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   Table of Contents - Current issue
April-June 2017
Volume 59 | Issue 2
Page Nos. 133-258

Online since Monday, July 17, 2017

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Prescription writing: Generic or brand? Highly accessed article p. 133
Chittaranjan Andrade, T S. Sathyanarayana Rao
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Psychiatry and clinical pharmacy: A logical partnership p. 138
Christopher P Alderman, Jisha M Lucca
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Making sense of the role of sense organs in trichotillomania p. 141
Anil Kakunje, T S. Sathyanarayana Rao
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Medical nutrition in mental health and disorders p. 143
M. S. V. K. Raju
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Psychiatric morbidity in the community: A population based-study from Kerala p. 149
KS Shaji, D Raju, V Sathesh, P Krishnakumar, Varghese P Punnoose, PS Kiran, BS Mini, Shibu Kumar, PK Anish, Ganga G Kaimal, Lekshmy Gupthan, TP Sumesh, UG Nikhil, Nisha Cyriac, MD Vinod, R Prasad Kumar, Ramesh Chandran, PP Rejani, R Amrutha, Mahesh , TN Anand
Background: Estimates of psychiatric morbidity in the community will help service development. Participation of trained nonspecialist health-care providers will facilitate scaling up of services in resource-limited settings. Aims: This study aimed to estimate the prevalence of priority mental health problems in populations served by the District Mental Health Program (DMHP). Settings and Design: This is a population-based cross-sectional survey. Materials and Methods: We did stratified cluster sampling of households in five districts of Kerala. Trained Accredited Social Health Activists (ASHAs) identified people who had symptoms suggestive of schizophrenia or bipolar disorder. Clinicians evaluated the information collected by the ASHAs and designated individuals as probable cases of psychosis or noncases. Screening instruments such as General Health Questionnaire-12, CAGE questionnaire, and Everyday Abilities Scale for India were used for identifying common mental disorders (CMDs), clinically significant alcohol-related problems, and functional impairment. Results: We found 12.43% of the adult population affected by mental health conditions. We found CMD as most common with a prevalence of 9%. The prevalence of psychosis was 0.71%, clinically significant alcohol-related problems was 1.46%, and dementia and other cognitive impairments was 1.26%. We found informant-based case finding to be useful in the identification of psychosis. Conclusions: Mental health problems are common. Nonspecialist health-care providers can be trained to identify psychiatric morbidity in the community. Their participation will help in narrowing the treatment gap. Embedding operational research to DMHP will make scaling up more efficient.
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The prospective, 24-week assessment of cost-efficacy of and compliance to antidepressant medications in a rural setting (PACECAR) study p. 157
T S. Sathyanarayana Rao, J Shivanand Manohar, Rajesh Raman, MS Darshan, Abhinav Tandon, KN Karthik, N Saraswathi, Keya Das, GT Harsha, Swetha Patil Kunkeri, Chittaranjan Andrade
Background: Anxiety and depression are common mental health disorders that are responsible for considerable societal burden. There are no data on cost-efficacy and medication compliance related to the treatment of these disorders in rural India. Materials and Methods: All consenting adults (n = 455) diagnosed with generalized anxiety or (unipolar) depressive disorders in Suttur village, Karnataka, were treated with open-label fluoxetine (20–60 mg/day), sertraline (50–150 mg/day), escitalopram (10–20 mg/day), desvenlafaxine (50–150 mg/day), duloxetine (30–90 mg/day), amitriptyline (75–150 mg/day), or clomipramine (75–150 mg/day) in a structured, monotherapy dosing plan. The study was nonrandomized and otherwise naturalistic. Patients were followed up every 4 weeks for 24 weeks. Study discontinuation was defined as medication noncompliance for 3 or more days or withdrawal due to treatment nonresponse. Results: There was substantial discontinuation (34.5%) in the first 4 weeks; 55.4% had discontinued by 12 weeks. Subsequently, only 11.2% discontinued treatment. Only 33.4% of the subjects tolerated the treatment, responded to it, and remained compliant for 24 weeks. Such successful completion was highest for escitalopram and desvenlafaxine (46%–47%) and lowest for clomipramine and amitriptyline (10%–14%). Adverse events were the most common reason for noncompliance with clomipramine and amitriptyline (45%–46%); the experience of sufficient improvement was the most common reason for noncompliance with the remaining drugs (28%–49%). Whereas the average cost of efficacious treatment for a continuous period of 24 weeks was lowest for fluoxetine, an examination of the cost-efficacy tradeoff suggested maximum advantage for escitalopram, sertraline, and desvenlafaxine. The cost-efficacy profile for amitriptyline and clomipramine was poor. Conclusions: Reasons for noncompliance vary by drug class and need to be considered when prescribing antidepressant drugs. Escitalopram, sertraline, and desvenlafaxine perhaps have the most favorable 24-week cost-efficacy profile; tricyclics are poorly tolerated. Rural subjects need to be educated that treatment must be continued even after improvement is established.
