|How to cite this article:|
. Day 4 25th January 2020 Abstracts. Indian J Psychiatry 2020;62, Suppl S1:137-65
| SYM 48: Digital cocaine: a glimpse into the Behavioural addictions|| |
Dr Era Dutta (LOM/E01/12), Consultant Psychiatrist, Fortis Healthcare Kolkata
Dr Payal Sharma, Consultant Psychiatrist, Rekindle Mind Clinic, Mumbai
Dr Kedar Tilwe, Consultant Psychiatrist, Fortis Healthcare, Mumbai
Technology is an imperative and quintessential part of our lives. Growing evidence suggests that behavioural addictions resemble substance addictions in many domains, including natural history, phenomenology, tolerance, comorbidity, overlapping genetic contribution, neurobiological mechanisms, and response to treatment.
Description: Behavioural addiction is a form of addiction that involves a compulsion to repeatedly perform a rewarding non-drug-related behavior. The term “behavioural addiction” is not included in the DSM-5 due to insufficient peer-reviewed evidence to establish the diagnostic criteria and course descriptions needed to identify these behaviours as mental disorders. However, we all know how these”SOFT ADDICTIONS” take over and encompass our day-to-day lives.
Internet addiction is a psychosocial disorder and its characteristics are as follows: tolerance, withdrawal symptoms, affective disorders, and problems in social relations. Our own study amongst the youth of a urban school reflected similar trends showing 450(81.27%) as average users, 84 (15.14%) as over users, & 31 (5.58%) as internet addicts.
Smart phones are the need of the hour and also proving to have a negative aspect we didn't predict. Smart phone addiction is a relatively common phenomenon and needs to be delved into.
Selfie is defined as “a photograph that one has taken of oneself, typically shot with a smartphone or webcam and uploaded to a social media website.” We present data from our own study which is a first ever study on Selfie from our country, reflecting patterns of body image disturbances and narcissistic personality traits amongst medical students addicted to taking selfies.
Last, but certainly not the least, Facebook addiction has taken over most of our lives. With the wish to be “liked” and “commented” on, and the constant need for us to be virtually connected, this is certainly another behavioural addiction needing our focus.
Hence, we cover a gamut of Behavioural addictions beckoning our attention in this symposium. Covering two major studies conducted on Internet addiction and Selfie addiction amongst school students, this symposium provides the neurobiological, psychological theories of technological addiction. This interactive symposium aims at targeting the “real” problems brought to notice by the parents, students, and youngsters themselves in context of behavioural addiction related to technology.
| SYM49: Migration and Mental Health: Issues of Integrative Health Care and Well Being|| |
A. A. Mamun Hussain
Background: History reveals that mobility is a fundamental human activity, a vital component of developing human capital and a powerful driver of social change. According to a UN estimation, one-third of the world's population can be defined as migrants, when four out of every five migrants come from a developing countries.
Researchers consider the impact of migration on various level on the individual who migrate, and on the cultures and communities they leave behind.
Aims: This overview would examine the effects of migration on total well being of the migrant peoples, emphasizing the issues of integrative health care.
Methods: This paper is presented with the information's available from literatures after meticulous search in Pub Med, Google, Google Scholar and relevant journals with the searching
Keywords Viz. Migration, Health, Well being and Mental Health.
Results:There is considerable evidence in the literature to support that migrant peoples are more prone to mental illness
Conclusion: As the interaction between physical and mental health is a complex one, understanding issues of migration is a key-factor in assessing help-seeking behavior of the migrants for the formation of right integrative health care.
Finally, as the issues of migration is included in the 2030 agenda for sustainable development, it demands suitable strategy and its necessary implications from the policy makers of the every country.
| SYM50: Out Of The Closet : Challenges Of The LGBT In Clinics And Community|| |
Mythili Hazarika, Dr Shyamanta Das, Nilofar Rahman
”We health care providers don't know everything that our patients want, and that sometimes our preconceived notions are not what our patients want” Adil Haider, MD, MPH in The Nation's Health February/March 2019, 49 (1) E3.
Homosexuality,once considered a mental disorder is no longer pathological and currently after the decriminalization of Section 377, there has been a rapid increase in disclosure of this population from an age of adolescence. But interestingly, professionals' views and attitudes have been mixed leading to challenges in meeting the health care needs of this population.
In the last two decades, there has been a tremendous surge in the awareness about LGBT (lesbian, gay, bisexual and transgender) population. Psychiatry and psychology in today's era act as a portal to their mental and physical health care need. The prevalence reported in DSM 5 (0.005–0.014% for birth-assigned males; 0.002–0.003% for birth-assigned females) are based on people who received a diagnosis of Gender identity disorder (GID) or transexualism, and were seeking hormone treatment and surgery. In India, overall meta-prevalence per 1 lac population is 9.2 for surgical or hormonal gender affirmation therapy.
The LGBT community faces unique stressors in the form of non- disclosure, relationship dissatisfaction, social isolation and low self-esteem sometimes leading to depression and suicide. Hence, the health care professional's adequate knowledge and positive attitude in the process of transformation from self-disclosure to surgery with a patient centered care is essential in today's time.
Department of Health and Human Services launched Healthy People 2020 and one of their objectives is to encourage better collection of data on LGBT population. Their population-based data systems, state-level surveys and data systems would include standardized questions on LGBT people. Hence, the speakers by this symposium would discuss not to champion the cause of homosexuality but to expose ourselves to alternative views of sexuality, challenge the age old values and beliefs, and celebrate diversity with clinical and research work done in Northeast India so that the challenges of the population in and out of the closet are addressed in a comprehensive manner. The speakers have started support groups for LGBT population in their own state and would explore the necessity in creating a population based data system in their own state to meet the local needs in the symposium.
[TAG:2]F190: Assessing the unmet needs of patients with major mental illness in a tertiary care centre in north kerala - a cross sectional study [/TAG:2]
Introduction: The World Health Organisation (WHO) in 1948 defined health as a “a state of complete physical, mental, and social well being not merely the absence of disease or infirmity”.(1) While this definition is comprehensive (though rather utopian and ambitious) it clearly indicates what should be the goal of health care intervention. Medical professionals however tend to focus more narrowly on a medical model of health care -a history and examination- followed by investigation and treatment, and finally clinical measures of successful outcome. Surveys have shown high levels of unmet need in representative samples of people with severe mental illness
Aims And Objectives Of The Study:
- Assessing the needs of patients with major mental illness.
- The unmet needs
- The met needs
Materials And Methods:
TYPE OF STUDY: Cross Sectional study.
STUDY SETTING: A tertiary care center in North Kerala.
STUDY PERIOD: One year.
SAMPLE SIZE: All the patients who meet the criteria, visiting psychiatry opd
TOOLS AND METHODOLOGY:
1. Camberwell Assessment of Need Short Appraisal Schedule
2. Mini plus version5.0.0
Result And Conclusion: In the present study, the mean number of needs on CAN-R was 7. Of these about two-third of the needs were met,and one-third were unmet needs.The number of needs reported by the patients in the present study are more or similar to that reported in other
| F191: Role of Serum S100B in Schizophrenia|| |
Name of author :Dr R.Sravya
Co-authors : DrT.V.Pavan Kumar, Dr D.Phani Bhushan
Affiliation : Department of Psychiatry; NRI Medical College and General Hospital
S100B is a calcium-binding protein that is secreted predominently from astrocytes and other glial cells in central nervous system. It plays an important role in modulating the proliferation and differentiation of neurons and glial cells and is involved in the regulation of cellular energy metabolism and interacts with many immunological functions of the brain. High blood S100B levels have been linked to brain damage and psychiatric disorders. S100B levels have been reported to be higher in schizophrenics than healthy controls. Recent findings have strengthened the hypothesis that a dysfunction of neuronal synapses and dendrites is relevant for the pathogenesis of schizophrenia. It might be present during neurodevelopment as well as in degenerative and regenerative processes of the mature brain.
To study the level of Serum S100B protein in Schizophrenic patients.
After approval from institutional ethics committee and obtaining written informed consent, study was conducted on patients attending Psychiatry OPD & IPD at NRI General Hospital over 2months. 30 patients fulfilling the ICD-10 criteria for schizophrenia were considered for the study and their Serum S100B levels were measured.
Elevated levels were found in 5 patients.
Glial dysfunction appears to play a role in the pathogenesis of schizophrenia. Therefore, S100B seems to be an important marker of both state and prognosis of schizophrenia and other disorders with brain damage.
| F192: Bilirubin Levels in Individuals with Schizophrenia and Bipolar Affective Disorder: A Comparative Study|| |
1Dr.Sheena Varughese 2Prof.Roy Abraham Kallivayalil
1Assistant Professor, Dept. of Psychiatry, Pushpagiri Institute of Medical Sciences, Thiruvalla
2Professor and Head, Dept. of Psychiatry, Pushpagiri Institute of Medical Sciences, Thiruvalla
Background: Alteration in serum bilirubin level in psychiatric disorders have been addressed but the pattern of this alteration is controversial.
Aims: To compare the Bilirubin levels between Individuals with Schizophrenia and Bipolar Affective Disorder and the association between severity of illness and bilirubin levels.
Methodology: The research design was comparative & cross sectional. Serum bilirubin levels were compared between patients with Schizophrenia (N=50) and Bipolar Affective Disorder (N=50) admitted to an inpatient psychiatric unit of a tertiary hospital. MINI neuropsychiatric interview was used to generate ICD 10 diagnosis for primary psychotic illness, Brief Psychiatric Rating Scale, Young Mania Rating scale and Hamilton Depression rating scale were used to assess severity of psychopathology.
Results: There were significant relationship between the severity of the psychopathology and the levels of Bilirubin, but no other significant differences were found in terms of other variables.
Conclusion: Increased levels of Bilirubin may be considered as an indirect biochemical marker in terms of assessing the underlying psychopathology.
Keywords: Hyperbilirubinemia, Schizophrenia, Bipolar affective disorder
| F193: Predictors Of Negative Symptoms In Chronic Schizophrenia: A Cross-Sectional Study|| |
Dr. Shalini Bijali, Junior Resident, Institute of Mental Health, Amritsar.
Dr. Savinder Singh, Director, Institute of Mental Health, Amritsar
Aims And Objectives: To assess the correlation between various demographic, clinical and biochemical profile with the negative symptoms in chronic schizophrenia to identify the predictors of negative symptoms.
Materials And Methods: About 100 patients diagnosed with schizophrenia according to ICD-10, in Institute of Mental Health, Amritsar, Punjab, India who will meet the inclusion criteria and who do not get excluded were recruited into the present study after taking written informed consent. Socio-demographic data of patients like age, sex, education, occupation, residence, marital status and clinical data like age of onset of illness, duration of illness, duration of untreated psychosis, antipsychotic dose receiving, Body Mass Index (BMI) were collected. Patients were assessed for psychopathology, adverse effects and cognitive functions using Positive And Negative Symptom Scale (PANSS), Drug Induced Extra Pyramidal Symptoms Scale (DIEPSS), Abnormal Involuntary Movements Scale (AIMS) and Mini Mental Examination Scale (MMSE) respectively. Patients were also investigated for biochemical parameters like LDL, HDL, TG, uric acid and qTC interval on electrocardiogram. All these social, clinical and biochemical variables were correlated with negative symptoms using statistical analysis
Results: The negative symptoms were significantly high in illiterate and unemployed patients. Negative symptoms were significantly positively correlated with duration of illness, treatment duration, DUP, general psychopathology, abnormal involuntary movements and negatively correlated with age of onset of illness, positive symptoms and cognitive functions. Negative PANSS scores were not correlated with any of the biochemical variables.
Conclusion: Cognitive symptoms, positive symptoms and duration of Untreated Psychosis directly predicted the negative symptoms in schizophrenia patients.
Keywords: Negative Symptoms, Positive Symptoms, Extrapyramidal symptoms, Duration of Untreated Psychosis (DUP)
| F194: Assessment of Neurocognitive Function in Unaffected First Degree Relative of Schizophrenia Patients|| |
Derrick Johnson1, Prof Roy Abraham Kallivayalil2
1Post Graduate Resident, Dept. of Psychiatry, Pushpagiri Institute of Medical Sciences, Thiruvalla
2Prof and Head, Dept. of Psychiatry, Pushpagiri Institute of Medical Sciences, Thiruvalla
Background: Neurocognitive impairments are found in all stages of schizophrenia and are considered to be potential endophenotypes1. These impairments have been demonstrated even in remission stages and is considered to be trait factors. Healthy first degree relatives of patients with schizophrenia have also demonstrated these cognitive deficits indicating that these cognitive deficits could be a potential endophenotypes of the illness2.
Aims: To compare neurocognitive functioning in first degree relatives of patients with schizophrenia and unrelated healthy individuals.
Methods: The research design was comparative & cross sectional. Neurocognitive functioning was assessed in 51 unaffected first-degree relatives (FDR) of schizophrenia patients with an equal number of healthy controls. FDR group was compared with the control group on measures of attention, shortterm memory, verbal working memory, response speed, sustained attention, visual spatial skills, set shifting, visual scanning and psychomotor speed.
Results: Compared to healthy control, unaffected FDR performed poorly only on the tests of response speed, sustained attention, and visual spatial skills and set shifting but no significant differences were found in other cognitive functions.
Conclusion: These findings suggest that there were impairment in only certain domains of executive function tasks which could serve as an endophenotypes for schizophrenia.
Keywords: Schizophrenia, endophenotypes, cognitive functions, first degree relative
[TAG:2]F195: Atorvastatin as an adjunctive therapy in patients with Schizophrenia and its relation to C Reactive Protein: a randomised placebo-controlled study [/TAG:2]
By: Dr. Debasmita Dey, Junior Resident; Dr. Varun S. Mehta, Assistant Professor; Dr (Prof) D. Ram, Director, Central Institute of Psychiatry, Ranchi
Background - There is ample evidence that inflammatory processes play an important role in the pathophysiology of Schizophrenia. Randomized controlled trials have shown benefit of some anti-inflammatory drugs on symptom severity. Further, second generation antipsychotics are associated with changes in metabolic profile of the patient. Atorvastatin combines well-established lipid lowering effects with reduction of the inflammatory status of the brain, thus offering an attractive potential to further improve treatment of Schizophrenia. The study aimed to evaluate the effects of Atorvastatin (40mg/day) on metabolic profile, C Reactive protein, and symptoms of Schizophrenia (positive and negative).
Methods – Fifty male participants with Schizophrenia admitted in the Institute were allocated into 2 groups of 25 participants each. One group received Atorvastatin tablets (40 mg/ day) and the other group received a placebo as adjunctive treatment to a second generation antipsychotic for six weeks. They were followed up for 6 weeks for assessment of clinical, laboratory parameters and psychopathology.
Results – There was significant improvement from baseline in the positive and negative symptoms of Schizophrenia and total cholesterol, HDL, LDL and CRP on Atorvastatin therapy after 6 weeks.
Conclusion – From the present study findings, it can be concluded that Atorvastatin (40 mg/day) used as an adjunctive therapy with antipsychotics in the treatment of Schizophrenia shows improvement in the psychopathology, CRP levels as well as lipid profile of participants.
Keywords: Schizophrenia, Atorvastatin, C Reactive Protein, Lipid Profile
| F196: A Case of Schizo-Obsessive Disorder Posing as a Diagnostic and Therapeutic Dilemma|| |
By: Dr. Deepak M.B., Junior Resident, CIP, Ranchi
BACKGROUND: 12-14% 0f Schizophrenia patients have co- morbid obsessive - compulsive disorder, often posing a diagnostic and therapeutic dilemma due to overlapping symptoms and the exacerbation of OCD by antipsychotics. In such cases, non-pharmacological management may be particularly helpful as in this case.
CASE: A 39-year-old single unemployed male patient from HSES family, with family history of schizophrenia, came with complaints of hearing voices, decreased interaction, muttering to self since 1998 and repetitive doubts and checking since 2000 attributed by patient partially to hallucination and thought insertion phenomenon and have increased during exacerbations of psychosis in 2005 and 2017. The hallucinations and obsessions persist on Tab. Clozapine 450 mg, Tablet Risperidone 8 mg, Tab Sodium Valproate 500 mg, Tab Sertraline 250 mg, after failed trials of Olanzapine + Fluoxetine, Paroxetine, Amisulpride and Quetiapine. On MSE – anxious affect, technical neologism, thought insertion, obsessive doubts and fear of contamination, compulsive checking, delusion of persecution, second- and third-person auditory hallucination, voices coming from body part, somatic passivity, grade 2 insight.
DISCUSSION: There was significant diagnostic dilemma as the obsessions were partially attributed by him to the thought manipulation and hallucinations and the obsessive symptoms correlated with the exacerbation of psychosis. Also, the management was difficult, several drugs having shown minimal response. He finally showed good response to the same drugs along with predominant non- pharmacological managements including distraction techniques for hallucination, ERP for OCD, anger management, psychoeducation, activity scheduling, supportive psychotherapy for family and vocational training.
Keywords: Schizophrenia,OCD, treatment resistance
| F197: Cognitive Remediation in Schizophrenia|| |
Dr. Sathi Vineesha, Dr.Ramanand Satapathy
1. Postgraduate, Department of Psychiatry, Andhra Medical College, Visakhapatnam.
2. Professor, Department of Psychiatry, Andhra Medical College, Visakhapatnam.
INTRODUCTION: Schizophrenia is a mental disorder characterized by the presence of delusions, hallucinations, disorganized thinking (speech), grossly disorganized or abnormal motor behavior (including catatonia),negative symptoms and cognitive dysfunction.Cognitive deficits are highly prevalent in schizophrenia, with estimates that as many as 98% of patients with schizophrenia suffer with cognitive dysfunction.Most of them are unemployed , dependent, homeless and they continue to experience significant social, functional, and vocational disability leading to a poor quality of life.
AIM: This study aims to examine the effects of cognitive remediation in schizophrenia and to test the hypothesis that cognitive remediation will improve cognition in schizophrenia.
MATERIALS AND METHOD:
- Study design: The study will be a single blind randomized controlled trial, conducted at Government hospital for mental care , Visakhapatnam, India.
- Study Sample: 30 patients
- Study Period: Study will be conducted for a period of one year
- Inclusion criteria: I will recruit participants aged 18 to 45 yrs with a diagnosis of schizophrenia (made by a psychiatric consultant) based on ICD-10 .Who have the ability to give written informed consent. Able to speak, read, and write English. Who have basic computer skills.
- Exclusion criteria : Suffering from an underlying organic or neurological condition affecting cognition, e.g. traumatic brain injury or seizure disorder. History of substance use meeting dependence criteria excluding nicotine & caffeine . History of ECT within past one month. History of intellectual disability.
Instruments used :
- WHO Disability Assessment Schedule
- Attention Network Test (ANT)
- Trail making test
- N- back memory task
- CIRCuiTS (Computerized Interactive Remediation of Cognition and Thinking Skills) is an online computerized cognitive remediation programme developed by kings college london. Software has tasks and exercises area where the therapist helps the participants in completing them through drill and strategy based CRT which inturn help in improving their metacognition. Finally transferring them to bring out real world changes to meet their goals.
RESULTS: There were significant improvements in neurocognition at post-treatment in favour of the CIRCuiTS group. Community function was also differentially and significantly improved in the CIRCuiTS group at post-treatment.
CONCLUSION: Cognitive remediation is a behavioural training-based intervention to improve cognitive processes with the general aim of durable benefits on community functioning.
| F198: Prevalence and Frequency of First Rank Symptoms in patients of Schizophrenia attending Tertiary Care Centre in North-Eastern part of India|| |
Authors-Dr.Rezib-Uz-Zaman1, Dr. Madhurima Khasnobis2
1-Professor/Head, Department of Psychiatry, Silchar Medical College and Hospital
2- PGT, , Department of Psychiatry, Silchar Medical College and Hospital
Presenting Author-- Dr. Madhurima Khasnobis
Background:-Schizophrenia is perhaps the most tragic manifestation of mental illness known to mankind. The consequences of the illness are devastating. Kurt Schneider tried to make the diagnosis of schizophrenia more reliable by identifying a group of eleven symptoms characteristic of the illness, but rarely found in other disorders, these were his First Rank Symptoms.
1. To assess the socio-demographic and clinical profile of the schizophrenics.
2. To find the prevalence and frequency of First Rank Symptoms (FRS)
Materials And Method:-This study was prospective cross sectional.100 consecutive schizophrenic patients from Psychiatric OPD was taken, diagnosed using ICD-10 criteria. FRS was assessed using items from the SCAN and Mellor's Checklist. The data obtained was analysed using SPSS Version 21.
Results:- Most of the patients were within 27-37 years (41%), females (56%), Muslims (50%), primary school educated (38%), unskilled workers (32%), married (63%), from lower middle class socio-economic status (36%), belonging from rural area (72%). Also, majority were neither first born nor last born (57%), belonged to nuclear families (51%), had a duration of illness of more than twelve months (77%), did not have a family history of psychotic illness (61%). First Rank Symptoms was found in 34% of cases, single FRS in 27%. Commonest FRS was found to be “voices commenting” (21%).
