Indian Journal of PsychiatryIndian Journal of Psychiatry
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   2011| January-March  | Volume 53 | Issue 1  
    Online since January 13, 2011

 
 
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CURRENT THEME
"Attenuated psychotic symptoms syndrome" as a risk syndrome of psychosis, diagnosis in DSM-V: The debate
Amresh Shrivastava, PD McGorry, Ming Tsuang, Scott W Woods, Barbara A Cornblatt, Cheryl Corcoran, William Carpenter
January-March 2011, 53(1):57-65
DOI:10.4103/0019-5545.75560  PMID:21431011
Schizophrenia is a common disorder, affecting approximately 1 out of every 100 people, with a typical onset during adolescence and early adulthood. The personal and societal costs of schizophrenia are extremely high. Prevention of schizophrenia, would offer substantial benefits to patients, their family members, and the community at large. The prodromal phase of schizophrenia has been recognized since the 19th century. At-risk individuals for psychosis and schizophrenia are the subjects who can provide information for intervention prior to development of frank psychosis. This approach is currently being investigated. The question remains, however, whether it can be a diagnostic category by itself. The proposal for including the risk syndrome is one of the recommendations by the working group on schizophrenia and psychotic disorders for the forthcoming DSM-V. There are differing views in academia regarding this proposal. Prior to becoming fully psychotic, a consistent literature demonstrates that patients generally had suffered from accelerating attenuated symptoms and distress. It is important that the prodromal phase be accurately recognized in order to accomplish the goal of prevention. We can then purposefully engage in early intervention aiming toward prevention. A recent strong resurgent interest in this area stems largely from two developments: First, the identification of the neurobiological deficit processes associated with the severity and chronicity of schizophrenia, and second, the development of reliable criteria for diagnosis. Although the general at-risk construct appears to offer great potential to advance both the treatment and research dealing with psychotic illnesses, it seems premature to many researchers to include the syndrome as an established entity in the text of the new DSM-V. It would be far more appropriate to include this proposed syndrome in the appendix and evaluate the many contemporary issues in future studies. The main issues involved in this discussion are the clinical validity of the syndrome, concern about stigma and unnecessary treatment, and need for responding to patients' distress in addition to the ethical dilemma. In this review we examine the issue of inclusion of the risk syndrome as a diagnosis.
  11 4,866 381
BRIEF RESEARCH COMMUNICATION
Identifying the 'mentally disabled' in the community: How much more is to be imparted to the internees in training?
Annigeri Bindu, TS Sathyanarayana Rao, NC Ashok, AK Prabhakar, L. S. S Manickam
January-March 2011, 53(1):53-56
DOI:10.4103/0019-5545.75562  PMID:21431010
Background: Studies have been conducted on the skills of physicians in general hospitals in identifying mental disorders,but there are no studies assessing the proficiency of internees in identifying mental disorders. Aim: To confirm the diagnosis of the cases identified by 40 internees in the community as 'mentally disabled'. Materials and Methods: Of 15,583 people,29 were identified in the community by the internees as 'mentally disabled'. This was followed by home visits to the houses of these 29 individuals conducted by two qualified psychiatrists and one clinical psychologist, and these cases were screened for their psychiatric status using MINI Plus. Results: Most of the cases identified by internees as having 'mental disability' were cases of mental retardation and the others were mood and psychotic disorders and epilepsy. Cases of mental retardation and mental disorders other than those identified by the internees could also be identified while visiting the respective geographical areas. Conclusions: There is a need to hone the skills of the medical students during the course of their training in identifying cases of mental retardation, severe as well as minor psychiatric disorders, as a part of their training. There is also a need for the use of structured scales for the same.
  9 2,007 222
ORIGINAL ARTICLES
A preliminary study of factors affecting adherence to medication in clinic children with attention-deficit/hyperactivity disorder
Prabhat Sitholey, Vivek Agarwal, Suneel Chamoli
January-March 2011, 53(1):41-44
DOI:10.4103/0019-5545.75561  PMID:21431007
Background: Attention-deficit/hyperactivity disorder (ADHD) is a common and chronic condition requiring long-term management. However, nonadherence to treatment and its reasons have not been studied in Indian children with ADHD. Objective: To identify the factors affecting adherence to medication in clinic children and adolescents with ADHD. Methods and Materials: Twenty-four children and adolescents newly diagnosed with ADHD on Kiddie schedule for affective disorders and schizophrenia - present and lifetime - were prescribed medication on an outpatient basis and followed-up to check their adherence to medication. Information regarding adherence was obtained from the parents on a proforma to assess the factors affecting the adherence to medication. Results: Twenty (83.3%) subjects were nonadherent within the first month. The most common reasons as given by the parents for nonadherence to treatment were side-effects of medication in 13 (65%), lack of effectiveness of medication in 10 (50%), problems in hospital, like long waiting time and procedural delay, in 10 (50%), fear that the child will become addicted to medication in nine (45%), problems in accessing medication in eight (40%), careless attitude of caregivers in eight (40%) and high cost of medication in eight (40%). Conclusions: The rate of adherence to medication in this short-term follow-up of newly diagnosed children with ADHD was very low. Other than the commonly reported reasons in Western countries, there were some sociocultural and local reasons for nonadherence to treatment in our country. Efforts are needed to improve adherence to medication in children with ADHD.
