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 Table of Contents    
Year : 2020  |  Volume : 62  |  Issue : 7  |  Page : 23-29
Murugappan Award

Click here for correspondence address and email

Date of Web Publication14-Jan-2020

How to cite this article:
. Murugappan Award. Indian J Psychiatry 2020;62, Suppl S1:23-9

How to cite this URL:
. Murugappan Award. Indian J Psychiatry [serial online] 2020 [cited 2021 Mar 4];62, Suppl S1:23-9. Available from:

   Do the patients with Somatic Symptom Disorder attending mental health services and medicine services differ? Top

Chandrima Naskar*, Sandeep Grover*, Susanta Padhy#, Aman Sharma**

*Department of Psychiatry, **Department of Internal medicine, PGIMER, Chandigarh,

#Department of Psychiatry, AIIMS, Bhubaneswar

Aim:To compare the symptom profile, etiological model and pathways to care of patients with Somatic Symptoms Disorder (SSD) attending Psychiatric outpatient services versus Medicine outpatient services. Methodology: Patient of both groups were assessed on Somatic Symptom Scale (SOMS), Explanatory Model Interview Catalogue (EMIC) and WHO- Pathways to Care (WHO-PWC) instruments. Results: The study sample included 62 patients from Psychiatry outpatient services (OPD) and 41 patients from Medicine OPD. The mean age of participants of both the groups was around 41 years and more than half of the participants in both groups were females. Significantly higher proportion of patients attending the Medicine OPD was from rural background. Mean age of onset of those attending medicine OPD was significantly higher in comparison to those attending Psychiatry OPD, while, the duration of illness was significantly higher among the latter group. Significantly higher proportion of those attending Medicine OPD had symptoms of backache, joint ache, limb pain, pain on breathing, palpitation, atopy and per-vaginal whitish discharge; and demanded further investigations as well as newer medications. There was no significant difference in the explanatory models between the two groups except that those attending the Medicine OPD attributed their symptoms to prior illness and less often to stress. In terms of pathways to care, compared to those attending Medicine OPD, higher proportion of those attending Psychiatry OPD had sought help at home initially, whereas significantly lower proportion of those attending Medicine OPD did not seek any Psychiatric consultation throughout the duration of their illness.Conclusion: There are differences between the patients of SSD attending the Medicine and Psychiatric services in terms of locality, symptomatology, explanatory model and pathways to care. Hence both the population must be taken into account while designing any research or services for SSD.

   A Retrospective Analysis Of Psychopathology In Children And Adolescents With Refractory Epilepsy Before Epilepsy Surgery Top

Suraj Singh, Neena Sawant

Department of Psychiatry, Seth GSMedical College & KEM Hospital, Mumbai.

Aims & Objectives: Epilepsy being one of the most prevalent neurological diseases in children is associated with psychopathology and academic concerns. Epilepsy surgery is considered for refractory epilepsy at some centers in India and hence this study was undertaken to find out prevalence and type of psychopathology in children and adolescents with refractory epilepsy before epilepsy surgery.

Methodology: All data was analyzed from the records of patients undergoing pre- epilepsy surgery protocol workup in comprehensive centre of epilepsy care at a general municipal hospital in Mumbai. A record of 150 children and adolescents in the age group of – 18 over a period of 10 years was taken and all details of demographics, epilepsy and psychopathology were recorded.

Results: The mean age for our sample was 11.4years. The prevalence of psychopathology was 46% (n=70). We found behavioral disorders (n=25), intellectual disabilities (n=20), attention deficit hyperactive disorder (n=17). Complex partial seizure (n=59), generalized tonic clonic seizures (n=41) and myoclonus with GTCS (n=7) were the seizure types. 122 children were school going with 35 patients in primary, 77 in secondary and 10 in higher secondary schools.

Discussion: Similar findings were noted by other researchers, though a higher prevalence of psychiatric morbidity (83%) was seen. Autism spectrum disorders have also been reported though were not seen in our patients. Psychopathology can precede or follow the development of epilepsy and may occur due to common neuropathology, genetic predisposition, developmental disturbance, ictal or sub-ictal neurophysiologic effects.

Conclusions: Refractory seizures and associated psychopathology impact family life, friendships, and academics and worsen prognosis and quality of life. Screening for psychopathology in children with epilepsy would therefore lead to better outcomes especially prior to epilepsy surgery.

   A study on the sociodemographic and clinical profile of patients leaving against medical advice Top

Chayanika Choudhury, Shyamanta Das

Department Of Psychiatry, Gauhati Medical College


Leaving against medical advice (LAMA) is admitted patients choosing to leave the hospital before his/her treatment is complete or before the physician recommends. It requires evaluation to avoid a new revolving door phenomenon.


To study the sociodemographic and clinical profile of patients opting for LAMA.


