Year : 2017  |  Volume : 59  |  Issue : 6  |  Page : 167--219

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. Free Papers.Indian J Psychiatry 2017;59:167-219

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Patient's perspective of Clozapine

Dr. Anisha Agarwal, Dr. Neha Singla,Dr. Sandeep Grover

Department of Psychiatry, PGIMER, Chandigarh. Email Id : [email protected]

Background: Subjective evaluation of a treatment is very important determinant of long term continuation of treatment. Little is known about patient's subjective perception about clozapine. Aim: To evaluate the patient's own perception about effect of clozapine on their symptoms, side effects of clozapine, investigations required for clozapine monitoring and functioning.

Methodology: 45 patients receiving clozapine for varying duration were evaluated on a self designed questionnaire to understand their perception about clozapine. The questionnaire included 45 statements with "yes" and "no" options.

Results: The mean age of patients was 32.35 (SD-10.2) years and the mean duration of education was 13.6 (SD-3.12) years. More than half were males (53.3%), currently single (73.3%) and from urban locality (73.3%). Majority of the patients reported improvement in their hallucination (82.2%) and delusions (93.3%). More than half (57.8%) of the patients reported that they were feeling like their premorbid self. Two-third (66.7%) of the patients reported that because of clozapine their functioning has improved. Majority of the patient reported that with clozapine they feel less tense (95.6%), have clear thinking process (80%), have less concentration difficulties (75.6%). Majority of patient felt that stopping clozapine can worsen their condition (75.6%) and their life would be ruined if they stop clozapine (55.6%). More than two-third (68.9%) reported that the benefits of clozapine outweigh the side effects, more than half (53.3%) reported that clozapine was delayed for their condition and majority (91.1%) reported that clozapine should not be relapsed with any other antipsychotic. Majority of participants reported that with clozapine there is improvement in their work output (66.7%), attitude and behaviour towards others (91.1%) and compliance (91.1%). More than half (57.8%) of patients were not distressed with repeated blood investigations while receiving clozapine. Overall 91.1% were happy with taking clozapine. More than half (57.8%) reported that clinicians should not wait for treatment resistance to consider starting clozapine.

Conclusion: In general, majority of the patients are satisfied with receiving clozapine. Hence, clinicians should not withhold clozapine in needy patients, because of fear of its unacceptability by the patients.

Keywords: Clozapine, Perception.

Concurrent Validity of Indian Disability Evaluation and Assessment Scale (IDEAS) with Socio-occupational functioning scale in patients with Schizophrenia

Dr. Swapnajeet Sahoo, Dr. Sandeep Grover

Department of Psychiatry, PGIMER, Chandigarh. Email Id : [email protected]

Background: The Government of India (GOI) has recommended the use of Indian Disability Evaluation and Assessment Scale (IDEAS), developed by Indian Psychiatric Society for assessment and certification of disability in patients with mental illnesses and currently it is been used widely for disability certification in patients with schizophrenia across India. Previous studies evaluated the internal consistency and construct validity of IDEAS in patients with schizophrenia. However, concurrent validity of IDEAS has rarely been evaluated.

Aim: To study the concurrent validity of IDEAS with Global Assessment of Functioning (GAF) and Social and Occupational Functioning Assessment Scale (SOFS) in patients with schizophrenia.

Methodology: 178 consenting patients with schizophrenia in remission were assessed for disability, functioning and psychopathology using the IDEAS, SOFS, GAF and Positive and Negative symptom scale (PANSS) respectively.

Results: Mean Total PANSS score was 51.30 (SD-11.19). Disability (>40%) was present in 84.8% of the sample. All the component scores of IDEAS (Self-care, Interpersonal activities, Communication and Work), total IDEAS score and Global IDEAS score correlated significantly (p<0.001) with three domains of SOFS (Adaptive life skills, Social appropriateness and Communication and Interpersonal relationships) along with total SOFS score. Negative but significant correlation (p<0.001) was found with all the components of IDEAS, total and global IDEAS score with GAF. Higher residual psychopathology was also associated with overall higher disability as assessed by total IDEAS score and Global IDEAS score.

Interpretation & Conclusions: The study findings showed that the GOI-modified IDEAS had good concurrent validity with global and socio-occupational functioning as assessed by GAF and SOFS.

Keywords : Schizophrenia, Disability, IDEAS, SOFS

A Study of Clinical and Socio-Demographic Profile of Patients with Alcohol Dependence Syndrome

Dr Khushboo Dewani , Dr Khushboo Dewani, Dr. Narayan R Mutalik

Department of Psychiatry, SNMC, Bagalkot, Karnataka. Email Id : [email protected]

Background: Worldwide there is a rising trend in number of people who resort to substance use at an early age. Over the years, consumption of alcohol has increased worldwide, and in India, the per capita consumption of alcohol has increased by a whopping 55% during the period of 1992-2012. The percentage of drinking population aged less than 21 years has increased from 2% to more than 14% in the past 15 years. Research is needed to optimize treatment strategies especially in the understudied group of Asian Indians based on local epidemiology of alcohol use.

Objectives: To study the clinical and socio-demographic profile of males diagnosed with alcohol dependence syndrome.

Materials and Methods: A descriptive study comprising of 40 subjects attending psychiatry de-addiction clinic in HSK hospital during September 2015- August 2016 was done after taking institutional ethical committee clearance. A semi-structured proforma was used to determine the socio-demographic details like education, occupation, socio economic status, history of substance use, etc. and various other clinical determinants like age of first use, reasons for substance abuse, age of dependence were explored. Descriptive analysis using appropriate statistical tests will be done.

Results: The mean age of starting drinking was 23.2 years. Most of the patients had early onset alcohol dependence. Most of the patients have not sought any previous help, 48.7% patients were brought by family members for de-addiction, medical complications being the reason for seeking help. Most common cause (46.2%) for initiation of alcohol was peer influence followed by experimentation. Family history of alcoholism was positive in 56.4% of patients. Detailed results will be presented later at the conference.

Conclusion: Results showed an urgent need of interventions that are family centered. Early age of first use of alcohol greatly heightens the risk of progression to the development of alcohol disorders and therefore is a reasonable target for intervention strategies. The dreadful repercussions of substance abuse justify the urgency to evolve a comprehensive strategy.

Keywords: Alcohol Dependence Syndrome,Socio demographic Profile

Yoga therapy in Schizophrenia: Effect on Heart Rate Variability

Dr . Sneha Karmani

NIMHANS Integrated Center for Yoga, National Institute of Mental Health And Neurosciences, Bangaluru. Email Id : [email protected]

Background: Studies assessing ANS function in patients with schizophrenia through heart rate variability have found decreased basal parasympathetic activity.

Feasibility as well as effects of yoga on improving negative & cognitive symptoms and functioning have been demonstrated in patients with schizophrenia.

Relaxation by yoga training is associated with a significant increase of cardiac vagal modulation among healthy yoga practitioners. We hypothesise that yoga practice may lead to improvement in parasympathetic activity in schizophrenia patients.

Materials and Methods: Schizophrenia patients (N=17) consenting for add-on yoga therapy (1 month duration) were recruited along with age and sex matched healthy volunteers (N=14).

Assessments, viz., PANSS, CGI, socio-occupational functioning scale (SOFS) and ECG for HRV analysis, were done at base-line and one month. Healthy subjects were assessed for HRV (ECG), and did not undergo yoga therapy.

Statistical analysis was done using R software;non-parametric tests (Mann-Whitney test &Wilcoxan Signed Rank test) were used for data analysis.

Results: On HRV analysis, High Frequency (HF) normalized units power was significantly higher (p=0.01) in healthy subjects compared to schizophrenia patients. Both Low Frequency (LF) normalized units power (p=0.006) and LF/HF ratio were significantly higher in the schizophrenia group (p=0.005).

Following yoga therapy, there was no significant change in LF and HF power nor in LF/HF ratio, patients showed a significant decrease in scores on CGI (p=0.006) and all domains of PANSS [positive (p=0.027); negative (p=0.017); general psychopathology (p=0.029)]. There was no significant change in SOFS scores.

Conclusion: Add-on yoga therapy is associated with clinical improvement in schizophrenia. Change in parasympathetic activity in this population cannot be established with one month of yoga practice. Further studies need to follow up patients over longer periods to explore possible positive effects.

Keywords: Yoga, Schizophrenia, Parasympathetic

Validation And Feasibility Of The Global Mental Health Assessment Tool/ Primary Care Tamil Version

Dr. Paranthaman Bhoopathi Sethupathi, Dr. Vikram Palanisamy 1 , Prof. Vimal Kumar Sharma 2

Kovai Medical Centre Hospital, 1Wellcroft Centre, Uk, 2University Of Chester And Cheshire And Wirral Partnership Nhs Foundation Trust, Mr Steven Lane, University Of Liverpool, Ms Antony Sharlin Berna, South West Healthcare, Australia. Email Id : [email protected]

Background/introduction: A computer-assisted interview, the global mental health assessment tool (GMHAT/PC) has been developed to assist mental health practitioners to assess and identify mental health problems in the community. Gmhat/pc has been translated into various languages. We present the results of a study conducted using the tamil version of this tool.

Methodology/ Materials And Methods: This study was conducted in a psychiatric outpatient clinic of a multi specialty hospital, kovai medical center and hospital, coimbatore, tamil nadu, india. Consecutive patients attending the psychiatric out patient clinic were approached and consenting patients were interviewed using the tool gmhat/pc tamil version. Diagnosis generated by gmhat/pc was compared against the diagnosis made by a psychiatrist applying icd-10 criteria.

Results: 107 patients were interviewed. The average time taken to interview was 13.5 Seconds with a sd of 2.2. There was 70% agreement for a primary diagnosis (95% ci- 61 to 78) and 81% agreement for presence or absence of a mental disorder (95% ci- 67 to 94).

Conclusion: Gmhat/pc tamil version detected mental disorders accurately in a psychiatric setting. The tool was easy to use.

Keywords: GMHAT/PC, Validity, Tamil version

Impact Of Adjunctive Aripiprazole On The Body Weight And Clinical Parameters In A Series Of Patients Suffering From Treatment-resistant Schizophrenia On Clozapine

Dr. Sanjay Kumar Pattanayak, Dr. Mrinal Jha, Dr. Tanay Maiti

V.I..M.H.A.N.S, New Delhi, Email Id : [email protected]

Clozapine continues to be the gold standard for treatment of schizophrenic patients who do not respond adequately to atleast two or more adequate trials of first line anti-psychotic drugs, with a proven superior efficacy in such cases. Even with regular compliance, nearly half of treatment-resistant patients may not respond adequately. Further, some of the troublesome side-effects of clozapine including significant weight gain can lead to poor compliance. Few small-scale studies have indicated that the addition of aripiprazole (with low risk of weight gain) to clozapine therapy might influence the body weight and metabolic variables, however it is not firmly established. Further, there are no prior research reports from indian settings in this regard. The paper discusses in detail the profile and clinical outcome of a series of treatment resistant schizophrenia (trs) patients (using modified kane's criteria), a total of five in number, who received clozapine and aripiprazole, with a longitudinal follow-up over a period of time (from 1 to 3 months). Though the exact mechanism for weight reduction caused by aripiprazole is not clear, but it can be concluded that the addition of aripiprazole in trs patients on clozapine was safe and efficacious in this series of patients and was associated with weight reduction. This area merits further research using large-scale, placebo-controlled trials in future.

Keywords: Treatment resistant Schizophrenia, Aripiprazole, Weight loss

Symptom Profile In Obsessive Compulsive Disorder

Dr. Vijayakumar, Dr. Sandhya, Dr. Daniel, Prof. Kannan, Prof. Malaiappan

Email Id : [email protected]

Background: Obsessive-compulsive disorder(ocd) is represented by a diverse group of symptoms that include intrusive thoughts,rituals,preoccupations, and compulsions.These recurrent obsessions or compulsions cause severe distress to the person. The obsessions or compulsions are time consuming and interfere significantly with the persons normal routine,occupational functioning,usual social activities, or relationship.A patient with ocd may have an obsession,a compulsion, or both. Aim of the study is to study the symptom profile in patients diagnosed with ocd in a tertiary care hospital in Chennai.

Method: All the Outpatient records with the diagnosis of obsessive compulsive disorder from may 1 2013 to april 31 2016 were reviewed by the postgraduate. Socio-demographic profile of the patients were taken. Types of obsession and compulsion were noted. Various frequencies and bivariate analysis were done.

Result: In this study ,we found that most common obsession is contamination and compulsion is checking

Conclusion: From this study we found that obsession were more Common than compulsions. Like other studies, contamination obsession were more common and followed by sexual obsession and pathological doubts. In compulsion, washing was the most common followed by checking

Keywords: OCD, symptom profile

Psychiatric Morbidity Among Burn Injury Patients In A Tertiary Care Hospital Of Orissa

Dr. Udit Kumar Panda

Email Id : [email protected]

Burn iinjuries are devastating, sudden and unpredictable forms of trauma which affect the victim both physically and psychologically.With an increased survival of patients with burns, there comes a new focus on the psychological challanges and recovery that such patients face.

Keywords: Burns, Injury, Psychological Challenges

Acamprosate Combined With Either Motivational Enhancement Therapy (MET) Or Life Skill Training (LST) For Alcohol Use Disorder (AUD) Comparing Quality Of Life As Outcome Measure

Dr. Ambar Tiwari , Prof. Sanjay Gupta, Prof Pankaj Sureka

Email Id : [email protected]

Introduction: we compared acamprosate with either MET or LST.

Material and method: this study was a randomised control trial done at psychiatry dep, IMS. 60 Male patients aged 18 Year with criteria of AUD as per DSM 5 and with audit score 16 Was enrolled and randomised to two group

WHO QOL-BREF Scale At 0, 4, 12 Wk Of Study

Intervention Used -




Physical Domain -p

Psychological Domain-ps

Social Domain-s

Environmental Domain-e

For all 60 patient -p mean at 0 wk to be 21.58 And at 12week to be 25.4, Of ps as 17.6 At 0 wk and 19.9 At 12 weeks, of s at baseline as 9.11 And 10.2 At 12 wk and of e at 0 wk to be 23.95 And 26.6 At 12 wk.

In met -p mean at 0 wk to be 21.267 And at 12week to be 25.296, Of PS as 18.033 At 0 wk and 20.154 At 12 weeks, of s at baseline as 9.1 And 10.481 At 12 wk and of e at 0 wk to be 25.133 And 26.107 At 12 wk.

In LST p mean at 0 wk to be 21.90And at 12week to be 25.643, Of ps as 17.167 At 0 wk and 19.786 At 12 weeks, of s at baseline as 9.133 And 9.487 At 12 wk and of e at 0 wk to be 22.767 And 23.897At 12 wk.

Conclusion: Qol score increased in both groups.For both group significant change within the group as p value <0.05 But between the group no significant change as p value >0.05

Disability Associated With Dissociative Disorders

Dr. Divya Deepak Srivastava, Prof. Shantanu Bharti, Prof. Ajay Kohli, Prof. A.q. Jilani, Prof. Anju, Prof. Priyadarshi Srivastava

Eras Lucknow Medical College And Hospital, Lucknow, U.P. Email Id: [email protected]

Background: Dissociative disorders manifest as disruption of normal integration between the memories of past, awareness of identity and immediate sensations and control of bodily movements. Dissociative disorders are long term illness associated with disabilities in day to day life. There is dearth of literature from developing countries about disability associated with dissociative disorders.

Aim And Objectives: The aim of the study is to find out disability associated with dissociative disorders.

Material And Methods: This cross sectional study was conducted at department of psychiatry, eras lucknow medical college & hospital with a aim to see disability in dissociative disorders. 50 Subjects between 16-60 years of age and giving informed consent of dissociative disorder diagnosed as per i.C.D-10 were included in the study. Purposive sampling method was used for the study. Semi-structured performa was used for socio demographic details and disability was assessed by whodas 2.0 Hindi version (world health organization disability assessment scale).

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

Keywords: Disability , dissociative disorders, whodas

Augmentation Strategy With Low Dose Aripiprazole In Long Standing Persistent Depressive Disorder: A Case Report From India

Dr. Sushil Kumar S. V.

Institute Of Medical Sciences And Research Centre, Davangere, Karnataka. Email Id : [email protected]

Depression is the leading cause of disability among women in the world, frequently under recognized and inadequately treated. In spite of the different antidepressants available at the present time, they are far from ideal and show a similar slow & frequently incomplete response. This case report describes a 75 yr. Old woman with persistent depressive disorder with intermittent major depressive episodes lasting for almost 40 years who was inadequately treated. It highlights the effectiveness of augmentation of low dose aripiprazole in long standing persistent depressive disorder with intermittent major depressive episodes. After optimization of treatment with a known anti-depressant the augmentation strategy can produce a therapeutic response as early as 2 weeks with more than 50% reduction in symptoms on phq-9 scores.

Keywords: Depression, Aripiprazole

A Case Of Early Onset SSPE Presented As Juvenile Myoclonic Epilepsy

Dr. Ranjan Bhattacharyya, Dr. Bhaskar Mukherjee, Dr. Sumita Bhattacharyya

Murshidabad Medical College & Hospital, West Bengal, India.

Email Id : [email protected]

Introduction: SSPE is a very rare complication of measles usually occurs 7-10 years after measles. The incidence is slightly higher in India when compare to western counterpart. Methodology: a 7.5 Years old girl presented with myoclonic jerks and initially diagnosed as juvenile myoclonic epilepsy. Sooner the scholastic performance started deterioration and dyskinetic, jerky movements were seen with dystonia with irritability, agitation and temper tantrums both in the school and home setting for the last six months. Then she developed jerks initially involving head and later spreading to trunks and limbs. The differential diagnosis made at this point were (i) LGS (ii) JME, (iii) ADME (iv) Infective etiology (meningoencephalitis), (v) Metabolic syndromes, (vi) SSPE etc results: the EEG shows diffuse slowing, high voltage waves and PLED. The presence of both periodic complexes and left dominated pled suggests grim prognosis. The titer for IGG antibodies to measles virus by elisa in CSF-625 was found to be positive which points to the diagnosis of SSPE. Most sspe patients present with ataxia and fall, and then myoclonic jerks appear. The index patient is presently in stage ii and will rapidly progress to stage iii as per modified jabbour classification discussion: the anti measles antibody is strong but not absolute for diagnosis. The eeg findings can change across stages. The management options in current scenario are intrathecal IFN beta, intraventricular ifn alpha, oral isoprinosine but lacks evidence. The symptomatic treatment with antiepileptic drugs and baclofen are being used commonly. Only around 5% of cases may have sustained spontaneous, long term improvement. A high index of suspicion and awareness is required from the part of treating physician keeping in mind that sspe can occur at very early age as in this case.

Keywords: Early onset SSPE, Juvenile myoclonic epilepsy

Hyper Sexuality As A Case Series

Dr. Praveen S R , Dr. Suresh Yadav, Dr. Geetha Desai, Prof. Santhosh K Chaturvedi

Email Id : [email protected]

Introduction: Definition, classification and management of hyper sexuality has been a problem despite research in this area. Formidable legal and ethical issues make the task of treating of hyper sexuality difficult. The present case series is an effort to highlight these challenges faced in day to day clinical situations.

Case Summary: In this case series, we report three cases who presented with hypersexual behaviour in the absence of diagnosable psychiatric illness with socio-occupational and legal difficulty. biochemical, radiological and psychological tests did not reveal any findings suggestive of organicity. neurology and endocrinology opinion was sought and no abnormality was detected.

Discussion: The evidence base for treatment of hyper sexualityβ disorder has few studies with no proper treatment guidelines future of these patients is uncertain.This report discusses problems regarding diagnosis, treatment, ethical issues and rehabilitation. We also highlight the possible differential diagnosis, treatment and outcome.

Keywords: atypical hyper sexuality, legal, ethical issues.

Acting On Delusions In Patients Suffering From Schizophrenia

Dr. Anu Hasmukh Patel , Dr Chirag Barot

Medical College, Vadodara, Gujarat. Email Id : [email protected]

Acting On Delusions In Patients Suffering From Schizophrenia

Background And Introduction: Schizophrenia is a clinical syndrome of profound disruptive psychopathology involving thought, perception, emotion and cognition. Disorders of thought reflect the patients ideas, beliefs and interpretation of stimuli.


1. To Assess The Prevalence Of Delusional Action In Patients Suffering From Schizophrenia.

2. To Identify The Phenomenological Characteristics Of Those Delusions Which Are Associated With Action.

Method: A cross-sectional study was conducted on a sample of 40 patients and their informant using dsm- 5 diagnostic criteria for schizophrenia and maudsley assessment of delusion schedule was applied.

Results And Conclusion: 24 patients out of 40 (i.E. 60%) Acted on their delusions. Delusion of persecution was present in 62.55%, Delusion of reference in 55%, delusion of infidelity in 17.5%, Delusion of control in 10% and other delusions in 2.5%. Actions associated with delusion consisted of protecting themselves (12.5%), Losing temper , hitting self/others(15%), moving/leaving house(20%),trying to stop it (15%). Significant association was found with acting on delusion and feeling angry (p=0.0196). No association was found with acting on delusion with feeling elated, miserable, anxious, and frightened. No association was found between insight, judgment and delusion of control with acting on delusion.

Keywords: Schizophrenia , Deusions, Acting on

Women's Mental Health Camapign: Initiative Of DMHP, East Sikkim

Dr. Satish Rasaily

District Nodal Officer, DMHP, East Sikkim. Email Id : [email protected]

Title: Women's Mental Health Campaign In East Sikkim

Author: Dr Satish Rasaily (md Psychiatry & Post-doctoral Fellowship In Addiction Medicine)

District Nodal Officer (mental Health, Ntcp, Ost Program), East District, Sikkim

Introduction: In 2013, the national rural health mission, sikkim included mental health, substance abuse, tobacco addiction and domestic violence in asha (make accredited social health activist) module to sensitized all the 666 ASHAS in the state. Ashas received booster session on mental health and substance abuse implemented by district mental health program (DMHP) in 2014 and 2015. The outcome of initial training encourages DMPH team to plan for special program targeting women population.

Methods: Women's mental health campaign was initiated as a pilot project in east district in 2015 with an objective to promote mental health education, positive parenting skills, awareness on harmful effects of tobacco, alcohol and substance abuse, early signs and symptoms of mental health problems and awareness on child personality development. A total of 160 ashas was imparted one day training on these issues to provide counseling on preventive mental health to eligible couples during pregnancy, nursing mothers and reproductive age groups females. The asha was supported with rs 700 each and directed to conduct women's mental health program in respective icds centers between aug 2015 to mar 2016.

Outcome: After an initial training of asha , there was an appreciable change in knowledge, attitudes,beliefs and behavior regarding mental health and mental illnesses as evidenced by early identification of mentally ill clients and referral to district hospital. Asha are accompanying clients for initial assessment to district hospital and follow up care. Asha conducted 173 women's mental health programs with an objective to take mental health service to rural population.

Keywords: Womens mental Health, ASHA, DMHP

A Rare Good Prognoses Of A Rare Diagnosis Presented With Major Depressive Disorder

Dr. Ranjan Bhattacharyya Dr. Bhaskar Mukherjee, Dr. Sumita Bhattacharyya

Murshidabad Medical College & Hospital, West Bengal, India. Email Id : [email protected]

Background: the depression can be comorbid with various musculoskeletal disorders. At times, it becomes difficult to find whether the depression is primary or secondary to illness following the diagnosis. Case description: A previously healthy 18 year old gentleman presented with gradual onset weakness in right hand over past 18 months without any involvement of any other limbs. He also complained of cramping sensation in his right hand. On examination there is a hollow at 1st dorsal web space and the individual is unable to extend his right thumb. The careful analysis of MRI findings shows no loss of normal lordosis. There is almost straightening of the cervical curvature. The deep tendon reflexes (DTR) were brisk and planters were bilaterally flexor. Diagnosis: the plain and contrast MRI of cervical spine shows abnormal enhancement of posterior epidural soft tissue at flexion position of cervical spine causing compression over the cord. The emg study shows normal insertional activity and no spontaneous activity is seen at rest. Volitional MUP shows features of chronic partial denervation with re-innervation in small muscles of right upper limb (APB, ADM, FCR) and no MUP could be recruited in rt extn digitorum com. The nerve study in right upper limb suggests chronic partial neurogenic denervation predominantly distal and forearm small muscles due to segmental neuronopathy (ahc disease) involving cervical region with secondary motor axonopathy of right radial and ulnar nerve. Conclusion: hiramaya disease is a rare neurological disorder characterized by insidious unilateral or bilateral muscular atrophy and weakness of muscles of forearms and hands without sensory or pyramidal signs. Management is mostly supportive as it's a non progressive disease and prognosis is good. The index patient responded very well to tab escitalopram 20 mg. The hiramaya disease has one of the rare good prognoses of a rare diagnosis. Rn

Keywords: Hiramaya disease, Musculoskeletal disorders, prognosis

A Case Vignette Of Auto Erythrocyte Sensitization (Gardner Diamond) Syndrome Presenting In The Outpatient Department Of A Rural Hospital

Dr. Ranjan Bhattacharyya , Dr. Debasish Sanyal, Dr. Ranjan Bhattacharyya, Mrs Nabanita Banerjee, Dr Suddhendu Chakraborty

KPC Medical College & Hospital, Kolkata. West Bengal, India. Email Id : [email protected]

Background: The article deals with two rare cases of autoerythrocyte sensitization syndrome that presented in the outpatient department of psychiatry of a rural hospital over a period of time. Introduction: in patients with mental health problems it should always be considered as a differential diagnosis whenever there is spontaneous, painful bruising. Materials & methods: we present the two cases of 28-year-old and 44 year old female patients who were referred to our psychiatry clinic with a history of recurrent episodes of spontaneous painful bruising. Each of them had been attending departments of different discipline for months and had been given ambiguous diagnoses.The patient's left forearm served as a control into which was injected 0.1 Ml of normal saline. The patients were blinded to the constituents of the injections. There were no immediate reaction in either arm on both the case. Over the next few hours both reported a tingling sensation at the red cell injection site and noticed a faint bruise. The bruise was 15 mm and 20 mm respectively in diameter at the 24-hour review. There were no alteration to the size of the bruise or the symptoms for the next 24-48 hours. The bruise started fading thereafter. Meanwhile on the control forearm there were no reaction or bruising at the needle puncture site. Discussion: autoerythrocyte sensitisation syndrome or diamond-gardner syndrome is a rare disorder characterized by painful and spontaneous purpura occurring in women with mental health problems. Conclusion: extensive hematological work up proved uneventful. The diagnosis and treatment of the primary psychiatric illness helped the patients to overcome the condition without further delay. Awareness of this condition among physicians required to prevent unnecessary investigations and referral to mental health professionals should be prompt and mandatory.

keywords: autoerythrocyte sensitization syndrome; psychogenic purpura, gardner diamond syndrome,

A Case Of Polymicrogyria With Alpha Dystroglycanopathy Presented With Milder Form With Intellectual Disability And Partial Seizure

Dr. Ranjan Bhattacharyya, Dr. Supriya Kumar Mondal, Dr. Siddhartha Shankar Saha

Murshidabad Medical College & Hospital, Kolkata. West Bengal, India. Email Id : [email protected]

Background: Congenital muscular dystrophy (CMD) refers to a group of muscular dystrophies that become apparent in early infancy or at birth. Muscular dystrophies are mostly genetic and a degenerative disease primarily affecting voluntary muscles. Introduction: Alpha dystroglycanopathies both phenotypically and genetically are heterogeneous group of disorders and a subgroup of these patients has characteristic brain imaging findings. Material and methods: the case vignette shows a four year old girl presented in the opd with history of throwing tantrums, delayed developmental milestones, irritability and anger outbursts. She had a history of admission in paediatric neurology with complex partial seizures controlled by tab oxcarbazepine. She was born full term of non-consanguineous marriage by LSCS. There was progressive muscular weakness since early infancy with difficulty in sucking and breathing. No developmental regression was noticed. Results: her development quotient was found to be 46, plasma ammonia and lactate levels were normal, creatinine kinase was high (314 IU/L). MRI of brain reveals polymicrogyria, white matter changes and subcortical cerebellar cysts. The pattern recognition of mr imaging features may serve as a clue to the diagnosis of alpha dystroglycanopathy although definite diagnosis could be obtained only by muscle biopsy and genetic testing. Conclusion: in japan, fukuyama disease is fairly common, second to duchenne muscular dystrophy but milder form lie this case is rare. The mutation in fktn gene which gives instructions for making a protein called fukutin, which chemically modify a protein alpha-dystroglycan. High index of suspicion and early diagnosis is required to initiate prompt therapy which is mainly supportive with rigorous physiotherapy, antiepileptic drugs, parental and genetic counseling.

Keywords: Alpha dystroglycanopathy; Complex partial seizures; Fukutin; Polymicrogyria; developmental delay

Intracranial Structural Changes- Assessment Of Cortical Atrophy In Dysthymia

Dr. Adya Shanker Srivastava, Dr. Kailesh K.S. Jagatpal, Prof. A.K.srivastava

I.M.S.B.H.U., Varanasi. Email Id : [email protected]

Introduction: The advent of Computerised Tomographic study , a non-invasive technique of screening intracranial contents ; has provided a tool to investigate possible changes in brain structures associated with major psychiatric illnesses. The present study was carried out with the aim to find out intracranial structural changes - evidence of cortical atrophy in dysthymia .Methodology - thirty patients of age range 21-40 years fulfilling dsm-iv criteria for dysthymia , without any evidence of other associated organicity or physical morbidity were taken into study . Their cranial c t scan was done under supervision of expert in neuro-imaging . The control group consisted of thirty age and sex matched persons screened for headache . The evaluation of cortical atrophy was done and it was scored as 0-2,3-5 and 6-8 for five cortical areas - frontal,temporal, parietal, insular and occipital .Result - significant cortical atrophy was observed in female patients of study group as compared to control group. Conclusion - the intracranial structural change - presence of significant cortical atrophy in female patients of dysthymia is an important finding. Details will be discussed during presentation.

Keywords: intracranial structural changes, cortical atrophy, dysthymia

Ventricular Brain Ratio And Ventricular Enlargement In Dysthymia

Dr. Adya Shanker Srivastava , Dr. Kailesh K.s. Jagatpal, Prof. A.k,srivastava

I.M.S.B.H.U,Varanasi. Email Id : [email protected]

Introduction: The Computerised Tomographic, a safe and non-invasive technique , is used for identification and assessment of various intracranial structures and associated abnormalities in brain. The present study was carried out with the aim to find out any change in ventricular system i.e. Change in ventricular brain ratio (VBR) and ventricular enlargement in patients of dysthymia .Methodology - thirty patients of age range 21-40 years fulfilling dsm-iv criteria for dysthymia , without any evidence of associated organicity or physical morbidity ; were included in the study .The cranial c t scan of patients was done under supervision of expert in neuro-imaging . The control group consisted of thirty normal c t scans of age and sex matched persons screened for headache . The assessment of ventricular brain ratio (VBR) and ventricular enlargement was done in both study and control group .Result - mean ventricular brain ratio (VBR) was higher in study group as compared to control . Mean ventricular size was also found to be higher in patients of higher age group as compared to control .Conclusion - patients of dysthymia have increased vbr and ventricle size as compared to control .Details will be discussed during presentation .Key-word : dysthymia , ventricular brain ratio , ventricular enlargement .

Depression, Anxiety And Quality Of Life In Percuataneous Coronary Interventions: Current Indian Scenario

Dr. Rajiv Kumar Saini, Prof. S Chaudhury

AFMC, Pune. Email Id : [email protected]

Coronary artery disease (CAD) is the leading cause of morbidity and mortality in the world. However, some fascinating advances in the field of cardiology have not only added years to peoples life but life to years as well. Percutaneous coronary artery intervention (PCI), commonly known as coronary angioplasty is a non-surgical procedure used to treat stenotic coronary arteries. In recent years pci has become preferred modality of treatment for occluded coronary arteries. However, there has been growing interest in the quality of life issues for those who undergo such procedures. Depression, anxiety, vital exhaustion, hostility, anger, and acute mental stress have been evaluated as risk factors for the development and progression of CAD. Further, they also have strong bearing towards recovery from an acute coronary event. Current article discusses the role of depression, anxiety and quality of life of patients undergoing pci. Key words : coronary artery disease (CAD), percutaneous coronary artery intervention (PCI), depression, anxiety, quality of life.

A Case Of Factitious Disorder, Misdiagnosed And Treated As A Parkinsons Disorder And Depressive Disorder, In Middle Aged Female: Case Report

Dr. Bhuvana R C

Email Id : [email protected]

A 52 years old female presented with the complaints of slowness of all voluntary movements, weakness, dizziness, urinary incontinence, constipation etc from the past 6 years. She was diagnosed of having parkinsons disorder by most of the neurologists, was advised antiparkinsons drugs. She had also underwent several investigations, requesting for other procedures and consulted various specialists including psychiatrists, and diagnosed as a parkinsons with co-morbid mixed anxiety and depressive disorder based on her feigning symptoms, tab. Escitalopram 10mg was added along with. But she claims to have no improvement in any of her symptoms with medications. Her inconsistent clinical picture and symptoms that do not respond to the seemingly appropriate treatment alert the psychiatrist about the possibility of having factitious disorder with co-existing other psychiatric illness. These misleading information and manipulative behaviors makes her illness to become a chronic with adverse prognosis. In this case report, a middle aged women is factitiously presented as parkinsons and depressive symptoms is going to be presented, which is a very interesting and challenging case.

Keywords: Factitious disorder, parkinsons disorder, depressive disorder

To Compare The Prevalence Of Personality Disorders In A Community From Rural And Urban Areas: A Cross-sectional Study In South Karnataka, India

Dr. Bhuvana R C

Email Id : [email protected]

Background: There is a lack of study on the prevalence of personality disorders from rural areas, since the degree of willing of people from rural areas to use mental health services, self report of mental illness and availability of these services in these areas is very less. These personality disorders frequently co-occurs with other psychiatric disorders which can complicates the treatment, worsens the prognosis. Few studies has been done only in urban areas, but comparative studies were nil.

Aims: To compare prevalence of personality disorder among rural and urban people in south karnataka.

Methods: An equal numbers of 300 subjects from urban and 300 subjects from rural areas, aged 16-74 years, were screened by using SAPAS to identify the cases and the diagnosis was confirmed further by using dsm-iv tr2, in a two-phase survey. A chi-square test has used for statistics.

Results: The weighted prevalence of overall personality disorder in urban areas was 19.4% And 17.2% In rural areas. Cluster-c personality disorders were found to be highest prevalent among rural areas than urban and cluster-b were found to be more among urban than rural areas and both subgroups were found to be significant statistically.

Conclusions: Since the rural mental health problems tend to be less visible than urban and can lead to the erroneous conclusion that rural areas have a lesser need for mental health services. Our study has found that there is almost equal prevalence of personality disorder in rural and urban areas, but differences were in (quality) cluster subgroups of personality disorders. Reasons for these different findings need to be study further in detail.

Keywords: personality disorder,rural and urban areas

To Study The Prevalence Of Sexual Dysfunction In Patients With Mood And Psychotic Disorders

Dr. Bhuvana R C

Email Id : [email protected]

Background: Sexual dysfunction is common in psychotic disorders and mood disorders no study still compared the prevalence of sexual dysfunction b/w psychotic and mood disorders before starting neurotropic medications.

Methods: Patients have been divided into two samples, sample˜a and˜b. Sample a are individual belong to psychotic disorders and sample˜b includes mood disorders. 30 Members in each group. Severity of psychotic disorders is assessed by panss scale and mood disorders by ham-a, ham-d and ymrs. Sexual dysfunctions are assessed by using shf (sexual history form) and fsfi (female sexual function index).

Results: This study shows prevalence of sexual dysfunction found to be more in group b, but no statistically significant differences found between 2 groups. In patients with mood disorders, loss of sexual libido/desire found to be more (40 %) than psychotic disorder and also loss of sexual desire is more common than other sexual disorders. In psychosis premature ejaculation is more common (13.3% > Group b).Although prevalence of erectile dysfunction are equal in both groups negative emotions, including anxiety or fear associated with mood disorder or psychotic disorder, represent one of the most common causes of erectile dysfunction . Severity of illness associated with sexual dysfunction found more in group b than group a with statistically significant p<0.05.

Conclusion: Sexual dysfunction associated with less severity of illness in psychotic disorder says that it begins prior to onset of psychosis, suggesting it is intrinsic to the development of illness before starting antipsychotic medication. The potential causes of sexual dysfunction in patients with mood disorders and psychotic are complex and little investigated, and future research must distinguish and explore the various biological/psychological/psychosocial factors that are likely to be involved.

Keywords: sexual dysfunction,mood and psychotic disorders

Prevalence Of Psychiatric Comorbidity In Patients Presenting With Chronic Daily Headche- A Hospital Based Cross Sectional Study

Dr. Bhuvana R C

Email Id : [email protected]

Aims And Objectives: To study the prevalence of psychiatric co-morbidity in patients presenting with headache and to know the nature and extent of psychiatric co-morbidity associated with headache among the patients who visited the department of psychiatry /department of medicine, MVJ medical college and research hospital, hoskote.

Methods: Our sample consists of 100 patients who presented with the complaints of headache to the department of psychiatry /department of medicine in mvj medical college and research hospital from november 2012 to june 2014 were included in the study. The data was collected using the semi-structured proforma for all subjects meeting the inclusion criteria. They were administered the mini 5.0.0 To elicit the presence of any axis i and axis ii disorders respectively.

Results: In this study 74% of the patients presenting with headache had co-morbid psychiatric disorders. Out of 74% of the psychiatric illnesses ; 28% were suffering from affective spectrum disorders, 16% were suffering from anxiety disorders [GAD (2%), mixed anxiety and depressive disorder (10%), PTSD (1%), panic disorders (2%) & OCD (1%)], 16% had psychotic disorders, [schizophrenia (9%), psychosis (3%), psychosis nos (4%)], 12% had other neurotic stress related disorders [adjustment disorder (6%), dissociative disorders (5%), and somatization disorder (1%)] and 2% had personality disorder among the patients presenting with headache. Socio-demographic findings were; 24% of the patients with headache were illiterate, 2% were unemployed, and 78% were in the age group of 18 to 40 years and 73% were females.

Conclusion: Patients presenting with headache have high levels of co-morbid psychiatric disorders and the presence of headache in these patients was associated with increased severity of the co-morbid psychiatric conditions. In view of the present findings, the management of patients presenting with headache should include the detail assessment of coexisting psychopathology and treatment of both coexisting conditions.

Keywords: Headache, psychiatric comorbidity

A Psychiatrist's Role In Times Of Doubt

Dr. Martien Snellen

Mercy Hospital For Women, Melbourne, Australia. Email Id : [email protected]

Psychiatrists can assist their medical and surgical colleagues to ensure that a patient is able to give informed consent for a medical/surgical procedure should any doubt exist regarding capacity to provide such consent. This involves establishing that the elements of competence, voluntariness, disclosure, recommendation, understanding, decision and authorisation have been addressed. Should a particular patient be unable to give informed consent due to mental impairment, a surrogate or third party may be legally authorised to consent to treatment on their behalf. In cases of emergency, in particular if an intervention is considered to be life-saving, treatment may proceed without informed consent. Clear and detailed documentation of the process in which informed consent is established or contested is essential.

The presentation will examine the ethical and legal principles involved in such decision making with particular focus on the socio-cultural and legal situation in contemporary india and the world more generally.

Keywords: Psychiatrist Role, doubts, Medical surgical procedure

Attitude Toward Mental Illness And Psychiatry Among The Medical Students And Interns In A Western U.p. Medical College

Dr. Jitender Singh, Dr. Tarun Pal, Prof. Prakash Chandra

Saraswathi Institute Of Medical Sciences, Hapur (U.P.). Email Id : [email protected]

Introduction: Medical Students tend to have a neutral or negative attitude to psychiatry as a discipline. This study was initiated to explore the attitude towards mental illness and psychiatry among the medical students and interns in saraswathi institute of medical sciences.