Conclusion:- The study of the symptomatology provides an excellent opportunity to discuss the cross-sectional profile of an illness. The study of FRS is still significant in today's context as they are more objective and easier for clinicians to recognize and there are very few studies in this topic in NE India.
Keywords:- prevalence, frequency, reliability, eleven, first rank symptoms, schizophrenics, North Eastern India,
[TAG:2]F199: Comparative study on caregiver burden and their quality of life in caring patients of Schizophrenia and Bipolar Affective Disorder [/TAG:2]
Dr. Prosenjit Ghosh1, Dr. Monu Doley2, Dr. Puneet Verma3
Assistant Professor1, Postgraduate Trainee2,3
Department of Psychiatry,Silchar Medical College & Hospital, Silchar,Assam
BACKGROUND:- With the advent of deinstitutionalization mentally ill patients are now being cared at community level by their families. Caregivers play an important and ever expanding role in caring mentally ill patients. Major mental illnesses like Schizophrenia and Bipolar disorder lead to great deal of morbidity and disability among the patients. AIMS AND OBJECTIVES:-To determine the level of perceived burden and quality of life among caregivers of schizophrenia and bipolar patients. MATERIALS AND METHODS:- Cross sectional study conducted in tertiary care centre in Department of Psychiatry, SMCH, Silchar. Family Burden Interview Schedule by Pai and kapur,1981 was used for burden assessment and WHOQOL BREF for quality of life assessment. RESULTS AND CONCLUSIONS:-More burden perceived by the caregivers of schizophrenia than bipolar patients caregivers and the difference was statistically significant(p=0.000).Better quality of life was seen in caregivers of bipolar patients than caregivers of schizophrenia patients. There was a negative correlation of burden perception with all quality of life domains.
KEYWORDS- Caregiver burden, Quality of life, Schizophrenia, Bipolar disorder
| F200: Study of delusional themes as a diagnostic aid among psychotic patients|| |
Dr. Shivangi Aggarwal1, Dr. Kalyani Bhukar2,Dr. Rajat Oswal3
1. Second Year Resident Doctor, Department of Psychiatry, Medical College, Baroda
2. Third Year Resident Doctor, Department of Psychiatry, Medical College, Baroda
3.Associate Professor, Department of Psychiatry, Medical College, Baroda
Introduction: Delusion has been viewed as a basic, distinctive feature of Psychotic illness. Only some studies have examined the distribution of delusional themes in different diagnostic groups. A detailed study of delusional contents can be helpful for diagnostic purpose and to plan further line of management.
Aim:To study the association between delusional themes and major psychotic disorders (affective and non-affective) and examine the frequency of delusions among psychotic patients with a diagnosis of various affective and non-affective psychotic disorders
Materials and Methods: A cross-sectional study was performed on 288 patients in the department of psychiatry, S.S.G. hospital, Vadodara, diagnosed with major psychotic disorder after detailed interview using DSM-5 (Diagnostic and Statistical Manual of Mental Disorder-5th Edition). Delusion were assessed by scale for assessment of positive symptoms (SAPS). Delusional narratives were reviewed to determine whether an unusual idea is truly a delusion or a culturally appropriate belief.
Results: Out of 288 patients in study delusion of persecution, grandiosity, reference, somatic delusion, infidelity, guilt was 50%, 21.9%, 16.67%, 9.02%, 5.02% and 5.02% respectively. Delusion of persecution and reference were predominantly seen in psychotic non-affective group; delusion of guilt was specific for psychotic depression; delusion of grandiosity was predominantly seen with mania in Bipolar I disorder.
Conclusion: As observed in the current study, persecutory and referential delusions were predominantly seen in psychotic non-affective disorders while delusion of grandiosity was predominantly seen in affective group, the same being negligible in non-affective group. So, it can be concluded that these delusions can aid in diagnosis.
Keywords: Delusions; psychosis; persecutory; referential; grandiosity
| F201: A Study Of Relationship Of Social Functioning And Internalized Stigma With Insight In Patients Of Schizophrenia And Bipolar Affective Disorder|| |
Dr. Komal Kahat
Background: Social functioning is significantly impaired in chronic mental illness, which can be further intensified by internalized stigma. Insight has been found to act as a moderator between internalized stigma and social functioning.
Aim: The aim of our study was to study the relationship of social functioning and internalized stigma with insight in patients of Schizophrenia and Bipolar affective disorder.
Material and method: This was a cross sectional descriptive study, conducted in the Department of Psychiatry & Drug De-Addiction Centre, Lady Hardinge Medical College, New Delhi. Systematic Random Sampling technique was used with fifty patients in each group was taken. The scales used were, Positive and Negative Syndrome Scale (PANSS), Hamilton Rating Scale for Depression-17 (HAM-D 17), Young Mania Rating Scale (YMRS), Scarf Social Functioning Index (SSFI), Internalized Stigma of Mental Illness Scale (ISMI), Babs-Brown Assessment of Beliefs Scale (BABS). The data obtained were subjected to statistical analysis.
Results:These three variables severely impaired in patients of Schizophrenia as compared to patients of Bipolar affective disorder.
Conclusion: Our study concludes that, social functioning shows negative correlation with insight and stigma whereas insight was found to be positively correlated with stigma. This may be useful for better intervention and to improve management and social integration of patients.
| F202: Metabolic Syndrome In Schizophrenia And Their Degree Relatives In Comparison With Normal Controls|| |
Archana Singh, Abhay Singh Tomar, CRJ Khess, Sanjay Munda, Aleem Siddiqui, Shivani
Background: A major concern for both cliniciansand researchers is the metabolic dysregulation associated withschizophrenia before and after pharmacotherapy, includingweight gain, hypertension, hyperglycaemia, and dyslipidemia. These disorders are clustered together under the term “metabolic syndrome (MS)”,which has been reported in about 43% of persons with chronicschizophrenia in the Clinical Antipsychotic Trials of InterventionEffectiveness (CATIE) study. MS poses increased cardiovascular risk and leadsto early mortality, but frequently remains untreatedin many persons with schizophrenia.
Methodology: This is a hospital based prospective study with purposive sampling. The study population consisted of 30 patients of schizophrenia and their first degree relatives along with 30 healthy controls with age and sex matched. Clinical Parameters and Laboratory parameters were measured and analysed using SPSS.
Result: Statistically significant difference was found in waist circumference, body mass index, blood glucose and HDL levels across the 3 groups with values higher in first degree relative group than patient and control group. Statistically significant difference was noted in blood glucose and HDL levels even after correction for age.
Conclusion: There is no difference in parameters of metabolic syndrome in patients of schizophrenia, their first degree relatives and normal controls as only 1 patient and 4 FDRs qualified for metabolic syndrome in a sample size of 30. The anomaly in the result is primarily due to the demographic profile of patients who were from lower income group, older FDR and short duration of the study.
Keywords: Metabolic Syndrome, Schizophrenia
| F203: Efficacy Of High Definition Transcranial Direct Current Stimulation In Negative Symptoms Of Schizophrenia As Measured By Proton Magnetic Resonance Spectroscopy: A Pilot Study|| |
Dr. Dharani R1, Dr. Nishant Goyal2, Dr. Aniruddha Mukherjee3
Introduction: In schizophrenia, negative symptoms account for a substantial amount of the comorbidity resulting in poor performance in social interaction, interpersonal relationships, economic functioning and recreational activities. Antipsychotic drugs have been only mildly effective in improving negative symptoms. The negative symptoms and the cognitive deficits in schizophrenia are superficially similar to the behavioural changes associated with coarse pathology of the dorsolateral aspect of the prefrontal cortex. We intended to study the effect of HDtDCS ( High Defintion transcranial Direct Current Stimulation) in negative symptoms of schizophrenia and assess the acute and chronic changes in the levels of GABA, Glutamate & Glutamine, N-Acetyl Aspartate & N-Acetyl Aspartyl Glutamate in left Dorsolateral Prefrontal Cortex (DLPFC) using Proton MR Spectroscopic imaging (HMRS).
Materials and Methods: 10 patients with schizophrenia with negative symptoms and 5 healthy controls were recruited for the study. Baseline HMRS of left DLPFC was done on both patients and controls. Baseline symptoms of the patients were rated on PANSS, SANS, CDSS. Patients were randomly assigned to active or sham treatment by randomized double blind sampling method. HD tDCS or sham treatment was given twice a day for 5 days with an interval of atleast 5 hours. HMRS of left DLPFC was done after 2 sessions (1 day) of HD tDCS & at the end of 6 weeks and levels of GABA, Glutamate & Glutamine, N-Acetyl Aspartate & N-Acetyl Aspartyl Glutamate were analysed. PANSS, SANS, CDSS were applied at the end of 2 weeks & 6weeks and changes in the score were analysed.
Results and Discussion: Results would be presented at the time of paper presentation.
Keywords: Schizophrenia, negative symptoms, high definition transcranial direct current stimulation, proton magnetic resonance spectroscopy, left dorsolateral prefrontal cortex
| F204|| |
A study of insomnia severity and cognitive impairment in patients of serious mental illness under remission.
1st author: Dr Sai Naveen Singagari
2nd author: Dr Siva Anoop Yella
3rd author: Dr Uma Shankar Molangur
• Presenting author:
Dr Sai Naveen Singagari
Sleep disturbances are common in acute psychiatric conditions. Some of the serious mental illness like schizophrenia, bipolar effective disorder, obsessive compulsive disorder, major depression has greater influence in the normal biological functions under remission too. This study aims to study the severity of insomnia and its impact on cognitive functions in serious mental illness(remission).
• Aims and objectives:
-to study the severity of insomnia in patients of serious mental illness under remission.
-to study the cognitive impairment secondary to insomnia.
This is a cross sectional study conducted in a tertiary care hospital at hyderabad. Patients with serious mental illness like Schizophrenia BPAD OCD depression under remission suffering from insomnia are selected. Insomnia is diagnosed using icd-10 criteria. Severity of insomnia is assessed using insomnia severity index scale. Cognitive impairment in such patients is assessed using MOCA. Correlation of both the parameters is obtained by pearson correlation coefficient.
Positive correlation is found between insomnia severity and cognitive impairment.
Sleep disturbances can cause significant cognitive impairment in patients of serious mental illness even under remission. Hence it is necessary to address sleep disturbances in patients with serious mental illness under remission.
Insomnia severity, Serious mental illness, cognitive impairment.
| F205: A case discussion of Folie a Familie|| |
Dr. Piyush Verma, Dr. Priti Singh, Dr. Rajiv Gupta
Background- Shared psychotic disorder is a rare clinical phenomenon, characterized by transmission of symptoms concurrently in the people who are either close to each other or members of the same family living together. Such shared psychotic disorder is termed as “Folie a famille” when more than two members of the same family are involved.
Case Description- We present a case of a 27 years old unmarried female with schizoid personality traits, who developed psychotic symptoms, following which the patient's mother and brother were secondarily affected. The patient was found to have delusions of persecution and passivity along with hallucinations- both auditory and tactile, which were transferred to the mother and later to her brother, who shared her thoughts of persecution and passivity but did not have any hallucinatory experiences.
Conclusion- The patients were separated after a brief counselling session, and started on atypical antipsychotics. The patient's mother and brother improved significantly after a period of temporary separation. The patient herself was slow to respond. The diagnostic implications and management of the index case are being discussed in the case report.
Keywords- shared psychosis, folie, familie, schizoid.
[TAG:2]F206: A Descriptive Study On The Psychiatric Morbidities , Body Dissatisfaction & Quality Of Life In Transgender Population [/TAG:2]
Dr.Monica.V, Dr.Poorna Chandrika, Dr. Karthikeyans
Affliation : Institute Of Mental Health, Madras Medical College, Chennai
OBJECTIVES : In Transgenders, there is a constant discrepancy between the biologically assigned sex and the identity of gender. Transgenders shows higher rates of psychosocial problems and psychiatric disorders negative self-image, low-self esteem, adjustment disorders, depression, anxiety, suicidality, substance use & personality disorders . In this study I assess about psychiatric morbidities, the body dissatisfaction & the quality of life in Transgenders.
METHOD OF STUDY : A descriptive study done over 6 months in 100 transgender population above 18 years who are screened for any psychiatric morbidities using MINI, Body dissatisfaction using Body Image Questionnaire & assessment for Quality of life using WHO-QOL BREF .
RESULT : The study is on process and the results will be presented in the conference
| F207: Effect of males sexual dysfunction on marital relationship and sexual functioning of female partner|| |
Dr. Abhishek Gupta1, Dr. Ramgulam Razdan2, Dr. Koustubh Rajgopal Bagul3
Background : “ Premature Ejaculation (PME)” and “ Erectile dysfunction (ED) “ is defined as persistent or recurrent pattern of ejaculation during sexual activity within 1 minute & of difficulty in getting or maintaining erection or marked decrease in erectile rigidity respectively. Sexual dysfunction(ED and PME) affect both partner and may result in disruption in sexual functioning of their female partner, also occasionally resulting conflicts in marriage
Aim : To study effect of males sexual dysfunction on marital relationship and sexual functioning of female partner
Method : Study includes 50 male patient of sexual dysfunction(PME and ED) and their partner. It is cross-sectional study held in Department of Psychiatry, Mahatma Gandhi medical college, Indore. Diagnosis of Sexual dysfunction based on D.S.M-5. Arizona sexual experience scale (ASEX) is applied for sexual dysfunction in male patient and Golombok rust inventory of marital state(GRIMS) and Female Sexual Function Index (FSFI) applied on female partner to asses marital relationship & female sexual functions respectively
Result : Initial assessment shows lower score sexual satisfaction domain of FSFI & raw GRIMS score suggestive of average or above indicating poor marital relationship.
Conclusion : There is need to involve female partner in treatment process and marital conflict or doubts should be addressed, as this will result serve as a path for healthy sexual life and relationship
| F208: Problematic Pornography Consumption In Patients With Male Sexual Dysfunction (PME & ED)|| |
Dr Kapil Upadhyay1, Dr Kunal Kumar2, Dr Abhinit Kumar3, Dr Shruti sharma4, Dr Nikhil Nayar5
1- Junior Resident, 2- Professor & head, 3- Associate Professor, 4- Assistant Professor, 5- Senior Resident
Introduction: Online pornography consumption is a widespread phenomenon. Pornography websites are among the top 50 most visited websites worldwide and more than 90% of adults have viewed pornography in their lives. In 2016, one of the most popular pornography websites (Pornhub) reported that 4,599,000,000 hours of pornographic videos were watched worldwide. Their statistics also showed that the website was visited approximately 23 billion times meaning that around 44,000 people visited the site every minute. In most of the cases, viewing is not problematic and appears to have little or no negative
job reported It also creates unrealistic expectations, negative self-image eventually presenting as sexual disorder.
Aim: To study prevalence of problematic pornography consumption in patients presenting with male sexual dysfunction (PME & ED).
Method: 100 male patients who fulfill the criteria for sexual dysfunction (PME & ED), not caused by organic disorder or disease as per ICD-10 criteria will be assessed for problematic pornographic consumption.
Tools: Problematic pornographic consumption scale, Semi-Structured Performa (SSP) Result & conclusion: Will be presented during conference.
| F209: Conclusive Study about the effect of Mirtazapine on Metabolism and Energy substrate partitioning in Healthy persons|| |
1. Dr. Jishnu Bhattacharya (Psychiatrist at Siuri Superspeciality Hospital BIRBHUM)
2. Dr. Sagarika Ray (Senior Resident in Psychiatry at IPGME&R Kolkata)
Background: During the course of treatment with Antidepressants the issue of weight gain & metabolic changes have emerged as an important concern and specifically in long-term therapy. Though it's an ongoing debate whether weight gain and metabolic perturbations with antidepressants use are the consequences of increased appetite and weight gain, respectively, or represents direct pharmacological effects of the drug in metabolism.
Methods: We therefore conducted a proof-of-concept, open-label clinical trial, hypothesizing that in exceptionally healthy men no change if metabolic parameters would occur under Mirtazapine , when environmental factors --- nutrition, sleep and physical exercise etc were controlled and kept constant. Over a 4 week preparation phase , 15 healthy young men were attuned to a Standardized diet adjusted to their individual calorie need, to a regular sleep/ wake cycle and moderate exercise. Continuing this protocol , we administered 15 mg of mirtazapine daily for 10 days.
Results: While no significant weight gain or changes in resting energy expenditure were observed under these conditions, hunger and appetite for sweets increased with Mirtazapine , accompanied by a shift in energy substrate partitioning towards carbohydrate substrate preference. It is assessed by Indirect Calorimetry . Furthermore with Mirtazapine, there is increasing release of insulin &C-peptide in response to a Standardized Meal.
Conclusions: Our findings provide important insights into weight-independent metabolic changes associated with Mirtazapine and allow a better understanding of the long term metabolic effects observed in patients treated with antidepressant drugs.
Keywords: mirtazapine, antidepressants, metabolic changes, weight gain, environmental factors, carbohydrates, insulin, C peptide
| F210: A Cross-Sectional Study On Prevalence Of Antipsychotic Induced Tardive Dyskinesia in a tertiary hospital|| |
Dr.P.Revathy, Dr.Aravindan, Dr.Poorna Chandrika
Institute of Mental Health, Chennai-10
Background:Antipsychotic induced movement disorders represent a major and troublesome complication in the management of psychiatric disorders. Among the drug induced movement disorders Tardive dyskinesia is one of the most distressing side effects of antipsychotic treatment. Reported Prevalence of Tardive Dyskinesia ranges widely between 6 % to 60 %.
Aim:To study the prevalence of antipsychotic induced tardive dyskinesia among inpatients of our institute.
Methodology: Selection of patients with psychiatric disorders taking antipsychotic medication and admitted as inpatient at Institute of mental health, Chennai.Using patient review and medical record review to establish temporal connection between antipsychotics & Tardive dyskinesia. All patients were screened for abnormal movements. Abnormal Involuntary Movement Scale (AIMS) was administered for Tardive dyskinesia. Results were analysed using appropriate statistical procedure.
Results & conclusion:As the statistical analysis is yet to be completed, the results and conclusions will be presented during the paper session
Key words ; Tardive dyskinesia, antipsychotic
| F211: Study of assessment of Relationship of Extrapyramidal symptoms occurrence with type of antipsychotic used and clinical profile of the In-patients of a Tertiary Care Centre.|| |
Authors: Dr. Nirmal. M, Dr. Jai Kumar V, Dr. Poorna Chandrika P
Affiliation : Institute of Mental Health, Madras Medical College, Chennai.
Background : EPS (Extra Pyramidal Symptoms) are a typical side effect of antipsychotics. It includes akathisia, dystonia, Tardive dyskinesia and drug induced parkinsonism. The propensity for EPS varies with each antipsychotic and the clinical profile of the patient.
Aim of the study is to assess types of EPS among the in-patients of IMH (Institute of Mental Health, Chennai), for a period of 2 years who received any kind of antipsychotic treatment and developed EPS and to find out relation of type of antipsychotic, route of administration, gender, duration of antipsychotic use, comorbid medical illness and other clinical characteristics with development of a particular EPS.
Methodology of the study is to review the case sheets of the patients selected and obtain the necessary information as discussed in the aims and the data collected has to be analysed statistically.
Results show that risk of development of EPS varies with the type of antipsychotic used (first generation more than second generation) and also varies with the various clinical characteristics of the patient.
It can be concluded that the use of antipsychotics should be with caution with minimum required doses considering the clinical profile of the patient and risk of developing EPS.
| F222: Vilazodone induced hyperglycemia|| |
Dr. Abhipsa Das, Dr.R C Das, Dr. Ravan JPR, Dr.Pratheek V
Department of Psychiatry,Kalinga Institute of Medical Sciences,Bhubaneswar.
Background: Studies suggest a positive correlation between depression and insulin resistance and cortisol levels.Antidepressants should ideally improve the depression as well as glycemic control in the patients. However,Tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) have been reported to worsen glycemic control in people with diabetes.Vilazodone is a newer antidepressant with novel mechanism of action whose side effect profile has not been completely studied.
It offers a combination of selective serotonin reuptake inhibition and serotonergic (5-HT1A) receptor partial agonist activity.
Aim: To investigate the relationship of vilazodone and hyperglycemia in depressed patients.
Methods: Laboratory investigations including fasting plasma sugar,postprandial plasma sugar,HbA1C were carried out both before and after initiation of vilazodone.
Result and discussion: We report 2 cases of moderate depression,one with well controlled type 2 Diabetes and another non-diabetic patient who developed hyperglycemia following initiation of vilazodone. In both these cases the plasma glucose levels returned to normal after stopping the drug. Hyperglycemia induced by stimulation of the 5-HT receptors could be related to the inhibition of insulin release due to adrenaline release from the suprarenal glands.
