Indian Journal of PsychiatryIndian Journal of Psychiatry
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   2005| April-June  | Volume 47 | Issue 2  
    Online since September 24, 2009

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Psychological autopsy of suicide-a cross-sectional study
Farooq Ahmed Khan, B Anand, M Gowri Devi, K Krishna Murthy
April-June 2005, 47(2):73-78
DOI:10.4103/0019-5545.55935  PMID:20711285
Background: Psychological autopsy is the reconstruction of events leading to death. There are few studies on psychological autopsy. Aim: To understand the profile of suicide completers and find out ways of dealing with it. Methods: Fifty suicide cases were analysed. Using a semi-structured, self-designed questionnaire, the family, friends and relatives of the deceased were interviewed. Results : The presence of some type of psychiatric disorder and stressful life events are two important reasons for committing suicide. Conclusion: Psychological autopsy is a very important tool for assessing the causes and precipitants of suicide. More and more studies in this field are required with a larger sample size for the evaluation of suicides.
  4,180 636 26
Syndrome of inappropriate ADH secretion (SIADH) associated with citalopram use
Vivek C Kirpekar, Prashant P Joshi
April-June 2005, 47(2):119-120
DOI:10.4103/0019-5545.55960  PMID:20711296
Selective serotonin reuptake inhibitors (SSRIs) can cause the syndrome of inappropriate antidiuretic hormone secretion (SIADH). SIADH is associated with hyponatraemia without oedema. We report the case of a patient who developed acute-onset hyponatraemia that progressed rapidly to serious neurological dysfunction shortly after the introduction of citalopram. All SSRIs including citalopram should be used with care in the elderly. The water and electrolyte balance should be monitored carefully during SSRI therapy.
  2,940 360 4
Effectiveness of clozapine in treatment-resistant schizophrenia
Janakiraman Raguraman, K John Vijay Sagar, R Chandrasekaran
April-June 2005, 47(2):102-105
DOI:10.4103/0019-5545.55955  PMID:20711291
Background: Clozapine has been shown to be superior to chlorpromazine in improving the positive and negative symptoms of schizophrenia. However, technical experience with clozapine in Indian patients has not been documented. Aim: To assess the improvement in psychopathology of treatment-resistant schizophrenia with clozapine therapy and to study the relationship between sociodemographic and various psychopathology variables among patients with treatment-resistant schizophrenia. Methods: Twenty-two patients with treatment-resistant schizophrenia were evaluated using the Positive and Negative Syndrome Scale (PANSS) for schizophrenia, Calgary Depression Scale, Global Assessment of Functioning (GAF) Scale and Abnormal Involuntary Movement Scale (AIMS). These scales were used to determine the level of psychopathology, depression, overall functioning and severity of abnormal involuntary movements in the patients. The patients were admitted to the hospital for a short time to initiate clozapine therapy. At discharge, patients were stabilized on 300-400 mg/day of clozapine. The patients were re­evaluated after 20 months. Results: The study group showed better global functioning after clozapine therapy. The therapy was well­tolerated though moderate side-effects were seen. Suicidal thoughts declined with clozapine therapy. There was a significant reduction in the negative symptom and general psychopathology scores of PANSS. Conclusion: Clozapine has therapeutic efficacy in some but not all treatment-resistant patients with schizophrenia.