Methodology: A cross-sectional questionnaire based study was conducted among the medical students and interns at saraswathi institute of medical sciences. Two self-rating scales; attitudes towards psychiatry-30 and attitudes to mental illness were used to assess attitudes towards mental illness and psychiatry among the 140 total subjects. Descriptive statistics and independent sample t-test were applied using spss-16 for analysis.

Results: Among the total 140 subjects, 37 (26.4%) Were interns. Comparison of means of each item in attitudes towards psychiatry-30 and attitudes to mental illness was done between males and females, medical students and interns, first prof,second prof and final prof students. Most of the subjects showed neutral attitude towards all the scoring items; though there were a few significant differences in mean scores of some items in group wise comparison.

Conclusions: Overall attitudes towards mental illness and psychiatry among the medical students and interns in our medical school were positive or neutral. A further study with medical students from different institutions needed to get a detail nationwide picture.

Keywords: Attitude, interns, medical students, mental illness, psychiatry

Study On Smartphone Use, Its Addiction And Impact On Sleep Parameters Due To Night Time Use Among College Students

Dr. Jigneshchandra Chaudhary, Dr. Prahlad Patidar

Smt.NHL MMC. Email Id : [email protected]

Introduction : Nowadays mobile phones turn out to be a major part of our life due to its advance features. Its problematic use among youth population leads to various adverse impact on health and wellbeing of them. In this study we try to examine addiction of smartphone and problem related to sleep due to bed time smartphone use.

Materials And Methods: This is cross- sectional study conducted on volunteers among college students, 200 students screened randomly. The investigator administered pre set questionnaires on smartphone addiction and parameter of sleep and demographic questionnaire after consent from participating students. Smartphone addiction scale-short version, pittsburg sleep quality index (PSQI), athens insomnia scale (ASI), epworth sleepiness scale (ESS) were used.

Results And Discussion- In our study we found that 39% of college students are addicted to smart phone. Those addict use smartphone within 15 min of their wake up. Smartphone addiction behavior is associated with years of smartphone use, numbers of smartphone use and also addicted shows excessive night time smartphone use. Problematic use of smartphone associated with negative outcome sleep quality, insomnia and daytime sleepiness.

Conclusion: According to findings of the present study, smartphone addiction were high among college students and its bed time use leads to various sleep related problems.

Keywords: Problematic Use, Addiction, Smartphone, Sleep Related Problems.

Functionality In Schizophrenia: A Study Assessing The Functional Ability Attained In Schizophrenia Patients Over The Course Of The Illness

Dr. D M Arasi , Dr. M Tamil Selvi, Dr. Sharon Joe Daniel, Dr. P P Kannan, Prof. M Malaiyappan

KM. Email Id : [email protected]

Background: Schizophrenia has a prevalence of 2.8 To 8.7 Per 1000 in indian population. It causes significant distress in terms of suicide, threat, loss of man power, and burden to the caregivers. The loss of functional ability resulting and the disability caused is significant. With the newer antipsychotics added and professional guidances available with protocols, the scenario has much changed in terms of the functional ability attained. This study wishes to explore the functional ability attained in patients with schizophrenia, over the course of the illness

Methodology: We assessed 202 patients diagnosed with schizophrenia according to ICD- 10 criteria and on regular treatment and follow up, for a period of at least 1 year, having proper records, attending our opd and without co morbid mental or physical illness, with gaf and ideas scale.

Results: The results will be discussed at the end of the study

Conclusion: This study will help us understand the recent trends in the course of schizophrenia. It will also show a light upon the duration of undiagnosed illness and the prognosis of the illness.

Keywords: schizophrenia,functional ability

Socio-demographic Profile And Pattern Of Opioid Abuse Among Patients Presenting To A De-addiction Centre In Tertiary Care Hospital Of Punjab

Dr. Deepali Gul, Dr. Gulbahar Singh Sidhu

Punjab Institute Of Medical Sciences, Jalandhar, Punjab. Email Id : [email protected]

Background: The substances abuse has become one of the major public health problems of present society. Recently there has been an increase in the incidence of substance abuse including that of opioids throughout the world.

According to world report-2013 published by united nations office on drug and crime (unodc), about 16.5 Million, or 0.4% Of world adult population (15-64 years of age), used illicit opioids in year 2011.

Geographical location of punjab is such that the transit of drugs is possible across the state. Many reports in the regional newspapers have , of late, pointed at the widespread drug abuse in the state of punjab.

Methodology: Number of patients to be included: 300

Inclusion Criteria

A cross-sectional target population based study that would be conducted at the out-patient facility of the department of psychiatry, punjab institute of medical sciences, jalandhar, starting from april 15, 2016.

Three hundred consecutive treatment seeking subjects, fulfilling american psychiatric association's diagnostic and statistical manual of mental disorders - iv-TR criteria for opioid-dependence would be included in the study.

Psychiatric interview and medical history taking would be performed by the consultant psychiatrist at the start of study and subjects interviewed as per drug abuse monitoring system (dams) proforma.

Questionnaire recording information on age, gender, marital status, status of education and pattern of substance abuse.

Approximate Duration Of Project

6 Months

Results And Conclusions: The results and conclusions cannot be discussed as the study is currently under way

Keywords: opiod, deaddiction

Comparative Study Of Creatine Phosphokinase, Lipid Profile And Serum Vitamin B12 Levels Among Drug Naοve/drug Free Patients With Schizophrenia, Bipolar Mania, Depression And Healthy Controls

Dr. Supriya Dsilva

Email Id : [email protected]

Background: Neural mechanisms mediated by hypothalamic dopamine and by autonomic nervous system may be contributing to the elevation of serum cpk. Also patient with mental illnesses such as schizophrenia and bipolar disorder have an increased prevalence of metabolic syndrome. Vitamin b12 deficiency has long been linked to depressive behaviour, especially subjects with lethargic, apathetic symptomology.

Objectives: To compare the serum creatine kinase levels (all three fractions- ck-mm, ck-mb, ck-bb); lipid profile and serum vitamin b12 levels in drug-Naοve/drug-free patients with schizophrenia, bipolar mania and depression with healthy controls.

Method: This study was a cross sectional hospital based study. The sample size was 80, divided into 4 groups. Blood samples were collected and ck-nac levels were measured using the biochemistry kit - modified procedure of the ifcc method and the various fractions of ck (ck-mm, ck-bb and ck-bb) were measured. The fasting lipid profile was measured and serum vitamin b12 was measured by the microplate enzyme immunoassay, colorimetric. Clinical assessment was done on BPRS scale. Temperament and character inventory was applied on all patients.

Results: CK-NAC values were seen to be significantly higher in bipolar mania compared to healthy controls. There was no significant difference among CK-MM, CK-BB & CK-MB among the 4 groups. LDL cholesterol was seen to be significantly higher and serum vitamin B12 levels was significantly lower in depressive patients than healthy controls.

Conclusion: Compared to healthy controls, bipolar mania patients had higher CK-NAC values and depressive patients had higher ldl cholesterol and lower serum vitamin b12.

Keywords: Vitamin B12,CPK

The Relocation Of Culture In The Era Of Globalization: A Fragmentary Appraisal With Some Psychiatric Correlates

Mr. Bappa Sarker, Dr. A.A. Mamun Hussain

Rajshahi Medical College, Bangladesh. Email Id : [email protected]

Background: Globalization is a term introduced in the 1980s, principally to describe the world expansion of economic market in the late twentieth century. In many ways this process follow the underlying topic of industrial capitalism in the west as it enters the information age and the reign of multi-corporation (held & mcgrew, 2000). Broadly speaking, globalization refers to intensification of trans-border interconnectedness in all spheres of economy, politics, society and culture. In other words, globalization refers to a world in which complex economic, political, social and cultural processes operate and interact without any influences of national boundaries and distance (peter, 2000). As such the growing public anxiety and backlash against globalization is becoming apparent day by day. A further important theme in these debate is the relation of the˜local and the˜global or what is styled as˜glocalization (robertson, 1995). This phenomenon has destroyed the environment, corrupted the political processes and the rapid pace of change associated with it, has not allowed countries times for cultural adaptation.

Aims: The process of acculturation, often bring immense miseries and suffering to the people, of the country like us. This paper aims to explore the hidden turmoil of our everyday life,, considering era of globalization.

Method: Common databases (e.G. Pub. Med, google scholar) and relevant books as references were studied.

Result: It will help us in understanding the after effect of globalization in our society.

Conclusion: Psychiatrists being the foremost savior in the domain of human suffering hardly can remain aloof from understanding some of the myth and the reality of the process of globalization. This presentation hopefully, would be a prelude, illustrating some facts of the˜globalization and its discontents (joseph, 2002) in front of very scholarly audiences from different part of the globe.

Genesis Of Suicide Bombing: An Overview Of A Newer Suicidal Behaviour

Mr. Bappa Sarker , Dr. A A Mamun Hussain

Rajshahi Medical College, Bangladesh. Email Id : [email protected]

Background: Suicide, although, is a conscious act of self-induced annihilation, but often it is a multidimensional phenomenon. Study reveals that suicidal behaviour is the most frequently encountered mental health emergency for the mental health professional, when average psychiatrist has a 50% chance of having a patient with suicidal attempt. In this millennium suicide bombing, as such has become a newer way of self-intentioned death. Furthermore, suicide bombing is killing oneself and others at the same time. So, on elaboration, the debate is extended towards the idea of suicide terrorism and the horror experienced by the suicide bombing victim.

Aim: A broader social science review would allow mental health professional to explain this suicide behaviour in further details.

Method: Common database (e.G. Pub. Med., Google scholar) psychiatric literature on suicide bombing and relevant books as references were studied.

Result: It will help us in understanding a newer suicidal behaviour.

Conclusion: A probe into the pathologies of suicide bomber would provide adequate tools to the psychiatrist for necessary intervention in overcoming the emerging crisis, which aspires towards a certain universalism

Keywords: suicide bombing,suicidal behavior,pathological suicide

Voices Of The Unheard: Experiences And Perceptions Of Motherhood In Mothers With Severe Mental Illness- A Qualitative Perspective

Dr. Debanjan Banerjee, Dr. Geetha Desai, Prof. Prabha S Chandra

National Institute Of Mental Health & Neurosciences, Bangalore. Email Id : [email protected]

Background: Desire of the female to bear children can surpass the most extreme of situations. Over and above that, majority of mentally ill women are mothers with increasing number of them seeking help. Little is known about their own experiences in this regard and the extent to which their needs are met.

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

Method: The study used qualitative design with social constructivist paradigm. A purposive sample of 30 mothers with severe mental illness was obtained. Data was collected through one-to-one in-depth semi-structured interviews. After verbatim transcription, inductive thematic analysis was used to explore transcripts.

Results: The varied experiences were arranged along the pre-pregnancy and post-pregnancy timelines. Overall: feelings for the child ( ambivalence, possessiveness, guilt ), impact of illness ( stigma, symptoms, medication ), unmet needs ( for shared responsibility, emotional support, support groups ) & caregiver reaction ( blame, discrimination, custody threats ) appeared as the main categories ( and themes ). Most women considered motherhood˜central to their lives & almost all of them experienced the burden ofœdual role. A widespread idea that mentally ill women cannot beœgood mothers was common and the services for parenting were inconsistent and lacking.

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

Keywords: motherhood,severe mental illness,mental health services

Prevalence Of Major Depressive Disorder In Patients Suffering From Tuberculosis

Dr. Pooja Nalinchandra Thakrar, Dr. Aditi Garg, Dr. Rajat Oswal

Deprtment Of Psychiatry, SSG Hospital, Baroda. Email Id : [email protected]

Background: Tuberculosis (TB) is a chronic disease of utmost health concern in developing country like india where it is one the leading cause of morbidity and mortality. Amongst the various psychiatric illnesses associated with TB, major depressive disorder (MDD) is very common.

Aim: 1. To study the prevalence of mdd among patients suffering from TB. 2. To assess the relationship of depression in these patients with socio demographic factors, disease characteristics and treatment factors.

Materials And Methods: This was an analytical, cross sectional study conducted on 125 patients suffering from tb coming to a tertiary care hospital. All subjects were personally interviewed separately using a semi-structured questionnaire. Mdd was diagnosed on the basis of DSM 5 criteria and its severity was rated by hamiltons depression rating scale.

Results: Out of 125 patients of pulmonary tb 37 (29.6%) Were diagnosed with mdd. Of these 37 patients; 14 had mild depression, 21 had moderate depression and 2 had severe depression. In these patients significant correlation was established with past history of tb, alcohol dependence, treatment category, treatment phase, persistent cough, side effects of AKT & subjective report of weight gain.

Conclusion: Diagnosis of mdd in patients suffering from tb is challenging due to a significant overlap of symptoms. Several studies have found high rates of depression due to use of rating scales only to diagnose depression. We have tried to be realistic in our approach to diagnose mdd in these patients focusing on the core symptoms of depression. In our study almost 1/3rd of the patients were depressed. Correlation was established between tb and number of risk factors including past history of tb, alcohol dependence, treatment category, treatment phase, persistent cough, side effects of AKT & subjective report of weight gain.

Keywords: TB, major depressive disorder, risk factors

Assesment Of Sleep Quality In Medical Students In A Tertiary Care Hospital

Dr. Anil Kumar Nayak, Prof. Dr Neelmadhav Rath, Dr. Satyakam Mohapatra, Dr. Jigyansa Ipsita Pattnaik

SCB Medical College, Cuttack. Email Id : [email protected]

Introduction: Disruptions of sleep and circadian rhythm have adverse effects on physical and mental health. Almost 70% of those referring to psychiatric clinics complain of sleep disorder. A huge number of studies have considered sleep quality of medical students showing alarming results.

Aims And Objectives: To evaluate subjective sleep quality, day-time sleepiness, prevalence of substance use, satisfaction with life among students at our institute and to compare the findings between students in undergraduate and postgraduate departments.

Materials And Methods: 0"Total 102 students(58 ug & 44 pg ) sample were taken randomly with consent & , interviewed with the semi-structured performa and following scales were applied- the pittsburgh sleep quality index (psqi), epworth sleepiness scale (ess); the satisfaction with life scale(swls)

Results: Among the ug student group, 19% were poor sleepers compared to72.7% of the pg. Abnormal daytime sleepiness was found in the p.G. Students"22.7% Whereas 6.9% In ug. Also, 56.8% of the pg students were satisfied with their lives compared to 82.7% of undergraduate students. Alcohol, nicotine-containing products like smoking and chewing tobacco were the three most commonly used substances in both the groups (44%, 21%, and 14% respectively). Conclusion" impaired subjective sleep quality and sleep duration, increasing trends of day time nap, dissatisfaction with life and substance use among medical students of our college and are more pronounced in postgraduate residents than undergraduate mbbs students. In conclusion, our study highlights the need for early identification of sleep disturbances, interventions to introduce flexible working hours and shifts of manageable durations and education regarding the principles, and practice of sleep hygiene among medical students.

Keywords: sleep quality,medical students,sleep cycle

Impact Of Whats App Use And Its Addictive Potential

Dr. Kiran Anant Deshpande

Govt. Medical College, Chandrapur. Email Id : [email protected]

Introduction: Whatsapp is commonest form of information transfer for internet users with conveys pictures, messages within seconds. Beep of Whatsapp message distracts user making him restless till it is seen . Beep thus interferes his schedule and hence mental status.

Whats-ap is used across the globe. India is 4th among 1 billion users. Over 70 millions use this message services in india ( sept 16). In absence specific test for whats-ap use, validated and reliable internet addiction test (i a t ) of kimberly young having 20 questions is used in this study. Severity pattern is that of mild, moderate, severe. Greffiths criteria of ia is accepted by DSM 5 (4/2013) to be diagnostic criteria this includes pre-occupation withdrawal tolerance relapse or loss of control conflict and mood modification .

Aim: To explore prevalence, effects and addictive potential of what app use in general population.

Material & Methods: A cross sectional sample comprising of 300 people from chandrapur is studied. They were given it questionnaire having 20 question evaluated by trained persons in 3 months.

Results: Of the 300 persons 167 ( 56%) were males and 133 (44%) were females. There were 36% students. More than 50% are using whatsapp for 2 yrs. Among them severity is calculated .34.7% Had score - nil to mild as not problematic while 63% were in moderate range and 1.3% In higher score with sever severity, all are females having high score

Conclusion: Keeping in mind the addictive potential there is a need to educate people and making them aware about excessive use and damage.

Key Words : IAT internet addiction test and its correlation with whats app addiction.

Study Of Correlation Among De-pigmented Body Areas And Sex Of Vitiligo Patients On Their Self Esteem And Quality Of Life

Dr. Baranwal Divyesh

Email Id : [email protected]

Objectives: To study correlation among bodyareas of de-pigmentation in vitiligo patients, sex of vitiligo patients on their self esteem and impact of vitiligo on different domains of life which affects overall quality of life.

Methodology: 100 vitiligo patients and 100 subjects as control group were evaluated for self-esteem & quality of life by rosenbergs self-esteem scale (RSES), who quality of life -brefs scale (WHO QUOL BREFS). Data were tabulated, analyzed & suitable statistics applied (i.E. Chi square, t-test).

Results: Vitiligo patients report significantly low self-esteem, compared to lighter skinned individuals. Vitiligo patients suffered from low, normal and high self esteem. Vitiligo patients had developed poor body image for himself, due to which they faced unexpected psychosocial traumas and made negative view for life, which declined quality of life in various life domains. Data Wise results will be shown at the time of presentation.

Conclusion: Vitiligo generates psychological distress, violates self confidence, self esteem, disrupts social relationship & creates stress-vitiligo vicious cycle.

Keywords: Quality Of Life, Self Confidence, Self Esteem, Vitiligo.

Neuroimaging Of Transcendental Meditation

Dr. Paolo Nucifora, Dr. Carla Brown, Dr. Fred Travis, Dr. Murali Rao

Loyola University Chicago. Email Id : [email protected]

Transcendental meditation is a simple mental technique that is easily learned by anyone and does not involve any belief or change in ones lifestyle. Penner, et.Al (1974) discovered practitioners of transcendental meditation have greater adaptability of mental orientation, greater autonomy; greater social extraversion, less impulsiveness, and greater personal integration (decreased social alienation and emotional disturbance). Additionally, FERGUSSON, BONSHEK & BOUDIQUES (1995) found reductions in both state and trait anxiety for undergraduate students practicing the technique. A 1997 study on the effects of a stress management program in a high security government agency by sheppard, staggers & john revealed a decrease in anxiety and depression, as well as an improved self-concept with those practicing this intervention. Brooks & scarano (1985) also found decreased depression when testing the technique as a treatment for post-vietnam veterans.

We will review the latest findings regarding health benefits of transcendental meditation in contrast to mindfulness and other cognitive behavioral interventions. We will also review the neurophysiologic mechanisms behind the effects of meditation on the brain. Using bold-fmri, we found that mindfulness may cause changes in functional connectivity in some healthy volunteers. We will present these and other preliminary results from a pilot study at our institution using both functional and structural connectivity to examine the effect of transcendental meditation and mindfulness in healthy physicians.

Keywords: Functional Connectivity, Bold-fmri, Meditation

A Study Of Major Depressive Disorder ,quality Of Life And Permanent Functional Disability In Patients Of Chronic Low Backache

Dr. Dharamveer Chaudhary , Dr. Sarandha Srivastava, Dr. Bharat N Panchal, Dr. Ashok U Vala, Dr. Pinakin Vora, Dr. Imran J Ratnani, Dr. Prerak Yadav, Dr. Archana Kantak, Dr. Pushpa Khania

Email Id: [email protected]

Background: Chronic backache is defined as a pain that lasts for 12weeks or longer. The disease burden of backache and depression is rising rapidly . We studied frequency of depression , assessed quality of sleep ,functional disability and quality of life in chronic low backache patients and established associations between the variables mentioned above.

Methods: This is an observational, cross sectional , single-centred ,interview based study. Hundred consecutive patients visiting orthopedic outpatient department with chronic low backache in tertiary hospital were included. Interview of patients was taken for diagnosis of major depressive disorder using dsm 5 and assessed for severity of major depressive disorder, health related quality of life and sleep quality by ham d, sf 36, pittsburg quality of sleep index respectively. Statistical data were analyzed by graph pad instat version 3.06.

Results: Frequency of major depressive disorder , poor quality of sleep in patients of chronic low backache was 74 and 81 respectively. Patients having mdd had higher ham d score,poorer quality of sleep ,poorer quality of life and higher functional disability.Higher the functional disability more severe were the depressive symptoms. Backache for duration of more than 1 year had greater chances of depression. Severe permanent functional disability due to low backache had severe depressive symptoms, poorer quality of sleep and life

Conclusions: Patients with chronic low backache had high frequency of depression,poor quality of sleep and life and higher functional disability.

Keywords: Chronic Low Backache, Depression,functional Disability, Quality Of Life

A Study Of Sexual Dysfunction And Quality Of Life In Female Patients On Selective Serotonin Reuptake Inhibitor (ssri)

Dr. Sneha Vadher, Dr. Kinjal J Vasava, Dr. Bharat N Panchal, Dr. Ashok U Vala, Dr. Imran J Ratnani, Dr. Nidhi Nagori, Dr. Sneha Vadher, Dr. Dharmesh Gohil

Email Id: [email protected]

Background: Sexual dysfunction is one of the most common and disconcerting side effect during treatment with selective serotonin reuptake inhibitors(ssris).Female sexual dysfunction includes hypoactive sexual desire,arousal disorder,orgasmic disorder,dyspareunia and vaginismus. Sexual side effects from these medications have significant impact on self esteem,quality of life,quality of relationships and can lead to non compliance,relapse in long term treatment.

Methods: This was an observational,cross sectional, single-centred,interview based study. Hundred consecutive female patients who were sexually active,on ssris for six weeks or more were recruited from the psychiatry outpatient department of a tertiary care hospital from october 2015 to april 2016. Diagnosis of mdd,anxiety disorders,female sexual dysfunction was done by clinician administered interview as per dsm 5.The patients were further assessed for demographic details,csfq-f-c (changes in sexual functioning questionnaire) for sexual dysfunction,ham-d (hamilton rating scale for depression),ham-a(hamilton rating scale for anxiety),whoqol-bref(world health organization quality of life assessment scale for quality of life).

Statistical data were analyzed by graphpad instat version 3.06. P value of<0.05 was considered to be statistically significant.

Results: Frequency of sexual dysfunction among female patients on ssris is 84 %. Among sexual dysfunctions difficulty in arousal was commonest (82%) followed by orgasmic difficulty (55%) and genito-pelvic pain (39%). Patients with sexual dysfunction scored significantly lower value in social relationships(p= 0.0002),Environment(p= 0.033) Domains of quality of life. Patients with anxiety disorders were more likely to suffer from sexual arousal disorder(p=?0.0001) And poor quality of life.Frequency of sexual dysfunctions among patients on fluoxetine was 86.20%,On escitalopram was 86.76% And on sertraline was 66.6%. Frequency of sexual dysfunctions increased with increasing the dose of ssris.

Conclusions: Our study suggests that patients on various ssris experienced sexual dysfunctions like orgasmic disorder,arousal disorder and genito-pelvic pain and had poor quality of life.

Key Words: Sexual Dysfunction, Selective Serotonin Reuptake Inhibitors, Depression, Anxiety And Quality Of Life

Use Of Mobile Apps In Facilitating Intervention Delivery: Innovation In Autism Interventional Research

Dr. Harshini. M , Dr. Preeti Kandasamy

Email Id : [email protected]

Recently, There is an enormous proliferation of mobile technologies and mobile penetration is dramatically increasing even in the low and middle income countries. Mobile apps have been gaining popularity in addressing the existing treatment gap in mental health, though many are not rigorously tested.

It is recognized that autism spectrum disorder (asd) is an emerging global public health issue. Early intervention programs for children with autism have been proven efficacious in terms of optimal outcome. Developing cost-effective, acceptable and feasible intervention models is seen as a solution to improve sustainability, more importantly in the community settings where resources for service delivery are limited.

In our previous study, parent-mediated home-based interventions for children with asd, with components addressing the core deficits was found to be effective in terms of child-related and parent-related outcomes (es=0.46). We attempted to the translate components of our intervention model into a smart phone application to facilitate intervention delivery. Goal setting for parents, tracking implementation of interventions, reminders or alerts in case of failure to adhere to prescribed targets were the important components of the mobile app. Here we highlight the usefulness of adapting evidence-based interventions to technology assisted devices in innovating and facilitating service delivery.

Keywords: Autism, Asd, Mobile App, Smart Phone, Intervention.

Alcohol Consumption: A Study Of Psychosocial Factors Influencing Alcohol

Dr. Vaibhav Chaturvedi, Dr. Sagar Kulkarni

Email Id : [email protected]

Objective: Alcohol use and abuse are prevalent in india and there are many social and psychological factors that lead to this dilemma. The focus of this study is to identify psychosocial factors that cause alcohol use and abuse in as well as examining socio-demographic characteristics in order to determine the susceptibility of a person to use alcohol.

Method: Analysis was based on questionnaire which was used to identify the determinants of drinking and estimate peer influence on a person. Study subjects included alcoholic patients attending psychiatric opd at bharati hospital, sangli. All the participants were provided with a set of questionnaire to access the cause of alcohol use and their socio-demographic status. The research question provided relationship between alcohol use with educational status, family history, income, depression, any physical abuse, and friends influence.

Result: The study examined the target population about psychosocial factors influencing alcohol use and answered research questions about influencing factors. The major causes of alcohol and drug abuse are peer pressure, psychological factors, academic factors and social factors, and family history.

Research shows that one of the factor is family history leading to alcohol use. Individuals, particularly adolescences, respond to their friends pressure to drink alcohol in order to avoid social rejection from group. Social class is also another influence in use of alcohol. Also it is important to consider the socio-environmental factors such as accessibility, law, policies which oppose or support use of alcohol. Unregulated production, distribution, and commercialized alcohol sales and alcohol availabilities contribute to increase of alcohol consumption. The findings of can be utilized by social workers to address the issues and the need for intervention strategies to manage this issue among alcoholic population.

Keywords: alcohol,psychosocial factors,socioenvironmental factors

Prevalence Of Psychiatric Morbidity, Its Patterns And Marital Quality Among Spouses Of Men With Alcohol Dependence Syndrome

Dr. Kamal Kishore Verma

Email Id : [email protected]

Background: Alcohol dependence syndrome (ADS) is one of the most common psychiatric disorders that has deleterious consequences not only on the patient with ads but also hampers social, financial, and legal matters of his family. Spouses of patients with ads, a key member of such dysfunctional family system, are most vulnerable to have significant psychiatric disorders and psychosocial problems. Hence we have undertaken this study in order to understand and address such issues which is largely neglected in psychiatric research. Aims: to assess the severity of alcohol dependence & its adverse effect on families, the prevalence and pattern of psychiatric morbidity and marital quality in spouses of men with ads and to explore the association between them. Materials and methods: 130 spouses of men with ads were screened for psychiatric morbidity using ICD-10 and symptom checklist and severity of specific psychiatric disorders were measured by comprehensive psychopathological rating scale. Severity of alcohol dependence in men and its adverse consequences was assessed using short alcohol dependence data and drinkers inventory of consequences, respectively. Marital quality was assessed using the marital quality scale. Results: high prevalence of psychiatric morbidity (58.5%) Among spouses of ads, patterns were found be dysthymia, depression, anxiety disorders and adjustment disorder. None of them had personality disorders. Psychiatric morbidity, psychopathology, poor marital quality in spouses and high alcohol dependence in their husbands and its adverse consequences were found to be significantly correlated with each other and their association was significant in interpersonal, impulse control, physical problems, intrapersonal domains were most affected. Conclusion: spouses of alcohol dependent men have high psychiatric morbidity and low marital quality. Addressing these issues will be beneficial as spouses are known to play an important role in the treatment of ads.

Keyword: Psychiatric Morbidity, Marital Quality, Spouse Of Men With Alcohol Dependence

Manifestation Of Catatonia In Clinical Settings

Dr. Daniel Saldanha , Dr Samiksha Sahu, Dr .prajakta Pathak, Dr Gagandeep Singh, Dr Shivaji Marella

Dr D .Y. Patil Medical College, Hospital And Research Centre, Pimpri, Pune. Email Id : [email protected]

Background: Catatonia is a state of neurogenic motor immobility and behavioral abnormality manifested by stupor. It was first described in 1874 by Karl Ludwig Kahlbaum. In DSM 5, catatonia is not recognized as a separate disorder, but is associated with psychiatric conditions such as schizophrenia, bipolar disorder, PSTD, depression and also in infections. There are a variety of treatments available; benzodiazepines are a first-line treatment strategy. Electro-convulsive therapy is also used. There is a growing evidence for the effectiveness of NMDA antagonists for benzodiazepine resistant catatonia. Antipsychotics can worsen symptoms and have serious adverse effects. Four interesting cases of catatonia in different clinical settings are presented.

Case.1 25 year old male presented with catatonic features. Scored 20 on the bush francis catatonia rating scale (bfcrs).

Case.2.15 year old female brought by mother with complaints of maintaining uncomfortable postures, repetitive movements of hands and withdrawn behaviour, sleeplessness and not taking care of personal hygiene of 2 weeks duration. Scored 27 on the bfcrs.

Case 3. 20 year old married male was brought to the casualty by his mother. She gave history of chronic cannabis use since 1΍ years, decreased sleep and appetite along with withdrawn behavior, staring look since 30 days and maintaining uncomfortable postures for the last 2 days. Scored 23 on the bfcrs.

Case.4: 35 Year old female was brought to the opd by her husband with complaints of crying spells, suicidal ideas following delivery of her 5th daughter. She was admitted and treated with antidepressants and ect. After a week she developed enteric fever and 2 days later she had catatonic symptoms and a bfcrs score of 20 .Catatonic symptoms were treated with benzodiazepines and ect's.

Discussion: The cases will be discussed in the light of available literature.

Key Words: Catatonia, Postpartum Depression, Enteric Fever, Cannabis, Schizophrenia

Study Of Internet Addiction Disorder In Medical Students

Dr. Siddharth Rathore, Prof. C.S.Sushil , Dr. D.k.Sharma

Department of Psychiatry, Medical College, Kota. Email Id : [email protected]

Background: Internet addiction is defined as a compulsive loss of impulse control resulting in damage to the user and his or her relationships, schoolwork, or employment. Online gaming, compulsive use of social networking, and marathon internet surfing sessions are all included in this addiction.

Objective: To study the prevalence of internet addiction disorder (iad) in undergraduate medical students of govt. Medical college and to study the psychiatric co-morbidity in patients with iad.

Materials And Methods: A cross sectional study was carried out among 200 undergraduates medical students of govt. Medical college kota selected by simple random sampling. The data was collected by inter personal interviews using a standardized internet addiction test questionnaire developed by dr. Kimberly S. Young, goldbergs health questionnaire-12 (ghq-12),hamilton rating scale for anxiety (ham-a) and beck depression inventory and have been tabulated and, analyzed using suitable statistics.

Results And Conclusion: Will be discussed at the time of presentation in the light of previous studies.

Key Words-internet Addiction Disorder(iad),youngs Internet Addiction Test, Medical Students, Mobile Phones, Prevalence.

Current Status Of Telepsychiatric Utility In India

Dr. Shashidhara Harihara N. ,Dr. N. Manjunatha

Department Of Psychiatry, National Institute Of Mental Health And Neurosciences, Bengaluru.Email Id: [email protected]

Background: The prevalence of psychiatric disorders in India, as revealed by several studies varies anywhere between 9.5 to 370 per 1000 population (math sb, 2007). As per the global health observatory (gho) data in 2014, 45% of the world's population lived in a country where there was less than one psychiatrist to serve 100,000 people and India is one such country. In this scenario there is a need for exploring the means of effective utilization of the available resources and delivering quality health care to the people and telepsychiatry is one such means, which is defined asœthe use of electronic communication and information technologies to provide or support clinical psychiatric care at a distance (tracy j, 2004). The telepsychiatry service started globally in 1950s and is one of the fastest developing fields of telemedicine (chakrabarthi s, 2015). However telepsychiatry is not effectively used in india and there is no systematic review of the data about utility of telepsychiatry services in india. In this background we would like to review the published data on telepsychiatry services in india. Aims and objectives: systematic review of the telepsychiatric services in india. Methodology: The review is being done by searching the published data on telepsychiatry from various sources like pubmed, medline, neuromed, cochrane database and google using the key words: telepsychiatry, telemedicine, telehealth, tele mental health, e-health, video conferencing, telephonic consultaion, online consultation andœpsychiatry, mental health, and mental illness. The articles so extracted will be grouped into original research article, case reports and series, reviews and guidelines and they will be critically analyzed and reviewed. Results and discussion will be presented at the time of presentation

Anti NMDA Receptor Antibody Encephalitis Presenting As Acute Psychotic Episode And Confusion

Dr. Kusumamala N ,Dr. Neha Shah, Dr. Avinash Dsousa, Dr. Nilesh Shah

Email Id : [email protected]

Background: The auto immune encephalitis has surpassed the incidence of encephalitis with viral etiology; its strikingly different manifestations especially the psychiatric symptoms urges the need for a novel diagnostic approach.

Case Description: A 13 year old boy with mild intellectual disability was brought to our opd with history of talking incessantly, singing & dancing spontaneously & fearfulness following a recent febrile illness. A series of serological investigations showed nothing but a raise in titre of NMDA receptor antibody. Concurrently his MRI brain revealed significant changes in the form of patchy t2/flair hyper intense areas showing no diffusion on dwi in the periventricular white matter which led us to the diagnosis of anti nmda receptor antibody encephalitis which responded fairly well to the immunosuppressants.

Conclusion: This case is reported for its rarity of presentation, its diagnostic challenges and the need and advantages of a collaborative liaison.

Key Words: Auto Immune, Encephalitis, Nmda, Immunosuppressants

Cognitive Deficits And Its Correlation With Functioning In Euthymic Phase Of Bipolar Affective Disorder: A Cross Sectional Study

Dr. Gourav Chandravanshi, Prof. Mahendra Jain, Dr. Charan Singh Jilowa, Dr. Parth Singh Meena, Dr. Krishan Kumar Sharma

Department Of Psychiatry, J.L.N. Medical College, Ajmer. Email Id : [email protected]

Background: Previous studies suggest that patients diagnosed as bipolar affective disorder have full remission between episodes; however recent evidence suggests the presence of cognitive deficits even in euthymic condition which affects their day to day functioning. The aim of our study was to determine neurocognitive deficits during euthymic phase of bipolar affective disorder and its correlation with functional outcome.

Methods: Fifty patients with bipolar disorder in remission were compared with 50 normal subjects on tests of attention, learning, memory and executive functions. The correlation of neurocognitive tests with functional outcome was studied using gaf scale.

Results: Patients with bipolar disorder, in remission, have neurocognitive impairment in attention, memory and executive functioning. Functional outcome was also correlated significantly with the neurocognitive tests.

Conclusions: Our study demonstrates that the patients of bipolar affective disorder have neurocognitive deficits even during the euthymic phase which significantly affects their social and occupational functioning. Intervention should be required to focus on this phase of illness too.

Key Words: Bipolar Affective Disorder, Remission, Executive Function, Neurocognitive Deficits, Functional Outcome

The Efficacy Of Adjunctive Theta Burst Repetitive Transcranial Magnetic Stimulation To The Cerebellar Vermis In Negative Symptoms Of Schizophrenia: A Randomized Double Blind Sham Controlled Study

Dr. Narendra A R ,Prof. Dr Vinod Kumar Sinha

Central Institute Of Psychiatry, Ranchi. Email Id : [email protected]

Objectives: To assess the change in negative symptoms following cerebellar vermal theta burst RTMS in patients suffering from schizophrenia as compared to sham stimulation.

Method: Forty patients with schizophrenia were given 10 sessions of intermittent theta burst stimulation (itbs) to the vermal part of cerebellum located according to the 10 - 20 international system. Patients were randomized into two groups; active group receiving ITBS and control group receiving sham RTMS. Patients were rated before and after completion of 10 sessions and the final rating were done 14 days after sessions of repetitive transcranial magnetic stimulation (RTMS). Patients were maintained on optimal antipsychotics before the start of rtms sessions and were maintained till the end of study period.

Results: We found significant reduction in scores of scale for assessment of negative symptoms (sans), positive and negative syndrome scale (PAN-SS), calgary depression scale for schizophrenia (CDSS) after the ITBS sessions in patients receiving active RTMS as well as SHAM RTMS. No significant difference in simpson-angus scale (SAS) scores was found. There was significant reduction in scores (SAS, PANSS, CDSS) over time in both the groups, with the sans and PANSS score remaining significant even in the follow-up period.

Conclusion: We concluded that intermittent theta burst (ITBS) over cerebellar vermis does not seem to have significant effect on psychopathology in the patients of schizophrenia with negative symptoms.

Keywords: Repetitive Transcranial Magnetic Stimulation (RTMS); Intermittent Theta Burst Stimulation (ITBS); Vermis; Cerebellum; Schizophrenia.

Cognitive-behavioural Interventions In Nicotine Dependence Syndrome

Dr. G S Kaloiya

National Drug Dependence Treatment Centre, All India Institute Of Medical Sciences , New Delhi. Email Id : [email protected]

Cognitive behavioral treatment focuses mainly on learning coping and problem solving strategies for understanding and disrupting patterns of tobacco use, dealing with beliefs related tobacco use, craving, resisting social pressures to use tobacco, and managing stressful situations. The cognitive skills required for successful behavior change include the ability to identify and self-monitor behavioral patterns, anticipate problem situations, develop and prepare plans for handling high risk situations, and remember both the plan and the need to take action in the future. Behavioral interventions typically target users' motivation, self-efficacy, skills, and social support. Two of the most common intervention paradigms that derive from these conceptual underpinnings are motivational interviewing and skills training. Motivational enhancement helps users to remain in treatment. Skill training is used with individuals who are actively working on cessation. The core components of skills training include- identifying and coping with high-risk situations associated with tobacco use, modifying cognitive expectancy and attributions associated with tobacco use, teaching stress management skills, and modifying general lifestyle activities. The presentation will include models & theories, components of CBT, techniques used in cb interventions and effectiveness of CBT in tobacco cessation.

Key Words-CBT,nicotine dependence,motivation

Study Of Internet Addiction: Prevalence, Pattern And Psychopathology Among Health Professional Undergraduates

Dr. Sachin Ratan Gedam, Dr. Lipsy Modi, Dr. Himanshu Mansharamani

Email Id : [email protected]

Background: Internet has become an essential part of our daily life especially among the adolescents and youth. It is mainly used for education, entertainment, social networking and information sharing. Its excessive use among the health care providers is becoming a major concern. Aims: the aim of our study was to estimate prevalence, understand pattern and to determine association between psychopathology and internet addiction among health profession undergraduates. Materials and methods: a cross sectional study was conducted on 846 students of various faculties from deemed university. Students were assessed with the semi-structured data, internet addiction test and mental health inventory after giving them brief instructions. Students were classified into normal students and addicted students for comparison. Results: the total prevalence of internet addiction was calculated equal to 19.85%, With moderate and severe addiction being 19.5% And 0.4% Respectively. The internet addiction was associated with gender, computer ownership, preferred time of internet use, login status and mode of internet access (p < 0.05). It was also associated with anxiety, depression, loss of emotional/behavioral control, emotional ties, life satisfaction, psychological distress and lower psychological well-being (p < 0.05). Conclusion: the significant association was found between psychopathology and internet addiction. Male gender, login status, emotional ties and psychological distress were found to be important predictors of internet addiction among the students. So these parameters should be taken into consideration while promoting awareness of problematic internet use and to educate students for healthy internet use.

Key Words-Internet addiction,health care professionals,predictors

A Study Of Sociodemographic Characteristics & Psychiatric Comorbidity In Patient With Chronic Low Back Pain

Dr. Bhal Singh, Prof. C.S.Sushil, D.K. Sharma

Department of Psychiatry, Govt. Medical College, Kota. Email Id : [email protected]

Background: Pain is usually caused by intense, noxious stimulation yet it sometimes occurs spontaneously without apparent cause. Depression, anxiety and painful symptoms are common co-morbidities and that their combination is costlier and more disabling than each of them alone. It becomes especially important to understand the liason between these two conditions.