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Mental well-being of migrants in urban center of India: Analyzing the role of social environment p. 164
Ghuncha Firdaus
Background: Rural to urban migration has become a salient feature of the country. However, there is a dearth of study highlighting impact of this movement on mental health of the migrant people. Aims: The main objective of the present study was to examine the relationship between specific components of social environment and psychological well-being of migrants in an urban center. Settings and Design: The National Capital Territory of Delhi was selected for intensive study and has an exploratory design supported by cross-sectional primary data. Methodology: A standardized questionnaire was used to obtain data about the socioeconomic characteristics of the respondents. For measuring the mental well-being, the World Health Organization Well-Being Index (WHO5) was used. The required information was procured through interview method from 1230 sampled respondents. Statistical Analysis: Influence of socioeconomic variables on mental well-being of the people was estimated through multivariate logistic regression methods. For different combinations of risk factors, five models were developed based on unstandardized likelihood coefficients. Results: Poor mental health was significantly higher among single/widow/divorced/separated (odds ratio [OR] =0.76, P < 0.01), unskilled (OR = 2.26, P < 0.01), daily wager (OR = 2.57, P < 0.01), and illiterate (OR = 2.55, P < 0.01). Longer year of immigration, younger age, and higher income level (P < 0.001) were positively related to mental health. Poor housing conditions (P < 0.001), adjustment problem (P < 0.001), and feeling insecure (P < 0.01) were independent predictors of poor mental health. Conclusion: Socioeconomic and environmental problem caused by the migrants and faced by the migrants is required in-depth study to formulate comprehensive policies.
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Reasons for referral and diagnostic concordance between physicians/ surgeons and the consultation-liaison psychiatry team: An exploratory study from a tertiary care hospital in India p. 170
Sandeep Grover, Swapnajeet Sahoo, Shivali Aggarwal, Shallu Dhiman, Subho Chakrabarti, Ajit Avasthi
Background: Very few studies have evaluated the reasons for referral to consultation-liaison (CL) psychiatry teams. Aim: This study aimed to evaluate the psychiatric morbidity pattern, reasons for referral and diagnostic concordance between physicians/surgeons and the CL psychiatry team. Materials and Methods: Two hundred and nineteen psychiatric referrals made to the CL psychiatry team were assessed for reason for referral and diagnostic concordance in terms of reason of referral and psychiatric diagnosis made by the CL psychiatry team. Results: In 57% of cases, a specific psychiatric diagnosis was mentioned by the physician/surgeon. The most common specific psychiatric diagnoses considered by the physician/surgeon included depression, substance abuse, and delirium. Most common psychiatric diagnosis made by the CL psychiatric services was delirium followed by depressive disorders. Diagnostic concordance between physician/surgeon and psychiatrist was low (κ < 0.3) for depressive disorders and delirium and better for the diagnosis of substance dependence (κ = 0.678) and suicidality (κ = 0.655). Conclusions: The present study suggests that delirium is the most common diagnosis in referrals made to CL psychiatry team, and there is poor concordance between the psychiatric diagnosis considered by the physician/surgeon and the psychiatrist for delirium and depression; however, the concordance rates for substance dependence and suicidal behavior are acceptable.
