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   2010| October-December  | Volume 52 | Issue 4  
    Online since December 29, 2010

 
 
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ORIGINAL ARTICLES
Empowering adolescents with life skills education in schools - School mental health program: Does it work?
Bharath Srikala, KV Kishore Kumar
October-December 2010, 52(4):344-349
DOI:10.4103/0019-5545.74310  PMID:21267369
Aim : Mental Health Promotion among adolescents in schools using life skills education (LSE) and teachers as life skill educators is a novel idea. Implementation and impact of the NIMHANS model of life skills education program studied. Materials and Methods: The impact of the program is evaluated at the end of 1 year in 605 adolescents from two secondary schools in comparison to 423 age, sex, socioeconomic status-matched adolescents from nearby schools not in the program. Results: The adolescents in the program had significantly better self-esteem (P=0.002), perceived adequate coping (P=0.000), better adjustment generally (P=0.000), specifically with teachers (P=0.000), in school (P=0.001), and prosocial behavior (P=0.001). There was no difference between the two groups in psychopathology (P - and adjustment at home and with peers (P=0.088 and 0.921). Randomly selected 100 life skill educator-teachers also perceived positive changes in the students in the program in class room behavior and interaction. LSE integrated into the school mental health program using available resources of schools and teachers is seen as an effective way of empowering adolescents.
  13,657 1,557 35
PG CME
How antidepressant drugs act: A primer on neuroplasticity as the eventual mediator of antidepressant efficacy
Chittaranjan Andrade, N Sanjay Kumar Rao
October-December 2010, 52(4):378-386
DOI:10.4103/0019-5545.74318  PMID:21267376
Depression is conventionally viewed as a state of chemical imbalance, and antidepressants are suggested to act through increasing monoaminergic neurotransmission. These views are currently considered simplistic. This article examines the animal and human literature on the neurohistological mechanisms underlying stress, depression and antidepressant treatment. Pathological stress and depression are associated with changes such as loss of dendritic spines, shrinkage of the dendritic tree and loss of synapses in the hippocampus and prefrontal cortex. There is also a decrease in glia. Apoptosis may occur under extreme circumstances. In contrast, there is increased dendritic arborization and synaptogenesis in the amygdala. Antidepressant treatment protects against and even reverses some but not all of these stress-induced neurohistological changes. Pathological stress results in an aberrant neuroplasticity response characterized by abnormally increased activity in the amygdala and by impaired functioning of the hippocampus, prefrontal cortex and downstream structures. This aberrant neuroplasticity response directly explains most of the clinical symptoms of depression. Antidepressant treatment protects against stress-induced pathoplastic neurohistological and neurocognitive changes. Antidepressant treatment also restores functional neuroplasticity in stressed organisms and, thereby, presumably, facilitates re-adaptation through learning and memory mechanisms. Thus, the stress-depression syndrome and the therapeutic and prophylactic efficacy of antidepressant treatments can be explained through a hardwiring analogy. In this context, glutamate is an important neurotransmitter.
  7,475 976 42
REVIEW ARTICLE
Biological basis of tobacco addiction: Implications for smoking-cessation treatment
RC Jiloha
October-December 2010, 52(4):301-307
DOI:10.4103/0019-5545.74303  PMID:21267362
Tobacco use became common all over the world after discovery of Americas. Tobacco, a plant carries in its leaves an alkaloid called nicotine, which is responsible not only for several pathophysiological changes in the body but also develops tolerance to its own action with repeated use. Studies suggest that the alpha-4 beta-2 nicotine acetylcholine receptor subtype is the main receptor that mediates nicotine dependence. Nicotine acts on these receptors to facilitate neurotransmitter release (dopamine and others), producing pleasure and mood modulation. Repeated exposure to nicotine develops neuroadaptation of the receptors, resulting in tolerance to many of the effects of nicotine. Withdrawal symptoms appear on stoppage of tobacco use, which are characterized by irritability, anxiety, increased eating, dysphoria, and hedonic dysregulation, among others. Smoking is also reinforced by conditioning. Pharmacotherapies for smoking cessation should reduce withdrawal symptoms and block the reinforcing effects of nicotine obtained from smoking without causing excessive adverse effects.
