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   2018| July-September  | Volume 60 | Issue 3  
    Online since October 16, 2018

 
 
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VIEWPOINT
Buprenorphine-based opioid substitution therapy in India: A few observations, thoughts, and opinions
Abhishek Ghosh, Debasish Basu, Ajit Avasthi
July-September 2018, 60(3):361-366
DOI:10.4103/psychiatry.IndianJPsychiatry_218_17  
The most evidence-based treatment for opioid dependence is opioid agonist maintenance treatment also known as opioid substitution therapy (OST). However, there are some critical, yet unaddressed issues of buprenorphine-based substitution therapy, especially in the Indian context. These comprise of generalizability of the evidence for OST, especially for natural and pharmaceutical opioids and for all age groups, optimum dose and duration of OST, and mode of treatment delivery including the frequency of dispensing. Notwithstanding the use of buprenorphine-naloxone combination, abuse and diversion are serious but often underreported problems. There is an urgent need for health services research in India on OST, focusing on these aspects. Rather than directly copying from Western models, it is important to try to understand the useful and safe program and policy options likely to be applicable in the Indian setting, with our own assets as well as vulnerabilities.
  3,892 294 -
GUEST EDITORIAL
Strength and weakness of the guidelines of Rights of Persons with Disabilities Act, 2016 (dated January 5, 2018): With respect to the persons with neurodevelopmental disorders
Thomas John, Alka Anand Subramanyam, Rajesh Sagar
July-September 2018, 60(3):261-264
DOI:10.4103/psychiatry.IndianJPsychiatry_326_18  
  3,277 411 -
REVIEW ARTICLES
Opioid substitution therapy: Legal challenges
Suresh Bada Math, Ashwin Mohan, Naveen C Kumar
July-September 2018, 60(3):271-277
DOI:10.4103/psychiatry.IndianJPsychiatry_391_18  
Drug dependence syndrome is a medical condition classified as a multifactorial health disorder that often follows the course of a relapsing and remitting chronic disease. Opioid substitution therapy (OST) is one of the established standard treatments for opioid dependence syndrome. OST, a process in which opioid-dependent injecting drug users, is provided with long-acting opioid agonist medications for a long period under medical supervision along with psychosocial interventions. OST service provider may have to deal with issues of license/registration/recognition/permission under various legislations such as the Drugs and Cosmetic Act, 1940; Narcotic Drugs and Psychotropic Substances Act, 1985; Rights of person with disability Act, 2016 and Mental Healthcare Act, 2017 depending on the drug prescribed, type of services provided, procuring, transportation, storage, and prescribing these narcotics and psychotropic medicines. The narcotics and psychotropic drugs are administered through various ministries and departments causing huge confusion, lack of coordination, overlapping roles and responsibilities, and various laws/rules and gives an opportunity for the abdication of the responsibilities. The “public mental health issue,” where the number of opioid users in the country is approximately two million and opioid dependence syndrome is approximately 0.5 million. The number of beds in the public governed deaddiction centers is abysmally low, number of psychiatrist, or trained medical practitioners in OST are also few in number to face this humongous challenge. Against this background, this article focuses on the legal issues surrounding the OST.
  2,964 397 -
ORIGINAL ARTICLES
Factors affecting quality of life of caregivers of children diagnosed with autism spectrum disorder
Borte Gurbuz Ozgur, Hatice Aksu, Erhan Eser
July-September 2018, 60(3):278-285
DOI:10.4103/psychiatry.IndianJPsychiatry_300_17  
Context: Since autism spectrum disorder (ASD) is a lifelong disease and because of its nature, the negative effects of the disease on the quality of life (QoL) of caregivers as well as patients are incontrovertible. Aims: It was aimed to evaluate the effect of the variables related to both parents and children on the QoL scores of the parents of the children with ASD. Settings and Design: This is a causality analysis study. Subjects and Methods: Questionnaire on sociodemographic/disease-related variables, QoL in Autism Questionnaire-Parent Version (QoLA-P), autism behavior checklist and Clinical Global Impression scale were assessed of 162 patients with ASD. Statistical Analysis Used: Unpaired t- test, Mann–Whitney U test, Kruskal–Wallis test, and one-way ANOVA test were used for comparing groups. The parameters found to be statistically significant for QoLA-P in different analyses were included as the independent variable in the logistic regression analysis. The backward (variable elimination) model was selected as the model in the analysis. Results: The causality has been established may be stated as the severity of autism, the presence of psychiatric disorder in the mother/father, attendance of the child at school, duration since the diagnosis of autism, and the child's medication use. Conclusions: Autism affects the QoL of caregivers. The intervention of treatment by considering the factors that affect the QoL positively or negatively may increase the QoL of caregivers.
