Indian Journal of PsychiatryIndian Journal of Psychiatry
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   2014| October-December  | Volume 56 | Issue 4  
    Online since December 8, 2014

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Females too suffer from Dhat syndrome: A case series and revisit of the concept
Sandeep Grover, Natasha Kate, Ajit Avasthi, Nikita Rajpal, V Umamaheswari
October-December 2014, 56(4):388-392
DOI:10.4103/0019-5545.146537  PMID:25568483
Dhat syndrome as a clinical entity has been rarely described in females. Ethnographic studies suggest that as in males, whitish vaginal discharge in females is also associated with depressive and somatic symptoms and many women with symptoms of whitish discharge attribute their depressive and somatic symptoms to the whitish discharge. In this report, we describe two female patients who presented with psychiatric manifestations also with somatic symptoms and attributed their somatic complaints to whitish vaginal discharge. In this background, we discuss whether this entity requires nosological attention and what criteria can be used to define the same.
  10,994 225 8
A clinico-epidemiological study of cognitive function status of community-dwelling elderly
Indarjeet Singh Gambhir, Vishal Khurana, Dhiraj Kishore, Ashutosh K Sinha, SC Mohapatra
October-December 2014, 56(4):365-370
DOI:10.4103/0019-5545.146531  PMID:25568477
Background: Cognitive decline and dementia are an important problem affecting quality-of-life in elderly and their caregivers. There is regional variation in prevalence of cognitive decline as well as risk factors from region to region. Aim: The aim was to determine the prevalence of dementia and cognitive decline and its various risk factors in the elderly population of more than 60 years in Eastern Uttar Pradesh (India). Materials and Methods: A camp-based study was conducted on rural population of Chiraigaon block of Varanasi district from February 2007 to May 2007. Block has 80 villages, of which 11 villages were randomly selected. Eleven camps were organized for elderly people in 11 randomly selected villages on predetermined dates. A total of 728 elderly persons of age >60 years were examined, interviewed and data thus collected was analyzed. Elderly who got Hindi-mini-mental state examination (HMSE) score developed by Ganguli based on the Indo-US Cross-National Dementia Epidemiology Study) score ≤23 were evaluated further and in those with confirmed cognitive and functional impairment, diagnosis of dementia was assigned according to Diagnostic and Statistical Manual for Mental Disorder fourth edition criteria after ruling out any psychiatric illness or delirium. Based on International Classification of Diseases-10 diagnostic criteria sub-categorization of dementia was done. Results: Mean, median and 10 th percentile of HMSE of the study population were 23.4, 24 and 17, respectively. About 14.6% elderly had scored <17. 42.9% of rural elderly population had HMSE score <23, 70.6% <27 and 27.7% between 23 and 27. Literate people had statistically significant higher mean HMSE score (26.1 ± 3.9) than illiterate people (22.9 ± 4.9). Other risk factors were female gender, malnutrition, and obesity. Prevalence of dementia was 2.74%; in male 2.70% and in female 2.80%. Most common type of dementia was Alzheimer (male 1.5%, female 1.5%) followed by vascular (male 1.2%, female 0.6%) and others 0.6% (male 0%, female 0.6%). Conclusions: Study showed that a very high percentage of rural elderly attending health camps had poor cognitive function score; though the prevalence of dementia was relatively low. Alzheimer dementia was most common, followed by vascular dementia, which was predominant in males. Illiteracy, age, and under-nutrition were the most important risk factors for poor cognitive function. Our study suggest that cut-off of HMSE score should be 17 (10 th percentile) for illiterate population.
