Year : 2007  |  Volume : 49  |  Issue : 5  |  Page : 1--60

Abstracts of 59th Annual National Conference of Indian Psychiatric Society

Indian Psychiatric Society 

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Indian Psychiatric Society

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Indian Psychiatric Society. Abstracts of 59th Annual National Conference of Indian Psychiatric Society.Indian J Psychiatry 2007;49:1-60

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Indian Psychiatric Society. Abstracts of 59th Annual National Conference of Indian Psychiatric Society. Indian J Psychiatry [serial online] 2007 [cited 2021 Oct 22 ];49:1-60
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 Award sessions

Col. Kirpal Singh Award

Paper 1:

Correlation of regional cerebral blood flow and neuropsychological impairment in depression: Kaustubh Ashok Joag, Surg. Cdr. Sunil Goyal, Surg Cdr. B.S. Gill.

Paper 2:

Study of deliberate self harm among serving personnel in counter insurgency operations area. Lt. Col. P.S. Bhat, Lt. Col. J. Gambhir.

Marfatia Award

Paper 1:

Serum Serotonin abnormality in depression - an insight into clinical correlates and effects of treatment: Col. D. Saldanha. A. A. Pawar. Kalpana Srivastava.

Paper 2:

T2 relaxometry of brain regions following Electro Convulsive Therapy: Girish K Jayakumar P.N., Janakiramiah N., Gangadhar B.N.

Paper 3:

Treatment related decision making capacity in psychotic inpatients. Zindadil Gandhi, G.K. Vankar.

Paper 4:

Mental health morbidity and service needs in Tsuanami affected population in coastal Tamilnadu: Nambi. S, Desai N. G,

Shah B.

Paper 5:

BIS IIA - Hindi version and preliminary study of impulsivity in rural and urban Indian adolescents: Singh P.J, Bhatnagar P.S, Solanki R.K.

Paper 6:

Creativity and mental health: A profile of writers and musicians: Pavithra K.S, Chandrashekar C.R, Partha Chaudhari.

Bombay Psychiatry Society Silver Jubilee Award

Paper 1:

An open label comparison of aripiprazole versus haloperidol for the treatment of childhood and adolescent psychotic disorders: Monideepa Banerjee, D. Ram, Anindya Das.

Paper 2:

Do antipsychotics limit disability in schizophrenia? A naturalistic comparative study in the community: Jagadisha T., Venkatesh B.K, Naveen M.

Paper 3:

PTSD in children and adolescents - four years after the communal violence: G.K. Vankar, Girish Banwari, Viral Parikh, Hemang Shah.

Bhagawat Award

Paper 1:

Body appearance, weight pre occupations and eating habits - gender differences in medical students: Tushila Mayanil, Biswarup Ghosh.

Paper 2:

Primary care psychiatric service: effectiveness IRMC model involving multipurpose health Workers at Namkhana Block, Sunderban, India. Arabinda Bramha.

Paper 3:

Social phobia and its impact on the youth: Parag S. Shah, Lakhan R Kataria.

Paper 4:

Neuro anatomical correlates of psychopathology in antipsychotic naοve Schizophrenia: G. Venkatasubramanian.

Paper 5:

A study of the clinical course of development of alcohol and opioid dependence in India: Baxi Neeraj Prasad Sinha, Saddichha Sahoo, Manjunatha N.


Paper 1: Correlation between regional cerebral blood flow and neuropsychological impairment in depression

Kaustubh Ashok Joag, Surg Cdr Sunil Goyal, Surg Cdr B. S. Gill

Dept. of Psychiatry, Dept of Nuclear Medicine INHS Asvini, Mumbai, India

Paper 2: Study of deliberate self harm among serving personnel in counter insurgency operations area

Lt. Col P.S. Bhat, Lt. Col. J. Gambhir

Background: Soldier serving in counter insurgency operational area are subjected to a significant higher level of physical and mental stress, sometimes leading them to commit Self Harm. The aim of this study is to evaluate the individual and socio occupational risks factors for such behavior.

Methods: Twenty six serving personnel admitted with Deliberate Self Harm to a forward Zonal hospital located in Counterinsurgency Operations area during two years were evaluated in detail by clinical interview and relevant psychometric rating scales.

Results: Majority of cases were from Infantry (54%) were less than 35 years of age (81%) and married (65%), Domestic (62%) and marital (35%) stressors were more common; gunshot wound (54%) was the commonest method. Psychometry revealed that exposure to high level of stress in the last one year in majority (85%) and nearly half had severe suicide intent (35%).

Conclusion: Domestic and marital sphere problems act as significant stressors more than the occupational stressors. Exposure to high - level of stress in the year before the act was common and hence there is a need to implement more stress management measures. In view of high suicide intent score in many of them, immediate psychiatric intervention is recommended in all such cases.


Paper 1: Serum serotonin abnormality in depression: An insight into clinical correlates and effects of treatment

D. Saldanha. A. A. Pawar. Kalpana Srivastava

Background: Serotonin has been implicated playing an important role in treatment of depression.

Aim: To evaluate correlates of plasma serotonin levels in depressed patients before and after the treatment.

Methods: Sample for the study comprised of 40 patients diagnosed on ICD - 10 diagnostic criteria, and an equal number of healthy matched controls. Subjects were evaluated on Beck's depression Inventory (BDI), Beck's Hopelessness Scale (HOP) and on suicide ideation scale (SIS), before and after the treatment. 5 ml of blood were collected from all the cases and controls before starting the antidepressant medication with SSRIs in adequate doses. Serum serotonin levels were then calculated by ELISA Nanotechnology method twice, before and after treatment.

Results : Significant differences in scores before and after the intervention on BDI, HOP Scale, Suicide Intention Scale and serotonin levels of cases and controls (PConclusion : Treatment with SSRIs has shown significant changes in clinical conditions. However these changes were not related significantly with serum serotonin levels.

Paper 2: T2 relaxometry of brain regions following electro convulsive therapy

K. Girish, P. N. Jayakumar, N. Janakiramiah, B. N. Gangadhar

Background : Although ECT causes no structural brain damage, recent studies reported altered brain perfusion acutely following ECT. This is in keeping with brain oedema which was noted in animal experiments following electroconvulsive shock.

Aim : This study examined alteration in magnetic resonance imaging (MRI) T2 relaxation time, a measure of brain oedema and its relation to therapeutic efficacy, orientation, and memory impairment with ECT.

Methods: Fifteen drug naοve consenting patients of major depressive disorder with melancholia (DSM - IV) received ECT as first line treatment. MRI scans were done before the first ECT and at medial temporal lobes and dorsolateral frontal cortex by a blind rater.

Results : Depression scores and memory scores were reduced significantly both after the second and fifth ECT. There was no change in T2 relaxation time after second ECT.

Conclusion : The finding suggests that ECT does not produce demonstrable change acutely in brain parenchyma detectable by T2 relaxometry, MRI scans.

Paper 3: Treatment related decision making capacity in psychotic inpatients

Zindadil Gandhi, G. K. Vankar*

Little research has been done in India in the field of determinants of mental capacity. A large number of patients are admitted against their will in psychiatric settings and are declared incapacitated to take treatment related decisions. Psychotic patients are considered to have lack of mental capacity and they outnumber the patients with other disorders in involuntary admission. In this cross sectional study total 63 patients were interviewed and it was found that around 64% of patients had lack of capacity. Lack of capacity was associated with level of education, lack of employment and thus less family income, and high score on brief psychiatric rating scale (BPRS) (Overall, 1968) and low scores on MMSE (Mini Mental State Examination) (Folstien 1969) and SAT - F (David, 1992). Around 62% of patients were admitted involuntarily. 23% of patients who were involuntarily admitted had capacity present at the time of interview and 41% of patients who were voluntarily admitted had a lack of capacity. Discrepancies in the presence or absence of capacity and type of admission suggest that a comprehensive method to judge capacity should be applied which assess the patient for multiple components.

Paper 4: Mental health morbidity and service needs in tsuanami affected population in coastal Tamilnadu

S. Nambi, N. G. Desai, B. Shah

The field of disaster and mental health has been rapidly evolving, due to the frequent disaster of different magnitude. The Indian studies have been progressing from clinic based studies to epidemiology to epidemiology with anthropodogical methods of qualitative research. The short term mental health morbidity and service needs of the Tsunami affected population in coastal Tamilnadu were studied as part of a larger study on mental health aspects at four research sties in costal Tamilnadu, Combining epidemiological techniques and Qualitative Research Methods (QRM). Two stage epidemiology, using GHQ-12 and scan based clinical interviews, was carried out on a representative adult population, along with 80 In depth Interviews, 28 key informant Interviews and 28 Focused Group Discussions (FGDs). The prevalence rate for psychiatric disorders was found to be 272/1,000 (27.2%) and for psychological symptoms was found to be 79.7/1,000 (79.7%) at 6 th and 9 th month following the disaster. The commonest psychiatric disorder was depression, followed by alcohol use disorders in males and anxiety disorders in females. The rate of PTSD 12.5/1,000 was found to be lower than expected. These findings were complemented by QRM findings of similar nature, with the clear indication of community perception that the psychological symptoms get taken care of by the informal social mechanism and counselors working with NGOs and that the specialist psychiatric services are required for a smaller proportion of populations. The study carried out in collaboration with the state mental health programme, has helped in focusing and enhancing the activities of the National Mental Health Programme (NMHP) in the state of Tamilnadu.

Paper 5: Bis Iia 0 - Hindi version and preliminary study of impulsivity in rural and urban Indian adolescents

P. J. Singh, P. S. Bhatnagar, R. K. Solanki

India has a large population base of approximately one billion. No behavioral instrument is available to access impulsivity in adolescents, The present work focused on developing adolescent Hindi version of BIS - 11. First translation of 818-11 (as it is meant for adults) and cultural substitution resulted in Hindi adult version. Adolescent version was derived from adult version by replacing adult activities with adolescent activities. T - test (two tailed) showed no significant difference in rural and urban adolescent - There were no gender differences. As impulsivity can lead to suicide and is implicated in disorders like Schizophrenia for substance abuse, it is important that culturally sensitive impulsivity studies are done in India on a large scale keeping in view the large size of population. Standardization of the BIS 11 - A Hindi version is being taken up.

Introduction : There is no behavioral instrument in India to gauge the impulsivity in adolescents and no earlier studies have been done in India to access impulsivity in adolescents. Even in western countries, no study has been done in rural setting to access impulsivity, although segment of rural population is small in western nations with major population residing in urban areas.

There are a number of instances in day-to-day life when happenings due to impulsivity come to notice such as persons committing suicide after examination results or jumping in front of a running train to die. Impulsivity and sensation seeking are involved in a wide spectrum of psychopathological and social challenges; which are a part of impulse control disorders. The significance of managing impulsivity can be gauged from the answers given by inmates who committed acts of aggression in prison despite of knowing that outcomes will not be desirable as they will be moved to less desirable living conditions and are less likely to be considered for parole. The inmates answered that "we can't help it, we just do it" (Barratt, et al., 1977).

Paper 6: Creativity and mental health: A profile of writers and Musicians

K. S. Pavithra, C. R. Chandrashekar, Partha Chaudhari

Creativity and its link with mental health have always been much speculated about. However, there have been a handful of method-ologically sound studies to clearly establish the relationship between creativity and mental health.

The objective of the study therefore was to examine the psychiatric morbidity stress profile, coping skills, and personality profile in creative versus non-creative populations. Forty writers, 40 musicians and 40 controls chosen after randomization, who met the inclusion and exclusion criteria constituted the sample of the study.

All the subjects were administered GHQ-28; SCAN for all GHQ positives (and 10% of GHQ-ves), Perceived Stress Scale and Coping Check List and NEO -FFI. Statistical analysis was done using SPSS 11.0 version. Pearson's correlation, chi-square and ANOVA one - way tests were used.

The present study corroborated the findings of earlier studies in 70's and 80's that there was no difference between creative and non-creative groups in terms of mental illness, and stress profile. The writers differed significantly from the other two groups on religious and faith domain of coping skills. The two creative groups had similar personality characteristics and scored significantly high on all dimensions compared to the non creative group.

The limitations of the study were the lack of proper adoption of two of the instruments (PSS and NEO - FFI) in our population, small sample size, not using a creativity scale and studying only two creative groups.

There is a need in future to carry out large epidemiological studies which will further our understanding in future.


Paper 1: An open label comparison of aripiprazole versus haloperidol for the treatment of childhood and adolescent psychotic disorders

Monideepa Banerjee, D. Ram, Anindya Das

Background : Aripiprazole is a novel antipsychotic with established efficacy in psychotic disorders in adults but with limited evidence of use in pediatric patients.

Aim : The purpose of this study was to compare the efficacy and safety of aripiprazole monotherapy with haloperiodol for schizophrenia and related psychotic disorders in children and adolescents.

Methods : Total 30 patients with ICD-10 DCR diagnoses of schizophrenia and acute transient psychotic disorders, were assigned to receive either aripiprazole (10-15 mg/day) or haloperidol (10-15 mg/day) for four weeks, with each group containing 15 patients respectively. Primary outcome measure was Positive and Negative Syndrome Scale for Schizophrenia (PANSS) while secondary out come measures were three PANSS subscales and Clinical Global Impressions - Severity of illness (CGI-S). Assessments were done at baseline and then on weekly by Simpson - Angus Scale and Bars Akathisia Scale.

Results : Endpoint improvement for the aripiprazole group was not significantly different from haloperidol group on PANSS total score, as well as PANSS positive and negative subscale scores. However, haloperidol produced significantly greater improvement in PANSS general psychopathology subscale score and CGI-S score at endpoint, compared to aripiprazole. Again, aripiprazole produced significantly less extra pyramidal side effects and weight gain than haloperidol.

Conclusion : This trial shows that aripiprazole therapy was as efficacious as haloperidol in improving both positive and negative symptoms of schizophrenia and related psychotic disorders in children and adolescents but demonstrated better tolerability. Given the limitations of the study design, futher double blind placebo - controlled trials are warranted.

Paper 2: Do antipsychotics limit disability in schizophrenia? A naturalistic comparative study in the community

T. Jagadisha, B. K. Venkatesh, M. M. Naveen, G. Venkatasubramanian, U. Arunachala, K. V. Kishore Kumar, B. N. Gangadhar

Background : Though anti psychotics are effective against symptoms of schizophrenia and prevent relapse, their effect on disability has not been studied in a comparative design.

Aim : To compare disability of schizophrenia patients receiving continuous antipsychotic treatment with that of those not receiving antipsychotic treatment or receiving irregular treatment in a rural community setting using a naturalistic comparative study design.

Method : Disability was assessed in 182 schizophrenia patients living in Thirthahalli taluk of Shimoga, district, Karnataka. A using Indian Disability Assessment and Evaluation Scale (IDEAS). Fifty patients (27.5%) were receiving regular treatment in the previous two years and their disability was assessed for the period when they were on antipsychotics. The rest 132 patients (72.5%) had periods off antipsychotics in the previous two years and their disability was assessed for the period when they were off antipsychotics.

Results : Patients on antipsychotics had significantly less disability across all domains of disability and in total IDEAS scores. Multivariate regression analysis showed that treatment status predicted disability scores after controlling for the effects of the confounding factors; Different levels of exposure to antipsychotic treatment were associated with different levels of disability.

Conclusion : Treatment with antipsychotics is associated with significantly less disability. There is urgent need to bring schizophrenia patients under the umbrella of treatment.

Paper 3: PTSD in children and adolescents: Four years after the communal violence

G. K. Vankar, Girish Banwari, Viral Parikh, Hemang Shah

Introduction : PTSD is a common psychiatric sequel among children and adolescents after exposure to extreme stressors.

Methods : Children and adolescents who had lost one of their parents in communal violence in 2002 were evaluated in 2006 i.e. four years after the event for PTSD. UCLA Index for PTSD (Rodriguez 1998) I was used to screen for PTSD.

Results : Out of 255 subjects studied, 10 had PTSD (3.9%), 2 had PTSD co morbid with major depression (0.8%), and 12 had major depression (4.7%). 40 had partial PTSD (15.7%) and 10 had MDD co-morbid with partial PTSD (3.9%). Thus 12 (4.7%) had PTSD 4 yeas post - trauma. PTSD was associated with age older than 12 and residence in Ahmedabad (the worst affected city). PTSD was not associated with gender, religious affiliation, change of residence, income or education.

Implications: PTSD occurred in about 4.7% children and adolescents even after 4 years of exposure to communal violence. Major depression was present in 9.4% children and adolescents. This emphasizes need for assessment and treatment of these disorders in child and adolescent population exposed to trauma.


Paper 1: Body appearance, weight pre-occupations and eating habits: Gender differences in medical students

Tushila Mayanil, Biswarup Ghosh

Paper 2: Primary care psychiatric service: Effectiveness irmc model involving multipurpose health workers at Namkhana block, Sunderban, India

Arabinda Bramha

Objective: Assessing the ability of the trained Multi-Purpose Health Workers (MPHWs) to identify cases of psychiatric illnesses and recognize other psychosocial problems of clinical interest (e.g., domestic violence, non-fatal deliberate self - harm, alcohol dependence) in the Sundarban region, India, as a component of community based primary care psychiatric service.

Methods : Brief mental health orientation training was given to MPHWs using IRMC model to identify cases of common mental illnesses and other psychosocial problems of clinical interest from the four villages of Namkhana block and subsequent referral of those cases to community psychiatric clinic.

Results : MPHWs identified and referred 294 cases from the community during household visits with slight … preponderance over male. MPHWs identified 48.5% cases having psychiatric illnesses, which fulfilled different clinical diagnosis according to ICD - 10 criteria. They showed excellent performance in identifying Mental retardation (learning disability) and Epilepsy. Some interesting clinico - demographic finding were revealed from the cases detected with domestic violence and non-fatal deliberate self-harm (DSH) attempts.

Conclusion : In most developing countries including India, organized mental health service is minimal at the primary care. Utilization of the community level and local resources (e.g. MPHWs) with brief mental health orientation training may be of value for an effective community mental health service development.

Paper 3: Social phobia and its impact in youth

Parag S. Shah, Lakhan R. Kataria

Dept. of Psychiatry, Medical College & SSG Hospital, Baroda, India

Social Phobia even though being a common psychiatric disorder is still underrecognized and undertreated, with a great impact on quality of life and making a person disabled in various areas of functioning. Present study looks for prevalence, severity, disability and quality of life with respect of social phobia in 380 undergraduate students of various faculties of M.S. University of Baroda. Prevalence of social phobia was 19.5%, varied degrees of severity and resulted into significant disability in work, social life and family life as well as impairment in quality of life. Commonly feared / avoided situations were identified. Impairment in functioning in academic, social and interpersonal areas due to social phobia was also reported.

Paper 4: Neuro anatomical correlates of psychopathology in antipsychotic naοve schizophrenia

Ganesan Venkatasubramanian

Dept. of Psychiatry, NIMHANS, Bangalore - 560029, India

Background : Previous magnetic resonance imaging (MRI) studies using manual techniques reporting significant relationship between psycho pathology and gray matter volume in schizophrenia were limited by various confounding factors. None used automated image analysis to examine gray matter volume correlation of psycho pathology in antipsychotic naοve schizophrenia patients.

Aim : This study aimed at examining the relationship between psychopathology and gray matter volume abnormalities in antipsychotic - naοve schizophrenia patients.

Methods : MRI of 30 antipsychotic - naοve schizophrenia (DSM IV) patients and 27 age, sex, education and handedness matched healthy controls were compared for gray matter volume differences using Optimized Voxel - Based Morphometry (VBM) - an automated, rapid and unbiased technique. Psychopathology was measured using Positive and Negative syndrome scale (PANSS) with good inter - rater reliability. The correlations between PANSS scores and gray matter volume were examined using VBM.

Results : Schizophrenia patients had significant gray matter volume deficits in frontal, cingulate, temporal, insular and precuneus cortices, thalamus, caudate and cerebellum. Positive syndrome score had significant negative correlation with left superior temporal gyrus volume. Negative syndrome score had significant inverse correlation with frontal, cingulated and cerebellar gray matter volumes.

Conclusions : Cortical and cerebellar gray matter volume deficits and their significant negative correlations with psychopathology scores and supportive of "Cognitive Dysmetria" in schizophrenia.

Paper 5: A study of the clinical course of development of alcohol and opioid dependence in India

Baxi Neeraj Prasad Sinha, Saddichha Sahoo, N. Manjunatha

Background : The prevalence of alcohol use in Indian Society is high, still it is considered socially acceptable to the extent that it has not been included in the Narcotic Drugs and Psychotropic Substances (NDPS) Act, 1985 unlike opium.

Aim : To compare the clinical course of development of alcohol and opioid dependence.

Methods : Consecutively admitted persons in Centre for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, India with ICD - 10 (DCR) diagnosis of alcohol or opioid dependence syndrome were recruited for the study after written informed consent and approval from ethical committee for the study. They were then administered the relevant section of SSAGA - II.

Results : Total sample size was 112.81(72%) were alcohol dependent and 31(28%) were opioid dependent. Subjects with opioid dependence had significantly significant (P=0.05) lower ages of onset - 20.73 (± 3.93) of substance use as compared to alcohol dependents -18.72 (± 6.84) and a significantly (PConclusion : The lower age of onset of alcohol use and rapid development of alcohol dependence once the first criterion appears calls for a debate on legal measures to stop further alcohol use. The rapid progression of development of dependence from onset of use in opioid dependents prompts the delineation of factors for primary and secondary prevention during the window period.


Paper 1: NHS experience and training in relation to the Indian context

Rajkumar, M. Marudkar, A. Rathore

Introduction : The new NHS is still a free service for all people living in UK and lays an emphasis on cost effective, safe and innovative healthcare. This includes the ongoing training for the healthcare workforce. Mental health receives a high priority and this symposium intends to look at how this may be relevant to Indian psychiatric services. The speakers are to talk on the various aspects of psychiatric healthcare delivery from the point of view of service delivery and training.

General Adult Psychiatry: The services are part of the NHS and caters to the population of ages between 16 and 65 and patients beyond the age who are already being served.

It is a team culture with consultant being a team facilitator. The team in the community consists of a consultant, community psychiatric nurses, social workers, occupational therapists. Services are inpatient and out patient. Emphasis is on the community based treatment. The specialized services are the treatment and recovery, assertive out reach and crisis home treatment services and psychotherapy and counseling services. Description of the services and relevance to Indian context is detailed.

Old Age Psychiatry and MRCPsych training: Services for dementia and management of functional psychiatric disorders in the elderly go beyond prescribing medication and initially involve a range of psychosocial approaches. The issues associated with the later stages of illness, respite and terminal care are within the remits of responsibility of the old age psychiatrists.

Psychiatry of Mental Retardation and Collaborative work with the Royal College of Psychiatry: Services for psychiatry of mental retardation are well established in the UK and are gaining more ground in North America and Australia. There is a need for increased awareness of assessment and management of mental illness within the population with mental retardation especially in relation to dealing with autistic spectrum disorder. A number of links have already been established with centers in India in providing training opportunities for Post-graduates in psychiatry and also other allied healthcare professionals.

Child and adolescent psychiatry (CAMHS) and applying NHS experience to the Indian context: The CAMHS services deal with the similar problems dealt with in India with the exception of Mental Retardation. The areas that will be covered include parents groups, psycho-education, compliance issues, improving self-esteem and confidence building, monitoring of mental health and liaison with other professionals. The management approaches include group work, CBT, solution focused therapy, parental management advice, bereavement work, supportive counseling (clinic and school based) etc.

Future collaboration can be on exchange of views, training teaching, online discussions, telemedicine, exchange programmes and learning from each other.

Paper 2: The importance of psychotherapy in the era of pharmacotherapy

Roy Abraham Kallivayalil, Sudhir Bhave, Rakesh Chadda, Mrugesh Vaishnav, Varghese P. Punnosse

Our clinical practice should consider patient's experiences and try not to invalidate them. Many times, our treatment might make the patient worse than before. In such instances, increasing the medication or adding new drug are the options we generally consider. This is often done without carefully listening to the patient, as many of us are extremely busy. We are tempted to believe, drugs are the remedy for all human sorrows and difficulties. We know, a drug which is curative for one may be dangerous for another. Hence over reliance on medication can be extremely harmful.

Another happening is that company representatives are penetrating into patient groups. This has already happened in the West and is probably happening in India. The question asked by such patient group is, should patients be denied the latest and most effective treatment just because the drugs are costly? One can easily see the powerful marketing strategies for newer drugs. But new evidence is now emerging, patients might do equally well, even marginally better with older antipsychotics as well.

In summary, we may state that drug treatment along-despite the vast advances in Psychopharmacology - still remains unsatisfactory. Psychiatry is a bio psychosocial speciality. We have to consider biological, psychological and socio-culture aspects in diagnosis and treatment.

What can be the answer to the situation in India? Combining supportive psychotherapy with pharmacotherapy might well be the answer. Unfortunately in our country, psychotherapy has been neglected for long. Even in the book, "Mental Health - an Indian Perspective" (2004), which deals with the psychiatric services in post independent India, Psychotherapy has largely been left out. There are only few centers in the country, which give adequate training, and emphasis in psychotherapy even during post-graduate training. This might lead to some of our young psychiatrist colleagues woefully lacking in psychotherapeutic skills.

We know that a significant number of patients on placebo in clinical trials show improvement probably due to psychotherapeutic factors. A proper evaluation of the symptoms and history can make the patient aware of the relationship between external events and his illness, and help him gain insight. A caring psychiatrist, who is willing to listen and providing help is a positive emotional experience for all patients. Tenets of psychotherapy like transference, resistance, counter-transferences etc are integral to Pharmacotherapy as well. Patient noncompliance may be due to the one of the above factors. Good listening skills, rapport and the therapeutic alliance are essential for treatment success.

We are not against prescribing adequately for our patients. But let us refrain from indiscriminate prescriptions and over medicalization for all emotional problems. Let us also understand, psychotherapy should be an essential skill for psychiatrists. Something, which should not be forgotten - especially when drugs do not seem to provide all answers in our clinical practice. Dysfunctional brain in a distressed mind is a model, which can be helpful.

Paper 3: Suicide prevention: Issues and perspectives

Suicide prevention - ways and means

Ajit Avasthi, PGIMER, Chandigarh

Dealing with Suicide Surviors

Lakshmi Vijay Kumar, Chennai

Law and Suicide in India Critique

A.K. Kala, Ludhiana

National Programme for Suicide Prevention need and application

Shubhangi Parker, Mumbai.

IAPA - CIPA - BIPA biological psychiatry

Paper 1: Quantification in psychiatric research: From heart rate and qt interval variability to mood fluctuations

Vikram K. Yeragani

Several physiological measures exhibit frequent fluctuations over the course of milliseconds to hours. For example, an increased variability in heart rate (RR) from beat to beat usually indicates a state of health, whereas irregular QT interval, blood pressure and respirations are usually associated with cardiovascular dysfunction. Human mood fluctuates frequently and this differs between people with and without mood disorders. Until recently, we mainly used classical moment statistical analysis such as mean and standard deviation to quantify these measures. However, most of these series are irregular, nonlinear, and hence, linear statistics may not quantify these signals adequately. This presentation will focus on nonlinear and newer linear statistics may not quantify these measures. Along with investigators in various other fields, we have shown the utility of these techniques to quantify these measures in a more meaningful way. Such applications can improve the quantification of mood in studies to evaluate treatment effects or the course of illness, especially in bipolar and unipolar mood disorders. Variability of RR and other medications. We focus on a recent technique, that uses the mean, the standard deviation, and the coefficient of variation of the mood scores of the subjects over a user deemed period, and derive a new mathematical technique to arrive at a normalized measures to quantify the fluctuations of mood. This method may be an ideal technique to perform meta analysis of different studies quantifying mood.

Paper 2: Depression and coronary heart disease: Recent update

Antony Fernandez

Depression as a risk factor: Depression and CHD occur together commonly. About 20% of patients with new CHD and those recovering from an acute myocardial infarction (MI) suffer from major depression (MDD). These rates are twice the lifetime prevalence of MDD in the general population. An emerging consensus is that persons suffering from MDD are more likely to develop or have CHD than those free of depression and, patients with CHD & MDD die sooner than non depressed CHD patients. MDD following MI is an important risk factor for subsequent unfavorable cardiac events & mortality during the 1-2 year period following MI, even after counseling for CHD and previous MI. Frasure - Smith et al. 2005 have urged cardiologists to include depression as a risk factor for both the development and unfavorable clinical course of CHD. The evidence on risk factors are reviewed by Wulsin, 2004 and Ford et al 1998 will be discussed.

Treatment of depression in patients with CHD: ENRICHED is the best study to suggest that treatment of depression may favorably alter morbidity and mortality in CHD patients. The findings and interpretation of ENRICHED will be discussed.

Conclusion: The best existing model to study link between psychiatric illness and cardiac illness is depression and CHD. We do not know if effectively treating MDD patients with CHD alters the cardiac morbidity and mortality. It may be that we must use prospective paradigms and / or new biological markers to conclusively demonstrate relief reduces cardiac morbidity and mortality.

Paper 3: Brain imaging applications to biological-psychiatry

Muruli Doraiswamy

This presentation will present an update of brain imaging application to biological psychiatry. This will include:

Review of newer structural, diffusion tensor, fMRI and PET findings in mood disorders. PET and fMRI findings in schizophrenia PET, volumetric MRI and other imaging techniques in dementia. Potential application of imaging techniques to help drug development.

These finding will be presented both in relation to their practical utility in daily practice and the understanding of the neurobiology of various psychiatric disorders.

Paper 4: Neuromodulation: Therapeutic applications in psychiatry

This presentations will present the recent advances in the application of neuromodulation techniques to refractory depression and schizophrenia and contrast the mechanism of action of drugs with that of neuromodulatory techniques and electroconvulsive therapy. The following will be presented:

Vagus nerve stimulation Transcranial magnetic stimulation Deep brain stimulation Direct cortical stimulation Electroconvulsive therapy

Each technique will be briefly presented and the psychiatric literature summarized for each advantages and disadvantages of these techniques in relation to current therapies will be discussed.

IAPA - CIPA - BIPA psychopharmacology

Paper 1: Antipsychotics for older patients: Are they safe and effective?

Dilip V. Jeste, HauJin, Sunder Mudaliar, Danielle Glarioso, David Folsom

Atypical antipsychotics are commonly used for the treatment of various psychiatric disorders, although these medications have been approved by the drug administration only for schizophrenia and bipolar disorder. In general, the published studies report varying degrees of efficacy for atypicals in different conditions when compared to placebo and conventional antipsychotics. We and others have reported a significantly lower risk of extra - pyramidal symptoms and tardive dyskinesia with atypical antipsychotics when compared to conventional neuroleptics. On the other hand, a number of studies have shown an increased risk of metabolic effects in various age groups, and cerebrovascular adverse events and mortality in elderly individuals. At the same time, other data show that the positive risk of CVA and mortality is at least similar (and possibly higher) with typical antipsychotics than with atypicals. There are few effective and safe alternatives to antipsychotics in older patients with psychotic disorders including those with dementia. A careful evaluation of risk vs benefit of atypicals as well as that of available alternative treatments is needed in each patient. The daily dosages of antipsychotics recommended for older patients are generally considerably lower than those in younger adults. Also, careful monitoring for side effects would result in better overall management of the patients.

Paper 2: UK: Nice and not so nice facts about treatment of dementia

A. N. Ramakrishnan

Dementia, including Alzheimers disease is an increasing health problem affecting millions of mainly elderly people all over the world. Acetychlolinesterase inhibitors are the mainstay of treatment of Alzheimes disease although there have been treatments developed with Tacrine, vitamin E, Folic acid etc. that were proved ineffective. Over the last several years, new agents have now emerged that enhance cholinergic transmission in the brain, and thereby presumably benefit memory and other cognitive performance. The current drugs available in U.K. Are Donepezil, Galantamine, Rivastigmine and Memantine (NMDA antagonist).

The National Institute for Health and Clinical Excellence (NICE) is the independent organization responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health in UK. NICE in its guidelines in 2001 approved the acetyl cholinesterase drugs for treatment of mild to moderate Alzheimers disease (MMSE score 10 to 26). In its revised guideline (final draft) issued in may 2006, NICE recommended the following.

Access to acetyl cholinesterase drugs should be withdrawn from the early stages of Alzheimer disease and only be prescribed to people in the moderate stage (with MMSE score of between 10 and 20)Prescription of Memantine on the NHS is completely prohibited, although this is the only drug approved for people in the late stages of Alzheimer disease.

NICE has been accused of failing to act fairly because it has not explained how it has taken into account the clinical needs of people in mild stages and late stages of Alzheimer disease and the clinical priorities of the Department of Health of UK.

Paper 3: Psychopharmacological advances in the treatment of substance abuse

Ashwin. A, Patkar

Knowledge of substance abuse disorders has greatly increased from the identification & cloning of receptors for many substances of abuse. There is also a greater understanding of the brain circuits that are disrupted by chronic exposure to drugs including those that are common to different groups of drugs. There is a better acceptance of the 'chronic disease model' of addiction that focuses on functional improvement as a realistic goal of treatment rather than cures. There have been advances in understanding preclinical research findings and their application to pharmacotherapy of substance abuse. Effective agents have been developed to treat ETOH, nicotine, and opioid use disorders and promising agents are being investigated to treat stimulant addiction. These include injectable naltrexone and acomprosate for ETOH, varenicline and rimonabant for nicotine, buprenorphine - naloxone for opiates and other agents in different stages of development. This presentation discusses the growing linkage between neuroscience and therapeutics in the field of addiction and reviews newer agents available to treat addiction disorders. Integrating the newer pharmacological approaches with practical behavioral treatment has the potential to improve clinical treatments for substance abuse.

Paper 4: Pharmaceutical research for practicing psychiatrists

Shivakumar S. Hatti

This presentation will cover issues faced by practicing psychiatrist in conducting a drug trial. The goal is to help clinical psychiatrist transition of Clinical Researcher. With expected expense for pharmaceutical research in India exceeding $ 10B by 2010, clinicians can play valuable role in this new opportunity. The interesting paradox is that there are a limited number of psychiatrists conducting drug trials & most of them are in academia, while the majority of patients are seen by private practitioners. In their practices, one fmd patients who are drug - naοve. Further in local communities it will be easier to reach out to relatives with similar illnesses offering the potential for phannacogentic studies. Private psychiatrists could become the backbone of real world drug trials upon completion of short course of training. ANCIPS offers an excellent opportunity to conduct such training.

The presentation includes the following topics. (1) Why clinicians should conduct research? (2) The anatomy of a drug trial - phases I -IV (3) Pharmaceuticandustry & Research, (4) Investigator Qualifications & Desirable Qualities of an Investigator (5) Investigator responsibilities, (6) Research Methodology, Small Vs Large Trial Design, (8) Why do investigators fail? (9) Administrative aspects ora Clinician / Researcher. (10) Q & A.

Paper 5: Prescribing practices in Delhi, India and Baltimore, USA

Ajay Wasan, Karen Neufeld, Geeta Jayaram

Background : While it is known that cultures are similar in the prevalence of mood disorders culture - bound differences among practitioners in different regions have not been examined. Our goal was to evaluate differences between psychiatrists in New Delhi and Baltimore using structured instruments.

Method : 2 - stage study ethnographic methods - (1) design & validation of a practice patterns questionnaire culturally specific of Indian patients, and (b) survey of a sample of Delhi & Baltimore psychiatrists. This was a qualitative study of psychiatric practice in the two cities and the R.x of Indian patients.

Results : Using Chi square and T tests, significant differences were found in the attitudes, practice patterns and medication prescribing practices of psychiatrists in the 2 geographic regions; the involvement of family members was also significantly different.

Conclusion : Although the quality of care did not differ greatly, the lack of trained psychiatrists in India greatly increases the volume of patients seen, lack of time for psychotherapy in busy hospital settings, and burden sharing with family members, legal requirements are an added feature of care delivery in the US, and psychotherapy is more often advocated for patients. Practice patterns need to accommodate practice settings.

Paper 6: Cosmetic psychopharmacology

Satish Shrikhande

At the end of this session, participants will be able to:

Decide if quality of life (QOL) corresponds with clinico-pathologic indices.Identify if improving QOL is an explicit goal for doctorsDecide if role of psychiatry is to cure pathology or improve QOL Evaluate off label use of drugsConsider if the future of psychiatry will be shaped by consumer demand.

Therapy refers to treating disease and Enhancement is improving normal abilities. The line between therapy and enhancement can be vague, more so if the boundaries of disease are fuzzy. If a goal of medicine is to improve the QOL to sick people, then should this knowledge be also used for healthy person?

Psychiatric drugs are promoted as cures for specific disorders. But often the pathologies are speculative or fixed. Currently, the treatment of psychological syndromes is available only on prescription. Should medicines be provided on demand? Should Psychiatry concern itself with enhancing QOL? Is it wrong to take medicines to enhance memory, mood, energy or alertness without a diagnosis? As consumers become more educated and influential, the demand for enhancement drugs will increase. Is Psychiatry ready for "cosmetic psychopharmacology?"

IAPA - CIPA - BIPA forensic psychiatry

Paper 1: Informed consent and decisional capacity in the medical setting

Ramaswamy Viswanathan

The web page of the ANCIPS 2007 on the theme "Empowering Psychiatry" states: "Liaison Psychiatry is gaining an important place in clinical practice due to concomitant psychiatric problems associated with various medical conditions. "This presentation will address an important aspect of liaison psychiatry at interface of law, psychiatry and medicine, namely the informed consent process and decisional capacity assessments in the medical setting. The following will be discussed:

The evolution of case law pertaining to informed consent in the USA (Natanson v. Klinem 1960; Canterbury v. Spence, 1972; Truman v. Thomas, 1980), and the legal principles underlying decisional capacity assessment.The bedside approach to clinical assessment of decisional capacity; Practical difficulties encountered in applying these concepts at the bedside, and how to deal with them. How general physicians lack of understanding of mental illness can lead to wrong opinions about decisional capacity, Is patient autonomy over emphasized in western law, at times to the detriment of the patient? In contrast in the East too paternalistic? Balancing autonomy and beneficence. The higher bar set in the USA to override patient's refusal of psychiatric medications (Rogers v. Commissioner, 1983; Rennie v. Klein, 1983; Rivers v. Katz, 1986; Washington v. Harper, 1990). The need for physicians to play an active role in shaping legislation affecting medical practice. Finally we will discuss how culture influences medical practice in this area, comparing the East and the West and how there is a variable approach to different diseases.

Paper 2: Detection of malingering

Jagannathan Srinivasaraghavan

Malingering is intentional production or gross exaggeration of symptoms motivated by external incentives. It differs from factitious disorder in that the voluntary production of symptoms in factitious disorder serves the purpose of assuming the 'patient' role and is not understandable otherwise. Recall of the event and testimony about the event may include non-deliberate distortion or deception. Omission and confabulation are examples of non-deliberate distortion of facts; secrecy and fabrication are examples of deception. Often clinicians and courts are unwilling to label an individual as a malingerer. However, clinicians have to be vigilant to consider the possibility in clinical settings and especially in forensic settings. In this presentation we will review clues in detecting deception and malingering, research on malingered psychosis clues in detecting malingered psychosis is clinical settings and criminal defendants. Further, we will address faking on psychological tests, feigned mania, faked depression and significantly faking suicidal ideation.

Paper 3: Charting the waters of informed consent for psychiatric treatments

Asha Mishra

While in some countries, it may be assumed that the doctor knows best, in the USA, patient autonomy, right to know, and civil liberties are of paramount importance. Treatment without consent amounts to 'battery' and treatment with inadequate consent can amount to malpractice. The more invasive and risky the treatment, or the more permanent any disfigurement as a result of adverse effects of the treatment, the greater is the burden of proof that informed consent was obtained. Accrediting and licensing agencies do define the scope of this consent but a lot of ambiguity remains. On the positive side, the process of informed consent strengthens the therapeutic alliance and may improve adherence to prescribed treatment plans.

This presentation will explore the practical issues and challenges in the seeking of informed consent in a typical suburban community mental health clinic in the USA. It will focus on what constitutes an informed consent, professional standards of disclosure, therapeutic privilege and where exception to seeking consent may be justified. The issue of weighing the risks benefits of treatment in the context of respecting the value of autonomy while simultaneously balancing the often compromised insights into the mental illness and the special problems with informed consent in psychiatry due to tardive dyskinesia and metabolic syndromes will be discussed.

Paper 4: Decision making capacity a UK perspective

Seshagiri Rao Nimmagadda

Assessment of 'Decision - Making Capacity' is considered to be an important skill of a psychiatrist. It not only involves making decisions about one's medical treatment, but also a variety of scenarios such as making decisions on managing one's property.

In the UK, the test for assessing one's mental capacity to make decisions was first formulated by Courts in the case of a forensic psychiatric patient in 1994. Since then this test was further developed by successive case law and was formally codified with the passing of the Mental Capacity Act 2005 by the British Parliament. It clarifies the current law on capacity to make decisions, on best interests and the legal status of advance decisions. It aims to regulate individuals who are appointed to act on behalf of the incapacitated person through a new Court of Protection. This law enables substituted decision - making by attorneys who will not only be capable of being appointed to manage a person's property and financial affairs but also will be able to make health and welfare decision on behalf of the incapacitated person.

The test for assessing a person's decision-making capacity with particular reference to treatment decisions will be explained in this talk. The role of psychiatrists in assisting other professionals including their medical colleagues in assessing decision - making capacity will be elucidated. The likely implications of the Mental Capacity Act 2005 with particular reference to the status of advanced decisions made for medical treatment will be discussed.

