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 Table of Contents    
Year : 2016  |  Volume : 58  |  Issue : 5  |  Page : 41-121
Free Papers

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Date of Web Publication19-Jan-2016

How to cite this article:
. Free Papers. Indian J Psychiatry 2016;58, Suppl S1:41-121

How to cite this URL:
. Free Papers. Indian J Psychiatry [serial online] 2016 [cited 2021 Feb 25];58, Suppl S1:41-121. Available from:

Blues of the Heart…

Poonam M

Sarigama Nilaya, Bondel, Mangalore, Karnataka. [email protected]

Background and Objectives: Disturbances of mental function are common among patients with chronic heart failure (CHF) and may become more frequent and serious as failure of the heart progresses. Depression and Anxiety in these patients are more commonly reported in the literature. The current study attempts to study the prevalence of depression and anxiety symptoms in chronic heart failure patients with normal cognitive abilities, using standard scales.

Methodology: The sample consists of 100 in patients with chronic heart failure of more than one year duration. A diagnosis was established using Framingham's criteria for heart failure and severity was assessed using the New York Heart Association functional class. Subjects were assessed using Hospital Anxiety and Depression rating Scale (HADS) and Montgomery Asberg's Depression Rating Scale (MADRS) for Anxiety and Depressive symptoms. Descriptive Statistics, Chi square, Pearson's correlation and one way ANOVA tests were used for data analysis.

Results: Symptoms of Depression and Anxiety were common. On HADS, 8% had severe symptoms of depression. On MADRS, 28% were in the moderate category of depressive symptoms. Common Depressive symptoms were lassitude, concentration difficulty, inner tension, reduced appetite and reduced sleep on MADRS. On HADS, common anxiety symptoms were worrying thoughts, feeling tense or wound up, inability to relax and fear that something awful might happen.

Conclusion: Chronic Heart Failure patients do commonly report anxiety and depressive symptoms. There were discrepancies among the two scales used in eliciting common psychiatric symptoms of anxiety and depression. This was because of language difficulties and physical symptoms in CHF. Screening instruments are useful but a structured diagnostic clinical interview is essential to confirm the diagnosis before treatment intervention.

Keywords: Chronic Heart Failure; Depression; Anxiety; Quality of Life; Coping skill

Quality of Life in Matters of The Heart…

Poonam M,

Sarigama Nilaya, Bondel, Mangalore, Karnataka. [email protected]

Background and Objectives: Disturbances of mental function are common among patients with chronic heart failure (CHF) and may become more frequent and serious as failure of the heart progresses. There can be a gradual deterioration in the quality of life and coping skills. The current study attempts to study the quality of life in the study subjects.

Methodology: The sample consists of 100 in patients with chronic heart failure of more than one year duration. A diagnosis was established using Framingham's criteria for heart failure and severity was assessed using the New York Heart Association functional class. Subjects were assessed using WHOQOL- BREF.

Results: On quality of life scale, physical domain was the most commonly affected, followed by the domain of psychological health. Social relationships and environment domains were least affected.

Conclusion: Chronic Heart Failure patients do commonly report significant impairment in all the domains of quality of life and poor coping skills.

Keywords: Chronic Heart Failure; Quality of Life

Usefulness of Gamma Glutamyl Transferase as Reliable Biological Marker in Objective Corroboration of Relapse in Alcohol Dependent Patients

Col Siddharth Dixit,

60/15 Baird Place Delhi Cantt, New Delhi. [email protected]

Background: The development of reliable diagnostic tool for assessing alcoholism is an utmost necessity in treating and preventing damage due to alcoholism to both individual and armed forces as alcoholism represents a serious health issue with major socioeconomic consequences.

Method : 52 consecutive cases of alcohol dependence syndrome admitted to a peripheral hospital were evaluated for the biological marker Gamma Glutamyl Transferase (GGT) and compared against the gold standard of psychiatrist assessment .The cases were followed up for one year at 3 months,6 months,9 months and 12 months interval . The GGT value of the cases was correlated with the abstinent /relapse status to find the cutoff levels of the GGT as a biological marker.

Result: At cutoff level of 50 IU/lit GGT exhibited specificity of 100% and sensitivity varying from 56% to 100%. At lower cut off levels chances of false positive cases with adverse consequences on service prospects of the individuals are high. The mean difference in GGT levels across relapse and abstinent group reached significant statistical proportion at admission and during follow up at 3 months /6 months/9 months and 12 months.

Conclusion : GGT can serve the practical utility of firmly establishing alcohol dependence syndrome in armed forces to aid in fair disposal of cases. It helps in providing motivational inputs to patients. Clinician should pay due consideration to clinical profile, ward observation and unit report as the diagnosis of alcohol dependence syndrome has serious implications towards service prospects of a soldier.

Key Words: Alcohol dependence syndrome, relapse, serum GGT, diagnostic marker, military

Prevalence of Sexual Dysfunction in male patients with Alcohol Dependence

Sneha Sharma, Keshava Pai

Shrijwala, Sharma Hospital, Professors colony, Bhusawal, Maharastra. [email protected]

Topic category: A6 Alcohol and Substance use Disorders.

Background: Patients with Alcohol Dependence frequently have sexual dysfunction but this problem is usually underreported and underdiagnosed. This study was Aimed to find out the prevalence of Sexual dysfunction in male patients with alcohol dependence.

Methods: 81 subjects diagnosed to be having Alcohol dependence syndrome were included in the study. A written informed consent was taken and socio demographic details of the patient were collected. Patient were then assessed by Sexual Dysfunction Checklist. After collecting all the information data so obtained was subjected to statistical analysis.

Results: It was found out that the mean age of the subjects was 39.37 years, mean years of alcohol use was 18.96 years and they had consumed a mean of 11.20 standard drinks per day. 48% of subjects had concurrent use of tobacco. 83% of the subjects reported of one or the other sexual dysfunction. The most common sexual dysfunction which was seen in the subjects was premature ejaculation (40%), followed by frequency dissatisfaction (39%). It was found out that more was the duration of alcohol use for subjects more had they reported of one or the other sexual dysfunction. No significant correlation was obtained for any of the other parameters.

Conclusion: People with prolonged heavy drinking usually suffer from Alcohol dependence syndrome which leads to physical, sexual as well as psychiatric comorbidity. Early recognition and proper intervention will improve the patient outcomes including the overall quality of life. This area has enormous public health implications considering high prevalence of alcohol use as well as sexual dysfunction associated with it and there is need for further research to elucidate this complex relationship.

Keywords: Alcohol Dependence, Sexual Dysfunction

Dementia in Indian Cinema: A narrative review

Badr Ratnakaran, Sethulakshmi S. Anil

Holy Cross Hospital and Mental Health Centre Koovapally, Kerala, India. Email: [email protected]

Background: . Indian cinema is known for portraying social, cultural, political issues and this also includes issues in mental health.

Objectives: To review the portrayal of dementia in Indian cinema

Methods: Films were identified after Discussion with various experts in person, telephone and email correspondence. Web databases were also checked to identify the films.

Results: Eight films portraying balanced and unbalanced versions of dementia and it's related issues have been identified. Caregiver issues have been discussed in the films. However treatment and other interventions have not been discussed

Conclusion: It can be concluded that these films can be used as a resource for movie clubs as a part of teaching curriculum during post graduate and under graduate training. They can be an excellent medium to understand cultural issues related to dementia in the community

Keywords: Dementia, Indian cinema, Movie clubs

Rapidly induced hyponatremia associated with low dose olanzapine treatment: A case report

Badr Ratnakaran, Sethulakshmi S. Anil

Holy Cross Hospital and Mental Health Centre Koovapally, Kerala, India. Email: [email protected]

Introduction: Psychotropics have been described to cause hyponatremia, especially by Selective Serotonin receptor inhibitor's and antiepileptics

Methods: We present a case of olanzapine induced hyponatremia in a case of hypomania during inpatient treatment, which occurred at a rapid onset and with a low dose of olanzapine due to syndrome of inappropriate antidiuretic hormone secretion

Results: The patient was treated symptomatically with fluid restriction and cessation of medications upon which the patient's condition improved. Naranjo algorithm score was 4 suggesting a possible association of hyponatremia and olanzapine use. We will be reviewing literature in relation to olanzapine and hyponatremia

Conclusion: Our case highlights the need to monitor side effects of olanzapine including fatal complications like hyponatremia as demonstrated in our case

Keywords: Hyponatremia, Olanzapine, Syndrome of Inappropriate Antidiuretic Hormone secretion

Nosological status of 'Behavioural' Disorders: Are 'Behavioural' Disorders a separate category of disorders?

Shrirang Bakhle

#6 Om Niwas, 11 th Road, Chembur, Mumbai, Maharastra. [email protected]

Aims: The term 'Behavioural' Disorders (BDs) is used often in Psychiatry - as a single term or as a part of a double term (e.g. 'Mental and Behavioral Disorders' in ICD-10). But does the term BDs represent a separate nosological category of disorders? Should all disorders with behavioural abnormalities be called BDs? Is behaviour an organ or physiological system in body that we should dedicate a category of disorders to it? The paper explores the rationale behind the term BDs.

Methodology: The paper seeks the inclusion / exclusion criteria for designating /excluding a disorder as a BD. It describes a survey of literature for any standard definition and usage of the term BDs. Different Mental and non-mental disorders with behavioural manifestations are examined to understand why some disorders are considered BDs while others are not.

Results: There is no well-defined nosological category of disorders called BDs. Different persons and organizations list different combinations of Mental Disorders as BDs.

There is no standard definition nor inclusion /exclusion criteria for BDs.

It is not possible to define such criteria in terms of behavioural abnormalities, social or functional impairments since most of the Mental Disorders produce behavioural manifestations or impAiments. So even among the Mental Disorders, we cannot define why some disorders should be termed BDs and why other Mental Disorders should not be called BDs.

Conclusion: BDs are not a separate, well-defined nosological category of disorders. Although many mental and non-mental disorders (e.g. orthopaedic) produce behavioural abnormalities, only some Mental Disorders with mental dysfunctions are termed BDs.

Since the purpose of nosology is clarity of categorization, the use of the ambiguous term 'Behavioural Disorders' should be discontinued and discouraged. The correct usage is Mental Disorders and behavioural manifestations.

Keywords: Behavioural' Disorders, Mental disorders.

Platelet Serotonin Levels and Balance Tilting Factors in Human Self Destructive Behaviour

Maj Sriniwas Gupta

166 Military Hospital, Jammu & Kashmir, [email protected]

Background: Suicide is a disease and a global public health problem. It is defined as a human act of self inflicted, self intentioned cessation. Suicidology has come to become a serious topic of study for intervention and investigation. The Serotonin system has remained a prime area of investigation. Neurons and Platelets display structural and functional similarities. In blood more than 99% of 5HT is contained in platelet, which shares similar Serotonin uptake and release mechanisms with 5HT neurons. We have attempted to explore the biological as well as psychosocial and psychological areas related to suicide.

Aim: To study human self destructive behavior.

Settings and Design: Study was carried out in a tertiary hospital, for persons above 18 years of age, with recent history of self-destructive behavior. 31 patients were assessed, for whom a detailed interview, an ICD-10 diagnosis and psychological tests were carried out.

Methods and Material: For the Platelet Serotonin estimation, blood samples were collected and Enzyme Immunometric assay was carried out.

Results: Female subjects outnumbered males by 2:1. There was a significant difference in the Method employed by male and female patients. Major depression, adjustment disorder, personality disorder were predominant diagnoses. The mean platelet serotonin concentration for males was 57.3 while that of females was 56.05. The difference was not significant. Platelet Serotonin levels were found to be negatively correlated with impulsivity scores and this was found to be statistically significant.

Conclusion: Platelet Serotonin levels in our study sample were quite low when compared with those reported in published literature. Low Serotonin levels were found to be inversely related to impulsivity only in males. The predominant experiential theme that emerged out of the study was restabilising bonds.

Keywords: Platelet Serotonin Estimation, Suicide.

Living with the Corpse: Introspection Amidst the Media Hype

Ranjan Bhattacharyya

Department of Psychiatry, Murshidabad Medical College & Hospital, West Bengal, India. [email protected]

Introduction: A scene reminiscent of Hitchcock's 1960 thriller was found in Kolkata on 11 th June 2015. The police recovered a charred body of a 77-year-old man, a fully-clothed skeleton of a woman in bedrooms, two bags full of bones of dogs with only living person, a man in his mid-40s in the house 3 No Robinson Street in Kolkata.

Methodology: The event has been described as the reports collected from media sources, police and forensic evidences. The police recovered various notes, diaries, various sketches and drawing books from the place. Police enquiry and expert opinion from psychiatrists and clinical psychologists work taken.

Discussion: The event has been described on the basis of psychopathology with expert reviews. There were lots of speculations with media hype over this issue. Possibilities of psychosis in the Background of Schizophrenia and shared delusional disorder have been discussed. The necrophilia and personality disorder also have been discussed. The people having shared psychotic disorder too are susceptible to unhealthy bonding, lowered self-esteem, and lack of personal responsibility that would otherwise foster healthy interdependence within intimate relations.

Conclusion: These people especially from urban area seldom come to mental health professionals for their problem because they don't think that they have any. Thousands of this kind of family is present in all cities. The media role has been highlighted along with an attempt had been made to generate more awareness about mental illness removing the stigma associated with it.

Key words: notes and diaries, forensic aspects, media reporting, necrophilia, shared delusional disorder.
" Neuropsychiatric Manifestation of Prion Diseases: Recent Updates"

Ranjan Bhattacharyya

Department of Psychiatry, Murshidabad Medical College & Hospital, Berhampore, West Bengal. [email protected]

Background: Prion diseases are rare neurodegenerative disorder presented having host of neuropsychiatric manifestations. Objectives: There is a wide variety of symptoms in prion diseases, which often leads to its misdiagnosis. CJD is the most common type of human prion disease and four forms of CJD exist: (1) sporadic CJD, (2) familial CJD, (3) variant CJD, and (4) iatrogenic CJD.

Methods: Systematic search of prospective clinical research studies has been done in which more than 300 patients with prion disease have been followed up from diagnosis to death. The other CSF proteins, neuron-specific enolase (NSE) and total tau (t-tau), may be somewhat better than 14-3-3 for diagnosing CJD, but none are currently as helpful as a brain MRI.

Discussion: The behavioral and psychiatric symptoms can be grouped into psychotic features, agitated features, and mood disorder. The diagnosis is based on WHO criteria, clinical features; CSF analysis, EEG, MRI brain and definite diagnosis can only be made by brain biopsy.

Conclusion: No specific treatment of prion diseases is currently available. The antimalarial agent quinacrine and the phenothiazines have been tried with little success in animal and human trials. Preventive measures are most important. Newer regulations that govern the handling and feeding of cows may help prevent the spread of prion diseases. If health workers experience a needle-stick or laceration standard guidelines are recommended including washing the area with 1 N NaOH and rinsing thereafter with soap and water.

Key words: Prion diseases, neuropsychiatric manifestations, Neuroimaging findings, antimalarial drugs, novel therapeutics.

Magnitude of Problem of Persons Having Intellectual Disability its Impact on Parents and Their Unmet Needs in Indian Subcontinent

Ranjan Bhattacharyya, Prof Malay Ghoshal, Debasish Sanyal, Supriya Kumar Mondal

Department of Psychiatry, Murshidabad Medical College & Hospital, West Bengal, India. E-mail: [email protected]

Background: Intellectual disability is the clearest example of the mixture of medical and social system models. People with intellectual disability do not represent homogenous groups. Their unmet needs and impact on parents as caregivers also vary especially with changing social milieu, socio economic status and ethnicity.

Objectives: To assess the disability of intellectually disabled and the nature and degree of impact on their parents.

Methods: The clinico-demographic profile of (n=102) intellectually disabled and intellectually average children and their caregivers compared. The impact of disability measured in NIMH-DIS scale.

Results: Mother's experiences more difficulties than father in physical care (p < 0.03), health (p<0.02), career (p<0.03), sibling effect (p<0.04) and specific thoughts domain (p<0.04). Father's experiences more trouble in support (p<0.02), financial (p<0.05), social (p<0.01), embarrassment/ridicule domains (p<0.02). There is no difference in Relationship domain (p=0.56) in between the parents. Higher patience (p<0.02) and empathy (p<0.04) among mother and higher tolerance (p<0.03) and sensitivity (p<0.04) has been found among mother. The impact on mother increases in physical care, health and specific thoughts domains whereas the impact on father increases in financial and embarrassment/ridicule domains from first to fourth assessment.

Conclusion: Rehabilitation needs increase with severity of disability and impact on parents as caregivers. Appropriate assessment and finding out unmet needs can guide to formulate individualized treatment plan for them as well as to their parents.

Keywords: Intellectual disability, Rehabilitation, Clinico demographic profile.

Intracranial Structural Changes - Assessment of Cortical Atrophy in Mood Disorder - Bipolar I disorder (Mania)

A. S. Srivastava, Raj Sekhar Singh, A. K. Srivastava

Department of Radio-diagnosis, I.M.S., B.H.U., Varanasi. [email protected]

Objective: The advent of computerized tomographic study, a non-invasive technique of screening intracranial contents has provided a tool to investigate possible changes in brain structures associated with major psychiatric illnesses . The present study was carried out with the Aim to find out intracranial structural changes - evidence of cortical atrophy in patients of mood disorder Bipolar I (Mania).

Method: Thirty patients of age range 21-40 years fulfilling DSM-IV criteria for mood disorder-Bipolar I (Mania), without any evidence of other associated organicity or physical morbidity were taken into study. Their cranial C T scan was done under supervision of expert in neuro-imaging. The control group consisted of thirty age and sex matched persons screened for headache . The evaluation of cortical atrophy was done and it was scored as 0-3,4-7 and 8-11 for five cortical areas - frontal, temporal, parietal, insular and occipital.

Result: Significant cortical atrophy was observed in patients of study group as compared to control .

Conclusion: Intracranial structural changes-the presence of significant cortical atrophy in patients of mood disorder, Bipolar I Mania is an important finding.

Details will be discussed during presentation.

Key-words : Intracranial structural changes, Cortical atrophy, Bipolar I Mania

Doctor-patient Relationship in A Changing World - The Psychiatrist's Perspective

K. S. Pavitra, Adithya Pandurangi, Abhay Matkar

Department of Psychiatry, SDM medical College, Dharwad. [email protected]

The patient-doctor relationship is an important concept in health care, especially so in psychiatry. The symposium addresses the concept of doctor-patient relationship keeping communication a art as a main ingredient with an attempt to frame a conceptual structure of the factors that define this relationship with special emphasis on mental health professionals. The symposium will unfold the different dimensions of doctor-patient relationship including psychiatric consultation, therapeutic measures, model of approach to treatment modalities, consent and liabilities, confidentiality and patient protection. It also discusses the concept in the view of patient's perception, family's perspective, biological advances in Psychiatry,current scenario and ethical issues in newer mental health care bill - 2014.

Keywords: Relationship, Mental Health Care bill.

Adherence Pattern and its Association with Course and Outcome in Bipolar I Disorder: A Retrospective Study

Karthick Subramanian, Shivanand Kattimani, Siddharth Sarkar, Ravi Philip Rajkumar

#9, Muthamizh street, Amirtha Nagar, Thattanchavady, Puducherry, [email protected],

Introduction: Bipolar I disorder is a chronic psychiatric illness with variable course. Adherence to treatment plays an important role in altering its course and outcome.

Objective: To identify the adherence attitudes and its association with course of the illness among bipolar I patients following up in a General Hospital Psychiatric unit.

Methods: This is a cross-sectional descriptive study. Using Structured Clinical Interview for DSM-IV-TR, 150 patients with BD-I were taken for the study. Their illness course was assessed using National Institute of Mental Health- Life Chart Methodology- Clinician Retrospective Chart (NIMH-LCM-CRC). Outcome of illness was assessed using Clinical Global Impression- Bipolar (CGI-BP). Medication adherence was assessed with Medication Adherence Rating Scale (MARS). Those who scored ≤ 5 were considered non-adherent.

Results: Out of 150 bipolar I disorder patients, 109 were in remission clinically. Their self-report on MARS suggested 24 (22%) were non-adherent to medications. Non-adherent status was significantly associated with shorter total duration of illness, yet more percentage time spent in symptomatic phase, and a worse overall severity of BD-I illness, when compared to adherent patients.

Conclusion: Poor course of BD-I illness is associated with current non-adherence. Such persons need to be identified actively and intervened.

Limitations: Adherence pattern assessment was limited to past one week which is a shorter duration. The findings bear recall bias due to the inherent retrospective design of the study.

Keywords : Bipolar disorder, adherence, remission, course, outcome, India.0

Study of Substance Abuse in Patients of Road Traffic Accident admited in Orthopedic Ward

Sonam Motani

G6 Vindhyachal hostel, Lata Mangeshkar Hospital, Digdoh hills, Hingna, Nagpur, Maharastra. [email protected]

Background: Road traffic accidents are one of the leading cause of morbidity and mortality. Many of them need orthopedic management. Substance abuse and intoxication is one of the commonest cause leading to such accidents. It is important to find out the intake of any substance in patients with accident related traumatic injuries. With this Background, the present study was carried out in the admitted patients of road traffic accident in orthopaedic ward of tertiary care hospital.

Aims and Objective: To analyse, nature and extent of substance abuse in patients of road traffic accident admitted in orthopaedic ward and its correlation with various demographic and clinical profile.

Methodology: 30 consecutive patients of road traffic accident admitted in orthopaedic ward were assessed using a special proforma which contained demographic profile, clinical profile of orthopaedic illness and clinical profile of substance abuse, the data was analysed statistically.

Results and Discussion: The mean age of the participants was 33.2 years with S.D. =10.11, 93% were males, most of them employed, 70% married and about half were rural Background. Though majority of them did not have any psychiatric presentation, a few had anxiety features. Majority of them 66.7% did not have any substance abuse and 33% had substance intake (alcohol). 21% satisfied criteria for alcohol abuse and 10% for alcohol dependence of duration of about 5 years. 10% of them had history of physical complication due to alcohol. No significant co relation was found between alcohol and age, occupation, marital status, residential Background and nature of orthopedic injury.

Conclusion: Substance use (alcohol intake) has been found in 33% of the patients of road traffic accident admitted in orthopedic ward. Thus alcohol related disorders should be screened with all patients with road traffic accidents to start de addiction in them to prevent future accidents.

Keywords: Substance Abuse, Road traffic accident, orthopaedic injury.

Neurocognitive Dysfunction in Patients of Major Depressive Disorder

Bhavik Shah, Lakhan Kataria, Kajal Tanna

Smt. B. K. Shah Medical Institute & Research Centre, Department of Psychiatry, Piparia, Vadodara. [email protected]

Introduction: Depressive disorders affect about 10-25% of women and 5-12% of men and are considered as the most common mood disorder, which may manifest as single or recurrent episodes. Depression is known to affect mood, movement and cognition and cognitive deficits are considered as the epiphenomenona of the disorder. It is important to understand the pattern of cognitivedysfunctionas it may directly affect the capacity of the patients to participate in occupational and social activities. There is also paucity of data on neurocognitive functions in depressive disorders in Indian scenario.

Aims And Objectives: (1) To evaluate neurocognitive function in MDD. (2)To find prevalance and know pattern of cognitive dysfunction in patients with MDD.

Methodology: it is observational, croos -sectional study that is conducted on 100 patients of MDD coming to psychiatry o.p.d. of Dhiraj general hospital. Patients are recruited randomly. With prior consent of IEC and patients, patients are case report form, Hamilton's depression scale (HAM-d) & Montreal cognitive assesment (MOCA) scales. Data are analysed by spss-16 software for different anlytical tests.

Results: 88% of patients with MDD have significant level of neurocognitive dysfunction.

Conclusion: In patient of MDD, there is significant nuerocognitive dysfunction present. Visiospatial, registration, and recalling, attention concentration and abstraction skill is significantly affected.

Keywords: Major Depressive Disorder, Cognitive Dysfunction.

Ventricular Brain Ratio (VBR) and Ventricular Enlargement in Mood Disorder-Bipolar I Disorder (Mania)

A. S. Srivastava, Raj Sekhar Singh, A. K. Srivastava

Deptt. of Radio-diagnosis, I.M.S., B.H.U., Varanasi. [email protected]

Objective: The computerized tomographic study, a safe and non-invasive technique is used for identification and assessment of various intracranial structures and associated abnormalities in brain. The present study was carried out with the Aim to find out any abnormality in ventricular system e.g. change in ventricular brain ratio and ventricular enlargement in patients of mood disorder- Bipolar I Mania.

Method: Thirty patients of age range 21-40 years fulfilling DSM-IV criteria for mood disorder - Bipolar I Mania, without any evidence of associated organicity or physical morbidity ; were included in the study . The cranial C T scan of patients was done under supervision of expert in neuro-imaging. The control group consisted of thirty normal C T scans of age and sex matched persons screened for headache. The assessment of ventricular brain ratio and ventricular size for ventricular enlargement was done in both study and control group.

Result: Mean ventricular brain ratio was higher in study group . Also ventricular enlargement was found in patients of study group as compared to control.

Conclusion: The patients of mood disorder- Bipolar I Mania have increased ventricular brain ratio and enlarged ventricles as compared to controls .

Key-words : Mood disorder - Bipolar I Mania, Ventricular brain ratio, Ventricular enlargement.

A Study of Vitamin B 12 Levels in Patients with Psychiatric Illness

Nimmi A. Jose

Department of Psychiatry, Academic Block,6 th floor, G B Pant Institute of Postgraduation Education and Research, New Delhi-02. [email protected]

Aims And Objectives: To study the levels of cobalamin in patients with psychiatric illness.

Methods: This cross-sectional study was conducted on Psychiatry in-patients, from 1/1/11 to 31/12/11, with the Aim to see the pattern of cobalamin levels in patients with psychiatric illness. Patients of ages <18 years, having significant co-morbid medical illness undergoing or requiring treatment, receiving cobalamin supplementation for at least three months duration, or those not consenting were excluded from the study. A total of 368 subjects were diagnosed as per ICD-10. Complete blood counts, Vitamin B12 levels etc. were measured in all the subjects. Serum homocysteine & ferritin were measured in subjects with low cobalamin levels {< 211 pg/ml).

Results: 73/368 subjects (19.8%) had low cobalamin levels. Cobalamin deficiency was noted most frequently in: schizophrenia > psychosis NOS > OCD > depressive disorders > bipolar affective disorder & somatoform disorders > dissociative disorders > Anxiety disorders. Rest of the Results will be discussed.

Conclusion: Significant proportion of psychiatric patients was found to be cobalamin deficient. In-depth studies are required to establish the cause effect relationship between cobalamin deficiency and psychiatric illness, and the effect of cobalamin replacement.

Keywords: vitamin B 12, psychiatric illness, ICD-10.

A Study of Role of Co-Morbid Depression on Neuropsychological Deficits in Obsessive-Compulsive Disorder


Khinchi, Kota, Rajasthan. [email protected]

Introduction: Depression is commonly comorbid with OCD and there has been considerable interest in the neuro-cognitive functioning of subjects with depression, OCD and also depression with OCD since long time. The cognitive dysfunctions that have been demonstrated in the patients of OCD could in part be because of co-morbid depression.

Aim: To assess neuropsychological deficits in patients suffering from OCD & co-morbid depression, To compare the magnitude of neuropsychological deficits in OCD patients in relation to severity of co-morbid Depression

Methodology: it's a cross sectional study and included 72 patients of OCD having score < 20 on BDI scale with depression and OCD having score ≥20 on BDI scale who attending OPD at psychiatric centre, Jaipur and Control group had 36 healthy persons matched for age and education. To enter in the study, patient was screened with a specially designed screening Performa, which encompassed the entire exclusion criteria, followed by application of various neuropsychological tests applied.

Results: We found that patients with OCD with moderate/severe depression showed higher neurocognitive impairment in domains of attention and working memory, verbal learning and delayed recall, visuso spatial recognition and memory, executive functioning, visuo constructual and visuo motor speed, shifting attention, perseverance, when compare to OCD with mild Depression.

Conclusion: Cognitive impairment was presents both in moderate/severe depressed as well as mild depressed OCD patients. But OCD with moderate/severe depression showed greater cognitive impairment than OCD with mild depression.

Keywords: Cognitive impairment, depression, neuropsychological deficits

Internet Addiction, Associated Psychopathology and its Impact on Health And Lifestyle: A Study on Junior Doctors of A Medical College in Kolkata

Arijit Mondal

VILL & P.O. RAYAN, Burdwan, West Bengal. [email protected]

There is rapid growth in internet use not only in India but also worldwide in last decade. There have been growing concern world wide of the potential adverse effects arising from excessive maladaptive or addictive internet usage.

Kendell reports that there are a number of emotional factors which may be related to college students' internet addiction. Among these factors the most remarkable are depression, anxiety and stress. Other Conclusion of excessive usage have been documented as neglect of academic, work and domestic responsibilities, disruption of relationships, social isolation and financial problems. The understanding that internet use can be a disorder is still in its initial stages in India.

This present study is to assess the internet addiction among the junior doctors at a medical college in Kolkata (using Young's Internet Addiction Test). This is also to assess associated psychiatric morbidity (using DASS, i.e. Depression Anxiety Stress Scale ) and the impact of internet addiction on physical, mental ad social health (using Duke Health Profile).

STUDY AREA: R. G. Kar Medical College & Hospital, Kolkata.

STUDY POPULATION: Junior doctors (internees, house physicians, house-surgeons & post graduate trainees).

STUDY DURATION: Thee months from the approval of institutional ethics committee.

SAMPLE SIZE: Approximately 50 cases.

SELECTION: Simple Random Sampling


  1. Junior doctors
  2. Both sexes
  3. Willing to give consent
  4. History of using internet


  1. Not using internet
  2. Not willing to give consent


Short term cross-sectional study


  1. Consent form
  2. Young's Internet Addiction Test
  3. DASS (Depression, Anxiety, Stress Scale)
  4. Duke Health Profile.

Keywords: DASS, Kendell report, Psychpathology.

Risperidone Induced Benign Intracranial Hypertension Leading to Visual Loss

Dheeraj Kattula Sushil Thomas Alexander Pavithra Mannam Ramya Iyyadurai

Department of Child and Adolescent Psychiatry Christian Medical College, Vellore 632002. [email protected]

Benign intracranial hypertension (BIH) is a rare but potentially serious condition causing visual loss. Occasionally, medication use has been associated with the occurrence of BIH. We report the case of a 40-year-old obese lady being treated with risperidone for schizophrenia who presented with features of BIH. We report this case, occurring for the 1st time in India, to emphasize that a commonly used atypical antipsychotic drug can rarely cause BIH leading to visual loss.

Keywords: Risperidone, BIH, Intracranial hypertension.

Changes of Criminal Thinking in Opioid Users After One Month Buprenorphine Maintenance

Namita, Yadav J S

Department of Psychiatry and NDDTC, AIIMS, New Delhi. [email protected]

It is well established that criminal behaviours are more common in opioid users and these behaviours are reflection of their thinking. The development of criminal thinking is complex process that can develop by external or internal factors; opioids are powerful predictors of change in these factors mainly in dependent patient.

Aim: To find out change of criminal thinking in opioid (smack) dependent patients after one month buprenorphine therapy.

Method: 30 patients of opioid (smack) dependent were recruited from NDDTC, OPD Ghaziabad AIIMS, their socio demographic data was noted and the exclusion, inclusion criteria were applied. All the patients were rated on TCU Criminal thinking scale on day 0 and after one month of buprenorphine and brief psychotherapy, both scores were analysed.

Results: 28 patients completed the study. On analysis of data criminal thinking was common in age between (20 -25 years). Chronic opioid users had 75 percentile higher score on CTS .The mean total score of patients at day 0 was 30.5 and these score reduced up to 26.8 after one month. On further analysis of all six domain of scale, the scores of power of orientation, criminal rationalization, criminal justification (44.44, 43.33 and 40) were higher than other components.

Conclusion: Criminal thinking was more common in younger age of patients and higher scores on TU-CTS were found in chronic opioid users. Buprenorphine therapy in dependent patients reduced criminal thinking in all age group of patients.

Keywords: Buprenorphine therapy, NDDTC, Chronic opioid.

Study of Cognitive Functions With Relation to Sociodemographic Profile in Patients of Schizophrenia In Remission

Sarmistha Priyadarshani

3rd lane, Hillpatna, Behrampur, Orissa. [email protected]

Background: Schizophrenia is a chronic and debilitating psychiatric illness consisting primarily of positive and negative symptoms. However, cognitive deficits in various domains have been consistently replicated in patients with schizophrenia even in the remission phase. Therefore, the present study was designed to assess cognitive impairment in schizophrenia and to correlate the same with sociodemographic factors.

Material And Methods: Cognitive function in 40 patients with schizophrenia in remission as per Diagnostic and Statistical Manual of Mental Disorders, (DSM V) criteria attending the psychiatry outpatient department (OPD) of Department of Psychiatry, MHI,SCB.MCH, Cuttack, Orissa was assessed using Addenbrooke's Cognitive Examination Revised (ACER) rating scale and sociodemographic details was obtained using semistructured proforma. Data was analyzed by Chi-square and t-test.

Results: About 70% patients of schizophrenia were found to have cognitive dysfunction for attention, concentration, memory, language, and executive function. Patients of lower socioeconomic status showed decline in total ace-r score and deficit in attention and concentration.. Male patients were associated with impairment in the memory domain. Females had more decline in total ace-r score.

Conclusion: The study findings depict that persistent cognitive deficits are seen in patients with schizophrenia. Its correlation with sociodemographic factors showed that patients with >2 years of illness, females and belonging to lower socioeconomic status showed more cognitive dysfunction. Male patients were associated with memory impairment. Our study recommends that the neurocognitive impairment should be included in the DSM-V diagnostic criteria for schizophrenia.

Keywords: Addenbrooke's cognitive examination revised, cognitive impairment, schizophrenia, remission

"A Case Control Study of Aggressive Behaviour in Stable Patients of Schizophrenia Who Have Improved on Treatment and in Normal Individuals At A Tertiary Care Centre-Government Medical College Surat."

Radha Jaiprakash Mehta

202, Meet Complex, Opposite Nilkanth Temple, Tapodhan Street, Navsari, Gujarat. [email protected]

Abstract: The term aggression is not specifically defined but it refers to a behaviour intended to cause injury to others. Aggression is a basic innate instinct, an emotion and it is present in normal person also. A myth that mental illness is associated with aggressive behaviour is common in society and person with psychiatric illness is always violent or risky for the community. Especially schizophrenia is considered a grave illness and associated with aggression. Aggression also affects the quality of life and disability in patients with schizophrenia.

Many studies have been done to study aggression in indoor patients of schizophrenia, but there are very few studies which compare aggression between normal individuals and patients of schizophrenia. This study compared the prevalence of aggression in normal individuals and in patients with schizophrenia and observes the association of aggression on quality of life and disability. Total 60 patients of schizophrenia who were stable since last 6 months and 60 normal individuals were compared by using semi structured questionnaire based on Overt Aggression Scale. Normal individuals having substance dependence, personality disorders were excluded.

From the Results, overall it was concluded that stable patients of schizophrenia were not verbally or physically more aggressive compared to normal population breaking the popular myth that Schizophrenic patients are harmful due to their aggressive behaviour. Physical Aggression against self was significantly high in normal females compared to patients. Patients with more negative symptoms showed less aggression.

Keywords: Aggressive Behaviour, Schizophrenia.

Study of the Association Between Functional Somatic Complaints (FSC) And Depression.

Akshatha D, Sathyanarayana MT, Prabhu HRA, Hemanthkumar BG, Vidhyavathi M

#1119 3rd main road M.C layout, Vijayanagar, [email protected]

Aim: To study the functional somatic complaints (FSCs) associated with depression.

Materials And Methods: A cross sectional study was done on 40 patients in a tertiary care hospital in Karnataka who were diagnosed to be having depression according to the ICD-10 DCR criteria. They were assessed on the Bradford Somatic Inventory (BSI) and the Montgomery- Asberg Depression Rating Scale (MADRS).

Results: Majority of the participants were married, Hindus, educated up to middle school level, employed and of lower socioeconomic Background. Functional Somatic Complaints were significantly more common in females. All patients were found to be having a minimum of 4 FSCs. The most common FSC was lack of energy followed by pain/tension in the neck and shoulders, dryness of mouth/throat, severe headache, palpitations and increased sweating. The mean MADRS score of the study sample was 24.25 indicating that FSCs were more common in mild to moderate depression.

Conclusion: Functional Somatic Complaints are highly prevalent in patients diagnosed with depression. Most of the patients have more than 10 FSCs and the type of FSCs are similar to a certain extent across different socio demographic and clinical variables. Hence, patients reporting to primary health centres with these multiple vague somatic complaints must be routinely evaluated for depression. A thorough psychiatric assessment with appropriate intervention would aid them for a better quality of life.

Keywords: Functional Somatic Complaints, Bradford Somatic Inventory, Montgomery- Asberg Depression Rating Scale.

Sociodemographic and Clinical Variables in Association With Metabolic Syndrome-A Cross Sectional Study

Ramya Sampath

Tc1/984, Krishnagiri, Behind Sct Quarters, Medical College, Trivandrum, Kerala, [email protected]

Background: The constellation of abdominal obesity, elevated triglycerides, low high density lipoproteins, elevated blood pressure and elevated fasting blood glucose levels called 'metabolic syndrome ' is more common in psychiatry patients than general population and goes largely unidentified and unaddressed reflecting higher morbidity and mortality rates in this group. This study highlights the significance of this issue.

Objectives: To estimate the proportion of patients with metabolic syndrome and its components in inpatients of psychiatry ward with primary psychotic and mood disorders in a tertiary care setting in South India and to assess its association with sociodemographic and clinical variables.

Methods: It was a cross sectional study among 170 psychiatry inpatients in Government medical college, Trivandrum. Mini International Neuropsychiatric Interview was applied and waist circumference, body mass index, blood pressure, fasting lipid profile and fasting blood glucose were measured. International Diabetes Federation (IDF) criteria was used for the diagnosis of metabolic syndrome.

Results: The proportion of metabolic syndrome in this representative sample was 54.7%.The proportion of individual components of metabolic syndrome like abnormalities in waist circumference(61.2%), fasting HDL (54.1%), blood pressure(68.8%), fasting triglycerides(49.4%), fasting blood glucose(48.8%) and abnormal BMI(9.4%) were estimated. Age greater than 35 years, female gender, education below high school level and use of mood stabilisers were significantly associated (p≤0.01) with the presence of metabolic syndrome with an adjusted odds ratio of 2.67, 8.08, 3.13 and 2.52 respectively.

Conclusion: Psychiatry patients have a high risk for developing metabolic syndrome inherent in the disease process and psychotropic medications further complicate the issue. Therefore, baseline and periodic medical evaluations should become a standard component in the ongoing assessment of this at risk population. In addition, patient education and proactive interventions including life style modifications need to be implemented.

Keywords: Sociodemographic, MINI, International Diabetes Federation (IDF).

Effect of Zinc Supplementation on Antidepressant Therapy and Serum Zinc Level in Unipolar Depression: A Randomized Double Blind Controlled Study

Dileep Kr Verma, Basudeb Das

Department of Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand, India. [email protected]

Introduction: Depression is a major cause of human disability. Efficacy of new antidepressants is still unsatisfactory warranting need to search newer, more effective and safer therapies. Recent, studies have shown importance of zinc in pathogenesis and therapy of depression. There is no clinical trial on efficacy of zinc in treatment of unipolar depression in India.

Aims And Objectives: To assess: a. efficacy of zinc in reducing severity of depression, b. difference in zinc levels before and after treatment, c. Correlation of zinc level with albumin and C-RP.

Material And Methods: A randomized double blind controlled study, was conducted at CIP Ranchi between September 2013 and January 2015. Sixty drug naïve or drug free (for ≥2 weeks) subjects having diagnosis of unipolar depression (including recurrent depressive disorder) were recruited and divided into two equal groups by computer based simple random sampling. Socio-demographic data and physical examination were recorded after informed consent. Both groups were assessed with HAM-D, BDI, BSSI, UKU scales, and baseline complete hemogram, LFT, serum zinc, C -RP. 20mg of elemental zinc daily were given along with antidepressants to zinc group and other group received antidepressants only. Blood tests and assessment were repeat after 2, 4 & 8 weeks.

Results and Discussion: 66.7% of zinc group and 80% of control group had low baseline serum zinc level. There was no significant difference between zinc group and control group for improvement of depressive symptoms. No significant inter-group difference of serum zinc level was seen over the period of time. Zinc group, having low baseline serum zinc shown significant increase, while those having normal baseline serum zinc had shown decrease in serum zinc level over the period of time. No significant correlation of change of serum zinc with change of serum C-RP and serum albumin was found.

Keywords: Antidepressant therapy, Unipolar Depression, Correlation.

Comparative Study of Neurological Soft Signs in Late Onset Schizophrenia

Sathish Kumar S V

House No-56, Moole Beedhi, Shirangala [Post+Village], Kodagu District, Karnataka. [email protected]

Background - Late onset Schizophrenia has been proposed as a subtype of schizophrenia and associated with subtle neurological abnormalities and there are limited studies in this field. Our study tries to identify possible etiological role of neurological soft signs.

Aims - To compare the relationship between Neurological soft signs (NSS) in late onset Schizophrenia and healthy control group.

Methodology - This study was Hospital based cross sectional comparative study by purposive sampling Method which included 41 patients with late onset schizophrenia with Clinical Global Impression severity 3 or less and 41 healthy subjects (Age and Sex matched).They were assessed on Hindi mental state examination,Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms and Neurological Evaluation Scale.

Results - Mean age of cases 49.97years (SD 5.24) and controls 50.12years (SD 5.75), Education status of controls is higher as compared to cases. 78% (32 out of 41) of the cases are females. More neurological soft signs in all components i.e., sensory integration, motor coordination scale, sequence of complex motor acts, primitive reflex subscale, other and total neurological soft signs which is statistically significant.

Conclusion - Neurological soft signs are most common in cases with late onset schizophrenia which supports the possible neurodevelopmental hypothesis of schizophrenia.

Keywords: Neurological soft signs (NSS), Clinical Global Impression severity.

Impulsivity and Serum Uric Acid Levels

Nikhil Goel, Arun Kumar Pandey, Mukesh Swami, Mahesh Kumar

Bhagat Phool Singh Government Medical College, Village Khanpur Kalan, Sonepat, Haryana 131305. [email protected]

Background: Ability to control impulses varies greatly, and difficulty with impulse control may reflect some underlying disorder. Impulsivity is a key component of many psychiatric disorders such as attention-deficit/hyperactivity disorder, bipolar disorder, pathological gambling and substance abuse. Recently uric acid is suggested as a biomarker associated with trait of impulsivity. Uric acid level has also been associated with some psychiatric condition characterized by impulsivity. Literature search yielded only one study which directly examined association of uric acid and impulsivity. The study used subjective measure personality for assessment of impulsive trait 4. So, present study is planned to find this association using both subjective and Objective measures to minimize possibility of bias. The present research will test the hypothesis that the individual scoring high on impulsiveness will have with higher serum uric acid level.

Aim: To determine correlation between the impulsivity and serum uric acid level

Settings and design: a cross sectional study conducted in the Department of Psychiatry at BPS GMC (W), Khanpur Kalan, Sonepat

Material And Method: minimum 30 subjects were included in the study who are attendants of psychiatric patients, educated at least upto 8th std with absence of psychiatric & physical illness. After taking consent they were subjected to Barratt impulsiveness scale and then to computerized continuous performance task. Serum uric acid, creatinine, urea and electrolyte level of the subjects were assessed.

Results and Conclusion: will be discussed at the time of presentation.

Keywords: hyperactivity disorder, bipolar disorder, Serum uric acid levels

The Clinical Presentation of Cannabis Induced Psychosis At First Day And After 7 Days of Abstinence In Psychiatry Inpatient Department, Rims, Imphal, Manipur

Prakash Haldar, Senjam Gojendra Singh, N Heramani Singh, Rajkumar Lenin Singh, Th.Bihari Singh

Department of Psychiatry, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, India. [email protected],

Background: Cannabis is within the heart of Indian culture and religion. But research on cannabis related psychopathology are very less. Now a days cannabis abuse among the adolescence (mainly students) are increasing. This study has highlighted on the clinical presentation of cannabis induced psychosis at first day and after 7 days of abstinence.

Objectives: To document the clinical presentation of cannabis induced psychosis at first day and after 7 days of abstinence

Material And Method: A prospective study of the indoor patients of aged 18-55 years who attended Psychiatry Department, RIMS, Imphal during the period between November 2013 to June 2015 were analyzed.

Result: A total of 50 patients admitted in the indoor during the study period. Mean age was 30.06±9.66years, 76% were in the age group 20-30 years, 94% of them were male and 70% belonged to Hindu religion. Over all, unusual thought content (96%) was found to be the most common mental health disorder followed by excitement (90%), grandiosity (88%), disorientation (68%), uncooperativeness (64%), hallucinatory behaviour (60%). The less common are depressed mood (36%), blunted affect (28%), motor retardation (12%), guilty feeling (10%). There was significant improvement in symptoms after 7days abstinence.

Conclusion: The majority of the patient belonged to the age group of 20-30years and the commonest psychiatric presentations were unusual thought content, excitement, grandiosity, disorientation, uncoperativeness, hallucinatory behavior. There was a significant improvement in symptoms after 7days abstinence. This finding has to be taken with consideration that this is a prospective inpatient based study.

Key Words: Cannabis, psychiatric disorder, abstinence.

A Case Report of Kluver Bucy Syndrome Following Bilateral Frontal Lobe Traumatic Injury: A Rare Occurrence

Sonia Malhotra

Faridabad, Haryana, [email protected]

AimS/ Objectives: The Aim of this case report is to bring forth a rare case of Kluver- Bucy syndrome occurring post-frontal lobe traumatic injury.

Methodology: A detailed history taking, mental status examination, neurocognitive testing and IQ testing was done. All records of past hospital admissions, treatment and various investigations (blood and radiological) that were done, were examined in detail.

Results: This was a case of a 15 year old boy who suffered a traumatic bilateral frontal lobe contusion with Rt. Frontal lobe multiple fractures. He showed symptoms of hyperactivity, hypersexuality, inappropriate laughter, hyperorality, voracious appetite and disturbed sleep. In spite of being variously treated, his symptoms did not respond to any medications like antipsychotics, antidepressants, mood stabilisers or stimulants.

Discussion: Kluver- Bucy Syndrome is a rare neuropsychiatric disorder occurring as a sequel of limbic encephalitis, lesions of the amygdala and systemic diseases and infections, as reported till date. The patients may have features of Kluver- Bucy Syndrome like - Hyperorality, Hypersexuality, hyper metamorphosis, affective blunting, memory difficulties, eating disturbances etc. It is also seen after traumatic brain injury affecting the subcortical areas of temporal lobe and around amygdala. Usually, a bilateral damage to amygdala leads to Complete Kluver- Bucy syndrome. Frontal lobe damage is usually more associated with disinhibition syndromes rather than such a typical Kluver- Bucy syndrome.

Conclusion: This was a rare case where it was seen that Kluver- Bucy syndrome occurs after a bilateral frontal lobe damage, which is an unusual and unreported cause of this disorder. What really needs attention is the poor response to treatment that this particular case showed and what can be done further in case such rare cases do occur. Also, it points to an alternate etiology of Kluver- Bucy syndrome apart from its correlation with amygdala pathology.

Keywords: hyperactivity,Kluver- Bucy Syndrome, Hypersexuality, metamorphosis

Tobacco Use in Male Heroin Dependent Patients on Buprenorphine Maintenance Treatment in an Urban Community

Sonali Jhanjee, Roshan Bhad, Hem Sethi, Ravindra Rao

Additional Professor, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi. [email protected]

Aims: This study examined the characteristics of tobacco use in male heroin dependent patients on buprenorphine maintenance treatment in an urban community in India with a view to plan intervention.

Methods: This is a cross sectional study of 50 consecutive male heroin dependent patients enrolled in Buprenorphine Maintenance Treatment. Tobacco use characteristics was filled in a semistructured proforma, severity of nicotine dependence was measured using Fagerstrom's test for nicotine dependence(FTND) and Readiness to change questionnaire (RTCQ) was used to assess motivation.

Results: Mean age of the sample was 36 (SD=13) years, nearly half (48%) were unmarried, one-fifth were illiterate, majority (62%) were employed and most belonged to lower socio economic status. Smoking only, smokeless tobacco use only and dual use of both smoking and smokeless tobacco was present in 64%, 8% and 28% of participants respectively. Mean age of tobacco initiation was 14 years (SD=4) and mean age of onset of heroin use was 21 (SD=4) years. The mean dose of buprenorphine received was 6 (SD=1.54) mg. 90% of patients showed interest in quitting tobacco use and 53.5% and 37% were in contemplation and action stage of motivation respectively. The mean FTND score was 5.2(S.D= 2.7) and the median score of FTND-ST was 3. Perceived risk and awareness of smoking related hazards was highest for chronic lung problems (77%) followed by cancer (65%) and cardiovascular problems (58%). 4% of tobacco users admitted difficulty in opening mouth and 14% reported oral lesions. Nearly two thirds of the participants perceived tobacco cessation as important/very important.

Conclusion: As opposed to predominant smokeless tobacco use amongst general population in India, smoking was more commonly reported here. Most participants had moderate levels of nicotine dependence, reported interest in quitting and perceived intervention as important. Using these profile appropriate tobacco cessation treatment may be provided.

Keywords: buprenorphine, heroin dependent, FTND-ST

"To Study the Predictors of Relapse in The Patients of Schizophrenia"

Ram Kumar Solanki, Pankaj Borade, Alok Tyagi, Suresh Gupta, Sonia Malhotra, D.R. Swami

Department of Psychiatry, SMS Medical College, Jaipur. [email protected]

Background: Relapse in schizophrenia is associated with severe impact on individuals quality of life and social functioning. Our study Aims to study possible predictive factors associated with relapse, which can be utilized in management and improving patients functioning.

Aim: To investigate the relapse rate among the patients of schizophrenia, within a year of their discharge from the hospital, and to explore possible risk factors related to relapse.

Method: A cross sectional observational study of total 167 schizophrenic relapsed and remitted patients of 18-60 years of age group coming to the outpatient department of psychiatric center, SMS medical college and Hospitals Jaipur, who were admitted and treated in the hospital in last one year and were discharged on recovery. The current diagnosis of schizophrenia was made according to ICD 10 criteria. After obtaining informed consent from the subjects, a reliable informant were approached for information about relapse and correlative factors was recorded using a semi-structured clinical performa. The possible risk factors analysed were sociodemographic, illness characteristics and treatment adherence. The illness information included duration of illness, age at onset, lifetime number of hospitalisations, family history of physical and psychiatric illness, history of substance abuse and premorbid functioning.

Results and Conclusion: All observations of sociodemographic, illness characteristics tabulated and its correlation was assessed with relapse rate. The data was analysed using suitable statistical analysis.

Keywords: Schizophrenia, Relapse, Sociodemographic.

Minor Physical Anomalies in Positive Versus Negative Symptom Patients of Schizophrenia

Sneh Shyam Babhulkar

Central Neurological and Medical Institute, 80 Shankar Nagar, Nagpur, Maharashtra. [email protected]

Background: Minor physical anomalies (MPAs) has been described by Jones (1988)78 as "unusual morphologic features that are of no serious medical or cosmetic consequences to the patient. The value of their diagnosis is that they may serve as indicators of altered morphogenesis in a general sense or may constitute valuable clues in the diagnosis of a specific pattern of malformation"

Objective: This study was designed to examine the Minor Physical Anomalies in positive versus negative subsets of schizophrenic patients and identify the degree of abnormalities of this specific endophenotype and for understanding the association between various socio demographic and illness variables(like age, gender, duration of illness, handedness) between the subsets of schizophrenic patients.

Materials And Methods: 30 patients with positive symptoms of schizophrenia, 30 schizophrenic patients with negative symptoms and 60 age and sex matched controls were recruited from Psychiatry OPD and IPD from a tertiary care rural hospital. The Waldrop Minor Congenital Anomaly Scale (Waldrop and Halverson 1971) was applied for recording the scores of Minor Physical Anomalies.

Result: The Minor Physical Anomaly(MPA) scores were significantly more in positive as well as negative subsets of schizophrenic patients with a statistical difference of (p<0.0001) as compared to healthy controls. However there was no statistical significant difference in MPA scores between the two groups of schizophrenics.

Conclusion: Increased MPA scores in schizophrenic patients in comparison to controls advocates that Minor Physical Anomalies may be considered as a useful Neuroendophenotypic marker for establishing an etiopathogenesis in the schizophrenic disease process.

Key Words: Schizophrenia, positive and negative symptoms

Assessment of Abuse Potential of Tramadol: A Double Blind Randomised Controlled Trial

Mrinmay Das

Dept of Psychiatry, gmc & stmh0 , Haldwani, Uttarakhand. [email protected]

According to world drug report 2014, prescription opioid drugs are emerging as new threat as there is an increasing trend of abusing these drugs, especially in Asian and African countries. Tramadol is an opioid analgesic and being used widely through out the globe. In some countries it is being sold over the counter. The research showed conflicting Results regarding abuse potential of tramadol. There are only few studies on abuse liability of tramadol, in the form of case report from India. Therefore, it was considered worthwhile to conduct the study on abuse potential of this widely used opioid analgesic.

Keywords: Tramodol, Abuse potential, opioid analgesic

Assessment of Knowledge of Psychiatry Among Interns

Akanksha Rathi, Shubhangi R. Parkar

C-8, Jay Apartments, 32, Nehru Road, Santa Cruz (East), Mumbai, Maharastra. akanksha [email protected]

Objectives: Recent years have revealed that medical education in psychiatry in developing countries is not yet at par with that in developed countries. The situation is possibly due to the fact that psychiatry is a short subject during the undergraduate curriculum and almost optional in examinations. Also, there is insufficient sensitisation of students to mental health problems. Additionally, there is a restricted period of two weeks for psychiatry during the internship period. As a Result, the knowledge, skills and attitude of an intern, who is a basic doctor in reality, towards psychiatry, remain largely deficient to deal with a large chunk of patients with mental health problems.

It is a known fact that the proportion of psychiatric disorders amongst patients coming to a primary care physician is on the rise in recent times. Also, India has a unfavorably skewed ratio of psychiatrists to patient population. Knowing these facts, the need to develop doctors with a reasonable efficiency in identifying and managing psychiatric patients in the community becomes imminent.

Hence this study was undertaken with a view to evaluate the quality of knowledge of interns pertaining to common psychiatric disorders.

Methodology: The study was done in the setting of a medical college in Mumbai. The subjects for the study were 65 interns from the same college, having completed their rotatory internship post in the department of psychiatry. Participation in the study was voluntary. Feedback assessment forms consisting of MCQs and qualitative data were developed and administered to the subjects. Data was collected, compiled and analysed.

Results and Conclusion: Will be discussed at the time of presentation.

Keywords: knowledge, attitude, skill, psychiatry, doctors, interns

Prevalence of Psychiatric Morbidity in Intensive Care Unit Patients

Mona Nongmeikapam, Mohan Reddy, Ruth Sneha

Department of Psychiatry, Sri Devraj Urs Medical College, Tamaka, Kolar. [email protected]

Aims: To study the prevalence of Psychiatric morbidity in patients admitted to the intensive care unit at Sri R.L.Jalappa Hospital and Research Centre, Tamaka, Kolar using the SCL-90 (Symptom Checklist) (ii)To identify the major problem areas

Materials & Methods: Source of data: To study 60 consecutive patients admitted in the intensive care unit in Sri R.L.Jalappa Hospital and Research Centre, Tamaka, Kolar.

Method of data collection: The study is a prospective observational study. Data was collected using the SCL-90 (Symptom Checklist). After obtaining informed consent, 60 consecutive patients were administered the questionnaire once they got stabilised and just before they were transferred to a step-down ward from the Intensive care unit. Inclusion criteria: 60 consecutive patients admitted to the Intensive care unit who give written, informed consent Exclusion criteria: Patients who submitted incomplete forms and those who do not provide consent. Patients under the influence of drugs or substance that alter mental status, or presenting with confusion, delirium or frank psychotic symptoms

Results & Conclusion: 34% reported little distress, 4% were moderately distressed and the remaining 62% denied any distress. No patient complained of extreme distress. Depressive symptoms like feeling sad, worrying too much, having trouble falling asleep were rated the highest where queries pertaining to paranoid ideation like hearing of voices and phobic anxiety like feeling afraid to fall in public were rated the lowest.

There is a significant prevalence of psychiatric morbidity amongst patients admitted to the intensive care facilities, though the degree of distress ranges from mild to moderate. Hence more attention to psychological and stress management should be paid to the intensive-care patients once their acute distress has been addressed.

Keywords: Psychiatric Morbidity, Depressive symptoms, intensive care

Cross-Cultural Adaptation, Reliability, and Validity of the Autism Treatment Evaluation Checklist in Hindi

Savita Sapra, Tanuja Kaushal, Madhulika Kabra, Ganesh P Das, Ankita Pradhan

#1, Genetic Unit, Old Ot, Aiims, New Delhi-110029. [email protected]

Introduction: Research indicates intensive early intervention is critical for improving outcome for children with ASD and their families. Hence in order to establish a reliable baseline for tracking the trajectory of early treatments, sensitive monitoring tools are becoming mandatory.

Objective: The Objectives of the current study were to translate and adapt Autism Treatment Evaluation Checklist (ATEC) into Hindi language and to investigate its reliability and validity in Indian sample.

Methods: A total sample of 60 children with autism spectrum disorders aged 18 months to 6 years were included in the study. The process of cross-cultural adaptation was performed according to international Methodological steps as following: Forward translation, Synthesis of the Translated Versions, Back translation, Synthesis of Back translated version, Expert committee. Internal consistency and test retest reliability of the questionnaire was evaluated through stability and homogeneity assessments. The content validity of the ATEC was reviewed by the expert committee.

Findings: The Results showed excellent test retest reliability (Intra Class Correlation =0.99) and Internal consistency for complete scale (Chronbach's alpha= 0.93) as well as for the subscales (Cronbach's alpha= 0.84-0.90). Content validity (Content Validity Index= 0.87- 1.00) was also found to be good.

Conclusion: Cross-cultural adaptation of ATEC was successful. The psychometric properties were verified and indicated that the adapted questionnaire is valid and reliable to use in Indian culture.

Keywords: Autism Treatment Evaluation Checklist (ATEC), ASD, Cross-cultural adaptation.

Prevalence of Depression Among Type 2 Diabetic Patients Attending Outpatient Clinic At Tertiary Care Center, Visakhapatnam

Madhavilatha K. Padma V.

Dept of Psychiatry, Andhra medical College, Visakhapatnam [email protected]

Background: India has 2nd largest number of diabetic population in the world .According to WHO by 2025 diabetic population in India will be 69.9 million. Compared with patients with diabetes alone, patients with diabetes and depression show poor outcome. This study was carried out to study the prevalence and determinants of depression in patients with established type 2 diabetes attending Dept of Endocrinology, King George hospital, Visakhapatnam.

Materials And Methods: A cross-sectional study was conducted among type 2 diabetic patients above 30 yrs of age, attending outpatient clinic, Dept. of Endocrinology, KGH Visakhapatnam. Depression was assessed using HDRS(Hamilton Depression rating scale) also known as HAM -D. The relationship with sociodemographic profile, duration of diabetes and complications of diabetes were analysed.

Results: Out of 72 study subjects 40( 55.5%) were females. Majority of the study subjects 26(36% ) belong to age group of 60-69 years of age . 52(72%) of them belong to urban areas. Of the study subjects 58 (80.5% ) had depression, of which 28 (39%) met the criteria for moderate depression,22(30.5% ) for severe depression and 8 (11%) for mild depression and remaining 14(19.5%) had clinically no significant depression. With increased duration of diabetes, there is an increase in the prevalence of depression. Neuropathy was the major complication 48(66.6%) followed by retinopathy 22(30%).

Conclusion: Our study shows higher prevalence of depression among type 2 diabetic patients. Depression is more common in females, urban population and with duration of diabetes more than 5 yrs. Neuropathy and retinopathy were the major complications associated with diabetes.

Keywords: Depression, Type 2diabetes, HDRS(HAM-D).

Prevalence and Profile of Substance Abuse in Railway Running Staff

Dr.Usha Rajendra Kumar, Ms. P. Prabha, Ms. R. Kannamma

Department of Psychiatry, Southern Railway Headquarters Hospital, Perambur, Chennai - 23. [email protected],

Background: Substance Abuse (alcohol) has been a significant problem in an industrial setup Resulting in social and occupational dysfunction, psychiatric and physical complications. WHO estimates 140 million alcoholics worldwide. Out of this, 76.3% suffer from alcohol dependence and this accounted for 1.8 million deaths per year in India alone. In the Indian Railways, Running Staff are the most important group responsible for safe transportation of nearly 25 million passengers and more than 2.8 million tons of freight daily.With this Background, we studied the profile of Running Staff referred for De-addiction to a tertiary Railway Hospital.

Aim: To study the profile of Substance Abuse in Running Staff referred to Psychiatry Department, Southern Railway Headquarters Hospital.

Materials And Methods: A total of 79 train running staff were referred to Psychiatry Department for consultation during the period January 2014 to June 2015. Among them, 38 were referred specifically for De-addiction after they failed the Breath Analyzer test. Their psychosocial profile and substance abuse profile are discussed in this paper.