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Burden of psychiatric morbidity among attendees of a secondary level hospital in Northern India: Implications for integration of mental health care at subdistrict level p. 176
Partha Haldar, Rajesh Sagar, Sumit Malhotra, Shashi Kant
Background: There is little information available on the type, pattern, trend, and demographic differentials of psychiatric cases attending a subdistrict level facility in India. Our objectives were to describe the sociodemographic profile of the patients availing the psychiatric outpatient department services and document the diagnosis. Materials and Methods: This study is based on a retrospective analysis of routinely recorded administrative data collected during psychiatry consultations that took place between January 2010 and June 2014, at the subdistrict level hospital, Ballabgarh, Faridabad district, Haryana, Northern India. The data were abstracted in Microsoft Excel, scrutinized for duplicates, and cleaned in terms of the International Classification of Diseases 10th Revision coding. Descriptive analysis was done for dependent variables and continuous variables were compared using independent t-test. Results: A total of 2806 people (new registrations) were provided psychiatric consultations between January 2010 and June 2014. The mean age of males was 33.7 years (95% confidence interval [CI], 32.9, 34.5) and of females was 35.6 years (95% CI, 34.9, 36.3). Neurotic, stress-related, and somatoform disorders (F40–F48) comprised the major category of diagnoses with 661 cases (24%), followed by unspecified mental disorders (F99) with 528 cases (19%), mood (affective) disorders (F30–F39) with 448 cases (16%), and episodic and paroxysmal disorders (G40–G47) with 334 cases (12%). Conclusions: We reported an increase in level and trend in the monthly attendance of patients who required psychiatric at a secondary care hospital in Northern India. We suggest that setting up of mental health units only at district hospital might not be a sufficient health system's approach as has been envisaged under the District Mental Health Program.
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Motivation to change and factors influencing motivation in alcohol dependence syndrome in a tertiary care hospital p. 183
Prima Cheryl DíSouza, P John Mathai
Context: Motivation plays an important role in the treatment of alcohol dependence syndrome (ADS) by influencing the patient to seek and comply with treatment as well as make successful long term changes. Aim: The aim of this study is to study the motivation for change in inpatients with ADS. Settings and Design: One hundred consecutive patients admitted for the treatment of ADS in a medical college hospital were evaluated. Materials and Methods: The International Classification of Disease 10th Revision - AM symptom checklist for mental disorders screener and appropriate modules were used to establish ADS. The assessment of motivation was done using the University of Rhode Island Change Assessment scale at baseline and after 2 weeks of admission. The Severity of Alcohol Dependence Questionnaire and Kuppuswamy's scale for socioeconomic status were used. Statistical Analysis: Paired and unpaired t-test, Fisher's exact test, and Wilcoxon signed-rank test were used to analyze data. Results: The assessment of motivation showed 60% of patients in precontemplation (PC) stage at baseline, compared to 34% of the patients in PC, 57% in contemplation, and 9% in action stage after 2 weeks of inpatient stay. A highly significant change was seen in the levels of motivation toward contemplation and action stage after 2 weeks of inpatient stay (Z = 5.745, P < 0.001). Motivation to change had a significant association with complications of alcohol use, medical comorbidity, onset and severity of alcohol dependence, socioeconomic status, religion, and mode of referral. Conclusions: The study concludes that certain patients with ADS may have low pretreatment levels of motivation, with significant improvement in the motivation levels after a short duration of inpatient treatment.
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Effectiveness of gratitude disposition promotion program on depression and quality of life of chronic schizophrenic patients p. 189
Miran Jung, Kuemsun Han
Context: Gratitude intervention is expectedly an effective intervention to reduce depression and improve the quality of life in schizophrenic patients, but there is a lack of literature on it. Aims: We attempted to develop and test the effectiveness of the gratitude disposition promotion program for chronic schizophrenic patients in Korea. Settings and Design: Nonequivalent control group pre- and post-test design was used in two mental health centers located at Gyeonggi-do in South Korea. Materials and Methods: This paper was a quasi-experimental study and the participants who took part in the gratitude disposition promotion program were 17 of experimental group and 15 of control group. Gratitude disposition (the short gratitude, resentment, and appreciation test), depression (Beck Depression Inventory), and quality of life (developed by Kook) of chronic schizophrenic patients were measured before and after an intervention, as compared to the control. Statistical Analysis: Chi-square test, Fisher's exact test, and t-test were performed for prehomogeneity testing for variables related to the general characteristics. Testing for the effectiveness of gratitude disposition promotion program and hypothesis testing for its effect on depression and quality of life were by ANCOVA and t-test, as verified to significance level of P < 0.05. Results: The participants who received the gratitude disposition promotion program showed significant improvements in gratitude disposition (F = 18.740, P < 0.0001) and in quality of life (F = 9.800, P = 0.004), but no significant difference in depression (F = 3.870, P = 0.059). Conclusions: The gratitude disposition promotion program was an effective clinical intervention program for enhancing gratitude disposition and quality of life of chronic schizophrenic patients in community.