In our case scenerio,close temporal association of hyperglycemia with the administration of vilazodone, ruling out other possible reasons for hyperglycemia, suggests an involvement of this drug in increasing plasma glucose levels.
Conclusion:There is a significant need for more prospective and longitudinal studies examining the complex relationships and mediational pathways between vilazodone and insulin resistance.A close monitoring of patients on vilazodone for blood sugar levels is therefore warranted.
| F223: A study of sexual dysfunctions associated with atypical antipsychotics|| |
Col (Dr) Jyoti Prakash, Maj (Dr) Charanpreet singh
Sexual dysfunction associated with antipsychotic medications is well recognised but there are relatively few alternatives. Moreover, sexual dysfunction is rated as one of the most distressing adverse effects of antipsychotic treatment. However sexual function is often sacrificed “for the sake of sanity” in psychotic disorders. Study was done To compare and evaluate the frequency of sexual dysfunction associated with atypical antipsychotics assessed after 01 month of administration. 150 patients in the age group of 18-45 years were studied. Arizona sexual experience scale (ASEX) was used to assess the sexual dysfunction. The study was carried out over 15 months at psychiatry centre of a tertiary care hospital. It evaluated sexual dysfunction in olanzapine, quetiapine, aripirazole and risperidone treated outpatients. Patients in the quetiapine and aripirazole group had less severe sexual dysfunction than those in the risperidone group or olanzapine group (albeit the effect between risperidone and quetiapine was not statistically significant). Patients in all treatment groups, nonetheless, experienced a moderately high degree of sexual dysfunction.
| F224: An observational study on changes in Intraocular pressure(IOP) and iridocorneal Angle following use of Escitalopram or Amitryptyline.|| |
Background: Recent publications have suggested a causal association between anti depressant use eg. SSRI( Escitalopram) and TCA( Amitryptyline) with occurrence of angle closure glaucoma. However inadequate studies in Indian population keeps these issues in a blurred state.
Aims: Detecting changes in Introcular pressure(IOP) and Iridocorneal angle(ICA) with use of escitalopram or amitryptyline; therafter compare the results of the two drugs and observe patterns of changes related to gender and age.
Methods: In this observational study drug naïve non diabetic non hypertensive consenting patients with normal IOP and open ICA, diagnosed with depression were randomly allocated Escitalopram and Amitryptyline in Department of Psychiatry, MCK. Therafter they were followed up at 4 and 8 weeks with Applanation tonometry and Gonioscopy in Department of Ophthalmology,MCK.(RIO).
Results:A raise of IOP was recorded in 32.14% patients on Escitalopram and 14.28% patients on Amitryptyline.Narrowing of ICA was found in 14.28% patients on Escitalopram and 7.14% on Amitryptyline.The raise in IOP was more in younger (<25yrs) age groups (69.23%) and were almost equal in both genders(Males:53.84% Females:46.16%)
Conclusion: Our study found a positive trend between use of antidepressants and IOP raise, particularly with Escitalopram and in younger age groups but no incidence of angle closure glaucoma. So we recommend the use of these drugs as done in common practice but with vigilance for symptoms of IOP raise during prescription and in follow up.
| F225: To study psychiatry co-morbidity and cognitive profile in subjects from seizure disorders.|| |
Dr Savita Patel, Dr Abhay Paliwal, Dr RamGulam Razdan
Department of Psychiatry, MGMMC,Indore
BACKGROUND- Epilepsy is a chronic disorder characterized by intermittent, stereotype disturbance of consciousness, behavior, emotions, motor functions or sensation that on clinical ground is believed to result from cortical neuronal discharges.
The prevalence of psychiatric comorbidity is higher in epileptic person. The psychiatric disorders associated with epilepsy are depression, anxiety disorder, panic disorder, psychosis and personality changes.
Cognitive deficits in epilepsy are frequent and have negative effects on daily functioning.
AIM- To assess different socio - demographical factors.
• To study the prevalence of psychiatric comorbidity and cognitive profile in subject with seizure disorder.
METHODS- After applying strict inclusion and exclusion criteria participants was included. Subjects were taken from OPD of mental hospital banganga and dept. of psychiatry .MGM Medical college Study population consists of 100 individuals, aged 18-60 years of either sex and diagnosed as epilepsy as per ICD 10.All socio-demographical and clinical factors were recorded.MINI Questionnaire used to assess psychiatric comorbidity and Neuropsychological test were used to check cognitive profile in seizure disorder.
RESULTS -we analyzed 100 OPD patients with epilepsy .the most prevalent psychiatry co-morbidity is depression, panic disorder, psychosis while the most reported cognitive complaints are mental slowness, memory impairment and attention deficits.
CONCLUSIONS-psychiatry co-morbidities and impaired cognitive function have positive impact on quality of life in epilepsy so, effort is to be made to improve health and reduce the burden of epilepsy.
| F226: Internalized Homophobia And Its Correlates In Gay Men And Lesbians.|| |
Background: In most of the societies, there is presence of stigma towards non-heterosexual behaviour, identity, or relationships. Lesbians and gay men usually experience some degree of negative feeling toward themselves when they first recognize their own homosexuality in adolescence or adulthood which is usually known as internalized homophobia. It often makes the process of identity formation more difficult and can pose psychological challenges to gay men and lesbians throughout life.
Aims: To systematically assess internalized homophobia and its correlates among gay men, lesbians and bisexuals in the community.
Methods: 50 gay men and 50 lesbians by convenient sampling from a local support organization were selected for study. After taking approval from ethics committee and consent from participants, their demographic data was taken by a semi-structured proforma. Internalized Homophobia Scale (IHS), Collective Self-esteem Scale (CSES) were applied. Appropriate scales for disclosure of sexual orientation (outness), psychological wellbeing (Depressive symptoms, Demoralization, Self-esteem) were applied. Data was entered in MS Excel and analyzed using SPSS software.
Results: Gay men scored higher than lesbians on IHP. IHP scores were negatively correlated with outness and collective self-esteem among lesbians and gay men alike. Gay men's IHP scores were significantly correlated with low psychological wellbeing. Detailed results will be presented in the paper.
Conclusion: Internalized homophobia may indeed be an underlying cause of psychological distress. Also, it may indirectly be related to depression as a result of non-disclosure and community support.
| F227: A Comparative Study to Find out Correlation between Degrees and Patterns of Communication and the Prevalence of Depression, Anxiety and Stress among Undergraduate Medical and Pharmacy students in Ahmedabad.”|| |
Background: Communication is the main stay of human interaction and mainly has two types, verbal and non verbal. In the present times, due to the virtual media of communication, physical human interaction suffers.
Studies conducted in India and abroad have found the prevalence of depression, anxiety and stress in medical students to be almost double than in general population. Poor communication skills could be one of the many reasons for the same.
According to a study done by the IMA, 75% doctors have faced violence at work. Efficient communication of unfortunate news, from doctors to the patients may reduce these incidents.
Aim: To find and compare the correlation between the degrees and patterns of communication and the prevalence of depression, anxiety and stress among undergraduate medical and pharmacy students in Ahmedabad.
Methods: Two questionnaires, i.e 'The Interpersonal Communication Inventory' (ICI) and 'Depression, Anxiety and Stress Scale' (DASS) were administered to 300 medical and 300 pharmacy students of similar age and gender.
Results:The difference between total ICI scores of medical and pharmacy students was not significant. (p = 0.7). Total anxiety score was significantly greater in pharmacy students (p=0.03). A weak negative correlation was established between total ICI scores and the total scores for depression, anxiety and stress in both the groups.
Conclusion: In context of the Competency based Undergraduate Curriculum, 2018 by the MCI which emphasizes on proficiency in communication skills, various aspects of communication need exploration, which would help us in formulating targeted intervention for remedial purpose.
| F228: Psychiatric Morbidity And Quality Of Life In Acne Vulgaris|| |
Acne Vulgaris (AV) is a common chronic inflammatory condition of the pilosebaceous unit of the skin. Patients seeking treatment for AV in Dermatology OPD are often referred to psychiatrists for problems like Depression, Anxiety and Body Dysmorphic Disorder.
The aim was to study the psychiatric morbidity and quality of life in patients with acne vulgaris
MATERIAL AND METHODS
61 cases and 50 age and sex matched controls were studied. The subjects were administered two questionnaires to assess their quality of life, and psychiatric morbidity. These were the General Health Questionnaire-12 (GHQ-12), Dermatology Life Quality Index (DLQI)
Acne patients have higher psychiatric morbidity than controls, on applying GHQ-12 a significant difference (p= 0.0034) was noted between the subjects and controls acne. Acne vulgaris seems to have 'moderate effect' on the quality of life of 59% of the subjects in the case group. The mean DLQI score of the patient group was 7.45, which fell in the range of moderate effect. On comparing the scores with acne severity a weak positive and significant correlation was observed (R= +0.272, p=0.034).
The study found 44.2% patient of acne vulgaris had psychiatric morbidity compared to controls in GHQ-12 scores, which was significant statistically. Acne moderately affects quality of life. A routine short psychiatric evaluation is recommended in dermatology clinics so that psychological co-morbidities may be addressed in time.
| F229: Comparison of empathy among medical undergraduate students in a Tertiary Teaching Hospital in South India: First year versus Final Year|| |
Authors: Keya Das, Patheti Venkata Satyasiva Arun, B. Srujan Kumar
Introduction: Empathy is the ability to share, understand & respond with care to the experiences of others. Being empathic involves actively listening to the cognitive & emotional reactions of others, identifying and understanding their concerns & emotions, and conveying this understanding to them. Essential component of medical professionalism and also a competency skill, as it is associated with better quality of care & health outcomes.
Materials & Methods: A cross sectional study, with a total of 266 undergraduate medical students belonging to First year MBBS and Final year MBBS were universally selected for the study after obtaining consent. A semi-structured questionnaire of Demographics and academic particulars were collected followed by Scale for Empathy Scoring (SES), a validated and reliable tool being applied. Data was analyzed using SPSS 21.
Results: A total of 8 students scored < 75 on the SES scale (3%) with 1 being out of 132 first year students (12.5%) and 7 out of 134 Final yr MBBS students (87.5%), p=0.033. Co-relation of factors with Empathy found Self interest in joining MBBS to be associated with better Empathy scores >75, p=0.001
Conclusion: Empathy was found to decline with successive years of undergraduate course. A significant co-relation was found between self motivation to take up medicine as a career and empathy.
Keywords: Empathy, Medical Undergraduates, competency
| F230: Beliefs and attitudes of women towards menstruation|| |
Background: Menstruation has been surrounded by different perceptions in different countries, cultures, religions, and ethnics groups. It is linked with several misconceptions and inadequate practices, which result into adverse health outcomes .There is very limited social and health related research on menstruation issues in low and middle- income countries including India.
Aim: To study the beliefs and attitudes of women towards menstruation.
Methodology: A Prospective Cross-Sectional Analytical Study was carried out in the Department of Psychiatry in a Tertiary care hospital starting from August 2019 to March 2020.
A written informed consent was obtained for participation in the study from all subjects recruited for the study after explaining the purpose and design of the study. By purposive sampling a total of 50 women in the age group of 18-40 years residing in urban area were recruited in the study after fulfilling the inclusion and exclusion criteria.
Results: The results indicated that 81% were prepared, 75% had access to information, 40% were secretive, 28% had ideas of disability and 68% had annoyance associated with menstruation, among the educated class subjects. Whereas, 52% were prepared , 36% had access to information, 89% were secretive, 72% had ideas of disability and 42% had annoyance associated with menstruation, among the uneducated class subjects.
Conclusion: Educated women were found to be better prepared, had more access to information, were less secretive, had lesser ideas of disability, and more annoyance associated with menstruation, as compared to the uneducated women.
| F231: Study of Defence Mechanisms and Childhood Experiences in Patients Undergoing Psychodynamic Psychotherapy.|| |
Co-authors: Dr. Macha Shruthi Goud, Post graduate, Email ID: [email protected]
Guide: Dr. Raghuveer Raju Boosa, Assistant Professor, Email ID: [email protected]
Background: Psychotherapy is an important integral part in the management of psychiatric disorders along with pharmacotherapy. Psychodynamic psychotherapy helps in understanding the dynamics underlying patients behaviour to various situations. The defence mechanisms which are part of his personality may be influenced by the childhood experiences. Understanding such defences helps in treating the patients.
Aims and Objectives:
1. To study the childhood experiences of the patients undergoing psychodynamic psychotherapy
2. To understand the various defences mechanisms used by them.
All patients were enrolled from Tertiary Care Hospital. The inclusion criteria were of age >18 years and who are motivated to undergo Psychotherapy.
Clinical and Socio-Demographic data were assessed using a standardized protocol. Written informed consent was obtained.
Results and Conclusion: The results are yet to be analyzed and will be discussed later.
Keywords: Defence Mechanisms, Psychodynamic Psychotherapy, Childhood Experiences
| F232: Determinants Of Paucity Of Facial Expressions Of Major Depressive Patients Using Facial Expression Recognition Software – A Preliminary Study To Analyse Content And Construct Validity.|| |
Tabitha Jezreel, Praveen Khairkar, MD; Vishwak Reddy V, MD
Background: Facial expressions are the most powerful, natural and direct way to communicate emotion in everyday life. However, patients of depression tend to have decreased facial expressions during the course of the disorder. It is generally assumed that depressed individuals show abnormal patterns in recognition of facial expression.
Aim: The aim of this study is to determine the paucity of facial expressions in patients of major depressive disorder and to correlate the lack of facial expression stability with severity of symptoms.
Methodology : A hospital based, short term qualitative cross sectional sample of 30 diagnosed patients of MDD were taken up for the study after informed consents were taken and photographs were obtained. They were made to mimic the basic expressions and their facial movements were recorded on the facial expression recognition software.
Results: The results will be analyzed by using SPSS software and appropriate statistical tests.
Conclusion: Paucity of facial expressions can be a major criteria in determining treatment progress in depressive patients.
| F233: Need for course correction in Indian Psychotherapy context- A reviewer's experience|| |
Psychotherapies are practiced around the globe using varied approaches. A successful psychotherapy should serve the intended purpose of healing the psychological distress of a suffering patient. Even though the therapies offered to patients can differ slightly in delivery aspects, the core framework should be built around an evidence-based psychotherapy protocol. Being a reviewer of current practices of psychotherapy in India, I have noticed several drawbacks in Indian psychotherapy works that could have far flung effect in treatment response. These deficits, if rectified could improve the standards of psychotherapy services in India.
[TAG:2]F232: Irrational fear of being away from mobile phone in the smartphone users of medical fraternity [/TAG:2]
Dr.Nikunj S Gokani, Dr.Deepanjali D Deshmukh1, Dr. Praveen J Godara2
Junior Resident 2,1Assistant Professor,2Junior Resident 1at Department of Psychiatry at MGM Medical College and Hospital, Aurangabad, Maharashtra, India.
Aims: To find the presence and severity of nomophobia and its association with certain demographic factors amongst the smartphone users in medical fraternity.
Settings and Design: Medical College and Hospital,Observational, cross-sectional study
Methods and Material: An online survey by using Google Form and utilizing validated Nomophobia questionnaires (NMP-Q). A self-reported questionnaire regarding demographic data, information regarding smartphone use and factors of Nomophobia. A total of 446 people participated in this survey. Data was collected by snowballing technique.
Statistical analysis: Statistical analysis was done under the guidance of statistician Levene's Test for Equality of Variances,independent t-test for Equality of Means and ANOVA were used. A p value of <0.05 was considered as significant.
Results: Mean NMP-Q score was 79.08. Mean age of participants was 22.83 (± 4.68), study had slightly more response rate from female participants (56.5%). Majority (62%) participants reported moderate level of nomophobia. Age less than 25 years, female gender, single, MBBS student and having more than 50 applications on their smartphones, was associated with more nomophobia scores. Though living arrangements, number of phones and sim cards, duration of cell phone use has no significant impact on nomophobia scores.
Conclusions: Our study found moderate level of nomophobia amongst the majority of participants.
Key-words: Nomophobia, smart phone, Internet
| F233: Attitude towards and choice to opt psychiatry among medical internship students|| |
Dr Renu Pandey , Dr S.N Desai , Dr M.K Deshpande, Dr Nikhil Nayar
Negative attitudes toward psychiatric disorders lead to deep seated prejudices toward mentally ill persons. Globally, psychiatry as a subject, psychiatry as professionals, and patients with psychiatric disorders are subjected to cultural stereotypes and negative attitude by the general population.
Aims and objectives:
- To assess the attitude of medical internship students towards psychiatry
- To find psychiatry as a choice for post-graduation among these students
Material and Methods
On an average 3-4 students are posted in psychiatry posting for 15 days among which100 students were taken. To these students following below mentioned scales and tests were applied after explaining them about the study.
- Informed consent form (Hindi and English)
- Socio-demographic questionnaire
- ATP- 30 (Attitude towards psychiatry questionnaire)
Results and Conclusion:
Current study conclude that majority of responders with the ATP 30 gave unfavourable response towards psychiatry, among that majority of them were females of age group 24 years.
The response to opt psychiatry as a post-graduation choice among students were neutral.
| F234: Pilot-Study To Validate “Psychiatry-Associated Services Tracking Enquiry (P.A.S.T.E.)”|| |
Dr. Ankan Paul1, Dr. Lakshmi Prabha2, Dr. Rajkumar3, Dr. S. Nambi4
1: Post-Graduate Student, 2: Assistant Professor, 3: Professor, 4: Professor and H.O.D.;
Department Of Psychiatry, Sree Balaji Medical College and Hospital (S.B.M.C.H.), Chennai}
Background: In recent times “patient satisfaction” and “care-giver satisfaction” (including care-giver burden) has been a driving force behind improvement in health-care.The question naturally arises as to how do we quantify these aspects of health-care, particularly in psychiatry.Unfortunately, not many instruments exist that serve this purpose and choices are even fewer when we talk of combining both “patient satisfaction” and “care-giver satisfaction in a single instrument.Hence, we intend to fill this gap by presenting P.A.S.T.E..
Aims: 1. To validate “Psychiatry-Associated Services Tracking Enquiry (P.A.S.T.E.)” as an instrument for quantifying “patient satisfaction” and “care-giver satisfaction” with psychiatric and associated services.
Methodology: The following sequence of steps was followed while formulating P.A.S.T.E. and assessing the outcome of the pilot-study (At Sree Balaji Medical College and Hospital, Chennai):
- Receiving inputs from psychiatric professionals.
- Receiving inputs from patients who were not part of the pilot-study.
- Review of available literature.
- Formulating items for the instrument.
- Conducting pilot-study (50 patients and their care-givers) for validation.
- Statistical analysis of data.
Results: P.A.S.T.E. consists of 10-items, 5 each for the patient and care-giver.Each item is rated on a scale from 0 to 10, with 0 being “not at all satisfied” and 10 being “completely satisfied”.The individual items and scoring-details are not being discussed here due to space-constraintsThe mean score on P.A.S.T.E. was 82.84+/-11.59.The mean score for patients was 41.17+/-5.74.The mean score for care-givers was 41.67+/-6.06.The 95% confidence-level for P.A.S.T.E. scores was 82.84+/-3.26.Internal consistency was measured using Cronbach's alpha, which was found to be 0.95 for patients and 0.96 for care-givers.Pearson's coefficient was used to assess test-retest reliability, with R=0.99 (p-value= < 0.00001).No statistically significant difference was found with regards to scores based on gender, age or duration of treatment.
Conclusion: On analysing the results, P.A.S.T.E. seems to be an efficient tool for assessment of “patient satisfaction” and “care-giver satisfaction” as was intended.
| F235: Perceived stress, levels of social support and marital satisfaction among wives of alcoholics.|| |
Dr Kathleen Anne Mathew*, Dr N Dinesan**
*Senior resident, Department of Psychiatry, Amrita Institute of Medical Sciences, Kochi
**Professor, Department of Psychiatry, Amrita Institute of Medical Sciences, Kochi
Background: Alcoholism is a major problem which not only affects an individual but also has rippling effects on the family especially their spouses. Psychiatric morbidities especially depression has been reported among the wives of alcoholics. However, those without major depression are usually not identified which leads to poor quality of life and higher rates of divorce. Hence this study to identify the stress levels, marital satisfaction and social support in this subset of individuals becomes relevant.
Aims: To study the levels of perceived stress, social support and marital satisfaction in wives of patients with alcohol dependence and their association with the severity of alcohol dependence.
Methods: A study was undertaken, among 30 wives of patients admitted with an ICD-10 diagnosis of alcohol dependence, not meeting criteria for any comorbid axis-1 diagnosis except tobacco dependence. Short Alcohol Dependence Data was employed to grade the severity of alcohol dependence in the husbands. Those scoring <5 on Patient Health Questionnaire-9 screen of depression were administered Perceived Stress Scale, Oslo's Social Support Scale and Couple Satisfaction Index.