  6,214 294 13
Scale for assessment of lethality of suicide attempt
Nilamadhab Kar, Mohanram Arun, Manoj K Mohanty, Binaya K Bastia
October-December 2014, 56(4):337-343
DOI:10.4103/0019-5545.146512  PMID:25568473
Background: Lethality of suicidal attempt provides useful information regarding the behavior. There is a perceived need for a clinically useful scale that can be easily adapted to various methods and circumstances of attempt. Aims: The study intended to develop and test utility of a scale for measuring lethality that can reflect overall clinical observation taking into account various indicators of lethality and which can be used across clinical scenarios involving different methods. Settings and Design: Cross-sectional study in a hospital. Materials and Methods: The scale for assessment of lethality of suicide attempt (SALSA) has two components: The first component has four items indicating seriousness of the attempt and its likely consequences and the second component is the global impression of lethality. All the items are scored from 1 to 5, higher scores suggestive of increased lethality. SALSA was used to evaluate lethality of 82 consecutive suicide attempters; and it was compared with lethality of suicide attempt rating scale (LSARS) and risk-rescue rating scale. Statistical Analysis: Chi-square, t-test, analysis of variance, Cronbach's alpha, binary logistic regression. Result: There was significant correlation of SALSA score with that of LSARS (r: 0.89) and risk score of risk-rescue rating (r: 0.93, P < 0.001); and negative correlation with rescue score (r: −0.569; P < 0.001). Internal consistency reliability of SALSA was high (Cronbach's alpha: 0.94). Lethality scores of SALSA differentiated known groups with different lethality, e.g. deceased and survived; attempters with different levels of medical intervention: In-patient only, intensive care, ventilator support. SALSA score significantly predicted the lethal outcome (odds ratio: 3.2, confidence interval: 1.12-8.98). Conclusion: SALSA is a useful instrument for assessment of lethality of suicidal behaviors during clinical evaluations considering the ease of administration, its ability to differentiate clinical groups with known variations of lethality and clinical outcomes.
  5,277 539 13
A case report of pornography addiction with dhat syndrome
MS Darshan, TS Sathyanarayana Rao, Sam Manickam, Abhinav Tandon, Dushad Ram
October-December 2014, 56(4):385-387
DOI:10.4103/0019-5545.146536  PMID:25568482
A case of pornography addiction with dhat syndrome was diagnosed applying the existing criteria for substance dependence in International Classification for Diseases-10 and Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision. There is a lack of clear-cut criteria for identifying and defining such behavioural addictions and also lack of medical documents on pornography addiction. An applied strategy in lines with any substance addiction is used, and we found it helped our patient to gradually deaddict and then completely quit watching pornography. This is one of the few cases being reported scientifically, and we hope more work will be carried out in this ever increasing pornography addiction problem.
  5,172 331 3
Indian story on semen loss and related Dhat syndrome
Om Prakash, Sujit Kumar Kar, TS Sathyanarayana Rao
October-December 2014, 56(4):377-382
DOI:10.4103/0019-5545.146532  PMID:25568479
India is a country of many religions and ancient cultures. Indian culture is largely directed by the Vedic culture since time immemorial. Later Indian culture is influenced by Buddhism, Islam, and Christianity. Indian belief system carries the footprints of these cultures. Every culture describes human behaviors and an interpretation of each human behavior is largely influenced by the core cultural belief system. Sexuality is an important domain which is colored by different cultural colors. Like other cultures, Indian culture believes "semen" as the precious body fluid which needs to be preserved. Most Indian beliefs consider loss of semen as a threat to the individual. Ancient Indian literature present semen loss as a negative health related event. Dhat syndrome (related to semen loss) is a culture-bound syndrome seen in the natives of Indian subcontinent. This article gathers the Indian concepts related to semen loss. It also outlines belief systems behind problems of Dhat syndrome.
  4,713 366 5
Hallucinations in the classical Indian system of Ayurveda: A brief overview
Anuradha Balsavar, Smita N Deshpande
October-December 2014, 56(4):325-329
DOI:10.4103/0019-5545.146510  PMID:25568471
The ancient Indian system of medicine "Ayurveda" is a compendium of various health related theories and practices and explained the abnormal state of mind, i.e., psychopathology in various contexts. Hallucinations were deemed abnormal. In Ayurvedic classics, hallucinations were called false perceptions (mithyajnana), illusions (maya), infatuations (moha), or confusion (bhrama). Hallucinations were not independent but a symptom of mental disorder (manasa roga). Hallucinations of different sensory organs were observed and explained. These symptoms could be observed in patients suffering from any illness of tridosha origin, organic disease or psychiatric disorder. False perceptions observed in patients were used as tools to understand the prognosis of the condition. This article may help provide preliminary insight and encourage interdisciplinary study toward understanding one of the main symptoms of schizophrenia.