Paper 5: The excellence in canadian forensic psychiatry

Mansfield Mela

The practice of forensic psychiatry in Canada reflects the respect for rights and freedom accorded to citizens by the Canadian Charter, including mentally ill persons accused of crime. Current practice is informed by lesions in history and shifts in the rights of an accused vis-à-vis the safety of the public at large. Being at the interface of the Corrections and the Mental Health Systems, forensic psychiatry faces unique problems that can only be addressed by knowledge of both Law and Medicine. Hence, the Canadian Psychiatric Association recognizes Forensic Psychiatry as a subspecialty. As a matter of strategy, the field interfaces with institutions at the federal, regional, province, and community levels. Regional centers such as the Regional Psychiatric Centre (RPC) is Saskatchewan serve as a center of excellence. RPC serves the dual role of a hospital and a corrections center, there by attending to reformative and therapy needs of an individual and, offers a comprehensive range of mental health services. To address the social re-integration of patients, the Senate of Canada recently passed a Mental Health Plan that charts a way forward to support a lifelong, community - based system for mentally ill offenders.

The presentation will highlight the excellence achieved in the practice of forensic psychiatry in Canada - second best recidivism rates after the Scandinavian countries. The Canadian forensic training & services have welcomed researchers who have become the pace setters in developing risk assessment tools used worldwide. These include the HCR - 20, Violent Risk Appraisal Guide (VRAG), Sex Offender Risk Appraisal Guide (SORAG) and the most valid tool developed in British Columbia by Robert Hare, the Psychopathy Checklist - Revised (PCL -R). The Presentation will cover these developments and identify other training opportunities.


Paper 1: Recent advances in schizophrenia in neurobiology of schizophrenia; current understanding

Topic: Neurobiology of schizophrenia: Current understanding

Speaker: Sanjay Gupta, Varanasi

Topic: Acute Schizophrenia: Treatment issues

Speaker: R. Sathianathen, Chennai

Topic: Treatment resistant Schizophrenia: Current issue

Speaker: Shiv Gautam, Jaipur

Topic: Atypical Antipsychotics are safe: Myth or Reality Speaker: YA Matcheswala, Mumbai.

Paper 2: "Human resources development in mental Health for reducing the treatment gap"

Chairperson: Dinesh Bhugra and Shekar Saxena

Proposer and Coordinator: Nimesh G. Desai.

Speakers: B. N. Gangadhar, Nimesh G. Desai, Tom Clowson,

Sonia Chehil

Paper 3: Community based working model of school mental health in India: An update

Mental health of our children: Children are the most important assets of any country and the most important human resources for overall development schools are one of the settings outside the home where children can acquire new knowledge and skills to grow into productive and capable citizens, who can involve, support and help their communities to grow and prosper. A health promoting school is a setting where education and health programmes create a "health promoting", environment that in turn "promotes learning". As we introspect on issues that matter to us as part of a rapidly changing society, it is imperative that an approval be made of the psychosocial needs and influences on the child and adolescent of the nineties who is leading the baton of human chain into the 21 st century.

Childhood and adolescence : Is a time in life span when children realize who they are, what they would like to be… its time to forge an identity. Career choices to be made, meaningful relationships to be formed and sustained, technological advances tackled, attitudes and roles chiseled. A few of our youngsters seem to be in vague kind of disturbances, of having lost something, of a boredom, defiance and a feeling of being on the brink of crisis symptoms that are spreading through the nervous system of the entire generation.

Paper 4: WHO (2001) report on mental health estimates a global burden of serious emotional disturbances in children and adolescents up to 15%

The Indian Scenario

India - Children and adolescents constitute 40% - 44% of over 1000 million population.10-12% of

The workshop envisages to highlight the school's potential for Promoting Mental Health.

The school plays a crucial role in the development of cognitive, linguistic, social, emotional and moral functions and competencies in a child. Schools have profound influence on children, their families and the community. Schools can act as a safety net, protecting children from hazards that affect their learning, development and psychosocial well-being. In addition to the family, schools are crucial in building or undermining self-esteem and a sense of competence. School mental health programmes are effective in improving learning mental well-being, and channelizing management of mental disorders. When teachers are actively involved in mental health programmes, the interventions can reach generations of children.

An interactive made is designed to facilitate audience participation and partnerships.

Organized by : "Expression India"- The Life Skills Education & School Mental Health Programme, New Delhi.

P.C. Shastri M. Thirunavakarasu Jitendra Nagpal Amulya Khurana Ms. Divya S. Prasad.

Paper 5: 'Time to build bridges instead of walls', integrating pharmacotherapy and psychotherapy

Avdesh Sharma

The battle between psychotherapy oriented professionals and those adhering to biological psychiatry is being fought on many fronts due to inherent interests of many lobbies. The proponents of biological psychiatry cite evidence from studies related to newer imaging techniques and ultra-sophisticated computerized models of measuring chemical changes in the brains of these with mental illnesses. The proponents of psychotherapeutic models point towards large studies showing qualitative as well as quantitative improvements in lives of those with emotional disturbances. The mind cannot exist without the brain and brain without the mind serves no purpose. Even thoughts and emotions (which are modified during psychotherapy) have been shown to create lasting changes in the brain. Psychopharmacology and psychotherapy may thus be just two of the many ways of looking at the same thing. The number of medications and therapies themselves should humble us that none of us or the treatment modality has the complete answer. The debate probably has more to do with our inadequacy to be comfortable with application of a particular therapeutic modality rather than a shortcoming of the technique. The workshop/symposium would focus on ground realities and discuss ways of moving forward practically in all aspects of psychiatric disorders.

Paper 6: Health promotion using life skills education for adolescents

Srikala Bharath, K. V. Kishore Kumar

The concept: The education, currently prevalent in India places, stress on acquiring information, knowledge and technical skills rather than psychosocial competence and realizing one's potentials. It is achievement oriented than child oriented.

Life skills education on the other hand promotes empowerment of the child. Life skills (L.S) are abilities for adaptive and positive behavior that enable individuals to deal effectively with the demands, challenges and stress of every day life. Childhood and adolescence are the developmental periods during which one acquires these skills through various methods and people.

Life skills education: Life Skills Education is a novel promotional program that teaches generic Life Skills through Participatory Learning Methods, conceptual understanding and practicing of the skills occurs through experiential learning in a non-threatening setting. Such initiatives provide the individual with a wide range of alternative and creative ways of solving problems pertaining to various health and psychosocial issues like Nutrition, Drug Use, Sexual Abuse, Early Sexual Experimentation, Teenage Pregnancy, Bullying etc.

Paper 7: Life skills program in India

In the last one decade some of the Mental Health Professional in India have made initiatives in the development of Promotional Program using Life Skills Approach for children and adolescents both in schools and out of school.

The pedagogy, methodology, target population, goals and the mandate of these program and models have differed.

The symposium would address the various models and program in this area of Life Skills Education.


Specialty under


Chairperson: Sarada Menon, Charles Pinto

Proposed & Coordinators: Uday Chaudhari

Speakers: Uday Chaudhari, K.S. Shaji, Jeffery Cummings

Paper 8: Urban mental health care: Need for separate programme

Speakers: Om Prakash, Kishore Kumar, S. Nambi, S. C. Tiwari

Coordinators: B. N. Gangadhar, Nimesh G. Desai

It is expected that about 50% population will be living in urban areas in the country in next two decades. The urbanization brings deleterious consequences for mental health through the influence of increased stressors and factors such as over crowded and polluted environment, dependence on a cash economy, high levels of violence and reduced social support There is considerable stigma attached with mental disorders and ignorance regarding information about "mental illness and available help and treatment.

It is possible to identify, diagnose and treat mental disorders in primary care settings as effectively as the hospital with currently available resources and developments in the area of mental health. It is based on this justification that the entire world is moving towards the primary health care services to deliver mental health care. It is recognized that such a care is, economical, very effective, helps in reduction of treatment gap because of early identification and treatment, lastly it helps in reduction of stigma and discrimination because of reduction in disability as a result of early treatment.

It is interesting to note that most community initiatives have occurred in rural areas. Urban initiative has been very limited. It is important to reflect of the changing urban communities and respond to their mental health needs. The mental health care is urban areas is at present limited to psychiatric hospitals and departments of psychiatry in medical colleges. It is proposed to develop models for mental health care in urban areas with focus on extension of mental health care to community level.

It is this context that NIMHANS is very keen to development urban mental health car in Bangalore city. This mode can be useful for many urban locations in the country. On the back ground, NIMHANS, Bangalore and the Mahanagara Palike, Bangalore are collaborating to integrate mental health care into the existing general health services by empowering the doctors and paramedical workers with knowledge and skills to deliver mental health care in primary care settings for priority mental disorders. The proposed symposium will cover status of urban mental health in India and need to improve current infrastructure in area of mental health with emphasis on current NIMHANS -BMP collaborated urban mental health initiatives.

Paper 9: Anxiety disorders in the 21 st century: Status challenge, opportunities

Sanjay Kumawat, Thirunavakkarasu, Uday Choudhary, Sandeep Vohra

Management of anxiety disorders: The added challenge of comorbidity Unmet needs in the treatment of anxiety disordersDebate on the role of benzodiazepine in management of anxiety disorders: for and against Review of a 1.5 benzodiazepine in anxiety disorders

Paper 10: Implications of law relating to marriage in psychiatric patients

Chairperson: Prof. Indira Sharma & Prof. S. Nambi

Topic: Law Relating to Marriage: Clinical Consideration

Speakers: Vipul Singh

Topic: Applicability of Laws of Relating to Marriage. Forensic Consideration

Speaker: Prof. R. K. Mahendru

Topic: Applicability of Laws Relating to Marriage Case illustrations

Speaker: Ms. Reet Sharma

Topic: Application of Laws Relating to Marriage in Psychiatric Patients: Indian Scenario and Future Directions

Speaker: Akilesh Kumar Pandey

Paper 11: Training psychiatry at UG and PG level: South asian scenario

J.K. Trived and Mohan Dhyani

In the last century Psychiatry has evolved as an independent scientific discipline. Around the middle of the century the medical schools accepted psychiatry as a subject to be taught in the curriculum, this was an addendum to medicine and with certain neurological emphasis. As a result of growing increasing solidification in the scientific basis and wealth of clinical experiences psychiatry began to develop into medical specialty. In the last few decades a need to reform the medical curriculum has been a subject of debate and the place of psychiatry is one of the focal points discussion.

Psychiatric training has undergone major development over the past decades and scientific developments in the field of molecular biology, neurobiology, genetics, cognitive neurosciences, neuro imaging, Psycho-pharmacology, Psychiatric epidemiology and many other related fields have contributed to increasing growth of psychiatry as medical discipline. However there is very little knowledge about the quality and availability of the psychiatric training to medical students in different countries. The basic information about psychiatric training is especially deficient from the low and middle-income countries.

There are many unanswered questions related to the training in psychiatry. There are issues like whether adequate number of psychiatrists are being trained to take care of mental health needs of country? Whether the training takes into account the different needs and environment of different populations across the world is another issue All these and related issues will be discussed in the symposium.


Atlas: Psychiatric education and training across the world 2005World Health Organization Technical Report Series: The Under Graduate Teaching of Psychiatry and Mental Health Promotion, 1961.


Training in Psychiatry: Customizing the curricula for South Asian Countries, Prof. Pichet Udomrath, Professor of Psychiatry; Department of Psychiatry; Faculty of Medicine.

Prince of Songkla University; Thailand Undergraduate Training of Psychiatry: South Asian Scenario. Prof. Jaganathan Srinivasaraghavan, Srilanka. Are we training enough Psychiatrists? A South Asian Scenario, Prof. T. Maniam, Hospital UKM Kuala Lumpur, Malaysia. Are south Asian countries training Psychiatrists for the western world? Prof. M.P. Deva, Prof. Of Psychiatry, Faculty of Medicine, University of Technology MARA, 40450 Malaysia. The course content and duration of Post Graduate Psychiatric Training: Are South Asian Countries different? Prof. Mohan Issac; primary care Mental Health unit; UWA school of psychiatry and clinical Neurosciences; Australia.

Paper 12: Theme: Current Trends in Psychiatric Rehabilitation.

Speakers: Pfizer, Alok Sarin, C. Ramasubramanium, Ashok Reddy

Rehabilitation has come to age in India with varieties of facilities for the mentally ill. It has to noted that these facilities differs very much in philosophy and approach. India being a culturally diverse country should encourage different models of care so as to bridge the gap between needs and services. Professionals currently working in Psychiatric Rehabilitation will cover their experiences in the above Symposium.

Paper 13: Family therapy in 21 st century India: Cultural adaptations and systems transitions

Mathew Varghese, Lakshmi Sankaran, Rathna Issac, Steven Wolin

The practice of family therapy in India has so far relied on principles from the Western systemic schools and their adaptations by therapists with an index family therapists in India have had to adapt to the socio cultural, linguistic and regional diversity that typifies India. Families in modern India are going through rapid transitions especially in the cities and so old systems are making way for new levels of adoptation and flexibility.

In this symposium the speakers would discuss some of these challenges in the practice of family therapy. Despite the changes brought on by modern society, Indian families seem to be resilient and adept with different patterns and rituals that protect their functioning. We will discuss how normal and dysfunctional families use rituals as protective measure. In addition, we would discuss the added problems faced by families and therapists in dealing with chronic mental disorders like alcoholism or schizophrenia. The speaker would also discuss the new challenges faced by the marital system and how therapists use techniques to deal with marital discord in Indian couples. Finally we look at the prototypical Amercian family and see what lessons we could take home in respect to predictions for the future on how Indian families would function and how therapists would adapt their interventions with changing family systems.

Paper 14: Capturing the mind: Neuro imaging in organic and functional psychoses

Speakers : Rajesh Shankar Iyer, Nagaraj D. M., Srinivasa Raman

The role of imaging in psychiatric diseases has undergone a paradigm shift from ruling out a structural organic disease to understanding various aspects of neuro psychiatric diseases by delineating the structural damage, physiological and biochemical derangements and monitoring treatment apart for opening up of a new frontier in the assessment of various domains of speech, memory and other cognitive and behavioral functions.

The neuroimaging in psychiatry can be broadly classified in terms of that of primary psychiatric and neurological disorders with prominent cognitive and behavioral manifestations. The format include the major psychoses - schizophrenia and bipolar disorder and neuroses including OCD and ADHD. Under the latter category included are the various dementias and other degenerative disorders, cerebral palsy and other conditions of psychomotor retardation in children, alcoholism and associated syndromes, post-traumatic sequelae and epilepsy.

The modalities available are CT, MRI and USG for anatomic delineation, functional imaging using SPECT, PET, fMRI and biochemical information from MR spectroscopy (H, P and other nuclei). Anatomical imaging is further refined by quantitative MR morphometry. Electro-diagnostic techniques like EEG & MEG can be combined with functional imaging techniques (fMRI + MEG - Magnetic Source imaging).

Advances in anatomical and functional imaging have more helped to understand the underlying pathophysiological mechanism rather than for diagnosis, which still largely remains clinical. The ultimate in noninvasive exploration of mind and behavior has not been reached. In fact, the imaging of imagination has just started unfolding.

Paper 15: Imaging in organic psychoses

The role of imaging in acute confusional state (delirium) is done mostly using CT mainly to rule out causative or associated structural pathology. However, high index of clinical suspicion is essential in apparently normal CT to evaluate further with MRI as subtle changes can be missed in CT (e.g., signal changes in mamillary bodies / hypothalamus in Wernicke's ecnephalopahty).

Newer MR techniques have also been used in assessment of various neuropsychiatric conditions. Magnetization transfer is used to image the macromolecular content of the tissue. Diffusion - weighted imaging reflects the translational (Brownian) motion of water molecules. Diffusion Tensor imaging is used to image the white matter tracts (Tractography). These techniques offer an insight into patho physiology underlying various organic diseases that was not available before.

The role of imaging in dementia is expanding in many aspects - to look for reversible causes particularly in young - onset and acutely developing dementia, to differentiate normal age- related atrophy from early abnormal disproportionate atrophy, to look for early patterns of regional atrophy like temporoparietal in Alzheimer's frontotemporal in Pick's etc. and for quantitative measurement of atrophy using various linear, planimetric and volumetric measures. The commonly used methods currently are ROI based (Manual / automated), voxel based morphometry (VBM) and registration - subtraction techniques.

MRI with contrast can help to identify the protentially reversible but uncommon causes of dementia like neurosyphillis, cysticercosis and dural vascular malformations particularly in young patients. In early onset dementias like Huntington's Hallervaorden - Spatz, Wilson's diseases and B 12 deficiency, neuroimaging plays a major role in the diagnosis and follow up. MRI can also help in the diagnosis of subcortical dementias of extrapyramidal origin like parkinson's disease, progressive supranuclear palsy, multi system atrophy, olivepontocerebellar atrophy.

Functional imaging though not in routine clinical practice can show changes even before structural changes. SPECT/PET shows reduced blood flow / metabolism regionally and with functional MRI even early cognitive changes can be looked for using various task - specific activity studies. Though functional changes can be seen before visible atrophy, their wider non-availability has restricted.

Paper 16: Imaging of functional psychoses

The anatomic abnormalities in primary psychiatric diseases are subtle ('soft' imaging findings / signs like cavum septum pellicudum / vergae, callosal abnormalities) and improved upon by using quantitative morphometry. The regional alterations that are looked for are, of volume loss or abnormal architecture. Morphometric techniques have a major role in monitoring of individual patients with schizophrenia, alcoholics and disorder like OCD and ADHD. In future, with the MR microscopy, even better delineation of these alterations can be expected.

The various functional aspects images are regional perfusion (Xe-CT, SPECT, PET, MR Perfusion) metabolism (PET, MRS) and neural activity (PET, fMRI). The imaging of neural activity is based on the principles of flow metabolism coupling. The sample phenomenon underlies the Blood Oxygenation Level Dependent (BOLD) principle is now widely used is fMRI. In an area of neural activity, the increase in blood flow is more than necessary for the activity resulting in slight increase in signal (due to decrease in deoxy Hb) is statistically reconstructed into an area of activity. MR spectroscopy also has shown abnormalities where structural imaging is normal. The decrease in N-acetyl aspartate (NAA) the putative neuronal marker has been used to delineate areas of neuronal loss. Phosphorus (31P) spectroscopy has been used to characterize tissue in terms of bioenergetics, membrane phospholipid turnover and pH.

Paper 17: Bipolar affective disorder: New horizons of development

R. K. Chadda, S. K. Khandelwal, R. C Jiloha, R. Sagar, M. Sood

Bipolar affective disorder (BAD) is severe and persistent mental illness that is associated with significant morbidity and mortality. It is now recognized as a major public health problem. It is the sixth leading cause of disability adjusted life years world wide among persons aged 15 to 44 years.

The illness is more common than thought earlier and has a lifetime prevalence varying from 2-3% affecting men and women equally. The course is not as being perceived earlier. The illness is under recognized (many times misdiagnosed as major depressive disorder), under treated and often inappropriately treated. It is associated with high costs and significant use of health care resources. Two third patients experience functional and occupational impairment and strained social relationships. There is limited functional recovery despite successful syndromal treatment. Nearly one third to one fourth of BAD patients attempt suicide and 15% eventually complete it. There is often a delay of 5-10 year between symptom onset and diagnosis.

The present symposium will discuss about the latest research developments in bipolar affective disorder including nosological issues, biological aspects, public health aspects and advances in management.

Paper 18: Neurochemistry of depression

Looking beyond the changes in neuro transmitters, changes in the neuro chemistry of the brain due to depression are discussed. Functional neuro imaging studies have lead to discovering anatomical areas involved in mood disorder.

For instance, stress leads to decrease in the volume and decreased neurogensis of hippocampus. There have been a lot of advancements in molecular genetics of mood disorders. A part from inheritance of vulnerability to develop depression, early childhood traumatic events bring about neuro endocrine changes. As a result hyothalamo pituitary adrenal axis become more sensitive to life events. Whenever an individual, already vulnerable to develop depression, happens to face adverse life events changes in the HPA

axis become more pronounced. Thus an attempt is made to integrate biological an psychological models of depression.

Changes in glucocorticoid receptor are discussed. Bio chemical substrates of depression are dealt with in detail.

Implication of those developments for the pharmocotherapy of depression are explored.

Paper 19: Treatment protocols in military psychiatry

Topic: Treatment protocol for Schizophrenia in the Armed forces

Speakers: Col. HRA Prabhu

Topic: Treatment protocol for Bipolar disorder in the Armed forces

Speakers: Col. PK Pardal

Topic: Treatment protocol for Depression disorders in the Armed forces

Speakers: Lt. Col. R. Saini

Topic: Treatment protocol for Alcohol abuse in the Armed forces Speakers: Surg Cdr K Chatterjee

Topic: Treatment protocol for stress disorders in the Armed forces

Speakers: Lt. Col. PS Bhat.

Psychiatric patients in the Armed forces face special problems. The patients are often followed up by more than one psychiatrist as both patients and their doctors are transferred throughout the country. Due to this reason the treatment that the patient receives varies from psychiatrists to psychiatrist, which in the long run may affect his health adversely. It has therefore been proposed to have all psychiatrists working in the Armed Forces. A two hours symposium on this topic has thus been planned.

Paper 20: Geriatric psychiatry update

Charles Pinto, K. S. Shaji

Delirium: Diagnostic and treatment implications

The incidence of delirium may be as high as 50% in hospitalized patients with dementia and that symptoms of delirium include a difficulty in coherent thinking, anxiety, restlessness, insomnia, disturbing dreams, and fleeting hallucination. Delirium is multifactorial and needs to be diagnosed appropriately and treated. Effective screening including a thorough physical examination, routine blood draws including RRR for syphilis, folate, Vitamin B 12 and TSH is requisite. Something as straight forward as a distended bladder or constipation, sensory deprivation, fever, infection, and the process referred to as "actively dying" may all be implicated. As with all symptoms, it is important to assess, intervene, and then reassess. Another important cause of delirium to screen for is polypharmacy. Discontinue any medications that are not needed, paying special attention to antidepressants, anticonvulsants, beta - blockers, antineoplastics and benzodiazepines. Although commonly used as a therapy for delirium, this class of drugs has been shown to worsen delirium.

Majority of the cases of delirium can be reversed. Using a combination of pharmacologic and non pharmacologic interventions will lead to the best clinical outcome.

Pharmacologic therapy for hyperactive delirium includes antipsychotics, such as haloperidol and chlorpromazine. Newer antipsychotic medications are also being used to treat delirium. Delirium with a high mortality rate needs to be accurately diagnosed and aggressively treated.

Paper 21: Substance abuse in the elderly

Ashwin A. Patkar

Associate Professor and Director, Duke Addiction programs, Duke University Medical Centre, Durham, NC USA

Alcohol and prescription drug misuse has been called 'the invisible illness' in the elderly. Detection is difficult because presenting symptoms are often mistaken for those associated with aging such as dementia and depression. For various reasons substance abuse in the elderly-specific treatment resources have been developed.

Practitioners should be aware of the pathways of development of substance abuse and the influences that perpetuate the disorder. Additionally, it is important to be aware of the physiological and concomitant effects of alcohol and other substances in the elderly.

Finally, appropriate screening instruments can be used in identifying substance use, abuse, and dependence in the elderly. When substance abuse is found, the elderly should be treated as aggressively as their younger counterparts, with slow, careful detoxification, and the use of pharmacological and behavioral interventions to prevent relapse. Co morbid illness should be addressed effectively. Above all, future research should center on unique, elderly-specific identification, intervention and treatment strategies.

Paper 22: Delirium: Diagnostic and treatment implications

Meera Narasimhan

The incidence of delirium may be as high as 50% in hospitalized patients with dementia and that symptoms of delirium include a difficulty in coherent thinking, anxiety, restlessness, insomnia, disturbing dreams, and fleeting hallucinations. Delirium is multifactorial and needs to be diagnosed appropriately and treated. Effective screening including a through physical examination, routine blood draws including RPR for syphilis, folate, Vitamin B 12 and TSH is a requisite. Something as straight forward as a distended bladder or constipation, sensory deprivation, fever, infection, and the process referred to as "actively dying" may all be implicated. As with all symptoms, it is important to assess, intervene, and then reassess. Another important cause of delirium to screen for is polypharmacy. Discontinue any-medications that are not needed, paying special attention to antidepressants, anticonvulsants, beta - blockers, antineoplastics and benzodiazepines. Although commonly used as a therapy for delirium, this class of drugs has been shown to worsen delirium.

Majority of the cases delirium can be reversed. Using a combination of pharmacologic and non pharmacologic interventions will lead to the best clinical outcome. Pharmacologic therapy for hyperactive delirium includes antipsychotics, such as haloperidol and chlorpromazine. Newer antipsychotic medications are also being used to treat delirium. Delirium with a high mortality rate needs to be accurately diagnosed and aggressively treated.

Paper 23: Child and adolescent psychiatry

V. Jayanthini, Sabesan, Gopalakrishnan

Vijay Nagasami: Approach to relationship problem

Dheep: Approach to adolescent ODD (Opposition defiant disorder)

Sujay Subramaniyan: Substance misuse in children and adolescents.

Paper 24: Cultural psychiatry: "Gas" syndrome as a new culture bound syndrome entity discovered in India

Govind Bang

Background: Many different languages, dialects, religious beliefs, immigration patterns, socio economic status and traditional pattern of health seeking create heterogeneity and diverst cultural syndromes across the globe. Various culture bound syndromes (CBS) prevalent in our country includes "Dhat syndrome", "Amok" and "Koro" and so on.

Aim and Objectives: Understanding the dynamic outlines and cultural understanding of various cultural psychiatric syndromes prevalent in India and to discuss the appreciation and validity of "Gas syndrome" as a new culture - bound syndrome.

Discussion: We are briefly discussing the background, clinical manifestations, the constructs and dynamics of various (CBS) prevalent in India which includes "Dhat syndrome", "Amok" and "Koro" and so on in varying degrees. We have observed certain group of patients who presented to us with alternations in behaviour and experience characterized by marked somatic symptom configuration. Their symptom attribution is entirely to the consequences occurring secondarily to the upward drifting of abdominal gases in the brain. We have tried to discuss the face, criterion and construct validity of this syndrome. Pfeiffer's postulates and criticism of such syndromes is also briefed. Proper approach and treatment of such CBS ordains the genuine clinical skills of the psychiatrist. Only through repeated experiences we can hope to master the subtleties of culturally appropriate diagnosis and treatment. If cultural cognition plays and role in the conceptualization of this abnormal behavior requires replication and multicentric studies.

Paper 25: Spirituality and mental health

Pedro Ruiz: Spirituality: The Relevance to Psychiatry

E. Mohan Das: Neuroimaging Correlates of Spirituality

Russel D'Souza: Spirituality Augmented Cognitive therapy

Paper 26: Special issues in reproductive psychiatry

Sharita Shah: PMS/PMDD

Shaila Misri: Controversies of Antidepressant us in Pregnancy

Mohandas: Mood Stabilizers in Pregnancy and Lactation.

Paper 27: 'Media and mental health - innovation and strategies'

Avdesh Sharma

The decades gone by have shrunk the world and increased the information load on each individual to such an extent that it is becoming difficult to cope. Yet, if information technology can be harnessed, it can serve as a boon to provide factual infotainment to the general population. The rapid strides in technology and interface of information systems have helped us understand that no system in redundant. Each traditional or state of art system of information dissemination can be used to provide encapsulated, target specific information to that population. Unfortunately there is hardly any teaming up of professionals working in the field of information systems and mental health. It is mandatory to create long term strategies keeping in mind the budgets, target population and mental health messages along with the available / popular / viable information system. Mental health information is sought by the general population and could possibly reduce the increasing trends of psychiatric morbidity. The onus is on mental health professionals to utilize the revolution in information technology while retaining the time tested techniques of dissemination of mental health promotion and preventive programs. The symposium / workshop would focus on planning a long term perspective on interface of media and mental health.

Paper 28: Parenting skills

Venkatesh Ramachandran, N. Rangarajan, M. Thirunavakarasu

Parental skills, is one of the topics which forms a integral part of every parent and vital part of any clinical practice in psychiatry future most of us are at our different stages in the parenting process. With the breakup of the joint family system and era of working parents and single parenting we have many parents who seek our advice on parenting skills.

Parenting skills is not formally taught at any psychiatric or psychological course, and it mostly done with commonsense, intuition and advice from other parents, elders or done on a trial and error basis.

Parental is a unique experience weather it is thrust upon you or planned what ever it may be you become a parent for life. They you have the daunting task of making your children the best they can be so as to face the competitive world ahead, this also becomes a delicate balance between tradition and evolving trends.

Further it is very important for parenting skills to evolve with time with this ever changing competitive environment. This symposium gives a comprehensive look at the parenting and parenting skills and on parenting for children with special needs.


Paper 1: Study of insight in schizophrenia

Aditi Dagaonkar, B. Jadhav, B. Shah, H. S. Dhavale, Sunitha Shanker

K. J. Somaiya Hospital and Research Centre, A-1203 Serenity Towers, Behind Oshiwara Police Station, Off Link Road, Oshiwara, Mumbai - 400102, India.

E-mail: [email protected]

Unawareness of one's own illness among people with schizophrenia has been a much documented phenomenon. Along with the severity or symptoms, the insight in to the illness and level of functioning are known to be important in determining outcome in schizophrenia. Poor insight has profound consequences for treatment compliance, frequency of hospitalization and relapse, disease prognosis, potential to commit violent acts and general quality of life. In view of this we decided to conduct a study with the following aims.

To assess the level of insight in patients of schizophrenia.To study the correlation between global functioning and level of insight in the patient.To assess the association between the level of insight in the patient and extent of disability in them. Fifty patients diagnosed as having schizophrenia according to DSM IV TR between the ages of 18 to 60 years selected. Patients with other psychotic illnesses, mental retardation, substance use and other co-morbidity excluded. Patients interviewed using semi structured proforma. The level of insight determined using the Birchwood. Self report insight Scale. Global assessment of functioning and Indian disability evaluation and assessment of functioning and extent of disability respectively and their association with the level of insight studied. Data pooled and statistically analyzed. Results will be discussed in view of available literature.

Paper 2: Post schizophrenic depression: A district hospital perspective

Praveen Somani, T. Hema, P. S. V. N. Sharma

Department of Psychiatry, Kasturba Medical College, Manipal, Karnataka - 576104, India. E-mail: [email protected]

Aim : To study the prelevance of post schizophrenic depression in the patients attending an out patient clinic at the district hospital, Udupi.

Methods : All schizophrenics attending the Udupi district hospital psychiatry care unit between 01/01/2006 and 30/09/2007 who were maintaining well for more than one year [N = 75] were screened for postschizoprenic depression using Calgary depression rating scale.

Results : Data will be analyzed and presented.

Paper 3: The significance of birth spacing in schizophrenia

R. Thara, R. Mangala, Suji John

Schizophrenia Research Foundation (SCARF), R/7A, North Main Road, Anna Nagar (w), Chennai - 101, India.

Introduction : Several family-structure related factors such as birth order, family size, parental age and age differences between siblings have been suggested as risk factors for schizophrenia. Prenatal nutritional deficiency of folic acid has been implicated as a cause for schizophrenia based on which some studies say that short birth intervals are associated with higher risks for schizophrenia. There are few other studies, which have reported contrary findings. The aim of our study is to study the association between the length of the preceding birth interval and the risk of schizophrenia in the offspring.

Methods : 120 families with one or more affected individuals were interviewed and the dates of birth of affected siblings their immediate elder and younger siblings established beyond reasonable doubt. Those families, which could not give exact dates of birth and reasonable obstetric history, were excluded.

Results: There was no significant association between birth spacing and risk of schizophrenia. Most persons with schizophrenia were born as one of the first three siblings in birth order. There was no significant differences between families with one affected person and those with 2 or more affected persons.

Conclusions : Birth spacing does not appear to be a major risk in developing schizophrenia in the Indian population studied.

Paper 4: Pattern of formal thought disorder in mania and schizophrenia: A comparative study

Sujit Sarkhel, Manu Arora

Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand - 834006, India.

E-mail: [email protected]

Background : Formall thought disorder is known to be widely prevalent in schizophrenia statistics will be used for analysis and results will be discussed at the time of presentation.

Paper 5: Schizo-obsessive disorder: An evidence from a tertiary care center

Sumit Deoro, Ashutosh Chauhan, P. S. V. N. Sharma

Department of Psychiatry, Kasturba Medical College, Manipal, Karnataka - 576104, India.

Aim : To study prevalence of OCD and its correlates in patients with a diagnosis of schizophrenia.

Background : Generally prevalence of OCD in schizophrenia has been postulated to be around 8% but no consistent data is available in Indian population.

Methods : A 5-year retrospective study is being undertaken in Dept. of Psychiatry, KMC, Manipal, to look at prevalence and correlates of OCD in schizophrenia.

Results : Data will be analyzed and presented.

Paper 6: Season of birth in schizophrenia

T. N. Srinivasan, Sujit John, Ayankaran, Anita, R. Mangala

Introduction : The genetic contribution to the causation of schizophrenia is well established. Several family studies have looked for factors contributing to susceptibility to schizophrenia. One such factor studied is the season of birth of persons with schizophrenia. While association between winter births and schizophrenia has been reported in several studies, deficit schizophrenia has been associated with summer births.

Methods : This study examined 99 families with sporadic cases and 65 families with sib pairs affected with schizophrenia. All the families belong to Tamil Nadu, which has similar climatic conditions throughout the state.

Results: Most sporadic cases were born in November and affected sib pairs in July and August. The sporadic cases born between March and June were more ill, while sib pairs born between July and October were more ill. There was a preponderance of male births in March and June in both sporadic cases and sib pairs.

Conclusion : There is an association between summer births and schizophrenia in the population studied. Winter births do not appear to be strongly associated with development of schizophrenia as found in western studies.

Paper 7: Relationship between psychopathology, insight and treatment compliance in schizophrenia

Vikrant Bajaj, Somnath Sengupta, Dhanesh Kumar Gupta

Institute of Human Behaviour and Allied Sciences, Delhi - 110095, India.

E-mail: [email protected]

A 4 week longitudinal study was conducted to assess the relationship between insight, psychopathology and treatment compliance in schizophrenia using insight and treatment attitude questionnaire (ITAQ), positive and negative syndrome scale (PANSS) and medication adherence rating scale (MARS). Study sample consisted of 50 patients with schizophrenia diagnosed as per diagnostic criteria of research of WHO(ICD-10-DCR) with a mean period of illness being 5.32 years.

There was substantial psychopathology at intake which improved significantly after 4 weeks. Similar changes were found with insight and compliance scores over 4 weeks. Insight and compliance were positively correlated to each other at intake and at the end of 4 weeks. While both of these were negatively correlated with psychopathology scores on both the occasions. Regression analysis showed psychopathology at intake only weakly predicted the insight and compliance at intake and at the end of week 4. The clinical relevance of these findings will be discussed during presentation.

Paper 8: Blood glucose levels in drug Naοve Schizophrenic patients, first-degree relatives and bipolar disorder patients

Jayakumar Menon, S. J. Daniel, V. Karthikeyan, M. Murugappan

Institute of Mental Health Chennai, Room No 7, IMH PG Quarters, Institue of Mental Health, Kilpauk, Chennai - 600010, India.

E-mail: [email protected]

Background : Studies have shown increased incidence of Diabetes and impaired glucose tolerance in schizophrenic population not exposed to drugs compared to general patients. There is an increased incidence of Diabetes in relatives of schizophrenic patients. None of the students have evaluated the glucose metabolism in first-degree relatives of schizophrenic patients and their first-degree relatives with that of bipolar patients.

Methods : Fasting and postprandial blood sugar values of newly diagnosed drug naοve patients and their frist-degree relatives were measured and compared with that of drug naοve bipolar patients.

Results : Will be discussed at the conference.

Paper 9: Delusional disorders: An exploratory study

Krishna Prasad, Amit Zutshi, Pratima Murthy

Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (Deemed University), Bangalore - 560 029, India.

Concept of paranoia, recognized by Kraepelin, found its place in classificatory systems in the DSM-III-R as delusional disorder. Delusional disorder remains enigmatic with sparse literature available from the developing world. There is little data available on the socio-demographics and comorbidities of patients presenting with delusional disorders.

Aim of the present study is to look at the common comorbidities in patients with delusional disorders in a tertiary care centre in India. Clinical charts of all patients diagnosed with delusional disorder who presented to NIMHANS out-patient services between 2001-2005 were reviewed. These patients were diagnosed by at least two clinicians one of whom was a senior consultant of the treating team. Total of 202 patients were included in the study. Socio-demographic details with age of onset of delusional disorder and other common psychiatric comorbidities were analyzed. Results and implications would be presented.

Paper 10: Signal events in schizophrenia

Kumar Gaurav, Mohan Dhyani

Department of Psychiatry, King George's Medical University, Lucknow, India.

The word schizophrenia is less than 100 years old but the illness has probably accompanied mankind throughout its history. Schizophrenia is known to have a protracted course with frequent remissions and exacerbations. One of the areas of recent interest has been the study of the predictors which herald the onset of prodrome of relapse in an ongoing schizophreniac illness. These acts or symptoms which may act as forewarning are called signal events. The signal events may be specific to an individual, and can be understood as a learned behavior, conditioned to appear with the onset of symptoms. These may at times be identifiable as a recurring event evident from the history of patient's illness and relapses. Some of the known signal events in these patients are: disturbed sleep, increased substance abuse, emotional outbursts, absence from work, threats of self harm or harm to others, inability to cope with problems of daily activity. Prospective studies have shown that psychotic relapse can be predicted with a sensitivity of 50-79% and a specificity of 75-81%. (1) A large percentage of people with schizophrenia and their relatives are aware of these early signs of impending relapse. (2) Educating the caregiver about the signal events, which may tune them to recognize relapse at early stage may help in early intervention and treatment. This may also prevent occurrence of a full blown syndrome and a subsequent distress.

We will conduct a prospective study at our centre to study these events & the results will be discussed and displayed.

Paper 11: Prevalence of catatonic signs and symptoms in drug naοve/drug free persons suffering from schizophrenia in adult psychiatric clinic

Manish Kumar, Daya Ram, Baxi Neeraj, Prasad Sinha

Central Institute & Psychiatry, Ranchi - 834006, India.

Objective : To investigate the prevalence of catatonic signs and symptoms in drug naοve / drug free persons suffering from schizophrenia and its association with clinical and socio-demographic variables.

Methods : A total of 5043 patients were screened during 8 months period, out of which 61 adults suffering from schizophrenia who gave informed consent were taken up for the study. They were assessed for presence of catatonia symptoms from a key relative using Bush Francis Catatonia Screenng Instrument (BFCSI) and then were examined for catatonic signs with Bush Francis Catatonia rating scale (BFCRS). Subjects who had at atleast two catatonic signs were considered as displaying catatonic features. Severity of psychopathology was assessed using the Positive and Negative syndrome scale (PANSS).

Results : 23 out of 61 subjects had catatonic features (37.3% of total sample). Catatonic signs were found to be more frequently present in persons having undifferentiated and catatonic subtypes. Catatonic signs were significantly more frequent in males and in subjects with higher mean PANSS negative, general psychopathology and total scores.

Conclusion : The prevalence of catatonic signs and symptoms in drug naοve/drug free persons suffering from schizophrenia in adult psychiatric is 37.3% and inturn reflects that catatonic phenomenon are still prevalent among them. It also shows correlation of catatonic phenomenon with severity of psychopathology. Further studies with larger sample size needs to be done to give greater credence to results.

Paper 12: Severe glossal injury as self harm in schizophrenia: A case report

P. K. Pardal, P. S. Bhat, M. Diwakar

Department of Psychiatry Command Hospital (CC) Lucknow, UP - 226 002, India.

Patients with schizophrenia have a substantial lifetime suicide risk, especially by violent means. They may also indulge in self mutilation, the deliberate destruction and alteration of body tissue without conscious suicidal intent. Those acts may be major in the form of eye enucleation, amputation of limbs and genitals, or minor in the form of self cutting and self hitting. These acts may occur due to command auditory hallucinations, catatonic excitement and co morbid or post psychotic depression. We present a case of severe tongue bite as self harm in schizophrenia, since no such case has been reported in literature to the best of our knowledge.

A twenty five year old Air force soldier, known case of catatonic schizophrenia on maintenance medication with olanzapine presented with relapse following stoppage of medication and domestic stress. He started biting the tongue forcefully and repeatedly causing injury and severe glossal edema. His two lower incissors got loosened and sustained dentatoalveolar fracture of mandible. He was intubated and put under sedation with general anaesthesia using Propofol for more than 36 hours and then gradually weaned off. Subsequently he made good recovery with neuroleptics.

Paper 13: Catatonia in the course of Kleine Levin syndrome: A case report

Anit Kumar Gupta, Ravindra Rao, Rajesh Sagar

Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110029, India.

Introduction : Kleine Levin syndrome (KL syndrome) is a rare disorder characterized by recurrent episodes of hypersomnia, hyperphagia and hypersexuality with a favorable course and prognosis.

Case Report : A 21 year old unmarried male with well adjusted pre morbid personality presented with an episodic illness of 10 year duration. The current episode was characterized by persecutory ideas initially for five months, followed by sitting in a single posture for hours, decreased interaction and decreased food intake over two months with socio-occupational dysfunction and decreased personal care. There were no features of hypersomnolence, hyperphagia or hyper-sexuality in the current episode. There were a total of nine episodes in the past, each episode characterized by hypersomnolence, hyperphagia and hypersexuality lasting for 1 ½ month to 2 ½ months. During the 9 th episode, obsessive images were also reported, which continued after the resolution of other symptoms. These obsessive images resolved after treatment with sertraline. Family history of psychotic illness in father was noted. On examination, general physical examination was unremarkable. There was posturing, mutism and refusal to feed. During the lucid phase (by administration of lorazepam intramuscularly), delusions of persecution with second person auditory hallucination were reported by the patient. A diagnosis of KL syndrome with catatonia was made.

