Indian Journal of PsychiatryIndian Journal of Psychiatry
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   2003| July-September  | Volume 45 | Issue 3  
    Online since February 20, 2009

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Decentralisation of Mental Health Services under DMHP
BK Waraich, Lok Raj, BS Chavan, R Badhan, SN Panda
July-September 2003, 45(3):161-165
The Bellary model of district mental health programme(DMHP) has been adopted by the government of India under the national mental health programme with the primary aim of making mental health care accessible to all by setting up psychiatric services in peripheral areas, training primary health care personnel and involving the community in promotion of mental health care. The DMHP was set up in Chandigarh in a 50 bedded Civil Hospital in a suburb of Chandigarh.This study aims to present the sociodemographic and clinical data of all cases seen in the first six months and discusses the need of decentralisation of mental health services. A total of 527 patients were seen in the first six months. 52% of the males presented with substance use disorders while a majority of the females (40%) presented with mood disorders. In patients with illness of duration more than one year, upto 51.9% had no past psychiatric treatment and 27.6% were on irregular treatment. Reasons for this are discussed. In conclusion, it was seen that decentralisation was a felt need of the community and required not only in rural but urban areas as well.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  846 256 -
Predictors of Outcome Following Alcohol Deaddiction Treatment : A Prospective Longitudinal Study for one Year
N Kar, S Sengupta, PSVN Sharma, Gunasagari Rao
July-September 2003, 45(3):174-177
The factors influencing the short-term outcome of alcohol dependence patients psychiatric set up were studied prospectively in an Indian population. Consecutive 60 patients with alcohol dependence syndrome according to the ICD 10 criteria, were studied. Positive outcome was noted in 55%, negative in 35%; and 10% were lost to follow up at the end of one year. There was no difference between the groups on educational level, marital status, economic status, religion, social support, associated physical or psychiatric diagnoses, type of treatment for deaddiction, age of regular drinking, days of previous abstinence and inpatient treatment days. However the negative outcome group were younger, and their average age for problem drinking was significantly less than the other group. They achieved many mile-stones of drinking career like onset of day drinking, development of dependence, diagnosis of dependence earlier. The negative outcome group also had higher psychosocial problem index, family history of alcoholism, more follow-up days using the mental health services. They did not come for follow up as quickly as the abstinent group after initiation of pathological drinking.The study suggested many clearly identifiable variables, which may distinguish prospectively patients with probable positive and negative outcome one year after the alcohol deaddiction treatment
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  874 189 -
Psychiatric Morbidity of Cannabis Abuse
Jaydip Sarkar, Pratima Murthy, Swaran P Singh
July-September 2003, 45(3):182-188
The paper evaluates the hypothesis that cannabis abuse is associated with a broad range of psychiatric disorders in India, an area with relatively high prevalence of cannabis use. Retrospective case-note review of all cases with cannabis related diagnosis over a 11 -year period, for subjects presenting to a tertiary psychiatric hospital in southern India was carried out. Information pertaining to sociodemographic, personal, social, substance-use related, psychiatric and treatment histories, was gathered. Standardized diagnoses were made according to Diagnostic Criteria for Research of the World Health Organization, on the basis of information available. Cannabis abuse is associated with widespread psychiatric morbidity that spans the major categories of mental disorders under the ICD-10 system, although proportion of patients with psychotic disorders far outweighed those with non-psychotic disorders. Whilst paranoid psychoses were more prevalent, a significant number of patients with affective psychoses, particularly mania, was also noted. Besides being known as either the causative agent or a potent risk factor in cases of paranoid psychoses, cannabis appears to have similar capabilities with regard to affective psychoses, particularly in cases of mania. It is suggested that cannabis has the potential to act as a "life event stressor" amongst subjects vulnerable to develop affective psychoses and the possible aetiopathogenesis of such a finding is discussed.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  753 213 -
The Nature and Extent of the use of Physical Restraint and Seclusion in Psychiatric Practice : Report of a Survey
Udayan Khastgir, Anirudh Kala, Utpal Goswami, Satindra Kumar, Debakanta Behera
July-September 2003, 45(3):155-157
Restraint and seclusion has been used to manage patients despite all controversies. Our study analyzed the opinions of different psychiatrists on the use of this method in their clinical practice. Most of them (80%) practice restraints as a treatment modality and believe that they are integral to the management of psychiatric patients. None is using seclusion.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  792 158 -