Results: The mean perceived stress score was found to be 16.85. Majority of the women reported intermediate levels of social support (60%). Marital satisfaction of the wives was negatively correlated with the severity of alcohol dependence.
Conclusion: Identifying stress, levels of social support and marital dissatisfaction among spouses of alcoholics and instituting appropriate interventions may be helpful for effective psychosocial management.
| F236: Neighbourhood socio economic disadvantage and type 2 diabetes comorbidity in serious mental illness|| |
Objectives: The primary aim of this study was to describe the association between neighbourhood socioeconomic disadvantage and serious mental illness (SMI) - type 2 diabetes(T2D) comorbidity in an Australian community using routinely collected clinical data. The secondary objective was to determine how much of the between neighbourhood variations in SMI-T2D comorbidity was attributable to neighbourhood socioeconomic disadvantage.
Methods: This cross-sectional study considered 3816 individuals with an SMI diagnosis in Illawarra and Shoalhaven regions of NSW, Australia between 2010 to 2017. Data were analysed using multilevel logistic random intercept modelling that controlled for individual age, gender and country of birth.
Results: SMI individuals residing in the most disadvantaged neighbourhoods had 3.2 times increased odds of reporting SMI-T2D comorbidity compared with the SMI individuals residing in the least disadvantaged neighbourhoods (OR 3.20, 95% CI 1.42-7.20 for Q1 vs Q5). Significant neighbourhood level variations in SMI-T2D comorbidity were also observed in our sample (Median Odds Ratio =1.35) and neighbourhood socio economic disadvantage accounted for approximately 17.3% of these variations.
Conclusions: The findings from this study highlight a potentially important role for geographically targeted public health prevention strategies in order to reduce the public health burden imposed by SMI-T2D comorbidity
| F237: To study the prevalence of depression in patient suffering from headache in psychiatry opd in a tertiary care institute|| |
Prasad S1, Paliwal A2, Razdan R3
1. M.D Resident, M.G.M. Medical college, Indore
2. M.D, Associate Professor, M.G.M. Medical college, Indore
3. M.D, Professor, M.G.M Medical College, Indore
Background: Primary headache and psychiatric disorders are quite often comorbid, previous studies have reported that depression have bidirectional relationship with headache. The research in India in this field strikingly scarce.
Aims: To investigate the socio demographic profile, subtypes of headache and correlation with Depression in patients who comes in psychiatry OPD.
Methodology: our study is a descriptive cross sectional study with 200 sample size. Patients with Headache in Headache Clinic of department of Psychiatry, MGMMC, Indore. Patient aged between 18-65 years , either sex. Diagnosis of headache was done clinically in accordance with International Classification of Headache disorders, while depression was diagnosed as per ICD-10. Semi-structured headache questionnaire, Comparative Pain scale, Hamilton Depression Rating Scale, were used for assessment of samples.
Results: Among 200 patients, there were 73(36.5%) males and 127 (63.5%) females. The mean age was 33.35 ± 10.7 years. Tension type headache was 73.5%, Migraine was 22%,Mixed headache was 4.5%. Depression in headache was 68%. Depression was more in females (59.5%) than males(40.5%). It was also more in urban (60.2%) than semi urban areas (26.4%) & rural areas (13.2%).Tension-type headache (73.5%) was the most predominate type of headache. Conclusion: Patients with headache had higher comorbid depressive disorder. Screening patients with headache for depression and timely psychiatric intervention can go a long way in improving the quality of life of headache patients with comorbid depressive disorder.
Keywords: Primary Headache, Depression, Prevalence
| F238: Case Series Showing Association Of Parathyroid Hormone And Neuropsychiatric Manifestation|| |
Background : Hyperparathyroidism has been associated with psychiatric presentations in various literatures. They present as deranged calcium levels, the importance of the which in regulatory functions of the central nervous system has been acknowledged. The mental disturbances could significantly reduce after correction of the cause of these abnormalities, and may require pharmacological or surgical management.
Aim: Presenting case series of 3 patients who presented with varied neuropsychiatric manifestations showing poor response to psychiatric medications with elevated parathyroid levels.
Methods: Detailed workup was done in view of ineffective response to psychiatric medications. Which revealed raised calcium levels in spite of normal vitamin D levels. Further investigations revealed hyperparathyroidism , which was managed accordingly.
Results: Significant improvement in the symptoms was seen in the patients after parathyroid correction and return of calcium levels to baseline.
Conclusion : Initial investigations for a psychiatric patient should include calcium levels as well and should then be correlated with para thyroid levels.Corrective endocrine therapies , pharmacological as well as surgical for parathyroid abnormalities may diminish or even cure psychiatric complaints in a patient, especially those with atypical symptoms and poor response to medications.
| F239: Depression as initial presentation in SLE|| |
Dr.JK Ajithraa1, Dr.T Kumanan2MD,DPM, Dr.G Amutha3MD, Dr.Prabha Samiraj4DPM.
1.Post graduate,2.Professor,3.Associate Professor,4.Senior Resident
Background: Depression is the most common mood disorder in Neuropsychiatric Systemic lupus erythematosus and its lifetime prevalence is 17 to 65%.The possible mechanisms were identified as antibody mediated, vasculopathy,cytokine-induced neurotoxicity,loss of neuroplasticity. Identification of anti-DNA antibodies is critical to diagnosis and allows to distinguish different presentations.Anti ribosomal P antibodies is one among the antibodies associated with neuropsychiatric SLE.Although they are detected in only approximately 14% patients with SLE, the specificity is 90%.
Aim: To report a single case of neuropsychiatric SLE which presented with depressive features and to highlight the importance of physical examination in psychiatric patients.
Methods/case description: We report a 28 year old married female presented with initial clinical features of Major depressive disorder for 6 months along with physical examination findings of scarring alopecia and severe pallor. Later, she is diagnosed as anti ribosomal P positive neuropsychiatric SLE with secondary autoimmune haemolytic anaemia and autoimmune thyroiditis and started on prednisone 40mg /day,Thyroxine 100mcg /day and other nutritional supplements.Mini neuropsychiatric interview was done to confirm depression and quantified with HAMD and MADRS scales.She was started on Escitalopram 10mg HS and followed up twice monthly. Her depressive symptoms remitted by 8 weeks.
Results: She scored 27 in HAMD and 32 in MADRS at initial presentation and her depressive symptoms remitted by 8 weeks with scores of 7 in HAMD and 10 in MADRS.
Conclusion: The 5-year survival rates of SLE have improved from 50% reported in 1950s to greater than 90% in 1990s, with 15-year survival rates in excess of 80% in some series .This case merits discussion for the importance of medical evaluation and meticulous physical examination of patients presenting with depression, to find the possible etiology like SLE, since early diagnosis of this primary condition improves the prognosis and long term survival.
| F240: A Case Report Of A 5 Year Old Patient Presented With Trichotillomania And Trichobezoar|| |
BACKGROUND- Bezoars are collections or concretions of indigestible foreign material in the gastrointestinal tract. Trichotillomania is an impetuous disorder of pulling out one's own hair, whereas trichobezoar is the formation of a hairball after trichophagia, which contains a large quantity of hair, varying in length, matted together.
CASE HISTORY: A 5 year old Hindu child, operated for trichobezoar ,was referred to Psychiatry from the Paediatric surgical department of a tertiary care hospital, with complain of eating of hair, since 2 years.Her USG showed Dense shadowing in the entire stomach, s/o Gastric Bezoar and all other investigations were within normal limits. According to her parents, Without any significant stressor, Patient started Having c/o: Pulling out of her own hair 1-2 times a day, would stop if someone saw her. Whenever she would see hair irrespective of any one's hair ,would pick it up from the ground and eat 4-5 times in a day,not even this she would also Pick her doll's And toys' hair, bristles of brush and eat. No H/O Ingestion of other substance. The patient had delayed speech at 4 years of age. After further evaluation, patient revealed that she was being teased by boy's in her school.The mother also had ? OC traits as Cleaning.The patient was advised Psychologist test (CAT) Child Apperception test by Clinical Psychologist and Psychotherapy was started.
CONCLUSION: Thus, here is a case report of a patient with Trichotillomania and trichophagia and phenomenology of OC spectrum disorder.
| F241: A Study of depression and anxiety disorders in the patients with Rheumatoid Arthritis.|| |
Prakash Haldar1, Senjam Gojendra Singh2, N Heramani Singh3
BACKGROUND: Significant evidence in the scholarly literature suggests that depression and anxiety is a common comorbidity among patients with rheumatoid arthritis. Psychiatric comorbidity especially depression and anxiety are more common in the patients with rheumatoid arthritis. This study has highlighted on the psychiatric comorbidity of depression and anxiety in the patients with rheumatoid arthritis.
OBJECTIVES: To assess depression and anxiety among patients with rheumatoid arthritis.
MATERIAL AND METHOD: A prospective study of the outdoor patients of aged 20-60 years who attended Rheumatology Department, RIMS, Imphal during the period between November 2013 to July 2016 were analyzed.i
RESULT: Depression and anxiety are more common in the patients with rheumatoid arthritis. Among 680 patients 47.35%(n=322) are in age group of 41-50 yrs, female are 66.47%(n=452), Hindu are more 53.24%(n=362). In our study we found 36.18%(n=246) are having anxiety disorder where as 23.09%(n=157) are depression.
CONCLUSION: The study was carried out to assess depression and anxiety in the patients with rheumatoid arthritis.
| SYM51: Stress among Doctors- Symposium|| |
Dr Uttam C. Garg, Dr Derrick Johnson, Dr Sheena Varughese, Dr Joice Geo
As medical professionals we deal, study among patients and their caregivers, even teach others how to overcome the stress. But, very little is researched on the stress among ourselves, the magnitude of which is overwhelming in this current scenario. We keep hearing the violence against medical professions, more commonly the doctors, media coverage questioning our duties and ethics but everybody including us fail to see the stress or the burnouts we face in our profession at our workplace. There are very few number of studies from the world, even fewer from our nation where we have the most eminent medical professions and pioneer institutes in the world. The brunt of all problems, working in poorer state or conditions falls mostly on our heads but no one throws a limelight on the problems we face. In an online study conducted in India, two-third of the participants experienced stress and around 20% had suicidal ideations. This study throws light only on the tip of the problems faced by the doctors and people in the medical community.
This symposium will discuss in the detail about the prevalence of the condition in our nation, its manifestations and subsequent impact it has on the life of doctors and people around them as well as managing and preventing this state together.
| SYM52: Ecopsychiatry in Sundarban Delta, India.|| |
Prof. Arabinda N Chowdhury, Dr. Arabinda Brahma, Dr. Sayanti Ghosh
Ecopsychiatry- where environmental issues influence positively or negatively on the mental health of the people (individual) and the community (collective). Or in other wards the impact of environmental specificity (of normal or abnormal state) on the mental health and wellbeing (as also physical and spiritual) of the community or individual. The Millennium Ecosystem Assessment (MEA,) a major UN-sponsored project, offers a useful framework to explore these links. Four major MEA categories of Ecosystem Services are: Provisioning services; Regulating services; Cultural services and Supporting services. It is a matter of great regret that in recent decades 60% of the world's ecosystems services are being degraded, destroyed and used unsustainably and thus presents a significant challenges and threat to maintaining the wellbeing of the current population and future generations. The multifactorial degradation of ecosystem, nature or manmade, imbalances the stable relation between human and environment and thus risk their health and wellbeing. In our present presentation we put the case study of Sundarban Delta of India and try to enumerate the changing ecological equilibrium and different Ecopsychiatric problems and issues that risk the life of people, flora and fauna including the Royal Bengal tigers and the total mangrove landscape of the region- in other ward, destroying the unique bio-diversity and turn the Sundarban as a “Delta of Distress”.
The main Eco-system Services of Sundarban Bio-Reserve are: (1) Sundarban and its Mangroves provide significant socio-economic benefits such as timber, fish, and environmental services like fresh air and coast protection. (2) It provides an outstanding nursery for fish population which is a major source of subsistence for the fringe population. (3) People get benefited by ecological functions of Mangroves such as providing essential habitat, spawning grounds, reproduction locations and nutrients for birds, fish, crustaceans, shellfish, reptiles and mammals. (4) Mangrove ecology supports the population of honey bees resulting in economic activity through honey collection. (5) Mangroves protect shore lines from coastal erosion, floods, hurricanes, tsunamis and storm surges and acts as carbon sink and nutrient reservoir
We will discuss from the view point of Ecopsychiatry that how these ecosystem services through a wide ranging risk web causing damage to human and environmental health. Prof. A.N. Chowdhury will introduce the subject. Dr. Arabinda Brahma will focus the ecopsychiatric risk factor in Sundarban and Dr. Sayanti Ghosh will discuss the climate change related human morbidity and mortality in Sundarban
| SYM53: Prevalence and its relation to sleep and self-esteem: A comparative study|| |
Presenter: Dr Priya Nayak K, Assistant Professor, FMMC, Mangalore
Co-investigators: Dr Dilshana N.B., Dr. Anil Kakkunje, Dr Safeekh A.T
Introduction: Problematic computer usage is one of the growing problems world-wide. Many hours are spent on social media and it varies across age groups. Most of the studies are conducted on one group of college students. Hence the current study is comparative study among students in medical and engineering colleges.
Objectives of the study:
- To study and compare the prevalence of internet addiction and problematic use among the medical undergraduates and engineering students.
- To assess the degree of loneliness, self-esteem and quality of sleep in these students.
- To find any association between severity of internet addiction and other clinical correlates.
Methodology: The MBBS students from two medical colleges and B E students from two engineering colleges constitute the sample for the study. Current pilot study is conducted on 400 students after obtaining institutional ethical clearance. Prevalence of internet addiction is assessed using Internet Addiction Test. Other clinical correlates such as loneliness, self-esteem and sleep quality are assessed using University of California, Los Angeles Loneliness Scale, Rosenberg Self-esteem Scale, Pittsburg sleep quality Index respectively. Statistical analysis will be done using t-test and Chi-square test.
Results: This is an ongoing study and hence results will be discussed during presentation.
Implications of the study: The present study helps in assessing the prevalence of internet addiction and the severity of the same. Early diagnosis of comorbid psychiatric disorder if noted helps in treatment and better prognosis of the disorder.
| SYM54: When Thrills Turns Into Pills: Comprehensive Management Of Neuropsychiatric Aspects Of HIV/AIDS|| |
SPEAKER: Ranjan Bhattacharya1, Tamoghna Bandyopadhyay2, Aratrika Sen3
1. Associate Professor & HOD, Dept. of Psychiatry, Murshidabad Medical College & Hospital, Berhampore
2. RMO cum Clinical Tutor, Dept. of Psychiatry, Murshidabad Medical College & Hospital, Berhampore
3. Senior Resident, Dept. of Psychiatry, Murshidabad Medical College & Hospital, Berhampore
HIV infection and neuropsychiatric psychiatric disorders have a complex relationship. HIV infection result in psychiatric disorders as a psychological response to the infection or because of the direct effect of the HIV virus on the brain. Disorders may be as varied as depression, post-traumatic stress disorders, AIDS phobias, grief and cognitive disorders. In addition, several psychiatric conditions can arise following the treatment with ART. Holistic management is beneficial in preventing as well as treating the psychiatric aspects of HIV/AIDS.
.Topic 1: Case Based Neuropsychiatric Presentations Of HIV/AIDS
Among HIV patients, clinical depression is the most frequently observed psychiatric morbidity.  Other psychiatric disturbances reported are generalized anxiety disorder  and adjustment disorder. AIDS phobia, psychosis and substance abuse have been reported as significant comorbidity in HIV positive patients. Due to penetration of HIV virus into the central nervous system (CNS), a proportion of HIV patients may develop cognitive disorder, termed as mild neurocognitive disorder (MND), delirium secondary to CNS impairment and AIDS Dementia Complex (ADC). 
Topic 2: Managing Neuropsychiatric Manifestations In Day To Day Practice
Treating HIV infected or People living with HIV/AIDS (PLWHA) is one of the toughest job for the physician due to stigma associated with both HIV infection and mental disorders. Following disorders are most commonly encountered in psychiatry OPD or ART clinic. 
v Common Mental Disorders (CMDs)
v Severe Mental Disorders (SMDs)
v HIV-Associated Neuro Cognitive Disorders (HANDs)
v Caregiver Burnout
Topic 3: Guidance To Caregivers And PLWHA.
In low resource setting, discrepancy between vast majority of PLWHA and inadequate health care delivery system, the caregivers play a pivotal role in management of the HIV/AIDS patient. Home based caregivers are often unrecognized with limited AIDS policies and programs focusing on them. Guidelines to caregivers and PLWHA will help in reducing and early detection of psychiatric disorders among PLWHA.
| SYM55: Insuring inpatient care of those with mental health conditions|| |
Dr Sharad Philip1, Dr Prabhu Jadhav1, Dr Vishu Kumar H S1, Dr Sachin Nagendrappa1, Dr Hareesh Angothu2, Dr Deepak Jayarajan3
1-Senior Residents of Psychiatry, NIMHANS, Bengaluru
2-Associate professor of Psychiatry, NIMHANS, Bengaluru
3- Assistant Professor of Psychiatry, NIMHANS, Bengaluru
Government's flagship insurance program Ayushmann Bharat has included mental health conditions. However, it only caters to inpatient care. Actuarial models being utilized to ensure mental health conditions under this programme appear arbitrary. These models taking to account duration of in patient stay rather than types of treatment offered. This coverage is however limited to government run hospitals. Our Symposium will broadly review the Ayushman Bharat scheme and what it has to offer for clients availing mental health care services. We will discuss enrolment, utilization, implementation and administration of the scheme. We will then go on to enumerate conditions included treatments covered and maximum coverage. We will inform regarding existing literature on costs of mental health care services and discuss systems and payments structure at a large central government run tertiary psychiatry centre.
To examine inpatient mental health care services offered at NIMHANS in their range (conditions covered), extent (duration, cost and treatments) and settings.
We obtained data from the NIMHANS hospital information system. This information system logs socio demographic details, details of inpatient care such as discharge summary etc and has been functional since April 2012.
Details such as diagnosis, duration of inpatient care, duration of illness, indication of admission, repeat admissions if any for persons obtaining services from general adult, child and adolescent, addiction medicine, geriatric psychiatry and psychiatric rehabilitation were extracted and analysed.
With information from more than 20000 entries, our symposium on this topic could throw light on the operative variables that could help on developing more accurate actuarial models.
Insurance schemes should incorporate the nuances of the biopsychosocial model that is required for mental health care. Such robust data from multiple centres may aid the policy makers to extend this insurance coverage to hospitals run under private sector. Overall it may aid in reducing barrier to care, which may be due to the financial issues in the process of receiving inpatient care at a hospital of choice.
| SYM56: Should MHL be Globalised (or localised)? An international cross-cultural perspective in youth MH.|| |
Sardinha S; Estibeiro. A; Anand.M; Hume .M
BACKGROUND: Over 70% of mental illness begins between ages of 14-24 and is highly prevalent in this age group with almost 20% having a clinically diagnosable mental disorder. Yet, youth are least to seek help.
This phenomenon may be explained by socio-cultural factors influencing recognition and perceived need for help, low mental health literacy(MHL), self-reliance in youth and other social influences International comparisons and differences in socio-cultural and health system influences on help seeking and early intervention in youth are under researched.
OBJECTIVE:This paper summarises literature and compares MHL, stigma and help seeking in youth in Australia, Ireland and India.
It also reviews the health service systems and accessibility with its influence in help seeking and evidence based early interventions.
METHOD: A comprehensive literature search of MHL, stigma and help seeking in Youth was conducted with a comparative analysis of similarities and differences.
A pilot interview of youth consumer, GP and Child &youth specialist in each of the 3 countries was conducted for validation.
RESULTS:Similarities and differences in socio-cultural and health system influences on help seeking and early interventions in Youth MH will be presented.
CONCLUSION:There are universal similarities and significant differences ranging from socio-cultural to health systems influences in MH attitudes and help seeking in youth. These are considerations for a local need based responsive and cost-effective early intervention MH service design.
| SYM57: Internet Addiction, Cybercrimes and Cyberbullying in Adolescents|| |
1. Dr. Seema Parija, Assistant Professor, Department of Psychiatry, Mental Health Institute, S.C.B Medical College and Hospital, Cuttack
2. Dr. Pallabi Sahu, Assistant Professor, Department of Psychiatry, Hi-Tech Medical College, Bhubaneswar
The explosive growth of the internet usage in our day-to-day life has created numerous technological advantages. Simultaneously, a range of side effects have emerged impacting psychological and somatic health in the socially vulnerable groups specially adolescents. Internet addiction is now being recognized as an alarming problem which is negatively affecting the growing body and unformed mental function in this group. It comprises of excessive and compulsive internet usage, neglect of other important activities, tolerance and withdrawal symptoms like mood swings, anger, depression and anxiety.
