Indian Journal of PsychiatryIndian Journal of Psychiatry
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   2006| April-June  | Volume 48 | Issue 2  
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Disability associated with mental disorders
Pranit K Chaudhury, Kamala Deka, Dhrubajyoti Chetia
April-June 2006, 48(2):95-101
DOI:10.4103/0019-5545.31597  PMID:20703393
Background: Disability associated with mental illness is a major contributor to the global burden of disease. The present study looks at some aspects of disability associated with 7 psychiatric disorders: schizophrenia, bipolar affective disorder, anxiety disorders, depression, obsessive-compulsive disorder, dementia, and mental and behavioural disorders due to the use of alcohol. Aims: (i) To evaluate the nature and quantity of disabilities in the study groups; (ii) to compare the degree of disability with the severity of the disorder; (iii) to compare disability among various disorders; and (iv) to study the longitudinal stability of disability in the disease groups. Methods: A total of 228 patients attending the OPD, Department of Psychiatry, Assam Medical College, Dibrugarh, between July 2003 and June 2004, who were diagnosed as per ICD-10 guidelines and SCAN, were included in the study. Severity was assessed by the application of some commonly used rating scales for each specific disorder. The level of disability was assessed by using the Indian Disability Evaluation and Assessment Scale (IDEAS). Patients were followed up at 6 and 12 months. Statistical analysis was done on SPSS version 10. Results: All the 7 disorders under study are associated with significant disability; schizophrenia being maximally disabling. Disability associated with alcohol use disorder and anxiety is comparable to disability on account of OCD. Over a period of 12 months, disability due to depression, alcohol use disorder and anxiety tend to remain significant.
  9,376 1,200 5
Failed suicide and deliberate self-harm: A need for specific nomenclature
P Sarkar, FA Sattar, N Gode, DR Basannar
April-June 2006, 48(2):78-83
DOI:10.4103/0019-5545.31594  PMID:20703390
Background: Out of those who attempted self-harm and survived, many actually wanted to die and many did not. Presently, no distinctive nomenclature exists for these two groups, which causes difficulty in understanding as well as in management and research. Aim To study whether there exist two such groups which are distinct and can be differentiated clinically. Methods: Seventy-eight persons who attempted self-harm were evaluated in detail by a psychiatrist. The data were recorded in an especially designed proforma which documented sociodemographic variables, psychiatric and physical illnesses, psychosocial stress factors, substance abuse, past and family history and details of suicide attempt. Results: Two groups emerged with distinct characteristics. The two groups were different in factors such as age, diagnosis, intentionality, lethality, mode, motive to kill oneself, past/family history, relation to stress, personality traits and precaution to prevent detection before and/or after the act. The group which had persons who really wanted to die but survived is suggested to be named as the 'failed suicide' group and the other group which had persons who did not actually want to die is suggested to be named as the 'deliberate self-harm' group. Conclusion: Those who cause harm to themselves but survive can be distinctly put into two groups: (i) the 'failed suicide' group constituting those who actually wanted to kill themselves and (ii) the 'deliberate self­harm' group constituting those who did not actually want to die. The criteria for distinctions are suggested.
  8,673 642 1
Ganser syndrome and lesion in the temporoparietal region
M Anupama, K Nagaraja Rao, S Dhananjaya
April-June 2006, 48(2):123-125
DOI:10.4103/0019-5545.31605  PMID:20703401
Ganser syndrome is a rare dissociative disorder. It has been reported in association with various functional psychiatric disorders and organic states, most often in patients with head injury and stroke, especially those involving the frontal lobes. The present case of Ganser syndrome had features of hysterical dissociation but was found to have haemorrhage in the temporoparietal region of the dominant hemisphere. The complexities of Ganser syndrome in the presence of an organic lesion with an overwhelming emotional component are discussed.
  8,443 282 2
Psychiatric morbidity in geriatric people
Prashant Tiple, SN Sharma, AS Srivastava
April-June 2006, 48(2):88-94
DOI:10.4103/0019-5545.31596  PMID:20703392
Background: The number of geropsychiatric patients is increasing but sufficient work has not been done in this area in many parts of India. Aim: This study explored the sociodemographic profile and clinical characteristics of patients aged 60 years and above, attending the psychiatric services of Institute of Medical Sciences and geropsychiatric patients of Mumukshu Bhavan (old age home) in Varanasi from September 1998 to September 1999. Methods: For the screening of psychiatric patients at Mumukshu Bhavan the Indian Psychiatric Survey Schedule was used. DSM-IV criteria were used for the diagnosis of patients and Chi-square test with Yate correction and Z-test were used for statistical analysis. Results: Depressive disorders were the most common psychiatric illnesses. Many patients had associated physical illnesses and among them hypertension was the most common. Family jointness was adequate for most of the patients. Objective social support was moderate for the majority of patients but perceived social support was poor. Patients of Mumukshu Bhavan perceived their social support to be either moderate or good. Conclusion: Depressive disorder was the most common psychiatric illness and among the physical illnesses hypertension was the commonest. People living in the old age home felt better than those who lived with their children's family.
