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 Table of Contents    
Year : 2018  |  Volume : 60  |  Issue : 5  |  Page : 24-47
Symposia and Workshops

Click here for correspondence address and email

Date of Web Publication1-Feb-2018

How to cite this article:
. Symposia and Workshops. Indian J Psychiatry 2018;60, Suppl S4:24-47

How to cite this URL:
. Symposia and Workshops. Indian J Psychiatry [serial online] 2018 [cited 2022 Dec 4];60, Suppl S4:24-47. Available from:

Global Controversies in Psychiatry – Relevance to clinical practice in India

Amit Banerjee, Soumya Basu

Consultant Psychiatrist, St John of God Public Hospitals, Perth, Western Australia, [email protected]

Through this , they would like to highlight some of the major controversies that are currently plaguing Anglo-American psychiatry. Their examination will be through a social and critical lens and they would like to encourage a discussion about what lessons can be learnt from these by psychiatrists practicing in India.

Dr Banerjee would like to discuss the sociology and politics of mental health from a critical psychiatry perspective, and draw links between the increasing prevalence of mental illness and late capitalism. He would also like to discuss theoretical aspects of the sociology of the professions in mental health, and have a discussion with the audience about how inter-disciplinary collaboration between psychiatrists and other stakeholders in mental health at a societal and governmental level might become increasingly relevant in Indian jurisdictions in the years to come.

Dr Basu would like to discuss his experience of working in an Australian regional and rural community child psychiatry program where most of the clinical presentations are in the background of complex social determinants, like abuse, neglect, trauma, parents with trans-generational trauma, substance abuse etc. He would use his recently concluded study on a cohort of 100 Australian Aboriginal children and children from cultural and linguistically different background like children of immigrants and refugee children to emphasize the need of a much broad based conceptualization of determinants of mental health presentations in child psychiatry. He would also try critically address issue of the rise in the diagnosis of Pediatric Bipolar, Autism and ADHD from the prospect of an ever increasing but narrow bio-medical understanding of the maladies of the mind, with relevant case examples.

Keywords: Psychiatry, practice

Bipolar Spectrum Disorders: An appraisal.

Lagnajit Dash, Abhijeet Soni, Abhishek Samal

Senior Resident, Department of Psychiatry, G.S. Medical College and Hospital, Pilkhuwa, Hapur, Uttar Pradesh. [email protected]

History of Mood Disorders, and Current Status of Bipolar Spectrum Disorder (BSD)

Bipolar disorders are one of the most prevalent psychiatric disorders with significant morbidity. A clear-cut categorical approach based on symptoms and signs has been in place ever since mood disorders have been delineated.. However, many others agree upon the clinical occurrence of a continuum of affective disorders brought under the conceptual rubric of the bipolar spectrum. While successive editions of Diagnostic and Statistical Manual of Mental Disorders have accommodated newer additions in Bipolar Disorder, the recent most edition has fallen silent on the issue of adding BSD. Is there an overall reluctance and suspicion regarding the noslogical existence of Bipolar Spectrum Disorder?

Current body of research on Bipolar Spectrum Disorder

A lot of theoretical elaboration, research, and publications have been carried out on BSD for almost five decades now. Many of them have focussed on the gamut of clinical experience and research, including genetic and familial studies, affective temperaments and sub-threshold mood symptoms. Many tools have been developed to assess BSD. We examine this body of research and literature.

Critical analysis of Bipolar Spectrum Disorder

An appraisal of the BSD is much needed in this juncture. Critical analysis of the evidence and arguments in support of and against the BSD is warranted. Is it necessary to take a side or is there a middle way out? What is the future of BSD?

Keywords: Bipolar spectrum disorders, mood disorders

Evolutionary Psychiatry: New Insights into the Genesis of Mental Illnesses

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

Assistant professor, NKP Salve Institute of Medical Sciences, Nagpur,Mahaarashtra. [email protected]

Evolutionary psychiatry is an exciting new field which is not only interesting, but one that gives unparalleled insights into the genesis of mental illnesses and their management. It is perhaps a harbinger of a paradigm shift in the way we see “psychopathology” today.

Human brain/mind evolved and is still evolving through evolutionary-processes since millions of years. Behavioral patterns can be designed by evolutionary-processes in exactly the same way as anatomical structures. These evolutionary-processes are considered to be adaptive for the individuals in adverse situations.

Etiology and symptomatology of most of the psychiatric disorders includes biological, genetic, social-environmental and psychodynamic- psychological and all of these can be traced to evolution that is evident in the form of some or the other behavior.

Evolution (natural selection) doesn’t design disease or disorder but creates the vulnerability to a disorder. This vulnerability arises from the evolutionary-processes where selection (natural/sexual/social) operates to benefit reproduction and not health. Neglecting the evolutionary perspective so far has led clinicians to formulate theories of psychopathology with many unexplained areas. Evolution provides a framework which can help define the role of various phylogenetic and proximate factors in the causation of mental disorders. Evolutionary science has the capacity to provide psychiatry a plausibility or reality check that can favor not only promising etiological hypotheses, but treatment guidelines as well. Presently there are several evolutionary hypotheses for various psychiatric disorders like schizophrenia, depression, OCD, Bulimia, Personality disorder, PTSD, etc. It is important to know why complex human psychological characteristics evolved, why some individuals are vulnerable to illness and ultimately, what we can/might do in terms of prevention and treatment.

This aims at discussing the basic concept of evolutionary psychiatry, how evolutionary-processes shape the causation of various mental illnesses, and can the management strategies be planned based on the evolutionary paradigm?

Key words- evolutionary psychiatry, evolutionary theories, evolutionary processes, psychiatric disorders, management.

Challenging issues of Childhood psychosis and future directions

Srivastava AS, Tripathi MN, Yadav Harinath, Yadav J S

Professor, IMS, BHU, Varanasi, Uttar Pradesh. [email protected]

Introduction: Childhood-onset Psychosis, characterized by onset of psychosis before 12 year of age, this is a severe form of the illness with gradual onset and poor outcome. Prevalence of psychotic symptoms in child populations markedly exceeds the estimated prevalence of early-onset schizophrenia1and the symptoms that occur in psychosis are present in many alternative diagnoses. Though childhood psychosis is common in the general population therefore it may signal that neuro developmental processes that lead to psychosis are similar or different from normal development. Few studies present preliminary evidence of an association between child hood trauma and psychosis but still it is not very clear. However, it is also not clear whether these symptoms are associated with the same extensive risk factors established for adult schizophrenia. The childhood hallucinations and delusions are influenced by genetic and environmental factors are also unique in the life of each sibling.

Further the evaluation and treatment of children with psychotic symptoms are challenging for clinicians because psychotic symptoms may present in the context of medical illnesses, substance use, congenital disorders, a variety of psychiatric conditions (eg, affective disorders), as well as primary psychotic diagnoses such as schizophrenia or schizoaffective disorder. There is presently insufficient research for the implementation of evidenced based combined treatments of psychosis in children and adolescents. Even though knowledge about the neurobiological underpinnings of psychotic disorders has steadily accumulated, much is still unknown about the progression of psychosis in childhood and adolescence and its most effective treatment.

Key Words: Childhood psychosis

Medically Unexplained Symptoms: controversies and current understanding

Alakananda Dutt, Rajarshi Neog

Consultant, AMRI Mukundapur, Kolkata, Kolkata, West Bengal. [email protected]

Symptoms which cannot be fully understood in the light of existing medical illness constitute one fourth to two thirds of all presentations in primary and secondary care. Even after evaluation by specialists one third to half of these patients remain undiagnosed and contrary to popular belief these symptoms are rarely found to be due to undetected physical disorders on long term follow up. In addition to the distress and discontent suffered by the patients and caregivers, these patients impose a considerable burden on the health care system. However despite this apparent salience the medical community has till date failed to reach a consensus regarding the characterization, etiology and management of these conditions.

They may be identified as fibromyalgia, irritable bowel syndrome, non-cardiac chest pain, Somatoform or Conversion disorder by different specialties. In psychiatry medically unexplained symptoms involving the nervous system are categorized separately from those pertaining to other parts of the body although in clinical practice symptoms of both types usually coexist.

Several mechanisms like altered autonomic balance, stress-axis dysfunction, sensitized nervous system and activated inflammatory response have been implicated in the production and maintenance of somatic symptoms but clear understanding of aetiopathogenesis is still lacking. Treatment strategies like exercise, psychological treatment, information and structured care appear to be more effective than standard medicines in these patients but little research has been conducted in this field.

Hence it is time that psychiatry and other medical specialties work in unison and develop a uniform diagnostic system and management strategy for the relief of symptoms and improvement of functionality of these patients which in turn will have far reaching impact on the quality of life and productivity of society in general.

Keywords: symptom, patient, caregiver

Prescription writing in mental health: guidelines, current status and future direction.

Vihang Vahia, Ajit Avasthi, Sharmila Sarkar, Monali Deshpande, Ambrish Dharmadhikari

Psychiatrist, Dr. H. D. Gandhi Memorial Hospital, Mumbai, Maharashtra. [email protected]

1. Introduction: Is prescription writing a lost art? –Vihang Vahia

Prescription writing is an art, which should be learned and practiced by each and every clinician. In current era of psychopharmacology, it is important to practice prescription writing correctly. Error occur when planned actions failed to achieve desired outcome. There are mainly two types of error in prescription writing, i.e. slips & lapses and mistakes. It cannot be quantified how much error occurs, However it is known that patients can be harmed as a result of some prescribing errors. Prescribing errors can occur as a result of inadequate knowledge of the patient and their clinical status, inadequate drug knowledge, calculation errors, illegible handwriting, drug name confusion. Poor history taking Fatigue and workload may also contribute to the risk of slips and lapses. It is important that all prescribers are aware of the risks and principles of safe prescribing.

2. Current status: What are guidelines for prescription writing? And how much they are being implemented. –AjitAvasthi

Guidelines to write a prescription is deep rooted. World health organization recommends education of prescription writing at under graduation level. Guidelines have formulated from undergraduate level to practicing clinician. Medical council of India have included guidelines of prescription writing in all graduate courses of medical fraternity. Various international bodies like World health organization, American psychiatry association, and British national formulary have their own guidelines for writing a prescription. Many other guidelines do suggest about pharmacodynamics and pharmacokinetics which needs consideration while writing drug prescription. Recently guidelines in India got updated regarding branded drugs verses generic drugs, which did not receive widespread acceptance in practice given the difficulties inherent in the circumstances. However we often observe slips and lapses in patient care due to error in writing prescription and writing unethical prescriptions. Many hospital audits across globe reports poor compliance to guidelines of prescription writing. Hence there is dire need to educate clinician about prescription writing.

3. Future direction: what we need to improve? How to prevent unethical prescription? – Ambrish Dharmadhikari

It’s time that we collectively need to act and minimize mistakes and unethical practices in prescription writing. In era, where doctor patient relationship has shifted to consumer provider law framework, mental health practitioners need to take extra care. In the time, where doctors are not perceived in their best of image, we can’t afford to have fall in standard of patient care due to lapses and slips in prescription writing. Hence there is need for uniformity, strict adherence to guidelines and use of technology in prescription writing to improve quality. In mental health, many strategies can be administered. Education, Audit of hospital prescription and active feedback to practicing clinician, multidisciplinary working, support at government level, patient safety culture are few steps leading to minimize errors in prescription writing. At the same time, in depth knowledge and emphasis should be given on understanding basics of pharmacodynamics and pharmacokinetics of psychotropic medications from post graduate levels.

4. Interactive sessions with audience. – Dr. Rajesh Dhume, Dr. Sharmila Sarkar, Dr. Monali DeshpandeWe would like to take suggestions, opinions and feedback of participating colleagues. We intent to give worksheets to them and collect feedbacks, suggestions and assimilate them to make consensus opinion. Consensus opinion will be forwarded to executive committee of Indian Psychiatry Society for further deliberation.

Keywords: Prescription, mental health, education

Child Psychiatry in a Modern Era

Avinash Desousa, Kersi Chavda, Ajit Bhide [email protected]

The Current study shall look at the newer disorders that plague child psychiatry and provide guidelines to the busy clinician to deal with the same in an office based practice. The lectures shall be infused with case examples and this shall help illustrate the underlying psychopathology and pharmacological and non pharmacological management of these conditions.

On Selecting Proper Statistical Tests in Mental Health Research

Prof. Basudeb Das, Hariom Pachori

Professor of Psychiatry,, Central Institute of Psychiatry,, Ranchi, Jharkhand. [email protected]


Statistical analysis plays pivotal role to understand outcome, causes, effect, efficacy, factors, determinants, dimensions and compression in mental health research. In this workshop we would discuss the basic statistical methods and techniques commonly used in mental health research. We would try to answer all the below mentioned questions through examples in the workshop. How to avoid common errors in statistical analysis and common pitfalls?

Where to use which statistical test, rational behind the test?

Why the selection of valid statistical tests is important?

What are the factors to be considered for test selection?

Which type of test do you need: Univariate or Bivariate or Multivariate?

Do you want to test for a difference between groups or want to test for correlation between variables?

How many groups are there for the independent (predictor) variable?

What is the total sample size?

Keywords: Mental Health Research, Statistical Tests

Pre-pregnancy Counseling in women with pre existing mental illnesses

Balaji Bharadwaj, Sundarnag Ganjekar, Sonia Parial, Shubhangi Dere

Assistant Professor, JIPMER, Puducherry, Pondicherry. [email protected]

With increasing awareness and better treatment available for women with severe mental illness (SMI), many women may opt to get pregnant. Several concerns of couples planning for pregnancy need to be addressed which include. The risk and benefits related to continuing or stopping psychotropic drugs, The effect of mental illness on pregnancy and fetal outcome, The preparedness of women with SMI to take on a mothering role and The course of mental illness in the postpartum period. This workshop will discuss some of the above challenges and provide an overview of the steps involved in the preconception counselling of women with pre-existing mental illnesses. Methods: The workshop will consist of video enabled discussion on decision making of psychotropic use in pregnancy. (30 min) Small group work on decision making in various psychiatric conditions. (30 mins) Group discussion on handling accidental exposures, barriers & facilitators to (20 mins) Summary and conclusion (10 min). Expected outcome: This workshop will enable skill development among mental health professionals in dealing women with mental illness in Decision making with couples, assessing and discussing risks and benefits and developing protocols for specific drugs. It will also provide perinatal psychiatry forms for all participants to help in using them at their service. Participants will be better equipped to handle pre-conception counseling and aiding decision making with respect to pregnancy planning in women with SMI.

Keywords: Pregnancy, postpartum

Genetic aspects of addictive disorders

Biswadip Chatterjee, Rizwana Quraishi, Ravindra Rao

Assistant Professor, All India Institute of Medical Sciences, Delhi, Delhi [email protected]

Addiction is a syndrome that has an unknown aetiology and is frequently chronic, with a relapsing/remitting course. Like most other NCDs, multiple biological and environmental factors are known to affect its initiation and progression. However till date, there is a lack of knowledge about its aetiology. This in turn affects its effective prevention and treatment. Knowledge of genetic factors in aetiology and treatment may enable effective and individualized prevention, treatment, and prediction of prognosis of this disorder. It may also help in identification of new therapeutics and ultimately help in reducing stigma related to this disorder.

Presentation titles:

1. Genetic approaches to addictive disorders (Rizwana Quraishi)

Heritability in addictive disorders have been studied in many ways. Some of them are family, adoption, and twin studies. Gene identification can be accomplished both by genome-wide methods and by candidate gene studies. Genome-wide analysis, includes whole-genome linkage, whole-genome association, and mRNA expression analyses. This method allows mapping of disease-causing loci within the genome without making any a priori hypothesis. Alternately, candidate gene analysis is often done to confirm, rule-out or delineate role of a specific functional gene in phenotypic expression. These functional gene(s) can have role in drug-specific or general vulnerability and/or resiliency, drug metabolism and elimination, pharmacological response etc.

2. Genetic influences on vulnerability to addiction (Biswadip Chatterjee)

The heritability of addictive disorders is considered to be in the range of 30–60%. Those with some complex personality and physiological traits—such as impulsivity, risk taking and stress responsively are found to be particularly vulnerable to substance use - initiation of drug use, addiction/ dependence and potentially relapse. Genetics influences the vulnerability to addiction by affecting these particular personality and physiological traits. Besides increasing general vulnerability to addiction, genetic variation may lead to increased propensity to particular kind of addiction. The presentation will focus on role of genetic variation in different personality and physiological traits, and their influence on and interaction with addictive diseases.

3. Genetics and course / outcome of addictive disorders (Ravindra Rao)

In contrast to the of drug use initiation, its progression is considered to be primarily determined by the environmental factors. However, genetics also play an important role in determining the course and outcome of one’s substance use career. In many instances, both these factors affect each other, epigenetics. Treatment response is another area in addictive disorder where there is increasing evidence of genetic influence. Evidences are also emerging that genetic factors may also influence the severity of physical harms associated with use of substance, general motivation to seek treatment and propensity to relapse and have comorbidity. All these points will be touched upon in this presentation.

