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 Table of Contents    
Year : 2011  |  Volume : 53  |  Issue : 5  |  Page : 27-72
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Date of Web Publication3-Apr-2012

How to cite this article:
. Free Papers. Indian J Psychiatry 2011;53, Suppl S1:27-72

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. Free Papers. Indian J Psychiatry [serial online] 2011 [cited 2021 Sep 20];53, Suppl S1:27-72. Available from:


Does treatment influence relationship between verbal intelligence and psychopathologies? A study on 46 acute Indian schizophrenia subjects

Gautam Anand, P.K. Singh

Mansik Arogyashala, Gwalior, Madhya Pradesh, India

Backgroud : Since severity of psychopathology has a negative relationship with Verbal intelligence. The quetiapine improves psychopathologies and restores cognition in schizophrenia. Quetiapine is quite effective in both. The improvement of different symptoms measured on sub-domains of negative and positive symptoms may influence relationship between them.

Aims and Objective : To explore variation in relationship between Verbal Intelligence and psychopathologies before and after treatment.

Tools and apparatus : Semi-structured questionnaires based on ICD-10* for diagnosis of a case. Scale for Assessment of Negative Symptoms (SANS) Scale for Assessment of Positive Symptoms (SAPS). WAIS-R verbal (Indian adaptation) - Weschler's Adult Intelligence scale - Revised. Study design : The study consists of 46 cases of acute schizophrenic Indian subjects attending psychiatric out patient department at Patna Medical College, Patna diagnosed on ICD-10 criteria. Only those patients were taken into the study who had history of illness of 1 month to 1 year, belonging to age group of 18 to 65 years, drug free from last 6 month and did not have any neurological or physical disease or history of substance abuse.

Procedure : The taken subjects had been diagnosed on ICD-10 at first visit Positive, negative symptoms and verbal intelligence were assessed on SANS, SAPS and WAIS-R (Indian adaptation), respectively. 300 mg of quetiapine was prescribed into two divided does and titrated symptoms of schizophrenia. The maximum doses were achieved within 15 days. All parameters assessed were repeated on same scale after 8 weeks of treatment. During the study all ethical consideration had been maintained. The obtained data were analysed and compared.

Result : The relationship between verbal intelligence and psychopathologies measured on SANS and SAPS at 0 week (initial visit) or pretreatment. The established (regression coefficient) of verbal intelligence co-efficient vs psychopathologies eg. Affect flattening, inappropriate-affect, alogia, avolition-apathy, anhedonia-asociality attention impairment and SANS (total), hallucination, delusion, bizarre-behaviour, positive formal thought disorder and SAPS (total) were -0.622, -0.597, -0.233, -0.422, -0.301, -0.05, (NS), -0.518, -0.144 (NS), - 0.433, -0.203, -0.373 respectively. Post treatment after 8 weeks of ingestion of 300 mg/d quetiapine daily same were repeated and found as -1.79, -0.262, -0.536, -0.539, -0.14, -0.086 (NS), -0.428 and -0.374, -0.119 (NS), -0.07, +0.49 (NS), -0.019 (NS).

Conclusion : The persistent negative relationship between verbal intelligence and psychologies was maintained pre and post treatment throughout the study. But different components such as attention impairment and delusion has insignificant negative relationship. The formal thought disorder which has changed its sign from negative to positive after treatment.


A study to analyse how anxiety, threat perception, and knowledge interplay and affect behavioural change in patients affected with swine flu (H 1 N 1 )

Rajarshi Neogi, Asit Kumar Biswas, Akhil Bandhu Biswas

Introduction : Word Health Organisation declared H 1 N 1 pandemic alert in April 2009 leading to widespread public outcry and media attention. India was also a stakeholder as pandemic reported cases and deaths that caused public concern. There are several studies looking into the public psychology/anxiety, threat perception, knowledge and behavioral change though the same data about patients is lacking.

Aim : To study the interplay of anxiety, threat perception, and knowledge about H 1 N 1 in modifying behaviours of the patients admitted with H 1 N 1 in state nodal hospital for H 1 N 1 management in Kolkata (ID and BG Hospital, Beliaghata, Kolkata).

Methodology : The patients admitted in the H 1 N 1 ward of the ID and BG Hospital, Kolkata from July to September 2010 were assessed on Beck Anxiety Inventory and anxiety questionnaire used for different H 1 N 1 studies. Sociodemographic, clinical variables, contact/travel history was also assessed in a structured questionnaire. Threat perception questionnaire, knowledge and practices questionnaire that were used in different studies on H 1 N 1 epidemiology were also used to assess patients. All patients were assessed during the first day of the admission or whenever they deemed themselves fit to comply with the interview. Correlations were drawn and stepwise regression done.

Results : Most were middle class males, who came from an urban back ground, had no history of contact with H 1 N 1 patient or travel to a H 1 N 1 endemic zone. Mean duration of illness was ~7days, and the mean age of the sample was ~ 30 years. A few patients had complications like hypertension, h/o stroke, Diabetes, respiratory distress etc. Most of the patients had significant anxiety on the day of admission. Threat perception and anxiety scores correlated highly and knowledge as well. All of them correlated with behavioural changes. Step-wise regression was done to find the weights of the different variables on behaviour change.


Impact of psychiatric illness on marrige analysis of patients with schizophrenia in comparison to bipolar who are deserted by their spouse

Priyanka Rai, Preeti Mishra

Central Institute of Psychiatry, Ranchi, India

Aim and Objective : Schizophrenia is often evaluated by the spouse as a decisive point in life that seriously affects the couples' relationship, the family, and the spouses' own life. The aim of this study is to delineate factors; clinical, social, cultural, economic and demographic in the schizophrenia patients in comparison to bipolar who are deserted by their spouse and living separately because of having a serious psychiatric morbidity.

Materials and Methods : Sampling technique used was purposive sampling. The sample consisted of two groups of married patients both gender, between ages of 18 and 60 years under treatment in the Outpatient department at the C.I.P, Ranchi, Jharkhand, India. Each group consisted of 30 patients. Schizophrenia and Bipolar Disorder was diagnosed by consensus by two psychiatrist using research DCR-X. Clinical groups were assessed on. The world health organization - quality of life Scale, marital adjustment scale (Locke and Wallace, 1959), Garroes Sexual Inventory. Socio-demographic data sheet was filled for each sample that included age, gender, education, habitat, financial support, premarital onset of illness, treatment response, and embarrassing behavior, and delusion of infidelity was specially enquired into.

Result : The result showed that spouses with schizophrenia were deserted more in comparison to bipolar because the partner's impairment is perceived as more severe and when the frequency at which psychotic episodes occur is intolerable. The implication of the study in therapeutic situation will be dealt in the conference.


Efficacy of family therapy with respect to expressed emotions in patients presenting with relapse after in-hospital opioid detoxification

Harsh Chalana, Amritpal Singh Brar, Vivek Munjal,

Harjot Singh

SGRD Institute of Medical Sciences & Research ,Vallah, Amritsar, India

Aims & objectives : 1. To determine efficacy of family therapy with respect to expressed emotions (EE) in patients who relapsed. 2. Comparative load of expressed emotions in family members of opioid dependent patients who relapsed with those who did not relapse.

Methodology : 126 consecutive patients were taken in study that had undergone opioid detoxification in SGRDIMSR hospital situated in village Vallah, Amritsar. They were followed up for 2 months with weekly visits. 74 patients relapsed within 2 months and 42 did not.10 cases were lost to follow up. Patients were asked to fill questionnaire for measuring EE at relapse or end of 1 month, whichever earlier. Family members of 74 patients who relapsed were involved in family therapy with focus on managing high expressed emotions. Patients were further followed up for further 2 months with once a week family therapy session. Data was analysed and efficacy of family therapy was assessed after 2 months.

Results : It was found that 87.84% patients (65 out of 74) reported high EE as the reason to relapse while only 28.57% patients (12 out of 42) who did not relapse reported high EE in family. Out of 65 patients who were started on family therapy focusing on expressed emotions, 57 (87.69%) remained abstinent after 2 months.

Conclusion : High family expressed emotions are a major risk factor for relapse after opioid detoxification and should be concomitantly managed with family therapy focusing on EE.


Metabolic syndrome in subjects with bipolar disorder

Nidhi Malhotra, Sandeep Grover, Subho Chakrabarti,

Munish Aggarwal, Alakananda Dutt, Ajit Avasthi,

Parmanand Kulhara

Background : Studies from the West suggest that 16.7 to 67% of subjects with bipolar affective disorders (BPAD) have metabolic syndrome (MS), however, there are no data from India. Aim of the study : To study the prevalence and risk factors of MS in subjects with BPAD.

Materials and Methods : Sociodemographic, clinical data, Anthropometric data and metabolic profile were collected prospectively from 192 BPAD subjects attending the psychiatry outpatient. Metabolic syndrome was defined according to the international diabetes federation (IDF-criteria). Results : About two-third of the subjects were male, Hindu by religion from urban background. Three-fourth of them were married. About half of them belonged to nuclear families, were employed and were less than 40 years of age. Overall 41.7% of subjects (N=80) met the IDF criteria for MS. Among the various criteria of metabolic syndrome, the most commonly satisfied criterion was that of waist circumference (N=140; 72.9%), followed by triglyceride (N=87; 45.3%), high density lipoprotein (N= 83; 43.2%) and the least commonly satisfied criterion was that of fasting blood sugar (N=57; 29.7%). Among the various sociodemographic risk factors only significant risk factor was age and there was no difference between those with and without metabolic syndrome with respect to gender, years of education, type of family, locality and number of medications.

Conclusion : To conclude, our study suggests that there is a high prevalence of MS in subjects of BPAD. This increased risk must be remembered while choosing various psychotropic agents. Further, the subjects with BPAD should routinely undergo physical evaluation and should be investigated from time to time to take appropriate measures.


Depression and coping skills in relation to violence against women

Arvind Jinger, Pradeep Sharma, Anil Tambi, Alok Tyagi, Gunjan

SMS Medical College, Jaipur, Rajashtan, India

Background : The epidemic of violence directed at women and girls constitutes a major human rights issue and a public health crisis. Around the world, women are regularly beaten and sexually abused by intimate partners, family members, neighbours, and by people not known to them. Besides the physical suffering, such violence has a profound impact on women's psychological well-being, on their reproductive health and security of their families and communities. Women have been the victum of the violence and exploitation by the male dominated society all over the world. In India the strong tradition binds society where women have been socially, economically, physically, psychologically, emotionally and sexually exploited. Coping Mechanism play a significant role in relation to violence against them.

Aims : The study was aimed at fulfilling the following objectives -

To evaluate the role of coping mechanism in relation to violence against

To find out relationship between depression and coping mechanism.

Materials and Methods : The present study was carried out on a sample population of 35 women consecutively attending Mahila Salah Suraksha Kendra, Violence against women counseling Centre Jaipur and same number of control group were taken from relatives of these women with suitable inclusion and exclusion criteria. The two groups were compared for their psychiatric morbidity on following measures of Sociodemographic Proforma and Identification Sheet, Beck's depression inventory, Moos coping response inventory.

Results : By using the suitable statistics the results revealed that on all the four measures of approach coping (viz. Logical analysis, positive reappraisal, seeking guidance and support, problem solving) case group woman have scores significantly lesser than their normal counter parts. On avoidance coping no significant difference were observed in both these groups. However case group women had shown significantly more resignation (acceptance or surrendering attitude, seeking alternative rewards and greater means for emotional discharge as compared to their counter parts who were normal women and correlation was BDI v/ s LA - 0.495, BDI v/s PR -0.398, BDI v/s SG - 0.441, BDI v/s PS + 0.433, BDI v/s CA - 0.378, BDI v/s AR + 0.358, BDI v/s SR + 0.490, BDI v/s ED + 0.424.

Conclusion : Those women who suffer from violence inflected on them have faulty coping response and show higher emotional problem like depression.


Study of metabolic syndrome in patients of dementia

M.N. Ansari, P.P. Singh, R.K. Gaur

Objective : To ascertain relationship between metabolic syndrome and dementia.

Materials and Methods : The present study was conducted in the Department of psychiatry J.N. Medical College and Hospital, AMU, Aligarh. The sample consisted of 30 consecutive patients of dementia who presented to psycho-geriatric out patient department of J.N. Medical College, AMU during January 2009 to August 2010, and 30 age and sex matched controls.The diagnosis of dementia was made according to DSM-IV TR. A semi-structured proforma was used for collecting clinical data.Patients as well as control subjects were investigated for metabolic derangements.

Result : Sample consisted of 30 patients (18 males and 12 females) diagnosed with dementia as per DSM-IV TR and 30 age and sex matched controls. Concurrent result revealed lower high density lipoprotein-Cholesterol in 56.6% patients and elevated Serum Triglyceride level in 50% of patient of dementia. Detailed result will be discussed during the presentation.

Conclusion : In this study we found that metabolic derangements were more common among patients with dementia as compared to controls. This hints that there may be a relationship between metabolic syndrome and dementia.


Experience of subjective symptoms in euthymic bipolar disorder and remitted schizophrenia patient: A comparative study

Manish Kumar, V.K. Sinha, M. Ghoshal, Apala Bhattacharya

Institute of Psychiatry, IPGMEANDR, Kolkata, West Bengal, India

Introduction : Subjective experience means subtle, not yet psychotic abnormalities of experience that might be present during remitted phase and also in prodromal phase of schizophrenia and might be accurately efficient in identifying an individual at risk of eminent psychosis. Most studies on subjective experiences have been conducted in schizophrenia and to a lesser extent in affective disorders. Only few studies have compared subjective experience of patients with bipolar disorder with the patients with schizophrenia, and the results were inconsistent.

Objective : The current study aims at comparing the subjective experience in schizophrenia and bipolar patients, in order to elucidate the difference between the two groups and this study was further extended to measure the effect of subjective experiences on one's occupational and social functioning.

Materials and Methods : The present study was a hospital based, cross-sectional study based on single assessment of the patients. The study was done on 30 euthymic bipolar patients (euthymia was defined as young's mania rating scale score ? 12 and hamilton rating scale for depression cutoff values ? >7), and 30 remitted schizophrenic patients positive and negative symptoms scale ((PANSS) score < 60 and the mean of any three sub scale of PANSS was not greater than 3) diagnosed as per international classification of diseases-10-diagnostic criteria for research. The patients who were in stable remitted state were rated for on Frankfurt Complaint Questionnaire (FCQ-24) and Symptoms check list 90 revised (SCL90-R) to assess subjective symptoms. Work and social adjustment scale, functional status questionnaire and world health organization-quality of life BREF were administered one by one on the patient.

Results : Diagnosis of schizophrenia was associated with elevated score on FCQ as compared to bipolar disorders mainly in the areas of perception, thought, language and motility as well as total FCQ scores. FCQ scores correlated negatively with scores on functional status questionnaire, positively with work and social adjustment scale and negatively with all the domains of WHO-QOL BREF except environment/financial resources. Similarly SCL scores correlated negatively with scores on functional status questionnaire, positively with work and social adjustment scale and negatively with all the domains of WHOQOL BREF except environment/financial resources.

Conclusion : These findings, in conjunction with those from other, methodologically similar studies, suggest that certain anomalies of subjective experience aggregate significantly in schizophrenia when compared with bipolar disorders and these experiential anomalies appear to be relevant for early differential diagnosis and therefore potentially useful in the preonset detection of the schizophrenia spectrum illness.


Does hypertension affect quality of life?

Rohit Sharma, R.K. Solanki, Deepti Munsi

S.M.S. Medical College, Jaipur, Rajashtan, India

Quality of life (QOL) is a global concept which includes mental and social actions, physical activities, and the beneficial aspects of a good physical and mental condition as well as negative ones caused by disease and infirmity. Currently, QOL is one of the methods of comprehensive evaluation of a patient's health status. Hypertensives represent a vulnerable population that merits special attention from health care providers and systems. This is specially important given that low health related QOL can be a risk factor for subsequent cardiovascular events and complications. With this background we plan this study to assess the QOL impairment in patients of essential hypertension and compare it with normotensives. The study included 60 patients of essential hypertension and the control group consisted of 30 normotensive subjects as per the selection criteria. Results : The mean scores in all the four domains Physical (44.83), Psychological (42.27), Social (42.05), Environment (44.18 )as well as the total Scores(174.23) were lower in hypertensives in comparison to normotensive's Physical (72.70), Psychological (74.47), Social (76.50) , Environment(78.80) and total (300.47). The mean values were statistically significant when subjected to unpaired t test (P < =0.001).

Conclusion : Hypertensives experience significant impairment in QOL in comparison to normotensives; on all four domains, i.e Physical, Psychological, Social and Environment. This Can be attributed to the "Labelling Effect" as well as poor blood pressure control.


Functional imaging of the nigro-striatal pathway: A clinical review

Velusamy Sivakumar, Saminathan Anand 1

Beighton Hospital,Sheffield, UK, 1 Whitham Court, Lincoln, UK

Background : Dementia with Lewy Bodies (DLB) is often misdiagnosed as Alzheimer's disease (AD). The central feature of DLB is progressive dementia and core features are fluctuating cognition, recurrent visual hallucinations and Parkinsonism. Accurate diagnosis is vital for appropriate treatment and to avoid antipsychotics.

Objective : To review the clinical utility of SPECT with dopaminergic presynaptic ligand to differentiate between DLB and AD. In the UK, the NICE guideline recommends the use of Dopaminergic iodine-123-radio labelled 2â-carbomethoxy-3â- (4-iodophenyl)-N-(3-fluoropropyl) nortropane (FP-CIT) SPECT (DaTSCAN) to establish the diagnosis of DLB.

Methodology : This article reviews the usefulness of DaTSCAN in clinical practice. Three case reports and the scan pictures demonstrate how it helped in the differential diagnosis. The first patient presented with Organic Delusional disorder with fluctuation in cognition and neuroleptic sensitivity. For a possible DLB, Rivastigmine was started. A repeat CT and a MRI confirmed a pituitary adenoma and she responded to hydrocortisone. Her cognitive scores returned to normal with isolated visuo-spatial deficits. DaTSCAN revealed intact nigro- striatal pathway and Rivastigmine was successfully withdrawn. The second patient's initial presentation was gait dyspraxia and cognitive impairment. MRI showed widespread ischemia and cerebral atrophy. A mixed Vascular and Alzheimer's dementia was diagnosed and treated with Donepezil. Twelve months later he developed complex visual hallucinations and parkinsonian features. An abnormal DaTSCAN confirmed DLB. The third patient with a diagnosis of Psychotic Depression received Fluoxetine and Olanzapine. Parkinsonism, fluctuating cognition and an abnormal DaTSCAN led to the diagnosis of DLB and was treated with Rivastigmine. Depression responded well to ECTs and Lithium. Subsequent neuro-psychology ruled out dementia. At 12 and 18 months' follow-up, he showed no Parkinsonism. A repeat DaTSCAN after 18 months was normal and Rivastigmine was successfully discontinued.

Conclusion : These three case reports highlight the importance of accurate diagnosis and target symptom approach. DaTSCAN is well tolerated by patients and its sensitivity and specificity for the diagnosis of DLB is 94% and 100% respectively.


Socio demographic and clinical profile of patients presenting with headache

Dinesh Kataria, Santosh Kumar Sah, Priyanka Gautam

Department of Psychiatry, Lady Hardinge Medical College, New Delhi, India

Introduction : Prevalence of headache is 16.54% in general population. It has been seen that large proportion of patients visiting psychiatry OPD present with headache. The history is the key source to differentiate primary headache and secondary headache (due to underlying structural brain lesions). Secondary headache is, however, relatively rare and the majority of patients seen in our OPD have primary headache.

Aim : To study Socio-demographic and clinical profile of patients diagnosed with headache in a tertiary care general hospital psychiatry unit.

Methodology : A retrospective chart review of 100 patients diagnosed with headache evaluated in the department of psychiatry, Lady Hardinge Medical college, New Delhi from august 2009-10.The results were analyzed using appropriate statistics and the implications of the study will be discussed.

Results : Majority of patients had primary headache which included tension type and migraine. Secondary headaches constituted of post-traumatic headache, refractive error, central nervous system lesions, cervical spondylosis, trigeminal neuralgia, and hypertension, in the order of descending frequency. Results will be discussed in detail during the presentation.

Conclusions : Primary type headaches were common among housewives married persons those belonging to socioeconomic class II, and in nuclear families. Education does not have any significant role to play.


Attachment styles in patients with alcohol dependence and their correlation with self esteem and anger

Deyashini Lahiri Tikka, D. Ram,. Indu Dubey, Sai Krishna Tikka

Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand, India

Aims and objectives : To study the types of attachment styles used by patients with alcohol dependence as compared to normal control and to find out the relation of severity of alcohol dependence on attachment styles, self-esteem and anger.

Methodology : It was a cross-sectional comparative hospital based study using purposive sampling. The patient group consisted of 40 male patients with ICD-10 (DCR) diagnosis of Alcohol dependence syndrome (P). Forty age and sex matched individuals with general health questionnaire (GHQ)-12 score of < 3 served as controls (C). Alcohol dependence severity was assessed on Severity of Alcohol Dependence Questionnaire (SADQ). Relationship Scale Questionnaire (RSQ), Rosenberg self-esteem scale and State trait anger expression inventory (STAXI) were administered for assessment of types of attachment style, self-esteem and domains of anger. P was further divided into two groups - high (H) and low (L) severe dependence based on the median score on SAD-Q.

Results : Attachment styles were not significantly different between the groups or subgroups. H had significantly lower self esteem scores than C. H had significantly higher anger expression and anger out than C and L had significantly higher anger in than C. Fearful style of attachment had significant correlation with Trait Anger, angry reaction and Anger expression. Anxiety and avoidant attachment styles were significantly related to state Anger and Anger expression. Self-esteem had significant negative correlation with trait anger and anger expression in patients.

Conclusions: Severity of dependence effects self-esteem and it has different significant effects on different domains of anger expression but does not affect anger experience. Also different attachment styles are correlated differently to various domains of anger. An inverse correlation exists between self-esteem and trait anger in alcohol dependent patients.


Psychopathology and personality profile of post myocardial infarction indoor patients in a tertiary hospital

Arun Kumar Pandey, S. Lal, Pramod M. Shyangwa

BPKIHS, Dharan, Nepal

The aim of the study was to find out the role of personality patterns and prevalence of psychiatric morbidity in correlation with myocardial infarction. Sample consisted of 50 cases of myocardial infarction and equivalent number of controls without having concomitant other medical illnesses. Both the groups were administered neuroticism-extraversion-openness Personality Inventory (Revised) for assessing personality and Beck's Depressive Inventory for assessment of depression. Noteworthy differences across groups were observed in neuroticism and conscientiousness. The myocardial infracted patients also have significant high score on depression. Along with other factors personality influences and role of depression are discussed as determinants of coronary heart disease.


A controlled study of plasma omega-3 fatty acids in patients of depressive disorder

Bichitra Nanda Patra, Sudhir K. Khandelwal, Rakesh K. Chadda, R. Lakshmy

Background : It has been hypothesized that there may be depletion of plasma omega 3 polyunsaturated fatty acids, particularly eicosapentathenoic acid and docosahexaenoic acid in depression. A lower level of serum cholesterol is associated with patients presenting with self harm and patients of depressive disorder.

Aims : To study plasma omega-3, omega-6 fatty acid and serum cholesterol levels in depressed subjects and normal controls.

Materials and Methods : We measured plasma omega-3, omega-6 fatty acid and serum cholesterol levels of 30 depressive patients and 30 healthy matched control subjects.

Result : There was no significant difference in plasma omega 3 fatty acid levels and serum cholesterol level between study group and control group. The plasma omega 6 fatty acid levels of 30 subjects in study group were significantly less than that of control group.

Conclusion : This is formally a negative study. The present study is an initial attempt to investigate the link between omega-3 and omega-6 fatty acids in patients of depression in a clinical setting of a tertiary care hospital in India. This comparative study with normal controls failed to etiologically link these polyunsaturated fatty acids in our small sample of depressive disorder. We, however, conclude that research efforts must continue in our country by large and well designed comparative study taking into consideration all confounding variables to investigate if rates of depression vary within India between populations consuming diets with high or low omega-3 fatty acids.


Predictors of aggressive behaviours in drug de: Addiction centre

Maheshwar Nath Tripathi, Heman Ram Phookun, Uddip Talukdar

Aim : Associations have been reported between aggression and psychoactive substance use. This study aimed to assess the prevalence and nature of aggressive incidents and to examine the factors associated with aggression in in-patients of a drug de-addiction unit.

Materials and Methods : Forms of aggression and their severity were assessed based on questions of Overt Aggression Scale. Data were collected from inpatients about the nature of their aggressive incident during a 12-month period. The characteristics of those patients involved in aggressive incidents were compared with those of others who had not been aggressive.

Results : Fifty out of 83 patients admitted during this period were involved in some form of aggressive behaviour. Most common diagnosis was alcohol dependence. Verbal aggression increased with past history of aggression (P=0.006) and incidences of number of aggression behaviour in the past (P=0.009) which also was found to more in patients with comorbidities (P=0.043). While all other forms of violence showed increase with past histories, statistical significance was there only in aggression towards others (P=0.043). Younger age group and being single were also significantly associated with incidents of aggression. Aggressive behaviours generally decreased with voluntary admission patients. There were high correlations of one form of aggression in presence of other forms. Comparison of aggressive behaviour in relation to family type, locality, religion, family history of violence did not yield any significant variation.

Conclusion : Like weather forecasting, predictions of future violence will not always be correct. However, present study revealed that younger age group, past history, number of aggressive incident in the past, and comorbidities are significantly associated with aggressive behaviour. Aggressive behaviour decreases with voluntary admission.


Comparative study of perception of stigma among caregivers of persons with bipolar affective disorder and schizophrenia

Pravin Yannawar, Rajesh Kumar, Jahanara Gajendragad,

Nimesh Desai

Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi, India

Introduction : The stigma of mental illness has been shown to be a strong negative feature in the lives of many people with mental illnesses and their families. A robust literature in the social and medical sciences has addressed stigma as it applies to a wide range of stigmatizing circumstances (Link and Phelan, 2001). In the area of mental illnesses studies indicate that stigma plays a role in social isolation, income loss, opportunities for employment and housing, depressive symptoms, quality of life, and access to medical care (Link, 1987).

Aim : The aim of the present study was to assess the perceived stigma of the caregivers of persons with Bipolar affective Disorder as compared to Schizophrenia patients.

Methodology : This study was a cross-sectional hospital based one and carried out at the Institute of Human Behaviour and Allied Sciences (IHBAS) in Delhi. For the purpose of study 30 caregivers of persons having the diagnosis of Bipolar Affective Disorder and 30 patients of Schizophrenia were selected purposively as per the inclusion and exclusion criterion of the study. After selection of the samples instruments like Socio-Demographic and Clinical Data Sheet, and Devaluation and Discrimination Questionnaire were used for data collection. Written as well as informed consent was taken from the samples of either group before starting data collection. Statistical measures like descriptive statistics, Chi-Square Test, Independent Sample T Test and Pearson Correlation-Coefficient were used to analyse and interpret the collected data. Statistical software of Statistical Package for Social Sciences (Windows Version 13) was used in this study.

Conclusion : Mental Health Professionals should assess the effect of stigma of the caregivers of persons with mental illness, and help patients and family members reduce the consequence of stigma on their lives. The details of the results will be discussed during presentation.


Patients' satisfaction with their mental health care and quality of life

Rohit Verma 1 , Yatan Pal Singh Balhara

Introduction : This research considering the patient's perspective of psychiatric care has examined many constructs, including attitudes, perceptions, preferences, wishes, goals, needs, requests, expectations, desires, satisfaction and evaluations of quality of care. Patient and carers' satisfaction with psychiatric services are a particularly salient and appropriate measure of outcome and quality. A reliance on psychiatric symptoms alone as a measure of service satisfaction is considered too narrow a concept. Quality of life is a strong predictor of psychological wellbeing, and people with mental illness are believed to experience lower life satisfaction than the population as a whole.

Objectives : The study investigated the factors related to the patient and carers' satisfaction with the mental health care and quality of life.

Materials and Methods : The cross sectional study sample comprised of 200 consecutive patients with their caregivers from the outpatient department of Psychiatry at Postgraduate Institute of Medical Education & Research, (PGIMER) and Dr RML Hospital, a tertiary care hospital in New Delhi. The sociodemographic and clinical profile was evaluated using a semi-structured proforma and diagnosis made as per ICD- 10-DCR. Satisfaction assessment is done using the Carers' and User's Expectations of Services, User Version (CUESU) questionnaire. This 16 item self rated outcome measure covers the issues that those using mental health services have identified as being their priorities. Descriptive statistical analysis for continuous and categorical variables is done as needed.

Result/Conclusion : The analysis is being embarked upon and the results and conclusion will be presented at the conference.


Premature ejaculation - A cross-sectional study

Anurag Jhanjee, M.S. Bhatia, Pankaj Kumar, Shruti Srivastava, Deepika Verma 1

U.C.M.S. & G.T.B. Hospital, Delhi, 1 Navodaya Medical College, Raichur, India.

Premature ejaculation (PE) is one of the most common male sexual disorders but is insufficiently understood. Difficulties with the definition and divergent study designs hamper the collection of relevant data pertaining to this commonly encountered psychosexual disorder. The objective of the proposed study is to explore socio-demographic profile, age distribution, educational status, comorbidities (psychiatric and medical), and prevalent attitudes and beliefs of the patients suffering from premature ejaculation. Fifty male subjects with diagnosis of PE (ICD-10 Diagnostic Criteria for Research) will be recruited on consecutive basis from the patients will attending psychosexual clinic of the Psychiatric outpatients department of U.C.M.S. and G.T.B. Hospital, Delhi, in the period from 1 st September to 31 st December 2010. Each subject will undergo thorough clinical assessment using proforma and all relevant details like age, educational status, socio-economic status, associated comorbidity (Psychiatric and Medical), Prevalent attitudes and beliefs regarding PE will be recorded and subjected to statistical analysis. The results and conclusions of this study will be discussed during free paper presentation at ANCIPS, 2011.


Comparison of quality of life in generalized anxiety disorder with healthy controls and major depressive disorder

Shruti Srivastava, M.S. Bhatia, Rajat Thawani, Nishit Bhatnagar, Anurag Jhanjee, Pankaj Kumar

U.C.M.S. & G.T.B. Hospital, Delhi, India

Background : Anxiety disorders are disabling disorders associated with impaired quality of life (QOL). Nevertheless, there have been few studies reported from India comparing the Quality of Life in Anxiety and Depressive disorders.

Aims and Objectives : (1) To compare QOL in patients of Generalized Anxiety Disorder with healthy controls and patients of Major Depressive Disorder; (2) To correlate the QOL with Disease Severity.

Methodology : A cross-sectional study of QOL of 30 outpatients with Generalized Anxiety disorder with or without panic attacks, 30 outpatients of Major Depressive disorder and 50 Healthy Controls was carried and using world health organization (WHO) QOL BREF. The association of QOL with symptom severity using Hamilton Anxiety rating scale was also assessed.

Results : We found significant lower domain scores of WHO-QOL Bref patients of generalized anxiety disorder and Major Depressive Disorders than Healthy Controls. We found significant correlation between disease severity and domains score of QOL.

Conclusion : There is significant impairment in QOL in patients of Generalized Anxiety Disorder which maybe correlated with the disease severity and hence, requires specifically tailored interventions.


Risk and prevalence of major depressive disorder in HIV positive population from tribal India

Amit Bhatnagar, Kiran Deshpande, Praveen Khairkar, Susanta Kumar Padhey, Govind Bang

JNMC, Wardha, India

Background : Major depression remains a significant psychiatric problem in HIV positive patients as documented consistently in several studies. Although there are as many as 20 published studies in HIV from India, none of them had been done in tribal Indian population.

Aim and objective : We aim to evaluate the risk and prevalence of Major Depressive Disorder in HIV positive patients hailing from Tribal Indian Population from Central India.

Materials and Methods : Snowball sampling technique is used for the collection of data from the non-governmental organizations working in the epidemiological catchment area in tribal districts of Chandrapur and Gadchiroli for recruiting 100 HIV patients. A Cross-sectional, single time evaluation was performed using standardized psychometric instruments. Study was conducted from September 2010 to August 2011 after approval from IEC.

Results : Mean age of patient was 31.6 years 34% of them were females and all of them were illiterate and drug naive. Heterosexual mode of transmission was reported in all the cases. Mean duration of onset of HIV was 34 weeks, 47% were suffering from Major Depressive Disorder, 40% had subthershold depressive symptoms, 23% of them expressed suicidal ideation at some point of time in last one year. Mean Global Assessment of Function (GAF) score was 43.3.

Conclusions : Major Depression remains significant psychiatric problem in HIV positive individual irrespective of the socio-economic status. To our knowledge, this is the first study from India exploring psychiatric comorbidity in HIV positive Tribal population.


Prevalence, correlates and management of comorbid anxiety disorders in schizophrenia

Chandra Kiran, Suprakash Chaudhury

Department of Psychiatry, RINPAS, Kanke, Ranchi, India

Background : Anxiety disorders appear to co-occur with schizophrenia at substantial rates, and play a very important role in the diagnosis and management of the condition. They may also be a source of disability for patients with schizophrenia, but the significance of these findings has remained obscured. Aims and objectives : The aim of the study was to find out the prevalence of different anxiety disorders and the effect of treatment in patients with a diagnosis of schizophrenia. Settings and Design : the study was carried out on the inpatients of a tertiary care hospital using a prospective, purposive sampling technique.

Methodology : The study consisted of 93 schizophrenia patients and a similar number of normal controls. The schizophrenia patients were evaluated for the psychopathology and the presence of anxiety disorder at baseline. After being prescribed with an antipsychotic in a suitable dose they were followed up at weekly intervals for the course of both schizophrenia and anxiety disorders. An selective serotonin reuptake inhibitors (SSRI) was prescribed after a period of 8 weeks and the patients were again followed up for the progress of schizophrenia and anxiety disorder. The data was analysed using chi square test, Spearman's correlation, Mann Whitney u and Wilcoxon tests.

