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   2013| October-December  | Volume 55 | Issue 4  
    Online since October 25, 2013

 
 
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ORIGINAL ARTICLES
Post-stroke depression and lesion location: A hospital based cross-sectional study
Pooja Rajashekaran, Keshava Pai, Ravish Thunga, B Unnikrishnan
October-December 2013, 55(4):343-348
DOI:10.4103/0019-5545.120546  PMID:24459304
Background: Depression is a common neuro-psychiatric consequence of stroke, affecting approximately 40% of the patients. Many studies show that in addition to the psychosocial stress, neurobiological factors such as site of infarct and brain atrophy may also be related to Post Stroke Depression (PSD). There are conflicting results in this area of research and paucity of such data in Indian literature. Thus the aim of this study is to weigh the importance of lesion location in PSD. Materials and Methods: Sixty two subjects with their first ever stroke were interviewed using a semi-structured proforma and PSD diagnosed using MINI Plus interview. Scales of Beck Depression Inventory and Montgomery Asberg Depression Rating Scale were used to assess severity of depression. Mini mental state examination was used to assess cognitive impairment and Barthel Index to measure Activities of Daily Living. Neuro-imaging provided information on site and side of lesion. Collected data was analysed using SPSS version 15.0. Results: PSD was diagnosed in 28 subjects, amongst who 19 had left sided lesions. Left sided cortical infarcts and sub cortical infarcts showed statistically significant association with PSD. Conclusion: Results are in keeping with previous landmark studies. Differences in emotional reactions depending on hemisphere and site of the infarct as shown in this study suggest organic biological basis for post stroke depression. Understanding the etiological basis would allow clinicians to monitor patients at risk of developing PSD, enabling early detection and treatment thus improving their quality of life and rehabilitation.
  3 2,871 385
Prevalence of attention deficit hyperactivity disorder in primary school children
Jyothsna Akam Venkata, Anuja S Panicker
October-December 2013, 55(4):338-342
DOI:10.4103/0019-5545.120544  PMID:24459303
Context: There is a lacuna of studies on Attention Deficit Hyperactivity Disorder (ADHD) in the Indian context. Aims: (i) To identify the prevalence of ADHD in primary school children, (ii) To identify the gender difference in the prevalence of ADHD, (iii) To compare the distribution of ADHD among different socioeconomic status, (iv) To identify the presence of any co-morbid factors associated with ADHD. Settings and Design: This is a cross sectional study of school aged children selected from four different schools in Coimbatore district. Materials and Methods: Seven hundred seventy children aged between 6 and 11 years were selected from four schools in Coimbatore district after obtaining informed consent from their parents. The presence of ADHD was assessed by using Conner's Abbreviated Rating Scale (CARS) given to parents and teachers. The children identified as having ADHD were assessed for the presence of any co-morbid factors by administering Children's Behavioural Questionnaire (CBQ) to the teachers and Personal Information Questionnaire to the parents. Statistical Analysis: Statistical Product and Service Solutions (SPSS) 10 software, Mean and Standard Deviation, and student's t test were used for statistical analysis. Results: The prevalence of ADHD among primary school children was found to be 11.32%. Prevalence was found to be higher among the males (66.7%) as compared to that of females (33.3%). The prevalence among lower socio-economic group was found to be 16.33% and that among middle socio-economic group was 6.84%. The prevalence was highest in the age group 9 and 10 years. Conclusion: The present study shows a high prevalence of ADHD among primary school children with a higher prevalence among the males than the females.