Keywords: Addiction, genetics

Active collaboration between NIMHANS and Govt. of Karnataka for scaling up Primary Care Psychiatry (including DMHP): Processes, Outcomes, Challenges and Future directions

Rajani Parthasarathy, N Manjunatha, Suresh Bada Math

Additional Professor of Psychiatry, National Institutte of Mental Health and Neurosciences, Bengaluru, Karnataka. [email protected]

Urgent largescale efforts are the need of the hour to reduce the huge treatment gap for psychiatric disorders. (measuring up to 75%, National Mental Health Survey, 2016) is. In this direction, recently, the Department of Psychiatry of the National Institute of Mental Health and Neurosciences (NIMHANS), since the past year, has taken many innovative steps in collaborating with the Health and Family Welfare Department of the Govt. of Karnataka to realize this goal. Some results of this collaboration include: expansion of the District Mental Health Program (DMHP) to all the districts of Karnataka, Junior residents of the Dept. of Psychiatry started postings in DMHP (as part of their MD curriculum), Primary Care Physicians were started on-consultation training (both in-person as well as by using video-conferencing technology), a couple of service-cum research projects are initiated, six extension camps that were running since the past 40 years were stopped, an online monitoring format was developed and is being piloted. Finally, the coverage of patients has gone up tremendously in this financial year.

This aims to cover the details, processes and outcomes of this collaboration and while doing so, will touch upon the challenges, future directions and lessons for national action as well

Technology and innovation: the inevitable way forward in furthering Primary Care Psychiatry?

Keywords: Psychiatry, Karnataka

Mental Health Act, National Mental Act Policy and Human right of mentally ill in 21st century in India

Devashish Konar, O. P. Singh, Debjani Bondhopadhyay

Director, Mental Health Care Centre Burdwan & Kolkata, Burdwan, West Bengal. [email protected]

Quality of life of a society is not decided by how the successful and the rich lead their life, but also by the facilities and rights enjoyed by the disadvantaged and the poor. Keeping mentally ill in the fold of society and taking care so that they lead a healthy and happy life is a daunting task. We need to work hard to harmonise the health services, taking help of the law and society at large. Ideally there should be a single window solution for them where one ombudsperson takes care of every need of that person and all the related departments work in tandem.

Mental Health Act.- O.P. Singh

Mental Health Act 2017 is definitely an improvement over 1987 but there is definite scope of refining it further. This act should not be like a full stop but should be like a comma providing a continuity in the course of improvement.

National Mental Health Policy – Devashish Konar

Our National Health Policy 2017 mentions about strengthening mental health services by developing sustainable networks for community to reach the unreached. Collaborating with private health care system for capacity building, awareness and service delivery has been envisaged.

Human Rights For Mentally Ill- Debjani Bondhopadhyay

By giving as much opportunity as possible to mentally ill so that they can lead a near normal life without feeling constrained, discriminated and disadvantaged should be the aim of a modern society. India should come up with different programmes at Government and Non-Government Organization (NGO) level to make it happen.

Keywords: Mental health, mental illness

Positive Psychiary for Children and Adolescents: From Mental Illness to Mental Health

Devashish Konar, Anweshak Das, Nishant Goyal

Director, Mental Health Care Centre Burdwan & Kolkata, Burdwan, West Bengal. [email protected]

Child and Adolescent Psychiatry is one such area where traditional patient – disease - treatment model is not going to give bountiful result. To be able to reach the problem to its core and find solution we need to have a big picture approach.

Prevention starts from planning of marriage of parents, to planning pregnancy, to prenatal, natal and post natal care. For healthy childhood myriad of issues need to be taken into account.

In spite of all Precautions there will be unwanted intrusion of trauma and difficulties during childhood and adolescence. Empowering the children to face difficulties and overcome them without being overwhelmed, needs a targeted approach in enhancing resilience.

Many important psychiatric illnesses start in childhood and adolescents. Treatment planning and supporting the child with a multidisciplinary recovery model is important so that the illness does not devastate the formative years and helps him rejoin the mainstream.

Research on cognitive underpinnings of delusions has shown that several reasoning biases can play role in the genesis and/or maintenance of delusions. It has led to development of insight oriented therapies that aim to help patients in developing insight into these reasoning biases which, in turn, pave way for discussion about the contents of delusions and veracity of the beliefs.

Present workshop will be conducted in two parts – the first part will focus on reasoning biases implicated in delusion formation and maintenance (such as Jumping to Conclusions, Belief Inflexibility, Attributional Bias and Theory of Mind) and the second part will be focused on therapies that target building insight into these biases. The major focus will be Metacognitive therapy (MCT) which recent meta-analytic reviews show to be effective in reducing conviction in delusions.

Present workshop will introduce the participants to the basic techniques of insight-oriented therapies for delusions (especially MCT) and sensitize them about the empirical findings, including a few from India.

Keywords: Positive psychology, adolescence

Delusions are amenable to reasoning: Empirically supported Insight-oriented therapies for delusions

Devvarta Kumar

Additional Professor, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka. [email protected]

Research on cognitive underpinnings of delusions has shown that several reasoning biases can play role in the genesis and/or maintenance of delusions. It has led to development of insight oriented therapies that aim to help patients in developing insight into these reasoning biases which, in turn, pave way for discussion about the contents of delusions and veracity of the beliefs.

Present workshop will be conducted in two parts – the first part will focus on reasoning biases implicated in delusion formation and maintenance (such as Jumping to Conclusions, Belief Inflexibility, Attributional Bias and Theory of Mind) and the second part will be focused on therapies that target building insight into these biases. The major focus will be Metacognitive therapy (MCT) which recent meta-analytic reviews show to be effective in reducing conviction in delusions.

Present workshop will introduce the participants to the basic techniques of insight-oriented therapies for delusions (especially MCT) and sensitize them about the empirical findings, including a few from India.

Keywords: Delusions, therapy

New gene editing techniques: Is a new ray of hope for genetic mental illness

Dheerendra Kumar Mishra, Amankishore

898, S.S. Medical College Rewa, Rewa, Madhya [email protected]

Objective: The goal of this workshop is to understand and know about the new genetic technique for gene editing especially CRISPR with the help of this researchers can permanently modify genes in living cells and organisms and, in the future. This technique a ray of hope for treating genetic illness and will be revolution for management of psychiatric illness. Psychiatrist must be aware and understand about newer emerging treatment techniques in near future.

Understanding for genetic basis of disease.

Evolution gene editing techniques.


Ethical concern and doubt

Future directions & Challenges

Brief Description: Gene editing techniques are important technique in which DNA is inserted, deleted or replaced in the genome of a living organism using “molecular scissors”. There were four families of engineered nucleases being used: meganucleases, zinc finger nucleases, transcription activator-like effector-based nucleases. CRISPR is a new gene editing technology to target and change a single letter in a string of DNA bases — no cutting necessary. Francisco Mojica was the first researcher to characterize what is now called a CRISPR locus, reported in 1993. CRISPR is more precise and efficient than previous gene editing technique. Invention of new technique is a hope for various genetic disease especially psychiatric illness but “A tremendous amount of work is needed before this molecular machine can be used to treat diseases in humans,” he said. “But having a machine is an important starting point.”

Keywords: CRISPR, Gene editing, Designer baby, Mental illness

Stress, Storm and Struggle in Women- A plot for paradise loss?

Dhrubajyoti Bhuyan, Lakshimi Borgohain, Sabita Dihinigia, Budhiswatya Shankar Das,

Assistant Professor, Assam Medical College, Dibrugarh, Dibrugarh, Assam. [email protected]

Historically men have been deemed as being “rational” whereas women “emotional” along with men being perceived as wrong “doers” and women as “disordered” (Wild, 2005). Although findings of both Indian and international studies have been equivocal, there is consensus that women have higher rates of mental illness (Davar, 1999; Gove, 1972; Gove & Tudor, 1973). Within the Indian context, prevalence rates for mental illness for men and women are around 10.48% and 14.45% respectively (Davar, 1999). There have been attempts to study socio-demographic aspects of this distribution such as, single versus married persons. Indian studies have found that irrespective of socio-demographic category, “more women show up with symptoms than men” (Davar, 1999). This is in contrast to international studies that have reported equivalent prevalence rates for mental illness among single men and women (Gove, 1972; Gove & Tudor, 1973). In short, women are found to have greater prevalence of mental illnesses. Theories examining this association have been few, possibly due to the vast societal differences in the conceptualization of gender and its roles. This is especially important, as mental illnesses have been found to vary across cultures.

Outline: Fatigue and daytime sleepiness are common complaints in psychiatry. Patients who experience sleepiness at unwanted times that adversely affects their daytime functioning are said to have pathological sleepiness or excessive daytime sleepiness (EDS). Multiple syndromes with varying etiologies impair the normal sleep-wake homeostatic architecture, which may manifest clinically as EDS.

In psychiatric patients, specially EDS tends to be a nebulous complaint, clouding the overall clinical picture. There is phenomenal interplay between psychiatric pathogenesis and EDS, which make the distinction all the more difficult. Furthermore, majority of such patients would ultimately come to the psychiatrist for primary consultation or as referral. Lack of understanding of these conditions leads to gross mismanagement of psychiatric disorders (example: antidepressants in hypersomnia, misdiagnosed as depression) whereas correct workup and diagnosis can tremendously improve the quality of life in psychiatric patients.

Keeping this in background, there should be an attempt to generate discussion on the following constructs:

Keywords: Stress, struggle, women

Excessive Daytime Sleepiness (EDS): Considerations & Concerns for the Psychiatrists

Debanjan Banerjee, Suhas Satish, Vishwas Yadawad, Sachin N

Senior Resident, Psychiatry, NIMHANS, Bangalore, BANGALORE, KARNATAKA. [email protected]

Syndromes of EDS (the primary disorders of EDS, sleep related breathing disorders and sleep related movement disorders)

Psychiatric disorders and medication: bidirectional relationship with EDS

Differentials and management of EDS: psychiatrist perspectives

Keywords: EDS, Sleep

Tele psychiatry in India: ethical, legal and practical challenges

Kiran B R, Suresh Badamath, C Naveen Kumar, N Manjunatha

Assistant Professor, DM-WIMS, Meppadi, Waynad,Kerala-673577. [email protected]

Telemedicine is an innovation in health care following advances in technology and has given us the promise of ‘reaching the unreached’. Tele psychiatry has promise of bridging treatment gap, is a cost effective model and provides easy accessibility of care for patients who otherwise find it difficult to reach out tertiary centers. However even after ISRO initiated telemedicine project across India in 2001, progress so far is unsatisfactory. Reasons for this include practical challenges like lack of trained man power and technological resources, attitudinal barriers among doctors and policy makers. Legal and ethical issues include patient confidentiality, privacy issues and safety of information. Lack of clear guidelines and clarity about liability issues has made doctors hesitant in using this technology. In this we plan to discuss briefly about the evolution, various models of tele-psychiatry, it’s pros and cons, current status in India and the world with review of few existing protocols. We would discuss in detail about various ethical, legal challenges and practical challenges along with ways how we can try and overcome these in order to tap the potential of telemedicine technology.

Key words: telepsychiatry, challenges, legal and ethical

Epilepsy: Psychiatrist’s perspective

Nishant Goyal, Alok Pratap, Aniruddha Mukherjee, Vidya K.L

CIP, Ranchi, Ranchi, Jharkhand. [email protected]

Epilepsy forms the perfect interface between Psychiatry and Neurology. It has been viewed as mental disorder for ages and continues to straddle between two disciplines because of the absence of visible neuropathology in majority of patients as well as the presence of psychological comorbidities in most cases. Symptoms of epilepsy are known to disguise and pose real challenge to psychiatrists. Occasionally, an altered mental state can be the only sign of non-convulsive status epilepticus such as that of complex partial or absence types of seizures. Even in diagnosed patients of epilepsy, Psychiatric consequences rule rather than just being an exception. They are classified according to how they are related in time to occurrence of seizure i.e. ictal, peri-ictal and inter ictal. Not only are patients with epilepsy at greater risk of developing psychiatric disorders but also patients with mood, attention deficit disorders and autism are at a significantly greater risk of developing epilepsy, hence forming a bidirectional Relationship. Apart from creating diagnostic confusions, drug interactions between psychotropic and antiepileptic medications are also puzzling. Some of the newer antiepileptic medications are known to cause behavioral symptoms further obscuring the scenario. Add to this, psychotropic medications, which may be used for treatment of psychiatric disorders in epilepsy, can have negative effects on seizure control. So dealing with these patients demand careful deliberation from mental health professionals and mindful selection of medications. Hence, it is vital for us to have our epilepsy knowledge updated.

Key words: Epilepsy, recent concepts, psychiatric comorbidities, management

Mental Health Literacy in India: Concept, Various Aspects & Perspectives and Way Forward

Bhaveshkumar Manharlal Lakdawala, Naresh Nebhinani, Falguni B. Patel

Professor and HOD, Psychiatry, AMC- MET Medical College and Sheth L.G. General, Hospital, Ahmedabad, Ahmedabad, Gujarat. [email protected]

Objectives: The term “Mental Health Literacy” (MHL) refers to knowledge and beliefs about mental disorders which aid their recognition, management or prevention. The objectives of this are to address what is MHL and Indian research and Contribution; MHL for persons having Substance use disorder, research and work on MHL in Suicide and how we can improve MHL so that society at large will be benefited.

Description: Mental health literacy includes the ability to recognize specific disorders; knowing how to seek mental health information; knowledge of risk factors and causes, of self-treatments, and of professional help available; and attitudes that promote recognition and appropriate help-seeking.

Many studies have shown that poor knowledge and negative & stigmatized attitudes towards mental illness and mentally ill are widespread. It is even more seen for in persons suffering from Substance Use Disorders (SUD) and Suicide related issues. Many studies report that stigma is universal and doesn’t spare even various health professionals including our colleagues of other branches, nursing personnel and health workers. Stigma and discrimination result in the underuse of mental health services. The main strategies for addressing psychiatric stigma focus on protest, contact and education.

Key Words: Mental Health Literacy, SUD, Suicide, Ways to Improve, India

Being positive: different facets of positive emotions

Sharmila Sarkar, Jayita Saha

Associate Professor, IPS, Kolkata, West Bengal. [email protected]

Emotion can be described as a neural impulse that moves an organism to action. Whereas emotional feelings are the subset of affect that are associated with brain-body interactions, their neural representations, and their expression. Ekman postulated that in addition to a neutral state, there are six basic types of emotions namely, happiness, sadness, anger, disgust, fear, and surprise. Recent studies have shown that there are 10 most commonly reported categories of emotions which are grossly classified into ‘positive’ and ‘negative’ emotions. Negative emotions such as fear and anger have short term adaptive value as they help to ensure survival and safety. The positive emotions, on the other hand, increases ego-resilience and amplify cognition and behavior to optimize performance. It has been found that each of these positive emotions has specific role in growth of personal resources. Like awe is linked to several benefits including increased generosity, ethical decision-making, helping behavior to others, and reduction of impatience.

According to ‘broaden-and-build theory’ positive emotions expand people’s thought–action repertoires and these positive emotions allow them to build psychological, intellectual, and social resources. Happiness is conceptualized as affective component (comprising of the experience of frequent positive and infrequent negative emotions) and a cognitive component that reflects a global sense of life satisfaction. On the other hand, it is well established that dopamine is the neurotransmitter related to pleasure principle. Dopamine is released from nucleus accumbens of sub neocortical region when we experience pleasure or just anticipating pleasure.

There are multiple on-going researches to explore the neurobiology that might be responsible for different positive emotions. The objective of the current presentation would be to highlight the different facets of positive emotions and its implication in therapy.

Keywords: positive emotions, therapy, performance

Workshop - CBT for OCD with Predominant Obsessions

Adarsh Tripathi, Pronob Kumar Dalal, Eesha Sharma, Sujit Kumar Kar

Associate professor, King George’s medical university, Lucknow UP. [email protected]

Cognitive Behaviour Therapy (CBT) is an evidence based psychological intervention which intends to reconstruct the cognitive errors and maladaptive behaviours in various psychiatric disorders. It has been used successfully in management of depression, anxiety disorders, obsessive compulsive disorder, borderline personality disorder, persistent auditory hallucination in schizophrenia and many childhood psychiatric disorders.

Obsessive Compulsive Disorder (OCD) is a psychiatric disorder with prevalence of 0.76% as found in the recent National Mental Health Survey 2015-16. When it is projected to the national population, approximately 10 million people in India are suffering from OCD. A significant portion of patients with OCD have predominantly obsessions which Produce significant distress and impairment in them. Pharmacotherapy alone might not be beneficial in many such patients. Many such patients even do not tolerate to conventional pharmacotherapy regimen. In such clients add on CBT might be beneficial.

In OCD of mild to moderate severity, CBT is recommended as the first line Treatment. Exposure and response prevention is most commonly used treatment method for OCD. Management of OCD with predominant obsession however, may require certain modifications in the strategies to be used. Skill set and approach of ERP may also be different in such cases. Many cognitive skills, acceptance and commitment therapy principles and mindfulness are also applied to deal with such cases.

This workshop intends to sensitize the mental health professionals about the CBT process with specific focus on cognitive interventions to deal with predominant obsessions in OCD.

