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   2013| July-September  | Volume 55 | Issue 3  
    Online since August 28, 2013

 
 
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GUEST EDITORIALS
Diagnostic and statistical manual of mental disorders 5: A quick glance
Vihang N Vahia
July-September 2013, 55(3):220-223
DOI:10.4103/0019-5545.117131  PMID:24082241
  17,508 3,596 113
REVIEW ARTICLES
Sexual violence against women: Understanding cross-cultural intersections
Gurvinder Kalra, Dinesh Bhugra
July-September 2013, 55(3):244-249
DOI:10.4103/0019-5545.117139  PMID:24082244
Interpersonal violence whether it is sexual or nonsexual, remains a major problem in large parts of the world. Sexual violence against children and women brings with it long-term sequelae, both psychiatrically and socially. Apart from sexual gratification itself, sexual violence against women is often a result of unequal power equations both real and perceived between men and women and is also strongly influenced by cultural factors and values. Within sociocentric and ego-centric cultures, the roles and representations of genders, and attitudes toward sexual violence differ. Cultures which are described as feminist, provide equal power to both men and women. Sexual violence is likely to occur more commonly in cultures that foster beliefs of perceived male superiority and social and cultural inferiority of women. Although culture is an important factor to understand sexual violence in its entirety, we need to look at, as well as beyond cultural structures, their strengths and weaknesses.
  10,159 1,364 50
Mental health assessment of rape offenders
Jaydip Sarkar
July-September 2013, 55(3):235-243
DOI:10.4103/0019-5545.117137  PMID:24082243
There is an urgent need for development of methods of assessment and management of sex offenders (rapists, child sex offenders, other sexual offenders, and murderers) to mount a society-wide battle against the scourge of sexual offences in India. This paper provides an overview of theories, models, and assessment methods of rapists. It draws upon literature from psychiatry, psychology, criminology, probation, and ethics to provide a framework for understanding reasons behind rape, how mental health issues are implicated, what mental health professionals can do to contribute to crime management, and why this is ethically right and proper.
  7,447 895 5
ORIGINAL ARTICLES
Clinical validity of NIMHANS neuropsychological battery for elderly: A preliminary report
Ravikesh Tripathi, Janakiprasad Keshav Kumar, Srikala Bharath, Palaniappan Marimuthu, Mathew Varghese
July-September 2013, 55(3):279-282
DOI:10.4103/0019-5545.117149  PMID:24082250
Background: Neuropsychological assessment plays a crucial role in the assessment of cognitive decline in older age. In India, there is a dearth of culturally appropriate standardized measure to assess cognitive functions in early dementia. The aim of the study was to examine clinical validity of NIMHANS Neuropsychological Battery for Elderly (NNB-E) in identifying early dementia. Objectives: To examine validity (discriminant and concurrent) of NIMHANS Neuropsychological Battery for Elderly (NNB-E). Materials and Methods: The study sample consisted of 99 participants [39 patients with Alzheimer's disease (AD) and 60 normal controls] within an age range of 55-87 years. All the participants were assessed on NNB-E, which comprised of tests for verbal and visuo-spatial memory, working memory, executive function, language, and construction. Receiver operating characteristic (ROC) curve was used to examine the discriminating power of different neuropsychological tests. Pearson correlation coefficient was used to examine the concurrent validity. Results: Participants with AD showed significantly poorer performance on every test including memory and non-memory domains. However, tests of episodic and semantic memory were particularly sensitive in discriminating between normal and AD groups. Further scores on various subtests in the NNB-E were positively associated with scores on HMSE and negatively associated with Clinical Dementia Rating and Everyday Abilities Scale for India (EASI) scores. Conclusions: NNB-E was able to differentiate normal controls from AD patients, and it can therefore be an ecologically valid tool for Indian older adults.
