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   2007| October-December  | Volume 49 | Issue 4  
    Online since December 26, 2007

 
 
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ORIGINAL ARTICLES
A 5-year course of predominantly obsessive vs. mixed subtypes of obsessive-compulsive disorder
SB Math, Jaideep Thoduguli, YC Janardhan Reddy, PN Manoj, A Zutshi, RP Rajkumar, AM Adarsh
October-December 2007, 49(4):250-255
DOI:10.4103/0019-5545.37664  PMID:20680136
Background: Obsessive-compulsive disorder (OCD) is considered a heterogeneous disorder. One of the traditional approaches to subtype OCD is based on the predominance of obsessions, compulsions or both. Some studies suggest that the "predominantly obsessive" subtype of OCD may have poor outcome, whereas few other studies suggest that "mixed" OCD is associated with poor outcome. Therefore, it is not clear if the long-term course of "predominantly obsessive" subjects is different from those with "mixed" OCD. In the establishment of diagnostic validity of psychiatric conditions, differential course is an important validating factor. Aim: This study compares the 5-6 year course of the "predominantly obsessive" subtype with that of the "mixed" subtype of OCD with the objective of determining if the course of OCD differs according to subtypes and whether course could be a validating factor for subtyping OCD based on predominance of obsessions, compulsions or both. Setting and Design: Tertiary hospital, institutional setting. The study has a retrospective cohort design. Materials and Methods: Fifty-four subjects with "predominantly obsessions" and an equal number of the "mixed" subtype of OCD were recruited from the database of a specialty OCD clinic of a major psychiatric hospital. They were followed up after 5-6 years. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) checklist and severity rating scale was used for assessing OCD. The course of OCD was determined according to predefined criteria. Statistics: The Chi-square/Fisher's exact test and the independent samples "t" test were used to compare categorical and continuous variables, respectively. Correlations were tested using the Pearson's correlation analysis. Results: Thirty-eight "predominantly obsessive" (70%) and 39 ''mixed'' (72%) OCD subjects could be traced and evaluated. The course of illness was similar in the two subtypes. A majority of the sample (72%) did not have clinical OCD at follow-up. Conclusions: ''Predominantly obsessive'' subjects have a course similar to those with ''mixed'' OCD. Clinically, it is reassuring to know that obsessive subjects do not have an unfavorable course as was suggested by some previous studies. In this sample, course did not validate the subtyping method employed, but it would be premature to conclude that the subtyping method employed is incorrect based on the course alone. Prospective study of the course in larger samples and neurobiological and family-genetic data may help further validation.
  3 5,467 424
AWARD PAPERS
Acute and transient psychosis: A paradigmatic approach
Savita Malhotra
October-December 2007, 49(4):233-243
DOI:10.4103/0019-5545.37662  PMID:20680134
  2 14,571 1,938
Schizophrenia is a disorder of aberrant neurodevelopment: A synthesis of evidence from clinical and structural, functional and neurochemical brain imaging studies
Ganesan Venkatasubramanian
October-December 2007, 49(4):244-249
DOI:10.4103/0019-5545.37663  PMID:20680135
  2 7,475 813
ORIGINAL ARTICLES
Cannabis-related psychosis: Presentation and effect of abstinence
Vani Kulhalli, Mohan Isaac, Pratima Murthy
October-December 2007, 49(4):256-261
DOI:10.4103/0019-5545.37665  PMID:20680137
Background: The correlation between cannabis and negative mental health outcomes has been unequivocally established. Nevertheless, there is still a great need to research different dimensions of cannabis-related disorders, among which the study of cannabis-related psychosis is very important. There is a dearth of research regarding phenomenology and effect of abstinence, particularly from India. This study attempts to research the clinical presentation of cannabis-related psychosis and effect of abstinence. Aim: The aim of the present study was to document the clinical presentation of cannabis-related psychosis at presentation and after 7 days' abstinence from cannabis. Materials and Methods: Subjects with psychosis following cannabis use without any other prior or concurrent psychiatric disorder presenting to the outpatient department of a large tertiary care hospital were consecutively recruited for study. They were observed in a drug-free, protected environment for 7 days, during which clinical features were recorded using the Brief Psychiatric Rating Scale (BPRS). Results: Twenty male subjects were recruited and phenomenology was evaluated on the BPRS. Items with highest frequencies were unusual thought content (100%), excitement (75%), grandiosity (75%), hallucinatory behavior (70%) and uncooperativeness (65%). The least common symptoms were anxiety (5%), guilt feeling (5%), depressive mood (10%), motor retardation (10%) and blunted affect (30%). Nine subjects (45%) presented with cognitive dysfunction. Affective psychosis was the predominant diagnosis. At the end of 1 week of abstinence from cannabis, there was a significant decrease in scores. Significant improvement was observed in cognitive dysfunction, conceptual disorganization, grandiosity, tension, hostility, hallucinatory behavior and excitement. Conclusions: Cannabis-related psychosis presented with a predominantly affective psychosis and prominent thought disorder, excitement and violence. All subjects showed improvement in symptoms with abstinence from cannabis. A small heterogeneous sample and short duration of observation were the important limitations of this study.