Cybercrimes are the unlawful acts where the computer is used either as a tool or a target or both. It covers crimes like phishing, credit card frauds, illegal downloading, child pornography, identity theft, creation and/or distribution of viruses, spam etc. Cyberbullying is an aggressive, intentional act carried out by a group or individual, using electronic forms of contact, repeatedly and over time against a victim who cannot easily defend himself or herself. The victims of such cyberbullying often develop psychological problems. Many cases of self harm and suicides have also resulted due to this. With the drive for digitalisation of modern India, emotional and behavioural issues in adolescents due to internet addiction, cybercrimes and cyberbullying, have become an upcoming challenge for the mental health professionals.
We will review the epidemiology and pathogenesis of internet addiction, cybercrimes and cyberbullying among adolescents. We will discuss the approach to deal with the psychological issues arising due to them including the preventive measures.
| SYM58: Predictors Of Suicide : Is There An Indicator For Detecting Suicidal Behaviour Even Before It Sets In|| |
Dr V.S Pal; Dr K.R. Bagul, Dr. Varchasvi Mudgal
Suicide Is A Behemoth Of A Public Health Problem. More Than 1,00,000 People Die Of Suicide Each Year In The India, And 1 Million People Die Globally. Suicide Is The 14th Cause Of Death Around The World And Tragically The 2nd Leading Cause Of Death In Young Population (15–29 Years Of Age. Early Identification Of Suicidal Behavior Is Vital For The Prevention And Meticulous Treatment Of Suicide. Biochemical, Psychological, Behavioural Risk Factors Are Important In Pointing The Psychiatrist Towards The Right Path, However, Many Times They Produce A False Positive Or A False Negative Diagnosis. Multiple Studies Suggest That Abnormal Biology And Genetic Basis May Be A Risk Factor For Suicidality. Hence, A Combination Of Bio-Psycho-Social Factors Might More Accurately Predict Suicidal Behavior And Be Of Key Importance In Finding At Risk Patients. It Is Thus Of Utmost Importance To Develop Such Biomarkers For Suicidal Behavior. A Useful Biomarker Should Not Only Reflect The Psychopathology, In This Case Suicidal Behavior, But It Should Also Be Measured In The Least Invasive Manner Possible.
Development Of Biomarkers Focused Primarily On Peripheral Tissues Such As Csf, Serum, Platelet, Urine, Etc. Because Of The Esoteric Nature Of The Human Brain. Initial Studies Of The Biology Of Suicidal Behavior And Initial Studies Of Peripheral Tissues Focused On The Levels Of Neurotransmitters And Their Metabolites In Suicidal Behavior. Recent Studies Have Found Functional Abnormalities Of These Neurotransmitters—For Example, In The Receptors And Receptor-Linked Signaling Systems For The Serotonin (5-Hydroxytryptamine [5ht]) And Norepinephrine (Ne) Neurotransmitters. Newer Studies Have Found A Link Between Inflammatory Pathway And Suicidal Behaviour, Hs-Crp, Il, Tnf Have Been Shown To Have Significant Alterations In Suicidality.
| WS: Short Behavioural Therapy Of Ritualistic/ Compulsive Behaviour In OCD|| |
Cognitive Behavioural Therapy is systematically studied, structured therapy and has been shown to be very effective along with Pharmacotherapy in management of OCD. However, its application in its strict sense is governed by several factors (not limited to) such as availability of resources, financial constraints, busy OPD's and most importantly, it is time consuming.
This workshop details about a modified approach- a model for Psychiatrists who wish to carry out BT in their busy schedules- which is short term- 3-5 sessions, active intervention based on the principles of CBT, focussing on here and now issues with limited goals.
The workshop entails-
Choosing the right patient
Planning of the sessions
Skill learning- usage of cognitive restructuring, ERP in a simple and effective way
Target audience: Psychiatrists and Psychologists open to novel ideas
| SYM59: Terrorism ,fundamentalism and Psychiatry –Do we have a role?|| |
Dr Jassar Abdul Jabbar, Dr DInesh R.S, Dr Arun Ayyappan
Terrorism and fundameentalism have always fascinated human minds . The psychological ,biological and cognitive underpinnings of terrorism and fundamentalism is yet to be clearly understood .A thought on a deviant social behavior whether to be considered a mental disorder or merely a social evil is necessary can be of interest to mental health professionals. Mental health professionals always find an opportunity to interact with victims of terrorism. But the perpetrators of terrorism and fundamentalism and their profiles need to be thoroughly investigated. This symposium consisting of 2-3 sessions is to sensitize regarding etiology of terrorism and fundaamentalism, research among terrorist groups world wide, various social and biological perspectives ,and the anticipated role of mental health professionals in future if required. As the world is facing an unprecedented threat of terrorism, dealing with terrorist activites in the light of modern mental health perspective might be of benefit for generations to come.
| SYM60: An idiot's guide to psychiatry as a training and career options in England|| |
First presenter: Dr Supriya Agarwal MBBS, MD, MRCPsych (UK), Ex- Assoc. Prof Psychiatry, SMC, Meerut, India, Assoc. specialist, Community mental health team, DPT, Exeter, UK, Fellow IPS, Ex-Co Chairperson young psychiatrists committee IPS, Convenor, Sexual psychiatry Committee, IPS, Fellowship WPA (2017), Fellowship ACP (2017), Fellow ECPBangalore (2016)
Dr Agarwal will be talking about the pathway to studying psychiatry in UK for overseas young psychiatrists who want to understand first hand about the various routes especially the membership of royal college of psychiatrists examinations, Medical Training Initiative (MTI) scheme pathway and the 'PLAB test' pathway. The overseas specialists also known as International medical graduates is the term used for psychiatrists who want to study or practise in UK. She will help early career psychiatrists to unravel confusing terminologies, and the pros and cons of going through the various pathways for gaining experience, training and working in the UK.
Second presenter: Dr Tushar Upadhye MBBS, Diploma in Psychiatry (Leeds, UK ), MRCPsych(Uk). Chair of Higher Speciality Trainee, MRC Psychiatry Course Lead and currently a Fellow of Royal College of Psychiatrist's Leadership and Management Scheme.
Dr Upadhye is working as a Higher specialty trainee in Devon Partnership Trust(UK). He will be talking about his journey about his experiences of training at a junior (Core Specialty training) and senior level( Higher Specialty).
Third Presenter: Dr Subhash Gupta MBBS, DPM( India). Currently MRCPsych Lead, Peninsula Deanery Core Trainee Training Programme Director and QI Lead for DPT.
Dr Subhash Gupta works as a Consultant Psychiatrist (General Adult, Community) with the Devon partnership NHS Trust in UK since 2005. He will talk about how he ended up being a Consultant psychiatrist in UK and his experience in Community psychiatry since then.
| SYM61: Indian Mental Health Landscape :Where do women stand?|| |
1) Dr. Aruna Yadiyal, Professor and Consultant ,FMMC , Mangalore.
2)Dr.Syeda Ruksheda, Consultant Psychiatrist , Mumbai, (Convener 2019 of WMH Specialty section , IPS.)
Recent surveys show, number of psychiatrists in India, to be around 9000 or 0.75 psychiatrists per 1, 00,000 population, versus, 6/1, 00,000 figure in developed countries. The trends are changing and improving, though not uniformly, with concentration in urban areas and substantial increase in female psychiatrists. Sporadic data have estimated burnout in 32% of psychiatrists, though not severe, with no difference in sexes. Women have responded to stress through career dilution and diminution, skewing their career graphs clearly .The significant rise is in numbers, matching global trends. But, they account for just 14.6% of registered members in Indian Psychiatric Society (IPS). They are hugely under-represented in power sectors, involving important decisions and policy-making, like in IPS Executive Councils, Tribunals, Indian Journal of Psychiatry Editorial Board, in senior faculty positions of national institutions to name a few. Archaic organizational structure, sexism, societal ethos, work-family role conflicts, internal mental models of females are some factors,contributing for this paradox. Psychiatry, as a specialty, should lead the way, in role re-integration of women professionals, by influencing governments and societies, to make policies conducive for women to succeed, flourish, and continue to contribute wholesomely to the intellectual, social and emotional capital of the nations they reside in!
| SYM62: “GATE KEEPER” in Suicide Prevention|| |
Dr Kunal Kumar1, Dr Lokesh Kumar Singh2, Dr Abhinit Kumar3, Dr Sai Krishna Tikka4, Dr Nikhil Nayar5
Suicide occurs all over the world and can take place at almost any age. More than 8,00,000 people die by suicide every year – around one person every 40 seconds, according to WHO's first global report on suicide prevention. Some 75% of suicides occur in low and middle income countries. Notably, suicide is the second leading cause of death in 15-29 year olds globally. This report is a call for action to address a large public health problem which has been shrouded in taboo for far too long. Reducing access to means of suicide is one way to reduce deaths. Other effective measures include responsible reporting of suicide in the media, such as avoiding language that sensationalizes suicide and avoiding explicit description of methods used, and early identification and management of mental and substance use disorders in communities and by health workers in particular.
Gatekeeper Training is a sustainable initiative that extends knowledge, skills and practical application throughout communities and raises awareness of suicide risks and prevention. Early identification of suicide risk is crucial for suicide prevention; many people at high risk of suicide often do not seek help though recognizable risk factors exist. Gatekeepers are local people with front line roles (teachers, health workers, police officers etc) who undertake training to recognize vulnerable people at risk of suicide and direct them towards appropriate support.
Owing to very low number of psychiatrist, psychologist & psychiatric social worker in India, the gate keepers can be a major support to the mental heath care providers and can help tackle the problem of rising suicide rates in country. This symposium will highlight on the concept of gate keepers in suicide prevention, various training programmes ongoing and few steps that can be taken to promote it.
[TAG:2]SYM63: Mental health literacy and access to care: Cross cultural perspectives [/TAG:2]
Australian perspective-Dr. Charles Ajoy Estibeiro
Staff Specialist (Psychiatry) Manning Hospital Mental Health Unit Taree 2430 NSW Australia
INTRODUCTION: Mental Health literacy (MHL) is a construct expanded from WHO defined Health Literacy(HL). A higher HL has been linked to early prevention, help seeking, access to care and better health outcomes.
BACKGROUND : Australia has a leading role in research in MHL and access to care. It has also a high proportion of mental health professionals delivering collaborative mental health care.
However there is lack of comparative studies of first Australians (who have a holistic view of health)and other Australians with a biomedical model where determinants of MHL are different.
FINDINGS: The distillate of research include 1) Lack of recognition and misperception of disorders 2) Gap in perception of treatment for mental health and admission to a mental health unit.
Perceptions of dangerousness, unpredictability and resistance to employment exist for schizophrenia .Social phobia ,anxiety and depression are perceived as personal weakness.
A high proportion report exposure to media and recognition of BEYONDBLUE. Those with greater understanding that mental illness(MI) is common and debilitating were more likely to recall recent media stories, spontaneously recall relevant organizations , have had direct or family experiences, are younger and more educated.
Following an interactive session on MHL indicated 1) better understanding of MI; (2) gain a more sympathetic understanding of the suffering of people with MI
CONCLUSIONS: In Australia, despite specialised workforce , gaps in MHL impacts access.
MHL needs to evolve from a risk factor to core competency. Innovations around culturally accepting messaging need to be explored to enhance MHL in special populations.
| SYM64: Symposium on Tic Disorders|| |
Tics are the defining symptom of Tourette syndrome and other tic disorders ; however, they form only a part of their overall symptoms. Distinct brain pathways mediate the expression of tics, whereas others are involved in the generation of the premonitory urge, associated comorbidities, and other changes in brain state. The management of tic disorders include comprehensive assessment and psychoeducation along with behavioral and pharmacological interventions.
Nosology and neurobiology: Dr Soumya Chatterjee
Comorbidities: Dr Aviruchi Chatterjee
Management: Dr Suddhendu Chakrabo
| SYM65: Role of media in todays time and age|| |
Dr. Sagar S Garag, 3rd year PG, Department of Psychiatry KIMS, Hubli
Dr. Nishmita T.J, 3rd year PG, Department of Psychiatry KIMS, Hubli
Dr. Sameer Belvi Mangalwedhe, Assistant Professor, Department of Psychiatry KIMS, Hubli
Background: The portrayal of psychiatry and psychiatric illness in the media has become an issue of increasing concern in the last decade. Internet is more accessible than ever before in the history of mankind. But at this dawn of Digital era more than 66% of the population is underserved by digital services. The population demographics accessing digital services is predominantly 16-29 year old youths, rest of the population are technologically challenged in terms accessibility and ease of use. Even in the digital era, print media are still among the most frequently identified sources of information. Print media has more penetration and accessibility than any other means of information.
1. Depiction of mental health across various mass communications.
2. Impact and relevance of print media of mental health issue in digital era
3. Smart use of print media in creating awareness of mental health
Methods: The frequency and content of articles of psychiatric interest in print media were investigated. The tendency for these opinions to emanate from persons other than psychiatrists has been noted and other often less qualified individuals offer their 'expert' opinions.
Results and Conclusion :Print media has been instrumental over the last century for anti-stigma campaigns, providing a voice for people with mental illness. It would be a disservice to the public to ignore the relevance of print media in digital era. All the more it is need of the hour to fortify and innovate smarter use of print media in digital era.
| SYM66: Critical Issues in Alcohol and Drugs of Abuse Testing in De-addiction Programs|| |
Raka Jain*, Shayani Ghosh, Biswadip Chatterjee
National Drug Dependence Treatment Centre, Department of PsychiatryAll India Institute of Medical Sciences, New Delhi
Widespread substance abuse has led to increase demand of urine drug testing in de-addiction programs. Drug testing is an integral part of management of substance use disorders. However, there are number of issues in drug testing related to type of substance use, route of administration, time of consumption and sample collection, physiological mechanisms for drug metabolism, biological matrices and analytical techniques used for drug testing. The focus of the presentation would be on issues of interferences with immunoassays used for screening drugs of abuse in urine, point of care devices for drugs of abuse testing and drugs of abuse screening with lower cut-off values, prescription drugs and inhalants along with the pitfalls of substance use testing, alcohol biomarkers and clinical issues, with an emphasis on our own experience among substance users.
| SYM67: Body dysmorphic disorder- challenge for plastic surgery practitioners and psychiatrists|| |
Dr Sona Kakar MD Psychiatry
Dr Preeti Shukla MS. M.Ch, Plastic Surgery
Patients suffering from Body Dysmorphic disorder occasionally reach plastic surgery practitioners. Some of them are easily identifiable and some show subtle symptoms and are often missed by even experienced plastic surgeons leading to multiple corrective surgeries ,and a dissatisfied patient. The often secretly held symptoms can be missed by even experiences psychiatrists . The non acceptance of traditional treatment by the patient create another challenge to both.
In this paper we will discuss our experience with body dysmorphic disorder patients and review treatment guidelines .
To reduce morbidity due to surgical interventions in patients with body dysmorphic disorder by discussing current treatment guidelines
[TAG:2]SYM68 : Evaluation And Management Of Conduct Disorders : Experiences From A Tertiary Care Centre In India [/TAG:2]
Dr Siddhesh Shere, Dr Utkarsh Karki, Dr Bikram Dutta
Background : Conduct disorder (CD) and associated antisocial behavior is one of the most common mental and behavioral problems in children and young people. Globally, prevalence of CD in the general population is found to be between 1.5% and 4%. Prevalence rates rises from childhood and adolescents and are higher among males than females. Children & adolescents with CD usually present with a wide range of comorbidities, making management complex and challenging. However, data from our country is sparse at best.
Following a comprehensive evaluation of the individual and family, services are provided on both inpatient and outpatient based care. Inpatient care is offered following a consultative and collaborative approach with individual and family. The department of child & adolescent psychiatry has an effective liaison with the departments of Clinical Psychology, and Psychiatric Social Work and public health and legal services to provide multi-disciplinary inputs for the evaluation and management of children with conduct disorder. The clinical profile of children with CD and experience of managing such individuals in a tertiary care inpatient settings will be deliberated upon.
Learning Objectives :
The participant delegates will be able to learn the following :
1. Profile of children with conduct disorder presenting to a tertiary care centre
2. Approach and evaluation of conduct disorder
3. Key elements in the management of conduct disorder
| SYM69 : Sexual dysfunction in men with psychosis: Incidence and risk factors|| |
Rajesh Gopalakrishnan, Dhananjayan Ravichandran
Department of Psychiatry, Christian Medical College, Vellore
The high prevalence of sexual dysfunction in patients with psychotic disorders is well established. It has also been clearly proved that these may be due to medication related side effects.
This study estimated the incidence, nature and risk factors of sexual dysfunction in drug naïve or drug free men with psychosis following treatment.
Men with a diagnosis of acute psychosis or schizophrenia who were either drug naïve or drug free for six months were recruited after obtaining informed consent. Sociodemographic and clinical data were collected using a structured proforma. During follow up at six weeks and six months, psychopathology (PANSS) and sexual functioning (IIEF and DSM-IV TR criteria) were assessed. Serum testosterone levels were also measured. Bivariate and multivariate statistics were obtained.
Twenty one patients completed the six month follow up. At baseline four patients (19%) reported sexual dysfunction. At six months the incidence of sexual dysfunction was 41.2%. Hypoactive sexual desire disorder was the most commonly reported sexual difficulty. The factors associated with sexual dysfunction were current marital status, older age and longer duration of illness. Psychopathology scores, antipsychotic dose and testosterone levels did not have any association with sexual dysfunction
The incidence of sexual dysfunction in patients with psychotic disorders on treatment is moderately high. Clinicians need to routinely assess for this distressing condition to provide comprehensive care for these patients thereby improving medication adherence and quality of life.
| SYM70: INCEPTION: DREAMS - History, Neurobiology, Psychiatry and Therapeutics.|| |
The Mandukya Upanishad states that dreaming is one of three experienced states during a lifetime along with waking and sleep. Ancient cultures from Indigenous Australia to Ancient Sumer have all developed a vivid vital role for dreaming in their mythology and indeed in their conduct of daily life. Indians using dreams as one premise developed the idea that the universe as we see it is an illusion.
Medieval and modern culture around the world has extensive use of dreams as devices and themes. The title of this symposium references one of the most famous and discussed movies of modern times.
An extensive body of research has now been gathered, slowly leading to an ever better appreciation of the biology of human (and non human) dreaming. There is an annual conference on Dreams which has a very high level of attendance and participation along with publication of distinct journals on dreaming. We will aim to provide a concise overview of this branch of neuroscience.
Psychiatric literature had from the turn of the 19th century begun a deep exploration of dreams. Throughout the 20th century and continuing into the 21st there has been good work done looking at the changes in dreaming among those with psychiatric illnesses.
There is also significant development in the understanding of the use of dreams as a means to advance mental health. We will present data from Indian and International studies on dreams. We will also endeavor to bring forth the many effective methods in which dreams are being used by clinicians around the world to help their patients.
1. Brig. (Dr.) M S V K Raju. MD. (Past President IPS, President SAARC PF, President AIPI, Zonal Representative WPA)
2. Dr. Shivaji Marella. MD. (Psychiatrist, Maharani District Hosp., Jagdalpur, Dist- Bastar, Chhattisgarh, Convener – Young Psychiatrists Sub-committee, IPS)
3. Dr. Mitashi Singh. BSc, MSc, MSc, MBBS (MO, Maharani District Hosp., Jagdalpur, Dist- Bastar, Chhattisgarh.)
4. Dr. Jwalant Chag. MBBS. ( JR2, Dept. of Psychiatry, Dr DY Patil Medical College, Pimpri, Pune)
| SYM71: Assessment of Quality and Best Practices under District Mental Health Program|| |
Prof. Rajesh Sagar (Dept. of Psychiatry), Dr. Harshal Salve (Centre for Community Medicine), Dr. Bichitra Patra (Dept. of Psychiatry), Dr. Ashish Pakhre (Dept. of Psychiatry)
Background: Under National Mental Health Programme, District Mental Health Programme (DMHP) has been upscaled in recent years and presently being implemented in 655 districts of 36 States/UTs in the country. It is important to ensure delivery of quality mental health services in the facilities, in these districts. In India the Mental Healthcare Act 2017, which is being operationalized since May 2018, has many progressive clauses to safeguard the rights and dignity of the mentally ill.
Aims: To improve the quality of mental healthcare services under the District Mental Health Programme and Health and Wellness Centers
Methodology: Preparatory Expert Group Consultation, a multi-disciplinary team has been constituted, comprising of psychiatrists, clinical psychologists, psychiatric social workers, public health specialists, WHO and MoHFW officials and the State Programme Officers of select States. The comprehensive Questionnaire and tools for assessment were finalized, including number of States, districts to be included, constitution of the teams and duration of field visit.
Results: Analysis of the data from the 10 assessment visits (Oct – Nov 2019) will be assessed.
