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   2016| October-December  | Volume 58 | Issue 4  
    Online since December 27, 2016

 
 
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ORIGINAL ARTICLES
Efficacy of mindfulness-integrated cognitive behavior therapy in patients with predominant obsessions
Ajay Kumar, Mahendra P Sharma, Janardhanan C Narayanaswamy, Thennarasu Kandavel, YC Janardhan Reddy
October-December 2016, 58(4):366-371
DOI:10.4103/0019-5545.196723  PMID:28196991
Background: Cognitive behavior therapy (CBT) involving exposure and response prevention is the gold standard psychotherapeutic intervention for obsessive-compulsive disorder (OCD). However, applying traditional CBT techniques to treat patients with predominant obsessions (POs) without covert compulsions is fraught with problems because of inaccessibility of mental compulsions. In this context, we examined the efficacy of mindfulness-integrated CBT (MICBT) in patients with POs without prominent overt compulsions. Materials and Methods: Twenty-seven patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of OCD were recruited from the specialty OCD clinic and the behavior therapy services of a tertiary care psychiatric hospital over 14 months. Patients had few or no overt compulsions and were free of medication or on a stable medication regimen for at least 2 months prior to baseline assessment. All patients received 12–16 sessions of MICBT on an outpatient basis. An independent rater (psychiatrist) administered the Yale–Brown Obsessive-Compulsive Scale (YBOCS) and the Clinical Global Impression Scale at baseline, mid- and post-treatment, and at 3-month follow-up. Results: Of the 27 patients, 18 (67%) achieved remission (55% reduction in the YBOCS severity score) at 3-month follow-up. The average mean percentage reduction of obsessive severity at postintervention and 3-month follow-up was 56 (standard deviation [SD] = 23) and 63 (SD = 21), respectively. Conclusions: Our study demonstrates that MICBT is efficacious in treating patients with POs without prominent overt compulsions. The results of this open-label study are encouraging and suggest that a larger randomized controlled trial examining the effects of MICBT may now be warranted.
  2,934 488 -
BRIEF RESEARCH COMMUNICATIONS
A 10-year retrospective study of suicide in Sikkim, India: Sociodemographic profile and risk assessment
Reshma Chettri, Jiwan Gurung, Bisu Singh
October-December 2016, 58(4):448-453
DOI:10.4103/0019-5545.196712  PMID:28197004
Objective: The present study had been undertaken to investigate the sociodemographic profile of individuals who had committed suicide in Sikkim which may throw light on the vulnerable groups. Materials and Methods: Ten-year suicide data (2006–2015) obtained from Police Headquarters, Crime Branch, Gangtok, have been statistically evaluated to study the sociodemographic profile. Results: The results showed that out of 1604 suicide cases recorded for the past 10 years, 1051 were males (65.5%) and 553 (34.5%) were females. Suicide was found to be common among the age group of 21–30 years (24.4%), Rai community (15.8%), population of rural areas (82.6%), and among the population of eastern districts (50.6%). Hanging (94.8%) was found to be the most common method adopted for suicide. Conclusion: The study provides preliminary information about the vulnerable groups for suicide in the state which may be vital for taking necessary steps for its prevention shortly.
  2,667 220 -
ORIGINAL ARTICLES
Subclinical depression in Urban Indian adolescents: Prevalence, felt needs, and correlates
Meghna Singhal, M Manjula, K John Vijay Sagar
October-December 2016, 58(4):394-402
DOI:10.4103/0019-5545.196727  PMID:28196996
Background: Subclinical depression in adolescents constitutes a risk factor for future clinical depression and hence warrants examination. However, there is a paucity of research that documents subclinical depression among adolescents in India. Objectives: (a) To investigate the prevalence of subclinical depression in urban school-going adolescents; (b) to investigate the problems and felt needs of these adolescents; (c) to examine depression-related variables; and (d) to examine the relationships between socio-demographic and depression-related variables. Materials and Methods: Eight hundred adolescents (ages 13–18 years) of English-medium schools of Bangalore city were assessed using standardized self-report measures. Results: Academic difficulties were the most frequently reported problem, followed by interpersonal issues. Of the sample, 18% adolescents were identified as endorsing subclinical depression. Adolescents in the present study scored higher on measures of depression and negative cognitions than their Western counterparts. In addition, girls were found to be at higher risk for experiencing depressive symptoms and negative cognitions, lower social problem-solving skills, and more problematic interpersonal relationships as compared to boys. Conclusion: Identification of subclinical depression constitutes an important goal, as it places an adolescent at risk of considerable vulnerability and impairment.