Keywords: CBT, OCD, predominant obsessions

Workshop: Assessment and management of Premature Ejaculation

Adarsh Tripathi, Sandeep Grover, Kishor M Rao, Anil Nischal, Adarsh Tripathi

Associate professor, King George’s medical university, Lucknow, UP. [email protected]

Premature ejaculation (PME) is one of the most common sexual complaints in the clinics (Kendurkar et al, 2008). Various reports suggest that community prevalence of the PME varies from 5-40%. The great variation of prevalence is due to vague definitions, sensitive nature of the problems and resultant variable reporting. However as definition was standardized and studies conducted world over, a greater insight was achieved regarding prevalence and associated correlates. Based on the data generated, the prevalence of Lifelong PE was unlikely to exceed 4% of general population (Update of ISSM’s guidelines for diagnosis and treatment of PE, 2014). Premature Ejaculation has been further subdivided into subtypes [Lifelong PE (LPE), Acquired PE (APE)]. Waldinger and Schweitzer (2008) have proposed two new subtypes [Natural Variable PE (NVPE), Premature-like ejaculatory dysfunction (PLED)] according to clinical characteristics. The classification influences the modality of treatment as well as provides an insight into possible etiology. The exact etiology might be unknown but a variety of socio-demographic and clinical variables are associated with patients of Premature Ejaculation. Premature Ejaculation is associated with Age, Lifestyle, comorbidities such as anxiety and depression, Diabetes, Prostate diseases and Erectile dysfunction. Despite being a common cause of clinical consultations, the knowledge and skills of clinicians regarding assessment and management of the PME remains to be low. Assessment of PME include looking for all the possible causes of PME (i.e., both organic and functional, taking a proper treatment history and evaluating the Comorbidities). Various pharmacological agents have been evaluated for management of PME, including SSRIs. Non-pharmacological measures include use of relaxation exercises and squeeze technique.

Keywords: PME, LPE, SSRIs

Genetics in psychiatry hope, hype and future

Amrit Pattojoshi, Mohd Aleem Siddiqui, Bhaskar Mukherjee

Professor and Head, Hi-Tech Medical College and Hospital, Bhubaneshwar, Odisha. [email protected]

In psychiatry the diseases are multifactorial. Many theories of their origin came into play during the development of humankind from the dawn of civilization. Since the heritability of genetic traits were discovered humanity has started to understand the role of genetics in formation of different diseases. Once rest of the medical field has adopted to genetics and started integrating genetics in every Sphere, psychiatry also had to start exploring genetics to keep up.

The family studies, twin studies and adoption studies undertaken at initial stage proved there is heritable association in psychiatry. Later came genome wide association studies and they found the possible genetic loci for different psychiatric diseases. Now whole genome study and other deep genetic association tests have taken over to find the association.

There are also few angles of genetics besides disease detection and disease classification. Genetic markers can act as diagnostic, prognostic and therapeutic bio markers too. That would also help immensely in early diagnosis and management of psychiatric diseases.

Then comes genetic or genomic based treatment in psychiatric disorders. A futuristic treatment none the less but has firm practical basis and will be applicable soon enough.

so the object of this would be to explore the full extent of scope of genetics in psychiatry from different angles.

Keywords: Genetics, psychiatry

Transgender and Mental Health Issues: Past, Present and Future

Amrit Pattojoshi, Darpan Kaur, Mohd Aleem Siddiqui, Suresh Bada Math

Professor and Head, Hi-Tech Medical College and Hospital, Bhubaneshwar, Odisha. [email protected]

Introduction: Transgender and mental health is a very complex and important area of enhanced understanding for mental health professionals. Understanding contemporary mental health issues in Transgender to bring them into mainstream is the need for the hour!

Aims and Objectives: To sensitize psychiatrists and allied mental health professionals towards transgenders, need of the hour and Mental Health issues

To discuss relevant epidemiological trends, historical evolution of concepts and psychosocial and medicolegal aspects in transgenders

Methods: This shall focus on global and national scenarios in transgenders and mental health. Key epidemiological studies shall be discussed. Relevant concepts of historical evolution, concepts, Transgender movement, psychosocial and psychological issues will be covered. Relevant legal and legislative aspects pertaining to Transgender and mental health shall also be discussed. This shall also cover key areas of stigma reduction and empowerment in Transgender and positive strategies for the way forward.

Conclusion: This will provide future directions in the arena of stigma reduction, empowerment and collaboration in Transgender and Mental Health.

Topics and Speakers Information:

Introduction to Transgender and various definitions - by Amrit Pattajoshi,

Historical aspects of Transgender - by Darpan Kaur,

Mental Health issues in Transgender – by Dr Mohd Aleem Siddiqui, Associate Professor, Department of Psychiatry, Era Medical College and Hospital, Lucknow, Uttar Pradesh, India. [email protected]

Legal and ethical issues in providing care to Transgender - by Suresh Bada Math.

Keywords: Transgender, Mental Health Issues

Depression in elderly: Phenomenology, Neurobiology and Management of late onset depression

Ashok Kumar, R K Solanki, Naresh Nebhinani

Assistant Professor, Dr S. N. M. C. Medical College, Jodhpur, Jodhpur, Rajasthan. [email protected]

Depressive disorders are common throughout the human life span and one of the most common causes of global burden of disease. Late onset depression (LOD) affects 09% to 42.0% of elderly population and prevalence of depressive symptoms reported among 7.2% to 49.0% of older individuals.

Phenomenologically LOD is considered different and termed as “depression without sadness”, “depletion syndrome” and “depression-executive dysfunction syndrome”. LOD in general is thought to have a worse prognosis, a more chronic course, and higher relapse rate in Comparison to patients with early onset depression (EOD). Individuals with LOD have more dominance of cognitive symptoms, psychomotor retardation, anhedonia, severe melancholic symptoms while low prevalance of sadness, Agitation and guilt in comparison to EOD.

Similarly neurobiology of LOD is congruent with phenomenology. Reductions of grey-matter volume and glial density in the prefrontal cortex and the hippocampus, regions thought to mediate the cognitive aspects of depression are implicated in the causation and manifestation of LOD. Functional studies indicate involvement of amygdala and subgenual cingulate regions in dysphoric symptoms of depression among older individuals. Dysfunctional hypothalamic–pituitary–adrenal axis and thyroid abnormality are more obvious among LOD patients.

There is still no clear consensus as to first line treatment in the elderly. Consensus to, Elderly are more prone to the side-effects of antidepressant drugs and experience greater difficulty in tolerating doses. They also take longer to respond to antidepressant medication than younger patients. Ultimately, choice is determined by the individual clinical circumstances of each patient, particularly physical co-morbidity and concomitant medication. This will cover phenomenology, neurobiology and management of late onset depression with emphasis on how it differs from early onset depression.

Keywords: Depression, elderly, late-onset

Early intervention in first episode psychosis, an initiative in OPD: A VIMHANS experience

Shivani Aggarwal, Natasha Ryntathiang, Pallav Bonerjee, Avinash Shukla, Tushar Kant

Senior Resident, Central Institute of Psychiatry, Rewa, Madhya Pradesh. [email protected]

Background: Early Intervention (EI) after the onset of psychosis is critical because delay in treatment results in poor clinical outcomes and are extremely stressful for the patient and their families. Such delays have been Seen to lead aggravation of psychopathology, problems in psychological and social development, strain on relationships, poor family and social support, disruption of study and employment, substance misuse, increased costs of management and years of disability.

Aim: To develop an Early Intervention Program at the OPD level and assess its efficacy.

Methodology: The program was intended for patients with first episode psychosis and patients with duration of untreated psychosis up to two years between ages of 16-30 years. Spread across four phases, the program outlines detailed steps within each phase. Phase 1 includes initial assessment and psychopharmacology. Phase 2 includes case management, CBT, and cognitive remediation. Phase 3 includes psycho-education, psycho-social support, and relapse prevention. Phase 4 includes documentation of the program. A team of clinical psychologists, psychiatrists and occupational therapist were part of the team.

Results: The program improved aggravation of symptoms, alleviated secondary symptoms like depression and anxiety, enhanced coping skills, and fostered better adjustment. It also helped families look and seek for support by widening the care and support options.

Conclusion: EI can prevent aggravation of symptoms and improve short-term and long-term outcomes, thereby significantly increasing the likelihood of recovery.

Keywords: Early intervention, OPD

The Rights of Persons with Disabilities Act, 2016 – Implications in Mental Health Care and Treatment

Choudhary Laxmi Narayan, Rajesh Kumar, Thomas John, Rajesh Sagar

Ex Professor, A.N. Magadh Medical College, Gaya, Bihar. [email protected]

Background - UNCRPD, 2006 has proved to a be major milestone so far as the Rights of Persons with Disabilities are concerned. It introduced a paradigm shift of viewing the disabilities from a social welfare issue to a human right issue.

India was also a signatory to the Covenants and it was ratified by the Indian Parliament in 2008. Following the ratification, it became necessary for the Government of India to amend all the disability related Laws, to make them compliant with the UNCRPD, 2006. Ministry of Social Justice and Empowerment initiated a process of amendment of Persons with Disabilities Act, 1995 in 2010 and after a series of drafts and consultation process, a new Act, the Rights of Persons with Disabilities Act, 2016 was finally enacted in December, 2016. The new Act has enlarged the list of disability conditions from seven to twenty-one. Principles for empowerment of persons with disabilities (PWD) are stated to be respect for inherent dignity, individual autonomy including the freedom to make one’s own choices, and independence of persons. The Act lays stress on nondiscrimination, full and effective participation and inclusion in society, respect for difference and acceptance of disabilities as part of human diversity and humanity, equality of opportunity, accessibility, equality between men and women, respect for the evolving capacities of children with disabilities, and respect for the right of children with disabilities to preserve their identities. Central Government has also notified the Disabilities Rules in June 2016, which also provides for, among other things, the procedure and guidelines for certification of disabilities.

Plan of the – Different sections of the are given below which are to be covered by different speakers as follows -

  1. Overview of the RPWD Act, 2016 - Dr. C.L. Narayan, Ex-Professor of Psychiatry, ANMMC, Gaya
  2. Benefits to the Persons with Disabilities under the RPWD Act, 2016 – Dr. Rajesh Kumar, Professor and HOD of Psychiatry, IGIMS, Patna.
  3. Guidelines for Certification and Quantification of Disabilities – Dr. Thomas John, Kerala 4. Assessment and Quantification of Disabilities for ASD and SLD – Dr. Rajesh Sagar, Professor of Psychiatry, AIIMS, New Delhi.

Conclusion - The Act includes mental illness, intellectual disabilities, autism spectrum disorders and specific learning disabilities among others as the conditions of disabilities conditions. The Act also has provisions of guardianship for persons with disabilities including those with mental illness. As the Act is going to have wideranging implications on mental health care and treatment, it is necessary for all psychiatrists to have a firsthand knowledge of the provisions of the Act.

Key Words – Disabilities, Certification, mental illness, intellectual disabilities, quantification of disabilities.

Nosology, Current understanding and management of Catatonia

Guru S Gowda, Harshit Hemant Salian, Kiran B R, Sathish kumar S V

Post doctoral Fellow in Acute Care and Emergency Psychiatry, NIMHANS, Bangalore, Karnataka. [email protected]

Catatonia is a common neuropsychiatric syndrome with a unique combination of mental, motor, vegetative, and behavioral signs. It is seen with psychiatric and medical etiologies. Although known to psychiatrists for more than a century, it is still poorly understood and often under-recognized. Recently there is a surge in interest in catatonia reflected by changes in its classification in DSM-5. There is no much evidence based studies or common consensus on approach and treatment of catatonia.

This is aimed at discussing following issues

  1. understanding historical evolution & current status of concept of catatonia,
  2. pathophysiological hypothesis and neurobiology,
  3. diagnostic approach and differential diagnosis and
  4. management of catatonia.

Keywords: Catatonia, Nosology

Autoimmune Neuropsychiatric Disorders of Childhood

Kshirod K Mishra, Sally John, Naresh Nebhineni

Professor, JNMC Wardha, Wardha, Maharashtra. [email protected]

Pediatric Autoimmune Neuropsychiatric disorders a group of disorders associated with OCD symptoms in the presence of emotional lability ,poor attention span ,hyperactivity ,reading deficit and other associated psychiatric symptoms. The symptom manifestation occurs within a wk following infection with Group-A streptococcal infection (GAS).Autoimmune associated OCD in childhood differ from regular OCD in its aetiopahology ,clinical presentation, and treatment outcome, it has got its varied spectrum of presentation. we intend to present this un common manifestation on a common platform.

Keywords: Autoimmune Neuropsychiatric Disorders, Children, OCD

Metabolic syndrome, Circadian disruption and Obstructive sleep apnea Patients with Schizophrenia

Naresh Nebhinani, Sourvav Das, Ravi Gupta

Associate Professor, AIIMS, Jodhpur, Rajasthan. dr[email protected]

People with schizophrenia have high mortality rate and shortened life expectancy for 10-20 years than the general population. Its major cause is physical comorbidities, predominantly cardiovascular disorders. Metabolic syndrome (MetS) may partly mediate the association, as the subjects with MS are three times more likely to develop myocardial infarction or stroke. Compared to the healthy population patients with schizophrenia suffer from more metabolic (MetS prevalence 8%-68%) or sleep problems (around 45%). Illness variables, lifestyle factors (diet, activity and substance abuse etc.) and antipsychotics contribute to obesity of patients, which influences their sleep quality. Sleep-wake disturbance, resulting in chronic sleep loss has been associated with increased risk for weight gain, obesity, MS, OSA and cardiac disorders. Metabolic syndrome and sleep disturbances in schizophrenia are interrelated and further affecting their drug compliance, quality of life, illness course and prognosis.

Keywords: Metabolic Syndrome, Circadian Rhythm, Schizophrenia, OSA

Music and Mind - Cognitive, Sociocultural and Medical Dimensions

Rajashree Ray, P K Singh, Vinay Kumar

Consultant Psychiatrist, Vivekananda Institute of Medical Sciences, Kolkata, Kolkata, West Bengal. [email protected]

Music is often thought of as a non verbal language, capable of communicating emotional messages. It has been with us from pre-historic times as evidenced from Paleolithic cave drawings and remains of rudimentary Flutes mentioned in the Vedas. In different forms it has been used in every culture to help connect people, counsel them and soothe them in times of distress.

It is a complex experience that utilizes seemingly divergent abilities of the brain. While the initial sensation of the sounds that make up music is predominantly an auditory experience, the neural basis of music perception lies in several different areas of the brain and overlaps with those used in language, emotion and motor tasks.

In the last few years, music has increasingly been used as a tool for the investigation of human cognition and its underlying brain mechanisms. Making music is a tremendously demanding task for the human brain, engaging Virtually in all cognitive processes like perception, action, social cognition, emotion, learning, and memory. It plays a Key role in the evolution of language, and covers important evolutionary functions such as communication, cooperation, social cohesion and group coordination. Being a universal language, transcending time, generation and cultures, music also contributes to the coherence and maintenance of social groups, encouraging bonding and emotional communication with others.

Playing music has several direct benefits, including keeping our brain healthy as we age, raising IQ and academic performance, strengthening learning and memory, lowering stress and improving health, increasing verbal intelligence, making us happier and improving our sleep patterns. Music therapy techniques have included guided listening or improvisational playing, for mental health and neurological disorders like Schizophrenia, Depression, Autism , Dementia and Traumatic Brain Injury.

This will cover three key areas related to different aspects of Music by three speakers as given below:

Keywords: Music, cognitive, Medical

Revisiting Suicide and Parasuicide

Rajarshi Neogi, Kaustav Chakraborty, Ranjan Bhattacharyya

Assistant Professor, Murshidabad Medical College & Hospital, Kolkata, West Bengal. [email protected],

Suicide is the one of the emerging causes of death among adolescents in India. The sociodemographic factor in India is different from the western counterpart. With a global mortality rate 16 per 1,00,000 population there is one attempt in every 3 seconds and one death in every 40 seconds globally (WHO2011). Beyond Durkheim’s sociological typology, the neurobiology of suicide has been explained in different studies. Studies on the neurobiology of suicide have implicated dysfunction of serotonin, dopamine, acetylcholine, adrenaline, noradrenaline, opioid, GABA, and glutamate systems. Once the suicide is committed it’s no longer treatable. The SUPRE-MISS study by WHO (2000) evaluated various management option in this culturally diverse world. The management and prevention of suicidal and parasuicidal behaviours requires proper assessment, empathic listening skills and interview, pharmacotherapy, psychotherapy, media management and awareness is utmost important.

Rajarshi Neogi: Sociodemography of Suicide and Parasuicide: Indian perspective

Kaustav Chakraborty: Neurobiology of Suicide

Ranjan Bhattacharyya: Management and prevention of Suicidal behavior

Keywords: Suicide, Parasuicide

Clinical Practice Guidelines for Management of Various Psychiatric Disorders among Elderly

Shiv Gautam, Ajit Avasthi, Sandeep Grover, Alka A. Subramanyam, Sameer Praharaj

Professor, PGIMER, Chandigarh, Chandigarh. [email protected]

Indian Psychiatric Society (IPS) is in the process of revising the Clinical Practice Guidelines (CPGs) for various Psychiatric Disorders. In the year 2017, IPS released revised CPGs for management of schizophrenia, bipolar disorder, depression, obsessive compulsive disorder, anxiety disorders, sleep disorders and sexual dysfunction among adult patient. In continuation of the revision process the IPS task force on CPGs, revised the CPGs for management of various disorders (Dementia, Delirium, Depression, Psychotic disorders, Anxiety disorders, Sleep Disorders and Sexual disorders) among elderly.