  4,408 303 -
The Mental Health Care Bill 2013: A step leading to exclusion of psychiatry from the mainstream medicine?
Choudhary Laxmi Narayan, Deep Shikha, Mridula Narayan
October-December 2014, 56(4):321-324
DOI:10.4103/0019-5545.146509  PMID:25568470
  4,107 591 3
Indian Psychiatric Society-World Psychiatric Association - World Health Organization survey on usefulness of International Classification of Diseases-10
Ajit Avasthi, Sandeep Grover, Mario Maj, Geoffrey Reed, M Thirunavukarasu, Uttam Chand Garg
October-December 2014, 56(4):350-358
DOI:10.4103/0019-5545.146522  PMID:25568475
Background: World Health Organization (WHO) is in the process of revising the International Classification of Diseases 10 (ICD-10). For increasing the acceptability of the ICD-11, WHO along with World Psychiatric Association (WPA), conducted a survey of psychiatrists around the world, in which 386 psychiatrists from India participated. Aim: To present the findings of "WPA-WHO Global Survey of Psychiatrists' Attitudes toward Mental Disorders Classification" for Indian psychiatrists who participated in the survey as members of Indian Psychiatric Society. Methodology: The online survey was sent to qualified psychiatrists who are members of Indian Psychiatric Society and are residing in India. Results: Of the 1702 members who were urged to participate in the survey, 386 (22.7%) participated. Most(79%) of the psychiatrists opined that they use formal classificatory systems in their day-to-day clinical practice. ICD-10 was the most commonly (71%) followed classificatory system. Nearly half (48%) felt the need for only 10-30 categories for use in clinical settings and another 44% opined that 31-100 categories are required for use. Most of the participants (85%) suggested that a modified/simpler classificatory system should be designed for primary care practitioners. Similarly, the same number of participants (89%) argued that for maximum utility of a nosological system diagnostic criteria should provide flexible guidance that allows cultural variation and clinical judgement. About 75% opined that the diagnostic system they were using was difficult to apply across cultures. Conclusion: Findings of the survey suggest that classificatory systems are routinely used in day-to-day practice by most of the participating psychiatrists in India and most expect that future classificatory system should provide flexible guidance that allows cultural variation and clinical judgement.
  3,075 186 -
Late-onset schizophrenia with isolated cavum vergae: Case report and literature review
Rashmin Achalia, KS Bhople, Pankaj Ahire, Chittaranjan Andrade
October-December 2014, 56(4):399-401
DOI:10.4103/0019-5545.146533  PMID:25568486
Cavum septum pellucidum (CSP) and cavum vergae (CV) have separately and together been associated with an increased risk of neurodevelopmental disorders and psychosis; however, there is little literature on the psychopathological significance of isolated CV, and no previous report of isolated CV in late-onset psychosis. We describe an 80-year-old woman who presented with a 1-month history of psychotic symptoms qualifying for a diagnosis of schizophreniform disorder. Physical (including neurological) examination, bedside cognitive testing, and laboratory investigations were all within normal limits. A magnetic resonance imaging scan of the brain revealed an insignificant CSP with prominent CV. The patient showed almost complete recovery from psychosis after 4-6 weeks of treatment with quetiapine (200 mg/day). She maintained improvement with this medication at an 18-month follow-up; medication taper was associated with re-emergence of hallucinations. We briefly discuss CSP and CV in the context of vulnerability to psychosis. We examine whether isolated CV is a benign and incidental finding versus a biological risk factor for neuropsychiatric illness. We suggest specific studies to resolve the uncertainty.