Data was collected by a semi structured proforma from inpatients of Psychiatry department, GMCH from a period of April to September 2019. ICD-10 was used for diagnoses. Descriptive statistics was applied.


Out of the 523 patients admitted, 11.47% (60 patients) chose to leave against medical advice.

The frequency of LAMA was observed to be more in ages 21-30 years (43.33%), in males (78%) and in those with urban background (53%). 36.6% had passed high school and 26% were uneducated. 55% left within 1-4 days of admission.

The diagnosis distribution was- 33.3% in F10-F19, 30% in F20-F29, 20% in F30-F39 and 8% in F40-49. The patients leaving within 1-4 days of admission had diagnosis between F20-F29.

Reasons cited for LAMA were - 28% were 'Dissatisfied with the treatment', 15% cited 'Can't Specify', 12% had 'Family Issues', 12% had 'Financial Problems', 13% felt 'Improved' and 8% wanted to go to 'Higher centre', 5% to a 'Faith Healer' and 7% had 'Personal Reasons'.

F23 was the most common diagnosis for the shortest duration of stay with the cited reason 'Can't specify'.


Ashrafi E et al. 2017 reported 'personal problems' as the highest ranked amongst all reasons. Ghosh & Kurmi (2018) noted that most hailed from rural background and were females and had diagnosis between F40-F49.


The revolving door of LAMA and re hospitalization can be intervened by prior information about the diagnosis, nature of illness, management and treatment protocol which are corner stones of dealing with this problem.

   A Descriptive Study of Patients Suffering From Major Depressive Disorder Top

Crissen Kennedy Pereira

Introduction: Major Depressive Disorder being a major contributor of Disability adjusted life years (DALYs) among mental, neurological and substance use disorders. Studying the socio demographic and clinical characteristics of patients with MDD such as the family history, psychotic features will help to improve the medical and non-pharmacological management of patients suffering from MDD.

Methodology: Sample of 114 patients suffering from MDD from past medical records from outpatient department of ABC – Clinic for mood disorders and OCD of Asha hospital. Statistical measures like means and frequencies were applied.

Results: Out of 114 patients, 52.6% were females and 47.4% were males, mean age of presentation of sample was 36.9 years, mean duration of illness before presentation was around 6 years, comorbid Alcohol use disorder was found in 1.6 % of the sample,4.4% of the patients had psychotic features which consisted of persecutory delusions , positive family history was found in 50.9% of patients, presence or absence of family history did not affect age of onset or duration of illness or gender. 22 patients out of the 114 followed up with a mean duration of 5 years.

Conclusion: In this study presented, epidemiological parameters of MDD were studied, we have discussed the importance of looking for family history of psychiatric illness, presence of comorbid medical illness and substance use and psychotic features. All these socio demographic and clinical characteristics help us to treat and prognosticate MDD better.

   Prefrontal Cortical Activity In Children With ADHD: A Functional Near Infrared Spectroscopy (fNIRS) Study Top

Srinivas Rajkumar1, Rajesh Sagar2, Deepak KK3, Rachna Bhargava4, Bichitra Nanda Patra5

1Senior Resident, Department of Psychiatry and NDDTC

2 Professor, Child Guidance Clinic, Department of Psychiatry and NDDTC

3 Professor and Head of Department, Department of Physiology

4 Additional Professor, Department of Psychiatry and NDDTC

5 Associate Professor, Child Guidance Clinic, Department of Psychiatry and NDDT All India Institute of Medical Sciences (A.I.I.M.S), New Delhi


Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder with a prevalence of 6-8% in children. The real time task related activation data in brain regions can be acquired using functional Near-infrared spectroscopy (fNIRS).


The objective of the study was to examine and create a comprehensive clinical and neurocognitive profile of children with ADHD and matched controls then to correlate with prefrontal cortical activity as assessed by fNIRS.


15 children with drug naïve ADHD and 15 matched controls were interviewed according to semi structured performa, MINI-KID was used to screen for comorbidities. The cases fulfilled DSM 5 criteria of ADHD and were again subjected to Conner's Parent Rating Scale 3 – Revised (CPRS-3R) to ascertain type and severity of ADHD. Cases and controls were subjected to 16 channel fNIRS with software package for analysis during carefully designed working memory tasks (Stroop test, Visual and Verbal N-back (1 step and 2 step) tasks).

Results & Discussion:

Out of 15 cases of ADHD, majority belonged to combined type (n=11), the inattentive and the hyperactive/impulsive subtype were equally represented (n=2). Mean CPRS-3-R scores on Inattention was 80.67(SD=6.97), Hyperactivity was 87(SD=8.46), Learning Difficulty was 72.27(SD=12.17), Executive function was 72.97(SD=10.38), Aggression was 78.20(SD=15.9) and Peer Relation was 84(SD=11.14). There was a significant difference between cases and controls with cases performing poorly in measures of executive function like verbal two back (p=0.02), visual one back (p=0.04), visual two back (p=0.03). The comparison of functional imaging data obtained by using fNIRS on channel wise analysis showed evidence of hypofrontality and deficient recruitment of regions necessary for effective performance of tasks (p<0.01).