  2 13,198 1,223
REVIEW ARTICLES
Group psychotherapies for depression in persons with HIV: A systematic review
Abhijit Ramanna Honagodu, Murali Krishna, Rajesh Sundarachar, Peter Lepping
October-December 2013, 55(4):323-330
DOI:10.4103/0019-5545.120541  PMID:24459301
Studies investigating effectiveness of group psychotherapy intervention in depression in persons with HIV have showed varying results with differing effect sizes. A systematic review of randomized controlled trials of group psychotherapy in depression in persons with HIV has been conducted to present the best available evidence in relation to its effect on depressive symptomatology. Electronic databases were searched to identify randomized controlled trials. Selected studies were quality assessed and data extracted by two reviewers. If feasible, it was planned to conduct a meta-analysis to obtain a pooled effect size of group psychotherapeutic interventions on depressive symptoms. Odds ratio for drop out from group was calculated. The studies were assessed for their quality using the Quality Rating Scale and other parameters for quality assessment set out by COCHRANE. The quality of reporting of the trials was compared against the Consolidated Standards of Reporting Trials (CONSORT) checklist for non-pharmacological studies (CONSORT-NPT). Four studies met the full inclusion criteria for systematic review. The trials included in the review examined group interventions based on the Cognitive behavioral therapy model against other therapeutic interventions or waiting list controls. In all four studies, group psychotherapy was an effective intervention for reducing depressive symptoms in persons with HIV in comparison to waiting list controls. The reported benefits from the group psychotherapy in comparison to active controls were less impressive. There were no statistically significant differences in drop outs at post treatments across group psychotherapy, wait list control, and other active interventions. The methodological quality of the studies varied. The quality of reporting of the studies was sub-optimal. The results of this systematic review support that group psychological interventions for depression in persons with HIV have a significant effect on depressive symptomatology. This review also indicates that group cognitive behavioral therapies are an acceptable psychological intervention for persons with HIV and comorbid depression.
  2 2,514 287
CASE REPORTS
Dothiepin-induced transient hypomania and extrapyramidal syndrome
Amir Inamdar, Ashish Agarwal, Pankaj Kataria, RP Beniwal
October-December 2013, 55(4):383-385
DOI:10.4103/0019-5545.120549  PMID:24459312
A case has been reported here, who developed transient hypomanic symptoms as well as extrapyramidal symptoms after being switched from sertraline to dothiepin therapy. The possible mechanisms and clinical implications of the same are discussed.
  1 1,430 108
ORIGINAL ARTICLES
Psychiatric morbidity and marital satisfaction among spouses of men with alcohol dependence
M Kishor, Lakshmi V Pandit, R Raguram
October-December 2013, 55(4):360-365
DOI:10.4103/0019-5545.120557  PMID:24459307
Background: Alcohol dependence has adverse health and social consequences; Alcohol related problems primarily occur within the family context and maximum impact is felt on spouses, given the intimate nature of their relationship. Spouses play an important role in treatment programs related to alcohol. There is thus a need to study psychiatric morbidity and marital satisfaction in spouses of alcohol dependent patients in order to understand and address such issues. Aims: The aim of this study was to assess the pattern of psychiatric morbidity, marital satisfaction in spouses of men with alcohol dependence syndrome and explore the association. Materials and Methods: For psychiatric morbidity, 60 spouses of men with alcohol dependence syndrome were evaluated. Marital satisfaction was assessed using the marital satisfaction scale. Severity of alcohol dependence in the husbands and consequences of drinking was assessed using short alcohol dependence data and drinkers inventory of consequences respectively. Results: More than half of the spouses (65%) had a psychiatric disorder. Primarily mood and anxiety disorder were present. Major depressive disorder was present in 43%. Psychiatric morbidity, marital dissatisfaction in spouses and higher adverse consequences alcohol dependence in their husbands, were found to be significantly correlated with each other and their association was robust particularly when problems in the physical, interpersonal and intrapersonal domains were high. Conclusion: Psychological distress and psychiatric morbidity in spouses of alcohol dependent men is high, with marital satisfaction being low. Addressing these issues will be beneficial as spouses are known to play an important role in the treatment of alcohol dependence syndrome.