  2,686 539 -
EDITORIAL
Nonsuicidal self-injury: Implications for research and management
Om Prakash Singh
July-September 2018, 60(3):259-260
DOI:10.4103/psychiatry.IndianJPsychiatry_396_18  
  2,670 519 -
REVIEW ARTICLES
Research on opioid substitution therapy in India: A brief, narrative review
Atul Ambekar, Ravindra Rao, Alok Agrawal, Preethy Kathiresan
July-September 2018, 60(3):265-270
DOI:10.4103/psychiatry.IndianJPsychiatry_385_18  
Opioid dependence is a significant clinical and public health issue in India. Opioid substitution therapy (OST) is the most evidence-based treatment for opioid dependence. Although available in India for about three decades now, Indian research on this treatment modality has not been adequately reviewed so far. We conducted a narrative review of Indian research on OST. We conducted an online search for relevant literature in the peer-reviewed journals as well as the general online search for books and monographs. We present the findings of the review in the form of description of literature according to certain identified themes. Considering that methadone has became available in India, only recently, the Indian research on OST predominantly features buprenorphine as the agent. Effectiveness of OST among Indian opioid-dependent patients has been well established through prospective, experimental designs as well as through naturalistic studies using retrospective, chart-review approach. Naturalistic and observational postmarketing surveillance studies have demonstrated the safety of buprenorphine and methadone when used as OST. There are certain areas in which more research on OST will be beneficial for Indian clinicians as well as policy-makers. However, the quantum of evidence base that exists in India is more than adequate to justify the scale-up of this modality of treatment. A conducive policy environment for scaling-up OST is need of the hour.
  2,472 471 -
ORIGINAL ARTICLES
Can positive parenting program (Triple P) be useful to prevent child maltreatment?
Gonca Ozyurt, Cagla Dinsever, Zehra Caliskan, Derya Evgin
July-September 2018, 60(3):286-291
DOI:10.4103/psychiatry.IndianJPsychiatry_92_17  
Objective: This study aimed to determine the effect of the positive parenting program (Triple P) on child maltreatment, children's behaviors, and coping strategies of mothers. Materials and Methods: This study was the pretest-posttest quasiexperimental design. Secondary care state hospital located in the Cappadocia region between January and February 2016. This study was conducted with mothers (n: 138) of children aged between 4 and 12 years, 126 mothers were available to finish the study. Triple P was provided to the mothers in totally three sessions as once per a week. Mothers filled the scales and parent-child information form before the intervention and just after the intervention. Parent-child information form, child behavior checklist, and ways of coping inventory were administered to the mothers. Results: It was determined that after the training, mean scores obtained by the children from the subscales of anxiety, social problems, somatic complaints, attention problems, rule-breaking, and aggressive behaviors decreased (P < 0.05) and desperate approach and submissive approach mean scores of the mothers decreased (P < 0.001) whereas their social support mean scores increased (P < 0.05). In addition, the mothers, who stated that they were frequently looking angry (17.4%), yelling (24.6%), sometimes humiliating (27.7%) to their children, and injured their faces (6.3%) in the past 1 month, said that they did these behaviors to their children at lower rate at the end of the training (3.9%, 17.4%, 19.8%, and 0.0%, respectively). Conclusions: It was determined that Triple P was effective in reducing children's behavioral problems and improving mothers' strategies of coping with stress and contributed the reduction of emotional and physical abuse applied to children. It is recommended to ensure the continuity of these training programs.