  3,000 149 2
Indian Journal of Psychiatry: Changes in instructions to contributors
TS Sathyanarayana Rao, Chittaranjan Andrade
October-December 2014, 56(4):319-320
DOI:10.4103/0019-5545.146508  PMID:25568469
  2,534 151 2
Determinants of symptom profile and severity of conduct disorder in a tertiary level pediatric care set up: A pilot study
R Jayaprakash, K Rajamohanan, P Anil
October-December 2014, 56(4):330-336
DOI:10.4103/0019-5545.146511  PMID:25568472
Background: Conduct disorders (CDs) are one of the most common causes for referral to child and adolescent mental health centers. CD varies in its environmental factors, symptom profile, severity, co-morbidity, and functional impairment. Aims: The aim was to analyze the determinants of symptom profile and severity among childhood and adolescent onset CD. Settings and Design: Clinic based study with 60 consecutive children between 6 and 18 years of age satisfying International Classification of Disease-10 Development Control Rules guidelines for CD, attending behavioral pediatrics unit outpatient. Materials and Methods: The family psychopathology, symptom severity, and functional level were assessed using parent interview schedule, revised behavioral problem checklist and Children's Global Assessment Scale. Statistical Analysis: The correlation and predictive power of the variables were analyzed using SPSS 16.0 version. Results: There was significant male dominance (88.3%) with boy girl ratio 7.5:1. Most common comorbidity noticed was hyperkinetic disorders (45%). Childhood onset group was more predominant (70%). Prevalence of comorbidity was more among early onset group (66.7%) than the late-onset group (33.3%). The family psychopathology, symptom severity, and the functional impairment were significantly higher in the childhood onset group. Conclusion: The determinants of symptom profile and severity are early onset (childhood onset CD), nature, and quantity of family psychopathology, prevalence, and type of comorbidity and nature of symptom profile itself. The family psychopathology is positively correlated with the symptom severity and negatively correlated with the functional level of the children with CD. The symptom severity was negatively correlated with the functional level of the child with CD.
  2,230 216 2
Oxidative stress and level of antioxidant enzymes in drug-naive schizophrenics
Mohammed Reyazuddin, Suhail A Azmi, Najmul Islam, Abid Rizvi
October-December 2014, 56(4):344-349
DOI:10.4103/0019-5545.146516  PMID:25568474
Background: Schizophrenia is a chronic illness having varied etiology which affects cognition, emotion, perception, and other aspects of behavior. There are data which show possible role of oxidative stress and disturbance in antioxidant mechanisms in various neurological and neuropsychiatric disorders. Materials and Methods: Fifty drug-naive schizophrenic patients, who attended psychiatry outpatient department/inpatient department for the 1 st time, were selected and compared with 50 age-sex matched healthy controls. The erythrocyte level of malondialdehyde (MDA) - a lipid peroxidation product and marker of oxidative stress, antioxidant enzymes - superoxide dismutase (SOD), glutathione peroxidase (GPX) was estimated. We also correlated the sociodemographic parameters and severity of illness (positive and negative syndrome scale score) with oxidative stress (MDA) and level of antioxidant enzymes (SOD, GPX). Results: The level of oxidative stress (MDA) was increased, and the levels of antioxidative enzymes (GPX and SOD) were decreased in schizophrenic patients as compared to normal healthy controls and the difference was statistically significant. No significant relationships of age, sex, educational status, marital status, and PANNS score with oxidative stress (MDA) and antioxidative enzymes (GPX and SOD) level in schizophrenic patients was found; but there was significant relationship of locality with oxidative stress (MDA) and antioxidative enzymes (GPX and SOD) level in schizophrenic patients was found. Urban population have a higher level of MDA, GPX, and SOD than the rural population. Conclusion: Our findings put great emphasis on the weak pro/antioxidant defense mechanisms and its role in the pathophysiology of schizophrenia. We can make recommendations of dietary nutritional supplementation and adjunct antioxidants therapy with antipsychotics to treat schizophrenics.