  2,478 337 -
Injection drug use among children and adolescents in India: Ringing the alarm bells
Anju Dhawan, Raman Deep Pattanayak, Anita Chopra, Vinod Kumar Tikoo, Rajesh Kumar
October-December 2016, 58(4):387-393
DOI:10.4103/0019-5545.196701  PMID:28196995
Introduction: Injection drug use (IDU) is intricately linked to preventive aspects for human immunodeficiency virus from a public health perspective. No large-scale data are yet available for injectable drug use among children and adolescents in India, apart from few anecdotal reports. Aims and Methods: The present paper reports on the profile and substance use pattern of 509 child IDU users, among a total sample of over 4000 children using substances across 100 sites from 27 states and 2 UTs in India. It was undertaken in 2012–2013 by the National Commission of Protection for Child Rights in collaboration with the National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi. For inclusion, participants had to be 18 years or less, should have used at least one other substance besides tobacco in the last 1 year, and should be living at home/street, in or out of school. Data were gathered using a 95-item semi-structured questionnaire. Results: A large proportion of ever users of IDU also reported use in the past year (96.5%) and past month (92.7%). Apart from IDU, tobacco, alcohol, cannabis, and pharmaceutical opioids were the most common substances of abuse in order of frequency. There was an interval of about 3 years from the initiation of tobacco to the initiation of IDU. Average age of onset for IDU was a year lesser in males than female users. The street children initiated IDU earlier than out-of-school and schoolgoing children. No quit attempt was made by more than half of the children. More than 40% had frequent familial conflicts, more than half had a familial history of substance use, and three-fourths had drug-using peers. Conclusion: The paper highlights the profile and pattern of children and adolescents using IDU across many parts of India, dispelling the myth that IDU is largely an adult phenomenon in India. There is a clear need to promote different harm reduction and preventive strategies across the “hard-to-reach” younger age groups using injecting drugs.
  2,382 302 -
Personality disorders and its association with anxiety and depression among patients of severe acne: Across-sectional study from Eastern India
Sharmila Sarkar, Paramita Patra, Kakali Mridha, Sudip Kumar Ghosh, Asish Mukhopadhyay, Rajarshi Guha Thakurta
October-December 2016, 58(4):378-382
DOI:10.4103/0019-5545.196720  PMID:28196993
Background: In many patients, emotional stress may exacerbate acne. Psychological problems such as social phobias, low self-esteem, or depression may also occur as a result of acne. The presence of acne may have some negative effect on the quality of life, self-esteem, and mood of the affected patients. While some studies have been undertaken about anxiety, depression, and personality patterns in patients with acne, only a few studies have been done to identify specific personality disorders in patients with acne. Furthermore, there is a dearth of data regarding the effect of personality disorder on the psychological states of the patients which prompted us to undertake the present study. Methodology: This was a descriptive cross-sectional study, undertaken in a Tertiary Care Teaching Hospital in Eastern India. Consecutive patients suffering from severe (Grade 3 and 4) acne, attending the Dermatology Outpatient Department, aged above 18 years were included to the study. Results: A total of 65 patients were evaluated with a mean age of 26 years. Personality disorder was present in 29.2% of patients. The diagnosed personality disorders were obsessive compulsive personality disorder (n = 9, 13.8%), anxious (avoidant) personality disorder (n = 6, 9.2%), and borderline personality disorder (n = 2, 3%), mixed personality disorder (n = 2, 3%). All patients with personality disorder had some psychiatric comorbidity. Patients having personality disorder had higher number of anxiety and depressive disorders which were also statistically significant. Conclusion: The present study highlights that personality disorders and other psychiatric comorbidities are common in the setting of severe acne.