Objective: To find out socio-demographic profile, psychiatric co-morbidity and correlation between severity and duration of pain and psychiatric morbidity in chronic low back pain patients.

Material And Methods: A cross sectional study was carried out among 50 patients of chronic low back pain attending orthopaedic department of new medical college hospital, kota and 50 suitably matched subjects preferably the relatives of the patients constituted the control group.

The data were collected by semi structured performa designed especially for the study, goldbergs health questionnaire-12(ghq-12), hamilton anxiety scales (hama), hamilton depression scale(hada), oswestry disability index and have been tabulated,and analyzed using suitable statistics.

Results And Conclusion: Will be discussed at the time of presentation in the light of previous studies.

Key Words-chronic Low Back Pain, Socio-demographical Profile, Disability Index, Psychiatric Co-morbidity.

Prevalence And Risk Factors Of Postpartum Depression In A Teriary Care Centre, Puducherry

Dr. Zarine Maria Punnoose, Dr. Pradeep Thilakan, Dr. Susan Solomon, Dr. Mary Daniel

Pondicherry Institute Of Medical Sciences, Pondicherry. Email Id : [email protected]

Background: Postpartum depression (PPD) is the experience of depressed mood that begins anytime within the first four weeks after delivery. When left untreated, it can affect the infants emotional and cognitive development and mothers health and family. Studies on this topic are sparse in this part of the country. This study aimed at identifying the prevalence and risk factors of PPD in a tertiary care centre in puducherry. Materials and methods this was a prospective cohort study which included 140 antenatal women between 34-36 weeks period of gestation, and followed up at 6 weeks binge eating/purging type anorexia nervosa- an eating disorder postpartum. Tools used in the study were semi-structured questionnaire to collect the sociodemographic details, postpartum depression predictive inventory" revised version and edinburgh postnatal depression scale. Results: 10% were found to have depression, but 16.4% Of them were lost for follow up hence they were excluded from the analysis. At the postpartum visit, 18.6% Were found to have depression. The risk factors identified were inadequate spousal support, unsatisfactory marital relationship, poor relationship with in-laws, prenatal anxiety and depression, low self esteem, maternity blues, child care stress, infant temperament, health problems and frequent hospital visits. Among these, presence of maternity blues (or=30.370)And infant health problems (or=14.742) Had the highest risk. Conclusion majority of the women with PPD reported depressive symptoms in the third trimester itself,hence antenatal and postnatal women should be routinely screened for depression and managed promptly.Not attaching significance to prolonged maternity blues and frequent infant health problems has been found to increase the risk for developing ppd significantly.

A Comparative Study Of Quality Of Life Among Primary Infertile And Fertile Women

Dr. Shilpa Maida ,Prof. Dr.B.S. Shekhawat, Dr. Suresh Kumar Parihar, Dr. Dr.Vimal Meena

Department of Psychiatry , GMC, Kota. Email Id : [email protected]

Background: Infertility is a major life crisis, it is a frustrating, painful emotional experience for women that affect them not only physically, but also psychologically and thereby the impact of infertility in women negatively affects their overall quality of life.

Objective: The aim of study is to compare the quality of life (QOL) with fertile women and to identify the determinants that influence the quality of life (qol) of primary infertile women.

Material And Method: 60 primary infertile women who attended gynecology opd of new medical college hospital, kota for treatment of primary infertility were included. Similarly 60 age matched healthy married females (preferably relative of the patient) were recruited as control group. A specially designed performa was used to record socio demographic variables. World health organization quality of life assessment scale whoqol-bref (hindi version) was used to assess the quality of life in patients and control group. Results and conclusion: will be discussed at the time of presentation in the light of previous studies.

Keywords: Infertility, Infertile Women, Quality Of Life, WHO QOL-BREF, Socio-demographic Profile.

Follow Up Study On Patient Of Dual Diagnosis And Efficacy Of Management Programmes At Private Mental Health Care Facility (apana Ghar )

Dr. Santosh Kumar Kesharwani , Dr. Snehal Vijay Thamke, Prof. A.K. Singhal, Prof. K.K. Verma, Dr. Harful Singh

Email Id : [email protected]

Background: Dual diagnosis is a term applied to the co-existence of the symptoms of both intellectual or developmental disabilities and mental health problems. Social skills training is usually a timed limited approach that helps persons to improve the quality of life by enhancing interpersonal interactions. Hence this study is conducted to evaluate the efficacy of various social skill training programmes in patients of dual diagnosis at a private mental health care facility.

Material And Method: The present study was carried out on 30 patients of moderate to severe mental retardation having comorbid psychiatric illness (dual diagnosis) at apana ghar. Patients were assessed by a team of psychiatrists 6 months back and psychiatric diagnosis was established according to ICD-10. All patients were administered psychiatric medication as per need and subjected to various social skill training programmes like self care interpersonal relation helping the management of apana ghar and anger management. The assessment was done for observable behaviour , interpersonal relation ,personal care and rating done as per self designed rating scale according to severity. Rating was done at 6 month, 4 month , 2 month before the present behavioural examination.

Results: There was significant improvement in clinical profile of almost all the patients of dual diagnosis. It was found that various social skill training programmes are efficacious in combination with pharmacotherapy .Behavioral symptom like aggression and violent behavior, stereotype movement ,capacity of independent living have shown significant improvement. Interpersonal relationship and personal care also showed significant improvement.

Conclusion: All the patients of mental retardation require psychiatric assessment and need for psychiatric intervention.

Keywords: Dual Diagnosis; Co Morbidity; Social Skill Training Programmes

Tele-psychiatry In India - A Step Towards Better Mental Health Care

Dr. Ashish Pakhre , Dr. Shobhit Jain, B.H.U , Varanasi

Email Id : [email protected]

Introduction: Telepsychiatry uses information technology to offer psychiatric services from a distant place to the needy patients. Telepsychiatry has both clinical utility and non-clinical uses such as administrative, learning and research applications. Telepsychiatry services can be offered through intermediary companies that partner with facilities to increase care capacities, or by individual providers or provider groups. Telepsychiatry has advantage of providing psychiatric services where there is shortage of psychiatrists. Access to psychiatrists by people living in remote areas becomes feasible.

Methodology: An extensive literature search was done to gather studies on use of telepsychiatry in India using pub med. All the articles collected were reviewed for utility, issues and challenges in telepsychiatry practices in india.

Result: Telepsychiatry practices can be wisely used in developing countries like india for improving training, diagnosis and treatment of psychiatric illnesses.

Conclusion: Application of advanced communication technology should be used in psychiatric services in india considering huge population and lack of well-trained psychiatrists, for improving ignored mental health care services.

Key Words: Tele Psychiatry, Tele Mental Health, Communication Technology

The Major Shortcomings Of Current Mental Status Examination

Dr. Shrirang Sadashiv Bakhle

Email Id : [email protected]

There are two components of clinical examination in every branch of medicine: observations and inference. Clinician makes observations of patient and then draws inferences about dysfunctions in organs. Cardiologist observes raised JVP, feet oedema and infers that patient has LVF, a dysfunction in the organ of interest for cardiology, heart. Current MSE does not make any distinction between observations and inferences. This is because there is confusion about what organ of interest for psychiatry is. Is it brain (which is organ of interest for neurology) or is it mind?

Methodology: The paper addresses fundamental questions about the MSE. Does mental status mean status of mind or brain? Can we use the term brain status examination instead of˜mental status examination? At the end of MSE, do psychiatrists diagnose dysfunctions in brain (e.g. Dysfunction in amygdala) or dysfunctions in mind (e.g. Intense sadness related to divorce)?

The paper aims to distinguish between clinical observations during MSE, and inferences about dysfunctions in the organ of interest for the specialty of psychiatry, the mind.

Results: Currently used MSE is compared with a new mind-based mse. The paper uses theoretical framework provided by 4-level, 5-part theory of mind. The framework describes mind-brain relationship and how the mind is a subset of brain functions but is a distinct entity.

The use of the mind-based MSE in clinical settings is described using case vignettes.

Conclusion: Mental status means the status of mind. Aim of MSE is to diagnose dysfunctions in mind. The term brain status examination cannot be used instead of˜mental status examination. MSE should distinguish between observations and inferences about dysfunctions in the patient. 4-Level, 5-part theory of mind provides a sound framework for a new mind-based MSE.

Keywords: Mental Status Examination, Observations, Inference

Post Graduate Psychiatry Training In India: Insights From An Anthropological Fieldwork

Mr. Clement Bayetti Ucl

Email Id : [email protected]

Background/introduction: Scholarly inquiries into the nature of post-graduate training in india have so far been limited. Despite studies having examined the nature of the curriculum, the quality of supervision, and outlined possible novel methods of pedagogy; there is currently a lack of understanding in regard to the social nature of psychiatry training and its implication on the formation of trainees professional identity. The later is particularly crucial as it is through this process that the beliefs, attitudes and understanding that trainee have about their professional roles will be shaped, thus directly impacting their future clinical practice and sense of ethics.

Methodology/ Materials And Methods: This paper proposes to address this lacunae using data gathered as part of a year long ethnographic fieldwork observing nine PG psychiatry students and their teachers in a government training institution.

Results: Echoing the voice of students and teachers, this paper presents an anthropological account of their training experience. By framing such observations and stories through different sociological and anthropological theories, this paper will demonstrate how students come to form their professional identity through various experiences and interactions taking place during their training.

Conclusion: To Conclude, This paper argues that a re-engagement with social sciences can Led to a renewed understanding of the processes taking place during post graduate psychiatry training, and ultimately improve it

Prevalence And Characteristics Of Dual Diagnosis Among Patients Admitted To A De-addiction Treatment Facility

Dr. Abhineet Sayal, Prof. Rakesh Lal, Dr. Yatan Pal Singh Balhara, Dr. Siddharth Sarkar

Department Of Psychiatry And National Drug Dependence Treatment Centre, All India Institute Of Medical Sciences, Ansari Nagar, New Delhi. Email Id : [email protected]

Background And Aims: It has been observed that substance use disorders occur more frequently with other psychiatric disorders than expected by chance. The comorbidity of substance use disorders and other psychiatric disorders, referred to as dual diagnosis, has been seldom studied in the indian setting. This study aimed to assess the prevalence and characteristics of dual Diagnosis of patient admitted to a tertiary care de-addiction setting.

Methods: The study is being conducted at the national drug dependence treatment centre, affiliated with AIIMS, new delhi. One hundred and thirty three inpatients admitted for the treatment of substance use disorder would be recruited through 1:2 systematic sampling. The inpatients would be assessed for demographic details and substance use characteristics. The presence of additional psychiatric disorders would be ascertained using mini international neuropsychiatric interview (MINI). Presence of a personality disorder would be assessed using the international personality disorder examination (IPDE).

Results: The prevalence and characteristics of the dual diagnosis patients would be presented at the time of the conference.

Conclusion: Would be discussed at the time of the conference.

Key Words- dual diagnosis,substance use disorder,deaddiction

Common Is ADHD And Alcohol Dependence Syndrome?

Dr. Daniel Saldanha ,Vivek Pratap Singh, Dr. Ekram Goyal Ekram, Dr. Ichpreet Singh, Dr. Vinayak Pathak, Prof. Saldanha D

Department Of Psychiatry, Dr D.Y. Patil Medical College Pimpri, Pune. Email Id : [email protected]

Background: ADHD is the most common childhood disorder with a prevalence of 5-10%. 60% Of them will continue to have clinically significant symptoms of ADHD as adults and the prevalence of adult ADHD is around 2-5%. 25 Percent of patients receiving treatment for alcohol or drug dependence have had adhd in childhood and meet the criteria for an alcohol or drug dependence. We present a case of 24 yr old male who presented to us with alcohol dependence syndrome.

The Case: A detailed history revealed that he was having problem of inattention while he was working at a local firm 12 yrs back. Due to this inattention he was not able to concentrate on his work and used to forget even small things which was told to him like paying bills, to deposit money, to purchase vegetables etc. According to his mother he was very hyperactive, inattentive and impulsive child. These features were first noticed when he was 4 yrs old which lead to frequent change of schools and poor academic performances. His hyper activeness, impulsivity decreased with time but his inattention persisted which led to occupational and social impairment. Being distressed by his inattentive problems he sought refuge in alcohol which eventually increased in amount and led him to become alcohol dependent.

We treated this case as an adult attention deficit hyperactive disorder (inattentive type) with alcohol dependence syndrome. Eventually he showed improvement and remained abstinent completely, his inattention improved along with his abstinence of alcohol he could sustain his job at the local firm.

Discussion: Importance of treating ADHD along with alcohol dependence management in these types of cases will be discussed.

Key Words: Adhd, Alcohol Dependence Syndrome, Adult Adhd

Treatment Gap And Barriers For Depression Care: A Cross Sectional Community Survey In Nepal

Mr. Nagendra Prasad Luitel, Dr. Mark Jd Jordans, Dr. Brandon A, Dr. Sujit D. Rathod, Dr. Ivan H. Komproe

Transcultural Psychosocial Organization (TPO) Nepal. Email Id : [email protected]

Background: Despite numerous prevalence studies in low- and middle-income countries, there has been a lack of research on the gap between the burden of depressive disorders and treatment use. Therefore, the aim of this study was to assess the treatment gap among adults with depressive disorder, and examine possible barriers to initiation and continuation of treatment in nepal. Methods: a three-stage sampling technique was used in the study to select 1,983 adults from 10 village development committees (VDCS) of chitwan district. Presence of depression was identified with validated versions of the patient health questionnaire (phq-9). Barriers to care were assessed with the barriers to access to care evaluation (bace). Results: the prevalence of depression in the sample was 11.3% (N=228). Among those scoring above clinical cut-off thresholds, only 8.1% Had received treatment from any providers in the past 12 months. The major reported barriers to treatment were lacking financial means to afford care, fear of being perceived as weak for having mental health problems, fear of being perceived as crazy, having no one to help in seeking mental health care, and being too unwell to ask for help. Conclusion: barriers to care did not differ based on demographic characteristics such as age, sex, marital status, education, or caste/ethnicity. With more than 90% of the respondents with depression not participating in treatment, it is crucial to identify avenues to promote help seeking and uptake of treatment. Given that demographic characteristics did not influence barriers to care, there is the possibility of pursing general population-wide approaches to promoting service use.

Keywords: Barriers, Depression, Nepal, Treatment Gap

Social Cognition Craving And Mu Wave In Alcohol Dependence

Dr. Deepak Kumar, Prof. Dr. D.Ram, Dr. Sanjay Kumar Munda,

C.I.P., Ranchi. Email Id : [email protected]

Alcohol dependence has been linked to social and cognitive impairments in domain of facial expression, emotional empathy and, generally speaking in social cognition. Mirror neuron system has claimed role in imitation and action understanding. Recently increased mu suppression has been found in smokers to interacting smoking related cues. Relation of mirror neuron activity to empathy and craving is not yet seen in alcohol dependence. We hypothesize that due to cue related craving there might be increased mu suppression to alcohol related movements in alcohol dependence subjects. Alcohol dependence patients (n=40) and healthy controls (n= 40) were administered inter personal reactivity index measuring facets of empathy. Baseline severity of alcohol intake was evaluated by severity of alcohol dependence questionnaire. Penns alcohol craving scale was applied to asses craving in patient group. Both group were shown some still images and videos consisting of three tasks( video clips) containing 1. Hand movement in social situations as movement control. 2. Hand movement related to water as liquid control. 3. Hand movement related to alcohol as experiment study in social and drinking related motions at different levels like pouring, 3rd person offer, cheers, 2nd person offer-action (where subject will offer their hand to direct handshake video). 2 nd person offer-observation(where subject would just watch without acting on it). Each spaced by white noise. Subjects were asked to rate their craving after each video on scale of 0 to 100 ( 0"no craving, 100-maximum craving) during white noise space. Simultaneous geodesic sensor net of 256 channel eeg recording noted for look in the mu wave activity. The spectral power and coherence of the mu for each subtasks were computed using a fast fourier transform. Detail analysis to be shared during conference.

Key Word: Mu Suppression, Craving Fast Fourier Transform

Can Health Privacy Be Disclosed?

Dr. Shobhit Jain, Dr. Ashish Pakhare, Dr. Jai Singh Yadav, Prof. Adya Shanker

Dept. Of Psychiatry, I.M.S., B.H.U., Varanasi. Email Id : [email protected]

Objectives: Maintenance of health privacy have been emphasized since hippocratic era. It helps to build trust and rapport which is important in further treatment of patient. Often health information is requested under right to information act (rti 2005) which jeopardize health privacy and raise dilemma among medical professionals whether to disclose or not. This paper will review the provisions in indian legislation regarding confidentiality of patients information.

Results: All registered medical practitioners in india are bound to code of medical ethics of indian medical council (IMC) which emphasis on health privacy, maintenance and retrieval of medical records. However disclosure may be considered under certain conditions as in the court to the presiding judge, to safeguard serious and identifiable risk to a specific person or community and to public health authorities in case of communicable/notifiable diseases. All patients have right to review their records as per provision in imc, rti and consumer protection act. But also RTI act exempts disclosure of information under special conditions which shall be discussed during presentation. This paper will also discuss interesting cases and orders passed by central information commission and state information commission in this regard.

Conclusion: The paper will help medical professionals to deal with such medico-legal case with due ethical consideration. Decision to disclose the information must always be taken in best interest of patient, if overweighing the public interest.

Key Words-medico-legal case, ethical consideration,health privacy

A Cross Sectional Study Of Caregiver Burden And Knowledge Among Attendents Of Mental Ill Patients

Dr. Y. Jayakrishna , Dr. M. Gireesh Kumar

Osmania Medical College, Hyderabad. Email Id : [email protected]

Introduction: Indian families shows tremendous resilience for mental ill patients. They experience a lot of physical and emotional distress, burden as the consequences for those in close contact with severely ill psychiatric patients. Burden refers to the presence of problems, difficulties or adverse events that affects the lives of psychiatric patients. There is a distinction of subjective and objective burden.

Objective Burden-physical burden is used in reference to the physical burden of care consequent to the behavioural change of mental ill individuals and social effect on care givers daily life such as changes in family relations, employment and health.

Subjective Burdens refer to emotional reaction of care giver including perception of strain, reduced morale, anxiety and depression.

Family burden is an important research area in developing country like india.

Knowledge of attendants about mental illness is an important aspect in psycho education. It improves the coping mechanism and affects the burden of family .Knowledge decreases the stigma about the mental illness.


1. To Assess Burden In Caregiver Of Mental Ill Patients

2. To Assess Knowledge About Mental Illness Among Attendants Of Mentally Ill Patients

Materials And Methods: Inpatients of institute of mental health, sample size 45; including males and females of rural and urban background,

Burden Assessment Scale

Knowledge Questionnare

Study Design: Cross sectional study

Results And Conclusion: Will be discussed at the time of presentation as we have not analyzed the data

Key Words: Care Giver Burden, Knowledge, Psychiatric Patients.

Socio Demographic Profile Of Attempted Suicide Cases From A Rural Agrarian Community (farmer V/s Non Farmer)

Dr. Kshirod Kumar Mishra, Prof. Dr Kk Mishra, Dr. Kanika Kumar, Dr. Vinay Kumar, Dr. Girish Agarwal

Department Of Psychiatry, J.N.M.C., Wardha. Email Id : [email protected]

Background: Attempted suicides occur 10 -15 times more frequently than completed suicides. It occurs more frequently among the younger population and tends to be higher among men. Factors and mode of suicides attempt have been studied extensively. Stressful life events and precipitating events like interpersonal problems are the common reasons for attempt. In this study we intend to evaluate the socio demographic profile of attempted suicides cases admitted to a rural medical college of central india. We also intend to compare the different factors related to farmer v/s non farmer among these cases of attempted suicide.

Materials And Methods: We evaluated all the cases of attempted suicide admitted and referred for psychiatric evaluation and management in a rural medical college of central india during a period of one year (april 15-march-16). Following initial recovery they were evaluated on a semi-structured proforma on sociodemographic profile, mode of attempt and reason for attempt. Data collected where analyzed using suitable statistical methods.

Results: Total 117 cases were evaluated.Among those only21% of the cases were involved in farming. Male preponderance was observed in the study sample(87 % farmers and 55% non farmers). Pesticide consumption was the commonest mode of attempt among farmers as well as non farmers. Interpersonal conflict in the family was the commonest reason for attempt in the non farmer(56 percent) whereas the commonest reason among farmers was due to debt (38 percent).

Conclusion: There was no gross difference in the reason for attempts among farmers and non farmers from a rural agrarian community.Though the most common reason for attempt among the study sample was interpersonal problems,indebtedness was the commonest reason among farmers.Attempted suicide associated with alcohol dependence and was seen among 30 percent of sample,inspite of study area being a dry district of india

Keywords: Attempted Suicide,rural Agrarian Community, Central India

Study Of Socio Demographic Characteristics And Psychiatric Morbidity In Patients With Chronic Kidney Disease Undergoing Hemodialysis

Dr. Pankaj Kumar, Dr. D.K.Vijayvergia, Dr. Suresh Kumar Parihar

Email Id : [email protected]

Background: Chronic kidney disease (CKD) is a worldwide public health problem, including india. Constant stress caused by not only the disease, but also the development of functional and nutritional limitations, medication side-effects, comorbid chronic diseases, changes in self-perception, and fears of death, predispose these patients to numerous emotional problems including depression and anxiety.

Objectives: To find out sociodemographic characteristics, prevalence of psychiatric illnesses and severity of depression and anxiety disorder in patients with chronic kidney disease undergoing hemodialysis.

Materials And Methods: The sample of study would be constituted of 70 random patients suffering from CKD who underwent dialysis procedure in dialysis unit of New Medical College Hospital, Kota.

All the patients will be evaluated on the specially designed performa to obtain socio-demographic data, those who will be diagnosed as with anxiety and depression will be further evaluated for severity by ham-d and ham-a. Data obtained will be tabulated, analysed & conclusion will be drawn using suitable statistical methods.

Result And Conclusion: Will be discussed at the time of presentation in the light of previous studied.

Key Words : Sociodemographic Characteristics ,psychiatric Morbidity, Chronic Kidney Disease, And Hemodialysis .

Binge Eating/purging Type Anorexia Nervosa- An Eating Disorder

Dr. Sandeep Sekhon

Email Id : [email protected]

Introduction: Anorexia nervosa is an eating disorder characterized by three essential features- persistent energy intake restriction, intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain and a disturbance in self-perceived weight or shape. There are 3 types of presentation- restrictive type, binge eating/purging type, atypical anorexia nervosa.

Case Report: The current case report is a case of 16 Year old adolescent female, student of class 11, hailing from upper middle social class hindu family, living with her parents and a younger brother in Palam, Delhi, presented to our tertiary care centre with complains of gradual loss of weight, recurrent episodes of binges and self induced vomiting, body image distortion from a period of 8 months, menstrual irregularities from 6 months and amenorrhea since 3 months, BMI 14.6 with a probable precipitating factor being her classmates critical comment on her weight. Diagnosis of anorexia nervosa, binge eating/ purging type was made with. A multidisciplinary therapeutic approach with non pharmacological(cognitive behavior therapy, family therapy) and pharmacological(tablet olanzapine and tablet fluoxetine) measures were employed for the management of this case.

Discussion: Binge eating/ purging type of anorexia nervosa is a rare occurrence. The data available for its occurance in indian population is discrete. Thus, this case report is unique as it presents the overview of symptomatology of this rare entity that can be beneficial for the need of early intervention of psychiatric measures by emphasizing the required awareness about this disorder amongst all medical professionals.

Keywords: Anorexia Nervosa, Eating Disorder, BMI, Cognitive Behavior Therapy

A Study Of Escitalopram Add-on On Psychopathology, Cognition And Functioning In Patients With Stable Schizophrenia Having Subsyndromal Depressive Symptoms

Dr. Abhijeet Shrivastava, Dr. Pooja Singh, Prof. Anil Nischal, Prof. Anuradha Nischal, Dr. Bandna Gupta, Dr. Adarsh Tripathi, Dr. Manu Agarwal

King Georges Medical University, Lucknow, U.P. Email Id : [email protected]

Background: Subsyndromal symptoms of depression in patients with schizophrenia are common and clinically important. While many physicians prescribe antidepressants to patients with schizophrenia who have SSD, evidence for their effectiveness and safety has been meager. A randomized placebo-controlled trial of escitalopram in 66 stable patients of schizophrenia was conducted as there is limited research on this area.

Aims: To study the effect of addition of escitalopram on psychopathology, cognition and functioning of patients with stable schizophrenia having SSD and to compare the changes in psychopathology, cognition and functioning of patients in the study group with the placebo control group.

Method: The study was a prospective, 8 week randomized, double blind, placebo controlled trial. Sixty six patients who fulfilled the diagnostic criteria of schizophrenia stable on the basis of the ICD 10 - DCR and adjudged to be clinically stable having panss score < 70 and had ssd with hamd score ? 8 Were recruited into the study. The patients randomly received either escitalopram (10 mg/day) or placebo for 8 weeks. The patients were assessed using the panss, Hamd0 , cdrs0 , sofas0 , scors0 , cgi0 and the adverse event checklists at baseline and week 4 and 8.

Results & Conclusion: The total score of panss as well as the positive symptoms score and negative symptoms score (based on mann-whitney u test) showed significantly greater reduction in the escitalopram group than in the placebo group. Significant reduction in the depressive symptoms was observed in study group than the control group. Functioning and cognition was also found to be significantly better in the escitalopram group than in the placebo group. There was no significant difference between the two groups in terms of observed side effects. Escitalopram showed significant beneficial effect as add-on to usual antipsychotic treatment in patients of stable schizophrenia having ssd.

Keywords: Escitalopram, Schizophrenia, Subsyndromal Symptomatic Depression.

A Study Of Psychiatric Morbidity Among The Adolescent Students Attending Professional Examination Coaching

Dr. Krishan Kumar Sharma, Prof. Mahendra Jain, Dr. Gourav Chandravanshi

Department Of Psychiatry, J.L.N. Medical College, Ajmer. Email Id : [email protected]

Introduction: Around 20% of world adolescents have mental health problems. Depression is the common contributor for the same among 15-19 year age group, and suicide is one of the three leading causes of mortality among people aged 15-35 group. The prevalence of mental problems in adolescents has increased in the past 20-30 years; it is mainly attributed to disrupted family structures, families unrealistic educational and vocational aspirations from adolescents. Mental health problems among adolescents carry high social and economic costs, as they often develop into more disabling conditions later in life. Aim of our study is to find out psychiatric morbidity among the adolescent students attending professional examination coaching.

Materials And Methods: It is a cross sectional study which included 110 students attending professional examination coaching. To enter in the study, patient was screened with a specially designed screening performa, which encompassed the entire exclusion criteria, followed by application of various neuropsychological tests applied.They were assessed on GHQ 12 and the Hamilton anxiety rating scale (HARS) Montgomery- Asberg depression rating scale (MADRS) for the purpose of meeting the above aims and objectives.

Result: Appropriate statistical analysis was used for analysis the data using microsoft excel and we found that 30 % of student the study group had psychiatry morbidity and most common psychiatry disorder was depressive disorder followed by GAD.

Conclusion: School mental health program should be carried out to help the identified case along with proper guidance.

Key Word: Psychiatric Morbidity, Adolescence, Coaching Students

Study Of Academic Patterns In Newly Admitted Patients Of Schizophrenia In Psychiatry Ward

Dr. Amit Kautik Sonawane, Prof. Dr Vivek Kirpekar, Prof. Dr Sudhir Bhave, Dr. Rahul Tadke, Dr. Sushil Gawande, Dr. Abhijeet Faye

NKP Salve Institute Of Medical Sciences And Lata Mangeshkar Hospital, Nagpur. Email Id : [email protected]

Background: Cognitive impairment is one of the core features of schizophrenia. Studies have shown that cognition may be affected even before the appearance of psychotic symptoms. Also there is evidence of accelerated brain aging in schizophrenia. The effects of cognitive impairment may reflect in the academic and professional domains. Thus the present study was carried out to assess the extent and severity of academic difficulties in patients with schizophrenia.

Methodology: The present study was carried out in patients with schizophrenia (ICD-10) admitted in psychiatry ward. 40 Patients participated in study. The study protocol was approved by institutional ethics committee. Each participant was individually interviewed along a semi-structured proforma prepared for the study which included socio-demographic, clinical, psychiatric and academic profile questionnaire. BPRS rating scale was administered. Data thus collected was statistically analyzed and conclusions were drawn.

Results And Discussion: Mean age of participants was 33.75 Years with 60% females, predominantly urban, unemployed, married. Mean duration of illness 6.91 Years, predominantly paranoid schizophrenia. Mean BPRS score was 59.8 (SD-7.06). 22% Educated till primary, 65% till higher secondary and 15% till graduation and above. Marathi and hindi was the medium of education in majority of patients. 42% said they had completed their education. More than 2/3rd reported they faced difficulties during education like fear of examinations, failure and difficulty in concentration. Science and Mathematics were reported as difficult subjects by majority of them. 42% could not complete education properly due to factors related to illness and finances and 1/3rd of them said given a chance they would like to study further. 61% Of them received some vocational training.

Conclusion: Marked academic difficulties are faced by patients with schizophrenia in various aspects of education. Prompt intervention and vocational guidance can help in reducing disabilities in them.

Keywords: Schizophrenia, Academic Patterns, Vocational Guidance.

A Cross Sectional Study On Prevalence And Pattern Of Internet Addiction Among Medical Students

Dr. Deeptanshu Hanu Agarwal, Prof. Anju Agarwal, Prof. S.b. Gupta, Prof. Ajay Kohli

Eras Lucknow Medical College, Lucknow. Email Id : [email protected]

Background: In tandem with the splurge in access to internet globally, with the rise of new generation gadgets, the risk of internet addiction is emerging as a significant behavioral addiction pandemic to be tackled worldwide. In the new generation, the internet has become an important tool for education, entertainment, communication, and information-sharing. Easy access and social networking are two of the several aspects of the internet fostering addictive behavior. There is an urgent need to recognize and respond to the reality of internet addiction and the threat of its rapid expansion.

Aims And Objectives: To assess the prevalence and various patterns and risk factors associated with the internet addiction among the medical students at eras lucknow medical college.

Material And Methods: This is a cross sectional study with sample size of 500 plus medical students of the eras lucknow medical college, conducted for a period of 6 months at eras lucknow medical college amounting of a sample size of 500 plus medical students aged 17-25 yrs of both genders and using internet over time period of 1 year atleast. A semi-structured proforma for socio-demographic details and internet usage will be applied along with the youngs internet addiction test (IAT). Youngs iat is a 20 item, 6 point likert scale with scores ranging from 0 to 5 for each item, which measures the severity of self-reported compulsive use of the internet. Iat were applied to assess severity of internet addiction. We will also assess various patterns and risk factors associated with the internet addiction.

Results: They will be shared at the time of presentation

Key Words-internet addiction,medical students,rapid expansion

Myths, Beliefs And Perceptions About Mental Disorders Among Caregivers Of Persons With Mental Illness

Dr. Shalini Chaubey, Prof. Anju Agarwal, Prof. A.Q. Jilani, Prof. Ajay Kohli

Eras Luck Now Medical College, Lucknow. Email Id : [email protected]

Background; Mental illness is associated with various myths and misconceptions leading to stigma and discrimination towards patients. These beliefs highly influence the attitude and health seeking behaviour of the caregivers of patients with mental illness. Care and support from caregivers during periods of mental illness are critical for people with mental illness. Therefore this study was aimed to assess the various myths and beliefs and perceptions about mental disorders among the caregivers of persons with mental illness.

Methodology: This is a cross sectional descriptive study with sample size of 150 caregivers of mentally ill patients attending adult psychiatry opd of a tertiary health care centre, in northern india. A structured questionnaire was used to assess various myths, beliefs and perceptions regarding mental disorders among the caregivers.

Results: Results will be declared at the time of presentation

Key Words: Myths, Beliefs And Misconceptions, Mental Illness, Stigma, Caregivers.

Comorbidity Of BPAD With OCD: A Case Report

Dr. Harihar Chilukuri

Katuri Medical College. Email Id : [email protected]

Background/introduction: Comorbidity of obsessive compulsive disorder (ocd) with bipolar affective disorder (BPAD) has been reported frequently in the western literature mostly on the children and adolescents. In india, there have just been a few case reports on such a co-morbidity. Management of such cases poses special problems as the drugs used for ocd tend to worsen mania in cases of BPAD, or can cause a manic switch in bpad (depressed type). Hence, management of a case of bpad with ocd is reported here.

Methodology/ Materials And Methods: A 57 year old male with an anankastic premorbid personality who has been suffering from BPAD since 2002 reported to us for a severe depressive episode on 02 september 2016. So far, he had nine episodes of mania and two depressive episodes prior to this episode. Current episode started with obsessions of sexual thoughts since april 2016 with consequent guilt feelings leading to suicidal ideation. Before he came to us, he had received a course of modified electroconvulsive therapy besides divalproex sodium. He has been treated with oral lithium, divalproex sodium and quetiapine. Fluoxetine 20 mg per day was added for his ocd and increased to 40 mg per day after two weeks.

Results: His depression began improving satisfactorily though his obsessive symptoms improved much slower. There was no manic switch.

Conclusion: Extra care is needed in managing comorbid cases of BPAD and ocd in view of the risk of a manic switch while treating them with anti-obsessive drugs. Addition of lithium is an effective option in controlling suicidal ideation in bpad. Assiduous monitoring is required while treating the ocd symptoms with drugs, watching closely for emergence of any manic symptoms. Management of such comorbidity is thus a challenge to our professional diligence and competency.

Key Words: Comorbidity, BPAD, OCD.

Self-efficacy, Emotional Regulation And Perception Of Life Among Prisoners

Mrs. Sandamita Choudhury, Dr. Rejani. T.g, Ms Shubham Thukral

Mind India, Institute Of Positive Mental Health And Research. Email Id : [email protected]

Introduction: The Indian prison system which houses both the under trials and convicts offers a complex range of experiences to its inmates. While there are dark aspects to prisons, there also lies positive aspects and teachings which has a role in giving better lives and personal growth through the activities. Prior studies have documented that prisons are emotionally fraught places where successful adaptation depends on the prisoners abilities to calibrate their emotional expressions and deal effectively with the challenges. Also efficacy beliefs influences whether people think pessimistically or optimistically. Therefore, the present study aims to understand the effect of socio demographic variables and self efficacy on the emotional regulation and perception of life.

Methodology: For the purpose, total of 49 participants comprising both male and female were selected from Sabarmati central jail, Ahmedabad using purposive sampling. Assessment tools used includes: the general self-efficacy scale, life orientation test-r (LOT-R), and emotion regulation questionnaire (ERQ).

Results: Data would be analyzed using appropriate statistical procedures and will be discussed with relevant literature.

Conclusion: The study will be highlighting the emotional aspects and perception of self and the world among the prisoners who are often seen with a negative connotation attached to their name.

Keywords: Emotional regulation, self efficacy, optimism, pessimism.

A Cross Sectional Study On Prevalence And Pattern Of Internet Addiction Among Medical Students

Dr. Deeptanshu Hanu Agarwal, Prof. Anju Agarwal, Prof. S.B. Gupta, Prof. Ajay Kohli

Eras Lucknow Medical College, Lucknow. Email Id : [email protected]

Background: In tandem with the splurge in access to internet globally, with the rise of new generation gadgets, the risk of internet addiction is emerging as a significant behavioral addiction pandemic to be tackled worldwide. In the new generation, the internet has become an important tool for education, entertainment, communication, and information-sharing. Easy access and social networking are two of the several aspects of the internet fostering addictive behavior. There is an urgent need to recognize and respond to the reality of internet addiction and the threat of its rapid expansion.

Aims And Objectives: To assess the prevalence and various patterns and risk factors associated with the internet addiction among the medical students at eras lucknow medical college.

Material And Methods: This is a cross sectional study with sample size of 500 plus medical students of the eras lucknow medical college, conducted for a period of 6 months at eras lucknow medical college amounting of a sample size of 500 plus medical students aged 17-25 yrs of both genders and using internet over time period of 1 year atleast. A semi-structured proforma for socio-demographic details and internet usage will be applied along with the youngs internet addiction test (iat). Youngs iat is a 20 item, 6 point likert scale with scores ranging from 0 to 5 for each item, which measures the severity of self-reported compulsive use of the internet. Iat were applied to assess severity of internet addiction. We will also assess various patterns and risk factors associated with the internet addiction.

Results: They will be shared at the time of presentation

Keywords: Internet Addiction, Youngs Internet Addiction Test, Medical Students

Long-term Effectiveness Of Standardized Drug-treatment Training On Participant Knowledge - A 12- Month Follow-up Study

Dr. Swati Kedia Dr. Ravindra Rao, Dr. Swati Kedia, Dr. Atul Ambekar, Dr. Alok Agrawal, Prof. Sudhir Khandelwal

All India Institute Of Medical Sciences. Email Id : [email protected]

Background: Opioid substitution therapy (OST) is highly effective in reducing illicit opiate use and preventing HIV transmission, overdose deaths and criminal behaviours. However, a meagre number of injecting drug users receive ost in developing countries like india. To improve quality of treatment services, national drug dependence treatment centre, AIIMS in collaboration with national aids control organization, has been conducting trainings for ost centres established in India. This study aimed to assess whether service providers who receive these trainings retain their knowledge over long term.

Methodology: OST trainings are conducted using standardized NDDTC training module and participants comprise a mixed-group including all cadres of ost centre. The training programmes include 5-day induction training and 3-day refresher training usually separated by an interval of few months. In all trainings, each participant is administered a 20-item questionnaire consisting of mcqs covering clinical and operational aspects of ost implementation, before and after the training. We analysed pre- and post-test data from participants (n= 103) who attended both induction and refresher trainings between 2012 and 2015.

Results: Mean age of the participants was 36.8 Years (sd: 8.9); 66% Were females (n=68). The cadre-wise break-up was: 25.2% Doctors, 35.9% Nurses, and 38.8% Counsellors. The refresher trainings were conducted after a median period of 12 months (iqr: 1, 42). The mean scores were: induction pre-test 8.5 (Sd: 2.9), Induction post-test 13.2 (Sd: 4.0), Refresher pre-test 12.2 (Sd: 3.3), Refresher post-test 14.6 (Sd: 3.0). Cadre-wise paired t-test showed that for all cadres, induction post-test scores were significantly higher than induction pre-test scores (p<0.0001). No significant difference was observed between induction post-test scores and refresher pre-test scores.

Conclusions: Service providers working in ost centres are able to retain ost-related knowledge gained after attending five-day training on ost till 12 months.

Keywords: Opioid Substitution Therapy, Training, Injecting Drug Users

Study Of Psychiatric Comorbidity In Patients With Vascular Headache Using A Short Structured Clinical Interview In A Psychiatric Opd Of A Tertiary Teaching Hospital In Western India

Dr. Nimish Gupta, Dr. Vivek Kumar

Subharti Medical College, Meerut, U.P. Email Id : [email protected]

Background/introduction: The comorbidity of headache and psychiatric disorders is a well-recognized clinical phenomenon warranting further systematic research. When present, psychiatric comorbidity complicates headache management and portends a poorer prognosis for headache treatment. The relationship between migraine and psychiatric disorders remains of growing interest to headache researchers and clinicians alike. Identifying and managing comorbid illness is essential and can prove challenging in the treatment of patients with migraine.

Methodology/ Materials And Methods: The cross sectional study was done at the psychiatry opd in the department of psychiatry at Subharti Medical College, Meerut. A total of 20 patients with newly diagnosed migraine were included in the study. Demographic and clinical profiles of these patients were noted in a specially designed socio-demographic and clinical data sheets prepared for the present study. The structured clinical interview for dsm-iv axis i disorders (scid-i) was applied to the patients to diagnose any axis 1 psychiatric disorders and were also clinically correlated as per international classification of diseases 10. Simple statistical procedures like frequency, percentages,˜t-tests and chi-square tests were used for analysis of data thus obtained.

Results: Will Be Discussed At The Time Of Presentation.

Conclusion: Will Be Discussed At The Time Of Presentation.