Discussion : A comprehensive literature review failed to retrieve reports of catatonic symptoms occurring either as an associated symptom during the episode or in the course of KL syndrome. This is the first case where catatonia is seen in the course of KL syndrome.

Paper 14: Minor physical anomalies and neurological soft signs in neuroleptic naοve schizophrenic patients and healthy controls

Vikram Arunachalam, John P. John, R. Bhuvaneshwari, C. C. Lopes

Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore - 560 029, India.

In the etiological investigation of schizophrenia, an emphasis has been placed on the neurodevelopmental hypothesis. According to this hypothesis, schizophrenia results from an early prenatal abnormality in neurodevelopment. The relationship between minor physical anomalies (MPAs) and prenatal Insults has been clearly demonstrated.

Aim : The aim of the study is to investigate the rate and topographical pattern of minor physical anomalies and neurological soft signs (NSS) in neuroleptic naοve recent onset schizophrenics as compared to healthy controls.

Methods : 34 patients who are drug naοve, fulfilling DSM IV criteria for schizophrenia and duration of illness Results and Conclusion : There were significant group differences between schizophrenia subjects and controls on MPA and NSS. Linear discriminant functional analysis revealed that 87% of the original cases were correctly classified into schizophrenia group (82.1%) and control group (93.3%). MPA and NSS constitute important vulnerability indicators for susceptibility to develop schizophrenia.

Paper 15: Association of neurocognitive deficits with duration of illness in schizophrenia

R. K. Solanki, Renu Khandelwal, Renu Khandelwal

S.M.S. Medical College, Jaipur, India.

Introduction : Schizophrenia is one of the most severe and disabling illness of all mental illness. The diagnosis of schizophrenia involves a constellation of sign and symptoms and impairment in occupational, social and cognitive functioning. Psychiatric symptoms include delusions, prominent hallucinations, disorganized and catatonic behavior, negative symptoms include alogia, affective blunting, avolition, asociality and anhedonia. Finally a separate domain of illness that appears closely related to functional outcome involves the cognitive deficits in schizophrenia. The range of cognitive deficits is broad and includes problems in perception, attention, memory and problem solving.

There has always been a debate on nature, selectivity and time of onset of these cognitive dysfunction in relation to the onset of illness, symptomatology and duration of illness.

So we proposed this study to find out association between neurocognitive deficits and duration of illness.

Methods : In this study, 100 schizophrenic patients meeting the criterion of schizophrenia according to ICD-10, were taken at the psychiatric centre. Patients were enrolled after taking written informed consent. Patients were screened with a specially designed Proforma which include the exclusion and inclusion criteria's.

These patients were sub typed in two groups either with predominant positive symptoms or negative symptoms after using appropriate rating scale [PANSS].

Matching of these two groups were done on the basis of the age, sex, socio economic and educational standards.

Patient's socio demographic data were recorded and details of schizophrenic illness were obtained. Each group is further divided in two group according to duration of illness.

The cases were administered a battery of tests to assess their neurocognitive function.

The results were drawn, appropriate statistics were used, the results were showing that the duration of illness was not significantly associated with duration of illness.

Paper 16: Comparison on burden and coping in caregivers of persons with schizophrenia and obsessive compulsive disorder

K. M. Agarwal, Rahul Chandhok

Department of Psychiatry, VMMC and Safdarjang Hospital, New Delhi, India.

Background : Research shows that caregivers of mentally ill people also undergo considerable suffering. As the illness of a relative beings along with it various hardships, care giving becomes a chronic stressor, thus, it is important for the caregiver to cope with it efficiently.

Aims and Objectives : This study sought to compare burden experience and coping strategies adopted by caregivers of two different patient groups-schizophrenia and OCD.

The impact of caregiver's age, sex, education, occupation, marital status and relationship with the patient on burden and coping were also assessed.

This study also attempted to find the predictors of burden in caregivers of patients suffering from schizophrenia, OCD and in the total sample of caregivers.

Methods : Caregiver burden was assessed using Pai and Kapur's Burden Interview Schedule. Folkman and Lazaru's Ways of Coping Questionnaire measured the caregiver's coping. Indian Disability Evaluation and Assessment Scale assessed the disability of the patient.The total caregiver population comprised of 40 caregivers of patients with schizophrenia and 40 with that of OCD. Data collection was done at Safdarjung Hospital, Delhi.

Results : Caregivers of OCD patients experienced significantly less objective burden. However, no significant differences arose in the total coping strategies used.

Paper 17: Acute and transient psychotic disorder: 5 year outcome from Jan 2000 to Dec 2000

Antonio D'Costa, Sumitkumar Chandak, H. A. Borkar

Institute of Psychiatry and Human Behavior, Goa, India.

E-mail: [email protected]

A retrospective study was performed in the institute, of cases of acute and transient psychotic disorders from jan '00 to dec '00 and the outcome for a period of 5 years, with the diagnostic stability was obtained.

The diagnostic stability was evaluated against various variables including family loading. The results will be presented.

Paper 18: Outcome of schizophrenia: Is it really better in developing countries

Alok Agarwal, S. K. Kandelwal, Shivanand Kattimani

All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110029, India.

The outcome of schizophrenia has been a matter of speculation and debate since the time the disorder was first conceptualized. However the understanding of the course and outcome of this illness has advanced significantly after several international research projects like IPSS, DOSMeD, ISoS etc. These studies helped in discarding the Kraepelinian views of the illness having a progressively deteriorating course and established the concept of heterogeneity in the course and outcome. One of the major finding of these transcultural studies was the better outcome of Schizophrenia in the developing countries like India and infact the question that how 'societies and cultures shape the process of illness' became the DOSMeD challenge. This finding was also replicated in several of the Indian studies like (Dube et al, 1984; Verghese et al, 1989) and also in other developing countries. However, the finding of these studies is now being challenged due to some of the methodological limitations (Patel et al, 2006). Moreover, some of the recent studies from developing countries like India (Thara et al, 2004), Nigeria (Gureje and Bamidele, 1999), Ethiopia (Kebede et al, 2003) etc. have failed to replicate the previous finding of better outcome of Schizophrenia in these countries especially in functional and social domains. The current paper re-examines the evidence in support and against the long held view of better outcome of Schizophrenia in developing countries and also attempts to identify the areas where evidence needs to be generated through further research.

Paper 19: Maintenance treatment in schizophrenia


Professor & Head, Psychiatry Unit, G.S.V. Medical College, Kanpur, India

A total of 356 patients diagnosed as having schizophrenia as per the ICD-10 formed the sample of the study Patients were in the age group of 20 to 35 years. Average age was 29.37 years. Average duration of illness was 4.4 years Those schizophrenics who could completely recover from illness with a large dose of olanzapine and trifluperazine combination and could be maintained on low dose of antipsychotic drug that is 2.5 mg of olanzapine or 2.5 mg of trifluperazine were put on 2.5 mg of penfluridol once in a week. These patients were followed up for a period of 5 years. At the end of 5 years 80% of patients were well maintained. 20% patients relapsed within 2 years. Of this 15% could recover with renewed treatment with large dose of antipsychotic medication.

Paper 20: Cognitive deficits in schizophrenia

Preeti Sinha

Department of Psychiatry, All India Institute of Medical Sciences,

New Delhi - 110029, India.

The mental faculty of knowing and handling information, which includes perceiving, recognizing, judging, reasoning, and imagining, is called cognition. Tests applicable to Indian population are available for most of cognitive functions. The presence of cognitive deficits in schizophrenia is known since recognition of the disorder but poorly influencing diagnosis and management. Specific deficits are present in sub-divisions of attention, memory and executive function on the background of generalized poor performance in cognitive assessment. Almost every patient has cognitive deficits with varying degree. Generally, relative subtle deficits are there in premorbid as well as prodromal stages and become more apparent during first episode. Later on, it usually maintains stability but Aging has an impact, depending on stores of cognitive functions. Some aspects of positive or negative symptoms can be partly explained by cognitive deficits. Currently available biological hypothesis for schizophrenia gives partial explanation for cognitive deficits with emphasis on both neurodevelopmental and neurodegenerative theories. All aspects of functioning including social and occupational area are affected significantly by cognitive dysfunction, much more than expected by positive or negative symptoms, with impact on both pre-psychotic and post-psychotic phases. No definite information regarding response, dose required and its implications are available regarding the medications to be used for cognitive improvement. Atypical antipsychotics seem to be more effective than typicals but not to the extent affecting functional outcome significantly. Knowledge about other cognitive enhancer seems to be currently at primitive level. However, cognitive rehabilitation usually leads to improvement in cognitive functions but may provide partial projection in functioning.

Paper 21: Schizophrenia associated with psoriasis

Susanta K. Padhy, Suresh Kumar, N. Warikoo

PGIMER, Chandigarh, India. E-mail: [email protected]

Psychocutaneous disorders as an entity are well known, but association of psoriasis and schizophrenia is less reported in literature. In some reports, both the conditions are linked to chromosome 6.

Aim : To present a case in which Schizophrenia was associated with Psoriasis.

Case Report : A 45 yrs old male, a case of paranoid schizophrenia with psoriasis for last 10 years, seen by psychiatry referral team of PGIMER, Chandigarh. On detailed exploration, he had paranoid delusions and auditory hallucinations of commanding and commenting type. Interestingly, his psoriatic lesions and psychopathology would aggravate in summer, lessen in winter. In addition, there was very interesting, complex Phenomenological correlation between the two conditions and alcohol intake.

Paper 22: Effects of patients' dysfunction on emotional states of female spouses of chronic schizophrenic patients

Sudhir Kumar, Sandhyarani Mohanty

Institute of Mental Health and Hospital, Mathura Road, Agra - 282002, India. E-mail: [email protected]

Patient's dysfunction produces adverse effects on caregivers of the patients with schizophrenia. The index study is designed to explore to what extent patients' dysfunction produces negative emotional states in spouses of chronic schizophrenic patients. 30 Female spouses of chronic schizophrenic patients seeking consultation at OPD of Institute of Mental Health and Hospital, Agra served as study sample. Dysfunction analysis questionnaire and eight state questionnaire were administered on the participants. The results of regression analysis revealed that every domain of dysfunction contributes to one or the other negative emotional states of the spouses.

Paper 23: Evolution of insight in psychotic disorder: A prospective study from rural hospital in Vidarbha

G. Bang, P. Khairkar, N. Ingle, P. Patil

Department of Psychiatry, JNMC, Sawangi (M) Wardha, India. E-mail: [email protected]

Background : Evolution of an insight reflects the shift from an essential to an experiential understanding of mental illness. Up surging interest to interpret the differences in the various dimensions of insight in patients of psychotic disorder moved us to conduct the present study.

Aim and Objectives : To map the development and evolution of insight over 3 months in patients of first episode Psychosis and their caregivers.

Study Design : Prospective longitudinal follow-up study.

Instruments: Socio-demographic profile sheet, SCID, Beiser's scale, PANSS and SAI

Methods : Consecutive 50 patients of the first episode psychosis and their respective first degree relative were serially assessed and interviewed using structures instruments every 4 weekly for next 3 months after obtaining due ethical approval and informed consent. First episode psychotic patients were divided into schizophrenic and non-schizophrenic groups.

Results : Patients in both the groups and their relatives were assessed on various socio-demographic variables PANSS insight item and 3 dimensions of insight. Only 4% of the patients were having complete insight on PANSS scale which improved to 12% and 30% by 4 and 12 weeks respectively. While on SAI, there has been gradual improvement in insight parameters including RMI, RNT and ARPS in both patients as well as their first degree relatives.

Discussion : Insight seems to be a gradual process of adjustment to illness and to grasp the full ramification of diagnosis. Adequate treatment is a key factor in improving insight.

Paper 24: A study of catatonic signs and symptoms in patients presenting with acute psychoses

Anuj Mittal, P. K. Pathak, R. C. Jiloha

D.D.U. Hospital, New Delhi, India.

This is a prospective study done in 50 patients presenting with acute psychosis at DDU Hospital, New Delhi. Various inclusion and exclusion criteria were applied. The diagnosis was made according to ICD-10. A semi structured Proforma was used to record socio demographic profile, clinical history, various laboratory investigation results, treatment details and diagnosis. Then following scales were administered; Brief Psychiatry Rating Scale, Simpson - Angus Rating Scale, Bush Francis Catatonic Rating Scale, Abnormal involuntary movement scale and Bech Rafaelsen Mania Rating Scale. The results and implications of the findings will be discussed.

Paper 25: Catatonia: Treatment implications, an Indian perspective

Prashant Tibrewal, Amit Zutshi, B. M. Suresh

Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (Deemed University), Bangalore - 560 029, India.

E-mail: [email protected]

Catatonia, first described by Karl Kahlbaum in 1874, is the most common psychiatric emergencies seen in developing countries. There is paucity of data related to treatment and outcome of catatonia from India. The aim of the present study is to review the response rate of catatonia to Lorazepam. All consecutive patients, admitted to NIMHANS over a period of 12 months, with at least 2 signs of catatonia as per DSM-IV criteria were taken up for the study and their clinical charts reviewed. 62 patients met the criteria of the study.

The patients admitted to the hospital were extensively evaluated at baseline usinga proforma(based on Mayer Gross proforma followed in NIMHANS for all inpatients) for evaluating the psychiatric disorders by a post-graduate junior resident in psychiatry and findings further confirmed by at least two qualified psychiatrist, one of whom was a senior consulting psychiatrist of the treating team. For the present study the clinical charts has been reviewed and consensus opinion was taken from two qualified psychiatrist. Results and implications of the study will be presented.


Paper 1: Depression and disability in schizophrenia

K. Ramakrishnan, N. Arunkumar, M. B. Rajaram, Sujeetha, A. Ayesha Beevi

Neurocentre Triuchirapalli, Tamilnadu, Neurocentre No.12 BAC 10 th Cross East, Thillai Nagar, Triuchirapalli, Tamilnadu, India. E-mail: [email protected]

Depression is one of the commonest commorbid psychiatric conditions associated with schizophrenia. Comorbid depression is found to be associated with poor overall outcome, work impairment, lower activity, dissatisfaction, and suicidal tendencies.

Presence of depression has negative impact on rehabilitation, increased suicidal rates and makes the illness more disabling.

Aim : to study the rate of depression in patients diagnosed with schizophrenia.

To assess the disability in these patients.

Methods : 100 consecutive patients diagnosed as schizophrenia using DSM IV were studied. Illness characters were recorded using PANSS scale; presence of depression was identified using Hamilton depression rating scale, and Calgary depression scale.

Disability was recorded using IDEAS.

Other demographic characters like education, current occupation, living circumctances were noted.

Results : Will be discussed at the presentation.

Paper 2: Depression and anxiety disorders following stroke

N. Arunkumar, M. Rajaram, K. Ramakrishnan, R. Sundarajan

Neurocentre Trichirapalli TamilNadu, Neurocentre No.12 BAC 10 th Cross East, Thillai Nagar, Triuchirapalli, Tamilnadu, India. E-mail: [email protected]

Depression and anxiety are the commonest emotional disorder following cerebrovascular disease. Life events and location of stroke in the brain determines the prevalence of these disorders. Presence of depression or anxiety found to have a negative on the prognosis of the stroke.

Aim : To study the prevalence of depression and anxiety disorders following stroke.

To study the social impact following stroke.

To neurologically correlate the site of lesion and the emotional disorders.

Methods : 100 consecutive patients who attended NEUROCENTRE during follow up were interviewed using MINI neuropsychiatry inventory for depression and anxiety. Clinical diagnosis was made using DSM IV criteria. Illness severity measured using Hamilton depression rating scale.

Site of the lesion was noted clinically and using CT findings.

Life events preceding and following stroke was clinically correlated.

Results : Will be discussed at the presentation.

Paper 3: Social origins of depression in women: An experience from South India

K. S. Pavithra, K. R. Sridhara

Sridhar Narsing Home. E-mail: [email protected]

Over the course of a lifetime, depression occurs in approximately 20 percent of women compared with 10 percent of men. Although the exact reason for this difference is not known, the higher prevalence of depression in women is most likely due to a combination of gender-related differences in cognitive styles, certain biologic factors and a higher incidence of psychosocial and economic stresses in women. Possible biologic mechanisms may include differences in brain structure and function, genetic factors and the cognitive-behavioral or mood-related effects of female gonadal steroids on neurotransmitters and enzyme functions in vulnerable persons.

The objective of the study was to examine the differences in social origins of depression in men and women. One hundred married women and one hundred married men participated in the study. Apart from a detailed history taking and mental status examinations structured scales were used to detect depression and psychosocial problems.

Coping difficulties in joint familiy system, having female children, lack of intimate tie with husband, sexual problems, illness in children and poor coping with children's problems emerged as the significant factors. Implications of these findings in the management of depression in women will be discussed in the presentation.

Paper 4: Depression in dementia subtypes

Charles Pinto, A. B. Shah, Suvarna Karande, Mira Shah

T.N.M.C. & B.Y.L. Nair Hospital Mumbai, Bombay Central, Mumbai - 400008, India.

Introduction : One of the clinical challenges lies in the differentiation between dementia and depression. It is of major importance to diagnose the patient with depression, because this condition is treatable and is not associated with bad prognosis. Depression can be the first symptom of developing dementing illness and is considered to be the risk factor for AD. At least one-third of all patients with AD will suffer from depressive symptoms at some stage of their disease. Depression is acute in onset with short duration history, patient has memory complaints for both recent and remote memory, as against recent memory loss only in early stages of dementia. Also, orientation and attention not affected in depression. Clock drawing test is not affected in depression as well. Validity of depressive symptoms as reported by patients suffering from dementia is questionable, hence history from caregiver also has to be taken into account.

Aim : 1) To analyse prevalence of clinically significant depression in patients of dementia. 2) To relate self reported depression by person with dementia using GDS with associated behavioural problems as rated by a family caregiver using NPI. 3) To compare the percentage of depression in subtypes of dementia.

Methods : Elderly patients above 45 years with memory and other cognitive complaints were screened at municipal hospital for dementia. After obtaining socio demographic data, patients presenting with depressive symptoms were screened using GDS. Care takers were evaluated using NPI for assessment of behavioural problems in patients.

Results and Conclusions : Will be discussed during the presentation.

Paper 5: Premenstrual dysphoric disorder as a risk factor for antenatal depression

Sidhesh Phaldessai, Yvonne S. Pereira

Institute of Psychiatry and Human Behavior, Bambolim, Goa, India.

Introduction : Premenstrual dysphoric disorder (PMDD) is seen in 2-10% of women in the reproductive age group. It has been associated with a higher incidence of depression in later life. Reports of the course of PMDD in pregnancy are variable. In this study we examined the frequency of PMDD in women diagnosed with antenatal depression.

Aims and Objectives : To determine whether women diagnosed with antenatal depression had a higher frequency of PMDD compared to healthy subjects.

Methods: 210 patients attending the obstetrics and gynecology outpatient clinic were screened using the Edinburgh Postnatal depression scale which has been validated for use in pregnancy. The patients were retrospectively assessed for symptoms of PMDD. A standardized personal interview was performed to make a diagnosis of PMDD based on DSM IV criteria. 46 patients were found to be having clinical depression.

Results : A significant association was found between the presence of PMDD in the past; and current antenatal depression.

Premenstrual dysphoric disorder may be a risk factor for antenatal depression: Which has been associated with adverse impact on the health of both: The mother and child.

Paper 6: Depression in patients of diabetes mellitus

Vaibhav Dubey, R. K. Solanki*, Paramjeet Singh*, Renu Khandelwal, Aarti Midha*, Deepti Munshi*

P.C.M.S. Bhopal, *S.M.S. Medical College, Jaipur, India.

E-mail: [email protected]

Identification and effective treatment of Comorbid depression increasingly is considered an essential component of high quality clinical care of patients with chronic medical illness in the speciality medical setting. Of all the major chronic medical illness, diabetes mellitus may be particularly affected by depression. Diabetes is considered one of the most psychological and behaviorally demanding of the chronic medical illnesses. Co-morbid depression in diabetics may lead to poorer outcomes and increased risk of complication by lowering adherence to glucose monitoring, exercise, diet and medication regimes.

The emerging interest of the medical community and scarcity of the Indian studies we planned to assess the

Sociodemographic characteristics of diabetic subjects who have depression.To find out prevalence of co-morbid depression in diabetic subjects and its severity.To assess Cognitive performance in diabetic subjects having depression.

Instruments of study:

Screening proforma

Self made proforma - demographic data

- Data about the diabetes mellitus

Beck depression inventory (BDI)

Neuropsychological tests

a. Digit span test (DST)

b. Stroop test

c. Controlled oral world association test (COWA)

d. Visual target cancellation test

e. Digit symbol substitution test (DSST)

f. Visuo-spatial working memory test.

Operational Method : 50 patients of diabetes mellitus were taken from diabetic clinic, S.M.S. Medical College, Jaipur meeting the inclusion criteria. 30 comparable normal subjects formed the control group. The sociodemographic characteristics and details of diabetes of each subject were recorded on proforma followed by Beck depression inventory and series of neuropsychological tests to assess depression, its severity and status of cognitive impairment.

Results : In our study 36% diabetic patients were significantly depressed as compared to controls. 12% patients were suffering from mild depression, 16% from moderate depression, 8% with severe depression. Cognitive performance in our study was not found significantly correlated with depression.

Paper 7: Depression in long term spinal cord injury

Harpreet Singh

Department of Psychiatry, Military Hospital Kirkee, Khadki, Pune - 411020, India.

Depressive symptoms are extremely common after spinal cord injuries, and many studies have reported that almost all patients with traumatic paraplegia or quadriplegia experience depression at some time during the course of their illness. However most studies do not distinguish between depressive disorders and sub-syndromal depressive symptoms. In this study 50 cases of traumatic paraplegia/quadriplegia were assessed for depression using clinical interview and ICD-10 Diagnostic Criteria. All patients were also administered the Beck's Depressive Inventory (BDI) for quantification of depressive symptomatology. The duration of injury in all cases was more than 3 years and all were staying in a long term rehabilitation centre for disabled soldiers. Five patients (10%) met the criteria depressive episode and two (4%) met the criteria for dysthymia. Twenty seven patients had some depressive symptoms which were not clinically significant. There was no significant difference between tetraplegics and quadriplegics with regard to prevelance of a depressive disorder or the severity of symptoms. The duration of injury was also not correlated with occurrence or severity of depressive symptoms. The implications of the findings will be discussed.

Paper 8: Disability associated with bipolar affective disorder

Nand Kumar, Rajesh Sagar, Sujata Minhas

Department of Psychiatry, 4 th Floor, Teaching Block, AIIMS, Ansari Nagar, New Delhi, India.

Introduction : Disability related to mental disorder accounts for quarter of the world's disability and 9% of the total burden of disease and bipolar affective disorder is one of the five leading cause of mental disability. In India it is estimated that about 60 million people are suffering from one or other type of disability of various degree.

This study was planned to assess the disability associated with bipolar affective disorder and to compare the nature and degree of disability in one year on different disability instruments.

Methods : This study is part of WHO study conducted in the department of psychiatry All India Institute of Medical Sciences (AIIMS), New Delhi, India from August 2003 to December 2004. Total no of 36 patients of bipolar affective disorder as per ICD-10 were included for the study.

After Informed consent WHODAS II, Indian disability evaluation assessment scale (IDEAS), London Handicap scale (LHS) were administered by research assistant on baseline then subsequently at 6 months and one year. Trained research psychiatrist administered YMRS and HAMDRS at baseline and then after one year of initial assessment.

Results : The mean age of the patients was 32.81 ± 12.95 years. Male patients constituted 52.8 percent of sample and rest were female. Approximately 1/3 of patients were employed with 9.17 mean years of education on baseline assessment. Mean YMRS score on baseline and after 1 year of assessment reflected statistically highly significant difference (30.03:2.56) than mean HMDRS score (15.33:7.16). On prospective disability assessment (baseline, 6 months and 1 year) significant difference was observed in all the domain of IDEAS and WHODAS II except domain V.2. of WHODAS II. The LHS also reflected significant improvement in disability in all the domain except domain 5 and domain 6. The IDEAS showed significant improvement in all the domains.

Conclusion : There is significant improvement in disability score on IDEAS, WHODAS-II, LHS and marked reduction in severity of symptoms as per YMRS and HAMDRS on longitudinal assessment.

Paper 9: A study of physical comorbidity in patient with depression in psychiatry OPD

Krishna Kumar Singh, P. K. Singh

Patna Medical College, Ram Jaipal Road, New Bailey Road, Danapur, Patna - 801503, India.

Somatic symptoms of different kinds are often seen in patients of Depression Somatic symptoms are also suggestive of possible co-existing physical illnesses. It is also known that physical illnesses are relatively more common in patients of Depression. To gain greater insight into the inter relationship between physical illnesses and depression, 100 consecutive patients of Depression presenting in the Psychiatric OPD of Patna Medical College were examined for presence or absence of co-morbid physical illnesses through symptom check-list, clinical examination and biochemical investigations. Study comprised of 100 cases of depression between age group 21-60 (males 53 and females 47); 22 males had physical illnesses as compared to 17 females 34 patients had only one associated physical illness and the remaining 5 had more than one physical illnesses. Various physical illnesses seen in the present study were hypothyrodism (8), hypertension (9), diabetes mellitus (8), heart disease (3) Irritable Bowel syndrome (5), peptic ulcer (2), COPD (1), TB (2), osteoarthritis (3), STDs (2) infections (1), renal failure (1). Patients having depression for less than 1 year were substantially less likely to have associated physical illness (6 out of 14) as compared to those having illness for more than 10 years (3 out of 3). Similarly patients having initial HAM-D score between 8-13 were less likely to have associated physical illnesses (8 out of 26) as compared to those have in HAM-D. Score 23 and above (13 out of 24). The statistical and clinical significance of these findings shall be presented and discussed in the paper.

Paper 10: M.D.D. Due to forcible rape: A case report

Manaswini Dash, Mihir Ranjan Nayak

IV.S.S. M.C.H. Burla, Sambalpur, Orissa - 768017, India.

Rape is increased more rapidly in the last decade than any other type of violent crime. But due to social stigma very few of them come to sight.

A 19-yr old girl came to me with her mother who was completely in a stupor state. She was suffering from 'mutism" which is very often seen in MDD. But her family members tried to hide all the fact. One of her cousin brother gave some hint which helped me a lot to find the root cause.

After that I consulted with a psychiatrist for pharmacological treatment and I started psychotherapy as an adjacent.

By subsequent follow-ups the girl tried to talk a little. After a few days I asked repeatedly about rape and her affect was depressed every time. After developing free-associate, that girl described about being raped 3 times by one of her family members. After that she cried with a loud voice-that nobody will marry me specially that person whom I loved. That helped me a lot to treat her.

After that I gave her insight-oriented psychotherapy with the pharmacological treatment. And the result was her happiness and the smiling faces of her family members. So no doubt combined psychotherapy and pharmacotherapy gave a drastic result within 2 months. But till 6 months the treatment undergoes. And now she recovered fully.

Paper 11: Study of anxiety and depression in rheumatoid arthritis

Sanjay Acharya, A. Rathi, B. Jadhav, H. S. Dhavale, Sunitha Shanker

K. J. Somaiya Hospital and Research Centre, Sion, Chunabhatti,

Mumbai - 400022, India. E-mail: [email protected]

Rheumatoid arthritis is a chronic disabling autoimmune disorder characterized by persistent inflammatory synovitis, typically involving peripheral small joints in a symmetrical pattern. Because of a disabling course, an individual with rheumatoid arthritis experiences more psychiatric sequelae than a healthy individual. Patient experiences life stress not only because of burden of chronic physical symptoms but also because personal losses resulting from rheumatoid arthritis and associated disabilities. When the clinical picture of rheumatoid arthritis becomes complicated with anxiety or depression, problems with patient adaptation and response to treatment may occur. In view of this we decided to conduct a study with the following aims;

1. To study the prevalence of depression and anxiety in patients with rheumatoid arthritis.

2. To assess the quality of life in these patients. Thirty consecutive patients diagnosed as rheumatoid arthritis interviewed using a semi structured proforma designed specifically for this study. Psychiatric morbidity assessed using Hospital anxiety and depression scale and WHO QOL (BREF) administered to assess the quality of life. Data pooled and subjected to statistical analysis. Results will be discussed in view of available literature.


Paper 1: Course and outcome of obsessive compulsive disorder and its impact on quality of life

A. Praveen, C. Ashutosh, P. S.V.N. Sharma

Department of Psychiatry, Kasturba Medical College, Manipal, Karnataka - 576104, India. E-mail: [email protected]

Background : Being a chronic illness with a waxing and waning course, obsessive compulsive disorder has an impact on quality of life. An attempt is made to study the same in a tertiary care center.

Aim: To study the course and outcome, and quality of life in patients treated for obsessive and compulsive disorder.

Methods : All cases of obsessive compulsive disorder who presented to the dept of psychiatry, KMC Manipal between Jan 1 st 2003 and Dec 31 st 2005 (n=73). Of these subjects who had come for follow up during the period of May 1 st and Sep 30 th 2006 and had consented for the study (n=16) had been assessed using Y-BOCS, HAM-D and WHO QOL BREF

Results : The data will be analyzed and presented

Paper 2: Kenyon revisited: The primary secondary debate from a tertiary care center

N. Mona, C. Ashutosh, P. S.V.N. Sharma

Department of Psychiatry, KMC Manipal Karnataka - 576104, India.

E-mail: [email protected]

Background : Diagnosis of hypochondriasis has been plagued by primary secondary debate from very beginning. An attempt has been made to study the same in a tertiary care center.

Aim : The primary aim of the study was to assess diagnostic stability of hypochondriacal disorder. The secondary aim was to establish other primary/co-morbid diagnosis in the sample.

Methodology : All cases of hypochondriasis who presented to KMC, Manipal from 1996 to 2006 were taken. We looked at Co-morbid psychiatric diagnosis, physical diagnosis, sociodemographic variables and the stability of the diagnosis.

Results : The results will be detailed later.

Paper 3: Retrospective analysis of patients with migraine attending psychiatric OPD in the year 2005 at a general hospital

Riswin. R. Babu, S. Kotresh

Department of Psychiatry, KMC, Manipal, Karnataka - 576104, India.

E-mail: [email protected]

Aims and Objectives : To examine socio-demographic profile and psychiatric co-morbidities in patients with migraine.

Methods : Retrospective analyses of records of all patients who had been diagnosed with migraine by neurologist/psychiatrist attending psychiatric OP service at Kasturba Medical College, from January 2005 to December 2005. The details regarding socio-demographic profile and co-morbid psychiatric diagnosis were collected. The relationship between the socio-demographic variables of migraine and psychiatric co-morbidity were assessed.

Results : The sample size was 58 (N). It represented 87.9% females and 12.1% males. The samples consisted of 17.2% in the 18-25 age group, 56.7% in the 26-45 age group and 25.9% in the above 45 age group.

Conclusion : Gender and the age at onset of migraine showed significant correlation (sig=0.00). Other findings will be discussed.

Paper 4: A study on quality of life in OCD

V. Karthikeyan, S. J. Daniel, M. Jayakumar, M. Murugappan

Institute of Mental Health - Chennai, India.

Aim : To determine the quality of life in OCD.

Background : OCD is a widely prevalent disorder with significant psychiatric comorbidity and social and occupational dysfunction and impairment in quality of living. Studies have demonstrated that the quality of life (QOL) in OCD is much impaired and that this might depend on features like disease severity, treatment response, regularity of treatment, comorbid disorders, side effect of drugs.

Methods: The study is done on 30 patients diagnosed as OCD, on treatment, attending the neurosis clinic in IMH, Chennai. The diagnosis and symptom severity are determined by Y-BOCS scale and nature of symptoms by the Y-BOCS checklist. The Quality of Life was assessed by WHOQOL-BREF scale. The correlation of the QOL with socio demographic variables like age, sex, occupation, marital status, symptom severity, nature of symptoms and drug side effects are analysed. Appropriate statistical methods are used.

Result : The results of the study will be discussed during presentation.

Paper 5: A study of quality of life and eating behaviour of obese females

Abhay Paliwal, R. K. Solanki, Krishna Kanwal, Suresh Gupta, Aarti Midha, Navendu Gaur

M.G.M. Medical College, Indore, *S.M.S. Medical College, Jaipur - 302017, India.

According to Columbia encyclopedia, obesity is defined as a condition resulting from excessive storage of fat in the body. These are those who abuse food, love to eat food. They enjoy the crunch of food, and/or love to create with it, as a result of these joys with food they over indulge and/or abuse food. Han had concluded that large waist circumference and high BMI are more likely to be associated with impaired quality of life.

This study was conducted at obese clinic of department of medicine S.M.S. Medical College, Jaipur to assess the quality of life and eating behavior of obese females.

30 subjects meeting the inclusion criteria with their verbal consent and 30 comparable normal weight females were registered for the study.

The sociodemographic characteristics were recorded on proforma followed by hindi version of eating attitude test-26 (EAT-26) and short-form health survey (S.F.36) self rating scales to know their eating attitude and quality of life.

In our study obese females scored higher on E.A.T. scale showing more abnormal eating behavior. Further on S.F. 36 scale they score lower on physical functioning, role impairment due to physical functioning, bodily pain and general health. Regarding the mental health, obese subjects scored significantly lesser than control group.

Paper 6: Bipolar and non-bipolar obsessive - compulsive disorder: A clinical exploration

Y. C. Janardhan Reddy, Amit Zutshi, B. M. Suresh

Department of Psychiatry, NIMHANS, Hosur Road, Bangalore, India.

In the last few years, effects of co-morbid anxiety disorders in general, and OCD in particular in bipolar patients have been extensively studied. However there is a paucity of studies looking at effect of bipolarity on the co-morbid OCD. The objective of the present study is to compare the clinical characteristics of bipolar and non-bipolar obsessive-compulsive disorder (OCD). Twenty-eight subjects with bipolar-OCD co-morbidity were chosen from a sample of 80 remitted bipolar subjects (bipolar OCD) attending the outpatient services of the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India over a period of 11 moths. Seventy-eight non-bipolar OCD subjects were recruited consecutively during the same period from the OCD clinic of the institute. They were assessed systematically using both structured and unstructured clinical interviews and corroborative information was obtained for all patients from the immediate family members and hospital clinical charts. Bipolar OCD subjects were characterized by episodic course of OCD, high family loading for mood disorders and co-morbidity with depression, social phobia and generalized anxiety disorder. They had less severe OCD and had somewhat different symptom profile compared to non-bipolar OCD. OCD predated bipolar disorder in 54% of the bipolar OCD subjects. A majority of bipolar OCD subjects reported worsening of OCD in depression (n = 22, 78%) and improvement in manic/hypomanic episodes (n = 18, 64%). OCD in subjects with primary diagnosis of bipolar disorder seems to have a closer relationship to bipolar disorder than OCD. This is strongly supported by the episodic course of OCD, high familial loading for mood disorders and worsening of OCD in depression with improvement in hypomania/mania phases. There is a need for systematic exploration of the OCD-bipolar co-morbidity in both OCD and bipolar samples.

Paper 7: The clinical features and phenomenology of obsessive compulsive disorder in patients with and without co-morbid schizophrenia

Y. C. Janardhan Reddy, Ravi Philip Rajkumar

National Institute of Mental Health and Neurosciences, Bangalore - 560029, India.

Obsessive compulsive disorder (OCD) is a common co-morbidity in schizophrenia. However, no studies have compared the phenomenology or clinical profile of OCD in schizophrenia with that of patients with OCD alone. The current study aims to examine differences in the phenomenology and clinical profile of OCD in patients with and without schizophrenia.

50 patients with schizophrenia and OCD (SCZ+OCD) rated as moderately ill (CGI-S of 4 and above) and 77 patients with OCD alone, diagnosed using DSM-IV criteria, were recruited from NIMHANS. They were assessed using structured instruments.

Patients with SCZ+OCD had a later onset and a shorter duration of OCD. They had fewer obsessions and compulsions. Y-BOCS obsessions and total scores were lower, but they showed significantly poorer insight into OCD. Obsessions related to symmetry, contamination and hoarding and miscellaneous compulsions were less common in SCZ+OCD, The SCZ+OCD group had less co-morbid depression, but more co-morbid substance use, specific phobia and schizoid personality disorder. Finally, SCZ+OCD patients had poorer global functioning, more hospitalizations, and received less trials of anti-obsessionals.

These findings suggest that patients with OCD and schizophrenia may present earlier, but have poorer insight into their OC symptoms in spite of having fewer OC symptoms. They have poorer functioning, less co-morbid depression, and more substance use disorders, and are under treated for their OCD. These findings suggest the need to recognize and treat OC symptoms in schizophrenia more actively to improve functioning, while the finding of poorer insight suggests that this may represent a specifically "psychotic" dimension of OCD, and may have implications in terms of treatment.

Paper 8: A 5-year course obssessive-compulsive disorder: Predominality obsessive vs. mixed subtypes

Suresh Bada Math, T. Jaideep, Y. C. Janardhan Reddy, P. N. Majoj, V. Mathew, A. M. Adarsh

Department of Psychiatry, NIMHANS, Hosur Road, Bangalore - 560029, India.

Obssessive-compulsive disorder (OCD) is considered a heterogeneous disorder. One of the traditional approaches to subtype OCD is based on the predominance of obsessions, compulsions or both. This method is employed by the ICD-10. However, this approach is less well studied although there is conflicting evidence regarding the relation between subtypes and treatment response. This study, therefore, examines the 5-6 year course of "predominantly obsessive" subjects in comparison with "mixed" OCD subjects in a retrospective cohort design.

The study included 54 subjects with "predominantly obsessions" and an equal number of the "mixed" subtype of OCD. They were recruited from the database of a specialty OCD clinic in India for the years 1999 and 2000. All the 54 obsessive subjects out of a total sample of 440 DSM-IV OCD subjects were included in the study. For comparison, we randomly selected 54 subjects from the remaining sample of mixed OCD subjects. We attempted follow-up 5-6 years later; 38 of the obsessive group (70%) and 30 of the mixed group (72%) could be traced and evaluated. The evaluated and unevaluated subjects did not differ significantly with respect to certain important demographic and clinical details, The course was determined according to the predefined criteria. A majority of the sample (72%) did not have clinical OCD; however, there was no difference in the course between the two subtypes. Diagnostic stability was high in both the groups. Although the OCD subtypes remained stable over the years, the course was similar. Thus, the course does not validate the subtyping method that is currently employed by ICD-10.

Paper 9: A eating behavior of obese females

R. K. Solanki, Abhay Paliwal, Paramjeet Singh, Aarti Midha, Abhay Paliwal

S.M.S. Medical College, Jaipur, M.G.M. Medical College Indore, India.

Encyclopedia Britannica defines obesity, as excessive accumulation of body fat, usually caused by the consumption of more calories than the body can use, pointing out that the excess calorie intake is stored in the body as fat, or adipose tissue.

McFarland and Baker - Baumann (1996), note that disturbances in the way women perceive their bodies influence their eating pattern and self-esteem. In this sense, women can trap themselves into a negative vicious circle. Having a distorted image of their bodies and a consequent low self-esteem, they can develop eating disorders and become overweight. The present study was planned to test the hypothesis that psychiatric profile and eating attitude of obese subjects differ from normal weight subjects. 30 obese females meeting the inclusion criteria with their verbal consent were registered from obese clinic of department of medicine S.M.S. Medical College, Jaipur to assess the psychiatric profile and eating behavior. 30 comparable normal weight females were also registered for the study.

The sociodemographic characteristics of each subject were recorded on proforma followed by hindi version of self rating scales of Middlesex Hospital Questionnaire (M.H.Q.) and Eating Attitude Test 26 (E.A.T. - 26) to know the psychiatric profile and eating attitude.

In obese subjects scores on subscale of M.H.Q. i.e., free floating anxiety, phobic anxiety, obsessional trait, somatic symptoms were significantly different from normal weight subjects while there was no difference in scores on hysterical subscales. The obese females scored higher on eating attitude test (E.A.T.-26) showing more abnormal eating behavior. To conclude the obese females are vulnerable to psychological ill health.

Paper 10: Panic attacks in a teaching hospital in rural South India: Pattern of presentation, and co-morbidity

Christina George, Gauthamdas, Kishore Kumar, Jacob John

Department of Psychiatry, S.M.C.S.I Medical College Hospital, Karakonam, Trivandrum, Kerala, India.

Background : We find that many individuals attending the psychiatric department present with symptoms suggestive of panic attacks. Our review of literature shows a paucity of studies on panic disorder / panic attacks in India. Most studies in international literature are on individuals without any psychiatric or medical co-morbidity. The life time prevalence of panic disorder has been estimated to be 1% to 3%. However there is a disproportionate use of the health care resources by this population.

The aim of the study was to determine the source of referral of patients, co-morbidity and outcome of individuals treated for, panic disorder/panic attacks.

Methods : Data on 53 patients, presenting consecutively to the psychiatry department with panic disorder/panic attacks for 12 consecutive months, was analyzed.

Results: Over 80% of the patients were referred from general medicine, and other specialities. 67.3% had psychiatric co-morbidity and 55.8% had medical co-morbidity. 42 patients were treated for periods longer than 8 weeks.