ECT and Clozapine Combination Producing delirium : A Case Report
Satindra Kumar, Utpal Goswami, Debakanta Behera, Udayan Khastgir
July-September 2003, 45(3):193-193
Although successfully used, caution has been advised with the combined use of clozapine and electroconvulsive therapy (ECT).The combination has been associated with delirium, in this report, which successfully resolves on discontinuation of ECT.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  796 78 -
Seasonality in Affective Disorders Using SPAQ
Ajit Avasthi, Nitin Gupta, Pramanand Kulhara, Pratap Sharan, Gagandeep Singh, Rajinder Pal Kaur, Rajni Sharma
July-September 2003, 45(3):166-173
Seasonal affective disorder (SAD) is a subtype of affective disorder, which causes significant distress but has no-definitive treatments available till date. Research on SAD has shown variable prevalence due to different climates and latitudes in which these studies are carried outThe present study was an attempt to study prevalence of SAD, its socio-demographic and clinical characteristics and relationship between seasonality and development of affective disorder in a tertiary care psychiatric centre in North India. 421 consecutive patients of affective disorder were assessed on Socio-demographic profile sheet. Seasonality Pattern Assessment Questionnaire (SPAQ), Dysfunctional Assessment Questionnaire, Hamilton Depression Rating Scale and Mania Rating Scale. Most of patients were male and were living in the present climatic area for a mean duration of 35 years. Severe Depressive Episode with/without Psychotic Symptoms was the commonest diagnosis (ICD-10). Most of the patients did not report any variation in mood or behaviour. 2.85% patients were found to have syndromal / subsyndromal SAD based on Global Severity Score of SPAQ. Comparison of 'Seasonality' and 'Non-Seasonality' groups revealed that both groups were comparable on Socio-clinical variables, family history and severity of illness. Low prevalence of SAD in the present study could be due to the different method of assessment used in the study (assessment lasting for the whole year, direct interview method). It may also be speculated that season of changes are not related to underlying processes or consequent to the development of affective disorders
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  760 78 -
Special Article : Spiritual Throughts in Psychiatry-I
Thomas R Osborne, Dinesh Bhugra
July-September 2003, 45(3):142-144
One of the greatest religions in the world. Buddhism and its tenets have been used for understanding the pain and human emotions. Using these tenets social and psychological development of the individuals can be encouraged.They key constructs of Buddhism can be employed in cognitive therapy. In this paper we provide an overview of the key principles embedded in Buddhism and also place these in the context of Western concepts of psychotherapy. We link the Buddhist concepts with anxiety, obsessive compulsive disorders, addictions and chronic illness.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  718 107 -
Antidepressant Induced Mania : Is It a Risk Factor for Antidepressant Abuse?
S Ramesh, Sudhir K Khandelwal
July-September 2003, 45(3):194-195
Induction of mania is a common occurrence with antidepressant use. A case of antidepressant induced hypomania leading to antidepressant abuse is presented. The clinical implications of antidepressant abuse in bipolar disorder are discussed.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  727 91 -
Enlargement of the Third Ventricle in affective Disorders
Rano Bhadoria, David Watson, Paul Danson, Ian Nicol Ferrier, Victor I Mcallister, Peter Brian Moore
July-September 2003, 45(3):145-150
Introduction : There have been inconsistent reports of dilation of the third ventricle (lll-V) in bipolar disorder. Within the lateral walls of lll-V are hypothalamic nuclei which mediate the neuroendocrine, sleep, appetite and autonomic disturbances which characterise a depressive episode. Methods : The lll-V width, immediately anterior to the mamillary bodies, was measured in 74 bipolar I or II subjects (m=25, f=49, mean age 36.1(1 l.3yr) and 33 healthy controls (m= 17, f= 16, mean age 35.6( 12.6yr) from MRI coronal inversion recovery scans. Results : Bipolar subjects had significantly (t=2.l6,p=0.03) wider lll-V (0.45(0.15cm) than controls (0.40(0.12cm). Examining data with a General Linear Model with gender and diagnoses as categoric variables and age as a continuous variable, lll-V width depended significantly on gender (p=O.OI6), age (p<0.00l) and differed significantly (p=0.03) between bipolar subjects and controls. The rate of lll-V dilation was estimated to be 0.0048cm/yr in male bipolar subjects and 0.0040cm/yr in females. Comment : Bipolar disorder is associated with increased lll-V width and progressive dilation. It is proposed that dilation may be associated with dysfunction of hypothalamic nuclei in the lll-V lateral walls.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  720 75 -
Influence of Duration of Untreated Psychosis on the Short-Term Outcome of Drug-Free Schizophrenia Patients
Mariyamma Philip, BN Gangadhar, Jagadisha , Latha Velayudhan, DK Subbakrishna
July-September 2003, 45(3):158-160