Results and Conclusions : The results proved that the prevalence of anxiety disorder was significantly higher in schizophrenia patients. There was no significant correlation between anxiety disorder scores and psychopathology scores. Schizophrenia patients having anxiety disorders responded well to the combination of SSRIs and antipsychotics but not antipsychotics alone.


The role of life events in obsessive compulsive disorder

Varun S. Mehta, Samir Kumar Praharaj, Sujit Sarkhel, Sakshi Rai, Vinod Kumar Sinha

Aims and Objectives : To assess the role of life events in the onset and exacerbation of obsessive compulsive disorder.

Methodology : 30 patients in the age group of 18-60 years belonging to either sex meeting the international classification of diseases-10-diagnostic criteria for research criteria for obsessive compulsive disorder attending the inpatient and outpatient facility of the institute were selected for the study. 30 age and sex matched normal healthy subjects with a GHQ score < 3 were accordingly matched. The patients were rated on the Yale Brown Obsessive Compulsive Disorder Scale (YBOCS) after applying the check list to evaluate the severity of symptoms. Subsequently Hamilton scales for Anxiety and depression were applied respectively to know the severity of symptoms. The Presumptive stressful Life events scale (PSLES) was then applied to obtain information regarding the presence of life events in the past one year and lifetime before. The events were subsequently rated to assess the severity. Similarly, the life events were assessed in the healthy controls to obtain a comparison among patients and controls.

Results and Conclusions : The results and conclusions would be presented in the conference.


Group cognitive behavioural therapy: A model for a staff support group in an oncology setting

Jayita Deodhar 1 , Savita Goswami 2

Tata Memorial Hospital, Mumbai, India

Aims and Objectives : Literature reports that health care workers in oncology are a vulnerable population because they frequently encounter situations at work that are physically and emotionally demanding. The aim of the current study was to evaluate the planning, process of implementation and benefits, if any, of a staff support group programme, based on group cognitive behavioural therapy, in an oncology setting, conducted for urban outreach programme project workers of a tertiary care oncology institute in India.

Methodology : A staff support group programme was conducted for non-professional health care workers working (in fieldwork and hospital duty) for an urban outreach program project, in a tertiary care oncology institute, in India. It consisted of weekly sessions, conducted over 8 weeks, by one of the team members of the in-house liaison psychiatry service and was based on cognitive behavioural therapy principles. The key elements in the planning and implementation and the process and components of the group work are identified from records maintained for this activity. Immediate evaluation (by verbal feedback) and sustained benefits (by anonymous formal feed back questionnaire after 4 months) of support group sessions were done by the team member who was not the primary therapist.

Results : The group consisted of 11 members. Elements identified in planning stage included preparatory talks with the team leader of the participants, the time, venue and type of group (closed), homogeneity of participants, method of record keeping and pre-group assessment. The main issues were stress related to dealing with patients and communication problems. The components of implementation work were information provision regarding the planned programme, maintaining attendance, and emphasis of confidentiality. The process contained ventilation of emotions, development of coping skills, information provision and encouraging mutual support. All found the sessions useful, mainly in areas like improving communication, handling grief reactions and developing better coping skills, both immediately and 4 months after completion of sessions.

Conclusions : Group cognitive behavioural therapy can be a useful model for staff support groups with an immediate as well as sustained beneficial effect for non-professional health care workers in an oncology setting.


Frequency and phenomenology of morbid jealousy in psychiatric out-patients

Satyajeet Kumar Singh, P.K. Singh

Patna Medical College, Patna, India

Background : Morbid jealousy is an often seen symptom in clinical practice and an important cause of dispute and hostility between couples. But information regarding its magnitude, subtypes and associated diagnosis either in clinical or general population is not available. Present study was carried out to fill up this gap.

Aims : (1) To find out the frequency of occurrence of symptoms of morbid jealousy in patients attending psychiatric Out Patient Department (OPD). (2) To find out the relative frequency of its three subtypes, i.e. delusional, obsessional or over-valued idea type. (3) To find out the diagnostic break-up of patients exhibiting morbid jealousy. Methods : A total of 1326 consecutive new patients attending OPD, Department of Psychiatry of Patna Medical College Hospital, were screened over a period of about four months to get a final study sample of 50 patients who also had morbid jealousy as defined by the operational criteria of Albert Michael and Mirza (1995). The issue of jealousy was applicable only to 972 patients out of 1326, because only they were either married or had a sexual partner.


A study of stress, quality of life and psychiatric morbidities in police personnel

Santanu Ghosh, P.K. Chaudhury, R.U. Zaman

Introduction : Policing is associated with psychologically stressful work environment filled with danger, high demands, and equivocalness in work, encounters human misery and death exposure.

Aims : To assess perceived stress by police personnel, correlation between stress and quality of life among Constables and Officers, psychiatric morbidities in the study groups.

Methodology : Community study was done in police stations of Dibrugarh District, Samples were recruited from among the police personnel of different ranks of Assam Police by Systemic random sampling. Sample Size : Group-A (83) and Group-B (33).

Inclusion criteria : Policeman in service for minimum 3 years, aged more than 21 years, with minimum primary school education. Exclusion criteria : who is unable to comprehend study questionnaire, on leave, exclusively doing clerical job, who are found inebriated. Self-reported questionnaire was used for evaluated. Tools : Police specific Stress Questionnaire, measures of chronic job stressors, WHO QOL-BREF, General health questionnaire-30, Mini International neuropsychiatric interview (Version 5).

Results and Conclusion : 1/4 th of constables are significantly stressed and 2/3 rd of officers are significantly stressed. Positive linear relationship exists between age and stress in both the groups. Tenure of work has positive linear relationship only in officers. Officers are more stressed than constables. Bellow secondary constables are more stressed and Graduate officers are more stressed. No relationship exists between education and stress level. Mean score of neglected family life, job boredom, and quantitative work overload score is more in officers group and noxious physical environment, communication quality and praise is more in constables. The general health questionnaire-30 score does not cross the threshold in either group. Diagnostic evaluation by M.I.N.I. could not be performed. In quality of life, the mean score of all the domains is higher than officers.


Sub-typing of delirium in medically ill hospitalized patients

Ruchita Shah, Sandeep Grover

Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

Aim : To study the prevalence of the various sub-types of delirium in medically ill hospitalized patients.

Methodology : Ninety-nine patients with delirium seen by the consultation-liaison team of the Department of Psychiatry at Postgraduate Institute of Medical Education and Research, Chandigarh were recruited for the study after obtaining consent from an adult caregiver. Sociodemographic and clinical details were recorded. The patients were rated on Delirium Rating Scale- Revised 98 (DRS-R98) and the Delirium Motor Checklist.

Results : The mean age of the patients was 46.29 (±18.88) years and the mean number of years of education was 8.21 (±5.66). Most of the subjects were male (N=71, 71.7%) and had hospital emergent delirium (N=70, 70.7%). The mean duration of delirium was 4.11 (±5.66) days at the time of assessment and the mean DRS-R- 98 score was 30.54 (±5.09). As per the delirium motor checklist, hyperactive (N=57, 57.6%) subtype was the most common motoric subtype, followed by mixed (N=20, 20.2%) and hypoactive (N=17, 17.2%) subtypes. Only 5 subjects couldn't classified into either of the above 3 subtypes. Males were more likely to be classified as having hyperactive delirium (67.6% vs 32.14% in females), whereas females were more likely to be classified as having mixed motoric subtype (35.71% vs 14.08% in males).

Conclusions : Hyperactive motoric subtype of delirium is the most common subtype of delirium in medico-surgical set-up.


Group intervention for children with ADHD a prospective intervention technique in a private camhs0 setting

Bhavana Goel, Soumini Menon, Deepak Gupta

Sir Ganga Ram Hospital, New Delhi, India

Purpose : In the following paper, we aim to explain the development of a group intervention program for children with Attention Deficit Hyperactive Disorder (ADHD).

Background : ADHD is one of the most prevalent and well researched mental health problems amongst young children and adolescents across the globe. Over the years various therapeutic interventions have been validated for the management of ADHD, like Cognitive Behavior Therapy, Behavior Modification Plan and Psychotropic Medications. However, a child with ADHD often faces a lot of comorbid psychological issues secondary to impulsivity, hyperactivity and attention difficulties. These could include low confidence, poor peer relations, low self esteem and aggression. Experiential understanding of their difficulties and hence forth developing their insight intelligence for the management of these difficulties is one of the main focuses of the intervention. A group intervention provides an opportunity for a child self growth and improve social skills.

Materials and Methods : In the following research we included a mixed group of children, diagnosed with ADHD (DSM-IV-TR), within the age group of 8 years -10 years, belonging to upper middle class section of New Delhi. Parents of the participant children filled in the Strengths and Difficulty Questionnaire form, once before the enrollment and second after 4 weeks and third after 8 weeks of group interventions. Techniques used in the sessions included role play, enactment of emotions, drawings, dance, music and other form of activities to improve the child's functioning in a natural setting.

Conclusion : Over the past two months, an initial qualitative and quantitative analysis of the current group has shown promising results, indicating that group intervention is a possible promising therapeutic technique for symptomatic management for ADHD children in a private Child and Adolescent Mental Health Services (CAMHS) setting.


Factors associated with deliberate self harm - A 5 year retrospective analysis

Sachin Kaushik, Ajeet Sidana, B.S. Chavan, Priti Arun,

Paramleen Kaur

Government Medical College and Hospital, Chandigarh, India

Aims and Objective of study : (1) To study prevalence of Deliberate Self Harm in psychiatry referrals of a tertiary care hospital. (2) To study the factors associated with deliberate self harm.

Methodology : The department is providing 24 hours round the clock emergency services to the patients of the emergency department and to the other disciplines in hospital. As per the protocol of the department, all the referred patients are seen by senior resident/consultant and information is entered in walk-in proforma as well as in the referral register. To fulfil the desired goal, patients who were referred to psychiatry referral services during period from 1st August 2005 to 31st July 2010, were included in the study. The information was gathered from the walk-in proforma and referral register. The results regarding pattern of Deliberate Self Harm (DSH) along with factors and the mode of DSH will be discussed in this presentation.


Brain and alcohol: A study of effect of duration and severity of alcohol dependence on standard cognitive functions

Aparna Ramakrishnan, Shilpa Adarkar, S.R. Parkar

K.E.M. Hospital, Mumbai, India

Introduction : Alcohol drinking has been proposed as a possible risk factor for cognitive impairment and dementia, though understanding the association has proved difficult. Some studies have found an increased risk of visuospatial and executive dysfunction, decreased psychomotor speed and recent memory and increased risk of dementia in chronic alcoholism. Some studies have found no association between alcohol consumption and cognitive impairment while some have claimed there is a J or U shaped relation between alcohol drinking and cognitive impairment or dementia; that is light to moderate alcohol drinking might have a protective effect compared with total abstinence and heavy drinking.

Aims and Objectives : (1) To evaluate standard cognitive functions in alcohol dependence. (2) To assess the effect of duration and severity of alcohol dependence on the identified cognitive functions.

Materials and Methods : 40 alcohol consumers attending the deaddiction out patient department at KEM hospital participated in the study. Relevant sociodemographic and other details of the subjects were collected using a predesigned proforma. Severity of alcohol dependence was evaluated using Severity of Alcohol Dependence Questionnaire (SADQ). Standard cognitive functions were evaluated using Standardised Mini Mental Status Examination (SMMSE) and Trail Making Test Part B (TMT-B). Duration and severity of alcohol dependence and cognitive functions were compared. Data was statistically analysed by regression analysis. The results will be discussed.


Psychological benefits of yoga in troops

(Maj.) Vishal Chopra, (Brig.) HRA Prabhu,VSM, (Col.) P.S. Bhat

AFMC, Pune, Maharashtra, India

Aims and Objectives : Today our society is fraught with increasing stress due to rapidly changing scenario with nuclear families, high aspirations and competition all around. The troops in security forces are further exposed to stress and strain due to the tough nature of their duties which calls for a need to incorporate simple, cost effective, and easily implementable measures in the Armed forces to tackle the same. Yoga has been considered a suitable candidate for reducing stress. Hence this study was undertaken to evaluate the psychological benefits of yoga in troops.

Methodology : Four hundred healthy young troops of a peace station were enrolled for the study after applying relevant inclusion and exclusion criteria. One group of 100 troops were given regular Yoga practice in the morning, another group of 100 troops were given regular Physical training (PT) in the morning, third group of 100 troops were given regular PT in the morning and Yoga in the evening, and the last group of 100 troops were neither given PT nor Yoga. All were assessed for their psychological state at base line, 4 weeks and at 12 weeks using specified scales. The findings were statistically analyzed.

Results : Yoga was found to have beneficial psychological effect comparable to physical training. However maximum benefit was obtained when Yoga was combined with PT.

Conclusion : Yoga has got positive psychological benefits in troops when practiced regularly. The benefits are enhanced when Yoga is combined with PT.


Factors associated with drop out from psychiatry walk-in clinic

Suravi Patra, Ajeet Sidana, B.S. Chavan

Government Medical College and Hospital, Chandigarh, India

Introduction : The rate of drop out in mental health services (40%) is almost twice of that seen in any other specialty. Administrative problems, barriers to care often compound the low awareness about psychiatric disorders prevalent in the community and often result in the patients not getting appropriate treatment. There is a need to address these problems so as to strengthen the existing mental health facilities in order to enhance its efficiency.

Aim and Objective : (1) To see the prevalence of drop out in psychiatry walk-in clinic. (2) To see the factors associated with drop out.

Methodology : The Department of Psychiatry, GMCH Chandigarh runs a daily walk-in clinic in the out patient department. It is run by a Senior Resident under the supervision of a Consultant and caters to all types of patients with psychological problems reporting for the first time to the Department. After the first clinical assessment, the senior resident usually writes medicine for 1 week. The patient is then allotted to a junior resident for detailed work up for discussion with consultant for making a final diagnosis and planning treatment. If the patient does not report for follow up for 2 consecutive weeks, it will be considered as drop out. A preliminary analysis of 400 patients who dropped out of the clinic was made. 56.79% were males, 38% were of high income group, 28% were of middle income group and 34% were of low income group. A large section of these patients (49%) had anxiety-depression-somatic symptoms, followed by patients with substance use (11.52%), psychosis mania (9%), only a few had dementia type complaints.


Consultation liaison psychiatry

Shrigopal Goyal, Sivakumar T., Pratap Sharan, Rajesh Sagar

AIIMS, New Delhi, India

Socio-demographic profile and psychiatric diagnosis of patients referred to consultation liaison psychiatric services at tertiary care centre (AIIMS).

Introduction : literature search showed that 0.6 to 12 percent of all general hospital admissions received psychiatric consultations. It revealed affective disorder was the most commonly diagnosed psychiatric condition for patients receiving a consultation. They also found that the consultation rates were higher in hospitals affiliated with medical schools, hospitals with psychiatric inpatient units, urban hospitals (Wallen J 1987). The consultation rate was highest for patients with the principal diagnosis of accidents, poisoning, and violence. The most common reason for referral in general medical and surgical hospital patients is depression.

Aims and Objective : Assessment of socio-demographic profile and psychiatric diagnosis of patients referred to consultation liaison services at AIIMS.

Methodology : The study was carried out at AIIMS in Patients, who were referred for consultation liaison psychiatry for the period of 2 months. Socio-demographic profiles of patients were assessed by using semi-structured questionnaire. Psychiatric co-morbidity was assessed by detail clinical interview and diagnosis was made by using ICD-10 criteria.

Results : Total 160 referral received for consultation liaison psychiatric services. On socio-demographic variables, Mean age of patients were 40.69±16.40, education was 10.35±5.04. One hundred nine (68.1) patients were married and 51% were females. All most all belongs to Hindu religion. Seventy nine (49.4%) were currently employed. Maximum referral were received from medicine department (17.5) followed by nephrology (15.0%) and neurology (10.6%). Most common psychiatric diagnosis was moderate depressive disorder (12%) followed by delirium (8%).

Conclusions : Most patients referred for consultation liaison services were adult females with average level education. Maximum numbers of patients were having mood disorder.


A study on the prevalence of generalized anxiety disorder and comorbidity among psychiatric outpatients

Pankaj Kumar, Anurag Jhanjee, M.S. Bhatia, Deepika Verma 1 , Shruti Srivastava

UCMS and Guru Tegh Bahadur Hospital, Delhi, 1 Navodya Medical College, Raichur, India

Objective : In this study, we aimed to investigate the prevalence of generalized anxiety disorder (GAD), its association with sociodemographic characteristics, and its comorbidity with other anxiety and depressive disorders among psychiatric outpatients.

Materials and Method : In the first phase of the study, outpatient psychiatry clinic physician interviewed with consecutive 720 patients who presented to psychiatry outpatient clinic of University College of Medical Sciences & associated Guru Tegh Bahadur Hospital, Delhi by using GAD module of Composite International Diagnostic Interview, version 2.1 (CIDI) during 4-month. Ninety-nine patients with diagnosis of GAD in the first phase were referred to the researcher physician for further evaluation. In the second phase, patients were interviewed by using CIDI anxiety and mood (major depression, dysthymic disorder) disorder modules. By this way, 12-month additional diagnoses were examined, and diagnosis of GAD was confirmed. One patient was excluded, because he did not meet the GAD criteria during re-examination by the researcher physician.

Results : Ninety-eight patients (10.3%) met DSM-IV criteria for GAD. Eighty-nine (90.8%) of the cases had comorbid any anxiety or depressive disorder. The rates of comorbidity with any of depressive disorders and anxiety disorders were found 84.7% and 56.1%, respectively. The most common comorbid diagnosis was major depression (83.7%). The most common anxiety disorders were social phobia (30.6%), Obsessive-Compulsive Disorder (OCD) (19.4%) and specific phobia (17.4%). The prevalence of GAD was observed significantly higher in women, married ones, housewives, unemployed girls, subjects with history of medical illness and lower educational status.

Conclusion : Our results show that among psychiatric outpatients, GAD has high comorbidity rates with depressive and other anxiety disorders, and it is associated with some sociodemographic characteristics such as gender, and marital, working and educational status.


To identify the various behavioral problems in children of mental retardation

Harful Singh, Ashok Singhal

S.P. Medical College, Bikaner, Rajasthan, India

Background : The co morbid behavioral problems in children of mental retardation are very common. These problems interfere in the learning capability of the child as well as put a challenge in front of attending staff in their rehabilitation.

Materials and Methods : This study will be conducted at Asha School. This is situated at army cantonment area, Bikaner in which the mentally retarded children are looked after. Children are mainly from the army camp and if the seats are vacant the civilians are also get admission. All the children from this school will be examined and their sociodemographic variables will be recorded in a self designed pro forma. The diagnosis of the children will be assigned according to ICD-10. Parents of all these children will be asked to fill up Child Behavior Check List and the responses will be verified from the school teachers.

: The obtained data will be analyzed and results will be discussed as per literature available on this subject.


Weight changes occurring in hospitalized patients in the first month of treatment of mania in bipolar affective disorder and its relationship to clinical improvement

Sam Calvin, Rebecca K. Raj, Sunita Simon Kurpad

St. Johns Medical College Hospital, Bangalore, India

Objectives : There is higher prevalence of obesity in individuals with bipolar disorder. The largest increment in weight occurs during the acute treatment of episodes which predicts long-term increase in body weight. There is an intrinsic relationship between clinical improvement and weight gain. This however has received little attention. Naturalistic studies looking at this phase of treatment with factors associated with weight gain are required. We looked at weight changes occurring during the first month of an episode of mania in individuals with Bipolar disorder and its correlation with clinical improvement.

Materials and Methods : This was a 4 week Prospective longitudinal cohort study looking at 50 subjects hospitalised for an episode of mania. The subjects were assessed 3 times once at baseline, 10±2 days and 28±5 days. All subjects underwent a diagnostic screening MINI and clinical profile was assessed using Young Mania Rating Scale (YMRS), Montgomery Asberg depression Rating Scale (MADRS), Global Assessment of Function (GAF), clinical global impressions scale for use in bipolar illness. Weight and waist circumference, 24 hr diet recall, treatment received were noted. Separate scales which looked at Eating behavior pattern, appetite, 24 hour recall of activity level were used.

Results : We studied 27 men and 23 women, with a mean age of 32.26 years (18-58), with a mean duration of illness of 7.32 years (10 days - 30 years). Subjects had a mean weight change of 2.55 kg between day 1 and day 28. There was a significant correlation between change in YMRS scores between day 1, day 10 and day 28 and the weight changes between these days. There was also significant relationship between eating behaviour such as eating rapidly and night eating.

Conclusions : There are significant associations between weight gain, clinical improvement, and specific eating behaviours. This is of importance in treatment where weight gain can be used as a marker for improvement and simple targeted interventions may help prevent long term morbidity and mortality associated with weight gain.


Perceived stress and burnout in nurses

(Lt. Col.) K.J. Divinakumar

Command Hospital, Pune, Maharashtra, India

Introduction : Nursing is an extremely stressful profession (Tyler and Ellison, 1994), with nursing stressors being the largest predictors of burnout (Payne, 2001). Stress and burnout contribute to increased likelihood of nurses leaving the profession (Omdahl and O'Donnell, 1999).

Aim : To determine the prevalence of perceived Stress and Burnout among Nurses.

Methodology : 300 nurses in various multispeciality hospitals were mailed a questionnaire containing perceived stress scale and Copenhagen Burnout Inventory. The Perceived Stress scores and Burnout scores were analysed with sociodemographic characteristics of nurses surveyed using statistical software.

Results : the results of the study will be discussed in this paper.


Attribution of locus of control and traumatic life events in depressive patients: An investigation in hospital patients

Kedar Ranjan Banerjee, Tanmoy Mitra

National Institute of Behavioural Sciences, Moulali, Kolkata, India

Background : Negative life events are noted to have a major impact in depressive patients. In fact, it has been noted that more than 75% patients with major depression report negative life events prior to depression (Jenaway and Paykel, 1997). Locus of control is a personality construct that has been observed to be associated with features of depression and anxiety. The relative risk of depression after exposure to negative life events varies from 3 to 10. It can be conceived that depression onset is more strongly related to dependent to independent life events. Life events can also be predecessor of anxiety disorder. Personality traits can be linked to life-event exposure and attribution. The locus of control may play a role in appraisal of life events which in turn affect the cognitive and behavioural approaches of the individuals.

Aim : The present study investigate the link between locus of control, life events and negative affectivity in depressive patients.

Materials and Methods : A Total of 100 (n=100) patients (age group 20-50) were selected from the Salt Lake Government hospital out door with symptoms of major depression. The test batteries used were Beck's depression Inventory (BDI), Montgomery Asberg depression Rating Scale (MADRS), Life events Schedule, Locus of control, and Personality Questionnaire. They were given the tests after one week of first visit at the hospital outdoor. A group of same number of healthy subjects was used as control.

Results : Previous history of depression, gender and type of negative events were found significant (P=0.05) related with negative affectivity. External locus of control was also observed to be significantly (P=0.05) related to the above construct. The controls indicated no significant relations among measures. The appraisal of stressful events remains obligatory for elevated level of negative affectivity.

Discussion : It can be assumed that personality style and attribution as locus of control has a major role in evaluation of traumatic life experiences. This in turn can make a subject vulnerable for the occurrence of depression. Personality trait and constitution can be a link between distressing life events and resultant depression. The feeling of having no control over situations or events cause worries which in turn incite helplessness leading to depression. Although it is established that negative life events can precipitate depression, the association is a complex one and probably operates in both directions. Improper appraisal of negative events thus probably form a vulnerability construct for onset of depression.


Neuropsychological performance in unaffected first degree relatives of patients with bipolar disorder type-I and matched health controls

Pattanayak R.D., Sagar R., Mehta M.

A.I.I.M.S. New Delhi, India

Introduction : The unaffected at-risk relatives of individuals with bipolar disorder have been under-represented in neuropsychological research, particularly from India. Recent evidence suggests that subtle neuropsychological impairments are found in unaffected first degree relatives of bipolar patients, making them a group of potential interest to investigate cognitive biomarkers for bipolar disorder.

Aim : We aimed to study the neuropsychological performance in unaffected first-degree relatives of bipolar disorder type-I and compare them with matched healthy controls.

Methodology : The study universe was Out-patient clinic, Department of psychiatry, All India Institute of Medical Sciences, New Delhi. The study subjects were included if they were between 18-45 years of age, had at least one first degree relative with a DSM-IV diagnosis of Bipolar Disorder type-I and willing to provide informed consent (n=25). Current or lifetime psychiatric illness, substance abuse other than nicotine, history of significant head injury or neurological illness was a criteria for exclusion. The controls were age, gender and education matched and did not meet any current or lifetime diagnosis for psychiatric illness. The socio-demographic and clinical information was collected on a semi-structured proforma. Both the cases and controls were assessed for neuropsychological performance using Trail making test, Stroop Color Word Test and Verbal Working Memory N-Back Test. Statistical analysis will be done using Statistical Package for the Social Sciences (SPSS).

Results : Detailed results from this study will be discussed at the time of presentation.

Conclusion : Neuropsychological performance of unaffected relatives of bipolar patients may help in ascertaining the potential role of cognitive tests as biomarkers of bipolar disorder.


Analysis of prevalence of psychiatric disorders in patients with suicide attempt

Swetha Raghavan, M. Venkatalakshmi, Poorna Chandrika, Shanmugaiah, R. Sathianathen

Institute of Mental Health, Kilpauk, Chennai, India

Background : Studies have shown that around 90% of persons making suicide attempts have at least one mental disorder. Aim : The aim of this study is to study the prevalence of psychiatric disorders in subjects making suicide attempts.

Materials and Methods : 30 consecutive patients with history of suicide attempt(s) attending out patient department at Institute of Mental Health, Chennai will be selected and will be assessed for psychosis and depression using the following rating scales namely: Positive And Negative Symptom Scale (PANSS), Brief psychiatric rating scale (BPRS) and HAM-D.

Results : Data analysis, findings and implications will be discussed at the time of presentation.


Psychoactive substance use in drug naive first admission psyhiatric patients - A radio immuno assay method

M.S.V.K. Raju, Surg. Capt. S. Goyal

Bharathi Vidyapeeth University Medical College, Pune, Maharashtra, India

Background : Self Reports of Psychiatric patients about use of Psychoactive Substances are generally not reliable. Testing Urine for Substances are considered to yield reliable information. No report of objective evidence of substance use in Drug Naïve First Admission Psychiatric Patients is available from India.

Aim : To estimate Morphine, Cannabinol, Amphetamine, Barbiturate and Benzodiazepine Levels in the Urine of first admission psychiatric patients.

Materials and Methods : 80 Drug Naïve (As Per Clinical Records) First Admission Psychiatric Patients Diagnosed as per ICD-DCR Criteria formed the study sample.Urine samples were collected on admission and tested by Radio Immuno Assay using double antibody R.I.A. Kits supplied by Diagnostic Products Corporation, Los Angeles, USA. A Gamma counter supplied by Electronic Corporation of India Ltd, Hyderabad, was utilised for the study.

Results : 51% of patients tested positive for various Drugs. 45% used Benzodiazepines while 7.5%, tested positive for Cannabinols. 1% each were positive for Amphetamine and Morphine. None tested positive for Barbiturates. 43% of Alcohol dependence, 55% cases of Mood Disorder and 80% cases of Psychosis not tested positive for substances. 50% cases of Psychosis NOS and 29% cases of Schizophrenia tested positive for Cannabinol.

Conclusion : There is high incidence of unrecorded substance use in first admission psychiatric patients. The finding has several clinical implications. Screening for substance use in psychiatric patients should be mandatory as self and collateral reports are not found satisfactory.


Executive functions in currently euthymic bipolar patients in a tertiary care hospital - A case control study

Khanra Sourav, Mallick A.K., Ghosal M., Sanyal D, Chakraborty S., Acharya R.P., Kuila S.

Institute of Psychiatry, IPGME, Kolkata, India

Background : Impaired cognitive functions, including executive dysfunction is common in patients with bipolar disorder during the acutely symptomatic periods. However, this may also persist during the euthymic phase, years after the acute episodes, and may adversely affect the quality of life.

Objective : This study compared executive functions of currently euthymic bipolar patients, with age- and gender-matched healthy controls.

Materials and Methods : Thirty consenting and diagnosed patients of bipolar affective disorder, attending the out-patients department between March and August 2010, who were known to be euthymic for last 6 months as per follow-up records, were included in this study. Thirty healthy age- and sex-matched subjects, without any family history of psychiatric disorder, were assessed as controls if they scored < 1 GHQ-5. Executive functions were evaluated using backward digit span, A-vigil test, COWAT, Stroop test (Parts I and II) and Trail making (Part-B).

Results : The two groups showed no significant difference in socio-demographic measures, including mean years of education (P=0.517). The euthymic bipolar patients had significantly higher executive dysfunction compared to the controls. Patients were impaired in all tests, except in Trail making and part-I of Stroop tests. The most significant difference was in A-vigil test (P=0.00).

Conclusion : Executive dysfunction is a trait factor in bipolar illness, like in schizophrenia. More studies should be carried on larger samples to focus on other cognitive domains also.


A study of relationship between cognitive and non-cognitive symptoms in delirium

Aarya K.R., S.K. Mattoo, Sandeep Grover

PGIMER , Chandigarh, India

Background : Although operationalized diagnostic criteria of delirium point to cognitive disturbances to be at the heart, very few studies have specifically focused on the cognitive domains of delirium.

Aim and Objective : The purpose of the current study was to evaluate the relationship between cognitive functioning and non-cognitive symptoms of delirium.

Methodology : Forty patients diagnosed to have delirium (as per the DSM-IVTR criteria), were recruited after proper informed proxy consent from their caregivers. The non-cognitive phenomenology was assessed using the Delirium Rating Scale-Revised version (DRS-R98). Cognitive functioning was assessed using Cognitive Test for Delirium (CTD).

Results : The mean age of the patients was 46.30 (±17.99) years and the mean number of years of education was 9.75 (±3.35). Most of the subjects were male (N=31, 77.5%). The mean duration of delirium was 81.42 (±34.59) hours at the time of assessment and the mean DRS-R-98 score was 22.77 (±3.23). On CTD the impairment for attention was the highest (100%; mean +SD scores 2.55±1.78), followed by vigilance (97.5%), orientation (90%), memory (80%) and the lowest for comprehension (77.5%; mean+sd scores 4.6±1.03). There were significant correlations (P<0.05) between all domains of CTD (except vigilance) and DRS-98 for total score, severity score, and cognitive symptom score (items 9-13). However, only memory domain had significant correlation with non-cognitive symptoms.

Conclusion : There is a high correlation between cognitive dysfunction and delirium severity.


Importance of cytokines in depression

K.K. Mishra, A.A. Pawar, V.S.S.R. Ryalli

INHS Kalyani, Malkapuram, Gandhigram , Visakhapatnam, Andhra Pradesh, India

Depression is a heterogeneous disorder with variable set of symptoms, diverse course, and an inconsistent response to treatment. Cytokines are a group of soluble messenger proteins involved in the regulation and repair of cells and control of immunological events. A group of cytokines viz IL1, IL6 and TNF α augment the immune response, speed of the elimination of pathogens and helps in the resolution of inflammation. Depression is hypothesized to be consequence of increase in pro inflammatory cytokines production leading to immune activation. On that basis, a sub type of depression is named as "cytokines induced depressive disorder". This is characterized by predominant vegetative symptoms than emotional symptoms. On this background 50 consecutive cases of first episode depression of different severity attaining to the psychiatric OPD and admitted to the psychiatric ward of a 50-bedded general hospital psychiatric unit of a tertiary care urban hospital were evaluated clinically and assessed on psychometric tests. The blood samples for cytokines were collected prior to initiating the treatment. Equal numbers of age and sex match controls were included in the study. The cases were evaluated after 4-6 weeks of treatment and after 6 months of treatment with conventional antidepressants. The blood samples were collected at this point and matched with the pretreatment level. The levels of cytokines were raised significantly at the entry point in comparison to healthy control. The value reduced significantly following the treatment. Earlier studies have shown cytokines may be trait markers of depression or can be bystander effects of illness. It is premature at the stage to draw any conclusion with the small sample size. Details of the findings will be discussed during the presentation.


Differential characteristics of injectable drug users in community setting

Sonali Jhanjee, Hem Sethi

All India Institute of Medical Sciences, New Delhi, India

Aims : To describe the differential characteristics of injectable drug users among opioid dependent patients enrolled in a community mobile clinic in a metropolitan city of India.

Materials and Methods : Oral Substitution Therapy with Buprenorphine for opioid dependent drug users is being carried out through a mobile clinic in East Delhi. The information on socio-demographic and drug use characteristics was gathered from self report on Drug Abuse Monitoring System (DAMS) questionnaire and a semistructured proforma on drug use at baseline.

Results : Majority of opioid dependent (mainly heroin) drug users(n=104)were male (97.1%).Among the opioid dependent males attending clinic, around 67.3% had a history of injecting drug use while 49% were still injecting drug (current users) in the last one month. Among current injecting drug users the mean age of initiation of opioid use was 18.7±5.0 and mean duration of opioid use 0.3±8.1.Among non injecting drug users the mean age of initiation of opioid use was 22.1±9.0 and mean duration of opioid use 11.3±9.8. The difference in the age of initiation among injecting drug user (IDU) and non IDU was statistically significant. The mean age of initiation of injectable drug use was 24.4±9.0yrs and mean duration of injectable drug use 3.2±2.3yrs. 78.4% of IDU's reported sharing of syringes and other injection related paraphernalia. The highest rates of injecting drug use were among those males who were between the age of 18-25 yrs, were not employed, were unmarried (OR=3.699, CI=1.247-10.977) and having sex with sex workers (OR=2.990, CI=1.453-7.753).