  2,322 348 -
LITERARY PSYCHIATRY
Jainism-Its relevance to psychiatric practice; with special reference to the practice of Sallekhana
Ottilingam Somasundaram, AG Tejus Murthy, D Vijaya Raghavan
October-December 2016, 58(4):471-474
DOI:10.4103/0019-5545.196702  PMID:28197009
Jainism is one of the oldest religions of India. Since the founding of the religion, Jainism has given prominence to Sallekhana, death by ritual fasting facing north, as exemplified in the deaths of Bhadrabahu and Chandragupta Maurya. The controversy whether this religious form of starvation is related to suicide is debated since the time of the early Jain teachers. History is replete with instances where kings and warriors who have failed in their duty punish themselves for their sin and welcome death as expiation. Such starvation deaths are referred to as vadakirutthal (literally, facing north) and become quite prevalent during the Sangam age, probably copied from the Jain culture. The present-day thinking on Sallekhana needs to be considered here in more detail which should be brought to the knowledge of current-day psychiatrists. These ideas are relevant to psychiatric counseling of the ordinary people and would be very useful if included in the armamentarium of the mental health professionals.
  2,275 356 -
GUEST EDITORIAL
The UNESCO movement for bioethics in medical education and the Indian scenario
Smita N Deshpande
October-December 2016, 58(4):359-362
DOI:10.4103/0019-5545.196722  PMID:28196989
  2,365 185 -
ORIGINAL ARTICLES
Perceived stigma of mental illness: A comparison between two metropolitan cities in India
Aron Zieger, Aditya Mungee, Georg Schomerus, Thi Minh Tam Ta, Michael Dettling, Matthias C Angermeyer, Eric Hahn
October-December 2016, 58(4):432-437
DOI:10.4103/0019-5545.196706  PMID:28197001
Purpose: An increasing number of comparative studies are conducted on the stigmatization of persons with mental illness, in particular with regard to regional and diachronic variation. So far, there have been no studies comparing stigmatization of persons with mental illness in two different regions of India. Therefore, we examined the differences in perception of stigma attached to mental illnesses in Kolkata and Chennai, with regard to cultural and geographical differences to better understand the roots and origins of this issue. Materials and Methods: Explorative surveys in the context of public attitudes toward people with mental disorders were conducted among conveniently selected members of the general population in Chennai (n = 166) and Kolkata (n = 158) with identical methodology. Link's perceived devaluation-discrimination measure was used. The samples were matched for age, gender, and education. Results: The calculated sum score indicated that respondents from Kolkata had a higher level of perceived discrimination toward persons with mental illness than respondents from Chennai (P = 0.043). Furthermore, regression analysis revealed that lower perceived stigma was associated with stronger religious devotion (P = 0.049) and higher educational attainment (P = 0.001) in both cities. Discussion: The results showed that perceived stigma was higher in Kolkata than in Chennai. The correlation of higher stigma with lower education was in line with the previous research, and interestingly, it was found that higher stigma correlated with weaker religious devotion. Further studies exploring a wider variety of factors may provide us with a better understanding of the roots of perceived stigma in India.