  2,279 345 -
Efficacy of buprenorphine and clonidine in opioid detoxification: A hospital- based study
Neeraj Jain, BS Chavan, Ajeet Sidana, Subhash Das
July-September 2018, 60(3):292-299
DOI:10.4103/psychiatry.IndianJPsychiatry_381_17  
Background: The need for effective and accepted method for opioid detoxification is ever increasing. Sublingual buprenorphine and oral clonidine have been effective in opioid detoxification. As often, there is a great variation in the dosage of buprenorphine and clonidine prescribed by the clinicians; hence, there is a felt need to find an effective dosage for a favorable outcome of opioid detoxification. Objective: The objective of this study was to compare the effectiveness of different doses of sublingual buprenorphine and clonidine in opioid detoxification. Materials and Methods: A total of 100 patients with the diagnosis of opioid dependence as per the international classification of diseases-10 criteria were recruited for this study. Participants were assigned randomly into four groups – low-dose clonidine, high-dose clonidine, low-dose sublingual buprenorphine, and high sublingual dose buprenorphine using a computer-generated random number table, resulting in 25, 26, 23, and 26 patients in each group, respectively. Results: The four groups had comparable scores on all the items of “stages of change readiness and treatment eagerness scale” for the assessment of motivation at baseline. Progressive decrease in withdrawal score was seen in all the groups on “clinical opiate withdrawal scale” and “subjective opiate withdrawal scale.” Conclusion: From the current study, we can infer that both low and high doses of buprenorphine and clonidine are comparable regarding controlling withdrawal.
  2,168 336 -
Use of social networking site and mental disorders among medical students in Kolkata, West Bengal
Lisa Barman, Dipta Kanti Mukhopadhyay, Gautam Kumar Bandyopadhyay
July-September 2018, 60(3):340-345
DOI:10.4103/psychiatry.IndianJPsychiatry_210_18  
Background: Use of social networking sites (SNS) and prevalence of anxiety and depression among the young population is on the rise. Objectives: The aim of this study is to assess the pattern of use of SNS and the prevalence of anxiety and depression among medical students as well as to examine the relation, if any, between the use of SNS and anxiety and depression. Methods: A cross-sectional study was conducted among 200 undergraduate students of a medical college in Kolkata, West Bengal during 2017. Information on individual characteristics and use of SNS of medical students were collected using a structured questionnaire. Anxiety and depression were measured using State-Trait Anxiety Inventory (STAI) and becks depression inventory (BDI). Prevalence was expressed in percentage and association was examined with Mann–Whitney U-test. Results: More than 90% of students use more than one SNS or instant messaging system. One-third remained active in SNSs all through the day and around 80% for ≥4 h. Use of SNSs during odd hours was reported by 55% participants, and 23.5% expressed their inability to spend a day without SNSs. Nearly 24% reported depression and 68.5% had state anxiety. STAI and BDI scores were significantly (P < 0.05) higher among students who used SNSs for 4 h or more, used it during odd hours or stated inability to spend a day without SNSs than their counterparts. Conclusion: The use of SNS by medical students was pervasive. More use of SNSs and dependence on it were associated with anxiety and depression.
  2,068 392 -
Psychopathology and coping mechanisms in parents of children with intellectual disability
Suyog Vijay Jaiswal, Alka Anand Subramanyam, Henal Rakesh Shah, Ravindra M Kamath
July-September 2018, 60(3):312-317
DOI:10.4103/psychiatry.IndianJPsychiatry_259_17  
Background: Raising a child with intellectual disability (ID) can add to parenting stress significantly. This stress can manifest into psychopathologies such as anxiety and depression. The aims of the study were to assess psychopathology and coping mechanisms in parents of children with ID. Materials and Methods: A total of 100 consecutive consenting parents of children with ID were interviewed from child psychiatry outpatient department of a municipal-run tertiary care teaching hospital. A semi-structured pro forma, symptom checklist 90 revised (SCL90R) and Mechanism of Coping Scale (MOCS) were used for assessment. Results: Mean age for the parents was 37.02 (±7.35) years, and for the children, it was 8.29 (±3.11) years. There were 60 mothers and 61 parents of a male child among sample. Eighty-five of parents considered their child's ID to be a major concern in their life. Depression had highest mean among psychopathologies. Mothers had higher score for depression and Interpersonal-sensitivity. Parental psychopathology did not differ significantly with severity of ID of child. Global severity index of SCL90R correlated negatively with age of parents (P = 0.015) and positively with fatalism (P = 0.004), expressive-action (P < 0.000) and passivity (P = 0.001) coping mechanisms. Conclusion: Depression is the most common psychopathology especially among mothers of child with ID. Psychopathology is independent of severity of ID and worsens with coping mechanisms like fatalism, expressive-action, and escape-avoidance. A child with ID should be seen and treated as a family unit giving enough attention to parent's psychological needs as well.