Conclusion : The majority of patients with panic disorder or panic attacks do not seek mental health care spontaneously. There is a high percentage of psychiatric and medical co-morbidity in patients with panic attacks. A number of patients fulfilled criteria for panic attack and panic disorder. Prospective studies on panic attacks are required for extrapolating the findings.

Paper 11: Youth with anxiety disorders in partial hospitalization: Predictors of treatment outcome

Thatte. S.. Westmacott, R., Woods, V.. Nguyen, H., Makinen. J. & Flament. M.

Royal Ottawa, Mental Health Centre, Ottawa, Canada

A youth (15 - 18 years) partial hospitalization program (YPHP) has been implemented at the Royal Ottawa Mental Health Centre, Ontario, Canada. Many youths in YPHP are diagnosed with an anxiety disorder, which interferes negatively with their school and social functioning and daily life. It is necessary to determine individual predictors of treatment response, to tailor treatment to youth who may require a different level of care or specialized treatment approaches. The purpose was to identify illness-related and environmental predictors of treatment outcome in YPHP adolescents diagnosed with an anxiety disorder. Current DSM-IV disorders at admission were confirmed using the Children's Interview for Psychiatric Syndromes (ChIPS). Patients (n=50; 34 girls and 15 boys; mean age = 16.16, SD = 1.14 years) were assessed at admission and discharge for clinical symptoms (Brief Psychiatric Rating Scale-Expanded Version; BRPS-E) and psychosocial functioning (Child and Adolescent Functional Assessment Scale. CAFAS). First, repeated measures ANOVAs indicated significant improvements in both clinical symptoms and functioning (PPaper 12: An analysis of anxiety disorders in cognitive impairment

Manu Tiwari, Ravindra Kamath, Seetha Ramanathan, Priya Sivashankar

TNMC & B.Y.L. Nair, Hospital, Bombay Central, *Dept. of Psychiatry, KEM Hospital, Mumbai, India.

Introduction : The prevalence of anxiety disorders among the elderly varies from 10% in individuals without cognitive impairment to approximately 70% among elderly with dementia. Anxiety disorder is very often accompanied by co-morbid depression, and frequently masked as a somatic symptom; thereby going unrecognized and untreated. Among individuals with cognitive impairment, anxiety symptoms are commonly accompanied by physical symptoms such as wandering and aggression. These physical symptoms can cause immense distress to the caregivers and management of the same form an essential component of treatment of dementia.

Among the behavioral symptoms that accompany memory impairment, anxieties and phobias form an important and distressing component.

Aim : To analyze the prevalence of anxiety disorders among elderly individuals with cognitive impairment (dementia and MCI).

Methods : Randomly selected individuals coming to the Psychiatry out patient department diagnosed as having cognitive impairment (Dementia and MCI) were screened for anxiety disorders (GAD, OCD, panic and phobia). Screening was done using the GAI and a clinician's judgment. These individuals were then classified into two groups: I a - with anxiety symptoms and I b - without anxiety symptoms.

Results and Conclusions : Will be discussed during the presentation.

Paper 13: Study of obsessive compulsive disorder in pregnancy and puerperium

Sushil Dadaji Gawande, Alkasubramaniyam, Ajita Nayak, R. R. Patel

Department of Psychiatry, Opp Building Second Floor, SIR J.J. Hospital, Byculla, Mumbai - 400008, India. E-mail: [email protected]

Aims : 1) To determine prevalence of OCD during pregnancy and Puerperium. 2) To study types of obsessions and compulsions. 3) To evaluate differences between OCD and non OCD cases with respect to sociodemographic factors, parity, obstetric history, past history, associated disorders and personality fruits.

Methods : 75 ANC and 75 PMC patients were interviewed using semistructured proforma Diagnosis of OCD was done by using DSMIVTR criteria while severity by YBOCS HDRS applied for co-morbid depression. SCIDH was used for personality fruits. Statistics by SPSS 11.5.

Conclusion : 1) The prevalence of OCD in pregnancy and puerperium was 12.00%. 2) Aggressive obsessions to harm the baby were found in 11.11% of patients. 3) Severity of OCD was mild or moderate. No cases of severe OCD were fund. 4) Onset of OCD was significantly higher in ANC period. 5) Patients were significantly from nuclear family. 6) In 50% depression was present.

Paper 14: Obssessive-compulsive disorder with bipolarity: A comparative study

Rajnarayan M., Amit Zutshi, B. M. Suresh, Y. C. Janardhan Reddy

National Institute of Mental Health and Neurosciences, Bangalore.

Since last 10 years various studies have inferred that comorbidity of OCD in primarily bipolar patients has substantial impact on the course, treatment and prognosis of bipolarity. However there is a paucity of studies on effect of bipolar disorder on primary OCD patients who have underlying bipolarity. These patients turn into BPAD during the natural course of illness or due to treatments with antidepressants or any other treatment modality. This study aims at evaluating clinical characteristics of OCD patients with underlying bipolarity. Thirty patients with primary diagnosis of OCD, who have later received diagnosis of BPAD were selected by purposive sampling and were compared with thirty randomly selected patients with diagnosis of OCD those who did not receive life time diagnosis of BPAD. Both the groups were compared in terms of different clinical characteristics. The diagnosis at the baseline was made by atleast 2 clinicians (one of them was a senior consultant) by using semi-structured interview (MINI PLUS). Results and implications of the study will be discussed at the conference.

Paper 15: Sociodemographic and psychosocial correlates of somatization in a community clinic

Akash Kumar Mahato, Susmita Halder, Deepak Kumar, Giri, Suprakash Chaudhury, P. K. Chakraborty

Department of Psychiatry, Ranchi Institute of Neuropsychiatry and Allied Sciences (RINPAS), Kanke, Ranchi - 834006, Jharkhand, India.

E-mail: [email protected]

Somatization is a global disorder. People with somatization often fail to recognize their symptoms and keep changing physicians. The disorder is more common in developing countries, especially among women. Various studies have related sociodemographic and other psychosocial factors with somatization among patients. The motive behind the study was to explore the sociodemographic and psychosocial nature of these patients. As it was noticed that a large number of these patients belonged to a particular age group, sex, and religion. The present study was conducted at a community outreach clinic run by RINPAS at Hazaribagh. 60 consecutive patients with bodily symptoms without any demonstrable physical basis and an equal number of age and sex matched healthy controls were studied. The Bradford Somatic Inventory, and the Hospital Anxiety and Depression Scale were used to assess the somatic symptoms and associated depression and anxiety. Results will be presented and discussed.

Paper 16: Behavioral problems and temperament in children with epilepsy

R. T. Jose, M. P. Appaya, M. V. Ashok

Department of Psychiatry, St. Johns Medical College Hospital, Sarjapur Road, Bangalore, India. E-mail: [email protected]

Background : Many studies report a higher rate of psychiatric morbidity in children with epilepsy. Whether epilepsy influences temperament or specific behavioral responses remains uncertain.

Aim : To study the behavioral problems and temperament of children with epilepsy as compared to normal children.

Methods : 75 school going children aged between 6 and 12 with a diagnosis of epilepsy from two tertiary hospitals were studied. The mother was interviewed to collect socio-demographic data, family history and to rate children on the strengths and difficulties questionnaire (SDQ) and the temperament measurement schedule. Teacher reported SDQ was available for a majority of the children. Age and sex matched normal controls were used for comparison.

Results : 16% of epileptic children were rated by mothers abnormally high in all categorgies - conduct problem, emotional difficulties, hyperactivity, peer problems and poor prosocial behaviors. 25% of epileptic children had abnormal score in all domains are rated by teachers. The epileptic group was significantly different from controls in emotional problems (P=0,04) and total difficulties (P=0.01) subscale of the SDQ. In temperamental dimensions, epileptic children had higher levels of activity and intensity of reaction.

Conclusion : Children with epilepsy were found to have a higher incidence of behavioral problems and temperamental vulnerabilities. It is necessary to study such issues in a longitudinal design with a developmental perspective.

Paper 17: A study of phenomenology of non-epileptic seizures in psychiatric OPD

Santosh Kumar, P. K. Singh, K. K. Singh

Department of Psychiatry, Patna Medical Callege, Patna, India.

E-mail: [email protected]

Patients presenting with 'seizures' of non-epileptic nature is quite common in psychiatric OPDs. Often it is thought to be insignificant and inconsequential and is referred to as 'hysterical', conversion disorder' or suggestive of manipulative motives. Clinical experience suggests that not uncommonly a NES may occur in the context of another psychiatric disorder of greater significance, thereby dictating different lines of treatment. Present study was designed to study the phenomenology of individual NES episodes as well as the context of psychiatric diagnosis in which they occur.

Fifty, almost consecutive, patients presenting with non-epileptic seizures were studied for this purpose. These patients were mostly females, had poor educational attainments, were mostly from rural background; many patients had history of trauma to head and of having witnessed an episode of seizure earlier; most of them had history of significant recent or concurrent stresses; most of them had sudden onset, variably prolonged duration and rapid recovery; onset was often associated with experiencing darkness in front of eyes, followed by a mute motionless posture with closed eyes, some also exhibited asynchronous or stereotyped movements; neither incontinence nor any significant bodily injury was seen.

Patients presenting with NES episodes only were in a minority; majority had associated features which often necessitated another psychiatric diagnosis which includes depression, GAD, mood disorder, schizophrenia, personality disorder. malingering, acute Grief reaction, Acute Stress Reaction. Nosological status of an NES' episode will be discussed in light of observations of this study.


Paper 1: Patients satisfaction with the services in a drug de-addiction center

Arun Misra, Ms. Seema

Drug De-addiction and Treatment Center, Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh - 120016, India. E-mail: [email protected]

Quality of care provided to patients by care givers is a subject of concern for health planners particularly in the field of mental health. This is because no satisfactory measures are so far developed which can be considered a reliable indicator for mental health care need.

Aim : To compare quality of care perceived by drug abuse patients in the background of some key socio-demographic and clinical variables

Objective : To compare quality of care perceived by the patients of alcohol and substance abuse of outpatient and ward services with different duration of exposures.

Methods : By using inclusion and exclusion criteria, 100 patients from drug deaddiction and treatment center outpatient and ward constitute sample by the use of non-probability sampling method. Patients administered pre-tested 4-questions Hindi version of patient satisfaction questionnaire.

Results : The preliminary findings suggests that most patients from outpatient and ward were satisfied with place and time of appointment. Little more that one fifth of the patients were not satisfied with the time spent with them. Similar trend was also observed about their opinion about the professionals' competence. One third of the patients from both the services were not satisfied with the services provided to them. There is a tread suggesting that comparatively more patients are opioids addiction were dissatisfied with the amount of time given by professionals to them. Trend also suggest that more patients opioids addiction were dissatisfied with the competence and level of services provided to them than their alcohol counter parts. Preliminary results show that the exposure to services was detrimental to level of satisfaction with the services. Further data will be presented and discussed.

Paper 2: Nicotine dependence and consumption patterns in various psychiatric disorders

Avani Sarvaiya, Nilesh Shah, Nikhil Pandey

Lokmanya Tilak Municipal General Hospital & LTMMC, F/66, Star Apartments, S. V. Road, Borivali (w), Mumbai - 400 092, India. E-mail: [email protected]

Nicotine consumption among psychiatric patients is consistently higher than general population, yet the relationship between it and psychiatric diagnoses remain largely unspecified. Large proportions of difficult-to-treat smokers have co-existing psychiatric disorders. Chewed tobacco, which is more prevalent in India, needs to be evaluated for nicotine dependence and co-morbid disorders on axis-I. Tobacco use remains the single most preventable cause of death in our society. Advantages in our understanding of differential consumption behavior among various psychiatric diagnoses may lead to the development of more targeted and effective treatment.

To study the frequency of nicotine use in out-patient psychiatric populationTo compare nicotine use among patients with different psychiatric disorders and with control groupTo study the subjective perception of effect of psychiatric disorders on nicotine use.

Sample size: Total 500 patients (100 in each group-schizophrenia and related disorders, bipolar disorder, MDD, socio-demographic profile).

Setting : Out-Patient psychiatric department of a general hospital attached to medical college in urban setting.

Outcome measures: 1. Self reported questionaire and interviews for consumption behavior. 2. Fagerstorm test for nicotine dependence

Results and Conclusion : Will be discussed in the paper.

Paper 3: Wernicke's encephalopathy

P. Kulhara, S. K. Mattoo, D. Basu, S. Kumar, K. Chakraborty, R. Bharadwaj, S. M. Singh

Post-Graduate Institute of Medical Education and Research, Drug De-addiction and treatment center, Department of Psychiatry, Chandigrah - 160012, India. E-mail: [email protected]

Wernicke's encephalopathy is the result of a relatively severe deficiency of the B vitamin thiamine which reverses fairly rapidly with vitamin supplementation.

Aim : To present a series of cases of Wernicke's encephalopathy from a de-addicition center in North India.

Method : A retrospective design is adopted. All out- and in- patients with Wernicke's enecephalopathy over a 10-year period (November 1996 to November 2006) (N~10) attending the drug de-addiction and treatment center, PGIMER, Chandigarh will be included. Socio-demographic and clinical data will be gathered. Results will be presented and implications for management will be discussed.

Paper 4: A study on characteristics of psychotic disorder due to alcohol use (F10.5)

P. P. Kannan, V. Karthikeyan, S. Sudhakar, N. Vijaya, Murugappan

Institute of Mental Health, Kilpauk, Room No 3, PG Quarters, IMH (OP Campus), Ayanavaram, Chennai - 23, India. E-mail: [email protected]

Aim and Objectives : To identify the factors associated with emergence of psychotic disorder in persons dependent on alcohol by comparing alcohol dependence severity, family history of psychosis, Eysenck's personality profile and alcohol use behaviors of patients suffering from alcohol dependence syndrome, currently abstinent (F10.20 with those of Psychotic disorder due to alcohol use (F10.5).

Methods : Case control study of cross sectional design was used. Local ethical committee's approval was obtained before conducting the study. Consecutive patients meeting the following criteria and attending outpatient department of Institute of Mental Health, Chennai-10, during the period from August 2005 to January 2006 were enrolled in the study. Study group comprised those suffering from psychotic disorder due to alcohol use and the control group of alcohol dependence syndrome without psychotic features.

Summary and Conclusions : Persons with severe alcohol dependence are at risk of developing psychotic features. Family history of psychosis predisposes alcohol dependent patients for development of psychotic features. Persons with alcohol dependence, having neurotic traits as measured by Esyenck Personality Questionnaire, are more prone to development of psychotic features. Persons with alcohol dependence are at increasing risk of developing psychotic disorder as the age progresses. Suicidal ideations and attempts are common in psychotic disorder due to alcohol use compared to alcohol dependence syndrome. Alcohol use duration is not associated with development of psychotic features. Patients with alcohol dependence taking their first drink in morning and consuming more amount of alcohol per occasion are at risk of developing psychotic features. Medical illnesses are common among psychotic disorder due to alcohol use compared to alcohol dependence syndrome.

Paper 5: School intervention program in substance dependence

R. Bharadwaj, K. Manpreet, A. K. Misra, P. Kulhara

Drug De-addiction and Treatment Center, Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Chandigarh - 160012, India. E-mail: [email protected]

Throughout the world, school intervention programs in the field of drug addiction have yielded favorable outcomes. These programs have ranged from student, parent and teacher education about the harmful consequences of illicit drug use to brief intervention programs for high risk children in schools.

Aim : The aim of the school program of the Drug De-addiction and Treatment Center, Department of Psychiatry, PGIMER, is to assess the knowledge and attitude of school children to drug use and to educate them about the consequences of the same.

Methods : The intervention is implemented in two steps at each school. First, on a pre-decided day, the students are asked to fill up a questionnaire in Punjabi which is used to assess their knowledge and attitude to drug use.

This questionnaire was especially developed for this program at the DDTC, PGIMER. It consists of a total of 30 items, to be answered Yes or No and takes about 15 minutes to fill up. Following this, usually on the next day, these students, are addressed. A presentation consisting of animated slides (using Microsoft PowerPoint) is made by a team from the DDTC consisting of a Senior Resident and a Psychiatric Social Worker. The students are encouraged to participate actively during the course of the presentation, and if required, to seek help for themselves or their family members.

Results : The results of this program from September 2006 to December 2006 will be presented and discussed.

Paper 6: Inhalent abuse: Profile of patients presenting at adolescent clinic of national drug dependence treatment center, AIIMS

Rohit Varma, Anju Dhawan, Alok Agarwal, Yatan Balhara, Kaushik Sinha Deb

All India Institute of Medical Sciences, Amsari Nagar, New Delhi - 110029, India. E-mail: [email protected]

Background : Substance abuse amongst adolescents has been one of the major areas of concern to those working in the field of substance use treatment. Out of the substances used by adolescents, Inhalants form a unique group as their abuse is largely restricted to this age group. Inhalants abuse has often been associated with graduation to higher forms of substances like alcohol and heroin over the course of time. Management of such patients presents a unique clinical problem not only due to their easy availability and difficulty in recognition but also due to the various psychosocial issues associated with the early experimentation with substances.

Objective : Since there are a very few published Indian studies looking into this area (e.g., Basu et al, 2004), the present study attempts to gain some insight into the profile of adolescents presenting with current or past inhalant use attending a specialized Adolescent Substance Use Clinic being run at the National Drug Dependence Treatment Center, AIIMS.

Methods : All consecutive adolescent patients with past or current inhalant use presenting during the study duration shall be included into the study after taking a written informed consent. The patients would be interviewed and diagnosis of various substance use disorders would be established using DSM IV criteria. The patients would also be screened for comorbid psychiatric disorders and information would be obtained regarding the familial and social background of these patients.

Results : The study is currently underway and results shall be presented at the time of the conference.

Paper 7: Impact of emotional states and psychosocial stressors in contributing to relapse in subjects with alcohol dependence syndrome

Shubhra Nautiyal, Col. H. R. A. Prabhu*

Department of Psychiatry, Base Hospital, *Lt Col. Neatu Narang, Classified Specialist, Psychiatry, Base Hospital, Delhi Cantt - 110010, India.

E-mail: [email protected]

Relapse is one of the hallmarks of alcohol dependence and constitutes therapeutic challenge throughout the life of an alcoholic. Approx. 90% of alcoholics are likely to experience at least one relapse over a 4-year period following treatment. No controlled studies definitively have shown any single or combined risk factor that predicts relapse in a reliable manner. Therefore, relapse as a central issue in the treatment of alcohol interpersonal emotional states, social pressure to drink and interpersonal conflict preceded the majority of relapse incidents. The present research work has been undertaken in order to study the profile and relative contribution of relapse precipitants, life events, and dysfunction in men undergoing treatment for relapse of alcohol dependence.

Aims : To assess the contribution of emotional stress and psychosocial stressors in relapse of alcohol dependence syndrome.

Methods : 50 diagnosed male patients of alcohol dependence admitted to a large Military Hospital Psychiatry unit's de-addiction center for treatment of relapse, along with 50 age and sociodemographically matched controls (non-relapsers), were administered Relapse Precipitants Inventory, Armed Forces Life Events Scale and the screening batteries. Multi-variate Analysis was applied to the data in order to get the results. Results: The mean value for undesirable events in relapse vs non relapse was 5.57 vs 4.32 which was statistically significant with p avl = 0.028. On analysis of CAGE questionnaire 42% relapsers were reported to have positive result as compared to 2% non relapses.

Conclusions : This study elucidates a significant impact of the emotional states in the alcohol dependents, and the stressful life events encountered by the patients as contributing to the relapse in the subjects. The presenter will discuss the implications of the ongoing research.

Paper 8: One year profile of patients attending tobacco cessation clinic in a National level de-addiction center

Sonali Jhanjee, Prashant Goyal, Anita Chopra

National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, Ghaziabad (UP), India.

Tobacco dependence among drug treatment patients is highly prevalent and deadly. In addition to addressing the primary drug of abuse, it is important to systematically assess and treat tobacco dependence in these patients as they are at high risk of mortality from tobacco related illnesses. The one year profile of patients attending tobacco cessation clinic was as follows:

Majority of the patients were males (97.3%), with most (31.5%) being in the 31-40 yrs age group. Most were hindus (78%) and were married (86%). 26.1% were illiterate and 21.5% were presently unemployed. Majority of them belonged to the states of Uttar Pradesh (50.5%) and Delhi (46%).

Drug use profile revealed that opiod dependence was seen in 65.7% of these patients with heroin being the most commonly abused opioid. 37.8% of these patients currently used alcohol and 10.8% of these patients were current users of cannabis.

Tobacco related profile revealed that 47.7% of patients used tobacco in smokable form, 14.7% reporting only smokeless tobacco and 36% of patients reported consumption of both smokable and smokeless tobacco products.

Majority of the patients were in contemplation stage (57.1%) to give up tobacco use as measured by readiness to change questionnaire (RCQ). 17.2% of patients had moderate and 47% (approx) had high to very high level of tobacco dependence as measured by Faegerstrom's test for nicotine dependence (FTND). This has obvious treatment implications.

Paper 9: Amphetamine type stuimulants: "Forewarned is forearmed"

Vijieta Kushwaha, Rohit Verma, Sonali Jhanjee, Atul Ambekar

National Drug Dependence Treatment Centre and Department of Psychiatry, All India Institute of Medical Sciences, Ghaziabad (UP), India.

Stimulants are substances that alter neurotransmitters in brain, mainly norepinephrine, dopamine, and serotonin, leading to increased alertness, concentration well being euphoria and dependence. They include cocaine, amphetamine and related compounds known as amphetamine type stimulants (ATS) like methamphetamine. MDMA (Ecstasy) and others. Stimulant abuse is increasingly being seen as a potential threat to the health of individuals, societies and nations in general. At a global level, there is an increasing evidence that stimulant abuse is on the rise in our part of the world i.e., Asia Pacific region.

The geographical spread of stimulant use is widening and for many countries including India the problem is relatively new, is growing quickly and is unlikely to abate. India is one of the major producers mainly of ephedrine and pseudo ephedrine (which are precursors of ATS) which are smuggled mainly to Myanmar from where the finished product (ATS) reaches the market in East Asian countries and probably comes back to India as well.

This trend of rise in stimulant abuse remains poorly understood though it could be attributed to change in lifestyle, economic growth of nation. There are certain misconceptions among the youth regarding ATS to be non-addicting and safe recreational drugs whose use may be linked to club culture and perceived as a status symbol. Considering these facts it may be said that India is an emerging market for supply and use of ATS. Keeping this in view that clinicians, academicians and researchers are aware of this trend and prepare themselves to prevent and manage the emerging abuse of stimulants by young people in India. The management of stimulant use disorders is especially challenging as the role of specific long term pharmacotherapy is as yet limited.

Paper 10: Duration of ward stay and compliance to treatment in substance users

Yatan Pal Singh Balhara, Rohit Verma, Vijeta Khushwaha, Anju Dhawan, Jahnder Mohan Chawla

Department of Psychiatry, All India Institute of Medical Sciences, AIIMS, New Delhi, India. E-mail: [email protected]

Introduction : Substance use is a problem having multi-faceted impact on the individuals, family members, society and the nations. It has been approached through various interventions modalities. The management of the substance use disorders includes a multitude of interventions both pharmacotherapeutic and non-pharmacological. These interventions can be carried out in different clinical settings like in-patient, OPD, emergency department among others. Inspite of different intervention modalities the condition is characterized by a high relapse rate.

Objectives : To study the relation of duration of the in-patient stay with the future compliance among opioid/ alcohol/cannabis dependent individuals.

Methods : Opioid/ alcohol/ cannabis dependent individuals admitted to the ward at the institute would be prospectively followed up in the OPD to look for the compliance.

Analysis : The data would be analysed to find the correlation among the variables related to the duration of the ward stay and compliance to the long term management plan.

Results : The results would be presented at the conference.

Paper 11: Alcholism: Family history and severity

Johnson Pradeep, M. V. Ashok

Department of Psychiatry, St. John's Medical College Hospital, Bangalore, India. E-mail: [email protected]

Increased family history of alcoholism is said to impact on severity of alcoholism. We have evaluated this relationship in 200 male alcoholics using family history interview for genetic studies with multiple informats and severity of alcohol dependent quesionnaire. Results are presented using both categorical measures (family history positive/ negative) and dimensional measures (Family History Density Method). A strong relationship (PPaper 12: Age of onset of alcoholism and its severity: Evidence and implications

Johnson Pradeep, M. V. Ashok

Department of Psychiatry, St. John's Medical College Hospital, Bangalore, India. E-mail: [email protected]

Earlier age of onset is reported to predict a more severe form of alcoholism. There is a paucity of direct explorations of this relationship from the Indian context. We studied 200 male patients admitted for alcohol related problems from different wards of an urban tertiary teaching hospital. Severity of alcoholism was assessed using severity of alcohol dependence questionnaire (SADQ). The schedule for clinical assessment in neuropsychiatry (SCAN)- alcohol section was used to arrive at the age of onset of use, of problem drinking and dependence. Severity of alcohol use was significantly and inversely related to age of onset. The strength of the relationship persistent even after controlling for current age and family history density. The findings imply a role for Psycho-educational preventive approaches in those genetically at high risk for alcoholism.

Paper 13: Prevalence and pattern of psychiatric co-morbidity among alcohol dependence syndrome cases

M. D. Sahdullah, Kamal Nath

Department of Psychiatry, Silchar Medical College and Hospital, P. O. Ghungoor, Silchar - 788014, Assam, India.

Introduction : Psychiatric co-morbidity is common among patients with alcohol dependence and it is important to recognize it, because alcohol dependence and psychiatric disorders not only perpetuate each other but also interfere with the management. So, it is important to recognize the co-morbid illness among alcoholics. Though literatures on this topic is available across the globe and some part of India, none has conducted such kind of study in this southern part of Assam.

Aims and Objectives : To see the socio-demographic pattern and to find out to co-morbid psychiatric illness among ADS cases and to find the correction between the common Co-morbid psychiatric illness with socio-demographic factor.

Materials and Methods : Samples consist of all the consecutive alcohol dependence cases attending the drug de-addiction centre, Department of Psychiatry, SMCH, starting from 1 st of January 2006 and is evaluated only after the period of withdrawal and detoxification is over. Co-morbid psychiatric illness is diagnosed using the MINI scale 5.0.0. Socio-demographic variables were recorded as per the standard proforma prepared in the Department of Psychiatry, SMCH, with consultation with the faculty.

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

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

Paper 14: Impact of psycho education on wives of person dependent on alcohol

R. Bala Guru, C. Ramasubramanian, M. Kannan, R. RajKumari, Jeyashree Jegan

M. S. Chellamuthu Trust and Research Foundation Madurai - Tamilnadu, India.

Individuals using alcohol, demonstrate a wide variety of patterns of use. Many studies have been conducted on various psycho-social components or issues for the persons dependent on alcohol. The wives of such persons are the most affected ones in the family due to alcohol, and followed by them the children in the family, too are very much affected.

Psycho-education is a package by which the knowledge about the alcoholism, attitude of the persons dependent on alcohols (PDA's), myths and misconceptions, the investigations and treatment, prognosis and follow-up activities etc, are provided to the required target group in any de-addiction centre.

An attempt has been made to find out the impact of psycho-education on wives of persons dependent on alcohol (WPDA). Thirty (30) WPDA have been selected randomly from the list provided by the Social Worker of TRISHUL, a De-Addiciton Hospital and a project of M. S. Chellamuthu Trust and Research Foundation, Madurai, Tamil Nadu. A psycho-education package was provided for 120 hours (120 sessions) as per the Minimum Standard of Care, Suggested by the Ministry of Social Justice and Empowerment, New Delhi for WPDA by the professionally trained mental health professionals. A Pre-post assessment was done with WPDA on various issues of alcoholism. The results have clearly shown that, after the psycho-education, the WPDA have learnt more about various components of alcoholism. The authors have suggested the different methods of providing psycho-education and various issues and challenges met while providing such psycho-education in this paper.

Paper 15: Prevalence of adult attention deficit-hyperactive disorder in patients with alcohol dependence syndrome

N. Ravi Kumar, Prabhat K. Chand, P. S. V. N. Sharma

Department Psychiatry, KMC, Manipal, India.

Aim : To study the prevalence of adult attention deficit/hyperactive disorder (ADHD) in patients diagnosed as having alcohol dependence syndrome.

Background : Studies have shown that 25% of adolescents with substance use disorders (SUDs) had current ADHD with conduct and mood disorders also studies of alcohol abusers yielded rates of between 35% to 71% of adult alcoholics with childhood onset and persistent ADHD. 15% to 25% of adults addicts and alcoholics have current ADHD. More severe SUD had been reported in adults with ADHD compared with adults without ADHD.

Methods : 62 in-patients admitted to the psychiatry ward with diagnosis of ADS between May, 2006 to June 2006 were interviewed using structured interviews.

The statistics employed and results would be discussed and presented subsequently.

Paper 16: Alcoholism and personality disorders: The morbid co-morbidity

S. Harshavardhan, S. Arunkumar, G. Gopalkrishnan

Department of Psychiatry, Sowmanasya Hospitals and Institute of Psychiatry, 6, V. N. Nagar, Chinthamani, Trichy - 620002, TamilNadu, India.

E-mail:drharsha [email protected]

Aim : To define the most frequent personality disorders related to alcohol dependence and to assess the complex relationship between substance use and personality disorders.

Methods : The authors determined the prevalence of personality disorders in consecutively admitted patients with alcohol dependence syndrome (ICD-10) to the inpatient substance abuse program at Sowmanasya Hospitals and Institute of Psychiatry, Trichy from July 06-

Sep-06, using the ICD-10 International Personality Disorders Examination schedule.

Comparison was made between patients with and without personality disorders, social adjustment, family functioning, and quality of life.

Results : Will be discussed at the time of presentation.

Paper 17: Clinical profile of patients presenting to a drug-deaddication centre with a diagnosis of opioid dependence syndrome

Arjun Arya, Hardeep Singh, Suman Gupta

Sco 801, Arya Hospital Manimajra, UT Chandigar, India.

E-mail: [email protected]

Aims and Objectives : Clinical profile of patients presenting to a drug-deaddication center with a diagnosis of opioid dependence syndrome.

Methods : A three year retrospective file review of 50 in-patients subjects presenting to neuropsychiatry and drug-deaddication cum rehabilitation center at chandigarh from October 2003 to October 2006.

Conclusion : Subjects with opioid dependence presenting to drug deaddication center have a longer duration of illness, higher number of males, with very high ratios of psychiatric comorbidity warranting a comprehensive treatment approach.

Paper 18: A case control study of major psychiatric illness among the first degree relatives of patients with alcohol dependence syndrome

M. D. Sahdullah, Kamal Nath

Department of Psychiatry, Silchar Medical College and Hospital Silchar, Assam, India. E-mail: [email protected]

Background : Relationship between the various psychiatric illnesses and the abuse of alcohol and drugs is well known and is an established fact. In many a cases, the abuse of alcohol and drugs and other psychotropic substances are in fact secondary to the underlying various mental disorders and vice-versa. Although the relationship between the psychiatric illnesses in the close family members to that of alcoholics has been extensively studied elsewhere but it remains obscure and less explored in this region of North-East India. As we know various behavioral patterns (adaptive and maladaptive) develops in childhood or adolescence which has got direct or indirect relation ship to the family or home environment, major mental illness in the members of a family definitely changes the psychological milieu of the home which may indirectly influence the behavior of the other members of the family. So it will be interesting to study the major mental illness in the close family members of an individual who has been abusing alcohol for long.

Aims and Objectives : To find out the Axis I diagnosis (DSM IV TR) of mental illness in the first degree relatives of alcohol dependence syndrome cases.

Methods : Cases consist of all the consecutive alcohol dependence patients attending drug de-addiction centre, Department of Psychiatry, SMCH, Silchar, starting from 1 st of January 2006 and is evaluated only after the period of detoxification and withdrawal is over. Alcohol Dependence is diagnosed by using MINI Scale 5.0.0. Family history of A.D.S. cases is evaluated from the patient as well as from the close attendants and is recorded on a Semi-structured proforma prepared in consultation with the faculty in the Department of Psychiatry, SMCH under three headings: a. Diagnosed case, b. Probable diagnosis, c. Undifferentiated.

Control consists of equal no. of patients attending outdoor clinic of Medicine having diagnosis other than ADS.

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

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

Paper 19: The impact of drug awareness and treatment camps on outpatient attendance at a de-addiction clinic

O. P. Giri, R. Bharadwaj, A. K. Misra, P. Kulhara

Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Chandigarh - 160012, India. E-mail: [email protected]

The drug de-addiction and treatment center, Department of Psychiatry, PGIMER has been running a drug de-addiction and treatment clinic at the Kharar Civil Hospital, Kharar, Dist. Mohali, Punjab since 1998. As part of an effort to enhance this community outreach programme, community-based drug awareness and treatment camps have been organized since March 2004 in villages in and around Tehsil Kharar in district Mohali.

Aim : To study the impact of the drug awareness and treatment camps on the attendance of patients at the community clinic at Kharar Civil Hospital.

Methods : Socio-demographic and clinical variables, including treatment outcome related variables, of patients attending the clinic at Kharar Civil Hospital, before and after the camps will be compared. The results will be presented and discussed.

Paper 20: Nicotine use among the army personnel

K. J. Divinakumar, Arun Daniel

Department of Psychiatry, Military Hospital, Danapur Cantonment, Bihar - 801503, India. E-mail: [email protected]

Background : Use of Nicotine, a gateway psychoactive substance among the army personnel has a direct impact on military readiness. The previous two published studies of the Indian army were data from the recruits and officers.

Aims : This study was carried out to estimate the prevalence of current nicotine use and the factors associated with its use among the active army personnel.

Methods : 750 participants randomly selected from populations of army personnel below officer rank posted in two adjacent cantonments in

western India were administered the questionnaire in Hindi containing demographic profile, patterns of smoking, use of smokeless tobacco and alcohol.

Results : 41% of the surveyed army soldiers used tobacco either by smoking or smokeless route or both. (9.7% used both, 27.3% smoked and 23.4% used smokeless). The maximum prevalence was among the 26-30 yrs age group (50%, OR = 1.55, P th class: OR = 1.72, PPaper 21: Relationship between personality and well-being of patients with alcohol dependence

Rita Das, Susmita Halder, Suprakash Chaudhury, P. K. Chakraborty

Department of Psychiatry, Ranchi Institute of Neuropsychiatry and Allied Sciences (RINPAS), Kanke, Ranchi - 834006, Jharkhand, India.

E-mail: [email protected]

Well-being is a subjective experience which incorporates an individuals perception of his functioning in personal, social, occupational and various other areas. Personality is one of the major contributing factors to determine one's well-being. Well-being has been found to be lowered in mental illness.

The aim of the present study is to find out the relationship between personality and well being of the persons with alcohol abuse. The study included 60 individuals; 30 outpatients with alcohol dependence and an equal number of sex, age, education and social background matched normal control subjects. All the subjects were evaluated with a selfmade personal questionnaire, Michigan alcoholism screening test, short personality questionnaire and the WHO general wellbeing questionnaire. The tests were scored as per the test booklet. Statistical comparisons were performed with SPSS 13 using chi square test. Results show that there is significant relationship between personality and well-being of alcoholics.

Paper 22: Hematological changes in alcohol dependence

Suprakash Chaudhury, D. Bhattacharyya, D. Saldanha, D. K. Giri, R. P. Chakraborty, P. K. Chakraborty

Department of Psychiatry, Ranchi Institute of Neuropsychiatry and Allied Sciences (RINPAS), Kanke, Ranchi - 834006, Jharkhand, India.

E-mail: [email protected]

In 100 consecutive male inpatients with alcohol dependence and an equal number of age, sex, occupation and regional background matched controls, the level of hemoglobin and the reticulocyte count were statistically significantly less, while the values of serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), and mean corpuscular volume (MCV) were statistically significantly raised among alcoholics on admission as compared to controls. In the absence of reliable data on alcohol consumption, these objective laboratory tests can be used to support the clinical diagnosis of alcohol dependence.

Paper 23: Co-morbid substance use disorder in schizophrenia: Results from a community survey

B. N. Gangadhar, Jagadisha Thirthali, B. K. Venkatesh, M. N. Naveen, G. Venkatasubramanian, U. Arunachala,

Kishore Kumar KV

Department of Psychiatry, National Institute of Mental, Health and Neurosciences, Bangalore - 560029, India.

Background : Outcome of schizophrenia is better in India than in the western countries. The reasons for this are only putative at this stage. One plausible reason could be lesser prevalence of co-morbid substance use among Indian schizophrenia patients. Lifetime prevalence of co-morbid substance use disorders is reported to be up to 50% among schizophrenia patients in the West. However, Indian literature on the prevalence of substance use disorders in schizophrenia is sparse. This study aimed at estimating the prevalence of co-morbid substance use among schizophrenia patients in a community setting.

Methods : The data for this report comes from the project "Community Intervention in Psychotic Disorders" (ColnPsyD). This project entails identification of all schizophrenia patients living in Thirthahalli taluk of Karnataka. Health workers were trained in identifying patients with schizophrenia in the community. The diagnosis of schizophrenia was made according to ICD-10-DCR by a trained psychiatrist and confirmed by another experienced psychiatrist. All patients were interviewed regarding lifetime use of psychotropic substances (except nicotine and caffeine) and when present, diagnosed using ICD-10-DCR criteria.

Results : Two hundred and seven (51.2% males) schizophrenia patients were identified. None had history of using illicit substance in their lifetime. The lifetime co-morbid prevalence of alcohol dependence/harmful use was 17.2%. It was 31.4% among males and 2.1% among females.

Conclusions : The prevalence of co-morbid substance abuse/dependence among schizophrenia patients in India is much lower than that in the western countries. This is especially true of illicit substances. One reason for better outcome of schizophrenia in India could be this.

Paper 24: Cannabis use and schizophrenia: Review of the evidences

Rohit Garg, Adarsh Tripathi, J. K. Trivedi

Department of Psychiatry, K.G.M.U., Lucknow, India.

Psychoses are serious and disabling disorders. Several recent evidences suggest that there are good reasons to consider the possibility that cannabis use may be a cause of psychotic disorders.

There are a number of hypotheses about the relationship between cannabis use and psychosis that need to be distinguished.

There is little dispute that cannabis intoxication can lead to acute transient psychotic episodes in some individuals (D'Souza et al, 2004) and that it can produce short-term exacerbation or recurrences of pre-existing psychotic symptoms (Thornicroft, 1990; Mathers and Ghodse, 1992; Hall and Degenhardt, 2004).

Studies have also proven that cannabis induced psychotic symptoms are important risk factors for the subsequent development of the schizophrenia spectrum disorder (Arendt et al, 2005). However, controversy remains about whether cannabis use can actually cause schizophrenia or other functional psychotic illness in the long term (Johns, 200).

Here we review literature relevant to drug use and schizophrenia within the framework of established criteria for determining causality.

Paper 25: Spirituality and addiction

Rajinder Singh, Onkar Singh

Department Psychiatry Chandigarh Medical Centre, Chandigarh - 160 017, India.

Aristotle's definition of man as a rational animal developed an obsession with IQ. Alfred Binet gave the concept of IQ in 1905. In mid nineteen nineties Daniel Goleman popularized the concept of emotional intelligence. By the end of the twentieth century there was enough collective evidence from psychology, neurology and anthropology and cognitive science to show that there is third Q that is spiritual Intelligence. Unlike IQ which computers have EQ exists in higher mammals. SQ is uniquely human. Spiritual Intelligence is linked to human being's quest for meaning, it is souls intelligence. It has been observed since long that the primary strategy for intervention and prevention of Alcohol and Drug abuse must involve a spiritual component. Following this lead the concept of spiritual intelligence was incorporated in the management of substance related disorders.

315 cases, all males were admitted in a charitable deaddiction and rehabilitation centre located in a shrine. After admission all the addictive drugs were stopped. They were administered symptomatic treatment. After the phase of detoxification all the patients underwent a daily structured time schedule of spiritual activities for 5-6 hours a day. In addition the counselor had individual group therapy sessions with the patients. Domestic problems were resolved through family therapy. 80% of the patients became symptom free within 3 weeks of stay in the centres.

The recovering cases attributed the amelioration of their condition to the nature of treatment given and the grace of the Almighty. And the subsequent dawn of new knowledge and awareness which gave them equipoise, stability and firmness to fight back the feelings of powerlessness, vulnerability and helplessness. It is hypothesized that there is robust connection between the arousal of spiritual awareness and the outcome of addictive disorders.

Paper 26: Axis I psychiatric co-morbidity in substance dependence

D. Basu, S. K. Mattoo, S. Kumar, R. Bharadwaj, S. M. Singh, P. Kulhara

Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Chandigarh - 160012, India. E-mail: [email protected]

Patients with substance dependence have a high incidence of Axis I psychiatric co-morbidity.

Aim : To study the profile of Axis I psychiatric co-morbidity in patients attending a de-addiction center in North India.

Methods : A retrospective design is adopted. All out-and in-patients with Axis I psychiatric co-morbidity over a 6 year period (November 2000 to November 2006) (N ~350) attending the drug de-addiction and treatment center, PGIMER, Chandigarh will be included. Patients with sexual dysfunction, organicity (head injury, seizure disorder etc.) and substance-related disorders will be excluded. Socio-demographic and clinical data will be gathered. Results will be presented and discussed.

Paper 27: Seizures in patients with substance dependence

Mattoo SK, Kumar S, Basu D, Singh SM, Bharadwaj R. Kulhara P.

