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   2012| April-June  | Volume 54 | Issue 2  
    Online since August 8, 2012

 
 
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ORIGINAL ARTICLES
Twenty-five years of schizophrenia: The Madras longitudinal study
Thara Rangaswamy
April-June 2012, 54(2):134-137
DOI:10.4103/0019-5545.99531  
Aim: To determine the 25 year follow-up of subjects originally enrolled in the "Study of factors associated with course and outcome of schizophrenia" (SOFACOS) at Chennai. Materials and Methods: All subjects who were followed up were administered the same research tools which were done at inclusion, namely the PSE & PPHS. Results: At the end of 25 years, 47 of the original ninety subjects were assessed completely. Twenty five (26%) had died and 18 (20%) were lost to follow-up during the 25 year period. 32 of the 47 followed up were in partial or total remission. Outcome was good in 27.7%, intermediate in 52% and poor in 19%. More men were single and more women were either married or separated. Gender differences were not marked. Conclusions: This is one of the few prospective, long term follow up studies from India. Although outcome was good in those followed up, the numbers who died and could not be followed up causes concern.
  5,733 1,012 3
Mental health problems among inhabitants of old age homes: A preliminary study
SC Tiwari, Nisha M Pandey, Indrapal Singh
April-June 2012, 54(2):144-148
DOI:10.4103/0019-5545.99533  
Background: An exceptional increase in the number and proportion of older adults in the country, rapid increase in nuclear families, and contemporary changes in psychosocial matrix and values often compel this segment of society to live alone or in old age homes. As this group of people is more vulnerable to mental health problems, therefore a pilot study was carried out by the Department of Geriatric Mental Health, Lucknow with following aim. Aim: To study mental health and associated morbidities among inhabitants of old age homes. Materials and Methods: It was an exploratory study in which information about available old age homes at Lucknow were obtained and three of them were randomly selected. All the heads of these institutions were contacted and permission to carry out the study was obtained. Consent from the participants was obtained. Survey Psychiatric Assessment Schedule (SPAS), Mini Mental State Examination (MMSE), Mood Disorder Questionnaire (MDQ), and SCAN-based clinical interviews were applied for assessment by a trained research staff. Results: Forty five elderly inhabitants who had given their consent to participate in the study were interviewed. Depression (37.7%) was found to be the most common mental health problem followed by anxiety disorders (13.3%) and dementia (11.1%). Conclusions: A majority of the inhabitants (64.4%) were having psychiatric morbidity and no one was observed physically fit. Large sample studies are needed to substantiate the observations.
  5,705 591 -
AWARD PAPER
Psychiatric oncology: Cancer in mind
Santosh K Chaturvedi
April-June 2012, 54(2):111-118
DOI:10.4103/0019-5545.99529  
Psychosocial oncology is an upcoming area of interest, which deals with numerous psychiatric, psychological, and social aspects of malignancies. Psychiatric oncology relates to some of the common psychological and emotional problems encountered in persons with malignancy and their formal and informal caregivers. This oration will discuss the importance of this field of Consultation Liaison Psychiatry, with a focus on the research and practice in the Indian setting. This presentation will also share the findings and researches of the presenter. All these range from studies on cancer pain and palliative care, screening for psychiatric morbidity, quality of life, communication skills for health professionals in breaking bad news and handling difficult questions, and counseling. The findings on researches on somatization and illness behavior in cancer patients would highlight newer challenges in this field. Caregivers of persons with cancer are as important as the patient, but usually ignored. The stress, strain, burden, positive emotions, and coping in the context of care giving for persons with cancer are being increasingly realized. Professional caregivers should be aware of caregiver difficulties and support them through their ordeal. Lastly, the importance of dealing with staff stress and burnout among health professionals looking after families with cancer patients and survivors will be emphasized.
