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| EDITORIAL |
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Urbanization and Mental Health : A New Challenge |
p. 1 |
JK Trivedi
PMID:21206872 |
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| PRESIDENTIAL ADDRESS |
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Research in Biological Psychiatry in India |
p. 3 |
V. Palaniappun
PMID:21206873 |
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| ARTICLES |
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Coping Startegies of the Relatives of Schizophrenic Patients |
p. 9 |
R Chandrasekaran, B Sivaprakash, SR Jayestri
PMID:21206874Families caring for a member with a chronic severe mental illness like schizophrenia have to cope with a lot of burden and distress. The coping styles used by these families and their relationship to burden has not been studied in Indian families. This study aims to identify the coping styles adopted by the relatives of schizophrenic patients. 44 patients with schizophrenia and 44 relatives from an outpatient psychiatric clinic were assessed. Resignation, an emotion-focussed coping strategy, was found to be more commonly employed by the relatives, than other strategies. Majority of the relatives failed to maintain social contacts. Levels of burden and negative symptoms correlated significantly with the resignation strategy. Analysis of the coping strategies of the relatives is essential before clinical interventions with families are planned to improve the coping skills of the carers. |
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Expressed Emotions in Obsessive Compulsive Disorder |
p. 14 |
A. Shanmugiah, Mathew Varghese, Sumant Khanna
PMID:21206875Social factors are recognised to play an important role in Obsessive compulsive Disorder. There is some evidence that expressed emotions may be high in Obsessive Compulsive Disorder. However, no study has looked at the concept of Expressed Emotions in Obsessive Compulsive Disorder in India. In the current study, 35 patients diagnosed as OCD according to ICD-10 DCR were assessed for Expressed Emotions using Family Emotional Involvement and Criticism Scale. The OCD patients had an increased score on expressed emotions with an increase in both subscales of perceived criticism and emotional involvement, as compared to the normative data suggested by the developers of the scale. There was no significant correlation between scores on these scales and YBOCS, duration of illness or age. The relevance of these factors in the pathogenesis and maintenance of the illness, and as predictive variables to therapy, needs to be explored. |
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Reasons for Transition and Reverse Transition in patients with Heroin Dependence |
p. 19 |
Ramesh Kumar, Anju Dhawan
PMID:21206876Most physical complications related to opiate use are associated with the route of drug administration. The route of administration in opiate dependent patients may change overtime Change from non-parenteral to parenteral route of administration is more common than the reverse transition. In the current study, 17 patients of opiate dependence syndrome (DSM-IV) who had history of reverse transition (Shift from parenteral to inhalational route), were evaluated for the reasons for the reverse transition. Verbatim responses were recorded in response to open-ended questions and a semistructured questionnaire was also used. All the patients gave health-related reasons for this reverse transition and reported knowledge of health hazards of injecting route as one of the reasons for it. Other reasons cited by subjects for this transition were occurrence of physical complications due to drug use in peers and patients themselves; drug related death of peers, knowledge of risk of HIV/ AIDS and difficulties in getting a vein. The study emphasizes the need to educate the patients about the health hazards of parenteral route. |
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Merits of EEG Monitoring During ECT : A Prospective Study on 485 Patiens |
p. 24 |
K. Girish, B. N Gangadhar, N. Janakiramaiah
PMID:21206877Eliciting cerebral seizure during electroconvulsive therapy (ECT) is essential for therapeutic purposes. When it exceeds beyond 120 seconds (Freeman, 1995) i.e., prolonged, it adds to adverse effects of ECT. Estimating seizure duration using 'cuff method' alone has limitations. This study examined the merits of electroencephalographic (EEG) monitoring in routine ECT practice on a large representative sample. Modified ECT either unilateral or bilateral electrode placement, was administered to 485 patients under EEG monitoring at first ECT session. Ninety one (18.8%) patients had prolonged seizures of which only 59 would have been detected if 'cuff method' alone was used. Twenty nine (6%) patients had inadequate motor seizures but had adequate EEG seizure duration. Twenty five (5.2%) of them had no motor seizure and two such patients even had prolonged seizures. The prolonged seizure was unpredictable in majority. In conclusion, EEG monitoring during ECT is essential to detect both adequacy of cerebral seizure in patients having no or inadequate motor seizures and a/so to detect prolonged seizures. |
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ICTAL RPP - A Supplement to Cuff Method in Detecting ECT-Induced Cerebral Seizure |
p. 29 |
Neeraj Singh Gill, K. Girish, B. N Gangadhar