Results And Discussion: Among the 38 Running Staff registered for De-addiction, 31.6% were drivers and assistant drivers, 2.6% TTE, while 65.8% comprised of staff working in open line. 39.5% had Single Substance (Alcohol) Abuse. 57.9% had combined Alcohol and Nicotine Abuse, while 2.6% had multiple substance abuse. Based on the duration of abuse, 63.2% had more than 10 yrs of abuse and 36.8% had less than 10 yrs of abuse. 15.8% were abstinent for nearly a year or more. 23.7% were abstinent for less than a year. 26.3% were abstinent for 6 months. 34.2% were abstinent for less than 3 months.

Conclusion: Substance Abuse is a significant problem in Railways for which stringent measures has to be taken to ensure public safety during train travel.

Keywords: Substance Abuse, De-addiction, Breath Analyzer test.

Predictors of Attrition with Buprenorphine/Naloxone Treatment in Emerging Adults

Prabhoo Dayal, Yatan Pal Singh Balhara, Ashwani K. Mishra

Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India. [email protected]

Background: Emerging adulthood between ages 18-25 has been conceptualised as a developmental stage based on psychosocial characteristics. Emerging adults aged 18-25 years report a lower retention rates between 9% and 17% at 12 months than adult population.

Aims: The current study Aimed to examine the factors associated with leaving the first episode of Buprenorhine /naloxone treatment among emerging adults aged 18-25 years entering Buprenorphine /Naloxone treatment for opioid dependence .

Materials & Methods : we reviewed the records of all emerging adults aged 18-25 years commencing opioid maintenance treatment for the first time between 1st January 20012 and 31st December 2014, with follow-up data until 31st March 2015.

Results: A total of 68 emerging adults with opioid dependence disorder were inducted for Buprenorphine maintenance treatment at the centre over the study period of three years. Out of 68 patients, 33.8% retained in treatment at 90 days, 19.11% at 6 months and 11.76% at one year. Cox regression was used to analyse the unadjusted and adjusted risk (hazards ratio, HR) and 95% confidence intervals (CI) for leaving a first buprenorphine maintenance treatment episode. After controlling for various covariates, substance use in 1 st degree relatives (AHR 2.278,CI 95% 1.281-4.051), Buprenorphine induction setting (inpatient/outpatient) (AHR: 2.961,CI95% 1.599-5.483) and past month injection use (AHR: 0.282,CI 95% 0.137-0.582) were significant predictors of leaving treatment .

Conclusion: Young adults aged 18-25 is difficult population to engage and retain for long term maintenance treatment as compared to adults .This study would help in understanding the predictor of outcome of opioid dependence in a real-world situation. These findings would help in developing novel age-specific interventions or alternative treatment approaches for this age group.

Key words; Buprenorphine, Emerging adults, Retention

Thyroid Profile in Drug Naive Cases of Depression

Talukdar B, Goswami H K

Department of Psychiatry, Assam Medical College and Hospital, [email protected]

Introduction: Depression is a disorder of major public health importance, in terms of its prevalence and suffering, dysfunction, morbidity, and economic burden.Thyroid dysfunction is often encountered as a part of depression .Thyroid Function Test's(TFT) can be considered as an integral part of evaluation of newly depressed patients. It will be beneficial for the treating psychiatrists to be cautious in cases of treatment resistant depression as well.

Aim And Objective: 1.To asses the thyroid profile in newly diagnosed drug naïve depression cases and healthy control. 2. To find out clinical correlation between the thyroid profile and severity of depression.

Material And Method: It is a case control study where - Study group is newly diagnosed drug naïve case of depression and control group is equal number of same age and sex matched people selected from normal healthy population. Thyroid profile level is evaluated in both this group and levels are compared.

Result: In the Result it has been seen that female cases outnumbered the male cases and 9(18%) cases of depression have increase TSH level than the normal value, 2(4%) cases have low T4 level and 1(2%) cases have low T3 level. Among the study and control group it has been seen that T4 level is high in control group (90.14 mean) and it is highly significant (.0001). No significance has been found between thyroid profile and severity of depression.

Conclusion: Though thyroid dysfunction is seen in depression however there is no significance is found with severity of depression.

Key Words : Depression,T3,T4,TSH

Psychiatric Morbidity and its Relation with Serum Cortisol Level in Breast Cancer Patients

Satya Kumar Dutta, H. K.Goswami, J. Ahmed,

Department of Psychaitry, and Department of surgery: Assam Medical College and Hospital, Dibrugarh. [email protected]

Introduction: Breast cancer is the second most common malignancy and second leading cause of cancer death in women. Women when diagnosed as breast cancer suffer from psychological stress which leads to various psychiatric manifestations. Of these depression is the most common. There is evidence that biological sequelae of depression such as hypothalamic-pituitary-adrenal dysregulation may directly promote tumor growth.

Objective: The Objective is to study the psychiatric morbidity and its relation with serum cortisol level in breast cancer patients.

Methods: This is a cross sectional study including 40 breast cancer patients and 40 healthy female. Cases are divided as new cases (≤ 1 month of diagnosis) and old cases (> 1 month of diagnosis). Two groups are evaluated for psychiatric morbidity by applying Mini International Neuropsychiatric Interview Scale. Then three samples of serum cortisol level are taken at 11pm and 8am & 8.30 am and Results are compared with the normal values of cortisol.

Results: Results indicated that breast cancer patients have high incidence of psychiatric morbidity (55%). 25 % patients have major depressive disorder, 22.5 % have MDD with generalized anxiety disorder. 2.5 % have MDD with GAD with panic disorder and 5% have GAD alone. Out of 9 new cases 7 have psychiatric morbidity. Breast cancer patients also have higher levels of cortisol at baseline than controls. Newly diagnosed cases of breast cancer patients have higher cortisol level than old cases.

Conclusion: The Results of the study indicate that breast cancer patients have high prevalence of psychiatric morbidity. The psychiatric morbidity is more in the newly diagnosed cases. Results also reveal elevated cortisol level in the cancer patients specially in the newly diagnosed cases which may be due to physiologic stress associated with disease process, psychological stress associated with fear of cancer, or a combination of both.

Key Words: Breast cancer, major depressive disorder, generalized anxiety disorder, panic disorder, cortisol

Emotional Intelligence of Medical Graduates Doing One Year Compulsory Rural Service Under Nrhm0

Partha Pratim Saikia, S. Ghosh

Department of Psychaitry, Assam Medical College and Hospital, Dibrugarh. [email protected]

Introduction: Emotional Intelligence (EI) is a type of social intelligence that involves ability to monitor one's own and others' emotions, to discriminate among them and to use this information to guide one's thinking and actions .It has been considered to be playing an important role in deciding success in varied professions including that of ours by helping in tackling problems and coping with negative emotions evoked in stressful situations. Thus an assessment of EI in a group of recently passed out rural doctors would probably help us determine factors towards better patient- centred care.

Aims And Objectives: To Assess EI of medical graduates doing one year compulsory rural service under NRHM.

Materials And Methods: It was a comparative study where data was collected from randomly selected medical graduates working under 1 year compulsory rural service in dispensaries, MPHC's and PHC's 50 in total. A control group was selected from post graduate students from Dibrugarh University. Emotional quotient as well as its three psychological dimensions- sensitivity, maturity and competency were assessed in both the groups and compared using the EQ Scale developed by Dr. Dalip Singh and Dr. NK Chadha.

Results: It has been seen that the mean score of EI was greater in the study group than that of the control group. When the individual dimensions of EI- sensitivity, maturity and competency were compared between the study groups, a statistically significant p-value of 0.0255 was found when competency was compared. No significance was found when the dimensions of sensitivity and maturity were considered.

Discussion: The explanation for a higher competency may be attributed to tackling emotional upsets, high self-esteem, tactful response to emotional stimuli, and handling egoism. However, this study has not been reported in any literature and thus it is required to be validated by other researchers too.

Key Words : Emotional intelligence, Medical Graduates

A Comparative Study of The Nature and Extent of Coverage of Mental Health Issues In Newspapers

Deepali Gul, Gulbahar Singh Sidhu, Rupesh Chaudhry

Department of Psychiatry, Punjab Institute of Medical Sciences, Garha Road, Jalandhar (Punjab). [email protected]

Introduction: Psychiatric illnesses are shrouded in the clouds of stigma and misconceptions in our country. Even in the era of the internet, printed media are still among the most frequently identified sources of mental health information. Many studies have shown that this information is frequently negative and contributes to stigmatization of people with mental illness. This stigma and lack of awareness among people owes to great extent to the nature and extent of coverage of issues related to mental health in the print media.

Is the picture any different in developed nations like the US or the UK, where there is greater awareness of psychiatric problems in the society? This is the question we set out to answer in our study.

Objectives: We Aimed at finding out the extent and nature of coverage of issues related to mental health in newspapers over a one year period in a prospective study. We Aimed to compare the coverage in a leading national newspaper of our country (THE TIMES OF INDIA) and a leading newspaper of the United States (THE NEW YORK TIMES).

Methods: All items related to mental health were identified by searching for) from the online editions of a leading newspaper of our country( The Times of India) and a leading newspaper of the united states( The New York Times) over a one year period ending November 30, 2015.The process of identification and analysis was carried out by a team of two psychiatrists.

Results: The Results of the study will be discussed at the conference as the study is currently underway.

Key Words: Mental Illness, Mentally Ill, Depression, Suicide, Addiction, Alcohol, Heroin, Nicotine, Schizophrenia

A Model of Spreading Awareness - Wherein Medical Students Could Empower 1000 Rural People Within 1 Month

Dharav Sunil Shah

602, Sai Krishna Kunj, D.N. Nagar, Andheri (west), Mumbai, Maharastra. [email protected]

Introduction: Though alcohol & tobacco are leading causes of morbidity & mortality they continue to be popular. Evidence about their hazards needs to be broadly disseminated and misconceptions answered. Medical professionals are in a unique position to spread awareness because they have access to the journals, have personally witnessed the suffering of people and because they are regarded to be authority in this field.

What was done: Students of a medical college (MGIMS, Sewagram), were appealed to participate in a time bound awareness drive of 1 month; in which they would be conducting awareness talks near the hospital wards, for patients and their relatives, during evenings after routine college hours or on Sundays. The issue was discussed in detail with the students who came forward to volunteer. Soft copy of compiled information was emailed to them and they were encouraged to study other resources as well. To help them prepare and feel confident, 1st health talk was presented by a faculty member. This talk was recorded and uploaded on you-tube so that students can review it. Later students started presenting in groups and distributed pamphlets after the talks, to enable the audience to revise and pass-on the message.

What we could achieve: In 29 days, our team of 25 people made 21 presentations and empowered 1090 people with an increased understanding of the addictive poisons alcohol & tobacco. As observed in the retro-pre feedback, there was significant enhancement in the knowledge & skills of participating students too.

Conclusion: This model of conducting health talks in hospital premises itself using the collective energies of the large skilled manpower in a medical institution, can take health awareness effectively to a large number of people in a time-efficient and cost-effective way. Also, the experience is immensely satisfying and enriching for the participating volunteers.

Keywords: Tobacco, Alcohol, addictive poisons.

Quality of Life In Patients With Dual Diagnosis

Sidharth Arya, Preeti Singh, Rajiv Gupta

Rohtak, Haryana - 124001. [email protected]

Quality of life(QoL) is increasingly being recognised as an important outcome measure in alcohol dependence syndrome. QoL may depend on various factors including drinking variables, period of abstinence, psychiatric co-morbidity amongst others. Current study Aims to study the QoL in patients with dual diagnosis.

100 out-patients diagnosed with alcohol dependence were randomly selected from de-addiction center (department of psychiatry, PGIMS, Rohtak). They were assessed using a specially designed proforma for socio-demographic and drinking variables, psychiatric co-morbidity was assessed with Mini International Neuropsychiatric Interview 5.0 (M.I.N.I ) and quality of life with WHOQoL-Bref Hindi. Results were calculated using SPSS 19.

All subjects were male, with mean age of 38.00 ± 8.57 years and 6.74 ± 5.4 years of dependence duration. Psychiatric comorbidity was present in 32 patients. These two groups didn't differ amongst socio-demographic variables. 53.1% with psychiatric comorbidity reported poor overall quality of life as compared to 30% of those without comorbidity, while 56% were dissatisfied with their physical health as compared to 38%. There were significant difference between two groups in physical (57.78 ± 18.57 vs 42.12 ± 21.29), psychological (53.29 ± 17.63 vs 40.19 ± 21.76), social relationships (66.90 ± 23.62 vs 43.97 ± 19.05) and environment (62.71 ± 15.02 vs 50.47 ± 18.39) domains.

Keywords: Quality of life, WHOQoL, MINI.

"Unheard and Un-Served Voices": Experiences And Perceptions of Motherhood In Mothers With Severe Mental Illness- A Qualitative Perspective

Banerjee, D, Desai, G, Chandra P.

Department of Psychiatry, NIMHANS, Hosur Road, Lakkasandra, Bengaluru, Karnataka. [email protected]

Background: A woman's desire to bear children may surpass the most extreme of situations and mothers with mental illness are no exception. Most women with severe mental illness in the current era of better treatment options are becoming mothers. However, little is known about their own experiences in this regard and the extent to which their needs are met by mental health professionals.

Objectives: To assess the needs and experiences of pregnancy & motherhood in women with severe mental illness

Method: The study used a qualitative design with social constructivist paradigm. Data was collected through face to face in-depth semi-structured interviews in a purposive sample of 20 mothers with SMI. After verbatim transcription, inductive thematic analysis was used to explore transcripts.

Results: The varied experiences were arranged along the pre and post pregnancy timelines. In each of them the overarching categories were feelings about the child, impact of illness, unmet needs and caregiver reaction. Along these categories, the following themes emerged: in pre-pregnancy ( ambivalence on childbirth & concerns about health of child; stigma & impact of medications; unmet emotional support & unanswered doubts; discrimination ) while in post-pregnancy ( possessiveness & guilt as mother; difficulty in bonding & concealment of illness; need for home based treatment and support groups; family reaction of blame, custody threats & institutional care ). Most women considered motherhood 'central' to their lives & almost all of them experienced the burden of "dual identity". A widespread idea among people, especially women, that mentally ill women cannot be "good mothers" was common and women reported that services for parenting advice were inconsistent and lacking.

Conclusion: Women who are mothers and also users of mental health services do prize motherhood though facing special challenges in managing the contradictory aspects of their dual identity. Hearing their voices is essential for service provision and ensuring adequate their special needs. Strategies to understand and address their unmet needs are critical for the well-being of both mother and child.

Keywords: Pregnancy, Motherhood, dual identity.

Spirituality and Religiousness: A Source of Coping During Remission In Patients With Schizophrenia

Soumitra Das, Varghese P Punnoose

Department of psychiatry, Govt. T. D. Medical College, Alappuzha. [email protected]

Background : Religion and spirituality seems to offer valuable benefits to patients living with and recovering from Schizophrenia. Patients suffering from Schizophrenia often report that religion is source of strength and resilience in their life even though the role of religion in mental illness remains understudied.

Aim and Objective: To know the usefulness of spirituality and religiousness in coping during remission in Schizophrenia patients.

Methodology: Hospital based cross sectional study in the Department of psychiatry, Govt .T. D. Medical College, Alappuzha.

Duration: 1 year duration.

Tools for assessment:

  1. Positive and Negative Syndrome Scale [PANSS]
  2. Ways of coping questionnaire - Revised (WAYS)
  3. WHO Quality of Life-Spirituality, Religiousness and Personal Belief scale [WHOQOL-SRPB].

Procedure: Clinically diagnosed patients with schizophrenia obtained by consecutive sampling were screened with PANSS to collect cases in remission. Then cases were examined with WHOQOL-SRPB followed by WAYS. All the scales were applied in a single setting after taking written consent from the patient as well as care giver.

Statistical analysis: Results are analyzed using SPSS software. Following tests are used:

Independent T test, Mann Whitney U test, Kruskal Wallis H test, Chi-square test, Pearson's product moment correlation test.

Results and Discussion: Domain score of WHOQOL-SRPB is significantly (P<0.05) related with all of its facets. There is also significant relationship (P<0.05) between domain score and all the scales of WAYS except escape avoidance. It signifies the importance of spirituality domains in coping mechanism during remission of Schizophrenia.

Conclusion: Understanding and assessing the spirituality and religiousness of subjects with schizophrenia can help in better management of the disorder.


Prevalence and Risk Factors of Neuropsychiatric Disorders In Parkinson Disease: A Study From Eastern India

Alakananda Dutt, Hrishikesh Kumar, Muktalekha Mukherjee, Marium Umme Kulsum, Chitrita Sengupta

Institute of Neurosciences, Kolkata, West Bengal. [email protected]

Neuropsychiatric disorders in Parkinson's disease (PD) have greater impact on the health status and quality life of patients compared to the motor symptoms. However there is a scarcity of literature from India focusing on neuropsychiatric disorders in PD.

Method: 150 consecutive consenting patients with PD, fulfilling UK Brain Bank Criteria attending a Neuro-speciality hospital were evaluated with the Unified Parkinson's Disease Rating Scale (UPDRS), Modified Hoehn and Yahr staging, Schwab and England Activities of Daily Living Scale, the Mini International Neuropsychiatric Inventory (M.I.N.I), the National Institute of Neurological Disorder and Stroke- National Institute of Mental Health (NINDS - NIMH) criteria, Mini Mental State Examination (MMSE) and Patient Health Questionnaire 9 (PHQ9).

Results: 63.3% (N=95) patients had psychiatric disorders with 22% (N=33) having more than 1 psychiatric illness. 33.3% (N= 50) had PD associated psychosis, 32% (N= 48) had Major Depressive Disorder and 22.7% (N=34) had Anxiety Disorders. The high prevalence of psychotic disorders was due to the use of the broader NINDS-NIMH criteria which includes sense of presence and illusions as psychotic symptoms. Patients with Major Depression had significantly higher family history of psychiatric illness, performed poorly in activities of daily living, had greater severity of motor symptoms, more dyskinesias and clinical fluctuations with treatment as compared to those without depression. Anxiety disorders were significantly more common in patients who were younger, with early age of onset of PD and such patients were more likely to have depressive symptoms and family history of psychiatric disorders than those without anxiety disorders. Patients with PD associated psychosis had significantly more visual disturbances, lower cognitive performance, more depressive symptoms, more deterioration of motor functions, greater severity of illness, poor functioning in daily activities and lower quality of life as compared to those without psychosis.

Conclusion: The study highlights the high prevalence and risk factors of psychiatric disorders in patients with PD seeking hospital services.

Keywords: Neuropsychiatric disorders, NINDS-NIMH, MMSE.

Early Onset Illicit (Heroin) Substance Use With Comorbid Conduct Disorder: Management Issues And Challenges

Shobhit Jain, Ramandeep Pattanayak, Rachana Bhargav, Anju Dhawan

#84, Jawahar Nagar Colony, Bhelupur, Varanasi, Uttarpradesh. [email protected]

Objectives: Childhood substance abuse and delinquency often progress to harder substances and antisocial personality disorder and carries deleterious consequences for self, family and community at large. Early management of such cases poses several clinical and management challenges, as highlighted in the present case. The treatment seeking for this sub-population is very low in spite of community surveys showing a worrisome pattern of substance use among younger population. Further, very few specialty clinics and trained manpower exist in the country to manage early onset substance use.

Case description: A 15year male child of nuclear family, lower socio-economic status and easy going premorbid temperament, presented with beedi use at 6years, ganja use at 9years, inhalant use at 11years and smack use at 12years in dependent pattern, along with high accessibility to drugs in his surroundings. There is history indicative of conduct disorder from the childhood. From an early age, he developed friendship with deviant peer group, dropped out school at 9 years and was devoid of adequate parental supervision, since both parents were involved in daily wage work, with no social support. After two previous unsuccessful treatment attempts, patient visited the adolescent substance use clinic at NDDTC (AIIMS), where he was admitted for 3 weeks.

Considering various factors identified during comprehensive assessment, both pharmacological as well as psychosocial management based on Multidimensional Family Therapy was provided to the patient, details of which shall be discussed in presentation.

Conclusion: Whether conduct disorder be cause or consequence for drug use is debatable, in view of shared risk factors. The present case helps to understand need for comprehensive assessment for identifying risk factors and comorbid conditions. Only pharmacological management does not help, psychosocial management must be delivered. Several prevention strategies may also help if these risk factors are identified before progression to illicit substance use disorder.

Keywords: Adolescent, Substance Abuse, Conduct Disorder, Management

Role of Life Events In Schizophrenia: A Study Among Rural South Indian Population

Ashok Mitra

Department of Psychiatry, OPD block, Sree Siddhartha Medical College, Tumkur. [email protected]

Introduction: Life events play an important role in predisposition, precipitation, sustaining and relapse of schizophrenia. High scores on life event scales were found in majority of them. The impact of life events are also influenced by the defense mechanisms and coping skills, which in turn, depend on the personality of the individual.


Method: A retrospective study was done on 46 consecutive patients diagnosed with schizophrenia, meeting ICD-10 DCR criteria, attending psychiatry OPD in a tertiary care hospital in rural Karnataka. After taking informed consent, a semi-structured proforma was used to collect socio-demographic details. Presumptive Stressful Life Event Scale (PSLES) was administered to study life events.

Results: Majority of patients were Hindus, educated up to middle school level, self-employed and from low socio-economic Background. Undesirable life events (U) had more associations with schizophrenia and they commonly preceded the onset of symptoms by around 1-2 months.

Conclusion: Life event/s commonly precedes/precede the onset of schizophrenia. Role of life events in initiating and sustaining schizophrenia need to be understood and suitable counseling measures need to be employed in management.

Keywords: DCR criteria, Presumptive Stressful Life Event Scale (PSLES)

Lower Lipid and Cholesterol Levels Might be Associated With Increased Suicidality In Patients With Schizophrenia

Anjana Rao Kavoor, Sudhir Kumar, Anil Sisodia, Rakesh Kumar

Department of Psychiatry; Institute of Mental Health and Hospital, Agra, India [email protected]

Impulsivity and poorly moderated affect have been implicated in excess suicide and violence-related morbidity in patients with schizophrenia. Recent literature indicate possible role of serum lipids in modulating impulsivity and associated behaviors in human beings, though studies on these lines in patients with schizophrenia are sparse.

Present study evaluated 39 consenting, drug-free, male patients with schizophrenia for impulsivity, suicidality and aggression; and correlated scores with serum lipid levels. We found significantly lower levels of Total-Cholesterol (TC), HDL and LDL (p<0.05) in patients, compared to 38 age-sex matched healthy controls; for equivalent BMI values (patients 19.94kg/m2; controls 20.34kg/m2; p=0.538). In patients, impulsivity (Impulsivity rating scale, IRS) correlated negatively with TC, LDL and HDL (p<0.05); while suicidality (Beck Scale for Suicidal Ideation, BSSI) correlated negatively with TC (p=0.011) and IRS-BSSI scores correlated positively (p<0.001).

Findings indicate increased need for caution while using lipid-lowering agents in schizophrenia patients.

Keywords: Lipid profile; Cholesterol; Schizophrenia; Suicidality; Impulsivity

The Heart Of Bipolarity: Coronary Risk Status At Initial Stages Of The Disorder

Anjana Rao Kavoor, Daya Ram

Department of Psychiatry, Institute of Mental Health and Hospital, Agra, India [email protected]

Lipid abnormalities and metabolic risk-factors in bipolar disorder have mainly been evaluated in western population; in patients with prolonged illness-duration and/or on psychotropic medications. Present study evaluated these risk factors in drug-naïve/free first episode mania patients in a representative Indian scenario.

With institutional ethical committee approval, 49 consecutive consenting drug-naïve/free (4-weeks) male patients (age 26.96±7.01years) with first-episode Mania (DOI 2.11±4.61weeks; ICD-10-DCR) were evaluated using NCEP-ATP-III and 10-Year Risk for Coronary Heart Disease Framingham Point Scores; for cardiovascular risk.

None were hypertensive, and 32 were smokers. Overall, 8.16% patients had "undesirable" total-cholesterol values, 22.45% had supra-optimal LDL levels and 48.98% patients had low serum HDL. Finally, 10.20% patients had ≥1% 10-year risk by total Framingham point score for coronary heart disease; one being at 3% risk.

Present findings indicate that even at disease onset, relatively young bipolar patients could still be at an increased risk for metabolic and cardiovascular-related morbidities.

Keywords: Mania; Cardiovascular risk; Cholesterol; India

Critical Comparative Analysis of the Efficacy of Statistical Tools Used in The Field of Forensic Psychiatry In India

Aarthi Raghavan

Indian Institute of Management, Ahmedabad. [email protected]

Forensic psychiatry is an upcoming super-specialty in India. Although most of the work in the field is clinical in nature, it is not a field that depends on professional judgment alone. Psychiatrists working in forensics utilize statistical instruments to give them a scientific edge in their assessment procedures. Such instruments are commonly called violence risk assessment instruments and are used primarily to predict the possibility for violent behavior in a given patient in future. Unlike the usual criminal cases, criminals who suffer from mental health disorders are particularly susceptible to violence if their condition is severe and they have a past history of violence. These can be complicated cases and even experienced psychiatrists might get perplexed at the range of judicial, medical, ethical and social implications their judgment can entail. That being the case it is important to understand the range of reliable tools that are at the disposal of the psychiatrist. However, studies indicate that no two instruments have the same reliability in a given case. The overall predictive efficacy also tends to vary from one instrument to the other. The original purpose for which each instrument was designed also differs and does not coincide entirely with another. For example, there are instruments that are Aimed at identifying the risk for sexual recidivism, psychopathy or extreme violence. There are also instruments that Aim at identifying the risks associated with juvenile criminals, thus catering to specific age groups. Although there is extensive literature that has compared the efficacy of these instruments in general, a country specific comparative analysis of the scales that are in use is limited. More importantly almost all of these instruments have been developed abroad with almost none developed for an Indian context. The issue and its repercussions on forensic psychiatry practice in India are highlighted.

Keywords: forensic psychiatry, statistical instruments, statistical instruments in forensic psychiatry, violence risk assessment, violence risk assessment tools, forensic psychiatry in India, predictive efficacy of violence risk assessment instruments, predictive efficacy, statistical tools in forensic psychiatry, forensic psychiatry practice, forensic psychiatry practice in India, violence risk assessment in India

Single Session Counselling For Psychosomatic Symptoms: Findings From A Pilot Randomized Control Trial At A Tertiary Care Center

Vikas Menon, Shanmuganathan Balasubramanian, Anand Babu Arun, Siddharth Sarkar

Dept. of Psychiatry, JIPMER, Puducherry-605006 and Dept. of Psychiatry and NDDTC, AIIMS, New Delhi-110029. [email protected]

Background and Aims: Psychosomatic symptoms are traditionally a drain on the medical resources and often poorly responsive to standard treatments. We Aimed to identify the acceptability and preliminary efficacy of a single session of counselling for patients with medically unexplained symptoms (MUS).

Methods: Patients referred with MUS were randomized to receive either the single session counselling (n=12) or treatment as usual (n=8). The single session counselling focussed on three areas - reattribution, relaxation exercises and shifting cognitive focus and lasted for around 45 minutes. The two groups were re-assessed after 1 month for change in outcome measures. The primary outcome measure was Patient Health Questionnaire - Somatic, Anxiety, Depressive Scale (PHQ-SADS) and secondary outcomes included hospital visits in last month, number of workdays lost in last month, and the number of somatic symptoms reported.

Results: The entire sample (n = 20) showed statistically significant differences from baseline at 1 month follow-up in terms of PHQ-SADS scores (p = 0.001), number of hospital visits in last month (p = 0.001) and number of workdays lost in last month (p = 0.001), but not in terms of the number of somatic symptoms reported (p = 0.065). Significant differences were not found in primary or secondary outcome measures between the single session counselling and treatment as usual groups, though this might be constrained by limited sample size. Eleven out of the 12 patients in the intervention group rated the session. Two patients rated the session as 'very good', 8 as 'good' and 1 as 'fair', with relaxation exercises being reported as the most useful element of the session.

Conclusion: Brief and specific counselling is an acceptable intervention for patients with MUS. Efficacy of such an intervention needs to be evaluated in a larger sample.

Keywords: Psychosomatic symptoms, SADS,

A Case of Cinderella Complex (Depressive Disorder)

Ishan C, Shivaji Marella, Spandana Devabhaktuni, Shivang Aggarwal, Saldanha D

Department of Psychiatry, Dr D Y Patil Medical College Pimpri, Pune.

[email protected]

Cinderella Complex is a psychosocial culture bound construct, was first described by Colette Dowling, who had written about it in a book "The Cinderella Complex : Women's Hidden Fear of Independence" The complex is said to become more apparent as a person grows older. This unique phenomenon is named after the fairy tale character Cinderella. It describes women's unconscious desire to be taken care of by others, based primarily on a fear of independence, often coupled with an unconscious need to be rescued by an outside force e.g., a prince, in the form of wish fulfillment.

We present such a case of a 17 year old girl with a history of childhood abuse in the context of psychosocial adversities in the form of neglect and a dominant, abusive, harsh father culminating into major depressive episode with suicide attempt in the presence of severe psychosocial conflict and turmoil. She also had a co-morbid medical condition in the form of severe hypothyroidism .This seems to have contributed greatly towards a bidirectional relationship with depressive disorder, which needed adequate treatment for recovery.

The learning points from this case are a Holistic Approach to clinical Psychiatry-a complete bio-psycho-social intervention which will unearth the biological, psychosocial and cultural underpinnings in the panorama of Psychological Medicine.

Keywords: Cinderella Complex, Colette Dowling. Psychological Medicine.

Casting Alcohol Dependents From South India Into Cloninger's And Babor's Classification

Balaji Bharadwaj, Muthukrishnan Venkatesan, Shivanand Kattimani, Siddharth Sarkar

410, NEW hostel complex, Jipmer campus, Puducherry.

[email protected]

Introduction: Various experts have tried to classify alcoholics. They have used mostly drinking pattern and associated complications. Though Jellinek's is outdated, Cloninger and Babor classification of alcoholism are commonly quoted. They may have prognostic value

Aim: To know whether our alcohol dependent patients fit into typology given by Cloninger and Babor


  1. To identify how many percent of alcohol dependent patients can be classified as per Cloninger's classification of alcoholism
  2. To identify how many percent of alcohol dependent patients can be classified as per Babor's classification of alcoholism

Methodology: It is descriptive study, based retrospective chart review. Case records of alcohol dependent patients who sought treatment from de-addiction clinic, over a period of three years were used for extracting the data. Both classifications were modified to make it clinically relevant based on operationalized criteria achieved through consensus of three psychiatrists with experience of working in the de-addiction services. Available data from case records was extracted and classification criteria were applied. A patient who has greater number of criteria will fall into that classification group.

Results: A total of 108 records were assessed. The mean age of the sample was 40.8 (8.9) years and all the subjects comprised of males. Of the patients, 9 (8.3%) could be classified into Cloninger's Type I, 86 (79.6%) could be classified into Cloninger's Type II, and 13 (12.0%) remained inconclusive. Also, 98 patients (90.7%) were classified into Babor's Type B, none were classified as Babor's Type A and 10 (9.3%) were inconclusive.

Conclusion: 12.0 % could not be classifiable into Cloninger's types and 9.3% could not be classifiable into Babor's types. Though authors have cautioned that their classification is not perfect and not yet developed for clinical use, it is high time that we Indians develop our own typology.

Limitations: selection bias, retrospective data collection

Key words: alcoholism, relapse, classification, typology, alcohol dependence, psychoactive, substance abuse

Profile of Treatment Seeking Individuals At A Dual Disorder Clinic of A Tertiary Care De-Addiction Centre In India Over 12 Year Period

Nishtha Chawla, Yatan Pal Singh Balhara, Rishi Gupta, Sagar Chandra Bera, Siddharth Sarkar, Rakesh Lal

Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi; [email protected]

Background and Aims: Dual diagnosis patients present specific challenges in treatment, as are better treated in a dedicated setting. The present study Aims to describe the profile of patients seen in a dual disorders clinic over a period of 12 years.

Materials And Methods: This retrospective study used case records of patients registered in the dual diagnosis clinic of National Drug Dependence Treatment Centre (NDDTC), Ghaziabad. Data was extracted related to the demographics of the sample, substance use disorders and psychiatric disorders. Relationship of specific substances with psychiatric illnesses was assessed.

Results: Over the study period, 492 patients were registered at the clinic, the majority of whom were males, were married and were employed. Psychotic disorders were the largest category of the comorbid psychiatric disorders (38.7%) followed by depressive disorders (27.5%) and bipolar affective disorders (20.0%). Among the patients with primarily psychotic disorders, 40.8% were deemed to have substance-induced psychosis. Cannabis use had greater odds of being associated with psychotic disorders, opiate and benzodiazepines with depressive disorders, and alcohol with anxiety disorder.

Conclusion: Establishment of a dual diagnosis clinic offers an opportunity to gain further insights of characteristics of patients with concurrent psychiatric illnesses and substance use disorder. It may also offer opportunities for evaluating specific treatment approaches, training health-care personnel, and providing services customized to patient needs.

Keywords: Dual disorder, NDDTC, Cannabis.

Internet Based Learning In Addiction Psychiatry for Professionals: Review

Nishtha Chawla, Yatan Pal Singh Balhara, Anju Dhawan

National Drug Dependence Treatment Centre, Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi.

[email protected]

Introduction: Education in medicine can be imparted either through traditional ways, e.g. attending lectures, attending ward rounds, tutorials etc., or via distance education, e.g., correspondence courses, internet-based learning etc. Distance learning techniques have evolved since 1840s. Internet is currently the fastest, most convenient, and exhaustive source of spreading education.

Methods: The research studies chosen for this literature review focused on effectiveness of web-based training. Two main databases were employed to search for relevant research studies: PubMed and Google Scholar. The Keywords used in searching these databases and websites were: distance education, substance related disorder, teaching, internet, and searching the reference lists of those articles already found.

Results: Most of the courses offered online were specific, like, training on motivational interviewing, twelve step facilitation, cognitive behavioural therapy, alcohol screening and brief intervention etc. They were based on various aspects like, acquisition of knowledge or skills, feasibility of distance learning, level of satisfaction of the trainees/ students, cost-effectiveness of the techniques and the type of trainees who access the course.

Conclusion: There appears to be a need for internet based learning in addiction psychiatry as there has been a significant rise in SUDs in past two decades, inadequate number of facilities, lack of trained manpower, shortage in basic skills and expertise, less time devoted to psychiatry lectures and psychiatric training during MBBS.

Keywords: Google Scholar, Addiction, Internet based learning.

Socio Demographic and Clinical Profiles of Women Substance Abusers Reporting For The First Time In Rims Hospital, Imphal

Ashutosh Dash, S. Gojendra Singh, R.K Lenin Singh, N. Heramani Singh

Department of Psychiatry, Regional Institute of Medical Sciences, Imphal. [email protected]

Background: Substance abuse has been a great burden to the family members and even to the society. In recent years substance abuse in women has been increasing, despite that the report data is very limited from India.

Objectives: The present research Aimed to study the demographic and clinical profile of women seeking de-addiction treatment for the 1st time at a tertiary care center in North eastern part of India. Materials And Methods: Retrospective structured chart review of 36 women substance abusers seeking treatment at a de addiction center between April 2014 and April 2015. Results: A typical case was of 32.3 years age, age of onset (21.7%), married (47.2%), urban (69.5%), nuclear family (72.2%), housewife (44.4%), graduate (22.2%). The commonest substance of abuse was alcohol (55.6%), followed by opioids (13.9%), benzodiazepine (11.1%), cannabis, dendrite (5.6%) each and poly drug abuser (2.8%). Family history of drug dependence (66.7%), comorbid psychiatric illness (16.6%) and physical illness (2.8%).

Conclusion: The common substances of abuse were alcohol, benzodiazepines, opioid, cannabis and tobacco. Family history of drug abuse common. This profile gives us some clues to address a hidden health problem of the community.

Keywords: Substance abuse, women, alcohol.

Do Non-Psychiatry Medical Professionals in Teaching Institutes Endorse Socially Restrictive Attitudes Towards Mentally Ill?

Sathyanath S, Mendonsa RD, Thattil AM, Karkal RS, Mohan Chandran VV

Flat no. 1401, Maharaja Heights, Opp St Mary, Mangalore, [email protected]

Background: Unfortunately stigmatising attitudes towards mentally ill are common among medical students, nurses as well as doctors. This is a major obstacle in the delivery of mental health services.

Aims: To assess the socially restrictive attitudes towards mentally ill among the medical professionals; to investigate the association between such attitudes and relevant variables.

Methods: We assessed the attitudes towards mentally ill among the medical professionals (N=130) in a medical university using shortened version of the 40-item Community Attitudes toward the Mentally Ill (CAMI) scale.

Results: We found that socially restrictive attitudes were endorsed by quite a number of faculty members and trainees. Significantly higher number of faculty members (22.5%) compared to the trainees(9.1%) endorsed unfavourable attitudes towards previously mentally ill man getting married. Similarly, significantly more number of faculty (22.5%) were averse to the idea of living next door to someone who has been mentally ill compared to the trainees (9.1%). However, significantly lesser number of faculty members (16.1%) compared to the trainees (30.3%) believed that previously mentally ill people should be excluded from taking public office. Personal acquaintance with a mentally ill individual was the only variable that was associated with significantly lesser socially restrictive attitudes among the medical professionals, irrespective gender and years of experience.

Conclusion: Socially restrictive attitudes towards people with mental illness are prevalent among substantial number of medical professionals despite their relatively favourable attitudes towards mentally ill. Personal acquaintance with a mentally ill person appears to be the strongest factor in reducing the socially restrictive attitudes towards mentally ill among medical professionals.

Keywords: Non-Psychiatry, CAMI, Mental illness.

Change In Quality of Life In Heroin Users Receiving Methadone Maintenance Treatment In Manipur

Mohit Saini, Gojendra Singh, R.K. Lenin Singh

Department of Psychiatry, Regional Institute of Medical Sciences, [email protected]

Background: Opioid Substitution Therapy (OST) helps the opioid dependent individual not only to stop opioid use, but also in reducing family, social, occupational and legal complications. It also helps bring about an overall improvement in the quality of life of the individual. A good quality of life (QOL) is associated with successful treatment in patients with opioid dependence. Therefore, it is of clinical benefit to examine what factors can predict a change in QOL among heroin users in the course of a methadone maintenance treatment (MMT) program. Objective: This cross sectional study Aimed to examine the patterns and predictors of change in QOL among heroin users after a period of 6 month of methadone maintenance therapy. Method: A total of 20 intravenous heroin users receiving MMT in Manipur were interviewed using the Indian version of the Brief Version of the World Health Organization Quality of Life Instrument (WHOQOL-BREF) at baseline and after 3 and 6 months of treatment. Demographic and substance-use characteristics, severity of heroin use, HIV and HCV sero status, criminal record, and family function data were collected during baseline interviews. Data on methadone dosage at each follow-up point and the duration of retention in the MMT program were also collected. Result: Improvement in quality of life was seen after 6 months of treatment. Longer retention in the program may be associated with a better QOL. Conclusion: It is important to discuss the findings of this study in order to draw a road map for the future of MMT in India. Among those who are retained in the treatment, regarding QOL, heroin users can benefit rapidly and continuously from a methadone maintenance treatment.

Key words: methadone maintenance treatment, heroin users, quality of life.

A Clinical Study of Anxiety and Depression in Pulmonary Tuberculosis Patients

Hemalatha Mutthagari-Yemineni, R. S. Swaroop Chary, V. Sharbandh Raj

SVS Medical College and Hospital, Mahabubnagar.

[email protected]

Background: As the rates of Tuberculosis world over have increased during the past 15 years, tuberculosis is second only to HIV/AIDS as the greatest killer worldwide due to a single infectious agent. There has been growing awareness of anxiety, depression and its role in the outcome of chronic disorders. Though the prevalence of pulmonary tuberculosis is high in Indian population, there are very few studies regarding the presence of psychiatric disorders in patients with pulmonary tuberculosis

Aim: To determine the prevalence of co morbidity of anxiety and depression in patients suffering from tuberculosis in SVS hospital, Mahabubnagar.

Methodology: A cross sectional study is being conducted at the in- patient department of

General Medicine, chest and tuberculosis, SVS Medical College and hospital, Mahabubnagar.

Study will be conducted on 100 subjects from January 2015 to August 2015.

Tools being used are socio demographic data-semi structured proforma, General health questionnaire(GHQ-12)-to screen for the psychiatric co morbidity, Hospital Anxiety and

Depression Scale(HADS) to screen anxiety and depression, Hamilton Severity scale for anxiety (HAM-A) -to asses severity of anxiety, Hamilton severity scale for depression (HAM-D)- to assess severity of depression.

Results and Conclusion: Results and Conclusion will be discussed at the conference

Keywords: Pulmonary Tuberculosis, anxiety, depression, Co morbidity

A Comparative Study of Psychiatric Morbidity in Wives of Patients with Alcohol Dependence Syndrome Vs Wives of Patients with Bipolar Mania

Caroline Dias, Rohan Mendonsa, P John Mathai

Flat No 1101, C Block, Maurishka Park, Kodialbail, Managalore, Karnataka. [email protected]

Aims: To evaluate the frequency and nature of psychiatric disorders in wives of patients with Alcohol Dependence Syndrome and wives of patients with Bipolar Affective Disorder- Mania

To study the relationship between psychiatric morbidity and quality of marital life in wives of patients with Alcohol Dependence Syndrome and wives of patients with Bipolar Affective Disorder-Mania

Methods: A total of 150 wives, 100 wives of patients with Alcohol Dependence Syndrome and 50 wives of patients with Bipolar Affective Disorder were consecutively selected and evaluated. Each subject was screened using the ICD-10 AM symptom checklist screener and a diagnosis of psychiatric disorder was made on the basis of Diagnostic Criteria for Research. The psychopathology was rated using the Comprehensive Psychopathology Rating Scale. The quality of marital life was assessed using the Marital Quality Scale.

Results: Psychiatric disorders were diagnosed in 75% of the wives of patients with alcohol dependence syndrome, Dysthymia being the most common (45%), followed by mild depressive episode (12%), adjustment disorder- prolonged depressive reaction (8%), moderate depressive episode (5%) and anxiety disorder unspecified (5%). Psychiatric disorders were diagnosed in 60% of wives of patients with Bipolar Affective Disorder-Mania of which Adjustment Disorder- brief depressive reaction (48%) was most common followed by mild depressive episode (8%), anxiety disorder unspecified (4%).

Conclusion: The present study concludes that the wives of patients with Alcohol Dependence Syndrome have significant psychiatric morbidity compared to wives of patients with Bipolar Affective Disorder-current episode mania however there was a significant association between the psychiatric morbidity and the quality of marital life in both groups.

Keywords: Psychiatric Morbidity, Alcohol Dependence Syndrome, Bipolar Affective Disorder-Mania.

Psychological Predictors in Alcohol Abuse

Lt Col Amitabh Saha

Dept of Psychiatry, AFMC, Pune, Maharastra. [email protected]

Brief Description: While on one side an addict sinks himself into alcohol, on the other futility of all efforts of resurrection gives the psychiatrist a sinking feeling. How helpless we are in-front of those few pegs of liquor which do get into a bloodstream despite our best effort against it?

We need concerted efforts and force multiplier. We would have to learn all from a man's biological, social or psychological domain to combat this ugly spirit. Current symposium will discuss the bio-psycho-social predictors of alcohol use disorder and suitable use of these in management.

Keywords: Alcohol abuse, bio-psycho-social predictors,

Study of Prevalence of Stress in Post Graduates Working in Tertiary Care Centre: Visakhapatnam

Padma V, Sandeep P

Department Of Psychiatry, Andhra Medical College, Visakhapatnam, Andhra Pradesh. [email protected]

Introduction: With rapid globalization, increased competition and economic crisis, stress has become the major health problem in the present times. As a Result of this, there is an increasing stress related morbidity in all age groups from children, adolescents and adults. The occurrence of stress related morbidity is increasing in medical students, trainees and qualified professionals. As they take on the burden of handling the health of the community and as also medical education is stressful and demanding, the young professionals are effected in all aspects of their life.

Aim: The present study was conducted to know, how the professional stress effects medical post graduates students in different specialities and their levels of burnout.

Materials And Methods: This is a cross sectional study done in post graduates students in Andhra medical college working in King George Hospital, tertiary care centre in Visakhapatnam, using Professional Life stress scale, Perceived stress scale, Maslach Burnout Inventory (MBI) as tools .

Result: Our findings showed that significant number of post graduates were under stress and different levels of burnout. Among them post graduates of anaesthesia and critical care showed higher levels of stress and burnout.

Conclusion: As stress has become one of the major problems of the present day among the highly educated professionals, it should not be ignored as it can cause many health issues. Stress should be evaluated and addressed with remedial Methods so that they can provide better services professionally and increase their quality of life and life span.

KEY WORDS: stress, post graduates, depression, burnout.

"Psychiatric Co-Morbidity in Employees Attending Medical Outpatient Department of Central Hospital, Northern Western Railway, Jaipur"

Ramswaroop Matoria, Sanjay Jain, Pankaj Mittal

Department of Psychiatry, SMS Medical College, Jaipur. [email protected]

Aims And Objectives: To assess proportion and patterns of psychiatric co-morbidity in medical out-patients.

To find out association between clinico-socio-demographical factors and type of psychiatric morbidity.

To identify association between occupational factors and psychiatric morbidity of affected individuals.

Methodology: Present institution based observational descriptive study was carried out at medical OPD of Central Hospital of Northern Western Railway, Jaipur. Total 450 randomly selected individuals were screened for psychiatric co-morbidities by using Mini-international neuropsychiatric interview-PLUS. Psychiatric diagnosis confirmed by two psychiatrists separately using the ICD, 10th revision (diagnostic and research criteria); while author will be reliant upon the treating physician for diagnosis of medical disorders. The data was analyzed in terms of descriptive statistics, Chi-square test and logistic regression by using SPSS, Primer Version '6'.

Results: In male predominated study 365 (81.11%), mean age of subjects were 36.4 ± 6.37 years. More than half (n = 242, 53.78%) had some psychiatric diagnosis, out of which 156 (34.67%) were diagnosed as co morbid psychiatric illness. Among the various physical disorders the overall proportion of symptoms of depression, anxiety, dysthymia and somatization were found to be 26.92% (n = 42), 19.87% (n =31), 14.74% (n = 23) and 12.82% (n = 20) respectively; while Major depressive episode 69 (15.33%) was the most common psychiatric diagnosis among study individuals followed by mixed anxiety depression disorders 48 (10.67%), dysthymia 37(8.22%), sleep disorder 33 (7.33%). and somatization 30 (6.77%). Univariate analysis shows that education, income, perceived stress, job satisfaction and stressful life events were the significant determinants of psychiatric morbidity; while shift duties were associated with more sleep disorders.

Conclusion: A significant proportion of employees attending medical OPD had psychiatric morbidity and many psychosocial and occupational factors were associated with caseness; which underlines the need for having a psychiatrist at study hospital if not available.

Keywords: Psychiatric co-morbidity, PLUS, SPSS.

Coping Patterns, Perceived Stress, Anxiety and Depression Profiles in Adult Patients of Hemophilia

Dhruv Devendra Bardolia

9/C, Alaukik Apartment, Near Arihant Park, Sumul Dairy Road, Surat, Gujarat. [email protected]

Introduction: Chronic illnesses are associated with greater risks of depression, anxiety and other psychiatric morbidities and as hemophilia being a chronic illness there is high risk of psychiatric morbidities in these patients. Hence, it is important to understand the psychosocial dimension of hemophilia as psychological factors play a crucial role in the management of hemophilia. Overall, there are very few studies that look at Depression, Anxiety and Coping Patterns in adult patients with hemophilia.

Aims & Objectives: The Aim was to study the Coping patterns, Perceived Stress, Anxiety and Depression profiles in Adult Patients of Hemophilia.

Methodology: A cross sectional study was carried out on 52 clinically diagnosed Adult Patients of hemophilia. Consenting participants were administered self-assessment questionnaires investigating their psychological dimensions. Four self-assessment questionnaires were used: 1. COPE (coping, orientation to problems experienced), 2.BDI (Beck's depression inventory) 3. Anxiety Scale 4. Life Event Scale (LES). The parameters were studied using appropriate statistical tests.

Results & Discussion: Problem focussed coping is used more often by the patient with haemophilia, patients of haemophilia with depression and anxiety more often use Avoidance focused coping. Patients with LES score>300 more often use Emotion focused coping.

The prevalence of depression and anxiety are 40.38% and 26.92% respectively and more was the stress level based on LES score more was the prevalence of Depression and Anxiety.

The situational anxiety tested during different stressful situation we found that there was significant rise in percentage of patient with anxiety during moderate to severe stressful situation.

Conclusion: Along with the Medical aspect of treatment an equal emphasis should be given to the psychological aspect of the patients with Hemophilia as the prevalence of depression, stress and anxiety are high in these patients and to help them cultivate more problem-based coping.

Keywords: Hemophilia, Coping Patterns, Stress, Depression & Anxiety

Knowledge and Attitudes Toward Electroconvulsive Therapy Among Final Year Medical Students

V.Swarajya Lakshmi, S. Kiran Kumar

Department of Psychiatry, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India. [email protected]

Background: Despite the proved effectiveness of Electroconvulsive Therapy (ECT) in the treatment of many psychiatric emergencies and disorders, there are many misconceptions and groundless negative attitudes about its prescription and utilisation by health professionals. Aim: The purpose of this study is to determine the knowledge and attitudes towards ECT among final year medical students. Materials And Methods: Knowledge and Attitudes towards ECT were assessed using ECT Knowledge and attitudes Questionnaire among 88 final year medical students from Andhra medical college, Visakhapatnam. Results: Majority of students obtained information mostly from movies(n=49;55.68%),from doctors (n=20;22.72%) from course and lectures(n=22;25.0%).Except for basics regarding ECT more than two thirds are unaware of indications, nearly half are aware of efficacy and less than half are aware of side effects of ECT. Interms of attitudes towards ECT, on most of the 15 questions positive attitudes were found ranging from 29.5-70.4%, significant proportions of students are uncertain about their attitudes towards ECT(20.45-54.54%) less than one fourth have negative attitude(5.6-21.5%). Conclusion: The findings of the current study highlight the need for modifications towards provision of teaching ECT for medical students so that the mental health related issues can be addressed including interventions which might contribute to increased knowledge leading to favourable attitudes towards ECT.

Key words: ECT, Medical students, Knowledge, Attitude

Adolescent Onset Wilson Disease Misdiagnosed as Psychosis

Dharmdeep Singh

AB -91, Shivshakti Vihar, Benar road, Jaipur, Rajasthan. [email protected]

Wilson disease (WD) is a rare but treatable condition that can present as diagnostic dilemma in psychiatric settings. WD is an autosomal recessive genetic syndrome caused by mutation of ATP7B gene Resulting in abnormalities of copper metabolism. Clinically it can present as liver disease, as a progressive neurological entity, or as psychiatric illness. Compared to other psychiatric manifestations, Psychosis has been less commonly described in literature of patients with WD.

Master M, 14 years old Hindu boy belonging to rural nuclear family of middle socio-economic status, presented with two and a half years illness of gradual onset and continuous course. The chief complaints were disorganized behavior in form of decreased interaction with family members, suspiciousness in form of fleeting persecutory delusions, easy irritability on provocation leading to anger and abusive behavior, impaired self-care and daily routine along with disturbed sleep and appetite and socio-occupational dysfunction. No history of head injury, fits, substance use or abdominal complaints were reported. Consultation to multiple clinicians including neurologists and psychiatrists had been sought with variable diagnoses such as ADHD, Mood disorder and Psychosis. Multiple psychotropics like Atomoxetine, Mood stabilizers, Anti-psychotics and Benzodiazepines have been used with minimal improvement.

Examination revealed conscious and oriented patient with increased reaction time and dysarthria in speech. Intermittent gazing, mumbling and aggression were observed. There were no rigidity and tremors. A typicality of presentation and poor response to psychotropics led to suspicion of WD which was affirmed by presence of Kayser-Fleischer ring in slit lamp examination. Consistent findings were seen in laboratory investigations done in liaison with neurologist and hepatologist.

Psychiatric abnormalities are often frequent and initial manifestations of WD and may occur without overt hepatic or neurologic involvement. A better understanding of the psychiatric presentations in WD would lead to early diagnosis and timely intervention thus preventing fatal outcome.

Keywords: Psychosis, Adolescent, Hepatologist, Psychotropic.

To Assess the Prevalence and Associated Factors of Delirium Among Hospitalized Patients in A Tertiary Care Centre in Gangtok: A Cross Sectional Study

Manish Tyagi, Samrat Singh Bhandari

Dept. of Psychiatry, SMIMS, CRH, Gangtok, Sikkim. [email protected]

Background: Delirium is an acute organic mental syndrome characterized by disturbance of consciousness, global cognitive impairment, disorientation and attention deficits, perceptual disturbance, decreased or increased psychomotor activity and fluctuation in presentation.

Despite its high prevalence, delirium is not well recognized in hospitals and left untreated; which in turn produces negative consequences on the patient's prognosis. Estimates of this misdiagnosis have been between 40-60% depending on the setting studied.

The topic under study is not much investigated in India and none in Sikkim. The Result of this study will help the clinicians to have a good insight about delirium prevalence and associated factors.

Aim of the study: To find the prevalence and associated factors of delirium among hospitalized patients in a tertiary care centre in Gangtok, Sikkim.

Methodology: The study is an institutional based cross sectional study conducted in a tertiary care centre in Gangtok.

Sampling Procedure: The sampling will be done by systemic random sampling. The duration of the study is three months.

Inclusion criteria: All inpatients above 18 years of age who were admitted to inpatient department will be included in the study

Exclusion criteria: Patients who are unconscious during the data collection time will be excluded from the study.

Patients will be assessed using the following tools:

A Study on Internet Addiction And its Relation to Psychopathology, Self Esteem Among College Students

Manish Kumar 1, Anwesha Mondal

Department of Psychiatry, NRS Medical College, Kolkata, West Bengal.

[email protected]

Background: Internet use is one the most important tools of our present day society whose impact is felt on college students like increased use of internet. It brings change in mood, the inability to control the amount of time spent with internet, withdrawal symptoms when not engaged, a diminishing social life and adverse work or academic consequences and it effects self esteem of the students. Objective: The main Objective of this study is to explore the internet use and its relation to psychopathology and self esteem among college students. Method: A total of 200 sample of college students has been selected from different colleges of Kolkata through random sampling. After selection of the sample Young's Internet Addiction Scale (IAS), Symptom Checklist Revised (SCL-90-R) and Rosenberg Self Esteem Scale were used to assess the internet use, psychopathology and self esteem of the college students. Result: Depression, anxiety and interpersonal sensitivity are found to be correlated with internet addiction. Along with that low self esteem is found in students to be associated with possible users of internet. Conclusion: Internet usage is found to have a very strong impact on college students especially in the areas of anxiety and depression and at times it effect their social life and their relationship with their family.

Keywords: internet addiction, psychopathology, self esteem

A Comparison Of Phenomenology of Depression Among Younger and Older Sikkimese Women

Arnab Ghosh Hajra, Geeta Soohinda, Sanjiba Dutta

Dept. of Psychiatry, SMIMS, C.R.H. [email protected]

Background: The culture plays an important role in the phenomenology of psychiatric illness in the community. Late-life depression may differ from early-life depression in its phenomenology. In our country females are subjected to much more stress leading to depression. Although few studies have been done regarding the phenomenology of depression, all over the world & in the different states of India, no study has been conducted in Sikkim.

Aims: To study the psychopathology of depression among Sikkimese women.

To compare the characteristic of depressive symptoms among younger (20 to 54 years) vs. Older (55 years and above) Sikkimese women.

Methodology: International Classification of Disorders (ICD-10) will be used for diagnosis of depression and 17 items Hamilton Depression Rating Scale (HDRS) will be used for phenomenology of depression on those female who will fit the inclusion criteria.

Results: Results will be discussed in ANCIPS.

Keywords: HDRS, Phenomenology, ICD-10.

Psychiatric Morbidity, Coping Strategies and Attitude Towards Appearance Among Patients with Psoriasis And Acne: A Comparative Study

Nidhi Jain, C.R.J. Khess, S.K. Munda

Central Institute of Psychiatry, Kanke, Ranchi, India. [email protected]

Introduction: Chronic and severe dermatological disorders are often associated with psychiatric comorbidity. Although previous researches indicate strong connection between psychosocial distress experienced by the skin patients but very few studies investigating attitude towards appearance (ATT), coping strategies in India.

Aims And Objectives: To compare occurrence of psychiatric morbidity, ATT, coping strategies and study the relationship of severity of disease with psychiatric morbidity, coping strategies and ATT among patients with Psoriasis and Acne.

Method: 50 Psoriasis and 50 Acne patients were taken from dermatology department, RIMS, Ranchi. For assessing the severity of the disorder Psoriasis area severity index and global Acne severity scale were applied on respective patients. Attitude to appearance, Brief COPE and GHQ-60 were applied on both the patients groups. Then Mini International Neuropsychiatric Interview (MINI), Hamilton rating scale for anxiety, Hamilton rating scale for depression, Beck depression inventory were applied on only those patients, who scored ≥12 in GHQ-60.

Results: Patients with Psoriasis had significantly higher psychiatric morbidity, in terms of both GHQ-60 (p=.00) and MINI (p=.01). Psychiatric morbidity diagnosed by MINI were 22(44%) and 10(20%) in patients with Psoriasis and Acne respectively. The psychiatric diagnosis in patients with Psoriasis were: major depressive episode (18%), dysthymia (10%), generalized anxiety disorder (12%), suicidality (12%), alcohol abuse (12%), psychotic disorders (2%).

There was no significant difference in terms of ATT but significant difference found in coping with higher scores for Psoriasis in terms of Self-distraction, Denial, Behavioral disengagement, Venting, Planning, religion, Self-blame than Acne. We found significant positive correlation between severity of skin lesions and coping, anxiety, depression; coping and anxiety, depression; ATT and anxiety in patients with Psoriasis.

Conclusion: The high psychiatric and psychosocial morbidity in Psoriasis and Acne patients indicates a need for more related studies. The availability of psychiatric consultation at dermatology clinics and regular liaison between dermatologists and psychiatrists are essential.

Keywords: Coping Strategies, RIMS, GHQ-60.

"What Tilted My ATPD?: Finding the Predictive Factors of Diagnostic Instability of ATPD"

Sonia Malhotra

[email protected]

Introduction: The relevance of ATPD as a separate diagnostic entity has been questioned time and again because of its diagnostic instability due to overlap of symptoms with schizophrenia and affective psychosis in many cases. The diagnostic shift is more commonly either towards bipolar disorder or schizophrenia, if any. Our current study was planned to find out the predictive factors of the instability of the diagnosis of ATPD for a future diagnosis of schizophrenia or bipolar affective psychosis.

Method: A retrospective hospital inpatient case records based study was done on 1000 case records of psychotic patients admitted between Jan'15 to Mar'15 at Dept. Of Psychiatry, SMS Medical College, Jaipur. 183 case records which were completely recorded were considered after qualifying on the inclusion and exclusion criteria. All descriptive data was analysed by frequencies, mean and standard deviation. The statistical significance and correlations were assessed using Chi- square test, Independent t-test and Linear Regression.

Result: This study recognised that some sociodemographic and illness factors may be used for predicting whether a patient will be diagnosed as Bipolar affective disorder or Schizophrenia, if at all, the patient who had been diagnosed as ATPD at the first contact with the psychiatrist is rediagnosed.

Conclusion: Factors which predict a more likely diagnosis of schizophrenia are early age of onset, lower level of education, unskilled or semiskilled occupation, lower socioeconomic status, negative family history, treatment with only antipsychotics and not taking treatment for more than 4 months regularly. The opposite factors were predictive of Bipolar affective disorder.

Keywords: Predictive factors, Diagnostic instability, ATPD

Attitude Towards Mental Illness Among Staff Nurses In A Tertiary Care Hospital

Kavitha M S


[email protected]

Background: Worldwide, mental illness and the very concept of mental health receive negative publicity and are stigmatized in public perceptions. Negative and stigmatizing attitudes are found even among health-care staff including nurses. Today, the focus of psychiatric care is on de-institutionalization and encouragement for general hospital psychiatry practice. The success of this depends on a number of factors of which, tolerance and non-discrimination are among the most important. In the current scenario, attitude of health care professionals especially nurses towards mental illness plays a significant role.

Aim: To assess the attitude of nurses towards mental illness in a tertiary care hospital.

Method: Staff nurses in each ward were individually approached for participation in the study. They were requested to fill a socio-demographic data sheet and Attitude towards Mental Illness questionnaire.

Result: 160 staff nurses were approached. 48 refused participation. 112 took part in the study. 91.1% of the sample was of female gender. 55.3% were Hindu and 44.7% belonged to Christian religion. Majority (64%) belonged to the age group of 21-30 years. 75% belonged to nuclear family. 85% of the nurses had completed diploma in nursing, and majority (33.9%) had experience of 6-10 years. Significant number of nurses (63.4%) did not have experience in psychiatry ward. Of those who had worked in psychiatry, 77% had an experience of < 6 months only. 69.2% of the sample did not have any training in Psychiatric nursing. The attitude of nurses towards mental illness varied with age, exposure and experience.