  6 2,623 275
Status of disulfiram in present day alcoholic deaddiction therapy
Princy Louis Palatty, Elroy Saldanha
January-March 2011, 53(1):25-29
DOI:10.4103/0019-5545.75557  PMID:21431004
Aim: Assessment of safety and efficacy profile of disulfiram (DSM) in the alcoholic de-addiction regimen. Objectives: a . Assessment of Adverse Drug Reaction (ADR) profile; b. Evaluation of effectiveness of various de-addiction regimen; c. Defaulters and dropouts Patients and Methods: Fifty-one patients in a de-addiction center were investigated on 0 th , 30 th and 60 th day along with psychiatric evaluation, ADR surveillance was made. Statistical analysis was done thereafter. Results: 125 mg DSM given OD for 2 months. 76.5% patients had taken full course of treatment, 45% didn't complain of any ADR. Of ADR reported 27.4% had drowsiness, 21.4% tiredness, 7.8% skin manifestation. Conclusion: DSM is the main drug among naltrexone, acamprosate, nalmefene and other drugs used in alcoholic de-addiction. Relative and effectiveness is lost by the degree of dropouts and hence relapses. Low-dose DSM had decreased adverse effects with 76.5% patients taking the full course of treatment. DSM alters liver functions as there were significant changes in the lab parameters of SGPT(P=0.007), SGOT(P=0.001), GGT(P=<0.001) between first and third samples. Occurrence of ADR is not the cause of default; patients find it confusing to differentiate between the symptoms of alcohol withdrawal and those due to ADR of DSM.
  5 6,403 640
Phenomenology and treatment of Catatonia: A descriptive study from north India
Alakananda Dutt, Sandeep Grover, Subho Chakrabarti, Ajit Avasthi, Suresh Kumar
January-March 2011, 53(1):36-40
DOI:10.4103/0019-5545.75559  PMID:21431006
Background: Studies on clinical features of catatonia in the Indian population are few in number. Aim: To study the phenomenology, clinical profile and treatment response of subjects admitted to the psychiatry inpatient with catatonia. Materials and Methods: Detailed treatment records of all the inpatients were scanned for the period January 2004 to December 2008. Patients with catatonia (diagnosed as two symptoms as per the Bush Francis Catatonia Rating scale) were included. Results: During the study period, 1056 subjects were admitted in the inpatient unit, of which 51 (4.8% of the total admissions) had catatonic features and had been rated on the Bush Francis Catatonia Rating scale. The mean age of the sample was 30.02 years (SD=14.6; range 13-69), with an almost equal gender ratio. Most of the patients presenting with catatonia were diagnosed as having psychotic disorders (40; 74.8%), of which the most common diagnosis was schizophrenia (27; 52.9%) of the catatonic subtype (20; 39.2%). Three subjects with primary diagnosis of a psychotic disorder had comorbid depression. Other diagnoses included mood disorders (7; 13.72%) and organic brain syndromes (04; 7.9%). According to the Bush Francis Rating scale, the common signs and symptoms exhibited by the subjects were mutism (94.1%), followed by immobility/stupor (78.5%), staring (78.4%), negativism (74.5%), rigidity (63%) and posturing/catalepsy (61.8%). All the patients were initially treated with lorazepam. Electroconvulsive therapy was required in most cases (42; 82.35%). Conclusion: The common symptoms of catatonia are mutism, immobility/stupor, staring, posturing, negativism and rigidity. The most common underlying psychiatric diagnosis was schizophrenia.