  2,215 324 -
BRIEF RESEARCH COMMUNICATIONS
Celebrity suicide and its effect on further media reporting and portrayal of suicide: An exploratory study
Devavrat Harshe, Sagar Karia, Sneha Harshe, Nilesh Shah, Gurudas Harshe, Avinash De Sousa
October-December 2016, 58(4):443-447
DOI:10.4103/0019-5545.196704  PMID:28197003
Background: Suicide is a grave mental health problem in India, and suicide rates in India have risen over the past decades. Suicide reporting by the media is a common cause for spurts of suicides that may occur from time to time. The aim of the present study was to assess the change in trends in media reporting of suicide after a celebrity suicide. Methodology: Suicide by the renowned actor Robin Williams was selected as the reference case. The top three Indian daily newspapers published in English having the highest circulation as per the Registrar of Newspapers, Government of India report were selected to be scanned in the study. These were the Times of India – Mumbai edition, Mumbai Mirror, and the Daily News Analysis – Mumbai edition. The authors screened all news stories in the three newspapers within a 6-month period (3 months prior and 3 months post the date of the reference suicide case), and these news reports were evaluated as per the suicide reporting guidelines for media laid down by the Indian Psychiatric Society. The data were analyzed using Chi-square test and descriptive statistics where appropriate. Results: A total of 708 newspaper articles were identified on the basis of the guidelines mentioned above. Nearly 88% (n = 623) of the articles directly covered suicide while 4.09% (n = 29) focused on suicidal threats and 7.91% (n = 56) focused on parasuicide behavior. There was a significantly greater increase in the total number of articles printed after the celebrity suicide (n = 409) for all article types except teasers as compared to that before the celebrity suicide (n = 299). There was a significantly greater increase in front page news on suicide after the celebrity suicide (P = 0.0016), description of the method of suicide (P = 0.0221), and the mention of the suicide notes (P = 0.0002). Most articles after the celebrity suicide placed the blame on someone or the environment for the act (P = 0.0001). Conclusions: A change in media trend toward reporting suicide was noted post a celebrity suicide, and it is important that media follow guidelines stringently when reporting a serious problem like suicide.
  2,022 280 -
Feasibility of using everyday abilities scale of India as alternative to mental state examination as a screen in two-phase survey estimating the prevalence of dementia in largely illiterate Indian population
Sunil Kumar Raina, Vishav Chander, Sujeet Raina, Dinesh Kumar
October-December 2016, 58(4):459-461
DOI:10.4103/0019-5545.196715  PMID:28197006
Introduction: A situation analysis report on elderly in India shows that the literacy rate for persons aged above 60 is 36%. Using HMSE and its modification in the first phase of a two phase study to estimate the prevalence of dementia in such a population must be read with caution as these tests are literacy dependent. We conducted a post hoc analysis to explore the feasibility of using EASI as an alternative to HMSE and its modifications as the first phase screen in two phase surveys to estimate the prevalence of dementia. Materials and Methods: A post hoc analysis was conducted on data obtained from a study conducted on elderly population (60 years and above) from selected geographical areas (Migrant, Urban, Rural and Tribal) of Himachal Pradesh state in North-west India. The co-relation coefficient was used to establish the strength of association between EASI and HMSE and its modification and therefore the feasibility of using it as an alternative. Results: As the scores on EASI rise, the scores on HMSE fall both pointing to identification of the same clinical diagnosis i.e., dementia. Further the Pearson Correlation coefficient at -2.52 was found to be statistically significant. Conclusion: EASI may be used as alternative to mental state examination.
  1,928 184 -
ORIGINAL ARTICLES
Validation of hindi version of stages of recovery instrument
Sandeep Grover, Neha Singla, Ajit Avasthi
October-December 2016, 58(4):403-409
DOI:10.4103/0019-5545.196728  PMID:28196997
Objectives: To translate the Stages of Recovery Instrument (STORI) and evaluate its psychometric properties, demographic, and clinical correlates among patients with schizophrenia. Materials and Methods: The English version of the scale was translated into Hindi using the World Health Organization methodology. The Hindi version was completed by thirty patients with schizophrenia on two occasions, 4–7 days apart. Another thirty patients completed both Hindi and English version within a gap of 4–7 days. In addition, 100 patients completed the Hindi version of STORI once for studying the demographic and clinical correlates of recovery. Results: Hindi version of STORI demonstrated good internal consistency (α = 0.854) for the full scale and also for all the five stages of recovery (α = 0.745 to 0.756) as described in the scale. Split-half reliability of the scale was also good, as reflected by a high Spearman-Brown coefficient (0.781) and Guttmann's split-half coefficient (0.778). All the items of the scale showed high test-retest reliability and cross-language equivalence. Correlation between different stages and correlation between the allocated stage and different stages reflected good concurrent and construct validity of the subscales described as various stages of recovery. In general, demographic and clinical variables did not have any significant correlation with stages of recovery. However, those with lower level of general psychopathology scores showed significant correlation with higher stages of recovery. Conclusions: Hindi version of STORI has good psychometric properties.
