Indian Journal of PsychiatryIndian Journal of Psychiatry
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   2009| October-December  | Volume 51 | Issue 4  
    Online since December 10, 2009

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Suicide in South India: A community-based study in Kerala
CR Soman, S Safraj, V Raman Kutty, K Vijayakumar, K Ajayan
October-December 2009, 51(4):261-264
DOI:10.4103/0019-5545.58290  PMID:20048450
Background: Studies from Tamil Nadu, South India, have reported the world's highest suicide rates. As per official reports, Kerala, another South Indian state has the highest suicide rate among the major states in India. Objective: The purpose of this analysis is to estimate the rates and age-specific incidence of suicide in a rural community in Kerala, under continuous observation for the last five years. Settings and Design: The study setting comprised of seven contiguous panchayats constituting a development block in Kerala. A prospective cohort study design was used. Materials and Methods: Through regular home visits, every death that occurred in the community was captured by local resident health workers and the cause of death assigned. Statistical Analysis: Suicide rates by age and sex and relative share of suicide deaths to all-cause deaths in men and women were calculated. Results: During the five-year period from 2002 to 2007, 284 cases of suicide were reported. The suicide rates were 44.7/100,000 for males and 26.8/100,000 for females. Male to female suicide ratio was 1.7. Among females aged between 15 and 24, suicides constituted more than 50% of all deaths. Male to female ratio of suicide varied from 0.4 in children aged 14 years or less to 4.5 in the 45-54 year age group. Conclusion: Our analysis shows that the level of under-reporting of suicides in rural Kerala is much less than that reported in Tamil Nadu.
  18 6,786 860
Prayer and healing: A medical and scientific perspective on randomized controlled trials
Chittaranjan Andrade, Rajiv Radhakrishnan
October-December 2009, 51(4):247-253
DOI:10.4103/0019-5545.58288  PMID:20048448
Religious traditions across the world display beliefs in healing through prayer. The healing powers of prayer have been examined in triple-blind, randomized controlled trials. We illustrate randomized controlled trials on prayer and healing, with one study in each of different categories of outcome. We provide a critical analysis of the scientific and philosophical dimensions of such research. Prayer has been reported to improve outcomes in human as well as nonhuman species, to have no effect on outcomes, to worsen outcomes and to have retrospective healing effects. For a multitude of reasons, research on the healing effects of prayer is riddled with assumptions, challenges and contradictions that make the subject a scientific and religious minefield. We believe that the research has led nowhere, and that future research, if any, will forever be constrained by the scientific limitations that we outline.
  14 11,764 1,046
A comparative study of sexual dysfunction involving risperidone, quetiapine, and olanzapine
Anil Kumar M Nagaraj, Nagesh B Pai, Satheesh Rao
October-December 2009, 51(4):265-271
DOI:10.4103/0019-5545.58291  PMID:20048451
Background: With the advent of newer antipsychotic drugs, side effects such as sexual dysfunction have been a major contributor toward treatment compliance. There are only a few studies that have compared different atypical antipsychotic agents regarding sexual dysfunction. We have not come across any data in this area on Indian population. Aims: To determine and compare the frequency of sexual dysfunction associated with risperidone, olanzapine, and quetiapine, among patients with clinically stable schizophrenia. Settings and Design: It is a cross-sectional hospital-based study. The subjects were recruited for the study by the purposive sampling technique. Materials and Methods: The total sample size was 102, consisting of 25 each in the quetiapine and risperidone groups, 22 in the olanzapine group, and 30 healthy volunteers. A Brief Psychiatric Rating Scale and Sexual Functioning Questionnaire (SFQ) were administered. The Kruskal Wallis test was used to compare the variables in the demographic data and the mean chlorpromazine equivalent doses of the study groups. To analyze the sexual dysfunction, the mean scores on all the domains of sexual functioning in SFQ were compared across the study groups using the Chi square test, for proportions. Results and Conclusion: Twenty-three percent of the healthy volunteers had some impairment in one or more domains of sexual functioning. For the medication groups this was 96, 88, and 90%, respectively for risperidone, quetiapine, and olanzapine. However, there was statistically no significant difference across the study groups although it was relatively less with quetiapine.
