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|Year : 2014
: 56 | Issue : 5 | Page
|Free Papers (Oral)
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. Free Papers (Oral). Indian J Psychiatry 2014;56, Suppl S1:19-62
Ondine curse: A severe presentation of obsessive compulsive disorder
Abhilove Kamboj, Prerna Kukreti, Amit Garg, Omprakash Jhirwal
Department of Psychiatry, Institute of Human Behaviour and Allied Sciences, New Delhi, India
Introduction: Treatment resistant obsessive compulsive disorder has been a challenge for psychiatrists. We report a personal experience of life-threatening presentation of difficult to treat obsessive compulsive disorder.
Case Report: Miss S, 28-year-old, Muslim, unmarried female presented to psychiatric unit of a tertiary care hospital, Institute of Human Behaviour and Allied Sciences. Patient had no past or family history of psychiatric illness and presented with insidious onset continuous illness of 8 years duration characterized by obsession of contamination, obsessive doubts, compulsive cleaning, and repetitive ritualistic acts. Mental status examination confirmed the same. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score was 30. Patient's clinical condition has deteriorated so much till presentation to us that due to fear of contamination from environmental air, patient used to stop taking breath and used to turn cyanose three to four times a day. Patient was not ready for coming to the hospital due to obsession of contamination. Patient in past has not responded to adequate trial of several pharmacological agents namely sertraline, fluoxetine, fluvoxamine, clomipramine, and risperidon tried on outpatient department (OPD) basis. Patient was admitted and started on combination of clomipramine, olanzapine, and buspirone and was started on systematic desensitization addressing initially her life-threatening behavior of breath holding. After 2 months of intensive behavior therapy and pharmacotherapy patient improved and Y-BOCS score reduced to 14. Patient after 8 months of follow-up is maintaining well.
Comparative effectiveness of antipsychotics in delirium in elderly
Abhishek Ghosh, Sandeep Grover
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Aims and Objectives: The objective of the study was to assess and compare the effectiveness of antipsychotics (haloperidol vs olanzapine and risperidone) in elderly patients with delirium admitted to medical and surgical wards.
Materials and Methods: This was a naturalistic follow-up study in which consecutive elderly patients with delirium referred to the consultation-liaison psychiatry team and who were prescribed any antipsychotic were recruited. The study sample consisted of 33 patients, with 17 subjects in the haloperidol group and 16 subjects in the atypical antipsychotic (olanzapine or risperidone) group. A flexible dose regimen (haloperidol - 0.25-5 mg; risperidone - 0.25-2 mg; and olanzapine - 1.25-5 mg) was used. Effectiveness was assessed by using Delirium Rating Scale-Revised-98 (DRS-R98) and Mini Mental Status Examination (MMSE). Besides the medications, subjects in both the groups received nonpharmacological treatment in the form of reorientation cues.
Results: There was no significant difference in mean baseline DRS-R98 severity scores between the two groups, but the baseline MMSE score was significantly lower in the haloperidol group. At the end point of the study, both haloperidol and the atypical antipsychotics were found to be effective in the form of significant reduction in DRS-R-98 scores and increase in MMSE scores compared to the baseline in the baseline. There was no statistically significant difference between the effectiveness of haloperidol and atypical antipsychotics.
Conclusion: Typical and atypical antipsychotics have equivalent effectiveness in management of delirium in elderly.
Wilson's disease: Catatonia as the only manifestation
Abhishek Pratap Singh, Abhilove Kamboj Prerna Kukreti, Omprakash Jhirwal
Department of Psychiatry, Institute of Human Behaviour and Allied Sciences, New Delhi, India
Introduction: Catatonia is a clinical presentation with varied causes ranging from infectious causes to metabolic causes. Wilson's disease is one of the known causes of catatonia, but catatonia has been reported as a rare presentation (0.01%) of Wilson's disease. We hereby report a case of Wilson's disease presenting as catatonia as the only manifestation.
Case Report: Ms. S, a 20-year-old, young unmarried Muslim female presented with acute onset 5 month history suggestive of catatonia (mutism, stupor, ambitnedency, waxy flexibility, and rigidity). Patient had no past history of psychiatric illness. Family history of suicide in an elder brother and two elder sisters having died of 7 months illness of similar presentation was there. Patient did not respond to intravenous lorazepam trial of 3 days and 10 modified electroconvulsive therapy. Magnetic resonance imaging (MRI) brain revealed multiple hyperintensities in internal capsule and basal ganglia. Ultrasonography (USG) abdomen was normal. Biochemical investigations showed increased urinary copper, decreased serum copper, and decreased blood ceruloplasmin. Slit lamp examination was unremarkable and neuropsychiatric examination revealed a catatonic state with no obvious cardinal neurological manifestations of Wilson's disease. Diagnosis of Wilson's disease was made and patient improved on penicillamine, zinc sulfate, and lorazepam.
Implications: Wilson's disease should be kept as a differential diagnosis in young adults presenting with catatonia.
Role of armodafinil as an adjunct in drug resistant adhd0
Abhishek Pratap Singh, Pramod Kumar Singh
Department of Psychiatry, Institute of Human Behaviour and Allied Sciences, New Delhi, India
Background: Attention deficit hyperactivity disorder (ADHD) affects 3-8% of children of 5-16 years of age. It is associated with co morbidities in up to two-third of the cases which poses significant diagnostic and therapeutic challenges in real world settings. We hereby report a similar therapeutic challenge and our clinical experience.
Case Report: This is case report of a 12-year-old, female patient with diagnosis of mild mental retardation, speech impairment, epilepsy, and ADHD. Her seizure disorder was well controlled on antiepileptic medication, but symptoms of ADHD in the form of hyperactivity, impulsivity, and inattention were quiet problematic. She has shown no significant response with adequate trial of atomoxetine, methylphenidate, clonidine, risperidone, aripiprazole, and tricyclic antidepressant (TCA) in monotherapy as well as in combination. She had developed breakthrough seizure with lower dosage of TCA and marked restlessness, agitation, and decrease of appetite with methylphenidate. Patient was not much cooperative for behavior therapy, due to low intelligence and speech impairment and deteriorating symptomatic status. She finally showed significant improvement with combination of methylphenidate and armodafinil.
Pattern of memory disturbances in traumatic brain injury: A cross-sectional analysis
AH Mullegama, Jyoti Prakash
Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
Introduction: Traumatic brain injury (TBI) is a silent epidemic of modern times. It leads to significant disability and financial loss to the nation. Advances in imaging and management have led to an increasing number of survivors with residual cognitive impairments. These effects can include a wide range of memory disturbances.
Aim: A study was done to ascertain and describes the pattern of memory disturbances in TBI patients.
Methodology: A cross-sectional study undertaken on patients admitted directly to the neurosurgical ward at tertiary care referral hospital or transferred from primary care center. Memory deficit were assessed using PGI Memory scale (PGIMS).
Results: Memory dysfunction was found to be highest in domain of recent memory and attention-concentration; whereas, it was least for mental balance and visual recognition. Other deficits were intermediate in nature.
Conclusions: Study concludes that there is significant decline in memory function with TBI. An effective remediation will require multidisciplinary approach which as well involves memory enhancement techniques.
Executive cognitive dysfunction in alcohol dependence: A case control study from a tertiary care center
Akanksha Sonal, Shanmugiah Arumugam, Jeyaprakash R.
Institute of Mental Health, Kilpauk, Chennai, Tamil Nadu, India
Background: Alcohol dependence is highly associated with the impairment of cognitive executive function. However, considering the difficulty to assess the executive function clinically, the aim of present study is to assess the executive cognitive function using a brief neuropsychological battery, frontal assessment battery (FAB). The FAB is a short cognitive and behavioral six subtest battery for the bedside screening of a global executive function. The study presents with preliminary data about the use of FAB for quick assessment of cognitive function in alcoholics with aims to improve its use for both clinical and research purposes.
Aims and Objectives:
- To assess the executive cognitive function in alcohol-dependent subjects.
- To compare the scores of the alcohol-dependent subject group with the nonalcoholic control group.
Materials and Methods: For the present study 152 male subjects attending Institute of Mental Health, Chennai, from July 2012 to December 2012 for deaddiction services were taken up, ageing between 17 and 60 years. The diagnosis of alcohol dependence syndrome was made according to International Classification of Diseases, 10th revision (ICD-10; Research and diagnostic criteria) with normal intelligence. After getting informed consent their sociodemographic details were collected using semistructured pro forma and executive cognitive function was assessed using FAB. Subjects with current or past history of psychotic complaint and neurological deficits were excluded from the study. They were compared with 153 male controls similar in age and education.
Result and Conclusion: It will be discussed at the time of presentation.
Neuropsychiatric disorders in idiopathic Parkinson's disease
Alakananda Dutt, Hrishikesh Kumar, Chitrita Sengupta, Muktalekha Mukherjee
P481 Keyatala, 1st floor, Kolkata.
Aims: To compare sociodemographic, clinical, cognitive profile and activities of daily living in patients with and without psychiatric disorders in idiopathic Parkinson's disease (PD).
Materials and Methods: Hundred patients with PD diagnosed by the UK Brain Bank Criteria were assessed on sociodemographic and clinical profile, the Unified Parkinson's Disease Rating Scale, Modified Hoehn and Yahr Staging, and Schwab and England Activities of Daily Living Scale. Cognitive assessment was done by the Mini Mental State Examination. The Mini International Neuropsychiatric Interview was used to screen for psychiatric illness and the National Institute of Neurological Disorders and Stroke, National Institute of Mental Health (NINDS-NIMH) criteria was used to assess Parkinson's associated psychosis.
Results: Sixty-eight percent patients had comorbid psychiatric disorders. Depressive disorder (38%) was the most common diagnosis followed by anxiety disorders (17%) and psychotic illness (13%). Patients with psychiatric disorders had significantly higher difficulties in activities of daily living, motor impairment, and cognitive impairment than those without psychiatric disorders.
Conclusion: Findings highlight the importance of recognizing psychiatric disorders in patients with PD as they are quite common and are associated with greater impairment in activities of daily living and quality of life.
Impact of attention deficit hyperactivity disorder on family
Amit Arya, Suresh Yadav, Vivek Agarwal, Pawan Kumar Gupta
Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
Aims and Objectives: To study the impact of attention deficit hyperactivity disorder (ADHD) on the family.
Methodology: Impact of ADHD on the life of 67 patient's families (patients were between 6 and 16 years fulfilling the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria for ADHD) was assessed on impact questionnaire. Sociodemographic and clinical details including the severity of ADHD were assessed.
Results: Impulsive behavior had a definite impact on the family (79.1%), followed by demanding behavior (74.6%). The relationship among parent and child was most affected (91.0%), followed by relationship among parents (77.6%). Worry for the future of the child (89.6%), child's behavior affecting parent's work (88.1%), and worry that second baby might also get similar problems (79.1 %) had significant impact on lives of parents. Problems at school (92.5%), interaction with relatives (83.6%), and problems in society due to behavior of the child (80.6%) were reported.
Conclusions: ADHD has widespread impact on all aspects of the family's functioning. The impact on various domains and its implications are discussed in this study.
Asenapine triggered depressive episode in a case of schizophrenia: A case report
Amit Garg, Pallavi Sinha, Bhavuk Garg, Om Prakash
Department of Psychiatry, Institute of Human Behaviour and Allied Sciences, Delhi, India
Asenapine is an antipsychotic drug used for the treatment of schizophrenia. Recently, it has been used for the management of bipolar disorder also. In the following case report, a patient with schizophrenia developed syndromal depressive episode after addition of asenapine to the ongoing treatment regimen and had complete resolution of symptoms after asenapine discontinuation. Cautious use of this drug in cases with bipolar disorder and schizophrenia is hence emphasized.
Prevalence of risk and protective factors for mental health among adolescent school students
Anilkumar TV, Indu PS, KA Kumar, Rajamohanan
Department of Government Medical College, Trivandrum, Kerala, India
Objective: To estimate the prevalence of risk and protective factors for mental health among adolescent school students.
Materials and Methods: A survey was conducted among adolescent school students in private and government schools in four districts in Kerala using Kite visual explanatory Adolescent Screening Questionnaire (Kite-ASQ), which was developed and validated by the same authors. A separate version was used for boys and girls. The questionnaire was self-administered. Risk and protective factors in the social, behavioral, emotional, somatic, and cognitive domains were elicited using appropriate pictures attached to each domain.
Results: The questionnaire was administered to 590 students which included 282 boys and 307 girls. Mean age of the sample was 14.01 years with standard deviation of 2.04 years. While 18.5% of adolescents wanted help for their problem, 10.6% expressed willingness to discuss their problem. Detailed analysis of risk and protective factors will be presented.
Conclusion: Prevalence of risk factors in the emotional and learning domains was higher compared to those in the social, behavioral, and somatic domains.
Depression and quality of life in key caregivers of dementia
Wg Cdr, Anindya Kumar Gupta, Garima Srivastava
Department of Psychiatry, Air Force Hospital, Nathu Singh Road Cantt, Kanpur, Uttar Pradesh, India
Aims: To assess the level of depression and quality of life in key caregivers of patients of dementia and to analyze gender-based differences, if any. To formulate intervention where needed to improve the level of care in dementia and quality of life of key caregivers.
Materials and Methods: The sample consisted of 50 dementia key caregivers giving informed consent (25 males and 25 females) from the outpatients of the Department of Psychiatry, Air Force Hospital, Kanpur, UP. The sample was purposively selected fulfilling the inclusion and exclusion criteria. Semistructured pro forma for sociodemographic details, Hospital Anxiety Depression Scale, and World Health Organization (WHO)-Quality of Life-BREF were administered on all the subjects.
Results: All the key caregivers of dementia patients exhibited mild to moderate level of depression. The overall perceived quality of life and health were found to be in the range of average to poor. Mean scores on Hospital Anxiety Depression Scale for female caregivers were found to be higher (19.75) in comparison to male caregivers (12.45) and the difference was statistically significant. Mean scores on physical health, psychological health, and social relationship of female caregivers were found to be lower; whereas, males scored lower than females on environmental health; indicating poor quality of life of dementia key caregivers. The findings were discussed with the key caregivers and they were psychoeducated about their condition in order to improve their quality of life and also the quality of care provided to the dementia patients.
Conclusion: Female key caregivers of dementia patients were found to have more depression and poorer quality of life than their male counterparts. These findings are discussed.
A study of lipid profile and apolipoproteins A1 and B: Their relationship with attentional impulsivity in first episode mania patients
Anjana Rao Kavoor, Daya Ram, Sayantanava Mitra
Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand, India
Background: Attentional/cognitive impulsivity has been demonstrated as being associated with an increased risk for suicide and other self-harming behaviors, along with a more severe course in patients with bipolar disorder. It has been proposed in the past that an alteration in various serum lipid fractions might be associated with increased impulsivity, but evidences are ambiguous and mainly based on western population data.
Objective: Present study analyzed the relationship between attentional impulsivity and various serum lipid fractions in bipolar patients from an Indian perspective.
Materials and Methods: Sixty drug-free/naïve first episode mania patients were rated on the Barratt Impulsiveness Scale-11 (BIS-11) and Young Mania Rating Scale; body mass index (BMI) was calculated and blood samples were analyzed for total cholesterol (TC), high, low, and very low density lipoproteins (HDL, LDL, and VLDL), triglycerides (TG), and apolipoproteins A1 and B.
Results: Based on the mean attentional subscale score of BIS-11, the subjects were divided into with (n = 31) and without (n = 29) significant attentional impulsivity, and compared. Statistically significant differences emerged in terms of TC (P = 0.042), TG (P = 0.021), VLDL (P = 0.029), and BMI (P = 0.002), all being lower in those with attentional impulsivity.
Conclusion: This is a pioneering study in a developing population, and the results contribute to the current literature on a lower TC, TG, and VLDL in subjects with significant attentional impulsivity, as compared to those without. The finding regarding the BMI is a novel finding, which needs further exploration.
A case report of petrol dependence with comorbid adhd0 : Is there a bidirectional relationship?
Ankit Gupta, Anju Dhawan, Rachna Bhargava, Ramandeep Pattnayak, Vaibhav Patil
Department of Psychiatry, 4 th floor teaching block, All India Institute of Medical Sciences, New Delhi, India
Aim: The present case report aims to illustrate clinical presentation and management of an adolescent boy with inhalant (petrol and liquid petroleum gas (LPG)) dependence and attention deficit hyperactive disorder (ADHD).
Methodology: A 12-year-old boy attending the outpatient clinic of National Drug Dependence Centre, All India Institute of Medical Sciences (AIIMS), New Delhi was diagnosed with inhalant dependence and ADHD according to International Classification of Diseases, tenth revision (ICD-10). A multidisciplinary team conducted detailed inpatient clinical evaluation and observation. Psychometric tests, namely, Malin's Intelligence Scale for Children and Conner's Rating Scale for Parents were administered to assess intellectual functioning and hyperactivity. Conner's Rating Scale for Parents was administered 3 weeks after admission (prior to starting atomoxetine) and 1 week after reaching optimal dose of atomoxetine.
Results: Cognitive impairment was evident. Striking features include unusual choice of substance of abuse, bidirectional relationship between psychiatric illness, and substance abuse and rapid response to treatment. An integrated management approach including pharmacotherapy and behavioral therapy led to significant improvement.
Conclusion: Petrol and LPG abuse is an unusual presentation in deaddiction settings and it can potentially lead to physical, neurocognitive, and psychiatric complications. ADHD as a comorbid psychiatric illness acted as a risk factor for and may have been exacerbated by inhalant dependence.
Implications: ADHD is frequently associated with substance abuse and its identification and management has implications for treatment of the latter. Development of diagnostic and treatment guidelines is required for effective management of such populations.
A comparative study of the profiles of children diagnosed as ADHD with non-ADHD
Anshul Mahajan, Sandeep Choudhary, (Brig) S. Sudarsanan, Supriya Vaish, Sumit Puri, Priyanka Sharma, Sandip Kamal, Nashad Usman Ghani
Department of Psychiatry, Subharti Medical College, Meerut, Uttar Pradesh, India
Introduction: Attention deficit hyperactivity disorder (ADHD) is a heritable neurobehavioral disorder associated with significant impairments in occupational, academic, neuropsychological, and social functioning. A substantial portion of bipolar disorder (BD) has a comorbid ADHD. ADHD comorbidity is frequent in juvenile BD and can influence the age of onset, phenomenology, comorbidity, and course of BD. Other disorders like depression, conduct disorder (CD), and oppositional defiant disorder should also be delineated while evaluating for ADHD and childhood BD. There is a common consensus that uncomplicated classical manic-depressive illness is rare in children. Thus, it is of immense importance that the changes and variability in the profiles of these children are studied and compared with the control group, and thus better management strategies can be formulated based on the results.
Objectives: To compare the profiles of ADHD with non-ADHD children.
Materials and Methods: The study was conducted in Department of Psychiatry, Subharti Medical College and Hospital, Meerut. Studied population included 60 children (30 - ADHD and 30 - non ADHD). They were evaluated thoroughly using semistructured pro forma.
Results and Conclusions: Mean age of ADHD patients was 9.9 years, age group 10-13 years (56.6%), male:female ratio - 27:3, and 23.3% comorbidities with ADHD; and in non-ADHD mean age - 12.6 years, male:female ratio - 19:11, and age group 14-17 years (46.66%). The implications of these results along with a final conclusion would be discussed during the presentation.
Compassion fatigue and burnout amongst clinicians
Anupsinh H Chhasatia, Sandip Shah, Lakhan Kataria, Kajal Tanna
Room no.182 / NRI block (old), Sumandeep Vidyapeeth Campus, Piparia, Waghodia, Vadodara, Gujarat, India
Clinicians are the one who are involved in most stressful events. Compassion fatigue comprises of two components: Burnout and secondary traumatic stress. Up to one-third of practicing clinicians could be expected to be suffering from burn out if assessed cross-sectionally. More importantly there has been an increasing trend in the emotional exhaustion of clinicians over the years. There is paucity of literature in this area, especially in the Indian setting.
Aim: Identifying 'burnout' and 'compassion fatigue' among clinicians involved in care of individuals suffering from medical illness.
Materials and Methods: A total of 100 clinicians were included in the study. A semistructured questionnaire was administered to gather information related to personal and professional details of the study participants. Professional Quality of Life Scale (ProQoL Version V) was used to assess burnout, compassion satisfaction, and secondary traumatic stress. Analysis was carried out using the Statistical Package for Social Sciences (SPSS).
Results: Burnout score was significantly higher in those involved in emergency duty. Similarly, compassion satisfaction score was greater among those with greater years of practice as well as among those in private practice. Clinicians who reported a poor working condition, as opposed to good, had more burnout and less compassion satisfaction.
Conclusion: The current study suggests that it is important to find out ways of decreasing burnout and compassion fatigue among clinicians.
Psychiatric morbidity in patients suffering from chronic pain
Archana Javadekar, Vishal Patel, Sameer Guliani
45, Sahawas Society, Karvenagar, Pune, Maharashtra
Aim: To find out the psychiatric morbidity in patients suffering from chronic pain.
Methodology: The study sample consisted of 50 consecutive patients attending medicine, orthopedic, and psychiatry out- and inpatient departments in age group of 18-60 years, having nonmalignant musculoskeletal pain for more than 6 months. Those who consented and volunteered for the study their verbal and written consent was taken. Demographic profile of study sample was documented. They were then interviewed with the Schedule for Clinical Assessment in Neuropsychiatry (SCAN). The data collected was organized, tabulated, and analyzed using statistical tests of significance.
Results: Thirty-six percent had depression, 18% had generalized anxiety disorder, 16% had somatoform disorder, and 8% had panic disorder which shows that patients with chronic pain are more likely to have mood disorder than other psychiatric disorders.
Conclusion: The present study revealed that psychiatric comorbidity was significantly high in patients suffering from chronic pain.
Personality disorders and risk factors associated with suicide attempt
Arun Kumar Pandey, Shakya DR, Adhikari BR, Shyangwa PM, Sapkota N
Department of Psychiatry, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
Introduction: Deliberate self-harm or suicidal attempts can be seen in any society and may be having various underlying causes. Every 40 s a completed suicide case happens globally and it has been found that 20+ suicide attempts may be there for every completed suicide. A previous suicide attempt is one of the strongest predictors of future completed suicide. Present study was done to evaluate clinico-sociodemographic and personality profile of suicide attempters.
Aims and Objectives: To analyze the clinic-sociodemographic profile, personality disorders, and other related factors in suicide attempted patients referred to the Department of Psychiatry.
Materials and Methods: The study was conducted in B. P. Koirala Institute of Health and Sciences (BPKIHS). After getting the informed consent, hundred willing suicide attempting patients admitted in various departments of BPKIHS fulfilling the inclusion criterion, referred to and attending the psychiatric outpatient department (OPD) in 1 year were screened and included in the study. Appropriate research tool were selected and the data collected out of the study was subjected to a qualitative and quantitative analysis as per the aims and objective of the study.
Result and Conclusion: Majority of suicide attempters are young, mostly from rural background and with comorbid psychiatric disorder including personality disorders. Early referral for psychiatric intervention and restriction of the availability of toxic pesticides can decrease the risk of suicide.
Depot antipsychotic use in children and adolescents: A case series
Arun Vijay Gadad, Preethi Jacob, Vijay Danivas, Satish Chandra Girimaji, Shoba Srinath, Shekar Sheshadri, John Vijay Sagar
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
Aim of the study: To study the use of depot antipsychotics in children, the reasons for choosing the same, and its effects and side effects in children and adolescents
Methodology: A 15-month (1 st January 2011-1 st March 2012) retrospective review of children and adolescents who were diagnosed with a psychotic disorder (affective and nonaffective) and treated with depot antipsychotics was studied. Data was entered and analyzed on Statistical Package for Social Sciences (SPSS) version 20.
Results: One hundred and twenty children and adolescents were diagnosed to have a psychotic disorder during the study period. Out of this population, 62 were diagnosed to have a bipolar affective disorder. Seven (5.83%) children and adolescents received depot antipsychotics. Number of males and females were three and four, respectively. Average age was 14 ± 0.75. Reasons for use of depot medication were noncompliance in three; add on in two; and failure, failure of oral medication, and to augment oral medication. Average numbers of trials of oral medication received were two. Types of depot antipsychotics used were first generation antipsychotics (fluphenazine in two, flupenthixol in three, and zuclopenthixol in two). Most common side effects seen were extrapyramidal symptoms and dystonia.
Conclusion: Although associated with extrapyramidal side effects, depot antipsychotics have a place in the treatment of refractory severe mental illnesses in children and adolescents.
A study to correlate the neuropsychiatric manifestations of dementia with the MRI-Based hippocampal volume
Arunava Datta, HR Phookun, D Bhuyan, A K Kayal
Background: It is the neuropsychiatric manifestations of dementia which are a major cause of caregiver and patient distress. Neuropsychiatric manifestations are a major cause of financial burden to the patient's caregivers and are a major cause of caregiver burnout.
Aims: To study the neuropsychiatric manifestations of dementia and to correlate the findings with magnetic resonance imaging (MRI)-based hippocampal volume.
Materials and Methods: Forty patients who were diagnosed with dementia were taken up for the study. They were assessed for the presence and severity of neuropsychiatric manifestations of dementia using the neuropsychiatric inventory. These patients then underwent a MRI scan of the brain where the estimation of the hippocampal volumes was done.
Results: Though there was no statistically significant relationship between the total Narcissistic Personality Inventory (NPI) scores and the hippocampal volumes. But there was a very significant correlation between the depression/dysphoria subscale of the NPI and the left hippocampal volumes with a P-value of 0.0032. Also the depression/dysphoria subscale shows a significant relationship with the total hippocampal volumes (P < 0.0001). The apathy subscale also shows a significant relationship with the right hippocampal volumes (P = 0.01425).
Conclusions: This is the first study done in India which has attempted to find out the presence of any relations between the hippocampus and the neuropsychiatric manifestations of dementia. Despite the small sample size, there seems to be some correlation between the neuropsychiatric manifestations of dementia and the volume of hippocampus which should be studied more in detail in the future.
A study of relationship between psychometric measure of clinical analysis and violence against women
ArvindJinger, Pradeep Sharma, Gunjan, Vijay choudhary, Bhakti Murkey
Department of Psychiatry, Consultant Psychiatrist, SMS Medical College, Jaipur, Rajasthan, India
Background: The epidemic of violence directed at women and girls constitutes a major human rights issue and a public health crisis. It affects women across the life span from sex selective abortion of female fetuses to forced suicide and abuse, and is evident, to some degree, in every society in the world. It causes physical or psychological harm, humiliation, or arbitrary deprivation of liberty that perpetuates female subordination (Heise, Pitanguy, and Germain, 1994).
Aims and Objectives: A study of relationship between psychometric measure of clinical analysis and violence against women.
Materials and Methods: The present study was carried out on a sample population of 35 women consecutively attending Mahila Salah Evam Suraksha Kendra, a violence against women counseling center in Jaipur and same number of control group were taken from relative of these women with suitable inclusion and exclusion criteria. The two groups were compared for their clinical analysis of personality by using clinical analysis questionnaire (CAQ).
Statistics: The proposed study was conducted in phased manner observing ethics of voluntary participation and informed consent of the women participants were taken. Mean and standard deviation, were computed.
Results: With use of suitable statistics, the results revealed that those women who suffer from violence inflected on them have higher emotional problem like depression and anxiety and personality plays significant role in precipitating violence.
Metabolic syndrome and first episode mania - A 12-week prospective study
Asha Krishnan, C. R. J. Khess
Department of Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand, India
Background: Different antipsychotics have varying propensities to induce weight gain, dyslipidemia, and diabetes. Prospective data and data on metabolic indices early in the course of first manic episode treated only with second generation antipsychotics are lacking.
Aim: To study the influence of second generation antipsychotics on metabolic profile of patients with first episode mania after 4 and 12 weeks.
Materials and Methods: Thirty patients with a diagnosis of mania with or without psychotic symptoms according to International Classification of Diseases, 10 th revision Diagnostic Criteria for Research (ICD-10 DCR) and 30 healthy controls were taken up for the study. The patients were treated with optimal doses of a second generation antipsychotic. The two groups were assessed at 0, 4, and 12 weeks for body mass index (BMI), waist circumference, blood pressure, fasting blood sugar (FBS), lipid profile, and glycosylated hemoglobin. The results obtained were analyzed using Statistical Package for Social Sciences (SPSS) version 16.0 for Windows ® , with different parametric and nonparametric measures.
Results: At baseline, there was a significant difference in BMI, waist circumference, total cholesterol, and glycosylated hemoglobin between the two groups. A significant difference was also seen in blood pressure, BMI total cholesterol, triglycerides, very low density lipoprotein (VLDL), and waist circumference at 4 and 12 weeks. High density lipoprotein (HDL) showed a significant difference at 12 weeks. Two patients fulfilled the criteria for metabolic syndrome, while many others showed derangement in one to two metabolic parameters.
Conclusion: Two patients fulfilled the criteria for metabolic syndrome at 12 weeks. Most of the other patients showed an increasing trend towards weight gain and deranged lipid profile suggesting a risk for the development of metabolic syndrome and associated cardiovascular morbidity in future.
Prevalence of Substance use disorder (SUD) in psychiatric patients: A prospective hospital based study
Ashok Patel, Mona Srivastava
Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
Aims : Substance use disorder (SUD) is very commonly found in psychiatric patients. Systematic analysis of this group of dual diagnosis patients can help in optimal management of these patients. Very often this diagnosis is also missed in a busy outpatient department (OPD).
Materials and Methods: All new cases presenting to the OPD services of the Department of Psychiatry of Sir Sunderlal Hospital, Institute of Medical Sciences (IMS), Banaras Hindu University (BHU) were screened for the presence of SUD including nicotine use. All patients having SUD were then assessed by using a sociodemographic data sheet. Severity of alcohol use questionnaire, drug abuse screening test, and dysfunctional analysis questionnaire. Thirty users and 30 age- and sex-matched normal subjects who were often the accompanying relatives of the patients were assessed on the scales.
Results: The prevalence of substance abuse and psychiatric illness was studied in a Psychiatric Evaluations Unit. Twenty-six percent of the subjects received a psychiatric diagnosis only with no concomitant substance use disorder. Thirty-four percent were diagnosed with a substance use disorder but with no other psychiatric disorders. Thirty-nine percent of the subjects had a history of both psychiatric and substance use disorder; 62% of these substance abusers with a psychiatric illness reported using drugs (including alcohol) the week before the interview; 56% used illicit drugs; while 44% used alcohol only. The substance abuse diagnosis is often missed and it is only obtained after an in depth screening and analysis.
Conclusion: Diagnosis of drug abuse in psychiatric patients is not an exercise in futility. The presenting symptoms of florid psychosis may not be related to the patient's underlying psychosis, and hence appropriate diagnosis of drug-related psychopathology may change the prognosis. Drugs also may have an impact on nutrition and on the physical health of the patient.
Associations between life events and the suicide intent of first episode of deliberate self-harm
Bhagwat Rajput, Col Rajesh Goger, Col D. Bhattacharya, Lt Col NC Shekhar, Lt Col M Diwakar
Aims and Objectives:
- To determine the associations between life events in the 12 months preceding an episode of DSH
- To determine severity of suicide intent for first deliberate self-harm (DSH) attempt
- Preventive and social intervention methods to prevent further acts of DSH in at risk population.
Materials and Methods: Necessary clearance from hospital ethical committee and informed consent was taken. Consecutive 100 patients who have attempted DSH for the first time and healthy relatives as control. Place: Tertiary care hospital, New Delhi. Source of data: Psychiatry outpatient department (OPD), psychiatry ward, and other wards. Inclusion criteria: Informed consent; age ≥ 15 years; attempted DSH for the first time only (in past 6 months). Exclusion criteria: Prior history of DSH and mental retardation. Scales used: 1. Pierce suicidal intent scale: Completed after DSH attempts; scores included (circumstance + self-report + medical risk) total score 0-21; low intent 0-3; medium 4-10; severe > 10. 2. Pressumptive stressful life event scale (Singh et al., 1984): Contains stressful life events items standardized on Indian population. Stressful life within 12 months of DSH attempt; score '1' and "2" for 1 or 2 stressful life events. Any event happens twice or more in the preceding 1 year, a score of '1' is given.