Summary And Conclusion: This study explored the attitude of nurses towards mental illness in a tertiary level general hospital setting. Study highlights the need for interventions among nurses to prevent discrimination and negative attitude towards mentally ill.

Keywords: Mental illness questionnaire, publicity,

Efficacy of Mirtazepine Vs Escitalopram: An Observational Prospective Study

Dheerendra Kumar Mishra, Ujwal Sardesai, Ram Ghulam Razdhan, Aman Kishore

Department of Psychiatry MGM Medical College Indore.

[email protected]

Introduction: The notion that onset of action of antidepressants takes several weeks is widely quoted in clinical guidelines (Anderson et al, 2000; National Institute for Clinical Excellence, 2004). It is also a notion that has been thoroughly translated into clinical practice, where clinicians regularly tell patients that the antidepressant is likely to take 2 to 4 weeks to start to work (Garfield et al, 2004). Data support the possibility that Mirtazepine may have a more rapid onset than SSRIs (Quitkin FM, 2001). Orally disintegrating tablet of Mirtazepine has a faster onset of therapeutic effect than Sertraline (Bhenke et al 2003).

This study intended to study the onset of therapeutic effect in relation to time in Mirtazepine and Escitalopram

Aim: To study the onset of antidepressant effect and efficacy of Mirtazepine vs Escitalopram.


  1. To study demographic profile of patients.
  2. To study clinical profile of patients.
  3. To study the onset of antidepressant effect of prescribed medication.
  4. To study the response rate of antidepressant effect of prescribed medication.
  5. To study the side effect profile of prescribed medication.


Study design:
An observational naturalistic prospective study

Study site: Department of psychiatry out patients (OPD)

Study duration: 6weak

Study sample

Inclusion criteria

  1. Patients had to be 18 years or older,
  2. Suffer from International classification of disease-10 (ICD-10) major depressive episode
  3. Patients had to declare that they understood the goal of the study and gave their informed written consent.

Exclusion criteria.

  1. Nonstabilized somatic disease (seizures, renal, or hepatic insufficiency),
  2. History of blood dyscrasias.
  3. Known case of diabetes mellitus
  4. Known allergic reaction to Mirtazepine, Escitalopram.
  5. Current suicidal risk (according to the physician's judgment).
  6. Pregnancy, breastfeeding, no contraception in women of reproductive age.
  7. Current depressive episode of more than 1 year's duration or nonresponsive to 2 antidepressant treatments,
  8. Antidepressant use including monoamine oxidase inhibitor treatment during the previous 2 weeks.


  1. International classification of disease-10 (ICD-10)
  2. Hamilton depression rating scale for depression (HAM-D 17)
  3. MADRS


  1. After Discussion with mentor study was conceptualized and study protocol was made and approved by institutional scientific committee.
  2. Patient who were attending psychiatry OPD and diagnosed major depressive disorder (as per ICD-10)
  3. Detailed history regarding socio demography, illness and medication taken.
  4. Data was collected in the semi-structured profarma and HAM-D & MADRS scale applies to asses baseline severity of depression.
  5. Patient receives antidepressant either Mirtazepine 15mg or Escitalopram 10mg at single dose as per advice of consulting psychiatrist.
  6. Patient review every week up to 6week and apply HAM-D, MADRS scale for severity of depression and asses for side effects.
  7. If patient getting serious side effect or not tolerated medication or clinical condition get worse during follow up subjected is treated as individually by treating psychiatrist and excluded from study.

Result & Discussion: Appropriate statistical analysis was used for analysis the data using SPSS v16 and Results will be discussed at the time of free paper presentation.

Keywords: HAM-D17, Mirtazepine, Escitalopram.

A Study of Prevalence of Anxiety and Depression in Patients With Diabetes in A Tertiary Hospital

Neilofor Hussain, R. S. Swaroop, V. Sharbandh Raj

SVS Medical College And Hospital, Mahbubnagar, Telangana, India, [email protected]

Background: Diabetes is a metabolic disorder with a high worldwide prevalence. It has been reported that diabetic patients are more prone to depression and anxiety. It has also been observed that both diabetes and anxiety/depression are associated with premature morbidity and mortality. It is distinguished that diabetic patients with anxiety and depression, in comparision to diabetic patients alone, have been associated with poor self care and medical treatment, poorer glycemic control, and more diabetes complications.

Aims/Objectives: The present study Aims at assessing the prevalence of anxiety and depression among the patients of diabetes mellitus type-2 using standardized instruments.

Materials And Methods:

Study Design: Cross sectional study

Study sample and setting: 100 patients from the patients diagnosed with Diabetes Mellitus type-2 who attended the Diabetic clinic between January 2015 to August 2015 at SVS Medical College and Hospital


  • Semi structured proforma for socio-demographic data
  • GHQ-12(General Health Questionnaire-12) to screen for psychiatric morbidity
  • HADS (Hospital Anxiety and Depression scale) to screen for anxiety and depression
  • ICD-10 RDC to confirm psychiatric diagnosis
  • HAM-A(Hamilton Anxiety Scale) to assess severity of anxiety
  • HAM-D(Hamilton Depression Scale) to assess severity of depression

Results: Results will be discussed at the conference.

Keywords: Depression, Anxiety, Diabetes Mellitus-type 2, HAM-A, HAM-D

Psychiatric Morbidity in Parents of Children with Attention-Deficit Hyperactivity Disorder Attending Child Guidance Clinic

Tom. C. Babu

Junior Resident, Psychiatry, Govt. Medical College, Kottayam.

[email protected]

Background: Parental psychiatric morbidity has been shown to be related to child's behavioral problems especially Attention- Deficit Hyperactivity Disorder(ADHD) and ADHD with co-morbidities. This may be both due to genetic and environmental influences. Parental psychiatric morbidity also leads to poor awareness about the child's illness and this may Result in poorer response to treatment. Hence it is important to improve our understanding regarding the nature and frequency of psychiatric morbidity in parents of children with ADHD.


  1. To evaluate the frequency and nature of psychiatric morbidities in parents of children with ADHD.
  2. To compare the relationship between the ADHD profile of children and parental psychiatric morbidity.

Study Design: cross-sectional study
Study period: 1/7/2014 to 30/6/2015
Study setting: Child Guidance Clinic, Department of Psychiatry Government Medical College, Kottayam, Kerala.
Study sample: Constitutes parents of all the children attending the Child Guidance Clinic (CGC) over a period of one year during the study period with a definite diagnosis of ADHD.

Study tools:

  1. ICD symptom checklist for mental disorders
  2. Vanderbilt ADHD diagnostic parent rating scale
  3. specially designed proforma to collect demographic profile, socioeconomic status and other necessary data of the subjects.

The subtypes of ADHD in children and the co-morbid conditions associated will be assessed using the Vanderbilt ADHD diagnostic parent scale. The ICD-10 symptom checklist for mental disorders will be applied to the parents for screening the psychiatric morbidities in them and the diagnosis will be confirmed using the DCR criteria for ICD-10.Statistical analysis will be done using the computer software SPSS 16.0 with a P value of <0.05 taken as significant. The Results shall be discussed in later for presentation.

Keywords: ADHD, DCR Criteria, Child guidance, Vanderbilt

To Assess the Psychological Morbidity Amongst Medical Interns Using Social Media and Whatsapp

Alok Vinod Kulkarni

Manas Nursing Home, Prabhat Colony, Vidyanagar, Hubli, Karnataka. [email protected]

Aim: Social Networking Sites are virtual communities used by individuals to create public profiles. These sites facilitate online interaction with real-life friends and provide an opportunity to meet new people having shared interests. These sites have become a ''global consumer phenomenon'' as there has been an exponential rise in their usage in the last few years. Considering the steep rise in social media usage and the scarcity of such studies, we did an observational study on medical interns evaluating levels of dependence and the associated psychological morbidity.

Methodology: 100 medical interns posted to the department of Psychiatry at J.J.M. Medical College Davangere were recruited into this study. Dependence on Facebook was measured using Bergen's Facebook Addiction Scale (BFAS) and dependence on WhatsApp was measured using Bergen's Facebook Addiction Scale modified for WhatsApp usage. Negative mood states like depression, anxiety and stress were measured using Depression and Anxiety Stress Scale (DASS). Loneliness was evaluated using Differential Loneliness Scale (DLS). Life satisfaction was measured using Satisfaction With Life Scale (SWLS). Self-esteem was measured using Rosenberg's Self-esteem scale (RSES).

Results: Significantly higher levels of stress were found amongst those with greater dependence on Facebook (Pearson correlation test score 0.211). Significantly lower life satisfaction (Pearson correlation test score -0.297) and lesser self-esteem (Pearson correlation test score -0.209) was seen in those with greater Facebook dependence. Those with greater WhatsApp dependence had significantly higher levels of depression (Pearson correlation test score 0.295), anxiety (Pearson correlation test score 0.236) and stress (Pearson correlation test score 0.362) and lower life satisfaction (Pearson correlation test score -0.343) and self-esteem (Pearson correlation test score -0.235).

Keywords: Whatsapp, Social Media, BFAS, DLS.

Prevalence and Pattern of Sexual Dysfunction Among Drug Naïve Anxiety And Depressive Disorder In A Multidisciplinary Teaching Hospital


Department of Psychiatry, Regional Institute of Medical Science (RIMS), Imphal, Manipur, [email protected]

Background: Little is known about the prevalence, typology, and natural course of non-drug-induced sexual dysfunction in patients with anxiety and depressive disorders. The degree of sexual dysfunction and its prevalence appears to be correlated with the severity of disease.

The Aim of the study is to find the prevalence and pattern of sexual dysfunction among drug naïve Anxiety and Depressive disorder.

Materials And Methods:
After diagnosing their illness using ICD-10 criteria, patients undergo assessment of severity of illness using HAM-A and HDRS respectively, then, the study group were subjected to Arizona Sexual Experience Scale (ASEX) questionnaire and were given time and private place for filling it up.

Result: After analysing the 100 patients (50 with Anxiety disorder + 50 with Depressive disorder), prevalence of Sexual dysfunction was 42% and 44% in Anxiety and Depressive disorder respectively. Also, there was a direct positive correlation between the severity of illness and the degree of Sexual dysfunction. While seeing the pattern of sexual dysfunction on the four phase of sexual cycle, maximum number of patient showed problem with desire and arousal while lower percentages of patient showed problem in orgasm and satisfaction. No significant correlation was found between duration of illness and sexual dysfunction.

Keywords: Anxiety disorder, Depressive disorder, Sexual dysfunction.

Challenges Faced By Health Care Professionals in Providing Quality of Life (QOL) to Alzheimer's and Dementia Patients: A Systemic Review

Sanam Z. Mcnojia

Alumni of Aga Khan University School of Nursing and midwifery, Sindh, Karachi, Pakistan. [email protected]

Introduction: As we are moving towards future, life expectancy of human has been increased, which also required to improve quality of life of an individual.

Background: WHO suggested that by 2025, around three-quarters of the population aged 60 or over will be living in developing countries. Out of which the number of elderly people affected by chronic disease such as dementia, will get double between 2020 (42 million) and 2040 (81 million). Neurologic conditions, including dementia, estimated by the Global Burden of Disease 2010, Study as the third leading cause of years lived with disability at global level. It projects direct influence on health care professionals and health care system to strive and provide quality of life (QOL) to elderly patient living with chronic cognitive conditions.

Method: A systemic review of articles from 2005-2015, published in renowned medical journals were analyzed.

Result: This literature review highlights the prevalence of dementia increases from 2-3% among those aged 70-75 years to 20-25% among those aged 85 years or more (Liara, 2014) and becoming huge challenge on health care professionals. We required to build such nursing homes which are well equip in managing challenges such as acute memory loss, medication compliance and performing activities of daily living (ADLs) in Alzheimer's and dementia patients. However, health care providers need to practice multiple care approaches in dealing with neurological and cognitive symptoms including behavioral and psychological approaches and non-pharmacological interventions to manage and prevent their symptoms and to aid their quality of life. Furthermore we need plan strategies to lessen the burden on health care system by involving family and community to support people with Alzheimer's and Dementia.

Conclusion: As elderly people need to live with these cognitive impairment for the rest of their lives, therefore we health care professional need to make significant strides in alleviate their disease progression and improve their quality of living.

Keywords: Quality of Life, Dementia, ADLs,

Age and Gender Differences in Phenomenology of Major Depression in A Tertiary Mental Health Institute in Northeast of India

Anantprakash Siddharthkumar Saraf

Dept. of Psychiatry, Lgbrimh Tezpur, Assam. [email protected]

Background: Depression has been viewed as a heterogeneous condition, with differences in phenomenological and psychopathological aspects with respect to age, sex and other sociodemographic variables. Possible reasons for differential presentations may be age or sex related biological factors; also psychological and sociocultural factors. Many studies have been conducted throughout world to determine and delineate these factors, with variable Results.

Objective: To determine to the sociodemographic factors associated with depression in patients visiting Regional Mental Health Institute in North East India.

Method: A total of 94 patients (39 males and 55 females) diagnosed as Depressive episode (unipolar major depression) according to the ICD-10 criteria, were administered Hamilton Depression Rating Scale (HAM-D 17 ). Various phenomenological factors were correlated with sociodemographic variables and significance was determined by Pearson's Chi-square test.

Results: Statistical analysis revealed age is significantly correlated with genital symptoms (p=0.005); psychic anxiety (p=0.011) and somatic anxiety (p=0.021); with decrease in these symptoms as the age progresses. Also the severity of depression was found to be less with increasing age (p=0.013). Females were found to be more likely to report somatic symptoms, both gastrointestinal (p=0.007) and general (p=0.038). Suicidality, guilt feelings and agitation symptoms were found to be reported less by older depressives. Symptoms of suicidal feelings, agitation and anxiety (both psychic and somatic) were found more common in females and they were more likely to have severe depression. Unemployed were more likely to be depressed. Severity of depression was found to be less in married male as compared to married females, but this was not statistically significant.

Conclusion: This study supports previous studies done elsewhere, which found heterogeneity among presentations of depression with age, sex and sociodemographic variables; and would be helpful in clinical practice with better management of depression.

Keywords: Major depression, HAM-D, Heterogeneity,

Relationship of Impulsivity and Depressive Symptoms In Alcohol Dependence

Diptadhi Mukherjee

LGB Regional Institute of Mental Health, Tezpur, Assam.

[email protected]

Background: Both Depressive symptoms and increased impulsivity are studied with special interest in alcohol dependence. These factors are known to affect the prognosis of this disorder. Till date mutual relationships between impulsivity and depression have been investigated only in few studies in patients alcohol-dependent.

Methods: By means of the Barratt Impulsiveness Scale (BIS-11) and stop-signal task, levels of impulsivity among 60 alcohol-dependent inpatients were measured after the period of detoxification. The stop-signal task was used as an Objective Method of estimating the level of behavioral impulsiveness, and the BIS-11 is a self report measure of global as well as cognitive impulsivity. Hamilton Depression Rating Scale (HAM-D) was used as a measure of depressive symptoms. The Results were analyzed to examine relationships between impulsivity and depressive symptoms as well as relationships of depressive symptoms with other socio-demographic and alcohol-related parameters.

Results: Statistical analyses revealed significant associations between impulsiveness and severity of depressive symptoms. Individuals with higher HAM-D scores were more impulsive on all subscales of the BIS-11. Among them most strong correlations were found with the attention impulsivity subscale of BIS-11(r= 0.531, p<0.0001). In addition, Cognitive impulsivity (Attentional + Non-planning impulsivity) was correlated with depressive symptoms the strongly (r=0.537, p<0.0001). But HAM-D scores were not significantly correlated with manipulation-free behavioral impulsivity measures of stop signal task (p=0.113). Adjusting for other variables, a linear regression analysis showed that cognitive impulsivity was the strongest predictor of depression severity. Additionally we found that the subjects with positive family history of alcohol dependence had significant increase rate of early-onset dependence as well as increase rate of criminal charges.

Conclusion: Our findings point towards a strong association between depressive symptoms and impulsivity in alcohol-dependent patients. The relationship between depressive symptoms in general applies mainly to cognitive impulsiveness- reflects impulsive decisions rather than impulsive actions.

Keywords: Alcohol dependence, Depressive symptoms, BIS-11, HAM-D

Gender Differences in Academic Motivation and Attitude Towards Research of Psychiatry Residents

Neena Sawant, Shubhangi Parkar, Akanksha Sharma

Department of Psychiatry, Seth GS medical college & KEM hospital, Mumbai.

[email protected]

Background: In our daily life it is necessary to have motivation in order to fulfill tasks and achieve satisfaction. Very often the medical students do post graduation in a specific branch for a particular motive and goal in life. In our country where there is work pressure residents do research as an obligation and students are hesitant to take up research projects. This study was undertaken to study the intrinsic and extrinsic motivation to learning and the attitudes to research of the psychiatry residents.

Materials And Methods: This study was conducted in 40 psychiatry residents of 3 general hospitals after written informed consent and ethics committee approval. A semi structured questionnaire, Academic Motivation Scale, Attitudes Toward Research Scale collected the information pertaining to Aims of study.

Results: 57 proformas were distributed, of which 40 were complete and analysed. There were 22 females and 18 males matched for demographic details. Gender differences on the sub domains of academic motivation were intrinsic( t= 0.018, p =0.9854) and extrinsic (t=0.47, p=0.64)and attitudes towards research (t=0.332,p=0.741). Correlation between academic motivation, intrinsic (r=0.5177, p=0.028) and extrinsic ( r=0.781,p=0.0001) with attitudes towards research in males and in females for intrinsic motivation(r=0.8537, p=<0.0001), extrinsic motivation (r=0.66, p=0.0008) with attitudes towards research.

Discussion: Learning is based on the need for mastery on subject, need for knowledge, authority impact and peer pressure. In our study both genders had significant differences. The need to do research is achieved only when one has set goals, is motivated for the same. In our study in both the genders a highly significant correlation was seen.

Conclusion: The Results of the study will help us in determining the ways of improving motivation of psychiatry residents towards academics and research.

Keywords: Academic Motivation Scale, post graduation, correlation.

C-L Psychiatry- Road Yet Less Travelled: A Cross Sectional Study Of Psychiatry Referrals in a GHPU

Ankit Goel

A-1/163 Janak Puri, New Delhi. [email protected]

Background: Despite high level of psychiatric co morbidity in patients presenting with various physical and surgical ailments, rate of psychiatric referrals made is quiet low. Studying the pattern of referral may pave path for interventions to improve the current scenario.

Methods: All patients referred for psychiatric consultation (emergency and in-patient) over 6 month period were evaluated. Data related to socio-demographic profile, source of referral, reason for referral, psychiatric diagnosis and attendant accompanying were recorded. Analysis was done using descriptive statistical Methods.

Results: A total of 411 patients were referred for psychiatric consultation. Most common reasons for referral were abnormal behavior (33%) & substance abuse (29%), followed by anxiety (16%), and depressive symptoms (13%). Most commonly diagnosed psychiatric disorders were substance use disorders (37.7%) followed by mood disorders (12.9%) and neurotic, stress related and somatoform disorders (12.7%). 10% cases were referred for suicide attempt. Amongst in-patients, referral rate was 0.47%, majority being from department of medicine (47%). In nearly 34% cases examination findings did not match with the reason of referral and 43% referrals were done before proper investigations. Most common person accompanying the patients was parents (26%), followed by spouse (19%). Nearly 10% patients presented alone.

Conclusion: Inspite of evident emerging role of Consultation-Liaison Psychiatry (C-L Psychiatry) in providing better management, it still needs a long way to go. Our study shows psychiatric consultations are not frequently requested, as seen by low referral rates, that too are limited for acute crisis management of behavioral emergencies rather than psychiatric disorders. Future studies should focus on interventions that can improve referral rates through early recognition of common psychiatric conditions, with an emphasis on sensitizing the general physician and timely intervention.

Keywords: abnormal behavior, substance abuse, Consultation-Liaison Psychiatry

Factors Associated with Risk of Transition to Injecting Among A Sample of Non-Injecting Opioid Users: A Multi-Site Study From North India

Atul Ambekar, Tuleshwar Singh, Ashwani Mishra, Ravindra Rao, Alok Agrawal

National Drug Dependence Treatment Centre (NDDTC), AIIMS, New Delhi. [email protected]

Introduction: Many Injecting Drug Users (IDUs) report beginning their drug-use careers with non-injecting opioid drug use. The switch to the injecting route of intake occurs due to a variety of factors, which have been poorly studied. We examined the factors associated with the self-reported likelihood to start injecting drugs among non-injecting opioid users.

Methodology: In this cross-sectional study, we administered a semi-structured questionnaire after obtaining informed consent to non-injecting opioid users recruited from various sites in seven north Indian states. Data on socio-demographic, drug-use practices and likelihood to start injecting were collected. Factors associated with the response 'yes' to the question "are you likely to start injecting?", were analysed using Pearson's Chi-Square test. Institute Ethics Clearance was obtained.

Results: In the total sample of 753 Non-IDUs, only 33% had ever received any specific information on risks and harms of IDU. Ninety-two non-IDUs (12%) reported that they were likely to start injecting. Factors significantly associated (p<0.05) with this self-reported likelihood were: "knowing an IDU personally", "witnessing an act of injection", "history of having received an offer to inject", and beliefs that injections "act faster" and "are cheaper."

Conclusion: A sizable proportion of non-injecting opioid users is in close contact with injecting drug users and is at risk of switching to injecting route. Unfortunately these drug users do not receive appropriate services or information to make informed choices. The ambit of harm-reduction services should be expanded to prevent this risk.

Keywords: IDUs, act of injection, opioid users

A Case of Acute Extrapyramidal Side Effects Due to Clozapine

Nathalia, Rani jancy

Department of Psychiatry, Caritas Hospital Kottayam, Kerala, India.

[email protected]

Introduction: Since the Introduction of antipsychotic drugs in the early 1950s the term "neuroleptic" implied the closely connected antipsychotic drug effects and neurological side effects on the motor system. Soon after its Introduction, clozapine demonstrated its clinical efficacy in the treatment of schizophrenic psychoses. Extrapyramidal side effects have rarely been noted and clozapine has been called an "atypical neuroleptic".

We report an unusual case of acute dystonia in a 30year-old male schizophrenic patient. He was having an IQ of 60.

Case Report: He was diagnosed with schizophrenia in 2012.he had presented with severe persecutory delusions and irritability with auditory hallucination. He was first treated in with haloperidol, upto 5 mg per day. After two years the medication was switched to clozapine because of marked extrapyramidal side effects (tremor, rigidity) under haloperidol. Further exacerbations followed each time that clozapine was increased from the maintenance dose of 100 mg to up to 300 mg/daily. After a month the patient was again admitted to hospital with persecutory delusion, psychomotor agitation and aggression. Under a dose of 300 mg clozapine the symptoms slowly abated over a time of five weeks, while lorazepam 2 mg twice daily was given, tapered and discontinued. In the sixth week of treatment two days after the discontinuation of diazepam the patient suffered from an acute dystonic syndrome with retrocollic torsion of the neck. The clozapine dose had remained unchanged at 300 mg/daily. The acute dystonia was successfully treated with intra muscular injection of 25 mg of prochlorperazine. Then oral trihexyphenidyl was given 2mg thrice daily for two days. After tapering the clozapine dose to 150 mg the anticholinergic was discontinued without further recurrence of dystonic incidents. interestingly by this time the psychotic symptoms abated.

The ECG, EEG, chest x-ray, and routine blood chemistry including thyroid function did not reveal any abnormalities. CTbrain showed diffuse cortical atrophy. This extrapyramidal syndrome was a classic acute dystonia which has not been reported with clozapine. Such a syndrome may be considered more typical in a younger male patient, but several aspects are remarkable and atypical. Acute dystonia usually appear 12-72 hours after first administration of the neuroleptic. Our patient had been treated for weeks with the same dose of clozapine.

The only change in medication was the discontinuation of a benzodiazepine. The possibility of accidental or conscious ingestion of typical neuroleptics was excluded by enquiring thoroughly from the mother about medications.

Discussion: The appearance of an acute dystonia after such a long time of treatment and unchanged dose would lead us to the Conclusion, that the rare incidence of EPS with clozapine is not due, as proposed earlier, to its weak D2-receptor blockade and relatively marked antimuscarine (anticholinergic) properties alone. The dopamine/acetylcholine model of dyskinetic side effects under neuroleptics oversimplifies the pathophysiology of the basal ganglia. Although the exact mechanism of action of clozapine is uncertain, more complex mechanisms like the high DI-receptor blockade of clozapine or the marked antiserotonergic properties must be involved. Some authors speculate on the action of clozapine on the gabaergic system, which has been implicated in the pathogenesis of dyskinetic reactions. In our case a benzodiazepine which exerts its action at GABA-receptors-had been stopped shortly before the acute dystonia. Moreover the patient has mental retardation which poses him at a greater risk for cortical atrophy and extra pyramidal side effects. We also suspect an undiagnosed neurological disorder might cause acute dystonia in patients with schizophrenia treated with clozapine.

Conclusion: Clozapine has been postulated as a wonder drug for the treatment of treatment resistant schizophrenia since ages.But it may produce unexpected dystonic reaction in vulnerable patients.

Keywords: extrapyramidal, Clozapine, hallucination

Neurocognitive Impairment in Remitted First Episode Schizophrenia and its Correlation with Functional Outcome

Krishan Kuamr Sharma

B8 Chatri Yojana Vaishali Nagar, Ajmer, Rajasthan. [email protected]

Cognitive impairment considered a main feature of schizophrenia because it is relatively stable across the life span. Gold's review (Gold, 2004) showed that cognitive impairment was present before the emergence of psychotic symptoms Starting with onset of illness to late adulthood, relative stability of cognitive impairment is assumed (Gold, 2004).

Objective: The Aim of this study was to evaluate neurocognitive impairment in first episode schizophrenia and to compare it with control group and correlation of cognition with functioning.

Methodology: It's a cross sectional study and was carried out on 60 patients of remitted first episode schizophrenia attending OPD at JLNMC&H & Ajmer . To enter in the study, patient was screened with a specially designed screening Performa, which encompassed the entire exclusion criteria, followed by application of various neuropsychological tests applied.

Results: We found that patients with schizophrenia showed neurocognitive impairment in domains of visual attention, concentration, psychomotor speed, cognitive flexibility, executive functions, verbal learning and memory, visuo spatial working memory, verbal fluency, verbal attention, concentration and short term memory, which also affect functioning.

Conclusion: Patients with schizophrenia scored significantly lower than control group in various neuropsychological tests and neurocognitive impairment was associated with functional outcome

Keywords: Neurocognitive, schizophrenia, psychotic symptoms

Prevalence of Psychiatric Comorbidities Among Opioid Injectors Attending Rims Hospital

Andreecia Mn Mawiong, N. Heramani Singh, S. Gojendra Singh

Department of Psychiatry, Regional Institute of Medical Sciences, Imphal, Manipur. [email protected]

Background: Psychiatric comorbidity among opioid injectors is the co-occurrence of other mental disorders among them besides being dependent on injecting opioid.

Objectives: The purpose of this study is to find out the co-occurrence of other psychiatric illness among opioid injectors besides being dependent on opioid.

Methods: All the consecutive opioid injectors who attended the Psychiatry OPD were interviewed with GHQ12 to assess the mental health status, they were interviewed with MINI-Plus for the diagnosis of mental conditions. The data was analyzed statistically using spss21 software.

Results: In this study there were 105 opioid injectors, out of 105 the prevalence of psychiatric comorbidities were anti-social personality disorder 85.7% (N=90) being the commonest in this study, depression 61.9% (N=65), poly-substance dependence 52.4% (N=55), anxiety disorder 41% (N=43), psychosis 23.8%(N=25), suicide 11.4%(N=12), panic disorder 4.8% (N=5), specific phobia 4.85(N=5).

Conclusion: This study shows that many dependent opioid injectors are vulnerable to many psychiatric comorbidities which should be screen and treat side by side while treating the dependency.

Key words: opioid, injectors, psychiatric, comorbidities.

Marital and Sexual Functioning Among Spouses and Patients with Bipolar Disorder

Devakshi Dua

# 264, 2nd Floor Sector 15 A, Chandigarh. [email protected]

Aim: This study Aimed to evaluate the marital functioning and sexual functioning among the spouses and patients with bipolar disorder. Methods: 35 married couples, with one partner suffering from bipolar disorder (currently in remission) were evaluated on couple satisfaction index (CSI) scale, Arizona sexual experience scale and satisfaction with sex life scale. Additionally patients were evaluated on Hamilton depression rating scale (HDRS), Young Mania rating Scale (YMRS) and Global Assessment of Functioning (GAF) Scale. Results: Majority of the patients were males (N=23; 65.7%) and the mean age of the both the partners was around 42 years. The couple had been married for mean duration of 18.74 (SD-9.64) years. In 77% of couple's bipolar illness in one of the partner started after marriage. The mean duration of illness at the time of assessment was 119.65 (130.14) months. The mean CSI scale score for patients was 123.85 (SD-16.82) and that for spouses was 121.77 (SD-20.64), indicating high level of marital satisfaction. The difference between the patients and spouse was not significant and the CSI scores of patients and spouse had positive correlation (p=0.004). About one-third of patients (N=12; 34.28%) and spouses (N=13; 37.14%) of spouses had sexual dysfunction as per ASEX. There was no difference between the patients and spouses in terms of satisfaction with sex life scale. Marital satisfaction among the spouses was associated with self rated sexual satisfaction (p<0.001) and lack of sexual dysfunction in self. Marital satisfaction in both the partners was not associated with demographic and clinical variables, duration of marriage, time of marriage (onset of illness before or after marriage), level of residual psychopathology. Conclusion: Married couples, with one partner suffering from bipolar disorder have high level of marital satisfaction and there is no difference between both the partners in terms of marital and sexual satisfaction.

Keywords: sexual functioning, CSI scores, HDRS, Global Assessment

Attitudes Towards Mental Illness Among Doctors in A Medical College Hospital

Bishnu Sharma

Central Referral Hospital, Dept. of Psychiatry, SMIMS, 5th mile, Tadong, Gangtok, Sikkim, [email protected]

Stigma towards adults with mental illness is both a longstanding and widespread phenomenon. Negative stereotyping leads to prejudice and discrimination of psychiatric patients and affects all areas of their care and well-being. Stigmatizing attitudes are prevalent not only among the general population but also among the medical community. It has been suggested that these negative attitudes about mental illness among doctors might be due to inadequate exposure and training on mental illness. Harboring even covert negative attitudes towards mental illness by doctors has been shown to adversely affect the prognosis of the medical/surgical (non-psychiatric) illness of psychiatric patients. Hence it is imperative that doctors of all specialties are aware of their attitudes towards psychiatric patients and make a concentrated effort to change them for the better.

This study Aims to study the attitudes towards mental illness among doctors at a tertiary care medical college hospital. It also seeks to find if there is any difference in attitudes toward mental illness based of area of specialization and number of years of experience in the medical profession. A cross-sectional observational study design was chosen. Relevant socio-demographic data was collected from all the doctors after informed consent. The Community Attitudes toward the Mentally Ill scale and the Social Distance Scale was used to assess the attitudes towards mental illness. The Marlowe-Crowne Social Desirability Scale was used to check for social desirability response bias (a tendency of respondents of survey to answer questions in a manner that will be viewed favorably by others) among doctors.

Appropriate statistical analysis will be used to analyze the data. The Results will be presented at the time of presentation.

Keywords: Stigma, Mental illness, Marlowe-Crowne

Factors Associated with Retention On Opioid Substitution Therapy in A Community Clinic Setting

Ravindra Rao, Swati Kedia Gupta, Prashanth R, Atul Ambekar, Anju Dhawan

Department of Psychiatry, AIIMS, New Delhi. [email protected]

Introduction: Engaging individuals in opioid dependence treatment is a challenge. Opioid substitution therapy (OST) is an effective opioid dependence treatment modality, and leads to improved retention, which, in turn, is associated with better outcomes. However, rates of retention and factors association with retention among OST recipients from community drug treatment settings are lacking, which is the Aim of the present study.

Methodology: The study followed retrospective cohort design. Case files of opioid dependent patients were retrieved and those initiated on OST from 1 January 2005 - 31 December 2007 were included in the study. The data from the file was entered into a structured proforma. Descriptive analysis was done using Stata v.12. Ethical clearance was obtained from Institute Ethics Committee.

Results: A total of 153 patients were included. The mean age of the subjects was 38±11.5 years; almost all were males. Majority (58.2%) were married and living in urban areas. Most subjects had completed primary education (42.5%); 30% were illiterate. About 51% were employed and 25% worked as skilled laborers. Heroin was the most common opioid used (91 %), and 25% had ever injected. Mean dose of buprenorphine was 7 mg/day.

The one-year retention on OST was 45%. Retention was significantly associated with occupational functioning improvement (IRR=3.9, (2.1-7.0)), problem alcohol use (IRR=1.6 (1.16-2.34)), abstinence from opioids during follow-up (IRR=1.4; (0.99-2.1)), and receipt of counselling services (IRR=2.4, (1.39-4.16)). Multivariate analysis showed retention to be significantly associated with occupational functioning improvement and problem alcohol use.

Conclusion: Community settings yield one-year retention on OST comparable to other settings. Psychosocial factors play an important role in ensuring retention on OST.

Keywords: Opioid Substitution Therapy, OST

A Clinical Study on Somatic Symptoms in Patients of Depression

Swati Arora, Anshuman Tiwari, Shantanu Bharti, A.Q.Jilani, Ajay Kohli

Dept. of Psychiatry, ELMCH, Lucknow. [email protected]

Background: Depression usually presents with wide range of psychological symptoms as well as somatic complaints. Patients presenting only with somatic complaints often have underlying major depression. Hence, the underlying psychopathology is usually remains unrecognised. The present study was designed to explore the somatic symptoms and its prevalence in depression.

Material And Method: This was across sectional study with sample size of 50 patients of major depressive disorder as per ICD-10 DCR, conducted for a period of 1 year at Era's Lucknow medical college. HAM-D and Bradford somatic inventory(BSI) were applied to assess severity and somatic symptoms respectively. We also compared between different somatic symptoms and their association with severity of depression.

Results: The mean age of the study sample was 34.84 years. Majority of the patients were Females (66%), Married (82%),Muslim(54%), and from Rural Background (62%).Most of the patient presented with multiple somatic complaints. The most common symptom being severe headache (92%) and lack of energy (84%) followed by constriction in head(78%), pain in neck and shoulder(76%), pain all over the body(76%) and heaviness in whole body(76%).The other common somatic complaints were dryness of mouth and throat, feeling of dizziness and awareness of palpitations, heaviness of head, feeling tired when not working, pressure inside head or going to burst, burning of head, pain in legs and pain in chest or heart.

On BSI assessment, 32% of patients were having >20 Functional somatic complaints (FSCs) and 68% were having >10 FSCs. However, no significant difference was found between severity of depression and somatic symptoms.

Conclusion: Majority of patients in depression had functional somatic complaints. Somatic complaints should be taken into account while diagnosing depression.

Keywords: Somatic symptoms, Bradford somatic inventory, ICD-10, Functional somatic complaints.

Prevalence and Pattern of Anxiety and Depressive Disorders in Pregnant Women Attending Antenatal Clinic

Pallabi Sahu

TC. No. 14/256(6), Avas Poonthi Road, Trivandrum, Kerala.

[email protected]

Background: Managing perinatal depression and anxiety is important for maternal, as well as infant, wellbeing. Persistent maternal stress, depression and anxiety can Result in detrimental effects on infant development; both during pregnancy and postnatally.

Aims: The Aim was to study the prevalence, pattern of anxiety and depressive disorders in pregnant women attending antenatal clinic and the various socio-demographic factors, obstetric factors and other factors related to Anxiety and Depressive disorders in pregnant women.

Materials And Methods: A cross- sectional study was conducted at the Anti natal clinic, under Department of Obstetrics and Gynaecology, of a tertiary care hospital in Rajkot. Hospital Anxiety and Depression Scale (HADS) was used as screening tool. Those participants who scored ≥ 11 in each of the item of HADS were further evaluated by psychiatric history and mental status examination for psychiatric morbidity. Final diagnosis of Psychiatric disorder was established by applying DSM-IV TR diagnostic criteria.

Results: Out of 200 pregnant women 15% women were suffering from various Anxiety Disorders, 7% were suffering from Depressive disorders and 2.5% suffered from combined Anxiety and Depressive disorders. Depression or Anxiety was more prevalent among those women who were unwilling for the current pregnancy (P=0.033), those who had high risk obstetric (P=0.0306) and medical complications (P=0.0121) during the pregnancy and also among those who had history of domestic violence (p=0.000005).

Conclusion: Depression and anxiety during pregnancy was found to be prevalent in our study. This study also indicates the need to incorporate screening for anxiety and depression in antenatal programs and providing practical support to women during pregnancy. High risk factors need to be focused and interventions related to it need to be taken.

Keywords: HADS, DSM-IV TR, Anxiety, Depressive disorders.

Cognitive Impairment in Euthymic Bipolar Patients - A Cross Sectional Case Control Study

Devlina Talapatra

#202/3 Sp Mukherjee Road, Kolkata, West Bengal. [email protected]

Background: Growing body of evidence suggests that cognitive deficits are found in bipolar disorder patients even in euthymia. Our study Aims at identifying the cognitive domains that are affected in euthymic bipolar patients compared to matched controls and compare functional outcome in the two groups a well.

Method: It is a cross-sectional, case -control study of 50 euthymic BPAD patients and 50 age sex and education matched healthy controls. Both groups were tested for 6 cognitive domains viz. Speed of processing, Attention, Working memory, Verbal and Visual learning and Executive function using 10 neuropsycological tests. Functional outcome was measured with FAST(Functioning assessment short test)

Results: Bipolar patients had statistically significant(p=0.000) lower scores across all the tests .

Conclusion: Euthymic bipolar patients showed cognitive deficits across all 6 domains as well as a poor functional outcome. This knowledge can guide us to minimize cognitive impairment and poor functioning in bipolar patients in the coming years.

Limitations: Small sample size and cross-sectional study design.

Keywords: Cognitive impairment, Functioning assessment short test, euthymia

Evidences From A Longitudinal Study of Factors Affecting Outcome in Patients of Delirium

Sandeep Sekhon, Manushree Gupta

Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi-110002. [email protected]

Background: Delirium is understood as a complex neuropsychiatric syndrome associated with elevated morbidity and mortality. Very few studies on the longitudinal course of motor profile in delirium and no studies of the stability of actual motor subtypes over time are found in literature with a need of detailed study to clarify such Objectives.

Aims And Objectives: To study the phenomenology and outcome of delirium in psychiatry referrals sought among inpatients.

Material And Methods: This was tertiary hospital based longitudinal study, prospective in nature, evaluating the frequency as well severity of symptoms and outcome of delirium using the DRS-R-98 scale over one year. SPSS (Statistical package for Social Sciences) version 15.0 was used. A p-value < 0.005 was considered statistically significant. The qualitative variables were compared across chi-square test, while quantitative variables were compared across groups using ANOVA. The variables were also compared within each group across follow-ups using unpaired t test.

Result: Out of 40 patients, hypoactive type patients were the most common type of subtype diagnosed with the highest mortality rate followed by hyperactive and mixed type. The mixed type had a higher mortality rate as compared to hyperactive type. The mean DRS-R-98 (total score) was 22.66.Disorientation and Inattention deficits are key phenomenological markers of delirium which can aid in more reliable detection of delirium. The highest number of discharged patients were of hyperactive type whereas the least number of discharge was seen in mixed type.

Conclusion: This study indicates delirium is associated with poor prognosis. The highest mortality rate among patients with delirium was found in hypoactive type. According to our study the key phenomenological markers for delirium are disorientation and inattention deficits.

Keywords: Delirium, hyperactive, hypoactive, mixed, phenomenology, outcome.

Temperament and Family History in Women Seeking Treatment for Alcohol Dependence: A Gender Based Comparison

Sowmyashree Narayan, Prabhat K Chand, Pratima Murthy

LHMC, New Delhi. [email protected]

Background: In recent times, increasing number of women are seeking treatment for alcohol dependence in India, and there is a potential need for research in the field.

Objectives: The present research Aimed at a systematic assessment of drinking pattern, temperament and family history among women and men with alcohol dependence. To assess the telescoping in two groups and to compare the temperament and character profiles between the two groups.

Materials And Methods: Cross sectional assessment of 50 men and 50 women seeking treatment for alcohol dependence at NIMHANS, between August 2013 and September 2014, using the tools; Centre for Addiction Medicine detailed evaluation proforma, Temperament and Character inventory-revised (TCI-R 240), Family History Assessment Module-COGA group, MINI plus and SCID II

Results: The initiation as well as various milestones of drinking is achieved at a significantly later age in women compared to men. There was no significant difference between the two groups with respect to telescoping and Family history of alcohol use disorders. On TCI-R, Women scored similar on domains of novelty seeking, harm avoidance, reward dependence, persistence and cooperativeness. On self directedness, women scored significantly higher and on self transcendence, men scored significantly higher.

Conclusion: This was one of the very few studies which used TCI-R 240 in the Indian setting to study the gender difference in personalities of alcohol dependent patients. Unlike earlier studies, there was no telescoping for women observed in our study. Also family history of alcoholism was similar for men and women. The implication of TCI scores in vulnerability to substance use disorders may be considered in future research.

Keywords: Alcohol dependence, TCI-R, SCID-II.

Psychiatric Morbidity Among Chronic Low Back Pain Patients

Vijit Jaiswal, B. S. Sidhu, Avinash Chander Gupta

Department of Psychiatry, King George's Medical University, Lucknow, U.P., [email protected]

Background: Chronic Low Back Pain (CLBP) Result into various types of impairments like bio-physiolological, psychosocial and occupational. Pain affects mood, and mood affects ability to cope with pain. Pain also affects how someone interacts with other people. For this reason, learning appropriate coping skills for dealing with anxiety, depression, irritability and frustration can be invaluable. Psychiatric disorders more prevalent in CLBP patients are somatoform disorders, affective disorders and substance abuse disorders, with major depression as the most common single diagnosis.

Method: Questionnaire based survey of psychiatric morbidity was done among CLBP patients attending orthopaedic out patients in a tertiary care hospital setting. The study population consisted of 50 patients with complaints of CLBP for at least past 3 months and 50 healthy controls from general population.

Results: Out of 50 CLBP patients, 33(66%) were having significantly higher psychiatric morbidity (p=0.0001) as compared to control group (10%). The prevalence of Major Depressive Disorder (including co-morbidities), Anxiety disorders (including co-morbidities) and substance abuse or dependence was significantly higher among the cases than the control.

Conclusion: Nearly two thirds of the CLBP patients were having one or another psychiatric co-morbidity.

Keywords: Chronic Low Back Pain (CLBP), Major Depressive Disorder, substance abuse

Gender Sensitive Substance Use Treatment Services: Challenges and Opportunities

Bigya Shah, Priyanka Yadav, Atul Ambekar, Piyali Mandal

Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India. [email protected]

Introduction: The term 'Gender-sensitive' refers to policies, programs and practices responsive to the needs, roles, responsibilities and constraints of different genders. Gender differences are not only important for initiation, continuation of substances and the problems encountered, but also in treatment accessibility and its course. Female substance users, including sexual minorities (lesbian gay bisexual and transgender substance users), are highly marginalized and stigmatized. To address the varied and different issue, there is growing need for gender-sensitive substance use treatment services.

Method: The paper reviews literature on gender sensitive substance use treatment services using 3 electronic databases( pubmed, google scholar, IndMED).

Results: There is limited data from the developing countries on this issue. Literature from developed countries shows that gender-sensitive treatment services have favourable outcome. Specifically, addressing the need of pregnant and parenting mothers have increased the efficacy. However there remain concerns with the Methodologies of some studies. Populations with different age groups and special situations such as violence, detainment, medical and psychiatric comorbidities and LGBT have remained a neglected research area. Establishing gender-sensitive services presents many challenges and obstacles.

Conclusion: Gender sensitive substance use treatment services are important not just from the point-of-view of public health but also from a justice, fairness and equality perspective. Components of gender-sensitivity include ensuring safety, proper location, scheduling and staffing, empowering and consideration of feasibility along with cost, culture and social norms. More research is required in this area in India.

Keywords: pubmed, google scholar, IndMED, gender-sensitive

Absenteeism And Psychiatric Illness In Public Sector

Bharath D U

#737, 300 Residents Hostel, Jj0 Hospital, Mumbai, Maharastra.

[email protected]

Introduction: Sickness absence is an important health status indicator of the employees and a major setback to the organisation's productivity. Studies have shown that psychiatric illnesses contribute a big share as reason for sickness absenteeism. Maharashtra government employees claiming sickness absence are referred to our hospital as medical board cases and then to Department of Psychiatry for evaluation and reporting.

Aims And Objectives: To study the pattern, prevalence and percentage of psychiatric illness responsible for sickness absence among medical board cases and co-relate with socio-demographic factors.

Materials And Methods: This is a record based retrospective cross sectional study done using medical board cases referred to our department between September 2014 to August 2015. Psychiatric illnesses are diagnosed using DSM V criteria. Chi square test was applied to evaluate significant co-relation between variables.

Results: 2331 employees were referred to medical board between September 2014 to August 2015. Out of which 245 (10.51%) were referred to the Department of Psychiatry. 31.02% were police personnel, 21.63% were Municipality and PWD employees, 11.42% from government hospitals, 11% from educational institutions constituting 3/4 th of total number of patients. 179 patients had psychiatric illness and most common diagnosis were alcohol use disorder (25.3%), Major depressive disorder (17.5%), Schizophrenia (13.8%). 33% of patients with psychiatric illness did not have prior psychiatric consultation. A total of 1,28,405 days were lost due to sickness absenteeism with 1,00,970 days lost exclusively due to psychiatric illness.

Conclusion: The high prevalence of absenteeism due to psychiatric illness necessitates measures to promote mental health awareness; initiation of special programs for enhancement of mental health in vulnerable occupational groups .Interventions to help employees with psychiatric illnesses to adapt optimally to work environments is the need of the hour.

Keywords: Sickness absenteeism, psychiatric illness, socio-demographic factors, public sector

A Study of The Self-Esteem and Social- Occupational Functioning Among Persons with Schizophrenia

Nikitha Harish, Dharitri Ramaprasad, Diana Ross

Department of Psychiatry, NIMHANS, Bangalore. [email protected]

The present research Aimed at studying the Self-Esteem and Social-Occupational functioning among persons with Schizophrenia. The data was collected from tertiary care out-patient clinics across Bangalore city. Thirty five (males=21, females=14) individuals diagnosed to have Schizophrenia were interviewed along with their care-givers and administered standardized tools. The Rosenberg Self-Esteem Scale was administered to assess Self- esteem and the Social-Occupational functioning scale was administered to assess Social-Occupational functioning.

The findings revealed that the group mostly had a moderate level of Self- Esteem as well as a moderate level of Social-Occupational Functioning. No statistically significant relationship could be established between Self-Esteem and Social-Occupational functioning. However, certain socio-demographic factors and illness related data was found to have an association with the study variables; Self-Esteem and Social-Occupational functioning. Gender of the respondent was found to be associated with both Self-Esteem and Social- Occupational functioning. Other variables that were associated were; Insight with Self-Esteem and Adherence to treatment with Social-Occupational Functioning. The study was limited in terms of small sample size and limited time period. However, it stresses on the importance of psycho-education and calls for further research in the area.

Key words: Schizophrenia, Self-Esteem, Social-Occupational Functioning

A Comparative Study of Prevalence of Postnatal Depression Among Subjects With Normal and Caesarean Deliveries

Dinesh P

Naryana medical college and hospital, Nellore, Andhra Pradesh.

[email protected]

Aim and Objectives: To study the prevalence of postnatal depression among subjects with normal and caesarean deliveries and to compare sociodemographic data and prevalence of postnatal depression among subjects with normal and caesarean deliveries.

Material And Methods: The sample of patients will be obtained from those attending the outpatient clinic or admitted to the inpatient unit of the Department of Pediatrics at Naryana medical college and hospital, Nellore. The sample comprises of 100 subjects who underwent normal delivery and 100 subjects who underwent caesarean delivery and all are within three months of delivery. Subjects in both the samples were asked to complete the Edinburgh Postnatal Depression Scale (EPDS). Those found to have scores suggestive of depression on EPDS were assessed for depression according to ICD-10. Then the prevalence of postnatal depression is calculated in both the samples and comparison between sociodemographic data, and prevalence of postnatal depression is done by using paired t test and chi square test.

Results: Among Post caesarean subjects, depression was diagnosed in 30% (n=30) as compared to 15% (n=15) in subjects that delivered normally. Prevalence of postnatal depression is more in caesarean delivery than normal delivery. There was significant difference found in the prevalence of post natal depression between two groups at p value < 0.005.

Conclusion: Postnatal depression is seen in both normal and caesarean deliveries. However, in line with previous studies our study also found the prevalence of Postnatal depression is more in caesarean deliveries than in normal deliveries.

Keywords: postnatal depression, caesarean, EPDS

A Descriptive Analysis of Instructions to Authors For Statistical Reporting of Article in Addiction Medicine Journals

Ashwani Kumar Mishra, Arpit Parmar, Gauri Shanker Kaloiya, Yatan Pal Singh Balhara

Department of Psychiatry and National Drug Dependence Treatment Center, AIIMS, Delhi. [email protected]

Introduction: Instructions to authors provided by journals for the articles submission varies from journal to journal. These instructions covers mandatory requirements for authors to prepare their manuscript so they can be subjected to editorial processing. In addition to various instructions, it also contains information on statistical aspects of the manuscript that should be addressed. However, the coverage and specification of statistical aspects under instruction to authors lacks comprehensiveness. This leads to incomplete statistical reporting of the article as well as unnecessary delay in the publication of a particular article.

Methods: The present study Aims to study 'instruction to authors' of 55 core addiction medicine related English journals. They were identified by the SCImago journal ranking list 2014.

Results: Out of 55, majority of journals published articles on any substance (including behavioral) addictions (76.4%) while 6 journals (10.9%) were dedicated to alcohol research and 3 journals each (5.5% each) were dedicated to nicotine and gambling research. One journal was dedicated to opioids research. Out of 55, total of 50 journal instructions could be accessed online. Majority of journals did not suggest any descriptive (70.9%) or inferential (74.5%) statistics reporting to the authors. Only 13 journals (23.6%) instructed authors to follow one or the other reporting guideline (for e.g. CONSORT/STROBE).

Discussion: More detailed instruction to authors (especially the statistical reporting of a manuscript) is necessary in order to do better reporting of articles published in addiction medicine journals.

Conclusion: The instruction to authors in core addiction related journals on statistical aspects seems to be inadequate.

Keywords: SCImago, Journal, Manuscript.

Sexual Dysfunction Among Opioid (Heroin) Dependent Men: A Descriptive Study

Liton Mallik, Atul Ambekar, Rakesh Lal, Arpit Parmar

[email protected]

Introduction: Heroin dependent subjects suffer from various sexual dysfunctions which includes decreased desire, increased latency of ejaculation, pre mature ejaculation (PME) and decreased satisfaction. Sexual dysfunction plays a critical role in initiation, maintenance and relapse of substance use.

Aim: We Aimed to assess the frequency of various sexual dysfunctions among patients of opioid (heroin) dependence.

Methods: A semi structured questionnaire (to inquire about various symptoms of sexual dysfunction), Addiction Severity Index (ASI) - lite version and Brief Male Sexual Functioning Inventory (BMSFI) were administered to a sample of 100 heroin dependent sexually active men from a treatment seeking population at National Drug Dependence Treatment Centre, AIIMS, Delhi.

Main outcome measures: Frequency of various sexual dysfunction symptoms including low sexual desire, increased ejaculatory latency, PME, and overall sexual satisfaction were measured.

Results and Discussion: About 97% patients reported increased ejaculatory latency while 84% and 83% reported experiencing reduced sexual desire and PME respectively. While erectile dysfunction was maximum during intoxication (82%), PME was most commonly reported during withdrawals of heroin (92.77%). All patients reported increased ejaculation latency during intoxication. BMSFI score for sexual desire and its ratio was lowest in last 1 month as compared to other domains. However, least dysfunction was reported in erectile function on BMFSI score.

Conclusion: Chronic use of opiates is associated with various sexual dysfunctions. These leads to initiation, maintenance or relapse of substance use. Further studies are required to ascertain the factors associated with the severity of heroin use and various domains of substance use.

Keywords: Sexual dysfunction, PME, BMSFI.

A Study of Caregiver's Factors Affecting Family Burden in Chronic Psychiatric Illness

Ashok Kumar Arora

1/5, MP Colony, Bikener, Rajasthan, [email protected]

Background: Chronic psychiatric patients need assistance or supervision in their daily activities often placing a major burden on caregivers, placing them at a great risk of mental and physical problems and an impaired quality of life. The burden perceived by the caregivers refers to daily difficulties and negative life events Resulting from caring or living with ill member and can be said as physical, emotional and financial toll of providing care.

Objectives: This study Aimed to assess the associating factors of caregiver affecting family burden in chronic psychiatric disorders (schizophrenia and OCD).

Methods: This is a hospital based observational analytical study conducted over 1 year period (2013-14) in Psychiatry OPD of SMS medical college, Jaipur. Healthy caregivers in blood relation and spouse, residing for atleast 2 years with patients of chronic psychiatric disorders with written informed consent were included. 60 primary caregivers of patients of psychiatric disorders (30 each of schizophrenia and OCD) as per ICD-10 diagnosis, were included. The following instruments were applied; Semi-structured proforma(SSP) especially designed to assess socio-demographic and associating factors and Family Burden Interview Schedule (FBIS) to assess burden of care.

Results: The family burden was affected by caregiver's factors like age, gender, education, marital status, occupation, duration of living and relation to the patient. Statistically significant increase in burden was observed in subjective (SB) and Objective burden (OB) with increasing age of caregivers. OB and SB were observed to be significantly higher in married and separated/widow as compared to unmarried caregivers. The spouse caregivers were having more SB in comparison to other relations who were found to have more OB.

Conclusion: The family burden (Objective and Subjective) borne by caregivers were found to be significantly affected by caregiver's factors like age, marital status and relation to the patient.

Key words: Family Burden, Caregivers, Illness, Psychiatry.

Financing Mental Health: Estimation of Resource Requirements for Scaling up Mental Health Services Using The United Nations-One Health Tool

Sharmishtha Nanda, Rahul Shidhaye, Shalini Ahuja, Sandesh Samudre

#6, Rishi Nagar, Bhopal, Madhya Pradesh. [email protected]

Introduction: To strengthen the argument for mental health financing, the EMERALD Project is working towards addressing the question of resource adequacy for mental health service and system scale-up, through a resource planning tool or United Nations-One Health Tool (UN-OHT), for mental, neurological and substance use (MNS) disorders.

Methods: Resource need and health impact modules for key MNS disorders and interventions covered in the WHO mhGAP Intervention Guide were programmed into the UN OHT. We adapted input parameters to best reflect local data, experiences and priorities, which enables examination of the potential health system implications of scaled-up mental health services.

Findings: With a per capita total expenditure of $1.70 or Rs. 103, over a period of six years from 2014-2020 of scaling up the care package for psychosis and depression, the healthy life years gained per million people is 1519, i.e., 14 life years gained per rupee spent.

Conclusion: From a financial perspective of resourcing for mental health, two key questions need to be addressed: what is it actually going to cost to implement such an envisaged plan of action and who is going to pay? This study makes an attempt to tackle the first of these questions, and in so doing may help to stimulate Discussion of the second question. It is expected that the health gains hereby demonstrated will be useful for advocating of modelling more precise resource requirements for mental health (and even other co-morbidities) in various settings in India.

Keywords: WHO, mhGAP, MNS disorders

Disabilty in Obssesive Compulsive Disorder and Schizophrenia: A Cross Sectional Comparitive Study

Nisha Singla, Anju Agarwal, A. Q. Jilani, Vikas Dixit, Ajay Kohli

Dept of Psychiatry, ELMCH, Lucknow. [email protected]

Background: Both OCD and Schizophrenia are chronic severe mental illness with poorer prognosis of schizophrenia. Though, the prevalence of OCD is higher than schizophrenia and rank fourth among all psychiatric illness but disability due to OCD is less studied. The present study was designed to assess and compare disability between subjects of OCD and Schizophrenia.

Method: This was cross sectional study with sample size of 60 including 30 subjects of OCD and 30 subjects of Schizophrenia for a period of one year at Department of Psychiatry, ELMCH, Lucknow. Diagnosis was made as per ICD-10.Severity of OCD and schizophrenia were assessed by Y-BOCS and PANNS respectively. Assessment of Disability was done by application of IDEAS.

Result: The average age of patient of OCD (32.366 ± 7.46) was approximately equal to patients of schizophrenia (31.966 ± 8.38). Also majority of patients of OCD and schizophrenia were having 5-10 years of illness duration. The mean total PANNS score of schizophrenia patients were 116.9 (severe psychopathology); and similarly patients of OCD were having severe symptoms (Y-BOCS obsession: 15.4 and compulsion: 7.43). On assessment of IDEAS, there were no difference (p=0.05) in global disability score of patient of schizophrenia (15.26±2.30) and OCD (13.5±4.26). On comparing individual domains of IDEAS between the groups 3 of them namely interpersonal activities, communication and work, there was no significance difference except for self care in which disability score significantly exceed in schizophrenic patient than that of OCD.

Conclusion: OCD patient suffer comparable disability as of schizophrenia .so measures should be taken for its early recognisation and for treating effectively and also educating general masses about the nature & cause of OCD in general.

Keywords: OCD, Y-BOCS, PANNS.

A Retrospective Study On Psychiatric Comorbidities Amongst Children Referred to Tertiary Care Hospital From School

Riteeka S Dikshit

770, Dr Ghanti Road,Parsi Colony, Dadar, Mumbai, Maharastra. [email protected]

Introduction: Education is one of the most important aspects of human resource development. Poor school performance not only Results in the child having a low self-esteem, but also causes significant stress to the parents and child. There are many reasons for children to under perform at school, such as, medical problems, below average intelligence, specific learning disability, psychiatric disorders and even environmental causes

Material And Method: This is an observational cross sectional study.100 consecutive children referred to psychiatry department from Learning Disability clinic over a period of 6 months were studied. The students were referred to Learning Disability clinic from school.

Results: A significant number of children had Intellectual disability. These children had an eventful birth history and delayed developmental history. The most commonly seen psychiatric comorbidites were ADHD, ODD, conduct disorder, enuresis amongst others.

Conclusion: It is important to find the reason(s) for a child's poor school performance and come up with a treatment plan early so that the child can perform up to full potential. There is a need to have a structured multidisciplinary evaluation in such cases all over the country.

Keywords: psychiatric comorbidities, ADHD,ODD,

A Cross Sectional Study on The Relationship Between Cigarette Smoking and Suicidal Behaviour in Bipolar Affective Disorder Patients Attending A Tertiary Care Centre

Parvathy S Keshavankutty, Nayar Sreekumar

Department of Psychiatry, Amrita institute of medical sciences, Kochi.

[email protected]

Introduction: Cigarette smoking in individuals with bipolar affective disorder is associated with poorer functioning, more severe symptoms and impulsive behaviour. In view of the impact of smoking on bipolar disorder and the paucity of Indian research pertaining to this topic, our study was undertaken to measure the association between smoking and suicidal behavior in bipolar patients.

Methods: This cross-sectional study was conducted on 70 consecutive patients of bipolar affective disorder, over a period of 16 months in a tertiary care centre. Current and past smoking history and history of suicidal attempts were obtained by self report.

Results: Of the 70 patients assessed 37 patients had history of smoking. 13 (35.1) patients in smoking category had made suicidal attempts when compared to 5 (15.2%) in nonsmoking category. Cigarette smoking had a significant positive correlation with history of suicide attempts (p=0.05) in bipolar patients .

Conclusion: The study highlights that suicidal behaviour in bipolar patients was significantly high among smokers. The Results of this study emphasize on the need for further research on smoking as an endopheno type associated with impulsive behaviour in bipolar patients.

Keywords: Cigarette smoking, bipolar disorder, suicidal behavior.

Coping From A Disaster: An Anecdotal Study

Shridhar Sharma, Kaustubhi Shukla

Professor Emeritus, National Academy of Medical Sciences and Institute of Human Behavior and Allied Sciences, New Delhi. dr.[email protected]

Natural and industrial disasters are occurring globally at an increasing rate. Due to the upward trend of hydro-meteorological disasters the frequency of Natural Disaster strike has gone up in recent decades. The unpredictability and rapidity of disasters often causes many thousands to experience immense losses with considerable subsequent physical, social and economic hardships.

A majority of Natural Disasters occur in developing countries where the availability of professional mental health services is limited. This poses two important questions- "how do affected communities and individuals cope with trauma and loss in the aftermath of a disaster?" and "what is the appropriate place of mental health services in disaster relief work, especially psychological interventions?"

Coping and resilience have been among the key interests of researchers who have studied disaster affected communities. The ability to cope and recover from loss is determined by a host of factors in pre-disaster, within-disaster and post-disaster periods. Personal strength, religious belief and faith and external/community support appear to play key roles in coping after a massive disaster. Studies on coping conducted with Hurricane Katrina survivors in the United States, 2004 Asian Tsunami-affected populations, 2008 Chinese earthquake survivors and survivors of 1998-2005 floods in Bangladesh all suggest coping strategies mediate the impact of disaster.

In the present study using anecdotal evidences from 1984 Bhopal gas tragedy, 2004 Indian Ocean Tsunami in Andaman and Nicobar Islands and 2015 Nepal Earthquake we set out to investigate the strategies adopted by survivors to escape and cope with the disaster.