  2,770 352 9
Efficacy and safety of citalopram versus amitriptyline in the treatment of major depression
Anand Mathur, DK Sharma, Ashok Choudhary, Mahendra Jain
April-June 2005, 47(2):89-93
DOI:10.4103/0019-5545.55952  PMID:20711288
Background: Double-blind clinical trials comparing citalopram with amitriptyline or other tricyclic antidepressants are lacking in India. Aim: To evaluate the efficacy and safety of the newer antidepressant citalopram in the treatment of major depression. Methods: The clinical acceptability and safety profile of citalopram was assessed and compared with that of amitriptyline in 40 patients in an outpatient set-up. Patients aged 18 to 65 years who fulfilled the diagnostic criteria for a single or recurrent major depressive disorder (as defined by DSM-IV) for a minimum of 2 weeks were enrolled. Patient assessment was done at screening, baseline, end of week 1, week 2, week 3, week 4, week 5 and week 6 for efficacy and safety parameters such as Hamilton Depression Rating Scale (HDRS), Clinical Global Impression (CGI) Scale, adverse event follow up, blood pressure and pulse. Three­level statistical analysis including ANOVA was performed on all efficacy measures. Results: On the HDRS the percentage reduction in the mean score for the citalopram group (Group 1) was 72.12%, while that for the amitriptyline group (Group 2) was 67.93%. On the CGI-Improvement Scale, the percentage reduction at the end of the study for the citalopram group was 56.79% while in the amitriptyline group it was 44.70%. Twenty per cent of patients in Group 1 reported adverse events compared to 75% in Group 2. Conclusions: Citalopram is effective in the treatment of major depression at the dosages range of 20-60 mg/ day and its efficacy is equivalent to that of standard tricyclic antidepressants such as amitriptyline, with a substantially better tolerability profile.
  2,749 312 5
An epidemic of mass hysteria in a village in West Bengal
AN Chowdhury, A Brahma
April-June 2005, 47(2):106-108
DOI:10.4103/0019-5545.55956  PMID:20711292
This is a report of an outbreak of mass hysteria, attributed to an unknown infectious disease, in a small village near Baruipur, South 24 Parganas district of West Bengal. The epidemic was triggered following the death of 2 persons of the same family on the same day. Thereafter, several other family members and villagers became ill and complained of similar symptoms. They were hospitalized for observation and all were discharged after a couple of days. We report the detailed sequence of events and the management of this mini epidemic.
  2,820 170 4
Historicizing Indian psychiatry
Amit Ranjan Basu
April-June 2005, 47(2):126-129
DOI:10.4103/0019-5545.55963  PMID:20711299
Our historical endeavour to map Indian psychiatry has largely remained linear, positivistic and evolutionary. Whether it starts from the ancient times or modern, it shows our past as a tale of victory for the western science, without questioning the borrowed paradigm. The use of historical methods for serious enquiry of psychiatry has been ignored. Emergence of a new genre of historicism that is critical of both colonialism and psychiatry as a universal science, has raised hopes to critically review the emergence of psychiatric knowledge.
  2,524 430 7
Suicidal behaviour among terminally ill cancer patients in India
KS Latha, SM Bhat
April-June 2005, 47(2):79-83
DOI:10.4103/0019-5545.55950  PMID:20711286
Background: Passive suicidal thoughts are relatively common in patients with terminal cancer. There is a need for more information about the factors that influence these patients to desire death. Aim: To examine the prevalence of suicidal ideation among terminally ill cancer patients. Methods: Fifty-four terminally ill inpatients (27 men and 27 women) from the palliative care unit of the Oncology department of Kasturba Hospital, Manipal were evaluated on various rating scales for depression, hopelessness and suicidal ideation, and the correlation of suicidal ideation with medical symptoms such as pain, as well as awareness of the diagnosis and understanding of the illness. Results: Most patients (79.7%) denied having suicidal thoughts or wishing for an early death; only 9.2% had severe suicidal ideation. Two patients (3.8%) with severe suicidal ideation had a past history of major depression. Factors such as the presence of pain, awareness of the diagnosis and understanding of the illness contributed to depressive mood states. Conclusion: Suicidal ideation and a desire for death appear to be linked exclusively to the presence of a mental disorder. In addition, poor pain control, and awareness of the diagnosis may also contribute to suicidal ideation.
  2,529 359 7
Rett syndrome
Prabhat Sitholey, Vivek Agarwal, Rohit Srivastava
April-June 2005, 47(2):116-118
DOI:10.4103/0019-5545.55959  PMID:20711295
Rett syndrome is a rare, progressive, neurodevelopmental disorder that has been reported only in the girl child. We describe the case of a 6.9-year-old girl with Rett syndrome. She had normal development till the age of 2 years. However, over the next 4-5 months, she lost her acquired, purposeful hand skills; expressive and receptive language; and reciprocal social interaction; and gradually developed a broad-based gait and typical midline stereotyped hand movements (mouthing, rubbing).
