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 Table of Contents    
Year : 2014  |  Volume : 56  |  Issue : 5  |  Page : 6-15

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Date of Web Publication14-Jan-2014

How to cite this article:
. Symposia. Indian J Psychiatry 2014;56, Suppl S1:6-15

How to cite this URL:
. Symposia. Indian J Psychiatry [serial online] 2014 [cited 2022 Dec 8];56, Suppl S1:6-15. Available from:

Depression in epilepsy: A relationship that cannot be ignored

Alakananda Dutt, Kaustav Chakraborty Rajarshi Neogi, Amitava Dan

Institute of Neurosciences, Kolkata, West Bengal, India

Aim of Symposium : To discuss the impact of depression in patients with epilepsy and its management. Special focus will be on the biological and social relationship between the two disorders, as people with epilepsy are not only more likely to have depression; those with history of depression are more likely to develop epilepsy. The first speaker will highlight this bidirectional interaction between depression and epilepsy and emphasize how despite the adverse effects of depression on epilepsy it is often underrecognized and hence not treated. The second speaker will focus on the biopsychosocial model of depression in epilepsy with special emphasis on the similarities between the two disorders with respect to genetic predisposition, neurotransmitters, and stress. The third speaker will enumerate the risk factors for depression along with the effect of antiepileptics on mood. The methods of identifying depression and its contribution in increasing the risk of suicide in this population will be highlighted. The last speaker will focus on the available treatments, their effectiveness, and controversies associated with antidepressant treatment in epilepsy.

Domestic violence and its consequences and awareness of newly Protection of Women from Domestic Violence Act (PWD Act 2006)

Arvind Jinger

Department of Psychiatry, Sawai Man Singh Medical College, Jaipur, Rajasthan, India

It is often said that the status and position of women in society is the best way to understand a civilization, its progress, and its shortcomings. Indian population represents a beautiful unity in diversity of various ethnic, sociocultural, and religious groups. With only 2.4% world's land area, India supports 16% of the world population. According to 1991 census out of total population of India (486.3 million) there are 407.1 million female against the male population of 439.23 million. Traditionally a strong patriarchal norm directs women to live in servitude and subordination. The situation is further complicated by illiteracy among women, poor out rich of services, and ignorance of women of their rights.

In case of India, women have come a long way from women sages and scholars in the Rig Vedic period to women in the armed forces, information technology (IT) sector, politics, industry, and other significant areas while balancing their role as a daughter, wife, and mother. This journey towards modernization has not been easy. Women have had to fight the traditional Indian male-dominated society to emerge as stronger and independent entities. While all these are positive developments, cases of rape, harassment at workplace, and dowry deaths are widespread. Illiteracy and ignorance about their rights are still prevalent among a majority of the women. It was in this background that the Committee on the Status of Women in India (CSWI) recommended nearly 2 decades ago, the setting up of a National Commission for Women (NCW) to fulfill the surveillance functions to facilitate redressal of grievances and to accelerate the socioeconomic development of women. In January 1992, the NCW, was set up as a statutory body under the NCW Act, 1990 (Act no. 20 of 1990 of Government of India) to review the constitutional and legal safeguards for women; recommend remedial legislative measures, facilitate redressal of grievances, and advise the government on all policy matters affecting women.

Newspapers and periodicals of all hues in India often carry reports about violence against women. These include among others incidents of young brides being burnt for bringing insufficient dowry, women dying in abnormal circumstances, rape on helpless women, and molestation of young girls. Deaths of women are extreme outcome of ill treatment, psychological abuse, or physical violence suffered by women. On the other hand domestic violence suffered by women on a regular basis in the form of psychological or physical abuse goes unreported. Very rarely do women themselves file police cases against the ill treatment meted out to them. A few women who escape death end up in shelter homes, but the majority continues to live in marital union and endure abusive behavior. The epidemic of violence directed at women and girls constitutes a major human rights issue and a public health crisis. Around the world women are regularly beaten and sexually abused by intimate partners, family members, neighbors, and by people not known to them. The impact on women's health goes far beyond bruises, broken bones, or even death. As well as causing physical suffering to women, such violence has a profound impact on women's psychological wellbeing, on their sexual and reproductive health, and on the wellbeing and security of their families and communities.

As the problem of violence against women is multifaceted, the NCW has adopted a multipronged strategy to tackle the problem. The commission has initiated generation of legal awareness among women, thus equipping them with the knowledge of their legal rights and with a capacity to use these rights. It assists women in redressal of their grievances through pre-litigation services. To facilitate speedy delivery of justice to women Parivarik Mahila Lok Adalats are organized in different parts of the country to review the existing provisions of the Constitution and other laws affecting women and recommending amendments thereto, any lacunae, inadequacies or shortcomings in such legislations. It organizes promotional activities to mobilize women and get information about their status and recommend paradigm shift in the empowerment of women. The Complaints and Counselling Cell of the commission processes the complaints received oral, written, or suo moto under Section 20 of the NCW Act. The complaints received relate to domestic violence, harassment, dowry, torture, desertion, bigamy, rape, refusal to register first information report (FIR), cruelty by husband, deprivation, gender discrimination, and sexual harassment at work place. Till 2005, remedies in form of civil law (divorce) and criminal law (S. 498A IPC). Its consequences includes physical and psychological disorder including bruises, frequent trauma and fractures, anxiety, depression, insomnia, posttraumatic stress disorder, substance abuse, and other emotional and behavioral disorders. Newly developed domestic violence act reduced morbidity and psychological ailments and their implementations has been discussed.

Widening Clinical Horizons in the management of female sexual dysfunctions

T S Sathyanarayana Rao, Raj Brahmabhatt, Darpan Kaur

Department of Psychiatry, JSS University, JSS Medical College, Mysore

Background for conducting symposium : Globally, the prevalence of sexual dysfunction is estimated as high as forty to fifty percent. Sexual dysfunction is more prevalent in women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Experience of sexual dysfunction is more likely among women with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall well-being. Female sexual dysfunction is an under researched and poorly understood area of psychiatry. Most physicians, psychiatrists, allied health care providers globally express concern over little or no formal training in this area. Physician and patient needs are not well defined, nor are the public health or cost implications.

There are newer concepts emerging in the nosology, clinical presentations and management of female sexual dysfunction. These concepts are being highlighted in the DSM-V. The International Consensus Body on Female Sexual Dysfunction recommends sensitization of medical, psychiatric and allied mental health professionals to these newer clinical concepts for comprehensive management of female sexual dysfunction.

Aims and Objectives of the symposium: This symposium intends to sensitize psychiatrist, psychologist and allied mental health professionals to various clinical aspects of female sexual dysfunction. The key focus of this symposium shall be on widening existing perspectives on clinical management of female sexual dysfunction.