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A factor analytical study report on mania from Nepal p. 196
Sanjeev Shah, Tapas Kumar Aich, Sandip Subedi
Background and Objectives: Phenomenological studies on mood disorder are rare in Nepal which prompted us to undertake the current factor analytical study of mania. Materials and Methods: It was a cross-sectional descriptive study for which we did purposive sampling technique according to certain inclusion and exclusion criteria. The study sample consists of fifty patients, who fulfilled the International Classification of Diseases, Tenth Edition (ICD-10) diagnostic criteria for Manic Episode and/or Bipolar Affective Disorder-current episode mania. Tools used were ICD-10 Diagnostic Criteria for Research, Young's Mania Rating Scale (YMRS), and Brief Psychiatric Rating Scale (BPRS). Principal component factor analysis was applied to the 35 symptoms taken from YMRS and BPRS. Results: Factor analysis revealed the presence of four main factors, which explained 51.082% of the total variance. These are “pure mania” which isolated 11 manic symptoms, “dysphoric mania” which isolated five depressive symptoms, “hostile mania” which isolated six symptoms, and the fourth factor, we called it “delirious mania,” isolated four symptoms. Conclusion: The identified factors and subtypes are a useful conceptualization of atypical features among patients with acute mania. Further validation studies are required to determine whether the identified subtypes are of clinical and theoretical importance.
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Silence of male child sexual abuse in India: Qualitative analysis of barriers for seeking psychiatric help in a multidisciplinary unit in a general hospital p. 202
Vyjayanthi Kanugodu Srinivasa Subramaniyan, Praveen Reddy, Girish Chandra, Chandrika Rao, T S. Sathyanarayana Rao
Introduction: In 2007, Ministry of Women and Child Welfare, supported by United Nations Children's Fund, save the children and Prayas conducted a study to understand the magnitude of child abuse in India, they found that 53.22% children faced one or more forms of sexual abuse; among them, the number of boys abused was 52.94%. Aim: The aim of this study was to explore the barriers for seeking psychiatric help by qualitative analysis of stake holders of male victims of child abuse. Materials and Methods: All the statements made by the stakeholders regarding psychiatric assessment and treatment were recorded in each referral made to the psychiatrist. Semistructured interviews and in-depth interviews were conducted to explore the topic of understanding the need for psychiatric treatment to the victims. Results: Collaborative child response unit, a multidisciplinary team, to tackle child sexual abuse in a general hospital received three referrals of male child abuse among the 27 referrals in 20 months. The main theme of the barrier that was generated by interviewing the stakeholders of male child victims of abuse was the misconception of superiority of a male victim due to gender (patriarchy) an expectation that he will outgrow the experience. In-depth interviews of three cases of homosexual abuse explored the theme. Conclusion: Patriarchy is oppressing male children and acts as a barrier to seek psychiatric help in collaborative child response unit.
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Predictors of intention to quit tobacco among construction site workers in Delhi, India p. 208
Mamta Parashar, Mitasha Singh, Rashmi Agarwalla, Meely Panda, Rambha Pathak
Background: Information on predictors of quitting behavior among construction site tobacco users is scarce in India. Hence, this study was conducted to assess the intention of tobacco users toward quitting and its predictors with reference to sociodemographic profile. Methodology: A community-based, observational study was conducted on adult 172 construction site workers in a university campus of Delhi. Data were collected by an interview using the WHO-adopted, pretested, semi-structured questionnaire. Chi-square test was used for univariate analysis. Pearson's correlation coefficient and multivariate logistic regression model were used to identify the predictors. Results: Of the 172 users, 73% had intention to quit. More than half of smokers (56.5%) and 81% of smokeless tobacco users intended to quit. Majority of the tobacco users who intended to quit were literate (75.0%), started tobacco use >15 years of age (75.4%), occasional tobacco users (78.9%), and less dependent on nicotine (74.4%). Conclusions: Suitable plan for quitting keeping in mind this vulnerable group of workers should be developed depending on the literacy, type of tobacco used, and nicotine dependency.