  1 3,088 604
Psychiatric morbidity in prisoners
Vinod Kumar, Usha Daria
October-December 2013, 55(4):366-370
DOI:10.4103/0019-5545.120562  PMID:24459308
Background: Prisoners are having high percentage of psychiatric disorders. Majority of studies done so far on prisoners are from Western countries and very limited studies from India. Aim: Study socio-demographic profile of prisoners of a central jail and to find out current prevalence of psychiatric disorders in them. Materials and Methods: 118 prisoners were selected by random sampling and interviewed to obtain socio-demographic data and assessed on Indian Psychiatric Interview Schedule (IPIS) with additional required questions to diagnose psychiatric disorders in prisoners. Results: Mean age of prisoners was 33.7 years with 97.5% males, 57.6% from rural areas and 65.3% were married. Average education in studied years was 6.6 years and 50.8% were unskilled workers. 47.4% were murderers while 20.3% of drugs related crimes. 47.5% were convicted and history of criminal behavior in family was in 32.2% prisoners. Current prevalence of psychiatric disorders was 33%. Psychotic, depressive, and anxiety disorders were seen in 6.7%, 16.1%, and 8.5% prisoners respectively. 58.8% had history of drug abuse/dependence prior to imprisonment. Conclusion: One prison of Hadoti region of Rajasthan is full of people with mental-health problems who collectively generate significant levels of unmet psychiatric treatment need. Prisons are detrimental to mental-health. Beginning of reforms is the immediate need.
  1 3,183 397
A TRIBUTE
Prof. J. K. Trivedi
Roy Abraham Kallivayalil, Pronob Kumar Dalal
October-December 2013, 55(4):311-312
DOI:10.4103/0019-5545.120527  PMID:24459297
  - 3,154 219
ART & PSYCHIATRY
Music and Mind
Sravanti Sanivarapu
October-December 2013, 55(4):400-400
DOI:10.4103/0019-5545.120529  PMID:24459316
  - 1,040 167
BOOK REVIEW
Em and the big Hoom: A book review
Alok Sarin
October-December 2013, 55(4):409-410
  - 1,751 128
BRIEF RESEARCH COMMUNICATION
The course and outcome of alcohol use disorders in men in Goa: A population- based follow-up study
Abhijit Nadkarni, Bhargav Bhat, Shah Ebrahim, Vikram Patel
October-December 2013, 55(4):376-379
DOI:10.4103/0019-5545.120573  PMID:24459310
Background: Research on the natural history and long-term outcomes of alcohol use disorders (AUD) is important to guide health policy. However, attrition is a major challenge in longitudinal studies and can affect validity of findings. Materials and Methods: A 4-year follow-up study was conducted on a randomly selected subgroup of a sample of men in rural and urban communities in Goa to assess attrition, preliminary estimates of AUD outcomes, and chronic disease risk factors. Results: Overall attrition rate was 16.7% with a higher attrition in AUD compared to abstainers or casual drinkers. Incidence of AUD at 4 years was 12.8% while the persistence rate of AUD was 53.9%. A trend for poorer health and health behaviors and higher blood pressure was observed in AUD. Conclusion: The results of this study suggest a relatively low attrition rate despite the long follow-up period and support the feasibility of conducting a definitive cohort study with the entire sample.
  - 1,494 212
CASE REPORTS
Body dysmorphic disorder: Borderline category between neurosis and psychosis
K Raman
October-December 2013, 55(4):380-382
DOI:10.4103/0019-5545.120547  PMID:24459311
Body dysmorphic disorder is an under-recognised chronic problem, which is established as independent diagnostic entity. Its clinical features, co-morbidity, course, and prognosis have been studied in detail. But the issue of its psychotic and non-psychotic variants and the question of dimensional or categorical method of classifying this disorder still poses a diagnostic dilemma. This case report tries to highlight on this issue.
  - 2,534 170
A case of Hallervorden-Spatz disease presenting as catatonic schizophrenia
Yogesh Pawar, Gurvinder Kalra, Sushma Sonavane, Nilesh Shah
October-December 2013, 55(4):386-389
DOI:10.4103/0019-5545.120553  PMID:24459313
Hallervorden-Spatz disease belongs to a group of disorders characterized by predominant involvement of basal ganglia. These cases may present to the psychiatrist with symptoms of depression, nervousness and rarely other psychotic symptoms. Very few cases of this disease have been reported from India. We report a case of Hallervorden-Spatz disease that presented to the psychiatry outpatient department with catatonia. This case highlights how presentation of Hallervorden-Spatz disease may overlap with catatonic symptoms and hence a high index of suspicion is required to make an accurate diagnosis.