Psychopharmacology of Sex

T. S. Sathyanarayana Rao

Department of Psychiatry, Jagadguru Sri Shivarathreeshwara Medical College, Jagadguru Sri Shivarathreeshwara University, Mysore, Karnataka, India

Sex is a biopsychosocial phenomenon. The research has sufficiently advanced concerning brain and its mechanisms to explain various nuances of sex and relationship. In fact, brain is considered as the biggest sex organ. Apart from neuroanatomy and neurophysiological explanations, the neurobiochemistry is essential in understanding psychopathophysiology of sex. Also hormones and neurotransmitters play a major role in human sexual life. They determine who we love, when we love, how we love, and how often we love. They mediate desire, arousal, and orgasm stages of sexual response. There are significant differences between males and females which can be interpreted and understood taking into consideration all the aspects from biology to psychology and sociology. A sexual relationship is fulfilling when there is synergy of many hormones and chemicals that are released at different phases of the love relationship. Many psychopharmacological agents have both direct and indirect, cause and effect upon sex; hence, a thorough understanding and sensitivity is needed in psychopharmacology practice. The presentation looks at all the above aspects from the perspectives of sexual health, sexual disorders, and its correlation to management and in particular psychopharmacology of sex in health and disease.

Depression in Elderly

To discuss the epidemiology, assessment, and management of depression in elderly

Ajit Avasthi, Sandeep Grover, Susanta Kumar Padhy

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

Depression in old age is an important public health problem causing considerable morbidity and disability worldwide including India. Depression is the commonest psychiatric illness across the study settings. Prevalence of depression in elderly varies from 12.7 to 45.9% in community sample, 13.2-25% in old age homes, 46.5% among inpatients, 13-29% in clinic population, and 20-30% in outpatients. It is more common in people with lower educational level, poor economic background, female, widowed, living alone and in those living in nuclear families, increasing age, and physical ill health; good social support is a protective factor.

The symptomatology of depression has many similarities with depression seen in other age group, but certain symptoms occur more frequently in elderly. The assessment of depression in elderly is very crucial as many patients may have symptoms which are considered as part of the physical illnesses that are commonly associated in this age group. Many scales have been devised to assess depression in elderly.

Management of depression in elderly is challenging because of pharmacodynamic and pharmacokinetic changes, physical comorbidities, and concomitant medication use. Therefore, the selection of medication in these patients requires taking into account the pharmacokinetic and pharmacodynamic drug interactions, body reserve, and side effect profile of antidepressants. This presentation will focus on how selection of antidepressants in elderly with depression.

DSM-5 psychotic disorders (IAPAV- USA sponsored symposium)

Ananda K. Pandurangi

Virginia Commonwealth University, 1200 East Broad Street, P. O. Box 980710, Richmond, USA

Aims : Present and discuss Diagnostic and Statistical Manual of Mental Disorders (DSM) 5 psychotic disorders.

Materials and Methods: The 5 th edition of the DSM was approved for clinician use in the USA in May 2013. The psychotic disorders sections did not undergo major changes from the DSM-IV. However, some changes have been made to reflect current nosological literature on psychosis and aim to bring greater coherence and clarification to the criteria for various disorders. The important changes are:

  • Elimination of the classic subtypes of schizophrenia.
  • Elimination of special treatment of Schneiderian first-rank symptoms (FRS).
  • More precise delineation of schizoaffective disorder from schizophrenia and psychotic mood disorders.
  • More prominent status for catatonia.
  • Schizotypal disorder is included in the psychosis section.
  • New category of "attenuated psychosis syndrome" as a condition for further study.
  • Specify eight psychopathological constructs with severity dimensions.

Results and Conclusions: We will discuss these changes and their impact on clinical practice and also implications for Indian psychiatry.

National Scale Up of Opioid Substitution Therapy for Injecting Drug Users in India: The Journey So Far and the Road Ahead

Ravindra Rao, Alok Agrawal, Atul Ambekar

Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India

India has a concentrated but growing human immunodeficiency virus (HIV)-epidemic among injecting drug users (IDUs) with 7% IDUs being HIV positive. The National AIDS Control Programme has adopted the strategy of targeted interventions (TIs) for preventing HIV. These TIs provide various harm reduction services such as peer-based education, needle syringe exchange, condom promotion, abscess management, referral linkage, and opioid substitution therapy (OST). In order to achieve adequate control of HIV, at least 20% of the estimated 180,000 IDUs in the country must be covered with OST services.

Till 2010, about 51 OST centers, (nongovernmental organization (NGO)-based) were providing OST services to about 4,800 IDUs, nationally. Since 2011, a scale-up program of OST services is underway. Under the new scheme, government hospitals provide the clinical services; while linked NGOs provide the outreach and field-based services. An elaborate process of selection and preparation of implementing institutions exists. So far, the scale-up has resulted in about 125 OST centers nationally, providing OST to about 12,500 IDUs, though the ambitious target of more than 300 new centers is still far away.

Most challenging aspects of this huge national level scale-up are ensuring coordination between government hospitals and NGOs, building capacities of human resources, and ensuring the minimum quality of services. Owing to dearth of psychiatrists, general physicians are being trained to provide services under the supervision of psychiatrists, through systematically designed training systems and resource materials. A large network of academic institutions provides trainings. Periodic visits by psychiatrists ensure quality and provide hands-on experience. Members of the psychiatric academic fraternity have played an important role in the entire process bringing credibility, ensuring quality, and at the same time enhancing the opportunities for training of postgraduate (PG) students in addiction psychiatry.

India still has a long way to go in terms of achieving adequate coverage. Sustaining the momentum along with ensuring quality is a major challenge in this scale-up process.

Presenters and Topics:

  1. Dr. Ravindra Rao*: "Preventing HIV among Injecting Drug Users: The How's and Why's under the National AIDS Control Programme"
  2. Dr. Alok Agrawal**: "From 51 OST centres to 125 (and counting): How the scale-up of OST services is being achieved"
  3. Dr. Atul Ambekar***: "Addressing the challenges in scale-up: Building Capacities and Ensuring Quality".

Dementia: Is the time for a uniform diagnostic approach here?

Arunava Datta, Shyamanta Das, Uddip Talukdar, Atmesh Kumar, Mythili Hazarika

: To determine the relevance of modern investigative approach as a mode of diagnosis in patients with dementia.

Outline: Not all old patients who forget are suffering from dementia. Using the diagnostic criteria such as International Classification of Diseases, 10 th revision (ICD-10), Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), National Institute of Neurological Disorders and Stroke and Association Internationale pour la Recherché et l'Enseignement en Neurosciences (NINDS-AIREN), etc., do help in diagnosing dementia, but only when the symptoms are prominent enough for the patients to be significantly debilitated. This symposium aims at evaluating the various new approaches that have come into action in an attempt to diagnose dementia. Future diagnostic guidelines will definitely take into account the newer investigative approach to dementia including the magnetic resonance imaging (MRI)-based volumetric analysis of specific brain regions. Recent research has shown that hippocampal atrophy is a sensitive predictor of developing dementia and mild cognitive impairment. Research with special emphasis on the temporal lobe and the hippocampus has found that that there is significant atrophy in these regions of the human brain in patients with dementia. The symposium is aimed at evaluating the relevance of modern investigative methods in patients with dementia presently and will attempt to comprehensively compare the newer methods with the existing validated tests currently used to diagnose cognitive impairment and the progression of dementia.