This will involve sharing of CPGs as per the following:

CPGs for management of Depression among elderly: Ajit Avasthi

CPGs for management of Psychosis among elderly: Shiv Gautam

CPGs for management of Delirium among elderly: Sandeep Grover

CPGs for management of Anxiety Disorders among elderly: Alka A. Subramanyam

CPGs for management of Sleep Disorders among elderly: Sameer Praharaj

Keywords: Elderly, guidelines

Dhat Syndrome: An update of recent research

Sujita Kumar Kar, Om Prakash, Amit Arya, Adarsh Tripathi, Anamika Das

Assistant Professor in Psychiatry, King George’s Medical University, Lucknow, Uttar Pradesh. [email protected]

Dhat Syndrome is a culture bound syndrome which is commonly found in South East Asia. It was considered as an entity affecting males only but recent literature shows the presence of the entity in female population too. There remains controversy regarding the nosological status of dhat syndrome in the current diagnostic systems of psychiatric disorders. Many researchers question about the diagnostic validity of Dhat Syndrome, as it has been described as phenotypic expression of depression, anxiety or other psychiatric diagnosis. Individuals with Dhat Syndrome have their unique ways of attribution for their symptoms which covers a broad range of entities. The knowledge, attitudes and beliefs of an individual regarding sexuality stems in the second decade of life, thus it is worthy to see it in the perspective of an adolescent. Dhat syndrome has been an under studied topic in literature and thus a detailed knowledge would be deemed useful. Existing literature support the role of psychoeducation, relaxation therapy, cognitive behaviour therapy and anti-anxiety medications in the management of Dhat syndrome. There is a need to study the outcome and diagnostic validity of Dhat syndrome so that a treatment guideline can be formulated for it.

Keywords: Dhat Syndrome, Relaxation, CBT

From Morals to Molecules – Private Practitioners Journey

Swaminath G, Nanasaheb M Patil, Abhay Matkar

Consultant Psychiatrist, Smruthi Clinic, Bangalore, Karnataka. [email protected]

Use of molecules to treat mental illness has revolutionised the management of persons with mental Illness. Pharmacological interventions have resulted in improved functionality of the patient as well as made them amenable to other psychosocial interventions. However given the very unique nature of mental illness, the treatment of persons with mental illness is not straightforward, and it raises a lot of ethical issues. Certain issues involve divergence of views between ethics and practicality of treatment. Consequently, the prescription of these molecules to patients with mental illness has created a lot of ethical and moral issues.

This is conducted by three of us with experience both in academia as well as private practice. We find that these ethical and moral issues have a bearing on the treatment meted out by us to our patients in private practice. These issues encompass prescription practices to persons with mental illness as well as difficulties in translating ethical issues to practice while managing persons with mental illness. The highlights our journey in merging ethical and moral issues and practicality to bring benefit to our patients.

Keywords: Morals, Molecules

Immuno-inflammatory pathways in depression: From biological mechanisms to clinical practice

Siddharth Sarkar, Aniruddha Mukherjee, Vikas Menon

Associate Professor, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Pondicherry. [email protected]

The last couple of decades have seen significant research into the biological underpinnings of major depression. Accumulating evidence indicates that inflammation and depression are bi-directionally linked; however the relationship may be clinically significant only in a certain subset of the subjects. It then becomes important to identify this subgroup from a diagnostic and therapeutic point of view. The will briefly outline the various lines of evidence linking inflammation and depression. Using clues from studies that assess the immunophenotype of depression, the immune signatures of depression and spectrum conditions would be constructed. Current understanding of neurogenic inflammatory mediators both, as potential biomarkers in depression, as well as identification of subgroups in depression would be dealt with. Ramifications of these biomarkers can be many such as aiding a diagnosis of depression and also monitoring the clinical progress and course of these patients. The discussion would then move on to therapeutics; in particular the anti-inflammatory basis of anti-depressants and a summary of the various trials that have studied the role of add-on agents such as omega-3 fatty acids, statins, NSAID’s among others. Based on this, we would address key questions and challenges that may be most relevant to future studies such as most effective treatment duration, timing of these agents and identifying subgroups most likely to respond better to different anti-inflammatory regimens. The is likely to inform and enhance clinical practice and research in this growing area.

Speaker 1: Immune signatures in depression and spectrum conditions

Speaker 2: Identification of depression subgroups by means of inflammatory biomarkers

Speaker 3: Harnessing inflammatory mechanisms to enhance clinical treatment of depression

Kewords: Immuno Inflammatory Pathways, Depression

Attempted Suicides and Suicide Prevention

V. K. Radhakrishnan, Hemendra Singh, SatheshVadasseril,

Professor, Department of Psychiatry, Kottyam Medical College, Kottyam, Kerala. [email protected],

The major risk factor for suicide is mostly an untreated and a frequently undiagnosed mental disorder. Dr Radhakrishnan will be talking about hidden epidemiology of suicide in India. More than one lakh persons (1,33,623) in the country lost their lives by Committing suicide in the year 2016. Hence there is an urgent Need of suicide prevention strategies. Prevention strategies can be looked at an individual, community and universal levels. India is still deficient in having an Effective, relevant and appropriate national suicide prevention plan. Dr. Hemendra Singh will discuss about the Clinical correlations of suicidal attempts in psychiatric patients. It is predominantly based on the Studies done on consecutive psychiatric patients with suicide attempts done in the held at the Emergency Ward of Ramaiah Medical College as well as National Institute of Mental Health and Neuro Sciences (NIMHANS). It throws light on factors associated with high suicide risk in psychiatric patients and the early detection of these factors can prevent suicide. Dr.SatheshVadasseril discusses the gender – based comparison of psycho-socio- demographic and clinical profile of 1300 suicide attempters. The study helps in the selection of appropriate suicide preventive strategies. As the history of suicidal attempt is a risk factor for future suicide, it is high time that the various factors associated with suicide attempt are to be identified to prevent future suicide and also to rehabilitate them psychosocially.

Key Words: Suicide attempts, Psychiatric patients, Suicide Prevention

Cancer and Psycho-sexual Functioning

Dushad Ram, Kishor M, T S Sathyanarayana Rao

Associate Professor, JSS Medical College, Mysore, Mysore, Karnataka. [email protected],

Cancer is by far Considered a devastating terminal illness and emerging cause of preventable death. Cancer related psychological, Cognitive and sexual dysfunction is an area of importance for individuals affected and Researchers and clinicians worldwide because of the close association between them. The presentation gives the overview of their association with various cancers and treatment modalities, biochemical markers implicated, assessment tools and outcome measures. The Presentation is based on integrated model of health care service providers that includes basic science researchers & clinicians, jointly working for understanding-treating- preventing cancer related dysfunctions in the affected population.

After its introduction in 1938 in Italy, the use of electroconvulsive therapy (ECT) expanded during the 1940s. It is the oldest method of somatic treatment, long before chlorpromazine and lithium came. After the initial surge, the use of ECT declined with advent of psychotropics, however its use picked up momentum after 1980s for its utility in drug resistant cases. Although originally used in schizophrenia, presently ECT is considered an effective and relatively safe treatment of severe psychiatric states, including major depression, mania, and schizophrenia. In certain situations, for example, treatment-resistant schizophrenia, ECT augmentation is still the Treatment of choice. overall the use in affective disorders has been the main indication of ECT.

ECT is being prescribed worldwide, around one million patients being treated annually. ECT standards and practice vary markedly between different countries, within same country, and even within individual centers. Several studies have examined the practice of ECT in Asian countries where psychotic and affective disorders predominate the list and a wide variation in usage and clinical profile.

Kashmir Valley has a special geopolitical place and the Data reveals that in conflict situations over the past two decades, there has been a phenomenal increase in psychiatric morbidity in Kashmir and so the need for psychiatric services. The application of ECT has been one the main pivots of psychiatric services in Kashmir.

Cancer & Psychological Morbidity - Dushadram

Cancer & Cognitive Dysfunction –Kishor

Cancer & Sexual Dysfunction - TSS Rao

Key words : Conflict,Electro convulsive therapy,Kashmir,

ECT in Kashmir : Our experience

Majid Shafi Shah, Mansoor Ahmad dar, Fazle Roub, Ubaid Rasool

Senior Resident, GMC Srinagar, Srinagar, Jammu and Kashmir. [email protected]

After its introduction in 1938 in Italy, the use of electroconvulsive therapy (ECT) expanded during the 1940s. It is the oldest method of somatic treatment, long before chlorpromazine and lithium came. After the initial surge, the use of ECT declined with advent of psychotropics, however its use picked up momentum after 1980s for its utility in drug resistant cases. Although originally used in schizophrenia, presently ECT is considered an effective and relatively safe treatment of severe psychiatric states, including major depression, mania, and schizophrenia. In certain situations, for example, treatment-resistant schizophrenia, ECT augmentation is still the treatment of choice Overall the use in affective disorders has been the main indication of ECT.

ECT is being prescribed worldwide, around one million patients being treated annually. ECT standards and practice vary markedly between different countries, within same country, and even within individual centers. Several studies have examined the practice of ECT in Asian countries where psychotic and affective disorders predominate the list and a wide variation in usage and clinical profile.

Kashmir Valley has a special geopolitical place and the data reveals that in the conflict situation over the past two decades, there has been a phenomenal increase in psychiatric morbidity in Kashmir and so the need for psychiatric services. The application of ECT has been one the main pivots of psychiatric services in Kashmir.

Key words : Conflict, Electro convulsive therapy, Kashmir,

Newer insights in neurobiology of OCD using Magnetic Resonance Spectroscopy (1H-MRS)

Gagan Hans, Pratap Sharan, Arpit Parmar

Assistant Professor, All India Institute of Medical Sciences, New Delhi, New Delhi, Delhi. [email protected],

Use of 1H-MRS in understanding neurobiology of psychiatric disorders

Advances in magnetic resonance spectroscopy (MRS) methodology and related analytic strategies allow sophisticated testing of neurobiological models of disease pathology in psychiatric disorders. From its earliest days, psychiatry has sought to relate psychological processes to brain mechanisms. The development and research application of newer imaging modalities is beginning to make this goal feasible. Magnetic resonance spectroscopy (MRS) provides a non-invasive method for characterizing chemistry and cellular features in vivo. The ultimate goals for research and clinical applications of MRS are to fully understand mechanisms underlying psychopathology and to identify relationships between alterations in brain chemical makeup or metabolic homeostasis and symptom expression. The potential to identify specific brain biomarkers for more informed and targeted treatment interventions, and as indices of treatment response separate from symptom abatement that may lag behind, further encourages the pursuit of this important objective.

Neurochemicals as putative vulnerability biomarkers for obsessive compulsive disorder and search for newer regions of interest

Though structural magnetic resonance imaging techniques have demonstrated an association between brain anatomical functions and psychiatric disorders, they have not demonstrated mechanisms underlying this relationship. Magnetic resonance spectroscopy (MRS) provides a non-invasive method to characterize chemistry and cellular features in vivo, which are invaluable in demonstrating the pathogenesis of psychiatric disorders like OCD. MRS has enhanced our knowledge of OCD by demonstrating reduction in neuronal viability in regions previously implicated in the neurobiology of OCD. The symptoms in OCD are closely related with the cortico-striatal-thalamo-cortical (CSTC) circuit, which forms a neural network interconnected with the orbitofrontal cortex (OFC), ACC, DLPFC, striatum, and thalamus. The DLPFC is an important area of cognitive functions including attention, executive function, and memory that are damaged in individuals with OCD.

Evidence for Hyper-glutaminergic state and neurodegeneration in CSTC circuitry in patients with OCD

It is now understood that abnormalities in basal ganglia-frontal cortex interaction are central to the neurobiology of OCD. Further, the technique has provided indirect support for the neurodegenerative hypothesis of OCD, particularly in those regions of the brain already implicated in OCD through structural neuroimaging methods. Many studies have been conducted to identify neurobiology of obsessive compulsive disorder but only few studies are available on treatment-related responses in neurochemicals assessed by magnetic resonance spectroscopy (MRS). There is evidence for hyper glutaminergic state and neurodegeneration in CSTC circuitry in patients with OCD suggested by previous studies using MRS as well as other functional imaging studies.

Keywords: OCD, MRS, Neurobiology

Homeopathy - A New Frontier in Psychiatry

Mahesh Gandhi, Ankur Singal

Consultant, Dr.Gandhi’s Clinic, Mumbai, Maharastra. [email protected],

Samuel Hahnemann, a German doctor, about 200 years ago, founded homeopathy. It is based on the Law of Similars as its core guiding principle.

We, Psychiatrists and other allied fields have been working with George Engels Bio-Psycho-Social conceptual model in the treatment of our patients. It has turned into an Eclectic way of working with the patient where one chooses parts of the model according to his skills to help the patient. With time there is a growing dissatisfaction with this model.

Studies have shown variously that a large number of our patients with various disorders don’t do well in the long term with lot of morbidity. So there is always the possibility of finding new ways to help our patients. Homeopathy as a science is founded on solid principles and has the philosophical underpinning to give a better understanding of the Human behavior and its disorders.

In the practice of Modern Psychiatry a lot of information which the patient can provide if inquired into is not used as we don’t have any framework to use this information. Examples of this can be taking in detail the content of psychopathology that the patient displays which we classify as a particular phenomenon being present in the patient and take it as criteria for diagnosis and don’t go into the experience of what the patient goes through during such phenomenon. There is no place for using the unconscious phenomenon like the dreams which is very much a part of the patient’s psyche. We put little emphasis on what are the likes and dislikes or what are the hobbies and interests of the patient, though we very well understand that these are parts of the patient’s pre-morbid personality.

Dr. Mahesh Gandhi has proposed a new conceptual model called The Personal Evolution Model adapting the principles of Homeopathy to Psychiatry for understanding of the illness and treatment there off with Homeopathic medicines with very good results.

In our presentation we want to propose this as a New Conceptual Model to understand Behavioral disorders and to demonstrate its success in treating patients of various Psychiatric disorders like OCD, Panic, social Phobia, And Bipolar disorders etc.

Keywords: Homeopathy, Psychiatry

on: “Cannabis Use and Mental Illness: The Hen & Egg Dilemma”

Prabhoo Dayal, Om Sai Ramesh, Shiv Prasad

Associate Professor, AIIMS, New Delhi, Delhi. [email protected]

Cannabis, also known as marijuana among other names, is a psychoactive drug from the Cannabis plant intended for medical or recreational use. History of cannabis use is long and it is used for different purposes like- religious, recreational, industrial and medicinal. Several studies have linked cannabis use to increased risk for psychiatric disorders, including psychosis (schizophrenia), depression, anxiety, and substance use disorders, but whether and to what extent it actually causes these conditions is not always easy to determine. The amount of drug, the age of first use, and genetic vulnerability have all been shown to influence this relationship. The strongest evidence to date concerns links between cannabis use and substance use disorders and between cannabis use and psychiatric disorders in those with a pre-existing genetic or other vulnerability. Cannabis use causes dependence and there are pharmacological and non-pharmacological treatments available for it. In the proposed cannabis use, its history, prevalence and concerns will be discussed by Dr. Prabhoo Dayal. The relationship or causal effect between cannabis use and psychiatric illness and evidence for that will be discussed by Dr. Om Sai Ramesh. Different psychological interventions and pharmacological treatments for cannabis use and co-occurring mental illness will be discussed by Dr. Kaloiya and Dr. Shiv Prasad respectively. The will also include natural cannabis and synthetic cannabinoids, increasing risk of psychosis and risk in early user adolescents, legal status of medical and recreational cannabis in world scenario.

Keywords: Cannabis, Mental illness

Models of Vocational Rehabilitation for Persons with Severe Mental illness- NIMHANS Experiences and Challenges

Hareesh Angothu, Deepak Jayarajan, Krishna Prasad, Sivakumar T

Asst Professor, NIMHANS, Bangalore, Karnataka. [email protected],

Severe mental illnesses like schizophrenia, mood disorders, dementia, etc. are known to cause significant occupational dysfunction. Factors influencing such dysfunction could range from symptoms of illness and adverse effects due to medication, to their social, environmental and cultural milieu. Symptoms of severe mental illnesses could interfere with the patient’s ability to learn the skills required to obtain employment – or even to sustain themselves in an occupation which they were previously skilled in – in order to earn their livelihood. After recognizing extent and impact of disability due to mental illness (DDMI) on a person’s ability to be in a vocation, the Government of India (GOI) has enacted the Rights of Persons with Disabilities, 2016, which specifies that a minimum of 1% of all groups of government sector jobs should be reserved for persons with disabilities due to various mental illnesses. There are various kinds of models of employment for persons with mental illness across the world, and include transitional employment, sheltered workshops, individual placement and assistance, buddy system at work, etc. Whatever the vocational model for persons with mental illness, it has been observed that for persons with DDMI to maintain employment, reasonable accommodation at work-place is of paramount importance. The reasonable accommodation required for persons with mental illness could differ significantly from reasonable accommodation provided to persons with disabilities due to other causes. Often, addressing the environmental barriers and improving the access to work would be helpful for persons with physical disabilities. In contrast, persons with DDMI may require flexibility in work or shift timings, reduction in the complexity of the tasks, avoiding task shifting, buddy system at work place, sensitivity of the work supervisors about mental illness etc.

In this , we would like to discuss various models of in practice towards vocational rehabilitation and employment of persons with DDMI, NIMHANS experience in adapting few such models and practical challenges of utilization of such models by professionals at NIMHANS psychiatric rehabilitation along with experiences of few other agencies which were shared with us.

