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   2011| October-December  | Volume 53 | Issue 4  
    Online since January 16, 2012

 
 
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AWARD PAPER
Sexuality: Desire, activity and intimacy in the elderly
Gurvinder Kalra, Alka Subramanyam, Charles Pinto
October-December 2011, 53(4):300-306
DOI:10.4103/0019-5545.91902  PMID:22303037
Background: Sexual function and activity in old age have been inadequately studied world over. It is important to know that aging processes are not confined to persons beyond the age of 60 years; many changes in elderly have their antecedents in the middle age. Aims: This study sought to determine the patterns of sexual activity and function in individuals over 50 years of age. It also sought to discuss barriers such as chronic illness that may interfere with sexual function. Materials and Methods: We conducted a study of subjects above the age of 50 years in various outpatient departments (OPDs) of a teaching municipal hospital in Mumbai, by interviewing 60 individuals who attended the OPDs, after taking their informed consent. Socio-demographic and other information on their sexual function and activities were obtained. Data was analyzed using statistical package for social sciences v15. Results: 72% individuals below 60 were sexually active, while only 57% above 60 were active. Others had become completely abstinent at some time in their lives. Statistical analysis revealed significant gender, health and educational status based differences in the sample. Conclusion: Our study showed significant presence of sexual desire, activity and function even after the age of 50 years; a decline by the age of 60 and above was a finding that reflected more in women. Chronic illness did affect sexual function and desire.
  6,988 693 -
CME
Maternal mental health in pregnancy and child behavior
Veena A Satyanarayana, Ammu Lukose, K Srinivasan
October-December 2011, 53(4):351-361
DOI:10.4103/0019-5545.91911  PMID:22303046
Maternal mental health research is a public health priority due to its impact on both maternal and child health. Despite the growing number of empirical studies in this area, particularly from developing countries, there is a paucity of synthetic review articles. Therefore, attempting to synthesize the existing literature in this area seems relevant to appraise the readers of the field's progress and to infer directions for future research. The present review aims to provide an overview of the literature on maternal mental health and its association with birth outcomes and child behavior. Specifically, the literature on mental health during pregnancy and in the postpartum period and its influence on birth outcomes and child behavior have been reviewed. Further, a conceptual and methodological evaluation of the existing literature has been provided to identify gaps in the literature and to suggest directions for future research.
  5,893 608 4
ORIGINAL ARTICLES
Myths, beliefs and perceptions about mental disorders and health-seeking behavior in Delhi, India
Jugal Kishore, Avni Gupta, Ram Chander Jiloha, Patrick Bantman
October-December 2011, 53(4):324-329
DOI:10.4103/0019-5545.91906  PMID:22303041
Objectives: To assess the myths, beliefs and perceptions about mental disorders and health-seeking behavior in general population and medical professionals of India. Materials and Methods: A cross-sectional study was carried out with a sample of 436 subjects (360 subjects from urban and rural communities of Delhi and 76 medical professionals working in different organizations in Delhi). A pre-tested questionnaire consisting items on perceptions, myths, and beliefs about causes, treatment, and health-seeking behavior for mental disorders was used. The collected data were statistically analyzed using computer software package Epi-info. Appropriate tests of significance were applied to detect any significant association. Results: The mental disorders were thought to be because of loss of semen or vaginal secretion (33.9% rural, 8.6% urban, 1.3% professionals), less sexual desire (23.7% rural, 18% urban), excessive masturbation (15.3% rural, 9.8% urban), God's punishment for their past sins (39.6% rural, 20.7% urban, 5.2% professionals), and polluted air (51.5% rural, 11.5% urban, 5.2% professionals). More people (37.7%) living in joint families than in nuclear families (26.5%) believed that sadness and unhappiness cause mental disorders. 34.8% of the rural subjects and 18% of the urban subjects believed that children do not get mental disorders, which means they have conception of adult-oriented mental disorders. 40.2% in rural areas, 33.3% in urban areas, and 7.9% professionals believed that mental illnesses are untreatable. Many believed that psychiatrists are eccentric (46.1% rural, 8.4% urban, 7.9% professionals), tend to know nothing, and do nothing (21.5% rural, 13.7% urban, 3.9% professionals), while 74.4% of rural subjects, 37.1% of urban subjects, and 17.6% professionals did not know that psychiatry is a branch of medicine. More people in rural areas than in urban area thought that keeping fasting or a faith healer can cure them from mental illnesses, whereas 11.8% of medical professionals believed the same. Most of the people reported that they liked to go to someone close who could listen to their problems, when they were sad and anxious. Only 15.6% of urban and 34.4% of the rural population reported that they would like to go to a psychiatrist when they or their family members are suffering from mental illness. Conclusion: It can be concluded from this study that the myths and misconceptions are significantly more prevalent in rural areas than in urban areas and among medical professionals, and the people need to be communicated to change their behavior and develop a positive attitude toward mental disorders so that health-seeking behavior can improve.