  4 5,590 582
BRIEF RESEARCH COMMUNICATION
Catatonia, schizophrenia, and affective disorders - Diagnostic associations in different cultural settings
Padmaja Chalasani, Karthikeya Krishnamurthy, Healy David
January-March 2011, 53(1):49-52
DOI:10.4103/0019-5545.75564  PMID:21431009
The nosological status of catatonia in modern classificatory systems and the influence of culture on its presentation are not fully understood. A secondary analysis of the data collected for another study that looked at the incidence of catatonia in India and Wales was performed to examine the association of catatonia to ICD 10 F diagnostic categories in two different cultural settings. The most common clinical diagnosis assigned by clinicians in India was from ICD10 F 20, while in Wales it was from ICD10 F30. The differences between the two settings were found in the F20 group. Association of catatonia appears to be more consistent with affective disorders in the two settings, but not with schizophrenia spectrum disorders. The findings are subjected to the limitations of secondary analysis.
  3 1,984 216
EDITORIAL
Standard operating procedures for clinical practice
TS Sathyanarayana Rao, Rajiv Radhakrishnan, Chittaranjan Andrade
January-March 2011, 53(1):1-3
DOI:10.4103/0019-5545.75542  PMID:21430999
  3 4,069 494
GUEST EDITORIAL
Relevance of para-psychology in psychiatric practice
Satwant K Pasricha
January-March 2011, 53(1):4-8
DOI:10.4103/0019-5545.75544  PMID:21431000
  3 4,137 543
ORIGINAL ARTICLES
Efficacy of psychosocial rehabilitation program: The RFS experience
Rupasri Chowdur, Ramaprasad Dharitri, S Kalyanasundaram, N Suryanarayana Rao
January-March 2011, 53(1):45-48
DOI:10.4103/0019-5545.75563  PMID:21431008
Background: People with severe and persistent mental illness need help in most aspects of their lives, as the disability associated with these diseases can be debilitating. Psychosocial rehabilitation interventions aim to help them relearn skills that would reduce disabilities so that they can be reintegrated into society. Objective: To study the efficacy of the rehabilitation program at the Richmond Fellowship Society (RFS) 'ASHA' half-way home. Subjects: Fifty-four clients diagnosed with either schizophrenia or affective disorder who stayed at the half-way home for more than 6 months. Materials and Methods: A retrospective evaluative approach was followed. An evaluation checklist was developed for the purpose and this was used to assess the level of functioning of the clients. A paired sample t-test was used to score changes in client progress between admission and discharge. Results: Significant improvement ( P≤.05 level) was noticed on all the parameters from baseline to discharge. Conclusion : The psychosocial rehabilitation program at the RFS half-way home has a beneficial effect.
  3 2,786 418
RESEARCH AND TRAINING -1
A 6-week, multicentre, randomized controlled clinical trial to evaluate the safety and efficacy of placeboxetine hydrochloride in the treatment of major depressive disorder in an Indian setting
Chittaranjan Andrade
January-March 2011, 53(1):69-72
DOI:10.4103/0019-5545.75555  PMID:21431013
Introduction: This paper describes a fictitious study of a fictitious drug. A companion paper in this issue of the Indian J Psychiatry critically examines this paper and provides author, reader, reviewer, and researcher perspectives on problems related to the design and conduct of a clinical trial; on issues related to the analysis of data; on how to write a research paper; and on how to critically read or review a journal article. Readers are invited to appraise this paper and then compare their assessment with that presented in the companion paper. Background: This study sought to compare the safety and efficacy of placeboxetine (PB) hydrochloride extended release capsules with sertraline hydrochloride in patients diagnosed with major depressive disorder in 15 general hospitals in south India. Materials and Methods: In a prospective, open-label, 15-center, randomized controlled clinical trial, consecutive outpatients diagnosed with major depressive disorder of at least moderate severity were randomized 1:1 to receive flexible doses of either PB or sertraline once each morning. Patients were evaluated every two weeks, until the study endpoint, using the Hamilton Rating Scale for Depression (HAM-D) and the Montgomery-Asberg Rating Scale (MADRS). Safety was determined through assessments of vital signs, adverse events, study discontinuation rates, hematological parameters, metabolic parameters, electrocardiography, and other measures. Results: Ten patients dropped out of the study from each treatment arm. There was a significant, marked improvement in HAM-D and MADRS scores in each group by the treatment endpoint. There was no significant difference between PB and sertraline groups on either HAM-D or MADRS at any visit. The response rate was 90% with PB and 92% with sertraline. The remission rate was 70% with PB and 75% with sertraline. All laboratory parameters were within normal limits in all patients. There were no serious adverse events. Conclusions: Placeboxetine is as safe and effective as sertraline in Indian patients with major depressive disorder.
