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   2005| January-March  | Volume 47 | Issue 1  
    Online since February 20, 2009

 
 
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PRESIDENTIAL ADDRESS
Marriage, mental health and the Indian legislation
S Nambi
January-March 2005, 47(1):3-14
DOI:10.4103/0019-5545.46067  
  5,779 830 3
ORIGINAL RESEARCH PAPERS
Somatoform and dissociative disorders in children and adolescents: A comparative study
Savita Malhotra, Gagandeep Singh, Ashwin Mohan
January-March 2005, 47(1):39-43
DOI:10.4103/0019-5545.46073  
Background: Somatoform and dissociative (conversion) disorders in adults have been reported to have a close relationship because of a diagnostic overlap and comparable aetiological models. The literature on these disorders in children and adolescents is scarce. Aim: The present study attempted to compare these two disorders in children and adolescents since antecedents of these disorders are said to be laid in childhood. Methods: Case files of 118 patients (69 of somatoform disorders and 49 of dissociative disorders) were reviewed and the two groups were compared with respect to sociodemographic profile, clinical profile, neurotic traits, behavioural problems, temperament, intelligence and family dysfunction. Results: Age at presentation and intelligence were significantly higher in those with somatoform disorders than in those with dissociative disorders. Patients with dissociative disorders had a significantly higher number of co-morbid somatoform symptoms. Conclusion: Somatoform and dissociative disorders are closely linked.
  2,708 511 1
Substance abuse co-morbidity in schizophrenia: An inpatient study of course and outcome
Tapas K Aich, Vinod K Sinha, Christoday R. J Khess, Sahilja Singh
January-March 2005, 47(1):33-38
DOI:10.4103/0019-5545.46072  
Background: Differences in opinion exist among researchers in relation to the course and outcome of substance abuse co-morbidity in schizophrenia. Aim: To compare the pattern of remission of symptoms in positive and negative schizophrenics with and without a history of substance abuse. Methods: Seventy schizophrenics were divided into two groups based on the history of presence or absence of substance abuse/dependence. Thirty-eight patients (54.3%) were diagnosed as having co-morbid alcohol/ substance abuse/dependence. Patients were rated at two-weekly intervals on the Positive and Negative Syndrome Scale (PANSS) with one follow-up rating by the end of the third month. Co-morbid substance abusers were predominantly represented by a positive syndrome and non-abusers by a negative syndrome at the time of admission. Results: Psychopathology remitted much faster in the substance-abusing group but after discharge, these patients tend to return to their pre-admission state. Conclusion: The following hypothesis is proposed based on the findings of the present study: 'Short-term inpatient outcome of substance-abusing schizophrenics is significantly better than non-substance abusing schizophrenics because of the faster rate of remission of their symptoms.' A corollary to the above hypothesis may be evolved-'through intense inpatient follow-up one may be able to differentiate substance-abusing and non-abusing schizophrenics'.
  2,006 273 1
BRIEF RESEARCH COMMUNICATIONS
Neurocognitive function in women affected by the Bhopal gas disaster
RN Sahu, GP Naik, Asha Dusad, Vikas K Agrawal
January-March 2005, 47(1):51-53
DOI:10.4103/0019-5545.46076  
Background: Methyl isocynate (MIC) is a reactive, toxic, volatile and inflammable gas. Exposure to MIC causes neurotoxicity and somatic abnormalities in human beings. Aim : We compared neurocognitive function in MIC-exposed women and a control group, as well as cognitive function in the MIC group and examined them with reference to age. Methods: The study sample comprised 30 women and a control group of 30 women. Both the groups were subjected to a detailed neuropsychiatric examination along with assessment of neurocognitive function using the PGI-Battery of Brain Dysfunction (PGI-BBD). Results: Mean scores of immediate recall, visual retention, difference in performance quotient/verbal quotient, Nahar-Bensen and Bender-Gestalt test were significantly affected in MIC-exposed women. However, among MIC-exposed women, neurocognitive functions were similarly affected in women in various age groups. Conclusion: Women in the MIC-exposed group had significant neurocognitive dysfunction in some specific areas as compared to women in the control group. The mean score of dysfunction rating of the PGI-BBD showed significant differences in neurocognitive functions between MIC-exposed and non-exposed women.