  7,635 767 16
GUEST EDITORIAL
Old-age insecurity: How far does the "Parents and Senior Citizen's Act of 2007" address the problem?
PK Kuruvilla
October-December 2010, 52(4):298-300
DOI:10.4103/0019-5545.74302  PMID:21267361
  6,597 346 1
ORIGINAL ARTICLES
Pathway of care among psychiatric patients attending a mental health institution in central India
Chandrakant Lahariya, Shyam Singhal, Sumeet Gupta, Ashok Mishra
October-December 2010, 52(4):333-338
DOI:10.4103/0019-5545.74308  PMID:21267367
Introduction : Only a limited proportion of patients with psychiatric disorders attend the healthcare facilities, and that too when the condition becomes severe. Treatment from unqualified medical practitioners and faith healers is a common practice, and is attributable to the delay in proper treatment. Materials and Methods: A cross-sectional study was conducted to understand the pathway of care adopted by psychiatric patients and its relationship with the socio-demographic determinants in the study population. The subjects were selected from urban specialty psychiatric hospitals and interviewed using a pre-tested, semi-structured interview schedule. The data was analyzed using SPSS v10.0 software. The Chi square test, T test, and Kruskall Wallis Test were used, as needed. Results: A total of 295 patients (203 males) were included in this study. The majority of the patients (45%) were suffering from Bipolar affective disorders (45%), followed by schizophrenia (36%). The majority, 203 (68%), were from the rural area, with 94 patients being illiterate. The mean distance traveled for treatment was 249 km. The majority of these (69%) had first contacted faith healers and a qualified psychiatrist was the first contacted person for only 9.2% of the patients. Conclusion: A large proportion of psychiatric patients do not attend any health facility due to a lack of awareness about treatment services, the distance, and due to the fear of the stigma associated with treatment. The psychiatric patients first seek the help of various sources prior to attending a psychiatric health facility. The pathway adopted by these patients need to be kept in mind at the time of preparation of the mental health program.
  5,575 631 49
The global mental health assessment tool-validation in hindi: A validity and feasibility study
Vimal K Sharma, Savita Jagawat, Aarti Midha, Anil Jain, Anil Tambi, Leena Kumari Mangwani, Bhawna Sharma, Parul Dubey, Vipin Satija, John R.M Copeland, Peter Lepping, Steven Lane, Murali Krishna, Ashok Pangaria
October-December 2010, 52(4):316-319
DOI:10.4103/0019-5545.74305  PMID:21267364
Background: A computer-assisted interview, the Global Mental Health Assessment Tool-validation (GMHAT/PC) has been developed to assist general practitioners and other health professionals to make a quick, convenient, yet reasonably comprehensive standardized mental health assessment. GMHAT/PC has been translated into various languages including Hindi. This is the first study conducted in India, using the Hindi version GMHAT/PC of the series of studies assessing its validity in different cultures. Aim: The study aims to assess the feasibility of using a computer assisted diagnostic interview by health professionals and to examine the level of agreement between the Hindi version GMHAT/PC diagnosis and psychiatrists' ICD-10 based clinical diagnosis. Design: Cross-sectional validation study. Setting : Psychiatric clinic of a General Hospital and an out patient (Neurology) clinic in the Teaching General Hospital in Jaipur, India. Materials and Methods: All consecutive patients attending the psychiatric out patient clinic were interviewed using GMHAT/PC and psychiatrists made a diagnosis applying ICD-10 criteria for a period of six weeks. A small sample of subjects was interviewed in a similar way in a Neurology clinic for four weeks. Results: The mean duration of interview was under 17 minutes. Most patients were pleased that they were asked about every aspect of their mental health. The agreement between psychologists' GMHAT/PC interview diagnoses and psychiatrists' clinical diagnoses was excellent (Kappa 0.96, sensitivity 1.00, and specificity 0.94). Conclusion: GMHAT/PC Hindi version detected mental disorders accurately and it was feasible to use GMHAT/PC in Indian settings.