Homosexuality: Indian perspective

Bhavesh M. Lakdawala, Rajat M. Oswal, Mohit Sholapurkar

Department of Psychiatry, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India

Objectives : In different eras, cultures, and religions; homosexual behavior has been variously approved, tolerated, punished, or banned. There are lacunae in scientific studies of homosexuality, their psychiatric morbidity, and attitude towards them particularly in India. To address this issue and to show recent researches done by us in these areas, we have planned a symposium on this neglected and untouched subject.

Description: Homosexuality can refer to both attraction and sexual behavior between people of the same sex, or to a sexual orientation. Homosexuality can be referred to both erotic and romantic attachment directed towards the person of same sex and physical relations between the two. The modern view of homosexuality had its origin in the second half of 19 th century when a number of European sexologists, including several prominent psychiatrists began to study homosexuality from a scientific perspective. Little is known about sexual behavior and psychiatric morbidity in MSM (men who have sex with men) and attitudes of health professionals and general community towards homosexuals. The speakers will talk on following topics: (1) Homosexuality and attitudes towards them, (2) Exploring sexual behavior and psychiatric morbidity in MSM, and (3) Clinical issues in care of people with homosexuality.

Unmet needs in bipolar disorder

Debjani Bandyopadhyaya, Devashish Konar, O P Singh

Manasij, 17 D N Mitra Lane, Khosbagan, Bardhaman, West Bengal, India

Bipolar disorder is a complex, chronic condition associated with considerable morbidity and mortality, including a high rate of suicide. Currently available treatment options for bipolar disorder fail to adequately address many of the important needs of bipolar patients.

The spectrum of bipolar disorders includes the subtypes of bipolar I disorder, bipolar II disorder, cyclothymic disorder, and bipolar disorder not otherwise specified (NOS). Because depression is the most pervasive symptom of bipolar disorder, this condition is frequently misdiagnosed as unipolar major depressive disorder. As a result, patients often experience substantive delays in receiving the correct diagnosis and appropriate treatment. To help meet this important diagnostic challenge, various markers have been identified that have predictive value for a bipolar outcome, including early onset of depression, family history of bipolar disorder, atypical depressive symptoms, and the presence of psychosis.

Unmet needs in the management of bipolar disorder include an enhanced diagnostic process, more options for treating bipolar depressive episodes, and safer, more tolerable medications for long-term maintenance treatment.

Shaking the unshakable: Metacognitive therapy for delusions

Devvarta Kumar

Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India

Delusions have traditionally been considered impervious to counter arguments and thus not amenable to psychotherapy. However, a growing body of evidence has indicated that challenging the delusional beliefs may be effective in reducing their severity. Metacognitive training/therapy (MCT) for patients with psychosis is one such intervention that targets delusions using a backdoor approach by helping patients gain insight into the cognitive biases behind delusions followed by the attempts to plant the seeds of doubt and weaken delusional beliefs.

The purpose of the present symposia will be to elucidate the background of this therapy, details of the therapy process and its empirical status.

Where to from here for our mental hospitals?

Hamid Dabholkar, Alok Sarin, Vilas Bhailume, Shailendra Deuri, Sudipto Chatterjee, Harsh Mander, Nachiket Mor

Parivartan Institute, Sadar Bazar Satara, Satara, Maharashtra, India

In the ongoing discourse on provision of community-based care for people with mental disorders in India, the issue of introducing and sustaining changes in mental hospitals remain largely neglected. Despite a series of reforms, there is little indication of substantive changes in many of these institutions. Understanding why this is so and what can be done to accelerate changes in treatment systems and practices within these institutions is an important public mental health priority.

The symposium will bring together a range of speakers and perspectives to the table. We start by looking at the history of reforms in mental hospitals in India and the lessons it holds for the future; this is followed by an experiential account and update of the challenges and solutions to implementing changes from two mental hospitals. In the next section, we discuss the outcomes of a recent public private initiative (the INCENSE program) in these two mental hospitals and the potential relevance of the program approach in planning the next stage of reforms. Finally, we have two eminent persons from outside of the mental health sector describe their understanding of the problems and potential solutions for sustained and visible changes in these critical but undervalued institutions.

Cinema and Psychiatry

Indla Ramasubba Reddy

Vijayawada Institute of Mental Health and Neuro Sciences, Vijayawada, Andhra Pradesh, India

Cinemas are the world's most popular and powerful art form. Some argue that portrayal in the movies reflects the happenings in the society and it is not true that movies have an impact on the mental health of the people. Many movie makers argue that cinema is only for entertainment and not to be taken seriously. However, strong scientific evidence exists that there is a definite influence of movies in shaping the beliefs, attitudes, and behavior of the people.

Movies act as a 'double edge sword', but the sword is sharp in portraying the negative image of mental illness and mental health professionals, which have fuelled further the misconceptions about mental illness. Violence committed by the mentally ill characters is the norm in movie portrayal, whereas the reverse is true. The distorted portrayal about the mentally ill instills fears among the public and increases the stigma. The fast music, pub culture, dating, premarital and liberal sex, crime, and violence among youth can be largely attributed to the western movie and media impact on the Indian conservative youth, which is definitely an indication of 'cultural attack' by the west.

In the Indian movies, psychiatrists are depicted as comedians, aggressive, exploitive, and as villains; which would do a lot of harm to people who are already hesitant to seek psychiatric treatment. Electroconvulsive therapy is shown as frightful, painful, and as a punishment to the rivals and also to the patients. The impact of movies is much more on the emotionally disturbed individuals than on the average or normal people. The impact of movies and their popularity has made many cine stars as MPs, MLAs, Ministers, and even as Chief Ministers. The strong cinema charishma has a definite impact in changing the 'political psyche' of the masses.

The impact of horror and violent films and sex crimes due to erotic scenes in movies and glorification of suicides in cinemas and other media will also be discussed. A lot of research is done on the impact of cinemas on brain functioning.

Cinema remains one of the cheapest and most easily accessible forms of entertainment. Movies appeal to an individual's unconscious desires and means of self-identification and wish fulfillment. To many, films offer a release from the day's frustrations and compensate for the deficiencies of real life. In the course of watching a film, the spectator for a while not only loses higher self-consciousness, but also identifies with a character-down trodden or middle class. Psychological effects of films include influencing fashion, dress, jewelry, hair styles, personal mannerisms, and speech; but the immediate response may be fear, jealousy, love, and hero worship. Films no doubt influence the conduct of individuals and the influence depends upon a number of factors including social experience and personal idiosyncrasies. A common platform for movie makers and psychiatrists should be periodically organized at different places for mutual exchange of ideas.

Biological correlates of psychiatric disorders: Importance and validity

Jyoti Prakash, Kshirod K. Mishra, AK Gupta, R Shashikumar

Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India

Objective : We want to appreciate the role of biological markers in diagnosis and management of mental illness.