The finding from our study confirms working memory deficits in ADHD its relation to dysfunction in corresponding neurobiological substrate ie. prefrontal cortex.

Key words: fNIRS, ADHD, Executive Function

   ”When I Cannot Sleep...”: Lived Experiences of People Suffering From Chronic Insomnia – A Qualitative Perspective Top

Debanjan Banerjee, Anirudhha Basu

National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore


Insomnia, being an age-old problem can be multi-factorial, tends to be chronic and debilitating to the lives of the affected. Being highly subjective in its nature, understanding the experience of 'suffering from insomnia' can be vital in planning interventions for them.


To understand the perceived needs and lived experiences of people suffering from chronic insomnia


The study used qualitative design with constructivist paradigm. Participants were selected from patients who presented to our institute and were referred to various sleep centres/general hospitals and were diagnosed to have chronic insomnia there, through both clinical and objective measures. A purposive sampling of 20 patients was obtained. Data was collected using one-to-one in-depth semi-structured interviews and then thematic analysis done based on grounded theory approach. Super-saturation and respondent validation done to increase reliability.


The overarching theme for 'lived experiences' came out to be 'chronically depressed mood' with sub-themes of 'chronic worries and apprehension about sleep', 'monotonous lifestyle' and 'perceived treatment gap'. On the other hand, the main theme for 'perceived needs' was 'need to be looked at like genuine patients' with subthemes of 'need for a new schedule', 'need for talking out their problem' and 'need for multiple medications'. Over-medication by treating physicians and pre-occupation with 'sleep' were concerning problems.


The above results clearly lay out the unpleasant experiences in the daily lives of patients with chronic insomnia, which affects functioning. In routine clinical practice, these complaints are often ignored or which creates barriers for treatment. Patient-tailored interventions are thus highly needed to reduce this common source of distress.

   Clinical profiles of patients presenting with complaints of headache Top

Diptangshu Roychowdhury, Lakhan Kataria

Department of Psychiatry, Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth, Piparia, Vadodara.

Background: Headache being a common complaint amongst people visiting primary health care practitioners with different presentations, corresponds to a lifetime prevalence of 99%. Headache has been described in several studies, being the chief somatic presentation of depression in primary and general healthcare settings. By assessing the clinical profiles of patients presenting with headache, it would further provide a range of various associated comorbidities in psychiatry which are overlooked, contributing towards overall enhancement of neuro-psychiatry in India.

Aim: To assess the correlation between the clinical profile of headache with other psychiatric comorbidities and various socio-demographic factors.

Methods: Total 1392 participants were enrolled in the study with prior written informed consent. Consecutive patients were enrolled from Psychiatry OPD and IPD in Dhiraj Hospital, Vadodara. Participants were given to fill the case report form containing demographic details, questions related to their complaints of headache and evaluated with New Patient Headache Questionnaire.

Results & Discussions: Our study has shown a significant prevalence of Major Depressive Disorder amongst patients coming with complaint of headache, accounting to 73% of the total number. A major involvement of patients diagnosed with Major Depressive Disorder with anxious distress and amongst married persons, accounted to 40% and 70% respectively of the total patients. No significant differences between gender, schooling and educational status were observed.

Conclusion: Patients with complaints of headache are significantly associated with psychiatric comorbidities, especially Major Depressive Disorder with or without associated specifiers. No significant association was found between headache and gender or educational status. However, married patients were more prone towards development of headache. This study focusses on the varied components associated with headache, henceforth being beneficial in preventing further complications involving the underlying psychiatric comorbidities. This would further improvise the work efficacy, academic performances, occupational impairment, personal and social relationships.

Key words: Headache, psychiatric comorbidities, major depressive disorder, anxiety disorder

   Experience of Caregiving and Coping in Caregivers of Obsessive Compulsive Disorder Top

Erika Pahuja, Anil Nischal, Anuradha NIschal, Bandna Gupta, Adarsh Tripathi, Manu Agarwal

Department of Psychiatry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru


It is established that severe mental disorders like Obsessive Compulsive Disorder translate to a significant level of burden of care on caregivers. Whereas burden of care tends to represent only negative connotation, experience of caregiving represents both positive and negative appraisals of caregiving. Caregiving experience depends on various patient/caregiver related factors including coping strategies used by caregivers. Experience of Caregiving has been studied in disorders like Schizophrenia, Anorexia nervosa; however this area is unexplored for OCD. Hence, considering the burden associated with a family member having OCD we planned our study on the experience of caregiving and coping in caregivers of patients with OCD


To study the experience of caregiving and coping in caregivers of OCD and the association between them.