  2 8,456 833
REVIEW ARTICLE
Clozapine: Current perspective
Ram K Solanki, Paramjeet Singh, Mukesh K Swami
October-December 2007, 49(4):271-276
DOI:10.4103/0019-5545.37668  PMID:20680140
The author conducted a review of studies that compared the efficacy, tolerability and indication for the use of clozapine in current perspectives for the treatment of resistant schizophrenia/ partial responders.
  2 6,964 781
LITERARY PSYCHIATRY
Compulsive gambling in ancient Indian texts
Ajit V Bhide
October-December 2007, 49(4):294-295
DOI:10.4103/0019-5545.37674  PMID:20680146
  1 3,097 276
ORIGINAL ARTICLES
Pesticide poisoning in non-fatal deliberate self-harm: A public health issue: Study from Sundarban delta, India
AN Chowdhury, Sohini Banerjee, Arabinda Brahma, MK Biswas
October-December 2007, 49(4):262-266
DOI:10.4103/0019-5545.37666  PMID:20680138
Background: Non-fatal deliberate self-harm (DSH), particularly with pesticides, is a major public health problem in many developing countries of the world. Agriculture is the primary occupation of most people living in the Sundarban region in West Bengal, India. Pesticides are extensively used in agriculture, and these agents are most frequently used in DSH. Aim: This study aimed to identify the nature of methods and agents used in non-fatal DSH attempts in the Sundarban area under South 24 Parganas district of West Bengal. Materials and Methods: Detailed demographic and clinical data on DSH cases of 13 Block Primary Health Centres' (BPHCs') admission registers were analyzed. One Focus Group Discussion (FGD) with the Panchayat Samiti of each block (totally 13 FDGs) was conducted to elicit the Samiti members' perception about the problem of pesticide-related DSH or suicide in the region. Results: A total of 5,178 (1,887 male and 3,291 female) subjects were admitted at the BPHCs during the study period from 1999 to 2001. Organophosphorous pesticide poisoning was found to be the most common method (85.1%) in DSH. This emphasizes the importance of developing an urgent poisoning-prevention program with a special focus on improving clinical services, as well as initiating farmers' education programs focusing on safe pesticide practices at the primary-care level.
  1 4,083 372
BRIEF COMMUNICATION
Repetitive love proposing: A case report and review of phenomenology of impulsivity and compulsivity
Narayana Manjunatha, Devvarta Kumar, Haque S Nizamie
October-December 2007, 49(4):267-270
DOI:10.4103/0019-5545.37667  PMID:20680139
Interest in opposite sex is a normal phenomenon; however, when this interest starts affecting one's own or others life in a pathological manner, it warrants clinical attention. We report the case of a young man who had a tendency to propose love to girls impulsively. Apart from the presence of this, otherwise, normal behavior in a pathological manner, another dimension of this case was that he was having obsessive-compulsive disorder too. Since both impulsivity and compulsivity are repetitive in nature and result in a sense of relief when the act is committed, the chance of impulsivity to be misconstrued as compulsivity is high. In light of important differences between compulsive and impulsive behavior, the psychopathology of the present case has been discussed.
  - 4,110 385
CASE REPORTS
A case of neuroleptic malignant syndrome induced by olanzapine in postpartum period
Mehmet Ustundag, Murat Orak, Cahfer Guloglu, Mustafa Burak Sayhan, Mahmut Tas
October-December 2007, 49(4):287-289
DOI:10.4103/0019-5545.37671  PMID:20680143
Neuroleptic malignant syndrome (NMS) is a life-threatening medical complication that occurs as a result of dopaminergic receptor blockage in nigrostriatal pathways. This syndrome is mainly accepted to be an idiosyncratic reaction for antipsychotic medications. Incidence of NMS induced by olanzapine - an atypical antipsychotic - is extremely rare. However, there has been contradiction on postpartum period as a risk factor for NMS. This case is of interest due to the fact that it happens on postpartum period and is induced by olanzapine. We aimed in this study to evaluate the successfully cured case of neuroleptic malignant syndrome induced by olanzapine in postpartum period with the literature view.
