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   2006| July-September  | Volume 48 | Issue 3  
 
 
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BRIEF RESEARCH COMMUNICATIONS
Wisconsin Card Sorting Test: Normative data and experience
Adarsh Kohli, Manreet Kaur
July-September 2006, 48(3):181-184
DOI:10.4103/0019-5545.31582  PMID:20844649
Background: The Wisconsin Card Sorting Test (WCST) has been increasingly employed as a clinical neuropsychological instrument. However, in India the use of WCST is still in a relatively preliminary stage. Aim: To analyse the utility of WCST in the Indian population. Methods: Fifty-three subjects in the age group of 20-50 years, comprising both men and women, were recruited for the study. The normality was established by administering the General Health Questionnaire as a screening instrument to evaluate their health status. The WCST was administered and the norms for various dimensions were established; these were compared with those of normal healthy individuals from the West as per the WCST manual. Results and conclusion: The significance of differences and the experience of administration have been described. The present study found highly significant differences between the means on almost all WCST scores among the Western and the Indian sample, except for the number of correct responses.
  8,323 543 4
ORIGINAL RESEARCH PAPERS
Prevalence of conduct disorder in schoolchildren of Kanke
Sujit Sarkhel, Vinod Kumar Sinha, Manu Arora, Pushpal DeSarkar
July-September 2006, 48(3):159-164
DOI:10.4103/0019-5545.31579  PMID:20844646
Background: Prevalence estimates of conduct disorder, one of the most frequently diagnosed psychiatric conditions in children, vary widely from 0.2% to 8.7%. Aim: To find out the prevalence of conduct disorder and its DSM-IV subtypes and comorbid attention deficit hyperactivity disorder (ADHD) in 4 schools of Kanke block among students of classes V to X. Methods: A total of 240 students, selected by stratified random sampling, were subjected to the Schedule for Affective Disorders and Schizophrenia for School Age Children: Present and Lifetime Version (K-SADS-PL) screening interview. Nineteen students who qualified were subjected to conduct disorder and ADHD supplement of K-SADS-PL with additional information from parents. Results: Conduct disorder was found in 4.58%; the ratio of boys to girls being 4.5:1. Childhood onset was found in 73% and adolescent onset in 27%. Mild conduct disorder was found in 36%, moderate in 64% and severe conduct disorder in none. Comorbid ADHD was found in 36%, hyperactive-impulsive being predominant. Significant difference was found in temperament between students with and without conduct disorder with difficult temperament predominating in the former and easy in the latter (p=0.004). Lying, bullying and cruelty to animals were most frequent symptoms. Conclusion: The prevalence of conduct disorder was 4.58%, more common in boys, the majority had childhood onset, and one-third had comorbid ADHD.
  8,081 606 2
CASE REPORT
An analysis of six cases of acute intermittent porphyria (AIP)
Soumitra Ghosh, Pranit KR Chaudhury, Hiranya K Goswami
July-September 2006, 48(3):189-192
DOI:10.4103/0019-5545.31584  PMID:20844651
This analysis describes the diagnosis and psychiatric treatment modalities of 6 patients (5 women, 1 man; mean age 28.5 years) of acute intermittent porphyria (AIP), who presented to the Psychiatry OPD over a period of one year. The mean number of episodes was 2.83. Premorbid personality traits, clinical presentation, urine colour and urinary porphobilinogen titre were recorded. Among the 6 patients, 4 had abdominal pain, 5 had autonomic instability, all 6 had mental symptoms, 3 had depression, 2 came in delirium, and 3 had an episode of seizure.
