Indian Journal of PsychiatryIndian Journal of Psychiatry
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   2014| July-September  | Volume 56 | Issue 3  
    Online since September 12, 2014

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Neuro-cognitive functioning in unaffected siblings of patients with bipolar disorder: Comparison with bipolar patients and healthy controls
Ritu Nehra, Sandeep Grover, Sunil Sharma, Aditi Sharma, Siddharth Sarkar
July-September 2014, 56(3):283-288
DOI:10.4103/0019-5545.140645  PMID:25316940
Aim: Neurocognitive tests can provide reliable endophenotypes for bipolar disorder (BD). The aim of this study was to compare the neurocognitive functioning of unaffected siblings of patients of bipolar affective disorder (BPAD) with that of patients with BD and a group of healthy controls. Materials and Methods: A total of 20 unaffected siblings of patients with BD-I, 20 patients of BD-I who were currently in remission and a group of 20 healthy control subjects were assessed for neurocognitive functions using Wisconsin Card Sorting Test, Brief Visuospatial Memory Test-Revised, Hopkins Verbal Learning Test-Revised and Wechsler Adult Intelligence Scale Digit Symbol Test. Results: Compared to healthy controls, unaffected siblings of patients with BD performed poorly on tests of verbal learning, but no significant differences were seen between the two groups for executive functions, visual learning and psychomotor speed, concentration and graphomotor abilities. Compared to unaffected siblings, patients with BD performed poorly on the tests of executive functions, visual memory, verbal memory, psychomotor speed, concentration, and graphomotor abilities. Conclusion: Verbal memory can serve as an endophenotype of bipolar disorder.
  1 2,514 263
Acute psychosis induced by isotretinoin
Sundararajan Rajagopal
July-September 2014, 56(3):295-297
DOI:10.4103/0019-5545.140652  PMID:25316943
Isotretinoin is used for the treatment of severe acne. Psychiatric side-effects, particularly depression, have been well-documented. This dramatic case report is about a young male patient who developed acute psychosis within a few days of starting isotretinoin. Due to his persecutory delusions, the patient, who was an Indian engineer working in Germany, decided to immediately return to India fearing for his life in Germany. Careful history taking established the cause of the psychosis. Isotretinoin was stopped; patient showed rapid improvement, within a week, on a low dose of risperidone. Risperidone was continued as a precaution for 3 months. After a further 8 months, the patient remains well without any psychotropic medication.
  1 2,198 190
Self-transcendence: Awaken your inner warrior!
Sravanti Sanivarapu
July-September 2014, 56(3):305-305
  - 1,221 100
Comprehensive Textbook of Sexual Medicine (Second Edition)
Ajit Avasthi, Mohit Varshney
July-September 2014, 56(3):311-312
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Sleeping Beauty: Kleine-Levin syndrome
Soumiya Mudgal, RC Jiloha, Manish Kandpal, Aparna Das
July-September 2014, 56(3):298-300
DOI:10.4103/0019-5545.140654  PMID:25316944
Kleine-Levin syndrome (KLS) alias sleeping beauty syndrome, is a rare sleep disorder. Clinically presenting as episodes of hypersomnolence, behavioral and cognitive disturbances, hyperphagia and hypersexuality. KLS may have an idiopathic onset or may be precipitated by neurological event or infection. Until date, no definite underlying cause is established and neither there are any definitive management guidelines. It remains a diagnosis of exclusion after other psychiatric and neurological causes have been ruled out. Coloring of presentation with behavioral and mood elements makes it important for a psychiatrist to be well-informed about the condition to avoid the erroneous diagnosis. KLS is a devastating illness, which robs the patient of time, experiences, and relationships. An early diagnosis and effective management can help patient escape from the morbidity caused by this disorder. Armodafinil and oxcarbamazepine have found to be effective in two of the case. The emphasis of this report is to add to the existing clinical knowledge of neurologists, psychiatrists and physicians. In the future, research is needed on genetic etiology and management of this disorder.