PMID:21206878During electroconvulsive therapy (ECT), occurrence of seizure must be confirmed. Cuff method, although simple and reliable, can sometimes miss an adequate EEG seizure. Predictable cardiovascular response occurs during ECT seizure. We examined if this can be an additional guide to detect cerebral seizure. In 164 modified ECT sessions, EEG and cuff methods were used for seizure monitoring. Heart rate (HR in beats per minute) and blood pressure (BP in mm of Hg) were recorded before (baseline) and 20 seconds after the stimulus (ictal). The rate pressure product (RPP=HR x systolic BP) was computed. The ECT sessions consisted of three groups, viz., adequate EEG and motor seizure (n=126), adequate EEG but not motor seizure (n=21) and neither EEG nor motor seizure adequate (n=17). Significant elevation of RPP occurred from baseline to 'ictal' recording and this was different between the three groups. Ictal RPP did not differ between groups with or without adequate motor seizure if EEG seizure was adequate. The group with no adequate EEG or motor seizure had the least 'ictal' RPP. Findings suggest that RPP response can be an additional clinical measure to detect seizures during ECT. |
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Life Events and Depression in Elderly |
p. 34 |
Niruj Agrawal, HP Jhingan
PMID:21206879Thirty-one elderly depressive patients (diagnosed as suffering from depressive episode or recurrent depressive disorder according to LCD-10 diagnostic criteria for research) attending psychiatry O.P.D. or geriatric clinic at the All India Institute of Medical Sciences, New Delhi (AIIMS) and thirty-one elderly nonpsychiatric patients, attending geriatric clinic at AIIMS were subjected to a semi structured interview to gather information regarding life events. It was found that the elderly depressed patients experienced significantly higher number of stressful life events as compared to the control group. The stressful life events were specifically more in the females, those with low 'per capita income', and those who perceived crisis in the family. |
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Prevalence of Delirium in Geriatric Hospitalized General Medical Population |
p. 41 |
Paramjeet Singh Khurana, P.S.V.N. Sharma, Ajit Avasthi
PMID:21206880The present study was carried out on the hospitalised geriatric general medical patients. The assessment of the patients was carried out within 24 hours of admission and on every fourth day thereafter using Mini Mental Status Examination (MMSE), Confusion Assessment Method (CAM), Delirium Symptom Interview (DSI) and ICD-10-Diagnostic Criteria of Research for delirium. An overall rate of delirium of 27% was found in the 100 patients who constituted the sample. 19% was the rate of 'prevalent' delirium and 8% was the rate of 'incident' delirium. It is observed that the CAM is a useful screening method with high sensitivity for diagnosis of delirium at the bedside. |
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Pattern Performance of Schizophrenic Patients on Luria-Nebraska Neuro-Psychological Battery |
p. 47 |
B. P Mishra, V. Gupta, R. Mahajan, R. L Narang
PMID:21206881Luria-Nebraska Neuro-psychological Battery, is now an established tool to assess brain damage in recent years. This test battery has been reported to be very useful to find out functional organization of the brain. The biological basis of psychiatry is also now well explained. The present study is directed towards the neuro-psychological functioning of schizophrenic disorder, and the findings are discussed in the light of biological researches. The pattern of performance of schizophrenia on Luria-Nebraska Neuro-psychological battery is indicating the possibility of combined cerebral dysfunction, more towards left hemisphere functions. No single localization was found responsible for this illness. Limitations of present study, and need for well organized further research is indicated using advance technology of brain imaging techniques and neuro-psychological profile of brain functioning, would be helpful for the rehabilitation purposes and to understand the illness better. |
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Neuro-Psychological Profile of Epilepsy on Luria-Nebraska Neuropsychological Battery |
p. 53 |
B. P Mishra, R. Mahajan, A. Dhanuka, R. L Narang
PMID:21206882Neuropsychological functioning of epileptic patients is emerging as an interesting area of research among clinician. There is sufficient evidence suggesting cognitive deficits among epileptics. No specific rehabilitation planning was prepared in this regard. The planning for rehabilitation can be prepared if a comprehensive functional organization of the brain of epileptics can be identified. The present study is directed towards the neuropsychological functioning of patients with idiopathic generalized epilepsies, and its comparison with normal controls. All the 60 subjects (30 normal controls and 30 epileptics), after matching their age and education were assessed on Luria-Nebraska Neuropsychological Battery (LNNB). The performance level and pattern of epileptics were significantly different than normal controls on all the parameters of LNNB. The battery could detect specific organic malfunctioning in epileptic patients. |
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ECT in Mentally Retarded Subjects with Psychiatric Illness |
p. 57 |
V. K Chopra, V. K Sinha