  10 6,050 651
Venlafaxine-induced psychotic symptoms
AT Safeekh, Denzil Pinto
October-December 2009, 51(4):308-309
DOI:10.4103/0019-5545.58301  PMID:20048460
Venlafaxine, an antidepressant belongs to Serotonin Norepinephrine Reuptake Inhibitors (SNRI), blocks the synaptic reuptake of serotonin in lower doses and also blocks reuptake of norepinephrine in higher doses. In addition it also blocks dopamine reuptake in still higher doses. This last mechanism of action is found to cause psychotic symptoms. Very few cases are reported with this adverse effect of venlafaxine. Here is a case report where a 32 year-old male with social phobia developed delusions of persecution on two occasions when he was put on venlafaxine 150 mg/day, which responded to withdrawal of venlafaxine and a short course of antipsychotics. The delusions never reappeared when he was maintained on escitalopram.
  8 3,048 214
Current perspectives in the treatment of resistant schizophrenia
RK Solanki, Paramjeet Singh, Deepti Munshi
October-December 2009, 51(4):254-260
DOI:10.4103/0019-5545.58289  PMID:20048449
This article summarizes the current knowledge base on the diagnosis and management of treatment resistant schizophrenia. While the prevalence of treatment resistant schizophrenia is definition dependent, estimates have ranged from 30% to up to 60%. This article first looks into the various diagnostic criteria of treatment resistant schizophrenia. Then the literature is reviewed about the pharmacotherapeutics of its management. Clozapine emerges to be the gold standard. In addition risperidone and high dose olanzapine also emerge as clinically useful options. Other emerging adjunctive treatment options are equally addressed.
  6 7,726 1,290
Clinical practice with antidementia and antipsychotic drugs: Audit from a geriatric clinic in India
Krishna Prasad, Himanshu Gupta, Srikala Bharath, Om Prakash, PT Sivakumar, C Naveen Kumar, Mathew Varghese
October-December 2009, 51(4):272-275
DOI:10.4103/0019-5545.58292  PMID:20048452
Background: Dementia is one of the most disabling disorders afflicting the elderly, with a staggering emotional and economic impact. Antidementia agents have been used for delaying cognitive decline. Antipsychotics are commonly prescribed for behavioral symptoms associated with dementia. Objectives: To explore the use of anti-dementing agents and antipsychotics used in patients with a diagnosis of dementia Materials and Methods: A retrospective chart review method; geriatric clinic of tertiary care setting. Results: The study sample included 51 consecutive patients with a diagnosis of dementia. The commonest subtype of dementia that was diagnosed was Alzheimer's disease (45%), followed by Frontotemporal dementia (25%).The commonest antidementia drug that was used was donepezil, which alone was prescribed in 27 patients (52%). The commonest antipsychotic used was quetiapine, which was used in 24 patients (47%). Conclusions: The study found donepezil to be the most commonly prescribed antidementia drug and quetiapine to be the most commonly used antipsychotic in a tertiary care geriatric clinic, in a developing country. There is a need to study the cost-effectiveness of antidementia and antipsychotic drugs in patients with dementia, in developing countries.
  5 3,537 378
Moving towards ICD-11 and DSM-V: Concept and evolution of psychiatric classification
PK Dalal, T Sivakumar
October-December 2009, 51(4):310-319
DOI:10.4103/0019-5545.58302  PMID:20048461
A classification is as good as its theory. As the etiology of psychiatric disorders is still not clearly known, we still define them categorically by their clinical syndrome. There are doubts if they are valid discrete disease entities and if dimensional models are better to study them. We have come a long way till ICD-10 and DSM-IV, but there are shortcomings. With advances in genetics and neurobiology in the future, classification of psychiatric disorders should improve further. The concept, evolution, current status and challenges facing psychiatric classification are discussed in this review.
  4 23,004 1,414
Farmers' suicide: Across culture
PB Behere, MC Bhise
October-December 2009, 51(4):242-243
DOI:10.4103/0019-5545.58286  PMID:20048446
  3 4,350 631
Duration of first admission and its relation to the readmission rate in a psychiatry hospital
S Vasudeva, MS Narendra Kumar, K Chandra Sekhar
October-December 2009, 51(4):280-284
DOI:10.4103/0019-5545.58294  PMID:20048454
Background: Most psychiatric illnesses have a chronic relapsing course. It is estimated that the readmission rate for discharged patients is approximately 40-50% within one year of their discharge from the hospital. The current emphasis in mental health service is on brief hospitalization and providing community-based services. Aim: To understand the relationship between the duration of first hospital admission and the rates of readmission in a psychiatry hospital. Materials and Methods: All the patients admitted at Asha hospital, Hyderabad for the first time between16 September, 2003 to 15 March, 2004, were included in the study. The hospital records of these patients were examined and the data was collected on various variables, which included demographic variables, duration of hospital stay, diagnosis, and the number of readmissions for a period of approximately three-and-a-half years. The duration of the first hospital stay was divided into four categories, Group 1:1-7 days, Group 2:8 to 14 days, Group 3:15 to 30 days, and Group 4: More than 30 days. Results: The sample consisted of 516 patients, out of whom 17 were excluded because of insufficient data. Two hundred and fifty patients belonged to Group 1 (1 to 7 days), 206 patients in Group 2 (8 to 14 days), Group 3 (15 to 30 days) constituted 35 patients, and eight patients were in Group 4 ( > 30 days). Conclusion: The length of the initial hospital stay is important to prevent future hospitalization. There are no definite predictors for readmission that could be detected, except for the length of the initial admission in the study.