  - 2,201 274
Child who presented with hematohidrosis (sweating blood) with oppositional defiant disorder
Manjiri Deshpande, Vishal Indla, Varinder Kumar, Indla Ramasubba Reddy
July-September 2014, 56(3):289-291
DOI:10.4103/0019-5545.140649  PMID:25316941
Hematohidrosis is a very rare condition of sweating blood. A child's case who presented to us with hematohidrosis is reported. There are only few reports in the literature. A 10-year-old boy presented to our hospital with a history of repeated episodes of oozing of blood from navel, eyes, ear lobules, and nose. During the examination, it disappeared as soon as it was mopped leaving behind no sign of trauma only to reappear within a few seconds. Bleeding time, clotting time, and prothrombin time were normal. Patient was diagnosed with hematohidrosis and oppositional defiant disorder clinically. Management of this condition at our center is discussed below.
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The curious case of the "inseparable child"
Praveen Navkhare, Gurvinder Kalra
July-September 2014, 56(3):292-294
DOI:10.4103/0019-5545.140650  PMID:25316942
Streptococcal infections in children rarely lead to neuropsychiatric manifestations referred to as pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. The common sequelae include tics, Tourette's syndrome or obsessive-compulsive disorder. Rare presentations may include separation anxiety disorder, body dysmorphic disorder and attention deficit hyperactivity disorder. We present a case of a 10-year-old child that presented primarily with abrupt onset of separation anxiety without any other neuropsychiatric manifestations such as tics or obsessive-compulsive symptoms. Streptococcal infections may present with varied neuropsychiatric manifestations in the pediatric age group and one needs to be more vigilant in cases that have an abrupt onset and unusual presentation. A high index of suspicion is important to diagnose such cases and provide them with a timely treatment.
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Approaches to psychiatric nosology: A viewpoint
Ajit Avasthi, Siddharth Sarkar, Sandeep Grover
July-September 2014, 56(3):301-304
DOI:10.4103/0019-5545.120560  PMID:25316945
Psychiatric nosology is required for communication among clinicians and researchers, understanding etiology, testing treatment efficacy, knowing the prevalence of the problems and disorders, healthcare planning, organizing the services, and reimbursement purposes. Many approaches have been used for psychiatric nosology, including categorical, dimensional, hybrid, and etiological. The categorical approach considers illness as being either present or absent, and similarity with prototypical description of a disorder is taken as a marker for the disorder. The dimensional approach regards that symptoms of disorder exist on a continuum from normal to severely ill. The hybrid approach combines categorical and dimensional approaches, with categorical diagnosis for broad diagnostic group and dimensional indicator for severity. The etiological approach tends to find "reason" for the set of symptoms, which could be biological, psychological, or social. In this article, certain critical issues about the different nosological approaches are discussed. Hybrid approach currently seems to be the most preferred for widespread usage. In conclusion, psychiatric nosology needs to evolve through epistemic iteration leading to successive changes and devising a more refined and useful system with time.
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Caring for the family caregivers of persons with mental illness
Rakesh K Chadda
July-September 2014, 56(3):221-227
DOI:10.4103/0019-5545.140616  PMID:25316932
  - 12,040 1,024
Policy of the Indian Journal of Psychiatry on the problem of plagiarism
TS Sathyanarayana Rao, Chittaranjan Andrade
July-September 2014, 56(3):211-212
DOI:10.4103/0019-5545.140613  PMID:25316929
  - 1,596 251
Integrating mental health into public health: The community mental health development project in India
Chee Ng, Ajay P Chauhan, Bir Singh Chavan, Chellamuthu Ramasubramanian, Amool R Singh, Rajesh Sagar, Julia Fraser, Brigid Ryan, Jagdish Prasad, Sujeet Singh, Jayanta Das, Mohan Isaac
July-September 2014, 56(3):215-220
DOI:10.4103/0019-5545.140615  PMID:25316931
The Ministry of Health and Family Welfare and its public health institutes are collaborating with Asia Australia Mental Health on an innovative community mental health development project designed to enhance initiatives under the District Mental Health Program and increase accessibility of essential community mental health services. The project is an exciting opportunity to create positive change in meeting the challenges of community mental health care in India. It recognizes that no one single model of care can be applied to all the community in the country and that locally appropriate models working in close partnership with local communities is required. Targeted and skill-based training programs are useful to build local leadership capacity in implementing quality and culturally appropriate community mental health services.