Conclusions : Given the public health importance of intervention of this high risk group, studying characteristics of injectable drug users will help to define preventive interventions in the community.


Symptom distress, depression and quality of life in advanced cancer patients

Arun K., S.K. Chaturvedi, Geetha D.

SRM Medical College Hospital and Research Center, Kanchipuram District, India

Objectives : To study the Symptoms of distress and its influence on depression, different dimensions of Quality of life and spiritual well being in advanced cancer patients undergoing palliative care.

Materials and Methods : The study was cross sectional in nature where 50 patients with advanced cancer from a hospice were assessed with Visual analogue scale for pain (VAP), M.D. Anderson symptom inventory (MDASI), Hospital Anxiety Depression Scale (HADS), Functional assessment of cancer therapy - Palliative Care (FACT-pal) and Functional assessment of chronic illness therapy-spiritual well-being (FACIT-sp). Symptoms of distress were correlated with different variables of other scales.

Results : The most distressing symptoms for the study sample, as detailed below, were - in order of subjective severity -sadness, distress, dry mouth and fatigue. They were significantly negatively correlated with all dimensions of well being including spirituality. HADS depression score was significantly correlated with Fatigue (r=0.535, P<0.001), Nausea (r=0.283, P=0.049), Sleep disturbances (r=0.442, P=0.001), Distress (r=0.727, P<0.001), Memory (r=0.488, P<0.001), Loss of appetite (r=0.440, P=0.001), Drowsiness (r=0.378, p=0.007), Dry mouth (r=0.420, p=0.002) and Sadness (r=0.694, P<0.001).

Conclusions : Symptoms of distress influence the psychiatric co-morbidity like depression in advanced cancer patients. They also determine the quality of life in these patients. This implies that symptoms of distress need to be systematically assessed and managed in palliative care settings.


Growing up with
b-thalassaemic family using accelerated longitudinal design

Praveen Khairkar, Savita Malhotra, Pratap Sharan

Postgraduate Institute of Medical Education and Research, Chandigarh, India

Background : It is difficult for a single investigator to study the psychosocial changes that occur over the life span of an individual affected with a chronic illness like b-thalassemia major. Therefore, a developmental epidemiological perspective is required to understand the chain of events and problems of psychological nature.

Aim and Objectives : We aimed to construct the picture of developmental epidemiology for psychosocial aspects in families of b-thalassemia major patients attending a tertiary care hospital in north India.

Materials and Methods : The accelerated longitudinal design was used. The sample consisted of 100 children with b-thalassemia and their 150 parents, both groups were subdivided further so that each group represented the continuum of longitudinal course. The sampling was done for a period of 16 months from January 2004 to April 2005.

Results : Overall 54 percent of children had significant psychopathology. Within the parents groups, 10% had adjustment disorder, 33.3% depressive disorder, and 10% had anxiety disorder and 11% somatoform disorder; 95% of the parents of newly diagnosed children expressed feeling of dazed and shock, fear of death, hopelessness, separation anxiety and problems with their memory and concentration. There was significant difference only in the domain of psychological health in all the three groups of parents with respect to the quality of life. Among children, quality of life improved with their progression of illness. Growing up with b-thalassaemic family was analyzed.

Conclusions : The developmental epidemiological perspective was constructed in b-thalassaemic children and their family using and accelerated longitudinal design. Such a design can test the hypothesized etiological or developmental function of a targeted risk factor within a developmental path and may be used in studying the psychological impact of even other chronic illnesses over the life span of an individual for conceptual and holistic understanding.


A prospective study on the association between disability and residual symptoms in depressive patients

Anurag Jhanjee, Pankaj Kumar, M.S. Bhatia, Deepika Verma 1 , Shruti Srivastava

UCMS & Guru Tegh Bahadur Hospital, Delhi, 1 Navodya Medical College, Raichur, India

Objective : In this 5-month naturalistic follow-up we aimed to investigate depression treatment outcome and the correlation between improvement of depressive symptoms and level of disability.

Material and Method : The study included 104 patients with depression that presented to the Psychiatry Outpatients Department of University College of Medical Sciences & associated Guru Tegh Bahadur Hospital, Delhi. The subjects were assessed using the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, and Structured Clinical Interview for DSM-IV Axis I Disorders. The World Health Organization Disability Assessment Schedule (WHO-DAS II) was administered to determine level of disability. Patients received follow-up assessments using the same instruments 3 months after receiving antidepressant treatment.

Results : Follow-up assessments showed that improvement. in Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale total scores was statistically significant and lower anxiety and depression ratings were correlated with lower disability levels. The patients that had severe depression and anxiety at the beginning of the course had residual depressive symptoms. The results showed that severity of depression was a predictor of residual symptoms in our cohort. Psychological anxiety was the most common residual symptom (consistent with other studies) and the patients with a psychological anxiety score e" 2 had higher disability levels (P<0.05).

Conclusion : Severity of depression was a predictor of residual symptoms and partial remission after a depressive episode appeared to be strongly associated with disability. These findings highlight the importance of adequate treatment of depression.


A case - control study of eeg abnormalities in patients with obsessive compulsive disorder

Simmi Kumari, Arunlata Agarwal, Vinod Puri

G.B. Pant Hospital, New Delhi, India

Aims and Objectives : The aim of this study was to compare Electroencephalogram (EEG) findings in drug free patients of (obsessive compulsive disorder) OCD with normal healthy controls.

Materials and Methods : In this case control study, 30 patients diagnosed as OCD according to ICD 10 criteria in psychiatry OPD of a tertiary care referral hospital between October 2007 and April 2009 were compared with thirty normal healthy controls who did not have any neurological or psychiatric disorders and were group matched for age, sex and handedness with the cases. The patients with OCD were drug free (free from all sedatives including antidepressant and antipsychotic medications and antiepileptic drugs for at-least 2 weeks, had not used depot medications/research drugs in the last 4 weeks or ECT in the last 6 months.) Standard EEG was recorded using 16 channels and recordings were also made during photic stimulation and hyperventilation.

Results : EEG abnormalities were found in 36.7% of OCD group compared to 0% of controls (P<0.01). Out of cases with abnormal EEG, 50% had frontal localization of EEG abnormality and 50% had temporal localization, where as 66.7% had right hemispheric localization and 33.3% had left hemispheric localization of EEG abnormality.

Conclusion : The occurrence of EEG abnormality in about one-third of OCD patients suggests the importance of this investigative tool in patients with OCD in clinical practice.


A study on neuro-cognitive function in recovered patients of acute psychosis

Sujit Kumar Kar, J.K. Trivedi, P.K. Dalal, P.K. Sinha, Maya Bajpai

CSMMU, Lucknow, Uttar Pradesh, India

Background : Acute psychosis is one of the common psychotic illnesses described as "acute and transient psychotic disorder" in ICD-10 and "brief psychotic disorder" in DSM-IV-TR. Onset is usually abrupt to acute and the illness subsides between 1 to 3 months. Complete recovery usually occurs. Cognition is expected to return to premorbid level with recovery.

Aim of the study : To study the neuro-cognitive function of patients of acute psychosis after complete recovery.

Materials and Methods : A total of 180 patients initially diagnosed to be suffering from acute psychosis as per the criteria of ICD-10-DCR, 1993 were screened and kept in follow up for 3 months. Cognitive assessment of 20 patients satisfying selection criteria were done on wisionsin card sorting test, continuous performance test and spatial working memory test after full recovery from acute psychosis and compared with healthy controls.

Result : There was significant improvement in performance in Wisconsin Card Sorting Test, Continuous Performance Test, and Spatial Working Memory test following recovery from acute psychosis. Cognitive parameters of the patient group were compared with that of healthy controls and there was no statistical difference between the two groups.

Conclusion : With complete recovery from acute psychosis, there occurs improvement in cognitive functions almost to the premorbid level. Executive functions, working memory, attention and concentration return back to normal level.


Extent of comorbid tobacco dependence in patients of bipolar I disorder

Sannidhya Varma, H. Singh, J.K. Trivedi, V. Agarwal

Chatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India

Background : Bipolar disorders are one of the most common causes of psychiatric morbidity and mortality and cause significant distress to the patient as well as their families. They often coexist with other psychiatric disorders which complicate the course and outcome of the former. Epidemiologic studies have shown that substance use disorders and anxiety disorders are the most commonly comorbid conditions in bipolar disorder. Nicotine is one of the most highly addictive and heavily used drugs around the world. Inspite of this, not many studies have been conducted on the interaction of nicotine dependence and bipolar affective disorder. The current study aimed to assess the extent of comorbid tobacco use disorders in patients of bipolar I disorder.

Materials and Methods : On specified days in adult psychiatry opd, C.S.M.M.U., lucknow, U.P., the first four diagnosed cases of bipolar I disorder were screened. Detailed psychiatric history was obtained on a semi-structured proforma. Mini hindi version 5.0.0. Was administered by the investigator either on the same day or on a mutually convenient day to find the extent of any axis I psychiatric comorbidities in the subjects.

Results : A total of 101 patients were included in the study out of which 30 did not have any axis-I psychiatric comorbidity. 57 (56.43%)patients qualified for tobacco dependence out of which 36 (35.64%) patients had tobacco dependence without any other axis-I psychiatric comorbidity. As compared to the subjects without any comorbidity, those with tobacco dependence were found to have significantly more depressive (P=0.0397) and total number of affective episodes (P=0.0234) and higher lifetime history of suicidal ideation (P=0.0057), suicidal attempts (P=0.0042) and psychotic symptoms (P=0.0253). The 'no comorbidity' group stayed well (3.20±4.31) for a significantly longer time than the 'only tobacco dependence' group (1.36±0.95) (P=0.0152).

Conclusion : Comorbid tobacco use disorder in patients of bipolar-I disorder was found to have a significant impact on the course of the latter. It is therefore that tobacco use disorders should be assessed and managed appropriately in this patient group.


Delirium under diagnosis in geriatric medically ill

Deepak S. Tiwari, Bharat N. Panchal, Jaladhi R. Trivedi,

Saurabh N. Shah, Ela Vatsala Sharma

Sir Takhatsinhji Hospital, Bhavnagar, Gujarat, India

Introduction : Delirium is commonly under diagnosed and neglected in medically ill geriatric patients.

Aims : To study the under diagnosis of delirium in the geriatric patients in the medical ward by physician.

Materials and Methods : 102 patients above 60 years admitted in Medical wards, Sir T Hospital, Bhavnagar were recruited in study. DSM-IV-TR criteria were used to diagnose delirium. Delirium Rating Scale Revised 98 (DRS-R-98) and Confusion Assessment Method (CAM) were applied.

Results : 14.7% prevalence was found during the study. More than half were not diagnosed to having delirium by physician. CAM had the higher sensitivity than DRS-R-98 in diagnosing delirium. Sleep-wake cycle, orientation, attention, memory are most frequently affected areas.

Conclusion : Raising awareness in the physician about the condition is necessary.


Risk factors for suicidal ideation in bipolar depression

Umamaheswari V., Ajit Avasthi, Sandeep Grover

PGIMER, Chandigarh, India

Background : Patients with Bipolar disorder are at a greater risk of attempted and completed suicide than with unipolar major depression. Hence, it is important to have a better understanding about risk factors for suicidal ideation in patients with bipolar depression (BD).

Aim of the study : To identify the risk factors for suicidal ideation in subjects with bipolar depression.

Methodology : The study sample included 52 subjects with BD (as per MINI) and aged between 18 to 60 years. On the basis of the score obtained on Beck Depression Inventory (score of 1 or more than 1 on suicidal thoughts and wishes) the study sample was divided into those with and without suicidal ideation. All the subjects in both the groups were assessed on Beck hopelessness scale (BHS), Beck depression inventory (BDI), Patient health questionnaire (PHQ-15) for presence and severity of somatic symptoms, Barrat's impulsivity scale version-11 (BIS-11), irritability, anxiety and depression (IDA) scale for irritability, anxiety and depression, Young Mania Rating Scale (YMRS) (for subsyndromal manic symptoms), Buss-Durke Hostile Inventory (BHI) and Brief psychiatric rating scale (BPRS).

Results : The study sample included 52 patients with BD, of which 31 had suicidal ideation. Among the sociodemographic and clinical variables, those with suicidal ideation had significantly shorter duration of illness, longer duration of current episode and more frequently had a family history of bipolar disorder. Those with suicidal ideation had significantly higher BDI total score, residual manic symptoms as measured by YMRS, past history of suicidal attempts, were more suspicious as measured on BHI, had significantly higher level of anxiety and inward directed irritability as measured by IDA. There was no difference between those with an without suicidal ideations on PHQ total score, number of functional somatic symptoms, BHS total score, BIS-11 total score, all subscales of BHI except suspiciousness and BPRS total scores.

Conclusion : Longer duration of current episode, family history of bipolar disorder, higher severity of current depressive episode, residual manic symptoms, past history of suicidal attempts, suspiciousness, presence of anxiety and inward directed irritability are risk factors for development of suicidal ideation in patients with BD.


Diagnostic stability of internet addiction in obsessive compulsive disorder: Data from a naturalistic one-year follow-up study

Rajashekhar B., Y.S.S.R. Rao, Ashok Reddy K., Srinath G.

Consultant Psychiatrists, Hyderabad, Andhra Pradesh, India

Introduction : A sub-set of people who use internet develop Internet Addiction (IA), which is relatively a new concept in psychiatry. Conceptually, the diagnosis is a compulsive spectrum disorder. However there is considerable controversy whether IA is a disorder in itself qualifying for inclusion as a separate diagnostic entity in DSM-V, or whether it is a just a manifestation of an underlying psychopathology.

Aims and Objectives : The present study systematically investigated the stability of diagnosis of IA in Obsessive Compulsive Disorder (OCD) patients who were followed-up prospectively for 1 year.

Methodology : IA was assessed with Young's Diagnostic Questionnaire and Internet Addiction Test (Young, KS, '98) at baseline in OCD patients. Those who fulfilled the criteria for IA were then followed-up over a period of 1 year. Yale Brown Obsessive Compulsive Scale (YBOCS) was administered at various points of time to assess the severity of OCD. Different analytic methods assessed the stability of IA symptoms in this study population.

Results : Most of these patients did not maintain the criteria for IA at follow-up. Although all these patients had received treatment for OCD during the follow-up period, and had shown improvement on YBOCS score, the symptoms of IA improved with treatment for OCD, and no specific treatment was per se given for IA.

Conclusions : The frequent co-occurrence of psychiatric disorders with problematic Internet use raises questions regarding the distinctness of IA as a diagnosable psychiatric disorder. At the most, IA appears to be a manifestation of an underlying psychological disturbance, and treatment of this disturbance appears to improve the symptoms of IA. Till further robust data becomes available IA should not be ratified as a separate diagnosis in DSM-V.


Battery for ect related cognitive deficits (B4ECT-RECODE): Development and validation

Shashidhara N. Harihara, Abhinav Nahar, Biju Vishwanath,

Vivek Phutane, Jagadisha T, B.N. Gangadhar

National Institute of Mental Health and Neurosciences, Bangalore, India

Objective : It is recommended that the cognitive impact of electro convulsive therapy (ECT) be assessed regularly. This study was aimed at development and validation of a short and sensitive scale to assess cognitive deficits associated with ECT in the Indian setting.

Materials and Methods : Battery for ECT Related Cognitive Deficits (B4ECT-RECODE) is a brief cognitive test battery which tests the following functions: verbal learning and memory, subjective and autobiographic memory, non-verbal memory, sustained attention, working memory, and psychomotor speed. It has both subjective and objective components. The battery was administered to 12 in-patients who received bilateral ECT. Assessments were done one day after the 1st, 3rd and 6th ECTs. Each assessment took 20-25 minutes duration. Repeated measures analysis of variance (RMANOVA) was used to analyse the course of cognitive functions.

Results : The study group was aged 32.8±9.9 years. Statistically significant deficits were found in subjective memory (F=65.01; P<0.001), autobiographic memory (F=6.29; P=0.007), verbal (F= 5.7; P=0.01) and working memory (F=3.51; P=0.05), and psychomotor speed (F=18.26; P<0.001).

Conclusions : B4ECT-ReCoDe is a simple, sensitive and valid measure of cognitive impairments associated with ECT. The ease of administration of this test battery should allow us to use it in routine clinical practice.


Impact of amalgamating psychiatric services with polyclinic in service hospital: Experience in a zonal hospital

Lt. Col. R.K. Saini, Lt. Col. Sunil Aggarwal, Lt. Col. J. Debnath, Col. Vinay Lal, Brig M.P.S. Sawhney

Military Hospital, Pathankot, Punjab, India

Background : In recent years there has been great advancement in the overall quality of health care that is being provided to our clientele in service hospitals. Most of the service hospitals now have a functioning polyclinic adjacent to the MI room complex. Psychiatric services, however, are still confined within the premises of psychiatric wards which are often located at a distance from the main OPD (polyclinic) complex. Besides, psychiatry services also carry a social stigma due to which many patients with psychiatric problems are reluctant and fail to utilize the much needed psychiatric services.

Materials and Methods : It was a prospective study in a 697 bedded busy zonal hospital having all the major specialties, the study period extending from 01 Jan 2009 to 31 Dec 2009. From 01 Jan 2009 to 30 Jun 2009, existing system of psychiatry out patient department (OPD) services continued in the psychiatry ward. From 01 Jul 2009, psychiatric OPD was renamed as "Department of behavioral sciences and deaddiction" and relocated near the MI room complex along with other specialist OPDs. The patient related data was tabulated for the whole of year 2009 and comparison drawn between the two halves of the same year.

Results : There was substantial rise in the total number of new OPD patients between the two halves of the same year from 222 to 779 (P<0.05). Amongst various age groups, patients of 41-50 year {24(10.81%) vs 174 (22.34%), P<0.05} and those above 70 years {7 (3.15%) vs 39 (5%), P<0.05} have shown significant rise in numbers in second half of the year. Amongst various diagnostic categories, cases of substance abuse {8 (3.60%) vs 48 (6.16%), P<0.05}, childhood and adolescent psychiatric cases {22 (9.9%) vs 106(13.6%), P<0.05} have shown significant increase in number. Overall utilization pattern of psychiatry services has shown dramatic improvement in the second half of the study period.

Conclusion : Amalgamation of psychiatric OPD services in a new avatar with other specialist services in military hospitals results in allaying social stigma and better utilization of psychiatry services. This concept of user friendly and easily approachable psychiatry OPD services can become a role model for replication in other service hospitals.


Military psychiatry - Psycosocial correlates and clinical risk facors in survivors following their first attempt of deliberate self harm in armed forces personal and their families

Bhagwat Narayan Rajput, Col. Rajesh Goger, Lt. Col. D. Bhattacharyya, Lt. Col. M. Divakar,. Lt. Col. N.C. Shekhar

Base Hospital, Delhi Cant, New Delhi, India

Backgroud : A million people worldwide die from suicide each year. Leading to a large toll both in terms of human resources as well as economy. Also leading to an increase in research on the probable causes for this behavior, many reviews indicates that 30 to 47 percent of suicide completers had a prior history of deliberate self harm. Deliberate Self Harm (DSH) is encountered frequently in psychiatric hospitals and also in out patient settings. Unlike other countries deliberate self harm in India is an unrecognized, hidden and a silent epidemic.

Aims and objective : (1) To determine the psychosocial correlates of act of deliberate self harm; (2) Identification of modifiable factors and use of this data to suggest (a) preventive and social intervention methods to prevent further acts of DSH (b) for the improvement of mental health of armed forces personnel and their families to contribute to the morale and efficiency of the organization.

Materials and Methods : The study will be conducted at the department of psychiatry, base hospital, Delhi cantt, after obtaining clearance from the hospital ethical committee.

Source of data : (1) Psychiatry OPD (2) Inpatient. A sample size of 80 which consist of consecutive patients who have attempted deliberate self harm for the first time. (a) Clinical data sheet (socio-demographic profile and clinical risk factors) (b) Scales - M.I.N.I. and presumptive stressful life event scale.

Inclusion criteria : (1) Participation will be based on informed consent. (2) Age during interview >15 years (3) Patients having attempted deliberate self harm for the first time only. (4) Able to read english or understand spoken hindi.

Exclusion criteria : (1) Persons having prior history of deliberate self harm (2) Mental retardation.

Result and conclusion : to be submited before or at the time of ANCIP - 2011.


Psychiatric co-morbidity in geriatric in patients

K. Lokesh Kumar, Samrat Kar, C.M. Pavan Kumar Reddy,

R. Sateesh Babu

Mamata General Hospital, Khammam, Andhra Pradesh, India

Background : Psychiatric illness like Depression and Anxiety disorders are an important area of concern in the elderly population.

Aim : To study the prevalence of psychiatric disorders in geriatric inpatients.

Materials and Methods : In an ongoing study for a period of one month, the geriatric inpatients in our hospital will be examined for the presence of psychiatric disorders. The diagnosis will be made according to ICD-10 diagnostic criteria.

Results : The results will be discussed in the conference.


Various clinical presentations of dissociative (conversion) disorder in south eastern Rajasthan

Indira Morya, Supriya Agarwal, D.K. Sharma, C.S. Sushil,

D.K. Vijayvergia

Government Medical College, Kota, Rajasthan, India

Aims & Objectives : (1) To study the multitude of clinical presentations and their correlation with various sociodemographic factors in patients of Dissociative (Conversion) Disorder.

Methodology : 50 consecutive patients of Dissociative (conversion) disorder, attending/admitted in the Psychiatric OPD/ Ward, were taken up for the study. The diagnosis of Dissociative (conversion) disorder was confirmed by 2 consultant Psychiatrists as per ICD-10 criteria and then the patients were evaluated using: (1) A Specially Designed Semi-Structured proforma for collecting the socio-demographic variables & details regarding clinical features.

Results & Conclusions : In the study group there was predominance of patients who were females (88%), married (70%), housewives (66%), illiterate (40%), belonging to Hindu religion (54%), of lower socio-economic status (58%), coming from joint family (50%), of rural domicile (66%) and age group of 18-30 years. There was found to be almost equal distribution of monosymptomatic (48%) & polysymptomatic (52%) presentation in these patients. The most common clinical presentation was trance and possession disorder (34%) followed by dissociative convulsions (30%), dissociative motor disorder (16%), dissociative stupor (16%), dissociative fugue (2%) and dissociative sensory anaesthesia (2%). Results will be discussed in detail at the time of presentation.


Buying pathology: A study of certain psychosocial variables

Gargi Dasgupta 1 , Nilanjana Sanyal 2 , Saugato Basu 3

1 Calcutta Medical College and Hospital, 2,3 University of Calcutta, Kolkata, India

The present day globalized economy calls for steep competition and consumeristic orientation which gets manifested by compulsive consumption in different folds. The present study delves into this arena by examining the roles of Materialistic Attitudes and Materialistic Values on Compulsive Buying and its association with depression and anxiety of the buyers. Materialistic Attitude Scale (Mochis and Churchill, 1978), Materialistic Value Scale (Richins and Dawson, 1992), Compulsive Buying Scale ( Valence, d'Astous and Fortier,1998), Beck Depression Inventory (Beck et al.., 1961) and State-Trait Anxiety (The Trait-Anxiety Scale; Speilberger, 1970) were administered to working population (N=152) of which 84 were males and 68 were females, who were matched on the basis of age, sex and educational qualifications. Significant positive correlation were found among materialistic attitude, compulsive buying, depression, trait anxiety; between depression, materialistic value, trait anxiety and between materialistic attitude and materialistic values. No significant differences were noted in gender in this study. However, significant differences were noted in case of Materialistic value between the three age groups taken in the study. The findings have also been explained from the qualitative angle. The present research is of much significance in understanding compulsive buying resulting in pathology and thereby would shed light to consumer psychology from mental health perspective.


Clinical supervision of psychiatrists: A governance perspective

Palaniappan Sundaram

Suffolk Mental Health NHS Trust, Suffolk, UK

Policy Background : Governance is about processes which are, ultimately, concerned with creating the conditions for ordered rule and collective action. Clinical governance (CG) incorporates clinical supervision (CS) and is one of the public manage-ment practices by which governance theory is put into action.

Aim : The aim of the study is to understand the role of clinical supervision of psychiatrists in implementing clinical governance.

Objectives : (i) To survey the current practice in the area of CS of psychiatrists in the eastern region of the UK (ii) To explore the supervisors' and supervisees' perceptions of the role of CS in implementing CG.

Methodology : A mixed methods research was conducted to develop a picture of the current practice of CS using an online survey and to study the supervisors'/supervisees' perceptions through focus group (FG) discussions conducted using a topics guide developed from the results of the above survey. Descriptive statistics was used to analyse the results of the survey and qualitative methods (thematic analysis) were employed to identify key themes from data gathered through FG.

Results : Out of a total of 120 psychiatrists, 63 responded (50.25% response rate) to online survey. The results suggested a need for regular CS felt by more than two-thirds but inadequate coverage of some of the topics considered to be a priority by respondents. Qualitative analysis revealed a number of key themes, including the positive role of CS in implementing CG and the limitations imposed upon it by existing constraints in the work environment and challenges within the system.

Conclusion : The study helps to gain some fresh insights into the role of CS in implementing CG at a more conceptual level than other perspectives (such as educational or clinical) might have yielded.


Somatoform disorders, stress (perceived stress, life events & symptom severity in somatoform disorders)

Supriya Kumar Mondal, Kamala Deka, Soumitra Ghosh

Assam Medical College, Dibrugarh, Assam, India

Introduction : The role of stress in the causation of somatoform disorder has been studied in earlier and some recent literatures but studies are scanty about the predictors of symptom severity but literatures in country are very few about the topic.

Objective : The purpose of the study was to asses' stressful life events and perceived stress with symptom severity to predict correlation between stress and somatic symptom severity.

Materials and Methods : The study was conducted in Department of Psychiatry, Assam Medical College & Hospital, Dibrugarh, Assam, within a period of 8 months with a case control model and systemic random sampling for drawing the study sample from outpatient and indoor patient's pool and demographically matched control populations collected from the same sociocultural background. DSM IVTR was used as the diagnostic tool. Life events, perceived stress and physical symptoms were assessed through presumptive stressful life event scale, Perceived Stress Scale-14 and Patient Health Questionnaire-15 for both the groups. The obtained results are compared.

Result : Somatoform disorder patients scored significantly high physical symptom, life events and perceived stress in comparison to control groups. Physical symptoms have linear correlation with perceived stress. In case group perceived stress remains almost same in relation to ascending order of life event score.

Conclusion : Somatoform disorder group experienced more life events and perceived stress than healthy population. Their somatic symptoms are positively correlated with stress perception. Patient groups tend to experience similar stress in more and less severe life stress. Somatization and undifferentiated somatoform disorder groups tend to experience more stress than conversion disorder group. Higher stress perception might be a reason for the chronic course of the disorder. It raises the possibility of symptom control in somatoform disorders by decreasing the stress perception through appropriate psychotherapy.


Study the socio-demographic variable, stressful factors and effect of depression on academic performance of the child - A case control study - II

Satya Prakash, Ashok Singhal

SP Medical College, Bikaner, Rajasthan, India

Aims : (i) To identify the various factors having relationship with the development of childhood depression. (ii) Does depression affect the academic performance of child. (iii) To know other psychiatric co-morbidity in childhood depression.

Materials and Methods : The children who received the final diagnosis of depression according to ICD-10 on a school based prevalence study will be further subjected to detail evaluation. The information relating to socio-demographic variables, Stressful factors and academic performance etc will be recorded in a self designed Performa. The equal number of healthy children will be taken as a control group from the same school.

Result : The data's obtained will be analyzed statistically and will be presented at the time of conference.


Patient's explanation models for their illness and help-seeking behavior

Pankaj Kumar, Anurag Jhanjee, M.S. Bhatia, Deepika Verma 1

University College of Medical Sciences & Associated Guru Tegh Bahadur Hospital, Delhi, 1 MBBS, Navodya Medical College, Raichur, Karnataka, India

Objective : The aim of this study was to investigate some variables that affect patient's explanation models for their illness and help-seeking behavior.

Materials and Methods : The study included 54 patients who presented to the Psychiatry Outpatients Department of University College of Medical Sciences & associated Guru Tegh Bahadur Hospital, Delhi between April to September 2010 with Diagnoses of schizophrenia and schizoaffective disorder according to DSM-IV criteria. A semi-structured interview based on a short questionnaire was conducted for collecting patient demographic data, and patient explanatory model for illness and help-seeking behavior.

Results : The 54 patients that were evaluated included 30 males and 24 females. The mean age of the patients was 31.22±9.29 years (range: 16-57 years). In explaining their disease, 46.6% of the patients cited family trouble, 42% their inner problems, 19.3% economic difficulties, and 10.2% cited the consequences of supernatural forces. Among the patients, help-seeking behavior included visiting traditional and religious healers (51.1%), presenting to medical doctors (19.3%), and visiting a psychiatrist (65.9%).

Conclusion : The study revealed that patients with low-level education were more prone to seek religious solutions and those with high-level education tended to visit a psychiatrist. It has been suggested that psycho-educational programs for patients and families will be very useful in ameliorating the problems created by the disease.


Prevalence, patterns and correlates of tobacco use in psychiatric in- patients and the family members

Nithyaraja R., Depa Braganza

Meenakshi Medical College, Entahur, Kanchipuram, Tamilnadu, India

Objectives : (1) To estimate the prevalence of tobacco use in Psychiatric in-patients and their family members. (2) To find out the patterns of tobacco use (form of use) in psychiatric in-patients and their family members. (3) To correlate tobacco use and socio-demographic variables. (4) To correlate tobacco use and clinical variables (5) To compare the dose of chlorpromazine equivalents between smokers and non-smokers among the psychotic in-patients who are currently on antipsychotic medication.

Materials and Methods : A prospective, cross-sectional research design was used to estimate the prevalence, patterns and correlates of tobacco use in psychiatric in-patients and their family members.

Setting : This study was carried out in the Department of Psychiatry, Christian Medical College and Vellore.

Participant recruitment : Patients of consecutive admissions in psychiatry ward over a three month period were recruited for the study. Both patients from 4-6 week inpatient facility and 48 hrs acute care facility giving meaningful informed consent were included. Patient's family members who were the primary care givers staying with patient in the ward and any person living in the same house with the patient were recruited for the study.

Selection criteria:

Inclusion criteria :

1. Age between 18 and 65 years.

2. Any psychiatric in patients and family members or care givers.

3. Any psychiatric diagnosis - both Axis-I and Axis-II disorders.

Exclusion criteria :

1. Age less than 18 and more than 65.

Those patients who were unable to participate meaningfully in the research due to the severity of illness or those who refuse to take part in the study.

Sample size calculation : A minimum sample size of 92 was calculated using the formula=4pq/d 2 (4×36×64/10 2 ) based on the following variables: expected prevalence of tobacco use (p) in psychiatric in- patients is 36% with precision 10% ( d) and 90% confidence interval and q=(100-p).

Data collection : Patients and family members were separately interviewed for the Tobacco use variables, Sociodemographic profiles and Clinical data. The frequency, patterns of tobacco use and tobacco use in the current one year and other details regarding the tobacco were recorded using the proforma designed for purpose of this study. Details regarding the family member's socio-demographic status and the tobacco use were recorded based on the family form designed for the purpose of this study. Through detailed chart review and individual interview by the principal investigator the psychiatric diagnosis, onset of illness in relation to tobacco use, current antipsychotic dosage and its chlorpromazine equivalent dose in psychotic patients, severity of illness and comorbid substance use were recorded. International Classification of Diseases (ICD-10) criteria was applied forevaluating the harmful use or dependence pattern of tobacco use in both patients as well as family members. The severity of illness was quantified based on appropriate validated rating scales.

Data analysis : Descriptive statistics was done for all demographic and clinical variables. The prevalence rates of tobacco use in psychiatric in-patients and their family members were calculated. Patients were grouped into categories like tobacco users and non-users; categories based on form of tobacco use like smokers and smokeless form of tobacco users; current users of tobacco and non-current users of tobacco; based on severity of tobacco use patients were categorized into occasional users, abuse and dependence patterns; based on nature and course of tobacco use patients are categorized into regular, intermittent and ex-users; clinical categories included various diagnosis and chlorpromazine equivalent groups. Logistic regression, Pearson Chi-Square test and Fisher's Exact Test were implemented to correlate tobacco use and the socio-demographic and clinical variables. P value and odds ratio were calculated to find the significance of correlation. The analysis was done using SPSS 16 and ZAS programmes.