Sixty-seven caregivers of patients with OCD were assessed on Experience of Caregiving Inventory and Cope Inventory. Association of experience of caregiving and coping strategies with socio-demographic variables of caregivers and patients and clinical variables of patients was studied. Correlation of ECI with coping strategies was also assessed.

Result and Conclusions

'Dependency', 'Negative Symptoms' and 'Need to Back up' contributed maximally to negative appraisal of caregiving. 'Good Aspects of Relationship' and 'Positive Personal Experience' contributed to positive appraisal. Negative appraisal was higher in females, rural and illiterate caregivers and in caregivers of patients with severe OCD. Caregivers in our sample used a variety of coping strategies with socio-demographic differences. Use of Instrumental social support and Emotional social support correlated positively with negative appraisal; whereas use of progressive reinterpretation and growth, active coping and planning correlated positively with positive appraisal of caregiving.

The proposed poster intends to discuss the findings in further detail to enhance understanding of caregiver experience and coping and proposes ways to help caregivers deal with OCD of their love d ones.

   A Cross Sectional Study of Prevalence of Gaming Disorder and Correlation of self Esteem, Parenting Style, Perceived Stress and Sleep Quality With Gaming in College Students Top




The inclusion of gaming disorder in ICD-11 has resulted in increased awareness amongst health professionals regarding risks of developing this disorder and to formulate the relevant prevention measures. This study aims to know Prevalence of gaming disorder and correlation of Gaming with self esteem ,parenting style, Perceived stress and Sleep quality.

METHODOLOGY: Cross sectional study of 348 college students of various branches, 18-25 years of age, selected by Stratified Random Sampling were given questionnaires after Ethics approval, out of which 28 incomplete proformas were discarded. Those students who had positive gaming behaviour were further administered Internet Gaming disorder Scale- short form, Scale Of Parenting Style, Perceived Stress Scale-10, Rosenberg Self Esteem Scale, PSQI.


The Prevalence of Gaming disorder was 4.6%.Positive correlation was found between gaming behaviour and perceived stress( p=0.001), poor sleep quality (p=0.001)and time spent on gaming(p=0.001) and negative correlation with self esteem (p=0.02). Most common type of parenting style found was Authoritative type (around 86% of gamers).


People with gaming behaviour prioritise gaming over important activites and hence have trouble controlling time spent on games. People with poor self confidence consider success in gaming as a boost to their self esteem. For children who are socially isolated or living in a difficult family situation, stepping into a virtual world can provide a feeling of relief from stress of daily life. As people spend more time on gaming ,their sleep quality is poor.

CONCLUSION: Our study shows that gaming is related to low self esteem, high perceived stress, poor sleep quality and Authoritative parenting style. Hence early identification among students will help to formulate better preventive and treatment measures.

Keywords- gaming, parenting style, self esteem, perceived stress

   A cross-sectional study of levels of Anti TPO Antibodies in Rapid cycler bipolar affective disorder and its co-relation with total duration of illness and severity of episodes. Top

Himanshu Sharma, Chitra Singh, R.K Solanki

Dept. of Psychiatry, SMS medical college, Jaipur

Introduction-The interaction between genetic, environmental and psychosocial factors leads to the development of BPAD but exact cause is still unknown. The immune system is hypothesised to be linked to its pathophysiology and severity.

Aim and objective- To Quantify the levels of Anti TPO Antibodies in Rapid cycler bipolar disorder patients and its co-relation with total duration of illness (TDI) and severity of episodes .

Methodology- A cross-sectional & comparative study was conducted in the Department of Psychiatry , SMS Medical College & Hospitals, Jaipur. 24 patients of rapid cycler bipolar disorder( lithium naïve) were selected after taking informed consent and screened with inclusion and exclusion criteria. Severity of mania was assessed by young mania Rating scale (YMRS), severity of depression was assessed by Hamilton Depression Rating Scale(Ham-D).24 patients of non-rapid cycler bipolar affective disorder selected as control group by direct standardization. The blood sample was taken for levels of Anti TPO Antibodies of all the patients. Socio-demographic data and illness characteristic of all the patients were recorded.

Results & Discussion - In our study 16 out of 24(66.66%) patients had levels more than the normal range of AntiTPO Antibodies(odds ratio = 2.0 & relative risk = 0.5 ,compared with control group). Anti TPO antibodies levels when compared with TDI ,in case and control group, no correlation was found. A positive co-relation( P.Coef.=0.711, p=0.002) in between levels of AntiTPO Antibodies and YMRS score and no correlation (P. Coef.=0.443, p=.272) in between levels of AntiTPO Antibodies and HAM-D scores was observed.

Conclusion- The pathophysiology and severity in rapid cycler BPAD concludes more towards autoimmunity and needs further research and new management strategies.