  2,600 216 1
Life skills profile of patients with schizophrenia and its correlation to a feeling of rejection among key family carers
LSS Manickam, R Satheesh Chandran
April-June 2005, 47(2):94-98
DOI:10.4103/0019-5545.55953  PMID:20711289
Background: The behaviour of patients with schizophrenia is of great concern to key family carers. Life skills profile (LSP) is the measure that has considerable importance in assessing the functioning of people with schizophrenia in the community. Aim: To assess the sociodemographic correlates of LSP, and to find the correlation between LSP and the rejection response of key family carers. Methods: The LSP of 48 patients with chronic schizophrenia (29 men and 19 women) was assessed. The rejection responses of key family carers (28 men and 20 women) were evaluated using the Patient Rejection Scale. Results: The LSP did not significantly differ on the variables of gender, income level or attendance of day­care centre. However, there were differences between patients from urban and rural areas. A new dimension of family harmony, added as a subscale to LSP, also did not show any significant difference on the above variables. The rejection responses of key family carers were found to be significantly related to the LSP of the patients and, among the subscales, family harmony and communication were positively related to rejection. Conclusion: Though family interventions have been found to have positive implications on relapse and social functioning of patients with schizophrenia, a model of a family intervention programme for families of patients with schizophrenia needs to be developed.
  2,392 306 3
Stevens-Johnson syndrome-toxic epidermal necrolysis (SJS-TEN) overlap associated with carbamazepine use
PN Suresh Kumar, Biju Thomas, Kishore Kumar, Shibu Kumar
April-June 2005, 47(2):121-123
DOI:10.4103/0019-5545.55961  PMID:20711297
A benign pruritic rash occurs in 10%-15% of persons treated with carbamazepine. A small fraction of them may experience life-threatening dermatological syndromes such as exfoliative dermatitis, erythema multiforme, Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). The case of an 18-year-old female suffering from bipolar affective disorder (mania) who was being treated with carbamazepine, lithium, chlorpromazine and benzhexol is presented. After 10 days of treatment, she developed high-grade fever and mucocutaneous manifestations of SJS-TEN overlap. She was treated in hospital with systemic corticosteroids, antibiotics, intravenous fluids and other supportive measures, and recovered after 3 weeks.
  2,354 205 3
Comparison of three instruments used in the assessment of dementia in Sri Lanka
ST Kathriarachchi, S Sivayogan, SD Jayaratna, SR Dharmasena
April-June 2005, 47(2):109-112
DOI:10.4103/0019-5545.55957  PMID:20711293
Background: Dementia is poorly recognized even by physicians. This study compares three instruments used to assess dementia in a community setting in Sri Lanka. Method: Translated and culturally adapted versions of the Mini Mental State Examination (MMSE), Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and Clinical Dementia Rating (CDR) were administered to 363 individuals selected by stratified random sampling in a periurban community in Sri Lanka. The results on the three instruments were compared with the independent psychiatric evaluation done on a concentrated sample of 37 individuals from the study population. Results: Culturally adapted MMSE, IQCODE and CDR can be used to screen dementia in Sri Lanka. IQCODE is the best among the three instruments with a sensitivity of 71.4% and a specificity of 82.6% when 3.5 is the cut-off. In addition, IQCODE is culturally acceptable, easy to administer and can be used in those with a low level of literacy as well as in those with hearing or visual impairment. Conclusion: IQCODE was found to be more effective and culturally acceptable as a screening tool for dementia in Sri Lanka, compared with MMSE and CDR.
  2,172 211 6
Sleep disorders in children with attention-deficit hyperactivity disorder
Subhash C Bhargava, Sujata Sethi
April-June 2005, 47(2):113-115
DOI:10.4103/0019-5545.55958  PMID:20711294
Background: Sleep disturbances are frequently associated with attention-deficit hyperactivity disorder (ADHD) though they are not included in the current classification systems such as the DSM-IV and ICD-10. These problems may complicate the course of the illness as they may be associated with the treatment given Aim: To evaluate children with ADHD for sleep-related problems. Methods: The study group comprised 32 children with ADHD and their 20 healthy siblings made up the control group. Sleep-related problems were assessed on a checklist prepared on the basis of the Children Sleep Questionnaire-parent version. Results: A majority of the children with ADHD had at least one sleep-related problem. Comparison with healthy siblings revealed non-significant differences on the parameters of sleep-related movement disorders and parasomnias. Conclusion: There is a need for more detailed studies involving sensitive parameters.