Key Words-Headache, migraine, psyciatric disoreder

Sexual Attitude And Myths Among Medical Students

Dr. Brahmani

Dantala raghuram Macharapu, Pramod Kr Mallepalli, Ravulapati Sateesh Babu. Email Id : [email protected]

Introduction: Sexual attitudes,myths and knowledge of the Indian society are undergoing a gradual transformation over the recent decades.Very few studies have investigated sexual attitudes and myths in india. There is a need to improve the attitudes of adolescent students towards sexual intercourse and provide an opportunity to evaluate the effectiveness of educational interventions.

Aim: The present study was planned in order to assess the prevalence of sexual knowledge and myths among medical student groups.

Materials And Methods: The present study was conducted under the guidance of department of psychiatry, Mamata Medical College, Khammam. 300 Students of Mamata Medical College, Khammam, were involved in this study with their consent. The students were assessed using eysenck sex attitude questionnaire and sex myth checklist

Results: Medical students from the clinical year were more knowledgeable on sex as they learned and had greater exposure to sexual health than preclinical year students. This study also found less sexual myths in the medical students.

Conclusion: As expected students expressed a conservative attitude towards controversial sexual issues.Gender and religiosity plays important role in determining students attitude on these issues. Students would benefit from courses on sexuality to prepare them for challenging lives as medical practitioners who must be able to manage issues on sexuality in a holistic and balanced manner.

Keywords-sexual attitude, myths, medical practioners

Stress And Sexual Satisfaction Among Spouses Of Male Patients With Bipolar Disorder: A Cross-sectional Study

Dr. Sanchari Mukhopadhyay, Prof. Dinesh Kataria

Department Of Psychiatry And Drug De-addiction Centre, Lady Hardinge Medical College. Email Id : [email protected]

Introduction: Spouses of patients with bipolar affective disorder (BPAD) experience substantial amount of stress. Stress has been associated with lower degree of sexual satisfaction. Few studies have examined stress among and its relationship with sexual satisfaction in spouses of patients with BPAD. We attempted to bridge this knowledge gap.

Methods: Spouses of twenty-five male patients with bpad were interviewed using the perceived stress scale-10 (pss-10) and sexuality scale (ss) to determine the levels of stress and degree of sexual satisfaction respectively. Socio-demographic data and data regarding the illness and marriage duration were also collected for analysis.

Results: Average age of spouses was 34.08 Β± 7.62 Years. The average duration of illness was 113β± 88.03 Months with a maximum of 360 months and a minimum of 3 months. The average duration spouses spent in caregiving was 96.78Β±70.08 Months with a maximum of 240 and minimum of 3 months. Pearson correlation coefficient between ss and pss scores was -0.49 Indicating moderate level of relationship of sexual satisfaction with stress. Pearson correlation coefficients between duration of illness and duration of caregiving was -0.38 And -0.35 Indicating increasing duration of illness decreased levels of stress.

Conclusions: Spouses of male patients with BPAD who undergo considerable stress have lower levels of sexual satisfaction. However, they seemed to cope better with increasing duration of illness. Physicians must interview and offer interventions in this population, if required.

Keywords-stress, sexual satisfaction, bipolar disorder

Childhood Schizophrenia. Does Early Diagnosis And Management Offers Hope?

Dr. Daniel Saldanha, Dr. Ichpreet Singh, Dr. Vivek Pratap Singh, Dr. Ekram Goyal, Dr. Vinayak Pathak, Prof. Saldanha D, Prajakta Patkar

Department Of Psychiatry, Dr D Y Patil Medical College, Pimpri, Pune 411018. Email Id : [email protected]

Background: Autism spectrum disorder (ASD) and childhood onset schizophrenia (cos) are paediatric neurodevelopment disorders thought to share an underlying genetic makeup. Childhood onset schizophrenia (cos) is a relatively rare disorder, affecting 1 in 10,000 30,000 children. The diagnostic criteria are the same as in adult onset schizophrenia, including the presence of positive and/or negative symptoms, but with onset occurring prior to the 13th birthday. Despite clinical heterogeneity, cos typically presents with psychotic symptoms after age seven, and is associated with a more severe course and poorer outcomes as compared to adult onset schizophrenia .We present a case of childhood schizophrenia of very early onset.

The Case: An 11 years old female child was brought to the psychiatric outpatient department with catatonic symptoms along with history of withdrawn behavior of 8-10 days. After initial management under conventional lines for two days her catatonic symptoms resolved. She later revealed auditory hallucinations and frequent crying spells as well. There was no family history of mental illness. All clinical investigations including imaging were within normal limits. She was started on antipsychotics adequate to her age. She showed remarkable improvement and is maintaining well on treatment and is being followed up regularly.

Discussion: The case will be discussed in the light of available literature as the symptoms had started insidiously at such an early age (less than 13 years) which is quite uncommon and rare.

Key Words: Autism Spectrum Disorder (asd), Childhood Onset Schizophrenia (cos), Paediatric Neurodevelopment Disorders.

Personality Characteristics And Quality Of Life Of Patient With Psoriasis

Dr. Brajesh Kumar Mahawar, Prof. Dr. Devendra Vijayvagiya, Prof. Dr. D.k. Sharma

Government Medical Hospital, Kota. Email Id : [email protected]

Background: Psoriasis is a chronic, inflammatory, painful and disfiguring skin disease. Person living with psoriasis poses problem for the individual concerned with physical, psychological, social functioning and daily living activities. It is linked with social stigmatization, discomfort, physical disability and profound impact on quality of life of patients. The aim of this study was to evaluate personality characteristics and quality of life in patient with psoriasis.

Methods And Materials: 100 consecutive patients diagnosed as suffering from psoriasis by consultant dermatologist attending dermatology opd at department of dermatology in tertiary care center in rajasthan were taken up for study and 100 normal subjects preferably the relatives of the patients were constituted the control group.

Tools: 3 tools were used to collect data, (1) semi structured proforma include sociodemographic characteristics of the study subjects (2) eysencks pen inventory (3) who quality of life bref scale

Results: The data were analyzed with appropriate statistical test. In our study personality characteristics were evaluated by administering of pen inventory, the study population was more introverted (54%) than control group (14%) and control group had higher score for extraversion (58%) than study group (28%). On whoqol-bref scale patients with psoriasis had poorer quality of life in all four domains than control group.

Conclusion: Β the psoriasis patients are more neurotic and introverted and poorer quality of life than the control group.

Keywords: Quality Of Life, Psoriasis, Personality Characteristics.

Is It Difficult To Manage Depression In A Hypertensive Patient?

Dr. Daniel Saldanha, Dr. Vivek Pratap Singh, Ichpreet Singh, Dr. Prajakta Patkar, Dr. Ekram Goyal, Prof. Saldanha D

Dept Of Psychiatry, Dr D Y Patil Medical College, Pimpri, Pune. 411018. Email Id : [email protected]

Background: Addressing depression in hypertensive patients and hypertension in depressed patients is a complex issue that has drawn attention of many researchers over a number of decades and it is not uncommon to find hypertensive patients presenting to psychiatric outpatient with depressed symptoms. Published reports do describe higher hypertension levels, hypotension and circadian variation abnormalities in depressed patients. Several causative factors have been proposed to explain this association.I.E autonomic nervous system dysfunction and more recently, genetic influences. Detection of depression by primary care physicians, and early adequate treatment improves quality of life and lessen the complications of hypertension. Caution has to be exercised to minimize the side effects of antidepressants on hypertension. We present a case of depression to highlight the importance of early diagnosis and management.

The Case: 45 yrs old male who presented to psychiatric outpatient with complaints of low mood, apprehension, decreased interest in daily activities, decreased sleep and appetite of 4 months duration. Past history revealed hypertension on poor control. He was diagnosed as a case of moderate depression both clinically and on ham-d and started him on antidepressant medication (SSRIS) .After a month of antidepressants and control of hypertension with anti- hypertensives he improved remarkably. His dose of antihypertensive medication also decreased over time.

Discussion: Depression has a prevalence of 4.8% To 8.6% In primary care settings. At a prevalence of 30.1%, Hypertension is a common health problem. There is considerable evidence to suggest that hyper reactivity of the sympathetic nervous system and genetic influences are the underlying mechanisms in the relationship between depression and hypertension. It is reasonable to consider depression in hypertensive patients (and hypertension in depressive patients) to decrease the cardiovascular morbidity and mortality in patients suffering from co morbid hypertension.

Key Words: Depression, Hypertension, Autonomic Nervous System

A Study Of Correlation Of Neurological Soft Signs In Schizophrenia With Sociodemographic And Clinical Variables

Dr. Rupa Gohain, Prof. H.R.Phookun

Department Of Psychiatry; Gauhati Medical College And Hospital, Gauhati. Email Id : [email protected]

Introduction: Endophenotypes is an emerging concept in the search for more valid and scientific psychiatric diagnostic system .Neurological soft signs have been proposed as potential endophenotype for schizophrenia. For a biological marker to be established as an endophenotype, it needs to fullfill the criteria of familial association (i.E, it should be heritable,cosegregate with the illness) and be a trait marker, (i.E it should be independent of sociodemographic and clinical variables.) . The above characteristics also need to be demonstrated across diverse ethnic groups and geographical location.

Aim Of The Study: To assess correlation of mean neurological soft signs (NSS) score in schizophrenia with sociodemographic and clinical variables.

Methodology: A self designed proforma and the heidelberg manual for assessment of neurological soft signs was administered to 30 patients of schizophrenia attending opd of department of psychiatry to collect sociodemographic and clinical data and assess for neurological soft sign (NSS) score. Appropriate statistical methods were used to study the correlation between the mean nss score and various sociodemographic and clinical variables.

Results: No significant correlation of neurological soft signs (nss) was found with age, sex, marital status, place of residence, duration of illness and positive/negative symptomatology.

Significant negative correlation was found between NSS and education.

Conclusion: Further researches are required with properly adjusted controls to confirm the correlation obtained between nss and different variables.

Key Words: Endophenotypes, Neurological Soft Signs, Schizophrenia, Trait Markers

A Study Of Psychiatric Comorbidity Among Silicosis Patients

Dr. Mahipal Singh, Prof. D. K. Vijayvergia, Dr. Rajendra Singh Rathore, Dr. Suresh Kumar Parihar, Dr. Pankaj Tandon, Dr. Rajmal Meena, Dr. Mayuresh Bodliya

Pg Resident, Deptt. Of Psychiatry, GMC, Kota. Email Id : [email protected]

Background: Silicosis is a long-term fibrosing and irreversible lung disease caused by inhaling large amounts of crystalline silica dust, usually over many years. There is an influence of the functional capacity and subjective well ­being and significant stress in patients with silicosis.

The Aims Of This Study Are To Evaluate The Influence Of The Disease On the patients mental state in term of anxiety & depression, so that we provide the scientific basis for further intervention measures, and improve their mental health status.

Materials And Methods: A cross sectional study was carried out among 50 silicosis patients who came to opd of department of respiratory medicine, govt. Medical college kota selected by simple random sampling. The data were collected by inter personal interviews using a semi-structured performa for socio-demographical data , goldbergs health questionnaire-12 (ghq-12), hamilton rating scale for anxiety (ham-a) and beck depression inventory and have been tabulated and analyzed using suitable statistics.

Results And Conclusion: Will be discussed at the time of presentation in the light of previous studies.

Key Words: Silicosis, Anxiety, Depression,ghq-12.

Rising Suicide In Medical Aspirants: Students Reflection Of Causes And Possible Solutions

Dr. Naresh Nebhinani, Mrs Mamta, AIIMS, Jodhpur

Email Id : [email protected]

Objectives; Youth suicide is rising among medical aspirants. To understand this rise and possible way out index study was planned among students pursuing mbbs.

Methods: After obtaining informed consent 243 medical students recruited through convenient sampling from mbbs first, second, third year at aiims jodhpur. Students were asked to about possible factors and solutions for rising youth suicide among medical aspirants.

Results: Assessment through think-pair-share technique highlighted various student related, coaching/institutional, family and other factors associated with rising youth suicide among medical aspirants. They have also suggested following solutions to prevent youth suicide: skill building (like training for communication skills, stress management skills); to handle their loneliness, adjustment issues, high expectations, parental and peer pressure; to address high demand but lesser medical seats, rising expenses for coaching, poor teacher to student ratio; to stop segregation of students on the basis of low vs. High performance; to formulate fair exit policy/refund, regulation for coaching institutions; and to add facility of counselors and mentors.

Conclusion: Medical students reflection about causes and possible solutions for rising youth suicide among medical aspirants is important for planning effective, multidisciplinary intervention plan.

Key Words: Youth, Suicide, Prevention, India

Mindfulness Based Cognitive Therapy (mbct) For Depression: A Case Report

Dr. Naresh Nebhinani, AIIMS, Jodhpur

Email Id : [email protected]

Background & Objectives: Major depressive disorder is the second leading cause of disability worldwide, but a significant proportion of subjects dont achieve complete remission with antidepressant therapy. This emphasizes the important role of psychotherapies and combined treatment. Mindfulness based cognitive behavior therapy (mbct) is a new technique with promising results.

Case Details: Ms. Z, 30 year, diploma, single, female, from jodhpur, presented with 11 years history of episodic depression (2-3 episodes in a year, every episode for nearly 2 months, with in between complete remission for 2-3 months). Background stressors were mothers illness (psychosis), Parental discord, maltreatment by step mother and later adopted by a socialite at the age of 10 year. Diagnosis of recurrent depressive disorder, moderate episode, and hypovitaminosis d was made (vitamin d- 14 ng/ml).

She was prescribed t. Escitalopram 10 mg, hiked to 20 mg/day, later added t. Agomelatine 25 mg hs, hiked to 50 mg later, as depressive symptoms were not improving with monotherapy and sadness was reported frequently. T. Zolpidem 10 mg was given for sleep, along with vitamin d & multivitamin supplementation. In view of earlier treatment with various antidepressants with minimal improvement, at first contact we have discussed rationale of non-pharmacological management. We have taken psychoeduction sessions for patient and family, advised for daily yoga, meditation and brisk walk. After further exploration we have started mindfulness based cognitive behavior therapy. She has followed up for 15 times in last 1 year, with 10 sessions of psychotherapy, and now maintaining well for last 8 months with significant improvement in mood, functionality, and overall interaction.

Conclusions: Mindfulness based cognitive behavior therapy with antidepressants have shown good outcome in index case. It calls for psychiatrists awareness and expertise in field of mindfulness based therapies.

Key Words: Mindfulness Based Cognitive Therapy, MBCT, Depression

Long Term Efficacy Of Brain Spect Assisted Repetitive Transcranial Magnetic Stimulation (rtms) In Treatment Resistant Major Depressive Disorder- One Year Follow-up Study

Dr. Shailesh Jha Prof. Rakesh Chadda Prof. Nand Kumar, Prof. C.S.Ba

Department Of Nuclear Medicine, AIIMS, New Delhi. Email Id : [email protected]

Background: Several studies have assessed the acute antidepressant effects of repetitive transcranial magnetic stimulation (RTMS), and many have revealed positive results. The efficacy of rtms has been poorly investigated in the long-term. The present follow-up study was aimed to assess the long-term efficacy of brain single-photon emission computed tomography (spect) assisted rtms on treatment in patients with treatment resistant major depressive disorder (MDD).

Methods: After the completion of acute trial with twenty sessions of rtms administered to 20 patients with treatment resistant mdd, the patients in each group i and ii (based on brain spect findings) ) entered a naturalistic follow-up for one year. The patients were evaluated two times with the standardized instruments i.e; After six months and one year. The subjects were continued on their antidepressant medications as usual.

Results: Patients in the group i showed a better response as compared to those in group ii, as shown by higher reduction in scores on MADRS, BDI and CGI. No long term complication were noticed.

Limitations: Small sample size, drop outs and non-controlled design. All patients were receiving the standard antidepressant therapy.

Conclusion: This prospective study found that administration of rtms with enhanced protocol including specified site of stimulation has better clinical outcome and long term efficacy compared to the standard protocol. The immediate remission is predictive of sustained benefit after 1 year. Larger controlled studies are needed to confirm present preliminary findings.

Key Words: Long Term Efficacy, Treatment Resistant Depression, Brain Spect, Rtms

Role of Add On Bethanechol With Clozapine Rechallenge In Clozapine Induced Gastrointestinal Hypomotility

Dr. Shailesh Jha, Dr. Pankaj Kumar , Dr. Amit Garg

Assistant Professor, Department Of Psychiatry,IHBAS, Delhi. Email Id : [email protected]

Introduction: Clozapine is considered the most effective antipsychotic. However, its side effects profile can limit its use to resistant cases and not as first line. Clozapine induced gastrointestinal hypomotility though rare but with serious outcome or even death which further warrants clinician for cessation of therapy.

Method: This is a prospective study on six selected cases of treatment resistant schizophrenia on clozapine with emergent complaints of constipation. The clozapine optimization was based on recommended guidelines. Patients were monitored for their blood counts and detailed physical examinations.

Results: The mean duration for developing constipation on starting clozapine therapy was 16 (sd=3) days. The criteria for CIGH on abdominal girth measure was increase by >15 cm. There was single death cigh leading to bowel rupture within 3months of clozapine initiation.

Conclusion: The role of cholinergic drugs in managing anticholinergic side effects seems promising. This study highlights the dreaded outcome of clozapine induced gastrointestinal hypomotility leading to bowel rupture followed by death and in others the potential role of add on bethanechol with clozapine rechallenge in case of clozapine induced gastrointestinal hypomotility syndrome.

Key Words: Clozapine, Gastrointestinal Hypomotility, Bethanechol.

Problematic Internet Use And Its Association With Impulsivity And Anxiety-depression Among College Students

Dr. Anantprakash Saraf, Dr. Dr. Kangkan Pathak

Deptt Of Psychiatry, LGBRIMH, Tezpur Assam. Email Id : [email protected]

Background: Problematic internet use is modelled on the lines of substance abuse and impulse control disorder and impulsivity is considered to be significant risk factor for it. Hence it is worthy and necessary to find association between problematic internet use and impulsivity in indian setting, so that the future studies of causal relationship could be planned; and persons suffering from problems can be helped; also preventive measures can be planned for people at risk.

Methodology: 460 students from 4 educational institutes of tezpur were selected by purposive sampling, after taking requisite permission from respective college authorities and written consent from students. Socio-demographic data sheet, patterns of internet use questionnaire; along with self-administered scales; youngs internet addiction test, barrats impulsiveness scale (bis-11), self-reporting questionnaire, AUDIT, FTND and DAST-10 were distributed and later collected.

Results: Sample was almost equally distributed among male and female students; also among undergraduates and postgraduates of four major streams, namely medicine, sciences, humanities and commerce. Predominant device of access was smartphone (81.5%); Mode was 3g (40.9%); Time was night (63.3%); Place was hostel (63.9%). 43.5% Reported using internet as first activity after waking up. Average age at first use was 15 yrs.; Average daily usage 4-5 hours; average duration of sessions 45 minutes. Top three uses were instant messaging (42%), social networking (25.9%) And entertainment (9.8%). According to youngs criteria, 55.7% Were at risk, while 0.4% Were internet addicted. Significant (p<0.01) Correlation (pearsons) was found between scores of youngs internet addiction test and bis-11 and srq; also with stream of study and using internet as first activity after waking up.

Conclusion: Although prevalence problematic internet use is less than 1% in indian students, almost half of them are at risk of developing problems. Also interventions targeting impulsivity will help to manage such cases.

Key Words-internet use, anxiety-depression, college students

A Study Of Tele-psychiatrist Assisted Program For Integration Of Psychiatric Care At Primary Care

Dr. Kiran B R ,Dr. N Manjunatha, Dr. H N Shashidhara, Dr. Rajani Parthasarathy, Dr. C Naveen Kumar, Dr. Suresh Bada Math, Prof. Jagadisha Thirthalli, Prof. Mathew Varghese

Department Of Psychiatry, National Institute Of Mental Health And Neurosciences(nimhans), Bangaloru. Email Id : [email protected]

Background: There are various attempts to integrate psychiatry to primary care for last 2-3 decades. Manochaitanya program is one of classic example (Manjunatha & Singh, 2006). However there is a need for an innovative training program for primary care physicians (pcp) which may be using telemedicine technology (manjunatha & chaturvedi, press).

The community psychiatry team, nimhans has been conducting extension clinic (termed as camps) to deliver psychiatric care at maddur taluk hospital once a month for more than 3 decades (burns, 1998). After integrating with Manochaitanya program, two doctors from primary health centre joined this team where these doctors are posted in rotation and are undergoing on-the-job training for managing psychiatric disorders for last 2 years. Recently this camp has been augmented with addition of tele-psychiatric application for on-the-job training for these pcps by one of the author (nm) from telemedicine centre, nimhans, bengaluru.

This study aims to test the utility and feasibility of video based tele-psychiatrist assistance to pcps in managing psychiatric patients. Aim is also get feedback from these physicians on this method of training.

Methodology: This study is being conducted at Maddur taluk hospital from telemedicine centre, nimhans, bengaluru. A tele-psychiatrist (nm) is assisting pcps using principle of adult learning and bottom-up approach. Screening tool cum proforma developed by two of authors (nm & jt) for dmhp of karnataka is being used for on-the-job training assistance to pcps to manage psychiatric disorders. Medical audit of this study including utility and feasibility till december 31, 2016 will be analyzed.

Results And Discussion: Will be presented at the time of presentation.

Key words-Physician, telepsychiatry

Study On Internet Addiction And Its Relation With Perceived Stress And Self-esteem In Medical College Students

Dr. Amey Yeshwant Angane, Prof. Dr. Kranti Kadam, Dr. Geetanjali Shivhari Ghorpade, Prof. Dr. Shubhangi Parkar

Seth G.S. Medical College And K.E.M. Hospital. Email Id : [email protected]

Introduction: The internet has become one of the most popular media and it is utilized by adolescents to enforce their competitiveness, but heavy use of the internet results in many negative effects. Medical college students experience major stressful life changes which may lead to increase perception of stress and in turn lead to internet addiction as a way of coping with stress. Internet addiction may also have negative effects on self-esteem.

Aim And Objectives: The purpose of this study is to assess the prevalence of internet addiction in medical college students. The study will also assess the level of perceived stress and self-esteem in students. Also to find out association between internet addiction with perceived stress and self-esteem.

Materials And Method: Cross-sectional study, with consecutive sampling technique was undertaken. Sample consisted of 200 medical college students. After taking informed consent, subjects were assessed on youngs internet addiction test (yiat-20), rosenbergs self-esteem scale (rses) and cohens perceived stress scale (cps-10). Two groups were made using yiat-20, those having internet addiction and those without and were compared.

Results: Mean age of medical students was 19.16 Years (β±1.45). The mean time of internet usage of the sample population was 107.15 Minutes (β±67.99). The prevalence of internet addiction was 18%. No gender difference was found. The group of students that had internet addiction showed high perceived stress (p=0.001) And low self-esteem (p<0.0001).

Conclusion: Medical students having internet addiction were found to have higher levels of perceived stress and lower levels of self-esteem when compared to students not having internet addiction.

Keywords: Internet Addiction, Perceived Stress, Self-esteem, Medical Students

Effects Of 0.5 Ms And 1.5 Ms Pulse Widths On Cardiovascular Function, In Patients With Schizophrenia Receiving Electroconvulsive Therapy

Dr. Sayantanava Mitra, Dr. Dhruva Ithal, Dr. A Shyam Sundar, Dr. C Naveen Kumar, Prof. J Tirthalli, Dr. V.J. Ramesh, Prof. B.N. Gangadhar

NIMHANS. Email Id : [email protected]

Background: Electroconvulsive therapy (ECT) has been shown to have a profound effect on cardiovascular functions, and these effects have been proposed to have seminal bearings on the final clinical outcome. Present study tried to look into the differential effects of 0.5Ms and 1.5Ms pulse-widths on cardiac function in patients with schizophrenia during ect.

Method: Fifty-one consenting adult (m=22, f=29; mean age 30.55Β±10.39 Years, mean duration of illness 88.29Β±84.24 Months) patients, with a diagnosis of schizophrenia, were selected and randomly assigned to receive either 0.5Ms(n=25) or 1.5Ms(n=26) pulse-width ect stimulus; after obtaining adequate IEC approvals. Seizure threshold was titrated upwards during the first session and mean rate-pressure product (rpp; pulse*systolic blood-pressure) was calculated during the second ect session for the two groups at 5 time points, viz. Pre-anaesthesia, during anaesthesia, during convulsive seizure, 1 and 5-minutes post seizure. They were compared between the groups using independent-sample t-test. The psychopathology was assessed at baseline and after 6th ect on PANSS.

Results: Two groups did not differ based on socio-demographic characteristics and mean PANSS scores at baseline. Mean administered dose of anaesthetic agent (thiopentone sodium), muscle relaxant (succinylcholine) and the stimulus charge at 2nd session were comparable (p>0.05). The mean duration of seizure (motor and eeg) did not differ between the two groups. The groups failed to differentiate from each other based on rpp at all 5 time-points, maximum rpp achieved during the session, or the difference between pre-seizure and maximum rpp. Further, after 6 sessions, the groups remained comparable in terms of their panss scores.

Conclusion: The two pulse-widths of 0.5Ms and 1.5Ms seem to have similar effects on cardiovascular function, at least in otherwise-healthy adult schizophrenia patients, for comparable charge doses and similar anaesthetic agents.

Key Words-ECT, Cardiovascular function, Schizophrenia

Assessment Of Cognitive Functioning In Prediabetes, Diabetes And Healthy Controls

Dr. Ashish Pakhre, Prof. S.k. Khandelwal, Dr. Raman Deep Pattanayak, Dr. Ashima Nehra, Dr. A.C. Ammini

AIIMS, New Delhi. Email Id : [email protected]

Introduction: Diabetes is a significant clinical problem throughout the world. Cognitive decrements may start to develop years before the actual diagnosis, even in the pre-diabetes stages. Findings from studies also report that information processing, psychomotor efficiency, attention, visuoconstruction and mental flexibility are greatly impaired in diabetes.

Aims And Objectives: To assess and describe the cognitive functioning in diabetics and prediabetes, to assess the relationship of cognitive variables to various socio-demographic, clinical and blood parameters in pre-diabetics and diabetics and to compare the cognitive functioning across pre-diabetics, diabetics and healthy individuals.

Methodology: It was an observational, cross sectional study. Sample was collected from outpatient clinic and in-patient ward, department of endocrinology, AIIMS, New Delhi. Three groups were diabetics, prediabetics and healthy controls (n = 30 for each group).

Results: On evaluation of sociodemographic data, a significant relationship noted on gender and residential distribution in groups. In cognitive tests, Hindi Mental Health Status Exam (HMSE) showed significant relationship between groups on post hoc analysis. A significant relationship was obtained between groups on auditory verbal learning test- memory score (p=0.01). A trend towards significance was noted on digit span test between groups (p=0.07). Prediabetics did poorly than other two groups on visual retention test and significant difference was noted. On Nahor Benson Test (NBT), healthy controls did better than two groups and significant difference was observed (p=0.02). On Post Hoe analysis (bonferroni test) a significant relationship was seen on n back test 1- error score, AVIT memory score and on nbt.

Conclusion: Prediabetics showed poor working memory as assessed by NBT. Attention concentration was impaired in both diabetics and prediabetics. Visual memory function and visuoconstruction ability was also reduced in both diabetics and prediabetics.

Key Words: Cognitive function, Prediabetes, diabetes

Role Of Neurocognition In Functional Outcome In Patients With Bipolar Disorder

Dr. Bhavneet Kaur Ahuja Dr. Sanjay Jain, Dr. Ajitabh Soni,

Dept Of Psychiatry, SMS Medical College, Jaipur. Email Id : [email protected]

Objective: To determine the role of neurocognition on functional outcome in patients with bipolar disorder.

Methodology: 61 patients were incuded which were in the euthymic state of bipolar disorder and 30 healthy individuals were also included which were taken as control. The patient group was divided into low functioning (30 patients) and high functioning (31 patients) subgroups based on functioning level as measured by global assessment of functioning scores. Groups were subjected to the neuropsychological assessment.

Results: The three groups had significant differences on backward digit span, verbal learning and memory, trail making and color stroop tests. Backward digit span, trail making and color stroop tests had a direct correlation to the global assessment of functioning scores.

Conclusion: Executive dysfunction was the most significant predictor of psychosocial outcome in patients of bipolar disorder currently in euthymic state.Thus long-term therapeutic strategies should target the relapse prevention along with rehabilitation in the cognitive domains.

Key Words: Functioning; Euthymic Patients; Bipolar Disorder; Cognitive Dysfunction

Body Dysmorphic Disorder And Associated Psychological Factors In Patients Of Acne Vulgaris - A Psycho-dermatology Interface !

Dr. Anisha. P. Landge, Dr. Darpan Kaur, Dr. Shubhangi Dere, Dr. Chetan Vispute, Prof. Rakesh Ghildiyal, Prof And Hod

Department Of Psychiatry, MGM Medical College, Navi Mumbai. Email Id : [email protected]

Introduction: Psycho-dermatology is a relatively newer concept of interface between psychiatry and dermatology which has emerged significantly over the last decade. Literature on body dysmorphic disorder (BDD) and associated psychological factors in acne vulgaris patients is sparse from developing countries such as india.

Methodology: This was a cross-sectional, observational study conducted at department of psychiatry with patients referred from acne clinic for the study using simple random sampling. Fifty six consenting patients, fulfilling the inclusion criteria were assessed on the global acne grading system for acne severity and BDDE-SR scale for bdd and dsm-v clinical interview. Data was analysed using spss 17. Institutional ethic clearance was obtained.

Results: Data analysis for patients with acne (n=56) revealed mean age of patients was 27.1 Years (s.D.- 8.09). Majority of patients(73.2%) Belonged to young age group (16-30years) and (51.8%) Were females. Majority (62.5%) Of patients had grade ii severity of acne. The minimum and maximum score on BDDE-SR questionnaire was 41 & 141 respectively with mean score of 85.1 (S.D.- 22.7). The prevalence of BDD in acne vulgaris patients was found to be 7.1%. Majority of the patients (71.4%) Had cluster b personality traits and 78.5% Patients reported presence of stressor in the last one year with interpersonal stressors being most common (53.5%). Statistical analysis revealed a significant association between acne severity and BDD-E score with p= 0.02 Implying that the more severe the acne, the higher were the scores on bdde questionnaire.

Conclusion: Further clinical and research implications in the arena of psycho-dermatology with area focus on bdd and acne vulgaris are recommended. Regular screening of acne vulgaris patients for mental health issues and programs providing multidisciplinary care involving psychiatry, clinical psychology, counselling and stress management are recommended for a better outcome.

Keywords: Body Dysmorphic Disorder, Psychological Factors, Acne Vulgaris, Psycho-dermatology

Psychiatric Co-morbidities In Persons Of Mental Retardation In A Community- Run Residential Home For Mentally Handicapped (apna Ghar)

Dr. Snehal Vijay Thamke Dr. Santosh Kumar Kesharwani, Dr. Harful Singh Bishnoi, Prof. A K Singhal, Prof. K K Verma, Dr. Girish Chandra Baniya

Email Id : [email protected]

Introduction: The mental health needs of persons with mental retardation or developmental disabilities have been a serious but neglected issue. Concerning their mental health, a study is planned with the aim to evaluate for the psychiatric co-morbidities in persons of mental retardation.

Methodology: This study was conducted on 30 inmates, of moderate to severe mental retardation with behavioral problems, of a private residential mental health care facility (apna ghar) at Bikaner, Rajasthan. A semi structured scale was used to assess the presence of psychiatric symptoms in these persons. Psychiatric diagnosis was made on the basis of icd-10 diagnostic criteria by a team of psychiatrists.

Results: In our study, mean age of the subjects was 28.37 Years (s.D= 8.64) With maximum number of males (n=29), their mean duration of stay at apna ghar being 14.3 Months (s.D=10.5) And most of them were found wandering at bikaner (n=9) followed by those who were transferred from Apna Ghar, bharatpur. Out of 30 persons of mental retardation with behavioral problems, 30% (n=9) were diagnosed as schizophrenia, 16.66% (N=5) with mood disorders including depression and mania, 6.66% (N=2) as anxiety disorders and 3.33% (N=1) each of obsessive compulsive disorder and pseudo-seizures. Also, 26.66% (N=8) persons showed hyper-sexuality.

Conclusion: The paper proposes psychiatric evaluation of all the persons with mental retardation having psychiatric co-morbidities (dual diagnosis) and needs to be treated. Present mental status examination of all the patients concluded that these patients could be manageable with anti-psychotics.

Keywords: Psychiatric comorbidities, mentally handicapped

Quality Of Life And Burden On Caregivers Of Patients With Dementia

Dr. Suresh Kumar Parihar ,Prof. B.S. Shekhawat, Dr. Shilpa Maida, Dr. Vimal Meena

Deptt Of Psychiatry, GMC, Kota. Email Id : [email protected]

Background: Dementia is a devastating, chronic & progressive disease of brain. It not only affects the patient but also Imposes significant burden on people taking care of the patient thereby affects quality of life of caregivers.

According To world alzheimer report 2015 over 46 million people are living with dementia around the world and 4.1 Million of them in india. This number is estimated to increase to 131.5 Million by 2050.

Objective: The present study is designed to evaluate quality of life & burden on primary caregivers of dementia patients.

Materials And Methods: 30 primary caregivers of dementia patients who attended psychiatry and neurology OPD of a tertiary care hospital were included in this study. Patients and caregivers were evaluated by using a semi-structured performa that includes socio-demographic data and other details. Cases of dementia were be diagnosed by using MMSE.

30 age and sex matched subjects were recruited as control group. World health organization quality of life-bref hindi version (WHOQOL) was used to assess quality of life of caregivers and control group.

Likewise burden on caregivers was assess by using zarit burden interview. Data will be analysed by using SPSS software window version 20.

Results And Conclusion: Will be discussed at the time of presentation in the light of previous studies.

Key Words: Dementia, Quality Of Life, Caregiver Burden.

Caregivers Perspective In Schizophrenia: Study Of Expressed Emotions And Psychological Distress In Primary Caregivers

Dr. Sweta Roy ,Dr. Shubhangi Dere, Dr. Darpan Kaur, Dr. Chetan Vispute, Dr. Rakesh Ghildiyal

Department Of Psychiatry, MGM Medical College, Navi Mumbai. Email Id : [email protected]

Background: Schizophrenia is a chronic debilitating mental illness affecting cognition, emotion, perception and various aspects of behavior.Expressed emotion by the caregiver is a significant predictor of treatment outcome and relapse. Similarly, caregivers themselves experience severe depression anxiety and stress which can affect the quality of caregiving.Hence the need for this study.

Aim: To study expressed emotions and psychological distress in the primary caregivers of patients with schizophrenia and to study its association with the type, severity and duration of illness in their patients.

Methods: Total of 150 patients suffering from schizophrenia and their primary caregivers attending the psychiatry opd of a tertiary care hospital in navi mumbai, fulfilling the inclusion and exclusion criteria were assessed after obtaining informed consent. Patients were administered PANSS to assess severity of illness. The primary caregivers were administered family attitude scale (FAS), and depression anxiety and stress scale (dass) to record their expressed emotions and psychological distress. Data was analyzed using spss 17.

Results: Equal number of males (50.3%) And female patients (49.7%) Were assessed. Majority of the patients had paranoid schizophrenia (60%) and mean duration of patients illness was of 6.3 Years. Male caregivers (63.3%) Were predominant than females (36.7%). Mean scores on panss, fas, dass scales were 82.64, 45.62 And 47.94 Respectively. Among caregivers, 26% had high expressed emotion and 21% experienced high psychological distress. Fas score and dass had a significant positive co-relation with severity of illness and a negative co-relation with duration of illness. Both the expressed emotions & psychological distress were high in caregivers of disorganized schizophrenia.

Conclusion: There is a void to address the needs of caregivers of schizophrenia patients. Caregivers should be screened for expressed emotions and distress so as to achieve a good therapeutic success in their patients.

Key Words: Expressed Emotion, Psychological Distress, Schizophrenia Caregivers

Perceived Stress In Caregivers Of Patients With Dementia

Dr. Anu Karthika,Dr. Aditi Chaudhari, Dr. K. Mazumdar, Dr. Shobha Nair, Mrs Divya Ramadas

Email Id : [email protected]

Background: In india, most of the patients with dementia are cared for by their family members. Research has shown these caregivers experience significant stress. There are not many indian studies that have assessed the contribution of social support and impairment in the activities of daily living (adl) to stress in the caregivers.

Aims And Objectives: 1. To study the perceived stress in the caregivers of patients with dementia. 2. To study their perceived social support. 3. To study any correlation between the perceived stress and the perceived social support 4. To study any correlation between the perceived stress and the disability due to dementia.

Materials And Methods: Observational, cross sectional study of 35 patients with dementia who were interviewed along with their caregivers. The perceived stress was assessed using the perceived stress scale. The perceived social support was assessed using the multidimensional scale of perceived social support. The disability and impairment in adl was evaluated using the disability assessment for dementia scale. Relations between the variables have been assessed using pearsons correlation coefficient and anova tests.

Results: The mean score on the perceived stress scale was 19.23. 31.4 % Caregivers were found to have high while 62.8% Caregivers had moderate social support. There was no statistically significant difference in the perceived stress between these groups (p = 0.762). Perceived stress did not correlate with disability due to dementia (p = 0.658). Spouses living in joint families reported significantly less stress than those in nuclear families.

Conclusions: Caregivers in india do have social support but significant stress is seen in spouses, when the elderly couple live by themselves.

Keywords: Dementia, Care-giver, Stress, Social Support, ADL

A Study Of Co-morbid Depression And Anxiety In Pre-menstrual Dysphoric Disorder (PMDD) And Its Effect On Quality Of Life ( Qol) Among Undergraduate Medical Students : A Descriptive Study

Dr. Rajshri, Dr. S.b. Chaudhari, Dr. Sushma Inamdar

Senior Resident, Department Of Psychiatry , S. Nijalingappa Medical College & HSK Hospital, Bagalkot, Karnataka. Email Id : [email protected]

Background: PMDD is a somatopsychic illness triggered by changing levels of sex steroids that accompanies an ovulatory menstrual cycle. Though around 40% women suffer from one or the other symptoms, about 3-7% of these women suffer from full diagnostic criteria of PMDD. It is therefore important to recognize those in whom the condition is associated with functional impairment.

Common Disorders That co- exist with PMDD are major depressive disorder and generalized anxiety disorder.

Medical workers, including physicians and medical students are among the high stress employees. Thus, it is predictable that depression and pre menstrual symdrome (PMS) have elevated frequencies in this population thereby impairing the quality of life in these females.

Methodology: The study is done among undergraduate medical students of Nijalingappa medical college, bagalkot. A total of 350 students were approached for the study. They were asked to fill a proforma with sociodemographic details and to report their premenstrual symptom severity using the daily record of severity of problems (DRSP) each night prospectively for 2 months for a diagnosis of PMDD. Co- morbid depression and anxiety was assessed using the hamilton depression rating scale (HAM-D) and hamilton anxiety rating scale (HAM-A) respectively. Qol was assessed using the short form of health survey (sf-36). The study population was divided into two groups: with and without pmdd and the quality of life was compared in both the groups.

Statistical Analysis: Will be done using microsoft excel .Frequency and percentages calculated for all quantitative measures, mean and standard deviation for qualitative measures and chi- square test for categorical values.P value of < 0.05 Would be considered as statistically significant.

Results: Awaited

Conclusion: Awaited

Keywords: Pmdd, Depression, Anxiety, Medical Students, QoL

A Study Of Psychiatric Disorders, Personality Disorders And Medical Conditions In Patients With Alcohol Use Disorders

Dr. Akanksha, Prof. Shubhangi R Parkar,Dr. Kranti Kadam, Dr. Akshata Bhat

Dept Of Psychiatry, KEM Hospital, Mumbai. Email Id : [email protected]

Introduction: National household survey done in 2001 reported prevalence rates of psychiatric disorder of 30% in alcohol dependence as compared with 12% prevalence in the non-dependent population (farell, et al). Studies have also demonstrated that people with certain kinds of personality traits or disorders are more prone for substance use disorders. A number of medical complications are also seen in patients of alcohol use disorders. Compared with patients who have a mental health disorder or a substance use problem alone, patients with comorbid conditions often experience more severe and chronic, medical, social and emotional problems and a poor prognosis. Because they have two or more disorders, they are vulnerable to relapse and a worsening of both the psychiatric disorder and the addiction problem.