Results : The prevalence of tobacco use in 100 psychiatric in-patients was 39%. The tobacco users were only males (n=39,100%) and none of the females used tobacco. The prevalence of tobacco use in the 267 family members was 6.7%. Of family members the rate of tobacco use in men was 77.8 % (n=14) and women was 22.2 % (4). In patients smoking bidi or cigarette (79.5%) was the predominant form of tobacco use followed by smokeless form of tobacco use (20.5%) which included tobacco chewing and sniffing tobacco. 64.1% of tobacco users began using tobacco in adolescence. Most of the tobacco users were regular and current users. Of smokers most of them were smoking moderate (38.7%) to heavy amount of tobacco (35.4%). Of those using smokeless tobacco, half used less than 3 packets a week, and half used one or more packets a day. 76% of tobacco users were nicotine dependent followed by harmful use and occasional use of tobacco. In family members smoking bidi or cigarette (50%) and sniffing tobacco (27.8%) were the predominant form of tobacco use followed by tobacco chewing. Of smokers most of them were moderate (77.8%) to heavy smokers (11.1%) and most of them used 2-3 packets per week of smokeless form of tobacco. Most of the tobacco users were dependent to tobacco (55.6%). The prevalence of tobacco use was highest in those with alcohol dependence with a frequency of 100%, 36.8% in schizophrenia, 16.2% in mood disorders, and 28.5% in the neurotic group. Most of the tobacco users were from (74.4%) low monthly income (less than Rs. 3000), (89.7%) urban and (56.4%) low socio-economic status background. In this study tobacco use among patients had significant correlation with male gender, urban living, occupation, and education. This study showed no correlation between tobacco use and the severity of psychopathology.However, larger samples with greater spread of scores within each major diagnostic group may be required to elicit differences, if any. The mean doses of chlorpromazine equivalents when compared between the smokers and non-smokers,tobacco users and non-users the differences were not significant. It was concluded that it could be an insufficient sample size to demonstrate a true difference. The study proves that the prevalence of tobacco use is higher in psychiatric patients than the general population. The tobacco use is associated with significant morbidity and mortality and leads to significant burden to personal health and economy. The studies also have shown that the prevalence of tobacco use is high in chronic illness like schizophrenia. Most of the psychiatric patients are from low-socio economic status and hence this proves how tobacco use will further extend the morbidity and burden to these patients. The routine assessment for tobacco use is not practiced in the routine psychiatric hospital care. Furthermore, the nicotine abuse or dependenceare mostly ignored and not treated. This study gives an insight in to how the practice of routinely addressing the tobacco use among the psychiatric patients is important. Knowing the long-term burden of tobacco use it is also important to address this issue among the family members also. This approach can be a prelude to the tobacco prevention and intervention programs.


Behavioural intervention for weight loss in schizophrenia: An RCT with active controls

Rohan Ganguli, Jaspreet S. Brar

University of Toronto, Center for Addiction and Mental Health, Ontario Canada

Objective : Metabolic syndrome, diabetes, heart disease, and obesity are all prevalent in schizophrenia patients (Sz) at rates 2-5 times that in the general public. Weight reduction, by lifestyle change is the foundation of all risk prevention in heart disease and diabetes, since the other risk factors for both diseases are strongly correlated with obesity. We report on a randomized controlled clinical trial (RCT) of behavior therapy for weight loss in Sz.

Materials and Methods : Community dwelling, obese and overweight Sz patients (N=260) were randomly assigned to either a 14 week behavior therapy for weight loss (BT), to usual care (TAU) or to 14 weeks of behavioural treatment for enhancing social skills (SST). Randomization was stratified by type of antipsychotic medication and initial BMI. This was designed to be a pragmatic trial, hence patients with medical, psychiatric, or substance misuse co-morbidities were not excluded. Both interventions (BT & SST) were manualized into a 20 session format, to be delivered over 14 weeks, by mental health clinicians, who were familiar with running groups for this population.

Results : There was mean weight loss in subjects assigned to BT (-11.8 lb), while the SST patients lost no weight, and those in the TAU group gained weight (+2.3 lb), at 14 weeks. The differences were highly statistically significant (F 2, 256=36.5; P<0.0001) in both intent-to-treat and "on treatment" analyses. The effect size of the difference between BT and SST was 0.93-1.1 and 1.0-1.3 versus TAU. Fifty percent of patients lost at least 3% of baseline weight and 40% lost at least 4% of baseline weight in the BT group.

Conclusions : Obese and overweight Sz patients want to lose weight, and are able to do so when offered group behavioural treatment. The finding shows that this is not a non-specific effect of increased attention and clinician contact. The large effect size also suggests that the treatment effect is robust. These results which were obtained by mental health clinicians, using a manual to conduct group therapy, suggests that it should be possible to implement the treatment in the usual settings of care. We are following subjects who lost weight to see whether treatment benefits can be maintained by subjects, over a two year period.


(I.T.) In psychiatry - Recent developments

M. Murugan, M. Vennimalai

Aarches Clinic, Chennai, Tamilnadu, India

It is now commonly accepted that I.T is part of any professional venture, be it banking, defence or medicine. However Doctors in general and Psychiatrists in particular are only now waking up to the possibilities that I.T brings to their sphere of activity.

This paper covers the WHY, the WHAT and the HOW -

Why I.T in Psychiatry,

What are the various I.T options available to Psychiatrists and

How to implement/use I.T effectively.

We will also look at the effective switch over to and implementation of EMR's (Electronic Medical Records), in our clinics and hospitals today.


Mood disorders a clinical study on association of anxiety and depressive disorders in postpartum period

Kamal Narayan Kalita, Hemendra Ram Phookun 1 ,

Gokul Chandra Das

LGB Regional Institute of Mental Health; 1 Guwahati Medical College, Assam, India

Background : Postpartum period is associated with higher rates for mental problems. Anxiety and depression share many symptomatologies. There is relative lack of data in this area.

Aim and Objective : We tried to estimate postpartum anxiety and depression in a group of women and tried to find out their association.

Materials and Methods : 100 postpartum and non-postpartum women selected randomly were assessed for depression and anxiety using Edinburgh Postnatal Depression Scale (EPDS), Hospital Anxiety and Depression Scale, MINI.

Results : 18 and 15% depression and anxiety were found respectively in postpartum group in contrast to 3 and 8% in the control. Postpartum period is significantly associated with these disorders. Higher maternal age, parity, any post operative history correlated with it significantly. EPDS is an easy screening tool for finding both conditions. It was found that anxiety and depression are not associated significantly and are distinct categories. However 1% of variance of symptomatologies of depression can be explained by anxiety and 20% of variance of symptomatologies of anxiety can be addressed by that of depression.

Conclusion : Depression and anxiety are separate clinical conditions having significant prevalence in postpartum period. As anxiety, depression, psychosis all are increased in postpartum period a term 'Postpartum mood disorder' may be proposed. Using easy screening tools by the paramedical workers will help early detection of the cases and it will have long term effect on cognitive development of the infants.


Community based rehabilitation - Our experience

C. Ramasubramanian, M. Kannan, R. Selvi, K.S.P. Janardhan Babu, S. Koodalingam, R.Rajkumari

M.S. Chellamuthu Trust & Research Foundation, Madurai, Tamilnadu, India

Introduction : There is an enormous gap in the provision of treatments for persons with mental illness living in rural communities of India. Community Based Rehabilitation (CBR) is a potential option of service delivery for severe mental illnesses. This may be appropriate in resource poor settings. CBR Should be an integral part of any rehabilitation initiatives. Community care results in better treatment outcomes and quality of life for individuals with chronic mental illness.

Objectives : This paper is focused on discussing the various approaches, difficulties encounteredand success of this initiative being renewed after 9 years of the original term.

Materials and Methods : Community Mental Health Project, a Programme of M.S. Chellamuthu Trust and Research Foundation, Madurai, supported by Andheri Hilfe, Bonn, Germany caters to the needs of people in the rural community through CBR programme since 2000. Treatment camps, home based care, awareness, day care centres, self help groups were key strategies of this community initiative.

Results : It has been found out that due to this approach there exists better network among families, more awareness about illness, less discrimination among the public, better quality of life for the families and getting credit support from Government to start livelihood activities.

Conclusion : The success of this programme greatly relied on the active involvement and participation of the rural folk leading to the formation of Self help groups and Family support groups which in turn has greater role to play in the process of CBR.


Association study of dopamine D4 receptor (DRD4) polymorphisms and minor physical anomalies with attention deficit hyperactivity in south Indian population

C. Guru Prasad, Satish C. Girimaji, Sanjeev Jain, Shoba Srinath, Shekar P. Seshadri

Aim : To study association of DRD4-EXON-3-7 repeat allele and minor physical (MPA) anomalies with Attention Deficit Hyperactive Disorder in South Indian Population.

Methodology : Attention Deficit Hyperactive Disorder (ADHD) cases (DSM IV-TR) and matched case-healthy controls [cases=60; controls=60; in both groups - 49 males, 11 females, mean age (SD)=7.17 years (2.80)] were recruited with appropriate informed consent from Child and Adolescent psychiatry services at NIMHANS in South India. Severity of ADHD was assessed by ADHD RS IV. Both groups were assessed for MPAs by Modified Waldrop Scale and the perinatal complications by Lewis Murray Obstetrics Complication Scale (LMOCS) and genotyped using 2.5% agarose gel-electrophoresis.

Results : (1) Distribution of DRD4-7R alleles was equal between cases (6.7%) and controls (6.7%). (2) Modified Waldrop score [mean (SD)=3.67 (1.90)] and LMOCS score [mean (SD)=0.45 (1.26)] was significantly higher in ADHD cases than healthy controls (P value=0.0001). (3) There was no association between DRD4 7R and ADHD. Those cases with this allele had (mean rank=38.75) a non-significantly higher mean rank of ADHD RS-IV score and Waldrop score (mean rank 42.62).

Discussions : (1) There was no association between DRD4-7R and ADHD. There appears to be a trend of greater severity of ADHD in the presence of factors DRD4-7R allele. (2) The MPAs are associated with ADHD indicating that some early embryonic either genetic or non-genetic had played a role in the genesis of ADHD. (3) The obstetric complications are significantly more in cases therefore it could be an environmental factor contributing to the illness. (4) DRD4-7R could be having influence on MPAs in ADHD.


Neuropsychological performance in patients with alcohol dependence

Sanjay Kumar Pattanayak, Vaswani M., Dhawan A., Jena R.

A.I.I.M.S, New Delhi, India

Introduction : Alcohol use is known to impact the neurocognitive functions. However, there is no consistent evidence regarding association of various alcohol use parameters and cognitivedysfunction The studies are especially limited to Indian setting.

Aim : To study neuropsychological functions in alcohol dependent subjects and see the association with various alcohol use parameters.

Matrerials and Methods : A total of 30 subjects fulfilling DSM-IV criteria for alcohol dependence were included after the detoxification phase was over. The concomitant use of other substances except nicotine, history of neurological illness, significant head injury, mental retardation or significant general medical condition was a criteria for exclusion. The sociodemographic and clinical details were taken on a semi-structured proforma. All subjects were assessed using WAIS-R Indian adaptation and PGI memory scale after informed consent.

Results : The detailed findings and significant associations will be discussed during presentation.

Conclusion : The cognitive deficits may explain the often seen gap between clinical and functional recovery. The alcohol dependent patients should be assessed for neuropsychological performance.


H 2 - receptor antagonists for olanzapine-induced weight gain: A systematic review and meta-analysis

Samir Kumar Praharaj, P.S.V.N. Sharma

Kasturba Medical College, Manipal, Karnataka, India

Aims and Objectives : To conduct a systematic review and meta-analysis of randomized controlled trials of H 2 - receptor antagonists for the treatment of olanzapine-induced weight gain.

Methodology : Studies will be identified using online searches of PUBMED/MEDLINE and Cochrane database (CENTRAL), supplemented with manual search of cross-references. The search will be restricted to publications in the English language. Systematic review and if possible, metaanalysis will be performed to see the effect size of the treatment on body weight, waist circumference and body-mass index (BMI).


Prevalence of psychiatric morbidity among patients with systemic lupus erythematosus

Rajiv Radhakrishan, Galgalirb, Shobhav

St. Johns Medical College, Bangalore, India

Aim & Objectives : The prevalence of psychiatric morbidity among patients with Systemic Lupus Erythematosus (SLE) has been variously reported to be 17 - 75%. There have been very few studies in India that have systematically assessed prevalence of psychiatric disorders in this population of patients. The objective of this study was to study the prevalence of psychiatric morbidity among patients with SLE, aged 18-60 years in hospital sample.

Methodology : The study was cross-sectional, hospital-based, descriptive study conducted in liaison with the Department of Medicine. The study included both in-patients and out-patients. The psychiatric evaluation was based on a structured interview using the Structured Clinical Interview for Diagnostic and Statistical Manual, Fourth Edition-TR for Axis-I Disorders (SCID-I) Severity of SLE was assessed using the Systemic Lupus Erythematosus Disease Activity Index (SLEDA) score. Statistical analysis was done using SPSS.

Results : The sample consisted of 62 in-patients (n=100). Prevalence of current psychiatric morbidity (excluding Adjustment Disorder) was 67%. Lifetime-prevalence rate of psychiatric morbidity was 85%. The pattern of distribution of psychiatric disorders wereMajor Depressive Disorder-46%, Adjustment Disorder-21%, Dysthymia-9%, Bipolar Affective Disorder-4%, Agoraphobia without Panic Disorder-5%, Social Phobia-13%, Specific Phobia-13%, Obsessive Compulsive Disorder (OCD)-12%, Generalized Anxiety Disorder-1%, Anxiety Disorder NOS-7%, Substance Abuse-1%, Substance Induced Mood Disorder-2%, Substance Induced Psychotic Disorder-1% and Psychotic Disorder NOS-1%. Presence of psychiatric morbidity was significantly associated with in-patient/out-patient status, educational status and income < Rs. 10,000 per month. SCID-I diagnosis was also associated with duration of illness.

Conclusion : The high rate of OCD and low rate of "Psychosis" are key findings. The prevalence of psychiatric morbidity in this study is comparable to that in other studies. The lack of association with SLEDAI scores reflects that psychological factors are as important, if not more, in mediating psychiatric morbidity in SLE.


Sexual dysfunction in male subjects receiving trifluoperazine, risperidone and olanzapine

Naresh Nebhinani, Sandeep Grover, Ajit Avasthi

PGIMER, Chandigarh, India

Background : Sexual dysfunction is a common side effect of psychotropic medications.

Aim : To assess the prevalence and typology of sexual dysfunction in male subjects receiving trifluoperazine, risperidone and olanzapine.

Materials and Methods : Sample included 100 subjects suffering from psychotic disorders and receiving one of there antipsychotics (trifluoperazine N=20, risperidone N=30 and olanzapine N=50) for atleast 3 months duration. Subjects with history of sexual dysfunction prior to antipsychotics intake or chronic medical illness were excluded. Subjects were assessed on 3 sexual dysfunction scales: Arizona Sexual Experience Scale (ASEX), Psychotropic Related Sexual Dysfunction Questionnaire (PRSexDQ), UKU side effect rating scale (sexual function subsection).

Results : Prevalence of sexual dysfunction varied from scale to scale with 25% on ASEX, 37% on PRSexDQ and 40% as per UKU side effect rating scale in entire group of 100 subjects. While sexual dysfunction in trifluoperazine, risperidone and olanzapine group was 20, 43.3 and 16% respectively on ASEX, 35, 50 and 30% respectively on PRSexDQ and 40, 50 and 34% respectively on UKU side effect rating scale. Sexual dysfunction was highest in the group receiving risperidone and lowest in the group receiving olanzapine. Most common sexual dysfunction as assessed on any of scales was decreased libido followed by difficulty in erection.

Conclusions : Sexual dysfunction is quite prevalent in subjects receiving antipsychotics. In our study prevalence of sexual dysfunction was highest for risperidone followed by trifluoperazine and olanzapine. However the rate of sexual dysfunction varies from scale to scale. Hence there is a need to have a comprehensive instrument to assess sexual dysfunction in subjects receiving antipsychotic.


Microglia abnormality in catatonia - Revisiting immune theory of catatonia

Vishal Kasal, Naren P. Rao, Narayan R. Mutalik, Ganesan Venkatasubramanian, Rishikesh V. Behere, Shivarama Varambally, Bangalore N. Gangadhar

National Institute of Mental Health and Neurosciences, Bangalore, India

Introduction : Catatonia, one of the most dramatic psychiatric presentations, is rare and virtually extinct in western world but still common in Indian context. Decrease in infectious diseases inwestern countries is one possible reason along with improved pharmacotherapy. Involution of Thymus in adolescence and associated changes in immune system has been implicated in pathogenesis of catatonia but is yet to be examined. Thus we aimed to examine the immune characteristics of patients with catatonia and their relation with treatment response.

Methodology : A chart review of patients admitted to Psychiatric Intensive care unit of National Institute of Mental Health and NeuroSciences (NIMHANS), Bangalore in the past two years was done. Data of 77 patients with clinical details were analyzed.

Results : Catatonia was more common in winter months (September-February : March-August=44:33). It was more common in females (females : males=46:31) and in rural population (rural : urban=53:24). 9% of patients had fever at onset. All patients were treated with Lorazepam but only 50.6% of patients responded (50% Reduction in Bush-Francis-Catatonia-Rating-Scale) to Lorazepam trial. Those who did not respond to Lorazepam had significantly higher number of Monocytes (2.45±2.23) than those who responded (1.18±1.33) (P=0.01).

Conclusion : Study findings suggest that patients with poor response to Lorazepam had higher number of monocytes indicating potential abnormalities in monocyte macrophage system. Microglia, the macrophage in central nervous system is implicated in pathogenesis of different neuropsychiatric disorders; importantly, peripheral blood monocytes have been postulated as proxy markers for microglia changes in the central nervous system Within the limiations of retrospective methodology, our findings suggest Monocyte abnormality might be related to pathogenesis (and possible indicator of treatment response) in catatonia. This postulate needs further systematic evaluation.


Gender difference in psychology programme admission in IGNOU

Shobha Saxena, Dinesh Kataria, Vimala Veereraghavan

*School of Social Sciences, Psychology Division, IGNOU, New Delhi, **Lady Harding Medical College, New Delhi, ***Psychology Division, Indira Gandhi National Open University, New Delhi

The Indira Gandhi National Open University (IGNOU) is a university with a difference; it aims at providing educational opportunities to all those who desire higher education without being handicapped by the limitations of place and time. With a view to develop a versatile education system, with the emphasis on innovation, cost effectiveness, flexibility, universality and societal involvement, the university was established to provide distance education. IGNOU has been a world leader in open distance education and has received many awards for excellence. From 2010 IGNOU started Psychology programme and offers B.A and M.A degree in the subject. Analysis of the admission profile of students indicates that there are large no. of male students joining the course in different regional centres and at Delhi. This figure of male in the distance education mode is higher as compared to the one that is obtained in many colleges and university level psychology programme offered as a regular programme in different parts of India. This gender variation in admission to psychology course is the focus of this paper.


Metabolic syndrome associated with typical antipsychotic (trifluoperazine) and atypical antipsychiotic (olanzapine) treatmet: A comparative study

Srikanth M. Reddy, Prakash B. Behere

Mahatma Gandhi Intitute of Medical Sciences, Wardha, Maharashtra, India

Aims and Objectives : To comparatively evaluate the changes in factors related to development of metabolic syndrome in subjects treated with antipsychotics trifluoperazine and olanzapine.

Methodology : In a prospective case control study, 80 consecutive patients, diagnosed as schizophrenia or schizophreniform or brief psychotic disorder as per DSM IV criteria, comprising either newly diagnosed cases or those who were off drugs for the past 4 years were treated with either trifluoperazine or olanzapine on random basis. The factors related to the metabolic syndrome viz., waist circumference (WC), systolic and diastolic blood pressure (SBP, DBP), fasting blood glucose (FBG), serum HDL cholesterol (HDL-C) and triglycerides (TG) were measured before and after four months of treatment with drugs.

Results : The mean WC increased from 70.7+8.2 to 74.9+10.3cm and from 70.7+7.6 to 72+8.2cm in subjects on olanzapine and trifluoperazine respectively. While the subjects treated with olanzapine had their mean SBP and DBP increase from 122.9+9.3 and 79.5+6.7 mmHg to 129.2+9.7 and 83.1+6mmHg, those on trifluoperazine showed and increase from 123+9.9 and 77.9+5.4 mmHg to 125.9+10.2 and 78.5+4.8 mmHg. There was also increase in the levels of mean FBG from 79.2+11.6 to 91.5+11.5 mg/dL and from 83.3+12.7 to 85.1+14mg/dL in the subjects on olanzapine and trifluoperazine respectively. The mean levels of TG increased from 74.9+24 to 104.3+23.6 mg/dL in subjects on olanzapine and from 85.8+27.3 to 92.3+28.6 mg/dL in cases on trifluoperazine. While the mean HDL-C levels decreased from 39+7.8 to 33.1+7.8 mg/dL after t/t with Olanzapine, it increased from 41.3+10.6 to 41.8+10.1 mg/dL after t/t with trifluoperazine. The prevalence of metabolic syndrome increased from 5% to 12.5% in subjects on olanzapine. Conclusion : Although both trifluoperazine and olanzapine showed potential to increase metabolic syndrome, the effect was more severe with the latter.


Group interactive sessions among homeless with substance dependence

Pradeep Kumar, Ajit Yadav, Sanjay Kumar, Durgesh N. Dubey, Rupali P. Shivalkar, Om Prakash, N.G. Desai

Institution Institute of Human Behaviour and Allied Sciences, New Delhi, India

Aims & Objectives : Homeless population is ever increasing with high prevalence and incidence of Poly-substance abuse. Lack of motivation for initiation and maintenance of abstinence are common factors that make treatment difficult, added to it is the poor level of the awareness in the group. The endeavour was aimed at intake assessment, followed by finding the clinical profile, exploring the level of knowledge regarding the substance, and finding the impact of change in substance abuse pattern after imparting group therapy sessions.

Materials and Methods : The study was conducted at DMHP Outreach Clinic of IHBAS at Jama Masjid in evening hours to ensure that the persons don't lose their wage and a group of about 16 patients attending the outreach clinic who consented for structured group therapy sessions were selected. The patient population kept changing and was dynamic due to the apparent logistic issues involved. Twenty five sessions were held over period of 9 months by a trained Mental Health Professional. The clinical profile of the patients and details of the individual substance use pattern was noted. They were then subjected to group interactive sessions where the professional restricted its role to occasional psycho education and moderation in the group. The outcomes in the patterns of substance abuse were noted at end of each session among the group.

Results : Most of the homeless were from the 3 rd and 4 th decade, started substance abuse in early childhood, harboured poor knowledge about the risks involved with substance abuse, and indulged in Poly-substance abuse. Majority was either unmarried or was separated. Few had HIV positive status and involved in high risk behavior. The individuals attending more than 40 to 60% of the Group Interactive sessions showed perceptible reduction in high risk behavior and showed positive changes in behaviors related to substance abuse.

Conclusions : Though challenging, in highly de-motivated set of Patients, group interactive sessions can be potential tools in management of Substance abuse in Homeless.


Correlation of negative and positive symptoms in schizophrenia with neurocognitive deficits

Purkanti Shwetha, R.Sathianathan, M. Malaiappan, Shabeeba Z.

Institute of Mental Health, Kilpauk, Chennai, India

Background : Its been well established that schizophrenic patients have neurocognitive deficits and these deficits have an important role to play in functional outcome of these patients. Therefore in this study we attempt to study the correlates of neurocognitive deficits.

Objective : To identify the correlation of positive, negative symptom and general psychopathology symptoms with neurocognitive deficits in schizophrenia.

Materials and Methods : Thirty patients with chronic schizophrenia attending the Institute's out patient department and thirty age matched healthy volunteers were administered PGI neuro-cognitive battery and Wisconsin card sorting test for assessing neurocognitive deficits and Positive And Negative Syndrome Scale (PANSS) was given for assessing positive and negative symptoms and general psychopathology scales and the results were further assessed for correlation between them.


Prevalance of anxiety disorder and psychoactive substance use in bengali patients of bipolar affective disorder

Souvik Chakraborty, M. Ghoshal, A.K. Mallick, D. Sanyal,

S. Kuila, S. Khanra, R. P Acharya

Objective : Some western studies reported that the life time prevalence of anxiety disorders is more among the patients of bipolar disorder than in general population. The prevalence of alcohol or other drug dependence was also reported to be higher in these patients and more so if associated with anxiety disorders. Data of similar kind in Indian population is lacking. This ongoing study is being conducted to find the lifetime prevalence of anxiety disorders and alcohol and other substance dependence among patients presenting with bipolar disorder, who are currently in remission. The preliminary report is presented here.

Methodology : So far 30 consecutive Bengali patients attending out-patient department with past history of bipolar disorder were interviewed cross-sectionally using Mini International Neuropsychiatric Interview validated Bengali Version 5.0.0 regarding current mood state, any anxiety disorder or any substance dependence or abuse. In some places it was adapted additionally to assess lifetime prevalence of anxiety disorders. The prevalence rates of different anxiety disorders were calculated.

Results : Out of the 30 patients 15 (50%) reported history of anxiety disorders in their lifetime. Out of the total 15, 2 (13.33%) had panic disorder, 5 (33.33%) had social phobia, 4 (26.67%) had Obsessive Compulsive Disorder and 4 (26.67%) had Generalized Anxiety Disorder. 3 (10%) persons had alcohol dependence and 2 (6.67%) persons had alcohol abuse in past 1 year. Among the persons of alcohol abuse 1 person had additional diagnosis of GAD. No case of non-alcohol drug dependence was found.

Conclusion : The prevalence of anxiety disorders was found to be higher among Bengali population similar to those in western population. Out of them social phobia is most prevalent. It is concluded that anxiety disorder in this patient group merits more attention as conventional therapy of this group of disorder can worsen the course of primary disorder i.e. Bipolar disorder.


A prospective study of astrological prediction of mental illness and its short-term outcome

Rajeshkrishna Bhandary P., P.S.V.N. Sharma, Hema Tharoor

Kasturba Medical College , Manipal, India

Aims & Objectives : To determine the predictive ability of astrology in identifying mental illness and its short term outcome based on birth chart and planetary position.

Methodology : A prospective cohort of 150 subjects with 75 having mental illness (MI) diagnosed with MINI Plus and 75 age and sex matched normal subjects (N) screened with SRQ 24 were taken into the study and data regarding their date, time and place of birth were randomly divided for interpretations between 4 astrologers fulfilling predefined criteria. Predictions were then matched with clinical condition at intake and at 6 months.

Results : Kappa coefficient was used and found a moderate agreement in the prediction of presence of mental illness (k=0.560, P=0.001) and a substantial agreement in predicting current state of illness (k=0.626, P=0.001). However only fair agreement in prediction of suicide (k=0.298, P=0.001) and outcome (k=0.259, P=0.001) was noted. There was poor match for prediction of symptom cluster (34.6% in MI, 42.6% in N group) and age of onset (28%). Amongst planets implicated, significant association was found only for Moon(X 2 =4.625, P=0.03) and Saturn (X 2 =6.887, P=0.009). Viewed as a diagnostic test, astrology shows a fairly good sensitivity (77.3%), specificity (78.7%), positive predictive value (78.4%) and negative predictive value (77.6%) in identifying the Life-time and current presence or absence of mental illness.

Conclusions : Overall, the evidence seems to tend towards astrology as practiced in the study, only modestly predicting mental illness and its course. Several caveats concerning the methodology, statistics including poor inter-astrologer agreement makes it difficult in reconciling conflicting findings. Hence the findings in this study are at best tentative and needing more extensive enquiry.


A study on psychopathology in the children of parents with bipolar affective disorder

Anurag Jhanjee, Pankaj Kumar, M.S. Bhatia, Deepika Verma 1

Department of Psychiatry, University College of Medical Sciences & Associated Guru Tegh Bahadur Hospital, Delhi, 1 MBBS, Navodya Medical College, Raichur, India

Objective : The aims of this study were to determine the occurrence of psychopathology in the children of parents with bipolar disorder and to examine the relationship between the psychopathology in these children and the characteristics of bipolar disorder in their parents.

Materials and Methods : The study included 36 children of 28 bipolar I parents and 33 children of 28 control parents, all between the ages of 6 and 17 years, all recruited from the Psychiatry Outpatients Department of University College of Medical Sciences & associated Guru Tegh Bahadur Hospital, Delhi. The bipolar parents and all of the children were screened using the Schedule for Affective Disorders and Schizophrenia-Lifetime Version (SADS-L) and the Schedule for Affective Disorders and Schizophrenia for School Aged Children, Present and Lifetime Version (K-SADS-PL), respectively. The spouses of bipolar parents completed the Symptom Checklist-90-Revised (SCL-90-R) and the children completed the Parenting Style Scale (PSS).

Results : The children of bipolar parents exhibited higher rates of psychopathology than those of the control parents. Affective disorders and disruptive behavior disorders were observed with significantly greater frequency in the children of the bipolar parents. Attitudes in study group parents were related to the presence of psychopathology in their children.

Conclusion : The results of this study suggest that children of bipolar parents have an increased risk of developing mental health problems, especially affective disorders and disruptive behavior disorders. The children of bipolar patients need to be screened for psychiatric symptoms and referred for psychiatric consultation when necessary.


Magical thinking and beliefs in psychiatry

Variankaval Ramasamy Annadurai

Mercy Hospital, Thillai Nagar, Tiruchirapalli, Tamil Nadu, India

As we all know, magical thinking is noticed in obsessive fears and compulsive rituals to ward off those fears. Telepathy, clairvoyance and ideas that soul entering other's body etc seen in schizotypal personality disorder are nothing but magical thinking. Delusion of black magic, and various other delusions seen in psychoses and phobia of ghosts are clear cut examples of magical thinking. In this article the author postulates that magical thinking is the basic cognitive processes in borderline and hysterical personalities . Suicidal attempts and deliberate self harm in these people are the result of magical thinking. Magical beliefs are the psychopathology behind altruistic, anomic and egoistic suicides. In hysterical personality, possession attacks as well as disassociation are out of magical thinking only. These personalities would have served the community in the remote past as priests, magicians and would have participated in sacrificial rituals. The self injurious borderline personality people would have been the "objects of sacrifice" (human sacrifice) in community rituals in the primitive era. Their readiness to shed blood can explain their role in the past. Self sacrificial behavior is the subtle form of self injurious behavior. Psychotherapy in these clients needs attention to their magical thinking and beliefs. The author concludes by saying that the 3-5 years boys moving away from mothers is because of magical fear of possession of female attributes, not only character but also physical attributes-contradicting oedipal theory.


A study of effects of antipsychotic drugs on metabolism in indian population

Haresh Barvadia, Rajat Oswal, Kamlesh Dave, Ritambhara Mehta

Government Medical College, Surat, Gujarat, India

Aims and Objectives : To assess the metabolic effects of antipsychotics drugs.

Methodology : 100 drug-naïve consecutive patients were studied, out of which 56 patients were treated with Risperidone, 39 with Olanzapine and 5 with haloperidol. None were suffering from metabolic syndrome at onset of the study. Several parameters including body mass index, fasting blood glucose and lipid profile were examined for 12 weeks at regular intervals.

Results : Sixteen patients developed metabolic syndrome at the end of the study, out of which 10 were on Olanzapine and 6 on Risperidone. Olanzapine caused maximum mean weight gain of 3.61 kg (8.09%) among the patients while Haloperidol caused least mean weight gain of 0.82 kg (1.71%) during the study period. Risperidone and Olanzapine increase mean blood sugar levels significantly but not Haloperidol. Risperidone and Olanzapine also increase Triglyceride / Cholesterol levels and decrease HDL levels significantly. One out of every four patients (25%) who were on antipsychotics in this study developed significant weight gain (>7% weight gain).

Conclusion : Risperidone and Olanzapine have adverse effects on all indices of metabolism, whereas haloperidol causes only weight gain. All patients on antipsychotics should be monitored regularly for metabolic changes.


Cognition in nonaffected full biological siblings of patients with schizophrenia

Pramit Jain, Arun Kumar, Sudhir Kumar

Institute of Mental Health and Hospital, Agra, Uttar Pradesh, India

Cognitive deficits in schizophrenia is often present at the onset of the illness, which is independent of psychotic symptoms & stable over time related to underlying neuronal dysfunction and predict functional outcome. Cognitive deficits associated with schizophrenia have received increasing attention as potential endophenotypes (trait or vulnerability markers) of the disorder that could also potentially discriminate relatives of patients from controls. Endophenotypes should be associated with the illness, relatively stable in patients even when their illness is in remission (state-independent), found in nonpsychotic relatives compared with controls (i.e. heritable) and less common or milder in individuals with other disorders or their relatives. Many studies have been conducted in the families of patients with Schizophrenia concluding that relatives perform lower than that of healthy normal people on a range of cognitive measures; still this field holds promise for increasing the understanding of many aspects of schizophrenia.

Aims and objectives : (1) To assess neurocognitive functions in non-affected full biological siblings of patients with schizophrenia (2) To compare neurocognitive functions of these siblings with normal healthy controls.

Methodology : Twenty non-affected full biological siblings having no psychiatric illness or medical illness with likely central nervous system affects or history of psychoactive substance use; with no history of Bipolar Affective Disorder, Psychosis other than Schizophrenia in the family, will be selected from Outpatient Department of Psychiatry, Institute of Mental Health and Hospital, Agra on specified days. Twenty group matched controls according to age, sex and education with GHQ < 3, will also be selected. Tools like Letter Cancellation Test, PGI Memory Scale and Stroop Colour Word Test for assessing cognitive functions, will be used.

Results : will be discussed at the time of presentation.


Assessment of personality and underlying psychosocial stressors in cases of deliberate self harm

Abhinav Kumar, Rakesh Kumar Paswan, Vishal Sinha

Aims and Objectives : To assess the personality variables and underlying psychosocial stressors in cases of deliberate self harm in a tertiary care hospital.

Methodology : All consecutive patients with deliberate self harm admitted to the emergency department during a six month period lasting from March '10 to August '10 were enrolled and were assessed on a preformed proforma designed by authors after being declared physically fit. Information from guardians was also taken and corroborated with that taken from the patient. Personality was assessed by Standardized Assessment of Personality Abbreviated Scale (SAPAS) and psychosocial stressors were assessed on Perceived Stressful Life Events Scale (PSLES) for past one and six months. Data were segregated and analyzed.

Result : Majority of respondents have had some score on SAPAS but only a smaller proportion scored high enough to be identified as having risk of personality disorder (SAPAS score>3). Almost all of the respondents have had high PSLES score in past one month with a significant proportion of them having high PSLES score in past six months.

Conclusion : Though psychiatric illness and certain personality disorder are established risk factors for deliberate self harm, for majority of respondents in our study; it was impulsivity which lead to the act. Presence of high impulsivity along with greater PSLES score in past one month was major predictor for committing deliberate self harm and can be utilized to assess the risk of the act.


