Quality Of Life and Suicidal ideations in Wives of Men with Alcohol Dependence: A Hospital based Study
Dr Suprakash Chaudhary, Dr Colonel Tejvir Walia
Background: Addiction to alcohol not only affects the quality of life of the individual abusing it but also the people living with them. Enormous research has been done on various aspects of alcoholism, but the lives of their caretakers are always considered secondary by society and researchers alike. Very few studies have been done on wives of alcoholic men in the Indian setting.
Aim: This study aimed to assess the quality of life and suicide ideation in wives of men with alcohol dependence.
Materials and Methods: This is a cross-sectional study conducted in a tertiary care hospital. A study group of 50 wives of men with alcohol dependence were included in the study along with an age-matched control group of 50 wives of non-alcoholic men without any medical comorbidities. They were assessed by the perceived quality of life scale, Hospital Anxiety and Depression Scale, and Suicidal Behaviours Questionnaire-revised and the results were then correlated.
Results: Results revealed poorer perceived quality of life in the study group than in controls. The wives of alcoholic men scored significantly more on depression as compared to control group but not on anxiety. Suicidal ideation and attempts were significantly more common in wives of men dependent on alcohol.
Conclusion: Alcohol dependence in the husbands is associated with poorer quality of life and higher levels of depression and suicidal ideation in their wives.
Substance use characteristics among truck drivers visiting a tertiary care centre in North India
Dr Aarti Karahda1 (karahdaaarti@gmail.com) Dr Shobhit Kumar Prasad2,
1Senior Resident, Department of Psychiatry, Kalpana Chawla Government Medical College and hospital, Karnal, Haryana, 2Consultant Psychiatrist, Sukoon Hospital, Ambala Cant. Haryana, This research has not been published nor is under consideration for publication
Background: The extent of psychoactive drug consumption in the truck drivers has a relevant impact on the drivers’ health and safety, increasing the risk of injuries and traffic accidents, potentially affecting the general public health as well. The study is important as it gives epidemiological perspective regarding this important issue.
Objectives: To assess substance using correlates of truck drivers visiting a tertiary care centre in North India
Methods: 50 cases were included in the study. A semi-structured questionnaire was devised to evaluate substance use characteristics and
Drug Abuse Monitoring Scale(DAMS) was used to collect data and analysed using descriptive statistics and SPSS 25.0
Results: Among them 90% were using opioids (primary opium then tramadol tablets), 80% were using Nicotine(mostly chewing), sedative hypnotics in 27% (primarily alprazolam, nitrazepam), 8% were using alcohol.
Conclusion: Primary reason for use was in order to increase productivity, to combat boredom. Chronic and high dose consumption decreases driving skills, placing drivers at risk for health and road safety. Further research is required, in order to fill the knowledge gap and improve the strength of evidence.
keywords: Truck-drivers, Psychoactive drugs
Perceived stress in spouses of patients with schizophrenia and bipolar disorder: A comparative study
Dr Akul Gupta1, Dr Prerana Gupta2
1Resident Doctor, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India. 2Professor, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India.
Background: Schizophrenia and Bipolar Disorder (BD) are the most common psychiatric disorders where spouses of patients experience a higher level of perceived stress more frequently. High-intensity caregiving negatively impacts the mental health of spouses putting them at high risk for developing psychiatric disorders.
Aims: Assess perceived stress and its correlation with the socio-demographic profile among the spouses of these patients.
Methods: Spouses of patients of schizophrenia and bipolar disorder diagnosed according to ICD-11 criteria who gave written and informed consent were included in the study. A semi-structured proforma and PSS-10 were used. Statistical analysis was performed to assess the data.
Results: The two groups did not differ in age and gender distribution, education, socioeconomic status and religion. 52% and 62% of subjects in schizophrenia Group and BD Group respectively reported a moderate PSS score. Association was significant between the 2 groups (p = <0.01). Overall, the mean (SD) score of PSS was 21.45 (8.03) with a range of 5-39. A statistically significant negative correlation was observed between the duration of marriage with PSS in schizophrenia group and between age, duration of marriage and socio-economic score with PSS in BD group.
Conclusion: Nearly 72% in Schizophrenia group and 94% in BD group perceived moderate to high stress. There was significantly higher stress in spouses of patients with BD than those with Schizophrenia. A statistically significant negative correlation was observed between age and duration of marriage with PSS score, however, the degree of correlation was higher in BD group.
“Neurocognitive Deficits in HIV / AIDS Patients on HAART Regime - A Cross Sectional Study”
Dr Amit Kumar
Background: Human immunodeficiency virus (HIV) infected individuals on national AIDS control organization NACO India based highly active antiretroviral therapy (HAART) regimen often continue experiencing neurological complications referred to as HIV associated neurocognitive disorders (HAND). Changes in memory, mood, attention, and motor skills are common in HIV infected patients and present in diagnostic challenge to the clinicians. HIV enters the brain shortly after infection and has predilection for the sub cortical regions brain areas .The cognitive impairment is attributed to HIV replication in the brain and release of inflammatory neurotoxins leading to neuronal dysfunction. Timely detection of Cognitive dysfunction in patients with HIV infection is very crucial as HAND could affect patient’s activities of daily living such as medication adherence, employment; driving and so on this worsens disease indirectly.
Objectives of the study: To assess the status of neurocognitive deficits among HIV infected individuals on HAART.
Methodology: A cross sectional study was done on 46 HIV infected individuals who come to Victoria hospital ART centre, who fulfil inclusion and exclusion criteria will be considered, aged 21 to 50 years with minimum education of 10 Class [SSLC and above] who gave informed consent, with no major psychiatric or medical co- morbidities were included. Semi structured proforma was used for collecting socio demographic and clinical variables. IHDS scale was applied to know the neurocognitive severity (score less than <=10) patients were considered Then the Neuro Psychiatry battery was applied under the supervision of Neuro cognitive trained clinical Psychologist.
Results: 67 per cent of our study participants have been detected for HIV-associated neurocognitive disorder (HAND) and were classified as asymptomatic neurocognitive impairment. Memory, executive function, speed of processing, motor skills, and language domains were shown to be significant at the p <0.05 level in patients over 35 years old, with less than PUC education, with CD4 counts less than 400, and those on HAART.
Conclusions: More than 60% of HIV patients have HIV associated neurocognitive disorders (HAND), and they are categorised under asymptomatic category. Patients aged above 35 years, with less than PUC education, with CD4 count less than 400, and those on HAART had exhibited low on Memory, executive function, speed of processing, motor skills and language scores.
HIV, HAND, IHDS, Neuro Psychiatry battery, HAART.
Relationship between a Doctor and his Patient
Dr Amitabh Shanker Saxena
The relationship between a doctor and his patient is primary contractual. Violation of the doctor patient relationship leads to civil suits resulting in unliquidated damages. Examination of a patient without his consent is both an offence in criminal law as well as a tortious wrong. An important ingredient in a contractual relationship is Consent. Consent is all the more important in psychiatric practice because there are valid concerns if the consent given by a mentally ill patient is legally valid. In view of the provisos of the Mental Healthcare Act, 2017, which is highly patient-centric, it is relevant and topical to examine the issues related to contractually valid consent. The same are discussed in the light of decided cases and relevant laws.
Consent, Mental Healthcare Act, 2017, Privacy, Law
Suicide Attempt & Follow-up in India, Does It Correlate?
Dr Ankit Gupta
Introduction: Individual with suicidal attempt carries highest risk for repeat attempt, but most individual with high risk for suicide doesnot have access or would not consult a mental health professional.
Objective: There is paucity of information regarding follow-up with mental health services following a suicidal attempt. The objective is to ascertain the rate of follow up at mental health services following a suicidal attempt of those patients who were admitted for management of attempted suicide and treated at a tertiary care centre in Bengaluru, India.
Material and Methods: Details were collected from 120 patients from June 2020 to December 2021 over telephone calls and were analyzed to determine their follow up rates with mental health professional within 1 year of the suicidal attempt.
Results: After discharge, 17% of patients had single follow-up with mental health professional. Amongst them, those with psychiatric diagnosis had higher rate of follow-up as those without the same (P<0.001).
Conclusion: Most of patients without any psychiatric diagnosis do not have a follow up at mental health centre after a suicidal attempt. Telephonic communication and online consultation (teleconsultation) can be a useful resource to increase the frequency of follow up of the high risk population. Limitation is study in a general setting population of urban area, small population.
Keywords: Suicidal attempt, follow up, telephonic communication
Study of Prevalence of Sexual Dysfunction in Males with Psychiatric Illness Compared to Other Medical Patients
Dr Ankita Shahi1, Dr Ram Ghulam Razdan2, Dr Suvaran Sagar Bajpai3, Dr Surya Pratap Singh Chauhan4
2Professor & Head; 1,3 & 4PG Resident
Introduction: According to DSM5 Sexual dysfunction is defined as “a clinically significant disturbance in a person’s ability to respond sexually or to experience sexual pleasure” Sexual dysfunction is highly prevalent in Psychiatric ill patients which may be caused by the psychopathology of the illness or by the drugs given during there illness. Psychiatric disorders like Depression, Schizophrenia, Mood disorders, anxiety disorders, eating disorders etc. may affect sexual relationship and difficulties in patient. This study aims to find out the prevalence of sexual dysfunction among male psychiatric ill patients compared to other medical patients.
Aim & Objectives: To assess prevalence of sexual dysfunction in males with psychiatric illness compared to other medical patients in Psychiatry Department, Medicine Department, Respiratory Department of Index Medical College Hospital And Research Centre, and Indore
Material & methods: Study Design - This study is a Comparative cross-sectional study.
Study Centre- Index Medical College Hospital and Research Centre, Indore.
Duration of Study- 5 Months (July to November).
Study Participants - Subjects will be taken from department of psychiatry, Medicine Department, Respiratory Department Index Medical College, Hospital and Research Centre, Indore fulfilling the inclusion criteria.
Sample Size – Study sample will consists of 100 cases and 100 control.
Statistical Methods- SPSS will be used.
Result: There was a positive relationship established between Psychiatric ill male patients and sexual dysfunction. Sexual dysfunction was significantly high in mentally ill patients i.e. 59% compared to our control group i.e. other medical patients (23%). Among the Psychiatric disorders highest frequency was observed in Schizophrenia which was 73%. Other prevalence were: Bipolar disorders-49%, depressive disorders-51%, anxiety disorders – 36% and Alcohol Use Disorder – 58%. Among our control group the maximum frequency was observed in patients with heart diseases which was 41%. Other prevalence were liver disorders -25%, Diabetic-20%, genitourinary tract disorders-15% and resp. disorders -10%. It was also found that there was no significant difference in total testosterone level of both groups but prolactin level were significantly higher among psychiatric patients.
Conclusion: Prevalence of sexual dysfunctions are higher among psychiatric ill male patients than medical patients therefore more attention should be given to the treatment of these disorders and counselling should also be done.
Portrayal of Transgenders In Bollywood Setting Unrealistic Expectations. Recent Trends
Dr Ashish Aggarwal
Assistant professor , Department of Psychiatry, Kalpana Chawla Government Medical College and hospital, Karnal, Haryana. This research has not been published nor is under consideration for publication
Background: Cinema has the power to influence more than any other art form. Transgenders have been portrayed more and more in evolving Bollywood. Main characters have been picked as transgenders in films like “LAXMI”, “Chandigarh kare aashiqui”. But it is an exigent task to build up and portray one’s identity when the identity is of someone who doesn’t fit into the mainstream society with high transphobia and gender-based violence.
Objectives: To analyze the portrayal of transgender in Bollywood movies and their representation in selected Bollywood movies.
Methods: We performed a comprehensive literature review that analyzed recent trends on this topic.
Results: media content establishes the identities of transgenders through characterization in stereotypical ways and enable viewers to think about the transgender’s community in a specific manner. However, transgender community is looking for a change regarding the stigmatization and misconceptions. Recent movies want them to become aesthetically pleasing and patients try to imitate them resulting in unrealistic mindsets and exaggerates risk of mental illnesses
Conclusion: Strategies sensitive to gender must be implemented to tackle entrenched prejudice and social exclusion reported by transgender women. Social media and other cinematic platforms need to show support strategies, rights of education and employment rather than setting unrealistic expectations.
Keywords: Bollywood, transgenders
Prevalence of personality disorders in patients of alcohol dependence.
Dr Ashwani saini1, Dr Ajay2, Dr VP Mahla3
(Assistant Prof1, JR2, Professor3, SGT Medical College, Gurugram, Haryana)
Background: Personality disorders lead to a disturbance in functioning as great as that in most major mental disorders. Their co-existence makes treatment complicated, lengthier and less successful. Even though personality disorders are common among psychiatric population their association with alcohol dependence is less well studied.
Aims: Estimate the frequency of personality disorders in relation to alcohol dependence.
Methods: The study was a hospital based cross-sectional study. Convenient sampling was used to enrol 50 patients diagnosed with alcohol dependence and 50 participants were taken as controls ‘non-drinkers’. ASSIST and IPDE were applied to both the groups for screening of alcohol use and personality disorders respectively.
Results: Alcohol dependent patients showed a higher prevalence of personality disorders (50%) as compared to non-drinkers (10%). Dependent personality disorder (30%) was most prevalent, anti social personality disorder (18%) followed by paranoid personality disorder (10%).
Conclusion: Treatment compliance and abstinence can be increased by guiding treatment decisions based on patient’s personality.
“Study of gender differences in sociodemographic and clinical characteristics in schizophrenia”
Dr. Avnish Bhargava1, Dr. Deepanjali Medhi2, Dr. Bobby Hmar3
1Post Graduate Trainee, 2Professor & Head of Department, 3Associate Professor, Dept. of Psychiatry, Gauhati Medical College and Hospital, Guwahati, Assam, India
Background: Studying finer aspects of gender differences in sociodemographic and clinical characteristics in schizophrenia can pave way for personalized medicine whereas only few studies have been done in India specially in Northeast region.
Aims: Aim is to examine gender related differences in sociodemographic and clinical characteristics of Schizophrenia.
Methods: Cross sectional study in 70 Schizophrenia patients as per ICD 10 criteria aged 18-60 excluding other psychiatric comorbidities (except substance use disorder) at psychiatry department, GMCH, Guwahati with Sociodemographic proforma, PANSS scale & SPSS26
Results:
• Predominantly female patients, majority in age group 26-32 yrs., Hindu religion, rural domicile, upper lower socioeconomic background, secondary level education, unemployment for more than one month and statistically significant difference of male: female education & employment status
• Clinically mean age of onset 31 yrs. with majority illness duration <1 year, with positive family history in 27% (more in females) and 45 % comorbid substance use disorder
• PANSS scale total score of 104.38(overall), 103.30 (female) and 105.52 in (Males)
• Comparing mean PANSS scores showed statistically insignificant difference in all subdomains but close to significance in the PANSS Positive domain.
Conclusion: Findings of our study matched findings of different earlier studies. However, statistically significant difference between male vs. female educational and employment status and predominance of rural background patients calls for further exploration. High prevalence of substance use calls for proactive management of these two major mental illnesses in a holistic manner.
A Comparative Study Of Premenstrual Syndrome Among Engineering And Medical Students Of Guntur, Andhra Pradesh
Dr B Hari Manasa1 , Dr Kota Suresh Kumar2 , Dr SriRamya3
1Senior Resident, 2Professor & Hod, 3Assistant Professor Department Of Psychiatry, Katuri Medical College And Hospital ,Guntur, Andhra Pradesh
Background: Premenstrual syndrome (PMS) is defined as the presence of physical , behavioral , and mood symptoms that arise in the luteal phase of the menstrual cycle . Hormonal changes may underlie and can lead to poor quality of life .
Aim: The aim of the study is to compare prevalence of premenstrual syndrome among the students of engineering and medical colleges in Guntur , Andhra Pradesh.
Materials and Methods: A cross-sectional survey was done on medical and engineering students of Guntur in the age group of19-25 years. Sociodemographic data and PSST were applied on 200 subjects. The data was analyzed using SPSS software-22 version and Chi-square test applied
Results: The prevalence of PMS was 54% in medical students and 44% in engineering students . Higher prevalence among medical students was due to stress related to education, exams and others. Back pain, muscle aches were the most common symptoms.
Conclusion: Prevalence of PMS among college students is similar to other studies. Routine screening with PSST can identify college girls who can improve with treatment which can as well improve their quality of life .
Keywords: Premenstrual syndrome, premenstrual symptom screening scale.
Effectiveness Of Repeated Ketamine Infusions On Suicidal Thoughts vs Ect: An Open Label Comparative Study
Dr Bhakat Udayan
Background: Suicide is a major global problem, depression being its leading cause worldwide. Multiple subanaesthetic ketamine infusions as well as ECT are known to be effective in depression as well as suicidality. However, there are very few studies that have looked into the comparisons between immediate and sustained effects of ketamine and ECT in relation to suicide.
Aim: To compare immediate and sustained responses to suicidal ideation among patients with MDD and RDD within and between patients receiving ketamine in comparison to electroconvulsive therapy.
Methods: Twenty patients fulfilling inclusion criteria were randomised into two groups, first group (n=8) received repeated thrice weekly ketamine infusions for a period of two weeks in comparison to patients who received a similar schedule of modified ECT(n=12). All the patients were continuously clinically evaluated for their severity of depression (MADRS), suicidality (BSSI, C-SSRS), anxiety (HAM-A), clinical improvement (CGI), at baseline,1 hour, 4 hours and 24 hours of each session and 4 weeks after the last session (Ketamine/ECT).
Results: Statistically significant difference in scores of MADRS, BSSI, C-SSRS, HAM-A, CGI in both ketamine and ECT groups while assessing for immediate as well as sustained effect in depressive symptoms and suicidality but when compared between the groups ketamine was not found to be superior to ECT
Conclusion: There is clinically significant reduction in symptoms of depression and suicidal ideations in both ketamine and ECT groups when compared within the groups signifying ketamine is comparable and not inferior than ECT.
Keywords: Ketamine, ECT, Suicidal Ideation.
Study of prevalence of premenstrual syndrome in nursing students in tertiary care teaching institute.
Dr Ravindra Chavhan1, Dr Gaurav Pawar1, Dr Sarika Dakshikar1
1Grant Government Medical College, Mumbai
Background: Premenstrual symptoms are deemed as ranging from mild to moderate in intensity and not necessarily occurring regularly, while premenstrual syndrome is more severe, involves specific subset of symptoms, occurs relatively regularly, and significantly affects a woman’s life. So initiated the study to find prevalence of premenstrual syndrome in nursing students who has medical knowledge.
Aims: To study prevalence of pre-menstrual syndrome in nursing students in tertiary care teaching institute.
Methodology: 72 participants, who are studying nursing courses in tertiary care teaching institute are included. The symptoms of pre-menstrual syndrome are asked for using PMS questionnaire and case record proforma. The severity of symptoms and time when they occur was asked using PMS questionnaire.
Results and Discussion: 72 participants with mean age 19 years, Of them 81.9% had premenstrual syndrome. Irritability was commonest symptom reported by 81.9% participants. Acne, backache and diarrhoea was reported in week of menses. Insomnia was least common symptom reported in study population, but in all 81.9 % participants having premenstrual symptoms, the symptoms disappeared in next week of onset of menses.
Conclusion: Premenstrual syndrome is prevalent in nursing students (81.9%).
Keywords: Premenstrual syndrome, nursing students, PMS questionnaire.
Case Series of Gratification Behavior In Toddlers, Mimicking Epilepsy
Dr. Deepa Gupta, Dr. Deepa Gupta, Dr. Om Sai Ramesh, Dr Nitin Raut, Dr. Dinesh Kataria
Postgraduate Student, Department of Psychiatry and Drug Deaddiction Centre, Lady Hardinge Medical College, New Delhi, India- 110 001, Email ID- drdeepa.gupta@gmail.com, Phone No.: 9205021678, Postgraduate Student, Department of Psychiatry and Drug Deaddiction Centre, LHMC, Professor, Department of Psychiatry and Drug Deaddiction Centre, LHMC, Specialist, Department of Psychiatry and Drug Deaddiction Centre, LHMC, Director Professor & Head, Department of Psychiatry and Drug Deaddiction Centre, LHMC
Background: Gratification behavior is rarely seen in children. Physiological changes that occur during masturbation in adults are been noticed in children also. It occurs in children between age of 3 months and 3 years. The exact mechanism is poorly understood. Little research has been published regarding this behavior. Failure to recognize this behavior can lead to being wrongly diagnosed as epilepsy or dyskinesia leading to unnecessary invasive investigations and treatment thus we presenting this case series.
Aim: A case series to study presentation of gratification behavior in toddlers
Case Description: Two children with age 18months and 3years respectively were referred from Pediatrics Department with total duration of illness of 12months and 18months respectively, abrupt onset with symptoms of Rubbing of their own genital area against any surface accompanied by flushing, sweating, and tachypnea lasting for minutes. Behavior was embarrassing and distressing for family members. All investigations (including urine microscopy, culture and EEG) turned out to be normal. Diagnosis was made from history, videotapes and direct observation of the act during interview. Appropriate behavior therapy was started.
Conclusion: Gratification behavior is not uncommon in children and should be considered in the differential diagnosis of epilepsy and other paroxysmal events in early childhood. Video clips play a pivotal role in establishing correct diagnosis. Counselling and behavior therapy constitute main stay of management
A cross sectional study on prevalence and factors associated with medication non adherence in patients with major psychiatric disorder attending psychiatry department, KIMS, Hubballi
Dr Delcine Maria Jose
Background: According to WHO’s operational definition for nonadherence as “missing medications three consecutive times, two times in a week, five times in a month or change in the dose of the medications without the advice of the prescribing physician”. Poor adherence to psychiatric medication regimens is a major obstacle to the effective care of persons who have chronic mental illness.
Aim: To study the prevalence of non-adherence, factors affecting non-adherence and its relationship with insight and severity of illness.
Methods: A cross sectional study was done to assess the prevalence of non-adherence among 147 patients diagnosed with Psychotic disorders, BPAD and Major Depressive Disorder by ICD 10 using MARS Scale. Insight was assessed using clinical rating of insight scale and severity of illness using CGI severity scale.
Results: Prevalence of non-adherence was 68% (100) among 147 participants using MARS scale. Among the 147 patients, forgetfulness (21.8%), followed by adverse effects (16.3%) and improvement in symptoms (15.6%) were the most common reasons for nonadherence. There was statistically significant relationship between non-adherence and insight. The severity of illness and relationship with non-adherence was not statistically significant.
Conclusion: The observed rate of medication non-adherence in the study was high. Realistic assessment of patient’s knowledge about illness and belief in treatment regimen will enable a more effective targeting for adherence problems
Influence of Social Media on Psychopathology in Erotomania: A Case Report
1Dr. Devangi Shukla, 2Dr. Pooja Sharma
1Junior Resident, Central institute of Psychiatry, Ranchi- 834006, Jharkhand, India, 2Senior Resident, Central institute of Psychiatry, Ranchi-834006, Jharkhand, India
Introduction: Erotomania is a form of delusional disorder in which an individual believes that another person, usually of higher status, is in love with him. It is a relatively rare condition, and with the lifetime prevalence of delusional disorder is 0.2%. Although many theories exist for the etiology of delusional disorder, recent postulations have suggested that social media networks may play a role in enmeshing technology into the delusional systems of those predisposed to psychosis.
Case Summary: A 30-year-old married female with family history of psychiatric illness in sister and aunt was brought by her husband with complaints of belief that Sushant Singh Rajput, a male Bollywood actor, was in love with her, stalking that male actor on Facebook, suspiciousness that her husband has kidnapped and separated her from that actor for one year and irritability, anger outbursts, hearing voices of that actor and disturbed sleep for 5 months. Illness had insidious onset, continuous course and deteriorating progression. The patient had normal speech productivity, delusion of Love, persecution, Ideas of grandiosity and second person auditory pseudo hallucination. The patient was diagnosed as Paranoid Schizophrenia. The patient showed improvement on Tab Risperidone 6 mg.
Discussion: This is a case report of a young female who exhibited cyber stalking behavior motivated by delusions. This case strengthens recent theories have postulated that social media networks play a pivotal role in the formation of delusions.
Keywords: Erotomania, Social media, Schizophrenia
Osmotic Demyelination Syndrome in Alcohol use disorder: A case report
Dr Dhritiman Das,
JuniorResident, MD-2, Department of Psychiatry, NIMHANS
Introduction: Osmotic demyelination syndrome(ODS) previously known as Central pontine myelinolysis, is a non-inflammatory demyelination of white matter described by Adams and Victor (1959) in cases of rapid correction of hyponatremia and chronic alcohol use commonly. Recent literature also implicates hypokalemia and thiamine deficiency also in development of ODS. The prognosis is poor with high mortality and morbidity.
Case Description: A 28-year old male with ADS presented with postural imbalance, difficulty walking since 6 months and decreased sensations and paraesthesia of B/L upper and lower limbs. On examination, decreased muscle bulk and wasting of bilateral lower limbs with spasticity , power ⅘, asymmetric knee reflexes, B/L absent knee reflex, and mute plantar reflexes. Sensory examination revealed loss of fine touch and proprioception and decreased vibration in B/L upper and lower limbs upto mid-calf. Cerebellar signs include broad based gait and impaired finger nose test. MRI depicts hyperintensity in central area of basal pons.
Discussion: Patient did not have hyponatremia but had heavy alcohol use with poor oral intake. In addition, patient had thiamine deficiency which may be implicated in the development of ODS. MRI showed symmetrical pontine hyperintensity suggestive of ODS. Iatrogenic cause of ODS was ruled out as neither rapid sodium correction was done nor treated with desmopressin or 5% dextrose for re-induction of hyponatremia was needed. The patient had shown 70-80% improvement in neurological symptoms with medical management/ physiotherapy during hospital stay. Residual deficits noted were postural imbalance and sensory deficits.
Conclusion: ODS can also result in Alcohol use disorder without rapid correction of hyponatremia. Other factors may be implicated in its cause. Residual deficits are a common feature in ODS.
An observational study to assess problematic use of Smart phone among undergraduate students of tertiary care referral hospital and its association with quality of life.
Dr Dhritiman Das,
Junior Resident, MD-2, Department of Psychiatry, NIMHANS
Aims and Objectives:
Primary objective
• To assess the level of smart phone use and extent of “Nomophobia” among undergraduate medical and nursing students
Secondary objective
• To assess the relationship of smart phone use with quality of life among them
• To compare the level of smart phone use and associated “Nomophobia” among undergraduate medical and nursing students
Materials and Methods
Type of the study:
Cross-sectional observational study
Sample size:
The present study aimed for a sample size of 450 medical and nursing students of All India Institute of Medical Sciences, Bhubaneswar. This sample is based upon feasibility of students at the medical and Nursing College. Out of which data could only be collected from 437 students in all.
Inclusion and exclusion criteria:
Inclusion criteria:
1. First year to final year students of Medical and Nursing college of AIIMS, Bhubaneswar
2. Presence of Smart Phone
3. Willing to provide informed consent
Exclusion criteria
1. Not willing to participate in the study
2. Not having a smartphone
Instruments:
Semi Structured proforma: This will capture details like age, gender, living arrangement, duration of smart phone use per day and years of mobile phone usage was recorded. According to their responses, participant’s severity was rated.
Test for mobile dependence questionnaire Brief Version (TMD Brief): The questionnaire exhibits good reliability (Cronbach’s alpha 0.87), and consists of 12 items grouped into four factors: (a) abstinence,(b)lack of control and problems derived from use,and (c)tolerance and (d) excessive use and interference with other activities.
Nomophobia Questionnaire (NMP-Q): The Nomophobia Questionnaire included the 20 items and four themes or dimensions, developed and validated. These dimensions are: (1) not being able to communicate, (2) losing connectedness, (3) not being able to access information and (4) giving up convenience. The statements are rated on a seven point likert scale. Items have a good internal consistency (Cronbach’s alpha 0.918).
World Health Organization of Quality of Life Bref (WHOQOL Bref): This instrument is a 26 item questionnaire [48]. The statements are rated on a five point likert scale. The quality of life is computed in various domains: i.e. physical, psychological, social and environmental. Each of the domains is further converted to score from 0 to 100.
Procedure of the study: Participants were recruited from the Classroom of Medical and Nursing College of the Institute. Data was also collected by email in case that they couldn’t respond in the classroom. Information was gathered in a single sitting. All the data collected were analyzed using suitable statistical methods.
Results: MBBS 1st year preclinical batch is most smart phone dependent , the most nomophobic , and henceforth it has the least overall perception of Quality of life and health. On the other hand Prefinal MBBS batch is least dependent, least nomophobic and henceforth it has the maximum overall perception of QOL among all other MBBS Batches.
Conclusion: In conclusion , severity of smart phone use and nomophobia leads to poor quality of life.
Comorbidity in Psychiatry- Approach and Management: A Review
Dr Dhritiman Das, Dr Parkrithi, Dr Urvakhsh M Mehta
Junior Resident, MD-2, Department of Psychiatry, NIMHANS, Senior resident (Acad), Centre for Addiction Medicine, NIMHANS, Additional Professor, Department of Psychiatry, NIMHANS
Advent of comorbidity: Psychiatric disorders were initially diagnosed based on categorical systems. But a new dimensional concept of diagnosis has emerged which considers symptoms cut across disorders. Comorbidity in psychiatry has become a rule rather than an exception.
Etiology: Comorbidity can be explained based on shared genetic architecture, overlapping biobehavioral mechanisms, dimensional theory, genetic pleiotropism, and the recently proposed p-factor model.
Studies on comorbidity: The COMO study in Denmark and World Mental health Survey reports that comorbidity is pervasive. Every psychiatric disorder is a risk factor for another. They are bidirectional in nature and temporally correlated. Highest absolute risk of receiving a second diagnosis is within the first 6 months of receiving the first one.
Common clinical scenarios: A psychiatric disorder can be comorbid with another psychiatric disorder, neurological disorder (Parkinson’s disease, stroke), general medical condition (diabetes mellitus, hypothyroidism), Axis II disorders (Intellectual disability and personality disorders), iatrogenic disorders (Tardive Dyskinesia, Drug-induced Parkinsonism) ,developmental disorders (Attention deficit Hyperactivity Disorder, Oppositional and Defiant Disorder, Conduct Disorder) and with substance use disorders.
Management guidelines: There are different management approaches to deal with comorbidity. Three models of treatment can be described: Series, Parallel and Integrative. Two approaches are described: Reductionist and Anti-reductionist. There are guidelines for rational polypharmacy in management. There is a lack of proper guidelines in management of comorbidity. Hence management should be patient oriented and case to case tailored to deal the same.
Conclusion: More research is needed in this field to establish validated guidelines to manage common comorbidities in psychiatry.
Serum Uric Acid As A Predictor Of Metabolic Syndrome In Patients With Schizophrenia- A Longitudinal Study
Dr Disha Mukherjee
Background: Metabolic syndrome is a cluster of several cardio-metabolic risk factors including abdominal obesity, dyslipidemia, elevated blood pressure and insulin resistance. Uric acid (UA) is the final product of purine metabolism pathway & the relationship between serum Uric Acid levels and schizophrenia still remains unclear. In recent years, a number of studies have suggested that serum UA might be associated with the risk for Insulin resistance and metabolic disturbances.
Aim: To asses the relationship between serum levels of uric acid and development of metabolic syndrome in a sample of patients with schizophrenia and to determine whether uric acid can act as a predictor of metabolic syndrome in schizophrenia.
Methods: 18-60 years aged stable patients diagnosed with Schizophrenia as defined by ICD-10 DCR was taken into the study from Out Patient Department. Sociodemographic datawere recorded. Baseline measurements of Waist circumference, height, weight,was taken and Blood pressure was noted. Blood was then sent for analysis in the laboratory for HDL,triglycerides, Fasting Blood Sugar, and Serum uric acid levels. All the patients were started on Olanzapine at a dose of 5-15 mg according to severity of symptoms . All the patients were followed up at 2 months and 4 months.
Results: Analysis showed Metabolic Syndrome was present among 32.5% of study population & Uric acid level has a significant correlation with development of Metabolic syndrome (p<0.001).
Conclusion: The study concludes serum Uric Acid is significantly associated in developing Metabolic Syndrome in patients with Schizophrenia due to involvemnent of oxidative stress pathway.
Keywords: Metabolic syndrome, MetS, Uric Acid, Schizophrenia.
Mental Health among Primary Caregivers of Children with Disability
Yashodharakumar G.Y
1All India Institute of Speech and Hearing, Mysuru, yash.gy@gmail.com
Research in mental health has progressed enormously, whereas the focus on mental health issues among primary caregivers of children with developmental disabilities (CwDD) has not been given much prominence. Parenting can be stressful for most who feel they cannot cope as a parent with limited parenting skills, especially with primary caregivers. Children with disabilities are more likely to have profound limitations in activities of daily living as well as complex medical conditions that require a high level of caregiving commitments. Earlier studies established links between distress and risk for psychopathology. As there are individual differences in reacting to these demands, measuring how it affects primary caregivers’ mental health is necessary to address a child’s development through building caregivers’ resources to handle their child with a disability. With this background, the present study aimed to understand psychopathology in terms of depression, anxiety and stress among primary caregivers of children with disability. For the present study, 40 primary caregivers of children with disabilities (CwDD) were selected through purposive sampling. They were administered the Depression Anxiety Stress Scale (DASS 21) developed by Peter Lovibond (1995). The entire study data were collected at the institute with national importance; collected data were subjected to descriptive and inferential statistics to fulfil the formulated objectives.
Results revealed that there was a significant level of psychopathology (Depression, anxiety & stress) observed among study samples. Demographic factors had limited influence on the psychopathology of primary caregivers. Implications of the study in terms of on-pharmacological and pharmacological interventions have been delineated.
Conclusion: Parents of children who have a developmental disability may be in need of programmes and services that support their mental health.
Prescription Pattern of Antidepressants in a Tertiary Care Hospital
Dr Harpreet Singh
Background: The prescription of antidepressants is increasing due to the increasing incidence of depression and the use of antidepressants for other indications. There is a need to monitor their prescription practices not only to ensure evidence-based clinical use but also to align teaching with the current clinical trends.
Materials and Methods: This observational study was conducted in the department of psychiatry of a tertiary care hospital on anonymized prescriptions received within the study period.
Results: A total of 214 prescriptions were analyzed during the study period. 59.05% of prescriptions were of selective serotonin reuptake inhibitors (SSRIs), 18.11% of atypical antidepressants, 16.92% of tricyclic antidepressants (TCAs), and 5.90% of serotonin-noradrenaline reuptake inhibitors. 46% percent of prescriptions were as per defined daily doses (DDDs), 26% more than DDD and 28% less than DDD. Escitalopram and mirtazapine were the most commonly prescribed drugs. Both are not included in the National List of Essential Medicines and World Health Organization–Essential Medicines List (EML). Out of 214 prescriptions, 209 prescriptions were for psychiatric indications and the rest 5 were for non-psychiatric indications. TCAs were prescribed more for psychiatric indications other than depression, while SSRIs were prescribed equally for depression and other psychiatric indications.
Conclusion: Prescription trend in this study is in consonance with other contemporary studies. Extensive use of mirtazapine is a peculiar finding requiring further exploration. As in other studies, SSRIs have been used in doses more than their defined daily dose. Off-label use of antidepressants is common.
Disability and its association with symptoms among schizophrenics
Dr Harshitha V Handral, Dr Madhusudhan S, Dr Shoyaib
(Junior Resident), (Associate Professor), Department of Psychiatry, Bangalore Medical College and Research Institute, Bangalore.
Background: Schizophrenia is a chronic mental disorder, with typical onset in late adolescence or early adulthood. It is a disorder with chronic and relapsing course with incomplete remission and functional decline. Positive, negative symptoms, cognitive impairments contribute to disability in schizophrenics.
Aims: To evaluate the frequency of disability and also to evaluate its association with the positive, negative symptoms and cognitive symptoms.
Methods: 30 patients who were diagnosed as schizophrenia with atleast 2 weeks of drug compliance were included. Scales like PANSS (Positive and Negative Syndrome scale), MoCA (Montreal Cognitive Assessment scale) and IDEAS (Indian Disability Evaluation And Assessment Scale) are applied.
Results: Among the 33 study participants 42% had mild disability, 36.36% had moderate disability, 21.21% had severe disability. Study showed that negative symptoms were found to have significant negative association with cognition (p=0.011) and had significant positive association with percentage of disability (p=0.00). Total MoCA scores were found to have significant negative association with percentage of disability (p=0.002). Global disability scores were found to have significant positive association with negative symptoms (p=0.00) and general psychopathology (p=0.003) and had significant negative association with cognition(p=0.001)
Conclusion: Disability is more among individuals with increased positive symptoms, negative symptoms and general psychopathology and with increased cognitive impairments.
Cross-sectional study of psychiatric morbidity and coping patterns, body image concerns and quality of life in post-burn patients
Dr Harshitha V Handral, Dr Archana, Dr Aarshie
(3 year Postgraduate), (Assistant Professor), (Senior Resident)
Background: Psychiatric morbidity in burns patient is said to be considerable and higher than that of general population. Burns may lead to long lasting impact on the quality of people’s lives, with persisting problems related to body image concerns, emotional disturbances, sleep disturbances, pain, scarring, contractures, weakness, body image.
Aims: To assess the frequency of the psychiatric morbidity in post-burn patients. To determine its association with body image concerns, coping and quality of life.
Methods: Data from 30 patients who visit burns clinic OPD are included in the study, DASS21 (Depression Anxiety Stress Scale 21), WHOQOL-BREF (World Health Organisation Quality of Life), Brief-COPE (Abbreviated version of Coping Orientation to Problems Experienced) and Satisfaction with Appearance Scale were applied. Statistical analysis was done.
Results: Among the 30 study participants 16.7% had depression, 23.3% had anxiety, 10% had stress. Patients with high satisfaction with appearance of face and non-facial region had decreased prevalence of anxiety (p = 0.2), depression (p=0.02) and stress (p=0.03). Among the patients who used high avoidant coping skills had increased levels of depression (p=0.115) and anxiety (p=0.3). Individuals with higher scores on problem-solving type of coping style had reduced depression (p<0.001) and stress (p=0.04) and the association was found significant. Presence of anxiety, depression, stress reduced quality of life across physical, psychological, social and environment domains. Absence of depression is significantly associated with increased quality of life across all 4 domains (p=0.041, 0.028, 0.002, <0.001)
Conclusion: Good satisfaction with appearance and use of problem-solving style of coping skills reduces prevalence of psychiatric morbidity. Absence of psychiatric morbidity, especially depression is found to be associated with improved quality of life.
Impact of psychoeducation on mental health literacy towards depression among late adolescents
Dr. Heerendra Singh, Dr. O. P. Raichandani (M.D. DNB), Dr. Aftab Ahmad Khan (M.D.)
Department of Psychiatry Netaji Subhash Chandra Bose medical college, Jabalpur (M.P.)
Background: Depression is a common mental disorder across age, gender, and socioeconomic status in India as well as in the world. Considering the nature of the illness, the psycho-education approach has proved its effectiveness in improving the mental health literacy of late adolescents towards depression thereby improving prognosis as well as the quality of life.
Aims: To find out the efficacy of one hour didactic lecture in improving the knowledge of late adolescents regarding depression.
Methods: This was an intervention study conducted in a Government school and college in the Mahakaushal region. A total number of 350 non-medical students of age group 15-18 years were selected and psycho-educated about depression and then their mental health literacy was assessed using the D-Lit scale both before and after psycho-education.
Results: There was a significant improvement seen in the mental health literacy of the late adolescents as the number of questions of the D-lit scale which was answered correctly has been increased after one hour of the didactic lecture (Psycho-education) regarding depression.
Conclusion: Psycho-education is feasible and effective in improving literacy towards depression among late adolescents thereby improving the prognosis of illness and their quality of life.
Keyword: Depression, Mental health literacy, Psycho-education
Characteristics and Patterns of Non-suicidal Self-injury among Patients with Current Suicide Attempts
Dr. Hemendra Singh1*, Dr.Swati Chandramouli2
1Department of Psychiatry, MS Ramaiah medical college, Bengaluru, India, 2Senior Resident, Department of Psychiatry, St John’s National Institute of Health Sciences
Background: Several researchers have investigated primary features of NSSI such as frequency, function, and medical treatment. However, such measures are less useful in describing secondary NSSI features such as NSSI context, habituation, or perceived life interference and perceived life impact. Hence, the study aimed to explore NSSI features such as NSSI habituation, perceived life interference, and perceived life impact of NSSI among patients with current suicide attempts in a tertiary care hospital.
Methods: The study based on 100 patients who had current suicide attempt. Non-Suicidal Self-Injury Assessment Tool (NSSI-AT) was used to assess, presence, frequency and type of NSSI, various other features of NSSI such as the habituation, perceived life interference, perceived reflections and advice).
Results: NSSI was found in 36% of study participants, with frequency ranging from 1 to 10 times in most. Most patients were aged ≤ 30 years (77.8%) with female preponderance (77.8%). One-third (33.3%) of patients were habituated to hurt themselves more deeply to get the same effect (30.56%) and had trouble in stopping hurting themselves (33.33%). Nearly three-fourths (61.76%) felt that NSSI interfered with their valuable relationships. Three-fourths (75%) of patients felt comfortable discussing about NSSI; however, were reluctant to help others who injured themselves (75.76%).
Conclusion: Overall, the findings demonstrate that measurements of functional habituation, perceived interference, and perceived experience of NSSI might aid in risk assessment among NSSI patients. Moreover, the study findings may help mental health counsellors in the implementation of novel and effective intervention strategies.
Efficacy of brief intervention module in the reduction of suicide related cognitions: An exploratory study
Hemendra Singh1, MD;Mohan S Raju2 ;Swati C3, MD
1Associate Professor, Department of Psychiatry, M S Ramaiah Medical College, Bangalore - 560054, India. 2Clinical Psychologists, Department of Psychiatry, M S Ramaiah Medical College, Bangalore - 560054, India. 3Senior Resident, Department of Psychiatry, St John’s National Institute of Health Sciences
Background: About 800,000 persons die due to suicide worldwide annually. People with suicide ideations have underlying suicide related cognitions. Hence, there is need to assess efficacy of the brief intervention module to reduce suicide related cognitions, so that future risk of suicide can be minimized.
Materials and methods: Interventional study was conducted in Ramaiah Hospital from February 2020 to January 2021. Consecutive patients aged 18-60 years who present to Accident and Emergency with current suicide attempt were included. Data pertaining to socio-demographic details, methods and reasons of self harm were recorded. Cognitions related to suicide were measured using Suicide Cognition Scale (SCS) before and after intervention. A three session brief intervention module for suicide was given to every patient and telephonic follow up was done for 6 months post discharge.
Results: Of the 40 patients recruited for the study, 30 completed 6 month follow up. Most of them were female (N=21, 70.0%), age below 30 years (N=17, 56.7%), married (N=15, 50.0%), employed (N=21, 70.0%), and urban population (N=17, 85.0%). The most common method of self harm was poison/ corrosive consumption (N=13, 43.3%) followed by overdosing on pills (N=11, 36.7%) and reason for self harm was family problems (N=15, 50.0%). The mean of Suicide cognition scale reduced from before therapy (M=70.05, SD=14.51) to after therapy (M=26.6, SD=7.32) which was statistically significant (P value < 0.001).
Conclusion: Brief intervention module comprising of 3 sessions prior to discharge appears to be effective in the reduction of suicide related cognitions.
Internet Addiction and its Determinants among Medical Undergraduates during the Covid-19 Pandemic: A Cross Sectional Survey
Jeevan YM PG; Pranjal Sharma R, PG; Sourabh S, Intern; Vallabh N Shet, Intern; Shankar Kumar, AP: Dr.Jeevan YM, PG
Department of Psychiatry, Mohammed Shoyaib Khazi, PG, Dept of Community Medicine, Bangalore Medical College & Research Institute, Bengaluru, Dept of Psychiatry, 2nd floor, New OPD Block, Victoria Hospital, Bengaluru, Karnataka- 560002. Email: drjeevanym@gmail.com , Ph: 7353075730
Background: Medical students are at higher risk of adverse mental health outcomes, with higher risk of developing substance & behavioural addictions which stem from maladaptive coping behaviours to stress. Considering the dearth in literature regarding internet addiction in this population, this study was undertaken to understand its associations with various psychological determinants.
Methodology: An online survey was conducted among undergraduates at a government medical college using snowballing technique for sampling during COVID pandemic. Assessment tools included Young’s Internet Addiction Test, WHO ASSIST V 3.0, DASS-21, MSPSS, UCLA Loneliness Scale, fear of Coronavirus-19 scale and 2 others. The objectives were to estimate prevalence of problematic internet usage, internet addiction with compulsive substance abuse in this population and to assess its psychological determinants. Data was analysed using SPSS v27.0 Grad Pack.
Results: Of the 106 study participants, 40 (37.7%) screened positive for moderate to severe internet addiction. Internet addiction was found to have significant positive association with tobacco use (p=0.04), depression (0.03) & stress (p=0.03) significant negative association with perceived social support from family (p=0.02) and friends (p=0.038). Stepwise multiple linear regression was done to derive predictive model which included substance use, fear of COVID perceived social support and time management & performance domain; that explained 78.5% change in internet addiction.
Conclusion: The findings suggest significant co-occurrence of substance & behavioural addictions which speaks to common vulnerabilities underlying addictions. The identification of risk factors for internet addiction will help screening & their redressal may influence the outcomes in vulnerable individuals.
Keyword: Internet addiction, risk factors, medical students, COVID-19
To Compare the Level of Stress, Depression, Anxiety and Quality of Life Among Medicinal and Surgical Branch Post Graduate Medical Students
Dr. Jyoti Prakash, Dr. Achyut Kumar Pandey
Senior Resident, Department of psychiatry, IMS, BHU, Varanasi. Professor, Department of psychiatry, IMS BHU, Varanasi. achyutpandey575@gmail.com, Department of Psychiatry, IMS, BHU, Varanasi. Email: - mauryajpgsvm8@gmail.com. Contact: - 6393149083
Background: Medical training has reportedly been found stressful, which may be further increased during residency training as a result of increased expectations and responsibilities. Studies conducted in Western countries on trainees in family practice, internal medicine, pediatrics, dentistry, emergency medicine, and surgery residencies have demonstrated that 3% to 35% have been suffering from significant depression and/or anxiety during their training, which can even lead to suicide. Medical field is one such stressful environment that can decrease the QoL of medical students.
Aims: To compare the level of stress, depression, anxiety and Quality of life among medicinal and surgical branch post graduate medical students.
Method: This cross-sectional study was conducted in the department of psychiatry, Institute of Medical Science, Varanasi, Uttar Pradesh, India. Data were collected from 150 residents through face-to-face interview and applying Student Stress Dimension Questionnaire (SSDQ), HAM-D, HAM-A, WHO QoL BREF instrument. The data were analyzed using software SPSS version 23.
Results: This study found that majority of residents in medicinal and surgical branch were male, belonged to Hindu religion, unmarried, nuclear family, upper and upper middle socioeconomic status, past history and family history of psychiatric illness. This study found significantly high stressful situation in families of medicinal branches residents as compared to Surgical branch (30.77% vs 13.46). The results of this study demonstrate predominance of anxiety disorder among surgical branch residents as compared to medicinal branch (67.3% vs. 57.59%). However, we could not establish predominance of depression among surgical branch residents as compared to medicinal branch (53.8 % vs. 46.2%). There was no significant difference in QoL among resident of medicinal branch to surgical branch in all domain. Among the various domains of quality-of-life, medicinal branch residents had higher mean score in environment domain followed by physical followed by social relationship and psychological domain respectively.
Conclusion: All the post graduate medical residents have stress in at least one domain and cumulative stress loading is high in surgical branch residents. Prevalence of anxiety among surgical branch residents are high and QoL is better in medicinal branch residents.
Keyword: Stress, SSDQ, HAM-D, HAM-A, WHO QoL BREF, Postgraduate Medical Students.