  1,827 172 1
Dhat syndrome in relation to demographic characteristics
Nashi Khan
January-March 2005, 47(1):54-57
DOI:10.4103/0019-5545.46077  
Background : The area of men's sexual health has been poorly understood, particularly with reference to South Asian cultures. The belief that losing semen is detrimental to health is a concept common to both Oriental and Occidental thinking. Aim : To estimate the number of patients with the dhat syndrome consulting different professionals in Lahore and to examine their demographic characteristics. Method : Seventy health professionals of various types were approached and asked to fill in a daily record form for all patients reporting at their clinics for a period of 1 month. Results : A total of 1777 patients were reported to attend the outpatient clinics of health professionals of various types over a period of 1 month. The majority of patients consulted hakims for professional help. Most of the patients were single, with a mean age of 24 years and had a monthly income of less than Rs 3000. Conclusion : These data have important implications for patients, professionals and researchers. The alarming number of people consulting various professionals to seek help for anxiety due to semen loss highlights the fact that research into and interventions for this neglected area of men's sexual health are urgently required.
  1,660 299 3
CASE REPORTS
Psychotic symptoms in acromegaly
Denzil Pinto, AT Safeekh, Mohit Trivedi
January-March 2005, 47(1):58-59
DOI:10.4103/0019-5545.46078  
Various psychiatric symptoms have been reported in patients with acromegaly. Most of them are personality changes characterized by lack of initiative and spontaneity. There are few case reports of the presence of auditory and visual hallucinations, and delusions in patients with acromegaly. We report a patient with acromegaly who had psychotic symptoms including Schneiderian first-rank symptoms.
  1,800 158 1
ORIGINAL RESEARCH PAPERS
Executive functions in schizophrenia
S Sabhesan, S Parthasarathy
January-March 2005, 47(1):21-26
DOI:10.4103/0019-5545.46069  
Background: Executive functions constitute the core deficit in schizophrenic illness and have been related to structural and functional deficits, cognitive impairments and final outcome. Aim: To study the various dimensions of executive functions such as goal formulation, planning, behavioural programming and effective performance. Methods: By using direct and indirect clinical neuropsychological methods, 31 patients were studied neuropsychologically by the trail-making test (TMT), Raven matrices and fluency tests, and their symptom patterns were quantified using the Positive and Negative Syndrome Scale (PANSS). Results: The patients had varying degrees of involvement of different dimensions of executive functions. There was an inverse relationship to TMT and a positive correlation with Raven matrices and fluency tests. Conclusion: The dimensions of executive functions did not show any significant relationship with age, duration of illness or most scores in PANSS. Our findings are relevant for remediation and rehabilitation measures.
  1,570 318 1
TILAK VENKOBA RAO ORATION
Social origins, biological treatments: The public health implications of common mental disorders in India
Vikram Patel
January-March 2005, 47(1):15-20
DOI:10.4103/0019-5545.46068  
Common mental disorders (CMD) is a term used to describe depressive and anxiety disorders. It replaces the old term 'neuroses' and is widely used because of the high level of co-morbidity of depression and anxiety, which limits the validity of categorical models of classification of neurotic disorders, particularly in primary care settings. The global public health significance of CMD is highlighted by the fact that in developing countries, depression is the leading cause of years lived with disability in both men and women aged 15-44 years. This oration brings together research evidence, mostly from South Asia, to show that although the aetiology of CMD may lie in the socioeconomic circumstances faced by many patients, biological treatments such as antidepressants may be among the most cost-effective treatments in resource-poor settings. The oration demonstrates the public health implications of CMD by briefly reviewing the burden of CMD in the region and presents evidence linking the risk for CMD associated with two of the region's most important public health risk factors-poverty and gender disadvantage. The oration also presents recent evidence to establish the association of CMD with some of the region's most important public health issues: maternal and child health; and reproductive and sexual health. Next, the evidence for the efficacy of treatments for CMD in developing countries is presented, focusing on a series of recent trials that show that both psychosocial and biological treatments are effective. Finally, the implications for policy and future research are considered.