Western studies in the recent past have suggested that reducing the duration of untreated psychosis (DUP) is associated with better control of symptoms of schizophrenia. The present investigation attempts to assess the influence of duration of untreated psychosis and other predictors on the outcome of schizophrenia, six weeks after the treatment. Data of 45 DSM-IV schizophrenia patients (Mean age 31 ± 9.2; 27 males) who were treated for the first time formed the sample. Based on the clinical notes in files two psychiatrists independently rated the outcome at 6-8 weeks of neuroleptic treatment. The inter rater agreement was good. Improved and unimproved groups did not differ on any variables except the duration of untreated psychosis. Duration of untreated psychosis was longer in the unimproved group. In a logistic regression model, only duration of untreated psychosis emerged as a significant predictor (OR= 0.9854. with 95% Cl= 0.9717 - 0.9993; p=0.039). DUP affects acute outcome in schizophrenia.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  668 109 -
A Study of Substance Non-Use
Vasantha Jayaram, T.S.J Anandaram, Anand Balan, V.S.P Bashyam
July-September 2003, 45(3):189-192
120 persons belonging to the four different groups namely, students, unskilled workers, skilled workers and professionals were interviewed using a semi-structured interview schedule on subsunce non-use. Results were analysed using SPSS 7.5 version. 65% of the sample used, at least, one of the substances during their lifetime. Alcohol (55.8%) and nicotine (45%) were the commonly used substances and paan (21.7%) was used to some extent. The non-users were questioned on the reasons for nonuse, with respect to each of the substances, namely, nicotine, alcohol, paan, cannabis, sedatives, opioids and others. Familial values, disinterest, effects of the substance, adverse effects due to substances, moral values, responsibilities and being a role model were the commonly attributed reasons for substance non-use.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  652 100 -
Craving by Imagery cue Reactivity In opiate Dependence following Detoxification
Debakanta Behera, Utpal Goswami, Udayan Khastgir, Satindra Kumar
July-September 2003, 45(3):178-181
Background: Frequent relapses in opioid addiction may be a result of abstinentemergent craving. Exposure to various stimuli associated with drug use (drug cues) may trigger craving as a conditioned response to 'drug cues'. Aims: The present study explored the effects of imagery cue exposure on psychophysiological mechanisms of craving, viz. autonomic arousal, in detoxified opiate addicts. Methodology: Opiate dependent subjects (N=38) following detoxification underwent imagery cue reactivity trials.The subjects were asked to describe verbally and then imagine their craving experiences. Results: Craving was measured subjectively by using Visual Analogue Scale and autonomic parameters of galvanic skin resistance (GSR), pulse rate (PR), and skin temperature (ST) was taken during cue imagery. Spearman's r and Wilcoxon signed ranks test were employed in analysis. Multivariate repeated measurement analysis (wilk's Lambda) was employed wherever appropriate. Subjective measures of craving, GSR and PR increased significantly whereas ST decreased significantly during drug related cue imagery as compared to neutral cues. Conclusions: The results support that cue imagery is a powerful tool in eliciting craving. Hence, it can be used as a screening manoeuvre for detecting individuals with high cue reactivity, as well as for extinction of craving.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  642 82 -
Attitudes Towards Taking Medicine Among Those Patients who Either Received Olanzapine or First Generation Antipsychotic Agents
NR Chengappa, Haranath Patepally, Jaspreet S Brar, Aziz Gopalani, Lokaranjit Chalasani, Jonathan Bear, Joseph Levine
July-September 2003, 45(3):151-154
This project evaluated the attitudes of psychiatric patients towards receiving either olanzapine or the first-generation antipsychotic agents. Newly admitted patients to a state psychiatric hospital who were either prescribed olanzapine (n=35) or other first-generation antipsychotic agents (n=34) were compared on measure of their personal attitudes toward receiving medicines using the Drug Attitude Inventory (DAI). Subjects were evaluated prior to receiving olanzapine and 8 weeks later unless they were discharged or discontinued sooner. The olanzapine-treated group recorded significantly greater improvements on their positive attitude scores toward taking the medicine, and reduced negative attitude scores relative to the comparator group. These results remained statistically significant even after correction of baseline differences between the two groups for the positive attitudes and a statistical trend persisted for negative attitude scores too. During the subsequent 30 month follow-up, significantly fewer of the olanzapine treated subjects (5, 14.3%) were readmitted to the hospital compared with 13 (38.2%) of the comparator group. These data suggest switching patients to olanzapine may improve their attitudes towards taking medicines at least in the short-term. These preliminary data need affirmation or refutation in a controlled random-assignment longer-term clinical trial where specific measures of adherence are evaluated, and where the comparators are the other second generation antipsychotic agents.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  619 62 -
Teaching and Learning in Medicine
Gareth Holsgrove
July-September 2003, 45(3):139-141
Full text not available  [PDF]  [PubMed]
  478 58 -
Glimpses of Neurobiological Underpinnings of Bipolar Disorder
Utpal Goswami
July-September 2003, 45(3):135-138
Full text not available  [PDF]  [PubMed]
  334 73 -