  5,662 357 5
Predictors of long-term outcome of first-episode schizophrenia: A ten-year follow-up study
Amresh Shrivastava, Nilesh Shah, Megan Johnston, Larry Stitt, Meghana Thakar
October-December 2010, 52(4):320-326
DOI:10.4103/0019-5545.74306  PMID:21267365
Objective: Schizophrenia is a severe mental disorder for which final outcomes continue to be unfavorable. The main objectives of this research were to examine and determine the baseline predictors of outcome status of first-episode schizophrenia in a long-term follow-up of ten years and of recovery ten years later. Materials and Methods: The study was carried out in a non-governmental, psychiatric hospital and participants consisted of patients available for assessment ten years following their initial diagnosis. Outcome was assessed on clinical and social parameters. Clinical measures of outcome included psychopathology, hospitalization, and suicidality. Social parameters included quality of life functioning, employability, interpersonal functioning, and the ability to live independently. Results: In our sample, mean positive symptoms' score were reduced by more than 65% between baseline and endpoint. The percentage of reduction in scores of negative symptoms is much less than reduction in positive symptoms. It was observed that only 23-25% patients showed social recovery on two or three different parameters. Additionally, fewer negative symptoms, lower depression scores, and low levels of aggression at baseline predicted good outcome. A higher level of positive symptoms at baseline also predicted recovery. The two social variables that predicted later outcomes were initially high levels of work performance and the ability to live independently at baseline. Conclusions: Clinical information is not sufficient to make an accurate prediction of outcome status; rather, outcome depends upon multiple factors (including social parameters). A major implication of this research is the argument for moving toward a comprehensive assessment of outcome and to plan management accordingly. Bringing social outcome measures to the forefront and into the communities will allow for a more patient-centric approach. It also opens newer vistas for addressing the complex interaction of clinical and social parameters.
  4,993 578 16
Problem alcohol drinking in rural women of Telangana region, Andhra Pradesh
Padmavathy S Potukuchi, Prasada G Rao
October-December 2010, 52(4):339-343
DOI:10.4103/0019-5545.74309  PMID:21267368
Background: This is the first ever study conducted to assess the prevalence of problem alcohol use in the rural women of Telangana region of Andhra Pradesh. Aims: To evaluate the prevalence of dependence and problem drinking, observe the factors that led to it and to monitor the effect of intervention in the form of psycho-education on their treatment seeking attitude. Materials and Methods: Cases were referred by the registrar from the Medicine Out-Patient Department using a three-item questionnaire for history of alcohol intake. Consecutive consenting female patients fulfilling the inclusion-exclusion criteria formed the sample. ICD-10 criteria and CAGE Questionnaire were used to assess dependence, problem drinking and co-morbid psychiatric illnesses. The socio-demographic data and the details regarding the nature and pattern of drinking and its complications were recorded using a semi-structured proforma. All patients were instructed to report at the end of 1 and 3 weeks for follow-up after a brief psycho-education regarding the problems of alcohol use. Results: Dependence was seen in 4.1% and problem drinking in 1%. Physical complications possibly due to alcohol were seen in 4.1% and psychiatric co-morbidity in 1%. Pregnancy drinking was recorded in 4.4%. Only 0.2% came for follow-up. Conclusion: To conclude, there is a perceptible degree of problematic use of alcohol in the rural women of this region. Yet, none of them were seeking psychiatric help. The soaring number of pregnancy drinking needs further exploration. The poor psychiatric follow-up leads us to conclude that in this sample the perception of alcohol problem is very low.