Hence, this study aims to determine the prevalence of psychiatric disorders and personaliy disorders. It further evaluates medical conditions in patients of alcohol use disorder.

Methodology: This cross sectional observational study was conducted in drug deaddiction center at a tertiary care hospital in Mumbai. After institutional ethics committee permission, this study included 100 patients with alcohol dependence. Relevant data was compiled in a structured proforma, results are discussed after analysis.

Results: Comorbid psychiatric diseases seen were mood disorders (50%), anxiety disorders (45%) and psychotic disorders (25%). Borderline, antisocial, paranoid and dependent personality disorders were seen in overall 20% patients with alcohol dependence. Various medical conditions were seen in 42%.

Conclusions: Psychiatric disorders, personality disorders and medical conditions are common in patients with alcohol use disorders. Addressing the comorbidities while treating individuals with alcohol use disorders would result in improved treatment outcome and decreased chance of relapse.

Key Words: Alcohol, Psychiatric Co-morbidity, Personality Disorders

Prevalence Of Substance Abuse Among Motor Vehicle Drivers Sustaining Road Traffic Injuries Admitted In Emergency Department

Dr. Yogesh Dosodiya, Dr. Parth Singh Meena, Prof. Mahendra Jain, Dr. Charan Singh Jiloha

JLN Medical College, Ajmer. Email Id : [email protected]

Background: A high proportion of beds in emergency department of trauma centres and general hospitals are occupied by victims of rta. A large proportion of road traffic accidents (RTA) are associated with substance abuse. A significant number of people can be prevented from untimely death and disability appear to be preventable if more effective measures against driving after substance abuse can be implemented. This study was aimed to investigate the prevalence of substance abuse among drivers of motor vehicles who visit emergency department following road traffic accidents (RTA).

Materials And Methods: This case-control study was carried out from 1st june 2016 to 31st july 2016. Two hundred motor vehicle drivers admitted in the ed were included as the case group and 150 hospitalized patients, due to non-traumatic causes were used as controls. History of substances abused other than nicotine, was obtained from the case records. Data obtained regarding socio-demographic profile and substance abuse was analysed statistically using spss v11.

Results: Of the 200 patients in the case group, 80 (40%) were positive for substance abuse (100% males). On the other hand, 46(24%) patients in the control group had positive history or laboratory findings of substance abuse (92% male). Alcohol was the most common agent abused in both groups. There was significant difference between two groups regarding the prevalence of substance abuse (p = 0.000).

Conclusions: The prevalence of substance abuse is high among victims of road traffic accidents. Health education and counselling is needed to reduce substance abuse in the general population and strict laws to be implemented to discourage substance abuse while driving.

Keywords: Road Traffic Accidents, Substance Abuse, Emergency

Adolescents' Knowledge And Attitude About Mental Health

Dr. Surjya Roy ,Dr. Dr Prasenjit Roy, Prof. Dr(prof) Asim Kr Mallick

Burdwan Medical College. Email Id : [email protected]

Background: Mental health literacy among adolescents has received increasing attention to promote early identification and management of mental health problems and to reduce stigma in our community. Current study aims to assay knowledge and attitude of adolescents regarding mental health issues.

Methodology: It was a cross sectional study conducted with adolescent boys and girls from urban background of west bengal (n=50, 12 to 18 yrs of age). Mental health awareness questionnaire (MHAQ) and a socio demographic datasheet were administered to each of them. MHAQ has 13 items. Four questions are to assess knowledge about mental health, one is a open ended question and other questions are to assess their attitude and practice pertaining mental health issues. Data were analyzed using spss (20 versions).

Result: Out of the four knowledge based questions two had more correct responses (84%, 64%) whereas for the rest of the responses were incorrect (64%, 66%). Forty four % of population considered adolescent problem not very serious, 68% expressed a helping attitude towards troubled friends, 58% tended to seek help for their own from their parents. In the open ended question adolescents were asked about what would make them feel happy. Most of the responses pertained to hobbies and recreational activities (34.6%).

Conclusion: Though majority of the study population were able to recognize abnormal behavior and expressed helping attitude, they lacked clear idea about cause of mental illness and they are not able to differentiate between physical illness and mental illness. This leaves ample scopes to work upon adolescents knowledge regarding mental health.

Keyword: Adolescents, Mental Health, Knowledge, Attitude

A Study Of Stressful Life Events In Psoriasis

Dr. Nilima Kumari Mahapatro ,Dr. Harshavardhan Sampath, Prof. Sanjiba Dutta

Email Id : [email protected]

Introduction: Psoriasis is an immune mediated, genetically determined, common dermatological condition which primarily affects the skin, nails, and joints with widespread systemic manifestations. In india the prevalence of psoriasis varies from 0.44 To 2.8% (Dogra s, 2010). Stressful life events have been reported to impact on the onset, exacerbation, and treatment response in psoriasis (verhoeven ew, 2009). The purpose of this study was to assess the prevalence of stressful life events among psoriasis patients in this part of the country.

Methodology: Hospital based cross-sectional study, conducted in the dermatology OPD at Tertiary Care, Medical College Hospital, in Gangtok, Sikkim, from June 2015 - May 2016. Consecutive sampling of all non-paediatric psoriasis patients (16-70 years) who had consented were taken as the sample. Diagnosis of psoriasis was done clinically by two senior dermatologists. Stressful life events were assessed using psoriasis life stress inventory (plsi), a 15 item questionnaire specific for psoriasis, rated on a 4 point likert scale (0=not at all to 3= a great deal) with higher scores indicating high stress (gupta ma, 1995).

Results: Of the 39 psoriasis patients, 51% were male and 48.7% Were female. The distribution of psoriasis life stress inventory scores ranged from a minimum of 0 to a maximum of 31, with a mean of 11.90 (Sd=8.52) And median of 10. Subjects with PSLI scores less than10 were categorized as low stress reactors and those greater than 10 were high stress reactors (gupta ma, 1995). 59 % (N=23) were high stress reactors in the sample.

Conclusion: Psoriasis patients experience significant stressful life events. Clinicians should incorporate the assessment of life events in this vulnerable population to improve the quality of care.

Keywords: stressful events, Psoriasis

Delirium: Subjective Distress And Its Association With Motoric Subtypes

Dr. Ayush Kumar Jayaswal, Dr. Harshavardhan Sampath, Dr. Sanjiba Dutta

Professor, Sikkim Manipal Institute Of Medical Sciences, Sikkim. Email Id : [email protected]

Introduction: Delirium is a common yet underdiagnosed and incompletely understood clinical condition. The core features of delirium are fluctuating disturbance of consciousness of acute onset; an inability to focus, sustain and shift attention; with an impairment of immediate and recent memory. Clinically there are 3 subtypes based on motor activity viz., Hyperactive, hypoactive and mixed. Despite the significant anguish experienced by patients and caregivers, the distress associated with delirium has not been explored. This is the first indian study to have studied the subjective distress of delirium in patients and caregivers and its association with delirium subtypes.

Methodology: Research was conducted in the medical intensive care unit at a tertiary care medical college hospital in sikkim from march-november 2015 with an observational study design. The following scales were used: confusion assessment method for icu (cam-icu) (ely ew et al 2001)" delirium diagnosis; richmond agitation & sedation scale (rass) (sessler cn et al 2002)" motor subtypes; delirium experience questionnaire (deq) - distress associated with delirium in patients and caregivers.

Results: Of the 88 delirious patients hyperactive, hypoactive and mixed subtypes constituted 34.1%, 55.7% And 10.2% Respectively. Deq scores of patients and caregivers were 2.27 (Sd 2.16) And 3.78 (Sd 0.72) Respectively. Hyperactive and mixed delirium was associated with significantly more distress than hypoactive delirium (f=115.5 P< 0.001). Comparing the difference in distress experienced among the delirium subtypes, it was found that the families experienced more distress than the patients themselves. The difference, however, was significant only for the hypoactive subtype (t=5.67, P< 0.001).

Conclusion: Contrary to common belief, patients who have recovered from delirium do recall the experience as distressing and traumatic. Caregivers find delirium distressing and need to be given education and support when their loved ones are admitted in the ICU.

Keywords: Delirium, Intensive Care Unit, Delirium

Cross Sectional Comparative Study Of Disability In Patients With Mental Illness Schizophrenia, Depressive Disorder, Bipolar Affective Disorder, Obsessive-compulsive Disorder, Alcohol Dependence

Dr. Shahjahan Akthar, Dr. Vijaya Kranthi

Institute Of Mental Health , Hyderabad. Email Id : [email protected]

Introduction: The origins of rehabilitation in psychiatry in the west can be traced to the community mental health movement. It was assumed that people with major mental illness should be helped to maintain themselves in the community. Although deinstitutionalization was a positive step, it was too idealistic. What was achieved was merely a shift in the locus rather than the focus of care. The major mental illnesses are associated with chronicity and functional impairment resulting in high disability. There are very few indian studies, which have specifically addressed the disability associated with mental illnesses.

Methodology: The study will be conducted at institute of mental health, hyderabad; which is a 600-bed strength tertiary care referral hospital. Patient diagnosed as schizophrenia, depressive disorder, bipolar affective disorder, obsessive-compulsive disorder and alcohol dependence as per ICD-10 and on regular treatment with minimum one year duration and under remission, will be included in the current study. 40 Subjects of each diagnostic group having age 18-65 years, who will give consent to voluntarily participate in the study will be evaluated for disability by applying indian disability evaluation and assessment scale (ideas).

Sampling: Subjects selected from review outpatient unit of institute of mental health by convenience sampling method

Statistical Method: Sociodemographic profile frequencies are calculated and categorical data will be analysed using chi-square test. Parametric test t-test and anova will be used to compare data between groups.The data will be analysed using spss 19 version.

Results And Conclusion: Will be discussed at the time of presentation as we have not analysed the data.

Keywords: Disability, Mental Illness, Ideas.

A Study On Stressful Life Events Among Adolescent Students

Dr. Upashna Gurung, Dr. Harshavardhan Sampath, Prof. Sanjiba Dutta

Sikkim Manipal Institute Of Medical Sciences, Sikkim. Email Id : [email protected]

Introduction: Adolescence is a developmental period characterized by tumultuous changes in virtually every aspect of life, calling for constant adaptation and coping. While most adolescents navigate the turbulent stressors without difficulty, a significant minority experience what is known as adolescent crisis(errikson eh, 1968). This crisis can be conceptualized as the cumulative effect of negative stressful life events on the adolescent, impacting their wellbeing and healthy development (lazarus & folkmann, 1984). Stressful life events can be theoretically divided into positive and negative depending on its effects and into dependent and independent based on the degree of control over the life events (hammen, 1991). The purpose of this study was to determine the nature and levels of stressful live events experienced by adolescent students.

Methodology: A quantitative, cross sectional study design was used. The sample consisted of 500 adolescent students aged 11-19 years, from one public and one private school in gangtok, sikkim. The child and adolescent survey of experiences (case) questionnaire was used to assess the nature and levels of stressful life events among the students (Allen jl et al, 2012).

Results: Adolescents experienced nearly identical levels of positive and negative life events (t-value 1.62, P=0.11). Among the positive life events, dependent events occurred significantly more than independent events (t-value 27.78, P < 0.001). Among the negative life events, independent events occurred significantly more than dependent events (t-value 11.67, P <0.001). There was no gender difference in the experience of dependent or independent, positive and negative life events.

Conclusion: Adolescents experience positive and negative life events similarly. However, they are exposed to significantly more negative life events which are beyond their control. Interestingly, despite the biopsychosocial differences between the genders, both experienced similar levels of stressful life events.

Keywords: Adolescents, Stressful Life Events, Gender Differences.

Marital Satisfaction In Spouses Of Chronic Schizophrenia Patients

Dr. Bandela Sowmya Grace, Dr. Anitha Rayirala

Institute Of Mental Health, Osmania Medical College, Hyderabad. Email Id : [email protected]

Introduction: Schizophrenia is a serious mental illness that interferes with the ability to think clearly, manage emotions, make decisions and relate to the others. Schizophrenia may cause disability leading to restrictions in many domains of daily life such as hygiene, self management, vocational and leisure activities and family and social relationships. There are very less studies on marital satisfaction and occupational impairment in chronic schizophrenia patients. Hence an attempt is being made through this study to delve into the same.

Aims And Objectives: To study marital satisfaction in spouses of chronic schizophrenia patients

Materials And Methods: Sample will be collected from patients attending the review outpatient department of the institute of mental health according to the inclusion and exclusion criteria through convenience sampling. A semistructured intake and couple satisfaction index will be adminstered to the sample

Results And Conclusion: Will be discussed at the time of presentation, as we have not analysed the data.

Key Words : Chronic Schizophrenia ,mental Illness ,marital Satisfaction.

Course Of Bipolar Affective Disorder- A Naturalistic Follow Up Study

Dr. Karan Dhawan ,Prof. Sudarshan C.Y, Prof. Shamshad Begum, Prof. K.nagaraj Rao

JJM Medical College, Davangere. Email Id : [email protected]

Introduction: Bipolar affective disorder (BPAD) is characterized by episodes of mania/hypomania and depression. It causes considerable disability worldwide and involves a substantial risk of suicide. Recurrence in BPAD is very common and patients are euthymic only half the time. Mood stabilizers (MS) can substantially reduce recurrence and thereby disability. Indian studies regarding course of affective disorders and long term efficacy of mood stabilizers are sparse and beset with methodological problems. Thus a naturalistic follow up of patients having BPAD for more than 5 years to assess the course of illness and effect of ms on the course was planned.

Methodology: Information regarding socio demographic data, details about illness, treatment and course were elicited for 48 patients diagnosed as BPAD who were on regular follow up for more than 5 years by reviewing their treatment records. Patients on MS and not on ms were compared statistical analysis was done using spss version 22

Results: Mean age of onset of illness was 36.13 Years.56.14% Of patients were females. Mean duration of illness was 12.13 Years.56.17 % Had mania as the first episode.89.58% Of patients had their second episode within next 2 years. Mean duration of treatment at our set up was 9.98 Years. Mean duration of treatment with ms was 5.77 Years. Patients on mood stabilizers had significantly younger age of onset. 71.8% Of patients were started on mood stabilizers in their second or third episode.In 56% of patients lithium was the first choice as mood stabilizer.47.16% Patients could be maintained only on the first mood stabilizer.12.8% Patients required three or more mood stabilizers. Mood stabilizers significantly decreased the duration of episode and number of episodes.

Conclusion: Mood stabilizers administered early in the course of illness can significantly reduce the duration and frequency of episodes.

Keywords : BPAD, Mood stabilizer, episode frequency

Study Of Anxiety Features In Patients Posted For Hysterectomy Surgery

Dr. Kanchan Anil Patil , Prof. Dr. Vivek Kirpekar, Prof. Dr. Sudhir Bhave, Dr. Rahul Tadke, Dr. Sushil Gawande, Dr. Dr. Abhijeet Faye

NKP SIMS And Lata Mageshkar Hospital, Hingna Road, Nagpur, Maharashtra. Email Id : [email protected]

Background: Hysterectomy is gynecological surgical procedure involving removal of the uterus and one of the important surgeries in women. Patients undergoing hysterectomy are prone to have anxiety and other psychiatric morbidities. Study of anxiety in the women posted for surgery can give more insight into this aspect.

Methodology: The present study was carried out in the women admitted in gynecological unit and posted for hysterectomy. 30 Consecutive patients participated in this study. The study protocol was approved by institutional ethics committee. Each participant was individually interviewed along a semi-structured proforma prepared for the study which included socio-demographic profile, clinical profile(gynecological diagnosis and psychiatric profile), and hamilton anxiety rating scale was administered. Data thus collected was statistically analyzed and conclusions were drawn.

Results And Discussion: The mean age of the participating women was 46.16 Years (s.D. 5.91), All of them married, majority of them being housewives, with good educational background and from urban area. Majority of participants had gynecological diagnosis of abnormal uterine bleeding. The mental status examination in some (37%) of them revealed anxious mood, and preoccupied with worries. Pain symptoms were present in 67% of the participants. None of the participants had diagnosable anxiety disorder as per DSM 5. The mean HAM-A score was 16.5 (Sd=5.04) With mild 30% and moderate 37%. Correlation with age, education, residence, duration of symptoms and gynecological diagnosis were not found significant. Significantly higher anxiety (on ham a) was found in those with pain symptoms present.

Conclusion: Thus women posted for hysterectomy surgery have anxiety which correlates with pain symptoms. They should be regularly evaluated for anxiety symptoms which can help in early diagnosis and treatment and reduce further morbidity in them.

Keywords: Hysterectomy, Anxiety, Pain Symptoms.

A Study Of Demographic Profile And Psychosocial Factors In Attempted Suicides In A Tertiaru Care Centre

Dr. Muhammed Rajees M ,Prof. James T Antony, Prof. Saibunnisa Beevi K, Dr. Girish Menon

Emeritus Jubilee Mission Medical College, Thrissur. Email Id : [email protected]

Background: India alone accounts for approximately 30% of worlds suicide. On an average more than one lakh thirty thousand people commit suicide in india per year. Kerala contributes more than 6% of suicides in india with only 3% of the country's population.With a suicide rate of 24/100000 population Kerala is among the states with high suicidal rates.Causes of high suicide in Kerala are attributed to various factors. A study on the demographic profile and psychosocial factors on attempted suicide will help to formulate measures to decrease existing high suicide rate.

Methodology: This study is conducted in a tertiary care center in middle of kerala . It is a retrospective study based on the hospital records of patients admitted with attempted suicide during the last 3 years - 2013 to 2015. Those patients who undergone psychiatric consultation after recovered medically from suicide attempts were taken into study.Their demographic profile were assessed using a proforma.Psychosocial factors were assessed based on the finding of psychiatrist who examined the patients.

Results: Out of total 652 suicide attempters 594 patients underwent psychiatric assessment.58% Of the attempters were females. 62% Of attempters were less than 40 years of age. A diagnosable psychiatric syndrome is present in approximately 50% of the cases.In remaining patients adjustment disorder constitute the major psychosocial factor.

Conclusion: Eventhough kerala has high literacy rate and good social and health indicators , its high suicidal rate points towards a unhealthy social system/life style prevailing in the state.Only by a proper assessment of the various contributory factors, we will be able to formulate strategies to decrease high suicide rate.

Key words : psychosocial factors, suicide, literacy rate

A Comparative Study Of Markers Of Oxidative Stress In Patients With Obsessive Compulsive Disorder, Their First Degree Relative And Healthy Control Groups

Dr. Abhijeet Shrivastava,Prof. P K Dalal, Dr. Sujit Kumar Kar, Dr. Eesha Sharma, Prof. Abbas A Mahdi

Department Of Biochemistry King George Medical University, Lucknow , U.P. Email Id : [email protected]

Background: Role of oxidative stress in pathophysiology of various psychiatric disorders has been studied. Our study had focussed on the role of oxidative stress in obsessive compulsive disorder.

Aims: To study the biomarkers of oxidative stress (superoxide dismutase (sod), glutathione peroxidase, catalase, malondialdehyde, serum cortisol level) and their correlation with clinical variables in drug naοve patients of obsessive compulsive disorder and to compare these parameters between patients, their first degree relatives and control group.

Method: This study was done in a tertiary hospital, institutional setting and was a single point cross sectional observational study. 30 Patients of ocd, their 30 first degree relatives and 30 healthy controls were taken in this study and the above parameters were assessed in them and correlated with various clinical variables. The data was assessed using anova test, tukey kramer multiple comparison test and pearson correlation.

Results: This study has found significantly raised level of malondialdehyde among patients compared to their first degree relatives and healthy controls, however no significant difference was found when first degree relatives were compared to the controls. This study has found significantly low levels of plasma catalase, superoxide dismutase and glutathione peroxidase among patients of obsessive compulsive disorder as compared to their first degree relatives and healthy controls, and also significant difference was found among them and no significant difference in have been found in the serum cortisol levels among the three groups. This study also did not find any significant correlation between study parameters and clinical variables of patients of ocd.

Conclusion: Oxidative stress was increased in patients of obsessive compulsive disorder compared to their first degree relatives and healthy controls.

Keywords: Obsessive compulsive disorder, oxidative stress, first degree relatives

A Study Of Gender Difference In The Prevalence Of Depression And Anxiety In Parents Of Child Psychiatric Patients

Dr. Nabanita Sengupta, Dr. H. R. Phookun

Department Of Psychiatry, Gauhati Medical College And Hospital, Gauhati. Email Id : [email protected]

Introduction: Mental illnesses cause great stress not only to the patient but also to the care givers of the patient. Mostly the primary caregivers in child psychiatric patients are parents and are responsible for providing physical and emotional support for the mentally ill patients for long periods from months to years. This responsibility in turn can affect the parents own mental and physical health and compromise their role as a care giver. Mothers often suffer more burden of the patients illness than fathers. Aims of the study were 1. To assess the gender difference in the prevalence of depression in parents of child psychiatric patients. 2. To assess the gender difference in the prevalence of anxiety in parents of child psychiatric patients

Methodology: 50 fathers of child psychiatric patients were compared with their spouses (50 mothers of child psychiatric patients) and were administered hamilton depression rating scale (hdrs) and hamilton anxiety rating scale (hars) and their scores were compared.

Results: Significantly high proportion of mothers had depression as compared to fathers (88% vs 56%, p= 0.0007). Mothers also had higher ham-d score as compared to fathers. (12.18 Vs 9, p<0.0001). Prevalence of anxiety did not differ among mothers and fathers (p=0.4356). However mothers had higher HAM-D score as compared to fathers (13.06 Vs 9.92, P=0.0021).

Conclusion: Depression and anxiety were more prevalent in mothers as compared to fathers of child psychiatric patients.

Key Words: Care Givers, Child Psychiatric Patients, Depression, Anxiety

A Randomized Controlled Trial Of rtms Augmentation In Depression

Dr. Abhijeet Shrivastava, Dr. Jyoti Singh , Prof. P K Dalal, Dr. Eesha Sharma, Dr. Sujit Kumar Kar

Department Of Psychiatry, King George Medical University, Lucknow, U. P. Email Id : [email protected]

Background: Major depression is a serious disorder of great clinical and sociological importance. Resistance to the available treatment strategies is observed in 30-40% of patients. To date mainly effectiveness of high frequency rtms has been studied in major depressive disorder. However studies on low frequency rtms also provided equal effectiveness and better tolerability profile.

Aims: To study the efficacy of RTMS augmentation in depression with inadequate response to antidepressant(s).

Method: The study was a randomized, double blind, sham controlled trial of 3 week duration with 3 week follow up period. 29 Major depression patients were randomly assigned to receive 18 sessions of real tms (14 patients) or sham TMS (15 patients) of the right dorsolateral prefrontal cortex as adjuvant treatment to pharmacotherapy. The main stimulation parameters were" low frequency (1hz) rtms with 60 pulses/train in 20 trains at 100% ofthe resting motor threshold over right dorsolateral prefrontal cortex (dlpfc). Blinded external evaluators administered the montgomery asberg depression rating scale. Statistical analysis used were fisher exact test and unpaired t test.

Results: Low frequency rtms showed significant improvement in the true rtms group starting from second week onwards. Improvement was also sustained at 3 week followup. Response rate was significantly higher in true rtms group as compared to sham rtms group; 85.7% In true rtms and 13.3% In sham group (p<0.0001). Headache was the only side effect that was observed in both the groups.

Conclusion: Low frequency RTMS over right DLFPC is better than sham rtms in patients of depression.

Keywords: Depression, Transcranial Magnetic Stimulation, Low-frequency Rtms, Dorsolateral Prefrontal Cortex.

Prevalence Of Substance Use Disorder Among The Outpatients Of A Tertiary Care Psychiatric Hospital: A Cross-sectional Study

Dr. Tathagata Mahintamani, Dr. Savinder Singh

Email Id : [email protected]

Background: Substance use disorders are commonly encountered co-morbidity among patients with mental illness. The multifaceted psycho mimetic effects of substance may mimic, induce, aggravate, and sometimes attenuate different psychiatric symptoms leading to their rampant use among psychiatric population. This often complicates the presentation and treatment options, jeopardising the treatment outcome. The prevalence of substance use disorders in psychiatric population vary widely across different socio-cultural, religious contexts, geographical areas as well as among various psychiatric illnesses. There is no published study measuring the prevalence of substance use in outpatient psychiatric population in northern india.

Aim: To measure the prevalence of substance use disorders among the psychiatric outpatients in relation to their socio-demographic variables.

Materials & Methods: Two hundred adult patients, having a psychiatric diagnosis as per icd 10 DCR (not having any neurological problem, mental retardation, substance intoxication, dependence or substance induced psychosis as primary diagnosis), attending the outpatient department of vidyasagar institute of mental health (Govt. Mental hospital), punjab for the first time were randomly selected after taking informed consent. These patients diagnoses in the outpatient department were made by a psychiatrist having post graduation qualification. Patients were subsequently assessed using socio demographic proforma and alcohol smoking and substance involvement screening test (assist) for assessment of substance use disorder.

The data are statistically analyzed using SPSS 20 software.

Result & Conclusion: To be discussed at the time of presentation.

Keywords: Substance Use Disorder, Prevalence, Psychiatric Population.

Study Of Psychopathology In Juvenile Criminal Offenders And Its Relation To The Nature Of Crime

Dr Bhakti Murkey, Dr. Gunjan, Dr. Pradeep Sharma

Dr Punjabrao Deshmukh Medical College, Amravati. Email Id : [email protected]

Background/Introduction: The prevalence of antisocial and delinquent behavior in juveniles has increased dramatically over the past decades. It is posed that these changed might reflect underlying psychopathology in children contributing to criminal behavior as opposed to subjects without significant psychopathology. This study was conducted with the objectives to study the nature and intent of crimes committed by juvenile delinquent population and to study the relation of externalizing and internalizing behaviors of children with crime.

Methodology: 60 boys (between age 12 and 16 years) were chosen randomly with permission from the presiding officials, from the juvenile home, jaipur affiliated to the government of rajasthan. These children, who were on variable probation period were interviewed regarding the nature of crime committed by them, intent of crime, nature of harm/injury caused and their socio-economic and educational background. The childhood behavior check-list (self report) and the adhd rating scale (self report) were applied on them. The data was classified into externalizing and internalizing symptomatology and a qualitative assessment was done with the help of spss 22.0

Results: Both externalizing (p=0.011) And internalizing (p=0.019) Symptoms were significantly associated with the severity of crimes committed. Externalizing symptoms significantly manifested in the crimes as intentional (p=0.030).

Conclusions: Criminal behaviour by children and adolescents is a result of multiple factors including environment, parenting, socio-economic background, education, peers and psycho-pathology. Early identification and management of externalizing symptoms in childhood and adolescence is critically important for successfully preventing violence/crime in adulthood.

Keywords: Juvenile Delinquency; Crime; Psychopathology; Intent

Study Of Percieved Stress In Spouses Of Alcohol Dependent Individuals Attending Governament Hospital For Mental Care Visakhapatnam

Dr. Madhavilatha Kalla , Dr. P Padma, Himakar. P

Government Hospital For Mental Care, Visakhapatnam. Email Id : [email protected]

Background: In India 62.5 Million people are alcohol users and 4% of males are alcohol dependents . Alcohol use not only disrupts the life of person who consumes alcohol , but also the life of family members especially their spouses. It has impact on the marital relationship and consequently on the mental health of spouses and it has always been a challenge to understand and treat. This study was carried out to know the level of perceived stress in spouses of alcohol dependent individuals.

Materials And Methods: A cross sectional study was conducted to assess the level of perceived stress in spouses between age groups 18-60 years of alcohol dependent individuals attending government hospital for mental care, visakhapatnam, using perceived stress scale .

Results: Out of 80 subjects majority 38 (47.5%) Belong 30-39 age group, 58(72.5%) Subjects had duration of marriage above 10 years , in 50 (62.5%) Subjects ,age at onset of alcohol use between 20-24 yrs,mean age at onset of alcohol intake is 23yrs, 70(87.5%)Subjects had daily intake of alcohol , mean duration of alcohol intake 17.3 Years , in 60(75%) subjects ,high level of stress observed ,out of which , 44(55%) hadœmuch higher than average level of stress, 16(20%) had slightly higher than average level of stress, in spouses with duration of alcohol intake more than 10 years.

Conclusion: Our study shows high prevalence of much higher than average level of stressin spouses of alcohol dependent individuals, increased stress with duration of marriage and alcohol intake.

Key Words: Perceived Stress, Spouse,alcohol Dependent Individuals,perceived Stress Scale.

Asenapine Triggered Depressive Episode In A Case Of Schizophrenia

Dr. Pallavi Sinha, Dr. Amit Garg

Institute Of Human Behaviour And Allied Sciences, Delhi. Email Id : [email protected]

Introduction: Asenapine sublingual tablet is indicated for the treatment of schizophrenia and for the acute treatment of manic or mixed episodes associated with bipolar i disorder. Notable psychiatric adverse effects reported with asenapine therapy have been insomnia (6%), anxiety (4%), depression (2%) and suicidal ideation (4%).The aim of this paper is to present a case and discuss the possibility of a treatment emergent depressive episode with asenapine in a case of schizophrenia.

Case Report: A 19 year old male with schizophrenia with partial improvement on olanzapine 20mg per day presented to our centre was started on asenapine in a dose of 5 mg per day which was increased to 20 mg per day in 2 week along with olanzapine 20 mg per day. Family reported worsening in depressive symptoms as dose of asenapine was increased. Stoppage of asenapine led to improvement of depressive symptoms and he continued to remain asymptomatic on a combination of two second generation antipsychotic agents.

Discussion: The multireceptor profile of asenapine mainly antagonism of serotonergic and dopamine receptors in prefrontal cortex may have led to variance in bioamine function culminating in a depressive episode in the index case. The complex interaction with antagonism at 5HT2A, 5HT2C postsynaptic serotonin receptor and partial agonism of 5-ht1a presynaptic receptors and antagonism at alpha 2 adrenergic and presynaptic nor epinephrine receptor can theoretically decrease serotonin release leading to hypothetical serotonin deficiency syndrome leading to depression and anxiety symptoms. Cautious use of asenapine in cases with schizophrenia and bipolar disorder is hence emphasised as it can precipitate treatment emergent affective switch (teas) in vulnerable/high risk patients.

Key Words: Asenapine; Schizophrenia; Depressive Episode

Study Of Expressed Emotion And Caregiver Burden In Bipolar Manic Patients

Dr. Bhakti Hemant Murkey, Dr. Gunjan, Dr. Pradeep Sharma

Dr Punjab Rao Deshmukh Medical College, Amravati. Email Id : [email protected]

Background: Bipolar affective disorder is known to be a challenging and burdensome entity in the lives of patients and also their caregivers. This leads to expression of negative emotions by the family members on patients and further adds to worsening of the disease process. The current study explores caregivers burden and level of expressed emotions in bipolar manic patients.

Materials And Methods: 30 consecutive patients diagnosed with bipolar affective disorder; mania (as per icd 10 criteria) and 30 respective caregivers were recruited from opd at psychiatric center sms hospital jaipur. The burden assessment schedule (BAS), young mania rating scale (ymrs), family emotional involvement and criticism Scale-ii (feics) were applied. Spss 20.0 Was used as a statistical tool.

Results: The scores of bas and its domain perceived severity were significantly associated with feics total scores (p=0.043). Bas total score (p=0.001), Impact on well-being (p=0.001), Impact on relationships with others (p=0.031), Perceived severity of disease (p=0.004), Feics total score (p=0.002) And its avoidance (p=0.036) Sub-scale were significantly associated with number of episodes of illness. Ymrs scores were not significantly associated with feics or bas total score or its domains.

Conclusion: Avoidance by caregivers may be a predictor of relapses through its association with more number of episodes. Expressed emotions and burden of care are more dependent on relatives appraisal of the patient's condition than on actual deficits. This highlights the need for addressing expressed emotion and needs of caregivers during psycho-social interventions in order to alleviate their burden while managing mentally ill patients.

Keywords- Mania; Expressed Emotions; Caregiver Burden

Comparision Of Burden Among Care Givers Of Patients With Bipolar Affective Disorder And Alcohol Dependence Syndrome

Dr. Sujitha Gurram, Raghuram Macharapu,

Pramod Kr Mallepalli, Ravulapati Sateesh Babu

Mamata Medical College, Khammam. Email Id : [email protected]

Introduction: The present study is to compare burden on caregivers of patients with bipolar affective disorder (BPAD) and alcohol dependence syndrome (ADS).

Materials And Methods: The present study is a cross sectional hospital based comparitive study which is conducted in in-patient department of psychiatry,mamata medical college ,khammam,telangana. Study period is from sep 2015 to aug 2016.The study sample consisted of 60 patients with bpad and their care givers , 70 patients with ads and their care givers.The tools used are family burden interview schedule (FBIS),severity of alcohol dependence questionnaire (SADQ), icd-10 criteria for diagnosis.Statistical analysis was done using chi square test.

Results: Care givers of BPAD and ads patients experienced significant burden but there is no statistically significant difference in burden experienced by them.In care givers of BPAD,burden is more in depressive patients than in maniac patients and the correlation is statistically significant.Burden was significantly more with care givers of severe ads patients than in mild and moderate ads patients.

Conclusion: The study suggests need for sensitisation of psychiatrists to evaluate and treat the care givers of patients with any psychiatric illness like bpad and ads.

Keywords: Care Giver,burden,bpad,ads

A Comparative Study About The Domains Of Biological Rhythms In Patients With Bipolar Disorder Under Remission

Dr. Bhaskar Katram , Dr. Ch. Siva Kumar, Dr. Sindhuri Potluri

Institute Of Mental Health, Osmania Medical College, Hyderabad. Email Id : [email protected]

Background: Domains of biological rhythms like sleep, activity, socialization and diet are important aspects governing the human life. The patients suffering from bipolar disorder have issues affecting their psychiatric illness and its course. Study of this factors may help in improved compliance with better quality of living. Thus, reducing the need for hospitalizations.

Aims And Objectives: 1) To study the domains of biological rhythms in bipolar disorder patients under remission and analyze the clinical variables based on their socio-demographic profile and drug compliance. 2) To compare among various groups in the sample.



All patients (n=100) were enrolled from tertiary care hospital. The inclusion criteria were (a) age >18 years, (b) fulfilling icd 10 criteria for bipolar affective disorder, and (c) meeting remission criteria defined as a score 8 On the 17-item hamilton depression rating scale (HAM-D) and a score 5 On the young mania rating scale (YMRS) score for at least 2 months prior to the assessment of circadian rhythms. 100 Control participants matched by age, gender, and education with no psychiatric disorders that manifested interest in participating in the study were included.


Biological rhythms interview of assessment in neuropsychiatry (brian):

The biological rhythms interview of assessment in neuropsychiatry (brian) was used to assess biological rhythm disturbance.

Clinical and socio-demographic data were assessed using a standardized protocol. Written informed consent was obtained.

Results And Conclusion: The results are yet to be analyzed and will be discussed later.

Keywords: remission, Biological rhythms, Bipolar disorder

Social Participation And Life Satisfaction Among Caregivers Of Persons With Severe Mental Disorders Attending A Day Care Facility In Bangalore, India

Dr. Nikitha Harish , Dr. Shanivaram.k , Dr. Krishna Prasad.m, Dr. Hareesh.a, Dr. Jagadisha Thirthalli, Dr. Aarti Jagannathan, Dr. Aneel Raj

Department Of Psychiatry, NIMHANS. Email Id : [email protected]

Background: In India, more than 90% of patients with chronic mental illness live with their families. Family care-giving for persons with severe persisting mental disorders has been associated with reduced quality of life and high levels of burden. There is dearth of literature available on the assessment of social participation and life satisfaction among caregivers which would be specific indicators predicting the quality of life of caregivers and detrimental in determining the process of caregiving which could be crucial to the recovery of patients.

Aim: The present study aims to assess the social participation and life satisfaction among caregivers of persons with severe mental disorders.

Methodology: Caregivers of persons diagnosed with a severe mental disorder (n=30), attending a day care facility were assessed on participation scale, satisfaction with life scale (SWLS), subjective happiness scale and bradburn scale of psychological well-being.

Results: The study is ongoing and would be presented at the conference.

Conclusion: The study is ongoing and would be presented at the conference.

Key Words: Social Participation, Lifestyle, Care-givers, Severe Mental Disorders.

A Study Of High Risk Behaviours In Patients With Alcohol Dependence Syndrome

Dr. Pavurala Swathi 1 , Raghurammacharapu 2 , Pramod Kr Mallepalli 3 , Ravulapati Sateesh Babu 4

Department Of Psychiatry, Mamata Medical College, Khammam. Email Id : [email protected]

Introduction: The present study is to assess the high risk behaviours in patients of alcohol dependence and to study the association between high risk behaviour and severity of alcohol dependence.

Materials And Methods: This is a cross-sectional study conducted from September 2015 to August 2016 among 242 patients admitted for treatment of alcohol dependence in mamata medical college and hospital, khammam,telangana. Tools used are severity of alcohol dependence questionnaire(sadq) , high risk behaviour questionnaire (HRBQ) and icd-10 criteria for diagnosis. Statistical analysis was done using chi-square test.

Results: Road traffic accidents came out to be most frequent high risk behaviour.Severity and duration of alcohol dependence were significantly associated with high risk behaviours.

Conclusion: The present study helps to target these high risk behaviours as part of treatment intervention to reduce mortality and morbidity in heavy drinkers.

Key Words: High Risk Behaviour, Alcohol Dependence Syndrome

Prevalence Of Attention Deficit Hyperactivity Disorder Among Primary School Children In Cachar, Assam, North-East

Dr. Hasina Anjuman Choudhury, Dr. Prosenjit Ghosh, Dr. Robin Victor

Department Of Psychiatry,Silchar Medical College & Hospital, Silchar. Email Id : [email protected]

Background: Attention deficit/ hyperactivity disorder (adhd) is characterized by a pattern of diminished sustained attention and higher levels of impulsivity in a child or adolescent than expected for someone of that age and developmental level. Since children with this disorder spend a large amount of time at school, school history and teachers reports are important in evaluating the symptoms and forming a diagnosis.

Aims And Objectives: (i) To identify the prevalence of attention deficit hyperactivity disorder (adhd) in primary school children. (Ii) to identify the gender difference in the prevalence of ADHD. (Iii) to assess the subtypes and comorbidities of ADHD.

Methodology: This is a cross sectional study of school going children selected from 2 different schools in cachar district.300 Children aged between 6 and 11 years were selected from two schools in cachar district.. The presence of adhd was assessed by using conners abbreviated rating scale (cars) given to parents and teachers. The children identified as having adhd were reassessed for typing of adhd & also to identify the presence of any comorbid illness by administering vanderbilt scale (vadprs & vadtrs) meant for the parents and teacher respectively.

Statistical Analysis: Descriptive statistics and unpaired t-test were applied for statistical analysis.

Results: The prevalence of ADHD among primary school children was found to be 12.66% And male: female ratio being 5.33: 1. The prevalence was highest in lower middle socio?Economic group and most common subtype being combined type of adhd and comorbidity being oppositional defiant disorder(81.57%).

Conclusion: The present study shows a high prevalence of adhd among primary school children. It is important to evaluate the disease in details to have better understanding and management.

Key Words: Attention Deficit Hyperactivity Disorder, Conners Abbreviated Rating Scale, Prevalence, Comorbidity.

Study Of Socio Demographic Characteristics And Psychiatric Morbidity In Patients With Chronic Kidney Disease Undergoing Hemodialysis

Dr. Pankaj Kumar, Prof. D.K. Vijayvergia, Dr. Suresh Kumar Parihar

Deptt. Of Psychiatry, GMC, Kota. Email Id : [email protected]

Background: Chronic kidney disease (CKD) is a worldwide public health problem, including india. Constant stress caused by not only the disease, but also the development of functional and nutritional limitations, medication side-effects, comorbid chronic diseases, changes in self-perception, and fears of death, predispose these patients to numerous emotional problems including depression and anxiety.