Department of Psychiatry Post-Graduate Institute of Medical Education and Research Chandigarh - 160012, India.

Patients with substance dependence present with primary seizure disorders and seizures related to substance use and withdrawal.

Aim: To study the incidence of seizures in patients attending a de-addiction center in North India. Method : A prospective design is adopted. All consecutive out- and in- patients over a 6 month period (June 2006 to November 2006) (N-250) attending the drug de-addiction and treatment center, PGIMER, Chandigarh will be invited to participate in the study after obtaining consent. Socio-demographic and clinical data will be gathered. Results will be presented and discussed.

Paper 28: Prevalence of harmful use of alcohol/alcohol dependence in care givers/parents of children suffering from ADHD

Amit Sethi, Salvador Tereza

Institute of Psychiatry and Human Behavior, Goa, India.

There is growing interest in identifying the burden of care in families of children suffering from pervasive developmental disorders. This studies examines the prevalence of harmful use of alcohol/alcohol dependence according to the ICD-10 criteria in care givers/parents of children suffering from attention deficit hyperkinetic disorder, visiting the Child Guidance Clinic of I.P.H.B over the past 6 months.

Paper 29: A study of female drug users in Manipur and their vulnerability to HIV/AIDS and STIs

S. Gojendra Singh, Kh. Dinesh Singh, A. K. Brogen

Dr S Gojendra Singh, Doctors quarter, Type v, Qtr no 30, RIMS, lamphel, Imphal, Manipur-795004

The study was conducted in Churachandpur district during August to December 2005. Both quantitative and qualitative data were collected from 40 female drug users, 5 key informants of service centres, 10 community key informants and 1 key informant of law enforcement agency. Secondary data were also collected from other sources.

Majority (80%) of the female IDUs were above 24 years of age, 67.5% of them had education up to middle grade or below. Only 29 of them were employed and out of these, 62% (18/29) were engaged in jobs like drug peddling and sex work. The rates of divorce and separation or divorce due to drug use behaviour were high (60%). Majority of them (60%) didn't live in their home and 80%( 32/40) had their first experience of drug use after age of 19 and they also reported to use 2 or more drugs since the initiation of drug use. Heroin constitutes the most common primary drugs used by them (80%), 77.5% (31/40) were injecting drug users and all of them injected at least once, 1 week prior to the interview. Out of these 31 injectors, 30 (96.8%) had reported sharing of needles and syringes during the last episode of injecting drugs. Number of sharing partner ranged from 2 to 20 persons and all of them reportedly use clean syringes and needles before sharing with others. Majority of them also used plain water and saliva for cleaning needles and syringes. Only 16.2% (3/37) had complete knowledge of routes of HIV transmission and preventive measures. Out of 33 respondents who had heard of STIs, 78.8% believed that STIs are curable and 77.55% had some kind of STIs and they mainly procured drugs from pharmacies without proper consultation with doctors. 92% (38/40) of female drug users reported having sex experience, only 13.1% (5) had used condoms during last sexual act with regular partner.

Paper 30: Sexual dysfunction in alcohol dependence syndrome

Suprakash Chaudhury, S Sudarsanan, S Kumar, AA Pawar, Kalpana.Srivastava

Department of Psychiatry Ranchi Institute of Neuropsychiatry and Allied Sciences (RINPAS), Kanke, Ranchi - 834006, Jharkhand, India.

E-mail: [email protected]

A total of 30 patients admitted to psychiatry ward of a tertiary care psychiatry center and meeting the ICD 10 criteria for alcohol dependence syndrome formed the study group of the present project aimed at studying the prevalence of sexual dysfunction in alcohol dependence syndrome. Equal number of age and sex matched healthy subjects formed the control group. All patients filled a specially designed proforma and the Hilton drinking behavior questionnaire, Sexuality scale, State-Trait anxiety inventory and Carroll rating scale for depression. Result showed that 30% of the alcohol dependent patients had reduced libido despite having normal liver function tests. In addition, 26.7% patients also complained of disturbed sleep. On the sexuality scale though the alcohol dependent patients had lower sexual esteem and higher sexual depression scores the differences were not statistically significant. The alcohol dependent patients had significantly higher state and trait anxiety and depression scores as compared to the normal controls. During psychiatric treatment and follow up of patients with alcohol dependence syndrome the Psychiatrist should specifically inquire about sexual and sleep functions apart from looking for co-morbid anxiety and depression.


Paper 1: ECT for major depression: Possible role for augmentation with mefepristone

Chittaranjan Andrade

National Institute of Mental Health and Neurosciences, Bangalore - 560 029, India. E-mail: [email protected]

Background : Major depression is characterized by deregulation of the hypothalamico-pituitary-adrenal axis; serum cortisol levels are usually raised. ECT elicits an acute hypercortisolemic response.

Methods : The literature was reviewed to determine how hypercortisolemia may impact upon depression and contribute to the neurobiological effects of ECT.

Results : Glucocorticoid receptors are densely distributed in the hippocampus. Chronic hypercortisolemia may result in overstimulation of these receptors and a resultant loss of dendritic spines and synapses. Acute hypercortisolemia after ECT may aggravate these effects. Hypercortisolemia may therefore explain the neuropsychological impairments associated with depression, cushing's syndrome, chronic steroid therapy, and ECT.

Conclusion : The use of glucocorticoid antagonists, such as mifepristone, may protect against cognitive impairment associated with hypercortisolemic states, and may attenuate the amnestic effects of ECT. Preliminary clinical and animal research supports this conclusion; mifepristone may also be directly therapeutic in psychotic depression.

Paper 2: Knowledge and attitude among caregivers, nursing students and under graduate medical students

S. Sudhakar, Sumit Puri, V. Karthikeyan, M. Murugappan

Institute of Mental Health, Chennai, India.

Background: It is believed that people including health professionals lack sound knowledge and attitude towards ECT.

Aim : To examine the knowledge and attitude of caregivers nursing students and under graduate medical students.

Methods : A 16 item questionnaire with satisfactory face validity and content validity was constructed and administered to 50 care givers, 50 nursing students and 50 under graduate medical students.

Results : Results and conclusion will be discussed at the venue.

Paper 3: Cyclo-oxygenase and glutamenergic mechanisms in ECT: Induced retrograde amnesia

Chittaranjan Andrade, S. Thyagarajan, Nagendra Madan Singh, N. Snjay Kumar Rao, J. Suresh Chandra

Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore - 560 029, India. E-mail: [email protected]

Background : We had earlier shown that chronic pretreatment with indomethacin attenuates retrograde amnesia induced by electrocon-vulsive shocks (ECS) in rats. Cyclo-oxygenase (COX)-2 selective inhibitors however, impair learning and memory. We therefore compared indomethacin and celecoxib to explore nonselective vs selective COX mechanisms in the context of ECS-induced retrograde amnesia.

Methods : Adult, male, Wistar rats (n=116) were trained for 3 days on a passive avoidance task in a step-down apparatus. On each of the next 5 days, the rats received true or sham suprathreshold ECS (30 mC). During the training period, indomethacin (4 mg/kg/day), celecoxib (15 mg/kg/day), or vehicle were orally administered 3 h after exposure to the task. On ECS days, these medications were administered shortly after the ECS. One day after the fifth ECS, recall of pre-ECS learning was tested.

Results : There were no baseline or pre-ECS differences in learning between the drug groups. ECS seizure duration also did not differ across the drug groups. ECS-treated rats showed impaired recall. Celecoxib but not indomethacin protected against ECS-induced retrograde amnesia.

Conclusions : We hypothesize that ECS may saturate COX-2-dependent processes, resulting in cognitive impairment; if so, celecoxib but not necessarily indomethacin may protect against ECS-induced amnesia. Or, ECS-induced increase in hippocampal kynurenic acid levels may impair glutamate-dependent learning and memory; selective inhibition of kynurenic acid synthesis by celecoxib but not indomethacin may explain the protective effect of celecoxib. Or, both inflammatory and glutamateric mechanisms may be involved.

Paper 4: Use of electroconvulsive treatment in elderly: A clinical audit

Gaurav Jain, Vineet Kumar, Subho Chakrabarti, Sandeep Grover

Department of Psychiatry, PGIMER, Sector - 12, Chandigargh, India.

E-mail: [email protected]

Aims and Objective : To study the sociodemographic and clinical profile of elderly subjects, who received electroconvulsive therapy (ECT) at Department of Psychiatry, PGIMER, Chandigarh.

Methods : Records of all the elderly patients (>60 years) who received ECT during January 1999 to July 2006 at the Department of Psychiatry, PGIMER, Chandigarh were traced. All subjects whose detailed records were available were taken up for the study. Fifty subjects fulfilled the intake criteria for the study.

Results and Conclusion : Equal number of patients of either sex received ECT. Age range of the patients varied from 60 to 85 years. Most common diagnostic indication for ECT was recurrent depressive disorder (RDD), current episode severe depression with psychotic symptoms (26%). This was followed by RDD current episode severe depression with psychotic symptoms (20%), severe depressive episode with psychotic symptoms(18%) and severe depressive episode without psychotic symptoms (26%). Very few patients with diagnosis of mania or psychosis received ECT. Number of ECTs during one treatment course ranged from 1 to 22 (mean -9.12; SD + 4.31). Majority of the subjects had no comorbid physical illness. Other results of the study will be discussed in the presentation.

Paper 5: A survey on falling trends in ECT in a mental health trust in UK: Future implications

G. Kunigiri

Department Psychiatry, NIMHANS, Bangalore - 29, India.

Objectives : A local survey was conducted to find the changing trends in the use of ECT in Leicestershire Partnership Trust UK over the last 6 years.

Methods : The total number of ECT administered and the number of patients prescribed ECT in the first quarter 2005 was obtained from the ECT register and Maracis (database of patients across the Trust). This was compared with similar figures from previous surveys in 1999 and 2002.

Results : The number of ECT treatment administered in the first quarter of 2005 was 139 compared to 257 and 292 in 2002 and 1999 respectively. The number of patients receiving ECT in these years was 81, 39 and 26 respectively. Male to female ratio was 1:4.2 in 2005 in contrast to 1:2.5-2.8 in the previous years. All had a diagnosis of depression in 2005 while the diagnostic break-up in 2002 was mood disorder (15), schizophrenia (1), neurotic illness (1) and unspecified mental disorder (22). Patients were distributed nearly equally in each of the age groups 22-44, 45-65 and above 65 years in 2005 while in previous years around 45% were above 65 years. In 2005 6 (23%) patients received ECT under the mental health act in comparison to 14 (35.9%) and 18 (22.2%) in 2002 and 1999 respectively. None of them had consented for treatment except for 2 in 1999.

Conclusions : The survey suggests significant decline in the use of ECT from 1999 to 2005. If this decline continued, the fear is that ECT treatment may become non-existent in future. There is need for all those involved in ECT to be proactive to safe guard such a potential treatment in severe depression.

Paper 6: Why do psychiatrists prescribe ECT to schizophrenia patients?

Vivek Phutane, Jagadisha Thirthalli, T. Harish, Bangalore N. Gangadhar

Department of Psychiatry, NIMHANS, Bangalore - 560029, India.

Background : Use of ECT in treatment of schizophrenia has been a neglected area of research. Official guidelines in the West have been cautious in prescribing ECT in schizophrenia (Scott 2005; APA 2001). However, ECT as a mode of treatment of schizophrenia is popular among Indian practitioners. This study examined the indications for which patients with schizophrenia receive ECT in a tertiary care centre.

Methods : Medical records of inpatients with schizophrenia receiving ECT in one calendar year in National Institute of Mental Health and Neurosciences, Bangalore were reviewed. Reasons recorded by the treating team for prescribing ECT were noted. Change in clinical condition was rated using a Likert scale

Results : Of the 321 schizophrenia (F20.0-F20.9) patients admitted during one calendar year 101 (31.4%) received ECT. The three most common reasons were: "Cannot afford to wait for medication effects" (56.3%), "to augment medication therapy" (42.5%) and "adequate dosage and duration of treatment failed" (40.2%). The symptoms for which ECT was prescribed the most was catatonia (57.3%) followed by suicidality (19.6%) and aggressive behavior (16.4%). In 19.5%, ECT was chosen as a first line treatment. The mean number of ECTs (SD) received was 8.5 (3.9). There was substantial improvement in nearly 80% of patients who received ECT

Conclusions : Though there is little data in the literature that addition of ECT to antipsychotics expedites the recovery in schizophrenia, it is most commonly used in schizophrenia for rapid recovery. There is need for methodologically sound studies to examine this issue.

Paper 7: Subjective experiences of patients who have undergone ECT

Saumil Dholakia, Parag Shah

Department of Psychiatry, Baroda Medical College and Shri Sayajirao Gayakwad Hospital, Baroda, India.

Out of inquisitiveness to know what the patients actually feel after 1 st electro convulsive therapy, we are using a descriptive methodology with a 12 point self made questionnaire for this study. The study is under progress and the results are awaited. The aim of this study was to know the emotions felt, the good and bad experiences undergone by the patients after their 1st ECT. The sample size is the no. of patients who have experienced their 1st ECT till the month of November 2006.

Paper 8: Knowledge and attitude towards ECT among medical and nursing students

Dinesh Kataria, Neeraj Kumar Gupta, N. Aggarwal, Shashi B. Kumar, Srinivas, Neelam

Department Psychiatry Lady Hardinge Medical College, New Delhi, DMHP Kurukshetra, India. E-mail: [email protected]

It is a proven fact that ECT has been a safe and effective method in the management of some of the psychiatric illnesses for more than sixty-five years. This is a very long time for any therapeutic modality to survive the clinical marketplace, especially when its mechanism of action is said to be unknown and whose application is loaded with controversy. There are various issues related to ECT, such as knowledge, attitude, availability, social stigma attached and cost effectiveness, which are constantly debated not only among general public but also between medical personnel. So it was decided to assess the knowledge and attitude towards ECT among medical and nursing students. A 24-item questionnaire pertaining to the topic was used for the purpose of this study. It was administered to 100 medical students and equal number of nursing students. Findings will be presented in the conference.

Paper 9: Effects of ECT in enhancing quality of life in mania

Sudhir Kumar, Manish Jain, Sandhyarani Mohanty

Institute of Mental Health and Hospital, Mathura Road, Agra - 282002, India. E-mail: [email protected]

ECT is associated with good therapeutic outcomes in major psychiatric disorders. The index study is an attempt to investigate if ECT enhances QOL in Mania. A sample of 30 manic patients was drawn from in-patients of Institute of Mental Health and Hospital, Agra. The participants were allocated to two subgroups and were placed under two conditions - (a) ECT plus pharmacotherapy and (b) Pharmacotherapy only. QOL Scale, global assessment of functioning scales and mania rating scale were used to assess the participants at baseline and four repeat assessments over pre-specified intervals. The results of mixed between-within group design revealed superior outcomes for ECT plus pharmacotherapy group.


Paper 1: Possible role for augmentation with mefepristone

Chittaranjan Andrade, Nandakumar Nagaraja, Suresh Sudha, Nagendra Madan Singh, Mphil, J. Suresh Chandra,

B. V. Venkataraman

National Institute of Mental Health and Neurosciences, Bangalore - 560 029, India. E-mail: [email protected]

Rationale : Cortisol levels rise sharply immediately after electrocon-vulsive therapy (ECT); the resultant stimulation of steroid receptors in the hippocampus may be beneficial or harmful to cognition, depending on the magnitude of the stimulation. Steroid mechanisms may therefore modulate ECT-induced amnesia.

Objectives: Using mifepristone (a glucocorticoid receptor antagonist) as a chemical probe, we sought to examine steroid mechanisms in an animal model of ECT-induced retrograde amnesia.

Method : Adult male wistar rats (n=68) trained in a step-through passive avoidance task were randomized to receive mifepristone (20 or 40 mg/kg/day) or vehicle (control). These treatments were administered 1 day before the electroconvulsive shock (ECS) course and again, 1 h before each of 5 once-daily true (30 mC) or sham ECS. Recall of pre-ECS learning was tested 1 day after the last ECS.

Results : Relative to sham ECS, true ECS resulted in significant retrograde amnesia in the vehicle group but, not in either of the mifepristone groups. In sham ECS-treated animals, mifepristone did not significantly influence recall. In ECS-treated rats the higher but, not the lower dose of mifepristone was associated with significant protection against the retrograde amnesia evident in the vehicle group.

Conclusions : Mifepristone administered before the ECT seizure mat attenuate ECT-induced retrograde amnesia. This suggests that glucocorticoid mechanism may contribute to ECT-induced retrograde amnesia.

Paper 2: Metabolic profile in schizophrenia patients on anti psychotic medication

Shravani Sur, Saurabh Gupta, Vinod Kumar Sinha

Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand, India - 834006.

E-mail: [email protected]

Background : Antipsychotic drugs are mainstay of treatment in schizophrenia. Anti-psychotic drugs have been documented to cause weight gain, dyslipidemia, and changes in glucose tolerance of these patients. These have recently been grouped together under one condition known as the metabolic syndrome, [Adult Treatment Protocol III of the National Cholesterol Education Program 2001]. In past researchers have studied these parameters separately. There is a paucity of research in the relation of antipsychotic use and metabolic syndrome.

Aim : To investigate metabolic profile including changes in blood glucose, lipid profile, and weight in schizophrenia patients on antipsychotic medication.

Methods : This is a longitudinal study, carried out on male in-patients at Central Institute of Psychiatry, Ranchi. Sixty anti-psychotic free (drug naοve or at least three months off antipsychotic drugs) patients diagnosed as schizophrenia according to ICD- 10 DCR were enrolled in the study. Patients with co-morbid psychiatric and medical conditions were excluded. Socio-demographic details and clinical data besides weight, waist circumference (in cm.), blood pressure, fasting blood glucose, total cholesterol, serum triglycerides and high and low-density lipoproteins were measured on the day of admission before starting on any antipsychotic and subsequently at the end of six weeks.

Results : This is an ongoing study, which is likely to be completed by November 2006. Appropriate statistics will be used for analysis. The results will be discussed during final presentation.

Paper 3: Treatment related decision making capacity in psychotic in-patients

Zindadil M. Gandhi, G. K. Vankar

Little research has been done in India in the field of determinants of mental capacity. A large member of patients are admitted against their will in psychiatric settings and are declared incapacitated to take treatment related decisions. Psychotic patients are considered to have a lack of mental capacity and they outnumber the patients with other disorders in involuntary admission.

In this cross sectional study total 63 patients were interviewed and it was found that around 64% patients had lack of capacity. Lack of capacity was associated with level of education, lack of employment and thus less family income, high score on brief psychiatric rating scale (Overall, 1968) and low scores on mini mental state examination) (Folstein et al., 1968) and SAI-E (David, 1992).

Around 62% of patients were admitted involuntarily. Twenty-three percent of patients who were involuntarily admitted had capacity present at the time of interview and 41% of patients who were voluntarily admitted has a lack of capacity.

Discrepancies in the presence or absence of capacity and type of admission suggest that a comprehensive method to judge capacity should be applied which assess the patient for multiple components.

Paper 4: Atypical antipsychotics and metabolic syndrome: An Indian perspective

R. K. Solanki, Paramjeet Singh, Navendu Gaur, Deepti Munshi, Navendu Gaur

Psychiatric Centre, S.M.S. Medical College, R. K. Solanki, Professor and Unit Head-III Communication, India. E-mail: [email protected]

A prospective study of 50 patients at the dept of Psychiatry, S.M.S. Medical College is being undertaken. Patients belonging to different diagnostic categories according to ICD-10 criteria are being evaluated while on atypical antipsychotics over a period of 14 weeks. The appropriate physical examination and lab investigations are being undertaken including body mass index, blood sugar (F & PP), lipid profile and liver function tests. The data at the end of 14 weeks will be analysed and discussed.

Paper 5: Sexual side effects of psychotropic medications

Naveen Kuma, M. H. Raja, Om Prakash

Department of Psychiatry, National Institute of Mental Health and Neuroscience (NIMHANS), Bangalore - 5600 29, India.

Background : Routine follow up in psychiatric clinics doesn't include enquiry into sexual side effects of psychotropic medications. There is enough literature to suggest that patients on psychotropic drugs develop sexual side effects.

Objective : This study examined the nature of sexual side effects in a schizophrenic outpatients attending psychiatric clinic at NIMHANS Bangalore.

Methods : Psychiatric outpatients having ICD diagnosis of schizophrenia (with treatment duration of at least one year) attending clinic were administered a checklist to measure sexual side effects of psychotropic medications.

Findings, results and implications will be the focus of presentation in the conference.

Paper 6: A prospective study on effects of different antipsychotics on metabolic and physical parameters

Anup Mathew Joseph, Prabhat Chand

Department of Psychiatry, KMC, Manipal, Karnataka - 576104, India.

Aim : To compare the pattern of weight changes of patients on olanzapine with those on risperidone.

Methods : Patients started on risperidone or olanzapine will be evaluated against the following inclusion criteria:

Availability of written informed consentAge within the range of 12 to 65 years

An approximate sample size of 20 is planned, those in group 1 n=20 (receiving risperidone) and those in group 2 n=20 (receiving olanzapine) are incorporated into a 60 day study protocol.

On day one baseline weight, body mass index, waist hip ratio and wherever consent is available random blood sugar is measured.

Statistics : Comparison of the groups by Student test and other appropriate statistical methods.

Results: To be presented.

Paper 7: Olanzapine discontinuation induced relapse in bipolar disorder: A retrospective chart review

Manu Arora, Samir Kumar Praharaj, Vinod Kumar Sinha

Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand, India.

E-mail: [email protected]

Background : The aims of long-term treatment in bipolar disorder are to decrease mortality, to reduce the rate of relapse and to shorten illness duration. The mainstay of treatment of bipolar disorder remains mood stabilizers. The efficacy of atypical antipsychotics including olanzapine in acute treatment of manic episode has been established. There have been few studies on the role of olanzapine as a prophylactic agent in the bipolar disorder.

Aim : To find out various socio-demographic and clinical factors associated with relapse in patients with bipolar disorder after discontinuation of olanzapine.

Methods : Twenty patients of bipolar disorder who are on regular treatment with mood stabilizer and subsequently relapsed into mania or depressive episode after discontinuation of olanzapine will be studied for various socio-demographic and clinical factors using retrospective chart review.

Results : Appropriate statistics will be used for analysis and results will be discussed at the time of presentation.

Paper 8: A study of effect of atypical antipsychotics on insulin resistance, lipid profile and ECG in patients of schizophrenia, schizotypal and delusional disorder

Prasenjit Ray, C. R. Khess, Banita Lal

Department of Biochemistry, Central Institute of Psychiatry, Kanke, India.

E-mail: [email protected]

Background : Studies have shown increased incidence of cardiovascular diseases and new onset diabetes mellitus (DM) in patients treated with atypical antipsychotics. Also, an increased prevalence of DM has been found in persons suffering from schizophrenia. With the recent trend of preferential use of novel antipsychotics and the manifold increase of DM and cardiovascular disease over the last decade in our country, it is needed to see whether we are going to push a sizeable population suffering from schizophrenia towards this new threat by using novel agents.

Level of insulin resistance(by using HOMA-IR) has been established as a reliable predictor for development of type II DM. ECG reflects cardiovascular profile. Whereas lipid profile abnormality is known to be associated with risk for both DM and cardiovascular diseases.

Aim : To compare prevalence of insulin resistance, lipid profile and ECG among patients with schizophrenia receiving atypical antipsychotic and those not receiving any medication.

Methods : Study design was cross sectional, hospital base. 54 males, 18-60 years of age, with diagnosis of schizophrenia, schizotypal and delusional disorders (F20-29, as per ICD-10, DCR) without any other comorbidity, either on single atypical antipsychotic or off medication for atleast 3 months were assessed crossectionally for ECG, lipid profile, insulin resistance and PANSS rating. Results were compared between 2 groups.

Result and Conclusion : It is an on going study, likely to be completed by last week of October. So result and conclusion will be shared during presentation.

Paper 9: Adverse effects of disulfiram

Elsie Oommen, C. Ashuthosh, P. S. V. N. Sharma

Department of Psychiatry, KMC Manipal, Karnataka - 576104, India.

E-mail: [email protected]

Aim : To study the prevalence of patients receiving disulfuram and also its adverse effects on them.

Methods : All individuals diagnosed with Alcohol dependence syndrome/ harmful use attending the deaddiction clinic of a tertiary care general hospital are involved in the study. It includes retrospective chart review of medical records of 1600 odd patients. We look at the prevalence of patients receiving disulfiram, adverse effects documented, its management and outcome.

Results and Conclusions : Will be presented.

Paper 10: Use of melationin in childhood psychiatric disorder

Pankaj Kumar, Vivek Agarwal

Department of Psychiatry, KGMU, Lucknow, UP, India.

Melatonin (N-acetyl-5-methoxytryptamine) a neurohormone controls the body's circadian rhythm. In children, melatonin has been used primarily for chronic insomnia, as well as in the management of sleep disturbances associated with vision disturbances, ADHD, Neuro developmental disorder etc.

Since the first case report by Palm et al., 1991, there have been over two dozen papers describing the use of melatonin in children with sleep disorders. Various studies conducted on this population show trends towards positive improvement in sleep onset and / or maintenance.

Use of melatonin supplementation had also been studied in some other neuropsychiatric disorders of childhood like ADHD, PDD and neurological disorders.

In this report, we will review the use of melatonin for the treatment of a number of childhood sleep problems associated with different childhood disorders. Moreover, we will review the safety and effectiveness of melatonin in the childhood disorders.

Paper 11: Who receives naltrexone for maintenance therapy in opioid dependence? A study from a national drug dependence treatment centre

Prakash S. Shiva, Preeti Sinha, Ravindra Rao, Anju Dhawan

Department of Psychiatry, AIIMS, Ansari Nagar, New Delhi - 110029, India.

Aim : To study the profile of patients who were prescribed naltrexone as antagonist maintenance therapy for opioid dependence syndrome (ODS).

Type of Study: Retrospective chart review for 4 months.

Methods : The study was conducted in the National Drug Dependence Treatment Centre at All India Institute of Medical Sciences, New Delhi, India. All the patients who were diagnosed as suffering from ODS and admitted for initiation of naltrexone as maintenance therapy were included in the study. Socio-demographic details along with other clinical details were collected in a Semi-Structured Proforma prepared for the study.

Results : A total of 65 patients were included. Majority of the sample was males (N = 62; 95.4%) with a mean age of 37.65 years (S.D. = 9.5) and an education level of 7.85 years (S.D. = 4.1). Majority were married and living with their spouses (N = 45; 69.2%). About 38.5% (N = 25) were unemployed, while 30.8% (N = 20) were semiskilled or unskilled workers (27.7%, N = 18). Only 4.6% (N = 3) patient had history of other Axis 1 psychiatric illness while 13.8% (N = 9) had a positive family history of substance use. About 6.2% (N = 4) met the ICD 10 diagnostic criteria for Anti Social Personality Disorder, while 53.8% (N = 35) were involved in high risk sexual behavior and 29.2% (N = 19) were involved in illegal activities just prior to admission.

Conclusion : Naltrexone is being prescribed to a diverse group of patients in India.

Paper 12: Pharmacological intervention for smoking cessation

Biswadip Chatterjee, Sonali Jhanjee

Department of Psychiatry, All India Institute of Medical Sciences, New Delhi - 110029, India.

Tobacco consumption in the form of smokable tobacco products is a major cause of mortality and morbidity world wide. The health benefits of discontinuing smoking have been well established by numerous studies. There were no effective pharmacological treatments for nicotine dependence till the mid seventies. Since then the landscape of nicotine dependence treatment has changed with the introduction of nicotine replacement therapy, various medications and behavioural therapy specific to nicotine dependence. First-line therapies include nicotine replacement and/or bupropion. Second-line treatments include clonidine and nortriptyline. Additional treatment strategies with limited benefit include monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, opioid receptor antagonists, Bromcriptine, anxiolytics, nicotinic receptor antagonists (mecamylamine) and glucose tablets.

Varenicline, a partial agonist at the alpha4beta2 nicotinic acetylcholine receptor, eliminates the reward from smoking and also prevents withdrawal symptoms. Nicotine conjugate vaccine, which acts by inducing nicotine-specific antibodies and sequestering the nicotine in the blood, is currently under phase 2b of clinical trial. Nicotine sublingual tablet delivering 2 mg of nicotine has been found to provide excellent relief from withdrawal symptoms and craving and doubles the quit rate. Other drugs under investigation include inhibitors of the hepatic P-450 enzymes (e.g., methoxsalen) and cannaboid-1 receptor antagonists (e.g., rimonabant). In addition, few studies have reported excellent results with combination therapies for nicotine dependence. This poster will discuss the various pharmacological interventions currently available and their efficacy in the treatment of nicotine dependence.

Paper 13: Risperidone alone versus risperidone and citalopram in patients with neuroleptic-naοve, recent-onset schizophrenia: A randomized double-blind study

John P. John, Vikrama, R. Bhuvaneshwari, C. C. Lopes

Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), PB No. 2900, Dharmaram P.O., Hosur Road, Bangalore, Karnataka - 560 029, India.

Introduction : We report the preliminary findings of a study designed to look at additional benefits, specifically improvement in negative symptoms, of combining 20 mg of citalopram with 4-8 mg of risperidone in the treatment of neuroleptic-naοve, recent-onset schizophrenia/schizophreniform disorder.

Methods : 26 neuroleptic-naοve patients with recent-onset schizophrenia/schizophreniform disorder were randomly assigned to receive risperidone (4-8 + placebo (n=13) or risperidone (4-8 mg/day) + citalopram (20 mg/day) (n = 13). Assessment with PANSS and CGI was done at baseline and repeated at 12 weeks by blind raters. The study had the approval of the Institute Ethics Committee of NIMHANS. Written informed consent was obtained from all the participants and or their legal representatives prior to enrolling into the study. A GLM repeated measures analysis of variance (RMANOVA) was done with PANSS negative symptom total score as the within-subject factor (two levels: baseline, week 12) and group as between-subject factor (two levels: ris + plac, ris + cit).

Results : Both groups showed significant improvement in negative symptoms (F = 88.88; PConclusions : The results lend further support for the efficacy of risperidone in improving both positive and negative symptoms of schizophrenia. However, the results indicate that it may be the secondary negative symptoms that respond to risperidone in the early phase of treatment. Further, this study showed that there was no added benefit on combining 20 mg of citalopram with risperidone for improving negative symptoms in the early phase of treatment.

Paper 14: Tardive dyskinesia as dysphagia: A case report

P. S. Bhat, P. K. Pardal, M. Diwakar

Department of Psychiatry, Command Hospital (CC) Lucknow, UP - 226 002, India.

Tardive dyskinesia (TD), neuroleptic induced delayed onset movement disorder, remains an enigmatic phenomenon and a therapeutic challenge. In its classical form, it involves buccolingual-masticatory muscles resulting in rabbit syndrome. Only few cases of dysphagia also have been reported in world literature and to the best of knowledge of authors no case of TD manifesting as isolated dysphagia been reported so far from India. although many treatments have been tried, none have been proven completely efficacious and best treatment of TD even today is prevention. We report a case of TD consequent to prolonged exposure to typical neuroleptics, manifesting as isolated dysphagia.

Thirty seven year old serving Army Officer, a diagnosed case of Schizophrenia was on maintenance medication for the last seven years. In view of relapses due to poor drug compliance he was put on Inj Haloperidol Decanoate as depot preparation for the last three years. He reported with difficulty in swallowing liquid food for the last one year to an ENT specialist and relevant investigations were WNL. He was reviewed by Psychiatrist and treatment was changed to a combination of quetiapine, donepezil and vit E for which he responded well and became asymptomatic in about eight weeks. Relevant literature on the management of TD is being discussed.

Paper 15: Quetiapine induced neutropenia and thrombocyyopenia

B. Ravi Shankar

Krishna Nursing Home, Coimbatore - 641009, India.

Objective : Quetiapine is a relatively new atypical antipsychotic. Reporting a case of leucopenia and thrombocytopenia with quetiapine, requiring its discontinuation.

Clinical picture : A 45 year old man with chronic mania. He was brought for treatment following an exacerbation.

Treatment: He was started on sodium valproate 1500 mg daily and quetiapine 25 mg b.d. The quetiapine was gradually increased to 600 mg per day. Seven weeks after commencing quetiapine, white cell and neutrophils counts were 2.7 and 1.1 x 109 /L respectively and platelets were 146 x 109/L.

Outcome : Seven weeks after stopping quetiapine blood cell counts had returned to normal. (WBC 4.8x109/L, neutrophils 3.1x109/L and platelets 146x109/L).

Conclusions : This case suggests the importance of monitoring blood cell indices in patients treated with quetiapine. There are at present no guidelines for doing so.

Paper 16: Psychotropics induced dementia in an elderly patient: A case report

Alok Agrawal, Kedar Mal Agarwal

Department Psychiatry, V.M.M.C. & Safdarjang Hospital, New Delhi, India.

E-mail: [email protected]

An elderly patient is more susceptible to drug induced cognitive disorders. Polypharmacy and psychotropic drugs, anticholinergics and benzodiazepines are more commonly implicated in cognitive impairment. Atypical antipsychotics possess favourable cognitive profile, however atypical antipsychotics with higher anticholinergic activity like olanzapine may have adverse effect on cognition.

We are reporting a case of a 63 year old farmer, who was diagnosed as a case of "acute and transient psychotic disorder" and was put on olanzapine 20 mg/day and lorozepam 4mg/day. Later on trihexy phenidyl 6 mg/day was added to manage extrapyramidal symptoms. The psychotic symptoms subsided within a month of initiation of treatment. Continuing on the same treatment, the patient's cognitive functions gradually starting deteriorating over a period of 6-7 months to the extent that he had difficulty in recognizing close friends and family members and performing day to day activities. At the time of presentation his "mini mental state examination (MMSE) score was 14. Delirium and depression had been ruled out and was diagnosed provisionally as a case of "dementia". Olanzapine, trihexyphenidyl and lorazepam were with drawn in 2 weeks and rivastigmine 3 mg/day was started.

There was dramatic improvement in the patient's condition within 2 weeks following complete withdrawal of olanzapine, trihexyphenidyl and lorazepam. The patient's MMSE score increased to 25. This dramatic improvement strongly favours these medications as a cause of dementia like presentation.

Explanations and risk factors of "dementia like presentation" in this susceptible elderly will be discussed.

Paper 17: Efficacy and safety of risperidone in pediatric bipolar disorder: An open label prospective study

Kuldip Kumar

Department Psychiatry, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi - 29, India. E-mail: [email protected]

Several open and double blind comparative trials especially placebo controlled comparisons have shown use of risperidone in adult population; Because of its antagonistic action at 5HT-2 and nor-epinephrine alpha-2 receptors it not only resolves manic and hypomanic symptoms but also postulated as an effective therapy to avoid post-manic depression.

The main aim of the study was to evaluate the efficacy and tolerance of risperidone in children and adolescents with bipolar disorders. The study was conducted at the Department of Psychiatry, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi. Thirty six patients who fulfilled ICD-10 criteria of bipolar disorder were subjected to an open label trial of risperidone (including mania, hypomania, rapid cycler or mixed bipolar affective disorder). Thirty one patients completed the 8 weeks trial of study. The dose of risperidone (2-6 mg/day) was used as per clinical decision of the treating psychiatrist. However, zolpidem was added whenever required. Progress of the subjects was monitored with a total five examination at 2-weekly intervals by Young Mania rating scale and global assessment scale and side effects by UKU side effect rating scale.

Most of the young patients showed significant short term improvement. Further results and their clinical implications will be discussed at the presentation.

Paper 18: Mirtazapine induced restless-leg syndrome

Pali Rastogi

M.G.M. Medical College and M.Y.H Hospital, Indore, India.

E-mail: [email protected]

A case of 45 years old male suffering from servere depressive episode without psychotic symptoms was started on mirtazapine - 15 mg/day; three weeks after treatment he developed restless leg syndrome. The presentation would give the details of the case with the discussion on induction of restless leg syndrome by anti-depressant drug and its management.

Paper 19: Therapeutic trial of risperidone with omega: 3 fatty acids in schizophrenia

Ravi S. Pandey, Gunapu Shivakumar, Vishal I, Naveen Kumar C.

Department Psychiatry, NIMHANS, Bangalore - 560 029, India.

Aim: To evaluate the efficacy of eicosopentacnoic acid (EPA) and docosohexaenoic acid (DHA) in enhancing the short-term improvement with risperidone in Schizophrenia.

Methods : Thirty Schizophrenics diagnosed according to DSM IV and satisfying specified exclusion criteria were randomly assigned to experimental (n = 15) and control groups (n = 15) which received 6 mg risperidone +3 gm EPA + 1 gm DHA/day and 6 mg risperidone + 3 gm placebo + 1 gm placebo/day respectively for 30 days. Under double blind conditions, the patients were rated for schizophrenic symptoms at weekly intervals with PANSS.

Observation and Result: On RMA NOVA, there was no statistically significant difference between total PANSS scores or subscale scores between the two groups.

Conclusion : Omega fatty acids do not increase the antipsychotic efficacy of risperidone in schizophrenia.

Paper 20: Rationale of psychiatric drug treatment in pregnancy and puerperium

Tushar Singh, Vani Kaler

Department of Psychiatry, Govt. Medical College and Hospital, Sector 32, Chandigarh, India. E-mail: [email protected]

Clinicians are cautions about prescribing drugs during pregnancy or when a mother is breast feeding due to the possible risk to the fetus and infant.

Potential adverse effects for the fetus and neonate include:

Structural malformations, acute neonatal effects - like intoxication and neonatal abstinence syndrome, IUD, altered fetal growth, neurobehavioral teratogenicity. neonates exposed to psychotropic medications during pregnancy should be monitored for withdrawal syndromes following delivery. Estimates of the risk for drugs used during pregnancy are largely derived from case reports or retrospective cohort epidemiologic studies. These are often biased or flawed and our knowledge will remain limited because prospective randomized and well controlled investigational studies are neither feasible nor ethical. With these limitations in mind, certain literature based guidelines are there to assist appropriate drug selection.

We conducted a review of the latest available literature and reached to a few conclusions regarding the following:

Categorization of risk of drug use in pregnancy.

Tetratogenic risks of specific psychotropic drugs.

Dosing recommendations.

Special considerations like drug treatment and lactation.

The findings will be presented and discussed in the conference.

Paper 21: Factors influencing non-compliance to antipsychotic medication

Madhukar J. Chaudhury, Kamal Nath

Department of Psychiatry, Silchar Medical College, Silchar Assam, India.

E-mail: [email protected]

The study was carried out at the Psychiatric Department of Silchar Medical College, Assam from 1 st April 2006 to June 30 th 2006. In total 80 cases of different psychotic illness were compared with 80 cases of chronic medical illnesses viz hypertension and diabetes towards the factors influencing further non compliance to medication. The main aim were to find out the sociodemographic factors associated with non compliance of antipsychotic medication, to see the role of primary care givers in compliance by the patient and to see the correlation of non compliance with various social and clinical factors.

It was found that non compliance was more among the psychotic group of patients staying in a nuclear set up in comparison to joint family set up for the chronic medical illnesses. Marriage did not influence the compliance in the affected group of population. That indicated psychotic patients were better looked after in a joint family set up as far as compliance was concerned. The factors which mainly contributed towards non compliance was the low education level, poor socio economic status, poor awareness towards the nature of illness making them to seek the help of traditional faith healers. Other important factor was non-availability of psychiatric set up in the primary and secondary care level. Further details will be discussed in the poster.

Paper 22: Divalproex sodium vs sodium valproate (enteric coated): Their efficacy, side-effect profile and cost effectiveness

S. Harshavardhan, S. Arunkumar

Sowmanasya Hospitals and Institute of Psychiatry, Trichy - 620 002, India.

E-mail: [email protected]

Introduction : Sodium valproate has been used, for long in treating bipolar affective disorder (BAD). Numerous preparation of their compounds are available in market today but their relative advantages over one another has not been studied thoroughly in BAD.

Objective : To study the efficacy, side-effect profile and cost-effectiveness of patients treated with Divalproex sodium and Sodium valproate enteric coated preparation for BAD.

Methods: Patients on the above two medications are followed up and assessed for the control of mood symptoms, their reported side-effects and total cost of treatment for a period of 2 months.

Results of the study will be discussed at the time of presentation.

Paper 23: Melatonin in schizophrenic patients with insomnia: A double-blind, placebo-controlled study

P. N. Suresh Kumar, Chittaranjan Andrade, Savita G. Bhakta, Nagendra M. Singh

National Institute of Mental Health and Neurosciences, Bangalore - 560 029, India. E-mail: [email protected]

Background : Low nighttime levels of melatonin have been demonstrated in patients with insomnia, and melatonin has been shown to have hypnotic properties in some groups of such subjects. Low melatonin levels have also been observed in schizophrenic patients, however, there is little literature on the efficacy of exogenous melatonin in treating insomnia associated with schizophrenia.

Method : Stable schizophrenic outpatients (n=40) with initial insomnia of at least 2 weeks duration were randomized to augment their current medications with either flexibly­-dosed melatonin (3-12 mg/night; n=20) or placebo (n=20). Using a questionnaire, double-­blind assessments of aspects of sleep functioning were obtained, daily across the next 15 days.

Results : The modal stable dose of melatonin was 3 mg. Relative to placebo, melatonin significantly improved the quality and depth of nighttime sleep, reduced the number of nighttime awakenings, and increased the duration of sleep without producing a morning hangover. Subjectively, melatonin also significantly reduced sleep onset latency, heightened freshness on awakening, improved mood, and improved daytime functioning.