ECT in first episode schizophrenia in nepal

Shailendra Raj Adhikari

Chitwan School Of Medical Sciences, Nepal

Aims and Objectives : Little is known regarding efficacy and effectiveness of electroconvulsive therapy (ECT) in young, first episode schizophrenia. Present study was done to evaluate short term and long term efficacy and effectiveness of ECT in patients with first episode schizophrenia.

Methodology : This is a prospective study where forty five patients were evaluated at medical college in Nepal.12 patients received ECT as compared to 33 non-receivers. Patients were evaluated at admission, at discharge, 1st month, 6th month and at 12th month after discharge from the hospital. Evaluations were done using Brief Psychiatric Rating Scale (BPRS), Global Assessment of Function (GAF).

Results : The mean duration of hospitalization was 25.42 days among ECT receivers as compared to 34.75 days among non-receivers (decrease in duration of hospitalization by 9 days). Patients who received ECT showed significant improvement in BPRS at discharge (P=0.000), 1st month (P=0.000), 6th month (P=0.000) and at 12th month (P=0.000). Similarly there was significant improvement in GAF at discharge (P=0.000), 6th month (P=0.053) and at 12th month (P=0.003).

Conclusions : Though used infrequently, ECT in young first episode schizophrenia give significant overall improvement and wellbeing with very minimal side-effects. ECT also shortens duration of hospitalization with early discharge and improvement in psychosocial well being.


Study of mental health profile of geriatric age group in an urban slum of delhi

Manisha Arora, S.K. Kapoor, Amod Kumar, Dhanesh K. Gupta

1 St Stephens' Hospital, Delhi, 2 Institute of Human Behavior and Allied Sciences, Delhi, India

Objective : To study the mental health problems of geriatric age group in an urban slum of Delhi, with emphasis on depression, anxiety, and cognitive impairment.

Materials and Methods : A cross sectional study was carried out on 450 elderly (237 males and 213 females) participants aged 60 years and above in a representative sample from an urban slum of East Delhi. After interviewing for socio-demographic characteristics, Geriatric Depression scale-Hindi version (GDS-H), Clinical Anxiety scale (CAS) and Hindi Mental State Examination (HMSE) were administered on the participants to assess depression, anxiety and cognitive impairment respectively. In addition, Relatives' assessment of Global Symptomatology Scale-Elderly (RAGS-E) assessed the participants for psychiatric symptoms and behavior in the community.

Results : The prevalence of depression in the elderly was 14.7%, of which 12% met the cut off score for mild depression and 2.7% for severe depression. The prevalence of anxiety in the elderly was 10.7 % of which 8.2 and 2.5% had mild and moderate anxiety respectively. Cognitive impairment was positive on screening among 3.1% of the elderly. Depression and anxiety occurred together in a considerable number of participants. Sleep disturbance was associated with depression and anxiety.

Conclusion : The above findings of mental health problems in an urban slum reflect the need for strong community mental health services and their integration with primary health care.


Expressed emotions and their relations with symptom severity and insight in obsessive compulsive disorder - A controlled study

Priyanka Rastogi, Ajay Bakhla, Daya Ram

Central Institute of Psychiatry, Kanke, Ranchi, India

Background : Obsessive compulsive disorder (OCD) is a relatively common disorder, characterized by persistent and unwanted thoughts and compulsive behavior aimed at undoing the distress related to the obsessive thought. Traditionally, OCD has been described as a condition in which patients have good insight into their symptoms. However, a possibility has been suggested that that there is a range of insight in OCD. Expressed emotions (EE) refers to family members feelings about an identified patient and includes emotional over-involvement, criticism and hostility. In contrast to the several studies conducted on the role of EE in Schizophrenia, very few studies have explored the role of EE in OCD. Specifically, the literature remains deficient regarding the impact of expressed emotions on symptoms severity and insight of the patient.

Aims of the study : (1) To assess the levels of insight in patients OCD and Normal control groups. (2) To assess the presence of childhood trauma, levels of expressed emotions and empathic abilities in patients of OCD and Normal control groups (3) To assess the co morbid depression, anxiety, and other clinical and demographic variables in OCD group. (4) To correlate among, childhood trauma and perceived expressed emotions and insight in OCD groups.

Methodology : It is a cross-sectional comparison study in which purposive sampling was used. 12 patients fulfilling the clinical criteria of Obsessive Compulsive Disorder using the ICD-10 criteria and fulfilling the inclusion and exclusion criteria of the study were assessed using the Socio-demographic data sheet, Brown assessment of Belief scale, Yale-Brown obsessive compulsive scale (Y-BOCS), Family attitude questionnaire and Childhood trauma scale. 12 age and education matched normal individuals were assessed using Brown assessment of belief scale and childhood trauma scale. Both groups were compared using statistical techniques.

Results : Significantly high levels of expressed emotions were found in the OCD group as compared to the normal individuals. Significant correlations were found between expressed emotions and insight of the patients and with the severity of symptoms on the Y-BOCS scale.

Conclusion : Expressed emotions are high in OCD patients as compared to normal individuals; Expressed emotions also play a vital role in symptoms severity and insight levels of the patients suffering from OCD.


Effect of cannabis on schizophrenia psychopathology

Rahul Saha, P.K. Dalal, J.K. Trivedi, P.K. Sinha

CSMMU, Lucknow, India

Aims and Objectives : To compare the symptoms of schizophrenia in patients with cannabis use and those without cannabis use.

Materials and Methods : The patients diagnosed to be suffering from schizophrenia, along with cannabis use - harmful use / dependence, as per diagnostic criteria of ICD-10 DCR were taken as cases and those patients diagnosed to be suffering from schizophrenia, as per diagnostic criteria of ICD-10 DCR without any substance use except nicotine were taken as controls. A total of 50 patients were taken both in cases and controls. Positive And Negative Symptom Scale was applied to compare the symptomatology of patients of schizophrenia with or without cannabis use. Chi square test and unpaired t - test were applied to arrive at meaningful results. The study was carried out from September 2009 to august 2010.

Results and Conclusions : Schizophrenic patients with cannabis use have significantly more positive symptoms compared to cannabis nonusers as evident in statistical analysis which included more conceptual disorganization, more excitement, more grandiosity, more suspiciousness/persecution and more hostility, while they have significantly less emotional withdrawal as compared to cannabis nonusers in their positive and negative symptom scale. Patients with cannabis use were also found to have significantly more somatic concern, more anxiety, more guilt feeling, more unusual thought content, more poor attention and more impairment in judgment and insight and significantly less motor retardation, less disturbances in volition and less impairment in active social avoidance as compared to cannabis nonusers in their general psychopathology scale.


Parental supervision and its association with behavioral and emotional problems in children

Shankar K., Manohari. S.M.

Aims and Objectives : Behavioural and emotional problems form a major portion of psychiatric morbidity in India. There has been a definite increase in reporting of these problems in the last 50 years, reasons however unclear, with speculations over changes in family structure, lifestyle and parenting. We intended to find out if there is an association between various aspects of parental supervision and behavioural and emotional problems in children.

Methodology : Three hundred twenty two childrens in the age group of 10-15yrs (class 7-9) from a school catering to predominantly middle socioeconomic strata in urban Bangalore were selected after informed consent and Strengths and Difficulty Questionnaire (SDQ)? Was administered to their class teacher and parent to assess for behavioural and emotional problems. The supervision questionnaire with socio-demographic data was administered to parents and children of all subjects who scored above the cut-off in the SDQ of both versions and association between various parameters studied.

Results : The prevalence of behavioural and emotional problems in the sample was 12.65 %. Parents of children with behavioural problems were less educated, older, working for longer hours, were in skilled jobs than those without behavioural problems. Behavioural problems as reported by both the teacher and parent correlated well with various parameters of supervision as reported by both the parent and child which are discussed. There was an excellent correlation observed between parent-teacher reports of behavioural problems and parent- child reports of supervision.

Conclusions : Various aspects of parental supervision, as discussed, have a good association with behavioural problems in children. This can be applied to clinical practice for interventions involving parents for children with behavioural problems and it is to be tested if a modification in a small yet important factor like supervision could bring about improvement in these children.


Prevalence of metabolic syndrome among psychiatric outpatients in a tertiary care centre in eastern India

Chakraborty K, Dan A 1

Institute of Neurosciences, Kolkata, 1 Burdwan Medical College and Hospital, West Bengal, India

Background : Metabolic Syndrome (MS) refers to a clustering of metabolic risk factors including central obesity, glucose intolerance, hyperinsulinaemia, low HDL cholesterol, high triglycerides and hypertension. Compared to the general population, the prevalence of MS and its components is higher in populations with mental illness across all major diagnostic groups.

Aim : To study the prevalence and correlates of MS in a cohort of psychiatric outpatients in a tertiary care centre in Eastern India.

Methodology : One hundred consecutive consenting patients attending the outpatient service of Department of Psychiatry were recruited. The socio-demographic, clinical and physical activity profile of these patients were recorded by using a proforma specially designed for this purpose. MS was diagnosed by the International Diabetic Federation criteria (IDF, 2006).

Results : A typical subject was: aged 41.57 years, educated for >10 years (71.4%), married (57.1%), from a nuclear family (78.6%), from urban background (100%), and a student or semi-professional (21.4%). The most common ICD-10 diagnostic categories were unipolar depression (35.7%), psychoses (28.6%), and bipolar disorder (14.3%). The mean age for onset and duration of illness were 36.71 years and 60.36 months respectively. The mean number and duration of psychotropic medication received by the subjects were 5.14 and 68.71 months respectively. A sedentary life style was reported by 85.7%, with mean duration of physical activity of 10.36 minutes. The mean serum triglyceride, high density lipoprotein, and fasting plasma glucose level were 150.42, 38.50 and 109.85 mg% respectively. An IDF criteria based diagnosis of MS was made in 28.6% cases. A diagnosis of MS had a significant positive correlation with age of the subjects and the total duration of psychiatric illness.

Conclusion : MS is common among mentally ill subjects and the prevalence of MS in our sample is consistent with the findings reported in literature.


Improving recognition and management of austism spectrum disorder

Savita Sapra, Rachna Seth

Department of Paediatrics, AIIMS New Delhi

Autism is a disorder of neural development characterized by impaired social interaction and communication, and by restricted and repetitive behavior. These signs all begin before a child is three years old. Recent estimates have placed autism in the US at approximately 1 in 150. At India's current population, this means there are more than 2 million autistic persons in the country.

Aims and Objective : To assess the children with Autism using DSM IV TR criteria. To assess the effective modalities of intervention.

Methodology : Although there is no cure, early diagnosis and intensive behaviour intervention has emerged as crucial tool for its management. In Autistic clinic held by AIIMS 100 of 125 children age group 3-12 years fulfilled DSM IV TR criteria were enrolled for this study, the male female was 8:1. The severity, cognitive level, hyperactivity and base line evaluation was done using childhood autism rating scale. Developmental Profile III, Conner's Rating Scale and Autism Treatment Evaluation checklist on childhood autism rating scale 35 % mild, 47% moderate and only 18% were severe category on Developmental profile III, 5% had normal and 15% had borderline intelligence, 80% mild to moderate intelligence.

Result : Intensive intervention was given in the area of eye contact, imitation, attention enhancement, echolalia, verbal communication, self help skills. The baseline score was in the area of speech, social interaction, cognitive skills and behaviour 24-26, 34-36, 42-44 after intensive intervention of 2 years the score was 18-20, 20- 22, 22-24, 28-30 in the above four areas. The lower the score, the better the level of adaptation. The intervention technique and diagnostic method will be discussed on Autism treatment evaluation checklist.

Conclusions : DSM IV TR is a gold standard method for diagnosis of autism and early intensive and continuous behaviour therapy plays a crucial role in its management.


The context of methadone maintenance treatment in Nepal

Saroj Prasad Ojha

Tribhuvan University Teaching Hospital, Nepal

Nepal is a land locked south-east Asian country with immense cultural and geographical richness and diversity. It has a population of around 26.4 million (CBS, 2007) with 2.25% annual population growth rate. The rapid population growth rate is a major development challenge of the country. Ranked 142 in Human Development Report (2007) with per capita income US 240 Dollar and low literacy rate (46.6). Drug abuse and drug trafficking have been a serious threat to whole nation.It is a serious threat to human security, human development, and youth productivity. School children and campus student, street children and uncared children, sex workers and young people of so called elite community, migrant population and internally displaced persons are the critical mass falling under most vulnerable groups to drug abuse in Nepal. From the beginning of 1990s, the use of narcotic drugs and psychotropic substances became increasingly popular among youth population. The drug use appears to be increasing more and more popular since drugs are easily available, comparatively cheaper in price and with relatively longer effect. A study conducted by Central Bureau of Statistics (CBS July, 2008) has shown that there are 46,309 (male 42954 and female 3356) hard drug-users in Nepal. The study has shown that around three fourth (75.7%) drug users are below the age of 30. Among the total drug users, 61.4% are injecting drug users (IDUs) and 29% of them share needles with their friends. In Nepal, HIV prevalence is high among IDUs in major clusters of urban population. Currently, there are 70,256 people estimated to be living with HIV. Among them 6493 (9.2%) persons with HIV are IDUs. It shows that IDUs are prone to HIV and at the same time they are major source of spreading HIV. As per the data around 38.4% of IDUs live with HIV in the country whereas this problem is not equally prevalent across the country. The prevalence varies: in Kathmandu - 51.6%, in Eastern Tarai districts 31.7% and in Western Tarai 11.7% and Pokhra 21.7%. In a view of alarming situation of drug use among Nepalese youth, the government of Nepal had announced a National Drug Policy in 1996. Nepal was the first developing country to establish a "Harm Reduction" Program for IDUs. In Nepal Methadone Maintenance Treatment Program (MMTP) was started in 1994 at the Mental Hospital in Kathmandu valley and Nepal is considered as one of the first in South Asia to start methadone as Opioid substitution therapy. The number of patients enrolled during 1994 to 2002 were about 180to 200 daily. This MMTP program was stopped in 2002 due to various reasons. There was five years gap of MMTP in Nepal. In November 2007, Department of Psychiatry, Tribhuvan University Teaching Hospital has started Methadone Maintenance Treatment Program in Kathmandu as an "Emergency Response for IDUs" under the financial and technical support of UNODC, GTZ and collaboration with Ministry of Home affairs of Nepal Government. At the beginning of program (2007), the number of new patients enrolled was 100 and this was increased to 170 in subsequent year 2008-09. The total number of patients enrolled during 2009-10 is about 250. With a provision of scaling up of the MMTP in different parts of the country, Pokhra, another major city was chosen as second MMTP site where 85 patients have been enrolled till the end of 2009. In order to prevent new HIV infections and reducing harms from unsafe injecting, Nepal government has decided to expand MMTP in two other major cities from this year (2010). Till now, methadone as OST has been well accepted by patients and their relatives. Improving quality of life and health, decline in quarrel with family members, reducing varieties of drug related social harms and illicit opioid are some important benefits observed among patients maintained on MMTP. In addition, their job and daily activities are improving gradually following treatment. Based on these facts the MMT program in Nepal has been evaluated and found to be beneficial for the opioid dependents and their relative.


The comparative efficacy of memantine and diazepam in alcohol withdrawal syndrome: An open label trial

Manish Kumar, C.R.J. Khess, Samir Praharaj, P.K .Sinha

Introduction : Accumulating evidence suggests that neurophysiological and pathological effects of ethanol are mediated to a considerable extent through glutamatergic system. Acute effects of ethanol disrupt glutamatergic neurotransmission by inhibiting the response of the N-methyl-D aspartate (NMDA) receptor and prolonged inhibition of the NMDA receptor results in development of super sensitivity. Acute removal of ethanol causes marked augmentation of activity of postsynaptic neurons leading to glutamate-induced excitotoxicity. Therefore, drugs modulating NMDA receptor action has been hypothesized to be effective in different domains of alcohol use disorder.

Objective : To examine the effectiveness of Memantine either alone or in combination with Diazepam in alleviating alcohol withdrawal syndrome.

Materials and Methods : Total of 75 adult inpatients diagnosed as alcohol dependence syndrome fulfilling inclusion/exclusion criteria were recruited consecutively. After obtaining informed consent, 25 patients each were assigned to one of the three fixed dose detoxification regimen i.e. tab Diazepam 10 mg TID, tab Memantine 10 mg BID or combination of tab Diazepam 10 mg TID and tab Memantine 10 mg BID for initial 8 days, the rater being blind to the regimen assigned. Alcohol withdrawal signs and symptoms were recorded with the help of Clinical Institute Withdrawal Assessment of Alcohol (CIWA-AR) for eight days. Any adverse drug side effect was assessed on a self designed side effect checklist.

Result and Conclusion : Memantine was found to be equally efficacious in alleviating symptoms of alcohol withdrawal syndrome in comparison to Diazepam and combination of Diazepam and Memantine both. In particular alcohol withdrawal tremors were significantly better controlled with Diazepam and Memantine combination group as compared with Memantine alone, whereas the frequency of insomnia was found to be relatively higher in patients treated with Memantine alone. It was also found to be safe and well tolerated in patients with alcohol dependence syndrome during acute withdrawal.


Attitude of medical professionals towards substance of use

Munish Aggarwal, Gayatri Devasthali, Debasish Basu

PGIMER, Chandigarh, India

Background : Substance use and adverse attitude towards it is prevalent in all societies in the world. Medical professionals are supposed to interact and treat them. There is a dearth of studies assessing the attitude of the medical professionals towards substance use from India.

Aim : To measure the attitude of the medical professionals towards substance use.

Methodology : For the present study, a 21 item previously validated scale has been used. The scale was either sent to medical professionals through e-mail or they were approached in person.

Results : The mean age of the sample was 27.65 years. Two thirds of the subjects were males. The subjects were from various disciplines of medicine. Majority of the subjects reported that they do not smoke while a third of the subjects reported taking alcohol. Among the various scores on the attitude toward substance use, subjects have a mean score of 17.61 on "rejection" subscale, 13.61 on "drugs more dangerous than alcohol" subscale and 8.74 and 7.84 on "active endorsement of the drug" and "passive acceptance of drug" subscales respectively.

Conclusion : Medical professionals have a high rejection towards substance use and think drugs to be more dangerous than alcohol and low active or passive acceptance of drugs.


Attitude of subjects with first episode depression towards antidepressant medications

Prabhakar Holikatti, Sandeep Grover, Subho Chakrabarti, Parmanand Kulhara, Vineet Kumar, Shikha Tyagi, Pritpal Singh

PGIMER, Chandigarh, India

Aim : To study the attitudes and beliefs of the patients with first episode depression towards medication.

Materials and Methods : For the study 164 patients who attended the walk-in clinic of a busy psychiatry outpatient department of a general hospital psychiatric unit were evaluated on a self rated questionnaire for their attitudes and beliefs towards antidepressant medications.

Results : More than half of the sample comprised of males (N=85; 51.8%) and most of the subjects were married (N=128; 78%), came from urban background (N=89; 54.3%) and were Hindus (N=86; 52.4%). Most of the cases (N=103; 62.8%) were diagnosed to have Moderate Depressive episode with or without somatic symptoms and the mean Hamilton Depression Rating Scale score was 19.89 (SD-5.32; range 8-36). More than two third of the subjects (N=138; 84.7%) considered that combination of antidepressant medications and talk therapy is useful in the treatment of depression and 75.5% (N=123) considered treatment with antidepressants to be better than other modalities like Homeopathy and Ayurvedic medications for treatment of depression. About 70% (N=113) of the patients considered antidepressant medications to be the most appropriate method of treatment for their psychiatric ailment; 65.6% (N=107) considered that antidepressant medications can prevent relapse of symptoms on long-term use; 63.8% (N=104) thought that antidepressant medications improve the symptoms but do not cure the condition; have manageable side effects (N=99; 60.7%) and do not lead to permanent damage (N=86; 52.8%); about half of the patients considered antidepressants be beneficial than harmful cause more benefit then harm (N=89; 54.3%). About half of them considered antidepressants were only capable of only calming down the patient (N=95; 58.6%). Only about one third of the patient (38.0%) considered antidepressants to be dependence producing. Less than one third to one-fifth of the sample considered antidepressants to lead to extreme changes in body temperature (N=51; 31.3%), to be costly (N=50; 30.7%), poisonous and toxic substance (N=24; 14.7%), can worsen the illness (N=32; 19.6%), it is better to take less than the prescribed doses (N=21; 12.9%), antidepressants can lead to weakness of brain (N=25; 15.3%), not the best option of treatment for depression (N=30; 18.4%) and the only cause of inability to work in mentally ill subjects (N=16; 9.8%).

Conclusion : Overall patients with depression have positive attitude towards antidepressants on some of the variables. However, patients have some negative attitude towards antidepressant medications. Hence, it is important to identify and address the negative attitude towards antidepressant medications to improve treatment adherence.


Magico-religious beliefs of caregivers of pateints with schizophrenia

Natasha Kate, Parmanand Kulhara, Sandeep Grover, Ritu Nehra

PGIMER, Chandigarh, India

Background : Culture influences the manifestations, treatment seeking and treatment adherence in subjects with mental disorders. The influence of culture on mental disorders can be evaluated as "magico-religious beliefs" held by persons in a particular culture with respect causation and manifestations of mental disorders.

Aim and Objective : To study the "magico-religious beliefs" held by primary caregivers of subjects with schizophrenia with respect to causation and management of mental disorders.

Methodology : For the study a self rated questionnaire was developed in Hindi. Primary caregivers of patients with schizophrenia were approached for the consent.

Results : Seventy three caregivers returned the completed proforma. The mean age of the caregivers was 47.15 years. The mean number of years of education for the patients was 12.75 years and that for caregivers was 13.42 years. Most of the patients and caregivers belonged to Hindu religion (79.5%) and came from rural (58.9%) non-nuclear families (58.9%). About half of the caregivers were parents (48%) and one-fourth were either spouse (23.2%) or siblings (26%). Very few caregivers believed in sorcery (15.1 %), ghosts/evil spirit (9.6%) and spirit intrusion (16.4%). However, 72.6% of the patients admitted that people in their culture believe in sorcery and other magico-religious beliefs. With respect to etiology more than half (56.2%) of the caregivers of subjects with schizophrenia believed that mental illness can occur either due to sorcery, ghosts/evil spirit, spirit intrusion, wrath of divine powers, planetary/astrological influences, dissatisfied or evil spirits and bad deeds of the past. About one-third (33%) of the caregivers attributed mental disorders to more than one of these causes. Only 20% of the caregivers believed that only performance of religious rituals was sufficient to improve their mental status but about 60% of them admitted that during the recent episode of illness magico-religious rituals were performed in the hope of improvement in the patient's clinical status.

Conclusions : More than half of the caregivers of subjects with schizophrenia attribute the symptoms of mental disorders to magico-religious beliefs and admitted that during the recent episode of illness magico-religious rituals were performed in the hope of improvement in the patient's clinical status.


Metabolic syndrome in subjects with substance dependence

S.K. Mattoo, Munish Aggarwal, Naresh Nebhinani,

Debashish Basu

PGIMER, Chandigarh, India

Background : Research on metabolic syndrome (MS) among persons with substance dependence is scanty, especially from India.

Aim : To study the prevalence of MS in subjects with substance dependence.

Materials and Methods : Sociodemographic, clinical, anthropometry and metabolic data were collected prospectively from 250 non consecutive subjects with substance dependence attending the Drug De-addiction and Treatment Centre, PGIMER, Chandigarh, between 1 st January and 31 st July 2010. MS was defined as per the International Diabetes Federation (IDF).

Results : Of the total all male sample, 75% were aged < 40 years, 69% were married, 67% were employed, 60% were from an urban background and 47% were from a nuclear family. The reported substances of dependence were: only alcohol in 39%, and opioids, alcohol+opioids, and other substances in nearly 20% each; tobacco smoking or chewing, reported in 75% subjects, was broadly similar across different groups and slightly higher in the alcohol+opioid group. MS was present in 34 (13.6%) subjects. Of the various IDF criteria the most common abnormalities were high triglyceride level (N=135, 54%), followed by high waist circumference (N=92, 36.8%) and high blood pressure (N=70, 28.0%); while low HDL cholesterol level (N=19, 7.6 %) and high fasting blood sugar (N=16, 6.4%) were least common. Across different groups the prevalence of MS was high in alcohol dependent group (21.6%), and similar across other groups: 9.6% in only opioid dependent, 8.2% in alcohol+opioid dependent, and 7.7% in subjects with 'other' substances with or without alcohol or opioids or their combinations.

Conclusion : Our study found MS to have a higher prevalence in subjects with dependence on alcohol as compared to substances other than alcohol.


Needs of the patients with severe mental illness as perceived by their caregivers

Deepak Ghormode, Subho Chakrabarti, Sandeep Grover, Alakananda Dutt

PGIMER, Chandigarh, India

Background : Various instruments like Camberwell need assessment (CAN) instrument, Avon Mental Health Measure (AMHM) and the Cardinal Needs Schedule have been designed to assess the needs of the patients with mental disorders. However, these instruments have been designed to tap the needs of the patients in the background of well organized community mental health care system and social service network. Hence, these instruments may not be the ideal instruments to tap the needs of the patients with mental disorders in Indian setting.

Aim of the study : To assess the needs of the patient as perceived by their primary caregivers using a self designed need assessment instrument.

Methodology : A 21 item instrument was designed based on the felt needs in the Indian context by the patients, their primary caregivers, treating psychiatrists, psychiatric social workers and psychologists. The items were rated as no need, met need and unmet needs. The instrument was administered to 100 primary caregivers of subjects with Sever Mental Illness.

Result : The study sample included 57 subjects with schizophrenia or other psychotic disorders, 39 subjects with affective disorders and 4 subjects with obsessive compulsive disorders. According to the caregivers the mean numbers of needs of the patients were 7.09 of which 3.37 (47.5%) were unmet needs. The most commonly reported needs of the patients as perceived by the caregivers were for psycho-education (72%), medical reimbursement (58%), free treatment (56%), Govt./ NGO help during emergency due to symptoms (50%), certification needs, spiritual needs and travel concessions (45% each), financial help (44%), and job reservations/occupational help (42%). Other areas in which needs were expressed were rehabilitation facilities (39%), home visits (33%), religious needs (36%), help to manage caregivers stress (36%), more time from the clinicians (25%) and having patient groups/clubs/societies (22%). Very few caregivers expressed needs in the areas of guardianship (13%), legal aid (1%), tax benefits (6%), flexible job timing (9%) and insurance (3%).

Conclusions : About half of the needs of the patients with severe mental illness as perceived by their caregivers are unmet. Further the caregivers express more needs with regard to treatment related issues rather than social service related needs.


Dilemmas in private psychiatric practice

N.M. Patil, R.B. Nayak, S.S. Chate, G.S. Bhogale

Jawaharlal Nehru Medical College, KLE University, Belgaum, Karnataka, India

Aims and Objectives : To study the nature of psychiatric practice by the practicing psychiatrist in the areas of Admission, Discharge, Consent, Physical Restraint, electro convulsive therapy (ECT), Certification, Treatment, Suicide and Psychotherapy.

Methodology : This was a cross sectional study. It was carried out during the regional psychiatric conference. A special proforma was prepared, which addresses the common dilemmas in the clinical psychiatric practice. All the psychiatrists were given specially designed proforma and requested them to fill the proforma with appropriate answers. Data was collected and analysed using SPSS software.

Results : The study included 48 psychiatrists attending the conference. There were 42 male and 6 female psychiatrists. The age of the psychiatrists ranged from 28 years to 65 years with mean of 43.08 years. The mean duration of practice of these Psychiatrists was 14.81±11.07 years. 26 (54.2%) of psychiatrist had in-patient psychiatric services and 22 (45.8%) were having out-patient services. 14 were with MD qualification, 18 were with Diploma degree, 14 were both MD and Diploma degree holders and 2 were Diploma and DNB degree holders. Question and answers related to Admission, Discharge, consent, Physical Restraint, ECT, certification, treatment, suicide and psychotherapy are discussed.

Conclusions : The present standard and practice specially in private psychiatric set up does not confirm to the rules, recommendations, regulations suggested by Mental Health Act 1987, Mental Health Authorities and various guidelines of practice. The present private psychiatric practice finds itself unable to confirm to the legal, ethical and evidence based standards recommended. Since the present study involves a small sample of private psychiatrists and belongs to a small geographic area, the findings cannot be generalized. It is essential that a larger study be undertaken and if the findings remain same then necessary corrections in regulations, rules and recommendations may be made.


A study of psychiatric morbidity in elderly patients attending, geriatric clinic

D.K. Sharma, C.S. Sushil, D.K. Vijayavergiya, M. Sharda

Government Medical College, Kota, India

Background : The population of elderly is growing rapidly and the number of geriatric Patients in psychiatry is also increasing rapidly. The psychiatric services & the literature on psycho geriatrics have not kept pace with increase in the longevity and the psychiatric needs in many parts of India.

Aim : This study was aimed at finding out the socio-demographic characteristics of elderly patients aged 60 years and above, the magnitude of psychiatric problems & to understanding the pattern of associated physical illness in elderly patients, attending the Geriatric Clinic, MBS Hospital, Kota (Rajasthan).

Materials and Methods : All the patients were evaluated on specially designed semi structured proforma & GHQ-12, MMSE, HAM-A, GDS was used. ICD-10 criteria were used for the diagnosis of patients and Chi-square test was used for statistical analysis.

Results : Psychiatric disorders were present in 35% of the elderly patients, in which depressive disorders (18.5%) were the most common psychiatric illnesses. Many patients had associated physical illnesses and among them hypertension was the most common.

Conclusion : Depressive disorder was the most common psychiatric illness and among the physical illnesses, hypertension was the commonest.


A comparison of phenomenology, co-morbidities and functioning of people with adhd0 from childhood to adulthood

Anubhav Rathi, Prabhat Sitholey, Sivakumar T., Swapnil Sharma

CSMMU, Lucknow, India

Aims and Objectives : To compare the phenomenology of Attention Deficit Hyperactive Disorder (ADHD) in childhood, adolescence and adulthood, to compare the Psychiatric Co-Morbidities with ADHD in childhood, adolescence and adulthood, to compare the global functioning of subjects with ADHD in childhood, adolescence and adulthood.

Methodology : A statistical comparison was made between studies done in Department of Psychiatry, CSMMU UP, Lucknow on Childhood, Adolescent and Adult ADHD for its various aspects.

Conclusions : Hyperactivity-impulsivity decreases as subjects with ADHD grow up and inattention symptoms become more impairing, ADHD is highly Co-Morbid across all age groups but the nature of Co-Morbidities change, functioning of subjects with ADHD improve as they grow older.


A study on association between disability income and medication outcomes in schizophrenia

Jack Tsai, Rajiv Radhakrishnan, Robert A. Rosenheck

Yale University and VA Connecticut Healthcare System

Objectives : As India has only recently begun providing disability income, its effects on patient outcomes has not been examined. Using data on adults with schizophrenia in the United States, this study examined the association between disability income and medication outcomes. It was hypothesized that disability income creates a disincentive for medication adherence. The findings may inform policy decisions in India regarding disability income.

Methodology : Data from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE), which included 1,534 adults with schizophrenia in various treating settings, were used. Regression analyses were used to test the relationship between disability income and time to discontinuation from the CATIE study, controlling for symptomatology and other covariates.

Results : There appears to some association between disability income and medication outcomes, as measured in the CATIE study.

Conclusions : The possible implications of these results for treatment and mental health policy in India are discussed.


A study of mental health and substance abuse in juvenile deliquent children and street children

Jai Singh Yadav, Samiksha Kaur

Aim : To assess the mental health of both delinquent and street children. To assess the substance abuse behavior both in delinquent and street children.

Introduction : Juvenile delinquency is the legal term for behavior of children and adolescents that in adults would be judged criminal under law. Theft is the most common offense by children; more serious property crimes and rape are most frequently committed in later youth. The causes of such behavior, like those of crime in general, are found in a complex of psychological, social, and economic factors. Clinical studies have uncovered emotional maladjustments, usually arising from disorganized family situations, in many delinquents. Street Children are those unfortunate children who basically have only intermittent contact with parents or family (usually mother or sisters) but live most of the time with other street children in the city streets, or are on the move. There are numerous reasons for a child to leave home, some have been literally abandoned by their parents/relatives, some found themselves on the street from the beginning because of family problems, or have chosen to leave home due to some kind of constant abuse. Those who have run away from home can further be separated into two categories. Those have an unpleasant or traumatic home environment. They experience family problems that they are unable to solve: i.e., alcoholism, child abuse, ill treatment by step-parents, unemployment and poverty.

Materials and Methods : 35 delinquents subject and street childen were taken for the study from the observation home (Bal Sampresan Grih) Ramnagar Varanasi. The age, sex, socioeconomic status were same. The group of was 15 to 22 years. The mean age of subject was 18.5 years. All delinquent were male and non convicted.

Tools : Dr. O.N. Srivastava and Dr. B.K. Bhatt Hindi adaptation scale was used. This scale was reliable and valid. The scale was divided in to five subsection Free Floating Anxiety (FFA), Obsessive Trait and Symptoms (OBS), Phobic Anxiety (PHO), Somatic Concomitants (SOM), Depression (DEP), Hysterical Trait and Symptoms (HYS) each subsection have 8 items. The number of item in the scale was 48. Scoring was positive and negative worded.

Procedure : Subject were taken individually first and demographic details was written. Then the questioner was applied individually.

Result : The results showed that low socioeconomic status, low education of parents and child, low occupation, neglect, separated or single parents, death of both parents was responsible for delinquency. The results showed that delinquent children were more involved in substance abuse than street chide. The result of mental health questionnaire was anxiety and depressive symptoms and somatic symptoms were higher than delinquent children.Obsessive behavior, phobic attitude, hysterical symptoms were higher in delinquent children then street child.

Conclusion : The study shows that poor socioeconomic status, low education, lots of siblings were responsible for substance abuse and mental health.