Results and Conclusion: The associations between life events in the 12 months preceding an episode of DSH and the suicide intent of this episode were compared in individuals for whom the index episode was their first; with healthy controls. The Pierce scale distribution as low risk, medium risk, high risk, and very high risk. Majority scored medium risk on the scale (26.4%), followed by high risk in 18.3% of cases and low risk in 4.1% and P-value is <0.01 which is statistically significant. The distribution pattern of amount of stress in study group. The life event has been classified into zero event to four event and majority of cases have two event (21.5%) followed by three event (10.5%), four event (7%), and single event 2%; and P-value is <0.01 which is statistically significant.
Results indicated a significant interaction between independent life events and the prediction of suicide intent.
The results provide preliminary evidence to suggest the presence of a suicidal process in which the impact of negative life events on suicide intent is significant.
Spectrum of behavioral abnormalities in patients with CNS infections, meningitis, and encephalitis
Bhagwat Rajput, Monika Thomas, Rani Bhatiya, Sanjida Prasad
Aims and Objectives:
- To investigate behavioral abnormalities in patients suffering from central nervous system (CNS) infection like meningitis and encephalitis
- Use of this data to suggest preventive and clinical intervention to prevent; and treat at risk population.
Materials and Methods: The study will be conducted at the Department of Neurology, St Stephens Hospital, Tis Hazari. A sample size of 50 consecutive patients who have suffered from meningitis and encephalitis was taken for the study. Source of data: Inpatient - Medicine Ward and intensive care unit (ICU), Neurology ICU, and other wards (brought to Neurology attention). Patients and healthy controls and caregivers of the patients were interviewed with the Neuropsychiatric Inventory (NPI). Inclusion criteria: Participation will be based on diagnosis as meningitis and encephalitis by lumber puncture or magnetic resonance imaging (MRI) or clinical symptomatology. Exclusion criteria: Patients with prior history of (h/o) dementia, psychosis, and mental retardation
Results and Conclusion: We investigated 50 consecutive patients who have suffered from meningitis and encephalitis diagnosed by MRI or lumber puncture or clinical history, and behavioral abnormalities diagnosed by neuropsychiatric inventory (NPI) and compared with normal healthy control subjects. The frequency and severity of the following 10 behaviors were assessed: Delusions, hallucinations, agitation, dysphoria, anxiety, euphoria, apathy, disinhibition, irritability, and aberrant motor behavior. Correlations among these 10 behaviors and their relationship with cognitive impairment were also investigated. Seventy-six percent of patients had measurable behavioral changes. All 10 behaviors were significantly increased as compared with normal subjects. The most common behavior was agitation, which was exhibited by 80% of patients, followed by irritability (60%), hallucinations (54%), anxiety (50%), dysphoria and aberrant motor behavior (both 40%), disinhibition (36%), delusions (22%), and apathy 30%.
Hallucinations, delusions, agitation, dysphoria, apathy, and aberrant motor behavior were significantly correlated with cognitive impairment.
Study of expressed emotion and caregiver burden in bipolar manic patients
Bhakti Murkey, Pradeep Sharma, Gunjan, Vijay Choudhary, Arvind Jinger
SMS Medical College, Jaipur, Rajasthan, India
Aim : The current study explores caregivers' burden and level of expressed emotions (EEs) in bipolar manic patients.
Materials and Methods: Thirty consecutive patients diagnosed with bipolar affective disorder; mania (as per International classification of Diseases, 10th revision (ICD-10) criteria) and 30 caregivers were recruited from outpatient department (OPD) at Psychiatric Center, Sawai Man Singh (SMS) Hospital, Jaipur. The Burden Assessment Schedule (BAS), Young Mania Rating Scale (YMRS), and Family Emotion Involvement and Criticism Scale II (FEICS II) were applied. Pearson correlation test was used as statistical tool.
Results and Conclusion: The scores of BAS and its domain-perceived severity were significantly associated with FEICS total scores (P = 0.043). BAS total score (P = 0.001), impact on well-being (P = 0.001), impact on relationships with others (P = 0.031), perceived severity of disease (P = 0.004), FEICS total score (P = 0.002), and it's avoidance (P = 0.036) subscale were significantly associated with number of episodes of illness. YMRS score was not significantly associated with FEICS, BAS total score, or any of their subdomains. This may indicate that EEs in the form of avoidance by the caregivers may be a predictor of relapses; and hence, is associated with more number of episodes. EE and burden of care are more dependent on relatives' appraisal of the patient's condition than on actual deficits. The study highlighted the need for addressing EE in psychosocial interventions. More attention should be paid to the needs of the caregivers in order to alleviate their burden in managing mentally ill patients.
Mental health literacy in college students
Bhaveshkumar Manharlal Lakdawala, G. K. Vankar
Department of Psychiatry, B. J. Medical College and Civil Hospital, Asarwa, Ahmedabad, Gujarat, India
Background : High level of mental health literacy which includes adequate knowledge and positive attitudes in medical, psychology, and sociology students towards psychiatric illnesses would make early recognition of and appropriate intervention in these disorders more likely.
Aims: Our aim was to assess knowledge and attitude of college students of three faculties-medical, psychology, and sociology-towards the mentally ill and sociodemographic correlates using Community Attitude towards the Mentally Ill (CAMI) subscales and to know other components of attitude to mentally ill.
Materials and Methods: One medical college and five Arts colleges were surveyed regarding students' attitude towards psychiatric illness using the CAMI scale. Various components of attitude to mentally ill were assessed using National Health Service (NHS) survey questionnaire. Total 1,231 completed responses were analyzed. Statistical analysis methods used were chi-square test, Student's t-test, one-way analysis of variance (ANOVA), and Statistical Package for Social Sciences (SPSS) version 15. P-value of <0.05 was considered statistically significant.
Results: On CAMI scale, positive attitudes for benevolence subscale and community mental health ideology subscale, mixed response on social restrictiveness subscale, and negative attitude on authoritarianism subscale was found in majority items. Significant differences were observed in attitude towards mentally ill by gender, faculty of education, family type, and domicile. There was association between present and past contact with someone with mental health problem and future willingness to have relationship with the same.
Conclusions: Areas of deficits in attitude of students can be targeted for further educational interventions and training so that positive attitudes can be inculcated in future health professionals which will ultimately benefit our society.
Triage in psychiatric emergency
Bhavuk Garg, Manish Borasi, Paramjeet Singh
Department of Psychiatry, Institute of Human Behaviour and Allied Sciences, Dilshad Garden, New Delhi, India
Aim : To present data of the triage of cases presenting to psychiatric emergency.
Introduction: Psychiatric emergencies constitute a substantial proportion of cases referred to a mental health institute. Triage means sorting out and classification of emergencies to determine priority of need and place of treatment. An efficient triage system substantially improves quality of service. This study examines the triage system at a mental health institute.
Materials and Methods: Study was conducted using data from the emergency department of a tertiary care academic neuropsychiatric institute. Data of a total of 150 patients presenting to the psychiatric emergency was analyzed and tabulated.
Results: The patients were triaged into different groups according to the severity of presentation and urgency of intervention.
Conclusion: Triage in psychiatric emergency is an important practice to ensure quality delivery of service to the patients. The concept which has been picked from disaster management is worthwhile to be implemented in mental health setting across the country.
Study of sleep patterns in alcohol recovery patients
Bhavya K Bairy, Santosh I Ramdurg
SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
Introduction : Patients in early alcohol recovery have high rates of sleep disturbances. The rates of insomnia in this population could be as high as 36-72%.
Aim: To study the prevalence of insomnia in alcohol dependence patients after detoxification.
Methodology: Persons diagnosed with alcohol dependence syndrome as per International Classification of Diseases, 10th revision (ICD-10) criteria were included in the study. Their sleep patterns were studied after detoxification by using Pittsburgh Insomnia Rating Scale. Distress, sleep parameters, quality of life, and total scores were calculated, higher the score indicating more sleep disturbances.
Results: Total of 55 cases was included in the study. Preliminary data analysis suggested all patients were males with mean age presentation of 35 years, educated up to 9.27 ± 4.66 standard, 78% were married, majority of them were working as farmers or were skilled laborers, and 63% living in rural areas. Average amount of alcohol intake was about 540 ml of 42.8% alcohol with 9.27 ± 7.36 years of alcohol consumption. Mean of total score was 50.45 ± 35.01, mean of distress score was 30.02 ± 20.76, mean sleep score was 9.54 ± 7.8, and mean quality of life score was 11.2 ± 7.58.
Conclusions: Sleep disturbances are very common in alcohol recovery. Addressing this problem by clinical detection and managing this will improve the quality of life and help in preventing relapse.
Prevalence and associated risk factors of postpartum depression in women attending rural hospital
Cattamichi Vimila, Shiva Chidambaram, Srinivasaa Gopalan
Department of Psychiatry, Meenakshi Medical College Hosital and Research Institute, Enathur, Tamil Nadu, India
Aim : To study the prevalence of postpartum depression and its association risk factors in women attending Meenakshi Medical College Hospital and Research Institute, Kanchipuram.
Materials and Methods: Sixty postpartum women attending the vaccination clinic at 6 weeks period in the Department of Pediatric would be interviewed using Tamil version of short explanatory model interview, the Edinburgh Postnatal Depression Scale, and semistructured interview to assess sociodemographic data.
Results: The results will be assessed with appropriate statistics and will be discussed in the case conference.
Conclusion: Will be discussed in the conference.
Study of profile of patients with substance use disorder in a tertiary care hospital
Chandrashekar H, Ajay Prakash, Kasthuri P, Vedamurthy
Department of Psychiatry, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
Introduction : Substance use disorders are a major public health concern. There are about 62.5 million alcohol, 8.7 million cannabis, and about 2 million opiate users in India (Murthy, 2002). Most of the care is delivered through primary care service.
Aim: To study the profile of patients with substance use disorders attending the psychiatry department of a tertiary care institution.
Materials and Methods: Victoria Hospital is a 2,500 bedded tertiary referral general hospital. The Department of Psychiatry is functioning since 1972 with deaddiction center.
The case records of patients who were treated for substance use from 2007 to 2011 were reviewed, tabulated, and statistical analysis was done. Observations were made based on the findings.
Observations: There were 862 patients with substance use disorders. 56.1% were men. Seventy percent were between the age 26 and 45 years. 59.5% were married and 10.3% were separated as a result of drug abuse. 96.9% were abusing alcohol, tobacco use seen among 66.2%, opioids 1.2%, cannabinoids 2.7%, and sedatives and hypnotics 0.3%.
Conclusion: The incidence of alcohol was more common with nicotine. Other implications will be discussed.
A study of relationship between duration of first hospital stay and readmission rate in a psychiatric unit of teaching hospital
Chandrashekar Jampala, C. M. Pavan Kumar Reddy
Department of Psychiatry, Mamata General Hospital, Kaviraj Nagar, Khammam, Andhra Pradesh, India
Background : Most of the psychiatric diseases have a chronic relapsing course. It is estimated that 50% of the discharged patients get readmitted within 1 year of discharge.
Aims and Objectives: To understand the relationship between duration of first hospital stay and readmission rate in a psychiatric unit of teaching hospital.
Materials and Methods: This is a retrospective hospital-based study. Discharge summaries are reviewed for all admissions to Mamata General Hospital inpatient psychiatric unit from January 2010 to December 2013. Data regarding sociodemographic variables, duration of hospital stay, and diagnosis according to International Classification of Diseases, 10th revsion (ICD-10) will be noted. Duration of hospital stay is divided into four groups, that is, Group 1 - 1-S7 days, Group 2- 8-14 days, Group 3 - 15-21 days, and Group 4 - more than 21 days. This duration of hospital stay is then compared with subsequent readmissions in past 4 years and reasons will be noted.
Results and Conclusions: Will be discussed during the presentation.
Study of personality profile and psychiatric comorbidity in patients with chronic daily headache
Chhavi Bhasin, R C Jiloha, Meena Gupta
Department of Psychiatry Maulana Azad Medical College, New Delhi, India
Aim : To study the pattern of personality profile and psychiatric comorbidity in patients with chronic daily headache (CDH).
Materials and Methods: Seventy-seven patients of CDH were recruited after ruling out causes for secondary headaches, and then assessed with Mini International Neuropsychiatric Interview (MINI) and Eysenck Personality Questionnaire (EPQ) to assess the pattern of psychiatric morbidity and personality traits, respectively.
Results: The most common CDH subtype found in this study was chronic tension type headache (CTTH) with 62.3% of the patients suffering from it, followed by chronic migraine (CM) patients (35.1%). Overall, 58.4% of the patients of CDH had a psychiatric comorbidity. 20.8% of the CTTH patients suffered from depression, while the same was true for 59.2% of CM patients. 8.3% patients of CTTH were found to have panic disorder. MINI screening questionnaire found social phobia in 2.1% of the patients of CTTH and 11.1% of CM patients. Obsessive compulsive disorder was found in 6.2% patients of CTTH and 3.7% of CM patients, there being no statistical significance. Generalized anxiety disorder (GAD) in the two groups, 22.2% patients of CM had diagnosable GAD through MINI, while in cases of CTTH it was seen in 16.6%. Patients with chronic migraine scored the highest on the neuroticism domain of the EPQ amongst all subgroups of CDH.
Conclusions: Psychiatric comorbidity is found in a significant number of patients suffering from CDH. Diagnosable depression is present in a majority of cases suffering from chronic migraine. Patients with chronic migraine show a high preponderance of neurotic traits in comparison with other CDH subgroups. These findings have significant implications for the management of patients with CDH, and highlight the need for a liaison between psychiatrists and the primary physicians who manage headache.
Premenstrual syndrome: Prevalence, phenomenology, and personality factors in college going girl students
Chitra Verma, Madhu Nijhawan, Rajinder Pal Singh, Mahendra Jain, Ashok Chaudhary
Department of Psychiatry, Mahatma Gandhi Medical College and Hospital, RIICO Institutional Area, Sitapura, Jaipur, Rajasthan, India
Aims and Objectives : The study was conducted at Jawaharlal Nehru (JLN) Nursing University, Ajmer with the aims of: 1. To find out the prevalence of premenstrual syndrome (PMS) in college going girls and study the sociodemographic variables related to it. 2.To study characteristic symptomatology of PMS in the study group in comparison to normal control. 3. To study the personality profile in the PMS study group in comparison to normal control.
Materials and Methods: Three hundred female nursing students belonging to JLN nursing University, Ajmer, were screened for PMS by Menstrual History Form and Screening Questionnaire and Menstrual Distress Questionnaire 'A' form (MDQ-'A' form by Moos 1968). Those students who fulfilled the criteria for PMS formed the experimental group and the control group was selected from the remaining sample matched on sociodemographic variable.
Both the groups were subjected to a specially designed pro forma which included personal and sociodemographic details and Eysenck Personality Inventory (EPI) for assessing the personality type.
Result and Conclusions: The result revealed that the prevalence of PMS in college going girls was 8%. It was found higher in subjects of age group of 20-24 years (9.3%). Domicile, religion, birth order, economic status, and family size were not found to have any relationship with prevalence of PMS.
The results revealed that girls living alone and in nuclear family have little higher prevalence of PMS (8.2%), but the difference was statistically insignificant.
Mean score of PMS cases on MDQ-'A' form during premenstrual phase of cycle were found to be significantly higher in comparison to control group.
PMS patients scored significantly higher on Neuroticism Scale on EPI.
The results will be discussed in detail.
Depressive disorder among caregivers of cancer patients
Damodar Raghunath Chari, MaldarAftab Ahmed, P John Mathai
Father Muller Medical College, Kankanady, Mangalore, Karnataka, India
1. To study the prevalence of depressive disorder among caregivers of cancer patients.
2. To study the sociodemographic variables of patients and their caregivers and its relation to depressive disorder.
Materials and Methods: Sample consisted of 40 caregivers of cancer patients admitted in Father Muller Medical College who were directly involved in patient care. Subjects were initially screened using Mini-International Neuropsychiatric Interview (MINI) plus to make diagnosis of depressive disorder. Subsequently those diagnosed with depression were assessed using Montgomery-Åsberg Depression Rating Scale (MADRS) for severity of depression. These were compared with relatives of cerebrovascular accident (CVA) patients who acted as controls using appropriate statistical method.
Results: In our study about 60% subjects reported of depressive symptoms compared to about 28% of controls. Females were more than males. Most of subjects had mild depression (30%) as per MADRS. Presence of depression was related to the age of cancer patient and type of treatment received by patient.
Conclusion: A significant number of caregivers suffered from depression while taking care of cancer patients. Hence, early diagnosis and management is essential to reduce the burden of caregivers.
Disability profile of psychiatric outpatients using the sheehan disability scale
Darpan Kaur, Shaunak Ajinkya, Rakesh Ghildiyal
Department of Psychiatry, Mahatma Gandhi Mission Medical College, Navi Mumbai, Maharashtra, India
Background : Epidemiologic research in community and clinical settings reveals a strong correlation between psychiatric disorders and impaired socio-occupational functioning.
Aims and objectives: To assess disability of patients among stable old patients attending psychiatric outpatient services.
Materials and Methods: This was an observational cross-sectional survey conducted at Psychiatry Outpatient Department at MGM Hospital, Navi Mumbai. Clinically stable adult patients on regular medications for at least 6 months and willing to participate were included in the study. Patients having severe psychiatric illnesses, mental retardation, or sensory impairments were excluded. Consecutive patients coming to Psychiatry Outpatient Department (OPD) meeting the eligibility criteria given above were assessed using the data collection form and the Sheehan Disability Scale. Data of 50 patients was analyzed using appropriate tests with SPSS.
Results: Predominantly females (57.4%) from rural areas (80.3%) with mean age 35.85 years. Alarming level of disability (scores >5) was seen in 60.7% of patients. Psychiatric profiles were psychoses 36.67%, anxiety and other neuroses 36.67%, mood disorders 23.33%, and substance use disorders 2.33%. In the week prior to consultation, 60% of patients had lost at least 1 day at work because of their symptoms and 73.33% of patients were unproductive. Mean number of days lost at work and days of unproductivity were 2.75 and 3.23, respectively.
Conclusion: Psychiatric patients from rural areas experience alarming disability because of their symptoms. Psychiatric symptoms can lead to unproductivity and absenteeism at work even in stable patients maintained on regular medications. Functionality assessments and rehabilitation should also be addressed in routine psychiatric care.
Accidental risperidone poisoning in a 4-year-old child with ADHD
Darpan Kaur, Shaunak Ajinkya, Gurvinder Kalra, Rakesh Ghildiyal
Department of Psychiatry, Mahatma Gandhi Mission Medical College, Navi Mumbai, Maharashtra, India
Background : Risperidone is used with increasing frequency in children. There is sparse literature regarding its safety in children.
Aims: To report a rare case of accidental risperidone poisoning in a child with ADHD.
Materials and Methods: Master S, a 4-year-old boy was referred for emergency psychiatric referral following ingestion of risperidone tablets accidentally. He had consumed 10 tablets of 0.5 mg of risperidone approximately 3-5 h prior to presenting in the casualty. He had vomiting, inability to talk, and move his limbs. He was recently diagnosed with attention deficit hyperactive disorder (ADHD) and was started on oral risperidone (0.5 mg/day) from a private psychiatrist.
Results: He was drowsy, slurred speech, dribbling saliva, rigidity in all four limbs, with Glasgow Coma Scale (GCS) 10/15. Blood investigations (complete blood count (CBC) and liver function test (LFT)), serial electrocardiograms (ECGs), electroencephalogram (EEG), and computed tomography (CT) imaging were normal. He was kept for observation in pediatric intensive care unit (PICU). Gastric lavage, supportive management, and intramuscular promethazine (37.5 mg over 3 days) were given. On day 3, he was shifted to pediatric ward as rigidity reduced significantly and GCS scores became normal. He was discharged on day 5 since admission.
Discussion: Children less than 12 years of age who have acutely ingested more than five times their prescribed daily dose of risperidone need intensive evaluation. Overdose management includes gastrointestinal lavage, activated charcoal, and cardiovascular monitoring. No specific antidote for risperidone poisoning is known and treatment is symptomatic and supportive.
Conclusion: World Health Organization (WHO) pharmacovigilance guidelines emphasize reporting of adverse reactions and toxicities in children particularly in ADHD.
Attention deficit hyperactivity disorder with comorbid seizure disorder and myelin abnormalities
Darpan Kaur, Shaunak Ajinkya, Gurvinder Kalra, Rakesh Ghildiyal
Department of Psychiatry, Mahatma Gandhi Mission Medical College, Navi Mumbai, Maharashtra, India
Background : Attention deficit hyperactivity disorder (ADHD) is an impairing disorder resulting from abnormal levels of inattention, hyperactivity, and impulsive behaviors.
Aims and Objectives: To present a rare case of ADHD with developmental delays and seizure disorder with myelin and white matter abnormalities on brain imaging.
Materials and Methods: A 5-year-old boy brought by parents with 1 year history of poor attention, excessive hyperactivity, and impulsive behavior seen across both settings of school and home. Third day after delivery he had two episodes of generalized tonic-clonic seizure (GTCS). His milestones were globally delayed. He was started on oral phenobarbitone 60 mg per day when he had one seizure episode of GTCS at age 3. There were no facial dysmorphisms. Systemic examination was normal. History and Mental Status Examination (MSE) fulfilled Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria for ADHD. Vineland Social Maturity Scale (VSMS) functioning was 4 years. Blood investigations and electroencephalogram (EEG) were normal. Magnetic resonance imaging (MRI) brain showed abnormalities in myelin and white matter microstructure. Sodium valproate (10 mg/kg/day) was subsequently started and phenobarbitone was tapered off. ADHD symptoms reduced by 70% as per Vanderbilt assessments.
Discussion: Abnormalities in frontolimbic pathways and decreased total white matter volumes exist in ADHD. Delayed myelination, disruptions in white matter microstructure, and insufficient astrocyte functioning play a role in ADHD. Long-term exposure to antiepileptic medications especially phenobarbitone, combination of antiepileptics, early onset epilepsy, subclinical seizures, and disturbed sleep play a definite role in ADHD with seizures. Valproate reduces ADHD symptoms in such children.
Conclusion: Multiple factors need to be taken in consideration while planning comprehensive management for ADHD in children with comorbidities.
Selective mutism with premorbid speech delay in a 6-year-old anemic child with abnormal EEG tracings
Darpan Kaur, Shubhangi Dere, Shaunak Ajinkya, Rakesh Ghildiyal, Yogita Solanke
Department of Psychiatry, Mahatma Gandhi Mission Medical College, Navi Mumbai, Maharashtra, India
Background : Selective mutism is a multidimensional disorder characterized by persistent failure to speak in selected social settings despite possessing required ability.
Aims and objectives: To describe a rare case of a 6-year-old boy with selective mutism and multiple comorbidities.
Materials and Methods: Case report study design. A 6-year-old boy was brought by parents to psychiatry outpatient department (OPD) with complaints of not speaking at school and social settings despite having the ability. Birth and developmental history was normal except that child spoke after 3 years. No history of autism, language regression, seizures, obsessive compulsive symptoms, and social anxiety. No significant family, personal, or medical history. Child spoke minimally and was non-cooperative for Mental Status Examination (MSE).
Results: Hemoglobin = 9 g%, intelligent quotient (IQ) = 85, and magnetic resonance imaging (MRI) brain was normal. Electroencephalogram (EEG) showed generalized seizure activity. Ear, nose, and throat (ENT) evaluation was normal. Pediatrician advised deworming and iron supplements. Pediatric neurologist ruled out Landau-Kleffner syndrome, but antiepileptics were not suggested. Parents were initially reluctant for psychopharmacology due to prejudices. They continued speech therapy at a private center with no symptomatic improvement and followed-up again after 6 months. Patient was started on syrup fluoxetine 5 mg per day along with weekly sessions of behavioral therapy. Parents reported 70% improvement after 8 weeks.
Discussion: Selective mutism is rare disorder with prevalence of 0.033%. Abnormal epileptiform discharges could either be coincidental or pathogenic. Premorbid speech problems and developmental delay coexists in 38% of patients. Treatment consists of behavioral therapy and pharmacotherapy with fluoxetine being the most studied drug.
Conclusion: Multidisciplinary approach across various specialties is required for comprehensive management.
Migration and Acute Psychosis in Children and Adolescents Requiring Mental Health Services
Deepak Moyal, Bhavuk Garg, Deepak Kumar
Institute of Human Behavior and Allied Sciences, New Delhi, India
Aim : To study the sociodemographic profile of migrant children and adolescents presenting with acute psychosis at tertiary care psychiatric institute.
Materials and Methods: Study was carried out in children and adolescents who developed acute psychosis post migration. All such children and adolescents who were admitted to the child ward of a tertiary care academic neuropsychiatric institute were included. The case records were reviewed and the sociodemographic data was tabulated and analyzed.
Results and Conclusion: Migration can be a source of significant mental distress and can contribute to development of significant psychiatric morbidity of which acute psychosis can be one. There is a need to keep in mind the migration status of an individual during psychiatric assessment and management.
Study of anxiety symptoms in patients of multidrug resistant (MDR) tuberculosis
Deepanjali Deshmukh, Abhijeet Faye, Sushil Gawande, Rahul Tadke, Sudhir Bhave, Vivek Kirpekar, B. O. Tayade
Department of Psychiatry, Narendra Kumar Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, Maharashtra, India
Introduction : Tuberculosis (TB) is a chronic infectious multisystemic disease caused by Mycobacterium tuberculosis and is one of the leading causes of mortality worldwide. multidrug-resistant TB (MDR-TB) refers to strains of Mycobacterium tuberculosis that are resistant to at least isoniazid (INH) and rifampicin, the two most powerful anti-TB agents. TB itself being chronic medical condition, psychiatric comorbidities is common and in case of MDR-TB, both baseline psychiatric disorders and development of psychiatric complications related to anti-TB drugs and psychosocial factors require aggressive management as it may affect the compliance and overall prognosis of MDR-TB.
Aims and Objectives: To assess the anxiety and other psychiatric symptoms in patients of MDR-TB.
Materials and Methods: Forty consecutive patients of 18 years of age or older with diagnosis of MDR-TB will be included in the study. Each patient will be individually interviewed after their consent, by using a semistructured pro forma including demographic profile and details about TB (history, course, etc.) and its treatment with any relevant psychiatric history. Hamilton Anxiety Rating Scale will be administered to assess anxiety and Brief Psychiatric Rating Scale to find other psychiatric symptoms in these patients. Data thus collected will be tabulated and analyzed statistically.
Result and Conclusion: Will be discussed depending on the findings.
Skindex 29 to determine quality of life and emotional factors in dermatological conditions
Desiree Saimbi, MSVK Raju, Vaibhav Dubey
PG Girl's Hostel, Peoples College of Medical Sciences, Bhanpur, Bhopal, Madhya Pradesh, India
Aim : To study disturbance in quality of life (QOL) in dermatological patients. To assess anxiety and depression in them.
Materials and Methods: Ninety-one patients taken from a dermatological center at a tertiary hospital. Anxiety and depression measured by a structured interview Anxiety Status Inventory (Zung et al., 1971), and Depression Status Inventory (Zung et al., 1965). QOL measured by Skindex 29 (Chren 1996). QOL is categorized into mild, moderate, and severe as per Prinsen et al.
Results: The obtained results were analyzed by one-way analysis of variance (ANOVA). Anxiety and depression scores were found to be uniform across diagnostic categories. ANOVA for anxiety showed (F: 1.507; P: 0.176). ANOVA for depression (F: 1.410; P: 0.212). However, QOL shows differential disturbance. ANOVA (F 2.489; P: 0.023). Eighty-nine percent of psoriasis and 65% of pemphigus patients have severe disturbance in QOL. The lowest scores were found among the pigmentary disorders (8.3%). Rest of the patients fell in the range of 14-50% disturbance in QOL.
Conclusion: To the workers knowledge this is the first time Skindex 29 is applied in India. Disturbance in QOL appears to be determined by the chronic disfigurement of the dermatological conditions. Psoriasis is a recurrent and a cosmetically disabling disease. Pemphigus vulgaris a chronic blistering disease. The discrepant findings between anxiety and depression scores across dermatological diagnosis and QOL on other hand are rather striking. Findings will be discussed with updated review of literature.
Socioemotional factors in stable carcinoma patients
Deyashini Lahiri Tikka, Arup Ghoshal, Sai Krishna Tikka
Qtr No 10, Type IV quarters, CIP Campus, Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand, India
Background : Attachment styles might vary across patients with carcinoma. Other socioemotional factors related to attachment styles are loneliness, hopelessness, and anger. This relationship in Indian patients with carcinomas is relatively unexplored.
Aim: To explore the relationship between attachment styles, loneliness, hopelessness, and anger.
Materials and Methods: Fifty patients availing inpatient care for various carcinomas were included in the study. Attachment styles, loneliness, hopelessness, and anger were assessed on the Relationship Scale Questionnaire, the UCLA Loneliness Scale, the Beck's Hopelessness Scale, and the State Trait Anger Expression Inventory. Pearson's correlation coefficient was measured to understand the association between various variables. Based on scores obtained on the Relationship Scale Questionnaire, the patients were divided into patients with 16 - secure attachment, eight - dismissing attachment, 12 - preoccupied attachment, and 14 - fearful attachment styles. Analysis of variance (ANOVA) was performed to compare groups on loneliness, hopelessness, and anger.
Results: Significant correlation (P < 0.01) was found between attachment scores and loneliness, hopelessness, and anger. Significant correlation (P < 0.01) of loneliness with hopelessness and anger was also found. Patients with secure attachment styles had significantly higher (P < 0.01) scores of loneliness, hopelessness, and anger than patients with other insecure attachment styles. However, between various insecure attachment styles there was no significant difference of any of the variables studied. Significant correlation (P < 0.05) of duration of diagnosed cancer with hopelessness was found. No significant correlation between type of cancer and the variables studied found.
Conclusions: Understanding this relationship and formulating therapies from a cognitive behavioral perspective to improve attachment styles would alleviate emotional difficulties in carcinoma patients.
Bipolar disorder in a 7-year-old child: A case report
Akhil Dhanda, Tushar Jagawat, Preeti Parakh,Vikas Gaur, Savita Jagawat, Jatin Garg, Sasha Raikhy, Archna Patel
National Institute of Medical Sciences University Hospital, Jaipur, Rajasthan, India
Aim : Bipolar disorder has only rarely been reported in prepubertal children. Research has shown that it is often misdiagnosed. We present the case of a young girl who had her first episode of mania at 7 years of age, was initially misdiagnosed and later responded well to treatment for mania.
Materials and Methods: A 7-year-old girl was referred to our outpatient department (OPD) from the Pediatrics Department of our institute for complaints of excessive talking, increased socialization, head banging, stubbornness, and irritability. Before coming to our institute, she had been admitted at another tertiary care pediatric institute and diagnosed as typhoid encephalopathy, but had not improved on treatment.
Results: A diagnosis of mania was made, as per International Classification of Diseases, 10th revision (ICD-10) criteria. She was treated with valproate and responded well. She is performing well in school and has been symptom free for the last 1 year.
Conclusion: Bipolar disorder in such young children is difficult to diagnose. Hence, a high index of suspicion is needed amongst both pediatricians and psychiatrists to ensure that no cases are missed.
Prevalence and severity of postnatal depression in relation to the perceived social support, nature of delivery, and gender of the baby
Dipti Reddy Nallu, R. S. Swaroopa Chary, V. Sharbandh Raj
SVS Hospital and Medical College, Yenugonda, Andhra Pradesh, India
- To know the prevalence of depression in postnatal women in relation to their sociodemographic profile.
- To assess the severity of depression in them according to the perceived social support.
- To assess the severity of depression in relation to the nature of delivery.
- To know how the severity of depression varies by gender of the baby.