  1,780 141 -
An exploratory study for bladder dysfunction in atypical antipsychotic-emergent urinary incontinence
Preeti Sinha, Anupam Gupta, V Senthil Kumar Reddi, Chittaranjan Andrade
October-December 2016, 58(4):438-442
DOI:10.4103/0019-5545.196719  PMID:28197002
Introduction: This is an exploratory study, which aimed to analyze urodynamic findings in patients who are on atypical antipsychotics and present with urinary incontinence (UI) in order to understand the mechanisms of antipsychotic-emergent UI. Patients and Methods: Eight patients (34 ± 7.6 years; five males and three females) diagnosed with schizophrenia or other psychotic disorders, who were on risperidone, olanzapine, or clozapine monotherapy and having UI were recruited. Urodynamic study was performed in all patients. Results: Six out of eight (75%) patients had abnormal urodynamic findings. Three of them had detrusor overactivity (DO) without detrusor-sphincter dyssynergia (DSD); two had DO with DSD; and one had hypoactive detrusor with nonrelaxing sphincter during void phase. The common urinary symptoms were urgency, enuresis, and straining to void urine. Significant postvoid residual urine was found in two patients. Conclusion: The evidence of bladder dysfunction in atypical antipsychotic-emergent UI is similar to that present in patients with neurological disorders. Urinary complaints in patients on antipsychotics thus need to be evaluated and managed systematically using the protocol followed for neurological conditions.
  1,697 215 -
Indian psychiatric society multicentric study: Correlates of 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
October-December 2016, 58(4):417-424
DOI:10.4103/0019-5545.196703  PMID:28196999
Background: There is a lack of information on the clinical and sociodemographic correlates of prescription of psychotropics by psychiatrists. Aim and Objective: This study aimed to evaluate the relationship of prescription patterns with various clinical and sociodemographic variables. Methodology: Data of prescription patterns, psychiatric diagnosis, sociodemographic variables, and comorbid physical illnesses were collected for 4480 patients, across 11 centers. Results: Females are more often prescribed escitalopram, sertraline, amitriptyline, amisulpride, nonlithium mood stabilizers, and benzodiazepines, whereas males are more often prescribed fluoxetine, olanzapine, two antipsychotics concurrently, typical antipsychotics, valproate, lithium, and more than one benzodiazepine. Elderly (>65 years) participants are more often prescribed sertraline when compared to adolescents. In addition, elderly more often receive quetiapine and less often are prescribed benzodiazepines. Those with comorbid neurological disorders are commonly prescribed antipsychotics, amitriptyline, and more than one antidepressant and are less commonly prescribed lithium, combination of two mood stabilizers, and benzodiazepines. Those with cardiac ailments are more commonly prescribed sertraline, quetiapine, and lithium and less frequently prescribed amitriptyline, fluoxetine, olanzapine, risperidone, and typical antipsychotics. Those with diabetes mellitus more often received escitalopram and quetiapine. Presence of more than one psychiatric diagnosis was associated with the use of more number of medications. Further, diagnosis of affective disorders was associated with the use of a higher number of medications. Conclusion: Findings of the present study suggest that sociodemographic variables and physical and psychiatric comorbidity influence the prescription patterns of psychotropics.
  1,638 238 -
Subtyping of alcohol dependence in Indian males: A cluster analytic approach
Savita Malhotra, Debasish Basu, Abhishek Ghosh, Madhu Khullar, Neeraj Kakkar
October-December 2016, 58(4):372-377
DOI:10.4103/0019-5545.196707  PMID:28196992
Objectives: Two cluster solutions for the subtyping of alcohol dependence (AD) was investigated in an Indian male population. Subtypes were compared for various personality traits and childhood externalizing disorders. They were also compared with respect to single-nucleotide polymorphisms (SNP) of various candidate genes. Materials and Methods: This was a clinic-based study conducted among 202 patients with AD. All patients were assessed with SSAGA-II for comorbid antisocial personality disorder (ASPD) and childhood conduct disorder (CD), oppositional defiant disorder (ODD), and attention deficit hyperactivity disorder (ADHD). For the assessment of personality traits, the Indian Adaptation of Sensation Seeking Scale (SSS) and Barratt's Impulsiveness Scale were administered. SNP genotyping was done using taqmann assay by real-time polymerase chain reaction. Results: Among those with AD, the two-cluster model which was able to produce the maximum degree of cohesion among disorders in the same cluster and separateness from the other cluster was the one with or without ASPD and CD. The quality of the cluster analysis was reduced when ODD and ADHD were included in the model along with ASPD and CD. Thus, in our index population, there are two distinct clusters of AD, one with ASPD and CD or the externalizing cluster (Cluster 2) and the other without ASPD and CD or the nonexternalizing cluster (Cluster 1). Externalizing cluster had significantly higher score in both the impulsiveness and the SSS. This cluster was also significantly associated with childhood ADHD and ODD. The genotype frequencies of all candidate genes were found to be nonsignificantly distributed among the two groups. Conclusion: Our study has conferred a cross-cultural validation of the known alcoholism subtypes.