   Study of social functioning and factors associated with it in patients with bipolar disorder in remission and its comparison with that of normal controls - a cross sectional study Top

Kumar Hemant Saurabh, Ajita S. Nayak

Department of Psychiatry, Seth GS Medical College and KEM Hospital, Mumbai


Background: Bipolar disorder is characterized by incomplete remission of notable proportion of symptoms, poor interpersonal relationships, and a marked influence on social functioning. There is less clarity regarding actual causes and predictors of such impairment due to dearth of adequate literature, and constraints in its measurement.

Aims: To study social functioning in patients with bipolar disorder in remission, to compare it with normal controls, and to study associated factors, namely insight, stress and illness variables.

Methodology: 50 Bipolar disorder patients in remission were taken as cases, and their social functioning, measured using the Social Functioning Scale (SFS), was compared with 50 normal controls. The SFS scores of cases were compared with respect to their Perceived Stress Scale (PSS) and Mood Disorders Insight Scale (MDIS) scores, and with illness variables. SPSS 17.0 was applied for statistical analysis. Data obtained were analysed using Unpaired -'t' and Pearson Correlation tests.

Results: The difference between mean SFS scores for cases and controls was statistically significant (p<0.0001). Negative correlation was obtained between mean SFS and PSS scores (r= -0.2665). Statistically significant positive correlation was obtained between mean SFS and mean total MDIS scores (r=0.2824, p=0.0469). Significant difference in social functioning for age at illness onset up to, and more than 30 years was obtained (p=0.0002).

Discussion: Significant gap exists between clinical remission and functionality in bipolar disorder, over 2 years follow-up. Interpersonal relationships, leisure, independence and work functioning are affected, leading to higher stress, defeatist beliefs and maladaptive coping. Insight might not return to premorbid levels and affects outcome. Illness-onset at an older age predicts functional impairment in patients with bipolar disorder.

Conclusions: Social functioning of bipolar disorder patients is significantly poorer compared to controls, even in remission. This impairment worsens with increase in their stress levels. Patients with better insight have better social functioning.

KEY WORDS: bipolar disorder, social functioning, remission.

   Does the treatment with clozapine lead to increase in the cost of illness in patient with treatment resistant schizophrenia? Top

Meha Verma, Sandeep Grover, Subho Chakrabarti

Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh

Background: Clozapine is the only recommended antipsychotic for management of treatment resistant schizophrenia. However, treatment with clozapine is associated with close monitoring of patients for various side effects and use of concomitant medications to manage the same. All these lead to more frequent visits to the hospital. However, little is understood about the impact of starting clozapine on cost of illness.

Aim of the study: To evaluate the cost of illness during the first 3 months of clozapine therapy and compare the same with the cost of illness, 3 months prior to starting clozapine.

Methodology: 52 patients of treatment resistant schizophrenia were evaluated for cost of illness (direct, indirect and provider's cost), by using a structured questionnaire, for the period 3 months prior to starting clozapine and then at the end of the 3 months of clozapine therapy.

Results: Total treatment cost for the period 3 months prior to starting clozapine was rupees 40,524 and the total treatment cost while on clozapine was rupees 40552 for the first 3 months of clozapine therapy. At both the assessments, indirect cost formed the main bulk of the total cost, with no significant difference in the indirect cost at both the assessments. The total direct treatment cost reduced from rupees 13931 to rupees 8756, and the difference between the 2 assessments was statistically different, with advantage for clozapine.

Conclusion: Treatment with clozapine is not associated with significant increase in the overall treatment cost, in the short term. However, there is significant reduction in the direct treatment cost.

Effect Of Emotional Intelligence Enhancement Intervention On Emotional Regulation In Children With Learning Disability Undergoing Remedial Therapy

Mrinmai Pevekar, Delnaz Palsetia, Alka. A. Subramanyam, Ravindra Kamath

Department of Psychiatry, T.N.M.C & B.Y.L Nair Hospital, Mumbai

Background: There has been an increasing focus these days on academic performance and its association with emotional intelligence. Emotional intelligence becomes important to manage self-emotions, emotions of others and regulating self-emotions in order to cope better with academic pressures. It may be even more important, especially when it comes to children suffering from learning disabilities.

Aims/ Objectives : To study the effect of Emotional Intelligence Enhancement Intervention on Emotional Regulation in Children with Specific Learning Disability undergoing Remedial Training.

Method : 30 consecutive participants whose parents gave written informed consent were chosen based on inclusion and exclusion criteria from our institute affiliated remedial center for Learning Disability of which 7 dropped out. Trait Emotional Intelligence Questionnaire – Adolescent Short Form (TEIQ – ASF) and Difficulty in Emotional Regulation scale (DERS) were applied after explaining study procedure. 6 sessions of intervention were conducted, one each week. After each session, feedback was taken for confirmation of learned skills. The scales were reapplied and data was compared.