Conclusions: Important findings and draft recommendations for strengthening the services will be discussed
| SYM72: Manifestation of Anxiety in Indian Context|| |
Chairpersons: M V Ashok (Professor of Psychiatry, St John's Medical College, Bangalore) and Manoj Sahu (Professor of Psychiatry, JNMMC, Raipur)
1) Dr. Pratap Sharan ,( Professor of Psychiatry, AIIMS, Delhi)
2) Shivani Purnima (Scientist, AIIMS, Delhi )
3) Dr. M V Ashok (Professor of Psychiatry, St John's Medical College, Bangalore)
4) Dr. Priya Sreedaran (Associate Professor of Psychiatry, St John's Medical College, Bangalore)
5) Manoj Sahu (Professor of Psychiatry, JNMMC, Raipur)
Background: Review of published literature on phenomenology of Anxiety disorders primarily focuses on studies from European and Northern American populations. There is minimal data on phenomenology of Anxiety disorders in Indian population.
Objective: To report on the phenomenology of Anxiety disorders as obtained from ICMR National Task force for “Development of PANIQ (Panic and Anxiety National Indian Questionnaire).”
Methodology: PANIQ is a tool that is under development to be used in Indian population to identify Anxiety related phenomenology and symptoms.
As part of the study, the presenters conducted extensive review of published literature, original research article, popular literature and scales assessing Anxiety.
Results: The findings shows that expression of the phenomenology is varied and it is not always captured by current ratting tools. Idioms of distress pertaining to Anxiety in Indian population are unique and varied from that seen in North American and European population.
Conclusions: There is a need for tool to assess Anxiety that is culturally relevant in the Indian context.
| SYM73: Mental Health Promotion and Prevention in school setting: Are we prepared for tomorrow|| |
Rajesh Sagar1, Biswadip Chatterjee2, Nishant Goyal3, Anamika Sahu4,
School-going children and adolescents face a wide range of emotional and behavioural problems, affecting their mental health. It is further complicated with issues like globalization, urbanization, digitalization, shifting into a nuclear family system, restricted social interaction that narrow social support systems and ever-increasing demand to achieve academically excellence. In this context, empowering children and adolescents is very necessary. Children and adolescents spend more time in schools than they do anywhere else except their own home. Therefore, the school is an ideal place to promote mental health of children and adolescents.
• Mental Health of School Going Children and adolescents: Need for Promotive and Preventive Focus: India has one of the largest proportions of young people in the world. However, disease burden for common Mental disorders and Neurotic and stress related disorders are common in young children and adolescents. Lack of attention to the mental health in this period may lead to mental disorders with lifelong consequences. The presentation shall highlight the common mental health issues in school going children and adolescents and need to prevent and promote their mental health.
• Ensuring mental health in school children and adolescents: Effective promotive and Preventive Interventions for substance use: substance use initiation is a major problem which usually initiates in school age. Thus, effective health promotion and scientifically proven preventive strategies can help in reducing its prevalence, prevent early drop-out from school and dependence later in life. Early identification and intervention is also essential. The presentation shall focus on the recommendations for promotive and preventive strategies in detail.
• School Mental Health Services: What we have accomplished till date?: Schools can create a progressive learning environment where academic success is not only linked to effective methods of learning but to positive mental health as well. A comprehensive action plan like school mental health programme is essential to ensure students' holistic development so that they grow into adaptively functioning and well-adjusted adults. The presentation shall focus on the school-based and school-linked mental health services, policy development and its implementation.
• Life Skill Education: Role in School Mental Health Programme: Schools can be a great location for mental health promotion, early identification and intervention. Life skills are abilities for adaptive and positive behaviour that enable individuals to deal effectively with the demands and challenges of everyday life. Life Skills education in school during the formative years of adolescent life can ensure mastery over skills. Hence, they should be integral part of School Mental Health Programmes in the country
| SYM74: Insights and Learning: working with LGBTQ+ community|| |
Dr Ruksheda Syeda, Dr Jyoti Shetty, Dr Purnima Nagaraja,
10% of the population belong to sexual minorities. With plenty of information available online and social media, there is increased awareness in the youth regarding sexuality, gender preferences, and orientations, leading to more numbers of people from the LGBTQ+ community seeking help for their choices and challenges. There is a need for competency in health professionals, undergraduate and postgraduate medical students sensitization too.
Considering the recent events viz Indian Psychiatric Society's position statement on Homosexuality dated 2-07-2018, Decriminalization of Section 377 on 6-09-2018, the Transgender (Protection of Rights) Bill 2016 and our experiences as mental health professionals with treating LGBTQ+ individuals, there is a need for the largely “straight” mental health professional community to address our ingrained cultural attitudes and prejudices, even aggressive homophobia in some cases.
Dealing with “coming out” which is a process of understanding, accepting, valuing one's sexual orientation and identity and disclosing it to others is fraught with anxiety, fears, depression. Getting bullied, feeling isolated, handling rejection, facing discrimination, being ostracized by family, friends, peers, and institutions, brings with it its own trauma.
In view of the above we would like to share experiences working with the LGBTQ+ community at
1) Bharati Hospital Pune – there is a LGBTQ+ clinic and a MOU with a Gay Rights group Samapathik Trust Pune. A protocol is developed with a panel of consultants for gender affirmation interventions.
2) Dhrithi Wellness Center, Hyderabad – it continues to be a safe place for the LGBTQ+ community since 20 years. Since 2013 a lot of work is being done with activists, offering support and assurance, medical help when needed, couple counselling, trans counselling, closet group issues and psychiatric interventions
| SYM76: Designing the Ideal Mental Health Center|| |
• If psychiatrist had a magic lamp what would he do? He will design an ideal mental health center.
• An Ideal Mental Health Center offers preventive, promotive, curative and rehabilitative services to the mentally ill, disabled and handicapped within the catchment area.
• A consultation-liaison service for general medical conditions is a crucial if less well known role.
• Research and data management for future planning would of course be a core task.
• Training of medical graduates and post-graduates in psychiatry, psychology, psychiatric and general nursing, psychiatric social work, neurological rehabilitation, child guidance professional would also be a core function.
• It may choose to offer specialised services such as genetic testing & counselling, family therapy and legal support.
• A design brief consisting of an analysis of each functional element in such a facility will be presented and discussed.
Ø The symposium will have three speakers speaking for 15 minutes each and additional 15 minutes for question-answers.
a. The best of existing infrastructure – Lt Col Sanjay Kumar
b. Designing the ideal mental health center- Col T Madhusudan
c. Getting the job done: Finances and processes – Col RK Saini
| SYM77: Mobile methadone dispensing unit: An innovative model for opioid Agonist Maintenance Treatment in India|| |
Dr Ravindra Rao1;Roshan Bhad2, Mr Deepak Yadav3
Opioid use disorders are one of the most serious global health problems. According to the latest report of “National Survey on Extent and Pattern of Substance Use in India – 2019”, current use of any opioid was 2% in India. A substantial proportion of people using opioids are using it in a dependent or harmful pattern. An estimated 8.5 Lakh people who inject drugs (PWID) in India. Injecting drug use is an important risk factor for transmission of HIV as well as other Blood Borne Viral infections. In order to counter opioid use disorder problem in the country, scientific evidence-based treatment needs to be made available for people with opioid use disorders – at the required scale. Opioid Agonist Maintenance Treatment (OAMT) is the most effective evidence-based strategy for management of opioid use disorders. Both buprenorphine as well as methadone are available in the country for treatment of opioid use disorders. However, there is limited coverage of OST in India. Community based treatment is not readily available to clients/users at similarly high levels of treatment quality in all parts of the world. Lowering threshold of treatment services, with increasing accessibility, reducing waiting lists, using personalized treatment options, flexible treatment duration improves adherence and increases effectiveness of OST. Methadone mobile clinic as treatment service model has been used in different countries worldwide. Netherlands, Canada, Austria, Germany, USA & Hong Kong has established methadone mobile clinics with variable success. In India, mobile methadone dispensing was initiated by NDDTC, AIIMS in March 2019. The symposium would share experience of NDDTC team in running the mobile methadone dispensing unit. The processes followed in initiation of the mobile dispensing as well as in providing daily services would be discussed in the symposium.
| SYM78: Conceptualizing and Enriching First Line Treatment of Conversion Disorder|| |
Dr. Bidita Bhattacharya, Dr. Rudrani Chatterjee
Conversion disorder (functional neurological symptom disorder) is characterized by neurologic symptoms (eg, weakness, abnormal movements, or non-epileptic seizures) that are inconsistent or cannot be fully explained with a neurologic disease, but cause physical and/or psychological distress and impairment. The disorder is common in clinical settings and often has a poor prognosis in the form of persisting, remitting or relapsing of symptoms and associated co-morbidities. Literature shows that there is agreement on first-line treatment, with education about the condition to the patient and family, specially to help understand and believe the diagnosis. But conversion disorder often does not fully respond to education alone. Second line management includes physical therapies (for functional motor disorders) and cognitive behavior therapy, which though superior to usual care has been found to be moderately efficacious. However, second line care usually fails where first line treatment failed because the diagnosis was not believed. Refractory patients are subject to various third line treatment modalities like hypnosis (for sensory loss or speech disturbance), brief psychodynamic psychotherapy, family therapy, group therapy, multidisciplinary inpatient treatment apart from pharmacotherapy. Here, Discussant 1 builds the theoretical premises for the conceptualization of psychopathology. Discussant 2 builds a tentative eclectic therapy framework combining elements of behavior therapy including skills training in specific areas, cognitive therapy and dialectical behavior therapy in a 3 session format, as an addition to education alone, combining existing literature with clinical experience in the field.
Key words: Conversion Disorder, Cognitive Behaviour Therapy, Eclectic Therapy
| SYM79: Optogenetics|| |
Dr Rajnish Raj , Professor, Dept of Psychiatry, Gmc Patiala.
Dr (Brig.) D Saldanha, Professor, Dept of Psychiatry, DYPMC, Pune
Dr Rohit Garg , Associate Professor, Dept of Psychiatry,Gmc Patiala.
OBJECTIVE:The goal of this workshop is to give a detailed review of the various aspects of the new and upcoming discipline of Optogenetics which integrates optics and genetics to display gain or loss of function of precise events within specific living cells.
Optogenetics uses genetically addressable photosensitive tools to monitor and control activity of living cells and tissue. It integrates optics and genetics to display gain or loss of function of precise events within specific living cell . It causes manipulation of neural populations by delivering light to light-sensitive ion channels or other proteins called microbial opsins. This enables refined manipulation of specific types or compartments of neurons with millisecond precision, whereas traditional electrical brain stimulation affects all neurons in a given area. Additionally, intracellular pathways can be studied using opto-XRs which could aid psychopharmacological research.
Components of technology includes: i. Building of light responsive resources. ii. Incorporation of light responsive molecule to target tissues iii. Delivery of light to the target tissues. iv. Analysis of response or behavior.
It has been used in Neuropsychiatry to understand psychophysiology of Reward seeking and Fear conditioning , psychopathology of Narcolepsy and Sleep wake transition , Schizophrenia , Autism , Post traumatic Stress disorder , Anxiety disorder and Depression.
It would enable integration of psychology, physiology, pharmacology, genetics, and imaging in the paradigms of psychiatry.
These workshop will illuminate the audience on these issues.
| SYM80: Management of behavioral and psychological disturbances of Dementia – Pharmacological and non-pharmacological methods.|| |
Dr. Saumitra Nemlekar, Dr. Ashish Srivastava
Dementia is progressive cognitive impairment with multiple etiologies. These changes are responsible for bringing a change in the individual mood, personality and behavior. The greatest risk factor for developing the problem is age. Behavioral and psychological symptoms of dementia (BPSD) contribute to significant care-giver burden and have a very wide range of clinical manifestations.
Dementia includes behavioral problems which are difficult to manage and need adequate management. Guidelines for management start with assessment and evaluation for other factors that may also be responsible for these features.
Both Non-pharmacological and pharmacological methods are available. However Monitoring of treatment regularly with a risk-benefit ratio must be done so that an ineffective drug is not continued unnecessarily. Similarly use of non-pharmacological treatments will be appraised according to the availability of resource and effectiveness in our scenario. The symposium will focus on available evidence for effective management of this problem.
Keywords – Behavioral and psychological disturbances of dementia (BPSD), pharmacological treatment, non-pharmacological treatment
| SYM81: Recovery in schizophrenia: A utopian concept or an achievable reality?|| |
The classical views about schizophrenia, that it is a chronic illness with no recovery are questioned of late. Many studies have consistently reported that significant proportion of patients with schizophrenia significantly improve or recover. The recent demands to transform mental health system into a consumer and family driven and recovery focused system have hastened the research on recovery in schizophrenia.
However, there is no consensus about the definition of recovery and different researchers have used different operational criteria of recovery, leading to variable results. Although, some research on schizophrenia is done elsewhere, there are no studies on recovery in schizophrenia from India. Considering the unique socio-cultural concepts, attitudes and their influence on mental illnesses and its outcome, it was worthwhile to explore this unexplored territory in our country.
In a cross-sectional study done at our centre, aimed to assess the rate of recovery in schizophrenia and the factors associated with recovery, we d found that, around 25% of the individuals met the criteria for recovery. Being married, and being on clozapine were significantly associated with recovery.
The speakers of this symposium will be throwing some light on the concept of recovery, research evidences pertaining to recovery in schizophrenia apart from the detailed discussion of the study findings mentioned above.
| SYM82: Comprehensive Geriatric Assessment (CGA) for the psychiatrists: A ONE-STOP TOOL for assessing older adults?|| |
(With special focus on Fall prevention and Frailty in the elderly)
Speakers: Dr. Debanjan Banerjee, Dr. Sujoy Mukherjee, Dr. Neelanjana Paul
Conditions like functional impairment, dementia and sub-clinical symptoms are frequently under-recognized and inadequately addressed in older adults. Identifying these geriatric conditions with a multi-dimensional yet sensitive tool can help in management and preventing complications.
Psychiatrists often face 'geriatric syndromes', a term used to refer to common health conditions in older adults that do not fit into distinct organ-based categories and usually have multi-factorial causes. Dizziness, incontinence, sleep disorders, gait disturbances, delirium, cognitive impairment, falls and frailty are some of them. One such assessment using multi-disciplinary approach is Comprehensive Geriatric Assessment (CGA), initially developed in medicine and later used in mental health and oncology. It identifies medical, psychosocial and functional limitations in an older person; eventually helping to develop a coordinated plan of management for overall well-being.
CGA also helps tap into the two DARK HORSES of the elderly: namely 'frailty' and 'falls'. These two often under-treated conditions can have immense physical and mental health implications. CGA can help detect these commonly co-morbid states in almost all elderly thus helping to prevent or treat them.
So why should a psychiatrist be aware of this tool and its use?
This symposium answers the question under the following heads:
• The Concept of Frailty: Definition, assessment, implications and management
• Fall prevention in the elderly: Risks, importance and interventions
• Comprehensive Geriatric Assessment (CGA) as a ONE-STOP TOOL: Components, efficacy and feasibility in our settings
| SYM83: Dermatological Side Effects Of Psychotropic Medications: When Beauty Can Turn Into A Beast|| |
Aratrika Sen1, Goutam Mahati2, Aritra Chakraborty3, Tamoghna Bandyopadhyay4
Psychiatric disorders frequently co-occur with dermatological conditions and psychotropic agents may be indicated in treating the underlying psychiatric symptoms. Use of psychotropics can be associated with significant dermatological adverse effects.
Topic 1: Cutaneous side effects of anti-depressants
Though less commonly cited, Adverse cutaneous drug reactions [ACDRs] can occur with SSRIs. As ACDRs are less common, their management can present less familiar clinical scenarios to clinicians. Severe skin complications associated with antidepressant use include the following:
1. Erythema multiforme (EM)
2. Stevens-Johnson syndrome (SJS)
3. Toxic epidermal necrolysis (TEN) (Lyell's syndrome)
4. Acute generalised exanthematous pustulosis (AGEP)
5. Drug-induced hypersensitivity syndrome (DIHS),,,,,,
Topic 2: Cutaneous side effects of anti-psychotics:
Many skin reactions have been reported with neuroleptic drugs, including urticaria, abscesses after intramuscular injection, maculopapular erythematous rashes of the trunk, face, neck, and extremities, photosensitivity or exaggerated sunburn, contact dermatitis, and melanosis or blue-gray skin discoloration. Skin rashes are usually benign. More serious types of skin reactions are rare, but angioedema, non-thrombocytopenic purpura, exfoliative dermatitis, and Stevens–Johnson syndrome have been reported. .
Topic 3: Cutaneous side effects of Mood Stabilisers.
Cutaneous Adverse Drug Reactions (ADRs) have been reported with the use of sodium valproate, carbamazepine, oxcarbazepine and they include Stevens-Johnson syndrome, toxic necrolytic erythema, and leukocytoclastic vasculitis. Dermatological adverse effects of lithium carbonate include occurrence or worsening of acne, psoriasis, and follicular keratosis. There are reports on rashes of various types. Hair loss in patients on lithium therapy is probably related to lithium-induced hypothyroidism. ,
Topic 4: Treatment approach to cutaneous side effects of psychotropic medications by a Psychiatrist.
Dermatological side-effects play a pivotal role in worsening an already depressed or psychotic patient, which may lead to non-compliance, making patient's life difficult. Thus, primary care to the side effects by a psychiatrist is necessary before the patient is being referred to a dermatologist.
| SYM84: Cortisol, as the main human glucocorticoid, is considered to be a biological marker of stress and anxiety|| |
Background and objective: Cortisol, as the main human glucocorticoid, is considered to be a biological marker of stress and anxiety. Since it is known that oral lichen planus (OLP) can appear and worsen during stressful events, cortisol levels have been previously studied in OLP patients. The present meta-analysis aims to assess the salivary concentration of cortisol in OLP patients compared to healthy controls. Materials and methods: Web of Science, PubMed, Cochrane Library, and Scopus databases were searched up to October 2018. The RevMan 5.3 software was used with the mean difference (MD) and 95% confidence intervals (CIs). The CMA 2.0 Software was used to evaluate the publication bias, sensitivity analysis, and meta-regression as possible sources of heterogeneity. Results: 10studieswereanalyzedandatotalof269OLPpatientsand268controlswere included. The pooled MD of the salivary levels of cortisol in OLP patients compared with controls was4.27ng/mL(95%CI:2.33, 6.21;P < 0.0001), thus,thesalivarylevelofcortisolinOLPpatientswas significantly higher than in controls. In Indian-based population studies, a significant difference in the salivary cortisol levels in OLP patients compared with controls was detected (MD = 5.62 ng/mL; 95% CI: 2.67, 8.56; P = 0.0002). In addition, a significant difference in the salivary cortisol levels in the OLP patients compared with the controls was obtained in studies performed with enzyme-linked immunosorbent assay (ELISA) method (MD = 5.33 ng/mL; 95% CI: 2.72, 7.93; P < 0.0001). Conclusion: We suggest that supportive psychological treatment together with the conventional therapy could increase patients' capability to prevent stress, anxiety, and depression.
| SYM85: Alzheimer's Disease: Current Perspectives and Future Trends|| |
Dr. Sharmila Sarkar, Dr. Abhijit Chakraborty, Dr. Soumen Karmakar
Dementia describes a group of symptoms affecting memory, thinking and social abilities severe enough to interfere with daily functioning. Alzheimer's disease (AD) is the most common form of dementia, and possibly contributes to more than 60% of cases globally.
Alzheimer's disease is a clinico-pathological diagnosis and definite diagnosis needs a histopathological (HP) confirmation. In absence of HP confirmation, the diagnosis of AD is only probable, and can only be made in advanced stages when it has reached the threshold of dementia. Early detection of AD is very important, as at this stage the disease process can be arrested temporarily with proper intervention. So, search of specific tests and selective biomarkers is going on for its early detection. Lack of a good screening test in regional languages and lower educational levels in Indian patients are challenges to the clinician.
Acetyl cholinesterase inhibitors and NMDA receptor antagonists are most often used medications in AD. Apart from specific medicines, control of risk factors is also very important in management of AD. Decreased renal clearance, slowed hepatic metabolism, and multiple medications are the issues to be remembered before starting drug treatment.
A comprehensive system of humane care for patients with dementia requires consideration of psychosocial strategies to enhance quality of life.
In our presentation we will revisit the current concept of AD with possible identification of biomarkers of AD pathology, current and upcoming promising molecules, and comprehensive non-pharmacological approaches to AD
| SYM86: Autism and Violence: A Reality or Situational|| |
Dr Soumya Basu, Dr Shabbir Amanullah, Dr K S Shivakumar
In the past few decades, with the rapid increase in public awareness of autistic spectrum disorders, there has been a push by parents to have a formal diagnosis made to access funding in some jurisdictions . However, the diagnosis itself, does not explain many of the behaviors and in many instances, violence is triggered by a combination of external factors rather than an internal 'autistic' trigger.