  5,550 806 4
REVIEW ARTICLE
Serotonin transporter gene polymorphism and psychiatric disorders: Is there a link?
Mushtaq A Margoob, Dhuha Mushtaq
October-December 2011, 53(4):289-299
DOI:10.4103/0019-5545.91901  PMID:22303036
Though still in infancy, the field of psychiatric genetics holds great potential to contribute to the development of new diagnostic and therapeutic options to treat these disorders. Among a large number of existing neurotransmitter systems, the serotonin system dysfunction has been implicated in many psychiatric disorders and therapeutic efficacy of many drugs is also thought to be based on modulation of serotonin. Serotonin transporter gene polymorphism is one of the most extensively studied polymorphisms in psychiatric behavioral genetics. In this article, we review the status of evidence for association between the serotonin gene polymorphism and some common mental disorders like affective disorders, post-traumatic stress disorder, obsessive-compulsive disorder, suicide, autism, and other anxiety and personality disorders. Going beyond traditional association studies, gene-environment interaction, currently gaining momentum, is also discussed in the review. While the existing information of psychiatric genetics is inadequate for putting into practice genetic testing in the diagnostic work-up of the psychiatric patient, if consistent in future research attempts, such results can be of great help to improve the clinical care of a vast majority of patients suffering from such disorders.
  4,177 333 1
ORIGINAL ARTICLES
Relationship between religiosity and psychopathology in patients with depression
Swapnil Gupta, Ajit Avasthi, Suresh Kumar
October-December 2011, 53(4):330-335
DOI:10.4103/0019-5545.91907  PMID:22303042
Objective: To compare the psychopathology between depressed patients with low religiosity and those with high religiosity and to correlate the level of religiosity with the psychopathology in the psychiatric clinic of a general hospital in Chandigarh, North India. Materials and Methods: Thirty depressed patients with low religiosity and 30 patients with high religiosity were assessed on the Religiosity Scale, Beck Depression Inventory, Hamilton Depression Rating Scale, Beck Hopelessness Scale and Suicidal Intent Questionnaire. Results: In the patients with depression, hopelessness and suicidal intent correlated negatively with the level of religiosity. Conclusion: In depressed patients, hopelessness and suicidal intent are inversely related to the level of religiosity.