  4,411 406 9
Children of men with alcohol dependence: Psychopathology, neurodevelopment and family environment
Vijaya Raman, Suveera Prasad, M Prakash Appaya
October-December 2010, 52(4):360-366
DOI:10.4103/0019-5545.74313  PMID:21267372
Background: Children of people with alcohol dependence (COAs) are at high risk for behavioral and cognitive problems. Aim: Aim of this study was to compare the nature and extent of these problems in children of men with and without alcohol dependence. Materials and Methods: 32 children (17 in study group and 15 controls) were evaluated for psychopathology, neurodevelopment, cognitive functioning and family environment. Tools used were: Socio-demographic data sheet, Malin's Intelligence Scale for Indian Children (MISIC), Child Behavior Checklist, Trail Making Test, Neurodevelopment Scale and the Family Environment Scale. Results: Children of men with alcohol dependence had higher externalizing than internalizing scores. Children of alcohol-dependent fathers had higher scores on the neurodevelopment scale and lower scores on the performance scale of the MISIC than the children in control group. These children also made more errors on the Trail Making Test. The family environment of COAs was characterized by lack of independence for its members, greater perceived control and lack of adequate cultural and intellectual activities. Conclusion: Our findings suggest that children of men with alcohol dependence have difficulties with frontal lobe functions and neurodevelopmental tasks. There are also difficulties in the family, which are related to alcohol consumption by the father.
  4,160 566 7
EDITORIAL
Work, family or personal life: Why not all three?
TS Sathyanarayana Rao, Vishal Indla
October-December 2010, 52(4):295-297
DOI:10.4103/0019-5545.74301  PMID:21267360
  3,936 558 14
CME
The assessment of insight across cultures
KS Jacob
October-December 2010, 52(4):373-377
DOI:10.4103/0019-5545.74316  PMID:21267375
The assessment of insight is a part of the routine clinical examination for people with mental illness. Such assessment, by psychiatrists, is based on the current definitions of insight, which rely on western notions of health and illness. This paper discusses the recent findings of illness perspectives of people with a variety of physical diseases and mental disorders from India. Studies on insight in schizophrenia and bipolar disorders also examined explanatory models of illness among patients, relatives, and the general population. The findings argue for the fact that the assessment of insight should be against the local cultural standards rather than universal yardsticks. The assessment of insight should evaluate awareness, attribution, and action. People with psychosis who are able to re-label their psychotic experience, offer non-delusional explanations for changes in themselves, which correspond to beliefs about illness held by the subculture, admit to the need for restitution, and seek locally available help, can be said to possess insight. The results recommend the use of universal conventions to assess insight in people with psychosis rather than the use of uniform criteria.
  3,728 530 8
ORIGINAL ARTICLES
A functional magnetic resonance imaging study of neurohemodynamic abnormalities during emotion processing in subjects at high risk for schizophrenia
Ganesan Venkatasubramanian, Dawn Thomas K Puthumana, Peruvumba N Jayakumar, BN Gangadhar
October-December 2010, 52(4):308-315
DOI:10.4103/0019-5545.74304  PMID:21267363
Background: Emotion processing abnormalities are considered among the core deficits in schizophrenia. Subjects at high risk (HR) for schizophrenia also show these deficits. Structural neuroimaging studies examining unaffected relatives at high risk for schizophrenia have demonstrated neuroanatomical abnormalities involving neo-cortical and sub-cortical brain regions related to emotion processing. The brain functional correlates of emotion processing in these HR subjects in the context of ecologically valid, "real-life" dynamic images using functional Magnetic Resonance Imaging (fMRI) has not been examined previously. Aim: To examine the neurohemodynamic abnormalities during emotion processing in unaffected subjects at high risk for schizophrenia in comparison with age-, sex-, handedness- and education-matched healthy controls, using fMRI. Materials and Methods: HR subjects for schizophrenia (n=17) and matched healthy controls (n=16) were examined. The emotion processing of fearful facial expression was examined using a culturally appropriate and valid tool for Indian subjects. The fMRI was performed in a 1.5-T scanner during an "implicit" emotion processing paradigm. The fMRI analyses were performed using the Statistical Parametric Mapping 2 (SPM2) software. Results: HR subjects had significantly reduced brain activations in left insula, left medial frontal gyrus, left inferior frontal gyrus, right cingulate gyrus, right precentral gyrus and right inferior parietal lobule. Hypothesis-driven region-of-interest analysis revealed hypoactivation of right amygdala in HR subjects. Conclusions: Study findings suggest that neurohemodynamic abnormalities involving limbic and frontal cortices could be potential indicators for increased vulnerability toward schizophrenia. The clinical utility of these novel findings in predicting the development of psychosis needs to be evaluated.