Objectives: To find out sociodemographic characteristics, prevalence of psychiatric illnesses and severity of depression and anxiety disorder in patients with chronic kidney disease undergoing hemodialysis.

Materials And Methods: The sample of study would be constituted of 100 random patients suffering from CKD who underwent dialysis procedure in dialysis unit of new medical college hospital, kota.

All the patients will be evaluated on the specially designed performa to obtain socio-demographic data, those who will be diagnosed as of anxiety and depression will be further evaluated for severity by HAMD, HAMA. Data so obtained will be tabulated, analysed & conclusion will be drawn using suitable statistical methods.

Result And Conclusion: Will be discussed at the time of presentation in the light of previous studies.

Key Words : Sociodemographic Characteristics ,psychiatric Morbidity, Chronic Kidney Disease, And Hemodialysis .

A Clinical Study Of The Prevalence Of Psychiatric Comorbidities Among Patients With Cannabis And Opioid Use Disorders

Dr. Reema Dey , Dr Deepanjali Medhi

Dept. Of Psychiatry, Gauhati Medical College & Hospital, Gauhati. Email Id : [email protected]

Introduction: Comorbidity denotes the presence of a distinct clinical entity that has existed or may occur during the clinical course of a patient with the index disease. The prevalence of patients with dual diagnosis suffering from a psychiatric disorder along with co-occurring substance use disorders are increasing through time which worsen treatment outcome and increase relapse rates. The aims of the study is to see the prevalence of different psychiatric comorbidities among patients with cannabis use disorder and opioid use disorder.

Methodology: 40 Cases of cannabis dependence and 40 opioid dependent patients are selected based on ICD-10 criteria for substance dependence. The psychiatric comorbidities are assessed in them using mini international neuropsychiatric interview (7.0 Based on dsm v) and compared.

Results: In our study, out of 40 cannabis dependent patients psychiatric comorbidities are found in 39(97.5%). Out of 40 opioid dependent patients, 25 (62.5%) Have comorbid psychiatric disorder. Among the cannabis dependent patients, the comorbidities are found to be mood disorder 18 (45%), followed by psychotic disorder in 16 (40%), antisocial personality disorder 3 (7.5%) And anxiety disorder in 2 (5%). Among the opioid dependent patients, the comorbidities are found to be mood disorders 13 (32.5%), Followed by antisocial personality disorder 8(20%), anxiety disorder in 4(10%).

Conclusion: From the present study we came to the conclusion that psychiatric comorbidities are common among both cannabis and opioid dependent patients and early detection and treating the comorbidity is essential for better treatment outcome and prevention of relapse.

Keywords: Dependence, Comorbidity, Substance

Expectations Of Patients Using Mental Health Services

Dr. Ramananda Kishore Kavi, Dr. Kiran Singuru

Department Of Psychiatry, Government Hospital For Mental Care, Visakhapatnam. Email Id : [email protected]

Background: Treatment in psychiatry is almost always individualized to cater to the needs of the patient. Improvement of quality of life of the patient is the ultimate goal of any psychiatrist. Satisfaction with life is a direct reflection of the quality of care. Thus assessment of the patients expectations and their experiences is essential in order to provide complete care to the patient.

Aims And Objectives: This study aims to measure experiences and expectations of patients using mental health services. This study also aims to measure the relationship of these expectations with socio-demographic data, psychiatric diagnosis, and duration of the illness.

Methodology: Outpatients and inpatients attending government hospital for mental health, visakhapatnam were invited to the study. After taking a written informed consent, socio-demographic data was collected. Then they were asked to complete the carers and users expectations of services, user version(cues-u) questionnaire. This is a 16 item self-questionnaire divided into comparison score and service satisfaction score. Statistical analysis will be done on the data along with correlation between demographic variables and scores obtained on the scale using SPSS software.

Results: Results will be declared after completing the study within one month. Results were delayed to include more patients to increase the sample size which leads to better statistical results and thus better clinical application.

Keywords: Expectations, Experiences, Carers And Users, Quality Of Life

Asenapine Triggered Depressive Episode In A Case Of Schizophrenia

Dr. Pallavi Sinha

Email Id : [email protected]

Prevalence Of Depression In Geriatric Population And Associated Factors

Dr. G J Vijay Mathews , Prof. Dr D. Vijaya Lakshmi, Dr. Vijayasree

Andhra Medical College, Andhra Pradesh. Email Id : [email protected]

Background: Depression is regarded as the most common psychiatric illness among geriatric population. It accounts for more than half the psychiatric morbidity in indian elderly

Objective: To assess prevalence of depression, quality of life and associated factors in geriatric population in an urban area in visakhapatnam, a south indian city of Andhra Pradesh, India.

Method: 60 participants aged over 60 years in an urban area in visakhapatnam city of andhra pradesh were interviewed to assess their psychiatry morbidity, quality of life and associated factors

Methodology: The cross sectional epidemiological study was conducted in an urban area in Vishakapatnam city with a sample of 60 geriatric population.

The tools used for the study are sociodemographic proforma, geriatric depression scale (GDS), WHO QOL BREF Scale.

Analysis: Descriptive statistics and other appropriate statistical studies have been used.

Results: Results will be discussed.

Keywords - Geriatric Population, Depression, Associated Factors..

Comparative Follow Up Study Of Alcohol Dependent Patients With High And Low Motivation For Relationship Of Craving In Relapse At Tertiary Care Hospital Of Surat

Dr. Prashant Agrawal,Dr. Pradhyuman Chaudhary,

Dr. Ritambhara Mehta, Dr. Kamlesh Dave

Email Id : [email protected]

Introduction: Alcohol dependence is a complex health problem which has a course of frequent relapses due to craving (craving - a strong desire to consume alcohol). The treatment of alcohol dependence is important to reduce its mal-effects on health and social as well as occupational impairment & consequences and to improve the well-being and social functioning of patient affected. In this study motivation will be assessed and 2 groups with high and low motivation will be compared for craving and relapse of alcohol use.

Aims And Objectives: 1. To evaluate the relationship of relapse with craving during 2 month follow up after inpatient treatment in alcohol dependents. 2. To compare the frequency of relapse and quality of craving for alcohol in two groups of alcohol dependent patients, with high and low motivation.

Methodology: This is comparative follow up study in 2 groups [high and low motivation] of alcohol dependent patients between 18-60 years with no other psychiatric and medical co morbidity for 8 weeks after alcohol detoxification for craving and relapse of alcohol. Motivation is assessed by socrates 8a scale and craving by ACQ-SF-revised version in every 2 weeks follows up till 8 weeks.

Results And Conclusion: Total 64 patients were enrolled in study out of which 53 patients relapsed to alcohol use due to high craving 9 patients were completed the study without relapse of alcohol use and two patients were not came for follow up. In low motivation group 87.5% Patient relapsed and high motivation group 78.1% Were relapsed having high craving for alcohol. Craving is considered as independent important risk factor for relapse in alcohol use irrespective of age, sex, educational, marital status, socioeconomic status and motivation which has to be given foremost priority for long term alcohol deaddiction.

Keywords: Alcohol dependence,relapse, tertiary hospital

Socio-demographical Factors, Psychiatric Comorbidities & Quality Of Life In Patient Of Atopic Dermatitis

Dr. Mayuresh Bodliya, Prof. R.s.rathore, Prof. C.S. Sushil, Dr. Shreyance Jain, Dr. Suresh Parihar, Dr. Rajmal Meena, Dr. Mahipal Singh

GMC, Kota. Email Id : [email protected]

Background: Atopic dermatitis (AD), also known as atopic eczema, is a type of inflammation of the skin (dermatitis). It results in itchy, red, swollen, and cracked skin. Dermatological patients invariably suffer one or the other psychological problems which may escalate to the extent of a mental disorder. It has also been put forward that intense itching in dermatitis leads to sleep disturbances causing irritable behavior, decreased concentration, and decreased threshold of tolerance.

On exploring the patients suffering from dermatitis, some traits commonly found are of feelings of insecurity, inferiority and inadequacy, tension, anxiety, depression, aggressiveness, emotional liability, hyperactivity.

Our aim to quantify the mental health burden specifically anxiety and depression associated with atopic dermatitis in our setting.

Materials And Methods: The study was carried out in the outpatient clinic of dermatology department in new medical college hospital, kota. A total of 50 subjects diagnosed with atopic dermatitis were assessed after giving informed consent along with brief semi?Structured performa for collecting demographic and clinical information, GHQ-12, hamilton depression rating scale, hamilton anxiety rating & dermatology quality of life index (DLQI) scale.

Descriptive analysis was done for the socio?Demographic profile and data analysis was done using SPSS software window version.

Results And Conclusion: Will be discuss at the time of presentation.

Key Words:- Atopic Dermatitis, Depression, Anxiety, Quality Of Life.

Study On Sociodemographic Profile And Psychiatric Comorbidity In Patient With Dhat Syndrome Attending Opd In New Medical College Hospital, Kota

Dr. Rajmal Meena ,Prof. C.S. Sushil, Dr. D.K.Sharma, Dr. Mayuresh Bodliya, Dr. Suresh Kumar Parihar, Dr. Mahipal Singh

GMC, Kota. Email Id : [email protected]

Background: That syndrome is a culture-bound disorder which manifests in

The form of preoccupation regarding semen loss among patients in the indian subcontinent. It is associated with vague multiple somatic and psychological complaints such as fatigue, listlessness,loss of appetite, lack of physical strength, poor concentration and forgetfulness. It is commonly accompanied by anxiety or depressive symptoms

Materials And Methods: The study was carried out in the outpatient psychiatry department in new medical college hospital, kota.A total of 50 subjects diagnosed with dhat syndrome as per international classification of diseases-10 (ICD-10) criteria were assessed along with socio- demographic profile, GHQ-12, hamilton depression rating scale, hamilton anxiety rating scale.

Results And Conclusion: Will be dicussed at the time of presentation.

Key Words: Culture Bound Syndrome, Dhat Syndrome, Depression, Anxiety,

Online Social Networking And Depression: A Cross-sectional Analytical Study

Dr. Dhawal Patel , Dr. Lakhan Kataria, Dr. Rohit Bhardwaj

Department Of Psychiatry, Smt. B.K.. Shah Medical College And Research Centre, Vadodara, Gujrat. Email Id : [email protected]

Introduction: Today's digital age of technology and gadgets has made the use of many online social networking sites (SNS) a part of our daily routine. Increasingly rampant use of these have also raised an intriguing question of their impact on users mental health status. Researchers across the globe are now expressing concerns regarding the addictive potentials of SNS and their deleterious effect. In this analytical cross sectional study we investigated the relationship between online social networking and depression amongst under graduate students.

Methods: A total of 1392 students of medical and dental undergraduate students were interviewed using an anonymous structured questionnaire including details of age, gender, number of hours spend daily on SNS and becks depression inventory- second edition (BDI-2).

Results: Out of 1392 students 707(51%) were male and 685(49%) were female. Mean age of study participants was 19.09 Years. Average daily time spent on online social networking was 1.10 Hours (sd=1.749 Hrs). Significant proportionate relation was found between the time spent on social networking and depression severity as evident by BDI- ii scores (?2 Value=19.594, Df=9, p=0.021).

Conclusions: Result from our study indicate a positive correlation between online social networking and depression.

Key Words: Social Networking, Sns, Depression, BDI- ii, Undergraduate Students, Internet.

Referrals To Psychiatry In A Rural Teaching Hospital

Dr. V Vishwak Reddy , Dr. V Anil, Prof. M Dattatrey

Kamineni Institute Of Medical Sciences. Email Id : [email protected]

Background: Studying the referrals to the department of psychiatry from the other disciplines, in a rural teaching hospital with multi-specialty services having a wider catchment area of a district, is a useful indicator of psychiatric awareness among the clinicians and their intent to utilize the consultation-liaison psychiatry services. Outcomes of such studies certainly help to evolve effective strategies to further develop the field of c-l psychiatry to bolster comprehensive healthcare.

Methodology: This study includes all the referrals to the department of psychiatry from other disciplines of the hospital over a period of three years. Collected data includes details about the source and reasons for the referrals, sociodemographic and clinical profiles of the referred patients.

Results: In total 680 referrals were studied during this period. Frequency of referral was 0.18%. Most of the referrals, both inpatient and outpatient, were from general medicine (65.7%) Followed by general surgery (7.5%) And orthopedics (7.4%). Most common reasons for referral were evaluation of abnormal behavior (24.2%), Medically unexplained physical symptoms (19.1%) And suicide attempt (15.1%). Psychiatric illness was diagnosed in 85.7% Of the referrals and the most common diagnoses were substance use disorders (21.5%) And neurotic, stress-related and somatoform disorders (18.2%).

Conclusion: Stigma and superstition are the twin scourges that plague psychiatry at all levels. The vital role of the multi-specialty teaching hospitals in addressing these issues, needs no special mention. However, in the present study a low referral rate indicates under utilization of the available psychiatric services, which warrants a sincere search for the reasons. Perhaps an unbiased mindset of the medical fraternity to accept c-l psychiatry as a subspecialty, will empower the systems of integrated comprehensive health care, both in hospitals and community as well.

Keywords: rural teaching, multispeciality

Study Of Psychiatric Comorbidity In Patients With Vascular Headache Using A Short Structured Clinical Interview In A Psychiatric Opd Of A Tertiary Teaching Hospital In Western India

Dr. Nimish Gupta, Dr. Vivek Kumar

Subharti Medical College. Email Id : [email protected]

Background/introduction: The comorbidity of headache and psychiatric disorders is a well-recognized clinical phenomenon warranting further systematic research. When present, psychiatric comorbidity complicates headache management and portends a poorer prognosis for headache treatment. The relationship between migraine and psychiatric disorders remains of growing interest to headache researchers and clinicians alike. Identifying and managing comorbid illness is essential and can prove challenging in the treatment of patients with migraine.

Methodology/ Materials And Methods: The cross sectional study was done at the psychiatry opd in the department of psychiatry at subharti medical college, meerut. A total of 20 patients with newly diagnosed migraine were included in the study. Demographic and clinical profiles of these patients were noted in a specially designed socio-demographic and clinical data sheets prepared for the present study. The structured clinical interview for DSM 5 Axis I disorders (SCID-I) was applied to the patients to diagnose any axis 1 psychiatric disorders and were also clinically correlated as per international classification of diseases 10. Simple statistical procedures like frequency, percentages,˜t-tests and chi-square tests were used for analysis of data thus obtained.

Results: Will be discussed at the time of presentation.

Conclusion: Will be discussed at the time of presentation.

Keywords: Migraine, Psychiatric Comorbidity, General Assessment Of Functioning.

An Atypical Presentation Of Psychiatric Symptoms In Wilsons Disease

Dr. Manamohan N, Dr. Bhavya Acharya, Dr. Divya Hegde, Dr. Johnson Pradeep

Email Id : [email protected]

Introduction: Wilsons disease is an autosomal recessive disorder which affects copper metabolism due to mutations in ATP 7b gene.Psychiatric manifestations in this disorder has been well known with about one fifth of the people suffering from depression. Personality changes but not mood or psychotic disorders are noted to correlate with severity of neurological involvement in this disease. Presentations with mood symptoms is a rare scenario.

Method: In this report we describe the case of a 30 year old male with presentation of mood symptoms in the background of personality change and psychotic disorder

Case: A 30 year old male who presented initially to psychiatric clinic 7 months back with 3 years duration of illness characterised by apathy, withdrawal, anhedonia and psychotic symptoms. On lab evaluation he was diagnosed with wilsons disease. He was then treated with chelating agents and with adequate dose of olanzapine with which he responded to psychotic symptoms. He was behaviourally better for four to five months but did not reach premorbid functioning. Then he developed an episode with classical features of mania like elated mood, overfamiliarity, disinhibited behaviour, increased libido, overenergetic and decreased need for sleep since last 1 month.

Conclusion: We hereby illustrate a case of atypical presentation of psychiatric symptoms in wilsons disease suggesting bipolar disorder in the background of personality change and psychotic disorder adding to the sparse literature in this regard. We would discuss the current understanding on the association of various psychiatric disorders with a special emphasis on manic and bipolar disorders in wilsons disease and the challenges in management of the same. Wilsons disease should always be considered in differential diagnosis of psychiatric disorders in young patients, especially if they present with sensitivity to antipsychotics or abnormal liver function tests.

Keywords: Wilson's disease, atypical presentation, Anti Psychotics

Prevalence Of Depression In Myocardial Infarction

Dr. Arunima George, Pradeep Thilakan

Department Of Psychiatry, PIMS. Email Id : [email protected]

Background: The association between cardiovascular disease and depression has been studied and have found the prevalence of depression in post myocardial infarction (MI) to be as high as 30%. The occurrence of depression in mi can affect the patients quality of life and their compliance to cardiac medications,placing the patients life at a greater risk. Hence, the study was aimed to find the prevalence of depression in MI patients and the sociodemographic and clinical correlates, as there is a dearth of studies from this region on this topic.

Materials And Methods: This is a case control study conducted in the department of cardiology at Pondicherry institute of medical sciences. We have assessed 100 cases and 100 controls using mini plus and HAM D. Analysis was done using appropriate statistical tests.

Results: Prevalence of depression in cases was 22% and in controls it was 10 %.( P value=0.011, Odds ratio 2.53). Medical co-morbidities (p value=0.016) And alcohol consumption (p value=0.033)Had significant association with the prevalence of depression in cases.

Conclusion: The prevalence of depression in MI was found to be as high as previous studies done in other parts of the world. Hence, routine screening for depression in MI patients and its prompt management is essential as it can improve the prognosis. Interventions directed towards prevention and adequate management of medical co-morbidities and alcohol use disorder will reduce the risk of both cardiovascular disease and depression.

Key Words: Depression, Myocardial Infarction, Prevalence

Psychiatric Co-morbidities,stressors, Socio-demographic Profile Of Children And Adolescent Patients With Dissociative [conversion ] Disorder In A Tertiary Clinic

Dr Aritra Chakraborty, Prof. Dr Pradeep Kumar Saha, Prof Dr. Avik Kr Layek

Email Id : [email protected]

Introduction: In this study, an attempt is made to try and highlight the socio-demographic profile , associated co-morbidities,stressors among children and adolescent patients with dissociative (conversion) disorder

Method: Place of study: at the out-patient department of the institute of psychiatry,IPGMER,kolkata.

Period Of Study: 1 Year.

Study Design: Cross-sectional.

Sampling Method: Consecutive Sampling.

Sample Size: (n = 42).

Ethical Clearance And Written Consent.

Tools: Semistructured proforma for sociodemographic profile, icd 10 dcr, kiddie-sads - lifetime version (K-SADS-PL), child and adolescent survey of experiences (CASE) .

Results: Among the patients examined: 11.9% - Male, 88.1% - Female; 23.8% - Urban, 76.2% - Rural; 64.2% - Nuclear; 59.5% - Low ses , 40.5% - Middle ses; the mean age of presentation" 14.8 Yrs ( <12yrs : 11.9%, 12-18 :88.1%),[Among 12-18 :12 to <14:24.3%,14-<16:16.2%,16-18 Yr:59.5%. ]

Dissociative Convulsions [F44.5]-54.8%,Dissociative motor-16.7%,Mixed-23.8%,Trans and posession-4.7%

Comorbid somatoform disorder found in 28.5% Cases,anxiety and depressive disorder in 19.1 % Cases each,ocd in 7%,others in 2.3%.

Study and family related stressors were found in 19.1% Cases each,medical illness in 7% cases,change of place,break up and other stressors in 4.8% Cases each.

Conclusions: Most of the cases were female with a ratio F:M=7.4:1 ,Coroborative with other studies.

More common in adolescent and more specifically in late adolescent group (16-18 yrs)

Most of them were from nuclear family.

Dissociative convulsions were most common presentation .

Study related and family related stressors were the most common stressors.

So, probably reflecting too much pressure for study on young generation.

Somatoform disorders were the most common co morbidity ,anxiety and depressive disorders were even less common than this.

Excessive generalization of our findings is unwarranted for many reasons;.

So ,we should conduct study on a large scale and if possible at community level.

Key words: females, family stress, somatoform disorder

Disability Assessment, Quality Of Life (qol) And Caregiver Burden In Depressive Disorder And Schizophrenia: A Comparative Study

Dr. Bhavya K. Bairy, Dr. Abhay V Matkar

St Johns Medical College And Hospital, Bangalore. Email Id : [email protected]

Background: Psychiatric disorders cause significant burden on caregivers and disability to patients and affects qol of patients.

Aims: This study was planned to compare disability scores, qol and caregivers burden in patients with depressive disorder and schizophrenia.

Methods: Cross-sectional comparative study conducted from december 2012 to december 2014 at SDM CMSH, dharwad. Consecutive patients diagnosed using ICD 10 DCR to have schizophrenia (53) and depressive disorder (64) were included in the study after taking written informed consent. Patients were evaluated using panss, ham d-17, ideas, bas and who-qol bref.

Results: Burden and disability in depressive disorder was lesser than seen in schizophrenia group. QOL was better in depressive disorder group in all domains and difference was statistically significant except in physical domain. Severity of depressive disorder and schizophrenia correlated positively with disability, caregiver burden and negatively with qol.

Conclusions: Patients with depressive disorder had mild to moderate disability while schizophrenia had moderate to severe disability. Qol was poor and caregiver burden was higher in schizophrenia group when compared to depressive disorder. Assessments and interventions targeting improvement in disability, burden and qol should be taken up as future research in patients with depression and schizophrenia.

Key Words: Depression, Schizophrenia, Disability, Burden, Quality Of Life

Thyroid Profile In Psychiatric Patients

Dr. V Anupama, Dr. Swaroopachary, Prof. Sharbandh Raj

Email Id : [email protected]

Introduction: The psychiatric manifestations of thyroid disease have long been recognized. Nicholson et al reported a figure of 8% in newly admitted female psychiatric patients. Hyperthyroidism is prevalent in 0.5% General population and hypothyroidism in 0.5-1%. There is uncertainty, however, about the prevalence of thyroid disorder among the mentally ill. Psychiatric symptoms are common in hyperthyroidism and include irritability, anxiety, emotional liability, mood may resemble agitated or apathetic (in elderly) depression, restlessness, distractibility, psychosis and insomnia. The association between depression and hypothyroidism is consistent with the hypothesis that increases in thyroid hormone accelerate recovery and decreases interfere with recovery.

Aims: 1. To study the prevalence of thyroid dysfunction in psychiatric patients. 2. To correlate the thyroid function abnormalities with psychiatric disorders.

Methodology: A prospective study is being planned to be conducted for duration of 3 months from 1st october to 31st december 2016. Expected total sample size is 500 consecutive psychiatric patients. After a detailed history taking and clinical examination, appropriate psychiatric diagnosis will be done by two senior psychiatrists according to international classification of disease-10, research and diagnostic criteria (ICD-10 RDC). Fasting thyroid function test (including tsh, t3 and t4) will be done in all these patients. Type and severity of thyroid dysfunctions will be correlated with the psychiatric diagnosis of the patients.


1. Semi-structured proforma: to record the socio demographic and clinical details of the patients

2. General health questionnaire (GHQ-12): to validate the level of impairment in patients

3. International classification of diseases" 10, research and diagnostic criteria(ICD-10 RDC) - to diagnose the patients.

4. Global assessment of functioning (gaf): to assess the psychological, social, and occupational functioning of the patients

Statistical Analysis: Will be done using spss 20v

Results And Conclusion: Will Be Discussed At The Conference.

Key words: thyroid dysfunction, Psychiatric comorbidities

Does Medical Comorbidity In Bipolar Disorder Increase With Number Of Episodes Or Duration Of Illness?

Dr. Tess Maria Rajan,Dr. Prashant S Adole, Dr. Ravi Philip Rajkumar, Dr. Balaji Bharadwaj

Department Of Psychiatry, JIPMER. Email Id : [email protected]

Introduction: Medical comorbidities are more frequent in bipolar disorders (BD) than in the general population, contributing to higher mortality due to medical causes in BD. Apart from lifestyle changes due to illness and side effects of the drugs they are on, systemic inflammation may be the cause of the comorbidity. If this holds true, the presence of medical comorbidities must be related to markers of disease progression such as total duration of illness (TDI) and number of mood episodes.

Objectives: Whether the presence of medical comorbidities in BD is related to the TDI and number of mood episodes?

Methodology: This was a cross sectional study and eighty patients with bd (dsm-5 criteria) were assessed for medical comorbidities using a semi-structured questionnaire and file review. The relation between the comorbidities and TDI and number of mood episodes were explored.

Results: Among the 80 patients recruited, the patients with TDI > 5 Years, 42% had medical comorbidities whereas in those with TDI > 5 years, 65% had comorbidities. But the difference was not statistically significant (p=0.100).When the number of episodes were taken into account, in the group of patients with number of episodes ? 4, 54% Had medical comorbidities and in those with episodes >4, 64% had comorbidities and the difference was not statistically significant (p=0.498)

Conclusion: Our study does not support that view that the burden of medical comorbidity among patients with bd increases with number of episodes or total duration of illness. Thus medical comorbidity may not be related to the theory of staging or disease progression in bd.

Keywords- Bipolar Disorder, Medical Comorbidity, Staging

To Study Psychiatric Morbidities (anxiety & Depression) In Patients Suffering From Pulmonary Tuberculosis

Dr.Rishabh Pratap Singh Yadav, Prof. Dr. Sudhir Maurya, Dr.Mahendra Singh Bhadoriya , Dr.Prabhat Sharma

Department Of Psychiatry, Index Medical College Hospital And Research Center, Indore. Email Id : [email protected]

Introduction: Tuberculosis is a chronic infectious disease caused by mycobacterium tuberculosis and is one of the leading causes of mortality worldwide. The bacteria usually attack the lungs,if not treated properly, TB can be fatal. Though the prevalence of pulmonary tuberculosis is high in indian population.

Tuberculosis is second only to HIV/AIDS as he greater killer worldwide due to a single infectious agent.

Symptoms of depression and anxiety have been commonly observed among patients in the aftermath of pulmonary tuberculosis in both indian and international studies

Aim & Objective: To study psychiatric morbidity in pulmonary tuberculosis patients and establish their correlation if any.

Material &methodology: After obtaining informed consent, patients will be interviewed. Special proforma has been prepared for collecting the socio demographic profile.

After this application of HADS scale(hospital anxiety and depression scale).

Result: This study sample consists of 100 patients suffering from pulmonary tuberculosis. The patients included in the study are selected through purposive sampling; from the inpatient department of medicine,chest and tuberculosis wards.

Out of 100 patients 40 patients with psychiatric disorder 6 qualified for dual diagnosis 36 patients are diagnosis to have depressive illness and 10 patients have anxiety disorder.

Conclusion: Pulmonary tuberculosis is significantly associated with depression and anxiety.

These results will highlight the importance of holistic care in managing


Recognition & early intervention of depression and anxiety will improve Quality of life in patients.

Key Words: Anxiety,depression,tuberculosis

Profile Of Dhat Syndrome In North-western India: An Exploratory Study

Dr. Naresh Nebhinani, Dr. Navratan Suthar

AIIMS, Jodhpur. Email Id : [email protected]

Background & Aim: Very few studies have assessed phenomenology and presentation of DHAT syndrome with structured questionnaire. The study was aimed to assess the profile of dhat syndrome for better understanding and management of such cases.

Materials And Methods: By convenient sampling, 30 patients with dhat syndrome were recruited from psychiatric outpatient clinic at aiims jodhpur and evaluated through˜dhat syndrome evaluation questionnaire for the phenomenology, difficulties, and their perception about comprehensive management of Dhat syndrome.

Results: Mean age and duration of dhat syndrome were 28 years and 4.8 Years respectively. Psychiatric comorbidity was following: premature ejaculation-11 patients, erectile dysfunction- 2 patients, and other psychiatric disorders- 6 patients (anxiety disorder-2, depression-2, obsessive compulsive disorder-1). Fluoxetine (15 patients) and multivitamins (10 patients) were prescribed commonly. Majority of patient reported daily secretion of˜watery-milky fluid of semen like consistency, mostly during night fall, urination or arousal. Majority of patients considered excessive masturbation and dreams with sexual content as cause and subsequent physical, mental and sexual weakness as effects of dhat syndrome. Majority of patients were concerned about risk of further weakness- physical and mental, lack of joy and appetite, fatigue and stress. Most of patients opined for need of timely evaluation and comprehensive management with drugs and dietary measures.

Conclusion: Majority of patients had poor sexual knowledge and reported physical, mental and sexual weakness as effect of dhat syndrome. This calls for thorough evaluation of their belief, concerns and physical and psychiatric comorbidity.

Key Words: Dhat Syndrome, Sexual Problem, Culture Bound Syndrome, North-western India

Comparative Study Of Menstrual Irregularities And Sexual Dysfunction In Female Patients Using Olanzapine, Risperidone.

Dr. Chichili Manoj Kumar Reddy, Dr. B.surya Prabha, Dr. Kesavareddy Sudha Rani

Institute Of Mental Health, Hyderabad. Email Id : [email protected]

Guide And Co-author

Introduction: Antipsychotics are known to cause increased prolactin levels, which can lead to decreased blood estrogen causing menstrual irregularities. These drugs reduce dopaminergic activity in tubulo-infundibular pathway raising the prolactin level. Hyperprolactinemia causes amenorrhoea,oligomenorrhoea,anovulation and infertility. Hyperprolactinemia if sustained, vertebral bone mineral density can be reduced, particularly when associated with pronounced hypoestrogenemia. Patients may also complain of decreased libido, weight gain, and mild hirsutism. These side effects have many short term and long term implication on general health of patient or it may also lead to noncompliance with medication. This study is taken up because many patients do not come up with these complaints to the clinician. Discussing sex and the problems associated with it has been a stigmatized area, more so among the females.In this study we are comparing the effects of olanzapine, risperidone on menstrual cycle and changes in sexual function associated with their use.

Methodology: Hospital based cross sectional study at institute of mental health, osmania medical college, hyderabad .Those persons attending the review outpatient department, fulfilling the inclusion and exclusion criteria will be taken as the study subjects. A written informed consent will be taken before study. A semi structured intake proforma will be administered to the subjects. Changes in sexual functioning will be assessed by the antipsychotics and sexual functioning questionnaire (asfq).

Sampling Technique: Convenience sampling.

Statistical Methods: Chi-square test,students t-test,spearmans correlation test depending upon the type of variable being investigated.

Results And Conclusion: Will be discussed at the time of presentation as we have not analyzed the data.

Key Words:-menstrual Irregularities, Sexual Dysfunction, Olanzapine, Risperidone.

Perceived Stress, Quality Of Life And Coping Skills In Patients With Schizophrenia In Remission.

Dr. Soumitra Das

Email Id : [email protected]

Background: Coping refers to the person's constantly changing cognitive and behavioral efforts to manage an encounter appraised as stressful. Coping strategies can be problem focussed or emotion focussed. The former refers to strategies where the emphasis is on finding solutions to the problem, while the latter refers to ways in which the individual regulates the emotional response to the problem situation. Patients of schizophrenia use various coping methods to overcome their distress. In situations of chronic stress, emotion focussed coping strategies are more likely to be adopted

Aim: To evaluate the association between perceived stress, quality of life and coping skills in patients with schizophrenia in remission.

Methodology: A total of 48 consecutive patients with schizophrenia attending the outpatient dept. Of psychiatry, satisfying the inclusion and exclusion criteria were assessed on PANSS, personal and social performance scale (PSP), perceived stress scale, whoqol-bref and ways of coping checklist - revised (WCC).Results were analysed using spss 16.

Results: Highest medial was found in self controlling and positive reappraisal coping skills. Distancing is associated with high physical domain of quality of life whereas patients with good social support score more in social and physical domain of quality of life. Other than seeking social support and planful problem solving, all coping skills are associated with high level.

Conclusion: Patients with history of schizophrenia even though in remission dwell a stressful life. They often need different kind of social support or cognitive aids. In that view, studying their stress level, ability to cope with it and quality of life will help us to manage them in better way.

Key Words: Stress, Coping Skills, Schizophrenia, Remission.

Prevalence Of Internet Gaming Disorder Among Adolescents

Dr. Muchipalli Sai Prashanthi, Dr. Pingali Sreelakshmi, Dr. Umashankar.m

Institute Of Mental Health, OMC, Hyderabad. Email Id : [email protected]

Introduction: The internet has become an integral part of day to day life. Use of internet increased tremendously all over the world in past few years. Inclusion of internet gaming disorder in the latest edition of diagnostic and statistical manual of mental disorders (DSM 5) as a tentative disorder shows the emerging craze for internet gaming. These games are particularly fascinating to adolescents who are at risk for developing internet gaming disorder. Our study is an attempt to know the presence and frequency of internet gaming disorder among adolescents of age group 15-16 in a private school in hyderabad.

Methodology / Materials And Methods: The study was done in private school in urban region

School based cross sectional study.

Students of age group 15-16

Convenience sampling

Scales: a semi structured proforma to obtain sociodemographic data.

Internet gaming disorder scale short form 9(igd-sf9)

The childhood psychopathology measurement scale (CPMS) which is used for children of age 4 to 16 to screen disturbed children.

Permission for the study was obtained from the management of the school and imh,Erragadda.

The children were explained the nature, purpose of study and confidentiality assured. Those willing to give assent were taken up for the study.

The cpms was completed for each student willing to participate in the study by the parent.

The results so obtained were analysed by appropriate statistical methods.

Results And Conclusion: Will be discussed during presentation

Key Words : Internet Gaming , School Based ,adolescents.

Study Of Relationship Between Depression Literacy And Medication Adherence In Patients With Depression

Dr. Dushad Ram, Mrs Neethu Benny

JSS Pharmacy College Mysore. Email Id : [email protected]

Objective: To find out the relationship between depression literacy and adherence to medications in subjects with depression in remission.

Material And Methods: In this cross sectional hospital based study 130 subjects with depression were assessed with socio-demographic data and clinical profoma designed for this study, depression literacy questionnaire and medication adherence rating scale.

Result: Mean score on d-lit and mars was 13.2(Sdβ±2.0) And 0.32(Sdβ± 0.46) Respectively. Two patterns of common incorrect responses were regarding the cognitive and treatment aspect of depression. Female gender had statistically significant higher D-LIT score (mu=2029.0, Z=-.109, P=.025) Than male, and score on D-LIT had significant positive predicted value of score on MARS (r2=0.055, Df=1, f=7.518, Sig=.007).

Conclusion: Cognitive and treatment aspect of depression literacy is lower in patients with depression in india. Depression literacy is more in women and positively associated with medication adherence.

Key words: depression, literacy

Nicotine Abuse Among Medical Professionals: A Study At Tertiary Referral Centre

Dr. Anil Kumar Kumawat, Dr. Parth Singh Meena, Dr. Mahendra Jain, Dr. Charan Singh

JLN Medical College, Ajmer. Email Id : [email protected]

Background: Nicotine abuse is related to number of medical problems ranging from bronchitis to a variety of malignancies. In india nicotine is consumed in various forms like bidi, cigarette, hukka, gutkha, khaini etc. Despite being aware of the harmful effects of nicotine abuse its consumption is widely prevalent and a large section of society including medical professionals consume it on daily basis. In this study, we aimed to investigate of nicotine abuse in our hospital healthcare workers.

Materials And Methods: This cross sectional study was conducted in jln hospital, ajmer during august 2016. A total of 500 (males 350 and females 150) subjects were included in this study. A questionnaire, including demographic findings, tobacco consumption information and the fagerstorm nicotine dependence test, was distributed to healthcare workers and collected.

Results: Among the respondents, 70% of whom were male, and 30 % of whom were female. Overall, the rate of nicotine abuse was 59%; 80% of males and 10 % of females were current nicotine abusers. When classified according to clinic, the greatest rate of smoking was in the surgery department (68.0%), And the lowest rate of smoking was psychiatry department (40.0%). 35% Of smokers had very low levels of dependence, while 24% had very high levels dependence. Ninety-two percent of cases indicated they would prefer to work at a smoke-free hospital. 85% Of cases would support making this facility a smoke-free hospital.

Conclusion: The smoking rate was 59% amongst our hospital health workers. Smoking prevalence was higher in males (80%) than females (10%). 85% Were supportive of a law requiring hospitals to be smoke-free.

Keywords: Healthcare Workers, Medical Facility, Smoking

Psychological Distress In Survivors Of Farmers Suicides In Draught Hit Marathwada Region Of Maharashtra, India

Dr. Manik Changoji Bhise , Dr. Arun Marwale, Dr. Ashish Mohide, Dr. Gaurav Murambikar, Dr. Shraddha Jadhav

MGM Medical College, Aurangabad. Email Id : [email protected]

Background: Successive fourth year of drought in marathwada region led to the large number of suicides in last one year. This leaves behind bereaved and distressed survivors of these suicide victims. Our prior study on farmers suicide survivors found that almost 60% survivors were in severe distress and 20% had suicidal ideas. We planned to evaluate survivors from this region to further strengthen scarce literature from country.

Aims And Objectives: To assess the psychological distress and its correlates in survivors of farmers suicides.

Materials And Methods: This is a cross sectional study conducted in marathwada region in the central india. A predesigned and pretested semi structured questionnaire to assess demographic variables and self-reporting questionnaire-20 questionnaire to evaluate psychological distress in 93 survivors of farmers suicides. Standard descriptive statistics (percentages, means) was used.

Results: Female to male ratio was 2.8. Majority (76%) survivors were adults and 97.8% Were from rural area. Most were spouse (68.8%) Followed by parents (9.6%), Siblings (2.2%), Progeny and others (19.35) Of suicide victims. 75% Were doing farming while rest were having some other sources of income. 81.7% Of survivors were having significant psychological distress. 28% Of survivors had thought of ending their life in past 1 month. Most commonly distress was expressed through somatic symptoms and depressed mood. There was no significant correlation of psychological distress and age, sex, occupation and residence of survivors. There was no significant correlation of psychological distress and relation of survivors with suicide victim.

Conclusions: Survivors of farmers suicides are suffering from significant distress which is needs systematic psychological approach to alleviate their suffering.

Key Words: Farmers Suicide, Psychological Distress, Suicide Survivor

A Correlational Study On Caregiver Burden And Global Functioning In Patients With Schizophrenia And Bipolar Affective Disorder

Dr. Rahul Taneja Dr. Shripathy M. bhat, Professor, Dr. Sanjeev Kumar Manikappa

Email Id : [email protected]

Introduction: Schizophrenia and bipolar affective disorder are chronic mental disorders that are among the top 10 causes of global disease burden. Some of the contributors of the burden are: severity of symptoms, functionality of the patient and support system availability. The aim of this study was to assess the relationship between functionality of patients diagnosed with schizophrenia and bipolar affective disorder and caregiver burden. Method: this cross-sectional study, with two group design was conducted in the outpatient unit of dept. Of psychiatry, Kasturba Medical College, Manipal, in which caregivers and patients (in remission since last 6 months) were recruited. Participants were assessed on caregiver burden and global assessment of functioning using, standardized measures.

Results: strength and magnitude of correlation was calculated using spss-16 and assessed by spearman correlation coefficient. The magnitude and strength and correlation in bipolar affective disorder (rho= -0.75, P<0.001) Is higher in comparison to schizophrenia (rho= -0.57, P<0.001).

Discussion & conclusion: data suggests that severity of burden is strongly correlated with functionality of the patients. In bipolar affective disorder functionality was more strongly correlated with caregiver burden as compared to schizophrenia.

Key Word: Schizophrenia, Bipolar Affective Disorder, Caregiver, Burden, Functionality

Depression, Anxiety And Stress Among Resident Doctors Of A Teaching Hospital

Dr. Srinivasa Kartik V, Dr. Sarthak Dave, Prof. Minakshi Parikh, B.J

Medical College, Ahmedabad. Email Id : [email protected]

Background/aims And Objectives: 1. To compare depression, anxiety and stress among 1st, 2nd and 3rd year resident doctors of a teaching hospital and among clinical vs non-clinical branches as well as surgical vs non-surgical branches

2. To study demographic characteristics among residents and their correlation with depression, anxiety and stress found in them.