  - 1,705 135
Emetophobia: A fear of vomiting
Abhijeet D Faye, Sushil Gawande, Rahul Tadke, Vivek C Kirpekar, Sudhir H Bhave
October-December 2013, 55(4):390-392
DOI:10.4103/0019-5545.120556  PMID:24459314
Emetophobia is an intense, irrational fear of vomiting including fear of feeling nausea, seeing or hearing another person vomit, or seeing vomitus itself. It may occur at any age and we need to understand its symptomatology. We report a case of emetophobic child whose fear of vomiting started after an attack of acute appendicitis. In the initial stage, fear was limited to vomiting, later it became generalized to a fear of seeing the vomitus, worries that parents may suffer vomiting, fear of vomiting in public places followed by avoiding social activities. Patient improved on short course of anti-anxiety drugs and Graded Exposure Therapy.
  - 2,365 190
CME
Forensic evaluations in psychiatry
RK Chadda
October-December 2013, 55(4):393-399
DOI:10.4103/0019-5545.120558  PMID:24459315
Forensic psychiatry is an important subspecialty of psychiatry. Forensic psychiatrists play an important role in the society in assisting the judiciary in many complicated cases. In India, forensic psychiatry work is undertaken mostly by the general psychiatrists. Forensic psychiatric assessments are often associated with an element of anxiety or fear for a young psychiatrist. The present paper aims at familiarizing the readers with forensic evaluation in various situations so that they are able to carry out the assessments in real-life situations comfortably. Various steps of forensic assessment in different situations are discussed in the background of real-life cases. Assessment areas include criminal responsibility, fitness to plead, issue of guardianship, assessment of mental status, testamentary capacity and others. The paper gives some general guidelines on forensic psychiatric assessment in practical situations in our country. The readers are advised to refer to the standard textbooks and the Indian law for further details.
  - 4,428 799
COMMENTARY
Have you forgotten?
Jerry Pinto
October-December 2013, 55(4):411-412
PMID:24459323
  - 679 75
EDITORIAL
Psychosomatic paradigms in psoriasis: Psoriasis, stress and mental health
TS Sathyanarayana Rao, KH Basavaraj, Keya Das
October-December 2013, 55(4):313-315
DOI:10.4103/0019-5545.120531  PMID:24459298
  - 2,422 394
GUEST EDITORIAL
Sexual abuse in women with special reference to children: Barriers, boundaries and beyond
PB Behere, TS Sathyanarayana Rao, Akshata N Mulmule
October-December 2013, 55(4):316-319
DOI:10.4103/0019-5545.120535  PMID:24459299
  - 2,513 304
Loneliness: A disease?