Conclusion : Melatonin may be a useful short-term hypnotic for schizophrenic patients with insomnia. Melatonin could be considered for patients in whom conventional hypnotic drug therapy or higher sedative antipsychotic drug doses may be problematic.


Paper 1: Relationship between caregivers expressed emotions and Psychiatric morbidities in HIV infected individuals

Praveen Somani, T. Hema, A. Anil, P. S. V. N. Sharma

Department of Psychiatry, Kasturba Medical College, Manipal, Karnataka - 576104, India. E-mail: [email protected]

Aim : To study the correlation between caregivers expressed emotions and psychiatric symptoms in recently diagnosed (less than 6 months) HIV infected individuals.

Methods : 30 patients with HIV positive status (based on ELISA and Western blot results) were studied. The care giver of the patient was rated on Attitude questionnaire and the patient on SRQ-25. Additionally, latest CD4 counts of the patient were also collected from records.

Results : Data will be analyzed and presented.

Paper 2: Do caregivers provide adequate information to HIV infected children?

R. V. Rao, R. Sagar, S. K. Kabra, R. Lodha

Department of Psychiatry, AIMS, Delhi, India. E-mail: [email protected]

Introduction : Caregivers are an important source of information for children about any illness they are suffering from.

Aim : To study the nature and extent of information provided by the caregivers to HIV infected children.

Methods : The sample comprised of caregivers of 18 HIV positive children, chosen conveniently, attending the pediatric outpatient clinic of a tertiary care hospital. Responses of the caregivers to a semi-structured, interviewer -administered questionnaire were analyzed.

Results : The mean age of children was 9.06 (± 1.89) years. Transmission was through parental route in 78%. In majority (56%), both the parents were HIV positive. About 39% had only their father alive, while another 22% had only their mother alive. Majority of the caregivers (72%) had not disclosed the child's HIV status to him/her. A large majority (94%) had not disclosed HIV status of other family members to the child. None of them thought that the child was aware of the transmissible nature of HIV. About 67% had revealed the HIV serostatus of the child to their relatives and 11% to their neighbors. In about 56% of cases "associated physical problems" was the reason cited to the children for frequent hospital visits and medications. About 83% opined that the child should not be disclosed about his/her HIV status because of various reasons.

Conclusion : Majority of the caregivers did not provide adequate information to the children about HIV infection. The findings have implications for issues such as stigma, discrimination and adherence to treatment.

Paper 3: Children and adoloscent living with human immunodeficiency virus and the associated changes in emotional and neuropsycological functioning

V. Dutta, P. S. Murthy, R. Satish, S. Gopal, N. K. Venkataraman

Department of Psychiatry, Manipal Hospital, Rustam Bagh, Airport Road, Bangalore - 560 017, India.

Objective : Neuropsychological status was assessed for its usefulness in predictive CNS impairment and disease progression in human immunodeficiency virus (HIV) infected children and adolescents on antiretroviral treatment (ARVT).

Methods : Twenty two children, aged 6 to 18 years, vertically infected with HIV and undergoing treatment with ARVT were evaluated in terms of health status, and neuropsychological testing. A randomly selected group of 22 healthy children who were age and gender - matched were evaluated also.

Results : Children with the lowest neuropsychological functioning (IQ90) functioning.

Conclusion : These children represent a significant subgroup of HIV-infected child survivors for whom the progress of the disease is less aggressive throughout early life and the effect of ARVT inhibits the disease progression. Measures of neuropsychological status provide unique information regarding HIV disease progression. As such, these findings have important implications for predicting long-term outcomes in patients. Periodic neuropsychological assessment is recommended to trace disease progression.

Paper 4: Quality of life of the persons living with HIV/ AIDS

C. Ramasubramanian, Paulus Samuel, M. Kannan, P. R. Rajeshkumar, P. Rajkumari, M. Sankarapandian

M. S. Chellamuthu Trust and Research Foundation, Madurai, Tamil Nadu, India.

People living with HIV/AIDS (PLWHA) have been experiencing multiple problems both physical as well as psychological. Until the introduction of highly active anti retro viral therapy), they had more physical sufferings. Hence the psychological components were not focused on the lime light. There was a real shift for better for the PLWHA after the introduction of ART and their longevity has greatly changed. However, those who are working for PLWHA have been asking whether or not introduction of ART has changed the Quality of Life of those persons.

An attempt has been made to study, measure and compare the quality of life of PLWHA who are on ART and who are not in such treatment. Fifty (50) PLWHA who are getting ART adherence services from CARE (Centre for AIDS Rehabilitation and Education) and Psycho-Social Care by M.S. Chellamuthu Trust, Madurai have been selected randomly. Yet another 50 persons who are not getting ART were also selected and matched.

The 26 items WHO-QOL-BREF scale was administered on both the groups to study the quality of life. The four sub-dimensions namely physical health, Psychological, level of independence, social relation along with Total QOL were also compared for the two groups of PLWHA. It was observed that PLWHA who are in ART adherence have better quality of life than the others. The authors have also suggested the various psycho-social care and support services for PLWHA.

Paper 5: Neuropsychiatric manifestations of syphilis at tertiary care hospital in South India

T. Harish, P. Murthy, S. Sinha*, Chandramukhi**

Departments of Psychiatry, *Neurology, **Neuromicrobiology, NIMHANS, Bangalore - 560029, India. E-mail: [email protected]

Syphilis is an important health problem in the developing countries and is still a problem in India. It can present with several kinds of neuropsychiatric manifestations. Due to the presence of HIV, there has been a new interest in the area of neurosyphilis. This retrospective study was carried out to report the neurosyphilis cases diagnosed at a tertiary care hospital in South India, and to analyse the demographic details, clinical and laboratory parameters of these cases. The case files of thirty two patients were analyzed from the year 1999 to 2006. Nine patients belonged to female sex. Five patients tested positive for HIV. Further details of the study will be presented and discussed.

Case Report : Quetiapine induced neutropenia and thrombocytopenia.

Objective: Quetiapine is a relatively new atypical antipsychotic. Reporting a case of leucopenia and thrombocytopenia with quetiapine, requiring its discontinuation.

Clinical Picture : A 45 year old man with chronic mania. He was brought for treatment following an exacerbation.

Treatment : He was started on sodium valporate 1500 mg daily and quetiapine 25 mg b.d. The quetiapine was gradually increased to 600 mg per day. Seven weeks after commencing quetiapine, white cell and neutrophils counts were 2.7 and 1.1 x 109/L respectively and platelets were 146 x 109/L.

Outcome : Seven weeks after stopping quetiapine blood cells counts had returned to normal. (WBC 4.8 x 109/L, neutrophils 3.1 x 109/L and platelets 146 x 109/L).

Conclusions : This case suggests the importance of monitoring blood cell indices in patients treated with quetiapine. There are at present no guidelines for doing so.

Paper 6: Delusion of HIV Infection "How severe it can be"?

K. K. Mishra, R. Koshi

HIV pandemic is spreading worldwide. In the next few years India will have the credit of having largest number of HIV positive cases. No definite cure is available till date. Proper health education is the main stay of prevention. Counseling should be fact based and client oriented than creating undue fear.

Few cases of HIV delusion with devastating outcome are discussed in the presentation. This will just give a glimpse to the situation. These are just the tip of iceberg. Many more may be suffering silently. If this aspect is not dealt properly and adequately it may happen more and more may suffer from delusion of HIV infection than the actual infection per-se .

Paper 7: Psychiatric morbidity in AIDS patients

Anuj Mittal, P. K. Pathak, I. C. Borgaria, Charu Shiva

D.D.U. Hospital, New Delhi, India.

This study was done in 100 patients attending ART center at DDU hospital, New Delhi. The screening was done by GHQ scale; brief psychiatry rating scale was used and clinical diagnosis was according to ICD-10. 15% of the patients were suffering from depressive disorders, 12% had GAD, 10% had drug dependence, 3% had panic disorder, 2% had schizophrenia and 2% had personality disorders. The commonest age group was 25-35 years, married and had multiple sexual partners.


Paper 1: Analysis of somatic symptoms in geriatric psychiatry patients and treatment challenges faced

Rahul Tadke, Vivek Kirpekar, Sudhir Bhave, Satyen Sharma, Madhav Raje, Sonal Anand

N. K. P. Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Digdoh Hills, Hingna, Nagpur, Maharashtra, India.

33 patients presenting in Geriatric-Psychiatry outpatient-department were analyzed along demographic-profile, presenting-symptoms, clinical-features, somatic-symptoms and diagnoses, administration of Brief Psychiatric rating scale (BPRS) and Mini Mental State Examination (MMSE), treatment given, challenges faced, support-group and carer burden.

The patients aged 60 to 80 yrs (16 males, 17 females) presented with Somatic (11), Depressive (7), Psychosis (8), Cognitive (3) and anxiety (4) of duration around 1 year. All except two patients had somatic symptoms like headache, body ache, multiple pains, tingling-numbness, heaviness, fullness, burning, itching and persistent giddiness. Although 9 patients were diagnosed having somatoform pain disorder, Somatic delusions (2), Major Depression (3), Dysthymia (3), Anxiety (4), Brief-psychosis (2), Delirium (1), Dementia (2), Schizophrenia (4) and Delusional disorders (3). A third of them had comorbid medical-illness and only 6 had significant impairment on MMSE (scorePaper 2: Cognitive decline in elderly in-patients of a general hospital

Siddesh. D. Parhar, Pavan. A. Sonar, Yusuf. A. Matcheswalla

Department of Psychiatry, Masina Hospital, Byculla (E), Mumbai, India.

Introduction : The dementias are a heterogeneous group of psychiatric disorders characterized by loss of prevention levels of cognitive, executive, and memory function in a state of full alertness.

The loss of socio-economic productivity and burdens to family caregivers are profound. Dementia is most common in the elderly, with the increasing age of the population, the prevalence of dementia is expected to double by 2030.

Dementia directly increases health care expenditures and complicates the management of co-morbid medical conditions. Patients with dementia have increased rates of institutionlization and mortality.

Early identification of cases is now imperative, given that prompt evaluation and diagnosis facilities early use of cognition-enhancing and neuroprotective therapies and supportive care to the patient and family. Therefore, we decided to do this study which aimed at,

To study the prevalence of cognitive decline in elderly in-patientsTo compare the illness related variables with cognitive decline.

100 patients age above 45 years admitted in medical and surgical wards of general hospital, interviewed using semi-structured proforma and assessed on mini-mental status examination, clinical dementia rating scale and Geriatric rating scale.

The data thus collected, will be tabulated and analysed using statistical methods. The results obtained will be discussed in relation to the literature.

Paper 3: A study of depression in old age individuals

V. K. Aravind, V. D. Krishnaram, Sangeetha

Ram Psychiatry Hospital and Institute, Madurai, India.

Depressive symptoms are present in 15-20% of all older community residents and inpatient settings. Age is not a risk factor for development of depression, but factors like being widowed, individuals with chronic physical illness, financial burden and several psycho-social risk factors are highly associated with depression in old age. Elderly patients with depression do not present with typical presentation but more of atypical symptoms often associated with co-morbid physical conditions.

The aim of the current study is to find out the prevalence of geriatric depression. Patients were recruited from two hospitals, one from a general hospital and other from patients directly coming to psychiatry hospital. A semi structured proforma is used to study the soci-demographic profiles. Individuals were then screened with Golberg's general questionnaire (GHQ) -12 item version. After screening with GHQ, individuals scales. Using appropriate statistical analysis results will be discussed.

Paper 4: Mental health problems in the elderly

Elsie Oommen, C. Ashuthosh, P.S.V.N. Sharma

Department of Psychiatry, KMC Manipal, Karnataka - 576104, India.

E-mail: [email protected]

Background : The increased frequency of mental health problems above the age of 60 yrs require specific diagnostic, therapeutic approaches

Aim : To study the nature and prevalence of psychiatric disorders seen in elderly with a secondary aim of reviewing the diagnostic stability of late onset psychiatric disorders.

Methods : All individuals with a late onset psychiatric diagnosis i.e., no pre-existing psychiatric diagnosis prior to the cut off age admitted as in patients or attended geriatric psychiatry clinic in a tertiary care general hospital are included in the study. It involves 5 yrs retrospective chart reviews of medical records including about 200 old patients. We look at the psychiatric diagnosis, comorbid physical diagnosis, associated cognitive dysfunction, treatment given under and their outcome in terms of diagnostic revision, attrition and improvement.

Results and Conclusion : Will be presented.

Paper 5: Coping or moping? A psychosocial profile of a geriatric population at a community health center

Hemath Sonanis, Urmila Sawant, Ravindra Kamth, Ajita Nayak, Alka, Subramanyam, Priya Sivshankar

Department of Psychiatry, BYL Nair Ch. Hospital, Mumbai, India.

Aim: To study psychosocial profile and its correlation with depression among the patients attending geriatric OPD of a community health center.

Methods : 42 consecutive elderly people from lower socio-economic class, within age group of 60 to 80 years were interviewed in a community mental health camp. Each patient was administered - a semi structured questionnaire for psychosocial profile and mini international neuropsychiatric interview (MINI) for diagnosis of depression.

Discussions and Results : It was found that majority, i.e., 86% had never planned for their future. The daily activities in order of preference included television viewing, religious activities, caring for grandchildren and household chores. Community activities and exercise were not present.

None of them had any financial savings. Although 24% were found to be still earning. 38% were completely financially dependent. 38% of them were not involved by their family members in any decision making. However majority wished to spend the rest of their life with their family. Only 9.5% were open to the idea of living in a home for the aged. On inquiring about future plans, only 14% expressed interest in leading a physically active life. It was also found that 67% expressed no wish to live any longer.

On applying the MINI, 29% were found to have depression. Suicidal risk was present in 9.5%. The psychosocial factors were correlated with the depression in the study population.

Paper 6: A study of psychiatric morbidity amongst the hospitalized elderly patients

Das Jibananda, Chaudhury Pranit Kumar, Deka Kamala, Das Anup Kumar

Department of Psychiatry, Assam Medical College, Dibrugarh, Assam, India.

Background : The average lifespan in many parts of the world has increased over the past century beginning with new challenge (Pereira 2002). So the number of elderly people is growing very fast in both developed and developing countries. It has been observed from the review of literature that some studies have been conducted on psychiatric morbidity in the elderly but no such study have been conducted from this part of the country. Maximum reports have reflected that majority of elderly patients have higher rates of psychiatric disorders specially depression, anxiety disorder, psychosis and psychoactive substance use disorder.

Aim : To assess psychiatric morbidity amongst the elderly patients admitted in psychiatry ward (group A), psychiatric morbidity amongst the elderly patients admitted in medicine and it's allied branches Viz.Neurology, Nephrology, Cardiology, Dermatology, TB and Chest (Group B), and sociodemographic variables in different study group.

Methods : A total of 100 patients (20 from psychiatry department and 80 from medicine and its allied branches) were enrolled for the study. Sociodemographic data was collected on a semi-structured proforma. The patients were assessed using "MINI Plus" and DSM-IV-TR diagnostic criteria. Cognitive functions were assessed using MMSE.

Results : In group B; 25% patients have depressive disorder, schizophrenia and other psychotic disorder followed by bipolar disorder (10%), anxiety disorder, substance use disorder and dementia (5% each). But in group B; 46.25% of the study sample have no Psychopathology, 27.50% have depressive disorder followed by anxiety disorder (8.75%), Bipolar disorder (7.50%), Somatoform disorder (3.75%), suicidality (2.50%), schizophrenia, other psychotic disorder, substance use disorder and sleep disorder (1.25% each).

Discussion and Conclusion : Would be discussed at due course at the time of presentation.


Paper 1: Tobacco use among school children in North Bengal

Lt. Col. R. Shashi Kumar

Classified Specialist (Psychiatry), Military Hospital, Chennai - 600041, India. E-mail: [email protected]

Introduction : Children are routinely exposed to movie stars, television where smoking is depicted and also parents who use tobacco. Since tobacco is harmful and behaviour can be changed if caught early, understanding these influences, prevalence and attributes of its use are essential to formulating effective intervention strategies.

Objective : To assess prevalence, type of tobacco use, role of parental use of tobacco various other attributes related to its use among English medium secondary school children in a small town of North Bengal.

Methods: An English questionnaire was administered by the author to students from class eight to class twelve in three different schools over a period of 3 weeks.

Results : A total of 848 students were administered the questionnaire, of which 492 were boys. It was found that 14.98% of all students were stars, using some form of tobacco. Use of non smoking type if tobacco was highest (76.38%) 85.83% had begun before the age of 10 yrs. The average age of smokers was higher than non smokers in all classes. Daily frequency was highest among both types of tobacco user 39.37% of tobacco users parents were also using tobacco while only 28.98% of non tobacco user children's parents were using tobacco. An interesting finding was that girls were more influenced by movie stars while boys were almost equally influenced by movie stars and spot icons for getting motivated into tobacco use. Various other findings are discussed in the article.

Conclusion : Tobacco is significant among school going children and daily use is alarmingly high. Non smoking type of tobacco use is more prevalent. Parental use of tobacco, movies and sport icons appear to be important in initiating children into smoking.

Paper 2: Behavioral problems and temperament in children with epilepsy

R. T. Jose, M. P. Appaya, M. V. Ashok

Department of Psychiatry, St. Johns Medical College Hospital, Sarjapur Road, Bangalore, India. E-mail: [email protected]

Background : Many studies report a higher rate of psychiatric morbidity in children with epilepsy. Whether epilepsy influences temperament or specific behavioral responses remains uncertain.

Aim : To study the behavioral problems and temperament of children with epilepsy as compared to normal children.

Methods : 75 school going children aged between 6 and 12 with a diagnosis of epilepsy from two tertiary hospitals were studied. The mother was interviewed to collect socio-demographic data, family history and to rate children on the strengths and difficulties questionnaire (SDQ) and the temperament measurement schedule. Teacher reported SDQ was available for a majority of the children. Age and sex matched normal controls were used for comparison.

Results : 16% of epileptic children were rated by mothers abnormally high in all categories - conduct problem, emotional difficulties, hyperactivity, peer problems and poor prosocial behaviors. 25% of epileptic children had abnormal score in all domains were rated by teachers. The epileptic group was significantly different from controls in emotional problems (P=0,04) and total difficulties (P=0.01) subscale of the SDQ. In temperamental dimensions, epileptic children had higher levels of activity and intensity of reaction.

Conclusion : Children with epilepsy were found to have a higher incidence of behavioral problems and temperamental vulnerabilities. It is necessary to study such issues in a longitudinal design with a developmental perspective.

Paper 3: A study of sleep habits and sleep problems in Indian urban adolescents

Ravi Gupta, Manjeet S. Bhatia, Sameer Sharma, Devendra Dahia, Kapil Simalti, Rahul Sapra, Ramanpreet Singh Dua

Department of Psychiatry, University College of Medical Sciences and GTB, Hospital, Shahdara, Delhi - 110095, India.

In the present study 1989 healthy adolescents aged 12 to 17 years were recruited from schools. Information regarding their usual sleep pattern was noted in some-structured proforma containing questions regarding sleep habits. Subjects with poor motivation and known chronic illness (diagnosed by the information of school health records as well as the student) were excluded from the study. Incompletely filled proforma and those having contradictory information were also excluded.

A total of 1933 proformas were found valid and they were finally analyzed. Results show that adolescents spend 7.89 ± 1.53 hours per day in the sleep. 58% children retire to bed between 10 pm to 11 pm in the night and attain sleep within 30 minutes. Most of the children wake up between 5 am to 6 am on an average took 5 minutes to leave the bed after waking up. Around three fourth (73%) did not follow this schedule on the weekends.

37.7% persons complained of nocturnal awakenings, starting during past 2 years, with a frequency of 2-3 days a week (40.1%) and 1-2 times per night (80.6%). Wake up time after sleep onset (WASO) was 3-4 hours (52.3%). Most common reasons for the awakenings were physiological- toilet (24.7%) and thirst (23.7%). Bad dreams were complained by 15.7% subjects only. Most of the persons remained awake for 5-10 minutes and then fell asleep again.

Abnormal movements during sleep were complained by 26.7% children, in whom sleep talking was reported by 0.6% and leg movements by 0.2%. 90% adolescents denied any kind of breathing difficulty; snoring was reported by 1.5% and breathlessness by 4%. These problems occurred regularly in 2.1% and occasionally in 7.3% subjects. 1.8% complained of increasing severity and 2.4% of increasing frequency. 56.2% reported daytime napping mostly for 1-2 hours; 16.4% complained of fatigue and 5.7% of poor concentration and 17.5% had increased duration of sleep on the following night if they could not sleep during the day. Examinations, the stress period affected their sleep badly with 57% children reported decreased sleep during exams.

Though the majority of children had sleep efficiency above 85% but refreshing nocturnal sleep was reported by 31% children only. 41.2% felt sleepy during most of the days and 25.9% complained of urge to sleep during the day. Family history of sleep related problems was found in 16.4% cases.

Paper 4: Dealing with exam stress amongst students: Challenge for psychiatrists

Sameer Malhotra

Consultant Psychiatrist, Department of Neurosciences, Fortis Hospital, Noida, D-32, Nizamuddin East, New Delhi - 110013, India.

E-mail: [email protected]

Stress is a growing problem in today's age of competition. Adolescence is in itself a period of significant stress. Significant biological (hormonal) changes take place during this phase, which in turn affect the mind. Exam pressure adds to the stress. Each year around the 12 th and 10 th class exams and results, we come across unfortunate incidents of suicide amongst students. Such cases reflect the growing vulnerabilities with failing hopes and confidence and are a cause for grave concern.

Models for developing coping abilities, positive cognitive reasoning and problem solving abilities, life skill training and communication skills shall be discussed. The abilities to set realistic goals/targets, explore and keep other career alternatives in mind, deal with adversities, gracefully accept-deal with and learn from failures, recognize their limitations and build on their strengths, take challenges in life, and the ability to appropriately and timely communicate distress seem to be important in this regard. There is also a need to generate awareness regarding timely recognition and help-seeking for underlying psychiatric problems (incl. Anxiety and depression) without the fear of stigmatization. The role of parents, peers, school teachers, psychiatrists and policy makers is very important in dealing with this challenge and in bringing forth a healthier and stronger generation.

Paper 5: Changing concepts in referral patterns in a school mental health clinic of a tertiary municipal hospital in India across 25 years

Yogesh N. Kamkhedkar, Ravindra Kamath, Ajita Nayak, Alka Subramanyan, Manu Tiwari, Gurvinder S. KalraDepartment of Psychiatry, BYL Nair Ch Hospital, Mumbai, India.

Introduction : In the latter half of 20 th century, mental health in children had gone through periods of expansion. This initiated systematic identification of children with emotional and behavioral disabilities; and created need of clinical referral to school mental health clinic. There have been studies on the referral patterns, but there is always a scope for a retrospective study comparing and analyzing the changing trends in the references.

Aim : To analyze and correlate the referral patterns in a school mental health clinic of a tertiary municipal hospitals, across last 25 years.

Methods : Annual reports of three nodal years (1979, 1994, 2005) were studied across 25 years, each one separated by a gap of 10 years. We compared the referrals, reasons for referrals and the diagnosis.

Results and Discussions : It was found that there has been a significant increase in the number of referrals over this span of 25 years. Over the years, the reasons for referrals have changed considerably. Scholastic backwardness (86%) and behavioral problems (37%) predominant in 1979. They constituted only 26% and 28% of the referrals in 2005. respectively. There were increased referrals for hyperactivity, seizure related problems, sleep problems and deliberate self harm.

There has been an increase in the diagnosis of hyperkinesis from 1.66% in 1979 to 8% in 2005. the incidence of psychosis in referrals was found to be 1% in 2005 as compared to none in 1979 and 0.3% in 1994.

Paper 6: Childhood and adult schizophrenia: A phenomenological comparison

Vivek Kumar

Department of Psychiatry, King George's Medical University, Lucknow, India

Schizophrenia is rare in children, affecting only about 1 in 40,000 birth compared to 1 in 100 in adults. Compared to adults, childhood schizophrenia is difficult to diagnose because of phenomenological differences. These problems of identifying and diagnosing children with schizophrenia can be attributed to following reasons a) Behavioral changes in children may be considered normal for one age but abnormal for another. b) Low incidence c) As one set is rare below 12 years of age, it is difficult for parents and caregivers to detect or accept the abnormal symptoms d) Parental thinking that child may outgrow the symptoms with age e) Diagnostic confusion with ADHD, conduct disorder and ODD f) the diagnostic criteria are more tuned to catching the adult schizophrenia patients.

An alert parent / physician should be equally concerned about any abnormal symptoms which become evident. The difference in the presentation of childhood and adult schizophrenia will be analysed and discussed.

Paper 7: Clinical profile and temperament of children with conversion disorder

Indira Sharma, Basant Kumar

Department of Psychiatry, Institute of Medical Sciences Benares Hindu University, Varnasi, India.

The aim of the present study was to study the clinical profile of children and adolescents with conversion disorder with regard to socio-demographic characteristics, symptom profile and temperament. 30 children, aged between 5-18 years, diagnosed as conversion disorder as per DSM-IV-TR, and without any co- morbid psychiatric or major physical disorder were selected from the out-patient department of the psychiatric section of the University Hospital, BHU, Varanasi. 30 healthy children comprised the control group.

They were group-matched with the patient group on age, sex, education, domicile and socioeconomic status and scored less than 10 on the childhood psychopathology measuring scale. The patients and controls were evaluated in detail. Information relating to socio-demographic variables, psychiatric history, physical and mental status findings, and reports of various investigations were recorded on a structured proforma. The Malhotras temperament schedule (1988) was employed to assess the temperament of children before the onset of symptoms.

The patient group had a mean duration of illness of 43.8 weeks and mean age of onset illness was 659 weeks. Family history of psychiatric illness was present in 10 first degree relatives (FDRs) of 8 (26.67%) patients. Conversion disorder was most common (40%) psychiatric diagnosis in the FDRs. The most common clinical presentation was fainting fits (80%), occurred in Paper 8: Behavioural problems in adolescent children: School based study

H. R. A. Prabhu, Jyoti Prakash, A. Kotwal

Base Hospital, Delhi Cantt - 110010, India. E-mail: [email protected]

One thousand adolescent children studying in class IX and XI in five large public schools in a metropolitan city were studied. Sociodemographic details of the parents particularly regarding their social background, occupation, family size, siblings of children etc. were obtained. Child Behaviour Check List (CBCL) of Achenback, parent version was used to analyse the behavioural problems. Two hundred and fifty five of the total study sample (25.5%) were found to be scoring above the cut off levels recommended for the CBCl. Boys and girls were analysed separately as the cut off scores are different for the genders.

Possible factors in the sociodemographic profile of the parents which might have contributed significantly to the higher cut off score in the children with behavioural problems have been analysed and presented.

Paper 9: Clinical characteristics of mass trance and possession symptoms among school children in Assam

Prosenjit Ghosh, S. K. Talukdar

Prosenjit Ghosh, C/o. Drugs Corner, Itkhola, Silchar, Assam - 788001, India. E-mail: [email protected]

The term Trance is derived from the Latin word Transitus (a passage) and Transire (to pass over), implying a passage into another psychic state. Trance has been described as a state of functional non-awareness, a detachment from the environment (Bourgigon).

The experienced of being "possessed" by another entity, such as a person, god, demon, animal, or inanimate object, holds different meanings in different cultures. Yet the phenomenon of possession states has been reported worldwide.

Possession states are often accepted as normal. Affected individuals can even achieve status by being seen as having supernatural powers of healing and understanding. Alternatively, these experience can be regarded as abnormal, particularly when possessed individuals become so distressed and dysfunctional that they seek assistance from faith healers and mental health professionals. Possession symptoms can occur in disociative disorders, schizophrenia, mania, depression and in OCD. Very rarely it has been seen as part of general paralysis of insane, senile psychosis and febrile delirium, organic CNS lesion.

The concept of possession is ancient. There are numerous biblical references to possession (Prins,1992). What is often misunderstood, however, is that possession phenomena may be normal, and occur as an everyday part of cultural or religious experience. Trance and possession symptoms can occur within a religious ritual with a group expectation for possession to occur. These type of possession states are not considered as illness by those affected and by the members of the community/religion. But when the trance and possession states are not considered as a normal religious practice/ritual by the community members of the affected individual then it becomes an illness or psychopathological issue.

These disorders are very common in India and African countries, where a belief in supernatural power is very widely prevailing. Therefore, it is extremely important to ensure that the disorder being diagnosed are not merely a culturally sanctioned behaviour.

Both DSM-IV and ICD-X puts the pathological form of Trance and possession states under the category of dissociative disorders. DSM-IV puts two conditions for these syndromes to be included as dissociative disorders NOS- (A) the trance or possession trance is not accepted as a normal part of a collective cultural or religious practice, (B) the trance or possession trance causes clinically significant distress or impairment in social or occupational or other important areas of functioning. ICD-10 includes these group of disorders as dissociative trance and possession disorders with code 44.3. In this group of disorders there is a temporary loss of identity and awareness and the individual may appear to be taken over by another personality or a spirit or deity. These disorders are limited to those that are involuntary and unwanted and occur outside of accepted religious or cultural experiences. Excluded are psychoses, MPD, substance-induced disorders and temporal lobe epilepsy.

The first Indian study on the phenomenology of possession was done (Teja 70) in Chandigarh with fifteen patients showing symptoms of possession. There are very few studies on the phenomenology of Mass Trance and Possession states in India. States seen among school students and aims to shed light on their experience. The study also aims to determine the impact of culture and religion on the presentation and degree of functional impairment. We also tried to find out presence of prodromal symptoms in the affected school children. We assessed fourteen school children who showed trance and possession symptoms almost simultaneously during school hours. We enquired into the demographical, phenomenological, personal, family and other related aspects of the affected children by using a semi structured interview proforma designed for this study. The detailed results and their implications will be discussed. Photographs and video footage will be presented.

Paper 10: Developmental changes and gender differences in the experience of stress and coping strategies among children

M. Mehta, G. Chugh, P. Pandey

Children often have to face not only the challenges of rapid developmental changes, but also have to deal with several stressful life events. All these may cumulatively contribute to increasing levels of stress among children, imposing a serious risk to the child's coping abilities,

The experience of stress varies across each child and is largely influenced by factors such as age, gender and kinds of coping strategies used to deal with stress. In the present study, the effect of age and gender on the experience of stress and coping strategies was studied. 2000 school children in the age range of 8-14 years from 6 different schools of Delhi were administered scales to measure physical and psychological symptoms of stress, daily hassles, stressful life events as well as their coping strategies.

Data analysis reveled that age is positively related to increase in physical and psychological symptoms of stress as well as experience of daily hassles and stressful life events. Also, with increasing age, children learn to use more positive coping strategies like cognitive self-instruction, distraction and a decreased need for seeking social support. It was also found out that females had higher physical as well as psychological manifestation of stress, and had a somewhat higher levels of daily hassles contributing to their stress. The study revealed that girls make more use of seeking social support and problem solving as coping strategies as compared to boys.

Paper 11: Role of maternal psychopathology in 'battered baby syndrome': A case report

Kushal Jain, Manju Mehta, Rajesh Sagar, Amit Gupta

Department of Psychiatry, 4 th Floor, Academic Section, AIIMS, New Delhi - 29, India.

Background : Battering or child abuse often goes unrecognized and untreated. Several cases of child abuse are reported in the literature. However this is not widely reported in Indian literature. Child abuse is difficult to diagnose due to a number of factors. Often such cases are seen in pediatrics, orthopedics, and dermatology specialities. Very few of them are seen by mental health professionals. Complexity of the presentation and lack of training in mental health problems make cases of child abuse a nightmare for the treating physicians. The case highlights the role of maternal factors especially maternal psychopathology in this case of battered baby syndrome.

Case Report : A 3 years old male child belonging to middle socioeconomic status Hindu joint family of Punjab was referred for evaluation to Child Guidance Clinic, Dept of Psychiatry, AIIMS. The child had normal birth and developmental history. Illness started 15 months back characterized by consecutive and repeated fractures mostly in upper extremities, repeated painful swellings in different parts of body followed by repeated painful peeling of finger and toenails. The child was evaluated in several reputed hospitals in North India however the changing symptom profile and appearance of vague symptom aroused suspicion over the diagnosis. After several sessions with the mother multiple factors were uncovered that had temporal relationship with the battering of child. Further information about evaluation and management of the case will be discussed in the conference.

Paper 12: Clinical profile of the patients presenting at child and adolescent psychiatric unit of a psychiatric hospital

Kusum Rai, Sandhyarani Mohanty, Sudhir Kumar

Institute of Mental Health and Hospital, Mathura Road, Agra - 282002, India.

The present study was designed to investigate the demographic and clinical characteristics of the patients presenting at Child and Adolescent Psychiatric Unit of Institute of Mental Health and Hospital, Agra. All cases registered at OPD between May 2005 and April 2006 were included. The results were analyzed along the dimensions of age, gender, education, domicile, duration of illness, nature of illness, family history of psychiatric illness, and religion. The results shall be presented.

Paper 13: Child and adolescent clinic: Recent trends in Goa

Mary C. De Souza, N. S. Naik, Y. Da Silva Pereira

Institute of Psychiatry and Human Behavior, Bambolim, Goa, India.

Introduction : Goa is a westernized state with eighty two percent literacy rate and a population of about fourteen lakhs of which forty percent is between 0-18 years. Institute of Psychiatry and Human Behavior is a tertiary care psychiatry hospital at Bambolim in Goa and has a Child and Adolescent Clinic since the past twenty years. Earlier data shows that few people were availing the services offered by this clinic. In recent years the Child and Adolescent population visiting the clinic has increased substantially. Hence this study was conducted to explore and compare the various sociodemographic characteristics and clinical profile of patients attending the Child and Adolescent Clinic.

Methods : A prospective study was conducted in the Child and Adolescent Clinic at the Institute of Psychiatry and Human Behavior, Bambolim, Goa. Cases attending the clinic for the first time from January 2004 to December 2005 (i.e., two year period) and meeting the ICD-10 criteria (WHO, 1992) formed the study sample. The data was collected on a structured proforma designed for the study.

Upon finding a trend for increase in the number of patients a comparison was done with a retrospective case note survey, (January 1994 to December 1995), to confirm the same. Data from case note survey was collected on the above mentioned structured Proforma and the diagnosis was based on ICD-10.

Analysis of the data was done using Chi-Square test of significance.

Result : Will be discussed at the conference.

Conclusion : The study will throw light on the probable factors responsible for the changing trends in the Child and Adolescent Clinic in Goa.

Paper 14: Child psychiatric morbidity in tertiary care hospital child guidance clinic

Yatam Pal Singh Balhara, Jatimder Mohan Chawla, Manju Mehta, Rajesh Sagar

Department of Psychiatry, 4 th Floor, Teaching Block, AIIMS, Ansari Nagar, New Delhi - 110029, India.

Objective : Indian children and adolescents suffer the turmoil of developmental stages through these years. Multiple and complex distressing factors have been implicated to be playing an important part in this development process that puts these children at risk of mental and psychological problems. However, there is a lack of child mental health facilities and services. At the same time the information on the prevalence of these disorders is limited. Understanding the prevalence of psychological and psychiatric disorders among children and adolescents is an essential component of a sound public health policy for the provision of mental health and other services. The objective of this study is to find the distribution of psychological and psychiatric disorders among children who attended the child guidance clinic at the tertiary care hospital at All India Institute of Medical Sciences, New Delhi, India.

Methods : Children and adolescents who attended the clinic over the past 3 years were assessed by using ICD-10 criteria, and socio demographic data were investigated. We have also compared the findings with the available literature and also commented on the possible reasons of differences observed in situations they were found.

Results : The results of the study will be presented at the conference as the analysis is still underway.

Paper 15: Descending academic performance in adolescent female students: Role of personality and perceived social support

Kedar Ranjan Banerjee, Tanmoy Mitra

National Institute of Behavioral Sciences, 7 CIT Road, Kolkata - 700 014, India.

Background : Increased concern regarding academic achievement in school and college students is prevailing among the urban families. Parent's desire their offspring to do well academically notwithstanding the youngsters' altered mindset. Teenage girls with recent problems with academics warrant for psychological investigations once the related physical issues are ruled out. National institute of Behavioral Sciences (NIBS) has been running a fully equipped psychiatric outdoor facility at the Salt Lake Government Hospital, Kolkata, which was the site for present investigation.

Methods : The study included total of fifty (N = 50) teenage girls who came to the Psychiatry outdoor of the Salt Lake Government Hospital for their recent academic problems. The average age was 14 and they came from middle to high income group. They were seen first by psychiatrist and then by psychologist for at least three times for investigation, diagnosis and follow-up. Subjects with apparent organicity or with psychotic components were excluded from the study. A control group without any psychopathology and having no academic holdings was used to compare. The subjects with same socioeconomic and other backgrounds are chosen for the study. ICD personality assessment (IPD), State-Trait Anger Expression Inventory (STAXI), Scale for Perceived Social Support (MPSS) had been used for the study.

Results : Majority (30%) of the subjects were assessed to have emotionally unstable personality disorder (impulsive type). Most of them reflected significantly higher (P=0.01) expressed anger and significantly lower (P=0.01) perceived social support compared to the control group. The study group indicated lesser control on expressed anger. The diagnosis show the various diagnostic status of the study group.

Unstable personality disorder (15), Dependent personality (3), Other personality disorder (3), Anxiety (4), Depression (7), Other psychological problem (4).

Discussion : In urban areas the school-going teenage girls are faced with multiple stress factors. The high expectation from the parents, and may also be from the society, make them decide career concern notwithstanding their own interest or choice. The more stringent rules are laid for their academic activities, the more intensive desire to do opposite has been watched. Impulsivity has been reported and results indicate a good number of unstable personalities in this group. Expressed anger was higher significantly than the control group which supports the impulsive personality pattern. When the area of perceived social support was looked at, these students indicate that they perceive receiving lesser support and thus remain discontented with their environment.

Conclusion : The study results indicate that adolescent female students having academic recede may be assessed for personality disorder and those with personality disorder can benefit from intervention toward lowering the impulsivity and changing the way to look at the social support they receive from their environment.

Paper 16: Correlation between teachers' report and clinical diagnoses in a child guidance clinic

Varghese P. Punnoose, A. M. Fazal Mohamed, G. Mohan Roy

T. D. Medical College, Vandanam, Alappuzha, Kerala, India.

Majority of children presenting in the Child and Adolescent Clinic are brought with complaints of poor scholastic performance. Information gathered from parents alone is often insufficient. Tools like Connor's Rating Scale - Teachers' version are in use, but their appropriateness, suitability and acceptability in a rural Indian setting has not been established.

We have evolved a method by which a teachers' report is sought in a semi-structured format to elicit the various aspects on child's scholastic performance, learning skills, attention-concentration, general behavior, relating with others (peers and teachers), peculiarities, problem behaviors and special abilities and strengths. The teacher chosen for reporting is the one with at least one year of interaction with the child. Of the 100 children reported upon, the data was analyzed to find out the degree of agreement between the teachers' observation and the clinical diagnoses and psychometric findings. Co-morbidity is a rule rather than an exception in child psychiatry settings. As this format cover most of the aspects of a child's behavior, many hidden co-morbidities may be brought to light for the first time. This also can serve as a base line data on which interventions can be planned and the changes monitored over a period of time. This kind of an involvement from teachers has shown to enhance teachers' interest in the child and reduction in discrimination and stigma attached to a child with poor scholastic performance. We expect that this may be a suitable method, which can be adapted by CGCs functioning with limited manpower and professional expertise.

Paper 17: Childhood sexual trauma and its manifestation in adult hood: A case report

Mihir Ranjan Nayak, Manaswini Dash

V.S.S. M.C.H, Burla, Sambalpur, Orissa, India.

A twenty-four year girl coming along with her brother and mother by reference of a gynaecologist to psychiatric O.P.D. The lady gynaecologist clearly mentioned in her referral slip that she has no gynecological problems, The symptoms are purely psychological.

She is presenting an abnormal sensation in the uterus. That sensation is due to an imaginary sexual intercourse. This gives pleasure some times and impaired sleep is the another complain. At that time she feels that, there is a connection in my head to pubic area, for that the sensation occurs from the head to the breast and next it goes downwards.

By subsequent interview, we came to know that in her childhood, she was being raped by an old army personnel staying as a neighbour to her house. Four to five times, she was victimized by that person. At that time she was ignorant about what is going on but subsequently she remembered the past activities.

In her adult hood since last 1 year, she had an abnormal feeling in her genital organs, imaginary, enjoying the sexual intercourse.

By consultation with our clinical psychologist we gave her psychotherapy and pharmacotherapy combined to reduce that abnormal sensation.

By frequent counselling and psycho-pharmacotherapy her symptoms reduced to 60% by the end of 2 nd month. By the end of 6 months 90% recovery in the disease was noticed. But after marriage the symptoms seemed to be collapsed. Now she is enjoying a very good married life with her husband.

Paper 18: Play therapy for children with conversion disorder and attention deficit hyperactivity disorder

Rahul Tadke, Jayeeta Gupta, Vivek Kirpekar, Sudhir Bhave, Satyen Sharma, Sangeeta Mule

Department of Psychiatry, N.K.P. Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Digdoh Hills, Hingna, Nagpur, Maharashtra, India.

Play-therapy was given to six children three of whom had conversion ­disorder motor-type and three had attention deficit hyperactivity disorder (ADHD).