  2,024 291 -
Consultation-liaison psychiatry services: A survey of medical institutes in India
Sandeep Grover, Ajit Avasthi
July-September 2018, 60(3):300-306
DOI:10.4103/psychiatry.IndianJPsychiatry_256_17  
Aim: The aim of this study was to evaluate the consultation-liaison psychiatry (CLP) training and services in India. Methodology: An online survey was conducted involving at least one faculty member from the department of psychiatry working in various institutes providing postgraduate training in psychiatry. Results: A total of 90 faculty members from different postgraduate institutes across the country participated in the online survey. In three-fourth of the institutes, the CLP services were provided in the form of on-call services with a three-tier system (i.e., CLP team comprising of faculty member, a senior resident, and a junior resident) existing in only about one-third of the institutes. In majority (60%) of the institutes, junior resident was the first-line person responding to the call of other specialists. On an average, CLP teams receive 7.33 calls per day from various clinical departments with a range of 0–20. Among the three most common psychiatric syndromes seen in CLP setting, delirium figured as one of the three most common diagnoses among 79 (87.8%) institutes, and this was followed by substance use disorders (70%), self-harm (60%), and depression (38.9%). Specific CLP posting for junior and senior residents exists only in 28.9% and 12.2% of the institutes, respectively. Joint academic activities with other departments are conducted in 42.2% of the institutes. Regarding research, very few research projects are carried out in the area of CLP. Majority of the participants felt that CLP should be given equal importance or more importance than other subspecialties such as child psychiatry, addiction psychiatry, and geriatric psychiatry in postgraduate training programs. Almost all the participants felt that having good knowledge of CLP helps in managing psychiatric patients in better way. All the participants reported that improving focus on CLP psychiatry will help in reducing stigma attached to mental illnesses and improve the training of postgraduates and the undergraduates. Conclusions: There is a need to improve the CLP services, training program, and research in various medical institutes to provide good mental healthcare to medically ill patients.
  1,918 265 -
Effectiveness of adjunctive repetitive transcranial magnetic stimulation in management of treatment-resistant depression: A retrospective analysis
Rohit Verma, Nand Kumar, Saurabh Kumar
July-September 2018, 60(3):329-333
DOI:10.4103/psychiatry.IndianJPsychiatry_182_16  
Background: There is limited number of studies from India investigating role of repetitive transcranial magnetic stimulation (rTMS) in treatment-resistant depression (TRD). This clinic-based study reports on the efficacy of rTMS as an add-on treatment in patients suffering from TRD. Materials and Methods: Twenty-two right-handed patients suffering from major depressive disorder who failed to respond to adequate trials of at least two antidepressants drugs in the current episode received rTMS as an augmenting treatment. High-frequency (Hf) rTMS at 110% of the estimated resting motor threshold (MT) was given over the left dorsolateral prefrontal cortex (DLPFC). A total of 15 sessions were given over 3 weeks with 3000 pulses per session. The outcome was assessed based on the changes in scores of Hamilton Rating Scale for Depression or Montgomery–Asberg Depression Rating Scale. Results: There was a significant reduction in final assessment scores after rTMS intervention as compared to baseline with almost 50% of the participants showing response in either scale. Conclusion: Hf rTMS applied over left DLPFC is an effective add-on treatment strategy in patients with TRD.
  1,886 268 -
BRIEF RESEARCH COMMUNICATION
New legislation, new frontiers: Indian psychiatrists' perspective of the mental healthcare act 2017 prior to implementation
Richard M Duffy, Choudhary L Narayan, Nishant Goyal, Brendan D Kelly
July-September 2018, 60(3):351-354
DOI:10.4103/psychiatry.IndianJPsychiatry_45_18  
Context: The mental healthcare act 2017 represents a complete overhaul of Indian mental health legislation. Aims: The aim of this study was to establish the opinions of Indian psychiatrists regarding the new act. Settings: Mental health professionals in Bihar and Jharkhand were interviewed. Design: A focus group design was utilized. Materials and Methods: Key questions explored the positive and negative aspects of the act and the management of the transitional phase. All focus groups were recorded and transcribed. Analysis: Data were coded and analyzed using an inductive approach. Results: Many positive aspects of the new legislation were identified especially relating to rights, autonomy, and the decriminalization of suicide. However, psychiatrists have significant concerns that the new legislation may negatively impact patients and increase stigma. Psychiatrists held varying views on the proposed licensing and inspection of general hospital psychiatric units. Conclusions: Careful evaluation of the new legislation is needed as the concerns raised warrant ongoing monitoring.