  2,462 472 3
CURRENT THEME
The ongoing process of amendments in MHA-87 and PWD Act-95 and their implications on mental health care
Choudhary Laxmi Narayan, M Narayan, Deep Shikha
October-December 2011, 53(4):343-350
DOI:10.4103/0019-5545.91910  PMID:22303045
  2,344 554 2
PG CME
How to read a research paper: Reading between and beyond the lines
Chittaranjan Andrade
October-December 2011, 53(4):362-366
DOI:10.4103/0019-5545.91912  PMID:22303047
Background: Despite peer review, publications in scientific journals are not always well written, sometimes contain errors, and often exhibit deliberate or unintended biases. It is necessary to learn how to identify such limitations. It is also necessary to learn how to read between and beyond the lines of papers no matter how well written they are and no matter how highly ranked the journal is. Materials and Methods: This paper critically examines an important article in a leading journal with a view to help the reader learn how to place the findings of a study in perspective, understand its limitations, and glean information beyond that actually presented and discussed in the text. Results: Several issues are examined; these relate to case-control research designs, confounding, propensity matching, absolute risk, confidence intervals, interpretation of findings, real-world relevance, ecological validity, and definition of a cause-effect relationship. Conclusions: The issues examined in this paper reflect common themes in research, and a reader aware of these themes will more easily identify them in his future readings.
  2,283 505 2
BRIEF RESEARCH COMMUNICATIONS
Developing a model for resource room training for slow learners in normal schools
P Krishnakumar, AM Jisha, Sowmya K Sukumaran, M.K.C Nair
October-December 2011, 53(4):336-339
DOI:10.4103/0019-5545.91908  PMID:22303043
Background: A significant number of children with scholastic backwardness in normal schools are slow learners. The aim of the present study was to evaluate the effectiveness of an individualized education program (IEP) for slow learners, modeled on resource room training in normal schools. Materials and Methods: 15 children with IQ in the 70-90 range were given individualized education for a period of 4 months. The children were divided into three equal groups and were given individualized training in reading, writing and mathematics for 5 hours a week in two sessions. The academic level of each child was rated before and after the training program by independent assessors. Results: After the training, 87% of children had improvement in either mathematics, reading or writing and 47% had improvement in all the three areas. The overall academic improvement was statistically significant. Conclusion: IEP will lead to improvement in academic functioning of children who are slow learners.
  2,545 205 -
ORIGINAL ARTICLES
Are anxiety disorders associated with a more severe form of bipolar disorder in adolescents?
Aswin Ratheesh, Shoba Srinath, YC Janardhan Reddy, Satish C Girimaji, Shekhar P Seshadri, K Thennarasu, Yvan Hutin
October-December 2011, 53(4):312-318
DOI:10.4103/0019-5545.91904  PMID:22303039
Background: Anxiety disorders are common among children and adolescents with bipolar disorder. Among adults, anxiety disorder comorbidity is associated with a more severe form of bipolar disorder and a poorer outcome. There is limited data on the effect of comorbid anxiety disorder on bipolar disorder among children and adolescents. Aim: To study the prevalence of anxiety disorders among adolescents with remitted bipolar disorder and examine their association with the course and severity of illness, global functioning, and quality of life. Materials and Methods: We evaluated 46 adolescents with DSM IV bipolar disorder (I and II) who were in remission, using the Schedule for Affective Disorders and Schizophrenia for School-Age Children. We measured quality of life using the Pediatric Quality of Life Inventory and global functioning using the Children's Global Assessment Scale, and then compared these parameters between adolescents with and without current anxiety disorders. We also compared the two groups on other indicators of severity such as number of episodes, suicidal ideation, presence of psychotic symptoms, and response to treatment. Results: Among the 46 subjects, the prevalence of current and lifetime anxiety disorders were 28% (n=13) and 41% (n=19), respectively. Compared with others, adolescents with anxiety had more lifetime suicidal ideation, more number of episodes, lower physical, psychosocial, and total subjective quality of life, and lower global functioning. Conclusions: Among adolescents with bipolar disorder, anxiety disorders are associated with a poorer course, lower quality of life, and global functioning. In these subjects, anxiety disorders should be promptly recognized and treated.