  3 3,307 229
'Cinemadness': In search of sanity in films
G Swaminath, Ajit Bhide
October-December 2009, 51(4):244-246
DOI:10.4103/0019-5545.58287  PMID:20048447
  3 3,989 387
Online infidelity: The new challenge to marriages
Angelina Mao, Ahalya Raguram
October-December 2009, 51(4):302-304
DOI:10.4103/0019-5545.58299  PMID:20048458
Increased usage of the Internet has given rise to a new challenge to marriages: That of online infidelity, which is perceived to be as traumatic as actual infidelity. This article highlights the negative impact of online infidelity on marital relationship and its detrimental effect on the mental health of the offended spouse using a case vignette. The article discusses the importance of marital therapy in dealing with the factors contributing to online infidelity and in rebuilding marital trust.
  2 6,215 535
Report of the Indo-US health care summit 2009 - Mental health section
Anand K Pandurangi, Nimesh G Desai
October-December 2009, 51(4):292-301
DOI:10.4103/0019-5545.58298  PMID:20048457
The 2nd Indo-US Health Care Summit held in January 2009 was a forum to discuss collaboration between physicians in the US and India on medical education, health care services and research. Six specialties were represented including Mental Health (MH). Using Depression as the paradigmatic disorder, the following objectives were developed. Objective I - Leadership and Public Education: Linkage with like-minded agencies and organizations. The core message should be simple. Major Depression is a brain disorder. Depression is treatable. Timely treatment prevents disability and suicide. Objective II - Medical Education: To improve psychiatric education, it was proposed that (1) relations between US/UK and Indian mid-level institutions be established, (2) teaching methods such as tele-psychiatry and online courses be pursued, (3) use models of teaching excellence to arouse student interest, and (4) develop core curricula for other branches of medicine, and CME. Objective III - Reduce Complications of Depression (Suicide, Alcoholism): Goals include (1) decriminalizing attempted suicide, (2) improving reporting systems, and including depression, psychosis, alcoholism, and suicide in the national registry, (3) pilot studies in vulnerable groups on risk and interventions, and (4) education of colleagues on alcoholism as a link between psychiatric and medical disorders. Objective IV - Integrating MH Treatment& Primary Health Care: The focus should be on training of general practitioners in psychiatry. Available training modules including long distance learning modules to be suitably modified for India. Collaborations and specific project designs are to be developed, implemented and monitored by each specialty group and reviewed in future summits.
  2 3,642 235
The biochemistry of belief
TS Sathyanarayana Rao, MR Asha, KS Jagannatha Rao, P Vasudevaraju
October-December 2009, 51(4):239-241
DOI:10.4103/0019-5545.58285  PMID:20048445
  2 5,574 582
Toluene associated schizophrenia-like psychosis
Naren P Rao, Arun Gupta, K Sreejayan, Prabhat K Chand, Vivek Benegal, Pratima Murthy
October-December 2009, 51(4):329-330
DOI:10.4103/0019-5545.58307  PMID:20048466
  2 2,456 185
Apoptosis in subicular neurons: A comparison between suicide and Addison's disease
K Printha, SR Hulathduwa, K Samarasinghe, YH Suh, K. R. D De Silva
October-December 2009, 51(4):276-279
DOI:10.4103/0019-5545.58293  PMID:20048453
Background: Stress and depression shows possible links to neuronal death in hippocampus. Subiculum plays a prominent role in limbic stress integration and direct effect of corticosteroids on subicular neurons needs to be defined to assess its subsequent impact on hippocampal plasticity. Aim: This study was intended to assess apoptosis in subicular neurons of a young depressed suicide victim, where presumably stress induced excess of corticosteroids and a case of young Addison's disease with low level of corticosteroids. Materials and Method: Both bilateral adrenal glands (Addison's) and subiculum (both cases) were initially stained with hematoxylin and eosin; subicular neurons of both cases were examined for the degree of apoptosis using 'ApopTag Kit'. Apoptotic cell counts were expressed as average number of labeled cells/mm 2 and the results were analysed statistically using a non-parametric Mann-Whitney U test. Result: Apoptotic neurons were detected in the subicular region of both suicide and Addison victims, and it is statistically significant in both right and left between the cases (P < 0.05). In suicide victim, the neuronal apoptosis is considerably significant between the two hemispheres (P < 0.05), in contrast to Addison disease where the number of neuronal cell death between right and left was statistically insignificant (P > 0.05). Conclusion: The present study confirms the vulnerability of the subicular neurons to apoptosis, possibly due to corticosteroids in both ends of spectrum.