  1,816 260 -
ORIGINAL ARTICLES
Correlation of cognitive functions with emotional dysregulation in alcohol dependence: A preliminary study
Dushad Ram, Manju George, Basawanna Gowdappa
July-September 2018, 60(3):307-311
DOI:10.4103/psychiatry.IndianJPsychiatry_183_18  
Context and Aims: Dysfunction of cognition and emotion is known in alcohol dependence; however, their relationship in alcohol dependence is unknown. Thus, this study aimed to know the level of emotional dysregulation and cognitive functions and their correlation in patients with alcohol dependence. Materials and Methods: In this hospital-based cross-sectional study, 120 patients with alcohol dependence were consecutively recruited and assessed with sociodemographic and clinical pro forma, Montreal Cognitive Assessment (MoCA), and Difficulty in Emotional Regulation Scale–Short Form (DERS-SF). Statistical Analysis: Descriptive statistical, Kruskal–Wallis H, and regression analysis. Results: Results revealed a mild level of cognitive impairment (mean MoCA score = 0 23.76) and high levels of emotional dysregulation (mean DERS-SF score = 0 26.90). On linear regression analysis (R2 = 0.266, df = 0 1, F = 0 42.782, P =0.000), the score on MoCA had statistically significant negative association with score on DERS-SF (P = 0.001). Conclusions: Cognitive impairment and emotional dysregulation are inversely related in patients with alcohol dependence. Improving the dysfunction may improve the outcome of alcohol dependence.
  1,614 236 -
Cross-sectional study of psychiatric morbidity in patients with melasma
Sharmishtha Shailesh Deshpande, Swapna S Khatu, Geeta S Pardeshi, Neeta R Gokhale
July-September 2018, 60(3):324-328
DOI:10.4103/psychiatry.IndianJPsychiatry_115_16  
Context: Patients with dermatological problems have higher prevalence of psychiatric illnesses than the general population. Melasma, hyperpigmentation of skin over sun-exposed areas, has bidirectional cause-effect relationship with depression and stress through psycho-neuro-endocrine pathways. Aims: The aim of this study is to study the psychiatric morbidity and perceived stress in patients with melasma and statistically compare objective study parameters with those without melasma. Settings and Design: This cross-sectional descriptive study was carried out in Tertiary hospital in urban setting, jointly by psychiatrist and dermatologist. Methods and Materials: The study involved 50 consecutive patients with melasma and 30 relatives of patients coming to dermatology clinic not having any skin disorder. Cases were assessed by psychiatrist as per the International Classification of Diseases-10 Diagnostic Criteria for Research, Cohen's 4 item perceived stress scale, Disability Assessment Scale 2.0 by WHO and Hospital Anxiety Depression Scale (HADS) and Dermatologist calculated melasma area severity index score (MASI). Results: Majority patients were females (88%) in the reproductive age group. The most common psychiatric morbidity seen in 42% cases was major depressive disorder. Adjustment disorder (26%) was the second most common diagnosis. Nonparametric analysis using Mann–Whitney U test revealed significantly more perceived stress (P = 0.001), more disability (P = 0.000) and anxiety-depression on HADS (P = 0.0 16) in cases than in their relatives. Limitations: This was a hospital-based study and thus melasma patients in the community are not represented. Small sample size, less number of controls, lack of structured diagnostic interview are other limitations of this study. Conclusions: There is high psychiatric comorbidity (76%) of depressive and stress disorders, higher functional disability and perceived stress in patients with melasma compared to controls.