  1,984 283 4
Treatment-refractory, juvenile-onset bipolar affective disorder
K John Vijay Sagar
April-June 2005, 47(2):124-125
DOI:10.4103/0019-5545.55962  PMID:20711298
A case of juvenile-onset bipolar affective disorder with a childhood history of attention-deficit hyperactivity disorder (ADHD) is presented. As the patient was refractory to treatment with mood stabilizers, clozapine was given, which succeeded in achieving remission. The disorder's natural history needs further study. Data also need to be collected for optimal pharmacotherapeutic guidance.
  2,020 203 3
Comparison of the efficacy and safety of moclobemide and imipramine in the treatment of depression in Indian patients
Ajit Avasthi, Parmanand Kulhara, Gagandeep Singh, Rajni Sharma, Rajinder P Kaur
April-June 2005, 47(2):84-88
DOI:10.4103/0019-5545.55951  PMID:20711287
Background: Moclobemide, a benzamide, is one of the new-generation monoamine oxidase-A inhibitors (MAO-AIs) which belongs to the class of reversible inhibitors of monoamine oxidase (RIMA). Numerous studies have shown that moclobemide is well-tolerated and as effective as other antidepressants. So far, there is no evidence available regarding its efficacy and tolerability in India. Aim: To compare the efficacy and safety of moclobemide with that of imipramine, a tricyclic antidepressant, in the treatment of major depressive disorder. Methods: In this prospective study, patients (n=60) were randomly assigned to treatment with moclobemide or imipramine for 6 weeks. Efficacy of the drugs was assessed by observing the mean change in scores on the Hamilton Depression Rating Scale (HDRS) and the Montgomery-Asberg Depression Scale (MADRS). Results: Both the groups showed significant decrease in scores at the end of 6 weeks. Patients who received moclobemide had a better side-effect profile. Conclusion: Moclobemide is an effective antidepressant and is better tolerated than imipramine.
  1,986 181 3
Cognitive decline in elderly medical and surgical inpatients
Srinivasan N Tirupati, Rebecca N Punitha
April-June 2005, 47(2):99-101
DOI:10.4103/0019-5545.55954  PMID:20711290
Background: Impairment in cognitive function increases with age. Aim: To study the prevalence of cognitive decline in inpatients ³60 years of age. Methods: One hundred and thirty patients (85 men and 45 women), admitted to a community general hospital for medical or surgical treatment, were selected. The Mini Mental State Examination (MMSE) was used to identify subjects with cognitive dysfunction. Patients were categorized as having cognitive decline or normal cognition. The Global Rating of Memory Decline (GRMD) and Global Rating of Intellectual Decline (GRID) scales were used to assess the decline in memory, thinking and reasoning ability. Results: Cognitive decline was diagnosed in 54 subjects (41.5%). Significantly more patients ³70 years of age had cognitive decline compared to patients £70 years of age. On the GRMD, 71 patients had subjective decline in memory, 62 of them reported that the decline interfered with their daily life. On GRID, subjective decline in intellectual function was found in 91 patients, with 55 reporting that the decline interfered with their daily lives. Conclusion: Patients ?70 years of age with an acute medical problem are the most likely to have cognitive problems.
  1,542 169 1
Regional cooperation for mental health in South Asia: Opportunities and challenges
Nimesh G Desai
April-June 2005, 47(2):71-72
DOI:10.4103/0019-5545.55932  PMID:20711284
  1,255 156 1
Reboxetine-induced urinary hesitancy
Suresh Borade, Mahesh Bhirud, Kranti Kadam
April-June 2005, 47(2):130-130
DOI:10.4103/0019-5545.55964  PMID:20711300
  1,205 84 -