Materials And Methods: A cross sectional, non-interventional study was conducted in a teaching hospital in which 520 forms each having a dass-42 (depression, anxiety and stress scale), consisting of 14 questions each of depression, anxiety and stress along with a socio-demographic data sheet, were distributed among resident doctors out of which 462 completely filled forms were returned. The data was entered in microsoft excel version 2007 and the data was calculated using epi info, microsoft excel version 2007 and chi-square test.

Results: The prevalence of depression (27.71%), Anxiety (36.58%) And stress (24.24%) Among the resident doctors of the teaching hospital was found. Also, there was a significant difference (p<0.05) Found among the resident doctors, when variables like duty hours, job satisfaction, strictness of the department, year of residency, pg branches, hobbies and accommodation were considered.

Conclusion: The prevalence of depression (27.71%), Anxiety (36.58%) And stress (24.24%) Among the resident doctors was found, which was much higher than among the general population. It was also higher among residents who are juniors, have longer duty hours, no job satisfaction, residents of clinical branches, residents without any hobbies and also those staying at hostel, when compared with their respective counterparts.

Keywords : Depression, Anxiety, Stress, Prevalence, Postgraduate Residents.

Prevalence Of Depression In Patients Of Alcohol Dependence And Their Quality Of Life

Dr. Jyoti Priya , Dr. R C Jiloha

Hamdard Institute Of Medical Sciences And Research, Delhi. Email Id : [email protected]

Introduction: The distribution of psychiatric illnesses related to alcohol use is universal and the burden is heavy. Alcohol dependence is a chronic illness with fluctuating course with several co morbid psychiatric illnesses. Depression is one of the common co-morbidities prevailing among 16-68% patients of alcohol dependence. Co morbid depression affects the quality of life of these patients.

Aim: To study the prevalence of depression among patients of alcohol dependence and their quality of life.

Material And Methods

Study Design: The study was a cross-sectional hospital based study.

Study population

Fifty patients with alcohol dependence aged 18-60 years consulting the department of psychiatry, gb pant hospital, new delhi.

Study procedure

Patients with alcohol dependence (diagnosed as per icd 10) aged 18-60 years consulting the department of psychiatry, GB pant hospital were taken up for the study as per inclusion and exclusion criteria with written informed consent. Severity of alcohol dependence was assessed and graded by sadq (severity of alcohol dependence questionnaire). Depression was diagnosed as per criteria of icd 10. Ham-d (hamilton depression rating scale) was applied to patients diagnosed with co-morbid depression and rating was done. WHO quality of life scale brief version was applied to determine the quality of life of the patients.

Statistical Analysis: To study the difference between the two groups˜t-test was applied. The difference was accepted statistically significant when˜p value was less than 0.05.

Results: Among patients with alcohol dependence, 32 % had co-morbid depression. The quality of life of patients with comorbid illness was poorer and the difference was found to be statistically significant.

Conclusion: Depression is a common psychiatric co morbidity prevailing among 32 % patients of alcohol dependence. The co-morbid illness deteriorates the quality of life of the patients.

Key Words : Depression, Alcohol Dependence, Quality Of Life

Personality Traits In Patients With Dissociative Disorder: A Study From A North Indian Psychiatric Setting

Dr. Prashant Kumar, Ms J.dubey, Dr., Dr. A.q.jilani, Dr. A.Agarwal, Prof. A. Kohli

ELMCH. Email Id : [email protected]

Background And Objectives: Dissociation may be seen as a result of a disturbance or alteration in normally integrative functions of identity, memory or consciousness .Personality is a relatively stable pattern of behavior that determine the overt expression of nature of dissociative symptoms. This study aimed to investigate the role of personality traits in patients with dissociative disorder and compare it with the healthy controls.

Methodology: It is a cross sectional study on 50 subjects of dissociative disorder diagnosed as per ICD 10 criteria and 50 age, sex, matched healthy controls. Purposive sampling method was used for the study. Semi-structured performa was used for socio demographic details and 16 personality factor scale were applied on both the groups.

Results: Study revealed that both groups were comparable on socio- demographic and their personality profile. Females tend to be emotionally less stable, get easily upset, stubborn, tense, threat- sensitive, apprehensive and appeared tense and frustrated.

Conclusions: Findings of the study are suggestive that personality traits attributed to the expression of nature of dissociative symptoms.

Key Words: Personality Traits, Dissociative Disorder

Study Of Creativity As An Endophenotype In Bipolar Affective Disorder

Dr. Jayanath B P, Prof. Basudeb Das,Dr. Sanjay Kumar Munda

Department Of Psychiatry, Central Institute Of Psychiatry, Kanke, Ranchi, Jharkhand, India. Email Id : [email protected]

Background: A link between enhanced creativity and bipolar affective disorder has been speculated from ancient times. Most of the studies on this regard had evaluated eminent creativity. There are only few methodologically sound studies evaluating non- eminent creativity and its relation to bipolar affective disorder and there are no indian studies on this regard. The aim of the current study was to assess creativity, abstract reasoning and basic personality factors in patients with bipolar affective disorder-currently in remission in comparison to their first degree relatives and normal healthy controls. This study also aimed to find out whether creativity can be considered as an endophenotype of bipolar affective disorder.

Methods: This study was a hospital based, cross sectional, comparative study. Thirty each of bipolar affective disorder currently in remission patients, their first degree relatives and healthy controls were assessed on divergent production abilities test for creativity, ravens spm for abstract reasoning and Neo-FFI for basic personality factors. A comparison of these findings between the groups was done taking major confounding factors into consideration.

Results: The three groups didnt differ significantly on abstract reasoning and basic personality factors. Though not found in all domains of divergent thinking, the present study observed an endophenotype nature in one parameter of divergent thinking, i.E. Associational fluency. An association between one of the basic personality factors, i.E. Conscientiousness, with divergent thinking was also observed.

Conclusion: By the findings of elevated scores on one of the domains of divergent thinking in patients and first degree relatives, and a positive association between personality factors and creativity, the current study opens the scope for future research in endophenotype study of bipolar affective disorder.

Key Words: Creativity, Bipolar Affective Disorder, Endophenotype

Psychiatric Co-morbidity In Adult Males With Alcohol Dependence A Study From Rural Teaching Hospital In Telangana

Dr. Kakumanu Monalisa , Dr. Pola Krishna Chaitanya

Kamineni Institue Of Medical Sciences. Email Id : [email protected]

Introduction: Alcohol related disorders often coexist with other psychiatric disorders and its incidence is ever increasing. Patients with co-morbidity, especially those with psychiatric disorders, have higher rates of suicide, relapse, money spent in treatment, homeless and place more burden on medical services. It is usually associated with greater treatment challenges and poor prognosis. Our aim is to study the frequency of psychiatric disorders and factors affecting them in alcohol dependent adult male

Materials And Methods: Our study included all patients attending psychiatric out-patient department for alcohol de-addiction from august 2015 to july 2016. A total of 120 patients were included who met the diagnosis of alcohol dependence according to international classification of diseases -10 (ICD 10) by a qualified psychiatrist. Details regarding socio-demographic particulars and alcohol were collected using semi structured questionnaire. Patients were assessed for psychiatric co-morbidity using icd-10 criteria.

Results: The psychiatric disorders were diagnosed in 7.5% (N=9) of the 120 patients. The most common disorder was found to be mood disorders (44.44%), Schizophrenia and other psychotic disorders (33.33) And anxiety disorders (22.22%)

Conclusion: Given the high rate of psychiatric disorders in alcohol dependent males, their diagnosis and treatment should form an essential part of their treatment regimen in deaddiction centers.

Key words : psychiatric comorbidity, Alcohol dependence

A Study Of Phenomenology In Patients Suffering From Post Partum Psychosis In A Tertiary Care Hospital

Dr. Sarmistha Priyadarshani , Dr. Sarada Prasanna Swain

Email Id : [email protected]

Background: The mental health of women in the weeks and months following childbirth is of critical importance to the well being of the mothers, their children and their families. Our study is a single point noninvasive descriptive clinical study of new cases.

Materials And Methods: Assessment of phenomenology was done on 100 patients suffering from postpartum psychosis admitted in our ipd using the icd-10 criteria for the diagnosis of postpartum psychosis, self designed proforma consisting of socio-demographic data , symptomatology and indepth mental status examination and bprs( brief psychiatry rating scale).

Results: A significant number of patients were suffering from acute psychosis like picture. Multiparous females were in higher proportion than primiparous among the patients. Noticeable number of women had not taken even a single ANC visit. Higher mental functions were deranged in a certain proportion of patients. A significant number of patients had past as well as well as family history positive for mental illness.

Conclusion: Most women experience mood symptoms in the postpartum period which are disruptive to life and impair functioning in all domains. Prenatal education and postpartum screening may significantly decrease the impact of postpartum psychosis.

Keywords: Postpartum Psychosis, Phenomenology, BPRS

Association Of GABA- A And Glutamate Receptors Gene Polymorphism With Alcohol Dependence: A Preliminary Study

Mr. Ranjan , Mrs Tripti Grover, Dr. Atul Ambekar, Prof. Arundhati Sharma

Department Of Anatomy, AIIMS, New Delhi. Email Id : [email protected]

Introduction: Alcohol dependence (ad), a complex biopsychosocial disorder characterized by profound disruptions in specific circuits in the brain is influenced by a multitude of factors. While environmental factors play a significant role in developing addiction, genetics makes some individuals more susceptible to such disruptions. Polymorphisms present in various neurotransmitter genes are reported to increase the risk of developing ad.

Objective: To identify possible association of GABA- A and glutamate receptors gene polymorphisms with alcohol dependence (ad).

Method: The study group comprised of 141 male ad patients recruited from the outpatient department of national drug dependence treatment center (nddtc), aiims, new delhi and 110 male healthy volunteers from the general population. Detailed clinical and family history was noted from all the subjects and 5 ml peripheral blood drawn for genetic analysis. Genomic dna isolated was used for genotyping of rs2279020 and rs3219151 from the GABA pathway, rs12325652, rs16966381 and glutamate pathways using pcr/pcr-rflp. Genotype frequencies were assessed and associations analysed with age at first use of alcohol, quantity of alcohol consumption (g/day), duration of alcohol use, duration of alcohol dependence, age at onset of dependence.

Results: The marker frequencies did not differ significantly between cases and controls except for gaba a rs3219151. GABA A receptor rs2279020 and rs3219151 were also found to be significantly associated with age at first use (p <0.0001), Rs2279020 with higher audit score (p=0.002) And rs3219151 with alcohol intake (p=0.0001). Higher frequency of GABA- A rs3219151 (tt genotype) in ad (p=0.04) Confirmed its role of conferring risk for ad.

Conclusions: This is the first study to report association of gabaa receptor polymorphisms with ad in north indian population. Robust studies with large sample size are required.

Key Words: Alcohol Dependence, Polymorphism, Neurotransmitter

A Study Of Phenomenology In Patients Suffering From Post Partum Psychosis In A Tertiary Care Hospital

Dr. Sarmistha Priyadarshani, Dr. Sarada Prasanna Swain

Email Id : [email protected]

Background: The mental health of women in the weeks and months following childbirth is of critical importance to the well being of the mothers, their children and their families. Our study is a single point noninvasive descriptive clinical study of new cases.

Materials And Methods: Assessment of phenomenology was done on 100 patients suffering from postpartum psychosis admitted in our IPD using the icd-10 criteria for the diagnosis of postpartum psychosis, self designed proforma consisting of socio-demographic data, symptomatology and indepth mental status examination and bprs (brief psychiatry rating scale).

Results: A significant number of patients were suffering from acute psychosis like picture. Multiparous females were in higher proportion than primiparous among the patients. Noticeable number of women had not taken even a single anc visit. Higher mental functions were deranged in a certain proportion of patients. A significant number of patients had past as well as well as family history positive for mental illness.

Conclusion: Most women experience mood symptoms in the postpartum period which are disruptive to life and impair functioning in all domains. Prenatal education and postpartum screening may significantly decrease the impact of postpartum psychosis.

Keywords: Postpartum Psychosis, Phenomenology, BPRS

Suicidal Preoccupation And Self Directed Aggression Measured By Thematic Apperception Test In Normal Adolescents

Mrs. Ishanya Raj, Dr. Nishant Goyal, Mrs Madhumita Bhattacharyya

CIP, Kanke, Ranchi, Jharkhand, India. Email Id : [email protected]

Background: although much considerable work has been done in this field of psychodynamic understanding of suicidal preoccupation and self-directed aggression in normal adolescents but less of them included the use of thematic apperception test (t.A.T) as a tool to do so, despite the fact that t.A.T is the most useful tool in revealing the unconscious materials, like ego defenses, repressed wishes, need press and sentiments. So, the present study was in a way, likely to tested, verified and illuminated the relevance of psychodynamic findings on the basis of the findings of thematic apperception test regarding the suicidal preoccupation and self-directed aggression in normal adolescents. Aim: to assess the frequency of suicidal preoccupation and self-direction aggression through thematic apperception test in apparently normal adolescents. Method: the present study was a community-based prospective study. For the study, sample was collected from 2 different co-education schools of kanke, ranchi. Students from class 8th, 9th and 10th were included. All the 3 classes were having different sections; therefore 9 students from each section and total 54 students were taken through random sampling technique. Students, both male and female and aged between 13-17 years were selected in the study after matching inclusion and exclusion criteria. Socio-demographic data sheet, GHQ-28 and 4 selected cards of thematic apperception test i.E. Card no. 3Bm, 8bm, 12bg and 14 for male participants and card no. 3Bm, 12bg, 17gf and 18gf for female participants was administered individually. Results: no significant difference was observed between

Key words: suicidal preoccupations, aggression, TAT

Internet Use Profile In Final Year Medical Graduates- A Research Article

Dr. Sarmistha Priyadarshani , Prof. Neelmadhav Rath, Dr. Snehansu Dey, Dr. Udit Panda

Email Id : [email protected]

Background: Internet addiction is a new condition increasingly recognized as a disorder which is under research. It is gaining importance as a behavioural addiction worldwide. It is rising tremendously and gaining concern among adolescents and the young mass.

Aim And Objective: To study the pattern of use of internet related services among medical students of final year mbbs

Methods: A cross sectional study was conducted among 100 students of final year mbbs at scb medical college of odisha. The subjects were assessed using semi structured sociodemographic proforma and the youngs internet addiction test questionnaire.

Results: Among all students, 68% were average online users and 32% experienced occasional and frequent problems in their life due to internet which brings them into a level where internet has full impact on their lives. Among those, 71% were males. 90% Were residing in hostel.56% Were single and ,21.8% Were committed. Rest were in a one sided relationship. 53.1% Students had started using internet services only after entering into medical college. Only 12.5% Were familiar to internet from class 10th. Most of the students were using social networking sites.

Conclusions: Technology can be a boon as well as curse, based on how we use it. Although it is important to keep in pace with the advanced learning procedures. It is high time to analyse into the severity with which technology is getting into our mind and life.

Keywords: Internet, Medical Graduates, Use

Psychological Attributes Of Patients With Functional Bowel Disorder Attending Medical Gastroenterology Department Of A Tertiary Care Hospital

Dr. Sukanto Sarkar, Dr. Sivaprakash B, Dr. Robbin Bose

Mahatma Gandhi Medical College & Research Institute, Pondicherry. Email Id: [email protected]

Introduction: One in twenty-five indians suffer from functional bowel disorders (FBDS). Psychological factors like acute or chronic stress play a major role in the etiology of FBDS. We intent to study the relationship of psychological factors in patients with FBDS attending a tertiary care centre. Methods: seventy five patients visiting the department of medical gastroenterology at mahatma gandhi medical college & research institute, pondicherry during january to august 2016 diagnosed by consultant gastroenterologist as FBDS was taken up for the study. Final analysis was done on 70 patients who consented for the study. Patients were screened with functional bowel disorder severity index (fbdsi). 21 Item depression, anxiety and stress scale (dass) were applied and patient was divided into 2 groups: mild to moderate stress (group a) and severe stress (group b). Quality of life was assessed using whoqol-bref scale. Statistical analysis was done using spss version 16.Results: the mean age of the cohort was 38.8 Years. Most of the patients were married (88%) and belonging to middle & lower socioeconomic status (86%) coming from rural background (68%). Most of them were non-vegetarian (73%) and on high protein and carbohydrate diet. The mean duration of symptoms was 1.8 Years (range 3 months- 6.2 Years). Group a, consisting of 42 patients, had higher anxiety levels at das-21 when compared to group b (p=0.06), Whereas depression were significantly higher in group b (p=0.03). The severity of fbd as measured by fbdsi was directly correlated with depression in these group of patients (r=0.8; P=0.02). The physical & psychological domain of whoqol-bref scale was significantly affected in group b in patients having syndromal depression (p=0.04).Conclusion: depression & anxiety are common comorbidities in patients of fbd. A comprehensive assessment by psychiatry team along with gastroenterologist is needed for treating such disorder.

Key words : functional bowel disorder, Gastro enterology

A Study Of Phenomenology Of Aberrant Behaviours In Children And Adolescents With Autism Spectrum Disorders

Dr. Abhijeet Shrivastava , Dr. Pallavi Sharma, Prof. Vivek Agarwal, Dr. Amit Arya, ,Dr. Pawan Kumar Gupta, Ms Pooja Mahour

Department Of Psychiatry, KGMUY, Lucknow, U.P. Email Id : [email protected]

Background: Autism is a neuro developmental disorder, characterized by early onset difficulties in social communication , and restricted, repetitive patterns of behaviors or interests. Children with asd may have various aberrant behaviours , including aggression, self injurious behaviour, severe temper tantrums. Previous studies suggests that aggressive behaviors are more common, yet poorly understood, among children with asd than in other populations.

Aim: Current study aimed at assessing the phenomenology of aggression in children and adolescents with autism spectrum disorders.

Method: The present study is a cross sectional study in which 46 patients of ASD aged 4-16 years were studied. Diagnostic and severity assessment of ASD patients have been done on autism diagnostic interview- revised (adi-r). Diagnosis has been established as per DSM-5 criteria for ASD. Phenomenology of aggression was assessed on aberrant behaviour check list.

Results: Mean age of the sample is 7.09 Β± 3.03 And most of the study subjects are male (82.61%). The clinically significant aggression is present in 73.91% Of the patients. 26.09% Of patients has mild aggression, 54.35% Has moderate aggression and 19.56% Has severe aggression. Self injurious behaviour (sib) is present in 36.9% Of patients and physical aggression is present in 71.73% Of the patients. Most of the patients has combination of physical and verbal aggression. The intellectual functioning (iq) of the sample is negatively correlated with aggression (r= -0.555, P=0.000062), Self injurious behaviour (sib) (r= -0.526 , P=0.000172) And total abcl scores (r= -0.665 , P=0.0000). Total adir scores is also positively correlated with aggression scores.

Conclusion: Children and adolescents with asd have various types of aggression like physical aggression, verbal aggression and self injurious behaviours. Severity of aggression is more in patients with poor intellectual functioning and with severe autistic symptoms.

Keywords : Autism Spectrum Disorders, Aggression, Phenomenology .

Association Of GABA And Glutamate Receptors Gene Polymorphism With Alcohol Dependence: A Preliminary Study

Mr. Ranjan , Mrs Tripti Grover, Dr. Atul Ambekar, Prof. Arundhati Sharma

Department Of Anatomy, AIIMS, New Delhi. Email Id : [email protected]

Introduction: Alcohol dependence (ad), a complex biopsychosocial disorder characterized by profound disruptions in specific circuits in the brain is influenced by a multitude of factors. While environmental factors play a significant role in developing addiction, genetics makes some individuals more susceptible to such disruptions. Polymorphisms present in various neurotransmitter genes are reported to increase the risk of developing ad. Therefore, this study aimed to identify possible association of gabaa and glutamate receptors gene polymorphisms with alcohol dependence (ad).

Method: The study group comprised of 141 male ad patients recruited from the outpatient department of national drug dependence treatment center (nddtc), aiims, new delhi and 110 male healthy volunteers from the general population. Detailed clinical and family history was noted from all the subjects and 5 ml peripheral blood drawn for genetic analysis. Genomic dna isolated was used for genotyping of rs2279020 and rs3219151 from the gaba pathway, rs12325652, rs16966381 and glutamate pathways using pcr/pcr-rflp. Genotype frequencies were assessed and associations analysed with age at first use of alcohol, quantity of alcohol consumption (g/day), duration of alcohol use, duration of alcohol dependence, age at onset of dependence.

Results: The marker frequencies did not differ significantly between cases and controls except for gaba a rs3219151. Gabaa receptor rs2279020 and rs3219151 were also found to be significantly associated with age at first use (p <0.0001), Rs2279020 with higher audit score (p=0.002) And rs3219151 with alcohol intake (p=0.0001). Higher frequency of gabaa rs3219151 (tt genotype) in ad (p=0.04) Confirmed its role of conferring risk for ad.

Conclusions: This is the first study to report association of gabaa receptor polymorphisms with ad in north indian population. More studies with robust methodology are required.

Keywords: GABA, Glutamate, Gene Polymorphism

Psychiatrist And The Pharmaceutical Industry: Lesson From A Yearlong Anthropological Fieldwork In A Psychiatry Department

Mr. Clement Bayetti

Email Id : [email protected]

Background/introduction: The nexus currently existing between the psychiatric profession and the pharmaceutical industry has been shown to be at the root of various unethical behaviors and conflicts of interest in the practice of psychiatrists worldwide. Despite the recent publication of guidelines aiming to regulate the nature and extent of this relationship, the influence that drug companies have on the development of psychiatry students, and on the behavior and professional identity of psychiatrists in india, is still poorly understood.

Methodology/materials And Methods: Using data gathered during a year-long ethnography of post-graduate psychiatry training in india, this paper proposes to explore the impact that the pharmaceutical industry has on the psychiatric profession in india.

Results: Through the anthropological concept ofœgift-giving the author demonstrates how the relationship between drug companies and psychiatrists begins and evolves, impacting the development of psychiatrists' professional identities, their future practices, and sense of ethics. Particular consideration is given to the mechanisms used by psychiatrists to rationalize such relationships and how cognitive bias may shift their perception of the ethical nature of their practices. Additionally, this paper demonstrates how various socio-cultural and political factors come to shape the nature and outcomes of such interactions.

Conclusion: In doing so, this paper hopes to provide a fruitful platform to discuss and improve the ethical training of psychiatry students in india, as well as the policies and guidelines which regulate the interactions between drug companies and the profession of psychiatry.

Inhalant Abuse: Newer Trends In Addiction

Dr. Rajiv Kumar Saini, Dr. Kaushik Chatterjee

AFMC, Pune. Email Id : [email protected]

Inhalant abuse is common in adolescent and young persons. However, awareness about its harmful effects is low and its potential to cause dependence remains a cause of concern. Solvents, glue and correction fluids are common substances of abuse in the community. Inhalant abuse is often associated with underlying novelty seeking traits and it can predict propensity for other psychiatric conditions as well. Inhalants are cheap, freely available, and legal to possess and escape detection in vulnerable groups. We present a study of 30 cases of various age groups who suffered from inhalant abuse. It was remarkable to note that 18 (60%) of them suffered from comorbid psychiatric conditions ranging from depression, anxiety and multiple drug abuse. 14 (46%) Had significant cognitive deficits after two weeks of abstinence. There is a need to spread awareness about the harmful effects of inhalants and devise effective relapse prevention strategies in the community.

Key Words: Solvent, Glue, Correction Fluid, Neurological Consequences

Relationship Of Stigma With Disability Among Treatment Seeking Substance Users

Dr. Shreeya Gyawali , Dr. Vinay Saini, Dr. Swarndeep Singh, Dr. Yatan Pal Singh Balhara, Dr. Siddharth Sarkar, Dr. Shreeya Gyawali

AIIMS. Email Id : [email protected]

Background And Aims: Disability has been documented in patients with substance use disorders. Stigma is also an important consideration among substance users as well. We present the data of the relationship of disability with stigma in a sample of substance users in this presentation.

Methods: This study conducted at a tertiary care de-addiction facility recruited patients with substance use disorders. Disability was assessed using indian disability evaluation assessment scale. Perceived stigma and internalized stigma was assessed using perceived stigma of substance abuse scale (psas) and internalized stigma of mental illness scale (ismi) respectively.

Results: The study included 68 participants majority of whom were males, educated up to 10th grade, employed, and from a nuclear family from urban background. Opiates was the primary substance of abuse in the majority (n = 53) with ever-injecting drug use present in a considerable proportion (n = 24). The ideas scores ranged from 2 to 16, with a mean of 9.6 (Β±3.2), And the largest disability contributed by the 'work' domain. Greater degree of disability was associated with greater duration of substance use (spearman ? = 0.264, P = 0.030) And with greater degree of internalized stigma (? = 0.488, P < 0.001), But not perceived stigma (? = -0.126, P = 0.305)

Conclusion: Greater disability in substance users is associated with greater degree of internalized stigma. Perceived stigma towards substance use is however not associated with disability among substance users.

Keywords: Stigma, Disability, Substance Use

Prevalence Of Social Anxiety In Post Graduates Of Andhra Medical College

Dr. Praveen Kumar Tamminana, Dr. D. Vijayalakshmi

Government Hospital For Mental Care, Andhra Medical College, Visakhapatnam. Email Id : [email protected]

Introduction: Social anxiety in adults can be manifested as performance anxiety and stage fright, associated with many central, peripheral and autonomic symptoms. It can thereby bring down self-esteem and efficacy leading to social inhibition. Social anxiety can turn out to be a great professional hindrance for medical students who are expected to give reassurance to patients in day to day work. Present study attempts to gauge social anxiety in PGs of various clinical departments in medical field.

Methodology: Sample constituted the post graduates of various departments in andhra medical college, visakhapatnam. Spin (social phobia inventory), a self-report, was given to PGs.

Results: Out of 78 PGs from various departments, 37 (47.43%) Have significant social anxiety symptoms. Of these 37, 25 have mild, 9 have moderate, 1 has severe and 2 have very severe social anxiety (x2 = 47.539, P = 0.193). General medicine PGs had the highest social anxiety score (mean = 28.25) While psychiatry PGs had the least (mean = 14.8), However these results were not statistically significant (t = -1.648, P = 0.125)

Conclusion: Given the extent of presence of social anxiety in medical students, it might be necessary to focus on training to overcome social anxiety and improve communication and social interaction skills. It is a possibility that, psychiatry PGs students had the least social anxiety because of repeated interactions with various people they go through in their training period.

Keywords: Social Anxiety, Self-esteem, Spin

A Comparative Study Of Psychiatric Co-morbidity And High-risk Behavior Among Persons With Injecting Prescription Opioid Dependence And Injecting Heroin Dependence

Dr. Vaibhav Patil, Dr. Yatan Pal Singh Balhara, Dr. Prabhoo Dayal

Email Id : [email protected]

Background: There is limited information on the psychosocial profile and high risk injecting and sexual behavior among prescription opioid dependent persons from indian setting. Moreover, these persons have not been compared with persons with injecting heroin dependence for these variables.

Aims And Objective : The current study aimed at comparison of the psychiatric co-morbidity and high risk behavior among persons with injecting prescription opioid dependence and injecting heroin dependence.

Methodology: The study was a cross-sectional observational and was carried out at a tertiary care substance use disorders treatment center. Subjects with injecting prescription opioid dependence were compared with subjects with injecting heroin dependence. The study instrument included the semi-structured proforma for socio-demographic profile, MINI, IPDE addiction severity index (asi), injecting risk questionnaire (irq), risk behavior survey (rbs). Data were analyzed using spss ver 21.

Results: The mean age of the study subjects in the two groups was comparable. The two groups differed significantly from each other with regards to the educational qualification and current occupation. The motivations for first use of opioids as well as first use of opioids through injecting route were comparable between the two groups. The prevalence of co-morbid psychiatric disorders was comparable between the two groups except for dysthymia, which was significantly more common among individuals with heroin dependence (p< .05). Except for the employment domain (higher in individuals with heroin dependence) the severity of addiction was comparable between the two groups. A significantly greater number of individuals with heroin dependence shared needles/ syringes in the past four weeks, while these individuals were more likely to have reported never sharing needles/ syringes with others (p< .05). While individuals with heroin dependence were more likely to report never lending or giving the injecting equipment with friends or acquaintances, the individuals with prescription opioid dependence were more likely to report never sharing the same with a sexual partner (p< .05). Individuals with prescription opioid use were more likely to report never injecting with needle/ syringe that has been used by a friend or an acquaintance during the last four weeks (p< .05). The number of sexual partners was significantly higher in the individuals with heroin dependence (p< .05).

Conclusions: The persons with dependence on prescription opioids differ form persons with dependence on injecting heroin on certain socio-demographic variables, high-risk injecting and sexual behavior.

Keywords:Opioid Dependence, Heroin Dependence, High Risk Behavior

Study Of Anxiety In Patients With Pulmonary Tuberculosis Admitted In Pulmonary Medicine Ward

Dr. Anand Arvind Khare , Prof. Dr Sudhir Bhave, Prof. Dr Vivek Kirpekar, Dr. Rahul Tadke, Dr. Sushil Gawande, Prof. B O Tayad

NKP SIMS And Lata Mangeshkar Hospital Hingna Road, Nagpur. Email Id : [email protected]

Background: Patients with pulmonary tuberculosis having complications and multi drug resistance are prone to have various psychiatric co-morbidities including anxiety. Presence of anxiety in them can be more disabling and an area of concern for the treating physician. Thus study of anxiety in this population can give a better insight in addressing this issue.

Methodology: The present study was carried out in patients with pulmonary tuberculosis admitted in pulmonary medicine ward. 40 Patients participated in this study. The study protocol was approved by institutional ethics committee. Each participant was individually interviewed along a semi-structured proforma prepared for the study which included socio-demographic, clinical, and psychiatric profile and BPRS, HAM-A rating scales were administered. Data thus collected was statistically analyzed and conclusions were drawn.

Results And Discussion: The mean age of the participating patients was 36.32 Years (s.D. 7.39), Predominantly males (70%), majority married, employed and from rural background. Of the substances, use of nicotine(47.5%), Alcohol(25%), and both(17.5%) Was seen in the participants. 32.5% Of the participants reported anxious mood, 50% had preoccupation with worries and 35% had depressive cognition. 10% Of the participants had generalised anxiety disorder. Mean ham a score was 16.75 (Sd:5.59). 70% Of the participants had significant anxiety on ham a(mild=22.5%, Moderate=37.5% And severe=10%). Surprisingly significantly higher anxiety on HAM-A was found in participants having education higher than primary.

Conclusion: Significant anxiety is present in patients with pulmonary tuberculosis admitted in pulmonary medicine ward. Diagnosable anxiety disorder can be seen in them. Thus patients with pulmonary tuberculosis should be screened for anxiety.

Keywords: Anxiety, Pulmonary Tuberculosis, Substance Use.

Successful Use Of Graded Exposure Therapy In The Treatment Of Social Phobia In A 10 Year Old Child

Dr. Satyakam Mohapatra

Email Id : [email protected]

Introduction: Social phobia is one of the most common psychological disorder in children and adolescents. Studies from india showed that the prevalence of social phobia in children and adolescents varies between 0.19%- 0.27%. Unfortunately, a paucity of literature exists regarding the treatment of social phobia in young children, despite the knowledge that traditional techniques (cognitive-behavioral therapy) may not be practical.

Methodology: The purpose of this presentation is to discuss a case of 10-year-old child where graded exposure therapy was done successfully for treatment of social phobia.

Results: Master a, 10-year-old child presented with complaints of difficulty in reading in class in front of all classmates and teachers, difficulty in answering questions in classroom, difficulty interacting with classmates from last 4 years. He also avoids interacting with known and unknown people who come to his home. According to dsm -v a diagnosis of social phobia was made. Non-pharmacological treatment was planned. Patient was assessed for suitability of CBT, but he was unable to understand the cognitive concept of CBT. So graded exposure therapy in vivo was started. Hierarchy of phobic cues made after discussing with child and mother. The patient was moved up in the hierarchy of phobic cues as soon as anxiety caused by easier ones has decreased. The earlier one was repeated later on and incorporated into everyday life through homework assignment. Reinforcement was given to the child constantly. After 8 sessions of therapy there was significant improvement in the social anxiety of the child.

Conclusion: The purpose of the present case was to demonstrate the utility of behavioral treatments for social phobia in children. Our case has shown significant improvement with 8 sessions of graded exposure therapy. Exact rules of graded exposure therapy are usually difficult to follow in children with phobia. That also happened in our case.

Keywords: Social Phobia, Children, Adolescents, Behavioural Treatment

Study Of Factors Influencing Caregiver Use Of Mechanical Restraints On Patients Presenting To Acute Psychiatric Emergency

Dr. Anusha Sridharan Dr. Bhaskar Katram, Dr. Srilakshmi Pingali

Institute Of Mental Health, Tirumala Emeralds, Sri Tirumala Gruhanirman, Ragannaguda, Rr. District Telangana. Email Id : [email protected]

Background: Whether or not to restrain a person with mental illness has been a relatively less probed topic with no clear consensus as to the rights and wrongs of it. Most of the research on restraints has been in the clinical setting. However, many patients are brought by caregivers to the acute emergency in mechanical restraints. Review of literature has found no focus on this category of patients. Insight into factors that lead the caregiver of a person with mental illness to mechanically restrain them while bringing them to a psychiatric emergency, could help us modify those leading to it. Thus, reducing the associated morbidity and mortality.

Aim: To study the factors influencing caregiver use of mechanical restraints on patients presenting to the acute psychiatric emergency.


1) To study the socio-demographic profile and clinical variables of patients brought in mechanical restraints to acute psychiatric emergency.

2) To study caregiver factors influencing their use of mechanical restraints.

Methods: ICD-10 criteria was used to make a diagnosis; a semi-structured proforma was administered to elicit patients and caregivers socio-demographic profiles and illness factors. Knowledge questionnaire was administered to caregivers to understand their concept of mental illness. Modified overt aggression scale was administered to assess the level of aggression of the patient.

Results And Conclusion: Preliminary results indicate proximity to emergency psychiatric services as an important factor determining the restraining. The complete results and analysis will be discussed.

Keywords: Mechanical Restraints, Factors, Caregivers, Emergency Psychiatry

Psychiatric Comorbidities Among Oral Opioid Users

Dr. Senilo Magh ,Dr. R.k. Lenin Singh, Dr. N. Heramani Singh, Dr. Th. Bihari Singh, Dr. S. Gojendra Singh

Email Id : [email protected]

Background: Problem drug users number about 27 million, which is 0.6 Per cent of the world adult population. Psychiatric comorbidity is often associated with high rates of continued substance use, greater psychosocial impairment and increased utilization of services. It is reported that outcome is better when both are addressed.

Objectives: The aim of the study is to document the presence of comorbid psychiatric disorder among oral opioid users.

Materials And Methods: All oral opioid users attending psychiatry department over a period of two years (September 2014 - August 2016). They were assessed for comorbid psychiatric disorder using MINI - PLUS.

Results: A total of 53 patients were enrolled for the study out of which only one client was a female. All of them were literate and majority of them were in the productive age group from upper socio-economic status and unmarried. Two third of oral opioid users had associated psychiatric morbidity. More than half were diagnosed with antisocial personality disorder followed by suicidality and mood disorders.

Keywords: Oral opioid users, comorbidity, antisocial personality disorder, major depressive disorder.

A Study Of Socio Demographic Factors And Quality Of Life In Depressed Women

Dr. Ram Kumar Solanki ,Ms Neha Tewari, Dr Chitra Singh, Neha Tewari

SMS Medical College, Jaipur. Email Id : [email protected]

Depression is one of the most common mental disorders in developing countries and is ought to be associated with sociodemographic factors, life events and low quality of life. Females are more prone to depression due to factors like physical and emotional exhaustion, hormonal imbalance and child bearing, malnutrition, deblitiating effect of traditional practices. The sociodemographic factors of age, marital status, education, income, socio-economic status, number of life events have consistently been identified as important factors in explaining the variability in depression.

Aim: To study the relationship between depression and the sociodemographic factors, life events and quality of life in female.

Methodology: 120 females recruited for the study, consulting in opd psychiatric centre SMS medical college, jaipur diagnosed by ICD-10 moderate to severe depression and confirmed by psychiatrist. These females were further subjected to becks depression inventory (bdi), psle scale, WHO QOL Brief Scale. Data was evaluated for correlation of sociodemographic factors with depression, life events, and quality of life.

Result And Conlusion: In the study the result shows females who are illiterate, belongs to low socio economic status with large family, have history of early marriage and early child birth are found to be the associated sociodemographic factors with severe depression. By the findings of psle family problems, marital disputes, addiction in family members and death of either the spouse or any loved one is more prevalent among the life events. Majority of depressed females scored low in social relationship domain of the WHO QOL Brief Scale.

Keywords: Depression,Female, Qol

Prediction Of Cardiovascular Risk In Drug Naive Patients Of Depression

Dr. Ram Kumar Solanki , Dr. Parag Sharma, Dr Mahendra Sharma

SMS Medical College, Jaipur. Email Id : [email protected]

Background: Patients suffering from depression are at higher risk of experiencing adverse cardiovascular events owing to sleep and metabolic disturbances, lifestyle, use of antidepressants, and depression itself. Several epidemiological studies have associated depression with cardiovascular disease. We investigated whether depression constituted a risk for coronary heart disease (chd).

Aim: To study the socio demographic and clinical characteristics of drug Naive patients of depression and healthy controls.

To assess and to ascertain cardiovascular risk among drug Naive depressed patients versus healthy controls.

Methodology: Fifty patients suffering from depression (as quantified by MADRS) along with fifty age and sex matched healthy controls participated in the study. Both groups were subjected to measurement of framingham risk index after carefully evaluating on sociodemographic and clinical profile sheet.

Results And Conclusion: Clinical depression appears to be an independent risk factor for incident coronary artery disease. Patients suffering from depression and having comorbid medical disorder & substance abuse significantly elevates the risk.

Keywords: Depression, Cardiovascular Risk

Prevalence Of Toxoplasma Infection In First episode Schizophrenia And Bipolar Disorder: Comparison Between Toxoplasma seropositive And Toxoplasma seronegative Groups

Dr. Ram Kumar Solanki , Dr. Chitra Singh, Dr. Vikash Mishra

SMS Medical College, Jaipur. Email Id : [email protected]

Background : Recent epidemiologic studies indicate that infectious agents may contribute to some cases of schizophrenia. In animals, infection with toxoplasma gondii can alter behavior and neurotransmitter function. In humans, acute infection with t. Gondii can produce psychotic symptoms similar to those displayed by persons with schizophrenia. Establishing the role of T. Gondii in the etiopathogenesis of schizophrenia might lead to new medications for its prevention and treatment.

Objective: To compare the prevalence of toxoplasma infection between the first-episode schizophrenia, bipolar affective disorder and the controls and to compare the clinical features between the toxoplasma-seronegative and toxoplasma-seropositive patients.

Method: The rate of serum reactivity to toxoplasma in 50 schizophrenia, 50 bipolar affective disorder patients and 50 controls was investigated. The clinical symptoms of the patient group were scored and compared.

Results: The rate of IgG antibody, not IgM in the schizophrenia patients, was significantly higher than the control group. The seropositive schizophrenia patients had higher scores on the positive subscale.

Conclusion: This study further strengthens the hypothesis that exposure to toxoplasma may be a risk factor for schizophrenia.

Keywords: Toxoplasma, Schizophrenia, Bipolar Disorder.

Serum Levels Of Neuroactive Steroids In First Episode Antipsychotic Naive (FEAN) Schizophrenia Patients And Its Correlation With Aggression: A Case Control Study

Dr. Ram Kumar Solanki

SMS Medical College, Jaipur. Email Id : [email protected]

Background: The evidence of HPA axis dysfunction in schizophrenia has been reviewed in the context of the stress-diathesis model and over activation of this axis leads to varied levels of cortisol and dhea-s in blood. These neurosteroids in turn acts on hippocampus, interacts with GABA and NMDA receptors, leads to neurotoxicity and may be involved in neurobiology of aggression.