Keywords: Disaster, Coping, Anecdotes.

rTMS (cTBS) And Its Effect On Qeeg In Patients With Schizophrenia With Auditory Hallucinations

Niraj Singh Yadav

Central Institute of Psychiatry, Jharkhand, Ranchi.
[email protected]

Background: There will be ectrophysiological correlates [qEEG] of changes in auditory hallucinations in patients of schizophrenia with continous theta burst stimulation(cTBS).

Objectives: This study is designed to to assess the electrophysiological correlates [qEEG] of changes in auditory hallucinations in patient of schizophrenia with continous theta burst stimulation (cTBS).

Method: The study is prospective hospital based randomized, sham controlled study. The subjects were recruited for the study by purposive sampling, followed by random allocation to active or sham group using block randomization technique. Sample size consists of 30 schizophrenia patients divided in two groups, active & sham, according to ICD-10 DCR (WHO, 1993) and 15 healthy control subjects. Regimen of medications had not be changed during continous theta burst stimulation (cTBS) period. Prior, to (cTBS) screening standard questionnaire had been applied followed by baseline qEEG. Clinical scales like PANSS, PSYRATS WHO DAS-2, had been administered to assess baseline symptomatology. Then cTBS or sham treatment in adjunct to antipsychotic treatment had been given for 5 days a week for 2 week. rTMS side effect checklist applied after each session. Same scales like PANSS, PSYRATS, WHO DAS-2 administered after the end of all 10 sessions and after one month of enrollment. After base line qEEG, recording had been done again after 1 st session of cTBS and finally 10 th sessions of cTBS. For normal controls, qEEG recording done at day 0.

Results: The Results will be assessed with appropriate statistics and will be discussed in the case conference.

Conclusion: Will be discussed in the case conference.

Keywords: rTMS, EEG,PANSS cTBS.

Auditory Hallucination A Phenomenological Study

Gaurav Verma

Room No. 103, New Pg Hostel, Civil Hospital, Asarwa, Ahmedabad,

[email protected]

Aim and Objectives:

  1. To explore the phenomenology of auditory hallucination in schizophrenia spectrum psychoses.
  2. To find out clinical correlation between different dimensions of auditory hallucination and other psychotic features.

Method and materials: One hundred patients who were having schizophrenia spectrum diagnoses attending the out-patient department and indoor in Civil Hospital and Hospital for Mental Health, having auditory verbal hallucination(AVH) in last seven days were requested to participate in the study. Phenomenology was assessed by using Psychotic Symptoms Rating Scale( PSYRATS) and Positive And Negative Syndrome Scale( PANSS). Data was analysed by using SPSS-17(Statistical Package for Social Sciences,version-17), Pearson correlation was calculated.

Result: In study 82% were schizophrenic. > 1/3 hearing the voices continuously, >2/3 admitted that voices were coming from outside head only, had no control over them and were of same loudness as one's own voice. 1/3 had AVH of all negative content.19% had AVH commanding in nature. 79% had delusion, 96% had hallucinatory behavior. Bipolar index showed dominance of positive symptoms. 80% reported depression.

Conclusion: In this study of AVH phenomenology among the schizophrenia spectrum disorder, most dimensions of AVH correlated well with one another.

Key words: Auditory hallucination, PSYRATS, Schizophrenia spectrum psychoses.

Clinical Profile and Outcome of Koro: A Follow up Study From A Koro Epidemic In West Bengal, India

Amitava Dan, Kaustav Chakraborty, Rajarshi Neogi, Paramita Patra, Sangita De, Moumita Chatterjee

Department of Psychiatry, Calcutta National Medical College and Hospital, Kolkata, WB, [email protected]

Introduction: Koro is a psychiatric illness prevalent at Asia-pacific region with its strong cultural underpinnings. Several large epidemics of Koro have been reported from India including West Bengal in the last few decades. However, there is dearth of well-designed research focusing on course and long term outcome of Koro.

Method: Ninety two consecutive patients with symptoms of Koro attending various departments of a tertiary care Government Hospital were recruited over a 3 month period. Sixty four consenting patients were treated and followed up for next 3 months. Their socio-demographic data, help seeking pattern, referral pattern, clinical course and outcome, physical and psychiatric comorbidities as per International Classification of Disease, Tenth Version (ICD-10) were recorded.

Results: A typical subject was: single (81.25%), male (76.56%), aged 17.28 years, educated up to primary (42.19%), agricultural worker (42.19%) by occupation, and belonged to Hindu (57.81%), rural (95.31%), joint family (53.13%). Majority of the subjects reported first at the Emergency out-patient department (57.81%) and were referred by private doctors or hospitals (29.69%). Past and family history of Koro were present in 27% (male 31%, female 13%) and 11% (male 6%, female 27%) of the subjects respectively. Majority (95%) had new/old case(s) of Koro in their locality. Psychiatric and physical comorbidities were present in 47% (male 41%, female 60%) and 23% (male 20%, female 33%) of the subjects respectively. Twenty percent of the subjects needed indoor treatment and 31% of the subjects received specific pharmacological and psychosocial treatment. A new modality of psycho-sexual intervention 'sex education in vivo' was applied on patients of Koro with favourable Result. Dropout rate was 28% (male 33%, female 13%) and recovery rate was 89% (male 89%, female 92%).

Conclusion: Koro is predominantly seen in single Hindu male from rural Background. Majority of the subjects were referred by allopathy doctors but a sizeable numbers of subjects had their first contact with traditional form of healers or experts in alternative medicine. An overall good outcome was noted among the Koro victims in spite of having psychiatric and physical comorbidities.

Keywords: Koro, ICD-10, psycho-sexual intervention

Insecticide Phobia treated with Paroxetine and Exposure-Response prevention: A Rare Case Report

Rajeev Ranjan

# 4096, 4th Floor, Teaching Block, Aiims Campus, Ansarinagar, New Delhi, [email protected]

Objectives: Specific phobia is defined as marked and persistent fear cued by presence or anticipation of an object or by situation. Insecticide phobia is a type of specific phobia, rarely been described in literature. Here we report a case of 30 year old male with insecticide phobia and responded to paroxetine and exposure treatment is reported here.

Methods: A physically handicapped male farmer from Haryana presented to outpatient psychiatric clinic, referred from dermatology clinic with insidious onset fluctuating illness of 7-8 year duration. His problem started after organophosphorus poisoning while spraying crops in his farm. Over the next few years, his symptom progressed further; he started becoming anxious on smelling insecticide even though he was not working in the farm. He would feel ghabrahat at the sight of insecticide container or kerosene lamp at home. He would avoid going outside fear of vehicular exhaust. All of the above symptoms led to marked difficulty in his day to day functioning.

Results: He was initially treated with Paroxetine 25mg and exposure and response prevention. Following a structure analysis of his problem, a hierarchy of anxiety provoking stimuli was created. After 32 sessions over four month period, patient became completely asymptomatic, but medication was continuing. He was able to resume his work at the farm and tolerate insecticide without much trouble.

Discussion: Allergic reaction to insecticide or poisoning seems to be common. Phobia for insecticide has rarely been reported. Two cases of obsessive compulsive disorder with fear of contamination to insecticide, poorly responded to systemic desensitization and one case of phobia responded well to exposure and response prevention.

Conclusion: The present case report supports the clinical evidence that combination of Paroxetine with exposure and response prevention is helpful in treatment of Insecticide phobia.

Keywords: Insecticide Phobia, Paroxetine, Exposure and Response- prevention

Eveningness and Its Correlates in Euthymic Patients With Bipolar Disorder

Sitara M. Medhar, Shankar Kumar, Chandrashekar Hongally

Department of Psychiatry, Bangalore Medical College and Research Institute, Bangalore, [email protected]

Introduction: Bipolar Disorder is a severe psychiatric illness manifesting with episodes of mania and depression. The exact pathophysiology is not known, but it has been suggested to be due to disruption of natural rhythms. Circadian Rhythm abnormalities have also been implicated in triggering onset/offset of Mania/Depression. Hence, Bipolar Disorder may also be related to the preference of morning/day activity (i.e. morningness) or evening/ night activity (i.e. eveningness), an indicator for circadian rhythm. Studies which have looked into morningness and eveningness have recently recognized that eveningness may be associated with metabolic issues such as Dyslipidaemia, Diabetes Mellitus and Obesity.

Aims And Objectives: Thus, in this study, our Aim was to look at the prevalence of eveningness in euthymic patients with Bipolar Disorder, without any psychiatric co-morbidities and its association with metabolic issues, namely Metabolic syndrome and its components.

Methodology: 30 Euthymic patients with Bipolar Disorder were recruited from a tertiary care hospital. Those on atypical antipsychotics were excluded. Morningness-Eveningness Questionnaire (MEQ) was administered to these individuals. Metabolic syndrome was diagnosed using ATP 3 criteria. The following investigations were also done for these individuals- Lipid profile including Lp(a) & Apo B/Apo A1, fasting blood sugars. Statistical analysis was done using SPSS version 20.

Results and Conclusion: 13 individuals had eveningness chronotype. Those with eveningness had significantly higher triglyceride levels, Lp(a) levels. There were no differences in BMI or a diagnosis of metabolic syndrome between those with and without eveningness.

Though eveningness was not associated with MS, those with eveningness had a higher risk for developing MS as evident by the higher Lp(a) and triglyceride levels which also is a risk factor for CAD. Clinicians treating Bipolar Disorder should be alert in recognizing this association and seek medical consultations appropriately as this heralds future risk of coronary artery disease.

Keywords: Bipolar Disorder, Euthymic, MEQ

Changing Trends in Duration of Psychiatric Inpatient Stay Over the Past Decade - A Retrospective Study

Jayamadhuri Mothukuri

11-24-108 Shatavahanapuri, Warangal, [email protected]

Background: Research on duration of psychiatric inpatients is an under investigated issue. Moreover, there is a lack of data regarding the patterns of psychiatric admissions and the factors leading to long psychiatric hospitalization. This study Aims to investigate the changing trends of psychiatric inpatient stay over the past decade (2004-2014).

Methods: All voluntary & involuntary admissions of a tertiary care psychiatric hospital (IMH, Hyderabad) over a period of 3 months (January to March) were taken for the years 2004 & 2014.A retrospective chart review of all the admissions was conducted. The collected data was compared & analyzed using SPSS 16 for any changes in hospital stay.

Findings: A significant increase (33%) seen in total admissions over the decade, more so in case of involuntary admissions (10%). However no changes found in the average duration of stay over the decade. But the mean duration of involuntary admissions was 60 days in comparison to voluntary mean duration of 13 days. The mean duration of stay for schizophrenia had increased from 22 to 29 days while mood disorders & alcohol use disorders decreased from 21 to 15 days & 11 to 8 days respectively.

Conclusion: The increased admission indicates a growing public awareness of mental health treatment. Surprisingly, the trend is more in favor of involuntary admissions rather than voluntary undermining the importance of family support in recovery of patient leading to greater stay, cost & burden on the State services. The lesser stay in mood & alcohol disorders appears to be due to improved treatment protocols & newer drugs among other attributes. The increase in duration of stay in Schizophrenia has to be further investigated.

Keywords: Duration, inpatient stay, changing trends, cost issues.

Event Related Potential Correlates of Attention Impairment In Dissociative Disorder And Effect of Pharmacological Intervention

Jitendra Kumar, D. Ram, Nishant Goyal0

Department of Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand, India, [email protected]

Background: Various studies found that patients with dissociative disorder showed increased startle reflexes and delayed habituation. These findings suggest that dissociative disorders are not associated with increased physiological reactivity. In fact, dissociative disorders seem to be associated with reduced physiological reactivity. One possible mechanism that could explain reduced physiological reactivity in dissociative disorders is reduced attention to external stimuli. Though it has been suggested that amplitudes of P300 might be a state dependent biological marker of dissociative disorders, there has only been limited exploration on this aspect. It is possible that an attenuated P300 might decreases the amount of information flow, reducing allocation of attention resources, and updating of working memory to avoid both excessive long-term memory system activity and resurgence of affect laden memories.

Aims And Objectives: Sensory gating abnormalities have not been studied in patients with dissociative disorders. Present study, therefore, attempts to investigate on these lines, and study the electrophysiological correlates of attention in dissociative disorder using event related potential and subsequent changes in these properties with treatment.

Material And Method: This will be a Hospital based Prospective controlled study. Sample size will include 20 patients with Dissociative Disorder (ICD-10-DCR) and 20 age, sex, education & handedness matched healthy controls. Sociodemographic and clinical data of the subjects will be collected. Baseline ERP will be done using TAT card stimulus and auditory oddball paradigm, and data related to P300 and P50 will be collected from patients. It will be matched with data from controls, collected on similar task. The dissociative subjects will then be treated as per institute's standard protocol. After one month's follow up, ERP will be re-recorded and data related to P300 and P50 will again be collected. Appropriate statistical Methods will be used for analysis.

Results and Discussion: The Results will be discussed during the time of presentation.

Keywords: Dissociative Disorder, Pharmacological Intervention, ICD-10-DCR

Clinical Profile, Impact on Quality of Life & Disability In Patients of Primary Chronic Daily Headache

Shreyance Jain, B.S Shekhawat, Shilpa Maida

Deptt of Psychiatry, Govt. Medical College, Kota, Rajasthan.

[email protected]

Background: The term chronic daily headache (Silberstein and Lipton)has been introduced in recent years to refer to daily or almost daily headache regardless of cause. Primary CDH have a considerable negative impact on patients, it leads to poor quality of life and diminished ability to function in day to day life. Studies also confirm negative impact on Quality Of Life and disability associated with chronic headache patients. Most studies had been focusing on migraine and only a few studies on primary chronic headache disorders are available in Indian literature. To find out QOL and Disability in Indian patients this study is planned.

Aims & Objectives:

  1. To study the clinical profile, QOL and disability in the Primary Chronic Daily headache (CDH) patients.
  2. To find out the correlation between primary chronic daily headaches and QOL and disability.

Methodology: This prospective study was designed to carried out in 3o consecutive patients of Primary CDH with age group between 18 to 55 years of either sex attending the Psychiatry OPD of Govt Medical College, Kota. Primary Headache was diagnosed as Per the International Headache Society Classification (IHS) and diagnosis was confirmed by Consultant Psychiatrists. Those fulfilling the specified inclusion criteria were selected as study group. Healthy age and sex matched persons were recruited as control group. The sociodemographic and clinical profile was evaluated by the using a specially designed semistructured proforma. Quality Of Life was studied using WHO-QOL BREF(Hindi) version and disability was assessed by Ford's Headache Disability Inventory (HDI). Statistical Analysis was done using SPSS.

Results and Conclusion: Will be discussed at time of presentation in the light of previous studies.

Keywords: Chronic Daily Headache(CDH), Quality of Life(QOL), Disability.

Assessment Of Characteristics Of Patients With Delirium Tremens

Jazla Moidu Kunnoth

Jubilee Mission Medical College, Trissur, Kerala. [email protected]

Delirium tremens is recognized as a potentially fatal and debilitating complication of alcohol withdrawal. This cross sectional study was carried out to study the prevalence of delirium tremens, assessment of characteristics of patients with delirium tremens and any association between delirium tremens and psychiatric comorbidity in our setting using ICD-10 diagnostic criteria. Patients with delirium tremens were all males, continuous pattern of drinking, using alcohol from morning time and most patient were with no history of abstinence during the last 1-year. Other observation and Results will be discussed.

Keywords: Delirium, ICD-10, alcohol

Repetitive Behaviours in Children and Adolescents of Autism Spectrum Disorder

Abhijit Chakraborty

Vill-Kantagoria; P.O. Singrapur, Dist. Hooghly, West Bengal, Kantagoria. [email protected]

Background: Several types of repetitive behaviour seen in patients of autism spectrum disorder (ASD). Four subtypes of restrictive and repetitive behaviour (RRB)are identified in DSM 5 namely repetitive motor movements(RMM), Insistence on sameness(IS),Preoccupation with restricted patterns of interest(PRPI), unusual sensory interest(USI).

  • Objective: In this study we tried to explore the frequency and patterns of these repetitive behaviours in ASD in respect to intellectual functioning and severity of Autism.
  • Method: Consecutive patients of ASD attending child clinic with CARS score more than 30 were included in the study. Their IQ was measured by MISIC or obtained from VSMS. To measure repetitive behaviour we used Repetitive behaviour questionnaire (RBQ-2), a 20 question parent rated questionnaire.
  • Result: Among 44 patients examined 70.5% were male and 29.5% female. Mean age -7.23 years. MR was present (IQ<70) in 72.73%patients.72.73% were in mild to moderate autism group (CARS<36) and 27.27% in severe autism group. Patients with low IQ also have more CARS score (p-0.001). Highest prevalence of repetitive behaviour noted in item of repetitive hand and/or finger movements (63%marked or notable). Individual items of repetitive motor movement subscale have much higher score than others. We found significant difference in repetitive behaviour in relation to IQ. Co-morbid MR in autism have more repetitive motor movements, preoccupation with restricted patterns of interest and unusual sensory interest from their non-MR counterpart but no significant difference observed in insistence on sameness behaviour. Frequency of Repetitive behaviour increases with severity of autism except in the IS subtype.
  • Conclusion: The Result shows that RRBs are an important predictor of autism spectrum disorder. IQ, severity of autism both affects the frequency of repetitive behaviour.

Key words: Autism spectrum disorders, RRBs, IQ, severity of autism.

An Exploratory Study on The Status of Follow Up In Psychiatry By Patients Who Attempted Suicide

Sharmin Fifina Bisma

Dept of psychiatry, Jubilee Mission Medical College, Trissur, Kerala.

[email protected]

Introduction & Objective: Attempted suicide is a frequent cause of admission to emergency medical services. It is important that these patients are assessed and treated by a psychiatrist. However, due to several reasons follow up may not happen. In this study, the case sheets of such patients who presented to the emergency department were scrutinised, to ascertain whether they were referred to psychiatry, and whether they followed up in psychiatry.

Design: Retrospective assessment of case files.

Methodology: The case files of 110 consecutive patients who presented to the emergency department of a teaching hospital in Kerala due to attempted suicide were reviewed. Data regarding demographics and clinical characteristics, management, past history, psychiatric consultation and follow up in psychiatry/other departments, were collected and analyzed.

Results: Ingestion of poison was the most common Method. Over 90% of the patients had a psychiatric consultation. Less than 10% had a prior history of psychiatric illness. Out of those who had a psychiatry consultation, less than half came for follow up to psychiatry. 6% had gone for follow up to other departments, but not to psychiatry; the remaining did not follow up in any department.

Keywords: Suicide, emergency, Exploratory

A Study of Neurological Soft Signs In Patients of Ocd 0 And Their First Degree Relatives: State Marker OR Trait Marker?

Sonia Malhotra

[email protected]

Obsessive-compulsive disorder (OCD) is a disabling condition characterized by recurrent intrusive thoughts (obsessions) or impulsive, repetitive, irresistible and often ritualized behaviours (compulsions). Neuropsychological impairment in OCD has been regarded as an intermediate phenomenon linking brain dysfunctions with clinical symptomatology. These impairments manifest as Neurological Soft Signs (NSS). Interestingly, the origin of NSS seems to be, at least in part, genetic. In fact, studies of relatives of patients with schizophrenia and OCD also suggest that NSS are, to some extent, heritable, and as such represent a potential trait marker and endophenotype for OCD.

Aim: To establish the status of Neurological Soft Signs as a state marker or trait marker by comparison in patients of OCD and their first degree relatives.

Methodology: A cross-sectional study of 45 consecutive patients of OCD along with their first degree relatives, after satisfying inclusion and exclusion criteria of the study, from the OPD at Department of Psychiatry, SMS Medical College, Jaipur were recruited in the study. Informed consent was taken from all participants. 10-points YBOCS was applied on OCD patients and Cambridge Neurological Inventory, Part-II, was applied on all patients and their first degree relatives. Appropriate statistical tests were applied on the collected data.

Results: to be declared at the time of conference

Conclusion: to be declared at the time of conference

Key Words: Neurological Soft Signs, Obsessive Compulsive Disorder, State Marker, Trait Marker, First Degree Relatives

The Prevalence of Alcohol Use Disorders Among Autorikshaw Drivers In Rural Kerala- Findings From A Community Based Pilot Study

Krishna Mahadevan, Arun Madhumal Palayat Yesudas K.F

Pariyaram Medical College,Kannur, Kerala. [email protected]

Background: Alcohol use among rural community population is high in the state of Kerala. Autorikshaw drivers are a risk group for alcohol abuse due to various reasons. AUDIT was developed to screen for excessive drinking. A study in southern rural India showed that 14.2% of population surveyed had hazardous alcohol use on AUDIT. From various studies conducted in low income countries, it has been found that alcohol was present in between 33% and 69% of fatally injured drivers.

Methodology: Aim of this pilot study was to assess the prevalence of alcohol use disorders among autorikshaw drivers in a rural community of north Kerala. A community based cross sectional survey was conducted among consenting autorikshaw drivers in four randomly selected areas within 5 kilometer radius of a state medical college. The drivers filled a socio-demographic data sheet and AUDIT scale self report version (Malayalam translation). The drivers were asked to put the filled proformas in a box to keep anonymity. The filled forms were then analyzed.

Results: 120 auto drivers were approached. 90 consented to participate in the study. 100 % of the participants were males, majority belonged to Hindu religion and rural Background. Alcohol use pattern among auto drivers showed majority having harmful patterns use.

Discussion: Alcohol use disorders exist among autorikshaw drivers of this rural community. Early identification and community based awareness programmes may help to curb the problem.

Key words: alcohol use disorders, prevalence, autorickshaw drivers

Pain Catastrophizing, Disability and Its Relationship With Suicidality in Patient With Headache

Dushad Ram

Department of Psychiatry, JSS Medical College, Mysore.

[email protected]

Background: Study suggests that pain catastrophizing may associate with disability. In patient with headache it may contribute to chronicity. Patient with chronic headache do often develop suicidal ideation.This study was conducted to know the catasprophization of pain and disability and its relationship with suicidality

Methods: Two hundred patients were suffering from headache were recruited in this study as per selection criteria and assessed with Sociodemographic proforma and Pain catastrophizing scale (PCS), Henry ford headache disability inventory (HDI) and Columbia-suicide severity rating scale (C-SSRS).

Results: Result revealed that 11 % had death wishes and 2% had attempted for suicide. Pain catastrophising is higher in lower socioeconomic status, while disability is higher among females and unemployed. Score on disability had a statistically significant association with suicidal thoughts or intention to act; while score on catastrophising pain was statistically significantly associated with death wish, suicidal ideation with or without intention to act on it, deterrent and controllability of suicidal ideation, and non-suicidal self-injurious behaviour.

Conclusion: Disability and tendency to magnify seriousness of pain are associated with suicidality in patients with headache.

Keywords: PCS, HDI, C-SSRS.

Factors Influencing Advance Directives Among Psychiatric Inpatients In India

G S Gowda, EO Noorthoorn, C N Kumar, B N Raveesh, P Lepping, S Bada Math

Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India. [email protected]

In India the Mental Health Care Bill (2013) advocates Psychiatric Advance Directives (PADs). However, there is a dearth of evidence on its use. This study was examined factors influencing PADs.

Methodology: We conducted a hospital based descriptive study. A total 182 patients were recruited by way of computer generated random number sampling, assessed with CGI - S & GI, for insight, and questioned about their perspective on PADs within 3 days of discharge.

Results: At discharge, 67% (122) welcomed the need for PADs in India, 95.6% (174) made their own PADs and 98% (178) wanted treatment in case of future mental illness. Most patients wished to be treated as advised by their doctor or psychiatrist 80% (140). Patient who lacked insight, or remained symptomatic with less clinical improvement at discharge opted significantly more often against treatments like ECT, antipsychotics, and inpatient care. In linear regression, analysis showed that low socio-economic status, not willing to stay in hospital and having received ECT showed an inverse relation with the positive appreciation of PADs, whereas a Dual Diagnoses was positively related.

Conclusion: A majority of patients welcomed the need for PADs and wanted to continue treatment in the future. Most opted for treatment as advised by their doctor or psychiatrist. Absent insight, severe psychopathology and incomplete recovery may influence PADs. Therefore, clinicians must assess patient's capacity for PADs carefully, as it may significantly influence patient's views. Also, the timing to formulate PAD within the illness process of the patient may be essential.

Keywords: PADs, CGI - S, ECT, antipsychotics.

Prevalence of Psychiatric Comorbidities in Intravenous Opioid Users Attending Ost 0 Centre of A Tertiary Care Hospital

Angshuman Kalita

Gauhati Medical College, Gawhati, Assam, [email protected]

Introduction: Opioid use especially intravenous drug use (IDU) has a major impact on individual, families & communities. The effect is cumulative, significantly contributing to costly social, physical, mental and public health problem. Although the etiological significance of psychiatric comorbidities in genesis of opioid addiction is not established, it is known that treatment for both conditions is necessary for substance abuse treatment to be effective.

Aims And Objectives: To study the prevalence of depression and anxiety as psychiatric comorbidities among IDUs and to study their association with various sociodemographic factors.

Material And Method: 100 IDUs attending OST centre of a premier healthcare institute of North East India were selected by serial sampling and administered Hamilton rating scale for depression (HAM-D) and Hamilton rating scale for anxiety (HAM-A) to find out prevalence of depression and anxiety. To observe their association with different sociodemographic factors Fisher's Exact Test is applied.

Results: 91 percent of IDUs were found to be depressed. There was equal distribution between mild and moderate depression. Depression was more prevalent among younger heroin abusers, in male heroin abusers, in those who were educated more than middle school, who were unmarried, and who were on heroin for less than 10 years. Mild anxiety is found in 15 percent of IDUs. Anxiety was more prevalent among younger, unmarried, unemployed IDUs and more in those who have psychiatric illness in their families.

Conclusion: Comorbidities like depression and anxiety are very much prevalent among IDUs. Each patient with opioid dependence should undergo a thorough psychiatric evaluation so that the clinician can develop a multi-model treatment plan.

Key words: Depression, Anxiety, IDUs, North East India

Attitude Towards Psychiatry Among Medical Students And Medical Doctors: A Comparative Study

Swapnil Tripathi, Mukesh Gehlot, Naresh Nebhinani

Department of Psychiatry, AIIMS Jodhpur, Rajasthan, India.

[email protected]

To measure attitudes of medical students and medical doctors towards psychiatry in tertiary care teaching institution and to assess its correlates.

Methods: Cross sectional survey of 50 final year medical students and 50 medical doctors' (house job/ junior residents) attitudes towards Psychiatry was done by using Attitude Towards Psychiatry Scale (30 items) at AIIMS Jodhpur, Rajasthan. Their attitudes were compared and further association was assessed with demographic variables.

Results: Compared to medical doctors, medical Students had better attitude towards Psychiatry. Significantly greater proportion of medical students considered psychiatry training important, and perceived psychiatry in line of real medicine, they were interested to assess causes of psychiatric disorders, and they respected psychiatrist and psychiatry equal to other specialties, compared to medical doctors.

Conclusion: Better attitude towards Psychiatry among medical students may be because of their better exposure to psychiatry during theory lectures, clinical teaching, increased awareness and knowledge base and reduction in stigma towards psychiatry, psychiatrist, and psychiatric disorders.

Key words: Attitude towards Psychiatry, Medical students, Medical doctors, India

Perceived Stress And Coping Profile Of Undergraduate Medical Students

Rohan Kaalra

# 41, S.nijalingappa Medical College, Navanagar, Bagalkot-587102, Karnataka. [email protected]

Introduction: Stress is a state of mental or emotional strain or tension Resulting from adverse or demanding circumstances. Stress is the "wear and tear" our bodies experience as we adjust to our continually changing environment. As a positive influence, stress can help to compel us to action. As a negative influence, it can Result in feelings of distrust, rejection, anger, and depression, which in turn can lead to various health problems.

Aims: To study the perceived stress and coping profile of Undergraduate medical students and to relate the grade of stress with the various coping styles adapted.

Methodology: This cross-sectional study enrolls 100 undergraduate medical students by using systematic random sampling test Methods. Each enrolled student was given two self reporting questionnaires-Perceived Stress Scale and Brief Cope Inventory. Chi-square test and Fisher's exact were used for analysis.

Results: Majority of study participants were male (78%), from urban Background (73%), nuclear family (79%) and from higher socio-economic status. Based on the Perceived Stress Scale, majority belonged to very high health concern level (42%) followed by high health concern level (28%). Based on Brief Cope Inventory, 45% of study participants are having self distraction, 38%-active coping, 13%-denial, 11%-substance use, 24%-use of emotional support, 30%-use of instrumental support, 12%- behavioural disengagement, 16%-venting,17%-positive reframing, 25%-planning, 28%-humour, 24%-acceptance, 27%-religion and 26%-self blame. Perceived stress was not associated with gender, religion, place, type of family. They are not statistically significant.

Conclusion: The etiopathogenesis of stress is complex and multi-factorial and varies across environments. Stress contributes to various health problems worldwide. Its presence is felt in home, office, industry, and academic environments. The effects of stress vary with the ways it is appraised, and the coping strategies used differ between individuals and are influenced by ethnic, cultural, and socioeconomic characteristics.

Keywords: Cope Inventory, Chi-square test, etiopathogenesis

An Explorative Study - Pulse Rate And Blood Pressure of Patients On Clozapine

Merin Poulose

Jubilee mission Medical College & Research Institute, Trissur, Kerala.

[email protected]

Introduction: Ever since clozapine has been reintroduced, it has gained a high profile among all antipsychotics till date due to its better efficacy. Clozapine has paved a further step in treatment of schizophrenia especially in treatment resistant schizophrenia. But the major challenge we face while using clozapine is its side effects. Patients on clozapine need to be monitored more meticulously so that side effects could be prevented and the maximum potential of clozapine could be exploited for the good.

Objective: Pulse rate and Blood pressure are basic parameters for assessment of cardiovascular system. Though one of the dreaded complications of clozapine is myocarditis, there is yet more to find out how clozapine cause cardiovascular changes. Finding what are the changes,if any, in Pulse rate and Blood pressure of patients taking Clozapine is a stepping stone.

Method: Retrospectively, patients who were started on clozapine after admitting to psychiatry ward during June, July, August 2015 & monitored regularly and dose hiked were assessed. Fluctuations in blood pressure and pulse rate noted and any other conspicuous findings noted.

The observations and Results are discussed

Keywords: Pulse rate, Blood pressure, Clozapine.

Prevalence of Anxiety and Depression in Schizophrenics With VS. Without Alcohol Abuse

T. Anil Kumar, T. Praveen Kumar, D. Vijayalakshmi, P.Himakar

Government Hospital for Mental Care, Andhra Medical College, Visakhapatnam, [email protected]

Background: Substance abuse is reportedly common in schizophrenia

Aim: To examine whether anxiety and depression are related to alcohol consumption in schizophrenia

Methodology: This is a cross sectional study done among patients attending the OPD of Government Hospital for Mental Care, Visakhapatnam. 60 cases of schizophrenia (diagnosed as per ICD-10) in remission are screened with AUDIT (Alcohol Use Disorders Inventory Test) for alcohol abuse (with no H/O other substance abuse) and then rated using HAM-D (Hamilton Depression Rating Scale) for depression and HAM-A (Hamilton Anxiety Rating scale) for anxiety.

Results: Among 30 patients of schizophrenia with alcohol abuse, 8 patients (26.67%) have anxiety and depression. Among 30 patients of schizophrenia without alcohol abuse, 18 patients (60.00%) have anxiety and depression. The Results are statistically significant with Chi square value × 2 (1) = 6.787, p = 0.009

Conclusion: Alcohol use is much prevalent among men with schizophrenia. Alcohol use was not associated with anxiety and depression in schizophrenia patients, rather, anxiety and depression are more prevalent in schizophrenics without alcohol abuse.

Key words: Anxiety, Depression, Alcohol, Schizophrenia

Assessment of High Suicidal Intent and Associated Factors Among Suicide Attempters in A Tertiary Hospital

K. N. Lavanya, M. Thirunavukarasu M.D., D.P.M., T. V. Asokan M.D.,D.P.M., R.Rajkumar M.D.,D.P.M.

Department of Psychiatry, SRM Medical College Hospital & Research Centre, Kattankulathur. [email protected]


  1. To study the socio demographic and other Background details of those who were referred for attempted suicide.
  2. To assess them for high suicidal intent
  3. To identify factors which are associated with high suicidal intent.

Materials And Methods: This is a hospital based retrospective study, case sheet review. The study conducted in the SRM Medical College Hospital & Research Centre .All the patients who attempted suicide and were referred to Psychiatry OPD for psychiatric assessment and necessary intervention from the medical facility after their physical condition improved were considered. All the attempted suicide patient's case sheets who attended Psychiatry OPD with a reliable informant from January 2014 retrospectively till a sample size of 308 was attained, were evaluated in detail for assessment. Case sheets with incomplete data were excluded. The psycho-socio-demographic variables were documented in a specially designed suicide proforma which include their age, sex, marital status, address, education, occupation, income, mode of attempt, family history, Co-morbid physical/psychiatric diagnosis, past history of attempts and precipitating factors were recorded.The Beck's suicide Intent scale was used to assess the level of the intent. Statistical analysis of data was done using appropriate software.

Results AND Conclusion: The Results will be discussed during conference.

Keywords: suicide, Statistical analysis, family history

Factors Determining Control of Seizures in Patients Having Epilepsy

Hemavathi H

# 12, Bapuji Hospital, J J M Medical College, Davangere, Karnataka, [email protected]


  1. To elicit factors which can contribute to seizure control in patients who have good seizure control & poor seizure control
  2. To compare the above factors between the two groups

Methodology: Consecutive patients attending out patient department of Psychiatry who were on treatment for epilepsy for more than 5 years were included after obtaining informed consent. After eliciting sociodemographic data, information about epilepsy, its treatment, associated neurological & psychological conditions, associated brain damage and substance abuse was elicited using a self designed proforma. Depending on regularity of follow up & seizure control patients were grouped into two groups.- one having good seizure control & another having poor seizure control. The above mentioned variables were compared between the two groups. Statistical analysis was done using SPSS version 20.

Results: Sample consisted of 103 patients, 54 having good seizure control and 49 having poor seizure control. The groups did not differ with respect to the sociodemographic variables studied. Even though the duration of illness before treatment was less in those who had good seizure control compared to those having poor seizure control it did not reach statistical significance. The two groups did not differ with respect to age of onset of epilepsy, duration of treatment, family history of epilepsy, type & frequency of epilepsy, head injury, birth asphyxia, neurological deficit, history of intracranial surgery, mental retardation, substance abuse, associated psychopathology and dosage of anti epileptic drugs.

Conclusion: Sociodemographic features, illness variables, treatment variables, associated brain damage and associated neurological & psychiatric morbidity did not differ significantly between the two groups. Further large scale studies are required to elicit factors which determine seizure control, to aid in efficient treatment.

Keywords: epilepsy, psychopathology, anti epileptic drugs.

Premature Ejaculation and Associated Psychological Problems: A Study at Psycho-Sexual Clinic at Department of Psychiatry, Ajmer

Om Prakash, Mahendra Jain, Dr Parth Singh Meena, Surendra Paliwal

# 1915 New Kayastha Colony, Ajmer, Rajasthan. [email protected]

Background and Objectives: Sexual dysfunctions are cognitive, affective, and behavioral problems that prevent an individual or couple from engaging in or enjoying satisfactory intercourse. PME affects a large number of men worldwide, and have an impact on couples which may lead to the low level of individual well-being and mental health. On this Background current study was undertaken with the Aim to find out the psychological problems among patients having PME and its association with demographic variables.

Methods: Patients visiting psycho-sexual OPD at Psychiatric Department, Ajmer during months of January2015 to September 2015 with the complaint of inability to control ejaculation sufficiently long enough during intra vaginal containment were screened for the diagnosis of premature ejaculation (PME) using DSM-V diagnostic. 156 subjects who fulfilled criteria for PME were included in the study. Beck's depression Inventory (Hindi Version) and Depression, Anxiety and Stress Scale-21 (DASS-21) were applied on the selected subjects

Results and Conclusion: 23% (n=36) patients suffering from premature ejaculation have significant psychopathology qualifying for the diagnosis of clinical depression. PME patients in the age group 20-30 yrs were having most no. of cases of clinical depression indicating that young male patients who have had experienced sexual relationship were most vulnerable to depression.

Conclusion: Significant number of patients having PME were suffering from depression and clinically significant anxiety and stress.

Keywords: Sexual dysfunctions, Premature Ejaculation, DSM-V

Shadows in the Dark: Finding Ways Through Children's Apperception Test

Divya Prasad, Shabari Dutta, Hemant Naidu

Nur Manzil Psychiatric Centre, Lucknow. [email protected]

Background: Children's Apperception Test (CAT) serves as a powerful projective technique to understand the child's personality and the dynamics playing behind the psychological processes. The test comprises of 10 quasi-ambiguous pictures to which the child is asked to create a story. Thus information about the psychological functioning is acquired through the process of projection. The ambiguity of gender allows the children to relate to all the child animals in the pictures. Card I of CAT is described as baby chicks seated around a table with an adult chicken in the Background. Often in the backdrop of sever conflicts and psychopathology, the "adult chicken" is perceived in a distorted manner. Thus we hereby present a series of case reports with varying dimensions of psychological disturbances, ranging from conversion to conduct problems to psychosomatic complaints.

Objective: The main Aim of the study was to analyze the Background of conflicts of those children who perceived Card I in a distorted pattern.

Methodology: Patients ranging from 8 years to 11 years were included in the study. Keeping in view of the presenting chief complaints, CAT was planned and administered. Specifically stories on card I were selected and analyzed for deeper analysis of the hidden impulses and dynamics of the problem.

Conclusion: Stories on card I opened windows to the child's disturbed and conflicting state of mind. Instead of the "adult chicken" figure perceived that of nurturance, it was seen as figure of origin for trauma, ordeal and pain. Stressors paved their way in the stories, which were later subjected for further therapeutic measures.

Keywords: CAT, adult chicken, psychological functioning.

Pattern of Opioid Use In Opioid Dependent Treatment Seekers

Rakesh Mohanty, N. Heramani Singh, Gojendra Senjam

Room No-43, New PG Mens Hostel, Cip, Kanke, Jharkand, Ranchi. [email protected]

Introduction: In the last few decades, use of opioids has increased markedly all over the world. The National Household Survey 2004 of Drug Use in the country found that the nationwide prevalence of opioid use is 0.7%. Among the opioid users, the largest proportion were opium users followed by heroin and other opioids. Opioid use in Manipur region is relatively more common as compared to other parts of country.

Objectives: To study the pattern of opioid use in opioid dependent treatment seekers in Manipur.

Methods: All 80 consecutive patients with a diagnosis of opioid dependence syndrome made as per ICD-10 diagnostic guidelines were included. All patients were administered with a semi structured questionnaire to collect pattern of opioid use. Data collected were analysed using descriptive statistic.

Result: In the study population mean age of initiation of opioid use was found to be 22.94. Majority of them were using combination of Heroin and Pharmaceutical opioids (40%) followed by only heroin users (33.8%). Combination of routes for opioid use was preferred in majority of study population. Majority of opioid users were using opioids for more than 5 years.

Conclusion: Pattern of opioid use differs according to geographical variation and availability of opioid. So it is necessary to document the pattern of opioid use for successful treatment, harm reduction and long term treatment outcome.

Key Words: Opioid, pattern, opioid dependent, heroin.

"A Study of Cardiovascular Risk Among Depressed Obese Patients"

Chitra Verma, R K Solanki, Pankaj Borade

SMS Medical College, Jaipur. [email protected]

Background: Its well established fact that obesity associated with significant cardiovascular risk. Studies have also been conducted regarding the evaluation of cardiovascular risk.

Aim: To asses and correlate cardiovascular risk in obese patients with depression and without depression.

Methodology: A cross sectional observational study was done in department of psychiatry and the department of endocrinology SMS Medical College and Hospital, Jaipur. The subjects were divided into two groups, depressed obese patients and non depressed obese patients ( BMI> 30Kg/m2) . The diagnosis of depression was done according to ICD 10 criteria for depression and conformed by consultant psychiatrist. The cardiovascular risk was assessed and compared using Framingham risk score assessment tool. Prior to inclusion in the study, a written informed consent was obtained from all the subjects. Both the groups were subjected to specially designed Performa which included personal and socio - demographic details and Framingham risk assessment tool for assessing Cardiovascular risk.

Results and Conclusion: The data was analyzed by using suitable statistical Methods. A significant cardiovascular risk is observed in obese patients with depression. .

Keywords: Cardiovascular, Depressed Obese, ICD 10

A Study of Prevalence And Predictors of Cardiovascular Risk in Schizophrenic Patients

Chitra Verma

G1, 3/264, Chitrakoot Sector-3,Jaipur, Rajasthan. [email protected]

Background & Objective: Cardiovascular disease being the leading cause of mortality in patients of Schizophrenia as compare to general population. Studies have also been conducted regarding the evaluation of cardiovascular risk in schizophrenic patients.

Title: "A study of prevalence and Predictors of Cardiovascular risk in Schizophrenic patients.

Methodology: A cross sectional observational study was done in department of psychiatry, SMS Medical College and Hospital Jaipur. 50 patients of schizophrenia were recruited for the study, who were stable on maintenance dose. They matched on inclusion and exclusion criteria and diagnosed by according to ICD 10 criteria for schizophrenia and conformed by consultant psychiatrist. 30 Normal subject matched on socio-demographic characteristic were included in control group. The cardiovascular risk was assessed by using Framingham risk score assessment tool. Prior to inclusion in the study, a written informed consent was obtained from all the subjects. All the patients were subjected to specially designed Performa which included personal and socio demographic details and Framingham risk assessment tool for assessing Cardiovascular risk.

Results and Conclusion: The data was analyzed by using suitable statistical Methods. A significant cardiovascular risk is observed in patients of schizophrenia. Hence, there is need to screen the patients of schizophrenia for cardiovascular risk and manage as early as possible during the course of illness just to avoid morbidity and mortality.

Keywords: Schizophrenia, risk assessment, Framingham risk score

Towards A New Dawn: Psychoeducation Based Intervention For Guardians of Adolescents With Borderline Personality Traits

Shabari Dutta, Divya Prasad, Hemant Naidu

Nur Manzil Psychiatric Centre, Lucknow. [email protected]

Background: Borderline personality disorder reflects a complex and enduring difficulties experienced by individuals particularly with emotional regulation, sense of self and interpersonal functioning. It is one of the most widely researched yet controversial of all personality disorders. In the absence of stable relationships in which to regulate emotions, people with BPD often employ damaging high risk coping strategies such as self harm, substance misuse etc. Psychoeducation plays an important role in imparting basic information about the illness to the guardians. Key areas of concern are basic understanding of the patient's pathological behavior pattern, ways of handling the BPD patient's maneuvers. We hereby present a series of case reports of adolescent patients with borderline personality traits and the strategies employed to psychoeducate the guardian and parents. The cases were selected on grounds of their common salient features namely, indulging in reckless activities, intense anger, sensitivity to criticism, threatening behavior, self harm and internet addiction.

Aims And Objectives: The guardians of the selected cases were greatly alarmed by the patient's behavioral pattern. The main Aim of the study was to impart psychoeducation to the parents and guardians about borderline personality traits and the ensuing problems related to it.

Methodology: Most of the cases had history of traumatic experiences, separation and neglect thereby contributing to the borderline traits. Keeping in view of the underlying issues, psychoeducation based Discussions and seminars were organized from the month of December 2014 to October 2015 each month. The initial Discussions focused primarily on core symptoms of borderline personality traits and gradually transcended towards patient's manipulative behavior at home. Further Discussions centered on defense mechanism and anger management.

Conclusion: The Discussion based therapeutic strategy helped in developing empathy among the group members and a zeal to learn better coping strategies for a more meaningful life.

Keywords: Psychoeducation, personality disorder, Adolescent.

Correlation Between Severity of Alcohol Use Disorder And Disability Among Persons Seeking Treatment at A Tertiary Care Drug Dependence Treatment Center

Tamonud Modak, Yatan Pal Singh Balhara, Shalini Singh

Department Of Psychiatry, National Drug Dependence Treatment Centre (Nddtc), All India Institute Of Medical Sciences (Aiims), New Delhi, India. [email protected]

Introduction: Alcohol use disorders have been identified as a major contributor to global burden of disease. However, there is limited research on disability associated with alcohol use disorders.

Aims And Objectives: The current study was Aimed at assessment of disability among persons with alcohol use diosrders seeking treatment from a tertiary care drug dependence treatment centre. The findings on correlation between severity of alcohol use disorder and level of disability have been resented here.

Materials And Methods: A cross sectional assessment was carried of the subjects conforming to the study inclusions and exclusion criteria. Assessments were made using WHO DAS II for assessment of disability and DSM 5 criteria for alcohol use disorders. The level of statistical significance was kept at p< .05.

Results: There was a significant correlation between the severity of alcohol use disorder and the disability in the 'household' domain of WHO DAS II (r- .22, p= .03). Also there was significant correlation between duration of alcohol use and 'cognition' (r- .37, p< .05), 'mobility' (r- .53, p< .05), 'household' (r- .29, p= .004), and 'work' (r- .21, p= .04) domains.

Conclusion: Although the over score on WHO DAS II did not correlate with severity of alcohol use disorder, certain domains of WHO DS II did have a significant correlation with the severity of alcohol use disorder.

Keywords: WHO DAS II, alcohol use disorder, DSM 5

Auto Erythrocyte Sensitization Syndrome in A Young Girl: A Case Report

Abhishek Singh Chauhan, Deepak Gupta, Sujata Sawhney

Department of Child Psychiatry and Paediatrics, Sir Ganga Ram Hospital, New Delhi. [email protected]

Abstract: This is to report a rare case of an adolescent with Auto erythrocyte sensitization syndrome (psychogenic purpura) also known as Gardner- Diamond syndrome. A 16 year old girl presented with episodic purpura from past 2 years triggered by examination stress and high performance anxiety and associated with raised ESR. In this case report, we present the case with ASS and approach towards the treatment.

Keywords: Diamond syndrome, ASS, erythrocyte.

Smartphone Addiction Among Medical Students of Medical College Baroda and its Association With Academic Performance

Sutanaya Pal, Rajat M. Oswal, Anu Patel

Department of Psychiatry, Medical College, Baroda. [email protected]

Background: With the advent of internet enabled hand held devices such as smartphones and tablets, technological addiction has become a tangible problem due to prompt access to such devices. Adverse effects of its overuse range from an impact on social interactions and academic performance to physical injury with a few reported cases of accidental deaths.

Methodology and Analysis: It is a cross-sectional study. All the undergraduate medical students from 2nd year to Internship (n=572) were included in the study after getting written informed consent. Sociodemographic details, patterns of smartphone use, class 12 marks and Results of final MBBS exams appeared so far were obtained to assess academic performance using a self-report semi-structured questionnaire. Smartphone addiction was diagnosed using the Smartphone Addiction Inventory (SPAI). As high school grades are estimated to be the best indicator of future performance, Class 12 marks were taken to account for the intrinsic differences between students. An average of all the MBBS final exams was taken as an estimate of the current performance.

Results: Out of 523 students approached, 427 returned completed forms. The population of 54% males and 46% females had a mean age of 20.8 years (SD = 1.4 years). 88 students (20.6%) were found to be addicted to Smartphones using a cut-off of 64 on the SPAI. No significant association was found between Smartphone addiction and academic performance.

Conclusion: While a high percentage of students were found to be addicted to smartphones, it did not seem to have a significant impact on their academic performance.

Keywords: Addiction, smartphone, SPAI.

Efficacy of Transcranial Direct Current Stimulation (tDCS) in Somatic Symptom Disorder, Predominantly Pain: A Randomized, Double-Blind, Sham-Controlled Study

Prashanth Peethala

Dept of Psychiatry, Kasturba Medical College, Manipal.

[email protected]

Background: Chronic benign pain is a symptom which contributes significantly to morbidity and causes considerable distress affecting various domains in a patient's life. There is a growing need to address this issue for a safer and a better therapeutic intervention, especially when there is a lifetime risk of 10% in these individuals to commit suicide. tDCS is a non-invasive tool that has been found to have therapeutic efficacy in pain syndromes. There is much scope for study on non-invasive, non-pharmacological Methods of neuromodulation for the therapy of pain, which are safe and effective.

Aim: To study the efficacy of tDCS in somatic symptom disorder with predominant pain as compared to sham stimulation.

Methods: We investigated in a randomized, double-blind, sham-controlled trial the analgesic effects of a 5 day treatment of anodal (tDCS) with 2mA current over the primary motor cortex in somatoform pain disorder. 26 subjects were assessed on VAS and CGI-S for response to treatment at end of 5 days and on follow up of 30 days.

Results: VAS Scores showed significant change as compared to sham group (Pillai's Trace F = 74.32, p <.001); the effect size for the difference was high (ηp2 = 0.86). CGI-S score had similar effect over time (Pillai's Trace F = 56.33, p <.001); the effect size for the difference was high (ηp2 = 0.702). These effects lasted over a period of 30 days as denoted by the group over time interaction.

Conclusion: Our findings give preliminary evidence that patients with somatoform pain symptoms have a positive and lasting effect on tDCS of the primary motor cortex. These effects may be related to electrical currents induced in pain-related cortical and subcortical regions.

Keywords: tDCS, neuromodulation, CGI-S

Sexual Satisfaction in Spouses of Alcoholics - A Comparative Study of Spouses of Alcoholics Attending A Tertiary Care Centre in North East India

Shamiul Akhtar Borbora

#205, PG hostel #5, Dibrugarh, Assam. [email protected]

Introduction: Alcohol is a major public health problem of the world and its use in India is also on the rise. Wives are the principal care givers in alcoholic patient and they are constantly subjected to different kind of stress owing to the intimate nature of the relationship shared with their husband. Sexual relationship is an important aspect of marriage and it's seen that is often neglected in spouses of alcoholics who have low levels of sexual satisfaction in particular and marital satisfaction in general.

Aims And Objectives: To assess the sexual satisfaction in spouses of alcoholics and to study the association between sexual satisfaction between various sociodemographic factors.

Methodology: 80 cases who are spouses of alcoholics were compared with 80 controls (non alcoholic spouses) and were administered Sexual Satisfaction Scale for woman (SSS-W) and their scores were compared with unpaired t-test. The different sociodemographic factors were also compared with the sexual satisfaction scores to find the association between them.

Results: The mean value for SSS-W in the cases came out to be 81.038 which was lower compared to mean value of controls i.e. 111.388 and was found to be statistically significant (P<0.05). Education, type of locality and duration of marriage were found to have significant association with low sexual satisfaction in spouses of alcoholics.

Conclusion: Sexual satisfaction in spouses of alcoholics was low compared to spouses of non alcoholics. Addressing these issues will be beneficial as spouses play an important role in treatment of alcoholics.

Key words: care givers, sexual satisfaction alcoholics.

Study of The Impact of Impulsivity and Understanding of Alcoholism on The Severity of Alcohol Dependence

Anagha Jog, Bindoo Jadhav, Girish Pandey, Bharat Shah, Sunitha Shanker

403, Vijaya sadan, Above axis bank, Sion West, Mumbai, Maharastra. [email protected]

Introduction: Alcohol use disorder represents a significant public health concern worldwide. Current research is examining the role of endophenotypes like impulsivity in the study of addiction. A large number of studies have shown evidence of a relationship between impulsivity and alcohol use. Also, it has been observed that a patient's understanding of, and viewpoint towards the etiology of alcoholism has a bearing on the ultimate success of treatment.

Keeping this Background in mind, this study has been conducted with the following Aims:

  1. To study the understanding of alcoholism in the study population
  2. To assess the level of impulsivity
  3. To study the relationship between the above and severity of alcohol dependence

Methods: Consenting male adults (n=50), attending a tertiary hospital in Mumbai, fulfilling criteria for alcohol dependence syndrome, with no other psychiatric comorbidity or substance dependence were studied. A cross sectional study was done wherein Severity of Alcoholism Questionnaire, Understanding of Alcoholism scale, and Barrett's Impulsivity Scale were applied to the patients. The data obtained was analysed and interpreted using the SSPS statistical software version 20. Descriptive statistics using the mean (average) of the sample and Spearman rho correlation was used.

Results: There was a significant positive correlation between P (Psychosocial) factor of Understanding of Alcoholism scale and severity of alcohol dependence. Similarly, a significant positive correlation was seen between H (Heterogeneity) factor of Understanding of Alcoholism scale and severity of alcohol dependence. However, there was no significant correlation between severity of alcohol dependence and impulsivity.

Conclusion: This study showed that understanding of alcoholism is more important than impulsivity in determining the severity of alcohol dependence. This highlights the need to include the concept of understanding of alcoholism in the management of these patients to improve prognosis.

Keywords : Alcohol Dependence, Impulsivity, Severity, Understanding Of Alcoholism

Cognitive Dysfunction, Coping Strategies and Associated Psychological Problems In Women During Post-Partum Period: A Study From North India

Ruchi Soni

B- 1 Janki Nagar Bhopal, Madhya Pradesh. [email protected]

Background and Objectives: Pregnancy and child birth are considered as turnover in life of women, due to vulnerability of this period, current study was undertaken with the Aim to evaluate the presence of cognitive dysfunctions, coping strategies and associated psychological problems during postpartum period.

Methods: A cross-sectional study was carried out at JLN medical college, department of obstetrics and gynaecology Ajmer. The sample for the study constituted consecutive 200 women who came for first follow up after childbirth and 100 healthy and non-pregnant women were taken as control. Subjects were administered Standard mini mental state examination scale (SMMSE); Brief cognitive rating scale (BCRS) and Trail making test part B (TMT-B) to assess cognitive dysfunction, subsequently coping Strategy check List (CSCL) was administered to assess coping strategies and depression stress scale 21 (DASS 21) was administered to assess associated psychological problems.

Results: Data analysis reveals a highly significant difference between cases and controls on total SMMSE, BCRS and TMT-B score (p<.001).On administering CSCL, we found that the main coping mechanisms during post-partum period were denial and internalization subsequently we found greater association of depression, anxiety and stress in post-partum period.

Conclusion: Present study concludes that women during the postpartum period have significant cognitive deficits and prevalence of depression, anxiety and stress which are adversely affecting the physical and mental health of mother and child.

Keywords: Postpartum period; cognitive decline; behaviour problems in post-partum period

Study of Prevalence of Depression in Patients with MDR-TB

Aditi Garg, Rajat Oswal, Ujaas Dawar, Sangram Dhalgade

Department of Psychiatry and Department of Pulmonary Medicine2, Medical College, Baroda. [email protected]

Introduction: Tuberculosis is a chronic debilitating disease of utmost public health concern in developing countries such as India and remains a leading cause of morbidity and mortality throughout the world. MDR-TB is associated with significant stigma and psychological distress, which adversely affects the psychological well being of the patients predisposing them to a plethora of mental illnesses including depression.

Aims & Objectives: To assess the prevalence of MDD among patients suffering from MDR-TB and the relationship of depression in these patients with socio demographic factors, disease characteristics and treatment factors.

Methodology: This cross sectional analytical study was conducted in Pulmonary Medicine OPD in SSG Hospital, Vadodara between May 2015 to September 2015 among 100 patients diagnosed with MDR-TB who have undergone treatment for at least 1 month under Category IV of RNTCP. Patients were diagnosed to have MDD using DSM-5 criteria and severity was assessed using HAMD scale.

Results: Out of 100 patients suffering from MDR-TB, 32 were diagnosed to have Major depressive disorder according to DSM-5 criteria. On HAMD scale, 7 had mild depression, 20 had moderate depression and 5 were severely depressed. Risk factors namely Female sex, Nicotine dependence (Overall), Nicotine dependence (in males) and Alcohol dependence were found to be significantly associated with MDD.

Conclusion: Prevalence of depression among MDR-TB patients was found to be 32%, which was much lower than other studies.

Discussion: Mental health professionals have to be cautious in diagnosis of MDD in patients of MDR TB because of significant overlap of symptoms. Early diagnosis and treatment of depression in these patients is warranted in order to help both the treating physician and the patient in maintaining compliance, improving prognosis and improving the quality of life.

Keywords: DSM-5, HAMD scale, MDR-TB,

Psychiatric Morbidity in Suicide Attempters

Sathish S, P Kishan, N D Sanjay Kumar, Sumhita Sharma

Prathima Institute of Medical Sciences Karimnagar, Telangana, Hyderabad. [email protected]

Background: The number of suicides in India during the last decade has recorded an increase of 25.0%. Suicide attempt rates are found to be higher than rates for completed suicides. Persons with psychiatric co- morbidity have markedly high risk of suicide attempts.

Aim: To study the socio-demographic variables, and prevalence of psychiatric diagnosis in suicide attempters. The present study has been undertaken with an intention to have deeper insight in to the mental health of suicide attempters.

Material And Methods: A prospective study was conducted in Prathima Institute of Medical Sciences, Karimnagar, Telangana, South India. 50 consecutive cases of attempted suicide were recruited for the study. Structured proforma containing sociodemographic variables and suicide attempt data was administered. Mini International Neuropsychiatric Interview (M.I.N.I. Plus) was applied to assess the psychiatric disorder and the diagnosis was confirmed using ICD 10.

Results: majority of the suicide attempters (70%) are in the age group of 18-30 years, men (52%), education below or up to 10th std (60%), married (54%), low socioeconomic status (74%) and employed (66%), Consumption of insecticides is the most common Method employed (60%) and made an impulsive attempt (90%). With 70 % having recent stressor 86% suffered from a psychiatric disorder and adjustment disorder (50%) was found to be most common diagnosed disorders.

Conclusion: The presence of psychiatric morbidity was observed to confer a considerable risk of suicide.

Keywords - attempted suicide, psychiatric morbidity, MINI Plus.

A Cross-Sectional Study on the Prevalence, Risk Factors & Illeffects of Internet Addiction Amongst The Medical Students In Silchar Medical College & Hospital, North Eastern India

Kamal Nath, Subrata Naskar, Robin Victor

Department of Psychiatry, Silchar Medical College & Hospital, Assam. [email protected]

Background: The Internet is the global system of interconnected computer networks that use the Internet protocol suite (TCP/IP) to link billions of devices worldwide. Internet in the last few years has become an important part of our daily life. It has made life easy for us as all sort of information being available at our fingertips. But recently there has been over usage of internet leading to addiction causing various mental and physical illness.

Aim: To evaluate Internet Addiction amongst medical students in Silchar medical college & hospital and gain knowledge about the prevalence, pattern, risk factors and ill effects commonly associated with it.

Material And Methods: A cross-sectional study sample comprising of 188 medical students of Silchar medical college & hospital was taken and study was conducted after obtaining Institutional Ethical Committee approval and permission from the college. Students were assessed with a specially constructed semi-structured proforma, Internet use questionnaire and The Internet Addiction Test (IAT; Young, 1998) which was self-administered by the students after giving them brief instructions.

Results: Out of the total 188 medical students 114 (60.6%) were males and 74 (39.4%) were females. The mean age was found to be 22.51 years (standard deviation 2.91).Using Young's criteria it was found that 0.5% of the students are addicts and 46.3% are possible addicts. Internet addicts had longer duration of internet usage and had always online status. Also the addicts often had formation of online relationship which was more in males. Excessive internet usage also led to poor performance in college and these individuals reported feeling moody, anxious and depressed.

Conclusion: In the emerging era of internet use, we must learn to differentiate excessive internet use from addiction.

Keywords: Risk factors, internet addiction, TCP/IP.

"Study of Incidence & Nature of Sexual Dysfunction In Drug Free Male Depressive Patients"

A. S. Mansoori, D. K. Vijayvergia, C. S. Sushil, D. K. Sharma

Department of Psychiatry, Govt. Medical College, Kota. [email protected]

Introduction: Adequate sexual expression is an essential part of many human relationships and provide a sense of physical, psychological and social well-being. Sexual health, once regarded as taboo subject, is currently discussed widely. Sexual functioning is influenced by a number of factors, mental illness being one of them. Epidemiological and clinical studies show that depression is associated with impairments of sexual function, even in untreated patients. Most antidepressant drugs have adverse effects on sexual function. The purpose of this study is to identify the incidence and severity of sexual dysfunction (SD) in 50 patients of Depression without taking any antidepressant drugs.

Aims And Objectives:

  1. To study the socio-demographic characteristics of depressed male patients.
  2. To study the incidence of sexual dysfunction in drug free male depressed patient.
  3. To assess the type and severity of sexual dysfunction in drug free male depressed patients.

Material And Method: To fulfill the above Aims And Objectives a study was conducted in Department of Psychiatry, Govt. Medical College, Kota. 50 consecutive patients diagnosed as suffering from Depressive episode as per ICD-10 by consultant Psychiatrist attending Psychiatry department of New Medical College Hospital, Kota were taken up for study And 50 suitably matched normal subjects constituted the control group. All the patients and control group were evaluated on Semi structured proforma designed especially for the study to record socio demographic variables, a Sexual Function Questionnaire-Arizona Sexual Experience Scale (ASEX) was applied to record sexual dysfunction. GHQ-12 was applied on control group to rule out any psychiatric illness. 17 Item Hamilton rating scale for depression ( HAM-D) was applied on all the patients to record the severity of depression.

Result and Discussion: The Results will be presented at the time of presentation in the light of previous studies.

Keywords: Depression, sexual dysfunction, quality of life.