  7,412 798 1
Psychological assessment of alcoholism in males
Suprakash Chaudhury, SK Das, B Ukil
April-June 2006, 48(2):114-117
DOI:10.4103/0019-5545.31602  PMID:20703398
Background: Little work has been done in India on the personality factors of alcoholics. These personality factors have a significant effect on treatment outcome. Aim: To study the personality characteristics, stressful life events and diagnostic utility of the Michigan Alcoholism Screening Test (MAST) and CAGE (Cutting down, Annoyance by criticism, Guilty feeling, and Eye-opener) Questionnaire in service personnel with alcohol dependence. Methods : Psychological assessment of 100 consecutive male inpatients meeting the DSM-IV criteria for alcohol dependence, and an equal number of controls matched for age, sex, occupation and regional background was carried out utilizing the MAST, CAGE Questionnaire, State-Trait Anxiety Inventory, Hamilton Rating Scale for Depression, Multiphasic Personality Questionnaire, Maudsley Personality Inventory, Toronto Alexithymia Scale, Self-esteem Inventory and Presumptive Stressful Life Events scale. Results: The MAST and CAGE were of limited value in the diagnosis of alcohol dependence. Alcoholics obtained significantly higher scores on state and trait anxiety, depression, mania scale, paranoia scale, schizophrenia scale, psychopathic deviance, neuroticism, extroversion, and the Presumptive Stressful Life Events scale. Alcohol-dependent individuals had significantly lower self-esteem compared with control subjects, and significantly more alcoholics were identified as alexithymic. Conclusion: Alcohol-dependent individuals show significantly high neuroticism, extroversion, anxiety, depression, psychopathic deviation, stressful life events and significantly low self-esteem as compared with normal control subjects. Significantly more alcoholics were found to be alexithymic compared with normal controls.
  6,873 662 1
Neuropsychological disposition and its impact on the executive functions and cognitive style in patients with obsessive-compulsive disorder
Sreemoyee Tarafder, Pallabi Bhattacharya, Debika Paul, Gautam Bandyopadhyay, Pritha Mukhopadhyay
April-June 2006, 48(2):102-106
DOI:10.4103/0019-5545.31598  PMID:20703394
Background: Recent brain imaging and electrophysiological studies have consistently shown dysfunction of the fronto-striatal thalamic pathways in patients with obsessive-compulsive disorder (OCD). Aim To study the relationship of neuropsychological disposition with the executive functions and cognitive style in patients with OCD. Methods: Twenty OCD patients (14 males, 6 females) and 20 normal control subjects, matched for all relevant variables including age, sex and education, were studied. Neuropsychological disposition was assessed on the Adult Neuropsychological Questionnaire (ANQ), the executive functions were assessed through Wisconsin Card Sorting Test (WCST), and the cognitive style was assessed by employing the Embedded Figure Test (EFT). Results: Subcortical-cerebellar-spinal domain of ANQ was found to be associated with cognitive style and executive functions. Conclusion: The impairment of executive functions and poor activation of specific neurological circuitry in OCD patients affirms the neurobiological basis of the disorder.