  - 3,782 264
Mania as an unique life event
Manu Arora, Piyali Mukherjee, Samir Kumar Praharaj, Vinod Kumar Sinha
October-December 2007, 49(4):290-291
DOI:10.4103/0019-5545.37672  PMID:20680144
Despite substantial evidence of relationship between life events and psychiatric illness in general and mood disorder in specific, none of the research has documented 'mania' itself as a life event in the onset of mania in a family member who is genetically vulnerable to the disorder. We describe three such cases that had strong temporal association between manic episode in the family member and subsequent manic episodes among the first-degree relatives. Mania as a life event might play a significant role as a precipitator towards the onset of mood disorder with a special impact on those who have vulnerability towards the disorder; the cases are discussed from both psychological and biological perspective.
  - 3,364 257
A case presented with "as if" phenomenon
Soumitra Ghosh, Kushal K Tamuli, Sabita Dihingia
October-December 2007, 49(4):292-293
DOI:10.4103/0019-5545.37673  PMID:20680145
A 22-year-old young male who was brought with a history of feeling of unreality, as if he himself and his surroundings had changed, since six months without any comorbid mental disorder or physical illness. Premorbidly he had some "obsessional traits". Mental state examination revealed perceptual disorder in the form of depersonalization and derealization with insight grade VI. The patient was admitted and treated with pharmacotherapy and behavior therapy (relaxation exercise).
  - 3,373 270
COMMENTARY
Proposal to the Indian Psychiatric Society for adopting a specialty section on addiction medicine (alcohol and other substance abuse)
Vivek Benegal, Alok Bajpai, Debasish Basu, Neelam Bohra, Sudipto Chatterji, RB Galgali, DS Goel, Mohan K Isaac, Venugopal Jhanwar, Rajkumar Lenin, PM Madhavan, AK Mittal, E Mohandas, Thyloth Murali, Pratima Murthy, Rajesh Nagpal, S Nambi, C Ram Subramaniam, Shubhangi Parkar, Prasad Rao, MS Reddy, Alok Sarin, TP Sudhakar, BM Tripathi, Matthew Varghese
October-December 2007, 49(4):277-282
DOI:10.4103/0019-5545.37669  PMID:20680141
  - 6,377 500
EDITOR SPEAKS
They also serve who stand and wait...
G Swaminath
October-December 2007, 49(4):227-227
DOI:10.4103/0019-5545.37659  PMID:20680131
  - 2,458 237
EDITORIAL
You can lead a horse to the water..
G Swaminath
October-December 2007, 49(4):228-230
DOI:10.4103/0019-5545.37660  PMID:20680132
  - 3,455 347
GUEST EDITORIAL
Criminal behavior: A dispassionate look at parental disciplinary practices
TS Sathyanarayana Rao
October-December 2007, 49(4):231-232
DOI:10.4103/0019-5545.37661  PMID:20680133
  - 4,411 425
LETTERS TO EDITOR
Rejoinder in reply to critical appraisal on "factitious schizophrenia"
Rajnish Raj, Balwant Singh Sidhu
October-December 2007, 49(4):296-297
DOI:10.4103/0019-5545.37675  PMID:20680147
  - 3,478 163
More on responsibility of psychiatrists in Indian setting
Prakash Gangdev
October-December 2007, 49(4):298-298
DOI:10.4103/0019-5545.37676  PMID:20680148
  - 1,710 183
A rare case of head (scalp) trauma with foreign body
Gurvinder Pal Singh
October-December 2007, 49(4):299-299
DOI:10.4103/0019-5545.37677  PMID:20680149
  - 2,348 150
VIEW POINT
Clinical practice guidelines for psychiatrists: Indian Psychiatric Society guidelines vs. international guidelines: A critical appraisal
Dishanter Goel, Jitendra Kumar Trivedi
October-December 2007, 49(4):283-286
DOI:10.4103/0019-5545.37670  PMID:20680142
Various guidelines have been proposed to assist psychiatrists all over the world in making appropriate health-care decisions. Though the fundamental premises of all guidelines are the same, yet they differ in certain important aspects; this hampers the universality of these guidelines. There are many internationally accepted guidelines which are based on robust research; still they do not necessarily address the geographical and cultural differences. This necessitates the formulation of regional guidelines, which usually lack the background of robust regional research. The Indian Psychiatric Society (IPS) guidelines were also formulated to cater to the needs of the Indian population. It is now almost three years old, and it is high time it should be compared to the international guidelines, so as to appraise ourselves of the success or shortcomings of the guidelines. This article critically analyzes the IPS guidelines in comparison with the available international guidelines and schematically brings out the positive points, as well as the shortcomings, with the aim of further improvement in our indigenous guidelines.
  - 6,798 790