  3,500 288 12
Awareness on psychosomatic health among adolescent girls of three schools in north Kolkata
Palas Das, Ranabir Pal, Shrayan Pal
October-December 2010, 52(4):355-359
DOI:10.4103/0019-5545.74312  PMID:21267371
Introduction: Psychosomatic health of adolescent girls at crossroads of childhood and mature adulthood, may lead to various health problems in future. Objective: To determine the improvement in the knowledge and attitude on health among adolescent girl students of Kolkata after the health education intervention. Materials and Methods: This 'Health Education Intervention Study' was conducted in October and November 2006, in three senior secondary schools of North Kolkata. The Simple Random Sampling Technique was applied to select three schools from the spot map of North Kolkata for this study, and 282 girl students in the adolescent age group of 13 to 19 years were selected from the completed updated list of students from the enrollment registers in these schools. Results: The mean age of the participants was 15.7 years (΁1.8 years). This health education intervention showed a significant improvement in their knowledge on adolescent health, in the aspects of sex differences in pubertal spurts, probable causes of health problems during adolescence, physical changes in adolescent boys and girls, and psychological problems of adolescence. A significant improvement in positive attitude was observed, with regard to their opinion on substance abuse in the adolescent period and importance of sex education for adolescents. Conclusion: This study revealed some unknown parts of psychosomatic health among adolescent girls, in this part of India.
  3,202 220 4
Subsyndromal states in bipolar disorder
Dushad Ram, Daya Ram
October-December 2010, 52(4):367-370
DOI:10.4103/0019-5545.74314  PMID:21267373
Background: Despite adequate treatment, patients with bipolar disorder suffer from subsyndromal symptoms. This study has been done to see the association of subsyndromal symptoms with age of onset, duration of illness, duration of episodes, and number of episodes. Aims: To know the prevalence of subsyndromal symptoms and their relationship with age of onset, total duration of illness, number of episodes, and duration of episodes in patients with bipolar disorder in remission. Materials and Methods: The study was cross sectional and hospital based. One hundred patients, aged between 18 and 65 years, diagnosed as bipolar disorder according to Research Diagnostic Criteria of ICD-10, and with good compliance with the prophylactic medications, score of ≤5 on Beck's Mania Rating Scale (BMRS) and score ≤8 on Hamilton Depression Rating Scale (HDRS) were recruited by the purposive sampling method. Descriptive statistics were used to describe various sample characteristics. Group differences for categorical variables were examined with the chi-square test, whereas an independent 't' test was used for continuous variables. Results: The most common manic symptom was a decrease in sleep (49%), followed by an increase in verbal activity (39%), hostility (37%), and increase in motor activity (33.33%). The subsyndromal manic group had a lower age of onset (58.8%), males (82.4%), unemployed (23.5%), educated (80.4%). There was no significant difference between with and without subsyndromal mania groups with respect to age, age of onset, duration of illness, number of episode, and average duration of episode. Conclusion: Subsyndromal manic symptoms are prevalent and have no relationship with current age, age of onset of illness, duration of illness, number of episode, and average duration of illness in patient with bipolar disorder in remission.
  2,734 372 1
Psychiatric morbidity in outpatients of gynecological oncology clinic in a tertiary care hospital
Rohan Dilip Mendonsa, Prakash Appaya
October-December 2010, 52(4):327-332
DOI:10.4103/0019-5545.74307  PMID:21267366
Background: Psychiatric morbidity in gynecological oncology patients is relatively less studied. Aims: This cross-sectional observational study was undertaken to assess the common psychiatric disorders in women who consult the gynecological oncology outpatients' department. Materials and methods: We assessed a total of 101 outpatients who were recruited by convenience method of sampling. The main outcome measures were PRIME-MD PHQ diagnoses, gynecological and sociodemographic profiles. Results: Psychiatric disorders as detected by PRIME -MD PHQ were diagnosed in 44% of the patients. Mood disorders were most common. Major depression was present in 25.7% of patients. Anxiety disorders were diagnosed in 16.8% of the patients. Among 44 patients with a psychiatric diagnosis only one patient was on psychiatric treatment. Major depression was much more common (34.4%) in cancer patients than in women with benign conditions (16.6%). Conclusion: The findings of our study reveal a high rate of psychiatric morbidity in the gynecological oncology outpatients.