To Study Quality of Life Among Intravenous Drug Users on Opioid Substitution Therapy: A Follow Up Study

Pinky Swaroop, B. S. Sidhu, Baldeep Kaur

Deptt. of Psychiatry, GMCH, Patiala. [email protected]

Introduction: The practice of injecting drug use(IDU) has been spreading to different parts of world as well as in India. Opioid substitution therapy (OST)is oral administration of an opioid drug prescribed as a replacement. In India, methadone and buprenorphine are recognized as effective agonists for maintenance treatment. Quality of Life (QoL) is defined as subjective assessment of impact of disease and treatment across the physical, psychological, social and somatic domains of functioning and well-being. Researches has shown that QoL among IDUs improve on OST.

Objective: Aim of present study is to assess QoL among IDU on OST.

Material & Method: Subjects aged 18-60 years who come for treatment at OST Centre, Rajindra Hospital, Patiala were included. Purposive sampling Method was done. Written informed consent was taken. Identification data including socio-demographic profile was recorded. World Health Organization Quality of Life Bref Hindi version scale (WHOQoL Bref) was administered at baseline (at the start of treatment) at 6 month and 1 year. The Results and observations were recorded and data was statistically analysed by using Statistica 7.0.

Results: The Results of present study revealed that QoL improves in patients on OST. From the repeated measure design, Results revealed that patient's QoL was poorer at the time of joining OST as compared to the patient's QoL at the interval of 6 months and 1 year.

Conclusion: Thus it can be concluded that buprenorphine showed an improvement in QoL within 6 months and maintains QOL at 1year.

Keywords: Quality of life, intravenous drug users, opioid substitution therapy, buprenorphine

A Study of Depression and Associated Factors in High School Adolescents

Seema Anis, G. K. Vankar, Nilima Shah, Sarthak Dave

C-109, New Pg Hostel, CiviL Hospital, Ahmedabad -380016, Gujarat. [email protected]

Background: There is an increasing trend of depression and suicide in adolescents worldwide. There is a need to explore this situation in detail, along with the associated factors in the local context.

Aims And Objectives: In high school students,

  1. To find out the prevalence of depression and associated factors.
  2. To assess the knowledge and attitude towards depression and suicide.

Setting and Design: The study was conducted in an ICSE school in two batches, followed by an informative session.

Material And Methods: This is a descriptive cross sectional study. A self-report, semi-structured questionnaire with demographic details, PHQ-9, various factors associated with depression, knowledge about suicide and beliefs about depression, was administered. In PHQ-9, students who had low mood and/or lack of pleasure plus those who scored at least 10, were considered depressed.

Statistical Analysis: Chi square and t test were done using SPSS Version 17.

Results and Conclusion: Out of 1171 students, 132(11.2%) were depressed (94 males, 38 females) Depression was significantly associated with loneliness, problems in studies and conflicts with friends and not significantly associated with substance use, social problems in family, financial problem, problem with teachers and relationship issues. There was a statistically significant difference in the mean score of knowledge about suicide between depressed (6.0/12) and non depressed (5.23/12) adolescents. Beliefs about depression were generally desirable, except that more adolescents reported that depression was a sign of personal weakness (24.2%), they would feel embarrassed/ashamed if depressed(39.6%), would not share it with teachers (50.6%) and worry that their classmates would tell others about their depression (33.6%).

Keywords: Depression, Chi square and t test, SPSS

We conclude that the prevalence of depression is quite high in adolescents and the associated factors must be rectified. Also, we need to conduct more awareness programmes to bring about a change in attitude and beliefs towards depression and suicide.

Case Series Describing Neuropsychiatric Manifestations in Wilsons Disease -Implications for Early Diagnosis and Treatment

Potula Namrata

Mehdipatnam, Telangana, Hyderabad. [email protected]

Wilson's disease (WD) is a relatively rare disease of copper metabolism. According to the literature, psychiatric symptoms as initial presentation accounts for only 10% of the cases. Psychiatric symptoms in WD may range from major depression, mania, and anti-social behavior to psychosis .Here we describe 3 cases presenting with neuropsychiatric manifestations prior to the diagnosis of Wilsons disease.

Case 1: A 39 year old male previously diagnosed with Bipolar Affective Disorder presented with c/o involuntary movement of hands bilaterally past 15 years treated with multiple medications Resulting in no improvement on further evaluation revealed 24 hr. urinary copper 671 mcg/ day .

Case 2: A 21 year old male presented with h/o academic decline, eating edible and nonedible substances picking from the ground and muttering since 4 years has received antipsychotics for inadequate duration,on further examination revealed catatonic features and stereotypical movements, 24 hr. urinary copper 363 mcg /day

Case 3: A 34 year old male presented with 10 years duration of continuous illness characterized by repeatedly doing one act and ambiguity in carrying out particular act and negative symptoms like apathy avolition and alogia and ambitendency diagnosed initially as psychosis but on further evaluation revealed 24 hr urinary copper 127 mcg/day .

Keywords: Wilsons Disease, psychiatric symptoms, Bipolar Affective Disorder

A Study of Intellectual Disability, its Types & its Correlation with Various Sociodemographic Variables in Barak Valley, North-Eastern India

Kaveri Saxena, Subrata Naskar, Kamal Nath

Department of Psychiatry, Silchar Medical College & Hospital, Assam.

Background: Intellectual Disability(ID) is a developmental deficit. According to DSM-5"intellectual disability is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual,social and practical domains." Many psychosocial factors influence the central nervous system of developing child & influences child's psychological development. Therefore an attempt has been made with this study to find nature of associations between types of ID & important socio-demographic variables, in the southern part of state Assam, India.

Aims & Objectives: To find out socio-demographic variables of patients with intellectual disability(ID), distribution of ID according to its types & correlation between types of ID with various socio-demographic variables.

Methodology: A total of 100 patients above age 4 were taken serially from outpatient & inpatient department of psychiatry, silchar medical college & hospital, who fulfill the diagnostic criteria for intellectual disability according to DSM-5. The classification of intellectual disability was done according to the scores obtained using the following tools: Malin's Intelligence Scale for Children(MISIC), Wechsler Adult Intelligence Scale-Third Edition, The Vineland Social Maturity Scale. Assessment of scoring was done by clinical psychologist as senior faculty member of department.

Results: Majority of study subjects belong to age group 11-20 years(43%), male gender(59%), Hindu religion(50%), illiterate(56%), of lower socio-economic status(76%), with joint family(59%), rural Background(52%), with parents working mainly as unskilled workers(46%). In our study mild ID was most prevalent(42%); followed by moderate type(40%).

Conclusion: We found a strong association between the distribution of ID with few important socio-demographic variables. 52% of cases were from rural Background, 68% cases with parents either illiterate or education upto primary level & 76% cases from lower or lower middle socio-economic status. Though many of these associations are not statistically significant, they definitely highlight the role of various socio-demographic variables in Intellectual Disability

Keywords: Disability, MISIC, DSM V

Mania Secondary to Physical Illness

Saugata Bandyopadhyay, Rajashree Ray

19, Creek Row, Kolkata, West Bengal. [email protected]

Mania secondary to physical illness is an important diagnosis to be cognisant of in clinical practice, particularly for liaison and old age psychiatry specialties where the interface between mental health and physical disorders is more acute. 'Secondary mania' is important to differentiate from primary mania and delirium. The term was first introduced by Krauthammer & Klerman in 1978 to describe mania Resulting from organic dysfunction in a patient without any previous history of affective disorder. Based on clinical evidence several neurological and non neurological disorders have been implicated in the aetiology of secondary mania. A predominance of right hemisphere lesions in patients developing mania from focal brain lesions have been debated though exact mechanism remains unclear. The essential clinical features of mania are superimposed on the clinical picture of physical illness that has been associated with secondary mania. Psychiatrists need to be aware of the subtle clinical differences between primary and secondary mania. Mania arising in late life has higher risks of cognitive impairment which is partially reversible and hence needs to be differentiated from delirium and dementia. The challenges faced by clinicians in management of secondary mania are due to broad aetiological factors leading to diagnostic uncertainty and treatment difficulty. Treatment in secondary mania needs to be tailored to some degree to what clinically appears as the primary cause. Judicious selection of mood stabilizers, antipsychotics and benzodiazepines and psychotherapy as needed along with knowledge of the pharmacokinetics, side effect profile and drug interactions of the medications used for the physical and psychiatric disorders. Available data on secondary mania is based on case studies and retrospective cohort studies. There is absence of systematic data which clearly establishes a causal relationship between mania and physical illness. Notwithstanding these caveats, there is clear support for the association between mania and medical illness.

Keywords: Physical illness, Predominance, Mania

Marital Adjustment, Life Satisfaction, and Quality of Marital Life-A Comparative Study Between Working and Non-Working Married Women

Asiya Ameen, Raghuram Macharapu, Pramod KR Mallepalli

16-8-11/1, Kaladera, Chanchalguda, Malakpet, Telangana, Hyderabad. [email protected]

Introduction: Marital adjustment is the state in which there is an overall feeling between husband and wife regarding happiness and satisfaction with their marriage and with each other.Marital satisfaction is a mental state that reflects the perceived benefits and costs of marriage to a particular person.

Aim: The Aim of our study was to compare the marital adjustment,life satisfaction and quality of marital life between working and non working married women.

Materials And Methods: The study is cross sectional with sample consists of 100 married women [50 working and 50 non working women] selected from various areas of Khammam town,conducted from April 2014-April 2015 under supervision of Dept of Psychiatry,Mamata Medical College,Khammam. Random sampling technique was used to select the participants.Assessment was done by using Marital-satisfaction scale, Marital Quality Scale and Dyadic adjustment scale.Analysis was done by student's t test.

Results: The non-working women are more satisfied than working women( p<0.02), and quality of marital life is poorer in working married women when compared with non-working women(p< 0.034).Both working and non-working married women are well adjusted.

Conclusion: The study concludes that non-working women have more life satisfaction than working women may be due to responsibilities like domestic, social with regard to child care, cordial relationship with in-laws and their relatives and satisfactory relationship with the husband are the factors that are important in marital adjustment, because of the added responsibilities and stress at jobs, they may suffer from more maladjustment at home or in the office.

Keywords: Quality of marital life, maladjustment, Dyadic.

Increased Risk of Anxiety & Depression in Relatives of Psychiatric Patients VS Relatives of Patients with Surgical Illness: A Comparative Study

Saurav Bardalai

Flat No. 2, Plot 147, Nandanvan CHS, Navi Mumbai, Maharastra.

[email protected]

Stress is a known factor in relatives of patients suffering from psychiatric illness and patients with long standing surgical illness. This stress can lead to development of psychiatric disorders, namely anxiety and depressive disorders in the relatives. However, the exact risk and incidence of developing either anxiety or depression in these relatives is not known.

Ours was a comparative, cross-sectional study done in a tertiary care hospital on 100 relatives, 50 relatives of psychiatric patients and 50 of patients with long standing surgical illness, using pretested questionnaires for anxiety and depression.

This study would help us to psychoeducate the relatives and reduce the caregiver burden.

Keywords: surgical illness, psychoeducate, depressive disorders.

A Study of Prevalence of Depression, Anxiety and Associated Factors Amongs the Patients of Arthritis in A Tertiary Care Center

Faisal Siddiqui

H. No. 33, Rajat Nagar Bhel, Bhopal, Madhya Pradesh.

[email protected]

Background: Arthritis is one of the common chronic disease and leading cause of disability in India. Due to increasing number of older adults, the prevalence of arthritis is expected to rise dramatically. Depression and anxiety are generally more common among people with arthritis than in general population and interplay independently and synergistically with clinical outcomes such as pain and disability.

Aim: To study the prevalence of depression, anxiety and the factors associated with them among Indian adults suffering from arthritis in a tertiary care centre.

Setting And Design: The study sample comprised of adults age above 30 years with clinician diagnosed arthritis (n=185). Depression and anxiety were measured using separate and validated scales. Prevalence was estimated for the sample overall and stratified by subgroups. Associations between correlates and each condition were estimated with prevalence ratios.

Results: Depression was more common than anxiety (24% and 11% respectively) overall; about 8% of patients have mixed depression and anxiety disorder. Among them only 2-3% of patients seek consultation for mental health condition.

Conclusion: Despite of high prevalence of depression and anxiety among the patients of arthritis help seeking for the psychiatric disability appears to be minimal. Untreated anxiety and depression may negatively impact on pain, mobility and quality of life.

Keywords: Depression, disability, Arthritis.

Cycloserine Induced Psychosis in A Patient with MDR-TB - A Case Report

Trina Lucille D'Souza, Amirtha G, Divya Hegde

Department of Psychiatry, St John's Medical College, Bangalore.

[email protected]

Aim: With the rise in incidence of MDR-TB there has been an increased use of second line anti-tubecular drugs for its treatment, this in turn has led to the resurgence of various neuropsychiatric side effects. Common second line ATT known to cause psychiatric manifestations are cycloserine, ethambutol and isoniazid. Here we describe a case of a MDR-TB multiple defaulter, who developed psychotic symptoms on ATT and our approach to treatment.

Case report: Mr. R a 42 year old painter, K/C/O pulmonary TB since 2008. Patient had defaulted on treatment on multiple occasions (>3) and presented with recurrence this year. He was investigated and MDR-TB regimen initiated. On day 3 of starting medications, patient became agitated, talking irrelevantly however was conscious and well oriented to time place and person. He had visual and tactile hallucinations such as ants crawling over his body, roof changing color and walls beginning to burn. These symptoms lasted for 2 days. His metabolic parameters were normal. In view of suspected drug induced psychosis, cycloserine was withheld and patient was given BZDs. In 2 days of stopping cycloserine, psychotic symptoms subsided and patient was discharged.

Conclusion: This case highlights the need of awareness regarding psychiatric side effects of antitubercular agents and their reversible nature on drug withdrawal. In this age of drug-resistant tuberculosis, it is important for clinicians to be aware of the same so that early diagnosis and treatment of this reversible condition is undertaken and patient is not subjected to inadvertent investigations.

Keywords: cycloserine, psychotic symptoms, MDR-TB.

Sexual Myths in Dhat Syndrome: A Comparative Study

Zeeshan Anwar, Vishal Sinha, Sayantanava Mitra, Ashwani Kumar Mishra, Vipin Kumar, Mahboobul Hasan Ansari, Manjeet Singh

Department of Psychiatry, S.N. Medical College, Agra.

[email protected]

Background: In India sex education is not a norm & large proportions of Indians are still getting sexual information through the peers, cheap magazines, television, movies and internet. Social and cultural norms pose barriers to the transfer of sexual information and as a Result many deep routed sexual myths are prevalent in our society. In India, seminal fluid is falsely considered an elixir of life which guarantees health, longevity and power. In Dhat syndrome, susceptible individual's thoughts are preoccupied with the prevalent misconception that semen loss is associated with impotency, bodily weakness, fatigue, severe anxiety, lack of concentration etc.

Aim: To assess the prevalence and pattern of sexual myths and preconceptions in dhat syndrome patients and compare it with healthy controls.

Methods: It is a cross sectional study and all the patients attending psychiatry OPD of a medical college in northern India, between September 2015 December 2015 and receiving diagnosis of dhat syndrome (according to ICD-10 clinical criteria) were included in it. Sexual myth in these patients was assessed and compared it with their matched controls from general population (having no history of any documented psychiatric illness). Patients having sexual dysfunctions such as erectile dysfunction, premature ejaculation associated with the complaint of passage of semen were excluded from the study.

Result: Result will be discussed at the time of presentation.

Key words: sex, myth, dhat

Recognition of Depression in Primary Care

Sutanaya Pal, Rajat M. Oswal, Aamirkhan Pathan

Department of Psychiatry, Medical College Baroda

Introduction: Depression is a major source of unrecognized morbidity and mortality. It commonly presents with somatic complaints making the Primary Care Center a nodal point of contact for these patients. However, data is scarce regarding its prevalence at this level in India and this study is unique in trying to bridge the deficit in the data base.

Objectives: This study Aims to find the prevalence of depression in primary care and its correlates. It also assesses the reliability of depression diagnosed by the Primary Care Physician when compared with the Psychiatrist's diagnosis.

Methodology: 120 adult patients attending a Primary Health Center OPD were first screened with Patient Health Questionnaire-9 (PHQ-9) and then interviewed and diagnosed according to DSM-5 criteria for MDD after taking written informed consent. The Primary Care Physician interviewed the patients independently and gave her opinion regarding depression along with her clinical diagnosis according to the presenting complaints.

Results and Discussion: There were 71 males and 49 females with an average age of 42 years (SD=13.4 years). 46 (38%) patients screened positive for MDD (PHQ-9 >=9) and 34 (28%) were diagnosed as MDD according to DSM-5. 14 males (19.7%) and 20 females (40.8%) had MDD. Important predictors included female gender, family environment, domestic violence in women, significant life events and life stressors. Multivariate analysis further showed life stressors to be the strongest predictor followed by female gender and significant life events, respectively. Kappa statistics for inter rater reliability between Primary Care Physician's diagnosis and Psychiatrist's diagnosis is 0.38 which is fair.

Conclusion: This study concludes that one-fourth of patients attending the Primary Health Centers suffer from MDD with strongest predictors being life stressors, female gender, family environment and domestic violence among women. The Primary Care Physician's diagnosis was fair compared with that of a specialist.

Keywords: Primary Care, Depression, DSM-V.

Study of Sleep Architectural Pattern in Patients of Substance use Disorder with Special Reference to Patients Dependant on Alcohol

Ashwani Kumar Mishra, Vishal Sinha, Zeeshan Anwar, Vipin Kumar, Mahaboobul Hasan Ansari, Manjeet Singh

Department of Psychiatry, S.N. Medical College, Agra.

[email protected]

Background: Alcohol is used by many as a sedative. Alcohol causes disturbances in sleep architecture, measured by polysomnography, of both non alcoholics and alcoholics leading to insomnia.These disturbances in sleep architecture persist for a long duration of time and are important predictor of relapse in abstinent patients.

Aims: Study the alterations in the various parameters of sleep by polysomnography, caused by alcohol in the alcohol dependants.

Methods: This is a case control study, including drug naïve patients of alcohol use disorder fulfilling criteria of dependence according to ICD-10 DCR, and a control group giving written informed consent and fulfilling inclusion and exclusion criteria. Patients were assessed clinically by baseline investigations and by appropriate tools like General Health Questionnaire-30 (GHQ-30), Pittsburgh Sleep Quality Index (PSQI), Drug abuse screening tool-20 (DAST-20), Addiction Severity Index (ASI) and polysomnography (PSG) for sleep architecture.

Result: Result will be discussed at the time of presentation.

Keywords, GHQ-30, ICD-10 DCR, PSG, PSQI, ASI.

Prevalence of Depression, Menopausal Symptoms in Perimenopausal Women Attending Primary Care

Asifa A, Arun Madhumal Palayat, Yesudas K F

Academy Of Medical Sciences Pariyaram, Kerala, India. [email protected]

Background: Depression is a disorder of major public health importance, in terms of its prevalence, suffering, dysfunction, morbidity, and economic burden. Depression is more common in women than men. Studies done in primary care clinics have estimated a prevalence rate of 21-40.45 % . Perimenopausal period is an important period during a women's reproductive cycle as it is associated with a lot of physiological, hormonal and psychological changes.

Objectives: 1. To assess prevalence of depression among women in perimenopausal age attending a primary health centre. 2. To assess the correlation of depression with severity of menopausal symptoms in the same population

Methods: A cross-sectional study was conducted at a primary health centre in rural Kerala. Consecutive 72 women in perimeopausal age attending the centre were approached. 50 women of the sample were recruited. Each subject was assessed using sociodemographic data sheet, and screened with PHQ-9 questionnaire. Women who scored ≥ 5 in PHQ-9 were further assessed using Beck's Depression Inventory. Perimenopausal symptoms were assessed by Menopause rating scale.

Results: 36% of the sample had only primary education. 72% were housewives, majority belonged to rural Background (76%) and low socioeconomic status (68 %). Of the total sample, 38% had depressive symptoms. 26% had mild mood disturbances, 8% had borderline clinical depression and 4% had moderate depression. 58% of the depressed sample belonged to 46-50 years age group. In the menopause severity rating scale, psychological and somatic symptoms were high for the study population.

Conclusion: The menopausal transition is a time of increased vulnerability to depressive disorders. The current study highlights the presence of depressive symptoms and depressive disorders in this vulnerable age group.

Key words: Depression, Perimenopause, Primary care

Assessment of Self-Esteem in the Mentally Ill

P. Rahul, D. Vijaya Lakshmi

Government Hospital for Mental Care, Andhra Medical College, Visakhapatnam. [email protected]

Introduction: Self-esteem plays a major role in the rehabilitation of an individual, especially after recovery from a mental illness. High self-esteem leads to a better insight, and better re-incorporation into their respective socio-cultural environment. The degree of self-esteem in patients discharged from a psychiatric hospital and the impact of mental illness over the self-esteem of an individual is reviewed in this study.

Aim: To review the patients who came to follow ups after 4-6 weeks after discharge and to assess the differences between self-esteem scores in a government psychiatric hospital.

Methodology: A total of 60 (30 were schizophrenic and 30 suffered from affective illness) patients, who were currently under remission for a period of about 4-6 weeks, consented to undergo Rosenberg's Self-Esteem Questionnaire and the data was analysed and categorised with respect to gender, age and diagnosis.

Results & Conclusion: Results will be discussed in the full paper.

Key Words: Mental illness, Self-esteem, Rosenberg's Self-Esteem Questionnaire.

Brain SPECT Based Neurobiological Correlates of Treatment Resistant Major Depressive Disorder Without Cognitive Impairment

Shailesh Jha, Rakesh K Chadda, Nand Kumar, C S Bal

Department of Psychiatry, IHBAS, New Delhi 110095, India.

[email protected]

Introduction: Major depressive disorder (MDD) is associated with myriad of neurobiological findings which are perhaps as varied as the range of clinical presentations and its treatments. The neurobiological correlates of depressive disorders have been studied at length including REM sleep, cellular immunity and hormonal dysregulation, structural and functional changes in brain involving cortical and relatively deeper structures in brain. However Treatment Resistance though a common clinical entity in MDD, has not been studied yet. Single-photon emission computed tomography (SPECT) offers a potential technique to identify perfusion deficit and help to study neurobiological correlates in Treatment Resistance MDD.

Methods: Out of Twenty eight patients, 20 patients with Treatment Resistance MDD were assessed on MADRS, BDI, CGI, SF36 and HMSE. All patients went through Brain SPECT study and findings were analyzed.

Results: Their mean of total duration of depressive illness was 34.20 ± 22.12 months. The mean scores of MADRS, BDI, CGI and SF-36 were suggestive of moderate to severe depression. All patients had HMSE score >25/30. Around 2/3ed patients had hypo perfusion in prefrontal cortex and 1/3ed had no hypo perfusion in prefrontal cortex. All twenty patients had temporal lobes hypoperfusion which include 7 patients also showed hypoperfusion in left temporal lobes, 2 had it in right temporal lobes and eleven subjects had bilateral temporal lobes hypoperfusion.

Limitations: Small sample size and non-controlled design. All patients were receiving the standard antidepressant therapy.

Conclusion: This study found that the temporal hypoperfusion is consistent among treatment resistant entity in MDD without cognitive impairment. Based on available literatures, neurobiological correlates found are different from MDD and analogous to dementing illness like Alzheimer's disease.

Key words: Neurobiological Correlates; Treatment resistant depression; Brain SPECT

Relationship Between Adaptive Inferential Feedback (A Subtype of Social Support), Perceived Stress and Major Depressive Disorder

Hrishikesh Nachane

First Year Resident, Seth G.S. Medical College, Mumbai. Address: 63, Sharmishtha, Tarangan, Near Cadbury's, Thane West, Mumbai 400606. [email protected]

Internet Addiction and its Association with Depression, Anxiety and Stress

Kapil Dev Sharma, Ishwar Dayal Gupta

Dept of psychiatry SMS Medical College, Jaipur. [email protected]

Introduction: Internet addiction (IA) is one of the major problems that is arising in psychiatry, especially in developing countries. This study was done to quantify IA amongst Indian school students of class 11th and 12th and to find its association with socio-educational characteristics, internet use patterns and psychological effects such as depression and anxiety.

Methodology: Six hundred students of four English medium schools of Jaipur city participated, of which 500 (83.3%) who completed forms were analyzed. Young's Internet Addiction Test and 21 item Depression Anxiety and Stress Scale were used to measure IA and psychological variables respectively. Logistic regression analysis was applied to find the predictors of IA.

Results: Sixty (12%) students had IA; it was predicted by time spent online, usage of social networking sites and chat rooms, and also by presence of anxiety and stress. Age, gender and academic performance did not predict IA. There was a strong positive correlation between IA and depression, anxiety and stress.

Conclusion: IA may be a relevant clinical problem, and needs more research in India. All high school students suffering from depression and anxiety must be screened for IA.

Keywords: Internet addiction, psychological effects, depression and anxiety

A Clinical Study on Memory Dysfunction in Patients of Depressive Disorder

Karnik Kishore, Deepanjali Medhi

# 301 New Pg Hostel, Silchar Medical College and Hospital Campus, Silchar, Assam. [email protected]

Background: Research in the last decades have shown that depression is associated with a significant disturbance in cognitive functioning. Memory dysfunction appear to represent one of the core features of cognitive dysfunction in depressive disorders with an impact on many functional outcomes.

Objective: This study Aimed at assessing the memory deficits in patients suffering from depression and to study the corelation between memory dysfunction and severity of depression.

Method: A Total of 40 patients with Depression diagnosed according to ICD - 10 Criteria and 40 healthy controls were included. PGI Memory scale and Hamilton Depression Rating scale (HAM - D) was adminstered and analysis was done using Chi - square test and Pearson's correlation.

Results: The study revealed significant differences in the Dysfunction scores between the study and control population. In the study group majority of patients(80%) had memory dysfunction and a positive correlation was found between memory dysfunction and HAM - D scores.

Conclusion: Depression is associated with significant disturbance in memory and the memory dysfunction increses with increase in the severity of depression.

Key Words: Depression, Memory, Memory dysfunction.

Developing Community Mental Health Resources Under District Mental Health Programme in Sikkim, Report;2014-15

Satish Rasaily, Geeta Gurung

Singtam District Hospital, Sikkim. [email protected]

Considering high suicide rate in Sikkim at 29 per 1 lakh population (2013) and availability of meagre human resources in the field of mental health to tackle high suicide rate, Deptt. Of Health under DMHP have initiated several innovative programmes ranging from human resources development to community level activities to sensitize students, women and general public.

The PHCs should be strengthened with training, information, & skills to make treatment provision for minor mental illness, develop capacity to train sub-ordinate health workers and conduct mass awareness campaign ( School Health, Community Mental Health Camp etc), initiate dialogue about taboo subject in VHSNC/ RKS committee, and develop their own area specific mental health plan of action so that mental health services are made available at the doorsteps of population in each/ every block & PHC.

Under the DMHP, 93 Medical Officers, 435 Health workers, 666 ASHA (accredited Social health Activists), 698 Teachers, 30 Police personnel, 120 Panchayats were imparted training in 2014-15.

The DMHP team also conducted 71 community mental health camp, 142 school/ college programmes & sensitized 205 Village Health, sanitation & Nutrition committees in 14-15.

Conclusion: We have achieved remarkable progress so-far in last 2 years with regard to DMHP in the State, and anyone can appreciate our collective efforts depicted on Facebook page called "Maansick Rog" Therefore, time has come to rely primarily on Primary Care health workers to fights against stigma, correct wrong notions & locally prevalent beliefs about mental illness, & educate community about mental illnesses so called community mental health.

Keywords: Nutrition, community mental health, Primary Care health

Correlation Between Stress and Anxiety in Parents of Mentally Retarded Children

Subhash Chandra Chouhan, Paramjeet Singh

Dept of psychiatry SMS Medical College, Jaipur. [email protected]

Introduction: There are very few Studies comparing the stress perceived by parents of mentally retarded and normal children are limited. Mental retardation is a highly disabling condition. This study was done to find out the negative impact on caregivers to help and manage this problem in the best possible way. This study was helpful to find out the correlation between the severity of mental retardation on the level of stress and burden perceived by the caregivers.

Methodology: This study was conducted at Psychiatric Centre Jaipur attached to SMS Medical college, Jaipur. The study sample, comprising 120 subjects, was categorized as: group A (40 parents of profound to moderately mentally retarded children), group B (40 parents of mild to borderline mentally retarded children) and group C (40 parents of children with normal intelligence), which served as the control group. Each of the parent was assessed using the Family Interview for Stress and Coping (FISC) in Mental Retardation, and the Hamilton Anxiety Rating Scale (HARS).

Results: Parents in group A had a significantly higher frequency of stressors and level of anxiety as compared to those in groups B and C. There was a positive correlation found between the level of anxiety and stressors.

Conclusion: There were multiple factors which lead parents in groups A and B more susceptible to stress compared with parents in the control group.

Keywords: stress and anxiety, HARS, FISC.

Prevalence of Physical Comorbidities in Psychiatric Patients

Nikhil Nayar, A. Agarwal

Department of Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand, India. [email protected]

Background: Mental health and physical health are inextricably linked. Just as many general medical conditions increase the risk for co-occurring psychiatric illnesses, it has been known that the presence of a psychiatric illness increases a person's risk of developing a number of medical disorders. Many health care systems do not adequately provide an integrated approach for physical and mental health care. Generally mental health care is provided by one organisation and physical health care from a different system. In some cases, one condition may be receiving adequate attention while the other is not. Many mental health practitioners have little training in physical care, physical assessments of psychiatric inpatient is unsatisfactory. The consequence of fragmented or incomplete care is that the individual does not receive appropriate holistic care that looks at the "whole person".

Aims And Objectives: This study has been carried out to examine the nature and prevalence of physical illnesses in patients admitted in tertiary care mental health institution .

Material And Method: This is a Hospital based cross sectional study. Sample size included 20% of the patients admitted in adult psychiatric wards ( 18-65 y, both male and female, with any psychiatric diagnosis) in a period of 4 months (through simple random sampling). All these patients (included in sample) underwent physical examination. Along with this, any history of medical illness in past and treatment history was also be recorded. Biochemical ivestigations (CBC, KFT, LFT, Lipid profile, blood sugar, S. electrolytes) were then recorded. Based on history and physical examination the need for further investigations ( radiological, thyroid, ECG) were assessed. The type and prevalence of various medical illness was then recorded.

Results and Discussion: The Results will be discussed during the time of presentation.

Keywords: Mental Health, ECG, Lipid Profile.

Psychiatric Morbidity Among Burn Injury Patients

Yumnam Sana Devi, Senjam Gojendra Sigh, N.Heramani Sigh, N.Snjib

Manipur Health Services, Regional Institute Of Medical Sciences, Imphal. [email protected]

Introduction: Burn injuries are devastating, sudden and unpredictable forms of trauma which affect the victim both physically and psychologically. With an increased survival of patients with burns, there comes a new focus on the psychosocial challenges and recovery that such patients much face.

Aims and Objects: The present study Aims:

  1. To find out the prevalence of psychiatric disorders after burn injury.
  2. To determine the effects of burn related factors on development of psychiatric disorders.

Materials And Methods: A hospital based cross-sectional study conducted in two year period in Regional Institute of Medical sciences, Imphal, Manipur. Patients with burn injury were assessed using semi-structured socio-demographic proforma,proforma for burn injury, and MINI International Neuropsychiatric Interview version 5.0.0.(M.I.N.I. PLUS). The data were analysed using SPSS-21and chi-square test was used to measure the relationship between the variables.

Results: A total 40 patients were enrolled and 28(70%) of them had psychiatric disorders. Major depressive disorder (MDD) was the most common disorder 20 (71.43%), followed by Post Traumatic Stress Disorder (PTSD) with 8(28.57%).there were clinically significant association of psychiatric disorders and degree of burn injury,mode of injury

Conclusion: Over the last couple of decades, there is increase in the rate of survivors of patients with burn injuries as a consequences of the development of new therapeutic approaches. The most common mode of injury was accidental and due to flame burn. The prevalence of psychiatric disorders among our study population was as high as 70%.There were six different types of psychiatric disorder and the most common psychiatric disorder was MDD.

Keywords: Psychiatric Morbidity, MINI.PLUS, PTSD.

A Study of Role of Insight in Aggression in Schizophrenia Patients- A Case Control Study

Dinesh Kumar R

M5, Pg Quarters, Institute of Mental Health, Chennai.

[email protected]

Background: Insight- conscious awareness and understanding of one's own psychodynamics and symptoms of maladaptive behavior.

Aggression: behaviors by one person causing pain, damage(verbal,physical), or destruction to another person or property. More the symptoms in the patient more the difficulties in functioning and related to both violence as well as lack of insight. So increasing insight into illness and maintaining them on compliance to treatment can play a role in reducing violence. Insight and compliance are regarded as separate though overlapping constructs. Social factors also play role in aggression for example victimisation.

  • Aims And Objectives:
    Primary Aim: To study role of INSIGHT as risk factor for aggression in patients with schizophrenia.
    Secondary Aim: role of compliance, number of relapses and social support in insight and aggression.
  • Methods And Materials: The ethical committee approval obtained in may 2015
  • Sample Size-
  • 100. 50 aggressive(CASES) and 50 non- aggressive (CONTROLS)
  • Study Period-
    3 Months (June 2015 To August 2015)
  • Study Design- Case-Control Study
  • Sampling Method-

Non- probability sampling-Convenient sampling

SCAN based on ICD-10 DCR was used to diagnose schizophrenia and also for subtyping.

Tools: aggressive (CASES) and non- aggressive (CONTROLS) divided based on history of aggression and modified overt aggression scale(MOAS).


compliance was divided into nil,partial, complete.

Social support assessed using SSQ(SOCIAL SUPPORT QUESTIONNAIRE).

Details statistically analysed using SPSS 20(statistical analysis software).

Results And Conclusion: Insight was significantly low in the aggressive group (negative value for BCIS). Subjects in the aggressive group had a mean bcis of -0.78 in comparison to 3.50 in the non- aggressive group and this mean difference was statistically significant This indicates the importance of improving insight in reducing violence.

Keywords: Schizophrenia, MOAS, BCIS, SSQ.

How Common are Psychotic Like Experiences

Zeeshan Anwar, Vishal Sinha, Sayantanava Mitra, Ashwani Kumar Mishra, Mahboobul Hasan Ansari, Manjeet Singh

Department of Psychiatry, S. N. Medical College, Agra.

[email protected]

Psychotic-like-experiences (PLEs) are attenuated form of full blown symptoms experienced by psychotic patients. The evidence indicates a reasonably high prevalence of PLEs in general population and are proposed to increase vulnerability to schizophrenic psychosis and related disorders in this sub-group.

We have assessed PLEs in 310 medical students using Peters-Delusions-Inventory (PDI) and Launay-Slade Hallucination Scale-Revised (LSHS-R). Mean age was 21.77±3.17 years. Most common delusional domains reported were suspicion (>65%) and grandiosity (>60%) while perceptual disturbances were seen in > 30% of students. Hallucinatory experiences correlates positively with perceived stress and sleep disturbances; and negatively with the general health of the students.

Our study reports a very high prevalence of PLEs in medical students; especially in those under considerable academic and emotional stress, and consequently reducing quality of life. So, a reduction of stress might be helpful in decreasing PLEs and predisposition on to psychotic disorders.

Key words: Psychotic like experiences; PLE; medical students

A Study of Depression in Diabetic Patients: Prevalence And Correlation of Depression Severity with Diabetes Severity

Rahul Mathur

F-5 Radio Colony, Indore, Madhya Pradesh. [email protected]

Background: High prevalence of co-existing depression in diabetic patients has been seen in many previous studies and bidirectional relation between these two has already been established.

Objectives: (1) Assessment of prevalence of depression in a diabetic population. (2)Correlation between severity of depression (assessed through HAM-D scores) and severity of diabetes (assessed through HbA1c levels). (3) Correlation between duration of diabetes and depression.

Materials And Methods: The study included 200 patients with diagnosed type 2 diabetes between ages 25-60 years. Glycosylated haemoglobin levels were recorded for all patients. Depression in all patients was evaluated clinically as per the ICD-10 diagnostic criterion of depression. Those who were diagnosed with depression, severity levels were quantified based on the Hamilton Depression Rating Scale. Study sample was divided into 3 groups based on age for better analysis - young adulthood (25-35 years), middle adulthood (36-45 years) and late adulthood (46-60 years). Data were recorded in a structured performa and analysed.

Results: The mean age of the sample is 35.17 years. The prevalence of depression was found out to be 31.5%. No statistical difference of depression prevalence between males and females. Mean HAM-D scores were significantly lower in the middle adulthood. Duration of diabetes was significantly correlated with presence of depression (p=0.010). Severity of depression was significantly correlated with the HbA1c levels (p=0.011).

Conclusion: We have made an effort to understand the various factors affecting the presence of depression in diabetes- age, gender, duration of diabetes, religion and glycemic control. We found a high prevalence of depression in diabetes and that severity of depression increases with severity of diabetes. We would recommend routine screening of depression in diabetic patients and especially in those with high glycosylated haemoglobin levels.

Keywords: Diabetic, ICD-10, HAM-D.

Eveningness and its Correlates with High Risk Behavior in Young Adults with Attention Deficit Hyperactive Disorder

Karthik A, Shankar Kumar, Chandrashekhar Hongally

Department of Psychiatry, Bangalore Medical College and Research Institute, Bangalore. [email protected]

Introduction: Attention deficit Hyperactive Disorder (ADHD) is currently recognized as a potentially life-long disorder.Similarly to childhood ADHD,adult ADHD is also associated with sleep disturbances or circadian abnormalities.Hence, Adult ADHD may also be related to the preference of morning/day activity (i.e, morningness) or evening or night activity(i.e., eveningness), an indicator for circadian rhythm.Studies which have looked into morningness and eveningness have recently recognized that those with eveningness chronotype may have higher behavioural problems.

Aims And Objectives: Thus,in this study, our Aim was to look at the prevalence of eveningness in young adults with ADHD without any psychiatric co-morbidities and its association with high risk behavior in young adult males.

Methodology: 30 young adults diagnosed with ADHD were recruited from tertiary care hospital. Those with psychosis and mood disorders who were psychotropics were excluded.Morningness - Eveningness questionnaire (MEQ) was administered to these indivivuals.Stimulating and Instrumental risk questionnaire(SIRQ),Positive and negative Affection Scale (PANAS), Senister questionnaire with details regarding risky sexual behavio, risky driving was also asked.

Results And Conclusion: 13 individuals had a eveningness chronotype.Those with eveningness had significantly higher stimulating risk taking behavior, higher negative affect scores. Thus it is important to recognize 'eveningness' chronotype in ADHD individuals as it has high significant association with Risk Taking Behavior. This has important implications for prevention of Risk Taking Behaviour in these individuals.

Keywords: Hyperactive disorder, ADHD, Risk behavior.

"Prevalence and Intervention for Agitation in Psychiatry In-Patients in A Tertiary Teaching Hospital"

Tisha Jacob, Arun Kumar, Christina George

[email protected]

Introduction: Agitation and aggression are a common occurrence in a psychiatry setting and cause burden and distress to both the patient, family and staff. There is evidence of its high prevalence within psychiatry inpatient settings from western studies. There is a dearth of studies on agitation in Asian settings .

Objectives: To determine the prevalence, pattern and intervention for agitation in psychiatry in-patients.

Methodology: A review of inpatient records of inpatients admitted from 1st June 2013 till sample size was obtained was done employing a predesigned semi structured proforma and analysed with SPSS 16.

Results: Of 272 admissions, 103(37.9%) of the discharge diagnosis were Schizophrenia/ Psychosis, while 64(23.5%) had alcohol use disorders .54(19.9 %) of the admissions involved the emergence of agitation. Non goal directed physical agitation (n=37; 13.6%) and verbal agitation (n=28; 10.3%) were most commonly recorded, while goal directed physical agitation was present in (n=19; 7%) admissions. Out of 272 admissions, emergency medication was given in 8.1%, restraints in 3.3% and emergency injections 13.2%.The management strategy used for verbal agitation was most commonly "wait and watch" & "talking down" (n=18) and for goal directed physical agitation was emergency injection(n= 10) and emergency injection and restraints (n=9). Significant correlates of emergency injection were using parenterals at admission (p=0.000), agitation at admission(p=0.000), history of violence (p=0.000), history of substance abuse(p=0.051), persecutory delusions(p=0.033), diagnosis of alcohol disorders (p=0.00) or schizophrenia (p=0.014).

Conclusion: This is one of the few studies examining patterns for agitation in an Indian Setting .The limitation is its retrospective nature leading to a potential under reporting of intervention techniques such as "wait and watch "and "talking down" Determining the pattern of agitation may assist in planning more effective intervention strategies.

Keywords: Agitation, aggression, injection.

Comparative Study of Attitude Toward Psychiatry in Medical Students Before and After Psychiatry Posting

Gourav Chandravanshi, Charan Singh, Mahendra Jain

Dept of Psy Jln Medical College Ajmer, Rajasthan.

[email protected]

Introduction: Subject psychiatry as a specialty and mental illness carry a lot of stigmatizing attitudes, which are often due to inaccurate information and inadequate knowledge. A few studies had been conducted to know the attitude of medical students of various years toward psychiatry round the globe. It has been hypothesised that as the exposure to psychiatry increases, positive attitude toward psychiatry increases.

Aims & Objectives: Present study was designed to compare the attitude of interns towards psychiatry before and after psychiatric posting.

Methedology: The presenting study is a cross-sectional and comparative study. Self administered socio-demographic performa and attitude toward psychiatry-30 items (ATP-30) questionnaires were given to intern students before and after 15 days psychiatric posting in dept. of Psychiatry, JLN Medical College, Ajmer.

Results: Among 100 intern students, 68 were male and 32 were female. Positive Attitide of intern students at the beginning was 52 % and at the end of posting was 84%. Only two students have shown interest in choosing psychiatry as a career choice at the start of posting and number increased to five at the end of posting.

Conclusion: The Results of the study supported the hypothesis that the greater the exposure to psychiatry, the higher the positude attitude toward psychiatry. Through exposure in depth and high quality teaching will decrease the negative attitude. It has been felt that psychiatry remains neglected subject during the undergraduate training.

Key words: Attitude, interns, mental illness, psychiatry

A Study of Burden of Care and Quality of Life in Caregivers of Children and Adolescents with Autism Spectrum Disorder

Amar Deep Patel, Vivek Agarwal, Amit Arya, Manu Agarwal, Pawan K. Gupta

Department of Psychiatry K.G. Medical University, Lucknow.

[email protected]

Background: ASD is a neurodevelopmental disorder which is increasing across the globe. The disorder in children not only create burden of care in caregivers but also leads to impaired quality of life of families having children with such disorders. Aims of this study were to study the burden of care and quality of life in caregivers of children and adolescents with autism spectrum disorder.

Methods: The sample consisted of 40 caregivers having children with ASD. Mean age of the caregiver's were 34.72 years with ± 6.32 and mean age of children were 7.4 years with ±3.04. Children between 4-16 years were included. All the caregivers in this study were mothers. Screenings were done by DBCL. Diagnosis was established by DSM-5. Burden of care was assesses by using Burden assessment schedule. (Thara et al., 1998) and Quality of life was measured by the WHOQOL-BREF questionnaire.

Results: Unpaired t-test was applied to identify the significant difference between various domains of burden assessment schedule, WHOQOL-BREF and sociodemographic and clinical variables. In this study we recorded a total burden of 71.73±8.62 meaning thereby that quite a high degree of burden exists on the caregivers. In the present study significantly (p< 0.01) more burden was reported by parents belonging to low income families. Significant (p<0.05) burden of care is also found in the caregivers with the children having age group 6-12 years. In our study it was found that QOL was significantly impaired in parents with family income less than Rs. 10000 group.

Conclusion: Caregivers of children with ASD suffer from high burden of care and impaired quality of life. These findings indicate that these children need more intervention and importance of providing more support to such caregivers.

Keywords: ASD, Burden of care, Quality of Life.

To Assess the Knowledge of Psychiatric Aspects of Alcohol Use Disorders in Medical Students

Gautham Tialam, Raghuram Macharapu, Pramod KR Mallepalli

Vikas Nagar Ngos Colony Hanamkonda, Warangal, Telangana. [email protected]

Introduction: Lack of appropriate as well as frequent training may be the problem behind the poor knowledge of Alcohol use disorders in the medical students as well as medical practitioners. Hence, under diagnosis of Alcohol use disorders.

Aim: To assess the knowledge of psychiatric aspects of Alcohol use disorders in medical students of Mamata Medical College.

Methods: The study is a cross sectional and was conducted in Mamata Medical College, Khammam, from June, 2014 to May, 2015 under the supervision of faculty of department of psychiatry. 180 medical students (115 Final year & 65 Interns) belonging to Mamata Medical College, Khammam, agreed to answer the KPAAQ anonymously, indicating their gender, year of study and whether they had attended any lecture or workshop on alcohol. The Knowledge of Psychiatric Aspects of Alcohol Questionnaire (KPAAQ) consists of 50 questions of 6 clinically relevant categories. Each response to the 50 questions of the KPAAQ was assessed as to whether it was correct or not. Each correct response was awarded 2 points, thereby, yielding a possible range from 0 to 100 points. Statistical analysis was done by using t test.

Results: The mean knowledge of alcohol score in medical students is 44.53 (SD =11.23) without any significant differences (p<0.24) between final year and interns. The mean knowledge of alcohol score is high in 74 male students than in 106 female students (46.62 ± 10.58; 43.07 ± 11.49) (t= 2.103; p<0.037).

Conclusion: Knowledge of psychiatric aspects of AUD in both final year medical students and interns is inadequate.

Key Words: Knowledge, Alcohol use disorders, Medical students.

A Study of Prevalence of Internet Addiction and its Association with Psychopathology Among Professional College Students in Bagalkot City- A Cross Sectional Study

Tejaswi T. P.

Department of Psychiatry, Bagalkot, Karnataka. [email protected]

Background: Internet use population has increased from 360 million in December 2000 to 2.4 billion in June 2012. In Asia, it has grown from 114 million internet users in December 2000 to 1.07 billion in June 2012. In India there were about 137 million internet users in 2012 as compared to 5 million in 2000. There has been an explosive growth of internet use not only in India but also worldwide in last decade. It has been suggested that excessive internet use could represent addictive behavior with mental health implications. Younger internet users have been found to become internet addicts more easily than older internet users. Internet use is a way to adapt or cope to overwhelming developmental stressors. Psychological and environmental factors in lives of college students may leave them disproportionately vulnerable to internet addiction.

Objectives: 1. To find out the prevalence of Internet addiction among professional students in Bagalkot. 2. To study the associated psychopathology among the same population.

Materials And Methods: A cross sectional study comprising of 750 professional college students from various faculties was conducted after taking institutional ethical committee clearance. A semi-structured self answering proforma was given to collect demographic details and various other parameters, presence of internet addiction was found out by Young's internet addiction test and presence of associated psychopathology was assessed by using Duke's health profile. Based on standardized scores users were classified as normal users, mild, moderate and severe addicts and the groups were compared later for associated psychopathology.

Results: Awaited

Conclusion: To be drawn.

Prevalence of Hepatitis C Viral Infection Among Opiod Dependent Injectable Drug Users: A Study Conducted at Swami Vivekananda Drug De-Addiction and Treatment Centre, Amritsar

Piyush Mahajan, P.D. Garg, Manjit Singh, Rajiv Arora, Neeru Bala, Khushbinder Singh

Swami Vivekananda Deaddictioncentre, G.M.C Amritsar. [email protected]

Introduction: Injecting drug use is a major route of hepatitis C virus (HCV) infection in north India especially Punjab with very high rates of substance abuse. While the average rate of prevalence of hepatitis C in India is 2.9%, some pockets of Punjab have exceeded the average between 3.5% to 7%. The present study was attempted to study the prevalence of hepatitis C among the injectable drug users,which is more important in a country like India where viral hepatitis is estimated to be among the top ten causes of deaths.

Material And Methods: A cross-sectional study was conducted in 2014-2015(FEB-FEB).The subjects included were 1162 IDUs who were opiod dependent as diagnosed by ICD-10 and confirmed for morphine in urine with help of Instant-View opiates (300) urine cassette test and IDU status confirmed by observing injection marks on body parts.After that every patient was subjected to blood sampling for anti HCV antibodies using immunoassay technique and opiod dependent IDUs positive for anti HCV antibodieswereinterviewed regarding demographics, injecting and sexual behaviours.

Results: Sero-prevalence of HCV was found to be 38.12%(443 positives).Out of 443 positivesabout 98.6% were males, 63%were of rural Background,60% were married and 43% unemployed. Majority was between the age group of 25-30yrsage(58%).The median time since commencement of injecting drugs was 2.5 yr.Sero-prevalence was greater among those who had injected drugs for more than 2 yr(51%).

Interpretation: Our study shows a high sero-prevalence of HCV in IDUs.The study helps us to evaluate various aspects associated with Hepatitis C infection in Punjab. The need of the hour is to increase awareness about HCV among the public and practicing physicians.

Keywords: Hepatitis C Virus, Viral Infection Among Opiod Dependent

Effect of Haloperidol and Olanzapine on ECG When Administered Orally in Patients of Schizophrenia.

Ashish Chandrakantrao Mohide

Thakre Nagar, N-2 Cidco, Aurangabad, Maharastra.

[email protected]

Background: Cardiovascular causes are most common cause of mortality in schizophrenia, accounting for of 5% sudden and unexpected death.Among first generation antipsychotic haloperidol is known for QTc prolongation and olanzapine from second generation antipsychotic is considered safe. It is essential to study the ECG changes caused by these two drugs in prospective study.

Aim: To study the ECG changes caused by haloperidol and olanzapine in patients of schizophrenia in therapeutic dose range during study period.

Materials And Methods: Patients of schizophrenia attending hospital are studied for ECG changes caused by haloperidol and olanzapine in period of 8 weeks. Schizophrenia patients randomlyallocated one of two treatment groups. At baseline and in follow upsECG is taken. These ECGS are studied for changes in waveforms and QTc.

Statistical Analysis: Data was analyzed using Frequency distribution, Chi-square test using 'SPSS- 17'.

Results: Patients on Olanzapine up to 15 mg have no significant change in QTcclinically as well as statistically, as the maximum QTC difference is 0.04 and p value is 0.174.In Haloperidol group dose up to 6 mg, the QTC change is found to be statistically significant as p value is 0.000933, but it is clinically non significant as the maximum QTc difference is 0.04.

Conclusion: Olanzapine (dose up to 15 mg) has no co relation with changes in QTc levels during study period of 8 weeks, as well as it statistically non significant. Haloperidol (dose up to 6 mg) cause statically significant change but also has no clinical significance.

Key words: Schizophrenia, Olanzapine, Haloperidol, ECG, QTc, p value.

To Study the Psychiatric Consultation Liaison Practice Pattern and Intervention in Tertiary Care Hospital: A Follow Up Study

Satinder Kaur Cheema, Rohit Garg, B S Sidhu

Dept. of Psychiatry, GMCH, Patiala. [email protected]

Introduction: Modern consultation-liaison psychiatrists are, perhaps, the vanguard of those whoadvocate re-medicalization and maintenance of the physician role for psychiatrists. Psychiatric consultants' playa unique role in modern medical practice. Changes in the social environment and new understandings of traumatizing situationshave played a major role in shaping the in-patient and out-patient consultative situations.Consultation-liaison (CL) psychiatry refers to the skills and knowledge utilizedin evaluating and treating the emotional and behavioral conditions in patients who are referred from medical and surgical settings. Consultation Liaison Psychiatry however has not yet flourished well in Indian setting. By considering the number of referrals coming to the psychiatry, health practitioners are now observing that in order to provide the psychosocial services to patients in a prompt manner a regular follow up can be maintained in order to compare the rate of the improvement in a patient coming for the referral.

Objective: Tostudy and monitor the pattern of psychiatric referral and to evaluate the outcome of intervention.

Material & Method: The sample for the study comprises of 200 patients (age ranging 20-70 years) referred from various departments of Rajindra Hospital, Patiala. Clinical Global Impressions (Guy, 1976;CGI) Scale was used to assess the rate of improvement in the patients. A descriptive analysis of the data had been made by applying the analysis of variance.

Results: The Results revealed that majority of psychiatric problemswere found in the age ranging 30-50 years. The majority of referrals came from the medicine department (58%) followed by surgery department (14%) and ICU (12%) respectively. After complete analysis, there was significant improvement in majority of patients in terms of CGI score.

Conclusion: This work depicts the pattern of psychiatric referral in tertiary care hospital. A timely referral from non-psychiatric departments and early intervention can help to combat the psychiatric disordersthat disrupt the functionality of the patient.

Keywords: Liaison Practice, Psychiatric disorders, Clinical Global Impressions.

A Cross-Sectional study of Patients of Headache Attending Opd0 At General Hospital

Gaurav Chittora, Ram Ghulam Razdan, Abhay Paliwal

Department of Psychiatry, M.Y. Hospital, M.G.M. Medical College, Indore. [email protected]

Introduction: A headache or cephalalgia is pain anywhere in the region of the head or neck. Headaches are broadly classified as "primary" or "secondary. Primary headaches are benign, recurrent headaches not caused by underlying disease.Most of the headaches are primary headache.commonly they include migraines and tension-type headache. Most of these primary headaches are tension headaches. Approximately 12-18% of people in the world have migraines.Secondary headaches are caused by an underlying disease, like an infection, head injury, vascular disorders, brain bleed or tumors

Aim:To study the clinical profile of patients attending headache clinic of Psychiatry department at Tertiary care hospital

Objectives: 1) To study demographic profile of patients attending headache clinic at M.Y. hospital Indore 2) To study clinical profile of patients attending headache clinic at M.Y. hospital Indore

Methodology: (a)Study Design: Cross sectional (b)Study population: Patients attending OPD at M.Y. hospital (c)Duration of study:july 2014 to Dec. 2015 (d)Tools:Semi structuredsociodemographic and data entry performa.

Analysis will be done using SPSS v16 using appropriate statistical analysis.

Results and Discussion: Will be discussed at the time of free paper presentation.

Keywords: headache, tension-type headache, brain bleed or tumors

Psychiatric Disorders in Wives of Patients with Alcohol Dependence Syndrome

Sumit Rana, R.C. Jiloha

Department of Psychiatry, Hamdard Institute of Medical Sciences and Research, New Delhi. [email protected]

AimS: Alcohol use in patients is known to cause psychological problems in their wives, but the severity of those psychological symptoms is less well documented. We studied the psychiatric disorders in the wives of patients with Alcohol Dependence Syndrome.

Method: Severity of alcohol dependence was assessed in patients diagnosed with Alcohol Dependence Syndrome. Their wives were assessed for psychiatric disorders using SCID- I (Structured Clinical Interview for DSM-IV Axis I Disorders).

Results: Around 1/3rd of subjects had Axis I psychiatric disorder. Adjustment disorder was most common diagnosis present in 29.4%. Mild depressive episode and Anxiety disorder NOS came close second each present in 23.5%.

Conclusion: Significant number of wives of patients with Alcohol Dependence Syndrome was suffering from Axis I Psychiatric Disorders. So there is urgent need to focus on the treatment of wives of such patients and enhanced use of harm-reduction model in the treatment of patients with Alcohol Dependence Syndrome.

Keywords: alcohol, wife, psychiatric, disorders

Knowledge, Attitude, Beliefs and Practices of Injecting Drug Users: A Multi-Site Study From North India

Tuleshwar Singh, Atul Ambekar, Ashwani Mishra, Ravindra Rao, Alok Agrawal

National Drug Dependence Treatment Centre (NDDTC), AIIMS, New Delhi. [email protected]

Introduction: Injecting Drug Use (IDU) is an established mode of drug use in India. The knowledge attitude and beliefs of drug users regarding this route of drug intake have not been studied well in India. Such data could inform development of evidence-based interventions. We examined the knowledge, attitude, beliefs and practices among injecting drug users.

Methodology: In this cross-sectional study, we administered a semi-structured questionnaire after obtaining informed consent to injecting opioid users recruited from various sites in seven north Indian states. Data on socio-demographic and various parameters on drug-use knowledge, beliefs and practices were collected and analyzed with appropriate statistical measures. Institute Ethics Clearance was obtained.

Results: In the total sample of 1234 IDUs, 87% injected Buprenorphine, 74% pharmaceutical sedatives and 43% Heroin in their life time. About 74% reported first exposure to injecting by one of their IDU friend. Reasons of initiation were peer influence among 64% followed by curiosity in 29%. One-third reported needle sharing while 35% syringe sharing. Side effects experienced by IDU were blocked (31%), abscess (26%) and excessive bleeding (22%). Reasons for preferring injecting route were 'faster intoxication' (64%), 'easy and cheaper accessibility' (32%), 'less risk of police' (27%). About 80% were aware of HIV and sizable proportion knew the routes of transmission. IDU reported having received various types of interventions in their drug-careers: counseling (36%), drug center treatment/ rehab (28%) and peer education (36%).

Conclusion: IDU has become a major public-health concern in various parts of India. Though IDUs seem to possess a degree of HIV-related knowledge, there are some misconceptions about injecting and risky practices still persist despite receiving interventions. There is a need to tailor the intervention programmes as per the level of awareness among IDUs and thus prevent HIV transmission.

Keywords: Beliefs and Practices of Injecting Drug Users

Psychiatric Morbidity in Patients Coming to Tertiary Care Centre

Vermani A. D, Saoji S. G., Marwale A. V., Bhise M. C.

Department of Psychiatry, MGM Medical College, Aurangabad, Maharastra. [email protected]

Introduction: Patients coming to a tertiary care centre have a variety of medical and surgical symptoms however it has also been seen that people suffering from psychiatric illness present with multiple somatic or vague ill defined complaints. Most of the psychiatric morbidity patients are being treated for physical illnesses and the treating clinicians do not always realize the magnitude of the psychiatric morbidity or its presentation so that many patients only received symptomatic treatment or underwent fruitless investigations frequently reported as normal. There are very few Indian studies about the psychiatric morbidity in patients who are attending tertiary care centre and our study was Aimed to find morbidity among such patients.

Material And Methods: This study was conducted in MGM hospital in Aurangabad. A two stage screening procedure was adopted. Patients were initially screened using self reporting questionnaire (SRQ) and Alcohol use disorder identification test (AUDIT). SRQ which was developed by W.H.O and consists of 20 yes or no questions and additional 4 psychotic questions were based on items in Foulds symptom sign inventory. This questionnaire was translated in Marathi. 350 patients were entered into the study by random selection from outpatient ques(non-diagnostic que based triage) who had sought treatment in the hospital from 5th January 2015 to 12th January 2015. Patients who had a score of 12 or more on SRQ or who had any one of the psychotic symptoms or had a score of more than 8 on AUDIT were then assessed interviewed by a psychiatrist and a diagnosis was made using Mini International Neuropsychiatric interview (MINI) based on DSM IV TR.

Results: We are computing the Results at present.

Key words: Psychiatric Morbidity; Tertiary care centre

Electroconvulsive Therapy Augmentation of Antipsychotics in Treatment Resistant Schizophrenia

Sneha Sharma

Shrijwala, Sharma hospital, Professors colony, Bhusawal, Maharastra. [email protected]

Background: Various estimates place the prevalence of treatment resistant schizophrenia from 20% to as high as 60% depending on the definition for the same. These patients present a challenge for the clinicians with poor response and higher rate of hospitalization. Limited data is available regarding ECT augmentation of antipsychotics in such patients.

Objective: The Aim of the study was to determine the short term efficacy of electroconvulsive therapy (ECT) augmentation of antipsychotic drugs inpatients with treatment-resistant schizophrenia (TRS).

Methods: The study was conducted on 15 patients, aged 24-55 yearsdiagnosed with TRS from an inpatient psychiatric unit in New Delhi. Patients completed course of ECT ranging from 6 to 15 sessions, while continuing antipsychotic drugs which had previously been ineffective. Patients were assessed at baseline, 2 days after each ECT and 1 week and 2 months after their last ECT session on Brief Psychiatric Rating Scale (BPRS).

Results: 67.7% patients showed ≥ 40% reduction in symptoms on the BPRS at one week and 46.7% maintained the same reduction at 1 months follow up.

Conclusion: Augmentation of antipsychotic treatment with ECT Resulted in significant decrease in symptom severity on short term follow ups.

Key words : ECT, BPRS, antipsychotic treatment

Treatment Adherence in Psychiatry Patients

Geeta Gurung, Bhanu Pratap Singh, I. L. Sharma

Department of Psychiatry, STNM hospital, Sikkim. [email protected]

Abstract: Adherence is defined as the extent to which a patient's behaviour coincides with medical or prescribed health advice (1).Non-adherence can lead to increased morbidity, mortality, and healthcare costs(2). Non-adherence ranges between 28% - 52% for major depressive disorder, 20%-50% for bipolar disorder, and 20% - 72% for schizophrenia, while one study estimated it at 57% for anxiety disorders(1). Abyot et al observed thatadherence among schizophrenia was 75.7%; psychotic was 46.7%; bipolar disorder was 37.5%; and psychosis withdepression was 52.6%. Reasons for non-adherence included recovery from the illness (26.7%), seeking alternative therapy andunavailability of drugs (18.1% each), adverse drug reaction (12.7%), forgetfulness (10.6%), and being busy (8.6%)(3). Study done in Washington showed that 74% of outpatients with schizophrenia stopped takingnarcoleptics or antipsychotics within two years ofleaving a hospital and 20 to 57%patients with bipolar affectivedisorder are non-adherent (4). G. Morken et al found that non-adherent patients areover 10 timesmore likely to have a psychotic relapse and 4times more likely to be hospitalized than adherent patients(5). Rekha R. et al in India showed that the most common reasons for poor medication adherence were financial problems (41%), long distance to facilities (35%), improvement in symptoms (28%) and other causes like side-effect, lack of caregiver, lack of insight about the illness, and nature of job(6).