  3 2,657 275
ORIGINAL ARTICLES
Are the effects of cannabis dependence on glucose metabolism similar to schizophrenia? An FDG PET understanding
Shubhangi R Parkar, Seethalakshmi Ramanathan, Narendra Nair, Shefali A Batra, Shilpa A Adarkar, Purushottam Kund, Nawab Singh Baghel, SH Moghe
January-March 2011, 53(1):13-20
DOI:10.4103/0019-5545.75552  PMID:21431002
Background: Cannabis has been associated with transient psychotic states; however, the causal relationship between cannabis and schizophrenia continues to remain a matter of debate. Epidemiological and some biological studies hint at cannabis being an independent risk factor for schizophrenia; this has not been definitively proved. Aims: We aimed to understand the patterns of glucose uptake in important brain regions among individuals with cannabis dependence and schizophrenia. Furthermore, we compared the interregional metabolic rates in pertinent neural circuits among individuals with cannabis dependence, schizophrenia and normal controls. Setting and Design : This is a case-control cross-sectional study that was carried out by a general psychiatry department in collaboration with a nuclear diagnosis unit. Materials and Methods: Male volunteers with cannabis dependence, schizophrenia and normal controls underwent FDG PET scanning. Glucose uptakes in pre-selected regions of interest were compared using MANOVA. Finally, Chow tests were used to compare interregional metabolic relationships in the mesocortical and cortical-subcortical-cerebellum circuits. Results: Significant differences (P<0.05) were noted among individuals with cannabis dependence and schizophrenia in the medial and lateral temporal regions. When the neural circuits were compared, significant interregional differences (P<0.05) were noted between individuals with cannabis dependence and normal controls. However, among individuals with cannabis dependence and schizophrenia, no significant differences (P>0.05) were noted in these patterns. Conclusions: Our findings suggest that cannabis dependence can alter interregional relationships in a manner similar to schizophrenia. This indicates that cannabis could potentially play a role in the development of psychosis by altering neural circuits.
  2 3,413 355
Problem-solving counseling as a therapeutic tool on youth suicidal behavior in the suburban population in Sri Lanka
EA Perera Ramani, Samudra T Kathriarachchi
January-March 2011, 53(1):30-35
DOI:10.4103/0019-5545.75558  PMID:21431005
Background: Suicidal behaviour among youth is a major public health concern in Sri Lanka. Prevention of youth suicides using effective, feasible and culturally acceptable methods is invaluable in this regard, however research in this area is grossly lacking. Objective: This study aimed at determining the effectiveness of problem solving counselling as a therapeutic intervention in prevention of youth suicidal behaviour in Sri Lanka. Setting and design: This control trial study was based on hospital admissions with suicidal attempts in a sub-urban hospital in Sri Lanka. The study was carried out at Base Hospital Homagama. Materials and Methods: A sample of 124 was recruited using convenience sampling method and divided into two groups, experimental and control. Control group was offered routine care and experimental group received four sessions of problem solving counselling over one month. Outcome of both groups was measured, six months after the initial screening, using the visual analogue scale. Results: Individualized outcome measures on problem solving counselling showed that problem solving ability among the subjects in the experimental group had improved after four counselling sessions and suicidal behaviour has been reduced. The results are statistically significant. Conclusion: This Study confirms that problem solving counselling is an effective therapeutic tool in management of youth suicidal behaviour in hospital setting in a developing country.
  2 2,481 256
PERISCOPE
Medical errors II, the aftermath: Mea culpa!
G Swaminath, R Raguram
January-March 2011, 53(1):9-12
DOI:10.4103/0019-5545.75547  PMID:21431001
  2 2,221 160
RESEARCH AND TRAINING -2
Placeboxetine for major depressive disorder: Researcher, author, reader, and reviewer perspectives on randomized controlled trials
Chittaranjan Andrade
January-March 2011, 53(1):73-76
DOI:10.4103/0019-5545.75553  PMID:21431014
Background: Postgraduate students, budding authors, clinicians who read journals, and new reviewers need to develop skills in reading, writing, and reviewing papers that describe randomized controlled trials (RCTs). Materials and Methods: This commentary critically examines a specially-written paper (published in the same issue of this journal) that describes a fictitious, industry-driven, multicentre RCT comparing the fictitious antidepressant placeboxetine with sertraline in Indian patients with major depressive disorder. Readers are invited to independently assess the RCT paper before they continue with this commentary. Results: Scientific aspects of the design and execution of the RCT are examined in the context of ethical issues in research. Comments and suggestions are offered on issues such as the statistical handling of data, manuscript content, and manuscript writing style. The reader's attention is drawn to subtle and not-so-subtle errors, as well as to curiosities in the data. Conclusions: It is hoped that this practical commentary on research design, execution, analysis, and reporting, based on specific examples, will benefit researchers, authors, readers, and reviewers more than guidance delivered in the form of general advice.