Materials and Methods: This is an ongoing study planned for a duration of 5 months that is from 1st July to 30th November 2013. The expected total sample size is 100 postnatal women who delivered at SVS Medical College and General Hospital, Mahabubnagar, Andhra Pradesh. The sample selection is consecutive.
- Sociodemographic and clinical data sheet: To record the demographic details of the postnatal women.
- Edinburg Postnatal Depression Scale (EPDS): To screen for the presence of depression.
- International Classification of Diseases, 10th revision, Research Diagnostic Criteria (ICD-10 RDC): To confirm the diagnosis of depressive episode.
- Multidimensional scale of perceived social support assessment to assess the perceived social support from family and friends.
- Hamilton Depression Rating Scale (HAM-D): To know the severity of depression.
Results and Conclusions: Will be discussed in the conference.
Clinical Characteristics of Patients with Severe Depression with Hypothyroidism
Sunil Suthar, I. D. Gupta, Pradeep Sharma, Vijay Choudhary
Sawai Man Singh Medical College, Jaipur, Rajasthan, India
Introduction : Clinical characteristics of patients with severe depression is well known, but how does they differ by presence of hypothyroidism is little known. Because hypothyroidism can co-occur as a physical comorbidity in depressive patients, patients with hypothyroidism may be candidates for thyroid hormone to improve depressive symptom.
Aim: To compare the clinical characteristics of patients with severe depression associated with hypothyroidism and patients with severe depression without hypothyroidism.
Materials and Methods: The study included drug naïve 60 patients suffering from severe depression without psychotic feature (diagnosis as per International Classification of Diseases, 10 th revision (ICD-10) criteria) were recruited from psychiatry outpatient department at our hospital. Clinical characteristics of patients were assessed with help of Hamilton Depression Rating Scale (HAM-D). Patients were divided into two groups based on thyroid profile with and without hypothyroidism. The statistical analysis was done by using Statistical Package for Social Sciences (SPSS)-20.
Result: Two groups did not differ significantly in severity of depression, but patient with depression with hypothyroidism had statistical more genital symptoms and anxiety symptoms.
Conclusion and Discussion: Patients with severe depression who have more psychological anxiety, somatic anxiety, and genital symptoms on HAM-D should be investigated for thyroid profile.
Prevalence of psychiatric morbidity in male population in primary care: House-to-house survey
Fiaz Ahmed Sattar, Swapna B, Kiran Kumar K, Niharika Singh, Malini Govindan, Santosh J
Department of Psychiatry, Vydehi Institute of Medical Sciences and Research Center, Bangalore, Karnataka, India
Aim: To study the prevalence of psychiatric morbidity in male population in primary care.
Materials and Methods: Psychiatry Department of Vydehi Institute of Medical Science and Research Center, Bangalore carried out house-to-house survey using oral questionnaire method to assess the prevalence and nature of psychiatric morbidity in the villages under Sarjapura Primary Health Center (PHC) which has 30 villages and covers a population of around 30,000 and has 6,322 houses.
Results: The population covered was 5,349 in 913 houses and 303 cases with psychiatric morbidity were detected, out of that 246 were male. The most common morbidity in male population was alcohol dependence and alcohol-related problems in 207 (84%) followed by depression in 24 cases (9%), somatoform disorder in eight (3%), dementia in six (2%), psychosis in two (1%), and two cases of anxiety disorder (1%).
Conclusion: The predominant disability in the primary care in the male population was alcohol dependence and alcohol-related problems. Implications will be discussed at the time of presentation.
Study of correlation of paranormal belief with treatment satisfaction and medication adherence in patients with mental illness currently in remission
Swetha, Dushad Ram, T. S. Sathyanarayana Rao
Department of Psychiatry, Jagadguru Sri Shivarathreeshwara Medical College Hospital, Jagadguru Sri Shivarathreeshwara University, Mysore, Karnataka, India
Aims and Objectives : To know the pattern of paranormal beliefs and its correlation with treatment satisfaction and medication adherence in patients with mental illness currently in remission.
Materials and Methods: Study was conducted at JSS Hospital, Mysore. Eighty-nine consecutive patients were recruited as subjects by purposive random sampling. Study group included both male and female patients of 14-65 years age group. Following tools were used for assessment: Sociodemographic and clinical pro forma, Revised Paranormal Belief Scale, Treatment Satisfaction Scale, and Morisky Medication Adherence Scale.
Result: Majority of the study population were married and belonged to nuclear family and urban background. Majority of them had affective illness and preferred allopathic treatment. Revised paranormal belief scale has significant negative correlation with residence, diagnosis, and method of treatment sought earlier. Total score on Morisky Medication Adherence Scale has significant correlation with total scores on Revised Paranormal Belief Scale and Treatment Satisfaction Scale. Similarly total score on Treatment Satisfaction Scale has significant correlation with score on Revised Paranormal Belief Scale, Mental Distress Explanatory Modal Questionnaire, and Morisky Medication Adherence Scale.
Conclusion: This study underlines an important role of paranormal belief in medication adherence and treatment satisfaction.
A pilot study of prevalence of female sexual dysfunction in type 2 diabetes patients presenting to a tertiary care hospital in south India
Mehak Nagpal, Rajesh Raman, T S Sathyanarayana Rao
Department of Psychiatry, Jagadguru Sri Shivarathreeshwara Medical College Hospital, Jagadguru Sri Shivarathreeshwara University, Mysore, Karnataka, India
Aims and objectives : Assessment of female sexual dysfunction (FSD) in patients with type 2 diabetes mellitus.
Introduction: Diabetes has long been known as a major cause of impaired sexual function in men. However, studies assessing sexual dysfunction in diabetic women are scanty and hardly any studies on Indian patients exist. Most international studies have found a higher prevalence of FSD in diabetic women as compared with nondiabetic women. Recent studies suggest an increase in overall incidence as compared to earlier literature. Factors such as cultural and geographical variations, presence of diabetic complications, and obesity are known to play an important role, unlike in the case of male sexual dysfunction in diabetes.
Materials and Methods: Consecutive 100 outpatients with previously diagnosed type 2 diabetes attending the Medicine Outpatient Department (OPD) in JSS Hospital over a period of 2 years were recruited into the study group. The control group consisted of 60 nondiabetic age-matched female participants. Height and weight were measured and body mass index (BMI) calculated for each participant and written consent was taken.
FSD was assessed by screening all participants using Arizona Sexual Experience Scale (ASEX)-F. Both study and control participants who tested positive with the same, were further assessed using the Female Sexual Function Index (FSFI) instrument with a cutoff score of 26.
The Appraisal of Diabetes Scale (ADS) was applied for study group to assess diabetes-specific health related quality of life and the impact of diabetes on psychological functioning. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) software. Descriptive statistics were used to categorize both study and control group. UNIANOVA and t-test were used to determine correlation between the variables of diabetes and FSD.
Results: A total of 160 women completed the assessment for FSD. Analysis of the study group revealed that on screening with ASEX-F; a total of 67% subjects tested positive although only 12% had complaints of a sexual nature and none had ever approached a physician for the same. In the control group also on screening with ASEX-F, 61.6% had sexual dysfunction. On application of FSFI statistically significant difference was present between mean value of cases and controls.
Conclusion: Our study concludes that FSD is significantly associated with type 2 diabetes mellitus. Identification as well as assessment of factors that contribute to sexual dysfunction, such as the patient's current interpersonal and psychosocial status, her sexual and medical history, comorbid illness as well as medication adherence of a diabetic woman must be considered in detail.
Therefore, psychiatrists and more so other clinicians should be informed and educated about the evaluation of female sexuality which should be part of routine screening in women with type 2 diabetes like other diabetic complications.
Pediatric epilepsy and anxiety disorders: specific correlation to type of epilepsy
Harsha GT, Rajesh Raman, TS Sathyanarayana Rao
Department of Psychiatry, Jagadguru Sri Shivarathreeshwara University, Jagadguru Sri Shivarathreeshwara Medical College, Mysore, Karnataka, India
Introduction and Background : The prevalence of anxiety in pediatric epilepsy is estimated to be 15-20%, with a wide range reported (9-49%) that were generally higher than for depression. Despite the high prevalence of anxiety disorders in patients with epilepsy, there are no systematic treatment studies or evidence-based guidelines for best treatment practice.
Objectives: To study the association between type of epilepsy and clinical variables to severity of anxiety symptoms.
Materials and Methods: Hundred consecutive children and adolescents aged 8-17 years diagnosed to have epilepsy presenting to the Outpatient Department of Pediatric and Neurology at JSS Hospital, Mysore from December 2011 to June 2013 were enrolled. Detailed sociodemographic and epilepsy characteristics were recorded in pro forma specially designed for the study after fulfillment of the inclusion and exclusion criteria. After screening for mental retardation, all the patients were assessed further using Screen for Child Anxiety Related Emotional Disorders (SCARED) scales for anxiety disorders.
Results: The study sample contained four different types of epilepsy namely generalized tonic-clonic seizures (GTCS; 60%), absence (7%), focal/complex partial seizures (CPS; 18%), and hot water/reflex epilepsy(18%). About 44% of the sample had elevated anxiety scores. In particular patients with hot water epilepsy, variety, had significantly elevated scores for anxiety in patients when compared to absence seizures.
Conclusion: The severity of symptoms of depression and anxiety are high in patients with epilepsy. Nearly 35% of patients had specific type of anxiety disorder with social anxiety disorder being the most common type. Hot water epilepsy had strongly significant association with elevated scores of anxiety. Increased awareness of the clinical presentations of anxiety and depressive disorders may help clinicians to develop effective prevention and intervention strategies to improve the long-term outcome.
An epidemiological study of psychiatric disorders in rural population: Using global mental health assessment tool
Karthik K N, T S Sathyanarayana Rao
Department of Psychiatry, Jagadguru Sri Shivarathreeshwara University, Jagadguru Sri Shivarathreeshwara Medical College Hospital, Mysore, Karnataka, India
Aims and Objectives : To estimate the prevalence of psychiatric disorders in rural population using computerized global mental health assessment tool (GMHAT) and to find put the quality of life by using World Health Organization Quality of Life (WHO QoL), and to help the health workers in primary care setting in identifying psychiatric problems and referring them to higher centers by applying GMHAT.
Materials and Methods: All the permanent residents of Suttur above the age of 6 years were considered eligible for the study. A systematic random sampling method was used and about 300 households were visited and the sociodemographic data was collected, each subject was visited at his door step by the examiner and GMHAT was applied. Later WHO Qol-BREF was applied to the psychiatrically ill. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 16.0.
Results: Prevalence of psychiatric disorders in Suttur village by using GMHAT was 284 per 1,000 population. Depression was most prevalent (59.5%), followed by alcohol abuse (15.1%), and anxiety (14.4%). Other detailed results will be presented in the conference. Sociodemographic variables like age, sex, occupation, marital status, economic status, etc., were found to have a statistically significant relationship with the occurrence of psychiatric illness.
Conclusion: The detailed results are comparable to the earlier studies conducted in the same area. Implying that, computerized global mental health assessment tool can be used as a standardized diagnosing tool in primary health care centers helping the primary care workers to diagnose psychiatric cases in a short span of time and also in referring them to specialty centers.
Psoriasis: Pattern of presentation and associated psychiatric distress
Keya Das, Sathyanarayana Rao TS, Basavaraj KH
Department of Psychiatry, Jagadguru Sri Shivarathreeshwara University, Jagadguru Sri Shivarathreeshwara Medical College Hospital, Mysore, Karnataka, India
Background : Emerging evidence of the role of nervous system in skin pathophysiology provides clues into possible links between stress and dermatological diseases. Several studies have shown psoriasis has an increased risk of psychiatric distress which is often overlooked. A more holistic approach for patients with Psoriasis, including a thorough psychiatric evaluation to benefit the patients' longitudinal treatment outcomes is the need of the hour.
Objective: Assessing the pattern of presentation of psoriasis and associated extent of psychiatric distress in these individuals.
Materials and Methods: This is a cross-sectional study of descriptive and explorative design, conducted from October 2011 to April 2013 at JSS Hospital, Mysore. The source of data are collected from the psoriasis patients satisfying the inclusion and exclusion criteria, from outpatients and the outpatient registry of Department of Dermatology and Venerology, JSS Hospital, Mysore. The method of sampling has been random. All the cases were screened and diagnosed by a consultant dermatologist. Ninety-five cases were taken into the study. Detailed sociodemographic data using a proforma specially designed for the study was used. The severity of psoriasis was assessed using Psoriasis Area and Severity Index (PASI) and noted by the consultant dermatologist. The various types of presentation were also documented. They were further assessed for psychiatric distress using General Health Questionnaire. The needed statistical analysis was done.
Results: Four patterns of psoriasis were prevalent in the population, majority of the patients presented with plaque psoriasis (76.8%) followed by erythrodermic psoriasis (11.6%). Majority had moderate PASI scores (54.7%). 61.1% of the patients presented with significant psychiatric distress.
Conclusion: These will be discussed in the presentation.
Prevalence of female sexual dysfunction in Mysore urban population
M. S. Shwetha, T S Sathyanarayana Rao
Department of Psychiatry, Jagadguru Sri Shivarathreeshwara University, Jagadguru Sri Shivarathreeshwara Medical College, Mysore, Karnataka, India
There is a paucity of literature regarding female sexual behavior and very few studies have been done on this neglected area.
Aim: To know the prevalence and various causes of female sexual dysfunction.
Materials and Methods: A descriptive cross-sectional survey on 100 healthy female participants selected after they fulfilled inclusion criteria and gave informed consent. These women were selected from house to house survey in Lakshmipuram, Mysore. Female sexual functioning index (FSFI) scale and a specially prepared proforma was applied.
Results and Conclusion: Will be presented.
Clinical correlates of suicidality in obsessive compulsive disorder
Gayatri Saraf, Biju Viswanath, Upasana Baruah, Janardhanan C Narayanaswamy, Anish V Cherian, Thennarasu Kandavel, Suresh Bada Math, Y.C. Janardhan Reddy
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
Aim : To examine the suicidality and its clinical correlates in a large sample of adult patients with DSM-IV obsessive compulsive disorder (OCD).
Materials and Methods: A total of 545 consecutive patients who consulted a specialty OCD Clinic in the National Institute of Mental Health and Neurosciences (NIMHANS) during the period 2004-2009 were evaluated with the Yale-Brown Obsessive Compulsive Scale (YBOCS), the Mini International Neuropsychiatric Interview (MINI), and the Clinical Global Impression scale (CGI). Suicidality was assessed using the suicide subscale of the MINI. Correlation analysis and linear regression analysis were performed to identify clinical features associated with suicidality. Binary logistic regression (Wald) backward stepwise analysis was employed for prediction of lifetime suicide attempt.
Results: Among 545 patients, 87 (16%) had current suicidal risk. Death wishes, suicidal thoughts, and suicidal plan were present in 73 (13.4%), 45 (8.3%), and 17 (3.1%) patients respectively. Forty-five (8.3%) patients had a lifetime suicide attempt; whereas, nine (1.7%) attempted suicide in the past month. The suicidality scores correlated significantly with female gender, greater Y-BOCS obsession score, presence of any comorbid axis I disorder especially major depressive disorder (MDD), and the number of comorbid axis I disorders. After controlling for age, age of onset, duration of illness, and severity at baseline on linear regression analysis, comorbid MDD was the only factor significantly associated with suicidal risk. Comorbid lifetime MDD and greater Y-BOCS obsession score predicted lifetime suicidal attempt in binary logistic regression.
Conclusions: Suicidal risk needs to be carefully evaluated in OCD, especially in those patients with greater severity of obsessions and comorbid MDD. Early identification and aggressive treatment of MDD may be warranted to modify the risk for suicide.
Assessment of quality of life and disability in patients with alcohol dependence syndrome
C. M Gopal Das, H. Chandrashekhar
Department of Psychiatry, Bangalore Medical College and Research Institute fort, Bangalore
Objectives : To assess the extent of disability and quality of life in patients with alcohol dependence syndrome who presented for inpatient deaddiction and to study the relationship between sociodemographic and clinical variables with disability and quality of life.
Materials and Methods: Hundred consecutive consenting patients within the age of 18-65 years, admitted under inpatient deaddiction unit of Victoria Hospital are included after excluding axis-1 psychiatric disorders, major medical illness, and other disabilities. Alcohol Use Disorders Identification Test (AUDIT), 36 item interview version of WHODAS 2.0 and World Health Organization Quality of Life Brief Scale (WHOQOL-BREF) are administered and statistical analysis done.
Results: The mean summary score of WHODAS obtained in the study group is 53.7 and lies around the 95th percentile. Highest disability was found in life activities (work activities-84.3 ± 17.38 and household activities-75.8 ± 22.26). Patients scored lowest on physical domain (33.95 ± 11.39) of WHOQOL-BREF. Late onset group had statistically significant higher scores of disability in domain of 'getting along with people' and early onset dependence group had higher scores on work activities domain. Disability scores were found to be higher in complicated withdrawal group in statistically significant levels. Alcohol-induced psychotic disorder was found to have statistically significant higher disability scores in domains of 'getting along with people' and participation of WHODAS. Alcoholic liver disease was found to have statistically significant higher disability scores in work activities domain.
Conclusion: Alcohol dependence syndrome has high disability and poor quality of life reflected in occupational dysfunction and poor physical mobility affecting QOL. Early onset dependence group, complicated withdrawal group, and those with complications resulting due to alcohol use have higher disability. These findings may help in devising better treatment approaches, planning and individualizing rehabilitation, and improving productivity and functioning of patients; and thus, ultimately reducing burden on society. Further studies may incorporate interventional approaches, following-up patients, and comparison groups to improve the significance of the measures.
Myths related to psychosexual disorders: Extent and impact
Haseeb Khan, Vishal Sinha, Rakesh Kumar Paswan, Abhishek Kumar Bharti
Department of Psychiatry, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India
Introduction : Psychosexual problems are the least talked about problems and since time immortal have been an area of shame, curiosity, and dammed up by numerous myths. The myths related with psychosexual disorders are deep rooted and have undesired impact on their outcome.
Aims and Objective: To explore the myths prevalent in patients of psychosexual disorders and establish a correlation with the delay in treatment seeking and the role of faith healers in the management of psychosexual disorders.
Materials and Methods: All consecutive patients with psychosexual disorders presenting to the outpatient department during 6 months period were enrolled for the study. Subjects were assessed on semistructured pro forma and sex myth checklist.
Results: Men with psychosexual dysfunction mostly had a low education profile and scored high on sex myth checklist. Other results will be discussed during the presentation.
Conclusions: Significant myths related with psychosexual disorders can result in delay in seeking treatment from qualified professionals and faith healers can be quite instrumental in this area.
Association of depression with autonomic and somatic neuropathy and glycemic control in diabetes mellitus
Hritu Singh, (Brig) MSVK Raju, Vaibhav Dubey
Department of Psychiatry Peoples College of Medical Sciences and Research Centre, Bhanpur Road, Bhopal, Madhya Pradesh, India
Aims : To objectively measure peripheral and autonomic neuropathy and glycemic control in patients of diabetes with depression.
Materials and Methods: Ninety-three patients suffering from noninsulin-dependent diabetes mellitus are selected. Somatic neuropathy was objectively measured by biothesiometer, vibration, and monofilament. Glycemic control was assessed by measuring glycosylated hemoglobin (GHb). Symptoms of autonomic neuropathy were measured by questionnaire devised by Casellini et al., (2007).
Depression was assessed by clinical examination and Hamilton Rating Scale for Depression by experienced consultants independently.
Results: A total of 63 (67.7%) patients were found to be having depression. Within the sample comparisons between depressed and nondepressed patients were made on various parameters. There is no difference in age and gender between the two groups.
Forty-eight (80%) depressed patients and 12 (45%) nondepressed patients had poor glycemic control. This difference was found to be highly significant (χ2 = 17, P < 0.001). Twenty-three (36%) of depressed and one (3%) of nondepressed had impaired touch sensation. The difference was found to be highly significant (χ2 = 11.68, P < 0.001). Vibration was significantly impaired (P = 0.007) in 16 (25%) patients. Forty (63%) of the depressed patients had autonomic neuropathy, while 12 (36%) of the nondepressed patients have autonomic neuropathy (P = 0.025). There was no significant difference in pressure between depressed and nondepressed patients. Impaired glycemic control related significantly to autonomic neuropathy.
Conclusions: This study has an important heuristic value for managing depression in patients suffering from diabetes mellitus. Findings of this study, their biological underpinnings, and their relation to depression will be discussed along with updated review of literature.
A cross-sectional study of psychoactive substance use, other than tobacco, in psychiatric inpatients
Igam Bagra, R. C. Jiloha, NImmi Jose, Rashmi Prakash, Deepika Makkar
Maulana Azad Medical College, New Delhi, India
Aims and Objectives: To study the prevalence of psychoactive substance use, other than tobacco, in patients with psychiatric illness.
Materials and Methods: This cross-sectional study will be conducted on psychiatry inpatients, in a fixed time period, with the aim to see the prevalence and pattern of psychoactive substance use in patients with psychiatric illness. All the patients admitted in the psychiatric ward within a fixed time frame with a primary diagnosis of a psychiatric illness diagnosed as per International Classification of Diseases, 10th revision (ICD-10) would be included. Complete clinical history and examination, duration of illness, treatment history, substance use pattern, and routine blood investigations would be measured in all the subjects.
Results and Conclusion: The data will be analyzed using suitable statistical tools. The results will be discussed later at the time of presentation.
Quike study: A qualitative study on the health needs of elderly
Indu PV, Remadevi S, Thomas Mathew, Sairu Philip
Department of Psychiatry, Government Medical College, Thiruvananthapuram, Kerala, India
Background : Elderly population constitutes 12% of the total population of Kerala as per 2011 census and is expected to be greater than the child population by 2030. The protection and welfare of the aged will be a major challenge to the state and society.
Objectives: To assess the physical and psychological needs of elderly, with attention to special groups like widows, tribal population, etc.; and to assess the services provided to them.
Materials and Methods: A qualitative study, with indepth interviews of key informants and focus group discussions, was undertaken in five districts of Kerala: Thiruvananthapuram, Pathanamthitta, Ernakulam, Wayanadu, and Kasargode. A total of 166 indepth interviews were conducted with various stakeholders: Clients from community and institutions, superintendents of old age homes, facilitators, medical officers, and Panchayati Raj Institution and district level officers. Nine focus group discussions were conducted including elderly people from different socioeconomic strata, special populations like slum dwellers, tribal promoters, and caregivers.
Results: Majority reported lifestyle diseases as chronic health problems, while infectious diseases were reported as acute problems by approximately half of the elderly and majority of the medical officers. Approximately half the elderly reported being sad and also had depressive ideas. Only a few of the elderly were receiving professional care for these psychological problems. Majority of them found that health services provided to them were not elderly-friendly.
Conclusions: Physical and psychological health problems are common among elderly. Elderly-friendly health services, especially mental health services are deficient.
Self-reported ADHD symptoms and comorbidities among college students in Chandigarh, India
Ishani Jhamb, Priti Arun, Jasmin Garg
Government Medical College and Hospital, Chandigarh, India
Background : Existence of attention deficit hyperactivity disorder (ADHD) in adults is scantily researched in India. There is dearth of information on prevalence of ADHD in college students worldwide. Further fewer studies in the past have evaluated the impact of ADHD on the psychological well-being of college students.
Aims: To study the prevalence of ADHD among college students and psychological problems related to ADHD.
Design: Cross-sectional study.
Materials and Methods: A total of 237 students were recruited from various medical, engineering, commerce, and arts colleges of Chandigarh, India. They were administered the Adult ADHD Self Report Scale (v. 1.1) and the Wender Utah Rating Scale to diagnose adult ADHD. To assess comorbidities, General Health Questionnaire-12, Zung Depression Rating Scale, Rosenberg's Self-esteem Scale, and questions on emotional stability, social problems, and substance use (alcohol, tobacco, and cannabis) were administered on all participants.
Results: Thirteen students (5.48%) fulfilled the criteria for adult ADHD. These students experienced significantly higher emotional instability and low self-esteem than those without ADHD (N = 224). The occurrence of psychological problems, depression, social problems, and substance abuse was comparable in students with and without ADHD.
Conclusions: ADHD is prevalent among the college students studying in the most competitive institutes as well. Students with ADHD experience higher emotional instability and poor self-esteem than others. It has little effect on their psychological well-being and social adjustment. Prompt detection and management of ADHD in college students may help them deal with these problems effectively.
Psychiatric comorbidity and personality profile of patients with attempted suicide
Junaid Nabi, Rakesh Ghildiyal, Shaunak Ajinkya, Darpan Kaur, Shubhangi Dere, Yogita Solanke
Mahatma Gandhi Mission's Medical College and Hospital, Kamothe, Navi Mumbai, Maharashtra, India
Suicide is a fatal act that represents a major public health concern. Globally, suicide is now one of the three leading causes of death among people. Suicide rates vary across demographic groups and are strongly associated with psychiatric illnesses. It has been observed that varied psychiatric morbidity and personality factors play an important role in emergence of suicidal ideations and suicidal behavior. Research in this area can provide newer insights in prevention and management of suicide.
- To study sociodemographic characteristics of suicide attempters.
- To study the psychiatric comorbidity in these patients.
- To study personality profile in these patients.
Materials and Methods: It was a cross-sectional observational study carried out in tertiary care hospital in Navi Mumbai.
Attempted suicide patients referred to psychiatry for opinion and willing to participate were included. Sociodemographic details were obtained through self-designed pro forma. Mini International Neuropsychiatric Interview (MINI) was used to diagnose psychiatric morbidity and personality assessment was done using International Personality Disorder Examination (IPDE) scale.
Results: Majority of the suicide attempters (68%) were of young age group (18-27) years with male predominance (54%), were married (54%) and belonged to Hindu (91%) nuclear (51%) family. Major depressive disorder (32%) was most common diagnosis followed by substance use disorder (21%) and borderline personality disorder (28%) was found to be the personality profile in majority of the patients followed by dissocial personality (17%).
Conclusion: Attempted suicide patients at our setting had a distinctive pattern which was different from the norm.
Comparison of causes of domestic violence in married women with mental illness and non-mental illness
Jyoti Srivastava, Indira Sharma, Anuradha Khanna
Department of Psychiatry, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
Background : Violence against women is a serious human rights and public health issue. Domestic violence is a major contributor to the health of the women. However, there is limited data on its cause especially in developing countries.
Aim and Objective: To assess the magnitude and pattern of domestic violence in woman.
To compare the causes of domestic violence with mental illness and non-mental illness.
Materials and Methods: The sample of study comprised of 30 women with mental illness and 30 women with non-mental illness. Mental illness patient diagnosed with axis I psychiatric disorder according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) were selected from the Psychiatry Outpatient Department (OPD) of the Sir Sunderlal (SS) Hospital, Banaras Hindu University; and non-mental illness women were selected from the Outpatient Department of SS Hospital, BHU and used General Health Questionnaire for normal healthy women. The patients were assessed using a structured questionnaire on domestic violence, Cruelty Rating Scale, and Deficiency in Maintenance Scale.
Results: Domestic violence was significantly higher amongst the mental and non-mental illness women who were educated up to graduation/postgraduation and house makers.
The study found out the overall domestic violence in mental illness and non-mental illness group was 83.3 and 30%, respectively. The prevalence of verbal violence was 21% in mental illness and 20% in non-mental illness, economical violence was 17 and 0.07%, physical violence was 21 and 16.7%, and sexual violence was 10 and 16.7%, respectively.
The main etiological factors of domestic violence in mental illness and non-mental illness were 66.7 and 16.7%, respectively of participants unable to perform domestic chores; 43.3% reported that women remain mentally sick, so husband does not like, was one of the cause in mental illness which created violence in the family and 13.3% not good sex partner in non-mental illness women which is causing violence so they were becoming the victim of domestic violence.
Conclusion: It was observed that causes of domestic violence were greater in mental illness as compared to non-mental illness.
A retrospective chart review of frequency of reversible causes in patients of dementia and their correlates
S. Kailash, Umamaheshwari Vanamoorthy, Srikala Bharath, Mathew Varghese, L. Santosh,. P. T. Sivakumar, Preeti Sinha, S. R. Chandra, P. S. Mathuranath
Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
Aim : To study the percentage of dementia patients who have been evaluated for common reversible causes like vitamin B12 deficiency, folate deficiency, hypothyroidism, human immunodeficiency virus (HIV), syphilis, and neuroimaging in a geriatric clinic setup, where the standard protocol is to evaluate these causes in every patient. Further the study aims to determine the frequency with which these factors are found to be deranged in them.
Materials and Methods: A retrospective file review of all dementia patients who were evaluated in detail in Geriatric Clinic, National Institute of Mental Health and Neurosciences (NIMHANS) between June 1st 2012 and May 30th 2013 were done. Demographic details, details about illness, and details about evaluation for the previously mentioned reversible causes of dementia were collected from their files. Appropriate analysis was used to arrive at meaningful conclusions.
Results: Out of the 93 dementia patients included in the study, the frequency with which they were evaluated for various reversible causes varied from a maximum of 66.6% for hypothyroidism to a minimum of 16.1% for HIV. Out of the various factors evaluated, the frequency of derangement varied from a maximum of 22.41% for serum vitamin B12 levels to no patient being detected positive for syphilis serology.
Conclusion: Adequate measures need to be taken to ensure that all patients of dementia are thoroughly evaluated for the common reversible causes. This would help in prompt intervention and improvement in the patients suffering from reversible dementias.
Supernatural attitude and faith healing practices in psychiatric patients
Kalrav Mistry, Prateek Sharma, H. A Gandhi, N. C Parikh, G. H Banwari
Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmadabad, Gujarat, India
Aims : To study faith healing practices in psychiatric in- and outpatients and its association with sociodemographic and illness-related characteristics.
To find association between supernatural attitudes and faith healing practices.
Contexts: Despite significant advancement made and availability of psychiatric services in the form of community psychiatry, minimal changes have taken place in the myths and beliefs related to causation of psychiatric disorders a major pathway of care.
Materials and Methods: All the patients/relatives visiting the psychiatry outpatient department (OPD) or admitted in the psychiatry ward of a tertiary care teaching hospital consenting to participate will be asked to fill sociodemographic and brief details regarding traditional healer visits. Participants will be required to express their opinion on Supernatural Attitude Questionnaire which consists of 28 questions regarding cultural beliefs and myths shared by patients or caregivers. All data will be collected cross-sectionally and analyzed by using the appropriate statistical software and tests.
Results and Conclusions: Result will be discussed at time of presentation after detailed evaluation.
A comparative study of subjective positive and negative aspects of caregiving in bipolar disorder and schizophrenia
N. Kate, S. Grover, S. Chakrabarti
Department of Psychiatry, King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, India
Objective : To compare the positive aspects of caregiving and subjective caregiving experience in the primary caregivers of patients with bipolar disorder and schizophrenia.
Materials and Methods: Seventy-three primary caregivers of patients with diagnosis of bipolar disorder and 100 primary caregivers of patients with schizophrenia were evaluated on the Scale for Positive Aspects of Caregiving Experience (SPACE) and the Involvement Evaluation Questionnaire (IEQ).
Results: On the SPACE, the caregivers of patients with bipolar disorder had highest mean score in the domain of motivation for the caregiving role (2.44), followed by that of caregiver satisfaction (2.37) and caregiver gains (2.2). The mean score was least for the domain of self-esteem and social aspect of caring (2.02). The positive caregiving experience of patients with schizophrenia was similar to that of caregivers of bipolar disorder. The mean score on the IEQ in the bipolar disorder group were 7.00 for the tension domain, 8.73 for the worrying urging-I domain, 5.34 for the worrying urging-2 domain, and 3.48 for the supervision domain. Caregivers of patients with schizophrenia had slightly higher scores in all the domains of IEQ, but the two groups differed significantly on the domain of worrying urging-I only.
Conclusion: The positive caregiving experience of primary caregivers of patients with bipolar disorder is similar to those of caregivers of schizophrenia. However, in terms of negative subjective caregiving experience, the caregivers of patients with schizophrenia had significantly more worrying and urging.