Methodology: Thirty patients in their first episode of schizophrenia along with twenty age and sex matched healthy controls participated in the study. Both groups were subjected to serum cortisol and DHEA-S measurement after measuring psychopathology and aggression on standardized psychometric scale.

Results: Serum Dhea-s was significantly higher in fean schizophrenia individuals (p=0.001). No difference in values was noted between males and females in the patient group (p=0.93) But female controls had significantly lower blood dheas compared to male controls (p < 0.01).Plasma DHEA-S inversely correlated with modified overt aggression scale (p=0.011) And not with panss (p=0.39) And cgi-s (p = 0.28).

Conclusion: FEAN schizophrenia patients show significantly higher levels of the DHEA-S in their blood as compared to healthy controls. Serum DHEA-S levels have inverse relationship with aggression which may serve as a biological adaptive mechanism to antagonizes the neuronal damage caused by cortisol.

Keywords: Cortisol, Dhea-s, Aggression, Fean Schizophrenia

A Descriptive Analysis Of Patients Admitted In Short Stay Ward At Psychiatric Centre, Jaipur

Dr. Ram Kumar Solanki, Dr. Parag Sharma

SMS Medical College, Jaipur. Email Id : [email protected]

Background: The average length of stay (los) at psychiatric centre and the factors determining longer los in psychiatry disorders remains largely unexplored. Longer los is associated with social isolation and maladaptive behaviours in patients thus warrant a shorter stay. The observed los and predicted los among different psychiatry hospitals in future may serve as an index of quality care and efficient management of meagre but available resources in our country.


(1) To study the socio demographic and clinical factors of patients admitted at our hospital.

(2) To ascertain the relationship between the socio demographic, clinical factors and LOS.

method: A retrospective analysis of psychiatry in patients admitted in psychiatric centre, jaipur during july 2014 and june 2015. The data was analysed studying the 489 case records. The socio demographic characteristics and clinical factors were correlated with los in hospital.

Results & Conclusion: Our study has shown the correlation of socio-demographic factors and clinical factors with LOS. Rural population, marital status, employment status, number of episodes and diagnosis itself has positive correlation with longer los.

Keywords: Socio-demographic, Clinical Factors, Length Of Stay, Correlation, Psychiatry In Patients,

Diagnostic Stability Of Acute And Transient Psychotic Disorders

Dr. Chaitra Vhm, Dr. Nithin Kondapuram, Dr. Mukund V Rao, Dr. Vijay Kumar, Dr. Naren P Rao, Dr. K Muralidharan, Dr. Shivarama Varambally, Dr. G Venkatasubramanian, Prof. Bangalore N Gangadhar

Department Of Psychiatry , NIMHANS. Email Id : [email protected]

Introduction: The long term diagnostic stability of acute and transient psychotic disorders is controversial. The diagnostic stability of acute episode psychosis is of high clinical relevance for prognostication and optimization of early interventions for long term outcome. Hence, we examined the diagnostic stability of acute and transient psychotic disorders in patients attending a tertiary care psychiatric hospital.

Materials And Methods: We analyzed the case records of patients presenting with first episode of˜acute and transient psychotic disorder, to one unit of department of psychiatry, national institute of mental health and neurosciences, bangalore. Case records of a total of 144 patients, over 10 years (2002-2012) were analyzed, and the follow-up diagnosis was recorded.

Results: The mean age of the sample was 30.81Β±11.42 Years. The mean duration of illness episode was 14.68Β±12.61 Days. Out of the 144 subjects, 55 (38%) had only one episode of acute psychosis. Remaining 89 (62%) had a relapse of symptoms with mean duration for relapse being 21.9Β±17.9 Months. Among these, 36 subjects (41%) had second episode of acute psychosis while in 15 (17%) diagnosis was revised to schizophrenia and in 19 (21%) it was revised to bipolar affective disorders.

Discussion: Our study indicates that acute psychosis is a relatively stable diagnosis and a considerable number of patients had complete remission or another episode of acute psychosis. However, a significant proportion of patients developed schizophrenia or bipolar affective disorder. Further studies are required to identify the clinical and biological markers for the patient group, to ascertain, as to, who are going to develop schizophrenia or bipolar affective disorder. Such biomarkers could have significant clinical implication for prognostication and treatment.

Keywords: Acute Psychosis, Long Term Diagnosis, Schizophrenia, Diagnostic Stability

Serotonin Transporter Promoter Polymorphism (5-HTTLPR) And Severity Of Depression A Pilot Study

Dr. Shiraz Ul Hasan, Dr. Shantanu Bharti, Dr. Anju Agarwal, Prof. Ajay Kohli, Dr. A. Q. Jilani

Dr. Jyoti Dubey, ELMCH, Lucknow. Email Id : [email protected]

Introduction: Depression has now become a major problem. It is also among top five leading causes of disability and disease burden throughout the world. Multiple factors have been linked to depression but identification of genes for depression is a crucial step in ascertaining mechanism underpinning the disorder. Studies have shown the role of several genes, but very little progress has been made to find the responsible genes for severe depression. The aim of this study is to establish whether there exist a relationship between a polymorphism in the promoter of the serotonin transporter gene (5-httlpr) and risk for severe depression.

Method: The study was carried out in department of psychiatry, eras lucknow medical college, lucknow. It was a case control study on 50 subjects (18-60 years of age) of major depressive disorder diagnosed as per ICD-10 criteria and was compared with 50 age, sex matched healthy controls. Severity of depression was rated on 17 item hamilton depression rating scale. Extraction of genomic dna was done from blood samples of cases using standard techniques (magna pure lc350; roche diagnostics corp.). In control subjects, we will use a mouth swab sampling technique and extract the dna from buccal cells using a standard commercial extraction kit qiaamp dna micro kit (qiagen inc., Tokyo, japan). Statistical analysis of data was done using appropriate software.

Results And Conclusion: The results and conclusion will be discussed during the time of presentation.

Keywords: 5-HTTLPR, Severe Depression, Gene Polymorphism

Evaluation Of Outpatient Psychiatric Rehabilitation Services - Experiences From A Tertiary Care Hospital

Dr. Nithin Kondapuram Dr. Nithin Kondapuram, Dr. Krishna Prasad, Dr. Hareesh Angothu, Dr. Jagadisha Thirthalli

Department Of Psychiatry, NIMHANS. Email Id : [email protected]

Introduction: Unlike Other medical conditions, recovery in a psychiatric illness is not only about symptoms but includes various other aspects which require team work of all mental health professions. The ultimate goal is that the individuals with psychiatric illness should function in social, vocational, educational and familial roles with the least amount of supervision from the helping professionals making resource distribution and service utilization a very important aspect. Many of the problems in rehabilitation in the developing countries arise due to the poor utilization of these resources. The quality of care is one of the major factors of service utilization which indicate that people are conscious of the kind of the services they need. Most of the psychiatric opd ignore the rehabilitation needs of the patients and give more emphasis on medical treatment. In this study we evaluated various services provided in psychiatric rehabilitation opd

Methodology: Cross sectional data was collected using semi structured proforma regarding various services provided to the patients and care givers in rehabilitation opd of a tertiary care hospital in south india over a period of two months.

Results: 77% of the patients utilizing rehabilitation services were male with mean age of 29.37 years. 38% Of patients had schizophrenia and related disorders, 36% had intellectual developmental disorder. 91% Of patients received inputs regarding socialwelfare benefits, 86% received psychiatrist consultation regarding medication. 68% Of them received vocational input, 42% regarding basiclife skills 35% regarding social skills and 11% received cognitive functioning inputs.

Conclusion: With, our study we would like to emphasise that along with medications, inputs regarding various other aspects like social welfare benefits, vocational inputs, basic life skills,social skills and cognitive functioning are important in recovery of a psychiatric patient

Keywords: Rehabilitation, psychiatric Opd,evaluation Of Opd Services

Novel Role Of Tofisopam In Organic Catatonia : Hypothesis Generated From A Case Series In A Tertiary Medical College And Hospital Setting

Dr. Siddhartha Sankar Dash, Dr. Anshuman, Dr. Sumit Kumar, Dr. Sanjay Kumar Pani, Dr. Jayaprakash Russell Ravan

Kalinga Institute Of Medical Sciences, Bhuvaneshwar, Orissa. Email Id : [email protected]

Background: Organic catatonia is a well documented condition . This phenomenon would be encountered in consultation liaison practice in general hospital setting. The role of conventional approach with lorazepam shown to have its limitation. Tofisopam, a 2,3-benzodiazepines, on the other hand proved to be effective in these special clinical scenarios which necessitates a need for development of a novel hypothesis.

Aim And Objectives: The aim of the study is to examine the pharmacodynamic properties of tofisopam in relation to the management of organic catatonia.

To find out the difference between pharmacological response of lorazepam as compared to tofisopam in organic catatonia.

Methods And Materials: Consecutive cases with organic or secondary catatonia were included in this study . The classical drug lorazepam was administered and response was noted. All these subjectes had excessive sedation and hypotention. And the progress of the catatonic symtoms could not be assessed. For that lorazepam was discontinued and tofisopam was considered. The comaparision of the effectiveness between lorazepam and tofisopam was made.

Result & Observation: Out of ten patients with organic catatonia eight patients had significant improvement with tofisopam as compared to lorazepam in bush francis catatonia rating scale. 20% Of patients who did not show significant change were with head injury.

Organic catatonic patients with primary diagnosis of post stroke , post cabg , post colectomy in ulcerative colitis and post hypertensive encephalopathy had responded well with tofisopam.

Conclusion: Non sedative, with no muscle relaxation and non hypotensive property of tofisopam could have provided the added advantage in these situation of organic catatonia over lorazepam.

Keywords: Tofisopam, Catatonia

A Study Of Phenomenology Of Aberrant Behaviours In Children And Adolescents With Autism Spectrum Disorders.

Dr. Abhijeet Shrivastava, Dr. Pallavi Sharma, Prof. Vivek Agarwal, Professor ,Dr. Amit Arya, Dr. Pawan Kumar Gupta, Ms Pooja Mahour

Department Of Psychiatry,KGMU, Lucknow. Email Id : [email protected]

Background: Autism is a neuro developmental disorder, characterized by early onset difficulties in social communication, and restricted, repetitive patterns of behaviors or interests. Children with ASD may have various aberrant behaviours , including aggression, self injurious behaviour, severe temper tantrums. Previous studies suggests that aggressive behaviors are more common, yet poorly understood, among children with asd than in other populations.

Aim: Current study aimed at assessing the phenomenology of aggression in children and adolescents with autism spectrum disorders.

Method: The present study is a cross sectional study in which 46 patients of ASD aged 4-16 years were studied. Diagnostic and severity assessment of ASD patients have been done on autism diagnostic interview- revised (adi-r). Diagnosis has been established as per dsm-5 criteria for asd. Phenomenology of aggression was assessed on aberrant behaviour check list.

Results: Mean age of the sample is 7.09 Β± 3.03 And most of the study subjects are male (82.61%). The clinically significant aggression is present in 73.91% Of the patients. 26.09% Of patients has mild aggression, 54.35% Has moderate aggression and 19.56% Has severe aggression. Self injurious behaviour (sib) is present in 36.9% Of patients and physical aggression is present in 71.73% Of the patients. Most of the patients has combination of physical and verbal aggression. The intellectual functioning (iq) of the sample is negatively correlated with aggression (r= -0.555, P=0.000062), Self injurious behaviour (sib) (r= -0.526 , P=0.000172) And total abcl scores (r= -0.665 , P=0.0000). Total adir scores is also positively correlated with aggression scores.

Conclusion: Children and adolescents with asd have various types of aggression like physical aggression, verbal aggression and self injurious behaviours. Severity of aggression is more in patients with poor intellectual functioning and with severe autistic symptoms.

Keywords: Autism Spectrum Disorders, Aggression, Phenomenology .

Study Of Prevalence Of Depression In Patients With Hypothyroidism

Dr. Shaik.Reshma, Dr. K.Sarada, Prof. S.Radha Rani, Dr. Mythili

Department Of Psychiatry, Andhra Medical College. Email Id : [email protected]

Introduction: An association between hypothyroidism and depression has been accepted for many years; however the nature of this relationship has not been convincingly proved. Similarity of symptoms between severely depressed patients and hypothyroid patients; therapeutic use of thyroid hormones in treatment of depression and apparent abnormalities in hypothalamic pituitary thyroid axis are well known facts.

Aim: To assess the prevalence of depression in patients with hypothyroidism.

Methodology: Setting: Outpatient unit in department of endocrinology.

Design: Single stage cross sectional study.

Method: 60 patients who were known cases of hypothyroidism and were on treatment for the past 1 yr were recruited in to the study. Hamilton depression rating scale was used to assess depression.

Results: Out of 60 patients, more than 1/3 of patients were having symptoms of depression.

Conclusion: Depression is common among patients with hypothyroidism .There is a broad over lap of symptoms between both of them. Correlation between psychiatric disorder and thyroid status is a major area of concern which should be monitored and treated by endocrinologist and psychiatrist in liaison.

Keywords: Hypothyroidism, Depression, Treatment.

Behavioral Addictions: Conceptual Issues And Current Nosological Status

Dr. Mohit Kumar Varshney , Dr. Atul Ambekar

Department Of Psychiatry And National Drug Dependence Treatment Centre, AIIMS, New Delhi. Email Id : [email protected]

Background: Entities included in the umbrella term behavioral addictions have been known to exist for some time, but recently there has been a proliferation of literature on the subject. Gambling and internet gaming are accepted and recognized clinical entities while others like kleptomania, pyromania, hypersexual disorder, skin picking disorder etc., Are still in candidate status. The key questions that arise are all excessive behaviors, disorders? And even if they are disorders, should they be labeled asœaddictive? Methods: literature search on all the candidate and accepted behavioral addictions on pubmed (till august 2016). Publications discussing conceptual and nosological issues screened and a narrative review synthesized. Results: a three step approach for considering a new disorder asœaddiction has been described in the literature and the pros and cons with the approach highlighted. The concept of behavioral addictions fits well to internet / gaming use disorder. Dsm-5 recognizes gambling disorder while places internet gaming disorder in section iii. In the beta-draft of ICD-11, the proposed categories are: hazardous gambling and betting (qf32), hazardous gaming (qf33): both online and offline as well asœgambling disorder andœgaming disorder under the category of disorders due to addictive behaviours. The role of established policies (for substance use disorders) like demand reduction, supply reduction and harm reduction needs to be studied in the context of behavioral addictions. Conclusion: the heuristic construct of˜behavioural addiction appears to be useful so far for some entities, but caution should be exercised for others. More research is needed to understand their phenomenology, clinical-characteristics and course / outcome. There is a risk that multi-faceted nature and heterogeneity of these disorders can be neglected in favor of a simplistic symptomatic description. Tendency to over-pathologize everyday behaviours should also be avoided.

Keywords: Behavioral Addictions; Nosology Of Behavioral Addictions; Gambling Disorder; Internet Gaming

A Study Of Ondansetron Add-on To Fluoxetine In Obsessive Compulsive Disorder

Dr. Abhijeet Shrivastava ,Dr. Jamshed Ahmad, Prof. Anil Nischal, Prof. Anuradha Nischal, Dr. Bandna Gupta, Dr. Adarsh Tripathi, Dr. Manu Agarwal

Department Of Psychiatry, KGMU, Lucknow. Email Id : [email protected]

Background: Majority of patients of obsessive compulsive disorder do not respond to first line medications adequately. Ondansetron, a 5 HT3 receptor antagonist, has been shown to be beneficial in the treatment of ocd both as monotherapy as well as an augmentation agent to SSRIs. There is limited research on this area in india.

Aims: To study the effect of ondansetron add-on to fluoxetine on psychopathology, functioning and quality of life in patients with obsessive-compulsive disorder and compare results with a control group.

Method: The study was a prospective, 12 week randomized double blind placebo controlled trial. Eighty four patients who fulfilled the diagnostic criteria of ocd (ICD-10) and had a CGIs 4 Were recruited into the study. The patients received ondansetron (4 mg/day) plus fluoxetine (study group) or placebo plus fluoxetine (control group) for 12 weeks. The patients were assessed using the Y BOCS, SOFAS, CGI, WHOQOL-BREF and the adverse event checklists at baseline, and week 4, 8 & 12. Seventy patients completed the study.

Results & Conclusion: The Y-bocs total score as well as the y-bocs obsession subscale score and compulsion subscale score (based on mann-whitney u test) showed significantly greater improvement in the ondansetron add-on group compared to the fluoxetine only group. Functioning and quality of life also showed greater improvement in the study group. There was no significant difference between the two groups in terms of doses of fluoxetine, clonazepam, zolpidem and side effects. In conclusion, ondansetron showed significant beneficial effect as add-on to fluoxetine in patients of obsessive compulsive disorder.

Keywords: Ondansetron, fluoxetine, obsessive compulsive disorder.

Smart Phone Addiction And Associated Sleep Disturbances In Medical Students

Dr. Pushyami Satya Bandi, Dr.T.S.N. Raju , Dr. S.Radha Rani

Department Of Psychiatry, Andhra Medical College. Email Id : [email protected]

Introduction: The usage of smart phones has increased rapidly in recent years. Access to the internet is increasingly easy due to improvements in mobile Technology and the prevalence of smart phone and this has brought up addiction

Aim: To study smart phone addiction in medical students and associated sleep disturbances.

Methodology: A total of 175 students were taken and among them 43 were excluded due to incomplete questionnaires attempt , 2 were without smart phone , finally 130 ( females = 75[57.6%] And males = 55[42.3%] ) Students were included in the study . All participants were evaluated cross sectionally using sas-sv(smart phone addiction scale shorter version) and PQSI ( pittsburgh sleep quality index ) scales.

Results: Out of 130, 41(31.53%) Showed smart phone addiction ( males 19.2% ; Females 12.3% ). Positive correlation (r = 0.311) Was established between smart phone addiction and sleep disturbances in medical students with statistical significance (p < 0.001).

Conclusion: Smart phone addiction was significantly found and associated with sleep disturbances in medical students in this study.

Keywords: Smart Phone,addiction, Sleep, Medical Students

Psychiatric Morbidity In Patients With Multi-drug Resistant Tuberculosis

Dr. Rohan Gautam Shah

Email Id : [email protected]

Aims: To study prevalence of psychiatric disorders in patients with multi-drug resistance tuberculosis.

Hypothesis: The chronic nature of illness, medication side-effects and uncertain outcomes of the illness may lead increased biological, psychological and social problems which may lead to development of psychiatric disorders.

Materials And Methods: Descriptive study was done in department of psychiatry and pulmonary medicine in a tertiary care institute, after obtaining permission from ethics committee. Study group consisted of 50 participants who were assessed using a semi-structured proforma. A detailed history, complete general & systemic examination was noted. All the study participants were screened for psychiatric morbidity by using mini version 6.0.0 (Mini international neuropsychiatric interview)

Results: Age of the subjects ranged 18-65 years, out of 50 subject 27 were male, and 23 were females. Prevalence of psychiatric disorder was 32%; with anxiety disorders -50%, depression-31.25%, Insomnia-18.75% And acute stress reaction-6.25%.

Conclusion: The high prevalence of psychiatric morbidity in this study indicates that patients with mdr-tb should be routinely assessed for psychiatric morbidity.

keywords- Psychiatric morbidity,Multi drug resistant TB

Serum S100b Levels In Patients With Depression

Dr. Parul Arora, Dr. Pooja Pallavi, Dr. Subhadra Sharma, Dr. Rajesh Sagar, Dr. Manju Mehta, Dr. Asok K Mukhopadhyay

Department Of Laboratory Medicine, AIIMS. Email Id : [email protected]

Introduction: The biochemical basis of depression has been related to the state of bbb (blood brain barrier) allowing/ restricting a number of components to enter the brain milieu from the peripheral plasma milieu. S100b, a calcium (ca2+) binding protein has been associated with bbb damage and is used as a marker of integrity of bbb. It is a marker of neuroplasticity. Several studies have reported that depressive patients have increased levels of s100b in the serum and cerebrospinal fluid (csf).

Methods: Forty-two confirmed cases of depression, 13-25 years of age were recruited from the department of psychiatry, all india institute of medical sciences during the period of january 2013 to june 2014 after approval by the ethics committee of aiims. Forty-two healthy controls of comparable age and sex were also recruited. Psychometric evaluation of the patients and the controls was done and scores were given based on the interview. The psychiatrist rated severity of depression on the beck's depression inventory (bdi-ii) and hamilton depression rating scale (ham-d). Routine medical assessment and laboratory investigations were done on all participants. S100b levels were measured using sandwich elisa. The results obtained were then analyzed.

Results: Levels of serum s100b were significantly elevated in the patients with major depression as compared to healthy controls. Significantly higher levels of s100b were seen only in females as compared to their healthy control counterparts. Serum s100b was higher in depressed subjects with the recurrent disorder than those with single episode. No correlation of the levels of this marker was seen with the clinical severity of the patients. It was found that with increased duration of illness for which the patient was being treated with antidepressants the patients had higher levels of s100b.

Conclusions: Serum S100b Can Be Used As A Biomarker Of Depression.

Keywords: Serum 100b,Major depression

Impact Of Modified Ect On The Executive Functions Of Patients : A Longitudinal Study

Dr. Ankita Garg

Lourdes Hospital, Kochi

Email Id : [email protected]

Introduction: The primary objective is to compare the pre-ECT & post-ECT status of the executive functions of the patients and report deficits found at follow-up. The secondary objective is to find the association between executive function changes & patient characteristics and ect parameters.

Methodology: It is a prospective longitudinal observational study. Study area was lourdes hospital (kochi, kerala). Study population consisted of patients admitted in psychiatry ward from january 2014- december 2014, between 18-65 years of age and receiving modified ect for the first time. Sample size was 50. Patients were selected using consecutive type of convenience sampling. Relevant clinical and socio-demographic data was collected from patients and subjected to a neuropsychological battery consisting of digit span forwards, digit span backwards, spatial span forward, spatial span backward, phonemic verbal fluency test, semantic verbal fluency tests, stroop test & wisconsin card sorting test. Clinical evaluation took place 1 day before ect and 3 & 6 months after first ect. Data was transferred to spss ver.17. Mean, standard deviation, students t test, chi square test and regression analysis were used. Confidence level of 95% was taken as significant.

Results: Improvement was seen in the performance of patients at executive function tests at 3 months follow-up, which continued at 6 months follow-up. This was significant for phonemic and semantic verbal fluency, stroop test and wisconsin card sorting test (perseverative error percentage score).

Premorbid education level had significant positive correlation with the patients executive function post ect. Phonemic verbal fluency test had a positive correlation with younger age of the patient and male gender.

Conclusion: There are no executive function deficits 3-6 months following brief pulse modified electroconvulsive therapy with bilateral electrode placement. A higher premorbid education level is associated with better performance post-ect.

Key Words: Modified Ect, Executive Function, Long Term

Burden Of Care In Primary Care Givers Of Obsessive Compulsive Disorder Patients

Dr. Rashmi Dilip Joshi , Prof. Dr. Neena S. Sawant, Prof. Dr.S.R.Parkar, Dr. Dr.Pulkit

Seth G.S.M.C.. And K.E.M.H., Mumbai. Email Id : [email protected]

Background: Caregiving has been identified as an important factor in course and prognosis of patients with obsessive compulsive disorder (ocd). Studies have shown that the strain of caring for these patients impacts caregivers to a great extent and leads to burden over caregivers. However, there has been a paucity of data regarding burden in caregivers of patients with ocd, especially in the indian scenario and hence this study was undertaken to investigate the extent of caregiver burden and their associated factors in families having a member with ocd.

Methodology: The study was conducted after ethic committee approval in the department of psychiatry of a tertiary care hospital. 35 Caregivers of patients diagnosed with ocd as per ICD-10 criteria and who were staying with the patient for the last 6 months were screened and 23 who satisfied the inclusion & exclusion criteria were included in the study. Sociodemographic details of the caregivers were recorded and a semi-structured proforma, the family burden interview schedule (fibs) was administered to the subjects to assess their burden.

Results: The mean age of the patients was 31.8± 10.8 Years and that of the caregiver was 53± 18 years. There were 11 males and 12 females with all being hindus except 1 who was muslim.12 Of the caregivers were spouses and 11 were children. The duration of ocd was 5.75± 4.8 Years. 17 Of the caregivers were employed while the remaining were house wives.Severe burden on fibs was experienced by 10 caregivers, moderate burden by 5 caregivers, 2 mild burden while 6 caregivers gave no burden.

Conclusions: This study shows the burden experienced by the caregivers of ocd on the various domains. Hence psychoeducating them would help in increasing their awareness and having group therapy would help in reduction of the burden experienced by them.

Keywords: Primary care givers, OCD

Study On Effect Of Psychotropic Drugs With And Without Electroconvulsive Therapy On Cognition

Mr. Divyam Mathur, Mr Hussain Gavandhe, Ms Smita Daw

Email Id : [email protected]

Background/introduction: Cognitive impairment are proven to be present in most of the patients of psychiatric disorders and are directly linked to inability of human brain to perform a mental action. Improvement in cognition is considered to be a better outcome than positive and negative symptoms as it gives a better impact on health related quality of life. Both, psychotropic drug therapy and electroconvulsive therapy (ect) show effect on cognition individually and in combination.

Methodology/ Material And Method: The study was a prospective observational study for six months and was carried out in a tertiary care teaching hospital in pune, india. The patients diagnosed under dsm iv criteria of psychiatric illnesses, on treatment for more than 6 months and having mini-mental state exam(mmse) score <24 were included for the study. The addenbrookes cognitive examination- revised (ace-r) score was used to examine the cognition at the time of enrollment and twice after, at one-week interval each.

The mean, standard deviation and p-value of differences in initial and final ace-r scores were calculated for both group of patients, receiving psychotropic drug therapy with and without ect.

Result: 50 patients were included in the study, 29 received psychotropic drug therapy alone and 21 received psychotropic drugs with ect. Patients who received electroconvulsive therapy with psychotropic therapy showed clinically significant improvement (57%, sd=11.84, P-value-0.0024) Than psychotropic drug therapy alone (47%, sd=8.42, P-value=5.4986)

Conclusion: Psychotropic drug therapy with and without ect shows improvement in each of cognitive parameters although it cannot be concluded that psychotropic drugs with ect show better improvement than psychotropic drugs alone since this is an uncontrolled study with methodologic limitations. Insignificant effect of psychotropic drugs alone (p-value>0.05) On cognition can be attributable towards non-adherence, limited time span of monitoring and varied response of drugs in different patients.

Keywords: Psychotropic drugs,ECT,Cognition

A Clinical Study On Elderly Patients Attending Psychiatric Opd In Tertiary Health Care Centre For Evaluation Of Axis I (dsm Iv Tr) Psychiatric Disorder

Dr. Suman Baidya,Dr. Jibananda Das, Dr. Kamal Nath

Email Id : [email protected]

Background: The average lifespan in many parts of the world has increased over the past few centuries beginning with new challenge(pereira 2002).So the number of elderly population is increasing rapidly in both developed & developing countries.The rapid change in social structure and in traditional value system will have tremendous impact on the well being of senior citizen as well as the equilibrium of the society itself.6.4% Of the indian population is above the age of 60 years. The figure is likely to increase to 15% by 2025. There are many studies available on psychiatric morbidity in relation to physical illness in general population but few studies available on elderly group of population in this part of country. The present study therefore attempts to assess the psychiatric morbidity in the elderly group of population who seek for health services.

Aims & Objectives:

1) To find out the socio demographic variables of the cases included in our study samples.

2) To find out the distribution of types of axis i psychiatric disorders in our study samples.

3) To find out the association between the axis i psychiatric disorders with various important sociodemographic variables.

methods: Total 100 patients aged 60 years & above ,who attended psychiatric opd and gave full consent for the study were taken using serial sampling procedure. Sociodemographic datas were collected on a semi-structured proforma.The patients were assessed using DSM IV TR diagnostic criteria.

Results: In our study out of 100 patients, 74% belongs to rural area, 14% have depression and schizophrenia each, 20% dementia, 18% bipolar disorder, 12% other psychotic disorder,6% somatoform disorder, 1% each dissociative disorder and sleep disorder, 3% have no psychiatric morbidity.

Discussion And Conclusion: Would be discussed at due course at the time of presentation.

Keywords: Elderly Patient, Axis I Psychiatric Disorder.

A Comparative Study Of Serum C-Reactive Protein In Patients With Generalised Anxiety Disorder And Depression

Dr. Sandipan Nayek ,Dr. Soumitra Ghosh

Department Of Psychiatry, Assam Medical College And Hospital, Dibrugarh, Assam, India. Email Id : [email protected]

Background: Previous studies have shown that generalized anxiety disorder (gad) and depression were associated with increased serum crp level. Some studies also reported a linear correlation between the c-reactive protein level and severity of gad & depression.

Aims And Objectives: The aim is to assess and compare the level of serum c-reactive protein in GAD, depression & control group and to find out clinical correlation between the c-reactive protein level and severity of gad & depression.

Settings And Design: It is a hospital based cross sectional study conducted from june 2015 to may 2016 in the department of psychiatry, assam medical college & hospital, dibrugarh.

Materials And Methods: 50 cases each of gad & depression and 50 age & sex matched controls from normal healthy population of 18-65 years age group, admitted in the department of psychiatry, amch were estimated for serum c-reactive protein level by particle enhanced turbidimetric immunoassay (petia) technique. Severity of gad was assessed by hamilton anxiety rating scale (ham-a) & severity of depression was assessed by 17 items hamilton depression rating scale (ham-d).

Statistical Analysis: Done by analysis of variance (anova), chi square test and fischers exact test.

Results: Serum c-reactive protein was elevated significantly in gad and depression compared to healthy controls and elevation in depression patients were more than gad patients. There was also a significantly strong positive linear correlation between serum c-reactive protein and severity of gad and depression.

Conclusions: Our study findings are consistent with the role of inflammation in gad and depression. So, future study in this aspect with a larger sample and follow up is needed to explore the existence of a possible psychoneuroimmune link between gad and depression and inflammatory markers.

Key Words: C-reactive Protein, Depression, Generalized Anxiety Disorder, Inflammation

Changes In Mean Corpuscular Volume (mcv) & Serum Gamma Glutamyl Transferase (GGT) Among Patients With˜alcohol Use Disorder

Dr. Furkhan Ali, Dr. Swaroopachary, Prof. Sharbandh Raj

Email Id : [email protected]

Introduction: Alcoholism ranks as one of the main current threats to the health and safety of people in our country. A variety of liver enzymes assist in the diagnosis of alcohol addiction including, gamma-glutamyl transferase, alanine aminotransferase and aspartate aminotransferase. Gamma-glutamyl transferase is the most sensitive and widely employed marker and one of the longest established biochemical tests for excessive alcohol consumption.

Studies show mean corpuscular volume is elevated in approximately 50 to 60% of people who chronically ingest excessive alcohol quantities

Aim: In Patients With Alcohol Use Disorder

1. To assess the mean corpuscular volume

2. To assess gamma-glutamyl transferase

3. To correlate the changes in these bio-chemical parameters with the clinical variables

methodology: A prospective study being planned to be conducted for duration of 3 months from 1st october to 31st december 2016, in hospital, mahabubnagar, telangana. The sample would be 100 consecutive patients diagnosed with alcohol use disorder. Mean corpuscular volume & serum gamma-glutamyl transferase tests will be done in all these patients. Results will be correlated with the diagnosis of the patients.


1. Semi-structured Proforma: To record the socio demographic and clinical details of the patients

2. International Classification of Diseases 10, research and diagnostic criteria (icd-10 rdc) to diagnose the patients

3. Severity of alcohol dependence questionnaire (sadq): to assess the severity of alcohol dependence in patients

4. Global assessment of functioning (gaf): to assess the psychological, social, and occupational functioning of the patients

5. General health questionnaire (ghq-12): to validate the level of impairment in patients

statistical analysis will be done using spss 20th version.

Results And Conclusion: Will be discussed at the conference

Keywords: MCV,Serum GGT

Intent And Psychiatric Morbidity In Suicide Attempters

Dr. S.Prasanna Latha, Raghuram Macharapu, Pramod Kr Mallepalli, Ravulapati Sateeshbabu

Department of Psychiatry, Mamata Medical College, Khammam. Email Id : [email protected]

Introduction: Suicide always has a major impact on the survivors. Attempted suicide is one of the main predictor of completed suicide and is more common than completed suicide. The present study has been undertaken with the intention of deeper insight into the mental health of suicide attempters.

Aims & Objectives: 1) To evaluate the socio-demographic profile of subjects admitted for suicide attempt. 2)To assess the suicidal intent of the suicide attempt.3) To evaluate the nature of psychiatric morbidity in patients who have attempted suicide.4) To study the association of the suicide intent score with the various socio-demographic factors.5)To study the association between the socio-demographic characteristics, psychiatric diagnosis, and suicidal intent in suicide attempters.

Materials And Methods: The study was conducted in the department of psychiatry, mamata general hospital, khammam,telangana from september 2015 to august 2016. Tools used-Beck's Suicide intent scale, Mini international neuropsychiatric interview plus (MINI Plus).

Results: high intent score was found more in alcohol dependence syndrome and lowest in deliberate self-harm.Study includes a significant proportion of the individuals who attempt suicide had a psychiatric morbidity, and deliberate self-harm was also present.

Conclusion: Suicide attempters are more among the groups of young age, male gender, married, belonging to nuclear family and low socio economic class. Majority of the suicide attempters are suffering with psychiatric illness.

Key Words: Attempted Suicide, Suicidal Intent, Psychiatric Illness.

High Dose Baclofen In Treatment Of Resistant Alcohol Dependence In India

Dr. Kalpana Nischol Raval , Dr. Nischol Raval

Sahyadri Hospitals, Pune. Email Id : [email protected]

Evidence shows that the GABA-B receptor agonist baclofen is effective for the treatment of alcoholism. A low dose (30 mg/day) of baclofen significantly decreases alcohol intake in most individuals, but may not achieve desired effect in some patients. Recent evidence is emerging showing effectiveness of high dose baclofen in treatment of alcohol dependence, which has been resistant to other modalities of treatment. There are very few indian studies showing the effectiveness and safety of using high dose baclofen in treating alcohol dependence.

Our Patient, mr.V.G, 30yr male, farmer, presented with severe alcohol dependence. His past inpatient deaddiction treatments had failed to achieve any significant change in the alcohol use. He was started on baclofen 20mg/day which was increased upto 110mg/day in divided dose. At this dose his alcohol consumption stopped completely and he reported no craving at all for alcohol. He did not suffer from any adverse effects of the high dose of baclofen. He was maintained on the same dose of baclofen and was completely abstinent from alcohol at 12 weeks follow-up.

There are very few indian studies using high dose baclofen in treatment of alcohol dependence. Further research needs to be undertaken to evaluate the efficacy and safety of this modality of treatment in indian population.

Keywords: baclofen resistant ,alcohol dependence

Study On Psychiatric Morbidity Among Young Patients Of Acne vulgaris At Tertiary Care Institute

Dr. Robin ,Dr. Mayuresh Ghadge, Dr. Sunil G. Gupte, Dr. Anup Bharti

Dr. Vasantrao Pawar Medical College. Email Id : [email protected]

Introduction: Acne vulgaris is a common disorder of youth and adolescence, a period with psychological turmoil. As acne vulgaris can affect visible appearance of a person, some individuals may develop serious psychopathology which requires immediate clinical attention.

The aim of this study was to find out the various socio-demographic details, psychiatric morbidity and the coping mechanisms used by the acne vulgaris patients being treated in the tertiary care centre.

Material And Methods: Study type/ design: descriptive observational study.

Study Settings: The study was conducted in department of psychiatry & dermatology in a tertiary care institute. Approval from institutional ethics committee was taken.

Sample Size: 100 Patients

Inclusion Criteria

Patients of 18 to 30 years, irrespective of gender, clinically diagnosed˜acne vulgaris (both new as well as old cases).

Acne vulgaris patient willing for participation in study after written informed consent.

Exclusion Criteria

Past history of any documented psychiatric illness.

Patients having dermatological illness other than acne vulgaris.

Results: It was noted that psychiatric morbidity was present in 35 (35%) of the study population. Major depressive disorder was found in 22 (22%) patients. It was found to be the most common psychiatric morbidity. Psychiatric morbidity was more in young (18-22 years), single, females, patients from nuclear families, rural background and acne with grade 3 & 4, using coping mechanisms fatalism and passivity.

Conclusions: Acne vulgaris is one of the common dermatological conditions. Some of these patients may experience somatic, emotional and psychiatric problems. Psychiatric morbidities in these patients are often ignored. Therefore, it is vital to give importance to the dermatological conditions as well as any psychological issues. Routine psychiatric evaluation of these patients may be important to understand and treat such patients from holistic point of view.

Keywords: acne vulgairs,psychiatric morbidity

Antidepressant-induced Sexual Dysfunction and Quality Of Life

Dr. Parth Mehta, Prof. R.c. Jiloha

Dept of Psychiatry, HIMSR & HAHC Hospital, Jamia Hamdard, New Delhi. Email Id : [email protected]

Objective: Antidepressant induced sexual dysfunction is a very common side effect and has a major impact on treatment compliance. The present study aims to assess the quality of life in male patients (currently in remission from depressive episode) having antidepressant-induced sexual dysfunction.

Methods: The study was a cross sectional hospital based observational study, conducted among male patients visiting the o.P.D. Of dept. Of psychiatry, G.B.Pant hospital, new delhi. 50 Male patients fulfilling the selection criteria were taken and semi-structured proforma (detailing sociodemographic and clinical characteristics), arizona sexual experiences scale hindi version & who quality of life (whoqol)-bref hindi version were applied. Results were obtained using statistical methods like chi-square test, students t-test and pearson correlation coefficient.

Results: The prevalence of sexual dysfunction was 32% in our study. There was statistically significant lower quality of life scores in patients having sexual dysfunction (p < .001) And there was negative correlation between sex and all domains of WHO QOL and total scores ( r = -0.707, P<0.01).

Conclusion: Even though the patients in our study had achieved clinical remission from their depressive episode, antidepressant-induced sexual dysfunction leads to a poorer quality of life in them as compared to those without this side effect. Hence identification and management of this adverse effect is necessary to improve the overall outcome of the depressive episode.

Keywords: Antidepressant, Sexual Dysfunction, Quality Of Life

A case report of a female patient with Pica.

Manju George, ShreemitMaheshwari, Dushad Ram, Rajesh Raman, T S Sathyanarayana Rao*

Department of Psychiatry, JSS Medical College and Hospital, JSS University, Mysore.

HYPERLINK "mailto:[email protected]" [email protected]

Background: The central element of Pica is the repeated ingestion of non-nutritive, non food substance over the course of 1 month, resulting in the need for specialized clinical attention .This type of non-food items vary depending on the patients' age and the availability of different materials. Examples of non food substances are not limited to but include soil, hair, paper and soap. The prevalence of Pica is difficult to establish because of differences in definition and the reluctance of patients to admit to abnormal cravings and ingestion.

Method: Here we are reporting a case of 35 years old female patient Pica secondary to depression.

Case: Mrs. H, a 35 year old female, presented to the psychiatry outpatient department with complaints of consuming paper and cardboard whenever she was alone from the past 2 months.She also started chewing on the ends of pencils and ice-cream sticks. On certain days she would end up consuming two to three A4 size sheets bit by bit. Her physical examination was normal and on MSE she was well kempt and groomed, rapport established with mood being subjectively sad, objectively depressed with nil thought or perceptual disturbances and normal cognitive functions with an insight of 3/6.Complete blood count revealed Hemoglobin of 10.8mg/dl and other blood parameters were within normal range. Urine routine examination, X-ray abdomen, Ultrasound abdomen was normal. Patient was diagnosed with Pica secondary to Depression.

Conclusion: Pica is sometimes a culturally sanctioned practice and may not be pathological. Although Pica is the most common eating disorder in individuals with developmental disabilities and children, in this case there was no history of childhood developmental disabilities. Although the etiology of Pica is unknown, more recent cases of Pica have been tied to the obsession - compulsion spectrum disorder. The details about the case will be presented.

Keywords: Pica, Depression, non-nutritive substances