  2 2,191 142
Experiences of a sensitization program on common mental disorders for primary care physicians using problem-based learning approach
Rakesh K Chadda, Mamta Sood, Nand Kumar
October-December 2009, 51(4):289-291
DOI:10.4103/0019-5545.58296  PMID:20048456
Authors describe their experience of conducting a series of one-day sensitization programs on common mental disorders for primary care doctors. One hundred and two doctors attended the program. A problem-based learning approach involving active participation by the participants was used. The program was conducted as a part of the educational activities under the National Mental Health Program of India. It is suggested that this approach can be used effectively to impart training to mental health professionals in low-income countries like India.
  1 1,761 206
Dissociative fugue in the elderly
Anita Rajah, R Suresh Kumar, CP Somasundaram, A Anand Kumar
October-December 2009, 51(4):305-307
DOI:10.4103/0019-5545.58300  PMID:20048459
Dissociative fugue is a rarely reported diagnostic entity. It is one of the least understood and yet clinically one of the most fascinating disorders in Mental Health. Here, we describe a case of fugue in a 62-year-old housewife who was brought to our hospital with pockets of memory loss. This case illustrates the need for timely referrals, which could channelize valuable professional time and help avoid expensive and unnecessary investigations.
  1 6,098 246
Chittaranjan Andrade
October-December 2009, 51(4):320-323
DOI:10.4103/0019-5545.58303  PMID:20048462
  1 3,261 432
The story of antipsychotics: Past and present
Chaitra T Ramachandraiah, Narayana Subramaniam, Manuel Tancer
October-December 2009, 51(4):324-326
DOI:10.4103/0019-5545.58304  PMID:20048463
  1 3,431 528
Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10 th Edition
Sujit Sarkhel
October-December 2009, 51(4):331-331
  - 4,772 1,886
Suicide Prevention: A Handbook for Community Gate Keepers
RC Jiloha
October-December 2009, 51(4):332-332
  - 1,163 200
Amoxapine-induced tardive dyskinesia
Gurvinder Pal Singh
October-December 2009, 51(4):327-327
DOI:10.4103/0019-5545.58305  PMID:20048464
  - 1,402 119
Obsessive-compulsive disorder of vowels (rare type)
V Anandprakash Ghorpade
October-December 2009, 51(4):328-329
DOI:10.4103/0019-5545.58306  PMID:20048465
  - 1,627 139
The conceptualization of terms: 'Mood' and 'affect' in academic trainees of mental health
Narayana Manjunatha, Christoday Raja Jayant Khess, Dushad Ram
October-December 2009, 51(4):285-288
DOI:10.4103/0019-5545.58295  PMID:20048455
Background: The management of psychiatric disorders should ideally be carried out by a multidisciplinary team that consists of mental health professionals from different disciplines. All mental health professionals are expected to learn similar basic clinical skills during their training, despite the difference in their graduation. Objective: To compare the conceptualization of the terms 'mood' and 'affect' in all academic trainees of mental health in the Central Institute of Psychiatry (CIP), Ranchi, India. Materials and Methods: The 'modified mood and affect questionnaire' administered to all mental health trainees of CIP, Ranchi, India, in this study. The participants were requested to mark one response (either 'true', 'false' or 'not sure') for each item. The completed questionnaire was collected on the spot. Results: The statistical analysis was done for the data from psychiatric residents and trainees of clinical psychology. The statistical differences were observed between these two groups in response to the items-'Mood is the moment to moment emotional tone' and items of 'sign/symptom dimension'. Conclusions: The observed statistical difference in items could be the reflection of the differences in the description of 'mood' and 'affect' in textbooks of psychopathology, as well as, the difference in their graduation. The trainees of clinical psychology may be benefitted with more exposure in medical knowledge during their training.
  - 3,955 401