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   2009| April-June  | Volume 51 | Issue 2  
    Online since April 21, 2009

 
 
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ORIGINAL ARTICLES
Incidence of childhood psychiatric disorders in India
Savita Malhotra, Adarsh Kohli, Mehak Kapoor, Basant Pradhan
April-June 2009, 51(2):101-107
DOI:10.4103/0019-5545.49449  PMID:19823628
Background: Studies on incidence of childhood mental disorders are extremely rare globally and there are none from India. Incidence studies though more difficult and time consuming, provide invaluable information on the pattern and causes of occurrence of mental disorders allowing opportunity for early intervention and primary prevention. Aim: This study aimed at estimating the incidence of psychiatric disorders in school children. Materials and Methods: A representative sample of school children was assessed through a two stage evaluation process involving teacher's rating (N=963) and parent rating (N=873). Children who scored below the cut-off for psychiatric disorder (N=727) on both the screening instruments were re-contacted six years later. 186 children and their families were personally available for reevaluation. All the children and their parents were re-assessed on Parent Interview Schedule; Strengths and Difficulties Questionnaire: and detailed clinical assessment by a psychiatrist. Psychiatric diagnosis was made as per ICD 10 criteria. Data on children who were found to have psychiatric disorder were compared with those who did not have psychiatric disorders. Results: 20 children out of 186 followed up had psychiatric disorder giving the annual incidence rate of 18/1000/yr. Children who had disorder at follow-up did not differ from those who did not on age, gender and psychological (temperament, parental handling, life stress and IQ) parameters at baseline. Discussion: Incidence figures cannot be compared due to lack of any comparable studies. Factors associated with occurrence of new cases of psychiatric disorder and implications for future studies are discussed.
  13 7,348 1,465
Effect of depression on sleep: Qualitative or quantitative?
Ravi Gupta, Sushant Dahiya, Manjeet Singh Bhatia
April-June 2009, 51(2):117-121
DOI:10.4103/0019-5545.49451  PMID:19823630
Background: The present study was designed to assess whether subjective sleep patterns differ between: (i) depressed patients and controls, and (ii) between subjects with different severity of depression. Based on available literature, it was hypothesized that sleep patterns must be different between the above mentioned groups. Materials and Methods: This study included 60 subjects with major depressive disorder and 40 subjects in the control group. Subjects with sleep disturbance secondary to any other factor, e.g ., medical illness, environmental factors, other psychiatric illness etc, were not included in the study. Depression severity was assessed in the subjects with depression with the help of Beck Depression Inventory II. Subjective sleep complaints were noted in the presence of a reliable informant, preferably bed partner. All the information was recorded in a semistructured performa. Statistical analysis was done with the help of SPSS v 11.0. The Chi square and Fisher exact tests were used for categorical variables; independent t-test and one way ANOVA were applied for numerical variables. Ordinal variables were analyzed using Mann Whitney U and Kruskall-Wallis tests. Results: Depression and control groups were similar in age ( P = 0.32) and gender ( P = 0.14) distribution. Subjects in the depression group had lesser total sleep time ( P = 0.001), longer sleep latency ( P = 0.001), frequent awakenings ( P = 0.04), greater wake-after-sleep onset and offset times (both P = 0.001), lesser sleep efficiency, and tended to wake up early (Mann Whitney U = 913.5; P = 0.05). Subjects with severe depression were different from the mild and moderate groups with regards to total sleep time ( P = 0.002), night-time sleep ( P = 0.007), and sleep efficiency ( P = 0.001) even when the three groups were comparable in age. Conclusion: Depression is associated with sleep disturbances, not only qualitatively, but also quantitatively. Sleep disturbance arises only after a critical level of depression is reached, and depression of varying severity may selectively affect different sleep parameters.