Keywords: Severe Mental illness, Vocational Rehabilitation, NIMHANS

Role of antipsychotics in the management of Depressions

Abdul Qadir Jilani, Anshuman Tiwari, Santosh Kumar Singh

Assistant professor, Era’s Lucknow Medical College, Lucknow, Lucknow, Uttar Pradesh. [email protected]

Major depressive disorder is most common type of serious mental illness with high recurrence rate and morbidity. Further, the response rate to first antidepressant occurs in about two third of patients only. Thus, the complete resolution of all the symptoms may require the use of multiple medications that have different mechanisms of action. The management strategy involves use of single antidepressants to combination of antidepressants along with augmentation and potentiation by other pharmacological agents.

Some authors also believe that concurrent treatment with antidepressants and antipsychotic. This may be due to receptor profiles for atypical antipsychotics which also involve regulation of Monoamine, Glutamate, Gamma-Aminobutyric acid (GABA), Cortisol, and Neurotrophic factors. Hence, many of the atypical antipsychotics are recommended either as monotherapy e.g. Quetiapine, Lurasidone; and others as an adjunctive treatment therapy.

Antipsychotics are also indicated as primary therapeutic agent depending upon clinical profile and course of illness e.g. in the management of treatment resistant depression, depression with psychotic symptoms, bipolar depression, suicidal patients etc. Further, the late onset depression, where melancholic and psychotic symptoms are important phenomenology, often needs atypical antipsychotics as part of management strategy.

In this regard, the presenters will discuss the recent increment in use of antipsychotics in the management of depression under following headings:

Pharmacological profile and mechanism of action: A. Q. Jilani

Indications and clinical uses: Anshuman Tiwari

Special cases and open discussion: Santosh Kumar Singh

Keywords: Antipsychotics, Depression, GABA

Competency Evaluations In Psychiatry – Practical Aspects

Indu V. Nair Smitha C.A., Supriya Desilva, Anil Prabhakaran

Senior Consultant, Mental Health Centre, Trivandrum, Trivandrum, Kerala. [email protected]

From treatment decisions, wills and contracts to self representation in a criminal trial or entering a guilty plea, competence is an essential ingredient of a fair and efficient legal system. The law presumes competence. When the issue of competence is raised, the law does not regard any particular mental disorder as a proxy for incompetence. Eg. Legal standards are rarely framed in terms of diagnostic category, some people with schizophrenia lack testamentary capacity and others do not and the capacities of people with schizophrenia may change over time. Competency evaluations are situation specific.

Three main aspects of competency evaluation are being dealt Within this. Competence to consent of treatment, testamentary capacity (competence to make a will) and fitness to stand trial. The Competence to consent of treatment includes aspects like psychiatric advance directives, statutory surrogate and guardianship.

In India, where psychiatrists have no opportunity for forensic psychiatry training, the need to dwell deeper into these practical aspects is necessary, especially in certain centres. The expects to draw clarity in these matters.

Keywords: Competency, Psychiatry

Current practices in psychosocial rehabilitation for severe mental illness

James J W, shuvabrata poddar, Narendra Kumar Singh,

Ph. D Schloar in Mental Health Rehabilitation, NIMHANS. [email protected]

Background: Psycho social rehabilitation is a range of interventions used to help a person recover from severe mental illness. Psychosocial rehabilitation is provided in institutional and non institutional settings. The objective of this is to discuss about the current practices in psychosocial rehabilitation for severe mental illness in India.

Outline: Psychosocial rehabilitation in an institutional setting

Neuro-psychological rehabilitation for persons with severe mental illness

Community based rehabilitation for severe mental illness.

Keywords: Psychosocial Rehabilitation, Severe Mental illness

Working with Families where a Parent has a Mental Illness

Josy K. Thomas, Jayanta Deb, Soumya Basu

PhD student (Social Work), Monash University, Melbourne, Australia, Caulfield East, Melbourne, Victoria. [email protected]

Over a million Australian children (about 4% of Australia’s population) have at least one parent with a mental illness. Approximately 23% of children in the Victoria State live in a household where a parent has a mental illness. Around 35,000 children live in about 18,500 Victorian families where a parent has a severe mental illness being assisted by specialist mental health services. Children of parents with mental illness are at greater risk of developing a mental health problem later in life. They are at the highest risk if they live with a single parent who has mental illness (Mayberry, 2005). They are more likely to experience a range of psychological, social and financial difficulties which may threaten their development and wellbeing. Research demonstrates that parents with mental illness may be less emotionally available to their children (Reupert & Maybery, 2007), have less support from family or services (Perera et al., 2014), are more likely to experience poverty and homelessness (Reupert et al., 2012), and face discrimination and stigma, which can prevent them from seeking support when needed (Hinshaw, 2005). Research also demonstrates that parents with mental illness may have difficulty responding to their children’s developmental needs due to symptoms and/or medication (Nicholson & Blanche, 1994; Brunette & Dean, 2002), and may be less likely to seek help due to a fear of losing custody of their child (Davies & Allen, 2005; Montgomery et al., 2006; Seeman, 2010).

The Families where a Parent has a Mental Illness (FaPMI) program has been launched as a service development strategy in 2007 by the Department of Health, Government of Victoria State, Australia following increased recognition of the impact of mental illness on parents and other family members, particularly dependent children. The overall aim of the FaPMI Strategy is to reduce the impact of parental mental illness on all family members through timely, coordinated, preventative and supportive action. This, in turn, would deliver greater opportunities and more positive outcomes for all family members. The priority is on better understanding the needs of families where a parent has a mental illness and the associated risks for all family members, including children. This is primarily achieved through service and network development. The details of the program will be discussed.

Keywords: Families, Parent, Mental illness

Indian Psychiatric Society Travel Fellowship: Perspective Sharing, Training Experience and Trajectories for Early Career Psychiatrist

Darpan Kaur, Sujit Kumar Kar, Shubhangi Dere, Chetan Vispute, Suravi Patra

Associate Professor, Department of Psychiatry, MGM Medical College, Navi Mumbai, Mumbai, Maharashtra. [email protected]

Introduction: The Committee for Research and Education Foundation and Training of Indian Psychiatric Society (IPS) has started the Travel Fellowship Training for young life fellow/life ordinary member psychiatrists of IPS. The fellowship training program is of two weeks duration focusing on strengthening the clinical skills of young psychiatrists in their areas of interest by undergoing training in any institute, within the country under the guidance of national experts as mentors for the program with logistic support for travel, stay and facilitation of the official process by the Committee under the auspices of the Indian Psychiatric Society.

Aims and objectives of :

  1. To create awareness among early career psychiatrists in India about the unique opportunity of IPS travel fellowship
  2. To discuss about its scope and objectives of Travel Fellowship Programme initiated by IPS.
  3. To share positive perspectives and learning experiences from the fellowship programme.

Methods: The shall attempt to create awareness and share perspectives of individual recipients of IPS travel fellowship over the past three years. They shall discuss their experiences of the fellowship that they received in their respective areas of training and shall discuss relevant clinical and research aspects of the fellowship. The recipients shall also discuss individual trajectories and how it was beneficial at individual and institutional level.

Conclusion: The shall provide suggestions for collaborative work and future opportunities at national and international level for early career psychiatrists

Speakers and topics covered:

Darpan Kaur: IPS travel fellowship in child and adolescent psychiatry (2015)

Sujit Kumar Kar: IPS travel fellowship in Brain Stimulation (2015)

Shubhangi Dere: IPS travel fellowship in Perinatal Psychiatry (2016)

Chetan Vispute: IPS travel fellowship in Addiction Psychiatry (2017)

Suravi Patra: IPS travel fellowship in Child and Adolescent Psychiatry (2017)

Keywords: Early Career Psychiatrist, Training

Contributions and Future Scope of GHPUs in Mental Health Leadership in India

Rakesh Kumar Chadda, Mamta Sood, Rohit Verma, Koushik Sinha Deb

Assistant Professor, All India Institute of Medical Sciences, New Delhi, New Delhi, Delhi. [email protected]

With time and shift in global philosophy, general hospital psychiatry units (GHPUs) have become the major providers of mental health services in India. GHPUs are also the main training centres for providing undergraduate and postgraduate teaching in psychiatry and allied disciplines. The traces the history of the GHPUs in India from their beginning to the present. Contributions of the GHPUs in the form of service development, teaching, research, community awareness and reducing stigma, and their future scope are discussed. The speakers also deliberate on the new challenges and future directions that GHPUs must undertake in the coming future.

The rise of GHPU – Reflecting on the past to predict the future:

The term “general hospital psychiatry” refers to the psychiatric services in a general hospital or medical school and embodies the idea of integration of mental and physical health care, a concept included as one of the objectives of the National Mental Health Programme of India. The GHPU movement started in India in the 1930s as a part of the western mental hygiene movement, a trend reflected by the social media of the country at the time, which emphasized the need for psychiatric services outside the mental hospitals (The Times of India, 1st April, 1931). The, now famous first GHPU established in Kolkata by Dr. GS Bose in 1933 started under the aegis of the Indian Association for Mental Hygiene with the Carmichael Medical College (now known as RG Kar Medical College) providing only a room and some furnishings. Over time more medical institutions started such services. After World War II the military psychiatrists also took to the task of establishing psychiatric services in India outside mental hospitals, with the likes of Col. Kirpal Singh creating services along the lines of the GHPU model in the armed forces. GHPU services came to the forefront following the Bhore Committee recommendation for setting up psychiatry departments in every general hospital with enhancement of the existing curriculum and training in psychiatry for medical students. Post-graduate training courses started in 1955 Ranchi, Bangalore and in 1956 in Delhi, and subsequently GHPU became the de-facto model for providing Psychiatric services and training in the country.

Role of GHPUs in teaching and training manpower:

GHPUs in medical colleges serve as the main centers for teaching and training in psychiatry for undergraduates and postgraduates. The Medical Council of India (MCI) recommends that every medical college should have a department of psychiatry with a minimum of three faculty members, with outpatient and inpatient facilities, and provisions for various forms of treatment including electroconvulsive therapy. Sadly, approximately one-third of the medical colleges in India do not have adequate psychiatric services and the standards of services in GHPUs vary widely in the rest. GHPUs, however, have contributed significantly to increases in the numbers of qualified psychiatrists in the country in recent times, through the post-graduate training curriculum. Currently, in 176 medical colleges, 451 MD psychiatry seats exist, and in 59 medical colleges 135 seats for Diploma in Psychological Medicine are offered. Premier institutes at AIIMS, New Delhi; PGIMER, Chandigarh; and KGMU, Lucknow have started DM programs in addiction psychiatry, child psychiatry, and geriatric psychiatry, which constitutes a welcome endeavor. Additionally, GHPUs need to increase their training capacity and scope to develop manpower in the field of mental health in form of clinical psychologists, mental health care workers, mental health nurses, social service and occupational therapists.

Psychiatry in Non Psychiatric Settings - the Challenge of GHPUs

GHPUs have brought psychiatry out of the mental hospitals thereby reducing Stigma, not only among patients but also within medical professionals and establishments. The movement towards a biological understanding have brought psychiatry closer to the advances and philosophy of medicine. Integrative teaching now sensitizes residents of other departments to the psychological and psychiatric problems in their respective patients. GHPU psychiatry have evolved with acquisition of new skills, and have developed a new lingo, as it faces new psychiatric problems solvable only through liaison. ICU psychosis, Emergency psychiatry, Peri-partum psychiatry, Pain medicine, Neuropsychiatry, Psycho-immunology, Transplant Psychiatry, End of life care and Onco-psychiatry, represent only a few of the myriad of new ways psychiatry now integrates with other medical specialties. Consultation-liaison (C-L) psychiatry therefore has been recognized as a subspecialty area of clinical psychiatry that encompasses clinical, teaching and research activities of mental health professionals in the non-psychiatric divisions of a general hospital. In 2003, C-L Psychiatry was accredited subspecialty status in the field of psychiatry under the name “Psychosomatic Medicine” in United States. CL-Psychiatry provides a unique way to integrate psychiatry into all other medical specialties, thereby increasing visibility, acceptability, and decreasing stigma associated with the field. Additionally, such integration increases relevance and opens new horizons for research in the subject.

Beyond the Hospital - Role in Community:

Community psychiatry entails different notions in different settings. In western parlance, it is synonymous with therapeutic communities, half way homes or with community psychiatry teams providing in-house treatment to patients. In India, Community psychiatry at present is considered as a movement to provide basic mental health care, to a majority of the population, in a reasonable time-frame, with minimum resources. The GHPU movement can be considered as a first step towards providing universal mental health care to all needful citizens of the country. However, GHPUs are limited by their infrastructure, resource and manpower restrictions. While improving the infrastructure of GHPUs through increased health budgeting remains a urgent need of the hour, the MHGap of the country is too large to be covered only by health budgeting. The GHPUs need to form the nidus of the next phase of the movement, where community and primary care services become implemented and linked with the GHPUs. Creating community outreach centers and training primary care providers, liaising with NGOs, spearheading awareness campaigns and public lectures, utilizing print and television media for ICE, creating patient and care-provider self-help groups, all help in promotion and expansion of mental health awareness and services.

The GHPUs have come a long way from being a psychiatry OPD in a general hospital to being the catalyst of change for community psychiatry in the country.

Keywords: GHPU, Mental Health Leadership

Evidence based Assessment and Management of Dementia

Mina Chandra, R P Beniwal, Nupur Singh

Associate Professor, PGIMER and Dr Ram Manohar Lohia Hospital, Delhi, Delhi. [email protected]

India, a LMIC, currently has 4.4 million people with dementia and the numbers are projected to increase to over 10 million by 2040 (Alzheimer’s International, 2015). Dementia, despite being a common disorder and a global priority as per WHO, is a low priority for Indian policy makers resulting in paucity of trained specialist health care professionals and suitable infrastructure.

The paucity of trained psychiatrists and neurologists has resulted in a treatment gap of nearly 90%. (Ganapathy, 2015; Khurana et al, 2016; Dias, 2004). Even Psychiatry and Neurology training does not adequately focus on dementia assessment and management due to the demands of clinical duties and traditional course curriculum.

Most Indians with dementia live in resource poor settings with limited access to specialised dementia care services. Undiagnosed and untreated dementia puts a tremendous burden on families and caregivers. (Dias et al, 2004) Hence, capacity building for dementia care is an urgent priority.

Changes in nosology of dementia with advent of DSM 5, evidence base for biomarkers for reversible dementia and advances in management of dementia especially psychosocial interventions necessitates a review of our current diagnostic and management practices.

The aims to empower Psychiatrists and other Mental Health professionals with understanding about Evidence Based Assessment and Management of Dementia in clinical settings.

The schedule of presentations for the is as given below:

Evidence based Assessment of Dementia in Clinical Practice: Dr Mina Chandra, DNB (Psychiatry) PhD (Neurology), Associate Professor in Psychiatry, Department of Psychiatry, Centre of Excellence in Mental Health, PGIMER and Dr RML Hospital, New Delhi

Evidence based Pharmacological Management of Dementia: Dr RP Beniwal, MD (Psychiatry), Assistant Professor and Senior Specialist in Psychiatry

Evidence Based Psychosocial Interventions in Dementia: Ms Nupur Singh, MPhil (Psychiatric Social Work) Research Officer

Keywords: Dementia, Management, DSM-5

Childhood Antecedents and Risk for Adult Mental Disorders

Vel Prashanth, Ankit Chaudhary, Deepak MB

Junior Resident, Central Institute of Psychiatry , Ranchi., Ranchi, Jharkhand. [email protected]

The promise of early recognition & prevention of mental disorders lies within integration of development , genetics & neuroscience. The 3 pronged nature of disorders namely Neurodevelopmental, Psychotic and Emotional can be better understood by focussing on their trajectories from childhood and the alterations along the coarse may give clues towards the natural development of later obvious disorders of adults. The aim of this presentation is to study these antecedents and vulnerability markers that give potential clues into identification of future psychiatric disorders. They will be in parts dealing initially with various paradigms of risk factors ranging from Genetics , Temperament, Neuropsychology, Neurobiology and life events followed by discussion of development into adult disorders focusing mainly on psychotic, emotional, anxiety, substance use, personality disorders and finally with concluding discussion on biological commonalities among these and treatment implications. These studies will lead to future implications of novel treatments and one can hope psychiatry may eventually have its own construction of a screening test.

Keywords: Adult Mental Disorders, Childhood Antecedents

Developing a group of Teachers of Psychiatry – Focus on UG training

Mohan Isaac, Kishor M, Vikas Menon, Ashok Reddy, Anil Prabhakaran, Radhakanth C

Professor of Psychiatry and Head, Department of Psychiatry, St.John’s Medical College Hospital, Bangalore, Karnataka. [email protected]

For the last few years a group of teachers lead by Dr. Mohan Isaac has been Conducting, at state Zonal and National IPS fora to Draw attention to the need for a skilled Teachers of psychiatry. These efforts have lead to identifying a need for forming a Teachers group at State level to take their needs forward. One meeting organised at St.John’s Medical College, Bangalore in November 2016 to bring UG Teachers of Psychiatry of the State together was very successful. This was attended by many senior teachers too and showcased UG psychiatry teaching at Various institutions. More skill based programmes for these teachers have been planned. We wish to broaden the scope of such an Endeavor to Zonal and National level. Accordingly we have put together a workshop to highlight sensitivity to such a need and to think through the process of skilling teachers particularly in the area of UG psychiatry training. Through this workshop, we hope to share experiences and build networks to further this cause at every State in the country

Moderators:. Mohan Isaac, Professor of Psychiatry, University of Perth, Australia

Participants sharing experiences and planning further initiatives include the following:

Ashok Reddy K, Director, Government Medical College, Mahbubnagar, Telengana : UG Psychiatry training – Alta Vista – A Director’s view

Kishor M, Associate Professor of Psychiatry, JSS Medical University, Mysore – Efforts to develop an i-ToP group

Vikas Menon, Associate Professor of Psychiatry, JIPMER, Pondicherry - Issues in UG Psychiatry Training

Radhakanth C, Professor of Psychiatry, Maharaja Institute of Medical Sciences, Vijayanagara, AP – UG Psychiatry Training – Teachers’ needs.

