatry, since long. Other than being commonly associated with patients of chronic schizophrenia, as described in past, it can also mimic and present in other psychiatric disorders; and thus may be elusive for diagnosis and treatment. Here we describe a patient having polydipsia with prominent obsessive compulsive symptoms, which, after detailed investigations, was found to be secondary to herpes encephalitis. The organic nature of the illness was ascertained by distinct signal changes in right uncus, hippocampus and cingulate cortex; whereas conventional workup for polydipsia ruled out both central and nephrogenic diabetes insipidus. Treatment with fluoxetine, proper behavioural management and psychoeducation resulted in slow but sustained improvement in this patient. We then deconstruct the clinical manifestations and discuss the neurobiological explanation.
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LITERARY PSYCHIATRY Top

Rabindranath Tagore-his childhood and creativity from the perspective of a Psychiatrist p. 507
Debjani Bandyopadhyaya
DOI:10.4103/0019-5545.246187  
A man of prodigious literary and artistic accomplishments, Tagore played a leading role in Indian cultural renaissance and came to be recognized, along with Mohandas Gandhi, as one of the architects of modern India.Tagore's career, extending over a period of more than sixty years, not only chronicled his personal growth and versatility but also reflected the artistic, cultural, and political vicissitudes of India in the late nineteenth and the first half of the twentieth century. His work depicts all the human emotions in depth and as a psychiatrist it was an interesting to view his childhood and his literary work from this point of view.
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LETTERS TO EDITOR Top

District Mental Health Program – Moving beyond Bellary model p. 510
Kaustav Chakraborty
DOI:10.4103/psychiatry.IndianJPsychiatry_439_18  
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Understanding the correlates of manic episode in a woman with insular glioma p. 511
Sujita Kumar Kar, Jamshed Ahmad, Kuntal Kanti Das
DOI:10.4103/psychiatry.IndianJPsychiatry_245_18  
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Valproate-induced drug reaction with eosinophilia and systemic symptoms (DRESS) p. 512
Arun Kumar Dwivedi, Madhubrata Ray, Jithin Raj, Rajeev Kumar Saini
DOI:10.4103/psychiatry.IndianJPsychiatry_187_18  
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Selecting controls in a case–control study p. 514
Sunil Kumar Raina
DOI:10.4103/psychiatry.IndianJPsychiatry_43_15  
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Affective dimension of early psychosis and suicidality p. 515
Onur Durmaz
DOI:10.4103/psychiatry.IndianJPsychiatry_203_16  
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