  2 2,076 227
HISTORY PAGE
The seeds of creativity and the soil of poet Kannadasan
O Somasundaram
January-March 2011, 53(1):82-86
DOI:10.4103/0019-5545.75545  PMID:21431020
The links between creative genius and insanity have been studied by numerous experts and famous writers. Recent studies by several psychiatrists have revealed an increase in psychopathology in creative artists, especially writers and poets. The cyclothymic temperamental traits of a Tamil poet, Kannadasan, are studied here.
  1 3,195 161
LETTERS TO EDITOR
How prayer works
Amlan Kusum Jana
January-March 2011, 53(1):79-79
DOI:10.4103/0019-5545.75549  PMID:21431017
  1 1,552 202
BOOK REVIEWS
Can the world afford autistic spectrum disorder? Nonverbal communication, Asperger syndrome and the interbrain
Alakananda Dutt, Sandeep Grover
January-March 2011, 53(1):87-88
  - 1,510 129
Can the mind survive beyond death? In pursuit of scientific evidence
Nand Kishore
January-March 2011, 53(1):89-90
  - 2,130 161
Children of a better god
R Srinivasa Murthy
January-March 2011, 53(1):91-92
  - 1,483 116
CASE REPORT
Tourette's disease with impulse control disorder
Rajnish Raj, Balwant Singh Sidhu
January-March 2011, 53(1):66-68
DOI:10.4103/0019-5545.75556  PMID:21431012
We report a case of Tourette's disease (TD) with impulse control disorder which is rare;these type of patients are prone to rage attack and explosive outbursts in the childhood and adolescence which can be detrimental. Hence, a case is reported to understand the phenomenology of its co-morbidity in TD.
  - 3,147 227
LETTERS TO EDITOR
Deliberate self-harm and domestic violence: Some answers needed
Om Prakash, C Guru Prasad
January-March 2011, 53(1):77-77
DOI:10.4103/0019-5545.75546  PMID:21431016
  - 1,403 193
Universal mental health program: An extension of life skills education to promote child mental health
Narayana Manjunatha, Sahoo Saddichha
January-March 2011, 53(1):77-78
DOI:10.4103/0019-5545.75548  PMID:21431015
  - 1,559 220
Study of menstrual irregularities in patients receiving antipsychotic medications
Mukund P Murke, Suhas M Gajbhiye, Ameya U Amritwar, Smita R Gautam
January-March 2011, 53(1):79-80
DOI:10.4103/0019-5545.75550  PMID:21431018
  - 1,251 155
Lorazepam-induced prolonged apnea after ECT-induced prolonged seizure
Dattatreya Dhavale, Vidyadhar Watve, Chittaranjan Andrade
January-March 2011, 53(1):80-81
DOI:10.4103/0019-5545.75551  PMID:21431019
  - 1,415 111
ORIGINAL ARTICLES
Do attitudes of families concerned influence features of children who claim to remember previous lives?
Satwant K Pasricha
January-March 2011, 53(1):21-24
DOI:10.4103/0019-5545.75554  PMID:21431003
Background: Reported cases of nearly 2600 children (subjects) who claim to remember previous lives have been investigated in cultures with and without belief in reincarnation. The authenticity in most cases has been established. Aims: To study the influence of attitudes of parents of the subjects, families of the deceased person with whom they are identified and attention paid by others on the features of the cases. Settings and Design: The study is based on field investigations. Materials and Methods: Data is derived from analysis of a larger series of an ongoing project. Information on initial and subsequent attitudes of subjects' mothers was available for 292 and 136 cases, respectively; attitudes of 227 families of deceased person (previous personality) with whom he is identified, and the extent of attention received from outsiders for 252 cases. Observations and interviews with multiple firsthand informants on both sides of the case as well as some neutral informants supplemented by examination of objective data were the chief methods of investigation. Results: The initial attitude of mothers varied from encouragement (21%) to neutral or tolerance (51%) to discouragement (28%). However, it changed significantly from neutrality to taking measures to induce amnesia in their children for previous life memories due to various psychosocial pressures and prevalent beliefs. Families of the previous personalities, once convinced, showed complete acceptance in a majority of cases. Outside attention was received in 58% cases. Conclusions: The positive attitude of parents might facilitate expression of memories but subsequently attitudes of persons concerned do not seem to alter features of the cases.
  - 2,435 242