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Effect of listening to Vedic chants and Indian classical instrumental music on patients undergoing upper gastrointestinal endoscopy: A randomized control trial p. 214
Anita Padam, Neetu Sharma, O. S. K. S Sastri, Shivani Mahajan, Rajesh Sharma, Deepak Sharma
Background: A high level of preoperative anxiety is common among patients undergoing medical and surgical procedures. Anxiety impacts of gastroenterological procedures on psychological and physiological responses are worth consideration. Aims and Objectives: To analyze the effect of listening to Vedic chants and Indian classical instrumental music on anxiety levels and on blood pressure (BP), heart rate (HR), and oxygen saturation in patients undergoing upper gastrointestinal (GI) endoscopy. Materials and Methods: A prospective, randomized controlled trial was done on 199 patients undergoing upper GI endoscopy. On arrival, their anxiety levels were assessed using state and trait scores and various physiological parameters such as HR, BP, and SpO2. Patients were randomly divided into three groups: Group I of 67 patients who were made to listen prerecorded Vedic chants for 10 min, Group II consisting of 66 patients who listened to Indian classical instrumental music for 10 min, and Group III of 66 controls who remained seated for same period in the same environment. Thereafter, their anxiety state scores and physiological parameters were reassessed. Results: A significant reduction in anxiety state scores was observed in the patients in Group I (from 40.4 ± 8.9 to 38.5 ± 10.7; P < 0.05) and Group II (from 41.8 ± 9.9 to 38.0 ± 8.6; P < 0.001) while Group III controls showed no significant change in the anxiety scores. A significant decrease in systolic BP (P < 0.001), diastolic BP (P < 0.05), and SpO2 (P < 0.05 was also observed in Group II. Conclusion: Listening to Vedic chants and Indian classical instrumental music has beneficial effects on alleviating anxiety levels induced by apprehension of invasive procedures and can be of therapeutic use.
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Cognitive effects with rivastigmine augmentation of risperidone: A 12-month, randomized, double-blind, placebo-controlled study in schizophrenia p. 219
Pattath Narayanan Suresh Kumar, Seema P Mohemmedali, PK Anish, Chittaranjan Andrade
Objective: An important challenge in schizophrenia therapeutics is to develop an efficacious treatment for cognitive impairment. Acetylcholinesterase inhibitors, such as rivastigmine, have been studied for improving cognitive performance in these patients. Materials and Methods: Rivastigmine (uptitrated to 6 mg/day) was given as an add-on therapy to risperidone-treated stable schizophrenia patients in a randomized, double-blind, placebo-controlled design. Of 67 patients who met eligibility criteria, 55 were recruited into the study. Twenty-eight were assigned to rivastigmine and 27 to placebo. These patients completed tests of attention, executive functioning, verbal skills, verbal and visuospatial working memory, and psychomotor speed on five occasions: at baseline, and at the end of the 1st, 3rd, 6th, and 12th months. Results: The groups were similar in terms of sociodemographic profile and baseline clinical characteristics (Positive and Negative Syndrome Scale and Clinical Global Impression-Severity). Contrary to expectations, rivastigmine patients showed poorer outcomes on several cognitive measures. Rivastigmine patients experienced also more psychological as well as neurological side effects. Core psychopathology ratings, however, did not differ between rivastigmine and placebo groups. Conclusions: Our study does not support the long-term use of rivastigmine as an augmentation agent in schizophrenia. Rivastigmine may be associated with higher incidence of psychological and neurological side effects in patients with schizophrenia.
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(−)-Linalool influence on the cerebral blood flow in healthy male volunteers revealed by three-dimensional pseudo-continuous arterial spin labeling p. 225
Miho Ota, Noriko Sato, Daichi Sone, Jun Ogura, Hiroshi Kunugi
Background: Although aromatherapy is widely used, the pharmacology of the essential oils remains undiscovered. Aim: The present study assessed the effect of (−)-linalool, the main contained material of lavender, on the brain function. Materials and Methods: Healthy male volunteers calculated the regional cerebral blood flow (CBF) before and after inhalation of (−)-linalool, and CBF changes were evaluated. Results: There were significant CBF reductions in the right superior temporal gyrus to insula, anterior cingulate cortex after inhalation. Conclusions: The previous study detected the regulatory influence of (−)-linalool on the glutamatergic transmission. The effect of (−)-linalool on the ACC and insula would cause the sedative and anxiolytic activity.