  5,072 809 1
CURRENT THEME
Euthanasia: An Indian perspective
Vinod K Sinha, S Basu, S Sarkhel
April-June 2012, 54(2):177-183
DOI:10.4103/0019-5545.99537  
In our society, the palliative care and quality of life issues in patients with terminal illnesses like advanced cancer and AIDS have become an important concern for clinicians. Parallel to this concern has arisen another controversial issue-euthanasia or "mercy -killing" of terminally ill patients. Proponents of physician-assisted suicide (PAS) feel that an individual's right to autonomy automatically entitles him to choose a painless death. The opponents feel that a physician's role in the death of an individual violates the central tenet of the medical profession. Moreover, undiagnosed depression and possibility of social 'coercion' in people asking for euthanasia put a further question mark on the ethical principles underlying such an act. These concerns have led to strict guidelines for implementing PAS. Assessment of the mental state of the person consenting to PAS becomes mandatory and here, the role of the psychiatrist becomes pivotal. Although considered illegal in our country, PAS has several advocates in the form of voluntary organizations like "death with dignity" foundation. This has got a fillip in the recent Honourable Supreme Court Judgment in the Aruna Shaunbag case. What remains to be seen is how long it takes before this sensitive issue rattles the Indian legislature.
  5,121 489 -
SPECIAL ARTICLE
Position statement and guidelines on unmodified electroconvulsive therapy
Chittaranjan Andrade, N Shah, P Tharyan, MS Reddy, M Thirunavukarasu, RA Kallivayalil, R Nagpal, NK Bohra, A Sharma, E Mohandas
April-June 2012, 54(2):119-133
Background: In modern day psychiatric practice, it is assumed as a matter of fact that when electroconvulsive therapy (ECT) is administered, it will be administered under anesthesia and with succinylcholine (or its equivalent) modification. Yet, as surveys indicate, there is considerable practice of unmodified ECT in developing countries and, to a small extent, in the developed world, as well. Materials and Methods: This document examines historical and recent literature on the geographical practice, physiology, efficacy, and adverse effects of unmodified ECT. Particular attention is paid to musculoskeletal risks. Results: Although almost all the research is of poor methodological quality, there is a good reason to accept that unmodified ECT is associated with a wide range of adverse consequences, important among which are musculoskeletal complications, pre-ECT anxiety, and post-ECT confusion. However, it appears from recent data that these risks are not as large as historically portrayed. Possibly explanations are suggested, with seizure modification using parenteral benzodiazepines as a special possibility. Conclusions: Under exceptional circumstances, if ECT is strongly indicated and seizure modification with succinylcholine is not feasible, unmodified ECT, especially benzodiazepine-modified ECT, may be a viable option. A detailed set of recommendations for such use of unmodified ECT is proposed along with necessary checks and balances. This document has been approved by the Indian Psychatric Society, the Indian Association of Biological Psychiatry, and the Indian Association of Private Psychiatry (which commissioned the preparation of the document).
  4,625 603 7
ORIGINAL ARTICLES
A cross-sectional study of factors associated with adolescent sexual activity
R Shashikumar, RC Das, H. R. A. Prabhu, K Srivastava, PS Bhat, J Prakash, P Seema
April-June 2012, 54(2):138-143
DOI:10.4103/0019-5545.99532  
Context: Adolescents constitute about 20% of our population and increasingly more of them are initiating sexual activity at an early age. Several behaviors associated with adolescence like masturbation, expression of masculinity/femininity, lifestyle habits like attending late night parties, and consumption of alcohol have been variously implicated in initiating sexual activities. Sexual abuse can also lead to premature sexualization. In view of few worthwhile studies from India that have dealt with these issues this study was undertaken. Aims: To elicit information from two co-education schools adolescent boys and girls on matters related to pubescence, sexual experiences, and sexual health. Settings and Design: Study subjects involved students from class IX to XII in two co-education schools. Consent of parents was taken to administer the questionnaire to their wards. Materials and Methods: A total of 586 out of 1580 students completed a self-reporting questionnaire on matters related to sexuality. Statistical Analysis EpiInfo6 Software was used. Results: Significant association was found among those holding the view that having sex proves their masculinity, being sexually abused, masturbation among boys, and sexual activity. A significantly large number of boys and girls are unaware of role of alcohol on sexual activity and that pregnancy can be caused by single intercourse. Conclusions: This was probably the first such comparative study from India. Mechanisms need to be evaluated to help adolescents understand their sexual attitudes and situations that are likely to provoke sexual activity. Therefore, not only more detailed and longitudinal studies are needed to understand these relations in a better perspective, but also a well-planned educational program for adolescents is a need of the hour.