  1,602 213 -
BRIEF RESEARCH COMMUNICATIONS
P300 and neuropsychological measurements in patients with schizophrenia and their healthy biological siblings
D Vijaya Raghavan, Arumugam Shanmugiah, P Bharathi, Ramasamy Jeyaprakash
October-December 2016, 58(4):454-458
DOI:10.4103/0019-5545.196709  PMID:28197005
Background: Patients with schizophrenia and their first-degree relatives' exhibit abnormalities in neuropsychological and electrophysiological measures especially P300. The aim was to study the P300 and neuropsychological measures together in patients with schizophrenia, their unaffected siblings, and normal controls. Materials and Methods: Thirty patients diagnosed as schizophrenia, their unaffected biological siblings, and normal controls were included in the study. Inpatient group, the severity of symptoms was assessed by Positive and Negative Syndrome Scale. All subjects were administered P300 event-related potential, which was measured using oddball paradigm and specific neuropsychological tests from NIMHANS neuropsychiatry battery. Results: Both patients with schizophrenia and their unaffected biological siblings showed lower P300 amplitude and longer P300 latency when compared with the normal controls. The three groups showed statistically significant differences in digit symbol substitution test, digit vigilance test, Trail making test B and Stroop test (P < 0.001). Conclusion: Patients with schizophrenia and their unaffected biological siblings show deficits in both cognitive function tests and P300 event-related potential. Our results suggest a continuum in the electrophysiological and neuropsychological measures among the three groups.
  1,542 174 -
LETTERS TO EDITOR
Mental Healthcare Bill, 2016: Concerns required to be addressed
Choudhary Laxmi Narayan
October-December 2016, 58(4):483-484
DOI:10.4103/0019-5545.196717  PMID:28197016
  1,529 186 -
ORIGINAL ARTICLES
Clinical profile of patients seeking services at urban community psychiatric services in Chandigarh
Suravi Patra, Bir Singh Chavan, Nitin Gupta, Ajeet Sidana
October-December 2016, 58(4):410-416
DOI:10.4103/0019-5545.196729  PMID:28196998
Context: About two-third of patients with mental, neurological, and substance use disorder in India do not get adequate treatment due to insufficient clinical facilities. In a country with diverse population such as India, no single model can be effective and each region needs to develop local system of service delivery unique to population needs. Community outreach clinics (COCs) being run by the department of psychiatry provide mental health services in the primary health-care setting. The study reports on the pattern of service utilization across different COCs in Chandigarh. Aims: The aim of this study was to describe the sociodemographic and clinical profile of patients seeking mental health-care services from COCs and to compare this with patients seeking care at tertiary care center. Settings and Design: This was a cross-sectional case record review. Subjects and Methods: Community services are provided in the areas adjoining Chandigarh, through four COCs: Civil Dispensary, Dhanas; Khuda Ali Sher; Rural Health Training Center, Palsaura; and Police Dispensary Sector 26 by Department of Psychiatry, Government Medical College and Hospital, Chandigarh. The current study reports on sociodemographic and clinical profile of 728 patients seen in these clinics from July 2010 to June 2011. Statistical Analysis Used: Descriptive statistics were performed using SPSS version 16.0. Chi-square test was used to compare two groups, ANOVA for comparing more than two groups. Results: Out of the 728 patients, majority were males in productive age group with diagnosis of substance use disorder. Majority were reaching the clinics on their own and only a few were referred by various community referral agencies. Only twelve patients needed referral to the Department of Psychiatry in the above mentioned period. Conclusions: Patients of substance use disorder prefer to be seen in the outreach clinics and it is possible to manage them in these clinics with very little need to refer them to tertiary care hospitals.