PMID:21206883The mentally retarded subjects show a much higher prevalence of full range of psychiatric disorders than the non-retarded population. Whereas the role of psychotropic drugs in such patients is well discussed, the reports on the use of ECT are scarce. Many psychiatrists dealing with the mentally retarded psychiatric patients are reluctant to consider ECT due to lack of adequate experience. We report five mentally retarded patients with different psychiatric disorders who were successfully treated with ECT after failing adequate trials of pharmacotherapy. No disproportionately higher adverse events on account of mental retardation were observed. ECT need to be favorably considered in mentally retarded persons with psychiatric morbidity especially when treatment with psychotropic drugs either fail or is intolerable. |
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Trance and Possession like Symptoms in a Case of CNS Lesion : A Case Report |
p. 65 |
Soumya Basu, Subhash C Gupta, Sayeed Akthar
PMID:21206884Trance and possession symptoms along with religious and mystic experiences are commonly seen in Indian patients. Though, commonly conceptualized under the rubric of dissociative disorders, possession like symptoms can be present in variety of clinical conditions. Trance and possession syndrome results from a variety of central nervous system involvement. We report here such a case with lesion in the basal ganglia and fronto-patietal lobes. Pathophysiology and cultural connotation of the symptoms is discussed. |
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Transient Global Amnesia : A Case Report |
p. 68 |
P. K Pardal, S. P Rathee
PMID:21206885Transient global amnesia is characterized by abrupt and short lasting loss of ability to recall recent events or to remember new information. A case of transient global amnesia is presented and the importance of awareness of this condition for the psychiatrist is discussed. |
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Normal Pressure Hydrocephalus Presenting as Psychotic Depression : Moderately Successful Treatment with a Course of ECT & Pharmacotherapy : A Case Report |
p. 71 |
VK Chopra, VK Sinha, Subash Das
PMID:21206886The characteristic symptoms of normal pressure hydrocephalus are dementia, urinary incontinence and gait disturbance. Psychiatric symptoms make their appearance usually after the characteristic symptoms. In some cases, however, prominent psychiatric symptoms are the presenting picture even before the cognitive decline is evident. A case of NPH is discussed which presented with psychotic depression along with urinary incontinence. CT scan showed dilated supratentonal ventricular system and normal fourth ventricle. There was slight widening of cortical sulci. The cognitive impairment set in later during the course of illness. The psychiatric symptoms responded fairly well to a course of ECT and antidepressant drugs. |
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Recurrence of Puerperal Psychosis in Both Pre and Post-partum Periods : A Case Report |
p. 76 |
D. N Mendhekar, P. K Srivastava, R. C Jiloha
PMID:21206887A case of recurrent pre and postpartum psychosis is described. Pre-partum psychosis was more severe in intensity when compared with postpartum psychosis and, if untreated, it may have continued as postpartum psychosis. Presence of bipolar affective illness in the family, ongoing stressor and unplanned pregnancy may be the risk factors for developing pregnancy- related psychosis. This case report also adds weight to the proposition that puerperal psychosis might occur in late pregnancy also. |
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Atypical Bulimia Nervosa : A Case Report |
p. 79 |
D. N Mendhekar, Deepak Gupta, R. C Jiloha, Aneesh Baweja
PMID:21206888This report describes a case of bulimia nervosa presenting with atypical features and her treatment response to SSRIs. |
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| LETTERS TO EDITOR |
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Recognition & Clinical Assessment of Childhood PTSD |
p. 82 |
N Murali, Nilama Dhabkar, Jagadisha
PMID:21206889 |
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Yoga: Better Treatment or Better Placebo? |
p. 83 |
Chittaranjan Andrade
PMID:21206890 |
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Why Psychiatric Patients are Intolerant to Noise: A Theoretical View |
p. 84 |
MK Srivastava
PMID:21206891 |
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Manic Stupor or Stupor Resulting from Treatment of Mania? |
p. 85 |
Subhash Chandra Gupta, Sarita E Paul, Soumya Basu
PMID:21206892 |
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Response - Manic Stupor : Diagnosis and Treatment |
p. 85 |
Chittaranjan Andrade
PMID:21206893 |
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Formation of New State as A Life Event |
p. 86 |
Ratanendra Kumar
PMID:21206894 |
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| BOOK REVIEWS |
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Cultural Psychiatry : Euro-International perspectives |
p. 88 |
| Venkoba A Rao |
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Psychotherapy Training in India |
p. 90 |
| A. K Agarwal |
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Research Endeavours in Child and Adolescent Psychiatry in India |
p. 92 |
| Shoba Srinath |
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Mansik Rog Aur Ham  |
p. 94 |
| S. C Gupta |
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