  3,995 459 -
Neurological soft signs in children with attention deficit hyperactivity disorder
VC Patankar, JP Sangle, Henal R Shah, M Dave, RM Kamath
April-June 2012, 54(2):159-165
DOI:10.4103/0019-5545.99540  
Context: Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with wide repercussions. Since it is etiologically related to delayed maturation, neurological soft signs (NSS) could be a tool to assess this. Further the correlation of NSS with severity and type of ADHD and presence of Specific Learning Disability (SLD) would give further insight into it. Aims: To study neurological soft signs and risk factors (type, mode of delivery, and milestones) in children with ADHD and to correlate NSS with type and severity of ADHD and with co-morbid Specific Learning Disability. Settings and Design: The study was carried out in Child care services of a tertiary teaching urban hospital. It was a cross-sectional single interview study. Materials and Methods : 52 consecutive children diagnosed as having ADHD were assessed for the presence of neurological soft signs using Revised Physical and Neurological Examination soft Signs scale (PANESS). The ADHD was rated by parents using ADHD parent rating scale. Statistical Analysis: The data was analyzed using the chi-squared test and Pearson's co-relational analysis. Results and Conclusions: Neurological soft signs are present in 84% of children. They are equally present in both the inattentive-hyperactive and impulsive-hyperactive types of ADHD. The presence of neurological soft signs in ADHD are independent of the presence of co-morbid SLD. Dysrrhythmias and overflow with gait were typically seen for impulsive-hyperactive type and higher severity of ADHD is related to more errors.
  3,503 508 3
BRIEF RESEARCH COMMUNICATION
Suicide prevention is possible: A perception after suicide attempt
Dushad Ram, MS Darshan, T. S. S Rao, Abhijit R Honagodu
April-June 2012, 54(2):172-176
DOI:10.4103/0019-5545.99535  
Background: Suicide is a preventable cause of death, inspite of which its incidence is increasing worldwide. Very few studies are done to know the perception of suicide attempters regarding prevention of their suicide attempt. Such information may be helpful in implementing preventive strategies. This study was done to find out whether those who attempted suicide and recovered perceived that their suicide attempt could have been prevented or not. Materials and Methods: Fifty consecutive subjects were recruited by purposive sampling method. These subjects were admitted for suicide attempt and were stable after medical management. Subjects were assessed using socio-demographic and clinical proforma, Pierce suicide intent scale and structured questionnaire to assess their perception regarding suicide. Group differences for categorical variables were examined with the chi-square test, whereas an independent 't' test was used for continuous variables. Results: Analysis revealed that 80% of suicide attempters felt that their suicide attempt could have been prevented. 64% of the study subjects perceived that family members and near and dear ones could have helped in preventing their attempt while 16% of the study subjects perceived that society could have helped. Conclusions: Majority of subjects on recovery from the suicide attempt perceived that their suicide attempt could have been prevented by family members, near and dear ones and society.
  2,646 431 2
EDITORIAL
Social determinants of sexual health
TS Sathyanarayana Rao, Rajesh Gopalakrishnan, Anju Kuruvilla, KS Jacob
April-June 2012, 54(2):105-107
DOI:10.4103/0019-5545.99527  
  2,286 438 -
CME
Psychiatric assessment and the art and science of clinical medicine
KS Jacob
April-June 2012, 54(2):184-187
DOI:10.4103/0019-5545.99538  
The decline of phenomenology was associated with the corresponding rise of operational criteria for psychiatric diagnosis. Detailed and nuanced evaluations were replaced by symptom checklists, the diversity of clinical phenomena reduced to a few "typical symptom" and contexts ignored in favor of symptom criteria. This article highlights some issues related to the art and the science of clinical examination. It includes conceptual models, matching patients with typical typologies, cross-sectional and longitudinal perspectives, symptom checklists and contexts, population characteristics, prevalence and predictive values, demarcation of abnormalities, and the Bayesian approach to diagnosis. The challenge is to rekindle the interest in phenomenology, appreciate the complexity of the task of psychiatric assessment and to teach the principles of clinical examination.
