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| EDITORIAL |
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Evidence Based Medicine in Psychiatry |
p. 1 |
JK Trivedi
PMID:21407901 |
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| PRESIDENTIAL ADDRESS |
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Disaster and Mental Health |
p. 3 |
Gopal Chandra Kar
PMID:21407902 |
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| ARTICLES |
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Epidemiological Findings on Prevalence of Mental Disorders in India  |
p. 14 |
HC Ganguli
PMID:21407903Fifteen epidemiological studies on psychiatric morbidity in India have been analysed. National all-India prevalence rates for all mental disorders' and five specific disorders have been worked out The national prevalence rates for 'all mental disorders' arrived at are 70.5 (rural), 73 (urban) and 73 (rural + urban) per 1000 population. Prevalence of schizophrenia is 2.5/1000 and this seems to be the only disorder whose prevalence is consistent across cultures and over time. Rates for depression, anxiety neurosis, hysteria and mental retardation are provided. Urban morbidity in India is 3.5 percent higher than the rural rate, but rural-urban differences are not consistent for different disease categories. In Hindi speaking north India, mental morbidity amongst factory workers is two and half times that of the non-industrial urban inhabitants and five times the rural morbidity. The present data are expected to serve as baseline rates for mental health planners and for psychiatrists interested in epidemiological studies. |
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Patterns of Antidepressant Prescriptions : I Acute Phase Treatments |
p. 21 |
S Chakrabarti, P Kulhara
PMID:21407904Although depression is an eminently treatable condition, inadequate pharmacotherapy is far too common. Lack of uniform standards of care across different settings characterises psychiatric practice in a developing country like India. But, there have hardly been any attempts at assessing the standards of care being delivered. A case note study was carried out of patients attending a general hospital psychiatric unit with depression, over a one year period, to evaluate the nature and adequacy of antidepressant therapy. Prescribing patterns in 108 cases fulfilling the selection criteria, were examined. The sample consisted mainly of young to middle aged patients, predominantly female, with moderately severe depressive episodes. Antidepressants were prescribed universally with TCAs (mainly Imipraminc), followed by Fluoxetine being the most common drugs used. Pharmacotherapy was often found to be deficient in several areas such as, starting doses, rate of increase in dose, maximum doses used, dose titrations, duration of treatment, change of drugs, recording of side effects and compliance etc. Results regarding norms for adequate doses and periods of treatment before switching drugs, for the kind of patients included in this study, were
unclear, and need to be explored further. Inadequate treatment can have a number of adverse consequences, hence some guidelines for minimum standards of care while undertaking antidepressant treatment need to be formulated for India and other developing countries, as none exist at present. |
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Patterns of Antidepressant Prescriptions : II Continuation Phase Treatments |
p. 29 |
S Chakrabarti, P Kulhara
PMID:21407905In an exercise carried out to ascertain adequacy of antidepressant treatment, seventy case notes of patients of depression on continuation treatment with antidepressants were scanned. Antidepressants had been used universally. TCAs were the most commonly used drugs, although Fluoxetine had also been used quite frequently. Continuation treatment was found to be deficient in over a third (n=24; 34 %) of the cases, on either of the two parameters i. e. dose of drugs or duration of treatment. The outcome was poorer in those treated inadequately. The reasons for this 'treatment gap' need to be explored. Similar studies need to be conducted in other settings. Education of all clinicians about these central issues of antidepressant treatment is essential. |
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Management of "Dual Diagnosis" Patients : Consensus, Controversies and Considerations |
p. 34 |
Debasish Basu, Nitin Gupta
PMID:21407906The term 'dual diagnosis' denotes the coexistence of substance use disorder(s) and other, non-substance-use, psychiatric disorder(s). The last two decades, and especially the 1990s, have witnessed tremendous research and clinical interest in this previously neglected area. India, however, lags behind, inspite of indications that the problem exists here too. The current approach to managing such patients is the 'integrated treatment model' in which the same clinician (or team of clinicians) provides treatment for both the disorders at the same time, treating both with equal understanding and importance. Both pharmacotherapy as well as psychosocial therapies are specifically designed keeping in mind the integrated' philosophy of treatment. The specific principles and components are described Areas of difficulty, uncertainty, and future considerations are highlighted, with a note on the Indian setting. |
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Serum Prolactin Level and Severity of Psychopathology in Patients of Schizophrenia |
p. 48 |
Amresh Shrivastava, Manoj Tamhane
PMID:21407907Serum prolactin level was measured in 20 male and 11 female drug naive patients of schizophrenia Subsequently, these patients were treated with antipsychotics and ECTs. The severity of psychopathology at the baseline rind subsquent improvement at the end of 3 weeks and 6 weeks was assessed on modifies brief psychiatric rating scale (BPRS).