Selfie and Narcissism in Young Adults
Jyotik Tarak Bhachech
Safalya Mind and Body Clinic, Ahmedabad, India, jtbhachech@gmail.com
Selfie, a commonly observed behaviour, is symbol of virtual identity. Similarly, narcissism as described by grandiose view of oneself, seeking approval and admiration on social media is also frequent. The purpose of this study is exploring selfie taking behaviour and narcissism among young adults. A total 132 subjects were considered for study through an online questionnaire which included demographic variables, selfie taking behaviour and NPI-16 (Narcissistic Personality Inventory -16). The results showed majority of the subjects N = 76 (57.5%) had high narcissism (NPI ≥ 7). Age group 15 to 25 years (p= 0.0200), males, subjects who stayed in city, post graduates or graduate qualification, and married subjects had high narcissism. Using smart phone use more than 5 years (p=0.00942), taking 5 to 10 selfies per day with (p=0.00331), posting selfie for personal memory (p=0.03268), selfie on WhatsApp messenger (p=0.03268) and taking selfie with person alone and selfie taken on specific occasions (p=0.01122), had high narcissism. The conclusion of this study is selfie and narcissism are closely linked among young adults and a matter of psychological wellbeing during personality development.
Keyword: Selfie, narcissism, Narcissistic Personality Inventory-16, young adults
Prevalence of Depression and its Effect on Quality of Life in Patients with Diabetes Mellitus: A Cross Sectional Study.
Dr. Karthik J, (Post graduate) Guide: Dr. (col.) F A Sattar (Prof & HOD), Dr. Kiran Kumar K. (Prof)
Department of psychiatry, Vydehi Institute of Medical Sciences and Research Centre, Bangalore
Introduction: Patients with diabetes mellitus (DM) are at higher risk of depression. Prevalence of diabetes mellitus is 7.3%-75% in Indian population. Depression affects glycemic control and increases risk of diabetic complications and morbidity.
Aim: To assess prevalence of depression and quality of life in patients with diabetes mellitus.
Material and Methods: This is cross sectional observational study conducted in tertiary care hospital with sample size of 150 aged more than 18yrs diagnosed with T2DM. Presence of depression was assessed using ICD-10 criteria, severity by HAM-D and QOL by WHOQOL-BREF.
Results: Male and female patients were 77(51.33%) and 73(48.66) respectively. The prevalence of depression was 48% among 150 patients with T2DM. Females had higher rate of depression than male patients. In our study we found age (P=0.002816), female gender (P=0.008566) and poor glycemic control in the form of high HbA1c (P=0.010012) were significant predictors of depression among T2DM patients and those with depression had decreased quality of life.
Conclusion: Our study concluded that patients with diabetes needs to be screened to improve quality and life and glycemic control.
Rank Raglan Mythotype Revisited- A Scientific Misadventure
Krishnapriya Murlimanohar
1Resident Doctor, Dept. of Psychiatry, Cooper Hospital Mumbai
Background: Rank Raglan mythotype attempts to explore origin of hero in their cross-cultural study commenting on hero archetype prevalent across the world. Popularity of comic books and their cinematic universe make the validity of Rank Raglan mythotype for superheroes explorable. This study applies Rank Raglan scores to the contemporary superheroes and remarks on validity of the same in today’s world.
Discussion: Religion experts and pop culture enthusiasts state that superheroes reflect traditional religious archetypes and values in modern settings. They provide lessons in culturally relevant morality along with being the source of entertainment. Comic books and their cinematic universe have become important in revision of religious thoughts. Through their social commentary and impact on masses are vital in keeping nationalism and civil religion intact.
Conclusion: An understanding of the early connections between inception of religions and our conceptions of heroism would help us draw parallels. We could understand that superhero stories and religion are not strictly separate phenomena but have shared origins and concerns.
Significance: This study is an attempt to understand the link through Rank Raglan Mythotype scale and emphasizes utilization of these preexisting systems to be an integral part of psychotherapeutic care.
Prevalence of eating disorders, perceived socio-cultural stress and ideal body image in adolescents
Dr Lavanya Seth, Dr. Darpan Kaur , Dr. Jitendriya Biswal
Background: Despite increasing global trends across eating disorders, there is paucity of literature on eating disorders, perceived socio-cultural stress and ideal body image in adolescents in developing countries such as India.
Aims & Objectives:
(a) To estimate the prevalence of eating disorders, perceived socio-cultural stress and ideal body image in adolescents.
(b) To explore correlation between demographic factors, perceived socio-cultural stress, ideal body image and eating disorders in adolescents.
Methodology: Open label, cross sectional, questionnaire-based survey conducted across two high schools. Adolescents between 10 to 19 years were provided with the predesigned data collection form, informed consent documents and self-rated scales. Eating disorder scale, Perceived Socio-cultural pressure scale and Ideal Body Stereotype Scale (Revised) was distributed to the adolescents for self-rating. Sample size comprising of 1407 complete forms were statistically analysed using SPSS, regression analysis, t test and chi square tests. Institutional Ethics Committee approval was obtained and informed written consent was taken.
Result: Out of 1407 respondents, 40.65% were boys and 59.35% were girls. We found that the prevalence of eating disorders was 3.6%, perceived socio-cultural pressure was 4.3% and ideal body image was 36.3%. Females were significantly more likely to have an eating disorder as compared to males. Our study found a statistically significant association (p<0.05) between eating disorders and perceived socio-cultural pressure and a positive correlation between eating disorders and BMI.
Conclusion: Our study highlights the prevalence of eating disorders in adolescents especially in Indian context and the positive correlation with perceived socio-cultural stress and ideal body image.
A Cross-Sectional Study of Psychiatric Co-Morbidities In Patients Attending Neurology Outpatient Department In A Tertiary Care Centre.
Dr Lavish Chayal1, Dr Prakhar Jain1
1Grant Government Medical college
Background: Psychiatric co-morbidities is present in large number of patients attending Neurology OPD. Certain neurological disorders have symptoms overlapping with Psychiatric diagnoses, which often goes undiagnosed. Often patients having primary psychiatric symptoms report first to a Neurologist.
Aim: To study prevalence of psychiatric co-morbidities in patients attending Neurology Outpatient Department in a tertiary care center.
Methodology: 150 participants, attending neurology outpatient department of a tertiary care centre, were included. Psychiatric co-morbidities were assessed using MINI scale.
Results: In our study the number of patients having Psychiatric comorbidity was 56% while 40% did not have any Psychiatric comorbidity. 4% patients only had Psychiatric illness and no neurological disorder. 29% of those having psychiatric comorbidities were taking psychiatric treatment. Most common psychiatric comorbidities were Major depressive disorder, Generalized Anxiety disorder and Substance use disorder. Psychiatric comorbidities were mostly seen in Epilepsy, Headache/Migraine and were least seen in Cerebrovascular diseases.
Conclusion: This study supports that psychiatric disorders frequently accompany neurological diseases and often remain undiagnosed. Therefore, thorough psychiatric evaluation should be a routine part while assessing patients with neurological disorder, in order to increase the quality of life in neurological disorders.
Keyword: Psychiatric Co-morbidities, Epilepsy, Migraine, MINI Scale
Prevalence of Body Image Dissatisfaction and Eating Attitudes among Females with Polycystic Ovary Syndrome.
Dr Lopamudra pradhan, Dr Seema Parija , Dr Pallabi Sahu
Mental Health Institution,o & g opd, SCB Medical College, Cuttack
Introduction: Polycystic ovary syndrome (PCOS) is a condition in which the ovaries produce an abnormal amount of androgens, male sex hormones that are usually present in women in small amounts. Body dissatisfaction is currently a major health concern and is becoming the norm for children and adolescents & has strongest predictors for the development of negative out-comes such as depression, low self-esteem, and eating disorders.
Aim: To study the prevalence of eating attitudes, body dissatisfaction co-morbid with polycystic ovarian syndrome; co-relation between body satisfaction & eating attitudes in patients co-morbid with polycystic ovarian syndrome from outdoor patients of O&G Opd of SCB.
Methods: Rotterdam’s criteria for PCOS was taken. Eating Attitudes Test (EAT-26) & the Body Shape Questionnaire (BSQ 34) were used to measure eating attitudes and behaviors.
Results: The age range of the sample was between 13 to 40 years old. Total 30 number of pcos female and 30 control were taken & binge eating pattern was found most commonly with pcos along with sub clinical bulimia nervosa and they are mostly dissatisfied by their body image or structure.
Conclusion: Identifications of the early signs and symptoms for both disorders and collaborative management is required to effectively manage PCOS, Eating attitudes & Body satisfaction, and prevent the complications resulting from both disorders.
Coping Strategies used by Health Care Workers to Cope with Psychological Distress at NSCB Medical College, Jabalpur, during the COVID-19 Outbreak
Dr Mahendra Simgh Lodhi
Background: COVID-19 (Coronavirus Disease 2019), which is spreading domestically and internationally and has had a significant impact on the world, was first reported in December 2019 in Wuhan City, Hubei Province, China. Following the worldwide emergency of COVID-19, health care workers faced several issues, including an increase in workload. Many of them became infected and died as a result of close contact with COVID-19 patients.
The continuing epidemic of COVID-19 is inducing fear, anxiety, and fatigue in them, and there’s an urgent need to determine their mental health status.
Aims: To assess the psychological distress and identify various coping strategies among the health care workers
Methods: One hundred seventy health worker were selected. Following the candidates’ informed consent, information about their socio-demographics and COVID-19 duties was gathered in a semi-structured performa. All selected health care workers were assessed for psychological distress with the help of the General Health Questionnaire–12 and The coping strategies were measured by a brief cope questionnaire.
Result: The mean score on GHQ-12 scale was 13.69(SD= 6.26) indicating that the professionals’ mental health was poor condition.
The most frequently used coping strategies were Emotion Focused Coping, followed by Problem Focused Coping. Meanwhile, the least used coping strategies were Avoidant Coping.
Conclusion: Health-care professionals reported poor mental health during covid-19 outbreak and majority of professionals coped with adaptive coping strategies in this adverse situation.
A Study On Prevalence Of Internet Addiction Among Adult Psychiatric Patients
Dr Malarvizhi A
Background: Problematic internet use or pathological internet use is generally defined as problematic, compulsive use of the internet, that results in significant impairment in an individual’s function in various life domains over a prolonged period. In India, currently there is a lack of epidemiological data in psychiatric populations despite its higher prevalence. Internet use may regulate emotions and foster social connections, but addiction may exacerbate primary psychiatric condition and affect quality of life.
Aims: To study the prevalence of Internet addiction (IA) among the adult psychiatric patients attending the tertiary care hospital.
Methodology: A Cross sectional study of 150(convenient sampling) Adult psychiatric patients attending OPD in Institute of Mental Health, including patients diagnosed with ICD 10 criteria F10 to F 50 and excluding patients below 20 years, no access to internet and severely ill. After ethical approval and informed consent, socio demographic& clinical details collected using proforma designed for this study. IA diagnosed based on DSM 5 criteria for internet gaming disorder. Short screening questionnaire (in Tamil) & Internet Screening questionnaire (in Tamil) –10 items questionnaire was applied. Statistical analysis done by SPSS version 23.
Results: The prevalence of 42% was observed with 25.33% mild, 12.67%moderate and 4.67%severe categories of addiction with a primary diagnosis of 46% mood disorders, 22%substance use & 20%psychotic disorders. Due to IA, 4% had recurrence of primary psychiatric illness.
Conclusion: Increased prevalence than general population suggests screening and culturally adapted treatments in this context.
Study of Depression in Low Back Pain
Dr Malay Sarkar
Context: Pain is an important symptom of depression. There is a close relationship between two.
Purpose: This study aims to investigate whether chronic low back pain (LBP) increases the risk of depression.
Study Design: This is a case control study from Manan clinic Registry Barrackpore.
Patient Sample: The patient sample included 305 adults with mean age of 49
Outcome measure: The outcome of depressive symptom was evaluated with HAM-D
Methods: Patient was initially assessed as individual in the total sample analysis. There was no external funding for this study and no conflict of interest was declared.
Result: There was a significant association between chronic LBP and the risk of depression in the unadjusted total sample analysis
Conclusion: The relationship between chronic LBP and the future development of depression is not causal. The relationship is likely to be explained by confounding symptoms.
A Comparative Study Of The Course And Outcome In Patients Of Alcohol Dependence Syndrome With And Without Delirium Tremens
Dr Manoj Kumar
Delirium tremens is one of the serious withdrawal syndromes seen in patients with Alcohol dependence syndrome. A mortality rate as high as 10-15% is reported in literature if there is a delay in the management of this condition. It is hypothesized that Delirium tremens will have a positive impact and will deter the person from consuming alcohol in the future and hence their course and outcome will be better in comparison to patients without Delirium tremens. 30 patients with DT and a similar number of patients without DT will be taken in this study and their course and outcome will be studied and compared. The results of the study will be presented at the conference.
Altered Biochemical Parameters In Catatonia:A Short Term Evaluation
Deepanjali Medhi1, Monalisha Das2, Dr. Monalisha Das2
1Professor & HOD, Department of Psychiatry,Gauhati Medical College, Assam, India, 2Post Graduate Trainee, Department of Psychiatry,Gauhati Medical College, Assam,India.
Background: Catatonia, a bizarre psychomotor syndrome, which was earlier considered as a manifestation of schizophrenia, is now often seen in patients with mania, depression and many other medical condtions. It has been a matter of debate for several decades, whether catatonia is a separate disease entity or a manifestation of different psychiatric or medical disorder.
Aims And Objectives: In our study, we tried to evaluate and compare the altered biochemical parameters in different conditions of catatonia.
Methods: This hospital based cross-sectional observational study was conducted in a tertiary care hospital in Guwahati, Assam for a period of 1year from May2021 to April2022 after obtaining clearance from Institutional Ethical Committee(H) of the institution. Total 50 cases of catatonia fulfilling the selection criteria were included in the study. Bush Francis Catatonia Rating Scale(BFCRS) was used to quantify different conditions of catatonia.
Results: The biochemical parameters that were altered in majority of the catatonia patients were CPK(increased in 98%patients), haemoglobin(low in 64%patients) and serum iron(low in 54%patients). Statistically significant difference with the highest mean CPK(514.86) was found in schizophrenia while the lowest mean CPK value(254.54) was found in organic catatonia patients.
Conclusion: Although, there is no specific test for catatonia, laboratory studies provide insight into the pathogenesis of catatonia and has diagnostic and therapeutic implications.
Keyword: Serum CPK,Serum iron,BFCRS.
Prevalence Of Anxiety In Patients With Cardiac Disorders.
Dr. Mounika Chinta1, Dr. Hari Manasa2, Dr. Suresh Kumar3
Department of Psychiatry,Katuri Medical College and Hospital,Guntur,A.P
Background: Anxiety is commonly experienced among patients with cardiovascular disease. Psychiatric disorders such as depression and anxiety,represent a risk for cardiovascular disease besides contributing to impaired functions.To date,depression has received the most attention in the population,given its high prevalance especially in patients who have experienced a major cardiac event,such as an Acute Coronary Syndrome (ACS).However,anxiety has recently emerged as another important psychological construct that is highly prevalent,frequently co-occurs with depression and impedes response to depression treatment, and may ultimately influence the course of cardiovascular disease independent of depression.
Aim: To assess the prevalence of anxiety among patients diagnosed with cardiac disorders.
Methodology: A cross sectional study was done among 100 cardiac patients.A self designed semi structured questionnaire consisting of demographic details,relevant cardiac and psychiatric history and General Anxiety Disorder(GAD-7) scale was used.The obtained data was entered in MSexcel and analysed using SPSS software.
Results: 35% patients are recognised to have anxiety.Anxiety was found in 65% females and 45% males.No statistical significance was found among the variables.5% patients had past psychiatric illness.2-3% had family history of psychiatric illness.
Conclusion: These analysis confirm that anxiety is associated in patients with cardiac disorders;however this relationship is not as strong as that of depression and may be explained partly by other clinical factors.
Keyword: Anxiety disorder,cardiac disorders,General Anxiety Disorder-7 scale.
“Impact Of Motivational Enhancement Therapy In Medical Students Having Internet Use Disorder.”
Dr. Mridul Deepanshu1, Dr. Kirti Anurag2, Dr. Kritika Agarwal1, Dr. Lavanya Seth1
1Post Graduate Resident, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, 2Assistant Professor, Institute of Medical Sciences and SUM Hospital, Bhubaneswar
Background: Indians use internet around 8.2 hours per week. In College students there is higher prevalence of addictive internet use. However, there are very less evidenced based interventions particularly in Indian setup to control this explosive burden of pathological internet use.
Aims: The study intends to assess the associated psychopathology in internet addiction among medical students and to see the impact of MET to intervene the problematic behavior.
Methods: Medical students were selected and Pre-Assessment was done, the abuser group underwent 12 MET sessions and assessed after 3 months
Results: It was found that motivational enhancement therapy was useful in decreasing IAT and SAS-SV scores significantly with p value<0.05 Internet and smartphone usage after treatment became conscious and all subjects had a significant decrease in their addiction scores.
Conclusion: In this emerging era where young people have been more exposed to the internet and use online activity as an important form of social interaction. It is still a matter a debate whether to call internet addiction a distinct disorder by itself or a behavioral problem due to another disorder. We should also bring our attention to the fact that parents are not aware of this condition that is causing so much distress to children and they are not keeping a watch and are not spending adequate time with their children. Hence children to get over their loneliness are turning to internet and smartphones.
To Study Modifiable Risk Factors of Relapse Amongst Individuals with Alcohol Dependence Syndrome
Dr Navdeep Banyal
Background: Alcohol Dependence Syndrome patients are prone to relapsing despite treatment. Relapse prevention interventions may benefit from focused targeted study of intrapersonal modifiable risk factors as these are amenable and accessible for intervention in a hospital setting.
Aim: To evaluate the contribution of four select modifiable intrapersonal risk factors namely - relapse precipitants, self-efficacy, craving and impaired coping in the relapse of alcohol dependence syndrome.
Materials and Methods: This was a cross sectional study at a tertiary care centre and 100 patients diagnosed with Alcohol Dependence Syndrome previously treated and abstaining from alcohol for 2 months after the treatment and then relapsed were included. Both inpatients and outpatients were included. High risk situations were assessed by Relapse Precipitant Inventory (RPI), Self-Efficacy was assessed by Self-Efficacy Scale (SES), craving was assessed by Brief Substance Craving Scale (BSCS), coping strategies were assessed by Coping Behaviour Inventory (CBI). The correlation between relapse and intrapersonal modifiable risk factors was evaluated by ANOVA.
Results: Relapse precipitants, namely negative mood states and external situations/euphoric states were significantly associated with likelihood of relapse. Both general self efficacy and social self efficacy were found to be significant predictors of relapse. Craving was found to have significant association with the risk of relapse. Coping behaviours namely positive thinking, negative thinking, avoidance and seeking social support were found to be significant predictors of relapse.
Conclusion: The associations unveiled provide impetus to the formulation of interventions specifically to address these modifiable risk factors in relapse prevention.
Stigma And Knowledge Of Psychiatric Illness In Medical Students: A Cross-Sectional Study
Dr Neha Nilakh
Background: The National Mental Health Survey 2016 revealed that 14 crore Indians are suffering from mental illness, among them 10 crore (70%) patients are not on treatment. This significant treatment gap is mostly a result of the stigma associated with mental illness. Enhancing knowledge about mental illness may lessen stigma associated with psychiatric illness resulting in improved mental health care.
Aim: To measure the relationship between knowledge and stigma towards mental illness among medical students.
Methods: An online cross-sectional survey was conducted among medical students of our institute using Google forms. We obtained approval from Institutional Ethics Committee and informed consent from participants. Simple random sampling was used to select participants. We used Mental Illness: Clinicians’ Attitudes (MICA-2) to measure stigma and Mental Health Knowledge Questionnaire (MHKQ) to assess knowledge regarding mental health. Pearson’s correlation was used to measure the association between stigma and knowledge.
Results: We had 192 participants in our study. Mean score of MHKQ was 14.79± 2.67, indicating good knowledge regarding mental health. Mean score of MICA-2 was 56.47± 6.59, indicating a low level of stigma. We found an inverse correlation between MICA-2 and MHKQ (-0.04).
Conclusion: There is an inverse relationship between mental health knowledge and stigma among medical students. By increasing knowledge about mental illness, stigma can be reduced further. This will result in better management of patients with mental illness. The MBBS curriculum should have a strong emphasis on initiatives to promote understanding of mental illness among medical students.
“Study Of Excessive Internet Use & Its Psychosocial Aspects Among Female Medical Students”
Dr. Nidhi Dixit1, Dr Abhishek Gupta2, Dr Mayuresh Bodliya3, Dr Atul Agrawal4
1Senior Resident, 2Junior Resident, 3Assistant Professor, 4Professor & Hod Psychiatry Dept. of Grmc, Gwalior
Aim & Objectives: To assess the level of internet use & association of various factors of it among female medical students. Along with it to assess Alexithymia in female medical students.
Introduction: Internet use is increasing day by day & considered as one of the important & mandatory means of communication esp in adult & teenager group. As its use increased along with some positive benefits ,there are many drawbacks associated with it like Neglect of Academic, Disruption of Relationships, Social isolation, Work & Domestic Responsibilities & financial problems. The concept of Alexithymia is characterized by an inability to identify & describe emotions, difficulty in differentiating between feelings & bodily sensations that accompany emotional arousal & a paucity of imaginary life with externally oriented rather than psychologically minded thought. These people are more dependant. In India medical students depend largely on database for studying, gaming, chatting purposes. Many various studies are being done on Internet Addiction & some studies on Alexithymia. Therefore the present study aimed to investigate both internet use in excess & their psychosocial impact among female medical students & also their association with Alexithymia.
Setting & Design: Cross sectional study was done on 200 female medical students(both ug & pg) of a private medical college of central India.
Material & Methods: A cross sectional study will be done including 200 female students of institution (both pg & ug) in the age group of 18-40 years who are using their personal internet connection either on mobile/laptop/tablet for fourteen months. The sociodemographic profile will be assessed and data will be collected. Informed Consent Form (Hindi and English), Socio-demographic & semistructured interview questionnaire, Youngs Internet Addiction Questionnaire, Toronto Alexithymia Scale (TAS-20) as tools are used.
Result & Conclusion: Internet addiction is more in unmarried than married female medical students. The mean psychosocial problem score was comparatively higher in urban than in rural medical students. No significant difference in addiction between ug & pg students. In our study, mean score of possible alexithymia(>60 score) is maximum in female medical students with mild & moderate internet addiction. There was positive correlation between Alexithymia with Internet addiction.
Clinical Picture Of Delirium In Intensive Care Unit
Dr. G. Nikhil reddy, Dr. K. Pavan Kumar
PG 1st year, Department of psychiatry CAIMS, Karimnagar, Ph: 7893287880, EMail: gattupallynikhilreddy@gmail.com, Professor and HOD Department of psychiatry CAIMS, Karimnagar, Ph: +919949309277, E-mail: drrag27@gmail.com
Background: Delirium is a neuropsychiatric disorder with incidence varing widely, depending on the setting even within the hospital. The incidence of delirium in ICU ranges from 45% to 87% and prevalence of Delirium in ICU patients is 32.3%. Delirium has a sudden onset and fluctuating course, symptoms vary in individual patients.
Aim & Objectives:
• To study clinical symptoms of Delirium in intensive care unit setting.
• To determine prevalence of Delirium.
• To establish association between Delirium severity and socio demographic data.
• To establish association between Delirium severity and etiology.
Methods: A cross sectional study was conducted in Chalmeda anand rao hospital, Karimnagar including all consecutive patients admitted in ICU for a period of two months. All participants’ socio demographic data were obtained. Administered DELIRIUM RATING SCALE REVISED-98 and DELIRIUM ETIOLOGY CHECKLIST. 70 patients were evaluated for Delirium of which 27 patients developed Delirium at any point of their ICU stay, with a prevalence of 38.2% with male preponderance. 59.3% had mild Delirium and 40.7% were having moderate to severe Delirium. Metabolic disturbances were the most common etiology. Sleep wake cycle disturbance was the most common clinical feature in Delirium severity. The present study suggests that clinical features of delirium in ICU setting is similar to non ICU setting but hypoactive delirium is more common in ICU patients.
Arriving At The Diagnosis In An Atypical Case Of Trichotillomania: A Case Report
Dr Nikita Achar
Background: Trichotillomania is an important psychiatric entity causing significant distress and impairment, which is further worsened by trichophagia as this poses immense risk to physical health due to complications secondary to malnutrition and intestinal obstruction.
Aim: To report a case of a patient with trichotillomania and trichophagia with multiple diagnostic and therapeutic difficulties.
Methods: The patient, a young female underwent exploratory laparotomy for removal of multiple trichobezoars. Post medical stabilisation, detailed historical, clinical as well as psychiatric evaluation was done.
Results: A diagnosis of Generalized Anxiety disorder with trichotillomania and trichophagia in the background of Anxious Avoidant personality disorder was kept (HAM-A:30). Detailed clinical and historical exploration and evaluation revealed atypical features of trichotillomania and trichophagia in the background of poor nutritional status, which ultimately led to delayed diagnosis and intervention, and poor post-op recuperation in the index case. The patient displayed patterns similar to ‘impulsive pica’ mentioned in limited previous literature. Treatment modalities initiated post diagnostic confirmation included regular psychotherapy sessions and relaxation techniques as well as pharmacological treatment with T. Escitalopram at a dose of 10 mg.
Conclusion: Understanding variants of trichotillomania and trichophagia is required for prompt, appropriate and holistic management. Every case such as this is unique and maybe be complicated by several factors that need to be understood. Present case report highlights a unique case complicated by multitude of psychiatric and medical factors.
A Comparitive Study Of Substance Use Pattern And Impulsivity In Patients With Borderline Personality Disorder Vs Healthy Control Group.
Nirlipta Dash1, Jitendriya Biswal1, Surjeet Sahoo1
1Institute of medical sciences and SUM Hospital, Bhubaneswar
Introduction: Borderline-personality-disorder (BPD) is a significant public health problem characterized by persistent problems with emotional, behavioural, cognitive, and interpersonal functioning. Research indicates high rate of comorbidity between BPD and Substance Use Disorders. Prevalence of comorbid substance abuse in BPD range from 11%-69%. Very few data are available about substance use patterns in BPD. In this study We examined the role of substance use pattern and impulsivity in diagnosis of BPD.
Aim Of The Study: To compare substance use pattern and impulsivity in BPD with healthy control.
Method: A Cross sectional case control study was conducted in IMS & SUM Hospital, Bhubaneswar from 2020 to 2022 (2years). Sixty patients of BPD and 60 healthy volunteers recruited. Borderline personality, impulsivity is assessed by Borderline symptom list-23 (BSL-23), Self-harm inventory. For substance use pattern ICD-10 criteria used.
Result: In this study we found there is a high substance consumption rate in BPD (18.3% tobacco,15% alcohol, and 8.3% illicit drugs), compared to healthy control (Tobacco-5%, alcohol-3.3%, illicit drug-0%). Our study also suggests that persons with BPD have higher risk of self-harm behaviour.
Conclusion: Our study confirms previous reports that substance use is extremely common in BPD. This subgroup may respond particularly well to substance use treatment. Most importantly, this study suggests a compelling need for clinicians to address the problem of substance use in their borderline patients. The self-harm behaviour is significantly high in the patients of BPD due to their impulsive nature, usually followed by relationship crisis and have an increased risk of suicide. This study will help us to identify individuals with borderline personality trait and facilitate them early access to mental health services.
Sexual Dysfunction In Females OCD
Nirupama Jaiswal
junior resident,KGMU. Adarsh Tripathi, Professor, KGMU
Background: Sexual functioning in OCD remains a poorly researched area. Clinical research and evidences are lacking regarding sexual functioning in patients with OCD and the impact of pharmacological treatment on it. This study was undertaken to assess and compare the sexual functioning of females with disease per se with those solely on pharmacological treatment
Aim: To study sexual functioning in females with obsessive-compulsive disorder in three groups viz. among drug naïve symptomatic cases (group 1),receiving pharmacological treatment and in remission (group2) with age-matched healthy controls (group 3)
Method: Sample consisted of 150 subjects ,(50 in each group).Heterosexual sexually active females of 18 and 45 years were assessed on Relationship assessment scale(RAS) , Female sexual functioning index(FSFI), Sexual quality of life female(SQOL).
Results: Sexual dysfunction was 68% in (group1) and 60% in (group2) and 28% in (group3) as per FSFI. There was no significant difference between group1 and group2.Subjects having symptoms in contamination and sexual domain had more dysfunction in desire, arousal, and satisfaction. Sexual functioning and sexual quality of life were negatively correlated with the age and duration of illness
Conclusion: Sexual dysfunction is significantly higher in drug naïve symptomatic OCDas well as pharmacologically treated patient in remission.
A Study Of Depression, Anxiety And Stress In Gay And Bisexual Men Living In Gujarat State Of India
Dr Parth U Patel
(3rd year Resident, Psychiatry Department, PDU Medical college Rajkot)
Background: The LGBT (Lesbian, Gay, Bisexual and Transgender)-community has faced intense prejudice, discrimination and violence because of their sexual orientation which can impact negatively on their psychosocial and mental health. This study is important for the LGBT-community as there has been sparse research in India and in Gujarat regarding their mental-health.
Aims: To compare and co-relate Depression, Anxiety and Stress between gay and bisexual men.
Methods: A cross-sectional observational study was conducted with the help of online platform. Individuals belonging to LGBT-community were approached through various NGOs and total 80 LGBT individuals participated, of which 56.25% identified as gay and 32.5% identified as bisexual and rest belonged to lesbian and transgender category. They completed a google-form based self-report questionnaire which included socio-demographic details, information regarding sexual-identity and DASS-21(Depression, Anxiety and Stress Scale-21).
Results: Gay-men showed higher levels of depression, anxiety and stress scores ranging from moderate to extremely-severe levels on DASS-21, as compared to bisexual-men. Coming-out of the closet rates were also high in gay-men compared to bisexual-men.
Conclusion: Given the greater vulnerability of homosexual individuals to common mental-health problems, psychological-interventions that strategically target their identity-stress at multiple levels should be developed and made available to those in need. Social and psychoeducational interventions are also necessary to create a well accepting society and eradicate homophobia in wider communities.
Study Of Post Covid Psychiatric Disorders In A Tertiary Care Hospital
Dr Partik Kaur, Dr Varchasvi Mudgal, Dr Pali Rastogi
(M.G.M.Medical college,Indore,Madhya Pradesh), Email id :partikrai14@gmail.com, Contact no: 8146868368
Background: COVID-19, one of the deadliest pandemics, has taken a toll on physical and mental health alike. It has been noticed that there is a rise in psychiatric comorbidities in covid recovered cases. Various disorders like PTSD, anxiety, depression, sleep disorders have been reported in COVID-19 survivors .Current study aims to estimate the prevalence of psychiatric disorders and its associated correlation in patients with history of COVID-19.
Methods: The study population comprised the patients referred to the Psychiatry OPD from the post covid OPD over 3 months. Patients were assessed using a semi structured proforma, sociodemographic profile, treatment facility( institutional or home quarantined), duration of stay at treatment facility, medical and psychiatric diagnosis were recorded and analysed using descriptive statistics.
Results: 160 patients were included and assessed of which 66.25% were male and 33.75% were female. Mean age was 38.8 years.The referral rate was found to be 15.9%. Most common psychiatric disorder was sleep disorder (25%), followed by stress and trauma related disorder (16.25%), depression (11.25%), anxiety disorder (10%).
Conclusion: We would like to emphasize on vigilant approach and constant supervision of these patients so that an early diagnosis could be made and an add on burden to mental health care system could be reduced.For this to be achieved screening of such patients should be increased .
Pathways to care among patients with Schizophrenia
Agarwal Pranshu, Kohli Ajay
District Hospital, Sitapur, Uttar Pradesh, India
Background: Schizophrenia is a severe psychiatric disorder which has great impact on patient and caregiver. There are evidences that there is delay in treatment following onset of illness due to pathways that patients access before reaching mental health services.
Aim: To assess the pathways to care to the first contact with mental health services amongst patients with Schizophrenia.
Material and Methods:119 patients years recruited as per set inclusion and exclusion criteria. The socio demographic details were gathered using socio-demographic data sheet, pathways to care questionnaire and Positive and Negative symptoms for Schizophrenia (PANSS) were administered.
Results: The four major pathways to care were Psychiatrist (47.89%),Faith Healer(31.09%),General Physician(15.12%) and Quack(5.88%).This depends upon multiple socio demographic factors and awareness levels amongst population.
Conclusion: In our study most common pathway to care are psychiatrist followed by faith healers, general physician and quacks. Education of head of family, awareness about mental health amongst people, stigma and availability of services decides first contact person. These findings indicate towards importance of IEC activities about mental health and emphasis should also be made about collaboration between psychiatric and non psychiatric medical services.
Keywords: Faith healer, Pathways to care, Schizophrenia
“A Clinical Study To Assess The Distribution Of Clinical Diagnosis According To Demographic Pattern(Age/Gender/Sex) And Their Association With The Duration Of Hospital Stay”
Dr Prayashi Kashyap
Background: Most of the psychiatric illnesses are chronic in nature with some showing acute exacerbations and requiring immediate hospitalisation.In the last few decades,advances in availability of psychiatric treatment has led to shifting of patients from long stays in asylum institutions to short stay in general hospitals with psychiatry beds focusing on stabilisation,safety and rapid discharge thereby decreasing the cost of treatment.The total number of psychiatry beds in many countries is still quite less with India having 56,600 Psychiatry beds for a 130 crore population.
Aim:
1)To find the clinical diagnosis of patients admitted to psychiatry ward of Gauhati medical college and hospital(GMCH)
2) To find the demographic profile(age/gender/sex)among patients with different psychiatric illnesses.
3) To see the association of the duration of hospital stay with different psychiatric illnesses.
Method: Patient’s records were assessed retrospectively from the IPD registers and indoor history records of psychiatry department,GMCH for duration of June to November,2022.
Results: Total admissions-392,out of which substance use disorders -119(alcohol- 77.5%>opioid-12.31%>cannabis-5.7%>polysubstance -4.34%). Gender: Males-66%,females-33.9%. Age group: 18-60 years-86%,<18 years -9%(mostly dissociative),>60 years-4.8% (mostly mood disorders). Diagnosis:in males>females-schizophrenia,BPAD, substance use disorders. In females>males-dissociative,ATP,OCD,anxiety,somatoform,depression. Duration of hospital stay-<1 week-23.4%,1-2 weeks-33.4%,2-4 weeks -35.6%,>4 weeks-7.6%(includes substance use disorders followed by schizophrenia)
Conclusion: An overview about the different clinical diagnosis of patients requiring hospital admission along with it’s distribution as per age/gender/sex and the duration of hospital stay would be beneficial for better patient care.
Psychosocial Determinants Of Covid Vaccine Hesitancy And Stage Of Motivation In Lactating Women
Prerna Kukreti1*, Ramdas Ransing2 , Pracheeth Raghuveer3, Omsai Ramesh V1 , Dinesh Kataria1 , Shiv Prasad1, Manju Puri4, Manish Goel, Praveen Kumar, Dr Prerna Kukreti
Associate Professor Psychiatry, Lady Hardinge Medical, College, Delhi, India, dr.prernakukreti@gmail.com, 9810612578, 1Dept of Psychiatry, Lady Hardinge Medical College, Delhi, 2Dept of Psychiatry, BKLW Medical College, Ratnagiri, Maharashtra, 3Dept of Community Medicine, NIMHANS, Bengaluru, 4Dept of Obstetrics, Lady Hardinge Medical College, Delhi
Background: The Government of India recommends pregnant and lactating women to get vaccinated against the Novel Coronavirus Disease 2019 (COVID-19). However, vaccine hesitancy in this population adversely affects the uptake of vaccination. There is an urgent need for assessing extent of vaccine hesitancy in this group and study its determinants, motivation stages and barriers.
Objective: To determine psychosocial Factors affecting uptake of COVID-19 Vaccination in lactating women and their attitude towards infant vaccination in general and stage of motivation for vaccination.
Methods: A cross-sectional analysis survey was conducted amongst 80 women visiting postnatal OPD or immunization clinic of a tertiary care hospital of Delhi using Oxford COVID-19 vaccine hesitancy scale (OC19-VHS) and participants were classified as hesitant, non-hesitant, and unsure.
Results: We enrolled 80 postnatal women with mean age of 25.3 ((SD, 9.6) years. The vaccine hesitancy rate was 44% acceptance rate in the participants. Regression analysis showed young age group (20- 45 years), low socioeconomic status and no past history of COVID infection were factors independently associated with Vaccine hesitancy. Doubts on vaccine safety and concerns about its impact on lactation were primary barriers affecting vaccine uptake. Amongst participants in vaccine hesitancy group only 40% had got their children completely vaccinated for age.
Conclusions: Nearly 40% lactating women visiting hospital had vaccine hesitancy and concern for its impact on lactation and vaccine safety were the primary determinants for reduced vaccine uptake in lactating women.
Preferred presentation: Oral
Acknowledgement: This work is part of COVID Vaccine hesitancy project funded by the Indian Council Medical Research (ICMR)
COVID-19 vaccine, Vaccine-Hesitancy, lactating women
A Curious Case Of Restlessness
Dr Priyanka Shah
Background:
• Restlessness is an inability to remain at rest and difficulty in concentrating. Restlessness, when experienced often requires clinical attention.
• Restlessness can be caused as a result of various substances and medications. Restlessness can be distressing and can increase the risk of suicidal act.
Case Vignette
• 45 year old male patient with complaints of intense restlessness since 7 days.
• Patient was not able to sit still even for a minute which caused him severe leg cramps.
• Had past history of suspiciousness, fearfulness and hearing of voices before 5 months.
• Past history of psychotic features before 5 months.
• Other psychiatric causes for restlessness were ruled out.
• Patient was treated with T. Mirtazapine 45 mg and Clonidine 150 mcg was given after which gradual improvement was seen over 5-7 days.
Discussion:
• Restlessness can be a feature of organic and nonorganic disorders, and may be caused or influenced by psychological factors.
• The neuroanatomical basis of restlessness may consist of abnormalities in the cortico-subcortical neuronal circuits, the complex regulation of which may explain why different causes often lead to a common end result, restlessness.
Conclusion:
• Here the underlying condition for responsible for restlessness is unexplained.
• Common psychiatric conditions causing restlessness were ruled out.
• Patient responded to non-conventional molecules which raises further questions.
Quetiapine & India: A Case Series on its effectiveness as a Mood stabilizer
Dr Rachit Sharma
Introduction: Bipolar affective disorder (BD) had chronic episodic course with recurrent episodes of mania or depression leading to socio-occupational dysfunction. Standard pharmacology is dependent on conventional mood stabilizers, such as lithium, divalproex sodium and carbamazepine. The role of atypical antipsychotics is more as a first line adjunct in Manic episodes. Recently the evidence in Europe and America is favoring for use Quetiapine as primary mood stabilizer for all phases and episodes of Bipolar illness and has even been incorporated in clinical practice guidelines of some countries. However, the prescribing pattern of Indian Psychiatrists weighs heavily on time tested conventional mood stabilizers during acute episodes as well as during maintenance phases.
Methodology: In order to understand and assess the effectiveness of Quetiapine as a monotherapy in any phase of Bipolar affective disorder without compromising the standard of care and as per clinical requirements, Quetiapine was instituted/switched to 14 patients of BD in any of phase of illness.
Results: Three patients in Manic episode, three patients in Depressive episode and one patient in Mixed episode attained complete remission with Quetiapine monotherapy. Medications of six patients were successfully switched from conventional mood stabilizers to Quetiapine monotherapy without any signs of relapse. One patient was who already maintaining remission on combination of quetiapine and valproate was continued on the same regimen due to patient preference. All patients, whether in acute phase or maintenance phase were noted to be in remission on maintenance dosages of 300mg/day.
Conclusion: Role of Quetiapine as a primary mood stabilizer in acute phases and long-term stabilization appears promising. Quetiapine is a step forward even for Indian Population, considering its effectiveness and tolerability profile for all phases of episodes in BD across adults of all ages. Further prospective studies and controlled trials in Indian Population are required to validate these findings.
Effect of Haloperidol on C-Reactive Protein in Schizophrenia Spectrum and Other Psychotic Disorders
Dr Reema Bana, MBBS; Dr Subhash Das, MD; Dr Sushmita Bhattacharya, MD
Background: Immune system activation has been proposed in development of psychosis in various studies. Inflammatory markers have been found raised in psychosis and then decreased with treatment with antipsychotics. Index study intended to assess and compare the effect of haloperidol on CRP in persons with ‘Schizophrenia Spectrum and Other Psychotic Disorders’. The research also aims to study the correlation of changes in CRP with treatment response following haloperidol with the help of application of standard scale.
Materials and Methods: An interventional study was conducted at Department of Psychiatry of a Tertiary care teaching hospital in Chandigarh from July 2021 to August 2022. Patients between ages of 18-65 years were screened and those fulfilling the criteria were taken up for study. Samples baseline CRP were taken and baseline PANSS was applied. Patients were started on haloperidol and weekly assessment for side effects via GASS and two-weekly assessments for improvement of symptoms was done via PANSS for 6 weeks after which samples for CRP were taken again and compared from baseline.
Results: Baseline CRP levels were found to be raised 7.11 (+6.05) mg/L which after treatment decreased to 3.42 (+4.32) mg/L and PANSS from 104.20 (+22.77) to 71.00 (+27.32) in 6 weeks after treatment both of with were statistically significant (p-value<0.001).
Conclusion: Inflammatory markers in Schizophrenia Spectrum and Other Psychotic Disorders have been found to be altered and have been found to reach baseline levels after treatment with haloperidol being comparable to improvement in psychotic symptoms.
Keywords: Psychosis, Schizophrenia Spectrum and Other Psychotic Disorders, CRP, Haloperidol, PANSS
A Cross Sectional Study Of Correlation Between Emotional Intelligence,Work Performance And Burnout In Resident Doctors In Tertiary Care Centre.
Dr Richa Panpaliya1, Dr Sarika Dakshikar1, Dr Gaurav Pawar1
1Grant Government Medical College, Mumbai
Background: Residents work for long hours and undertake heavy academic pressure. Burnout is a common occurrence in Residents. Studies indicated that Emotional Intelligence has significant correlation with work, academic performance & even personal aspects of Resident’s life.
Aim: The aim of this study is to evaluate the correlation between Emotional Intelligence, Work Performance and Burnout in Resident Doctors in Tertiary Care Centre.
Methodology: 50 Residents working in tertiary care centre were included in the study. Emotional Intelligence was assessed using Wong and Law Emotional Intelligence scale. Work Performance was assessed using Individual Work Performance Questionnaire & Burnout was assessed using Oldenburg Burnout Inventory.
Result & Discussion: The results show that Moderate to High Burnout is present in 80% of Residents. A significant Co relation is found between Emotional intelligence and Burnout (p-0.002) .It is observed in the study that Lower Emotional Intelligence score is associated with increased Burnout & lower work performance. However Higher Emotional Intelligence score did not rule out the possibility of having Burnout ,owing to various other contributing factors.
Conclusion: There is a need to take measures to assess & when needed improve Emotional Intelligence and reduce chances of Burnout in Resident Doctors and improve their work performance.
Keywords: Emotional Intelligence, Burnout , Work Performance.
“Proportion and association of symptom profile on poor insight in individuals with schizophrenia spectrum disorders in a tertiary care centre- a cross sectional study”
Dr Dyuthy R (PG student, Dept of Psychiatry Dr SMCSI Medical college)
Dr Christina George ( Professor and HOD, Dept of Psychiatry Dr SMCSI Medical college)
Background:Schizophrenia spectrum disorders are a group of chronic psychiatric illnesses that would require long term antipsychotic medication. Poor insight is a common issue in Individuals with schizophrenia spectrum disorders. This study investigates the prevalence of poor insight and influence of various symptoms of schizophrenia in such individuals attending the OPD of a tertiary care centre in South Kerala.
Aim:To estimate the proportion and to assess association between various symptoms on poor insight in individuals with Schizophrenia spectrum disorders, attending the PsychiatricOPD in a Tertiary care centre, over one year.
Method:Cross sectional study among 54 individuals, who met DSM-V criteria for Schizophrenia spectrum disorders, who consecutively attended the PsychiatryOPD was done. Instruments employed were a Semi-structured Proforma, Birchwood Insight Scale[BIS], Medication Adherence Rating scale[MARS] and Positive and Negative Syndrome Scale(PANSS). The relationship between insight and selected clinical variables was analysed.
Results:The mean age of the sample was 30.89[SD–11.922]and frequency of poor insight was 63%[n=34]. Poor insight was significantly correlated with positive (χ2=18.516,P<0.01), negative (χ2=11.435,P<0.01), cognitive (χ2=18.516,P<0.01) and hostility (χ2=15.565,P<0.01) symptoms and no association was found with anxiety symptoms (χ2=5.082,P=0.047) of schizophrenia. Poor insight was also associated with low medication adherence(χ2=31.129,P<0.01).
Conclusion:Low medication adherence, positive, negative, cognitive and hostility symptoms are associated with poor insight in patients with schizophrenia spectrum disorders. This study highlights the role of specific interventions designed to improve various symptoms of schizophrenia for achieving better insight.
Impact on sexual satisfaction and functioning in women on various anti-depressants in a tertiary care centre-A cross-sectional observational study.
(Dr Krutika Jamdar -JR3, Dr Gaurav Pawar -Asstnt Prof, Dr Maithili Umate -Assoc Prof ‘Grant Medical college’ Mumbai)
Introduction – Antidepressants lead to impairment in the sexual functioning in all phases of the sexual cycle. There is high incidence (range 30-65%) of sexual dysfunction in patients receiving selective serotonin reuptake inhibitors (SSRI), serotonin norepinephrine reuptake inhibitors (SNRI) and monoamine oxidase inhibitors (MAOI). Prevalence rate of self-perceived sexual dysfunction to be 33% in patients receiving escitalopram, 27.3% in patients receiving venlafaxine, 28.57% in patients receiving paroxetine, 16.66 % in mirtazapine group and 7.7% in patients receiving sertraline.
Research questions- To study sexual satisfaction and functioning in women, with MDD in remission on various antidepressants and factors affecting it.
Methodology and data collection- With Institutional Ethical Committee (IEC) approval and appropriate consents/assents, data were collected from 78 women with MDD in remission (HAM-D score <7) who can understand Hindi, English or Marathi, with age 18-45yrs who are sexually active. SSS-W (Sexual satisfaction scale women) and Hindi version of FSFI(Female sexual functioning index) scales were used to assess the sexual satisfaction and functioning.
Results and conclusions -Antidepressants were found to have sexual side effects and affect sexual satisfaction. Of which SSRI (escitalopram and sertraline) were associated with majority of sexual side effects as compared to (SNRi , TCA, SPARI etc).
Keywords – Antidepressants, SSS-W, FSFI, satisfaction, functioning.
Aim- Application of Transactional Analysis in Psychiatric Practice
Introduction- Transactional Analysis is a versatile and comprehensive system of Psychiatric education and potential Psychotherapy which is often underutilized and doesn’t get its due with respect to how much it is used in our day-to-day clinical practice. This presentation aims at shedding light on basic principles of Transactional Analysis and how they can be put to use in Psychiatric practice as we know it.
Methodology- Transactional analysis improves upon rigid Freudian tripartite model and proposes a more flexible framework of PAC model (Parent, Adult and Child) for understanding and therapeusis.
In this presentation we elaborate upon the same with examples of day-to-day transactions with role playing and audience involvement.
Conclusion- The destiny of every human being is decided by what goes on inside of his skull, when confronted by what goes on outside of his skull said, Eric Berne. In this workshop, we plan to equip participants with the tools to implement principles of game theory in Psychiatric practice. We believe this would enrich the experience of history taking which otherwise is at risk of being either too stringent or too eclectic.
Background
Mental Health Care Act 2017 (MHCA) came into force on 29 May 2018. Goa State Mental Health Authority (GSMHA) notified the Mental Health Review Board on 8, February 2022 completing the important process of implementation of the act. The transition comes with challenges.
Aims
To study the experiences of psychiatrists upon transition from Mental Health Act (MHA 1987) to Mental Healthcare Act (MHCA 2017) in Goa, India.
Methods
Cross-Sectional observational mixed-methods study (qualitative and quantitative) , involving interviews of 18 Psychiatrist.
Results
18 psychiatrists participated - 4 private, 3 secondary and 11 tertiary level. Themes extracted were work During MHA 1987, Transition and After implementation of MHCA 2017.
During transition, (26%) reported difficulties, (26%) felt an increase in workload, (22%) felt negative emotions and (24%) were neutral indicating a lot of mixed perceptions.