Brief description: It is known for years that mental illness has a biopsychosocial perspective. Though over the years we have seen lot of progress in the field of psychometric testing and social understanding; not much of progress is visible in biological front at a clinical paradigm. We would like to discuss role of all biological correlates and its utility as a marker or indicator or predictor in various mental illness. While we discuss through the topic we would be able to understand the drawbacks in the existing tool, methods to improve the role of existing tool, and direction for future tools.

Farmers' suicide in India: A critical appraisal

Kshirod Kumar Mishra, Srikanth M. Reddy, (Col) Jyoti Prakash, Vivek Kirpekar

Department of Psychiatry, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India

Objective : We want to provide an update and appraise critically the current status of farmer's suicide in India and current efforts to prevent it.

Brief Description: Farmer's suicide is one the most burning issues in the nation and the recent wet-drought in many areas of the country have added to the problems. Despite rising awareness and multitude of efforts by the government and nongovernmental organizations, farmer's suicide is continuing unabated and this fact cannot escape a psychiatrist's purview. It's high time that necessary steps be taken at every point to prevent this malady. Otherwise another group, known as "farmers", will soon get extinct from the globe. We intend to provide an update on the trends of farmer's suicide and psychiatrist's perspective of the whole issue of prevention of farmer's suicide through this symposium.

Whether second generation antipsychotics change the scenario of tardive dyskinesia?

Lokesh Shekhawat, Rashmin Achalia, Om Prakash

Department of Psychiatry, All India Institute of Medical Sciences, Patna, Bihar, India

Extrapyramidal syndromes associated with antipsychotic treatment are very common and can cause the patient considerable distress. The tardive complications of neuroleptic treatment were not mentioned in the literature until the late 1950s. In 1960, the Danish authors Uhrbrand and Faurbye described 29 patients who exhibited bucco-linguo-masticatory movement after neuroleptic treatment. Faurbye proposed the term "tardive dyskinesia" (TD) for this condition. The pathophysiology of TD remains poorly understood, and treatment of this condition is often challenging. Several studies have suggested that as compared to first generation antipsychotics (FGAs), second generation antipsychotics (SGAs) have a reduced liability to cause extrapyramidal syndromes and TD. Previous studies have shown a relationship of TD with age, gender, duration of treatment, type of antipsychotic, cumulative antipsychotic dose, intermittent neuroleptic treatment, acute extrapyramidal symptoms, negative symptoms, diabetes mellitus, and anticholinergic medication, but only a few risk factors (non-white ethnic group, early extrapyramidal symptoms, and older age) have been replicated in patients with schizophrenia. The symposium will discuss an update on TD with FGAs. It also emphasizes the change of occurrence of TD after advent of SGAs.

Mental health morbidity in disasters: Update on Indian standpoint

Lokesh Singh Shekhawat, Rohit Verma, Kishore Dudani, Shrikant Sharma

All India Institute of Medical Sciences, Patna, Bihar, India

India is one of the most disaster prone countries of the world and has had some of the world's most severe disasters like droughts, famines, cyclones, earthquakes, chemical disasters, mid-air head-on air collisions, rail accidents, and road accidents. Even with probably having the world's oldest disaster relief code, until recently, only relief driven disaster management system was operable in India. In recent times, there have been escalating proactive efforts with emphasis on disaster prevention, mitigation, and preparedness. Emotional problems are common in disaster aftermath and have been elaborated in distinct phases to justify post-disaster mental wellbeing. However, the challenging experience of a disaster can cause mental health problems in the short- and long-terms, reinforcing its strong psychosocial and psychological effects.

The current symposia focuses on the recent patterns and prevalence of psychiatric morbidities associated with disasters in India. The topic will be discussed on aspects of vulnerability and impact of disasters, country disaster profile from mental health perspective, scotoma towards disaster psychiatry, and recent experiences from Libya and Uttrakhand.

Family therapy for Schizophrenics

Madhao G. Raje
"SHRISHTI" N8 / 180 - 118, Rajendra Vihar, Sunderpur, Varanasi U.P.

Introduction :

  1. Negative symptoms of schizophrenia are difficult to treat (Harvard mental health letter July 2006). Dysfunctional family perpetuates them, while disease makes family vulnerable to dysfunction. This vicious cycle can be broken by family therapy. Family therapy brings positive emotions in. In support, Fredickson says positive emotions facilitate creation of important skills and resources.
  2. Gurman et al., (1986) state that family therapy may be defined as any psychotherapeutic endeavor that explicitly focuses on altering the interaction between family members and seek to improve functioning of family as a unit (Journal of child Psychology & Psychiatry 43:5 -2002, 573-586).
  3. In 1990, Konstantareas, stressed psychoeducative family therapy for schizophrenics.

Aim: To facilitate long remission/recovery.


  1. Bridge 'polarity' between patient and family members.
  2. Initiate and encourage recovery through family interaction.
  3. Make schizophrenia 'a chronic but NOT a disabling' mental illness.

Materials and Methods: Appraise about following schools with case discussion.

  1. Milan's family therapy: Changes pattern of meaning and relationship within family members.
  2. Affective experiential family therapy: Virginia Satir focuses on 'intrapsychic and interpersonal pathology'.

    Help increase emotional bonds to raise self-esteem of family member.
  3. Structural family therapy: Jay Haley emphasizes to maintain intact personal boundaries and clear identity.
  4. Strategic family therapy: Milton Erickson focuses on cross-generation coalition and faulty interaction. It deals with 'resistance' strategically.
  5. Bowenian family therapy: Murray Bowen focuses on individuality and togetherness, triangulation of symptomatic member, emotional view of family/family projection of triangulated member.


  1. Resilience of patient/family members increases.
  2. Patient and family members make united efforts to combat/gain victory over symptoms.
  3. Remission invariably takes place.

Conclusion: Family therapy when added to pharmacotherapy, convert patient and family members from symptomatic to asymptomatic entity.

Malingering in psychiatric practice: Discovering the fact

Maj Bikram Datta, Surg Cmde VSSR Ryali, Col TR John, Wg Cdr AS Saxena

Objective : Malingering is a known baffling confounder in appropriate management of psychiatric cases more so in military and forensic practice. It is thus necessary to understand malingering to impart holistic psychiatric treatment in a military context.

Brief Description: Though malingering is known since ages; with the advent of science the nature, pattern, extent, and motive in malingering has changed significantly over the years. Malingering is a known baffling confounder in appropriate management of psychiatric cases in forensic and military context. Necessary understanding of malingering is paramount for imparting holistic psychiatric treatment.

Teacher's perspective on postgraduate training in psychiatry: Reflections, current trends, upcoming challenges

Mohan Isaac, M V Ashok, M Kishor

National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India

Objectives : To appraise and enrich the participants about the experiences of teachers in the training of postgraduate students in psychiatry. Reflecting upon more than 3 decades of experience in training of postgraduates, focusing on the strengths, the pitfalls and those that needs to be carried forward, also the current day practices and the upcoming challenges, one needs to be prepared as an teacher will be discussed.