Contrary to the expectations, a two fold increase in serum prolactin level was observed in drug naive male and female patients of schizophrenia The difference was found to be statictically significant in males No correlation was observed between the baseline serum prolactin level and the severity of baseline psychopathology and subsequent improvement in psychopathology at the end of 3 weeks and 6 weeks From the present study it seems that baseline serum prolactine level in drug naοve patients of schizophrenia may not be a reliable indicator of psychopathology and prognosis. |
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Comparative Study of Risperidone and Haloperidol on Clinical and Psychosocial Paramenters in Treatment of Schizophrenia : A Randomised Open Trial |
p. 52 |
Amresh Shrivastava, Sarkhel Gopa
PMID:21407908The study compares the efficacy of risperidone and haloperidol in patients of schizophrenia on various clinical and psychosocial parameters.
In the present open, comparative study, in patients suffering from schizophrenia (DSM-IV), 50 patients each were randomly treated with risperidone and haloperidol over a period of 1 year. The clinical improvement was judged on PANSS (Positive and Negative Symptom Scale) and CGIS (Clinical Global Impression Scale). The improvement in psychosocial functioning and other areas was judged using a five point scale (0-4). Though the improvement on PANSS was comparable in both the groups except on the general psychopathology subscale, on CGIS a better improvement profile was observed in risperidone group. In the other psychosocial areas such as social functioning, productivity and education a significantly more number of patients showed improvement in risperidone group as compared to haloperidol group. In significantly less number of patients suicidality and ^hospitalization was found in risperidone group as compared to haloperidol group. |
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Is a Grandmal Seizure Necessary and Sufficient for the Efficacy of Electro Convulsive Therapy ? |
p. 57 |
Abraham Verghese
PMID:21407909This paper highlights the recent research findings which suggest that the old teaching that a grandma! seizure is both necessary and sufficient for the efficacy of electroconvulsive therapy (ECT) is not correct. It is necessary; but not sufficient. The stimulus intensity should be adjusted so that it is far above the seizure threshold in order to get maximum efficacy of ECT. |
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Clinical Variables As Predictors of Response to Electroconvulsive Therapy in Endogenous Depression |
p. 60 |
Nitin Gupta, Ajit Avasthi, Paramanand Kulhara
PMID:21407910There is lack of consensus on the clinical variables that predict response to ECT. Identification of clinical variables could help in predicting the type of response before the start of ECT Therefore, a prospective study on 22 patients of severe depression, some of whom were drug-naive and others drug free at time of ECT was undertaken. A maximum of six ECT were administered with a prior definition of 'good response' (60% or greater reduction in Hamilton Depression Rating Scale scores) Results showed that three clinical variables could distinguish between good responders and poor responders Hence, response to ECT was associated with the duration of past depressive episodes, suicidal thoughts and somatic symptoms. |
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Applicability of Rutter-B Scale on Indian Population |
p. 66 |
Savita Malhotra, Priti Arun, Adarsh Kohli
PMID:21407911Applicability of Rutter-B Scale for completion by teachers was assessed on a representative sample of 963 school children between the ages of 4-11 yrs. The findings revealed that at the recommended cut-off score of 9, the scale has low sensitivity (51.8%) and very low specificity (34.1%). Concordance between assessment by Rutter-B Scale and clinical assessment to pick up psychiatric disorder was 33.6%. Limitations of the scale as a screening instrument in child psychiatry epidemiology are discussed. |
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Did Field Marshal Bernard Montgomery (Montgomery of Alamein) Have Aspergers Syndrome? |
p. 73 |
Michael Fitzgerald
PMID:21407912In the present paper the evidence for Field Marshal Montgomery having Asperger's syndrome is examined. Biographies of Montgomery were examined to search for evidence that he met criteria for Asperger's syndrome - Gillberg (1991) and Asperger's disorder (APA.1994) and Anankastic personality disorder (WHO,1992). He demonstrates a qualitative impairment in social interaction and restricted repetitive and stereotyped patterns of behaviour, interests and activities. It can be concluded that he met criteria for Asperger's disorder DSM-IV (APA.1994). |
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A Study of Scurce Traits : Medical Students |
p. 77 |
Kalpana Srinivastava, PK Chakraborty, PS Valdiya, M.S.V.K Raju, Dasharath Basannar
PMID:21407913Medical profession is one of the prestigious and esteemed professions amidst the professional opportunities available to young aspirants. Armed Forces Medical College by its virtue of selective admission procedures, training and induction becomes the primary focus of such research. The aim of the present study was to evaluate source traits of 300 medical students, 150 each from AFMC and civil medical college. 16 PF was administered to evaluate the source traits of study groups. Findings revealed significant differences between two colleges. The students from two colleges differed significantly on factors 'B', 'F, 'G', 'I', O', Q1, Q3, Q4. |
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Attempted Suicide in Ludhiana |
p. 83 |
RL Narang, BP Mishra, Nitesh Mohan
PMID:21407914This study assesses the various socio-demographic correlates, the method adopted and the psychiatric disorders in patients with attempted suicide.