  6,364 482 2
Assessment of mortality and marital status of schizophrenic patients over a period of 13 years
R Ponnudurai, J Jayakar, BWC Sathiya Sekaran
April-June 2006, 48(2):84-87
DOI:10.4103/0019-5545.31595  PMID:20703391
Background: Studies on standardized mortality rates of schizophrenic patients might help to increase the life span of these patients. Such data from developing countries including India are lacking. Investigations that provide clues regarding the quality of their family lives could also be beneficial. Aim: Besides mortality and causes of death, this study was also aimed to examine the marital status of a group of schizophrenic patients over a period of 13 years. Methods: Out of 121 schizophrenic patients recruited earlier for a different purpose, 60 were re-assessed after a period of 13 years with regard to their mortality and causes of death. The proportion of those who had to remain single because the onset of their illness was before they were 25 years of age were compared with those who had a later onset. Results: Seven deaths were recorded and the standardized mortality ratio (SMR) for all the age groups was 54.2. One patient who had absconded was not counted as a case of death. Furthermore, this trend of a high SMR persisted despite merging both the cohort and un-reassessed group (SMR 25.1) with and without known mortality. Among the deaths, the unnatural causes of death were noteworthy (28.57%)-1 accidental and another suicidal. Some deaths were probably due to poor general medical care. The proportion of patients who had to remain single because their onset of illness was before 25 years of age was significantly more than those with a later onset (p<0.001). Conclusion: It is speculated that strengthening the general healthcare delivery system for the mentally ill and sensitizing caregivers about the possible risky behaviours of patients might reduce the mortality.
  5,662 355 1
Psychiatry, colonialism and Indian civilization: A historical appraisal
Shridhar Sharma
April-June 2006, 48(2):109-112
DOI:10.4103/0019-5545.31600  PMID:20703396
  5,244 530 2
Is this 'complicated' opioid withdrawal?
SR Parkar, R Seethalakshmi, S Adarkar, S Kharawala
April-June 2006, 48(2):121-122
DOI:10.4103/0019-5545.31604  PMID:20703400
Seven patients with opioid dependence admitted in the de-addiction centre for detoxification developed convulsions and delirium during the withdrawal phase. After ruling out all other possible causes of these complications, opioid withdrawal seemed to emerge as the most likely explanation. The unpredictability of the course of opioid dependence and withdrawal needs to be considered when treating patients with opioid dependence.
  4,855 291 1
Proctalgia fugax with dysthymia
Gurvinder Pal Singh
April-June 2006, 48(2):126-127
DOI:10.4103/0019-5545.31606  PMID:20703402
A rare case of proctalgia fugax with dysthymia which was successfully treated with dothiepin and other psychological interventions.
  4,408 249 -
Efficacy and tolerability of injectable sodium valproate in patients with mania
RK Solanki, Paramjeet Singh, Renu Khandelwal, Aarti Midha
April-June 2006, 48(2):118-120
DOI:10.4103/0019-5545.31603  PMID:20703399
Background: Sodium valproate is among the newer mood stabilizers and is also an anticonvulsant. Aim To assess the effect of intravenous sodium valproate in patients with acute manic episodes of bipolar disorder. Methods: A 1-week open trial was conducted in the year 2004-2005 at the emergency ward of the Psychiatric Centre, SMS Medical College, Jaipur, in which 30 patients participated. Conclusion: Substantial improvement was seen. No major side-effects were noted except marginal elevation of the SGOT and SGPT. The findings suggest that injectable sodium valproate is a safe and effective mood stabilizer for patients with mania.
  4,352 295 -
Comorbidity in psychiatry: Way forward or a conundrum?
Nimesh G Desai
April-June 2006, 48(2):75-77
DOI:10.4103/0019-5545.31593  PMID:20703389
  4,126 363 -
Sore throat and obsessions: A causal link?
Chittaranjan Andrade, N Pfizer
April-June 2006, 48(2):130-131
DOI:10.4103/0019-5545.31608  PMID:20703404
  3,736 243 -
Clozapine-induced cardiac failure
Kuruvilla Thomas, Sr Susan , KK Jayaprakash
April-June 2006, 48(2):128-129
DOI:10.4103/0019-5545.31607  PMID:20703403
A 73-year-old woman with dementia was given clozapine for treatment-resistant psychotic symptoms. Subsequently, she developed cardiac failure. Caution should be exercised when using clozapine, especially in the elderly.
  3,129 200 -
Psychiatry must not be separated from its historical and cultural context
Paul Hoff
April-June 2006, 48(2):107-109
DOI:10.4103/0019-5545.31599  PMID:20703395
  2,934 264 1
Critical appraisal of an article on factitious schizophrenia
Rajnish Raj, Balwant Singh
April-June 2006, 48(2):132-132
DOI:10.4103/0019-5545.31609  PMID:20703405
  2,765 198 1
Author's Response
Amit Ranjan Basu
April-June 2006, 48(2):112-113
DOI:10.4103/0019-5545.31601  PMID:20703397
  2,275 196 -
Life as I know it
Mona Singh
April-June 2006, 48(2):133-134
DOI:10.4103/0019-5545.31610  PMID:20703406
  2,081 127 -