Obsessive compulsive disorder in a patient with tuberous sclerosis: A Rare presentation
A. Khandelwal, K. Kadam, I. S. Netto, A. V. Pawar
Department of Psychiatry, Sassoon Government General Hospital, Maharashtra Institute of Mental Health, Pune, Maharashtra, India
Background : Tuberous sclerosis complex (TSC) is an uncommon, multisystem, autosomal dominant disorder with a prevalence of 1 in 10,000. Most patients with TSC present with seizures, mental retardation, behavioral problems, skin abnormalities, and lung or kidney disease. Rarely they do not present with signs and symptoms of TSC and develop obsessive compulsive disorder (OCD) manifestations.
Case Report: A 30-year-old female presented initially with OCD features. She had obsessions of contamination and symmetry (excessive hand washing, repetitive thoughts to walk over symmetrical lines) and compulsions of washing, counting, and symmetry-precision (counting for five respirations before starting any work). She did not have any complaints relating to TSC, but reported past history of two seizure episodes in her late 20s. On examination, she had shagreen patches (two pebbly skin patches), ash leaf spots (six hypomelanotic macules), and Koenon tumors (four ungual fibromas). She did not have mental retardation with intelligent quotient (IQ) score of 98 on Wechsler Adult Intelligence Scale-IV. Her magnetic resonance imaging (MRI) and computed tomography (CT) scan revealed periventricular calcific nodules with subependymal giant cell astrocytoma. She was diagnosed to have tuberous sclerosis with Mixed Obsessional Thoughts and Acts (F42.2). She was treated with tablet (T.) clomipramine (100 mg/day), T. buspirone (10 mg/day), and T. valproate (400 mg/ day) along with behavior therapy for OCD and showed a good response. Her Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score decreased from 34/48 to 18/48 after 2 months of treatment.
Conclusion: Rarely patients with TSC may go undiagnosed due to late onset of seizures and no mental retardation. Such patients may present for the first time with symptoms of OCD and show a good response to treatment.
Profile of patients admitted with alcohol use disorder in a tertiary care centre over a decade
Kimberley Lourdes Lobo, Joraisa Da Costa, Lisa Mascarenhas, P. Sahastrabhojini, Francis, Anil Rane
H. No. 1001, Carona, Bardez, Goa, India
Aim : To study the sociodemographic profiles of patients with alcohol dependence admitted to our hospital over past 10 years.
1. To study changing trends in patient characteristics over last decade.
Materials and Methods: This retrospective case record study was conducted on patients admitted for alcohol use disorder over a 10-year period at Institute of Psychiatry and Human Behaviour which is the only tertiary level psychiatric hospital located at Goa. Information on the sociodemographic data, alcohol use severity, and diagnosis was collected and analyzed.
Conclusions: To be presented later.
Headache and psychiatric comorbidity: Clinical aspects
K. Kiran Kumar, F. A. Sattar, B. Swapna, Niharika Singh, G. Malini, J. Santhosh
Department of Psychiatry, Vydehi Institute of Medical Sciences and Research Center, Bangalore, Karnataka, India
Aim : To study the prevalence and risk factors of psychiatric disorders in patients with headache in a tertiary care facility.
Introduction: The comorbidity of headache and psychiatric disorders is a well-known clinical observation since centuries. Numerous epidemiological and community studies have revealed that psychiatric disorders (e.g., depression and anxiety) occur with greater frequency among recurrent headache patients than among the general population, and the prevalence of psychopathology increases and is overrepresented in clinical populations. There is evidence indicating patients with elevated psychological symptoms are more likely to seek medical assistance. When present, psychiatric comorbidity often complicates headache management and portends a poorer prognosis for headache treatment.
Materials and Methods: The study was conducted at the Headache Clinic, Vydehi Institute of Medical Sciences and Research Center, Bangalore. Three hundred and fifty patients were enrolled after obtaining written informed consent for the study. Diagnosis of headache was made based on International Classification of Headache Disorders II system. Psychiatric disorders were assessed using Mini-international neuropsychiatric interview (MINI) by the consultant psychiatrist. Other possible risk factors and demographic profile were extracted using a specifically designed semistructured pro forma.
Results and Interpretation: Will be discussed during the presentation.
Efficacy of haloperidol vs levosulpiride injection in patients with acute psychosis
Lokesh Kumar Singh, Sagar Lavania 1 , Samir Kumar Praharaj 2 , Vishal Sinha 1
Department of Psychiatry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, 1 Psychiatry, Sarojini Naidu Medical College, Agra, New Delhi, 2 Psychiatry, Kasturba Medical College, Manipal, Karnataka, India
Aim : The aim of the study was to compare the efficacy of haloperidol with levosulpiride in patients with acute psychosis.
Materials and Methods: This was a prospective, double-blind, parallel-group clinical study, involving 60 drug-naive acute psychotic patients. Patients were randomly assigned into two groups, 'A' and 'B', of 30 patients each, and received either intramuscular haloperidol injection or levosulpiride injection, for initial 5 days. A blinded rater assessed the subjects using sociodemographic pro forma, Brief Psychiatric Rating Scale (BPRS), Overt Agitation Severity Scale (OASS), Overt Aggression scale-Modified (OAS-M), Simpson Angus Scale (SAS), and Barnes Akathisia Rating Scale (BARS) at baseline and daily for next 5 days.
Results: Repeated measures analysis of variance (ANOVA) for BPRS scores showed significant effects of time (P < 0.001, h2 = 0.577), and a trend towards greater reduction in scores in haloperidol group as shown by group ΄ time interaction (P = 0.076) with small effect size (h2 = 0.046). For OASS, repeated measures ANOVA showed significant effects of time (P < 0.001, h2 = 0.431), but no group ΄ time interaction. Repeated measures ANOVA for OAS-M scores showed significant effects of time (P < 0.001, h2 = 0.532), and greater reduction in scores in haloperidol group as shown by group ΄ time interaction (P = 0.032) with small effect size (h2 = 0.077). Higher rates of akathisia as well as extrapyramidal symptoms were noted in the haloperidol group.
Conclusion: Haloperidol was found to be superior to levosulpiride injection for overt aggression, and possibly for psychotic symptoms.
Dandy-Walker variant presenting as complex partial seizure - A case report
T. J. Maanasa, Vidyendaran Rudhran
Department of Psychiatry, Chettinad Hospital and Research Institute, Kelambakkam, Chennai, Tamil Nadu, India
Aims : A rare case of Dandy-Walker variant (DWV) presenting with complex partial seizures was evaluated and is discussed.
Materials and Methods: Dandy-Walker complex (DWC) is a series of anomalies in the posterior fossa, including Dandy-Walker malformation (DWM), DWV, mega-cisterna magna, and posterior fossa arachnoid cyst. Neuropsychiatric manifestations of DWV are commonly seen in the form of spastic paraplegia, auditory and visual impairment, seizures, mental retardation (MR), hyperkinetic disorder and less commonly dysmorphic features. Seizures have been reported with varying prevalence of 15-25% in DWM. However, the types of seizures have not been specifically reported as per existing literature.
Results and Conclusions: Here we report a case of DWV presenting as complex partial seizure (CPS) with attention deficit hyperactive disorder (ADHD) and MR. The magnetic resonance imaging (MRI) findings of the brain revealed a hypoplastic cerebellar vermis with prominent fourth ventricle, with the rest of the structures being normal and no signs of hydrocephalus/enlargement of posterior fossa suggestive of DWV. This case highlights the need for a high index of suspicion to rule out organic brain conditions in children presenting with seizures and subnormal intelligence.
Management of difficult to treat recurrent depressive disorder with cushing's disease
Madhurima Ghosh Kahstagir, Paakhi Srivastava, Vaibhav Patil, Rajesh Sagar
Department of Psychiatry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
Cushing's syndrome is characterized by changes in body composition; where lipid, carbohydrate, and protein metabolism are dramatically affected. Psychiatric comorbidities with Cushing's disease are well known. We present a case of Ms. Y, 33-years-old, postgraduate unmarried female presenting with Cushing's disease and recurrent depressive disorder. This case study illustrates the complex symptom overlap between Cushing's disorder and affective disorders. The case was managed by a team of pharmacotherapy and cognitive behavior therapy, the course of and impediments in management will be highlights of the presentation.
A study of obsessive compulsive symptoms in schizophrenia
Mahesh Kumar, Pradeep Sharma, Alok Tyagi, Shubham Mehta, Gunjan, Richa Tripathi
Sawai Man Singh Medical College, Jaipur, Rajasthan, India
Introduction : Non-schizophrenic psychopathologies in schizophrenia patients such as, obsessive compulsive symptoms (OCS) are often ignored. Recent studies lend support for the validity of a putative schizo-obsessive diagnostic entity. Compared to schizophrenia, schizo-obsessive patients have distinct clinical features and more psychotic symptoms.
Aims and objectives: To compare the symptom profile of schizophrenic patients with and without significant OCS.
Materials and Methods: Hundred consecutive schizophrenia patients were recruited in the study from psychiatry outpatient department and were assessed using Positive and Negative Syndrome Scale (PANSS). We then categorized patients into three groups depending on total Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score. Those scoring 16 were put in first group, 8-15 in second group, and <8 in third group. The correlations among symptom profile of patients were analyzed using Statistical Package for Social Sciences (SPSS) 17.
Results: There was significant correlation of positive symptoms score with score on Y-BOCS compulsive scale in group 1 (P = 0.037) and group 2 (P < 0.026) and Y-BOCS total score (P < 0.008 and 0.005). There was no significant correlation of positive symptoms with YBOCS obsessive score in all three groups (P < 0.834, 0.234, and 0.242).
Discussion: Findings of our study suggest that delusional patient may have more compulsive symptoms as a result of hyper vigilance, internal distress, etc. Further, it would be important to specify if OCS are related to core content of delusion for a better characterization of schizo-obsessive diagnostic entity.
Personality profile of euthymic bipolar affective disorder patients in a tertiary mental care hospital
Maldar Aftab Ahmed, Damodar Raghunath Chari, A.T. Safeekh
Department of Psychiatry, Father Muller Medical college, Kankanady, Mangalore, Karnataka, India
Aim : To study the overall prevalence of all personality disorders in euthymic bipolar affective disorder (BPAD) patients.
- To study the different prevalent personality disorders in euthymic BPAD patients.
Materials and Methods: Ethical clearance was obtained. Informed written consent was taken. Sample consisted of 30 diagnosed BPAD patients attending psychiatry outpatient department (OPD) at Father Muller Medical College. Subjects were initially assessed using Young Mania Rating Scale (YMRS) and Montgomery-Åsberg Depression Rating Scale (MADRS) to ascertain absence of active mood symptoms. Subsequently, subjects were screened and later interviewed using International Personality Disorder Examination (IPDE) for diagnosis of personality disorders. Sociodemographic profile was obtained using a structured pro forma.
Results and Conclusion: To be presented later.
Burden and psychological wellbeing among primary caregivers of patients with schizophrenia
Manish Kumar Meel
F15, Hostel No. 1, Ihbas, Dilshad Garden, New Delhi, India
Background : Schizophrenia is one of the major mental illnesses, which is perceived as being chronic in nature, and requires care for almost the entire life span of the affected individual. Schizophrenia is an illness which has positive, negative, and cognitive symptoms. With deinstitutionalization being practiced in the early 50s, patient's family members became primary caregivers. With this, the burden on them grew, thereby affecting their psychological wellbeing.
Caregiver burden, psychological wellbeing, and the interface between the two variables needs to be assessed in order to develop strategies to aid in caregiving. Though western studies have looked into the relationship between these variables, there is a definite paucity of Indian studies in this field. This study aims to examine the relationship between the two variables.
Objectives: To evaluate family burden and psychological wellbeing among caregivers of schizophrenic patients.
Materials and Methods: A cross-sectional, descriptive study was done on 30 consecutive primary caregivers of schizophrenic patients. They were administered the Burden Assessment Schedule and Psychological Well Being Questionnaire.
The correlation between the two parameters was studied.
Results: The patients in the current study were in their early 30s, mostly males. Primary caregivers were both parents and spouses. Perceived burden was higher in the parent group, and in female care givers. Spouse care givers experienced better psychological wellbeing than parent caregivers.
Interpretation and Conclusion: Burden has a negative correlation with psychological wellbeing. Higher the perceived burden, lower was the psychological wellbeing.
A study of association of subclinical thyroid dysfunction with first episode depression
Manish Roy, Punyadhar Das
Agartala Government Medical College and Govind Ballabh Pant Hospital, Agartala, Tripura, India
Aims and Objective : To identify the subjects of the age group of 18-60 years with first episode of depression with their grading (mild, moderate, and severe with or without psychotic feature and with or without somatic syndrome) and their relationship with the thyroid function (triiodothyronine (T3), thyroxine (T4), and thyroid stimulating hormone (TSH)).
Materials and Methods: A matched-design, case-control study done between January and December 2012. Fifty-two drug naive first episode depressive patients in the age range of 18-60 years, reporting at outpatient department (OPD) of our institute and diagnosed as per International Classification of Diseases, 10th revision (ICD-10) were selected after ruling out endocrinological, hepatic, renal, cardiac, or other chronic systemic illness, alcohol, or other substance abuse and pregnancy or oral contraceptive use (in case of female subjects) and were rated with Hospital Anxiety Depression Scale (HADS) to assess the severity. Fifty healthy controls taken from medical and paramedical stuffs of this institute. T4, T3, and TSH were estimated using enzyme immunoassay. Abnormal TSH concentration with normal T4 levels was taken as a definition of subclinical thyroid dysfunction.
Results: The mean value of total T4 was significantly higher in the depressive group (P < 0.05). The mean value of total T3 was lower in case of depressives. T3/T4 ratio was higher in control group. No significant difference between depressive patients with and without psychotic features and with and without somatic syndrome with respect to total T3 and total T4. However, patients with psychotic features had significantly higher mean values of TSH.
Discussion: The present study included only drug-naive patients having first episode of depressive illness to eliminate the nonspecific effects of chronicity of illness and pharmacological agents on thyroid. Previous studies suggest relative increase in total T4 during acute depression is pathological indicating a relative state of hyperthyroidism and a substantial decrease in thyroxin level is required for recovery. In this study, the levels of T4 were not preformed after the recovery and this remains one of its limitations. Not finding any difference with respect to thyroid stimulating hormone (TSH) levels between the groups is similar to most of the previous studies. Notwithstanding the finding of Muller and Boning, it was found that the mean value of total T3 was lower in depressive patients, elevated levels of total T4, decreased (T3/T4), and decreased T3 in depressive patients suggestive of defective conversion of T4 to T3 in the depressive illness.
Conclusion: This study supports the view that there are subtle but significant abnormalities in the basal level of thyroid hormones in acute depressive illness. There is a need to continue the research efforts in this field to further clarify the etiopathological significance of altered thyroid functioning in depressive illness. However, subclinical thyroid disease is not associated with incident depression. These findings do not support the routine screening of subclinical thyroid dysfunction among adults with depression.
Psychiatric disorders, substance abuse, and AIDS: The triple diagnosis dilemma
Mona Srivastava, Ashok Patel
Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
Background : The spread of the human immunodeficiency virus (HIV) among drug users has added a third potential clinical problem, that of the acquired immunodeficiency syndrome (AIDS), to the difficulties already presented by drug abuse and psychiatric disorders. Patients with this triple diagnosis pose challenges to the addiction medicine specialists or psychiatrists.
Aim: Assessment of all the dual diagnosis patients presenting to the outpatient department (OPD) services of Department of Psychiatry of Sir Sunderlal Hospital were screened for HIV infection by enzyme-linked immunosorbent assay (ELISA) method (Group I).Group II included those subjects who were diagnosed as HIV positive at the antiretroviral therapy (ART) center and were assessed for the presence of psychiatric diagnosis and substance use disorder (SUD).
Materials and Methods: Group I was diagnosed on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV) and was examined by ELISA test for HIV. Group was assessed on Self-Reporting Questionnaire 20 (SRQ-20) and all positives were assessed through DSM IV to establish the diagnosis. SUD was assessed on substance abuse screening test to establish the severity of substance use (excluding nicotine use and dependence). After identification we took 60 subjects in each group through simple random sampling.
Results: The mean age of patients was 32 (± 4.5 years), about 92% were males in the first group and 18% of the subjects were HIV positive; and in the second group about 32% were screened positive on SRQ-20, but only 24% were positive for psychiatric diagnosis. The SUD was found in 38% of the second group. Comorbid SUD with AIDS had lower CD4 count and poorer wellbeing status. Details of the results to be presented.
Conclusion: The role of drug use in AIDS extends beyond simply transmitting the HIV through injection. Another way in which drug use may be involved in the spread of HIV is through drug-induced disinhibition of behavior, mainly in the form of intoxication-related hypersexuality due to stimulant use, as well as through unsafe, promiscuous sexual behavior in sex-for-drugs transactions that can accompany drug use. Drug abuse treatment is important in that it provides a setting for delivering other services needed by HIV-infected persons, including psychiatric care, medical care, social services, and AIDS education. Drug abuse treatment may also be helpful in reducing the morbidity associated with HIV infection, perhaps through decreasing the assaults on the immune system and reducing exposure. Caring for drug users with a dual and triple diagnosis is a growing challenge.
To study the association of metabolic syndrome and unipolar depression among patients attending RIMS, Imphal
Md Munnawar S. Hussain., Raj Kumar Lenin Singh, N. Heramani Singh
Department of Psychiatry, Regional Institute of Medical Sciences, Imphal, Manipur, India
Introduction : Depression is a newly recognized risk factor for ischemic heart disease (IHD). The results of many studies show that depression may contribute to the development of components of metabolic syndrome, such as arterial hypertension, obesity, and glycemic abnormalities. Thus, it may have a significant impact on IHD development and worsen the course of an already established disorder.
Aim: To study the association of metabolic syndrome and unipolar depression among patients attending RIMS, Imphal.
Materials and Methods: It is a cross-sectional study, with a sample size of 64. All patients of depression attending outpatient department (OPD) or admitted as in patients fulfilling the criteria for depression according to International Classification of Diseases, 10th revision (ICD-10) were taken up for the study. The patient's height, weight, and abdominal circumference were recorded. The patient were subjected to blood tests such as blood sugar fasting and post prandial, serum lipid profile, thyroid stimulating hormone. International Diabetes Federation criteria 2006 was used to diagnose metabolic syndrome.
Results: The patients were in the age group of 31-40 (33.3%), female (55.6%), Hindu (88.9%), married (81.5%), above matriculate (31.5%), house wife (46.3%). Blood pressure (P = 0.867), waist circumference (P = 0.758), triglycerides (P = 0.556), high density lipoprotein (HDL; P = 0.538), and fasting blood glucose (P = 0.848). The metabolic syndrome had a negative correlation with major depressive disorder, only nine patients in the sample satisfied the criteria for metabolic syndrome.
Conclusion: Our study concludes that metabolic syndrome and major depression has no significant correlation in the study group. A thorough research required to screen and manage the patients with metabolic syndrome associated major depressive disorder.
A study of 'pathway of care' in substance dependence disorder
Namita, J. K. Trivedi, P. K. Dalal, Anil Nischal, Manu Agarwal, Eesha Sharma
Department of Psychiatry, King George's Medical University, Chowk, Lucknow, Uttar Pradesh, India
Aim : To study the pathway of care in patients of substance dependence disorder.
Materials and Methods: Various sociodemographic factors and clinical factors (diagnostic subtypes, awareness, preference of careprovider, delay in seeking help, comorbidities, history in family/acquaintances) were assessed in a cross-sectional study of 128 patients who consulted for treatment of substance dependence disorder. The pathway from onset of dependence to our center was traced and studied.
Results: More than half of the patients had alcohol dependence (51.6%). Fifty-five percent patients were aware of availability of medical treatment for their problem. Most patients consulted general medical practitioners (36.7%) as first careprovider followed by psychiatrists (32.8%). Delay in seeking help was longest in alcohol dependence patients (11.33 ± 7.79 years) and shortest in polysubstance dependence (4.92 ± 4.77 years). Comorbidities were present in 20.3% patients and were more common in polysubstance dependence (30.7%) followed by alcohol dependence (19.7%). Awareness was higher in patients with positive history in family and acquaintances. Before reaching us, most patients had consulted just one careprovider (45.7%).
Conclusion: First careprovider was general medical practitioner or psychiatrist in most patients. Majority of the patients either consulted one or two careproviders. Average delay in seeking help was around 7 years. Higher education and positive history of substance use in family and acquaintance were significantly associated with awareness.
Change in prevalence of metabolic syndrome and metabolic disturbances with clozapine
Nandita Hazari, Sandeep Grover, Naresh Nebhinani, Natasha Kate, Subho Chakrabarti, Ajit Avasthi
Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Aims and Objectives : To evaluate the prevalence of metabolic syndrome (MetS) among patients prior to start of clozapine and changes in the prevalence of MetS after 3 months of clozapine therapy. Additionally longitudinal change in each subcomponent of MetS was assessed.
Materials and Methods: All patients considered for clozapine therapy were eligible for the study. MetS was assessed twice using the common consensus criteria, first just prior to starting clozapine and after 3 months (± 1 week) of clozapine treatment.
Results: Data for 75 patients was available for both the assessments. Majority of the patients were male (n = 50; 66.7%). Prior to start of clozapine, 32% (24/75) of the patients fulfilled the criteria of MetS. Additionally more than half of the patients (54.7%) had at least one metabolic abnormalities which are used to define MetS. After 3 months of treatment with clozapine, additional 35.3% patients fulfilled the MetS criteria (18 out of 51 patients). In two patients, there was reversal of MetS. Overall the prevalence of MetS during clozapine therapy was 53.3%. Among individual MetS parameters, highest prevalence of increase was seen in waist circumference (64%) and least in systolic blood pressure (32%).
Conclusion: All the MetS seen in patients receiving clozapine cannot be ascribed to clozapine per se, as a significant proportion of patients have MetS prior to starting clozapine.
Effect of COMT-gene polymorphisms on threat perception in schizophrenia and healthy subjects
Narayan R Mutalik, John P John, Harsha HN, Sanjeev Jain
Department of Psychiatry, Sri Nijalingappa Medical College and Hanagal Shree Kumareshwar Hospital and Medical Research Centre, Bagalkot, Karnataka, India
Aims : To assess performance on threat perception in patients with schizophrenia and matched healthy comparison subjects and to link the threat perception with polymorphisms of the COMT gene.
Materials and Methods: Examined 34 schizophrenia patients attending outpatient department (OPD) of National Institute of Mental Health and Neurosciences (NIMHANS) and 30 healthy comparison subjects recruited for the study after obtaining informed consent. Hypothesis-driven computerized threat perception task was applied on these patients. Symptom severity was assessed using Positive and Negative Syndrome Scale (PANSS). Genotyping data was available for 25 patients and 30 controls.
Results and Conclusions: Schizophrenia patients found to have higher threat perception as compared with healthy-matched controls. No significant effect of COMT genotype on threat perception emerged on separate analysis of patients and controls.
Metabolic syndrome in patients diagnosed with obsessive compulsive disorder
Naresh Nebhinani, Sandeep Grover 1 , Subho Chakrabarti 1 , Surendra Kumar Mattoo 1
Department of Psychiatry, All India Institute of Medical Science, Jodhpur, Rajasthan, 1 Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Objective: Very few have evaluated the prevalence of metabolic syndrome (MS) in patients with obsessive compulsive disorder (OCD). The aim of this study was to assess the prevalence of MS and subthreshold MS in inpatients with OCD.
Materials and Methods: By using consecutive sampling, 44 inpatients, admitted to the inpatient psychiatry unit during the period of January 2009-December 2011 with a diagnosis of OCD were evaluated for the presence of MS using common criteria for clinical diagnosis.
Results: Mean age and duration of psychiatric admission were 26.8 years and 37.8 days, respectively. Eleven patients (25%) with OCD fulfilled common criteria for clinical diagnosis of MS, of them seven were male (30.4%) and four were female (19%). Additionally, seven (15.9%) more patients met two out of five criteria for MS and another 18 (40.9%) met one criterion for MS. Being obese and having greater body mass index were significant predictors of MS.
Conclusion: One-fourth of patients with OCD had MS and additionally two-third of patients (56.8%) had subsyndromal MS. Awareness of this is important so that preventive measures can be instituted at the earliest phase.
Profile of substance abusing women seeking treatment at a deaddiction center in north India
Naresh Nebhinani, Siddharth Sarkar 1 , Sunil Gupta 1 , Surendra Kuma Mattoo 1 , Debasish Basu 1
Department of Psychiatry, All India Institute of Medical Science, Jodhpur, Rajasthan, 1 Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Background : In the recent decades, increasing number of women have been seeking deaddiction services. Despite that the report data is very limited from India.
Objectives: The present research aimed to study the demographic and clinical profile of women seeking deaddiction treatment at a tertiary care center in north India.
Materials and Methods: Retrospective structured chart review of 100 women substance abusers seeking treatment at a deaddiction center between September 1978 and December 2011.
Results: A typical case was of 36.3 years age, married (65%), urban (61%), nuclear family (59%) based housewife (56%), with good to fair social support (69%). The commonest substance of abuse was tobacco (60%), followed by opioids (27%), alcohol (15%), and benzodiazepines (13%). The common reasons for initiation of substance use were to alleviate frustration or stress (49%) and curiosity (37%). Family history of drug dependence (43%), comorbidity (25%), and impairments in health (74%), family (57%), and social domains (56%) were common. Only a third of the sample paid one or more follow visit, and of those 58% were abstinent at the last follow-up. Significant predictors identified were being non-Hindu and higher educational years for abstinent status at follow-up.
Conclusions: The common substances of abuse were tobacco, opioids, alcohol, and benzodiazepines; and family history of drug abuse and comorbidity were common. The follow-up and outcome were generally poor. This profile gives us some clues to address a hidden health problem of the community.
Nursing students' attitude towards suicide prevention initiatives
Naresh Nebhinani, Mamta 1 , Achla D Gaikwad 2 , L Tamphasana 3
All India Institute of Medical Science, Jodhpur, Rajasthan, 1 Silver Oaks College of Nursing, Mohali, Punjab, 2 National Institute of Mental Health and Neurosciences, Bangalore, 3 Syamala Reddy College of Nursing, Bangalore, Karnataka, India
Background : Preventing suicide depends upon the different health professionals' knowledge about suicide, attitude towards suicide attempters, and skills to assess and manage suicidal risk.
Objectives: This study was aimed to assess the attitude of nursing students toward suicide prevention.
Materials and Methods: Three hundred and eight nursing students were recruited from the two institutions through total enumeration method. 'Attitude towards suicide prevention scale' was administered. Study design was cross-sectional. Results: Majority were single females, from urban locality, who were pursuing B.Sc Nursing with the mean age of 20 years. Only minority had previous exposure to suicide prevention programs/workshops. Nearly half of the subjects had positive attitude towards working with suicidal patients. Again half of the subjects considered unemployment and poverty as main causes of suicide and were quite hopeless about it and they also perceived that most of the suicidal people won't reveal their suicidal plans to others.
Conclusions: Merely half of the students had positive attitude towards working with suicidal patients. Hence, there is strong need to organize more educational and training programs on suicide prevention so that these budding health professionals could be more equipped and trained to manage these suicidal patients.
Iatrogenic Tramadol Addiction
Naveen Jayaram, Prabhat Chand, Pratima Murthy
Department of Pharmacology, M S Ramaiah Medical College, Bangalore
Tramadol, either alone or in combination with paracetamol, is a commonly prescribed opioid analgesic in routine clinical practice. It has reportedly low abuse potential. There are, however, a few reports of tramadol misuse among healthcare professionals and persons with a family history of addiction. We describe the clinical profile of three women developing addiction to tramadol. In all these cases tramadol was initially prescribed for pain by the physician. Physicians should not only prescribe tramadol cautiously and for a limited time period, but also be trained in identifying misuse (self-use, over the counter procuring, and using for mind altering properties) and dependence (craving, withdrawal symptoms, etc.).
Role of genetic expression in transmission of mood disorders in children and adolescents
Naveen Kumar Srivastava, V. K. Sinha
Dept. of Psychiatry Central Institute of Psychiatry, Kanke, Ranchi
Background : A number of genetic factors (as suggested by family, twin and adoption studies, parent of origin effect, and linkage studies) have been found to play etiological role in mood disorders, but all of these efforts have been devoted to adult population.
Aim: To look for pattern of parental genetic transmission and to find out its role in mood disorders in child and adolescent population.
Materials and Methods: Fifty-five probands with diagnosis of mood disorder as per Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM IV-TR) were taken from Centre for Child and Adolescent Unit of Central Institute of Psychiatry. For this purpose Diagnostic interview for genetic studies (DIGS) was used to establish diagnosis of mood disorder in probands, Family Interview for Genetic Studies (FIGS) was used to establish diagnosis of mood disorder in false discovery rate (FDR; if present), Global Assessment of Functioning (GAF) and Impact of Illness scale were used to access severity of illness, while Young Mania Rating Scale (YMRS) and Conner's Attention deficit hyperactivity disorder (ADHD) rating scales were used for differentiating mood disorder from other causes of hyperactivity and irritability.
Results: Twenty percent probands had history of mood disorder in their FDR's. Mothers (45.5%) were insignificantly more frequently involved than fathers (36.4%). There was significant difference in age at onset of mood disorder in probands who had positive family history in FDR's. Probands developed disease around 6 years earlier than their FDR's.
Conclusion: There was significant difference between age at onset of probands and their first degree relatives, but pattern of parental genetic transmission (whether maternal or paternal) could not be established.
Trends of prescribing electroconvulsive therapy (ECT) in a tertiary care psychiatric hospital
Kalpa Govekar, Ashish Srivastava, Arya Prabhugaonkar
F-1, Atreenandan, Near Datta Mandir, Chinchole, Panaji, Goa.
E-mail: [email protected]
Background: Electroconvulsive therapies (ECTs) have been widely used in the treatment of different psychiatric disorders. It has remained a subject of debate and controversy for ages with differing preferences and trends in its use.
- To study the temporal trends in ECT use over the past decade.
- To study the differential trends of ECT use in the treatment of different psychiatric disorders.
- To study the sociodemographic data of patients receiving ECTs.
Materials and Methods: We are conducting a retrospective study by reviewing the patient case file records of patients receiving ECTs at a tertiary care psychiatric hospital (Institute of Psychiatry and Human Behaviour, Goa). We are compared the change in trends over the past decade by comparing the number of patients receiving ECTs in the year 2003 and 2012.
Using the same case file records, the differential use of ECT in various psychiatric disorders are being studied to establish whether use of ECT is more prevalent in a certain psychiatric disorder as compared to the others.
Results and Conclusions: The results of the study will be entered in excel data sheets and analyzed by appropriate statistical tests and the conclusions derived from the study will be presented later.
Efficacy of SSRI in management of hyperphagic behavior in an 84-year-old lady - a case report
Amit Kumar Chougule, Samir Kumar Praharaj, SM Bhat, PSVN Sharma
Kasturba Hospital, Manipal, Karnataka, India.
E-mail: [email protected]
Background: In medicine, hyperphagia refers to excessive hunger and abnormally large intake of solids orally. Disorders such as diabetes mellitus, craniopharyngiomas, Kleine-Levin Syndrome, Prader-Willi Syndrome, Bardet-Biedl Syndrome and frontotemporal dementia can lead to hyperphagic behavior. Research shows role of serotonin receptors in hyperphagic behaviour associated with diabetes mellitus.
Aim: To highlight the efficacy of selective serotonin reuptake inhibitor (SSRI) in controlling the hyperphagic behavior, anxiety symptoms along with control of blood sugar levels in an elderly lady recently diagnosed with diabetes.
Materials and Methods: A case study was performed in a tertiary care center and results were noted.
An 84-year-old lady with nil significant past and family history of psychiatric illness and medical comorbidity presented with 4 years history of excessive hunger with carbohydrate craving taking up to 14 meals per day with fragmented sleep and awakening due to hunger and nocturnal binging. Since 6 months patient has history of severe anxiety symptoms. She was recently diagnosed with diabetes. After detailed evaluation and investigations, a diagnosis of organic anxiety disorder was considered. She was started on sertraline for her anxiety symptoms and showed significant improvement in anxiety, hyperphagic behavior, and glycemic control and was taken off oral hypoglycemic on follow-up.