Description: For nearly 4 decades in India. Postgraduate training in psychiatry was primarily in government institutions. Today nearly 120 nongovernmental institutions across India provide postgraduate training in psychiatry. Teaching psychiatry has steadily evolved over the years. The valuable experiences gained from the journey travelled so far and the current trend, upcoming challenges in teaching psychiatry have rarely been discussed, will be presented and reflected upon.


Prof Mohan Isaac (Coordinator of symposia): Reflections

Prof MV Ashok: Current Trends

Dr M Kishor: Upcoming challenges

Harmful / Hazardous pattern of alcohol use among opioid dependent men, stabilized on agonist maintenance treatment with buprenorphine

Mohit Varshney* Prof. Rakesh Lal. Atul Ambekar, Deepak Yadav

Department of Psychiatry, 4 th floor teaching block, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029

Introduction : Many opioid dependent men stabilized on agonist maintenance treatment use alcohol often in an harmful / hazardous manner. We studied the rates of harmful / hazardous drinking among men receiving buprenorphine maintenance treatment at our centre.

Materials and Method: A two stage screening methodology was employed. In the first stage, records of all the patients receiving buprenorphine or buprenorphine-naloxone were screened. After applying inclusion criteria (males; age: 18-50 years; on buprenorphine maintenance for at least 3 months; compliant with the treatment), patients were interviewed with WHO ASSIST. Those who were already diagnosed with other substance use disorders or psychiatric co-morbidity were excluded.

Results: Out of 377 male patients who were maintained on buprenorphine, 239 were excluded on record screening for various reasons (co-morbidity - 98; out of age range - 45; non-compliance to buprenorphine - 28; on treatment for less than three months - 43; records not traceable - 22). On applying WHO ASSIST to the remaining 138 patients, 36 had ASSIST scores in the harmful-hazardous range (i.e. 11-26). Comparing these "ASSIST Positive" patients with those "non-ASSIST Positive", we found that more ASSIST positive patients tended to be non-employed (51% versus 72%), but were otherwise similar on most socio-demographic parameters. However more ASSIST positive patients reported use of other drugs as compared to non-ASSIST positive: Cannabis: 22% versus 11%; non-prescribed benzodiazepines: 17% versus 12% and Injecting Drug Use: 33% versus 19%. More than half ASSIST positive patients reported drinking '1-2 times per week', about 31% drank '2-4 times per month', while 8% and 6% drank 'almost daily' or 'alternate day' respectively. On other treatment-related variables (duration, dose and compliance of buprenorphine treatment) both the groups were similar.

Conclusion: A sizable proportion of patients maintained on buprenorphine for treatment of opioid dependence, consume alcohol in a harmful / hazardous pattern and hence require specific intervention strategies.

Role of investigations in diagnosis of dementia with special focus on region-specific MRI-based volumetric analysis

Mythili Hazarika, Shyamanta Das, Uddip Talukdar, Atmesh Kumar, Arunava Datta

Department of Psychiatry, Gauhati Medical College and Hospital, Guwahati, Assam, India

Objectives : To determine the relevance of modern investigative approach as a mode of diagnosis in patients with dementia.

Outline: Not all old patients who forget are suffering from dementia. Using the diagnostic criteria such as International Classification of Diseases, 10 th revision (ICD-10), Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), National Institute of Neurological Disorders and Stroke and Association Internationale pour la Recherché et l'Enseignement en Neurosciences (NINDS-AIREN), etc., do help in diagnosing dementia, but only when the symptoms are prominent enough for the patients to be significantly debilitated. This symposium aims at evaluating the various new approaches that have come into action in an attempt to diagnose dementia. Future diagnostic guidelines will definitely take into account the newer investigative approach to dementia including the magnetic resonance imaging (MRI)-based volumetric analysis of specific brain regions. Recent research has shown that hippocampal atrophy is a sensitive predictor of developing dementia and mild cognitive impairment. Research with special emphasis on the temporal lobe and the hippocampus has found that that there is significant atrophy in these regions of the human brain in patients with dementia. The symposium is aimed at evaluating the relevance of modern investigative methods in patients with dementia presently and will attempt to comprehensively compare the newer methods with the existing validated tests currently used to diagnose cognitive impairment and the progression of dementia.

Relapse prevention in private practice

N M Patil, G Swaminath, Abhay Matkar

Department of Psychiatry, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India

Chronicity is more of a rule than an exception in most major mental illnesses. Treatment options put a lot of burden both on the patient and caregivers. While strict treatment guidelines are unavailable as for duration of treatment each regimen has to be tailor made for each patient-in terms of treatment options and duration.

In private practice it is generally seen that three disorders need special mention in terms of relapses-depression, psychosis, and substance abuse. It is a triangular challenge between patient, caregivers, and therapists.

Economic factors being the predominant reason for treatment noncompliance and hence relapse, private practice throws up its challenges in more than one way-social, cultural, and biological to name a few.

Individual accountability is of utmost importance in clinic-based practice and hence relapse prevention strategies are of prime concern to the therapist. Both psychological and pharmacological methods towards patients and psychological measures aimed towards care givers have been the cornerstone of relapse prevention.

Each speaker with over 2 decades of experience wishes to share their experience regarding various causes of relapse and strategies for relapse prevention.

Stigma: A major barrier for suicide prevention

Naresh Nebhinani, Bhavesh M. Lakdawala, Deepak Ghormode, Darpan Kaur

Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India


  1. Introduction- Dr Naresh Nebhinani
  2. Stigma towards suicide: Patient perspective- Dr Naresh Nebhinani
  3. Stigma towards suicide: Community perspective- Dr Bhavesh M Lakdawala
  4. Stigma towards suicide: Health professional's perspective- Dr Deepak Ghormode
  5. The way forward- Dr Darpan Kaur

Suicide is a major public health problem in high-income countries and is an emerging problem in low- and middle-income countries. Suicide is one of the leading causes of death in the world, especially among young people. Nearly one million people worldwide die by suicide each year. Yet a significant number of those with mental illnesses who die by suicide do not contact health or social services near the time of their death.

In many instances there are insufficient services available to assist those in need at times of crisis. This lack of access to appropriate care is of the many factors that magnify the stigma associated with mental illness and with suicidal ideation and behavior. Major causes of stigma are simple lack of knowledge (ignorance) and negative attitudes about individuals with mental illnesses and/or suicidal ideation/attempts (prejudice).

Studies suggest that changing cultural attitudes about mental illness and suicidal behavior requires a scientific awareness of the many forces that influence community norms and the concerted effort of a wide range of community stakeholders in a consistent format.