  6,579 740 10
DLN MURTHYRAO ORATION
Resilience: Building immunity in psychiatry
Priyvadan Chandrakant Shastri
July-September 2013, 55(3):224-234
DOI:10.4103/0019-5545.117134  PMID:24082242
The challenges in our personal, professional, financial, and emotional world are on rise, more so in developing countries and people will be longing for mental wellness for achieving complete health in their life. Resilience stands for one's capacity to recover from extremes of trauma and stress. Resilience in a person reflects a dynamic union of factors that encourages positive adaptation despite exposure to adverse life experiences. One needs to have a three-dimensional construct for understanding resilience as a state (what is it and how does one identify it?), a condition (what can be done about it?), and a practice (how does one get there?). Evaluating the level of resilience requires the measurement of internal (personal) and external (environmental) factors, taking into account that family and social environment variables of resilience play very important roles in an individual's resilience. Protection factors seem to be more important in the development of resilience than risk factors. Resilience is a process that lasts a lifetime, with periods of acquisition and maintenance, and reduction and loss for assessment. Overall, currently available data on resilience suggest the presence of a neurobiological substrate, based largely on genetics, which correlates with personality traits, some of which are configured via social learning. The major questions about resilience revolve around properly defining the concept, identifying the factors involved in its development and recognizing whether it is actually possible to immunize mental health against adversities. In the clinical field, it may be possible to identify predisposing factors or risk factors for psychopathologies and to develop new intervention strategies, both preventive and therapeutic, based on the concept of resilience. The preferred environments for application of resilience are health, education, and social policy and the right approach in integrating; it can be developed only with more research and analysis with focus on resilience. Be it patient or family member or caregiver, advocating resilience will empower psychiatrists in India.
  6,423 708 14
GUEST EDITORIALS
Time to face new realities; mental health care bill-2013
Anirudh Kala
July-September 2013, 55(3):216-219
DOI:10.4103/0019-5545.117129  PMID:24082240
  5,921 1,055 11
ORIGINAL ARTICLES
Bereavement after the suicide of a significant other
Maurizio Pompili, Amresh Shrivastava, Gianluca Serafini, Marco Innamorati, Mariantonietta Milelli, Denise Erbuto, Federica Ricci, Dorian A Lamis, Paolo Scocco, Mario Amore, David Lester, Paolo Girardi
July-September 2013, 55(3):256-263
DOI:10.4103/0019-5545.117145  PMID:24082246
Context: It is estimated that approximately one in four people know someone who has taken their own life and that one suicide death leaves six or more suicide survivors. Aims: The aim of this paper was to review the literature regarding the association between suicide and bereavement, focusing also on the supportive and therapeutic resources available for survivors. Materials and Methods: Careful MedLine and PsycINFO searches for the period 1980-2013. Results: The review of the literature indicates that emotional turmoil in suicide survivors may last a long time and, in some cases, may end with their own suicide. Conclusion: Future research should evaluate the efficacy of professional treatments and of support groups targeting suicide survivors. Practice Implications: It is crucial to understand the bereavement process after the suicide of a significant other in order to provide proper care, reduce stigma, and improve the outcomes of related psychiatric conditions.
  5,178 524 71
REVIEW ARTICLES
Rape: Legal issues in mental health perspective
RC Jiloha
July-September 2013, 55(3):250-255
DOI:10.4103/0019-5545.117141  PMID:24082245
Rape of women by men has occurred throughout recorded history and across cultures and religions. It is a crime against basic human right and a most common crime against women in India. In this article, rape is discussed from legal and mental health perspective. In India 'rape laws' began with enactment of Indian Penal Code in 1860. There have been subsequent amendments and the main issue of focus remained the definition of 'rape and inclusion of 'marital rape' in the ambit of rape. Law Commission Reports related to rape and the psychological impacts of rape have been discussed.
  4,639 548 5
CASE REPORTS
A case of Zolpidem dependence successfully detoxified with gabapentin
Wenona H Fernandes, Yvonne Da Silva Pereira, Salvador O' Tereza
July-September 2013, 55(3):290-292
DOI:10.4103/0019-5545.117152  PMID:24082253
An elderly female patient with Zolpidem dependence, who was successfully detoxified using Gabapentin is reported. Gabapentin may be considered as an alternative in the detoxification of non-benzodiazepine hypnotics.