Efficacy of disulfiram in the treatment of alcohol dependence: A one year follow up study

Harisha Delanthabettu, Charles F. Saldana, Jayanth Kumar K.

Background : Substance dependence has been showing a rising trend all over the world including India. Alcohol related behavioral and medical complications are of a major concern for health professionals. Pharmacological treatment is emerging as another means to enhance abstinence and prevent relapse, complementing psychosocial interventions that have been in use for many years. Disulfiram has been used for close to 50 years and many practitioners believe that it has a great value.

Aims and Objectives : To evaluate the efficacy of Disulfiram at enhancing the abstinence and preventing relapse in patients with alcohol dependence.

Materials and Methods : Patients admitted to 'Ashakirana' (a rural de-addiction and rehabilitation center from Karnataka, recognized by Ministry of Social Justice & Empowerment, Govt. of India) between 1 st March 2008 and 28 th February 2009 were considered for the study. SCAN was administered. Diagnosis of dependence syndrome was based on ICD-10 criteria. A semi structured interview schedule for socio-demographic data. Patients on disulfiram (250-500 mg/day) were followed up for 1 year.

Results : Out of 292 patients with substance dependence, 253 patients were alcohol dependent. 241 patients were on Disulfiram and remaining 12 patients were not given the disulfiram for medical reasons. Out of 241 patients on Disulfiram, 154 patients came for regular follow up and remaining 87 (34.4%) patients were drop outs. Number of follow ups were documented. Patients with disulfiram showed good results with reduction in the drinking frequency and abstinence. Patients without Disulfiram did not turn up for follow up.

Conclusion : The pharmacotherapy of alcohol dependence is experiencing a major shift in direction, however traditional medications such as disulfiram, still have value.


A clinical study of phenomenology and comorbidity of paediatric bipolar disorders

V.K. Aravin, V.D. Krishanram, Thasneem

Ram Psychiatry Hospital and Institute, Madurai, India

Background : Considerable controversy exist regarding clinical presentation, diagnosis, and comorbidities specially, Attention Deficit Hyperactivity Disorder (ADHD) in paediatric bipolar disorders (BPD).

Aims : To discuss the phenomenology and comorbidities of paediatric BPD.

Materials and Methods : 60 subjects (6-14 years) attending child and adolescent psychiatry services of Ram Psychiatry Hospital Child Guidance Clinic who fulfilled, DSM-IV-TR 2000 cirteria for BPD were assessed using K-SADSPL, Child Mania Rating Scale (CMRS), child depression rating scale (CDRS) ADHD-rating scale and children's global assessment scales.

Results : All the subjects were diagnosed as bipolar disorder-I (BPD-I). Their mean chronological age was 12.6+1.7 years and the mean age at onset of BPD was 11.5+1.9 years. The commonest symptoms in mean were increased goal directed activities, distractibility (100% each), elation (100%), and grandiosity (96.6). Irritability and rapid mood swing were reported by parents in 77.6% and 46% subjects respectively. Psychotic symptoms were present in 12.9% of the subjects. 2(3.2%) subjects had chronic course, and one (1.6%) had rapid cycling. 10(16.1%) subjects had one or more current comorbid disorders. Two subjects had ADHD (3.2%), and one had oppositional defiant disorde (1.6%).

Conclusions : In children and adolescents elation/grandiosity is more a common presentation than irritability. Chronic course, rapid cycling, mixed episode and comorbidities are rare in paediatric BPDI. Differentiation of comorbid disruptive behaviour disorders especially ADHD from BPD is possible with respect to age of onset, quality of the disturbed mood, and the course of each disorder.


Study on association between primary psychiatric disorders and specific developmental disorders in children attending psychiatric opd0 in a general hospital

Kasthuri P., Jagadesh, Bharathi

Bangalore Medical College And Research Institute

Introduction : Psychiatric disorders in children were defined as conditions in which there was an abnormality of behavior, emotions or relationships which were sufficiently marked and prolonged to cause a child to be impaired in his social functioning and lead to distress, disturbance in the family or community (Rutter, 1976). Most psychiatric disorders in children consists of a quantitative departure from the normal cause of development.

Objective : To assess the association between primary psychiatric disorders and specific developmental disorders.

Materials and Methods : It is a cross sectional study.100 children below 16 yrs attending psychiatric out patient department at Kempegowda Institute of Medical Sciences, Bangalore were included in the study. The research intended to study the pattern and association between primary psychiatric disorders and specific developmental disorders. The clinical interview schedule, social demographic data, studies check list, child behaviour check list were administered. Connor's ADHD scale and Binet-Kamat were administered as and when required.

Results : 20% of the children did not have any axis 1 diagnosis. 31% ADHD, 8% Had dissociative disorder, 13% had eneuresis, 5% had depressive disorder and conduct disorder. 2% had social anxiety, separation anxiety, and sibling rivalry. 1% had phobic anxiety disorder, somatoform disorder and impulse control disorder. 4%had unspecified behavioral and emotional disorder. 1% had mania and bipolar affective disorder currently depressed. Association between psychiatric disorder and specific developmental disorder children with ADHD had 4 different axis diagnosis, i.e. One with speech and articulation, 1 had expressive language defect. One had mixed disorder scholastic skills, 1 had specific developmental delay in motor functions. One child had hysterical conversion and mixed disorder of speech and scholastic skills. One child had separation anxiety with mixed disorder of scholastic skills. One child had enuresis with mixed disorder of scholastic skills. One child had encoparesis with mixed disorder of scholastic skills.


Outcomes of mild cognitive impairment: A population study dementia subthemes - Alzheimer's disease, MCI, epidemiology

Mary Ganguli

Western Psychiatric Institute and Clinic, University of Pittsburgh

Objective : Mild cognitive Impairment (MCI) is widely regarded as a prodromal stage of Alzheimer's dementia, but outcomes of MCI in fact vary by setting. This study investigated the one-year outcomes of individuals classified as having MCI by different definitions at the population level.

Materials and Methods : A population-based stratified random sample of 1982 individuals aged 65+ years in a US community was characterized at baseline. Participants were classified as MCI using operational definitions of several current criteria for MCI: Amnestic MCI by Mayo criteria, Expanded MCI by International Working Group criteria, Clinical Dementia Rating (CDR)=0.5, and a purely cognitive classification into Amnestic and Non-Amnestic MCI. At one-year follow up, for each MCI definition, three outcomes were examined: worsening (progression to dementia with CDRe"1 or severe cognitive impairment); improvement (reversion to CDR=0 or normal cognition); and stability (unchanged CDR or cognitive status).

Results : Regardless of MCI definition, over one year, a small proportion progressed to dementia with CDR>1 (range 0-3%) or severe cognitive impairment (0-20%) at rates higher than their cognitively normal peers. Somewhat larger proportions improved or reverted to normal (6-53%). The majority remained stable (29-88%). Where definitions focused on memory impairment, and on multiple cognitive domains, higher proportions progressed and lower proportions reverted on CDR.

Conclusions : MCI is a heterogeneous entity at the population level although it progresses to dementia at rates higher than in normal elderly. Proportions progressing to dementia are lower, and proportions reverting to normal are higher, than in specialized clinical research settings. Memory impairments and impairments in multiple domains lead to greater progression and lesser improvement. Research diagnostic criteria for MCI should be validated at the community level before incorporation into clinical practice, to allow treatment strategies to be targeted appropriately.


Attitude towards antipsychotics medication among patients with schizophrenia

Karthik M.S., Kulhara P., Chakrabarti S.

Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

Aim : The present study aimed to assess attitudes towards antipsychotic medication among patients with schizophrenia.

Materials and Methods : It was a cross sectional study. For this purpose, structured assessment of these variables was carried out in a randomly selected sample of 50 patients with schizophrenia from those attending the out patient clinic or admitted to the inpatient unit of the Department of Psychiatry at PGIMER,, Chandigarh.

Results : Patients were mainly middle-aged (29.8±7.6 yrs), males (72%) who were educated (80%) and coming from nuclear (64%), and urban-based families (82%). A large proportion was, however, single (72%) and unemployed (78%). Most subjects were outpatients with chronic schizophrenia (7.9±5.7) with moderate levels of symptoms on Positive And Negative Symptom Scale with scores on positive symptoms (10.9±4.01), on negative symptoms (9.2±2.9), on general psychopathology (21.8±4.8) and moderate degree of impairment in their functioning GAF scores (58±11). Almost all of them were receiving second generation antipsychotics (98%). Most patients had a positive attitude towards antipsychotics 86% (n=43) of patients scored greater on items related to positive attitude in DAI-30. For the entire sample of 50 patients average positive attitude scores of (21±5.5) were significantly greater (t=12; P<0.0001; df=48) than average negative attitude scores of (9±5.5).

Conclusion : This study demonstrated that global attitude is favourable in patients. These findings can contribute to the understanding of attitudes towards antipsychotics of patients with schizophrenia.


Spousal support and self-esteem in postpartum depression

Supriya Hegde, Sripathy Bhat, Latha K.S., Sharma P.S.V.N.

KMC Hospital Mangalore,India

Aims : (1) To study the prevalence of post-partum depression and its emergence up to 14 weeks at follow-up. (2) To study marital quality and self-esteem as psychosocial correlates of postpartum depression.

Methodology : A total of 150 women were studied up to 14 weeks postpartum. Depression was assessed using the MINI PLUS. Marital quality was assessed using the Marital Quality Scale and self-esteem using the Rosenberg Self-esteem scale. The results were analysed using the SPSS Version 13.

Results : The point prevalence of depression was 11.3% at 1 st week, 15.8% at 6 weeks and 15.5% at 14 weeks postpartum. The depressed group had poor marital quality and lower scores on self-esteem than the non-depressed group.

Conclusion : This study is a modest exploratory attempt to assess the role of psychosocial variables in postpartum depression.


A study of non compliance of drug treatment in psychiatric patients

R.S. Swaroopa Chary, Samrat Kar, C.M. Pavan Kumar Reddy,

R. Sateesh Babu

Background : Non compliance for the medication is an important area of concern in psychiatry as it contributes to relapse and re-hospitalization of the patients.

Aims and objectives : To find out the reasons for drug non compliance and its association with clinical and socio demographic variables of the psychiatric patients.

Methodology : A study is being conducted on all patients attending psychiatry out patient department for duration of one month to evaluate the compliance for the treatment using a questionnaire designed for the purpose.


Evaluation of psychiatric disorders in patients of traumatic amputation

Anjali Karira, Nilesh Shah, Deepak Joshi, A.B. Goregaonkar

Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India

Introduction : The psychiatric aspect of traumatic amputation has received less interest even though they are common and on the rise. Traumatic amputation leads to development of psychiatric co-morbidities as reported by Mall et al.. (1997) with 34.6% incidence of psychiatric disorders (depression and PTSD). Depression may delay rehabilitation which in turn exerts a depressing effect on the individual. The prevalence rates of PTSD and major depression were 20% and 63% respectively in traumatic amputees as reported by Mansoor et al.. (2010). Awareness and proper treatment of psychiatric co-morbidities play important role in physical and occupational rehabilitation. The purpose of our study is to examine the prevalence of psychiatric comorbidities in traumatic amputees.

Aims and Objectives : (1) To assess premorbid psychiatric disorders and its impact on patients undergoing amputation. (2) To assess development of psychiatric disorders in patients undergoing amputation over three months. (3) To study effect of premorbid and post-morbid psychiatric disorder on post amputation adaptation based on mobility, self care, work and interpersonal communication. (4) To evaluate impact of psychiatric intervention on patients' adaptation.

Methodology : The sample consists of 30 patients of traumatic limb amputation at a tertiary municipal general hospital. Patients of either sex in the age group of 18-60 years are included in the study. The demographic profile of patients and reasons for amputation are assessed. Premorbid psychiatric disorder and its relation to amputation are assessed. Patients are interviewed clinically for development of psychiatric disorders over three months. They are also assessed objectively using Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale and SF36 (version 2) questionnaire for quality of life. Impact of psychiatric intervention is assessed.


ECT in general hospital psychiatry unit - A retrospective chart review

Survesh Kumar L.H., Supriya Hegde, Ravish Thunga

Aims and Objectives : The study aims to assess the socio demographic variables, psychiatric diagnosis, psychiatric medications and outcome measures in patients who have received ECT.

Methodology : This study is a retrospective chart review of patients who have received ECT between the period 2004 to 09. Appropriate statistical tests were done to analyse the data.

Results : A total number of 622 ECTs were administered. Common psychiatric diagnosis among the patients being schizophrenia, severe depression, acute mania and catatonia. Subjective improvement reported with ECT was significant.

Conclusions : ECT is a relatively safe and efficacious biological treatment modality available to the psychiatrist in the management of severe psychiatric condition.


A study of disability in psychiatric patients

K. Anupama, Samratkar, Pavan Kumar Reddy, Sateesh Babu

Mamata General Hospital, Khammam, Andhra Pradesh, India

Background : Disability in psychiatric patients is a major contributor to the global burden of diseases and on their families.

Aim : To evaluate and compare disability in psychiatric patients.

Materials and Methods : In an ongoing study, disability in psychiatric patients attending psychiatric outpatient department, is being assessed using Indian disability evaluation assessment scale (IDEAS)


Dissociative (conversion) disorder - A cross-sectional study of socio-demographic characteristics and stressful life events in Hadoti region

Supriya Agarwal, D.K. Sharma, C.S. Sushil, D.K. Vijayvergia

Government Medical College, Kota, Rajasthan, India

Aims & Objectives : (1) To study the socio-demographic profile of patients of Dissociative (Conversion) Disorder in Hadoti region. (2) To find the number of stressful life events precipitating the disorder in these patients.

Methodology : 50 consecutive patients of Dissociative (conversion) disorder above 12 years, attending/admitted in the Psychiatric or Emergency OPD/ Ward, were taken up for the study. The diagnosis of Dissociative (conversion) disorder was confirmed by 2 consultant Psychiatrists as per ICD-10 criteria. Further these patients were evaluated using- (1) A Specially Designed Semi-Structured proforma to collect the socio-demographic and other details. (2) Stressful life event's scale by Gurmeet Singh et al. (1982) - to study the number of stressful life events experienced in previous one year.

Results and Conclusions : In our studied population there was predominance of females (88%), married (70%), housewives (66%), illiterate (40%), Hindu religion patients (54%), and age group of 18-30 years. Majority of the patients came from rural background (66%). Most of the patients had joint family (50%), and had family size of 5-10 members (48%). 54% of the patients were of middle birth order. 50% of the patients were found to have some immediate or prolonged strained relation with their family members (parents/in-laws/ husband). 58% of them came from lower socio-economic status followed by middle (36%) and upper socio-economic status class (6%) respectively. Past psychiatric illness was present in 40% of the patients, of which 36% gave history of episodes of dissociative (conversion) disorder. One or more stressful life event was present in 46% of the patients at the time of presentation. The most commonly presented event was family dispute. Results will be discussed in detail at the time of presentation.


Prevalance of anxiety and depression in chronic obstructive pulmonary disease patients

T. Sukshma, Pavan Kumar Reddy, P. Sridhar, Samrat Kar,

Sateesh Babu

Mamata General Hospital, Khammam, Andhra Pradesh, India

Background : Patients with chronic respiratory illness, especially Chronic Obstructive Pulmonary Disease are known to have high rates of anxiety and depression due to prolonged period of illness.

Aims and Objectives : To assess the prevalence of anxiety and depression in Chronic Obstructive Pulmonary Disease patients.

Methodology : In an ongoing study, fifty Chronic Obstructive Pulmonary Disease in-patients will be examined in department of Pulmonary medicine in Mamata General Hospital, Khammam, Andhra Pradesh for anxiety and depression using tools- "The Hamilton Rating Scale for Anxiety" and "The Hamilton Rating Scale for Depression".


Temperamental and personality characteristics of sexual dysfunction patients: A hospital based study

Chaudhry, Rupesh Mishra B.P.

Dayanand Medical College and Hospital, Ludhiana, Punjab, India

It is reasonable to assume that personality factors will influence sexual development and establishment of sexual intimacy. Neuroticism was regarded as relevant to sexuality in earlier studies but results are not consistent (Copper, 1968; Eysenck, 1976; Slater 1945). Costa et al.. (1992) found neuroticism to be correlated with lower sexual satisfaction and extroversion with sexual drive. It is also reported that obsessive compulsive personality traits also leads to sexual dysfunction (Black et al.. 1997; Shapira et al.. 2000).

Aim of the Study : To see the personality characteristics of the patients presenting with sexual dysfunction and how it associated with the pathology.

Materials and Methods : Personality evaluation of 50 (both married and unmarried) diagnosed patients of sexual dysfunction presenting to Psychiatry out patient department was done using Cattel's 16 PF questionnaire. Patients with hypertension, diabetes, head injury and co morbid substance abuse were excluded from the study.

Results : The 16 PF profile of these patients reflect that they are more prone to decide impulsively rather than using their intellectual ability or reasoning. They have low frustration tolerance and gets easily upset and frustrated in smaller things. These type of emotional status leads to pre-mature ejaculation and erectile dysfunction since patient gets distracted to other things. These patients have apprehensive tendencies and worrying for small things which in turn leads to depressive cognition which is again a known factor for sexual inadequacy. Overall, majority of these patients show obsessive traits on 16 PF.


Profile of patients admitted in a dual diagnosis ward of a tertiary care neuro-psychiatric hospital

Rajesh Kumar, Vivek Rastogi, Nimesh G. Desai

Institute of Human Behaviour and Allied Sciences, Delhi, India

It has been realized that patients with dual diagnosis are clinically more complex and demanding than those with substance use disorders only. They have more complicated course of illness and usually a poorer prognosis generating a need for early identification of clinical profile of such patients.

Aims and Objectives : The present study is being carried out to study the profile of such patients admitted in the dual diagnosis ward of a tertiary care psychiatric hospital.

Methodology : The case record files of all consecutive patients admitted, between 1 st September 2009 and 31 st August 2010, in the dual diagnosis ward of IHBAS were reviewed for detailed information on a Semi-structured Proforma. The results were then analyzed using descriptive statistics.


Caregiver burden and psychiatric problems in caregivers of patients suffering from tension type headache and migraine: A comparative study

Vivek Rustagi, Lovleen Kaur

Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi, India

Caregiver burden in neuropsychiatry is well recognized but very few studies are available on care providers of patients with tension type headache (TTH) and migraine.

Aims and Objectives : On this background, the present study was conceptualized to assess caregiver burden and psychiatric problems in caregivers of TTH and migraine.

Methodology : 20 patients each, suffering from tension type headache and migraine were selected from Neurology OPD of IHBAS and Burden scale (Pai & Kapoor) and General Health Questionnaire were administered on the caregivers. Descriptive statistics were then used to analyze the data obtained.


A comparative study on socio-demographic and clinical profile of patients undergoing admission and readmission in a regional institute of mental health in north eastern India

Sourav Das

LGB Regional Institute of Mental Health, Tezpur, Assam, India

Aims and Objectives : To find out and compare the socio-demographic and clinical profiles of patients getting first admission and readmission in the LGB Regional Institute of Mental Health in the year 2009.

Methodology : A retrospective, record based observational study from the computerized database of the institute and the case record files of the patients admitted for indoor facilities of the institute within a period of 1 st January to 31 st December 2009.. Variables like age, sex, religion, marital status, locality, education, occupation, and diagnosis were taken into account. Standard statistical tools like percentage, mean, chi square tests were used for analysis. SPSS version 16.0 for windows was used for statistical analysis.

Results : Total numbers of patients with new admissions were those of patients undergoing admission more than once in the time period.

Conclusion : No significant difference in readmission rates found for sex, marital status, religion, educational status or locality. Readmission rates are significantly different among professions with P<0.001, with rates among housewives being less than expected. There were significant differences found among different diagnoses in terms of readmission with P<0.001, with F30-39 showing more than expected readmissions and F10-19 showing more than expected first admission with less than expected readmissions.


Quality of life of patients with generalized anxiety disorder

Vijay K.G., Ajit Avasthi, Sandeep Grover

PGIMER, Chandigarh, India

Background : Generalized Anxiety Disorder (GAD) is characterized by unfocused worry and anxiety that is not connected to recent stressful events, although it can be aggravated by certain situations. There is some data from West to suggest that GAD leads to poor Quality of life (QOL), however, there is scarcity of data from India. Aim of the study : To study the QOL and its correlates in patients with GAD.

Methodology : Thirty patients diagnosed as having GAD (as per MINI) were recruited. Those with co-morbid psychiatric and physical disorders were excluded. QOL was assessed by using WHOQOL - Brief Hindi version and the severity of GAD was assessed by GAD-7 scale.

Results : The sample included equal number of subjects of either gender and three-forth (76.7%) of them were currently married. About two-third of the patients were Hindus (66.7%), currently employed/student (63.3%), belonged to nuclear family (63.3%) and urban background (63.3%). The mean age of the sample was 42.4 years (SD-11.99) and the mean number of years of education was 11.5 years (SD-4.05). The mean duration of illness at the time of assessment was 53.83 months (SD- 56.45). The mean GAD-7 score was 13 (SD-3.50) and the mean QOL domains scores were: 5.86 (General well being domain), 19.13 (physical health domain), 17.96 (psychological health domain), 9.56 (social domain) and 26.63 (environmental domain). The total QOL score was 79.16 (SD-9.71). Poorer QOL in psychological domain was associated with higher symptom severity as assessed by GAD-7 (Pearson Correlation coefficient - 0.407*), in being younger at the time of assessment (Pearson Correlation coefficient - 0.336*) and being a male (Spearman rank correlation coefficient - 364*). Early age at onset was associated with poorer General well being QOL scores (Pearson Correlation coefficient - 0.377), whereas lower level of education was associated with poorer QOL in the environmental domain (Pearson Correlation coefficient - 0.475). There was no correlation of QOL domain scores and total QOL scores with other sociodemographic and clinical variables.

Conclusion : Patients of GAD with higher symptom severity, who are male and younger have poorer psychological QOL whereas lower level of education is associated with poorer QOL in the environmental domain.


Ventricular brain ratio as an endophenotype in depression

Amil Hayat Khan, S. Haque Nizamie, Amrit Pattojoshi

B.R.D. Medical College, Gorakhpur, Uttar Pradesh, India

Aim : To compare ventricular brain ratio (VBR) of patients with depression, their first degree relatives, and normal controls.

Objectives : To establish the ventricular brain ratio as an endophenotype of depression.

Methodology : 15 drug free male patients, with ICD-10 clinical diagnosis of depression or recurrent depressive disorder currently mild, moderate and severe without psychotic symptoms along with their first degree male relatives and 15 age matched normal controls went for CT scan without contrast with 8mm thick slice supra-tentorially and 5mm slice at posterior fossa in sequential mode. Results : Patients with depression have significantly more ventricular dilatation or VBR than their first degree relatives (FDR) and normal controls. FDRs have also comparable ventricular dilatation in comparison to normal controls.

Conclusion : Ventricular enlargement can be interpreted as an indirect indicator of a widespread brain dysmorphology influencing depression in one or the other direction.


Prevalence of suicidal incidents in Kolkata metro track

Prativa Sengupta, Arnab Banerjee, Tapas Kumar Ray

Aims and Objectives : To find out the prevalence of suicidal incidents in the Metro Track of Kolkata. Suicide is the process of purposefully ending one's own life. The World Health Organization (WHO) estimates that it is the 13 th leading cause of death worldwide. WHO also pointed out that approximately one suicidal death occurs in every 40 seconds and a suicidal attempt takes place in every three seconds across the globe. In Indian context suicidal death is also an alarming issue that draws the attention of nation because in the last two decades, the suicide rate has increased from 7.9 to 10.3 per 100000 population. There is also a wide variation in the suicide rates within the country. West Bengal records the highest rate of suicidal incidents (19 cases per 100000 population). Currently, jumping on the Kolkata Metro Track has become a chosen method of committing suicide. The increasing frequency of such incidence is of great concern to the society itself. This situation has prompted the Sane & Enthusiast Volunteer's Association of Calcutta team to under take a study titled 'Suicidal incidents in Kolkata Metro'.

Methodology : All necessary information regarding the socio demographic background of the persons who committed suicide or attempted for suicide at Metro track from March 2000 to March 2010 were collected from Metro Bhavan. The data was statistically analyzed.

Results : It was revealed that 143 persons attempted for suicide during the aforementioned period. Among them, 55.24% expired on the spot and 44.76% were rescued and hospitalized. Among the people who committed suicide/attempted for suicide 76.35% are male and 23.65 are female. Interestingly 52.03% belonged to the age group from 18 yrs to 38 yrs.


Personality correlates of hiv0 infection

Lt. Col. V.S. Chauhan, S. Sudarsanan, Lt. Col. (Retd.) S. Chaudhury

Aims and Objectives : To study psychiatric morbidity in asymptomatic HIV patients admitted in a large tertiary care hospital.

Methodology : A cross-sectional study was undertaken to assess psychiatric morbidity in 100 consecutive asymptomatic seropositive HIV patients and an equal number of age, sex, education, economic and martial status matched normal sero-negative control.

Statistical Analysis : The demographic characteristics of the group were compared by the chi-square test. For comparing the scores on psychiatric rating scales the Mann-Whitney-U test was used.

Results : Out of the 100 asymptomatic HIV patients included in this study, 55 were referred for initial work up and confirmation of diagnosis from peripheral hospitals. 45 were admitted for yearly review/surveillance. None of the patients had any physical ailment at the time of evaluation. The subjects in two groups were matched in age, sex and education status. Risk factors for HIV in the present study were heterosexual promiscuity in 85% of the cases while multiple injections/tattooing (3%), transfusion of unscreened blood (25), health worker handling blood (1%) and in (9%) patient denied any high-risk behaviour. These findings were similar in Indian studies of Madan et al.. (1997); Chandra et al.. (1999); and Singh et al. (2001). In contrast the western studies had higher number of homosexual transmission and IV drug abuse (Johnson et al., 199; Rabkin et al., 1997). Sensation seeking trait was assessed under the four different characteristics. Thrill and adventure seeking, Experience seeking and Boredom susceptibility revealed statistically significant higher scores in asymptomatic HIV patients compared to HIV seronegative controls. However Disinhibition scores did not reveal any statistically significant difference between two groups. These findings were similar to studies by Beatty et al. (1997), Chng and Galiga (2000), Lolejal et al. (1997) and Kalichman et al. (2002). It also confirms the findings of Anderson who had reported higher boredom susceptibility trait as one of the factor responsible for high-risk behaviour (Anderson et al., 1994). This also confirms the 85% of HIV positive indulging in high-risk behaviour leading to the dreaded illness. Twelve asymptomatic HIV patients out of 100 met the criteria for alcohol dependence syndrome compared to only 02 HIV sero-negative controls. The difference between the two groups for alcohol dependence syndrome was statistically significant. It confirmed the findings by Rosenberg et al. (2001) who revealed alcohol as strongest predictor of HIV drug risk behaviors, stronger than drug use generally.

Conclusion : In asymptomatic HIV patients high sensation seeking and substance abuse may play a vital role in engaging in high-risk behaviour resulting in this dreaded illness.


A study on socio-demographic and clinical profile of patients admitted in a regional institute of mental health in north eastern India

Sumit Mehta

LGB, Regional Institute of Mental Health, Tezpur, Assam, India

Aims and Objectives : To find out the socio-demographic and clinical profiles of patients getting admitted in the LGB Regional Institute of Mental Health in the year 2009.

Methodology : A retrospective, record based observational study from the database of the institute and the case record files of the patients admitted for indoor facilities of the institute within a period of 1 st January t0 31 st December 2009. Standard statistical tools like percentage, mean, chi square tests were used for analysis. SPSS version 16.0 for windows was used for statistical analysis.

Results : Total numbers of admissions were 1399, consisting of 1339 patients, and 60 admissions were those of patients undergoing admission more than once in the time period. Males were 992 (74%), and females were 347 (26%). 725 (54.1%) patients were in the age group of 16-30 yrs and 508(37.9%) were in the age group of 31-45 yrs. Mean age of admission in general was 31.2 yrs, with mean age for males being 30.79 yrs and mean age for females being 32.42 yrs. For admissions who were >45 yrs of age, the percentage for females was 33.33% and that for female patients admitted above 45 yrs age with psychosis was 37.33%. Hindu patients were 1049 (78%), Muslim 197 (15%) and Christian were 91 (7%). 1077 (80.4%) were from the rural and 233 (17.4%) from urban areas. 585 (43.7%) were married and 754 (56.3%) were single at the time of admission. 636 (47.5%) were unemployed, 168 (12.5%) were cultivator, and 159 (12%) were housewives. 74.4% of patients admitted had a diagnosis within F20-29 and 15% having that between F30-39.

Conclusion : Not only is the admission rate of females much lower than that of males but also the mean age of admissions higher in the female sex. Moreover, the frequency of female admission above 45 yrs age group is comparatively higher than its male counterparts, even more so in patients of psychosis in that age group. Schizophrenia and schizophreniform psychosis mostly from the rural population form the major reason for admission in the area.


Prevalence of attention deficit hyperactivity disorder in 6-8 year old school children

Anshu Gupta, B.P. Mishra

SPS Apollo Hospital, Ludhiana, Punjab, India

Background : Prevalence of Attention Deficit Hyperactivity Disorder in 6-8 year old School Children Attention Deficits and Hyper Activity is a common but under diagnosed disorder in India.

Aims : A study was undertaken to find out the prevalence of attention deficit hyperactivity disorder in 6-8 year old school children in Ludhiana District.

Methodology : The study comprised of 2224 children who were taken from 3 different socioeconomic strata of the society. Each child was screened by the SNAP-IV scale (teachers rating) for Attention Deficit Hyperactive Disorder (ADHD) and oppositional defiant disorder (ODD). A total of 78 children who were positive on this scale were called to the hospital for detailed assessment.

Results : It was found that there is a considerably high prevalence of ADHD in school going children, more in males 4.35% than in females 2.48%. Overall, the prevalence of ADHD increases with age while socie economic status appears to have minimal effect on the prevalence of ADHD. The most common subtype is the combined type followed by inattentive and hyperactive/impulsive type respectively. Male sex and younger age predispose to predominantly inattentive type of disorder while female sex and order age predispose to predominatly inattentive type of disorder. ODD as comorbid to ADHD is more common in males with increase in prevalence with increasing age. Prevalence of ADHD is more common in first born especially the only child while other socio- demographic factors do not seem to have significant influence on the prevalence of ADHD. Males show higher problematic behaviour and problem on more symptoms as compared to females.

Conclusions : The incidence and prevalence of Attention Deficit and Hyper Activity Disorder is on the rise in school going children. There should be proper attention and focus of professionals in the field to spread awareness and effective management strategies are required in current scenario.


Metabolic syndrome in subjects with schizophrenia

Munish Aggarwal, Sandeep Grover, Subho Chakrabarti, Alakananda Dutt, Ajit Avasthi, Parmanand Kulhara

PGIMER Chandigarh, India

Background : Studies from the West show a prevalence rate of metabolic syndrome (MS) in subjects with schizophrenia to be in the range of 9% to 54%, however, there are minimal data from India.

Aim of the study : To study the prevalence and risk factors of MS in subjects with schizophrenia.

Materials and Methods : Sociodemographic, clinical and anthropometry data and metabolic profile were collected prospectively from 297 subjects with schizophrenia attending the psychiatry outpatient clinic. Metabolic syndrome was defined according to the International Diabetic Federation (IDF) criteria.

Results : About one-third subjects were more than 40 years of age and were currently employed. Three-fifth of the subjects were males, from nuclear families and from urban background. Three-fourth of the subjects was Hindu by religion. Overall, 42.8% of subjects (N=127) met the IDF criterion for metabolic syndrome. Among the various criteria of metabolic Syndrome, the most commonly satisfied criterion was that of waist circumference (N=199; 67%), followed by high density lipoprotein (N=151; 50.8%), triglyceride and blood pressure (N=118; 39.7% each), and the least commonly satisfied criterion was that of fasting blood sugar (N=91; 30.6%). Among the various sociodemographic risk factors, age, female gender, being house wife or engaged in house hold work and from an urban background were found to be significant risk factors for the development of metabolic syndrome. Conclusion : Our study suggests that there is high prevalence of MS in subjects with schizophrenia. This increased risk must be remembered while choosing various psychotropic agents. It is suggested that the subjects with schizophrenia should routinely undergo physical evaluation and should be investigated from time to time to take appropriate measures.


Addiction, community care and rehabilitation impact of community sensitization on drug deaddiction camp: A preliminary study

Arun Misra, Seema, Manpreet Kaur, O.P. Giri, P. Kulhara

Drug Deaddiction and Treatment Center, PGIMER, Chandigarh, India

Drug Deaddiction and Treatment Center of Department of Psychiatry, PGIMER, Chandigarh is providing outpatient services once in a week to patients of substance use disorder (SUD) in the civil hospital in Kharar tehsil of District Mohali of Punjab. Center started drug Deaddiction camps in the catchment area and elsewhere with the objective of one, imparting awareness related to addiction to community; second, taking treatment in situ to link eventually the continuation of services in the primary care and if need be tertiary care level. Present study is an endeavour to see what best awareness strategy helps the center to motivate most cases of SUD to seek treatment services in the camp setting.

Aim : To study impact of awareness campaign on type of referral of SUD cases in the camp setting.

Objectives : To see the referral pattern of cases seen in the camp setting. Study socio-demographic profile and diagnosis in relation to referral pattern.

Methodology : Drug Deaddiction and Treatment Center has organized more than 50 camps. The present study has studied cases of the recent camps organised in the catchment area for the study. All the potential cases of substance use disorder were interviewed on semi-structured schedule for eliciting sociodemographic, referral pattern and clinical history in outreach setting by social workers and psychiatrists respectively.

Results : Analysis of the data for referral pattern show that most of the cases came on their own and motivated by the local leaders, or motivated by natives of the village close to cases. The implication of the findings were discussed in the light of inputs used in terms of manpower, time etc. to help in formulating strategies for using effective measures for awareness campaign for such camps in future.