  2,220 199 29
Psychosis in an adolescent with Wilson's disease: A case report and review of the literature
Sandeep Grover, Siddharth Sarkar, Soumya Jhanda, Yogesh Chawla
October-December 2014, 56(4):395-398
DOI:10.4103/0019-5545.146530  PMID:25568485
Neuropsychiatric manifestations are common in Wilson's disease and mainly include extrapyramidal and cerebellar symptoms. Presentations with psychotic symptoms have been described less frequently. In this report we present the case of a young boy with Wilson's disease who developed psychotic symptoms. A 12-year-old boy was diagnosed with Wilson's disease on the basis of the physical examination findings and low ceruloplasmin levels (8.1 mg/dl). After 2 weeks of being diagnosed with Wilson's disease, he developed an acute onset illness, characterized by delusion of persecution, fearfulness, hypervigilence and decreased sleep. These symptoms were not associated with any confusion, clouding of consciousness, hallucinations and affective symptoms. There was no past or family history of psychosis. One week after the onset of the symptoms he was prescribed tab penicillamine, initially 250 mg/day, which was increased to 500 mg/day after 3 days. After increase in the dose of penicillamine, his psychiatric symptoms worsened and led to hospitalization. A diagnosis of organic delusional disorder (F06.2) due to Wilson's disease was considered. Tab risperidone 1 mg/day was started, and the dose of penicillamine was reduced with which symptoms resolved. Whenever a young adolescent develops psychosis, especially of delusional type, the possibility of Wilson's disease must be considered.
  2,051 170 4
Cardiac risk factors and metabolic syndrome in patients with schizophrenia admitted to a general hospital psychiatric unit
Sandeep Grover, Naresh Nebhinani, Subho Chakrabarti, Ajit Avasthi, Debasish Basu, Parmanand Kulhara, Surendra Kumar Mattoo, Savita Malhotra
October-December 2014, 56(4):371-376
DOI:10.4103/0019-5545.146520  PMID:25568478
Objective: The study aimed to evaluate the prevalence of cardiovascular risk (CVR) factors and metabolic syndrome (MS) in patients with schizophrenia. Materials and Methods: By consecutive sampling, 143 patients (of age ≥ 20 years), out of total 159 patients with schizophrenia admitted to the inpatient unit were evaluated for the coronary heart disease (CHD) risk as per Framingham (10-year all CHD events) function/risk equation and systematic coronary risk evaluation (SCORE) - 10-year cardiovascular mortality risk (CMR). Prevalence of MS was estimated by using the consensus definition. Results: Fifty-two (36.4%) patients fulfilled the criteria for MS. 10-year CHD risk was 1.65%, and 10-year CMR was 1.39%. Compared to females, males had higher Framingham score (1.96 ± 2.74 vs. 1.09 ± 0.41, U value 1987.5*, P < 0.05). Conclusion: Patients of schizophrenia have a high prevalence of MS and CVR factors. Hence, there is a need to screen the patient of schizophrenia for the same and manage the same as early as possible during the course of illness.
  1,847 229 8
Paroxetine-induced galactorrhea
Prannay Gulati, BS Chavan, Subhash Das
October-December 2014, 56(4):393-394
DOI:10.4103/0019-5545.146529  PMID:25568484
Drug-induced galactorrhea has been reported with agents such as antidopaminergic antiemetics, antipsychotics, etc., with few case reports of galactorrhea with selective serotonin reuptake inhibitors, including paroxetine, being reported in last few decades. Prolactin levels have been found to be either raised or normal in these cases. We here report a case of paroxetine induced galactorrhea in a 48-year-old female patient of obsessive compulsive disorder, having hyperprolactinemic and euprolactinemic galactorrhea at different time with a pituitary incidentaloma.