Anil Prabhakaran, Professor of Psychiatry, Government Medical College Trivandrum

Ashok MV - What is the way forward in building the Forum for Teacher

Keywords: UG Training, Teachers

School Mental Health Task Force – Training the Trainers

Vel Prashanth, Ankit Chaudhary, Deepak MB

Chief Consultant Psychiatrist, Columbus Hospital, Hyderabad, Telangana. [email protected]

School and college going children and adolescents suffer from various psychiatric disorders which hamper their normal growth and development. Lack of knowledge among parents, teachers and educational instructors and stigma associated with the illnesses play important roles in addressing the school mental health. Training the trainers, teachers, authorities and parents involved in care and upbringing of the school going children and equipping them with the correct knowledge and necessary action would alleviate and resolve majority of the issues plaguing school mental health

Extent and Scope of Education, Prevention Involving Various Stake Holders: Laxmi Naresh Vadlamani

Different aspects of Training the Trainers of Various Eductional Institutions and Universities: Khyati Mehtalia

Acute Intervention and Post Event Issues Related to School Mental Health: Arti Mehta

Keywords: School Mental Health, Training

Interdisciplinary Overlaps Of Psychosomatic Disorders: Tying The Loose Ends

Amlan Kusum Jana, Sujit Sarkhel

Associate Professor of Psychiatry, ICARE Institute of Medical Sciences & Research, Kolkata, West Bengal. [email protected]

Psychosomatic disorders encompass a broad array of disorders, which have prominent physical or somatic manifestations, affecting one or more physiological systems with no demonstrable physiological abnormality. Starting from rigid Cartesian dualism to Franz Alexander’s psychosomatic illnesses to current nosology of DSM 5, these disorders have come a long way. However, an inherent problem is that many of these disorders tend to be conceptualized and managed by varied specialists who focus on the predominant mode of presentation as per the system they are dealing with. As a result, various specialists treat the same disorder under different names. Irritable Bowel syndrome and Fibromyalgia are discussed as two such prototypical conditions. The opening speaker shall discuss how the concept of psychosomatic disorders evolved over time till the current DSM 5. The next speaker shall discuss studies showing significant overlap of similar conditions existing by different names under varying specialties keeping Irritable Bowel Syndrome and Fibromyalgia as prototypes. Finally, based on available literature, the concluding speaker shall propose an unified approach to classification and management of these conditions to prevent unnecessary costs, harassment and resultant therapeutic nihilism in this group of patients.

Keywords: Psychosomatic Disorders, Interdisciplinary

Dissociation, factitiousness and malingering a continuum

Nupur Priya Sinha

Junior resident, Central institute of psychiatry, Ranchi, Jharkhand. [email protected]

Non-specific symptoms that are not explained by organic pathology are extremely frequent in the general population and also in medical settings. Dissociation, factitiousness and malingering have similar presentation in terms of symptomatology, psychodynamic basis, associated factors, assessment results, and phenomenology. They are separated by thin boundaries of consciousness and motivation often not appreciable. will be presented in three headings introduction, evolution of concepts and diagnostic dilemmas, overlap issues and management strategies. Aim of presentation is to evaluate and analyze conceptualization of these disorders, to delineate the diagnostic dilemmas, emphasizing overlap areas and discussing the various treatment strategies and need for further research in future. The classification of dissociation, factitious disorders and malingering has been a matter of debate for eras. We lack substantial research in these fields.

Keywords: Dissociation, Factitiousness, Malingering

Mild Coginitive Impairment- From Diagnostic Dilemma to Management Challenges

Om Prakash, Pallavi Sinha, Saumyajeet Sanyal

Assistant Professor, North Delhi Municipal Corporation Medical College, Delhi, Delhi. [email protected]

Ageing is a worldwide phenomenon. Demographically, nations across both developed and developing world are seeing a boom in the number of individuals in the elderly age group. While some degree of memory impairment is considered normal as the human brain ages, a sub-category of persons develops significant problems in cognition. The cognitive impairment present in normal ageing is subtle and minimal without causing any dysfunction in the patient’s day-to-day living. On the other end of the spectrum is dementia, which carries significant impairment in memory along with other cognitive domains causing an impact on the person’s ability to live independently and manage activities of daily living. In between lies the concept of mild cognitive impairment (MCI), which represents an intermediate state of cognitive impairment. Over the past 25 years, patients with MCI have undergone extensive research from the clinical, imaging, genetic, pathological and epidemiological perspective. The proposed to cover the salient features of the diagnostic entity of mild cognitive impairment.

Diagnostic Challenges for Mild Cognitive Impairment- Om Prakash

Predictors of Development of Dementia- Pallavi Sinha

Management of Mild Cognitive Impairment- Saumyajeet Sanyal

Keywords: Mild Cognitive Impairment, Management, dementia

What to tell ?How much to reveal ?–the art of Psychoeducation in an era of biological Psychiatry

Shubrata KS, Aditya pandurangi, Sridhar KR, Pavitra Ks

Consultant, Sridhar neuropsychiatric centre, shimoga, Karnataka. [email protected]

Psycho education is the provision of systematic, relevant, broad, and up-to-date information about an illness or condition, including its diagnosis and treatment. Psycho educational programs provide both disease specific information, e.g., early recognition and management of relapse symptoms or any potential genetic implications of the illness and general information e.g., promotion of healthy lifestyle, problem-solving and communication skills training, identification of stressors in households, and education of family members and primary care takers in their amelioration. Furthermore, psychoeducation includes information on how to explain aspects of living with an illness to family members so that they can understand the effect of the illness and assist the patient and treatment providers in the treatment program. The modern and rapid developments in Psychiatry poses challenges to a clinician as to the ways one needs to follow to impart psychoeducationto his patients. But even in this era of biological psychiatry, there is evidence that psychoeducation improves the outcomes of mental illness and many other medical illnesses. Family interventions, including psychoeducation for schizophrenia, have proved to be one of the most consistently effective treatment modalities available, with relapse rate reduction at 50–60% over treatment as usual.

Thus the Psychoeducation training is an important learning in Postgraduate psychiatric education.It should cover four major areas: (a) information about the illness, (b) recognition and management of early warning signs, (c) lifestyle management, including how to ameliorate stress in families and household groups, and (d) importance of involvement of relatives and primary care providers. The will discuss the importance of psychoeducation in today’s Psychiatric scenario,the aspects of psychoeducation with relevance to different psychiatric disorders and the training to be imparted regarding psychoeducation in postgraduate training.

Keywords: Psycho-education, Biological Psychiatry

Mental Health in tribal populations

Pallab K Maulik, Siddhardha Devarapalli, Sudha Kallakuri, Abha Tewari

Deputy Director, George institute for Global Health India, New Delhi, Delhi. [email protected]

Background/Introduction: There is scant literature on mental health in tribal populations and there is a definite need for more research in that area. The current will outline the results of a systematic review on mental health from tribal population in India and outline quantitative and qualitative results from an intervention conducted in tribal populations to provide mental health services.

Methodology/ Materials and Methods: The systematic review focused on mental health research conducted on tribal population in India between 1980 and 2017. Multiple databases were searched and the data was collated and presented in narrative format due to heterogeneity of the studies. The intervention was a mHealth based mental health services delivery model that used task sharing, training of primary care health workers and doctors in mental health, providing a technology enabled electronic decision support tool and conducting a large anti-stigma campaign. Mixed methods were used to evaluate the outcomes. A pre-post analysis was used.

Results: The systematic review identified 31 studies with a primary focus on common mental disorders and alcohol and substance use. Most studies were cross-sectional. The intervention resulted in a 1500 times increase in accessing mental health care and significant reduction in depression and anxiety post-intervention. Qualitative results identified a number of barriers and facilitators.

Conclusion: The systematic review identified huge gaps in knowledge and quality studies, which highlights the need for more studies on tribal populations. The intervention demonstrated the feasibility and acceptability of a mHealth based service delivery model in this population, and the need to explore strategies that could build on concepts used in the intervention to scale up services.

Key words: mental health in tribal populations, Mental health, mental health services, task sharing, stigma, common mental disorders

Distribution and determinants of psychiatric disorders among urban adults of Kolkata

Pradip Kumar Saha, Soumyadeep Saha, Tanmay Mahapatra

Director and Head, Institute of Psychiatry, Kolkata, West Bengal. [email protected]

Introduction: Alike global scenario, the silent epidemic of psychiatric disorders is currently a major public health concern in India. Social avoidance, denial, high latency period and resource-intensive diagnostic tools collectively culminate into a serious threat to the internal and external validity of findings regarding the distribution and determinants of these disorders through epidemiological studies conducted here. Consequently, there exists a dearth of population level data even from urban areas, more so in the eastern part.

Methodology: A population-based cross-sectional study was conducted in the ward no. 93 of Kolkata, the state capital of West Bengal, as a part of the first-ever on-and-offline synchronized, android-based, algorithm-defined, pre-validated psychiatric diagnostic approach in India. Using a proportional stratified random sampling method with a systematic component, through door-to-door visits, a representative sample of 1389 (as per the determined sample size) consenting (self or legally-authorized-representatives) adults were interviewed and the collected information were analyzed using SAS-9.4 to determine the distribution [frequency (95% confidence intervals: 95%CI)] of common psychiatric disorders and quantify their associations [adjusted odds ratio: AOR (95%CI)] with potential socio-demographic correlates though logistic regressions.

Results: Agoraphobia [29.6% (27.2-32.0)] was the commonest psychiatric disorder followed by obsessive compulsive disorder (OCD) [28.0% (25.6-30.4)], psychotic disorders [16.6% (14.6-18.5)], major depressive episodes (MDE) [17.4% (15.4-19.4)], social phobia [13.5% (11.7-15.3)]. About 10.9% (9.2-12.5) adults had high suicidal risks, 8.0% (6.6-9.4) had hypomanic episodes and 5.3% (4.2-6.5)] were suffering from generalized anxiety disorders (GAD). Urban young adults were specifically prone to most of the psychiatric disorders as opposed to their older counterparts. MDE and social phobia were more common among females compared to males. In addition to these two, OCD and GAD were more frequent among non-marginalized with reference to marginalized castes. With reference to poor, social phobia was more likely among wealthier while middle-class people had higher likelihood of GAD. With respect to unmarried, MDE and suicidality were higher while agoraphobia was lower among married women.

Conclusion: Burden of psychiatric ailments was observed to be quite high among urban adults of Kolkata.

Targeted intervention (for high-risk population groups) to enhance awareness for timely seeking of appropriate care and provision for efficient management of the problems through adequate treatment and counselling seemed to be the need of the hour.

Keywords: Psychiatric Disorders, Agaraphobia

Hands on Zotero reference manager software

Nishant Goyal, Hariom Pachori

Assistant Prof of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand. [email protected]

Now-a-days if we are in mental health research, managing references is a big problem. Reference management softwares are difficult to use and users needs to purchase the license on a regular basis. Researchers often encounter many problems to manage reference and this problem become more serious if we prepare our manuscript for a specific journal, as per their Guidelines, referencing style is also going to be different. Researchers generally are puzzled with different style of referencing. After this workshop participant would be able to manage references easily.

Zotero is the only research tool that automatically senses content in your web browser, allowing you to add it to your personal library with a single click. Whether you’re searching for a preprint on, a journal article from PubMed, a news story from the New York Times, or a book from your university library catalog, Zotero has you covered with support for thousands of sites. Zotero collects all your research in a single, searchable interface. You can add PDFs, images, audio and video files, snapshots of web pages, and really anything else. Zotero automatically indexes the full-text content of your library, enabling you to find exactly what you’re looking for with just a few keystrokes. This is open source software.

Keywords: Mental Health Research, Referencing styles, Zotero

Title of Presentation:

Overview of Zotero reference manager software: Nishant Goyal

Hands of demonstration of Zotero reference manager software: Hariom Pachori

Keywords: Software, Zotero

Positive Parenting

Om Sai Ramesh V., Sumit Rana, Sunaina Hooda

Assistant Professor, Lady Hardinge Medical College, New Delhi, New Delhi. [email protected]

Introduction: Entire globe is talking about adolescent problems. Many of them are not falling under criteria of any psychiatric disorder. Parenting has a role in raising a child so that the problems of the adolescent can be minimised. Parenting however is increasingly becoming more difficult due to changing times and circumstances. Parents are often found to be overwhelmed by the problems associated with children and adolescents. Based on the motto of “3Ps: Prevention, Promotion of Positive mental health” the current workshop focuses on development of parenting skills so that the children are better equipped to deal with the adolescence when it comes.

Workshop Objectives: Orienting the participants about the parenting styles.

Identifying the positive parenting styles.

Demonstrating the positive parenting skills to be used in daily life.

Analysing the negotiating strategies of parenting for healthy, positive living.

Create environment for healthy learning which also strengthens the parent-child relationship.

Learning Outcomes: Awareness of various parenting styles.

Learn to include Positive Parenting skills in daily life and customizing them as per the child’s needs.

Skills to negotiate with the child in daily life experiences.

Applying those skills without hampering the parent-child relationship.

Keywords: Positive parenting, Parenting Styles

Autism Spectrum Disorder - Current Scenario and Sensory Processing Issues

Rita Roy, Kaberi Bhattacharya, Rudraprasad Acharya

Psychiatrist, IPGME&R, SSKM Hospital, Kolkata, West Bengal. [email protected]

An overview of Autism: Environmental, biological and genetic factors have gained importance in the cause theory of Autism. Atypical sensory based behaviors are ubiquitous features of ASD. The distress caused by particular sensory stimuli can cause self injurious and aggressive behavior in those unable communicates their difficulties.

Symptom profile among children aged 2 – 7 years with special emphasis on sensory processing issues: an ongoing study in the Neurodevelopment clinic of Kolkata demonstrates the importance of detection and management of sensory processing issues among ASD patients. Behaviors like hyperactivity, being meltdowns, Aggression, catering to the sensory issues lead to remarkable improvement in behavior and responsivity among autistic children.

Adolescence issues in ASD: issues of socialization and sexual behavior present in a novel way during adolescence for individuals with autism. Social skills training play a vital role in management.

Sensory integration in diverse population (Pediatric): Neurological processing and sensory integration contribute to emotional regulation, learning, behavior and participation in daily life. Sensory integration focus’s primarily – in the areas of Tactile, proprioceptive, vestibular, auditory and visual senses. These senses are all interconnected to each other and also to other areas of brain. Sensory integration therapy helps the child in organization of CNS responses in the form of inhibition or modulation of sensory information and to give back an organized response.

Keywords: Autism Spectrum Disorder, Adolescent, Pediatric

A Study of Prisoners in a Tertiary Psychiatric Institute

V.Sabitha, S.Bevin, Shanthi Nambi

Associate Professor, Institute Of Mental Health Chennai, Chennai, [email protected]

Background: Prisoners are associated with high percentage of psychiatric disorders. Majority of the studies done are from the western back ground. Studies in India are very limited and mostly done in prison setting.

Aim: To assess the crime pattern and psychiatric morbidity in tertiary psychiatric hospital

Materials and methods: The data of 354 prisoners referred to Institute of Mental Health, Chennai from 2001 to 2016 were assessed. Socio-demographic profile, criminological history, clinical history and psychiatric diagnosis made as per ICD-10 was obtained. The methodology used was retrospective chart review.

Results: 34.7 was the mean age of prisoners. 85% were males, 14.6% were females and one transgender. 70.6% belonged to the rural back ground. 36.7% were semi-skilled labourers. 59% belonged to the lower socioeconomic group. 61.3% prisoners were married. 35.6% had primary school education and 25.4% were illiterate. Murder (40.4%) was the most common crime. On comparing the data between male and female prisoners, 76.9% males and 23.1% females have committed murder. Family members (61.5%) were the most common victim in murder. Among the family members, parents (39.8%) were the common victims. On comparing the victim details among males and females, 80% kids were murdered by female prisoners. Schizophrenia (40.1%) was the most common diagnosis followed by substance dependence(13.0%). On comparison, schizophrenia(90.1%) was most common among male prisoners and depression(50%) is most common among female prisoners.

Conclusion: There was found to be a strong relationship between psychiatric morbidity and crime. Early identification, intervention and treatment could reduce the crime rate which poses a great challenge for the psychiatrist and policy makers.