  1,997 281 -
ORIGINAL ARTICLES
Investigation of the possible role of Shankapushpi in the attenuation of ECT induced amnestic deficits
Chittaranjan Andrade, Ingrid Monteiro, Ravi Prabhakar Hegde, J Suresh Chandra
April-June 2012, 54(2):166-171
DOI:10.4103/0019-5545.99542  
Introduction: Shankapushpi (Evolvulus alsinoides and others) has received mention in traditional Indian writings as a potential enhancer of cognitive functioning. This study used an animal model to examine whether Shankapushpi improves learning and memory and attenuates anterograde and retrograde amnesia associated with electroconvulsive shocks (ECS). Materials and Methods: Adult, male, Sprague Dawley rats (n=64) were treated with an aqueous extract of Shankapushpi or vehicle all through the 13-day study. From Days 1 to 8, the animals received Shankapushpi or vehicle alone. On Days 8-10, the animals were trained in a T-maze. On Day 11, they received two true or sham 30 mC ECS 5 h apart. On Day 12, recall of pre-ECS training was examined, and on Day 13, new learning was assessed. Results: Shankapushpi-treated rats did not show better learning during the pre-ECS phase (Days 8-10). Seizure duration was not influenced by Shankapushpi treatment (Day 11). Shankapushpi did not attenuate ECS-induced retrograde amnesia (Day 12). ECS did not impair new learning, and the effect of Shankapushpi herein, therefore, could not be ascertained (Day 13). Conclusions: In this animal model of learning and memory, and of ECS-induced retrograde amnesia, Shankapushpi was found to have no favorable or unfavorable effects on either cognitive or seizure duration parameters. These findings diminish expectations of cognitive and anticonvulsant benefits of simple Shankapushpi decoctions in clinical settings, but do not preclude benefits with extracts obtained and concentrated by using other methods.
  2,027 202 1
Study to assess the prevalence, nature and extent of cognitive impairment in people living with AIDS
Karthigaipriya Muniyandi, J Venkatesan, T Arutselvi, V Jayaseelan
April-June 2012, 54(2):149-153
DOI:10.4103/0019-5545.99534  
Background: HIV directly affects the brain and produces varied psychiatric manifestations. 10-30% of patients with AIDS were found to have cognitive impairment and the virus is isolated in the CSF in 70% of AIDS patients. Aim: The present study is aimed at finding out the prevalence, nature, and extent of cognitive changes in AIDS patients. Materials and Methods: The consecutive sample of 33 patients with AIDS attending the ART center of our college were clinically interviewed and administered MMSE, BGT, Wechsler Memory Scale, and International HIV Dementia Scale. Results: In clinical assessment, only 1/33 (3%) patients could be diagnosed as dementia in HIV disease (ICD10-F02.4). This confirms the current Indian reports which indicate a lower prevalence of HIV dementia in our population. 2/33 (6%) patients were recognized to have mild cognitive disorder due to HIV disease (ICD10-F06.7). Asymptomatic cognitive impairment is very common in AIDS patients and it was noted in 69% of our study population. In the tests, MMSE was positive in only 3 of the 33 patients (9%) and it was not helpful to recognize cognitive deficits in our patients. The Wechsler Memory Scale was abnormal in 18 of the 33 patients (55%). BGT was abnormal in 48.5% of patients. The International HIV Dementia Scale was the most sensitive instrument and 63.6% the patients had abnormal scores in this scale. Conclusion: Tests which assess cognitive and motor speed may be more helpful than clinical psychiatric interview to spot the AIDS patients who have cognitive impairment.
  1,856 276 4
HISTORY COLUMN
Poet Bharathi, touched with fire
O Somasundaram
April-June 2012, 54(2):188-191
DOI:10.4103/0019-5545.99539  
Substance use among creative artists is very common. In this paper, such use by the great Tamil poet, Subramani Bharathi, is considered.
  1,983 137 -
CASE REPORTS
Antidepressant-induced mania in obsessive compulsive disorder
Johann Philip, R Janaki
April-June 2012, 54(2):194-195
DOI:10.4103/0019-5545.99543  
Serotonin-reuptake inhibitors have come forth to become the mainstay of treatment in obsessive compulsive disorder (OCD), predominantly as a result of evidence from clinical psychopharmacological response studies. Comorbid psychiatric disorders frequent OCD patients, most often depression. Although selective serotonin reuptake inhibitors are effective in the treatment of both OCD and depressive disorder, all antidepressants are associated with treatment-emergent affective switch. We present a 48-year-old patient with OCD, on antidepressants, initially for OCD and later for depression as well. She switched to mania after 20 years of treatment, which responded to olanzapine and divalproex sodium.