Results and conclusions: This case shows complex interaction between organic brain syndromes, diabetes, and eating behavior; and implicates role of serotonin in regulating eating behavior in diabetes.
- Eating disorders
Disability and quality of life in patients with bipolar disorder and schizophrenia
Mansi Somaiya, Sandeep Grover, S Chakrabarti, Ajit Avasthi
A- 105, Parul Apartment, Veera Desai Road, Andheri West, Mumbai-400 053, Maharashtra, India. E-mail: [email protected]
Aim: The study aimed at assessing the disability and quality of life in patients with bipolar disorder and schizophrenia. Materials and Methods: Seventy-two patients with bipolar disorder and 50 patients with schizophrenia who had similar level of functioning (as assessed by Global Assessment of Functioning Scale) were assessed on World Health Organization Disability Assessment Scale (WHODAS-II) and World Health Organization Quality of life (WHOQOL-Bref) scale. Results: Patients with schizophrenia were found to have significantly higher disability than patients with bipolar disorder on all domains of WHODAS-II, that is, understanding and communication, getting around, self-care, getting along well with others, life activities, participation in society, and also had higher total WHODAS-II score. However, no significant differences were found between the two groups on the various domains of QOL. Conclusion: Although the QOL of patients with schizophrenia and bipolar disorder are comparable, patients with schizophrenia have higher disability.
A cross-sectional comparison study of quality of life (QOL) in remitted schizophrenic, bipolar affective disorder, and recurrent depressive disorder subjects
S Anand Kumar
E-mail: [email protected]
Introduction: It is a common belief that patients suffering from schizophrenia have poor quality of life (QOL) when compared to bipolar affective disorder (BPAD) and recurrent depressive disorder (RDD), owing to the complete remission with treatment in the latter two disorders.
However, all the three disorders has to be followed-up by treating psychiatrist and social workers for therapy and medications to prevent further episodes because they have a chronic course with exacerbations and remissions.
Stigma of chronic mental illness, medication side effects, cost of medications, and social reintegration adds to the burden on patient and in turn affects the QOL.
Objective: To assess and compare the QOL of remitted schizophrenic, BPAD, and RDD subjects in a suburban setting in Tiruchirappalli, Tamil Nadu
Materials and Methods: Thirty patients each with diagnosis of schizophrenia in remission (Positive and Negative Syndrome Scale (PANSS) ≤ 3 in eight subcategories for ≥6 months), BPAD in remission (Young Mania Rating Scale (YMRS) ≤ 12, Hamilton Depression Rating Scale (HAMD) ≤ 8), RDD in remission (HAMD ≤ 8), and CGI S < 2 currently were assessed individually for QOL with QOL enjoyment and satisfaction questionnaire-short from (Q-LES-Q-SF)
The data was subjected to analysis using Statistical Package for Social Sciences (SPSS).
Results will be discussed during the presentation.
Psychosocial functioning in depressive patients: A cross-sectional comparative study between major depressive disorder and bipolar affective disorder
Shubha m Mehta, Pankaj Kumar Mittal, Alok Tyagi, Mukesh Kumar Swami, Suresh Gupta, Richa Tripathi
E-mail: [email protected]
Introduction: Major depressive disorder (MDD) and bipolar affective disorder (BAD) are two of the 10 leading causes of disability. These are often associated with widespread impairments in all domains of functioning including relational, occupational, and social. The main aim of the study was to examine and compare nature and extent of psychosocial impairment of patients with MDD and BAD during depressive phase.
Materials and Methods: A total of 96 patients (48 in MDD group and 48 in BAD group) were included in the study. Patients were recruited in depressive phase (moderate to severe depression) from psychiatry outpatient department. Patients having age outside 18-45 years, psychotic symptoms, mental retardation, and comorbid medical or psychiatric disorders were excluded. Psychosocial functioning was assessed using Range of Impaired Functioning Tool (LIFE-RIFT).
Results: Domains of job-work (t = -1.48, P = 0.142), interpersonal relationship (t = -1.16, P = 0.249), life satisfaction (t = -1.54, P = 0.126), and recreation (t = -1.661, P = 0.100) were all affected. BAD group had greater mean scores of impairment than MDD group, but there was no significant difference between two groups. Both the groups showed significant difference in impairment in global psychosocial functioning (P = 0.023).
Discussion: MDD and BAD cause similar level of domain-wise psychosocial impairment in their depressive phase. But BAD cause higher global psychosocial impairment than MDD.
Trihexyphenidyl dependence - A case report
Sudhir Mahajan, Debasish Basu, Pradeep C, Sonali Mahajan
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India. E-mail: [email protected]
Background: Trihexyphenidyl (THP) is a commonly used anticholinergic drug with mild euphoriant effect.
Aim: To present a case of paranoid schizophrenia with THP dependence.
Case Details: A 42-year-old male with paranoid schizophrenia for the past 20 years was receiving inj. fluphenazine decanoate 25 mg intramuscular (IM) biweekly with significant improvement and residual symptoms being sensory distortions and fearfulness. He was prescribed THP 4 mg for extrapyramidal side effects with which he reported relief from the sensory distortions and fearfulness. Initially he would THP in prescribed doses only. However, later on he would take more than the prescribed doses of THP. Since around last 8 years, on attempted abstinence from THP, he would have "withdrawal symptoms" in the form of low mood, fatigue, body aches, anxiety, palpitations, and difficulty concentrating at work; which would promptly improve after taking THP. The dose of THP has also gradually increased to 24 mg/day in six divided doses. For the last 2 years, in additions he was also taking cap tramadol in a dependent manner, average amount being 500-600 mg/day. He requested admission in our deaddiction ward for failure to abstain from THP, last intake of THP being on the day of admission (8 mg); although was abstinent from tramadol for 2 weeks before admission. After admission THP was stopped and patient had "withdrawal symptoms" which lasted for 2 weeks during which he would insist on giving him THP.
Conclusions: This patient used THP for self-medication of "positive" symptom rather than negative symptoms as reported in the literature. Also, he did not report euphoria or stimulant effect as the major motivational factor for his excessive THP use in contrast to literature.
Physical illness in admissible psychiatric patients in a tertiary psychiatry institute
Suprakash Chaudhury, Partha Sarathi Biswas 1 , DK Giri 1 , SK Sinha 1
Pravara Institute of Medical Sciences, Rural Medical College and Hospital, Loni, Maharashtra, 1 Ranchi Institute of Neuro-Psychiatry and Allied Sciences, Ranchi, Jharkhand, India. E-mail: [email protected]
Background: Clinical screening of patients being presented for admission to a tertiary care psychiatric institute is important to ensure safe, timely, and effective treatment of undiagnosed physical illnesses.
Aim: To determine the prevalence and characteristics associated with admissible psychiatric patients who had undiagnosed physical illness or who required transfer to medical surgical units.
Materials and Methods: Data of 1,026 consecutive admissible severe psychiatric patients and 2 months follow-up data of consecutive 930 admitted patients were documented. The data of 12 patients transferred within next 2 months of indoor treatment were evaluated to categorize the reasons for transfers.
Results: Ninety-six admissible patients (9.35%) before admission and 12 admitted patients (1.17%) during their hospital stay required transfer to a medical surgical unit. Reasons for transfer before admission included lower respiratory tract infection (2.83%), anemia (2.24%), tuberculosis (1.56%), and cardiovascular diseases (1.36). Medical factors associated with rapid transfer out of the inpatient unit were chest pain, shortness of breath, electrolyte abnormalities, signs of infection, and changes in the level of consciousness.
Conclusion: In view of the high prevalence of undiagnosed physical illness in psychiatric patients, all admissions to a mental hospital should undergo appropriate screening for physical diseases.
Comparison of Sucidality in Manic Phase of Bipolar Disorder with and without Substance Dependence Syndrome or Harmful Use
Suprakash Chaudhury, Anshuman Tripathi 1
Pravara Institute of Medical Sciences (DU), Rural Medical College & Hospital, Loni-413736, 1 RINPAS, Ranchi. E mail: [email protected]
Aim: To compare suicidality, in manic phase of bipolar affective disorder with and without comorbid substance dependence syndrome or harmful use.
Methods: In this study, 32 age matched male in-patients in manic phase of Bipolar affective disorder with substance dependence and 31 in-patients in manic phase of Bipolar affective disorder without substance dependence, fulfilling the inclusion and exclusion criteria were taken, out of which 3 patients had to be dropped out of the study; each group subsequently consisted of 30 patients. Baseline serum lipid profile was done within 48 hours of admission. In the second week after admission, once the patients settled clinically, they were rated on Young Mania Rating Scale (YMRS), Brief Psychiatric Rating Scale (BPRS),and Adult suicidal Ideation Questionnaire (ASIQ).
Results: There was no significant group difference in the mean YMRS total score and BPRS total score, which suggests the homogeneity in severity of mania and psychotic symptoms in both the groups and ensuring that these parameters did not influence the results of variables like suicidality, impulsivity and insight. Suicidal ideation as measured by mean ASIQ total score was slightly higher in Bipolar Affective Disorder patients with substance dependence (51.93 ± 14.99) in comparison to Bipolar Affective Disorder without substance dependence group (50.80 ± 12.35). However, there was no significant between group differences, indicating that substance use had no major influence on suicidal behavior in Bipolar Affective Disorder patients.
Conclusion: Substance use had no major influence on suicidal behavior in patients in manic phase of bipolar affective disorder.
The efficacy of adjunctive rTMS on executive functioning in early onset schizophrenia: A randomized double blind sham control study
VB Gaikwad, DS Ranawat, N Sayeed, N Goel, VK Sinha
201, preeti enclave, chandni chowk, kanke road, Ranchi, Jharkhand, India. E-mail: [email protected]
Aim: Early invasive electrical stimulation studies suggested that accentuation of non-dominant dorsolateral prefrontal cortex activity might prove valuable in symptomatic treatment of refractory neuropsychiatric diseases and improvement of executive functioning via modulation of emotion and affect. This study aim to test this hypothesis in early onset schizophrenia patients using high frequency non-invasive repetitive trans-cranial magnetic stimulation.
Materials and methods: 40 patients, 20 active and 20 sham group having early onset schizophrenia underwent 10 sessions (bi-weekly) of high frequency rTMS stimulation to the right DLPFC. Assessments included Calgary depression scale for schizophrenia (CDSS), positive and negative symptom scale (PANSS), mini mental state examination, N-back and trail making test A and B at baseline, after first session of rTMS, later at second week (completion of 10 sessions) and 4th week after the last session of rRTMS.
Results: overall, there was a significant reduction in severity of positive symptoms, general psychopathology and total score (PANSS-PS, GP, T), depressive symptoms (CDSS), improvement in cognitive (MMSE) and executive functioning (N-Back and TMT A and B) in the active patients versus sham group.
Conclusion: excitatory stimulation of right sided DLPFC using rTMS could induce cortical neural modulation to bring functional and neurochemical changes in frontal lobe to improve negative symptoms, mood and executive functioning in patients suffering early onset schizophrenia.
A study of risk factors in develpoment of depression in adolescents
Jithendra Keshwani, Jahnavi Kedare, Ajith Nayak, Parkar
Department of Psychiatry, Seth G.S. Medical College and K.E.M Hospital, Parel, Mumbai, Maharashtra, India
One year prevalence of depression in adolescents is 4% to 7%. Lifetime prevalence of depression in adolescents is 14% in the age group 15-18 years. Early onset of depression is associated with a chronic, episodic course of illness. Specific risk factors have been described in adolescents developing depression. These include low self-esteem, being female, developing negative body image, low social support, negative cognitive style, ineffective coping and family history of depression. Other risk factors like poverty, exposure to violence, social isolation, history of child abuse and broken families have also been described. It is necessary to identify these risk factors to be able to intervene at the earliest. A focus on decreasing these risk factors will also help in prevention of adolescent depression. Hence the present study was conducted.
Aims And Objectives:
- To study the socio-demographic risk factors in depressed adolescent patients.
- To study the social support in depressed adolescent patients.
- To study the coping mechanisms used by depressed adolescent patients.
- To evaluate the self esteem in adolescents developing depression.
Methodology: 30 adolescent patients (age group 11-19 years) attending Psychiatry OPD in a tertiary care hospital and clinically diagnosed as depression were included in the study 30 adolescents matched on gender and age and not having depression or any other psychiatric were included as controls. Socio demographic data was collected and the following were administered.
- Hamilton depression rating scale
- Multi-dimensional scale for perceived social support
- Coping inventory for stressful situation
- Rosenberg's self-esteem questionnaire
Appropriate statistical analysis was done.
Results and Conclusion will be presented
Role of Psycho education in improving knowledge regarding illness, coping strategies and quality of life in family members of patients with schizophrenia
Jahnavi Kedare, Deepika Singh, Ajita Nayak, Parkar SR
Department of Psychiatry Seth G. S. Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India. E-mail: [email protected]
Introduction: Schizophrenia is a chronic mental illness which affects patients and their families. Emotional strains, financial difficulties and social stigma all take a toll on family's coping strategies. Caregivers have a significant impact on the treatment outcome of patient's illness. Psycho education of caregivers plays an important role in providing knowledge and thereby improving their coping and quality of life. Hence we planned an interventional study wherein we assessed the effect of psycho education on coping strategies and quality of life of caregivers of patients with schizophrenia.
Aims and Objectives:
- To assess the knowledge about schizophrenia in caregivers of patients before and after psycho education.
- To study coping strategies used by caregivers of schizophrenic patients before and after psycho education.
- To assess quality of life of caregivers of schizophrenic patients before and after psycho education.
- To study an association between coping strategies used and quality of life of caregivers of schizophrenic patients.
Methodology: 60 patients of schizophrenia with illness duration more than 1 year and their caregivers attending the psychiatric OPD of KEM Hospital were selected. Patients were then randomly allocated into 2 groups, one group wherein psycho education was given (cases) and another wherein no psycho education was given (control) Questionnaire on caregivers' knowledge about schizophrenia, coping inventory for Stressful Situations WHOQOL-BREF, Brief psychiatry rating scale were administered during pre-assessment. 15 days later again they were administered as post assessment. Frequency distribution and appropriate statistical methods were used.
Results and Conclusion: Will be presented.
Perceived stress and quality of life among care givers having children with mental retardation (MR) and attention deficit hyperactivity disorder (ADHD) coming from a rural population
Mahua Jana Dubey, Asim Kumar Mallick, Amit Bhattacharyya, Paramita Ray, Syed Naiyer Ali, Prodipto Dhar
Aims: Caring of someone with a mental disorder can affect dynamics of family.There are various stresses that emerge and re-emerge with time which chronically affect their life.The study is done to evaluate perceived stress and quality of life among care givers with mental retardation and ADHD, and to look for any correlation between them.
Material and Method: Care givers of children of MR and ADHD (n=20+20, 18-60yrs, bothsexes)would be taken for the study after obtaining written informed consent.They would be assessed for perceived stress using PERCEIVED STRESS SCALE and for Quality of life using QUALITY OF LIFE ENJOYMENT SATISFACTION QUESTIONAIRRE SHORT FORM. The evaluation and correlation will be done by appropriate statistical tool.
Results and Conclusions: As this is an ongoing study results will be shared at the time of presentation.
Attention deficit hyperactivity disorder in temporal lobe epilepsy
Neena Sawant, Ragini Gulhane, Sangeeta Rawat, Majumdar
Departments of Psychiatry, Neurology, and Neurosurgery, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, India
Aims: We report a child having temporal lobe epilepsy and attention deficit hyperactivity disorder with remarkable improvement in both following lesionectomy.
Materials And Methods: A 9 year old child had seizures since the age of one year with a frequency of oneseizure per week. He also had severe attention deficit and hyperactivity with behavioral problems of increased irritability and hitting people. His schooling was affected due to these behavioral problems. FSIQ of the child was 40. In view of refractoriness to treatment and right temporal SOL on MRI, epilepsy surgery was planned. The p re-surgical evaluation required a psychiatric fitness which was given after the patient was 50% better on Syp. Risperidone 1mg in divided doses and Tb.Atomoxetine 10mg.
RESULT-Right temporal lobe lesionectomy was done and the child on 3months post- surgery follow up showed 90% improvement in hyperactivity, impulsivity and attention and with good behavioral and seizure control.
Conclusion: This child who had disruptive behavioral problem with moderate MR improved dramatically after epilepsy surgery where the removal of epileptic focus also resulted in improvement in behavior.
Epilepsy and stigma: Its impact on quality of life
Neena Sawant, Vartika Kinra, Ragini Gulhane
Department of Psychiatry, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, India.
E-mail: [email protected]
Background: Epilepsy stigma is one of the most important factors having negative influence on people with epilepsy and their family. Epilepsy changes patients' perception, making them concerned about future, about how they could face the society, get a job and have a family. This leads to a worse quality of life.
Aims & Obkectives: To study the perceptions of epileptic patients and their relatives to the disease and itsassociated stigma and the impact of stigma on the quality of life of patients with epilepsy in social, medical andpersonal domains.
Material & Method: Informed consent of 50 patients of epilepsy (18-45 yrs) and 50 relatives coming to a tertiary care hospital were taken & the details of the study explained. The Stigma Scale of Epilepsy for patients and for community and QOLIE-31 Scale was used to assess the aims of the study.
Results: 30% patients felt stigma associated with epilepsy. In medical domain, 60% patients and relatives felt that epilepsy was related to a problem in brain. In social domain, most affected areas for epileptic patients were difficulties in: work/job opportunities, marriage, social relations, memory impairment, restriction of activities and prejudice. Comparison of QOLS of stigmatized and non-stigmatized patients showed a significant difference in emotional wellbeing, energy/fatigue, cognitive functioning, social functioning and overall quality of life.
Conclusions: This study stresses the need to address the plight of epileptic patients and emphasizes importance of psychological interventions, rehabilitation and educational programmes to improve quality of life of an epileptic.
Psychological triggers and comorbidity of anxiety and depression in gastroesophageal reflux disease
Institute of Psychiatry and Human Behavior, Bambolim, Goa, India.
E-mail: [email protected]
Introduction: According to latest literature upto 64% subjects of GERD reported that their symptoms were aggravated by stress and stress diminution resulted in subjective improvement. It has been shown that stress inhibits the esophageal sphincter and increases diaphragm contractions. Psychiatric comorbidities in GERD may influence the outcome of surgical treatment. Unlike other psychosomatic gastrointestinal illnesses like Irritable Bowel Syndrome or Non Ulcer Dyspepsia, GERD has not been extensively studied with reference to its psychological correlates and psychological comorbidity. This makes the latter a significant area for study.
- To study physical and psychological triggers which initiate symptoms of GERD
- To study prevalence of anxiety and depression in patients suffering from GERD and compare it with healthy controls
Study Design- case control study
Setting- Outpatient department of Surgery and Medicine in Tertiary care hospital
Inclusion criteria- 30 consecutive patients of incident GERD diagnosed by endoscopy (index group) and 30 healthy individuals not suffering from GERD (control group)
Exclusion criteria- patients suffering from other comorbid physical illness severe enough to cause its own psychological morbidity; patients who refused to participate
Scales- Covi anxiety scale, Beck depression inventory
Statistical analysis- student t test, chi square test
Results: Alcohol consumption and smoking statistically significant physical contributing factors while family arguments and work tensions emerged as psychological triggers.
A rare skin condition, hematidrosis, associated with anxiety-NOS recovers in psychiatry ward
Nishant Vibhash, P K Singh
Department of Psychiatry, Patna Medical College, Patna, Bihar, India.
E-mail: [email protected]
Aims and Objectives: To report a rare case of Haematidrosis landing in Psychiatry OPD, associated with features of Anxiety - NOS. Haematidrosis is a condition of spontaneous bleeding through intact skin. It was referred to Psychiatry on suspicion of malingering.
Material, Method and Result: A 19 yrs. old, Xth class student, unmarried girl from Bettiah in Bihar was referred from Medicine OPD to Psychiatry OPD for symptoms of doubtful nature associated with headache, anxiety spell and fits of twenty days duration. The doubtful symptom was recurrent bleeding though intact skin of left temporal area. Such bleeding was always preceded by episodes of anxiety and profuse sweating surrounding the area of bleeding. Her description of symptoms in OPD suggested genuineness which was validated during later ward observation. Bleeding was always seen through the same patch of temporal skin; it would show punctate oozing of blood during bleeding episodes through multiple points. Cytological examination of oozed fluid showed human RBCs and skin histopathology after local punch biopsy showed abnormal blood-filled spaces in the dermis. All other cytological and biochemical parameters were within normal range.
She was prescribed Paroxetine and Propranolol. There was rapid and complete recovery in about twenty days as regards both bleeding and anxiety symptoms. She had maintained improvement till last follow up, about three months later. Possibly she has maintained improvement.
Conclusion: Rare conditions may often land up for psychiatric evaluation because of their seeming implausibility. Psychiatrists should keep their mind open to discharge responsibly the difficult role of helping many such genuine patients who inadvertently get referred to our specialty.
Clinical profile of patients with bipolar depression requiring inpatient management at a tertiary mental health setup
Nitin Sethi, Sai Krishna Tikka, Roshan Vitthalrao Khanande, Basudeb Das
E-mail: [email protected]
Background: A segment of patients with bipolar depression present with severe psychopathology requiring inpatient care. Demographic and clinical characteristics in this segment might vary from the overall representative sample of bipolar depression.
Aims: To investigate demographic determinants and clinical characteristics of inpatients with bipolar depression. To explore if any correlations exist among these variables.
Materials and Methods: A 2-year (August 2011- July 2013) retrospective case record file review was undertaken. Description statistics and frequencies were deduced. Correlation analysis among various variables was subsequently performed.
Results: Tabulation of results is under process.
Discussion and conclusion: To be shared at the time of presentation.
Skin popping - A less known mode of opioid abuse
Pankaj Kumar Sharma, Ashutosh Ratnam, Sonam Tobgay, A Saha, T Madhusudan
Resident, Department of Psychiatry, Golden Jubilee Block, Armed Forces Medical College, Pune, Maharashtra, India.
E-mail: [email protected]
Aim: Aim of the presentation is to highlight the clinical aspects of abuse of Opioids by sub-cutaneous injection.
Materials & Methods: Two patients who were exposed to parenteral Opioids for controlling pain of Pancreatitis & management of Insomnia respectively, developed dependence in due course. They started self-injecting opioids sub-cutaneously and developed complications of multiple, non- healing ulcers, secondary bacterial infection, scarring, distal lymph oedema and contractures. They had been managed variously as Cutaneous Tuberculosis, Deep Vein Thrombosis and Connective Tissue Disorder for over 2 years before being referred for suspected parenteral drug abuse. Patients had the characteristic lesions of Skin popping and tested positive for opioids on random urinary drug screen. Denial was striking, in both cases.
Results: Patients were subjected to multiple investigations & empirical treatments for years, before parenteral Opioid abuse were considered, highlighting the lack of knowledge about this phenomenon in the medical community, as well as the patients' successful concealment of the underlying substance use disorder.
Conclusions: Higher index of suspicion for possible drug dependence and an awareness of the lesions and complications of subcutaneous injection as a mode of Opioid abuse is needed, in general medical settings .Restrictions on the sale of oral Opioids that may be misused, for subcutaneous injection, is also needed.
A retrospective cohort study of predictors of retention and compliance to naltrexone treatment among patients with opioid dependence at tertiary care substance use disorder treatment center
Prabhoo Dayal, Yatan Pal Singh Balhara, Ashwani Mishra
Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India. E-mail:[email protected]
Aims: The current study aimed at assessment of retention rate and compliance to naltrexone for long term management among patients with opioid dependence syndrome over a follow up period of 15 months. Additionally, it aimed at identifying predictors of retention in naltrexone treatment.
Materials & Methods: The study involved review of the treatment records of the patients with opioid dependence syndrome who were prescribed naltrexone for long term management following the initial phase of detoxification. Patients with opioid dependence who were prescribed naltrexone over a nine month period (from January 2012 to September 2012) were included in the study.
Results: Treatment records of a total of 140 patients were included in the final analysis.Age at onset, educational attainment, living condition and employment were found to be significant predictors of retention in the binary logistic regression analysis.. Those having onset of dependence in the third and fourth decade were 15.7 and 14.5 times more likely to be retained, respectively. Finally, employed patients had 3.7 times greater likelihood for retention..The regression analysis further revealed that heroin users had significantly lesser chance of retention when adjusted for socioeconomic characteristics like education, age at onset, living status and employment.
Conclusions: The study findings suggest that. Good familial support, higher educational qualifications and occupational stability are predictors of retention beyond 90 days. Also, it is important to focus on vocational rehabilitation in the initial part of maintenance phase of treatment.
Effect of marriage on women with schizophrenia: A preliminary study
Prakash Behere, Akshata N Mulmule
Department of Psychiatry, Datta Meghe Institute of Medical Sciences (Deemed University), College, Sawangi, Wardha, Maharashtra, India.
E-mail: [email protected]
- To study the effect of marriage on women with schizophrenia in clinical outcome.
- To compare the family function of married and unmarried women.
- To assess marital adjustment in married women with schizophrenia.
Materials and methods: Study site: Psychiatry outpatient and inpatient settings of a Rural Medical College and Hospital in central India. Study design: It is an Analytical cross sectional study with comparison group.
Cases and comparison group will be 25 married & single female schizophrenia patients respectively, who fulfilled the selection criteria as led down in the study.
Data collection: Over 6 month period (Jan 2013 to June 2013).Written informed consents were obtained before participation in study. Clearance from institutional Ethical committee was taken.
Scales: The data was collected on a semi-structured Proforma to record demographic, clinical variables, Brief psychiatric rating scale for severity of illness, Family functioning by family assessment device, Family interaction pattern scale and marital adjustment rating scale.
Results and conclusions: There was no difference in sociodemographic variables in both groups other than occupation & marital characteristics. In the study 72 % patient had more than 5yrs of illness prior to marriage, 60% patients were not staying with their husbands, more than 60 % cases decision regarding marriage was taken by parents and nearly 70% couple had kids. Most of the patients and relatives were of opinion that marriage can cure mental illness. Cases with children had less separation rates. Mental illness was relatively severe in cases than comparison group; family functioning was similar in both groups. It was observed that with increasing severity of illness marital adjustment deteriorates with antagonistic interaction among members.
Biopsychosocial issues in the Spanish, homeless, and illegal immigrants in urban USA
7501 Little River Tpke., Suite#301, Annandale, Virginia 22003 USA.
E-mail: [email protected]
This study is aimed at treating the dysfunctional Latin homeless, illegal immigrants, with alcohol/substance dependence, part of violent street gang subjects who use up significant resources and public services such as the police, ambulance, hospital emergency room (ER), other emergency services and jail services in the society. The objective is to reduce the high utilization behavior in this group_These are adult males of various Latin American countries, who are homeless, unemployed, illegal immigrants with legal issues, in addition to active alcohol/substance dependence and psychiatric disorders. In this gO-day residential program the subjects are engaged in various daily activities. Intensive individual/group therapy sessions, medication teaching, and AAlNA are daily activities, while Medical, Psychiatric evaluation, and medication follow up are weekly.
This study suggests that there is a marked decrease in utilization of the services. Biologically: The participants in the program improved in their physical health, nourishment, secured housing, personal hygiene and treatment of their mental illness. Psychologically: Due to the daily intensive individual and group therapy, the participants gained the emotional support. These individuals are able to participate in classes to improve their English. Socially: These individuals have no jobs, no money, homeless, and illegal. They are now able to get a job and be able function. These immigrants who came to USA illegally have failed themselves. After the treatment for several months, almost all of them are sober, improved their physical health and in their mental health.
Assessment of intimate partner violence and its correlate in an Urban location
Prasad Jayaram, R Shashikumar, RC Das, PS Bhat, K Srivastava, J Prakash, S Patrikar
Department of Psychiatry, Golden Jubilee Block, Armed Forces Medical College, Pune, Maharashtra, India. E-mail: [email protected]
Introduction: Intimate partner violence (IPV), also called domestic violence, refers to any physically, psychologically or sexually harmful behaviour in an intimate relationship. Approximately 31% of Indian women experience IPV, 21% of males consumed alcohol and more than half of whom fit the criteria for hazardous drinking. Several factors among women and spouse especially consumption of alcohol are either protective or put them at risk of IPV and IPV may lead to a wide range of health problems.
Aim: This study aims to study the prevalence of IPV and alcohol abuse among a sample of households in a city in Maharashtra and to investigate the possible association between the two and with socioeconomic factors.
Methodology: The prevalence of IPV among both partners of a couple living together in an urban setting for past one year at least assessed using HITS questionnaire .Their alcohol consumption was assessed using AUDIT. Socio demographic data was collected using a questionnaire.
Results: Of the total of 318 individuals assessed IPV was reported by16 %women and only one male. Significantly moderate correlation was found between HITS score of women and AUDIT of their spouses. Higher age at marriage of women and availability of financial support from in-laws were protective from IPV. These and other findings are discussed in the paper.
Conclusions: IPV among women is prevalent in a large number and is significantly related to alcohol abuse by spouse.
Non-medical use of prescription medicines in Bangalore, India: Characteristics and patterns
Prasanthi Nattala, Pratima Murthy, Thennarasu K, Linda B. Cottler
Department of Nursing, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India. E-mail: [email protected]
Aim: The present ongoing study explored patterns of non-medical use (NMU) of prescription medicines in an urban metropolis (N=717).
Materials & methods: Participants were recruited using a mall-intercept approach, wherein they were intercepted in 5 randomly selected shopping malls, and interviewed on their use of prescription medicines.
Results: Participants' mean age was 28 years (SD:5). Past 12-month NMU of six prescription medicine categories was as follows: i) anti-inflammatories and analgesics-27% (Nimesulidebeing the most frequently reported), ii) opioids-17%, iii) drugs for common gastrointestinal complaints-13%, iv) antibiotics-13%, v) sedatives (benzodiazepines)-12%, vi) antihistamines-12%. Additionally, use of nutritional supplements was included, and was reported by 11%. Among women, non-prescribed use of medicines to relieve dysmenorrhea / delay menstrual cycle was reported by more than 70%. Majority reported 'use without prescription', while 'using in ways other than as prescribed' was also reported. In all cases, pharmacist was the major source of obtaining the drugs non-medically. NMU was also associated with participants' baseline characteristics like age, gender, education, current employment status. Sixty-seven percent stated that "doctor's prescription is not required for common complaints, we can decide ourselves", while 60% stated that "it's okay to deviate from a prescription as needed". Significant barriers reported for accessing health care services included: undesirable doctors' attitudes (72%), lack of time (40%), long waiting time to see doctor (26%), transportation difficulties (23%), high health-care cost (13%).
Conclusion: Findings underscore the need for considering various contextual factors in tailoring preventive interventions (including policy making, legislation) for reducing non-medical use of prescription drugs.
Safety of methadone for treatment of opioid dependence: Should India be concerned?
Prashanth R, Atul Ambekar, Ravindra Rao, Anju Dhawan
Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. E-mail: [email protected]
Introduction: Opioid dependence Syndrome (ODS) is chronic relapsing disorder associated with various harms to the individual and society. Opioid substitution therapy (OST) has documented effectiveness in treating opioid dependence worldwide. While buprenorphine is available in India and has established safety profile, methadone has been recently approved and is currently used in five centres. At this juncture, it is vital to discuss safety of methadone in Indian context considering that issues related to drug use profile, treatment and general healthcare settings are different.
Methodology: A review of literature on post-marketing surveillance, adverse drug reactions (ADR) and drug interactions (DI) of methadone was conducted using Medline and PsycINFO. Relevant English language articles were selected. Studies and reports for drug related issues in India were searched additionally.
Results: Methadone is associated with many ADR and DI, some of which have particular relevance for Indian setting. In India, with impure heroin being used commonly, the patient may experience overdose if methadone is used at the same dose as that in western countries. In India, many users inject buprenorphine that can precipitate withdrawals, if injected along with methadone. Medicines known to interact with methadone are commonly used in India, especially for HIV, tuberculosis and other infections. A weak liaison between different service providers can pose a challenge to manage potential overdose or withdrawals in methadone patients. Finally, existing infrastructure and capacity of service providers must gear up to handle any emergencies arising out of methadone overdose.