  4,065 202 4
BRIEF RESEARCH COMMUNICATION
Depression and type D personality among undergraduate medical students
Soma Gupta, Prosenjit Basak
July-September 2013, 55(3):287-289
DOI:10.4103/0019-5545.117151  PMID:24082252
Context: Academic pressure, though established, is an unavoidable cause of depression in medical students. Role of Type D personality as determinant of depression is a new approach to the problem. Aim: Determination of relationship between Type D personality and Depression among medical students. Setting and Design: Undergraduate students (both male and female, total 150) of Midnapore Medical College. Materials and Methods: Beck Depression Inventory for depression and DS 14 for type D personality. Statistical Analysis: The scores were expressed as mean + SD. The significance of difference between the scores was done by Fisher's 2 sample t test. Results and Conclusion: Prevalence rate of depression was 45.3%, which was mostly of mild type (34%). Type D personality was present in 70% cases of which 15.3% had only negative affectivity, 23.3% had only social inhibition and 31% had both the components. Both depression & Type D personality were present in 36% cases. Negative affectivity component was significantly associated with depression which could be therapeutically controlled.
  3,453 476 6
EDITORIAL
Sexual coercion: Time to rise to the challenge
TS Sathyanarayana Rao, Mehak Nagpal, Chittaranjan Andrade
July-September 2013, 55(3):211-213
DOI:10.4103/0019-5545.117125  PMID:24082238
  3,353 370 4
ORIGINAL ARTICLES
A study of neuropsychiatric manifestations in patients of neurocysticercosis
Smita Srivastava, Rakesh Kumar Chadda, Kiran Bala, Pradipta Majumdar
July-September 2013, 55(3):264-267
DOI:10.4103/0019-5545.117146  PMID:24082247
Background: Neurocysticercosis (NCC) is an endemic parasitic infection of Asia, Africa, Latin America, and central Europe. Neuropsychiatric manifestations of the illness include epilepsy and behavioral disturbances. There is a dearth of systematic studies on psychiatric manifestations of NCC from various Asian counties. The present study assessed the prevalence of various psychiatric disorders in a cohort of patients with NCC attending a neurological service. Materials and Methods: Detailed psychiatric assessment was carried out on 50 patients of NCC with epilepsy and 50 patients of epilepsy without any evidence of NCC. Comprehensive Psychopathological Rating Scale was used to elicit the symptoms. Cognitive functions were assessed using Mini Mental Status Examination. Psychiatric diagnoses were made as per International Classification of Diseases, 10 th edition (ICD-10). Results: Sixty eight percent of the patients with NCC suffered from a psychiatric disorder, as compared to 44% of those without NCC (P=0.02). Major depression and mixed anxiety depression were the two most common diagnoses. None of the patients was to found to suffer from a psychotic disorder. The most frequent site of brain lesion of NCC was the parietal lobe, followed by frontal lobes and disseminated lesions. Left sided lesions were associated with greater psychiatric morbidity. Focal seizures with or without secondary generalizations were present more frequently in patients with NCC whereas primary generalized seizures were more common in patients with idiopathic epilepsy (P=0.05). Conclusion: Psychiatric manifestations are more common in patients of epilepsy with NCC than those without NCC. The treating clinician need to be vigilant about the phenomenon.
  3,177 344 3
LITERARY PSYCHIATRY
Literary destigmatisation of mental illness: A study of the writings of Jayakanthan
O Somasundaram
July-September 2013, 55(3):295-299
DOI:10.4103/0019-5545.117154  PMID:24082255
National and international associations of psychiatry are busy formulating and executing anti-stigma measures and activities. Literary works of creative artists could be utilised for this purpose. This article based on the writings of a popular Tamil writer Jayakanthan discusses some of his works in relation to this.