Sarvada Chandra Tiwari
October-December 2013, 55(4):320-322
DOI:10.4103/0019-5545.120536  PMID:24459300
  - 4,365 446
LETTERS TO EDITOR
Dissociative identity disorder: An uncommon psychiatric disorder reported
Siva Shankar Priya, Nambi Siva
October-December 2013, 55(4):403-404
DOI:10.4103/0019-5545.120565  PMID:24459318
  - 1,437 148
Studies on posttraumatic stress disorder: Challenges ahead
Pallavi Sinha, Amit Garg, Om Prakash
October-December 2013, 55(4):403-404
DOI:10.4103/0019-5545.120568  PMID:24459319
  - 735 151
Prolonged, self-administration of ultra-high doses of quetiapine
Amar Bavle, Chittaranjan Andrade
October-December 2013, 55(4):404-405
DOI:10.4103/0019-5545.120570  PMID:24459320
  - 750 83
Alcohol use among in-patients of a medical college hospital in Delhi
Vinitha C Thilakan, Sanjeev K Rasania
October-December 2013, 55(4):405-407
DOI:10.4103/0019-5545.120572  PMID:24459321
  - 982 110
Job stress among emergency nursing staff: A preliminary study
Gurvinder Pal Singh
October-December 2013, 55(4):407-408
DOI:10.4103/0019-5545.120574  PMID:24459322
  - 2,136 250
ORIGINAL ARTICLES
Assessment of cognition in non-affected full biological siblings of patients with schizophrenia
Rohit Garg, JK Trivedi, PK Dalal, Anil Nischal, PK Sinha, Sannidhya Varma
October-December 2013, 55(4):331-337
PMID:24459302
Background: Schizophrenia is a devastating psychotic illness which is like the most mental disorders, shows complex inheritance; the transmission of the disorder most likely involves several genes and environmental factors. It is difficult to judge whether a particular person without schizophrenia has predisposing factors for the said disease. A few studies have shown the relative sensitivity and reliability of cognitive and psychophysiological markers of brain function as the susceptibility factors for schizophrenia which may aid us to find people with an increased risk of complex disorders like schizophrenia. The present work is an exploration on cognitive impairments in unaffected siblings of patients suffering from schizophrenia with a framework to explore why a mental disorder occurs in some families but not in others. Materials and Methods: This is a single point non-invasive study of non-affected full biological siblings of patients with schizophrenia, involving administration of a battery of neuropsychological tests to assess the cognitive function in the sibling group and a control group of volunteers with no history of psychiatric illness. The control group was matched for age, gender, and education. The siblings were also divided on the basis of the type of schizophrenia their siblings (index probands) were suffering from and their results compared with each other. Results: The siblings performed significantly poorly as compared to the controls on Wisconsin card sorting test (WCST), continuous performance test (CPT), and spatial working memory test (SWMT). The comparison between the sibling subgroups based on the type of schizophrenia in the index probands did not reveal any significant difference . Conclusion: These findings suggest that there is a global impairment in the cognition of the non-affected siblings of patients of schizophrenia. Cognitive impairment might be one of the factors which will help us to hit upon people who are predisposed to develop schizophrenia in the future.
  - 1,480 292
Efficacy of yoga for mental performance in university students
Tikhe Sham Ganpat, Hongasandra Ramarao Nagendra, V Selvi
October-December 2013, 55(4):349-352
DOI:10.4103/0019-5545.120550  PMID:24459305
Background: With growing scientific evidence, yoga is emerging as an important health behavior-lifestyle modifying module to achieve holistic health at physical, mental, emotional, social and spiritual levels. Brain wave coherence (BWC) recordings from the surface of the skull are associated with different cognitive processes and plays both critical and useful roles in yoga with wide range of functional significance. The psycho-physiological changes that characterize the efficacy of yoga for better mental performance in university students have not been studied adequately. Objective: The study was designed to assess the mental performance through BWC analysis in university students undergoing Integrated Yoga Module (IYM). Materials and Methods: The IYM subjects ( n=30) with 25.77±4.85 years of mean age participated in this single group pre-post study. The BWC data was collected before (pre) and after (post) the 21 days IYM using Brain Master (Model: 2E Part # 390-001), Michigan, USA. Statistical Analysis: Means, standard deviations, Kolmogorov-Smirnov test and Wilcoxon signed rank test were used for analyzing data with the help of SPSS-16. Results: A complete statistical and spectral analysis showed 43.24% increase ( P<0.001) in Delta, 9.13% increase ( P=0.289) in Theta, 57.85% increase ( P<0.001) in Alpha, 17.65% decrease ( P=0.136) in Beta and 9.19% increase ( P=0.586) in Gamma BWC between pre and post intervention measurements. Conclusion: BWC study showed significant increase in both Delta and Alpha wave coherence suggesting that IYM can result in improvement of coherent and integrated brain functioning among students, thus paving the way for their better mental performance. Although this preliminary research is promising, more well-designed studies are needed before a strong recommendation can be made.