  1,548 154 -
CASE REPORTS
A case of adrenoleukodystrophy presenting with manic symptoms in a patient on steroids for Addison's disease
KS Jyothi, Cyriac George, KS Shaji
October-December 2016, 58(4):467-470
DOI:10.4103/0019-5545.196705  PMID:28197008
Adrenoleukodystrophy (ALD) is an X-linked disorder with diverse clinical presentations. A 30-year-old male, previously diagnosed with Addison's disease, on steroid supplementation for 18 years, presented to us with manic symptoms for 4 years. He was found to have white matter hypodensities in computed tomography head and had white matter signal changes in magnetic resonance imaging, and therefore a diagnosis of ALD was made.
  1,520 114 -
LETTERS TO EDITOR
The efficacy of cognitive behavior therapy in an adult who stutters
Sanjeev Kumar Gupta
October-December 2016, 58(4):477-478
DOI:10.4103/0019-5545.196726  PMID:28197011
  1,443 172 -
EDITORIAL COMMENTARY
Mental Health Care Bill-2016: An illusory boon; on close reading it is mostlybane
James T Antony
October-December 2016, 58(4):363-365
DOI:10.4103/0019-5545.196721  PMID:28196990
  1,390 224 -
CASE REPORTS
Use of clozapine alongside chemotherapy in a treatment-resistant bipolar disorder patient with ovarian carcinoma: Acase report and brief review
Ashish Pakhre, Aarya Krishnan, Raman Deep Pattanayak, Sudhir K Khandelwal
October-December 2016, 58(4):462-466
DOI:10.4103/0019-5545.196711  PMID:28197007
Regular monitoring of blood counts ensures the safety of clozapine use; however, certain clinical situations may pose a dilemma for management such as use of clozapine in the presence of myelosuppressive chemotherapy. Further, there is very limited literature to guide such decisions. We report a case of a clozapine-stabilized, treatment-resistant bipolar disorder patient with ovarian carcinoma requiring chemotherapy. The clinical challenges are discussed in light of a brief review of the available reports.
  1,365 175 -
ORIGINAL ARTICLES
Distressing cutaneous lesion among bipolar affective disorder patients on lithium therapy: Aretrospective cross-sectional study
Syed Ummar, B Lakshmi Dorai, Shree Aarthi Ramanathan
October-December 2016, 58(4):383-386
DOI:10.4103/0019-5545.196708  PMID:28196994
Aim: To assess the incidence of cutaneous lesion in bipolar affective disorder (BPAD) patients on lithium therapy. To evaluate the relationship between duration of lithium therapy, dosage of lithium, serum lithium level, and cutaneous lesions. To assess whether reduction/stoppage of dose of lithium has any change in the course of cutaneous side effects. To look for a relationship between addition of isotretinoin and the course of mood disorder. Methodology: We retrospectively collected hospital case records of 125 consecutive BPAD patients initiated lithium therapy, assessed with inclusion and exclusion criteria. We follow up them for 2½ years for the assessment of above said aims. Results: The prevalence of skin reaction in BPAD patients with lithium therapy was 19.8%. Among patients on lithium therapy, cutaneous lesion emerged in initial 6 months and later after 1 year of treatment. Nearly 55% of patients on higher doses of lithium (1200 mg) had a cutaneous lesion. Patient on therapeutic serum level of lithium had a higher incidence of skin lesion. Out of six patients in whom dosage of lithium was reduced, three of them had reduced lesions (P = 0.6), in two patients, skin lesion increased, and one patient had no change. Among 11 patients treated with isotretinoin, only two patients had emergence of depressive symptoms. Conclusion: Lithium continues to increase the incidence of multiple cutaneous lesions among BPAD patients on lithium therapy. Incidence of cutaneous side effects directly correlates with the dose of lithium and therapeutic range of serum lithium level. Altering the dose of lithium does not statistically influence the cutaneous lesion.