  6,915 319 2
Neurocognitive deficits in HIV-positive patients-two case reports: Revising current AANTF guidelines in view of recent revelation of new neurocognitive symptoms
VN Vahia, Tejas Bhojraj, Dean A Creado
July-September 2006, 48(3):193-195
DOI:10.4103/0019-5545.31585  PMID:20844652
Certain organic antecedents such as fever, weight loss, diarrhoea and systemic infections often present with neurocognitive deficits (NCDs). However, routine HIV screening is not done in such cases. HIV can present with psychiatric and neurocognitive symptoms as highlighted in the two cases given below. Case 1, a housewife, had been exhibiting altered behaviour following a low-grade fever over the past 3 weeks, associated with muttering to self, talking irrelevantly, would wander away from home, had decreased sleep, loss of appetite, and neglected self-care. She had displayed impulsivity by jumping into a well. On admission, the patient was mute, lethargic and the cerebrospinal fluid (CSF) tested positive for cryptococcus. Her human immunodeficiency virus (HIV) status was positive. Case 2, a housewife, presented with one-month history of muttering to self, increased irritability, aggressive on minimal provocation, decreased sleep, loss of appetite, and suspiciousness towards family members. On provisional diagnosis of schizophrenia, the patient was started on low-dose antipsychotic drugs, which showed minimal improvement. There was a distinct slowness in her movements and she progressively lost weight. Routine investigations were normal but her HIV status was positive. It has recently come to light that HIV infection also presents with subtle manifestations of the central nervous system (CNS), which are distinct from NCD and, if harnessed, could enhance diagnostic sensitivity and reduce the 'asymptomatic period'. Hence HIV testing is recommended in such cases.
  5,673 187 -
ORIGINAL RESEARCH PAPERS
A Life Events Scale for Armed Forces personnel
Suprakash Chaudhury, Kalpana Srivastava, MSV Kama Raju, SK Salujha
July-September 2006, 48(3):165-176
DOI:10.4103/0019-5545.31580  PMID:20844647
Background: Armed Forces personnel are routinely exposed to a number of unique stressful life events. None of the available scales are relevant to service personnel. Aim: To construct a scale to measure life events in service personnel. Methods: In the first stage of the study open-ended questions along with items generated by the expert group by consensus method were administered to 50 soldiers. During the second stage a scale comprising 59 items and open-ended questions was administered to 165 service personnel. The final scale of 52 items was administered to 200 service personnel in group setting. Weightage was assigned on a 0 to 100 range. For normative study the Armed Forces Medical College Life Events Scale (AFMC LES) was administered to 1200 Army, 100 Air Force and 100 Navy personnel. Results: Service personnel experience an average of 4 life events in past one year and 13 events in a life-time. On an average service personnel experience 115 life change unit scores in past one year and 577 life change unit scores in life-time on the AFMC LES. The scale has concurrent validity when compared with the Presumptive Stressful Life Events Scale (PSLES). There is internal consistency in the scale with the routine items being rated very low. There is a pattern of uniformity with the civilian counterparts along with differences in the items specific to service personnel. Conclusions: The AFMC LES includes the unique stresses of service personnel that are not included in any life events scale available in India or in the west and should be used to assess stressful life events in service personnel.
  5,208 432 1
EDITORIAL
Public mental health: An evolving imperative
Nimesh G Desai
July-September 2006, 48(3):135-137
DOI:10.4103/0019-5545.31574  PMID:20844641
  4,615 533 1
BOOK REVIEW
The joy of mental health: Some popular writings of Dr N.N. Wig
Sudhir K Khandelwal
July-September 2006, 48(3):207-208
  4,789 341 -
ORIGINAL RESEARCH PAPERS
A biomedical educational intervention to change explanatory models of psychosis among community health workers in South India
D Joel, M Sathyaseelan, R Jayakaran, C Vijayakumar, S Muthurathnam, KS Jacob
July-September 2006, 48(3):138-142
DOI:10.4103/0019-5545.31575  PMID:20844642
Background: Community health workers in developing countries commonly hold indigenous beliefs about mental illness which differ markedly from biomedical models. Aim: To test the effect of a biomedical intervention on explanatory models (EMs) of community health workers. Methods: Indigenous beliefs about chronic psychosis were elicited from community health workers. The Short Explanatory Model Interview formed the basis of the interview. Half the workers were taught about the biomedical model after discussing their EMs of chronic psychosis. The others did not receive education. The beliefs of all community health workers were reassessed 2 weeks after the initial assessment. Results: A variety of indigenous beliefs, which contradicted the biomedical model, were elicited at the baseline evaluation. Seeking biomedical help at follow up was significantly related to receiving education about the biomedical aspects of chronic psychosis (OR 17.2; 95% CI: 18.75, 15.65; p<0.001). This remained statistically significant (OR 9.7; 95% CI: 82.28, 1.14; p<0.04) after using logistic regression to adjust for baseline variables. Conclusion: The high prevalence of non-medical beliefs among community health workers suggests the need to elicit and discuss beliefs before imparting knowledge about biomedical models of mental disorders. Biomedical educational intervention can change EMs of mental illness among health workers.