After MHCA 2017 implementation regarding admission and discharges, (48%) responses were positive reporting that autonomy of patients is preserved, (48%) negative due to increased documentation and repeated capacity assessments. (80%) responded positively to the concept of Nominated representatives. With respect to Rights of patients (84%) responses were positive that it preserves autonomy of patients & negative (15%) that rights would be misused by the patients. Responses for assessment of mental capacity were Difficulty in assessment (31%) and Need training of MHP’s (55.2%) and (13%) felt they were competent to assess mental capacity due to their experience and working under NHS, UK. With respect to working with MHRB responses were positive (56%) because decision making was less on psychiatrists and (43%) negative due to undue scrutiny.
Conclusion
This study captures the challenges faced by psychiatrists during transition. Furthermore, it gives insights for mental health professionals and equips them for its successful implementation.
Study of Clinical Profile, Type of Stressors, Temperamental Characteristics And Impairments In Children And Adolescents With Dissociative Disorders
Background: In children with Dissociative Disorder there is a partial or complete loss of integration between memories of the past, awareness of identity, immediate sensations, control of bodily movements and ability to exercise conscious selective control is impaired. There is a dearth of research studies among Indian children and adolescent population.
Aims: To study the clinical profile, type of associated stressors, temperamental characteristics & impairment in children and adolescents with dissociative disorders.
Methodology: Self-designed proforma to assess socio demographic variables, clinical profile and types of stressors and temperament Measurement Schedule,Children’s Global Assessment Scale to assess the impairment due to illness was administered. The study sample consisted of 60 new cases of Dissociative Disorder (ICD 11) in the age group of 6-16 years.
Results: The mean age of the sample was 13.7 years with 60% females. Stressors were present in all cases and 50% had extra familial stressors. 20% suffered from childhood trauma and 5% had a history of sexual abuse. 20% had comorbid psychiatric disorders. Poor scholastic performance was found in 60% of the patients. 40% of the patients had relationship difficulty. Variable functioning with sporadic difficulties (CGAS score: 51-60) & low level of adaptability and approach withdrawal was found on the Temperament Measurement Schedule.
Conclusion: Our study showed the association between dissociation & stressors, history of childhood trauma, sexual abuse. It also portrays lower adaptability among individuals with dissociative disorder. It also shows the impact on scholastic performance & relationships. These factors can be of importance in individualising therapy.
STIGMATISATION IN CHRONIC HEPATITIS B AND C INFECTIONS-time to debunk the myth!
Dr Sabreena Qadri , Consultant Psychiatrist, AIG HOSPITALS-HYDERABAD.
INTRODUCTION: Hepatitis B and C infections can be associated with mental and social impacts which can result in poor quality of life. Also the routes of transmission and lack of education may cause stigmatisation of the affected patients.
Aims: The aim of the study was to document the stigmatisation among Chronic Hepatitis B and C positive patients.
Methods: Stigma experienced and work/financial problems were assessed using a semi structured questionnaire in 242 Hep B and C +ve patients included in the study.
Results: The majority of patients 181 (75%) said they had had to change their lifestyle, and significantly more were males than females. Males were significantly more affected than females were in term of changes in lifestyle (85%v59%) and changes in relationship with the spouse (63%v19%). They were also more likely to report receiving treatment (90%v70%) and that the attitude of doctors towards them was as normal (92%v76%). Significantly more females than males reported feelings of loneliness and isolation (48% versus 30%).
Stigma was marked in terms of disease transmission, with 160(66%) of patients fearing that they could transmit the infection to others. Marital relationships were affected for 51% of married patients. Around 80% unmarried patients were experiencing delay in getting married due to fear of relations breaking out if the partner would come to know about the disease status.
Conclusions: Patients’ comments showed a sense of family and societal discrimination. A lot of these can be changed by educational interventions, effective and society centric awareness and scientific models of approach.
The pattern of alcohol use in Alcohol Use Disorder related cirrhosis in Indian patients AUDIT Indian Liver study
Aims :This study analyzed the drinking patterns along with the educational, socio-economic, and mental health in a cohort of patients with and without liver cirrhosis
Design : This was a prospective observational study
Setting: Study was conducted at a tertiary care hospital in the department of hepatology
Participants: Patients with harmful alcohol drinking were included in the study
Measurements: Patients with harmful drinking underwent a detailed demographic and alcohol intake history and an assessment of socio-economic and psychological status by modified Kuppuswamy-scale and the Beckwith Inventory, respectively.
Findings: Cirrhosis was present in 38.31% patients with heavy drinking (64%). Cirrhosis was more among illiterates (51.76%) with early onset (22.4. ± 7.30 yrs p=0.0001) and longer duration of alcohol (12.5 ± 6.5 vs. 6.8 ± 3.4 p=0.001). Higher education qualification was associated with lower cirrhosis(p<0.0001).With same employment and education qualifications, net-income in cirrhosis was lower (306 ± 129.8 vs. 424 + 305.34 USD p=0.001). Whiskey (86.8%) was the commonest drink consumed. Cirrhotics consumed more alcohol drinks/ week (47.01 ± 30.38 vs. 36.1 ± 26.64, p=0.0001) which was even more with indigenous alcohol (101.58 ± 80.2 vs. 84.84 ± 62.0, p=0.001). Loss of jobs (12.36%) and partner violence were more in cirrhotic (9.89% vs. 5.80%) with similar borderline depression.
Conclusion: AUD-related cirrhosis is present in a quarter of patients with harmful early onset and longer duration of drinking and is inversely related to the education status and affects the socio-economic, physical, and family health of patients.
Background:
Heroin is the most common used opioid in India and common routes of intake are intravenous and ‘chasing the dragon’ mode. Research regarding the comparison of the characteristics of these two groups is scant all over the world as well as in India.
Aim:
To compare socio- demographic and clinical differences between heroin chasers and injection heroin users (IHUs).
Methods:
A retrospective chart review of patients diagnosed with primary opioid dependence was made. Fifty heroin chasers attending the deaddiction clinic of the institute were compared with fifty injection heroin users regarding socio-demographic and clinical characteristics during. Severity of opioid dependence was assessed using Severity of the Opioid Dependence Questionnaire (SODQ) .Comparison of Heroin Chasers with Heroin Injectors was done using Chi square and t test, wherever applicable.
Results:
Most of the treatment seekers for heroin dependence were in the age group of 20-34 years (74% IHU and 76% chasers, P = 0.78). Mean scores on opioid dependence severity were higher (42.45 + 9.23) in injection users as compared to chasers (37.56 + 8.28, P < 0.01). As compared to chasers, IHUs had 4.64 odds of receiving Buprenorphine as withdrawal management (Confidence Interval:1.55-13.84) and this was statistically significant (P < 0.01). IHUs had lesser odds of early drop out but did not reach statistical significance (24% vs 34%, OR: 0.61, CI : 0.25-1.46 , P= 0.38).
Conclusion:
The study findings indicate that there was no difference in most of socio-demographic variables between IHUs and heroin chasers. IHUs had greater severity of opioid dependence and had higher odds of receiving Buprenorphine as withdrawal management. There was no difference in overall quality of life and early dropout rates between the two groups.
Objectives: Illicit opioid use is a major concern across the globe due to its adverse health consequences. Pharmacological intervention is regarded as the cornerstone of management of opioid dependence and the Opioid Agonist Treatment (OAT) is the most effective intervention for this chronic relapsing disorder. Since the pattern of use of illicit substances, like opioids, changes with the course of time, we studied the profile of patients registered in an OAT clinic of a tertiary care center in North India over last 8 years.
Methods : Retrospective chart review of patients registered in the OAT clinic was done. Comparisons were made among two periods (2012–2015 and 2016–2019).
Results : Total number of opioid dependent patients registered in OAT clinic has increased from 139 in 2012 to 2015 to 309 in 2016 to 2019. Mean age at the first use of opioids has reduced significantly from 20.2 (+ 2.7) years in 2012 to 2015 to 18.3 (+ 3.2) years in 2016 to 2019 (p = 0.02). Parenteral route continues to remain as the dominant mode of use of opioids, though it has increased from 80.6 to 99% of users. There has been increased use of heroin over these years (12.2% in 2012–2015 to 72.5% in 2016– 19) with concomitant decrease of pentazocine use (69.1–17.5%), respectively. Conclusion The changing demographic and opioid use pattern in the last couple of years among patients attending OAT clinic should alert the policy makers, so that an integrated approach is put into action for effective prevention and management of opioid use disorders.
Assessment of stigma among caregivers of persons with mental illness in armed forces population
Keywords : Stigma, Caregivers, Mental illness, Armed Forces, Military
Abstract : Background: Having a person with mental illness in the family often leads to stigmatic experiences to the family members. Perceived stigma in caregivers leads to social isolation, psychological distress and suboptimal functioning. Additionally, perceived stigma among such caregivers is one of the barriers that prevent them from taking appropriate care of their dependents with mental illness. There has been little research in this field in the Indian armed forces population. Objective: To assess the perceived stigma among caregivers of persons suffering from mental illness (both serving and retired including their family members). Methodology: A total of 150 caregivers visiting psychiatry OPD of a tertiary care military hospital in North India along with their mentally ill dependents were included in the study after obtaining valid informed consent. The subjects were interviewed, their socio-demographic data collected, and stigma scores assessed on a 15-item Explanatory Model Interview Catalogue (EMIC) stigma scale. Result: Total stigma score ranged from 20 to 40 with a Median of 31. Caregivers with a lower level of education, lower income, rural residency, higher age, and diagnosis of psychosis/substance abuse in dependent were found to have higher scores of perceived stigma. Conclusion: Caregivers of patients with mental illnesses experience significant stigma which needs to be addressed so that they can provide optimum care to their mentally ill dependents. Limitation: The cross-sectional nature of the study, non-inclusion of a control group, non-evaluation of coping strategies, EMIC not providing any standard cut-off for low or high stigma and limited sample size can also be considered as a limitation of the present study.
An association of Depression and Gaming Use amongst Medical students: A cross sectional study
Background: An Internet gaming is a leisure activity worldwide, and ease of internet access aids in that experience. But due to high prevalence of gaming uses among children and adolescent, gaming disorder emerges as a mental illness and its prevalence is increasing over the time, which may also lead to psychiatric problems like depression, anxiety etc.
Aims: To explore the association of depression and gaming use amongst medical students.
Materials & Methods: Cross-sectional study was conducted on 422 medical students of PDU Medical College, Rajkot. Case report form (CRF) containing demographic details, questions related to gaming use were filled by medical students and 2 scales (Internet Gaming Disorder Scale – Short Form and Public Health Questioner 9) were used for assessment of this morbidity.
Results: Overall 422 students participated; prevalence of gaming use is 87.44% (369). The mean age of students was 22.90 years. Amongst all gaming users 66.12% (244) are males and 33.87% (125) are females. Study shows that 82.37% (201) of males and 83.20% (104) of females with gaming use are having depressive features of different severity which is statistically not having significant difference (p value is 0.843). The prevalence of depressive features amongst non-gaming users and gaming users is 60.37% (32/53) and 73.98% (273/369) respectively which is significant statistically (p value is 0.038).
Conclusion: Depressive features amongst gaming users are more than non-gaming users, but among them females and males are equally prone to depression. Depression is common among gaming users requiring preventive measures and intervention.
Dr Savan Sapovadia
3rd Year Resident Doctor,
PDU Medical College, Rajkot.
Predictors of severity in first episode psychosis : a cross sectional study
Dr Shaily Mittal, Dr Subramaiah Nagendran
Background :- In India, psychiatric disorders account for highest , among causing the disease burden for non-fatal diseases. Persons who are suffering from the mental disorders, become an object of stigmatization in the society, which leads to prolongation of duration of untreated illness.
Aim:- To study the predictors of severity in first episode of psychosis in drug naive patients
Method:- 50 patients who developed psychosis for the first time were included in the study, BPRS & CRDPSS scales were applied to diagnose and to assess the severity of psychoses, Cannon spoor premorbid functioning scale was applied to assess premorbid functioning ,duration of untreated illness and age at the time of onset of psychotic symptoms was documented.
Results:- It was observed that patients of non-affective psychoses had an early age of onset and poorer premorbid adjustment scores as compared to patients of non-affective psychoses. severity of psychosis at the time of presentation of illness was more in cases of prolonged duration of untreated illness.
Conclusion:- Increased duration of untreated illness and poor premorbid functioning led to increased scores on BPRS and CRDPSS scales, predicting more severe psychotic illness and thereby prolonged treatment and increased burden upon the patient and their family both emotionally and financially, which can be reduced if patient gets psychiatric treatment earlier in the course of illness.
Prevalence of Adult ADHD Comorbidity in Alcohol Use Disorders in a General Hospital Setup
Background: Attention deficit hyperactive disorder (ADHD) symptoms persisting into adulthood can influence the course and outcome of alcohol use disorders (AUDs). A cross-sectional study was conducted to assess the prevalence of adult ADHD in patients admitted with AUDs in a general hospital setup.
Methods: In this study, 100 consecutive inpatients with alcohol use disorder (AUD) were evaluated for the diagnosis of ADHD. Patients with AUD were assessed with Severity of Alcohol Dependence Questionnaire, Clinical Institute Withdrawal Assessment for Alcohol and Adult ADHD Self Report Scale. Among the subjects who screened positive for adult ADHD on ASRS, diagnosis of adult ADHD was confirmed using the DSM 5 diagnostic interview. Epi-Info Version 7.2 was used for data entry and analysis. Mann Whitney test and Chi-square test (or Fisher’s Exact test) were used for statistical analysis.
Results: Twenty-one subjects screened positive for adult ADHD. Among them, 19 subjects had a confirmative diagnosis of adult ADHD. Patients with adult ADHD comorbid with AUDs showed accelerated progression towards dependence, and early relapses.
Conclusions: In all, 19% of treatment-seeking inpatients with AUDs have co-morbid adult ADHD. Regular screening of AUD patients for adult ADHD and addressing the psychopathology may improve the treatment outcome.
Key words: Adult ADHD, alcohol use disorder, prevalence
Promoting Gender Equality to reduce postpartum depression in mothers in child-care through male targeted strategies in community-based parenting programme delivered through home visits.
Background:
Stepping Stones, started in 2015, is an innovative program aimed at promoting Early Child Development, by using the locally available resources and the public sector ICDS program. The program was implemented in 58 villages in the forest buffer zone of two districts in Central India. This area had a sex ratio of 946 females for every 1000 males, and a literacy rate of 87.22%. Traditional practices are widely prevalent in these regions strongly influencing health-seeking behaviour and childcare. Culturally, childbearing and rearing are the domain of women. Thus, women are overburdened due to childcare responsibilities in addition to routine household chores and farm/forest labourer for income generation. Often, child is left to the care of an older sibling or neighbours, when the mother is too busy in her duties or out of home for work. In most of families, males are the heads of households, key earning members of family. They are reluctant to take child care as their responsibility and hesitate to spend time with their children. Care of children in daily routines like bathing children, feeding, changing diapers, and dressing them is mainly done by women. Hardly a few men spare time for playing with their older kids. But younger children are relatively less to have interacted with fathers and male members of the family. Fathers’ role in child development is evident and needed to be promoted in this programme.
Methodology:
For raising awareness through the Positive Parenting programme of Stepping Stones, we developed a set of modules and self-reflective assessment tools which particularly emphasized on the participation of males in child care and development activities. Subsequently, we involved fathers and grandfathers, adapted family-focused intervention, and updated the curriculum. Male field workers started delivering the sessions and provided space for fathers to participate and discuss. Prepared Picture books showing fathers/grandfathers engaged in childcare. The parenting sessions which were delivered through home visits are scheduled so that male members of the family are available at home. The effects are evident and are captured through photo/video documentation and notes in the work diaries of field staff. Gender disaggregated data on changes will be entered in RMAF. We used STATA/MP Version 14 for data analysis.
Results:
About 60% of home visits for parenting interventions by our field staff are well received by male members of the family and they have started spending time with children and participating in childcare activities. Active participation of males in childcare and development activities by reducing postpartum depression increased from 3 to 33%.
Keywords: Postpartum depression, Childcare, Gender equality, Home Visit, Parenting.
A STUDY OF SLEEP QUALITY IN ALCOHOL DEPENDENCE SYNDROME
Background- Alcohol use is second most commonly used substance in India with prevalence rate of 4.6%. Chronic alcohol use causes multiple medical and psychiatry illnesses, with increased risk of mortality. It is generally assumed that alcohol improves sleep in users. Long term alcohol use is associated with decrease in REM sleep& deep sleep (stage 4) increased sleep fragmentation, & longer episodes of awakening. Alcohol users are at the risk of developing parasomnia. There is lack of data from India on studies on sleep quality in alcohol dependence. This study aims to assess sleep quality in alcohol dependence & variables affecting sleep. This helps in detecting early sleep disturbance & preventing further episodes of alcohol relapse.
Objectives-
1. To asses sleep quality and parasomnias in patients of alcohol dependence syndrome
2. To associate the severity of alcohol dependence syndrome with quality of sleep disturbance
3. To evaluate the determinants of sleep quality among alcohol dependence syndrome
Method-
A cross sectional study was done on 62 patients with diagnosis of Alcohol dependence syndrome (ADS) as per ICD-10, with active use of alcohol, aged 18- 65 years, who give informed consent. Patients with other substance use other than nicotine dependence were excluded, also patients with co-morbid medical & psychiatric disorder, complicated withdrawal , withdrawal features> 2 days in the last month were excluded. Semi structured proforma, M.I.N.I. screening for psychiatric diagnosis, & parasomnia questionnaire were applied. SADQ & FTND, were applied for alcohol and nicotine dependence, Then ISI & PSQI were applied to assess insomnia & sleep quality respectively.
Results
Mean PSQI score of study sample is 5.97 with SD of ±3.55 .Prevalence of poor sleep quality is 58.1%. ISI mean score is 10 with SD of ± 6.13 and prevalence of insomnia as per ISI is 59.68%. Association between SADQ score and sleep quality (PSQI )and insomnia (ISI) is statistically significant and has moderate correlation. Locality of patients is associated with sleep quality.
Interpretations and conclusions-
• Patients with alcohol dependence syndrome with active alcohol use have high prevalence of poor sleep quality ( 58.1%) and insomnia (59.68%)
• Prevalence of parasomnias is 14.52 % .
• Severity of alcohol dependence is positively correlated ( moderate correlation) with sleep quality and insomnia.
• Residential status is the only sociodemographic variable which was associated with sleep quality
Keywords- alcohol dependent syndrome; sleep quality; insomnia; parasomnia;
Comparative study of personality traits in patients of major depressive disorder and patients with minor skin conditions
Background
Individuals with MDD differ from non-depressed individuals upon measures of dimensional personality traits. It is found that there has been complex and variable association of personality and depression. We can decide treatment plan, course of treatment and prognosis based on this knowledge.
Aims
To compare personality traits of patients of MDD with that of patients with minor skin conditions.
Methods
A case control study was conducted at tertiary care hospital at department of Psychiatry and department of Dermatology. 100 cases and 100 controls were taken. Patients attending dermatology OPD for minor skin conditions were taken as controls for being socio demographically similar to cases. Personality traits were assessed using the Big Five Inventory focused on domains like Neuroticism, Extraversion, Openness to experience, Agreeableness, Conscientiousness. Severity of depression was assessed using Hamilton Depression Rating Scale. Comparison of personality traits of the two groups was done using non parametric test.
Results
Statistically significant difference has been found between cases and controls in terms of following personality traits. Extraversion (p<0.019), Agreeableness (p<0.030), Conscientiousness (p<0.001), and Openness to experience (p<0.001) is higher in controls and Neuroticism (p<0.001) is higher in cases.
Conclusion
Personality trait Neuroticism may be a risk factor in developing major depression. Extraversion, Openness to experience, Agreeableness and Conscientiousness may be associated with some protective effect. Individual tailored approach to management is advisable for better long term outcome based on personality traits.
PALIPERIDONE INDUCED CONCURRENT TARDIVE DYSTONIA AND TARDIVE DYSKINESIA IN A YOUNG MALE WITH SCHIZOPHRENIA MANAGED WITH CLOZAPINE: A CASE REPORT
Shubham Tiwari, Sandeep Grover
Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh
Aim: To discuss a patient who developed tardive dystonia and tardive dyskinesia while receiving paliperidone and was managed with clozapine, with which there was significant improvement in the tardive syndromes. Methodology (Case Description): A 25-year-old male diagnosed with schizophrenia presented to us with tardive dyskinesia and tardive dystonia. Exploration of history revealed that patient had been using multiple substances in the form of opioids, tobacco and cannabis in dependent pattern since the age of 13 years and he developed psychotic symptoms in the form of smiling to self, muttering to self, unprovoked anger outbursts, self-absorbed behaviour, social withdrawal, alogia, asociality and avolition since the age of 19 years. The psychotic symptoms had continued for long durations even when he was abstinent from cannabis. Over the period he had initially received adequate trials of oral Olanzapine and Risperidone, but did not show much improvement. Later he was started on Inj. Paliperidone 150mg monthly injections with which there was some improvement in the symptoms. However, after receiving Inj. Paliperidone for 1 year, he developed tardive dystonia involving the neck and trunk, leading to tilting of the body to the left side. In addition, he also developed abnormal tongue movements, and involuntary and irregular stereotyped choreiform movements of the face and upper limbs. These symptoms were associated with marked psychosocial dysfunction. He was managed with clozapine, with which over the period of 3 months there was marked improvement in the psychopathology along with improvement in the dystonia and dyskinesia. Conclusions: Long acting paliperidone can lead to tardive dystonia and tardive dyskinesia. The patients being considered for the same, must be explained about the possible risk before starting the same.
A brief cognitive assessment of patients with schizophrenia and its correlation with disease severity
DR SIDDHARAM S
Dr Arun Gadad,Dr Manoj Shettar, Dr Sachin B S, Dr Girish Babu,Dr Abhay Matkar
Background-Schizophrenia is a complex, heterogeneous behavioural and cognitive syndrome whose origins appear to lie in genetic and/or environmental disruption of brain development, Cognitive functions are required to perform in the spheres of personal, social, and occupational activities of everyday life. .Restoring cognitive function or bypassing cognitive impairment could significantly contribute to better outcome and recovery in schizophrenia.
Aim-. To assess the cognitive functions in patients with schizophrenia and To study the relationship between cognition and disease severity
Methods-Cross sectional study done on 50 patients with schizophrenia visiting SDM hospital Dharwad,disease severity measured using PANSS,and cognitive assesment using BACS
Result-. The Brief Assessment of Cognition in Schizophrenia (BACS) assessed the aspects of cognition found to be most impaired and most strongly correlated with outcome in patients with schizophrenia
Conclusion-Cognitive functions are responsible for better day to day functioning and are related to functioning impairment in everyday living skills; hence by improving cognition, patient’s functioning in everyday living skills may improve, giving them a better chance of vocational and independent living success.
Background: Covid-19 (Corona Virus Disease 2019) virus has deadly effects on whole globe and creates a difficult situation for every human being. Through passage of time several Covid-19 vaccines available, many of them go through different stages of development, under trials, some rejected and accepted. There are several factors which affects the vaccination acceptance which included poor knowledge, fear and myths about vaccination.
Aim: The current study aims to evaluate the knowledge, attitude and practice toward Covid-19 vaccination.
Method: This is a cross- sectional survey- based study that was conducted between june to december 2021 by using semi-structured questionnaire.
Results: There were total 589 participants in which 62% females, 86% participants less than 40 years of age, 55% participants from rural background and nearly 57% participants were not vaccinated. From total sample 65% participant rely on information comes from health care provider than other sources i.e. social media, from their own family member, friends etc. It was observed that male having more knowledge about vaccination than females. Participant hails from urban background having more knowledge about covid-19 vaccination.
Conclusion: It was observed that many factors associated with covid-19 vaccination. Present study findings give a glimpse that which factors needs to address for making better knowledge, positive attitude toward vaccination and increase the practice in general population.
Key words: Knowledge, Practice, Attitude, COVID-19 Vaccination
“Do you hear what I hear? A case series on clinical profile of organic hallucinosis.”
Sudharshan Raghunathan, Abhiram Narasimhan Purohith, Samir Kumar Praharaj
Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India – 576104.
Background: Organic mental disorders are characterized by neurological dysfunction due to specific cerebral disease or systemic disease affecting the brain secondarily. It may include altered sensorium, impairments in cognition, mood disturbances, psychotic symptoms such as hallucinations, delusions and behavioural or personality changes. Among these, organic hallucinosis is a less described clinical entity.
Aim: We aim to report the clinical profile and treatment outcome of patients with organic hallucinosis.
Methodology: This was a retrospective file review study of eight patients diagnosed with organic hallucinosis between January 2016 and January 2022. We extracted sociodemographic details, clinical features, and details of medical co-morbidities, biochemical investigations, neuroimaging findings, and treatment responses.
Results: Eight patients (six male and two female) with a mean age of 34.1 years (SD 14.8) were diagnosed with organic hallucinosis with a median duration of 18 weeks (IQR 57). Multiple voices and derogatory content was the commonest presentation (n=5). Epilepsy was the commonest organic aetiology (n=5). Four of the eight patients treated with a median defined daily dose equivalent of 20 mg of Olanzapine (IQR 8.1) had a good recovery.
Conclusion: Organic hallucinosis is a relatively uncommon diagnosis, and little is known about the clinical correlates, pathophysiology, and management aspects. Further studies are warranted to address these crucial issues.
TITLE – RELATIONSHIP BETWEEN PERCEIVED COERCION AND SUICIDAL INTENT AMONG PERSONS ADMITTED FOLLOWING ATTEMPTED SELF HARM IN A TERTIARY CARE HOSPITAL IN INDIA – A CROSS SECTIONAL STUDY
Dr Raveesh BN, Prof. and Head, Department of psychiatry, MMCRI, Mysuru
Dr Suhas Bhargav AV, Junior resident, Department of psychiatry, MMCRI, Mysuru
BACKGROUND
Suicide is a fatal self-injurious act with some evidence of intent to die. According to WHO suicidal deaths are nearly 700,000 annually with at least one every 40seconds and 20 others who attempt the same. In order to treat them, some coercive methods must be used, which force the patient to act against their will. Their perception towards same is perceived coercion.
AIM
To study perceived coercion among persons admitted following attempted self-harm and its correlation with socio-demographics and suicidal intent.
METHODOLOGY
In order to conduct the cross-sectional study, we randomly selected 150 persons admitted following attempted self-harm who were referred to Dept. of Psychiatry, MMCRI. The subjects giving valid informed consent and with no cognitive impairment were included and those with accidental attempts were excluded from the study.
Socio-demographic proforma, MacArthur’s Admission experience questionnaire and Beck’s suicidal Intent Scale were applied.
RESULTS
Out of 150 samples, majority being male (59.3%), 20-39yrs (56%), from rural background (46%) with substance use (56%). Major mode of attempt being pesticide consumption (45.3%). Perceived coercion was found in (88.7%) and high suicidal intent in (60.7%). Strong positive correlation was found between perceived coercion and suicidal intent and level of the same predictable by nature of admission experience and suicidal intent.
CONCLUSION
Our study is unique in finding the correlation between perceived coercion and suicidal intent giving due importance to socio-demographics. Previous suicidal attempt and experience on admission being a major risk factor for recurrence, our findings give a much-needed insight in devising a comprehensive plan for suicide prevention.
PSYCHOSOCIAL FACTORS INVOLVED IN FIRST ATTEMPT SUICIDE OF YOUNG ADULTS
DR SURYA PRATAP SINGH CHAUHAN1, DR SUVARAN SAGAR BAJPAI2, DR RAM GHULAM RAZDAN3
(1,2=PG Resident, 3=Professor & Head)
Background :
Suicide is the conscious act of self induced annihilation. It is conceptualized as a continuum ranging from suicidal ideation and communication to suicide attempts and completed suicide. It is a complex phenomenon associated with psychological, biological and social factors.
Aim :
Study socio demographic & psychosocial risk factors in young adults who attempted suicide for the first time in their life.
Methods:
It is a cross sectional study. The sampling method used was stratified random sampling. 50 patients belonging to age group 17 to 30 yrs with history of first attempt of suicide. SDQ, Beck’s Suicide Intent Scale and ICD 11 for personality disorder.
Results:
60% of the attempters fall in the age group of 17-25 years and 40% were between 26 & 30 years. All belong to rural area. The most common method used by attempters in this study was by consuming poison 90%. Attempters with low to medium intent to die were about 80%. Borderline Personality Disorder has been reported as the most common personality disorder(76%).
Conclusion:
Most common reason attributed for the suicide attempt was interpersonal problems within the family. Borderline Personality Disorder has been reported as the most common personality disorder. The suicide intent score was comparatively more in persons with personality disorder than in persons with out personality disorder which was not statistically significant.
PSYCHIATRIC MORBIDITY AND COPING STRATEGIES AMONG WIFES OF ALCOHOL DEPENDENCE DISORDER MEN
DR SUVARAN SAGAR BAJPAI1, DR SURYA PRATAP SINGH CHAUHAN2, DR RAM GHULAM RAZDAN3
(1,2=PG Resident, 3=Professor & Head)
Background :
Alcoholism is considered to be an ongoing stressor not only for the individual, but for the family members as well. Spouses are particularly affected given the intimate nature of their relationship and the constant exposure to the behaviour of the alcoholics.
Aim :
Study the pattern of psychiatric morbidities in wives of men with alcohol dependence disorder.
Material & Methods :
Case-control study of 50 male patients came to psychiatry OPD at IMCHRC. They were compared with spouses of men who were not alcohol dependent. Alcohol Dependence Disorder diagnosis was made on basis of DSM-V. Data collected through Socio-demographic Questionnaire, SADQ for ADD male patient, GHQ, MINI & CSI for wife.
Result :
64%(32) of spouses had a psychiatric disorder. Primarily mood and anxiety disorder were present. 31.2% (10) had Major Depressive Disorder, 9.3% (3) had Dysthymia, 15.6% (5) had Generalized Anxiety Disorder and 25% (8) had Suicidality. Problem Focused Engagement and Emotion Focused Engagement were the main coping mechanisms adopted. Increasing severity of alcohol dependence in alcohol dependence were not significantly associated with any psychiatric disorder.
Conclusion :
Wives of alcohol dependent men suffer more commonly from Major Depressive Disorder, Dysthymia, Suicidality and Generalised Anxiety disorders. Psychological distress and psychiatric morbidity in spouses of alcohol dependent men is high. Spouses of alcohol dependent men deal with the stressful situation actively by problem focused engagement or emotion focused engagement.
Association of Non-Suicidal Self-Injury and Suicide Attempts in Psychiatric Inpatients with current suicide attempt
Swati C*1, Hemendra Singh2, Ashwin Kulkarni3
1Senior Resident, Department of Psychiatry, St. John’s National Academy of Health Sciences, Bengaluru, India. Email: swati.crs@gmail.com, Mobile no: 9880435635
2Associate Professor, Department of Psychiatry, MS Ramaiah medical college, Bengaluru, India.
3Associate Professor, Department of Medicine, MS Ramaiah medical college, Bengaluru, India
*Presenting author
Background and objective: Non-Suicidal Self-Injury (NSSI) is an important risk factor for suicide attempts. However, limited published data exist regarding the association of NSSI with suicide attempts among high-risk psychiatric inpatients in the Indian context, an area that needs to be comprehensively investigated. This study intended to determine the association of NSSI with suicide attempts in psychiatric inpatients with high suicidal risk.
Methods: Psychiatric inpatients (N=100) with current suicide attempt, aged 18-60 years were included. Lifetime history of suicidal attempts and NSSI, along with the frequency of NSSI in psychiatric patients were noted. Depression severity, hopelessness, suicidal ideations, suicide intent, and past attempts (both suicidal and NSSI) of the patients were recorded using valid tools.
Results: NSSI was found in 36% of study participants, with frequency ranging from 1 to 10 times in most. More than three-fourths (85%) of participants had attempted suicide ≥ three times. Depression score significantly differed between patients with and without the history of NSSI and was found to be a significant variable (P = 0.03) influencing suicide attempts in high-risk psychiatric patients. Number of suicides attempts significantly correlated with the frequency of NSSI (r = 0.41, P = 0.001), suicidal intent (r = 0.25, P = 0.01), hopelessness (r = 0.27, P = 0.005), and suicidal ideation (r = 0.34, P = 0.0004).
Conclusion: Frequency of NSSI appears to increase suicide risk in psychiatric patients. Furthermore, depression was found to be predictive of suicide attempt among high risk psychiatric patients.
ANXIETY, AND DEPRESSION AMONG PATIENTS WITH CHRONIC KIDNEY DISEASE ON HEMODIALYSIS IN A TERTIARY CARE HOSPITAL IN SOUTH KERALA
Dr Syam Krishna 1 Dr Roy Abraham Kallivayalil2
Background:
Chronic kidney disease is a complex debilitating medical condition affecting people worldwide. It has become one of the major health problems and it is the final pathway for many systemic diseases like diabetes mellitus, hypertension and autoimmune diseases affecting the renal system. The prevalence of CKD in India is about 17 -18 %. The most common psychiatric abnormality in CKD patients undergoing dialysis is Depression. The precise prevalence of anxiety disorder in CKD and Hemodialysis patients is unclear but estimates have ranged from approximately 12% to 52% in various studies.
Aims:
To estimate the frequency of anxiety and depression in chronic kidney disease patients on hemodialysis attending the department of nephrology in a tertiary care hospital in South Kerala.
METHOD OF DATA COLLECTION
Patients with Chronic kidney disease on dialysis presenting to the department of nephrology, Pushpagiri institute of medical sciences and research center, Thiruvalla will be recruited as the study sample.
All the patients will be assessed using Mini international neuropsychiatric interview (version 7.0.2), Hamilton depression rating scale and Hamilton anxiety rating scale and a self-administered questionnaire and data will be collected and analyzed using appropriate statistical measures.
Results:
Among the dialysis patients recruited as sample, 27 percentage of patients was found to have depression and 41 percentage had anxiety.
Conclusion:
Depression and anxiety are more prevalent among patients on dialysis.
Prevalence Of Internet Addiction And Its Impact On Professional Life Of Medical Students
Dr Tanul Jain1, Dr Ram Ghulam Razdan2,
Dr Surya Pratap Singh Chauhan3, Dr Suvaran Sagar Bajpai4
(2=Professor & Head; 1,3 & 4=PG Resident)
Introduction: One of the most modern forms of addiction that belongs to behavioural addictions is the internet addiction. Internet addiction is defined as “the inability to control the use of Internet that leads to feelings of pressure, anxiety and dysfunctional behaviours in everyday activities”. The phenomenon of reckless use of the Internet by young people has taken enormous dimensions and has created problems for the mental and social functioning leading them to addiction.
Aim & Objectives- To study the prevalence of internet addiction.
To study the impact of internet addiction on professional life and performance at work of medical students in Index Medical College and Research Centre, Indore.
Material & methods-
• Study Design: Cross-Sectional study.
• Study Centre: Index Medical College and Research Centre, Indore.
• Duration of Study: 5 months (June 2022 to October 2022).
• Study Participants: Subject will be taken from interns of Batch 2017 of Index Medical College and Research Centre, Indore.
• Sample Size: Study sample will consist of 200 cases.
• Statistical Methods: SPSS v24 will be used.
Result The study was conducted using an Internet Addiction test developed by Young and in total, we received 200 answers of an analytical questionnaire, of which 102 (52%) were from male students and 98 (48%) from female students.
• The 49% of the respondents said they were very often or always connected to Internet, having a non-academic screen time of more than 8 hours while 31% of them said they were occasionally connected to Internet with a non-academic screen time of less than 1.5 hours. The 62% believe that their performance at work is not affected due to the use of Internet, while the 33% said they are strongly influenced
Conclusion Internet offers incredible possibilities; it feeds us with information, news, entertainment, etc. It is a useful interactive tool, which facilitates our everyday life when used reasonably. Further our study reported that, excessive social media and internet use decreases social face to face interaction. This has a negative impact on social well-being and can lead to depression, anxiety, and mood swings.
Psychiatric co morbidities in HIV patients
By Dr. Tejesh V H 1, Dr Anupama M 2
1. Post graduate in Psychiatry, JJMMC, Davangere, tejeshvhemanna@gmail.com,
2. Professor of Psychiatry, JJMMC, Davangere, dranupama2@gmail.com
NEED FOR STUDY
• Patients diagnosed with HIV infection are treated with antiretroviral medications which can slow the progression of the disease and may lead to near normal life expectancy.
• However psychiatric co morbidity is associated with poor treatment adherence and reduced quality of life.
• Early identification and treatment of psychiatric co morbidities will improve medication compliance and illness outcome in these patients.
AIM
• To estimate the prevalence of psychiatric co morbidities in HIV/AIDS patients undergoing treatment
MATERIALS AND METHODS
SOURCE OF DATA:
• Patients within the age group of 18-60 years diagnosed with HIV and receiving anti retroviral treatment from J.J.M. Medical College for at least 1 year.
STUDY DESIGN:
• This is a hospital based cross –sectional study.
RESULTS
• Out of 119 patients 68 (57.14%) had psychiatric co morbidities.
• Out of 68, 32 patients had major depressive episode (47%) ,2 patients had dysthymia(2.9%), 4 patients had panic disorder(5.8%), 3 patients had agoraphobia(4.4%), 3 patients had social phobia(4.4%), 6 patients had generalized anxiety disorder(8.8%), 15 patients had alcohol dependence (22%) and 3 patients had psychotic disorders(4.4%).
CONCLUSION
• There is a high prevalence of psychiatric co morbidities in HIV patients.
• Early diagnosis and treatment of psychiatric co morbidities can improve compliance with medications and the quality of life in this group of patients.
Cross – sectional study of psychiatric morbidity and self-esteem and perceived social support in post – burn patients.
Dr Triveni M Gowdar (1st year Postgraduate), Dr Archana (Assistant Professor),
Dr Aarshie (Senior Resident)
Department of Psychiatry, Bangalore Medical College and Research Institute, Bangalore.
Background: Burns may lead to long lasting impact on the quality of people’s lives, with persisting problems related to pain, sleep, scarring, itching, weakness. Low self-esteem decreases social interaction. Social support perceived by the patient is important in recovery, to maintain good bio-socio-occupational functioning. Psychiatric morbidity is said to be considerable and higher than that of general population.
Aim: To assess the frequency of the psychiatric morbidity in post-burn patients. To determine the association between psychiatric morbidity, self-esteem and perceived social support.
Methods: Data from 30 patients who visit burns clinic OPD are included in the study. General Health Questionnaire, Rosenberg’s Self-esteem scale and Multidimensional Scale of Perceived Social Support (MSPSS)were applied. The frequency of psychiatric morbidity and its association with self-esteem and perceived social support is looked for.
Results: A Initial analysis of 10 revealed, 7 out of 10 were male. 1 female perceived decreased social support. None had decreased self-esteem. 2 had sleep disturbance. They had an average MSPSS score of 72. Detailed final results of the study will be presented in the conference.
Conclusion will be mentioned in conference.
A CROSS SECTIONAL EVALUATION OF PSYCHOLOGICAL WELL-BEING AND QUALITY OF LIFE IN PATIENTS WITH STABLE SPINAL CORD INJURY
Dr Vidur Makkar, Dr Aditya Pandurangi, Dr Ume Hani, Dr Mahesh M, Dr Swapna Pandurangi.
Background- A sudden event/ accident is associated with drastic changes in life, such as paralysis, loss of functions (e.g., walking), change in bowel bladder habits leading to dependency on others (parents/ caregivers), changes in routine and cutoff from the social life, impact on occupation etc., it is often difficult for the affected individual to accept the new reality.
Aim-This study aimed to evaluate the psychological health and quality of life in patients with stable spinal injury.
Methodology- This study was an observational cross-sectional study on patients with spinal cord injury using WhatsApp support group of the two centers i.e., Indian spinal injury center New Delhi and CMC Vellore. General Health questionnaire 12 and WHOQOL were used to assess psychological distress and quality of life respectively.
Results-A total of 65 individuals participated in the study. Majority were below 30years of age (53.8%), and about 90.8% cases were males.
The study found presence of psychological distress in 17(26.2%) while severe distress was observed in 7 (10.8%) cases.
Younger participants (<30) reported of poor quality of life on psychological domain as compared to older participants (>30) which was statistically significant (P-0.02). Employment status had a significant association with the physical domain (P-0.037) and overall scores (P-0.046) of QOL. Employed participants experienced better QOL on physical domain.
There was a significant association between psychological domain (P-0.004) and social domain (P-0.009) with the socio-economic status of the participants. Participants from upper socio-economic status had lesser mean scores compared to upper middle group on the psychological and social domain of QOL.
There was a significant association between psychological domain of quality of life with the experience of distress among the participant (p<0.05).
Majority of the participants scored <60 on QOL, indicating poor QOL.
Conclusions- Younger people with spinal cord injury experience significant psychological distress which can have an impact on the QOL. Physical health is significantly affected overall, but the impact on psychological aspect is given less significance. Rehabilitation measures aimed at reducing the distress and better employment can help reduce distress and improve QOL.
Keywords- Spinal cord injury, traumatic, psychological health, quality of life
Assessment of psychosocial risk factors in attempted suicide
Background:
Suicide is a major public health issue .Suicide attempts occur 30-100 times more frequently than completed suicide. Psychosocial factors seem to play major role.
Aims:
1. To assess the psychosocial risk factors in suicide attempters
2. To identify psychiatric morbidity in suicide attempters
3. To measure stress levels in suicide attempters
Methods:
Source of data: The study includes patients admitted to BIMS hospital for attempted suicide
Study design: Descriptive, cross sectional study
Study period: One year
Sample Size: 128
Statistical analysis: Association of Psychiatric illness and Social factors with different attributes will
be seen by using Chi-Square test. P<0.05 will be considered as statistically significant.
Method of collection of data
Informed consent
Socio demographic data proforma
M.I.N.I scale
Holmes and Rahe scale
Results:
Most affected were:
Age group: 31-40 years
Males
Farmers
Married
Lower middle socioeconomic status
Hindus
Rural residence
Most common method of attempt: Poisoning
Most common precipitating factor: Family conflicts
Most common Psychiatry morbidity: MDD
Significant association of psychiatric morbidity was found with past history of attempt, method
of attempt, precipitating factors, stress levels.
Significant association of stress levels was found with past history and precipitating factors
Significant association of precipitating factors was found with age, sex, occupation,
socio economic status, marital status, method of attempt.
Conclusion:
Most of the suicide attempters had psychiatric illness.
Most of the suicide attempters had family conflicts as precipitating factor.
Most of the suicide attempters had stress levels less than 100.
The knowledge, attitude and behaviour among ‘ASHAs’ towards people with mental illness – a community based cross-sectional study
Vikram Arunachalam1, Anish.V.Cherian 2, Kumar M V 3, Balasundar A S 4, Rajani P 5
1 Consultant psychiatrist, District mental health programme, Bruhat Bengaluru Mahanagara Palike, Bengaluru,India
2 Professor, Department of Psychiatric Social Work, NIMHANS, Bengaluru,India
3 Programme Officer, District mental health programme, Bruhat Bengaluru Mahanagara Palike, Bengaluru,India
4 Chief Health officer (Public Health), Bruhat Bengaluru Mahanagara Palike, Bengaluru,India
5 Deputy Director (Mental Health), Government of karnataka, India
Background: Mental illnesses are increasingly being recognised as major contributors of global health burden, especially in the low-middle income counties (LMICs)(1). More than 14% of the global burden of disease is due to neuropsychiatric disorders, mostly due to the chronically disabling nature of depressive disorders and other common mental disorders, alcohol-use and substance-use disorders, and psychoses and almost 75% of this burden lies in low- and middle-income countries (LMICs)(1, 2). These disorders impose huge burden not only on affected individuals but also their families and community(3).
The unmet needs of mental health care in LMICs are huge, with up to up to 90% of persons with mental illness receives no adequate treatment(1, 4). Although, the treatment guidelines emphasize the need to combine pharmacotherapywith psycho-social interventions(5, 6), the latter remain in accessible in LMICs due to paucityof human resources and non-availability of contextually appropriate interventions (1, 7, 8).Development and evaluation of such interventions top the Grand Challenges in Global Mental Health (9).
In India, the National Mental Health Program facilitated the process of integration of mental health into PHC; however, there has been limited success with only 24 of 600 districts currently covered by this program(10).Emerging research from LMICs indicates that community-based rehabilitation, delivered throughappropriately trained and supervised community health workers (CHWs) at primary health care (PHC) settings, is feasible andeffective in improving clinical and social outcome of major mental disorders (11-15). In addition, the presence of Accreted Social Health Activist (ASHAs) has in PHC setting has improved maternal and child health in rural villages in India. However, there is paucity of data on effectiveness of ASHAs delivered psycho-social intervention for people with mental illnesses(16).
The goal of this proposal is to understand theknowledge, attitude and behaviour of ASHAs towards people with mental disorders in the community. This would also facilitate the development of intervention to improve knowledge and attitude of ASHAs towards mental illness. This would facilitate them to identify and refer the people with mental illness in the community and eventually reduce the treatment gap for mental disorder.
Aims: The aims are to:
• Understand knowledge, attitudes and behaviour of community health workers (ASHAs – Accredited Social Health Activists) towards people with mental illness in primary care settings
Methods
Participating sites: The study will be conducted in DMHP covered PHCs under the BBMP area. We are intended to assess about 100 ASHAs in this area.
Design:
• Cross-sectional design complementing both qualitative and quantitative methods of data collection.
• Assessment of participants - knowledge, attitude and behaviour will be assessed using standardised assessment tools.
• Number of referrals to mental health services by community mental health workers and Uptake of mental health services (including total number of service users seen, total number of referrals) will be documented.
Subjects: All the ASHAs affiliated to the participating PHCs will be invited to participate in the study and informed consent sought.
The outcome measures
• Knowledge about mental health – will be assed using Mental Health Knowledge Schedule (MAKS), validly used in studied from India Attitude and behaviour will be assessed using Reported and Intended Behaviour (RIBS) and Mental illness: clinicians attitude scale (MICA).
• Number of referral rates to mental health services by community mental health workers and uptake of mental health services (including total number of service users seen, total number of new referrals)
Analysis plan: The data will be tabulated and analyzed using the Statistical Package for Social Sciences (SPSS) version 15 (SPSS Inc., Chicago, IL, USA). Chi-square test, Student’s t test, Mann– Whitney U test, and Kruskal–Wallis Analysis of variance (ANOVA) will be applied where appropriate. The predictor of delay in seeking psychiatric help will be analysed using logistic regression model. A two sided p-value of <0.05 will be considered statistically significant.
Ethical Considerations:The ethical clearance of protocol will be obtained from the Institutional Review Board (IRB) of NIMHANS, Bengaluru. All researchers will mandatorily undergo rigorous training to particularly ensure maintenance of confidentiality. Witnessed written informed consent will be taken from all participating subjects at the outset (17). Participants will be informed (A) about their right to withdraw consent at any stage and to refuse to answer any question, and that if they refuse to participate and/or withdraw consent they would continue to be in the clinical responsibilities currently they are holding,(B) that data collected will be anonymised and could be used by other researchers beyond the term and scope of the current study. All identifying information will be stored separately from the interview data.
Expected outcomes
This study would provide evidences current knowledge, attitude and behaviour of ASHAs towards people with mental illness and referral rate to mental health services.This would also facilitate the development of intervention to improve knowledge and attitude of ASHAs towards mental illness.
Assessment of Psychological distress in patients having Globus Pharyngeus
Dr Vinod Verma*[1] & Dr Dileep Kumar Verma[2]
Background: Globus pharyngeus is the painless sensation of a lump in the throat and frequently associated with persistent throat clearing, chronic cough, hoarseness, and catarrh. It mostly occurs in the background of stressful life events and in the presence of significant psychological factors.
Aims: The objective of this study is to assess the psychological distress and to find out clinical and psychological correlation in patients of globus pharyngeus.
Methods: It was hospital-based cross- sectional study conducted on 60 patients with primary diagnosis of globus pharyngeus. The Glasgow Edinburgh Throat Scale (GETS) was used to assess globus symptoms and Depression, Anxiety and Stress Scale - 21 Items (DASS-21) was used to assess anxiety, depression and stress symptoms. Spearmen’s rank correlation test was used to examine the relationship between globus symptom severity (GESTS) and DASS-21 score.