Geriatric Psychiatry

Research updates on late-life depression in India

Om Prakash, K. S. Shaji, Srikala Bharath, R. Suresh Kumar, Venu Gopal Jhanwar

Department of Psychiatry, Institute of Human Behaviour and Allied Sciences, Dilshad Garden, New Delhi, India


  1. Late-life depression in Indian elderly: An overview- Om Prakash
  2. Epidemiological research on late-life depression- KS Shaji
  3. Cognitive deficits in late-onset depression- Srikala Bharath
  4. Genetic research on late-life depression- R Sureshkumar
  5. Research on geriatric depression: Need of the hour- Venu Gopal Jhanwar

Depression is an important but inadequately diagnosed mood disorder more so in the elderly. Epidemiological studies found that depressive symptoms and depressive disorder are common amongst Indian elderly, including medical outpatients. Research in geriatric depression has always remained challenging particularly in methods used to characterize depression in this population. Geriatric Depression Scale 15 (GDS-15) with a cutoff of ≥5 is a good screening instrument to identify cases of depression in Indian studies. Cognitive deficits are well evident in cases of late-onset depression. Research studies from India tried to understand phenomenology, diagnosis, psychiatric and medical comorbidities, and genetics. ApoE4 allele frequency found to be increased in Indian patients with late onset depression. This symposium updates recent progress in the understanding of geriatric depression more particularly from Indian perspective.

Child abuse within the context of India: The epidemiology of child abuse in India

Pallab K Maulik, Rajesh Sagar

The George Institute for Global Health, Hyderabad, Andhra Pradesh, India

Aim : To outline the epidemiology of child abuse in India.

Materials and Methods: A comprehensive review of child abuse in India is being undertaken. Published literature on child abuse in India would be identified after searching a number of electronic databases.

The quality of the studies would be assessed according to defined criteria.

Result: Quantitative and qualitative information from the final set of studies will be enumerated.

Conclusion: This will provide important information about the epidemiology of child abuse in India and gaps in knowledge. This will help in informing policy makers.

Management approaches in alcohol dependence syndrome: Salience and variance

PS Bhat, Jyoti Prakash, VS Chauhan, Kalpana Srivastava

Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India

Objective : We want to find out multiple modalities available for effective treatment of alcohol dependence syndrome and how each of them or the combination will lead to more better or holistic goal of abstinence.

Brief description: Alcohol dependence syndrome is a chronic, relapsing illness with significant psychical comorbidity, and familial dysfunction which is not generally seen in any other mental illness. The illness has often shown less than satisfying response despite our evergrowing medical armamentarium. A review and discussion of all available modalities and optimal use of them for a larger goal is a felt need.

Child Abuse within the context of India: Current policies and future directions

Rajesh Sagar, Pallab K Maulik

Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India

Aim : To outline the current policies and identify the gaps that needs to be filled in the area of policy around child abuse in India.

Materials and Methods: A comprehensive review of current policies around child abuse in India is being undertaken. The different policies would be discussed against the burden of child abuse in India to find out if the current policies are being effective.

Result: The policies will be discussed in light of the current scenario in India and the gaps will be identified.

Conclusion: This will provide important information about the existing policies and provide directions about future needs. It is hoped that the information will help policy makers to better understand the current situation and identify the gaps in extant policies that may need to be filled.

ASSIST linked brief interventions in identification and management of substance use disorders

Rakesh Lal, Yatan Pal Singh Balhara, Deepak Yadav

Department of Psychiatry, National Drug Dependence Treatment Centre, All India institute of Medical Sciences, New Delhi, India

Outline of proposed symposium

Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) is simple to administer module aimed to help medical doctors, nurses, and other health professionals to identify patients with substance use problems. Additionally, the scores on ASSIST are linked with interventions that can be offered to these individuals. All India Institute of Medical Sciences (AIIMS), New Delhi has been involved in various stages of development of this tool.

Introduction to screening tools for substance use disorders (SUDs)

The first presentation will focus on introduction to the screening tools for substance use disorders (SUDs). It will highlight the importance of having such tools and their role in identifying those having problematic use of psychoactive substance. The available evidence supporting use of such tools will be presented. Also a brief overview shall be given for routinely used tools for this purpose.

Introduction to ASSIST and AIIMS contribution

The second presentation will focus on development of ASSIST. It will also present an overview of the research evidence available for ASSIST form across the globe. Also it will present the role of AIIMS at various stages of development of ASSIST through its inception to training courses focused on its use.

Getting familiar with ASSIST

This presentation will discuss ASSIST in detail. The instrument will be discussed at length with an aim to make the participants familiar with its use.

Introduction to brief intervention in context of ASSIST

This presentation will give an overview of brief intervention, specifically in context of ASSIST. It will discuss the principles of brief interventions and its utility in management of SUDs. Also, the presentation will focus on linking the ASSIST scores with appropriate interventions.

Mood Disorders and Anxiety Disorders DSM-V: Revisions and Rationale: IAPA Symposium, USA

Ranga Ram, Brielle Hanafin

Aim : Diagnostic and Statistical Manual of Mental Disorders (DSM)-V has attempted to revise extensively the chapters on the Diagnosis of Mood and Anxiety Disorders. Diagnoses are to be concordant with International Classification of Diseases, 10 th revision (ICD-10) and are also expected to more culture sensitive compared to the old DSM 9 diagnoses. DSM 5 was adopted in May 2013. The aim of the presentation is to give an overview of the many changes in the diagnosis of mood and anxiety disorders.

Materials and Methods: This presentation covers information from the DSM 5 highlighting the changes from DSM-IV-TR. The source material for this presentation is the Work Group publications for the various disorders and information disseminated by the American Psychological Association (APA) to mental health professionals via training programs.

Results: In the Bipolar Disorders the changes in bipolar I and II disorders are discussed. The presentation will clarify the nosology of anxiety disorders in the context of bipolar disorders and major depression. The controversies surrounding the bereavement exclusion in DSM 5 are discussed. In the Depressive Disorders, a new diagnosis of disruptive mood dysregulation disorder has been introduced and premenstrual dysphoric disorder has been elevated to a diagnosis in its own right within the body of the DSM 5 text. Changes to the diagnosis of dysthymic disorder are also discussed. Various changes to the diagnosis of anxiety disorders, the classification of obsessive compulsive disorders and trauma-related disorders will be touched upon.

Conclusions: The implications of these changes in the diagnosis of conditions that comprise the major focus of treatment efforts in the United States will be highlighted. The new DSM 5 manual and its use in conjunction with ICD-10 implementation in the US next year will be facilitated by this presentation, allowing for greater cross national understanding of the use of these nosological entities.

Scholastic backwardness: How informed we are?

RC Das, Jyoti Prakash, Kalpana Srivastava, PS Bhat

Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India

Objective : We want to understand the nature and extent of scholastic backwardness, clarify the ambiguity about its very definition and envisage a road map for early identification and appropriate management.

Brief description:

Scholastic backwardness is an all-inclusive term which includes specific learning disability and any other disability which may lead to poor academic performance. It is of significant concern as it not only causes distress to individual but also teachers, parent, and society at large. It is imperative to understand, screen, identify, and manage children with scholastic backwardness for larger interest of the society.

Godmen along the pathways to care

S. Mohan Raj

Consultant Psychiatrist and Director, Tharu Clinic, Chennai, Tamil Nadu, India

Objective : To explore the processes that take place when persons with distress seek help from godmen.

Brief description of the symposium:

People in distress seek help from many traditional sources, including godmen. The reasons for such help-seeking behavior are many. When such persons seek help from godmen, different processes take place.