  4,677 314 2
CASE REPORT
Compulsive symptoms in dissociative (conversion) disorder
Arun Lata Agarwal
July-September 2006, 48(3):198-200
DOI:10.4103/0019-5545.31587  PMID:20844654
According to Mayer-Gross, Slater and Roth's classical textbook Clinical psychiatry, obsessive-compulsive symptoms are rarely seen in hysteria. The release of obsessive-compulsive symptoms is said to occur only in those who are constitutionally predisposed. In this context, the case of a young woman with dissociative (conversion) disorder, who presented with compulsive symptoms, is reported. In her case, the dissociative phenomena manifested as compulsive symptoms without concomitant predisposing factors. Management on the line of treatment for hysteria promptly achieved lasting resolution of symptoms without recourse to pharmacological or non-pharmacological treatment strategies used for obsession(s) or compulsion(s). The underlying mechanism(s) are discussed.
  4,652 332 1
ORIGINAL RESEARCH PAPERS
Regional brain metabolism in schizophrenia: An FDG-PET study
R Seethalakshmi, SR Parkar, N Nair, SA Adarkar, AG Pandit, SA Batra, NS Baghel, SH Moghe
July-September 2006, 48(3):149-153
DOI:10.4103/0019-5545.31577  PMID:20844644
Background: Recent technological advances have established beyond any doubt the biological nature of schizophrenia. Functional neuroimaging using FDG-PET forms an important technique in understanding the biological underpinnings of psychopathology of schizophrenia. Methods: Eighteen male patients diagnosed as having schizophrenia and having active psychosis as determined by PANSS were subjected to FDG-PET scanning under resting conditions. The glucose uptake in selected regions of interest was studied across the spectrum of schizophrenia. Results: Chronicity and severity of illness did not influence cerebral glucose metabolism. Participants with negative schizophrenia had significantly decreased metabolism in all regions of the brain as compared to the positive type. The positive syndrome of schizophrenia was associated with significantly increased glucose metabolism in the medial temporal regions, basal ganglia and left thalamic regions. Hypometabolism was also noted in the cerebellum. Conclusion: While a number of brain areas can be identified as potential causative regions and hypotheses regarding putative mechanisms can be formed, the considerable heterogeneity of schizophrenia poses a great challenge in the precise delineation of the disease process.
  4,399 274 2
Deficiencies in social relationships of individuals with neurosis
Sunil Srivastava
July-September 2006, 48(3):154-158
DOI:10.4103/0019-5545.31578  PMID:20844645
Background: Social interaction and network of individuals with neurosis have been reported to be inadequate. Aim: To measure deficiencies in the social network of individuals with neurosis. Methods: Fifty consecutive patients with neurosis attending the OPD of the Department of Psychiatry, King George's Medical College, Lucknow, who were diagnosed as per the criteria of ICD-9, were included in the study. A control group of 40 healthy persons matched for age, sex, education and marital status was also taken. Interaction with the primary group (defined as consisting of all kin, nominated friends, work associates and neighbours) was measured by the Social Interaction Schedule of Henderson et al. as modified for the Indian population. Results: Patients reported significantly higher mean duration of unpleasant but affectively intense interaction with one person within or outside the primary group and affectively unpleasant and intense interaction with more than one person within or outside the primary group or affectively superficial but unpleasant interaction with one or more person of the primary group. Healthy subjects reported more of pleasant interaction with one person within or outside the primary group and affectively intense and pleasant interaction with more than one person within or outside the primary group or affectively superficial but pleasant interaction with one or more persons of the primary group; the difference was statistically significant as compared to patients with neurosis. Conclusion: The primary group of patients with neurosis was significantly smaller in numerical size as compared with that of controls and in terms of the total time spent with members of the primary group, patients with neurosis reported more interactions of unpleasant type and less of pleasant type as compared with healthy controls.