Married women coping with physical violence at home

Indira Sharma, Maheshwar Nath Tripathi, Anuradha

Banaras Hindu University, Varanasi, India

Objective : The aim was to study the pattern of responses opted by married women to cope with physical violence at home and to study the range of coping responses that were successful in preventing physical violence at home in the recent past (6 months).

Materials and Methods : Married women in the age range of 20 to 60 years were selected from the psychiatry OPD of a University Hospital, BHU, Varanasi. Coping with Physical Violence at Home Questionnaire (CPVHQ) was used for the assessment of pattern of responses opted by women for coping with physical violence at home and the methods actually used by women when faced with physical violence at home in the recent past (6 months).

Results : Coping method opted by majority of the women were, complaining to in laws (82%); complaining to parents or relatives at parents' place (78%); going to parents place for a short period of time (76%); non-cooperative movements like, refusal of sex (68%); refusal to go out with husband (68%) and not talking to spouse/perpetrator (66%). Among the 3 best coping methods, "refusal to go out with husband" figured the most prominently (54%), followed by "refusal of food" (38%)" and "to tell the perpetrator that it is wrong or illegal to beat a woman" (30%). The majority of women (66%) experienced physical violence in the recent past and used coping method which were found to be successful in 30% of the cases.

Conclusion : The study provided the list of coping methods that can be used by women when they are confronted with physical violence at home. It showed that some methods (refusal of food "complaining to parent-in-laws or parents" and "not talking to spouse", were the most effective in preventing physical violence in women.


A pharmacogenetic study on eastern Indian attention deficit hyperactivity disorder probands

Swagata Sinha, Sarkar K., Ghosh P., Ray A., Mukhopadhyay K.

Manovikas Kendra, Kolkata, India

The childhood onset neurobehavioral disease attention deficit hyperactivity disorder (ADHD) is considered to have a genetic basis due to high heritability. Since drugs used for remedial medication are mostly targeted at the dopaminergic system, different genes in this pathway have become interesting targets for genetic association studies.

Objective : of the present investigation was to explore relations between different dopaminergic gene variants and outcome of ADHD subjects following therapeutic intervention based on the pharmacogenetic approach.

Materials and Methods : Eastern Indian ADHD probands were recruited based on the Diagnostic and Statistical Manual of Mental Disorders-version IV. Intelligence quotient of the probands was assessed by the Wechsler's Intelligence scale for children. Hyperactivity level was scored by the Connor's rating scale. Peripheral blood samples were collected from ADHD probands after obtaining informed written consent from their parents for participation. Genomic DNA isolated was subjected to PCR based analysis of eight functional polymorphisms in DRD4, DAT1, MAOA, COMT, and DBH genes to identify the status of these dopamineric gene variants. Plasma dopamine beta hydroxylase enzyme activity was measured to understand the status norepinephrine, another neurotransmitter in the dopaminergic system. Based on the genetic setup and status of norepinephrine, ADHD cases were prescribed with two types of medications, namely methylphenidate and atomoxetine, drugs commonly used for treatment of ADHD subjects.


Attitudes of psychiatric hospital staff towards mental illness and patients' satisfaction with psychiatric services

Mohd. Shakeel, Sreeraj. S.V., Uvais N.A., Katshu, Mohammad Zia Ul Haq, Bhattacharya Deepanjan

Central Institute of Psychiatry, Ranchi, India

There is limited knowledge or understanding into the attitudes of nurses, ward boys and other staff associated with the care of the mentally ill and individuals experiencing mental health problems. Patient satisfaction as a vital component of health outcome remains an area of interest and need in health care and seems to be significantly affected by the attitude of the caregivers towards the mental health.

Aims and Objectives : Aim of this study was to assess the attitude of nurses, ward boys and others working in a mental health setup towards mental illness and assess the satisfaction of patients with psychiatric care and find correlation, if any, between these.

Methodology : It was a cross-sectional study conducted at an inpatient treatment facility. Hundred randomly selected hospital staff including registered nurses, ward-boys and others was assessed for the attitude towards mental illness using the Community Attitudes towards the Mentally Ill (CAMI) scale. 100 randomly selected patients who had completed at least 1 month of hospitalization were assessed for treatment satisfaction with Client Satisfaction Inventory (CSI-SF).

Results : Descriptive analysis of the data showed that there is a relationship between satisfaction towards treatment of psychiatric patients and a positive attitude towards them by the health caregivers. A significant correlation was also found between the attitudes of health care givers and the patients' satisfaction.

Conclusion : The attitude of the mental health caregivers towards mental illness has a significant bearing on the patients' satisfaction of the care.


Psychiatric manifestations of patients admitted for intentional self harm in a tertiary care hospital

Ajay Risal, Pushpa Prasad Sharma

Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Nepal

Background : Kavre is considered to be a district with high suicide prevalence in Nepal and some patients attempting suicide are brought to the hospital before they turn fatal. Dhulikhel Hospital is a university hospital (a tertiary care center) where many of such patients are brought. Among many factors of suicide, psychiatric illnesses are of vital importance. This study attempts to evaluate psychiatric manifestations of such patients admitted in a tertiary care hospital.

Aims and Objectives : To study various psychiatric manifestations in the patients admitted for Intentional Self Harm (ISH) in a tertiary care hospital.

Methodology : The study population included those patients who were admitted and being managed for ISH and brought for psychiatric evaluation during the period of six months (16 th April - 15 th October 2010) at Dhulikhel Hospital. Each patient underwent a detailed psychiatric evaluation by a consultant psychiatrist once they were medically stable. Psychiatric diagnoses were considered as per ICD-10 criteria and patients were managed with pharmacological / non-pharmacological measures.

Results : Details of the patients including socio-demographic data, mode of ISH, psychiatric diagnosis considered and outcome will be tabulated, analyzed and discussed. Statistical Package for the Social Sciences (SPSS) software will be used to compute the results.

Conclusion : The results so obtained will be discussed and conclusions will be drawn.


A study of clinical presentation and stressors among adolescents and early adults with depressive illness

Manisha Gaur, Manaswi Gautam, Anita Gautam

Manovikas Kendra Rehabilitation and Research Institute for the Handicapped, E.M. Bypass, Kolkata, India

Aim : To study clinical presentation and stressors among adolescents and early adults with depression.

Materials and Methods : 260 patients attending Gautam Hospital and Research Centre, Jaipur who were diagnosed to be suffering from depressive illness from November 2009 to till date were analyzed. 130 subjects from age group of 13 to 21 years and 130 subjects from 22 to 3o years were included in study to examine whether presentation of depression in adolescents (13 to 21 years) differs from that of early adults (22 to 30 years). They were compared on age, sex, presenting complaints and type of stresses they suffered from in the recent past (1 year).

Results : The study revealed that adolescents presented more with somatization, feeling of guilt, hopelessness, and helplessness rather than typical symptoms of clinical depression as seen in early adults like sadness, worthlessness, suicidal ideation and attempts, insomnia, loss of interest, irritability and loss of libido. The common stressors observed in adolescents were related to studies, adjustment problems with parents and peer group while more early adults suffered from the stress of marital disharmony, stress at work, relationship problems including, break of affairs and stress related to child bearing. Implication of the above results in psychotherapeutic intervention has been discussed and usefulness in psychotherapy has been highlighted.


Domestic violence among females from the slum population in Varanasi

Anuradha, Mona Srivastava

Varanasi, India

Background : Violence against women is a major public health and human rights issue in the world today.

Aim : This study was conducted to assess the consequences of domestic violence on the mental health of women of reproductive age group.

Materials and Methods : A community based, cross-sectional study was conducted in the slum area of Varanasi. 350 women of 15-49 years age group residing in the community were selected by stratified random sampling. These women were administered an interview schedule adapted from word health organization multi-country study on women's health and domestic violence. They were assessed for the presence of domestic violence. Mental health status of these women was estimated by using self-reporting questionnaire 20. Data were analyzed. The test applied was chi square test for proportion and binary logistic regression.

Results : 42.8% of the women reported one or the other types of violence. 34.9% of the women reported either physical or sexual violence ever in life. 29.1% of the women reported either physical or sexual violence in past 1 year (current violence). 12% of the women reported mental ill health. Women who had experienced domestic violence were more likely to report mental ill health status and suicidal tendencies as compared to women who had not experienced violence.

Conclusion : Domestic violence is associated with mental ill health.


Seroprevalence of anti-hepatitis c virus (HCV) antibody in injecting drug users

Debasish Basu, Vineet Kumar, Pawan Kumar Barnwal, Surendra Kumar Mattoo, Arun Kumar Sharma

Departments of Psychiatry and Gastroenterology, PGIMER,

Chandigarh, India

Aim : To study sero-prevalence of anti-HCV antibody in injecting drug users (IDUs) and non-IDUs with or without other HCV-related risk.

Methodology : Serum of inpatients of the three groups was screened for anti-HCV antibody by ELISA for 2 years. Case records were reviewed for presence of risk behaviors (sharing of needle, syringe or vial; multiple sex partners, unprotected sex with commercial sex workers/strangers), and blood transfusion.

Results : 90 IDUs, 91 non-IDUs with other HCV-related risk and 169 non-IDUs without other HCV-related risk were screened (all males; mean age 31.30 (SD=7.84), 33.66 (SD=10.38) and 38.02 (SD=10.93) years respectively). Almost 49% of the IDUs, 5.5% among the non-IDUs with HCV-related risk and 4.1% among the non-IDUs without HCV-related risk were seropositive for anti-HCV antibody. Majority of the IDUs were actively using the drugs (75.6%) for a mean duration of 59.63 months (SD=55.34); used injection buprenorphine in combination with antihistaminics (37.8%). About 46% of the IDUs had history of sharing of needle, syringe or vial. Majority of them were intravenous drug users (84.6%). The IDUs and the non-IDUs with HCV-related risk did not differ significantly with respect to all other HCV-related risk except history of blood/plasma/body fluid transfusion which was more often found in the latter group (P=0.006). Conclusion : Sero-prevalence of anti-HCV antibody is high (48.9%) in IDUs, and related to injecting behaviour.


Assessment of impressionistic view of clinicians other than psychiatrists about modification of current curriculum of undergraduate psychiatry

Bappaditya Chowdhury, Dilip Mondal, Asim Kumar Mallick

MCH, Kolkata; IPGMER, Kolkata, India

Aims & Objective : The need for modification of current training in undergraduate psychiatry has been reiterated again and again by Indian Psychiatric Society. One of the focuses of Indian Psychiatric Society for the year 2007 was to focus on undergraduate psychiatry and Vol 49, No. 3, July-September 2007 issue of the official journal contained a full symposium on this discussion. However, little data is available to address the issue on objective basis. This study aims to assess the unmet needs.

Materials and Methods : A consensus based questionnaire was developed and pretested. Clinicians of various disciplines other than psychiatrists were contacted and data collected from 457 respondents.

Result : In sample population (n-457), 246 (53.83%) were from medicine and allied super-speciality disciplines. 96% of the respondents opined for change regarding clinics and examination in undergraduate psychiatry. Opinions about various issues assessing unmet needs were significant with increasing practicing experience.

Conclusion : With increasing experience in clinical practice, a clinician is more opined about strengthening undergraduate psychiatry. In resonance with the principle of current national mental health policies of empowering primary care physician, subtle changes in undergraduate curriculum of psychiatry may be synergistic.


Family mental health; or alcohol and substance abuse disorders

Vibha Sharma, Ravinder Singh, Kaberi Baruah

IHBAS, Delhi, India

Aim & Objectives : To explore the stress, burden, coping and adjustment pattern among spouses (wives) of alcohol dependent males of Delhi and Assam.

Methodology : A sample of 60 spouses (wives) of alcohol dependent males (diagnosed by trained psychiatrist) was taken purposively according to inclusion and exclusion criteria. Out of which 30 patients were selected from IHBAS, Delhi and 30 from Assam Medical College, Dibrugarh and Guwahati Medical College, Guwahati. Data was collected using Semi structured Performa for socio demographic details, Checklist for stress, Family Burden Scale, and Coping with Drinking Questionnaire.

Results and Conclusions : Findings indicate high level of stress and burden among these wives. Relationship of some socio demographic variables like age and duration of marriage with psychological variables like stress, burden and coping were found significant. Significant differences were observed in Assam and Delhi groups regarding some coping behaviours only. Results are discussed in the light of related literature and socio cultural issues. Study also highlights the mental health need for family members, mainly of spouse of alcohol dependent males.


Use of baclofen in reduction of craving, anxiety in alcohol consumption: An open label study

Mona Srivastava, Ujjaini Srimanee

Institute of Medical Sciences, Varanasi, Uttar Pradesh, India

Background: Recent preclinical and clinical studies have shown that the alpha-amino-butyric acid-β agonist baclofen may be an effective treatment for reducing alcohol consumption. This preliminary open-label investigation examined the tolerability and effect of a 30 mg daily baclofen dose for reducing drinking, subclinical anxiety and depressive symptoms, and craving in alcohol-dependent subjects.

Materials and Methods : Eleven men and one woman participated in a 12 week trial during which they took baclofen on a 10 mg thrice-daily regimen and received four sessions of motivational enhancement therapy. Each participant received a comprehensive physical and psychiatric screening before being enrolled. At each visit, side effects were monitored by a general Inquiry, and drinking data were collected by a semi-structured interview. Participants also completed the Beck Depression Inventory, the Beck Anxiety Inventory, and the Penn Alcohol Craving Scale at each visit.

Results : Baclofen was reasonably tolerated. Two participants discontinued because of side effects. No serious adverse events were noted. Overall, there were statistically significant reductions in the number of drinks per drinking day and the number of heavy-drinking days, and there was an increase in the number of abstinent days. Significant decreases in anxiety and craving were also shown.

Conclusions : These findings suggest that baclofen is reasonably tolerated in an alcohol dependent population. Baclofen may be effective for the reduction of drinking, anxiety, and craving for some alcohol-dependent individuals. A larger-scale placebo-controlled study is needed to further explore these effects and to determine the characteristics of those who respond to this medication.


Caregiver's burden in obsessive compulsive disorder and schizophrenia: A comparison, extent and determinants in the Indian families

Jaladhi R. Trivedi, Bharat N. Panchal, Deepak S. Tiwari

Background : Psychiatric disorders impose major burden on the caregivers of the patients. Chronic psychotic disorder like schizophrenia is proven to be burden on the caregivers of the patients. We undertook this study to assess the burden caused by Obsessive Compulsive Disorder (OCD).

Aims : (i) To assess the burden on the caregivers of the patients suffering from OCD and schizophrenia, (ii) To compare the degree of burden between both the groups, (iii) To correlate the burden with disability caused by disease. (iv) To correlate the burden with the severity of the disease. (v) To assess the correlation between, burden caused by the disease and sociodemographic variables of the patient and caregiver.

Settings and Design : We recruited 62 patients, from both outpatient and inpatient department (OCD=31, Schizophrenia=31) who met the study criteria between March 2009 to March 2010 from the department of psychiatry, Sir T. Hospital, Bhavnagar.

Materials and Methods : Severity of the disease symptoms was assessed by Yale-Brown Obsessive Compulsive Scale (Y-BOCS) in patients suffering from OCD while in case of Schizophrenia Positive And Negative Symptom Scale (PANSS) was used. Indian Disability Evaluation and Assessment Scale (IDEAS) was used to assess the disability caused by the disease. Burden Assessment Schedule (BAS) was used to assess the burden imposed on the caregiver by the disease of the patient.

Results : The caregivers of the OCD patients have high degree of burden, comparable to the caregivers of schizophrenic patient. Model for the prediction of the burden score was generated and "caregivers at risk" of high burden score identified. IDEAS GS correlated significantly to the burden.

Conclusion : OCD is a disabling condition imposing high degree of burden over the caregivers. Therefore there is need to sensitize health professional to this problem and establishment of systems to support the caregivers.


Psychosocial factors related to depression in medical students

S. Vivekanandan, Janani Kumaraguru, Thirunavukkarasu, Sathianathan

Madras Medical College, Chennai, India

Context : Evidence of untreated mood disorders and increasing burden of suicide among medical fraternity is widely reported.

Aims : To estimate the cross sectional prevalence of depression among final year medical students in an urban Medical College and to evaluate the plausible psychosocial factors associated with depression.

Materials and Methods : One hundred and thirty four final year medical students who consented for the study have been included. Local Ethics Committee approval was obtained. A self reporting questionnaire on psychosocial background and a modified 13 item Beck depression inventory were administered. Every effort has been taken to maintain one's anonymity to prevent recording dishonest answers. Quantitative and qualitative statistical analyses were performed using Six statistical package and the results were tabulated.

Results and Conclusion : Of the 134 students who participated in the study, 53 (39.4%) had depression (mild-18.6%, moderate-16.4%, severe-4.4%) and the remaining were not depressed cross-sectionally. Preferring to stay alone with unhappy friendships, bleak outlook of future, feeling of lagging behind in academics with subjective memory disturbances were significantly associated with depression. The factors like belonging to a lower economic stratum, staying in the Hostel, use of alcohol, age group, gender, medical illness change in the medium of instruction, students' birth order were not significantly associated with depression among our study group. To conclude there is a high prevalence of depression among medical students, most of which is predominantly undiagnosed. Prompt identification of this cohort and initiating appropriate action would be necessary.


A comparative study of prevalence of neurological soft signs amongst the patients of brief psychotic disorder, schizophreniform psychosis and schizophrenia (Biological markers)

Pranjal Sharma, Atmesh Kumar, Shyamanta Das, Kamal Nath

Silchar Medical College and Hospital, Assam, India

Background : Neurological soft signs (NSS) are minor ('soft') neurological abnormalities in sensory and motor performance identified by clinical examination. NSS reflect a failure in the integration within or between sensory and motor systems,or a deficits in neuronal circuits involving subcortical structures (e.g. basal ganglia, brain-stem and limbic system).

Aim : To compare the prevalence of NSS amongst three different groups of drugs naive psychotic patients namely Brief Psychotic disorder, Schizophreniform Psychosis and Schizophrenia.

Materials and Methods : Cases are defined as subjects who were diagnosed of having the following three mental illness namely Brief Reactive Psychotic disorder, Schizophreniform psychosis and Schizophrenia according to the diagnostic criteria of text revision of fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), but have never being treated or have received any form of psychotropic medications either as outdoor or indoor treatment prior to the present visit. Psychiatric morbidity was diagnosed according to DSM IV-TR guidelines. Neurological soft signs were assessed by the Heidelberg manual.

Inclusion criteria:

1. Both the sexes are included in the study.

2. Only drug naive subjects are included in the study.

3. Subjects' age range from 15 to 50 years.

Exclusion criteria:

1. Patients with neurological disorders, alcoholism and drug abuse.

2. Patients previously treated with psychotropic medications.

3. Patients with mental retardation.


Pattern of psychiatric care referrals in department of telemedicine of a tertiary care institution

Gurvinder Pal Singh, K.C. Jindal

G.G.S. Medical College and Hospital, Faridkot, Punjab, India

Background : Telemedicine has been promoted by the felt need of health care delivery to the people at distant places. This facility is becoming wide spread, less costly and new applications are emerging.

Aims and Objectives : To study the profile of psychiatric cases referred to telemedicine department of G.G.S. Medical college and Hospital, Faridkot.

Materials and Methods : Department of Psychiatry, G.G.S. Medical college and Hospital, Faridkot receives many referrals cases for teleconsultation from various civil hospitals of Punjab. Pattern of these cases were analysed in detail retrospectively from the available information on a structured proforma of telemedicine department of this tertiary care institution.

Results and Conclusion : Results will be presented in the conference proceedings. Remedial measures will be suggested for improvement in telemedicine referral system. The advantages, problems and the experience gained so far will be presented. New challenges and opportunities in this field will be discussed. This facility is a boon or its opposite. A boon if the right information is available at the right time. New principles will need to be addressed to maintain appropriate boundaries. It will have implications for staffing and cost.


Comorbidity of psychiatric and personality disorders in survivors following their first suicide attempt: A

case - Control study

Ranganath R. Kulkarni, K. Nagaraja Rao, Sudarshan CY, Shamshad Begum

SDM College of Medical Sciences and Hospital, Dharwad, India

Background : Attempted suicide is a common clinical problem in general hospitals. Psychiatric disorders are at increased risk for suicide. There are few case-control studies on attempted suicide in India.

Materials and Methods : 100 consecutive cases of first suicide attempt (Group-I) were compared with 100 randomly selected controls (Group-II), matched for age and sex. Variables related to sociodemographic characteristics, family background, psychiatric morbidity and comorbidity were analyzed. Risk-Rescue rating was applied in suicide attempters to know the medical seriousness of the suicide attempt. MINI Plus and IPDE were used for axis-I and axis-II (personality) diagnosis. The two groups were compared using appropriate statistical measures.

Results : No significant difference in socio-demographic details was observed between the two groups except for education, which was significantly lower in the cases compared to controls. Group-I had significantly more number of patients with family history of psychiatric illnesses than group-II. 93% of the group-I compared to 41% of the group-II had at least one axis-I and/or axis-II psychiatric disorder. Most common diagnostic categories were mood disorders, adjustment disorders and substance related disorders. Group-I had higher psychiatric morbidity compared to group-II, with axis-I disorders (89% v. 25%), personality disorders (52% v. 25%) and comorbidity of psychiatric disorders (51.6% v. 19.5%).

Conclusion : Individuals who made first suicide attempt had lower educational achievement; higher prevalence of psychiatric morbidity, personality disorders and comorbidity, and had severe depression and anxiety in comparison to the controls.


Insight into psychotic disorders: Frontal lobe function and psychopathology (Biological correlates of mental disorder)

Atmesh Kumar, Pranjal Sharma, Shyamanta Das, Kamal Nath, Uddip Talukdar, Dipesh Bhagabati

Department of Psychiatry, S.M.C.H, Silchar, Assam, India

Introduction : The concept of insight is much larger than just knowing whether one is ill or not, and if so, having a sensible view regarding treatment. David (1990) has considered that insight is not "all or nothing" phenomenon but is composed of three distinct, overlapping dimensions, namely, the recognition that one has a mental illness, compliance with treatment and the ability to relabel unusual mental events (delusions and hallucinations) as pathological. Psychosis is a syndrome - a mixture of symptoms - that can be associated with many different psychiatric disorders, but is not a specific disorder itself in diagnostic schemes such as DSM-IV or ICD-10. Amador et al.. (1994) found that severely manic patients were similar to schizophrenic patients on scores of insight whereas depressed and schizoaffective patients had more insight. Studies have found a significant correlation between impaired performance on the WCST and poor insight, suggesting that cognitive impairment resulting from frontal lobe deficit may underlie poor insight in schizophrenia.

Aims & Objectives : To find the correlation between level of insight with frontal lobe function and psychopathology in Psychosis.

Materials and Methods : Patients admitted in the psychiatry ward with psychosis were included in the study. (i) Patients fulfilling the criteria for F2 and F3 with psychotic symptoms as per ICD-10 are included in the study. (ii) Patients are able to answer questions and show at least minimum co-operation . (iii) Schedule for assessment of Insight (SAI), Frontal Assessment Battery (FAB), and Brief Psychiatric Rating Scales (BPRS) are administered. (iv) Correlation statistics will be used for analysis.

Exclusion Criteria: (i) Patients totally uncooperative/violent; (ii) Patients with mental retardation; (iii) Patients with obvious neurological illness or substance related disorder.

Results and Conclusion : To be presented in conference.


A study of psychiatric morbidity and comorbid physical illnesses in elderly patients attending geriatric clinic, MBS hospital, Kota (Rajasthan)

Prem Raj Meena, D.K. Sharma, C.S. Sushil, D.K. Vijayavergiya, M. Sharda

Government Medical College, Kota, Rajasthan, India

Aim and Objectives : This study was aimed at finding out the socio-demographic characteristics of elderly patients aged 60 years and above, the magnitude of psychiatric problems and to understanding the pattern of associated physical illness in elderly patients, attending the Geriatric Clinic, MBS Hospital, Kota (Rajasthan).

Materials and Methods : All the patients were evaluated on specially designed semi structured proforma and GHQ-12, MMSE, HAM-A, GDS was used. ICD-10 criteria were used for the diagnosis of patients and Chi-square test was used for statistical analysis.

Results : Psychiatric disorders were present in 35% of the elderly patients, in which depressive disorders (18.5%) were the most common psychiatric illnesses. Many patients had associated physical illnesses and among them hypertension was the most common.

Conclusion : Depressive disorder was the most common psychiatric illness and among the physical illnesses hypertension was the commonest.


Clinical profile of patients admitted to a psychiatry rehabilitaton centre

Aman Kishore, Sreejayan K., Sharma P.S.V.N.

Kasturba Hospital, Manipal, Karnataka, India

Objectives : To study the clinical profile of patients admitted to a psychiatric rehabilitation centre.

Specific Objectives : To study the (a) Socio demographic profile (b) Illness characteristic (c) Reasons for admission.

Methodology : Study Design : Cross-sectional study.

Target population : Patients admitted to Hombelakku - a psychiatric rehabilitation centre between October - December 2010. Sample size : 23. Study period : Oct - Dec 2010.

Methodology of Data Collection : Ethical clearance will be taken from Institutional ethics committee (IEC). A semi structured data sheet would be used for data collection. The Data would be collected from the records of the patients Data collection. Appropriate statistical methods would be used to analyse the results.

Result and Conclusions : Were displayed at the time of presentation.


To study the psychiatric morbidity in 3rd trimester women attending antenatal clinic in tertiary care teaching hospital

Shefali Shah, Rashmi Bisen, Sarika Mahadeshwar, R.M. Haridas

JJ Hospital and Grant Medical College, Mumbai, India

Background : Mental health conditions arising in the antenatal period, including depression, have the potential to impact negatively on not only the woman but also her partner, infant, and family. The capacity for routine, universal antenatal psychosocial assessment, and thus the potential for reduction of morbidity, is very significant. The mother's mood during pregnancy and mental illness can impact on the development of the baby both during pregnancy and after birth. Assessing women for psychosocial risk factors and symptoms of distress during regular pregnancy checks gives the opportunity to link women with appropriate services.

Aims and Objective : To study prevalence of Psychiatric morbidity and the association of socio economic status and stressors with psychiatric morbidity in 3 rd trimester women.

Methodology : Study Site : Antenatal clinic in tertiary care teaching hospital.

Study Sample : 100 pregnant women in their 3 rd trimester.

Study Design : Cross-sectional.

Inclusion Criteria:

  • Women of child-bearing age group
  • Women attending antenatal clinic during 3 rd trimester
  • Language compatibility with Hindi, Marathi, Gujarati and English
Exclusion Criteria:

  • Women suffering from any major medical or surgical illness during pregnancy
  • Unwilling women
Study group has been assessed with a semi structured interview proforma for socio-demographic variables and psycho-social stressors and Rating scales for screening of psychiatric morbidity.

Scales used:

  • Brief Psychiatric Rating Scale (BPRS)
  • Hamilton Depression Rating Scale (HAM_D)
  • Hamilton Anxiety Rating Scale (HAM_A)
  • Positive and Negative Syndrome Scale (PANSS)
  • General Health Questionnaire (GHQ-12)
Results and Conclusions : The discussion on results and conclusions will be done at time of paper presentation. Data collection has been completed but the statistical analysis necessary for result could not be finished before submission deadline.


Themes of spiritual need in depression and addictions E-mail

Dinesh Kataria, Shin Sang Lim 1 , Vida Namdari 1

Lady Hardinge Medical College and Associated Hospitals, New Delhi, 1 Department of Psychology, University of Delhi, Delhi, India.

As many researchers have acknowledged the importance of spiritual care in clinical settings, including psychiatry today, this study aims to see the spiritual relevance of patients in depression and addictions. It is hypothesized that the factor of spiritual needs of two groups is different, which makes the dissimilar symptoms in them. To investigate on the spirituality, selected patients in depression and addictions were administered Spiritual Well-Being Scale (SWBS) in Lady Hardinge Hospital, New Delhi and their result were compared. Understating of distinctive spiritual tendency is expected to enhance the spiritual care on psychiatric patients. The details of result are discussed in the presentation.


Correlation of depression control (HAM-D score) with exacerbation of COPD in patients with co-morbid depression

Koushik Dutta, D.P. Bhadoria

Maualna Azad Medical College, New Delhi, India

Introduction : Depression has been associated with multiple somatic ailments as causative or contributory factor. The 'frequent exacerbation' category has been proposed as a separate group within patients of chronic obstructive pulmonary disease (COPD). It has also been shown that COPD symptomatology doesn't always correlate well with the pulmonary function tests (PFT) based Gold staging or even with Arterial Blood Gas analysis results. Psychological contributors may be playing important roles. Hence we investigated the contribution of depression in patients of COPD with co-morbid Major Depressive Disorder.

Aims and Objectives : To assess the correlation of exacerbation of COPD, need for rescue medications and COPD related emergency room visits/ hospitalizations with the average HAM-D scores over a period of one year in patients of COPD with co-morbid Major Depressive Disorder.

Materials and Methods : Fifty two patients of COPD with co-morbid MDD (diagnosed by independent psychiatrists) were recruited. Standard treatment for COPD was offered to all according to latest GOLD guidelines. Patients continued antidepressant therapy under their treating psychiatrists. Hamilton Rating Scale for Depression was applied on all participants once a month for one year. Baseline PFT and other parameters were recorded. Patients were closely monitored for pulmonary function, exacerbations, rescue-medicine use, emergency visits and hospitalizations during follow-up visits on every 14 th day. Six patients were lost in follow-up.

Results : Analysis of the 46 patients who completed regular one year follow-up showed that higher rate of use of rescue-drugs, exacerbations, emergency visits and hospitalization was associated with higher HAM-D scores. The associations were statistically significant and persisted after adjustment for GOLD stage and other confounders.

Conclusion : Depression is an independent contributor to symptomatic exacerbations of COPD and control of depressive symptoms may help significantly reduce the burden of acute exacerbation of COPD.


Assessment of psychiatric morbidity and lethality among DSH patients in a general hospital, Bikaner

L.N. Gupta, Brijlata Kotia, A.K. Singhal, K.K. Verma

Background : Deliberate self harm (DSH) describes an act of non-fatal, self destructive behaviour, that occurs when an individual's sense of desperation outweighs their inherent self-preservations instinct. It is underreported, unrecognized, silent epidemic underneath which lies various risk factors.

Aims : This study examined the presence of psychiatric morbidity and degree of lethality in DSH patients referred to the Department of Psychiatry, in a General Hospital, Bikaner.

Materials and Methods : The study was carried out at the Department of Psychiatry, S.P. Medical College & AGH, Bikaner. Those DSH patients admitted in emergency and other Departments of hospital, referred for psychiatric evaluation were included in the study. Every patient was assessed by semi-structured performa consisting of socio-demographic details and illness variables, BPRS and degree of lethality was assessed clinically by treating clinician.

Results : The male to female ratio was equally distributed. Thus, no statistically significant difference was found (n=50, m=24, f=26). Majority of the subjects were from the age group 20-30 years. The most common method used by attempters was consumption of insecticides and sedatives. 70% of male used high lethal method of suicidal attempts whereas 77% of females used less lethal methods of attempt. The differences were statistically significant. (χ²=11.45, df=1, P =<.005) Of all the DSH patients 38% had history of past psychiatric illness out of which male constitute 52% and female 48%. In the study 17 males (71%) and 20 females (77%) attempted first time for suicide whereas 7 males (29%) and 6 females (23%) had attempted more than once.

Conclusion : 38% of DSH patients had past history of psychiatric illness and statistically significant differences were found in degree of lethality among males and females.


Substance dependence in bipolar disorder, manic phase: Reasons for use, sensation seeking and substance sensitivity

Vijay B. Gaikwad, C.R.J. Khess

Central Institute of Psychiatry, Kanke, Ranchi, India

Aims and Objectives : To investigate the reasons for Substance use and to compare Substance sensitivity and sensation seeking between patients with Bipolar affective disorder, patients with Substance use disorder and patients with co-morbid Bipolar affective disorder and Substance use disorder.

Methodology : Study was conducted at the Central Institute of Psychiatry. It was a cross sectional hospital based study using purposive sampling. Patient population included 30 ICD 10 (DCR) diagnosed patients each of Bipolar affective disorder with mental and behavioural disorders due to psychoactive substance use (BS), Mental and behavioural disorders due to psychoactive substance use (S) and Bipolar affective disorder (B). Assessments included the Scale for Manic state, Brief Psychiatric Rating scale, Addiction Severity Index and the Structured Clinical Interview for the Spectrum of Substance Use (SCI-SUBS).

Results : The scores on substance sensitivity, self medication and sensation seeking domains were highest in the S group and least in the B group. Post hoc results showed that in substance sensitivity and medication domains S>B, S>BS, BS>B. But on sensation seeking domain there were no significant differences between BS and S groups. Although S>B and BS>B.

Conclusions : The high use of Substance/Drugs for Self medication in Co-morbid Bipolar affective disorder with mental and behavioural disorders due to psychoactive substance use is not exclusively linked to Depression or Manic phases of their illness but for more generic purposes. Even though the substance seeking scores were least, patients with bipolar affective disorder should be counseled about the risks of substance use with special emphasis on the dangers of Self medication.


A study of sibling relationships quality in children with ADHD

Shahzadi Malhotra, M.S. Bhatia, G. Rajender, T.B. Singh

CNBC Hospital & Maulana Azad Medical College, Delhi, India

Introduction : Children with Attention-Deficit/Hyperactivity Disorder (ADHD) have been reported to be significantly impaired in social relationships including difficulties in parent-child and peer relationships. Little research, however, has investigated potential impairment in sibling relationships among children with ADHD.

Aims and Objectives : This study investigated the quality of sibling relationships among children with ADHD relative to those without ADHD. It also examined whether externalizing and internalizing problems comorbid with ADHD affected sibling relationships.