Aims And Objectives: 1. Prevalence of medication adherence in psychiatry opd patients. 2. Comparison of medication adherence among various psychiatric disorders. 3. To identify possible reasons for non-adherence.

Material And Methods: Sample size- 200.

Study population-patientsattending Psychiatric opdin a State Referral hospital, Gangtok,Sikkim.

Study design-Cross-sectional

Inclusion criteria- above 18 ages, both genders, Consenting individuals.

Study period- 2 months.

Tools-Socio-demographic data

Psychiatric diagnosis

Morisky 8 item medication adherence scale.

Results: Will be discussed at the time of presentation

Key words : schizophrenia, andunavailability of drugs

Psychiatric Morbidities in Elderly Visiting Medicine OPD

Pranshu Agarwal, A. Q. Jilani, Anju Agarwal, M. Aleem Siddiqui, Ajay Kohli

Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh. [email protected]

Background: With the ageing process, there is increases risk of chronic physical disorders e.g. DM, HTN etc. Physical illness influences psychological wellbeing and mental health of elderly and vice versa. Unfortunately, physician's detection rate of mental illnesses in elderly population is low, probably due to excess burden and poor sensitization regarding psychological problems. Since, management of psychiatric comorbidity affects the prognosis and course of medical illnesses, this study was designed to study psychiatric co-morbidities among elderly with chronic physical illnesses.

Methodology: One hundred ten medically ill subjects aged ≥60 years attending outdoor of medicine department, ELMCH, Lucknow (UP) were recruited in study, and were assessed as per study protocol. The diagnosis of chronic physical disorders was confirmed by consultant in-charge on the basis of history, clinical examination and medical records. Following tools were used e.g. General health questionnaire, Geriatric depression scale, Geriatric anxiety scale, and Mini Mental status examination. Psychiatric diagnosis was made according to ICD-10 guidelines.

Results: The pattern of physical morbidities with decreasing prevalence was Hypertension (60%), Diabetes Mellitus (50.90%), Chronic Kidney disease (9.09%), Chronic Liver disease and Tuberculosis (2.72%), Chronic Myeloid Leukemia (1.8%) and Chronic Obstructive Pulmonary Disease (0.90%). Comorbid Psychiatric disorders were present in 58% of sample. Thepsychiatric comorbidities were Anxiety spectrum disorder (58%), Major depressive disorder (55%) followed by adjustment disorder (30%). MMSE scores were also below cut-off (<23) in 47% of patients.

Conclusion: The psychiatric comorbidities are common among elderly subject with chronic physical illnesses. These need to be included in management protocol of chronic physical disorders.

Keywords: Chronic Kidney disease, Comorbid Psychiatric disorders

Psychiatric Co-Morbidity in Orthopaedictrauma Ward Inpatients and Their Possible Influences in Outcome of Trauma Victims- Follow-Up Study

Sobana Eswaran, Sheron J. Daniel, Poorna Chandrika, Jeyaprakash R

Institute of Mental Health, Madras Medical College, Kilpauk. [email protected]

Background: In addition to physical stress trauma also induces severe psychological stress to the victim.Poor mental health, development of symptoms of PTSD(Post Traumatic Stress Disorder), depression and increased substance abuse leads to poor recovery. Prevalence of co-morbid psychiatric disorder in trauma is high .Alsofeelings of insecurity, self consciousness, restlessness, depression and insomnia are high in this group.Mental heath status is important for achieving best outcome after surgery .In patients with depression,Psychiatric co -morbidity serves as an indicator for greater severity of surgical risk like poor wound care and wound healing,failure to adhere to postsurgical instructions.

Aim: This study attempts to find out prevalence of psychiatric disorders and psychological factors influencing the outcome of trauma management.

Methods And Materials: Wereceived clearance from ethical committee in august 2015.

Study design: Prospective follow-up study

Sample Size: 100

Study Population: Patients admitted in Madras Medical College Orthopedics inpatient department in August 2015 were studied and followed-up after 2 months in October 2015.

Instruments Used: 1. Scan(Schedules For Clinical Assessment Neuro-Psychiatry Based On Icd-10), 2. Hdrs(Hamilton Depression Rating Scale), 3. Hars(Hamilton Anxiety Rating Scale), 4. Bprs(Brief Psychiatric Rating Scale), 5.Who-Das(Who- Disability Assessment Scale), 6.Who-Qol Bref(Who - Quality Of Life Scale)

Results: Data Collection has been completed, statistical analysis using SPSS-20 to be done and Results would be discussed at the time of presentation.

Key words : PTSD, Psychiatric co -morbidity

Effect of Residual Psychopathology and Level of Disability on Recovery in Patients with Schizophrenia

Neha Singla

Hno. 340, sector-12, Panchkula, Haryana. [email protected]

Background: Recovery as a concept has gained increasing prominence in the delivery of mental health services to people with severe mental illness over recent years. Both qualitative and quantitative studies have been done but quantitative studies assessing personal recovery can facilitate intake of larger sample and possible generalization of findings.

Aim:To evaluate the stages of psychological recovery in patients with schizophrenia and to assess their relationship with psychopathology and level of disability.

Materials And Methods:100 stable patients with schizophrenia were recruited by random sampling from the psychiatric outpatient services of PGIMER, Chandigarh. They were assessed on PANSS, IDEAS and stages of recovery instrument (STORI).

Results: Out of 100 patients, majority of the patients (N=50) belonged to the stage-5, i.e., stage of growth; followed by those in the stage-4, i.e., stage of rebuilding (N=22); stage-3, i.e., stage of preparation (N=16); stage-2, i.e., stage of awareness (N=7); while least number of patients were allocated stage 1, i.e., stage of moratorium (N=5). No significant association seen between residual psychopathology and various stages of recovery, while higher level of disability in the domain of self-care, communication and understanding was negatively associated with allocated stages of recovery. Positive correlation between domain of self care was seen with stage-1 (moratorium) and negative correlation with stage-4 and 5. Stage-1 also correlated positively with total disability scores and scores in the domains of interpersonal activities, communication and understanding.

Conclusion: Findings of the present study suggest that,unlike the obvious, level of residual psychopathologyin generaldo not influence the process of personal recovery. However, overall functioning as determined by the level of disability has significant association with personal recovery.

Key words: schizophrenia, PANSS, IDEAS

A Randomized Sham-Controlled Study of Transcranial Direct Current Stimulation in Depression

S Danish Ahmed

New Boys Hostel, Cip Campus, Kanke, Ranchi. [email protected]

Background: Transcranial direct current stimulation has been found efficacious in the treatment of depression.

Objectives: To Study the efficacy of active and sham tDCS as an adjunctive treatment on left dorsolateral prefrontal cortex in cases of depression

Results: This study revealed that there was no significant difference in improvement in depressive symptomatology in patients of unipolar depression as assessed by using pre and post Hamilton Rating Scale for Depression,Hamilton Rating Scale for Anxiety, and Brief Psychiatric Rating Scale between the active (receiving tdcs ) and sham (receiving sham stimulation) groups. There was no significant difference between the improvement in mild to moderate depression as compared to severe depression between the active and sham groups.

Conclusion: Tdcs does not cause any significant effect as an adjunctive treatment in improving symptoms of depression in patients of unipolar depression.

Key words: dorsolateral prefrontal cortex, Hamilton Rating Scale

Empathy in Medical Students: A Cross Sectional Comparative Study

Murali K Vallabaneni, Raghuram Macharapu, Pramodkr Mallepalli

[email protected]

Background: Empathy is a capacity to predict and respond to feelings and behaviors' of others by inferringtheir emotional states. The patient physician relationship is the center of medicine.One of the major tasks of medical educators is to help maintain and increase trainee empathy for patients.

Aim: to measure empathy levels in medical students and to compare empathy levels by year,sex, locality and specialty choice.

Methods: the evaluation was done in 584 medical students of Mamata Medical College by usingself-structured demographic Proforma and Jefferson's physician empathy scale-student version. Data was analyzed and comparison was done using T-tests and one way- ANOVA.

Results: In our study highest empathy scores were seen immediately after entering the medical college. Significantly low scores were seen in fourth year, internship students and post graduates when compared with first year students (p<0.01 ; p=<0.01 ;p=<0.01). Females out-rated males in empathy scores(p<0.01). Medical students prevailing from rural locality have higher scores when compared to semi urban and urban students. No considerable difference was seen based on choice of medical specialty.

Conclusion: Development and maintenance of empathy in medical students can be done by more continuously emphasizing this in the medical education in internship and

Key words: empathy,medical students

"Rage Attacks in Pediatric Obsessive Compulsive Disorder"

Shashikant Yadav, Nishant Goyal, V. K. Sinha

Department of Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand, India. [email protected]

Objectives: This study was Aimed to assess the presence and severity of rage attacks and tics and related disorder in pediatric OCD and to find out any relation between different clinical variable with rage attacks and tics related disorder in patients with pediatric OCD.

Methodology: The study was done in Central Institute of Psychiatry Ranchi. Total 30 cases of pediatric OCD (as per ICD10) fulfilling the inclusion criteria were selected for the study. Patients and their primary caregiver were administered Children's Yale-Brown Obsessive-Compulsive Scale, Hamilton Anxiety Rating Scale, Yale Global Tic Severity Scale, Center for Epidemiologic Studies Depression Scale, World Health Organization Disability Assessment Schedule 2.0 ( WHODAS 2.0), Rage Attacks Questionnaire, Clinical Global Impression-Severity (CGI-Severity).

Results: Rage attacks were found in 20 % of cases of study sample which were often occurred at home and frequently directed at parents and siblings. Tic was found only 10% cases.

Conclusion: Data suggested that Rage attacks and tics were found among child and adolescent patients with Obsessive Compulsive disorder but no clear association between rage and tics.

Key words: obsessive-compulsive disorder,rage, anger attacks.

"Comparison of Executive Functions in Schizophrenia Patients in Remission with and Without Socio-Occupational Impairment"- A Cross - Sectional Study

Delnaz Palsetia

Asha Hospital, Road Number 14, Banjara Hills, Telangana, Hyderabad. [email protected]

Aims And Objectives: The purpose of this study was to compare the executive functions in schizophrenia patients in remission, with and without socio-occupational impairment and to find out executive function tests, which can predict socio-occupational dysfunction.

Method: In this study 60 consecutive out patients with primary diagnosis of schizophrenia as per ICD10 criteria who were in remission measured by PANSS, were divided into 2 groups of 30 each, those with poor socio-occupational functioning (with socio occupational impairment)and good socio-occupational functioning (without socio occupational impairment) using PSP scale (Personal and Social Performance scale). All 60 patients were systematically administered executive function tests such as WCST, Strooptest,Color Trails Test 1 and 2, Verbal fluency and Tower of London to find out if there are any statistically significant differences between the performance of the patients of the two groups .

Results: There was statistically significant difference on Wisconsin Card Sorting Test (WCST), (number of categories, number of perseverative errors and % perseverative errors), Verbal fluency tests (Phonemic and Category Fluency) and Tower of London (Total number of problems solved with minimum number of moves) between the two groups (poor socio-occupational functioning and good socio-occupational functioning).

Conclusion: Performance on executive function tests are significantly correlated with functional outcome.

Key words: schizophrenia, remission, execution functions, socio-occupational impairment.

Isshame Phenomena A Predictor of Depressive Disorders?

Arvind Barad, Pradeep Sharma, Subhash Chandra Chouhan

Department of Psychiatry, SMS Medical College, Jaipur. [email protected]

Introduction: According to Helen Block Lewis et al. (1971, shame is a phenomena of a sense of scrutiny and negative evaluation by a more powerful others. This leads to feelings of inferiority, helplessness, anger and self-consciousness. It is reflect as "affective cognitive states" in which embarrassment, mortification, humiliation and shyness are among the variants (Lewis et al, 1986). Specific psychopathologies, such as depression have been correlated with shame (Tangney et al, 1994)

Aim &Objective: To find out role of shame phenomena in depression.

Methodology: The study was conducted at Psychiatric Centre, SMS Hospital, Jaipur including 100 subject both study and control groups with fulfilling the specified inclusion and exclusion criteria were included in the study. After detailed history and mental status examination diagnosis of depression was made by a senior consultant psychiatrist according to ICD-10 criteria. These subject work evaluated on Beck Depression Inventory to (BDI) to assess the severity of depression and other as Shamer scale (Kaufman 1989, Cook, 1993). With use suitable statistics significant difference between means, a coefficient co-relation.

Result: By use suitable statistics 16% study case had mild depression 40% had moderate depression and 44% had severe depression and Other as shamer- (OAS) score" was 38.02 in study group and 8.8 in control group the difference was statistically significant. Correlation between BDI Scores and OAS cores for Study Group r=0.85.

Conclusion: Shame phenomena predict further depression as per social origin depression.

Key words: Shame, depression, ICD-10 Criteria.

A Clinical Study on Seizure Disorder in Intellectually Disabled Patients in Barak Valley, North-Eastern India

Kamal Nath, Subrata Naskar

Department of Psychiatry, Silchar Medical College & Hospital, Assam. [email protected]

Background: Intellectual disability is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains. It Results in significant limitation of intellect or cognition and poor adaption to the demands of everyday life

Aims: To find out the prevalence of seizure disorders and its types in the intellectually disabled patients and find out their sociodemographic correlations.

Materials & Methods: A cross-sectional study sample comprising of 100 intellectually disabled patients of Silchar medical college & hospital was taken and study was conducted after obtaining Institutional Ethical Committee approval and permission from the college. DSM-V criteria were used for diagnosing intellectual disability. A standardized proforma describing socio demographic variables, Malin's Intelligence Scale for Children (MISIC), for children in age group 6-17 years, Wechsler Adult Intelligence Scale-Third Edition for subjects above 18 years and The Vineland Social Maturity Scale were applied to diagnose and classify intellectual disability by trained clinical psychologist. International League Against Epilepsy guidelines were used to classify seizure disorder.

Results: Prevalence of seizure disorder is found to be 22% among the intellectually disabled population in our sample. A significant correlation is found between the severity of intellectual disability and increased incidence of seizure disorder. Seizure disorder is more prevalent in the low I.Q. group (p=0.0067). Generalized tonic clonic seizure (GTCS) is the commonest among the types of seizure disorder (n=11, 50%). Among the GTCS cases (72.7%) are coming from severe/ profound ID group and from an I.Q. range of 1-35.

Conclusion: A strong correlation was observed in our study between seizure disorder and poor I.Q. group and with increasing severity of intellectual disability (severe and profound ID). In addition we have also observed a significant association between seizure disorder, intellectual disability and few important sociodemographic variables.

Key words: Intellectual disability, Malin's Intelligence Scale, seizure disorder

To Assess the Prevalence of Atypical Depressive Features Among the Patients of Unipolar and Bipolar Depression"- Cross Sectional Study

Priyadarshi Srivastava

Asha Hospital, Road Number 14, Banjara Hills, Telangana, Hyderabad. [email protected]

Aims And Objectives: The purpose of this study was to compare the prevalence of atypical depressive features in the patients of bipolar depression and unipolar depression, and to find out the presence of any statistically significant difference in the socio-demographic profiles of bipolar depression and unipolar depression patients.

Method: 50 patients diagnosed with unipolar depression, and another 50 patients diagnosed with bipolar (type I) depression according to DSM IV-TR were administered a questionnaire, Structured Interview Guide for the Hamilton depression scale (SIGH-D) and Inventory of depressive symptomatology (IDS-C) (SIGHD-IDS) and their socio-demographic data were taken. The unipolar depression group and bipolar depression group were compared to find out any significant difference in the prevalence of atypical depressive symptoms, and difference in socio-demographic profile between the two groups.

Results: There was higher prevalence of DSM IV -TR atypical depression diagnosis in bipolar I depression (36%) group than unipolar (12%) depression group. There was statistically higher prevalence of hypersomnia (20% vs 10%) and hyperphagia (36% vs 12%) in the bipolar I depression patients as compared to unipolar depression patients. Although, there was no statistically significant difference in the prevalence of leaden paralysis, mood reactivity and rejection sensitivity between the 2 groups. Bipolar I depression had females predominance, younger age of onset, greater number of depressive episodes, lesser duration of depressive episodes, greater severity of depressive symptoms on HAM-D and IDS-C as compared to unipolar depression group. There was no significant difference in the family history of bipolar disorder and history of suicidal attempts in the 2 groups.

Keywords: prevalence, atypical depression, bipolar depression, unipolar depression

Internet Pornography Use Among Medical Students: Extent & Effect

Vipin Kumar, Vishal Sinha, Zeeshan Anwar, Ashwani Kumar Mishra, Manjeet Singh, Mahboobul Hasan Ansari

# 35 Pg Hostel S N Medical College, Agra, Haryana. [email protected]

Objectives: Internet has become one of the main sources of pornography use, as internet pornography is easily available, affordable and accessible.Excessive use of pornography is associated with psychological distress, inter-personal isolation, family problems, vocational problems and legal consequences. Medical students spend long hours on the internet for using email, chat rooms, online games, Discussion forums,it is quite possible that they are browsing pornographic sites also on the internet to fill the emotional gaps in their lives arising out of boredom due to living alone away from the home. With this Background, the present study has been planned to estimate internet pornographyuse among undergraduate medical students.

Methods: All the under graduate students in S N medical college, Agra,who had given consent were included in the study. It was a cross sectional study and data were collected using pre designed semi-structured socio-demographic parameters and following scales at the time of interview: General Health Questionnaire (GHQ)-30, WHO Quality Of Life Index(WHO-QOL) - BREF& Internet addiction test (IAT).

Results: A total of 604 medical students are included in the study and internet pornography was used by 429 students and significantly large numbers of them were problematic internet users. As the duration of pornography increases general health measures and quality of life decreases.

Conclusion: Use of internet pornography has become a kind of compulsion which somehow prone to make students internet addicts. So, it's time to probe insight into various factors affecting internetuse and to curb the spread of this problem.

Keywords: Internet, Pornography, Medical Students

Dapsone Induced Psychosis in A Child with Tuberous Sclerosis- A Case Report

Udit Kumar Panda, Satyakam Mohapatra

Mental Health Institute, SCB Medical College, Odisha, India. [email protected]

Background: Tuberous sclerosis is a rare multi-system genetic disease that causes benign tumours to grow in the brain and on other vital organs such as the kidneys, heart, eyes, lungs, and skin& Result in varied manifestation. Developmental delay, Intellectual disability, behavioural problems, seizures are some of the problems those require psychiatric intervention in such patients. Leprosy is highly prevalent in rural india and among the three drugs used as MDT to treat Leprosy,Dapsone, a sulfone derivative antibiotics is most likely to develop Psychosis(Ref-Bhatia et al, 1989, Sahu et al 1972)

Aim and Objectives: We are reporting a rare case of Dapsone induced psychosis in a 13 yr old boy who was suffering Tuberous Sclerosis.

Methods: Master S.K, a 13yr old boy reported to Psychiatry OPD with complains of acute onset of aggressiveness, irritability, assaultive attitude towards siblings, being verbally abusive, throwing away household articles & sleep impairment since last 5 days. Patient was having intermittent episodes of Generalized TonicClonic Seizures since when he has an infant. Upon interrogation the parents revealed ingestion of Antileprotic Medication since last 15 days after a paramedical misdiagnosed some facial skin lesions he has as lesions of Hansen's disease. Upon evaluation patient revealed facial angiofibromas in butterfly pattern, Shagreen Patches &hypomelanoticAshleafmacuoles on back, periungal fibromas in big toe as skin lesions, seizures and mild mental retardation in standardized IQ evaluation tests. CT scan Brain showed subependymal& periventricular calcification & left frontal lobe calcification. Liasoning consultation by the other specialists along with detailed imaging & blood work revealed no other abnormality. Family history suggestive of Tuberous Sclerosis inmother & one maternal uncle is present..A diagnosis of DapsoneInduced Psychosis in a patient of Tuberous Sclerosis was given and patient was put on Tablet Haloperidol 1.5mg BD, Tablet Promethazine 25mg BD, Tablet Lorazepam 2mg HS and Tablet Sodium Valproate 300mg BD for seizures. Patient's behavioural symptoms improved over the next week and he was discharged after 10 days of hospitalization in the same schedule. He is under follow up.

Conclusion: Tuberous sclerosis must be included in the differentials of children presenting with seizures, mental retardation, developmental delay &behavioral problems. Awareness in medical & paramedical workers as well as general public can help in easy detection of the condition.

Key words: Tuberous sclerosis, subependymal& periventricular calcification

Expectations of Patients Using Mental Health Services

Ramananda Kishore Kavi, Kiran Singuru

Department of Psychiatry, Government Hospital for Mental Care, Visakhapatnam. [email protected]

Background: Treatment in psychiatry is almost always individualized to cater to the needs of the patient. Improvement of quality of life of the patient is the ultimate goal of any psychiatrist. Satisfaction with life is a direct reflection of the quality of care. Thus assessment of the patients' expectations and their experiences is essential in order to provide complete care to the patient.

Aims And Objectives: This study Aims to measure experiences and expectations of patients using mental health services and their correlation with socio-demographic data, psychiatric diagnosis, and duration of the illness.

Methodology: 50 adults of working attending Government Hospital for Mental Health, Visakhapatnam were invited to complete the Carers' and User's Expectations of Services, User Version(CUES-U) questionnaire. This is a 16 item self questionnaire divided into comparison score and satisfaction score.

Results: Patients age correlated significantly with service satisfaction scores(F=3.4, p<0.05). Satisfaction scores also correlated significantly with the type of the illness (F=5.4, p<0.05). Comparison scores were significantly correlated with the duration of illness (F=4.9, p<0.05).

Conclusion: Significant differences in both satisfaction scores and comparison scores suggest that psychiatric services have to be improved in order to provide better quality care to the patients. This also suggests that there are unmet needs and expectations of the patients.

Keywords: expectations, Carers' and User's, satisfaction scores

A Case Series to Understand the Psychological Impact of an Incident of Earthquake as A Stressful Life Event

Amitava Dan

Calcutta National Medical College, Department of Psychiatry, 18 Gobra Road, Kolkata, West Bengal. [email protected]

Background: Often a stressful life event (SLE) hits on the mind of vulnerable persons at individual or community level with its immense psychological impacts. One such a big hit happened on April 2015, on the country of Nepal in the form of a devastating earthquake and its several vigorous aftershocks that clAimed few thousands lives of people and millions of constructions in ruins. As a just next door neighbour, in the State of West Bengal many people scared with the experience of several vertiginous spells. For next few days, Bengali population at or around Kolkata (capital city of West Bengal) were watching or viewing the vivid and devastating pictures of Nepal on television or newspapers reported by both electronic and print media. Many of them lost their relatives in that incident at Nepal. Moreover, the ambience of red alert predicted by the experts forecasted by the media that Kolkata was on the verge of another such earthquake.

Observations and Result: In next one month after the above incident, in a tertiary care teaching hospital of Kolkata, at Psychiatry OPD, we got 25 psychiatric patients whose psychological state was significantly influenced by that incident. Ten of them were new cases, 15 were old cases. As per ICD-10, 8 cases were diagnosed as Panic Disorder (F41.0), 5 as Depressive Disorder (F32), 4 as Somatoform Disorder (F45), 3 as Generalised Anxiety Disorder (F41.1), 2 cases as Acute and Transient Psychosis (F23), 2 cases as OCD (F42), 1 case as Psychosis NOS (F29). All of them had at least one phenomenology evolved round that vertiginous experience with significant anticipatory anxiety, as a new symptom or change of pattern of existing symptom. In 15 patients the incident of earthquake had a precipitating role for the first episode, in 8 had aggravating role of existing illness, in 2 had precipitating role for the another recurring episode. Though there no other recurrence of earthquake in the vicinity in next four months, with standard (psychopharmacological and psychosocial) treatment, 16 patients had but rest 9 had no significant improvement in the symptoms related to the vertiginous experiences, though overall improvement in the illness was noted in all of them in next 3 months follow up.

Conclusion: SLE acts in unique way on individuals and can alter the clinical course of various types of psychiatric illnesses which has both pathogenic and pathoplastic effects.

Prevalence and Nature of Psychiatry Problems Among the Poor Academic Performing School Children Presenting with Somatic Complaints

Jitendra D Mugali, S S Chate

J N Medical College, KLE's University Belagavi, Karnataka.

[email protected]

Aims: 1.Prevalence of somatic complaints among poor academic performing school children 2.Psychiatry problems among poor academic performing school children presenting with somatic complaints

Materials And Methods: Children who score in their final examination with grade C and below are considered as poor academic performers, recruited these children in the study. Assessed each child Intelligence quotient by Raven's coloured progressive matrices then diagnosed the child by interviewing with MINIKID Questionnaire and using ICD-10 diagnostic guidelines.

Results: Prevalence of somatic complaints among poor academic performing 115 children is 29.57% . Nature of psychiatry problems in poor academic performing children presenting with somatic complaints are emotional disorders (anxiety disorders), mood disorders, sleep disorders, conduct disorders, specific learning disorders, borderline intellectual disabilities and substance abuse.

Conclusion: Children complain lot of somatic complaints like head ache, abdominal pain or discomforts as major, and also complaining like body pain, weakness, back pain,eye pain and giddiness. Most of the time underlined psychiatry problems with these complaints. Which are necessary to find out and to start early treatment. Also to decrease the severity of further suffering from the problem by intervention of Psychiatrist and to do well in the academics.Very less literature in the above mentioned area from India, This data may help to understand the underling psychiatry problems with somatic complaints by children

Key Words: Poor academic performers, children, somatic complaints, psychiatric disorders

Female Sexual Dysfunction: Affect of Antidepressants

Murali K Vallabaneni, Gautham Tialam, Raghuram Macharapu

2-4-1081/2, Gokulnagar, Hanamkonda, Telangana, Hyderabad. [email protected]

Background: sexual dysfunction negatively affects interpersonal relationships and quality of life of sufferers and their spouses and family. Sexual dysfunction is a common side effect of anti-depressants .In females these may be in many domains as desire, arousal, lubrication, orgasm satisfaction and pain . Female sexual dysfunction is mostly under diagnosed

Aim: to assess the prevalence of sexual dysfunction in female patients using antidepressants patients

Methods: in our study62 female patients diagnosed as depression and using antidepressants were rated by Hamilton depression rating scale. They were assessed for sexual dysfunction by using female sexual function index(fsfi).their overall level of functioning was assessed using Global assessment of functioning (GAF) scale

Results: in our study we found that 21 patients were having sexual all the patients the most affected domain was problems in desire and the least affected was pain.45% of all patients have problems in arousal,orgasm and lubrication

Conclusion: antidepressants affects all the domains of sexual function

Key words: empathy, medical students

Assessment Of Internet Addiction Among Medical Students and its Association with Personality Dimensions

Arindam Dutta, Subrata Das, Asim Kumar Mallick

Burdwan Medical College and Hospital, Burdwan. [email protected]

Introduction: Internet addiction is a rising problem in young age group specially students. Environmental and Psychological factor specially personality traits found to have influence on it.

Aims:prevalence of internet addiction among medical students and its association with personality dimensions.

Methods: 40 medical students evaluated cross-sectionally. Their socio-demography and internet use profile recorded. IAT and EPQ-R questionnaire administered. Their scores were compared using Chi square test. Correlation had been searched between IAT score and Personality dimensions.

Results:15% students were found to be in moderate addiction group.85% are average users.No students were under significant problem user or severe addiction group. IAT score has significant positive correlation with Psychotic and Extroversion dimension of personality.

Conclusion: The study showed 15% of medical students has moderate internet addiction. Among this group higher percentage of students belong to rural Background. Internet addiction is associated with duration of internet use along with Extroversion and Psychotic dimension of personality

Key words: Internet addiction, Medical students, IAT, Personality dimensions, EPQ-R

Effect of Childhood Trauma on Clinical Features of Schizophrenia in A Tertiary Care Centre in South India

Punya Mulky, Sujatha S, Venkatesh Mathan Kumar, Jeyaprakash R

Institute of Mental Health,Madras Medical College,Chennai.

[email protected]

Introduction: It has been reported that children who have experienced trauma in childhood are more at risk for developing schizophrenia.Patients with increased experience of childhood trauma demonstrated worse mental and physical health,poor social functioning,and non-adherence or lower treatment engagement in the course of their schizophrenic illness than those with less or no childhood trauma experience.

Aim:To study the prevalence of childhood trauma in schizophrenia patients in a tertiary care system and to compare it with normal controls,to correlate between childhood trauma and positive and negative symptoms of schizophrenia.

Materials And Methods:This was a cross-sectional study conducted in the Institute of Mental Health,Chennai.50 schizophrenia patients satisfying the ICD 10 criteria were selected randomly and 50 controls were chosen from the community.PANSS was used to assess the severity of schizophrenia and Adverse Childhood Events International Questionnaire (ACE-IQ) was used to assess the childhood trauma in these subjects.Statistical analysis was done using SPSS v.20.

Results:Prevalence of Childhood trauma was 80% for patients as compared to 54% for controls.Emotional abuse was mostly reported in patients while physical abuse was more common in controls.ACE-IQ scores related more positively with positive and general psychopathology symptoms in schizophrenia.

Conclusion:Greater attention to be given to trauma history among schizophrenia patients, and its impacts to formulate more comprehensive treatment plans for patients.

Keywords: Childhoodtrauma,schizophrenia,tertiarycare,ACE-IQ

Mental Health Services in the Veterans Administration in USA: Possible Model for Public Psychiatry in India

Salim Zulfiqar

Richmond VA Medical Center,1201 Broad Rock Blvd.Richmond, Virginia, USA. [email protected]

The U.S. Veterans Health Administration (VHA) provides health care to meet the needs of veterans of the U.S. armed services and is the largest integrated health care delivery system in the United States. In 1995, the VA reorganized itself into 22 geographically based networks known as Veterans Integrated Service Networks (VISNs). In 2007, the VA was providing mental health services to 836,699 veterans in 2007 which accounted for 15% of all veterans receiving health care services. This included more than 300,000 persons receiving inpatient psychiatric services. These services are being provided through 163 medical centers with more than 850 outpatient clinics (including medical center-based clinics and free-standing facilities), and 180 nursing home and domiciliary facilities. The services provided include: Inpatient Care, Residential Care, Outpatient Mental Health Care, Homeless Programs, Programs for Incarcerated Veterans, Specialized PTSD Services, Military Sexual Trauma, Psychosocial Rehabilitation & Recovery Services, Substance Use Disorders, Suicide Prevention Programs, Geriatrics, Violence Prevention, Evidence Based Psychotherapy Programs and Mental Health Disaster Response/Post Deployment Activities.

Two major features of the VA system of care are the fully integrated, user-friendly electronic medical record and an integrated database which now boasts 400,000 unique records and one of the largest medical databases, linking genetic, clinical, lifestyle and military-exposure information, which is goldmine for research. The VA facilities also serve as major teaching programs to health care professionals.

In this presentation, we will present the unique strengths and challenges of mental health services in this large system, and explore whether the VA models could be applied to serve large scale mental health care needs in India.

Keywords: Veterans, Substance Use Disorders, Military Sexual Trauma

A Study of Sexual Disorders in Women with Headache in A Tertiary Care Hospital in India

Mehak Nagpal

S-302 2Nd Floor Greater Kailash-2, New Delhi. [email protected]

Aim: To evaluate the prevalence and associated factors of sexual dysfunction in women with migraine and tension type headache and compare the same to that in the general population.

Background:Given that chronic illnesses are related to sexual dysfunction especially pain and disease severity in rheumatoid arthritis, fibromyalgia,etc; headache as a chronic condition mainly seen in women is known to negatively affect quality of life as well as sexual function.Alteration of sexual desire, genital arousal,orgasm along with pain threshold changes are known to occur in migraineurs. Previous studies have suggested that sexual dysfunction in migraine and tension type headache may not be the direct Result of migraine related disability but probably be moderated by other factors. There is no published data examining the relationship between migraine frequency/severity and sexual functioning in Indian women.

Methods: 100 consecutive patients aged 18 to 65 years with a history of headache for at least 1 month and sexually active in the last 6 months presenting to Psychiatry OPD of a tertiary care hospital in New Delhi giving informed consent were taken. The diagnosis of headache type was confirmed according to the 2ndedition of International Headache Society (IHS) International Classification of Headache Disorders (ICHD-II) in 2004. MINI 6.0 applied for diagnosing psychiatric disorders.The Female Sexual Function Index (FSFI), visual analog scale (VAS) score and headache impact test (HIT) score / Migraine disability assessment scale score (MIDAS) were applied.We excluded patients with cluster type headache, diabetes mellitus, hypertension or any other major comorbid medical conditions, pregnant, breastfeeding or postmenopausal, patients using antidepressants/any other medication known to have an effect on sexual function within the last 1 month. Statistical Analysis using SPSS version16 was done.

Results & Conclusion: will be discussed

Keywords: female sexual dysfunction, headache, India

A Study of Knowledge, Awareness and Attitude Towards Electro Convulsive Therapy (ECT) Among Health Care Professionals

Bharath D. U., Poornima Rao, Maithili S, Umate V P, Kale Sunil, Kumar Panigrahi

Grant Government Medical College, Mumbai. [email protected]

Introduction: Although ECT is an effective, safe and widely practiced treatment, it has been a controversial and misunderstood procedure. It is believed that people in general and health care professionals specifically, lack sound knowledge and appropriate attitude towards ECT. However, very little systematic research has gone into this area.

Aims And Objectives: To examine the knowledge, attitude and awareness towards ECT among different strata of health care professionals and establish co-relation between knowledge and attitude and study factors affecting the same.

Materials And Method: It is a cross sectional descriptive study using self prepared semi-structured questionnaire based on studies published on knowledge, awareness and attitude towards ECT. Data was collected from health professionals in a tertiary care hospital constituting consenting interns, post graduates, teaching faculty and staff nurse. Psychiatrists and psychiatry nursing staff were excluded.

Results: More than half the respondents opined that ECT should not be given in pregnancy, epilepsy and had poor knowledge about side effects and complications of ECT but had a generally favorable attitude towards ECT use in appropriate patients. Majority had never witnessed or assisted in ECT administration. There was no significant difference in knowledge and attitude among different groups of health professionals.

Conclusion: In developing countries, non-psychiatrist health professionals are the first point of contact for a large number of mentally ill patients. Lack of basic knowledge and negative attitude towards ECT among them might adversely affect patient's belief in ECT and psychiatry in general. Measures to create awareness about ECT among health professionals, changes in curriculum and teaching Methodology is essential to improve knowledge and attitude towards ECT in budding doctors .

Keywords: ECT, awareness, attitude, health professionals

Attitude Toward Psychiatry Among First Year and Final Year Students

T. Hasanthi, Raghuram Macharapu, Pramod KR Mallepalli

Mamata Medical College,Khammam. [email protected]

Introduction: Psychiatry is the medical specialty devoted to the study, diagnosis, treatment, and prevention of mental disorders.The attitude to psychiatry (ATP) among medical undergraduates are key factors in determining the choice of psychiatry as a career and willingness to deal with psychiatric disorders in general practice and their interest in psychiatry.

Aim:The Objective of the study is to identify the attitude of first year and final year MBBS towards psychiatry and to study the gender differences if any.

Materials And Methods: The study is cross-sectional,conducted among students of Mamata Medical College,Khammam under the guidance of psychiatry department.For study, all 107(46 males,61 females) final MBBS students who attended psychiatry posting and 140(46 males,94 females) first year MBBS students who didn't attend psychiatry posting are taken.In the present study ATP-30 scale was used to evaluate the Aim of the present study (Burra et al).Analysis was done by Student's t-test and one way ANOVA.

Results: The present study shows that females have shown more positive attitude when compared with males,where as significant difference was also observed in terms of attitude in final years when compared with first years.

Conclusion: The lesser number of hours assigned to psychiatry and absence of mandatory separate section in theory exams add to the cause by creating a neglect in mind of students. Subjects such as psychiatry are underrepresented also during the practical training.This attitude can be amenable to change by modifying the undergraduate medical curriculum by giving more weightage toward psychiatry both in forms of marks allotted in exams and also hours allotted in training.

Cerebral Venous Sinus Thrombosis Presenting with Acute Psychosis: Coincidence VS Causal Incidence

Abhilove Komboj, Shailesh Jha, Om Prakash

Department of Psychiatry, Institute of Human Behavior and Allied Sciences (IHBAS), [email protected]

Abstract: Acute psychosis can be induced by a variety of conditions that could latereither continue to coexist or remit spontaneously. In the case of coexisting psychosiswith medical or neurological illness, the causalityremains uncertain and subsequently it remains just a coincidence. The dilemma in understanding "coincidence or causal incidence" is not uncommon in clinical practice and especially when there are lacks in other corroborative evidences. This dilemma further brings difficulty in definitive diagnosis particularly when with atypical presentation, prognosticating and managingsuch case. With the effort of liaison setting many of such illness factors can be taken care but mystery remains unfolded. Herein we report on a case of adolescent presenting with acute psychosis with cerebral venous sinus thrombosis involving right transverse and sigmoid sinus.

Keywords: Acute Psychosis; Cerebral Venous Sinus Thrombosis; Causal Incidence.

Emotional Disturbances in Low and High Achieving Students

Brahmani Dantala, Raghuram Macharapu, Pramod KR Mallepalli

Dept. of Psychiatry, Mamata Medical College, Khammam. [email protected]

Introduction: Performance in academic life demands all aspects of well being. Students who are physically and psychologically stable are expected to perform better compared to those who are not physically,mentally and psychologically fit, which means students experiencing depression,anxiety,stress may face problem in managing academic performance.

Aim: To find out and compare emotional disturbances between low and high acheiving students.

Materials And Methods: The study is cross sectional,designed to study emotional disturbances in low and high achieving students. The present study was conducted under the guidance of Department of Psychiatry,Mamata Medical College,Khammam from July 2014 to June 2015. 274 students of Swarna Bharathi Institute of Technology (SBIT),Khammam,were involved in this study with their consent.The Depression Anxiety Stress Scale (DASS) was used to measure the depression, anxiety, and stress among students. Independent Sample T-test was used to differentiate the depression, anxiety, and stress between low-and high-achieving students.

Results: There is a significant difference of emotional disturbance in between low and high achieving students and there is a significant difference of emotional disturbances in between male and female.

Conclusion: As per the study,there is an impact of emotional disturbances on academic achievement of students and there is also a difference between both sexes.By concentrating on this area,it could be helpful for the educators,psychologists to reduce emotional disturbances among students which could benifit the students to handle themselves and to increase their academic achievement.

Keywords: Emotional Disturbance, DASS

Five Years Long Cohort Study of Empathy in Undergraduate Medical Students

Shashikumar R, Agrawal K, Aimon M, Srivastava K, Bhat PS, Das RC, Chattarjee K, Prakash J, Basannar D.

[email protected]

Introduction: Empathy an improvement aspect of doctors' repertoire has been studied in various contexts. In many cross sectional studies it has been noted to have a decline from first to third years of undergraduate medical course. Few followed up longitudinal studies also reported a decline but none have been a cohort study for the entire course.

Methodology: An entire batch of 130 medical undergraduates were assessed using Jacobsen's Scale For Physician Empathy (JSPE) student version. They were first evaluated in Sep 2011, within a month of joining the medical college. They were re-evaluated every September until 2015. In addition their academic, extracurricular performance was also evaluated using a performa. Analysis was done to find change in empathy, relation to gender, academic and extracurricular performance.

Result: A significant decline in empathy was noted from first to second year. No further decline noted. There was no co-relation found between empathy, academic & extracurricular performance over five years. The gender differences in empathy is significant only in first year. These and other parameters are analysed and discussed.

Conclusion: First such study from India showing significant decline in empathy in second year but no significant factors co-related with this. There is a need to further explore possible causes for this decline.

Organic Delusional Disorder (Epileptic-psychosis)

Spandana Devabhaktuni, Shivaji Marella, Ishan C, Shivang Aggarwal, Saldanha D

Department of Psychiatry, Dr D Y Patil Medical College Pimpri, Pune.

[email protected]

Background: Diagnosis of psychosis in the Background of longstanding epilepsy as an epileptic psychosis has been reported by a number of researchers in the past. An unusual case of posttraumatic epilepsy with psychosis is presented. 26yr old male, post-traumatic epilepsy of 10 years, on anticonvulsants, presented with fearfulness, suspiciousness, hearing of voices of 8 days duration. The complaints were acute in onset. General and systemic examination was NAD. MSE showed anxious mood, delusions of persecution, auditory hallucinations derogatory, commenting on patient and his activities, impaired judgement and absent insight. He was treated with atypical antipsychotics- olanzapine and first generation antipsychotic trifluperazinealongwithCarbamazepine 200mg TDS continued on the advice of Neurophysician.

Discussion: Head injury is a common cause of epilepsy.Pathology may be due to a circumscribed and superficial haemorrhage or a more extensive glial reaction with atrophy and distortion of brain visible on neuroimaging.Psychiatric presentations in epilepsy are classified into Pre-ictal, ictal, Post-ictal and Inter-ictal categories.The inter-ictal category includes disorders that would meet diagnostic criteria for depression or schizophrenia .Epilepsy may be associated with schizophrenia-like psychosis. It is likely that structural brain abnormalities, e.g., cortical dysgenesis or diffuse brain lesions, underlie both epilepsy and psychosis, and that the seizures modify the presentation of the psychosis, and vice versa.Landolt* found a paradoxical normalisation of the electro-encephalogram in patients with epilepsy while psychotic episodes became manifest. Strikingly simultaneous with the disappearance of psychotic symptoms epileptic seizures and accompanying EEG changes were found. The inter-ictal schizophrenia-like psychoses of epilepsy are psychotic disorders that would meet the criteria for schizophrenia was it not for the coexistence of epilepsy. It is a chronic disorder and clinically resembles chronic schizophrenia (symptoms of delusions, hallucinations, thought disorder) but there are some reports that personality is better preserved.

Key words: posttraumatic epilepsy, chronic schizophrenia, Carbamazepine

Psychiatric Co-Morbidity in Patients with Epilepsy

Danish Hussain

[email protected]

Aims And Objectives: To assess Psychiatric Co-morbidity in patients with Epilepsy

Introduction: Psychiatric disorders have been identified in a significant proportion of patients with epilepsy, with higher prevalence among patients with poorly controlled seizures. These disorders include depression, anxiety, psychotic disorders and cognitive changes. There has been a significant amount of research looking into the prevalence of these psychiatric disorders in patients with epilepsy both in developed as well as rapidly developing countries like that of India. In addition to this there are technological advances in terms of evaluation and intervention in the backdrop of rapidly changing socio-cultural and economical aspects of our societies. It is therefore worthwhile to observe the changing trends in this field of neuropsychiatric aspects of epilepsy.

Methodology: A cross-sectional descriptive study was done on 30 consecutive patients of either sex diagnosed with epilepsy by the consultant neurologist. The patients were assessed in the Department of Psychiatry, VIMS & RC, using a semi-structured sociodemographic proforma designed for the study. The co-morbid psychiatric disorder was diagnosed as per ICD-10 classification of Mental and Behavioural disorders.

Results: In our study 66% of the subjects were found to be males with 73.3% hailing from rural areas and 70% belonging to a low socioeconomic strata. The most common type of epilepsy according to ILAE classification was found to be generalised tonic clonic seizures (GTCS) making upto 50% of the total diagnosis with 26.6% having no psychiatric illness. The most common psychiatric co-morbidities found within the sample size where Generalised Anxiety Disorder (GAD) and Dysthymia with 26.6% and 23.3% respectively. The further detailed semiological characteristics and clinical variables shall be discussed at the time of presentation.

Key words: epilepsy, psychiatric disorder, Behavioural disorders.

Quality of Life, Coping Behaviour and Psychological Well Being Among the Caregivers of Cannabis Induced Psychosis Patients: A Cross-Sectional Study

Vivek Dave, Arunanshu Parial, Sonal Shukla

Department of Psychiatry, Post Graduate Institute of Behavioural and Medical Sciences, Raipur, Chattisgarh, India. [email protected]

Background: Cannabis products like charas, bhang, or ganja are abused throughout the country because it has attained religious sanctity. Taking care of the patients is responsibility of family and especially in the Indian context. Care giver is someone usually close to the patient like father, mother, siblings or spouse. Patient's illness substantially affects the quality of life of family members, financial security, mental health, social networks, and productivity. Family is the key resource in caregiving of mentally ill patients in India. Burden felt by family is said to be largely determined by family environment in terms of coping styles of family members and their tolerance of patient's aberrant behaviour which has a huge impact on caregivers Well-being and Quality of life.

Aim: The Aim of study is to evaluate quality of life, coping behaviour, and psychological well-being among caregivers of cannabis induced psychosis patients.

Materials And Methods: The study was conducted at Post Graduate Institute of Behavioural and Medical Sciences, Raipur, Chattisgarh. It is a cross sectional study where 72 patients with cannabis induced psychosis and their care givers who full filled the inclusion criteria were selected through purposive sampling. Further these patients were divided into two groups, 36 patients who have consumed cannabis for less than 2 years and 36 patients who have consumed cannabis for more than 2 years. They were assessed using sociodemographic and clinical data sheet, PGI wellbeing measure, General Health Questionnare (GHQ-5), WHOQOL- Brief Scale, Brief COPE Carver C.S scale. The patients were assessed using Brief Psychiatric rating scale.

Results and Conclusion: Will be discussed during presentation.


Stigma About Mental Illness & Knowledge Towards Mental Health Among Interns and Post Graduates

B. Sridhar, M. Raghu Ram, Pramod KR Mallepalli

Dept. of psychiatry, Mamata Medical College,Khammam. [email protected]

Background: Stigma is significantly prevalent in general population and also among medical professionals, which is hindering people from availing mental health services.

Aim: To evaluateif there is stigma towards mental illness, knowledge towards mental health, among interns and post graduates in a medical college.

Materials & Methodology: The study is cross sectional and was conducted in Mamata General Hospital under Psychiatry Department from April 2014- 2015. Four stigma measures were used in the study, two of which measure the stigma of mental illness DD (Devaluation and discrimination scale) and SDS (Social distance scale), while the other two assess the stigma associated with seeking help for a mental illness PSOSH( Perceptions of Stigmatization by others for seeking help) and SSOSH( Self -stigma of Seeking Help). Also, the LCR (Level-of-Contact Report) which measures prior exposure to and contact with mental illness. Finally, Knowledge is assessed using MAKS (Mental Health Knowledge Schedule).

Results & Discussion: Results of total 113 subjects(interns and post graduates) were analysed statistically - as whole group, interns v pg.'s, males vs. females on whole comparing all scales using Student t-test and ANOVA 1 way. The Results show that all subjects have some form of stigma toward mental illness according to mean scores of each scale. The only major statistical significancewas between male DD vs. Female DD (p -0.002), which states that females have more stigma, towards mental illness. LCR mean score was high &Previous contact with mental illness did not correlate significantly with the other stigma measures used in this study.Interns and post graduates have adequate knowledge and there was no significant difference in knowledge.

Conclusion: Knowledge about mental health and LCR are not sufficient to reduce stigma. Modifications to existing medical curriculum would help reduce stigma of medical students towards mentally ill.

Keywords: Devaluation and discrimination scale, Social distance scale, Level-of-Contact Report

Understanting the Aetiology of Schizophrenia Based on A Case of Schizophrenia with Early Bilateral Visual Loss and Occipital Gliosis

Kavitha M S

Vasantham, Kunnakkavu (Po), Perinthalmanna, Kerala.

[email protected]

Background: Schizophrenia is a chronic mental illness affecting approximately 1% of the population. A primary impediment to developing more effective treatment is the limited understanding of the etiology and neurobiology of this disorder. Neuroimaging studies demonstrated alterations in both structural and functional measures. There are controversies between neurodevelopmental and neurodegenerative hypotheses for the neuropathology of schizophrenia. Role of gliosis and role of early blindness in the genesis of schizophrenia are discussed in many studies.

Objective: To describe a case of schizophrenia with catatonic symptoms, early bilateral visual loss, occipital gliosis and try to understand aetiology of schizophrenia.

Case Report: 55 year old man withpast history of bilateral progressive visual loss since 10 years of age, presented with continuous course of gradually progressing illness of 15 years duration characterized by social withdrawal, occupational dysfunction, personality deterioration, delusion of persecution, delusion of grandiosity, bizarre delusions, hallucinatory behavior, emotional detachment, irritability, sleep disturbances, sleeping in sitting position. Patient was in catatonia. Treated with Lorazepam and Risperidone. CT brain showed right occipital gliosis. Patientshowed improvement with medication.

Discussion: Earlier it was believed that early blindness is a protective factor for schizophrenia. Studies on brain structure, revealed abnormalities of certain brain areas, especially posterior pole of occipital cortex, both in blindness and schizophrenia. The studies of gliosis in schizophrenia have yielded mixed Results- whether is a normal response to a pathological process or is secondary to very early developmental processes. This case report points towards the neurodevelopmental aetiology of schizophrenia.

Conclusion: The neuropathology of schizophrenia remains elusive. More studies has to be carried out. Structural pathology identification will help to improve quality of diagnosis and treatment of schizophrenia and there by reducing stigma.

Keywords: Neuroimaging, neurodevelopmental aetiology, schizophrenia

Prevalence of Depression and its Associated Factors Among Medical Students: Andhra Medical College, Visakhapatnam

K. V. Rami Reddy, Prasanna Rani, Sandeep P.

Andhra Medical College, Vishakapatnam. [email protected]

Background: Depression among medical students is a neglected public health problem in India.Early onset of depression among this group interferes with psychological,social and academic functioning, placing them at greater risk for suicidal behavior.A variety of factors were associated with depression among medical students.

Aims & Objectives: To assess the prevalence of depression and its associated factors including type D personality among medical students.

Materials: 1. Beck's Depression Inventory, 2. Distress Scale 14 (DS14)for type D personality.

Methods:A stratified random sample of 300 medical students from 4th- 9th semester wereassessed using Beck's Depression Inventory.Associations between depression and class of studying,type D personality,social factors like alcohol use, family problems,personal problems,family history of depression,staying away from home were analysed by univariate analysis.

Results: The overall prevalence of depression was found to be 38%.Among those, majority 34.67%has mild &moderate degree of depression.The study showed that63.15%(72) of the depressed were females & 36.84%(42) were males.According to cutoff scores,62%(186)students scored as normal(0-9),25%(75) as mild(10-18), 9.67%(29) as moderate(19-29),2.67%(9) as severe (30-40)and there were no cases of very severe depression[>40] .The prevalence of depression was significantly more among those with family problems,personal problems and family history of depression.This study showed the overall prevalence of type D personality as 36% (108) and both type D and depression were present in64.91%(74),this showed significant association of type D personality with depression.

Conclusion: Depression was highly prevalent among medical students of this area.Our findings point to the importance of broad screening and psychiatric counselling of this vulnerable population.

Key Words: Beck's Depression Inventory,type D personality.

Cognition and OST Drug Adherence in Patients With Opioid Dependence

Shabina Seth

Government Medical College, Surat. [email protected]

Objective: To assess the Cognition,Medical complications, Social, Financial impact of Opioid addiction and to study Cognition and its relation with OST Drug Adherence in patients with Opioid dependence.

Method: Department of Psychiatry is running DOST Centre for Opioid dependent patients for last 3 years. All patients taking OST as a part of DOTS were enrolled in this study.After taking Informed valid consent from all the participants, 'Participant Information Sheet' will be given.Semi structured questionnaires which investigate qualitative and quantitative information about Opioid and other substance use with related complications, Scales like ACER III - Hindi and MMSE for cognitive assessment were used and analyzed.

Results and Conclusion: Out of 22 patients coming to DOST Centre for OST 22.72%,31.81% and 45.45% patients are Irregular, Regular, Very Regular respectively.While studying relation between Cognition and OST Adherence, it is found that mean MMSE score in Irregular, Regular and Very Regular patients are 21.8, 23.29, 22.8 respectively and ACER score in Irregular, Regular and Very Regular patients are 63.2, 79.57, 67.9 respectively. As there is no significant Result outcome regarding comparison of Adherence with other variables, it can be concluded that factors like Education, Marital status, Socioeconomic status, Social support don't affect OST adherence in DOTS.Rather, the only robust factor which affects OST Adherence is Cognitive decline of the patient which is responsiblefor noBehavioral changes,Harmful use, Relapseand not maintaining Abstinence in Opioid dependent patients.

Keywords: Opioid dependence, OST Drug Adherence, DOST

Clinical Profile of Children Presenting with School Refusal : A Retrospective Analysis

Bijal Sangoiajita Nayakhrishikesh Nachane

[email protected]

Introduction: School refusal is a serious problem seen in around 1-5% of all school going children. It can be defined as'child motivated refusal to attend or difficulties remaining in school for the entire day'. The child usually stays or returns home and doesn't attempt to conceal their non-attendance. It is generally associated with other behavioural and emotional problems, which if not addressed immediately, can have a negative impact on the mental health of the child in his crucial growing-up years.

Aims And Objectives: There is dearth of literature on school refusal in India The Aim was to study the clinical profiles, socio-demographic factors, and the diagnosis associated with school refusal. The type of family, parental conflicts and birth complications were also studied.

Method: The study consisted of a retrospective analysis of children with school refusal attending the Child Guidance Clinic of a tertiary centre in Mumbai in the period of June 2013 to June2015. Children aged 5-16 years were included in the study. A semi-structured proforma was used to note the socio-demographic and birth details, and history of parental conflict. The clinical diagnosis was made using DSM-IVTR.

Results And Conclusion: 45 children(27males & 18females) presented with school refusal. Depression was diagnosed in 49.2%, anxiety in 37.7%, ADHD in 22%, Mental Retardation in 20%, conversion disorder in 8.8% and unexplained physical symptoms found in 37.7%. 1child was diagnosed with schizophrenia and 3with OCD. Parental conflict was present in 33.3% cases. Thus this study shows that children with school refusal should be screened for psychopathology so that early intervention can be instituted.

Key words: School refusal, DSM-IVTR, ADHD

"Co-Morbid Psychiatric and Medical Disorders in Patients with Bipolar Disorder"

Deepak R. Awchat, Subhangi R. Parkar, Sameer Kalani, Sanjay Ghuge

Department of Psychiatry, KEM Hospital, Mumbai.

[email protected]

Background: Bipolar disorder often exists with other psychiatric and medical disorder. Lifetime psychiatric co-morbidity in bipolar disorder varies from 50% to 70% in many of the hospitalized patients. Amongst this obsessive compulsive disorder and substance use disorder occurred more often after the onset of bipolar disorder. Similarly medical disorders also coexist with bipolar disorder, many neurological disorders such as stroke, tumor, and head trauma can cause secondary mania. It is possible that bipolar disorder is expression of primary medical disorder. Altogether, the burden of illness attributable to both psychiatric and medical co-morbidity in bipolar patients. Hence there is the need for conceptualizing co-morbidity as a primary target for preventative strategies and therapeutic interventions.

Aims: With this Background authors have decided to study psychiatric and medical disorders in bipolar disorder.

Methodolgy: The 70 patients with Bipolar disorder were recruited from the General Hospital Psychiatry Unit at KEM hospital Mumbai, after an approval of the Ethics Committee. Patients were interviewed using Semi Mini International Neuropsychiatric Interview (MINI) scale for assessment of co-morbid psychiatric illness on Axis 1 of DSM IV TR. Co-morbid medical conditions were identified as per the clinical diagnosis of the patients provided by the respective specialty consultants and the clinical notes on case record forms .

Results And Conclusion: Anxiety disorders were most common in 50% of the 70 bipolar patients studied. Mood disorder with psychotic features were present in 37.1% of subjects. Attention deficit hyperactivity disorder was present 2.9% patients. Co-morbid substance use disorder was seen in 35.7% patients with 24.3% having alcohol use disorder and 11.4% had other substance use disorder.In these patients 60% reported co-morbid medical/surgical illness such as Obesity and overweight in 27.14%, hypertension in 14.3% and diabetes mellitus in 12.3%.

Key words: Anxiety disorders, Bipolar disorder, therapeutic interventions.

A study of Anxiety and Depression in Vitiligo Patients: A New Challenge to Treat

Divyesh Baranwal, D. K.Sharma, C. S. Sushil, D. K. Vijayvergia

Govt. Medical College, Kota (Rajasthan). [email protected]

Background: Vitiligo affects around 0.5% of the population. The burden of disease perceived by patients seems to be underestimated by the medical community.

Aims & Objectives: To find out the influence of various Socio-Demographic factors & various psychiatric co-morbidities in vitiligo patients.

Methodology: Sample of study: 100 patients diagnosed vitiligo by consultant Dermatologist attending Dermatology department of NMCH, Kota were taken for study and 100 suitably matched subjects preferably the relatives of the patients constituted the control group, who were well enough to complete the assessment.

Scale: A semi-structured self designed Proforma to obtain Socio-demographic data. Goldberg's Health Questionnaire-12 (GHQ-12), Rosenberg's Self-Esteem Scale, Sheehan Disability Scale (SDS) and Hospital Anxiety and Depression Scale (HADA) to obtain the relevant information. Data so obtained were tabulated, analyzed & Conclusion were drawn using suitable statistics (i.e. chi square).

Results & Conclusion: In comparison to healthy controls, the rate of psychiatric morbidity was found to be significantly higher and mean self-esteem score was found to be significantly lower in the vitiligo group. Majority of the patients were disabled. Among the vitiligo cases, psychiatric morbidity was found more frequent in young participants. Anxiety and social avoidance scores negatively correlated with age. Details of Results will be discussed at the time of presentation.

Future suggestions: A simple perceived severity scale is useful in clinical practice.

Keywords: Self esteem, psychiatric morbidity, anxiety, Depression, vitiligo.

A Study to Evaluate the Effect of Escitalopram on Serum Il-6 Levels in Patients of Depression

Hiten Saresa, Anuradha Nischal, Anil Nischal, Manu Agarwal, Abbas A. Mahdi, K. K. Pant

Department of Pharmacology, King George's Medical University, Lucknow. [email protected]

Introduction: Inflammatory process has been implicated in pathophysiology of depression.Non-response to therapy is associated with increased inflammatory markers.

Objective:Toestimate serum IL-6 levels in patients of depression and to study the correlation between serum IL-6 levels and response to escitalopram, if any.

Methods:Patients suffering from depression(n=120) as per WHO ICD-10 criteria were enrolled in the study and prescribed escitalopram 10mg/day for 4 weeks.Patients were categorized into responders(>50% reduction in score), partial responders(25-50% reduction in score) and non-responders(<25% reduction in score)according to MADRS(Montgomery-Asberg Depression Rating Scale).Responders(Group I) were continued on Escitalopram 10 mg/day for further 4 weeks.Partial responderswere subdivided into Group II(Escitalopram 10 mg/day) and III(Escitalopram 20 mg/day) for another 4 weeks.In Non-responders(Group IV)20 mg/day of escitalopram was prescribed for 4 weeks.MADRS and serum IL-6 levels were measured in all the groups at 0,4 and 8 weeks.

Results:MADRS score decreased significantly in all the groups after 8 weeks of therapy.MADRS score evaluation also revealed significant clinical improvement in group III and IV at week 8 implying that dose increment is better strategy in both partial and non-responders.When serum IL-6 levels were compared between group III and group IV at week 8, there was statistically significant difference implying that dose augmentation of escitalopram is more effective in non-responders compared to partial responders in lowering serum IL-6 levels.

Conclusion:No significant correlation between MADRS score change from 0 to 4 week and change of serum IL-6 levels from 0 to 4 week was found. Significant positive correlation was seen between change in MADRS score from week 0 to week 8 and change in serum IL-6 levels from week 0 to week 8.

Keywords: Depression, MADRS, serum IL-6, Partial responder, Non-responder, Escitalopram

"A Study of Effect of Orientation Programme on Attitude Towards Psychiatry in Newly Entrant Undergraduate Medical Students"

Pankaj Kumar Mittal, Krishna Prasad M, Neha Agarwal

1025, Type - 1 Quarters, Aiims Residential Campus, Saket Nagar, Bhopal (M.p.). [email protected]

Aims & Objectives: Attitude of an individual determines orientation towards environment. Negative attitudes toward psychiatry and psychiatrists may be well established even before entry into medical colleges. For example, denigrating fictional images of mental illness are frequent in the media and potent.This study Aimed to assess the effectiveness of orientation programme on attitude toward psychiatry as speciality

Materials And Methods:This was a cross-sectional, single assessment study conducted at a tertiary hospital in Central India. The participants consisted of newly enrolled medical students of 1styear who didn't have any exposure to any subject of MBBS curriculum. Participants were

individually administered socio-demographic Performa and attitude towards psychiatry-30 (ATP-30) scale before and after three hour session of orientation programme by department of psychiatry.Statistical analysis done with the help of SPSS version 20.

Results: The study Results shows significant changes (p value < 0.05) on the domain of attitudes towards psychiatric patients and mental illnesses, attitude towards psychiatrist and psychiatry, attitude towards psychiatric knowledge and teaching and attitude toward psychiatric treatment and hospitals measured before and after orientation session on paired "t" test.