Results: In this study about 88.33%, 86.67% and 90% of patients showed depressive, anxiety and stress symptoms respectively. There was a significant positive co-relation between GESTS and DASS (D) (r= 0.340, p=0.008) as well as between GEST and DASS (A) (r=0.327, p=0.011).
Conclusion: This study emphasizes that psychological distress play a significant role in symptom production of Globus. They should be regularly screened for psychiatric illness and consider for an integrated approach of treatment.
Keywords: Globus pharyngeus, Glasgow Edinburgh Throat Scale (GETS), Depression, Anxiety and Stress Scale - 21 Items (DASS-21)
*Presenting Author
1. Assistant Professor, Department of Psychiatry, Uma Nath Singh Autonomous State Medical Collage, Jaunpur, U.P
2. Assistant Professor, Department of Psychiatry Maharshi Vashishtha Autonomous State Medical Collage, Basti, U.P
Correspondence Address: Department of Psychiatry, Uma Nath Singh Autonomous State Medical Collage Jaunpur, U.P
Email: vinodmbbs10@gmail.com
Contact no: 8707602093
A case-control study of myths regarding sexual practices along with sexual dysfunctions in patients of Major depressive disorder vs general population
Dr. Vishwa Thakkar , Dr. Pranjalee Bhagat, Dr. Pradip Dubale , Department of Psychiatry, Government Medical College, Nagpur.
Background: Sexual dysfunctions are common in depressed population but are often underreported and the misconceptions about sexual practices are highly prevalent. Hence, we decided to study the sexual dysfunctions and myths regarding sexual practices in these patients and compare it with general population.
Aim: To study regarding sexual dysfunctions and myths regarding sexual practices in depressed patients and compare them with general population.
Methods: A total of 61 depressed patients diagnosed as per DSM 5 criteria and 61 individuals from the general population were recruited after their informed consent. Beck Depression Inventory, the Arizona Sexual Experiences Scale and a Questionnaire to assess myths regarding sexual practices were used for assessment.
Results: Sexual dysfunctions were found in 68.85% of the patient group. Sexual drive and orgasm satisfaction was significantly decreased in the patient group as compared to control group. Myths regarding sexual practices were higher in the depressed patients as compared with control group.
Conclusions: Mental health-care professionals must inquire regarding sexual functioning sensitively and ensure that they psycho-educate those with misconceptions
Keywords: Sexual dysfunctions, sexual drive, orgasm satisfaction, sexual myths and major depressive disorder.
A cross sectional observational study to assess prevalence of depression and suicidality in 50 patients of obsessive compulsive disorder
ZairaIqbal,KushagraVarma
Background: Obsessive-compulsive disorder (OCD) is a Chronic debilitating disorder affecting almost 1% of adults & is 4th most common psychiatric disorder. Patients with OCD suffer from one or more co-morbid disorder with major depression being most common. The increased severity of comorbid depressive and anxiety symptoms,increased severity of obsessions,feelings of hopelessness and past history of suicide attempt have been associated with worsening levels of suicidality in OCD.
AIM: To find prevalence of depression and suicidality in patients of obsessive compulsive disorder.
Methods: Fifty patients were included in the study who visited psychiatry OPD & were diagnosed as a case of obsessive compulsive disorder were evaluated by a psychiatrist as per International Classification of disease diagnostic criteria. Those with diagnosis of OCD were further assessed using Yale-brown obsessive-compulsive scale (Y-BOCS) , Hamilton depression rating scale (HAM-D) & Columbia suicide severity rating scale (C-SSRS to find the prevalence and assess severity.
Results: Among the 50 patients, 32 (64%) were female, 28(56%) were hindu by religion, 18(36%) were from the age group of 25-30 yrs , 12 (24%) had severe-very severe depression and 8 (16%) of them had suicidal ideation among which 4 ( 8%) had a previous suicide attempt.
Conclusion: OCD is associated with high risk of not only depression but also of suicidal behaviour. It is vital that patients of OCD undergo detailed assessment for suicide risk and associated depression. Thus treatment management should also target co existing depressive symptoms so as to decrease morbidity and mortality.
Profile of Child and Adolescent Consultation Liaison Psychiatry Services at a Covid-19 Designated Tertiary Medical College and Hospital
Dr.Aakash Ponda, Dr. Darpan Kaur, Dr. Adarsh Singh, Dr.Rakesh Ghildiyal
Department of Psychiatry, Mahatma Gandhi Missions Medical College and Hospital, Navi Mumbai
Introduction: There is sparse literature on child and adolescent consultation liaison psychiatry during the COVID pandemic in India.
Aims and objectives: To study the patterns of Child and Adolescent Consultation Liaison Psychiatry Services at a Covid-19 Designated Tertiary Medical College and Hospital
Materials and methods: This was a retrospective chart-based study. Institutional Ethics Committee clearance was obtained. It was conducted from April 2020-21. The inclusion criteria comprised records of children and adolescents who were referred for consultation liaison services while they were admitted in COVID-19 designated tertiary hospital. Incomplete records were excluded. Data was tabulated and analysed with descriptive analysis.
Results: We found 50 referrals out of which 42 records were complete and 8 incomplete were excluded. There were 47.62% boys and 52.38% girls with the mean age (10.8 years) All the 42 patients had been tested for COVID-19 at the time of intake admission as per hospital protocol. We found that 11.9% were confirmed cases of COVID-19 disease and 88.1% had tested negative for COVID-19 disease .The referrals were received mostly from Paediatric Intensive Care Unit (57.14%) followed by Paediatric ward (26.19%) and Special Paediatrics COVID High Dependency Unit (16.67%). The most common psychiatric disorder in COVID negative patients was adjustment disorder with deliberate self-harm (35.14%) and in COVID positive patients was delirium (60%) .The most commonly used medication were Escitalopram, Risperidone and Clonazepam.
Conclusion: We conclude that psychiatric disorders were prevalent in child and adolescent patients admitted during COVID 19 pandemic and had a distinct profile.
Psychosocial factors and psychiatric morbidity in females reporting complaints in cases of marital disharmony
DR ADITYA SHRIVASTAVA1, DR SURYA PRATAP SINGH CHAUHAN2,
DR RAM GHULAM RAZDAN3
(1,2=PG Resident, 3=Professor & Head)
Background:
The foundation of a happy family lies in cordial husband wife relationships. However marital discord leads to familial disorganization. Legal authorities in India offer protection and counselling to females who have complaints regarding marital disharmony and domestic violence. Various psychosocial factors are usually involved in marital disharmony cases.
Aim :
To study psychosocial factors and psychiatric morbidity in females reporting complaints in cases of marital disharmony.
Methods:
100 married females reporting complaints about marital disharmony and domestic violence were interviewed in Crime against women cell of Police department in a city in India.
Results:
57% couples had duration of marriage less than 5 years. The predominant complaints of the females were physical abuse, emotional abuse, interference in marital life by in-laws and communication problems with husband. 68% stayed in joint families and had signicant complaints of interference by other family members. 2 % females were found to have clinically mild mental retardation, 2% had anxiety disorder, 27% had depressive disorder, and 3% had psychosis.
Conclusion:
Marital disharmony has multi-dimensional causative factors. Psychological factors need to be taken in consideration while dealing with cases of marital disharmony.
Cognitive Performance in treatment naive adults having Obsessive Compulsive Disorder
Dr. Aditya Singhal Resident, Dr. Sudarshan C.Y., Professor & H.O.D, Department of Psychiatry, J.J.M Medical College, Davangere
Introduction- In Obsessive Compulsive Disorder(OCD) there are deficits in cognitive functioning like Motor & Processing Speed, Spatial Working Memory and Visuoconstructive Memory. These may have neurobiological & therapeutic implications. Published Indian research is lacking in this area.
Aim-
To assess the cognitive performance (Motor and Processing speed, Spatial Working Memory & Visuoconstructive Memory) in patients having OCD.
Methodology-
Thirty treatment naive patients fulfilling DSM-5 criteria for OCD, aged between 18-45 years formed the sample. After obtaining informed consent & recording sociodemographic data, severity of OCD was assessed using Yale Brown Obsessive Compulsive Scale. Motor & Processing Speed was assessed using Colour Word Interference Test. Spatial Working Memory was tested by Trail Making Test and Visuoconstructive Memory by Rey-Osterrieth Complex Figure Test (ROCF). Data was analysed using IBM SPSS version 22 for Windows.
Results-
Of the 30 patients 56.7% were aged between 30-45 years, 53.3% were females, 60% were educated up to 12th standard and 86.7% had moderate OCD. Younger people had significantly poor Spatial Working Memory. Less educated patients showed significantly lower Motor and Processing Speed. Females were observed to have significantly higher Motor & Processing speed and good Visuoconstructive Memory. Patients having moderate to severe OCD had significantly slower Motor & Processing Speed and poorer Spatial Working Memory.
Conclusion-
OCD is associated with deficits in cognitive performance wherein age, gender, education and severity of OCD play a significant role.
DEPRESSION IN PERSONS WITH LOCO-MOTOR DISABILITY
ADYA SHANKER SRIVASTAVA*, KRISHNENDU MONDAL*, AMIT RASTOGI**
*Department of Psychiatry , **Department of Orthopedics , IMS , BHU, Varanasi
Background – Over recent years some attention has been paid to support needs of mental health in persons with physical impairment and loco-motor disability.
Aim – To evaluate the psychiatric morbidity in persons with loco-motor disability and find out its correlation with severity of disability .
Method – 100 persons of 21 to 50 years of age with loco-motor disability were screened for presence of psychiatric morbidity as per ICD-10 criteria . Severity of psychiatric morbidity was assessed using HAM-D , HAM-A and BPRS scales . Severity of disability was measured as per Disability guidelines , Government of India .
Result – 76% persons with psychomotor disability were found to have psychiatric morbidity and most common was Depressive Disorder (41%).
Conclusion – High prevalence of Depressive disorder in persons with loco-motor disability needs proper evaluation and mental health care for this special group of people .
Key words – Depression , disability , loco-motor
Prevalence of erectile dysfunction in male subjects with Alcohol use disorder
Background: chronic and persistent use of alcohol is known to induce sexual dysfunction(Premature Ejaculation, sexual pleasure, sexual desire, arousal, orgasmic function, and intercourse satisfaction). This study is specifically conducted to determine and correlate erectile dysfunction and Alcohol use disorder.
Aim: The aim is to estimate the prevalence of erectile dysfunction in male subjects with alcohol use disorder
Materials and Methods: Ninety two patients with alcohol use disorder attending from out-patient and in-patient psychiatry department of the Tertiary Care Center were assessed for erectile dysfunction using International Index of Erectile Function-5(IIEF-5) Questionnaire and alcohol dependence were assessed on severity of Alcohol Dependence Questionnaire(SADQ) for severity.
Result: Higher prevalence of erectile dysfunction found in patients of alcohol use disorder. The amount of alcohol consumed appeared to be the most significant predictor of developing erectile dysfunction.
Conclusion: Erectile Dysfunction is common in patients with alcohol use disorder. Heavy drinking proportionately increases the risk. Clinicians need to routinely assess sexual functioning in alcoholic patients.
Rapid Antidepressant Effect of Ketamine as compared with Electroconvulsive Therapy in patients with Severe Depression
Background
Severe depression has high morbidity and mortality. Treatment modalities like antidepressants take weeks to act, hence are useless in emergencies. Electroconvulsive therapy (ECT) although has a rapid antidepressant effect, comes with hindrances in the form of cognitive side effects, contraindications and stigma. It requires 3-5 sessions to show response. Ketamine, an N-Methyl-D-Aspartate (NMDA) receptor antagonist is stipulated to show rapid antidepressant response. However, its comparison with ECT has been inadequately studied, especially in the Indian population.
Aim
To study the rapid antidepressant effect of ketamine as compared with ECT in patients with severe depression
Method
Forty inpatients diagnosed with severe depression, were randomly allocated to either ECT or Ketamine group. Following due consent, each patient received modified ECT or Ketamine hydrochloride infusion every alternate day for upto 3 times under a qualified anaesthetist’s supervision. Depressive symptoms were measured using the 17-item Hamilton Depression Rating Scale (HAM-D17) at baseline and 24 hours after each intervention. Data was analysed using appropriate statistical methods.
Results
Patients receiving Ketamine showed a faster reduction in HAM-D17 score over the course of 3 infusions. This was found to be significant and steeper when compared with that of patients who received 3 sessions of ECT.
Conclusion
This study suggests that Ketamine produces rapid antidepressant effects. The response rate being significantly higher than that of ECT indicates that Ketamine is a superior alternative when administered in patients with severe depression.
Cognitive deficits in Schizophrenia and its correlation to treatment attitudes in patients attending tertiary care hospital
Dr. Aligandula Curie, Dr. Ganta Akhila, Dr. Vijay Raj Pratheek. P, Dr. K. Ashok Reddy
Department of Psychiatry, SVS Medical College, Mahabubnagar.
BACKGROUND
Schizophrenia is a severe and chronic illness which involves disturbances in thought and perception. Cognitive functions are important determinants of functional level of persons suffering from Schizophrenia. Poor attitude towards antipsychotic drugs is a factor for non-adherence to treatment which increases the risk of relapse, associated healthcare utilization and costs. Therefore the study and analysis of cognitive functions forms an important part of the data base to make effective decisions in Schizophrenia management.
AIM
The aim of the study is assess the cognitive function of patients with schizophrenia and to correlate with treatment attitudes.
METHODOLOGY
40 follow-up schizophrenia patients attending Psychiatry OPD at SVS Hospital, Mahabubnagar in the ages 18-60 years were included in the study. Schizophrenia cognitive rating scale is used to assess the cognitive functions such as attention, memory, motor skills, speech and problem solving skills. Hogan drug attitude inventory is used to understand how people view the use of psychiatric medication and the nature of their experiences of these drugs.
RESULTS
We found about 60% patients with schizophrenia have cognitive deficits mainly involving difficulty keeping track of money, difficulties with familiar tasks, difficulty to stay focused and understanding how other people feel about things. Results suggested people with negative treatment attitudes have cognitive deficits.
CONCLUSION
Schizophrenia patients have high risk of developing cognitive impairment especially in long standing cases. Therefore, it is necessary for the clinicians to keep in mind the cognitive impairment separately from the illness by regularly screening for any evidence of cognitive impairment.
KEYWORDS
Schizophrenia, Cognition, Cognitive impairment, Drug attitudes.
A Case of Basi frontal contusion leading to Organic Mania in the background of Hyponatremia and Alcohol abuse
Dr. Alok Gupta1, Dr. Jitendriya Biswal1
1Institute of Medical Sciences and SUM Hospital
Background
Traumatic Brain Injury (TBI) leads to multiple manifestations. While neurological deficits are well known, psychiatric sequelae are poorly understood. Diagnosis is delayed and missed in case of multiple obfuscations as seen here.
Description
The case here is of a 37-year-old man working as a lorry driver with a past history of alcohol intake. No other significant past history, substance history, medication history and family history was present. The patient suffered TBI with normal CT findings. He was admitted under neurology with persistent vomiting and behavioural changes. The patient was treated with a diagnosis of alcohol withdrawal and hyponatremia. When he became violent, talkative and had inappropriate behaviour a psychiatry consultation was sought. MRI scan revealed left basi frontal contusion. The case was managed adequately and over a period of two years, the diagnosis of organic mania was made.
Discussion
A history of alcohol intake, negative CT findings and routine tests with hyponatremia led to a delayed diagnosis and management.
Conclusion
Approximately half of the patients have psychiatric manifestations following TBI. Most of the time it is missed out and undertreated. Multiple confounding factors hinder determining the aetiology of behavioural disturbances. As these manifestations require a longer period of treatment and cause a significant burden a greater emphasis is needed.
Association of Ultrasound Abdomen findings with Liver function tests and AUDIT scores in cases of Alcohol Use Disorder
Introduction: There are three independent variables used in clinical practice to evaluate patients suffering from Alcohol Use Disorder (AUD), these are AUDIT (Alcohol Use Disorders Identification Test), LFT (Liver function tests) and the imaging findings on Ultrasound of abdomen. There is limited literature pertaining to the association of imaging findings with LFT and AUDIT scores in cases of Alcohol use disorder.
Objective: The study was conducted to determine the association of Ultrasound findings with Liver function tests and AUDIT Score in patients of Alcohol Use Disorders.
Methods: This study was conducted using data from 439 patients of Alcohol Use Disorder (DSM 5) treated in psychiatry department of tertiary care hospitals. The data hence obtained was subjected to statistical analysis with SPSS ver 22. The ordinal data sets were compared using Chi Square test and p-value of <0.05 was taken as statistically significant.
Results: The Ultrasonography (USG) findings in patients of alcohol use disorder show significant association with the corresponding range of AUDIT scores, Serum Bilirubin and AST (Aspartate transaminase) levels. The ultrasound findings also had significant association with total years of drinking and average drinking (in gm) per day in last 03 years. The USG findings did not show significant statistical association with ALT (Alanaine transaminase) and serum GGT level (gamma-glutamyl transferase).
Conclusion: In Patients with ALD, USG findings correlate with severity of dependence as indicated by years of drinking, average alcohol consumption per day for last 03 years and AUDIT score (last 01 year) and markers of liver injury (S. Bilirubin and AST). Combined use of clinical severity indicators (e.g. AUDIT), lab parameters and USG Abdomen can help in early diagnosis of ALD.
Key Words: Alcoholic Liver Disease, Alcohol Use Disorder (AUD), Alcohol Use Disorders Identification Test (AUDIT), Ultrasound Abdomen, deranged LFT
A survey to assess knowledge, attitude and reported practices regarding substance abuse in a selected rural community of Lucknow Uttar Pradesh.
Amita Singh
Background: There are 27 million active substance abusers across the world in 2020. One in four deaths can be attributed to alcohol, tobacco and illicit or prescription drug use. Substance abuse refers to harmful or hazardous use of psychoactive substances including alcohol and illicit drugs Globally 1.3 billion people consume tobacco products and annual death rate is 6 million. The increase in consumers of alcohol is up to 60% since 2011
Aim: To identify the prevalence of substance abuse and biological, environmental, behavioural and social factors associated with substance abuse.
Methodology: A survey to assess knowledge, attitude and reported practices regarding substance abuse in a selected rural community of Lucknow. It was measured through modified Likert scale and CAGE questionnaire. The data was analyzed with help of appropriate statistical and descriptive method.
Results: Survey revealed that
• 92% of the population had problem of substance abuse among families.
• 71% abusers were males and head of family who were active abusers.
• 74% of abusers were now habitual to the practise and it was difficult to leave as they had withdrawal symptoms
• 32% population had major withdrawal symptoms like lack of energy, mydriasis, palpitations and even delusion in a few
• Majority of 88% belong to low socioeconomic status and spend up to 1000rs on substance
• 63% were led towards abuse due to due to unemployment of meagre daily wage worker.
• Only 8% of families had no individual of abuse or have successfully quit abuse
Conclusion: The survey was effective as awareness regarding various harmful effects of substance abuse was given through health education to all the family members. ASHA and parents should actively participate in educating children not to drive towards substance abuse. The measures that has to be taken are
1. Sources of easily accessible substance should be cut down
2. Abuse is by choice and it should be cut down.
3. Preventing of relapse and decreasing the harmful effects
Difference in symptomatology and phenomenology among male and female gender with obsessive compulsive disorder in Bengali population.
Background: Obsessive compulsive disorder (OCD) is a chronic psychiatric illness with significant distress and disability. There is considerable heterogeneity in the presentation of OCD symptomatology and phenomenological pattern worldwide. Gender is the single most important factor explaining this phenotypical heterogeneity in OCD. Other than biological factor socio-cultural role of two genders in various communities often unfold the effect, where Bengali population is the prototype. Very few studies were conducted on Bengali population focussing on this effect.
Aim and objectives: To assess phenomenological pattern among male and female Bengali patients with obsessive compulsive disorder.
Methods: Consecutive 50 male and 50 female new patients of OCD (as per ICD-10, DCR) from Psychiatry OPD, fulfilling the study selection criteria (consented, 18-59 years, Bengali) were assessed on Socio-demographic data-sheet, Yale-Brown obsessive Compulsive Scale (Y-BOCS), Yale-Brown obsessive compulsive checklist (Y-BOCSCL).
Results: A typical subject (both male and female) was a single, aged between 20 to 40 years, from Hindu nuclear rural family, semiskilled worker with ‘mixed obsessional thoughts and acts’ subtype (F42.2 code by ICD-10). Mean Y-BOCS scores of total obsession and compulsion were higher in females without any statistically significant difference. In YBOCSCL, significant difference was observed in the items of contamination, hoarding /saving, somatic obsession, obsession of intrusive sounds, words, music or images in the obsession subdomain and in checking, repeating, hoarding/collecting, excessive list making and pathological slowness in the compulsion subdomain.
Conclusion: There is consistent differences in OCD symptomatology and phenomenology between male and female in the current study. The pathogenic and pathoplastic effect of Bengali socio-cultural milieu in explaining these differences, can be implicated in the development of more specific and effective therapeutic approaches.
Psychiatric comorbidities in patients with irritable bowel syndrome
Ankita Saroj*, Adarsh Tripathi**
Junior Resident*, Professor**
Department of Psychiatry, King George’s Medical University, Lucknow, U.P, India
Background: Clinical research has provided varying evidence regarding psychiatric comorbidities in patients with irritable bowel syndrome.
Aims: To study psychiatric comorbidities in patients with irritable bowel syndrome.
Method: A total of 100 patients were selected in the study from medical gastroenterology OPD, KGMU. Diagnosis of irritable bowel syndrome was made using Rome IV criteria and severity of symptoms were assessed by the irritable bowel syndrome symptom severity scale (IBS-SSS). Clinical evaluation was done for screening of psychiatric comorbidities and diagnosis was made as per DSM 5. DASS-21 and SSS-8 were used to assess depression, anxiety, stress and somatic symptoms.
Result: Majority of the cases were i.e., 38.0% in 18-29 years. Males were 62.0% and females were 38.0%. 61.0% of the cases were diagnosed with Moderate IBS while 32.0% with Severe IBS. Evaluation on DASS-21 revealed 53.0% were in moderate category in depression, 43.0% were having moderate anxiety & 33.0% had severe anxiety. 36.0% were having moderate stress. 48% cases were in high category in somatic symptom scale. Psychiatric comorbidities were present in 29.0% of cases.
Conclusion: Patients with IBS also have associated psychiatric disorders; anxiety disorders and depression are the most common. When developing screening and treatment strategies, the interaction between psychiatric disorders and IBS should not be overlooked.
Case report-Mephentermine use in young adults
Dr. Anshumi Bhattacharya
Dr. Jyoti Shetty
Dr Manjiri Datar
Email -- anshumibhattacharya@gmail.com
Mobile -- +91 9503299864
Address for correspondence - Dr. Anshumi Bhattacharya , Department of Psychiatry,
Bharati Vidyapeeth Medical college and Hospital, Dhankawadi , Pune-411043
BACKGROUND
Mephentermine is a N-alpha-alpha-trimethylphenethylamine sulphate dehydrate and is used as a vasopressor agent with sympathomimetic action.It acts on monoaminergic synapses and causes release of monoamines (noradrenaline,dopamine and serotonin)in the brain.Since the last decade,there has been increased trends of its misuse in young people for better performance in competitive sports,body building or as a recreational drug.Also,there are no established guidelines and protocol for treatment and there is a lack of awareness regarding its potential for dependence.Our case report includes two cases of young adults with mephentermine use in dependence pattern and their management.
AIMS AND OBJECTIVES
• The two patients and their relatives were interviewed in detail and the pattern of mephentermine use and dependence in them was established.They were started on treatment.
• Patients were reassessed after treatment was started and improvement was recorded.
METHODOLOGY
A detailed clinical interview was done which included details regarding their personal history.General physical examination followed by systemic examination and Mental Status examination was done. Basic laboratory investigations were done.Substance use and dependence were established using ICD-10 Criteria.Both the patients were started on treatment and serial MSEs were done.
RESULTS
Both the patients were started on medication and advised complete abstinence from substance,antipsychotics and benzodiazepines were started according to the presenting symptoms.
CONCLUSION:
Mephentermine is a substance with high abuse potential.As there are no established FDA guidelines for its treatment,patients were managed based on their presenting symptoms.
Adrenoleukodystrophy -A Puzzling Clinical Scenario
BACKGROUND: Adrenoleukodystrophy is a genetic disorder involving the peroxisomes, that leads to defects in beta-oxidation and collection of very long chain fatty acids. Blaw, in the year 1970 for the first time introduced the term “adrenoleukodystrophy” as a distinct disease with X-linked inheritance and thought to be a metabolic disorder due to enzymes affecting both adrenal cortex and cerebral white matter. Presently, it is known to be caused secondary to defect in ABCD1gene on X q28 (ATP - binding cassette, sub-family D [ALD], member 1) gene that results in a defect in peroxisomal beta-oxidation.
AIM: To highlight the rare clinical presentation of adrenoleukodystophy attending to psychiatry OPD.
METHODS: A thorough psychiatric history and clinical evaluation, a complete metabolic profiling and genetic analysis by exome sequencing test to confirm the diagnosis, following MRI findings suggestive of leukodystrophy.
RESULTS: a 14 year old boy presenting with behavioral abnormality, difficulty in motor co-ordination, disinherited behavior, for about 1 year, presenting to psychiatry opd, was found to have white matter hyper intensity suggestive of leukodystophy. Genetic study revealed a hemizygous, pathogenic variant in ABCD1 gene, elevation of C26.0 levels, and an increased ratio of C24/22 and C26/22. Later his brother was reported to have behavioral abnormality and was found to have same genetic findings.
CONCLUSION: The clinical scenario of ALD can be diverse and confusing. Therefore, keeping in mind the rare possibility will provide genetic testing and further management promptly.
Schizophrenia in Paget’s disease- A Rarity indeed!
Arushi Singh1, Poonam M2, Shashikala IM3
KVG Medical College and Hospital, Sullia, DK, Karnataka
Background: Paget’s disease, or osteitis deformans, is a rare chronic condition of the bone that typically results in enlarged and deformed bones. Psychiatric symptoms have been rarely reported in patients with Paget’s disease, schizophrenia being the least commonly reported.
Methods: We report a case of 60 year old male, diagnosed with schizophrenia of 40 years of illness, predominantly with delusions of infidelity, 3rd person commenting type of auditory hallucinations , never treated since he was not amenable to treatment , presented to the orthopaedics OPD with excruciating bone pains on multiple occasions which led to frequent admissions.
Result: MRI Spine showed Paget’s disease of left iliac bone, compressive myelopathy along with cervical and lumbar spondylosis. PANSS Score was 66 (positive score - 24, negative score – 10, General – 32). Patient was treated surreptitiously with depot antipsychotics after taking caregiver’s consent, in the orthopaedics ward during his inpatient stay.
Conclusion: The co-occurrence of Paget’s disease and schizophrenia is a very rare entity and our case report will add on to the literature of psychiatric manifestations predominantly psychotic with bone disease.
Keywords: Schizophrenia, Pagets disease, Osteitis deformans
Lemborexant (DORA) in Acute treatment of Insomnia coexisting with Delirium – Case series: Preliminary experience from a Tertiary care Psychiatry Centre.
Dr Noorul Hasan MD (1), Dr Arvind Rengarajan MD (1), Dr Aswath Babu MD., DNB (2), Dr C Panneer Selvan MD (2).
Sneka Mind Care Hospital, Tirunelveli, Tamil Nadu, 627005
Introduction: Lemborexant is a Dual Orexin Receptor antagonists (DORA), approved by the FDA in December 2019. This molecule proven to have good effect on insomnia in adults and to treat irregular sleep-wake rhythm in Alzheimer disease patients, with limited studies. However, the evidence for its use in the treatment of delirium or insomnia coexisting with delirium are limited.
Aim: This case series tried to examine the effect of Lemborexant for rapid improvement in insomnia coexisting with delirium in patients refractory to traditional measures.
Methods: The cases were primarily in-patients in a tertiary care setting, selected between July-September 2022. Totally ten cases fulfilling the DSM-5 criteria for delirium and were evaluated with Confusion Assessment method (CAM) were selected. Eight out of ten cases were above 50 years of age. Delirium due to electrolyte disturbances & traumatic brain injury were excluded. Five were Dementia cases primarily admitted for insomnia coexisting delirium and the rest five were either Schizophrenia / Mood disorder who developed delirium secondary to medications. Lemborexant was dosed at 5-10mg at night.
Results: Overall, six cases improved in both domains i.e. insomnia & delirium after the first night dose of Lemborexant 5 mg, others improved over 2-3 days. None were noted to have paradoxical worsening, daytime somnolence, postural instability, parasomnias or post-wakeup headache. Half of the cases stopped Lemborexant by the end of 4 weeks, however no rebound of insomnia noted.
Conclusion: These converging lines of benefits makes Lemborexant an ideal choice in acute treatment of Refractory insomnia coexisting with delirium or vice versa, also a preferred molecule in geriatric population considering its good tolerance profile. However, further RCTs are required to strengthen this pilot findings.
1-First author, 2- Co-authors.
Medications - Risperidone/amisulpride & Trihexyphenidyl
Tertiary care centre - Sneka Mind Care Hospital, Tirunelveli, Tamil Nadu, 627005
Acknowledgement: “Confusion Assessment Method. Copyright 2003, Hospital Elder Life Program, LLC. Not to be reproduced without permission.”
Disclaimer: “No responsibility is assumed by the Hospital Elder Life Program, LLC for any injury and/or damage to persons or property arising out of the application of any of the content.”
Cognitive impairment and development of dementia in late and very late-onset psychosis: case series.
Astut Kurariya*, Abhiram N Purohith, PSVN Sharma
Department of Psychiatry, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India – 576104
*Presenting author
Introduction: The current evidence suggests that late-onset and very late-onset schizophrenia-like psychosis substantially differ from early-onset schizophrenia. The evidence on the association between late/very late-onset schizophrenia-like psychosis and subsequent progression to dementia is heterogeneous. There is a lack of evidence on these two conditions’ symptomatology and cognitive profile, which predicts the subsequent progression into major neurocognitive disorder. We aim to describe the clinical, neurobiological and cognitive profile of individuals with late and very late-onset schizophrenia-like psychosis who subsequently developed dementia.
Methodology: This was a case series of seven patients diagnosed with late and very late-onset schizophrenia-like psychosis between January 2017 and September 2022. We extracted sociodemographic details, clinical features, biochemical investigations, neuroimaging findings, neurocognitive profile and treatment response.
Results: Seven patients (four male and three female) with a mean age of onset of psychosis at 63.6 years (SD ) progressed to dementia subsequently. The findings on the cognitive and neuroimaging profile are heterogeneous.
Conclusion: Late-onset and very late-onset schizophrenia-like psychosis can have a higher risk of developing dementia. Long-term prospective studies emphasizing clinical and neurobiological risk factors for progression to dementia are implicated.
Keywords: Late-onset psychosis, late-onset schizophrenia-like psychosis, dementia, very late-onset psychosis.
Late onset Psychosis as a predictor for Major Neurocognitive Disorders: A Case Series
Astut Kurariya 1, Abhiram P N 1, PSVN Sharma 1
1Department of Psychiatry, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India - 576104
Introduction: Various studies and follow up data is present in elderly age group for 1st psychotic episode after 65 years of age. There is, however, not enough evidence, to correlate the occurrence of late and very late onset schizophrenia like psychotic illness as a prodrome for major neurocognitive disease. Aim: In this case series, we aim to identify individuals with late and very late onset schizophrenia like psychosis and correlate with progression to major neurocognitive disease. Methodology: We did a retrospective file review of the last 5 years and identified individuals with 1st episode psychosis after 65 years of age, excluding substance induced psychosis and psychosis in individuals already diagnosed with Major neurocognitive disorders. We did a follow up among them to identify people having signs of major neurocognitive disorders and assessed them using Appropriate cognitive scales and compared it to the baseline cognitive scales. Results: We identified 9 patients meeting our inclusion criteria and out of them, approx 66% were males and approx 33% were females. Mean age of first onset psychosis was around 74 years and most common symptoms at presentation were irritability (55%), hallucinatory behaviour (44%) and fearfulness (44%). 33% of the patients on follow up had symptoms of major neurocognitive disorders in form of memory deficits, executive function deficits and needed supervision for activities of daily living. Conclusion: Late onset psychosis can be a predictor for major neurocognitive disorder in elderly population. Lacunae lies in the difficulty faced in conducting long term follow up studies and perceived ignorance towards elderly population in terms of access to proper mental health care. Long term studies and larger cohorts with better clinical correlates are needed to establish a role of late onset and very late onset Schizophrenia like psychosis as a prodrome for developing neurocognitive disorders.
A cross-sectional study of Emotional Intelligence and Empathy among Postgraduate residents
BACKGROUND: Emotional Intelligence (EI) is “a type of social intelligence that involves the ability to monitor one’s own and others’ emotions, to discriminate among them, and to use this information to guide one’s thinking and actions.” EI is a very important aspect of a person’s intelligence which is often under-recognized. The important domains of emotional intelligence (EI) are self-awareness and self-regulation, motivation, and empathy. These are necessary to handle any relationship.
AIM: This study aims to (i) assess emotional intelligence focusing specifically on empathy; (ii) to study the level of anger; and (iii) correlating level of anger with EI and empathy among postgraduate residents.
METHODS: Subjects were assessed randomly after obtaining informed consent, through semi-structured proforma and various scales, including Emotional Quotient Self-Assessment Checklist, Multi-Dimensional Emotional Empathy Scale, and Clinical Anger Scale. Data was analyzed using SPSS.
RESULTS: EI scores were low (<20) in more than 80 % of the residents. Understanding the suffering, a component of Empathy was found to be higher among first year residents than the final year residents. Residents with high anger level had low scores on EI (Self-control, Social competency, self-confidence) and Empathy.
CONCLUSION: Recognition of one’s anger and having self-control is necessary for better EI and Empathy. The training system for residents should focus on anger/stress management and improvement of EI and Empathy, without which there will be an impediment in patient care and health service management.
Clinical profile and Patient satisfaction level of patients attending District Mental Health Program Thoubal, Manipur
Dr. Athokpam Ranita Devi1, Dr. Rajkumar Lenin Singh2, Dr. Naveen Kumar C3
Background: Patient satisfaction in a clinical care setting is considered pivotal in health care delivery system and is one of the vital markers of treatment adherence and improved patient outcome.
Aims: 1). To study the socio-demographic and clinical profile of patients attending District Mental Health Program (DMHP),Thoubal.2)To determine Patient satisfaction level with mental health care services.
Methods: This is a descriptive study, done between September 2021 to August 2022 at DMHP, Thoubal outpatient clinic, comprised of follow up patients. Specific socio-demographic proforma and the International Classification of Diseases, 10 th Revision (ICD-10) was applied. Satisfaction was measured by Patient Satisfaction Questionnaire-18(PSQ-18).
Results: Total of 115 patients was selected by purposive sampling. Majority were females (69%), married (71%), in the age group 30-50 years (57%) and studied up to secondary level (39%) . Most common psychiatric diagnosis made was Generalised Anxiety Disorders (28%) followed by Schizophrenia (22%) and Mood disorders (16 % ) . Greatest level of satisfaction was noted with interpersonal aspects (87%) and time spent with doctor (85%).Composite satisfaction level is 79%.
Conclusion: Significant level of satisfaction to mental health care services rendered by DMHP, Thoubal was observed which depicts encouraging results of acceptance of community mental health care services.
Key words: Patient satisfaction, DMHP, Psychiatry
1) Senior Specialist (Psychiatrist), District Hospital Thoubal, Manipur Health Services.
2) Professor & Head, Department of Psychiatry, Regional Institute Of Medical Sciences,(RIMS) Imphal.
3) Professor of Psychiatry, Head, Community Psychiatry Unit, Department of Psychiatry,National Institute Of Mental Health and Neurosciences(NIMHANS), Bengaluru.
Challenges faced by women with alcohol use disorder- a case series from an Indian perspective.
Dr. Auroshreeta Das
Department of Addiction Medicine, Department of Psychiatry, LGB Regional Institute of Mental Health, Tezpur, India
Background: The prevalence rate of alcohol use among Indian women is much lesser than its male counterparts but ever increasing. The term alcohol use disorder (AUD) denotes either dependence or harmful use. Women with AUD suffer from multiple psychiatric, medical and social issues that make diagnosis and management challenging.
Aims: To highlight gender-specific issues in alcohol use disorder through examples of three cases of women with AUD.
Cases:
Case 1: A 44-year-old married female whose onset of regular drinking was to deal with the suffering from domestic violence and dysphoria, later perpetuated by stress of infidelity by her spouse, critical commenting from family members and alcohol withdrawal symptoms. Along with Alcohol Dependence syndrome, Recurrent Major Depressive Disorder, Seizure disorder, Functional neurological disorder, and Type II Diabetes Mellitus were the psychiatric and physical comorbidities respectively.
Case 2: A 33-year-old married female whose occasional drinking started with her husband but later regularized during the lockdown owing to the apprehensive circumstances and further escalating under self-criticism regarding failure as a mother and wife. Her condition deteriorated to alcoholic liver disease within a year. Comorbid diagnoses were Major depressive disorder and Hypothyroidism.
Case 3: A 47-year-old married female who has been experiencing multiple pain complaints along with pervasive low mood, anhedonia, persecutory delusion and death wishes started drinking to lessen her distress and get sound sleep, but later became dependent.
Discussion/Conclusion: Certain gender-specific differences and challenges evident from the cases are like later age of onset, higher medical harm, social stigma, victimization to assault, self-medication, misdiagnoses, delayed help-seeking, higher psychiatric co-morbidities. Likewise, management of these cases also should be tailor-made as per the need of the clients preferably in an integrated treatment set-up.
WORK LIFE BALANCE AND SUBJECTIVE WELLBEING AMONG INFORMATION TECHNOLOGY PROFESSIONALS -IMPLICATIONS ON MENTAL HEALTH
Need for the Study
In recent years, several studies have advanced our understanding of how work affects family life and vice versa. Research has identified several variables that influence the level of work/family conflict. Several researchers have addressed the relationship between work/family conflict and psychological distress and well-being. Most of the studies are in the Western context. But there is a scarcity of research into this area in the Indian context. Hence the researcher made an attempt.
Aim of the Study
To study the Work-Life Balance and subjective well-being among the professionals working in the information Technology industry.
Objectives of the Study
1. To study the socio-demographic profile of the respondents. 2) To study the extent of Work-Family Conflict (WFC) and Family-Work Conflict (FWC) among the respondents. 3) To study the Subjective Well-being of the respondents. 4) To study the inter relation between Work- Family Conflict (WFC) and Family-Work Conflict (FWC) and Subjective Well-Being.
Study Design
The research design used is the study is descriptive research design.
Tools for Data Collection
1. Socio-demographic data sheet
2. Work-Family Conflict and Family-Work Conflict Scale (Richard G Netemeyer, Robert McMurrian and James S Boles, 1996). Subjective well-being scale (Nagpal and Sell 1985) 40 items on 3.point scale.
Method of Data Collection
Questionnaires were used for data collection for the present study. Sixty (60) Software Engineers were selected from different organizations using purposive sampling and questionnaires were given.
Data Analysis
In order to analyze the data, descriptive statistics were used (mean, standard deviation, frequency distribution). Pearson correlation matrix was used to examine the relationship between the two variables.
Results & Conclusion
Majority of the respondents were males in the age group of 20 to 25 years of age who had completed their graduation. Majority of the respondents work for 8-10 hours a day with a monthly income of Rs.15001-30000. There is significant difference between the means of Work Family Conflict and Family Work Conflict with respect to Work Experience. There is also a significant difference between means of Subjective Well-being with respect to job satisfaction and satisfaction of Recreational Facilities. There is a negative correlation between Subjective Well-being and Work Family Conflict and Family Work Conflict (WFC & FWC). Family Interventions, Peer Support Groups, Carrier Guidance and Counselling in Individuals and Group are indicated are as remedial measures.
Psychiatric Morbidity, Perceived Stress and Coping Mechanism in the Caregivers of Patients with Intellectual Disability: A Cross-Sectional Study.
Dr. Bhagyashree H. Gaikwad, Dr. Savinder Singh, Dr. Rajdeep Kaur
Institute of mental health, Govt. mental hospital, Amritsar.
Background & Aims: It is often seen that caregivers usually neglect their own well-being, when caring for their patient with intellectual disability. Negatively impacting their ability to care for their patients. Thus, we conducted this study with an aim to assess the prevalence of psychiatric morbidity in the caregivers of patients with intellectual disability and evaluate their level of stress and coping mechanism to deal with it.
Method: It was a cross-sectional study with 90 caregivers included. The socio-demographics details of the caregivers and intellectually disabled patients were collected using a specially designed proforma. Psychiatric morbidities were assessed using M.I.N.I. international neuropsychiatric interview. Perceived stress scale (PSS) and Mechanism of coping scale (MOCS) were used to assess their stress and coping styles.
Results: We found 54.4% of caregivers met the criteria for major depressive disorder (MDD) and 31.1% met the criteria for dysthymia with female caregivers having significant association with psychiatric morbidity (MDD & Dysthymia) and high perceived stress. We found a significant association between MDD and passivity coping style. Our study showed, positive correlation of passivity with PSS score and negative correlation of problem solving with PSS score. Lastly, we found passivity and problem solving to be significant predictors of perceived stress and MDD was a significant predictor of high stress.
Conclusion: Our study shows that, major depressive disorder and dysthymia are most common psychopathology among the female caregivers along with high perceived stress. Also, that emotion focused coping results in higher level of stress. As it is seen that psychiatric illness, coping style and perceived stress among the caregivers is associated with each other, it is best to treat each ID patient as a family unit, with attention to assessment of the caregivers.
DIAGNOSTIC CHALLENGES IN SCHIZOTYPAL PERSONALITY DISORDER: A CASE REPORT
INTRODUCTION:
Schizotypal personality disorder (STPD) is widely understood to be “schizophrenia spectrum” disorder as prevalence of which are much higher in relatives of schizophrenia than of other mental disorders. It may also be considered as “extended phenotype” and it has also a genetic connection to mood disorders. This case report highlights the diagnostic dilemma when a patient of STPD presents with affective symptoms.
CASE SUMMERY:
A 22 years old male presented with complains of aloofness, odd religious believes, socially inappropriate odd behaviours, suspiciousness, referential ideas for past 10 years, 3 episodes of low mood, decreased energy, pessimistic views about future in past 6 years, 2 episodes of heightened sense of wellbeing, talkativeness, increased energy in past two years.
On mental status examination, patient did not maintain eye contact but had increased speech productivity, psychomotor activity, cheerful affect, fantasy thinking, overvalued ideas on religious theme, idea of reference and grandiosity, impaired social and personal judgement with no obvious disorder of speech, hallucinations. Physical examination, investigations revealed no abnormality. Diagnosis was made, STPD and Bipolar II disorder as per DSM 5. He was started on Tab Lithium Carbonate 800mg, Aripiprazole 10mg.Metacognitive therapy, supportive psychotherapy were provided and his family was psychoeducated about the illness. Patient’s symptoms started to improve and now he has resumed his functionality.
DISCUSSION:
Our case demonstrates when mood disorders co exists with STPD, how affective symptoms colour the dimensions of STPD and poses a challenge to diagnose it.
KEY WORDS: Schizotypal personality disorder, Bipolar Affective Disorder.
1.DR. Brototi Mandal, Junior resident, Central Institute of Psychiatry, Ranchi-834006, Jharkhand, India.
2.DR. Sambeet Patra, Junior resident, Central Institute of Psychiatry, Ranchi-834006, Jharkhand, India.
3.DR. Pooja Sharma, Senior resident, Central Institute of Psychiatry, Ranchi-834006, Jharkhand, India
4.DR. Chandramouli Roy, Senior resident, Central Institute of Psychiatry, Ranchi-834006, Jharkhand, India
5.DR. Basudeb Das, Director and Professor of Psychiatry, Central Institute of Psychiatry, Ranchi-834006, Jharkhand, India
Baseline C-Reactive Protein As A Predictor Of Response To Treatment In Depression.
Dr Bushra Zahoor, Dr Manoj Kumar
Background and Aim: Major depressive disorder has been linked with inflammatory processes, but it is unclear whether individual differences in levels of inflammatory biomarkers could help in predicting the response to treatment. The authors tested the hypothesis that C-reactive protein (CRP), a commonly available marker of systemic inflammation, predicts differential response to treatment in depression.
Method: The hypothesis was tested in patients admitted at a tertiary care centre. CRP was measured with a high-sensitivity method in serum samples from 50 adult men and women with major depressive disorder randomly allocated to this study. The primary outcome measure was the score on the Becks Depression Inventory, Hamilton depression rating scale along with the Clinical Global Impression scale administered on day 1, day 14, and day 28.
Results: CRP level at baseline differentially predicted treatment outcome within the two groups. For patients who were tested CRP Negative(level ≤6mg/l), an improvement on the HAM-D and BDI score was greater as compared to the CRP Positive group(level ≥6mg/l). This study showed that the response rate is affected by a high level of baseline inflammation measured by the serum C- Reactive protein levels.
Conclusions: An easily accessible peripheral blood biomarker may contribute to improvement in outcomes of major depressive disorder.
ASSESSMENT OF SEXUAL BELIEFS AMONG DRUG NAÏVE MALE PATIENTS ATTENDING PSYCHIATRY OPD IN A TERTIARY CARE SETTING: A CROSS SECTIONAL STUDY
Dr. Chaitanya Sheoran 1, Dr. Kunal Kumar 2, Dr. Abhinit Kumar 3, Dr. Shruti Sharma 4, Dr. Nikhil Nayar 5, Dr. Swaleha 6, Dr. Nikita Maan 7, Dr. Siddharth Bhargava 8, Dr. Parika Kochhar 9
1- Junior resident, 2-Professor & head, 3-professor, 4- Assistant prof,
5-Assistant professor, 6- Senior resident, 7-9 Junior resident
BACKGROUND The basic objective of any civilization is to preserve a happy family. The quality of one’s sexual encounters is crucial to a happy marriage. Couples’ dissatisfaction in this area may be the cause of a number of social, psychological, and medical issues. The way reality is interpreted, which shapes behaviours and emotions, is established by beliefs. These beliefs, which are among the most frequent causes of male sexual problems, include those relating to high performance, women’s sexual enjoyment, and sexual conservatism.
AIMS To identify the misconceptions about sexuality among psychiatry patients
METHOD This cross-sectional study was carried out at the School of Medical Sciences and Research, Sharda University. We enrolled 200 samples and it is assessed through Sexual Beliefs Questionnaire (Male version)
RESULT Sexual beliefs were assessed in different domains as well as overall sexual belief score was also estimated. The different domains in which the sexual beliefs were scored were sexual conservatism, female sexual power, macho belief, beliefs about women’s sexual satisfaction, restrictive attitude toward sex, and sex as an abuse of men’s power.
CONCLUSION The development of both psychiatric and sexological care will benefit from the early identification of the intricate relationships between psychopathology, the adverse effects of antipsychotic medicines, and sexuality. However, longitudinal studies are needed to anticipate the relationship more accurately between sexual dysfunction and sexual beliefs at a larger sample size. Sexual beliefs are significant contributors to sexual dysfunction.
Name of Presenting Author - Dr. Chandan Meena
Age – 32 Years, Date of Birth- 23-01-1990 (Attached Adhar Card)
Designation - 3rd Year Resident
Place of Work - Department of Psychiatry, Government Medical College, Kota, Rajasthan
IPS Member – Applied ( IPS Submission Reference Number – IPS/2022/100255 )
Email – meena.chandan@gmail.com
Phone Number – 9662399649
Topic Category - Stress
Title of Paper – Stress, Resilience and Social Connectedness in Indian LGBTQ Community.
Summary of Paper -
Background: Stereotype, stigma, victimization have been woefully affecting sexual minority. Understanding their unique stressor is difficult as the population is hard to reach & mostly conceding.
Aim: To measure and compare Stress level, resilience level and social connectedness in different Sexual Minorities.
Method: Anonymous online survey was conducted in month of July 2022 & n=116 responders were recorded. A semi structured Performa enquiring awareness, disclosure, comfortability with one’s sexual minority status, DSH, suicidal distress & victimization was used. The LGBT minority stress scale MSPSS & BRS scores were recorded.
Result: High level of stress & low resilience was common & alarming for bisexuals & transgenders. Friends provided maximum support victimization , DSH, suicidal distress is maximum in transgender group.