In clinical settings, ASD is associated with behavioral difficulties and comorbid psychiatric disorders, social and interpersonal challenges. Emotional dysregulation and disruptive behavior can be a part of the presentation, which may be due to the core symptoms or due to other psycho-social factors . Individuals with ASD are more likely to be victims of violence rather than the perpetrators of violence . Media reports however often highlight the 'abnormality' that then creates an environment of stigma where in the individual is more likely to react ,,.
However, due to the difficulties in perspective-taking and intuitive ability to have emotional reciprocity, some of these patients can plan and execute violent acts.
Violence perpetrated by individuals with ASD is a controversial topic. There have been few case reports and a few studies it is a delicate area as there is a definite possibility of stigmatization of a very vulnerable group. However, individuals at the milder end of the ASD spectrum, who are insightful about their difficulties and experience adverse life events are capable to psychopathic acts, including mass violence ,,. There have been several high profile cases where the perpetrator has either had a pre-existing diagnosis or a retrospective diagnosis of ASD ,,.
In this presentation, a few of the factors leading to violence in ASD will be explored. The underlying neurobiological mechanisms and treatment implications would be discussed with case examples.
[TAG:2]SYM87: Domestic violence : A psychiatric view point [/TAG:2]
Dr. Arvind Barad*, Dr. Sumit Upadhiya**
Genesis of domestic violence is deep rooted in social structure in our culture .women are given subsidiary role without their personal space . change in women in term of women empowerment women in politics , education & IT sector are of recent origin . sigmund frued & alferd alder focus on concept of masculine protest and woman was symbolized inferiority complex ,glass ceiling effect a well known phenomena in which women consider them self inferior to man at their own . so women in Indian context are vulnerable to abuse . In case of India, women have come a long way from women sages and scholars in the Rig Vedic period to women in the armed forces, IT sector, politics, industry and other significant areas while balancing their role as a daughter, wife and mother. This journey towards modernization has not been easy. Women have had to fight the traditional Indian male-dominated society to emerge as stronger and independent entities. While all these are positive developments, cases of rape, harassment at workplace and dowry deaths are widespread. Illiteracy and ignorance about their rights are still prevalent among a majority of the women. In January 1992, the National Commission for Women (NCW), was set up as a statutory body under the National Commission for Women Act, 1990 ( Act No. 20 of 1990 of Govt. of India ) to review the constitutional and legal safeguards for women; recommend remedial legislative measures, facilitate redressal of grievances and advise the Government on all policy matters affecting women.
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.
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.
It is 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. There is different kind of violence facing are physical, sexual, verbal, social , emotional, financial and intellectual violence .
To facilitate speedy delivery of justice to women Parivarik Mahila Lok Adalats are organized in different parts of the country to review the existing provisions of the Constitution and other laws affecting women legislations
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.
| EP 108: Circadian rhythm disruption and resistant depression|| |
Dr. Jigar Patel, Dr. Prakash Mehta
Abstract: The master regulator of biological clock situated in the suprachiasmatic nuclei of the anterior hypothalamus which involve in orchestrating the circadian rhythm of multiple biological process. Increasing evidence suggest an important role of biological clock for depression. Circadian system seems to play vital role in seasonal depression and bipolar disorders. Available data suggest primary role of circadian system for development of major depressive disorder, but further and larger studies are necessary to conclude.
Melatonin have chronobiotic effects,that mean it can readjust the circardian rhythm. Seasonal affective disorders and mood disturbances caused by circadian rhythm disturbance are theoretically treatable by manipulating the circadian system using chronobiotic drugs,chronotherapy or bright light therapy. This case focuses on the possible circadian rhythm dysruption induced major depression and its treatment by readjusting circadian system where antidepressant and stimulant agents didn't show proper response, there was drastic improvement in MDD after readjusting biological clock by chronotherapy and melatonin.
In short, agents and techniques with chronobiotic properties offer a novel approach to treatment of possible circadian rhythm disruption induced depression.
| EP 109: FAHR'S Syndrome: A Treatment Challenge|| |
Dr.Prashant Bamania; Dr.Prakash Mehta;
Fahr's disease (FD) is a rare neuropsychiatric disease consisting of bilateral basal ganglia calcification with neurological, cognitive, and psychiatric manifestations and commonly called as idiopathic basal ganglia calcification.It is a triad consisting of symmetrical calcification of the basal ganglia, neuropsychiatric symptoms, and hypofunction of the parathyroid gland.
A 40 year old male presented with episodes of uncontrolled seizures on anti epileptics since 10 years.Irrelevant talks, delusion of persecution, reference, disturbed sleep since 4 years.Excessive irritability poor self care, withdrawn behaviour, delusion of grandiosity, decreased food intake, mood lability, hearing of voices[music playing far away] since 6 months.Patient was on treatment for hypothyroidism and hypoparathyroidism since 4 years Family history was positive for similar illness in his grandfather.MRI showed symmetrical calcifications in bilateral globus pallidi,dentate nuclei and right thalamus, and chronic small vessel changes.Blood investigations revealed low vitamin D3,Low PTH,Low calcium level, low B12.General examination had restricted shoulder movements, cog wheel rigidity, parkinsonian features,multiple skin lesions.During his indoor admission multiple 1st and 2nd generation antipsychotics,mood stabilizers and benzodiazepines were given.Multiple difficulties were faced during treatment as he developed extrapyramidal symptoms easily, also DRESS syndrome, and electrolytes [Na+,Ca+2] imbalance.Prolonged admission[2.5 months]was needed.An intensive,multidisciplinary approach was implemented with collaborative efforts from Endocrinology,Neurology,General medicine,Dermatology department for holistic care of patient.The patient was relieved of his delusions within 4-5 months, irritability reduced and was able to perform daily chores.
Treatment is directed toward minimizing symptoms.The prognosis for any individual with Fahr's Syndrome is variable and hard to predict.
| EP 110: Perspectives on mental health status and experience of sex life among patients suffering from premature ejaculation.|| |
Background : Premature ejaculation (PE) is a common male sexual dysfunction that may adversely affect 20% to 30% of the male population. Broadly speaking, premature ejaculation refers to persistent or recurrent ejaculation occurring before, at, or shortly after penetration and causing distress to the patient and his partner. Men with PE complain about decreased sexual self-confidence and psychological comorbidities. Thus, it seriously impair mental health and couples sexual relationships.
Some cases of premature ejaculation have a medical cause, but most appear to be related to unknown physiologic or psychological factors. Individual psychological factors such as depression, stress, anxiety, and negative cognitive processing are strongly associated with the onset and maintenance of male sexual difficulties, specially for premature ejaculation.
The objective of this study was to assess the association between premature ejaculation with psychological factors particularly anxiety,depression and the impact of this illness on patients' overall quality of sex life.
To find out the mental health status and quality of sex life among patients suffering from premature ejaculation.
A cross-sectional study was conducted on 120 patients diagnosed with premature ejaculation. Subjects were recruited from outpatient section of Department of Psychiatry, Medical College & Hospital, Kolkata.
On every patient these below mentioned scales were applied :
1) PEDT (Premature Ejaculation Diagnostic Tool (PEDT)
Questionnaire) scale for assessing premature ejaculation
2) HAM-D scale for depression
3) HAM-A scale for anxiety
4) SQLI ( sexual quality of life questionnaire-male ) scale for male for overall sexual life status in male
5) ASEX ( Arizona sexual experience ) scale for overall sexual experience assessment
Scores of HAM-D, HAM-A, SQLI, ASEX scales were correlated with PEDT scale scores using correlation statistics.
Anxiety and depression were significantly associated with premature ejaculation.Scores of PEDT positively correlated and statistically significant with HAM-A and HAM-D scales.
Experience of sex life declined for patients with premature ejaculation. Scores on ASEX scale and SQLI scale are negatively correlated with PEDT scale score.
Our results are consistent with existing literature that shows an significant association between anxiety, depression and premature ejaculation, particularly the acquired subtype. Anxiety and depression may play a causal or perpetuating role in these patients in bi-directional way. Experience of sex life also declined for these people. Prevention and treatment of depression, anxiety may substantially decrease the risk of premature ejaculation.
| EP 111: A study of Affiliate stigma and Quality of life among Primary caregivers of children and adolescents with Intellectual disability|| |
Ram Anuj Verma1, Amit Arya2, Vivek Agarwal3, Pawan Kumar Gupta4, Pooja Mahour5
Background:, Caregivers 'internalized stigma' and 'quality of life' are most common predictor for morbidity of mental health problems in parents of children and adolescent with intellectual disability. Studies on stigma among primary caregivers of children with I.D., who spend most of their time in providing care, are very few. No study was conducted to assess the association between affiliate stigma and quality of life of primary caregivers of children and adolescent with intellectual disability.
1. To study Affiliate Stigma and Quality of life in primary caregivers of children and adolescents with intellectual disability.
2. To assess correlation between Affiliate Stigma and Quality of life in caregivers of children and adolescents with intellectual disability.
Methods: The present study is a cross-sectional, observational study conducted in a tertiary care general hospital psychiatric setting, Department of Psychiatry, King George's Medical University, Lucknow, between November 2018 to August 2019. The study was aimed to assess the affiliate stigma and quality of life among primary caregivers of children and adolescents with intellectual disability and to explore the relationship between affiliate stigma and quality of life in caregivers of these children and adolescents.
Results: In this study, a total 113 patients were included it was found that affiliate stigma of caregivers had weak to moderate negative correlation with overall QOL of caregivers
Conclusion: As affiliate stigma of caregivers of children and adolescents with intellectual disability increase the Quality of life of caregiver's decrease.
| EP 112: To study psychopathology, insight and functioning in patients of obsessive compulsive disorder.|| |
Chandan Prasad1, Bandna Gupta2, Anil Nischal3, Shweta Singh4, Manu Agarwal5,
Background: Insight varies among different symptom dimensions of OCD. Response to treatment is influenced by level of insight and insight improves with treatment. Insight plays important role in clinical outcome and level of functioning in daily life.
Aim: To study psychopathology, insight and functioning and assess association between them in patients of obsessive compulsive disorder.
Method: This is a cross sectional study Department of Psychiatry, King Georges Medical University, Lucknow, between September 2018 to August 2019. The diagnosis of OCD was confirmed as per ICD-10 DCR. Severity was assessed on Y-BOCS and those scoring more than 16 were included. Patient were assessed on DY-BOCS for different dimensions and its clinical severity. BABS was applied for assessment of Insight and SOFAS was applied for assessment of social and occupational functioning.
Result: Study sample consisted of total 94 patients out of which 81 % of patient had good insight and 19 % had poor insight. Among different dimension of OCD, contamination and cleaning compulsion were present in majority (75 %) of the sample followed by symmetry and arranging (54 %) and sexual and religious obsessions (38%). Majority who had their symptoms as aggression, sexual and religious obsessions had good insight. Patients with poor insight had longer duration of illness, longer duration of untreated illness and they had higher severity of illness. poor insight patients have better level of functioning as compared to good insight group.
Conclusion: functioning is reduced with increasing severity of illness but same gets better as insight became poorer probably due to lack of cognitive appraisal of symptoms and less distress.
| EP 113: An Open-Label Feasibility Trial of Repetitive Transcranial Magnetic Stimulation (rTMS) in Depressed Pacific Islander Adolescents|| |
Stivala, Adam; Portman, Will; Ruege, Andrew; Dawei Wang.
OBJECTIVES: To investigate the current response to psychopharmacology and transcranial magnetic stimulation (TMS) in Pacific Islander adolescents with Major Depressive Disorder (MDD).
BACKGROUND: Major depressive disorder (”MDD”) is an unfortunately common devastating condition, especially for 2-4% of those younger than 18, and is a contributor to the 3rd leading cause of mortality in adolescence, suicide. 40-60% of youth with MDD have a limited response to current treatment protocols and require either (a) medications with a wider side effect profile, (b) intensive psychosocial programs that interfere with school, and/or (c) the legally and publicly spurned option of electoconvulsive therapy. Such results are tempered further when working with Pacific Islanders (Native Hawaiians, Marshallese, and others), as such youth and families have shown in multiple studies,. The aversion to such standard treatment is concerning, as Native Hawaiian adolescents have a higher risk of suicide than other adolescents in Hawaii, with a suicide rate/100,000 people per year of 12.9, compared to Asian Americans' 7 and Caucasian Americans' 12.8. Where then can patients and families turn to in the case of medication and psychotherapy-refractory depression? Transcranial magnetic stimulation (TMS) has been proven to be effective in treatment resistant depression in adults and has been only recently examined in children and adolescents. One then wonders about its efficacy therein.
METHODS: 2 series of Pubmed, Ovid, Google Scholar, and OneSearch literature searches were conducted on 6/10/19: 1 investigating rTMS in adolescent depression, the other researching rTMS in depression in Native Hawaiian or other Pacific Islander youth.
RESULTS: At this point in time, 10 studies exist testing TMS' effects in children and adolescents with treatment refractory depression. 9 of said studies were open-label trials; 1 was a small (n=2) RCT, which was notable for having no patients randomized to sham (both were active, turning it into what amounts to another uncontrolled trial). Of those evaluating depression severity through Children's Depression Rating Scale-revised (”CDRS-R”) scores, 100% of the trials (8/8) displayed a statistically significant improvement, with a combined mean CDRS-R change/week of -3.6 +/- 1.1. None of the trials of the 1st series of searches nor the entirety of the 2nd series yielded information as to how TMS fairs in Native Hawaiian or other Pacific Islander youth with depression.
CONCLUSIONS: No studies exist that can verify the efficacy of TMS in youth, of Oceanic origin or otherwise, with the same degree of scrutiny as currently done in adults. Therefore, our group is engaging in a pilot study to evaluate the performance of TMS for the treatment of MDD in Native Hawaiian and other Pacific Islander adolescents aged 14-17; we are planning on then progressing on to a sham-controlled RCT in a larger sample size of the same population to test its efficacy in not just Pacific Islanders, but all youth.
| EP 114: Pregablin dependence disorder: A case report|| |
Introduction : Pregabalin is a GABA analogue, with a structure and mechanism that overlaps those of gabapentin and some structural similarity to other anticonvulsants. It is approved for the treatment of Diabetic peripheral neuropathy, postherpetic neuralgia, seizure disorders and fibromyalgia.
Case : We present the case of pregabalin dependence in a 35 years old male with a previous history of substance use and positive family history of ADS and NDS, seen in consultation in June 2019. The patient started using pregabalin 75 mg/day and incresed his intake to 1500 mg/day over a period of 1 year. The patient reported feeling euphoric, energetic and active following the intake of pregabalin and complained of withdrawal symptoms characterised by craving, feeling low, lethargic and irritable whenever he tried to reduce the dose and hence was diagnosed as a case of Mental and behavioural disorders due to use of other psychoactive substances. In this case report we discuss diagnosis, management and treatment given to the above patient.
Discussion : The abuse potential of pregabalin is still controversial in the literature and very few case reports are available for the same unlike gabapentin. Pregabalin is likely to be abused for its euphoric effect. In the above mentioned case, the risk for abuse of pregabalin appears to have been predicated due to the patient's previous histories of drug abuse and reward expectations. This case report emphasizes on the heightened level of risk of developing dependence on pregabalin in patients with a prior history of substance use disorder.
| EP 115: Explanatory models during illness and remission in patients with schizophrenia|| |
Cheryl Persis Petit, Anju Kuruvilla
Department of Psychiatry, Christian Medical College, Vellore
Patients' explanatory models (EM) emerge from their experience with a particular episode of illness. Eliciting EMs in clinical practice gives a better understanding of the subjective experience and attitudes towards the illness and treatment.
This study attempted to study EMs and its relationship with psychopathology and insight in patients with schizophrenia, at admission, and prior to discharge from a short-stay in-patient hospital setting.
Sociodemographic and clinical variables were collected from consecutive inpatients with a diagnosis of schizophrenia. Beliefs about the etiology , meaning of the illness etc were assessed with the Short Explanatory Model Interview (SEMI); psychopathology was assessed with the Positive and Negative Syndrome Scale (PANSS) ; insight was rated on the Schedule for the Assessment of Insight scale (SAI-E).These were re-assessed following remission.
93 subjects were recruited to the study. The mean age was 31.27 years (S.D. 8.9) and the mean duration of illness was 6.58 years (range 1 to 30). Common explanatory models for the cause of illness at initial assessment included other individuals, disease and black magic. Prior to discharge the majority reported a disease model of illness. Patients who endorsed a disease explanation had significantly higher scores on the insight scale.
The relationships between explanatory models, insight and psychopathology in psychosis are complex and mediated by the interaction of several variables. EMs can change over time, phase of illness and in response to treatment. Understanding them can help designing culturally appropriate and acceptable mental health interventions.
| EP 116: Sexual dysfunction in men with psychosis: Incidence and risk factors|| |
Rajesh Gopalakrishnan, Dhananjayan Ravichandran
Department of Psychiatry, Christian Medical College, Vellore
The high prevalence of sexual dysfunction in patients with psychotic disorders is well established. It has also been clearly proved that these may be due to medication related side effects.
This study estimated the incidence, nature and risk factors of sexual dysfunction in drug naïve or drug free men with psychosis following treatment.
Men with a diagnosis of acute psychosis or schizophrenia who were either drug naïve or drug free for six months were recruited after obtaining informed consent. Sociodemographic and clinical data were collected using a structured proforma. During follow up at six weeks and six months, psychopathology (PANSS) and sexual functioning (IIEF and DSM-IV TR criteria) were assessed. Serum testosterone levels were also measured. Bivariate and multivariate statistics were obtained.
Twenty one patients completed the six month follow up. At baseline four patients (19%) reported sexual dysfunction. At six months the incidence of sexual dysfunction was 41.2%. Hypoactive sexual desire disorder was the most commonly reported sexual difficulty. The factors associated with sexual dysfunction were current marital status, older age and longer duration of illness. Psychopathology scores, antipsychotic dose and testosterone levels did not have any association with sexual dysfunction
The incidence of sexual dysfunction in patients with psychotic disorders on treatment is moderately high. Clinicians need to routinely assess for this distressing condition to provide comprehensive care for these patients thereby improving medication adherence and quality of life.
| EP 117: Outcome of acute and transient psychotic disorders: a retrospective study from South India|| |
Department of Psychiatry, Christian Medical College, Vellore
Acute and transient psychotic disorder (ATPD) has a unique position in the International Classification of Diseases (ICD-10) and is a common presentation in the developing world. Various studies have looked at the diagnostic stability of this category and have reported diverging outcomes.
This study aimed at exploring factors associated with outcome of ATPD in a developing country.
A retrospective chart review of patients diagnosed with ATPD between January and March 2008 was carried out. Socio demographic details and clinical variables were collected for a period of 10 years.
There were 67 patients with ATPD, the majority was female (61.2%), from a rural background (71.6%) with a mean age of 33.78 years (SD= 14.729). The mean duration of illness at presentation was 10.99 days (SD= 8.617) and mean duration of follow-up was 46.78 months (SD= 52.832). The diagnosis was revised in 50.7%; among them a diagnosis of schizophrenia was made in 74.3%, mood disorder in 11.4% while 11.4% presented with recurrent episodes of acute psychosis. 19 (28.4%) of the patients continued to follow up at 10 years. Completion of 10 year follow-up was associated with single status (p=0.016) and revision of diagnosis (p= 0.000).
Prospective studies are needed to explore factors associated with outcome of ATPD.
| EP 118: TreadWill: an online treatment for depressive symptoms.|| |
Authors: Arka Ghosh, Pratibha Bhatt, Parth Sharma, Bharat Sati, Jagriti Agnihotri, Shoukath Ali, Silky Gupta, Alok Bajpai, Nitin Gupta
Background: Despite the availability of evidence-based therapeutic approaches, clinical depression is the leading cause of disability globally. One of the major reasons for this fact is the abysmally low mental health professional to patient ratio.
Aims: Providing automated online intervention has the potential to reduce the burden of depression. Our aim is to develop and evaluate an automated online intervention, TreadWill, that can help people with depressive symptoms.
Methods: We have developed TreadWill to provide automated online therapy to people suffering from depressive symptoms. TreadWill has been designed to deliver Cognitive Behavioral Therapy (CBT) in an automated manner using slides and interactive texts. TreadWill includes games based on Cognitive Bias Modification (CBM) paradigms to train the negative information processing biases common in people suffering from depression.
Results: TreadWill will be evaluated in a 3-armed randomized controlled trial. An earlier version of TreadWill based primarily on CBT has been evaluated in a randomized controlled trial and has been shown to reduce depressive symptoms.
Conclusion: Our study will provide new insights on the efficacy of CCBT in India and on factors affecting user engagement.
| EP 119: A novel medication approach to Autism Spectrum Disorder, Major Depressive Disorder and Social Anxiety Disorder. Adam Stivala, MD PGY4 Fellow Child and Adolescent Psychiatry, John A. Burns School of Medicine University of Hawaii|| |
Introduction: This case describes a 24 year old Hispanic male diagnosed with Autism Spectrum Disorder (ASD), Major Depressive Disorder (MDD), and Social Anxiety Disorder (SAD) and a novel medication treatment approach to treat associated symptoms of the patient's multifaceted pathology.