  1,546 291 1
BRIEF RESEARCH COMMUNICATIONS
Neuropsychological impairment in bipolar affective disorder
Mubeen Taj, R Padmavati
January-March 2005, 47(1):48-50
DOI:10.4103/0019-5545.46075  
Background : Recent neurocognitive investigations during the euthymic phase of bipolar affective disorder have shown persistent cognitive deficits in 32% of patients. There is limited evidence in the Indian literature in this area. Aim : To study the neuropsychological functions in patients with bipolar affective disorder in remission. Methods : Thirty patients with bipolar disorder in remission were compared with 30 normal subjects on tests of attention, learning, memory and executive functions. Neuropsychological measures of the two groups were compared using the chi-square and Student t tests. This study was conducted in the outpatient department of the Schizophrenia Research Foundation. Result : Patients with bipolar disorder, in remission, have neuropsychological impairment in attention, memory and executive functioning. Conclusion : Cognitive dysfunction in patients with bipolar disorder in remission can contribute to social and occupational difficulties, reduced insight, increased risk of non-adherence and relapse.
  1,551 269 -
CASE REPORTS
Interaction between escitalopram and risperidone
Pradeep Rao, Nishant Bhagat, Bharat Shah, Momin Bazegha
January-March 2005, 47(1):65-66
DOI:10.4103/0019-5545.46081  
The ever-increasing use of psychotropic drugs in clinical practice today is a blessing for the patient who can hope to achieve faster remission and possibly a higher rate of cure. However, the flip side is that the use of polypharmacy increases the potential for drug-drug interactions. Escitalopram is a novel antidepressant and there are several reports on its efficacy in the treatment of depression. Reports about its interactions with the cytochrome P450 (CYP 450) enzyme system are relatively few in number. We present a case report of a possible interaction between escitalopram and risperidone. Escitalopram has an inhibitory effect on the CYP 2D6 enzyme. Risperidone is the substrate for this enzyme. In the presence of escitalopram, there is a rise in the levels of risperidone, as evidenced by severe extrapyramidal adverse effects at a low dose of risperidone not normally known to cause extrapyramidal effects.
  1,475 151 -
BRIEF RESEARCH COMMUNICATIONS
Community 'de-addiction' camps: A follow-up study
Lok Raj, BS Chavan, Chandra Bala
January-March 2005, 47(1):44-47
DOI:10.4103/0019-5545.46074  
Aim: To evaluate the effectiveness of the camp approach for the treatment of alcohol and drug dependence. Methods: This was a prospective, longitudinal study with a 6-month follow-up. Patients were drawn from the villages covered under the community outreach programme of the Department of Psychiatry of the Government Medical College and Hospital, Chandigarh. Forty-six patients with a history of substance use (alcohol: 23, opioids: 20, cannabis: 2, sedative/hypnotic: 1) admitted to two different community camps for 10 days each were followed up in the community outreach clinics of the respective villages. Sociodemographic and clinical variables were recorded on a semi-structured proforma. Outcome variables, changes in dose, frequency, route of intake, status of complications, etc. were recorded on a specially designed semi-structured proforma at the end of 6 months of treatment. The ICD-10 criteria were used for diagnoses. Results: Thirty-six patients (78.3%) completed 6 months' follow-up, 61% recovered totally or their condition improved markedly. There were significant improvements in physical health and family life. Conclusion: The camp approach is a cheap and effective treatment alternative for patients with alcohol and drug dependence.
  1,373 205 -
CASE REPORTS
Psychiatric co-morbidity associated with pheniramine abuse and dependence
Hemraj Pal, Rajesh Kumar, Shashi Bhushan, Neeraj Berry
January-March 2005, 47(1):60-62
DOI:10.4103/0019-5545.46079  
The abuse of cough syrups containing antihistamines and codeine is being increasingly noted. The abuse of antihistamines alone has also been reported. The use of antihistamines alone or in combination with other substances of abuse may predispose individuals to develop psychiatric symptoms or syndromes as a part of intoxication, withdrawal or as co-morbid conditions. We present two case reports to highlight the occurrence of co-morbid psychopathology in association with antihistamine abuse and dependence. Case I used high doses of pheniramine for about 2 years and became suspicious of his wife; he even doubted the paternity of his yet-to-be-born child. The associated behavioural abnormalities suggested that he was acting out on the delusion. He also had seizures associated with the intake of a high dose of pheniramine. Case II had multiple substance use, and dependence on alcohol and pheniramine. He demonstrated abnormal behaviour suggestive of psychosis and organic brain syndrome that persisted for a few days and remitted on discontinuation of the substances. These two cases demonstrate the occurrence of psychotic syndromes associated with heavy pheniramine use. The psychopathology can vary from an independent psychotic syndrome to an organic brain syndrome-like disorder.