  1,321 170 -
Impact of an educational module in antidepressant-naive patients prescribed antidepressants for depression: Pilot, proof-of-concept, randomized controlled trial
Annie P John, Nagendra Madan Singh, Nagarajaiah , Chittaranjan Andrade
October-December 2016, 58(4):425-431
DOI:10.4103/0019-5545.196710  PMID:28197000
Background: Patients are educated about their illness and its treatment at the time of diagnosis. However, little is known about how much of this education is retained and how it influences knowledge about, attitudes toward, and experiences with medication in antidepressant-naive patients with depression. Methods: Antidepressant-naive outpatients with International Classification of Diseases-10 dysthymia or mild to moderate depression, who were advised antidepressant monotherapy, were randomized to control (n = 22) or intervention (n = 17) groups. Control patients received treatment as usual, and intervention patients received, in addition, a face-to-face, individualized, 10-min education session about the nature of depression, antidepressant treatment, efficacy and adverse effects of the prescribed drug, and plan of management. Knowledge about the illness and its treatment were assessed at baseline (before the educational intervention) and 6 weeks later. At follow-up, experiences with treatment were also evaluated. The study was double-blind. Results: At baseline, patients had poor knowledge about their illness and its treatment (most patients could not even name their diagnosis); however, few held unfavorable attitudes toward their prescribed medicines. At follow-up, there were modest improvements in both sets of outcomes. There were no differences between intervention and control groups in knowledge and attitude outcomes at baseline and end-point. Drug compliance did not differ between groups. However, importantly, intervention patients experienced a significantly larger number of adverse events than controls (mean, 3.5 vs. 1.7, respectively). Conclusions: For ethical reasons, patients need to be educated about their illness and its treatment. However, such education may be a two-edged sword, with an increased nocebo effect as the most salient consequence. Failure to identify benefits in our study may have been the result of a Type 2 error. This study provides a wealth of information on a large number of issues related to knowledge, attitudes, and experiences of depressed, mostly low-income outpatients in relation to education about depression and its treatment, and future research can build on the findings of this study. We also provide an extensive discussion on directions for further research.
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LETTERS TO EDITOR
Treating just-right symptoms in geriatric obsessive-compulsive disorder
Natalie R Noel, Phillip J Seibell, Joshua M Nadeau, Eric A Storch
October-December 2016, 58(4):481-482
DOI:10.4103/0019-5545.196700  PMID:28197014
  1,190 88 -
Acute onset mania with cycling between excitement and stupor
Mohapatra Debadatta, Sahoo Ashrumochan, Chittaranjan Andrade
October-December 2016, 58(4):478-479
DOI:10.4103/0019-5545.196714  PMID:28197012
  1,099 86 -
Methylphenidate-induced priapism in a prepubertal boy
Nidhi Chauhan, Sandeep Grover, Vandana Patidar
October-December 2016, 58(4):475-476
DOI:10.4103/0019-5545.196713  PMID:28197010
  1,078 97 -
Adolescent onset Wilson's disease misdiagnosed as psychosis
Kishore Dudani, Ram Kumar Solanki, Pradeep Sharma, Dharamdeep Singh
October-December 2016, 58(4):480-481
DOI:10.4103/0019-5545.196716  PMID:28197013
  1,027 99 -
EDITORIAL
Part publication: When it is ethical and when it is not
TS Sathyanarayana Rao, Chittaranjan Andrade
October-December 2016, 58(4):357-358
DOI:10.4103/0019-5545.196725  PMID:28196988
  969 139 -
BOOK REVIEW
Parenting, its agony and ecstasy
Indira Sharma
October-December 2016, 58(4):485-486
DOI:10.4103/0019-5545.196724  
  892 154 -
LETTERS TO EDITOR
Innovative services: Library for patients and their caregivers in the psychiatry ward
Tharun Krishnan, M Kishor, Eiman Najla, TS Sathyanarayana Rao
October-December 2016, 58(4):482-483
DOI:10.4103/0019-5545.196718  PMID:28197015
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