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Prevalence and predictors of metabolic syndrome in schizophrenia patients from Assam p. 228
Dulmoni Das, Kaustubh Bora, Banti Baruah, Gitumoni Konwar
Background: Metabolic abnormalities contribute enormously to morbidity and mortality in schizophrenia. Objectives: Our objectives were to determine the (i) prevalence of metabolic syndrome (MS); and (ii) predictors for MS in schizophrenia patients from Assam. Materials and Methods: Seventy-five schizophrenia patients were evaluated for MS. Risk factors were assessed by odds ratios (ORs) with 95% confidence intervals (CIs). Results: Fifty-nine patients (78.7%) had a metabolic abnormality. Twenty-two patients (29.3%, 95% CI: 19.9%–40.8%) fulfilled the criteria for MS. Female gender (adjusted OR = 7.8, 95% CI: 1.7–36.4), smoking (adjusted OR = 7.9, 95% CI: 1.7–35.8), family history of chronic lifestyle disease (adjusted OR = 4.4, 95% CI: 1.3–15.2), and atypical antipsychotic use (adjusted OR = 4.3, 95% CI: 1.1–16.9) significantly predicted MS. Conclusion: Metabolic abnormalities exist widely in schizophrenics from Assam. Females, smokers, and those with family history of chronic diseases and using atypical antipsychotics are at greater risk.
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Our failure to protect sexually abused children: Where is our 'willing suspension of disbelief'? p. 233
Sheila Ramaswamy, Shekhar Seshadri
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Addiction and technology: Plus ça change plus c'est la même (The more things change, the more they remain the same) p. 236
Alok Sarin, Pratima Murthy, Sanjeev Jain
Excessive use of the internet for gambling, gaming and behavioural addiction, are a focus of contemporary interest. The authors delve into the archives to explore the connections between the growth of various forms of technology, commerce, addictive behaviours and responses of the State, in colonial India. The interplay between the growth of the telegraph network in 19th century India, and its influence on various forms of gambling, including speculation on opium prices, and the rain, as a theme of wager make interesting stories, as do the governmental responses to these. Clinical and social responses to information technology raised much the same concerns as they do now
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Music in, as, or for therapy p. 240
Lakshmi Sravanti
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Occupational therapy in India: focus on functional recovery and need for empowerment p. 242
Reema Samuel, KS Jacob
While there have been significant advances in treatments for mental disorders over the past century, cure for many mental disorders remains elusive. The complex problems of mental illness require a multi-sectoral, multi-disciplinary and multi-dimensional approach to care. The need for focus on biopsychosocial model rather than on biomedical practise, client-centred rather than physician-oriented care, personal rather than clinical recovery, are often preached but rarely practiced. The lack of emphasis on functioning and the limited workforce and evidence base complicate issues related to the care of people with chronic mental illness in India. The role of occupational therapy in bridging the gap between symptomatic improvement and functional recovery is discussed.
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Association between depression and metabolic syndrome: Critical issues and missed opportunities p. 247
Abhishek Ghosh, Damodharan Dinakaran, Naresh Nebhinani, Chittaranjan Andrade
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Age is a number, not a group p. 248
Chittaranjan Andrade
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Olanzapine has poorer efficacy than risperidone for the treatment of the negative symptoms of schizophrenia p. 248
Laxmi Naresh Vadlamani, Girish Banwari, Damodharan Dinakaran, Vikas Menon, Chittaranjan Andrade
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Black hairy tongue with olanzapine: A rare case report Highly accessed article p. 249
Shubhra Kanodia, Vishal Prakash Giri, Ravindra Setru Veerabhadrappa, Om Prakash Giri, Vemanna Naveen Shankar
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Paroxetine-induced multifocal fixed drug rash: An incident, hitherto unreported p. 250
Anupam Das, Priyankar Misra, Amlan Kusum Jana
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Pretesting and cognitive interviewing are integral parts in translation of survey instrument p. 251
Himel Mondal, Shaikat Mondal
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Response to “Pretesting and cognitive interviewing are integral parts in translation of survey instrument” p. 253
Aron Zieger
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Use of Google Maps to target public awareness – A pilot retrospective study at tertiary hospital p. 253
Shreemit Maheshwari, M Kishor, Suhas Chandran, Rajesh Raman, T S. Sathyanarayana Rao
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Suicide from a global perspective p. 256
Prakash B Behere, Animesh Sharma
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Erratum: Clinical practice guidelines for the management of depression p. 258

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