Results: There was significant increase in scores of TEIQ – ASF (P = 0.004), and also the DERS scores showed significant reduction (P = 0.005) after the intervention. The following subscales of DERS showed significant reduction after intervention - non-acceptance of emotional responses (p=0.001), difficulties in goal directed behaviours (p=0.003), impulse control difficulties(p=0.024), limited access to emotional regulation strategies (p=0.023).

Discussion : Learning effective skills of emotional intelligence helps in emotional regulation in children with learning disabilities as indicated by increase in TEIQ – ASF and reduction in DERS scores. This in turn may result in better academic performance.

Conclusions: Enhancing emotional intelligence by teaching core components of emotional quotient helps deal with emotional problems faced by children of learning disability. Inclusion of emotional intelligence in academic curriculum especially for children with SLD may be considered .

   Obsessive Compulsive Disorder Following Acoustic Neuroma Excision- A Case Report Top

Porimita Chutia

Department of Psychiatry, Gauhati Medical College and Hospital, Guwahati, Assam.


Obsessive compulsive disorder (OCD) is a chronic mental illness. OCD secondary to cerebral lesions including traumatic brain injury, tumours, haemorrhages and infarcts in certain brain areas like temporal lobe, frontal lobes, basal ganglia and brainstem or pons is reported earlier.


A 37years old married Hindu male from Guwahati presented to psychiatry outpatient clinic of GMCH on 27th of March 2019 with a 4 days history of repetitive distressing thought of killing his daughter, palpitation, restlessness, increased worry and disturbed sleep. He tried to stop the thought but on failing to do so became very anxious and fearful that he may actually harm his daughter. Out of fear he collected all the sharp and blunt weapon available in his home and threw it to a trash and also started living alone in a room. On reviewing the history patient revealed that he had undergone a surgery four and half months back on (2.11.2018) for right sided grade 1 Acoustic Neuroma. The patient was diagnosed with OCD according to DSM-V criteria. He was treated with medications and he responded well to the treatment.


The model of diachisis can be applied in our case, as the tumour site is cerebello pontine angle, excision of this tumour may cause injury of the blood vessel leading to infarction and subsequently the involvement of remote areas. Several prior studies already reported the association secondary OCD symptoms with abnormalities in the temporal lobes.

   ”Sexual dysfunction in patients of smack (opioid) dependence and their relation with testosterone and prolactin level.” Top

Priyank Jain,Paramjeet Singh, Lalit Batra, Sunil Sharma, Mahipal Singh,Manish Kumar Goyal

Dept of Psychiatry, SMS Medical College, Jaipur.

Background- Men who chronically use opioids report an unexpectedly high prevalence of Sexual dysfunction (SD) at younger ages compared to the general population. Endogenous opioids play an important role in the physiological sexual functioning.

Aim – To assess plasma testosterone, prolactin level and sexual function in indian men of smack use disorder.

Methodology - This is the descriptive cross sectional study, conducted at OPD a tertiary care centre in Rajasthan. We collected sample for the period of one year from 1st July 2018 to 31st Jun 2019. Total 72 male patients of smack dependence evaluated using social demographics profile, plasma total testosterone (TT), prolactin levels and International Index of Erectile Function (IIEF- 15).

Result – In our study more than three-forth( 78%) patients having SD in smack dependence in atleast one domain of assessment scale (Erectile Function ,Orgasmic Function ,Sexual Desire ,Intercourse Satisfaction, overall Satisfaction) of IIEF-15. Significant lower mean value of testosterone (p = 0.016)was observed in SD group in smack dependence, while in mean prolactin level no significant difference was observed between SD and non SD group.

Conclusion – Results of this study shows that the possible mechanism of sexual dysfunction in patients of smack dependence is related to decreased testosterone level.

   Assessment of cognition in euthymic persons with bipolar disorder and healthy controls: correlation with quality of life and global functioning Top

Priyanka Hooda, Arvind Kumar

Department of Psychiatry, Centre of Excellence in Mental Health, ABVIMS & Dr RML Hospital, New Delhi

Aim: The study aimed to assess the cognition, quality of life (QOL) and global functioning in euthymic patients and healthy controls. It also assessed the correlation of cognition with QOL and global functioning of persons with bipolar disorder.

Methodology: In this cross-sectional study, we carried out assessment of 70 euthymic patients with bipolar disorder and compared them with 60 healthy controls. For assessment, trail making tests A & B were administered to assess cognition. Participants were also rated on World Health Organization QOL-BREF (Hindi version) and Global Assessment of Functioning scale to assess quality of life and functioning respectively.

Results: The patient and control group were comparable in their socio-demographic profile. Patients took significantly more time to complete TMT-A and TMT-B and, they had significantly lower scores in all domains of the WHOQOL-BREF and GAF scale when compared to controls; these differences had medium to large effect size. Physical, psychological and total domain score of WHOQOL-BREF and GAF scores had significant negative correlation with time taken on TMT-A (attention, psychomotor processing speed & visual scanning). On further analysis, number of depressive episodes and total no. of episodes had significantly negative correlation whereas, euthymic period had significantly positive correlation with the physical and psychological domains of WHOQOL-BREF and, the GAF scores.