  1,853 193 -
GUEST EDITORIAL
Euthanasia: Evolving role of the psychiatrists in India
Bir Singh Chavan, Suravi Patra
April-June 2012, 54(2):108-110
DOI:10.4103/0019-5545.99528  
  1,626 349 -
CASE REPORTS
Trichotillomania with trichorhizophagia in a schizophrenic patient: Case report and review of literature
PN Suresh Kumar, V Rajmohan
April-June 2012, 54(2):196-197
DOI:10.4103/0019-5545.99544  
Trichotillomania is a disorder characterized by chronic hair pulling that often results in alopecia. Eating the part of hair pulled out is a common practice and trichorhizophagia is a new term to denote the habit of eating the root of hairs pulled out, associated with trichotillomania. Many psychiatric disorders are prevalent among patients with trichotillomania. Here we report a case of trichotillomania with trichorhizophagia in a 58-year-old man with schizophrenia. The various treatment options are also discussed.
  1,663 149 -
BOOK REVIEW
Luminous life: A new model of humanistic psychotherapy
Ajit V Bhide
April-June 2012, 54(2):201-201
  1,641 137 -
ORIGINAL ARTICLES
Comparison between the effect of liothyronine and piracetam on personal information, orientation and mental control in patients under treatment with ECT
Mousavi Seyed Ghafur, Mohammad Saadat, Mohamad Reza Maraci, Reza S Bagherian, Mina Mazaheri
April-June 2012, 54(2):154-158
DOI:10.4103/0019-5545.99536  
Objective: The study aimed to compare the effect of liothyronine and piracetam on three subscales of the Wechsler memory test on patients under treatment with ECT. Materials and Methods: In a double blind clinical trial, 60 of 99 patients between 20 and 45 years old, under treatment with ECT were studied in three groups. Patients in the allocation groups received liothyronine, piracetam, or placebo, from the first session of ECT until 1 month after the last session of ECT. Personal information, orientation, and mental control were tested in the participants at first, fourth, and last session of ECT and 1 month after the last session of ECT. Data were analyzed with Repeated measure ANOVA using SPSS 13. Results: There wasn't any significant difference among three groups in demographic characteristics before the study and number of ECT sessions (P=0.684). After intervention, a significant difference in memory scores was seen in third and fourth assessment sessions (0.002). Orientation subscales showed a significant difference among four assessment sessions (P=0.001). Personal information and mental control never decreased in the liothyronine group. There was no significant difference among three studied groups in personal information, orientation, and mental control (P>0.05). Conclusion: Memory changes due to ECT may be limited to some parts of memory like orientation. More powerful studies for comparison between the effect of liothyronine and placebo are necessary.
  1,634 134 3
LETTERS TO EDITOR
Dissociative stupor, mutism and amnesia in a young man
RR Jayaprakash, AP Rajkumar, M Nandyal, S Kurian, KS Jacob
April-June 2012, 54(2):198-199
DOI:10.4103/0019-5545.99545  
  1,564 139 -
CASE REPORTS
A case of Todd's Palsy following unilateral electroconvulsive therapy
Christine Bell, Peter Lepping, John Clifford, Catherine Gardner-Thorpe
April-June 2012, 54(2):192-193
DOI:10.4103/0019-5545.99541  
This case describes a woman undergoing unilateral electroconvulsive therapy (ECT) who developed a Todd's Palsy following the treatment, and which resolved when converted to bilateral ECT. We go on to hypothesize that this rare side effect may be an indication of the need to switch laterality during a course of ECT.
  1,172 84 2
LETTERS TO EDITOR
NIMHANS' objective structured clinical assessment and feedback model could be a boon for budding medical colleges in India
Santosh Loganathan
April-June 2012, 54(2):199-200
DOI:10.4103/0019-5545.99546  
  944 113 -