  2,744 329 11
Postgraduate trainees as simulated patients in psychiatric training: Role players and interviewers perceptions
Santosh K Chaturvedi, Prabha S Chandra
October-December 2010, 52(4):350-354
DOI:10.4103/0019-5545.74311  PMID:21267370
Background : Teaching skills to enhance competence in clinical settings need to have a focus on learning "how to do." This paper describes the subjective experiences and feedback of trainees who participated in a teaching technique using postgraduate trainees as simulated patients. Materials and Methods : The Objective Structured Clinical Assessment and Feedback was employed for training using trainees as simulated patients and interviewers. This exercise is performed in front of consultants and peers who subsequently provide feedback about the content and process using a structured format. In order to assess the subjective experience of the interviewer and the role players they were requested to provide structured feedback on several aspects. The trainee role player provided feedback on comfort in playing the role, need for further inputs, satisfaction regarding role play, satisfaction with the interview, and the overall effect of the activity. The trainee interviewer gave feedback on his/her level of comfort performing in front of a peer group, being watched, and evaluated in a group. Results : The feedback forms from 15 sessions were analyzed. Only two of the role players indicated that they felt very uncomfortable while the rest reported comfort. Twelve of the 15 trainees who simulated patients felt they needed more inputs to improve the clarity of the role play; however they all reported feeling satisfied with the role play or interview. The feedback from the interviewers indicated that most were comfortable in all aspects, i.e. conducting the interview, performing in front of a group, being evaluated, and given feedback in front of a group. Conclusion: The trainees report indicates that those simulating patients need more clarity on their roles and majority had no discomfort performing in front of a group. Interviewers were satisfied and comfortable with all aspects. On the whole, simulated interviews and role plays were found to be an acceptable teaching method by postgraduate psychiatry trainees.
  2,342 188 8
CASE REPORT
Dose-dependent galactorrhea with quetiapine
Sujata Sethi, Manisha Sharma, Amit Malik
October-December 2010, 52(4):371-372
DOI:10.4103/0019-5545.74315  PMID:21267374
Quetiapine is an atypical antipsychotic agent with minimal propensity to induce hyperprolactinemia in standard therapeutic dosages. Despite that quetiapine is considered to be a prolactin-sparing atypical antipsychotic, hyperprolactinemia with related side effects may rarely be encountered in susceptible individuals. We report a case of quetiapine-induced hyperprolactinemia and galactorrhea in an adult female, which was dose-dependent.
  2,275 121 3
BOOK REVIEW
Contemporary topics in women's mental health: Global perspectives in a changing society
MR Asha
October-December 2010, 52(4):391-391
  1,515 134 -
LETTERS TO EDITOR
Preserve and strengthen family to promote mental health
Rajnish Raj
October-December 2010, 52(4):389-389
DOI:10.4103/0019-5545.74323  PMID:21267380
  1,505 109 -
Fee-based open-access journals: A fertile or slippery ground?
RD Pattanayak, R Sagar
October-December 2010, 52(4):387-387
DOI:10.4103/0019-5545.74321  PMID:21267377
  1,500 89 -
BOOK REVIEW
Law and Psychiatry
AK Kala
October-December 2010, 52(4):392-392
  1,321 175 -
LETTERS TO EDITOR
Differences in perceptions of family functioning among adolescents with internalizing and externalizing disorders
Harpreet Mehar, TM Ismail Shihabuddeen
October-December 2010, 52(4):389-390
DOI:10.4103/0019-5545.74324  PMID:21267379
  1,357 136 -
Need of a formal psychotherapist-delivered counseling as a part of management of bony deformities, with emphasis on clubfoot
Karun Jain, Mruthyunjaya , R Ravishankar
October-December 2010, 52(4):388-388
DOI:10.4103/0019-5545.74322  PMID:21267378
  1,259 95 4