Discussion: This is the second Indian study with a larger sample size, assessing and supporting the negative effects of poor cognitive performance on the QOL and functioning in bipolar disorder even during euthymic phase. Thus, targeting cognitive functions become an important area of research.

Conclusion: Cognitive impairments are an important consideration in bipolar disorder despite clinical remission. It needs to be addressed properly as it adversely affect their QOL, functioning and overall outcome.

   A Study of Cognitive Insight in First Episode Psychosis Top

Raj Rana, Anil Nischal, Bandna Gupta, Manu Agarwal

Department of Psychiatry, KGMU

Background: Lack of insight is an eminent feature of a psychotic illness. Better insight has been linked to a better overall outcome of the illness. Beck et al. in 2004 suggested that patients with psychosis have an impaired ability to scrutinize their own beliefs and experiences and question them and defined these capabilities as cognitive insight. They also proposed a scale to assess cognitive insight namely The Beck Cognitive Insight Scale.

Aims: To study Cognitive insight over a period of eight weeks in patients with First Episode Non-affective Psychosis.

Methodology: This is a follow-up case study of patients taken from Adult Psychiatry OPD, designated criteria according to the ICD-10 DCR. All the subjects enrolled in the study had given informed consent prior to inclusion in the study. Baseline assessment was done on the same day. The patients were followed on a 2week interval on each of which patients were re-assessed. Data was analysed using computerized software.

Results: 88 patients completed the study and the data for these was analysed. Significant improvement in cognitive insight was seen at every evaluation point and the values improved from -3.82 (SD±3.53) to 10.71 (SD±3.52). A significant change was seen at each successive evaluation.

Conclusion: Female patients had significantly more improvement in the cognitive insight than males. More improvement was seen in patients with a diagnosis of acute and transient psychotic disorder, when illness was of lesser duration at baseline and when a precipitating factor was present.

Comparative Prevalence of Common and Severe Mental Disorders at Mental Health Institute

K Rakesh Chander, N Manjunatha, C Naveen Kumar, Suresh Bada Math, YC Janardhan Reddy

Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India.

BACKGROUND: Common Mental Disorders (CMDs) includes Somatoform, Anxiety and Depressive disorders. Recent DALY report that depressive and anxiety disorders had jumped to 21st and 26th rank respectively over 26 years. Prevalence of CMDs at general population, primary care and general hospital 10.8%, 12-46% and 19-42% respectively. They are more prevalent among older women, associated with unemployment, lesser education and income. Such data on CMDs at speciality mental health institute is lacking.

AIMS: To compare the current prevalence of CMDs and SMDs and study the correlates of socio-clinical factors of CMDs at a specialty mental health institute.

METHODOLOGY: Total of 422 adult subjects selected through systematic random sampling at first contact psychiatry outpatient clinic and interviewed with Mini International Neuropsychiatric Interview Plus version-5.0.0, Clinical Global Impression-Severity Scale and Sheehan Disability Scale.

RESULTS: Prevalence of CMDS and SMDs are 29.3% and 35.2% respectively. Of CMDs, Depressive, Anxiety and Somatization Disorders are 17.3%, 12.8% and 5% respectively. CMDs are found more among married population in urban areas who continued working despite illness. Depressive Disorders are more prevalent among married women from urban, lower and middle socio-economic status with 85% having 7days/week unproductive at work. Anxiety Disorders are more among urban males from middle SES. Somatization Disorderaremore common among married women with <5 years of education.

DISCUSSION: Nearly one-third have CMDs at mental hospital with just above one-third having SMDs. CMDs continue to work in-spite having illness leading to poor work productivity thereby higher economic burden and poor quality of life. CONCLUSION: It is the first study on prevalence of CMDs at speciality mental health institute. In comparison with SMDs, the prevalence of CMDs is also high and comparable with primary care and general hospital. The study also suggest the need of similar or even higher clinical and research attention on CMDs.

Key words: Common mental disorders, prevalence, mental health institute, India.

   Recovery Model of children and adolescents with obsessive-compulsive disorder: a qualitative study Top

Lakshmi Sravanti, John Vijay Sagar Kommu

Department of Child & Adolescent Psychiatry, NIMHANS, Bengaluru.

BACKGROUND: Qualitative data on the phenomenon of obsessive-compulsive disorder (OCD) is limited. To the best of our knowledge there is only one published study that explored lived experiences of children with OCD.1Studying first-hand experiences of this sub-group will improve our understanding of their subjective perceptions and help in devising a plan for providing holistic care.

AIMS & OBJECTIVES: To comprehensively analyze the meaning of recovery for children living with OCD and design a recovery model that can help in connecting with these children in the process of treatment.