Materials and Methods : Participants were thirty dyads of children with ADHD and their siblings and thirty dyads of children without any behavioural/ developmental problem as control group. Sibling Relationship Quality Questionnaire was administered and sibling relationships were assessed by interviewing three informants: mother, self, and sibling.

Results : Analyses using SPSS version 14.0, utilizing hierarchical linear model to revealed increased conflict in sibling relationships, relative to children in control group. Comorbid externalizing problems were associated with less warmth/ closeness and increased conflict in the sibling relationship and largely accounted poor sibling relationship in children with ADHD. Comorbid internalizing problems were associated with less warmth/ closeness in the sibling relationship.

Conclusion : Interventions programmes for ADHD should incorporate building upon positive sibling relationship which may contribute more strongly to resilience among children with ADHD relative to children without ADHD.


Physical and psychiatric manifestations in patients of diabetic neuropathy

Pradeep Kumar, Deepanshu Dube, M.K. Jain

S.S.M.C., Rewa, Madhya Pradesh, India

Diabetic Neuropathy (DN) is one of the most and dreaded complications of diabetes (NIDDM). The psychiatric complications associated with DN though in plenty are still underreported.

Objectives : Objectives of the study were to quantify the magnitude of physical and psychiatric

comorbidities in patients of DN and to correlate them with the degree of glycaemic control.

Materials and Methods : Both in-patients and out-patients were studied. DN was defined as absence of ankle reflexes and vibration position sensation in a diabetic patients ruling out other causes of neuropathy. They were assessed on semi structured proforma for collecting various socio-demographic and clinical variables. Further four dimensional symptom questionnaire (4DSQ) scale was administered to quantify the psychiatric comorbidities in patients of DN.

Results : Only 24% were without psychiatric comorbidities whereas 57% had psychiatric comorbidities and were mainly in form of Depression, Anxiety, Somatisation, Distress and Sexual disorders etc. Interestingly 19% patients had pseudo-neuropathy, which masqueraded true neuropathy. Further higher psychiatric comorbidities were significantly related with poor glycaemia control and diabetic adherence variables and eventually higher diabetes related complications including ischemic heart disease, Hypertension, Diabetic Neuropathy, Retinopathy and Amputation.

Conclusion : Identification of diverse psychiatric comorbidities and their prompt management would only enable us to achieve a holistic care of NIDDM with DN.


Perception and attitude of medical students towards psychiatry and mental health

Shobhana Mittal, Sunil Mittal 1

Intern, Dr. Ram Manohar Lohia Hospital, 1 Director, Cosmos Institute of Mental Health & Behavioural Sciences, New Delhi, India

Background : Stigma attached to mental disorders is not limited to general public alone. Even medical students have been shown to have stigmatizing attitudes and may judge prevention and treatment of mental illness to be unscientific and imprecise. Consequently, physicians tend to focus on physical symptoms and are less likely to refer patients to mental health services indicating their poor training and lack of awareness.

Objective : A cross sectional study was conducted in a Government Medical College in north India to evaluate the perceptions, attitudes, beliefs and opinions of medical students towards psychiatry and mental health.

Materials and Methods : The study was conducted at Dr. Rajendra Prasad Medical College, Kangra at Tanda, H.P. A pretested, validated, 25 item questionnaire was used to assess the attitudes towards psychiatry; towards mental disorders and awareness of their causes and treatment; and contact with mental illness. The questionnaire was distributed to 100 medical students of which 78 responded. Purpose of study was explained, informed consent obtained and responses were kept anonymous to encourage candid opinions.

Results : In spite of the majority of medical students feeling that their undergraduate psychiatry training was adequate, yet poor knowledge and stigmatizing attitudes towards mental disorders and their treatments, the mentally ill, psychiatry and psychiatrists, were vastly prevalent. Details shall be presented.

Conclusion : This study reiterates the need to urgently re-plan undergraduate psychiatry curriculum and training and to incorporate strategies to reduce stigma. Interventions targeted towards this group as well as other health professionals may be more cost effective than interventions directed at the general public. Better exposure and psychiatric education of medical students would allay their fear and stigma towards mental illness and psychiatry and play a key role in delivering quality health care for the community.


Diagnostic dilemma in an organic manic disorder

Vishal P. Sumit B., Anuja K., Saldanha D., Mehta S., Archana J., Bhattacharya L. Padmashree

Dr. D.Y. Patil Medical College and Research Centre, Pune, Maharashtra, India

Background : Mood symptoms are quite common in many of psychiatric and organic conditions. The differentiation between non organic and organic affective symptoms becomes difficult when there are no signs and symptoms of an underlying organic pathology on clinical examination. However the emergence of affective symptoms in a background of a slowly growing intracranial lesion should always be kept in mind.

Aim : To estimate the incidence of Organic manic disorders reporting to Psychiatric Outpatient department in a semi urban area.

Materials and Methods : A total of 518 consecutive psychiatric admissions from January 2009 to June 10 were identified according to International Classification of Diseases (ICD-10). Demographic variables taken into account were Age, sex, economic status. The results were analysed by SPSS.

Results: 518 patients were taken into study. 69 (13.32%) were Alcohol dependent Syndrome. 60 (11.59% ) had Alcohol with medical problems. 38 (7.25%) had co morbid Psychiatric illness. 4 (0.77%) had Alcohol induced Psychosis. 104 (20%) had Affective Disorders. 1 (0.19%) had Intracranial Tumour. 242 (46.72%) were other Psychiatric cases.

Conclusions: The emergence of Affective symptoms though common in organic conditions require to be closely monitored for the effective treatment of underlying pathology.


A study to assess the influence of socio demographic, psychopathology, and personality factors in suicidal behaviours in the attempted suicide patients

Jaikumar V., Varadarajan, Suryaprabha, M. Thirunavukarasu

SRM Medical College and Research Institute, Kanchipuram, India

Aim: To assess the influence of socio demographic, psychopathology, and personality factors in suicidal behaviours in the attempted suicide patients.

Materials and Methods: In this cross sectional study, all cases (n=38) of suicide attempters who were admitted to the emergency department of the SRM Hospital between August 2008 and July 2009 were included in the study. The patients were assessed once the medical condition was stabilised Patients' gender, age, history, educational and martial status, time and method preferred for suicide and causes were recorded by interview using a proforma. The precipitating causes were explored. Life events scale, Suicide intent scale, Hamilton depression rating scale, Milan 'clinical multi axial inventory (MCMI-II) were assess the suicidal behaviour.


Duration of untreated psychosis in first episode non-affective psychosis

Jilani A.Q., Trivedi J.K., Dalal P.K., Sinha P.K., Dhyani M.

C.S.M. Medical University (Earlier KGMU), Lucknow, India

Objective: To date, the literatures are scarce from south Asian country regarding duration of untreated psychosis in first episode non-affective psychosis (FENAP), though in recent years, duration of untreated psychosis (DUP) has emerged as important indicator of prognosis of non-affective psychosis, as studies show that Patients with longer DUP have poorer outcomes with respect to relapse rates, control of symptoms, remission rates and poorer response to antipsychotic medications and treatment outcome.

Materials and Methods: Using reports by family and informants, about a sample of 151 subjects with first-episode non-affective psychosis, the investigators ascertained the 'Onset of psychosis' as per the definition as first appearance of prominent psychotic symptoms, i.e. "a score 4 or higher on the PANSS positive subscale". DUP in the present study was the measured duration between onset of psychosis and decision to start appropriate treatment on presentation to study centre.

Result: Mean 'DUP' in patients with FENAP was (124.93±122.13) weeks. DUP was significantly longer in married, old age, and uneducated patients. And it is not affected by demographic variables like gender, domicile, religion, and socioeconomic status.

Conclusion: DUP is longer in developing nations than developed worlds.


A study of psychiatric morbidity among male patients of alcohol dependence

Pankaj Sureka

Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi, India

Background: Alcohol abuse is a pervasive problem that is taking an increasing toll on the world's population, the 1993 world developmental report finds that alcohol related disorders affect 5-10% of the world's population each year and account of approximately 2% of the global burden of the disease.

Methodology: The study population comprised of male patients suffering from alcohol dependence admitted for treatment at DATRC ward of IHBAS for more than 3 week. A period sample of 12 months was taken for the study. Instruments used in the study included sociodemographic performa for sociodemographic variables, MMSE to rule out cognitive deficits, addiction severity index (ASI) for assessment of severity and pattern of alcohol dependence, symptom checklist-90- revised (SCL-90-R) to ascertain the subsyndromal psychiatric morbidity &SCAN diagnostic interview schedule used to ascertain the frequency and pattern of psychiatric morbidity.

Results: Out of the 50 patients, psychiatric disorders were present in 16 (32%) patients. Depression was the most common psychiatric morbidity present in 6 (12%) patients, anxiety disorders in 5 (10%), mania in 2 (4%), schizophrenia in 2 (4%) and OCD along with depression in 1(2%) patients.

Conclusion: Overall the psychiatric disorders among patients with alcohol dependence was less than that reported in Indian studies and some of the western studies. Alcohol dependence patients with psychiatric morbidity as compared to alcohol dependence patients without psychiatric morbidity had greater severity of alcohol use and poorer employment status.


Assessment of burden ,coping skill, family support and depression in parents of children with psychiatric morbidity

D.K. Mondol, K. Bhattacharyya, B. Choudhury

Govt. Medical College & Hospital, Kolkata, India

Aims & Objectives: Childhood psychiatric disorders are burdensome for parents and often precipitate depression and anxiety in them. One important objective of our study was to find out the perceived burden in parents and to compare them in different childhood psychiatric disorders. We also tried to find out relation between family support and burden, different coping skills and depression in parents, prevalence of depressive disorders in parents.

Methodology: Materials were Family support scale (FSS), Burden assessment schedule of SCARF (BASS), Coping health inventory of parents (CHIP), General health health questionnaire (GHQ) and Beck depressive inventory (BDI). All willing parents having children with psychiatric morbidity for more than 1 year and education above class V were selected and above scales were given. Datas were analysed statistically.

Result: Among the participants most were mothers and perceived burden was more in them. Disruptive behavior disorder was associated with significant burden.

Conclusion: Parents should be assessed to exclude depressive disorders and therapy should be started early. Coping skills which have positive effect can be taught to adjust with the adverse situation.


Risk and protective factors for homelessness among a national sample of veterans in the United States

Jack Tsai, Ellen L. Edens Wes Kasprow Robert A. Rosenheck

Yale University and VA Connecticut Healthcare System

Objectives: This study examines a national sample of patients who use health services at Veterans Affairs (VA) medical centers in the United States to compare those who are homeless to those who are not in order to determine risk and protective factors for homelessness.

Materials and Methods: Using VA administrative data, a case-control study of all veterans who used VA mental health specialty services in 2008 (n=1,026,586) was conducted comparing those who had recently been homeless to those who had not using logistic regression. Two especially low-risk subgroups were also examined : veterans who served in current Middle East wars (OEF/OIF) and veterans with 350% service-connected disability.

Results: Among VA mental health users nationally, OEF/OIF veterans (Odds ratio [OR])=0.35) and veterans with ³50% service-connected disability (OR=.38) were significantly less likely to be homeless, while illicit drug use (OR=3.3-5.2) and alcohol use (OR=1.9-2.2) disorders were by far the strongest predictors of homelessness, followed by being black (OR=1.9-2.3), and having a personality disorder (OR=1.6-2.2). In both low risk groups, the presence of a severe mental illness (schizophrenia or bipolar disorder) along with alcohol and illicit drug use significantly increased risk of homelessness.

Conclusions: Substance use and personality disorders confer the highest modifiable increased risks of homelessness among veterans using VA services, while service-connected disability conferred reduced risk. Clinical prevention efforts could specifically focus on these factors performance.


Neuropsychological performance in patients with alcohol dependence

Pattanayak S.K., Vaswani M., Dhawan A., Jena R.

A.I.I.M.S, New Delhi, India

Introduction: Alcohol use is known to impact the neurocognitive functions. However, there is no consistent evidence regarding association of various alcohol use parameters and cognitive dysfunction The studies are especially limited from Indian setting.

Aim: To study neuropsychological functions in alcohol dependent subjects and see the association with various alcohol use parameters

Materials and Methods: A total of 30 subjects fulfilling DSM-IV criteria for alcohol dependence were included after the detoxification phase was over. The concomitant use of other substances except nicotine, history of neurological illness, significant head injury, mental retardation or significant general medical condition was a criteria for exclusion. The sociodemographic and clinical details were taken on a semi-structured proforma. All subjects were assessed using WAISR Indian adaptation and PGI memory scale after informed consent.

Results: The detailed findings and significant associations will be discussed during presentation.

Conclusion: The cognitive deficits may explain the often seen gap between clinical and functional recovery. The alcohol dependent patients should be assessed for neuropsychological.


Cervical cancer survivors: Meaning in life

Sanjana Singh, Tej Bahadur Singh

Institute of Human Behaviour and Allied Sciences,Delhi, India

The present study makes an endeavour to recapitulate and understand the meaning in life of cervical cancer survivors in India by means of narrative analysis. A group of 10 participants were interviewed to obtain a holistic view of their experiences in their own words, which was followed by administration of Thematic Apperception Test (Indian version). The narratives suggest renewed meaning in life as predestined, fatalistic and death as the ultimate reality. Meaning in life associated with faith in God resulted in a sense of greater control. Support systems enhanced meaning in their lives. Yet, they continue to experience an undercurrent of factors related to distress like fatigue, fear of recurrence of disease and resultant self-perceived burden. However, those who experienced pre occupation with somatic complaints also experienced a sense of meaninglessness, lack of purpose, decreased hope and ambivalent feelings toward God.


A study on the prevalence of generalized anxiety disorder and comorbidity among psychiatric outpatients

Pankaj Kumar, Anurag Jhanjee, M.S. Bhatia, Deepika Verma 1 , Shruti Srivastava

UCMS & GB Pant Hospital, Delhi, 1 Navodya Medical College, Raichur, India

Objective: In this study, we aimed to investigate the prevalence of generalized anxiety disorder (GAD), its association with sociodemographic characteristics, and its comorbidity with other anxiety and depressive disorders among psychiatric outpatients.

Materials and Methods: In the first phase of the study, outpatient psychiatry clinic physician interviewed with consecutive 720 patients who presented to psychiatry outpatient clinic of University College of Medical Sciences & associated Guru Tegh Bahadur Hospital, Delhi by using GAD module of Composite International Diagnostic Interview, version 2.1 (CIDI) during 4 month. Ninety-nine patients with diagnosis of GAD in the first phase were referred to the researcher physician for further evaluation. In the second phase, patients were interviewed by using CIDI anxiety and mood (major depression, dysthymic disorder) disorder modules. By this way, 12 month additional diagnoses were examined, and diagnosis of GAD was confirmed. One patient was excluded, because he did not meet the GAD criteria during reexamination by the researcher physician.

Results: Ninety-eight patients (10.3%) met DSM-IV criteria for GAD. Eighty-nine (90.8%) of the cases had comorbid any anxiety or depressive disorder. The rates of comorbidity with any of depressive disorders and anxiety disorders were found 84.7% and 56.1%, respectively. The most common comorbid diagnosis was major depression (83.7%). The most common anxiety disorders were social phobia (30.6%), OCD (19.4%) and specific phobia (17.4%). The prevalence of GAD was observed significantly higher in women, married ones, housewives, unemployed girls, subjects with history of medical illness and lower educational status.

Conclusion: Our results show that among psychiatric outpatients, GAD has high comorbidity rates with depressive and other anxiety disorders, and it is associated with some sociodemographic characteristics such as gender, and marital, working and educational status.


The prevelance of depression and anxiety disorders in type 2 diabetes and their impact on quality of life

Shekhawat Lokesh, Khandpal Manish, R.C. Jiloha

G.B. Pant Hospital, Maulana Azad Medical College, New Delhi, India

Diabetes has been declared by WHO as a "growing epidemic" with 150 million cases estimated currently, and 300 million cases estimated worldwide by 2025. It is considered among the most psychologically demanding chronic medical illnesses as it often needs strict daily monitoring and adjustment of treatment. Studies report comparatively high prevelance rate (36%) of depressive and/or anxiety disorders in patients with Type 2 diabetes than other chronic medical illnesses and presence of these disorders have been associated with poor glycemic control, lower medication adherence and more diabetes related complications. Research has also demonstrated the adverse impact of co morbidity of these disorders on quality of life.

Aims and Objective: To study the prevalnce of depression and anxiety disorders (Obsessive Compulsive Disorder, Phobias and Other anxiety disorders) and their impact on quality of life of patients with Type 2 diabetes.

Methodology: Cross sectional screening of randomly selected 100 patients with type 2 diabetes was done for depression and anxiety disorders by Hospital Anxiety and Depression Scale and patients who scored>8, were further interviewed and diagnosis was made as per ICD-10. Quality of life of all these patients was simultaneously assessed on WHO quality of life scalel-BREF (Hindi) and was compared between patients with and without comorbid depression and anxiety disorders.

Results and Conclusion: will be discussed at the time of presentation.


A study of spirituality, religiousness and mindfulness in individuals with alcohol dependence

Abhishek Samal, C.R.J. Khess, S.K. Munda

Central Institute of Psychiatry, Ranchi, India

Aims and Objectives: (1) To study the spiritual and religious attitudes of individuals with substance dependence and compare it with normal controls. (2) To study the mindfulness of individuals with dependence and compare it with normal controls. (3) To study the relationship between spiritual and religious attitudes and mindfulness in individuals with substance dependence.

Methodology: Patients admitted to the de-addiction centre of the institute satisfying the ICD-10-DCR criteria for alcohol dependence would be selected for the study after their applying Hamilton's depression rating scale and Hamilton's anxiety scale to rule out depression and anxiety respectively. They would initially be assessed by the Addiction severity index (ASI) to obtain information about the areas of life that may contribute to their substance use disorder. Subsequently, the Multidimensional Measurement of Religiousness/Spirituality would be used to assess religiousness/spirituality in the multidimensional perspective and the Freiberg Mindfulness Inventory (FMI) would be applied to measure the mindfulness among them. Similarly, twenty age, sex and education matched healthy controls would be rated on same scales.


Alcohol and substance abuse disorder adverse effects of disulfiram in patients with alcohol dependence - A retrospective study

Mahima Acharya, Sreejayan K. P.S.V.N. Sharma

KMC, Manipal, India

Aims and Objective: (1) To study the adverse effects of Disulfiram in patients with alcohol dependence syndrome (2) To study the factors contributing to higher risk of developing these adverse effects

Methodology: Retrospective file review of patients who have been diagnosed to have alcohol dependence and would have been started on Disulfiram as aversive agent over the period from May 2005 to May 2010 at Department of Psychiatry, Kasturba Hospital, Manipal would be done for data collection. Data would be collected using a semi structured proforma. The data would be analyzed using appropriate statistical techniques.

Results and Conclusions: will be discussed at the time of presentation.


Appetite and weight loss in children with attention deficit hyperactivity disorder taking atomoxetine

Aparna Bhagat, Vikas Deshmukh, Mohit Shah, Anjali Karira

L.L.M.M.C. and G.H., Sion, Mumbai, India

Atomoxentine has been widely used for treating attention deficit hyperactivity disorder (ADHD) in children and adolescents. Several studies have confirmed its efficacy as assessed by parent and teacher ratings with respect to school performance and social and family functioning. Loss of appetite and weight has been its well documented side effect. Studies have been conducted to determine if this can help against obesity and drug-induced weight gain, Also, weight loss can cause increase in the 'medication to weight ratio' which may further lead to a rise in other side effects including psychosis, mood disorders, depression, abnormal thought patterns, suicidal thoughts/tendencies, and self injury. Manufactures have recommended precautionary monitoring of the child's height and weight and stoppage of the medicine to cope up with growth problems. Thus, it is desirable to known the percentage of children in whom this medication may cause loss of appetite and weight; as also those in whom treatment has to be discontinued due to growth disturbances, if any.

Aims and Objectives: In this study, we tried to assess the frequency and severity of the adverse event of loss of appetite and weight in children attending the child Guidance Clinic (CGC), diagnosed with ADHD and treated with atomoxetine.

Methodology: This study was conducted at a tertiary care hospital. Children attending the CGC, diagnosed as having ADHD, on the basis of Diagnostic and Statistical Manual for Mental Disorders (4th ed.) criteria were started on the minimum effective dose of Atomoxetine (0.5-1 mg/kg). The weight and calorie consumed by the patient per day were recorded before starting the medication. The doses were titrated over the next one month at the end of which parents were asked about any apparent change in appetite of patients. Weight and the caloric intake were noted and comparisons made with the previous record.


Depression and diabetes: Impact of anti-depressant medications on glycemic control

Mangesh Ghulghule, H.S. Dhavale, Vijay Panikar, Adita Dagaria

K.J. Somaiya Hospital, Mumbai, India

Introduction: One of the consistent findings among various studies on diabetes has been prevalence of depression with or without comorbid anxiety among patients of Diabetes Mellitus. Also, numerous other studies have pointed to the negative bearing of the same on blood sugar levels among patients. However there is a lack of data on the outcome of management of these symptoms on the blood glucose level. Considering the ever increasing population of diabetics in our country and the significant causal relationship established by current literature, this study was undertaken.

Aims and Objectives: (1) To study prevalence of depression and anxiety in patients of Type 2 Diabetes Mellitus with an increase in blood glucose levels. (2) To study the effects of management of depression and anxiety on blood glucose levels in patients of Type 2 Diabetes Mellitus. (3) To study the socio-demographic profile and role of stressors in patients of Type 2 Diabetes Mellitus.

Materials and Methods: Sample size : 100. Consecutive 100 patients diagnosed with Type 2 Diabetes Mellitus fulfilling the inclusion and exclusion criteria were screened for the presence of depression and anxiety using Montgomery Asberg depression Rating Scale (MADRS) AND Hamilton Anxiety Rating Scale (HAM-A) respectively. The socio-demographic profile of the patients was assessed using a specially designed semi-structured proforma. Patients detected with depression and/or anxiety were started on a combination of T. Escitalopram (10 mg) and T. Clonazepam (0.5 mg); keeping the management of them unchanged. Patients reviewed after 6 weeks from date of initial assessment and blood glucose levels repeated. Data collected was analysed using appropriate statistical methods.


Study of psychiatric morbidity and quality of life in patients with leprosy

Priyanka Gupta, Bindoo Jadhav, Pavan Sonar, H.S. Dhavale,

V.V. Pal

K.J. Somaiya Hospital, Mumbai, India

Introduction: Leprosy is a chronic infectious disease of the skin associated with high psychical an psychological morbidity. Leprosy is major public health problem in India and accounts for one third of the leprosy cases in the world and by far the greatest number of cases among individual country. Leprosy relentlessly deforms and disfigures the sufferer physically, disorganizes him psychologically, disables him vocationally, and disturbs his social harmony. In two studies from North India, the prevalence of Psychiatric morbidity was found to be 56-78%. The present study was carried out to find out the pattern of psychiatric morbidity in leprosy patients and the relationship of various factors with psychiatric morbidity.

Aims and Objectives : To study the prevalence of Psychiatric Morbidity in Leprosy patients. To study the Quality of life and social and Occupational Functioning of patients with psychiatric morbidity. To study the presence of depression an anxiety in leprosy patients.

Methodology: Inclusion Criteria: Patients from 18 to 60 years of age. Patients diagnosed with leprosy 6 months back.

Exclusion Criteria: Patients with history of previous psychiatric illness or comorbid medical illness. Fifty leprosy patients presenting to Bombay Leprosy Clinic interviewed using semi-structured proforma and Clinical Diagnosis made using DSM-IVTR. Quality of life and Social and Occupational Functioning assessed using WHO BREF QOL Scale and SOFAS respectively. Hospital Anxiety Depression Scale applied to study the presence of depressive and anxiety features. Data pooled and subjected to statistical analysis.

Results and Discussion: To discuss the Findings with available literature.


Study OD prevalence and severity of depression in dialysis patients

Ravi Rana, D.K. Sharma, C.S. Sushil, D.K. Vijayvergia

Government Medical College, Kota, Rajasthan, India

Aims and Objective: The study was aimed to study the magnitude and severity of depression in dialysis (End stage renal disease) patients.

Methodology: Fifty patients registered at the M.B.S. Hospital Kota in dialysis unit for dialysis formed the sample of study. All the subjects were thoroughly evaluated on the especially designed semistructured proforma which included sociodemographic derails and mental status examination. Diagnosis was made according to international classification of diseases and then Beck's depression inventory was administered to each patients in order to asses severity of depression.


Study of emotional processing in schizphrenia using optimized emotional stroop test

Vishal Vishwanath, Naren P. Rao, Ganesan Venkatasubramanian, Rishikesh V. Behere, Shivarama Varambally, B. N. Gangadhar

NIMHANS Bangalore, India

Introduction: Abnormal Facial emotion recognition is well described in schizophrenia. However, evidence for emotion processing abnormalities in Schizophrenia using emotional stroop test is less examined and the results are equivocal. Some of these discrepancies could be due to methodological issues, mainly differences in lexical characters of words which potentially influence word processing speed. Thus, we aimed to compare emotional interference in schizophrenia patients and healthy controls by using an optimized emotional stroop test.

Materials and Mehtods: The Optimized emotional stroop test with established methodology was used to assess the interference between emotion and attention. Twenty patients (10 females) satisfying DSM-IV criteria for Schizophrenia and 32 healthy controls (21 males) groups matched for age and sex were examined.

Results: Schizophrenia patients had significantly higher interference score for negative valence words (t=2.302; P=0.026) but did not differ for positive valence words (t=0.19; P=0.85), in comparison with controls. Also the number of errors committed was higher in schizophrenia patients (t=3.95; P<0.001). There were no significant correlations between other illness related variables (age at onset, total SANS and SAPS scores) and interference scores.

Conclusions : Study findings suggest presence of increased negative interference in patients with schizophrenia indicating impaired negative emotions processing in schizophrenia patients. The lack of association between clinical variables and interference scres raises the possibility that it could be a trait marker. In the background of negative expressed emotions affecting the prognosis of schizophrenia, our findings have potential clinical utility.


Depression in elderly: Gender differences

Abhijit M. Karegaonkar, Kameshvel C., Arunkumar N,Rajaram M., K. Ramakrishnan

ATHMA Institute of Mental Health & Social Sciences, Tiruchirappalli, Tamil Nadu, India

Depression is the most common psychiatric disorder in the elderly. With improved health care facilities and awareness, the elderly population above the age of 65 is going to rise from 6% in 2000 to 19% in 2020, i.e. nearly three times. Under-diagnosed and therapy left untreated, this depression is associated with worsening prognosis for certain medical conditions and contributes to increased suicidal risk. The presentation of depression in this population is complicated by the coexisting medical problems and cognitive deficits. Apart from this, significant gender differences have been noted in the prevalence, presentation, life events and adequacy of coping mechanism; the last two playing a role in the etiology of depression. The aim of this study will be to assess for the gender differences, especially in presentation and life events, in the ICD 10 diagnosed Depression patients aged 65 years and above attending the ATHMA Institute of Mental Health & Social Sciences based in Tiruchirapalli city of Tamil Nadu. They will be assessed using a semi-struc tured interview format and appropriate tools for Depression and Life events. The results of the study and their implications will be discussed during the presentation.


Interface between primary care and psychiatry in a semi urban set up

Devajit D., Saldanha D., Archana J., Bhattacharya L. Padmashree

Dr. D.Y. Patil Medical College, Pune, India

Background: The interface between primary care and Psychiatric services is of key importance in the delivery of mental health services in rural/semi urban areas. While the care of patients with severe mental health problems are exclusively dealt by psychiatric services, primary care retains the management of less severe mental health disorders.

Aim: To evaluate the psychiatric referral pattern by GP's in a semi urban area of Pimpri, Pune.

Materials and Methods: Consecutive psychiatric referrals by GP's to private Medical College in a semi urban areas from February 2010 to June 2010 irrespective of age sex, economic status were taken into study. They were identified according to International Classification of Diseases (ICD-10).

Results: 49 patients were taken into study. 27 (55.10%) male and 22 (44.90%) were females. Age of the subjects ranged from 7 - 79 years. 12 (24.49%) were acute cases, 33 (67.35%) were chronic and 4 (8.16%) were acute on chronic. 11 (22.45%) directly reported to the psychiatrist where as 33 (77.55%) cases were initially seen by specialists from different branches of medicine before a final referral was made. A wide range of Psychiatric disorders were seen.

Conclusion: Consultation liaison has a great role in delivery of mental health care semi urban areas.


Electrophysiological correlates in obsessive compulsive disorder: A comparative study of patients, their first degree relatives and normal controls

Roshan K. Khanande, S. Haque Nizamie, Basuded Das

Central Institute of Psychiatry (CIP), Ranchi, India

Aims and Objectives: (1) To investigate exposure and response prevention (ERP) and cognitive task in patients with OCD and to correlate with their clinical and demographic profiles. (2) To compare ERP and cognitive task in patients with Obsessive Compulsive Disorder (OCD) and matched normal controls. (3) To compare ERP and cognitive task in patients with OCD and their first degree relatives. (4) To compare ERP and cognitive task in first degree relatives of patients with OCD and normal controls.

Methodology: A population of 10 obsessive compulsive disorder patients meeting the ICD 10 DCR diagnosis, their 10 first degree relatives and 10 age, sex and education matched healthy controls in the age group of 18-50 years would be selected for the study. The patients would be rated on Yale Brown Obsessive Compulsive Rating Scale (Y-BOCS) to assess the severity of symptoms followed by the Hamilton rating scale for anxiety and depression to exclude those with severe symptoms. Sidedness bias schedule to assess handedness and Ishihara's chart to rule out colour blindness would be applied for all subjects. Subsequently 40 channel ERP would be done on them while doing Continuous performance test and colour Stroop test. P50, P300 and Contingent Negative Variation (CNV) paradigms would be studied along with ERP changes while doing these tests.


Duration of untreated psychosis and social congnition in patients of schizophrenia

Gunjan, Pradeep Sharma, Alok Tyagi, Anil Tambi, Arvind

S.M.S. Medical College Jaipur, India

Aims and Objectives: To determine correlation of duration of untreated psychosis with social cognition in patients of schizophrenia. Methodology: After obtaining Institutional Ethical Committee approval, 50 patients of schizophrenia attending OPD on Tuesday and Friday (constituting first 3 consecutive patients fulfilling inclusion criteria on each day of week) were included in the study. Socio-demographic profile and clinical data was gathered and SOCRATIS scale for social cognition developed and validated in NIMHANS, Bangalore was applied to measure social cognition. Appropriate statistical analysis was done using SPSS. Results and Conclusions: The correlation of Social cognitive score with DUP was found to be - 0.268, with P=0.06, when controlled for total duration of illness the partial correlation between Social cognitive score with DUP was 0.284 and was significant with P=0.048. It was concluded that early institution of treatment in patients of schizophrenia may improve social cognitive score and hence will be associated with better functional outcome.


Cognitive dysfunctions and their correlation with disability in schizophrenia

Prena Kukreti, Lokesh Shekhawat, Manish Kandpal, R.C. Jiloha

G.B. Pant Hospital and Maulana Azad Medical College, New Delhi, India

Background: Cognitive impairments are among the most debilitating symptoms of schizophrenia and have attracted attention of clinicians, initially for understanding brain pathology related to illness and later for their strong correlation with real world functional disability. Cognitive impairment associated with schizophrenia includes neuropsychological deficits in attention, working memory, verbal learning, and problem solving. Studies report that cognitive dysfunctions are the single best predictor of oral-world functioning.

Aims and Objectives: To study cognitive dysfunctions in people with schizophrenia and their association with disability.

Methodology: A cross-sectional sample of randomly selected 50 people with a diagnosis of schizophrenia (ICD-10 criteria) were assessed on digit span, digit symbol substitution, stroop and trail making-part B tests for cognitive functions. These patients were simultaneously measured for disability on WHO disability assessment scale-II and Indian disability evaluation and assessment scale. Symptoms were assessed on Positive and Negative Syndrome Scale (PANSS).


Efficacy of adjunctive high frequency right parietal cortex repetitive transcranial stimulation in unipolar depression: A randomised double-blind sham - Controlled study

G.M. Venkatesh Babu, V.K. Sinha, Sachin Gandotra

Central Institute of Psychiatry (CIP), Ranchi, India

Aims and Objectives: To compare the efficacy of adjuvant active high frequency rTMS over the right parietal cortex in patients with moderate to severe unipolar depression with sham stimulation.

Methodology: 12 right handed, normotensive patients in the age group of 18-60 years of either sex meeting the ICD 10 DCR criteria for moderate to severe unipolar depression would be taken for the study. Using the block randomization method patients would be allotted to active or sham groups where both the groups would receive a total of 10 daily rTMS sessions (5 days week for 2 weeks). The motor threshold (MT) for the left abductor pollicis brevis (APB) would be determined using figure-of-eight coil at 1 Hz frequency using Rossini Rothwell paradigm. In both the groups, rTMS would be applied at 90% MT with a frequency of 10 Hz with each session for 660 seconds (11 minutes) of 10 trains with each train of 120 pulses over the right parietal cortex using figure-of eight coil. A baseline assessment wit Structured interview Guide for the Hamilton Depression Scale (SIGH-D), Beck's depression Inventory (BDI), Hamilton Anxiety Scale (HAM-A) to assess the depressive symptoms, Brief Psychiatric Rating Scale (BPRS) to assess the severity of psychotic symptoms would be taken before rTMS session. This would be followed by repeat assessments after 1 week (after 5 th rTMS), 2 weeks (after 10 th rTMS) and at 4 weeks (2 weeks poster-rTMS) by an independent rater to ascertain double-blinding. Young Mania Rating Scale (YMRS) rating would be done only on 2 nd , 3 rd and last assessment to assess for switching to mania during rTMS.

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