  3,303 215 3
ORIGINAL ARTICLES
Psychological attributes and socio-demographic profile of hundred completed suicide victims in the state of Goa, India
Ashish Srivastava
July-September 2013, 55(3):268-272
DOI:10.4103/0019-5545.117147  PMID:24082248
Aims: To describe socio-demographic characteristics, psycho-social factors, psychiatric co-morbidity in hundred completed suicide victims. Materials and Methods: A detailed interview was carried out with family members of suicide victims using psychological autopsy questionnaire. Results: Males committed suicide significantly more often than females. The most common age group was 30-44 years, followed by 15-29 years. Most of them were married (68%) and majority (78%) had education less than 10 th standard. Psychiatric morbidity was found in 94%, depression being the most common diagnosis (54%), followed by alcohol use disorders (42%). 40% of the victims had contact with mental health services and 50% with general health services in the 3 months preceding suicide. Conclusions: The rate of suicide is high in middle age and a very significant proportion of these suffer from diagnosable psychiatric disorders. Many of the suicide completers visit health services in the preceding few months of the event. In prevention of suicides, health professionals, both mental and general, can play a major role.
  2,754 564 5
CASE REPORTS
A patient with Tramadol dependence and predictable provoked epileptic seizures
Naresh Nebhinani, Shubh M Singh, Gourav Gupta
July-September 2013, 55(3):293-294
DOI:10.4103/0019-5545.117153  PMID:24082254
Tramadol is an atypical, centrally acting synthetic analgesic with propensity for provoked seizures as well as abuse potential. The index case of Tramadol dependence discussed in this case report developed multiple epileptic seizures with high doses of Tramadol, used as a sexual enhancer by him, and later he learned to prevent the seizures by self-medicating with Alprazolam. The authors further emphasize on the regulation of Tramadol prescription.
  2,939 169 1
VIEW POINT
Child psychopharmacology: Is it more similar than different from adult psychopharmacology?
Himanshu Sareen, Jitendra Kumar Trivedi
July-September 2013, 55(3):301-304
DOI:10.4103/0019-5545.117158  PMID:24082257
Despite having a large chunk of human population, Asian countries face shortage of mental health professionals. There is further shortage of doctors dealing with special groups of population like the children, the elderly, and the medically ill. However, in this era of super-specializations, are the basic principles of general psychopharmacology being forgotten? Dealing with child population is different and often more difficult than adult population but are management guidelines for the two populations vastly divergent? A close look at this paints a different picture. Psychotherapies applied in adults and those in children and adolescents are disparate owing to cognitive, social, emotional, and physical immaturation in children and adolescents. But the drugs for the treatment of pediatric psychiatric disorders are mostly similar to those prescribed for adults (case in point -bipolar disorders, obsessive compulsive disorder, schizophrenia). Rather than focusing energy on propagating the differences in assorted subgroups of population, honing of skills regarding intricacies of psychopharmacology is required to be emphasized. Detailed history taking, careful evaluation of the patient, sound diagnostic formulation, and prescribing medications which are tailor made to the patient will all go a long way in ensuring a functional recovery of the patients irrespective of the group they belong to.
  2,045 211 -
EDITORIAL COMMENTARY
Childhood sexual abuse and the law: More problems than solutions?
Chittaranjan Andrade, TS Sathyanarayana Rao
July-September 2013, 55(3):214-215
PMID:24082239
  1,831 328 1
ORIGINAL ARTICLES
A psychometric cut-point to separate emergently suicidal depressed patients from stable depressed outpatients
W Vaughn McCall, Nicolas Batson, Megan Webster, Indu Joshi, Todd Derreberry, Adam McDonough, Suzan Farris
July-September 2013, 55(3):283-286
DOI:10.4103/0019-5545.117150  PMID:24082251
Context: The design of safe clinical trials targeting suicidal ideation requires operational definitions of what degree of suicidal ideation is too excessive to allow safe participation. Aims: We examined the Scale for Suicide Ideation (SSI) to develop a psychometric cut-point that would identify patients having a suicidal emergency. Settings and Design: The Emergency Department (ED) and the out-patient clinic of a university hospital. Materials and Methods: We used the SSI to contrast 23 stable, depressed adult out-patients versus 11 depressed adult ED patients awaiting psychiatric admission for a suicidal emergency. Statistical Analysis: The performance of the SSI was examined with nominal logistic regression. Results: ED patients were older than out-patients (P<0.001), with proportionally more men (P<0.05), and were more ethnically diverse than the outpatients (P<0.005). Compared to out-patients, ED patients were more depressed (Patient Health Questionnaire-9 score 23.1±3.8 vs. 11.7±7.3, P<0.005) and reported a greater degree of suicidal ideation (SSI scores 25.7±7.3 vs. 4.2±8.4, P<0.0001). Nominal logistic regression for the univariate model of SSI score and group yielded a score of 16 (P<0.0001) as the best cut-point in separating groups, with a corresponding Receiver Operating Characteristic Area Under the Curve = 0.94. Of 34 patients in the total sample, only two were misclassified by SSI score = 16, with both of these being false positive for ED status. Thus, the sensitivity of the cut-point was 100% with specificity of 91%. When the model was expanded to include SSI along with age, gender, ethnicity, sedative-hypnotic use, and over-the-counter use, only SSI score remained significant as a predictor. Conclusions: A SSI score ≥16 may be useful as an exclusion criterion for out-patients in depression clinical trials.