  9 3,814 593
Behavior profile of children with nephrotic syndrome
Prathama Guha, Arun De, Malay Ghosal
April-June 2009, 51(2):122-126
DOI:10.4103/0019-5545.49452  PMID:19823631
Background: Nephrotic syndrome, a primarily paediatric disease, is associated with a high relapse rate. Studies have reported behavioral and psychological difficulties in children with nephrotic syndrome, their caregivers and siblings, a factor that is likely to influence the overall outcome of the disease in an adverse manner. In clinical practice, however, the psychosocial aspects of care may be overlooked in the pressure to treat the disease process, unless their importance is stressed by appropriate evidence. Objectives: The study aims to assess the prevalence of behavior abnormalities in children with nephrotic syndrome attending the renal clinic of a state medical college in eastern India and to compare this with the prevalence in a control group of school children without any detectable physical illness. It also aims to explore the relationship between sociodemographic, disease, and treatment related variables and behavioral abnormalities in the nephrotic syndrome group. Materials and Methods: We assessed the prevalence of behavior abnormalities in 50 consecutive children with nephrotic syndrome attending the renal clinic of a state medical college and 51 school children as controls using the Developmental Psychopathology Checklist (DPCL). We also assessed the statistical association between sociodemographic, disease and treatment related variables and behavior profile in the nephrotic children group. Results: Prevalence of behavior disturbance in children with nephrotic syndrome was 68%, significantly higher than that in the control group (21.6%). The behavior abnormalities found in the nephrotic syndrome group were hyperkinesis, obsessive compulsive neurosis, conduct disorder, and emotional disorder, in that order. Frequency of relapse and low socioeconomic status showed significant association with presence of behavior disturbance in the nephrotic syndrome group. This association persisted even after adjusting for other sociodemographic, disease, and treatment related variables, including steroid therapy.
  9 5,836 607
CASE REPORTS
Memantine in the management of a clinically challenging case of bipolar disorder
Vivek Agarwal, Adarsh Tripathi
April-June 2009, 51(2):137-138
DOI:10.4103/0019-5545.49455  PMID:19823634
Use of memantine in bipolar disorders is not been studied except one case report. We report a case in which use of memantine lead to better medication tolerance and improvement in symptoms in bipolar disorder.
  8 2,778 303
Quetiapine: Relatively safe in overdose?
Surendra K Mattoo, Ruchita Shah, R Rajagopal, Partha Sarathy Biswas, Shubh Mohan Singh
April-June 2009, 51(2):139-140
DOI:10.4103/0019-5545.49456  PMID:19823635
Compared to other antipsychotics quetiapine has been reported to be relatively safer in overdose. We report a case with paranoid schizophrenia who attempted suicide with 1400 mg of quetiapine and manifested drowsiness, supraventricular tachycardia (167/minute) and minimal ST depression in leads V1 to V6 on ECG; all other physiological parameters were normal. Gastric lavage, lorazepam 2mg i/v to control agitation, and 14-hour observation in emergency ended in she being sent home. Subsequently she was successfully managed with ECTs, and quetiapine 600mg and risperidone 6mg daily. This report tends to support the literature suggesting quetiapine as a relatively-safer-in-overdose antipsychotic, and preferable in medication-overdose-suicidal-risk cases.
  7 4,749 317
PRESIDENTIAL ADDRESS
Promotion and prevention in child mental health
PC Shastri
April-June 2009, 51(2):88-95
DOI:10.4103/0019-5545.49447  PMID:19823626
  5 4,910 993
AWARD PAPER
Pattern of domestic violence amongst non-fatal deliberate self-harm attempters: A study from primary care of West Bengal
Arabinda N Chowdhury, Arabinda Brahma, S Banerjee, MK Biswas
April-June 2009, 51(2):96-100
DOI:10.4103/0019-5545.49448  PMID:19823627
Objective : Evaluation of various clinico-demographic variables and pattern of domestic violence in non-fatal deliberate self-harm (DSH) attempters admitted in 3 Block Primary Health Centers (BPHC) of Sundarban region of West Bengal, India in the year 2002. Materials and Methods: A prospective study of 89 DSH cases admitted at 3 Sundarban BPHCs by using a specially designed DSH register and a questionnaire on domestic violence in Bengali along with detail clinical interview. Results: Among the total of 89 DSH cases (23 male and 66 female), young (less than 30 years), female sex, low education and married status constituted major part of the sample. Pesticide poisoning was the commonest mode of DSH attempt. Typical stressors found were marital conflict or conflict with in-laws or guardian. A majority of DSH attempters (69.6%) experienced more than one form of domestic violence. Poverty and unemployment in the family were strongly associated with domestic violence. Among female DSH attempters, the most common perpetrator was husband (48.48%) followed by in-laws (16.67%) and parent (34.78%) was the most common perpetrator among males. Conclusion: Both DSH and domestic violence are serious socio-clinical issue of a major public health concern in the Sundarban region. Stressful life situations and various types of victimizations in the family intermixed with easy availability of lethal pesticides in this agriculture dependent community may facilitate the impulse of self-harm behavior, especially among the young housewives. Timely psychosocial intervention through community psychiatry program may mitigate the impact of psycho-cultural stressors and thus may help to reduce the morbidity and mortality from DSH.