  - 3,023 518
On "standing alongside the patient in his difficulties" or the privileging of the historical
Alok Sarin, Sanjeev Jain
July-September 2014, 56(3):213-214
DOI:10.4103/0019-5545.140614  PMID:25316930
  - 1,633 166
Clinical recognition of delirium
KS Shaji, KS Jyothi
July-September 2014, 56(3):306-306
DOI:10.4103/0019-5545.140665  PMID:25316947
  - 2,189 153
Depression in lung cancer patients
Hulegar A Abhishekh, Arjun L Balaji, Ravindra M Mehta
July-September 2014, 56(3):307-307
DOI:10.4103/0019-5545.140667  PMID:25316948
  - 1,258 129
"Mania": An unusual presentation of craniopharyngioma
Majid Mohammed Abdul, Paritosh Pandey, Avinash V Waghmare, Mayur V Kaku
July-September 2014, 56(3):308-308
DOI:10.4103/0019-5545.140669  PMID:25316949
  - 1,047 79
How can we avoid delay in referrals of patients with delirium?
Sandeep Grover, Natasha Kate
July-September 2014, 56(3):309-310
DOI:10.4103/0019-5545.140670  PMID:25316950
  - 905 117
Age of onset of dependence: Does it help our understanding of opioid dependence by generating meaningful categories or by acting as a useful dimension? A critical examination of the classic debate in psychiatry
Debasish Basu, Deepak Ghormode, Rohit Madan, Surendra Mattoo, Ritu Nehra, Sudesh Prabhakar
July-September 2014, 56(3):228-237
DOI:10.4103/0019-5545.140617  PMID:25316933
Background: Category vs. dimension is a classic debate in psychiatry. Applying age of onset of dependence (AOOD) to categorize opioid dependence into early- (EO) and late-onset (LO) types provides a unique opportunity to critically examine this debate. Aim: To study if EO and LO subjects differ significantly on 'validating variables' from five explanatory domains: Clinical (severity), genetic (family history), psychological (sensation-seeking and impulsivity), neuropsychological (attention-concentration and executive functions), and neurophysiological (P300-evoked response potential). Materials and Methods: In a cross-sectional design, 60 ICD-10 DCR-diagnosed opioid-dependent male subjects (30 with AOOD≤20 years and 30 with AOOD≥22 years) comprised the two index groups (EO and LO, respectively), with their respective age-matched control groups (EOC and LOC). They were administered an extensive battery of instruments and tests based on the above domains. Results: The two groups differed significantly on only three out of nearly 30 variables tested. However, there emerged a clear and consistent pattern of continuum of scores across the groups and across all the variables: The EO subjects were the most impaired or affected, the LO subjects were intermediate, and the control groups fared the best. Further, nine test variables correlated significantly and meaningfully with AOOD when the dichotomy was abolished and the sample was combined into one. Conclusions: These results suggest that, in this particular case, the variable AOOD is more meaningful when it is used as a dimension rather than for generating categories perforce.
  - 2,205 244
Suttur study: An epidemiological study of psychiatric disorders in south Indian rural population
TS Sathyanarayana Rao, MS Darshan, Abhinav Tandon, Rajesh Raman, KN Karthik, N Saraswathi, Keya Das, GT Harsha, V S T Krishna, NC Ashok
July-September 2014, 56(3):238-245
DOI:10.4103/0019-5545.140618  PMID:25316934
Background: Based on review of literature World Health Organization (WHO) Global Burden of Disease Study has estimated that psychiatric disorders are among the most burdensome, around the globe and has suggested general population surveys for future research. This study aims to estimate the prevalence of psychiatric disorders and study their association with various socioeconomic variables. Materials and Methods: This was an exploratory study where a door-to-door survey of the entire population residing in a South Indian village was done (n = 3033). Mini international neuropsychiatric interview kid (MINI) or MINI plus were administered to all the subjects according to the age group. Results: It was found that 24.40% of the subjects were suffering from one or more diagnosable psychiatric disorder. Prevalence of depressive disorders was found to be 14.82% and of anxiety disorders was 4%. Alcohol dependence syndrome was diagnosed in 3.95% of the population. Prevalence of dementia in subjects above 60 years was found to be 10%. Conclusion: Our study is among the very few epidemiological studies with respect to methodological design which does not use screening questionnaires and evaluates each subject with detailed administration of MINI. It concluded that one among four were suffering from a psychiatric disorder. Improving the training of undergraduate medical and nursing students is likely to play a significant role in addressing the increasing psychiatric morbidities.