  1,902 161 1
ART & PSYCHIATRY
Child Psyche
Sravanti Sanivarapu
July-September 2013, 55(3):300-300
DOI:10.4103/0019-5545.117156  PMID:24082256
  1,636 162 1
LETTERS TO EDITOR
Indian contribution to the cultural formulation interview and the DSM-5: Missing details from the position paper
Vasudeo Pralhad Paralikar, Smita N Deshpande, Sushrut Jadhav, Mitchell G Weiss
July-September 2013, 55(3):307-308
DOI:10.4103/0019-5545.117160  PMID:24082260
  1,641 150 2
BOOK REVIEW
Clinical assessment and management of childhood psychiatric disorders
Prabhat Sitholey
July-September 2013, 55(3):310-310
  1,407 231 -
ORIGINAL ARTICLES
Factors associated to depression in renal transplant recipients in Panama
Vivian Vásquez, Nelson Novarro, Régulo A Valdés, Gabrielle B Britton
July-September 2013, 55(3):273-278
DOI:10.4103/0019-5545.117148  PMID:24082249
Aim: High rates of affective disorders have been reported in kidney transplant recipients treated for end-stage renal disease. Latin America has experienced a significant increase in transplant activity in recent decades, but there is a dearth of data regarding psychosocial issues following kidney transplantation. The aim of this study was to measure the prevalence of depression and the demographic factors associated to depression among renal transplant recipients in Panama. Materials and Methods: This cross-sectional study was conducted between March to May 2010 in a hospital setting during routine outpatient evaluations. The study included 119 renal transplant recipients (58 males, 61 females). Depressive symptoms were measured using the self-report Hospital Anxiety and Depression Scale and diagnoses were established by a trained psychiatrist using the Mini-International Neuropsychiatric Interview. Regression models were used to explore the association between depression and sociodemographic variables. Results: The prevalence of depression was 11.8% among transplant recipients. Linear regression indicated that the presence of an anxiety disorder, increasing age, and lower education levels were significantly and independently associated with depressive symptoms. Logistic regression analysis confirmed that anxiety and a perception of negative social support significantly increased the likelihood of depression. Conclusions: These findings have important clinical implications. Depression after kidney transplantation has been shown to affect health outcomes adversely. Our results underscore the need to assess depressive symptoms as well as other affective disorders as part of the screening and treatment of renal transplant patients in Panama.
  1,347 172 6
LETTERS TO EDITOR
Response to article: The manpower development scheme under the National Mental Health Program
Kalyanasundaram Seshadri
July-September 2013, 55(3):306-307
DOI:10.4103/0019-5545.117157  PMID:24082259
  1,316 152 -
Reply to Indian contribution to the cultural formulation interview and the DSM-5: Missing details from the position paper
KS Jacob, RA Kallivayalil, AK Mallik, N Gupta, JK Trivedi, BN Gangadhar, K Praveenlal, V Vahia, T.S Sathyanarayana Rao
July-September 2013, 55(3):308-309
DOI:10.4103/0019-5545.117161  PMID:24082261
  1,260 120 -
Atypical presentation of dystonia in a polydrug user
Gurvinder Pal Singh, KC Jindal
July-September 2013, 55(3):305-305
DOI:10.4103/0019-5545.117155  PMID:24082258
  1,220 93 -