Conclusion: In this study we concluded that newly entrants undergraduate medical students have negative attitude towards psychiatry, psychiatric patients and psychiatry as a career and it can be changed effectively just orienting towards psychiatry by clearing myths.

Key words: Attitude, cross-sectional, mental illnesses,

A Comparative Study of Non Adherence Among Chronic Schizophrenia and Chronic O cd0 Patients

Preethi V Reddy, G Gopalakrishnan, Raghavendra Kumar K, Lavanya A

MVI Medical College And Research Hospital Hoskote, Bangalore. [email protected]

Background: Medical compliance or adherence is the extent to which the patient's behaviour coincides with medical or health advice. The consequences of poor adherence to long-term therapies are poor health outcomes and increased health care costs. Nonadherence is a problem among all fields of medicine and psychiatry is not an exception. Studies show that psychotic and neurotic patients differ in the rates and reasons for non adherence.

Methods: A descriptive study conducted among schizophrenia (n=60) and OCD (n=60) patients consecutive sampling. Medication adherence rating scale (MARS) used to assess adherence among schizophrenia patients and Morisky Medication Adherence Scale (MMAS) for OCD patients. Factors responsible for non adherence assessed using a semi structured proforma. Descriptive statistics and Chi square test and used for statistical analysis.

Results: Non adherence rates in our study showed no significant difference among the two groups. Schizophrenia 56.7% & OCD 53.3%. Socio-demographic factors like unemployment and comorbid substance use were associated with Nonadherence. Most common factors or reasons associated with non adherence were forgetfulness, longer duration of treatment, drug side effects and financial problems. There were differences noted among the two groups in terms of factors responsible for non adherence.

Conclusion: Clearly, non-adherence is a major public health problem that is likely to continue despite treatment advances. Whether psychotic or neurotic disorder non adherence is significantly high. It is also important to know differences in factorsresponsible for non adherence between the groups, as clinicians need to plan interventions and develop more effective strategies to improve adherence.

Key words: adherence, comorbid substance, Morisky Medication Adherence Scale

Hiv Status Among Morphine Addicts -A Study Conducted at Swami Vivekananda Drug Deaddiction And Treatment Centre

Gurpreetsingh, P. D. Garg, Manjit Singh, Rajiv Arora, Neeru Bala, Khushbinder Singh

P. G Hostel F-Block, Near Swami Vivekananda deaddictioncentre, G.M.C Amritsar. [email protected]

Introduction: HIV epidemic continues to be the most severe public health problem and concern across the globe with about 33 million people infected with HIV. HIV-1infected patients suffer from a wide range of neurological and neurocognitive disorders collectively known as HIV-associated neurocognitive disorder (HAND).Injection drug users are at a higher risk of getting infected with HIV and have greater chances of developing neurological abnormalities. Combined HIV infection along with opiate drug addiction has gained attention in the recent years and is an emerging problem in the post-HAART era.As the number of substance abusers is on the rise in Punjab so is the number of HIV positivesThis study Aims to find the HIV status among these addicts.

Material And Method: A cross-sectional study was conducted between february 2014 up to may 2015.A total of 10133 patients on outdoor basis were included and their urine was screened for various drugs (with rapid visual assay tests) as per the data provided in the interview. Patients found positive for morphine were tested for anti-HIV antibodies using immunoassay tests.

Results: 6883 patients were found positive for morphine. Among these morphine users, 1162 were injectable drug users and 61 patients were found positive for aniHIVantibodies among these injectable drug addicts.

Conclusion: High no of HIV positives among morphine dependent IDUs indicates the need to find out the risk factors in such cases and thus create an awareness for the prevention of such occurrences.

Keywords: HIV epidemic, HAART,

A Study of Factors Associated with Adherence to Treatment in Schizophrenia

Nilam Shivajirao Behere

#.1102,Ug-Pg Hostel,Kem Hospital, Parel, Mumbai, Maharastra. [email protected]

Introduction: Schizophrenia is a major mental disorder with a prevalence of 1% worldwide. Due to the chronic nature of illness and remitting-relapsing course, patients are subjected to regular longterm treatment, many a times lifelong.So adherence to the treatment plays a crucial role in the course of illness. Various reasons for nonadherenceinclude severity of the illness, adverse effect of medicines, various socio-demographic factors and the patients' and caretakers' knowledge about the illness.Insight and willingness for treatment,family support,the expenses for treatment and travelling distance to hospital are other important aspects.This study Aimed at evaluation of these factors and their contribution to the adherence to treatment.

Methodology: The study was conducted in Department of Psychiatry of G.S.Medical College and KEM Hospital,Mumbai. 100 patients of schizophrenia were selected fulfilling inclusion and exclusion criteria. A case record form with information of various socio-demographic factors like age, gender, education,occupation,family type, financial status, comorbidity was used. The statistical analysis of the collected data was done using appropriate statistical tests.

Results and Discussion: In our data 67% patients were found to be adherent,22% partially adherent and 11% nonadherent. The age and gender of the patient did not bear any significance with adherence(p value 0.765 and 0.788 respectively). Adherence was not found to be associated with time and expenses for travelling(p value0.243 and 0.253 respectively). 39% of the patients were found to have substance use,mostly tobacco. Factors like age,gender,time and distance travelled did not bear direct association with adherence. However as the course of illness progressed,compliance improved. The caretaker's endurance to treatment and supervision by doctor improved adherence in subsequent course of illness.

Key words: Schizophrenia, nonadherent.

Depression and Anxiety in Head and Neck Cancer Patients Before and after Radiotherapy

Rahul Savalgi, Chitra Venkateswaran, Kesavan Kutty Nayar

Department of Psychiatry, Amrita Institute of Medical Sciences, Kochi, Kerala. [email protected]

Introduction: Radiotherapy which is the backbone for most of the head and neck cancer treatments has several known adverse effects which when clubbed along with surgery and chemotherapy are one of the most disfiguring and debilitating treatment among all the cancer treatments, and may cause increased levels of depression and anxiety in these patients.So this study was designed to follow the psychological trajectory of Indian head and neck cancer patients before and after radiotherapy.

Objective: To assess symptoms of depression and anxiety in patients with head andneck cancers before and after radiotherapy.

Methods: Prospective observational study of 100 patientswith head and neck cancer patients was conducted at a tertiary cancer centre over a periodof 24 months. Symptoms of depression and anxiety were assessed by theHospital Anxiety and Depression Scale (HADS) before and after Radiotherapy.

Results: Mean depression score increased from 6.37 to 8.81 and mean anxiety scores increased from 5.44 to 6.63 from before to afterradiotherapy. Prevalence of depression increased from 24% pre treatment to an addition of 35.5% of subjects after radiotherapy.Pre and post radiotherapy depression were associated with higher educated subjects.Post radiotherapy anxiety was associated with lower income group.

Conclusion: These findings suggest that rates of depression in patients with Head and Neck Cancers increase after cancer treatment, with an addition of a third of subjects experiencing clinically significantsymptoms of depression after radiotherapy.

Key words: Radiotherapy, depression, Head and Neck Cancers

Comparison of Two Cognitive Assessment Scales - The Dasii and Bayley Iii0 in the Indian Context

Rita Roy, Suchandra Mukherjee

Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal. [email protected]

Aim: To compare two development assessment scales- Development Assessment Scale for Indian Infants (DASII) and Bayley Scales of Infant and Toddler Development (3rd edition) among 18-24 month old children born term and preterm ;and determine whether the DASII still holds significant value in evaluating cognitive and language development of the Indian child.

Methods: This study included 32 term and 18 preterm children between 18 and 24 months, ages adjusted for preterm babies. DASII which gives scores as mental and motor developmental quotients (MeDQ, MoDQ) was used to assess development at 18 months .To better understand the cognitive and language development; the same children were assessed using Bayley III at 24 months.

Results: Scores for cognition on DASII and on Bayley matched in most of the babies (33/50). Lower scores in Bayley was seen where behavioural issues including non compliance were present. However, language scores of Bayley varied widely with MeDQ showing significant discrepancy.

Conclusion: DASII, which was adapted from the first edition of Bayley (BSID1969) and standardized among Indian infants, is comparable to Bayley III in terms of cognitive assessment. However, it is not so for language development test. Specific terms and words expected from a child during the language test - not familiar to the Indian child Resulted in lower scores and significant discrepancy. Even though DASII can be used to test cognitive ability of a child with almost the same efficacy as Bayley III; items in the language test need adaptation before application to an Indian child.

Keywords: Cognitive assessment, DAS-II, Bayley III

Assessment of Chronic Care Services (ACIC) for Mental Disordersat Community Health Centers (CHCs) in Sehore District of Madhya Pradesh, India

Shital Muke, Shalini Ahuja, Sharmishtha Nanda, Sandesh Samudre, Rahul Shidhaye

Public Health Foundation of India (PHFI), Bhopal, India. [email protected]

Background: In high income countries, collaborative chronic care models in primary care settings have been found to achieve superior outcomes for people with mental disorders, particularly depression(Thota et al., 2012; Woltmann et al, 2012).In India, there is insufficient knowledge of best system level practices to support pathways to and through care to facilitate recovery within an integrated chronic care model. In the context of integrating primary health care service delivery, present study carried out to understand existing chronic care services at CHC level.

Objective: The Objectives of the study was to assess theexisting chronic collaborative care services for priority mental disorders (depression, AUD and schizophrenia) at community health (center) facility level.

Methods: Quantitative cross sectionalstudy design was adapted to assess chronic illness care using ACIC (Bonomi et al., 2002) questionnaire at three CHCsBilkisganj, Shyampur and Doraha where mental health services are integrated with primary care through PRIME program in Sehore district of Madhya Pradesh. Total 50 service providers, consisting of medical officers, case managers, staff nurses, pharmacist, ANM and ASHA were recruited for the study based on purposive sampling technique. SPSS software was used to enter and analyze data applying appropriate descriptive statistics.

Result: The overall mean score on ACIC was 3.2,indicated that three CHCs in Sehore district has basic level services for chronic care management of psychiatric disorders.

Conclusion: Effective and innovative strategies needed to be planned and implement to address gaps in chronic care services for better illness outcome and service delivery.

Keywords: chronic care services, ASHA, ANM

Study of Knowledge and Attitude Regarding Alcohol Among College Students

Darshan Patel, Gaurav Verma, Gauttam Prajapati, Tejas Patel, G K Vankar

Department of Psychiatry, B.J.Medical College, Civil Hospital, Ahmedabad, Gujarat. [email protected]

Background: Alcohol use common among adolescent, specially the college going students. This age group is also at risk of binge drinking and rapid progress to dependence. Hence it is important to spread the awareness regarding the alcohol use and its effect on physical, social, mental health.

Aims: To study the knowledge and awareness among college students, regarding alcohol use.

Setting and Design: A questionnaire of 39 questions consisting of 3 sections, each about the knowledge (21 True/False questions), attitude (15, 5-point Likert questions) and practice (3 questions) of the students, respectively.

Materials And Method: B.Com (Bachelor of commerce) students from a college in Kadi town of Ahmedabad district. The students were given 15 minutes to fill up the questionnaire just prior to educational intervention on Alcohol Use Disorder.

The statistical analysis was done using SPSS version 17 .

Results: 527 students completed the questioner. In general knowledge about alcohol use disorder was good, mean knowledge score 15.32 (SD 2.76) . In section two >2/3 students believed that alcohol use is not a psychiatric illness. 1/3 students believed that persons with alcohol use will never quit it. Half of students agreed that person with alcohol use is not reliable . Regarding prohibition as act violation of personal freedom the opinion was divided. Alcohol use was reported by only 7(1.3%) students and similar number of students agreed to be having someone having alcohol related disorder in their family.

Conclusion: Study found that college student's knowledge about alcohol use disorder was good however majority believed that alcohol use disorders are not psychiatric disorders.

Alcohol use among college students was infrequent.

Keywords: knowledge, Awareness, Alcohol, Students.

Juvenile Batten Disease: A Case Report

Gauravverma, Nilima Shah, G. K. Vankar, Gauttam Prajapati, Sarthak Dave, Taskin Jambusarvala

[email protected]

Introduction: Neuronal ceroidlipofuscinosis( NCL) is a rare,autosomal recessive, lysosomal storage disease, that presents with vision impairment, regression of mile stones and seizures. Gradually, the child becomes bedridden and dies. Four different types(Infantile, Late infantile, Juvenile, Adult) have been described based on age of onset of illness.

Case Report: Eleven years old male child presented with vision impairment, regression of mile stone, seizures and autistic features with bladder and bowel incontinence. Fundus examination revealed 'Bull's eye' maculopathy. EEG showed encephalopathic changes with epileptic discharges. MRI brain demonstrated loss of white matter with abnormal T2/FLAIR hyperintensity involving periventricular and deep white matter in the right fronto-temporo-parieto-occipetal region with cerebral cortical atrophy.On the basis of above findings we considered the possibility of Batten disease-Juvenile type. A skin biopsy from axilla was sent to see thepresence of inclusion bodies.Sodium valproate 1 gm, Phenytoin 300 mg and antioxidants (Vit C and E) were started. At two months of followup, seizures, autistic features, incontinence have remitted. Vision impairment persists.

Discussion: Batten disease is rare in Asia. Two main case series (Kamate et al., Sinha et al.) reported from India described total 28 cases of which 8 were of juvenile onset. Patients presenting with such symptoms are often diagnosed as mental retardation with epilepsy, retinitis pigmentosa or childhood disintegrative disorder; and the specific diagnosis of Battten's is missed. It must be suspected if fundus shows Bull's eye maculopathy and then confirmed by skin biopsy and gene analysis. Prognosis of disease remains poor, though antioxidant therapy can perhaps delay the deterioration.

Conclusion: Patient presented with regression of milestones, vision impairment and seizures. Though rare, Batten disease is an important differential diagnosis to be kept in mind, considering the role of anti-oxidant treatment, overall poor prognosis and implication for genetic counselling.

Key words: NCL, Batten disease, regression of mile stones, Bull's eye maculopathy, seizures

A Case Report - Shared Delusional Disorder

Vaishnavi, Venkatlakshmi M, Sathianathen R, Balakrishnan R

Sri Ramachandra Medical College and Research Institute, Chennai. [email protected]

Abstract: Shared delusional disorder- A delusional disorder shared by two or more people with close emotional link. 'Folie a deux' is the term used when psychiatric symptoms, usuallydelusions, are communicated from a mentally ill individual to another individual. When more than two people are involved it is termed as 'Folie a trois','folie a plusieurs'. Here we discuss a case of induced delusional disorder in a mother and daughter who attended the outpatient department of Sri Ramachandra Medical College and Research Institute. The delusion of infidelity towards the husband which the mother developed is transferred to the patients's daughter and she develops the delusion that her father is unfaithful to her mother.

Key words: shared delusional disorder induced delusional disorder, folie a deux, folie a trois.

A Study of Misconceptions About Sexuality in Mbbs0 Interns

Nupur Paul, Niteen N Abhivant, Neena S Sawant, Sanjay Mulje, Alka V Pawar

Department of Psychiatry, B. J. Government Medical College and Sassoon General Hospital, Pune.

Objectives: To study the misconceptions about sexuality among MBBS interns.

Materials And Methods: A semi structured questionnaire was designed based on the prevalent cultural beliefs in Indian society to assess the myths and misconceptions about the various aspects of sexuality regarding breast size, menstruation, masturbation, penis size, sexual activity and homosexuality. It was administered on 115 MBBS interns(62 boysand 53 girls) of a government medical college in Maharashtra.

Results:We found a high prevalence of misconceptions associated with sexuality. It was observed that males had more misconceptions about menstruation and breast size and females had more misconceptions about masturbation and penis size.

Conclusion: This study has elucidated the fact that inspite of having proper scientific education, misconceptions about sexuality have prevailed even among MBBS interns.

Keywords: misconceptions, sexuality, menstruation

Factors Affecting Non-Compliance Among Psychiatric Patients in the Regional Institute of Medical Sciences, Imphal

Maan C G, Munnawar Hussain M S, Heramani N, Lenin R K

Department of Psychiatry, Vydehi Institute of Medical Sciences & Research Centre, Whitefield, Bangalore, Karnataka,India. [email protected]

This study was carried out with an Objective to assess different reasons of medication non-compliance in a sample of out-door psychiatric patients and to evaluate the correlation between clinical variables and causes of non-compliance to drugs. This study was conducted at Psychiatry department, Regional Institute of Medical Sciences; from (30th Sept 2012 to 31st Aug 2013) .Data from a non-probability sample of 50 follow-up patients with a definite psychiatric illness was collected. Patients were recruited who were between 18 and 60 years of age and who were treated in the outpatient clinics of the psychiatry department. Information regarding socio-demographic characteristics (e.g., age, gender, level of education, marital status, and income) were recorded on a proforma designed by the author. A questionnaire designed for this purpose was administered to examine the factors that cause non-compliance. Data was analyzed using SPSS for window 20.0 version. Chi-square analysis done for variable of interest. Non-compliance to drug treatment is most common in between 21-30 years of age groups, more in females 72% than males 28%, those who are married(60%) than single(40% ),and with low education(28%) & low socio-economic status(54%). Notable reasons for non-compliance were feelings of wellness(26%), paranoia to medication(22%),lack of insight to the illness(14%),medication side effects(10%),hopelessness of cure & poor support (8%) respectively.\,financial problems (6%), no improvement(4%), too much of medication(2%). The commonest psychiatric illnesses leading to non-compliance were schizophrenia (26%), BPAD (18%), MDD (14%), psychosis (10%), epilepsy & OCD (8%) each, GAD (6%), somatization disorder & substance induced psychosis (4%) each, panic attack with agoraphobia (1%).

Conclusion: Non-compliance is quite common in psychiatric patients. Medical practitioners need to be aware of it and address this problem because compliance is directly related to the prognosis of the illness.

Key Words: Socio-demographic characteristics, non-compliance, psychiatric illness, reasons.

Reasons for Non-adherence and Attitude Towards Drugs in Patients with Schizophrenia

Prakash B. Behere, Himanshu D. Mansharamani

[email protected]

Background: Schizophrenia is a chronic illness and patients have to continue medications for a long time, due to which a common problem which Results in relapse and re-hospitalization of patients is non-adherence. Hence it is a felt need to know the reasons for non-adherence and plan a strategy to reduce non-adherence among these patients.

Aims: The Aim of this study was to find the reasons of non-adherence and also the attitude of patient towards medications.

Materials And Methods: The study was conducted on 40 follow up patients presenting to out-patient and in-patient setup of Department of Psychiatry, AVBRH, Wardha, who were diagnosed with Schizophrenia and fulfilled the Rosack's Criteria for Non-adherence. The study was conducted over a period of 6 months. Their socio-demographic details were noted. Attitude towards medication was assessed using the Drug Attitude Inventory Scale (DAI-10), and the reasons for non-adherence were assessed using Rating of Medication Influences scale (ROMI).

Results: The DAI-10 scale shows 70% patients in negative domain with a negative mean score of -6.35 ± 0.30. Significant reasons for non-adherence were found to be denial of illness, feeling that medications are un-necessary, economical issues, problem in assessing treatment, distressing side-effects, and stigma with mental illness and opposition of family and friends over taking psychiatric medications.

Conclusion: It can be suggested from the findings, that the patient and relative should be explained about the illness, its course, prognosis and treatment duration, as patient's knowledge about the illness can be regarded as a cornerstone for the treatment success.

Key words: Schizophrenia, Rosack's Criteria, prognosis

Burnout and Empathy Among Post Graduate Residents -Prevalence and Factors Affecting Them

Sharma RK, Shashikumar R, Chatterjee K, Madhusudan T, Srivastava K, Das RC, Prakash J

[email protected]

Introduction: Burnout is a state of mental exhaustion along with the physical stress and emotional deprivation.Cliniciansare particularly more susceptible to developing burnout and residency training has its additional unique stressors. Burnout adversely affects the doctor patient relationship, suboptimal patient satisfaction. Its relation with empathy has been variously reported.

Study design: Due institutional clearances and consent of individual participants were taken. In this cross-sectional study Maslach's Burnout Inventory and Jacobsen's Scale for Physician Empathy (JSPE) Physician version were used to assess burnout &empathy respectively in the postgraduate residents. A psycho-social Performa was used to ascertain various other issues in their lives.The total number of Post Graduate students (PGs) in each year of training was 110 in first year, 138 in second year & 117 in third year.

Results:In this study the rate of burnout is much lesser than previous studies; gender, subject of study did not appear to affect burnout. Factors that are likely to increase burnout were being in first year, having no children,number of hours spent with the family.Having higher levels of empathy protects from burnout but not significantly. These and other variables 'relations are discussed.

Conclusion:This was first of its kind study from India and opens a conundrum of more questions than it answers. Multicenter studies with larger samples would help unfold the extent of burnout and ways to overcome it.

Keywords: Burnout, Jacobsen's Scale, Physician Empathy (JSPE)

Tension Type Headache and Psychiatric Co-Morbidity in A Tertiary Care Hospital: Clinical Aspects

Shashank B, Sattar F. A., Kiran Kumar K., Mridula Priyadarshini, Danish Hussain P, Manasa S.

Department of Psychiatry, Vydehi Institute of Medical Sciences and Research Centre, EPIP area, Bangalore. [email protected]

Aim: To study the prevalence and nature of psychiatric disorders in patients with Tension type headache in a tertiary care facility.

Introduction: The co-morbidity of Tension type headache (TTH) and psychiatric disorders is a well known clinical observation since centuries. Numerous hospital based and community studies have revealed that psychiatric disorders occur with greater frequency among TTH patients than among the general population. However, these studies report a wide variation in the nature and prevalence of psychiatric co-morbidity in TTH because of the differences in the study setting, study design, diagnostic criteria and tools used to qualify and quantify the psychopathology. It is also well known that psychiatric co-morbidity often complicates headache management and portends a poorer prognosis. In this Background the present study was undertaken.

Materials & Method: The study was conducted at the Headache Clinic, Vydehi Institute of Medical Sciences and Research Centre, Bangalore. Thirty patients of Tension type headache diagnosed as per the ICD-10 criteria by qualified Psychiatrist were enrolled after obtaining written informed consent for the study. Psychiatric disorders were assessed using M.I.N.I Plus neuropsychiatric interview by the consultant Psychiatrist. Other possible risk factors and demographic profile were extracted using a specifically designed semi structured proforma.

Results: Out of the 30 patients, 4(13.3%) had depression, 3(10%) had dysthymia, 3(10%) had somatization disorder, 2(6.6%) had generalized anxiety disorder, 2(6.6%) had panic attacks and 2(6.6%) had dissociative conversion disorder. Details of the study will be discussed at the time of presentation.

Keywords: Headache, Prognosis, MINI PLUS.

Psychiatric Morbidity Profiles of Patient Attending Child Guideline Clinic (CGC) at Mental Hospital Indore

Amrita Chauhan, Ujwal Sardesai, Ram Ghulam Razdan, Aman Kishore, Gaurav Chittora

Department of psychiatry, M. G. M. Medical college, Indore. [email protected]

Introduction: Age factor play a great role in pattern of psychiatric morbidities. Various studies from developing countries including India show that a significant percentage (ranging between 7-35%) of child and adolescent population suffers from mental illnesses indicates differing needs and priorities. There clinical profile is different from general psychiatry clinic. So this study is intended to explore clinical profile of patient attending CGC for better understanding of their needs and priorities.

Aims And Objectives: To study the socio-demographic, morbidity profiles and clinical correlates of child and adolescent patients attending Child guideline clinic of mental hospital, Indore.

Material And Method: A cross-sectional observational study of the clinical profile of patients attending CGC clinic from Jan 2013 to Dec at mental hospital Indore.

Result & Discussion: Appropriate statistical analysis was used for analysis the data using SPSS v16 and Results will be discussed at the time of free paper presentation.

Psychosocial Determinants of Drop-Out From Treatment At Child & Adolescent Clinic of National Drug Dependence Treatment Centre

RachnaBhargava, Piyali Mandal, Ankit Gupta, Anju Dhawan

Department of Psychiatry &National Drug Dependence Treatment Centre All India Institute of Medical Sciences. [email protected]

Background: The biggest challenge in treatment of adolescent substance use is tackling the alarming rate of treatment drop-out. The long-term retention rates remain low despite provision of adolescent specific services and several factors may influence the treatment seeking.

Aim: To study the psychosocial determinants associated with drop-out from treatment setting.

Materials And Methods: Retrospective structured chart review of treatment seekers (N=86) attending the Child & Adolescent Clinic of a tertiary centre at National Drug Dependence Treatment Centre was done. The data of cases registered in Clinic between August, 2008 to December, 2014 was reviewed and analysed using SPSS 20. Data related to follow-up and drop-outs was correlated with various socio-demographic and clinical variables.

Results: The patients were mainly males (96.5%) with their mean age being 15.16+2.38 years. They were predominantly from urban Background and most commonly dependent on tobacco, followed by inhalants, heroin and cannabis. The minimum age of initiation of any substance was 6 years among subjects attending the clinic though only 2% reported to have started at this age. However, almost half of the patients had started before the age of 12 years. Further correlational analysis showed that demographic features did not significantly correlate with follow-up. However, clinical and other psychosocial factors emerged significant.

Conclusion: Our finding suggested several factors including presence of psychiatric illness in either self and/or in family were significantly associated with retention in treatment. Since retention in treatment has been documented as one of the important predictor towards relapse prevention and abstinence, the study has important clinical implications.

Key words: drop-out from treatment, substance, treatment.

Cross Sectional Study of Knowledge, Attitude and Practices About Effects of Alcohol on Sexual Functioning in Patients Presenting with Alcohol use Disorder and Sexual Problems

Nilanjan Chandra

Mnop Block, New Civil Hospital, Surat, Gujarat.

[email protected]

Objective: To assess the Knowledge, Attitude, Practices (KAP) about sex with or without alcohol in patients presenting with alcohol use disorder and sexual problems,and to see risky sexual behavior under influence of alcohol and comparison between these two different groups attending Alcohol group meeting(ALG) and Psychosexual counseling(PSG)to see the commonalities and differences of their KAP about effects of alcohol on sexual functioning.

Method:Two different groupsas alcohol group meeting and group for psychosexualcounseling are being run by Psychiatry Department,NCH, Surat.All patients in the age group of 15 to 65, participating ineither of these two sessions were enrolled,10 sessions each of ALG & PSG were taken separately. Same semi structured questionnaire covering qualitative and quantitative information about KAP about effects of Alcohol on sexual functioning wasadministered for both groups,which wasanalyzed and compared.

Results and Conclusion: 79.16% patients of ALG and 82% patients of PSGhad correct knowledge of effects of Alcohol on sex. 58.33% vs 28.13% of ALG and 48.33%vs 31.66% of PSG have healthy vs unhealthy attitude respectively. Regarding practice, 41.7% of ALG and none of PSG takes alcohol regularly before sex.66.7% of ALG but only 6.7% of PSG enjoy sex better after drinking alcohol.33.3% of ALG but only 13.3% of PSG had sex with CSW after alcohol. None of PSG had casual unwanted sex or sex without condom, 41.7% and 66.7% of ALG had casual unwanted sexand sex unknowingly without condom respectively after alcohol consumption.Despite good knowledge and healthier attitude, sexual practices are significantly different in Alcohol dependents. Thus,Knowledge and Attitude do not matter when alcohol prevails. As the study is ongoing, more Results will be discussed at the time of conference.

Key words: Cross sectional, Alcohol on sex, Psychosexual counseling

Thyroid Function Abnormality Among Patients of Depressive Disorders attending Psychiatry Department of Tertiary Teaching Hospital

Mehta A, Pandey A K, Adhikari B R, Deo B

Department of Psychiatry BPKIHS. [email protected]

Background: Thyroid dysfunction is common in patients with depression and depression is also common in patients with thyroid dysfunction. The purpose of this study was to estimate the prevalence of thyroid dysfunction in newly diagnosed depressed patients attending Psychiatry outpatient department of BPKIHS.

Objectives:1. To find out the prevalence of abnormal TFT in patients diagnosed with depressive disorder. 2. To assess the relationship of Thyroid abnormality and Severity of Depression. 3. To assess the association between Socio demographic factors and thyroid abnormality among patients diagnosed with depression.

Materials & Methods: The study population comprised of 221 patients; aged 18 years& above; selected bysimple random sampling technique who attended the Psychiatry OPD of Department of Psychiatry, BPKIHS, Dharan, Nepal and were diagnosed with first episode depression. These patients were diagnosed as depression as per the ICD-10 DCR Criteria and HDRS scale was used to assess the severity.

Results: Fifty nine patients (26.6%) were found to have thyroid dysfunction, the most common being sub-clinical hypothyroidism, seen in 33 (14.9%). The diagnosis of depression by ICD- 10 DCR Criteria was made.Most of the patients were in their middle age; were females; married and housewives.Relationship of Thyroid Abnormality and Severity of Depression was analyzed using chi-square test (p= 0.581, not significant).

Conclusion: This study concluded that thyroid dysfunction is common in depressed patients.Thyroid screening tests among depressive patients might help in assessing comorbid thyroid disorders in depressive patients.

Keywords: depression; HDRS; ICD-10 DCR Criteria; thyroid dysfunction.

Admission to Psychiatric Hospital-Patient and Caregiver Perspective

Kanchana Ramachandran, Mahesh R Gowda, Suresh B M, Preethi S, Srinivasa M.

#227, 2Nd A Main, 11Th Cross, First Block, Bellayout,Vidyaranyapura, Bangalore. [email protected]

Introduction: As per the World Medical Association, International Code of Medical Ethics, "A Physician shall respect a competent patient's right to accept or refuse treatment". Concerned law and medical ethics mandates that the Physician should obtain the INFORMED CONSENT of their patients before any treatment is initiated.

In the proposed MHC Bill 2013, sec4, "Every patient shall be deemed to have the capacity to make decisions regarding his or her mental health care or treatment, if such a person has the ability to

  1. Understand information
  2. Retain information
  3. Use or weigh information
  4. Communicate his or her decision

Mental disorder could prevent some patients from accepting that they need medical intervention. They may understand the treatment proposed but still decline or refuse it because in their judgment they are not ill or do not need treatment for their difficulties.

This study explores the Caregiver and Psychiatrist's perspective in this regard and Aims to throw somelight on the impact of a Rights based Bill on Treatment and Admission.


  1. To assess the Patient's capacity to consent to treatment and admission as per the MHC Bill 2013.
  2. To assess the Patient's capacity to consent to treatment and admission as per the instrument MacArthur Competence Assessment Tool for Treatment (Mac CAT-T)
  3. To explore the Caregiver's and the Psychiatrist's perspective on the need for admission.
  4. To co-relate the reasons for admission from the Caregiver's and Psychiatrist's perspective and the Patient's capacity to consent with the provisions in the MHC Bill 2013 in this regard.

Materials And Methods:

  1. Sample size-100
  2. Sample population-Patients consulting at Spandana Nursing Home, Bangalore
  3. Tools for study-as mentioned in the Aim of the study

Results: Shall be discussed at the conference

Key Words: Caregiver Perspective, Psychiatrist's Perspective

A Study of Depression in Essential Hyper Tension

G. Santosh Kumar, P. Kishan, N. D. Sanjay Kumar, S. Sathish, Pattabhi Rama Rao, Arun Kumar

Prathima Institute of Medical Sciences, Karimnagar, Telangana. [email protected]

Abstract: Essential Hyper tension is most common form of hyper tension in adults and it is recognised more often in adolescents and elderly persons than in children. It is well known that the probability of a diagnosis of essential hyper tension increases with age. Hypertension is a major contributor to the global burden of disease.

Aims And Objectives: To study depression and severity of depression in essential hypertension patients who are already taking medication and compare with normotensive patients, who are age, sex, education and socio economic status matched.

Source Of Data: Patients attending to outpatient Department of General Medicine in Prathima Institute of Medical Sciences karimnagar were included. Out of which 30 patients are with Hypertension with minimum duration of one month medication and 30 are Normotensives. Age of the patients in between 35 years - 65 year Total sample size is 60.

Materials And Methods: 12 Items General Health Questionnaire, Hamilton Depression rating scale (HDRS) are used and statistical analysis done.

Results And Discussion: After tabulation, Results were discussed with future directions in detail.

Keywords: hyper tension, normotensive,

A Study of Psychiatric Morbidity in Perinatal Women

Shweta Goyal, P. K. Dalal, Yashodhara Pradeep, Bandna Gupta Eesha Sharma

Department of Psychiatry,K.G.M.U., Lucknow, U.P., India,

[email protected]

Background: Poor maternal mental health affects the physical health of the mother, the neonate's health and development, and can adversely impact the whole family. Various studies, predominantly from Southern India, place different estimates of perinatal mental ill health in our country.Cultural factors can have a major role to play in perinatal mental illnesses. It is thus important to study perinatal disorders in different cultural populations.

Aims:To assess prevalence of psychiatric morbidity in perinatal women, attending perinatal care services in a tertiary hospital in North India, and to study the socio-demgraphic and clinical profile of women with psychiatric morbidity, vis-à-visthose without.

Method:A total of 281 perinatal women were recruited from out and inpatient services, over one year.Socio-demographic and clinical profiles were collected.Mini International Neuropsychiatric Interview version 6.0 (MINI) was used to identify psychiatric illnesses.

Results: (88.61%) of women were antenatal,mostly in their 3rd trimester of pregnancy, multigravida (59.79%) and the sample had a mean age of 25.9years. Medical or obstetric complications were present in (58.72%) and (19.22%) of the sample respectively. 10.3% perinatal women in our sample had a current psychiatric diagnosis, the most common being major depressive disorder(7.12%), followed by anxiety disorders (1.41%). In this sample, marital discord (χ2=65.18; p<0.0001), presence of other psychosocial stressors (χ2= 37.56; p< 0.0001) and a past history of psychiatric disorder (p=0.001) was significantly higher in perinatal women with current psychiatric diagnosis.Interestingly, among the women with a current diagnosis, only 2 women had sought any treatment.

Conclusion: The significant prevalence of psychiatric disorders in this sample of perinatal women, and the strikingly low help-seeking is noteworthy. These findings can help in planning treatment and prevention programmes for timely detection and intervention forperinatal psychiatric disorders.

Keywords: 'perinatal', 'psychiatric illness'

A Study of Oxidative Stress in Bipolar I Disorder Patients

Harpreet Singh, P. K. Dalal, Madhu Dikshit, S. M. Natu, Adarsh Tripathi, Sujit Kar, Wahid Ali

Department of Psychiatry,K.G.M.U., Lucknow, U.P., India.

[email protected]

Background: Bipolar disorder is one of the most commonly encountered psychiatric disorders in community as well as psychiatric clinics. The current study has focussed on evaluation of role of oxidative stress, marker of inflammation (myeloperoxidase) and glucocorticoids in patients of manic phase of Bipolar disorder in Indian population.

Aims: To assess levels of neuronal nitric oxide synthase (nNOS), nitrite levels, reactive oxygen species & myeloperoxidase in poly-morphonuclear leucocyte, plasma nitrite level and serum cortisol in drug free patients in current episode of mania in Bipolar-I disorder, to compare these parameters between patients, their first degree relatives and healthy control group and to study the relation of above parameters with clinical variables of the patients.

Method: A total of 30 patients provisionally diagnosed to be suffering from mania were included. 30 First degree relatives of the patients and age and sex matched healthy controls, who met the selection criteria, formed the sample of first degree relatives and controls respectively. Samples of all the participants were screened for cholesterol, blood sugar & liver functions and in case of derangement, the participants were excluded. If the above parameters were within normal limit, levels of neuronal nitric oxide synthase (nNOS), nitrite levels, reactive oxygen species and myeloperoxidase in poly-morphonuclear leucocytes, plasma nitrite level and serum cortisol were estimated in the collected blood sample.

Results: Study has found significantly raised level of nNOS,plasma nitrite, neutrophil nitrite, Reactive oxygen species and serum cortisol among patients compared to healthy controls and first degree relatives. No significant correlation between any of the parameters investigated and clinical profile of the patients.

Conclusion: Oxidative stress is increased in patients of mania in Bipolar 1 disorder compared to the first degree relatives and healthy controls.

Keywords: Bipolar disorder, poly-morphonuclear, neuronal nitric oxide synthase

Program for Improving Mental Health Care: Mixed Methods Sequential Evaluation of Integrating Mental Health at 3 Community Health Centres in Sehore, Madhya Pradesh

Kimberly Lacroix, Sharmishtha Nanda, Abhishek Singh, Radhika Dayal, Shoba Raja, Vaibhav Murhar, Sanjay Srivastava, Azaz Khan, Sandesh Samudre, Shalini Ahuja, Rahul Shidhaye and Rohit Ramaswamy

[email protected]

Background: The Program for Improving Mental Health Care [PRIME] is proposed as a model for integration of evidenced based interventions at three Community Health Centres in the Sehore District of Madhya Pradesh. The model delineates 4 levels and three interfaces, coupled with enabling packages, following a top down- bottom up feedback loop that runs across the levels. This paper will document the procedures related to setting up a system for the delivery of basic psychosocial support and interventions for people experiencing psychological distress related to three priority disorders: Depression, Alcohol use Disorder and Psychosis.

Method: Data for this study includes process data from the implementation phase of the project from August 2015 to June 2015 which will be triangulated with 42 key informant interviews and 6 focus group Discussions with 8 stake holders groups (case managers, medical officers, front like workers, service users, care givers, psychiatrists, community advisory board members and prime project team) that constitute the model. Each data set was analysed using the Framework Method for the coding and management of the data with the assistance of NVivo software.

Results: A detailed description and evaluation of each activity that has taken place between March 2015- March 2015 as part of the implementation phase of the PRIME project. A comprehensive understanding of all the processes that make up what is being called the PRIME model at three Community Health Centres, in Sehore, Madhya Pradesh.

Key words: Implementation of psychosocial interventions, primary health care, mental health care package

Study of Socio-demographic and Psychosocial Factors in Patients of MDR TB and XDR TB with Psychiatric Comorbidities

Nilanjan Chandra

P-9, Mnop Block, New Civil Hospital, Surat, Gujarat. [email protected]

Objective: To find out socio demographic profile, prevalence,type and factors associated with psychopathology in patients of MDR-TB & XDR-TB.

Method: All Indoor patients having MDR-TB & XDR-TB admitted in New Civil Hospital were enrolled in the study, evaluated as consecutive sampling after the initial stabilization of doses. After taking Informed Consent andDemographic data, Hospital Anxiety and Depression Scale (HADS),Brief Psychiatric Rating Scale (BPRS),General Health Questionnaire(GHQ),Morisky 8-Item Medication Adherence Questionnaire(M8MAQ) were applied to all patientsto assess Anxiety and Depression, psychotic symptoms, general health condition and treatment adherence respectively . After data collection patients were divided into two groups MDR and XDR TB Patients. Statistical Analysis weredone between these two groups to find out factors associated with psychopathology in MDR-TB & XDR-TB.

Results and Conclusion: In MDR TB 7.3%, 7.3%, 9.8%, 41.5%.and in XDR TB 12.5%, 25%, 0%, 25% patientshad mild, moderate, severe, and very severe depression respectively. The mean value of GHQ total score for MDR and XDR TB are 17.8 and 18.38 respectively. 2.4% were noted with hallucinatory behavior In MDR TB Patients only. In MDR vs XDR TB patients 39.5% vs 25% and 34.2% vs 12.5% had high and medium adherence respectively. In contrast62.5% of XDR and 26.3% of MDR had low adherence. As the study is ongoing more Results will be discussed at the time of conference.

Key words: MDR TB and XDR TB, Anxiety and Depression

Challenge and Approach in Treating Somatic Versus Psychological Symptoms in Depression in the Working Population in India

Arvind Barad, Kishore Dudani

department of Psychiatry, S.M.S Medical College, Jaipur.

[email protected]

Worldwide depression is the leading cause of year live with disability. It can affect many aspect of life including social, interpersonal and work also.

In fact, the impact of depression on job performance has been estimated to be greater than chronic conditions such as diabetes mellitus, hypertension, arthritis and back problem.

Although the disability is associated with depression make it difficult to find and keep a job, many people who have had a depressive episode are in the workforces. In 2012 majority of(71%) 25-64 year of age who had major depressive episode in the previous 12 months were employed and they were potentially dealing with interference of depressive symptoms on their ability to do their job. These depression has been associated with both absenteeism and decrease productivity(presenteeism).

Gilbert allan and goss, 1996 has been found that there submissive behavior associated with number of interpersonal problems especially depression proneness. He has been found the retrospective analysis of depression that the phenomenon of submissive behavior, defeat, shame and entrapment has been associated with depression and this lead to depression and subsequent psychopathology in working population.

Key words: depression, job performance, submissive behavior

Eveningness and its Correlates in Young Adults with Attention Deficit Hyperactivity Disorder

Shruthi Nayak, Shankar Kumar, Chandrashekar Hongally

Department of Psychiatry, Bangalore Medical College and Research Institute, Bangalore. [email protected]

Introduction: Attention deficit hyperactivity disorder (ADHD) is currently recognised as a potentially life-long disorder. Similarly to childhood ADHD, Adult ADHD is also associated with sleep disturbances or circadian abnormalities. Hence, Adult ADHD may also be related to the preference of morning/day activity (i.e. morningness) or evening/ night activity (i.e. eveningness), an indicator for circadian rhythm. Studies which have looked into morningness and eveningness have recently recognized that eveningnessmaybe associated with metabolic issues such as dyslipidemia, diabetes mellitus and obesity. Those with ADHD and eveningness is associated with higher behavioral problems.

Aims And Objectives: Thus, in this study, our Aim was to look at the prevalence of eveningness in young adults with ADHD without any psychiatric co morbidities and its association with metabolic issues, namely Metabolic syndrome and its components.

Methodology: 30 young adults diagnosed with ADHD were recruited from a tertiary care hospital. Those with psychosis and mood disorders who were on psychotropics were excluded. Morningnesseveningnessquestionnaire(MEQ) was administered to these individuals. Metabolic syndrome was diagnosed using ATP 3 criteria. The following investigations were also done for these individuals- Lipid profile including Lp(a) & Apo B/Apo A1, fasting blood sugars. Statistical analysis was done using SPSS version 20.

Results and Conclusion: 13 individuals had a eveningnesschronotype. Those with eveningness had significantly higher triglyceride levels, Lp(a) levels. There were no differences in BMI or a diagnosis of metabolic syndrome between those with and without eveningness.

Though eveningness was not associated with MS, those with eveningness had a higher risk for developing MS as evident by the higher Lp(a) and triglyceride levels which also is a risk factor for CAD. Clinicians treating ADHD should be alert in recognizing this association and seek medical consultations appropriately as this heralds future risk of coronary artery disease.

Key words: ADHD, dyslipidemia, SPSS version 20

Substance Abuse Among Elderly in Rural Community in South India

Sonali Sarkar, Shivanand Kattimani, Venkatalakshmi Penchilaiya, Gautam Roy, KC Premarajan

Department of PSM and Department of Psychiatry, JIPMER, Puducherry, India. [email protected],

Abstract: Elderly are prone for multitude of physical and psychological co-morbidities along with physiological changes.Substance use by the elderly poses unique problem: one that it is hidden, and second there is less optimism among health providers that it can be a focus of target for intervention.

We surveyed all elderly (aged 60years and above) in the rural area under the Rural Health Centre of a teaching hospital, using screening instrument ASSIST version 3.0 (Alcohol, Smoking and other Substance Involvement Screening Test). This particular screening scale helps in identifying type of substance used and also helps estimate how many require intensive hospital based intervention and how many require community based non-pharmacological intervention (brief intervention).

We found that among this group, lifetime prevalence of use of tobacco products, alcohol and cannabis was 55%, 30% and <1% respectively and majority of their substance use severity fell into low and moderate category. The need for intervention in such a population is discussed.

Keywords: Substance abuse, ASSIST, psychological co-morbidities

EEG Alpha/Theta Ratio: Novel Marker for Circuit Dysfunction in Negative Schizophrenia

Sayantanava Mitra, S H Nizamie, Nishant Goyal, Sai Krishna Tikka

Department of Psychiatry, Sarojini Naidu Medical College, Agra, India. [email protected]

Abstract: Negative symptoms have been found associated with reduced alpha and increased low frequency spectral powerson quantitative EEG recordings. Present analysis Aims at exploring these associationsover 4-weeks' treatment; searching for a EEG marker for symptoms and treatment response.

Eighteen right-handed drug-free/drug-naïve schizophrenia patients were recruitedand assessed on PANSS; spontaneous 192-channel resting-EEG was recorded (at baseline, repeated at 4-weeks) and compared with 18 age-sex-handedness matched controls.

Over left frontal and left temporal regions, ratio of alpha/theta power (ATR) was significantly lower in patients; correlating negatively with baseline PANSS negative score and its improvements over 4-weeks' treatment.

Reduced alpha power over frontal regions impliesimpaired attentional process, while abnormal theta oscillations suggest impairments in working memory. Left-predominant deficienciesin these processes, therefore,might mediate negative symptoms in schizophrenia and those with a better ATR (better cognitive resource) at baseline experience greater improvement in negative symptoms with treatments.

Keywords: Schizophrenia; Low-frequency; Alpha-Theta Ratio; Electroencephalogram; Low- Frequency oscillations

Magnitude and Pattern of Psychiatric Referrals in a Multi-disciplinary Teaching Hospital

Senilo Magh, Lalhriatpuia, S. Gogendra Singh, N. Heramani Singh

Department of Psychiatry, Regional Institute of Medical Science, Imphal, Manipur, India. [email protected]

Background: There is a dearth of studies which have focused on consultation-liaison psychiatry in India. Data from the previous studies have suggested that the referral rates in India are very low considering the higher psychiatric morbidity rates.

Objectives:The Aim of the study is to assess the magnitude and the pattern of Psychiatric referrals and to find out the scope and difficulties of Consultation Liaisons.

Materials And Methods: All inpatients referred to Psychiatry department over a period of five year (i.e. April 2010-March 2015). The data were taken and analysed in terms of socio-demographic characters, referring unit, reasons for referral and psychiatric diagnosis made.

Results:A total of 552 inpatients were referred for psychiatric opinion comprising 0.28% of total indoor admission. Male accounted for 57.97% of the referrals and majority of the referred patient belonged to middle socio-economic status.262 (47.46%) referrals were from Medicine and related specialities followed by Surgery and related Specialities (24.09%). The commonest reason for referrals was irrelevant talks and other Psychotic behaviors (25.18%), followed by anxiety features (21.55%). The most common final diagnosis was anxiety and stress related disorder (25%) followed bymood disorder (24.09%).

Keywords: Psychiatry referrals, Consultation - liaison psychiatry, anxiety disorder.

A Study of Caregiver Burden and Perceived Social Support in Relatives of Paients with Depression

Jahnavi Kedare, Rohit Singh, Aditi Joshi, Shubhangi Parkar

Green Fields Rocks End Chsl0 , Jvlr, Besides Majas Bus Depot, Andheri East, Mumbai 400069. [email protected]

Background: As per Baronet A.M., care giving leads to a significant amount of strain including a range of psychological, emotional problems.

Objectives: 1. To study the burden of caregivers of patients with depression. 2. To study perceived social support as experienced by caregivers of patients with depression. 3. To study the association between caregiver burden and perceived social support.

Methodology: 50 caregivers of patients suffering from depression for atleast 6 months, falling in age group of 18 to 60 years were selected from Psychiatry OPD of a tertiary care hospital.

Caregivers were administered

  1. Semi structured questionnaires for sociodemographic data
  2. Zarit Caregiver Burden Scale [ZBI score]
  3. Multidimensional Scale of Perceived Social Support

Result: Mean ZBI score was 45.42 which indicated high level of burden.

Mean MSPSS score was 49.40

Spearman's correlation coefficient gave an inverse association between ZBI score and MSPSS score.

Conclusion: This study concludes that caregivers of patients with depression have high level of burden which decreases with a good perceived social support. There is a need for psychosocial interventions addressing caregiver burden issues.

Keywords: caregiver burden, depression,

Assessment of Functional Somatic Complaints (FSC) in Depression

Akshatha D, Sathyanarayana MT, Prabhu HRA, Hemanthkumar BG, Vidhyavathi M

#1119 3rd main road M.C layout, Vijayanagar, Bangalore, Karnataka. [email protected]

Aim: To study the functional somatic complaints (FSCs) associated with depression.

Materials And Methods: A cross sectional study was done on40 patients in a tertiary care hospital in Karnataka who were diagnosed to be having depression according to the ICD-10 DCR criteria. They were later assessed on the Bradford Somatic Inventory (BSI) and the Beck Depression Inventory (BDI).

Results:Majority of the participants were Hindu, married, educated up to middle school level, employed and of lower socioeconomic Background. Functional Somatic Complaints were significantly more common in females. All patients were found to be having a minimum of 4 FSCs. The most common FSC was lack of energy followed by pain/tension in the neck and shoulders, dryness of mouth/throat, severe headache, palpitations and increased sweating. The mean BDI score of the study sample was 29.75, with 18 patients (45%) having severe depression.

Conclusion: Functional Somatic Complaints are highly prevalent in patients diagnosed with depression. Most of the patients have more than 10 FSCs and the type of FSCs are similar to a certain extent across different socio demographic and clinical variables. Hence, patients reporting to primary health centres with these multiple vague somatic complaints must be routinely evaluated for depression.A thorough psychiatric assessment with appropriate intervention would aid them in a better quality of life.


Psychiatric Aspects of Domestic Violence and Newer Protection Women Against D V Act 2005

Arvind Barad

Deptt. of Psychiatry, S M S Medical College, Jaipur. [email protected]

The epidemic of violence directed at women and girls constitutes a major human rights issue and a public health crisis. Around the world women are regularly beaten and sexually abused by intimate partners, family members, neighbors, and by people not known to them. The impact on women's health goes far beyond bruises, broken bones or even death. As well as causing physical suffering to women, such violence has a profound impact on women's psychological well-being, on their sexual and reproductive health and on the well-being and security of their families and communities.

As the problem of violence against women is multifaceted, the NCW has adopted a multi-pronged strategy to tackle the problem. The Commission has initiated generation of legal awareness among women, thus equipping them with the knowledge of their legal rights and with a capacity to use these rights. It assists women in redressal of their grievances through pre-litigation services. To facilitate speedy delivery of justice to women ParivarikMahilaLokAdalats are organized in different parts of the country to review the existing provisions of the Constitution and other laws affecting women and recommending amendments thereto, any lacunae, inadequacies or shortcomings in such legislations. It organises promotional activities to mobilise women and get information about their status and recommend paradigm shift in the empowerment of women.

Subordination of women has led to violence under this head to rise. Incidence of domestic violence crosses all the barriers of class, income, race, culture and religion and in a highly under reported crime. Domestic violence is one of the greatest obstacles to gender equality and securing for women their fundamental rights to equal protection under the law and the right to life and liberty. The Protection of Women from Domestic Violence Act, 2005 says that any act, conduct, omission or commission that harms or injures or has the potential to harm or injure will be considered domestic violence by the law. Even a single act of omission or commission may constitute domestic violence - in other words, women do not have to suffer a prolonged period of abuse before taking recourse to law. The law covers children also.

Domestic violence is the most common form of violence against women. It affects women across the life span from sex selective abortion of female fetuses to forced suicide and abuse, and is evident, to some degree, in every society in the world.

The World Health Organization reports that the proportion of women who had ever experienced physical or sexual violence or both by an intimate partner ranged from 15% to 71%, with the majority between 29% and 62%.

India's National Family Health Survey-III, carried out in 29 states during 2005-06, has found that a substantial proportion of married women have been physically or sexually abused by their husbands at some time in their lives. The survey indicated that, nationwide, 37.2% of women "experienced violence" after marriage.

Risk Factors for Perpetration

Individual Factor

  • Alcohol and drug use
  • Coercive sexual fantasies
  • Impulsive and antisocial tendencies
  • Preference for impersonal sex
  • Hostility towards women
  • Hyper Masculinity
  • Childhood history of sexual and physical abuse
  • Witnessed family violence as a child

Relationship Factors

  • Association with sexually aggressive and delinquent peers
  • Family environment characterized by physical violence and few resources
  • Strong patriarchal relationship or familial environment
  • Emotionally unsupportive familial environment

Community Factors

  • Lack of employment opportunities
  • Lack of institutional support from police and judicial system
  • General tolerance of sexual assault within the community
  • Settings that support sexual violence
  • Weak community sanctions against sexual violence perpetrators

Societal Factors

  • Poverty
  • Societal norms that support sexual violence
  • Societal norms that support male superiority and sexual entitlement
  • Societal norms that maintain women's inferiority and sexual submissiveness
  • Weak laws and policies related to gender equity
  • High tolerance levels of crime and other forms of violence

Protective Factors

  • Protective factors may lessen the likelihood of sexual violence victimization or perpetration, and exist at individual, relational, community, and societal levels. Although less is known about protective factors, the literature suggests measures to prevent potential perpetrators. Some examples for youth are connectedness with school, friends and adults in the community, and emotional health.

And by large find the above Discussion we conclude and prevent such social evil by creating awareness regarding newer act, protection of women against domestic violence 2005.

Key words: violence, mobilise women, sexual violence

A Study of Depressive Disorder in Students of Medical and Engineering Colleges of Sikkim

BhanuPratap Singh

# 613, PG doctor, Gangtok, Sikkim. [email protected]

Introduction: 75 percent of lifetime cases of mental health conditions begin by age 24. One in four young adults between the ages of 18 and 24 have a diagnosable mental illness. Many people experience the first symptoms of depression during their college years. Unfortunately, many college students who have depression aren't getting the help they need.

Review of literature: Chen et al found 4% major depressive disorder in Chinese university students. Quentin et al found prevalence at 24% in college students.

Aim and Objective: to find out prevalence of depressive disorder in medical and engineering college of Sikkim.Sociodemographic correlates of depressive individuals.

Material And Methods: sample size-500. Inclusion criteria- voluntary participants,above 18 year age, both gender. Exclusion criteria - below 18 year age, non-consenting individual. Tools-DSM-5 severity measure for depression(adapted PHQ-9 scale)sociodemographic variables. Statistical assessment usingstatistical package for social sciences.

Results: to be discussed in ANCIPS-2016.

Key words: depressive disorder, medical and engineering

To Study Internet Profilre and Use Amongest Medical Students

Ravi Shah

0-6, Mnop New Resident Hostel, New Civil Hospital,Majuragate, Surat, Gujarat. [email protected]

Background: Internet has become an integral part of daily lives of people. Internet is not an exception to addiction, as discussed in many studies conducted. But there are very few studies focusing on the addiction of various domains of internet use. After Introduction of Private Chat Rooms (PCR), there has been shift in the purpose of use of internet. And due to that, possibility of exploitation and addiction leading to impairment in academic performance and emotional balance in medical students, using such domains; cannot be denied.Thus this study was Aimed to measure the degree of Internet use in 10 domains of internet viz. Social networking (SN), PCR to Gaming to Cybersex among medical students.

Method: A cross sectional study on 232 medical students, was performed. After written informed consent, Focused Group Discussion on areas of use of Internet was done. Semi structured questionnaire including Young'sInternet addiction test, Knowledge Attitude and Practices questionnaire was applied.

Result: Amongst the study population (n=232,male=91(39.2%), female=141(60.8%). Females were more addictive in PCR(p=0.0089). 80% participants saw preference for Internet use for PCR and SN. In PCR, Moderate (34.48%) and severe addiction (0.86%) was found, which was highest amongst any other domains. 20% participants showed mild addiction in education and information domain. 40.5% of participants tried to cut down the time they spent on PCR but failed and 60.7% participant use PCR as soon as they wake up.

Conclusion: Internet usage for the purpose of PCR (WhatsApp) was very high among the medical students especially females. Despite adequate knowledge about advantages and disadvantages (including decline in academic performance and personal health) of Internet use, it did not reflect in practices,they used internet up to addictive level and did not consider need for help. Hence further exploration, awareness, and intervention are suggested.

Keywords: internet addiction,whatsapp,social networking

Proportion of Metabolic Syndrome Among Patients with Schizophrenia Receiving Antipsychotics

Shailendra Raj Adhikari

Department of Psychiatry, Chitwan Medical College Teaching Hospital (CMCTH), Bharatpur-10, Chitwan, Nepal. [email protected]

Background: Schizophrenia has been associated with an increased risk of cardio-metabolic morbidity and mortality due to antipsychotic drugs. Aim of this study is to find out proportion of metabolic syndrome among patients with schizophrenia.

Methodology: Cross-sectional analytical study design was used and total of 85 patients were selected by random sampling technique. Data were collected by using semi-structured interview schedule, physiological measurement and record review. Obtained data were entered in SPSS version 19.0 and analyzed by using descriptive and inferential statistics. The presence of metabolic syndrome was assessed according to International Federation of Diabetes (IFD) definition criteria based on gender specific. Findings were presented in different tables.

Results: Out of 85 patients, 24.7% of patients had metabolic syndrome according to IDF criteria. The most common metabolic syndrome parameters in patients were central obesity (64.7%), elevated fasting glucose (54.1%), hypertriglyceridemia (44.7%), and low HDL cholesterol (18.8%). Atypical antipsychotics were commonly used in both the metabolic and non-metabolic syndrome patients (76.2% vs. 75.0%) and proportion of metabolic syndrome was higher in patients receiving atypical antipsychotics as compared to typical antipsychotics (25.0% vs. 23.8%). There was significant relationship between metabolic syndrome with age (p=0.009), education (p=0.048), occupation (p=0.025), body mass index (p=0.013) and duration of treatment with antipsychotics (p=0.025).

Conclusion: Due to high metabolic syndrome in patients with schizophrenia receiving antipsychotics, treating physicians and health workers need to monitor metabolic parameters regularly, intervene appropriately when needed and refer the patients for the treatment of any other physical illness.

Key Words: metabolic syndrome, schizophrenia, antipsychotics

Medical Students Attitude Towards Psychiatry- Experiences from Nepal

Shailendra Raj Adhikari

Department of Psychiatry, Chitwan Medical College Teaching Hospital (CMCTH), Bharatpur-10, Chitwan, Nepal. [email protected]

Introduction: It is always difficult to attract medical students' interest in Psychiatry as a career choice. Most of the students have negative views of Psychiatry even before entering medical school such as 1) stigma on patients and psychiatrists. 2) Unscientific specialty with less prestige. 3) Derogatory remarks by other specialty physicians. 4) Less financial return.

Objective: To evaluate and analyze medical students' attitude towards psychiatry at their different levels of medical career.

Method: Medical students from three different years were surveyed to assess their perception and attitude on psychiatry and related matters. First year students were surveyed when they joined within 2 weeks in medical college. Third year were given questionnaire at the first day of Psychiatry clerkship and 4th year students were also given on the first day of posting.

Results: 280 students from 1st year (61out of 100), 3rd year (79 out of 104) and 4th year (70 out of 76) studying MBBS were surveyed. Majority of students from different levels preferred medicine, surgery, pediatric when they first joined medical college and their current preference choice of specialization. Fifteen out of 61 first year students planned to join Psychiatry when they entered medical college which changed to 11 while they were enquired about current planning.

Conclusion: Medical colleges need comprehensive course in Psychiatry that involves inpatient and outpatient to create interest in Psychiatry and we need strong advocacy to decrease stigma of "Psychiatry as a career choice" among medical students.


A Study of Major Depressive Disorder, Anxiety Disorders and Quality of Life in Patient with Seizure Disorder

Dhiraj Nana Bhivgade

Gmc & Sir T Hospital Bhavnagar, Gujarat. [email protected]

Background: Epilepsy is chronic neurological disorder, have profound physical,social and psychological consequences . Depression is common in patients with seizure disorder and anxiety, seizure frequency affect quality of life inpatientsseizure disorder. We studied the frequency of major depressive disorder, anxiety disorders and quality of life in patient with seizure disorder and it's association with seizure severity.

Methods: This is a single-center, cross sectional, observational, interview basedstudy. Hundred patients attending psychiatry outpatient department, having one year duration of seizure disorder were included in study. Diagnosis of major depressive disorder,anxiety disorders were done as per DSM -5 (Diagnostic and Statistical Manual of Mental Illness). The patients were further assessed for demographic details, NHSSS( National Hospital seizure severity scale ), HAM -D(Hamilton Rating Scale for Depression ), HAM -A ( Hamilton Rating Scale for Anxiety )and QOLIE-31 (Quality of Life In Epilepsy -31 ) .Data was analyzed by Graph Pad Instat version 3.6 . P value<0.05 was considered statistically significant .

Results: Frequency of major depressive disorder in patient with seizure disorder is 33%. Anxiety disorders is 31%,Agoraphobia(11%),Panic disorder (35%),social phobia (4%), and having both depression and anxiety (15%) .The patient with major depressive disorder and anxiety disorders showed higher anxiety severity symptoms(p<0.001), depressive severity symptoms(p<0.001) and poor quality of life .Last seizure episode and seizure free period showed significant association with depression severity (p<0.006),anxiety severity (p< 0.038) and poor quality of life .

Conclusion: Patient with seizure disorder havehigher depressive symptoms severity, anxiety symptoms severity, and poor quality of life. Those patients which have recent occurrence of seizure feel depressed, anxious and have poor quality of life.

Key words: Depression, Anxiety disorders, Quality of life, Seizure disorder.

SSRI Induced Galactorrhoea

Vrinda Pareek

235, PG Hostel, AIIMS Residential Complex, AIIMS, Basni, Jodhpur, Rajasthan. [email protected]

Hyperprolactinemia is an undesirable effect of several classes of psychotropic medications, especially with antipsychotics. There is limited literature reporting galactorrhea with antidepressants including selective serotonin reuptake inhibitors (SSRIs). Computer-assisted searches on galactorrhea with SSRIs yielded 24 cases, mostly with escitalopram and paroxetine and rarely with fluoxetine, fluvoxamine and sertraline, and it may be much more frequent than recognized.