  2,384 359 1
Proton magnetic resonance spectroscopy in depression
Naren P Rao, Ganesan Venkatasubramanian, Bangalore N Gangadhar
October-December 2011, 53(4):307-311
DOI:10.4103/0019-5545.91903  PMID:22303038
Magnetic Resonance Spectroscopy (MRS) is a unique technique that can directly assess the concentration of various biochemical metabolites in the brain. Thus, it is used in the study of molecular pathophysiology of different neuropsychiatric disorders, such as, the major depressive disorder and has been an area of active research. We conducted a computer-based literature search using the Pubmed database with 'magnetic resonance spectroscopy', 'MRS', 'depression', and 'major depressive disorder' as the key words, supplemented by a manual search of bibliographic cross-referencing. Studies in depression report abnormalities in the frontal cortex, basal ganglia, hippocampus, anterior cingulate cortex, and the occipital cortex. These abnormalities improve after treatment with selective serotonin reuptake inhibitor, electroconvulsive therapy, and yoga, and thus, are possibly state-dependent. The findings are consistent with other morphometric and clinical studies and support the proposed pathophysiological theory of dysfunction in the neuronal circuits involving the frontal cortex, limbic cortex, and basal ganglia. Spectroscopy also has potential implications in predicting the response to treatment and formulating individualized pharmacotherapy.
  2,429 259 -
GUEST EDITORIAL
Effect of marriage on pre-existing psychoses
Prakash B Behere, TS Sathyanarayana Rao, Kiran Verma
October-December 2011, 53(4):287-288
DOI:10.4103/0019-5545.91900  PMID:22303035
  2,229 458 3
BRIEF RESEARCH COMMUNICATIONS
Augmentation effect of repetitive transcranial magnetic stimulation over the supplementary motor cortex in treatment refractory patients with obsessive compulsive disorder
Nand Kumar, RK Chadda
October-December 2011, 53(4):340-342
DOI:10.4103/0019-5545.91909  PMID:22303044
Background: There are only a few effective treatment options currently available for treatment-refractory obsessive compulsive disorder (OCD). The supplementary motor area (SMA) has been reported to play an important role in the pathophysiology of OCD. Functional neuroimaging studies indicate that OCD is associated with increased activity in the SMA, caudate nucleus, and anterior cingulate gyrus. Novel treatment strategies like repetitive transcranial magnetic stimulation (rTMS) have been proposed for OCD refractory to standard treatments. These clinic-based data report on the efficacy of rTMS in medication-resistant OCD. Materials and Methods: Twelve right-handed persons with medication-resistant OCD were administered rTMS as an add-on treatment. Stimulation was given at 1 Hz for 10 seconds followed by 15 seconds pause and 100 trains of stimulus over the SMA per session for 5 days in a week. Assessments were done on yale brown obsessive compulsive scale (Y-BOCS) at baseline and at the end of rTMS intervention. Results: The subjects had a mean age of 33.17±12.74 years. Mean scores on Y-BOCS were 26.17 at baseline and 17.17 at the end of treatment, reflecting significant improvement. The subjects did not report any significant side effects except one person with known bipolar illness, who developed manic symptoms after the 3 rd session of the rTMS. Conclusions: Low-frequency rTMS over the SMA appears a promising treatment strategy as an add-on treatment in treatment-refractory patients of OCD.