Discussion: While introduction of methadone is a welcome step in increasing the treatment-options (along with existing buprenorphine) for ODS patients, there is a need to be cautious about safety issues of methadone specific to India. The on-going multi-site PMS of Methadone coordinated by NDDTC, AIIMS would be immensely useful for this purpose.
Prospective study of operative criteria for evolving capacity to consent for involuntary treatment
Prerna Kukreti, Amit Khanna
Department of Psychiatry, Institute of Human Behaviour and Allied Sciences, New Delhi, India. E-mail: [email protected]
Background: Indian law has legal provision for involuntary admission of persons with mental illness to safeguard general public as well as for better treatment of patients. However, involuntary hospitalization is considered a clear infringement of a person's autonomy& self determination. To strike a balance between patient's benefit & right to liberty is essential. Current study aims to suggest a mechanism for periodic assessment of capacity to consent for treatment.
Aims & Objective: To make operative criteria for converting involuntary admissions under section 19, MHA, 1987 to voluntary admissions under section 15 & 17, MHA,1987
Material & methods: 86 Patients admitted in month of February 2013, under section 19, MHA, 1987 were assessed. After 4 weeks of inpatient stay, patients were weekly assessed for further period of 3 months for capacity to give consent on a self devised semi structured questionnaire. Patients & family members were psycho educated, those who had attained the capacity, were offered option for being converted to section 15/17, MHA, 1987.
Results: After 6weeks of admission, nearly 56% patients could be converted to voluntary admissions. Patient's socio demographic data, clinical diagnosis, details of psycho educative session and implications will be discussed at the time of presentation.
Conclusions: UNCRPD gives all patients right to choose setting of their treatment. The study lays operative criteria for serial assessment of evolving capacity for consent to treatment. More research is needed in this area, particularly developing countries to bring effective change in law.
Quality of life and perceived social support among urticaria patients
R Sagar, Venkataraman Hariharan, CN Krishnamurthy,
E-mail: [email protected]
Background: Skin is an organ that has a primary functions in tactile function and also reacts upon emotional stimuli. Psychodermatology address the interaction between mind and skin. It is a complex interplay between neuro-endocrine and immune systems that has been described as the neuro-immuno-cutaneous system (NICS). Stress plays a central role in the subgroup of stress responders in urticaria via neuro-peptides or psychoneuroendocrinological factors. Even social relationship can act as stressors (e.g., strain in a relationship or at work) & or as a source of support against stress (e.g., emotional & or instrumental). Based on this assumption the present study aims to find out the relation between the perceived social support, and quality of life between patients with acute & chronic urticaria.
Methods: Patients who attended dermatology OPD with diagnosis of urticaria meeting ICD-10 criteria are included in the study. The patients having any chronic medical illness, sub-average intelligence & substance use disorders are excluded. On a sample size of 30 acute and 30 chronic cases of urticaria, Dermatology Life Quality Index & Multidimensional Perceived Social Support questionnaires are applied.
Results & Conclusion: Appropriate statistical methods are applied using SPSS and discussed during presentation.
Trichotillomania: Is it an Obsessive Compulsive Spectrum Disorder or an Impulse Control Disorder?
Rachna Dangi, Saldanha D, Madalsa A, Tewari A, Menon P, Bhattacharya L
Padmashree Dr DY Patil Medical College, Pimpri, Pune, Maharashtra, India. E-mail: [email protected]
Background: Trichitillomania is a chronic disorder characterized by repetitive pulling of hairs driven by escalating tension causing variable hair loss. Mid- adolescence is the most serious form with a prevalence of 1.6% to 3.4% commonly seen in males.
Aim: To report a case of Trichitillomania as an obsessive compulsive spectrum disorder.
Case: A 28 year old male was admitted with complaints of repeated plucking of hair from beard and scalp, inability to concentrate and restlessness of 13 years duration. Habit started while in 10th Std and persisted even after graduation. He consulted a native psychiatrist did not get relief hence reported to this hospital. Dermatological examination revealed a negative Hair pull test Overall density of hair was normal but reduced in beard. Hairs were broken and seen to be of different lengths and absence of local inflammatory conditions viz alopecia areata, tinea capitis}.
Treatment and outcome: Patient was treated with SSRI's and anxiolytics, Psychotherapy and Progressive Muscular relaxation. The individual recovered. Follow up showed good outcome.
Discussion: Trichotillomania can be grouped into three subtype's 1.A transient form that occurs in children between 2 to 6 years.2. A habit form where unaware one pulls his hair. 3. A tension-release type akin to obsessive compulsive disorder. A compulsion to pull that often leads to relieving of tension or anxiety and the individual may be compelled to engage in associated rituals.
Conclusion: Identification of the disorder at an early stage and appropriate treatment protocol would help the individual towards fairly good recovery
Socio-demographic-clinical characteristics and treatment variables among stabilized treatment-seeker population of opioid-dependent patients: Findings from a community clinic of tertiary care center in India
Rajeev Ranjan, Anju Dhawan, Yatan Pal Singh Balhara
Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. E-mail: [email protected]
Background & objectives: The Socio-demographic-clinical characteristics of substance abusers is known to be severely impaired leading to poor quality of life. Information on impact of opioid maintenance treatment on these domains of opioid dependent subjects though available from the developed countries, is lacking from India. This study was carried out to assess the impact of buprenorphine maintenance treatment on socio-demographic-clinical characteristics and treatment variables among stabilized treatment seeker population of opioid dependent subjects.
Methods: Based on specified inclusion criteria a total of 106 subjects, stable treatment seeker maintained on buprenorphine treatment were recruited from a community clinic of tertiary care centre in India in a period of 3 months. An author-constructed semi structured proforma was used to assess socio-demographic-clinical characteristics and treatment variables from a cross-sectional interview. Information was also gathered and corroborated from medical records. Treatment retention was taken as an outcome measure. Correlation between Treatment retention and selected socio-demographic, clinical and treatment variables was analyzed.
Results: The mean duration of buprenorphine treatment was 43.8 ± 20.9 months. The mean doses of buprenorphine maintenance was 6.8 ± 2.3 mg. This led to gainful employment (91.6 %), stable housing or single room occupancy (92.5%), Stable income(79.2%), presence of family support (83.9%), Significant decline in self reported illicit opioid use and craving in last 6 months (12.3%), Parenteral drug use (16.9%), Illegal activity (13.2%),and improvement in health parameter (medical comorbidity-12.3%, psychiatric comorbidity-16.9%). A strong correlation was observed between treatment retention and self reported illicit opioid use and craving( p<0.05) signifies there is significant decline in illicit opioid use and craving with treatment retention.
Interpretation & conclusions: The results showed the beneficial effects of buprenorphine maintenance treatment in improving the quality of life of opioid-dependent subjects in a community setting. These results point towards the need for an expanded nation-wide provision of buprenorphine maintenance treatment as a harm reduction strategy for the opioid dependent population.
Comparison of effect of antidepressant and combined antidepressant and antipsychotics medication in patients having psychotic depression
Rajesh Sharma, Mithlesh Khinchi, Sanjay Jain, I. D. Gupta, Parth Singh Meena
Sawai Man Singh Medical College, Jaipur, Rajasthan, India.
E-mail: [email protected]
Introduction:Severly depressed patient with delusions and hallucination or with depressive stupor are said to have severe depression with psychotic features or psychotic depression. Psychotic depression has been distinguished fron non psychotic depressionby its association with poorer morbid function, longer depressive episodes, less responsiveness to antidepressant medication with worse prognosis. Psychotic depression has been associated with more severe decline cognitive abilities. It is still not very clear wheather addition of antipsychotic medication to antidepressant have any added benefits in improving depressive sympomatology and cognitive function as compared to antidepressant alone.
Aim: To evaluate and Compare the effect of antidrpressant and combined antidepressant and antipsychotics medication on cognitive function of patients having psychotic depression.
Materials & Methods: 50 Patients having psychotic depression were included in the study after obtaining written informed consent. Severity of depression was assessd by Montgomary-Asberg Depression Rating Scales (MADRS). Cognitive functions of patient were assessed by using Digit -Span Test, Trail Making Test A & B and Digit Symbol Subsitution Test. Data was analysed by using Chi Squre Test and Unpaired t-test using SPSS Software.
Result: Patients receving combination of antidepressant and antipsychotics performed better on all the four tests and difference was statistically significant.
Conclusion: More improvement in the cognitive function can be achieved by adding antipsychotic on antidepressant drug therapy.
Nocturnal Enuresis - Analysis of six cases from Manipur, northeast India
Gojendra Senjam, Rakesh Mohanty, Heramani Ningombam
Department of Psychiatry, Regional Institute of Medical Sciences, Imphal, Manipur, India. E-mail: [email protected]
Introduction: Nocturnal enuresis is defined as night time bedwetting in children five years of age or older. Nocturnal enuresis is a common psychosocial concern for both parents and children.
Case Presentation: We have analysed 6 such cases who presented to our OPD, Department of Psychiatry for treatment. Nocturnal enuresis questionnaire was administered to collect personal and socio-demographic information. Out of 6 children, 4 were girls and 2 were boys. All the children were within the age group of 7-13 years.
Results: Majority of them started toilet training at the age of 3 years and bed wetting problems were continuing since birth. Only one child had received pharmacological treatment in the form of Imipramine 12.5 mg/day per oral. None of the children had any medical problems like ADHD, Learning disabilities, constipation or bladder infections. Only 2 had similar problems in their siblings. None of the children reported any emotional problem and all of them perceived bed wetting as a problem to them and it should be treated.
Misdiagnosis of bipolar mania
Virginia Commonwealth University, Division of Inpatient Psychiatry, 1200 East Broad Street, Richmond, USA. E-mail [email protected]
AIMS: To review the literature and present cases to highlight wrong diagnosis of bipolar mania.
Materials & Methods: Although psychiatric diagnosis was revolutionized in DSM III by operational criteria, practitioners continue to make diagnoses without using the criteria. Bipolar mania is one example.
Case I: 30-year old woman had an episode during which she ran out of a restaurant, across a busy road and was stopped by the police. At the hospital, she was agitated and fearful, was diagnosed with mania and Rxd with antipsychotics with no benefit. In the author's clinic, she was exhausted and pale but had no signs of DSM IV mania. TSH level showed hypothyroidism. T4 fully improved her behavior in 1-week.
Case II: 90-year old man was diagnosed with bipolar mania after he presented with agitation and fears. He was discharged to a nursing home after Rx with olanzapine. Upon examination by the author, he was seen to be hiding under the bed and talking about the Nazis shooting him. History revealed he was a WW II veteran whose ship had indeed been hit by the Nazis. He was diagnosed with Delirium. The olanzapine was stopped and a supportive environment was provided. He improved quickly to his baseline status.
Case III: 15-year old girl was admitted to the hospital for "aggressive" behavior. She had mood changes from crying to laughing and had visual hallucinations of her father. She was diagnosed as having mania with psychosis and Rxd with antipsychotics, with little benefit. During a later evaluation by the author, she revealed that she had been molested by her father who was incarcerated for this. She showed good improvement with psychotherapy, the hallucinations receded and she returned to her baseline.
Results & Conclusions: Bipolar mania may be loosely diagnosed in clinical practice and the label is being used a as short hand for states of agitation and over-activity without euphoric mood or other classic behaviors of mania. This leads to incorrect treatment. Organic causes, delirium, PTSD with dissociation, etc may be missed. Continuing education on correctly diagnosing bipolar disorder is needed.
A cross-sectional study of prevalence of tobacco use in psychiatric inpatients
Rashmi Prakash, R.C. Jiloha, Manish Kandpal, NImmi Jose, Igambagra, Ajay vashishtha
Maulana Azad Medical College, Govind Ballabh Hospital, New Delhi, India. E-mail: [email protected]
Aims and Objectives: To study the prevalence of tobacco use in psychiatric in-patient.
Methods: This cross-sectional study will be conducted on Psychiatry in-patients, during a fixed period, with the aim to see the pattern of tobacco intake, in any form, in patients with psychiatric illness. Patients of ages <18 years or those not consenting will be excluded from the study.
Results and conclusion:The data will be analyzed using suitable statistical tools. The findings of the study will be discussed at the time of presentation. The data will be analyzed using suitable statistical tools. The findings of the study will be discussed at the time of presentation.
Results and conclusion: The data will be analyzed using suitable statistical tools. The findings of the study will be discussed at the time of presentation.
Neurocognitive assessment of adolescent inhalant users in treatment setting of India
Roshan Bhad, Manju Mehta, Anju Dhawan, Raka Jain
Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India. E-mail: [email protected]
Background- Inhalant use in adolescents is common and growing problem. The literature is suggestive of cognitive dysfunction but most studies do not specify about dysfunction areas and has limitation of confounding results due to polysubstance use. Current study examines neurocognitive dysfunction due to inhalants in predominantly primary adolescent inhalant users in treatment setting of India.
Aim- to assess the adolescents with inhalant use in term of neurocognitive functions.
Materials and Methods - 23 consecutive adolescents coming to National Drug Dependence Treatment Centre (NDDTC), AIIMS between age groups 13 to 18 were recruited in study. Assessment of neuropsychological functioning was done using Malin's Intelligence scale for Indian Children (MISIC) full battery, NIMHANS Neuropsychological Battery for children-Visual learning and Memory and Stroop Test.
Results - 10 out of 23 subjects were having IQ less than 90. Subjects were having difficulties in arithmetic and digit span compared to other verbal subtests and difficulties in picture arrangement compared to other performance subtests.
Mean scores for immediate and delayed memory were 25 percentiles compared to normative data, which was below average and significant finding. In Stroop Test mean mistakes and time taken was more compared to similar studies conducted in same age group population.
Conclusions - The study findings suggestive of deficit in attention and concentration, organization, early memory, delayed memory and possible executive dysfunction in adolescent inhalant users.
Using technology to improve mental health care in India - A case study
S Kalyanasundaram, Sanjay Mittal
Hon.CEO, The Richmond Fellowship Society (India), 'Asha', 501, 47th Cross, 9th Main, 5th Block Jayanagar, Bangalore, India.
E-mail: [email protected]
In India, information technology systems in health care institutions specially in mental and behavioral health is largely used to collect basic data and the data collected is not shareable between institutions. This impacts the quality of care being provided to the clients with mental health issues as well as increases the cost of the treatment. Other issues include inability to clearly measure the success of the services.
RFS India collaborated with eHealthObjects, a US based health Technology Company that specializes in providing health care products and services to its customers in USA including many state departments of behavioral health. RFS India is in the business of providing behavioral health rehabilitation services at its many centers in Bangalore.
eHealthObjects with its implementation partner in India 'Kairav Health India Pvt Ltd.' is rolling out its flagship software product 'ThinkEHR' and 'ThinkHIE' at all of the RFS India centers in Bangalore.
ThinkEHR's unique and advanced technology has enabled RFS to automate the center specific unique work flows related to the behavioral health rehabilitations services. It also allows any authorized user to access clients' data from anywhere even using the smart phones. ThinkHIE enables each center to exchange the data with another center allowing a consolidated clients' data repository. And the most important benefit is its ability to measure the success of the services offered by RFS India.
Epidemiology of depression in adults
Sadia Rehman Safwi, Ali Amir, R. K. Gaur, N. Khalique
Department of Community Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India. E mail: [email protected]
Aim: To determine the prevalence and severity of depression and its possible association with socio-demographic variables in adult population of rural and peri-urban areas of Aligarh district
Method: The present study was conducted in the field practice areas of Urban Health Training Centre (UHTC) and Rural Health Training Centre (RHTC), Department of Community Medicine , Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh , Uttar Pradesh over a duration of 1 year.The study was a Community based Cross sectional study involving 720 subjects (360 each from UHTC and RHTC) in the age group 19 years and above .The sampling techniques used were Probability Proportion To Size (PPS) , systematic random sampling and simple random sampling. The data on socio-demographic variables was collected with help of a pretested semi-structured proforma and depression was assessed by using the standardized and globally accepted Patient Health Questionnaire -9 (Hindi Version).
Result and Conclusion: The overall prevalence was found to be 11%. The prevalence of depression was found to be higher in the women than men. There was a increasing trend in depression prevalence with increasing age. The prevalence was higher with low standard of living index.The prevalence was higher in widows and divorced as compared to the married group.
Gardner-diamond syndrome - A clinical correlate to immune-cytokine model of depression
Saikat Mitra, Anindya Kumar Ray
8/A, Birchand Goswami Lane, Kolkata-700005.
E-mail: [email protected]
Introduction: Gardner Diamond syndrome (GDS) is a transient painful bruising condition without any physical trauma, vasculitis and any other bleeding disorder, usually found to be associated with stressful psychological condition. The exact etiology of the syndrome is an enigma even today. Clinically, there is appearance of painful ecchymotic patches developing over a period of 1-2 days, mainly over the extremities and they discolor to disappear within one to weeks, leaving no scar.
Case series: Here we report case histories of three female patients of differing age groups with significant life stressors, presenting with these symptoms, eventually diagnosed to be depressive disorder. Hematological examination, autoimmune biomarker and histopathology were normal with elevated serum IL-6, IL-10 and TNF-alpha, but normal IL-1 and IFN-gamma.
Discussion: The balance between cell-mediated immunity and humoral immunity is largely regulated by cytokines produced by subpopulations of CD4 T-helper cells, Th1 and Th2. Chronic stress results in a shift towards Th2 cell-line and elevation of its corresponding cytokine levels in blood. Similarly, immune-cytokine model of depression (ICMD) proposes an elevated cytokine levels in depressive disorders. In this case series, we found cytokine response in the patients of depression, presenting with GDS, akin to immunology of chronic stress and ICMD would suggest.
Conclusion: Chronic stress and subsequent depressive disorder seem to follow a final common immunological pathway. GDS may be a clinical co-relate towards the missing link between biology of stress and development of depressive disorder, from an immunological perspective.
Measurement of empathy in postgraduate medical students of various specialties
Saikiran Pasupula, Madhavi Kodali, Krishna Mohan P
Dr. Pinnamaneni Institute of Medical Sciences and Research Foundation, Gannavaram, Vijayawada, Andhra Pradesh, India. E-mail: [email protected]
Background: Empathy is "doctor's awareness of the patient's concerns producing a sequence of emotional engagement, compassion, and an urge to help the patient. Empathy is known to play crucial role in outcome of patients' health.
Aim: To measure the levels of empathy in postgraduate medical students and to compare among the different specialties.
Methodology: Postgraduate medical students of various specialties of Dr.Pinnamaneni Institute of Medical Sciences and Research Foundation are included in the study. The Jefferson Scale of Physician Empathy, Student version (JSPE-S) is applied to measure empathy levels. Scores of empathy are correlated in between the students of various specialties.
Results: Will be discussed at the time of presentation.
Conclusion: Will be discussed at the time of presentation.
Is it feasible to create a database for dementia in tertiary care hospital?
Saldanha D, Bhattacharya L, Madalsa A, Sameer G, Madav G
Padmashree Dr DY Patil Medical College, Pimpri, Pune, Maharashtra, India. E-mail: [email protected]
Background: Biological process of ageing is steady and unidirectional. A century of advance has lengthened the human life and people seem destined to live to longer, thus increase in the elderly. Evidence from epidemiological surveys is scarce. It is estimated that 24·3 million people have dementia with 4·6 million new cases added every year (one case every 7 seconds). The number affected would double every 20 years to 81·1 million by 2040.
Aim: To study and Create a database of Dementia in patients attending medical OPD.
Material and Methods: Patients aged 50 years and above attending the medical OPD were screened for cognitive impairment till a sample size of 50 was reached with an inclusion and exclusion criteria, ethics committee clearance and using appropriate diagnostic tools and investigations
Results: 350 patients who reported were screened.77 scored 23 and below on MMSE.Males outnumbered females by 202/350(58%) to 148 (42%).22% were found with impaired cognition.63/77(81.82%) belonged to the age group between 50-70 years and only 14/77(18.18%) were over the age of 71 years.45/77(58.44%) were Males and 32/77(41.56%) were females. 50 out of 77 registered were further investigated. Mean scores of severity was Mild 21.97, Moderate 15.11 and severe 5.50. High risk for dementia was older age, low socio-economic status, low education, positive family history, presence of stroke. Investigation profile showed 42% anemic and 70% low Vit B 12 levels. High cholesterol levels, increase in triglycerides concentration were found in 12 to 14%
Conclusion: Feasibility of database for dementia is a necessity.
Old age problem and family support
Samiksha Kaur, Jai Singh 1
SRLNM Hospital, Uttar Pradesh, 1 All India Institute of Medical Sciences, New Delhi, India
Aim: Adjustment problems of old age in the family.
Method and material: 50 male and 50 females geriatric samples, randomized from urban family Varanasi India. Socio demographic data were filled. Age groups of subject were 60-75 years. Tools- adjustment checklist, geriatric depression scale, and Hamilton rating scale were used.
Result: Result was found that 32% subjects belonged poor socioeconomic status.52% were middle class. Female subject have high depression, sleep disturbance, anxiety, arthritis, eye sight problem. As per subject 70% general demands were ignored, 86% have social adjustment problems, 90% have social relation problems, 76 % have not find their fulfilled demands by family members, 70% have poor personal support networks. The lower percentage of family support social adjustment were find in female geriatrics than male, Loneliness was almost equal common in both.
Conclusion: In all socioeconomic status of family poor percentage of family social relation, poor expectation, family support, social satisfactions were find in both age groups.
Role of life events in alcoholic relapse
Samir Kumar Praharaj, PSVN Sharma
Department of Psychiatry, Kasturba Medical College, Manipal, India. E-mail: [email protected]
Aim: To study the role of life events in patients presenting with alcoholic relapse.
Materials & Methods:This is a cross-sectional, observational study, being conducted at Department of Psychiatry, Kasturba Hospital, Manipal, Karnataka. 50 consecutive patients, aged 18 to 60 years, ICD-10 Diagnostic Criteria for Research for alcohol dependence syndrome, with current relapse will be recruited for the study. All the patients will be assessed on Severity Alcohol Dependence Questionnaire (SADQ) to measure alcohol dependence severity level and Presumptive Stressful Life Events Scale (PSLES) to identify life events in past 1 year prior to the relapse.
Results: Will be presented later.
Discussion: Will be presented later.
Sociodemographic and clinical profile of patients attending a consultation liaison clinic in a tertiary care hospital in north India - Preliminary report
Sandeep soni, Aniruddha Basu, Priti Singh, Rajiv Gupta, Pratibha Gahlawat
Department of Psychiatry, Pt. B. D. Sharma University of Health sciences, Rohtak, Haryana, India. E-mail: [email protected]
Introduction: The Department of Psychiatry, Pt. B D Sharma PGIMS, Rohtak, Haryana, has started a consultation-liaison (CL) clinic. This is the first of its kind in the state of Haryana. This clinic caters to the psychosocial, psychiatric and mental health needs of patients admitted in various departments of this multi-specialty hospital. Various non-emergency referrals from almost all the departments of this institute, along with active liaison with them are part of the regular work of this clinic.
Aims and objectives: To study the socio-demographic profile and clinical features of patients in consultation liaison psychiatry in a tertiary care centre in North India..
Methodology: Cross-sectional study done in a tertiary care centre on 100 in-patients in various departments of hospital referred to C-L psychiatric clinic on daily basis. The information to be included: socio-demographic data, past psychiatric/medical history, family history, current psychiatric complaints and diagnosis as per International Classification of Diseases (10th Revision) along with prescribedpsychotropics. Patients were assessed on a specially designed proforma consisting of socio-demographic and clinical data by a post-graduate resident who has at least one year experience in the field of psychiatry and at least two months experience of running this clinic under the supervision of a senior resident and a consultant in psychiatry.
Results and Conclusions: To be discussed in the presentation.
Comorbid OCD and ADHD: A case report
Santhosh Kumar, Sunil Gupta, Sandeep Grover
Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India. E-mail: [email protected]
Background: Studies have shown thatthe neurobiology of attention deficit hyperkinetic disorder (ADHD) and obsessive compulsive disorder (OCD) may be opposite with respect to the dopamine and glutaminergic activity in the prefrontal cortex, but their co-occurrence and risk of one for another is still inconclusive.
Aim: To report a case of Obsessive Compulsive Disorder with history of ADHD.
Case description: A 15 year old boy, born of full term vaginal delivery, had developmental delay and by the age of 4 years developed features of hyperactivity, inattention, impulsive behaviour and poor scholastic performance. Additionally he developed tics at the age of 6 years. At the age of 6 years, he was diagnosed with ADHD alongwith comorbid Tic disorderandwas started on Tab. Methylphenidate with which his symptoms improved in 3-4 months. Tab. Methylphenidate was continued for the next 3 years and was then tapered off. By 15 years of age patient started to have repetitive, unwanted, intrusive, anxiety provoking thoughts of fear of harming otherswhich were recognized as own,which he would try to resist. In response to these thoughts he would indulge in controlling compulsions, which will lead to reduction in anxiety. On the basis of available information a diagnosis of OCD with past history of ADHD was considered and he was treated with Tab. Clomipramine and behaviour therapy in the form of exposure and response prevention. Patient showed significantimprovedwithin 2 months of treatment.
Conclusion: The co-occurrence of OCD and ADHD suggests that the two disorders may be related biologically and there is a need to explore the relationship between the two disorders.
Intervening with stigma and discrimination in different settings
Santosh Loganathan, Sudipto Chatterjee, Sabina Rao, Mathew Varghese
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, Karnataka, India. E-mail: dr.santos[email protected]
People suffering from mental illnesses have to deal with effects of stigma apart from the illness itself. It has an extensive impact on the lives of mentally ill individuals and is often termed as a hidden barrier to mental health care. Mental health awareness with respect to schizophrenia is generally poor, considering the barriers, cultural beliefs and myths that prevail in India. Interventions to mitigate stigma are limited in India and other low-and middle-income countries and assessments about their effectiveness are notably sparse. Based on the research data at various settings, interventions undertaken at various levels for different disorders (schizophrenia, other severe mental illnesses and dementia) in India will be discussed: (a) A culturally adapted intervention, such as theatre and its use in a semi-rural set up, (b) Quantitative and qualitative data related to specific experiences of discrimination of 282 persons with schizophrenia and their primary caregivers collected across three sites in India, (c) A community clinic model in rural settings to deal with stigma and (d) Qualitative findings from caregivers of people with dementia (Pw dementia) and discussion about a model of intervention and support that is easily available through the use of web portals.
Case-control study of Amitriptyline in treatment of insomnia in alcohol recovery patients: One month follow- up
Santosh I Ramdurg, Bhavya K Bairy
SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India. E-mail : [email protected], [email protected]
Introduction: Patients in alcohol recovery have high rates of sleep disturbances following detoxification. If insomnia is not addressed adequately, it will lead to high relapse rate
Aim: To study the role of amitriptyline in the treatment of insomnia in alcohol recovery patients
Methodology: This study is one month prospective case-control study open label nonrandomised study. The subjects were persons diagnosed with alcohol dependence syndrome as per ICD-10 criteria with sleep disturbances as cases and without sleep problems as controls. Their sleep patterns were studied after detoxification by using Pittsburgh Insomnia Rating scale and distress, sleep parameters, quality of life and total scores were calculated.Higher the score indicated more sleep disturbances. Cases were started on Amitriptyline and control did not receive any pharmacological intervention. We did one month follow up and same values were evaluated further.
Results: Total of 30 patients each were included in case and control group in the study. Preliminary data analysis suggested all patients were males with mean age presentation being 36 & 35 years, educated upto 10 & 8.5 years of alcohol consumption 12.7 & 13.1 years between cases & control respectively. Baseline mean total scores were 81 in cases and 13.7 in controls. After one month of follow up the total scores were 30.7 in cases and 4.6 in controls. Further analysis of the study will be presented during conference.
Conclusions: Sleep disturbances are very common in alcohol recovery. Amitriptyline has been found to be useful in the treatment of insomnia in alcohol recovery.
Clinical profile and prevalence of anxiety disorder in patients with diabetes mellitus
Santosh Ramdurg, Umesh Rajoor
Department of Psychiatry, SDM College of Medical Sciences and Hospital Sattur, Dharwad, Karnataka, India. E-mail: [email protected]
Introduction: Diabetes is chronic illness in nature and patients are having difficulties in achieving optimal diabetes control. People with diabetes are at higher risk of psychological problems than the general population such as depression, anxiety, Fear of injecting and self-testing, fear of hypoglycemia and complication, burnout, eating disorder. These psychological problems leads to poor glycaemic control and its complication. So early detection and treatment can prevent these problems.
Aim: To study the prevalence of anxiety disorder in diabetes mellitus in secondary care private hospital.
Methodology: It is cross sectional study. Person diagnosed with diabetes mellitus as defined by World Health Organization criteria were included. They were also on either oral hypoglycemic agents and /or on insulin therapy. Existence of anxiety was evaluated by using GAD-7 questionnaire which is standard tool used for evaluation for anxiety disorder.
Results: totally 75 cases were screened for existence of anxiety disorder. Preliminary data analysis suggest mean age presentation was 52.1± 12.5, educated upto 9.1 ± 4.8 standard, 95% were married, majority of them were working as farmer or housewives. Prevalence of anxiety disorder was present in 44% of patients. Out of them 27% had mild, 8% moderate and 19% severe anxiety disorder was present in these patients.
Conclusion: Prevalence of anxiety disorder was common in chronic illness and it require proper intervention
Overview of mental illness in Nepal: Prejudices and help-seeking behavior
Saroj Prasad Ojha
Tribhuvan University, Institute of Medicine, Kathmandu, Nepal.
E-Mail: [email protected]
Nepal is a land locked south-east Asian country with immense cultural and geographical richness and diversity. It has a population of around 26.62 million (CBS, 2012) with 1.40% 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).
There is mental health policy drafted in 1996 which requires extensive revision respective mental health rights and has yet to be implemented. There is no monitoring mechanism to look at human rights violations and inspect mental health facilities that persistently violate patients' right.
Nepal, a country of about 26.62 million populations has one government run hospital, name as Mental Hospital which is located in Kathmandu Valley. There are approximately 50 psychiatric clinics and 12 psychological counseling centers, besides; private medical colleges (about 16) of Nepal are also providing psychiatric services. There are around 70 registered psychiatrists but quarters of them are abroad. Most of the service providers are not practicing as per the best international practices too.
For mental health treatment, there is scarcity of resources such as trained manpower, service centers with proper infrastructures. The services that are available are centered in urban areas, which are costly and solely dependent on biological method of treatment.
As a strategy to prevent mental illness, mental health should be made a public health priority, integrated approach of mental illness in each primary health centre, and prevention should be at all levels from national to international as well as at different public sectors such as the environment, housing, social welfare, employment, education, criminal justice and human rights.
To study pattern and prevalence of psychiatric disorders among patients attending dermatology OPD
Sasha Raikhy, Shiv Gautam, Tushar Jagawat, Vikas Gaur, Sanjay Kanodia
National Institute of Medical Sciences University, National Institute of Medical Sciences Hospital, Shobha Nagar, Delhi Jaipur Highway, Jaipur, Rajasthan, India. E-mail: [email protected]
Aim: This study was conducted to study pattern and prevalence of Psychiatric disorders among patients attending dermatology OPD
Method: The study was carried out in Psychiatry department of NIMS Medical College, Jaipur, Rajasthan.The sample was taken from Dermatology department of NIMS Medical College, Jaipur. First four patients attending dermatology OPD, 6 days a week, every week were screened for presence of psychiatric morbidity .Total 1000 patients were screened for study period of about 1year. They were administered General Health questionnaire (GHQ) 60.Patients scoring more than 12 on GHQ were examined for presence of psychiatric illness. A clinical interview & Mental Status Examination (MSE) of these patients was carried out to ascertain diagnosis according to ICD-10.