  1,618 185 -
C-reactive protein, brain-derived neurotrophic factor, interleukin-2, and stressful life events in drug-naive first-episode and recurrent depression: A cross-sectional study
Jitendra Jeenger, Vikas Singroha, Manu Sharma, Devendra Mohan Mathur
July-September 2018, 60(3):334-339
DOI:10.4103/psychiatry.IndianJPsychiatry_169_18  
Aims: The aim of the study is to assess and compare serum C-reactive protein (CRP), brain derived neurotrophic factor (BDNF), and interleukin-2 (IL-2) levels in patients with first-episode depression (FED), recurrent depressive disorder (RDD), and healthy controls (HCs) and to determine the relationship between the above-specified inflammatory markers, severity of depression, and stressful life events. Materials and Methods: Consecutive drug-naive patients with FED and RDD (n = 85) and 50 HCs were studied. Serum concentrations of CRP, brain-derived nerve growth factor (BDNF), and IL-2 were measured. All participants were assessed using Mini-International Neuropsychiatric Interview Plus, Beck's depression inventory, and presumptive stressful life events scale. Results: The FED and RDD groups had statistically significant lower serum concentration of BDNF and higher IL-2 compared to the HC group, whereas no statistically significant difference was observed with regard to CRP level. No statistically significant differences were observed with regard to the severity of depression and serum concentrations of CRP, BDNF, and IL-2 in the FED and RDD groups. No significant correlation was found between severity of depression and serum concentration of CRP, BDNF, and IL-2 in both the groups. Serum CRP concentration was significantly higher in patients with ≥2 stressful life events. No significant difference was observed between number of stressful life events and BDNF and IL-2 in patients with depression. Conclusion: FED and RDD are associated with lower serum concentration of BDNF and higher IL-2 compared to the HCs, whereas there appears no difference with regard to CRP level. Multicentric studies are needed to further elucidate the role of inflammatory markers in depression.
  1,351 196 -
Behavioral activation and behavioral inhibition sensitivities in patients with substance use disorders: A study from India
Suhas Ganesh, Arun Kandasamy, Ubahara S Sahayaraj, Vivek Benegal
July-September 2018, 60(3):346-350
DOI:10.4103/psychiatry.IndianJPsychiatry_323_18  
Introduction: Addictive disorders are an epiphenomenon of underlying vulnerabilities. Research over the past decades into these vulnerabilities has distinguished internalizing and externalizing spectra as two distinct personality factors underlying substance use disorders (SUDs). In this study, we explore the behavioral activation and inhibition factors in patients with SUD. Materials and Methods: A total of 240 patients with SUD were recruited for the study. Behavioral inhibition system-behavioral activation/approach system (BIS-BAS) scale was used to assess the three domains of the behavioral activation, namely drive, fun seeking and reward responsiveness, and the behavioral inhibition as a single domain. BIS and BAS subscale total scores, inter-domain correlation, factor structure, and difference in the early-onset and late-onset SUD subgroup scores were calculated. Results: The drive, fun seeking, and reward responsiveness showed a moderate degree of correlation among each other ranging from 0.30 to 0.36. The behavioral inhibition subscale had a modest correlation r = 0.26 with the reward responsiveness subdomain of behavioral activation. The factor structure remained valid at two- and four-factor solutions apart from few items with inconsistent loading. The early-onset n = 209 (87.1%) and late-onset n = 31 (12.9%) SUD subgroup analysis showed a statistically significant difference in the mean scores of drive and fun-seeking subscales with P < 0.05. Discussion and Conclusions: Behavioral activation and inhibition remain two valid personality factors in patients with SUDs. Patients with early onset of SUD have a significantly higher behavioral activation scores in the drive, and fun-seeking subfactors suggesting a higher externalizing tendency.
  1,350 169 -
CASE REPORTS
Gulliver's world: Persistent lilliputian hallucinations as manifestation of Charles Bonnet syndrome in a case of cataract and normal pressure hydrocephalus
Seshadri Sekhar Chatterjee, Didakamiwan Khonglah, Sayantanava Mitra, Kabir Garg
July-September 2018, 60(3):358-360
DOI:10.4103/psychiatry.IndianJPsychiatry_236_18  
Charles Bonnet Syndrome (CBS) typically occurs in elderly people with peripheral vision impairment, or interruptions in the connections from eyes to visual cortex. The heterogeneity of presentations and causal mechanisms warrants clinical caution. In this report, we describe a case of CBS developing in the form of Lilliputian Hallucinations in an elderly gentleman, on the background of cataract and normal pressure hydrocephalus, the complexities arising out of such aetiogenesis, and its management. We emphasize upon the fact that CBS might develop through two concurrent mechanisms in a given individual. Treating one of these would mean persistent symptoms, and failing to recognize these would lead to continued morbidity.