Keywords: Prisoners, Socio demographic profile, crime, psychiatric morbidity

Mental Health Care Act 2017

Rajeev Jain, Jaiprakash Narayan Yadav

Associate Professor, F H Medical College, Agra, Uttar Pradesh. [email protected]

After assent of the honorable President of India on 7th of April 2017. The Mental Health care Act 2017 has come Into existence. The preparation of the bill has begun almost ten years back from now. While the 1987 Mental Health Act was solely conceived piloted drafted and prepared by psychiatrists under banner of Indian Psychiatric Society, the current bill is brainchild of Dr Patahre’s International School of law situated at Pune. Though marathon relies of discussion among organizations/ stakeholders/individuals/associations, the Professional body like IPS has no influence on this bill. As a signatory United Nations Convention on the Rights of Persons with Disabilities in 2007 there has to be need to aligning many laws concerning various disabled groups of persons in society. The Act, as per definition, aims to protect, only those mentally ill who have grossly impaired judgment, behaviour, capacity to recognize reality to the extent not able to meet day to day requirement. The admission of such patients, who are incapacitated for valid consent and severely lost capacity to recognize reality, while admitted for purpose of treatment or rehabilitation is considered to be protected by law in regard to their civil rights. This rather very contradictory to the basic principle laid down in the Act to apply the same rules on the various psychiatric patients admitted without such gross loss of capacity and have compulsory review. The act has been categorically applicable to admissions as this has also come Into definition of mental health establishment Health Establishment definition in the act also. This is understandable that the person as defined in act as mental illness who has lost capacity for consent and restricted with freedom of movement or kept in requires protection by law. This is unthinkable to have countrywide review of all Psychiatric Patients admitted. How the judicial review of such a large number of admission is possible while the judicial system is not able to cope the pending cases in courts.

Keywords: Mental Health Care Bill, Disabilities

BPSD, delirium and late onset psychosis in dementia– a clinical approach to diagnose, differentiate and manage

SC Tiwari, AN Ramakrishnan, Akanksha Sonal, Nisha M Pandey

Professor & Head, King George, Lucknow, Uttar Pradesh. [email protected]

Often dementia gets complicated with development of behavioural and psychological symptoms (70 to 90%), delirium and psychosis. In addition, there are patients of late onset psychosis in old age. It is reported that amongst elderly 15% of schizophrenic cases constitute late onset psychosis and 4% very late onset. These clinical conditions are often very confusing and require a clear differential diagnosis and management plan.

In this under the aegis of Indian Psychiatric Society’s Geriatric Psychiatry Specialty Section and Indian Association for Geriatric Mental Health the presenters will be presenting about clinical approaches to diagnose, differentiate and manage these conditions which are often problematic in tertiary care psycho-geriatric centres. The following is the format of Presentation.

Dementia and BPSD: A clinical approach to diagnose, differentiate and manage SC Tiwari

Delirium and late onset psychosis – A clinical approach to diagnose, differentiate and manage: A. N. Ramakrishnan

Managing delirium, BPSD and late onset psychosis: Akanksha Sonal

Psycho education to care giver in management of these conditions: Nisha M Pandey

Keywords: BPSD, Dementia, Clinical approach

Child Sexual Abuse: The Agony and Distress Within

T.S. Sathyanarayana Rao, Prakash B. Behere, Gautam Saha, Savita Malhotra, Shabiullah Syyed, Kaveri N. Chougule, Nikhil Chougule

Resident in Psychiatry, Dr. D.Y. Patil Medical College, Hospital And Research Institute, Kolhapur, Maharashtra. [email protected]

Child sexual abuse is the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent, or that violates the laws or social taboos of society. The global prevalence of child sexual abuse has been estimated at 19.7 % for females and 7.9 % for males. Most sexual abuse offenders are acquainted with their victims; approximately 30 % are relatives of the child, most often brothers, fathers, uncles, or cousins; around 60 % are other acquaintances, such as “friends” of the family, babysitters, or neighbours; strangers are the offenders in approximately 10 % of child sexual abuse cases.

Child abuse in one or another form has existed in almost all societies however; recognition of child abuse is of recent origin. Nearly 53 % of children faced some sort of sexual abuse; of which 52 % were boys and 47.06 % girls. Every fifth girl child and every twentieth boy is facing sexual abuse. More than 70 % of abusers are either immediate family members or acquaintances.

There are several physical, psychological and behavioural symptoms implicated in sexual abuse like dysmenorrhoea, GI disturbances, somatisation, depression, PTSD, cognitive impairment and substance abuse. This suggests the need to increase the awareness regarding CSA and sensitize the prime persons in a child’s life viz. parents, teachers and peers, who can bring a definite change in the intervention by reporting it early. There is need of sensitization of children, parents & teachers in school. Teachers in school themselves are inadequately sensitized and sex education is a mere formality. The post disclosure protocol needs to be strictly followed by all caregiversas it might lead to child mistrusting everyone if disclosure is not appropriately and empathetically addressed. A correlation exists between childhood abuse and sexual abuse to the adulthood psychiatric disorders, the etiopathogenic pathway may vary individually and is difficult to discern.

The most recent amendment in India is in the “Criminal Law Act 2013” safeguarding the children. It is especially important in the Indian context to make sure that these laws are strictly implemented. Collaborative effort on the part of parents, teachers, NGO’s, paediatricians and the children themselves is the need of the hour to help fight the problem of sexual abuse of children. Children’s involvement in the child protection policy is a must and special focus in the areas of handling young perpetrators, sensitization of police personnel about contact and non-contact abuse and also the reintegration of referral services.

The focus in tackling the problem of sexual abuse of children requires adoption of the five R’s - Raising the issue, Reaching out, Remembering the risk factors, Recognizing warning signs and most importantly Reporting the suspect cases.

Commonly associated misconceptions with this issue are that - abuse is always violent, only bad people abuse their children, child abuse doesn’t happen in “good” families, most child abusers are strangers, abused children always grow up to be abusers.

Addressing these misconceptions is the need of the hour. A child’s best interest can be served only when all the related agencies work in unison keeping the ultimate goal in mind i.e., the welfare of the child. The victims /survivors need a very strong support.

Keywords: Child, Sexual Abuse

Cognitive Behaviour Therapy for Alcoholism

Shahul Ameen

Psychiatrist, St. Thomas Hospital, Changanacherry, Kerala. [email protected]

Relapses in patients with alcoholism can usually be attributed to psychological factors like classical conditioning, operant conditioning, modelling and cognitive mediation. Identification of specific factors which are responsible for relapse in a particular patient, and helping the patient overcome the influence of such factors if they arise in the future, are the cornerstones of cognitive behaviour therapy (CBT) for alcoholism. This workshop will discuss various CBT techniques for management of alcoholism.

Keywords: CBT, Alcoholism

At Loggerheads - Treatment guidelines and Prescription practices

Shivaji Marella, Shivam Sunil, Akanksha Gajbhiye

JRIII, Dr D Y Patil Medical College, Pune, Maharashtra. [email protected]

Treatment guidelines and evidence based medicine have been promoted to enhance outcomes, reduce malpractices and minimise treatment related adverse events.

At the same time research into prescribing practices for psychotropic medication demonstrate a wide variation in prescriptions written for the same conditions in similar patients. This variation is noted at multiple levels. Variation could be because of the source of prescription - psychiatrist vs general practitioner vs other specialist. Differences have been noted on age and gender. A clinician may add medications due to inadequate response and not change this regimen once improvement is seen. Co-prescription may occur because of a halt called in cross titration. There is a pressure on psychiatrists to reduce hospital stays which leads to increased pressure towards poly-pharmacy. The issue of companies marketing to doctors and perhaps influencing their treatment decisions is germane to prescription practice trends. Busier doctors have different prescribing habits compared to their less pressured colleagues. Available mental health facilities also bias the type and number of medications prescribed.

In the literature multiple strategies have been suggested and studied to reconcile scientific recommendations with clinical practice. Among these CME programs and a regular look at current best evidence find particular mention.

This will discuss prescribing trends With respect to disorders and classes of psychotropic medications in India and some other countries and compare them with best practices. It will discuss the possible ways by which to integrate the evidentiary science and the clinical art of psychopharmacology.

Keywords: Treatment guidelines, Prescription practices

Psychiatric Forensic Interview - A workshop

C. L. Narayan, Ivan S. Netto, Santosh Chavan, Samiksha Sahu

JRIII, Dr D Y Patil Medical College, Pune, Maharashtra. [email protected]

A forensic psychiatry interview is necessary in multiple contexts - to wit - criminal and civil judicial proceedings, matters pertaining to finances and property of an individual and independent medical examinations requested by employers and insurers. The forensic evaluation frequently alters the doctor - evaluee relationship from its typical context as the issues of privacy and consequences of findings are very different. This consideration highlights the requirement for informed consent in context. The forensic interview may be complicated by a prior treatment relationship which compromises the objectivity and ethical considerations applicable.

It is necessary, on the part of the psychiatrist, to have great clarity regarding the specific legal questions asked, the laws and regulations which apply and the professional ethical guidelines. A deep knowledge of technique and procedure for the psychiatric interview in this setting as well as applicable standardised questionnaires is also vital. The outcome of such an interview has life and death import in criminal cases.

Indian authors writing in the IJP have bemoaned the inadequacy of training and lack of uniform best practices followed throughout India for forensic interviews. Recently this matter has taken centre-stage in widely reported court cases at trial and appeal stages.

The Forensic Psychiatry Specialty Division of the Indian Psychiatric Society has resolved to make an effort to promote training of PG students and continue education of practicing psychiatrists. To this end a workshop will be conducted consisting of:-

-Video Clips of a role played interview

-Real time audience interaction

-Expert advice by the Chairpersons of the specialty division

-Discussion of relevant techniques, instruments and laws,

in the context of establishment of Criminal Responsibility.

A Case Based Heuristic Approach to Primary Beningn Headaches

Aleem Siddiqui, Shobit Garg, Shazia Veqar Siddiqui

Assistant Professor, Sgrrim&Hs, Dehradun, Uttarakhand. [email protected]


Headache disorders account for more disability (currently being ranked 6th) than all other neurological disorders (including dementias) and 2nd only to depression, despite having no association with mortality. Diagnostic overlap between the primary headaches and psychiatric morbidities and poorly defined treatment approach neglecting the more heuristic BIOPSYCHOSOCIAL factors results in poor outcomes and tolerability. We intend to discuss this heuristic BIOPSYCHOSOCIAL approach in primary headaches in three presentations (each 30 minutes).

In first presentation, titled “BIOPSYCHOSOCIAL APPROACH TO PRIMARY HEADACHES: A CASE BASED PARADIGM” we would like to discuss the primary benign headaches mainly migraine, TTH, clusters and chronic daily headaches (comprising 90 % of these headaches). Neurobiological basis, clinical presentations (both atypical and typical), misconceptions hindering evaluation and diagnosis, red flags and evidence based management and neurology-psychiatry interface will be discussed.

Aleem Siddiqui (Associate Professor, Psychiatry Department, Era Medical College, Lucknow

In second presentation, titled “BIOPSYCHOSOCIAL APPROACH TO PSYCHIATRIC COMORBIDITIES AND HEADACHE: A CASE BASED PARADIGM”, we would like to discuss the psychiatric morbidities having phenotypic expressions as headache, the psychiatric co-morbidities (like depression, anxiety, substance and Bipolar disorders) with headache, the underlying mechanisms of comorbidities, proper identification and evidence based management and neurology-psychiatry interface in these conditions.

Dr Shobit Garg (Assistant Professor, Psychiatry department, SGGRRIM&HS, DEHRADUN,

In third presentation, titled “PSYCHOTHERAPEUTICS IN HEADACHE: A CASE BASED APPROACH”, psychotherapeutic approach addressing predisposing, precipitating and perpetuating psychosocial factors affecting primary headaches and psychiatric (co) morbidities alongwith treatment options (as per recommendation of US Headache Consortium system) in terms of Behaviour therapy (includes relaxation therapy, biofeedback, hypnosis), Cognitive Behaviour Therapy (CBT), coping skills and stress management would be addressed. When and whom to treat would be discussed, from psychologist point of view.

Dr Shazia Veqar Siddiqui ((Consultant Clinical Psychologist Lucknow).

All three presentations will have Case Vignettes to propel case based approach for better symptom analysis and understanding.

Keywords: Primary Beningn Headaches, Biopsychosocial

The nuts and bolts of performing a peer review

Siddharth Sarkar, Yatan Pal Singh Balhara, Rohit Verma, Ashwani Kumar Mishra, Roshan Bhad

Assistant Professor, AIIMS, New Delhi, New Delhi, Delhi. [email protected]

Increasingly, as a part of academic commitment and involvement, psychiatrists are asked to engage in peer review process. Peer review entails critical appraisal of the research work conducted by another individual/ team and which are sent for publication. The peer review process is quite often blinded, i.e. the person conducting the peer review is not aware of the identity of the individual(s) who had conducted the research. This workshop is aimed at mental health professionals who are / plan to engage in peer review for academic journals. The workshop is also likely to be helpful for the residents at it will help them gain understanding in carrying out a critical evaluation of scientific literature. Additionally, the tools and resources that can help one become a good reviewer shall be discussed.

The workshop shall include the following components-


The first section shall introduce the participants to the workshop and its layout. This section shall present an overview of the peer review process, need to engage in peer review, potential benefits of being a peer reviewer and process of peer review.

Hands on exercise on peer review

This section shall focus on a hands-on exercise on carrying out review of a scientific article. The participants shall be guided through the peer review process using specimen articles. They shall carry out a hands-on exercise on conducting the review in small groups and then present their findings. These shall be discussed subsequently.

Resources for peer reviewers

This section shall present the resources on being a good peer reviewer to the participants.

Discussion and feedback

The final section shall focus on the discussion based on the workshop, including the queries on the same.

E-cigarettes in adolescents: Issues and challenges

Sonali Jhanjee, Raka Jain, Piyali Mandal

Professor, All India Institute Of Medical Sciences, New Delhi, Delhi. [email protected]

Electronic cigarettes(EC’s) are devices that deliver nicotine to the user Vaporizing a solution that usually contains nicotine, propylene glycol and/or glycerol, plus flavours. The number of EC’s sold has increased exponentially since their introduction. The foremost reason for their growth is that they are perceived as a reduced harm alternative to traditional cigarettes as purportedly they do not burn tobacco and hence harmful products of combustion, such as tar and carbon monoxide are not generated. However many concerns regarding their use persist. Although e-cigarettes are free of combustion, they have different chemicals that could pose harm to health like propylene glycol, glycerine and added flavors. E-cigarettes deliver nicotine by creating an aerosol of ultrafine particles which may pose significant health risks in terms of respiratory and cardiovascular problems Additionally in adolescent population of concern is the fact that a substantial proportion of adolescents who are not using cigarettes or other combustible tobacco products are using e-cigarettes. There is also a concern about “Gateway effects” or risk of progression to cigarette smoking amongst adolescents who use e-cigarettes. Recent longitudinal studies have established associations between e-cigarette use and later smoking initiation. A U.S Surgeon general report states that E-cigarettes are now the most commonly used Tobacco products among youth, surpassing conventional cigarettes in 2014. Flavoured EC products are used disproportionately by youth and added flavors are a common reason for initiation. Of further concern is that now some adolescents are using e-cigarettes for making Smoke tricks, “dripping” and also use them to administer marijuana. Strong e-cigarette regulation could potentially curb use among youth and possibly limit the future population-level burden of cigarette smoking.

Key words: ENDS; e-cigarettes, adolescents

Autism Spectrum Disorder: Setting up of a multi-disciplinary assessment service, differential diagnosis and exploring its link with attachment disorder and developmental trauma

Anupam Thakur, Soumya Basu

Associate Prof Soumya Basu, Adjunct Associate Prof in Department of Psychiatry and Psychology, Monash University, Melbourne, Australia & Child and Adolescent Psychiatrist, Early in Life Mental health Services, Monash Health, Melbourne Australia, Consultant of the Neurodevelopment Assessment clinic, Monash Health and Latrobe Regional Hospital, Victoria, Australia. [email protected]

Introduction: Autism Spectrum disorder (ASD) though a neurodevelopmental disorder remains a diagnosis defined completely on the basis of behaviour; diagnostic assessment is both complex and expensive. Reports from both the USA and the UK have estimated costs to families of more than 3 to 5 million dollars beyond the ordinary lifetime costs of raising a child this is mainly due to loss of income from employment. Early diagnosis and treatment has been linked with improving of symptoms, reduction in disease burden, total burden of the disease and linked with access to funding. There has been a more than tenfold increase in the diagnosis of ASD in the last 20 years. What was once thought to be a rare disorder seems to be as common as 1 in 60. Although the main driver of the increase incidence of ASD has been better recognition of the condition and better awareness, one of the factors contributing to the increase in diagnosis was thought to be the criteria in DSM IV to diagnose ASD, hence there was a drastic revision of the diagnostic criteria with an intention to curb the possible over-diagnosis of ASD. DSM 5 criteria has been criticised as too restrictive which mightn’t detect subtle variations of ASD. While it is apparent that the proposed changes was clearly targeted to decrease the over diagnosis of ASD, there is an argument that Checklist approach which can be used by the DSM diagnostic system can be used to diagnose any psychiatric llness that can have a major impact in the way ASD is diagnosed and there is a need to have a more broad-based understanding of the symptoms that patients of ASD present with.

Aim of the Workshop: This workshop would essentially be divided into two parts. It would bring in experience from three continents Australia, Europe and North America about setting up a multi-disciplinary team consisting of Psychologists, Speech-therapists, Occupational Therapists and Psychiatrists and the need for a standardised assessment and reporting of cases of ASD. In the second part It would present the findings from two such clinics set up in Australia in a child psychiatric setup and discuss the common differential diagnosis that needs to be looked for in children presenting with ASD like symptoms. It would then tackle the complex and controversial issue of ASD and Attachment and Developmental trauma. The similarities in presentations, co-morbidities of these conditions and neurobiology would be discussed. Instructional methods include small and large group discussion.