  - 3,312 525
Nonmedical use of sedatives in urban Bengaluru
Prasanthi Nattala, Pratima Murthy, K Thennarasu, Linda B Cottler
July-September 2014, 56(3):246-252
DOI:10.4103/0019-5545.140619  PMID:25316935
Background: Nonmedical sedative use is emerging as a serious problem in India. However, there is paucity of literature on the patterns of use in the population. Aim: The aim of the present analysis was to explore sedative use patterns in an urban metropolis. Materials and Methods: Data for the present analysis come from the parent study on nonmedical prescription drug use in Bengaluru, India. Participants (n = 717) were recruited using a mall-intercept approach, wherein they were intercepted in five randomly selected shopping malls, and administered an interview on their use of prescription drugs. Results: Past 12-month nonmedical sedative use was reported by 12%, benzodiazepines being the commonest. Reasons cited for nonmedical use included "sleeplessness, pain relief, stress." A majority (73%) reported sedative use "in ways other than as prescribed," compared to "use without prescription" (27%). All prescriptions were issued by general physicians in private hospitals. About 11% among those who used "in ways other than as prescribed," and 100% of nonprescribed users, reported irregular use (skipping doses/stopping/restarting). Among those who used "in ways other than prescribed," pharmacy stores were the source of obtaining the sedatives. Among "nonprescribed users," family/friends were the main source. Three-percent reported using sedatives and alcohol together in the same use episode. In multivariate logistic regression analyses, nonmedical sedative use was significantly associated with graduation-level education or above (adjusted odds ratio [aOR]: 2.53, 95% confidence interval [CI]: 1.30-4.91), and married status (aOR: 2.32, 95% CI: 1.04-5.18). Conclusions: Findings underscore the need for considering various contextual factors in tailoring preventive interventions for reducing nonmedical sedative use.
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Indian Psychiatric Society multicentric study: Prescription patterns of psychotropics in India
Sandeep Grover, Ajit Avasthi, Vishal Sinha, Bhavesh Lakdawala, Manish Bathla, Sujata Sethi, DM Mathur, Puneet Kathuria, Sandip Shah, D Sai Baalasubramanian, Vivek Agarwal, Kamla Deka
July-September 2014, 56(3):253-264
DOI:10.4103/0019-5545.140632  PMID:25316936
Background: There is a lack of national level data from India on prescription of psychotropics by psychiatrists. Aim and Objective: This study aimed to assess the first prescription handed over to the psychiatrically ill patients whenever they contact a psychiatrist. Materials and Methods: Data were collected across 11 centers. Psychiatric diagnosis was made as per the International Classification of Diseases Classification of Mental and Behavioural Disorders 10 th edition criteria based on Mini International Neuropsychiatric Interview, and the data of psychotropic prescriptions was collected. Results: Study included 4480 patients, slightly more than half of the subjects were of male (54.8%) and most of the participants were married (71.8%). Half of the participants were from the urban background, and about half (46.9%) were educated up to or beyond high school. The most common diagnostic category was that of affective disorders (54.3%), followed by Neurotic, stress-related and somatoform disorders (22.2%) and psychotic disorders (19.1%). Other diagnostic categories formed a very small proportion of the study participants. Among the antidepressants, most commonly prescribed antidepressant included escitalopram followed by sertraline. Escitalopram was the most common antidepressant across 7 out of 11 centers and second most common in three centers. Among the antipsychotics, the most commonly prescribed antipsychotic was olanzapine followed by risperidone. Olanzapine was the most commonly prescribed antipsychotic across 6 out of 11 centers and second most common antipsychotic across rest of the centers. Among the mood stabilizers valproate was prescribed more often, and it was the most commonly prescribed mood stabilizer in 8 out of 11 centers. Clonazepam was prescribed as anxiolytic about 5 times more commonly than lorazepam. Clonazepam was the most common benzodiazepine prescribed in 6 out of the 11 centers. Rate of polypharmacy was low. Conclusion: Escitalopram is the most commonly prescribed antidepressant, olanzapine is the most commonly prescribed antipsychotic and clonazepam is most commonly prescribed benzodiazepine. There are very few variations in prescription patterns across various centers.