Conclusion: Our findings argue that particularly LGBT youth are highly vulnerable to distress & distress & DSH. Thus, highlighting the importance of targeted intervention for these groups.
Individual/Group work – Group.
Co Author: Dr. C.S. Sushil, Dr. Mithlesh khinchi, Dr. Akash Parihar.
Presented earlier – No
Caregiver Burden in Bipolar Affective Disorder
BACKGROUND: Bipolar patients require family support and care. Family caregiver can have negative repercussions during care including isolation, physical ill-health, financial difficulties and even psychiatric diagnosis. They are sometimes called invisible second patients and yet societal expectations are endless from them. Present study was planned to highlight burden of care of BPAD cases and to suggest measures to reduce this burden. AIMS: To study the burden experienced by the caregivers of the BPAD patients and to assess the relation of burden to socio-demographic profile of caregivers and any disease related factors of bipolar patient. METHODS: 70 caregivers of patients diagnosed with BPAD according to ICD-10 DCR formed study group and assessed by Burden assessment schedule (BAS), DUKE UNC social support questionnaire and GHQ-12 .Data expressed in mean was analysed by T-test and ANOVA and proportion through chi square test. RESULTS: 81.9% of caregivers had GHQ score more than 12 reflecting psychological burden. Among these 54.3% reported moderate to severe burden as indicated by BAS. Higher caregiver burden was reported in males (75.7%), unskilled employment (82.9%), lower socioeconomic status (77.1%), insidious onset (62.9%), co-morbidity (67.1%), high hospitalization (68.6%). It was seen that social support helped to reduce the burden of care. CONCLUSION: Burden experienced by caregivers is an invisible evil lurking in the shadows and consumes the caregiver’s resources both mentally and financially. Burden can be reduced by extending a better functional social support system. There is need to understand more determinants of caregiving burden so as to reduce the impact on caregivers.
Key words: Bipolar affective disorder, caregiver burden, depression, psychiatric morbidity
SUBSTANCE USE IN PSYCHOTIC INDIVIDUALS – CASE CONTROL STUDY
Introduction: Substance use disorder is a burdensome condition which often coexists in patients with psychiatric disorders, but are often undetected. Addiction and psychosis both have a dopamine dysregulation-related etiology and involves experiences of dissociation from the real world. Patients with psychotic disorders are considerably likely and have higher rates of substance abuse when compared to other psychiatric disorders or the general population
Objective: To determine the type and severity of substance use in psychotic patients and also to compare them with controls.
Method: A case control study was conducted among 33 cases and controls. All the participants were screened using Mini International Neuropsychiatric Interview (M.I.N.I) scale and World Health Organizations Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) scale. Chi square test/ Fishers exact test was used to compare study variables among cases and controls. P value <0.05 was considered to be statistically significant.
Results: Among the cases 13.6% were alcohol dependent, 18.2% were substance dependent and 16.7% were substance abusers. Among controls 7.6% were substance abusers and only 1.5% were alcohol abusers. Among the cases 3% need intensive treatment for tobacco, cannabis and 6.1% for Alcohol. Almost 19.6% need brief intervention for tobacco followed by alcohol (6.1%), sedatives (3.1%), cocaine and Amphetamine (1.5%)
Conclusion: Substance dependence and abuse was observed in psychotic patients indicating the importance of timely intervention, in understanding what started first and to take necessary steps in preventing the illness and the use of substances.
Self-help with minimal therapist contact; Mindfulness-based bibliotherapy for the management of patients suffering from obsessive-compulsive disorder with depression.
Dr. Deoshree Akhouri1 (Presenter) & Hamza
1Associate Professor (Clinical Psychology), Department of Psychiatry, J.N.M.C & H, Aligarh Muslim University, Aligarh, U.P., India
2Research scholar (Clinical Psychology), Department of Psychiatry, J.N.M.C & H, Aligarh Muslim University, Aligarh, U.P., India
Background: - Obsessive-compulsive disorder (OCD) is a chronic and long-lasting illness. Approximately 2% of the population has OCD (Alex Klien, 2020). Bibliotherapy is a self-help technique that facilitates psychological growth and healing through reading & mmindfulness involves the process of being purposely attentive to one’s moment-to-moment awareness without passing judgment which is proven effective in reducing anxiety, depression, and stress. Aim: - This study examined the effectiveness of mindfulness-based bibliotherapy intervention to reduce the symptomatology of OCD with depression. Methodology: - According to inclusion and exclusion criteria, sixty-eight patients were recruited through purposive sampling method and were randomly assigned to the intervention or waitlisted group. Before giving the intervention, all patients were assessed by measures of OCD, depression, affect, and mindfulness. Waitlisted group were taken TAU and experimental (intervention) group were taken for 12 weeks mindfulness-based bibliotherapy. For ethical consideration written consent was taken from all patients. All patients were reassessed after the completion of therapy (12 weeks) and at a follow-up of 3 months (experimental & waitlisted group). Results and conclusion: - Mindfulness-based bibliotherapy appears to be effective in the reduction of the symptomatology of OCD and depression. Among the intervention group, all gains were maintained at follow-up, providing an affordable prompt treatment that could reduce further medications. The intervention evidenced fidelity to its theoretical approach via increases in levels of mindfulness across time also.
Keywords:- Mindfulness-based bibliotherapy, OCD, depression, Self-help, anxiety.
Dual challenge: A pilot study of challenges using masks in individuals with intellectual disabilities during the Covid pandemic
Dr. Devika Kosana (MD Psychiatry, AIIMS, New Delhi), Senior resident in the Dept. of Psychiatry, Institute for mental health, Osmania Medical College, Hyderabad.
Dr. V. Sravan Reddy, Asst. Prof. Psychiatry, NIEPID, Secunderabad.
Introduction: Individuals with intellectual disabilities experience greater difficulties compared to the general population in using masks to protect from SARS-CoV-2 due to inability to understand the need to wear masks, hypersalivation, irritability etc. This study aims to identify the challenges faced by these individuals in using masks and their correlation with the severity of intellectual disability.
Methodology: 50 individuals aged 6 to 18 years with intellectual disabilities attending NIEPID were recruited after taking informed consent from the caregivers. Socio-demographic details and difficulties faced while using masks and when their family members wear masks were collected using semi-structured proforma. Data was analyzed using MS Excel and SPSS version 25.
Results: The mean age of participants was 11.06 years. Male: Female ratio was 1.94:1. Majority (92%) of individuals were having mild to moderate intellectual disabilities. 62% wore masks properly. Irritability (24%) and touching the masks repeatedly (54%) were the commonest mood and behavioral changes noted while wearing masks respectively. Soiling of masks as a result of hypersalivation was a concern in 18% of the cases. The strength of significant correlations between the degree of mental retardation and difficulties faced with mask usage was negligible to low.
Discussion: 88% and 54% of individuals observed their family members while wearing masks and tried to imitate this behaviour respectively. This can be utilized in training to wear masks. Behavioural issues when family members wear masks place them at a higher risk of contracting covid. Improper fitting of masks was an issue in 30% of the study population and requires exercising caution while selecting masks.
Conclusion: Insights gained into the challenges faced by individuals with intellectual disabilities while using masks help devise appropriate behavioral interventions to enhance compliance with using masks. Mask tolerance training is essential for preparedness for future pandemics.
The prevalence of depression in staff nurses treating covid 19 patients working in a tertiary care hospital.
INTRODUCTION. COVID 19 outbreak of the disease has put a lot of psychological pressure on Hospital staff who are in a direct contact with the patients. According to World Health Organization, among physical and mental illnesses, depression is one of the most common mental disorder in the world.
Nursing out of all the other occupations ranked 27th amongst those prone for mental illness. During COVID-19 pandemic, the heavier workload and life-threatening condition of nurses aggravated the psychological pressure and were more at risk for after contacting with COVID-19 patients.
Methodology: This cross-sectional study was conducted at tertiary care centre using convenience sampling after approval by Institutional ethics Committee. Tools used were ICD 10 for diagnosis, Patient Health Questionnaire (PHQ-9). Socio demographic factors and clinical variables were compiled using semi structured proforma.
Results: Out of 150 nurses working in tertiary care hospital,74.7% (109)were females and 25.3%(38) were males of which 83% (125)were married and 14.7%(22) were single. 40.7% were diagnosed with minimal depression, 45.3% had mild depression,10.7% had moderate depression with 2% had moderately severe, 1.3% with severe depression.
Conclusion: During the pandemic, nurses have worked under intense pressure, which has negatively affected their resilience and caused higher levels of depression. Awareness of health administration about the level of stress, anxiety, and depression and can help to provide psychological support programs for improving the mental health of nurses during the COVID-19 pandemic.
Psychological burden of doctors aspiring for postgraduate training in India during COVID-19 Pandemic.
Dheeraj Kattula1, Kavi Nila David Retina2, Cebasta Irudayaraj3
1. Associate Professor, Department of Psychiatry, CMC Vellore, Tamil Nadu
2. Consultant Community Physician, Scudder Memorial Hospital, Ranipet, Tamil Nadu
3. Senior Resident, Department of Psychiatry, CMC Vellore, Tamil Nadu
Background: Doctors are under tremendous amount of stress during the COVID-19 pandemic. The uncertainty regarding future is compounded by lack of clarity about the postgraduate entrance exam. We assessed aspirants of postgraduate (PG) National Eligibility and Entrance Test (NEET) for psychological burden in domains of depression, anxiety, stress COVID related stress, attitudes towards situation affecting doctors and explored the association between psychological burden and other variables.
Methods: Google form was used to collect data from aspirants who appeared for NEET PG 2021 aspirants. The variables included age, gender, career status, marital status, number of attempts and medical environment related stress. Depression, Anxiety and Stress Scale (DASS 21) and COVID-19 Student Stress Scale Questionnaire (CSSQ) scales were used to measure psychological burden. Analysis was done using SPSS version 21.0.
Results: Of 289 participants, two-thirds had very severe depression and anxiety while two-fifths had very severe stress. Most of them were distressed with NEET exam, the postponed Supreme Court verdict, mental health of PG aspirants, and violence against healthcare workers. There is low satisfaction with having chosen medical profession. The distress from the above medical environment was associated with depression and anxiety. Gender and COVID related stress were associated with severe depression, anxiety and stress. Multivariate logistic regression showed female gender and CSSQ score were associated with risk of severe stress and happiness with medical profession was protective. Conclusion: PG aspirants are undergoing severe psychological burden. Prompt action should be taken to address this crisis.
Impact of Post-COVID-19 or Long COVID-19 on Cognition and Health
Dilkhush Panjwani, Mujahid Ali Syed, Shabbir Amanullah
COVID-19 manifests itself as an acute but also as a chronic illness. Post-COVID-19 condition or Long COVID-19 is real. It is evident that it is a serious condition that can have at times irreversible health consequences. About 15% of adults who have had COVID-19 experienced symptoms three months or more after their initial infection. Women are twice as likely than men to get long Covid. People of ages 40-49 are more likely than other age groups to get long COVID-19. The symptoms range in severity and include brain fog, muscle pain, trouble breathing, extreme fatigue, gastrointestinal problems, and heart palpitations. It can accelerate the onset of other chronic conditions like diabetes and heart disease. So far, there is no consensus on the definition of the condition or how to diagnose and treat it. COVID-19 vaccines can reduce the risk of developing long-COVID symptoms. This paper discusses the impact of Long Covid on cognition and likely factors that are at play.
IMPACT ON MENTAL HEALTH WELLBEING, LIFESTYLE, AND FINANCIAL CONDITION OF STOCK TRADERS DURING THE UNPRECEDENTED SITUATIONS OF COVID LOCKDOWN AND UKRAINE-RUSSIA WAR.
Disha R. Sharma
Department of Psychiatry
Rajiv Gandhi Medical College and Chhatrapati Shivaji Maharaj Hospital,
Kalwa West, Thane, Maharashtra 400605
Disha R. Sharma Dr. Anu Kant Mital
Clinical Psychologist Psychiatrist
During this pandemic and Post Pandemic Volatility of the world economics and the various war like situations in different parts of the world, the stock markets around the globe are on a roller coaster. The level of uncertainty, and emotional turmoil, has increased among Indian stock traders. This has led to an enormous level of increase of the stress that the traders are under, while continuing to trade. The main objective of this research study is to evaluate the impact of trading stress on the mental health, lifestyle, and financial condition of stock traders. This study includes respondents of required sample size. A purposive sampling technique was used to consider only active Indian stock traders for the study. A 5-point Likert scale questionnaire which was developed by Manda & Sana, 2021 was given to respondents using Google forms. The simple linear regression statistical method was used. The results indicate that general trading stress has an impact on the mental health, lifestyle and financial condition of stock traders.
Keywords: Stock market crash, pandemic, emotional turmoil, stock market trader’s mental health and well-being.
Boredom Proneness and depression in working adults with problematic smartphone use
1. Dr. Drishti Goyal*, 1st year PG student, Department of Psychiatry, JLN Medical College, Ajmer. Mobile number 8890673613, mail Drishtiharsh@yahoo.com
2. Dr. Mahendra Jain, Head of department of psychiatry, JLN Medical College Ajmer
3. Dr. Parth Singh, professor, department of psychiatry, JLN Medical College Ajmer.
*Presenting author
Background: Mobile phones have become an integral part of our everyday lives. With the ease of availability of smartphones and internet access, the use has increased among all age groups. The prevalence and significance of smartphone use among adolescents and young adults is well established but the studies on adult groups are scarce. Previous research suggest higher rates of boredom proneness and depression among smartphone addicted adolescents and young adults.
Aim : To evaluate the association between problematic smartphone use with boredom proneness and depression in middle aged working adults.
Methodology : This study was carried out on 43 working adults in the age group of 40-60 years between august and october 2022. Problematic mobile phone usage was assessed on the basis of Mobile Phone Problematic Use Scale-10. Severity of Depression was assessed on Beck’s depression inventory and boredom proneness was assessed on short boredom Proneness scale. Chi square test and unpaired t test were applied to compare subjects with problematic mobile phone use with those not having problematic use.
Results: Persons with problematic smartphone use had significantly higher rates of depression. Persons with problematic smartphone use had significantly higher scores on Boredom proneness scales on comparison.
Conclusion: Depression and Boredom proneness were higher in persons with problematic smartphone use in middle aged working adults.
Assessment of Severity of Alcohol Dependence in patients attending Psychiatry out patient department of a Tertiary care hospital for treatment of Alcohol Dependence
Dr. P. Kishan1, Dr. Gajjala Ravichandra2, Dr. P. Sai Krishna3, Dr. N. D. Sanjay Kumar 4, Dr. R. Shiva Kumar 5
BACKGROUND: The development of alcohol dependence is a complex and dynamic process. Many neurobiological and environmental factors influence motivation to drink. Continued excessive alcohol consumption can lead to the development of dependence that is associated with a withdrawal syndrome when alcohol consumption is ceased or substantially reduced. This study is undertaken to assess the severity of alcohol dependence in patients attending psychiatry out patient department for treatment of alcohol dependence in a tertiary care hospital. AIMS: To assess the socio demographic profile of patients attending psychiatry outpatient department for treatment of alcohol dependence and assessing Severity of Alcohol Dependence among them. METHODS: The present study is a cross sectional observational study with a sample size of 50 subjects, collected by Convenience sampling method, were included in the study after taking consent. RESULTS: In the current study all the subjects were males, majority of them were from Rural background (n = 39, 78%), upper lower socioeconomic status (n=23, 46%) and majority of the subjects were moderately dependent (n=22, 44%). CONCLUSION: Alcohol consumption practices vary across different parts of India because of various socio-cultural diversity and difference in laws governing individual States. Alcohol consumption affects the individual and his family members in one way or the other. The person in an intoxicated state may indulge in domestic violence with his family members, may exhaust the savings of the family, which can negatively affect the family in many ways. Proper rehabilitation services need to be offered to decrease the rates of consumption and dependence.
Comparison of personality factors and adherence to treatment in bipolar disorder I patients with or without substance use disorder.
Dr Ganesh Kumar Meena, PG resident, Department of Psychiatry, VMMC & Safdarjung Hospital New Delhi.
Dr Abhilasha Yadav, Professor, Department of Psychiatry, VMMC & Safdarjung Hospital, New Delhi.
Dr Rahul Saha, Associate Professor, Department of Psychiatry, VMMC & Safdarjung Hospital, New Delhi.
Background - Bipolar disorder-I is a chronic debilitating episodic illness characterized by episodes of mania alternating with depression. Various studies suggests that almost 65-95% of patients with bipolar disorder also suffer from one or more comorbid psychiatric disorders. Substance use disorders (SUD) and anxiety disorders are most common among these comorbidities. Literature suggests that there are certain personality traits that have consistent correlation to comorbid substance use disorder and poor adherence to treatment in bipolar disorder patients.
Aim: The aim of the present study was to compare bipolar disorder-I patients with and without substance use disorder in terms of personality factors and adherence to the treatment.
METHODS: This cross-sectional study was conducted in the Department of Psychiatry of a tertiary care center. Total sample size taken was 90, 45 patients of bipolar disorder-I with and 45 patients without comorbid substance use disorder. Patients were diagnosed as per DSM-5 criteria. Patients with YMRS scoring of 12 or less were recruited in the study. Participants were assessed with 16 PF and MARS. Statistical analysis was done using SPSS 23.
Results: Majority of patients in substance user group were male 97.8%, in non-substance user group majority were female 31.1%. In substance user group 40.0% had upper lower socio-economic status whereas majority in non-substance user group belonged to upper middle socio-economic status(53.3%) . In substance user group majority had comorbid Alcohol Use Disorder (44.4%). There was no significant difference in terms of adherence to treatment between the two group. 44.4% patients in non-substance user group had high sten score on personality factor G suggesting their characteristics of rule-bound, stronger superego strength and conscientiousness where in substance-user group only 20% had high score on this factor. Individuals low on factor G score are self-indulgent, disregard rules, their freedom from group influence may lead them to antisocial act, this can explain their more propensity of developing comorbid substance use disorder. Factor F of 16 PF shows significant association with MARS score in SUD group, in NSUD group factor L have significant association with MARS score. Individuals who score high on factor F shows high adherence to medication. Traits of Cheerfulness, activism, enthusiasm help individuals to stick to treatment. In NSUD group individuals who have low score on factor L are more adherent to treatment, and who scored high on factor L fare poorer in treatment adherence. In simple terms people who have personality traits of trust, uncompetitive, adaptable, free from jealous tendencies are more adherent to treatment, while people who are skeptical, suspicious, self-opinionated are less adherent to treatment.
Conclusion Bipolar disorder-I patients with or without comorbid substance use disorder have different personality factors. Some specific personality traits are potential risk factors for developing comorbid substance use disorder, and comorbidity with substance use disorder can affect personality of the patient, both the probability should be taken into consideration while assessing these patients clinically. The present study has shown the positive correlation between adherence and some of the personality factors.
Introduction
Depression is associated with the highest burden to society. Childhood adversities (CAs) are known to be highly co-occurring, researches examines their associations with mental disorders. Recent evidence suggests that the associations of multiple CAs with mental disorders are non-additive, arguing for the importance of multivariate analysis of multiple CAs. The present study focuses to address these problems by examining the prevalence and associations of retrospectively reported childhood adversities with onset depression across the life course.
Aims: To study the occurrence of adverse childhood experiences (ACEs) among patients suffering from depression and measure its relationship with the onset of depression.
Materials and methods
This is cross-sectional hospital-based observational study with 120 patients. Diagnosis was made as per International Classification of Diseases, Tenth Revision (ICD-10) and then validated using MINI international neuropsychiatric interview (MINI Plus 5.0). Depression severity was assessed using the Hamilton Depression Rating Scale (HDRS). CAs was assessed using Adverse Childhood Experiences International Questionnaire (ACE-IQ).
Statistical Analysis: Statistical analysis was performed using SPSS Ver.25, Chi-square test and binary logistic regression.
Results
One or more categories of CA’s were reported in 68 % of male and 53 % of female patients. The most common was violence among the adults and physical abuse. In the sample, there was a significant association between severity of depression and experiencing three or more categories of childhood adversity (P = 0.01).
Conclusions
Adversity in childhood is a common occurrence and is associated with grades of severity of depression.
Keywords - Adverse childhood experiences, depression.
A STUDY ON KNOWLEDGE AND ATTITUDE TOWARDS ELECTROCONVULSIVE THERAPY AMONG HEALTH CARE PROFESSIONALS
Dr. Alok Ghanate1, Dr. Gouthami S G2
1. Professor and HOD, Department of psychiatry, MRMC, Kalaburagi, Karnataka.
2. Postgraduate resident, Department of psychiatry, MRMC, Kalaburagi, Karnataka (Presenter).
BACKGROUND
Electroconvulsive therapy (ECT) is an effective and affordable treatment for a range of Psychiatric disorders. Despite being efficacious, it carries social stigma owing to misconceptions. Health care professionals represent a major force in dispelling misconceptions and shaping public opinion regarding ECT. Hence, this study helps in recognizing the deficiencies in knowledge, so that the negative attitude gets corrected and ECT becomes a socially acceptable treatment.
AIM:
To explore the knowledge and attitude towards ECT among health care professionals in Kalaburagi, Karnataka.
METHODOLOGY:
This is an online cross-sectional study using google form comprising sociodemographic details and ECT knowledge and attitude questionnaire circulated to health care workers in Kalaburagi. Data is analysed using IBM SPSS Software 20.0
RESULTS:
A total of 260 health care workers participated in the study. The most common source of information was textbook (n=67;25.8). The mean knowledge score was 18.84 ± 5.98 (59.13%) and mean attitude score was 10.60 ± 4.32 (62.5%). Total score on knowledge and attitude questionnaire correlated positively (r = 0.617, P<0.01) suggesting that higher knowledge is associated with more positive attitude.
CONCLUSION
There were certain gaps in knowledge about ECT among health care professionals. To fill such gaps, curriculum comprising classes on ECT, clinical postings and formative assessments are needed. This ultimately leads to better acceptance of the ECT treatment.
Attitude, electroconvulsive therapy, knowledge, health care professionals
Assessment of prevalence, psychosocial factors, personality and psychiatric comorbidities among inpatients with single versus multiple substance use disorder – A comparative study.
Dr. Harpreet Singh1 (Senior Resident Doctor), Dr. Harful Singh2 (Professor) Department of Psychiatry, Sardar Patel Medical College, Bikaner, Rajasthan.
Introduction- Globally, millions of peoples making their lives miserable by drug addiction. In India also number of substance abusers rises every day. As new drugs were discovered, new problems related to their use emerged. Substance use disorders are complicated psychiatric conditions and like other psychiatric disorders, both biological factors and environmental circumstances are etiologically significant.
Materials and Methods- In this cross-sectional study, the sample were recruited from the Inpatient Department, Department of Psychiatry, Sardar Patel Medical College, Bikaner Rajasthan. To assess prevalence, total number of inpatients and patients diagnosed with substance dependence syndrome, collected from Inpatients record. Total 60 patients were interviewed for assessment of the psychosocial factors, personality disorders, personality traits and psychiatric comorbidities. These patients were divided into two groups of 30 each: Group 1 for single substance user and Group 2 for multiple substance user. The data was tabulated & analyzed using SPSS version 24.0 and the results obtained were expressed in proportions.
Results- Out of 5301 Inpatients, 602 patients were diagnosed with substance dependence syndrome. So, the prevalence of substance dependence syndrome was 11.35% in inpatients of Psychiatry Department. Out of 602 patients, 52.99% patients had alcohol dependence syndrome, 31.56% had opioids dependence syndrome and 10.79% had multiple substance dependence syndrome. Among 60 patients included in both the study groups, majority of patients were male. Most of patients introduced to their substance of abuse by their friends and mean age of initiation of drug use was 22.76±5.13 years in Group 1 and in Group 2 18.76±4.13 years with statistically significant difference (p value- 0.004). Alcohol dependence syndrome (56.67%) was found the most common dependence syndrome among Group1 patients and in Group 2 alcohol with opioids was the most common substance combination. Most of the patients (56.66%) in Group 1 and in Group 2 (76.66%) were having psychiatric comorbidities in the current study. Bipolar disorder found in 5(16.66%) patients of each Group. Depressive disorder was more prevalent among inpatients of Group 2 compare to Group 1. 10% and 20% patients of Group 1 and Group 2 had personality disorder respectively.
Conclusions- The findings of our study alarm us to motivate the youngsters about ill effects of substance dependence and we should bring appropriate awareness to eradicate these substance dependence problem. This study highlights the need to develop a broad-based treatment program that also addresses patient’s comorbid psychiatric disorders.
Sexual Dysfunction In Alcohol Dependent Males And Marital Satisfaction In Their Spouses
Harpuneet1 , Parth Singh Meena2, Mahendra Jain3
1. Resident, Department Of Psychiatry, JLN Medical College, Ajmer, 7009842756, harpuneetkaur50@gmail.com
2. Professor, Department Of Psychiatry, JLN Medical College, Ajmer,
3. Senior Professor & Head of Department, Department Of Psychiatry, JLN Medical College, Ajmer,
Background- Alcohol abuse is leading cause of sexual impotence and other disturbances in sexual dysfunction. Alcoholism has deleterious influence on marital quality and functioning. Wives of alcoholics are affected by drinking and this put strain on marriage causing low marriage satisfaction.
Aim- To evaluate sexual dysfunction in alcohol dependent males and marital satisfaction in their spouses.
Methodology- This cross sectional study was carried by department of psychiatry in medical college in north India. Study group consisted of 70 alcohol dependent male and their spouse. while control group consisted of equal number of males and their spouses. Diagnosis was made according to ICD-10 and subjects were included after applying inclusion and exclusion criteria. Severity of alcohol dependence was rated using CIWA-Ar and SADQ, sexual dysfunction was measured using ASEX, and marital dysfunction assessed using Marital adjustment scale. Data was analysed using appropriate statistical tools
Result- 56.6% of patients with alcohol dependence had sexual dysfunction while 18% of normal subjects had sexual dysfunction. Marital satisfaction in spouses of alcohol dependent males was significantly lower when compared to control group.
Conclusion- Sexual dysfunction is higher in alcoholic male as compared to control group. Severe alcohol dependence is related to low marital satisfaction.
CUMMULATED CHILDHOOD TRAUMA AND PERCEIVED STRESS IN ADULTHOOD
BACKGROUND: Early life adversities are associated with increased psychological vulnerability. Adverse childhood experiences (ACEs) may sensitize individuals to view situations in adulthood as more stressful, which may contribute to poor resilience and poor health outcomes. Based on the stress sensitization or effect modification hypothesis, ACEs also heightens perceived stress later in life due to its enduring impact. It is currently unclear how different domains of childhood trauma exert effects on specific subjective experiences of stress during adulthood.
AIM: To assess the relationship between various adverse childhood experiences with perceived stress.
METHODOLOGY: This study involved interviewing 50 individuals with no know psychiatric co-morbidity for perceived stress using the 14-item Perceived Stress Scale (PSS). Adverse Childhood Experiences International Questionnaire (ACE-IQ) was used to assess for various domains of childhood adversities. Socio-demographic details were collected through a semi-structured proforma. Data was analysed using SPSS. IEC approval was obtained for the same.
RESULTS: There is an association between adverse childhood experiences and perceived stress. Results indicated specific associations between distinct domains of childhood trauma and perceived stress.
CONCLUSION: Study emphasized the unique role of distinct domains of childhood trauma in psychological stress processes in adulthood, implying opportunities for targeted interventions aimed at reducing exposure to childhood adversities to reduce the experience of negative sequelae.
Dr. Hetashri Shah1, Dr. Shishir Kumar2, Dr. Shrinivasa Bhat3
1- Junior resident, 2-Assistant professor, 3-Professor and HOD, Department of Psychiatry, K.S. Hegde Medical Academy, Mangaluru, Karnataka, India
A comparative study of Prevalence of Mixed Features in Patients with Unipolar and Bipolar Depression
Himani Adarsh, Sandeep Grover
Department of Psychiatry, PGIMER, Chandigarh- 160012
Correspondence: himaniadarsh27@gmail.com
Background: There is lack of data on mixed specifier from the developing countries like India. Aim: In this background, the present study aimed to evaluate the prevalence of “mixed specifier” in patients with unipolar depression and bipolar depression. Additional aim was to evaluate the sociodemographic and clinical correlates of mixed specifier.
Methodology: 110 patients (51 diagnosed with current episode unipolar depression and 59 diagnosed with current episode bipolar depression) were evaluated on DSM-5 criteria for mixed specifier for depression, Clinically Useful Depression Outcome Scale, Koukopoulos Mixed Depression Rating Scale, Hamilton depression rating scale (HDRS) and Young mania rating scale.
Result: According to DSM-5, 11 (21.56%) out of the 51 patients with unipolar depression fulfilled at least 3 out of the 7 criteria for the mixed specifier for depression, and 14 (23.72%) out of 59 patients with bipolar depression fulfilled the criteria for mixed specifier, with no significant difference in the prevalence across the 2 groups. There was no significant difference in the sociodemographic and clinical profile of those with and without mixed features in both unipolar and bipolar depression groups. However, those with mixed and without mixed features differ on certain depressive symptoms as assessed on HDRS.
Conclusions: About one-fifth of patients with unipolar and bipolar depression have mixed features during the acute phase of depression.
A cross-sectional study of socio-demographic profile, co-morbid substance use and non-compliance among Opioid substitution therapy users attending the OST Clinic of Gauhati Medical College and Hospital, Guwahati
Background: Opioid substitution therapy (OST) is an evidence-based intervention for opiate dependent persons that replaces illicit drug use with medically prescribed and orally administered opiates. It reduces high-risk behaviours and harms associated with injecting. OST users are however found to be indulging in many other substances. They often have poor compliance to the therapy due to various reasons.
OST centre in Gauhati Medical College and Hospital (GMCH) is one of the oldest centres of North-East India and caters to 120-140 patients per day.
Aims: The study aims to explore the socio-demographic profile of patients with opioid use disorders attending OST centre of GMCH, to assess their co-morbid substance use and pattern, and also to find the prevalence and causes of non-compliance in them.
Method: The study was a cross-sectional study and simple random sampling method was used. 100 participants who gave consent were given semi-structured proformas and were also interviewed in August 2022 to record the details. Appropriate statistical methods applied to derive the results.
Results: The study found that the clients are mostly of 21-30 years, males, unmarried, educated upto high-school and semi-skilled workers. Nicotine followed by cannabis is commonly used substance along with OST. Relapses occur mainly in first three months, and peer pressure is the most commonly attributed cause.
Conclusion: The study emphasizes that frequent relapses to illegal drugs occur during the first three months, which is when strict supervision is needed. Further qualitative investigations are required to follow up these clients, to better understand their problem.
1. Dr. Himasree Thakuria, 1st year Post Graduate Trainee, Dept of Psychiatry, Gauhati Medical College and Hospital, Guwahati
Email: himasreethakuria@gmail.com , Ph: 7896976396
2. Dr. Prayashi Kashyap, 1st year Post Graduate Trainee, Dept of Psychiatry, Gauhati Medical
College and Hospital, Guwahati , Email: prayashikashyap4@gmail.com , Ph: 9365286052
3. Dr. Utpal Bora, Assistant Professor, Dept of Psychiatry, Gauhati Medical College and Hospital, Guwahati
4. Dr. Deepanjali Medhi, Professor and HOD, Dept of Psychiatry, Gauhati Medical College and Hospital, Guwahati
Previously presented in 47th Annual Conference of Indian Psychiatric Society, Eastern Zonal Branch (CEZIPS) 2022
Creutzfeldt-Jakob disease – Rare Cause of Familial Dementia
INTRODUCTION
Creutzfeldt-jakob (CJD) disease is a rare, rapidly progressive, neurodegenerative disease affecting one in million, caused by misfolded prion protein. Familial variant is rare comprising 10% -15% of the classical CJD. Inheritance is autosomal dominant. This case reports highlights the need of considering CJD as a cause of familial dementia.
CASE SUMMARY
A 54 years old married male, h/o of diabetes and hypertension, presented with forgetfulness, irritability for 2 years, repeated blurting out of words, and myoclonic jerks for last 4 months. Illness had insidious onset, continuous course and deteriorating progress. There was family history of forgetfulness and cognitive decline in his father and sister leading to death. On examination he had apraxia, dysphasia, shuffling gait and pout reflex. Mental status examination revealed cognitive decline and verbal and motor stereotypy in the patient. On MRI brain there was age related cerebral atrophy grade 3, Chronic white ischaemic changes fazeka score 3, hippocampal fissural cysts and partially empty sella. He was started on Donepezil 10mg and T. Memantine 10mg bd, Sertraline 50mg, Sodium valproate 400 mg, Haloperidol 2mg. The family members are counselled regarding the poor prognosis and need for supervised care.
DISCUSSION
Familial form of dementia can be rare presenting form of Creutzfeldt-Jakob disease. This case highlights that members of an affected family may remain unaware of a devastating genetic disease. The availability of genetic counselling and family planning can empower those with family history to prevent transmission.
Creutzfeldt-Jakob disease, Familial Dementia
1. Dr. Indira Naskar, Junior Resident, Central institute of Psychiatry, Ranchi-834006, Jharkhand, India.
2. Dr. Pooja Sharma, Senior Resident, Central institute of Psychiatry, Ranchi-834006, Jharkhand, India.
3. Dr Nishant Goyal, Professor of Psychiatry, Central institute of Psychiatry,Ranchi-834006, Jharkhand, India.
THE USE OF TELEPSYCHIATRY DURING CORONAVIRUS: A CROSS- SECTIONAL STUDY ON DEMOGRAPHIC AND CLINICAL PROFILE OF THOSE WHO SOUGHT HELP BY USING THIS FACILITY.
Dr. Iqra Rasheed Shah, senior resident, Department of Psychiatry, Govt. Medical College, Srinagar.
Email:iqrashah91@gmail.com Phone: 6005024400
Aim: We aimed to study the demographic and clinical profile of patients who sought teleconsultation for psychiatric disorders from august 2020 to January 2021.
Materials & Methods: In this cross-sectional descriptive study, data was retrieved from the telepsychiatry services and was analyzed to examine the demographic and clinical parameters of patients.
Results: A total of 3444 teleconsultations were sought with a mean age of 37.78 ‡ 15.08. About 80% of the patients were in the age group of 20-60 years. Females outnumbered males with 1938 (56.3%) females and 1538 (43.7%) males. Mood disorders were the most frequent diagnosis with Major Depressive Disorder in 1572 (45.6%) and Bipolar Disorder in 636 (18.5%). Co-morbidity was present in 234 (6.8%) of the study group. The mean psychotropics prescribed were 1.95 ‡ 0.84. One, two, three and four psychotropics were prescribed in 918 (26.7%), 1470 (42.7%), 900 (26.1%) and 42 (1.2%) respectively. Those aged < 20 years or ≥ 60 years prescribed psychotropics at lower rates in comparison to the 20-60 years age group. Female patients had a significantly higher rate of psychotropic prescription than male patients. Three or four psychotropics were prescribed to those with co-morbidity at a significantly higher rate.
Conclusion: Demographic and clinical profile of patients seeking treatment through telepsychiatry was found to be comparable with face-to-face outpatient consultations.
Clinical Significance: With the development of clinical, operational, legal, and ethical guidelines for telepsychiatry practice, the systematic application of Information and Communication Technologies to the practice of mental healthcare is being rapidly adopted.
Adverse drug reactions monitoring in Addiction Psychiatry at general hospital setting: Development and Status
Naveen Kumar Dhagudu,* Deepika Kommu
Department of Psychiatry and ESIC Medical College and Hospital, Hyderabad
Background/Introduction:Continuous, spontaneous reporting of adverse drug reactions (ADRs)as part of pharmacovigilance activity in speciality health care setting is infrequent in India. Speciality based monitoring and reporting programmes aim to identify and quantify the risks associated with use of medicines which are being commonly using in that field. This may helpful in better and safe prescribing practices, and would improve the knowledge and competence of prescribers. We describe here the activities of related to pharmacovigilance at the ESIC Medical College and Hospital (ESIC MCH), Hyderabad.
Methodology: The centre became an AMC and started its activities in August 2020. The presentation gives a glimpse of the training activities, and the measures taken to ensure continued reporting. A snapshot of the ADRs reported in the field of addiction psychiatry is also presented.
Results:Over the course of 2 years, about 550 ADRs have been reported. The medications commonly implicated included naltrexone, topiramate, baclofen and disulfiram. The challenges to continued reporting include sustaining motivation and training in reporting procedures. To make training flexible, online presentation of training has been initiated with knowledge check through a brief online questionnaire. Acknowledgements of the efforts of reporters are done through token appreciations. Active efforts from the pharmacovigilance associate from pharmacology department have helped to sustain the reporting.
Conclusions:The ESIC MCH provides a unique setting of generating ADR reports with respect to substance use disorders. Concerted efforts need to continue at micro and macro levels for effective ground implementation of the Pharmacovigilance Programme of India.
Psychological assessment and profile of patients presenting with delirium from a tertiary care hospital: A cross sectional, observational design.
Naveen Kumar Dhagudu,* Deepika Kommu
Department of Psychiatry and ESIC Medical College and Hospital, Hyderabad
Background: Delirium is a common and acute medical emergency condition. Knowing its aetiology and risk factor profile is essential to get prompt treatment.
Methodology: A cross-sectional observational study in 35 potential study subjects with delirium who were admitted from various departments. All patients were also subjected to assess their psychological condition with Family Confusion Assessment Method (FCAM), Confusion Assessment Method (CAM), and Mini Mental Status Examination (MMSE) apart from collecting the clinical and socio-demographic details.
Results: Majority among the 30 study subjects with delirium were belongs to <60 years age (73.33%), rural background (66.6%) and nuclear family type (86.5%). 26 members were men (86.67%).we were able to identify most common possible precipitating cause of an acute confusional state such as alcohol withdrawal state with delirium (70%), followed by the other medical cause (30%) such as stroke, septic shock, atropine poisoning, uremic encephalopathy, post-surgical intervention and COPD. Delirium incidence and severity had significant association with depressive disorder (p=<0.001).
Discussion: Precipitant or predisposing causes for delirium were heterogeneous, predominant observable finding was alcohol withdrawal complication followed by depression. Hence, identification of alcohol use disorders and depressive conditions in the context of delirium presentation is essential to early recognition and management which has implication in prevention delirium sequalae aftermath.
Level of Internet addiction and its co-relation with sleep disturbance among medical students
Background- Internet became an integral part of everyday’s life in the modern era of digitization. Also, its addiction has emerged as serious affliction. Internet addiction and the associated sleep disturbance can restrict medical students from acquiring psychophysiological capabilities; thereby this study is being carried out.
Aims- To find level of internet addiction and its relationship with insomnia.
Methods- Cross sectional survey conducted in SDMCMSH, Dharwad. Total number of 400 medical students aged 18 years and above were selected and their level of internet usage was assessed using Internet addiction test which was then correlated to the sleep disturbances using Insomnia severity index.
Result- There was significant association found between sleep disturbance in students having severe internet addiction
Conclusion- A holistic approach is required to limit the use of internet among medical students by involving and educating them about adverse consequences of internet addiction and associated sleep disturbances.
KEYWORD- Internet addiction, insomnia, medical students
Burden of care in caregivers of patients with Schizophrenia in Greater Noida,U.P ,India
Dr.Nikita Maan 1,Dr.Kunal Kumar 2,Dr.Abhinit Kumar 3,Dr.Shruti sharma 4,Dr.Nikhil Nayar 5,Dr.Swaleha 6,Dr.Chaitanya Sheoran 7,Dr.Siddharth Bhargava, Dr.Parika Kochhar
1-Junior resident, 2-Professor & head, 3-professor , 4- Assistant prof, 5-Assistant professor, 6- Senior resident, 7-Junior resident
Background: Schizophrenia is a serious mental illness that causes major functional impairments, raises the risk of disability, and reduces life expectancy. It affects around 7 in 1000 people b/w the age of 15 and 35 years. Schizophrenia poses a great challenge not only for the patient but also for the people and the society around the patient. Family members who serve as informal primary carers may suffer personal expenses as a result of providing care for those who have major mental illnesses. One outcome that is regularly studied is caregiver burden, or the challenges encountered in providing care.
AIMS: Burden of care in caregivers of patients with schizophrenia in greater Noida,U.P ,India
Methods: This cross sectional study was carried out at school of medical sciences and research, sharda university .We enrolled 100 caregivers and it is assessed through the burden assessment scale.
Results: Caregivers ranged in age from 20 to 85, with a mean age of 47 (SD=14.1). The male to female ratio was 1.7, with 63 men and 37 women present. Majority of the caregivers were parents (n=54), siblings (n=9), spouses (n=10), or their children (n=5). On burden assessment scale,severity of burden was found on the basis of mild,moderate,severe and v.severe.
Conclusion: It is important to understand mental health of caregivers in order to develop appropriate intervention to deal with their mental health problems. Therefore, this study highlighted the need for psychological interventions not only to the patients but also to caregivers.
Attitude towards Homosexuality among Medical students - A cross-sectional study in Southern part of India
Niranjan Hebbar YR, Soumya Hegde
Western countries have found that Medical students have a prejudice and negative attitude towards homosexuality. There is a dearth of literature on homosexuality in Indian context. The objective of the study was to assess the attitude towards homosexuality and to find out the predictors of attitude towards Homosexuality. A cross-sectional study was conducted among medical students across Mangalore, India with a sample size of 672. After informed consent, data was collected and analysed. The study found that medical students had a neutral stance/less positive on homosexuality. Gender and Marital status emerged as predictors of attitude towards homosexuality.
KEYWORDS: Homosexuality, Attitude, Medical students, India
Psychiatrist morbidities among patients with Prurigo Nodularis: A cross sectional study in a tertiary care hospital south Indian
Niranjan Hebbar YR, Soumya Hegde
Assistant Professor, Dept of Psychiatry, SUIMS, shivmogga
Assistant Professor, Dept of dermatology, SUIMS, shivmogga
Prurigo nodularis (PN) is a dermatologic itchy condition which affects the normal day to day life activities. Due to its chronic condition psychiatric comorbidities are regularly seen in these patients. Due to scarcity of literature in Indian background this study was conducted in our tertiary care centre. Materials and methodology- It was a descriptive, cross sectional study conducted at department of dermatology during May 2021 to April 2022 where all diagnosed PN patients were screened for psychiatric comorbidities using MINI- International Neuropsychiatric interview. Results- We found Generalised Anxiety Disorder among 27.2% and Major Depressive Disorder among 15.8% of study population. Also Social phobia among 16.8% of males. Majority of 61% in both males and females didn’t had any psychiatric disorders in our study sample. Conclusion-Higher incidences of anxiety, depression, somatization were found in our study sample thus highlighting the importance of psychiatric consultation liaison for chronic skin conditions.
Keywords- Prurigo Nodularis, Anxiety, Somatization, Depression
ANTI-NMDA ENCEPHALITIS: A DIFFERENTIAL DIAGNOSIS FOR PSYCHOSIS
DR. NISHA (SENIOR RESIDENT, MD PSYCHIATRY, IHBAS)
EMAIL –prajapatinisha163@gmail.com
PH NO.- 9758744610
Background: Anti NMDR (N-methyl-d-aspartate receptor) encephalitis is a common type of autoimmune encephalitis characterised by neuropsychiatric syndrome. a majority of patient experience a non-specific prodromal phase and often followed by psychiatric symptoms. This is the phase most patient consult doctors and are usually misdiagnosed leading to delay in proper treatment.
Clinical Case: A 26y married female, 6 months post-partum, with no past h/o psychiatric illness, with family history of psychosis in mother presented with an episode of fever 1 month back and 20 days of illness characterised by low mood, irritability, fatigue, anhedonia and apprehension regarding her child. over next 5 days her symptoms changed to aggression, inappropriate laughing to self and ideas of persecution. Within 24 hrs picture changed again to catatonia with autonomic dysfunction. csf examination showed lymphocyte elevation and anti-nmda antibodies. She was started on ivig which was ineffective and later treated with 6 cycles of rituximab.
Conclusion: This case presented with a diagnostic challenge with rapidly changing picture of psychiatric symptoms initially and later maifestation of neurological symptoms. This case demonstrates many of the core features of anti-nmda receptor encephalitis. It will help the clinician to understand and early consideration of anti-nmda-r encephalitis in the differential diagnosis of a patient presented with suspected psychiatric diagnosis.
Discussion: NMDA-receptors are normally found throughout the central nervous system, mediating a critical role in synaptic transmission and plasticity. in patients with anti-nmda-r encephalitis, antibodies are directed towards the nr1 and nr2 heteromers of nmda-receptors. they affect areas responsible for memory, personality, movement and autonomic control, accounting for the unique confluence of personality, behaviour changes and impairments in cognition.
Demographic and clinical profile of patients with acute and transient psychosis receiving ECT
Nishtha Chaurasia, Sandeep Grover, Subho Chakrabarti
Department of Psychiatry, Post Graduate Institute of Medical Education & Research, Chandigarh
Background: Despite being an effective and safe treatment, usefulness of electroconvulsive therapy (ECT) in patients with acute and transient psychosis (ATP) have not being researched adequately. Aim: To assess demographic and clinical profile of ATP patients receiving ECT. Methodology: Using a retrospective study design, ECT register of the department was reviewed for the period of 2009 to 2022 to identify the patients with diagnosis of ATP, who received ECT. The treatment records of the these patients were evaluated to extract the demographic and clinical profile. .Results: During the study period, 20 patients diagnosed with ATP received ECT with 2 patients receiving 2 courses of ECT and 1 patient receiving 3 ECT courses. The majority of patients with ATP who received ECT were females (79.2%), were inpatients at the time of receiving ECT (75%). The mean age of study sample was 31.54 (SD- 12.7) years and mean number of ECTs given in a course of ECT were 8 (SD- 5.4). In majority of the patients, ECT was used because of marked agitation, poor response to medication, and catatonic symptoms. Most of the patients showed very good response to ECT Conclusion: Although, ECT is less frequently used for management of ATP, when used, its use is associated with significant clinical improvement.
Impact of Covid-19 on mental health of healthcare professionals working in Covid-19 designated clinical areas in SDMCMSH-Dharwad.
INTRODUCTION
Healthcare workers (HCWs), at the heart of the unparalleled crisis of COVID-19, face challenges treating patients with COVID-19 . The psychological burden and overall wellness of HCWs has received heightened awareness showing high rates of burnout, psychological stress, and suicide. HCWs experience emotional exhaustion, which may lead to medical errors, lack of empathy in treating patients, lower productivity, and higher turnover rates..
AIM
To determine the impact of COVID-19 on HCWs including (Consultants, Postgraduate students- both medical and naturopathy, Interns and Nursing staff) and to identify the potential risk factors .
METHOD
A web based cross-sectional study done in SDM, Dharwad was done among 50 participants to identify the main mental health outcomes that include Depression, Anxiety, Insomnia and Distress using Patient health questionnaire (PHQ-9), Generalized anxiety disorder (GAD-7) scale , Insomnia severity index and The impact of event scale-revised.
RESULT
Out of 50 participants , 38(76%) were in age group of 26-30 years,31 (62%) were females and 28(56%) were Post graduates,10 (20%) Interns and 10(24%) Nursing staff. This study found that mod-severe GAD was seen in 6 % participants,2 % had high PTSD & mod-severe Depression was seen in 3 (6%) & 1(2%) had mod Insomnia
CONCLUSION
It is thus very important to assess the prevalence of psychological manifestations in the HCWs and help them to adequately cope with stressors to function adequately.
Cognitive functioning and Metacognitive beliefs in relation with severity of Depression
P. Rohith Reddy, Vijay Raj Pratheek. P,Ganta Akhila, K. Ashok Reddy.
Department of Psychiatry, SVS Medical College, Mahabubnagar
Background:Neurovegetative symptoms and Cognitive dysfunction is found to be common in depression. Though it was initially found that cognitive functions are associated with acute phase of depression, further lot of heterogenicity is found regarding cognitive functions in depression. Metacognition refers to interpretation of thinking itself. Metacognitive beliefs in psychological disorders can guide the activity of thinking and coping. More specifically, individuals have positive and negative beliefs about thinking that influences appraisals which can in turn affect cognitive functioning.
Aim: To assess cognitive functioning and metacognitive beliefs in patients with Major Depressive Disorder.