  4,125 196 -
An estimate of the monthly cost of two major mental disorders in an Indian metropolis
P Sharma, SK Das, SN Deshpande
July-September 2006, 48(3):143-148
DOI:10.4103/0019-5545.31576  PMID:20844643
Background: The components of high cost of treating a chronic psychiatric illness are: long-term continuous treatment consisting of consultation and medication costs, traveling to the treatment centre and taking time off from work for both patient and caregiver. Apart from direct treatment costs, expenditure of time in care­giving results in indirect costs. All these costs are borne by families as the sufferer may be unable to work. Aim: To estimate the cost of treatment of chronically ill patients at home, in terms of the above parameters. Methods: The sample consisted of 117 subjects of either sex in the age range of 18 to 60 years, ill for at least one year, diagnosed as schizophrenia (n=95) or bipolar disorder (n=22, a comparison group) who agreed to participate in the study along with at least one caregiver. The tools used were the Diagnostic Interview of Genetic Studies and Economic Burden Questionnaire administered to both the subject and the caregiver. Results and conclusions: The costs of treatment were found to be high but with wide variations in the range. Costs for bipolar disorder were somewhat higher than those for schizophrenia at least for the period of study. Demographic differences between subjects and caregivers were present.
  3,874 361 2
VIEW POINT
'Joke's A Part': In defence of humour
G Swaminath
July-September 2006, 48(3):177-180
DOI:10.4103/0019-5545.31581  PMID:20844648
  3,892 235 -
BRIEF RESEARCH COMMUNICATIONS
Psychiatric comorbidity of headache in a medical relief camp in a rural area
Himanshu Sharma, Savan Shah
July-September 2006, 48(3):185-188
DOI:10.4103/0019-5545.31583  PMID:20844650
Background: Headache is one of the most common complaints seen by primary care physicians, but very few well-planned studies have been conducted to know its prevalence. Aim: To study the prevalence of headache and associated psychiatric morbidity. Methods: A medical relief camp was held in village Mavta (near Ratlam in Madhya Pradesh) in 2002. Of a total of 1350 registered subjects, 80 with primary complaints of headache were referred to our expert team of psychiatrists. Results: Sixty-nine subjects (86.25%) had psychiatric morbidity-mainly affective disorders (depression) and panic disorder, dysthymia, alcohol and nicotine dependence. Subjects with migraine and depression were mostly women with onset of symptoms at an early age. Subjects with less education; who were unmarried or had lost a spouse; those with a nuclear family; who were unemployed and those with a family history and past history of mental illness, were all susceptible to headache and depression. Conclusion: Disturbed sleep, free floating anxiety, sad mood, lack of pleasure, body ache and fatigue were the main presenting complaints along with headache.
  3,620 266 -
CASE REPORT
Clozapine in pregnancy
Sujata Sethi
July-September 2006, 48(3):196-197
DOI:10.4103/0019-5545.31586  PMID:20844653
This report describes the case of a woman with treatment-resistant schizophrenia who became pregnant while being treated successfully with clozapine. Possible risks associated with continuation of clozapine during pregnancy are discussed.
  3,266 236 1
LETTER TO EDITOR
Is olfactory reference syndrome an OCD?
Gurvinder Pal Singh
July-September 2006, 48(3):201-202
DOI:10.4103/0019-5545.31588  PMID:20844655
  2,987 175 3
OBITUARY
Dr K. Bhaskaran (1924-2006)
S Kalyanasundaram
July-September 2006, 48(3):209-209
  2,759 105 -
LETTER TO EDITOR
Reply to 'Critical appraisal of an article on factitious schizophrenia'
Suresh Kumar, Sandeep Grover, SK Mattoo
July-September 2006, 48(3):203-204
DOI:10.4103/0019-5545.31589  PMID:20844656
  2,331 122 -
MY VOICE
My inner experience
BK Garg
July-September 2006, 48(3):205-206
DOI:10.4103/0019-5545.31590  PMID:20844657
  1,867 91 -