  1,328 169 -
A case of craniopharyngioma presenting as rapidly progressive dementia
Soumitra Das, Kamaldeep Sadh, Seshadri Sekhar Chatterjee, Jagadisha Thirthalli
July-September 2018, 60(3):355-357
DOI:10.4103/psychiatry.IndianJPsychiatry_230_18  
Rapidly progressive dementia (RPD) is generally obvious to family member but often difficult for physicians to pinpoint the underlying pathology. Some common causes, such as prion's disease, Alzheimer's disease, central nervous system vasculitis, or infection, might present with disease-specific signs or symptoms where many etiologies do not produce such warning signs. Here, we are presenting a case who attended the psychiatric clinic for decreased motivation to do work, easy fatigability, infrequent falls, recent memory impairment, increased appetite, polydipsia and polyuria, and provisionally diagnosed with RPD. Magnetic resonance imaging revealed solid cystic lesion in suprasellar location involving hypothalamus, optic chiasma, and optic tracts, compressing the floor of the third ventricle suggestive of craniopharyngioma which is one of the very few reports in literature.
  1,294 139 -
ORIGINAL ARTICLES
How valid is obsessive-compulsive inventory-revised scale among Sri Lankan adults?
Buddhika Senanayake, Mahesh Rajasuriya, Chathurie Suraweera, Carukshi Arambepola
July-September 2018, 60(3):318-323
DOI:10.4103/psychiatry.IndianJPsychiatry_171_18  
Background: Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder with a lifetime prevalence of 1.9%–3.0% in the general population. It is an easily missed diagnosis. Although several paper-based tools have been developed, none are culturally validated for Sri Lankans to screen for OCD at field level. Aims: This study aimed to translate and assess the validity and reliability of obsessive-compulsive inventory-revised scale (OCI-R) for Sri Lankan adults. Setting and Design: This study was a case–control study. Materials and Methods: This was conducted among 89 OCD patients and 89 controls recruited from the National Hospital of Sri Lanka to assess the criterion validity of OCI-R (an 18-item tool on common OCD symptoms using six subscales), by applying it and the gold standard (clinical diagnosis made by two independent consultant psychiatrists) to the same patient simultaneously. Before this, the tool was translated into local language (Sinhala) by bilingual experts and two psychiatrists using the forward-backward translation method. Receiver operating characteristics (ROC) curve was drawn to determine the cutoff value to identify OCD in Sri Lanka. Results: The translated tool demonstrated the following: sensitivity 84.4%, specificity 85.6%, positive predictive value 85.4%, negative predictive value 84.6%, and positive and negative likelihood ratios of 5.86 and 0.18, respectively. The cutoff value for diagnosing OCD was 21 according to the ROC curve. Internal consistency (Cronbach's alpha reliability coefficient) of all six domains and the total scale showed values exceeding Nunnally's criteria of 0.7. Conclusions: Sinhala version of the OCI-R scale was identified as a valid and reliable screening instrument to be applied in Sri Lankan adults.
  1,199 85 -
LETTERS TO EDITOR
“Precision psychiatry”: A promising direction so far
Sourav Khanra, Christoday R J Khess, Sanjay K Munda
July-September 2018, 60(3):373-374
DOI:10.4103/psychiatry.IndianJPsychiatry_203_18  
  1,065 196 -
Fluoxetine-induced pseudocyesis in a patient with obsessive-compulsive disorder: A case report
Naresh Nebhinani, Navratan Suthar, Shruti Modi
July-September 2018, 60(3):370-371
DOI:10.4103/psychiatry.IndianJPsychiatry_405_17  
  1,047 163 -
Somnambulism associated with the use of clonidine: A case report and review of the literature
Anupam Mitra, Samidha Tripathi, Gargi Bhattacharya, Pradipta Majumder
July-September 2018, 60(3):372-373
DOI:10.4103/psychiatry.IndianJPsychiatry_463_17  
  967 126 -
Successful treatment of bipolar disorder by resection of lung tumor: A case report
Pei-Chun Chao, Ta-Chuan Yeh, Chia-Luen Huang, Chuan-Chia Chang, Hsin-An Chang
July-September 2018, 60(3):369-370
DOI:10.4103/psychiatry.IndianJPsychiatry_266_17  
  935 157 -
Olfactory groove meningioma masquerading as psychiatric disturbances
Reddy Ravikanth, Denver Steven Pinto, Sunil Mathew
July-September 2018, 60(3):367-369
DOI:10.4103/psychiatry.IndianJPsychiatry_267_17  
  967 99 -