Methods: The study is a cross-sectional study conducted in Department of Psychiatry, SVS Medical College, Mahabubnagar. HAM-D (Hamilton Scale for Depression) was used to assess severity, MoCA (Montreal Cognitive Assessment) and CPFQ (Cognitive and Physical Functioning Questionnaire) to assess cognitive functioning. MCQ-30 (Metacognition Questionnaire – 30) to assess metacognitive beliefs.
Observations and Results: A total of 40 patients with Major Depressive Disorder were recruited in the study. Executive functioning and memory impairment was associated with severity of depression (p<0.05). Poor Cognitive functioning was related with lack of cognitive confidence and negative metacognitive beliefs (p<0.05).
Conclusion: The study found deficits in cognitive functioning and negative metacognitive beliefs. This can have significant implications on planning early interventions and improving functional outcomes.
Keywords: Cognition, Metacognitive beliefs, Depression
A Study on Body Image Perception in Pregnancy
Dr. P. Sri Sandhya1, Dr. N. Anusha2, Dr. N.N. Raju3
1-Post Graduate, 2- Associate Professor, 3- Professor and HOD, Department of
Psychiatry, Gayatri Vidya Parishad Institute of Health Care and Medical Technology, Visakhapatnam
BACKGROUND: Body image of a woman is her psychological representation of her body consisting of self- perceptions of her appearance and attitudes, developing from various biological, social, and psychological influences. This can be significantly affected by extensive physical changes during pregnancy and postpartum. Discrepancies between socially constructed ideals of physical characteristics of a woman and a woman’s body image can lead to body dissatisfaction and significant psychological distress.
AIMS: To study the impact of pregnancy related changes on a woman’s body image and perception.
METHODS: 100 pregnant women attending obstetrics department of a tertiary care hospital were assessed after taking their informed consent. Sociodemographic data was collected. Body image perception during pregnancy was assessed using Body Attitude Questionnaire [BAQ]. Psychological distress was assessed using Kessler Psychological Distress Scale [K10].
RESULTS: Data collection has started, and results will be presented at the conference.
Assessment of mental capacity and its associated factors related to treatment decisions among patients with major mental illnesses under remission.
Padmavathi Nagarajan1, Subasri2, Moushumi Purkayastha Mukherjee3
1. Assistant Professor ,College of Nursing, JIPMER, Pondicherry
2. Post Graduate in Psychiatric Nursing, College of Nursing, JIPMER, Pondicherry
3. Professor & Head, Department of Psychiatry, JIPMER, Pondicherry
Introduction
Indian mental health legislation allows treatment and supported admission for mental illnesses only when individual lacks capacity for mental health care decisions. Mental capacity related laws provide important safeguards to patient’s rights and help clinicians in dealing with capacity problems. Mental capacity assessment is crucial requisite to assist and support the person with mental illness in decision about their treatment.
Aim: This study was aimed to assess the mental capacity of patients with major mental illnesses.
Methodology
A Cross- sectional analytical research design was adopted and 369 patients were selected using consecutive sampling. Capacity Assessment for treatment Decision Guidance Document as per Section 81 of Mental Healthcare Act, 2017 for Medical Practitioners and Mental Health Professionals given by Ministry of Health and Family Welfare was used to assess the mental capacity of patients with major mental illnesses.
Results
Out of 369 patients, 80 (21.7%) reported that they were not provided relevant information about their mental healthcare and treatment pertaining to illness; 59 (16%) did not acknowledge that they have mental illness; 310 (93.7%) were able to explain why they agreed to receive treatment; 18 (52.9%) explained why they had not agreed to receive treatment and 3(75%) were able to communicate their decision by means of verbal and non-verbal or by any other means.
Conclusion
The present study concluded that 298 (80.8%) patients had mental capacity for making treatment related decision and 71(19.2%) needed support from nominated representatives. There was a significant association (P< 0.05) between clinical diagnosis and marital status with mental capacity among patients with major mental illnesses.
Keywords: Mental capacity, major mental illnesses
A Study on Prevalence of Internet Addiction in Patient attending Psychiatry Outpatient Department
Dr. Padmini Sahu1, Dr. G. Sravani2, Dr. N.N. Raju3,
1-Post Graduate, 2- Senior Resident, 3 - Professor& HOD, Department of Psychiatry, Gayatri Vidya Parishad Institute of Health Care and Medical Technology, Visakhapatnam, Andhra Pradesh.
Background: Internet addiction is a type of behavioural addiction. It includes form of Internet-enabled behaviour such as online video gaming, and socializing through social media, Loss of interest in previous hobbies and entertainment, excessive use of internet to escape or relieve a negative mood; history of loss of job, significant relationship, career opportunity because of excessive time spends with Internet use. Time period for internet addiction is 12 months according to DSM-5. In 2021, active internet users were, 4.66 billion, means that the Global population more than 59% is currently using internet. The shift from in-person learning to online education is associated with higher odds of having generalized anxiety and being depressed.
Aims and Objectives: To study the prevalence of use of internet in patients attending Psychiatry outpatient department. An additional aim is to examine the relationship between internet addiction and mental health problems such as subjective sleep quality, depression and anxiety symptoms and overall wellbeing.
Methodology: The cross-sectional study in 100 patient attending Psychiatry outpatient department after informed consent, sociodemographic data was collected, we used, MINI International Neuropsychiatric Interview (M.I.N.I.), Young’s Internet addiction Test (IAT).
Results: Data collection has started and results will be presented at the conference.
Role of Folic acid as adjuvant treatment in Schizophrenia: a randomized controlled trial
Parul Saxena1 Sudhir Kumar2 Kunwar Vaibhav3
1-Senior Resident, RDASMC, Ayodhya 2-Professor, Department of Psychiatry, HIMS, Lucknow
3-Assistant Professor, Department of Psychiatry, RDASMC, Ayodhya
Introduction-The interplay of dietary folic acid intake with common genetic variants that influence folate metabolism, has potential implications for schizophrenia pathogenesis and treatment. Therefore, its deficiency has been identified as a risk factor for schizophrenia.
Aim-To assess the efficacy of Folic acid supplementation on severity of symptoms and overall functional status of patients.
Method-A randomized control trial study was carried out in the inpatient department of a psychiatric tertiary care centre. The study was done on 40 participants (29 males and 11 females) between the ages of 18 – 55 years who met diagnostic criteria of schizophrenia (ICD 10) and had at least 2 years of illness duration while those with a co-morbid psychiatric illness, medical illness, substance abuse was excluded. The participants were then randomly allocated into two groups (experimental Group A which received 5mg folic/day along with anti-psychotic drugs and control Group B) and followed up for 3 months. Symptom severity was measured using the Positive and Negative Syndrome Scale and the Global Assessment of Functioning scale (GAF) for functional status.
Results- A significant difference (p value< 0.05) was observed in PANSS positive, general and total score and also in GAF scores at the end of the study between both groups.
Conclusion- Folic acid can be considered an adjuvant treatment in schizophrenia.
Reassessing the utility of electroconvulsive therapy in light of MHCA 2017: a retrospective data based study in a tertiary care hospital.
Introduction:
Electro-Convulsive Therapy (ECT) refers to the electrical stimulation of the brain to produce seizures for therapeutic purpose. ECT has been indicated in numerous psychiatric illnesses and has proved to be beneficial for the patients in clinical practice to a large extent.
In this study we have examined details of 300 patients and their treatment outcome .
The study aims to reflect the benefits of ECT in clinical practice and the need to reassess the aversions that prevails in our society against ECT.
Methods: The given study was a retrospective data based study carried out in a tertiary care hospital.The data was collected from ECT record book and we have studied the details of 300 patients who received ECT in the span of one year from august 2017 to august 2022. The details included patient demographic details of patient , diagnosis , ECT administration and treatment outcomes.Descriptive statistics will be used to analyse the data using appropriate software.
Results: Results are awaited.
Clinical profile of women on agonist maintenance treatment: Data from a tertiary centre in India
Choudhury Hemant, *Mandal Piyali, Ambekar Atul
National Drug Dependence Centre & Department of Psychiatry
All India Institute of Medical sciences, New Delhi
India
*Corresponding and presenting author
Email: piyum 2008@gmail.com
Background: Opioid Agonist Treatment is considered the most effective treatment for opioid dependence. There is little research on Indian women on agonist maintenance treatment for opioid dependence.
Aims: To describe the socio-demographic and clinical profile of women on Buprenorphine-naloxone maintenance treatment for opioid dependence
Methods: Medical records of women with opioid dependence syndrome (as per ICD 10) and receiving Buprenorphine-naloxone maintenance treatment from the Women’s clinic of a tertiary Addiction treatment centre, during data collection (March 2021), were retrieved and selected for the chart-review. Data was analyzed using licensed version of spss 21.
Results: Data was collected for 19 females, with a mean age of 42.7±10.6years, 14 were married, 15 belonged to nuclear families, 11 were formally educated. The primary opioid use at the time of presentation were heroin (10), pharmaceutical opioid (8) and 7 were injecting. Mean age at onset of opioid use was 27± 11.2 years (median 25 years), mean duration of untreated opioid dependence was 11.1±7.3 years. Most common reason for initiation was a pain condition (8), pressure from partner (3). Only 6 women reported past abstinence attempt. Median duration of buprenorphine-naloxone treatment was 200 months (1 received for <3 months, 4 for 3-12 months and 15 (78.9%) for >12 months), 18 (95%) reported complete abstinence and 12 (> 60%) of them reported improvement in functioning since initiation of maintenance treatment.
Conclusion: This is the first clinic- based case series on women on agonist maintenance treatment and highlights the need more research and data for overcoming the challenges in providing treatment to this demographic group.
“Psycho-social correlates of drug use among attendees of Women’s Clinic of national level addiction treatment centre”
*Mandal Piyali
National Drug Dependence Centre & Department of Psychiatry
All India Institute of Medical sciences, New Delhi, India
*Presenting author
Email: piyum 2008@gmail.com
Background: Substance use disorders in Indian woman have been known to exist for a long time, but the discipline suffers from a scarcity of gender-related data. The association of certain psycho-social factors make them unique and a difficult to treat population. Hence it is imperative to study the psycho-social correlates of substance-use among women.
Aims: To study the personality and other psycho-social factors among women who use drugs (WWUD) seeking treatment at a national level addiction treatment centre.
Methods: This cross-sectional study on women drug users attending Women’s clinic (N=50, control=30) of a national level substance use treatment centre during the study period assessed the participants using semi-structured questionnaires and validated instruments after obtaining informed written consent. The data was analyzed using licensed SPSS 21.
Results: The female substance user and control group did not differ regarding socio-demographic parameters. The women substance users were characterized by significantly higher score of neuroticism, less openness (p<0.05), less agreeableness (p<0.05), high score in intra-punitive response (p<0.05) and Obstacle –dominance, OD (p<0.05) and low perceived social support. compared to the control group (p<0.05). Self-stigma in all three subscales were in the middle to high score range and scored more in social and familial scale of ASI correlated with more self-stigma among women substance users.
Conclusion: This is the first study from India reporting on the personality and psycho-social factors associated with substance use among treatment seeking women. The study findings highlight the need for further research on from gender perspective.
GGT AND PLATELET COUNT AS PREDICTORS FOR SEVERITY OF ALCOHOL WITHDRAWAL DELIRIUM – CROSS SECTIONAL STUDY
DR. POOLA PRERANA
DR.K. ASHOK REDDY , DR. VIJAY RAJ PRATHEEK , DR. G .AKHILA , DR. P. SRISHTI DRAVID.
AFFILIATION AND DESIGNATION OF PRESENTING AUTHOR: KNRUHS , DEPARTMENT OF PSYCHIATRY, SVS MEDICAL COLLEGE, MAHABUBNAGAR , MD PSYCHIATRY- JUNIOR RESIDENT FINAL YEAR.
EMAIL OF PRESENTING AUTHOR: poolaprerana006@gmail.com
PHONE NO OF PRESENTING AUTHOR : 9573589206
BACKGROUND – Delirium tremens or alcohol withdrawal delirium is a severe complication of alcohol dependence. There are many dilemmas and controversies with respect to its occurrence, etiology, pathogenesis, evaluation and management of alcohol delirium tremens hence identifying accurate biomarkers may help solve the puzzle of its pathophysiology.
AIMS & OBJECTIVES - To study the relation between the levels of GGT (Gamma Glutamyl Transferase) and platelet count to severity of alcohol withdrawal delirium.
METHODOLOGY- Current study is a cross sectional observational study at SVS Hospital, Mahabubnagar. ICD-10 RDC was used for making diagnosis of alcohol withdrawal delirium. Semi-structured Proforma, Clinical Institute Withdrawal Assessment for Alcohol – Revised (CIWA- Ar) to assess the severity of alcohol withdrawal delirium after obtaining informed written consent. Investigations used were Platelet count and serum GGT values. IEC approval was taken.
RESULTS AND DISCUSSION:- The study results show that, mean age group was 41.27 ± 9.32. The platelet count was 1.56 ± 0.627 in lakhs/ml. The mean score of CIWA is 32.88 ± 10.10. Significant association was found in the values of CIWA scores and platelet counts, GGT (p<0.005).
CONCLUSION:-. Platelet counts and Serum GGT values which are feasible and affordable might help in predicting the severity of complicated withdrawal. Further larger studies on complicated withdrawal and biomarkers of DT can help in improving the outcome of Alcohol Dependence.
A CROSS SECTIONAL STUDY ON THE PREVALENCE OF PSYCHIATRIC COMORBIDITIES in moderate and severly affected COVID-19 infected patients admitted IN A TERTIARY CARE HOSPITAL IN west bengal
1.Dr.Prabir Seikh,2.Dr.Asim Kumar Mallick,3.Dr. Arnab Sarar and 4. Dr. Sulagna Saha
1. 3rd year Post Graduate Trainee, Department of Psychiatry, College of Medicine and Sagore Dutta Hospital, West Bengal (email id: pseih84@gmail.com, M-810058355).
2. Professor and Head, Department of Psychiatry, College of Medicine and Sagore Dutta Hospital, West Bengal.
3. Assistant Professor, Department of Psychiatry, College of Medicine and Sagore Dutta Hospital, West Bengal
4. Senior Resident, Department of Psychiatry, College of Medicine and Sagore Dutta Hospital, WWest Bengal.
Background: The COVID-19 pandemic caused by the novel Corona virus has impacted more than 200 countries.COVID-19 patients are frequently isolated and quarantined due to high infectivity thus adding to further mental stress in addition to physical symptoms, uncertainty, anger, stress and insecurity. It has given rise to various psychological problems such as anxiety, depression, fear of isolation, fear of dying, feeling of helplessness, insomnia and many more. The aim of this study is to investigate stress, anxiety, and depression in COVID-19 positive patients during the Corona pandemic in West Bengal.
Aims: To study the prevalence of psychiatric comorbidities lie stress, anxiety, depression in moderate and severely affected COVID 19 patients admitted in a tertiary care hospital in West Bengal.
Settings and Design: This cross sectional study was conducted at post COVID follow up clinic on 100 COVID-19 infected patients who were admitted in COVID ward of College of Medicine and Sagore Dutta Hospital, West Bengal.
Subjects and Methods: those EWS score more than equals to 5 and gave consent were selected as subjects and data was collected on socio demographic parameters and SRQ 24 was applied followed by assessment was done using the HAM-D for depression, HAM-A for anxiety, and PSS for stress in post COVID-19 patients at post COVID follow up clinic in the hospital. Statistical Analysis Used: SPSS 27.0 version for Microsoft Windows.
Results: 78% patients were suffering from moderate (N=78) and 22% from severe (N=22) COVID 19 infection. 57.0 % patients (N=57) were women and 43.0% (N=43) were men. The mean age of the patients was more in severe (50.6±12.8) compared to moderate (42.6±12.5) COVID-19 infection .Mean depression was more in severe (14.0±3.8) compared to moderate (5.57±2) (p<0.0001). Mean Anxiety was more in severe (16.72±11.6) compared to moderate (8.0±10.6.) (p=0.0014). Mean Stress was more in severe (20.18±3.36) compared moderate infection (19.0±3.2) (p=0.1397).
Conclusions: out of 100 COVID-19 patients majority were women and suffered from moderate COVID infection. Higher the age more the infection was found. Depression, Anxiety, Stress were more associated with the severe infection, low educated, lower socioeconomic status. Severe infection was commonly found among female, less educated, higher age, from rural area, lower economic status.
Key word: stress, anxiety, depression, psychiatric comorbidities, COVID 19 infection.
Assessment of decline of various cognitive domains in patient with obsessive-compulsive disorder
Background-: OCD is often chronic disorder and causes impairment of functional efficiency. Various researchers have found that cognitive dysfunction frequently present even when mild symptoms are present.
Aims: To assessment the various domains of cognitive function in OCD and their relation with clinical severities. We also compared the cognitive function of patients with OCD and their control.
Method: Total 60 subjects (30 incase group and 30 in control group) were taken for study. The study subjects (OCD group) were taken from psychiatric OPD and control group from general populations. The subjects of both the groups were screened as per inclusion and exclusion criteria and the Y-BOCS, ACE –III scales were applied.
Results: In the case group, 96.70% had a normal ACE-III score and 3.30% had an inconclusive score, while in the control group 100% had a normal score at ACE-III scale, On further scoring.60% patients have moderate and 33.3 % have severe score in the YBOCS scale. We have found the significant decline in total mean ACE-III scores between case and control group (p-value 0.000). and decline in memory domain with severity of illness was also significant (p-value 0.037)
Conclusion: Decline in Cognition domain of memory in patient with OCD, was significant in comparison to control group.
Keywords: OCD, Cognitive dysfunction
Dr. Pradeep Kumar, Senior Resident, Department of psychiatry, IMS, BHU, Varanasi.
Dr. Jai Singh Yadav, Professor, Department of psychiatry, IMS BHU, Varanasi. jsypsyjai@gmail.com
Address: - Department of Psychiatry, IMS, BHU, Varanasi.
Email: - pradeepky136@gmail.com
Contact: - 9450579653
First episode Mania after Ovulation induction with Human Chorionic Gonadotropin- A case report
Dr.Pradeepa.M(PG), Ph:9486931859
Background:
Gonadotropins have been associated with mood and anxiety symptoms. This case discusses the impact of exogenous hormones on psychiatric disease during ART procedures.
Case report:
A 29 year old married female reported to Out-patient department with complaints of increased energy, elevated mood, excessive speech, sleep disturbances, irritability and assaultive behaviour for one month. First episode. No past psychiatric history and family history. Mental status examination revealed increased psychomotor activity, overfamiliarity, pressured speech, flight of ideas and grandiose delusions. Past medical history revealed infertility treatment for primary infertility for past 5 years. Patient has undergone Laparoscopic ovarian drilling for Polycystic ovarian disease and hysteroscopic septal metroplasty for septate uterus a year back. One month back, she was started on clomiphene citrate 100mg OD from Day 2-6 of menstrual cycle followed by Injection human chorionic gonadotropin 7500IU on Day 13 and 14. Serial USG revealed dominant follicle. A diagnosis of First episode Mania was made and she was treated with T.Haloperidol 15mg , T.Sodium valproate 1200mg, T.Carbamazepine 400mg. there was improvement in young mania rating scale scores after 2 weeks. Endocrinology and gynecologist opinion sought.
Discussion:
To our knowledge, there has been only 2 reported cases of gonadotropins in an being a possible trigger for a manic episode. Temporal relationship of the exposure to gonadotropins and onset of manic symptoms, lack of a past psychiatric history points towards medication-induced manic episode.
Keywords: Gonadotropins, Mania, Infertility
Socio-demographic and Clinical Profiling of patients with Schizophrenia with predominantly Cognitive and Negative Symptoms in India
Praggapti Ghosh1, Dr. Nand Kumar1, Dr. Vaibhav Patil2, Dr. M V Padma Srivastava2, Dr. Rohit Verma1, Dr. Manoj Kumar3, Dr. M. Kalaivani4, Dr. Shiv Prasad5, Dr. Pankaj Verma6,Dr.Prakamya Singal1, Dr. Sujata Minhas1, Rashi Arora1,Srishti Asthana1
1. Department of Psychiatry, AIIMS New Delhi
2. Department of Neurology Cardio Neuro Centre, AIIMS New Delhi.
3. Department of Psychiatry, IHBAS Delhi
4. Department of Biostatistics, AIIMS, New Delhi
5. Department of Psychiatry, Lady Hardinge Medical College, Delhi
6. Department of Psychiatry, VMMC and Safdarjung Hospital Delhi
Presenter email- praggaptighosh@gmail.com
Background: Negative and cognitive symptoms of Schizophrenia contribute to significant impairment in socio-occupational function. Patients with predominantly negative and cognitive symptoms do not respond adequately to currently available interventions. A comprehensive analysis of this cohort can help delineate potential sociodemographic and clinical correlates of these symptoms allowing early identification and targeted interventions.
Objective: To explore socio-demographic and clinical correlates of patients with predominantly negative symptoms of Schizophrenia
Methodology: After due Institutional Ethical Clearance and obtaining written consent from participants, 347 patients diagnosed with Schizophrenia were screened from three tertiary care hospitals in Delhi under ICMR funded CARE project (Centre for Advanced Research and Excellence in Neuromodulation). Detailed sociodemographic data was obtained. Clinical symptoms were rated on the Scale for Assessment of Negative/Positive Symptoms (SANS/SAPS); cognitive symptoms were rated using PGI memory scale and Bender Visual Motor Gestalt Test (BVMGT).
Results: 84 patients (67% male and 33% female) with predominant negative symptoms were enrolled. With an average age of 31.47 ± 8.5 years, most patients had duration of illness of 9 ±5.8 years. Majority of the participants (68%) completed atleast secondary level of education, but only 8% had stable jobs. More than two-thirds never married. The average SAPS score (11.32 ± 9.6) and SANS score (70.86 ± 11.7) indicates high negative symptoms burden. The mean PGI-MS score was 20.45 ±7.4 while 82% of the patients had severe dysfunction on BVMGT.
Conclusion: Socio-demographic and clinical profile of patients with predominantly negative Schizophrenia can facilitate effective treatment for patients tailored to their symptoms.
Demographic and clinical profile of patients with postpartum catatonia receiving ECT
Pranshu Sharma, Sandeep Grover, Debasish Basu
Department of Psychiatry, Post Graduate Institute of Medical Education & Research, Chandigarh
Background: Whereas electroconvulsive therapy (ECT) is considered to be an effective treatment modality in severe depression and catatonia and brings about rapid clinical improvement, little is known about ECT during postpartum (PP) period. Aim: To assess demographic and clinical profile of PP catatonia patients receiving ECT. Methodology: Using a retrospective study design, ECT register of the department was reviewed for the period of 2019 to 2022 to identify the patients with diagnosis of PP catatonia, who received ECT. The treatment records of these patients were evaluated to extract the demographic and clinical profile. Results: During the study period, 6 patients diagnosed with PP catatonia received ECT ranging from 2-7, with the mean of 5.66 number of effective ECTs (SD- 2.80). The majority of patients with PP catatonia who received ECT were inpatients (66.7%) at the time of receiving ECT. The mean age of study sample was 27.33 (SD- 2.73) years. Apart from presence of catatonia, ECT was used because of requirement of early response, as treatment of choice, psychomotor retardation, poor response to medication, poor oral intake and suicidality. Most of the patients showed very good response to ECT Conclusion: Although, ECT is less frequently used for management of PP catatonia, when used, its use is associated with significant clinical improvement.
Family accommodation in obsessive-compulsive disorder: Prevalence, Dynamics, and Dimensions
Background: Obsessive-Compulsive Disorder (OCD) is a common psychiatric disorder with a global lifetime prevalence of 1-3%. OCD has a chronic course and variable outcomes. The obsessions and compulsions encompass diverse themes. With the closely knit social system of India, this illness leads to a varying degree of family members’ involvement and accommodation in obsessive-compulsive behaviours.
Aim: To determine the prevalence, nature, and severity of accommodating behaviors in caregivers of patients with OCD and identify their correlates/predictors.
Methods: A cross-sectional study was conducted at a tertiary care teaching hospital in north India. In those diagnosed with OCD according to DSM-5, Y-BOCS (Yale-Brown Obsessive Compulsive Scale) and DY-BOCS (Dimensional Yale-Brown Obsessive Compulsive Scale) were used to quantify OCD symptoms while FAS-IR (Family Accommodation Scale- Interviewer Rated) was used to measure accommodating behaviors in the primary caregiver.
Results:
Forty-eight patients and forty-eight caregivers were included in the study. 94% of the caregivers showed some degree of accommodating behaviors. A significant positive correlation was seen between FAS-IR scores and DY-BOCS and Y-BOCS scores. After applying multiple linear regression, the DY-BOCS was found to have significant association with FAS-IR score. It was also found that while the female caregivers had higher FAS-IR scores, the caregivers of female patients had lesser FAS-IR scores.
Conclusions: High levels of accommodating behaviors are seen in caregivers suggesting that OCD impacts the family members of the patients with OCD as well.
Typology and Prevalence of Psychosis, Bipolar affective disorder and Depression; by study of inpatient documents of a psychiatry ward in a tertiary care hospital: A Retrospective study.
Prof(Dr) Priyadarshee Patra, Dept of Psychiatry, INHS Asvini
Dr Om Panda, PG Resident, Dept of Psychiatry, INHS Asvini
BACKGROUND : Psychosis is a mental disorder in which ability to recognize reality and ability to communicate and relate to others are sufficiently impaired to interfere grossly with capacity to deal with reality. This includes schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, acute and transient psychotic disorder, psychotic disorder due to an organic condition and substance induced psychotic disorder. Worldwide prevalence rates remain constant (1-3%). The bipolar affective disorders (BPAD) commonly include BPAD I commonly referred to as manic depression, BPAD II and cyclothymia. The lifetime prevalence estimates of bipolar I (BP I) disorder of 3.3, Bipolar II (BP II) of 1.1 with corresponding 12 month rates of 2.0 and 0.8, respectively. Depression is quite prevalent and an estimated 5% of the adult world population has suffered from depression. It is estimated as high as 7% in US. Lifetime prevalence according to latest studies is 13.2% whereas 12-month prevalence is 5.3%. ICD-10 divides it into mild, moderate, severe and recurrent, with or without Psychotic symptoms. As limited literature is present on Indian population, this retrospective study aims to assess prevalence and typology of above-mentioned disorders in past one year, to allocate human resources and develop specialized center in tertiary care setup.
AIM:
1. Typology and prevalence of Psychosis in tertiary care center
2. Typology and prevalence of Bipolar Affective disorder in tertiary care center
3. Typology and prevalence of depression in tertiary care center
METHODOLOGY: A cross-sectional retrospective file review was carried out for all inpatient documents, freshly or previously diagnosed with Psychosis, BPAD or depression according to ICD-10 criteria, in psychiatry ward, in tertiary care hospital between Mar 2021 to Mar 2022. Socio-demographic, clinical and relevant assessments data were extracted from electronically saved opinions of Psychiatrists. Ms-Excel sheet was used to extrapolate data gathered and subsequently analyzed by SSPS. Prevalence of above-mentioned illnesses was calculated. Descriptive analysis were used for socio-demographic and clinical data.
RESULTS: 12 month prevalence of schizophrenia 50.2%, schizophreniform disorder 0.7%, schizoaffective disorder 2.2%, delusional disorder 27.8%, acute and transient psychotic disorder 9.4%, psychotic disorder due to an organic condition 5.2% and substance induced psychotic disorder 4.1%. BP I constitute 62.5% of all bipolar cases in 12 month period whereas BP II constituted 25% of the same. About 30% of patients diagnosed with depression had severe depressive features.
CONCLUSIONS: Findings underscore the important public health significance of depression, BPAD and Psychosis among Psychiatry inpatients and the need to improve screening and treatment access in this population.
Predicting the outcome of first episode psychosis subjects by assessing gray matter volume
Dr Rahul Bansal, Dr Praveen Arathil, Dr Arun Kuruppath
Background: Dorsolateral prefrontal cortex, Neurological Soft Signs and Cognitive impairment have been described as predictors of outcome of First Episode Psychosis. Aim: To find the predictors of clinical, social and functional outcome variables in a cohort of first episode non affective psychotic subjects. Settings & Design: A prospective follow up study was conducted from August 2018 to August 2020 in a tertiary care hospital of South India. Methods & Material: A semi-structure performa was given to all subjects for sociodemographic details. All subjects were assessed with Heidelberg scale, Bender Gestalt Test and underwent MRI Brain 3D volumetric scan to examine neurological soft signs, cognitive impairment, DLPFC volume at baseline respectively. Brief Psychiatric Rating Scale and Social and Occupational Functioning Assessment Scale scales were administered at baseline, 1 month and at three month follow up. At 3 months, clinical and socio-functional outcome was defined by BPRS scores and SOFAS scores. Statistical Analysis: Pearson’s correlation was found between DLPFC volume of all subjects, BPRS, BGT scores at baseline with BPRS and SOFAS at 3 months. To test the statistical significance of the comparison of mean values of all continuous clinical and demographic parameters between two groups of BPRS and SOFA, Mann Whitney U
test was used. Results: Smaller DLPFC volume predicted clinical, socio-functional outcome significantly. A significant moderate correlation was found between NSS and BPRS scores at baseline. Conclusion: Average right DLPFC volume was higher in good responders (4.80) compared to poor responders (2.95) which supports neurodevelopmental hypothesis.
Delirious mania: Learning from a case series
Dr. Raj Kumar Sahu1(presenter), Dr. Ajayveer Rana2
1Assistant Professor, Department of Psychiatry, ESIC Medical College and Hospital, Alwar, Rajasthan
2Psychiatry Post Graduate resident(3rd year), Institute of Human Behaviour and Allied Sciences, New Delhi
Background: Delirious mania aka Bell’s mania is a severe psychiatric syndrome characterized by the rapid onset of delirium, mania, and psychosis. Catatonic signs and autonomic dysfunction may accompany. Electroconvulsive therapy and high dose benzodiazepines provide effective management.
Aim: To understand the history, MSE findings, investigations to be done and treatment of delirious mania.
Method: 4 cases admitted to a government hospital were studied.
Case1-Patient N,40year old male, history of an episode of mania in the past.
Case 2- Patient S,22 year old female, known case of(k/c/o) BPAD.
Case 3- Patient K, 35 year old male, k/c/o BPAD with a history of delirious mania in the past.
Case 4- Patient A, 38 year old male, k/c/o BPAD.
Result: All of the patients’ initial presentation was characterized by irritability, increased energy, sleeplessness, impulsivity, increased goal directed activity, inappropriate sexual behaviour, emotional lability, hallucinations, grandiosity which had an acute onset and rapid progression. They had a history of mood disorder. They also showed clear signs of delirium, including fluctuations in attention, orientation, and recall. Catatonic signs of negativism, echolalia, echopraxia were present. No significant findings in haematological examination or imaging were found. The patients showed good response to IV Lorazepam/MECT.
Conclusion: In all cases of delirious mania all potential underlying etiologies must be searched for. Milder episodes of delirious mania may respond to antipsychotic drugs and mood stabilizers. Most cases show robust positive response to high doses of benzodiazepines and/or MECT.
Serum BDNF levels in patients with Major Depressive Disorder (MDD) and Healthy Controls: An Observational, Case Control Study
Background: Brain derived neurotrophic factor (BDNF) is hypothesized to play an important role in pathogenesis of major depression, with a growing number of studies indicating its lower levels in depressed patients. However, Indian data pertaining to BDNF in depressed individuals remains limited.
Aims: This study was aimed to measure serum BDNF levels among major depressive disorder (MDD) patients and compare it with healthy controls.
Methods: A total of 174 individuals were recruited (87 cases and 87 controls), from a tertiary care institute in North India. Cases comprised of adult patients with DSM-5 MDD, who were currently depressed (HAM-D>7). Exclusion criteria included comorbid psychiatric diagnosis, substance use disorder (except for nicotine dependence), significant medical or neurological illness and recent neuromodulation. Healthy individuals with no known medical or psychiatric disorders were included as controls. Serum BDNF levels were assayed using enzyme-linked immunosorbent assay (ELISA).
Results: Mean age (35.32±11.69 vs 36.37±10.42, p>0.05) and gender (48% males,52% females) was comparable across study groups. Mean serum BDNF level was significantly lower in cases (1.33±1.77 pg/ml) compared to controls (2.33±2.59 pg/ml), with a significant group difference (U: 2598.50 p=0.001). Mean BDNF levels in cases was significantly lower than controls for female gender (1.25±1.47 vs. 2.56±2.48 pg/ml; p=0.003) but not for male gender.
Conclusion: Patients with MDD patients had a lower serum BDNF compared to healthy controls, which is consistent with available literature. The gender-specific difference in the study finding warrants further exploration.
Raja Babu Ramawat*, Rizwana Quraishi, Raman Deep, Raka Jain
Self-enucleation of right eye in a male patient with bipolar disorder presenting as acute mania: A case report
Background: Self-enucleation or oedipism, a self-inflicted, complete removal of one’s own eye, is a rare form of self-mutilation typically associated with psychiatric disorders like schizophrenia, substance-induced psychosis, or bipolar disorder. Since first reported case in 1846, over 50 cases of self-enucleation have been published in literature so far. Here, we report a patient of bipolar disorder presenting with acute mania and self-enucleation of right eye.
Case Report: A 34-year-old male was brought by police to our hospital emergency department with alleged history of roaming around in blood-stained clothes being persistently irritable, verbally abusive, having verbal and physical altercation with strangers over trivial issues and sudden unprovoked enucleation of his right eye with fingers a few hours back. History revealed no known medical comorbidity, history of bipolar disorder for last 10 years (two episodes of mania in past and off-medication for last 3 weeks and current symptoms started around 10 days back with history of decreased need for sleep, euphoric mood, over-spending, over-religiosity, over-grooming, persecutory delusions, grandeur delusions, erotomanic delusion towards a Bollywood actress, for whose live concert patient flew to the current city and while searching for the event venue had delusional misinterpretation of cues and conversations of people around as their plan to sexually assault the actress he presumed to be in love with, thus, patient developed extreme anger, rage towards them as well as a sense of guilt due not inability to help her, leading to a sudden intolerable inner tension and patient found himself unable to breath properly and at once enucleated his right eye with his right hand reportedly to relieve the unbearable distress and state of breathlessness. On examination being conscious, oriented to time, place and person, non-cooperative for local examination which showed enucleated right eye ball, swollen eye lids with occasional full opening left eye, with watery discharge both eyes. Mental status examination showed combativeness (requiring physical restraint and repeated injectable haloperidol up to 20 mg/day), increased rate and volume, occasional irrelevant, non-goal directed speech, irritable affect, prolixity in thought flow, erotomanic delusion, grandeur delusions, persecutory delusion, almost no concern about enucleated eye ball, impaired judgment, and insight 1/5 (baseline YMRS-45). With a working diagnosis of bipolar disorder current episode mania with psychotic symptoms, patient was transferred to psychiatry inpatient unit after primary ophthalmological intervention. Ongoing dose of haloperidol 20 mg/day continued, and in view of past response, lithium started at 900 mg/day. All routine investigation within normal limits (WNLs) and urine toxicology was negative. No underlying neurological etiology could be found (MRI Brain- Normal study; Anti TPO antibody- Negative; Autoimmune profile- Negative; PET-CT (Brain)-WNLs; EEG-Normal study). Regular dressing and eye care was provided by ophthalmology team. NCCT (orbit) determined extent of injury and ruled out presence of any foreign body. Around three weeks following admission, patient achieved full remission of target psychiatric symptoms (YMRS-3). Dose of haloperidol optimised to 10 mg/day because of excessive sedation and extrapyramidal symptoms. Patient discharged after four weeks of hospital stay on lithium 1050 mg/day (S. Li-0.8 meq/L) and haloperidol 10 mg/day. Patient underwent ocular prosthesis implantation after two months and continued to maintain well in the next six month follow up period.
Discussion: Self-inflicted eye injuries are rare and difficult to predict. While motivations seem to vary frequently ensuing from various psychotic conditions, but hyper-sexual or hyper-religious delusions have often been seen as reasons behind such extreme forms of self-mutilation. This case report adds to the currently scarce literature on oedipism, or self-mutilation related to underlying psychiatric disorders. Further studies are required to substantiate or rule out any neurobiological or psychological basis for such extreme of self-mutilating behavior.
Keywords: Self-enucleation, Oedipism, Self-mutilation, Erotomania
A comparative study of Interleukin-6 among patients with Major Depressive Disorder and Healthy control
Rajiv Gurung1, Sanjiba Dutta1, Samrat Singh Bhandari1, Rinchen Doma Bhutia 2,Chandra Shekhar Sharma 3
1Department of Psychiatry, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University.
2Department of Biochemistry, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University.
3Department of Psychiatry, S.T.N.M Multispeciality Hospital.
Corresponding author: Dr Rajiv Gurung; Email:raaz11_gng@yahoo.com, 7872978107
Background: Depression is a common mental disorder affecting approximately 280 million people worldwide and one of the leading causes of disability globally. The causes of depression are considered to be multifactorial and one of which is the inflammatory hypothesis.
Objective: To assess serum Interleukin-6 (IL-6) level among participants with major depressive disorder (MDD) and compare with the age and gender matched healthy control. Secondly, to correlate specific depressive symptoms with IL-6 levels.
Material and Methods: This cross-sectional study included 83 MDD patients and 82 unrelated healthy controls. Depression was rated with Hamilton Rating Scale for Depression (HAM-D). Analysis of serum IL-6 was done with commercially available ELISA 96 test kit.
Result: The median (IQR) IL-6 level among cases was 30.45(6.95, 84.70) which was significantly higher than that of control, 11.75(2, 42.75), (p < 0.001, rank biserial correlation = 0.31). We found a weak but significant positive correlation of IL-6 level with HAM-D subscale score of depressed mood, feeling of guilt, suicide, agitation, psychic and somatic anxiety, general somatic syndrome, and hypochondriasis
Conclusion: The current finding and study suggests that increased serum IL-6 level among patients with MDD favouring the inflammatory hypothesis of depression.
Keyword: Depression, Interleukin-6, Inflammatory hypothesis, suicide, guilt, ELISA
HYPOKALEMIA AND THROMBOCYTOPENIA IN ALCOHOL WITHDRAWAL PATIENTS WITH AND WITHOUT DELIRIUM TREMENS: A COMPARATIVE STUDY.
Dr. Rakesh PolicePatil1(Presenter), Dr. Alok Ghanate2
3. Postgraduate resident, Department of psychiatry, MRMC, Kalaburagi.
4. Professor and HOD, Department of psychiatry, MRMC, Kalaburagi.
BACKGROUND
Alcohol withdrawal(AW) occurs in alcohol-dependent individuals who abruptly reduce or discontinue their alcohol consumption. The most severe manifestation of alcohol withdrawal is delirium tremens(DT). Many risk factors for DT have been identified, including comorbid medical illness or infections, Hypokalemia and Thrombocytopenia. Hence, the present study was undertaken to investigate the association of Delirium Tremens with hypokalaemia and thrombocytopenia in our population.
AIM:
To compare the platelet counts, serum potassium levels of the alcohol withdrawal patients with and without delirium tremens.
METHODOLOGY:
By using simple random sampling, 60 alcohol dependence syndrome patients currently in withdrawal (30 with and 30 without delirium tremens) were enrolled in the study. Patients giving consent for the study were assessed for socio-demographic profile and alcohol history. The CIWA-AR scale was applied and required investigation were carried out for the study. Data is analysed using IBM SPSS Software 20.0
RESULTS:
In our study, thrombocytopenia was observed in 18(60%) of the delirium patients and 07(23.33%) of the non-delirium patients, which was statistically significant(p<0.0001). Average platelet count is 1.52±0.49L among patients with delirium and 2.27±0.78L cells/mm3 without delirium. The average platelet among both groups were statistically significant(p<0.0001). Hypokalemia was found in 13(43.33%) of the delirium patients, compared to 5(16.67%) of the non-delirium group, which was statistically significant(p<0.0001).
CONCLUSION
In our study, thrombocytopenia and hypokalaemia were seen higher among alcohol withdrawal patients with delirium. A clinician should identify these risk factors in simple alcohol withdrawal which could predict the occurrence of delirium tremens.
Delirium Tremens, Hypokalemia, Thrombocytopenia.
DEPRESSION AND INTERLEUKIN-6 LEVELS: A CASE CONTROL STUDY
Dr Ranjit Singh1, Dr Suresh Gocher, Dr Sumeet Kaur Madaan, Dr Sushil Kherada
BACKGROUND: Depression is one of the commonest disorders worldwide and is considered to be the fourth leading source of global burden of disease. There is growing evidence of a relationship between inflammation and psychiatric illness. In particular, the cytokine Interleukin-6 (IL-6) has been linked to stress-related disorders such as depression. This study was conducted to observe any possible relationship between interleukin-6 levels and depression.
METHOD: This study was conducted in the Department of Psychiatry, RNT Medical college, Udaipur from July to November 2022. Patients with newly diagnosed Depression and relapsed cases of depression (treatment naive) were taken into study as cases (50) after they met inclusion and exclusion criteria. Same number of controls were taken. All cases and controls were assessed with self-designed proforma, Modified kuppuswamy scale, HAM-D score and Serum Interleukin 6 values.
RESULTS : Analysis showed higher mean value of IL-6 among cases than in controls (p value: 0.001). Among cases, patients with family history of depression were found to have higher value of IL-6 (p-value: 0.032). Patients with longer duration of illness were also found to have higher values of IL-6 (p-value: 0.013).
CONCLUSION: Significant difference was observed in the S. IL-6 value between Cases and Controls and a positive correlation was also found between higher IL-6 values and duration of illness indicating the possible inflammatory etiopathogenesis of depressive disorder.
Electroconvulsive therapy in twenty first century: Future prospects in the light of right based psychiatric practices in India
Ravi Mohan Sharma, Neeraj Raj B
Background: Electroconvulsive therapy (ECT) has been considered as a safe and effective treatment for many psychiatric disorders. However its acceptability in Indian population as a therapeutic modality remains low. This procedure is used mostly in a stigmatizing manner by most Indians as a punitive measure to improve craziness. Indian Mental health care act 2017 (MHCA 2017) prohibits ECT without the use of muscle relaxants and anaesthesia, however does not provide clear legal status of ECT administered without consent.
Aim: This study aims to assess future prospects of Electroconvulsive therapy in India in the light of current right based psychiatric practices and related legislations.
Methods: This paper is a review of literature on social acceptability and legal status of Electro-convulsive therapy in India. An internet search was performed using the terms “electroconvulsive therapy” combined with “consent”, “MHCA 2017”, “cognition” and “cognitive changes”. In addition to this various manual searches were also performed for guidelines on ECT and its legal status.
Results: Electro convulsive therapy is an effective psychiatric treatment for various psychiatric disorders. Despite having decisional capacity in the beginning of treatment, most of the patients fail to receive sufficient information and perceive a passive coercion for the procedure and retrospectively claim that they had not given free consent. Administering ECT without consent is still debatable as per current mental health legislation in India (MHCA 2017). Patients experiencing short term as well as long term cognitive problems after administration of ECT further complicate the picture.
Conclusion: Use of electroconvulsive therapy is decreasing in current psychiatric practices. Due to widespread stigma and lack of adequate knowledge about the procedure in general public, there is low acceptability of ECT. Lack of clarity with respect to obtaining consent for performing the procedure needs to be addressed in upcoming amendments of MHCA 2017.
The association between insight and self–stigma in patients with schizophrenia- a cross-sectional study
Rishav Singla, Avinash Kamath, Savitha Soman
Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka – 576104, India
Background
In psychiatry, “insight” includes awareness, attribution, and need for treatment need. 50–80% of patients with schizophrenia have poor insight, resulting in deteriorating outcomes. Because of the self-stigma, high-insight patients aren’t always well-functioning, as patients accept the label of mental illness. Since Indian literature is scarce, our study attempts to examine insight and self-stigma in patients with schizophrenia.
Aims:
To determine the association between insight and self-stigma in patients with schizophrenia
Methods:
Sociodemographic details were collected using semi structured proforma.
Clinical Global Impression -Severity scale was administered to recruit patients who come in the normal to moderate range. Brief Psychiatric Rating Scale-Expanded Version was administered to assess psychotic symptoms.
Schedule for Assessment of Insight-Expanded version, Beck’s Cognitive Insight Scale and Self-Stigma of Mental Illness Scale were administered to measure insight and stigma respectively.
Result- The mean age of the study sample (N=85) was 38.76 (SD, 9.8; range, 18–60) years. Among them, males (72.9.%) and females (27.1.%) have paranoid type of schizophrenia (74.1%). Self -stigma was found to be negatively corelating with clinical insight (correlation coefficient= -0.210) and cognitive insight (correlation coefficient= -0.155) which indicates more is clinical and cognitive insight lesser is the self-stigma.
Conclusion: To conclude both insight and self-stigma have good co-relation with each other
A clinical study on female bipolar patients and association of hypothyroidism and rapid-cycling states.
Background: Hypothalamic-pituitary-thyroid (HPT) axis dysfunction in the pathophysiology of bipolar disorder has received less attention as compared with that in depressive disorder. Different studies prove that female bipolar patients are more vulnerable for rapid-cycling type of bipolar disorder. Auto-immune thyroiditis is the commonest cause of hypothyroidism in females, detected by presence of anti TPO(Thyroid peroxidase antibodies or anti microsomal antibodies) antibodies in serum.
Aims and objectives:
1. To assess the prevalence of hypothyroidism in female bipolar patients.
2. To assess the prevalence of rapid-cycling state in female bipolar patients.
3. To see the association of the presence of Anti-TPO antibody in female bipolar patients.
Methodology: A cross-sectional study, conducted among female patients attending psychiatry OPD, GMCH and diagnosed with Bipolar Affective Disorder according to International Classification of Diseases-10, not on long-term lithium prophylaxis.
1. A semi-structured interview schedule for socio-demographic data.
2. Serum level of TSH, T3, T4 and Anti-TPO antibody.
Results: Out of 30 bipolar patients, 13 had hypothyroidism, none were rapid-cycling and 7 had raised Anti-TPO antibody showing a significant prevalence of hypothyroidism in female bipolar patients.
Conclusion: Treatment approach of bipolar females must be modified considering the high prevalence of hypothyroidism among them.
Authors:
1.Dr. Rishi Biswanath, Resident, Department of Psychiatry, GMCH, Guwahati.
Email: rishi.biswanath@gmail.com
Phone: 7979910462
2. Dr. Sahil Agarwal, Resident, Department of Psychiatry, GMCH, Guwahati
Email: sahilnandanvan@gmail.com
Phone: 9678367769
Guides:
1. Prof. (Dr.) Deepanjali Medhi, HOD, Department of Psychiatry, GMCH.
2. Prof. (Dr.) Bobby Hmar, Associate Professor, Department of Psychiatry, GMCH.
Factors associated with transition from first drug use to first injectable opioid use among patients visiting a tertiary health care centre in North-East India.
Background: Injectable opioid use has been on the rise since the past few years in Assam resulting in criminal activities and other medical co-morbidities. But little is known about the demographic, sexual, psychosocial and cultural factors which has led to the rapid transition from other drugs of abuse to injectable drug use.
Aim: The purpose of this study was to evaluate the demographic, sexual, psychosocial and cultural factors associated with rates of transition from first drug use to injectable opioid drug use.
Methods: A cross sectional study is planned from 1st November 2022 to 30 October 2023 among patients visiting Gauhati Medical College & Hospital and diagnosed with Opioid Dependence syndrome. Data was collected from 114 patients till the date of abstract submission by a semi-structured proforma. A multiple logistic regression was employed to identify the independent effects from potential risk factors of transition into injection.
Results: After controlling for other covariates being 20 years or older, single, school dropouts, urban residence, having history of smoking as the first drug use and having multiple sex partners were associated with faster transition from first drug use to first injectable opioid use.
Conclusion: Several demographic factors, sexual behaviours and drug use characteristics were related to injection initiation. Taking appropriate measures to address these factors would lead to delay in injection initiation and other related co-morbidities.
1. Dr. Rishi Biswanath, Resident, Department of Psychiatry, GMCH.
2. Dr. Madhushree Baruah, Assistant Professor, Department of Psychiatry, GMCH.
3. Dr. Rekha HG, Senior Resident, Department of Psychiatry, GMCH.
4. Prof.(Dr.) Deepanjali Medhi, HOD, Department of Psychiatry, GMCH
A Descriptive Study of Violence among Adult Patients in Psychiatry Ward
Background: Violence among patients in psychiatric wards is common, posing a serious threat to the patients’ and their caregivers’ safety and wellbeing. Mental health professionals are particularly vulnerable to inpatient violence. It has significant physical, psychological, and, financial repercussions. Patients who have a high risk of violence propagate the stigma associated with psychiatric disorders. Hence, psychiatric facilities should prioritize the assessment and prevention of violence.