3 children aged 11 yrs (female), 9 yrs (male), 12 yrs (female) presented with conversion episodes motor-type and one had hyperventilation. Initial evaluation could not explore the conflicts. Play therapy sessions were started daily for 1 week and then weekly with assessments, in which after hesitance they cooperated well. Drawing sessions were started in which after few sessions they started revealing their underlying conflicts in the pictures like conflicts with parents, sense of academic competition and intra-familial conflicts and stress due to it. They also revealed what they expected the ideal situation to be and improvement was noted in their behavior and anxiety symptoms. Episodes disappeared after 8-10 sessions when their conflicts were resolved but sessions were continued to strengthen their stress handling capacity. Significant improvement was noted on CGI scale.

3 children with ADHD already on pharmacotherapy, aged 9yrs(M), 7yrs(F), 4yrs(M) were taken for play-therapy for their aggressive-impulsive behavior. Play-therapy sessions in form of drawing modeling and story making were started on weekly basis and assessed. After initial hesitance children started participating actively. Mild changes in their behavior were noted after third session and significantly after sixth session in form of decreased aggression and impulsivity and increased attention span. They also opened up about stress due to parental conflicts which was secondary to their own behavior.

In above cases play-therapy was found to be very useful in exploring conflicts in conversion-disorder and for behavior-modification in ADHD.

Paper 19: Assessment of cognitive functions in children with attention - deficit / hyperactivity disorder

Rajesh Rastogi, Kunal Kumar, Suparna Kailash

Deptt.of Psychiatry, VMMC & Safdarjang Hospital, New Delhi

Background: Cognition denotes a relatively high level of processing of specific information including thinking, memory, perception, skilled movements and language. ADHD is believed to be the most common psychiatric disorder in children. It is characterized by hyperactivity, impulsivity and difficulties in sustaining attention.

Aims and Objectives : The objective of the study was to assess cognitive functions in children with ADHD and to compare them with normal controls. To use an objective array of measures of inattention, hyperactivity, impulsivity so as to obtain qualitative differences between the two groups.

Method : 30 children were taken, 15 with ADHD - C type were taken from the psychiatry department of Safdarjung Hospital and 15 forming the control group were taken from a school in Delhi after extensive interviews. The tools used in the study were the Bender Gestalt test, Digit Span Test, Colored progressive matrices and Porteus Maze Test.

Results : A significant difference was obtained between the two groups in terms of behavioral manifestation of inattention, hyperactivity, and impulsivity. The t - values calculated were 6.1, 4.29 and 3.59 respectively. Significant difference was also calculated on aspects of cognitive functioning such as working memory, T-calculated for digit span forward, backward is -5.56 and -4.17 respectively. The chief cognitive processes were assessed using the CPM, t- calculated was 2.8, visual motor perception was 4.08 and for planning ability 4.70 (PConclusion :Children with ADHD manifest more problems in areas such as inattention, hyperactivity, impulsivity and show poor performance on tests of cognitive functioning.


Paper 1: Comparison of cognitive deficits on MMSE and standard neurological battery

Arun Gupta, Pratima Murthy, Shobhini L. Rao

NIMHANS, Bangalore, Arun Gupta Room No. S-20, Kabini Hostel, Near Kidwai Hospital, Hosur Road, C/O NIMHANS, Bangalore - 29, India.

E-mail: [email protected]

Background : Scores on MMSE as indicator of the cognitive deficits may not be ideal in detoxified alcohol dependent patients. This study compared the scores on standard neuropsychology tests with that of the MMSE scores.

Methods : Inpatients (N=90) admitted at NIMHANS aged 20-60 years diagnosed as alcohol dependence syndrome according to ICD-10 criteria 3-4 weeks after abstinence from alcohol.

Results : There was significant correlation of the MMSE scores with the performance on attention, visuospatial, verbal learning and planning. MMSE did not pick up the deficits in all subjects who were deficient on neuropsychology tests.

Conclusions : There is a need for use of standard neuropsychology instruments in assessing the cognitive deficits in detoxified alcohol dependent individuals.

Paper 2: Neuropsychological assessment as a diagnostic aid

Susan Thomas, Prathima Murthy, L. N. Suman, Vishal Reddy, Sunil, Jamuna. N

Department of Mental Health & Social Psychology, NIMHANS, Bangalore, India. E-mail: [email protected]

Background : Neuropsychological assessment is an important diagnostic aid to obtain information on brain damage, especially when there is inadequate history.

Aims and Objectives : To use neuropsychological assessment as an aid to get information on brain damage in a patient who was primarily diagnosed with Alchohol Dependence syndrome. There was a history of assault and strangulation, but no further information was available.

Methods : The patient was a 23-year-old male, educated till 10 th standard, brought with complaints of being confused and difficulty in identifying people, giving inconsistent replies and wandering since the past 10 days and long term alcohol use. A primary diagnosis of alcohol dependence syndrome was made. The patient was referred for neuropsychological assessment, as the symptomatology seemed to be different from that of ADS. A comprehensive neuropsychological assessment was done, assessing the different lobe functions.

Results : The neuropsychological profile showed impairment in executive functions, verbal learning and memory, delayed visual recall and left parietal focal signs of agraphia, acalculia, alexia and also anomia. An impression of left temporo parietal and prefrontal involvement was made. An MRI done subsequent to this showed a left temporoparietal infarct, wedge shaped- probably embolic in origin which validated the findings of neuropsychological assessment,.

Conclusion : This case study shows that neuropsychological assessment can aid in the diagnosis of brain damage.

Paper 3: Workshop: Screening instruments for early detection of dementia

Om Prakash, P. T. Shivkumar, Srikala Bharath, Mathew Varghese

Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore - 560029, India.

The diagnosis of dementia requires three elements i.e., decline in atleast two domains of cognitive function, including memory; interference with social or occupational functioning; and the absence of an alternative explanation e.g., depression, for these phenomena. These criteria imply the need for cognitive testing and for a clinical examination of the participant, together with a collateral history from an informant. Determination of a patient's cognitive status by use of a valid and reliable screening instrument is of major importance as early recognition and accurate diagnosis of dementia. Deterioration in activities of daily living (ADL) performance because of cognitive decline is a key marker for dementia. The measures of cognitive status (HMSE-Hindi adaptation of MMSE) and ADL (EASI-Everyday Abilities Scale for India) have been developed with Indian adaptation by Ganguli and her group in order to characterize the performance of demented people. These instruments are suited for Indian population. Symptoms of disturbed perception, thought content, mood or behavior that frequently occur in patients with dementia can be easily assessed by Neuro-Psychiatric inventory (NPI) (Cummings et al., 1994). The aim of the workshop will be to train mental health professionals regarding these instruments for early detection and management of dementia and relevant proposed research in this area.

Paper 4: Rorschach test norms of older Indians

Suprakash Chaudhury, S. Sudarsanan, K. Seby, K. Srivastava, S. M. Kundeyawala, S. P. Rathee, S. K. Salujha

Department of Psychiatry, Ranchi Institute of Neuropsychiatry and Allied Sciences (RINPAS), Kanke, Ranchi - 834006, Jharkhand, India.

E-mail: [email protected]

Rorschach norms for older Indians are not available and no study has been carried out in India on older Indians. The Rorschach test by Klopfer's method was administered to 442 older Indians in the age group of 65 years or more, comprising of normal subjects and patient groups. The normal sample consisted of 282 subjects. The patient sample consisted of 160 patients with the diagnosis of dementia (n=66), alcohol dependence syndrome (n= 8), schizophrenia (n=16), mania (n=5), depression (n=50) and anxiety disorders (n=15). The Rorschach protocols of normal older Indians at different age groups showed significant differences from each other and also from the Western norms. The Rorschach profiles of the various groups of patients also showed significant differences between them, from normal older Indian subjects and also from the Western norms. Interpretation of the Rorschach protocols of normal older Indian and also patients using the Western norms would be fallacious and misleading. The use of the Rorschach test to study the aging trends of normal older adults as well as an aid to clinical diagnosis was strongly supported.


Paper 1: Prevalance of posttraumatic stress disorder among persons living with HIV/ Aids0 (PLWHA)

C. Ramasubramanian, V. Veera Balaji Kumar, S. Ganesh Kumar, R. Rawlin Chinnian, M. Kannan, V. Srilekha

M. S. Chellamuthu Trust and Research Foundation, Madurai, Tamil Nadu, India.

Posttraumatic stress disorder, or PTSD, also known as Da costa's syndrome, is an anxiety disorder that can occur following the experience or witnessing of life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults like rape, mugging etc. Patients afflicted with this psychiatric disorder experience flash back experiences of the traumatic event, avoidance of activities reminiscing it and numbing of emotions and hyperarousal symptoms, which impairs the person's daily life.PTSD is marked by clear biological changes as well as psychological symptoms. It frequently occurs in conjunction with related disorders such as depression, substance abuse, suicidal attempts, grief, etc.

An attempt has been made to understand and to measure the impact of HIV diagnosis in relation to PTSD. One hundred sixty PLWHA from HIV positive network group have been selected randomly. Yet another 160 persons who are the caretakers of patients attending the out patient facility of Padma Homeopathic clinic have been selected and matched using selected socio-demographic conditions. For both the groups the 17 item PTSD checklist - civilian (PCL-C) and 17 item life events checklist developed by National center for PTSD, USA were administered. The results have been analysed using SPSS and it was observed that PLWHA had more and significant PTSD scores than their counterparts. The authors have suggested different psycho-social intervention programs for PLWHA in detail in this paper.

Paper 2: Series of cases of post traumatic stress disorder

Col. B. Patra and Lt. Col. R. Shashi Kumar

Department of Psychiatry, Col. Balaram Patra, Senior Adviser (Psychiatry), Alipore, Kolkata - 700027, India.

Post traumatic stress disorder (PTSD) is characterized by onset of psychiatry symptoms immediately after exposure to traumatic events and it manifests with re-experiencing the trauma, avoiding the stimuli associated with the trauma and experiencing symptoms of autonomic hyper arousal.

Traumatic events involve either witnessing or experiencing threatened death or injury or witnessing or experiencing threat of physical integrity. Posttraumatic stress disorder was not long ago considered to be a disorder only of war veterans as about 15% of Vietnam veterans suffered from this disorder. It is now recognized as highly prevalent disorder affecting much larger section of population.

There have been reports of PTSD in low intensity conflicts in the Indian Armed Forces. However individuals exposed to interpersonal trauma can also present with PTSD. There are medical and surgical events such as cancer diagnosis or open heart surgery have been documented to meet the criteria of PTSD. In this article we shall present four such cases of PTSD following different types of traumatic events like undergoing CABG, experiencing Tsunami, witnessing violence and perceiving threat.

Paper 3: Disaster experience, substance abuse, social factors and severe psychological distress in male survivors of the 2004 tsunami in South India

Christina George, Ginesh Sunny, Jacob John

Department of Psychiatry, S.M.C.S.I Medical College Hospital, Karakonam, Trivandram, Kerala, India. E-mail: [email protected]

Background : Natural disasters in developing countries have been studied inadequately given the frequency of occurrence. Studies in developing countries have shown that up to 50% of the population have clinically significant psychological distress.

The aim of the study was to determine the mediating effects of long standing psychosocial factors on the psychological health of male survivors of the 2004 Tsunami.

Methods : Data on 352 male survivors of the 2004 Tsunami in the Kanyakumari district, South India on levels of psychological distress, Job related factors, substance abuse, strength of faith, social support and disaster experiences was analyzed. Data was collected for a 3 month period from August 2005.

Results : 43% of the population had clinically significant psychological distress and 31% of the population showed very high levels of psychological distress. Individuals with higher frequency of personal prayer, better quality of marital life, job satisfaction were relatively protected from developing psychological distress. The presence of substance abuse and severe disaster experience, such as losing a family member, was associated with severe psychological distress.

Conclusion : Male survivors of the 2004 Tsunami had significant levels of severe psychological distress. A further study of the mediating factors may serve to understand and even prevent the development of severe psychological distress in the post disaster period.


Paper 1: Attempted suicide and life events: An analysis

R. Vidyendaran, N. Solayappan, S. Purushothaman, Deepthi Joseph

Department of Psychiatry, SRM Medical College Hospital and Research Centre, India.

A sample of 100 patients admitted for having attempted suicide were assessed for various life events which were found to have a temporal relationship to the attempt.

The life events were assessed using the Holmes and Rahe's life event scale. The severity of depression was assessed using the Hamilton's rating scale for depression - 24 item. The results, conclusions and analysis will be described and discussed in the study.

Paper 2: Suicide prevention in India context: Psycho-socio-cultural perspective

Sameer Malhotra

Consultant Psychiatrist, Department of Neurosciences, Fortis Hospital, Nodia, D-32, Nizamuddin East, New Delhi - 110013, India.

E-mail: [email protected]

Suicide rates in India have witnessed an increase over the last two decades. In recent times, we have come across unfortunate incidents of suicide amongst diverse population groups. Such cases reflect the growing vulnerabilities with failing hopes and confidence and are a cause for serious concern. We are also observing significant changes in lifestyles and socio-familial support networks. With progress in the understanding of biological psychiatry, there is a need to reassess the role of socio-cultural factors in psychiatry. The possibly positive role of certain Indian socio-cultural practices in today's age of growing competition, stress, changing lifestyles and social networks shall be discussed.

Paper 3: Clinical indicators of suicide in depression

Arunima Chatterjee, Rudraprosed Chakraborty, Suprakash Chaudhury

Ranchi Institute of Neuropsychiatry and Allied Sciences (RINPAS), Kanke, Ranchi - 834006, India.

Background : In a depressive patient sociodemographic risk factors are not fully specific for predicting suicide.

Aim : To examine whether a depressive episode with suicidal ideation can be distinguished from a nonsuicidal depressive episode by other clinical indicators.

Methods : 18-55 years old individuals with a depressive episode (moderate to severe) according to ICD-10 diagnostic criteria for research formed the universe.

Both unipolar and bipolar depressive episodes were considered. 40 such persons were included consecutively into the study after they gave informed consent. All participants were assessed by Hamilton Depression Rating Scale (HDRS). Presence of suicidal ideation was than examined by Beck's scale for suicidal Ideation. 10 patients were found to have attempted suicide in the present episode.

Their most recent attempts were than evaluated by Beck's suicidal intent scale.

Results : Patients who attempted suicide had significantly more past suicidal attempts, early insomnia, lack of insight and total HDRS score. Nonsuicidal group had more past depressive episodes.

Conclusion : History of past suicidal attempts, difficulty to get sleep, lack of insight and severity of depression were significantly associated with suicidal attempt in depression.

Paper 4: Characteristics and correlates of individuals with completed suicide in the state of Goa

Ashish Srivastava

Institute of Psychiatry and Human Behavior, Hoste, Room No: 11 Bambolim, Goa, India

Introduction : The global average of suicide rate is 14.2 per lakh per year and the current national rate is 11.2 per lakh per year. Goa ranks ninth in the union of India states. The present rate being 23.40 per lakh per year.

Aims and Objectives : To find correlates of suicide from the description of family members.

To obtain family members' description of psychological history of suicide completers.

To assess psychiatric morbidity in family members.

Methods : Psychological autopsy questionnaire was used to obtain information about the suicide victims from the family members fifty randomized suicide completers in the year 2004 in the state of Goa. The statistical analysis was carried out with the help of SPSS 12 software.

Results : Males commit suicide more often than females. Unemployment was an important risk factor. Overall hanging was the most common means adopted by suicide victims, the same being most common in male suicide victims while the most common means adopted by female suicide victims was poisoning. 94% of suicide victims had at least one psychiatric illness. Depression was the most common diagnosis followed by alcohol use disorder.

58% of suicide completers had a past history of suicidal attempt. 40% had family history of mental illness and 16% had history of suicide in family members.

Paper 5: Study of parasuicides in municipal hospital in Mumbai

Amit Kulkarni, R. Kamath, A. Nayak, D. Sinha, M. Tiwari, S. Priya

Dept. of Psychiatry, 1 st Floor OPD Building TNMC and By l Nair Hospital, Bombay Central, Mumbai - 400008, India.

Introduction : 10% of the world's suicides take place in just three countries of the Indian subcontinent, viz. India, sri lanka, and Pakistan. Some differences have been noted from suicides in western countries.

There is need for more and better information regarding suicide in the countries of the Indian subcontinent. In particular, studies must address culture-specific risk factors associated with suicide in these countries, Mental illnesses, sleep difficulties, and interpersonal relationship problems are supposed to be the highest predictors of suicide attempts.

Suicides are a hidden and unrecognized epidemic in the Indian region, affecting predominantly younger age groups. Information on causative risk factors and mechanisms is not available in the country, which is crucial for designing intervention programmes.

A nonfatal suicide attempt is the strongest known clinical predictor of eventual suicide. Suicide risk among suicide attempters is hundreds of times higher than in the general population. Long-term follow-up studies show that a history of a suicide attempt indicates suicide risk over the entire adult lifetime. Hence the need to study parasuicides more seriously, to prevent suicidal behaviour in the future.

Aim : To study the demographic profile, precipitating factors, presence of mental illness, personality disorders and sleep disorders in suicide attempts across age groups.

Identifying patterns of referrals to inpatient psychiatric care.

Methods : Consecutive 150 referred patients of suicide attempters in municipal hospital were interviewed using DSM IV TR, SCID II, Sleep VAS Scale and ISST.

Results : The results and conclusions will be discussed during paper presentation.

Paper 6: Suicidal burns among female adolescents

H. Chandrashekar, N. L. Dani, G. B. Belavadi, Siddarajum

Bangalore Medical College, Bangalore - 560 002, India.

E-mail: [email protected]

Attempted suicide is a major public health problem. This was a prospective study with the aim to know demographic profile, cause of attempt and psychiatric morbidity, suicidal intent. This study was conducted between Jan 2005 to Aug 2005. There were 38 patients. Avg age 14.7 years. Causes of attempt include scolding (50%), psychiatric illness (21%), financial problems (5%), cause unknown (24%). Other findings will be discussed.

Paper 7: Study of the association between lipid profile and severity of depression and suicidality in patients with alcohol dependence

Rakesh Kumar, CRJ Khess, Baxi Neeraj Prasad Sinha, N. Manju Nath

Central Institute of Psychiatry, Kanke, Ranchi, India.

Background : It is a well-established fact that suicide is common in depressive disorder. Association between suicidality and alcohol intake is also found in some studies. But there is a lack of research showing association between the degree of severity of depression and suicidality with serum lipid profile in patients with alcohol dependence.

Aim : To study the association between the degree of severity of depression and suididality with serum lipid profile in patients with alcohol dependence.

Methods : Consecutively admitted patients in the center for addiction psychiatry, Central Institute of Psychiatry, Ranchi with diagnosis of alcohol dependence as per ICD-10 DCR and age more than 18 years who give informed consent are being taken up for the study. The Hamilton depression rating scale (HDRS), the Beck's Suicide Intent Scale (BSIS) and Adult Suicidal Ideation Questionnaire (ASIQ) are being administered on 3 rd -4th day of admission and again after detoxification. Fasting blood sugar (FBS) and lipid profile (FLP) are obtained at the baseline and will be analyzed. The data collected will be analyzed using SPSS 14.0 for statistical analysis.

Results and Discussion : The results and its implications will be the focus of discussion at the conference.


Paper 1: A variant of Dhat syndrome

Rakesh Goyal, M. Sameer, R. Chandrasekaran

Department of Psychiatry, 4096, 4 th Floor, AIIMS, Ansari Nagar,

New Delhi - 110029, India.

Dhat syndrome is regarded as a culture-bound syndrome (CBS) widely prevalent in Indian subcontinent. The word dhat is derived from the Sanskrit word Dhatu which means the vital or essential constituent of the body, or elixir of life. A prototype patient is a young male who presents with the complaint of loss of semen (Dhat) in urine in association with multiple somatic symptoms, physical weakness, anxiety and impotence or premature ejaculation. We report an uncommon presentation of Dhat syndrome. A 23 year old male patient with a past history suggestive of classical dhat syndrome presented this time with psychosomatic symptoms which he attributed to loss of colourless, sticky, non foul smelling fluid discharge from his anus. Dhat as a symptom is used by patients from certain cultures to communicate their emotional distress. But the nature and site of loss of dhat may vary sometime depending upon psychosocial factors.

Aim of this communication is to report an uncommon and unique case of dhat syndrome which has never been reported before to best of our knowledge.

Paper 2: Sex addiction: An interesting case report

K. Raman, R. Ponnudurai

Department of Psychiatry, Sri Ramachandra Medical College and Research Institute, Chennai - 600 015, India.

Aim : To present a case of sex addiction with homosexuality and paraphilias.

Case Report : A 22 year old unmarried male with nil significant family history of mental illness presented to us with 1 year history of distress and anxiety related to excess amount of time spent in sex seeking behavior and activities. Egodystonic homosexuality and paraphilic behaviors were evident on detailed interview. Patient was undergoing hypnotherapy from a private psychiatrist before the initial presentation to us. He was started on SSRI and taken up for therapy. Phenomenological and treatment issues will be discussed at the time of presentation.

Paper 3: Alcohol dependence and sexual dysfunction

Amit Sethi, H. A. Borkar

Institute of Psychiatry and Human Behavior, Goa, India.

The relation between alcohol dependence and male sexuality remains uncertain with conflicting reports on implication of alcohol use and sexual dysfunction. The study was conducted with aim to assess the effect of alcohol dependence on sexual function. 30 sexually active males aged 20-45 years fulfilling the ICD-10 criteria for alcohol dependence were interviewed using Arizona Sexual Experience Scale to assess difficulties, dissatisfaction associated with sexual function in outpatient department of Institute of Psychiatry and Human Behavior.

Paper 4: Dhat syndrome: A re-evaluation

Elsie Oommen, S. Kotresh

Department of Psychiatry, KMC, Manipal, Karnataka - 576104, India.

E-mail: [email protected]

Aim : To study the association of sexual dysfunction in patients diagnosed with Dhat syndrome.

Methods : A 5 yr retrospective chart review was done of patients diagnosed with Dhat syndrome who attended the psychiatry clinic in a tertiary care general hospital. We looked at the socio-demographic variables, age of onset, associated sexual dysfunction and other co-morbid psychiatric illnesses.

Results : It was found that there was a strong association between sexual dysfunction and dhat syndrome and the age of onset was early. Further details and conclusions will be presented.


Paper 1: A comparative study of stress and unmet needs in South Asian and white caucasian carers of adults with mental retardation

J. Devapriam, C. Ainsley, S. Bhaumik

Leicestershire Partnership NHS Trust, Leicester

People with mental retardation (MR) have high dependency needs and high prevalence of physical, and social morbidities. South Asian and White Caucasian populations have similar prevalences of MR and related psychological morbidity. However, South Asian carers report high levels of distress compared to White Caucasian carers and also were found to make significantly lower use of psychiatric services, residential and respite care.

We compared the stress levels and unmet service needs between these groups. The Leicestershire Learning Disability Register gathers information on all adults with MR who access health, social, voluntary services and this research involves analysis of data obtained through face to face interviews with informal carers of adults with MR. A sample of 766 carers (287 South Asian and 479 White Caucasian) was selected and the data regarding carer profile, client profile, stress levels and unmet service needs were analysed and compared. Significant differences were found between the 2 groups with South Asian carers reporting more stress than White Caucasian carers.

Some area of perceived unmet needs also differed. This has significant implications in service planning and delivery especially for South Asian carers. The results have led to a further study in which a random sample from both groups will be administered the GHQ to quantify and compare the morbidity between the groups.

Paper 2: Level of stress and burden in the carers of persons with mental retardation

Vishal Dhiman, S. C. Bhargava, Sujata Sethi

P.T. B. D. Sharma, PGIMS Rohtak, Haryana, India.


Family is the main source of support for diseased persons in any society. The families experience a lot of physical and emotional burden in caring for their disabled relatives. Poor performance by the disabled be it physical, physiological or social, needs to be compensated by the carers. "Mental retardation" is one of the most prevalent developmental disabilities. Those who are closest to the persons with mental retardation and care for them bear the brunt of this disability. It leads to unavoidable stress and trauma among the families. The present study tried to examine this issue.

The study is done at Department of Psychiatry, PGIMS, Rohtak wherein families of 100 persons with MR of all categories interviewed to assess the level of stress and burden caused by the disability. The results are discussed in the light of various socioeconomic variables and the knowledge of the disability.

Paper 3: A study of attitudes of carers of persons with mental retardation

Sujata Sethi, S. C. Bhargava, Vishal Dhiman

P. T. B. D. Sharma PGIMS, Rohtak, India.

By its very cultural and social nature, family is the closest support system and family members are the carers of the disabled in the society. However the disabling condition and the associated duties, carers exert emotional and physical toll on the carer. These in turn can effect the attitudes carers have towards the disabled. "Mental retardation" is one such area where carers play a major role in looking after these persons but not much work has been done to tap their attitudes towards the people they care for.

The present study tried to examine this issue. The study is done at Dept. of Psychiatry, PGIMS, Rohtak wherein caregivers of 100 persons with mental retardation in all categories interviewed to assess their attitudes regarding these disabled persons. The results are discussed in the light of various socioeconomic variables and the knowledge of the disability.

Paper 4: Disability impact on family efficiency in mental retardation

Sudhir Kumar, Sandhyarani Mohanty

Institute of Mental Health and Hospital, Mathura Road, Agra - 282002, India. E-mail: [email protected]

The present study is designed to assess the disability impact on family efficiency of parents of MR persons. 40 parents - (20 mothers and 20 fathers) of retarded persons drawn from OPD of Institute of Mental Health and Hospital, Agra served as sample for the study. NIMH Disability Impact Scale and NIMH Family Efficiency Scales were individually administered on the parents. The results of regression analysis revealed significant impact of disability on the functioning of the mothers of MR persons. Detail results will be presented.


Paper 1: Neuropsychological rehabilitation in herpes encephalitis: A case report

Shantala Hegde, N. Jamuna, John P. John*

Department of Mental Health and Social Psychology, NIMHANS, *Department of Psychiatry, NIMHANS, Delhi, India. E-mail: shantalahegd[email protected]

Herpes simplex encephalitis leads to considerable brain damage, leading to conditions like amnestic syndrome and organic personality change.

A 43 year old female presented with chief complaints of extreme distractibility, restlessness, irritability and anger outbursts and labile emotions, hyperorality, hyper sexuality, severe memory deficits, inability to recognize family members and severe impairment in social functioning and personal care. Magnetic resonance imaging showed bilaterally symmetrical extensive areas cortical and subcortical gliosis involving frontal, temporal and cingulate regions bilaterally. A diagnosis of cognitive and behavioral sequelae of herpes simplex encephalitis was made.

Patient was referred for neuropsychological assessment and cognitive retraining. A formal neuropsychological assessment was not possible as a baseline in view of her high distractibility. Hospital based cognitive retraining comprising of 1 hour daily sessions, for a period of 6 months was carried out, which focused on improving cognitive functions such as sustained attention, visual scanning, information processing, response initiation, mental control, verbal and visual encoding and memory. Behavioural modification using operant principles such as reinforcement of desired behavior was also incorporated in the treatment regimen. Family members reported 85% improvement in patient's global functioning and were observed on clinical evaluation.

Neuropsychological profile at the post retraining assessment on tests such as digit vigilance, color trails, verbal category fluency showed significant decrease in distractibility, improved sustained attention, and visual scanning. There was significant improvement in personal care and social functioning. Neuropsychological rehabilitation in post encephalitis sequelae has shown promising results. The details of the case, neuropsychological assessment and rehabilitation will be presented.

Paper 2: Characteristics of patients rehospitalised frequently in an in-patient acute care facility

Sharon Joe Daniel, V. Karthikeyan, M. Jayakumar, M. Murugappan

Institute of Mental Health, Chennai, India

Aim : To identify the characteristics of frequently readmitted patients in an acute care in patient set up.

Background: Patients who are readmitted frequently as inpatients are recognised as being more likely to have certain characteristics like female sex, poor social support, schizophrenic diagnosis, comorbid substance use, younger age of illness onset, poorer compliance, severe symptoms, more previous hospitalisations etc. This group of patients might benefit from altered treatment and rehabilitation strategies.

Methods : A cross sectional study design comparing two groups is used. Successive male and female patients readmitted often (at least one prior admission in the past year) in the acute care ward of the Institute of Mental Health - Chennai were identified and data about their socio-demographic profile, diagnoses and treatment, compliance, social and occupational functioning, number of previous admissions, substance use were gathered. This group was compared with another group patients who were also readmitted but with no admissions in the past year.

Result : The results of the study will be discussed at the conference.

Paper 3: Exploring psychological intervention for the persons with mental illness during discharge in a residential rehabilitation programme

C. Ramasubramanian, M. Kannan, S. Koodalingam, P. Kavitha, R. Rajkumari

M. S. Chellamuthu Trust and Research Foundation, Madurai, Tamil Nadu, India.

M. S. Chellamuthu Trust and Research Foundation - has been providing psychosocial rehabilitation services for the mentally disabled for the past 15 years. SHRISTI - a residential psychosocial rehabilitation, a project of M. S. Chellamuthu Trust and Research Foundation, has been providing structured psychosocial rehabilitation training through - Drug therapy, social skill training, occupational therapy, individual and group counselling, family psycho education, recreational therapy and activities of daily living.

These psychosocial interventions are being assessed with a semi constructed format to quantify and measure the level of intervention by the mental health professionals comprising of psychiatrist, medical officer, psychologist, psychiatric social workers, psychiatric nurses, occupational therapist and yoga therapist.

An attempt has been made to study and measure the different Psycho-Social Rehabilitation Centre. All the persons with mental illness who have obtained Rehabilitation from the Trust for a period of one year (i.e., 1 st January 2005 to 31 st December 2005) were considered for this study. Sixty persons (60) from the list have been selected randomly using inclusion and exclusion conditions. Using semi structured interview schedule the samples were studied and the data were analysed using appropriate statistical tests. The authors have presented the profile, different psycho-social intervention measures, major issues for the persons in psycho-social rehabilitation etc., in detail in this paper.

Paper 4: Stigma experienced by the relatives of patients with schizophrenia, bipolar affective disorder, depressive disorder and neurological disorders

Cyril Costany Lopes, Vikrama, John P. John, R. Bhuvaneshwari

Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), P. B. No. 2900, Dharmaram P.O., Hosur Road, Bangalore, Karnataka - 560 029, India.

Introduction : Stigma affects not only people with mental illnesses, but their families as well in view of their association with the individual who is suffering from the mental illness. Psychiatric disorders are known to invoke greater stigma in comparison to other medical conditions. However, it is not clear how the perceived stigma varies across different psychiatric conditions.

Aim : 1) To study the stigma experienced and perceived by the relatives of patients with schizophrenia, bipolar affective disorder, depressive disorder and neurological disorders. 2) To assess the perception of relatives regarding how others will perceive the mentally ill patient.

Methods : 200 caregivers (50 in each group) of patients belonging to the following diagnostic subgroups-schizophrenia, bipolar affective disorder, depression, neurological disorders-who avail the services at NIMHANS participated in study. The following tools were administered (1) A semi-structured socio-demographic proforma. (2) Brief psychiatric clinical interview - to screen the relatives for any DSM IV Axis I psychiatric conditions). (3) Stigma and discrimination faced by patient and their relatives, and (4) Link's perceived stigma questionnaire.

Results : Significant differences were observed between relatives of patients with psychiatric disorders in comparison with those of patients with neurological disorders on the various parameters that were assessed. Significant differences were also found between the relatives of schizophrenia patients and those with mood disorders.

Conclusion : The extent of perceived stigma differs not only across psychiatric and non-psychiatric conditions but among various sub-groups of psychiatric disorders as well.

Paper 5: Characteristics of long stay male patients in a psychiatric institution

Sharon Joe Daniel, M. Jayakumar, Sumit Puri, M. Murugappan

Institute of Mental Health, Medavakkam Tank Road, Kilpauk, Chennai - 600010, India.

Aim : To determine the characteristics of male long stay patients in Institute of Mental Health.

Background : Long stay patients are noted in western studies to be more likely to have certain characteristics like male sex, unmarried status, poor social support, involuntary status, cognitive impairment and social handicap, schizophrenic diagnosis, longer duration of illness to name a few. They account for significant utilization of resources. Identification and focussed care can help in treatment and rehabilitation of these patients.

Methods : A cross sectional comparative study done on male long stay (≥ 1 year) inpatients in Institute of Mental Health - Chennai. Data about the socio demographic profile, duration of stay, diagnosis, social support, nature of admission, assessment of functioning, illness duration of 50 patients admitted in the long stay ward will be gathered and the same will be compared with data from 50 consecutive patients admitted in the short stay acute care in-patient ward.

Results : The results of the study will be discussed at the venue.

Paper 6: Some successful experiences in rehabilitation

Suresh Kumar, P. Kulhara, Rama Malhotra

PGIMER, Chandigarh, India.

The case files (N=5) of persons with schizophrenia who demonstrated significant improvement in important domains of functioning during their follow up in Mental Disability Clinic, Department of Psychiatry, PGIMER, Chandigarh were screened to examine the commonalities, if any, in terms of their socio-demographic, clinical and treatment variables. The results will be presented and discussed.


Paper 1: A study of well-being in chronically ill patients

Priya Sivashankar, R. Kamath, C. Pinto, S. Alka, M. Tiwari, A. Kulkarni

TNMC and BYL Nair Hospital, 201, Neel Pride, Plot 24, Sector 2, New Panvel (E) Navi Mumbai - 410206, Maharastra, India. E-mail: [email protected]

Aim : To evaluate the percentage of happiness in chronically ill patients.

To evaluate the reasons of happiness in these happy patients.

Introduction : Chronic illnesses like diabetes, angina pectoris/heart failure, renal failure, chronic lung disease, epilepsy, stroke are known to be associated with clinically significant depression.

However, there are relatively few studies based on well-being in chronically ill patients. The subjects of this paper is the definition and measurement of the concept of quality of life, and happiness of life and questions the operationalization of quality of life simply in terms of health status measure and scales of functional ability.

In this paper we focus on the topic of chronic illness in the context of quality of life. We know very little about the content and extent of suffering. And, although it may not be sensible to borrow traditional scientific techniques for the study of suffering, we need as much intellectual penetration and rigorous analysis in order to clarify the nature of suffering as for any other scientific investigation. Moreover, there are good reasons for saying that we ought to direct much more of our attention to this humanistic aspect of medicine. We ought to remember that the elimination of suffering is one of the main motives, if indeed not the most important motive, for undertaking the medical enterprise.

Methods : 150 patients suffering from chronic illnesses like diabetes, angina, renal failure, stroke were selected at random from municipal hospital, along with healthy adults as controls.

All persons were screened for psychiatric disorder using MINI to screen people for any previously undiagnosed psychiatric illness.

Next, all were asked to report using 9 item coop chart for adult primary practices and 1 item namely self esteem of Duke's healty profile.

Results & Conclusion : The results will be discussed during the paper.

Paper 2: The cognitive and emotional effects on heart transplant patients

Soumen Acharya

H - 1524 C.R. Park, New Delhi - 110019, India.

Aim : To evaluate the changes in cognitive depression in heart transplant

Methods : Eleven successful heart transplant patient at AIIMS were evaluated 1 month before and 3 months after heart transplant with 16 PF and sinha anxiety scale and life satistation scale.

Results : The study revealed 75% of patients before surgery were anxious and were worried about the out come of surgery. After the surgery 50% of the patients felt better and came back to normal life again.

Conclusion : Successful heart transplant is associate with improved life solution and lead a normal life.

Paper 3: Medical comorbidity in a dual diagnosis unit

Vasant P. Dhopesh

VA. Medical Center, 116 A Philadelphia, PA 19104. USA.

Educational Objectives : At the conclusion of the work shop the participants will be knowledgeable about the common medical issues and their management in a dual diagnosis unit.

Summary : The issue work shop is for the people working in a dual diagnosis unit. Active participation by the audience is encouraged. Some basic and general knowledge of internal medicine is sufficient.

It was our empirical observation that a large number of patients on our unit required consultations from various services; therefore a review of the consultation requests of 137 patients was undertaken. It revealed 40% had one consultation while 60% had more than one consultation requests. The most common consultation was for dental, dermatology followed by medicine for common conditions such as hypertension, diabetes and COPD. Slides of interesting and unusual pathology will be shown and discussed.

Paper 4: Cognitive impairment in patients of diabetes mellitus

R. K. Solanki, Vaibhav Dubey, Aarti Midha

Department of Psychiatry, S.M.S. Medical College, Jaipur, P.C.M.S. Bhopal, Malviya Nagar, Jaipur - 302017, India.

The impact of diabetes on cognitive function has been of interest for more than 80 years, since miles and root demonstrated that individuals with diabetes performed less well than nondiabetic control subjects on measures of memory, mental arithmetic and psychomotor efficiency.

To test the hypothesis that there is an association between diabetes mellitus and cognitive impairment the present study was planned to assess

Sociodemographic characteristics of diabetic subjects who have impaired cognitive performance.Correlation of cognitive performance with the duration, severity and type of treatment of diabetes.

For the purpose of present study 50 patients of diabetes mellitus were taken from diabetic clinic, SMS Medical College, Jaipur meeting the inclusion criteria. 30 subjects, preferably relatives or attendant of patients of diabetes matched on age, sex, education, occupation and economical status formed the control group.

Information about the subjects sociodemographic data and diabetes status were asked and recorded in self made semi structured proforma.

After this subjects were asked to perform neuropsychological tests in a calm and quiet room. They were given the test in a particular sequence - Digit Span Test (DST), stroop test, Controlled Oral Word Association Test (COWA), Visual target cancellation test,

Digit-Symbol Substitution Test (DSST), and Visuo-spatial working memory matrix.

The composite score on all tests was used to make cognitive index. 48% of total diabetic patients were showing cognitive impairment. Females were showing poorer cognitive performance than males. The average fasting blood sugar level of diabetic patients showing poorer cognitive performance was 153 ± 30.5 mg%.

Poor metabolic control (hyperglycaemia) was associated significantly and negatively with cognitive index in diabetic patients.

Immediate memory and attention (Digit Span test), Verbal memory (COWA test), Psychomotor functioning (DSST) and Visual Spatial memory (Visuospatial working memory matrix) were significantly and negatively correlated in diabetic patients, It appears from the study that cognitive deficit may be associated with chronically poorly controlled diabetes.

Paper 5: Awarenes of health risk factors and health related behavior of medical, dental and nursing students

Shrikant K. Nimbhorkar, Ravindra Kamath, Ajita Nayak, Alka Subramanyam, Sunil Gowda, Hemant Sonanis

Department of Psychiatry, Nair Hospital, Mumbai, India.

Introduction : It has always been an endeavour by health professionals to advice their patients to avoid health risk behavior and adopt necessary health promoting attitude and life style. However not much literature is available about studies which show the implementation and incorporation of the same positive attitudes in the professionals themselves. Our study intends to find the ground reality and thereby create awareness among the professionals.

Objective of Study : The assumption of this study is that preventive care beliefs and practices of health science students stand-out among the general public. To test this assumption, a survey of beliefs, behaviors and disease prevention practices of medical, dental and nursing students was carried out in one of the tertiary care health institute in the city of Mumbai.

Methods : A questionnaire which consisted of information on socio-demographic data, life style patterns, health risk factors, and preventive care was used. The questionnaire was administered which consists of questions related to health risk behavior like smoking or other forms of tobacco consumption, heavy drinking, driving recklessly, not using helmets / seat belt while driving, accident under influence of alcohol, suicidal attempts, frequent night clubbing etc. Also health promoting behavior in the form of regular exercise, concern about their diet, regular health check-up of various health parameters and in case of female regular self breast examination etc. The data was pooled and subjected to statistical analysis and thus the assumption of study was tested. Results and conclusions will be discussed during the presentation.

Paper 6: Psychological comorbidity in chronic skin disorders

Sidhesh Phaldessai, Yvonne S. Pereira, Ashish Srivastava

Institute of Psychiatry and Human Behavior, Bambolim - Goa, India.

Introduction : A high co-morbidity of psychiatric disorders has been recorded in patients with chronic skin conditions.

Aims and Objectives : To determine and classify the psychiatric disorders in patients with chronic skin conditions versus normal controls.

Methods : 40 patients admitted in the dermatology department with chronic skin conditions were administered the General Health Questionnaire (GHQ). A standardized personal interview was performed to establish a psychiatric diagnosis in patients with a GHQ score more than 15.The results were compared with healthy controls matched for age and sex.

Results : A significant association was found between chronic skin diseases and occurrence of psychiatric disorders. The most common disorders were depression; anxiety and dissociative disorders.

A high psychiatric co-morbidity in dermatology patients indicates the need for considering emotional factors for an effect management of the cutaneous disorders.


Paper 1: Telepsychiatry: Empowering psychiatry through technology

Alok Agrawal, Jatinder M. Chawla, Rohit Verma, R. K. Chadda

Department of Psychiatry, All India Institute of Medical Sciences, New Delhi - 110029, India.

Over the last few decades mankind has made significant development in the fields of technology and communication. Not only has this knowledge resulted in improvement in the diagnostic and treatment methods but has also enhanced the capability of the health delivery system to reach the most distant of clients. Telemedicine or e-health has thus been fostered and promoted by the need of health care delivery to the people at distant places and holds great potential to provide quality psychiatric care to such people.

It includes healthcare delivery, diagnosis, consultation and treatment as well as education and transfer of medical data through various means like telephone, internet phone, e-mail, fax and audio-visual interaction, etc.

Telepsychiatry holds greater promise for a country like ours which has a population of one billion while the total number of practicing psychiatrist is a meager 3000. This paper reviews the origin of telepsychiatry, its current status in psychiatric practice, its advantages and disadvantages over conventional care, the various legal and ethical issues involved, and its future in the delivery of psychiatric care especially in a developing country like ours.