These processes could alleviate the person's distress or there could be new adverse consequences for the person. It would be educative to examine these processes, through the narratives of some of the patients who had sought help from godmen earlier.

In view of the sensitive nature of the topic and taking care not to offend any believer, no names of godmen will be mentioned.

This symposium is a tribute to Dr Narendra Dabholkar, who was killed in Pune recently.

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, Bangalore, Karnataka, India

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 healthcare. 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 theater and its use in a semirural 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.

Overview of mental illness in nepal: Prejudices and help-seeking behavior

Saroj Prasad Ojha

Department of Mental Health, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal

Nepal is a land locked southeast 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 dollar 240 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 center, 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.

Recovery in Schizophrenia

Vivek Kirpekar, Sushil Gawande, Abhijeet Faye, Rahul Tadke, Sudhir Bhave

Department of Psychiatry, N.K.P. Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, Maharashtra, India

Objective : To study the recovery in schizophrenia and how we can help the patients achieve good recovery.

Brief description: Though there are many definitions of recovery, the recovery in patients with schizophrenia is generally considered to involve clinical recovery, illness management, personal recovery, occupational, and other important areas and ability to live a meaningful life. The expectation and approach has now moved beyond remission from the symptoms and focuses on various other domains of life as a human being. Thus, traditional picture of schizophrenia being a progressive and disabling disorder has been challenged and reconsidered periodically. Because of advances in neurosciences and availability of effective therapies, the focus of recovery has been shifting and more importance is being given to the functional outcome rather than just remission of symptoms.

In this symposium the speakers will discuss about the concept of recovery in schizophrenia. The importance of various components of recovery will be explained. The approaches and various modes of assessment of recovery will be discussed in addition to rehabilitation. There will be discussion on the evidence-based treatments and their outcome as related to recovery in schizophrenia. The speakers will also touch upon the changing role of psychiatrists in relation to recovery. Additional issues like peer-to-peer and mutual support programs and recovery action plans will also be discussed.

At the end of the symposium the participant delegates will be able to get idea about various clinically relevant aspects of recovery, role of evidence-based treatments, and future aspects related to schizophrenia.

Reading disorder (Dyslexia): Current status

Rajesh Sagar, Raman Deep Pattanayak, Pawan Sharma, Nandha Kumara Pujam, Anamika Sahu

All India Institute of Medical Sciences, New Delhi, India

Despite the high prevalence (8-17%) among school-going children, the nature and origin of dyslexia remains unclear. However, in recent years the scientific understanding about the disorder has seen a rapid progress especially in neurological, genetic, and neuropsychological domains. There are findings from neurological studies indicative of involvement of different brain regions in reading disorder. The genetic basis is evidenced by the familial clustering of cases, concordance in the twin studies, karyotyping, and linkage studies. In terms of neuropsychological understanding, there is association of dyslexia with impairment in specific areas of memory, executive functions, and perceptuomotor tasks; identification of which would aid in planning of individualized intervention plans. The goal of this symposium is to provide an overview, current understanding, and future directions in this field.

Substance Use disorder in DSM-V: Revisions and Rationale: IAPA Symposium, USA

Ashwin A Patkar, Shilpas S Rele, Huwrah Mehta, Haresh Tharwani

Department of Psychiatry and Behavioral Sciences, Duke University Medical Centre, Durham, North Carolina, USA

Aims : Diagnostic and Statistical Manual of Mental Disorders (DSM) is the gold standard for the diagnosis and classification of psychiatric disorders in the United States and elsewhere it is widely used for clinical practice, research policy, and reimbursement purposes. Taking into account the advances in knowledge since the publication of DSM-IV-TR in 1994, the new version termed DSM-V was published in May 2013. The aim of this presentation is to review the major revisions to the substances use disorders section, discuss the rationale behind the revisions and inform how the new criteria impact clinical practice and research.

Materials and Methods: This presentation extracted relevant information from the published version of the DSM-V, the recommendations of the DSM-V substances-related disorders Work Group and the dissemination materials distributed by the American Psychological Association (APA) to approved trainers to educate clinicians in the appropriate use of DSM-V.

Results: The major revisions to the existing DSM-IV-TR substance use disorders section were:

DSM-V, abuse and dependence are no longer two separate diagnoses. The criteria are combined into a single substance use disorder with criteria count serving as severity indicator.

Legal problems are removed as criteria and craving is added as an additional criterion.

Inclusion of new category of behavioral addictions with gambling disorder as a representative disorder.

Elimination of poly substance dependence as a diagnosis and physiological dependence as a specifier.

Conclusion: The amount of scientific data available to support of these revisions has been variable and new studies will be needed to address specific issues. Nevertheless, it is hoped that the changes will lead to easier implementation of the DSM-V in clinical practice and research.

Violence attitude in juvenile delinquent

Jai Singh Yadav, Samiksha Kaur, Anju Dhawan, Nana J Kaw, Prabhoo Dayal

Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India

'Juvenile delinquency' refers to a large variety of disapproved behavior of children. Four longitudinal studies in the United States have shown that by age 17 years, 30-40% of boys and 16-32% of girls have committed a serious violent offense, defined as an aggravated assault, robbery, gang fight, or rape (US Department of Health and Human Services 2001). Only a small fraction of these offenses resulted in arrest, despite the dramatic drop in youth homicide rates since 1993, homicide remains the second leading cause of death in 15-19-year-olds.

The incidence of juvenile delinquency varies widely in different states of India. Four states-Maharashtra (24.1%), Madhya Pradesh (25.2%), Rajasthan (7.3%), and Gujarat (11.1%) account for about 68% of the total juvenile delinquencies in the country under Indian Penal Code (IPC). Many theorists believe hereditary conditions, psychological imbalances, family violence, social or environmental conditions, and parental drug and alcohol abuse are common stressors that influence violent behaviors (Chesney-Lind and Sheldon, 1992). These stressors may have biological, psychological, sociological, educational, and/or familial roots. These behaviors can be managed by making policy, provide safe environment, juvenile rehabilitation center, and reformative trainings.

Metabolic syndrome in psychiatric disorders

Sandeep Grover, Debasish Basu, Ajit Avasthi

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

It is increasingly realized that cardiovascular risk factors are responsible for high morbidity and premature mortality in patients with major psychiatric disorder. Metabolic syndrome is recognized as a constellation of risk factors which increases the cardiovascular risk. In recent times, metabolic syndrome has received considerable research attention. Many studies from India have evaluated the metabolic syndrome in patients with severe mental disorder and in those with substance abuse disorders. Various associations have provided guidelines for monitoring of metabolic syndrome in patients with severe mental disorders.

This symposium will cover the importance of studying metabolic syndrome in patients with mental disorders. First speaker will cover the conceptual issues and other alternative concepts which are useful in understanding the cardiovascular risk. Additionally, the speaker will also review the data on metabolic syndrome in patients with major mental disorders arising from India and compare the same with studies from the West. Second speaker will discuss the review of the data on metabolic syndrome in patients with substance abuse disorders, especially from India and discuss the implications in the light of studies from other parts of the world. The third speaker will discuss the monitoring and management implications of presence of/development of metabolic syndrome on selection of psychotropics and management of metabolic syndrome.