  1,381 137 2
ORIGINAL RESEARCH PAPERS
A double-blind randomized trial between risperidone and haloperidol in drug-naive patients with paranoid schizophrenia
KJ Vijay Sagar, CR Chandrashekar
January-March 2005, 47(1):30-32
DOI:10.4103/0019-5545.46071  
Background: Haloperidol is highly effective against the positive symptoms of schizophrenia, but is less effective against the negative symptoms. It also produces marked extrapyramidal symptoms. The newer atypical antipsychotics are believed to have an equal efficacy with a favourable side-effect profile. Aim: We assessed the effects of risperidone and haloperidol in patients with schizophrenia to compare their clinical efficacy and side-effect profile. Methods: A double-blind, randomized, prospective, comparative trial with a parallel treatment design of 6 weeks' duration was undertaken on 46 drug-naive schizophrenics to compare the efficacy and adverse effects profile of risperidone and haloperidol. Results: The study showed no difference in the positive and negative subscale scales on the Positive and Negative Syndrome Scale (PANSS). However, risperidone was found to have an edge over haloperidol in improving the general psychopathology as well as in bringing about global improvement. Conclusion: Of the two drugs, the adverse effect profile of risperidone is better, with less need for the use of antiparkinsonian medication.
  1,349 155 -
CASE REPORTS
Antidepressant-induced acute colonic (pseudo) obstruction (Ogilvie syndrome)
V A.P Ghorpade
January-March 2005, 47(1):63-64
DOI:10.4103/0019-5545.46080  
Patients on antidepressant drugs commonly complain of dryness of the mouth, tremors, blurring of vision and constipation, which are attributed to the anticholinergic action of the drugs. We report two cases of gastrointestinal complications (pseudo-intestinal obstruction), which are considered rare according to a review of the literature. This condition is also known as Ogilvie syndrome.
  1,204 112 -
ORIGINAL RESEARCH PAPERS
Felt affect in good- and poor-outcome schizophrenia
Anuradha Sovani, Shubha Thatte, CG Deshpande
January-March 2005, 47(1):27-29
DOI:10.4103/0019-5545.46070  
Background: Family members and caregivers may misinterpret blunted affect as a true lack of emotion in patients with schizophrenia. Aim: To assess felt affect or experienced emotion among low- and high-functioning schizophrenics. Methods: Two hundred people with schizophrenia were assessed using the Global Assessment of Functioning scale of DSM-IV and the Positive and Negative Affect Schedule (PANAS). Results: The findings reveal that people with good- and poor-outcome schizophrenia show no significant differences in the emotions experienced, implying that felt affect is comparable regardless of the severity of symptoms in chronic schizophrenia. In fact, low-functioning patients scored a mean (SD) of 46.07 (13.13) on the PANAS, in contrast to a slightly lower scored by high-functioning patients (44.33 [12.03]). Conclusion: Although patients may show flat affect, and therefore be mistakenly considered withdrawn and apathetic by the observer, they do, in fact, experience as much, or perhaps even more emotion than their higher-functioning counterparts.
  1,163 136 -
EDITORIAL
Why 'publish or perish'? Why not 'publish and prosper'? Perspectives from developing countries
Nimesh G Desai
January-March 2005, 47(1):1-2
DOI:10.4103/0019-5545.46066  
  848 102 -
LETTER TO THE EDITOR
National workshop on ECT practice
Jagadisha , Nilesh Shah, Prathap Tharyan, BN Gangadhar
January-March 2005, 47(1):67-68
DOI:10.4103/0019-5545.46082  
  762 84 -
MY VOICE
Ode to my physician
Shubhadarshini Singh
January-March 2005, 47(1):69-69
  597 38 -