Aims:
• to describe the nature of violence among patients of psychiatry ward.
• to determine association of sociodemographic and clinical profile with nature of violence in patients of psychiatry ward.
Methodology: This cross-sectional study was conducted at LGBRIMH over one and a half years. 100 adult inpatients were recruited after fulfilling the inclusion and exclusion criteria. Informed consent was obtained; socio-demographic and clinical data were taken using a semi-structured proforma. The Staff Observation Aggression Scale-Revised (SOAS-R) was administered. The nature of violence was assessed and it’s association with the sociodemographic and clinical data was statistically analyzed.
Results: The nature of violence was described by the provocation, means used by patient, target of aggression, consequence for the victim, and measures to stop. It was significantly associated with the severity of violence, determined by SOAS-R score. Severity of violence was also significantly associated with preceding threats, poor compliance to medications, ongoing electroconvulsive therapy(ECT), and documentation of previous acts of violence in case record.
Conclusion: The present study has been able to identify clinical correlates of violence and possible risk factors of inpatient violence.
A cross sectional study to assess the prevalance of psychiatric morbidity in recovered patients of COVID 19 infection attending a tertiary care centre in hubballi.
Background - The Coronavirus Disease 2019 (COVID-19) is a severe multiorgan pathology which, apart from cardio-respiratory manifestations, affects the function of the central nervous system (CNS). Most reviewed studies have reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects
Aim - This study aims to document the prevalence of psychiatric disorders among participants who had recovered from covid 19 attending the out patient department of a tertiary care hospital.
Methods - A Cross sectional study was done to assess the prevalence of psychiatric disorders among 136 recovered patients of COIVD 19 infection with the help of MINI International Neuropsychiatric Schedule 7.0.2
Results - Prevalence of psychiatric morbidity was 17.64% with majority of the patient(9.55%) having found to be suffering from Depressive disorders.
Conclusion - The psychiatric morbidity among recovered recovered patients of COVID 19 infection was found to be higher than the general populus,Given the growing incidence of these cases in our community, we consider that further studies based on psychiatric symptoms description, sociodemographic factors, physical symptoms and COVID-19related severity should be conducted.
Coping Skills between Bipolar Affective Disorder and Schizophrenia: A Comparative Study.
Dr. S. Gnanasekaran (Junior Resident),
Dr. Bondona Timungpi (Associate Professor)
Department of Psychiatry, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam
E-mail: gnanasekarsubramani13@gmail.com
BACKGROUND: Bipolar Affective Disorder and Schizophrenia are common psychiatric disorders and cause significant negative impact on patients. Stress is involved in the cause, course and treatment outcomes of these disorders. Stress, in turn is influenced by coping skills. Hence, a comparative study will enhance our understanding, to provide effective treatment to patients of Bipolar Affective Disorder and Schizophrenia
AIM: To compare coping skills between patients of Bipolar affective disorder and Schizophrenia.
METHODOLOGY: This is a cross-sectional study of 18 months, done at LGBRIMH, Tezpur. 30 patients each of Bipolar Affective Disorder and Schizophrenia as per ICD-10 criteria, were recruited from outpatient department after fulfilling inclusion and exclusion criteria. Informed consent, socio-demographic and clinical proforma were obtained. Coping skills were assessed using BRIEF COPE. Appropriate statistical measures were done to assess the correlation between coping skills.
RESULTS: A significant correlation in coping skills was observed between Bipolar affective disorder and Schizophrenia. Bipolar Affective disorder patients used more emotion focused coping when compared to patients of Schizophrenia (p value=0.010).
CONCLUSION: This study adds evidence to the hypothesis that Bipolar affective disorder patients used more emotion focused coping, which in turn can increase relapse risk. Adequate psycho-social interventions focusing on stress coping can improve treatment outcomes and decrease relapse risk in Bipolar affective disorder and Schizophrenia.
Attitude towards and Confidence about LGBTQIA+ individuals in medical students
S VINEELA , N GYAN NIHAL
Background:
LGBTQIA+ is an acronym for Lesbian, Gay, Bisexual, Transgender, Queer, Intersex , Asexual and (+) suggesting other identities of the gender and sexuality spectrum. Lesbians and gays are women and men attracted to their same gender , Bisexuals are attracted to their and opposite gender, Transgenders identify with the gender opposite to their birth sex , Queers are not heterosexual or cisgender , Intersex are born with chromosomes or sexual anatomy that isn’t typical of male or female. Asexuals have no sexual attraction towards anyone. This study aims to analyze the Attitude and confidence of medical students in providing medical care to LGBTQIA+ individuals.
Aim and objectives:
• To analyze the attitude of medical students towards LGBTQIA+ individuals.
• To evaluate the confidence about LGBTQIA+ individuals in medical students
Materials and Methods:
This Cross-sectional study consists of medical students in Khammam, Telangana , conducted for a period of 6 months(April-September).Questionnaires on Attitude towards and confidence about LGBTQIA+ individuals are the tools used. Students will be asked to respond anonymously to these questionnaires online.
Results:
Although attitudes toward LGBTQIA+ patients were favourable, there were disparities in the confidence .Participants were “neutral” in their attempts to clarify patients’ usage of unknown sexual or gender terms. Participants lacked confidence in choosing which ward (male or female) a transgender patient must be cared for in and where to get information about LGBTQIA+ specific healthcare options in their city. However, they were confident in asking LGBTQIA+ patients about their social or sexual history.
Conclusion:
As the Attitude and confidence effects the quality of health care and patient-doctor interactions, LGBTQIA+ inclusive teaching in medical colleges would be beneficial for future doctors and the patients.
Keywords:
LGBTQIA+, Attitude, Confidence ,Questionnaire, Medical students.
A Comparative Study of ICD-11 Diagnosis of Adjustment Disorder among 1st year Medical and Engineering Students
Background: Despite being one of the most common clinical presentations in day-to-day practice, Adjustment Disorder (AjD) remains one of the most under-researched and under-diagnosed areas of Psychiatry. Defined as an emotional disturbance that occurs as a consequence of significant psycho-social stressor(s), the diagnostic criteria of AjD underwent a paradigm shift and was fundamentally changed in ICD-11. While beginning of a new professional course, a first-year student is faced with several psycho-social stressors that may result in a failure to adapt or pre-occupations with the stressor leading to a maladaptive response, thereby causing significant bio-socio-occupational dysfunction. No study exists yet, as per the new definition of AjD which assesses the burden of this disease among first year students in the professional courses.
Aims: The aim of our study is to estimate the prevalence of Adjustment Disorder among first year undergraduate and post-graduate Medical and Engineering students, to identify the common stressors leading to this disorder and to compare between the different study groups to determine which group has more burden of this disease.
Methods: This is an observational study of analytical and cross-sectional design. Simple random sampling technique was employed to draw sample from first year students who had started their MBBS, B.Tech, MD/MS and M.Tech courses at the end of their 1st month of joining. Students with already pre-existing psychiatric and/or medical co-morbidities were excluded from the study. A semi-structured questionnaire was prepared to assess the socio-demographic profile and stressors of the participating subjects, while the self-report Adjustment Disorder New Module-20 (ADNM-20) was used to screen for the prevalence of Adjustment Disorder. The ICD-11 theory driven diagnostic algorithm was followed make a diagnosis of Adjustment Disorder as per the ADNM-20. Finally, Chi-Square Test was performed to compare the various study groups.
Results: Out of 1121 students participating in the study, 406 were MBBS students, 408 were B.Tech students, 208 were MD/MS residents while 199 were pursuing their M.Tech. 85.46% (347) MBBS, 56.12% (229) B.Tech, 87.5% (182) MD/MS residents and 28.14% (56) M.Tech students were found to be suffering from AjD. The most common stressor reported among Undergraduates was too much academic pressure, followed by moving to a new place away from home. Among Post-Graduates, most common stressor was the dissatisfaction with the chosen branch. Chi Square test revealed that statistically significant association exists between both undergraduate and post-graduate streams of study and development of AjD, more being among Medical students.
Conclusion: Results show a high prevalence of AjD among 1st year students of both the courses which is suggestive of their vulnerability and maladaptive response towards stressful life events. More risk of development of AjD was observed among Medical undergraduate and post-graduate students.
A Comparative Study of ICD-11 Diagnosis of Adjustment Disorder among 1st year Medical and Engineering Students
1.Dr. Sagnik Mukherjee, M.B.B.S, Junior Resident, Department of Psychiatry, Kakatiya Medical College, Warangal
Contact: sagnikmukherjeeisback@gmail.com, 9051298906
2. Dr. Tialam Gautham, M.D, Associate Professor, Department of Psychiatry, Kakatiya Medical College, Warangal
Contact: gautham.tialam@gmail.com, 9849044115
3. Dr. Adithya Sunka, M.D, Assistant Professor, Department of Psychiatry, Kakatiya Medical College, Warangal
Contact: adityane369senator@gmail.com, 9885724118
4. Dr. Srinivas SRRY, M.D, Professor and Head of the Department, Department of Psychiatry, Kakatiya Medical College, Warangal
Contact: dryssr@gmail.com, 9885820820
Department of Psychiatry
Corresponding Author: Dr. Sagnik Mukherjee
Address: Department of Psychiatry, Kakatiya Medical College, Warangal, Telangana, 506007
E-mail: sagnikmukherjeeisback@gmail.com
Phone Number: 9051298906
Background: Stigma is very common among patients and caregivers of patients with severe mental disorders; however, there is lack of comparative study data between Schizophrenia and Bipolar Affective Disorder in Indian setting.
Aim:
• To assess stigma and its correlates in Caregivers and Patients of Bipolar Affective Disorder and Schizophrenia currently in remission.
• To compare stigma in patients of Bipolar Affective Disorder and Schizophrenia currently in remission.
• To compare stigma in care givers of these patients.
Method: For this, caregivers of patients with schizophrenia (N = 50), bipolar affective disorder (N =50) were assessed on Affiliate Stigma scale, and patients with schizophrenia (N = 50), bipolar affective disorder (N =50) were assessed on Internalized Stigma scale.
Results: Patients and Caregivers of patients with schizophrenia reported significantly higher stigma than patients and caregivers of patients with bipolar affective disorder. Higher caregiver stigma in both the diagnostic groups was associated with higher psychological morbidity in patients and caregivers.
Conclusion: This study suggests that patients and caregivers of patients with schizophrenia experience higher stigma than the caregivers of patients with bipolar disorder. Higher stigma is associated with higher psychological morbidity in the patients and caregivers. Therefore, the clinicians managing patients with severe mental disorders must focus on stigma and psychological distress among the patients and caregivers and plan intervention strategies to reduce stigma.
Keywords:
Stigma, caregivers, schizophrenia, bipolar affective disorder
Background
Neurocognitive impairment in schizophrenia is difficult to treat and these deficits portend a less favourable clinical outcome. There is therefore a need for alternative treatments that might enhance cognition in schizophrenia and associated psychotic disorders. This study is to examine efficacy of adjunctive PUFA (EPA+DHA) supplementation in early phase of schizophrenia.
Aim
To study effect of adjunctive PUFA supplementation in clinical symptoms and cognitive functions in patients of schizophrenia.
Methodology
In a randomised double blind placebo controlled study 20 patients (10 adjunctive PUFA supplementation + 10 placebo) were studied and assessed on clinical rating scales and CANTAB battery in a 6 week pre and post analysis.
Results
Results and conclusions will be shared at the presentation.
A STUDY ON QUALITY OF LIFE IN PATIENTS WITH SCHIZOPHRENIA
Dr. Samia Ansari
Room no. 13, Lady Doctor’s Hostel, IMS, BHU, Varanasi
Email: samiaansari2018@gmail.com
Contact: 9990737164, 9318482429
A STUDY ON QUALITY OF LIFE IN PATIENTS WITH SCHIZOPHRENIA
Aim: To study the socio-demographic characters and to assess the quality of life in patients with Schizophrenia.
Methods: The cross-sectional study was conducted on 100 patients over a period of 4 months as per defined inclusion and exclusion criteria at tertiary care center. A semi-structured proforma, designed for the study was used to collect the sociodemographic and clinical details and assessment of Schizophrenia severity was done whichwas correlated with WHO-QoL bref scale.
Statistical Analysis Used: Statistical analysis was done by using descriptive and inferential statistics using Chi-square test and Student’s unpaired t-test.
Results: 52% were female and 48% were male. Mean age of males was 34.40+_9.55 and females mean age was 32.07+_11.12. 66% were educated more than high school. 40% particippants were of upper lower SES. Mean WHO score in physical domain was found 29.92+_17.481, 40.95+_17.48% in psychological domain, 46.01+_21.155 in social and 47.52+_15.15 in environment domain. Mean WHO social domain scores were higher compared to other domains.
Conclusion: The quality of life may be influenced by many socio economic factors including age, socio economic condition,duration of illness, marital status and clinical status of the patients.
A study of marital adjustment and quality of life in post hysterectomy patients
Background: Hysterectomy is a commonly done gynecological surgery. Removal of uterus has deep psychological impact on women’s mental health due to feelings of castration and loss of fertility. This as a result has impact on women’s marital adjustment and quality of life.
Aim & Objectives: (i)To determine marital adjustment in post hysterectomy patients and (ii) to assess quality of life (QOL) after hysterectomy and compare it with healthy control group.
Methods: 50 consecutive post hysterectomy cases attending Gynecology OPD of tertiary care hospital and fulling specific criteria laid down for study were included. 50 matched healthy women were recruited as control for comparison of quality of life. Tools used for the study were Quality of Life assessment scale WHOQOL BREF, Hindi (version), Revised Dyadic Adjustment scale (RDAS).
Results: 46% of patients were experiencing marital distress. Patients with higher family income had better marital adjustment in satisfaction domain of RDAS. No significant difference in QOL scores was found between both groups in all domains i.e. physical health (p=0.14), psychological health (p=0.19), social relationship (p=0.32), environmental health (p=0.24) and total QOL (p=0.21). Higher QOL scores were seen with higher education (in psychological and environmental health domains), higher family income (environmental and total QOL), higher parity (in all domains) and who had good marital adjustment.
Conclusion: There is significant correlation of socio demographic characteristics, marital adjustment with QOL of patients and of marital adjustment with sociodemographic characteristics of patients.
Perceptions and attitudes of Health Care Workers(HCW) towards restraint in paediatric ward at a tertiary care hospital
Dr Raveeesh B N Professor and head of Department of Psychiatry, Mysore Medical College & Research Institute, Mysore
Dr Sanjana R Kangil, Junior Resident, Department of Psychiatry, Mysore Medical College & Research Institute, Mysore
Background :
Restraint is widely used in paediatric wards across the globe. Seclusion and restraint can lead to severe psychological and physical consequences. Children are restrained at a rate that is 6 times higher than the adults. Restraing refers to an action where a child has been held/restricted with aim of promoting treatment and care. There seems to be a lack of consensus regarding what restraint is and how it should be understood, when it is justified, when it is possible to avoid restraint, and how important it is to reduce restraint. Restraint is a concept that is rarely defined in research articles about medical procedures performed on children and as per our knowledge first study in India looking at the HCWs perceptions regarding the same
Aim : To understand the perceptions and knowledge of HCW towards the use of restraint
Methodology : Perception of HCW were selected using consecutive sampling was assessed using PRUQ and Restraint Questionnaire used in the study Attitudes, Opinions, Behaviours, and Emotions of the Staff Toward Patient Restraint questionnaires
Results : 43% HCW agreed that restraint calms patients, 83% doctors wanted other staff members to be a part of making decisions regarding restraint, 40% HCW thought that child feels degraded when restrained. A combination of physical and chemical restraint was mostly used.
Conclusion : Further research is necessary in this area, given the potential effects of movement restriction on children, such as prolonged post-operative recovery times, a risk of respiratory issues, and the need for more staff training and resources to support this approach
Management of borderline personality - Simple management of a complex condition Anjula Siddhartha Licensed Psychologist Miramichi, Canada
Sanjay Siddhartha, MBBS, DPM, MD, FRCPC
Assistant Professor, Dalhousie University Canada Chief of Psychiatry, Miramichi, NB Chief of Staff, Miramichi Regional Hospital, Miramichi, NB
Borderline personality disorder is a common psychiatric disorder with significant mortality and morbidity.
Borderline personality disorder is a common psychiatric disorder with significant mortality and morbidity.
The other therapies such as Mentalisation Treatment and Transference based treatment are rigorous and are “resource intensive”.
The general psychiatric management proposed by Gunderson, can be learned and easy to practice.
The evidence suggests that it may be equally effective as compared to DBT MT and TBT.
I would discuss General Psychiatric Management in some detail.
Role of coping and psychological well-being in mediating burden of care among caregivers of patients with schizophrenia
Santosh Kumar, Viddur Arya, Vidhata Dixit, Chandra Shekhar Sharma, Suprakash Chaudhury
Background: Caring for a relative with schizophrenia is viewed as a chronic stressor and the family caregivers experience a significant burden.
Aims: The present study assesses the role of coping and the psychological well-being of caregivers in mediating the burden of care.
Methods: The sample comprised 52 caregivers and their 52 patients with schizophrenia. The caregivers were assessed with the Burden assessment schedule (BAS), Brief Approach/Avoidance Coping Questionnaire (BACQ), and General health questionnaire-12 items (GHQ-12) for their burden of care, coping strategies, and psychological wellbeing respectively. The patients with schizophrenia were assessed with the Positive and negative syndrome scale (PANSS). Bivariate and multivariate analyses were done to determine the mediators of the burden of care.
Results: Coping strategies (action-avoidance coping score and cognitive avoidance coping score) along with psychological wellbeing (GHQ-12 score) determined an additional 12% of the variance in the burden of care, after controlling the overlapping effect of other variables [R squared change=.12, F change (3,41) =6.768, p<.01]. Overall, in order of importance, five measures [Caregiver’s action-related avoidance coping (β=.274, p<.01), Caregiver’s extended family type (β=-.26, p<.01), Caregiver’s cognitive avoidance coping (β=.25, p<.05), Caregiver’s employment (β=.227, p<.05), and Patient’s PANSS Positive score (β=.225, p<.05)] appeared as significant predictors of the burden of care. Alone, the psychological well-being of caregivers was not a predictor of the burden of care.
Conclusion: Avoidance-oriented coping strategies and employment of caregivers together with positive psychotic symptoms of schizophrenia patients are significant factors to decide the increased burden of care among the caregivers while the extended familial system decreases it.
Keywords: caregiving, burden, coping, schizophrenia, wellbeing
Neurological morbidities in the older adults with mental illness attending psychiatry outpatient department
Rasmita Behera, Debasish Mahanta, Shreyan Kar, Nitya Gopal Mohanty, Satyakam Mohapatra, Nilamadhab Kar
Mental Health Institution, SCB Medical College, Cuttack, India; The Royal Wolverhampton Trust, UK; and Black Country Healthcare NHS Foundation Trust, UK.
Introduction
Comorbidities in the patients with psychiatric illness are commonly reported. These are known to increase the challenges in the treatment and are known to be negative prognostic factors. Amongst these neurological problems could be directly linked to the psychiatric illness.
Aim
We intended to study the neurological comorbidities as reported by the patients with mental illness attending the psychiatric outpatient department of Mental Health Institute, SCB Medical College, Cuttack, India.
Method
Consecutive 78 psychiatric patients were reviewed regarding their mental illnesses and comorbid neurological disorders. Information was collected from the patients and their caregivers.
Results
The age range of the sample was between 60 and 80 years old (mean: 63.7 ± 4.7). Overall the physical comorbidities were present in more than half (56.4%) of the attendees. Neurological problems were reported in 26.9%. These were cerebrovascular accident (17.9%), Parkinsonism (5.1%), neuropathic pain (2.6%), epilepsy (1.3%). It was interesting to note that there were no neurological side effects such as tardive dyskinesia.
Conclusion
The findings highlight the importance of assessing the neurological problems in psychiatric patients as some of them could be etiologically related and others could be side effects of the psychiatric treatment. Use of second generation antipsychotics has decreased the prevalence of tardive dyskinesia; however the metabolic side effects could be contributing to cerebrovascular accidents. The study reemphasised the clinical significance of neurology and psychiatry interface.
Acknowledgments
Geriatric Care and Research Organisations (GeriCaRe), India
Abstract for ANCIPS 2023
Dr Shahbaz Ali Khan MD
Shagufta PhD scholar
Command Hospital, Lucknow
City - Lucknow UP, Pin code 226002, Country India
Mobile No 8002404433/9560146276
Email - shahbaaz323@gmail.com
Resilience in Heath Care workers during Disaster situation- Experience from tertiary care hospital during Covid 19 and future lessons
Aims and objective: To present a series of 5 cases of Stress Related Disorders in HCWs during the covid second wave where they bounced back and recovered fully, returned to work
Methodology: Reporting 5 different cases of psychological trauma in healthcare workers working in the peak of covid pandemic as frontline workers - 02 doctors, 02 Nurses, and 01 health assistant who reported symptoms of vague nature arising out of stress during handling of Covid 19 pts. All of them had clear cut psychological symptoms arising in close temporal relation to experiencing the trauma of handling covid patients and the agony and disaster that befell us during the covid second wave from April to Aug 2021. None of them had any past history of psychiatric illness or genetic loading of significance. None of them had any other significant live stressor in personal life or h/o drug abuse. Thus underlying the life threatening nature of Covid exposure as a healthcare worker and it’s psychological implications. All of them were referred for vague symptoms like irritable mood, not able to function as before, physical symptoms of headache, marital discord etc. The exposure ranged from personal handling of serious covid patients to handling dead bodies in the mortuary to managing relatives of dying patients. No preventive distressing mechanism was available to them, the need of which is the learning from this study. Also, the remarkable recovery and resumption of functioning and return to duty shown by these frontline healthcare covid warriors with minimal support from the environment is a lesson in bouncing back from psychological trauma, a concept recognized as resilience. The Resilient HCWs ascribed their bouncing back to peer and organizational support during crisis, a sense of duty to care and psychoeducation as their driving force to early recovery, among other things
Results: High index of suspicion, early intervention, empathetic handling, psycho education, behavioral modifications and cognitive counseling with a short course of anxiolytics and antitidepressants in few, helped all of them improve completely with return to almost normal functioning.
Conclusion: The Covid experience has been a life threatening experience for HCWs involved in treatment of serious covid patients during covid pandemic esp the second wave. It has been a never before experienced reality, completely overwhelming and traumatogenic enough to cause psychological decompensation in some of them. For the few diagnosed, there would be many undiagnosed HCWs. The focus should be on high index of suspicion for stress related psychological trauma in HCWs and it’s mitigation through early detection and support for complete recovery. The importance of systemic, family and peer support is emphasized.
Serum Cortisol Levels in the Patients of Obsessive Compulsive Disorder
Dr. Shailja Singh1, Dr. Maria Madiha2
1Senior Resident, Department of Psychiatry, Autonomous State Medical College, Etah, India; 2PhD, Research Assistant, Department of Psychiatry, AIIMS, New Delhi, India
Background- OCD is a debilitating chronic illness characterized by intrusive thoughts, pervasive preoccupations, ritualistic behaviour and compulsions that can have a considerable impact. The neuroendocrine dysfunction hypothesis focuses on aberrant hypothalamic-pituitary-adrenal (HPA) axis function, comprising of altered adrenocorticotropic hormone (ACTH) and cortisol activity.
Aim- Current study aims to assess and compare the serum cortisol levels in the OCD patients and to see the correlation between the severity of OCD [Yales-Brown Obsessive Compulsive Scale (Y-BOCS) score] and the serum cortisol levels.
Methods- The current study was carried out in the Department of Psychiatry, J.N. Medical College and Hospital, Aligarh. 67 individuals with OCD who visited the Psychiatry Out-Patient Department (OPD) between January 2020-November 2021 meeting the inclusion and exclusion criteria were taken. The healthy attendants of the patients volunteering the study made up the age and sex matched control group. Appropriate statistical analysis was done.
Results- There was no significant difference in the serum cortisol levels in the patients of OCD when compared with the control group. Also, there was no correlation between the severity of OCD (Y-BOCS Score) and the serum cortisol levels.
Conclusion- The study concluded that amongst OCD patients, the serum cortisol levels are less likely to be raised.
Keywords- Obsessive Compulsive Disorder; Cortisol; Severity of OCD; Y-BOCS
Predominant Polarity In Bipolar Mood Disorder
Background:-
The course of bipolar mood disorder is relapsing in nature with high comorbidity rates, suicide and a worse social and work performance. All of those characteristics entail a significant economic impact and require an effective diagnostic and therapeutic approach.
Objectives:-
• To study the relation between predominant polarity and Cognitive functioning.
• To study the relation between predominant polarity and quality of life.
• To study the relation between predominant polarity and substance use.
Materials & Methods :-
We performed a cross-sectional study of 52 asymptomatic patients of Bipolar Mood Disorder. The study group was assessed on HAM-D,YMRS, MOCA and WHOQOL-BREF scales. Patients were interviewed independently and assigned to one of the three groups ; manic predominant polarity (MPP), depressive predominant polarity(DPP) and no polarity group.
Results:-
The mean MOCA score of patients of MPP and DPP were 23.8 and 22.3 respectively while for No Polarity group it was 27. Women had significant propensity for depressive whereas men for manic predominant polarity.Also depressive predominance was found to be having poor quality of life as per WHOQOL-BREF scale. Patients of MPP had significantly better scores on physical and psychological domains. In environmental domain, both groups had no significant difference amongst themselves. However, DPP had worse quality of life than No polarity group.
Conclusion:-
As per the study females have propensity for depressive and male for manic polarity. Patients of depressive polarity have worse outcomes with respect to cognition and quality of life. Cognition is worse in the depressive group as compared to no polarity groups but not significantly different from patients with manic predominance. Social quality of life is insignificant in both groups.No significant association between suicidality and substance use was found for all the 3 groups.
KEYWORDS:
Predominant polarity, QOL, mood disorder
HYPERSOMNIA AND VISUAL HALLUCINATIONS RESPONDING TO RIVASTIGMINE IN A CASE OF DEMENTIA WITH LEWY BODIES: A CASE REPORT
Dr. Shashank Saurabh Sinha1, Dr. Shailendra Mohan Tripathi 2
1. 2nd year DM trainee, Department of Geriatric Mental Health King George’s Medical University, Lucknow, Uttar Pradesh.
Phone-8287188508
Email- shashanksinha3@gmail.com
Corresponding and presenting author
2. Associate Professor, Department of Geriatric Mental Health King George’s Medical University, Lucknow, Uttar Pradesh.
Phone-9864501214
Email- dr_smtripathi@rediffmail.com
Phone- 9415531178
Place of study:- Department of Geriatric Mental Health, King George’s Medical University, Lucknow, Uttar Pradesh.
Preferred presentation type:- Poster
Introduction:
Lewy body dementia is a common cause of dementia in the elderly, accounting for perhaps 15% to 25% of dementia cases. Lewy body dementia is characterized by a progressive cognitive decline that interferes with normal social or occupational functioning. Memory and visuospatial deficits are often, but not necessarily, prominent. In addition, two of the following three features must also be present: recurrent visual hallucinations, fluctuating cognition, and spontaneous motor features of parkinsonism. Treatment of visual hallucinations in neurodegenerative disorders is not well advanced. Antipsychotic medication have risk of exacerbation of symptom of LBD. Rivastigmine is used primarily for the treatment of cognitive symptoms but has been underutilized for the treatment of non-cognitive symptoms.
CLINICAL CASE:-
Here we are reporting a Sixty-nine-year-old married undergraduate Muslim male from urban background. The duration of psychiatric illness was 5-years with insidious onset, progressive course characterized by moving limbs during sleep at night, lying on the bed most of the time during the day for the past 5 years, Episodes of confusion for the past 4 years, and Forgetfulness for 3 years. difficulty finding way for 3 years. Decreased interaction for 2 years. Seeing ants on bedsheets & images not seen by others for one & half years. The patient had significant impairment of Instrumental ADL for 2 years and considerable impairment of ADL requiring frequent assistance for the past 1.5 years. The patient was brought by a relative with complaints of not sleeping, confusion, and disorientation for 15 days. Rivastigmine was added during the further course of the ward stay and led to improvement in the movements of limbs at night, excessive daytime drowsiness, fatiguability, visual hallucinations, slowness of movements, and confusion.
DISCUSSION: Patients with Dementia with Lewy bodies have cholinergic deficiency other than dopaminergic neuronal degeneration. We hypothesize that Rivastigmine by improving attention & concentration improved hypersomnia and visual hallucinations in case of dementia with Lewy bodies.
Association between Psychiatric Disorders and Menstrual Cycle Characteristics
Shashikala I M1, Poonam M2, Arushi singh3
Department of Psychiatry: Post graduate1, Head of Department2, Post graduate3
KVGMCH, Sullia.
Background: The fluctuations in serum levels of oestradiol in the menstrual cycle also have a significant effect on psychopathology of psychiatry disorders in some women. A better understanding of the association between psychiatric illness and menstrual cycle characteristics is critical to the provision of care and treatment for women. The purpose of this study was to investigate whether psychiatric disorders are associated with menstrual cycle characteristics and menstrual cycle–dependent fluctuations in psychiatric symptoms.
Materials and Methods: A cross-sectional study conducted at a tertiary hospital from June-August 2022. Total of 52 patients diagnosed with psychiatry disorders under ICD 11 guidelines who fulfils the inclusion and exclusion criteria were selected and socio-demographic details, menstrual cycle characteristics data were collected. For group comparisons Pearson’s Chi-square test and independent sample t-test were used.
Results: In our study 63.5% were having regular cycles and 36.5% irregular cycles. BMI showed (p=0.029) significance association with the psychiatry disorders. We found no significance association between the psychiatry disorders and menstrual cycle characteristics. However we found significance association between enhancement of psychiatric symptoms and regularity of cycles (p=0.00), cycle interval (p=0.02).
Conclusion: This study is a step toward understanding the complex relationship between menstrual cycle characteristics and psychiatric disorders. However, more work is needed to clearly characterize the pathogenesis, nature of such psychiatry syndromes and their managements.
Assessment Of Psychiatric Morbidity In Healthcare Professionals Working In A Covid Hospital In West Bengal During Covid-19 Pandemic
1. Dr. Shekhar Halder, 3rd year Post Graduate Trainee , Dept Of Psychiatry, Sagore Dutta MCH, Kolkata [Mobile No- 9126787857, Email- shekhar1008halder@gmail.com, Applied for IPS LOM; NEFT UTR No- 0919i27674604701]
2. Prof (Dr.) Asim Kumar Mallick, HOD, Dept of Psychiatry, Sagore Dutta MCH
3. Dr. Somsubhra Chatterjee, Associate Professor, Dept of Psychiatry, Sagore Dutta MCH
Introduction: Pandemic, being unprecedented, leads to several mental health problems, especially among the front-line healthcare professionals (HCP). Front-line HCPs often suffer from anxiety, depression, burnout, insomnia and stress- related disorders. This is mediated by different bio-psychological vulnerabilities of the individuals; socio-environmental factors such as the risk of exposure to infection, availability of personal protective equipment, psychological impact of the isolation/quarantine and interpersonal distancing also play the major roles.
Aims: This study aimed to investigate the Psychiatric Morbidity in different Healthcare professionals (HCPs) and to observe any changes that occurred in this COVID pandemic situation.
Materials and method: The present study was a Hospital based Cross-sectional observational study, conducted over 1.5 years at College of Medicine and Sagore Dutta Hospital, Kamarhati. 126 HCPs (Consultants, Senior Resident, junior residents, Interns, Nurses, Paramedical Staffs, Non-Clinical staffs) were included in this study. Bengali version of Self Rated Questionnaire (SRQ-24) was used to assess the psychiatric morbidity.
Result: In our study 61.9% HCPs were having Psychiatric Morbidity and 38.1% were not having Psychiatric morbidity. Among Consultants 30.2% had psychiatric morbidity, among Senior Residents 40%, in Junior Residents 52.9%, among Interns 50%, among Nurse 77.8% and in Non-Clinical Stuffs 69.6% and in Paramedical Stuffs 75% had psychiatric morbidity.
Conclusion: Healthcare professionals had to do their duty in many adverse situations in COVID pandemic. They had to face tremendous mental and physical pressure and frequently they became exhausted. In spite this they did duty properly and saved millions of lives. So, their mental health should be assessed and proper intervention should be taken.
Key Words: Healthcare professionals, Self Rated Questionnaire, COVID-19,Psychiatric Morbidity
A Study on Coping styles in postgraduate medical students at a tertiary care centre
Introduction: Medical education is inherently stressful and demanding. After entering a postgraduate medical course, the residents should learn to balance multiple demands in life such as taking responsibility of patients care, heavy patient load, oncall schedules, death of patients, lack of sleep, academics, keeping oneself upto-date along with other necessities of family/personal life. To adapt or to overcome these adverse circumstances, an individual uses different ways of coping. The coping mechanism is described as an effort directed to stress management. This study was done to understand the different coping styles used by postgraduate medical students working at a tertiary care centre.
Methodology: The study was conducted at a tertiary care centre after approval from Institutional Ethics committee. Socio-demographic information was collected using semi-structured proforma. Tools used were Maslach Burnout Inventory and BriefCOPE scale.
Results: The coping strategies on Brief Cope were divided as Problem focused coping strategies, Emotion focused coping strategies and Avoidant coping strategies. Results were statistically significant with respect to Avoidant coping in males, Problem focused coping in doctors pursuing clinical courses and Emotion focused coping (p-value=0.037) in those working night shifts compared to those not working night shifts.
Discussion: Medical Education puts an enormous stress over those pursuing it, especially resident doctors. It is important to identify coping mechanisms employed by doctors in facing day to day workload and a need to address faulty coping, as it has consequences not only on the doctors, but on patients and the healthcare at large.
Alexithymia in hospital admissions of Alcohol Dependence – a case control study
Background
Alexithymia means difficulty in identifying or describing own feeling combined with external orientation of thinking. Presence of alexithymia is one of the factors linked to relapse in alcohol dependent patients. Very few Indian studies have compared alexithymia in alcohol dependence versus general population. The demographic and illness related factors associated with alexithymia were also studied.
Methodology
The study was done in the psychiatry ward of a rural hospital in central India where alcohol dependent patients are admitted. It was a case control study in which alexithymia scores were compared between admitted patients of alcohol dependence and their age matched controls who were chosen among relatives accompanying the patients. Hindi version of Toronto alexithymia scale4 was used to assess alexithymia in cases and controls.
Results
The data was collected from 49 patients of alcohol dependence and 52 controls. There was no significant difference between the mean ages of cases and controls (P 0.113). Majority of the study participants lived in rural area (80.9%) and nearly 14 percent among them were unemployed. The comparison of alexithymia scores between cases and controls revealed a significant difference in total score (P<0.01), difficulty describing feelings (P<0.01), and difficulty identifying feelings (P<0.01). The trait of externally oriented thinking was similar in both the groups (P 0.584).
Conclusion
Alexithymia has a significant association with alcohol dependence. Management protocols may be devised to target the improvement of emotional regulation for better outcomes.
The Top-down approach: Mind as the ‘organizational chart’ of the brain
Introduction
With 1000 trillion synapses, pathways, circuits and networks, all parts of brain are intensely and continuously interactive.
But it is important to realize that all this activity gives rise to one unified mind that each of us has.
Mind is the central unified organization of all brain parts.
Methodology
The paper discusses how mind is an information processor - receiving inputs, processing them to produce outputs.
Thus, all parts of brain are involved in processing of inputs – in either input pathways, or output pathways, or in the central processing (that includes memory and emotions).
The paper discusses the 2 approaches to studying mind-brain. The bottom-up approach involves going from molecules, neurons, circuits, networks - towards mind.
The top-down approach involves understanding the mind as a unified active functional organization of brain.
The paper describes a novel framework, the 4-Levels, 5-Parts Framework that describes parts of mind and how they arise in brain.
Results
For understanding function of any part of brain, it is important to understand the role played by that part in overall organization of brain.
The 4-Levels, 5-Parts Framework of mind-brain can serve as an ‘organizational chart’ of brain. It can be used to understand roles played by different parts of brain while processing inputs.
Conclusion
The top-down approach of using a framework of mind-brain as the ‘organizational chart’ of the brain provides a better understanding of brain - as compared to bottom-up approach.
Efficacy of melatonin in the management of Bipolar affective disorder : case series
Dr Taniya Garg, Dr Shobit Garg
Background :- . Despite the extensive research and wide range of therapeutics, bipolar disorder remains undertreated.(3).Bipolar disorder I is the manic-depressive type, associated with overexpression of protein kinase C (PKC). The antimanic activity of endoxifen has been demonstrated in phase II and III trials, with promise for use as monotherapy.
Aim:- To study the efficiency of endoxifen in the management of bipolar disorders
Method:- 2 patients who were a known case of bipolar affective disorder current episode mania with psychotic symptoms who did not respond on treatment with antipsychotics and mood stabilizers and later were prescribed endoxifen 8mg once daily as an adjuvant to usual treatment.YMRS scales were applied on every follow up.
Results:- It was observed that there was improvement in affective syptoms and aggressive behavior which was reported both clinically and with improvement in the rating of YMRS scores on follow up.
Conclusion:-. This case demonstrates the long-term safety and efficacy of endoxifen 8 mg once daily in a BPAD patient with psychotic symptoms through improvement in symptoms along with a reduction in the use of psychostimulants and dose of concomitant antipsychotic medications
PREVALENCE OF INSOMNIA AND IMPACT ON QUALITY OF SLEEP IN MAJOR DEPRESSIVE DISORDER
Dr. Tanmayee Vuthandam, Dr. K. Ashok reddy, Dr. Vijay Raj Pratheek, Dr. Akhila Ganta
SVS MEDICAL COLLEGE,
MAHABUBNAGAR.
BACKGROUND
Major Depressive Disorder (MDD) is a common illness worldwide, with 3.8% of population estimated to be affected. Approximately 280 million people in the world have MDD. Individual with MDD experiences mainly, depressed mood, or loss of interest in activities, low energy levels, for at least 2 weeks. Insomnia can be one of the signs of major depression with three quarters of MDD patients having insomnia, with difficulty in initiating or maintaining sleep or both.
AIMS AND OBJECTIVES
To study the prevalence of Insomnia among patients with major depressive disorder and to correlate the severity, type of Insomnia and quality of sleep in relation to severity of depression.
METHODOLOGY
Current study is a cross- sectional observational study conducted at SVS Hospital Mahabubnagar, Telangana. ICD-10 RDC was used for making the diagnosis of Major depressive disorder. Semi structured proforma, Hamilton Depression rating scale (HAM-D, 17 items), Insomnia severity index (ISI) and Pittsburgh sleep quality index (PSQI) were applied after obtaining informed written consent.
RESULTS AND DISCUSSION
In this study with (n=100), >60% cases with depression had insomnia and positive correlation was seen between severity of insomnia and of depression (p< 0.005). Higher incidence was among women with approximately 32% showing higher severity of insomnia with more severe depression.
CONCLUSION
MDD patients have a high prevalance of insomnia, and more the severity of depression, more the severity of insomnia and poorer the quality of sleep. Clinicians need to be wary of this to treat the symptoms together for a faster improvement and better outcome.
PREVALENCE OF INSOMNIA AND IMPACT ON QUALITY OF SLEEP IN MAJOR DEPRESSIVE DISORDER
Dr.Tanmayee Vuthandam
Post Graduate- Final year Svs Medical College and Hospital, Telangana
Kaloji Narayana Rao University Of Health Sciences (Knruhs)
Email of presenting author: tanmind1010@gmail.com
PHONE NO: 9666651406
Dr. K. Ashok reddy, Dr. Vijay Raj Pratheek, Dr. Akhila Ganta
Screening Sexual Addiction Among Gay and Bisexual Men in India: A Preliminary Exploration
Dr. Timirkant J Takwani (MD, DNB Psychiatry)
BACKGROUND: Men having sex with men (MSM) have a very active and varied sex life. This makes them particularly vulnerable to sex addiction or hypersexual disorder; characterized by a compulsive need for instant gratification of sexual urges.
AIMS: To screen for sexual addiction in gay and bisexual men warranting further evaluation and explore its association with openness about sexual orientation and difficulty accepting it.
METHOD: An internet-based cross-sectional survey was conducted among 213 gay and bisexual men between July and September 2022. The Google form was a compilation of socio-demographic details, information regarding sexual orientation and PATHOS questionnaire, a 6 item brief screening tool for assessing sexual addiction.
RESULTS AND DISCUSSION: Out of 213 men, 111 (52%) scored 3 or above on the PATHOS signifying potential sexual addiction. On examining individual items, (71%) men were preoccupied, (77%) felt ashamed, (40%) felt controlled, (29%) reported hurting others and (23%) felt sad by their sexual thoughts and behavior, although only (17%) sought treatment. Men who were closeted (63%, p=0.03) and had difficulty accepting their sexuality (62%, p=0.04) were at higher risk of potential sexual addiction compared to those men who were open (48%) and accepting their sexuality (48%).
CONCLUSION: Assessment and treatment should prioritize LGBTQ+ affirming care as sexual addiction has detrimental physical and mental health consequences owing to their diverse sociocultural context and unique life stressors.
Cross-sectional study of psychiatric morbidity and self- esteem and perceived social support in post-burn patients.
Dr Triveni M Gowdar (1 year Postgraduate),
Dr Archana (Assistant Professor),
Dr Aarshie (Senior Resident)
Department of Psychiatry, Bangalore Medical College and Research Institute. Bangalore.
Background: Psychiatric morbidity in burns patients is said to be considerably higher than that of general population. Low self-esteem further adds on the existing burden. Social support plays an important role in enhancing the mental image and self-esteem of burn patients.
Aim: To assess the frequency of the psychiatric morbidity in post-burn patients. To determine the association between psychiatric morbidity, self-esteem and perceived social support
Methods: Data from 30 patients who visit burns clinic OPD are included in the study. Depression, Anxiety and Stress Scale 21(DASS 21), Rosenberg’s Self-esteem scale (RSES) and Multidimensional Scale of Perceived Social Support (MSPSS) scales were applied. The frequency of psychiatric morbidity and its association with self-esteem and perceived social support is looked for.
Results: Out of 30 participants, 16.7% had depression, 23.3% had anxiety ,10% had stress.15% had low self-esteem. Among depressed 80% had low self-esteem. Among anxious 42.9% had low self-esteem. Among participants who had stress 66.7% had low self-esteem. Positive association was found between depression and low self-esteem (p value <0.001), stress and low self-esteem (p value - 0.048). Out of 30 participants, 20% had decreased perceived social support. Positive association was found between depression and decreased perceived social support (p value <0.001). Statistically non-significant association was found between anxiety, stress and perceived social support.
Conclusion: High self-esteem and increased perceived social support reduces psychiatric morbidity.
A cross-sectional study of Pathological gambling and its Correlates among patients seeking treatment for Substance use.
Tsephel Eden Bhutia1, Samrat Singh Bhandari2, Sanjiba Dutta3
1Department of Psychiatry, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University.
Corresponding author: Dr Tsephel Eden Bhutia
Email: tsepheleden@gmail.com, 8696844901
Background: Gambling, although being a leisurely pursuit can have deleterious effects when it becomes unrestricted. Despite having been associated with substance use, there are very few studies regarding the rates of pathological gambling among substance users in India.
Aim: To determine the prevalence of pathological gambling and its correlates in patients seeking treatment for substance use.
Methods: This cross-sectional observational study was conducted in a tertiary care hospital in Sikkim. Patients aged 18-60 years were interviewed about their substance use and gambling using standardized scales such as the Addiction Severity Index (ASI) and the South Oaks Gambling Screen (SOGS).
Results: A total of 145 patients participated in the study. The prevalence of probable pathological gambling according to SOGS was 37.9% (N=55). Alcohol (63.4%, N=92) was the most common substance used by the patients. Playing cards for money (48.3%, N=70) followed by playing lotteries (29.6%, N=43) and going to casinos (12.4%, N=18) were the common forms of gambling.
Conclusion: The study confirms the findings of previous studies regarding the occurrence of pathological gambling among substance users.
Gambling, Impulsive behaviour, Substance related disorders.
Introduction
Cannabis is one of the most commonly used substances in the world. A prevalence of 2.8% with a prevalence of 5% in males was reported for current use of cannabis in India. Various factors that predict the onset of cannabis have been studied, of which personality traits are readily identifiable and have received increased attention. Various previous studies show associations between cannabis use and personality traits such a schizotypal, antisocial and borderline personality traits. Also, there is considerable data to show association between early use of cannabis and schizophrenia spectrum of diseases. Those with cannabis dependence usually have a current dual diagnosis. Of these, mood, anxiety and personality disorders are the most common.
Aim
To study the psychiatric comorbidities amongst persons with cannabis use disorder.
Methodology
The study was initiated after obtaining institutional ethics committee approval from Ethics Committee, Osmania Medical College. Casesheets of patients with a diagnosis of cannabis use disorder over the past 5 years were identified and reviewed. Sociodemographic data was obtained from the casesheet. Caregivers were contacted with the phone numbers available in the casesheets. They were requested to review with the investigator at the Institute of Mental Health. DSM V criteria was used to screen for psychiatric comorbidities in those who follow up.
Emotional Disconnect Among Married Couples: Relation With Phubbing Behaviour
Background : The Covid-19 pandemic and social isolation has led to increased use of communication and information technology tools, definitely in young people but also in adults leading to phubbing. Phubbing, as described by Chotpitayasunondh and Douglas (2018), is the act of snubbing someone in a social setting by looking at one’s phone instead of paying attention to the other person. According to surveys carried out by the Lawyers in India, there is at least 30 percent increase in petitions seeking divorce.
Aim: Therefore, the aim of this research is to evaluate the relation between 1) phubbing and temperament in married couples 2) phubbing and intimacy in married couples.
Methods : A cross-sectional study will be carried in around 100 married couples by online survey or face-to-face interview. The Generic Scale of Phubbing, The Generic Scale of Being Phubbed, Marital Intimacy Questionnaire and TEMPS-M will be used to assess phubbing, being phubbed, intimacy among married couples and temperament in individuals respectively. The study will be done in a period of 3 months.
Results: The results and implications of the results will be discussed.
Cognitive Impairment In Unipolar And Bipolar Depression: A Cross Sectional Study From North India
Place of work- Department of Psychiatry, JLN Medical College, Ajmer
1. Dr. Varun bansal*, 1styear PG student, Department of Psychiatry, JLN Medical College, Ajmer. Mob. No.- 9653674740, Mail Id: bansalvarun1230@gmail.com
2. Dr. Charan Singh Jilowa, Associate Professor, Department of Psychiatry, JLN Medical College, Ajmer. Mob. No.- 9462265654, Mail Id: drcharansingh04@gmail.com
*Presenting Author
Background-Cognition means higher mental functions and includes attention, memory, language, orientation, executive function, judgment problem solving. Any degree of impairment in these processes results in cognitive impairment and deficits. Research suggest that neurocognitive deficits are a major component of unipolar depression. Studies also indicate the presence of cognitive disturbances during depressive phase of bipolar affective disorder.
Aim-To assess the differences in neurocognitive functions during depressive phase of bipolar and unipolar depression.
Methods-This study was carried out on 30 patients of bipolar depression and 60 patients of unipolar depression on OPD basis from June 2022 to August 2022.The diagnosis was made as per ICD-10 and after applying inclusion and exclusion criteria, severity was rated using Hamilton depression rating scale and the cognitive functions of patients were assessed using Digit span test, Trail making test, Stroop colour test, Controlled oral word association test.
Results-Patients with bipolar and unipolar depression were significantly impaired on all the domains studied. On comparing the two, patients with bipolar depression performed poor on all the neurocognitive tests more.
Conclusion- Bipolar depression performed poor on all the neurocognitive tests in comparison to patient with unipolar depression.
PREVALENCE AND RISK FACTORS OF PRENATAL DEPRESSION AMONG PREGNANT WOMEN
Varun Krishna Rao Koppula1, C Balvanth Reddy2, S Prasanna Latha3, K Lokesh kumar4,
Lt Col Harihar Chilukuri5.