Psychogeriatrics for the General Psychiatrists

S. C. Tiwari, Anand Ramakrishnan, Pradeep Arya

Department of Geriatric Mental Health, King George's Medical University, Lucknow, Uttar Pradesh, India

Background : Psychiatry of old age is not the same as psychiatry in general. It is a superspecialty medical subject rapidly growing across the globe. Knowledge and training in the subject in present scenario is not only important but essential as well. It is recommended for all psychiatrists regardless of their special interest and expertise as we all are in the face of an aging population in India and the world.

Objectives: To differentiate and establish the highly specialized nature of old age psychiatry and provide guidelines and help to develop capacity building in the area of psychogeriatrics for general psychiatrists.

Materials and Methods: Didactic lectures, case vignettes, video interviews, etc., will be used. This session will be started by Prof. Sarvada Chandra Tiwari, Head, Department of Geriatric Mental Health, King George's Medical University, Lucknow emphatically asserting the role of the superspecialty, emphasizing how it differs even in history and mental state examination to research and teaching followed by talks by Dr Pradeep Arya, MRCPsych and Dr Anand Ramakrishnan, MRCPsych on diagnosing and treatment of functional and organic mental disorders in the elderly. The session will incorporate real life case vignettes, video interviews of patients with an odd multiple choice questionnaire (MCQ) thrown in.

Results and Conclusions: The general psychiatrists will be sensitized in the area of practice of psychogeriatrics and the feedback will help in developing a teaching module on the lines of MRCPsych teaching, but specially tailored for Indian settings.

Love and psychiatry

Vishal Indla, Manjiri Deshpande

Vijayawada Institute of Mental Health and Neuro Sciences Hospital, Vijayawada, Andhra Pradesh, India

This symposium aims to discuss recent advances in neurobiological and psychosocial aspects of "love". The symposium will also focus on the psychiatric aspects of love.

Description: According to Oxford dictionary, love is a strong feeling of attachment, it can refer to a variety of different feelings, states, and attitudes, it can also be a virtue representing human kindness, compassion, and affection. Love is a universal emotion all of us experience throughout our lives in the various forms. However, it is fascinating to know the neurobiology governing this complex behavior. Love, previously a domain of poets, writers, and artists is now a hot topic for psychiatrists due to its association with various positive and negative behaviors. There have been a lot of advances in the recent times in the scientific understanding of love.

DSM-5 Changes in child psychiatric disorders

Uma Rao

Meharry Medical College and Vanderbilt University, Nashville, Tennessee, USA

Aim : Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 has instituted changes in several psychiatric disorders, some minor but substantial changes in other disorders, and in the process eliminated some conditions and created others. The aim of this presentation is to review the major revisions to child psychiatric disorders with particular emphasis on autism spectrum disorders (ASD) and disruptive mood dysregulation disorder (DMDD) and how the new criteria impact clinical practice and research.

Materials and Methods: Relevant information was extracted from recommendations of the DSM-5 Child and Adolescent Disorders Work Group and Work Group on Neurodevelopmental Disorders and the published version of the DSM-5.

Results: One of the major changes in the DSM-5 involved grouping all of the subcategories of autism into a single category, ASD. A recent study showed that 46.7% of toddlers diagnosed with ASD under the DSM-IV-TR (the previous version of the diagnostic manual) will no longer meet the criteria under DSM-5. The DSM-5 also eliminated the controversial diagnosis of pediatric bipolar disorder and created a brand new category, DMDD, described as intense outbursts and irritability beyond normal temper tantrums in young children.

Conclusions: Some of these changes may reduce false positives (e.g., more stringent criteria for ASD), while the opposite may be true in other cases (e.g., DMDD). The strength of scientific data available to support these revisions has been variable and new studies will be needed to address specific issues because the changes are likely to have significant impact on clinical practice and research.

Neurocognitive disorders and trauma and stress-related disorder: DSM 5 changes

Vani Rao

: The aim of this presentation is to review the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5 changes as it pertains to cognitive impairment and trauma and stress-related disorders.

Materials and Methods: The presentation will include succinct synthesis of material from the recent DSM 5 publication and review of literature on the topic from a variety of scientific publications and peer-reviewed journals.

Results: The major revisions under the domain of cognitive impairment include:

The term neurocognitive disorders has been adopted instead of the DSM-IV terminology of delirium, dementia, and amnestic and other cognitive disorders and the International Classification of Diseases, 10 th revision (ICD-10) heading of "Organic, including Symptomatic Mental Disorders".

Neurocognitive disorders will be subdivided into minor and major based on severity of functional and/or neurocognitive impairment.

Both minor and major neurocognitive disorders may be further subclassified according to etiology, for e.g., Alzheimer's disease, vascular neurocognitive disorder, frontotemporal degeneration, and Lewy body disease.

Delirium diagnostic criteria have been revised based on current available evidence.

Trauma and stress-related disorders is a separated chapter in DSM 5 and includes: Acute stress disorder, posttraumatic stress disorder (PSTD), and reactive attachment disorder. The DSM IV criteria of PTSD have been revised and a new diagnostic subtype has been created to include preschool children with PTSD symptoms.

Conclusion: These changes have clinical and research implications as it provides information on etiology and subtypes both of which can help with treatment. However, need more scientific data to support the validity of these disorders and their subtypes.

Interphase between Love and Aggression

O P Singh, Prasenjit Ray 1 , Gautam Saha 2 , Asim Kumar Mallick 3

Professor of Psychiatry and Head of the Dept., N R S Medical College, Kolkata, 1 RMO Cum Clinical Tutor, Dept. of Psychiatry, Burdwan Medical College, Burdwan, 2 Consultant Psychiatrist, 3 Professor of Psychiatry and Head of the Dept., Burdwan Medical College, Burdwan

Love and aggression are some of those perennial phenomena that have captured our imagination since ages. Conventionally, the two have been portrayed to be antagonistic, love, as soothing and pleasurable, while aggression, as unpleasant and destructive.

Investigation of neurobiological basis of love highlights the involvement of pleasure and reward processes, limbic lobes and certain frontal areas, oxytocin, vasopressin, dopamine, serotonergic signalling and endogenous morphinergic mechanisms coupled to nitric oxide autoregulatory pathways (Esch and Stefano, 2005). On the other hand, imbalance between prefrontal regulatory influences and hyper-responsivity of the amygdala and other limbic regions, evident through insufficient serotonergic control, excessive catecholaminergic stimulation, subcortical imbalances of glutamatergic/ gabaminergic systems, as well as pathology in neuropeptide systems have been implicated in aggression (Siever, 2008). The overlap between the two apparently opposite phenomenon is evident.

The proposed symposium attempts to conceptualize love and aggression in their multiple shades, in the light of the various theories, as well as taking help from something more objective like the different physiological processes and the proposed molecular and neuronal mechanisms.

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