A 17 year old female patient presented to us to us with complaints of episodic shortness of breath, sleep disturbance, decreased appetite for about 25 days and white secretion from both breasts since 4 days. Her symptoms had started after the patient had attended a wedding in her village where she clAimed to see ghosts and became fearful. After symptomatic management she was treated with Escitalopram 20 mg / day and Sertraline 50 mg / day for about 15 days. There was not much improvement in her somatic symptoms and furthermore she noticed milk like secretion from her breasts.

We got her investigated for serum prolactin levels which was raised significantly- s. prolactin- 164.4 ng/ml. She was diagnosed as Somatoform Autonomic Dysfunction- Respiratory System (F45.33) with drug induced galactorrhea. The said medications were stopped immediately and the patient was prescribed Clonazepam 1 mg/ day and was placed on regular psychotherapy sessions.

Key words: Hyperprolactinemia, galactorrhea, antidepressants

Pursuit of the Happiness - Ketamine Version

Smitha C. A.

Govt. Medical College Kozhikode, Kerala. [email protected]

Background: Major depressive disorder is an extremely debilitating condition affecting millions of people worldwide and Results in high public health costs. Although over the past half century better treatment strategies were evolved, delayed onset of antidepressant action remains one of the major limitations in the management of major depressive disorder. Recent research shows low dose ketamine, an NMDA receptor antagonist, emerging as a novel rapid acting antidepressant.

Objective:This symposium examines the antidepressant properties of ketamine in treatment resistant depression.

Overview: The pharmacological peculiarities including the chirality of ketamine,the preclinical and clinical data on ketamine's use as a rapidly acting antidepressant,various routes of administration, side effects, safety and abuse potential and on-going research on neurocognitive effects and mechanism of action of ketamine will be discussed.

Conclusion:Understanding the molecular pathways through which ketamine exerts its antidepressant effects would help in developing novel antidepressant agents that do not evoke the same negative side effects of this drug.

Keywords: Treatment resistant depression, Ketamine

Loss to Follow Up: As Important As Follow Up

Hemika Agrawal

[email protected]

While taking up clients for psychotherapy, thorough assessment is usually done to prevent the attrition and loss to follow up later. But still, a huge bulk of clients do end not following up. Here is a series of case reports evaluating such cases, and hopes to add to this neglected aspect of psychotherapy. This will have its implications in conserving and judicially utilizing our therapeutic resources.

Key Words: Loss To Follow Up, Psychotherapy

A Study on Metacognitive Abilities of Psychiatry Residents

Neena Sawant, Shubhangi Parkar, Akanksha Sharma

Department Of Psychiatry, Seth Gs Medical College & KEM hospital, Mumbai. [email protected]

Background: Postgraduate education is usually based on adult learning principles where metacognition plays an important role. Metacognition is essential to successful learning because it enables individuals to better manage their cognitive skills and to determine weaknesses that can be corrected by constructing new cognitive skills. It was with this Aim in mind we decided to study metacognitive abilities the metacognitive abilities of psychiatric postgraduate residents.

Materials And Methods: This study was conducted in 40 psychiatry residents of 3 general hospitals after written informed consent and ethics committee approval. A semi structured questionnaire, metacognition assessment inventory collected the information pertaining to Aims of study.Knowledgeabout cognition corresponds to what students know about themselves, strategies, and conditions under which strategies are most useful. Declarative, procedural, and conditional knowledge can be thought of as the building blocks of conceptual knowledge. Regulationof cognition corresponds to knowledge about the way students plan, implement strategies, monitor, correct comprehension errors, and evaluate their learning.

Results: When all the 40 residents were assessed on two domains of knowledge about cognition and regulation of cognition then on each of the sub domains an average score was obtained with none of them being in the higher or lower range except for lower scores on information managementstratergies. Higher scores are indicative of better metacognitive abilities

Discussion: All the residents had knowledge of one's skills, intellectual resources, and abilities to complete the same. In regulation of cognition domain, the residents were able to plan, assess which stratergy to use, evaluate themselves on their performance but were deficient in goal setting and organizational skills.

Conclusion: The Results of the study will help to make the residents aware of their strengths and weaknesses to improve their learning.

Key words: Postgraduate education, Metacognition

Metacognition and Insight in Persons with Schizophrenia

S. Kumar, S. Mohanty

Institute of Mental Health and Hospital, Agra. [email protected]

Abstract: Metacognitive capacity refers to the ability to think about one's own thinking and that of others. Metacognitive capacity allows an individual to form representations of own mental state and to revise and question what is believed, felt, feared or pretended in a wide range of contexts. It includes both explicit and implicit knowledge. It allows an individual to form and then accept or reject ideas about him/herself in the moment and also to sustain more enduring ideas about the kind of person he or she is across different situations. Research has established metacognitive deficits in persons with schizophrenia. These deficits are also related to symptoms and functional impairment. It is suggested that deficits in Metacognitive capacities may be a risk factor for severe levels of illness and dysfunction in persons with schizophrenia. Many persons with schizophrenia also experience poor insight or reflexive unawareness of the symptoms and consequences of their illness and as a Result, are at risk for treatment nonadherence and a range of negative outcomes. A theory regarding the origins of poor insight in schizophrenia suggested that it may Result, in part, from deficits in metacognitive capacity, or the ability to think about thinking, both one's own and the thinking of others. In the present study, we intended to examine to what extent metacognitive capacities are associated with insight in persons with schizophrenia. 50 persons with schizophrenia were sampled from Institute of Mental Health and Hospital, Agra. Metacognition Assessment Scale and Schedule for Assessment of Insight were administered. Correlation Coefficient were estimated between two measures. The Results revealed that the three dimensions of metacognitive capacities - (a) Understanding own's mind (b) Understanding others' mind (c) Mastery were significantly and positively correlated with the scores on Schedule for Assessment of Insight. The detailed Results will be presented.

Key words: Metacognitive capacity, schizophrenia, nonadherence

To Study Psychiatric Co Morbidity in Menstrual Disturbances

Dnyanda Vilas Korhale

PG Residents Hostel Dr PDMMC, Amaravathi, Maharastra.

[email protected]

Introduction: Menstrual disturbances is most common in women. It is observed that during menstrual disturbances there are changes in women's mental state. But, most of the women neglect the changes in their mental health as they have the stigma and no easy approach to psychiatrist or there is lack of awareness about mental illnesses due to which more and more women are suffering from mental illnesses. However, some studies reported about women's mental health but there are only few studies on mental illnesses in menstrual disturbances. Keeping in mind about women's mental health this study is planned to evaluate different psychiatric illnesses, their frequency and severity in the menstrual disturbances.

Aims And Objectives:

  1. To evaluate different psychiatric illnesses in menstrual disturbances.
  2. To evaluate frequency of different psychiatric illnesses in menstrual disturbances.
  3. To evaluate severity of different psychiatric illnesses in menstrual disturbances.
  4. To find out is there any correlation between psychiatric illnesses and menstrual disturbances.

Materials And Methodology:

Study Area: Study will be conducted in department of psychiatry in collaboration with obstetrics and gynecology department in Dr.PDMMC Hospital and Research Centre Amravati, Maharashtra, INDIA.

Study Type : - Cross-Sectional Study.

Study Subjects: Female patients from psychiatric and obstetrics and gynecology out patient department complaining of irregular menses in the age group 18 yrs to 40 yrs included in this study after their written consent.

Sample Size: 103 Patients.

Tools For Study :

  1. Composite International Diagnostic Interview Paper & Pencil Instrument (CIDI V-3.0 PAPI V-7.1) .
  2. Hamilton Depression Rating Scale (HDRS).
  3. Hamilton Rating Scale for Anxiety (HAM-A).
  4. Yale Brown Obsessive Compulsive Scale (Y-BOCS).
  5. Brief Social Phobia Scale (BSPS).
  6. Sleep Disorder Screening Questionnaire (SDSQ).
  7. Insomnia Severity Index (ISI).

Procedure : Data was collected from the out-patient Department of Obstetrics and Gynecology at the Dr. P.D.M.Medical College and Hospital Amravati. Cases were female patients of age group of 18 to 40 years who were diagnosed to have menstrual disturbances. The cases were explained the nature of the study and informed consent was taken from all subjects. The screening test Composite International Diagnostic Interview Paper & Pencil Instrument (CIDI V-3.0 PAPI V-7.1),administered in single session of 60 to 90 minutes duration approximately. The cases which are positive for screening test were taken for mental status examination and diagnosed according to Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR).After diagnosis severity of mental disorder measured by respective scales.

Results : Psychiatric morbidities are prevalent in menstrual disturbances. In this study findings revealed that 59.22% of psychiatric disorders were present in women suffering from menstrual disturbances. Anxiety disorders, Sleep disorder and Depressive disorder are the most common psychiatric conditions in these patients. Major depressive disorder (13.59%) with depressed/anxious mood was the most common diagnosis. Insomnia severity score and anxiety level score were found high.

Key words : Menstrual disturbances, irregular menses, Psychiatric morbidities

Cultural Impact Over Sexual disorder

Ram Ghulam Razdan, Dheerendra Mishra

Department of Psychiatry MGM Medical College Indore (M.P)[email protected]

Introduction: Human sexuality is clearly set apart from that of most other animals in being relatively separate from mere reproduction. Thus for humans, sex obviously plays a wider sociobiological function than mere production of an offspring. An individual's sexuality is influenced to a large extent by his or her personality traits, the biological makeup, by life circumstances, by one's relationship with others and by the culture in which one lives (Sadock al 2005) knowledge or a combination of these.

Although epidemiological data on prevalence of sexual dysfunction across cultures are scanty, it is likely that prevalences vary, as will pathways into care and patterns of help seeking,(Vishal Bhavsar et al 2013). And The International Classification of diseases ICD10 classifies Dhat syndrome as both a neurotic disorder (code F48.8) and a culture specific disorder (Annexe 2) caused by 'undue concern about the debilitating effects of the passage of semen.' We are intended to study the potential impact of culture on sexual dysfunction at tertiary care centre

Aim: To study the Cultural Impact over sexual disorder at tertiary care centre.


  1. To study the socio demographic profile of patient.
  2. To study the clinical profile of patients.
  3. To study the cultural belief of patients about Dhat(F.48.8).


  1. Study design: Cross sectional retrospective study.
  2. Sampling: Simple random sampling.
  3. Study Site: The study was conducted in the sex Clinic, Department of Psychiatry, Mahatma Gandhi Memorial Medical College Indore Associated M Y Hospital Indore which is a multi-speciality teaching institute and tertiary centre.
  4. Study duration: Six month
  5. Study sample: 100
  6. Study Population: Patient attending sex clinic and give informed consent.
  7. Tools:
    • Semi structured data entry perform to enter socio demographic characteristics.
    • Sex clinic perform designed by Department of psychiatry MGM Medical College Indore to enter clinical profile and socio cultural belief

Result & Discussion: Appropriate statistical analysis was used for analysis the data using SPSS v16 and Results will be discussed at the time of free paper presentation.

Key words : Human sexuality, sociobiological function, SPSS v16

A Study of Psychosocial Factors Associated with Adolescent Suicide Attempts in A Rural Setting

Veda Neelakanth Shetageri

#222, 8th C main, 1st Block, HRBR Layout, Kalyan Nagar, Bangalore, Karnataka. [email protected]

Aims & Objectives of the study:

  1. To study the psychosocial factors associated with adolescent suicide attempts.
  2. To identify the risk factors associated with adolescent suicide attempt with reference to socio-demographic characteristics, stressful life events and psychiatric morbidity.
  3. To identify the association between socio-demographic characteristics and stressful life events, psychiatric morbidity and suicide intent with references to adolescent suicide attempts.

Material And Methods: It is a hospital based cross-sectional descriptive study conducted at MVJ Medical College and Research Hospital. Data is collected for a period of six months.Patients meeting the inclusion criteria is assessed once the medical/surgical condition has stabilized.Nature of the study is explained to the patient and to the key relative and a written informed consent is obtained from them. Assessment is completed in two days in one or two sessions, each consisting of forty-five minutes to one hour. Instruments used are as follows.

  • Semi-structured proforma for recording socio-demographic details, family history, medical and psychiatric history
  • ICD-10:Classification of mental and Behavioural disorders
  • Beck's suicide intent scale
  • Presumptive stressful life events scale(PSLES)
  • Hamilton depression rating scale

Inclusion criteria:

  • Patients who have been admitted for treatment of attempted suicide of age between 10 to 19 years
  • Patients whose physical condition is stable and could undergo detailed assessment
  • Patients who give informed consent

Exclusion criteria:

  • Patients not willing to participate in the study
  • Presence of disorientation and confusion interfering with the administration of rating scales
  • Patients with mental retardation

Ethical clearance was obtained from the institutional ethical clearance committee.

Results and Conclusion: The data will be analysed using suitable statistical tools. The Results will be discussed later at the time of presentation.

Key words: adolescent suicide, ICD-10, psychosocial factors

Barrier to Kelp-Seeking Behaviour in Patients with Headache

Dushad Ram

Department of Psychiatry, JSS Medical College, JSS University, Mysore. [email protected]

Background: Study conducted in western countries revealed that characteristic of headache and socio-cultural factors determine health seeking. There is dearth of study from India that address help-seeking behaviour in patients with headache. This study was conducted to know the demographic factors, that may be a barrier to kelp-seeking behaviour in patients with headache.

Methods: Two hundred patients were suffering from headache were recruited in this study as per selection criteria and assessed with Sociodemofraphic proforma and Barriers to Help Seeking Scale (BHSS).

Results: Result revealed a that 99% experienced barrier to kelp-seeking behaviour. Such experienced involve the all the domains of barrier to kelp-seeking behaviour ( Need for control and self-reliance, Minimizing problem and resignation,Concrete barriers and distrust of caregivers, Privacy, Emotional control). Gender, occupation, Socio-economic status, Religion had a significant goup difference on the score of domain of barrier to kelp-seeking behaviour.

Conclusion: Patients with headache commonly experience barriers to kelp-seeking. Gender, occupation, socio-economic status, religion of the patient are associated with barrier to kelp-seeking.


A Comparative Study of Attitudes Towards Mental Illness Among Nursing Students

K. T. Rajasekhar Reddy, D. Dijayalakshmi, P. Himakar

Department Of Psychiatry, Government Hospital For Mental Care Vishakhapatnam. [email protected]

Background: Nursing students are significant part of future health manpower and are an integral component of a multidisciplinary mental health care team. Adequate exposure to psychiatry makes a difference in terms of their attitude towards mental illness.

Aim: To study the change in attitudes among nursing students towards mental illness after psychiatry posting in a tertiary psychiatry hospital.

Materials And Methods: The study is conducted in government hospital for mental care Vishakhapatnam. It is a follow up study. 75 nursing students attending psychiatry posting are included in study. Their attitudes towards mental illness is assessed using Attitude scale for mental illness on day 1 and day 15.

Results: Nursing students had negative attitudes towards mental illness in five of the six attitude factors on day 1,i.e. separatism(31.31), stereotypism(15.92), restrictiveness(11.80), pessimistic prediction(12.89),stigmatisation(11.71), however by day 15 there was significant positive change in only one of the five negative attitude factors, i.e. stereotypism(14.35).

Conclusion: Adequate training in psychiatry is needed in order to bring about a change in attitudes towards mental illnesses. This includes effective teaching strategies for adequate amount of time, which will challenge the beliefs and assumptions. This helps to provide better care for mentally ill people.

Keywords: attitudes, mental illness, nursing students

A Cross Sectional Study Among Patients with Co-Morbidities of Alcohol Dependent and Mental Illness Admitted in Institute of Psychiatry, Kolkata

Aritra Chakraborty

#7, East Mall Road, West Bengal, Kolkata. [email protected]

Context: Psychiatric comorbidities are not veryuncommon particularly in alcohol dependent patients. They are sometime very difficult to treat and overall prognosis is unpredictable most of the time.

Aims: To measure the prevalence of psychiatric comorbidities among alcohol dependent patients.

Settings and Design: The study assessed the prevalence of psychiatric comorbidities among 100 alcohol dependent patients admitted in Institute of Psychiatry, Kolkata (IOP).

Methods and Material: A semistructuredproforma and Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) diagnostic tools are used mainly among all those patients who meet inclusion and exclusion criteria.

Statistical analysis used: Statistical analysis was done by usingStatistical Package for the Social Sciences (SPSS).

Results: The psychiatriccomorbidities among alcohol dependent patients are depression(32%), (BPAD)Bipolar affective disorder (20%), Anxiety disorder(18%), Personality disorder(10%), Schizophrenia(10%).

Conclusion: Most of the patients are male in this study. (V-X) educational standard, married, Hindu male of mean age group 25.4 years and monthly family income of Rs 1,000-5,000 are most vulnerable group of alcohol dependence with comorbidities.The most common psychiatric comorbidity is depression(32.5%).

Key words: Alcohol dependence, Substance abuse, Psychiatric comorbidities.

A Study Determining Cognitive Functions, Thyroid Profile, and Their Interrelations in Schizophrenia Patients Wearing Redundant Clothing

Tathagata Mahintamani

13, Barijhati East; Chanditala, West Bengal. [email protected]

Background: We sometimes find patients with schizophrenia, wearing multiple layers of same clothing without any obvious reasons for the same. In this regard, redundant clothing may actually be a marker for schizophrenia. Many causes have been postulated for this behavior but none is conclusive. The abnormal cognitive and thyroid functionsare among them, but no study had been done to decipher this enigma.

Aims: The present study was Aimed at determining the relationship between wearing of redundant clothing and cognitive deficits, thyroid function in patients with schizophrenia.

Materials & Methods: Twenty patients of schizophrenia with redundant clothing (at least 3 instances of wearing multiple layers of same clothing without obvious relationship with change in environment requiring active intervention of guardians or caregiver) were taken. Twenty age & sex matched controls (with a diagnosis of schizophrenia without redundant clothing) were included. The cognitive dysfunction was assessed using SCoRS (Schizophrenia Cognition Rating Scale). The subjects were tested for serum FT3, FT4, and TSH to assess thyroid function. The groups were then compared to assess for significant differences, and within group correlation was applied.

Result & Conclusion: To be shared during presentation at the conference.

Key words: cognitive functions, schizophrenia, redundant clothing

A Phenomenological Study of Acute and Transient Psychosis- A Controlled Study

Achyut Kumar Pandey

Dept. of psychiatry, Type IV, Block D Flat No 201, Uprims & Saifaietawah Uttarpradesh. [email protected]

Introduction: For many decades the clinicians have recognized the importance of some non-organic atypical psychosis that are associated with a benign course like affective disorder but are unlike affective disorders in their symptomatology and sometimes resemble schizophrenia in that regard. Previous Indian studies have been done on a broader sample of acute psychosis- a loosely defined termincorporating manic episodes, acute schizophrenic episodes, and other non-organic psychosis. Therefore, it was planned to study acute psychosis using the newer ICD-10 criteria.

Material And Method: This study, prospective in design, was carried out on two samples of hospitalized inpatients meeting the specific inclusion and exclusion criteria. 32 patients of acute and transient psychotic disorder were included in patient group and 29 patients of first manic episode were included in control group. Patients beyond age range 17-65 years were excluded from both the groups. Patients suffering from schizophrenia other non- organic psychosis/mood disorder, substance abuse and other organic factors were also excluded. After obtaining informed consent patients were evaluated on standard proforma and they were also rated on the Comprehensive Psychopathological Rating Scale ((CPRS) at the time of admission, at 2 weeks, 6 weeks and then at 12 weeks .The patients were also assessed on the Severity of Psychosocial Stressor Scale. The statistical analysis was done using a standardized computerized SPSS.

Results: A large majority of control group cases had longer duration of illness (p<.001). A significant majority of from the study group had an abrupt onset of illness (p<.001). The phenomenology of the study group was assessed and compared with that of control group on the basis of the subjects' ratings on the CPRS items. Cases from the study group displayed a wide array of symptoms whereas the control group had a somewhat stereotyped symptomatology typical of manic episode.

Discussion: Results will be discussed in detail and will be compared with previous studies in the paper.

Key words: Acute Psychosis, atypical psychosis, CPRS.

A Study of Predictive Factors for Readmissions to Acute Psychiatric Unit - A 9 Year Retrospective Study

Praveen Sadananda Gopan

Plot No-95/12, Sector 12, Mvp0 Colony, Vishakapatnam, AP. [email protected]

Abstract: The Aim of the study was to identify rates of readmission and factors associated with readmission to acute psychiatric unit.

Methods: First admissions (n=1276) to acute psychiatric unit in Government Hospital for mental care, Visakhapatnam in 2005 were identified and followed up retrospectively for the 9 year period 2005-2014.

Results: Thirty percent (387/1276) of first admission in 2005 had one or more readmissions during the study period. 2.4% had 4 or more readmissions in the nine year period. Younger age and diagnosis of affective disorders were identified as predictive factors for readmissions.

Conclusion: Our study showed small percentage of patients required multiple admissions. Younger patients and patients with affective disorders require intensive follow up in the community after discharge to prevent readmissions. We advocate provision of psycho education to both patients and their families.

Keywords: Predictive factors, Psycho education, diagnosis of affective disorders

Deliberate Self Harm and Psychiatric Morbidity in A Tertiary Care Hospital- A Cross Sectional Study

Ruthsneha Chandrakumar

No. 40, Abbaya Reddy Layout, 6th main, 8th cross, Dodda Banaswadi, Bangalore. [email protected]

Introduction: Deliberate self-harm (DSH) is a behavioral problem with significant clinical and public health importance. It is reported in psychiatric illnesses like alcohol abuse, affective disorders and personality disorders. As in many countries, deliberate self harm in India is an unrecognized, hidden and a silent epidemic.

Objectives: a) To determine the nature of psychiatric disorders among patients with deliberate self-harm. b) To study the socio-demographic and clinical profile of these patients.

Methods: This descriptive cross sectional study was conducted in Sri R.L Jalappa hospital and research centre, Tamaka, Kolar.225 subjects were chosen by systematic random sampling Method. The subjects were assessed for presence of psychiatric illness using the DSM-IV-TR criteria. (Diagnostic and Statistical Manual of Mental Disorders, Fourth edition, Text revision).

Results: In this study we found that majority belonged to the younger age group <35 years (84%). Most of them were illiterate (78%) and were from the lower socioeconomic Background. A total of 108(48%) people in our study revealed one or the other major psychiatric disorder according to DSM IV criteria.Common psychiatric disorders found were substance abuse inmales and adjustment disorders in females. The mostcommon Method of self harm was poisoning (94%), followed by hanging. An important finding ofour study was that majority (89%) of the patients did not have an intention to die. A large number of them (86%) said that the attempt was impulsive and not a planned act. Most of the patients (92%) did not have any past history ofDSH. Only 4(1.7%) had a family history of DSH.Marital discord(48%) and family conflict (27%) were found to be the most commonprecipitating factors for DSH.

Conclusion: Early diagnosis of the psychiatric disorders and supportive measures for various stressors would help in prevention of these attempts of DSH.

Keywords: Deliberate self-harm (DSH), DSM IV

Psychiatric Morbidity in The Elderly - A Comparative Study Based On Location

Nithin Kondapuram

Department Of Psychiatry, Nimhans, Bangalore.

[email protected]

Introduction: India has around 100 million elderly at present and the number is expected to increase to 323 million, constituting 20% of the total population by 2050.Non Communicable Diseases(NCDs) accounts for 62% of the total disease burden worldwide of which Neuropsychiatric conditions account for 19% of it. Older populations are more likely to be affected by NCDs. In a developing country like India paucity of access to health care especially in rural areas, lack of training of primary care physicians, lack of awareness of psychological needs of elderly etc.,and positive aspects like cultural norms, tolerance, low expectations delay the pathway to care leading to increase health care burden.

Objective: To compare the Psychiatric morbidity between community and hospital based population of elderly.

Methodology:A crosssection of 215, urban community dwelling, elderly people werescreened as part of the study. Out of this, 50 elderly people were matched accordingly with 50 elderly persons who had come to seek treatment at a tertiary neuropsychiatric hospital(NIMHANS).

Results:The overall prevalence of depressive symptoms was found to be 76% in community people compared to 44% in the assessed hospital population. While 34% of Hospital people had Dementia compared only 10% in the community.

Conclusion:Our Results suggest that late-life depression remains undetected and most of them do not seek help due to barriers in the pathway to care. It was also found that depending upon the type of the Health care services, the neuropsychiatric diagnoses among elderly differ, so their needs. While dementia is seen as a significant clinical issue by most psychiatrists, the severity of the geriatric depression in the community is often overlookedwhich can increase the health care burden. Thus integrationof services as per the NPHCE and NMHP norms is the best possible answer to the current situation.

Key words : Non Communicable Diseases(NCDs), Psychiatric morbidity

Does Abnormalities in Psychomotor Responses Represent A Trait Marker in Schizophrenia - An Exploration in Terms of Reaction Time and Bilateral Transfer of Motor Learning in Schizophrenia and Their First Degree Relatives

Prama Bhattacharya

IIT Kanpur, Uttarpradesh. [email protected]

Abstract: The present study envisaged to identify whether psychomotor abnormalities underlieprecocious symptoms of schizophrenia. Choice Reaction Time (Suman Response-scope) and Bilateral Transfer of Training (Mirror Drawing Test; Starch, 1910) were measured in 14 patients diagnosed with schizophrenia as per DSM IV TR (APA, 2000) criteria, 11 first degree relatives (FDR) and 15 healthy participants matched in terms of age and education. Psychiatric morbidity in the FDR and normal control group were ruled out using General Health Questionnaire (Goldberg and Hillier, 1979); Edinburgh Handedness Scale (Oldfield, 1971) was administered on all participants to determine handedness. Positive and Negative Syndrome Scale (Kay et al., 1987) was used in the group of Schizophrenia patients to rule out predominant negative symptoms. Significant mean difference (p<0.05) were found among the three groups in terms of choice RT and bilateral transfer of training; schizophrenia patients having the slowest choice RT and least bilateral transfer of training. Non- affected relatives committed more errors as compared to the schizophrenia patients but they surpassed in terms of improvement with training.

Keywords: schizophrenia, first degree relative, trait-marker, psychomotor, transfer

A Systematic Chart Review of Electroconvulsive Therapy for Children and Adolescents at A Tertiary Centre In India

Sinha Joyita, Motichand Sandeep, Goyal Nishant, Sinha Vinod Kumar

Department Of Child And Adolescent Psychiatry, Central Institute Of Psychiatry, Ranchi, India

Aims And Objectives: The use of electroconvulsive therapy (ECT) in children and adolescents is a controversial issue and the literature regarding the use of ECT in this population is lacking. This study was done to study the pattern and practice as well as the outcome of electroconvulsive therapy administered to children and adolescents admitted to a tertiary care centre.

Methodology: A 2 year retrospective chart review of all children and adolescents (up to 18 years of age) admitted in the Erna Hoch Child and Adolescent Psychiatry Centre, Central institute of Psychiatry who had received at least 1 session of ECT was done. The details regarding the diagnosis, reasons for starting ECT and details regarding the procedure, safety aspects and outcome variables were collected from the case record files of the institute. The Clinical Global Impressions (CGI) scale rating of the severity of the illness and the improvement seen were done by 2 trained psychiatrists independently.

Results: The Discussion and Results will be presented at the time of presentation.

Key words : electroconvulsive therapy (ECT), children and adolescents

To Study the Insight and Severiety in OCD and Care Giver Burden Under Heading of "Anxiety disorders

Ravi Shah

[email protected]

A cross sectional study of illness severity and insight in patients of Obsessive Compulsive Disorder and relation of severity of OCD to burden amongst their primary caregiver.


Objective:To assess the severity of illness, insight in patients of OCD and comparison of severity and burden amongst the patients and his caregiver as till date very few studies are done in India regarding this topic.

Method: Previously diagnosed OCD patients who were on regular treatment for at least 3 months and caregivers of the same patients were enrolled in study. Consenting participants were administered semi-structured Performa which includes demographic data, Yale-Brown Obsession and compulsion scale (YBOCS), checklist for assessing severity and dimensions profile of the disease, IDEAS scale for assessing severity of disease, Brown Assessment of Belief Scale (BABS) for assessing insight. Burden Assessment scale of SCARF was administered to caregivers for assessing burden due to the disease in family.

Results and Conclusion: Data is analysed. The Results across different dimensions and themes of OCD, severity, insight and burden are correlated which will be discussed during presentation.

Keywords: OCD,Insight,care giver burden

Development and Validation of Inhalant Cue Pictures Paradigm

Shobhit Jain, Anju Dhawan, S Senthil Kumaran, Raka Jain, Ramandeep Pattanayak

National Drug Dependence Treatment Center (NDDTC), Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi - 110029, India. [email protected]

Introduction: Inhalant abuse is an emerging cause of concern in younger population. Craving is an important reason for continued inhalant use, which may be triggered by several conditioned cues. Research on cue-induced craving can enhance the neurobiological understanding of inhalant abuse with potential therapeutic implications. There is a dearth of validated visual cues for inhalant use, and no prior study is available from India.

Aim: The study Aimed to develop and validate visual cue stimulus for inhalant associated craving .

Method: The first step (picture selection) involved screening and careful selection of 30 cue pictures based on their relevance for naturalistic settings and 30 neutral pictures. In second step (time optimization), cue-pictures (n=10) were randomly presented to seven adolescent male inhalant users for 4, 6 and 8 seconds. The craving response was compared before and after cue exposure using a Visual Analogue Scale(VAS). Analysis did not reveal any group differences in craving. In third step (validation), 30 cue and 30 neutral pictures were presented for 4 seconds to inhalant users (n=20) to rate craving response for each picture.

Results: Statistical analysis revealed significant difference before and after craving response for cue-pictures, but not for neutral-pictures. The ROC Curve was plotted to arrange the pictures in order of intensity of craving. Detailed Results and their applicability in the neuroimaging study on cue-induced craving will be discussed during presentation.

Conclusion: This paradigm is ready after validation for use in a larger sample.It can be utilized for neurobiological researches and psychological interventions for Inhalant use disorders.

Keywords: cue induced craving, inhalant abuse, visual cues, validation, adolescents

To Study the Prevalence of Adult Adhd0 and its Significance in Substance Abuse Patients

Mahendra Singh Bhadoriya, Roop Sidana, Umar Mushir

Index Medical College & Hospital, Indore. [email protected]

Introduction: Attention -deficit/hyperactivity disorder (ADHD) is a common childhood disorder, with an estimated worldwide incidence of 8%-12%, yet it is now known that ADHD often persists into adulthood. Studies have reported an association between a specific genotype found in individuals with ADHD and the dopamine transporter. Other candidate genes that may be associated with ADHD have been identified in the norepinephrine and serotonin systems. A familial pattern has been documented by case control studies indicating that children of adults with ADHD are themselves at increased risk for developing the disorder.

Types Of Adult ADHD: According To the diagnostic and statistical manual of mental disorders, 4th edition, text revision (DSM-IV-TR),symptoms of ADHD begin in childhood (onset by age 7) and continue into adulthood.

Three ADHD subtypes are recognized in the DSM-IV-TR:

  • inattentive,
  • hyperactive/impulsive,
  • and combined type.

ADHD not otherwise specified is reserved for patients whose symptoms were not noted until or after age 7. To make a diagnosis of the predominantly inattentive subtype, atleast 6 of 9 symptoms of in attention must be present; to make a diagnosis of the predominantly hyperactive-impulsive subtype, 6 of 9 hyperactive impulsive symptoms must be present; for the combined subtype of ADHD to be diagnosed, criteria for both the preceding subtypes must be met.

Aims And Objectives:

Primary Objectives

  1. To estimate the prevalence of Adult ADHD among Substance abuse patients.
  2. To compare the prevalence of Adult ADHD among Substance abuse cases and non-substance abuse controls.

Secondary Objectives:

  1. To compare the socio-demographic profile of patients with and without Adult ADHD among patients with substance abuse.
  2. To compare the co-morbid psychiatric illness in patients with and without Adult ADHD among patients with substance abuse.
  3. To compare the patterns of substance use and relapse in 6 months in patients with and without Adult ADHD among patients with substance abuse.

Null Hypothesis

  1. Prevalence of ADHD symptoms do not differ with presence of the substance abuse.
  2. No significant difference in sociodemographic profile, clinical profile and comorbid psychiatric problems exists between presence and absence of ADHD in patients with Substance abuse

Materials And Methods:

Study design:

This was a prospective observational study.

Study Venue:

The study was conducted at Prerna De-addiction and Rehabilitation Centre at Tek Chand Sidana Memorial Psychiatric Hospital and De-addiction Centre, Sri Ganganagar, Rajasthan.

Study duration:

The study was conducted between June-2012 to June-2013.

Study population:

Study population consisted of patients and those accompanying patients to the De-addiction centre.

Sample size calculation:

Sample Size was calculated using formula N= Z2 [P (1-P)]/d2, where d (width of confidence interval) was determine to be 5%, Z = 1.96 (5% precision), P (Prevalence) = 3.5 % (As in previous studies prevalence of adult ADHD was 2- 5 %).

Sample size was calculated to be 49 in each group. Finally study was conducted with a Sample size of 50 patients and 50 controls.


Inclusion Criteria:

  1. Patients admitted in Prerna De-addicition& Rehabilitation Centre at Tek Chand Sidana Memorial Psychiatric Hospital & De-addiction Centre, Sri Ganganagar (Raj.)
  2. Fulfilling DSM IV-TR criteria for Substance use disorders (Substance Abuse or Substance Dependence)
  3. Males aged more than 18 years
  4. Willing to give written informed consent

Exclusion Criteria:

Patients with any substance induced disorders (eg. Intoxication, Withdrawal, induced sleep disorder, induced sexual disorder) without Substance Use Disorders.

Patients having any co-morbid neurological problems other than seizures.

Patients not willing to participate in the study.


Inclusion Criteria:

  1. Subjects who are accompanying the patients to the De-addiction centre
  2. Males aged more than 18 years.
  3. Subjects do not use any psychoactive substance.
  4. Willing to give written informed consent

Exclusion Criteria:

  1. Subjects with any history of any substance related disorder.
  2. Subjects having their first degree relatives with substance related disorders.
  3. Subjects having any neurological problems.
  4. Subjects not willing to participate in the study.


  1. Semi structured Performa for assessing Socio-demographic profile of the subjects and substance related behaviors and problems.
  2. Adult ADHD self report scale (ASRS VI.1)

Study Procedure: Written informed consent was taken from the participant subjects. All sampled cases and controls were assessed using semi-structured questionnaire for socio-demographic profile and substance use. A detailed history, physical and mental status examination was done. The Adult ADHD Self Report Scale (ASRS-VI.1) was applied on both cases and controls. Subjects with four or more positive scoring in part- A have high chance of adult ADHD. It was confirmed by applying DSM-IV-TR criteria of adult ADHD. After discussing with a consultant psychiatrist the diagnosis of substance use disorders and comorbid psychiatric disorders made according to DSM IV-TR were recorded. All those fulfilling DSM IV-TR criteria for substance use disorders viz., Substance abuse and substance dependence were termed patients with substance abuse in this study.

Cases were assessed on first day of admission and followed up every day till discharge. They were assessed for withdrawal symptoms, craving, aggressive behavior and impulsive behavior. The number of days taken for detoxification with an absence of signs of withdrawal was taken as duration for response to treatment.

All patients with substance abuse (both Adult ADHD positive and negative) were followed for 6 months either during follow up or readmissions or through telephonic contact to know the recurrence of substance use behavior. Resuming the use of the substance after a period of atleast 3 weeks of abstinence was considered a relapse. Number of relapses during the six months including rehospitalization for relapse was recorded.

Results: The Results indicate that there was a significant difference in substance abuse and non-substance abuse subjects. It was identified that subjects with substance abuse screened positive for ADHD had onset of substance abuse in early age, suffered from multiple substance abuse, and had delayed response to treatment in comparison to subject's diagnosed negative for ADHD.

Lastly, substance abuse subjects had more mood fluctuations and lesser anxiety in those diagnosed positive for ADHD.

There was a significant association of educational status in positive and negative ADHD substance abuse subjects (study group). Symptoms of ADHD were significantly associated with severity of addiction, onset of substance abuse, relapses, responding to therapy after treatment among substance abuse patients. Comorbid psychiatric illness among substance abuse patients was strongly associated with symptoms of ADHD. In non-substance abuse subjects (control group) the comorbid psychiatric illness such as depression was highly associated with symptoms of ADHD.

Conclusion: The prevalence of Adult ADHD in substance abuse was 22% and 4.0% in non-substance abuse subjects. Comorbidity of Psychiatric disorders and problems is significantly high in those with substance use disorder. Adult ADHD in substance abuse appears to increase the relapse rate and increase the chances of mood fluctuations even in absence of affective disorders. ADHD might also increase the risk of multiple substance abuse and delays the response to detoxification regimes. Above all interpretations and statistical confirmations sounded a concrete decision that Attention-Deficit/Hyperactive Disorder symptoms negatively influence the substance abuse. Thus a routine screening for ADHD in substance abuse would better conceptualize the complex disorder. Thus research focusing on managing ADHD in substance use is the need of the day.

Keywords: ADHD, Hyperactive Disorder symptoms, Psychiatric disorders


Inhalant abuse is common in adolescent and young people. However, awareness about its harmful effects is low and its potential to cause dependence remains a cause of concern. Inhalant abuse is often associated with underlying novelty seeking traits and it can predict propensity for other substances of abuse. Inhalants are cheap, freely available, legal to possess and escape detection in vulnerable groups. There is a need to spread awareness about the harmful effects of inhalants and devise effective relapse prevention strategies.

Key words : solvent, dependence, neurological consequences

Prevalence of Depression In COPD

Prabhat Sharma, Sudhir Maurya, Bhajan Lal Lilhare, Rishab Pratab Singh Yadav.

Index Medical College Hospital & Research Centre,Indore.

[email protected]

Aim& Objective: the Aim of study to know the prevalence of depression in copd patients attending tertiary care centre ( index medical hospital, indore).

Materials & Methods: 40 copd patients were enrolled in study according to copd gold criteria - 2015.They were screened for depression as per hamilton- d rating scale.

Conclusion : depressive symptoms are common in all stages of copd and increases with increase in severity of restricion .The prevalence of depression in rural patients with copd is high. Patients with copd should be screened for depression and those with higher depression score should undergo further evaluation and treatment.

Keywords: COPD, depression, HAM-D.

To Study Psychiatric Morbidities (Anxiety & Depression) in Post Myocardial Infarction Patients

Umar Mushir, M. S. Bhadoria, Sudhir Maurya, Parth Pandya, Viral Patel

Index Medical College & Hospital, Indore. [email protected]

Introduction: Ischemic heart disease (IHD) is a condition in which there is an inadequate supply of blood and oxygen to a portion of the myocardium; it typically occurs when there is an imbalance between myocardial oxygen supply and demand. Myocardial Infarction is a Result of Myocardial Ischemia. Acute myocardial infarction can develop at rest or with normal activity, and can be the first clinical manifestation of coronary heart disease. Symptoms of Depression and Anxiety have been commonly observed among patients in the aftermath of MI in both Indian and international studies

Aim & Objective: To study psychiatric morbidity in Myocardial Infarction patients and establish their correlation if any.

Material & Methodology: After obtaining informed consent, patients will be interviewed. Special Pro forma has been prepared for collecting the socio - demographic profile.50 Patients who have survived 6 months after AMI & who fulfil the criteria to establish a diagnosis of MDD and GAD based on DSM V diagnostic criteria will be administered HAM-D and HAM-A rating scales to assess the severity of depression & anxiety and shall be compared with control group.

Conclusion: Myocardial Infarction is significantly associated with Depression and Anxiety. These Results will highlight the importance of holistic care in managing patients. Recognition & early intervention of depression and anxiety will improve quality of life in patients.

Keywords: MDD, GAD, DSM V, Ischemic heart disease.

A Systematic Chart Review of Electroconvulsive Therapy for Children and Adolescents At A Tertiary Centre in India

Sinha Joyita, Motichand Sandeep, Goyal Nishant, Sinha Vinod Kumar

Department of Child and Adolescent Psychiatry, Central Institute of Psychiatry, Ranchi, India. [email protected]

Aims And Objectives: The use of electroconvulsive therapy (ECT) in children and adolescents is a controversial issue and the literature regarding the use of ECT in this population is lacking. This study was done to study the pattern and practice as well as the outcome of electroconvulsive therapy administered to children and adolescents admitted to a tertiary care centre.

Methodology: A 2 year retrospective chart review of all children and adolescents (up to 18 years of age) admitted in the Erna Hoch Child and Adolescent Psychiatry Centre, Central institute of Psychiatry who had received at least 1 session of ECT was done. The details regarding the diagnosis, reasons for starting ECT and details regarding the procedure, safety aspects and outcome variables were collected from the case record files of the institute. The Clinical Global Impressions (CGI) scale rating of the severity of the illness and the improvement seen were done by 2 trained psychiatrists independently.

Results: The Discussion and Results will be presented at the time of presentation.

Keywords: ECT, CGI-S, Adolescent.

Pure Delusional Jealousy

Naseem Akhtar Qureshi

Public Health Specialist & Consultant Psychiatrist, Scientific Publication Division, National Center of Complementary and Alternative Medicine, Riyadh, Saudi Arabia

Background: Pure delusional jealousy [DJL] is an uncommon disorder and is characterized by unshakable false belief of infidelity, lack of hallucination, thought disorder and mood disturbance, and not associated with alcohol or other drug abuse or any co-morbid illness. Objective: This paper Aims to briefly review the relevant literature (2000-2015) and present a case of delusional disorder- jealousy type. A 31-year-old housewife with three minor children developed an unshakable belief that her husband was having an extramarital affair since 5 years and no longer loved her. She was diagnosed with delusional disorder-jealousy type and was managed with aripiprazole and brief psychotherapy. Within three months, most of her symptoms improved, however she developed post-psychotic depression and attempted suicide by taking 125mg diazepam. She was immediately rushed to a private hospital and admitted to the intensive care unit (ICU). She recovered within five days and was shifted to the public hospital for the management of depression, where she was stabilized and discharged after two weeks. Conclusion: Typical and atypical antipsychotic drugs combined with psychotherapy are the main treatment options for patients with DJL with or without co-morbid physical and psychiatric disorders. Post-psychotic depression and suicide attempts, devastating biosocial consequences among patients with DJL need timely and appropriate interventions and continued followup.

Keywords: delusional jealousy, infidelity, aripiprazole, psychotherapy, depression, suicide attempt

Clozapine on the Treatment of Adolescent Onset Schizophrenia Associated with Hypersexuality

Anil Kumar B. N., Sanjay Raj G., Shalini M.

Dept. Of Psychiatry, Shridevi Institute of Medical Sciences and Research Hospital, NH-04, Sira Road, Tumkur 572106. [email protected]

Abstract: Hypersexuality is a change in types and increase in frequency of sexual behaviours. The aetiology of hypersexuality is complex and involves a variety of physiological and psychological mechanisms. Though hypersexuality is well observed in mania and dementia, few data exists in patients with schizophrenia. We report here three cases of adolescent onset schizophrenia, exhibiting hypersexuality (nonparaphilic sexual behaviours) in terms of greater sexual pre-occupation, increased attraction towards opposite gender and attempts to approach them, openly asking for sex, masturbation in front of parents without inhibition and watching porn for prolonged hours. These symptoms not in any way related to patients psychotic symptoms. These patients received adequate trial of either T. Olanzapine, T. Risperidone or T. Haloperidol as monotherapy and showed partial improvement in psychotic symptoms but with no significant improvement in hypersexuality symptoms. But with T. Clozapine (150-225mg/d) they showed significant improvement in both psychotic and hypersexuality symptoms over period of 2 months. Our study shows that Clozapine could be a better choice in patients with schizophrenia associated with hypersexuality.

Keywords: Olanzapine, Risperidone, Haloperidol, Clozapine.

Genetic Testing for Personalized Psychiatric Drug Therapy

Siddhartha Roy, Vaibhav Dubey

Senior Scientist and Genetic Counselor, Innovative Life Discoveries Pvt Ltd, Gurgaon. [email protected]

Pharmacogenetic profiling for administration of psychotropic drugs is carving out a fresh paradigm towards treatment and management of psychiatric illnesses. One of the challenges in the pharmacotherapy of mental disorders among others is lack of appropriate response to treatment, which may be associated with ineffective therapy, adverse drug reactions (ADRs) and self medication. Involvement of cytochrome P-450 isoenzymes (including CYP1A2, CYP2C19, CYP2D6, CYP3A4) in the metabolism of psychotropic drugs contributes to risk of adverse interactions, both in pharmacokinetic and pharmacodynamic phase. Pharmacogenetic studies are gaining recognition and importance in the field of improving both therapeutic effectiveness and safety of psychotropic drugs in treatment of mental disorders. For example, CYP2D6 is responsible for the oxidative metabolism of up to 25% of commonly prescribed drugs such as antidepressants, antipsychotics, opioids, antiarrythmics and tamoxifen. The ultrarapid metaboliser (UM) phenotype is recognized as a cause of therapeutic inefficacy of antidepressant, whereas an increased risk of toxicity has been reported in poor metabolisers (PMs) with several psychotropics (desipramine, venlafaxine, amitriptyline, haloperidol). CYP2C19 is involved in the metabolism of several antidepressants. As a Result of an increased risk of adverse effects in CYP2C19 PMs, dose reductions are recommended for some agents (imipramine, sertraline). Similar considerations are necessary to ensure enhanced drug efficacy/response and reduced drug induced side effects on an individualized level. Various established consortia like CPIC, FDA etc are advocating the utilization of such high throughput genotyping platforms and the Result thereof towards actualizing the ultimate goal of precision medicine. With the advent of newer and better molecules, it is professionally prudent to be aware of such approaches. I will put forward a brief presentation about a 'service' which is slowly but effectively gaining momentum in India, which is assisting physicians in choosing the most appropriate drugs, based on evidence based pharmacogenetic information.

Keywords: antiarrythmics, psychotropics, ultrarapid metaboliser

Unmet Needs of Survivors of Suicide

G. K. Vankar, Srikanth Reddy, Nishant Ohri, Pawan Rathi, Samir Desai

Psychiatry Dept. Sri Aurobindo Institute of Medical Sciences, Indore Ujjain Highway, Gram Bhanwarasala, Tehsil Sanwer, Dist.Indore, Madhya Pradesh. [email protected]

Suicide is a major public health problem globally with more than 1 million deaths every year. Every suicide affects at least seven persons survived by suicide. Although there are studies on epidemiology of attempted and completed suicide as well as psychiatric disorders and suicide, few studies from India focus on intervention. There are virtually no studies focusing on needs of survivors of suicide.

A Suicide evokes very strong emotions of shock pain, isolation, stigma, guilt, anger. They may be harbinger Depression, prolonged grief disorder, substance use disorder as well as suicide.

With clinical history of two suicide survivors seeking treatment in mental health system this paper endeavors to highlight the unmet needs of the survivors of suicide in Indian context.

Keywords: Depression, prolonged grief disorder, substance use disorder.

Psychiatric Comorbidities in Acute Coronary Syndromes

Ramya Shruthi D, Nagaraj Desai, T.S. Sathyanarayana Rao, Rajesh Raman

JSS Medical College and Hospital, JSS University, Mysore, Karnataka. Department of Psychiatry, 2Department of Cardiology. [email protected]

Background: Coronary Artery Disease is caused by atherosclerosis, which in turn could have underlying multiple risk factors. Research suggests that acute and chronic stresses are the risk factors for the development and progression of Coronary Artery Disease. The Prevalence of CAD and psychiatric co morbidities is not so well researched area in this part of the globe.

Objective: Assessing the prevalence of Psychiatric comorbidity in in-patients admitted for Acute Coronary Syndromes.

Materials And Methods: It is a cross-sectional study of 150 consecutive people presenting with Acute Coronary Syndromes at JSS Hospital, JSS University, Mysore which is a tertiary care referral and teaching center. The patients were evaluated on a structured and validated proforma, MINI, HDRS - 21, HAMA and PSS-10 . ANOVA and t-test were used for Statistical Analysis.

Results: Of the 150 study subjects, the age ranged between 20 -79 years(maximum 40-59 years). Males predominated (N=131), of which 98 % were married, majority were Hindus(96%), from Rural Background (76 %), had attended primary school (30.7 %), unskilled occupation ( 51.3 %), from Nuclear family ( 82.7%) and Upper Lower socioeconomic status ( 46.0%) . Medical comorbidities of DM-II and Hypertension were 36 % and 35.3 % respectively and 33% had dyslipaedemia. Among psychiatric comorbidities, MDD was recognized in 29.5% of the individuals while anxiety in 4.1%. Among the substance use disorders 86.9% had Nicotine usage while 75.4% had Alcohol use. Stress had played an important role irrespective of the other psychiatric comorbidities

Conclusion: Psychiatric comorbidities, in particular Depression and Anxiety and the Substance use along with high level of stress are commonly seen in patients with Coronary Artery Disease. Hence addressing the concerned issues during the stay in the hospital and at follow up is necessary for the better outcome of the patient. The issues related to prevention will be presented.

Keywords: Psychiatric comorbidities, Coronary Artery Disease, HDRS - 21, PSS-10.

A Case of Acute Dystonia Induced by Low Dose Amisulpride

T. Navya Spurthi, Kishor. M, Shivanand Manohar, Suhas Chandran, T.S. Sathyanarayana Rao, Rajesh Raman

Department Psychiatry, JSS Medical College and Hospital, JSS University Mysore. [email protected],

Abstract: Amisulpride is a second generation antipsychotic drug which has been introduced in India only a decade ago. It is distinct from that of classical neuroleptics and other SGA's because of its preferential action on D2, D3, 5HT2A, 5HT2B and 5HT7 receptors in the limbic system .Nowadays low dose Amisulpride is increasingly being used as a mood stabilizer during acute depressive and manic phases and dysthymia. At higher doses Amisulpride antagonizes post-synaptic D2 and D3 receptors preferentially in the limbic system than the striatum thereby reducing dopaminergic transmission. It has been postulated to have low propensity to induce EPS . In our clinical practice, we found the EPS of Dystonia with this drug even at a lower dose. A 23 year old unmarried female patient diagnosed with Bipolar affective disorder current episode mixed, started with amisulpride 200 mg/ day came back within 3 days with severe dystonia of the neck muscles. The case highlights the need to keep this spectrum of side effects in mind while starting and maintaining on Amisulpride.

Key words: Acute Dystonia, second generation antipsychotic, Amisulpride.

A Compulsion to Throw Away Prescribed Tablets in A Case Of Childhood OCD with Attention Deficit Hyperkinetic Disorder

Suhas Chandran, Kishor. M, T. Navya Spurthi, T.S. Sathyanarayana Rao, Rajesh Raman

Department Psychiatry, JSS Medical College and Hospital, JSS University, Mysore. [email protected]

Abstract: Obsessive-compulsive disorder (OCD) in children is one of the most complex and disabling disorders presenting to a hospital setting. It's symptomatology can mimic other psychiatric disorders, especially in children, making it confusing for the treatment team .It is often associated with co-morbidities like tics, depression and ADHD. The ADHD and OCD association still need to be established. We hereby report an instance of ADHD-OCD co-occurrence in a 16 year old boy, who presented with a 9 year history of restlessness, obsessions of contamination, symmetry, causing harm to others, setting fire, magical thoughts, with compulsions of washing, checking, ordering and arranging, counting and repeating, swallowing stones, mental rituals and self mutilating behaviour. The patient would pen his own rule book to fit his predilection for symmetry and though the patient recognized these repetitive rituals to be unwarranted and tried resisting most of them, there were multiple instances throughout his schooling where he would find himself in disciplinary trouble independent of these repetitive rituals. These instances were attributable to excessive activity which was disorganised and poorly regulated, an impaired attention Resulting in shifting to a new task without completion of the former one. The patient also had associated complex motor and vocal tics, and the Resulting distress had led to two suicidal attempts. His compulsion to throw away prescribed tablets was concerned with issues of contour, shape and texture. The interesting aspects of the phenomenology and management will be discussed.

Key words: OCD, ADHD, OCD-ADHD co-morbidity, compulsions

Use of Technology to Target Public Awareness -A Pilot Retrospective Study at Tertiary Hospital

Shreemit Maheshwari, Kishor M., T. S. Sathyanarayana Rao, Suhas chandran, Rajesh Raman

Dept of Psychiatry, JSS Medical College and Hospital, JSS University, Mysore. [email protected],

Background: The Awareness about Psychiatric illness in the Indian population is not adequate and hence there is a delay in early identification & intervention leading to increased mortality and morbidity. Patients who seek admission for psychiatric illness to tertiary care hospitals are indicative of the awareness of such facilities. Web based technology can be made use of to locate these patients to their geographical location and this can be utilized for targeting awareness that is more likely to yield better health care utilization.

The Objectives of the study were to use technology in localizing geographical location of In-patients who reported to Tertiary Care Hospital and to plan on creating awareness in high density areas.

Methodology: JSS Hospital is a multi-speciality 1800 bedded teaching hospital of JSS Medical College, Mysore .Retrospective documentation of In-patient addresses were done with the digitalized health records system which was introduced 3 months back. The Study was carried out from August 2015 using Google Maps.

Results and Discussion: More than 150 patients were traced by their address from the Electronic medical records. The geographical high density areas were traced. The Results obtained are discussed in relation to its implications in treatment, follow up and prevention.

Keywords: Web Based Technology, Mental health awareness, modern health care utilization

A Study on Adolescent Mental Disorders Prevalent in Our Country.... A study

Asis Krishna Acharya

Sr. Psychiatrist. [email protected]

Introduction: Child & adolescent psychiatry has tremendously developed in the last few decades in our country & also in other countries. The first book published from WPA Was published on Children & adolescent mental disorders after a task force study & edited by Dr. Norman Sattorious & Dr. Ahmed Osaka of Egypt. But in our country assessment & study of adolescent Mental Disorders & behavior disorders are not studied at large. In this study I have reviewed the presenting patterns of behavior & Mental disorder in 100 adolescent boys & girls those attended my clinic in Midnapore clinic from the period of January 2015 to June 2015.

Materials & Method of study: The 100 adolescent comprises of 60 boys & 40 girls in the age range of 11 to 17 years with a median age of 14 years. Some of them were referred by Pediatrician or other physicians, but majority 77% were came to attend the clinic with their own guardian's effort. They were clinically assessed with detailed history from birth onward & some of them were send for IQ assessment or psychometric assessment from Indian Psychoanalytical Society's clinic at Kolkata.

Findings & observation: The most prevalent disorder was behavior disorder with low intelligence rating from below normal intelligence to Mild to Moderate mental retardation. In girls mostly were found Neurological Conversion disorder (Conversion Disorder),rest while somatoform conversion disorder or Hysteria.

Anorexia nervosa were found in 2 girls & Autistic disorder or pervasive development disorder was found in one boy. Other Anxiety disorder or even depression was found. Kleptomania or Trichotolomania was also found. Ticks & violence or Bullying also found. Notable was a school dropout ranging from 30% in boys to 42% in girls.

Conclusion: A neglected arena of Psychiatry still remains in not getting to much studies or knowledge of actual incidence or prevalence of Adolescent Mental disorder is a lacking still prevails. This small cross sectional study may reveal a little input to focus on the subject & may triggers others to go on an in depth study on the urgent matter, because these Adolescents are going to be the future citizen & early diagnosis, awareness & early intervention may fill up the huge gap still persisting there.

Keywords: Mental Disorder, Adolescent Trichotolomania.

Comparison of Behavioural and Psychological Symptoms (BPSD) in Early Versus Late Onset Alzheimer's Disease - A Pilot Study from Kashmir

Raheel Mushtaq, M.S.V.K Raju, Arshad Hussain, Mohammad Maqbool Dar

Dept, of psychiatry, Govt. Medical college Srinagar.

[email protected]

Background: Behavioural and psychological symptoms (BPSD) represent non cognitive symptoms of AD. However no study has been carried out in India, which assesses behavioural and psychological symptoms in Early versus Late Onset AD.

Objectives: To assess and compare BPSD in Early and Late Onset Alzheimer's Dementia.

Material And Methods: The study was conducted in Memory Clinic of Postgraduate Department of Psychiatry, Government medical college, (India) from January 2012 to March 2014. The diagnosis of AD patients was done according to NINCDS-ADRDA criteria .A total of 80 patients of AD were screened (40 with age of onset less than 65 and 40 with age of onset greater than 64) .Patients with age of onset less than 65 were called as Early Onset Alzheimer's dementia (EAD) and patients with age onset greater than 65 were called as Late onset Alzheimer's dementia (LOAD).Neuropsychiatric Inventory (NPI) was the instrument used for evaluating symptoms of BPSD. The data was analysed using paired t test.

Results: The LOAD group had significantly higher symptom severity for delusions, agitation, anxiety, disinhibition, nighttime behavioural disturbances (NBD) than the EAD group (P≤.0001).

Conclusion: The LOAD had significantly higher symptom severity for delusions, agitation, anxiety, nighttime behavioural disturbances than EAD

Keywords: NBD, BPSD, Alzhiemer Disease.

Longitudinal Course of Negative Symptoms, Cognitive Deficits and Social Cognition in Schizophrenia

Aparajita Arora

[email protected]

Aim: To study the longitudinal course of negative symptoms, cognitive deficits, social cognition, and their interaction with each other and with the functional outcome in a cohort of patients with Schizophrenia

Methods: Prospective, hospital based longitudinal study of 45 clinically stable Schizophrenia subjects assessed at baseline on CDRS, PANSS, TRENDS, SCoRS, SOFS and CGI-S and then reassessed at 6 and 12 months.

Results: On repeated measures ANOVA, significant improvement was seen in negative symptoms (F = 34.1, p <.001), cognitive performance (F = 3.8, p = 0.032), social cognition (F = 6.9, p = 0.003) and socio-occupational functioning (F = 46.3, p <.001). On sub analysis using independent t-test, subjects with earlier age at onset were found to have significantly lower scores on TRENDS (p = 0.02). The improvement in cognitive performance by later age at onset subgroup was significant (p <.001). Co relation analysis showed that change in negative symptoms were positively correlated to the change in cognitive performance (r= 0.63, p=0.05) and also to change in socio- occupational functioning (r= 0.83, p <0.001). On binary logistic regression, baseline mean scores on TRENDS were able to predict 65.9% correctly that the subject belonged to early age at onset subgroup (p = 0.02). The model explained 19.2% variance.

Conclusion: Subjects showed improvement in negative symptoms, social cognition and socio- occupational functioning over course of 12 months. Subjects with later age at onset showed significant improvement in cognitive functioning while those with earlier age at onset did not. Lower baseline scores of social cognition were indicative of an earlier age at onset. Negative symptoms were found to be correlated with socio- occupational functioning of the subjects.

Keywords: Schizophrenia, ANOVA, CDRS, PANSS,

Are We Really Reaching the Unreached? Print Media and Mental Health

Pavitra KS, Sridhara KR, Shubrata KS

SDM Medical College, Dharwad, Karnataka. [email protected]

The portrayal of mental health related articles in the news paper and journals has been an incredibly powerful tool in educating and influencing public on mental health. The doctors as well as non-doctors by writing about health issues in the media are raising awareness about the mental illness. But the question is how extensive and accurate is the information provided in the media? This study was conducted to answer these questions. It reports the findings of an analysis of mental health-related articles in major daily newspapers of Karnataka. The study also attempted to find the number of psychiatric articles among the total health articles published and differences in presentation of mental health related articles by psychiatrists when compared to other doctors /non-doctors. The majority of the articles in mental health were concentrated on life style changes, child mental health related and depression. The articles were written in most instances by non doctors and lacked in updated information and clinical expertise. Information on major mental illnesses were significantly not seen. The implications to early recognition, early contact and stigma reduction through print media will be discussed in the presentation.

Keywords: Mental Health, depression, non-doctors.

Challenges and Opportunities for Integrating Mental Health Information in Health Management Information Systems

Shalini Ahuja, Rahul Shidhaye, Sandesh Samudre, Sharmishtha Nanda, Mark Jordans

[email protected]

Introduction: Linking routine patient information for providing care to evidence informed decision making at various levels is a crucial component of health system strengthening. Mental Health Information System (MHIS)strengthening has been particularly emphasized globally, as a means of improving monitoring of mental health care. Regrettably for mental health few indicators are reported through District Mental Health Programme (DMHP), providing MH services at primary care system in selected districts. We report the findings of a study under EMERALD project on integrating mental health information into HMIS.

Methods: In depth qualitative interviews with 33 stakeholdres at state and national level were conducted. Data was analysed by listing the responses, forming domains followed by coding the interviews. Code book was prepared in NVIVO 10 based on domains and sub domains which emerged while analyzing the data.

Results: Despite an increased Mental Health-HMIS budget in the 12th five year plan, challenges such as poor DMHP implementation, insufficient lobbying on behalf of planners at MOHFW/DOH level, weak technical link between MOHFW and DOH for providing expertise on implementation and monitoring of mental health programme have led to poor use of information in mental health policies, plans and decision making.

Discussion: MHIS in the current DMHP model is weak and fail to sustain and fulfill the purpose of generating robust evidence affecting planning and health management. It is not easy to converge all the national programme into the national HMIS although convergence through diagonal integration should be further explored.


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