Out of 208 cases presented to the hospital, one hundred individuals with suicide attempt were included in the present study. They were evaluated for socio-demographic profile and psychiatric illness on the basis of ICD-10 criteria.
Analysis of the results showed that single males outnumbered single females, whereas married females outnumbered married males in suicidal attempt. The prevalence of suicidal attempt was high among males with psychiatric illness, whereas more female suicide attempters were without psychiatric illness. The most common psychiatric illnesses were found to be mood disorders (35%) and adjustment disorders (13%) as per the ICD-10 criteria. Family type, economic status and education levels appears to be playing non significant role in suicide attempt in this part of the country Marital status and psychiatric illnesses are playing important role in suicide attempt. Other demographic variables, though, were statistically non significant, but, below 30 years of age group, low socio-economic status, low education and nuclear families were found to be more vulnerable factors for suicide. |
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Non Ulcer Dyspepsia and its Correlation with Life Stress, Anxiety and Depression |
p. 88 |
A Vishnar, R Ghulam, RK Mittal
PMID:21407915Non ulcer dyspepsia is essentially a diagnosis of organic disease exclusion. Non ulcer dyspepsia falls under the rubric of functional bowel disorder. Life stress, anxiety and depression may be important to the onset or exacerbation of this condition. The effect of life stress, anxiety and depression on non ulcer dyspepsia vary from region to region and group of population. Patients who had dyspepsia and undergone successful upper G.I. endoscopy at the M.G.M. Medical College, M.Y. Hospital, Gastroenterology Unit, between January 1997 and November 1997 and showed no organic lesion were tested for life stress, anxiety and depression. They were compared with healthy persons of comparable age. sex and social status on scales of life stress, anxiety and depression. Of the 38 patients with non ulcer dyspepsia, 26 (68%) experienced undesirable events, 35 (92%) significant anxiety Undesirable life events were statistically insignificant and anxiety was significantly related to non ulcer dyspepsia While other psychological variable, depression was seen in all 38 (100%) cases, but was not statistically related to non ulcer dyspepsia. |
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Valproate in Acute Mania - A Controlled Study |
p. 94 |
HM Prakash, Srikala Bharath
PMID:21407916A controlled blind study was carried out to establish the efficacy of Sodium Valproate as the first line of treatment in Acute Mania. Patients were studied over a period of 4 weeks. Using randomised table patients were assigned to either lithium or valproate. Decrease in the psychopathology was evident within 2-3 weeks. Valproate was found to be as effective as Lithium in controlling the manic episode. |
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Multiple Personality Disorder Following Conversion and Dissociative Disorder Nos : A Case Report |
p. 98 |
Harsh Prem Jhingan, Neeruj Aggarwal, Shekhar Saxena, Dhanesh K Gupta
PMID:21407917A case progressing from symptoms of conversion disorder to dissociative disorder and then to multiple personality disorder as per DSM-III-R criteria is being reported. The clinical implications are discussed. |
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Risperidone-Induced Neuroleptic Malignant Syndrome : A Case Report |
p. 101 |
G Venkatasubramanian, BH Yogananda, BN Gangadhar
PMID:21407918A young male schizophrenic presented with neuroleptic malignant syndrome (NMS). Risperidone was the probable precipitating agent. Rigidity and elevated CPK levels poorly responded to bromocriptine, but showed good response to dantrolene. The role of specific treatment and the differential response of the symptom clusters are discussed. |
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Sertraline Induced Hypomania |
p. 104 |
Ratanendra Kumar, CK Dubey, VK Sinha
PMID:21407919Mama due to tricyclic antidepressant use has been well reported in literature but reports of SSRI's induced mania are less. This case reports a sertraline induced mania and discusses the use of this drug in adolescent females. |
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| LETTERS TO THE EDITOR |
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Aggression in Psychotic Illness |
p. 106 |
Ratanendra Kumar
PMID:21407920 |
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Comparison Between Conduct Disorder and Hyperkinetic Conduct Disorder |
p. 107 |
K Jagadheesan
PMID:21407921 |
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Reply |
p. 107 |
Savita Malhotra
PMID:21407922 |
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| NON-INDEXED ARTICLES |
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Rehabilitation Home for Chronic Schizophrenics in or around Delhi: |
p. 108 |
| Satyawati Devi |
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Strategies in Mental Health Research: |
p. 108 |
| Shuba Kumar |
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| BOOK REVIEWS |
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Psychopharmacology of Antipsychotics |
p. 109 |
| SC Tiwari |
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Depression in Modern Life |
p. 110 |
| PK Dalal |
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