  - 2,177 203
Prevalence and pattern of psychiatric morbidity and health related quality of life in patients with ischemic heart disease in a tertiary care hospital
Shiny John
October-December 2013, 55(4):353-359
DOI:10.4103/0019-5545.120554  PMID:24459306
Background: Psychiatric morbidity and Health Related Quality of Life (Hr-QoL) in Ischemic Heart Disease (IHD) are relatively less studied in our country. Aims: This cross-sectional observational study was undertaken to assess the common psychiatric disorders and Hr-QoL in IHD. Materials and Methods: One-hundred and thirty patients with IHD were evaluated for psychiatric morbidity and Hr-QoL. Tools used were SCID-1, Euro QoL-5D, and Socio-demographic data sheet. The data were analyzed using SPSS v 10.0 software, Chi-square test, T-test, ANOVA were used as needed. Results: Psychiatric morbidity was assessed using psychiatric assessment schedule SCID-I for generating diagnosis as per DSM-IV criteria. Major depressive disorder was found in 34.6% (n=45) patients. 23.8% (n=31) patients had a diagnosis of depression due to general medical condition. Anxiety disorder due to general medical condition was present in 36.9% (n=48) patients. Around 95.4% of patients reported psychiatric symptoms, either depression or anxiety. Though widely disputed, low educational status was reported as significantly associated with psychiatric morbidity in IHD. Female sex of the patient and the presence of diabetes mellitus were associated with psychiatric morbidity in a significant manner. Majority of patients with poor quality of life were in the domain of anxiety/depression. Conclusion: The findings of our study reveal a high rate of psychiatric morbidity and impaired quality of life in IHD Patients.
  - 2,216 458
Chromosome 18p11.2 harbors susceptibility marker: D18S452, for bipolar affective disorder
Mutahar Andrabi, Arshad Hussain, Fouzia Rashid, Sheikh Ozair Nissar, Idrees Ayoub Shah, Yasir Hasan Rather, Waseem Hassan Ahangar, Nazir Ahmad Dar
October-December 2013, 55(4):371-375
DOI:10.4103/0019-5545.120567  PMID:24459309
Aim: The aim of our study was to investigate whether the tandem repeat polymorphism in D18S452 microsatellite marker at locus 18p11.2 is a risk factor of bipolar affective disorder (BPAD) in Kashmiri population. Materials and Methods: The repeat polymorphism in D18S452 was evaluated by polymerase chain reaction (PCR) analysis of in 74 diagnosed BPAD patients and 74 controls subjects. Results: Tandem repeat (300 bp*) allele frequency was found to be 1.35% in controls and 8.108% in cases. The tandem repeat (250 bp*) allele frequency was found to be in 91.89% in cases and 98.65% in controls. The 252 bp/252 bp genotype was found to be present in 89.18% of cases and 98.64% of controls, the 300 bp/300 bp genotype in 5.40% of cases and 1.35% of controls and the 252 bp/300 bp variant in 5.40% of cases and none among the controls. Although the proportion of patients homozygous for tandem repeat (300 bp/300 bp) was higher in cases than in controls, the difference was not statistically significant when 252 bp/252 bp genotype was taken as reference (odds ratio [OR]=4.4242; 95% confidence interval [CI] 0.4822-40.5924); P=0.1529). However, when the frequency of heterozygous genotype (252 bp/300 bp) was compared with 252 bp/252 bp statistical significance was observed (OR=8.0603; 95% CI 1.1112-58.4646; P=0.0383). Conclusion: This is the first study reporting a significant association between D18S452 maker with tandem repeat polymorphism in heterozygous condition (252 bp/300 bp) and the development of BPAD in Kashmiri population.
  - 1,622 127
VIEW POINT
The rise of super (?sub)-specialties courses in psychiatry: Is India ready for it!
N Manjunatha, Murali Thyloth, TS Sathyanarayana Rao
October-December 2013, 55(4):401-402
DOI:10.4103/0019-5545.120564  PMID:24459317
  - 10,184 319