Results: As per ICD-10 diagnosis 34.2% of total sample were diagnosed with definite Psychiatric comorbidity. Maximum number of cases were of Depression 36.32% (N=146) followed by Anxiety disorder 18.41% (74) and 7.96% (N=32) with Somatoform disorder. Obsessive compulsive disorder was diagnosed in 6.47% (N=26) followed by Adjustment disorder 4.98% (N=20) and Alcohol dependency 4.98% (N=20). Minimum number of cases belonged to Schizophrenia 2.99% (N=12) and Bipolar Affective disorder 2.99% (N=12).
Conclusion: Psychiatric and psychosocial factors play an important role in atleast 34% of the dermatology patients. Consideration of these factors is essential for the effective management of skin disorder because psychiatric co-morbidity is often one of the most important indices of the overall disability associated with the skin conditions.Patients with psychocutaneous disorders frequently resist psychiatric referral, and the liaison among primary care physicians, psychiatrists, and dermatologists can prove very useful in the management of these conditions.
First ever depressive episodes vs recurrent depressive episodes - prognostic factors
Senthil Vel Rajan R, Samir K Praharaj, PSVN Sharma
651/4, Veeravanji Street, Anbu Nagar, Melamadai, Madurai. E-mail - [email protected]
Aim: To compare the course and clinical features between first episode and recurrent depressive episodes in outpatient setting.
Methodology: 73 patients were assessed at baseline and followed up at 3rd, 6th, 9th and 12th month. Patients were assessed using Hamilton rating scales for depression and anxiety, Inventory of depressive symptomatology, Columbia suicide severity rating scale, WHO - QOL scale, CORE scale for psychomotor symptoms and PSLES. Response and remission criteria were based on SIGH-D score with 50 % reduction being response and less than or equal to 7 score being remission.
Results: Patients with RDD had earlier age of onset (p=0.037), more stressful life events (p =0.012). First episode patients had lesser severity in SIGH - D scores as compared to patients with RDD at baseline, 3rd month, 6th month and 9th month. First episode patients also had fewer somatic and melancholic symptoms. Patients with recurrent depressive disorders had significantly more medical disorders like diabetes mellitus (p=0.002), hypertension (p=0.001) and thyroid abnormalities (p =0.031).
Conclusions: Recurrent depressive episodes may be associated with greater severity and decreased remission rates. Co-morbidity is high in people with recurrent episodes of depression. An assessment at baseline may be helpful in predicting the trajectory of a depressive episode.
Electroencephalographic (EEG) correlates of depression: A simple biological correlate revisited
Shahbaz Ali Khan Shagufta
Military Hospital Danapu cantt, Patna, Bihar, India.
E-mail: [email protected]
Aims and objective: To study the EEG abnormality in Major Depressive Disorder (MDD) compared to a healthy non depressed group. To correlate these findings with severity of depression as well as past episodes of depression
Methodology: A cross sectional analytical control study to compare the EEG abnormalities in MDD. Based on the literature review, a broad criterion was devised as to when to call an EEG abnormal in depression. Patients of depression were compared to a matched control group for the presence of EEG abnormalities as defined above.
Results: The difference in EEG abnormality between depressed group and healthy controls was not significant. Also no significant difference was noted when First episode depression was compared to multiple episode group. The % EEG abnormality in the moderately depressed patients was significantly high as compared to the mild and severe depression but no trend was noted
Conclusion: As brought out in this study, a one of it's kind on Indian population, the enthusiasm generated by the scope of a simple visual based qualitative EEG being of any help to the psychiatrist in understanding the biological underpinnings of MDD has not been proved true and this chapter can be safely closed.
A comparative study of psychiatric comorbidity in vitiligo and psoriasis
Shaily Mina, Shalini, Masrat Jabeen, Rohit Verma 1
Departments of Psychiatry, 1 Dermatology, Lady Hardinge Medical College, New Delhi, India. E-mail: [email protected]
Aims and Objectives: To study and compare the co-morbidity of anxiety, depression and suicidal ideations among individuals with vitiligo or psoriasis.
Materials & Methods: A population based cross-sectional study with consecutive sampling was conducted between January to August 2011 at an outpatient setting in the department of dermatology of a tertiary care center in New Delhi. Clinical diagnoses of depression, anxiety, and suicidality among patients was assessed using Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder scale (GAD-7) after taking informed consent. The data was imputed and analyzed using SPSS ver17.0.
Results: The mean age of patients with vitiligo (n=33) and psoriasis (n=42) was comparable (34.83 ± 12.1 vs 29.88 ± 12.1 years) with no significant difference on socio-demographic parameters. The mean duration of illness was also comparable between the groups. About 21% with psoriasis and 18% with vitiligo had moderate to severe depression, while 31% with psoriasis and 21% with vitiligo had generalized anxiety disorder. Suicidal ideation was reported by 25% and 29% of patients with vitiligo and psoriasis. There was no significant difference in scores among the groups on PHQ-9 or GAD-7.
Conclusion: Depression, anxiety and suicidal ideation are significantly present in patients with vitiligo and psoriasis. Alertness is needed on the part of dermatologists to be aware of the presence of psychiatric disorders for an effective management. There is a need to develop cross-cultural database on psychosocial aspects and psychiatric morbidity associated with dermatological conditions.
A case series of diagnosis and management of six individuals with asperger's syndrome with comorbidities
Department of Psychiatry, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India. E-mail: [email protected]
Introduction: Asperger syndrome is an uncommon condition, but probably more common than classic autism with a prevalence rates of around 36 per 10 000 children for Asperger syndrome and 5 per 10 000 for autism. Though more common than Autism, there is lack of clear consensus about diagnosis and management with Misdiagnosis or delayed diagnosis of this disorder being a serious problem, and the average age at diagnosis is several years later than for autism. Here we describe a case series of 6 individuals who presented to our centre with various psychopathologies and how Asperger's Syndrome was diagnosed and issues of management.
Methodology: Case 1- 18 yr old boy A presented with 6 month H/O refusal to eat as he would say that "whatever he eats gets converted into a stone and is obstructing his food pipe". On enquiry, described to be a loner since childhood with emotional indifference and lack of interest in play or friendships. He exhibited excessive interest in automobile spare-parts and could identify any engine make with its noise though his academic performance was "just average".
Case 2- 29 yr old female X, married for 1 year, presented with 3 month H/O refusing to continue her 5 month old pregnancy, though being interested initially and being irritable at the talk of childbirth. Initial diagnoses of possible Mood Disorder/ Personality issues were considered. On enquiry, father describes her lack of attachment to anybody since childhood and being very rigid and preoccupied with certain issues.
Case 3- 35 yr old male B was referred by the hospital Superintendent's office with history of multiple dismissals for having inappropriate sexual behavior with many females in work place. On examination, patient talks at length about these behaviors without any remorse. His colleagues describe him to be "odd and eccentric" who cannot recognize basic emotions in others.
Case 4- 45 yr old male S, staying in an Ashram, was brought by his son with H/O inappropriate sexual behavior and complaints by ashram inmates. He was sent to the Ashram by his son and wife as a result of multiple behavioral problems at home. He was described by his brother as a loner with no attachments since childhood.
Case 5- 16 yr old boy G, was brought by his parents with 2 year H/O being excessively preoccupied with details of firearms, wars with increasing academic dysfunction due to the preoccupation with the same.
Case 6- 53 yr old ummarried male, staying in Ashram, presented with 1yr H/O inappropriate sexual behavior with no attachment patterns since childhood with a excessive preoccupation with handling clothes and ability to undo any difficult knot.
Results: Details about the method of diagnosis, management issues and course on follow-up will be discussed.
Eating behaviors in borderline personality disorder and its association with metabolic abnormalities
Shankar K, Yamini Devendran, Sharon Ruth, Ajay Prakash
Department of Psychiatry, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India. E-mail: [email protected]
Introduction: Borderline personality disorder is characterized by patterns of instability in interpersonal relationships, self-image, and emotions. One of the significant ways these patterns manifest is by way of abnormalities in eating behavior.
The aim of this study is to assess eating behaviors among borderline personality patients. We also aim to assess if these eating behaviors have an impact on physical health and morbidity including metabolic profile.
Materials and Methods: Fifty adults diagnosed to have borderline personality disorder by clinical interview were screened using International Personality Diagnostic Examination (IPDE). Comorbid depressive episode will be ruled out by Mini International Neuropsychiatric Interview (MINI)-Plus. They were then administered Eating Behavior Questionnaire. Body mass index (BMI), abdominal circumference, and blood pressure (BP) was calculated for all subjects and serum lipid profile and fasting and postprandial blood sugars were done.
Results: Will be discussed.
Conclusions: This study gives us insight into the 'subsyndromal' pathology of eating behaviors in borderline personality disorder and their association with physical morbidity. Implications of this study will add both a diagnostic and treatment value.
A study of sexual functioning in untreated and treated major depressive disorder
Sharmishtha S. Deshpande, Poonam Patil, Bhalchandra Kalmegh, M. R. Ghate
Smt. Kashibai Navale Medical College and General Hospital, Narhe Pune, Maharashtra, India. E-mail: [email protected]
Though sexual side effects of antidepressants have been extensively studied, research is needed to compare sexual function in major depressive disorder before and after treatment.
Aims: To study sexual functioning including sexual desire, sexual dysfunction, and sexual satisfaction in patients with major depressive episode/disorder across gender.
To compare these between untreated depressed patients and those who have received treatment with antidepressants for 6 weeks or more.
Material and Methods: Consecutive consenting newly diagnosed patients (N = 37) clinically diagnosed to have major depression were interviewed by authors. Structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders (DSM) IV axis I disorders was used to confirm the diagnosis of depression and Hamilton Depression Rating Scale (HDRS)-17 administered to assess its severity. Semistructured questionnaire was used to assess the sexual functioning. This included questions about adverse effect on sexual desire, sexual dysfunction, and sexual satisfaction compared to their own premorbid levels. Similarly patients who had received 6 weeks or more of treatment with antidepressants were also interviewed (N = 39).
Results: Sociodemograhic characteristics of both the groups were comparable. Mean HDRS - 17 score was 20.16 ± 4.7 for before treatment group and 11.74 ± 8.17 for after treatment group. Sexual dysfunction was commoner in men and improved in a significant number of patients after treatment (χ2 = 13.43, P = 0.0002). Sexual satisfaction improved to some extent in both (χ2 = 4.23, P = 0.039), but sexual desire remained affected in men and women (χ2 = 2.33, P = 0.126).
Conclusion: Sexual functioning was significantly affected in major depressive disorder (70.2% patients), which needs to be addressed in routine clinical practice. It improved after treatment with antidepressants in many of the patients (25.6% after treatment). There was comparatively less improvement in sexual desire and sexual satisfaction.
Benzodiazepine maintenance for alcohol dependent patients: Case series
Shivanand Kattimani, Balaji Bharadwaj
Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantari Nagar, Pondicherry, India.
E-mail: [email protected]
Aim: We hypothesized that in our sample of persons who sought treatment from de-addiction services, there are subgroup of people who benefit from longer treatment of benzodiazepine without being at risk for abuse of benzodiazepines.
Material and Methods: De-addiction services are run in the department of psychiatry at JIPMER, Puducherry. The weekly follow up clinic attendance averages about 40. We selectively picked up patients who were on benzodiazepines (Diazepam 5-15mg/day) for more than one month and interviewed them and their key informants on various aspects in keeping with our study aim.
Results: We present here qualitative analysis of 10 persons who were on benzodiazepine as treatment for alcohol dependence and had continued beyond one month after detoxification. Very few reported side effects. None were diagnosed to have either having harmful use or dependent use of benzodiazepines. Few were confident of stopping and most believed that they may have to take medication for one year. The subgroup people who continued on benzodiazepine did not abuse benzodiazepine.
Conclusion: Acute physiological withdrawal may take few weeks (1-4 weeks) to improve and chronic non-specific withdrawal take longer time to improve and may be related to brain changes that have to take place in absence of alcohol use. Benzodiazepine maintenance may reduce the risk of relapse and be safely used as maintenance therapy for selected alcoholic patients who are motivated for regular follow-up and supervised treatment.
Challenges in early diagnosis and therapeutic intervention on autistic children: ignorance, stigma, and media role
J 6, 1 Floor, Right-side, Greenpark Extension New Delhi, India.
E-mail: [email protected]
Introduction: Autism is a developmental disorder marked by deficits in social interaction, verbal and nonverbal communication & cognitive development. No conclusive cause or cure for autism has been found though studies on early intervention & therapy have shown successful management of the individual.
Aims and Objectives: The primary aim of the paper will be to highlight the challenges in early diagnosis and implementation of intervention programs on autistic children.
The objective of the study will be to focus on the crucial issues relating to ignorance and social stigma associated with autism and what role can the media play to spread awareness of the condition.
Methodology: A survey conducted in Guwahati, Assam will be presented where parents of 38 autistic children and educators from various special education centers have been included in the study.
Results: Autism has been a misunderstood disorder and diagnostic delay has been a great ordeal.
The reasons for delay in early diagnosis & intervention prevalent in India are:
- Ignorance among the parents about autism
- Lack of knowledge among professional for autistic diagnosis and management
- Parents and guardians need to cope with the social stigma & culture specific beliefs associated with mental disorders
Family-assisted cognitive training in improving cognition in schizophrenia
Shruti Sinha, P K Dalal, Adarsh Tripathi, Shweta Singh,
P K Sinha
Department of Psychiatry, King George Medical University Lucknow, UP, India. E-mail: [email protected]
Aims: To study and compare the effect of add on Family Assisted Cognitive Training along with treatment as usual with that of treatment as usual alone on cognition in stable patients of Schizophrenia.
Materials And Methods: Ours was a randomized case control study on patients of schizophrenia with a control group receiving treatment as usual (pharmacotherapy + brief counselling) alone and a study group receiving family assisted group cognitive training in addition. Patients of study group were called with their caregiver, in subgroups of 4-6, for four group cognitive training sessions every 2 weeks. Cognitive areas targeted were prospective memory, conversational and task vigilance, verbal learning and memory, cognitive flexibility and problem solving. The patients were trained on compensatory strategies that would bypass cognitive impairments by suggesting easier alternatives. The caregivers assisted in the perpetuation of this training by ensuring application of these strategies in day to day activities. The training was clinic based and required active involvement by therapist. Assessments were done on the Schizophrenia Cognition Rating Scale (SCoRS) at baseline, completion of training and at two months follow up.
Results And Conclusion: Significantly greater improvements (p<0.0001) in cognition were found in the study group as compared to the control group both at completion of training and at two months follow up. Among the cognitive domains significant improvements were seen in attention/vigilance, executive functions (working memory and processing speed) and social cognition. This concludes that cognitive training holds promise in the improvement in cognition in the patients of schizophrenia.
Good seizure control predicts better social and emotional functioning: A cross-sectional study in epilepsy patients
Shubham Mehta, Alok Tyagi, Richa Tripathi, Suresh Gupta, Mahesh Kumar
Sawai Man Singh Medical College, Jaipur, Rajasthan, India. E-mail: [email protected]
Introduction: Epilepsy characterized by an enduring predisposition of the brain to generate epileptic seizures and by the variable neurobiological, cognitive, psychological, and social consequences. It has diverse and complex effects on the overall well-being or subjective quality of life (QOL) of its sufferers.
Aims and Objectives: To assess the association of patients' QOL domain scores with socio-demographic and clinical variables.
Methodology: 31 subjects, who were currently receiving drug treatment for epilepsy with grand-mal seizures, were recruited from the psychiatry outpatient department. We elected to look at seizure frequency (in past 6 months) at three levels (0, 1, >1) rather than as a continuous variable to minimize inaccuracies related to participants' recall of seizure frequency. Their quality of life was assessed by QOLIE-31 (version 1.0). Statistical analysis was done using SPSS 20.
Results: No seizure in past 6 months correlated significantly with overall score on QOLIE-31 (r= -0.461, p=0.009). It also showed significant correlation with seizure worry (r=-0.525, p=0.002), emotional well-being (r=-0.399, p=0.026) and social functioning (r=-0.440, p=0.013).
Discussion: Better seizure control predicts emotional well-being, good social functioning and better overall quality of life. Interventions targeted at improving QOL in epilepsy patients should be domain specific to improve quality of care in such patients.
Neuropsychiatric interface in a patient with depression
Shubhangi Sambhaji Dere, Bharat Shah, Bindoo Jadhav, Hemangi Dhavale
K J Somaiya Medical College and Hospital, Sion, Mumbai, Maharashtra, India. E-mail: [email protected]
Psychiatric manifestations are significantly predominant in majority of the patients with Wilson's disease (WD) at the time of onset. Nearly half of the patients undergo psychiatric hospitalization before diagnosis of WD.
Aims/ Objectives: To report a case of WD who presented with non responding depression.
Methodology: A 31 years old patient came with complains of gradual onset of withdrawn behavior, irritability, sadness of mood, & slowness of movements since 1 year. A diagnosis of Major Depressive Disorder was made by a private psychiatrist. He was started on antidepressants and received 10 Electro Convulsive Therapy. However, he perceived no improvement & discontinued treatment due to side effects. Patient presented in KJSH after 6 months due to worsened symptoms.
On enquiry, h/o tremulousness, slurring of speech & leaning of body backwards while sitting since few months. Neurological examination revealed brisk deep tendon reflexes.
On MSE, patient had retarded psychomotor activity, grimacing facial movements with mannerisms. His mood was sad with restricted affect. Ideas of helplessness, hopelessness and death wishes were expressed.
MRI showed gliosis with calcification in bilateral basal ganglia. On ophthalmological examination, Keyser Fleischer ring seen. Investigations revealed raised liver enzymes and high urine Cu.
Patient was diagnosed with Wilson's disease and started on Tab. Penicillamine.
Discussion: Although WD is rare, it commonly presents with psychiatric symptoms. Depression is extremely common in WD patients, affecting 30-60% of them. The mood disturbance show limited response to anti depressants, whereas, use of chelating agent leads to normalisation of mood and improvement in non-psychiatric symptoms.
Conclusion: Psychiatrists has to be aware of psychiatric manifestations of WD. A differential of Wilson's disease can be considered if patient shows poor response or excessive sensitivity to the psychotropic medications. Consultation liaison across multiple specialties like neurology, ophthalmology is required for comprehensive management of WD.
Severe Debility Arising from Kinesthetic Hallucinations: A Case Report
Shwetank Bansal, Amit Khanna, Om Prakash
Department of Psychiatry, Institute of Human Behaviour and Allied Sciences, Delhi, India. E-mail: [email protected]
Aim: To highlight the extreme form of debility resulting from the presence of kinaesthetic hallucinations.
Materials & Methods: A 45 year old female was brought in a state of utter neglect, with poor personal hygiene and health status.
She had been bed ridden for the past two years, even doing her daily routine either on, or in the vicinity of the bed. She reported that she had a wireless transmitter in her body, causing her joints to become 'folded' and 'stiff'. This caused her inability to bathe and to walk to the toilet. She also felt that someone was spying on her as she constantly heard the Russian president speaking to the Russian secret service chief about her, all the way from Russia, through a 'wireless transmitter'. While in the ward, the patient was found to be mostly bedridden owing to the joint twisting and pain being caused by 'the criminals'.
Results: A physical examination revealed that the patient had developed muscle wasting in all 4 limbs, explained by her being bed-ridden for such a long period. Serial Mental status examination revealed a delusion of persecution, somatic passivity, third person auditory hallucinations, extracampine auditory hallucinations and kinesthetic hallucination along with impaired personal judgement and absent insight.
She was diagnosed with Paranoid Schizophrenia and started on the second generation antipsychotic Risperidone along with physiotherapy to restore limb muscle strength. The patient was found to be resisting this, saying that her joint twisting prevented her from doing the exercises. Gradually, she began to get up from her bed, and move about the ward. She showed significant improvement in terms of her positive as well as negative symptoms and was discharged.
Conclusion: Kinaesthetic hallucinations can be severely debilitating, and can cause several physical complications, unlike other hallucinations. The physical complications need to be given due cognizance and be tended to separately.
Symptom patterns and severity among children with ADHD: Data from south India
Sivashankar P, Madhavi Kodali, Krishna Mohan P
Dr. PSIMS and RF, Gannavaram, Vijayawada, Andhra Pradesh, India. E-mail: [email protected]
Background: Attention deficit hyper activity disorder (ADHD) is a common neuro behavioral, disorder of childhood and adolescence. These children lack inhibition and self control due to failure in brain circuitry. Children have problems of in attention, hyperactivity and impulsivity related behavior and learning. Thus, have difficulties at school and home, and in peer relationships.
AIM: The aim of the present study is to assess the symptom pattern and severity of children diagnosed as ADHD and its affect on academic performance.
Method: The study is conducted at the Department of Psychiatry, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation. The sample consists of 15 children between 6-12 years of age diagnosed as ADHD based on ICD 10. Child psychiatric rating scale, Conners scale, and ADHD rating scale are applied on the subjects. The data is analyzed pertaining to severity, symptom pattern and clinical manifestation.
Results: Will be discussed at the time of presentation.
Conclusion: Will be discussed at the time of presentation.
Sociodemographic evaluation of attempted cases of suicide admitted to an rural medical college of Maharashtra
Sneh Babhulkar, K K Mishra, Neha Gupta, Srikanth Reddy
Department of Psychiatry, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, Maharashtra, India. E-mail: [email protected]
Aim and objective: Suicide among the cotton farmers of Maharashtra has reached to an epidemic proportion at some point of time . Several cases of attempted suicide are admitted to the tertiary care centre due to non- farming reasons keeping this aim in the view the cases were evaluated to find out the different reasons in those cases.
Material and method: Socio demographic profile, economic condition, and the reason for suicide attempt of all the cases admitted between April - August,2013 to a rural medical hospital of Maharashtra were evaluated by a structured Performa and the data was analyzed using suitable statistical test.
Result: Total of around 40 cases of attempted suicide were admitted to our college hospital during this period. Majority of the patients were from the male gender and in the second/third decade of life . poisoning by insecticide was found to the most common method adopted by the patients. Maladjustment in the domestic environment was the most common cause. Details will be discussed during the presentation.
Conclusion: To conclude social reasons remains one of the most common cause among the suicide attempters proving that primary psychiatric diagnosis may not be always possible.
Tobacco Use in Opioid-Dependent Patients on Buprenorphine-Naloxone Treatment
Sonali Jhanjee, Piyali Mandal, Dharmender Singh
E-mail: [email protected]
Aims: This study aims to examine the pattern and severity of tobacco use, readiness to quit, perceived personal health and risk susceptibility associated with tobacco use and importance of intervention, among patients on opioid agonist treatment with buprenorphine-naloxone in community outreach.
Materials & methods: Thirty males on buprenorphine-naloxone treatment at one of the outreach clinic of National Drug Dependence Treatment Centre, India, were assessed using Tobacco Use Characteristics, Fagerstrom test for nicotine dependence (smoker and smokeless tobacco user), Readiness to Change questionnaire (RCQ), Smoker's Perceived Health Risk Evaluation (SPHERE), Importance of Intervention scale and a semi-structured questionnaire.
Results: 93.4% of the subjects were smokers, 6.6 % were using smokeless tobacco only whereas 3.3% were using both. Mean FTND score of 5.4 ± 2.3 among smokers, denotes medium dependence. Only 20 % were in action stage of change. Fifty-six percent showed interest to quit. Perceived personal health was poor and only 43.3% considered intervention for smoking cessation important.
Conclusions: The severity of nicotine dependence, low perception of harm from tobacco warrants immediate attention. High interest in quitting represents an important on-site treatment opportunity.
Profile of suicide attempters attending a tertiary care hospital in meghalaya
Sonali Shinde Tesia, Arvind Nongpiur
Department of Psychiatry, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India. E-mail: [email protected]
Background: More than one lakh persons (1, 34,599) in the country lost their lives by committing suicide during the year 2010 according to the NRCB (National Records of Crime Bureau- Suicide decade (2000-2010) data). Amongst the Seven sister states of North east India Meghalaya has a suicide rate of 4.1.
However, systematic profiling of suicide attempts in North east India is still lacking. Suicide still remains a major public health concern.
Aims: To study the risk factors and intentionality associated with suicide attempts, in Meghalaya.
Method: The present study was conducted on 50 patients who presented with a suicide attempt at a tertiary care hospital in Meghalaya. A written and informed consent was taken from all the patients included in the study. Socio demographic details and clinical data was collected in a semi structured Proforma. The intentionality of suicide attempt was rated on the Suicide Intent Scale. Data was analysed using the SPSS 16 version.
Results: Amongst the suicide attempters, 88% (n= 43) were less than 35 years of age. The youngest attempter was 15 years old. Female attempters were 62% (n=31) and males were 38% (n=18). 76% (n=38) of the attempters were from urban areas and 24% (n=12) were hailing from rural areas in and around Shillong. Consumption of household and farm chemicals was the mode of attempt for 44% (n=22) and medication overdose was attempted by 24% (n=12).
Conclusion: Modifiable risk factors can be addressed and used for preventive measures
Delusional parasitosis: "The mind eating parasite of Ekbom"
Sonam Tobgay, RShashikumar, PK Sharma
Department of Psychiatry, Golden Jubilee Block, Armed Forces Medical College, Pune, Maharashtra, India. E-mail: [email protected]
Aim: To highlightthe significance of early intervention in delusional parasitosis.
Materials and methods: Delusional parasitosis or Ekbom syndrome is an uncommon psychiatric illness in which the patients develop a fixed firm belief that worms are crawling under their skin. Patients generally take a long time to seek psychiatric attention and the dermatologist is almost always the first physician to see them.
Here we describe one such case in an elderly widow who presented to us following quick referral from dermatologist and was managed appropriately in time with medications and showed quick remission.
Results: The patient showed response to medications within two weeks of therapy and remission within one month and presently on maintenance medications.
Conclusion: Early recognition and timely referral and intervention would lead to rapid response and significant reduction in psychological distress and health care expenditure.
Acute Psychosis Among Adolescence
Sony Mathews Lukose, Minju Sajith, Paul Swamidhas Sudhakar Russell, Satya Raj
Department of Child and Adolescent Psychiatry, Christian Medical College, Bagayam, Vellore, Tamil Nadu, India. E-mail: [email protected]
Aim: Details on Acute Psychoses among adolescence is sparse. We studied the prevalence, clinical features, stability of diagnosis and the factors associated with it.
Materials and Methods: 5054 charts from 2007-12 were reviewed at the child and adolescent psychiatric unit of Christian Medical College, Vellore. Details of those ≤18 years with an ICD-10 diagnosis were reviewed. Over the 5-year follow-up, the diagnosis during the last visit was taken as the follow-up diagnosis in cases of attrition. Appropriate univariate and multivariate regression was used.
Results: The prevalence of Acute Psychoses was 1.62% (N=82). The mean (sd) age was 15.66 (1.77) years and there were 44% boys vs. 56% girls. Acute Polymorphic Psychotic Disorder without symptoms of Schizophrenia was seen in 57.3%, Acute Polymorphic Psychotic Disorder without symptoms of Schizophrenia in 19.5%, Acute Schizophrenia like Disorder in 2.4% and Acute Polymorphic Psychotic Disorder others/NOS in 20.7%. The duration of illness at presentation was mean (sd) of 2.07(1.18) weeks. Over a follow-up duration of 5 years 37.8% had a change of diagnosis, where 14.6% changed to Schizophrenia, 13.4% into Bipolar Affective Disorder, Episodic psychosis and Severe depression in 2.4% each as well as Psychoses NOS, Schizo-affective Disorder, Recurrent Depressive Disorder and Mania with psychosis in 1.2% each. Precipitating stressors [β(SE)=-1.33(0.48); P=0.005; unadjusted OR=0.26], severity of illness needing index hospitalisation [β(SE)=-2.73(0.81); P=0.001; unadjusted OR=15.5] and longer normal intermorbid period between the initial 2 episodes [β(SE)= 0.05(0.1); P=0.001; unadjusted OR=1.05] resulted in a change in the index diagnosis.
Conclusion: With this study the Acute Psychoses among adolescence has been more characterised in India and further prospective studies are suggested.
Valproate-Induced Hyperammonemia: A Case Series in a Psychiatric Setting
Soumitra Das, Badr Ratnakaran, Varghese P Punnoose, Aswin Krishnan Ajit, Mili Babu, Rekha Mathew, Arjun Kartha
Government Tirumala Devaswom Medical College, Alappuzha, Kerala, India. E-mail: [email protected]
Valproate is one of the most widely used anticonvulsant mood stabilizers. The indications of it's use ranges from Bipolar affective disorders to Schizoaffective disorders, Personality disorders, Impulse control disorders and also for controlling aggression associated with a variety of psychiatric disorders. One of the most serious adverse effects associated with its use is hepatotoxicity1. It is also known to cause an elevation of arterial ammonia without altering the hepatic enzymes.
Here, we present a series of 6 cases who were admitted as in-patients in a tertiary care setting for the management of affective disorders during the period September 2012 to August 2013. All these patients were initiated on Valproate but later developed confused behaviour during the course of therapy which could not be explained by any other metabolic alterations .Dueto the temporal correlation of onset of symptoms,Valproate was implicated as the most likely offending agent. Upon investigation, it was found that in all the cases arterial ammonia was elevated without hepatic impairment. Consequently, Valproate was reduced or stopped and the patient's clinical condition subsequently improved. This also correlated with falling and normalisation of arterial ammonia levels.
This highlights the potential risks of administering a loading dose of Valproate in the management of psychiatric disorders. Certain risk factors were also identified which contributed an increased risk for delirium such as a loading dose of valproate greater than 30mg/kg body wt., rapid dose escalation, polypharmacy and substance use. So we recommend forevery patient developing delirium during Valproate therapy,be initially evaluated forarterial ammonia levels before going in for more expensive tests, especially in a developing country like ours.There are stringent guidelines on estimation of arterial ammonia regarding its transportation on ice packs and analysis within 15 minutes of collection of sample, to avoid false positive results5. In our study, all the necessary precautions were taken to ensure the preventionof spurious elevations in arterial ammonia.
A study of clinical features and treatment response in catatonia in children and adolescents
Sowmya Bhaskaran T S, Satish Girimaji
Department of Child and Adolescent psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India. E-mail: [email protected]
Introduction: Catatonia was originally described in 1874 by Kahlbaum as a unique clinical presentation of motor, vocal and behavioural abnormalities. Modern studies of catatonia in children and adolescents are few, but demonstrate that catatonia in this age group occurring in psychotic, affective, autistic, developmental, drug-induced, and neurologic-medical disorders.
AIM: To examine the clinical characteristics and treatment response in children and adolescents diagnosed with catatonia at a tertiary care centre.
Materials And Methods: A retrospective chart review of 25 patients diagnosed with catatonia at the child and adolescent psychiatry department in a tertiary care centre over the period of August 2010 to August 2013.
Results And Conclusion: During the study period, patients were admitted in the in-patient ward, of which 25 has catatonic features. The mean age of thegroup was 13.9 ± 1.48 years with an almost equal gender distribution (male -13, female -12). Mood disorder (n= 12; 48%) was the most common diagnosis of which 16% had severe depression with psychotic features, 20% had bipolar affective disorder and 12% had recurrent depressive disorder in the study population.All patients were initially treated with lorazepam and 24 % had received ECT as a mode of treatment.
A case report of a patient with severe postpartum hypothyroidism presenting as acute polymorphic psychosis
Sreyoshi Ghosh, Haridas K
Flat No. 404, Manipal Hills Apartments, Ananth Nagar, Manipal.
E-mail: [email protected]
Thyroid dysfunction in the post-partum period typically occurs as a result of thyroiditis due to exacerbation of auto-immunity at this time. The majority of women with post-partum thyroiditis experience an isolated hypothyroid phase (48%) which typically occurs at 19 weeks post-partum with eventual return to euthyroid status in the majority. Although usually transient this condition may be associated with significant symptomatology, including an increased incidence of mild to moderate depression. We report a patient with severe hypothyroidism at 5 ½ months post-partum presenting as acute polymorphic psychosis.