  4 3,631 569
CULTURAL PSYCHIATRY
Forgiveness: A note for psychiatrists
Prakash Gangdev
April-June 2009, 51(2):153-156
DOI:10.4103/0019-5545.49459  PMID:19823638
Although forgiveness has received a lot of attention in the past two decades and its role in physical and mental health is being increasingly recognized, psychiatrists are unaware of its therapeutic benefits. A literature review was conducted with a view to create awareness of the recent advances in forgiveness research. Although forgiveness has been shown to be beneficial, more research is required, especially in the psychiatric setting. The role of resentment and bitterness in the causation of psychiatric disorders remain largely unevaluated and requires further study.
  4 5,479 420
LETTERS TO EDITOR
Inhalant abuse: An overlooked problem
Sumit K Gupta, Sonali Bali, RC Jiloha
April-June 2009, 51(2):160-161
DOI:10.4103/0019-5545.49463  PMID:19823642
  4 2,510 304
Treatment of Tardive Dyskinesia by tetrabenazine, clonazepam and vitamin E
Himanshu Sharma
April-June 2009, 51(2):162-163
DOI:10.4103/0019-5545.49466  PMID:19823645
  4 4,361 428
GUEST EDITORIAL
Retrospective introspection
M Thirunavukarasu, Pragatheeshwar Thirunavukarasu
April-June 2009, 51(2):85-87
DOI:10.4103/0019-5545.49446  PMID:19823625
  3 1,991 250
EDITORIAL
New drug discovery for Alzheimer's disease: Challenges and hopes
TS Sathyanarayana Rao, K Jagannatha Rao
April-June 2009, 51(2):79-81
DOI:10.4103/0019-5545.49444  PMID:19823623
  2 3,159 616
LETTERS TO EDITOR
CATIE and CUtLASS (UK): Is it time psychiatrists start changing their practice?- The debate goes on!
Rupak Dasgupta, Charu Dasgupta
April-June 2009, 51(2):161-162
DOI:10.4103/0019-5545.49464  PMID:19823643
  2 2,315 331
ORIGINAL ARTICLES
Cognitive behavior therapy in the treatment of panic disorder
M Manjula, V Kumariah, P.S.D.V Prasadarao, R Raguram
April-June 2009, 51(2):108-116
DOI:10.4103/0019-5545.49450  PMID:19823629
Background: Comprehensive cognitive behavior therapies have been proved to be more effective than behavioral interventions. However, the efficacy of CBT is not studied in the Indian context and also, the amount of change brought about by CBT is not known. Aims: This study aims to examine the efficacy of cognitive behavioral intervention (CBI) in the treatment of panic disorder. Our specific objectives were to assess the effectiveness of CBI in reducing symptom severity as well as cognitions related to panic and panic-related behaviors. Design: The study adopted a two-group comparison with pre- and postassessments design. Materials and Methods: The sample consisted of 30 patients sequentially allotted to the CBI (n = 15) and behavioral intervention (BI, n = 15) groups. Assessment was done using a semistructured interview schedule, panic disorder severity scale, Texas panic attack record form, Anxiety Sensitivity Index, Agoraphobic cognitions questionnaire, Behavioral avoidance checklist, and Panic appraisal inventory. The CBI group was provided with comprehensive cognitive behavior therapy and the BI group with psycho-education and applied relaxation. Results: CBI was found to be superior to BI in the reduction of panic symptoms, behavioral avoidance, safety behaviors, and cognitions. A large percentage of the CBI group patients met the criteria for clinically significant change with a large magnitude of change. Conclusion: Multicomponent CBI is superior to BI in terms of the amount of change it brings about with respect to panic symptoms, avoidance, safety behaviors, and cognitions.