METHODOLOGY: It is a qualitative study of ten children and adolescents. The transcribed interviews were analyzed by using Interpretative Phenomenological Analysis.

RESULTS: Children have identified six key areas of recovery. These areas identified by inductive analysis form the components of recovery model represented by the acronym SMILES, which stands for Sense of self, Mental Health, Institution of school, Lifestyle, Extracurricular and Social.

DISCUSSION: Recovery models such as WHO-CBR MATRIX,2 and Recovery Star,3 have been described in literature. We present two ways to present our model depending on child's level of understanding and preference – Rainbow Recovery and Blooming Recovery.

CONCLUSION: We are expecting that our models can inform clinical practices by connecting with these children in providing holistic care.

   A Retrospective Analysis Of Psychopathology In Children And Adolescents With Refractory Epilepsy Before Epilepsy Surgery Top

Suraj Singh, Neena Sawant

Department of Psychiatry, Seth G S Medical College & KEM Hospital, Mumbai.

Aims & Objectives: Epilepsy being one of the most prevalent neurological diseases in children is associated with psychopathology and academic concerns. Epilepsy surgery is considered for refractory epilepsy at some centers in India and hence this study was undertaken to find out prevalence and type of psychopathology in children and adolescents with refractory epilepsy before epilepsy surgery.

Methodology: All data was analyzed from the records of patients undergoing pre- epilepsy surgery protocol workup in comprehensive centre of epilepsy care at a general municipal hospital in Mumbai. A record of 150 children and adolescents in the age group of – 18 over a period of 10 years was taken and all details of demographics, epilepsy and psychopathology were recorded.

Results: The mean age for our sample was 11.4years. The prevalence of psychopathology was 46% (n=70). We found behavioral disorders (n=25), intellectual disabilities (n=20), attention deficit hyperactive disorder (n=17). Complex partial seizure (n=59), generalized tonic clonic seizures (n=41) and myoclonus with GTCS (n=7) were the seizure types. 122 children were school going with 35 patients in primary, 77 in secondary and 10 in higher secondary schools.

Discussion: Similar findings were noted by other researchers, though a higher prevalence of psychiatric morbidity (83%) was seen. Autism spectrum disorders have also been reported though were not seen in our patients. Psychopathology can precede or follow the development of epilepsy and may occur due to common neuropathology, genetic predisposition, developmental disturbance, ictal or sub-ictal neurophysiologic effects.

Conclusions: Refractory seizures and associated psychopathology impact family life, friendships, and academics and worsen prognosis and quality of life. Screening for psychopathology in children with epilepsy would therefore lead to better outcomes especially prior to epilepsy surgery.

   Can Reward Hypersensitivity Be a Marker of Bipolar Vulnerability ? - An Event Related Potential Study Top

Velprashanth Venkatesan, Christoday R.J.Khes, .K.K.Kshitiz

Department of Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi.


There is a need to predict bipolar episodes in vulnerable individuals. Remitted patients show motivational disturbances as enhanced sensitivity to reward which is marked by Evoked Potentials.


To study the behavioural and electrophysiological correlates of motivational cues in remitted Bipolar patients and their unaffected first degree relatives and compare them with healthy controls.

Materials and Methods

An originally designed 'Motivational Task' presented using E-PRIME 2 software was used. Arousing picture cues of Rewarding, Punishing and Neutral categories as Looming/Non-Looming cues was presented with a reaction time task while ERPs were recorded. The task was designed to assess Late Positive Potential(LPP) and Error Related Negativity (ERN) component and their relationship with Behavioural Inhibition/Activation systems (BIS/BAS). SPSS- 25.0 was used to analyse.


30 Bipolar subjects, their First degree relatives (FDR) and 30 controls adequately matched were chosen. Sensitivity to reward was significantly elevated among Bipolar and FDR in a pattern suggestive of endophenotype. Correlation between ERP and BIS/BAS scale variables was analysed. Significant positive correlation between Left Central LPP amplitude, Midline Anterior ERN amplitude and Behavioural Inhibition(BIS) was revealed. Subjects scoring higher on Behavioural Activation(BAS) showed smaller ERN amplitudes.


Remitted Bipolar subjects had elevated LPP amplitudes even for neutral cues reflecting a heightened vigilance. They displayed preferential allocation of motivated attention to more arousing cues. In comparison, ERN was significantly smaller for Bipolar group reflecting a measurable High BAS/Low BIS trait.


Reliable measurement of LPP and ERN in Bipolarity revealed a predisposition suggestive of enhanced reward sensitivity that can be marked even during euthymia but no pattern suggestive of measurable emotional endophenotype was found. Reward hypersensitivity paradigms of ERP can be explored to create cost effective biological markers of bipolarity.

Key Words : Late Positive Potential, Bipolar Endophenotype, Error Related Negativity.

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