Obsessive Compulsive Disorder Mimicking Dhat Syndrome
Srinivas Balachander, Jitender Aneja, Sandeep Grover
Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India. E-mail : [email protected], [email protected]
Introduction: Various themes have been reported with respect to the content of obsessions. In this case report we describe a case of obsessive-compulsive disorder in which content of the obsessions closely mimicked the description of Dhat syndrome.
Case Description: A 24 year old male presented with an insidious onset illness of two years duration with complaints of passage of whitish sticky fluid per-urethrum. Exploration of history revealed that his illness was characterized by repetitive thoughts of passing whitish sticky fluid (which he considered as semen) after micturition. Despite knowing that there was no such discharge, he had intrusive, anxiety-provoking thoughts of passage of semen. His attempts to control or resist these thoughts were futile, and later on he started yielding to these thoughts by checking his genitals for any discharge/stickiness, specifically near the urethral meatus and glans. While checking the same, he would find no such discharge and this would reassure him for some time. Patient was very much distressed due to the repetitive thoughts and his indulgence in yielding behavior, and this led to severe socio-occupational dysfunction. There was no history suggestive of depressive symptoms, somatic symptoms and beliefs typically associated with Dhat syndrome. He was evaluated on Yale-Brown Obsessive-Compulsive Checklist, which did not reveal any other obsessive-compulsive symptoms. He was diagnosed as having obsessive-compulsive disorder (mixed thoughts and acts) and was treated with Fluvoxamine 150 mg/day and behavior therapy in the form of exposure and response prevention, with which his symptoms remitted completely over a period of 8 weeks. Conclusions: The content of obsessions can mimic Dhat syndrome. Proper evaluation of history to understand the phenomenology can help to disentangle obsessive-compulsive disorder and Dhat syndrome in patients presenting with similar complaints.
Platelet serotonin levels in human self-destructive behavior
Sriniwas Gupta, Era Sharma, M.S.V.K. Raju
Command Hospital (Southern Command), Wanorie, Pune, Maharashtra, India. E-mail: [email protected]
Background: Suicide is a disease and a global public health problem. Suicidology has come to become a serious topic of study for intervention and investigation. The serotonin system has remained a prime area of interest. Neurons and Platelets display structural and functional similarities. In blood more than 99% of 5HT is contained in platelet, which shares similar Serotonin uptake and release mechanisms with 5HT neurons. We have attempted to explore the biological as well as psychosocial, psychological areas related to suicide.
Aims: To study human self destructive behaviour.
Settings and Design: Study was carried out on 31 patients in a tertiary hospital. A detailed interview, an ICD-10 diagnosis (if applicable) and psychological tests were carried out.
Methods and Material: For the platelet serotonin estimation, blood samples were collected and Enzyme Immunometric assay was carried out.
Results: Female subjects outnumbered males by 2:1. There was a significant difference in the method employed by male and female patients. Major depression, adjustment disorder, personality disorder were predominant diagnoses. The mean platelet serotonin concentration for males was 57.3 while that of females was 56.05. The difference was not significant. Platelet Serotonin levels were found to be negatively correlated with impulsivity scores and this was found to be statistically significant.
Conclusions: Platelet Serotonin levels in our study sample were quite low when compared with those reported in published literature. Low Serotonin levels were found to be inversely related to impulsivity only in males. The predominant experiential theme that emerged out of the study was restabilising bonds.
A study of predictive factors of post stroke depression
P. Sriram , T. Ranganathan, R. Jeyaprakash
23 / 10, Flat No. 9, Sree Vaishnavi Apartments, Indira Nagar, 3rd Avenue, Adyar, Chennai. E-mail: [email protected]
Background: Depression is the most common post stroke psychological sequel. It may impede recovery and affect prognosis. Thus early identification and treatment is of potential importance.
Aim: To assess the predictive factors of post stroke depression
To assess the prevalence of post stroke depression
Methodology: 50 patients admitted to the stroke unit of Rajiv Gandhi Government General Hospital, chennai are recruited for the study and followed up for one month for depression. Stroke patients between 18-65 years who satisfied ICD-10 criteria for depression were included in our study. seriously ill, un co-operative and non-consenting individuals are excluded. A semi-structured questionnaire is used to assess socio-demographic profile and illness management data. HAM-D is used to quantify depression. Eyesenck Personality Questionnaire is used to assess individual's premorbid personality. WHO - QOL BREF scale is used to assess the individual's quality of life.
Results And Conclusion: will be discussed at the time of presentation.
Role of psychoeducation in decreasing burden of care in spouses of persons with schizophrenia
Sudhir Kumar, Sandhyarani Mohanty
Institute of Mental Health and Hospital, Agra, Uttar Pradesh, India. E-mail: [email protected]
Psycho-education is considered as an integrated part of schizophrenia treatment process which is beneficial for both patients and families. Psycho-education is defined as systematic, structured, didactic information on the illness and its treatment and which includes integrating emotional aspects in order to enable the participants-patients as well as family members-to cope with the illness. Specifically, psycho-education plays an important role in providing family members with psychological and social support by offering information on the causes and symptoms as well as methods to deal with the patient in a way that is easily understood. Psycho-education for people with schizophrenia improves the understanding of mental illness, increases the quality of life, and can reduce relapse rates. The psychoeducational approach strives to empower family members to participate actively in the treatment of the patient. The present study aimed at assessing the role of psychoeducation in stigma, burden and family attitude in spouses of persons with schizophrenia. The study was conducted at Institute of Mental Health and Hospital, Agra using a pre-post design with control group. 80 spouses of schizophrenic patients presenting in OPD of the Institute participated in the study. Following measures were used (a) Burden Assessment Schedule (b) Devaluation-discrimination scale (c) Family attitude scale. After gathering baseline, 40 spouses were given psychoeducation for four weeks followed by five monthly sessions. Post-assessment was conducted for all the participants. The results will be presented.
Clinical indicators of suicide in schizophrenia
Sunil Suthar, I. D. Gupta, Girish Chandra Baniya, Vijay Choudhary, Gunjan
NMHP Trainee Hostle, Psychiatric Centre, Sethi Colony, Jaipur (Rajasthan), India. E-mail: [email protected]
Introduction: Suicide is one of important cause of premature death in schizophrenia.20 to 40 percent of people with schizophrenia will make a suicide attempt sometime during their illness. The evidence suggests that 5 to6 percent of patients with a diagnosis of schizophrenia die by suicide. The most significant risk factors include the age of the patient, male gender, depression, hopelessness,unemployed, presence of positive symptoms and substance use disorder.
Aim: To study of association between clinical risk factors and suicide in schizophrenia.
Method: Consecutively total thirty schizophrenia patients, both out and in-patient, who had attempted suicide were included in study. For assessment socio-demographic profile, PANSS, beck hopelessness scale, Calgary Depression Scale for Schizophrenia and Beck's suicide intent scale were applied.
Result and conclusion: The result and its implication will be the focus of discussion in conference.
Study of the prevalence of gastrointestinal symptoms and atopy in children with autism spectrum disorder (ASD)
Suresh VC, Vijay Sagar KJ, Desai G
Research Coordinator, Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India. E-mail : [email protected], [email protected]
Objectives: To study the prevalence of Gastrointestinal (GI) symptoms and Atopy in children with ASD and to correlate GI and atopic symptoms with sociodemographic and clinical profile.
Materials and Methodology: Study sample was recruited for the study from both in-patient and outpatient service, following the initial evaluation/discussion with consultants/senior residents with diagnosis of autism spectrum disorder from the department of Child and Adolescent Psychiatry, NIMHANS, Bangalore. 100 subjects who satisfied the inclusion and exclusion criteria were enrolled in the study. The data was collected from parents following confirmed diagnosis of ASD. Childhood Autism Rating Scale, Vineland Social Maturity Scale, Gastrointestinal symptoms questionnaire, International study of Asthma and Allergies in Childhood was used.
Results and Conclusions: Of the 100 children with autism spectrum disorder children 33% had autism, 2% had Asperger's and 65% had the diagnosis of pervasive developmental disorder not otherwise specified (PDD NOS). Overall 67% of the children had gastrointestinal symptoms and 16 children had more than one gastrointestinal symptom, as reported by parents. 34% children had constipation, 26% had food selectivity, 9% had abdominal pain, 8% had vomiting, 7% had diarrhoea, 2% had food allergy. 6 children had Asthma, 3 children had allergic rhinitis and 4 children had eczema in the current study sample. GI symptoms are common in children with autism spectrum disorder. Current study showed inverse correlation between CARS scores and VSMS scores (social quotient) indicating that higher the severity of autism associated with higher levels of intellectual impairment and difficulty of such children in expressing their problems. No significant difference between children with ASD and Atopic manifestations was noted.
Burden, stress, and coping styles of primary caregivers of patients with bipolar affective disorder
Syed Naiyer Ali, Asim Kumar Mallick, Amit Bhattacharyya, Paramita Ray, Prodipto Dhar
Burdwan Medical College and Hospital, Burdwan, West Bengal, India.E-mail: [email protected]
Aims: Bipolar Affective Disorder is a severe mental illness which is stressful not only for the patient but also for the family member. Only few studies have explored how factors such as coping style and social support influence burden and stress. The data on burden, stress and coping styles are even fewer in case of bipolar disorder.
So the present study aims to assess the burden, perceived stress and coping styles adapted byprimary caregivers of patients of bipolar affective disorder.
Materials and Method: Primary caregivers(n=60, 18-60 yrs.,both sexes) of patients of bipolar disorder were studied. Perceived stress scale, 20 item Burden assessment schedule and Ways of coping questionnaire were used to evaluate the stress level, burden and coping styles used by the caregivers. The data was analyzed using SPSS Version 20.
Results: The average burden in the domain of caregiver wellbeing was 8.33±1.45, in marital relationship was 7.394±1.2, appreciation for care giving was 6.74 ± 1.47, for perceived severity of disease was 9.3 ± 1.48, and for relations with others was 8.21 ± 1.5. Severe burden was found in the domain of caregiver wellbeing, perceived severity of disease and relationship with others. Average perceived stress score was 24.73 ± 4.1 which corresponds to much higher than average stress levels. The most commonly used coping style was seeking social support followed by escape avoidance.
Conclusion: Primary caregivers experience high stress and burden in many domains. Thus psychosocial interventions should be provided to them to reduce their stress and burden and to modify their maladaptive coping styles which in turn will lead to better care of the patients.
A study of burden of care on key relatives of children and adolescents with mental retardation
Tarun Pal, Vivek Agarwal, Amit Arya, Pawan Kumar Gupta, Pooja Mahour
Gauta m Buddha Hostel, King George's Medical University, Lucknow, Uttar Pradesh, India. E-mail: [email protected]
Background: Family is the main source of support for those disable children .Family specially parents perceive burden in caring of mentally retarded children.
Aim: The aim of the study was to study of burden of care on key relatives of children and adolescents with mental retardation.
Methodology: The study sample included patients of mental retardation in age group 5 to 16 years & key relatives attending child and adolescent psychiatry OPD. A semi structured Performa was used to collect the demographic and clinical details and key relative's demographic variables. The patients were assessed on K-SADS for psychiatric comorbidity. Burden of care on the key relative was assessed on THARA burden assessment schedule (1998). For analysis appropriate statistical tools were used.
Result: Key relatives of mental retardation patients experience an overall moderate degree of burden (Total burden score = 67.3). As the severity of mental retardation increases, burden of care on key relative increases. Amongst all the domains of Burden of Care Scale, Physical & mental health domain has highest burden of care on the key relative. Burden of care on key relatives of mental retardation patients with comorbidities was found to be extremely significant (p<0.0001). Total burden of care on key relatives increases as the family size increases .Key relatives with lower income had significantly more burden of care in terms of care giver's routine & taking responsibility domains.
Conclusion: In this study it was found that family specially mother of mentally retarded children experience burden of care and it increases as the level of disability increases. Burden of care is maximum with severe to profound mental retardation. Associated comorbidities increase the burden of care.
A study determining causes of redundant clothing in patients with schizophrenia
Tathagata Mahintamani, Daya Ram
Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand, India. E-mail: [email protected]
Background: It is a well known fact that some patients with schizophrenia often wear multiple layers of same clothing without any obvious reasons for the same. In this regard, redundant clothing may actually be a marker for schizophrenia. Many causes have been postulated for this behavior but none is conclusive. The abnormal thermoregulation has been proposed as one amongst these. This abnormality may result either from thyroid dysfunction or autonomic dysregulation, but no study had been done to decipher this enigma.
Aims: The present study aimed at determining the relationship between wearing of redundant clothing and psychopathology, cognitive deficits, thyroid function, autonomic function in patients with schizophrenia.
Materials & methods: Twenty patients of schizophrenia with redundant clothing (at least 3 instances of wearing multiple layers of same clothing without obvious relationship with change in environment requiring active intervention of guardians or caregiver) were taken. Twenty age & sex matched controls with a diagnosis of schizophrenia without redundant clothing were included. The psychopathology was rated in each group on PANSS scale; cognitive dysfunction on SCoRS and MMSE, and autonomic dysfunction was assessed by change in Blood pressure and heart rate following isometric exercise, postural change, and Valsalva manoeuvre. The subjects were also tested for serum FT3, FT4, and TSH to assess thyroid function. The groups were then compared to assess for significant differences.
Result & Conclusion: To be shared during presentation at the conference.
A novel application of high frequency magnetic stimulation: Enhancing putative mirror neuron activity
Urvakhsh M Mehta, Avinash V Waghmare, Jagadisha Thirthalli, Ganesan Venkatasubramanian, Bangalore N Gangadhar
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India. E-mail: [email protected]
Aims: Social cognition deficits in schizophrenia lead to substantial socio-occupational dysfunction and respond poorly to conventional medications. Dysfunctional mirror neuron activity (MNA) has been associated with these deficits. We examined if a single session of high frequency repetitive transcranial magnetic stimulation (HF-rTMS) would enhance TMS-measured MNA compared to sham-rTMS in healthy individuals, using a randomized controlled study design.
Materials &Methods: 31 consenting, right-handed, healthy individuals were randomized to receive true (n= 15) or sham (n= 16) HF-rTMS administered over the left inferior frontal gyrus. Putative MNA before and after HF-rTMS was assessed using investigational-TMS. We recorded 10 motor evoked potentials (MEP) in the right first dorsal interosseous (FDI) muscle with three stimulus paradigms: (a) 120% of resting motor threshold (RMT), (b) stimulus intensity set to evoke MEP of 1-millivolt amplitude (MT1) and (c) a short latency paired pulse paradigm, administered in random sequence. This was done while the subjects observed videos of (a) inanimate motion of two bouncing balls (control condition), (b) two videos depicting goal-directed action of the FDI (action-observation condition). The MEP difference between control and action-observation conditions formed the measure of putative MNA.
Results: On two-way RMANOVA, there was a significant group (true versus sham) X occasion (pre- and post-HF-rTMS MNA) interaction effect for MT1 [F (df)= 12.143 (1,29), p= 0.002] and 120% RMT stimulus [F (df)= 7.326 (1,29), p= 0.01] indicating greater enhancement of MNA in the true HF-rTMS group than the sham group. This effect was not noticed in the paired pulse stimulus paradigm [F (df)= 1.815 (1,29), p= 0.18].
Conclusions: HF-rTMS delivered at the left inferior frontal gyrus resulted in significantly greater MNA enhancement than sham-rTMS. These findings suggest the potential role of HF-rTMS as a novel therapeutic application to enhance MNAand thus improve social cognition and disability in patients with major psychiatric disorders.
A study report from Nepal on chronic migraine and co-morbid psychiatric illness
Uttam Kumar Gupta, Tapas Kumar Aich
Universal College of Medical Sciences, Bhairahwa, Nepal. E-mail : [email protected], [email protected]
Aim and Objectives: Aim was to study the socio-demographic and clinical profile of patients with chronic migraine, and to study the frequency& pattern of co-morbid illness amongst these patients.
Methodology: The study was done at the headache clinic under the Department of Psychiatry at Universal College of Medical Sciences, Bhairahawa, Nepal. All out patient attending our clinic over a period of three months and age between 15- 55 years were included in present study. Exclusion criteria all secondary headache. Demographic and clinical profiles of these patients were noted in a specially designed a sociodemographic and data sheet prepared for present study. SCAN was used as diagnostic instrument, HAM-A and HAM-D scale were used to rate the severity of Anxiety and Depression. Simple statistical procedures like frequency, percentage, 't' test and chi square test used for analysis of data.
Results: A total no of 48 cases of chronic migraine were included in the present study. Forty one cases (85.4%) were female and rest were male. Psychiatric co-morbidity was present in thirty one cases (64.6%). Anxiety was the most comorbid diagnosis (35.4%). Followed by Anxiety disorder (29.2%).
Conclusion: chronic migraine & other headache have high rate of co-morbidity with mood & anxiety disorder. Effective treatment of chronic migraine & other headache require screening and accurately diagnosing specific psychiatric disorder when present.
Study of schizotypal features in patients of moderate to severe OCD
Vijay Choudhary, Pradeep Sharma, Gunjan, Sunil Suthar, Bhakti Murkey, Arvind
Sawai Man Singh Medical College, Jaipur, Rajasthan, India. E-mail: [email protected]
Aim: Though Obsessive compulsive disorder (OCD) patients apparently do not have increased risk for developing schizophrenia, schizotypal personality disorder (SPD) has consistently been found in OCD patients. We aimed to assess the association of schizotypal traits in patients of moderate to severe OCD patients.
Materials and Methods: 30 Consecutive patients diagnosed with OCD as per ICD 10 criteria and Yale brown obsession compulsion scale (YBOCS) total score >15 were recruited from psychiatry outpatient departmentat our hospital.Schizotypal personality questionnaire-brief(SPQ-B) was applied to the patients.The statistical analysis was done by using SPSS-20.
Results: We found that the Y-BOCS obsession (p=.004, r=0.670) as well as compulsion (p=.011,r=0.617) score was significantly correlated only to the cognitive-perceptual(CP) component of SPQ-B.
Discussion: Since the items of the cognitive-perceptual factor include the idea of reference and magical thinking, a patient with a severe obsession may be likely to have a bizarre and incorrect confidence.A distinct clinical phenotype of OCD associated with SPD should be considered while investigating etiopathogenetic mechanisms.
Retention in opioid substitution therapy: How do you define it and does it matter?
Vijay Krishnan, Ravidra Rao, Ashwani Mishra, Atul Ambekar
Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. E-mail: [email protected]
Introduction: Retention in substance-use treatment is an important outcome indicator. Retention is associated with improvements in various domains (drug-use, physical, socio-occupational and family). Therefore, a robust definition of retention is essential for evaluating individual patients, treatment programmes and treatment policies. We reviewed relevant literature, focussing on various definitions of retention adopted in opioid substitution treatment (OST), and analysed data from an OST programme in Punjab as a case-study to compare different definitions.
Methodology and Analysis: Literature-review on definitions of retention in treatment for OST was conducted. Using these definitions, we analysed data from treatment records at five OST centres in Punjab (Amritsar, Batala, Jalandhar, Ludhiana, and Tarn-Taran) functioning under National AIDS Control Organisation (n=126 male opioid dependent patients). Retention was calculated at various time points (1, 3, 6, 9, and 12 months) using three definitions. Relationships of socio-demographic and treatment-related factors with retention as calculated under the three definitions was assessed and compared.
Results: Literature review showed that three competing definitions were used for defining retention viz. (1) retained, if accessing treatment at the end of observation period, (2) retained, if accessing treatment at different intervals of observation period and (3) retained, if accessing treatment over defined proportion of observation period. In our data too, retention at one year was markedly different under these three definitions, varying from 4.7% under definition (2), through 15.87% under definition (3), to 30.23% under definition (1). These differences also affectedcalculation of significance of other treatment-related factors in relation to retention.
Discussion: Literature review revealed no consensus on definition of retention.Defining retention has a large effect upon the calculated outcome. It is necessary to evolve a consensus so that the adopted definition of retention is valid and is uniformly applied to enable cross-comparison of different studies.
Catatonia due to surreptitious administration of disulfiram: A case report
Vikash Dixit, Sagar Karia, Gurvinder Kalra
SS-II, 823 Sector D-1, LDA Colony, Kanpur Road, Lucknow, India.
E-mail: [email protected]
Disulfiram is an aversive agent used as an alcohol deterrent in the treatment of alcohol dependence. Disulfiram causes many side effects including catatonia. We present a case report of catatonia that developed when disulfiram was administered to a patient without his knowledge.
Indications and prescription pattern of electroconvulsive therapy - A retrospective study
V Subbalakshmikota, Khyatiwadhwa, Avinash K, Rishikesh V Behere, P.S.V.N Sharma
Department of Psychiatry, Kasturba Hospital, Manipal, Karnataka, India. E-mail: [email protected]
Background: Electroconvulsive therapy(ECT) is used to achieve rapid and short-term improvement of severe symptoms when the condition is considered to be potentially life threatening and/or after an adequate trial of other treatment options has proven ineffective. Major indications being severe depression, catatonia and mania. Depression appears to be most common diagnosis for which ECT is prescribed worldwide. However studies from India report schizophrenia as most common diagnosis.
Aim: Evaluate the main indications & prescription pattern of Modified ECT (MECT) in a tertiary care centre.
Materials and methods: Case records of all patients who received MECT from 2008-2012 will be reviewed. Semi-structured proforma will be used to collect details regarding diagnosis, indication for MECT, psychopathology prior to receiving treatment.
Results and analysis: Data collection will be done from September - November 2013.Data will be analysed, results will be presented and discussed.
Predictive value of fluoxetine-induced early antidepressant improvement to late antidepressant improvement in depression
Ravi Shankar Pandey, Naveen Kumar C, Shree Mishra
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India. E-mail: [email protected]
Aims: To find whether fluoxetine-induced antidepressant improvement predicts fluoxetine-induced late antidepressant improvement in depression.
Materials and Methods: The study comprised 20 patients suffering from moderate to severe depressive episodes diagnosed according to International Classification of Diseases, 10th revision (ICD-10) provided they satisfied additional specific inclusion criteria for the study. They were prescribed fluoxetine 20-40 mg/day and were evaluated by 17-item Hamilton Depression Rating Scale (HDRS) at baseline, after 7 days and after 6 weeks. The improvement after 1 week was correlated with improvement after 6 weeks using Pearson's correlation coefficient.
Results: The correlation coefficients between the change in HDRS scores on all 17 items, HDRS scores without sleep item, HDRS scores without anxiety item, and HDRS scores without sleep and anxiety items were 0.78, 0.82, 0.81, and 0.64, respectively (all significant at P < 0.001).
Conclusion: Antidepressant-induced early improvement can be used to predict late antidepressant-induced improvement.
Effects of Cannabis use on cognitive functions and clinical features of Bipolar Manic Disorder in Eastern India
Uday Sankar Mandal, Ajay Halder
8/A Dover Road, Kolkata, West Bengal, India. E-mail: [email protected]
- To compare cognitive functions of patients having dual diagnosis of bipolar affective disorder and cannabis dependence with those having either diagnosis alone and with healthy control
- To find out which domains of cognitive function are affected.
- To compare clinical features of bipolar patients having dual diagnosis of bipolar affective disorders and cannabis dependence with those having bipolar disorder alone.
Materials and Methods: Cross sectional, hospital based 18 months study in Institute of Psychiatry, Kolkata.
Ethical clearance and informed consent are taken.
Only those who met inclusion and exclusion criteria are selected
Appropriate scales are used and statistical analysis are done by using SPSS 20 version.
Results and Conclusion: will be presented.
Quality of life in menopausal women
Veerendar Chitte, Sravan Reddy V, Sarat Chandra I,
Department of Psychiatry, Mamata General Hospital, Khamman, Andhra Pradesh, India. E-mail: [email protected]
Introduction: Menopause is a physiological process in women's life. More than 80% of the women experience physical or psychological symptoms in the years when they approach menopause, with various distresses and disturbances in their lives, leading to a decrease in the quality of life.
Aims: The aim of this study was to assess QOL and related factors among menopausal women.
Materials and Methods: The study was done at Mamata General Hospital, Khammam, and Andhra Pradesh. It is a cross sectional study. In the study 80 women who were in the age group of 40-65 years, who came to psychiatry outpatient department, were included in the study. The women were receiving hormonal treatment and those who refused to participate in the study were excluded. The women who were included in the study were divided into three groups as the menopause transition, early postmenopausal and the late postmenopausal groups. The data such as the socio-demographic information and the menstruation status, which were based on the reported length of time since the last menstrual period and the experience of the symptoms, were collected from each patient. Symptoms of menopause were assessed through the Kupperman Menopausal Index, Quality of life in menopause women were tested by using Menopause Specific Quality of Life (MENQOL) questionnaire. The relation between quality of Life and Demographic variables was assessed.
Results and Conclusions: Will be presented.
Disability and quality of life in relation with the severity of alcohol dependence
Dr Sunil kumar kasuvojvala, Dr R. S. Swaroopa chary, Dr V. Sharbandh Raj
SVS Medical College, Yenugonda, Mehabub Nagar, Andhra Pradesh, India. E-mail: [email protected]
- To assess the severity of alcohol dependence in patients according to their socio-demographic and clinical details.
- To assess the disability in these patients in relation to the severity of the dependence
- To know the quality of life of the patients and co-relate it with the severity of dependence
Materials and Methods: In an ongoing study of 6 months from may 1st to October 31st , a total of 100 patients will be approached consecutively who were admitted as in patients in the department of psychiatry, SVS medical college, Mahaboobnagar, Andhra Pradesh . After a 2 week period of detoxification patients will be interviewed by applying various scales to know the socio-demographic details, severity of alcohol dependence, disability owing to the presence of psychiatric morbidity and quality of life.
- Socio-demographic and clinical data sheet to collect the respective details from the patients.
- ICD -10 RDC to make a confirmative diagnosis of alcohol dependence syndrome.
- Severity of alcohol dependence questionnaire (SADQ-C) -to assess the severity of dependence
- World health organization disability assessment schedule 2.0 (12 item, interviewer administered)- to assess the activity limitations and participant restrictions experienced by patients
- The world health organization quality of life (WHOQOL- BREF)- to know the individuals overall perception of quality of life and health.
Results and conclusions: Will be discussed in the conference
Neurocognitive functioning in patients with temporal lobe epilepsy - a controlled study
Pradhyuman Chaudhary, Girish Banwari
Department of Psychiatry, Sheth V S General, Ellisbridge, Ahmedabad, Gujarat, India. E-mail: [email protected]
Objective: The study aims to the assess the neurocognitive functioning of patients with temporal lobe epilepsy with either right or left side mesial temporal sclerosis.
Method: Patients diagnosed with temporal lobe epilepsy (right or left) on MRI (?brain) will be subjected to neurocognitive evaluation on two instruments -PGI Battery of Brain Dysfunction (BBD) and Addenbrooke's Cognitive Examination -ACE-R, Hindi version 2006 (for literate subjects) and 2010 (for illiterate subjects) Areas of cognitive functioning assessed would include memory (verbal and visual), language, intelligence (verbal and performance), visuospatial ability and attention and concentration. Age, gender, education and handedness matched healthy controls (with no present/past/family history of epilepsy) would be subjected to similar neurocognitive assessment for comparison.
Results and Conclusion: As the study is ongoing, results would be discussed at the time of conference.
Study of various co morbidities in alcohol dependence patients admitted in psychiatric hospital in eastern India
Uday Sankar Mandal, Ajay Halder
8/A Dover Road, Kolkata, West Bengal, India. E-mail: [email protected]
Aim: To determine the prevalence of psychiatric co-morbidities among alcohol dependent patients and to compare between them.
Materials and Methods:
Study Design - Hospital based, cross sectional study, purposive sampling.
Time Duration - 12 months.
Place of study - Department of Psychiatry, Institute of Psychiatry, Kolkata.
Population - Patients from psychiatry indoor of IOP
Sample Size - the samples comprise of 40 patients of alcohol dependence having psychiatric co-morbidities
Results and conclusion: all the patients are males in the study. The reason is that alcohol consumption by women is socially unacceptable till now and women may not avail of treatment openly in a general hospital setting. V-X std, married, Hindu male of mean age group 25.4 yrs of monthly family income of Rs. 1000 - Rs. 5000 are the most vulnerable group of alcohol dependence with co-morbidities. The most common psychiatric co-morbidity is depression (32.5 %) which is compared with study of Cadoret et al (39 %) and Alec et al (33 %) and Sing et al (26 %).
How can we access 'suicidality' in first - episode psychosis? Use of Columbia Suicide Severity Rating Scale
Vivek H Phutane, Matthew Kruse, Cenk Tek, Vinod Shrihari
Yale University School of Medicine, New Haven, CT - 06511, USA.
E-mail: [email protected]
Aim: The first five years after psychosis onset represent a high-risk period for suicide in schizophrenia. Detailed assessments of suicidality in first-episode psychosis (FEP) patients will permit more targeted and effective prevention.
Materials and Methods: A sample of 53 patients (mean age 23.3 years, SD 5.5) who were early in the course (DUP median 26 weeks with range 0-101 weeks) of a schizophrenia spectrum disorder were assessed for suicidal intent and behavior with the Columbia Suicide Severity Rating Scale (C-SSRS) over the first year of treatment. Results were correlated with routine clinical assessment of hospitalization rates.
Results: At baseline, the clinical interview missed 25% (3 of 12) of patients classified by C-SSRS as having history of suicidal ideation (SI) and 14% (1 of 7) of patients having history of suicidal attempt (SA). These rates were similar at 6 month and 1 year follow up. At 6 month and 1 year follow up, there was reduction in overall suicidality. Prior hospitalization at baseline was correlated (Spearman's correlation) with history of suicidal ideation (r=0.55; p,0.001), suicidal plan (r=0.29; p=0.03), and suicidal attempt (r=0.29; p=0.04).
Conclusion: The C-SSRS is feasible in a FEP population and provides superior sensitivity to the clinical interview. In addition, the stratification and quantification of suicidal ideation and behavior may improve risk monitoring and preventive efforts.
Everyday memory and working memory functioning in adolescence with mild mental retardation and normal control group: a comparative pilot study
Singh geetha, gaikwad vijay B, sayeed Neha, Sinha Vinod K
Room 44, Hodgson's ladies hostel, central institute of psychiatry, kanke road, Ranchi, Jharkhand, India. E-mail: [email protected]
Aims: everyday memory and working memory is of great importance for learning and daily functioning, but it is hardly studied in adolescent children with mild intellectual disabilities (MID). Everyday memory and working memory strengths and weaknesses in these children are explored by comparing their performance with that of control groups of typically developing children.
Materials and methods: two patients having MID compared with two age matched normal control adolescents will be assessed using Malin`s Intelligence scale for children (MISIC), The river mead behavioral memory test-II (RBMT), verbal working memory N-back test, N-Back task of visuospatial working memory, Digit span test.
Results: IT will be shared at the time of presentation.
Conclusion: It will be shared at the time of presentation.
Prevalence and Severity of Depression in patients with stroke
Shakti Singh T, Swaroopa Chary, Sharbandh Raj
SVS Medical College, Yenugonda, Mehbubnagar, Andhra Pradesh, India. E-mail: [email protected]
- To know the prevalence of depression in patients with cerebrovascular accident in relation to their socio-demographic and clinical variables
- To assess the severity of depression in them
- To correlate the severity of depression with the type and location of the lesion.
Materials and Methods: In an ongoing study planned for a period of eight months starting from February 1st to September 30th, one hundred consecutive patients attending the medical out patient department of S.V.S Medical College, Mahabubnagar, Andhra Pradesh will be approached. Various tools will be administered on the patients to know their socio-demographic and clinical details which will be later correlated with the prevalence and severity of depression.
- Socio-demographic and clinical data sheet to record the demographic and the kind of physical morbidity.
- General health questionnaire (GHQ-12) - To assess the psychopathology
- ICD-10 RDC- To Confirm the diagnosis of depressive episode
- Hamilton Depression Rating Scale (HAM-D) - To know the severity of depression
Results and Discussion: Will be discussed in the conference.
List of Free Paper Abstracts that will be published in the next supplement. [Additional file 1]
Source of Support: None, Conflict of Interest: None