Paper 2: Psychiatric morbidity among hospitalized referred patients

Nazim Ahmed Saikia, P. K. Chaudhury, K. Deka, Pranit Kumar Chaudhury

Department of Psychiatry, Assam Medical College, Dibrugarh, Assam - 786001, India.

Background : Psychiatric morbidity has been found to be very high among hospitalized referred patients. In a study of a general medical clinic in a American Hospital, it has been found that one third of psychiatric problems were undetected in medical patients (Brody et al). Maguire et al 1974 carried out a study among medical in patients in an England Hospital, they found psychiatric disorder in about 25 percent of the patients, about half of which were unrecognized. Six percent of the patients in primary care units and 11% of medical in patients have major depressive disorder compaired with a 3% in the general population according to Katon & Sullivan 1980.

Another study of 100 consecutive cases referred to psychiatric ward in a teaching hospital from its different departments, found that delirium, depression, schizophrenia and conversion disorder accounted for 60% of the cases (Roy et al.). Studies have shown that delirium is common in elderly hospitalized patients (Inouye, 1994). More-over it has been seen that the mean length of hospital stay was found to be shorter in most chronic medical in-patients who receive psychiatric intervention.

Aim : To assess the psychiatric morbidity among the referred cases admitted at other specialities.

Methods : The study was carried out at the Dept. of Psychiatry, Assam Medical College, Dibrugarh. All the cases referred from other in-patients departments from July 2005 to June 2006 were taken for the study. Firstly, the referred cases register their names in the psychiatric OPD. Then the investigator attend to these patients and make a provisional diagnosis according to DSM-IV and MINI-Plus (Mini International Neuropsychiatric Interview-Plus) along with the concerned consultant and give appropriate treatment. Then the investigator fill up the particulars of the patient in a special proforma prepared for the study.

Results and Discussion : A total of 103 indoor cases has been referred to the psychiatry department. Majority are male (58.2%), belonging to the adult age group (30 yrs - st week of admission (80.55). non-organic psychosis (38.3%) was found to be highest among the psychiatric diagnosis which includes depression to be maximum. Whereas systemic disease (26.2%) was found to be highest among the medical-surgical diagnosis followed by infectious disease. Approximately 55% of patients with the diagnosis of neurosis was found to have no medical or surgical diagnosis.

Results : Further details regarding results and discussion will be done at the time of presentation.

Paper 3: Use of mobiles phones: Is it addicting?

Ritu Nehra, Sandeep Grover, Nitasha Khehra

Department of Pschyiatry, PGIMER, Chandigarh, India.

E-mail: [email protected]

India is now ranked 3 rd in mobile phone users in the world. As more and more people are using mobile phone for multiple purposes it is seen that is has become part and partial of life of people. In our daily interactions, it is very common to encounter people those who are regular mobile users become very much distressed when they are without their mobile phones.

Our study attempts to evaluate use of mobile phone as a dependence syndrome. For the study, a self administered questionnaire was designed and was given to 220 regular mobiles phone user student populations. The details of the results will be discussed in the presentation.

Paper 4: Characteristics of patients diagnosed with personality disorders in a tertiary care institute in North India

S. Gupta, N. Warikoo, J. Singh, S. K. Mattoo

Department of Psychiatry, Drug Deaddiction Center, PGIMER, Chandigarh, India.

Aims and Objectives : To determine the prevalence and pattern of Personality disorders and its subtypes among a clinical sample comprising subjects attending psychiatry and/or drug deaddiction inpatient as well as outpatients clinics. To compare subjects with personality disorder and comorbid substance use disorders with those having other psychiatric illnesses. To determine the sociodemographic correlates of patients with personality disorders. To assess the prevalence and patterns of Axis I Comorbidity in patients with personality disorders and its correlation with important facets of personality disorder.

Design: Retrospective chart review over a period of ten years with additional input from follow-up interviews if required to collect additional information.

Methods : Sample consecutive sampling based upon the requisite inclusion and exclusion criteria.

Inclusion-criteria: All subjects diagnosed as personality disorder according to ICD-10 criteria in the age group of 15-60 years.

Exclusion criteria : Mental retardation; neurological illness/head injury necessitating treatment or impeding collection of reliable/adequate data; schizotypal disorder.

Statistics : Appropriate statistical measures for description and comparison depending on the nature of data (nomial/categorical/ordinal) will be used.

Results and Discussion : To be presented.

Paper 5: Assessment of stereotypes towards people with mental illness among resident doctors and the general population

Kushal Jain, Rajesh Sagar, Tuchika Mehra, Abhijit Rozatkar, Kushal Jain

Department of Psyhiatry, 4 th Floor, Academic Section, A.I.I.M.S, New Delhi - 29, India.

Background : Stigma marks an individual out as being different and evoke some form of sanction. Illnesses can be stigmatizing. However, whereas the stigma of physical conditions such as cancer and epilepsy has declined, mental disorders remain some of the most stigmatized illnesses. Different forms of stigmatizing attitudes are known: stereotypes, i.e., (mostly negative) judgments, prejudice and discrimination. For people with mental illness, stigma is the largest single obstacle to improving their quality of life. Attitudes to mental illness are deeply rooted in society of which doctors are a very important constituent. In this paper we tried to highlight this important and often neglected issue.

Objective : Assessing stereotypes towards people with mental illness among resident doctors, comparing their view to the general population and analyzing the influence of demographic factors, profession and other variables.

Methods : A paper and pencil survey was conducted among resident doctors working in A.I.I.M.S. except in psychiatry department and educated general population with minimum graduate degree. The participants were requested to fill the semi-structured proforma consisting of demographic variables, rate 12 different stereotypes derived from different scales using 5-point likert scale in two steps. In step one general question on people with mental illness was asked. In step two case vignettes of people with mental illness were provided and they were requested to respond on different stereotypes. Factor analysis was used to achieve one- dimensional scales, which were analyzed by regression analysis.

Results : Results are in process of analysis and will be discussed in the conference.

Paper 6: Conducting clinical follow up study in northern India: Challenges and rewards

Adarsh Tripathi

Department of Psychiatry, King George's Medical University, Lucknow, UP, India.

Cultural differences are known to a play role in whether symptoms of psychiatric disorder are seen by individuals as problematic, and whether persons seek help and remain compliant to the treatment.

Cultural differences in terms of expectations at home, in school/college, and in the community affect attitude and belief about illness, choice of care, degree of trust towards medical institutions and authority figures, religious belief, and tolerance for certain behaviors.

The socioeconomic conditions are important factors in these procedures of compliance to the treatment and follow up.

The challenges faced by researcher in the developing countries are different from western countries.

Conducting research in the developing countries can even be beneficial in some situations.

This presentation systematically discusses these factors and pointsout common difficulties and benefits obtained by conducting research especially in context of a short term follow up study of adults with ADHD conducted by us.

Paper 7: Attitudes among medical students attending annual fest of AIIMS (Pulse 2006) about psychiatry as a profession

Kushal Jain, Rajesh Sagar, Esha Kaul, Abhijit Rozatkar, Ruchika Mehra

Department of Psychiatry, 4 th Floor, Academic Section, A.I.I.M.S New

Delhi - 29, India. E-mail: drkushal [email protected]

Background : World health organization has proposed that by 2020 depression will be the second most common cause of morbidity across the globe. India with its huge population will have its share of mental illness. But will we be able to tackle this problem? Will we be able to have adequate trained mental health professional by 2020? What are the reasons for the current status of psychiatry? What do medical undergraduates think about psychiatry? In this paper we tried to find out answers for few of these questions.

Objective : To assess attitudes among medical students attending annual fest of AIIMS (Pulse 2006) about psychiatry as a profession.

Methods : Paper and pencil opinion survey was conducted in-annual fest (Pulse 2006) of AIIMS among the undergraduates from different parts of the country. The participants were requested to report their choices for post graduation and their views about psychiatry as a profession. We tried to gather information about the psychiatry department, inpatient ward for mentally ill, close ward for persons with mental illness etc. They were also asked to express their suggestion using open ended questions.

Results : The collection of data is still going on. The results will be discussed in the conference.

Paper 8: A study of well-being in chronically ill patients

Priya Sivashankar, R. Kamath, C. Pinto, S. Alka, M. Tiwari, A. Kulkarni

TNMC and BYL Nair Hospital, 201, Neel Pride, Plot 24, Sector 2, New Panvel (E) Navi Mumbai - 410206, Maharastra, India. E-mail: [email protected]

Aim : To evaluate the percentage of happiness in chronically ill patients.

To evaluate the reasons of happiness in these happy patients.

Introduction : Chronic illnesses like diabetes, angina pectoris/heart failure, renal failure, chronic lung disease, epilepsy, stroke are known to be associated with clinically significant depression.

However, there are relatively few studies based on well-being in chronically ill patients. The subjects of this paper is the definition and measurement of the concept of quality of life, and happiness of life and questions the operationalization of quality of life simply in terms of health status measure and scales of functional ability.

In this paper we focus on the topic of chronic illness in the context of quality of life. We know very little about the content and extent of suffering. And, although it may not be sensible to borrow traditional scientific techniques for the study of suffering, we need as much intellectual penetration and rigorous analysis in order to clarify the nature of suffering as for any other scientific investigation. Moreover, there are good reasons for saying that we ought to direct much more of our attention to this humanistic aspect of medicine. We ought to remember that the elimination of suffering is one of the main motives, if indeed not the most important motive, for undertaking the medical enterprise.

Methods : 150 patients suffering from chronic illness like diabetes, angina, renal failure, stroke were selected at random from municipal hospital, along with healthy adults as controls.

All persons were screened for psychiatric disorder using MINI to screen people for any previously undiagnosed psychiatric illness.

Next, all were asked to report using 9 ITEM COOP CHART FOR ADULT PRIMARY PRACTICES & 1 item namely SELF ESTEEM of DUKE'S HEALTH PROFILE.

Results & Conclusion: The results will be discussed during the paper.

Paper 9: The consequences of brain circulation: Positive and negative impacts

J. K. Trivedi, Kumar Gaurav

Department of Psychiatry, K. G. Medical University, Lucknow - 226003, India

India has fewer than 3000 psychiatrists for its one billion population compared with one psychiatrist for every 9000 people in the United Kingdom, a 27-fold difference. NHS has launched a scheme to recruit senior psychiatrists and other specialists from India and other developing countries. Apart from UK the Indian psychiatrists are migrating to other counteries like USA and Australia. This has resulted in a large number of Indian psychiatrists going abroad making the condition worse in India. This involves years of experience, several credentials, a good amount of research and various levels of screening to then finally be foreign bound. The opportunity to work in different societies is a rich experience with benefits that go beyond financial gains. There is no place for creating new barriers to the movement of people between countries. What is needed is an acknowledgment that institutions in developed countries have an ethical obligation to facilitate the return of health professionals to developing countries.

Institutions in developing countries must acknowledge that doctors leave not only for monetary gain but also to escape from stifling hierarchies and bureaucracies. Promotions are more likely to be determined by the number of years of service than academic skills and achievements. Ultimately, all concerned parties need to define the obligations and responsibilities of institutions in rich and developing countries. Unless these steps are taken urgently, the brain drain will continue to fuel the huge inequities in global health.

Paper 10: Sociodemographic and clinical profile of subjects with deliberate self-harm presenting to a tertiary care hospital

Partha Pratim Das, Sandeep Grover, Ajit Avasthi, Subho Chakrabarti, Savita Malhotra, Suresh Kumar

Department of Psychiatry, PGIMER, Chandigarh

Aims and Objective : To study sociodemographic and clinical profile of patients presenting with deliberate self harm to a tertiary care hospital and referred to consultation liaison psychiatric services during the period from Jan 2000 to Dec 2005. Methodology: All subjects who presented with deliberate self harm and were referred to consultation liaison psychiatric services during the period from Jan 2000 to Dec 2005 were included. Results: The total sample comprised 166 cases. Mean age of the patient was 28.98 (SD ± 12.11). There was male preponderance (53%). Majority of the sample was married (61%), educated beyond matriculate (75%), belonged to middle socio-economic status (85%), Hindu (87%), nuclear family (64.5%), and urban background (53%). Three-fourth of the sample did not have a previous psychiatric diagnosis, and 94.6% did not have any family history of psychiatric illness. Most common reasons of attempting self-harm were interpersonal problems with family (38%), followed by interpersonal problems with spouse (16.9%) and depressive cognitions (16.9%). The most common method of self-harm used was consumption of insecticides (36.7%), followed by use of corrosives (17.5%). Half of the sample fulfilled criteria for a psychiatric diagnosis at the time of assessment and most common psychiatric diagnosis was first-episode depression (21.7%). Half of the sample fulfilled the diagnosis of deliberate self-harm only. Conclusion: Nearly half of the subjects who present to a tertiary care hospital have diagnosable psychiatric illness.

Paper 11: The opinions and attitudes of occupational therapy students towards mentally ill patients

Manu Tiwari, Ravindra Kamath, Deoraj Sinha, Alka Subramanyam, Amit Kulkarni, Praveen Navkhare

Department of Psychiatry, BYL Nair Ch Hospital, Mumbai Central, Mumbai - 400 008, India. E-mail: [email protected]

The worldwide movement of de-institutionalization prompted an increased need for the rehabilitation of mentally ill subjects. Individualized rehabilitation must be in mutual interaction with the social and occupational environment.

Stigmatization of mentally ill patients has negative effects on their rehabilitation. In this regard, the attitude towards mentally ill patients, especially, the attitudes of health professionals and paramedics, which might play a major role, as a model to public attitudes, could be a major factor in defining the quality of future life of the mentally ill.

Hypothesis : Negative attitude towards the mentally ill creates barriers to both recovery and full integration into the community. Education has a positive effect on the attitude towards individuals with psychiatric illness.

Aim : To determine the opinions and attitudes of occupational therapy students towards mentally ill patients.

Methods : After obtaining informed consent, consecutive students of occupational therapy were interviewed. A questionnaire comprising 2 parts was administered. First part had 13 general questions about attitude towards mentally ill. In the second part of the questionnaire, opinions about mental illness: depression, panic disorder, schizophrenia, dementia, alcohol use disorder and any substance use disorder, were asked.

Results : Results and conclusions will be discussed during the presentation of paper.

Paper 12: The professional life stress correlates job satisfaction: A study conducted among mental health professionals

S. Ganesh Kumar, M. Kannan, R. Rajkumari, M. Ramu

M. S. Chellamuthu Trust and Research Foundation, Madurai, TamilNadu, India.

Many research studies have been conducted among, not only from the persons who are Mentally Disabled, but also from the care givers and the persons who are working in the field of mental health (care providers). It was observed that very limited number of studies have been conducted on the professional stress or their level of job satisfaction for these care providers. An attempt has been made to measure and to find out the relationship between the professional Life Stress and the job satisfaction for the persons who are working in the field of mental health. All the mental health professionals of M.S. Chellamuthu Trust and Research Foundation like Psychiatrists, Psychologists, Psychiatric Social Workers, Psychiatric Nurses and other Para Professional have been selected for this study. The 24 items Professional Life Stress Scale by David Fontana (1989) have been administered on these Professionals. It was observed that there existed a negative and significant correlation between Professional Life Stress and job Satisfaction. The authors have suggested in detail various methods to reduce the Professional Life Stress and increase the job satisfaction so that they can work more for the mentally disabled.

Paper 13: A study on changing life-style patterns of the business process outsourcing employees

Aarthi Ganesh, Yamini Kannapan, Sujit John, V. Meena

Flat No. 1G, Sai Sarovar Apts., Velachery By Pass Road, Velachery, Chennai - 42, India.

With increasing number of multinational companies preferring India as their favorite destination for outsourcing operations; cultural and attitudinal changes are indeed setting in at a much faster pace in the country. The work schedule necessitates the employees to work at odd hours leading to a change in the 24-hour biological clock resulting in the employees facing various psychological, psychosomatic disorders and health related issues, which were non-existent in the normal routine. Unfortunately most employees either do not know that they face stress or are hesitant to bring it up for fear that they might lose their jobs/position.

This study was conducted on 65 employees of a leading business process outsourcing firm to assess the presence of depressive and anxiety features as a result of the above changes.

Paper 14: Homeopathy: An holistic approach towards the mentally ill

S. Mahaveeran

Department of Psychiatry, VMHMC, Salem, Tamil Nadu, India.

Homeopathy is included in the classification of alternative system of medical practice by "National institutes of health office of alternative medicines, USA".

HOMEOPATHY- An alternative system of medical practice which was invented 200 yrs ago by "Samuel Hahnemann MD", in Germany and was introduced to USA in 19 th century and is widely popular in UK and India now.

The term allopathy was coined by the inventor of homeopathy, Samuel Hahnemann to refer to the use of procedures and medicines that counter act the signs and symptoms of disease. This term allopathy was used in contrary to his method called homeopathy where the principle of treatment is "SIMILIA SIMILIBUS CURENTUR" (i.e., let likes be cured by likes).

The homeopathic process begins with administering a small dose of substance to the healthy volunteers to determine the symptom profile of that substance. This is called homeopathic proving.

A medicine would be chosen for a patient by close comparison between symptom profile of the patient and symptom profile of a proved substance recorded in homeopathic pharmacopoeia.

The homeopathic pharmacopoeia of United States contains more than 2000 medicines prepared from plants such as aconite, hellebore, minerals such as copper, gold, iodine and animal products such as snake venom and tissue extracts.

Medicines are prepared from mother solutions as Tinctures i.e., mixed with 95% of grain alcohol.

Medicines are dispensed by using vehicles such as sugar of milk and tiny pills with lactose fillers.

Concept of psychiatry and classification of mental diseases in homeopathy would be dealt in brief. A case study of depression treated with homoeopathic medicine. Two studies supporting that homeopathic medicines are effective in treating mental diseases. (source-comprehensive textbook of psychiatry by Kalpan, Sadock).

Paper 15: Transylvania effect (Lunar effect): Myth or reality?

K. Anil, P. S. V. N. Sharma

Department of Psychiatry, Kasturba Medical College, Manipal,

Karnataka - 576104, India. E-mail: [email protected]

Background : It is believed that the moon influences mind and behavior. The Moon is also the God for mental well being according to Indian astrological science. The influence of moon on behavior has been called the lunar effect or transylvania effect.

Aim : To study whether there is any relationship between lunar cycles and exacerbation of mental disorders.

Methods: All psychiatry ward in-patients admitted over a period of 1 year in a tertiary care General Hospital are included in this study. It involves 8 months retrospective chart review of medical records involving about 550 patients and 4 months prospective study involving about 250 patients. We looked at exacerbations of mental disorder during full moon and new moon period (the previous and next day included), by the use of SOS medications (oral/ injectable) over and above the usual orders. This is compared with similar data on three middle days between full moon-new moon and new moon to the next full moon.

Results and Conclusion : Will be analyzed and presented.

Paper 16: Awareness about mental illness and mental health act: Guardians' perspective

Baxi Neeraj, Prasad Sinha*, Manish Kumar, Sayeed Akhtar

Department of Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi - 834006, Jharkhand, India.

Background : Mankind has been plagued with mental illness since times immemorial. These account for over half the DALYs in the world, and their management consumes significant proportion out of meagre resources. However, the benefits accrued thereof as well as the provisions for treatment available have not yet been fully evaluated from the guardians' perspective. It is the family members and caregivers who bear the brunt of the illness, and have to consume precious manpower and resources for management of these illnesses over several years. There is a need, therefore, to get the guardians' perspectives too, and assess their knowledge regarding the laws meant largely for their benefit.

Aims and Methods : Guardians of persons consecutively admitted for treatment in Central Institute of Psychiatry, Ranchi, who gave informed consent, were taken up for the study.. They were assessed regarding their knowledge regarding provisions of the Mental Health Act, 1987. Their opinions regarding its different provisions, especially admission and discharge were also evaluated.

Results and Conclusion : The results and their implications in patient treatment as also in the larger perspective will be the focus of the presentation.

Paper 17: Development of a reliable method for parcellation of the frontal pole

B. S. Yashavantha, D. J. Ramesh, S. Ravishankar, Sanjeev Jain, John P. John

Department of Psychiarty, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka - 560029, India.

Introduction : Precise delineation of the FP (BA 10) from the posterior structures of the prefrontal cortex (PFC) has not been achieved on MR images due to lack of a natural sulcal demarcation that separates these areas. Hence, a landmark-based definition of the posterior boundary of the FP is of paramount importance to study this important frontal sub-region in various neuropsychiatric conditions. In our recent MRI-based parcellation study of the PFC, we have suggested that the coronal plane containing the anterior termination of the olfactory sulcus (ATOS) could be employed as a landmark for designating the posterior boundary of the FP (John et al., 2006, in press). This proposal has been made on the basis of previous cytoarchitectonic studies that have studied BA 10 (Ongur et al., 2003). We report the interrater reliability of estimating the FP gray matter volumes utilizing the above landmark-based definition of the FP.

Methods : Using high resolution MPRAGE MR scans, independent raters produced two sets of manual segmentations of the FP of both hemispheres in five subjects. These scans were initially rotated into AC-PC coordinates, and interpolated into 0.5x0.5x0.5 mm isotropic voxels using trilinear interpolation. Manual outlining of FP was carried out on successive coronal sections starting from the section anterior to that containing the ATOS, which was defined as the posterior boundary of the FP. Image pre-processing and manual segmentation were carried out using Analyze 7.0 (Robb et al., 1989). The inter-rater reliability of gray matter volumes generated by manual segmentation of the FP by the two independent raters was estimated by calculating the intra-class R coefficient (ICC).

Results : FP gray matter volumes obtained using the above method by the two independent raters yielded an average right FP gray matter volume 4770.50 mm 3 and left FP gray matter volume of 5586.50 mm 3 . The ICC of the FP gray matter volume estimates between the two raters was 0.91.

Discussion : We report a reliable method for parcellating the FP utilizing a landmark-based definition of its posterior boundary based on the cytoarchitectonic features of sub-divisions of the anterior prefrontal cortex. The high inter-rater reliability (ICC-0.91) of gray matter volumes generated using this method supports its potential utility in conducting non-biased comparisons of groups of subjects with and without neuropsychiatric disorders.

Paper 18: How to educate non-psychiatric doctors?

P. Anandhan

Mind Care Centre, Sairam Nagar Main Road, Medavakkam Koot Road, Chennai - 601302, India.

Of course psychiatry is a science, A branch of medicine like cardiology, endocrinology, diabetology etc. But this very basic fact is not reached to our doctors, even speciality and Super-speciality doctors. They are still in the mind that "relating psychiatry with unconscious, Hypnotism etc."

"Misconceptions about medications - sleeping pills causing addiction and side effects"

It causes millions of people everyday to spend lakhs and lakhs for unnecessary investigations and other health costs. Finally people end in socio-economic and health deterioration, and with 'Faith healers' and 'Quacks'. So, it is an emergency need of our psychiatrists to educate our colleagues.

This symposium discuss about how to teach psychiatry simply, at the same time scientifically.

Basically it is not to get referral from them, instead to identify and treat minor mental illnesses in primary care.

Paper 19: Mental health literacy in caregivers of Sundarban Estuary area of West Bengal

Kedar Ranjan Banerjee, Tanmoy Mitra, Pousali Saha

National Institute of Behavioral Sciences, 7 CIT Road, Kolkata - 700 014, India.

Background : National Institute of Behavioral Sciences (NIBS) has been working ceaselessly for more than five years doing a longitudinal study by visiting every month in the core area of Sundarban. Most studies done there are either sporadic or peripheral in nature and lack the potentiality to identify the intricacies of the native problems. Sundarban - the Gangetic delta of mangrove forest and the land of Royal Bengal tigers has also been inhabited by people who are dependent on the forest for their livelihood. In most areas critical medical assistance is not available within hundred kilometers. Mental patients are often confronted with stigma and prejudice. Mental health literacy (MHL; Jorm, 1997) is the idea of knowledge and belief about mental disorders that are cognizant for recognition, management and prevention of these disarray. Higher mental health literacy is vital in controlling the prevalence of mental disorders which are going to be the second cause of mortality after cardiovascular diseases in the next 15 years (WHO, 2000). In India the dearth of knowledge about mental health even in urban areas can be alarming.

Aim : Present study aims to assess the MHL in a population of a remotely located village area near mangrove forest inhabited by mainly people of lower socio-economic status.

Methods : The study included 260 subjects at the Rangaberia block of Sundarban (south 24 Parganas). They are the caregivers of the patients who visited the local primary care hospital for the last 3 years. The tools used were a narrative interview, Duke Mental Health Inventory, Social belief Questionnaire and Locus of Control (LOC). The data was analyzed by using standard statistical procedure.

Results : Increased public knowledge is required to empower the understanding of mental health as in these remote areas of Sundarban professional help is not easily available. The recognition of the disorders was much below the expected level (0.5%) as mostly the mental disorders are assumed as manifestation of physical illness (anxiety, depression) or some witchcraft (psychotic). Knowledge of symptomatology was scanty and insignificant (0.4%) and thus communication with health professionals become a problem even when professional help is available. Locus of control indicates significant (P= 0.05) emphasis on chance factors. Scores of Duke Health profile indicated poorer health status among these caregivers.

Discussion : Detection of mental disorders become easier when exact symptom presentation happens and lack of MHL is a setback. Belief systems as possession by evil spirits, witchcraft were predominant (>60%). Traditional healers and poor compliance to medication were other major areas of setback. While scarcity of professional help emphasize the importance of self-help interventions in this type of remote areas, knowledge and belief about self-help interventions were found to be feeble and inappropriate. It was implicit that many milder forms of mental disarray can well be managed by physical exercise, Yoga, simple cognitive exercises, behavior reinforcements, seeking support from family and friends and engaging in plausible activities. Thus improved MHL status can immensely help to curb on the cost and distress caused by the highly multiplying disorders of mental illnesses.

Paper 20: To compare coping burden of patients with mental disease in care giver in India and New Zealand

Soumen Acharya

H-1514, CR. Park New Delhi - 110019, India.

Aim : To evaluate the burden of coping of caregivers in relatives in India with New Zealand patients in same age and education level with mental disease.

Methods : A sample of 10 patients with their primary care giver attending the patients were assessed on Global Assessment of Functioning (GAF) with care giver burden assessment scheduler (BAS) and Mechanism of coping (MOC) scale in India and New Zealand cases.

Results : The Indian and New Zealand 10 patients and their care givers were used and the use of problem solving coping by the care giver in New Zealand patients were better the Indian one.

Conclusions : Coping mechanism such as problem solving by the New Zealand patients were better than Indian patients.

Paper 21: Where do faith healing stands in treatment seeking behaviour?

Arun Misra, V. K. Varma, P. Kulhara

Department of Psychiatry, Postgraduate Institute of Medical Education & Research Chandigarh - 120016, India.

Folk concept of mental illness and methods of treatment with those afflicted with them has been there for centuries. The approach to faith healing is widely prevalent almost everywhere in varying intensity and forms. It is always a non-specific entity in day today psychiatric practice to know the treatment seeking behaviour with particular reference to faith healing. Nevertheless, the importance of knowing this phenomenon at times helps psychiatrist to plan how to make their intervention important. Aim: To explore help seeking from faith healers for some common psychiatric conditions by patients from urban and rural areas in relation to helps from other help seeking agencies Material and Methods: 80 patients of Schizophrenia, Affective Disorder, Anxiety Neurosis and Depressive Neurosis were selected by incidental sampling method from the psychiatric outpatient of the department. Each of the patients' relative/relatives was interviewed using Treatment Seeking Behaviour Schedule- modified. (World Health Organization. 1978) Treatment Seeking Behaviour of patients at first contact, immediate preceding contact before contacting our center and maximum no. of contacts in relation to treatment sought from different help care agencies were noted and analyzed as to where the faith healing stands in overall treatment seeking behavior in different disease groups. Results: Comparison of psychotic and neurotic subjects with regard to their treatment seeking behaviour shows that significantly greater number of psychotic patients had their first contact and maximum number of contacts with faith healers. The study shows that more rural patients of all psychiatric conditions under the study had their first contact with faith healers than their urban counterparts. The urban patients of schizophrenia, however, had more contact with faith healers immediately before seeking help from our services. In rest of the psychiatric conditions, rural patients contacted faith healers more often than urban patients did. 36% of all rural patients had maximum number of contacts with faith healers whereas 13% of urban patients had maximum contact with faith healers out of all available help care facilities in the community. Implications of these observations have been discussed.

Paper 22: Psychiatric comorbidity and quality of life in end stage renal disease

Alok Agrawal, R. Sagar, Sanjay K. Agarwal, M. Mehta, Ravindra V. Rao

­ Department of Psychiatry, All India Institute of Medical Sciences, New Delhi - 110029

Background: End Stage Renal Disease (ESRD) is a relatively common chronic condition which is responsible for huge burden on the health care system and enormous losses of productivity. ESRD has been associated with significant increase in psychiatric comorbidity and poorer quality of life in western literature however few Indian studies have enquired into the same.

Objective : To Study the Psychiatric Comorbidity and Quality of Life in ESRD patients awaiting renal transplantation at a tertiary care centre in India.

Method: After taking written informed consent, 55 patients of ESRD on hemodialysis were recruited into the study about a week before receiving renal transplants. All patients were interviewed by the same researcher and diagnosis of psychiatric disorders was established using the Structured Clinical Interview for Diagnosis of Axis I Disorders (SCID I) - Clinical Version. The pre-transplant Quality of Life was assessed using the WHO Quality of Life Scale, Brief Version (WHOQOL- BRIEF).

Results : At the time of the assessment, 17 patients (30.9%) were found to be suffering from some psychiatric illness. Adjustment disorder was the most common diagnosis with 7 patients (12.7%) while Major Depressive Disorder was the second most common diagnosis with 5 patients (9. 1 %). The scores on all the domains of WHOQOL were found to be extremely low and the lowest scores were recorded in the physical and psychological domains of the quality of life.

Conclusions : Even in Indian Population ESRD is associated with significant psychiatric comorbidity and an extremely poor quality of life especially in physical and psychological domains.

Paper 23: Homeless mentally ill-psychopathology and treatment outcome

N. Arunkumar, M. Rajaram, A. Ayesha beevi, K. Ramakrishnan

Neurocentre and Trust Society, Thillai Nagar, Triuchirapalli, Tamilnadu, India. E-mail: [email protected]

Homelessness among patients with severe mental illness remains one of the most challenging problems faced by providers of psychiatric services. The risk of becoming homeless for persons with schizophrenia is ten times that in general population, and these patients are at increased risk of abuse-both physical and sexual, nutrition deficiency and life-threatening infectious disease.

This study aims to look at the nature of mental illness in wandering-homeless patients, the psychopathology, disability and the treatment outcome.

Methods : Patients brought to TRUST Shantivanam were admitted after the legal procedures, clinical diagnosis made using DSM IV criteria, treated with necessary drugs and ECT if required. Illness pattern was collected using BPRS scale, the functioning was assessed using GAF scale, and disability was noted by IDEAS scale.

Patient was followed up for progress and a reassessment for symptoms and disability was carried out at the end of 1 st month and 3 rd month of admission.

Results : Will be discussed at the presentation.

Paper 24: Deaths in NGO run shelters for homeless mentally ill: Some observations

N. M. Rath, G. S. Prusty

VSS Medical College Burla, SCB Medical College Cuttack Orissa -753004, India.

Death needs no definition yet deaths in NGO run shelters for mentally ill destitute women define quality of medical and psychiatric care, ability of rehabilitation unit to cope with and psychiatric emergencies as well as provision of terminal care and indicator for vagaries of street life and adequacy of social support units.

In three NGO run shelters of Coastal Orissa, among 300 inmates over last 3 years, 13 deaths have occurred. No suicide or Homicidal death. Three deaths were HIV related. Two died of resistance to tuberculosis. Two died of acute abdomen and surgical complications. Two had encephalitis. Four inmates belonged to extreme age - above seventy five years whose deaths were complications of hypertension, diabetes bronchopneumonia. All the patients were in medical care and were being followed up. 5 patients died with nurse/medical attendants present when physician was not available at bedside at the time of death. Three had died in hospital premises. One needed post-mortem to ascertain the cause of death. Two of patients own relatives took patients for last rites. One patient was cremated by the patients of shelter. That was traumatic for lack of larger social support. Impact on each death in close community was immense. Working through grief, observation of rituals, prayers, giving a just and dignified burial were essential. Medical care of physical conditions need further improvement in these shelters.

Paper 25: Effectiveness of psychiatric orientation programme for nursing students

Selinamma Antony, Soumya Sukumaran, Suprakash Chaudhury, D. K. Giri, P. K. Chakraborty

Department of Psychiatry, Ranchi Institute of Neuropsychiatry and Allied Sciences (RINPAS), Kanke, Ranchi - 834006, Jharkhand, India.

E-mail: [email protected]

This study aims to assess the effectiveness of the orientation programmes in psychiatric nursing conducted every year in batches at RINPAS during 2002-2006. During this period 475 GNM students participated in various sessions. Opinion towards mental illness scale was administered to the students before and after the orientation programme. In addition, self reports of programme evaluation was also collected from them. The programme included theory and practical sessions related to psychiatry and psychiatric nursing. The effectiveness was considered on the basis of whether their attitude towards mental illness has improved or not. Mean, SD and Wilcoxon Sign rank test was done for statistical analysis of the data. The results show that their attitude towards mental illness improved significantly. It was found that the orientation programme failed to create change in some areas. This would be taken into consideration when designing future programmes. However, the study implicates the effectiveness of such scientific programmes in alleviating stigma and in creating a positive attitude towards mental illness for the beginners in the field of psychiatry and in the related fields.

Paper 26: Socio-demographic and clinical variables in patients who are referred for psychiatric opinion

Subash Das, S. D. Purkayastha, Kamal Nath

Department of Psychiatry, Silchar Medical College and Hospital, P.O-Ghungoor, Silchar - 788014, Assam, India.

Background : Several studies have shown that about 15% to 50% of patients attending various medical care settings suffer from mental problems which remain undetected. The awareness of clinicians about psychiatric morbidity in their patients and their attitude towards psychiatry are of paramount importance in deciding whether a particular patient needs psychiatric intervention or not. Psychiatric referral rate varies in different hospitals across the country and our study aims to find out the referral rate and the sociodemographic profile of patients who are referred for psychiatric opinion in Dept. of Psychiatry, Silchar Medical College and Hospital (SMCH), Assam.

Aims and Objectives:

To study the socio-demographic patterns of patients who are referred for psychiatric opinion.To study the clinical variables in patients who are referred for psychiatric opinion.

Methods :

Study conducted by Dept. of Psychiatry, SMCH, Assam.Patients referred by other Clinical Departments, SMCH.Proforma for collecting relevant socio-demographic data used.ICD-10 diagnostic criteria used.Excluded patients without reliable attendants and from whom relevant data could not be collected.

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

Paper 27: Relationship of personality variables and outcome after percutaneous transluminal coronary angioplasty

Suprakash Chaudhury, Stuti Saxena, D. Saldanha, A. A. Pawar, V. S. S. R. Riyali, K. Srinvastava

Department of Psychiatry, Ranchi Institute of Neuropsychiatry and Allied Sciences (RINPAS), Kanke, Ranchi - 834006, Jharkhand, India.

E-mail: [email protected]

Despite increasing number of PTCA being performed there is a paucity of Indian studies on the psychological effects of PTCA. A total of 35 patients undergoing PTCA at a tertiary care Cardio-Thoracic center were included in the present project aimed at studying the relationship of personality variables to outcome after PTCA. All patients filled a specially designed proforma and the following psychological questionnaires: Hospital anxiety and depression scale, coronary scale, Seattle angina questionnaire and EQ 5D. Analysis of the result showed that 46% had significant anxiety and 32.1% had significant depression before PTCA. Following successful PTCA none of the patients had significant anxiety and only 2 (3.6%) had significant depression. On the Seattle angina questionnaire physical limitation reduced from 67.9 to 48. Disease perception improved from 21.2 to 37.1. On the EQ5D health status improved from 42.7 before PTCA to 78.7 after PTCA.

Psychological intervention is likely to improve the health status and psychiatric symptoms of patients undergoing PTCA.

Paper 28: Culture, spirituality and psychiatry

Vibha Pandey, Saddichha Sahdd, Ranjith Kumar

Department of Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi - 834006, India.

Psychiatry today has entered the realm of the purely scientific and biomedical area due to advances in the understanding of various disorders and the neurobiological revolution. Global endeavors such as the decade of the brain and the mapping of the human genome have given impetus to research and technology for the exploration of the biological basis of mental functions and mental disorders. Under pressure from the medical fraternity and scientific community, psychiatry may soon choose to empty itself of elements such as empathy, compassion, sensibility and psychological awareness, areas for which it was recognized earlier. This has reached to an extent that more and more practitioners apparently proceed to memorize the names and alleged properties of drugs, prescribing them to correct the chemical imbalances or deficiencies supposedly responsible for mental disorders and in this process come under the influence of the pharmaceutical industry. However in today's world and especially in our culture, one cannot ignore the role that culture and spirituality play in the evolution and content of psychiatric disorders. This is true even when the future prognosis and outcome of the illness has to be predicted since it has been well established that our countrymen recover faster and to a larger extent than is seen with other cultures. What is it that makes this possible? This paper attempts to answer these questions by exploring the relations between culture, spirituality and psychiatry.

Paper 29: Neuropsychiatric manifestations of vitamin B12 deficiency

M. Sahoo, R. Bharadwaj, A. Avasthi

Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Chandigarh - 160012, India.

The deficiency of vitamin B12 has been implicated in the etiology of dementia and organic psychiatric syndromes including organic mood disorders, paranoid psychoses and violence.

Aim : To present two cases of Vitamin B12 deficiency with neuropsychiatric manifestations.

Methods : Detailed case histories of two patients will be presented.

Observations : Case-1 had negative and cognitive symptoms, and case-2 had manic symptoms. Both responded well to parenteral vitamin B12 therapy. Implications for the diagnosis and the treatment of these disorders will be discussed.

Paper 30: A study of body image and psychological correlates among amputees

Kalpana Srivastava, D. Saldhanha, Surg CAPT VSSR Ryali, Surg CDRS. Goyal, S. Chaudhury

Department of Psychiatry, AFMC, Pune, India.

Background : Body Image after amputation gets affected and identification of distress and intervention helps in comprehensive management of patients.

Methods : Sample for the study comprised consecutive patients with limb amputations randomly assigned to intervention group (IG N = 60) and treatment as usual group (control group n = 53). Patients with psychotic disorder were excluded from the study. Amputees body image scale (ABIS), impact of event scale (IES) along with specially designed information schedule were administered individually. Psychological intervention was carried out as and when required in the cases addressing the specific areas of concern. All patients were evaluated on the same tools after two months of therapy.

Results : Analysis showed that after treatment a significant reduction in scores was noted on the ABIS and IES in the intervention group. On the TAU group a significant reduction was only seen in the ABIS.

Conclusion : The body image of amputees does undergo change. Findings revealed statistically significant reduction in scores of psychological distress, and impact of event scale after intervention.

Paper 31: Reception of mental illness in primary care

Shubhangi R. Parkar, Shefali Batra, J. Nanawala, Govind Bang, Paikakode

Department of Psychiatry, Seth G.S. Medical College & K.E.M. Hospital, Mumbai - 400012, India.

Introduction : Mental disorders are more than frequent among attendees of general practitioner clinics. They are diagnosed, treated and managed a great deal in these settings. However an accurate evaluation of these disorders depends much upon the outlook of the doctor attending to them. This qualitative study was conducted to gain an attitudinal viewpoint of general practitioners on mental illnesses seen by them in their daily practice.

Methods : A questionnaire survey of general practitioners was completed at academic meetings and seminars held by associations of general practitioners in different areas of the city. Open and close ended questions were asked to assess their views on vulnerability, causation as well as approach towards mental illnesses in their patients.

Results : The general practitioners had a varied opinion towards mental illnesses with reference to their causality. Their responses were also largely mixed as regards the treatment approach they deemed essential for the management of patients who presented with a psychiatric problem. Lastly, their attitude towards betterment of their own psychiatric knowledge was also assessed.

Implications: As general practitioners see a substantial volume of psychiatric patients, a positive scientific attitude towards mental illnesses would reproduce a better outcome in such cases. This would enhance a collaborative approach towards mental health in primary care and would contribute to positive mental health in the community.

Paper 32: Status of psychiatric issues in conferences of other medical disciplines

Yatan Pal Singh Balhara, Jatinder Mohan Chawla, Rajesh Sagar

Department of Psychiatry. All India Institute of Medical Sciences, AIIMS, New Delhi, India.

Introduction : Medical specialties are related to each other in an extensive way and could not be seen functioning in isolation. The disorders pertinent to one discipline are related to those of some other specialty. Similarly the clinical presentation of the disorders might extend beyond one specialty. This interaction of the medical streams continues in the management of the disorders. So for the advancement of the medical field as a whole and the individual sub-specialties one needs to look into them as an interlinked model. For the same the advancement s in any of the fields would facilitate the other branches as well. Keeping all these issues in mind one would think that various interrelated aspects of medical sub-specialties should be included in a conference. This presentation looks into the status of the psychiatric issues in the conferences of different medical sub-specialties.

Objective : To study the status of Psychiatric issues in Conferences of other medical disciplines.

Method : The conferences organized at the AIIMS during the past one year were screened by the authors and the information was collected on the schedule to look for the topics related to psychiatric issues.

Analysis : The findings were analysed for the representation of the issues pertinent to psychiatry.

Results : The results would be presented at the conference