Conclusion: There should be a cautious, thoughtful and multidisciplinary approach in the diagnosis of ASD. A combination of a thorough developmental and psychiatric assessment and then specific assessments should be the aimed specially for complex cases along with a formulation about the current predicament, which is more than merely a diagnostic formulation. Early Developmental trauma, neglect and attachment disruptions can mimic a lot of symptoms of ASD and despite the controversies its time to recognise these in clinical cold-face and research.

Keywords: Autism Spectrum Disorder, Developmental Trauma

New psychoactive substances: where do we stand now?

Manosij Maity, Bikramaditya Jaiswal, Sourav Khanra

Assistant Professor, Central Institute of Psychiatry, Ranchi, Ranchi, Jharkhand. [email protected]

Use of new psychoactive substances (NPS) is on rise. According to consecutive reports from United Office on Drugs and Crime (UNODC), no subcontinent including south-east Asia on this planet is free from this epidemic. NPSs are emerging at a very high rate upto one per week across the world along with incoming reports of their heterogeneous chemical nature, patterns of use and physical and psychological side effects. Although exhaustive lists exist for their street names, chemically most of them so far fall under few classes namely piperazine, cathinones, cannabinoids etc. Physical and psychological side effects are numerous and complicated more so in psychiatric patient populations. Though no controlled human studies are available, single case reports and anecdotal reports point toward this. For its ‘unknowing’ nature, several countries have promptly reacted to this and introduced legal provisions to curb its supply before their use converts into an epidemic. Unfortunately, none of these did have a significant impact on its supply to its targeted population. Therefore, its need of the hour for all stakeholders to collaborate and initiate research thereby leading to appropriate guidelines for medical and psychological care, long term policies in social sector, and legal provisions.

Keywords: Psychoactive substances, Newer

Malingering in Psychiatry: Is it Moving from West to East?

Susanta K Padhy, Swapnajeet Sahoo, Akhilesh Sharma,

Senior Resident, PGIMER,Chandigarh. [email protected]

Malingering is conceptualized in contemporary clinical practice as a condition requiring clinical attention. The malingering of psychiatric disorders is perhaps more prevalent than previously thought and is associated with considerable cost to the society. It is estimated that the prevalence of malingering among mental health patients is around 1% as per the Western data but the exact prevalence in Indian context is not available. There is no Foolproof method to identify malingerers and its detection and management raise complex methodological, ethical and legal questions. Moreover, after the widespread awareness of general public about various signs and symptoms of mental illnesses over electronic media and more legal empowerment of the persons with mental illness, insurance coverage for treatment of psychiatric illness as per provisions of the Mental health care act 2017, it can be assumed that in the upcoming years more and more issues related to malingering can crop up. There is an urgent need to orient, raise awareness in young psychiatrists in India about how to handle legally and administratively cases of malingering and how to safeguard ourselves without harming the client or society. In this , Dr Susanta K Padhy will talk about the concept and nosology of Malingering, Dr Swapnajeet Sahoo will talk about the when and how to suspect malingering and Dr Akhilesh Sharma will discuss on how to manage and safeguard one’s own interests.

Keywords: Malingering, West to East

Lithium and Kidney: “Well Known” to Something “Yet to Know”

Samir Kumar Praharaj, Ravindra Munoli

Assistant Professor, Kasturba Medical College, Manipal, Karnataka. [email protected]

Lithium has been a widely prescribed molecule for the treatment for bipolar affective disorders for decades. It has also been used in many psychiatric conditions as a valuable adjunctive. Despite its wide use, lithium has been problematic due to its narrow therapeutic index and concerns for its toxicity in various organ systems. Although uncommon, renal system may get affected due to long term lithium treatment. The renal side effects associated with lithium include polyuria, nephrogenic diabetes insipidus, proteinuria, distal renal tubular acidosis and reduction in glomerular filtration rate. Histologically, chronic lithium nephrotoxicity is characterized by interstitial nephritis with microcyst formation and occasional focal segmental glomerulosclerosis. Several mechanisms such as blocks of sodium transportation through the amiloride-sensitive epithelial sodium channel and hyperparathyroidism were descriptive for the lithium nephropathy. Also, downregulated aquaporin-2 expression, reduced principal to intercalated cell ratio may result in polyuria and renal concentrating deficit. On the contrary lithium has antiproteinuric, kidney protective, and reparative effects. This paradox may be partially explained by lower lithium doses and short duration of therapy. Lithium targets glycogen synthase kinase-3, a ubiquitously expressed kinase implicated in the processes of tissue injury, repair and regeneration in multiple organ systems, including the kidney. While the exact “kidney-protective dose” of lithium is unknown as what dose is sufficient to block GSK3 in the diseased kidney and alter the phosphorylation status of GSK3 substrates, resulting in proliferation of renal tubular cells and cytoskeleton remodeling in podocytes. Physicians should consider balance of risks before lithium therapy and monitor patients initial and during treatment according to clinical practice guidelines. Moreover, extensive researches are needed to understand the kidney protective mechanisms and doses required for the treatment of kidney diseases.

Keywords: Lithium, Kidney, Dosing

Preventive Psychiatry: Tertiary Prevention and Psychiatric Rehabilitation

Uttam C Garg, Rakesh Chadda, T V Asokan, Roy Abraham Kallivayalil, Adarsh Tripathi, Kabir Garg

Consultant, Garg Medical Complex, Agra, UP. [email protected]

Preventive medicine can be divided into primordial, primary, secondary and tertiary. While primordial deals with health promotion, primary prevention aims to prevent disease occurrence in people with risk factors, secondary prevention strives for early diagnosis and treatment and tertiary aims to limit the handicap and disability from the disorders. While the preventive paradigm has been traditionally ignored in psychiatric practice, it has started to receive some amount of attention from practitioners, researchers and policy makers alike, which is an encouraging development. Many evidence-based strategies have been developed and tested in different population and resource settings. While primary and secondary prevention strategies require a concerted efforts by the health professionals, health regulatory bodies and governments and are resource intensive endeavors, strategies of Tertiary prevention, i.e. limiting disability and rehabilitation are something that each and every practitioner can and should be aware about and following on a regular basis. It is not possible to overstate, the impact and the difference it makes to the life of an individual suffering from a psychiatric disorder and the amount of professional goodwill and satisfaction it can fetch for the practitioner.

Topics: -

Introduction of WPA Section for Preventive Psychiatry - U C Garg

Preventive healthcare in psychiatry: introduction T V Asokan

Role and scope of tertiary prevention and psychiatric rehabilitation Rakesh Chadda

Psychiatric rehabilitation: models and examples from the developed nations Adarsh Tripathi

Psychiatric rehabilitation: models and examples from the developing world Roy Abraham Kallivayallil

Rapporteur Dr Kabir Garg

Chair- Dr Helen Herrmen/ Dr Roy Abraham Kallivayalil/ Dr Uttam C Garg/

Keywords: Preventive Psychiatry, Rehabilitation

Challenges in promotion of child safety: School Mental Health

AK Dwivedi, Prateek Yadav, Manisha Jindal

Senior Adviser Psychiatry, Army, New Delhi. [email protected]

Child and Adolescent Psychiatry is still evolving in the Indian Subcontinent and guidelines regarding role of psychiatrist in handling cases of child abuse is ambiguous. Though, the law of the land warrants mandatory reporting of such cases but many service psychiatrists find themselves in a state dilemma when faced with such cases. Armed Forces have their own channel of reporting which at times may further add to the woes of the harried clinician. The will lay the ground for healthy and fruitful discussion regarding this complex topic.

  1. POSCO and the psychiatrist : Maj A K Dwivedi, Graded Specialist (Psychiatry), Base Hospital Delhi Cantt
  2. Role of AWWA in cases of Child Abuse : Lt Col Prateek Yadav
  3. Legalities of Securing an abused child : Maj Manisha Jindal, Senior Resident, AFMC, Pune

Military psychiatry: Title: Psychological Autopsy in Armed Forces: Methodology and limitations

Rajiv Saini, Vinay Singh Chauhan, Alok Sinha, KJ Divina Kumar, Uzma Hussain,

convener, military psychiatry, Reader, Dept of Psychiatry, AFMC, Pune

Brief outline

Military psychiatry is evolving and so are challenges being faced by military psychiatrists. Psychological autopsy aims to reconstruct events and mental framework of the deceased soldier prior to the act of suicide. Currently, psychiatrist posted in operational areas are being tasked to carry out psychological autopsy so as to suggest means to curb the suicide rates of soldiers. However, in absence of a laid down guideline or framework for the procedure, young psychiatrists often face dilemma about the procedure of psychological autopsy.

The will deliberate about the current evidence in the methodology and its limitations and will try to reach a consensus about its broad framework to ensure the uniformity of the process across various operational areas.

Col Rajiv Saini, convener, military psychiatry, Reader, Dept of Psychiatry, AFMC, Pune

Col Vinay Chauhan, Senior Adviser (Psychiatry), Base Hospital, New Delhi

Lt Col A K Sinha ,Classified Specialist (Psychiatry), Military Hospital, Jodhpur

Lt Col K J Divina Kumar, Classified Specialist (Psychiatry), Command Hospital, Kolkata

Lt cdr Uzma Hussain,Gd Spl Psychiatry, 92 Base Hospital, Srinagar

Use of technology in clinical care delivery, capacity building and research in addiction psychiatry: eNDDTC

Yatan Pal Singh Balhara, Siddharth Sarkar

Associate Professor, Aiims, New Delhi. [email protected]

Technological advances have changed the way we live. These technological advances have impacted each and every aspect of the present day living. Medical sciences has also witnessed multiple, significant technological advances in the recent past. Use of electronic media and internet has been one such advancement. Electronic media and internet offer multiple unique options and opportunities to strengthen the clinical care delivery, capacity building and research in addiction psychiatry. The current shall focus on use of technology in clinical care delivery, capacity building and research in addiction psychiatry. It shall also present an overview of the initiatives that have been undertaken and are being planned by eNDDTC in this regard.

Role of electronic media and internet in clinical care delivery, capacity building and research in addiction psychiatry

This presentation shall focus on the role of electronic media and internet in clinical care delivery, capacity building and research in addiction psychiatry. The presentation shall provide the rationale and benefits of use of such an approach. It shall also offer understanding into the set up and logistic requirements for integration of electronic media and internet in clinical care delivery, capacity building and research in addiction psychiatry. It shall also cite the best practice examples in this regard.

eNDDTC: Overview and Initiatives

This presentation shall provide an overview of eNDDTC- the online portal of National Drug Dependence Treatment Center (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi. It shall also provide information on the initiatives that have been undertaken so far, and future plans. This shall include the initiatives with regards to the academic program at NDDTC, DM (addiction Psychiatry) training, Project ECHO related initiatives, online training courses among others.

Third Wave Therapies: Basic principles and Clinical Applications


Additional Professor, NIMHANS, Bangalore, Karnataka. [email protected]

The Third Wave Behaviour therapies comprise of a heterogeneous group of treatments, however, they share commonalities with respect to view of psychological health, acceptance, mindfulness, the goal of a life and values. Most of these therapies have a here and now approach to the psychological distress and does not use longitudinal formulations in case conceptualisation. Many of these therapies are still not proven as empirically based interventions. However, there is preliminary evidence to show that these therapies benefit various psychiatric conditions. In clinical practice, Third wave concepts and conceptualizations can be effectively integrated with the cognitive behavior therapy formulation and therapy for improving effectiveness in certain conditions. The workshop would provide a brief introduction to the concepts of third wave therapies and demonstrate integration of these concepts in formulation and therapy.

Key words: clinical application, third wave therapies, integration

Issues and implications of school sex education

T.S. Sathyanarayana Rao,. Adarsh Tripathi, Darpan Kaur

Professor, Department of Psychiatry, JSS Medical College, JSS University, Mysore, Karnataka. [email protected],


The goal of sexuality education are comprehensive, multifaceted and are based on broad considerations of acquiring knowledge, motivation and personal insight to acquire skills to maintain and enhance sexual health and to avoid sexual problems. SEICUS (2011) defines that “Human Sexuality encompasses the sexual knowledge, beliefs, attitudes, values and behaviors of individuals. Its various dimensions involve the anatomy, physiology, and biochemistry of the sexual response system; identity, orientation, roles and personality; and thoughts, feelings and relationships. Sexuality is influenced by ethical, spiritual, cultural and moral concerns. All persons are sexual beings in the broadest sense of the word”. Even today the understanding of sexuality is mired with taboos and controversies. Historically learning of sexuality to a great extent based on behavior and thinking of people time to time and it was fragmented, inconsistent and limited in its focus. Today it is very much broadened with emphasis on total person and the decision making. There are many approaches like Comprehensive Sexuality Education, Abstinence-based Education, Abstinence-only education, Abstinence-only-until-marriage-education and Fear-based education. There are issues, implications and controversies regarding each of them. Importantly sexuality education is honestly looking at issues without moralizing, realistic and begins with parents. Non-verbal sexuality education is as important as verbal sexuality education. It is dealing accurately with topical areas and concerns. Many studies indicate that sexual misinformation and myths are still common. Sexuality education is not the same as sexual counseling, but both may be related. Sexuality educators work with groups of people and do not deal directly with specific individual problems. However, sexuality education focuses on need of the learners.

Keywords: Comprehensive Sexuality Education, Sex Education, Sex Education in schools, Sex Education and adolescents


Introduction, developmental sexuality, myths and misconceptions –T.S. Sathyanarayana Rao, Mysore.

Sexuality education in the west: Adarsh Tripathi, Lucknow

Sexuality Education in India and neighbouring countries –Darpan Kaur, Mumbai.

Psychiatric disorders and treatment emergent sexual dysfunctions

T.S.Sathyanarayana Rao, Shivananda Manohar, T. Navya Spurthi

Professor, Department of Psychiatry, JSS Medical College, JSS University, Mysore, Karnataka. [email protected]

Abstract: Sexual dysfunction associated with psychiatric disorders can itself be an intrinsic part or etiology of the disorder or can be induced by the medications. Prevalence of sexual dysfunction in psychiatric disorders as well as psychotropic associated sexual dysfunction is reported to be around 20-80%. Understanding the neuro-endocrinal, genetic, psychological and sociological components of normal sexual functioning will further aid in understanding of this complex association. Psychiatric disorders can lead on to varied range of difficulties in sexual functioning which often goes unrecognized clinically, which is further worsened by treatment with psychotropics. Studies have suggested that spontaneous reporting of the sexual adversities with psychotropics is less common and the grave consequence of non-adherence to therapy will lead onto poor treatment outcome. This sexual adverse effects produced by different classes of psychotropics reflects the pharmacological profiles of the individual molecule. Serotonergic effects of antidepressants, hyperprolactinemia caused by antipsychotics and reduction of testosterone bioavailability by anticonvulsants which are efficacious as mood-stabilizers are few of the proposed mechanisms for psychotropic induced sexual difficulties. Associated medical conditions and their treatment will add to the problem. Psychometric tools to assess and quantify the sexual adversities are being devised and validated but are mostly restricted to research purposes. Management of psychiatric disorders should aim for maintaining the therapeutic efficacy by selecting a psychotropic with minimal sexual adversities and for those already on treatment controlling the adversities by either adding an adjunct/antidote or by changing to a medication with a safer adverse profile. Non-pharmacological management with the principles of individual or couple psychotherapy or lifestyle modifications are few of many strategies followed in conjunction with other options. Thus, clinician should be well informed about this common yet ignored side-effect of psychotropics and timely recognition, appropriate evaluation and successful pharmacological and non-pharmacological interventions will have an effective role in the management of such patients and enhances the compliance to medications.

Keywords: Sexual dysfunction, Treatment emergent sexual dysfunctions in Psychiatric disorders, Antidepressant induced sexual dysfunction, Antipsychotic induced sexual dysfunction.

International Psychiatry: Issues And Perspectives

Umesh Prabhu, Raj Murali, Arun Chidambaram

Medical Director of NHS and Senior Medical Adviser. Edghill University. UK [email protected]

India and UK have had excellent relationship over many years and Indian Medical Training is based on UK education and training system modified to the needs of India. Indian doctors are well respected and well regarded throughout the World. Mental Health has been considered as Cinderella service and today there are only 7000 Psychiatrists in India to provide Mental Health Service to 1. 3 Billion people of India. Over the years Indian trained Psychiatrists have earned International reputation and many have transformed the Quality of Mental Health Services in India.

With Brexit, there is an amazing opportunity for India and UK to work together, with mutual respect and collaborate together and work closely which can benefit both the Nations. Today in UK there are 165,000 doctors and nearly 25,000 of them are originally trained in India and providing excellent service. However, India has lost these doctors and now we have an excellent opportunity to work together without any brain drain from India. Edghill University and Wrightington, Wigan and Leigh Foundation Trusts have been asked to work with Indian Medical Leaders The purpose of this session and discussion is to have honest debate about true collaborative working between UK and Indian faculties and to make this successful and beneficial to both the nations.

Key Words: Training, collaboration, Research, Sub-speciality Training in Mental Health and Faculty exchange. Patient Safety and Quality

Introduction: Umesh Prabhu, Medical Director of NHS and Senior Medical Adviser. Edghill University. UK

Training Schemes: Raj Murali, Director of International Training for Overseas Doctors. Edghill University UK

Collaborative research and Sub-specialization: Arun Chidambaram, Associate Medical Director, Consultant Mental Health. Mercycare Liverpool UK

Chair: Dinesh Bhugra, UK, MSVK Raju, India

Co-ordinator: T S Sathyanarayana Rao, India.

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Source of Support: None, Conflict of Interest: None

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