Year : 2018 | Volume
: 60 | Issue : 5 | Page : 22--23
Prof. M. Murugappan Poster Awards
|How to cite this article:|
. Prof. M. Murugappan Poster Awards.Indian J Psychiatry 2018;60:22-23
|How to cite this URL:|
. Prof. M. Murugappan Poster Awards. Indian J Psychiatry [serial online] 2018 [cited 2021 Jun 20 ];60:22-23
Available from: https://www.indianjpsychiatry.org/text.asp?2018/60/5/22/224510
Does Duration of Pupillary Non-reactivity to Light During Seizure Determine Clinical Response to Electro-Convulsive Therapy (ECT) in Schizophrenia?
Vani P., Sayantanava Mitra, Sudhir Venkat1, C.N. Naveen, Shyam Sundar A., Jagadisha Thirthalli
Department of Psychiatry and 1Department of Neuroanesthesia, National Institute of Mental Health and Neurosciences, Bengaluru, India
INTRODUCTION: The autonomic arousal consequent to seizures results in the phenomenon of pupillary dilatation and non-reactivity to light. Combined cortical and sub-cortical regulation of autonomic activity makes it likely that pupillary dilatation and non-reactivity act as surrogate markers of ongoing seizure activity in deeper brain structures, particularly the hypothalamus.
OBJECTIVES: The present analysis is a part of a larger study and is aimed at evaluating pupillary non-reactivity (PNR) to light as a tool for predicting clinical outcome of ECTs in patients with schizophrenia, with a working hypothesis that degree of clinical improvement, PNR and motor/EEG seizure durations might be positively correlated.
METHODS: This was a prospective observational study, involving consenting adult patients who were prescribed ECT (M=38/F=27 age=32.69+7.73 years; schizophrenia=60/Schizoaffective-disorder=5) following clinical decision. EEG/Motor seizures and hemodynamic functions were monitored, and PNR was assessed during the 2nd ECT session. Clinical parameters were assessed at baseline and after 6 sessions of ECT (thrice-weekly schedule) through BPRS and CGI scales.
RESULTS: The mean of motor and EEG seizure durations during 2nd ECT session were 45.85+18.97 and 52.97+27.66 seconds,respectively. The mean pupillary inertia time to light was 57.31+28.52 seconds. All three variables had significant positive correlations with each other.However, no correlation emerged between relative clinical improvements and PNR/motor/EEG seizure durations; nor could we establish any correlation between the hemodynamic parameters and clinical improvement.
CONCLUSION: Our findings show that PNR out-lives both motor and EEG seizures during ECT, indicating that the former might be a better marker of the cessation of actual seizure activity in deeper brain structures. However, we also found that improvement in clinical parameters did not correlate with PNR, suggesting that as long as a seizure is generalized for an adequate duration, the clinical improvements are similar.
Keywords: ECT; Pupil; Seizure; Schizophrenia
A survey on Medical Residents Knowlege, Comfort and Training with Sexual History Taking
Background: Sexual health is an important aspect of overall health affecting and assessing, diagnosing and treating sexual dysfunction requires training at the undergraduate level. The primary objective of this study is to determine medical residents knowledge, comfort and training regarding sexual history taking.
Methords: 200 resident in clinical disciplines were contacted after ethics approval, 172 consented, 46 incompleted proformas were discarded and 26 proformas were unreturned. 100 completely filled proformas were received and analysed. Data was collected with the help of a semi structured 27 items questionnaire pertaining to the aims which was validated.
Results: Nearly 40% residents found training and knowledge about sexual Health as inadequate for UG whereas PG, 45% found it inadequate. Only about 30% felt that importance was given to sexual health training. 64% felt that the teaching they received has helped improve knowledge and confidence in discussiong sexual problems with patients. 69% were comfortable taking sexual history from same sex patients whereas only 29% were comfortable taking sexual history from the opposite sex. 85% said that they did not enquire routinely about sexual problems. 91% wanted training workshop on sexual history taking.
Discussion: Most of the knowledge about sexual health functioning and disorders is given by the departments of anatomy, physiology, gynaecology, dermatology, urology. Though sexual functioning is an integral part of many relationships residents refrained enquiring about it. The fact that residents were uncomfortable talking to the opposite sex about sexual dysfunctions speaks volumes about the lack of training provided in medical schools. The lack of importance given to sexual health, shows that many patients would go undiagnosed and untreated.
Conclussion: Medical educators should re-evaluate the importance of providing undergraduate/postgraduate teaching of a human sexuality module to enable improvement in service provision and to support patients with sexual health issues.
Keywords: Sexual history, medical resident
A study of knowledge and attitude towards sex and relation with disorders of sexual response cycle in females with dissociative conversion disorder
Background: Females are affected by various disorders in relation to sexual response cycle. Desire, arousal, and orgasm are the three principle stages of this cycle. Knowledge and attitude towards sex may also affect sexual functioning in females. Stress of sexual dysfunction affecting the sexual response cycle may be interrelated to conversion disorder.