  2,330 244 4
BOOK REVIEW
Short textbook of Psychiatry
Kangkan Pathak
October-December 2011, 53(4):375-376
  2,203 303 -
ORIGINAL ARTICLES
Prospective study of duration of untreated psychosis and outcome of never-treated patients with schizophrenia in India
Jagadisha Thirthalli, Naveen Kumar Channaveerachari, Doddaballapura K Subbakrishna, Linda B Cottler, Mathew Varghese, Bangalore N Gangadhar
October-December 2011, 53(4):319-323
DOI:10.4103/0019-5545.91905  PMID:22303040
Context : Longer duration of untreated psychosis (DUP) is known to be associated with poorer outcome of schizophrenia. DUP is also known to be longer in lower- and middle-income countries. Methodologically sound studies that have examined the association of DUP and outcome of schizophrenia in these countries are lacking. Aim: The aim was to evaluate the association between DUP and outcome of never-treated schizophrenia patients. Setting and Design: This study was conducted at the National Institute of Mental Health and Neurosciences, Bangalore, using a prospective cohort design. Materials and Methods: 119 patients with schizophrenia/schizophreniform disorder diagnosed using the computerized diagnostic interview schedule for DSM-IV (CDIS-IV) were further assessed for DUP with the interview for retrospective assessment of onset of schizophrenia (IRAOS). After a mean (SD) follow-up period of 55.9 (37.2) weeks, the social and occupational functioning and psychopathology of 93 (80.2% of the surviving patients) patients were assessed using the social and occupational functioning scale (SOFS) and the positive and negative syndrome scale (PANSS), by raters blind to the DUP data. Spearman's correlation and Kendall's tau-B test were used to analyze the relationship between DUP and the outcome variables. Results: The mean DUP was 90.2 (median=30.1; SD=121.9) weeks. SOFS and PANSS scores at follow-up were statistically significantly associated with DUP, but not with other baseline variables (SOFS: rho=0.22, P=0.03; PANSS: rho=0.23, P=0.03). Among those with the shortest DUP (<16 weeks; n=33), 45.5%, 30.3%, and 24.2% had no impairment, mild-moderate impairment, and severe impairment, respectively. In contrast, 19.4%, 38.7%, and 41.9% of those with the longest DUP (>72 weeks; n=31) had no, mild-moderate, and severe impairment, respectively (Kendall's Tau-b=0.194; P=0.025). Conclusions: The delay in accessing treatment among patients with psychosis is considerable in India, a lower- to middle-income country. Longer DUP is associated with poorer psychopathological and functional outcomes in persons with schizophrenia/schizophreniform disorder.
  2,029 328 9
EDITORIAL
Exploring new frontiers in neuropsychopharmacology: SSRIs for stroke
TS Sathyanarayana Rao, Chittaranjan Andrade
October-December 2011, 53(4):283-286
DOI:10.4103/0019-5545.91899  PMID:22303034
  1,717 247 -
CASE REPORTS
Negative symptoms presenting as neuropsychiatric manifestation of vitamin B12 deficiency
Manoj Kumar Sahoo, Ajit Avasthi, Parampreet Singh
October-December 2011, 53(4):370-371
DOI:10.4103/0019-5545.91914  PMID:22303049
Long lists of psychiatric illness or symptoms have been documented to be caused by vitamin B12 deficiency. We describe an atypical case of a young adult who presented with predominant negative symptoms followed by neurological symptoms consistent with vitamin B12 deficiency. The symptoms showed complete remission after vitamin B12 supplementation. The uniqueness of this case is that vitamin B12 deficiency presented with predominant negative symptoms without other psychotic and manic symptoms, which has not been reported previously.
  1,650 173 1
Acute disseminated encephalomyelitis presenting as depressive episode
P Krishnakumar, MP Jayakrishnan, E Devarajan
October-December 2011, 53(4):367-369
DOI:10.4103/0019-5545.91913  PMID:22303048
A 9-year-old girl presented to the Child Guidance Clinic with clinical features suggestive of depressive episode of 1 week duration. There was history of short febrile illness 3 weeks prior to the onset of the depressive symptoms. MRI scan of brain showed features of acute disseminated encephalomyelitis.
  1,301 118 -
LETTERS TO EDITOR
Serotonin syndrome while switching antidepressants
BN Anil Kumar, Ruchita Shah, Sandeep Grover
October-December 2011, 53(4):372-372
DOI:10.4103/0019-5545.91915  PMID:22303051
  1,222 113 1
Folie `a famillie in a family multiply affected with schizophrenia
Ivan Netto, Nilesh Shah
October-December 2011, 53(4):372-373
DOI:10.4103/0019-5545.91916  PMID:22303051
  927 92 -
Indianizing psychiatry
Ramesh Bijlani
October-December 2011, 53(4):373-374
DOI:10.4103/0019-5545.91917  PMID:22303052
  841 129 -