  - 4,209 556
Assessment of oral mucosal lesions among psychiatric inmates residing in central jail, Bhopal, Madhya Pradesh, India: A cross-sectional survey
Nilesh Arjun Torwane, Hongal Sudhir, RN Sahu, Vrinda Saxena, Eshani Saxena, Shubham Jain
July-September 2014, 56(3):265-270
DOI:10.4103/0019-5545.140636  PMID:25316937
Aim: The aim of the current cross-sectional study was to assess oral mucosal lesions among psychiatric jail patients residing in central jail, Bhopal, Madhya Pradesh, India. Materials and Methods: The study subjects consisted of prediagnosed psychiatric patients residing in central jail, Bhopal. A matched control consisting of cross section of the population, that is, jail inmates residing in the same central jail locality was also examined to compare the psychiatric subjects. The WHO oral health assessment proforma, 1997 along with 18-item questionnaire was used for the oral health examination. Results: A total number of subjects examined were 244, which comprised of 122 psychiatric inmates and 122 nonpsychiatric inmates. Among all psychiatric inmates, about 57.4% of inmates had a diagnosis of depression, 14.8% had psychotic disorders (like schizophrenia), and 12.3% had anxiety disorder. A total of 77% study inmates, which comprised of 87.7% psychiatrics and 66.4% nonpsychiatrics had a habit of tobacco consumption (smokeless or smoking). Overall prevalence of oral mucosal lesions among the inmates was 85 (34.8%), which comprised of 39.3% psychiatric inmates and 30.3% nonpsychiatric inmates. Conclusion: The information presented in this study adds to our understanding of the common oral mucosal lesions occurring in a psychiatric inmate population. Leukoplakia and oral submucous fibrosis were the most common types of oral mucosal lesions found. Efforts to increase patient awareness of the oral effects of tobacco use and to eliminate the habit are needed to improve oral and general health of the prison population.
  - 1,647 209
Impact of psychiatry training on attitude of medical students toward mental illness and psychiatry
Prannay Gulati, Subhash Das, BS Chavan
July-September 2014, 56(3):271-277
DOI:10.4103/0019-5545.140640  PMID:25316938
Context: Attitude of fresh graduates toward psychiatric patients is important to bridge the treatment gap due to mental illness. Psychiatry as a subject has been neglected in the undergraduates of MBBS. Aims: (1) To compare the attitude of medical students and interns in a medical college toward mental illness and psychiatry. (2) To assess the impact of psychiatric training on attitude toward the mentally ill person and mental illness. Settings and Design: Cross-sectional, single assessment study conducted at a tertiary hospital. Subjects and Methods: Participants consisted of medical students of 1 st and 2 nd year who didn't have any exposure to psychiatry and interns, who had completed their compulsory 2 week clinical posting in psychiatry. Participants were individually administered sociodemographic proforma, General Health Questionnaire-12 (GHQ-12), opinion about mental illness (OMI) scale, and attitude to psychiatry-29 (ATP-29) scale. Statistical Analysis: Standard descriptive statistics (mean, percentage), Chi-square test. Results: A total of 135 participants formed the study sample, with 48, 47, and 40 participants from 1 st year, 2 nd year and interns, respectively. Mean GHQ score was 14.03 for the entire sample. There was better outlook of interns toward psychiatry and patients with mental disorders in comparison to fresh graduate students in some areas. Overall, negative attitude toward mental illness and psychiatry was reflected. Conclusions: Exposure to psychiatry as per the current curriculum seems to have a limited influence in bringing a positive change in OMI and psychiatry.
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Contributions of general hospital psychiatric units to psychiatric research in India
Sagar Chandra Bera, Mamta Sood, RK Chadda, TS Sathyanarayana Rao
July-September 2014, 56(3):278-282
DOI:10.4103/0019-5545.140644  PMID:25316939
Background: General hospital psychiatric units (GHPUs) are one of the major service and training providers in the field of mental health in India. However, there has not been any systematic attempt at their contributions toward research. Aim: The present paper reports on contributions of the GHPUs toward the psychiatric research based on analysis of publications in the Indian Journal of Psychiatry (IJP). Materials and Methods: All the issues of IJP of the last 25 years (1989-2013) were manually searched for original research papers, brief reports, and case reports. A semi-structured performa was used to collect information on various parameters. Results: About two-thirds of the papers were contributed by the GHPUs, most being multi-authored and from tertiary care centers. The research covered a variety of psychiatric disorders including schizophrenia, mood disorders, and common mental disorders. Most of the research reported was self-funded. Conclusion: GHPUs have contributed significantly to psychiatric research in India in the last 25 years.
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