Case Description: 24 year old Hispanic male with psychiatric history of MDD, ASD, and SAD presented for initial psychiatric evaluation due to low mood, social anxiety, anhedonia, poor sleep and feelings of hopelessness regarding his outlook on life. Family relations were also strained, in that he was unemployed and not seeking higher education after completing high school. Other issues the patient had encountered included no previous sexual relations and social isolation with long hours spent on his computer in the attic working on personal computer programming projects.
Medical history was unremarkable. Previous psychodynamic testing revealed ASD as well as a high IQ in the 140's. He had been in counseling services in the past for SAD, but abstained from pharmocological intervention due to hesitation regarding medications. At the behest of his biological mother and step-father, the patient was referred to outpatient psychiatric services due to decline in self care and activities of daily living.
Zoloft was chosen for serotonergic properties, and likewise Wellbutrin XL was selected to facilitate dopaminergic and norepinephrine properties. Adderall was finally added as a third line treatment to increase the latter medication's re-uptake and release of dopamine and norepinephrine.
Discussion: The patient was initially started on antidepressant therapy which included Zoloft as a first line treatment. After several months, when the symptoms of anhedonia, low mood, and social isolation continued even after optimization of Zoloft, Wellbutrin XL was added as an adjunctive medication for symptoms. Finally, Adderall XR was trialed as a second adjunctive medication to elicit benefits of improved attention and possible euphoric mood. After titrating Zoloft, Wellbutrin XL, and Adderall XR to appropriate dosages over 4-5 months, the patient became more socially engaged with family members. He also actively began searching for employment opportunities in computer based work, and was pursing Community College classes in order to begin college level classes. This case demonstrates the combination of several medications usually used in monotherapy for optimization of symptom management in a challenging patient with primary diagnosis of ASD.
| EP 120: Reflection On The Care Of A Patient With Palliative Care Needs|| |
Dr. S. Vineesha , Dr. B.J.P Mallika , Dr. P. Himakar
Patients with severe persistent mental illness like chronic schizophrenia and therapy refractory depressions, and wandering lunatics with abnormal behaviour need long term residential care. Many of which have poor family and social support, many of them are abandoned and finally, become homeless. An explicitly palliative approach within psychiatry has the potential to improve quality of care, quality of life and autonomy of these severely mentally ill patients. Here is a case reflection of a homeless, mentally ill person admitted in our hospital and was found to have multiple medical comorbidities.
Objective: To report and discuss the importance of palliative care for patients with severe persistent mental illness, wandering lunatics and homeless.
Case: A 57-year-old male patient was found to wander on roads, creating nuisance and disturbance to the public with his abnormal behaviour. He was brought by police escort with reception order from magistrate to admit, provide proper care and necessary treatment to the mentally ill person.
Conclusion: A team for palliative care provision with counsellers, social workers, caregivers, doctors, volunteers, nurses, physiotherapist and rehabilitation is very much essential for the management of terminally ill patients.The medical care of homeless individuals who are mentally ill poses a vexing challenge for our traditional health care delivery models. Common illnesses progress, and injuries fester, leading to increased numbers of emergency department visits and acute care hospital admissions as has been seen in this case scenario.
| SYM88: Challenges and opportunities facing Psychiatrists in India in the 21st Century|| |
Prof Dr Nirmal Kumar Bera, Dr Arunava Datta, Dr Shamiul Akhtar Borbora, Dr Payel Das, Dr Tanay Maiti
Title: Challenges and opportunities facing Psychiatrists in India in the 21st Century
Objective: To give a detailed insight into the various challenges faced by Psychiatrists regularly and the opportunities that they be aware of .
Outline: : India spends less than 1% of its GDP as its healthcare budgets even with 120 million citizens living below the poverty line. India has 0.75 Psychiatrists per 100,000 on anaverage. Recent prevalence studies evaluate that psychiatric illness are prevalent in >30% -40% of the population by conservative estimates. This mismatch in demand vs supply leads to various challenges that psychiatrists face in their day to day work which impairs them from functioning at optimum capacity.India has recently passed a rights based bill for mental health called the Mental Healthcare Bill,2017 which brings the laws for protection of PMI in alignment with the United Nations Convention Of Person With Disabilities.However with the advent of the new law a new set of challenges face the Indian Psychiatrist which also leads to newer opportunities . This symposium is aimed at presenting the major challenges faced by psychiatrists in current day scenario and the opportunities that wait us in the 21st century.
| SYM89: Non Psychotropic Medication for Psychiatric Disorders|| |
Malay Sarkar, Shankho Chatterjee, Tirthankar Dasgupta
There are some drugs used in Internal Medicine, which we used for non psychiatric disorders also influence mental and psychological function beneficially.
Studies have shown that inflammation , oxidative stress, mitochondrial dysfunctions play role in mood disorders ( depression , bipolar disorder) , Schizophrenia, Alzheimer's Disease. Acetal Salicylic acid and Non Steroidal Anti Inflammatory drugs protect against oxidative stress and shows beneficial effect in mood disorder and AD.
Diuretic Bumetanide reduces severity of Autistic Spectrum Disorder by enhancing GABA ergic inhibition.
Beta blockers are routinely used in treatment of anxiety disorder. Clonidine , alpha2 agonist , a common antihypertensive have been approved in treatment of ADHD. They are also used in alcohol and opiate withdrawal, smoking cessation.
Antiepileptic Gabapentine indicated in treatment of neuralgia, restless leg syndrome and certain anxiety disorders.
Ketamine ( NMDA antagonist) used in anaesthesia and post surgery pain found beneficial in treatment resistant .
Antibiotic Minocycline might be useful in depression.
S- adenosyl-L- methionine used as a dietary supplement by producing certain neurotransmitter, play role in treatment of depression.
Provision of these non psychiatric medications open window of several advantage, alternative drugs with few side effects and cost effectiveness.
Many non psychotropic medications prescribed for physical illness also influence brain function beneficially.
In this symposium we intend to discuss several non psychotropic medications that might or are useful in improving psychiatric disorder or symptoms in the absence of any physical diseaseM
| SYM90: Therapeutic implications of neurobiology of memory in treatment of psychiatric disorders.|| |
Harshal Sathe, Anantprakash Saraf, Muktesh Daund
Memory is the ability of the brain to store information for the purpose of later recall. The biological process of consolidation underlies the formation of long-term memories which involves long term potentiation and new protein synthesis.1 Recent studies have found out that the consolidated memories are not permanent. They enter a temporary fragile state when recalled and are reconsolidated via different pathway and thereby maintained. This transient reactivation provides a chance for updating and modification of these memories.2The molecular mechanism of consolidation if tapped into can form an important substrate for the action of novel pharmacological agents as well as the psychotherapeutic techniques to bring about the change in memory and hence the behaviour.
The pharmacological agents such as d-cycloserine have already been found to be effective in extinction training for cue induced cocaine use in rats. D cycloserine is an agonist at glycine binding site on NMDA receptor.3 Thus pharmacological agents have been successful in bringing about significant behavioural modifications by targeting the molecular machinery of memory formation. Similarly, a novel psychotherapeutic technique of cue exposure therapy which targets the same substrate has been found to have positive results.4 The psychoanalytic and the cognitive behavioural techniques also involve revisiting the stressful events in the past. The recall of these painful memories gives the subject a chance to see them in new light so as to bring about the desirable modification. The reconsolidation process can be considered as the neurobiological basis for the efficacy of these psychotherapeutic interventions.
The current discussion on the therapeutic implications of neurobiology of memory explores our current understanding on molecular mechanism of consolidation and reconsolidation process along with a discussion on the how this process is linked to the mechanism of action of pharmacological and non-pharmacological ways of treatment in various psychiatric disorders.
| SYM91: Telepsychiatry- Digitally driven training initiatives to reach the unreached|| |
Dr N Manjunatha,
Two learning objectives per symposium (up to 50 words)
1. To understand the need for technologically driven initiatives in providing mental healthcare services
2. To highlight certain initiatives by the NIMHANS Tele-medicine center in reducing the Mental Health Treatment Gap by task shifting
Brief description and consolidated abstract of the symposium (max. 250 words)
Information and communication technology has become an important part of our lives. Over the last two decades, advances in technology has been used extensively in different health care sectors by various stakeholders. Tele-psychiatry is a promising branch using audio-visual and data communication to provide psychiatric services. The mental healthcare treatment gap in India is > 75%, which implies that the mental health delivery system is fairly inadequate to deliver to the needs of persons with mental illness. Further majority of mental health care facilities and mental health professionals are clustered in the urban/semi-urban areas of major districts. These challenges could be effectively addressed through telepsychiatry with the current available mental health resources. The Telemedicine Centre of NIMHANS has developed multiple novel initiatives that have the potential to resolve the existing shortage of mental healthcare services through cost-effective and innovative use of technology in training, skill-building and mentoring of primary care physicians. Initiatives like the Karnataka Telemedicine Mentoring and monitoring Program, Uttarakhand Primary Care Psychiatry Program, Chhattisgarh Community Mental Healthcare Tele-mentoring Program have integrated mental healthcare into Primary Healthcare through a knowledge network with a team of specialists from the Telemedicine centre, who provide telementoring and ongoing education to enable community clinicians to treat patients with a variety of conditions. These innovative programs incorporate the principles of adult learning and occur in real-time in the workplace of practicing Primary Care Physicians. However, there are ethical and legal issues like the duty of care, role in emergency settings, privacy and confidentiality and security of data for which procedural guidelines and recommendations are yet to be formalized. These digitally driven initiatives to reach the unreached, exemplifies the utility of telemedicine technology in such ventures. Of course, more in-depth work is required to clearly establish the strengths and challenges of these technology based initiatives.
| SYM92: Smart Phones: Are they really making us smart?|| |
In recent years, the global percentage of smartphone owners and users has increased steadily. In 2017 there were 299 million users in India and is estimated to reach 422 million by 2022, while worldwide forecast to exceed 2.3 billion users by that time. Reasons may be varied like smart-phones have become a single gadget to fulfill varied needs like communication, accessing social media, paying bills, entertainment including gaming and other day to day needs like ordering groceries to ordering cabs and so on.
Despite these benefits there is a growing body of evidence which hints at negative consequences and dangers associated with excessive use. It has found to be is associated with health hazards such as poor academic & social participation, headaches, neck pain, fatigue, sleep disturbances, memory loss, hearing loss and poor concentration and psychiatric comorbidities like anxiety & depression. The prevalence has been shown to be ranging between 5-50%.
Further it is also being argued that problematic smartphone use can be viewed as a form of behavioral addiction like Internet or gaming addiction or simply as a newer way of life. Symptoms seen with behavioral addictions, like tolerance, withdrawal, mood changes, cravings, and loss of control, have also been found with problematic smart-phone use. Experts have suggested terminologies like problematic \ maladaptive smart-phone use or addiction in various studies till date for overuse that interferes with daily functioning. However, we are far from reaching consensus yet. Moreover, neither DSM 5 nor ICD-11 have listed the diagnostic criterion for this disorder.
Thus diagnosing smartphone addiction is challenging due to lack of standardized criterion, and unavailability of uniform data on signs and symptoms. Management also is challenging due to lack of specific management guidelines and rests mostly on supportive care.
To summarize, though smart-phone addiction or problematic use or any other term we give it is still in the conceptual stage and we are no-where near in reaching a consensus whether it is a form of addiction like gaming and internet or just a change in way of life or new fad & how to diagnose and manage it. However, one thing is sure that it is an emerging health hazard which is rapidly rising especially in younger population and poses a great challenge to already overburdened health and especially the de-addiction services in our country.
| SYM93: Intimate partner violence: - What is the role of a Mental Health Professional?|| |
Intimate partner abuse or violence (IPV) is defined by the Centers for Disease Control and Prevention as “physical violence, sexual violence, threats of physical/sexual violence and psychological/emotional abuse perpetrated by a current or former spouse, common-law spouse, non-marital dating partner or boyfriend/girlfriend of same or opposite sex”. 15% to
71% of women globally report of violence from an intimate partner at some stage in their lives. The World Health Organization (WHO) more recently estimated almost one third of women who have been in a relationship have experienced physical and/or sexual violence former intimate partner. The prevalence of DV is particularly alarming in light of its association with a range of negative health outcomes for women and children (World Health Organization, 2013). Research consistently shows that abused women are at increased risk of depression, anxiety, somatization, post-traumatic stress disorder (PTSD) and suicide. Many of them are also referred to psychiatrists for intervention. We have to deal with this sensitive issue keeping in mind the background and the support system these come women from.
The aim of this symposium will be to highlight and sensitize the issue of IPV and as well as to teach the participants how to screen for IPV Survivors in Mental Health settings, do safety assessments and discuss various treatment modalities including certain techniques of psychological interventions which will be helpful for effective management of such victims. The goal of the symposium will be to improve skills among the mental health professionals who deal with cases of IPV.
| SYM94: Role of rTMS as an Adjunctive Treatment in Treatment Resistant OCD : A Randomised Double Blind and Sham Control Trial|| |
Ravi Mohan Sharma, D Bhattacharyya, Kartikeya R Singh
Background: There are only few treatment options currently available for treatment of refractory obsessive compulsive disorder (OCD).Novel treatment strategies like repetitive trans cranial magnetic stimulation have been proposed for OCD refractory to standard treatment.
Aim:To assess the efficacy of rTMS (repetitive trans cranial magnetic stimulation) as an adjunctive treatment modality in patients of treatment resistant OCD.
Method : 28 diagnosed cases of treatment resistant OCD were included and randomized into two groups. They were assessed by administered Y-BOCS (Yale brown obsessive compulsive scale) score at initiation of therapy and thereafter at 2wks,.Group-I (n=14) underwent active rtms sessions 5 days /week for two consecutive weeks. Group-II underwent the similar treatment protocol but with sham coil..
Results: Both the groups were comparable. Statistically significant reduction in YBOCS scores were noted in Group-I (p<0.001).There was significant decrease in Y-BOCS scores after 2 weeks of treatment in both groups. Y-BOCS scores were significantly lower in Group-I than the other after 2 weeks (p< 0.001).
Conclusion: The augmentation of rtms in treatment of resistant OCD by active coil led to improvement in the Y-BOCS score in comparison to sham coil,giving additional therapeutic benefits in the management of resistant OCD.
| SYM95: Role of Neuromodulation therapies in addiction psychiatry: progress and prospects|| |
Debasish Basu,* Shubhmohan Singh, Abhishek Ghosh
Speaker 1 (Debasish Basu): Setting the backdrop
There are limited treatment options available for substance use disorders (SUDs), with either no approved pharmacological treatments for a large number of SUDs (e.g., cocaine and other stimulants, cannabis, hallucinogens, inhalants) and behavioral addictions, or only modest effectiveness of approved pharmacological treatments for other SUDs (e.g., alcohol, opioids, tobacco). In this background, the potential role of neuromodulation / brain stimulation (NM/BS) therapies in addiction psychiatry is worth exploring. Though there are a number of NM/BS modalities, this symposium focuses on repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). The theoretical rationale for the use of NM/BS techniques in addiction psychiatry is discussed.
Speaker 2 (Shubh Mohan Singh): An introduction to rTMS and tDCS
Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are the two neuromodulation techniques tested in clinical trials for people with SUDs. The former also includes deep TMS and theta-burst stimulation. The electromagnetic pulses in the TMS pass through the skull to a particular brain area, whereas tDCS delivers low-amplitude direct current to the head surface. Both these techniques have a direct impact on the brain area of stimulation (or inhibition) and an indirect downstream effect in the connected networks.
Speaker 3 (AbhishekGhosh): Efficacy of NM/BS in addictive disorders – current evidence, critique and challenges
A recently published meta-analysis showed a modest effect of high-frequency rTMS delivered in the left dorsolateral prefrontal cortex on craving for alcohol, tobacco and some other substances. Some evidence for reduction of substance use has also been documented. tDCS has shown some evidence in these areas. Thus, preliminary evidence of efficacy of NM/BS techniques is emerging. However, The ideal locus of stimulation (or inhibition), the parameters, frequency and duration of administration of rTMS and tDCS are yet to be settled. The durability of the effect is questionable. Additionally, the research on the efficacy of neuromodulation for the addictive behaviors is in its infancy. Finally, there is a need to empirically study the putative mechanisms of action of NM/BS techniques in treating addictive disorders. Multimodal, integrated studies involving brain stimulation, neuroimaging, and neurocognition might provide some answers.
| SYM96: Communication in digital era: The Family therapeutic perspective|| |
Ilora Barik Sil 1, Oindrila Ganguly 2, Soma Saha3, Rupa Chakraborty 4& Rituparna Jash5
Human beings, the stalwarts of our society, shapes and reshapes their happiness and distress by tying the knot with the patterns of communications and interaction, thereby creating a “Communication Environment” surrounding their physical and mental health. During the recent few decades focus has been on the new era of digital environment of communication which in turn has re-designed and restructured the “holistic” development i.e., the physical, mental, social and spiritual well- being of individuals affecting the younger generation as well as the older generation. Recent researches and interventions have extended the scope of family therapy and its possible association between digital communication and face-to-face social interaction – particularly an assumed relationship between family therapy and mental health. These lines of research on family therapy from Psychiatric Social Work perspective are expected to converge on a consistent model for understanding mental health of younger and older generation.
In this symposium five distinguished presenters will focus on different perspectives/ models of family therapy approach, skills and techniques and it's interrelation with mental health and well being. The presenters will also discuss the findings of their research which will include specific examples of evidence in favor of family therapy, which is the most essential and acceptable answer to the accelerating impact of digital communication and technological innovation.
| SYM97: Leveraging Primary Healthcare to Address Common Mental Disorders among Adults and Adolescents in Rural and Slum Area|| |
Pallab K Maulik*, Mercian Daniel*, Siddhardha Devarapalli*, Amanpreet Kaur, Sudha Kallakuri
A nationwide survey in India estimated the prevalence of depression, anxiety and substance use disorders to be around 10% among adults. Adolescents are equally vulnerable to common mental disorders (CMDs), which are leading causes of death, and disability in this group. In India, suicide is the third leading cause of death among adolescents. The treatment gap for CMDs in general is very high where majority of adolescent are left untreated and unidentified. These problems are particularly pronounced in rural and urban slum areas because of limited awareness as well as a lack of services and trained mental health professionals. Three speakers will present in the symposia different aspects of ongoing studies at The George Institute for Global Health, India that leverage existing govt. primary healthcare system in reducing the burden of CMDs especially among rural and slum populations:
(1) A cluster randomised controlled study (SMART Mental Health) among adults in 44 rural primary health centres and 106 villages in Haryana and Andhra Pradesh; Speaker – Mr. Siddhardha Devarapalli
(2) A cRCT (ARTEMIS) among adolescents in 40 block/ wards of urban slums of New Delhi and Hyderabad; - Speaker – Dr. Pallab K Maulik
(3) An ICMR sponsored study (ANUMATI) among adolescents in an urban slum each of Faridabad and Hyderabad Municipal Corporation.- Speaker- Dr. Mercian Daniel
| SYM98: Choosing Appropriate Anti-craving Pharmacotherapy for Alcohol and Opioid Use Disorder : A Psychopharmacological Approach|| |
Dr. Indranil Saha1 , Dr. Supartha Barua2 , Dr. Arijit Mondal3
1 Associate Professor, 2 Assistant Professor, 3 Senior Resident ; Department of Psychiatry, Institute of Psychiatry – A Centre of Excellence, IPGMER & SSKM Hospital, Kolkata.
Key words : Anti-craving pharmacotherapy, Alcohol, Opioid
Abstract : Substance abuse is a chronic disorder that results from a variety of genetic, psycho-social and environmental factors. Relapse prevention for alcohol and opioid dependence involves psychosocial and pharmacotherapeutic intervention with the goal of reduction of drug craving and avoiding compulsive drug intake.
The US FDA has so far approved three drugs – Disulfiram in 1951, Naltrexone in in 1994 and long acting naltrexone injection in 2006, acamprosate in 2004. Topiramate, gabapentin, ondansetron, baclofen, SSRI antidepressant are also used as anti-craving agent in alcohol dependence cases.
Opioid agonist therapies such as Buprenorphine and methadone can significantly reduce craving and relapse risk, and it is essential that patients are treated optimally with these therapies. Maintenance on the opiate antagonist Naltrexone is an alternative treatment. The goal is to block the effects of opioids, thereby discouraging opioid use and decreasing classically conditioned drug craving.
Choosing an appropriate anti-craving drug for relapse prevention depends on pattern of abuse, age of onset of abuse, comorbid personality and psychiatric morbidity, comorbid physical illness, cost and availability of the anti-craving agent, associated social support and monitoring of patients etc.
In this symposium, we are going to focus on the multiple factors contributing to selection of anti-craving pharmacotherapy and choosing the appropriate anti-craving agent.
Source of Support: None, Conflict of Interest: None