Objectives: 1. To assess knowledge and attitude towards sexuality and its relationship with disorders of sexual response cycle in cases and controls. 2. To find how sexual functioning is in phases of sexual response cycle and identify disorders of sexual functioning in cases and controls.
Materials and method: This study was conducted at Department of Psychiatry, S.P. Medical College; Bikaner. 30 new, drug naive patients of dissociative conversion disorder (married females) formed the cases while 30 matched healthy relatives formed the controls. Both groups were assessed on the semi-structured sociodemographic proforma, SKAQ II and BISF-W scale.
Results: No significant difference was found between the mean scores of knowledge and attitude towards sex between the two groups. No significant relation was seen between knowledge and attitude and sexual dysfunction in both the groups. All domains of sexual functioning i.e. desire, arousal, frequency, receptivity, orgasm, satisfaction were more commonly affected in cases (p value < 0.05). Significantly higher number of cases had encountered difficulty in reaching orgasm(46.6%) and conflicts with the spouse(36.6%).
Conclusion: Higher prevalence of sexual dysfunction in the past one month may be a contributory factor for stress for the manifestations of conversion symptoms or it may be a result of conversion disorder. So every sexually active women having conversion disorder should be thoroughly interviewed for the presence of underlying and unreported sexual dysfunction.
Keywords: conversion disorder, sexual response cycle, SKAQ II- sex knowledge and attitude questionnaire, BISF-W- brief index of sexual functioning for women.
Psychological Distress in Wives of Patients with Alcohol Dependence and its Relation with Severity of Disorder and Patients Abusive Behaviour
BACKGROUND: Alcoholism, being a major public health problem, poses considerable burden for the society. Wives, being the most intimately related to their alcoholic spouses, suffer from significant psychological distress, created by the problems faced due to consumption of large amount of alcohol by them. Also; they are often exposed to high rates of domestic violence which further escalates the distress.
OBJECTIVE: The study was undertaken to identify patterns of psychological distress amongst the wives of patients with alcohol dependence, assess the type of violence faced by them and find the association between their distress with patients’ violent behaviour & severity of alcohol consumption.
MATERIALS AND METHOD: 60 wives of patients with alcohol dependence were interviewed using semi structured proforma containing socio-demographic and alcohol use history of husband. Abusive behaviour faced by them was assessed using the abusive inventory. Spouses of these wives were also interviewed using severity of alcohol dependence questionnaire, to measure the severity of alcohol dependence.
RESULTS: The average age of wives was 39.7 years. Psychological distress amongst them was found to have a prevalence of 80% with majority suffering from mild stress along with moderate degree of anxiety & depression.The mean score of scale for severity of alcohol dependence was 25.18 indicating moderate degree of severity of alcohol dependence among the patients. Majority of wives suffered more of psychological abuse than physical abuse.
CONCLUSION: Significant psychological distress was found in those wives whose husbands had history of higher quantity of alcohol consumption, those who faced abusive behaviour from husband & those having shorter duration of marriage and lower age.
KEYWORDS: Alcohol dependence, Psychological distress, Abusive behaviour
Influence of Religiosity and Spirituality on suicide attempts in patients with first episode depression
Devakshi Dua*, Susanta Padhy, Sandeep Grover
Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Introduction: In the socio-cultural domain, religion and spirituality are considered to influence suicidal behavior. However, little information is available about the influence of religiosity and spirituality on suicide attempts among patients of depression experiencing current suicidal ideations. Accordingly, the aim of this study way to compare religiosity and spirituality of patients with first episode depression with and without suicide attempts.
Methods: 115 patients of first episode depression with suicidal ideation were selected by purposive sampling and divided into two groups on the basis of presence (N=53) or absence (N=62) of suicidal attempt in the previous 14 days. Religiosity was assessed by Centrality of Religiosity Scale (CRS), Duke University Religiosity Scale (DUREL), brief Religious coping scale (R-COPE) and Spiritual Attitude Inventory (which includes DUREL, negative subscale of brief R-COPE, Sense of purpose/connection as measured by the Existential Well-Being Scale EWBS, a subscale of the Spiritual Well Being Scale and Sense of hope/control measured by the internal/external subscale of the Multiple Health Locus of Control Scale).
Results: Both the study groups did not did not differ in terms of religiosity and spirituality as assessed by using CRS and Spiritual Attitude Inventory. Compared to patients without any suicide attempt (ideators group), subjects with suicide attempt more often used negative religious coping. Higher suicidal intent was associated with lower religiosity as per CRS. Total numbers of lifetime suicide attempts in the attempt group were associated with ideology domain of the CRS.
Discussion/Conclusion: In presence of comparable severity of depression, higher use of negative religious coping among patients with first episode depression is associated with suicide attempt. Further, lower level of religiosity is associated with higher suicidal intent
Key words: Suicide, religiosity, spirituality, depression