  2 5,726 664
BRIEF RESEARCH COMMUNICATIONS
Systematic enhancement of functioning as a therapeutic technique in conversion disorder
Chittaranjan Andrade, Savita G Bhakta, Nagendra M Singh
April-June 2009, 51(2):134-136
DOI:10.4103/0019-5545.49454  PMID:19823633
To explicitly outline a therapeutic technique for symptom removal in conversion disorder. We describe one patient with conversion dumbness and another with conversion paraplegia. The first patient was successfully treated in a single session, and the second was successfully treated across two weeks, both using systematic enhancement of functioning as a technique for symptom removal. This technique encourages the patient to express the desired behavior to whatever extent possible; subsequently, the patient is encouraged to gradually amplify the response until normal levels of functioning are achieved. The technique outlined is simple and practical but nevertheless receives no mention in conversion disorder literature. The technique can be applied to any situation in which behavioral amplification is desired.
  1 2,052 313
LETTERS TO EDITOR
Excessive sweating in a male patient caused by milnacipran
Yutaka Shinohara
April-June 2009, 51(2):162-162
DOI:10.4103/0019-5545.49465  PMID:19823644
  1 2,021 176
Unusual foreign body in the ear in an adult patient with psychiatric illness
Sanjay Arora, Sandeep Kumar Goyal
April-June 2009, 51(2):164-164
DOI:10.4103/0019-5545.49467  PMID:19823646
  1 1,669 142
ORIGINAL ARTICLES
Views about clinical practice guidelines of the Indian Psychiatric Society: A survey of psychiatrists in India
Sandeep Grover, Ajit Avasthi
April-June 2009, 51(2):127-133
DOI:10.4103/0019-5545.49453  PMID:19823632
Background: The Indian Psychiatric Society (IPS) constituted a task force on clinical practice guidelines (CPGs) in 2004 to formulate guidelines for management of various psychiatric disorders in the Indian setting. Over the next 4 years (2005-2008), the task force published 4 volumes of guidelines covering most of the psychiatric disorders and issues in special populations. However, till now, nothing is known about the usefulness, awareness and their implementation. This was a preliminary survey to know about the usefulness and awareness of the CPGs of the IPS. Materials and Methods: An email survey was sent to 1100 psychiatrists, of which 107 responded. Results: Only half of the responders were aware about all the 4 volumes of the guidelines and only 12.7% of the responders had read all the four volumes. About two-thirds of the responders had referred to these guidelines in their clinical practice, either occasionally (46.1%), often (16.7%) or always (2%). Similarly, more than two-thirds of the responders considered these guidelines to be helpful in making day-to-day clinical decisions in their practice, either occasionally (48%), often (19.6%) or always (3.9%). In the open-ended questions, many of the responders discussed their dissatisfaction with these guidelines and gave suggestions as to how these guidelines could be improved. Conclusion: There is need for better dissemination of the guidelines and making recommendations that can be applied in an Indian setting.
  1 2,935 446
PSYCHIATRIC PEARLS
Old but still gold: Lithium in stabilizing the mood
Richard Balon
April-June 2009, 51(2):157-158
DOI:10.4103/0019-5545.49460  PMID:19823639
  1 1,593 312
BOOK REVIEW
Understanding burnout
R Srinivasa Murthy
April-June 2009, 51(2):165-166
  - 1,592 301
CME
History, mystery and chemistry of eroticism: Emphasis on sexual health and dysfunction
MR Asha, G Hithamani, R Rashmi, KH Basavaraj, KS Jagannath Rao, TS Sathyanarayana Rao
April-June 2009, 51(2):141-149
DOI:10.4103/0019-5545.49457  PMID:19823636
  - 6,016 697
LETTERS TO EDITOR
The study of consciousness is an integral part of the Indian heritage
MR Asha
April-June 2009, 51(2):159-159
DOI:10.4103/0019-5545.49461  PMID:19823640
  - 1,436 160
Author's reply
Ravi Prakash
April-June 2009, 51(2):159-160
DOI:10.4103/0019-5545.49462  PMID:19823641
  - 1,639 171
PERISCOPE: ASSISTANT EDITORS COLUMN
Stickiness of the blues: Chronicity of depression
G Swaminath
April-June 2009, 51(2):82-84
DOI:10.4103/0019-5545.49445  PMID:19823624
  - 2,168 354
PG CME
Depression and schizophrenia
Chittaranjan Andrade
April-June 2009, 51(2):150-152
DOI:10.4103/0019-5545.49458  PMID:19823637
  - 2,807 652