Junior resident1, Senior Resident2, Assistant professor3, Associate professor4, Professor of Psychiatry5, Bhaskar Medical College.
INTRODUCTION: Pregnant women experience a set of psychological disturbances of which depression is most common, with a prevalence of about 20% worldwide. Identifying and treating this problem can reduce the possible morbidity of untreated maternal depression.
AIMS and OBJECTIVES: To assess the prevalence and risk factors of depression among pregnant woman.
METHODOLOGY: The present study is a descriptive method conducted among pregnant women attending antenatal check-ups at Bhaskar General Hospital, RR Dist, Telangana. The tools used are:- 1)Socio-demographic profile, 2) Clinical profile, 3) Hamilton Depression Rating Scale (HAM -D).
RESULTS: Statistical analysis will be done using SPSS-21. The results analyzed will be presented later.
Keywords: Depression, Risk factors,Pregnancy HAM-D.
Assess relationship of serum levels of vitamin D in adults with depression.
Dr Vibhor Jain, Dr Sumit Rana, Dinesh Kataria, Om Sai Ramesh, Swati Sharma
Background and Aim: Major depressive disorder has been linked with deficiency in many nutrients, especially vitamins, but it is unclear whether vitamin D deficiency plays a role at least in persons with clinically relevant depressive symptoms. This study investigates relationship between vitamin D in adults with depression and healthy adults, and its relationship with severity of depression.
Method: For this purpose, a total of 60 patients with clinically confirmed diagnosis of depression and 60 healthy controls were enrolled. Demographic and social profile of participants was noted and severity of depression was assessed in patients using Hamilton Depression Rating Scale. Serum Vitamin D levels were assessed for both groups.
Results: The mean levels of Vitamin D in cases were 27.15 ng/L, in control were 28.31 ng/L. In cases 38% had Vitamin D deficiency (< 20 ng/L), 27% had insufficient (20-30 ng/L) and in controls 21% had Vitamin D deficiency, 42% had insufficient levels. There was no significant difference between two groups regarding Vitamin D levels (p =<0.353). Although on further case analysis, a statistically significant (p =<0.001) moderate negative correlation between depression score and Vitamin D levels was found.
Conclusions: Baseline low Vitamin D levels although associated with severity of depression but our results do not support vitamin D supplementation.
Stigma, self-esteem and quality of life of vitiligo and leprosy patients: a Comparative cross-sectional study
Vidhata Dixit, Pravin Kumar Kesari, Santosh Kumar
Background: Vitiligo and leprosy are two common stigmatizing chronic skin dermatoses in Indian societies.
Aims: This study aims to compare stigma, self-esteem and quality of life of vitiligo and leprosy patients.
Methods: In this hospital-based cross-sectional study, a total of 55 vitiligo patients and 56 leprosy patients of both genders were enrolled using the purposive sampling technique. The sample was assessed on Participation Scale, Rosenberg Self-Esteem Scale and Dermatology Life Quality Index (DLQI) questionnaire to assess their stigma, self-esteem, and quality of life respectively.
Results: The patients of both groups were comparable in terms of all sociodemographic and clinical variables except the leprosy patients had significantly lower mean age and mean family income than vitiligo patients as well as a significantly higher number of the former group had members of male gender and of rural background than the later group. The Means of total scores obtained on the participation scale (28.73±10.98 vs 11.51±12.60, Mann-Whitney U=460, p<.001) and DLQI questionnaire (11.04±2.76 vs 5.62±3.22, Mann-Whitney U=333, p<.001) were significantly higher in leprosy patients than vitiligo patients. Significantly higher number of leprosy patients had stigma (91.1% vs 38.2%; χ2= 34.058, df=1, p<.001) and low self-esteem (60.7% vs 14.5%; χ2=25.146, p<.001) than vitiligo patients. Almost all the patients of vitiligo (98.2%) had moderate/very large effect on QoL while the majority of vitiligo patients (56.4%) had either no/small effect on QoL; χ2=40.284, df=1, p<.001.
Conclusion: In comparison to vitiligo patients, the leprosy patients had significantly higher stigma, lower self-esteem and poorer quality of life.
Keywords: Leprosy, vitiligo, stigma, self-esteem, quality of life, India
A Prospective Study Comparing Predictability of Relapse in Patients with Schizophrenia using Assessment Tools
Dr. Vidit Singh, Dr. Ramanand Satapathy, Dr. P. Padma, Dr. Snigdha Awasthi
BACKGROUND: Relapse in schizophrenia is a common phenomenon and seemingly cannot be eliminated even with the best combination of psychopharmacological and psychotherapeutic interventions. Subtle changes in thought, affect, and behaviour precede psychotic relapse in a patient of Schizophrenia, classified as ‘Early Warning Signs’ which can be assessed using different tools, thus helping in predicting an impending relapse and alleviation of psychiatric morbidity through early intervention.
AIMS: To assess early warning signs of relapse in patients with Schizophrenia and compare the efficacy of the Early Signs Scale (ESS) and the Relapse Assessment in Schizophrenia Patients (RASP) in assessment of early warning signs of relapse.
METHODS: Patients having schizophrenia with history of at least one previous hospitalization were assessed using ESS and RASP separately in 2 groups of 50 patients each for Early Warning Signs of Relapse and compared with a control group of 50 patients. The efficacy of both the tools were compared.
RESULTS: The sensitivity and specificity of both ESS and RASP were found to be comparable and they were able to successfully predict impending relapse as compared to the control group where no tools were used for the assessment of early warning signs of relapse.
CONCLUSION: Assessment of Early Warning Signs using assessment tools is an effective way to predict impending relapse in Schizophrenia which can help in reducing the rate of re-hospitalization.
Study of psychiatric morbidity and burden on key caregiver of patients with Alzheimer’s dementia
Dr. B.S.Shekhawat, Dr. Suresh Parihar ,*Dr. K.Vignesh, Dr. Mithlesh Khinchi, Dr. Vikas Dhaka, Dr. Sandhya
Introduction: Alzheimer’s Dementia(AD) is progressively deteriorating illness which is associated with psychiatric morbidity. AD patients need continuous care and possess significant burden on caregivers. The present study is conducted to determine the psychiatric morbidity and burden of key caregivers.
Aim & objectives of the study:
1. To assess psychiatric morbidity in key caregivers of patients with AD.
2. To assess burden on key caregivers of AD patients.
Materials and methods:
60 key caregivers of diagnosed cases of AD by consultant psychiatrist/neurologist attending psychiatry/neurology OPD at new medical college hospital & MBS hospital, Kota were included.
Tools of the study:
1. a specially designed sociodemographic proforma
2. Goldberg’s Health Questionnaire (GHQ-12)
3. Hamilton Anxiety Rating Scale (HAM-A)
4. Beck’s Depression Inventory (BDI)
5. The Zarit Burden Interview
Results and discussion: Our study found that 21.7% of caregivers were suffering from depression (mild depression - 3.3%, moderate - 11.7% and severe depression-6.7). Likewise, 6.7%, 8.3% and 5% were found to have mild, moderate and severe anxiety in caregivers respectively. The mean BDI score was found 22.67+/-9.06 whereas mean Hamilton anxiety score was found 19.80+/-5.32. 68% of caregivers were feeling severe burden whereas 30% were feeling moderate to severe burden while only 2% were feeling mild to moderate burden. Mean burden score was 61.03+/-10.125.
*presenting author
CLOZAPINE PRESCRIBING TRENDS AMONG INDIAN PSYCHIATRISTS
Dr Vijay savita
Dr Kashyap shah
Dr Shivani dua
Dr vijay niranjan
MGM boys hostel, mgm medical college, indore MP
Email: vijaysavita1411@gmail.com@gmail.com
Contact 9740844781
INTRODUCTION
Clozapine is a multireceptorial atypical antipsychotic approved for the treatment of resistant schizophrenia. However, clozapine is not considered as a top-of-the-line treatment because of issues with patient’s tolerability and adverse effects which can be bothersome and potentially dangerous . Therefore, every effort should be made to monitor and minimize these adverse effects in order to improve their early detection and management.Clozapine, in most countries, is underutilized and initiation is often delayed. Many psychiatrists are reluctant to use clozapine and this might be due to less experience and knowledge of clozapine.
AIMS & OBJECTIVES
To examine the awareness, familiarity and attitude of Indian psychiatrists regarding the use of clozapine, and also to evaluate their prescription practices for clozapine.
To clarify barriers to prescribing and elucidate factors that may improve patient access to clozapine.
METHOD
Data was collected using online questionnaire based survey. Survey included questions regarding clozapine properties, familiarity with guidelines, prescription and attitude towards specialized clozapine resources.
RESULTS
Most psychiatrists preferred starting dose 12.5 mg (52.5%). Most common side effect was hypersalivation(~50%), followed by sedation(37.5%) and weight gain(12.5%).82.5% of psychiatrist think there is delay in starting clozapine, most common reason being side effect and metabolic issues (37.5%) followed by difficulty in ordering investigation in follow up(20%).3/4 of psychiatrist think clozapine is underutilised in our country.
CONCLUSION Based on above survey, we will be able to identify the dominant barriers to prescribing. These can be targeted in training and professional development programmes.
A study of psychiatric morbidity and quality of life of head and neck cancer patients before & after radiotherapy
INTRODUCTION: Many aesthetic and functional changes are caused in head and neck cancer patients. Physical and functional impairment can cause psychiatric illnesses and may impair quality of life of these patients.
AIMS & OBJECTIVE: To study psychiatric morbidity and quality of life of head and neck cancer patients before and after radiotherapy.
METHODOLOGY: The present study was conducted in association of radiotherapy department of tertiary care hospital. 50 consecutive Head and neck cancer patients aged 18 to 65 years fulfilling the specific criteria laid down for the study were included. A semi structured proforma having patients’ sociodemographic and clinical profile, Hamilton Anxiety Rating Scale (HAMA), Beck’s Depression Inventory (B.D.I.) and World Health Organization Quality Of Life Assessment scale WHOQOL – BREF, Hindi (version) were used.
RESULTS: 38 (76%) and 28(56%) patients were suffering from psychiatric morbidity before and after radiotherapy respectively. 31(62%) and 23(46%) were suffering from depression & anxiety respectively before radiotherapy. Likewise, 20(40 %) and 19(38%) had depression and anxiety respectively after radiotherapy. Difference in mean HAM-A and BDI score before and after radiotherapy was not significant. QOL scores after radiotherapy were found better in all domains but it was not statistically significant.
CONCLUSION: Present study found that radiotherapy treatment decreased the psychiatric morbidity in head and neck cancer patients but it was not found statically significant. Similarly, QOL improvement after radiotherapy was not significant.
Study of Cognitive Impairment in Cases of Major Depressive Disorder
Background
• Major Depressive Disorder (MDD) is a chronic, often serious and disabling condition that is common in different age groups, gender and socio-economic status. Cognitive symptoms in depression seem to impact significantly not only on patient’s functioning and quality of life, but also on the risk of recurrence of depression. Assessing patients with depression for cognitive impairment and selecting treatment that address cognitive function should lead to improved functional outcomes.
Aims
• To assess and study prevalence and pattern of cognitive impairment amongst Indian patients diagnosed with Major Depressive Disorder.
Methods
• Observational cross-sectional study conducted on 171 patients coming to Psychiatry OPD. They were given to fill the case report form (CRF) containing demographic details and questions related to past depressive episodes. Hamilton Depression Rating Scale (HDRI) and Addenbrook’s Cognitive examination III (ACE III) scale were also administered for severity of depression and pattern of cognitive impairment respectively.
Results
• Total 171 cases having depression were participated in the study. More than half [61 (60.4%)] of the male and female [42 (60%)] cases were having abnormal score. One fourth cases [46 (26.9%)] were having normal and few cases [22 (12.9%)] were having inconclusive category. There was statistically significant correlation between HDRI scoring and Addenbrook ‘s cognitive examination scale III
Conclusion
• Depressive episode leads to significant impairment in cognitive aspects. Significant impairment can occur in all domains of cognition (i.e. Attention, Memory, Fluency, Language, Visuo-Spatial Ability)
Efficacy of Structured Psychoeducation on Treatment Adherence in First Episode Psychosis
Dr. Vishal Nagar1* Dr. Kamal Narayan Kalita2
M.D Trainee, Department of Psychiatry, LGB Regional Institute of Mental Health, Tezpur, Assam
Associate Professor, Department of Psychiatry, LGB Regional Institute of Mental Health, Tezpur, Assam
Background: Non-adherence to medication is a missing link between effective treatment and outcomes among psychiatric patients. It is related to higher relapse and admission rates in patients presenting with first episode psychosis. Although medication is mainstay of treatment with first episode psychosis, a structured psychoeducation can be a cost-effective intervention for better outcome. Aim: To compare treatment adherence in First Episode Psychosis between patients receiving and not receiving structured psycho-education. Material and Methods: It was longitudinal, prospective, and comparative study with 120 first episode psychosis out-patients, divided into 2 randomized groups. Both groups received treatment as usual and socio-demographic-clinical proforma was filled along with administration of Brief Psychiatric Rating Scale at baseline. One group received adherence focused structured psychoeducation also. Then patients were followed up at one month interval with both the groups receiving weekly reminder SMS in between. At follow-up, Drug Attitude Inventory-10 (DAI-10) and Brief Adherence Rating Scale (BARS) were applied to assess adherence. Results: Both groups were comparable in Socio-demographic-clinical profile, with mean age in intervention group being 31.1 and 29.1 years in control group. Mean DAI-10 score was 5.73 in intervention group, 4.53 in control group, mean BARS score was 79.55 in intervention group, 76.92 in control group, 10% of patients in the intervention group were unaware of the medications they were supposed to take as compared to the control group’s 18.3%. Conclusion: Structured psychoeducation likely to improve adherence in long term with continued sessions. Further research is required for such cost-effective intervention in India.
Keywords: Psychoeducation, Adherence, Efficacy & First Episode Psychosis
Social, Affective, Cognitive, and Behavioural correlates of Health Anxiety in Medical Students: A Cross-sectional Survey.
Background: Health Anxiety (HA) encompasses a spectrum of disordered health related concerns ranging from illness anxiety to hypochondriasis. It is characterized by affective, cognitive, and behavioural patterns where the focus of anxiety is on one’s health. Medical students are at risk of developing HA during their period of training. This is compounded by excessive online health-seeking behaviour (cyberchondria). Trait anxiety or neuroticism has been shown to predispose to HA. HA is associated with poor mental health.
Methods: A cross-sectional survey of HA and its social, affective, cognitive, and behavioural correlates was conducted among MBBS students of a Medical College in Northeast India. Health anxiety, depression, trait anxiety, resilience, and cyberchondria were assessed using validated self-report questionnaires.
Results: Of the 253 students 17.9% suffered from clinically significant HA. HA was significantly more common in 2nd and 3rd year students. Depression, trait anxiety, and cyberchondria were significantly more common in students with HA (all p values < 0.05). Psychological resilience was significantly lower in students with HA (p value =0.000).
Conclusions: HA is prevalent among medical students and is associated with depression, trait anxiety, excessive online health seeking behaviour, and poor resilience. Mental health professionals need to be aware of the extent of HA,its risk factors and consequences in Medical students.
Dr.Vivek Kumar
Email-vivekkumar007046@gmail.com
Mobile- 9199199699
Vivek Kumar1, Harshavardhan Sampath2, Sanjiba Dutta3.
Sikkim Manipal Institute of Medical sciences, Sikkim Manipal University.
A CASE CONTROL STUDY OF SLEEP DISTURBANCES IN CHILDREN WITH ATTENTION DEFICIT HYPERACTIVITY DISORDER
Dr Yeshwantsingh Solanki , Dr Gaurav Pawar 1
1-Grant Government Medical college
Background –Sleep disturbances are highly prevalent and often co-occur among children with Attention Deficit Hyperactivity Disorder (ADHD). About 50–70% of these children reportedly suffer from sleep impairments.
Aims- To examine the association between attention-deficit/hyperactivity disorder symptomatology and parent-reported sleep problems among children aged 6 to 12 years.
Methodology – After Institutional Ethical Committee (IEC) approval and appropriate consents/assents, data was collected from parents of 30 ADHD cases and 30 controls. ADHD was diagnosed using ICD-11 criteria (International Classification of Diseases 11th Revision). Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS) was used to assess severity of ADHD and sleep was assessed through parent reported sleep problems (Children’s Sleep Habits Questionnaire) in 30 cases and 30 controls.
Results – A statistically significant difference was found in sleep pattern of children with ADHD and those without ADHD. Though the sleep pattern did not statistically correlate with the severity of ADHD.
Conclusion- Sleep disturbances are commonly occurring problems in children with ADHD. Although not much clinical attention is given to it, it requires further large scale studies to understand various factors influencing sleep pattern in children with ADHD.
Keywords- ADHD, Sleep pattern
A Non-interventional, Naturalistic Study of Prescription Patterns, Clinical and Socio-demographic Profiles of Patients with Psychotic Disorders at a Tertiary Care Centre in India
1) Name: Dr. Zarrin Ansari
Affiliation: Resident, Department of Pharmacology.
Institute: Lokmanya Tilak Municipal Medical College and General Hospital, India
Highest Academic Degree: MBBS, MD Pharmacology Resident
2) Name: Dr. Abhilasha Rashmi
Affiliation: Associate Professor, Department of Pharmacology
Institute: Lokmanya Tilak Municipal Medical College and General Hospital, India
Highest Academic Degree: MD Pharmacology
3) Name: Dr. Sudhir Pawar
Affiliation: Professor and Head of Department. Department of Pharmacology.
Institute: Lokmanya Tilak Municipal College and General Hospital, Mumbai, India
Highest Academic Degree: MD Pharmacology
Corresponding Author:
Dr. Zarrin Ansari; Resident, Department of Pharmacology. Lokmanya Tilak Municipal
Medical College and General Hospital.
Past Senior Medical Advisor (Neuropsychiatry) with Cipla Limited
Mailing Address: Lokmanya Tilak Municipal Medical College and General Hospital.
Pharmacology Department, Dr. B. R. Ambedkar Road, Sion,
Mumbai-400022, India.
Email address: zarrinansari@yahoo.com
Phone number: +91 9819131436
Orcid Id: https://orcid.org/0000-0001-5002-3129
Objectives: The aim of this study was to document the sociodemographic and clinical profiles and prescription patterns in patients diagnosed with psychotic disorders attending the psychiatry outpatient department at a tertiary care centre.
Methods: A prospective, non-interventional, naturalistic, cross-sectional, observational study was conducted between March 2021 and April 2021 at Lokmanya Tilak Municipal Medical College and General Hospital in Mumbai (India). A total of 200 prescriptions were analyzed. Demographic and clinical data were collected using structured case-record forms after taking written informed consent. World Health Organization (WHO) indicators were also calculated to assess the rationality of prescriptions.
Results: The mean age of the cohort was 40.26 years with the range being 18-75 years and the mean duration of illness suffered was 10.75 years. In general, more males (122/200, 61%) were affected than females (78/200, 39%). College or higher education was attained only by 21% (42/200) patients out of which 31 (15.5%) were males and only 11 (5.5%) were females. Seventy-nine percentage (158/200) had attained school or lesser. Almost half (58%) of patients were married and the other 42% were separated/divorced/unmarried/widowed. One hundred and seven (68.5%) of patients were diagnosed of schizophrenia without any co-morbid neuropsychiatric condition. Amongst the 200 analyzed prescriptions, 13 antipsychotics were prescribed 343 times. The highest frequency of antipsychotic prescription was for olanzapine (132, 66%) followed by clozapine (75, 37.5%). There was a single prescription of depot flupenthixole. The typical antipsychotics prescribed were haloperidol (41, 20.5%), trifluperazine (3, 1.5%), loxapine (1, 0.5%) and flupenthixole depot (1, 0.5%). In total 91% (181/200) of patients were prescribed concomitant medications to antipsychotics. The commonest concomitant psychotropic drugs prescribed were trihexyphenidyl (45%), escitalopram (30%), clonazepam (26.5%), sodium valproate (10%), propranolol (10.5%) and modafinil (9.5%). The commonest non-psychotropic medications were multivitamin B-compex/iron supplements/calcium (52%). Only 6% of prescriptions had a single drug prescribed in the present study. Consequently, 94% (188/200) prescription demonstrated polypharmacy, defined as two or more than two drugs per prescription. The percentage of polypharmacy in males was 56% (112/200) and in females was 38% (76/200). Frequency of antipsychotics per prescription were; one in 44% (88/200), two in 36.50% (73/200), three in 17% (34/200), four in 0.5% (1/200) and five again in 0.5% (1/200) of patients. There were 3/200 (1.5%) prescriptions with zero antipsychotics.
Conclusions: Atypical antipsychotics formed a majority of antipsychotic prescription in the present study. The rapidly increasing use of this new class of antipsychotics highlights the need for better evaluation regarding their safety profile. This study also demonstrated a high rate of polypharmacy. Further evaluation demonstrated many off-label use of drugs viz. propranolol and metformin for balancing the adverse effects of the psychotropic drugs.
antipsychotics, prescription pattern, psychotropic drugs, polypharmacy, psychotic disorder, prevalence
Prevalence and Clinical co-relates of Obesity in patients of Schizophrenia
Background: Recent literature suggests that schizophrenia is associated with obesity. However, prevalence and clinical correlates of obesity among patients with schizophrenia have not been adequately studied in the context of Indian population.
Aims and Objectives: 1. To determine prevalence of obesity among patients with schizophrenia. 2. To study the association of body mass index (BMI) with duration of illness, symptomatology of schizophrenia, depressive symptoms, sleep patterns and anti-psychotic medications.
Material and Methods: 70 patients of schizophrenia, aged 18 to 60 years, were enrolled after due informed consent. Prevalence of obesity was determined by the BMI which was calculated after measuring the height and weight of patients. Patients were assessed for depressive symptoms, symptoms of schizophrenia and insomnia, using the Calgary Depression Scale for Schizophrenia (CDSS), Positive and Negative Syndrome Scale (PANSS), and Insomnia Severity Index (ISI), respectively. Their duration of illness and medication regimen was noted from case histories. Data was analyzed using Pearson’s Correlation Coefficient test and ANOVA.
Results: There was a significant positive correlation between BMI scores and scores on depression. There was no significant correlation between BMI and scores on PANSS and insomnia and duration of illness. The patients on different medication regimen did not differ significantly in their BMI scores
Conclusion: As the scores on the BMI increased, so did the scores on depression, possibly pointing to a link between weight and depression among schizophrenia patients.
Key words: Body-Mass Index, Schizophrenia, Depression, Insomnia, Medications.
Evolving Patterns of Emergency Psychiatry Services Utilization
*Dr Aswathi Nair, Junior Resident
**Dr Varghese P Punnoose, Prof and Head
Department of Psychiatry, Government Medical College, Kottayam, Kerala
BACKGROUND
Behavioural emergencies frequently present to general hospital emergency services which are managed by medical professionals with limited training in psychiatry. It has been observed that patterns of presentation to Psychiatry ERs are undergoing drastic changes in recent years.
AIMS
To study the pattern of clinical presentations to Emergency Psychiatry Services in the past year in comparison with 8 years before
METHODS
Chart review of Psychiatry ER at Govt. Medical College, Kottayam, Kerala in the past year (2021-22) and 8 years before (2013-14)
RESULTS
There is an increase of psychiatric emergency consultations from 841 to 1029 patients (22.35%). There is a remarkable increase in female- male ratios from 48.58 to 63.85. Those who presented with psychiatric diagnoses in ICD 10 F0 to F3 constituted 94.5% and 91.7%. The proportion of patients with problems related to substance use was 24.02% in 2014 and 29.80% in 2022, with a falling mean age, with those below 30 years constituting 13.86% and 25.08% respectively.
DISCUSSION
The public health implications of the findings of the study are evident from the rise in the proportion of female attendees, increase in the number of patients with no past history, more disorders in F4(ICD 10) category, rising proportion of SUDs and the decline in their mean age. The less than expected referrals of conditions like panic attacks and misdiagnosis of delirium as psychosis or stress reactions could be a reflection of inadequate training. These observations reiterates the need for more training for the first line health professionals in psychiatric emergencies and system innovations to meet the increasing demands of behavioural emergencies.
PERSONALITY PROFILE AND RELAPSE IN PATIENTS WITH ALCOHOL USE DISORDERS
Dr.Chinnu Mary Chacko 1 ,Dr. Roy A Kallivayalil 2
BACKGROUND :
Alcohol use disorder is characterised by craving, compulsion, tolerance, causing major obligation at work, school and home. Relapse is defined as resumption of alcohol intake following a prolonged period of abstinence within a period of 1 month. Persons with certain personality traits are more prone for relapse. Neuroticism, novelty seeking, low ego strength are the commonly associated with alcohol relapse .
AIM:To assess the impact of personality profile on alcohol relapse in patients with alcohol use disorder in a tertiary care centre.
METHOD: Patients satisfying inclusion and exclusion criteria and with a diagnosis of alcohol use disorder according to DSM 5 by a consultant will be recruited for the study by consecutive sampling after taking an informed consent. Semistructured Performa will be used to collect sociodemographic details and alcohol related factors by interview method. Psychiatric comorbities will be ruled out using M.I.N.I.7.0.2 .Patients personality profile will be assessed by Temperament and character inventory scale.
RESULTS :Personality traits among 85 samples collected of which harm avoidance (23.5%)and novelty seeking(32.5%) are prone for alcohol relapse and linked to higher scores of SADQ .
CONCLUSION: Alcohol Dependence is a disorder which is studded with relapses is a major cause of Psychiatric comorbidity .Personality plays a major role in relapse.There is a perfect blend for management which remains still elusive while milieu and entourage .
Chronic Fatigue Syndrome In Post Covid -19 Patients: A Community Based Study In North India
Place of work- Department of Psychiatry, JLN Medical College, Ajmer
3. Dr. Dharmveer gurjar*, 3rd year PG student, Department of Psychiatry, JLN Medical College, Ajmer. Mob. No.- 9680281498, Mail Id: dharamg2009@gmail.com
Dr. Parth Singh, Associate Professor, Department of Psychiatry, JLN Medical
4. College, Ajmer. Mob. No.-8209004822, Mail Id: parthaiims@gmail.com
Background- The COVID-19 pandemic, has been continuing for more than 2 years and more than 285 million cases of infection and 5.4 million deaths have been reported worldwide . In post COVID-19 conditions, general fatigue and post-exertional malaise are most common somatic sequelae It has been reported that some patients with COVID develop chronic fatigue syndrome . Hence, the present study has been conducted to investigate the presence of post covid somatic symptoms , their frequency, severity and prevalance of chronic fatigue syndrome in post-COVID-19 patients.
METHODS- cross sectional study in the form of an online survey. total of 400 response were finally included after inclusion and exclusion criteria
RESULTS: mean age was 36.1±7.7 years. the prevalence of CFS to be 12% of our study sample. The most frequent symptom among the patients who met the criteria of CFS was muscle pain (52.1%) followed by postexertional malaise lasting more than 24 hours (47.9%). Less common symptoms were unrefreshing sleep, impaired memory and sore throat
CONCLUSION: the prevalence of chronic fatigue syndrome among the recovered COVID-19 patients was 12% and these patients show moderate to severe symptoms like fatigue, impaired memory, sore throat, tender lymph nodes, muscle pain, pain in several joints, new pattern of headache, unrefreshing sleep and postexertional malaise lasting more than 24 hours.
Intimate partner violence and depression in spouses of alcohol dependence syndrome.
BACKGROUND:Alcohol use is considered as a major health and social problem. Family members especially the spouses suffer intense psychological,physical and social trauma due to core drinking problem. Intimate partner violence (IPV) is a globally acknowledged public health problem.About 1 in 3 have been subjected to IPV in their lifetime.
AIM:In this background the study as carried out to assess IPV and depression in spouses of Alcohol Dependence Syndrome(ADS)
Methods:This is a hospital based cross sectional study. Spouses of 30 ADS cases were interviewed. To assess IPV and depression in spouses,WHO Intimate partner violence scale(WHO-IPV scale) and Hamilton depression rating scale(HDRS) was used respectively.For assessing severity of ADS, severity of alcohol dependence questionnaire(Sadq-c)was used.
Results:SADQ showed 73 % had severe alcohol dependence .Intimate partner violence was seen in 56% of partner out of which 53% had emotional abuse,33% had both physical abuse and controlling behaviour and 10% had sexual abuse. In some all the 4 types of abuse as present (6%).Around 74% of spouses had Depression .Mean HAM -D score in 30 spouses 16.6±1.9. Severe depression was seen in 8% and 66% had mild to moderate depression.5% of ADS had extramarital affair.
Conclusions:Most of the spouses of ADS has IPV which is ignored while interviewing the patients of ADS.The above finding suggests that interviewing the partners for IPV and other psychological issues is important to help the spouses to provide the appropriate help.
NON-SUICIDAL SELF INJURIOUS BEHAVIOR IN SCHIZOPHRENIA: A CASE SERIES
Kritika Agarwal , Jitendriya Biswal , Surjeet Sahoo
Post Graduate Dept of Psychiatry , Ims and Sum Hospital , Bhubaneshwar
Background: Patients of schizophrenia are known to attempt self-harm due to commanding or threatening hallucinations, catatonic excitement, delusions or associated depression. Non suicidal self-injury and suicidal behavior are distinct terms, as there are significant differences in terms of the causation, psychiatric impairment, course and outcome.
Methods: 3 cases of patients with schizophrenia were evaluated for non-suicidal self-injurious behavior in the opd of Ims and sum hospital. Patient was examined for self-injurious behavior and evaluated in detail.
Results: All three of these patients are cases of non-suicidal self-injury and had harmed themselves due to either their delusions, commanding hallucinations or fearfulness during the active phase of psychosis and not due to their own will or with any intention of committing suicide.
Conclusion: Non suicidal self-injury is very common in schizophrenia. It is associated with severe scarring, nerve damage, risk of infectious diseases, accidental death, emotional distress and it was also found to be a strong predictor of future suicide attempts. Hence, treatment modalities should include immediate management of the injury and the psychopathology with appropriate precautions to avoid future self-harm.
Psychosocial and behavioural impact of COVID-19 pandemic in children and adolescents with autism spectrum disorder
Dr. Madhurima Mondal, Dr. Anweshan Ghosh, Dr. Amit Kumar Bhattacharyya
Background: The children and adolescents with ASD around the world have experienced a major disruption of their everyday lives due to the COVID-19 pandemic. Social isolation has inflicted a negative impact on the psychological well-being of these children and adolescents.
Aim: To investigate the impact of COVID-19 pandemic in children and adolescents with ASD in terms of comprehension and adherence to implemented measures and changes in their behavioural problem.
Methodology: A retrospective cross-sectional (descriptive) study was done involving 16 ASD children and adolescents attending OPD of a tertiary care institute within a time period of 12 months for various behavioural problems using ISAA scale and Nisonger CBRF. Each subject was assessed on a single occasion for 3 different timelines-Pre-COVID (before March 2020), during full Lockdown (March-May 2020) and Post-Lockdown (January 2021-January 2022).
Results: The ISAA scoring revealed significant increase in ASD-related behaviours (i.e. inappropriate emotional response, difficulty in communication etc.) from before pandemic to during pandemic and Post-Lockdown (p value<0.05).The Nisonger Child Behaviour Rating Form revealed deterioration in Positive Social behaviour (p value<0.05).Significant increase in problem behaviour was seen in all the six domains (Conduct problem, Insecure/Anxious, Hyperactive, Self-injury/Stereotype, Self-isolated/Ritualistic and Overtly Sensitive)(p value<0.05).
Conclusion: Disruption of daily routine and social distancing have led to increase in problem behaviours of the children and adolescents with ASD as well as an increase in deficits of positive behaviours.
Keywords: Autism, pandemic, COVID-19
“Cognitive impairment in persons with alcohol dependence syndrome : A cross-sectional study”
Dr.M.Ramya1, Dr.Sudha Rani Kesavareddy2, Dr.K.Rajeevi3, Dr.K.Siddarth4
1 Junior resident, 2 Professor in Psychiatry, 3 Asst. Professor in Psychiatry, 4 Junior Resident.
Department of Psychiatry, Institute of Mental Health,
Osmania Medical College, Hyderabad.
BACKGROUND: Cognitive impairment is characterized by decline in memory, language, visuospatial functions which are useful for smooth functioning of daily activities. Chronic alcohol use can result in cognitive impairment due to atrophy of frontal lobe and hippocampus with enlargement of brain ventricles. Quantity of alcohol consumed, duration of consumption of alcohol effects the cognitive impairment. 50-80% of patients with alcohol intake have altered cognitive functions which varies between individuals and depends upon quantity of alcohol consumption and their genetic makeup. Screening for cognitive impairment is important in management of alcohol related problems.
AIM: To assess cognitive impairment and its relation with severity of alcohol consumption in persons with alcohol dependence syndrome.
SAMPLE: 100 persons with alcohol dependence who visited tertiary health center for treatment.
MATERIALS AND METHODOLGY: After fulfilling inclusion criteria patients were administered AUDIT. Then cognitive functions are assessed using MOCA scale. Analysis is done using SPSS software V.29.0
KEYWORDS: Alcohol dependence, cognitive impairment, Alcohol withdrawal.
PSYCHIATRIC COMORBIDITIES IN PATIENTS WITH CHRONIC CERVICAL SPONDYLOSIS
FIRST AUTHOR: Dr. NAVYA (PG, MD PSYCHIATRY, ESIC MEDICAL COLLEGE, HYDERABAD)
SECOND AUTHOR: Dr. SIVA ANOOP YELLA (ASSISTANT PROFESSOR, MD PSYCHIATRY, ESIC MEDICAL COLLEGE, HYDERABAD)
THIRD AUTHOR: Dr. NAVEEN KUMAR DHAGUDU (PROFESSOR, DEPARTMENT OF PSYCHIATRY, ESIC MEDICAL COLLEGE, HYDERABAD)
INTRODUCTION: Patients with cervical spondylosis, which occurs as a nonspecific neck pain, it is one of the leading causes of disability. Most of the people have long term symptoms and there is gradual decline in physical activity and sleep disturbance thus leading to increased distress among the patients.
METHODOLOGY: 50 patients attending OP & IP department of tertiary care hospital are selected. Cross sectional study is done. Sociodemographic data is collected, HAM - D, HAM - A scales, Insomnia severity index are administered. Severity of Insomnia and depression and anxiety are correlated.
RESULTS: Results show a positive correlation with psychiatric disorders in patients with cervical spondylosis.
CONCLUSION: Positive co relation is expected between depression and anxiety in patients with cervical spondylosis.
Keywords: Disability, Depression, Anxiety , HAM -A, HAM -D, Insomnia severity index
Prevalence and Pattern of Nicotine Use among Medical Students.
Dr.Sai Mithra Kamineni1 ,Dr.Hari Manasa2 ,Dr.Suresh Kumar3
1-junior resident 2-senior resident 3-Professor & HOD
Department of Psychiatry,Katuri Medical College and Hospital,Guntur,A.P
BACKGROUND :It is important to study and understand the pattern and prevalence of nicotine use in medical students- especially with their ubiquitous availability, innovations in products and life-style factors.
AIM:We studied the prevalence and pattern of nicotine use, socio-demographic characteristics, and adverse effects of nicotine use among medical students and also to know the age at 1st puff.
METHODOLOGY:This was a cross sectional study, and included 300 participants from medical colleges in guntur. All data were collected using self-administered semi-structured proforma, after obtaining written consent from the participants. We used Fagerstrom scale for nicotine use, General Health Questionnaire and WHOQOL-BREF for quantifying various domains. Statistical analysis was done using SPSS.
RESULTS:The mean age of 1st puff is 20 years, and the majority of the participants started nicotine use between 18 and 25 years of age. Out of a total of 170 male participants, 40.25% used nicotine products,out of which 80% were using nicotine in the form of cigarettes,4% e-cigarettes,3% beedi,3% chewable and 10% in the combined form while only 4.5% of the 105 female respondents did so. The overall prevalence among medical students appears to be 23.4%.
CONCLUSION: Nicotine use seems to be a common problem among medical students. There is a possibility that a large proportion of this population can be addicted to harder drugs.
Keywords: Nicotine; Prevalence; Medical students
Knowledge & Attitudes of undergraduate medical students toward patients with mental illnesses-A cross-sectional study in a medical college in Vadodara, Gujarat.
BACKGROUND: According to the World Health Organization estimates mental illness constitutes 14% of the global burden of disease. Worldwide studies have shown that persons suffering from mental illness encounter stigma and discrimination from medical students and doctors as well.
AIM: To assess the knowledge & attitude toward mental illness among undergraduate medical students.
METHODOLOGY: It was a cross sectional observational study conducted at Parul Institute of Medical Sciences and Research , Vadodara in which around 212 students participated after taking a valid informed consent A Google Questionnaire was used to obtain basic demographic details. Knowledge & attitude was assessed using Mental Health Knowledge Questionnaire (MHKQ) & Community attitude towards mental illness (CAMI) scale respectively. Analysis was done using SPSS software.
RESULTS: A higher knowledge & public stigma score toward mental illness was found in 15 % & 21.2 % of the participants respectively. Participants with better knowledge had more positive attitudes and fewer stigmas as shown by a significant correlation of MHKQ with CAMI subscales. Participants with a past history of mental illness had more favourable attitude with higher scores on benevolence (t 2.731, p <0.05) & CMHI (t 2.624, p <0.05). Participants having relatives with mental illness had better knowledge (t 2.39, p <0.05)
CONCLUSION: To promote equality for people with psychiatric illness there is a need for recognising the value of changing attitudes and perceptions. A better knowledge and awareness regarding mental illness are essential among healthcare professionals to shape favourable attitude.
Keywords:
Knowledge, Attitude, stigma, medical students, mental illness.
Dr.Veni Nirudya K
Psychiatric Comorbidities in patients with Alcohol Dependance Syndrome and its correlation with severity of Addiction: A Cross Sectional Study.
Background:
Alcohol dependence, a chronic condition marked by pattern of alcohol use that compromises one’s ability to function normally in socioocupational settings as well as one’s physical and mental well-being.
Aim:
To assess the prevalence of psychiatric comorbidities in alcohol dependence patients and to correlate the severity of addiction.
Methods: Cross-sectional study.
Patients fulfilling the diagnostic criteria of alcohol dependence syndrome as per ICD-10 were included. MINI-6.0 questionnaire was administered to find out psychiatric comorbidities and SADQ-C questionnaire to correlate severity of addiction.
Results:
Of the 193 instances, 48 appear to be severe cases. A chi-square test of independence was performed to evaluate the correlation between sociodemographic characteristics and severity of conditions, which appear to be statistically significant(P=<0.001). Majority of the patients were Males with 95.85%.
The relationship between substance use and the severity of symptoms appears to be statistically significant (P=<0.001). The prevalence of psychiatric comorbidity is 46.63% and the severity of the conditions appear to be statistically significant (P=<0.001).
Comorbidities including personality disorder (13.3%), anxiety disorder (28.9%), mood disorder(35.5%) and psychotic disorder(22.2%) tend to have a statistically significant correlation with the severity of the disorders(P=<0.001).
Conclusion:
Psychiatric co-morbidity is common in people with alcohol dependence. This study suggests a significant prevalence of psychiatric comorbidity in alcohol-dependence patients with major comorbidity as Mood Disorder, bringing us insight to evaluate in detail and treat accordingly.
Sexual Knowledge and Beliefs Among Medical and Nursing Students
Md Adil Faizan1,M Pramod kumar reddy2.
1)Postgraduate resident, department of psychiatry, Mamata medical college,khammmam.
2)Professor and HOD, department of psychiatry, Mamata medical college, khammam.
Background: Doctors and nurses are essential in providing information to patients regarding sexual health and aiding in health education. They serve as the main point of contact for screening patients for high-risk sexual behaviour and educating them about the repercussions of such behaviour in order to stop the spread of sexually transmitted illnesses like HIV infection. Knowledge, skills, and attitude are three aptitudes that are essential for taking relevant sexual histories and offering effective sex counselling. In addition to knowing what questions to ask and how to ask them in a kind, compassionate way, doctors and nurses must also project to patients a supportive, non-judgmental attitude. However, there is evidence to suggest that many medical professionals, including nurses and doctors, as well as nursing and medical students, have inadequate sexual knowledge, inadequate sexual history-taking and sex counselling skills, and negative attitudes toward some of their patients’ sexual behaviours. Although it is unclear whether negative views affect actual medical and nursing practise, it is obvious that people who lack sex knowledge will not be capable of providing sex advice or taking a sexual history.
Aim and Objectives: The aim of this study was to evaluate the associations between sociodemographic and background factors, attitudes toward controversial elements of human sexuality, and sex knowledge among medical and nursing students.
Method: A questionnaire-based survey of medical and nursing students in Khammam was the study’s methodology. Participants included to fourth year medical students and first to third year undergraduate nursing students at the Mamata Medical College. Both the modified Kinsey Institute/Roper Organization National Sex Knowledge Test and the students’ attitudes about controversial aspects of human sexuality were used as outcome measures.
Results: A significant correlation between a number of sociodemographic and background factors, sexual attitudes, and sex knowledge was discovered. The frequency of attendance at religious services of any religious denomination over the previous month was the background factor that was most strongly associated with both attitudes and knowledge, with those who attended three or more times as often expressing negative attitudes and scoring lower on the sex knowledge scale. Lower sex knowledge was connected to negative attitudes regarding gay/lesbian/bisexual activity, masturbation, premarital sex and contraception. Other significant sociodemographic and background factors associated with negative attitudes were never having had sex, right-wing political orientation, lower family income, gender, and ethnicity.
Conclusions: On the basis of background and sociodemographic factors, negative attitudes toward disputed aspects of human sexuality and lower sex knowledge scores among medical and nursing students can be predicted. Students may be better able to perform as sexual history gatherers and sex counsellors if their education aims to promote sex knowledge and change negative attitude.
PREVALENCE AND PHENOMENOLOGY OF DEPRESSION IN SUBCLINICAL AND CLINICAL HYPOTHYROIDISM: HOSPITAL BASED COMPARATIVE STUDY
Dr Md. Shahnwaz, Dr Vikash Chandra Mishra
Background: It is well known that decreased thyroid abnormalities has effect on mood and there is similarity of symptoms in both hypothyroidism and depression. Depression produces number of functional limitations, including poorer physical, psychosocial, and role functioning, and an increased number of disability days. In contrast to clinical hypothyroidism(CH) which affect less than 1% of the population, subclinical hypothyroidism(SCH) is relatively common disorder with an overall prevalence of 5% to 10%. Very few studies have been done to explore phenomenological differences in patients of CH and SCH having depression.
Aim: To study prevalence and compare the phenomenology of depression in patients with SCH and CH.
Methods: We enlisted 70 patients using cross-sectional design. Hamilton Depression Rating Scale was used to assess depressive symptoms (HAM-D). The cognitive function measured by Mini-mental status examination. The purpose of this study was to compare depression in SCH and CH patients.
Results: SCH (n=35) and CH (n=35) were comparable on socio-demographic variables except gender.In our study, SCH & CH groups were dominated by females.The mean score on HAM-D depression scale in the subjects with CH was higher (7.09±4.57) when compared to SCH. The high mean score of anxiety was found in CH group(P=0.001). CH patients had lower mean MMSE scores than the SCH group, but these differences were not statistically significant. In contrast to the subclinical hypothyroidism group, the mean HAM-D score of the subjects with clinical hypothyroidism was statistically significant.(P <0.003).
Conclusion: The significant difference was found in severity of depressive symptoms between SCH and CH patients.
Keywords: ClinicalHypothyroidism, Subclinical Hypothyroidism, Prevalence, BPRS, HAMD
Resilience in wives of individuals with alcohol dependence syndrome
1Dr Priyanka Renita D’Souza, Department of Psychiatry, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India.
email id: priyankadsouza93@gmail.com
2Dr. Aruna Yadiyal, Department of Psychiatry, Father Muller Medical College, Mangalore
Background: The wives of individuals with alcohol dependence syndrome face the major brunt due to alcohol use by their husbands. Resilience in wives is not just crucial in overcoming adversities, but helps in understanding their mental health. Thus, it has a role in improving the outcome of treatment of individuals with alcohol dependence syndrome.
Objectives: To evaluate resilience in wives of individuals with alcohol dependence syndrome and also to study its relationship with marital quality and clinical variables of alcohol dependence syndrome.
Method: 230 individuals who were wives of patients diagnosed with alcohol dependence syndrome were evaluated. Resilience in the wives was assessed using Resilience Scale for Adults (RSA) and marital quality was assessed using Marital Quality Scale (MQS). The age of onset of initiation of alcohol use, age of onset of problem drinking, age of onset of dependence and severity of alcohol dependence syndrome were also assessed in their husbands.
Results: Most wives (51.7%) of the individuals with alcohol dependence syndrome had low resilience. The low resilience group of wives scored significantly low on all factors such as personal competency, structured style, social competency, social resources and family cohesion in comparison to the high resilience group. Severity of alcohol dependence in husbands had an inverse association with the resilience of their wives. Low resilience in the wives was also significantly associated with poor marital quality.
Conclusion: The present study concluded that most wives of the individuals with alcohol dependence syndrome had low resilience. Wives in the low resilience group had husbands with more severe alcohol dependence syndrome. There was also significant association between poor marital quality and lower resilience.
Keywords: Resilience; Marital quality; wives of individuals with alcohol dependence syndrome
A door-to-door approach for GUTKA MUKT GAM in central Gujarat-Community based assessment and intervention study.
Speaker: Dr. Yashika Nathani
Dr. Yashika Nathani, Dr. Drashti Shah, Dr. Sandip Shah, Dr. Nimisha
Desai, Dr. Saurabh Shah, Dr. Malika Sanspara, Dr. Preet Patel, Dr. Dipti Joshi
Background:
In rural population lack of awareness of tobacco’s harmful effect, ingrained myths related to tobacco use and its easy availability remain the chief factors for its continued use. The Global Adult Tobacco Survey reported that tobacco use is double in rural population as compared to urban population. Reviewing this we assessed tobacco use among 2 villages of central Gujarat and aimed to study the impact of brief, individualized cost-effective intervention in community delivered at their door step.
Aims:
1. To assess the tobacco use pattern among rural population.
2. To assess tobacco use and their Knowledge, Attitude, Practices (K.A.P.) towards tobacco use.
3. To evaluate the effectiveness of brief intervention for ‘GUTKA MUKT GAM’, delivered at their door step.
Methods
Study was done in 3 phases in 2 villages. In phase 1, all families were assessed and tobacco users were identified using CAGE and Fagerstorm questionnaire and pattern of tobacco use was assessed using semi-structured proforma including type of tobacco , it’s amount, method, financial burden, age of start etc. by going door to door in person interview.. In second phase, awareness session was conducted in each village. In the last phase, door to door treatment was delivered to each tobacco user.
Results
In first phase of 1016 total population (156 users), 260 villagers were assessed. Prevalence of tobacco use was 15%. Out of 156 tobacco users identified, 70 consented for assessment, 70% (n=50) of them were males and 60% had started tobacco in early adulthood and reported starting due to peer pressure. 61% (n=43) of males and all females tobacco users (n=20) were using oral smokeless tobacco. Mean amount of tobacco consumption was 6 packs/day. Average financial expenditure was Rs.25-30/day for tobacco and average duration of tobacco use was 15-20 years. Majority of villagers 43(61%) had past unsuccessful attempts to quit tobacco. The average duration of consumption was 17years while mean age of starting consumption was 20 years. They had adequate knowledge (81%) related to health implications of tobacco use, positive attitude (83%), but had poor practices (34.2%). In second phase 91 tobacco-users (out of 156) continued follow-up assessment, of these 57%, 76% and 71% tobacco-users were of precontemplation, contemplation and preparation phase of motivation respectively. In 3rd phase, out of 69 users provided treatment, 28 tobacco users (41%) had quit while 40 users (58%) had reduced intake of tobacco significantly. 68% of the users took oral tobacco, approx. 6 packs/day was the average consumption in the population.
Conclusion
Tobacco use prevalence was high in rural young population and women using smokeless tobacco.Tobacco use leads to direct and indirect financial burden.The study findings confirm the need to develop more effective tools to address this burden of tobacco use. While the study also concludes that door-to-door intervention in community shows significantly higher quit rates than traditional hospital-based treatments.
Key words: Tobacco deaddiction, community, door to door intervention, Gutka mukt gam