  1,681 119 -
Contributions of an Indian to the science and art of hypnosis
Sudhir K Khandelwal
October-December 2014, 56(4):415-417
  1,637 110 -
Research in Psychosocial Rehabilitation
Mohan Isaac
October-December 2014, 56(4):413-413
  1,516 194 -
A lunatic and a murderer or Berkeley-Hill's machine-gun
Alok Sarin, Sanjeev Jain
October-December 2014, 56(4):402-404
DOI:10.4103/0019-5545.146513  PMID:25568487
  1,508 147 -
The Rights of Persons with Disabilities Bill, 2014 and persons with mental illness
Choudhary Laxmi Narayan
October-December 2014, 56(4):411-412
DOI:10.4103/0019-5545.146524  PMID:25568495
  1,301 223 3
Association of attention deficit hyperkinetic disorder and epilepsy: Further explored
S Pratibha, GT Subhas, H Chandrashekar
October-December 2014, 56(4):405-406
DOI:10.4103/0019-5545.146515  PMID:25568489
  1,296 113 1
Gilles de la Tourette's syndrome successfully treated with electroconvulsive therapy
V Chore Rajashree, C Datar Manjiri, S Netto Ivan, V Pawar Alka
October-December 2014, 56(4):407-408
DOI:10.4103/0019-5545.146518  PMID:25568491
  1,274 93 1
Prevalence of depression and anxiety in irritable bowel syndrome: A clinic based study from India - Comments on the article
R Parthasarathy, Vikas Menon
October-December 2014, 56(4):409-410
DOI:10.4103/0019-5545.146521  PMID:25568493
  1,171 119 1
Relational enmeshment of entangled minds!
Sravanti Sanivarapu
October-December 2014, 56(4):384-384
DOI:10.4103/0019-5545.146535  PMID:25568481
  1,176 111 -
Depression versus you
Sravanti Sanivarapu
October-December 2014, 56(4):383-383
DOI:10.4103/0019-5545.146534  PMID:25568480
  1,131 132 -
Glimpses of Psychiatry for Doctors and Medical Students
Shrinivasa Bhat Undaru
October-December 2014, 56(4):414-414
  1,148 106 -
Appreciation of the study on mentally retarded children and their mothers in Madhya Pradesh, India
Nehra Ashima, Kaur Harsimarpreet
October-December 2014, 56(4):405-405
DOI:10.4103/0019-5545.146514  PMID:25568488
  1,126 114 1
Asenapine-induced double incontinence: A rare case report
Gurvinder Pal Singh, Rajinder Kumar, Poonam Bharti
October-December 2014, 56(4):410-411
DOI:10.4103/0019-5545.146523  PMID:25568494
  1,140 86 -
Response to article: Behavioral management in children with intellectual disabilities in a resource-poor setting in Barwani, India
Shwetank Bansal, Sumit K Gupta
October-December 2014, 56(4):407-407
DOI:10.4103/0019-5545.146517  PMID:25568490
  1,048 92 -
Role of super-specialities in psychiatry
C Shamasundar
October-December 2014, 56(4):408-409
DOI:10.4103/0019-5545.146519  PMID:25568492
  974 93 -
T102C polymorphism of serotonin-2A receptor gene in Turkish schizophrenia patients: Association with cognitive impairment and soft neurological signs
Adnan Özçetin, Burç Çagri Poyraz, Cana Aksoy Poyraz, Erol Bozhüyük, Nurullah Bolat, Ibrahim Balcioglu, Anil Çagla Özkiliç, Zehra Seda Genç, Müjgan Cengiz
October-December 2014, 56(4):359-364
DOI:10.4103/0019-5545.146528  PMID:25568476
Aim: Previous studies have shown an association between the T102C polymorphism of the serotonin-2A receptor gene and schizophrenia. In addition, an association of this polymorphism with clinical phenotypes in schizophrenia such as treatment response and cognitive impairment has been observed. Materials and Methods: In this case-control study conducted in Turkish Caucasians, we compared T102C polymorphism genotype and allele frequencies in 76 schizophrenic patients and 165 healthy controls. We also investigated interaction of this polymorphism with clinical and cognitive variables in patients. Results: No significant difference was observed in the distribution of the three genotypes (T/T, T/C and C/C) and in the allele frequencies in controls and patients with schizophrenia. No evidence of association was detected at various clinical phenotypes including symptom severity, suicidality, treatment response, age of disease onset, number of hospitalizations and history of violence (in co-dominant, dominant, or recessive models). However, as compared to the C/C genotype, patients with 1 or 2 copies of the T allele were characterized by better stroop test performances and less "motor coordination" soft neurological signs. Conclusion: Further research is needed to elucidate the impact of T102C polymorphism on neurocognitive functions in both healthy and patient populations.
  531 73 4